3 results
Colonization screening positivity rates for novel multidrug-resistant organism healthcare containment responses during 2019–2022
- Danielle Rankin, Lucas Ochoa, Guillermo Sanchez, Kaitlin Forsberg, Meghan Lyman, Nijika Shrivastwa, Maroya Walters
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, pp. s101-s102
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Background: The CDC recommends a public health response when novel and targeted multidrug-resistant organisms (nMDROs), such as carbapenem-resistant organisms or Candida auris, are identified in healthcare settings in nonendemic areas. nMDRO responses are supported by healthcare-associated infection-antimicrobial resistance programs in 50 state and 6 local and territorial health departments. Annually, health departments report nMDRO responses to the CDC. We summarize nMDRO responses nationally and report our assessment of colonization screening positivity rates by healthcare setting and pathogen. Methods: We analyzed nMDRO response data reported by health departments for the period August 2019–July 2021; we excluded prevention efforts (ie, widespread screening based on facility-level risk factors). Among nMDRO responses in which colonization screening was performed, we calculated the proportion of responses in which screening detected additional cases of the index nMDRO and the colonization screening positivity, by healthcare setting and pathogen. Results: Among 2,051 nMDRO responses, 732 (36%) had ≥1 colonization screening (representing 44,845 colonization screenings), of which 24 (representing 17,467 colonization screenings) were prevention efforts and were excluded. Among the remaining 708 nMDRO responses, the healthcare setting most frequently included was acute-care hospitals (ACHs; 337 of 708, 48%); the least frequently included was long-term ACHs (LTACHs; 83 of 708, 12%). Carbapenem-resistant Enterobacterales were the most common index nMDRO prompting a response (408 of 708, 58%). Screening identified additional cases of the index nMDRO in 248 responses (35%) and 2,378 (9%) of 27,378 colonization screenings. Identification of the index nMDRO varied by pathogen and setting (Fig. 1). Overall, ventilator-capable skilled nursing facilities (vSNFs) were the facility type in which colonization screening most frequently identified additional cases of the index nMDRO (63 of 92 responses, 63%), and LTACHs had the highest colonization screening positivity (750 of 5,798, 13%). Similar colonization screening positivity was observed in ACHs (9%) and vSNFs (8%). On average, Candida auris and carbapenem-resistant Acinetobacter baumannii (CRAB) had the highest colonization screening positivity rates across all healthcare settings: CRAB, 493 (12.6%) of 3,907 screened; Candida auris, 1,344 (11.7%) of 11,466 screened (Fig. 1B). More than one-half of responses identified ≥1 case of the index nMDRO. Conclusions: During public health nMDRO responses, additional cases were regularly identified through colonization screening. Responses in vSNFs and LTACHs and to environmental pathogens like Candida auris and CRAB detected additional cases in more than one-half of responses, suggesting that spread commonly occurred prior to detection of the first clinical case. The use of colonization screening is an effective strategy to detect unidentified nMDRO colonization, especially in high-acuity postacute-care settings.
Disclosures: None
Outbreak response activities conducted by public health programs in healthcare facilities nationwide, August 2019–July 2020
- Nijika Shrivastwa, Lucas Ochoa, Maroya Walters, Kiran Perkins, Joseph Perz, Jennifer C. Hunter
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 2 / Issue S1 / July 2022
- Published online by Cambridge University Press:
- 16 May 2022, p. s15
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Background: Rapid response is critical to control healthcare-associated infection (HAI) and antibiotic resistance threats within healthcare facilities to prevent illness among patients, residents, and healthcare personnel. Through this analysis, we aimed to quantify public health response activities, by healthcare setting type, for (1) novel and targeted multidrug-resistant organisms or mechanisms (MDROs), (2) SARS-CoV-2, and (3) other possible outbreaks. Method: We reviewed response activity data submitted by US state, territorial, and local health department HAI/AR programs to the CDC as part of funding requirements. We performed descriptive analyses of response activities conducted during the funding reporting period (August 2019–July 2020). SARS-CoV-2 response activities were reported from January through July 2020. Data were analyzed by response category (novel or targeted MDRO, SARS-CoV-2, other HAI/AR responses), and healthcare setting type. Results: During August 2019–July 2020, 57 HAI/AR Programs (50 state, 1 territorial, 5 local health departments, and District of Columbia) reported 18,306 public health responses involving healthcare facilities. These data included 3,860 responses to 1 or more cases of novel or targeted MDROs, 13,992 responses to SARS-CoV-2 outbreaks (beginning in January 2020), and 454 responses to other possible outbreaks. Novel and targeted MDRO responses most frequently occurred in acute-care hospitals (ACHs, 64.5%), skilled nursing facilities (SNFs, 24.5%), and long-term acute-care hospitals (LTACHs, 5.8%). SARS-CoV-2 responses most frequently occurred in SNFs (55%), and assisted living facilities (24%). Other HAI/AR responses most frequently occurred in ACH (50%), SNF (28.4%), and outpatient settings (19.6%). Of the “other” HAI/AR responses, 76% were responses to cases, clusters, or outbreaks, and 23.8% were responses to serious infection control breaches including device and instrument reprocessing, injection safety, and other deficient practices. Conclusions: During the study period, public health programs performed a high volume of HAI/AR response activities largely focused on SARS-CoV-2 in nursing homes and assisted living facilities. Other important response activities occurred across a range of other healthcare settings, including responses to novel and targeted MDROs, HAI outbreaks, and serious infection control breaches. Whereas SARS-CoV-2 response activities largely centered in long-term care settings, MDRO and other HAI/AR responses occurred mostly in acute-care settings. These data demonstrate the importance of building and sustaining public health response capacity for a broad array of healthcare settings, pathogens, and patient populations to meet the range of current and emerging HAI/AR threats.
Funding: None
Disclosures: None
Health Department Authorities to Assist Healthcare Facilities with Outbreaks or High HAI Rates—Preliminary Assessment, 2018
- Nijika Shrivastwa, Joseph Perz, Jennifer C. Hunter
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s244
- Print publication:
- October 2020
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Background: Health departments have been increasingly called upon to monitor healthcare associated-infections (HAIs) at the hospital- or facility-level and provide targeted assistance when high rates are identified. Health department capacity to effectively respond to these types of signals depends not only on technical expertise but also the legal and regulatory authority to intervene. Methods: We reviewed annual reports describing HAI and antibiotic resistance (HAI/AR) activities from CDC-funded HAI/AR programs for August 2017 through July 2018. We performed a qualitative data analysis on all 50 state health department responses to a question about their regulatory and legal authority to intervene or assist facilities without invitation when outbreaks are suspected (as determined by the health department) or high HAI rates have been identified (eg, based on NHSN data). Results: When an outbreak is identified, 31 health departments (62%) indicated that they have the authority to intervene without invitation from a facility and 8 (16%) did not specify. Among the 11 health departments (22%) that indicated that they do not have this authority, 5 (45%) states noted that they operate under decentralized systems in which the local health department can intervene in outbreak situations and the state health department is available to assist. When a health department identifies high HAI rates, 14 health departments (28%) indicated that they have the authority to intervene without invitation, 22 (44%) indicated that they do not, and 14 (28%) did not specify. Among those in the latter categories, 3 stated they can work through their local health departments, which do have this authority and 8 described working through partners (eg, State Hospital Association, n = 3 or State Healthcare Licensing Agency, n = 5). Discussion: Assistance from state health departments (eg, HAI/AR programs) in the context of outbreaks and high HAI rates has value that is usually well recognized and welcomed by healthcare facilities. Nonetheless, there are occasions when a health department might need to exert its authority to intervene. The preliminary analysis described here indicated that this authority was more commonly self-reported in the context of outbreaks than when high HAI rates are identified. These 2 situations are connected, as high rates might be indicative of unrecognized or unreported outbreak activity, and these issues may benefit from further analysis.
Funding: None
Disclosures: None