Factors associated with universal infant free school meal take up and refusal in a multicultural urban community.

BACKGROUND: Universal infant free school meals (UIFSM) were introduced in September 2014 and are available to all key stage 1 (4-7 years) children attending state-maintained infant and primary schools in England. The present study aimed to investigate the school-based factors, child and family socio-demographic characteristics, and parental beliefs associated with UIFSM take up in an urban community. METHODS: A cross-sectional questionnaire survey was completed in October to November 2015, amongst parents whose children attended eligible schools in Leicester, England. A questionnaire about school meals was also completed by each school. RESULTS: Parents reported their child did not take (non-UIFSM, n = 159) or took (UIFSM, n = 517) a UIFSM on most days. The non-UIFSM group were more likely to be White-British, have a higher socio-economic status, have English as a first language, and involve their child in the decision over whether or not to take UIFSM, compared to the UIFSM group. Cluster analysis revealed that non-UIFSM parents were either concerned over quality of meals and what/how much their child ate, concerned only by what/how much their child ate or whether their child did not like the food provided. Two subsets of parents in the UIFSM group were either very positive about UIFSM or appeared to take meals because they were free. Schools used a variety of measures to increase and maintain UIFSM take up. CONCLUSIONS: Parents like to have control over what their child eats at school and children need to enjoy their school meals. Using a range of interventions to target subsets of parents may help local authorities, schools and caterers to increase UIFSM take up.

A comparison of previous antibiotic therapy following isolation of MRSA versus MSSA in nursing home residents: a preliminary investigation.

OBJECTIVE: Antibiotic exposure is a risk factor for isolation of methicillin-resistant Staphylococcus aureus (MRSA). We reasoned that this relationship might be especially strong if the comparison was targeted to antibiotics with activity against methicillin-sensitive Staphylococcus aureus (MSSA), but not MRSA. SUBJECTS: Forty-eight cases with initial MRSA clinical isolates (15 urinary, 19 wound, 11 sputum, 3 blood) were matched to 48 with MSSA clinical isolates from the same location. In addition, 10 whose MRSA was noted screening around an index case were matched to 10 with negative screening cultures sampled around the same index case. DESIGN: MSSA was always/usually sensitive to dicloxacillin, amoxicillin/clavulanate, cephalosporins, imipenem, quinolones, and erythromycin, whereas MRSA was always/usually resistant. These antibiotics were defined as "targeted" and would be expected to facilitate the proliferation of MRSA by suppressing competing bacteria. We compared the use of all antibiotics over 60 days in cases and controls. RESULTS: The comparison of antibiotic exposure in the 48 clinical isolates revealed that 29 (60%) with MRSA isolates versus 16 (33%) with MSSA isolates had received a targeted antibiotic (RR 1.81, CI 1.33-3.34, P = 0.006). Twelve (25%) with MRSA clinical isolates versus 3 with MSSA isolates (6%) had received a nontargeted antibiotic (RR 4.00, CI 2.10-14.18, P = 0.009). The comparison of antibiotic exposure in MRSA screening isolates versus negative controls revealed that 7 (70%) had received a targeted antibiotic versus 2 (20%) of controls (RR 3.50, CI 1.57-16.85, P = 0.009)). One in the screening group versus 2 controls had received a nontargeted antibiotic. Twenty-one (62%) of 34 with MRSA (urine or wound) isolates versus 4 MSSA controls (12%) had received a quinolone (RR 5.25, CI 1.80-15.30, P < 0.000). CONCLUSION: There was a significant association between antibiotic exposure and MRSA isolates. The association was especially strong for quinolones with urinary or wound isolation of MRSA. Our data do not support the hypothesis that targeted antibiotic use was more likely to be associated with MRSA isolation than nontargeted antibiotic use. The use of nontargeted antibiotics was low, with greater use in the MRSA clinical group.

Adverse events associated with methicillin-resistant Staphylococcus aureus in a nursing home.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) generates concern in nursing homes. Restrictive isolation precautions may be applied for indefinite periods. Adverse events driving these concerns include transmission and infection. METHODS: The 721-bed Wisconsin Veterans Home in King performs approximately 645 cultures annually. The site, severity, and number of MRSA infections were determined for 69 months. Pulsed-field gel electrophoresis was performed on all initial isolates, followed by a statistical cluster analysis looking for evidence of transmission. RESULTS: Sixty-seven MRSA infections were identified (1.6 per 100 residents per year); many were polymicrobial, and it was difficult to determine the proportionate role of MRSA in morbidity or mortality. There was an episode of rapidly fatal MRSA septicemia in which empiric antibiotic therapy was ineffective. Twenty-one genetic strains were encountered. Statistical analysis identified 13 clusters of genetically identical strains clustered in time and space (P<.05). CONCLUSIONS: Infections with MRSA were identified at relatively low rates; however, the etiology of many serious nursing home infections is not determined, especially pneumonia. Statistical analysis revealed clustering and evidence of transmission. Nursing home practitioners should consider MRSA when applying empiric treatment to serious infections. We recommend a program including (1) judicious use of antibiotics, including topical agents, to reduce selection of resistant organisms; (2) obtaining and tracking cultures of infectious secretions to diagnose MRSA infections and focus antibiotic therapy; (3) universal standard secretion precautions because any resident could be a carrier; and (4) a detailed assessment and care plan for the carrier that maximizes containment of secretions and independence in activities. However, basic hygiene cannot be maintained in communal areas by some residents without restriction of activities of daily living.

Sputum bacteriology in nursing home pneumonia: a retrospective study.

INTRODUCTION: Pneumonia is the most lethal infection in nursing homes. The Infectious Disease Society of America recommends that attempts be made to obtain quality sputum to focus antibiotic therapy. This is especially important within the enclosed space of a nursing home, where constant pressure from broad spectrum, empiric antibiotics sets the stage for the emergence of resistant organisms. METHODS: We reviewed all cases of radiographic pneumonia diagnosed on-site at the Wisconsin Veterans Home, a 721-bed facility, for the recording of sputum bacteriology and 30-day mortality. RESULTS: Ninety-nine cases of radiographic pneumonia diagnosed on-site were identified over 1 year. Mortality was 10% within 30 days. Fourteen quality sputum specimens were obtained and processed microbiologically. None of the individuals who had a sputum specimen died within 30 days, probably because the ability to obtain a sputum specimen is a marker of higher functional status. DISCUSSION: Even if empiric therapy continues in the majority of cases, cultures in individual cases may alert clinicians to noncovered, resistant pathogens, and allow focused antibiotic therapy with agents like amoxicillin that might extend the usefulness of empiric, broad spectrum antibiotics. Institutions may also sum the results of sputum bacteriology to assist in the choice of empiric antibiotic therapy. Sputum bacteriology may benefit both the individual resident and the entire population of the institution.

A serious outbreak of parainfluenza type 3 on a nursing unit.

OBJECTIVE: To report a serious outbreak of respiratory illness in a nursing home, with isolation of parainfluenza type 3 in four cases. DESIGN: Viral respiratory cultures from a sample of symptomatic residents, and retrospective chart review. SETTING: A 50-bed nursing unit/floor in a skilled nursing facility. PARTICIPANTS: All residents of the nursing unit. MEASUREMENTS: Respiratory viral cultures and clinical chart review. RESULTS: Twenty-five of 49 residents developed new respiratory symptoms between September 2 and September 25, 1999. Ten cases (40%) had a tympanic temperature of 100 degrees F or greater. Eighteen (72%) had a chest X-ray with 11 (44%) new infiltrates. Sixteen (64%) were treated with antibiotics. Three cases were hospitalized and four died (16%) within 1 to 9 days after onset of symptoms. Four of 10 viral cultures yielded parainfluenza type 3. CONCLUSIONS: Parainfluenza type 3 may cause outbreaks complicated by pneumonia and fatal outcome. Clinicians should consider uniform secretion precautions to contain all viral URIs in nursing homes.