Predicting risk-adjusted incidence rates of methicillin-resistant Staphylococcus Aureus and Pseudomonas Aeruginosa in cystic fibrosis programs in the United States.

BACKGROUND: Healthcare-associated transmission of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa occurs for people with cystic fibrosis (CF), but CF programs lack a process to monitor incidence rates (IRs). We assessed predictors of incident infections and created a model to determine risk-adjusted IRs for CF programs. METHODS: Using the CF Foundation Patient Registry data for all patients from 2012 to 2015, coefficients for variables that predicted IRs were estimated. Hazard functions were then used to predict IRs of MRSA and P. aeruginosa for CF programs based on their patient and program characteristics. Predicted IRs were compared with observed IRs over multiple time intervals. RESULTS: Multiple patient and program characteristics were identified as predictors of observed IRs. Our model's predicted IRs closely aligned with observed IRs for most CF programs. Alarm values (defined as observed IR > 95% confidence interval of predicted IR) were found at 5.9%, 5.9%, 6.0% (adult, pediatric, affiliate) of programs for MRSA and 3.0%, 1.7%, 0.0% (adult, pediatric, affiliate) of programs for P. aeruginosa. CONCLUSIONS: We found patient and program characteristics that predicted MRSA and P. aeruginosa IRs. Our model accurately predicted risk-adjusted IRs of MRSA and P. aeruginosa. CF programs could use our model to monitor their IRs and potentially improve infection prevention and control.

Barriers implementing infection prevention and control experienced by healthcare workers, people with CF and parents.

BACKGROUND: Barriers to implementing infection prevention and control (IP&C) practices may be experienced by healthcare workers (HCWs) caring for people with CF (PwCF), PwCF, and their families. We hypothesized that these stakeholders from CF centers with early adoption of the updated 2013 IP&C guideline would experience fewer barriers implementing selected recommendations compared to stakeholders from CF centers with delayed adoption. METHODS: In 2018-2019 we surveyed HCWs and PwCF/parents from 25 CF centers to identify knowledge, attitude, and practice barriers. Each center recruited five HCWs with different occupations. Pediatric centers recruited five parents of children <18 years old and five young adults 18-21 years old. Adult centers recruited 10 adults ≥18 years old. We determined respondents' knowledge scores, the proportion who agreed with or perceived health benefits from recommendations, and reported adherence to recommendations. RESULTS: Knowledge scores, perception of health benefits, and adherence to selected practices were similar among participants from centers with early vs. delayed adoption, yet generally lower for inpatient nurses. IP&C practitioners were less likely to perceive health benefits from PwCF wearing masks and HCWs wearing gowns and gloves. Among HCWs, 57% educated >75% of PwCF/parents about IP&C and 43% advised >75% of PwCF/parents to avoid socializing with other PwCF. Among PwCF/parents, 69%, 53%, and 56% reported discussions with their care teams about performing hand hygiene, avoiding socialization, or the 2013 IP&C guideline, respectively. CONCLUSIONS: Our findings suggest opportunities for targeted education for specific HCW occupations and for PwCF and their families.

Impact of the SARS-CoV-2 pandemic on cystic fibrosis centres and care: survey results from US centres.

Lessons learnt from the pandemic show that telehealth for cystic fibrosis allows multidisciplinary visits but better means for monitoring of lung function and microbiology are needed https://bit.ly/2V7g09x.

Perceptions of safety monitoring in CF clinical studies and potential impact on future study participation.

BACKGROUND: Individuals with CF and their parents cite safety concerns as barriers to participating in clinical studies. We assessed whether a brochure/infographic describing patient safety monitoring processes could reduce knowledge and attitude barriers regarding safety monitoring. We also identified factors associated with likely participation in future CF studies. METHODS: Respondents from three CF centers in the U.S. were randomly assigned to receive the safety monitoring brochure/infographic or an unrelated brochure. Fifty parents of children with CF <16, 50 adolescents with CF 16-21, and 50 adults with CF ≥22 years old were recruited to complete the study survey. Factors associated with survey responses and with reported likelihood of participating in future studies were assessed. RESULTS: Overall the safety monitoring brochure/infographic was associated with increased likelihood of future participation in non-drug studies (aOR 2.30, CI95 1.01-5.28), but not in drug studies. Non-Hispanic respondents reported greater likelihood of participating in a future drug study than Hispanic respondents (aOR 3.18, CI95 1.30-7.74). Adults with CF (aOR 2.62, CI95 1.05-6.51) and parents (aOR 4.49, CI95 1.66-12.15) were more likely than adolescents to report they would ask their care team about clinical trials. Confidence in safety monitoring was associated with reported likelihood of future participation in drug studies. CONCLUSIONS: Potential future participation in CF drug and/or non-drug studies was associated with respondent age and ethnicity, receiving the safety monitoring brochure/infographic, and confidence in safety monitoring. Our findings underscore the need for education about safety monitoring, with targeted approaches for the Hispanic CF population and adolescents.

Cystic fibrosis program characteristics associated with adoption of 2013 infection prevention and control recommendations.

BACKGROUND: The Cystic Fibrosis (CF) Foundation disseminated an updated guideline for infection prevention and control (IP&C) practices for CF care programs in 2013. Assessing adoption rates of IP&C recommendations is crucial to evaluate their impact. METHODS: CF care programs provided their written IP&C policies for CF. Policies were analyzed to determine adoption of selected recommendations new in 2013, as well as recommendations made in both 2003 and 2013. Weighted adoption scores were analyzed for association with program characteristics. RESULTS: The median number of new recommendations adopted by each program was 7 (mean 6.3, range 0-9). The most commonly adopted new recommendations were universal mask use by patients in both inpatient and outpatient settings (85% and 87%, respectively) and contact precautions for CF patients in inpatient and outpatient settings (90% for both). The least frequently adopted new recommendations were the "6-foot rule" in inpatient settings (n = 66, 53%) and auditing disinfection of surfaces in clinic (n = 64, 49%). Larger program size was associated with a higher weighted adoption score (odds ratio [OR] 1.9, P =.02). CONCLUSIONS: Whereas most programs adopted more than one-half of the selected IP&C recommendations assessed, adoption was variable. Efforts to improve adoption of IP&C recommendations should focus on smaller programs with fewer resources.

Surveying Cystic Fibrosis Care Centers to Assess Adoption of Infection Prevention and Control Recommendations.

OBJECTIVEIn 2013, the Cystic Fibrosis (CF) Foundation developed an updated guideline for infection prevention and control (IP&C) practices for CF. We sought to assess the adoption of specific recommendations by CF care centers.METHODSDirectors of the 277 CF care centers in the United States were asked to complete a confidential online survey regarding the adoption of selected IP&C recommendations. Selected recommendations were those we considered less likely to be incorporated into a center's written IP&C policies.RESULTSCenter directors from 198 of 277 CF centers (71%) completed the survey between December 2015 and June 2016; pediatric and larger centers were more likely to do so. Overall, 70% have adopted ≥75% of the selected recommendations. As recommended, almost all provided education to CF center staff (98%) and patients and families (97%); fewer developed educational materials in collaboration with local IP&C teams (59%) and/or patients and families (37%). Among 108 centers with non-English-speaking patients, 65 (60%) provided educational materials in relevant languages. Most (74%) held group education events; of the 138 centers with in-person meetings, 45% allowed 1 individual with CF to attend, and 51% allowed no individuals with CF to attend. Most centers (93%) held outdoor events, and 84% allowed >1 individual with CF to attend. Audits of exam-room cleaning were performed by 49% of CF centers.CONCLUSIONSCystic fibrosis centers in the United States have adopted many of the recommendations addressed in this survey. Nonetheless, these findings suggest opportunities for improvement. More CF centers should provide education to non-English-speaking patients and families, and CF centers should perform audits of room cleaning.Infect Control Hosp Epidemiol. 2018;39:647-651.

Impact of New York State Influenza Mandate on Influenza-Like Illness, Acute Respiratory Illness, and Confirmed Influenza in Healthcare Personnel.

In 2013, New York State mandated that, during influenza season, unvaccinated healthcare personnel (HCP) wear a surgical mask in areas where patients are typically present. We found that this mandate was associated with increased HCP vaccination and decreased HCP visits to the hospital Workforce Health and Safety Department with respiratory illnesses and laboratory-confirmed influenza. Infect Control Hosp Epidemiol 2017;38:1361-1363.