ABSTRACT
A systematic approach to contact investigations has long been a cornerstone of interrupting the transmission of tuberculosis in community settings. This paper describes the implementation of a systematic 10-step contact investigation within an acute care setting during a multistate outbreak of healthcare-associated tuberculosis. A systematic approach to contact investigations might have applicability to the prevention of other communicable infections within healthcare settings.
Subject(s)
Tuberculosis , Humans , Tuberculosis/epidemiology , Contact Tracing , Delivery of Health Care , Disease Outbreaks/prevention & control , Health FacilitiesABSTRACT
Hypromellose acetate succinate (HPMCAS) is an enteric polymer that has been successfully employed as a carrier in amorphous solid dispersions (ASDs). Deprotonation of succinic acid substituents at intestinal pH levels results in solubilization of the polymer. However, the acidic moieties responsible for favorable pH-dependent solubility can also result in incompatibilities between acid-sensitive drugs and HPMCAS. Solution-state conversion of the carboxylic acid substituents of enteric polymers into carboxylate salts to reduce acid-mediated drug degradation is a demonstrated effective strategy for generating ASDs in enteric polymers. This work aimed to extend the use of a pre-ionized enteric polymer to KinetiSol solvent-free processing to reduce acid- or base-mediated drug degradation during processing. Pre-ionization of HPMCAS was accomplished by reaction with a stoichiometric quantity of sodium carbonate (Na2CO3) delivered as a saturated aqueous solution. The resulting ionized polymer, HPMCAS-Na, was dried thoroughly before processing. Tetrabenazine (TBZ) was chosen as a model drug for its susceptibility to degradation via both acid- and base-catalyzed reaction mechanisms and for its tendency to form a single impurity by these mechanisms. The use of HPMCAS-Na in KinetiSol solid dispersions (KSDs) of TBZ resulted in a 6- to 8-fold reduction of the acid- and base-generated TBZ impurity compared with KSDs formulated with untreated HPMCAS.
