Deploying Digital Health Technologies for Remote Physical Activity Monitoring of Rural Populations With Chronic Neurologic Disease.

Objective: The objective of this pilot study was to examine the feasibility of a remote physical activity monitoring program, quantify baseline activity levels, and examine predictors of activity among rurally residing adults with Parkinson disease (PD) or stroke. Design: Thirty-day observational study. Participants completed standardized assessments, connected a wearable device, and synced daily step counts via a remote monitoring platform. Setting: Community-based remote monitoring. Participants: Rurally residing adults with PD or stroke enrolled in the Veterans Health Administration. Intervention: N/A. Main Outcome Measures: Feasibility was evaluated using recruitment data (response rates), study completion (completed assessments and connected the wearable device), and device adherence (days recording ≥100 steps). Daily step counts were examined descriptively. Predictors of daily steps were explored across the full sample, then by diagnosis, using linear mixed-effects regression analyses. Results: Forty participants (n=20 PD; n=20 stroke) were included in the analysis with a mean (SD) age of 72.9 (7.6) years. Participants resided 252.6 (105.6) miles from the coordinating site. Recruitment response rates were 11% (PD) and 6% (stroke). Study completion rates were 71% (PD) and 80% (stroke). Device adherence rates were 97.0% (PD) and 95.2% (stroke). Participants with PD achieved a median [interquartile range] of 2618 [3896] steps per day and participants with stroke achieved 4832 [7383] steps. Age was the only significant predictor of daily steps for the full sample (-265 steps, 95% confidence interval [-407, -123]) and by diagnosis (PD, -175 steps, [-335, -15]; stroke, -357 steps [-603, -112]). Conclusions: A remote physical activity monitoring program for rurally residing individuals with PD or stroke was feasible. This study establishes a model for a scalable physical activity program for rural, older populations with neurologic conditions from a central coordinating site.

Dissemination of methicillin-resistant Staphylococcus aureus and bacteriophage MS2 from floors in long-term care facility resident rooms.

We demonstrated that methicillin-resistant Staphylococcus aureus (MRSA) contamination on floors in the rooms of colonized long-term care facility residents was frequently transferred by shoes to adjacent patient rooms. A benign virus inoculated onto the floor was transferred to floors and high-touch surfaces in adjacent rooms and the nursing station. These results suggest that shoes may serve as a vector for dissemination of health care-associated pathogens from rooms of MRSA-colonized patients.

Shedding of methicillin-resistant Staphylococcus aureus and multidrug-resistant gram-negative bacilli during outpatient appointments and procedures outside hospital rooms.

BACKGROUND: Limited information is available on the frequency of and risk factors for shedding of health care-associated pathogens in settings outside patient rooms. METHODS: We conducted a cohort study of hospitalized or recently discharged patients with methicillin-resistant Staphylococcus aureus (MRSA) (N = 39) or multidrug-resistant gram-negative bacilli (MDR-GNB) (N = 11) colonization to determine the frequency of environmental shedding during appointments outside hospital rooms or during outpatient clinic visits. Chi-square tests were performed to identify patient-level factors associated with environmental shedding. Spa typing was performed for environmental and nasal MRSA isolates. RESULTS: Of 50 patients enrolled, 39 were colonized with MRSA and 11 with MDR-GNB. Shedding during 1 or more appointments occurred more often for patients colonized with MRSA versus MDR-GNB (15 of 39, 38.5% versus 0 of 11, 0%; P = .02). The presence of a wound with a positive culture for MRSA was associated with shedding of MRSA during appointments (11 of 15, 73.3% with shedding versus 4 of 24, 16.7% with no shedding; P = .008). Eighty percent of environmental MRSA isolates were genetically related to concurrent nasal isolates based on spa typing. CONCLUSIONS: Environmental shedding of MRSA occurs frequently during appointments outside hospital rooms or during outpatient clinic visits. Decontamination of surfaces and strategies that reduce shedding of MRSA could reduce the risk for transmission in these settings.

Environmental Contamination of Contact Precaution and Non-Contact Precaution Patient Rooms in Six Acute Care Facilities.

BACKGROUND: Environmental contamination is an important source of hospital multidrug-resistant organism (MDRO) transmission. Factors such as patient MDRO contact precautions (CP) status, patient proximity to surfaces, and unit type likely influence MDRO contamination and bacterial bioburden levels on patient room surfaces. Identifying factors associated with environmental contamination in patient rooms and on shared unit surfaces could help identify important environmental MDRO transmission routes. METHODS: Surfaces were sampled from MDRO CP and non-CP rooms, nursing stations, and mobile equipment in acute care, intensive care, and transplant units within 6 acute care hospitals using a convenience sampling approach blinded to cleaning events. Precaution rooms had patients with clinical or surveillance tests positive for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, carbapenem-resistant Enterobacteriaceae or Acinetobacter within the previous 6 months, or Clostridioides difficile toxin within the past 30 days. Rooms not meeting this definition were considered non-CP rooms. Samples were cultured for the above MDROs and total bioburden. RESULTS: Overall, an estimated 13% of rooms were contaminated with at least 1 MDRO. MDROs were detected more frequently in CP rooms (32% of 209 room-sample events) than non-CP rooms (12% of 234 room-sample events). Surface bioburden did not differ significantly between CP and non-CP rooms or MDRO-positive and MDRO-negative rooms. CONCLUSIONS: CP room surfaces are contaminated more frequently than non-CP room surfaces; however, contamination of non-CP room surfaces is not uncommon and may be an important reservoir for ongoing MDRO transmission. MDRO contamination of non-CP rooms may indicate asymptomatic patient MDRO carriage, inadequate terminal cleaning, or cross-contamination of room surfaces via healthcare personnel hands.

Shedding of multidrug-resistant gram-negative bacilli by colonized patients during procedures and patient care activities.

BACKGROUND: Medical procedures and patient care activities may facilitate environmental shedding of health care-associated pathogens. METHODS: We conducted a cohort study of hospitalized patients in contact precautions for carriage of extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacilli (N = 38) or carbapenem-resistant gram-negative bacilli (CR-GNB) (N = 22) to determine the frequency of environmental shedding during procedures and care activities. Perirectal, wound, and skin were cultured for ESBL-producing and CR-GNB. High-touch surfaces and portable equipment were disinfected before and cultured after procedures; control cultures were collected in the absence of procedures. RESULTS: Of 60 patients enrolled, 34 (57%) had positive perirectal and/or skin or wound cultures. For these 34 patients, 15 (44%) shed their colonizing organism to surfaces during 1 or more procedures. Patients with shedding had significantly higher concentrations of the pathogens recovered from perirectal swabs than those with no shedding (mean, 3.5 vs 2.2 log10 colony-forming units per swab; P < .01). Environmental shedding occurred more frequently during procedures and care activities than in the absence of a procedure (21 of 117, 18% vs 1 of 61, 2%; P < .01), and 6 of 56 (10%) portable devices used for procedures became contaminated. CONCLUSIONS: Environmental shedding of antibiotic-resistant gram-negative bacilli occurs frequently during medical procedures and patient care activities. Decontamination of surfaces and equipment and approaches that reduce the burden of carriage could reduce the risk for dissemination.

Shedding of methicillin-resistant Staphylococcus aureus by colonized patients during procedures and patient care activities.

OBJECTIVE: Medical procedures and patient care activities may facilitate environmental dissemination of healthcare-associated pathogens such as methicillin-resistant Staphylococcus aureus (MRSA). DESIGN: Observational cohort study of MRSA-colonized patients to determine the frequency of and risk factors for environmental shedding of MRSA during procedures and care activities in carriers with positive nares and/or wound cultures. Bivariate analyses were performed to identify factors associated with environmental shedding. SETTING: A Veterans Affairs hospital. PARTICIPANTS: This study included 75 patients in contact precautions for MRSA colonization or infection. RESULTS: Of 75 patients in contact precautions for MRSA, 55 (73%) had MRSA in nares and/or wounds and 25 (33%) had positive skin cultures. For the 52 patients with MRSA in nares and/or wounds and at least 1 observed procedure, environmental shedding of MRSA occurred more frequently during procedures and care activities than in the absence of a procedure (59 of 138, 43% vs 8 of 83, 10%; P 0.9 m from the patient (52 of 138, 38% vs 25 of 138, 18%; P = .0004). Contamination occurred frequently on surfaces touched by personnel (12 of 38, 32%) and on portable equipment used for procedures (25 of 101, 25%). By bivariate analysis, the presence of a wound with MRSA was associated with shedding (17 of 29, 59% versus 6 of 23, 26%; P = .04). CONCLUSIONS: Environmental shedding of MRSA occurs frequently during medical procedures and patient care activities. There is a need for effective strategies to disinfect surfaces and equipment after procedures.

Evaluation of Viral Surrogate Markers for Study of Pathogen Dissemination During Simulations of Patient Care.

During patient care simulations, cauliflower mosaic virus DNA and bacteriophage MS2 performed similarly as surrogate markers of pathogen dissemination. These markers disseminated to the environment in a manner similar to Clostridium difficile spores but were more frequently detected on skin and clothing of personnel after personal protective equipment removal.

A cold hard menace: A contaminated ice machine as a potential source for transmission of carbapenem-resistant Acinetobacter baumannii.

During an investigation of potential sources of transmission of multidrug-resistant gram-negative bacilli on a spinal cord injury unit, we recovered genetically related carbapenem-resistant Acinetobacter baumannii isolates from the stool of 3 patients, the hands of a nurse, and an ice machine water outlet spout and drain. Our findings suggest that contaminated ice machines could serve as a potential reservoir for dissemination of multidrug-resistant gram-negative bacilli.

Evaluation of a Novel Alcohol-Based Surface Disinfectant for Disinfection of Hard and Soft Surfaces in Healthcare Facilities.

We examined the efficacy of a new 1-step cleaner and disinfectant containing 30% ethanol that is applied as a spray. The product rapidly reduced vegetative bacterial pathogens on carriers and on hard and soft surfaces in healthcare settings, but it did not stain clothing.

Dissemination of a nonpathogenic viral DNA surrogate marker from high-touch surfaces in rooms of long-term care facility residents.

A nonpathogenic DNA marker inoculated onto the television remote controls in rooms of 2 ambulatory long-term care facility (LTCF) residents disseminated to the hands of the LTCF residents, to high-touch surfaces in the room and on the ward, and to shared portable equipment. These findings suggest that contaminated high-touch surfaces in rooms of ambulatory LTCF residents are a potential source for widespread dissemination of pathogens.

How well does transfer of bacterial pathogens by culture swabs correlate with transfer by hands?

In laboratory testing and in isolation rooms, pickup and transfer of health care-associated pathogens by premoistened rayon swabs correlated well with pickup and transfer by bare hands or moistened gloves. These results suggest that swab cultures provide a useful surrogate indicator of the risk for pathogen pickup and transfer by hands.

Are hospital floors an underappreciated reservoir for transmission of health care-associated pathogens?

In a survey of 5 hospitals, we found that floors in patient rooms were frequently contaminated with pathogens and high-touch objects such as blood pressure cuffs and call buttons were often in contact with the floor. Contact with objects on floors frequently resulted in transfer of pathogens to hands.

Evaluation of an Ethanol-Based Spray Disinfectant for Decontamination of Cover Gowns Prior to Removal.

An ethanol-based spray disinfectant significantly reduced bacteriophage MS2 contamination on material from gowns meeting ASTM standard 1671 for resistance to blood and viral penetration and on a cover gown worn by personnel. Effectiveness of disinfection was affected by the type of gown material and the correctness of fit. Infect Control Hosp Epidemiol 2017;38:364-366.

Evaluation of an automated room decontamination device using aerosolized peracetic acid.

Because manual cleaning is often suboptimal, there is increasing interest in use of automated devices for room decontamination. We demonstrated that an ultrasonic room fogging system that generates submicron droplets of peracetic acid and hydrogen peroxide eliminated Clostridium difficile spores and vegetative pathogens from exposed carriers in hospital rooms and adjacent bathrooms.

A pilot study to assess use of fluorescent lotion in patient care simulations to illustrate pathogen dissemination and train personnel in correct use of personal protective equipment.

BACKGROUND: Simulations using fluorescent tracers can be useful in understanding the spread of pathogens and in devising effective infection control strategies. METHODS: During simulated patient care interactions in which providers wore gloves and gowns, we evaluated environmental and personnel dissemination of fluorescent lotion and bacteriophage MS2 from a contaminated mannequin. The frequency of skin and clothing contamination after removal of personal protective equipment (PPE) was compared before versus after an intervention that included education and practice in PPE donning and doffing. RESULTS: Ten healthcare personnel participated in 30 pre-intervention and 30 post-intervention patient care simulations. Fluorescent lotion and bacteriophage MS2 were rapidly disseminated to touched surfaces throughout the room; there was no difference in the frequency of contamination before versus after the PPE training intervention. After the intervention, there was a decrease in skin and/or clothing contamination with fluorescent lotion (9/30, 30 % versus 1/30, 3 %; P = 0.01) and bacteriophage MS2 (8/30, 27 % versus 2/30, 7 %; P = 0.08) and there was a significant reduction in the concentration of bacteriophage MS2 recovered from hands (0.31 versus 0.07 log10plaque-forming units; P < 0.01). CONCLUSIONS: Our findings suggest that simulations with fluorescent lotion can be a useful teaching tool to illustrate the spread of pathogens and provide further evidence that simple PPE training interventions can be effective in reducing contamination of personnel.

Evaluation of Hospital Floors as a Potential Source of Pathogen Dissemination Using a Nonpathogenic Virus as a Surrogate Marker.

Hospital floors are frequently contaminated with pathogens, but it is not known whether floors are a potential source of transmission. We demonstrated that a nonpathogenic virus inoculated onto floors in hospital rooms disseminated rapidly to the hands of patients and to high-touch surfaces inside and outside the room. Infect Control Hosp Epidemiol 2016;1-4.

Utility of a Novel Reflective Marker Visualized by Flash Photography for Assessment of Personnel Contamination During Removal of Personal Protective Equipment.

In an experimental study, the frequency of contamination of healthcare personnel during removal of contaminated personal protective equipment (PPE) was similar for bacteriophage MS2 and a novel reflective marker visualized using flash photography. The reflective marker could be a useful tool to visualize and document personnel contamination during PPE removal. Infect Control Hosp Epidemiol 2016;37:711-713.

Evaluation of a low-intensity ultraviolet-C radiation device for decontamination of computer keyboards.

Computer keyboards are a potential source for dissemination of pathogenic microorganisms. We demonstrated that a low-intensity ultraviolet-C (UV-C) radiation device was effective in reducing methicillin-resistant Staphylococcus aureus, carbapenem-resistant Escherichia coli, and Clostridium difficile spores on steel carriers and significantly reduced bacterial counts on in-use keyboards.