To develop a symptom assessment tool to assist health care providers with discussing bowel habits in a sensitive and accurate method.

Pre and Post education survey.

180 bed academically affiliated Veterans Affairs Hospital.

Nurses, nursing assistants and physicians who participated in a brief educational session.

A Bowel Habits Assessment Tool (BHAT) was developed to assist health care providers in learning skills to assess patient bowel habits accurately. The BHAT was introduced at educational sessions. An anonymous pre and post survey employing a 5-point Likert scale was administered to participants.

Pre-educational session survey results for Question 1 (Q1) “I am comfortable discussing patient’s bowel habits included: 4.6% strongly disagreed or somewhat disagreed, 3% neither agreed nor disagreed, 20% somewhat agreed and 72.3% strongly agreed. After the BHAT education, 100% (n=65) of participants strongly agreed or somewhat agreed that they were comfortable discussing patient’s bowel habits. Q1 pre/post mean difference 0.25 (CI 0.06539 - 0.4269, p = 0.0084). On the pre-survey, only 34% of participants strongly agreed that they were aware of tools to help discuss patients’ bowel habits. This increased to 77% after the BHAT educational session. (Q2). Q2 pre/post mean difference 1.02 (CI 0.7366 - 1.294, p <0.0001).

The BHAT improved clinicians’ comfort level discussing patient’s bowel habits. Health care providers found the BHAT useful and related to their work. This tool shows promise in improving providers’ comfort discussing bowel habits and diagnosing Clostridioides difficile in a timely manner.

To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP).

Retrospective observational cohort study.

This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies.

The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites.

To determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012–2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models.

The proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07–0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012–2013 and 2013–2014, 0.82; 95% CI, 0.72–0.93; OR for 2014–2015, 0.81; 95% CI, 0.69–0.95).

These data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies.

Infect Control Hosp Epidemiol 2018;39:452–461

To determine the relative risk of invasive methicillin-resistant Staphylococcus aureus (MRSA) infection among non-colonized (NC) patients, intermittently colonized (IC) patients, and persistently colonized (PC) patients.

Observational cohort study of patient data collected longitudinally over a 41-month period.

Department of Veterans Affairs Eastern Colorado Healthcare System, a tertiary care medical center.

Any patient who received ≥5 MRSA nasal swab tests between February 20, 2010, and July 26, 2013. In total, 3,872 patients met these criteria, 0 were excluded, 95% were male, 71% were white, and the mean age was 62.9 years on the date of study entry.

Patients were divided into cohorts based on MRSA colonization status. Physicians reviewed medical records to identify invasive infection and were blinded to colonization status. Cox and Kaplan-Meier analyses were used to assess the relationship between colonization status and invasive infection.

In total, 102 patients developed invasive MRSA infections, 16.3% of these were PC patients, 11.2% of these were IC patients, and 0.5% of these were NC patients. PC patients were at higher risk of invasive infection than NC patients (hazard ratio [HR] 36.8; 95% CI, 18.4–73.6; P<.001). IC patients were also at higher risk than NC patients (HR, 22.8; 95% CI, 13.3–39.3; P<.001). The difference in risk between PC and IC patients was not statistically significant (HR, 1.61; 95% CI, 0.94–2.78, P=.084). Alternate analysis methods confirmed these results.

The risk of invasive MRSA infection is much higher among PC and IC patients, supporting routine clinical testing for colonization. However, this risk is similar among PC and IC patients, suggesting that distinguishing between the 2 colonization states may not be clinically important.

Infect. Control Hosp. Epidemiol. 2015;36(11):1292–1297