Centers For Disease Control Guidelines Research Articles

Evaluation of the Universal Salt Iodization (USI) surveillance system in Tanzania, 2022.

The evaluation of surveillance systems has been recommended by the World Health Organization (WHO) to identify the performance and areas for improvement. Universal salt iodization (USI) as one of the surveillance systems in Tanzania needs periodic evaluation for its optimal function. This study aimed at evaluating the universal salt iodization (USI) surveillance system in Tanzania from January to December 2021 to find out if the system meets its intended objectives by evaluating its attributes as this was the first evaluation of the USI surveillance system since its establishment in 2010. The USI surveillance system is key for monitoring the performance towards the attainment of universal salt iodization (90%). This evaluation was guided by the Center for Disease Control Guidelines for Evaluating Public Health Surveillance Systems, (MMWR) to evaluate USI 2021 data. The study was conducted in Kigoma region in March 2022. Both Purposive and Convenient sampling was used to select the region, district, and ward for the study. The study involved reviewing documents used in the USI system and interviewing the key informants in the USI program. Data analysis was done by Microsoft Excel and presented in tables and graphs. A total of 1715 salt samples were collected in the year 2021 with 279 (16%) of non-iodized salt identified. The majority of the system attributes 66.7% had a good performance with a score of three, 22.2% had a moderate performance with a score of two and one attribute with poor performance with a score of one. Data quality, completeness and sensitivity were 100%, acceptability 91.6%, simplicity 83% were able to collect data on a single sample in < 2 minutes, the system stability in terms of performance was >75% and the usefulness of the system had poor performance. Although the system attributes were found to be working overall well, for proper surveillance of the USI system, the core attributes need to be strengthened. Key variables that measure the system performance must be included from the primary data source and well-integrated with the Local Government (district and regions) to Ministry of Health information systems.

Internal, external, genetic, or cultural? Lay theories about racial health disparities predict perceived threat, adherence, and policy support

AbstractDuring the COVID‐19 pandemic, the Centers for Disease Control (CDC) reported that Black and Latinx communities experienced a disproportionate burden of illness. The goal of this study is to investigate laypeople's attribution of these disparities. We hypothesized the following four potential attributions: external causes (e.g. systemic racism), internal causes (e.g. personal choices), cultural causes (e.g., being close knit), or genetic causes (e.g., being more vulnerable for genetic reasons). Data from 447 participants revealed that lay theories involving external factors were the most endorsed, whereas theories relating to genetic causes were the least endorsed. Our analyses further revealed that external attributions predicted broader COVID‐19 relevant outcomes (i.e., perceived threat of COVID‐19, adherence to CDC guidelines, and support for government policies in response to COVID‐19), even after controlling for political orientation, participant race, and other attributions. This research provides insight into how lay people's explanations for disparities can predict their reactions to the pandemic.

Epidemic-Prevention Measures and Health Management in a Nursing Home during the Coronavirus Disease 2019 Pandemic.

This study aimed to investigate the impact of epidemic prevention and isolation policies on residents' health and well-being and assess the effectiveness of implementing intervention measures to maintain their quality of life. This mixed-methods research study involved a retrospective record review of residents' daily life diaries and descriptive statistical analysis. Data were collected between March 2021 and June 2022, and epidemic-prevention measures were implemented using Taiwan's Centers for Disease Control guidelines. Three interventions were developed to address residents' health, social, and rehabilitation needs. Despite an overall infection rate of 10% at various times between 2021 and 2022, there were no reported outbreaks of nosocomial infections. The concept of reablement proved effective in helping residents maintain their independence and physical function, with a maintenance rate of 66.6%, thereby improving their quality of life. By implementing epidemic-prevention measures, we found that proper hand washing and the use of surgical masks were effective in controlling infections. Furthermore, the decline in physical function is a continuous and gradual process for older adults. Even under the restriction of social interaction, it is essential to incorporate rehabilitation plans into residents' daily activities and encourage their active participation, as this promotes improved physical function and enhances their overall quality of life.

The role of mindfulness and compassion in early adults' subsequent mental health, coping and compliance with health guidelines during the COVID‐19 pandemic: A prospective longitudinal study

AbstractThe present study explored prospective links between trait mindfulness and compassion on subsequent coping and compliance with Centers for Disease Control (CDC) guidelines and indirect effects via well‐being and internalized distress during the COVID‐19 pandemic. The study included N = 736 US college students who participated in a three‐wave longitudinal study across a single academic year. The first two assessment waves took place in 2018 and 2019, respectively, while the third wave took place in May 2020 during the COVID‐19 pandemic. Participants completed self‐report measures of trait mindfulness, compassion, well‐being, internalized distress, coping, and compliance with CDC health guidelines. Results of a series of autoregressive, cross‐lagged panel models revealed that trait mindfulness was associated with better coping via indirect effects of greater well‐being and lower internalized distress. Greater compassion was linked with greater adherence to CDC guidelines. Findings suggest that trait mindfulness and compassion may play a role in college students' coping and compliance during the pandemic.

The Sanders Classification and Obesity: Do Obese Kids With AIS Present With More Advanced Skeletal Maturity?

Obese and overweight (OOW) patients with adolescent idiopathic scoliosis (AIS) have been shown to initially present with a more advanced Risser score compared to normal weight (NW) patients. The Sanders Maturity Scale (SMS) is now more commonly used by surgeons to assist with treatment decisions because it more reliably predicts skeletal maturity. However, the relationship between SMS and obesity has not been described. We hypothesize that in patients with AIS, OOW patients will have a higher SMS score on initial presentation when compared to NW patients. Billing data from 2 different institutions were used to identify patients with AIS presenting to a pediatric orthopaedic spine surgeon for an initial visit between July 2012 and March 2020. We excluded those without height/weight data, spine radiographs, or left-hand radiographs for measuring SMS stage. Body mass index-for-age percentiles were calculated and used to group patients into NW (<85th percentile) or OOW (85th percentile and above) per Centers for Disease Control guidelines. After collecting preliminary data, a power analysis was performed using average SMS scores between NW and OOW patients with an alpha of 0.5, determining a needed sample size of approximately 300 male and 300 female subjects. Five hundred ninety patients (296 female, 294 male) were identified. The SMS stage at presentation was significantly greater in OOW compared to NW patients for both females (5.9±1.8 vs. 5.2±1.7; P =0.003) and males (4.9±1.9 vs. 4.1±1.8; P =0.002). The major curve magnitude for OOW females was significantly different from NW females (36±16 degrees vs. 30±16 degrees; P =0.004). The major curve magnitude was not different for OOW and NW males ( P =0.3). At initial presentation, OOW patients present at a greater skeletal maturity as measured by the SMS compared with NW patients. OOW female patients present with a greater major curve magnitudes than NW female patients. These results highlight negative implications of the pediatric obesity epidemic as it relates to the AIS population. These findings can be used to counsel families and provide anticipatory guidance for the AIS treatment plan. Level III-cross-sectional study.

Response to SARS-CoV-2 initial series and additional dose vaccine in pediatric patients with predominantly antibody deficiency.

Data regarding response to SARS-CoV-2 immunization in pediatric patients with predominantly antibody deficiency (PAD) is limited. We evaluated SARS-CoV-2 immunization response by anti-SARS-CoV-2-spike antibody level in 15 pediatric PAD patients. These data were compared to a published cohort of adult PAD patients (n=62) previously analyzed following SARS-CoV-2 immunization at our single center institution. We evaluated demographics, clinical characteristics, immunophenotype, infection history, and past medication use by chart review. Following a two-dose monovalent initial series SARS-CoV-2 immunization, mean anti-SARS-CoV-2-spike antibody levels were significantly higher in pediatric PAD patients compared to adult PAD patients (2,890.7 vs. 140.1 U/mL; p<0.0001). Pediatric PAD patients with low class-switched memory B-cells, defined as <2% of total CD19+ B-cells, had significantly lower mean anti-SARS-CoV-2-spike antibody levels than those without (p=0.02). Following a third-dose monovalent SARS-CoV-2 immunization, the mean anti-SARS-CoV-2-spike antibody levels in pediatric PAD patients significantly increased (2,890.7 to 18,267.2 U/mL; p<0.0001). These data support Centers for Disease Control guidelines regarding three-part SARS-CoV-2 vaccine series, including in the pediatric PAD patient demographic.

Readability of Patient-Reported Outcomes in Spine Surgery and Implications for Health Literacy.

Observational study. To evaluate the readability of commonly utilized patient-reported outcome measures (PROMs) in spine surgery. Although studies have evaluated patient education materials, discharge instructions, and informed consent forms in spine surgery, there is a dearth of literature on the readability of PROMs despite widespread health illiteracy. Without knowledge of PROM readability, it is unclear whether these measures are able to be understood by the average spine patient. We analyzed all commonly utilized nonvisual PROMs within the spinal literature and uploaded PROMs into an online readability calculator. The Flesch Reading Ease Score (FRES) and Simple Measure of Gobbledygook (SMOG) Index were collected. A FRES>79 or SMOG<7 was considered readable by the general population per American Medical Association and Centers for Disease Control guidelines. A stricter threshold recommended in health care (SMOG <6 or FRES>89) was then used to further review readability. Seventy-seven PROMs were included. Based on FRES, the mean readability of all PROMs was 69.2 ± 17.2 (range, 10-96.4), indicating an average eighth to ninth-grade reading level. The mean readability score categorized by the SMOG Index was 8.12 ± 2.65 (range, 3.1-25.6), representing an eighth-grade reading level. Compared with the reading level of the general population, 49 (63.6%) PROMs are written above the United States literacy level, according to FRES. Using stricter definitions of readability, 8 PROMs were considered readable, including PROM Information System pain behavior (FRES: 96.4 and SMOG: 5.2), PROM Information System sleep disturbance (SMOG: 5.6), Neck Pain and Disability Scale (SMOG: 4.3), and Zung Depression Scale (SMOG: 3.1). Most PROMs utilized in spine surgery require an average reading competency far above the average patient's comprehension. This may have a meaningful impact on understanding PROM instruments and may affect the accuracy of complete surveys and the rates of incompletion.

BI29 Crusted scabies: a complicated course in a renal transplant recipient

Abstract A 55-year-old man of Nigerian origin was admitted with a 3-month history of a generalized rash that was intensely pruritic at night. He had received a renal transplant 1 year prior for end-stage kidney disease in the context of hypertensive nephropathy. His maintenance immunosuppressive regimen includes mycophenolate mofetil, tacrolimus and prednisolone. No household contacts were affected by itch. He had been treated with the topical scabicide permethrin cream in the community, resulting in a painful fissuring of the lower limbs that prompted presentation to the emergency department. Full skin examination revealed an extensive scaling eruption, with profuse skin shedding and lichenified fissuring of the lower limbs. There were also loosely adherent, grey, hyperkeratotic scaling plaques widely extending from the genitals to mid-thigh and posterior upper limbs, with involvement of the ear lobes. There was relative sparing of the acral areas. He was initially treated empirically with oral ivermectin, oral flucloxacillin and topical clobetasol propionate ointment and paraffin gel. A full blood count revealed a prominent eosinophilia. A punch biopsy later revealed a number of scabies mites. He was prescribed ivermectin as per the Centers for Disease Control guidelines for crusted scabies in immunosuppressed populations with oral ivermectin 200 μg kg–1 on days 1, 2, 8, 9, 15, 22 and 29. Supply issues in the community delayed his treatment course. Further topical antiscabietic therapy was deferred until tolerated. He was subsequently re-admitted with methicillin-sensitive Staphylococcus aureus bacteraemia with pyelonephritis of the transplant kidney. The prescribed treatment regime of oral ivermectin, a topical keratolytic cream and topical permethrin cream daily for 7 days was completed as an inpatient. This yielded complete resolution of his crusted lesions. He responded well to a prolonged course of intravenous flucloxacillin. This case illustrates the challenge of diagnosing scabies in richly pigmented skin, as well in the immunosuppressed host (in this case due to defective T-cell responses). Maintaining a high index of suspicion is essential in the context of unexplained itch in the immunosuppressed as they may present with atypical presentations. Such vigilance will improve the recognition and management of this uncommon, potentially life-threatening infectious complication of crusted scabies in the transplant population (Wang MK, Chin-Yee B, Lo CKL et al. Crusted scabies in a renal transplant recipient treated with daily ivermectin: a case report and literature review. Transpl Infect Dis 2019; 21:e13077).

Factors Related to Compliance with CDC COVID-19 Guidelines: Media Use, Partisan Identity, Science Knowledge, and Risk Assessment

The present study surveyed 970 Americans during the first two weeks of May 2020 to explore the science communication environment and the factors related to COVID-19 risk assessment and compliance with Centers for Disease Control (CDC) COVID-19 mitigation strategies. We asked respondents about the media sources used to seek information about the COVID-19 pandemic, their political identity, and general level of scientific intelligence as well as their COVID-19 specific intelligence. Controlling for demographic factors and ordinary science knowledge, we demonstrated that ordinary science COVID-19 intelligence, risk assessment, and mainstream media use were positively related to compliance with CDC guidelines for Republicans, Democrats, and Independents. Democrats’ risk perception remained at a significantly higher level than Republicans, regardless of whether they tuned in to liberal sources, conservative sources, or conservative radio/podcast shows. All media sources used for seeking COVID-19 information significantly boosted Republican-leaners’ risk perception level but that level of risk assessment never reached that of the Democrats in the sample. Independent voters decreased their compliance when using liberal media and increased their compliance when using conservative media, rejecting the more extreme positions of these media. Even occasionally listening to conservative radio/podcasts significantly decreased Democratic compliance with the public health guidelines. From the beginning of the pandemic, a polluted science communication environment was exacerbated by polarized media discussions of COVID-19, making it difficult for the public to recognize valid science, assess risk, and follow scientifically based disease mitigation strategies.

Comparison of the Centers for Disease Control (CDC) recommendations and the risk index for overdose or serious opioid-induced respiratory depression (RIOSORD) tool for guiding naloxone coprescribing.

Patients treated with ongoing opioid therapy may be at an increased risk of respiratory depression or death, which may be mitigated through prompt administration of naloxone. The Centers for Disease Control (CDC) guidelines for prescribing opioids in primary care settings recommend patients treated with ongoing opioid analgesic therapy be offered a coprescription of naloxone based on total oral morphine milligram equivalents per day or concurrent benzodiazepine therapy. Opioid overdose risk is dose-dependent, yet other patient-specific factors contribute to this risk. The risk index for overdose or serious opioid-induced respiratory depression (RIOSORD) incorporates additional risk factors to assess the risk of overdose or clinically relevant respiratory depression. This study compared the frequency of meeting CDC, Veterans' Health Administration (VA) RIOSORD, or civilian RIOSORD criteria for naloxone coprescribing. A retrospective chart review of 42 Federally Qualified Health Centers in Illinois was conducted for all CII-CIV opioid analgesic prescriptions. Ongoing opioid therapy was defined as patients who received seven or more CII-CIV opioid analgesic prescriptions during the 1-year study period. Patients aged 18-89, receiving opioids for nonmalignant pain, and meeting the criteria of ongoing opioid therapy were included in the analysis. A total of 41,777 controlled substance analgesic prescriptions were prescribed during the study period. Data from 651 individual patient charts were evaluated. Of those, 606 patients met inclusion criteria. From these data, 57.9 percent of patients (N = 351) met civilian RIOSORD criteria, 36.5 percent (N = 221) met VA RIOSORD criteria, and 22.8 percent (N = 138) met CDC guideline recommendations for naloxone coprescribing. The percentage of patients who met RIOSORD criteria compared to CDC criteria was significantly higher (p < 0.001). Of all patients meeting ongoing opioid therapy criteria, only seven had been coprescribed naloxone. Coprescribing of naloxone is significantly underutilized in patients treated with opioid therapy for nonmalignant chronic pain and should not solely be based on total oral morphine milligram equivalents per day or concurrent benzodiazepine therapy. As risk assessment improves, consideration of other risk-conferring variables, such as gabapentinoids, skeletal muscle relaxants, and sleep hypnotics, should be considered.

Missed opportunities for diagnosis of HIV in the emergency department using non–risk‐based testing strategy

The objective of this study was to identify the number of missed opportunities (MO) for humanimmunodeficiencyvirus(HIV) diagnoses within our emergency departments (EDs) and assess any significant associated patient characteristics. Following current Centers for Disease Control guidelines, an opt-out HIV screening program was implemented in 2 of 7 EDs within a large Southern healthcare system. This study sought to differentiate the risk of MO in opt-out compared to clinician-initiated, risk-based ED screening protocols. A retrospective analysis was conducted from August 2019 to March 2022 of adult patients (≥18 years old) screened for HIV, comparing the ED screening method and characterization of all MOs. MO was defined as any ED visit, before HIV seropositivity, that included sexually transmitted infection screening and/or treatment with no HIV screening. Two EDs implemented generalized opt-out screening for all adult patients (>18years old); whereas, the remaining 5 sites relied on clinician-initiated screening. Patient characteristics associated with an MO were evaluated by χ2, t tests, and multivariable logistic regression. In total, 19,423 patients were screened for HIV, 142 of who tested positive. Of the 142 HIV-positive individuals, 12 (8.5%) had 1 MO and 3 of 12 (25%) had 2. The proportion of patients with a MO was significantly higher at clinician-initiated EDs as compared opt-out EDs (41.7%vs 13.9%, P=0.01). After adjusting for demographics, individuals seen at clinician-initiated EDs were more likely to have a MO compared opt-out EDs (adjusted odds ratio, 4.64; 95% confidence interval, 1.18-18.27; P=0.02). This novel study highlights the success and overall high positivity (0.7%) of an ED-based opt-out screening program. Taken together, the implementation of generalized opt-out screening within a large Southern healthcare system can rapidly increase overall screening, uncover a surprisingly high positivity rate, and decrease MOs for HIV diagnosis.

Evaluation of Scrub Typhus Surveillance, Alwar District, Rajasthan, India, July-August 2020.

Scrub typhus is one of the most underreported and fatal illnesses accounting for 23% of all febrile illness. Rajasthan reported cases during 2018-2019 in state reporting system but did not report any case to central Integrated Disease Surveillance Programme (IDSP) unit. We evaluated the Scrub typhus surveillance system in Alwar district, Rajasthan, with the objective of describing and evaluating the system and providing evidence-based recommendations to identify gaps. In cross-sectional study, we reviewed records and conducted key informant interviews at district- and block-level health facilities. Using US Centers for Disease Control guidelines, we evaluated the system by framing indicators for selected attributes for a defined reference period. Overall performance was ranked as outstanding (90-100%), excellent (80-89%), very good (70-79%), good (60-69%), and poor (<60%). Line list of confirmed cases was sent from district to block level for additional active case search (ACS) to implement control measures. We conducted 26 key informant interviews and reviewed records and calculated simplicity as 79%, flexibility 100%, data quality 46%, acceptability 92%, representativeness 48%, timeliness 43%, and stability 79%. Epidemiological surveillance (active and passive) is a core intervention under scrub typhus surveillance system. Lab reports were incompletely uploaded on IDSP portal. Surveillance reports should be updated after each ACS. Reporting format under IDSP should be uploaded timely, and lab reports from state should be sent within 48 hours of diagnosis so that case investigation is not delayed.

2216. ROAR ED-SANE: A Retrospective Observational Assessment Review of an Emergency Department Sexual Assault Nurse Examiner Program’s Adherence to CDC Guidelines for Sexually Transmitted Infections

Abstract Background Sexual assault survivors are at increased risk for sexually transmitted infections. Due to patient vulnerability, institutions have implemented Sexual Assault Nurse Examiner (SANE) protocols to care for these patients. These protocols guide evidence collection, testing, treatment, and medical follow-up to ensure optimization of sexually transmitted infections (STIs) treatment, monitoring and follow-up. Previous gap analyses have identified decreased prescribing of prophylactic STI medications and scheduling follow-up appointments compared to guideline recommendations. The purpose of this study was to assess adherence of medication prescribing and follow-up scheduling practices to Centers for Disease Control (CDC) guidelines. Methods This study was a single-center, retrospective, observational, descriptive assessment which evaluated adherence rates to CDC guidelines, to scheduling medical follow-up, and patient attendance at scheduled appointments. Pediatric and adult patients who presented to the emergency department at Mayo Clinic Health System in La Crosse, WI from January 2018 through December 2021 were included. Data collected through chart review included demographics and laboratory data necessary for prescribing prophylactic HIV medications, antibiotics for STIs, emergency contraception, and vaccine administration. Descriptive statistics were used to evaluate results. Results One hundred three patients were evaluated. Majority of patients were female and presented within 3 days of assault. Medication adherence to CDC guidelines was ≥ 80% for chlamydia and gonorrhea whereas &amp;lt; 80% was noted for trichomoniasis and HIV prophylaxis. Adherence to post-ED discharge follow-up was 40%. Conclusion Opportunities to improve adherence of ED-SANE protocols for medication prescribing and medical follow-up for trichomoniasis and HIV prophylaxis exist. Disclosures All Authors: No reported disclosures.

The Investigation of Clinical Guidelines and Standards on Infection Control in Specialized Dental Departments

Background: It is important to adhere to infection control measures in dental procedures due to direct contact with blood and saliva. During the Coronavirus disease 2019 pandemic, regular surveillance is imperative to ensure adherence to the standards. This study aimed to assess the level of adherence to infection control guidelines in specialized dental clinics in different working shifts.&#x0D; Materials and Methods: This study was assessed the level of adherence of 45 selected dental departments to three main guidelines released by (I) the Center for Disease Control (CDC), (II) Ministry of Health (MOH), and (III) armed forces organization (AFO) in three different working shift. The CDC checklist had eight domains. Thus, the items of each domain were individually scored, and considering the weighting coefficient of each item, the total score was calculated. The same procedure was carried out for the two remaining guidelines. Possible effect of working shifts and different specialties on infection control practice was also calculated.&#x0D; Results: The mean rate of adherence was 70.7% to the CDC, 93.8% to the MOH and 84.4% to the AFO guidelines indicating that adherence to the CDC guidelines was lower than the other two domestic guidelines. Individual assessment of each item revealed that hand hygiene (39%) and safe handling and disposal of sharp instruments (46%) acquired the lowest, and sterilization (79%) and safe injection (97%) acquired the highest score according to the CDC checklist. There was no relationship between working shifts and dental specialties regarding the adherence to infection control standards.&#x0D; Conclusion: Dental clinics had different performances regarding infection control guidelines. Further emphasis should be placed on hand hygiene and disposal of sharp instruments.

CLABSI in Hemodialysis– New Face to an Old Foe; A Look at Current Trends and a Review of Literature

Background: Bloodstream infections are a potentially devastating complication of hemodialysis. This study aimed to elucidate the rates of CLABSI (Central Line Associated Blood Stream Infections)in a south Indian dialysis cohort and determine the catheter care and hygiene practices in the dialysis unit which might contribute to CLABSI Methods: A prospective observational study involving in-center dialysis patients with temporary access was conducted from June 2019 to December 2019. The catheter insertion and line handling techniques were monitored using a proforma adapted from the CDC (Center for Disease Control) guidelines. Adherence to infection control practices, rates of CLABSI identified using CDC surveillance definitions, and organisms identified were reported. Results and Discussion: The median rate of CLABSI in this dialysis unit was 1.68 per 1000 catheter days. Gram-positive organisms were the majority – 69.2% and 72.27% were drug-resistant pathogens. The adherence to infection control practices in hand sterility, use of barriers, and sterile insertion technique were 100% with respect to existing CDC guidelines. The use of sterile semi-transparent dressings, however, was 98.2%. 65% of all patients had soiled dressings on arrival to the hospital. Line handling protocols were followed in accordance with CDC guidelines in 97.1% of cases Conclusion: CLABSI rates in this institute are in keeping with those around the world. There is a predominance of gram-positive organisms causing CLABSI. Drug-resistant organisms represent an alarming 72.27%of all infections. Soiled dressing and home care of the dialysis catheters represent a neglected aspect of catheter care and should be addressed.

Molecular characterisation and epidemiology of transmission of intraoperative Staphylococcus aureus isolates stratified by vancomycin minimum inhibitory concentration (MIC)

SummaryBackgroundReduced vancomycin susceptibility in Staphylococcus aureus (S. aureus) is considered a more pathogenic strain characteristic and is associated with treatment failure. We aimed to characterise the epidemiology of intraoperative transmission of S. aureus isolates with reduced vancomycin susceptibility.MethodsS. aureus isolates (N=173) collected from 274 randomly selected operating room environments at three major academic medical centres in 2009–2010 were characterised by vancomycin minimum inhibitory concentration (MIC). We aimed to characterise the transmission dynamics for VISA and isolates with relatively reduced vancomycin (MIC= 2μg/mL) susceptibility at the range of therapeutic differentiation.ResultsIntraoperative S. aureus MIC was 1.38 ± 0.34 μg/mL. No VISA isolates were identified (95% upper confidence limit 2.1%) and those with an MIC of 2 μg/mL accounted for 12.72% (22/173) of all isolates. MIC=2 μg/mL isolates were more frequently cultured from the hands of healthcare providers [19.3% (16/83)] versus otherwise [6.7% (6/90)], with unadjusted risk ratio 2.89, P=0.021, and from patients with >2 major comorbidities [25.0% (8/32)] versus otherwise [9.9% (14/141)], with unadjusted risk ratio 2.52, P=0.035. Both were significant when tested simultaneously. The adjusted relative risk for provider hands was 2.77 (95% CI 1.15 to 6.69, P=0.024). The adjusted relative risk for patients with >2 major comorbidities was 2.37 (95% CI 1.11 to 5.05, P=0.026). MIC=2μg/mL was not associated with greater risk of clonal transmission (unadjusted P=0.34, adjusted P=0.18).ConclusionIntraoperative VISA is a rare event. S. aureus isolates MIC=2μg/mL isolates were not associated with increased risk of intraoperative transmission. The epidemiology of detected intraoperative transmission is consistent with Centers for Disease Control guidelines.

The impact of body mass index and serum albumin in patients with advanced-stage non-small cell lung cancer.

e21037 Background: Non-small cell lung cancer (NSCLC) accounts for the majority of lung cancer diagnoses. Previous literature has evaluated associations between physical factors and outcomes in NSCLC. Throughout these studies, important physical factors that affect overall survival (OS) in NSCLC patients are body mass index (BMI) and serum albumin (SA) levels. In terms of BMI, previous research has come across the “obesity paradox.” That is, presenting an obese BMI serves as a protective role in patient survival. Hypoalbuminemia, defined as SA levels &lt; 3.5 g/dL, has been shown to have a significantly adverse effect on both early and late stage patients’ outcomes. Our study aims to analyze the role of BMI and SA in patients with advanced-stage NSCLC. Methods: This retrospective study includes 112 patients with stage III and stage IV NSCLC identified between January 1st, 2014 through December 31st, 2018. Categorical and continuous analyses (Pearson’s chi-square and Kruskal-Wallis test) were performed to analyze the associations between median OS, BMI, and SA. BMI subgroups are classified according to the Center for Disease Control guidelines. BMI and SA are calculated at time of diagnosis. OS is defined as the date of diagnosis until the date of death. Other notable confounders investigated include treatment modality, histology, and comorbidities. Results: Of the 112 patients, 57% of patients identified as male. The study population mean age was 73 years. The majority (88%) of patients identified as white. The median BMI was 26.1, with 26% of patients presenting as obese. The median SA level of the population was 3.8 g/dL, with 34% of patients presenting as hypoalbuminemic. Study population median OS was 0.734 years. Median OS for the obese BMI subgroup was 1.42 years, compared to 0.70, 0.71, and 0.42 years for overweight, normal, and underweight BMI, respectively. Kruskal-Wallis analyses confirm that patient BMI plays a significant difference in terms of OS, with a significant subgroup difference between patients with obese and underweight BMIs (p = 0.05). Regarding SA, both chi-square and Kruskal-Wallis tests confirm that at the time of diagnosis, patients with normal SA have a longer median OS compared to their hypoalbuminemic counterparts (median OS 1.29 years vs 0.32 years, respectively; OR = 6.72, 95% CI [2.48, 18.22], p &lt; 0.001). Conclusions: Our study reveals that an obese BMI plays a significant protective role regarding OS when evaluating prognostic outcomes between obese and underweight patients. Further, as SA levels are a known biomarker for nutritional status, our study highlights the importance of nutritional and educational optimization among healthcare professionals and patients alike prior to the diagnosis of malignancy. Future large prospective cohort studies are needed to analyze the efficacy of nutritional optimization, and further justify the “obesity paradox” and its underlying framework.

Managing dental unit waterlines: a quality improvement programme

The presence of bacterial biofilms within dental unit waterlines (DUWLs) can cause secondary bacterial infections in immunocompromised patients. As a result, the management of biofilms within waterlines has always concerned...

Autoantibodies and Severity of COVID-19 in Lung Transplant Recipients

PurposeCOVID-19 in lung transplant recipients (LTR) results in case-fatality rate of 10-46%. Disease severity is variable and it is unclear why certain groups of patients develop severe disease. Recent report suggests that 10% of patients with life threatening COVID-19 have auto-antibodies (AAbs) against type 1 interferons (IFN-1) but very few describe their impact in LTR. We therefore sought to identify AAbs in LTR with COVID-19 by using a customized proteomic microarray (CPM) bearing 120 antigens.MethodsWe retrieved samples collected for routine care within 3 months prior to and after diagnosis of COVID-19 of 13 LTR. IgA and IgG AAbs were analyzed using CPM. Predefined antibody score (ab-score) was used for downstream analysis. COVID severity was defined as per center for disease control guidelines. Changes in ab-scores from pre- to post-COVID were assessed via Wilcoxon signed-rank tests; association between continuous variables and AAbs using Spearman's correlation. Linear mixed-effects models were used to analyze the association between changes in AAbs pre- to post-COVID and COVID severity.ResultsAmong 13 LTR COVID severity was moderate (n=6), severe (n=4) and critical (n=3). Levels of 76 IgA antibodies and 9 IgG antibodies increased between pre and post covid samples (FDR adjusted p<0.05). In exploratory analysis, antibody response over time for one IgA antibody (IgA Nucleosome) and four IgG AAbs correlated with higher COVID severity (unadjusted p<0.05). IFN lambda is an antiviral cytokine and AAbs to it correlated with COVID severity (p=0.031). Such AAbs are shown to block the ability to block SARS-CoV-2 in vitro. No significant differences were observed in antibody response in the groups who were alive (n=9) versus deceased (n=4) and three inflammatory markers, ferritin, D dimer and absolute lymphocyte count.ConclusionChange in antibody response of five AAbs correlated with COVID severity in a small group of LTR. The results of this study are considered exploratory and need further validation.

Awareness of Coronavirus among Healthcare Workers in Ghotki city of Pakistan: a Cross-Sectional Study

Objective The fast spread and growing trends of coronavirus has turn out to be a main cause of fear for the healthcare workers. This study is aimed to report the awareness of Coronavirus and practices to control spread of infection amid Healthcare workers in the Ghotki city of Pakistan. Methods The sample of 200 healthcare workers from the Ghotki city of Sindh Province in Pakistan completed a research based survey to report the awareness, responsiveness, knowledge, and practices to contain spread of infection during Coronavirus pandemic in healthcare systems. The survey questionnaire was designed as per CDC (Centers for Disease Control) and WHO (World Health Organization) current provisional guidelines published for healthcare workers (Center for disease control, CDC. 2020). Data was collected through appropriate sampling method and results were reported as frequencies and percentages. The statistics were performed on the bases of percentage of correct responses. The median test was used to separate pairwise evaluations for percentage of correct responses. Results The general knowledge of coronavirus and awareness to prevention for all subcategories was un-adequate with 63% reporting un-correct answers. The maximum accurate replies were from private practicing doctors (Doctors running personal clinics with only out-patient services) and specialist 23%, lowest were from paramedical staff, non- clinical and administrative staff. A smaller amount of the total respondents could correctly define about contact precautions. Though, most of the healthcare workers were conscious of the accurate sequence for the use of a face mask. And, simply 23% of the individuals were found aware of the standards methods of hand wash as advised by who. Conclusion Healthcare workers from the Ghotki city showed inadequate awareness of Coronavirus in current pandemic at hospitals in Ghotki city with an overall percentage of 37 % correct responses.