Evaluation of an infection control protocol to limit COVID-19 at residential summer camps in 2021.

AIM: To assess the effectiveness of an infection control protocol developed to mitigate the spread of COVID-19 at two multi-week residential summer camps in 2021. SUBJECT AND METHODS: Data were collected from 595 camp attendees and staff members at two wilderness camps in Northern Minnesota. Testing was undertaken in all unvaccinated campers before arrival at camp, on day 4 of camp, and in the event of respiratory symptoms. Campers were limited to cohorts during the first 4 days of camp and wore masks indoors. The number of positive COVID-19 cases measured the efficacy of the protocol. RESULTS: The testing and cohorting protocol successfully prevented the spread of COVID-19 among campers and staff. During the first summer session, there were zero positive cases of COVID-19 among 257 campers and 127 staff. During the second summer session, compliance with the protocol limited the spread of COVID-19 to just three individuals of 266 campers and 129 staff. Maintaining cohorts at arrival limited spread from a single positive case to only two tent companions. CONCLUSION: The testing and cohorting protocol limited the spread of COVID-19 among residential summer wilderness campers and staff. Post-arrival testing ensured newly acquired virus was limited in spread before COVID-19 precautions were relaxed on camp day 5. A strict evidence-based cohorting protocol limited in-camp spread and allowed for a successful summer camp season. The usefulness of this protocol with an evolving pandemic, increasing vaccination rates, and virus variants could have implications for future practice.

Diagnosis of Occult Infection Using Fracture-Related Infection Criteria at the Time of Nonunion Repair.

OBJECTIVES: To apply the recently developed fracture-related infection criteria to patients presenting for repair of fracture nonunion and determine the incidence and associated organisms of occult infection in these patients. DESIGN: Retrospective study. SETTING: Tertiary referral trauma center. PATIENTS AND PARTICIPANTS: Patients presenting with fracture nonunion after operative intervention. MAIN OUTCOME MEASUREMENTS: Demographic variables, injury characteristics, culture results, and physical examination and laboratory values at the time of presentation. RESULTS: A total of 270 nonunion patients were identified. Sixty-eight percent (n = 184) had no clinical or laboratory signs of infection at presentation before nonunion repair. After operative intervention, 7% of these clinically negative patients (n = 12/184) had positive intraoperative cultures indicating occult infection. The most common organisms causing occult infection were low-virulence coagulase-negative Staphylococcu s (83%) and Cutibacterium acnes (17%). Thirty-two percent of patients (n = 86/270) presented with clinical and/or laboratory signs of infection at presentation before nonunion repair, with 19% of these patients (n = 16/86) having negative cultures. The most common organisms in this group of patients with positive clinical signs and intraoperative cultures were methicillin-resistant Staphylococcus Aureus (21%) and gram-negative rods (29%). Patients with nonunion of the tibia were significantly more likely to have high-virulence organism culture results ( P < 0.001). CONCLUSIONS: Based on this analysis, occult infection occurs in 7% of patients presenting with nonunion and no clinical or laboratory signs of infection. We recommend that all patients should be carefully evaluated for infection with intraoperative cultures regardless of presentation. Organisms associated with occult infection at the time of nonunion repair were almost exclusively of low virulence ( CoNS and C. Acnes ) and were more likely to present in the upper extremity. Patients with nonunion of the tibia were more likely to have infection secondary to high-virulence organisms and demonstrate clinical or laboratory signs of infection at the time of presentation. LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Risk Factors and Characteristics of Recalcitrant Osteomyelitis After Initial Surgical and Antibiotic Treatment.

OBJECTIVES: To evaluate the injury, patient, and microbiological characteristics that place patients at risk for recalcitrant fracture-related infection and osteomyelitis despite appropriate initial treatment. DESIGN: Retrospective chart review. SETTING: Three level I trauma centers. PATIENTS AND PARTICIPANTS: Two hundred and fifty-seven patients undergoing surgical debridement and antibiotic therapy for osteomyelitis from 2003 to 2019. MAIN OUTCOME MEASUREMENTS: Patients were categorized as having undergone serial bone debridement if they had 2 separate procedures a minimum of 6 weeks apart with a full course of appropriate antibiotics in between. Patient records were reviewed for age, injury location, body mass index, smoking status, comorbidities, and culture results including the presence of multidrug-resistant organisms and culture-negative osteomyelitis. RESULTS: A total of 257 patients were identified; 49% (n = 125) had a successful single course of treatment, and 51% (n = 132) required repeat debridement for recalcitrant osteomyelitis. At the index treatment for osteomyelitis, the most common organisms in both groups were methicillin-resistant (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA). There was no significant difference in incidence of polymicrobial infection between the 2 groups (25% vs. 20%, P = 0.49). The most common organisms cultured at the time of repeat saucerization remained MRSA and MSSA; however, the same organism was cultured from both the index and repeat procedures in only 28% (n = 37) of cases. Diabetic patients, intravenous drug use status, delay to diagnosis, and open fractures of the lower leg are independent risk factors for failure of initial treatment of posttraumatic osteomyelitis. CONCLUSIONS: Successful eradication of fracture-related infection and posttraumatic osteomyelitis is difficult and fails 51% of the time despite standard surgical and antimicrobial therapy. Although MRSA and MSSA remain the most common organisms cultured, patients who fail initial treatment for osteomyelitis often do not culture the same organisms as those obtained at the index procedure. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.