bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors Associated with Acute Hepatitis C in Mongolia
Authors: Chunt Munkhtsetseg , Luvsansharav Ulzii-Oshikh , Dugersuren tgon , Gombojamts Narantuya , Biedron Caitlin , Ganbold Sarangua , Dorjdamba Dorjpagma , Ganbaatar Khorolgarav , Jadambaa zarantuya , Jinnai Yuka , Drobeniuc Jan , Baggs James , Beckett Geoff , Bira Tsatsralt-Od , Smith Rachel 
Published: November 2020

Background: Hepatitis C virus (HCV) infection is endemic in Mongolia, with reported prevalence of HCV antibody (anti-HCV) positivity of 11%–16% in the adult population. Healthcare-related risk factors associated with development of acute HCV infection have not been evaluated in this population. Methods:We conducted a prospective, matched case-control study to identify risk factors associated with acute HCV infection in Ulaanbaatar, Mongolia. Cases were aged 18 years with discrete onset of symptoms consistent with acute viral hepatitis as well as jaundice or elevated serum alanine aminotransferase (ALT) levels who were admitted to the National Center for Communicable Diseases during January–October, 2019. Cases were both anti-HCV and HCV RNA positive and tested negative for acute hepatitis A, B, and E. Controls were randomly selected from the Population and Household Database, a national registry of all citizens, and were matched by age and gender. Data collection covered healthcare-associated and other risk factors in the 6 months before symptom onset (cases) or interview date (controls). Adjusted measures of association comparing cases and their matched controls were obtained using a multivariate conditional logistic regression model. Results: We enrolled 35 case patients and 104 controls. Median age of all participants was 44 (range, 23–63) years and 19% (27 of 139) were men. All case patients reported jaundice and loss of appetite; most cases reported nausea, malaise, and abdominal pain (97%, 91%, and 83%, respectively). The median ALT level among case patients was 1,185 IU/L (range, 212–3,349). Case patients were more likely than controls to have been admitted as inpatients (matched odds ratio [mOR], 4.3; 95% CI, 1.5–11.9), to have visited an outpatient clinic (mOR, 3.6; 95% CI, 1.3–10.2), to have had phlebotomy (mOR, 3.3; 95% CI, 1.5–7.5) or endoscopy (mOR, 10.7; 95% CI, 2.2–51.2) as an outpatient procedure, and to have received an injection outside of healthcare settings (mOR, 2.2; 95% CI, 1.0–5.1). Cases were also more likely to have lived in a yurt (mOR, 2.3; 95% CI, 1.0–5.0) and to have lived with persons diagnosed with HCV infection (mOR, 3.0; 95% CI, 1.1–7.9). In a multivariate model, only outpatient endoscopy (adjusted OR, 10.8; 95% CI, 1.7–69.6) was significantly associated with case status. Conclusions: This is the first study to evaluate risk factors for acute HCV infection among adults in Ulaanbaatar, Mongolia. Outpatient endoscopy was associated with new HCV infections in this population; evaluation of gaps in infection control practices at settings providing these services are needed to prevent transmission of communicable diseases, including hepatitis C.Funding: NoneDisclosures: None
Risk to Hospitals During a Community Hepatitis A Outbreak: Flipping the Perspective
Authors: Kressel Amy Beth , Swafford Katie 
Published: November 2020

Background: In February 2019, in the context of a nationwide community-based hepatitis A (HAV) outbreak, Eskenazi Health (EH), an acute-care hospital in Indianapolis, Indiana, identified a healthcare worker (HCW) with HAV who had potentially exposed patients via medicine administration. Objective: We began an investigation and mitigation plan to determine the source of the HAV and the risk to patients. Methods: The investigation and mitigation consisted of 6 measures. (1) We searched the electronic medical record (EMR) tracer report to determine whether any of the HCW’s patients had HAV during the incubation period (15–50 days prior to diagnosis) or were potentially exposed during the infectious period (0–14 days prior to diagnosis). 2. We searched the EMR and CHIRP (Indiana’s electronic vaccine database) for potentially exposed patients to determine HAV immunity or HAV vaccination (HAVx). (3) We contacted potentially exposed patients. (4) We communicated with public health partners. (5) We investiged other potential exposures. (6) We communicated with employees regarding free HAVx and the community HAV outbreak via e-mail newsletters (reaching almost 6,000 unique addresses) and posts on our internal website. Results: The HCW had not provided care for a patient with diagnosed HAV during the incubation period. The HCW had provided care for 14 patients during the infectious period. No potentially exposed patient had evidence of HAV immunity or HAVx in EMR or CHIRP. We initiated communication to all 14 patients or their surrogates regarding the potential exposure, symptoms of HAV, testing, and HAVx. We could confirm HAV testing for only 1 of 14 patients, and the result was negative. None of the 14 patients developed HAV. Public health partners confirmed notification of the HCW case. No further information about the HCW’s HAV source was determined. The HCW did not share community food at work. No workplace source of HAV was identified. HAVx dispensed at the pharmacy increased after communication about availability: December 2018–February 2019, 4 HAVx dispensed and March–May 2019, 82 HAVx dispensed. Conclusions: Traditionally, hospitals view infection risk in terms of HCWs acquiring infections from or spreading infections among patients. Viewed this way, the Indiana HAV community outbreak, although serious for the community, did not appear to be a threat to the hospital: HAV acquisition in hospitals has been rare, which is supported by our results. However, this episode demonstrates that the traditional view needs to be flipped: HCWs can bring community-acquired HAV into the hospital. Nudges can quickly increase HAVx uptake among HCWs.Funding: NoneDisclosures: None
Rotavirus Vaccination in the NICU: Where Are We? A Rapid Review of Recent Evidence
Authors: Sicard lanie , Bryant Kristina , Muller Martha , Quach Caroline 
Published: November 2020

Background: Rotavirus is a leading cause of viral acute gastroenteritis (AGE) in infants. Neonates hospitalized in neonatal intensive care units (NICUs) are at risk of rotavirus infections with severe outcomes. The administration of rotavirus vaccines is only recommended, in the United States and Canada, upon discharge from the NICU despite rotavirus vaccine being proven safe and effective in these populations, due to risks of live-attenuated vaccine administration in immunocompromised patients and theoretical risks of rotavirus vaccines strains shedding and transmission. We summarized recent evidence regarding rotavirus vaccines administration in the NICU setting and safety of rotavirus vaccines in preterm infants. Methods: We conducted a rapid review of the literature from the past 10 years, searching Medline and Embase, including all study types except reviews, reporting on rotavirus vaccine 1 and rotavirus vaccine 5; NICU setting; shedding or transmission; and/or safety in preterm. One reviewer performed data extraction and quality assessment. Results: In total, 31 articles were analyzed. Vaccine-derived virus shedding following rotavirus vaccination existed for nearly all infants, mostly during the first week after dose 1, with rare transmission described only in the household setting. No case of transmission in the NICU was reported. Adverse events were mild to moderate, occurring in 10%–60% of vaccinated infants. Extreme premature infants or with underlying gastrointestinal failure requiring surgery presented more severe adverse events. Conclusions: Recommendations regarding rotavirus vaccine administration in the NICU should be reassessed in light of the relative safety and absence of transmission of rotavirus vaccine strains in the NICU.Funding: NoneDisclosures: Sicard Mélanie: I reference the use of rotavirus vaccines in the NICU setting, which is not recommended; I discuss possible reassessment of these recommendations.
Scenario-Based, Interactive Infection Prevention and Control and Bloodborne Pathogen Education
Authors: Faller Rebecca , Sampathkumar Priya , Lande Lisa , Clarenbach Seth 
Published: November 2020

Background: Infection prevention and control (IPAC) and bloodborne pathogen (BBP) education are required for all healthcare workers at least annually by the Occupational Safety and Health Administration and The Joint Commission. An inventory in 2016 at a large health system with >60,000 employees identified 46 different training modules used to fulfill this regulatory mandate. Objective: Using quality improvement tools and management, we sought to reduce duplication of effort, to enhance education, and to improve employee engagement. Methods: A multidisciplinary team that included IPAC, physician, nursing, educational designn and occupational safety was formed. The team reviewed regulatory standards, cross checked site-specific practices, and identified gaps in the current training structure. The goal was to create a module with multiple pathways that tailored regulatory content and delivery to the employee’s job responsibilities (Figs. 1 and 2). Results: The 46 individual training modules were replaced with 1 module that averaged 24.46 minutes to complete. Branching was incorporated that customized education to the employee’s role. The employee completion rate was 99% (n = 61,456). The scenario-based interactive approach engaged learners by challenging them to respond to real-life activities tailored to their level of risk. Most responders (87.4%) rated the learning activity as “good” or “excellent,” and 92.4% of responders agreed or strongly agreed that the activities in the course aided their learning. Conclusions: We leveraged adult learning principles and industry-proven instructional design activities to deliver interactive and relevant infection control training that met regulatory requirements and engaged employees through action-driven tasks. In 2018, the work group created fast paths for employees who had previously completed this module whereby they could revisit the original content and/or focus only on updates and targeted areas of interest. A pathway for laboratory workers involved in specimen handling and processing is planned next.Funding: NoneDisclosures: None
Screening for Multidrug-Resistant Organisms in a Tertiary-Care University Hospital in the North West Bank: A Descriptive Study
Authors: Belkebir Souad , Kanaan Alaa , Jeetawi Rawan 
Published: November 2020

Background: The prevalence of multidrug-resistant organisms (MDROs) in acute healthcare settings is increasing worldwide. Active screening for MDROs carriers on admission permits the prompt implementation of the appropriate precautions to decrease the probability of cross transmission to other inpatients. Objective: To report the spectrum of bacterial nasal, axilla, and perianal colonization among in patients at Najah National University Hospital (NNUH) during 2018. Methods: A retrospective observational study was performed at NNUH, a tertiary-care referral university hospital in Nablus, north of Palestine, that includes medical and surgical ICUs for both adults and children from January to August 2018. Nasal, axilla, and perianal swabs were collected within the first 24 hours of admission according to hospital policy. Patients who were referred from another hospital, who were admitted to a hospital for at least 2 nights during the previous 8 months, and who are known to have an MDROs in the past were included. Swab samples were processed for isolation and identification of these multidrug-resistant strains. Transmission-based precautions were implemented if positive results were reported (ie, contact isolation) and decolonization regimens were applied according to the CDC recommendations (muporocin ointment for nasal MRSA, daily bathing with chlorhexidine 2% soap for the rest). A daily isolation list was circulated among bed managers and senior nurses and head of departments for appropriate management of beds and reallocation of patients. The antibiotic susceptibility pattern was assessed using the disc-diffusion method on Mueller–Hinton agar and a Vitek-2 system. Results: During the period of the study, 1,425 nasal swabs, 1,245 axilla swabs, and 300 perianal swabs were collected according to the inclusion criteria. Positive results were reportedin 7%, 4%, and 44% for nasal, axilla, and perianal specimens, respectively. Regarding the distribution of bacterial colonization in the nasal swab, 73% were MRSA; for the axial, 29% were Pseudomonas; and from the perianal swab, the most prevalent pathogen was ESBL (56%) (Figs. 1–3). A discrepancy between the number of nasal or axilla and perianal swabs was observed, which was mainly due to the refusal of many patients to have the sample collected by the nurse. Conclusions: Colonization of the skin and mucous membranes of inpatients with MDROs is considered a risk factor for developing future infections. Therefore, active screening for those pathogens is critical for infection prevention and control programs and patient safety in acute-care settings.Funding: NoneDisclosures: None
Secular Trends in Nosocomial Carbapenem-Resistant Enterobacteriaceae (CRE): Twenty-Five Years of Surveillance in Brazilian Hospitals
Authors: Ferreira Jose Antonio , Couto Braulio , Starling Carlos 
Published: November 2020

Background:
Enterobacteriaceae that develop resistance to carbapenems are a family of different types of bacteria that cause hospital-acquired infections. We evaluated the incidence of nosocomial infections caused by carbapenem-resistant Enterobacteriaceae (CRE) in 13 Brazilian hospitals over 25 years from 1995 to 2019. Methods: CRE was defined as Enterobacteriaceae that is nonsusceptible to any of the a carbapenem (doripenem, meropenem, or imipenem) AND is resistant to all of the following third-generation cephalosporins: ceftriaxone, cefotaxime, and ceftazidime. Hospital-acquired infections (HAIs) were diagnosed according to the CDC NHSN protocols in 13 hospitals from Belo Horizonte, Brazil, between January 1995 to June 2019. Results: In total, 33,922 HAIs caused by Enterobacteriaceae were diagnosed in 25 years across all 13 hospitals. The percentage of CRE varied among hospitals from a minimum of 3% in hospital to a maximum of 30% in hospital E (Fig. 2). The percentage of CRE varied along time as well: for 1995–1999, 0.1% (2 of 1,414) were CRE; for 2000–2004, 0.5% (28 of 5,160) were CRE; for 2005–2009, 2.0% (160 of 8,068) were CRE; for 2010–2014, 11.1% (971 of 8,771) were CRE; and for 2015–2019, 20.2% (2,127 of 10,509) were CRE (Fig. 1). ICU patients and elderly were the most affected by CRE, which has increased lethality, compared to non-CRE Enterobacteriaceae. Conclusions: Over 25 years, CRE percentage increase from almost zero in 1995–1999, to >20% in 2015–2019.Funding: NoneDisclosures: None
Self-Contamination and Failure Modes During PPE Doffing: A Comparison of Two Powered Air-Purifying Respirator Hoods
Authors: Erukunuakpor Kimberly , Kraft Colleen , Casanova Lisa 
Published: November 2020

Background: High-level personal protective equipment (PPE) protects healthcare workers (HCWs) during the care of patients with serious communicable diseases. Doffing body fluid–contaminated PPE presents a risk of self-contamination. A study assessing HCW failure modes and self-contamination with viruses during PPE doffing found that, of all PPE items, the highest number of doffing failure modes and highest self-contamination risk occurred during removal of the 1-layer powered air-purifying respirator (PAPR) hood. Hood type may affect contamination risk; however, no experimental evidence exists comparing hood types. Objective: We quantified and compared the risk of self-contamination with viruses during doffing of a 1e-layer versus a 2-layer PAPR hood. Methods: In this study, 8 HCWs with experience using high-level PPE donned PPE contaminated on 4 prespecified areas with 2 surrogate human viruses, bacteriophage MS2 (a nonenvelope virus) and Φ6 (an enveloped virus). They completed a clinical task then doffed PPE according to a standard protocol. Following doffing, inner gloves, hands, face, and scrubs were sampled for viral contamination using infectivity assays. HCWs performed the entire sequence twice, first with a 1-layer hood with 1 shroud then with a 2-layer hood with 2 shrouds. The Wilcoxon rank-sum test was used to compare viral contamination between the 2 hood types. HCWs were video-recorded to identify failure modes in their doffing process using a failure modes and effects analysis to identify ways that individual actions deviated from optimal behavior. Results: Φ6 transfer to hands, inner gloves, and scrubs were observed for 1 HCW using the 1-layer hood versus scrubs only for 1 HCW using the 2-layer hood. MS2 transfer to hands was observed for 2 HCWs using the 1-layer hood versus none using the 2-layer hood. Inner glove contamination was observed for 6 of 8 HCWs using the 1-layer hood versus 2 of 8 using the 2-layer hood. Conclusions: A significantly higher number of MS2 virus was recovered on the inner gloves of HCWs using the 1-layer versus the 2-layer hood (median difference, 2.27×104; P = .03). In addition, 31 failure modes were identified during removal of the 2-layer hood versus 13 failure modes for the 1-layer hood. The magnitude of self-contamination depends on the type of PAPR hood used. The 2-layer hood resulted in significantly less inner glove contamination than the 1-layer hood. However, more failure modes were identified during the doffing process for the 2-layer hood. In conclusion, the failure modes identified during the use of the 2-layer hood were less likely to result in self-contamination compared to the failure modes identified during use of the 1-layer hood.Funding: NoneDisclosures: None
Seroprevalence of Measles in Healthcare Workers in South Korea
Authors: Kim Sun Kyung , Jung Jiwon , Kwak Sun Hee , Hong Min Jee , Kim Eun Ok , Kim Sung-Han 
Published: November 2020

Background: Measles is a highly contagious disease that is transmissible by airborne particles but is preventable by vaccination. South Korea has maintained a highly immunized adult population; however, small local outbreaks of measles continued to occur, and there have been some reports of pockets of underimmunity among the young adult population. It is important to know the seroepidemiology of healthcare workers (HCWs) for policy-making process, but data on the seroprevalence of measles in HCWs in South Korea are limited. Methods: We investigated the seroprevalence of HCWs at Asan Medical Center, a 2,705-bed tertiary-care hospital in Seoul, South Korea, with 8,329 HCWs. In 2014, after an outbreak of measles occurred in a university in Seoul, Asan Medical Center required measles IgG tests for all HCWs born in and after 1967 for point-prevalence surveillance. In addition, we have routinely performed measles antibody test for new HCWs since 2014. In 2018, antibody tests were administered to HCWs who were born before 1967 or who had taken a leave of absence in 2014. We provided MMR vaccination to all HCWs whose antibody tests yielded negative results. Results: In total, 7,411 HCWs (89%) underwent measles antibody tests from 2014 to 2018. The overall seropositivity was 73% (95% CI, 72%–74%); seroprevalence was 73% in HCWs born in of after 1967, whereas the seroprevalence in HCWs born before 1967 was 98%. The seroprevalence sharply decreased from 85% in the 1986 birth cohort to 42% in the 1995 birth cohort. Conclusions: In conclusion, the proportion of measles-susceptible individuals was substantially high in HCWs, especially in young adults. Because the impact of measles outbreak in healthcare facilities would be critical, a policy regarding routine serologic screening followed by measles vaccination or routine measles vaccination in healthcare facilities should be considered, especially for young Korean HCWs.Funding: NoneDisclosures: None
Surgical Site Infections at a Level I Trauma Center in India: Data From an Indigenously Developed, e-SSI Surveillance System
Authors: Lohiya Ayush , Mittal Samarth , Trikha Vivek , Khurana Surbhi , Katyal Sonal , Sagar Sushma , Kumar Subodh , Malhotra Rajesh , Mathur Purva 
Published: November 2020

Background: Globally, surgical site infections (SSIs) not only complicate the surgeries but also lead to $5–10 billion excess health expenditures, along with the increased length of hospital stay. SSI rates have become a universal measure of quality in hospital-based surgical practice because they are probably the most preventable of all healthcare-associated infections. Although, many national regulatory bodies have made it mandatory to report SSI rates, the burden of SSI is still likely to be significant underestimated due to truncated SSI surveillance as well as underestimated postdischarge SSIs. A WHO survey found that in low- to middle-income countries, the incidence of SSIs ranged from 1.2 to 23.6 per 100 surgical procedures. This contrasted with rates between 1.2% and 5.2% in high-income countries. Objectives: We aimed to leverage the existing surveillance capacities at our tertiary-care hospital to estimate the incidence of SSIs in a cohort of trauma patients and to develop and validate an indigenously developed, electronic SSI surveillance system. Methods: A prospective cohort study was conducted at a 248-bed apex trauma center for 18 months. This project was a part of an ongoing multicenter study. The demographic details were recorded, and all the patients who underwent surgery (n = 770) were followed up until 90 days after discharge. The associations of occurrence of SSI and various clinico-microbiological variables were studied. Results: In total, 32 (4.2%) patients developed SSI. S. aureus (28.6%) were the predominant pathogen causing SSI, followed by E. coli (14.3%) and K. pneumoniae (14.3%). Among the patients who had SSI, higher SSI rates were associated in patients who were referred from other facilities (P = .03), had wound class-CC (P < .001), were on HBOT (P = .001), were not administered surgical antibiotics (P = .04), were not given antimicrobial coated sutures (P = .03) or advanced dressings (P = .02), had a resurgery (P < .001), had a higher duration of stay in hospital from admission to discharge (P = .002), as well as from procedure to discharge (P = .002). SSI was cured in only 16 patients (50%) by 90 days. SSI data collection, validation, and analyses are essential in developing countries like India. Thus, it is very crucial to implement a surveillance system and a system for reporting SSI rates to surgeons and conduct a robust postdischarge surveillance using trained and committed personnel to generate, apply, and report accurate SSI data.Funding: NoneDisclosures: None