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  • 1
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    Online Resource
    Transmission of Mycobacterium tuberculosis to Healthcare Personnel Resulting From Contaminated Bone Graft Material, United States, June 2021–August 2022
    Oxford University Press (OUP) ; 2023
    In:  Clinical Infectious Diseases Vol. 76, No. 10 ( 2023-05-24), p. 1847-1849
    Details
    In: Clinical Infectious Diseases, Oxford University Press (OUP), Vol. 76, No. 10 ( 2023-05-24), p. 1847-1849
    Abstract: A nationwide tuberculosis outbreak linked to a viable bone allograft product contaminated with Mycobacterium tuberculosis was identified in June 2021. Our subsequent investigation identified 73 healthcare personnel with new latent tuberculosis infection following exposure to the contaminated product, product recipients, surgical instruments, or medical waste.
    Type of Medium: Online Resource
    ISSN: 1058-4838 , 1537-6591
    URL: Article
    DOI: 10.1093/cid/ciad029
    RVK:
    XA 10000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2002229-3
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  • 2
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    Online Resource
    Carrots and Sticks: Achieving High Healthcare Personnel Influenza Vaccination Rates without a Mandate
    Cambridge University Press (CUP) ; 2015
    In:  Infection Control & Hospital Epidemiology Vol. 36, No. 6 ( 2015-06), p. 717-724
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 36, No. 6 ( 2015-06), p. 717-724
    Abstract: Achieving high healthcare personnel (HCP) influenza vaccination rates has typically required mandating vaccination, which is often challenging to implement. Our objective was to achieve 〉 90% employee influenza vaccination without a mandate. DESIGN Prospective quality improvement initiative SETTING AND PARTICIPANTS All employees of a 2-hospital, 1,100-bed, community-based academic healthcare system. METHODS The multimodal HCP vaccination campaign consisted of a mandatory declination policy, mask-wearing for non-vaccinated HCP, highly visible “I’m vaccinated” hanging badges, improved vaccination tracking, weekly compliance reports to managers and vice presidents, disciplinary measures for noncompliant HCP, vaccination stations at facility entrances, and inclusion of a target employee vaccination rate ( 〉 75%) metric in the annual employee bonus program. The campaign was implemented in the 2011–2012 influenza season and continued throughout the 2012–2013 through 2014–2015 influenza seasons. Employee compliance, vaccination, exemption and declination rates were calculated and compared with those of the seasons prior to the intervention. RESULTS Compared with vaccination rates of 57%–72% in the 3 years preceding the intervention, employee influenza vaccination increased to 92% in year 1 and 93% in years 2–4 ( P 〈 .001). The proportion of employees declaring medical/religious exemptions or declining vaccination decreased during the 4 years of the program (respectively, 1.2% to 0.5%, P 〈 .001; 4.4% to 3.8%, P= .001). CONCLUSIONS An integrated multimodal approach incorporating peer pressure, accountability, and financial incentives was associated with increased employee vaccination rate from ≤72% to ≥92%, which has been sustained for 4 influenza seasons. Such programs may provide a model for behavioral change within healthcare organizations. Infect Control Hosp Epidemiol 2015;00(0): 1–8
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1017/ice.2015.47
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2015
    detail.hit.zdb_id: 2106319-9
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  • 3
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    Online Resource
    1206. #HitMeWithYourFluShot: Consolidating a 3-Week Influenza Vaccination Program into a One-Day Drill
    Oxford University Press (OUP) ; 2019
    In:  Open Forum Infectious Diseases Vol. 6, No. Supplement_2 ( 2019-10-23), p. S433-S434
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 6, No. Supplement_2 ( 2019-10-23), p. S433-S434
    Abstract: Since 2011 our health system has achieved 〉 90% employee influenza vaccination via a 3-week intensive nonmandatory program offering entrance location vaccinations. We partnered with Emergency Management to consolidate this process into 1 day, fulfilling a dual purpose of conducting an emergency vaccination drill. Methods The health system comprises 2 hospitals (913-bed and 250-bed) and campuses, multiple off-campus clinical and nonclinical sites, and a free-standing emergency department, employing nearly 12,000 people in 4 states. A multidisciplinary team planned the drill, scheduled 4 am-9 pm at 3 locations in the 2 hospitals. In addition, roving vaccination teams visited all off-campus sites to either perform vaccinations or deliver supplies. Employees not scheduled to work were encouraged but not required to come in; all eligible employees working that day were expected to be vaccinated. Nonemployees (including physicians, volunteers and retirees) were also included. To promote the event, we developed posters and other communications using a #HitMeWithYourFluShot hashtag, and included radio stations, therapy dogs, photo booths and other activities. After the event we surveyed participants to elicit feedback. Results During the 1-day event we vaccinated 7267 (69%) employees, along with 1594 nonemployees, similar to prior 3-week campaigns (figure). Nearly 300 employees volunteered to vaccinate or perform other duties. The roving teams visited 81 practices at 42 separate locations, traveling 〉 250 miles. Of those completing the post-event survey (n = 656), 79% found the event very convenient, and 61% of those who had participated in prior campaigns found this format somewhat or much better. Employee vaccination rates for the entire season was 92%. Conclusion This effort demonstrated that we could achieve high levels of employee flu vaccination in a single day in a large and geographically diverse healthcare system, using a mass vaccination drill format that included multiple sites of vaccination as well as roving vaccination and transport teams. We identified the lack of a master list with locations of all off-campus employees as the greatest opportunity. Participants favorably accepted the drill format and employee engagement was high. Disclosures All authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofz360.1069
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2757767-3
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  • 4
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    Online Resource
    170. Reduction in Bloodborne Pathogen Splash Exposures After Implementation of Universal Masking and Eye Protection for COVID-19
    Oxford University Press (OUP) ; 2021
    In:  Open Forum Infectious Diseases Vol. 8, No. Supplement_1 ( 2021-12-04), p. S102-S102
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 8, No. Supplement_1 ( 2021-12-04), p. S102-S102
    Abstract: While splashes to the eyes, nose and mouth can often be prevented through appropriate personal protective equipment (PPE) use, they continue to occur frequently when PPE is not used consistently. Due to the COVID-19 pandemic, we implemented universal masking and eye protection for all healthcare personnel (HCP) performing direct patient care and observed a subsequent decline in bloodborne pathogen (BBP) splash exposures. Methods Our healthcare system, employing & gt;12,000 healthcare personnel (HCP), implemented universal masking in April 2020 and eye protection in June 2020. We required HCP to mask at all times, and use a face shield, safety glasses or goggles when providing direct patient care. Occupational Safety tracked all BBP exposures due to splashes to the eyes, nose, mouth and/or face, and compared exposures during 2020 to those in 2019. We estimated costs, including patient and HCP testing, related to splash exposures, as well as the additional cost of PPE incurred. Results In 2019, HCP reported 90 splashes, of which 57 (63%) were to the eyes. In 2020, splashes decreased by 54% to 47 (36 [77%] to eyes). In both years, nurses were the most commonly affected HCP type (62% and 72%, respectively, of all exposures). Physicians (including residents) had the greatest decrease in 2020 (10 vs. 1 splash exposures [90%] ), while nurses had a 39% decrease (56 vs. 34 exposures). Nearly all of the most common scenarios leading to splash exposures declined in 2020 (Table). We estimated the cost of each BBP exposure as & 2,940; this equates to a savings of & 123,228. During 2020, we purchased 65,650 face shields, safety glasses and goggles (compared to 5303 similar items in 2019), for an additional cost of & 238,440. Specific activities identified as leading to bloodborne pathogen splash exposures, 2019 vs. 2020. Conclusion We observed a significant decline in splash-related BBP exposures after implementing universal masking and eye protection for the COVID-19 pandemic. While cost savings were not observed, we were unable to incorporate the avoided pain and emotional trauma for the patient, exposed HCP, and coworkers. This unintended but positive consequence of the COVID-19 pandemic exemplifies the need for broader use of PPE, particularly masks and eyewear, for all patient care scenarios where splashes may occur. Disclosures All Authors: No reported disclosures
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofab466.170
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2757767-3
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  • 5
    Online Resource
    Online Resource
    Management of a large tuberculosis contact investigation related to a contaminated bone graft product used in spinal surgery
    Cambridge University Press (CUP) ; 2022
    In:  Antimicrobial Stewardship & Healthcare Epidemiology Vol. 2, No. S1 ( 2022-07), p. s57-s57
    Details
    In: Antimicrobial Stewardship & Healthcare Epidemiology, Cambridge University Press (CUP), Vol. 2, No. S1 ( 2022-07), p. s57-s57
    Abstract: Background: In March–April 2021, 23 patients at a 906-bed hospital in Delaware had surgical implantation of a bone graft product contaminated with Mycobacterium tuberculosis ; 17 patients were rehospitalized for surgical site infections and 6 developed pulmonary tuberculosis. In May 2021, we investigated this tuberculosis outbreak and conducted a large, multidisciplinary, contact investigation among healthcare personnel (HCP) and patients potentially exposed over an extended period in multiple departments. Methods: Exposed HCP were those identified by their managers as present, without the use of airborne precautions, in operating rooms (ORs) during index spine surgeries or subsequent procedures, the postanesthesia care unit (PACU) when patients had draining wounds, inpatient rooms when wound care was performed, and the sterile processing department (SPD) on the days repeated surgeries were performed. We created and assigned an online education module and symptom screening questionnaire to exposed HCP. Employee health services (EHS) instituted a dedicated phlebotomy station to provide interferon-γ release assay (IGRA) testing for HCP at ≥8 weeks after last known exposure. EHS managed all exposed HCP, including nonemployees (eg, private surgeons) via automated e-mail reminders, which were escalated through supervisory chains as needed until follow-up completion. The infection prevention team notified exposed patients, defined as those who shared semiprivate rooms with case patients with transmissible tuberculosis. The Delaware Division of Public Health performed IGRA testing. Results: There were 506 exposed HCP in ORs (n = 100), the PACU (n = 87), inpatient units (n = 140), the SPD (n = 54), and other locations (n = 122); 83% were employed by the health system. Surgical masks and eye protection were routinely used during patient care. All exposed HCP completed screening by December 17, 2021. Furthermore, 2 HCP had positive IGRAs without symptoms or chest radiograph abnormalities, indicating latent tuberculosis infection, but after further review of records and interviews, we discovered that they had previously tested positive and had been treated for latent tuberculosis infection. In addition, 5 exposed patients tested negative and 2 remain pending. Conclusions: This large investigation demonstrated the need for a systematic process that encompassed all exposed HCP including nonemployees and incorporated administrative controls to ensure complete follow-up. We did not identify any conversions related to this outbreak despite high burden of disease in case patients and multiple exposures to contaminated bone-graft material and infectious bodily fluids without respirator use. Transmission risk was likely reduced by baseline surgical mask use and rapid institution of airborne precautions after outbreak recognition. Funding: None Disclosures: None
    Type of Medium: Online Resource
    ISSN: 2732-494X
    URL: Article
    DOI: 10.1017/ash.2022.165
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2022
    detail.hit.zdb_id: 3074908-6
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