Utility of routine post-admission testing for SARS-CoV-2 in a rehabilitation facility.

Asymptomatic screening for SARS-CoV-2 is recommended in healthcare settings during periods of increased incidence, yet studies in rehabilitation settings are lacking. Routine weekly post-admission asymptomatic testing in a rehabilitation facility offered marginal gain beyond syndromic and targeted unit testing and was not associated with a reduced risk of healthcare-associated COVID-19.

Integration of hospital with congregate care homes in response to the COVID-19 pandemic.

Background: The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need to improve the safety of the environments where we care for older adults in Canada. After providing assistance during the first wave, many Ontario hospitals formally partnered with local congregate care homes in a "hub and spoke" model during second pandemic wave onward. The objective of this article is to describe the implementation and longitudinal outcomes of residents in one hub and spoke model composed of a hospital partnered with 18 congregate care homes including four long-term care and 14 retirement or other congregate care homes. Intervention: Homes were provided continuous seven-day per week access to hospital support, including infection prevention and control (IPAC), testing, vaccine delivery and clinical support as needed. Any COVID-19 exposure or transmission triggered a same-day meeting to implement initial control measures. A minimum of weekly on-site visits occurred for long-term care homes and biweekly for other congregate care homes, with up to daily on-site presence during outbreaks. Outcomes: Case detection among residents increased following implementation in context of increased testing, then decreased post-immunization until the Omicron wave when it peaked. After adjusting for the correlation within homes, COVID-related mortality decreased following implementation (OR=0.51, 95% CI, 0.30-0.88; p=0.01). In secondary analysis, homes without pre-existing IPAC programs had higher baseline COVID-related mortality rate (OR=19.19, 95% CI, 4.66-79.02; p<0.001) and saw a larger overall decrease during implementation (3.76% to 0.37%-0.98%) as compared to homes with pre-existing IPAC programs (0.21% to 0.57%-0.90%). Conclusion: The outcomes for older adults residing in congregate care homes improved steadily throughout the COVID-19 pandemic. While this finding is multifactorial, integration with a local hospital partner supported key interventions known to protect residents.

COVID-19 vaccine uptake among healthcare workers: an achievable quality improvement target.

There is a need to optimize SARS-CoV-2 vaccination rates amongst healthcare workers (HCWs) to protect staff and patients from healthcare-associated COVID-19 infection. During the COVID-19 pandemic, many organizations implemented vaccine mandates for HCWs. Whether or not a traditional quality improvement approach can achieve high-rates of COVID-19 vaccination is not known. Our organization undertook iterative changes that focused on the barriers to vaccine uptake. These barriers were identified through huddles, and addressed through extensive peer outreach, with a focus on access and issues related to equity, diversity and inclusion. The outreach interventions were informed by real-time data on COVID-19 vaccine uptake in our organization. The vaccine rate reached 92.3% by 6 December 2021 with minimal differences in vaccine uptake by professional role, clinical department, facility or whether the staff had a patient facing role. Improving vaccine uptake should be a quality improvement target in healthcare organizations and our experience shows that high vaccine rates are achievable through concerted efforts targeting specific barriers to vaccine confidence.

Impact of universal admission testing for severe acute respiratory coronavirus 2 (SARS-CoV-2) in era of the omicron variant.

In this prospective study, universal admission testing for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) averted transmission in shared patient rooms especially since the emergence of the SARS-CoV-2 omicron variant when the yield in identifying infectious asymptomatic cases more than doubled. This change may be due to the higher rate of asymptomatic infection with the omicron variant, the broader community prevalence during the omicron era, or both.

Risk of SARS-CoV-2 transmission from universally masked healthcare workers to patients or residents: A prospective cohort study.

In a multifacility prospective cohort study, we identified 116 acute care, 26 long-term care, and 67 rehabilitation patients who received direct care from a universally masked healthcare worker while communicable with COVID-19. Among 133(64%) patients with at least 14-day follow-up, 3 (2.3%, 95% CI, 0.77-6.4) became positive for SARS-CoV-2. Universal masking, embedded with other infection control practices, is associated with low risk of transmission of SARS-CoV-2 from healthcare workers to patients and residents.

Impact of mandatory online learning module for healthcare workers intending to decline influenza immunization: Implications for coronavirus disease 2019 (COVID-19).

A policy mandating the completion of an online learning module for healthcare workers intending to decline influenza immunization was associated with a nearly 25% relative increase in immunization and significant reduction in healthcare-associated influenza. In the absence of mandatory vaccination, this model may help to augment severe acute respiratory coronavirus virus 2 (SARS-CoV-2) vaccine efforts.

Acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in contacts of patients newly identified as colonized or infected with MRSA in the immediate postexposure and postdischarge periods.

The acquisition of methicillin-resistant Staphylococcus aureus (MRSA) after exposure to patients colonized or infected with MRSA was assessed. Among contacts with complete surveillance screening, the rate of acquisition was 5.7% and was lower in those identified postdischarge (17/683, 2.5%) compared with those tested in the immediate postexposure period (62/706, 8.8%).

Risk factors for Staphylococcus aureus surgical site infection during an outbreak in patients undergoing cardiovascular surgery.

BACKGROUND: This study examined the epidemiology of an outbreak of Staphylococcus aureus surgical site infections (SSI) after cardiovascular surgery, and analyzed risk factors for S aureus SSIs. METHODS: This was a retrospective case-control study to determine risk factors for S aureus SSI in 38 patients who developed S aureus SSI during the outbreak period, compared with age-, sex-, and procedure-matched controls. S aureus strains were typed by pulsed-field gel electrophoresis. RESULTS: A total of 38 patients had S aureus SSI. Pulsed-field gel electrophoresis identified transmission of 3 S aureus clones (2 MSSA clones and 1 MRSA clone). Twenty-one health care workers were carriers of outbreak strains. In multivariate analysis, the significant risk factors for S aureus SSI were previous cardiac surgery (odds ratio, 7.41; 95% confidence interval, 1.05-52.16) and long procedure duration (odds ratio, 1.49; 95% confidence interval, 1.00-2.21). CONCLUSIONS: This outbreak demonstrates evidence of nosocomial transmission of 3 clones of S aureus in the setting of incomplete compliance with recommended standard perioperative infection control measures, associated with a high prevalence of staff carriage of the predominant outbreak strains.

The impact of treatment modality on infection-related hospitalization rates in peritoneal dialysis and hemodialysis patients.

BACKGROUND AND OBJECTIVES: Infection is a major cause of morbidity and mortality in the dialysis population. This study compares the rates of infection-related hospitalization (IRH) in incident chronic dialysis patients initiating outpatient peritoneal dialysis (PD) and hemodialysis (HD). METHODS AND PATIENTS: This was a retrospective cohort study at the dialysis program of a tertiary-care center in Toronto, Canada. Incident chronic dialysis patients that were eligible for both PD and HD and started outpatient dialysis between 1 January 2004 and 31 August 2008 were included. Dialysis modality was assigned at the start of outpatient dialysis treatment. All hospital admissions were reviewed and incidence of IRH was compared between PD and HD using Poisson regression. RESULTS: Of 264 incident chronic dialysis patients, 168 (64%) were eligible for both treatment modalities: 71 (42%) started outpatient PD and 97 (58%) started outpatient HD. The unadjusted and adjusted incidence rate ratios (IRR) of IRH did not differ significantly between PD and HD: 1.23 [95% confidence interval (CI) 0.65-2.32, p=0.37] and 1.14 (95% CI 0.58-2.23, p=0.71) respectively. There was no difference between PD and HD in the risk of access loss (28% vs 35%, p=0.73), modality change (22% vs 0%, p=0.10), or death (17% vs 6%, p=0.60) following hospitalization for infection. Patients starting outpatient treatment on PD versus HD were more likely to be hospitalized for peritonitis (IRR 3.20, 95% CI 1.16-9.09; p=0.029) and there was a trend for fewer hospitalizations for bacteremia (IRR 0.19, 95% CI 0.028-1.30; p=0.091). The risk of IRH did not differ between PD and HD in the subgroup of patients that received adequate predialysis care (IRR 1.16, 95% CI 0.59-2.27; p=0.67) or when patients starting outpatient HD with a central venous catheter were excluded (IRR 1.52, 95% CI 0.53-4.37; p=0.44). CONCLUSIONS: Patients that initiate outpatient peritoneal dialysis do not have a significantly increased risk of infection-related hospitalization compared to those that initiate outpatient hemodialysis.

Utility of environmental sampling for the prevention of transmission of vancomycin resistant enterococci (VRE) in hospitals.

BACKGROUND: Although vancomycin resistant enterococci (VRE) have been shown to contaminate environmental surfaces in the room of a patient infected or colonized with VRE there is limited evidence that links environmental contamination with acquisition. OBJECTIVES: To determine whether a policy of environmental sampling and room closure is more effective than cleaning and visual inspection of the room without culturing, in preventing the transmission of VRE to the next admitted patient. METHODS: The rooms of consecutive patients with VRE were alternatively managed according to either Protocol I (terminal cleaning, inspection and admission of new patient(s)) or Protocol II (terminal cleaning, environmental cultures and closing of the room pending negative results). The next admitted patient to all rooms had rectal swabs obtained for VRE within 24 hours of admission, three to five days after admission and upon discharge from the room and/or the facility. The proportion of patients who acquired the same strain of VRE after being admitted to rooms handled according to either Protocol I or Protocol II was compared. RESULTS: The risk of acquisition of VRE by patients admitted to a room managed according to Protocol I (1/19) was not significantly different than for patients admitted to a room managed according to Protocol II (0/12) (p=0.99). At least one positive environmental culture was obtained in 8/14 (57.1%) rooms managed according to Protocol II. CONCLUSIONS: Although VRE may be detected in the hospital environment there is insufficient evidence to conclude that routinely obtaining negative environmental cultures from the room of a patient infected or colonized with the organism is more effective in preventing VRE transmission to subsequent patients, provided the room is adequately cleaned and disinfected.

The role of colonization pressure in nosocomial transmission of methicillin-resistant Staphylococcus aureus.

BACKGROUND: Colonized or infected patients are a major reservoir for patient-to-patient transmission of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals. Despite attempted adherence to recommended infection prevention and control procedures, a general medicine unit in our hospital continued to experience ongoing transmission of MRSA. The role that colonization pressure (CP) plays in nosocomial transmission of MRSA on a general medicine unit was assessed, and a threshold CP above which additional IP&C practices should be implemented was proposed. METHODS: From January 2005 to December 2006, all patients admitted to a 36-bed general medicine unit were screened on admission for MRSA. Monthly MRSA nosocomial incidence (new nosocomial cases x 1000/susceptible patient-days) and CP (number of MRSA patient-days x 100/total patient-days) were calculated. The relative risk (RR) of MRSA transmission above and below the median CP with 95% confidence interval was calculated. RESULTS: Twenty-one cases of nosocomially acquired MRSA were detected during the study period, with transmission occurring in 8 separate months. The median CP during the 2 years was 6.7%. The RR of MRSA acquisition increased as CP increased above the median (RR, 7.6; 95% CI: 1.1-52.6; P = .008). MRSA outbreaks were declared on 2 separate occasions, and, in each, the CP for the preceding month was greater than the median value of 6.7%. CONCLUSION: CP has a significant effect on the subsequent transmission of MRSA on a general medicine unit. Ongoing monitoring of CP provides the opportunity for early implementation of enhanced infection prevention and control practices and can potentially decrease nosocomial transmission of MRSA and prevent outbreaks.