Misdiagnosis of Clostridioides difficile Infections by Standard-of-Care Specimen Collection and Testing among Hospitalized Adults, Louisville, Kentucky, USA, 2019-20201.

Although Clostridioides difficile infection (CDI) incidence is high in the United States, standard-of-care (SOC) stool collection and testing practices might result in incidence overestimation or underestimation. We conducted diarrhea surveillance among inpatients >50 years of age in Louisville, Kentucky, USA, during October 14, 2019-October 13, 2020; concurrent SOC stool collection and CDI testing occurred independently. A study CDI case was nucleic acid amplification test‒/cytotoxicity neutralization assay‒positive or nucleic acid amplification test‒positive stool in a patient with pseudomembranous colitis. Study incidence was adjusted for hospitalization share and specimen collection rate and, in a sensitivity analysis, for diarrhea cases without study testing. SOC hospitalized CDI incidence was 121/100,000 population/year; study incidence was 154/100,000 population/year and, in sensitivity analysis, 202/100,000 population/year. Of 75 SOC CDI cases, 12 (16.0%) were not study diagnosed; of 109 study CDI cases, 44 (40.4%) were not SOC diagnosed. CDI incidence estimates based on SOC CDI testing are probably underestimated.

Knowledge and confidence gains after a COVID-19 vaccine continuing education program developed for nurse practitioners.

ABSTRACT: The COVID-19 pandemic has been marked by rapid innovation in vaccine development. Given that nurse practitioners (NPs) are often involved in vaccine counseling and administration, the American Association of Nurse Practitioners developed a continuing education (CE) series that covered COVID-19 vaccine development, recommendations, administration, and solutions for overcoming hesitancy. In 2020 and 2021, three separate live webinars were delivered; each webinar was updated with the latest vaccine recommendations and was then archived in an enduring format for up to 4 months. The goal of this study was to assess changes in preactivity and postactivity knowledge and confidence and to qualitatively report other learner outcomes. Across the three webinars, 3,580 unique learners who self-reported seeing patients eligible for COVID-19 vaccination completed at least one activity. Knowledge and competence improved from the preactivity to postactivity survey in all webinars, with the overall rates of correct answers increasing by 30% after webinar 1, 37% after webinar 2, and 28% after webinar 3 (all p < .001). Furthermore, mean confidence in learner's ability to address vaccine hesitancy improved across all three webinars (range, 31-32%; all p < .001). The majority of learners indicated that they planned to incorporate lessons from the activity into their clinical practice (range, 85-87%). In postactivity surveys, vaccine hesitancy was identified as an ongoing barrier by up to 33% of learners. In conclusion, this CE activity improved learner knowledge, competence, and confidence related to COVID-19 vaccination and underscores the importance of up-to-date CE targeted to NPs.

The Psychology of Coronavirus Behavioral Health Mindset, Vaccination Receptivity, Customer Orientation and Community Public Service.

Three studies were conducted to explore the psychological determinants of COVID-deterrent behaviors. In Study 1, using data collected and analyzed both before and after the release of COVID-19 vaccines, mask-wearing, other preventative behaviors like social distancing, and vaccination intentions were positively related to assessments of the Coronavirus Behavioral Health Mindset (CVBHM); belief in the credibility of science; progressive political orientation; less use of repressive and more use of sensitization coping; and the attribution of COVID-19 safety to effort rather than ability, powerful forces, fate, or luck. In Study 2, favorable COVID-19 vaccination intentions were related to greater willingness to work, lower emotional distress, and greater customer experience mindset. Study 3 examined the personality and motives of individuals who volunteered to help deliver COVID-19 inoculations to the local community. The vaccine-giving volunteers, especially those with prosocial motives, had high CVBHM scores, belief in the credibility of science, low use of repressive coping, greater attribution of COVID-19 protection to effort, low likelihood of voting conservative, were older, and had more education than others. The majority of public health volunteers expressed prosocial motives to help people or join a cause (60.7%), but many (39.3%) expressed the personal motives of getting the COVID-19 vaccination for themselves, conveying a public image of compassion, or structuring time. Based on the three research studies, a COVID-19 Mindset Hierarchy model is proposed to integrate the results.

Project Firstline: Report of Infection Control Learning Needs Assessment for Kentucky Healthcare Workforce

Background The COVID-19 pandemic has highlighted the need for strong infection prevention and control knowledge and elimination of practice gaps in healthcare, academic, and public health settings nationwide. As a result, Project Firstline (PFL) is a Centers for Disease Control and Prevention (CDC)-led, multiyear national training grant created in 2019/2020 to fund a collaborative of diverse healthcare, public health, and academic partners to develop training to strengthen foundational knowledge and implementation of healthcare infection prevention and control (IPC). Healthcare workers need and deserve transparent and trustworthy information on CDC's infection control recommendations and the science behind them. Project Firstline aims to deliver comprehensive, transparent, innovative, and responsive education and training to healthcare and public health workers in the United States. Project Firstline builds an IPC foundation of knowledge, education, and training expertise within the healthcare, academic, and public health workforce to support IPC culture across all healthcare communities. Partner engagement is crucial to sharing information across all health care settings via trusted channels to ensure content and tools are delivered to the health care professionals who need them and in ways facilitating use of new knowledge in clinical practice. To promote behavioral change, education needs to build and reinforce a universal understanding of the rationale for Infection Prevention and Control (IPC) practices. These practices must be evaluated to provide targeted training. In addition, to reach, be practical, and have a high impact across all levels of staff, training should be a collaborative learning experience and fit the learners' needs, abilities, and education. Therefore, training needs to be developed to address core competencies for the performance of IPC practices known to reduce issues and promote safety for all healthcare workers. To appropriately address the needs of a diverse workforce, information is needed to assess the following elements related to learning needs: preferred approaches for training delivery and post-training support, prior infection control training experience, confidence in and the capacity to implement infection control recommendations, practices, and training needs. The areas of infection control practices include specific COVID-19 recommendations, hand hygiene, personal protective equipment (PPE), source control, triage and screening, and environmental cleaning.

Association and predictive value of biomarkers with severe outcomes in hospitalized patients with SARS-CoV-2 infection.

This study analyzed the levels at admission of biomarkers for their association with and ability to predict risk of severe outcomes, including admission to the ICU, need for invasive mechanical ventilation (IMV), need for vasopressor use (VU), and in-hospital mortality (IHM) in 700 patients hospitalized with COVID-19. Biomarker data split by outcomes was compared using Mann-Whitney U tests; frequencies of biomarker values were compared using Chi-square tests and multivariable logistic regression analysis was performed to look at the impact of biomarkers by outcome. Patients that suffered IHM were more likely to have reduced platelet numbers and high blood urea nitrogen (BUN) levels among patients admitted to the ICU. Risk factors for mortality were related to hyper-coagulability (low platelet count and increased D-dimer) and decreased respiratory (PaO2/FiO2 ratio) and kidney function (BUN). Association with risks of other severe outcomes were as follows: ICU with hyper-inflammation (IL-6) and decreased respiratory function; IMV with low platelet count, abnormal neutrophil-lymphocyte ratio with reduced respiratory function, VU with inflammatory markers (IL-6), and low platelet count with respiratory function. Our studies confirmed the association of biomarkers of hematological, inflammatory, coagulation, pulmonary and kidney functions with disease severity. Whether these biomarkers have any mechanistic or causal role in the disease progress requires further investigation.

Influenza Management During the COVID-19 Pandemic: A Review of Recent Innovations in Antiviral Therapy and Relevance to Primary Care Practice.

Seasonal influenza requires appropriate management to protect public health and resources. Decreasing the burden of influenza will depend primarily on increasing vaccination rates as well as prompt initiation of antiviral therapy within 48 hours of symptom onset, especially in the context of the current coronavirus disease 2019 pandemic. A careful approach is required to prevent health services from being overwhelmed by a surge in demand that could exceed capacity. This review highlights the societal burden of influenza and discusses the prevention, diagnosis, and treatment of influenza as a complicating addition to the challenges of the coronavirus disease 2019 pandemic. The importance of vaccination for seasonal influenza and the role of antiviral therapy in the treatment and prophylaxis of seasonal influenza, including the most up-to-date recommendations from the Centers for Disease Control and Prevention for influenza management, will also be reviewed.

Induction of interferon response by high viral loads at early stage infection may protect against severe outcomes in COVID-19 patients.

Key elements for viral pathogenesis include viral strains, viral load, co-infection, and host responses. Several studies analyzing these factors in the function of disease severity of have been published; however, no studies have shown how all of these factors interplay within a defined cohort. To address this important question, we sought to understand how these four key components interplay in a cohort of COVID-19 patients. We determined the viral loads and gene expression using high throughput sequencing and various virological methods. We found that viral loads in the upper respiratory tract in COVID-19 patients at an early phase of infection vary widely. While the majority of nasopharyngeal (NP) samples have a viral load lower than the limit of detection of infectious viruses, there are samples with an extraordinary amount of SARS-CoV-2 RNA and a high viral titer. No specific viral factors were identified that are associated with high viral loads. Host gene expression analysis showed that viral loads were strongly correlated with cellular antiviral responses. Interestingly, however, COVID-19 patients who experience mild symptoms have a higher viral load than those with severe complications, indicating that naso-pharyngeal viral load may not be a key factor of the clinical outcomes of COVID-19. The metagenomics analysis revealed that the microflora in the upper respiratory tract of COVID-19 patients with high viral loads were dominated by SARS-CoV-2, with a high degree of dysbiosis. Finally, we found a strong inverse correlation between upregulation of interferon responses and disease severity. Overall our study suggests that a high viral load in the upper respiratory tract may not be a critical factor for severe symptoms; rather, dampened antiviral responses may be a critical factor for a severe outcome from the infection.

Outcomes and Risk Factors for Cardiovascular Events in Hospitalized COVID-19 Patients.

OBJECTIVE: To analyze outcomes and risk factors of cardiovascular events in a metropolitan coronavirus disease 2019 (COVID-19) database, and to perform a subgroup analysis in African American populations to determine whether outcomes and risk factors are influenced by race. DESIGN: Retrospective cohort analysis from March 9, 2020 to June 20, 2020. SETTING: Population-based study in Louisville, KY, USA. PARTICIPANTS: Seven hundred adult inpatients hospitalized with COVID-19. INTERVENTIONS: N/A. MEASUREMENTS AND MAIN RESULTS: This cohort consisted of 126 patients (18%) with cardiovascular events and 574 patients without cardiovascular events. Patients with cardiovascular events had a much higher mortality rate than those without cardiovascular events (45.2% v 8.7%, p < 0.001). There was no difference between African American and white patients regarding mortality (43.9% v 46.3%, p = 1) and length of stay for survivors (11 days v 9.5 days, p = 0.301). Multiple logistics regression analysis suggested that male, race, lower SaO2/FIO2, higher serum potassium, lower serum albumin, and number of cardiovascular comorbidities were highly associated with the occurrence of cardiovascular events in COVID-19 patients. Lower serum albumin and neoplastic and/or immune-compromised diseases were highly associated with cardiovascular events for African American COVID-19 patients. SaO2/FIO2 ratio and cardiovascular comorbidity count were significantly associated with cardiovascular events in white patients. CONCLUSIONS: Cardiovascular events were prevalent and associated with worse outcomes in hospitalized patients with COVID-19. Outcomes of cardiovascular events in African American and white COVID-19 patients were similar after propensity score matching analysis. There were common and unique risk factors for cardiovascular events in African American COVID-19 patients when compared with white patients.

President's Pen

The article discusses recently hosted our Annual Nurses Day at the Capitol where more than 250 Kentucky nurses and nursing students gathered to talk with legislators about issues important to all;and issue is Kentucky nurses is the growing Novel Coronavirus (NCov) epidemic.