Characteristics of nursing home residents and healthcare personnel with repeated severe acute respiratory coronavirus virus 2 (SARS-CoV-2) tests positive ≥90 days after initial infection: Four US jurisdictions, July 2020-March 2021.

One in six nursing home residents and staff with positive SARS-CoV-2 tests ≥90 days after initial infection had specimen cycle thresholds (Ct) <30. Individuals with specimen Ct<30 were more likely to report symptoms but were not different from individuals with high Ct value specimens by other clinical and testing data.

Burkholderia cepacia complex outbreak linked to a no-rinse cleansing foam product, United States - 2017-2018.

In March 2018, the US Food and Drug Administration (FDA), US Centers for Disease Control and Prevention, California Department of Public Health, Los Angeles County Department of Public Health and Pennsylvania Department of Health initiated an investigation of an outbreak of Burkholderia cepacia complex (Bcc) infections. Sixty infections were identified in California, New Jersey, Pennsylvania, Maine, Nevada and Ohio. The infections were linked to a no-rinse cleansing foam product (NRCFP), produced by Manufacturer A, used for skin care of patients in healthcare settings. FDA inspected Manufacturer A's production facility (manufacturing site of over-the-counter drugs and cosmetics), reviewed production records and collected product and environmental samples for analysis. FDA's inspection found poor manufacturing practices. Analysis by pulsed-field gel electrophoresis confirmed a match between NRCFP samples and clinical isolates. Manufacturer A conducted extensive recalls, FDA issued a warning letter citing the manufacturer's inadequate manufacturing practices, and federal, state and local partners issued public communications to advise patients, pharmacies, other healthcare providers and healthcare facilities to stop using the recalled NRCFP. This investigation highlighted the importance of following appropriate manufacturing practices to minimize microbial contamination of cosmetic products, especially if intended for use in healthcare settings.

Pseudomonas aeruginosa Outbreak in a Neonatal Intensive Care Unit Attributed to Hospital Tap Water.

OBJECTIVE To investigate an outbreak of Pseudomonas aeruginosa infections and colonization in a neonatal intensive care unit. DESIGN Infection control assessment, environmental evaluation, and case-control study. SETTING Newly built community-based hospital, 28-bed neonatal intensive care unit. PATIENTS Neonatal intensive care unit patients receiving care between June 1, 2013, and September 30, 2014. METHODS Case finding was performed through microbiology record review. Infection control observations, interviews, and environmental assessment were performed. A matched case-control study was conducted to identify risk factors for P. aeruginosa infection. Patient and environmental isolates were collected for pulsed-field gel electrophoresis to determine strain relatedness. RESULTS In total, 31 cases were identified. Case clusters were temporally associated with absence of point-of-use filters on faucets in patient rooms. After adjusting for gestational age, case patients were more likely to have been in a room without a point-of-use filter (odds ratio [OR], 37.55; 95% confidence interval [CI], 7.16-∞). Case patients had higher odds of exposure to peripherally inserted central catheters (OR, 7.20; 95% CI, 1.75-37.30) and invasive ventilation (OR, 5.79; 95% CI, 1.39-30.62). Of 42 environmental samples, 28 (67%) grew P. aeruginosa. Isolates from the 2 most recent case patients were indistinguishable by pulsed-field gel electrophoresis from water-related samples obtained from these case-patient rooms. CONCLUSIONS This outbreak was attributed to contaminated water. Interruption of the outbreak with point-of-use filters provided a short-term solution; however, eradication of P. aeruginosa in water and fixtures was necessary to protect patients. This outbreak highlights the importance of understanding the risks of stagnant water in healthcare facilities. Infect Control Hosp Epidemiol 2017;38:801-808.

Effect of multiple previous miscarriages on health behaviors and health care utilization during subsequent pregnancy.

BACKGROUND: Women with a history of miscarriage report feeling emotionally guarded during a subsequent pregnancy and may be at increased risk for pregnancy-related anxiety and greater health care utilization compared with women without a history of miscarriage. However, these behaviors have not been studied in women with a history of multiple miscarriages. METHODS: We examined the effect of a history of multiple miscarriages on health behaviors and health care utilization in 2,854 women ages 18 to 36 years expecting their first live-born baby. Self-reported health behaviors and use of health care resources during pregnancy were compared for women with a history of two or more miscarriages and women with one or no miscarriages. FINDINGS: Women with a history of multiple miscarriages were more than four times as likely to smoke during pregnancy (adjusted odds ratio [aOR], 4.69; 95% CI, 2.63-8.38) compared with women without a history of multiple miscarriages. They initiated prenatal care earlier (7.0 vs. 8.2 weeks gestation), had higher odds of third trimester emergency department visit (aOR, 2.21; 95% CI, 1.24-3.94), higher odds of hospitalization during pregnancy (aOR, 1.66; 95% CI, 1.01-2.73), and twice the mean number of third trimester emergency department visits and hospitalizations during pregnancy. CONCLUSIONS: Women with a history of multiple miscarriages may be more likely to smoke and may demonstrate increased health care utilization during a subsequent pregnancy. Compassionate, individualized, and supportive counseling by providers may address smoking and other health behaviors as well as increased health care utilization.

Effect of previous miscarriage on depressive symptoms during subsequent pregnancy and postpartum in the first baby study.

Our objective was to test the hypothesis that nulliparous women with a history of miscarriage have an increased risk of depression during late pregnancy, and at 1, 6, and 12 months postpartum compared to women without a history of miscarriage. We conducted secondary analysis of a longitudinal cohort study, the First Baby Study, and compared 448 pregnant women with a history of miscarriage to 2,343 pregnant women without a history of miscarriage on risk of probable depression (score >12 on the Edinburgh Postnatal Depression Scale). Logistic regression models were used to estimate odds ratios at each time point and generalized estimating equations were used to obtain estimates in longitudinal analysis. Women with a history of miscarriage were not more likely than woman without a history of miscarriage to score in the probable depression range during the third trimester or at 6 or 12 months postpartum but were more likely at 1 month postpartum, after adjustment for sociodemographic factors (OR 1.66, 95% CI 1.03-2.69). Women with a history of miscarriage may be more vulnerable to depression during the first month postpartum than women without prior miscarriage, but this effect does not appear to persist beyond this time period. We support the promotion of awareness surrounding this issue and recommend that research is planned to identify risk factors that may position a woman with a history of miscarriage to be at higher risk for depression.

Effect of miscarriage history on maternal-infant bonding during the first year postpartum in the first baby study: a longitudinal cohort study.

BACKGROUND: Miscarriage, the unexpected loss of pregnancy before 20 weeks gestation, may have a negative effect on a mother's perception of herself as a capable woman and on her emotional health when she is pregnant again subsequent to the miscarriage. As such, a mother with a history of miscarriage may be at greater risk for difficulties navigating the process of becoming a mother and achieving positive maternal-infant bonding with an infant born subsequent to the loss. The aim of this study was to examine the effect of miscarriage history on maternal-infant bonding after the birth of a healthy infant to test the hypothesis that women with a history of miscarriage have decreased maternal-infant bonding compared to women without a history of miscarriage. METHODS: We completed secondary analysis of the First Baby Study, a longitudinal cohort study, to examine the effect of a history of miscarriage on maternal-infant bonding at 1 month, 6 months, and 12 months after women experienced the birth of their first live-born baby. In a sample of 2798 women living in Pennsylvania, USA, we tested our hypothesis using linear regression analysis of Shortened Postpartum Bonding Questionnaire (S-PBQ) scores, followed by longitudinal analysis using a generalized estimating equations model with repeated measures. RESULTS: We found that women with a history of miscarriage had similar S-PBQ scores as women without a history of miscarriage at each of the three postpartum time points. Likewise, longitudinal analysis revealed no difference in the pattern of maternal-infant bonding scores between women with and without a history of miscarriage. CONCLUSIONS: Women in the First Baby Study with a history of miscarriage did not differ from women without a history of miscarriage in their reported level of bonding with their subsequently born infants. It is important for clinicians to recognize that even though some women may experience impaired bonding related to a history of miscarriage, the majority of women form a healthy bond with their infant despite this history.

Effect of previous miscarriage on the maternal birth experience in the First Baby Study.

OBJECTIVE: To determine whether a history of miscarriage is related to birth experience and/or maternal fear of an adverse birth outcome for self or infant during a subsequent delivery. DESIGN: Secondary analysis of a prospective cohort study, the First Baby Study. SAMPLE: Women age 18 to 35 who were expecting to deliver their first live-born infants in Pennsylvania between January 2009 and April 2011. PARTICIPANTS: Four hundred fifty-three pregnant women who reported perinatal loss prior to 20 weeks gestation (miscarriage) in a previous pregnancy and 2401 pregnant women without a history of miscarriage were interviewed during pregnancy and again one month after their first live birth. METHODS: Maternal birth experience and fear of an adverse birth outcome measured via telephone interview were compared across groups. RESULTS: Maternal birth experience scores did not significantly differ between women with and without previous miscarriage. Women with a history of miscarriage reported that they feared an adverse birth outcome for themselves or their infants more frequently than women without a history of miscarriage (52.1% vs. 46.6%; p = .033), however, this relationship was not significant after adjustment for confounders. CONCLUSION: Our findings indicate that there is no association between miscarriage history and birth experience. Additional research on this topic would be beneficial including an in-depth examination of fear of adverse outcome during birth. However, nurses and midwives may consider using therapeutic communication techniques to ensure that women with a history of miscarriage receive strong emotional support and reassurance during birth.

State of the science of maternal-infant bonding: a principle-based concept analysis.

OBJECTIVE: to provide a principle-based analysis of the concept of maternal-infant bonding. DESIGN: principle-based method of concept analysis for which the data set included 44 articles published in the last decade from Pubmed, CINAHL, and PyschINFO/PsychARTICLES. SETTING: literature inclusion criteria were English language, articles published in the last decade, peer-reviewed journal articles and commentary on published work, and human populations. MEASUREMENT AND FINDINGS: after a brief review of the history of maternal-infant bonding, a principle-based concept analysis was completed to examine the state of the science with regard to this concept. The concept was critically examined according to the clarity of definition (epistemological principle), applicability of the concept (pragmatic principle), consistency in use and meaning (linguistic principle), and differentiation of the concept from related concepts (logical principle). Analysis of the concept revealed: (1) Maternal-infant bonding describes maternal feelings and emotions towards her infant. Evidence that the concept encompasses behavioural or biological components was limited. (2) The concept is clearly operationalised in the affective domain. (3) Maternal-infant bonding is linguistically confused with attachment, although the boundaries between the concepts are clearly delineated. KEY CONCLUSION: despite widespread use of the concept, maternal-infant bonding is at times superficially developed and subject to confusion with related concepts. Concept clarification is warranted. A theoretical definition of the concept of maternal-infant bonding was developed to aid in the clarification, but more research is necessary to further clarify and advance the concept. IMPLICATIONS FOR PRACTICE: nurse midwives and other practitioners should use the theoretical definition of maternal-infant bonding as a preliminary guide to identification and understanding of the concept in clinical practice.