It takes a village: decreasing inappropriate antibiotic prescribing for upper respiratory tract infections.

Objective: Prescribing of antibiotics for viral upper respiratory infections (URIs) remains a pressing public health problem. We sought to reduce inappropriate prescribing of antibiotics for URIs in Mayo Clinic Arizona. Design: Single-center, quasi-experimental, and retrospective cohort study. Setting: Emergency medicine and all primary care departments. Methods: The interventions included sharing baseline prescribing data, education, resources, and quarterly peer comparison reports. Encounters with diagnostic codes for respiratory infections commonly caused by viruses were categorized as Tier 3 (ie, never appropriate to prescribe antibiotics). Our goal was to reduce inappropriate prescribing for Tier 3 encounters by 22% in 2022. Results: Department education was completed by June 2022. The annual antibiotic prescribing rate for Tier 3 encounters was reduced by 29%, from a baseline rate of 23.6% in 2021 to 16.4% in 2022 (P < .001). The posteducation prescribing rate was 13.1%. Repeat respiratory-related healthcare contact within 14 days of Tier 3 encounters did not differ between patients prescribed and not prescribed an antibiotic in all of 2022 (4.7% antibiotic vs 4.2% no antibiotic, P = .595) or during the posteducation period (3.7% vs 4.6%, P = .604). Conclusion: A multi-faceted intervention, which included baseline education, syndrome-specific order panels, resources for symptomatic management, and peer comparison reports, resulted in significant reduction of inappropriate antibiotic prescribing for URIs.

Association of Neutralizing Antispike Monoclonal Antibody Treatment With Coronavirus Disease 2019 Hospitalization and Assessment of the Monoclonal Antibody Screening Score.

Objective: To test the hypothesis that the Monoclonal Antibody Screening Score performs consistently better in identifying the need for monoclonal antibody infusion throughout each "wave" of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant predominance during the coronavirus disease 2019 (COVID-19) pandemic and that the infusion of contemporary monoclonal antibody treatments is associated with a lower risk of hospitalization. Patients and Methods: In this retrospective cohort study, we evaluated the efficacy of monoclonal antibody treatment compared with that of no monoclonal antibody treatment in symptomatic adults who tested positive for SARS-CoV-2 regardless of their risk factors for disease progression or vaccination status during different periods of SARS-CoV-2 variant predominance. The primary outcome was hospitalization within 28 days after COVID-19 diagnosis. The study was conducted on patients with a diagnosis of COVID-19 from November 19, 2020, through May 12, 2022. Results: Of the included 118,936 eligible patients, hospitalization within 28 days of COVID-19 diagnosis occurred in 2.52% (456/18,090) of patients who received monoclonal antibody treatment and 6.98% (7,037/100,846) of patients who did not. Treatment with monoclonal antibody therapies was associated with a lower risk of hospitalization when using stratified data analytics, propensity scoring, and regression and machine learning models with and without adjustments for putative confounding variables, such as advanced age and coexisting medical conditions (eg, relative risk, 0.15; 95% CI, 0.14-0.17). Conclusion: Among patients with mild to moderate COVID-19, including those who have been vaccinated, monoclonal antibody treatment was associated with a lower risk of hospital admission during each wave of the COVID-19 pandemic.

Two masks can be worse than one: N95 respirator failure caused by an overlying face mask.

We have demonstrated the effect of covering an N95 filtering facepiece respirator (FFR) with an overlying face mask. In total, 100 participants successfully completed quantitative fit testing wearing a 3M 1870+ FFR. Among them, 13 (13%; 95% CI, 7%-22%) failed subsequent fit testing when simultaneously wearing a Halyard 47117 procedural mask over the FFR.

Standardizing central line safety: lessons learned for physician leaders.

A comprehensive central venous catheter (CVC) safety program reduces mechanical and infectious complications and requires an integrated multidisciplinary effort. A multistate health care system implemented a discovery and diffusion project addressing CVC insertion, maintenance, and removal. Process and outcome measures were collected before and after the intervention. The project was completed in 12 months. It was associated with statistically significant improvement in 6 process measures and reduction in the rate of ICU central line-associated bloodstream infection (from 1.16 to 0.80 infections/1000 catheter days; incidence rate ratio = 0.69; 95% confidence interval = 0.51, 0.93). A comprehensive CVC standardization project increased compliance with several established best practices, was associated with improved outcomes, produced a refined definition of discovery and diffusion project components, and identified several discrete leadership principles that can be applied to future clinical improvement initiatives.

2009 H1N1 influenza in hospitalized transplant recipients.

BACKGROUND: The 2009 H1N1 influenza virus was first identified in April 2009 and rapidly evolved into a pandemic. There are limited reports of 2009 H1N1 influenza in transplant recipients. We report on our experience with hospitalized transplant recipients with 2009 H1N1 influenza virus. METHODS: Ongoing review of hospitalized 2009 H1N1 influenza cases identified six patients who had received transplants. Clinical characteristics and outcomes were abstracted from the medical record. RESULTS: Between April 27 and November 30, 2009, 29 patients with influenza A virus were admitted to the Mayo Clinic Hospital. Six of the 29 patients were transplant recipients; 4 were confirmed to have 2009 H1N1 influenza virus. Most patients presented with an acute febrile respiratory illness. Duration of antiviral treatment was 5 to 7 days except for one patient who was treated for 11 days until withdrawal of care. Prolonged viral shedding was not noted, and the patients recovered promptly except for a patient with recalcitrant multiple myeloma who died because of the disease. CONCLUSION: 2009 H1N1 influenza disease in this cohort of hospitalized transplant recipients was relatively mild. The majority of the patients improved promptly, and prolonged viral shedding was not noted.