Background: Infection Prevention (IP) practices in ambulatory care are often reactive and many communicable diseases in the community often do not fall onto IP’s radar until the patient becomes ill enough to seek inpatient services. The gap between ambulatory and inpatient care can lead to increased transmission and illness severity. Early identification has substantial impacts on timely implementation of IP mitigation strategies, appropriate handoff upon entry into other care settings, and timely reporting to public health organizations. Current IP processes underutilize electronic health record (EHR) capabilities by relying upon lab driven notifications. This project sought to redesign the IP’s workflows, advancing the health system beyond the acute care setting and into the ambulatory care setting by adding the power of diagnosis codes to close a practice gap. Method: Infection Prevention and Information Technology collaborated to build silent best practice advisories (BPAs) in the EHR that utilized diagnosis codes related to Varicella zoster (VZV) infection charted by ambulatory care providers. These BPAs function by triggering infection statuses that populate the patient chart and include instructions to front line staff on personal protective equipment (PPE) requirements. These BPAs also trigger real-time notifications to the IP team to determine the validity of the infection status and exposure work-up necessity. Chart reviews of diagnosis codes utilized in pre and post intervention timeframes were completed to understand the impact of the silent BPAs. Percentages of patients captured, and Healthcare Worker (HCW) exposure reviews reported were evaluated to demonstrate effectiveness. Plan, Do, Study, Act (PDSA) was utilized to respond to gaps, increase efficiency, and limit erroneous infection statuses. Result: The one-year pre-intervention period revealed 36 total diagnosis codes used for Varicella zoster (VZV) infection; 3% of these infection cases were captured and 4% of eligible cases were reported for HCW exposure review. The one-year post intervention period revealed 40 total diagnosis codes used for VZV infection; 80% of these infection cases were captured and 70% of eligible cases were reported for HCW exposure review. PDSA quality improvement cycles allowed for refinement of the BPA logic that further increased infection cases captured to 100% with 100% of eligible cases reported for HCW exposure review. Conclusion: Utilizing the EHR, the organization appreciated enhanced identification of patients in real-time with VZV infection that allowed for appropriate mitigation strategies to be implemented. This proactive workflow design helps minimize the risk of transmission between ambulatory and acute settings and facilitated HCW exposure reviews.

Firearm violence has soared in American cities, but most states statutorily preempt municipal firearm regulation. This article describes a unique collaboration in Philadelphia among elected officials, public health researchers, and attorneys that has led to litigation based on original quantitative analyses and grounded in innovative constitutional theories and statutory interpretation.

We perceive loss by tracing the contours of what we invent in its place. When a work of art invites spectators to engage with it, it offers them an opportunity to process loss. Such artworks can be theatrical, visual, or architectural—like a public memorial; what unites them is the experience of the spectator. Individual and personal experiences of grief connect with the social expressions of large-scale loss when the one shows up, fractal-like, in the details of the other.

Prenatal hypoxia is a common complication of pregnancy and is associated with detrimental health outcomes, such as impaired cardiac and vascular function, in adult offspring. Exposure to prenatal hypoxia reportedly impacts the reproductive system of female offspring. Whether exposure to prenatal hypoxia influences pregnancy adaptations and outcomes in these female offspring is unknown. We hypothesised that prenatal hypoxia impairs uterine artery adaptations in pregnancies of the adult offspring. Pregnancy outcomes and uterine artery function were assessed in 14–16 weeks old non-pregnant and late pregnant (gestational day 20; term = 22 days) adult female offspring born to rats exposed to prenatal normoxia (21% oxygen) or hypoxia (11% oxygen, between days 15–21 of gestation). Compared with normoxia controls, prenatal hypoxia was associated with pregnant adult offspring having reduced placental weights in their litters, and uterine artery circumferential stress that increased with pregnancy. Overall, prenatal hypoxia adversely, albeit mildly, compromised pregnancies of adult offspring.

Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC.

The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.

The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.

Background: Well-designed infection prevention programs include basic elements aimed at reducing the risk of transmission of infectious agents in healthcare settings. Although most acute-care facilities have robust infection prevention programs, data are sporadic and often lacking in other healthcare settings. Infection control assessment tools were developed by the CDC to assist health departments in assessing infection prevention preparedness across a wide spectrum of health care including acute care, long-term care, outpatient care, and hemodialysis. Methods: The North Carolina Division of Public Health collaborated with the North Carolina Statewide Program for Infection Control and Epidemiology (SPICE) to conduct a targeted number of on-site assessments for each healthcare setting. Three experienced infection preventionists recruited facilities, conducted on-site assessments, provided detailed assessment findings, and developed educational resources. Results: The goal of 250 assessments was exceeded, with 277 on-site assessments completed across 75% of North Carolina counties (Table 1). Compliance with key observations varied by domain and type of care setting (Table 2). Conclusions: Comprehensive on-site assessments of infection prevention programs are an effective way to identify gaps or breaches in infection prevention practices. Gaps identified in acute care primarily related to competency validation: however, gaps presenting a threat to patient safety (ie, reuse of single dose vials, noncompliance with sterilization and/or high-level disinfection processes) were identified in other care settings. Infection control assessment and response findings underscore the need for ongoing assessment, education, and collaboration among all healthcare settings.

Funding: None

Disclosures: None

Background: In 2017, the IDSA and the SHEA released updated Clostridium difficile practice guidelines. Implementing institutionally accepted criteria for identifying clinically appropriate patients for testing was endorsed. When utilizing NAAT as the sole laboratory testing methodology, testing clinically symptomatic patients is important to reduce inappropriate treatment of C. difficile colonization. C. difficile rates at a regional community health system were higher than expected, and patient case reviews identified inappropriate patient testing as an issue. Therefore, the infection prevention team sought to optimize and standardize protocols surrounding appropriate patient selection for C. difficile testing. Methods: Current recommendations were evaluated, and processes formulated to implement an innovative process to support our clinicians in identifying clinically appropriate patients to test for C. difficile infection. The electronic decision support is summarized as a bundled approach with 4 best practice alerts that incorporate algorithms that warn providers of potentially inappropriate testing scenarios. These alerts include the following criteria: (1) a laxative having been administered within 48 hours of attempted order, (2) a negative test resulted within 7 days, (3) a positive test resulted within 14 days, and (4) identification of patients at high risk for C. difficile infection (based on recent long-term care facility exposure, recent inpatient hospital visits, recent antimicrobial therapy). Outcomes of our acute-care hospitals were monitored by real-time evaluation of each hospital’s quarterly C. difficile LabID standardized infection ratio (SIR) as defined by the NHSN. For statistical analyses, the cumulative second and third quarters of 2018 (before the intervention) were compared to the cumulative second and third quarters of 2019 to account for seasonality of C. difficile infections. Results: Utilizing the NHSN statistical calculator to compare 2 SIRs, there was a statistically significant decrease (P = .0026) in the largest hospital’s C. difficile LabID SIR when comparing representative preintervention cumulative quarters to the postintervention cumulative quarters. Although the other hospitals did not see a statistically significant decrease in their C. difficile LabID SIR, a clinically significant decrease was appreciated for 2 of our hospitals. Conclusions: Electronic health record–based decision support helps clinicians identify clinically appropriate patients to test by NAAT alone for C. difficile infection. By limiting the number of patients tested without clinical signs or symptoms of infection and/or after receiving laxatives, hospitals more accurately capture their true C. difficile rates and maximize reimbursement based on this measure within the CMS Safety of Care Measure.

Funding: None

Disclosures: None

Advances in technologies and biomedical informatics have expanded capacity to generate and share biomedical data. With a lens on genomic data, we present a typology characterizing the data-sharing landscape in biomedical research to advance understanding of the key stakeholders and existing data-sharing practices. The typology highlights the diversity of data-sharing efforts and facilitators and reveals how novel data-sharing efforts are challenging existing norms regarding the role of individuals whom the data describe.

A medical information commons (MIC) is a networked data environment utilized for research and clinical applications. At three deliberations across the U.S., we engaged 75 adults in two-day facilitated discussions on the ethical and social issues inherent to sharing data with an MIC. Deliberants made recommendations regarding opt-in consent, transparent data policies, public representation on MIC governing boards, and strict data security and privacy protection. Community engagement is critical to earning the public's trust.

Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons (MIC). We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

Making data broadly accessible is essential to creating a medical information commons (MIC). Transparency about data-sharing practices can cultivate trust among prospective and existing MIC participants. We present an analysis of 34 initiatives sharing DNA-derived data based on public information. We describe data-sharing practices captured, including practices related to consent, privacy and security, data access, oversight, and participant engagement. Our results reveal that data-sharing initiatives have some distance to go in achieving transparency.

A 2011 National Academies of Sciences report called for an “Information Commons” and a “Knowledge Network” to revolutionize biomedical research and clinical care. We interviewed 41 expert stakeholders to examine governance, access, data collection, and privacy in the context of a medical information commons. Stakeholders' attitudes about MICs align with the NAS vision of an Information Commons; however, differences of opinion regarding clinical use and access warrant further research to explore policy and technological solutions.