ABSTRACT
Background. Methicillin Resistant Staphylococcus aureus (MRSA) bacteria have been long established as a major cause of infections. MRSA infections occurring in blood or other sterile sites are associated with poorer health outcomes and an increased risk of mortality, especially when acquired in a healthcare setting. The ongoing COVID-19 pandemic has not only stymied reduction efforts but has precipitated increases in invasive HO-MRSA infections, with increases seen of 12-34% in national MRSA standardized infection ratios in 2020 compared to 2019. The facility had seen similar increases of HO-MRSA infections, defined as a positive culture on or after the 3rd hospital day, despite no change in clinical practice. Methods. A prospective study was conducted in a 22 bed Medical-Surgical Intensive Care Unit from November 2021 to March 2022. 50 surface samples were collected from surfaces throughout the unit including two nurses' stations, physician charting area, and 5 areas in 7 patient rooms. The advanced photocatalytic oxidation (aPCO) equipment was then installed in the HVAC ductwork throughout the ICU and activated. Sampling was then repeated every four weeks during the study period. The facility's normal disinfection protocols were unchanged. HO-MRSA infections attributed to the unit were also tracked during the study period. Changes in MRSA surface burden were calculated using a repeated methods ANOVA with post hoc analyses as appropriate. Rates of HO-MRSA infections per 1,000 patient days were compared using the chi-square test. Results. There was a 98% statistically significant decrease in MRSA surface burden from the baseline to final post-activation test. The average colony forming unit count (CFU) went from 427 to 3 CFU/100cm2 during the same time. HO-MRSA infections also had a statistically significant decrease when compared to the same time frame a year prior and the immediate 6 months prior to the study. Conclusion. The aPCO technology resulted in a reduction of MRSA on frequently touched surfaces in a high-traffic ICU. Corresponding decreases in HO-MRSA cases were also seen. This study highlights a novel aPCO technology and its efficacy at reducing microbial burden and healthcare-onset MRSA infections despite no change in practice and through the continued COVID-19 pandemic.
ABSTRACT
COVID-19 pandemic-related restrictions on society have resulted in a recession, which is commonly defined as 2 consecutive quarters of decline in GDP (gross domestic product) growth. Restrictions within the equine industry have varied, with some governments mandating the closure of equine facilities to reduce the spread of the virus and minimize the chance of injuries, while others provided health guidelines and assigned responsibility to equine operation owners/managers. Because the equine industry is one of the most important sectors in Kentucky's agricultural economy, understanding the potential impact of COVID-19 on Kentucky's equine markets is vital. To that end, in this study we examined short run COVID-19 impacts on Kentucky's equine markets. In particular, we focused on 2 segments of the industry associated with vigorous business activities. First, we examined how Thoroughbred and Quarter Horse breeding activity and auction markets have responded to general market changes precipitated by COVID-19 restrictions. Second, we investigated the effect of COVID-related regulations on equine enterprises, including stallion farms, boarding/training/lesson operations (BTLO's) and competition enterprises. To achieve the first objective, for the calendar year 2020, we collected and analyzed data on number of mares bred, stud fees, and auction results. To accomplish the second objective, we designed and distributed a survey to 280 commercial equine enterprise owners/managers across the state. Data were collected between November 30, 2020, and January 11, 2021, and the average response rate was about 25%. Preliminary results from the first objective suggest that while there are downward trends in breeding activities and mean auction prices, few of those short-run declines are statistically significant. For the second objective, survey results suggest at least minimal impacts on most commercial enterprises. About 46% of stallion farms reported anticipate revenues losses of 10% or less, but about 23% expect revenue losses of 26 to 50%. Just under 60% of BTLO's anticipate a revenue loss of 10% or less, while about 10% expect a loss of more than 50%. The most damaging effects appear to have been experienced by competition enterprises. About 35% expect only minimal revenue losses, while nearly 40% expect losses of $50,000 or more. Overall, results from our study suggest that with the exception of competition-related enterprises, Kentucky's commercial equine enterprises may have avoided serious short run impacts;however, it will be some time before the long run impact of COVID-19 related restrictions on the industry can be fully determined.
ABSTRACT
BACKGROUND: Immunosuppressive therapy (IS) has altered the course of Inflammatory Bowel Disease (IBD). IBD patients are at considerable risk of developing vaccine-preventable illness and are even more susceptible when on treatment. Many of these patients fail to receive appropriate vaccinations for influenza, pneumonia, hepatitis B, Shingles and recently COVID. Our aim was to develop a quality improvement intervention to increase recommended vaccinations in IBD patients on IS. METHODS: A retrospective chart analysis was completed at the Memphis Veteran Affairs Gastroenterology Practice. 55 patients were found to be on immunosuppressive therapy with a biologic and/or immunomodulator. Once identified, these patient's vaccination records were reviewed to see if they were up to date on recommended vaccinations for influenza, pneumonia, hepatitis B, COVID, and Shingles. Patients who were not up to date on their vaccinations were called by a provider (Resident, Fellow, or Nurse Practitioner), and were offered a nurse visit to be given the appropriate vaccinations. After a 6-month intervention period, the data on the 55 patients was recollected and analyzed. RESULTS: Of the patients analyzed, 63% (n=35) had Crohn's disease and 37% (n=20) had Ulcerative Colitis. The most common biologic medication the patients were on was adalimumab (n=24), and the most common immunomodulator was azathioprine (n=17). Prior to the intervention, 22% had received the shingles vaccine, 20% had received the COVID-19 vaccine, 78% had received the hepatitis B vaccine, 69% had received the flu vaccine, 62% had received the pneumococcal 23 vaccine, and 72% had received the pneumococcal 13 vaccine. After the intervention, 65% had received the shingles vaccine, 65% had received the COVID-19 vaccine, 87% had received the hepatitis B vaccine, 85% had received the flu vaccine, 78% had received the pneumococcal 23 vaccine, and 84% had received the pneumococcal 13 vaccine. CONCLUSION: Patients on immunosuppressive therapy remain vulnerable to vaccine-preventable illnesses such as Shingles, Pneumococcal Pneumonia, Influenza, Hepatitis B, and COVID-19. Our quality improvement intervention increased overall vaccination adherence. This project was a proof of concept and in the future, we hope to integrate a warning system into our practice to alert providers when these patients are due for their appropriate vaccinations. It is also a practice that can be adopted by other healthcare providers who treat patients with IS and biologics to improve vaccination uptake.