Publications by authors named "Carolyn T A Herzig"

48 Publications

Coronavirus Disease 2019 (COVID-19) in Americans Aboard the Diamond Princess Cruise Ship.

Clin Infect Dis 2021 05;72(10):e448-e457

All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Background: The Diamond Princess cruise ship was the site of a large outbreak of coronavirus disease 2019 (COVID-19). Of 437 Americans and their travel companions on the ship, 114 (26%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Methods: We interviewed 229 American passengers and crew after disembarkation following a ship-based quarantine to identify risk factors for infection and characterize transmission onboard the ship.

Results: The attack rate for passengers in single-person cabins or without infected cabinmates was 18% (58/329), compared with 63% (27/43) for those sharing a cabin with an asymptomatic infected cabinmate, and 81% (25/31) for those with a symptomatic infected cabinmate. Whole genome sequences from specimens from passengers who shared cabins clustered together. Of 66 SARS-CoV-2-positive American travelers with complete symptom information, 14 (21%) were asymptomatic while on the ship. Among SARS-CoV-2-positive Americans, 10 (9%) required intensive care, of whom 7 were ≥70 years.

Conclusions: Our findings highlight the high risk of SARS-CoV-2 transmission on cruise ships. High rates of SARS-CoV-2 positivity in cabinmates of individuals with asymptomatic infections suggest that triage by symptom status in shared quarters is insufficient to halt transmission. A high rate of intensive care unit admission among older individuals complicates the prospect of future cruise travel during the pandemic, given typical cruise passenger demographics. The magnitude and severe outcomes of this outbreak were major factors contributing to the Centers for Disease Control and Prevention's decision to halt cruise ship travel in US waters in March 2020.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/cid/ciaa1180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454359PMC
May 2021

Perceived impact of state-mandated reporting on infection prevention and control departments.

Am J Infect Control 2019 02 12;47(2):118-122. Epub 2018 Oct 12.

Columbia University School of Nursing, Center for Health Policy, New York, NY.

Background: Currently, most US states have adopted legislation requiring hospitals to submit health care-associated infection (HAI) data. We evaluated the perceived impact of state HAI laws on infection prevention and control (IPC) departments.

Methods: A web-based survey of a national sample of all non-veteran hospitals enrolled in the National Healthcare Safety Network was conducted in fall 2011. Variations in IPC department resources and characteristics in states with and without laws were compared by use of χ², Mann-Whitney (Wilcoxon), and Student t tests. Multinomial logistic regression was used to identify increases or decreases, versus no change, in perceived resources, time, influence, and visibility of the IPC department in states with and without HAI laws.

Results: Overall, 1,036 IPC departments provided complete data (30% response rate); 755 (73%) were located in states with laws. Respondents in states with reporting laws were more likely to report less time for routine IPC activities (odds ratio, 1.61; 95% confidence interval, 1.12-2.31) and less visibility of the IPC department (odds ratio, 1.70; 95% confidence interval, 1.12-2.58) than respondents in states without laws, after controlling for geographic region, setting, and the presence of a hospital epidemiologist.

Conclusions: Respondents in states with laws reported negative effects on their IPC department, beyond what was required by federal mandates. Further research should examine resources necessary to comply with state HAI laws and evaluate unintended consequences of state HAI laws.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajic.2018.08.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6359958PMC
February 2019

Nursing Home Infection Control Program Characteristics, CMS Citations, and Implementation of Antibiotic Stewardship Policies: A National Study.

Inquiry 2018 Jan-Dec;55:46958018778636

3 RAND Corporation, Boston, MA, USA.

Recently, the Centers for Medicare & Medicaid Services (CMS) final rule required that nursing homes (NHs) develop an infection control program that includes an antibiotic stewardship component and employs a trained infection preventionist (IP). The objectives of this study were to provide a baseline assessment of (1) NH facility and infection control program characteristics associated with having an infection control deficiency citation and (2) associations between IP training and the presence of antibiotic stewardship policies, controlling for NH characteristics. A cross-sectional survey of 2514 randomly sampled US NHs was conducted to assess IP training, staff turnover, and infection control program characteristics (ie, frequency of infection control committee meetings and the presence of 7 antibiotic stewardship policies). Responses were linked to concurrent Certification and Survey Provider Enhanced Reporting data, which contain information about NH facility characteristics and citations. Descriptive statistics and multivariable regression analyses were conducted to account for NH characteristics. Surveys were received from 990 NHs; 922 had complete data. One-third of NHs in this sample received an infection control deficiency citation. The NHs that received deficiency citations were more likely to have committees that met weekly/monthly versus quarterly ( P < .01). The IPs in 39% of facilities had received specialized training. Less than 3% of trained IPs were certified in infection control. The NHs with trained IPs were more likely to have 5 of the 7 components of antibiotic stewardship in place (all P < .05). The IP training, although infrequent, was associated with the presence of antibiotic stewardship policies. Receiving an infection control citation was associated with more frequent infection control committee meetings. Training and support of IPs is needed to ensure infection control and antibiotic stewardship in NHs. As the CMS rule becomes implemented, more research is warranted. There is a need for increase in trained IPs in US NHs. These data can be used to evaluate the effectiveness of the CMS final rule on infection management processes in US NHs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0046958018778636DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5974557PMC
December 2018

Implementation of Electronic Health Records in US Nursing Homes.

Comput Inform Nurs 2017 Aug;35(8):417-424

Author Affiliations: Center for Health Policy, Columbia University School of Nursing (Drs Bjarnadottir, Herzig, Stone, and Travers); and Department of Epidemiology, Columbia University Mailman School of Public Health (Dr Herzig), New York, NY; and Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, PA (Dr Castle).

While electronic health records have emerged as promising tools to help improve quality of care, nursing homes have lagged behind in implementation. This study assessed electronic health records implementation, associated facility characteristics, and potential impact on quality indicators in nursing homes. Using national Centers for Medicare & Medicaid Services and survey data for nursing homes, a cross-sectional analysis was conducted to identify variations between nursing homes that had and had not implemented electronic health records. A difference-in-differences analysis was used to estimate the longitudinal effect of electronic health records on commonly used quality indicators. Data from 927 nursing homes were examined, 49.1% of which had implemented electronic health records. Nursing homes with electronic health records were more likely to be nonprofit/government owned (P = .04) and had a lower percentage of Medicaid residents (P = .02) and higher certified nursing assistant and registered nurse staffing levels (P = .002 and .02, respectively). Difference-in-differences analysis showed greater quality improvements after implementation for five long-stay and two short-stay quality measures (P = .001 and .01, respectively) compared with those who did not implement electronic health records. Implementation rates in nursing homes are low compared with other settings, and better-resourced facilities are more likely to have implemented electronic health records. Consistent with other settings, electronic health records implementation improves quality in nursing homes, but further research is needed to better understand the mechanism for improvement and how it can best be supported.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/CIN.0000000000000344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5555048PMC
August 2017

Drug Use Is Associated With Purulent Skin and Soft Tissue Infections in a Large Urban Jail: 2011-2015.

Open Forum Infect Dis 2017 3;4(3):ofx135. Epub 2017 Aug 3.

Department of Epidemiology, Mailman School of Public Health, Columbia University.

Background: Skin and soft tissue infections (SSTIs) are a common problem in jails in the United States. This study aimed to identify factors associated with purulent SSTIs in the New York City jail system.

Methods: We conducted a case-control study of purulent SSTIs at the New York City jail. Cases were matched to controls by visit date to the jail's urgent care clinic. Bivariate and multivariable analyses were conducted using conditional logistic regression.

Results: From April 2011 to April 2015, 1010 cases of SSTIs were identified and matched to 1010 controls. In multivariable analyses, report upon entry to jail of current injection drug use (odds ratio [OR], 2.76; 95% confidence interval [CI], 1.77-4.31), current snorting of drugs (OR, 1.50; 95% CI, 1.12-2.00), current heroin use (OR, 1.53; 95% CI, 1.08-2.17), current cocaine use (OR, 1.76; 95% CI, 1.18-2.65), and antibiotic use within the previous 6 months (OR, 4.05; 95% CI, 2.98-5.49) were significantly associated with SSTI diagnosis.

Conclusions: Skin and soft tissue infections were strongly associated with a history of drug use at jail entry. Targeting intravenous drug use may be a preventive strategy for SSTIs in this population. Strategies such as harm reduction programs may be investigated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ofid/ofx135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364227PMC
August 2017

Influence of staff infection control training on infection-related quality measures in US nursing homes.

Am J Infect Control 2017 Sep 16;45(9):1035-1040. Epub 2017 Jun 16.

Center for Health Policy, Columbia University School of Nursing, New York, NY.

Health care-associated infections are a leading cause of morbidity and mortality in US nursing home residents. Ongoing training of nursing home staff is vital to the implementation of infection prevention and control processes. Our aim was to describe associations between methods, frequency, and timing of staff infection prevention and control training and infection-related quality measures. In this national survey of nursing homes, timing of staff infection prevention and control training was associated with reduced indwelling urinary catheter use.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajic.2017.04.285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5581666PMC
September 2017

Infection Trends in US Nursing Homes, 2006-2013.

J Am Med Dir Assoc 2017 Jul 25;18(7):635.e9-635.e20. Epub 2017 May 25.

Center for Health Policy, Columbia University School of Nursing, New York, NY. Electronic address:

Objectives: The objectives of this study were to estimate trends in the prevalence of infections in nursing home (NH) residents using 2006-2013 Minimum Data Set (MDS) data, estimate the number of all infections in 2013, and evaluate differences in trends between MDS versions 2.0 and 3.0.

Design: Retrospective study.

Setting: NHs in the United States.

Participants: All NH residents with a quarterly or annual MDS assessment in 2006-2013 (n = 30,366,807 assessments).

Measurements: MDS 2.0 and 3.0 quarterly and annual assessment data (2006-2013) from over 15,000 NHs were used to estimate the 7-day prevalence of multidrug-resistant organism (MDRO) infection, pneumonia, septicemia, viral hepatitis, and wound infection and 30-day prevalence of urinary tract infection (UTI). Admission assessments were excluded. Annual infection counts were estimated using 2013 data. Changes in the prevalence of reported infections over time and differences in trends between MDS 2.0 and 3.0 were examined using tests of linear trends.

Results: In 2013, there were an estimated 1.13 to 2.68 million infections in NH residents. UTI and pneumonia were the most commonly reported infections in every quarter, ranging from 5.6% to 8.1% and 1.4% to 2.5%, respectively. Prevalence of all infections increased in 2006-2010 (P values < .01). In 2011-2013, prevalence of UTI, MDRO, and wound infections decreased and viral hepatitis increased (P values < .0001). Between MDS 2.0 and 3.0, the prevalence of UTI, MDRO, and wound infections decreased and the prevalence of viral hepatitis increased (P values < .0001).

Conclusion: Infections are a major and persistent problem in NHs. Although MDS data are useful for identifying trends in infection prevalence, revisions in definitions need to be accounted for when evaluating trends over time. Additional research is needed to identify factors that contribute to changes in infection prevalence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jamda.2017.04.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577941PMC
July 2017

HIV and colonization with Staphylococcus aureus in two maximum-security prisons in New York State.

J Infect 2016 12 1;73(6):568-577. Epub 2016 Sep 1.

Department of Medicine, Division of Infectious Diseases, Columbia University, 630 West 168th Street, Box 82, New York, NY 10032, USA.

Objective: To evaluate the association between HIV and Staphylococcus aureus colonization after confounding by incarceration is removed.

Method: A cross sectional stratified study of all HIV infected and a random sample of HIV-uninfected inmates from two maximum-security prisons in New York State. Structured interviews were conducted. Anterior nares and oropharyngeal samples were cultured and S. aureus isolates were characterized. Log-binomial regression was used to assess the association between HIV and S. aureus colonization of the anterior nares and/or oropharynx and exclusive oropharynx colonization. Differences in S. aureus strain diversity between HIV-infected and uninfected individuals were assessed using Simpson's Index of Diversity.

Results: Among 117 HIV infected and 351 HIV uninfected individuals assessed, 47% were colonized with S. aureus and 6% were colonized with methicillin resistant S. aureus. The prevalence of S. aureus colonization did not differ by HIV status (PR = 0.99, 95% CI = 0.76-1.24). HIV infected inmates were less likely to be exclusively colonized in the oropharynx (PR = 0.55, 95% CI = 0.30-0.99). Spa types t571 and t064 were both more prevalent among HIV infected individuals, however, strain diversity was similar in HIV infected and uninfected inmates.

Conclusions: HIV infection was not associated with S. aureus colonization in these maximum-security prison populations, but was associated with decreased likelihood of oropharyngeal colonization. Factors that influence colonization site require further evaluation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jinf.2016.08.016DOI Listing
December 2016

Impact of State Reporting Laws on Central Line-Associated Bloodstream Infection Rates in U.S. Adult Intensive Care Units.

Health Serv Res 2017 06 24;52(3):1079-1098. Epub 2016 Jul 24.

Center for Health Policy, Columbia University School of Nursing, New York, NY.

Objective: To examine the effect of mandated state health care-associated infection (HAI) reporting laws on central line-associated bloodstream infection (CLABSI) rates in adult intensive care units (ICUs).

Data Sources: We analyzed 2006-2012 adult ICU CLABSI and hospital annual survey data from the National Healthcare Safety Network. The final analytic sample included 244 hospitals, 947 hospital years, 475 ICUs, 1,902 ICU years, and 16,996 ICU months.

Study Design: We used a quasi-experimental study design to identify the effect of state mandatory reporting laws. Several secondary models were conducted to explore potential explanations for the plausible effects of HAI laws.

Principal Findings: Controlling for the overall time trend, ICUs in states with laws had lower CLABSI rates beginning approximately 6 months prior to the law's effective date (incidence rate ratio = 0.66; p < .001); this effect persisted for more than 6 1/2 years after the law's effective date. These findings were robust in secondary models and are likely to be attributed to changes in central line usage and/or resources dedicated to infection control.

Conclusions: Our results provide valuable evidence that state reporting requirements for HAIs improved care. Additional studies are needed to further explore why and how mandatory HAI reporting laws decreased CLABSI rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/1475-6773.12530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5441489PMC
June 2017

Central Line-Associated Bloodstream Infection Reduction and Bundle Compliance in Intensive Care Units: A National Study.

Infect Control Hosp Epidemiol 2016 07 7;37(7):805-10. Epub 2016 Apr 7.

4Center for Health Policy,Columbia University School of Nursing,New York,New York.

OBJECTIVES To describe compliance with the central line (CL) insertion bundle overall and with individual bundle elements in US adult intensive care units (ICUs) and to determine the relationship between bundle compliance and central line-associated bloodstream infection (CLABSI) rates. DESIGN Cross-sectional study. PARTICIPANTS National sample of adult ICUs participating in National Healthcare Safety Network (NHSN) surveillance. METHODS Hospitals were surveyed to determine compliance with CL insertion bundle elements in ICUs. Corresponding NHSN ICU CLABSI rates were obtained. Multivariate Poisson regression models were used to assess associations between CL bundle compliance and CLABSI rates, controlling for hospital and ICU characteristics. RESULTS A total of 984 adult ICUs in 632 hospitals were included. Most ICUs had CL bundle policies, but only 69% reported excellent compliance (≥95%) with at least 1 element. Lower CLABSI rates were associated with compliance with just 1 element (incidence rate ratio [IRR] 0.77; 95% confidence interval [CI], 0.64-0.92); however, ≥95% compliance with all 5 elements was associated with the greatest reduction (IRR, 0.67; 95% CI, 0.59-0.77). There was no association between CLABSI rates and simply having a written CL bundle policy nor with bundle compliance <75%. Additionally, better-resourced infection prevention departments were associated with lower CLABSI rates. CONCLUSIONS Our findings demonstrate the impact of transferring infection prevention interventions to the real-world setting. Compliance with the entire bundle was most effective, although excellent compliance with even 1 bundle element was associated with lower CLABSI rates. The variability in compliance across ICUs suggests that, at the national level, there is still room for improvement in CLABSI reduction. Infect Control Hosp Epidemiol 2016;37:805-810.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/ice.2016.67DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939802PMC
July 2016

Factors associated with resident influenza vaccination in a national sample of nursing homes.

Am J Infect Control 2016 09 9;44(9):1055-7. Epub 2016 Mar 9.

Center for Health Policy, Columbia University School of Nursing, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY.

Influenza vaccination remains the cornerstone of influenza prevention, yet national goals for nursing home residents and staff vaccination have not been met. Few studies have examined associations between facility and resident characteristics; employee processes, such as staff vaccination policies; and resident influenza vaccination. In this national survey of nursing homes, employee processes were not associated with resident influenza vaccination; however, various facility and resident characteristics were.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajic.2016.01.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5402757PMC
September 2016

Infection Prevention and Control Programs in US Nursing Homes: Results of a National Survey.

J Am Med Dir Assoc 2016 Jan;17(1):85-8

The RAND Corporation, Boston, MA.

Objectives: The objectives of this study were to (1) obtain a national perspective of the current state of nursing home (NH) infection prevention and control (IPC) programs and (2) examine differences in IPC program characteristics for NHs that had and had not received an infection control deficiency citation.

Design: A national cross-sectional survey of randomly sampled NHs was conducted and responses were linked with Certification and Survey Provider Enhanced Reporting (CASPER) and NH Compare data.

Setting: Surveys were completed and returned by 990 NHs (response rate 39%) between December 2013 and December 2014.

Participants: The person in charge of the IPC program at each NH completed the survey.

Measurements: The survey consisted of 34 items related to respondent demographics, IPC program staffing, stability of the workforce, resources and challenges, and resident care and employee processes. Facility characteristics and infection control deficiency citations were assessed using CASPER and NH Compare data.

Results: Most respondents had at least 2 responsibilities in addition to those related to infection control (54%) and had no specific IPC training (61%). Although many practices and processes were consistent with infection prevention guidelines for NHs, there was wide variation in programs across the United States. Approximately 36% of responding facilities had received an infection control deficiency citation. NHs that received citations had infection control professionals with less experience (P = .01) and training (P = .02) and were less likely to provide financial resources for continuing education in infection control (P = .01).

Conclusion: The findings demonstrate that a lack of adequately trained infection prevention personnel is an important area for improvement. Furthermore, there is a need to identify specific evidence-based practices to reduce infection risk in NHs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jamda.2015.10.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696513PMC
January 2016

"Striving for Excellence": Minimum Data Set Coordinators' Perceptions of Their Role in the Nursing Home.

J Gerontol Nurs 2015 Sep;41(9):32-41

The purpose of the current study was to explore how Minimum Data Set (MDS) coordinators perceive their role and the assessment process. Eleven MDS coordinators from 10 geographically dispersed nursing homes (NHs) were interviewed between May and September 2013. Four broad themes emerged from content analysis: (a) information gathering, (b) interdisciplinary coordination, (c) role challenges, and (d) resources. The first two themes referred to key components and competencies in the MDS coordinators' role, the third theme dealt with certain challenges inherent in the role, and the fourth theme highlighted resources that helped address these challenges. The current study provides insight into how MDS coordinators perceive their role, as well as some of the challenges they face to successfully enact that role. The current findings can help inform NH management staff, such as directors of nursing and NH administrators, and policy makers, on how best to support MDS coordinators' work to enable efficient and accurate resident assessment processes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3928/00989134-20150728-09DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4699170PMC
September 2015

Nursing Homes in States with Infection Control Training or Infection Reporting Have Reduced Infection Control Deficiency Citations.

Infect Control Hosp Epidemiol 2015 Dec 9;36(12):1475-6. Epub 2015 Sep 9.

1Columbia University School of Nursing,Center for Health Policy,New York,New York.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4658225PMC
http://dx.doi.org/10.1017/ice.2015.214DOI Listing
December 2015

Obesity as a Determinant of Staphylococcus aureus Colonization Among Inmates in Maximum-Security Prisons in New York State.

Am J Epidemiol 2015 Sep 19;182(6):494-502. Epub 2015 Aug 19.

Obesity increases a person's susceptibility to a variety of infections, including Staphylococcus aureus infections, which is an important cause of morbidity in correctional settings. Using a cross-sectional design, we assessed the association between obesity and S. aureus colonization, a risk factor for subsequent infection, in New York State maximum-security prisons (2011-2013). Anterior nares and oropharyngeal cultures were collected. Structured interviews and medical records were used to collect demographic, behavioral, and medical data. Body mass index (BMI; weight (kg)/height (m(2))) was categorized as 18.5-24.9, 25-29.9, 30-34.9, or ≥35. The association between BMI and S. aureus colonization was assessed using log-binomial regression. Thirty-eight percent of 638 female inmates and 26% of 794 male inmates had a BMI of 30 or higher. More than 40% of inmates were colonized. Female inmates with a BMI of 25-29.9 (prevalence ratio (PR) = 1.37, 95% confidence interval (CI): 1.06, 1.76), 30-34.9 (PR = 1.52, 95% CI: 1.17, 1.98), or ≥35 (PR = 1.49, 95% CI: 1.13, 1.96) had a higher likelihood of colonization than did those with a BMI of 18.5-24.9 after we controlled for age, educational level, smoking status, diabetes status, and presence of human immunodeficiency virus. Colonization was higher among male inmates with a BMI of 30-34.9 (PR = 1.27, 95% CI: 1.01, 1.61). Our findings demonstrate an association between BMI and S. aureus colonization among female prisoners. Potential contributory biologic and behavioral factors should be explored.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/aje/kwv062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4564937PMC
September 2015

Perceived barriers to infection prevention and control for nursing home certified nursing assistants: a qualitative study.

Geriatr Nurs 2015 Sep-Oct;36(5):355-60. Epub 2015 Jun 10.

Center for Health Policy, Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA.

Healthcare-associated infections, while preventable, result in increased morbidity and mortality in nursing home (NH) residents. Frontline personnel, such as certified nursing assistants (CNAs), are crucial to successful implementation of infection prevention and control (IPC) practices. The purpose of this study was to explore barriers to implementing and maintaining IPC practices for NH CNAs as well as to describe strategies used to overcome these barriers. We conducted a multi-site qualitative study of NH personnel important to infection control. Audio-recorded interviews were transcribed verbatim and transcripts were analyzed using conventional content analysis. Five key themes emerged as perceived barriers to effective IPC for CNAs: 1) language/culture; 2) knowledge/training; 3) per-diem/part-time staff; 4) workload; and 5) accountability. Strategies used to overcome these barriers included: translating in-services, hands on training, on-the-spot training for per-diem/part-time staff, increased staffing ratios, and inclusion/empowerment of CNAs. Understanding IPC barriers and strategies to overcome these barriers may better enable NHs to achieve infection reduction goals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.gerinurse.2015.05.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600411PMC
January 2017

Infection prevention and control in nursing homes: a qualitative study of decision-making regarding isolation-based practices.

BMJ Qual Saf 2015 Oct 22;24(10):630-6. Epub 2015 May 22.

Center for Health Policy, Columbia University School of Nursing, New York, New York, USA.

Background: Isolation-based practices in nursing homes (NHs) differ from those in acute care. NHs must promote quality of life while preventing infection transmission. Practices used in NHs to reconcile these goals of care have not been characterised.

Purpose: To explore decision-making in isolation-based infection prevention and control practices in NHs.

Methods: A qualitative study was conducted with staff (eg, staff nurses, infection prevention directors and directors of nursing) employed in purposefully sampled US NHs. Semistructured, role-specific interview guides were developed and interviews were digitally recorded, transcribed verbatim and analysed using directed content analysis. The research team discussed emerging themes in weekly meetings to confirm consensus.

Results: We inferred from 73 interviews in 10 NHs that there was variation between NHs in practices regarding who was isolated, when isolation-based practices took place, how they were implemented, and how they were tailored for each resident. Interviewees' decision-making depended on staff perceptions of acceptable transmission risk and resident quality of life. NH resources also influenced decision-making, including availability of private rooms, extent to which staff can devote time to isolation-based practices and communication tools. A lack of understanding of key infection prevention and control concepts was also revealed.

Conclusions And Implications: Current clinical guidelines are not specific enough to ensure consistent practice that meets care goals and resource constraints in NHs. However, new epidemiological research regarding effectiveness of varying isolation practices in this setting is needed to inform clinical practice. Further, additional infection prevention and control education for NH staff may be required.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjqs-2015-003952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575834PMC
October 2015

Epidemiological and biological determinants of Staphylococcus aureus clinical infection in New York State maximum security prisons.

Clin Infect Dis 2015 Jul 25;61(2):203-10. Epub 2015 Mar 25.

Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons.

Background: Large outbreaks of Staphylococcus aureus (SA) infections have occurred in correctional facilities across the country. We aimed to define the epidemiological and microbiological determinants of SA infection in prisons to facilitate development of prevention strategies for this underserved population.

Methods: We conducted a case-control study of SA infection at 2 New York State maximum security prisons. SA-infected inmates were matched with 3 uninfected controls. Subjects had cultures taken from sites of infection and colonization (nose and throat) and were interviewed via structured questionnaire. SA isolates were characterized by spa typing. Bivariate and multivariable analyses were conducted using conditional logistic regression.

Results: Between March 2011 and January 2013, 82 cases were enrolled and matched with 246 controls. On bivariate analysis, the use of oral and topical antibiotics over the preceding 6 months was strongly associated with clinical infection (OR, 2.52; P < .001 and 4.38, P < .001, respectively). Inmates with clinical infection had 3.16 times the odds of being diabetic compared with inmates who did not have clinical infection (P < .001). Concurrent nasal and/or oropharyngeal colonization was also associated with an increased odds of infection (OR, 1.46; P = .002). Among colonized inmates, cases were significantly more likely to carry the SA clone spa t008 (usually representing the epidemic strain USA300) compared to controls (OR, 2.52; P = .01).

Conclusions: Several inmate characteristics were strongly associated with SA infection in the prison setting. Although many of these factors were likely present prior to incarceration, they may help medical staff identify prisoners for targeted prevention strategies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/cid/civ242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490232PMC
July 2015

Understanding infection prevention and control in nursing homes: A qualitative study.

Geriatr Nurs 2015 Jul-Aug;36(4):267-72. Epub 2015 Mar 18.

Steven J. Schweon, LLC, 142 Owl Hollow Drive, Saylorsburg, PA 18353, USA.

Infections have been identified as a priority issue in nursing homes (NHs). We conducted a qualitative study purposively sampling 10 NHs across the country where 6-8 employees were recruited (N = 73). Semi-structured, open-ended guides were used to conduct in-depth interviews. Data were audiotaped, transcribed and a content analysis was performed. Five themes emerged: 'Residents' Needs', 'Roles and Training' 'Using Infection Data,' 'External Resources' and 'Focus on Hand Hygiene.' Infection prevention was a priority in the NHs visited. While all sites had hand hygiene programs, other recommended areas were not a focus and many sites were not aware of available resources. Developing ways to ensure effective, efficient and standardized infection prevention and control in NHs continues to be a national priority.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.gerinurse.2015.02.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530090PMC
February 2017

State law mandates for reporting of healthcare-associated Clostridium difficile infections in hospitals.

Infect Control Hosp Epidemiol 2015 Mar;36(3):350-2

5Dallas County Health & Human Services,Dallas,Texas.

US state and territorial laws were reviewed to identify Clostridium difficile infection reporting mandates. Twenty states require reporting either under state law or by incorporating federal Centers for Medicare & Medicaid Services' reporting requirements. Although state law mandates are more common, the incorporation of federal reporting requirements has been increasing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/ice.2014.61DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4514439PMC
March 2015

Implementation of antimicrobial stewardship policies in U.S. hospitals: findings from a national survey.

Infect Control Hosp Epidemiol 2015 Mar;36(3):261-4

6Columbia University,School of Nursing,Center for Health Policy,New York,New York.

Objective: To describe the use of antimicrobial stewardship policies and to investigate factors associated with implementation in a national sample of acute care hospitals.

Design: Cross-sectional survey.

Participants: Infection Control Directors from acute care hospitals participating in the National Healthcare Safety Network (NHSN).

Methods: An online survey was conducted in the Fall of 2011. A subset of hospitals also provided access to their 2011 NHSN annual survey data.

Results: Responses were received from 1,015 hospitals (30% response rate). The majority of hospitals (64%) reported the presence of a policy; use of antibiograms and antimicrobial restriction policies were most frequently utilized (83% and 65%, respectively). Respondents from larger, urban, teaching hospitals and those that are part of a system that shares resources were more likely to report a policy in place (P<.01). Hospitals located in California were more likely to have policy in place than in hospitals located in other states (P=.014).

Conclusion: This study provides a snapshot of the implementation of antimicrobial stewardship policies in place in U.S. hospitals and suggests that statewide efforts in California are achieving their intended effect. Further research is needed to identify factors that foster the adoption of these policies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/ice.2014.50DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356111PMC
March 2015

Spectratype analysis of the T cell receptor δ CDR3 region of bovine γδ T cells responding to leptospira.

Immunogenetics 2015 Feb 12;67(2):95-109. Epub 2014 Dec 12.

Department of Veterinary and Animal Sciences, University of Massachusetts, Integrated Sciences Building, 661 N. Pleasant St, Amherst, MA, 01003, USA.

Gamma delta T cells comprise the majority of blood T cells in ruminants at birth and remain at high levels for several years with most expressing the WC1 co-receptor. A subpopulation of Bos taurus WC1(+) cells expressing a restricted set of WC1 molecules respond immediately by proliferation and interferon-γ production to leptospira following vaccination, preceding the response by CD4 T cells. Our goal is to define the γδ T cell recognition elements involved. Previously, we showed that the responding cells employed a variety of TRDV genes indicating that the CDR1 and CDR2 of TCRδ could vary and may not be principally involved in antigen specificity. Murine and human γδ T cells bind T22 and self lipids through their CDR3δ. Like mice, cattle use up to five TRDD genes in a single CDR3δ adding flexibility to length and configuration for antigen binding. Here, we used spectratyping to evaluate the CDR3δ of leptospira-responsive cells. Little or no compartmentalization of CDR3δ was found for antigen-responsive cells that incorporated TRDV1, TRDV2, or TRDV3 even though they comprise the majority of the leptospira-responding population. Compartmentalization occurred for TRDV4-containing transcripts and was maintained over time and among cattle. However, no common amino acid motif was apparent in those CDR3δ sequences, although a bias in D gene usage occurred. We hypothesize that the restricted set of WC1 co-receptors expressed by the responding cells may lend specificity to the response through their ability to bind bacteria facilitating interaction of various TCRs with bacterial components resulting in cross-linking and activation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00251-014-0817-yDOI Listing
February 2015

Prevalence and correlates of hepatitis C virus infection among inmates at two New York State correctional facilities.

J Infect Public Health 2014 Nov-Dec;7(6):517-21. Epub 2014 Aug 30.

Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, United States; School of Nursing, Columbia University, 617 West 168th Street, New York, NY 10032, United States.

Previous studies have reported decreasing hepatitis C virus (HCV) infection rates in the general population. However, differential susceptibility in institutionalized populations suggest that HCV infection is even more prevalent in prison populations than previously reported yet, routine screening for HCV infection among prisoners is not generally available. We estimated the HCV prevalence and identified associated exposures at two maximum-security prisons using data obtained from 2788 inmates from the Risk Factors for Spread of Staphylococcus aureus in Prisons Study in New York, which recruited participants from January 2009 and January 2013. HCV prevalence was 10.1% (n=295); injection drug use, injection drug use sex partners, and HIV diagnosis exhibited the strongest associations with HCV infection in multivariable models, adjusting for covariates. Taken together, the findings of the present study provide an updated estimate of HCV prevalence and suggest that incarcerated populations represent a declining yet significant portion of the hepatitis epidemic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jiph.2014.07.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253716PMC
July 2015

The association of state legal mandates for data submission of central line-associated bloodstream infections in neonatal intensive care units with process and outcome measures.

Infect Control Hosp Epidemiol 2014 Sep 25;35(9):1133-9. Epub 2014 Jul 25.

Columbia University Medical Center, New York, New York.

Objective: To determine the association between state legal mandates for data submission of central line-associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) with process and outcome measures.

Design: Cross-sectional study.

Participants: National sample of level II/III and III NICUs participating in National Healthcare Safety Network (NHSN) surveillance.

Methods: State mandates for data submission of CLABSIs in NICUs in place by 2011 were compiled and verified with state healthcare-associated infection coordinators. A web-based survey of infection control departments in October 2011 assessed CLABSI prevention practices, ie, compliance with checklist/bundle components (process measures) in ICUs including NICUs. Corresponding 2011 NHSN NICU CLABSI rates (outcome measures) were used to calculate standardized infection ratios (SIRs). Association between mandates and process and outcome measures was assessed by multivariable logistic regression.

Results: Among 190 study NICUs, 107 (56.3%) were located in states with mandates, with mandates in place >3 years in 52 (49%). More NICUs in states with mandates reported ≥95% compliance to at least 1 CLABSI prevention practice (52.3%-66.4%) than NICUs in states without mandates (28.9%-48.2%). Mandates were predictors of ≥95% compliance with all practices (odds ratio, 2.8; 95% confidence interval, 1.4-6.1). NICUs in states with mandates reported lower mean CLABSI rates in the ≤750-g birth weight group (2.4 vs 5.7 CLABSIs/1,000 central line-days) but not in others. Mandates were not associated with SIR <1.

Conclusions: State mandates for NICU CLABSI data submission were significantly associated with ≥95% compliance with CLABSI prevention practices, which declined with the duration of mandate but not with lower CLABSI rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1086/677635DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4254852PMC
September 2014

Compliance with prevention practices and their association with central line-associated bloodstream infections in neonatal intensive care units.

Am J Infect Control 2014 Aug;42(8):847-51

Department of Pediatrics, Columbia University Medical Center, New York, NY; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY.

Background: Bundles and checklists have been shown to decrease the rates of central line-associated bloodstream infections (CLABSIs), but implementation of these practices and association with CLABSI rates have not been described nationally. We describe implementation and levels of compliance with preventive practices in a sample of US neonatal intensive care units (NICUs) and assess their association with CLABSI rates.

Methods: An online survey assessing infection prevention practices was sent to hospitals participating in National Healthcare Safety Network CLABSI surveillance in October 2011. Participating hospitals permitted access to their NICU CLABSI rates. Multivariable regressions were used to test the association between compliance with NICU-specific CLABSI prevention practices and corresponding CLABSI rates.

Results: Overall, 190 level II/III and level III NICUs participated. The majority of NICUs had written policies (84%-93%) and monitored compliance with bundles and checklists (88%-91%). Reporting ≥95% compliance for any of the practices ranged from 50%-63%. Reporting of ≥95% compliance with insertion checklist and assessment of daily line necessity were significantly associated with lower CLABSI rates (P < .05).

Conclusions: Most of the NICUs in this national sample have instituted CLABSI prevention policies and monitor compliance, although reporting compliance ≥95% was suboptimal. Reporting ≥95% compliance with select CLABSI prevention practices was associated with lower CLABSI rates. Future studies should focus on identifying and improving compliance with effective CLABSI prevention practices in neonates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajic.2014.04.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123126PMC
August 2014

State-mandated reporting of health care-associated infections in the United States: trends over time.

Am J Med Qual 2015 Sep-Oct;30(5):417-24. Epub 2014 Jun 20.

Columbia University School of Nursing, New York, NY.

Over the past decade, most US states and territories began mandating that acute care hospitals report health care-associated infections (HAIs) to their departments of health. Trends in state HAI law enactment and data submission requirements were determined through systematic legal review; state HAI coordinators were contacted to confirm collected data. As of January 31, 2013, 37 US states and territories (71%) had adopted laws requiring HAI data submission, most of which were enacted and became effective in 2006 and 2007. Most states with HAI laws required reporting of central line-associated bloodstream infections in adult intensive care units (92%), and about half required reporting of methicillin-resistant Staphylococcus aureus and Clostridium difficile infections (54% and 51%, respectively). Overall, data submission requirements were found to vary across states. Considering the facility and state resources needed to comply with HAI reporting mandates, future studies should focus on whether these laws have had the desired impact of reducing infection rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1062860614540200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4272669PMC
January 2017

Molecular characterization of methicillin-resistant Staphylococcus aureus clinical isolates obtained from the Rikers Island Jail System from 2009 to 2013.

J Clin Microbiol 2014 Aug 4;52(8):3091-4. Epub 2014 Jun 4.

Department of Medicine, Columbia University, College of Physicians and Surgeons, Division of Infectious Diseases, New York, New York, USA Department of Pathology and Cell Biology, Columbia University, College of Physicians and Surgeons, New York, New York, USA

Inmates of Rikers Island jail potentially introduce Staphylococcus aureus into New York State prisons upon transfer. In this study, methicillin-resistant Staphylococcus aureus isolates (n = 452), collected from infected inmates (2009 to 2013), were characterized. spa type t008 was the predominant clone identified, accounting for 82.3% of the isolates, with no evidence of mupirocin or chlorhexidine resistance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1128/JCM.01129-14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4136130PMC
August 2014

State focus on health care-associated infection prevention in nursing homes.

Am J Infect Control 2014 Apr;42(4):360-5

Columbia University School of Nursing, New York, NY.

Background: Despite increased focus on health care-associated infections (HAI), between 1.6 and 3.8 million HAI occur annually among the vulnerable population residing in US nursing homes (NH). This study characterized state department of health (DOH) activities and policies intended to improve quality and reduce HAI in NH.

Methods: We created a 17-item standardized data collection tool informed by 20 state DOH Web sites, reviewed by experts in the field and piloted by 2 independent reviewers (Cohen's κ .45-.73). The tool and corresponding protocol were used to systematically evaluate state DOH Web sites and related links.

Results: Three categories of data were abstracted: (1) consumer-directed information intended to increase accountability of and competition between NH, including mandatory HAI reporting and NH inspection reports; (2) surveyor training for federally-mandated NH inspections; and (3) guidance for NH providers to prevent HAI and monitor incidence. Only 5 states included HAI reporting in NH with differing HAI types and reporting requirements.

Conclusion: State DOH information and activities focused on NH quality and reducing HAI were inconsistent. Systematically characterizing state DOH efforts to reduce HAI in NH is important to interpret the effects of these activities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajic.2013.11.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4030678PMC
April 2014

State of infection prevention in US hospitals enrolled in the National Health and Safety Network.

Am J Infect Control 2014 Feb;42(2):94-9

Center for Health Policy, Columbia University School of Nursing, New York, NY; Mailman School of Public Health, Columbia University, New York, NY.

Background: This report provides a national cross-sectional snapshot of infection prevention and control programs and clinician compliance with the implementation of processes to prevent health care-associated infections (HAIs) in intensive care units (ICUs).

Methods: All hospitals, except Veterans Affairs hospitals, enrolled in the National Healthcare Safety Network (NHSN) were eligible to participate. Participation involved completing a survey assessing the presence of evidence-based prevention policies and clinician adherence and joining our NHSN research group. Descriptive statistics were computed. Facility characteristics and HAI rates by ICU type were compared between respondents and nonrespondents.

Results: Of the 3,374 eligible hospitals, 975 provided data (29% response rate) on 1,653 ICUs, and there were complete data on the presence of policies in 1,534 ICUs. The average number of infection preventionists (IPs) per 100 beds was 1.2. Certification of IP staff varied across institutions, and the average hours per week devoted to data management and secretarial support were generally low. There was variation in the presence of policies and clinician adherence to these policies. There were no differences in HAI rates between respondents and nonrespondents.

Conclusions: Guidelines for IP staffing in acute care hospitals need to be updated. In future work, we will analyze the associations between HAI rates and infection prevention and control program characteristics, as well as the inplementation of and clinician adherence to evidence-based policies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajic.2013.10.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951506PMC
February 2014
-->