Effects of Pollution on Marine Organisms.

This review covers selected 2017 articles on the biological effects of pollutants and human physical disturbances on marine and estuarine plants, animals, ecosystems and habitats. The review, based largely on journal articles, covers field and laboratory measurement activities (bioaccumulation of contaminants, field assessment surveys, toxicity testing and biomarkers) as well as pollution issues of current interest including endocrine disrupters, emerging contaminants, wastewater discharges, marine debris, dredging and disposal etc. Special emphasis is placed on effects of oil spills and marine debris due largely to the 2010 Deepwater Horizon oil blowout in the Gulf of Mexico and proliferation of data on the assimilation and effects of marine debris microparticulates. Several topical areas reviewed in the past (e.g.mass mortalities ocean acidification) were dropped this year. The focus of this review is on effects, not on pollutant sources, chemistry, fate or transport. There is considerable overlap across subject areas (e.g.some bioaccumulation data may be appear in other topical categories such as effects of wastewater discharges, or biomarker studies appearing in oil toxicity literature). Therefore, we strongly urge readers to use keyword searching of the text and references to locate related but distributed information. Although nearly 400 papers are cited, these now represent a fraction of the literature on these subjects. Use this review mainly as a starting point. And please consult the original papers before citing them.

Effects of Pollution on Marine Organisms.

This review covers selected 2016 articles on the biological effects of pollutants and human physical disturbances on marine and estuarine plants, animals, ecosystems and habitats. The review, based largely on journal articles, covers field and laboratory measurement activities (bioaccumulation of contaminants, field assessment surveys, toxicity testing and biomarkers) as well as pollution issues of current interest including endocrine disrupters, emerging contaminants, wastewater discharges, dredging and disposal etc. Special emphasis is placed on effects of oil spills and marine debris due largely to the 2010 Deepwater Horizon oil blowout in the Gulf of Mexico. Several topical areas reviewed in the past (ballast water and ocean acidification) were dropped this year. The focus of this review is on effects, not pollutant fate and transport. There is considerable overlap across subject areas (e.g.some bioaccumulation papers may be cited in other topical categories). Please use keyword searching of the text to locate related but distributed papers. Use this review only as a guide and please consult the original papers before citing them.

Cervical cancer screening in rural mountainous Honduras: knowledge, attitudes and barriers.

INTRODUCTION: Because cervical cancer is the leading cause of cancer mortality in Honduras, this study assessed knowledge, attitudes and barriers to cervical cancer screening services by Papanicolaou smear (pap smear) for women in rural, remote Honduras served by Virginia Commonwealth University's Global Health and Health Disparities Program (GH2DP). METHODS: Two interviewers administered an institutional review board approved, 20 question survey by convenience sample methodology to adult female patients visiting GH2DP clinics in June 2014. A total of 146 surveys were completed. Of the respondents, 30 were living in La Hicaca, the largest and wealthiest village in the region, and 116 were living in surrounding, less affluent, villages. RESULTS: On average, women from La Hicaca had 2.9 children whereas women from surrounding villages had 4.3 children (p=0.0095). There were no significant differences between La Hicaca and surrounding villages in average respondent age, age of first intercourse and number of sexual partners. Seventy three percent (22/30) of women from La Hicaca and 60% (70/116) from surrounding villages reported undergoing cervical cancer screening by pap smear (p=0.1890). Eighty-two percent (18/22) of the respondents from La Hicaca and 84% (59/70) from surrounding villages were screened in the past two years (p=0.7846). The majority of the women from surrounding villages (81%, 57/70) and 23% (5/22) from La Hicaca traveled >1 h to receive a pap smear (p≤0.0001). Women from La Hicaca (86%, 19/22) were more likely to receive their pap smear results than women from surrounding villages (60%, 42/70) (p=0.0225). Although 17% (5/30) of respondents from La Hicaca and 11% (13/116) (p=0.4175) from surrounding villages were aware of the cause of cervical cancer, 60% (18/30) of women in La Hicaca and 82% (95/116) in surrounding villages (p=0.0106) believed it is preventable. Of the 106 women (73%) who had heard of cervical cancer screening, only 92 women (63%) had been screened (p<0.0001). Women undergoing cervical cancer screening were more likely to believe that cervical cancer is preventable (n=78, p=0.0054). The most common screening barriers were lack of awareness and fear (19/54, 35%; 15/54, 28%). CONCLUSIONS: Although yearly screening services are available in this community, knowledge and access barriers exist for increased implementation. Notification of pap smear results is suboptimal. These findings will guide regional and collaborative effort to improve cervical cancer screening services.

Effects of Pollution on Marine Organisms.

This review covers selected 2015 articles on the biological effects of pollutants and human physical disturbances on marine and estuarine plants, animals, ecosystems and habitats. The review, based largely on journal articles, covers field and laboratory measurement activities (bioaccumulation of contaminants, field assessment surveys, toxicity testing and biomarkers) as well as pollution issues of current interest including endocrine disrupters, emerging contaminants, wastewater discharges, dredging and disposal, etc. Special emphasis is placed on effects of oil spills and marine debris due largely to the 2010 Deepwater Horizon oil blowout in the Gulf of Mexico. Several topical areas reviewed in the past (ballast water and ocean acidification) were dropped this year. The focus of this review is on effects, not pollutant fate and transport. There is considerable overlap across subject areas (e.g.some bioaccumulation papers may be cited in other topical categories). Please use keyword searching of the text to locate related but distributed papers. Use this review only as a guide and please consult the original papers before citing them.

Effects of Pollution on Marine Organisms.

This review covers selected 2014 articles on the biological effects of pollutants and human physical disturbances on marine and estuarine plants, animals, ecosystems and habitats. The review, based largely on journal articles, covers field and laboratory measurement activities (bioaccumulation of contaminants, field assessment surveys, toxicity testing and biomarkers) as well as pollution issues of current interest including endocrine disrupters, emerging contaminants, wastewater discharges, dredging and disposal, etc. Special emphasis is placed on effects of oil spills and marine debris due in part to the 2010 Deepwater Horizon oil blowout in the Gulf of Mexico and the 2011 Japanese tsunami. Several topical areas reviewed in the past (ballast water and ocean acidification) were dropped this year. The focus of this review is on effects, not pollutant fate and transport. There is considerable overlap across subject areas (e.g.some bioaccumulation papers may be cited in other topical categories). Please use keyword searching of the text to locate related but distributed papers. Use this review only as a guide and please consult the original papers before citing them.

Contact precautions for MRSA and VRE: where are we now? A survey of the Society for Healthcare Epidemiology of America Research Network.

Objective: Contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) have limited data on efficacy and have been associated with patient harm. Still, a 2015 Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN) survey showed only 7% of hospitals discontinued routine MRSA/VRE contact precautions. The study objectives were to identify the current proportion of hospitals that have discontinued routine MRSA/VRE contact precautions and motivations for change. Design: An online survey was conducted of the SRN on current use and views of contact precautions for MRSA/VRE in each facility. An initial survey followed by 2 reminders was sent between 5/18/2021 and 6/9/2021. Participants: SRN facilities. Results: The response rate was 43% (37/87) of facilities surveyed and 35% of respondents were not routinely using contact precautions for MRSA and VRE. The most frequently reported reason for discontinuing contact precautions was research on the safety of discontinuing contact precautions without an increase in healthcare-associated infections (reported for 92% of facilities for MRSA and 100% for VRE). Of those using contact precautions, the most frequently reported reason to continue was a lack of safety data for discontinuation (MRSA 58% and VRE 46%). Most of those continuing contact precautions were interested in using contact precautions differently in their facility (MRSA 63% and VRE 58%). Conclusions: Over one in three healthcare facilities surveyed do not use contact precautions for MRSA or VRE. Most facilities choosing to continue contact precautions are interested in a different implementation strategy.

Characterizing burnout among healthcare epidemiologists in the early phases of the COVID-19 pandemic: A study of the SHEA Research Network.

A multisite research team proposed a survey to assess burnout among healthcare epidemiologists. Anonymous surveys were disseminated to eligible staff at SRN facilities. Half of the respondents were experiencing burnout. Staffing shortages were a key stressor. Allowing healthcare epidemiologists to provide guidance without directly enforcing policies may improve burnout.

Bioaccumulation and toxicity of copper in outdoor freshwater microcosms.

This study characterizes the effects of copper (Cu) on Florida apple snails (Pomacea paludosa) and mosquito fish (Gambusia affinis) using a replicated outdoor microcosm design. Soils used in this study were collected from two Cu-enriched citrus agricultural sites in South Florida (Agler property (AGLR) in St. Lucie County and Sunrise Boys property (SRB) in Palm Beach County) and a reference site (Equus property) in St. Lucie County. The study included a 5-week aging phase, an 11 month exposure phase, and a 3 month post-treatment (exposure) phase. The aging phase was initiated by flooding agricultural soils with rainwater in 4 m(3) fiberglass microcosm tanks. Introducing juvenile apple snails (≤7 d old) and mosquito fish (2-3 cm) into the microcosm tanks initiated the exposure phase. Survival, growth, and reproduction of apple snails and fish, and Cu uptake in apple snails, fish, and periphyton were determined in this study. Water chemistry (e.g., dissolved Cu concentration, dissolved organic carbon and dissolved oxygen concentrations, pH, hardness, alkalinity, etc.) was measured daily or weekly during the study. Initial soil Cu concentrations in Equus, SRB, and AGLR microcosms were 7, 55, and 99 mg/kg dw, respectively. Dissolved Cu concentrations in Equus, SRB and AGLR microcosms at the beginning of the study were 3, 82, and 43 µg/L, respectively and decreased to low saturation levels of about ≤9 µg/L Cu after the first 3 months of the study. The decrease of dissolved Cu concentrations was likely due to the dilution of rainwater. Snail and fish mortality appeared to be higher in SRB microcosms than in Equus and AGLR microcosms. There was no significant difference in growth of the snails between treatments. Snail growth data followed the von Bertalanffy Model. The maximum shell length, shell height, and shell width of the snails calculated by the von Bertalanffy Model (L(∞)) were 2.76, 2.05, and 2.18 cm, respectively. The maximum wet weight was 9.38 g. Growth rate (k) of the snails increased in order of shell height (0.459), shell length (0.550), and shell weight (0.598). There was no reproduction in the snails in any treatments including the reference during the exposure phase. However, Cu did not affect reproduction of fish during this period. Copper concentrations in periphyton from Equus, SRB, and AGLR microcosms ranged from 2 to 62, 31 to 371, and 13 to 478 mg/kg, respectively. Copper concentrations in fish at the beginning, days 30 and 150 of the study ranged from 3.19 to 7.53 mg/kg and were not significantly different from the different treatments. Average Cu concentrations in the soft tissue of dead snails from SRB and AGLR microcosms were 4602 mg/kg dw (ranged from 2913 to 8370 mg/kg dw) and 2824 mg/kg dw (ranged from 2118 to 3600 mg/kg dw), respectively. The Cu concentrations in the soft tissue of dead snails found in this study were higher than the tissue Cu concentrations in live aquatic organisms reported in the literature. These high Cu concentrations in edible apple snail soft tissue might pose a risk to Florida apple snail predators, including the snail kite. The post-exposure phase, with snails exposed to only water (i.e., no soils) showed depuration of copper from apple snails and reproduction in all treatments.

Virtual infection prevention-The next frontier.

The coronavirus disease 2019 (COVID-19) pandemic has resulted in the acceleration of telehealth and remote environments as stakeholders and healthcare systems respond to the threat of this disease. How can infectious diseases and healthcare epidemiology expertise be adapted to support safe care for all?

Experiences in outpatient parenteral antimicrobial therapy (OPAT): Barriers and challenges from the front lines.

Background: Outpatient parenteral antimicrobial therapy (OPAT) is now the standard of care for managing patients who no longer need inpatient care but require prolonged intravenous antimicrobial therapy. OPAT increases patient satisfaction, reduces the lengths of hospital stay, lowers emergency department readmission rates, and decreases total healthcare spending. Objective: To investigate Virginia Commonwealth University Health System's experience with OPAT and to highlight the obstacles patients and clinicians face when navigating and utilizing this program. Design: We conducted this descriptive study at a large, academic, tertiary-care hospital in Central Virginia. Methods: We performed manual reviews of electronic medical records of 602 patient, and we evaluated the records of those receiving OPAT between 2017 and 2020. Reviews included antimicrobial agents, diagnoses requiring OPAT, adverse effects related to antimicrobials, adverse effects related to peripherally inserted central catheters (PICC), readmission rate, discharge destination, and death. We evaluated our program with descriptive statistics. Results: Among 602 patients who received OPAT, most were diagnosed with bacteremia or musculoskeletal infections. Patients were either discharged home or to another healthcare facility, with the former comprising most of the rehospitalizations. Ertapenem and vancomycin were associated with the most adverse drug events among our cohort. Elevated transaminase levels were noted in 23% of patients. The rate of PICC-line adverse events in this study population was 0.05%. Conclusions: Our findings highlight the barriers and challenges that patients and providers face when receiving OPAT, and they can inform efforts to improve patient clinical outcomes.

The coronavirus disease 2019 (COVID-19) delta wave: Refocusing effort and remaining resilient in the face of evolving infection prevention and antimicrobial stewardship challenges.

Challenges for infection prevention and antimicrobial stewardship programs have arisen with the fourth wave of the coronavirus disease 2019 (COVID-19) pandemic, fueled by the delta variant. These challenges include breakthrough infections in vaccinated individuals, decisions to re-escalate infection prevention measures, critical medication shortages, and provider burnout. Various strategies are needed to meet these challenges.

Management of the COVID-19-Infected Psychiatric Inpatients: Unique Infection Prevention Considerations and Evolving Strategies.

REASON FOR REVIEW: The COVID-19 pandemic has affected the way healthcare services are provided and created challenges to the delivery of behavioral health in the inpatient setting. Here, we present our front-line experience of infection prevention for the psychiatric patient in the COVID era. RECENT FINDINGS: There are unique challenges surrounding COVID-19 precautions within inpatient psychiatric settings. The challenges presented to psychiatric care by COVID-19 begin in the emergency department and follow the patient through the continuum of care once admitted to the facility. Unit infrastructure, patient population, treatment modalities, staffing considerations, and discharge planning are distinct instances where COVID-19 protocols that are well-suited for other hospital settings necessitate revision for psychiatric settings. SUMMARY: The purpose of this communication is to add to the current body of shared experience of infection prevention for the psychiatric patient in the COVID-19 era.

Barrier Precautions in the Era of Multidrug Pathogens.

Purpose of review: There is a continuing debate regarding contact precaution (CP) usage for endemic multidrug-resistant organisms (MDROs). In this review, we examine current recommendations for CP and highlight differences in CP use between endemic and non-endemic MDROs. Recent findings: The discontinuation of CP had no effect on the incidence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci. The evidence regarding CP for extended-spectrum beta-lactamase producing Enterobacteriaceae is inconclusive, highlighting the need for more research to determine best infection control strategies. Carbapenem-resistant Enterobacteriaceae maintains a sporadic pattern in the USA, supporting current recommendations to use CP for colonized and infected patients. MDR Acinetobacter baumannii (MDR-AB) is extremely virulent and responsible for outbreaks in healthcare settings, emphasizing the need for CP use with MDR-AB infected patients. Candida auris (C. auris) is often misdiagnosed; it is resistant to UV light and quaternary ammonium low-level disinfection. Because little is known about the transmission of C. auris, significant caution and CP use are necessitated. There is little research on vancomycin-resistant S. aureus (VRSA) control strategies due to its rarity; thus, CP is strongly recommended. Summary: Contact precautions are frequently part of a bundled infection control approach that involves meticulous hand hygiene, patient decolonization, chlorhexidine gluconate bathing, and reducing the use of invasive devices. Healthcare facilities should continue to utilize CP for non-endemic MDROs and the presence of endemic MDROs; however, CP may not add benefit to the current infection prevention bundle approach.

Effect of ultraviolet-C light disinfection at terminal patient discharge on hospital-acquired infections in bone marrow transplant and oncology units.

We employed an interrupted time series analysis to assess the impact of ultraviolet-C light disinfection at terminal discharge in an oncology unit and a bone marrow transplant unit on the incidence of hospital-acquired infections. The deployment of ultraviolet-C light disinfection was associated with a significant decrease in the rate of Clostridioides difficile infections and a significant decrease in the rate of central line-associated blood stream infections in the bone marrow transplant unit.

Nurse survey, knowledge gaps and the creation of an environmental hygiene protocol for patient transport and removing linen from patient rooms.

General guidance for personal protective equipment (PPE) is provided by the Occupational Safety and Health Administration and the United States Centers for Disease Control and Prevention. Previous research of PPE demonstrates the ability of gloves to harbor infectious pathogens. We surveyed health care workers to investigate current PPE practices during linen removal from patient rooms and during patient transport. The results suggest a possible risk for cross-contamination of the environment from overuse of gloves.

The learning hospital: From theory to practice in a hospital infection prevention program.

The learning hospital is distinguished by ceaseless evolution of erudition, enhancement, and implementation of clinical best practices. We describe a model for the learning hospital within the framework of a hospital infection prevention program and argue that a critical assessment of safety practices is possible without significant grant funding. We reviewed 121 peer-reviewed manuscripts published by the VCU Hospital Infection Prevention Program over 16 years. Publications included quasi-experimental studies, observational studies, surveys, interrupted time series analyses, and editorials. We summarized the articles based on their infection prevention focus, and we provide a brief summary of the findings. We also summarized the involvement of nonfaculty learners in these manuscripts as well as the contributions of grant funding. Despite the absence of significant grant funding, infection prevention programs can critically assess safety strategies under the learning hospital framework by leveraging a diverse collaboration of motivated nonfaculty learners. This model is a valuable adjunct to traditional grant-funded efforts in infection prevention science and is part of a successful horizontal infection control program.

Clostridioides difficile nurse driven protocol: A cautionary tale.

In a 12-month study, a nurse driven protocol was implemented at a tertiary academic medical center. The purpose of the nurse driven protocol was to identify community-onset Clostridioides difficile infections, expeditiously isolate patients with presumed C difficile diarrheal illness, and prevent transmission while simultaneously decreasing the incidence of hospital-onset C difficile. The overall adherence to fidelity of the protocol was poor and failed to have a significant impact on infection rates.

Stopping the routine use of contact precautions for management of MRSA and VRE at three academic medical centers: An interrupted time series analysis.

BACKGROUND: Contact precautions (CP) are a widely adopted strategy to prevent cross-transmission of organisms, commonly methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Some hospitals have discontinued CP for patients with MRSA or VRE; however, the impact on hospital-acquired infection rates (HAI) has not been assessed systematically. METHODS: Retrospective multicenter interrupted time series between 2002 and 2017 at three academic hospitals. Participating hospitals discontinued CP for patients with contained body fluids who were colonized or infected with MRSA or VRE. The primary intervention was stopping the use of CP. Secondary interventions were horizontal infection prevention strategies. The primary outcomes were rates of central line-associated bloodstream infections, catheter-associated urinary tract infections, mediastinal surgical site infection, and ventilator-associated pneumonia due to MRSA, VRE, or any organism using Centers for Disease Control and Prevention National Healthcare Safety Network surveillance definitions. RESULTS: Central line-associated bloodstream infections, catheter-associated urinary tract infections, mediastinal surgical site infection, and ventilator-associated pneumonia rates trended down at each institution. There were no statistically significant increases in these infections associated with discontinuing CP. Individual horizontal infection prevention strategies variably impacted HAI outcomes. CONCLUSIONS: Stopping the routine use of CP for patients with contained body fluids who are colonized or infected with MRSA or VRE did not result in increased HAIs. Bundled horizontal infection prevention strategies resulted in sustained HAI reductions.

Urine test stewardship for catheterized patients in the critical care setting: Provider perceptions and impact of electronic order set interventions.

We implemented an electronic medical record (EMR) decision support tool for ordering urine cultures per evidence-based guidelines. Following the EMR change, we found a significant increase in proportion of cultures ordered for catheterized intensive care unit (ICU) patients meeting guidelines. We surveyed providers and found poor understanding of urine culture guidelines for catheterized ICU patients. EMR-based interventions and educational opportunities have potential to improve urine culture guideline adherence and reduce unnecessary testing and antibiotic use.

A comparison of the accuracy of two electronic hand hygiene monitoring systems.

Interest in electronic hand hygiene monitoring systems (EHHMSs) is now widespread throughout the infection control community. We tested 2 types of EHHMS for accuracy. The type B EHHMS captured more HH events with superior accuracy. Hospitals considering an EHHMS should assess the technology's ability to accurately capture HH performance in the clinical workflow.