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A cluster of three extrapulmonary Mycobacterium abscessus infections linked to well-maintained water-based heater-cooler devices
- Jessica L. Seidelman, Arthur W. Baker, Sarah S. Lewis, Bobby G. Warren, Aaron Barrett, Amanda Graves, Carly King, Bonnie Taylor, Jill Engel, Desiree Bonnadonna, Carmelo Milano, Richard J. Wallace, Matthew Stiegel, Deverick J. Anderson, Becky A. Smith
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 45 / Issue 5 / May 2024
- Published online by Cambridge University Press:
- 21 December 2023, pp. 644-650
- Print publication:
- May 2024
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- Article
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Background:
Various water-based heater-cooler devices (HCDs) have been implicated in nontuberculous mycobacteria outbreaks. Ongoing rigorous surveillance for healthcare-associated M. abscessus (HA-Mab) put in place following a prior institutional outbreak of M. abscessus alerted investigators to a cluster of 3 extrapulmonary M. abscessus infections among patients who had undergone cardiothoracic surgery.
Methods:Investigators convened a multidisciplinary team and launched a comprehensive investigation to identify potential sources of M. abscessus in the healthcare setting. Adherence to tap water avoidance protocols during patient care and HCD cleaning, disinfection, and maintenance practices were reviewed. Relevant environmental samples were obtained. Patient and environmental M. abscessus isolates were compared using multilocus-sequence typing and pulsed-field gel electrophoresis. Smoke testing was performed to evaluate the potential for aerosol generation and dispersion during HCD use. The entire HCD fleet was replaced to mitigate continued transmission.
Results:Clinical presentations of case patients and epidemiologic data supported intraoperative acquisition. M. abscessus was isolated from HCDs used on patients and molecular comparison with patient isolates demonstrated clonality. Smoke testing simulated aerosolization of M. abscessus from HCDs during device operation. Because the HCD fleet was replaced, no additional extrapulmonary HA-Mab infections due to the unique clone identified in this cluster have been detected.
Conclusions:Despite adhering to HCD cleaning and disinfection strategies beyond manufacturer instructions for use, HCDs became colonized with and ultimately transmitted M. abscessus to 3 patients. Design modifications to better contain aerosols or filter exhaust during device operation are needed to prevent NTM transmission events from water-based HCDs.
Development of the MIND-TD Questionnaire as a Screening Tool for Tardive Dyskinesia
- Leslie Lundt, Rakesh Jain, Desiree Matthews, Chirag Shah, Autumn Roque, Dawn Vanderhoef, Crystal Kelly
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- Journal:
- CNS Spectrums / Volume 27 / Issue 2 / April 2022
- Published online by Cambridge University Press:
- 28 April 2022, pp. 233-234
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Introduction
MIND-TD is a collaboration of healthcare professionals (HCPs) who are committed to raising awareness of tardive dyskinesia (TD), a persistent and potentially disabling movement disorder associated with prolonged exposure to antipsychotics and other dopamine receptor blocking agents. The MIND-TD questionnaire was developed to help HCPs screen for TD and facilitate discussion with patients.
MethodsIn August 2020, an expert panel of 13 HCPs (4 psychiatrists, 6 neurologists/movement disorder specialists [MDSs], and 3 advanced practice providers [APPs]) met virtually to discuss potential screening questions for TD. This work was continued by 4 panelists (1 psychiatrist, 2 neurologists/MDSs, and 1 APP) who tested the questions in clinical practice for revision and refinement. The same group also worked with the sponsor to develop 2 additional sections that could be used to elicit more information from patients. The panel recognized the need for a tool that could facilitate telehealth screening for TD, including audio-only interactions. Therefore, practices from speech-language pathologists (eg, diadochokinetics) were used to refine the questionnaire.
ResultsPart 1 of the MIND-TD questionnaire includes a yes-or-no question for each of the 4 following topics: presence of extra or unwanted movements (Movement); feelings of embarrassment or self-consciousness (Impact); if anyone else has noticed the movements (Notice); and if movements interfere with everyday routines (Daily Activities). Part 1 can be administered by any trained medical staff, either in person or via telehealth (with video or audio-only). Routine administration is suggested in all patients who meet any of the following criteria: current or prior use of any first- or second-generation antipsychotic; use of an anticholinergic medication in conjunction with a current or past antipsychotic; or current diagnosis of TD. Part 2 of the MIND-TD questionnaire has 2 sections. The first (Thorough Interview) includes 9 items related to physical/functional difficulties (eg, eating, speaking, walking, and gripping objects) and 3 simple instructions for speech difficulties. The second section (Differentiate) includes checklists of characteristic movements for TD and drug-induced parkinsonism, along with an item related to akathisia and suggestions for observing abnormal or involuntary movements. Part 2 should be administered by the treating HCP in patients who have abnormal movements that may be related to TD. Part 2 requires visual observation of the patient, whether in-person or via video.
ConclusionsMIND-TD is a screening questionnaire that can facilitate a dialogue between HCPs and patients about the risks, symptoms, and impact of TD. The MIND questions can stand alone and be administered during in-person visits or telehealth visits (video or audio-only). The TD section can be used to gather more information about a patient’s abnormal movements.
FundingNeurocrine Biosciences, Inc.
Contributors
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- By Avishek Adhikari, Susanne E. Ahmari, Anne Marie Albano, Carlos Blanco, Desiree K. Caban, Jonathan S. Comer, Jeremy D. Coplan, Ana Alicia De La Cruz, Emily R. Doherty, Bruce Dohrenwend, Amit Etkin, Brian A. Fallon, Michael B. First, Abby J. Fyer, Angela Ghesquiere, Jay A. Gingrich, Robert A. Glick, Joshua A. Gordon, Ethan E. Gorenstein, Marco A. Grados, James P. Hambrick, James Hanks, Kelli Jane K. Harding, Richard G. Heimberg, Rene Hen, Devon E. Hinton, Myron A. Hofer, Matthew J. Kaplowitz, Sharaf S. Khan, Donald F. Klein, Karestan C. Koenen, E. David Leonardo, Roberto Lewis-Fernández, Jeffrey A. Lieberman, Michael R. Liebowitz, Sarah H. Lisanby, Antonio Mantovani, John C. Markowitz, Patrick J. McGrath, Caitlin McOmish, Jeffrey M. Miller, Jan Mohlman, Elizabeth Sagurton Mulhare, Philip R. Muskin, Navin Arun Natarajan, Yuval Neria, Nicole R. Nugent, Mayumi Okuda, Mark Olfson, Laszlo A. Papp, Sapana R. Patel, Anthony Pinto, Kristin Pontoski, Jesse W. Richardson-Jones, Carolyn I. Rodriguez, Steven P. Roose, Moira A. Rynn, Franklin Schneier, M. Katherine Shear, Ranjeeb Shrestha, Helen Blair Simpson, Smit S. Sinha, Natalia Skritskaya, Jami Socha, Eun Jung Suh, Gregory M. Sullivan, Anthony J. Tranguch, Hilary B. Vidair, Tor D. Wager, Myrna M Weissman, Noelia V. Weisstaub
- Edited by Helen Blair Simpson, Columbia University, New York, Yuval Neria, Columbia University, New York, Roberto Lewis-Fernández, Columbia University, New York, Franklin Schneier, Columbia University, New York
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- Book:
- Anxiety Disorders
- Published online:
- 10 November 2010
- Print publication:
- 26 August 2010, pp vii-xii
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