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Since the initial publication of A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals in 2008, the prevention of healthcare-associated infections (HAIs) has continued to be a national priority. Progress in healthcare epidemiology, infection prevention, antimicrobial stewardship, and implementation science research has led to improvements in our understanding of effective strategies for HAI prevention. Despite these advances, HAIs continue to affect ∼1 of every 31 hospitalized patients,1 leading to substantial morbidity, mortality, and excess healthcare expenditures,1 and persistent gaps remain between what is recommended and what is practiced.
The widespread impact of the coronavirus disease 2019 (COVID-19) pandemic on HAI outcomes2 in acute-care hospitals has further highlighted the essential role of infection prevention programs and the critical importance of prioritizing efforts that can be sustained even in the face of resource requirements from COVID-19 and future infectious diseases crises.3
The Compendium: 2022 Updates document provides acute-care hospitals with up-to-date, practical expert guidance to assist in prioritizing and implementing HAI prevention efforts. It is the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Disease Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Pediatric Infectious Disease Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), the Surgical Infection Society (SIS), and others.
New technologies and disruptions related to Coronavirus disease-2019 have led to expansion of decentralized approaches to clinical trials. Remote tools and methods hold promise for increasing trial efficiency and reducing burdens and barriers by facilitating participation outside of traditional clinical settings and taking studies directly to participants. The Trial Innovation Network, established in 2016 by the National Center for Advancing Clinical and Translational Science to address critical roadblocks in clinical research and accelerate the translational research process, has consulted on over 400 research study proposals to date. Its recommendations for decentralized approaches have included eConsent, participant-informed study design, remote intervention, study task reminders, social media recruitment, and return of results for participants. Some clinical trial elements have worked well when decentralized, while others, including remote recruitment and patient monitoring, need further refinement and assessment to determine their value. Partially decentralized, or “hybrid” trials, offer a first step to optimizing remote methods. Decentralized processes demonstrate potential to improve urban-rural diversity, but their impact on inclusion of racially and ethnically marginalized populations requires further study. To optimize inclusive participation in decentralized clinical trials, efforts must be made to build trust among marginalized communities, and to ensure access to remote technology.
Includes 'John Harvey of Ickwell, 1688-9', edited by Margaret Richards. 'Henry Taylor of Pulloxhill, 1750-72', edited by Patricia Bell. 'John Salusbury of Leighton Buzzard, 1757-9', edited by Joyce Godber. 'John Pedley of Great Barford, 1773-95', edited by F. G. Emmison. 'Elizabeth Brown of Ampthill, 1778-91', edited by Joyce Godber. 'Edward Arpin of Felmersham, 1763-1831', edited by C. D. Linnell. 'Catherine Young (later Maclear) of Bedford, 1832-5 and 1846', edited by Isobel Thompson. 'Sir John Burgoyne, Bart., of Sutton, 1854', edited by Brigadier P. Young, DSO, MC. 'Major J. H. Brooks and the Indian Mutiny, 1857', edited by Aileen M. Armstrong. 'The Rev. G. D. Newbolt of Souldrop, 1856-95', edited by Patricia Bell. 'Some Letters from Bedfordshire Pioneers in Australia, 1842-86', edited by Andrew Underwood.
To examine temporal changes in coverage with a complete primary series of coronavirus disease 2019 (COVID-19) vaccination and staffing shortages among healthcare personnel (HCP) working in nursing homes in the United States before, during, and after the implementation of jurisdiction-based COVID-19 vaccination mandates for HCP.
Sample and setting:
HCP in nursing homes from 15 US jurisdictions.
We analyzed weekly COVID-19 vaccination data reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network from June 7, 2021, through January 2, 2022. We assessed 3 periods (preintervention, intervention, and postintervention) based on the announcement of vaccination mandates for HCP in 15 jurisdictions. We used interrupted time-series models to estimate the weekly percentage change in vaccination with complete primary series and the odds of reporting a staffing shortage for each period.
Complete primary series vaccination among HCP increased from 66.7% at baseline to 94.3% at the end of the study period and increased at the fastest rate during the intervention period for 12 of 15 jurisdictions. The odds of reporting a staffing shortage were lowest after the intervention.
These findings demonstrate that COVID-19 vaccination mandates may be an effective strategy for improving HCP vaccination coverage in nursing homes without exacerbating staffing shortages. These data suggest that mandates can be considered to improve COVID-19 coverage among HCP in nursing homes to protect both HCP and vulnerable nursing home residents.
To evaluate the impact of a diagnostic stewardship intervention on Clostridioides difficile healthcare-associated infections (HAI).
Quality improvement study.
Two urban acute care hospitals.
All inpatient stool testing for C. difficile required review and approval prior to specimen processing in the laboratory. An infection preventionist reviewed all orders daily through chart review and conversations with nursing; orders meeting clinical criteria for testing were approved, orders not meeting clinical criteria were discussed with the ordering provider. The proportion of completed tests meeting clinical criteria for testing and the primary outcome of C. difficile HAI were compared before and after the intervention.
The frequency of completed C. difficile orders not meeting criteria was lower [146 (7.5%) of 1,958] in the intervention period (January 10, 2022–October 14, 2022) than in the sampled 3-month preintervention period [26 (21.0%) of 124; P < .001]. C. difficile HAI rates were 8.80 per 10,000 patient days prior to the intervention (March 1, 2021–January 9, 2022) and 7.69 per 10,000 patient days during the intervention period (incidence rate ratio, 0.87; 95% confidence interval, 0.73–1.05; P = .13).
A stringent order-approval process reduced clinically nonindicated testing for C. difficile but did not significantly decrease HAIs.
The U.S. Supreme Court has for decades served as an unlikely venue for the performance of music. Between 1988 and 2020, more than 125 musicians, including some of the country's most prominent performers, appeared for intimate audiences in the Supreme Court's East Conference Room. The concerts were officially “off the record,” but details survive in records kept by the U.S. Supreme Court, papers of former justices and friends of the court involved in the creation of the programs, and in interviews with individuals who supported and participated in the events. This article reconstructs the history of this long running but little-known music series and contextualizes it within the court's culture and broader themes of access and power.
Folate and choline are methyl donor nutrients that may play a role in fetal brain development. Animal studies have reported that prenatal folate and choline supplementation are associated with better cognitive outcomes in offspring and that these nutrients may interact and affect brain development. Human studies that have investigated associations between maternal prenatal folate or choline levels and neurodevelopmental outcomes have reported contradictory findings and no human studies have examined the potential interactive effect of folate and choline on children’s neurodevelopment. During the second trimester of pregnancy, maternal red blood cell folate was measured from blood samples and choline intake was estimated using a 24-h dietary recall in 309 women in the APrON cohort. At 3–5 years of age, their children’s neurodevelopment was assessed using the Wechsler Preschool and Primary Scales of Intelligence – Fourth EditionCND, NEPSY-II language and memory subtests, four behavioral executive function tasks, and the Movement Assessment Battery for Children – Second Edition. Adjusted regressions revealed no associations between maternal folate and choline levels during pregnancy and most of the child outcomes. On the Dimensional Change Card Sort, an executive function task, there was an interaction effect; at high levels of choline intake (i.e., 1 SD above the mean; 223.03 mg/day), higher maternal folate status was associated with decreased odds of receiving a passing score (β = −0.44; 95%CI −0.81, −0.06). In conclusion, maternal folate status and choline intake during the second trimester of pregnancy were not associated with children’s intelligence, language, memory, or motor outcomes at 3–4 years of age; however, their interaction may have an influence children’s executive functions.
The Residual Lesion Score is a novel tool for assessing the achievement of surgical objectives in congenital heart surgery based on widely available clinical and echocardiographic characteristics. This article describes the methodology used to develop the Residual Lesion Score from the previously developed Technical Performance Score for five common congenital cardiac procedures using the RAND Delphi methodology.
A panel of 11 experts from the field of paediatric and congenital cardiology and cardiac surgery, 2 co-chairs, and a consultant were assembled to review and comment on validity and feasibility of measuring the sub-components of intraoperative and discharge Residual Lesion Score for five congenital cardiac procedures. In the first email round, the panel reviewed and commented on the Residual Lesion Score and provided validity and feasibility scores for sub-components of each of the five procedures. In the second in-person round, email comments and scores were reviewed and the Residual Lesion Score revised. The modified Residual Lesion Score was scored independently by each panellist for validity and feasibility and used to develop the “final” Residual Lesion Score.
The Residual Lesion Score sub-components with a median validity score of ≥7 and median feasibility score of ≥4 that were scored without disagreement and with low absolute deviation from the median were included in the “final” Residual Lesion Score.
Using the RAND Delphi methodology, we were able to develop Residual Lesion Score modules for five important congenital cardiac procedures for the Pediatric Heart Network’s Residual Lesion Score study.
Racially and ethnically minoritized populations have been historically excluded and underrepresented in research. This paper will describe best practices in multicultural and multilingual awareness-raising strategies used by the Recruitment Innovation Center to increase minoritized enrollment into clinical trials. The Passive Immunity Trial for Our Nation will be used as a primary example to highlight real-world application of these methods to raise awareness, engage community partners, and recruit diverse study participants.
Childhood obesity prevention is critical to reducing the health and economic burden currently experienced by the Australian economy. System science has emerged as an approach to manage the complexity of childhood obesity and the ever-changing risk factors, resources and priorities of government and funders. Anecdotally, our experience suggests that inflexibility of traditional research methods and dense academic terminology created issues with those working in prevention practice. Therefore, this paper provides a refined description of research-specific terminology of scale-up, fidelity, adaptation and context, drawing from community-based system dynamics and our experience in designing, implementing and evaluating non-linear, community-led system approaches to childhood obesity prevention.
We acknowledge the importance of using a practice lens, rather than purely a research design lens, and provide a narrative on our experience and perspectives on scale-up, fidelity, context and adaptation through a practice lens.
Practice-based researcher experience and perspectives.
Practice-based researchers highlighted the key finding that community should be placed at the centre of the intervention logic. This allowed communities to self-organise with regard to stakeholder involvement, capacity, boundary identification, and co-creation of actions implemented to address childhood obesity will ensure scale-up, fidelity, context and adaptation are embedded.
We need to measure beyond primary anthropometric outcomes and focus on evaluating more about implementation, process and sustainability. We need to learn more from practitioners on the ground and use an implementation science lens to further understand how actions work. This is where solutions to sustained childhood obesity prevention will be found.
Seabirds are highly threatened, including by fisheries bycatch. Accurate understanding of offshore distribution of seabirds is crucial to address this threat. Tracking technologies revolutionised insights into seabird distributions but tracking data may contain a variety of biases. We tracked two threatened seabirds (Salvin’s Albatross Thalassarche salvini n = 60 and Black Petrel Procellaria parkinsoni n = 46) from their breeding colonies in Aotearoa (New Zealand) to their non-breeding grounds in South America, including Peru, while simultaneously completing seven surveys in Peruvian waters. We then used species distribution models to predict occurrence and distribution using either data source alone, and both data sources combined. Results showed seasonal differences between estimates of occurrence and distribution when using data sources independently. Combining data resulted in more balanced insights into occurrence and distributions, and reduced uncertainty. Most notably, both species were predicted to occur in Peruvian waters during all four annual quarters: the northern Humboldt upwelling system for Salvin’s Albatross and northern continental shelf waters for Black Petrels. Our results highlighted that relying on a single data source may introduce biases into distribution estimates. Our tracking data might have contained ontological and/or colony-related biases (e.g. only breeding adults from one colony were tracked), while our survey data might have contained spatiotemporal biases (e.g. surveys were limited to waters <200 nm from the coast). We recommend combining data sources wherever possible to refine predictions of species distributions, which ultimately will improve fisheries bycatch management through better spatiotemporal understanding of risks.
Dietary behaviours and the food systems in which they occur have a significant impact on climate change. The 2022 Intergovernmental Panel on Climate Change (IPCC) reports and other major climate reports have identified population-level dietary shifts towards balanced, sustainable healthy diets as an important mitigation (i.e. prevention) solution for climate change. Thus, public health nutrition researchers and practitioners have a crucial role to play in combatting the climate crisis. They have the content expertise, interdisciplinary training and technical skills needed to facilitate wide-scale dietary behaviour changes at multiple levels of influence and ultimately improve both human and planetary health. This commentary article: (i) summarises how dietary behaviours and food systems contribute to climate change, with a particular focus on high-income countries; (ii) reviews food-system-related climate change mitigation solutions most relevant to public health nutrition researchers and practitioners; and (iii) identifies key gaps in the literature and future research directions for the field.