cleanSURFACES® intervention reduces microbial activity on surfaces in a senior care facility.

As one of the top public health challenges outlined by the Centers for Disease Control (CDC), estimates report that hospital acquired infections (HAIs) claim the lives of 99,000 Americans and cost healthcare providers over $28 billion each year. In addition to underlying conditions related to age, elderly patients in long-term care facilities are at an elevated risk of acquiring HAIs. A large percentage of HAIs is attributable to contaminated surfaces and medical devices. To that end, this study utilized a metatranscriptomic sequencing workflow (CSI-Dx™) to profile active microbial communities from surfaces in the HJ Heinz Community Living Center, a long-term care facility in the Veterans Affairs Pittsburgh Health Care System. Swabs were collected from high-touch surfaces (Keyboard, Ledge, Workstation on Wheels, Worksurfaces) before (Baseline) and after cleanSURFACES® were installed at 4 timepoints (Day 1, Day 7, Day 14, and Day 30). Microbial richness was significantly reduced after cleanSURFACES® intervention (Wilcoxon test with Holm correction, p=0.000179). Beta diversity results revealed distinct clustering between Baseline and Post-intervention samples (Adonis, p<0.001). Reduction in bacterial (Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus hominis) and fungal (Malassezia restricta, Candida albicans, Candida glabrata, and Candida orthopsilosis) expression of opportunistic pathogens was observed. Additionally, a subset of taxa (Corynebacterium, Cutibacterium acnes, and Ralstonia pickettii) was present in specific Post-intervention timepoints and surface types. This study revealed decreased microbial activity, highlighting the potential for the combinatorial application of cleanSURFACES® and regular decontamination practices to reduce the prevalence of microbes causing HAIs.

Parenteral Nutrition Electrolyte Abnormalities and Associated Factors Before and After Nutrition Support Team Initiation.

BACKGROUND: Studied since the 1940s, refeeding syndrome still has no universal definition, thus making comparison of studies difficult. Negative outcomes (eg, metabolic abnormalities) may occur with the use of specialized nutrition, such as parenteral nutrition (PN). Less than half of medical institutions have a nutrition support team (NST) managing PN. Interdisciplinary team management of PN may reduce negative outcomes of PN. The objective of this study was to show the value of the NST by measuring differences in PN variables, especially electrolyte abnormalities (EAs), before and after NST initiation at a large medical center and to identify factors associated with EAs among adult subjects receiving PN. MATERIALS AND METHODS: During this retrospective study, computerized medical charts (N = 735) from 2007-2010 were reviewed for electrolyte changes (particularly potassium, magnesium, and phosphorus) the first 3 days following PN initiation in hospitalized adults. Changes in EAs with other variables were compared before and after NST implementation. Equivalent samples sizes were collected to better evaluate the impact of the team. RESULTS: Following the implementation of the NST, fewer EAs were seen in PN patients (53%; χ2  = 10.906, P = .004); significantly less potassium, phosphorus, and magnesium intravenous piggyback supplementation (88.8% vs 94%; χ2  = 5.05, P = .026) was used; and mortality within 30 days of PN cessation was significantly less (12.7% vs 10.6%, P = .012). CONCLUSION: Our study complements existing research, finding that an NST was associated with a decreased occurrence of EAs and mortality in the hospitalized adult receiving PN.

Contact investigation of a case of active tuberculosis in the community.

BACKGROUND: Ashtabula County, Ohio, has been a low-risk county for tuberculosis (TB) based on the Centers for Disease Control and Prevention guidelines. The Ashtabula County TB clinic is provided through the Ashtabula County Health Department. Over the past 10 years, there has been an annual average of one to 2 active cases of TB seen and treated at the county TB clinic. CONTACT INVESTIGATION: In 2005, over a period of 3 months there were 6 cases of active TB identified in Ashtabula County. Contact investigation and follow-up were complicated by the fact that the suspected source case likely had active disease for more than 4 years and had some medical procedures performed at health care facilities in another county. This person was unaware of having TB and was identified through contact investigation by the county health department staff and sent for testing. The investigation was complicated further because the index case did not reveal contact with the suspected source case, although this was confirmed later through investigation. Contact investigation involved Ashtabula County and notification of other counties in Ohio. The Ohio Department of Health also was notified. DISCUSSION: Following identification of each case of active TB, contacts were identified through interviews with the clients, physicians, and health care facilities where clients were treated. Initially in Ashtabula County, 97 people were reviewed for follow-up, and 87 people were skin tested for TB. There were 7 conversions. CONCLUSION: Although the overall incidence of TB has declined in the United States, increased awareness of TB, appropriate diagnostic work-up, treatment, and control measures among health care professionals in low-incidence areas is increasingly important. Contact investigation of a case of TB requires diligence and effective communication.

Evaluation of Veterans MOVE! Program for Weight Loss.

OBJECTIVE: To evaluate the degree of weight loss in subjects enrolled in the Veterans Affairs weight management program (MOVE!). DESIGN: Retrospective cohort design. SETTING: Tertiary care US veterans hospital, July, 2007 to September, 2008, using a retrospective database. PARTICIPANTS: Adult veterans (n = 1,659), mostly men (85%). INTERVENTION: Encounters with existing nutrition education classes were collected and outcomes were assessed. MAIN OUTCOME MEASURES: Primary outcome was weight change; the predictor was visits or encounters. ANALYSIS: One-way ANOVA. RESULTS: In this sample, ≥ 3 nutrition education encounters were associated with significantly more body weight loss compared with 1-2 encounters or no education (-1.62%, 0.2%, and -0.23%, respectively; P = .01). CONCLUSIONS AND IMPLICATIONS: Three or more nutrition education encounters within the MOVE! weight management program at the Michael E. DeBakey Veterans Affairs Medical Center are associated with modest weight loss. Future prospective studies are needed to determine causality and confirm these findings.

Evaluation of US Veterans Nutrition Education for Diabetes Prevention.

OBJECTIVE: Evaluate the effectiveness of nutrition education interventions for diabetes prevention. DESIGN: Retrospective cohort design. SETTING: Tertiary-care US Veterans' Hospital, July 2007 to July 2012, using pre-existing database. PARTICIPANTS: Prediabetic, adult veterans (n = 372), mostly men (94.4%, n = 351). INTERVENTIONS: Visits with existing nutrition education classes were collected. PRIMARY OUTCOME: diabetes status; predictors: visits/encounters, age, body mass index, weight change, and hemoglobin A1c. ANALYSIS: Cox proportional hazards method, χ(2) test, and logistic regression. RESULTS: In this sample, prediabetic veterans who received nutrition education were less likely to develop diabetes when compared with prediabetic veterans who did not receive nutrition education (hazard ratio, 0.71; 95% confidence interval, 0.55-0.92; P < .01). This difference remained significant after adjusting for body mass index and weight change. CONCLUSIONS AND IMPLICATIONS: Nutrition education was significantly associated with preventing the progression from prediabetes to diabetes in US Veterans participating in a nutrition education intervention at the Michael E. DeBakey Veterans Affairs Medical Center.