Monthly Census Research Articles

P-1871. Surge Protector: Characterizing the Challenges of Fluctuating OPAT Volume

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) is often overseen by multidisciplinary teams in infectious diseases (ID) provider groups. OPAT programs serve an important role in health systems to decrease inpatient length of stay and ensure safe transitions of medically complex patients. The optimal composition and staffing needs of OPAT teams are not defined. To gauge challenges facing OPAT program administration and provide insights for those initiating an OPAT program, we described trajectories in patient volume throughout our OPAT program. Methods We included all UNC OPAT courses from inception in 2015 through 2023. The OPAT team mainly provides care for home infusion OPAT, providing lab monitoring, assessment of adverse events, and care coordination. The OPAT team does not cap enrollment and currently accepts patients seen by general ID providers who require >14 days parenteral antimicrobials. OPAT team staffing has varied since inception. It is currently primarily administered by a nurse and a pharmacist, with support from a scheduler and an ID physician. We calculated the average monthly census of patients followed by the OPAT team over time. Census was defined as the number of outpatients followed by the OPAT team at a time. To gain granular detail we also trended the average weekly OPAT census in 2022 and 2023. Results 2,878 OPAT courses were cared for by the OPAT team. Median days on OPAT was 35. The most common diagnoses were osteomyelitis (43%), bacteremia (20%) and diabetic foot infection (12%). Average monthly OPAT census overall increased since inception (Fig 1) and demonstrated marked monthly variation across the entire period. In 2022-2023, the weekly census ranged from 32 to 60 patients, with a median weekly census of 45 patients (IQR, 41-50) (Fig 2). Conclusion We found our OPAT census underwent frequent, wide fluctuations in volume, which was met with adjustments in task prioritization and approach to accommodate surges. Of note, the OPAT team provides assessment and transition management for referred patients prior to discharge. These patients are not counted in census but are a key area to improve safety and stem readmission. Our results demonstrate that OPAT workload can be volatile and needs robust, expert staffing to meet unpredictable demands and patient needs. Disclosures Asher J. Schranz, MD, MPH, UpToDate: I receive fees for authorship of an UpToDate article.

The Evaluation of a Decade Barn Owl (Tyto alba) Introduction in Oil Palm Plantations Central Kalimantan

The barn owls (Tyto alba), as a biological control for the rat population, are relatively effective and safe for the oil palm ecosystem. So nowadays, many oil palm plantations are trying to introduce it to reduce the use of rodenticides. This paper’s objective is to evaluate a decade of T. alba introduction in ca 80,000 ha oil palm plantations in Central Kalimantan since the initial releasing three pairs of T. alba in July 2011. We use a quantitative descriptive method to provide the primary data on a monthly monitoring basis, i.e., the T. alba population, including its chick and eggs; the number of barn owl boxes occupied; rat damage percentage and the number of rat baiting applications. The population increment during the year 2011 to 2012 was retarded. However, since the year 2013, the population of barn owl population rapidly increased using a combination of self-released barn owl distribution from field barn owl boxes. It assisted augmentation from barn owl hatchery methods. Based on the monthly census in December 2022, the occupancy rates reached 75% from 4,234 boxes; occupied by 6,390 owls, 1,665 chicks, and 1,531 eggs. The established population of T. alba in an oil palm plantation in Central Kalimantan has reduced the rat damage percentage below the threshold level of 5%. It has no rat-baiting application (zero rat bait).

Effectiveness of a Staphylococcus aureus mupirocin decolonization protocol in a neonatal intensive care unit

Background:Staphylococcus aureus infections are a significant cause of morbidity in neonatal intensive care units (NICUs), and they are typically preceded by nasal colonization. Mupirocin decolonization protocols as an infection prevention tool can halt S. aureus outbreaks and prevent infections. We examined the effect of a mupirocin treatment protocol on S. aureus incidence, prevalence, decolonization, and infections in a level IV NICU. Methods: We conducted a retrospective before-and-after observational study from June 1, 2018, to May 31, 2020. Beginning June 1, 2019, patients identified with either methicillin-sensitive or -resistant S. aureus (MSSA or MRSA) received mupirocin ointment to bilateral nares 3 times daily for 5 days. Patients with central lines or surgical incisions were treated every 30 days. All NICU patients were screened weekly unless positive for MRSA. We defined MSSA decolonization as 3 consecutive negative screens following mupirocin treatment. We calculated monthly S. aureus incidence as any new positive per 1,000 patient days and monthly prevalence as a percentage of the average daily number of patients with S. aureus per the average monthly census. Total number of infections were compared. Statistical significance was determined using a 2 sample proportions test and P < .05. Decolonization was calculated as percentage of occurrences among treated patients. Results: Overall, 190 patients received mupirocin; 142 patients received 1 course and 48 received 2 or more courses. There was no difference in incidence of MSSA (P = .09), but prevalence decreased from 18.8% to 14.4% (P < .05) (Fig. 1). Of 66 patients with MSSA, 35% were decolonized. An additional mupirocin treatment for 16 of these patients had a 50% decolonization rate. For MRSA, incidence decreased from 0.24 to 0.20 (P = .36) and prevalence decreased from 21.9% to 18.6% (P < .05) (Fig. 1). There was no statistical difference in the number of total S. aureus infections (P = .91) or when stratified by MSSA (P = .72) or MRSA (P = .82). In the postmupirocin population, there were 5 MRSA and 7 MSSA infections. Of the MSSA-infected patients, 6 remained colonized at the time of infection. Conclusions: Implementing a single mupirocin treatment course for S. aureus decolonization in NICU was only effective in one-third of patients and had no effect on infection occurrence. Changes in incidence and prevalence could be confounded by other infection prevention practices. Further study is needed to determine whether continued screening and additional mupirocin treatment could improve effectiveness of S. aureus decolonization programs.Disclosure: None

Cost Effective Virtual Intensive Care Unit Expanding Capabilities in Critical Access Hospitals.

Tele-consults provide access to specialized care for a specific question and single point in time. eICU models utilize remote monitoring and ordering but have significant financial burden. We developed a virtual intensive care unit (VICU) for daily input of an intensivist working with local physicians. The purpose was to expand the acute care ability of the critical access hospital (CAH). The study evaluates the impact on the CAH and system. The CAH developed an ICU team, led by a hospitalist, who staffed the intensive care unit (ICU). The CAH ICU team rounds daily via a secure video link to provide care in consultation with intensivists based at a university, tertiary care center (TC). A retrospective analysis was conducted 6 months before and after implementation (4/2018-3/2019). Fisher's exact test was used to compare pre- and post-intervention with significance at P < .04. After VICU implementation, there were 265 initial daily and 35 follow-up consults. Monthly transfers to a higher level of care decreased from 63 to 57 (P = .03). Transfers to TC increased from 49.6 to 62.0% (P = .001). Critical access hospital average monthly census and average monthly inpatient days increased (69 to 130 (P < .0001) and 158 to 319 (P < .0001), respectively). Critical access hospital physicians report increased comfort to admit ICU and non-ICU patients due to the program. The total startup cost was $5180. CAH hired 11 providers. There were no unanticipated deaths. VICU implementation resulted in new CAH jobs. The CAH experienced increased inpatient census and revenues (ICU and non-ICU) while decreasing patients transferred out of the system.

Life in the Time of COVID-19: a Case Study of Community Health

IntroductionThis report uses a present day global pandemic as a case study of health inequities that are best understood by considering the role of time and place.MethodI provide a historical overview of Milwaukee, Wisconsin—one of the most segregated cities in the U.S.—to consider prior health disparities and social conditions. I then focus on COVID-19, tracking the monthly census tract distribution of cases for 6 months, including case and mortality data by race and class.ResultsAs expected, Black and Hispanic majority census tracts are the most affected by COVID-19, with some communities experiencing nearly 1 positive case per 10 residents. In previous years, Blacks and Hispanics provided approximately 27% and 3% of the shares of “natural” deaths, respectively; their shares of COVID-19 deaths in the first 6 months of the pandemic were approximately 35% and 13%. On the contrary, the share of natural deaths for whites was approximately 65% in previous years and dropped to 47% for COVID-19 deaths. The average ages of COVID-19 deaths were 72.5 for Blacks, 61.3 for Hispanics, and 79.9 for whites.ConclusionThe disparities in COVID-19 outcomes in Milwaukee cannot be separated from historical forces, including race-based politics that intensified during the Great Migration of African Americans from the Jim Crow South. The paper concludes by returning to the turn of the 19th century with a historical snapshot of Jane Addams, who lived a short distance south, in a time with conspicuous parallels to the COVID-19 crisis.

Unexpected return visits to emergency department: A healthcare quality management challenge

ABSTRACT Objective: The aim of the study was to assess the unexpected return visits (URV) rate attributed to emergency physicians (EP) diagnostic or therapeutic errors. Methods: Retrospective review was conducted based on electronic medical records (EMR) database of an emergency department with an annual attendance of 460,000 patient visits. The EMR tracked any revisit within 48 h of discharge from ED. Two teams of three EP reviewed EMR for each identified URV independently. The cases were categorized as Category-1: URV clearly unrelated to EP quality of care; Category-2: URV attributable to EP quality of care; or Category-3: uncategorizable into either of the above. The results were presented as proportions with 95% CI for categorical outcomes and kappa (κ) testing was utilized as an indicator of the inter-group agreement. Results: Total URV was 1753 with a URV rate of 5.1% (95% CI, 4.8–5.3) of the monthly census (34,649). The n of category-2 URVs were 615 (1.7%, 95% CI 1.6–1.9%) during the study month. Out of total URVs, 575 were registered as left without being seen (LWBS) on the initial visit. None of the URV patients died within a month from index visit, and none of the LWBS were admitted to the ICU. The κ calculation for the two groups agreement was .94 (95% CI 0.93–0.96). Conclusion: We found URVs were frequently due to factors that were exceedingly unlikely due to physician care quality on the initial ED visit. Study also found that there was nearly perfect agreement between independent groups of physicians tasked to categorized URVs, supporting the use of single physician review to do the task in resource limited setting.

Improving nursing home falls management program by enhancing standard of care with collaborative care multi-interventional protocol focused on fall prevention

Purpose: The objective of this quality assurance project was to implement a collaborative multi-strategy fall risk management program to reduce patient falls within a nursing home. Intervention: A multi-interventional program based on recommendations from Agency for Healthcare Quality was instituted. Direct care providers were required to conduct every 2-hour rounding on patients. The staff was required to participate in organizational education and training on fall prevention strategies. Patients were encouraged to participate in activities outside of their rooms throughout the day. Monthly meetings were held to review fall occurrences, collaborate on project initiatives, and discuss trends in fall rates. Setting and Sample: The setting for this project was a 150-bed nursing home in suburban Texas. A total of 10 participants were recruited for the fall team, and interventions were performed on each of three nursing units. The median age of the patient population was 75 years old of which 46% are males, and 53% are females. Measurement: The Falls Management Program-How to Reduce Fall questionnaire was completed before and after the intervention period to evaluate participants’ knowledge about falls and prevention. Quality assurance data were reviewed, analysis of documentation for rounding, activities, and falls data was completed. Results: The pre-implementation mean fall rate per month was 24.5 (average monthly census was 120 patients), compared to 2-month and 4-month post-implementation mean rates which were 13.5 (average monthly census was 116 patients), and 9.5 (average monthly census was 111 patients). Discussion: Implementation of best quality fall prevention programs can improve the overall health and quality of life of patients. Care providers must be vigilant in consistently facilitating evidence-based practices that contribute to best outcomes for every patient. In so doing, enhanced standards of care will circumvent patient falls and promote best patient outcomes.

Impact of clinical pharmacist in an Indian Intensive Care Unit.

Background and Objectives:A critically ill patient is treated and reviewed by physicians from different specialties; hence, polypharmacy is a very common. This study was conducted to assess the impact and effectiveness of having a clinical pharmacist in an Indian Intensive Care Unit (ICU). It also evaluates the clinical pharmacist interventions with a focus on optimizing the quality of pharmacotherapy and patient safety.Materials and Methods:The prospective, observational study was carried out in medical and surgical/trauma ICU over a period of 1 year. All detected drug-related problems and interventions were categorized based on the Pharmaceutical Care Network Europe system.Results:During the study period, average monthly census of 1032 patients got treated in the ICUs. A total of 986 pharmaceutical interventions due to drug-related problems were documented, whereof medication errors accounted for 42.6% (n = 420), drug of choice problem 15.4% (n = 152), drug-drug interactions were 15.1% (n = 149), Y-site drug incompatibility was 13.7% (n = 135), drug dosing problems were 4.8% (n = 47), drug duplications reported were 4.6% (n = 45), and adverse drug reactions documented were 3.8% (n = 38). Drug dosing adjustment done by the clinical pharmacist included 140 (11.9%) renal dose, 62 (5.2%) hepatic dose, 17 (1.4%) pediatric dose, and 104 (8.8%) insulin dosing modifications. A total of 577 drug and poison information queries were answered by the clinical pharmacist.Conclusion:Clinical pharmacist as a part of multidisciplinary team in our study was associated with a substantially lower rate of adverse drug event caused by medication errors, drug interactions, and drug incompatibilities.

Partner fidelity and reciprocal investments in the mating system of a simultaneous hermaphrodite

Simultaneous hermaphrodites that exchange gametes within pairs allow us to test whether equity of resource exchange is positively associated with duration of cooperative partnerships. The chalk bass (Serranus tortugarum) provides an excellent model system for such research because they spawn daily, trading sex roles with the same mating partners in repeated spawning bouts (a tactic called parceling). Even so, they live in site-attached aggregations with opportunities for extra-pair matings. We asked whether individuals spawn preferentially with 1 long-term partner and whether partner fidelity was associated with matching in the number of eggs produced in a single day by individuals within pairs. In addition, we observed random focal individuals during spawning to determine whether egg parceling was coordinated within pairs: we asked whether parcel number (per day) was well matched within pairs and whether parcels were exchanged in nonrandom sequences. We did not witness any break-ups in our long-term pairs; during each monthly census, all identified pairs were found spawning and courting with their mating partner until one or both of them disappeared. Daily egg production and the number of egg parcels exchanged within primary partnerships were coordinated. The sequence of parcel exchange was fairly regular, although ca. 20% of focal individuals fertilized or exchanged a few egg parcels with another partner(s); parceling allows individuals the option to exchange eggs outside of the primary pair. Our study provides novel empirical evidence of strong pair bonds and resource matching even in relatively large social groups with extra-pair trading opportunities.

Impact of a hospital-wide multifaceted programme for reducing carbapenem-resistant Enterobacteriaceae infections in a large teaching hospital in northern Italy

We performed a quasi-experimental study of a multifaceted infection control programme for reducing carbapenem-resistant Enterobacteriaceae (CRE) transmission and bloodstream infections (BSIs) in a 1420-bed university-affiliated teaching hospital during 2010–2014, with 30 months of follow-up. The programme consisted of the following: (a) rectal swab cultures were performed in all patients admitted to high-risk units (intensive-care units, transplantation, and haematology) to screen for CRE carriage, or for any room-mates of CRE-positive patients in other units; (b) cohorting of carriers, managed with strict contact precautions; (c) intensification of education, cleaning and hand-washing programmes; and (d) promotion of an antibiotic stewardship programme carbapenem-sparing regimen. The 30-month incidence rates of CRE-positive rectal cultures and BSIs were analysed with Poisson regression. Following the intervention, the incidence rate of CRE BSI (risk reduction 0.96, 95% CI 0.92–0.99, p 0.03) and CRE colonization (risk reduction 0.96, 95% CI 0.95–0.97, p <0.0001) significantly decreased over a period of 30 months. After accounting for changes in monthly census and percentage of externally acquired cases (positive at ≤72 h), the average institutional monthly rate of compliance with CRE screening procedures was the only independent variable associated with a declining monthly incidence of CRE colonization (p 0.002). The monthly incidence of CRE carriage was predictive of BSI (p 0.01). Targeted screening and cohorting of CRE carriers and infections, combined with cleaning, education, and antimicrobial stewardship measures, significantly decreased the institutional incidence of CRE BSI and colonization, despite endemically high CRE carriage rates in the region.

The role of an emergency department short-stay ward in the management of dengue fever

Dengue fever is endemic in Malaysia and poses a significant problem to the national health system. Because of its nonspecific clinical features, it creates clinical and administrative uncertainties. We evaluated the role of an emergency department short-stay ward (EDSSW) in the management of dengue fever in the Universiti Kebangsaan Malaysia Medical Centre (UKMMC). A retrospective study was carried out on suspected dengue patients who were admitted to UKMMC EDSSW, between January and March 2010. Data were retrieved from the EDSSW Monthly Census Book and patients' medical records. Patients were categorized as follows: group 1, which included patients who received treatment in the EDSSW only, and group 2, which included patients who received initial treatment in EDSSW and were subsequently admitted to the inpatient (IP) wards. A total of 147 patients' records were available. The total length of stay was 32.2 h in group 1 and 100.5 h in group 2. For group 2 patients, a median of 21.8 h was spent in EDSSW and 78.8 h was spent in IP. All patients in group 1 and group 2 were discharged well. The total EDSSW stay was 4309 patient-hours; IP stay totalled 5137 patient-hours. The use of the EDSSW reduced the IP burden in managing dengue by 45.6%. EDSSW limit the number and burden of dengue patients requiring formal IP admissions while acting as a 'safety net' for inappropriate discharges and unnecessary admissions.

Midwifery obstetric high dependency care training – a disaster waiting to happen?

BackgroundThe critically ill obstetric patient poses unique challenges to the healthcare profession. The last confidential enquiry recommended that there should be a properly equipped, staffed and supervised high dependency (HD)...

Geographical distribution pattern and interisland movements of Orii's flying fox in Okinawa Islands, the Ryukyu Archipelago, Japan

AbstractThe study of mobile animals such as flying foxes in insular habitats involves clarifying the population status on each island and determining the factors affecting movement patterns among the islands in their distributional range. We visited 25 of the Okinawa Islands and documented the number of Orii's flying foxes Pteropus dasymallus inopinatus from August 2005 to May 2006. We also conducted a monthly road census on the main island (Okinawa‐jima Island) and six adjacent islands from June 2006 to January 2007 and counted the number of fruit‐bearing trees of the bats’ four main food plants. The results of classification and regression tree analysis suggested that distance from the main island was a primary factor in determining the distribution pattern and population size of this flying fox, whereas island area, number of plant species, and food availability did not directly affect population size. The number of flying foxes on each island tended to decrease with an increase in distance from the main island; no flying foxes existed on islands &gt;30 km away from the main island. On the other hand, the results of the monthly census showed that the population size on each island fluctuated seasonally. Individuals may move between islands in response to seasonal changes in food availability. In conclusion, the distribution and abundance of Orii's flying foxes in the Okinawa Islands may be determined by the rate of immigration/emigration, depending on each island's distance from the main island. Seasonal changes in food availability may act as a trigger for interisland movement, but that movement may be restricted by island connectivity.

Phytosanitary monitoring and surveillance system for integrated management of oil palm pests in Ghana : A review

This paper discusses a phytosanitary monitoring and surveillance system as a component of an integrated pest management strategy. The main stages of the system are alert, census and action. The education and training of farmers, plantation personnel, and extension workers to recognise the main pests, early damage symptoms, and points of development of the pest are crucial for the successful implementation of the monitoring system. A monthly census and a visual assessment of the foliage to determine the extent of defoliation are essential. Two types of checks, ordinary and special, were used depending on the population levels of the various pests. The surveillance data collected from the field were processed and appropriate recommendations issued, based on the indices of pest infestation levels. The adoption and use of the system of monitoring and surveillance can lead to great savings in the huge investment, human and material, needed to control the pest if an outbreak occurs. Regular monitoring of the pests in a plantation is essential to determine natural relationships of pests and their natural enemies, which play a key role in lowering equilibrium positions of the pests for their sustainable management.

Impact of a Mental Health Training Course for Correctional Officers on a Special Housing Unit

Impact of a Mental Health Training Course for Correctional Officers on a Special Housing Unit

The feasibility of full computerization in the ED

For understanding the feasibility of full computerization of an emergency department (ED), we investigated the completion rate performed by doctors, nurses, or registration clerks since the implementation of full computerization in our ED. We evaluated the changing style of chart-recording, from hand-writing pattern to full computer recording, by recording the execution rate of different information keyed by doctors, nurses, or registration clerks according to their work in ED. We recorded and analyzed different monthly reports of the execution rate in the 18-month period of study. Statistical analysis was performed using Wilcoxon rank-sum test or Kruskal-Wallis one-way ANOVA. The average monthly census was 4570.1 ± 580.7 (95% confidence interval [CI] for mean: 4281.3, 4858.9). The average execution rate for mode of arrival and triage classification were 97.1 ± 4.1% (95% CI for mean: 95.1%, 99.1%) and 97.2 ± 4.1% (95% CI for mean: 95.2%, 99.2%), respectively. In comparison with the execution rate for disposition status between the period of the first 10 months (keying data by nurses) and the late 8 months (keying data by clerks), it showed 72.0 ± 33.2% v 96.7 ± 2.0%; 66.7 ± 35.0% v 95.8 ± 1.9%; 57.5 ± 32.0% v 88.2 ± 8.2% in nontrauma, trauma and pediatric section, respectively, with statistic significance (P <.01). To compare the rate of execution performed by physicians, we divided the study period into 3 phases (phase 1: first 6 months, phase 2: 7-12 months, phase 3: 13-18 months of the study period). The results were statistically significant (P =.004) in phase 3 (83.4 ± 5.3%) with higher execution rate than phase 1 (69.7 ± 7.7%) and phase 2 (75.2 ± 4.9%) in trauma physician. In the pediatric section, it was also significantly higher in phase 3 than phase 2 (88.2 ± 7.7% v 70.7 ± 5.9%, P =.012). We concluded that it is efficient to key in data by registration clerks instead of nurses, and it takes time to persuade and educate most physicians to cooperate in using the computer while seeing patients. (Am J Emerg Med 2002;20:118-121. Copyright 2002, Elsevier Science (USA). All rights reserved.)

A preliminary examination of depth associated spatial variation in fish assemblages on small artificial reefs

Small concrete artificial reef modules (hemisphere-shaped, approximately 1.3 m diameter, 1 m high) were placed at two sites, eight modules per site. The sites were in 7 m and 21 m of water, 1.6 km apart, off the coast of southeast Florida, USA. The reefs were censused monthly for fish over a 19-month period. Species, number of fish, and estimated total length of each individual were recorded by divers using SCUBA. After the monthly census, all fish were removed from the reefs with a piscicide. A total of 88 species were recorded in the study, with significantly greater diversity on the deep reefs (monthly mean of 7.6 versus 3.0 shallow, P < 0.001, anova). There were also significantly more biomass (calculated from length), and more large fish (>5 cm) on the reefs at 21 m than at 7 m (P < 0.001). There were more small fish at the shallow site (P < 0.05). Although it is not clear what variable(s) associated with the two depths is responsible for the differences, these results highlight the potential differences in artificial reef and ambient environment interactions within a localized area.

Characteristics of a Hospital Based Adult Transitional Care Unit and It's Impact on Nutrition Services

LEARNING OUTCOME: To provide data on a new Adult Transitional Care Unit that receives its population from an attached, affiliated tertiary/quartenary care facility, and to evaluate it's impact on nutrition services. A growing number of Acute Transitional Care Units (ATCU) have been established throughout the country in both hospital and long term care settings. For the hospital based ATCU's, these units often present a challenge for the nutrition services department primarily due to new rules and regulations enforced by the Omnibus Budget Reconciliation Act (OBRA), increased patient turnover, new documentation requirements, and aggressive rehabilitation goals. Our objective was to review data on the newly established 20 bed ATCU in our tertiary/quartenary care facility, and evaluate it's impact on nutrition services, including the functions of the Registered Dietitian (RD) and the Food Service Department (FSD). Data from the past 5 months was reviewed using the Monthly Census Statistical Review Report, and the Monthly Productivity Report with the goal to evaluate the daily average census, percent occupancy rate, length of stay, referrals, and diet orders. In light of the data obtained, the role of the RD would be required to 1) provide timely assessments, and frequent follow-up documentation 2) establish a broad knowledge of various disease states with emphasis on the geriatric population 3) consult with acute care RD's regarding previously established goals and treatment plans to provide a continuum of care 4) become proficient in nutrition support to deal with complex medical/surgical patients, and 5) become efficient in completing interdisciplinary care plans. The changes for the FSD would include 1) preparation of more specialized foods to cater to the special needs of the ATCU patient 2) development of a 3-week cycle menu to meet OBRA guidelines to ensure variety on the standard hospital menus 3) initiation of a snack program to provide patients with a choice of a substantial evening snack and 4) development of a texturized meal program to improve on presentation, taste, and quality of meals.

Comparison of methods for calculation and depiction of incidence infection rates in long-term care facilities

Assessment of changes in endemic infections in health care facilities are often based on comparison of infection rates over time. This study compared two methods for calculating and depicting infection data at a hospital-based nursing home care unit. Prospective incidence surveillance of nursing home acquired infections was conducted over a 12-month period, during which time denominator information on census and patient care days was also collected. Monthly infection rates were calculated based on (a) census (number infections per month/average monthly census), and (b) care duration (number infections per month/average monthly resident stay days). Results showed average monthly infection incidence of 27.4 episodes, (range 19–37), with average monthly census of 166.2 (range 160.0–180.0) and average monthly patient days of 5056 (range 4631–5583). The average census based monthly infection rate was 16.5 (range 11.9–22.4); average care duration based monthly infection rate was 5.4 (range 3.8–7.2) episodes per 1000 patient care days. Results indicate care duration based rates demonstrate less marked rate fluctuation than census based findings, and that duration based rates are more similar to values observed in acute care hospital nosocomial infection rates, thus are less likely to be misunderstood or misinterpreted by staff. Institutions should consider analyzing their methods for depicting infection data to provide consistency and clarity in data reporting.

Self-mutilation of the penis in C57BL/6N mice

A major cause of male reproductive failure in a C57BL/6N mouse production colony is self-inflicted mutilation of the penis. The extent of the damage ranged from loss of the distal end to loss of the entire penis. From January 1974 to August 1976, 645 adult male mice with mutilated penis were removed from this colony--where the monthly census was 9500 mice, mated 1 male to 4 females using a continuous mating system. On necropsy, it was observed that the substance blocking the urethra in the penile stump resulted in urine retention, grossly distending the urinary bladder. Proteus mirabilis and other bacteria isolated from the urethral plugs were considered secondary invaders.