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We surveyed infectious disease specialists about early COVID-19 vaccination preparedness. Almost all respondents’ institutions rated their facility’s preparedness plan as either excellent or adequate. Vaccine hesitancy and concern about adverse reactions were the most common anticipated barriers to COVID-19 vaccination. Only 60% believed currently that COVID-19 vaccination should be mandatory.
This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to COVID-19 with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplemental materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.
In a recent communication on carbon isotope chemostratigraphy of the uppermost Cambrian strata, it was claimed that the Top of Cambrian Excursion (TOCE) is (1) an undocumented negative δ13Ccarb excursion; (2) ambiguously defined; (3) deliberately fictitious or, in the authors’ words, a ‘nihilartikel’; and (4) not synonymous with the Hellnmaria–Red Tops Boundary (HERB) Event. As the authors who have been involved in much of the discussion surrounding the TOCE since its introduction and in subsequent clarification, we wish to emphasize that the recent communication overlooks the fact that the TOCE is in fact a well-documented and clearly defined negative δ13Ccarb excursion, and that the term ‘HERB Event’ was originally used informally, without definition or reference data, for a negative δ13Ccarb peak, a peak later shown to occur within the TOCE excursion. Nearly a decade after the TOCE was named, the concept of the HERB Event was modified from a negative δ13Ccarb peak to a negative δ13Ccarb excursion, making it conceptually synonymous with the TOCE excursion. The recently published commentary is misleading and replete with misconceptions, as we discuss here.
Background: Immunization resistance is fueling a resurgence of vaccine-preventable diseases in the United States, where several large measles outbreaks and 1,282 measles cases were reported in 2019. Concern about these measles outbreaks prompted a large healthcare organization to develop a preparedness plan to limit healthcare-associated transmission. Verification of employee rubeola immunity and immunization when necessary was prioritized because of transmission risk to nonimmune employees and role of the healthcare personnel in responding to measles cases. Methods: The organization employs ∼31,000 people in diverse settings. A multidisciplinary team was formed by infection prevention, infectious diseases, occupational health, and nursing departments to develop the preparedness plan. Immunity was monitored using a centralized database. Employees without evidence of immunity were asked to provide proof of vaccination, defined by the CDC as 2 appropriately timed doses of rubeola-containing vaccine, or laboratory confirmation of immunity. Employees were given 30 days to provide documentation or to obtain a titer at the organization’s expense. Staff with negative titers were given 2 weeks to coordinate with the occupational heath department for vaccination. Requests for medical or religious accommodations were evaluated by occupational heath staff, the occupational heath medical director, and the human resources department. All employees were included, though patient-interfacing employees in departments considered higher risk were prioritized. These areas were the emergency, dermatology, infectious diseases, labor and delivery, obstetrics, and pediatrics departments. Results: At the onset of the initiative in June 2019, 4,009 employees lacked evidence of immunity. As of November 2019, evidence of immunity had been obtained for 3,709 employees (92.5%): serological evidence of immunity was obtained for 2,856 (71.2%), vaccine was administered to 584 (14.6%), and evidence of previous vaccination was provided by 269 (6.7%). Evidence of immunity has not been documented for 300 (7.5%). The organization administered 3,626 serological tests and provided 997 vaccines, costing ∼$132,000. Disposition by serological testing is summarized in Table 1. Conclusions: A measles preparedness strategy should include proactive assessment of employees’ immune status. It is possible to expediently assess a large number of employees using a multidisciplinary team with access to a centralized database. Consideration may be given to prioritization of high-risk departments and patient-interfacing roles to manage workload.
Background: From August 2017 to June 2018, 11 hospitals within a large healthcare system switched from multiple different electronic medical records (EMRs) to 1 EMR. At the time of this transition, the NHSN provided guidelines to validate healthcare-associated infection (HAI) denominators when switching from manual denominator collection to electronic denominator collection, but the NHSN did not give guidelines for validation when switching from 1 EMR to another. We aimed to build a validation process to ensure the accuracy of central-line and urinary catheter days reported to the NHSN after switching EMRs. Methods: Our validation process began with a statistical phase followed by a targeted manual validation phase. The statistical phase used 3 prediction methods (linear regression, time series analysis, and statistical process control [SPC] charts) to forecast device days after the EMR switch for units within hospitals. Models were developed using baseline data from the old EMR (January 2015 through the new EMR implementation). Using prespecified criteria for each method to determine discrepancies, we built a decision tree to identify units needing manual validation. Any unit that failed the statistical phase would need to participate in the manual validation phase, using a midnight census and direct visualization of devices. The manual validation process was composed of 14-day blocks. At the end of each block, if manual device days were within ±5% of EMR device days, they were considered validated. Manual validation would be repeated in 14-day blocks until 2 consecutive blocks passed within ±5%. Results: Overall, 157 units were evaluated for urinary catheter days and central-line days. Among them, 143 units passed the statistical validation test for urinary catheter days and 151 passed for central-line days. There was no specific pattern when comparing forecasted versus actual device days. The manual validation process for the 20 failing units (14 urinary catheter and 6 central-line units) is ongoing; preliminary results identified issues with missing nursing documentation in the EMR and with inaccurate manual counting of device days. There were no systematic discrepancies associated with the new EMR. Conclusions: We developed a novel validation process using statistical prediction methods supplemented with a targeted manual process. This process saved resources by identifying the units that need manual validation. Discrepancies were largely related to nursing documentation, which the infection prevention team addressed with additional training.
We performed a mixed-methods study to evaluate antimicrobial stewardship program (ASP) uptake and to assess variability of program implementation in Missouri hospitals. Despite increasing uptake of ASPs in Missouri, there is wide variability in both the scope and sophistication of these programs.
Acute care research (ACR) is uniquely challenged by the constraints of recruiting participants and conducting research procedures within minutes to hours of an unscheduled critical illness or injury. Existing competencies for clinical research professionals (CRPs) are gaining traction but may have gaps for the acute environment. We sought to expand existing CRP competencies to include the specialized skills needed for ACR settings.
Qualitative data collected from job shadowing, clinical observations, and interviews were analyzed to assess the educational needs of the acute care clinical research workforce. We identified competencies necessary to succeed as an ACR-CRP, and then applied Bloom’s Taxonomy to develop characteristics into learning outcomes that frame both knowledge to be acquired and job performance metrics.
There were 28 special interest competencies for ACR-CRPs identified within the eight domains set by the Joint Task Force (JTF) of Clinical Trial Competency. While the eight domains were not prioritized by the JTF, in ACR an emphasis on Communication and Teamwork, Clinical Trials Operations, and Data Management and Informatics was observed. Within each domain, distinct proficiencies and unique personal characteristics essential for success were identified. The competencies suggest that a combination of competency-based training, behavioral-based hiring practices, and continuing professional development will be essential to ACR success.
The competencies developed for ACR can serve as a training guide for CRPs to be prepared for the challenges of conducting research within this vulnerable population. Hiring, training, and supporting the development of this workforce are foundational to clinical research in this challenging setting.
The South Fork of Wright Valley contains one of the largest rock glaciers in the McMurdo Dry Valleys, Antarctica, stretching 7 km from the eastern boundary of the Labyrinth and terminating at Don Juan Pond (DJP). Here, we use results from ground-penetrating radar (GPR), qualitative field observations, soil leaching analyses and X-ray diffraction analyses to investigate rock glacier development. The absence of significant clean ice in GPR data, paired with observations of talus and interstitial ice influx from the valley walls, support rock glacier formation via talus accumulation. A quartz-dominated subsurface composition and discontinuous, well-developed desert pavements suggest initial rock glacier formation occurred before the late Quaternary. Major ion data from soil leaching analyses show higher salt concentrations in the rock glacier and talus samples that are close to hypersaline DJP. These observations suggest that DJP acts as a local salt source to the rock glacier, as well as the surrounding talus slopes that host water track systems that deliver solutes back into the lake, suggesting a local feedback system. Finally, the lack of lacustrine sedimentation on the rock glacier is inconsistent with the advance of a glacially dammed lake into South Fork during the Last Glacial Maximum.
Presenteeism, or working while ill, by healthcare personnel (HCP) experiencing influenza-like illness (ILI) puts patients and coworkers at risk. However, hospital policies and practices may not consistently facilitate HCP staying home when ill.
Objective and methods:
We conducted a mixed-methods survey in March 2018 of Emerging Infections Network infectious diseases physicians, describing institutional experiences with and policies for HCP working with ILI.
Of 715 physicians, 367 (51%) responded. Of 367, 135 (37%) were unaware of institutional policies. Of the remaining 232 respondents, 206 (89%) reported institutional policies regarding work restrictions for HCP with influenza or ILI, but only 145 (63%) said these were communicated at least annually. More than half of respondents (124, 53%) reported that adherence to work restrictions was not monitored or enforced. Work restrictions were most often not perceived to be enforced for physicians-in-training and attending physicians. Nearly all (223, 96%) reported that their facility tracked laboratory-confirmed influenza (LCI) in patients; 85 (37%) reported tracking ILI. For employees, 109 (47%) reported tracking of LCI and 53 (23%) reported tracking ILI. For independent physicians, not employed by the facility, 30 (13%) reported tracking LCI and 11 (5%) ILI.
More than one-third of respondents were unaware of whether their institutions had policies to prevent HCP with ILI from working; among those with knowledge of institutional policies, dissemination, monitoring, and enforcement of these policies was highly variable. Improving communication about work-restriction policies, as well as monitoring and enforcement, may help prevent the spread of infections from HCP to patients.
The past few years have seen a remarkable amount of attention on the long-term future of artificial intelligence (AI). Icons of science and technology such as Stephen Hawking (Cellan-Jones, 2014), Elon Musk (Musk, 2014), and Bill Gates (Gates, 2015) have expressed concern that superintelligent AI may wipe out humanity in the long run. Stuart Russell, coauthor of the most-cited textbook of AI (Russell & Norvig, 2003), recently began prolifically advocating (Dafoe & Russell, 2016) for the field of AI to take this possibility seriously. AI conferences now frequently have panels and workshops on the topic. There has been an outpouring of support from many leading AI researchers for an open letter calling for greatly increased research dedicated to ensuring that increasingly capable AI remains “robust and beneficial,” and gradually a field of “AI safety” is coming into being (Pistono & Yampolskiy, 2016; Yampolskiy, 2016, 2018; Yampolskiy & Spellchecker, 2016). Why all this attention?