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Globally, nurses play pivotal roles in epidemic and emergency response. Nurses’ actions include supporting and informing surveillance and detection, dispensing live-saving medical countermeasures, implementing prevention and response interventions, providing direct care for patients, educating patients and the public, providing health systems leadership, and counseling community members. Despite these roles, there exist gaps in how countries train and prepare their nursing workforce for these health threats.
To help address this gap, the Johns Hopkins Center for Health Security has developed an International Resource Center for Pandemic and Disaster Nursing. We have established an international working group to provide input on the goals and mission of the center, website development and functionality, and advocacy efforts. This working group has met four times over the course of the last year. We have also met with several organizations involved in nursing and epidemic and disaster preparedness and response, including the World Health Organization and the International Council of Nurses (ICN), to identify ways to align our work with other ongoing efforts.
Presently, we have developed a static website that provides access to evidence-based, open-source trainings and educational resources applicable to pandemic and disaster nursing. The website also provides listings of upcoming webinars, guest blog posts, trainings, and conferences relevant to disaster and pandemic nursing. The website will be launched in early 2023.
The long-term vision for this center is to expand beyond a static website and create a vibrant and fully staffed virtual center. This center would be the first of its kind dedicated to developing the resources, technical assistance, partnerships, and advocacy efforts needed to build and support a global nursing workforce that is prepared for outbreaks and disasters. It would build on the existing wealth of expertise within the working group and forge lasting connections between disaster nurse experts across the globe.
Increasingly diverse caregiver populations have prompted studies examining culture and caregiver outcomes. Still, little is known about the influence of sociocultural factors and how they interact with caregiving context variables to influence psychological health. We explored the role of caregiving and acculturation factors on psychological distress among a diverse sample of adults.
Secondary data analysis of the California Health Interview Survey (CHIS).
The 2009 CHIS surveyed 47,613 adults representative of the population of California. This study included Latino and Asian American Pacific Islander (AAPI) caregivers and non-caregivers (n = 13,161).
Multivariate weighted regression analyses examined caregiver status and acculturation variables (generational status, language of interview, and English language proficiency) and their associations with psychological distress (Kessler-6 scale). Covariates included caregiving context (e.g., support and neighborhood factors) and demographic variables.
First generation caregivers had more distress than first-generation non-caregivers (β=0.92, 95% CI: (0.18, 1.65)); the difference in distress between caregivers and non-caregivers was smaller in the third than first generation (β=-1.21, 95% CI: (-2.24, -0.17)). Among those who did not interview in English (β=1.17, 95% CI: (0.13, 2.22)) and with low English proficiency (β=2.60, 95% CI: (1.21, 3.98)), caregivers reported more distress than non-caregivers.
Non-caregivers exhibited the "healthy immigrant effect," where less acculturated individuals reported less distress. In contrast, caregivers who were less acculturated reported more distress.
Candida auris infections continue to occur across the United States and abroad, and healthcare facilities that care for vulnerable populations must improve their readiness to respond to this emerging organism. We aimed to identify and better understand challenges faced and lessons learned by those healthcare facilities who have experienced C. auris cases and outbreaks to better prepare those who have yet to experience or respond to this pathogen.
Semi-structured qualitative interviews.
Health departments, long-term care facilities, acute-care hospitals, and healthcare organizations in New York, Illinois, and California.
Infectious disease physicians and nurses, clinical and environmental services, hospital leadership, hospital epidemiology, infection preventionists, emergency management, and laboratory scientists who had experiences either preparing for or responding to C. auris cases or outbreaks.
In total, 25 interviews were conducted with 84 participants. Interviews were coded using NVivo qualitative coding software by 2 separate researchers. Emergent themes were then iteratively discussed among the research team.
Key themes included surveillance and laboratory capacity, inter- and intrafacility communication, infection prevention and control, environmental cleaning and disinfection, clinical management of cases, and media concerns and stigma.
Many of the operational challenges noted in this research are not unique to C. auris, and the ways in which we address future outbreaks should be informed by previous experiences and lessons learned, including the recent outbreaks of C. auris in the United States.
This article describes implementation considerations for Ebola-related monitoring and movement restriction policies in the United States during the 2013–2016 West Africa Ebola epidemic.
Semi-structured interviews were conducted between January and May 2017 with 30 individuals with direct knowledge of state-level Ebola policy development and implementation processes. Individuals represented 17 jurisdictions with variation in adherence to US Centers for Disease Control and Prevention (CDC) guidelines, census region, predominant state political affiliation, and public health governance structures, as well as the CDC.
Interviewees reported substantial resource commitments required to implement Ebola monitoring and movement restriction policies. Movement restriction policies, including for quarantine, varied from voluntary to mandatory programs, and, occasionally, quarantine enforcement procedures lacked clarity.
Efforts to improve future monitoring and movement restriction policies may include addressing surge capacity to implement these programs, protocols for providing support to affected individuals, coordination with law enforcement, and guidance on varying approaches to movement restrictions.
Milk provides energy and nutrients considered protective for bone. Meta-analyses of cohort studies have found no clear association between milk drinking and risk of hip fracture, and results of recent studies are contradictory. We studied the association between milk drinking and hip fracture in Norway, which has a population characterised by high fracture incidence and a high Ca intake. Baseline data from two population-based cohorts were used: the third wave of the Norwegian Counties Study (1985–1988) and the Five Counties Study (2000–2002). Diet and lifestyle variables were self-reported through questionnaires. Height and weight were measured. Hip fractures were identified by linkage to hospital data with follow-up through 2013. Of the 35 114 participants in the Norwegian Counties Study, 1865 suffered a hip fracture during 613 018 person-years of follow-up. In multivariable Cox regression, hazard ratios (HR) per daily glass of milk were 0·97 (95 % CI 0·92, 1·03) in men and 1·02 (95 % CI 0·96, 1·07) in women. Of 23 259 participants in the Five Counties Study, 1466 suffered a hip fracture during 252 996 person-years of follow-up. HR for hip fractures per daily glass of milk in multivariable Cox regression was 0·99 (95 % CI 0·92, 1·07) in men and 1·02 (95 % CI 0·97, 1·08) in women. In conclusion, there was no overall association between milk intake and risk of hip fracture in Norwegian men and women.
We surveyed infection prevention programs in 16 hospitals for hospital-associated methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, extended-spectrum β-lactamase, and multidrug-resistant Acinetobacter acquisition, as well as hospital-associated MRSA bacteremia and Clostridium difficile infection based on defining events as occurring >2 days versus >3 days after admission. The former resulted in significantly higher median rates, ranging from 6.76% to 45.07% higher
Infect Control Hosp Epidemiol 2014;35(11):1417–1420
To evaluate whether an ecologic inverse association exists between methicillin-susceptible Staphylococcus aureus (MSSA) prevalence and methicillin-resistant S. aureus (MRSA) prevalence in nursing homes.
We conducted a secondary analysis of a prospective cross-sectional study of S. aureus prevalence in 26 nursing homes across Orange County, California, from 2008–2011. Admission prevalence was assessed using bilateral nares swabs collected from all new residents within 3 days of admission until 100 swabs were obtained. Point prevalence was assessed from a representative sample of 100 residents. Swab samples were plated on 5% sheep blood agar and Spectra MRSA chromogenic agar. If MRSA was detected, no further tests were performed. If MRSA was not detected, blood agar was evaluated for MSSA growth. We evaluated the association between MRSA and MSSA admission and point prevalence using correlation and linear regression testing.
We collected 3,806 total swabs. MRSA and MSSA admission prevalence were not correlated (r = −0.40, P = .09). However, MRSA and MSSA point prevalence were negatively correlated regardless of whether MSSA prevalence was measured among all residents sampled (r = −0.67, P = .0002) or among those who did not harbor MRSA (r = −0.41, P = .04). This effect persisted in regression models adjusted for the percentage of residents with diabetes (β = −0.73, P = .04), skin lesions (β = −1.17, P = .002), or invasive devices (β = −1.4, P = .0006).
The inverse association between MRSA and MSSA point prevalence and minimal association on admission prevalence suggest MSSA carriage may protect against MRSA acquisition in nursing homes. The minimal association on admission prevalence further suggests competition may occur during nursing home stays.
Infect Control Hosp Epidemiol 2014;35(10):1257–1262
We assessed characteristics associated with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) carriage among residents of 22 nursing homes. Of MRSA-positive swabs, 25% (208/824) were positive for CA-MRSA. Median facility CA-MRSA percentage was 22% (range, 0%–44%). In multivariate models, carriage was associated with age less than 65 years (odds ratio, 1.2; P < .001) and Hispanic ethnicity (odds ratio, 1.2; P = .006). Interventions are needed to target CA-MRSA.
We calculated hospital-onset methicillin-resistant Staphylococcus aureus (HO-MRSA) rates for Orange County, California, hospitals using survey and state data. Numerators were variably defined as HO-MRSA occurring more than 48 hours (37%), more than 2 days (30%), and more than 3 days (33%) postadmission. Survey-reported denominators differed from state-reported patient-days. Numerator and denominator choices substantially impacted HO-MRSA rates.
Recent research suggests that affective disorder is associated with increased mortality and physical morbidity, but the reasons for this association remain uncertain. This report describes a 50-year prospective study of 240 men evaluated from the time they were university students in 1940–1942. A family history of mental illness was obtained and the men's habits, psychological adjustment, and marital and occupational satisfaction were followed every 2 years and their objective physical health was tracked every 5 years until age 70. Twenty-five men were identified as having affective spectrum disorder prior to age 53. Of the variables studied, the presence of affective spectrum disorder was the most powerful predictor of poor psychosocial outcome at age 65 and one of the most powerful predictors of poor physical health. Alcohol abuse and cigarette abuse accounted for the observed increased rates of heart disease and cancer. When alcohol abuse, smoking, and suicide were controlled for, affective disorder made a significant contribution to physical morbidity by age 70, but not to mortality from natural causes. Affective spectrum disorder, even in an educated population without antisocial trends, carries a profound negative risk to late-life physical and social adjustment.
Diane Hutchins Meyer, Department of Microbiology and Molecular Genetics, University of Vermont, Burlington, Vermont 05405, USA,
Joan E. Lippmann, Department of Microbiology and Molecular Genetics, University of Vermont, Burlington, Vermont 05405, USA,
Paula Fives-Taylor, Department of Microbiology and Molecular Genetics, University of Vermont, Burlington, Vermont 05405, USA
ACTINOBACILLUS ACTINOMYCETEMCOMITANS: ADHERENCE MECHANISMS REQUIRED FOR INVASION
Colony phase variation
A. actinomycetemcomitans produces three distinct colonial morphologies on solid medium. A rough colony phenotype is typically generated by organisms upon isolation from the gingiva. These are small (~0.5–1 mm in diameter), translucent circular colonies with rough surfaces and irregular edges (Fig. 9.1). An internal star-shaped or crossed cigar morphology that embeds the agar is a distinguishing characteristic that gives A. actinomycetemcomitans its name (Zambon, 1985). In liquid culture, the rough colony phenotype cells form aggregates on the vessel walls, resulting in a clear medium (Fig. 9.1). Repeated subculture on agar of rough phenotypic isolates yields two distinct colonial variants; one is smooth surfaced and transparent, and the other is smooth surfaced and opaque (Slots, 1982; Scannapieco et al., 1987; Rosan et al., 1988; Inouye et al., 1990). The transparent smooth-surfaced variants appear to be an intermediate between the transparent rough-surfaced and opaque smooth-surfaced types (Inouye et al., 1990). In broth, the smooth-surfaced opaque type grows as a turbid homogeneous suspension, whereas the smooth-surfaced transparent type aggregates and adheres to the vessel walls (Inouye et al., 1990). In general, isolates undergo a rough-to-smooth variant transition soon after culture in vitro. In contrast, a smooth-to-rough variant transition that appears to be associated with nutritional requirements occurs only rarely during in vitro culture (Inouye et al., 1990; Meyer et al., 1991; Meyer, unpublished observation).
Following an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in our acute rehabilitation unit in 1987, all patients except in-house transfers (because of their low prevalence of MRSA colonization) underwent MRSA screening cultures on admission.
To better characterize the current profile of patients with positive MRSA screening cultures at the time of admission to our acute rehabilitation unit, and to determine the relative yield of nares, perianal, and wound screening cultures in this population.
Prospective chart review with ongoing active surveillance for infections associated with the acute rehabilitation unit.
The rate of MRSA isolation from one or more body sites increased significantly from 5% (1987–1988) to 12% (1999–2000) (P = .0009) for newly admitted patients and from 0% to 7% (P < .0001) for in-house transfers. A negative nares culture was highly predictive (98%) of a negative perianal culture. Prior history of MRSA infection or colonization and transfer from outside sources were independently associated with positive MRSA screening cultures.
The rate of MRSA isolation from screening cultures of newly admitted patients, including in-house transfers, has increased significantly during the past decade in our acute rehabilitation unit. When paired with nares cultures, perianal cultures were of limited value in this patient population.
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