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The seroprevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) IgG antibody was evaluated among employees of a Veterans Affairs healthcare system to assess potential risk factors for transmission and infection.
All employees were invited to participate in a questionnaire and serological survey to detect antibodies to SARS-CoV-2 as part of a facility-wide quality improvement and infection prevention initiative regardless of clinical or nonclinical duties. The initiative was conducted from June 8 to July 8, 2020.
Of the 2,900 employees, 51% participated in the study, revealing a positive SARS-CoV-2 seroprevalence of 4.9% (72 of 1,476; 95% CI, 3.8%–6.1%). There were no statistically significant differences in the presence of antibody based on gender, age, frontline worker status, job title, performance of aerosol-generating procedures, or exposure to known patients with coronavirus infectious disease 2019 (COVID-19) within the hospital. Employees who reported exposure to a known COVID-19 case outside work had a significantly higher seroprevalence at 14.8% (23 of 155) compared to those who did not 3.7% (48 of 1,296; OR, 4.53; 95% CI, 2.67–7.68; P < .0001). Notably, 29% of seropositive employees reported no history of symptoms for SARS-CoV-2 infection.
The seroprevalence of SARS-CoV-2 among employees was not significantly different among those who provided direct patient care and those who did not, suggesting that facility-wide infection control measures were effective. Employees who reported direct personal contact with COVID-19–positive persons outside work were more likely to have SARS-CoV-2 antibodies. Employee exposure to SARS-CoV-2 outside work may introduce infection into hospitals.
To directly observe healthcare workers in a nursing home setting to measure frequency and duration of resident contact and infection prevention behavior as a factor of isolation practice
SETTING AND PARTICIPANTS
Healthcare workers in 8 VA nursing homes in Florida, Maryland, Massachusetts, Michigan, Washington, and Texas
Over a 15-month period, trained research staff without clinical responsibilities on the units observed nursing home resident room activity for 15–30-minute intervals. Observers recorded time of entry and exit, isolation status, visitor type (staff, visitor, etc), hand hygiene, use of gloves and gowns, and activities performed in the room when visible.
A total of 999 hours of observation were conducted across 8 VA nursing homes during which 4,325 visits were observed. Residents in isolation received an average of 4.73 visits per hour of observation compared with 4.21 for nonisolation residents (P<.01), a 12.4% increase in visits for residents in isolation. Residents in isolation received an average of 3.53 resident care activities per hour of observation, compared with 2.46 for residents not in isolation (P<.01). For residents in isolation, compliance was 34% for gowns and 58% for gloves. Healthcare worker hand hygiene compliance was 45% versus 44% (P=.79) on entry and 66% versus 55% (P<.01) on exit for isolation and nonisolation rooms, respectively.
Healthcare workers visited residents in isolation more frequently, likely because they required greater assistance. Compliance with gowns and gloves for isolation was limited in the nursing home setting. Adherence to hand hygiene also was less than optimal, regardless of isolation status of residents.
Treatment of staphylococcal infection is dependent on the site involved, the severity of infection, and the antibiotic susceptibility pattern of the organism causing the infection. Although most serious staphylococcal infections are due to coagulase-positive staphylococci (Staphylococcus aureus), infections due to coagulase-negative staphylococci (e.g., Staphylococcus epidermidis) are increasing and may also be life threatening. S. aureus is a highly invasive pathogen, able to spread hematogenously to many organs, leading to metastatic foci of infection. Coagulase-negative staphylococci are generally healthcare-associated infections that require the presence of prosthetic material to gain a foothold and cause infection.
Susceptibility to antibiotics
Staphylococci have a propensity to develop resistance to antibiotics relatively quickly. Most staphylococci are no longer susceptible to the effects of penicillins alone because the bacteria produce enzymes or penicillinases that inactivate many of those drugs. One approach to the problem of antibiotic resistance in staphylococci has been the use of penicillinase-resistant penicillins, e.g., nafcillin, oxacillin, and methicillin. Alternatively, penicillins have been combined with inhibitors of penicillinase. Examples of penicillin–penicillinase-inhibitor combinations include: amoxicillin-clavulanate (Augmentin), ampicillin–sulbactam (Unasyn), piperacillin–tazobactam (Zosyn), and ticarcillin–clavulanate (Timentin). The penicillinase-resistant penicillins and penicillin–penicillinase-inhibitor combinations are effective for the treatment of penicillin-resistant, but methicillin-susceptible, staphylococci.
Other β-lactam antibiotics are also useful for the treatment of methicillin-susceptible staphylococci. First-generation cephalosporins (cefazolin, cephalexin) are the most active, followed by secondgeneration agents (cefuroxime, cefotetan, cefoxitin).
Infection surveillance definitions for long-term care facilities (ie, the McGeer Criteria) have not been updated since 1991. An expert consensus panel modified these definitions on the basis of a structured review of the literature. Significant changes were made to the criteria defining urinary tract and respiratory tract infections. New definitions were added for norovirus gastroenteritis and Clostridum difficile infections.
Treatment of staphylococcal infection is dependent on the site involved, the severity of infection, and the antibiotic susceptibility pattern of the organism causing the infection. Although most serious staphylococcal infections are due to coagulase-positive staphylococci (Staphylococcus aureus), infections due to coagulase-negative staphylococci (eg, Staphylococcus epidermidis) are increasing and may also be life threatening. Staphylococcus aureus is a highly invasive pathogen, able to spread hematogenously to many organs, leading to metastatic foci of infection. Coagulase-negative staphylococci generally require the presence of prosthetic material to gain a foothold and cause infection.
SUSCEPTIBILITY TO ANTIBIOTICS
Staphylococci have a propensity to develop resistance to antibiotics relatively quickly. Virtually all staphylococci should be considered to be resistant to penicillins that are susceptible to penicillinase (eg, amoxicillin, ampicillin, piperacillin, mezlocillin, and ticarcillin). However, the addition of clavulanic acid, sulbactam, or tazobactam to several of the above penicillins renders them resistant to penicillinase and thus useful for treating staphylococcal infections. Examples are amoxicillin–clavulanic acid (Augmentin), ampicillin–sulbactam (Unasyn), pipercillin–tazobactam (Zosyn), and ticarcillin–clavulanic acid (Timentin).
Cephalosporins are useful for the treatment of staphylococcal infections. First-generation cephalosporins (cefazolin, cephalexin) are the most active, followed by second-generation agents (cefuroxime, cefotetan, cefoxitin). Third-generation (ceftriaxone, cefotaxime) and fourth-generation (cefipime) cephalosporins have less activity. Only first-generation cephalosporins should be used for serious staphylococcal infections.
Persistent colonization with Staphylococcus aureus was assessed in 22 nursing home residents. Eighteen residents (82%) remained colonized with the same strain found at baseline; 6 (33%) of 18 residents transiently acquired a new strain. Four residents (18%) acquired a new persistent strain. Residents colonized with methicillin-resistant S. aureus were more likely to acquire a new strain (67%) than were residents colonized with methicillin-susceptible S. aureus (20%) (P = .04).
Influenza causes substantial morbidity and mortality annually, particularly in high-risk groups such as the elderly, young children, immunosuppressed individuals, and individuals with chronic illnesses. Healthcare-associated transmission of influenza contributes to this burden but is often under-recognized except in the setting of large outbreaks. The Centers for Disease Control and Prevention has recommended annual influenza vaccination for healthcare workers (HCWs) with direct patient contact since 1984 and for all HCWs since 1993. The rationale for these recommendations is to reduce the chance that HCWs serve as vectors for healthcare-associated influenza due to their close contact with high-risk patients and to enhance both HCW and patient safety. Despite these recommendations as well as the effectiveness of interventions designed to increase HCW vaccination rates, the percentage of HCWs vaccinated annually remains unacceptably low. Ironically, at the same time that campaigns have sought to increase HCW vaccination rates, vaccine shortages, such as the shortage during the 2004-2005 influenza season, present challenges regarding allocation of available vaccine supplies to both patients and HCWs. This two-part document outlines the position of the Society for Healthcare Epidemiology of America on influenza vaccination for HCWs and provides guidance for the allocation of influenza vaccine to HCWs during a vaccine shortage based on influenza transmission routes and the essential need for a practical and adaptive strategy for allocation. These recommendations apply to all types of healthcare facilities, including acute care hospitals, long-term-care facilities, and ambulatory care settings.
To examine the impact of introduction of an alcohol-based hand rub on hand hygiene knowledge and compliance and hand colonization of healthcare workers (HCWs) in a long-term-care facility (LTCF).
Two floors of an LTCF participated. Ward A used the hand rub as an adjunct to soap and water; ward B was the control. HCWs' hands were cultured using the bag-broth technique for Staphylococcus aureus, gram-negative bacilli (GNB), Candida, and vancomycin-resistant enterococci (VRE). HCWs completed a questionnaire at baseline and after an educational intervention and introduction of rub.
Hand hygiene practices, knowledge, and opinions did not change after the educational or rub intervention. Ward A HCWs thought that the rub was faster (P = .002) and less drying (P = .04) than soap. Hand hygiene frequency did not differ at baseline between the two floors, but increased on ward A by the end of the study (P = .04). HCWs were colonized frequently with GNB (66%), Candida (41%), S. aureus (20%), and VRE (9%). Although colonization did not change from baseline on either ward, the rub was more effective in clearing GNB (P = .03) and S. aureus (P = .003). Nosocomial infection rates did not change.
The alcohol-based hand rub was a faster, more convenient, less drying method of hand hygiene for HCWs in an LTCF, and it improved compliance. Although microbial colonization did not change, the rub was more efficacious in removing pathogens already present on the hands of HCWs.
Antimicrobial agents are among the most frequently prescribed medications in long-term–care facilities (LTCFs). Therefore, it is not surprising that Clostridium difficile colonization and C. difficile-associated diarrhea (CDAD) occur commonly in elderly LTCF residents. C. difficile has been identified as the most common cause of non-epidemic acute diarrheal illness in nursing homes, and outbreaks of CDAD in LTCFs have also been recognized. This position paper reviews the epidemiology and clinical features of CDAD in elderly residents of LTCFs and, using available evidence, provides recommendations for the management of C. difficile in this setting.