Harnessing the power of infection prevention and public health data systems to support health care in Washington State during the COVID-19 pandemic.

BACKGROUND: State health departments' (SHD) role in infection prevention and control (IPC) includes robust educational and consultative services for various health care settings. During the COVID-19 pandemic, Washington-SHD (W-SHD) IPC staff conducted remote and on-site Infection Control Assessment and Response (ICAR) consultations for long-term care (LTC) and non-LTC health care facilities. METHODS: ICAR consultations were classified as "reactive" in response to a COVID-19 outbreak or "proactive" to help facilities improve IPC protocols. Facility addresses were geocoded to census tracks, classifying urban or rural areas. Facility types and characteristics were analyzed, assessing the impacts of repeat visits. All descriptive statistics, Pearson's χ2 tests, and odds ratios were calculated. RESULTS: Between March 2020 and December 2022, W-SHD conducted 3,093 ICARs at 1,703 health care facilities in 94.9% (37/39) of Washington counties. Of the total visits, most were in LTC (90.5%) and 48.9% were reactive. Facilities with initial on-site ICARs had 1.5 times the odds of having a repeat visit than facilities with initial remote visit (95% CI: 1.21, 1.87). DISCUSSION: Maintaining strong connections with health care facilities can help bolster infection prevention practices and minimize loss of information at the facility level. CONCLUSIONS: Evidence-based findings on the sustainability of the W-SHD's ICAR services during the COVID-19 pandemic illustrated the value of public health IPC programs.

Underutilization of norovirus testing in hematopoietic cell transplant recipients at a large cancer center.

The development of a new laboratory-developed norovirus assay provided an opportunity to assess testing patterns, incidence, and outcomes of norovirus among hematopoietic cell transplant (HCT) recipients. Clostridium difficile and norovirus tests from 1,393 HCT recipients were compared in these analyses. In this population of high-risk patients, norovirus appeared to occur seasonally, but testing was infrequent despite a correlation with more severe disease when compared with patients with C difficile infection.

Unintended Consequences of Pretransplant Vancomycin-Resistant Enterococcus Screening on Antimicrobial Stewardship Among Allogeneic Hematopoietic Cell Transplant Recipients.

We examined vancomycin-resistant enterococci (VRE)-directed antimicrobial use and VRE bacteremia in a cohort of allogeneic hematopoietic cell transplantation patients from a center where VRE screening is standard prior to transplant. In this cohort, VRE bacteremia (VREB) was infrequent. In patients without VREB, colonized patients received VRE therapy more often than noncolonized patients.Infect Control Hosp Epidemiol 2018;39:730-733.

10-year trends in vancomycin-resistant enterococci among allogeneic hematopoietic cell transplant recipients.

OBJECTIVES: We examined VRE colonization, bacteremia (VREB) incidence and outcomes within 100 days of allogeneic hematopoietic cell transplantation (HCT). METHODS: HCT recipients screened for VRE were assessed, and colonization and VREB incidence compared over time using linear regression. Cox proportional hazards models were constructed to assess the relationship between mortality, pre-HCT colonization, and underlying disease. RESULTS: Of 1492 HCT recipients, 204 (14%) patients were colonized pre-HCT, while 90 (6%) acquired colonization post-HCT. Forty-two patients (2.8%) developed VREB within 100 days post-HCT; the majority, 32 (76%), were previously colonized. The cumulative incidence of VREB was 2.9 per 10,000 patient-days. Over the study period there were no significant changes in incidence of VRE colonization or VREB despite a number of interventions (p > 0.1). Patients with pre-HCT colonization had increased mortality compared to non-colonized patients (HR 2.1; 95% CI: 1.5, 3.3). CONCLUSIONS: We found a low burden of VRE at our center with no significant changes observed over a 10-year study period. VRE, while responsible for substantial resource consumption from routine screening and isolation, was an infrequent cause of bacteremia.