There are no active surveillance studies reported from South East Asian Region to document the im... more There are no active surveillance studies reported from South East Asian Region to document the impact of change in socio-economic state on the prevalence of rheumatic fever/rheumatic heart disease (RF/RHD) in children. Therefore, we conducted a study to determine the epidemiological trends of RF/RHD in school children of Shimla city and adjoining suburbs in north India and its association with change in socio-economic status. Active surveillance studies were conducted in 2007-2008 in urban and rural areas of Shimla, and 15145 school children, aged 5-15 yr were included and identical screening methodology as used in earlier similar survey conducted in 1992-1993 was used. The study samples were selected from schools of Shimla city and adjoining rural areas by multistage stratified cluster sampling method in both survey studies. After a relevant history and clinical examination by trained doctor, echocardiographic evaluation of suspected cases was done. An updated Jones (1992) criterio...
Tuberculous pachymeningitis is a rare disease that should be suspected in patients with chronic h... more Tuberculous pachymeningitis is a rare disease that should be suspected in patients with chronic headaches, focal neurological signs, and magnetic resonance imaging (MRI) findings of dural thickening. We report the case of a 62-year-old male who presented with chronic headaches for over a year, progressive right-sided vision and hearing loss for six months, and progressive dysphagia for a month. On investigation, MRI showed dural thickening, cerebrospinal fluid showed lymphocytic pleocytosis with high protein and normal glucose levels, and biopsy of the dural matter showed necrotizing granulomas with Langhans giant cells. The patient responded well to antitubercular treatment and steroids. Follow-up MRI 24 months later showed almost complete resolution of meningeal enhancement. Though tuberculosis is an uncommon cause of pachymeningitis, it should be considered, as it responds well to treatment.
Background & objectives: There are no active surveillance studies reported from South East Asian ... more Background & objectives: There are no active surveillance studies reported from South East Asian Region to document the impact of change in socio-economic state on the prevalence of rheumatic fever/rheumatic heart disease (RF/RHD) in children. Therefore, we conducted a study to determine the epidemiological trends of RF/RHD in school children of Shimla city and adjoining suburbs in north India and its association with change in socio-economic status. Methods: Active surveillance studies were conducted in 2007-2008 in urban and rural areas of Shimla, and 15145 school children, aged 5-15 yr were included and identical screening methodology as used in earlier similar survey conducted in 1992-1993 was used. The study samples were selected from schools of Shimla city and adjoining rural areas by multistage stratified cluster sampling method in both survey studies. After a relevant history and clinical examination by trained doctor, echocardiographic evaluation of suspected cases was done...
background: There is growing evidence that high aldosterone (AL)exposure is associated with reduc... more background: There is growing evidence that high aldosterone (AL)exposure is associated with reduced survival in patients with cardiovascular diseases. Further, the potent cardiorenal actions of natriuretic peptides (NP) that include vasodilatation, natriuresis and diuresis offer an innovative therapeutic option in the management of hypertension and heart failure. We report the results of a preclinical study investigating the effect of LCZ696, a novel angiotensin receptor neprilysin(NEP) inhibitor providing simultaneous neprilysin inhibition and AT1-receptor blockade, on the dynamics of the renin and NP cascades. Methods: Eighteen healthy beagle dogs were placed on a low-salt diet to activate the renin-angiotensin system. The effect of 10 days of treatment (p.o.,q.d.) with LCZ696 (15 and 45 mg/kg) was compared to placebo, valsartan (60 mg/kg) and benazepril (0.33 mg/kg), using a cross-over design. Biomarkers of the renin cascade and cGMP were measured in plasma on days 1, 5 and 10 of dosing and analyzed as a mean of the 3 days using random effect-repeated measures ANOVA. results: Compared to placebo, benazepril modestly reduced AL (p=0.08). In contrast, valsartan, LCZ696 15 and 45 mg/kg decreased AL levels to a significant extent (-23%,-45% and-43%, respectively, p<0.05). The greatest reductions were observed in the LCZ696 groups, where LCZ696 15 mg/ kg at 2 hours reduced AL 2-fold lower than valsartan (p<0.05). Administration of LCZ696 at 45 mg/kg resulted in a 180% increase of cGMP relative to placebo (p<0.0001), which is consistent with enhanced NP action consecutive to NEP inhibition. Neither valsartan nor benazepril changed cGMP levels. In LCZ696 45 mg/kg treated dogs, an ~2.5-fold (1.8-3.7) increase from placebo was found for renin activity (p<0.0005), angiotensin I (p<0.005) and angiotensin II (p<0.05), reflecting a known compensatory up-regulation of the renin-angiotensin system to AT1-receptor blockade. conclusion: The greater reduction of AL with LCZ696 over valsartan is consistent with the simultaneous blockade of the AT1-receptor and enhancement of the NP system. These results support further development of LCZ696 for the management of cardiovascular diseases.
Hypertension is the result of interaction between genetic vulnerability and exposure to unhealthy... more Hypertension is the result of interaction between genetic vulnerability and exposure to unhealthy lifestyle. However, studies investigating the impact of cardiovascular adaptive response to hypobaric hypoxia and extreme cold in natives of high altitude on the development of hypertension have yielded conflicting results. A community based cross-sectional study was carried out in an unique population of Spiti valley of Greater Himalayas residing at an altitude of 3100-3500 m (group 1) and 3500 m and above (group 2) to evaluate the impact of altitude of residence on prevalence of hypertension. 413 subjects, age 20 years and above were selected by stratified cluster random sampling technique and screened for recording socio-demographic profile, anthropometrics, fasting blood sugar and blood pressure. There was no significant difference in the mean age (40.1 vs.38.0 years) and gender distribution (65.7% vs. 61.4% females) between the two groups. The overall prevalence of hypertension was...
We report a fatal case of Rhizopus azygosporus pneumonia in a 56-year-old man hospitalized for CO... more We report a fatal case of Rhizopus azygosporus pneumonia in a 56-year-old man hospitalized for COVID-19 who had received methylprednisolone and tocilizumab. Although COVID-associated pulmonary aspergillosis has been widely documented, mucormycosis has been rarely reported. In this patient, receipt of two commonly used immunosuppressants likely contributed to mucormycosis risk, suggesting the need for vigilance in hospitalized patients with COVID-19.
Background. Human coronaviruses (HCoV) OC43, 229E, NL63 and HKU1 commonly cause upper respiratory... more Background. Human coronaviruses (HCoV) OC43, 229E, NL63 and HKU1 commonly cause upper respiratory tract infections, but can also cause severe lower respiratory tract disease. Increased use of diagnostic assays for respiratory viruses has facilitated detection and, since 2014, voluntary reporting of HCoV to the National Respiratory and Enteric Virus Surveillance System (NREVSS). Methods. We reviewed weekly aggregate test results for HCoV OC43, 229E, NL63 and HKU1 voluntarily reported to NREVSS by U.S. hospital and clinical laboratories from July 1, 2014-April 30, 2017. Laboratories reporting any HCoV result using PCR were included, and the weekly percentage of positive HCoV tests by type was calculated. For a subset of HCoV detections reported to NREVSS via the Public Health laboratory Interoperability Project (PHLIP), which collects individual-level demographic data, we described age distribution and sex. Age distribution by HCoV type was compared using the Kruskal-Wallis test. Results. 154 laboratories, across all 9 U.S. census divisions, reported 834,742 tests for HCoV; 18,514 (2.2%) were positive for HCoV-OC43, 8,363 (1.0%) for HCoV-NL63, 6,828 (0.8%) for HCoV-229E, and 5,170 (0.6%) for HCoV-HKU1. The percentage of tests positive for HCoV generally peaked between December and March (Figure 1). HCoV-OC43 showed distinct annual peaks with variation in magnitude by year. HCoV-HKU1 and NL63 had similar patterns, each with notable peaks during winter 2016 compared with 2015 or 2017. HCoV-229E showed a discernable peak in 2017 compared with the previous 2 years. Of 20,533 individuals with HCoV test results reported via PHLIP, 1,589 (7.7%) tested positive for any HCoV; 50% of HCoV-positive individuals were male, and the median age was 22 (range 0-96) years. Age distribution differed between HCoV types (P < 0.01, Figure 2). Conclusion. Over approximately 3 seasons, peak positivity for HCoV occurred during winter months, and annual differences in circulation by HCoV type were observed. Continued testing and surveillance for HCoV will allow for further characterization of circulation trends over time and by geographic region, and improved understanding of the contribution of HCoV to the winter respiratory virus season.
it became incumbent upon training programs to investigate evaluative measures. Interpersonal and ... more it became incumbent upon training programs to investigate evaluative measures. Interpersonal and communication competency assessment methods vary among medical educators. Tools such as 360 evaluations, chart audits, patient satisfaction questionnaires, and OSCEs have proven helpful, yet difficult and time-consuming to administer. Ideally, direct observation of trainees would improve the instruction and documentation of communication skills. Clear understanding of the domains of GME Outcomes as well as creation of specific measures that are reliable and accurate while not creating an undue measurement burden are necessary. Methods. Infectious Diseases (ID) physicians rely heavily on communication and interpersonal skills to care for their patients. This multi institutional, qualitative study investigated the approaches used as well as the process employed by ID faculty regarding Interpersonal and Communication skill competency evaluation. Faculty interviews were recorded, transcribed and coded. Results. Based on the interview transcripts, general themes discovered included a lack of standardization yet considerable value placed upon trainee competency in the areas of interpersonal and communication skills. In addition, ID faculty revealed current practices employed, challenges addressed as well as recommendations for assessment. Conclusion. Increase in accreditation requirements have contributed to additional evaluative responsibilities ID medical educators must adopt. Ascertaining competency assessment methods employed by other ID faculty can provide alternative means of assessment and increase understanding regarding evaluative tools. Disclosures. All authors: No reported disclosures.
Conclusion. MRSA colonization is associated with increased risk of NH transfer following hospital... more Conclusion. MRSA colonization is associated with increased risk of NH transfer following hospital admission. Additionally, acquisition of MRSA seems to result in a slightly elevated risk of NH transfer compared with those who are colonized at the time of hospital admission. Disclosures. All authors: No reported disclosures. 2182. Molecular Epidemiology of Community-Associated and Hospitalassociated Methicillin-resistant Staphylococcus aureus in a Japanese University Hospital
BACKGROUND SARS-CoV-2, has been implicated in the largest recorded CoV outbreak to date.Initially... more BACKGROUND SARS-CoV-2, has been implicated in the largest recorded CoV outbreak to date.Initially the majority of COVID-19 cases were in China, but the virus has spread to more than 184 countries worldwide with the United States currently having more cases than any other country. OBJECTIVE With person-to-person spread expanding in the United States, this study aims to describe hospital preparedness for managing suspected and confirmed COVID-19 patients. DESIGN Cross-sectional survey focused on various elements of respiratory disease preparedness SETTING Critical access hospital (CAHs) and acute care hospitals (ACHs) in Idaho METHODS The electronic survey was sent to infection preventionists (IPs) and nurse administrators in 44 hospitals in Idaho RESULTS In all, 32 (73%) hospitals responded to the survey. Participating facilities reported their preparedness with respect to existing, formalized structures for managing infectious disease incidents—specifically COVID-19—as well as avail...
BACKGROUND Patients with measles can precipitate outbreaks in health care facilities where they s... more BACKGROUND Patients with measles can precipitate outbreaks in health care facilities where they seek care. Rural critical-access hospitals (CAHs) may be at higher risk of outbreaks given their size and potentially limited infection prevention resources. METHODS We surveyed CAHs in Idaho to ascertain their levels of preparedness for managing measles cases. A 25-item questionnaire was sent to infection preventionists at all 27 Idaho CAHs. The questionnaire covered organizational structure, resources for managing measles cases, and hospital policies for ensuring immunity among health care workers. RESULTS A total of 22 (82%) CAHs responded, reporting varying availability of facilities and resources for managing measles cases and disparate procedures for testing clinical samples and providing vaccines to nonimmune, exposed staff. DISCUSSION With measles incidence on the rise in the United States, our survey found that most of the responding hospitals had the basic organizational structure for facility-wide prevention and management efforts in case a patient with suspected or confirmed measles presented to that facility. Most of the hospitals also had at least some available resources to manage measles cases, as well as policies for ensuring immunity to measles among at least some groups of health care workers. CONCLUSIONS This study provides initial perspectives on measles preparedness among Idaho CAHs, despite limited generalizability. Future studies should explore whether self-reported preparedness measures reflect the ability of the CAHs to control measles spread when cases present for care.
Background Prescribing an antibiotic is a complex process involving an interplay of prescriber’s ... more Background Prescribing an antibiotic is a complex process involving an interplay of prescriber’s knowledge, diagnostic acumen and patient factors. Understanding the prescriber rationale is key to provide feedback which might improve appropriateness of antibiotic prescribing. Currently, there are limited data on prescribing and test ordering practices among primary care physicians. Methods We surveyed primary care physicians taking care of adults (age 18 years and above). Physicians were contacted through the Idaho State Medical Board by a one-time email containing the survey link. The survey consisted of 25 questions under 2 major themes of diagnostic and antimicrobial stewardship (AS). It assessed physicians’ practice setting, ordering of diagnostic tests and antibiotics for common infections, delivery of patient education regarding antibiotics, availability of antibiogram and antimicrobial stewardship services, and assessment of penicillin allergy. Two infectious diseases physicia...
Anubhav Kanwar MD12 , Jessica A. Kumar DO, MPH2, Yilen K. Ng-Wong MD3, Manish Thakur MBBS3, Jenni... more Anubhav Kanwar MD12 , Jessica A. Kumar DO, MPH2, Yilen K. Ng-Wong MD3, Manish Thakur MBBS3, Jennifer L. Cadnum BS3, Heba Alhmidi MD3, Thriveen S. C. Mana MS3, Annette L. Jencson BS2 and Curtis J. Donskey MD24 1Infectious Diseases Division, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, 2Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, 3Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio and and 4Case Western Reserve University School of Medicine, Cleveland, Ohio
&NA; In an acute care hospital, we demonstrated that the clothing and shoes that physicians a... more &NA; In an acute care hospital, we demonstrated that the clothing and shoes that physicians and nurses wear home from health care facilities can be contaminated with health care–associated pathogens, particularly methicillin‐resistant Staphylococcus aureus. These findings suggest that the clothing and shoes of personnel have the potential to serve as vectors for the transfer of health care–associated pathogens to the community.
BACKGROUNDContaminated ice machines have been linked to transmission of pathogens in healthcare f... more BACKGROUNDContaminated ice machines have been linked to transmission of pathogens in healthcare facilities.OBJECTIVETo determine the frequency and sites of contamination of ice machines in multiple healthcare facilities and to investigate potential mechanisms of microorganism dispersal from contaminated ice machines to patients.DESIGNMulticenter culture survey and simulation study.SETTINGThe study took place in 5 hospitals and 2 nursing homes in northeastern Ohio.METHODSWe cultured multiple sites on ice machines from patient care areas. To investigate potential mechanisms of microbial dispersal from contaminated ice machines, we observed the use of ice machines and conducted simulations using a fluorescent tracer and cultures.RESULTSSamples from 64 ice machines in the 5 hospitals and 2 nursing homes (range, 3–16 per facility) were cultured. Gram-negative bacilli and/or Candida spp were recovered from 100% of drain pans, 52% of ice and/or water chutes, and 72% of drain-pan grilles. D...
We examined the impact of systemic antibiotics on the burden of nasal Staphylococcus aureus in ho... more We examined the impact of systemic antibiotics on the burden of nasal Staphylococcus aureus in hospitalized patients. Of 1,482 patients, 237 (16%) had nasal methicillin-susceptible S. aureus (MSSA) and 92 (6%) had nasal methicillin-resistant S. aureus (MRSA) on admission. Treatment regimens that included agents with inhibitory activity against MRSA or MSSA significantly reduced the burden of carriage, whereas regimens lacking anti-MRSA activity, including fluoroquinolones, promoted MRSA overgrowth.
Background Physicians’ white coats are often contaminated, but seldom cleaned. A “bare below the ... more Background Physicians’ white coats are often contaminated, but seldom cleaned. A “bare below the elbows” dress code policy has been advocated as a strategy to reduce the risk for transmission of healthcare-associated pathogens by white coats. However, transfer of contamination by clothing has not been demonstrated in clinical settings and it is not known if long sleeves are the major source of transfer. Methods We observed physicians during routine patient encounters and characterized the frequency of direct and indirect contact between white coats and the patient or environmental surfaces. To assess transfer from white coats in clinical settings, we applied one cauliflower mosaic virus DNA marker to the sleeve cuffs and another to the coat pockets of physicians prior to routine patient encounters. Polymerase chain reaction was used to determine whether DNA markers from the clothing sites were transferred to patients or environmental surfaces. Results Ninety percent of observed pati...
Background Due to concerns for emergence of mupirocin resistance, there is an interest in use of ... more Background Due to concerns for emergence of mupirocin resistance, there is an interest in use of topical antiseptics for nasal decolonization of Staphylococcus aureus. Alcohol-based nasal antiseptics have recently been developed as an alternative to mupirocin, but there is limited data on efficacy, particularly among patients where the burden of carriage is often high. Methods We evaluated the effectiveness of a one-time application of a commercial alcohol-based nasal sanitizer for reduction in nasal methicillin-resistant Staphylococcus aureus (MRSA) in MRSA-colonized patients. Patients received either a single dose or triple dose over 3 minutes; the triple dose is recommended for preoperative dosing. Swabs were used for quantitative culture of MRSA from the anterior nares and vestibule prior to and 10 minutes, 2 hours, and 6 hours after application. For a subset of patients, cultures for MRSA were collected from hands, clothing, groin, and chest/axilla. Results Of 34 MRSA carriers ...
There are no active surveillance studies reported from South East Asian Region to document the im... more There are no active surveillance studies reported from South East Asian Region to document the impact of change in socio-economic state on the prevalence of rheumatic fever/rheumatic heart disease (RF/RHD) in children. Therefore, we conducted a study to determine the epidemiological trends of RF/RHD in school children of Shimla city and adjoining suburbs in north India and its association with change in socio-economic status. Active surveillance studies were conducted in 2007-2008 in urban and rural areas of Shimla, and 15145 school children, aged 5-15 yr were included and identical screening methodology as used in earlier similar survey conducted in 1992-1993 was used. The study samples were selected from schools of Shimla city and adjoining rural areas by multistage stratified cluster sampling method in both survey studies. After a relevant history and clinical examination by trained doctor, echocardiographic evaluation of suspected cases was done. An updated Jones (1992) criterio...
Tuberculous pachymeningitis is a rare disease that should be suspected in patients with chronic h... more Tuberculous pachymeningitis is a rare disease that should be suspected in patients with chronic headaches, focal neurological signs, and magnetic resonance imaging (MRI) findings of dural thickening. We report the case of a 62-year-old male who presented with chronic headaches for over a year, progressive right-sided vision and hearing loss for six months, and progressive dysphagia for a month. On investigation, MRI showed dural thickening, cerebrospinal fluid showed lymphocytic pleocytosis with high protein and normal glucose levels, and biopsy of the dural matter showed necrotizing granulomas with Langhans giant cells. The patient responded well to antitubercular treatment and steroids. Follow-up MRI 24 months later showed almost complete resolution of meningeal enhancement. Though tuberculosis is an uncommon cause of pachymeningitis, it should be considered, as it responds well to treatment.
Background & objectives: There are no active surveillance studies reported from South East Asian ... more Background & objectives: There are no active surveillance studies reported from South East Asian Region to document the impact of change in socio-economic state on the prevalence of rheumatic fever/rheumatic heart disease (RF/RHD) in children. Therefore, we conducted a study to determine the epidemiological trends of RF/RHD in school children of Shimla city and adjoining suburbs in north India and its association with change in socio-economic status. Methods: Active surveillance studies were conducted in 2007-2008 in urban and rural areas of Shimla, and 15145 school children, aged 5-15 yr were included and identical screening methodology as used in earlier similar survey conducted in 1992-1993 was used. The study samples were selected from schools of Shimla city and adjoining rural areas by multistage stratified cluster sampling method in both survey studies. After a relevant history and clinical examination by trained doctor, echocardiographic evaluation of suspected cases was done...
background: There is growing evidence that high aldosterone (AL)exposure is associated with reduc... more background: There is growing evidence that high aldosterone (AL)exposure is associated with reduced survival in patients with cardiovascular diseases. Further, the potent cardiorenal actions of natriuretic peptides (NP) that include vasodilatation, natriuresis and diuresis offer an innovative therapeutic option in the management of hypertension and heart failure. We report the results of a preclinical study investigating the effect of LCZ696, a novel angiotensin receptor neprilysin(NEP) inhibitor providing simultaneous neprilysin inhibition and AT1-receptor blockade, on the dynamics of the renin and NP cascades. Methods: Eighteen healthy beagle dogs were placed on a low-salt diet to activate the renin-angiotensin system. The effect of 10 days of treatment (p.o.,q.d.) with LCZ696 (15 and 45 mg/kg) was compared to placebo, valsartan (60 mg/kg) and benazepril (0.33 mg/kg), using a cross-over design. Biomarkers of the renin cascade and cGMP were measured in plasma on days 1, 5 and 10 of dosing and analyzed as a mean of the 3 days using random effect-repeated measures ANOVA. results: Compared to placebo, benazepril modestly reduced AL (p=0.08). In contrast, valsartan, LCZ696 15 and 45 mg/kg decreased AL levels to a significant extent (-23%,-45% and-43%, respectively, p<0.05). The greatest reductions were observed in the LCZ696 groups, where LCZ696 15 mg/ kg at 2 hours reduced AL 2-fold lower than valsartan (p<0.05). Administration of LCZ696 at 45 mg/kg resulted in a 180% increase of cGMP relative to placebo (p<0.0001), which is consistent with enhanced NP action consecutive to NEP inhibition. Neither valsartan nor benazepril changed cGMP levels. In LCZ696 45 mg/kg treated dogs, an ~2.5-fold (1.8-3.7) increase from placebo was found for renin activity (p<0.0005), angiotensin I (p<0.005) and angiotensin II (p<0.05), reflecting a known compensatory up-regulation of the renin-angiotensin system to AT1-receptor blockade. conclusion: The greater reduction of AL with LCZ696 over valsartan is consistent with the simultaneous blockade of the AT1-receptor and enhancement of the NP system. These results support further development of LCZ696 for the management of cardiovascular diseases.
Hypertension is the result of interaction between genetic vulnerability and exposure to unhealthy... more Hypertension is the result of interaction between genetic vulnerability and exposure to unhealthy lifestyle. However, studies investigating the impact of cardiovascular adaptive response to hypobaric hypoxia and extreme cold in natives of high altitude on the development of hypertension have yielded conflicting results. A community based cross-sectional study was carried out in an unique population of Spiti valley of Greater Himalayas residing at an altitude of 3100-3500 m (group 1) and 3500 m and above (group 2) to evaluate the impact of altitude of residence on prevalence of hypertension. 413 subjects, age 20 years and above were selected by stratified cluster random sampling technique and screened for recording socio-demographic profile, anthropometrics, fasting blood sugar and blood pressure. There was no significant difference in the mean age (40.1 vs.38.0 years) and gender distribution (65.7% vs. 61.4% females) between the two groups. The overall prevalence of hypertension was...
We report a fatal case of Rhizopus azygosporus pneumonia in a 56-year-old man hospitalized for CO... more We report a fatal case of Rhizopus azygosporus pneumonia in a 56-year-old man hospitalized for COVID-19 who had received methylprednisolone and tocilizumab. Although COVID-associated pulmonary aspergillosis has been widely documented, mucormycosis has been rarely reported. In this patient, receipt of two commonly used immunosuppressants likely contributed to mucormycosis risk, suggesting the need for vigilance in hospitalized patients with COVID-19.
Background. Human coronaviruses (HCoV) OC43, 229E, NL63 and HKU1 commonly cause upper respiratory... more Background. Human coronaviruses (HCoV) OC43, 229E, NL63 and HKU1 commonly cause upper respiratory tract infections, but can also cause severe lower respiratory tract disease. Increased use of diagnostic assays for respiratory viruses has facilitated detection and, since 2014, voluntary reporting of HCoV to the National Respiratory and Enteric Virus Surveillance System (NREVSS). Methods. We reviewed weekly aggregate test results for HCoV OC43, 229E, NL63 and HKU1 voluntarily reported to NREVSS by U.S. hospital and clinical laboratories from July 1, 2014-April 30, 2017. Laboratories reporting any HCoV result using PCR were included, and the weekly percentage of positive HCoV tests by type was calculated. For a subset of HCoV detections reported to NREVSS via the Public Health laboratory Interoperability Project (PHLIP), which collects individual-level demographic data, we described age distribution and sex. Age distribution by HCoV type was compared using the Kruskal-Wallis test. Results. 154 laboratories, across all 9 U.S. census divisions, reported 834,742 tests for HCoV; 18,514 (2.2%) were positive for HCoV-OC43, 8,363 (1.0%) for HCoV-NL63, 6,828 (0.8%) for HCoV-229E, and 5,170 (0.6%) for HCoV-HKU1. The percentage of tests positive for HCoV generally peaked between December and March (Figure 1). HCoV-OC43 showed distinct annual peaks with variation in magnitude by year. HCoV-HKU1 and NL63 had similar patterns, each with notable peaks during winter 2016 compared with 2015 or 2017. HCoV-229E showed a discernable peak in 2017 compared with the previous 2 years. Of 20,533 individuals with HCoV test results reported via PHLIP, 1,589 (7.7%) tested positive for any HCoV; 50% of HCoV-positive individuals were male, and the median age was 22 (range 0-96) years. Age distribution differed between HCoV types (P < 0.01, Figure 2). Conclusion. Over approximately 3 seasons, peak positivity for HCoV occurred during winter months, and annual differences in circulation by HCoV type were observed. Continued testing and surveillance for HCoV will allow for further characterization of circulation trends over time and by geographic region, and improved understanding of the contribution of HCoV to the winter respiratory virus season.
it became incumbent upon training programs to investigate evaluative measures. Interpersonal and ... more it became incumbent upon training programs to investigate evaluative measures. Interpersonal and communication competency assessment methods vary among medical educators. Tools such as 360 evaluations, chart audits, patient satisfaction questionnaires, and OSCEs have proven helpful, yet difficult and time-consuming to administer. Ideally, direct observation of trainees would improve the instruction and documentation of communication skills. Clear understanding of the domains of GME Outcomes as well as creation of specific measures that are reliable and accurate while not creating an undue measurement burden are necessary. Methods. Infectious Diseases (ID) physicians rely heavily on communication and interpersonal skills to care for their patients. This multi institutional, qualitative study investigated the approaches used as well as the process employed by ID faculty regarding Interpersonal and Communication skill competency evaluation. Faculty interviews were recorded, transcribed and coded. Results. Based on the interview transcripts, general themes discovered included a lack of standardization yet considerable value placed upon trainee competency in the areas of interpersonal and communication skills. In addition, ID faculty revealed current practices employed, challenges addressed as well as recommendations for assessment. Conclusion. Increase in accreditation requirements have contributed to additional evaluative responsibilities ID medical educators must adopt. Ascertaining competency assessment methods employed by other ID faculty can provide alternative means of assessment and increase understanding regarding evaluative tools. Disclosures. All authors: No reported disclosures.
Conclusion. MRSA colonization is associated with increased risk of NH transfer following hospital... more Conclusion. MRSA colonization is associated with increased risk of NH transfer following hospital admission. Additionally, acquisition of MRSA seems to result in a slightly elevated risk of NH transfer compared with those who are colonized at the time of hospital admission. Disclosures. All authors: No reported disclosures. 2182. Molecular Epidemiology of Community-Associated and Hospitalassociated Methicillin-resistant Staphylococcus aureus in a Japanese University Hospital
BACKGROUND SARS-CoV-2, has been implicated in the largest recorded CoV outbreak to date.Initially... more BACKGROUND SARS-CoV-2, has been implicated in the largest recorded CoV outbreak to date.Initially the majority of COVID-19 cases were in China, but the virus has spread to more than 184 countries worldwide with the United States currently having more cases than any other country. OBJECTIVE With person-to-person spread expanding in the United States, this study aims to describe hospital preparedness for managing suspected and confirmed COVID-19 patients. DESIGN Cross-sectional survey focused on various elements of respiratory disease preparedness SETTING Critical access hospital (CAHs) and acute care hospitals (ACHs) in Idaho METHODS The electronic survey was sent to infection preventionists (IPs) and nurse administrators in 44 hospitals in Idaho RESULTS In all, 32 (73%) hospitals responded to the survey. Participating facilities reported their preparedness with respect to existing, formalized structures for managing infectious disease incidents—specifically COVID-19—as well as avail...
BACKGROUND Patients with measles can precipitate outbreaks in health care facilities where they s... more BACKGROUND Patients with measles can precipitate outbreaks in health care facilities where they seek care. Rural critical-access hospitals (CAHs) may be at higher risk of outbreaks given their size and potentially limited infection prevention resources. METHODS We surveyed CAHs in Idaho to ascertain their levels of preparedness for managing measles cases. A 25-item questionnaire was sent to infection preventionists at all 27 Idaho CAHs. The questionnaire covered organizational structure, resources for managing measles cases, and hospital policies for ensuring immunity among health care workers. RESULTS A total of 22 (82%) CAHs responded, reporting varying availability of facilities and resources for managing measles cases and disparate procedures for testing clinical samples and providing vaccines to nonimmune, exposed staff. DISCUSSION With measles incidence on the rise in the United States, our survey found that most of the responding hospitals had the basic organizational structure for facility-wide prevention and management efforts in case a patient with suspected or confirmed measles presented to that facility. Most of the hospitals also had at least some available resources to manage measles cases, as well as policies for ensuring immunity to measles among at least some groups of health care workers. CONCLUSIONS This study provides initial perspectives on measles preparedness among Idaho CAHs, despite limited generalizability. Future studies should explore whether self-reported preparedness measures reflect the ability of the CAHs to control measles spread when cases present for care.
Background Prescribing an antibiotic is a complex process involving an interplay of prescriber’s ... more Background Prescribing an antibiotic is a complex process involving an interplay of prescriber’s knowledge, diagnostic acumen and patient factors. Understanding the prescriber rationale is key to provide feedback which might improve appropriateness of antibiotic prescribing. Currently, there are limited data on prescribing and test ordering practices among primary care physicians. Methods We surveyed primary care physicians taking care of adults (age 18 years and above). Physicians were contacted through the Idaho State Medical Board by a one-time email containing the survey link. The survey consisted of 25 questions under 2 major themes of diagnostic and antimicrobial stewardship (AS). It assessed physicians’ practice setting, ordering of diagnostic tests and antibiotics for common infections, delivery of patient education regarding antibiotics, availability of antibiogram and antimicrobial stewardship services, and assessment of penicillin allergy. Two infectious diseases physicia...
Anubhav Kanwar MD12 , Jessica A. Kumar DO, MPH2, Yilen K. Ng-Wong MD3, Manish Thakur MBBS3, Jenni... more Anubhav Kanwar MD12 , Jessica A. Kumar DO, MPH2, Yilen K. Ng-Wong MD3, Manish Thakur MBBS3, Jennifer L. Cadnum BS3, Heba Alhmidi MD3, Thriveen S. C. Mana MS3, Annette L. Jencson BS2 and Curtis J. Donskey MD24 1Infectious Diseases Division, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, 2Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, 3Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio and and 4Case Western Reserve University School of Medicine, Cleveland, Ohio
&NA; In an acute care hospital, we demonstrated that the clothing and shoes that physicians a... more &NA; In an acute care hospital, we demonstrated that the clothing and shoes that physicians and nurses wear home from health care facilities can be contaminated with health care–associated pathogens, particularly methicillin‐resistant Staphylococcus aureus. These findings suggest that the clothing and shoes of personnel have the potential to serve as vectors for the transfer of health care–associated pathogens to the community.
BACKGROUNDContaminated ice machines have been linked to transmission of pathogens in healthcare f... more BACKGROUNDContaminated ice machines have been linked to transmission of pathogens in healthcare facilities.OBJECTIVETo determine the frequency and sites of contamination of ice machines in multiple healthcare facilities and to investigate potential mechanisms of microorganism dispersal from contaminated ice machines to patients.DESIGNMulticenter culture survey and simulation study.SETTINGThe study took place in 5 hospitals and 2 nursing homes in northeastern Ohio.METHODSWe cultured multiple sites on ice machines from patient care areas. To investigate potential mechanisms of microbial dispersal from contaminated ice machines, we observed the use of ice machines and conducted simulations using a fluorescent tracer and cultures.RESULTSSamples from 64 ice machines in the 5 hospitals and 2 nursing homes (range, 3–16 per facility) were cultured. Gram-negative bacilli and/or Candida spp were recovered from 100% of drain pans, 52% of ice and/or water chutes, and 72% of drain-pan grilles. D...
We examined the impact of systemic antibiotics on the burden of nasal Staphylococcus aureus in ho... more We examined the impact of systemic antibiotics on the burden of nasal Staphylococcus aureus in hospitalized patients. Of 1,482 patients, 237 (16%) had nasal methicillin-susceptible S. aureus (MSSA) and 92 (6%) had nasal methicillin-resistant S. aureus (MRSA) on admission. Treatment regimens that included agents with inhibitory activity against MRSA or MSSA significantly reduced the burden of carriage, whereas regimens lacking anti-MRSA activity, including fluoroquinolones, promoted MRSA overgrowth.
Background Physicians’ white coats are often contaminated, but seldom cleaned. A “bare below the ... more Background Physicians’ white coats are often contaminated, but seldom cleaned. A “bare below the elbows” dress code policy has been advocated as a strategy to reduce the risk for transmission of healthcare-associated pathogens by white coats. However, transfer of contamination by clothing has not been demonstrated in clinical settings and it is not known if long sleeves are the major source of transfer. Methods We observed physicians during routine patient encounters and characterized the frequency of direct and indirect contact between white coats and the patient or environmental surfaces. To assess transfer from white coats in clinical settings, we applied one cauliflower mosaic virus DNA marker to the sleeve cuffs and another to the coat pockets of physicians prior to routine patient encounters. Polymerase chain reaction was used to determine whether DNA markers from the clothing sites were transferred to patients or environmental surfaces. Results Ninety percent of observed pati...
Background Due to concerns for emergence of mupirocin resistance, there is an interest in use of ... more Background Due to concerns for emergence of mupirocin resistance, there is an interest in use of topical antiseptics for nasal decolonization of Staphylococcus aureus. Alcohol-based nasal antiseptics have recently been developed as an alternative to mupirocin, but there is limited data on efficacy, particularly among patients where the burden of carriage is often high. Methods We evaluated the effectiveness of a one-time application of a commercial alcohol-based nasal sanitizer for reduction in nasal methicillin-resistant Staphylococcus aureus (MRSA) in MRSA-colonized patients. Patients received either a single dose or triple dose over 3 minutes; the triple dose is recommended for preoperative dosing. Swabs were used for quantitative culture of MRSA from the anterior nares and vestibule prior to and 10 minutes, 2 hours, and 6 hours after application. For a subset of patients, cultures for MRSA were collected from hands, clothing, groin, and chest/axilla. Results Of 34 MRSA carriers ...
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Papers by Anubhav Kanwar