ABSTRACT
Background. Kansas ranks as the second-worst state nationally for inpatient antibiotic stewardship core element implementation. Based on the Center for Disease Control and Prevention's 2020 National Healthcare Safety Network (NHSN) Annual Survey, Kansas hospitals reporting at 17% below the national average. We sought to investigate and characterize the stewardship activities healthcare facilities including hospitals, ambulatory centers, long-term care settings, among others, are engaging in, regardless of whether a formal stewardship program exists or not. Methods. A survey was drafted based on the NHSN Annual Facility Survey for hospitals and long-term care settings. The survey was distributed to antibiotic stewardship experts and revised based on input. Surveys were distributed electronically from December 2021 through April 2022 via direct communication through Kansas Department of Health and Environment contacts, and partner organization dissemination. Results. A total of 95 programs responded to the survey. Facilities from 55 of 106 counties responded. 52 of the 95 responses were from critical access hospitals. The facility representation is shown in Fig 1. 33% facilities reported not having a formal ASP. Thirty-five percent of those with formal ASP have had it for 2 years or less. 53% of respondents found it challenging to establish an ASP. About 58% of respondents felt their facility leadership was committed to improving antibiotic use. Accountability amongst all respondents was poor with only 55% reporting a physician/ surgeon/dentist leader responsible for ASP activities. The most common activities implemented were clinical decision pathways and audit, and feedback (19% each), followed by guidelines (15%), dosing or duration optimization strategies (13%), with the least implemented being peer comparison (8%), prophylactic guidelines (5.5%) and pre-authorization (5.5%) as seen infigure 2. Figure 1 - Number of responses per facility type Figure 2: Actions reported (all healthcare facilities) Conclusion. There have been ongoing endeavors to start ASPs, but these appear to have been hampered by the COVID-19 pandemic, lack of adequate support from facility leadership and lack of leadership representation in antibiotic stewardship. Further efforts are needed in developing and supporting antibiotic stewardship activities across facilities in Kansas.
ABSTRACT
Objective: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has a myriad of neurological manifestations and its effects on the nervous system are increasingly recognized. Seizures and status epilepticus (SE) are reported in the novel coronavirus disease (COVID-19), both new onset and worsening of existing epilepsy;however, the exact prevalence is still unknown. The primary aim of this study was to correlate the presence of seizures, status epilepticus, and specific critical care EEG patterns with patient functional outcomes in those with COVID-19. Methods: This is a retrospective, multicenter cohort of COVID-19-positive patients in Southeast Michigan who underwent electroencephalography (EEG) from March 12th through May 15th, 2020. All patients had confirmed nasopharyngeal PCR for COVID-19. EEG patterns were characterized per 2012 ACNS critical care EEG terminology. Clinical and demographic variables were collected by medical chart review. Outcomes were divided into recovered, recovered with disability, or deceased. Results: Out of the total of 4100 patients hospitalized with COVID-19, 110 patients (2.68%) had EEG during their hospitalization;64% were male, 67% were African American with mean age of 63 years (range 20-87). The majority (70%) had severe COVID-19, were intubated, or had multi-organ failure. The median length of hospitalization was 26.5 days (IQR = 15 to 44 days). During hospitalization, of the patients who had EEG, 21.8% had new-onset seizure including 7% with status epilepticus, majority (87.5%) with no prior epilepsy. Forty-nine (45%) patients died in the hospital, 46 (42%) recovered but maintained a disability and 15 (14%) recovered without a disability. The EEG findings associated with outcomes were background slowing/attenuation (recovered 60% vs recovered/disabled 96% vs died 96%, p < 0.001) and normal (recovered 27% vs recovered/disabled 0% vs died 1%, p < 0.001). However, these findings were no longer significant after adjusting for severity of COVID-19. Conclusion: In this large multicenter study from Southeast Michigan, one of the early COVID-19 epicenters in the US, none of the EEG findings were significantly correlated with outcomes in critically ill COVID-19 patients. Although seizures and status epilepticus could be encountered in COVID-19, the occurrence did not correlate with the patients' functional outcome. (C) 2021 Elsevier Inc. All rights reserved.
ABSTRACT
Background. Correct personal protective equipment (PPE) use is key to prevent infection. Observations on a single unit at the Veterans Affairs (VA) Tennessee Valley Healthcare System (TVHS) prior to COVID-19 (October 2019-February 2020) showed low rates of correct PPE use among healthcare workers (HCWs) (Figure 1). In response to the COVID-19 epidemic, the VA implemented new PPE protocols. Based on our initial observations, we were concerned that incorrect use of PPE may increase the risk of COVID-19 exposure among HCWs. Resident physicians, who work at many sites, may be at high-risk for incorrect PPE use due to rapid turnover and limited site-specific PPE training. We aimed to assess and improve COVID-19 PPE use among internal medicine residents rotating at the VA TVHS. Figure 1: Pre-COVID-19 Observations of Adherence to Contact Precaution Protocols at the Veterans Affairs Tennessee Valley Healthcare System Methods. We used the plan, do, study, act (PDSA) model. Prior to starting VA rotations, residents were emailed PPE education to review. We implemented a 1-hour video conference PPE protocol review at rotation start followed by in-person PPE use evaluations for residents performed by infectious diseases fellows on day 2 and day 5-6 post-review to provide just-in-time educational intervention. Errors at each PPE don/ doff step were tracked. Correct PPE use data from both observations were compared using McNemar's test. Baseline and post-implementation resident surveys assessed PPE use knowledge and comfort. Results. Pre-implementation survey response rate was 72% (21/29);19/21(91%) reported knowing which PPE to use and 16/21(76%) reported knowing how to safely don/doff PPE. Twenty of 29 (69%) residents completed both observations. Errors decreased by 55% (p=0.0045) from 17/20 (85%) to 6/20 (30%) between initial and follow up observations. Errors in hand hygiene, inclusion of all donning/doffing steps, and PPE reuse decreased, but PPE don/doff order errors increased (Figure 2). Postproject survey response rate was 16/29 (55%). All 16 reported knowing which PPE to use and how to safely don/doff PPE, and 11/16 (69%) residents felt both online and in-person interventions were helpful. Figure 2: COVID-19 PPE Errors and Correction Types by Observation Conclusion. Correct COVID-19 PPE use is essential to protect HCWs and patients. Just-in-time education intervention for PPE training may yield higher correct use compared to pre-recorded or online training.