Strike Team Research Articles

An analysis of ICAR recommendations for long-term care facilities in Alabama

The Alabama Long-Term Care Strike Team was established in 2022 to help long-term care facilities build and maintain infection prevention and control (IPC) systems. Infection preventionists use CDC's Infection Control Assessment and Response (ICAR) tools to provide IPC-specific recommendations. Analysis of ICAR recommendations identified the 3 greatest training needs in Alabama: source control, hand hygiene, and environmental cleaning. The ICAR provides a standardized and objective way to monitor and mitigate IPC risk.

Addressing infection prevention and control in Alabama through the long-term care strike team.

The COVID-19 pandemic exposed the lack of infection prevention and control (IPC) infrastructure among long-term care facilities (LTCFs) in the United States; the situation in Alabama is particularly dire with LTCFs receiving some of the lowest quality ratings in the country. Alabama's LTCFs continue to be challenged by frequent staff turnover, vaccine hesitancy, and reluctance to embrace new Centers for Disease Control and Prevention (CDC) recommendations such as enhanced barrier precautions. However, the American Rescue Plan of 2021 made funds available to states through a CDC Epidemiology and Laboratory (ELC) Cooperative Agreement to promote IPC system improvement, including the creation of the Alabama Nursing Home and Long-Term Care Strike Team (LTC Strike Team). In this article, we reviewed preliminary data from Alabama for the first year of the 2-year cooperative agreement cycle (2022--2023). Data included activity tracking by Infection Preventionists (IPs) and evaluations submitted voluntarily by LTCFs upon completion of trainings and/or direct services provided by the LTC Strike Team. Results indicated a significant need for IPC training among LTCFs and a high level of satisfaction with the services provided by IPs. Despite successes, it is unclear if future funding will be available to support long-term sustainability efforts.

Pivoting COVID-19 Resources for an Equitable Mpox Vaccine Response in Louisiana

IntroductionThe first case of mpox in Louisiana was identified two months ahead of Southern Decadence Festival in New Orleans, the largest LGBTQ+ Pride festival in the South. With mpox case numbers reflecting racial disparities, the objective was to mount an equitable vaccination response. MethodsThe Louisiana Department of Health (LDH) rapidly pivoted its Covid-19 resources and strategies – specifically, using vaccine strike teams and mobile events, in-state vaccine redistribution through centralized warehousing and shipping support, and community partnerships – to now control mpox transmission. Here we have evaluated State-based Immunization Information System data to examine whether the vaccination response was geographically and racially equitable. Geographic equity was measured by taking into account vaccine availability as well as uptake in areas with high Social Vulnerability Index (SVI). Results113 providers were enrolled in the vaccination program, and 96 mobile vaccination events were held in locations frequented by at-risk populations. Racial disparities among vaccine recipients decreased over time, and vaccine availability and uptake was equitable in high SVI areas. However, Black, female and Hispanic/Latinx patients had significantly higher risk of not completing the two-dose series relative to their counterparts. ConclusionThe mpox vaccination response in Louisiana was geographically equitable, though some disparities remained.

A faculty-led resident strike team as a force expander during disaster.

The emergence of the coronavirus disease 2019 (COVID-19) pandemic produced an unprecedented strain on the United States medical system. Prior to the pandemic, there was an estimated 20,000 physician shortage. This has been further stressed by physicians falling ill and the increased acuity of the COVID-19 patients. Federal medical team availability was stretched to its capabilities with the large numbers of deployments. With such severe staffing shortages, creative ways of force expansion were undertaken. New Orleans, Louisiana, was one of the hardest hit areas early in the pandemic. As the case counts built, a call was put out for help. The Louisiana State University (LSU) system responded with a faculty-led resident strike team out of the LSU Health Shreveport Academic Medical Center. Residents and faculty alike volunteered, forming a multispecialty, attending-led medical strike team of approximately 10 physicians. Administrative aspects such as institution-specific credentialing, malpractice coverage, resident distribution, attending physician oversight, among other aspects were addressed, managed, and agreed upon between the LSU Health Shreveport and the New Orleans hospital institutions and leadership prior to deployment in April 2020. In New Orleans, the residents managed patients within the departments of emergency medicine, medical floor, and intensive care unit (ICU). The residents assigned to the medical floor became a new hospitalist service team. The diversity of specialties allowed the team to address patient care in a multidisciplinary manner, leading to comprehensive patient care plans and unhindered team dynamic and workflow. During the first week alone, the team admitted and cared for over 100 patients combined from the medical floor and ICU. In a disaster situation compounded by staff shortages, a resident strike team is a beneficial solution for force expansion. This article qualitatively reviews the first published incidence of a faculty-led multispecialty resident strike team being used as a force expander in a disaster.

Surgical Site Infection Prevention Using "Strike Teams": The Experience of an Academic Colorectal Surgical Department.

Surgical site infections (SSIs) are healthcare-acquired infections with substantial morbidity. Surgical site infection persist because of low adherence to prevention bundles comprising multiple infection control elements. We propose the "Strike Team" as an implementation strategy to improve adherence and reduce SSI in colorectal surgery. At an academic medical center, a multidisciplinary Strike Team met monthly to review colorectal SSI cases, audit and discuss barriers to adherence to SSI prevention bundle, and propose actionable feedback. The latter was shared with frontline clinicians by the Strike Team's surgical leaders in everyday practice. Colorectal SSI rates and bundle adherence data were disseminated quarterly via the hospital intranet and reviewed with surgeons at departmental meetings. Trends in adherence and SSI rates were analyzed by regression analysis using a time series model. While the Strike Team was active, adherence to antibiotic prophylaxis, maintenance of normoglycemia, and standardized intraoperative skin preparation significantly increased (p < .05). There was a trend toward statistically significant reduction in SSI (p = .07), although it was not maintained once the Strike Team activity was disrupted by the COVID-19 pandemic. Colorectal SSI prevention requires a resource-intensive, multidisciplinary approach with numerous strategies to improve adherence to infection control bundles, as illustrated by our SSI Strike Team experience.

Youth as essential problem-solvers of our futures

Youth as essential problem-solvers of our futures Nancy Butler Songer, Associate Provost of STEM Education at the University of Utah, discusses the importance of supporting and including young people as part of environmental decision-making teams and key problem-solvers of our futures. The New York Times calls the environmental threat of the Great Salt Lake in the United States an “Environmental Nuclear Bomb.” Even as water levels continue to decline (e.g., the 2022 average lake level was the lowest on record; Great Salt Lake Strike Team, 2023), regional population and water consumption continue to grow. The result is not only a dying off of the lake’s brine shrimp that support a stable ecosystem but the development of poisonous dust plumes that threaten human health.

Examination of misconceptions surrounding fatal fire victims

Fire deaths are not unusual in forensic investigative practice but due to the destructive nature of fire they are often very difficult to investigate. With the need to identify the deceased and the events surrounding the manner and cause of death, knowledge of thermally induced alteration to the human body is important. Within the fire investigation community, a number of misconceptions have been present for years regarding the protrusion of the tongue as an indicator of life during the fire, and fractured skulls as the result of brains boiling and skulls exploding. This work presents qualitative analysis on the experimental burning of 42 unembalmed human donated cadavers by the San Luis Obispo Strike Team (SLOFIST) on their annual Forensic Fire Death Investigation Course (FFDIC) between 2017 and 2019. Prior to burning, the position of the tongue within the dental arch was confirmed and sharp, blunt, surgical and gunshot trauma to the cranium documented. Temperature was recorded from ignition through to suppression with thermocouples present both within the scene and the body. Post burn analysis on the position of the tongue, observation of cranial fractures and presence of brain tissue were recorded and analysed in conjunction with thermocouple data, fire scene dynamics and body demographics. The results provide a more comprehensive understanding of the thermal environmental factors involved in producing the phenomena that facilitate these misconceptions, identifying that a more thorough understanding of individual fire scenes and their development is essential when interpreting alteration and injury to the body of the fatal fire victim.

Nursing home infection control strategies during the COVID-19 pandemic.

The American Rescue Plan Act of 2021 awarded $500 million toward scaling "strike teams" to mitigate the impact of Coronavirus Disease 2019 (COVID-19) within nursing homes. The Massachusetts Nursing Facility Accountability and Support Package (NFASP) piloted one such model during the first weeks of the pandemic, providing nursing homes financial, administrative, and educational support. For a subset of nursing homes deemed high-risk, the state offered supplemental, in-person technical infection control support. Using state death certificate data and federal nursing home occupancy data, we examined longitudinal all-cause mortality per 100,000 residents and changes in occupancy across NFASP participants and subgroups that varied in their receipt of the supplemental intervention. Nursing home mortality peaked in the weeks preceding the NFASP, with a steeper increase among those receiving the supplemental intervention. There were contemporaneous declines in weekly occupancy. The potential for temporal confounding and differential selection across NFASP subgroups precluded estimation of causal effects of the intervention on mortality. We offer policy and design suggestions for future strike team iterations that could inform the allocation of state and federal funding. We recommend expanded data collection infrastructure and, ideally, randomized assignment to intervention subgroups to support causal inference as strike team models are scaled under the direction of state and federal agencies.

Recognizing Local Champions in Infection Prevention and Control.

Recognizing Local Champions in Infection Prevention and Control.

The Strike Team as an implementation strategy for surgical infection prevention

Background: Surgical site infections (SSIs) incur up to $10 billion annually due to their excessive morbidity. SSI prevention bundles have had variable success in colorectal surgery. For example, at the University of Wisconsin Hospital, a 505-bed regional referral center, SSI rates have remained high despite the introduction of a 14-element SSI prevention bundle in 2016. To aid in the implementation of this complex bundle, the hospital started Strike Teams in 2019. We have described the impact of Strike Teams on colorectal SSI rates in our tertiary-care hospital. Methods: A Strike Team with key stakeholders from colorectal surgery (ie, surgeon, OR director, nurses, surgical technicians), anesthesia, pharmacy, infection prevention, and infectious disease was formed, supported by the hospital’s executive leadership. The Strike Team met monthly throughout 2019 to review each SSI case, discussed barriers to adherence for the SSI prevention bundle elements with implementation difficulties (Table 1), and proposed actionable feedback to increase adherence. The latter was disseminated to frontline clinicians by the teams’ surgical leaders during everyday clinical practice. The Strike Team was paused in 2020 due to resource reallocation in response to the COVID-19 pandemic. Monthly and quarterly SSI surveillance was conducted according to CDC guidance. Results: Colorectal SSI rates before, after, and during Strike Team activity are shown in Fig. 1. Adherence rates to the bundle elements targeted by the Strike Team are shown in Fig. 2. Conclusions: Adherence to the preferred antibiotic prophylaxis increased, although adherence to other bundle elements of focus did not change significantly. SSI rates decreased below our expectation while the Strike Team was active in our hospital, although SSI reduction was not sustained. Further research should study the effectiveness of Strike Teams as a long-term implementation strategy for SSI prevention in colorectal surgery.Funding: NoneDisclosures: None

Refined Classification System for Thermally Damaged Human Remains by Body Segment

This article provides a comprehensive regional approach to the classification of thermal damage of soft tissue and bone by assessing the body in segments, consisting of the head, torso, arms, and legs. The changes associated with each stage are generated from over 150 bodies over 12 years with the San Luis Obispo Fire Investigation Strike Team (SLO FIST), including photographs, video, and recorded statements. Each of the six stages represents a range and is bracketed from early to advanced phases. Each stage is presented with illustrations and descriptions that focus on the overall state of the remains at each stage and the features that define the transition from one stage to the next. As photographs make it difficult to discern the critical features, this system provides scientific illustrations with written descriptions. The system is also designed to be utilized by many in the death investigation field and can be used in the field and/or in the laboratory/morgue. Worksheets for recording burn damage have also been developed and facilitate recording on both soft tissues and bones.

Meharry Medical College Mobile Vaccination Program: Implications for Increasing COVID-19 Vaccine Uptake among Minority Communities in Middle Tennessee.

To end or curtail the COVID-19 pandemic, it is essential to incorporate mobile vaccination programs into the national vaccination strategy. Mobile COVID-19 vaccination programs play an important role in providing comprehensive vaccination from federally qualified institutions to underserved communities facing a higher risk for COVID-19 acquisition. The Meharry Medical College COVID-19 mobile vaccine program (MMC-MVP) has provided lifesaving COVID-19 vaccines, free of charge, to communities throughout Middle Tennessee. Mobile deployment is vital for those forced to travel long distances to get vaccinated and who have limited access to medical providers or vaccine clinics, lack access to public transportation, or may be homebound. The MMC-MVP, established on 13 April 2021, via funding from the Bloomberg Foundation, is sourced with infectious disease experts, nurse practitioners, and community engagement personnel to provide COVID-19 vaccinations and information in a culturally competent manner to diverse communities in Middle Tennessee. To provide broader access to COVID-19 vaccinations and vaccine-related information, the MMC-MVP partnered with the Tennessee Community Engagement Alliance, Vanderbilt University School of Nursing COVID-19 vaccine strike teams, non-academic, community-based organizations, and faith-based organizations. During the September 2021 COVID-19 surge in Tennessee, the MMC-MVP provided nearly 5000 free COVID-19 vaccinations to targeted, underserved communities. The MMC-MVP has provided vaccine equity in communities with the highest risk for acquiring COVID-19 and with greatest need in this pandemic.

Reflections on a Year as President

Reflections on a Year as President

Back to the Futures

As the Futures Program celebrates its 20th anniversary, I’m inspired to go “back to the future” when an invitation to the Futures Program from the Colorado state chapter of AMDA – The Society for Post-Acute and Long-Term Care Medicine arrived in my inbox. I was introduced to the Society as a geriatrics fellow after being instructed by my fellowship director to attend the monthly medical director meetings at the state health department (yep, medical directors and surveyors all in the same room). I was consistently struck during these meetings by the unique challenges and highly specialized skill set required of those working in nursing homes. So, when presented with an invitation to learn more and spend a few lovely days in San Diego in the middle of winter, I was in. Who could have known this truly would be my future? Cheryl Philips, MD, CMDR, the senior vice president of public policy for LeadingAge, was the first Futures Program presenter, and she had us doubled over with laughter. Two decades later, I still associate her with one of her amusing yet thought-provoking slides. The slide featured a picture of a baby in a kitchen sink, surrounded by bubbles and piles of dirty dishes. The slide was titled, “How did nursing facilities get the way they are?” The slide’s caption read, “... a grand plan ... or something else?” Dr. Philips made a compelling argument that there never was a grand plan but geriatrics training would be valued as nursing homes faced “something else” — pressures to care for increasingly complex patients and declining margins. I was intrigued by the potential to use my geriatrics training in the care of nursing home residents. Over the course of the next few days, I realized I was in terrific company, with kind people who were in this work for all the right reasons. As I get back in a time machine and arrive back from the future, it’s obvious that I found my professional home that day. Sadly, the “something else” Dr. Philips described is more shocking than any plot we could have imagined: the COVID-19 pandemic has devastated our communities and spirits. Fortunately, the features that attracted me to the Society 20 years ago are proving to have enduring value as we rebuild. As an example, those state chapter meetings at the health department have continued to facilitate natural collaborations with our health department during the COVID-19 pandemic. Similarly, the kind people I met in San Diego who were in it for all the right reasons have come together to create strike teams, lead COVID-19 Action Network ECHO networks, advance legislation, and appear on news programs, all while supporting one another as we look forward. Any depletion from the pandemic has been buoyed by the unflinching commitment of these colleagues. With over 1,000 participants to date, the Futures Program is slowly but surely introducing trainees into post-acute and long-term care. Where will we all be another 20 years from now? Will it be a grand plan ... or something else? I’d like to believe that the pandemic will allow us to step back and finally develop a grand plan. A plan that values the input of those working and living in nursing homes. A plan that dramatically expands programs such as AMDA Futures to develop leaders who are in it for all the right reasons. As I travel back to the future and consider the value of that invitation, I’m deeply grateful. I encourage all of us to extend an invitation, to support the Futures Program, and to continue to pursue a grand plan full of futures. Dr. Levy is a geriatrician board certified in hospice and palliative medicine, and is co-director of the Seattle-Denver Center of Innovation for Veteran-Centric and Value-Driven Care. The COVID-19 pandemic has devastated our communities and spirits. Fortunately, the features that attracted me to the Society 20 years ago are proving to have enduring value as we rebuild..

Deployment of Health Equity Strike Teams to Address COVID-19 Vaccine Disparities in Arkansas, 2021.

Minority populations have been disproportionately affected by the COVID-19 pandemic, and disparities have been noted in vaccine uptake. In the state of Arkansas, health equity strike teams (HESTs) were deployed to address vaccine disparities. A total of 13 470 vaccinations were administered by HESTs to 10 047 eligible people at 45 events. Among these individuals, 5645 (56.2%) were African American, 2547 (25.3%) were White, and 1068 (10.6%) were Hispanic. Vaccination efforts must specifically target populations that have been disproportionately affected by the pandemic. (Am J Public Health. 2022;112(1):29-33. https://doi.org/10.2105/AJPH.2021.306564).

Integrating Principles of Safety Culture and Just Culture Into Nursing Homes: Lessons From the Pandemic.

Decades of concerns about the quality of care provided by nursing homes have led state and federal agencies to create layers of regulations and penalties. As such, regulatory efforts to improve nursing home care have largely focused on the identification of deficiencies and assignment of sanctions. The current regulatory strategy often places nursing home teams and government agencies at odds, hindering their ability to build a culture of safety in nursing homes that is foundational to health care quality. Imbuing safety culture into nursing homes will require nursing homes and regulatory agencies to acknowledge the high-risk nature of post-acute and long-term care settings, embrace just culture, and engage nursing home staff and stakeholders in actions that are supported by evidence-based best practices. The response to the COVID-19 pandemic prompted some of these actions, leading to changes in nursing survey and certification processes as well as deployment of strike teams to support nursing homes in crisis. These actions, coupled with investments in public health that include funds earmarked for nursing homes, could become the initial phases of an intentional renovation of the existing regulatory oversight from one that is largely punitive to one that is rooted in safety culture and proactively designed to achieve meaningful and sustained improvements in the quality of care and life for nursing home residents.

The VA’s Long-Term Care Strike Team Supporting Florida’s Nursing Homes Workforce

In coordination with the Florida Department of Health, the VA Sunshine Healthcare Network (VISN 8) established Long-Term Care Strike Teams to provide services to the LTC facilities most affected by the COVID-19 pandemic across the state of Florida. Between April 2020 through September 2020, the Strike Teams provided direct patient care to community residents, infection control/ prevention education, and patient/staff COVID-19 swabbing. We encountered facilities with large numbers of staff infected with COVID-19 and agency staff that were refusing to come to “COVID-infected” facilities. Remaining staff, including the administrators, were under much psychological distress. However, our experience supporting the long-term care facilities also had a major impact on our own perceptions of nursing home care. The bravery, dedication, and caring that we witnessed reinforced that the health care workers in long-term care facilities are true heroes.

The Experience of Health Care Workers Caring for Older Adults During the COVID-19 Pandemic

Older adults are at increased risk for COVID-19 illness, hospitalization, and mortality. Essential health care workers became the backbone of their care during the pandemic, and their experiences are worthy of discussion. This symposium will highlight the emotional impact of COVID-19 on health care workers, and their scope of practice in various health settings. Using data from a cross-sectional survey, presenter one will describe concerns and coping strategies among nursing home social workers during COVID-19. Next, presenter two will present findings on the emotional health and wellbeing of home care workers. Then, presenter three will describe the experience of the VA’s strike teams sent into 82 Florida nursing homes most impacted by COVID. Presenter four will describe findings from a qualitative study on emotional distress experienced by hospital-based medical directors, nurse practitioners, and other health care workers. Finally, presenter five will describe findings from a scope of practice among health care social workers study, with an emphasis on how policies in their respective settings impacted their work. Taken together, the presenters’ findings in this symposium have implications for practice and policy recommendations to improve the experience of health care workers during pandemics.

1207. Coronavirus Disease, 2019 (COVID-19) in Long-Term Care Facilities (LTCF): One Large County’s Response, California 2020-2021

BackgroundThe coronavirus-19 disease (COVID-19) outbreak has had a particularly devasting effect on skilled nursing facility (SNF) residents and healthcare workers (HCWs). While representing only 11% of COVID-19 cases, the residents accounted for 43% of deaths in the United States. MethodsWe report a retrospective review of the support provided by our local health department (LHD) to long-term care facilities in response to the COVID-19 pandemic. This group comprised of staff from healthcare-associated infections (HAI); the Medical Operations Center (MOC); Testing, Tracing, and Treatment (T3); and the Healthcare Provider Status Taskforce (Table 1 outlines their functions). The HAI team with the State Public Health Department provided infection prevention and control (IPC) outbreak investigation, education, recommendations, and ongoing access to technical assistance. The T3 team focused on rapid response testing and tracing; the HPSTF team collected data and issued questionnaires; the MOC responded to staffing and PPE requests; and the Long-Term Care Facility sector presented routine telebriefings to update the facilities on public health guidance, share resources, and answer questions during and in between briefings. Table 1. Sectors and Function of Response Teams to COVID-19 ResultsFrom March 2020 through May 2021, there were 504 outbreaks in LTCFs; the HAI team performed 281 outbreak investigations (Figure 1). In the same period, 308,264 molecular tests were performed using various platforms; laboratory services were outsourced during peak testing requests (Figure 2); “strike teams were deployed to facilitate testing on 404 occasions. Self-reported fully vaccination rate for SNF staff was 73% (March 2021) and 76% for residents (April 2021). There were 568 staff requested; total orders for PPE were 4,839 and 16,892,823 PPE items were fulfilled (Figure 3). In addition to knowledge gaps in IPC, other challenges included shifting IPC guidance, PPE shortages, timeliness of test results that impacted cohorting, community acquisition of disease with transmission to residents, interfacility spread among staff, staffing shortages, and vaccine hesitancy issues. Figure 1. Number of Outbreaks and Number of Outbreak Investigations Figure 2. Number of Tests Performed by the Public Health Laboratory and the Number of Visits by “Strike Teams” Figure 3. Personal Protective Equipment Fulfillment during COVID-19 PandemicConclusionThe management of the recent COVID-19 outbreaks required a multi-pronged approach. Lessons learned are applicable to other highly transmissible infectious diseases. Disclosures All Authors: No reported disclosures

What Would Janeway and Roslin Do?: A Sci-Fi–Watching Library Historian Confronts COVID-19

What Would Janeway and Roslin Do?: A Sci-Fi–Watching Library Historian Confronts COVID-19