High Prevalence of Multidrug-Resistant Organism Colonization in 28 Nursing Homes: An "Iceberg Effect".

OBJECTIVE: Determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum beta-lactamase producing organisms (ESBLs), and carbapenem-resistant Enterobacteriaceae (CRE) among residents and in the environment of nursing homes (NHs). DESIGN: Point prevalence sampling of residents and environmental sampling of high-touch objects in resident rooms and common areas. SETTING: Twenty-eight NHs in Southern California from 2016 to 2017. PARTICIPANTS: NH participants in Project PROTECT, a cluster-randomized trial of enhanced bathing and decolonization vs routine care. METHODS: Fifty residents were randomly sampled per NH. Twenty objects were sampled, including 5 common room objects plus 5 objects in each of 3 rooms (ambulatory, total care, and dementia care residents). RESULTS: A total of 2797 swabs were obtained from 1400 residents in 28 NHs. Median prevalence of multidrug-resistant organism (MDRO) carriage per NH was 50% (range: 24%-70%). Median prevalence of specific MDROs were as follows: MRSA, 36% (range: 20%-54%); ESBL, 16% (range: 2%-34%); VRE, 5% (range: 0%-30%); and CRE, 0% (range: 0%-8%). A median of 45% of residents (range: 24%-67%) harbored an MDRO without a known MDRO history. Environmental MDRO contamination was found in 74% of resident rooms and 93% of common areas. CONCLUSIONS AND IMPLICATIONS: In more than half of the NHs, more than 50% of residents were colonized with MDROs of clinical and public health significance, most commonly MRSA and ESBL. Additionally, the vast majority of resident rooms and common areas were MDRO contaminated. The unknown submerged portion of the iceberg of MDRO carriers in NHs may warrant changes to infection prevention and control practices, particularly high-fidelity adoption of universal strategies such as hand hygiene, environmental cleaning, and decolonization.

Using the transformative paradigm to conduct a mixed methods needs assessment of a marginalized community: Methodological lessons and implications.

We explore opportunities as well as challenges associated with conducting a mixed methods needs assessment using a transformative paradigm. The transformative paradigm is a research framework that centers the experiences of marginalized communities, includes analysis of power differentials that have led to marginalization, and links research findings to actions intended to mitigate disparities. We argue that a community needs assessment is a natural fit for the use of a transformative framework, serving as an entry-point for the development of responsive programmatic and funding decisions. Based on a case study of efforts initiated by a local community health foundation to document disparities in their city, we show how an evaluation team used principles aligned with the transformative framework to guide the design and implementation of a community needs assessment. The needs assessment provided a better understanding of the power of community relationships, demonstrated how lack of trust can continue to constrain community voices, and revealed why agencies must actively support a social justice framework beyond the end of an assessment to ensure transformative change.

Volcano-estratigrafía asociada al campo de Domos de Cañas Dulces, Guanacaste, Costa Rica

Se realizó un mapeo geovulcanológico e interpretación de la sucesión estratigráfica de los productos volcánicos relacionados con un complejo caldérico festoneado, localizado al suroeste del volcán Rincón de la Vieja. Se reconocieron 16 unidades principales, siendo las más antiguas, rocas sedimentarias hidrotermalizadas del Paleógeno Inferior-Medio. Durante el Plioceno emerge el sistema volcánico de Alcántaro, representado por lavas e ignimbritas. Además, se reconocieron calderas menores (Guachipelín) y productos ignimbríticos. Una secuencia extensa(> 96 km2) de depósitos fluvio-lacustres con fuerte influencia volcánica y depósitos de tierras de diatomeas, representa la colmatación de un lago en la parte interna de la caldera Alcántaro - Guachipelín. Cuatro fases de evolución de la caldera explican la formación de depósitos volcánicos y lacustres: 1) subsidencia de la caldera y depositación de las ignimbritas de Alcántaro, 2) migración de la actividad al SE, 3) formación de la caldera Guachipelín, y 4) extrusión de domos dacíticos a riolíticos peri-caldéricos e intra-caldéricos. Posteriormente, durante el Pleistoceno Medio, se desarrolla el actual macizo volcánico Rincón de la Vieja. Finalmente, se da una serie de flujos y avalanchas de detritos provenientes del Rincón de la Vieja y del volcán Cacao, que cubren la parte NW de la zona de estudio. Una capa subpliniana de caída de unos 3500 años de edad cubre parcialmente la zona.(AU)