Support of nursing homes in infection management varies by US State Departments of Health.

BACKGROUND: In many countries, healthcare-associated infections (HAIs) are problematic in long-term aged care living facilities. In the United States (US), HAIs occur frequently in nursing homes (NHs). Identifying effective practices for state Departments of Health (DOHs) to help NHs improve infection prevention and control and reduce HAIs is necessary. AIM: As a first step, the objective was to systematically examine and catalogue the variations in state intentions and activities related to HAI prevention in NHs. METHODS: An environmental scan of state DOH websites, HAI plans, and HAI state infographics was conducted. Data were collected on 16 items across three domains: (1) intentions to reduce HAIs in NHs, (2) actions to reduce HAIs in NHs, and (3) website usability. FINDINGS: State infection control support for NHs varied widely. Most states (92%) mentioned NHs in their HAI plans and 76% included NHs in their infographic. Half has an HAI prevention advisory council, while one-third had a state HAI prevention collaborative. Only 57% of HAI plans that mentioned NHs included training materials on HAI reduction. The most common training available was on antibiotic stewardship. CONCLUSION: Many US states have room for improvement in the support they provide NHs regarding infection prevention and control. Specific areas of improvement include: (1) increased provision of training materials on HAI reduction, (2) focusing training materials on common HAIs, and (3) NH engagement in collaboratives aimed at HAI reduction. More research is needed linking DOH activities to resident outcomes.

Expression of beta-catenin in prostatic adenocarcinomas: a comparison with colorectal adenocarcinomas.

We studied 101 prostatic adenocarcinomas (72 acinar 29 ductal) and 16 cases with high-grade prostatic intraepithelial neoplasia (HPIN) immunohistochemically for the expression of beta-catenin and compared the staining patterns with those of nonneoplastic prostatic epithelium and 24 colorectal adenocarcinomas. While nuclear staining for beta-catenin was evident in 20 (83%) colorectal adenocarcinomas, predominantly, membranous staining was observed in 89 prostatic adenocarcinomas (88%); the remaining 12 cases showed no immunoreactivity. In prostatic tumors expressing beta-catenin, staining intensity was comparable, increased, and decreased in 81, 4, and 4 cases, respectively compared with adjacent nonneoplastic prostatic epithelium. No prostatic adenocarcinomas demonstrated nuclear staining. The beta-catenin staining characteristics in HPIN were comparable to those in nonneoplastic prostatic epithelium. Negative staining for cytokeratins (CKs) 7 and 20, high-molecular-weight (HMW) CK, and villin and positive staining for prostate-specific antigen (PSA) were seen in 22 prostatic adenocarcinomas examined, in contrast with colorectal adenocarcinomas, which stained positively for CK20 and villin and negatively for CK7, HMWCK, and PSA. These data suggest that the beta-catenin signaling pathway acts differently in prostatic than in colorectal tumorigenesis. The immunophenotypes documented herein also might aid in the distinction between prostatic and colorectal origins when metastasis is encountered.