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To assess whether 16 reporting guidelines of Enhancing the QUAlity and Transparency Of Health Research (EQUATOR) were used in infectious diseases research publications.
This cross-sectional, audit-type study assessed articles published in five infectious diseases journals in 2019.
All articles were manually reviewed to assess if a reporting guideline was advisable and searched for the names and acronyms of 16 reporting guidelines. An “advisable use rate” was calculated.
We reviewed 1,251 manuscripts across five infectious diseases journals. Guideline use was advisable for 973 (75%) articles. Reporting guidelines were used in 85 articles, 6.1% of total articles, and 8% (95% CI 6%–9%) of articles for which guidelines were advised. The advisable use rate ranged from 0.06 to 0.17 for any guideline, 0–0.08 for CONSORT, 0.53–1 for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and 0–0.66 for Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) : The TRIPOD statement. No trends were observed across the five journals.
The use of EQUATOR-related reporting guidelines is infrequent, despite journals and publishers promoting their usage. Whether this finding is attributable to knowledge, acceptance, or perceived usefulness of the guidelines still needs to be clarified.
The COVID-19 pandemic has disproportionally affected traditionally marginalized groups. Both the Delta and Omicron variants raised concern amongst public health officials due to potentially higher infectivity rates and disease severity than prior variants. This study sought to compare disease severity between adults infected with the Omicron variant and adults infected with the Delta variant who presented to the Emergency Department at an academic, safety-net hospital in Virginia.
This retrospective cohort study used electronic medical record data of patients who presented to the Emergency Department and received a positive SARS-CoV-2 test between September 1, 2021, and January 31, 2022. Positive tests were stratified by genotypic variant through whole genome sequencing. Participants with the Omicron variant were propensity scores matched with individuals with the Delta variant.
Among 500 Delta and 500 Omicron participants, 279 propensity score-matched pairs were identified. Participants were predominantly unvaccinated, with medical comorbidities, and self-identified as Black. Individuals infected with the Delta variant had more severe disease compared to those with the Omicron variant, regardless of vaccination status. Patients with kidney, liver, and respiratory disease, as well as cancer, are at higher risk for severe disease. Patients with 2 doses of COVID-19 immunization trended toward less severe disease.
Overall, these data further support the literature regarding the disproportionate effects of the COVID-19 pandemic on vulnerable patient populations – such as those with limited access to care, people of color, and those with chronic medical conditions – and can be used to inform public health interventions.
Diversity is recognized as a driver of excellence and innovation. Women represent a significant part of the infectious diseases (ID) and hospital epidemiology (HE) workforce. We aimed to assess gender representation among editors of top ID and HE journals and explore potential correlations with the gender of first and last authors in published articles.
Using Scimago Journal & Country Rank, we identified 40 ID and 4 HE high-ranking journals. Editorial members were categorized by decision-making influence (levels I-III). We retrieved names of first and corresponding authors from 12 ID-focused journals’ 2019 research articles. Gender assignment for editors, first authors, and last authors utilized digital galleries and manual searches.
Among 2,797 editors from 44 journals, 33% were women. Female representation varied across editorial levels: 26% at level I, 36% at level II, and 31% at level III. Gender balance disparities existed among journals. Female first authors accounted for 50%, and female last authors accounted for 36% of the 2,725 published articles. We found weak but significant correlations between the editors’ gender and the gender of the first and last authors.
Gender representation among ID and HE journal editors displayed unevenness, but no overt vertical segregation was observed. A generational transition among authors may be underway. Our findings suggest that a generational transition may be occurring among authors.
Background: Rates of ventilator-associated events (VAEs), including infection-related ventilator-associated complications (IVACs) and probable ventilator-associated pneumonia (PVAPs) have increased nationwide since the onset of the COVID-19 pandemic. In December 2021, our health system adopted a new electronic medical record (EMR), which changed the way surveillance for VAEs is performed. We reviewed surveillance criteria, COVID-19 status, and culturing practices in attempts to understand why VAE rates continue to be elevated. Methods: We collected data on VAE type, culture data, COVID-19 status, and surveillance criteria for all patients meeting NHSN definitions for VAE from 2018 through November 2022. For all patients in 2022 (post-EMR transition), 2 physicians (A.D. and M.D.) manually reviewed documented ventilator settings from flow sheets to validate the automated EMR data, and they evaluated culture data for appropriateness. Cultures were defined as appropriate unless they were included in “pancultures” for leukocytosis without concern for pneumonia documented. Rates were compared using an interrupted time series (ITS) analysis before and after the onset of the COVID-19 pandemic and the EMR transition. Patient level data were compared across periods using the χ2 test. All analyses were performed using SAS version 9.4 software. Results: COVID-19 has been implicated in the increasing number of VAEs since the pandemic began: 6% of patients in 2020, 18% in 2021, and 23% in 2022 (P < .001). The percentage of patients meeting criteria for VAE by positive end-expiratory pressure (PEEP) decreased from 2018 to 2022 (92%, 95%, 93%, 85%, 85%, respectively; P = .0004). Patients meeting criteria for VAE by fraction of inspired oxygen (FiO2) increased from 2018 to 2022 (9%, 6%, 11%, 17%, 19%, respectively; P = .0002). Manual review of 2022 data indicated opportunities for test stewardship in 8 of 65 patients with cultures (12%). ITS analysis revealed that IVAC+ rates were climbing prior to the onset of the COVID-19 pandemic (Fig. 1). We observed a marked increase in rates with the implementation of our new EMR and the changes to our surveillance process (0.32 cases per 100 ventilator days). Manual review of records from 2022 revealed 5 patients in which documentation of ventilator settings to meet VAE diagnosis could not be retrieved from flow sheets. Conclusions: COVID-19 continues to affect VAE despite vaccine availability and may partially account for elevated rates nationwide. However, changes in EMR-automated VAE surveillance may also affect rates. Our findings suggest that automated surveillance captures transient or spurious changes in ventilator machine settings that do not accurately represent clinical status. These data may contribute to spurious increases in VAE. More studies are needed to better understand the impact of both COVID-19 and automated surveillance on VAE.
Background: Hand-hygiene technology (HHT) intends to monitor and promote hand washing by healthcare workers, a critical measure of infection control. Healthcare worker noncompliance with HHT is a major limitation to its implementation and utility in clinical settings. We assessed perspectives on HHT in an academic hospital system. Methods: Hand-hygiene team members created an anonymous, 37-question, Likert-scale survey to assess healthcare worker attitudes toward HHT. Surveys targeted nursing staff, advanced practice providers, care partners, and internal medicine physicians. Clinical coordinators from 5 distinct nursing units and 1 physician department emailed surveys to eligible employees. Research coordinators and clinical coordinators also posted a QR code for survey fliers at nursing stations. Results: Overall, 120 surveys were completed. Most surveys were completed by nurses and physicians (66.4% and 14.0%). Most respondents (67.5%) do not find HHT useful. Additionally, 78.3% of respondents believe that HHT does not accurately record hand-washing events. Most (78.3%) do not like using HHT, and 75.8% find it annoying. Only 10.8% believe that patient care suffers because of HHT. Conclusions: Most healthcare workers dislike the HHT badges, primarily due to perceived inaccuracies, lack of utility, burden of use, and pressure to comply. Distrust and effect on patient care do not appear to be substantial factors contributing to negative perceptions of HHT. Weaknesses of the study include overrepresentation of nursing staff and potential bias because respondents may have provided exceptionally negative responses believing it could lead to the removal of HHT.
Background: Academic publishing is not exempt from potential structural disparities. We assessed the sex representation among the editors and on editorial boards by their level of influence in the decision of a manuscript of the leading journals focused on infectious diseases and healthcare epidemiology. We also explored whether the sex of the first or last author correlates with the sex of the editors in a convenience sample of these journals. Methods: In a cross-sectional study, the 40 top infectious disease journals (Scimago Journal and Country Rank) and 4 healthcare epidemiology journals were selected. The names and positions of the editorial members were extracted from the journal’s website, and a decision-making level was assigned (ie, editor-in-chief as level 1, board members as level 3). Next, the first and corresponding authors’ names of all 2019 research articles published in a convenience sample of 15 of these journals were retrieved for the second aim. A digital gallery was used to assign one of the binary denominations of woman or man based on the probability that a name was culturally given to a woman or man. Differences were determined by χ2 and linear regression. Results: Overall, 2,416 names were retrieved from the editorial boards of 44 journals; 799 (33%) were assigned as women and 1,617 (67%) as men. The decision-making level showed 70 (3%) at the editor-in-chief level, 756 (31%) at the associate editor level, and 1,600 (66%) as editorial board members. The frequency distribution of assigned gender by decision-making level showed 21 (30%) women and 49 (70%) men at the editor-in-chief level; 263 (35%) women and 493 (65%) men at the associate editor level; 515 (32%) women and 1,075 (68%) men at the editorial board level. Some journals showed an even sex distribution, such as Clinical Infectious Disease or Microbiology Spectrum. However, others were significantly unbalanced. We retrieved 2,725 articles from the convenience sample of infectious disease–focused journals. Women were the first authors in 1,373 (50%) and the last authors in 974 (35%). Editorial board sex composition and sex of authors showed no significant correlation. Trends between infectious disease–focused and healthcare epidemiology–focused journals were similar. Conclusions: Although the data showed uneven sex representation on the editorial boards of infectious disease–focused and healthcare epidemiology–focused journals, there is no apparent vertical segregation or influence on publishing by sex. A generational transition seems to be occurring in editorship and authorship in the field.
A multisite research team proposed a survey to assess burnout among healthcare epidemiologists. Anonymous surveys were disseminated to eligible staff at SRN facilities. Half of the respondents were experiencing burnout. Staffing shortages were a key stressor. Allowing healthcare epidemiologists to provide guidance without directly enforcing policies may improve burnout.
Mental fatigue and burnout are concerns for healthcare organizations, but their effects on leaders have not been thoroughly studied. Infectious diseases teams and leaders are at risk for mental fatigue and burnout due to the increased demands from the coronavirus disease 2019 (COVID-19) pandemic, additive effects of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) (omicron) and δ (delta) variant surges, and unique pre-existing pressures. No single intervention can reduce stress and burnout in healthcare workers. Work-hour limitations may have the biggest impact in physician burnout mitigation. Institutional and individual programs focused on mindfulness may improve well-being in the workplace. Leading during times of stress requires a multimodal approach and an understanding of goals and priorities. Greater awareness of burnout and fatigue across the healthcare spectrum and continued research are required to advance healthcare worker well-being.
To model the effects of active detection and isolation (ADI) regarding Clostridioides difficile infection (CDI) in the bone marrow transplant (BMT) unit of our hospital.
ADI was implemented in a 21-patient bone marrow unit.
Patients were bone marrow recipients on this unit.
We compared active ADI, in which patients who tested positive for colonization of C. difficile before their hospital stay were placed under extra contact precautions, with cases not under ADI.
Within the BMT unit, ADI reduced total cases of CDI by 24.5% per year and reduced hospital-acquired cases by ∼84%. The results from our simulations also suggest that ADI can save ∼$67,600 per year in healthcare costs.
Institutions with active BMT units should consider implementing ADI.
One fundamental strategy to address the public health threat of antimicrobial resistance (AMR) is improved awareness among the public, prescribers, and policy makers with the aim of engaging these groups to act. World Antimicrobial Awareness Week is an opportunity for concerted and consistent communication regarding practical strategies to prevent and mitigate AMR. We highlight 10 ways for antimicrobial stewards to make the most of World Antimicrobial Awareness Week.
We implemented a preoperative staphylococcal decolonization protocol for colorectal surgeries if efforts to further reduce surgical site infections (SSIs).
Retrospective observational study.
Tertiary-care, academic medical center.
Adult patients who underwent colorectal surgery, as defined by National Healthcare Safety Network (NHSN), between July 2015 and June 2020. Emergent cases were excluded.
Simple and multivariable logistic regression were performed to evaluate the relationship between decolonization and subsequent SSI. Other predictive variables included age, sex, body mass index, procedure duration, American Society of Anesthesiology (ASA) score, diabetes, smoking, and surgical oncology service.
In total, 1,683 patients underwent nonemergent NHSN-defined colorectal surgery, and 33.7% underwent the staphylococcal decolonization protocol. SSI occurred in 92 (5.5%); 53 were organ-space infections and 39 were superficial wound infections. We detected no difference in overall SSIs between those decolonized and not decolonized (P = .17). However, superficial wound infections were reduced in the group that received decolonization versus those that did not: 7 (1.2%) of 568 versus 32 (2.9%) of 1,115 (P = .04).
Staphylococcal decolonization may prevent a subset of SSIs in patients undergoing colorectal surgery.