System for rapid assessment of pneumonia and influenza-related mortality-Ohio, 2009-2010.

Rapid mortality surveillance is critical for state emergency preparedness. To enhance timeliness during the 2009-2010 influenza A H1N1 pandemic, the Ohio Department of Health activated a drop-down menu within Ohio's Electronic Death Registration System for reporting of pneumonia- or influenza-related deaths approximately 5 days postmortem. We used International Classification of Diseases-Tenth Revision (ICD-10) codes, available 2-3 months postmortem as the standard, and assessed their agreement with drop-down-menu codes for pneumonia- or influenza-related deaths. Among 56 660 Ohio deaths during September 2009-March 2010, agreement was 97.9% for pneumonia (κ = 0.85) and 99.9% for influenza (κ = 0.79). Sensitivity was 80.2% for pneumonia and 73.9% for influenza. Drop-down menu coding enhanced timeliness while maintaining high agreement with ICD-10 codes.

Subtance use and type and severity of injury among hospitalized trauma cases: Ohio, 2004-2007.

OBJECTIVE: The purpose of this study was to determine whether persons who were injured severely enough to require hospitalization suffered more severe injury when substance use was involved. This was accomplished by evaluating four proxy outcome measures with Ohio Trauma Registry data from January 2004 through December 2007. METHOD: Four injury outcomes were identified: injury severity score, admission to an intensive care unit, presence of at least one medical complication, and hospital length of stay. We examined their association with substance (alcohol and/or other drug) use stratified by the likelihood of being tested for substance use, mechanism of injury, sex, age, race, and insurance status. Relative risks and t test scores were calculated. RESULTS: Among 89,129 trauma cases reported to the Ohio Trauma Registry during 2004-2007, more than 21% were substance users. Those younger than 45 years of age were 65% more likely to use substances than those 45 or older, men were 110% more likely than women, Blacks were 86% more likely than non-Blacks, and uninsured persons were 127% more likely than insured persons. Stratified analyses yielded 16 comparisons (4 Injury Outcomes × 4 Age-Insurance Subgroups). For 13 of these 16 comparisons, injury severity was significantly worse (p < .0001) among substance users than nonusers. CONCLUSIONS: The evidence is strong enough to conclude that, among hospitalized trauma patients, use of substances (alcohol and/or drug) was associated with increased injury severity. These findings appear to be true for the young and old, regardless of insurance status.

Increasing chronic disease epidemiology capacity without increasing workforce: a success story in Ohio.

In many states the epidemiology capacity of specific chronic disease programs, for example, cardiovascular disease or diabetes, is limited by the skill set of a single epidemiologist who has been assigned to that program. To improve epidemiology support across categorical programs, the Division of Prevention at the Ohio Department of Health initiated a new policy early in 2003 whereby each program epidemiologist is responsible for learning to analyze data from at least two datasets as well as continuing to be the lead data person for his or her program. Now, for each critical dataset at least one epidemiologist is capable of conducting data analysis and providing support to other programs. Without the addition of new epidemiology staff, this policy has enabled the Ohio Department of Health to produce reports that better describe the burden of chronic diseases, make more informed decisions on what populations to target, and plan well-thought-out interventions.

Outbreak of Enterococcus gallinarum infections after total knee arthroplasty.

In September 2006, we investigated a cluster of 9 patients who developed Enterococcus gallinarum infection after total knee arthroplasty. Isolates recovered from these patients were from the same outbreak strain. Although all 9 patients were monitored by the same healthcare personnel, were given spinal anesthesia, and had the same specific type of wound irrigation procedure performed during their hospitalization, the source or sources of these infections were not identified.

Comorbidities among Ohio's nursing home residents with diabetes.

OBJECTIVE: To determine the magnitude of diabetes mellitus among Ohio nursing home residents and the comorbid conditions affecting residents with diabetes. RESEARCH DESIGN, METHOD, AND SETTINGS: In certified Ohio nursing homes during 1999, 161,723 residents were eligible for this study because they had been admitted for at least 1 day that year, had been assessed using the Centers for Medicaid and Medicare's Minimum Data Set instrument, were 21 years old or older, and had a known sex and race. Eligible residents with diabetes were compared with those without diabetes with respect to comorbidity. RESULTS: The 25% of residents diagnosed with diabetes were younger, more often male, and more often black than residents without this disorder. Residents with diabetes were also more likely to have cardiovascular diseases; visual problems; foot conditions, including missing limbs; and kidney failure. Residents with diabetes were less likely to have oral problems than residents without diabetes. CONCLUSION: The Minimum Data Set instrument identifies important comorbidities among nursing home residents with diabetes and allows their disease course to be followed longitudinally. Nursing home residents in Ohio, and presumably in other states, bear a heavy burden from diabetes and significant comorbidities.

The epidemiology and early clinical features of West Nile virus infection.

We studied early clinical features of the West Nile virus (WNV) infection. Case patients were Ohio residents who reported to the Ohio Department of Health from August 14 to December 31, 2002, with a positive serum or cerebrospinal fluid for anti-WNV IgM. Of 441 WNV cases, medical records of 224 (85.5%) hospitalized patients were available for review. Most frequent symptoms were fever at a temperature of 38.0 degrees C or higher (n = 155; 69.2%), headache (n = 114; 50.9%), and mental status changes (n = 113; 50.4%). At least one neurological symptom, one gastrointestinal symptom, and one respiratory symptom was present in 186 (83.0%), 119 (53.1%), and 46 (20.5%) patients, respectively. Using multivariate logistic regression and controlling for age, we found that the initial diagnosis of encephalitis (P = .001) or reporting abdominal pain (P < .001) was associated with death. Because initial symptoms of WNV infection are not specific, physicians should maintain a high index of suspicion during the epidemic season, particularly in elderly patients with compatible symptoms.

Cost burden of hip and knee replacements in Ohio: estimates from the National Hospital Discharge Survey, 2000.

This study estimated the number of arthritis-related hip/knee replacements performed in the nation as well as in Ohio. These estimates were then used to calculate the economic burden associated with arthritis-related surgeries. The National Hospital Discharge Survey in 2000 and the 2000 U.S. Census were utilized to estimate the number and cost of hip/knee replacements performed. In the United States, approximately 9.9 billion dollars was spent on 439,833 hip/knee replacement surgeries in the year 2000. In Ohio, approximately 420 million dollars was spent for 18,731 hip/knee replacement surgeries. The true cost of arthritis in terms of joint replacement is estimated to be much higher if preoperative and postoperative care is included.

A multistate outbreak of Salmonella enterica serotype typhimurium infection linked to raw milk consumption--Ohio, 2003.

In December 2002, the Ohio Department of Health was notified of two children with Salmonella infection. Both had a history of drinking raw milk from a combination dairy-restaurant-petting zoo (dairy). The dairy was the only establishment in Ohio licensed to sell raw milk and reported 1.35 million visitors annually. We investigated to determine the extent of the outbreak and identify illness risk factors. A case patient was any person with pulsed-field gel electrophoresis-matched Salmonella enterica serotype Typhimurium from 30 November 2002 to 18 February 2003. Sixty-two met the confirmed case definition. Forty dairy case patient patrons were included in a case-control study; 56 controls were their well meal companions. Consumption of raw milk was found to be associated with illness (odds ratio, 45.1; 95% confidence interval, 8.8 to 311.9). The dairy discontinued selling raw milk. Because 27 other states still allow the sale of raw milk, awareness of the hazards of its consumption should be raised and relevant regulations carefully reviewed.

Evaluating infection control practices among dentists in Vâlcea, Romania, in 1998.

OBJECTIVES: To evaluate infection control knowledge and practices, provide training on universal-standard precautions (USP), and improve infection control knowledge and practices among dentists. SETTING: Private and public dental offices in Vâlcea, Romania. METHODS: Information about the use of hepatitis B vaccine, knowledge of and training in USP, perceived risks of disease transmission, and infection control practices was gathered from a sample of dentists through interviews, direct observations, and a survey administered during a training session. RESULTS: Interviews among dentists and direct observations of infection control practices revealed that resources were often scarce in public clinics; however, availability of supplies in private or public clinics often did not correlate with adherence to proper infection control. Of 125 registered dentists, 46 (37%) attended the session and completed the survey. Of these, 75% worked in public clinics, 40% in private practices, and a few in both. More than 50% believed that the prevalence of hepatitis B virus (HBV) was low in their patients compared with the Romanian population. Only 26% of dentists had received hepatitis B vaccine. Dentists reported a mean of six percutaneous injuries a year. Most (89%) reported that gloves were effective in preventing HBV transmission; 24% wore them for every patient. Most used dry heat sterilization; however, chemical disinfectants were also used. CONCLUSIONS: Resources were limited, receipt of hepatitis vaccine was low, and infection control knowledge and practices varied. Training and education are needed regarding the importance of USP, hepatitis B vaccination, and alternative practices when resources are insufficient.

Improving water quality can reduce pyrogenic reactions associated with reuse of cardiac catheters.

OBJECTIVE: To report the results of our preintervention investigation and subsequent 19-month three-phase intervention study designed to reduce pyrogenic reactions among patients undergoing cardiac catheterization using reprocessed catheters. DESIGN: A case-control study for the preintervention period and a prospective cohort study for the intervention period. SETTING: A 400-bed hospital in Belo Horizonte, Brazil. PARTICIPANTS: Any patient undergoing cardiac catheterization in the hospital. INTERVENTIONS: Three intervention phases were implemented to improve the quality of the water supplied to the cardiac catheter reprocessing laboratory. Standard operating procedures for reprocessing cardiac catheters were established and reprocessing staff were trained and educated. RESULTS: The rate of pyrogenic reactions decreased significantly during the intervention phases, from 12.8% (159 of 1,239) in phase 1 to 5.3% (38 of 712) in phase 2 to 0.5% (4 of 769) in phase 3 (chi-square test for linear trend, 97.5; P < .001). CONCLUSION: Improving water quality and using standard operating procedures for reprocessing catheters can prevent pyrogenic reactions in hospitalized patients.