United States private schools have higher rates of exemptions to school immunization requirements than public schools.

OBJECTIVE: To compare medical, religious, and personal belief immunization exemption rates between private and public schools in US. STUDY DESIGN: Exemption rates were calculated using the Centers for Disease Control and Prevention School Immunization Assessment Surveys for the 2009-2010 school year excluding states with incomplete survey data. Standardized exemption rates weighted on enrollments in public and private schools were calculated. Differences in exemption rates between public and private schools were tested using Wilcoxon signed rank test. RESULTS: The overall state exemption rate was higher in US private than public schools, 4.25% (SD 4.27) vs 1.91% (1.67), P = .0001 and private schools had higher exemption rates for all types of exemptions; medical 0.58% (0.71) vs 0.34% (0.34) respectively (P = .0004), religious 2.09% (3.14) vs 0.83% (1.05) respectively (P = .0001), and personal belief 6.10% (4.12) vs 2.79% (1.57), respectively (P = .006). Overall exemption rates were significantly higher in states that allowed personal belief exemptions. CONCLUSIONS: Exemption rates were significantly higher in US private than in public schools. Children attending private schools may be at higher risk of vaccine-preventable diseases than public school children.

Risk factors for surgical site infection after abdominal hysterectomy, New York State, 2015-2018.

BACKGROUND: To identify risk factors for surgical site infections (SSIs) after abdominal hysterectomy (HYST) procedures using National Health care Safety Network (NHSN) data augmented with diagnosis codes available using administrative data. METHODS: We analyzed 66,001 HYST procedures in 166 New York State hospitals between January 2015 and December 2018, reported in NHSN, and matched to billing data. Risks factors for SSI after abdominal HYST were identified using logistic regression models. RESULTS: A total of 66,001 HYST procedures were analyzed. SSI was reported following 1,093 procedures, resulting in an infection rate of 1.66%. Risk factors associated with SSIs were open approach (not laparoscopic) with an adjusted odds ratio (AOR) of 2.72 and 95% confidence interval (CI) of 2.37-3.12, contaminated or dirty wound class (AOR 2.28, 95% CI 1.61-3.24), body mass index ≥30 (AOR 1.78, 95% CI 1.56-2.02), procedures lasting 186 minutes or more (AOR 1.78, 95% CI 1.56-2.02), American Society of Anesthesia (ASA) score ≥3 (AOR 1.74, 95% CI 1.52-1.99), gynecological cancer (AOR 1.54, 95% CI 1.32-1.80), and diabetes mellitus (AOR 1.46, 95% CI 1.24-1.70). CONCLUSIONS: Obesity, prolonged procedure duration, diabetes mellitus, wound contamination, open approach, ASA score ≥3, and gynecological cancer were significant independent risk factors associated with SSI after HYST.

Candida auris admission screening pilot in select units of New York City health care facilities, 2017-2019.

BACKGROUND: This pilot project implemented admission screening for Candida auris (C. auris) using real-time polymerase chain reaction (rt-PCR) in select high-risk units within health care facilities in New York City. METHODS: An admission screening encounter consisted of collecting 2 swabs, to be tested by rt-PCR, and a data collection form for individuals admitted to ventilator units at 2 nursing homes (NHA and NHB), and the ventilator/pulmonary unit, intensive care unit, and cardiac care unit at a hospital (Hospital C) located in New York City from November 2017 to November 2019. RESULTS: C. auris colonization was identified in 6.9% (n = 188/2,726) of admissions to participating units. Rates were higher among admissions to NHA and NHB (20.7% and 22.0%, respectively) than Hospital C (3.6%). Within Hospital C, the ventilator/pulmonary unit had a higher rate (5.7%) than the intensive care unit (3.8%) or cardiac care unit (2.5%). DISCUSSION: Consistent with prior research, we found that individuals admitted to ventilator units were at higher risk of C. auris colonization. CONCLUSIONS: This project demonstrates the utility of admission screening using rt-PCR testing to rapidly identify C. auris colonization among admissions to health care facilities so that appropriate transmission-based precautions and control measures can be implemented rapidly to help decrease transmission.

Prevalence of and risk factors for hepatitis B and C infection among Mongolian blood donors.

BACKGROUND: Mongolia has one of the highest rates of viral hepatitis infections worldwide yet risk factors have been largely unstudied. This sentinel study of hepatitis infection in Mongolia determined the prevalence of hepatitis B virus surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) among a sample of blood donors and identified demographic and behavioral factors associated with hepatitis infection. STUDY DESIGN AND METHODS: Data were collected by interview from 923 Ministry of Health Blood Center donors between August 2004 and February 2005. The exposure variables collected included donor demographics and health and behavioral risk factors. Bivariate and multivariate analyses assessed the prevalence ratio of hepatitis infection for each exposure. RESULTS: Of 923 donors, 72 tested positive for HBsAg (7.8%; 95% confidence interval [CI], 6.1%-9.7%), 89 donors tested positive for anti-HCV (9.6%; 95% CI, 7.8%-11.5%), and six (0.6%) tested positive for both HBsAg and anti-HCV. Prevalence of HBsAg was highest among donors 18 to 19 years and anti-HCV tended to be most prevalent among those more than 40 years of age. Both pregnancy and alcohol use were associated with seroprevalent anti-HCV. CONCLUSION: This sentinel study of hepatitis prevalence among Mongolian blood donors sheds considerable light on the epidemiology of hepatitis virus infection as well as the sociodemographic and behavioral risk factors associated with infection. Young age (HBsAg) and pregnancy (anti-HCV) were significant risk factors for hepatitis virus infection, indicating that improvements in education, vaccination rates, and general infection control procedures in health care institutions may reduce behavioral and nosocomial transmission.

[Primary hepatotropic viral infections in Mongolia]. / Zakazenia wirusami HBV, HCV i HDV w Mongolii.

Mongolia is known for its high endemicity for viral hepatitis infections, accounted for 25% of infectious disease cases in 2000. Studies revealed these infections are prevalent among young adults in Mongolia. The infections are first and foremost nosocomial infections. The incidence of primary liver cancer, caused HBV, HDV and HCV chronic infections has increased in the last several years. Although viral hepatitis infections are recognized as a serious health problem in the country, not many epidemiological and clinical studies have been done. Few studies that were done were conducted among limited numbers of high risk subjects. These reports indicated that HBsAg prevalence was between 6.9% and 28.7% and anti-HCV prevalence was between 10.7% and 48% in different population samples and in different years. More studies are needed to determine the real magnitude of hepatitis infections in the general population and to isolate and reduce the exposures specific to at risk population groups. National programs controlling hepatitis infections includes primary prevention strategies such as education, vaccination and infection control particularly in hospital settings, must be implemented to improve the awareness about hepatitis infection especially among youth, women and blood donors.

Effect of 2013 National Healthcare Safety Network definition changes on central line bloodstream infection rates: audit results from the New York State Department of Health.

Surveillance criteria for central line-associated bloodstream infections (CLABSIs) are continually being refined to more accurately reflect infections related to central lines. An audit of 567 medical records from adult, pediatric, and neonatal intensive care unit patients with a central line and a positive blood culture showed a 16% decrease in CLABSI rates after the 2013 National Healthcare Safety Network definitions compared with the 2012 definitions.

Surgical site infection risk factors identified for patients undergoing colon procedures, New York State 2009-2010.

BACKGROUND: Since 2007, New York State (NYS) hospitals have been required to report surgical site infections (SSIs) following colon procedures to the NYS Department of Health, using the National Healthcare Safety Network (NHSN). The purpose of this study was to identify risk factors for the development of SSIs in patients undergoing colon procedures. METHODS: NYS has been conducting validation studies at hospitals to assess the accuracy of the surveillance data reported by the participating hospitals. A sample of patients undergoing colon procedures in NYS hospitals were included in hospital-acquired infection program validation studies in 2009 and 2010. Medical chart reviews and on-site visits were performed to verify patient information reported and to evaluate additional risk factors for SSI. Bivariable and multivariable logistic regressions were performed. RESULTS: A total of 2,656 colon procedures were included in this analysis, including 698 SSI cases. Multivariable analysis indicated that SSI following colon procedure was associated with body mass index greater than 30 (odds ratio [OR], 1.48 [95% confidence interval (CI), 1.21-1.80]), male sex (OR, 1.34 [95% CI, 1.10-1.64]), American Society of Anesthesiologists physical classification score greater than 3 (OR, 1.33 [95% CI, 1.08-1.64]), procedure duration, transfusion (OR, 1.32 [95% CI, 1.05-1.66]), left-side colon surgical procedures, other gastroenterologic procedures, irrigation, hospital bed size greater than 500, and medical school affiliation. CONCLUSIONS: Male sex, obesity, transfusion, type of procedure, and prolonged duration were significant factors associated with overall infection risk after adjusting other factors. Additional factors not collected in the NHSN slightly improved prediction of SSIs.

Religious exemptions for immunization and risk of pertussis in New York State, 2000-2011.

OBJECTIVE: The objective of this study was to describe rates of religious vaccination exemptions over time and the association with pertussis in New York State (NYS). METHODS: Religious vaccination exemptions reported via school surveys of the NYS Department of Health from 2000 through 2011 were reviewed by county, and the changes were assessed against incidence rates of pertussis among children reported to the NYS Department of Health Communicable Disease Electronic Surveillance System. RESULTS: The overall annual state mean prevalence (± SD) of religious exemptions for ≥1 vaccines in 2000-2011 was 0.4% ± 0.08% and increased significantly from 0.23% in 2000 to 0.45% in 2011 (P = .001). The prevalence of religious exemptions varied greatly among counties and increased by >100% in 34 counties during the study period. Counties with mean exemption prevalence rates of ≥1% reported a higher incidence of pertussis, 33 per 100 000 than counties with lower exemption rates, 20 per 100 000, P < .001. In addition, the risk of pertussis among vaccinated children living in counties with high exemption rate increased with increase of exemption rate among exempted children (P = .008). CONCLUSIONS: The prevalence of religious exemptions varies among NYS counties and increased during the past decade. Counties with higher exemption rates had higher rates of reported pertussis among exempted and vaccinated children when compared with the low-exemption counties. More studies are needed to characterize differences in the process of obtaining exemptions among NYS schools, and education is needed regarding the risks to the community of individuals opting out from recommended vaccinations.

Use of administrative data in efficient auditing of hospital-acquired surgical site infections, New York State 2009-2010.

OBJECTIVE: To efficiently validate the accuracy of surgical site infection (SSI) data reported to the National Healthcare Safety Network (NHSN) by New York State (NYS) hospitals. DESIGN: Validation study. SETTING: 176 NYS hospitals. METHODS: NYS Department of Health staff validated the data reported to NHSN by review of a stratified sample of medical records from each hospital. The four strata were (1) SSIs reported to NHSN; (2) records with an indication of infection from diagnosis codes in administrative data but not reported to NHSN as SSIs; (3) records with discordant procedure codes in NHSN and state data sets; (4) records not in the other three strata. RESULTS: A total of 7,059 surgical charts (6% of the procedures reported by hospitals) were reviewed. In stratum 1, 7% of reported SSIs did not meet the criteria for inclusion in NHSN and were subsequently removed. In stratum 2, 24% of records indicated missed SSIs not reported to NHSN, whereas in strata 3 and 4, only 1% of records indicated missed SSIs; these SSIs were subsequently added to NHSN. Also, in stratum 3, 75% of records were not coded for the correct NHSN procedure. Errors were highest for colon data; the NYS colon SSI rate increased by 7.5% as a result of hospital audits. CONCLUSIONS: Audits are vital for ensuring the accuracy of hospital-acquired infection (HAI) data so that hospital HAI rates can be fairly compared. Use of administrative data increased the efficiency of identifying problems in hospitals' SSI surveillance that caused SSIs to be unreported and caused errors in denominator data.

Risk factors for coronary artery bypass graft chest surgical site infections in New York State, 2008.

BACKGROUND: All hospitals in New York State (NYS) are required to report surgical site infections (SSIs) occurring after coronary artery bypass graft surgery. This report describes the risk adjustment method used by NYS for reporting hospital SSI rates, and additional methods used to explore remaining differences in infection rates. METHODS: All patients undergoing coronary artery bypass graft surgery in NYS in 2008 were monitored for chest SSI following the National Healthcare Safety Network protocol. The NYS Cardiac Surgery Reporting System and a survey of hospital infection prevention practices provided additional risk information. Models were developed to standardize hospital-specific infection rates and to assess additional risk factors and practices. RESULTS: The National Healthcare Safety Network risk score based on duration of surgery, American Society of Anesthesiologists score, and wound class were not highly predictive of chest SSIs. The addition of diabetes, obesity, end-stage renal disease, sex, chronic obstructive pulmonary disease, and Medicaid payer to the model improved the discrimination between procedures that resulted in SSI and those that did not by 25%. Hospital-reported infection prevention practices were not significantly related to SSI rates. CONCLUSIONS: Additional risk factors collected using a secondary database improved the prediction of SSIs, however, there remained unexplained variation in rates between hospitals.

Infection control resources in New York State hospitals, 2007.

BACKGROUND: In July 2005, New York State legislation requiring the mandatory reporting of specific hospital-associated infections (HAIs) was passed by the legislature and signed by the governor. In an effort to measure the impact of this legislation on infection control resources, the New York State Department of Health (NYSDOH) conducted a baseline survey in March 2007. This report presents an overview of the methods and results of this survey. METHODS: An electronic survey of infection control resources and responsibilities was conducted by the NYSDOH on their secure data network. The survey contained questions regarding the number and percent time for infection prevention and control professional (ICP) and hospital epidemiologist (HE) staff members, ICP/HE educational background and certification, infection control program support services, activities and responsibilities of infection prevention and control program staff, and estimates of time dedicated to various activities, including surveillance. RESULTS: Practitioners in 222 of 224 acute care hospitals (99%) responded. The average number of ICPs per facility depended on the average daily census of acute care beds and ranged from a mean of 0.64 full-time equivalent (FTE) ICP in facilities with an average daily census of < or = 100 beds to 6.5 FTE ICPs in facilities with an average daily census of > or = 900 beds. Averaging the ICP resources over the health care settings for which they were responsible revealed that the "average full-time ICP" was responsible for 151 acute care facility beds, 1.3 intensive care units (ICUs) (average, 16 ICU beds), 21 long-term care facility beds, 0.6 dialysis centers, 0.5 ambulatory surgery centers, 4.8 ambulatory/outpatient clinics, and 1.1 private practice offices. The ICPs reported that 45% of their time is dedicated to surveillance. Other activities for which ICPs reported at least partial responsibility include staff education, quality assurance, occupational health, emergency preparedness, construction, central supply/processing, and risk management. CONCLUSIONS: This survey was designed to monitor and assess infection prevention and control resources and activities in hospitals as New York State embarks on mandatory public reporting of HAI rates. Monitoring infection control resources and activities will be important as HAI reporting moves forward. The information collected will serve as a baseline, and repeat surveys will be conducted to determine which, if any, of the various indicators correlate with the completeness and accuracy of HAI reporting.

Prevalence of infectious diseases among Mongolian blood donors.

OBJECTIVES: This study estimates the prevalence of screened infections: human immunodeficiency (HIV), hepatitis B (HBV) virus, hepatitis C (HCV) virus, brucellosis, and syphilis among Mongolian blood donors. METHODS: This report is based on routine data collected from simple questionnaires completed by a sample of consecutive donors visiting the Blood Center between August 2004 and February 2005. RESULTS: Seropositivity rates were as follows: HIV 0%, HBsAg 8.1% (n=185), anti-HCV 8.7% (n=195), brucellosis 3.3% (n=75), and syphilis 2% (n=44). HBsAg seropositivity was concentrated among young donors less than 20 years of age (P<0.01) while anti-HCV seropositivity tended to increase significantly with age. CONCLUSION: The prevalence of HBV and HCV among Mongolian donors is very high and appears to be differentially distributed by age. The data suggests further studies are warranted to identify key risk factors for blood-borne infections and to develop population-specific interventions to interrupt transmission.

Hemolytic uremic syndrome risk and Escherichia coli O157:H7.

We reviewed medical records of 238 hospitalized patients with Escherichia coli O157:H7 diarrhea to identify risk factors for progression to diarrhea-associated hemolytic uremic syndrome (HUS). Data indicated that young age, long duration of diarrhea, elevated leukocyte count, and proteinuria were associated with HUS.

Hemolytic uremic syndrome incidence in New York.

A comparison of New York's traditional communicable disease surveillance system for diarrhea-associated hemolytic uremic syndrome with hospital discharge data showed a sensitivity of 65%. Escherichia coli O157:H7 was found in 63% of samples cultured from hemolytic uremic syndrome patients, and samples were more likely to be positive when collected early in illness.