Staphylococcus, not MRSA? A final report of carriage and conversion rates in nursing students.

OBJECTIVE: To evaluate and characterize staphylococcal carriage, possibly including methicillin-resistant Staphylococcus aureus (MRSA), and conversion rates in nursing students across clinical semester rotations and to describe risk factors. DESIGN: A prospective longitudinal cohort design with six times of measurement. Data collected August 2010 to May 2012. Institutional Review Board approval (2010F5693). SETTING: Texas State University, San Marcos, TX. PARTICIPANTS: Eighty-seven nursing students. INTERVENTIONS: A positive MRSA swab was considered an end point for participation. Intervention offered was bactroban (mupirocin) for nasal decolonization and an oral antibiotic, doxycycline; follow-up post treatment collection sample was done to verify decolonization prior to next clinical rotation. MAIN OUTCOME MEASURES: Screening for Staphylococcus aureus and MRSA identification; confirmation and antibiotic susceptibility by Vitek 2; self-administered questionnaires delineating demographics and risk factors; panel logistic regression models by Stata version 13. RESULTS: MRSA colonization did not increase. S. aureus incidence was 17.7 - 26.4%. Staphylococcal species incidence other than S. aureus increased (9.2 - 82.3%). The following odds ratio (OR) associations were found to be statistically significant: boil or skin infections with S. aureus (OR = 2.94, p < .01), working or volunteering in a healthcare facility odds with species other than S. aureus (OR = 4.41, p < .01) and gym and sports facilities odds with S. other (OR 2.45, p < .01). The most frequently occurring species at Wave 5 was S. hominis (21 isolates) while the most frequently occurring species at Wave 6 was S. epidermidis (25 isolates). CONCLUSIONS: MRSA colonization did not increase during longitudinal study. S. aureus colonization remained fairly stable throughout the study (17 - 26%). Species colonization with non S. aureus species (e.g. S. hominis, S. epidermis, S. haemolyticus) increased significantly (9.2 - 82.3%) during clinical rotations. Knowledge of infection control and compliance may have contributed to an absence of MRSA colonization; however, the colonization by other staphylococci has been shown to be a risk factor for MRSA acquisition.

College students' willingness to accept COVID-19 vaccines.

Objective To assess college students' willingness to accept COVID-19 vaccines and the factors that influence their decisions. Participants: Traditional (aged 18-23) undergraduate students at a university in central Texas. Methods: An online survey was administered in fall 2020 to 614 students stratified by sex and race/ethnicity. Results: 40.9% of students planned to take the vaccine as soon as possible, 37.1% eventually, 11.4% only if required, and 10.6% did not intend to be vaccinated. Analyses indicated that gender, major/minor, political affiliation, receiving a flu shot in the preceding 12 months, perception of risk for COVID-19, and vaccine hesitancy were all associated with willingness to accept COVID-19 vaccines. Conclusion: Results confirm that no one-size-fits-all approach to promoting COVID-19 vaccination among college students is possible. Instead, administrators interested in increasing vaccine uptake should address concerns of specific groups, while also utilizing the prosocial beliefs of college students (e.g., being vaccinated will protect others).

MRSA model of learning and adaptation: a qualitative study among the general public.

BACKGROUND: More people in the US now die from Methicillin Resistant Staphylococcus aureus (MRSA) infections than from HIV/AIDS. Often acquired in healthcare facilities or during healthcare procedures, the extremely high incidence of MRSA infections and the dangerously low levels of literacy regarding antibiotic resistance in the general public are on a collision course. Traditional medical approaches to infection control and the conventional attitude healthcare practitioners adopt toward public education are no longer adequate to avoid this collision. This study helps us understand how people acquire and process new information and then adapt behaviours based on learning. METHODS: Using constructivist theory, semi-structured face-to-face and phone interviews were conducted to gather pertinent data. This allowed participants to tell their stories so their experiences could deepen our understanding of this crucial health issue. Interview transcripts were analysed using grounded theory and sensitizing concepts. RESULTS: Our findings were classified into two main categories, each of which in turn included three subthemes. First, in the category of Learning, we identified how individuals used their Experiences with MRSA, to answer the questions: What was learned? and, How did learning occur? The second category, Adaptation gave us insights into Self-reliance, Reliance on others, and Reflections on the MRSA journey. CONCLUSIONS: This study underscores the critical importance of educational programs for patients, and improved continuing education for healthcare providers. Five specific results of this study can reduce the vacuum that currently exists between the knowledge and information available to healthcare professionals, and how that information is conveyed to the public. These points include: 1) a common model of MRSA learning and adaptation; 2) the self-directed nature of adult learning; 3) the focus on general MRSA information, care and prevention, and antibiotic resistance; 4) the interconnected nature of adaptation; and, 5) the need for a consistent step by step plan to deal with MRSA provided at the time of diagnosis.

Snapshot prevalence and characterization of Staphylococcus species, including MRSA, in a student athletic facility: an undergraduate research project.

OBJECTIVE: To evaluate and characterize the prevalence of MRSA, Staphylococcus aureus, and other Staphylococcus species found on exercise equipment on one day point of collection. DESIGN: A cross sectional, point prevalence design (pilot study) with a single time of measurement. Data collected in summer of 2011 (Undergraduate Research Project for CLS Program, CLS 4361 Clinical Research). Project received Institutional Review Board exemption. SETTING: In a higher education athletic facility in Texas. SAMPLES: One hundred twenty-five environmental samples were collected from various exercise equipment and areas within the facility. MAIN OUTCOME MEASURES: Samples were screened for Staphylococcus species using standard microbiological techniques. Confirmation of S. aureus was conducted by DRYSPOT Staphytect Plus. MRSA isolates were confirmed with CHROMagar; VITEK 2 antibiotic susceptibility testing and PFGE characterized all MRSA isolates. RESULTS: Prevalence of MRSA was 6%, S. aureus 38%, other Staphylococcus species 52% and no growth 4%. Prevalence of S. aureus and MRSA was highest on free weights and mats, respectively. PFGE characterized all MRSA isolates as HA-MRSA (USA100 strain). CONCLUSIONS: Although limitations exist for this study with a single time of measurement for data, the findings indicate potential exposure risks from Staphylococcus species in college athletic facilities. Compliance (disinfection) and creative health education may reduce transmission of pathogens, environmental load, and incidence of colonization or infection in students.

Methicillin resistant Staphylococcus aureus (MRSA): an interim report of carriage and conversion rates in nursing students.

OBJECTIVE: To evaluate and characterize MRSA and staphylococci carriage and conversion rates in nursing students across clinical semester rotations and to describe risk factors. DESIGN: A prospective, longitudinal cohort design (interim report) with three times of measurement. Data collected between August 2010 and May 2011 (ongoing longitudinal study to May 2012). Institutional Review Board approval (2010F5693). SETTING: Texas State University, San Marcos, TX. PARTICIPANTS: Eighty-seven nursing students. INTERVENTIONS: A positive MRSA swab represented an end-point for a participant. Intervention offered was bactroban (mupirocin) for nasal decolonization and an oral antibiotic, doxycycline; posttreatment collection to verify decolonization prior to next clinical rotation. MAIN OUTCOME MEASURES: Screening for Staphylococcus aureus and MRSA identification; confirmation and antibiotic susceptibility by Vitek 2. Self-administered questionnaires collected demographics and risk factors. Generalized estimating equations calculated population-averaged panel logistic regression models allowing for an AR(1) error by Stata version 12. RESULTS: MRSA colonization did not increase. S. aureus prevalence (20-26%). Species prevalence other than S. aureus increased (9.2% to 80%). The following associations were found to be statistically significant: boil or skin infection odds with S. aureus (OR = 2.43, p < .05), working or volunteering in healthcare facility odds with S. other (OR = 2.72, p < .05) and gym and sports activities odds with S. other (OR = 4.98, p < .001). CONCLUSIONS: MRSA colonization did not increase. Knowledge and understanding of MRSA (risks) may play a role in compliance and barrier precautions. S. aureus colonization remained stable (25-30%). Species colonization other than S. aureus (e.g. S. epidermis, S. haemolyticus) increased to significant levels.

Growing our own: teaching and doing research in CLS.

The shortage of clinical laboratory scientists (CLS) has been well-documented in the healthcare environment. This growing concern only becomes more critical as we enter the retiring baby boomer era in our society. Concomitantly, the problem of addressing how university CLS programs recruit and retain faculty to teach and satisfy research agendas is not being studied. These two problems, if allowed to collide, will provide a "perfect storm" with serious implications for an ongoing shortage of personnel and overall quality for the profession. CLS faculty, in the university setting, must typically satisfy the three tenets for tenure and promotion - teaching, scholarship, and service. While teaching and service will always be critical, scholarship (research) is an area of expertise that must be "taught" and mentored for future CLS faculty to be successful in the very real arena of "publish or perish". This article provides a commentary with specific details associated with our experience in offering an evolving dedicated CLS clinical research course to purposively "grow our own" students in the art of conducting successful research. It offers a flexible template for adapting or incorporating a lecture and laboratory course to address theoretical and practical knowledge in the realm of clinical research. Additionally, a discussion of other research mentoring activities in our program will be outlined. The long term goal (and hope) of these program objectives is to build a culture of research for current faculty and for CLS graduates. This paper provides an approach to embedding these research ideals in all CLS graduates and, importantly, an intentional attempt to create a mindset for a possible career as a future CLS faculty member who can be successful in both the university and clinical environment.

Update on lyssaviruses and rabies: will past progress play as prologue in the near term towards future elimination?

Rabies is an ancient, much-feared, and neglected infectious disease. Caused by pathogens in the family Rhabdoviridae, genus Lyssavirus, and distributed globally, this viral zoonosis results in tens of thousands of human fatalities and millions of exposures annually. All mammals are believed susceptible, but only certain taxa act as reservoirs. Dependence upon direct routing to, replication within, and passage from the central nervous system serves as a basic viral strategy for perpetuation. By a combination of stealth and subversion, lyssaviruses are quintessential neurotropic agents and cause an acute, progressive encephalitis. No treatment exists, so prevention is the key. Although not a disease considered for eradication, something of a modern rebirth has been occurring within the field as of late with regard to detection, prevention, and management as well as applied research. For example, within the past decade, new lyssaviruses have been characterized; sensitive and specific diagnostics have been optimized; pure, potent, safe, and efficacious human biologics have improved human prophylaxis; regional efforts have controlled canine rabies by mass immunization; wildlife rabies has been controlled by oral rabies vaccination over large geographic areas in Europe and North America; and debate has resumed over the controversial topic of therapy. Based upon such progress to date, there are certain expectations for the next 10 years. These include pathogen discovery, to uncover additional lyssaviruses in the Old World; laboratory-based surveillance enhancement by simplified, rapid testing; anti-viral drug appearance, based upon an improved appreciation of viral pathobiology and host response; and improvements to canine rabies elimination regionally throughout Africa, Asia, and the Americas by application of the best technical, organizational, economic, and socio-political practices. Significantly, anticipated Gavi support will enable improved access of human rabies vaccines in lesser developed countries at a national level, with integrated bite management, dose-sparing regimens, and a 1 week vaccination schedule.

Hantavirus pulmonary syndrome in Texas: 1993-2006.

BACKGROUND: Hantavirus pulmonary syndrome (HPS) is a rare cardiopulmonary disease that was first described after a 1993 epidemic in the southwestern United States. This study reviewed all cases reported in Texas to date. METHODS: We reviewed case report forms submitted to the Texas Department of State Health Services and medical records (when available) to determine demographic and clinical features of Texas HPS cases. CONCLUSIONS: Middle-aged adults were more commonly affected. Respiratory symptoms were often accompanied by fever, gastrointestinal symptoms, and headache. Hypoxemia was observed in all cases. Common laboratory features included thrombocytopenia (92% of patients), elevated creatinine (61% of patients), increased polymorphonuclear leukocyte band forms (52% of patients), and hematocrit more than 55% (32% of patients). Most cases were associated with seeing rodents or rodent excreta at home. HPS was frequently misdiagnosed on initial presentation. Mortality was over 46%, higher for infection with the Sin Nombre virus (50%) than with the Bayou virus (0%). In Texas, the distribution of HPS is mainly along the coast and in west Texas.

Epidemiology of rabies in skunks in Texas.

OBJECTIVE: To obtain epidemiologic information on rabies in skunks in Texas. DESIGN: Epidemiologic study. SAMPLE POPULATION: Reports of skunks that had been submitted for rabies testing in Texas from 1953 through 2007. PROCEDURES: Reports were reviewed to obtain information on seasonality of rabies in skunks, seasonality of human and domestic animal exposure to rabid skunks, commonly reported clinical signs of rabies in skunks, domestic animals frequently exposed to rabid skunks, common scenarios for exposure of domestic animals to rabid skunks, disposition of domestic animals exposed to rabid skunks, age and gender of humans exposed to rabid skunks, and usual routes of exposure of humans to rabid skunks. RESULTS: On a yearly basis, the number of rabid skunks peaked in 1961, 1979, and 2001. On a monthly basis, the number of rabid skunks peaked in March and April. Over the study period, the percentage of rabid skunks from urban areas increased and the percentage from rural areas decreased. Striped skunks were the most common species. Dogs and cats were the domestic animals most frequently exposed to rabid skunks. On average, the highest numbers of humans exposed to rabid skunks were between 36 and 50 years old. Most humans were exposed through means other than a bite. Typical behaviors of rabid skunks were entering a dog pen, appearing outside during daytime, and attacking pets. CONCLUSIONS AND CLINICAL RELEVANCE: Information on the epidemiology of rabies in skunks may be useful in planning and implementing local, state, and national rabies control and prevention campaigns.

Methicillin resistant Staphylococcus aureus: carriage rates and characterization of students in a Texas university.

OBJECTIVE: To evaluate the carriage rates of Staphylococcus aureus and methicillin resistant Staphylococcus aureus (MRSA) in a university student population and describe risk factors associated with the carriage of each. DESIGN: Cross-sectional study (N = 203). Institutional Review Board approval was obtained from Texas State University-San Marcos. SETTING: Texas State University-San Marcos, San Marcos, TX. PARTICIPANTS: Two-hundred and three university student samples were collected from December 2007 to July 2008. INTERVENTIONS: None indicated. MAIN OUTCOME MEASURES: The sample set was screened for S. aureus and MRSA identification by standard microbiological techniques and confirmed by use of a Vitek 2 per manufacturer recommendation. Antibiotic susceptibility testing was conducted on each MRSA isolate by Vitek 2. A questionnaire was conducted with each student to acquire demographic and risk factor information. Demographic data is shown by raw numbers, percentages, mean, and median where applicable. The compiled data was screened and analyzed by chi square (p values) and odds ratio (OR) with confidence interval (CI) to determine significance. RESULTS: Of the 203 participants who were screened, 60 (29.6%) carried S. aureus. Univariate analysis found that only hospitalization in the past 12 months was significantly associated with the risk of being a S. aureus carrier (OR=3.0, 95% CI 1.28-7.03). Of the 60 participants that carried S. aureus, 15 were identified as MRSA. This relates to a 7.4% MRSA carriage rate among generally healthy university students. Univariate analysis found that hospitalization in the past 12 months (OR = 4.2, 95% CI 1.29-13.36) and recent skin infection (OR = 4.4, 95% CI 1.07-18.24) were significantly associated with the risk of being a MRSA carrier. No unique antibiotic susceptibility patterns were identified with the MRSA isolates. CONCLUSIONS: The carriage rate of S. aureus is consistent with similar studies. MRSA carriage in this university study appears high as compared to the general population. Although this study did not confirm a variety of risk factors for carriage of MRSA previously identified by others, university healthcare personnel should be aware of the changing epidemiology of MRSA and preventive measures needed to avoid outbreaks.

Molecular diagnostics clinical laboratory science course design: making it real.

The ability of a clinical laboratory scientist (CLS) to perform molecular diagnostic testing has become critical to the profession. Knowledge of methodology associated with detection of pathogens and inherited genetic disorders is imperative for the current and future CLS. CLS programs in the US teach human genetics and molecular diagnostics in various components and formats. Integrating these sometimes expensive methods into the curriculum can be challenging. This article provides a commentary with specific details associated with our experience in designing a dedicated CLS molecular diagnostics course. It offers a flexible template for incorporating a lecture and laboratory course to address theoretical and practical knowledge in this dynamic area of the laboratory.

A prospective study of patients diagnosed with sarcoidosis: factors - environmental exposure, health assessment, and genetic outlooks.

This original research is a directional study that determined the habits of individuals using four analyses to find statistical significance in the data collected from the surveys of 801 qualified of 1,340 individuals who agreed to participate. Results from the self-reported diagnosis of individuals affected by sarcoidosis produced seven statistically significant indicators of future research needed. The demographics revealed a significantly greater number of women and African-Americans participants than other minorities in the United States and suggested a sense of urgency to find a cure. Most important are the seven statistically significant findings that also gave credence to the researchers' four subdiagnostic classifications. They are acute sarcoidosis (AS) and chronic sarcoidosis with limited dissemination (CSLD), while more severe cases include those with chronic sarcoidosis with full dissemination including cutaneous involvement (CSFDIC) and chronic sarcoidosis with neurosarcoidosis (CSN). The most severe sarcoidosis cases (CSN) were on the "most likely" side of every statistically significant category except drinking alcohol, and the "least likely" to participate in physical activities. Conversely, the least severe case of sarcoidosis (AS) was the opposite. The complete list of statistically significant areas was related to alcohol use, tobacco use, ciprofloxacin use, environmental exposure to metals (copper, iron), infectious diseases (candidiasis), genetics, and physical exercise. Statistically, the most crucial study needed; emerged from the Rh blood grouping of the participants.

Global Diversity and Distribution of Hantaviruses and Their Hosts.

Rodents represent 42% of the world's mammalian biodiversity encompassing 2,277 species populating every continent (except Antarctica) and are reservoir hosts for a wide diversity of disease agents. Thus, knowing the identity, diversity, host-pathogen relationships, and geographic distribution of rodent-borne zoonotic pathogens, is essential for predicting and mitigating zoonotic disease outbreaks. Hantaviruses are hosted by numerous rodent reservoirs. However, the diversity of rodents harboring hantaviruses is likely unknown because research is biased toward specific reservoir hosts and viruses. An up-to-date, systematic review covering all known rodent hosts is lacking. Herein, we document gaps in our knowledge of the diversity and distribution of rodent species that host hantaviruses. Of the currently recognized 681 cricetid, 730 murid, 61 nesomyid, and 278 sciurid species, we determined that 11.3, 2.1, 1.6, and 1.1%, respectively, have known associations with hantaviruses. The diversity of hantaviruses hosted by rodents and their distribution among host species supports a reassessment of the paradigm that each virus is associated with a single-host species. We examine these host-virus associations on a global taxonomic and geographical scale with emphasis on the rodent host diversity and distribution. Previous reviews have been centered on the viruses and not the mammalian hosts. Thus, we provide a perspective not previously addressed.

Evaluation of oral rabies vaccination programs for control of rabies epizootics in coyotes and gray foxes: 1995-2003.

OBJECTIVE: To evaluate the effectiveness of intervention efforts to halt 2 wildlife rabies epizootics from 1995 through 2003, including 9 oral rabies vaccination campaigns for coyotes and 8 oral rabies vaccination campaigns for gray foxes. DESIGN: Retrospective study. ANIMALS: 98 coyotes during prevaccination surveillance and 963 coyotes and 104 nontarget animals during postvaccination surveillance in south Texas, and 699 gray foxes and 561 nontarget animals during postvaccination surveillance in west-central Texas. PROCEDURES: A recombinant-virus oral rabies vaccine in edible baits was distributed by aircraft for consumption by coyotes and gray foxes. Bait acceptance was monitored by use of microscopic analysis of tetracycline biomarker in upper canine teeth and associated bone structures in animals collected for surveillance. Serologic responses were monitered by testing sera for rabies virus-neutralizing antibodies by use of the rapid fluorescent focus inhibition test. The incidence of rabies in the distribution area was recorded via active and passive surveillance activities; tracking of rabies virus variants in confirmed rabid animals was used to determine the number and type of rabies cases before and after distributions of the vaccine. RESULTS: The expansion of both epizootics was halted as a result of the vaccine bait program. The number of laboratory-confirmed rabid animals attributable to the domestic dog-coyote rabies virus variant in south Texas declined to 0, whereas the number of laboratory-confirmed rabid animals attributable to the Texas fox rabies virus variant in west-central Texas decreased. CONCLUSIONS AND CLINICAL RELEVANCE: Data indicated that oral rabies vaccination resulted in protective immunity in a sufficient percentage of the target wildlife population to preclude propagation of the disease and provided an effective means of controlling rabies in these species.

Prevalence of Staphylococcus, including Methicillin-Resistant Staphylococcus aureus, in a Physical Therapy Education Facility.

UNLABELLED: The purpose of this study was to assess the prevalence of Staphylococcus species, including methicillin-resistant Staphylococcus aureus (MRSA), in a physical therapy (PT) education facility. The PT laboratory classrooms were routinely used by graduate PT students and faculty, undergraduate anatomy students, and licensed practitioners for continuing education purposes. METHODS: A total of 88 swab samples were collected from plinths and other equipment and plated onto mannitol salt agar (MSA). Suspected S. aureus colonies were confirmed by Staphyloslide latex testing. S. aureus isolates were plated to HardyCHROM agar to identify MRSA. VITEK antibiotic susceptibility testing confirmed MRSA isolates. RESULTS: Forty-seven samples showed growth (47/88, 53%), and 7 tested positive for S. aureus (7/47, 15%). Of those 7, one demonstrated oxacillin resistance and was confirmed as MRSA (1/7, 2%). Remaining samples grew other species of Staphylococcus and gram-negative bacilli. DISCUSSION: Given high classroom utilization, staphylococci environmental prevalence would be expected. However, the presence of MRSA was unexpected. Results demonstrate the potential for easily transmissible and potentially harmful organisms to be present in multi-use classrooms utilized by health professions students where frequent skin-to-skin contact occurs. Strict, routine cleaning of plinths and other equipment is imperative in reducing exposure risk.