4 results
Prevalence and Epidemiology of Healthcare-Associated Infections (HAI) in US Nursing Homes (NH), 2017
- Nicola Thompson, Nimalie Stone, Cedric Brown, Taniece Eure, Austin Penna, Grant Barney, Devra Barter, Paula Clogher, Ghinwa Dumyati, Erin Epson, Christina B. Felsen, Linda Frank, Deborah Godine, Lourdes Irizarry, Helen Johnston, Marion Kainer, Linda Li, Ruth Lynfield, J.P. Mahoehney, Joelle Nadle, Valerie Ocampo, Susan Ray, Monika Samper, Sarah Shrum, Marla Sievers, Srinivasan Krithika, Lucy E. Wilson, Alexia Zhang, Shelley Magill
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s45-s46
- Print publication:
- October 2020
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Background: With an aging population, increasingly complex care, and frequent re-admissions, prevention of healthcare-associated infections (HAIs) in nursing homes (NHs) is a federal priority. However, few contemporary sources of HAI data exist to inform surveillance, prevention, and policy. Prevalence surveys (PSs) are an efficient approach to generating data to measure the burden and describe the types of HAI. In 2017, the Centers for Disease Control and Prevention (CDC) performed its first large-scale HAI PS through the Emerging Infections Program (EIP) to measure the prevalence and describe the epidemiology of HAI in NH residents. Methods: NHs from several states (CA, CO, CT, GA, MD, MN, NM, NY, OR, & TN) were randomly selected and asked to participate in a 1-day HAI PS between April and October 2017; participation was voluntary. EIP staff reviewed available medical records for NH residents present on the survey date to collect demographic and basic clinical information and infection signs and symptoms. HAIs with onset on or after NH day 3 were identified using revised McGeer infection definitions applied to data collected by EIP staff and were reported to the CDC through a web-based system. Data were reviewed by CDC staff for potential errors and to validate HAI classifications prior to analysis. HAI prevalence, number of residents with >1 HAI per number of surveyed residents ×100, and 95% CIs were calculated overall (pooled mean) and for selected resident characteristics. Data were analyzed using SAS v9.4 software. Results: Among 15,296 residents in 161 NHs, 358 residents with 375 HAIs were identified. The most common HAI sites were skin (32%), respiratory tract (29%), and urinary tract (20%). Cellulitis, soft-tissue or wound infection, symptomatic UTI, and cold or pharyngitis were the most common individual HAIs (Fig. 1). Overall HAI prevalence was 2.3 per 100 residents (95% CI, 2.1–2.6); at the NH level, the median HAI prevalence was 1.8 and ranged from 0 to 14.3 (interquartile range, 0–3.1). At the resident level (Fig. 2), HAI prevalence was significantly higher in persons admitted for postacute care with diabetes, with a pressure ulcer, receiving wound care, or with a device. Conclusions: In this large-scale survey, 1 in 43 NH residents had an HAI on a given day. Three HAI types comprised >80% of infections. In addition to identifying characteristics that place residents at higher risk for HAIs, these findings provide important data on HAI epidemiology in NHs that can be used to expand HAI surveillance and inform prevention policies and practices.
Funding: None
Disclosures: None
Appropriateness of Initiating Antibiotics for Urinary Tract Infection Among Nursing Home Residents
- Taniece R. Eure, Nicola D. Thompson, Austin Penna, Wendy M. Bamberg, Grant Barney, Devra Barter, Paula Clogher, Malini DeSilva, Ghinwa Dumyati, Erin Epson, Christina B. Felsen, Linda Frank, Deborah Godine, Lourdes Irizarry, Helen Johnston, Marion A. Kainer, Linda Li, Ruth Lynfield, JP Mahoehney, Joelle Nadle, Valerie L. S. Ocampo, Susan M. Ray, Monika E. Samper, Sarah Shrum Davis, Marla Sievers, Krithika Srinivasan, Lucy E. Wilson, Alexia Y. Zhang, Shelley S. Magill, Nimalie D. Stone
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s127-s128
- Print publication:
- October 2020
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Background: Antibiotics are among the most commonly prescribed drugs in nursing homes; urinary tract infections (UTIs) are a frequent indication. Although there is no gold standard for the diagnosis of UTIs, various criteria have been developed to inform and standardize nursing home prescribing decisions, with the goal of reducing unnecessary antibiotic prescribing. Using different published criteria designed to guide decisions on initiating treatment of UTIs (ie, symptomatic, catheter-associated, and uncomplicated cystitis), our objective was to assess the appropriateness of antibiotic prescribing among NH residents. Methods: In 2017, the CDC Emerging Infections Program (EIP) performed a prevalence survey of healthcare-associated infections and antibiotic use in 161 nursing homes from 10 states: California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee. EIP staff reviewed resident medical records to collect demographic and clinical information, infection signs, symptoms, and diagnostic testing documented on the day an antibiotic was initiated and 6 days prior. We applied 4 criteria to determine whether initiation of treatment for UTI was supported: (1) the Loeb minimum clinical criteria (Loeb); (2) the Suspected UTI Situation, Background, Assessment, and Recommendation tool (UTI SBAR tool); (3) adaptation of Infectious Diseases Society of America UTI treatment guidelines for nursing home residents (Crnich & Drinka); and (4) diagnostic criteria for uncomplicated cystitis (cystitis consensus) (Fig. 1). We calculated the percentage of residents for whom initiating UTI treatment was appropriate by these criteria. Results: Of 248 residents for whom UTI treatment was initiated in the nursing home, the median age was 79 years [IQR, 19], 63% were female, and 35% were admitted for postacute care. There was substantial variability in the percentage of residents with antibiotic initiation classified as appropriate by each of the criteria, ranging from 8% for the cystitis consensus, to 27% for Loeb, to 33% for the UTI SBAR tool, to 51% for Crnich and Drinka (Fig. 2). Conclusions: Appropriate initiation of UTI treatment among nursing home residents remained low regardless of criteria used. At best only half of antibiotic treatment met published prescribing criteria. Although insufficient documentation of infection signs, symptoms and testing may have contributed to the low percentages observed, adequate documentation in the medical record to support prescribing should be standard practice, as outlined in the CDC Core Elements of Antibiotic Stewardship for nursing homes. Standardized UTI prescribing criteria should be incorporated into nursing home stewardship activities to improve the assessment and documentation of symptomatic UTI and to reduce inappropriate antibiotic use.
Funding: None
Disclosures: None
Are Women More Empathetic than Men? A Longitudinal Study in Adolescence
- María Vicenta Mestre, Paula Samper, María Dolores Frías, Ana María Tur
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- The Spanish Journal of Psychology / Volume 12 / Issue 1 / May 2009
- Published online by Cambridge University Press:
- 10 January 2013, pp. 76-83
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Since the 1970s there has been a growing interest in analysing sex differences in psychological variables. Empirical studies and meta-analyses have contributed evidence on the differences between male and female individuals. More recently, the gender similarities hypothesis has supported the similarity of men and women in most psychological variables. This study contributes information on women's greater empathic disposition in comparison with men by means of a longitudinal design in an adolescent population. 505 male and female adolescents aged between 13 and 16 years were evaluated at two different moments (grade 2 and grade 3, lower secondary education). They completed the Index of Empathy for Children and Adolescents by Bryant and the Interpersonal Reactivity Index by Davis. The results confirm a greater empathic response in females than in males of the same age, differences growing with age. The sizes of the effect estimated in the second evaluation (average age 14 years) are large for emotional empathy and medium for cognitive empathy.
Nutrition in Colombian pregnant women
- Olga L Sarmiento, Andrea Ramirez, Belén Samper Kutschbach, Paula L Pinzón, Sandra García, Angie C Olarte, Tatiana Mosquera, Eduardo Atalah, Gabriel Ojeda, Yibby Forero
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- Journal:
- Public Health Nutrition / Volume 15 / Issue 6 / June 2012
- Published online by Cambridge University Press:
- 05 January 2012, pp. 955-963
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Objective
The present study aimed to evaluate the nutritional status of pregnant women in Colombia and the associations between gestational BMI and sociodemographic and gestational characteristics.
DesignCross-sectional study. A secondary analysis was made of data from the 2005 Demographic and Health Survey of Colombia.
SettingBogotá, Colombia.
SubjectsPregnant adolescents aged 13–19 years (n 430) and pregnant women aged 20–49 years (n 1272).
ResultsThe gestational BMI and sociodemographic characteristics of the adolescents differed from those of the pregnant adult women. Thirty-one per cent of the adolescents were underweight for gestational age, compared with 14·5 % of the adult women. Eighteen per cent of adolescents were overweight for gestational age, in contrast to 37·3 % of adult women. The overall prevalence of anaemia was 44·7 % and the prevalence of low serum ferritin was 38·8 %. Women within the high quintiles of the wealth index (prevalence odds ratio (POR) = 0·56; 95 % CI 0·34, 0·91, P < 0·02) had lower odds of being underweight. Women who received prenatal care (POR = 2·17; 95 % CI 1·48, 3·09, P < 0·001) and were multiparous (POR = 2·10; 95 % CI 1·43, 3·15, P < 0·0 0 1) had higher odds of being overweight. Women in extended families (POR = 0·63; 95 % CI 0·50, 0·95, P < 0·025) had lower odds of being overweight.
ConclusionsUnderweight in pregnant adolescents and overweight in adult women coexist as a double burden in Colombia. Factors associated with malnutrition among pregnant women and adolescents should be considered for future interventions in countries experiencing nutritional transition.