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1.
Infect Dis Clin North Am ; 34(1): 129-143, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32008695

RESUMO

Antimicrobial stewardship is a collaborative venture and antimicrobial stewardship in long-term care (LTC) settings is no exception. There are many barriers to implementing effective antimicrobial stewardship programs in LTC settings, including constrained financial resources, limited access to physicians and pharmacists with antimicrobial stewardship training, minimal on-site infectious syndrome diagnostics and laboratory expertise, and high rates of staff turnover. This article suggests that collaboration at the level of health care facilities and systems, with public health departments, with laboratory partners, and among personnel, including nursing staff, prescribers, and pharmacists, can lead to effective antimicrobial stewardship programs in LTC settings.


Assuntos
Gestão de Antimicrobianos/métodos , Implementação de Plano de Saúde/métodos , Colaboração Intersetorial , Assistência de Longa Duração , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/organização & administração , Doenças Transmissíveis/tratamento farmacológico , Humanos , Médicos
3.
Infect Control Hosp Epidemiol ; 38(4): 399-404, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28065183

RESUMO

OBJECTIVE We report an outbreak of respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) infections in a dementia care ward containing 2 separately locked units (A and B) to heighten awareness of these pathogens in the older adult population and highlight some of the infection prevention challenges faced during a noninfluenza respiratory viral outbreak in a congregate setting. METHODS Cases were defined by the presence of new signs or symptoms that included (1) a single oral temperature ≥ 37.8°C (100.0°F) and (2) the presence of at least 2 of the following symptoms: cough, dyspnea, rhinorrhea, hoarseness, congestion, fatigue, and malaise. Attempted infection-control measures included cohorting patients and staff, empiric isolation precautions, and cessation of group activities. Available nasopharyngeal swab specimens were sent to the Tennessee Department of Health for identification by rT-PCR testing. RESULTS We identified 30 of the 41 (73%) residents as cases over this 16-day outbreak. Due to high numbers of sick personnel, we were unable to cohort staff to 1 unit. Unit B developed its first case 8 days after infection control measures were implemented. Of the 14 cases with available specimens, 6 patients tested positive for RSV-B, 7 for HMPV and 1 patient test positive for influenza A. Overall, 15 cases (50%) required transfer to acute care facilities; 10 of these patients (34%) had chest x-ray confirmed pulmonary infiltrates; and 5 residents (17%) died. CONCLUSIONS This case report highlights the importance of RSV and HMPV in causing substantial disease in the older adult population and highlights the challenges in preventing transmission of these viruses. Infect Control Hosp Epidemiol 2017;38:399-404.


Assuntos
Surtos de Doenças , Instituição de Longa Permanência para Idosos , Controle de Infecções/métodos , Casas de Saúde , Infecções por Vírus Respiratório Sincicial/epidemiologia , Infecções por Vírus Respiratório Sincicial/prevenção & controle , Vírus Sinciciais Respiratórios , Idoso de 80 Anos ou mais , Demência/enfermagem , Hospitalização , Humanos , Assistência de Longa Duração , Metapneumovirus , Infecções por Paramyxoviridae/diagnóstico , Infecções por Paramyxoviridae/epidemiologia , Infecções por Paramyxoviridae/prevenção & controle , Infecções por Vírus Respiratório Sincicial/diagnóstico
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