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Patient and facility characteristics of an NDM-producing Acinetobacter baumannii outbreak in California, 2020–2022
- Lian Hsiao, Sam Horwich-Scholefield, Tisha Mitsunaga, Diana Holden, Erin Epson
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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. s21-s22
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Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) are bacteria that cause healthcare-associated infections and outbreaks. Most produce carbapenemases like New Delhi metallo-β-lactamase (NDM), which are more commonly found in carbapenem-resistant Enterobacterales but rarely in CRAB. In 2018, selected laboratories began participating in a public health sentinel surveillance program by routinely submitting CRAB and other antimicrobial-resistant isolates to the AR Laboratory Network for specialized testing. In May 2020, the Antimicrobial Resistance Laboratory Network detected the first NDM-CRAB case in California, triggering an investigation. Initial whole-genome sequencing of subsequent isolates indicated high relatedness. Methods: We defined confirmed cases as patients with NDM detected in CRAB isolates and probable cases as NDM detected in a screening swab from a patient epidemiologically linked to a known case(s) with specimens collected during May 2020–September 2022. We defined outbreak facilities as having (1) 1 or more newly identified cases during a point-prevalence survey in response to a known case or (2) at least 2 cases identified within 4 weeks of each other that were epidemiologically linked. We analyzed demographic and specimen characteristics, as well as healthcare exposure history using R Studio version 1.3.959 software. Results: Of 230 total patients, 176 (77%) were confirmed and 54 (23%) were probable cases; 150 (65%) were identified through colonization screening. Among 176 NDM-CRAB isolates, the most common specimen sources were respiratory (n = 29), wound (n = 28), and urine (n = 24), and 87 (49%) of 176 isolates were nonsusceptible to all antimicrobials tested. Among patients, median age was 65 years (range, 24–97), 127 (55%) were male, 37 (15%) were Hispanic or Latino, and 100 (43%) were White. We identified 37 outbreak facilities across 13 counties, including 25 acute-care hospitals (ACHs), 6 skilled nursing facilities (SNFs), 5 ventilator-equipped SNFs (vSNFs), and 1 long-term ACH. We identified 125 cases (54%) in SNFs and vSNFs and 93 cases (40%) in ACHs; among ACH patients, 43 (46%) had been SNF or vSNF residents within the prior year. No patients reported international exposure. Conclusions: The first known case of NDM-CRAB in California was detected by sentinel surveillance. In this extensive regional outbreak, most cases were identified by screening at public health and clinical laboratories. Transmission occurred across healthcare settings connected by patient sharing, underscoring the importance of communication, active surveillance, and implementation of infection prevention and control practices to mitigate spread within and between facilities. Expanding these efforts, with support and resources from public health departments, is key to detecting, characterizing, and containing future outbreaks of antimicrobial-resistant pathogens.
Disclosure: None
Using a learning needs assessment to develop infection prevention training for certified nursing assistants
- Erin Garcia, Tisha Mitsunaga, Vikram Haridass, Brieanne Martin, Neha Sardana, Lisa Franqui, Kiya Komaiko, Tracy Lanier, Erin Epson
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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. s50
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Background: In 2021, the California Department of Public Health Healthcare-Associated Infections Program developed new infection prevention and control (IPC) training for skilled nursing facility (SNF) certified nursing assistants (CNAs), as part of the CDC Project Firstline. CNAs comprise approximately one-third of SNF healthcare personnel (HCP) nationwide; ~50,000 CNAs are employed in California SNFs. Despite making up a large proportion of direct care HCP, CNAs can frequently lack understanding of fundamental IPC practices, including hand hygiene and appropriate personal protective equipment use. We conducted a learning needs assessment for SNF can and leadership to understand and design our program to mecanCNA IPC training needs and preferences. Methods: We distributed the learning needs assessment via SurveyMonkey in English and Spanish with questions regarding current IPC practices and challenges, as well as preferred training delivery methods and posttraining support. We leveraged partnershipscanth CNA-affiliated organizations to engage CNAs throughout California. Results: Of 193 respondents, 80 (41%) were CNAs and 113 (59%) were leadership staff, representing 97 SNFs in 41 local health jurisdictions. Among CNAs, 34 (43%) believed that they had to do workarounds in their IPC practice and 18 (23%) stated that they would benefit from one-on-one question-and-answer sessions with an infection prevention expert. Also, 50 (63%) selected visual learning, 34 selected (43%) in-person learning, and 30 (38%) selected live or online trainings as their preferred learning style and training method. Most CNAs stated that they were most comfortable listening and speaking (73%) and reading (76%) in English only, followed by listening and speaking (16%) and reading (13%) in English and Spanish. For posttraining support, CNAs preferred access to online training materials (75%), digital materials (68%), virtual office hours with IPC educators (53%), and regular webinars (49%). Conclusions: The results of our learning needs assessment confirm the need for accessible IPC training and materials and continued engagement with posttraining support for CNAs. We will continue to provide online training and resources, access to IPC experts including an ‘AskBox’ for CNAs to e-mail IPC questions or request one-on-one support, and monthly office hours. Even though most CNAs are comfortable with training in English only, we will translate curricula into Spanish to support our bilingual Spanish-canaking CNA population. We are developing a tool kit to support SNFs and local health jurisdictions interested in providing their own training using our materials, and we will offer icanerson CNA training. We will use our experience from this process in future learning needs assessments to inform other frontline HCP training, including for SNF environmental services staff.
Funding: None
Disclosures: None
Multifacility Outbreak of NDM/OXA-23–Producing Acinetobacter baumannii in California, 2020–2021
- Diana Holden, Tisha Mitsunaga, Denise Sanford, Tanya Fryer, June Nash, Emily Schneider, Rituparna Mukhopadhyay, Erin Epson, Matthew Sylvester
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 1 / Issue S1 / July 2021
- Published online by Cambridge University Press:
- 29 July 2021, p. s79
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Background: NDM/OXA-23 carbapenemase-producing Acinetobacter baumannii isolates have been reported worldwide, but rarely in the United States. A California acute-care hospital (ACH) A identified 3 patients with pan-nonsusceptible A. baumannii during May–June 2020, prompting a public health investigation to prevent further transmission among the regional healthcare network. Methods: A clinical isolate was defined as NDM/OXA-23–producing A. baumannii from a patient at ACH A or B, or an epidemiologically linked patient identified through colonization screening during May 2020–January 2021. ACHs A and B are sentinel sites for carbapenem-resistant A. baumannii surveillance through the Antibiotic Resistance Laboratory Network (AR Lab Network), where isolates are tested for carbapenemase genes. The California Department of Public Health with 3 local health departments conducted an epidemiological investigation, contact tracing, colonization screening, and whole-genome sequencing (WGS). Results: In total, 11 cases were identified during May 2020–January 2021, including 3 cases at ACH A during May–June 2020, and 8 additional cases during November 2020–January 2021: 5 at ACH A, 1 at ACH B, and 2 at skilled nursing facility (SNF) A. Isolates from ACHs A and B were identified through testing at the AR Lab Network. Of the 11 patients (including the index patient), 4 had exposure at SNF A, where 2 cases were identified through colonization screening. Screening conducted at ACH A and 5 other long-term care facilities (LTCFs) identified no additional cases. WGS results for the first 8 cases identified showed 2–13 single-nucleotide polymorphism differences. Antibiotic resistance genes for all isolates sequenced included NDM-1 and OXA-23. On-site assessments related to a COVID-19 outbreak conducted at ACH A identified infection control gaps. Conclusions: Hospital participation in public health laboratory surveillance allows early detection of novel multidrug-resistant organisms (MDROs), which enabled outbreak identification and public health response. A high COVID-19 burden and related changes in infection control practices have been associated with MDRO transmission elsewhere in California. This factor might have contributed to spread at ACH A and hampered earlier screening efforts at SNF A, likely leading to undetected transmission. Extensive movement of positive patients among a regional healthcare network including at least 6 ACHs and 7 LTCFs likely contributed to the prolonged duration of this outbreak. This investigation highlights the importance of enhanced novel MDRO surveillance strategies coupled with strong infection prevention and control practices as important factors in identifying outbreaks and preventing further transmission in regional networks.
Funding: No
Disclosures: None
PREVALENCE OF AND RISK FACTORS ASSOCIATED WITH ALCOHOL ABUSE IN MOSHI, NORTHERN TANZANIA
- TISHA MITSUNAGA, ULLA LARSEN
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- Journal:
- Journal of Biosocial Science / Volume 40 / Issue 3 / May 2008
- Published online by Cambridge University Press:
- 01 May 2008, pp. 379-399
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This study aimed to assess the prevalence of and risk factors associated with alcohol abuse among women and men in Moshi in northern Tanzania. Alcohol abuse was measured by a CAGE score of 2–4, versus 0–1 for no alcohol abuse (Ewing, 1984). Crude and adjusted logistic regression models determined odds ratios (OR) and 95% confidence intervals (95% CI) of alcohol abuse by characteristics of, respectively, women with partners (n=1200), women without partners (n=614) and men (n=788) (women’s partners). Prevalence of alcohol abuse was 7·0% (95% CI: 5·6–8·4) among women with partners, 9·3% (95% CI: 7·0–11·6) among women without partners, and more than double among men at 22·8% (95% CI: 19·9–25·8). In general, Christians had higher alcohol abuse than Muslims or other religions, as did Chagga men compared with men of other ethnic groups. Other socio-demographic characteristics, such as education or income, were not significant. Sexual behaviours were significant predictors of alcohol abuse. For example, women without partners who reported more than two partners in the last year had higher alcohol abuse compared with women reporting no partners (OR=8·75; 95% CI: 2·37–32·31), as did men reporting it is ‘OK to hit a partner’ for any reason (OR=1·79; 95% CI: 1·16–2·77) compared with men who did not. HIV-1 infection was not significantly associated with alcohol abuse by women or men. The Christian Church in Moshi should consider raising awareness about the harmful effects of high alcohol use among its adherents. Comprehensive programmes focusing on reducing number of partners and alcohol use, particularly by men, are needed in this community.