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Environmental factors associated with invasive mold infections at a tertiary-care hospital
- Lindsey Tully, Schuyler L. Gaillard, Lucy Zheng, Tara Millson, Princy Kumar, Joseph Timpone
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, p. s88
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Background: Invasive mold infections (IMIs) in hospitalized patients can result in significant morbidity and mortality. Environmental factors, such as hospital construction and negative air-pressure rooms (NAPRs), have been associated with hospital-acquired IMI. Increased utilization of NAPRs during the COVID-19 pandemic created a unique opportunity to examine the impact of NAPRs on IMI risk. Methods: From 2018 to present, a new pavilion was being constructed adjacent to our hospital. The Theradoc platform was used to identify positive mold cultures among adult patients hospitalized at our institution between March 1, 2017, and October 15, 2022. We performed a retrospective chart review of 262 mold isolates to determine patient demographics, timing of IMI, and their relationship to hospital construction and exposure to NAPR. IMI incidence was compared across 3 observation periods: (A) before hospital construction; (B) during hospital construction alone; and (C) during hospital construction and NAPR enhancement during the COVID-19 surge. Hospital-acquired IMI was defined as an infection that occurred >72 hours after admission. A REDCap database was created for data storage and R software was used for data analysis. Results: Of the 262 mold isolates identified, 61 cases were classified as IMI, of which 29 were hospital-acquired IMI. The mean age of IMI patients was 51.8 years, and 55.2% were male. Among them, 20.7% were exposed to NAPR during admission; 65.5.% were immunocompromised; and 2 patients were diagnosed with COVID-19. The all-cause mortality rate among hospital-acquired IMI cases was 79.3% (23 of 29). Also, 82.8% of hospital-acquired IMI cases were respiratory in nature, with 83.3% of these cases due to Aspergillus spp. Yearly rates of hospital-acquired IMI were 3.0 before construction versus 5.6 during construction (periods B and C). Yearly rates of hospital-acquired IMI, respiratory IMI, and invasive pulmonary aspergillosis by period were as follows: Period A had 3 hospital-acquired IMI cases per year, 2 hospital-acquired respiratory IMI cases per year, and 3 hospital-acquired invasive pulmonary aspergillosis cases per year. Period B had 4.5 hospital-acquired IMI cases per year, 3.5 hospital-acquired respiratory IMI cases per year, and 3.0 hospital-acquired invasive pulmonary aspergillosis cases per year. Period C had 6.5 hospital-acquired IMI cases per year, 5.4 hospital-acquired respiratory IMI cases per year, and 5.0 hospital-acquired invasive pulmonary aspergillosis cases per year. Conclusions: Hospital-acquired IMI was associated with a high mortality. Our data demonstrate a >2-fold increase in yearly incidence of hospital-acquired IMI before construction compared with during construction in association with increased implementation of NAPR. We have now reversed the trend in NAPR at our hospital’s designated COVID-19 units.
Disclosures: None
Characteristics of Long-Term Care Hospital Ventilator-Associated Events, National Healthcare Safety Network, 2016–2018
- Cheri Grigg, Allan Nkwata, Cindy Gross, Tara Millson, Krista Powell, Shelley Magill
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s163-s164
- Print publication:
- October 2020
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Background: Ventilator-associated event (VAE) reporting to the CDC NHSN began in 2013. VAE reporting from long-term care hospitals (LTCHs) to the NHSN was required from January 2016 through September 2018 as part of the CMS LTCH Quality Reporting Program (QRP). We describe the incidence and characteristics of LTCH VAEs during the required reporting period. Methods: We analyzed VAE data reported to the NHSN from January 2016 through December 2018, from the LTCH ward and critical care locations participating in surveillance according to the NHSN protocol. We have described characteristics of VAE, and we determined the distribution of VAE types: ventilator-associated conditions (VAC), infection-related ventilator-associated complications (IVAC), and possible ventilator-associated pneumonia (PVAP). Furthermore, we calculated pooled mean VAE rates per 1,000 ventilator days, and we determined the rate distributions for locations with ≥20 units reporting >50 ventilator days per year. Results: Overall, 493 LTCHs reported 22,359 location months of VAE data from ward and critical care locations. In total, 5,290 VAEs were reported, of which 3,871 (73%) were VAC, 961 (18%) were IVAC, and 458 (9%) were PVAP. Also, 42% (2,241) of VAEs occurred in female patients, and 1,305 (25%) occurred in patients who died during their hospitalization. The median time from LTCH admission to VAE onset was 18 days (IQR, 9–37), and from initiation of mechanical ventilation to VAE onset was 22 days (IQR, 10–43). Pathogens were identified from 454 PVAPs, with Pseudomonas aeruginosa (43% of PVAPs) and Staphylococcus aureus (26%) being the most common organisms. Annual pooled mean incidence rates in critical care locations ranged from 2.11 to 2.62 VAEs per 1,000 ventilator days, whereas rates in ward locations ranged from 1.36 to 1.67 VAEs per 1,000 ventilator days (Table 1). Conclusions: During a period of required reporting, pooled mean LTCH VAE rates remained low. Most VAEs in LTCHs were reported as VACs. Additional work is needed to understand the clinical events associated with LTCH VAE, including whether most VAEs truly represent non–infection-related events or reflect limited evaluation to identify infection-related complications. This distinction might influence the identification of appropriate interventions to reduce LTCH VAE rates.
Funding: None
Disclosures: None