Publications by authors named "Melanie Swift"

29 Publications

  • Page 1 of 1

Pregnancy and birth outcomes after SARS-CoV-2 vaccination in pregnancy.

Am J Obstet Gynecol MFM 2021 Aug 20:100467. Epub 2021 Aug 20.

Mayo Clinic Division of Preventive, Occupational, and Aerospace Medicine.

Background: SARS-CoV-2 infection during pregnancy is associated with significant maternal morbidity and increased rates of preterm birth. For this reason, COVID-19 vaccine administration in pregnancy has been endorsed by multiple professional societies including ACOG and SMFM despite exclusion of pregnant women from initial clinical trials of vaccine safety and efficacy. However, to date little data exists regarding outcomes after COVID-19 vaccination of pregnant patients.

Study Design: A comprehensive vaccine registry was combined with a delivery database for an integrated healthcare system to create a delivery cohort including vaccinated patients. Maternal sociodemographic data were examined to identify factors associated with COVID-19 vaccination. Pregnancy and birth outcomes were analyzed, including a composite measure of maternal and neonatal pregnancy complications, the Adverse Outcome Index.

Results: Of 2002 patients in the delivery cohort, 140 (7.0%) received a COVID-19 vaccination during pregnancy and 212 (10.6%) experienced a COVID-19 infection during pregnancy. The median gestational age at first vaccination was 32 weeks (range 13 6/7-40 4/7), and patients vaccinated during pregnancy were less likely than unvaccinated patients to experience COVID-19 infection prior to delivery (1.4% (2/140) vs. 11.3% (210/1862), P<0.001). No maternal COVID-19 infections occurred after vaccination during pregnancy. Factors significantly associated with increased likelihood of vaccination in a multivariable logistic regression model included older age, higher level of maternal education, being a non-smoker, use of infertility treatment for the current pregnancy, and lower gravidity. No significant difference in the composite adverse outcome (5.0% (7/140) vs. 4.9% (91/1862), P=0.95) or other maternal or neonatal complications, including thromboembolic events and preterm birth, was observed in vaccinated compared to unvaccinated patients.

Conclusions: Vaccinated pregnant women in this birth cohort were less likely to experience COVID-19 infection compared to unvaccinated pregnant patients, and COVID-19 vaccination during pregnancy was not associated with increased pregnancy or delivery complications. The cohort was skewed toward late pregnancy vaccination, and thus findings may not be generalizable to vaccination during early pregnancy.
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http://dx.doi.org/10.1016/j.ajogmf.2021.100467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8378017PMC
August 2021

Comparison of two highly-effective mRNA vaccines for COVID-19 during periods of Alpha and Delta variant prevalence.

medRxiv 2021 Aug 9. Epub 2021 Aug 9.

nference, Cambridge, Massachusetts 02139, USA.

Although clinical trials and real-world studies have affirmed the effectiveness and safety of the FDA-authorized COVID-19 vaccines, reports of breakthrough infections and persistent emergence of new variants highlight the need to vigilantly monitor the effectiveness of these vaccines. Here we compare the effectiveness of two full-length Spike protein-encoding mRNA vaccines from Moderna (mRNA-1273) and Pfizer/BioNTech (BNT162b2) in the Mayo Clinic Health System over time from January to July 2021, during which either the Alpha or Delta variant was highly prevalent. We defined cohorts of vaccinated and unvaccinated individuals from Minnesota (n = 25,589 each) matched on age, sex, race, history of prior SARS-CoV-2 PCR testing, and date of full vaccination. Both vaccines were highly effective during this study period against SARS-CoV-2 infection (mRNA-1273: 86%, 95%CI: 81-90.6%; BNT162b2: 76%, 95%CI: 69-81%) and COVID-19 associated hospitalization (mRNA-1273: 91.6%, 95% CI: 81-97%; BNT162b2: 85%, 95% CI: 73-93%). In July, vaccine effectiveness against hospitalization has remained high (mRNA-1273: 81%, 95% CI: 33-96.3%; BNT162b2: 75%, 95% CI: 24-93.9%), but effectiveness against infection was lower for both vaccines (mRNA-1273: 76%, 95% CI: 58-87%; BNT162b2: 42%, 95% CI: 13-62%), with a more pronounced reduction for BNT162b2. Notably, the Delta variant prevalence in Minnesota increased from 0.7% in May to over 70% in July whereas the Alpha variant prevalence decreased from 85% to 13% over the same time period. Comparing rates of infection between matched individuals fully vaccinated with mRNA-1273 versus BNT162b2 across Mayo Clinic Health System sites in multiple states (Minnesota, Wisconsin, Arizona, Florida, and Iowa), mRNA-1273 conferred a two-fold risk reduction against breakthrough infection compared to BNT162b2 (IRR = 0.50, 95% CI: 0.39-0.64). In Florida, which is currently experiencing its largest COVID-19 surge to date, the risk of infection in July after full vaccination with mRNA-1273 was about 60% lower than after full vaccination with BNT162b2 (IRR: 0.39, 95% CI: 0.24-0.62). Our observational study highlights that while both mRNA COVID-19 vaccines strongly protect against infection and severe disease, further evaluation of mechanisms underlying differences in their effectiveness such as dosing regimens and vaccine composition are warranted.
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http://dx.doi.org/10.1101/2021.08.06.21261707DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8366801PMC
August 2021

Real-time analysis of a mass vaccination effort confirms the safety of FDA-authorized mRNA COVID-19 vaccines.

Med (N Y) 2021 Aug 1;2(8):965-978.e5. Epub 2021 Jul 1.

nference, One Main Street, East Arcade, Cambridge, MA 02142, USA.

Background: As the coronavirus disease 2019 (COVID-19) vaccination campaign unfolds, it is important to continuously assess the real-world safety of Food and Drug Administration (FDA)-authorized vaccines. Curation of large-scale electronic health records (EHRs) enables near-real-time safety evaluations that were not previously possible.

Methods: In this retrospective study, we deployed deep neural networks over a large EHR system to automatically curate the adverse effects mentioned by physicians in over 1.2 million clinical notes between December 1, 2020 and April 20, 2021. We compared notes from 68,266 individuals who received at least one dose of BNT162b2 (n = 51,795) or mRNA-1273 (n = 16,471) to notes from 68,266 unvaccinated individuals who were matched by demographic, geographic, and clinical features.

Findings: Individuals vaccinated with BNT162b2 or mRNA-1273 had a higher rate of return to the clinic, but not the emergency department, after both doses compared to unvaccinated controls. The most frequently documented adverse effects within 7 days of each vaccine dose included myalgia, headache, and fatigue, but the rates of EHR documentation for each side effect were remarkably low compared to those derived from active solicitation during clinical trials. Severe events, including anaphylaxis, facial paralysis, and cerebral venous sinus thrombosis, were rare and occurred at similar frequencies in vaccinated and unvaccinated individuals.

Conclusions: This analysis of vaccine-related adverse effects from over 1.2 million EHR notes of more than 130,000 individuals reaffirms the safety and tolerability of the FDA-authorized mRNA COVID-19 vaccines in practice.

Funding: This study was funded by nference.
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http://dx.doi.org/10.1016/j.medj.2021.06.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8248717PMC
August 2021

FDA-authorized mRNA COVID-19 vaccines are effective per real-world evidence synthesized across a multi-state health system.

Med (N Y) 2021 Aug 29;2(8):979-992.e8. Epub 2021 Jun 29.

nference, Cambridge, MA 02142, USA.

Background: Two US Food and Drug Administration (FDA)-authorized coronavirus disease 2019 (COVID-19) mRNA vaccines, BNT162b2 (Pfizer/BioNTech) and mRNA-1273 (Moderna), have demonstrated high efficacy in large phase 3 randomized clinical trials. It is important to assess their effectiveness in a real-world setting.

Methods: This is a retrospective analysis of 136,532 individuals in the Mayo Clinic health system (Arizona, Florida, Iowa, Minnesota, and Wisconsin) with PCR testing data between December 1, 2020 and April 20, 2021. We compared clinical outcomes for a vaccinated cohort of 68,266 individuals who received at least one dose of either vaccine (n = 51,795; n = 16,471) and an unvaccinated control cohort of 68,266 individuals propensity matched based on relevant demographic, clinical, and geographic features. We estimated real-world vaccine effectiveness by comparing incidence rates of positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR testing and COVID-19-associated hospitalization and intensive care unit (ICU) admission starting 7 days after the second vaccine dose.

Findings: The real-world vaccine effectiveness of preventing SARS-CoV-2 infection was 86.1% (95% confidence interval [CI]: 82.4%-89.1%) for BNT162b2 and 93.3% (95% CI: 85.7%-97.4%) for mRNA-1273. BNT162b2 and mRNA-1273 were 88.8% (95% CI: 75.5%-95.7%) and 86.0% (95% CI: 71.6%-93.9%) effective in preventing COVID-19-associated hospitalization. Both vaccines were 100% effective (95% CI: 51.4%-100%; 95% CI: 43.3%-100%) in preventing COVID-19-associated ICU admission.

Conclusions: BNT162b2 and mRNA-1273 are effective in a real-world setting and are associated with reduced rates of SARS-CoV-2 infection and decreased burden of COVID-19 on the healthcare system.

Funding: This study was funded by nference.
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http://dx.doi.org/10.1016/j.medj.2021.06.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238652PMC
August 2021

Evaluation of healthcare personnel exposures to patients with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) associated with personal protective equipment.

Infect Control Hosp Epidemiol 2021 May 12:1-5. Epub 2021 May 12.

Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota.

Objective: Personal protective equipment (PPE) is a critical aspect of preventing the transmission of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in healthcare settings. We aimed to identify factors related to lapses in PPE use that may influence transmission of SARS-CoV-2 from patients to healthcare personnel (HCP).

Design: Retrospective cohort study.

Setting: Tertiary-care medical center in Minnesota.

Participants: In total, 345 HCP who sustained a significant occupational exposure to a patient with coronavirus disease 2019 (COVID-19) from May 13, 2020, through November 30, 2020, were evaluated.

Results: Overall, 8 HCP (2.3%) were found to have SARS-CoV-2 infection during their 14-day postexposure quarantine. A lack of eye protection during the care of a patient with COVID-19 was associated with HCP testing positive for SARS-CoV-2 by reverse-transcriptase polymerase chain reaction (RT-PCR) during the postexposure quarantine (relative risk [RR], 10.25; 95% confidence interval [CI], 1.28-82.39; P = .009). Overall, the most common reason for a significant exposure was the use of a surgical face mask instead of a respirator during an aerosol-generating procedure (55.9%). However, this was not associated with HCP testing positive for SARS-CoV-2 during the postexposure quarantine (RR, 0.99; 95% CI, 0.96-1; P = 1). Notably, transmission primarily occurred in units that did not regularly care for patients with COVID-19.

Conclusions: The use of universal eye protection is a critical aspect of PPE to prevent patient-to-HCP transmission of SARS-CoV-2.
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http://dx.doi.org/10.1017/ice.2021.219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144829PMC
May 2021

Prevalence of SARS-CoV-2 Antibodies in a Multistate Academic Medical Center.

Mayo Clin Proc 2021 05 26;96(5):1165-1174. Epub 2021 Mar 26.

Mayo Clinic, Phoenix, AZ.

Objective: To estimate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in health care personnel.

Methods: The Mayo Clinic Serology Screening Program was created to provide a voluntary, two-stage testing program for SARS-CoV-2 antibodies to health care personnel. The first stage used a dried blood spot screening test initiated on June 15, 2020. Those participants identified as reactive were advised to have confirmatory testing via a venipuncture. Venipuncture results through August 8, 2020, were considered. Consent and authorization for testing was required to participate in the screening program. This report, which was conducted under an institutional review board-approved protocol, only includes employees who have further authorized their records for use in research.

Results: A total of 81,113 health care personnel were eligible for the program, and of these 29,606 participated in the screening program. A total of 4284 (14.5%) of the dried blood spot test results were "reactive" and warranted confirmatory testing. Confirmatory testing was completed on 4094 (95.6%) of the screen reactive with an overall seroprevalence rate of 0.60% (95% CI, 0.52% to 0.69%). Significant variation in seroprevalence was observed by region of the country and age group.

Conclusion: The seroprevalence for SARS-CoV-2 antibodies through August 8, 2020, was found to be lower than previously reported in other health care organizations. There was an observation that seroprevalence may be associated with community disease burden.
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http://dx.doi.org/10.1016/j.mayocp.2021.03.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997730PMC
May 2021

Effectiveness of Messenger RNA Coronavirus Disease 2019 (COVID-19) Vaccines Against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in a Cohort of Healthcare Personnel.

Clin Infect Dis 2021 Sep;73(6):e1376-e1379

Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.

In a large cohort of United States healthcare personnel without prior coronavirus disease 2019 (COVID-19) infection, 94 382 doses of messenger RNA (mRNA) COVID-19 vaccine were administered to 49 220 individuals. The adjusted vaccine effectiveness following 2 doses of each of the 2 available brands of mRNA vaccine exceeded 96%.
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http://dx.doi.org/10.1093/cid/ciab361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135611PMC
September 2021

Impact of the COVID-19 Vaccine on Asymptomatic Infection Among Patients Undergoing Pre-Procedural COVID-19 Molecular Screening.

Clin Infect Dis 2021 Mar 10. Epub 2021 Mar 10.

Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA.

Background: Several vaccines are now clinically available under emergency use authorization in the United States and have demonstrated efficacy against symptomatic COVID-19. The impact of vaccines on asymptomatic SARS-CoV-2 infection is largely unknown.

Methods: We conducted a retrospective cohort study of consecutive, asymptomatic adult patients (n = 39,156) within a large United States healthcare system who underwent 48,333 pre-procedural SARS-CoV-2 molecular screening tests between December 17, 2020 and February 8, 2021. The primary exposure of interest was vaccination with at least one dose of an mRNA COVID-19 vaccine. The primary outcome was relative risk of a positive SARS-CoV-2 molecular test among those asymptomatic persons who had received at least one dose of vaccine, as compared to persons who had not received vaccine during the same time period. Relative risk was adjusted for age, sex, race/ethnicity, patient residence relative to the hospital (local vs. non-local), healthcare system regions, and repeated screenings among patients using mixed effects log-binomial regression.

Results: Positive molecular tests in asymptomatic individuals were reported in 42 (1.4%) of 3,006 tests performed on vaccinated patients and 1,436 (3.2%) of 45,327 tests performed on unvaccinated patients (RR=0.44 95% CI: 0.33-0.60; p<.0001). Compared to unvaccinated patients, the risk of asymptomatic SARS-CoV-2 infection was lower among those >10 days after 1 st dose (RR=0.21; 95% CI: 0.12-0.37; p<.0001) and >0 days after 2 nd dose (RR=0.20; 95% CI: 0.09-0.44; p<.0001) in the adjusted analysis.

Conclusions: COVID-19 vaccination with an mRNA-based vaccine showed a significant association with a reduced risk of asymptomatic SARS-CoV-2 infection as measured during pre-procedural molecular screening. The results of this study demonstrate the impact of the vaccines on reduction in asymptomatic infections supplementing the randomized trial results on symptomatic patients.
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http://dx.doi.org/10.1093/cid/ciab229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7989519PMC
March 2021

Evidence-Based Strategies for Clinical Organizations to Address COVID-19 Vaccine Hesitancy.

Mayo Clin Proc 2021 03 30;96(3):699-707. Epub 2020 Dec 30.

Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN; Department of Medicine, and Division of Community Pediatric and Adolescent Medicine and Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. Electronic address:

The success of vaccination programs is contingent upon irrefutable scientific safety data combined with high rates of public acceptance and population coverage. Vaccine hesitancy, characterized by lack of confidence in vaccination and/or complacency about vaccination that may lead to delay or refusal of vaccination despite the availability of services, threatens to undermine the success of coronavirus disease 2019 (COVID-19) vaccination programs. The rapid pace of vaccine development, misinformation in popular and social media, the polarized sociopolitical environment, and the inherent complexities of large-scale vaccination efforts may undermine vaccination confidence and increase complacency about COVID-19 vaccination. Although the experience of recent lethal surges of COVID-19 infections has underscored the value of COVID-19 vaccines, ensuring population uptake of COVID-19 vaccination will require application of multilevel, evidence-based strategies to influence behavior change and address vaccine hesitancy. Recent survey research evaluating public attitudes in the United States toward the COVID-19 vaccine reveals substantial vaccine hesitancy. Building upon efforts at the policy and community level to ensure population access to COVID-19 vaccination, a strong health care system response is critical to address vaccine hesitancy. Drawing on the evidence base in social, behavioral, communication, and implementation science, we review, summarize, and encourage use of interpersonal, individual-level, and organizational interventions within clinical organizations to address this critical gap and improve population adoption of COVID-19 vaccination.
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http://dx.doi.org/10.1016/j.mayocp.2020.12.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772995PMC
March 2021

Expanding mandatory healthcare personnel immunization beyond influenza: Impact of a broad immunization program with enhanced accountability.

Infect Control Hosp Epidemiol 2021 05 10;42(5):513-518. Epub 2020 Nov 10.

Department of Pediatrics, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.

Objective: Evaluation of a mandatory immunization program to increase and sustain high immunization coverage for healthcare personnel (HCP).

Design: Descriptive study with before-and-after analysis.

Setting: Tertiary-care academic medical center.

Participants: Medical center HCP.

Methods: A comprehensive mandatory immunization initiative was implemented in 2 phases, starting in July 2014. Key facets of the initiative included a formalized exemption review process, incorporation into institutional quality goals, data feedback, and accountability to support compliance.

Results: Both immunization and overall compliance rates with targeted immunizations increased significantly in the years after the implementation period. The influenza immunization rate increased from 80% the year prior to the initiative to >97% for the 3 subsequent influenza seasons (P < .0001). Mumps, measles and varicella vaccination compliance increased from 94% in January 2014 to >99% by January 2017, rubella vaccination compliance increased from 93% to 99.5%, and hepatitis B vaccination compliance from 95% to 99% (P < .0001 for all comparisons). An associated positive effect on TB testing compliance, which was not included in the mandatory program, was also noted; it increased from 76% to 92% over the same period (P < .0001).

Conclusions: Thoughtful, step-wise implementation of a mandatory immunization program linked to professional accountability can be successful in increasing immunization rates as well as overall compliance with policy requirements to cover all recommended HCP immunizations.
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http://dx.doi.org/10.1017/ice.2020.1266DOI Listing
May 2021

Healthcare personnel absenteeism, presenteeism, and staffing challenges during epidemics.

Infect Control Hosp Epidemiol 2021 04 26;42(4):388-391. Epub 2020 Oct 26.

Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota.

Objective: Presenteeism is an expensive and challenging problem in the healthcare industry. In anticipation of the staffing challenges expected with the COVID-19 pandemic, we examined a decade of payroll data for a healthcare workforce. We aimed to determine the effect of seasonal influenza-like illness (ILI) on absences to support COVID-19 staffing plans.

Design: Retrospective cohort study.

Setting: Large academic medical center in the United States.

Participants: Employees of the academic medical center who were on payroll between the years of 2009 and 2019.

Methods: Biweekly institutional payroll data was evaluated for unscheduled absences as a marker for acute illness-related work absences. Linear regression models, stratified by payroll status (salaried vs hourly employees) were developed for unscheduled absences as a function of local ILI.

Results: Both hours worked and unscheduled absences were significantly related to the community prevalence of influenza-like illness in our cohort. These effects were stronger in hourly employees.

Conclusions: Organizations should target their messaging at encouraging salaried staff to stay home when ill.
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http://dx.doi.org/10.1017/ice.2020.453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7684021PMC
April 2021

Occupational exposure to varicella zoster in a tertiary-care healthcare setting.

Infect Control Hosp Epidemiol 2021 06 25;42(6):793-795. Epub 2020 Sep 25.

Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota.

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http://dx.doi.org/10.1017/ice.2020.351DOI Listing
June 2021

Revisiting the Safety of Health Care Workers.

Mayo Clin Proc 2020 09 7;95(9S):S14-S16. Epub 2020 Jul 7.

Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN; Occupational Health Services, Mayo Clinic, Rochester, MN.

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http://dx.doi.org/10.1016/j.mayocp.2020.06.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340055PMC
September 2020

Tuberculosis Screening, Testing, and Treatment of US Health Care Personnel: ACOEM and NTCA Joint Task Force on Implementation of the 2019 MMWR Recommendations.

J Occup Environ Med 2020 07;62(7):e355-e369

American College of Occupational and Environmental Medicine, Elk Grove, Illinois.

: On May 17, 2019, the US Centers for Disease Control and Prevention and National Tuberculosis Controllers Association issued new Recommendations for Tuberculosis Screening, Testing, and Treatment of Health Care Personnel, United States, 2019, updating the health care personnel-related sections of the Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. This companion document offers the collective effort and experience of occupational health, infectious disease, and public health experts from major academic and public health institutions across the United States and expands on each section of the 2019 recommendations to provide clarifications, explanations, and considerations that go beyond the 2019 recommendations to answer questions that may arise and to offer strategies for implementation.
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http://dx.doi.org/10.1097/JOM.0000000000001904DOI Listing
July 2020

A Framework for Sustainable Contact Tracing and Exposure Investigation for Large Health Systems.

Mayo Clin Proc 2020 07 16;95(7):1432-1444. Epub 2020 Jun 16.

Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN.

Contact tracing is a cornerstone of communicable disease containment and involves identifying, quarantining, and monitoring contacts of infected people. Although contact tracing is a known evidence-based strategy in the community setting, the COVID-19 pandemic highlighted the challenges to implementing labor-intensive contact tracing in the occupational setting of large health care systems and hospitals, the epicenter of the pandemic. We present a framework for feasible, scalable COVID-19 contact tracing in a large multistate health system in the United States employing approximately 69,000 health care personnel. The framework is shared with sufficient details to allow adoption or adaptation by other health systems. Continuous enhancement, optimization, and evaluation of the framework are ongoing.
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http://dx.doi.org/10.1016/j.mayocp.2020.05.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832466PMC
July 2020

Determinants of Latent Tuberculosis Treatment Acceptance and Completion in Healthcare Personnel.

Clin Infect Dis 2020 07;71(2):284-290

Department of Medicine, Mayo Clinic, Rochester, Minnesota.

Background: US public health strategy for eliminating tuberculosis (TB) prioritizes treatment of latent TB infection (LTBI). Healthcare personnel (HCP) are less willing to accept treatment than other populations. Little is known about factors associated with HCP LTBI therapy acceptance and completion.

Methods: We conducted a retrospective chart review to identify all employees with LTBI at time of hire at a large academic medical center during a 10-year period. Personal demographics, occupational factors, and clinic visit variables were correlated with LTBI treatment acceptance and completion rates using multivariate logistic regression.

Results: Of 470 HCP with LTBI for whom treatment was recommended, 193 (41.1%) accepted treatment, while 137 (29.1%) completed treatment. Treatment adherence was better with 4 months of rifampin than 9 months of isoniazid (95% vs 68%, P < .005). Increased age of the healthcare worker was independently associated with lower rates of treatment acceptance (odds ratio [95% confidence interval]: 0.97 [0.94-0.99] per year), as was having an occupation of clinician (0.47 [0.26-0.85]) or researcher (0.34 [0.19-0.64]). Male gender was associated with higher treatment acceptance (1.90 [1.21-2.99]). Treatment completion was associated with being from a low- (9.49 [2.06-43.73]) or medium- (8.51 [3.93-18.44]) TB-burden country.

Conclusions: Geographic and occupational factors affect acceptance and completion of LTBI therapy. Short-course regimens may improve adherence. Physicians, researchers, and HCP from high-TB-burden countries have lower treatment rates than other HCP. Improving LTBI treatment in HCP will require attending to cultural and occupational differences.
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http://dx.doi.org/10.1093/cid/ciz817DOI Listing
July 2020

Vaccines for Health Care Personnel.

Mayo Clin Proc 2019 10 9;94(10):2127-2141. Epub 2019 Sep 9.

Department of Emergency Medicine, Perelman School of Medicine, Philadelphia, PA.

Medical Center Occupational Health (MCOH) programs must protect health care personnel (HCP) against the occupational risk of vaccine-preventable diseases. This thematic review outlines the rationale for the use of recommended vaccines in HCP; summarizes the available evidence regarding vaccine effectiveness, administration, and assessment of immunity; and provides guidance for MCOH programs navigating challenging situations.
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http://dx.doi.org/10.1016/j.mayocp.2019.01.035DOI Listing
October 2019

Opportunities to bridge gaps between respiratory protection guidance and practice in US health care.

Infect Control Hosp Epidemiol 2019 04 18;40(4):476-481. Epub 2019 Feb 18.

National Personal Protective Technology Laboratory (NPPTL),National Institute for Occupational Safety Health (NIOSH),Pittsburgh,Pennsylvania.

Healthcare organizations are required to provide workers with respiratory protection (RP) to mitigate hazardous airborne inhalation exposures. This study sought to better identify gaps that exist between RP guidance and clinical practice to understand issues that would benefit from additional research or clarification.
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http://dx.doi.org/10.1017/ice.2018.361DOI Listing
April 2019

Medical Surveillance Programs for Workers Exposed to Hazardous Medications: A Survey of Current Practices in Health Care Institutions.

J Occup Environ Med 2019 02;61(2):120-125

Division of Preventive, Occupational and Aerospace Medicine (Drs Breeher, Molella, Vaughn, Swift, and Newcomb); Department of Nursing (Ms Brueggen), Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida (Dr Spaulding); and Division of Occupational Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania (Dr Green-McKenzie).

Objective: To assess current medical surveillance monitoring practices for health care workers who prepare, handle, or administer hazardous medications.

Methods: A cross-sectional survey was distributed to members of the American College of Occupational and Environmental Medicine and the National Comprehensive Cancer Network.

Results: Forty-six of the 91 survey respondents indicated that their institution had a hazardous medication surveillance program. We identified the most frequent laboratory (complete blood count) and physical (skin) examination components. A health history was frequently used. Statistical analysis did not suggest an association between institutions with greater resources and presence of a surveillance program.

Conclusions: A consensus standard for medical monitoring was not reported by the respondents. We recommend using a standardized surveillance questionnaire and applying uniform laboratory testing across institutions, in addition to establishing a national repository for surveillance data.
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http://dx.doi.org/10.1097/JOM.0000000000001494DOI Listing
February 2019

Emergency Preparedness in the Workplace: The Flulapalooza Model for Mass Vaccination.

Am J Public Health 2017 09;107(S2):S168-S176

Melanie D. Swift, Katherine Louise Hanson, and Mary I. Yarbrough are with Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. Muktar H. Aliyu is with the Department of Health Policy, Vanderbilt University School of Medicine. Daniel W. Byrne is with the Department of Biostatistics, Vanderbilt University School of Medicine. Keqin Qian, and Patricia O. Kinman are with the Occupational Health Clinic, VUMC. Paula McGown, Demoyne Culpepper are with Faculty/Staff Health and Wellness, VUMC. Tamara J. Cooley is with Environmental Health and Safety, VUMC.

Objectives: To explore whether an emergency preparedness structure is a feasible, efficient, and sustainable way for health care organizations to manage mass vaccination events.

Methods: We used the Hospital Incident Command System to conduct a 1-day annual mass influenza vaccination event at Vanderbilt University Medical Center over 5 successive years (2011-2015). Using continuous quality improvement principles, we assessed whether changes in layout, supply management, staffing, and documentation systems improved efficiency.

Results: A total of 66 591 influenza vaccines were administered at 5 annual Flulapalooza events; 13 318 vaccines per event on average. Changes to the physical layout, staffing mix, and documentation processes improved vaccination efficiency 74%, from approximately 38 to 67 vaccines per hour per vaccinator, while reducing overall staffing needs by 38%. An unexpected finding was the role of social media in facilitating active engagement.

Conclusions: Health care organizations can use a closed point-of-dispensing model and Hospital Incident Command System to conduct mass vaccination events, and can adopt the "Flulapalooza method" as a best practice model to enhance efficiency.
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http://dx.doi.org/10.2105/AJPH.2017.303953DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5594393PMC
September 2017

The Need for Mandatory Random Drug Testing in Anesthesia Providers.

Anesth Analg 2017 May;124(5):1712-1716

From the *Vanderbilt University Medical Center, Nashville, Tennessee; †Critical Care Medicine, University of Florida, Gainesville, Florida; ‡Occupational Health, Vanderbilt University Medical Center, Nashville, Tennessee; and §ABC News Consultant, Gig Harbor, Washington.

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http://dx.doi.org/10.1213/ANE.0000000000001796DOI Listing
May 2017

Respirator Use in a Hospital Setting: Establishing Surveillance Metrics.

J Int Soc Respir Prot 2016;33(1):1-11

National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA.

Information that details use and supply of respirators in acute care hospitals is vital to prevent disease transmission, assure the safety of health care personnel, and inform national guidelines and regulations.

Objective: To develop measures of respirator use and supply in the acute care hospital setting to aid evaluation of respirator programs, allow benchmarking among hospitals, and serve as a foundation for national surveillance to enhance effective Personal Protective Equipment (PPE) use and management.

Methods: We identified existing regulations and guidelines that govern respirator use and supply at Vanderbilt University Medical Center (VUMC). Related routine and emergency hospital practices were documented through an investigation of hospital administrative policies, protocols, and programs. Respirator dependent practices were categorized based on hospital workflow: Prevention (preparation), patient care (response), and infection surveillance (outcomes). Associated data in information systems were extracted and their quality evaluated. Finally, measures representing major factors and components of respirator use and supply were developed.

Results: Various directives affecting multiple stakeholders govern respirator use and supply in hospitals. Forty-seven primary and secondary measures representing factors of respirator use and supply in the acute care hospital setting were derived from existing information systems associated with the implementation of these directives.

Conclusion: Adequate PPE supply and effective use that limit disease transmission and protect health care personnel are dependent on multiple factors associated with routine and emergency hospital practices. We developed forty-seven measures that may serve as the basis for a national PPE surveillance system, beginning with standardized measures of respirator use and supply for collection across different hospital types, sizes, and locations to inform hospitals, government agencies, manufacturers, and distributors. Despite involvement of multiple hospital stakeholders, regulatory guidance prescribes workplace practices that are likely to result in similar workflows across hospitals. Future work will explore the feasibility of implementing the collection and reporting of standardized measures in multiple facilities.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008688PMC
January 2016

Implementation of an enhanced safety-engineered sharp device oversight and bloodborne pathogen protection program at a large academic medical center.

Infect Control Hosp Epidemiol 2014 Nov 24;35(11):1383-90. Epub 2014 Sep 24.

Department of Medicine, Division of Infectious Diseases, and Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee.

Objective: Exposure of healthcare personnel to bloodborne pathogens (BBPs) can be prevented in part by using safety-engineered sharp devices (SESDs) and other safe practices, such as double gloving. In some instances, however, safer devices and practices cannot be utilized because of procedural factors or the lack of a manufactured safety device for the specific clinical use. In these situations, a standardized system to examine requests for waiver from expected practices is necessary.

Design: Before-after program analysis.

Setting: Large academic medical center.

Interventions: Vanderbilt University Medical Center developed a formalized system for an improved waiver process, including an online submission and tracking site, and standards surrounding implementation of core safe practices. The program's impact on sharp device injuries and utilization of double gloving and blunt sutures was examined.

Results: Following implementation of the enhanced program, there was an increase in the amount of undergloves and blunt sutures purchased for surgical procedures, suggesting larger utilization of these practices. The rate of sharp device injuries of all at-risk employees decreased from 2.32% to 2.12%, but this decline was not statistically significant (P = .14). The proportion of reported injuries that were deemed preventable significantly decreased from 72.7% (386/531) before implementation to 63.9% (334/523; P = .002) after implementation of the enhanced program.

Conclusions: An enhanced BBP protection program was successful at providing guidance to increase safe practices and at improving the management of SESD waiver requests and was associated with a reduction in preventable sharp device injuries.
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http://dx.doi.org/10.1086/678417DOI Listing
November 2014

A comparison of 2 strategies to prevent infection following pertussis exposure in vaccinated healthcare personnel.

Clin Infect Dis 2012 Apr 11;54(7):938-45. Epub 2012 Jan 11.

Department of Medicine, Division of Infectious Diseases, Baylor College of Medicine, Houston, Texas 77030, USA.

Background: Antibiotic postexposure prophylaxis (PEP) following pertussis exposure is recommended but has never been evaluated in healthcare personnel (HCP) vaccinated with acellular pertussis vaccine (Tdap).

Methods: Tdap-vaccinated HCP were randomized to receive azithromycin PEP or no PEP following pertussis exposure. Acute and convalescent nasopharyngeal swabs and sera were obtained for pertussis testing by polymerase chain reaction (PCR) and anti-pertussis toxin (PT) immunoglobulin G, respectively. A nasopharyngeal aspirate was also collected for PCR and culture from subjects who reported respiratory symptoms within 21 days following identification of the exposure. Pertussis infection was defined as a positive culture or PCR, a 2-fold rise in anti-PT titer, or a single anti-PT titer of ≥94 enzyme-linked immunosorbent assay units/mL. Daily symptom monitoring without PEP was considered noninferior to PEP after pertussis exposure if the lower limit of the 1-sided 95% confidence interval (CI) for the reduction in pertussis was greater than -7%.

Results: During 30 months of study, 86 subjects were randomized following a pertussis exposure. Using the predefined definition of infection, pertussis infection did not develop in 41 (97.6%) of 42 subjects who received azithromycin PEP and 38 (86.4%) of 44 subjects who did not receive PEP (absolute risk difference, -11.3%; lower bound of the 1-sided 95% CI, -20.6%; P = .81). However, no subject developed symptomatic pertussis confirmed with culture or a specific PCR assay, and possibly no subject developed subclinical pertussis infection based upon additional serologic testing.

Conclusions: Using the predefined definition of pertussis infection, noninferiority for preventing pertussis following exposure was not demonstrated for daily symptom monitoring of Tdap-vaccinated HCP without PEP when compared with antibiotic PEP. However, the small number of exposed HCP warrants further study of this approach.

Clinical Trial Registration: NCT00469274.
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http://dx.doi.org/10.1093/cid/cir973DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3297652PMC
April 2012

Exposure to pulmonary tuberculosis in a neonatal intensive care unit: unique aspects of contact investigation and management of hospitalized neonates.

Infect Control Hosp Epidemiol 2007 Jun 20;28(6):661-5. Epub 2007 Apr 20.

Division of Pediatric Infectious Diseases and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.

Objective: We describe the investigation of a tuberculosis (TB) exposure in which a neonatal intensive care unit (NICU) respiratory therapist was the index patient, as well as the rationale by which exposed infants were managed and possible explanations for the lack of transmission to these patients.

Design: Description of an exposure investigation.

Setting: Academic, level IV NICU of a tertiary care children's hospital.

Participants: Contacts of a respiratory therapist with pulmonary TB disease, including household members, healthcare coworkers, and infant patients.

Results: In addition to 5 household contacts, 248 healthcare coworkers and 180 infant patients were identified as possibly exposed during the 24 days that the index patient worked between December 3, 2004, and January 30, 2005. Tuberculin skin tests (TSTs) were performed for 233 of the 235 contacts with the greatest degree of exposure (household and coworker contacts) who had a previously documented negative TST result or whose TST status was unknown prior to the investigation. No cases of latent tuberculosis infection or TB disease were identified. Because of characteristics of the index case, the exposure duration and setting, the infants' small lung volumes, and lack of evidence of transmission to higher-risk contacts, infants were not clinically evaluated or empirically treated for TB disease. Surveillance for subsequent illness was carried out by primary healthcare providers and parents. No TB disease or unexplained illness in these infants was reported in the 20 months following the exposure.

Conclusion: After limited hospital exposure to a healthcare worker with pulmonary TB disease who is not highly contagious, neonates can be safely managed without specific evaluation for TB disease or empirical treatment.
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http://dx.doi.org/10.1086/517975DOI Listing
June 2007
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