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2080 Implementing and evaluating an evidence-based intervention from the intensive care unit (ICU) setting into primary care using promotoras to reduce CA-MRSA recurrence and household transmission
- Brianna M. D’Orazio, Jonathan N. Tobin, Rhonda G. Kost, Chamanara Khalida, Jessica Ramachandran, Mina Pastagia, Teresa H. Evering, Maria P. de la Gandara, Cameron Coffran, Joel Correa da Rosa, Kimberly Vasquez, Getaw W. Hassen, Franco Barsanti, Satoko Kanahara, Regina Hammock, Rosalee Nguyen, Mark Trezia, Trang Gisler, Herminia de Lencastre, Alexander Tomasz, Barry S. Coller
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- Journal:
- Journal of Clinical and Translational Science / Volume 2 / Issue S1 / June 2018
- Published online by Cambridge University Press:
- 21 November 2018, p. 71
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OBJECTIVES/SPECIFIC AIMS: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) recurrence ranges from 16% to 43% and presents significant challenges to clinicians, patients, and families. This comparative effectiveness research study aims to disseminate, implement and evaluate whether an existing intervention, consisting of decolonization and decontamination procedures, which has been determined to be effective in hospital intensive care unit settings, can be implemented by Community Health Workers (CHWs) or “promotoras” conducting home visits prevent recurrence of CA-MRSA and transmission within their households for patients presenting to primary care with SSTIs. METHODS/STUDY POPULATION: In partnership with 3 Community Health Centers and 4 community hospitals in NYC, this study will recruit patients (n=278) with confirmed MRSA SSTIs and their household members. Participants are randomized to receive either a CHW/Promotora-delivered decolonization-decontamination intervention or usual care, which includes hygiene education. The highly engaged stakeholder team meets monthly to review interim results, identify areas for refinement and new research questions, and develop and implement strategies to improve participant engagement and retention. RESULTS/ANTICIPATED RESULTS: MRSA and MSSA were found in 19% and 21.1% of wound cultures, respectively. 59.5% with MRSA+ wound culture had one or more MRSA+ surveillance culture; 67.8% with MSSA+ wound culture had one or more MSSA+ surveillance culture. The “warm handoff” approach, developed and implemented by the stakeholder team to engage patients from their initial consent to return of lab results and scheduling of the home visits, helped improve completion of baseline home visits by 14%, from 45% to 59% of eligible participants. Home visits have demonstrated that 60% of households had at least one surface contaminated with S. aureus. Of the surfaces that tested positive in the households, nearly 20% were MRSA and 81% were MSSA; 32.5% of household members had at least one surveillance culture positive for S. aureus (MRSA: 7.7%, MSSA: 92.3%). DISCUSSION/SIGNIFICANCE OF IMPACT: This study aims to understand the systems-level, patient-level, and environmental-level factors associated with SSTI recurrence and household transmission, and to examine the interactions between bacterial genotypic and clinical/phenotypic factors on decontamination, decolonization, SSTI recurrence and household transmission. This study will evaluate the barriers and facilitators of implementation of home visits by CHWs in underserved populations, and aims to strengthen the weak evidence base for implementation of strategies to reduce SSTI recurrence and household transmission.
Mercury-arsenic sulfosalts from the Apuan Alps (Tuscany, Italy). II. Arsiccioite, AgHg2TlAs2S6, a new mineral from the Monte Arsiccio mine: occurrence, crystal structure and crystal chemistry of the routhierite isotypic series
- C. Biagioni, E. Bonaccorsi, Y. Moëlo, P. Orlandi, L. Bindi, M. D’Orazio, S. Vezzoni
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- Journal:
- Mineralogical Magazine / Volume 78 / Issue 1 / February 2014
- Published online by Cambridge University Press:
- 05 July 2018, pp. 101-117
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The new mineral species arsiccioite, AgHg2TlAs2S6, was discovered in the baryte-pyrite-iron oxide ore deposit exploited at the Monte Arsiccio mine, near Sant’Anna di Stazzema (Apuan Alps, Tuscany, Italy). It occurs as anhedral grains scattered in microcrystalline baryte, associated with cinnabar, laffittite, protochabournéite, pyrite, realgar, Hg-bearing sphalerite and stibnite. Arsiccioite is red, with a metallic to sub-metallic lustre. Minimum and maximum reflectance data for COM wavelengths in air are [λ (nm): R (%)]: 471.1: 29.0/29.4; 548.3: 27.6/28.3; 586.6: 26.1/26.5; 652.3: 24.2/24.6. Electron microprobe analyses give (wt.%): Cu 0.78(6), Ag 8.68(21), Zn 0.47(27), Fe 0.04(1), Hg 35.36(87), Cd 0.20(5), Tl 18.79(33), As 10.77(19), Sb 4.75(10), S 18.08(21), Se 0.07(5), total 97.99(44). On the basis of ΣMe = 6 a.p.f.u., the chemical formula is Ag0.87(2)Cu0.13(1)Zn0.08(4)Fe0.01(1)Hg1.91(5)Cd0.02(1)Tl1.00(2) (As1.56(2)Sb0.42(1))S1.98S6.12(6)Se0.01(1). Arsiccioite is tetragonal, I2m, with a 10.1386(6), c 11.3441(5) Å, V 1166.1(2) Å3, Z = 4. The main diffraction lines of the powder diagram are [d(in Å), visually estimated intensity, hkl]: 4.195, m, 211; 3.542, m, 103; 3.025, vs, 222; 2.636, m, 114; 2.518, s, 400 and 303. The crystal structure of arsiccioite has been refined by single-crystal X-ray data to a final R1 = 0.030, on the basis of 893 observed reflections. It shows a three dimensional framework of (Hg,Ag)- centred tetrahedra (1 M1 + 2 M2), with channels parallel to [001] hosting TlS6 and (As,Sb)S3 disymmetric polyhedra. Arsiccioite is derived from its isotype routhierite M1CuM2Hg2TlAs2S6 through the double heterovalent substitution M1Cu+ + M2Hg2+ → M1Hg2+ + M2Ag+. This substitution obeys a steric constraint, with Ag+, the largest cation relative to Hg2+ and Cu+, entering the largest M2 site. The ideal crystal chemical formula of arsiccioite is M1HgM2(Hg0.5Ag0.5)2TlAs2S6. The crystal chemistry of the routhierite isotypic series is discussed. Finally, the distribution of Hg ore minerals in the Apuan Alps is reviewed.
2424: National trends in ambulatory Versus emergency department visits for low-income patients with skin and soft tissue infections
- Brianna M. D’Orazio, Joel Correa da Rosa, Jonathan N. Tobin
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- Journal:
- Journal of Clinical and Translational Science / Volume 1 / Issue S1 / September 2017
- Published online by Cambridge University Press:
- 10 May 2018, p. 78
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OBJECTIVES/SPECIFIC AIMS: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) recurrence ranges from 16% to 43% and presents significant challenges to clinicians, patients, and families. The number of emergency department visits for SSTIs increased from 1993 to 2005 from 0.48 to 1.16 ED visits per 100 US residents (95% CI 0.94 to 1.39; p<0.001); high safety-net status EDs saw a 4-fold increase in visits. The CA-MRSA Project (CAMP2) comparative effectiveness research (CER) study aims to evaluate a home-based intervention implemented by Community Health Workers (CHWs) or “promotoras” to prevent recurrence and transmission of CA-MRSA in primarily low-income, minority patients presenting to primary care with SSTIs. The intervention disseminates and implements methods found effective in the REDUCE MRSA trial. The present analysis was conducted using publically available data set to characterize the national patterns of healthcare utilization for treatment of SSTIs. METHODS/STUDY POPULATION: An analysis was conducted using data downloaded from the CDC National Ambulatory Medical Care Survey (NAMCS) and the CDC National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2012 (most recent data available) to evaluate the addition of Emergency Departments (EDs) as compared to Ambulatory Care as recruitment sources for a clinical trial to reduce CA-MRSA SSTI recurrence and household transmission. “Low-income” population was defined using “Expected Source of Payment” categories “Medicaid” and “Uninsured,” and ICD-9-CM dermatologic diagnosis codes for SSTIs and ICD-9-CM Procedure Codes for Incision and Drainage (I&D) were used to define a visit for SSTI treatment. RESULTS/ANTICIPATED RESULTS: In all patients, I&D was performed at a higher rate in EDs as compared with the ambulatory care setting (49.57 vs. 1.44 per 10,000 US residents in Medicaid and Uninsured; 44.48 vs. 5.24 per 10,000 US residents in all other insurance types). Nationally, low-income patients are 4 times more likely to have I&D procedure performed (OR 4.05, 95% CI 0.614–26.759, p<0.0001) and 5 times more likely to be diagnosed with an SSTI (OR 5.10, 95% CI 2.987–8.707, p<0.001) in the ED setting. DISCUSSION/SIGNIFICANCE OF IMPACT: These results confirm that low income patients seek primary care for SSTIs in both EDs and ambulatory care, such as Federally Qualified Health Centers (FQHCs). This also confirms the trend we have experienced in FQHCs in NYC, many of whom refer patients to the ED for the I&D procedure, and those patients return to the FQHC for follow-up. Thus, the most comprehensive test of using CHWs to disseminate and implement the findings from the REDUCE MRSA trial would engage both EDs and Ambulatory Care/FQHCs for patient identification and recruitment.
2421: Patient and household member colonization and environmental contamination with Staphylococcus aureus in a comparative effectiveness study of home-based interventions to reduce CA-MRSA recurrence and household transmission
- Jonathan N. Tobin, Rhonda G. Kost, Brianna M. D’Orazio, Chamanara Khalida, Jessica Ramachandran, Mina Pastagia, Teresa H. Evering, Maria Pardos de la Gandara, Cameron Coffran, Joel Correa da Rosa, Kimberly Vasquez, Getaw Worku Hassen, Tracie Urba
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- Journal:
- Journal of Clinical and Translational Science / Volume 1 / Issue S1 / September 2017
- Published online by Cambridge University Press:
- 10 May 2018, p. 77
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OBJECTIVES/SPECIFIC AIMS: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) are commonly seen in primary care, with recurrence rates that range from 16% to 43%, and present significant challenges to clinicians, patients, and families. This comparative effectiveness research study aims to develop and evaluate a home-based intervention implemented by Community Health Workers (CHWs) or “promotoras” to prevent recurrence of CA-MRSA in patients presenting to primary care with SSTIs and transmission within their households. This presentation will examine associations between wound microbiology, clinical presentation, and housing characteristics, including housing density and household surfaces contamination. METHODS/STUDY POPULATION: In partnership with 3 Community Health Centers and 3 community hospitals in NYC, this study will recruit patients (n=278) with confirmed MRSA SSTIs and their household members. Participants will be randomized to receive either a CHW/Promotora-delivered decolonization-decontamination intervention (based on the REDUCE MRSA trial) or usual care. The highly engaged stakeholder team finalized the intervention protocol, developed and implemented CHW and clinician training, and developed an online health portal application for data management and exchange. RESULTS/ANTICIPATED RESULTS: We have collected 923 isolates from 237 individuals, including 240 wound culture isolates and 683 surveillance culture isolates (nares, axilla, groin). MRSA and MSSA were found in 19% and 21.1% of wound cultures, respectively; 59.5% with MRSA+ wound culture had 1 or more MRSA+ surveillance culture; 67.8% with MSSA+ wound culture had 1 or more MSSA+ surveillance culture. Of those with MRSA or MSSA infections, 70% of subjects were male, with an average age of 37.9 (SD=15.9 y). The most frequent sites of infection were the leg (20%), axilla (18%), buttock (17%), and abdomen/torso (12%). There was no association between the location and type of infection (MRSA/MSSA) (p-value=0.09). The kitchen floor (14.05%) and bedroom floor (14%) were the most common surfaces contaminated with MRSA. These were also the most common surfaces contaminated with MSSA, which was recovered from 10.2% and 9.1% of kitchen floors and bedroom floors, respectively. For individuals with an MRSA or MSSA wound infection, there was an average number of 3.2 (SD=1.6) co-residents per household, and 36.5% of household members were colonized with either MRSA or MSSA. There is no association between household density (number of co-residents) and type of infection (MRSA/MSSA) (Fisher’s p-values=0.171 and 0.371, respectively). In households of participants with MSSA wound infections, the number of colonized sites is positively associated with the level of household MSSA contamination (p=0.027). Further analyses will examine the associations between molecular subtypes, wound location, household surface contamination and household member colonization and infection. DISCUSSION/SIGNIFICANCE OF IMPACT: This study aims to understand the patient-level and environmental-level factors associated with SSTI recurrence, surface contamination and household transmission, and to examine the interactions between bacterial genotypic and clinical/phenotypic factors on decontamination, decolonization, SSTI recurrence and household transmission. This study will evaluate the barriers and facilitators to implementation of home visits by CHWs in underserved populations, and aims to strengthen the evidence base for implementation of strategies to identify and reduce household reservoirs and then control SSTI recurrence and household transmission.