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1.
Glob Health Sci Pract ; 10(3)2022 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-36332067

RESUMO

Standardized surveillance for health care-associated infections (HAI) is critical to understand HAI burden and inform prevention strategies at a national level. Due to differing and generally limited resources in Vietnam's health care facilities, implementation of HAI surveillance has been variable and data quality has not been systematically assessed. In 2016, the Vietnam Administration for Medical Services (VAMS) under the Ministry of Health, with the support of partners, began to establish a context-appropriate, standardized HAI surveillance system for bloodstream infections (BSI) and urinary tract infections (UTI) among 6 pilot hospitals in Vietnam. We identified 5 key elements of our HAI surveillance implementation process that have been conducive to ensuring data quality and program sustainability and scalability. These include: (1) engaging stakeholders, (2) designating roles and responsibilities, (3) developing context-sensitive, standardized surveillance protocols, (4) creating a surveillance implementation strategy, and (5) linking HAI surveillance and prevention activities. With the active participation of infection prevention and control staff from the 6 pilot hospitals, standardized HAI surveillance for BSIs and UTIs was expanded to 12 additional hospitals in 2019. Together, VAMS and partners are helping Vietnam fulfill its commitment to safe health care for all patients.


Assuntos
Infecção Hospitalar , Humanos , Vietnã/epidemiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Hospitais , Instalações de Saúde , Atenção à Saúde
2.
Infect Control Hosp Epidemiol ; 42(10): 1173-1180, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33308357

RESUMO

OBJECTIVE: To describe epidemiologic and genomic characteristics of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in a large skilled-nursing facility (SNF), and the strategies that controlled transmission. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted during March 22-May 4, 2020, among all staff and residents at a 780-bed SNF in San Francisco, California. METHODS: Contact tracing and symptom screening guided targeted testing of staff and residents; respiratory specimens were also collected through serial point prevalence surveys (PPSs) in units with confirmed cases. Cases were confirmed by real-time reverse transcription-polymerase chain reaction testing for SARS-CoV-2, and whole-genome sequencing (WGS) was used to characterize viral isolate lineages and relatedness. Infection prevention and control (IPC) interventions included restricting from work any staff who had close contact with a confirmed case; restricting movement between units; implementing surgical face masking facility-wide; and the use of recommended PPE (ie, isolation gown, gloves, N95 respirator and eye protection) for clinical interactions in units with confirmed cases. RESULTS: Of 725 staff and residents tested through targeted testing and serial PPSs, 21 (3%) were SARS-CoV-2 positive: 16 (76%) staff and 5 (24%) residents. Fifteen cases (71%) were linked to a single unit. Targeted testing identified 17 cases (81%), and PPSs identified 4 cases (19%). Most cases (71%) were identified before IPC interventions could be implemented. WGS was performed on SARS-CoV-2 isolates from 4 staff and 4 residents: 5 were of Santa Clara County lineage and the 3 others were distinct lineages. CONCLUSIONS: Early implementation of targeted testing, serial PPSs, and multimodal IPC interventions limited SARS-CoV-2 transmission within the SNF.


Assuntos
COVID-19 , Instituições de Cuidados Especializados de Enfermagem , Estudos de Coortes , Surtos de Doenças , Humanos , SARS-CoV-2 , São Francisco/epidemiologia
3.
MMWR Morb Mortal Wkly Rep ; 69(32): 1095-1099, 2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-32790655

RESUMO

Undetected infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) contributes to transmission in nursing homes, settings where large outbreaks with high resident mortality have occurred (1,2). Facility-wide testing of residents and health care personnel (HCP) can identify asymptomatic and presymptomatic infections and facilitate infection prevention and control interventions (3-5). Seven state or local health departments conducted initial facility-wide testing of residents and staff members in 288 nursing homes during March 24-June 14, 2020. Two of the seven health departments conducted testing in 195 nursing homes as part of facility-wide testing all nursing homes in their state, which were in low-incidence areas (i.e., the median preceding 14-day cumulative incidence in the surrounding county for each jurisdiction was 19 and 38 cases per 100,000 persons); 125 of the 195 nursing homes had not reported any COVID-19 cases before the testing. Ninety-five of 22,977 (0.4%) persons tested in 29 (23%) of these 125 facilities had positive SARS-CoV-2 test results. The other five health departments targeted facility-wide testing to 93 nursing homes, where 13,443 persons were tested, and 1,619 (12%) had positive SARS-CoV-2 test results. In regression analyses among 88 of these nursing homes with a documented case before facility-wide testing occurred, each additional day between identification of the first case and completion of facility-wide testing was associated with identification of 1.3 additional cases. Among 62 facilities that could differentiate results by resident and HCP status, an estimated 1.3 HCP cases were identified for every three resident cases. Performing facility-wide testing immediately after identification of a case commonly identifies additional unrecognized cases and, therefore, might maximize the benefits of infection prevention and control interventions. In contrast, facility-wide testing in low-incidence areas without a case has a lower proportion of test positivity; strategies are needed to further optimize testing in these settings.


Assuntos
Técnicas de Laboratório Clínico , Infecções por Coronavirus/prevenção & controle , Casas de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Idoso , COVID-19 , Teste para COVID-19 , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Pessoal de Saúde , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Estados Unidos/epidemiologia
4.
MMWR Morb Mortal Wkly Rep ; 69(27): 882-886, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32644985

RESUMO

Skilled nursing facilities (SNFs) are focal points of the coronavirus disease 2019 (COVID-19) pandemic, and asymptomatic infections with SARS-CoV-2, the virus that causes COVID-19, among SNF residents and health care personnel have been described (1-3). Repeated point prevalence surveys (serial testing of all residents and health care personnel at a health care facility irrespective of symptoms) have been used to identify asymptomatic infections and have reduced SARS-CoV-2 transmission during SNF outbreaks (1,3). During March 2020, the Detroit Health Department and area hospitals detected a sharp increase in COVID-19 diagnoses, hospitalizations, and associated deaths among SNF residents. The Detroit Health Department collaborated with local government, academic, and health care system partners and a CDC field team to rapidly expand SARS-CoV-2 testing and implement infection prevention and control (IPC) activities in all Detroit-area SNFs. During March 7-May 8, among 2,773 residents of 26 Detroit SNFs, 1,207 laboratory-confirmed cases of COVID-19 were identified during three periods: before (March 7-April 7) and after two point prevalence surveys (April 8-25 and April 30-May 8): the overall attack rate was 44%. Within 21 days of receiving their first positive test results, 446 (37%) of 1,207 COVID-19 patients were hospitalized, and 287 (24%) died. Among facilities participating in both surveys (n = 12), the percentage of positive test results declined from 35% to 18%. Repeated point prevalence surveys in SNFs identified asymptomatic COVID-19 cases, informed cohorting and IPC practices aimed at reducing transmission, and guided prioritization of health department resources for facilities experiencing high levels of SARS-CoV-2 transmission. With the increased availability of SARS-CoV-2 testing, repeated point prevalence surveys and enhanced and expanded IPC support should be standard tools for interrupting and preventing COVID-19 outbreaks in SNFs.


Assuntos
Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/métodos , Programas de Rastreamento/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Instituições de Cuidados Especializados de Enfermagem , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Teste para COVID-19 , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Michigan/epidemiologia , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Prevalência
5.
Clin Infect Dis ; 69(3): 445-449, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-30346502

RESUMO

BACKGROUND: Burkholderia cepacia complex (Bcc) has caused healthcare-associated outbreaks, often in association with contaminated products. The identification of 4 Bcc bloodstream infections in patients residing at a single skilled nursing facility (SNF) within 1 week led to an epidemiological investigation to identify additional cases and the outbreak source. METHODS: A case was initially defined via a blood culture yielding Bcc in a SNF resident receiving intravenous therapy after 1 August 2016. Multistate notifications were issued to identify additional cases. Public health authorities performed site visits at facilities with cases to conduct chart reviews and identify possible sources. Pulsed-field gel electrophoresis (PFGE) was performed on isolates from cases and suspect products. Facilities involved in manufacturing suspect products were inspected to assess possible root causes. RESULTS: An outbreak of 162 Bcc bloodstream infections across 59 nursing facilities in 5 states occurred during September 2016-January 2017. Isolates from patients and pre-filled saline flush syringes were closely related by PFGE, identifying contaminated flushes as the outbreak source and prompting a nationwide recall. Inspections of facilities at the saline flush manufacturer identified deficiencies that might have led to the failure to sterilize a specific case containing a partial lot of the product. CONCLUSIONS: Communication and coordination among key stakeholders, including healthcare facilities, public health authorities, and state and federal agencies, led to the rapid identification of an outbreak source and likely prevented many additional infections. Effective processes to ensure the sterilization of injectable products are essential to prevent similar outbreaks in the future.


Assuntos
Bacteriemia/epidemiologia , Infecções por Burkholderia/etiologia , Infecção Hospitalar/etiologia , Surtos de Doenças/estatística & dados numéricos , Contaminação de Equipamentos , Seringas/microbiologia , Idoso , Bacteriemia/etiologia , Infecções por Burkholderia/epidemiologia , Complexo Burkholderia cepacia/genética , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Eletroforese em Gel de Campo Pulsado , Humanos , Solução Salina , Instituições de Cuidados Especializados de Enfermagem , Estados Unidos
6.
7.
MMWR Morb Mortal Wkly Rep ; 65(45): 1274-1275, 2016 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-27855144

RESUMO

On May 24, 2016, the New York City Department of Health and Mental Hygiene notified CDC of two cases of Exophiala dermatitidis bloodstream infections among patients with malignancies who had received care from a single physician at an outpatient oncology facility (clinic A). Review of January 1-May 31, 2016 microbiology records identified E. dermatitidis bloodstream infections in two additional patients who also had received care at clinic A. All four patients had implanted vascular access ports and had received intravenous (IV) medications, including a compounded IV flush solution containing saline, heparin, vancomycin, and ceftazidime, compounded and administered at clinic A.


Assuntos
Infecção Hospitalar/etiologia , Contaminação de Medicamentos , Fungemia/etiologia , Injeções Intravenosas/efeitos adversos , Neoplasias/tratamento farmacológico , Instituições de Assistência Ambulatorial , Institutos de Câncer , Composição de Medicamentos , Humanos , Cidade de Nova Iorque
8.
MMWR Morb Mortal Wkly Rep ; 65(36): 979-80, 2016 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-27631346

RESUMO

The mcr-1 gene confers resistance to the polymyxins, including the antibiotic colistin, a medication of last resort for multidrug-resistant infections. The mcr-1 gene was first reported in 2015 in food, animal, and patient isolates from China (1) and is notable for being the first plasmid-mediated colistin resistance mechanism to be identified. Plasmids can be transferred between bacteria, potentially spreading the resistance gene to other bacterial species. Since its discovery, the mcr-1 gene has been reported from Africa, Asia, Europe, South America, and North America (2,3), including the United States, where it has been identified in Escherichia coli isolated from three patients and from two intestinal samples from pigs (2,4-6). In July 2016, the Pathogen Detection System at the National Center for Biotechnology Information (Bethesda, Maryland) identified mcr-1 in the whole genome sequence of an E. coli isolate from a Connecticut patient (7); this is the fourth isolate from a U.S. patient to contain the mcr-1 gene.


Assuntos
Farmacorresistência Bacteriana/genética , Infecções por Escherichia coli/microbiologia , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Região do Caribe , Connecticut , Escherichia coli/efeitos dos fármacos , Infecções por Escherichia coli/diagnóstico , Fezes/microbiologia , Humanos , Polimixinas/farmacologia , Viagem
9.
MMWR Morb Mortal Wkly Rep ; 65(18): 481-2, 2016 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-27171735

RESUMO

On September 17, 2015, the Pennsylvania Department of Health (PADOH) notified CDC of a cluster of three potentially health care-associated mucormycete infections that occurred among solid organ transplant recipients during a 12-month period at hospital A. On September 18, hospital B reported that it had identified an additional transplant recipient with mucormycosis. Hospitals A and B are part of the same health care system and are connected by a pedestrian bridge. PADOH requested CDC's assistance with an on-site investigation, which started on September 22, to identify possible sources of infection and prevent additional infections.


Assuntos
Infecção Hospitalar/epidemiologia , Surtos de Doenças , Mucormicose/epidemiologia , Transplante de Órgãos/efeitos adversos , Transplantados , Adulto , Análise por Conglomerados , Cuidados Críticos , Infecção Hospitalar/diagnóstico , Hospitais , Humanos , Mucormicose/diagnóstico , Pennsylvania/epidemiologia
10.
MMWR Morb Mortal Wkly Rep ; 65(14): 375-8, 2016 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-27078190

RESUMO

Since November 2015, Puerto Rico has reported active mosquito-borne transmission of Zika virus. Because of the potential for Zika virus to be transmitted through transfusion of blood components, and because a high percentage of persons infected with Zika virus are asymptomatic, the Food and Drug Administration (FDA) recommended that blood collections cease in areas of the United States affected by active vector-borne transmission of Zika virus until laboratory screening of blood donations or pathogen reduction technology (PRT) for treatment of blood components can be implemented. To inform efforts to maintain the safety and availability of the blood supply in Puerto Rico, CDC, in collaboration with the Puerto Rico Department of Health, conducted a rapid assessment of blood collection and use on the island. A total of 139,369 allogeneic red blood cell (RBC) units, 45,243 platelet units, and 56,466 plasma units were collected in or imported to Puerto Rico during 2015, and 135,966 allogeneic RBC units, 13,526 therapeutic platelet units, and 25,775 plasma units were transfused. Because of the potential for local Zika virus transmission in areas with a competent mosquito vector, other areas of the United States should develop plans to ensure local blood safety and adequacy. Blood collection organizations and public health agencies should collaborate to maintain the safety and availability of local blood supplies in accordance with FDA guidance.


Assuntos
Bancos de Sangue , Guias de Prática Clínica como Assunto , Infecção por Zika virus/prevenção & controle , Patógenos Transmitidos pelo Sangue , Humanos , Porto Rico , Inquéritos e Questionários , Reação Transfusional , Zika virus , Infecção por Zika virus/transmissão
11.
COPD ; 13(1): 100-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26418826

RESUMO

The purpose of this review is to evaluate the role of anemia on patient outcomes in chronic obstructive pulmonary disease (COPD), the potential contribution that low iron stores may play in this process, and possible treatment considerations. A review of research studies found that anemia is associated with declining functional outcomes, increased health care utilization and costs, and increased mortality in COPD. Associations exist between reduced iron intake and progression of COPD and in reduction of iron status with declining lung function. Currently data are limited on the effects of either treating anemia or utilizing iron supplementation in anemic COPD patients. If iron supplementation might therefore reverse some of the declines that patients experience, then routine screening and treatment may turn out to be an effective, simple and inexpensive intervention. Iron supplementation models utilized in other inflammatory-related disease states were reviewed as a possible starting point to evaluate treatment options in COPD. Future research can be directed to establish best practice standards for the use of iron supplementation in COPD.


Assuntos
Anemia Ferropriva/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Anemia/complicações , Anemia/fisiopatologia , Anemia Ferropriva/complicações , Anemia Ferropriva/tratamento farmacológico , Suplementos Nutricionais , Humanos , Ferro/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/complicações
12.
Front Microbiol ; 6: 1204, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26583007

RESUMO

Weissella spp. are non-spore forming, catalase-negative, gram-positive coccobacilli. They are often misidentified by traditional and commercial phenotypic identification methods as Lactobacillus spp. or Lactobacillus-like organisms. Weissella spp. were previously grouped along with Lactobacillus spp., Leuconostoc spp., and Pediococcus spp. Utilization of more sensitive methods like DNA sequencing or Matrix-Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) has facilitated identification of Weissella as a unique genus. Nineteen species have been identified to date. W. confusa, W. cibaria, and W. viridescens are the only species isolated from humans. The true prevalence of Weissella spp. continues to be probably underestimated. Weissella spp. strains have been isolated from a wide range of habitats including raw milk, feces, fermented cereals, and vegetables. Weisella is believed to be a rare cause of usually nonfatal infections in humans, and is often considered a contaminant. However, in recent years, Weissella spp. have been implicated in bacteremia, abscesses, prosthetic joint infections, and infective endocarditis. Alterations of the gut flora from surgery or chemotherapy are believed to facilitate translocation of Weissella spp. due to disruption of the mucosal barrier, predisposing the host to infection with this organism. Implications of the isolation of Weissella spp. from blood must be interpreted in context of underlying risk factors. Weissella spp. are inherently resistant to vancomycin. Therefore, early consideraton of the pathogenic role of this bacteria and choice of alternate therapy is important to assure better outcomes.

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