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To characterize associations between exposures within and outside the medical workplace with healthcare personnel (HCP) SARS-CoV-2 infection, including the effect of various forms of respiratory protection. Case-control study. We collected data from international participants via an online survey. In total, 1,130 HCP (244 cases with laboratory-confirmed COVID-19, and 886 controls healthy throughout the pandemic) from 67 countries not meeting prespecified exclusion (ie, healthy but not working, missing workplace exposure data, COVID symptoms without lab confirmation) were included in this study. Respondents were queried regarding workplace exposures, respiratory protection, and extra-occupational activities. Odds ratios for HCP infection were calculated using multivariable logistic regression and sensitivity analyses controlling for confounders and known biases. HCP infection was associated with non-aerosol-generating contact with COVID-19 patients (adjusted OR, 1.4; 95% CI, 1.04-1.9; P = .03) and extra-occupational exposures including gatherings of ≥10 people, patronizing restaurants or bars, and public transportation (adjusted OR range, 3.1-16.2). Respirator use during aerosol-generating procedures (AGPs) was associated with lower odds of HCP infection (adjusted OR, 0.4; 95% CI, 0.2-0.8, P = .005), as was exposure to intensive care and dedicated COVID units, negative pressure rooms, and personal protective equipment (PPE) observers (adjusted OR range, 0.4-0.7). COVID-19 transmission to HCP was associated with medical exposures currently considered lower-risk and multiple extra-occupational exposures, and exposures associated with proper use of appropriate PPE were protective. Closer scrutiny of infection control measures surrounding healthcare activities and medical settings considered lower risk, and continued awareness of the risks of public congregation, may reduce the incidence of HCP infection.

Testing of asymptomatic patients for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) (ie, “asymptomatic screening) to attempt to reduce the risk of nosocomial transmission has been extensive and resource intensive, and such testing is of unclear benefit when added to other layers of infection prevention mitigation controls. In addition, the logistic challenges and costs related to screening program implementation, data noting the lack of substantial aerosol generation with elective controlled intubation, extubation, and other procedures, and the adverse patient and facility consequences of asymptomatic screening call into question the utility of this infection prevention intervention. Consequently, the Society for Healthcare Epidemiology of America (SHEA) recommends against routine universal use of asymptomatic screening for SARS-CoV-2 in healthcare facilities. Specifically, preprocedure asymptomatic screening is unlikely to provide incremental benefit in preventing SARS-CoV-2 transmission in the procedural and perioperative environment when other infection prevention strategies are in place, and it should not be considered a requirement for all patients. Admission screening may be beneficial during times of increased virus transmission in some settings where other layers of controls are limited (eg, behavioral health, congregate care, or shared patient rooms), but widespread routine use of admission asymptomatic screening is not recommended over strengthening other infection prevention controls. In this commentary, we outline the challenges surrounding the use of asymptomatic screening, including logistics and costs of implementing a screening program, and adverse patient and facility consequences. We review data pertaining to the lack of substantial aerosol generation during elective controlled intubation, extubation, and other procedures, and we provide guidance for when asymptomatic screening for SARS-CoV-2 may be considered in a limited scope.

Daptomycin-associated myopathy is a known adverse effect, so creatine phosphokinase (CPK) monitoring is advised. Statin coadministration with daptomycin was found to increase risk of myopathy and rhabdomyolysis. During coadministration, we recommend enhanced CPK monitoring and consideration of withholding statins. Abstract Background Daptomycin-associated myopathy has been identified in 2%-14% of patients, and rhabdomyolysis is a known adverse effect. Although risk factors for daptomycin-associated myopathy are poorly defined, creatine phosphokinase (CPK) monitoring and temporary discontinuation of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or \"statins,\" has been recommended. Methods We conducted a single-center, retrospective, matched case-control risk factor analysis in adult and pediatric patients from 2004 to 2015. Patients in whom myopathy (defined as CPK values above the upper limit of normal) developed during daptomycin treatment were matched 1:1 to no-myopathy controls with at least the same duration of therapy. Risk factors independently associated with myopathy were determined using multivariable conditional logistic regression. Secondary analysis was performed in patients with rhabdomyolysis, defined as CPK values ≥10 times the upper limit of normal. Results Of 3042 patients reviewed, 128 (4.2%) were identified as having daptomycin-associated myopathy, 25 (0.8%) of whom had rhabdomyolysis; 121 (95%) of the 128 were adults, and the mean duration of therapy before CPK elevation was 16.7 days (range, 1-58 days). In multivariate analysis, deep abscess treatment (odds ratio, 2.80; P = .03), antihistamine coadministration (3.50; P = .03), and statin coadministration (2.60; P = .03) were independent risk factors for myopathy. Obesity (odds ratio, 3.28; P = .03) and statin coadministration (4.67; P = .03) were found to be independent risk factors for rhabdomyolysis, and older age was associated with reduced risk (0.97; P = .05). Conclusions Statin coadministration with daptomycin was independently associated with myopathy and rhabdomyolysis. This is the first study to provide strong evidence supporting this association. During coadministration, we recommend twice-weekly CPK monitoring and consideration of withholding statins.

In response to health care worker influenza vaccination rates that are below desired targets, strategies designed to stimulate vaccination have been proposed, including the use of declination statements for those refusing vaccination. The impact of these statements has not been thoroughly investigated and may be affected by their specific language and context. This review examines the available data on the use and impact of declination statements to increase health care worker vaccination rates and notes some potential pitfalls and issues that may arise with their use.

BACKGROUND Infants and young children are frequently colonized with C. difficile but rarely have symptomatic disease. However, C. difficile testing remains prevalent in this age group. OBJECTIVE To design a computerized provider order entry (CPOE) alert to decrease testing for C. difficile in young children and infants. DESIGN An interventional age-targeted before-after trial with comparison group SETTING Monroe Carell Jr. Children's Hospital at Vanderbilt University, Nashville, Tennessee. PATIENTS All children seen in the inpatient or emergency room settings from July 2012 through July 2013 (pre-CPOE alert) and September 2013 through September 2014 (post-CPOE alert) INTERVENTION In August of 2013, we implemented a CPOE alert advising against testing in infants and young children based on the American Academy of Pediatrics recommendations with an optional override. We further offered healthcare providers educational seminars regarding recommended C. difficile testing. RESULTS The average monthly testing rate significantly decreased after the CPOE alert for children 0-11 months old (11.5 pre-alert vs 0 post-alert per 10,000 patient days; P<.001) and 12-35 months old (61.6 pre-alert vs 30.1 post-alert per 10,000 patients days; P<.001), but not for those children ≥36 months old (50.9 pre-alert vs 46.4 post-alert per 10,000 patient days; P=.3) who were not targeted with a CPOE alert. There were no complications in those children who testing positive for C. difficile. CONCLUSIONS The average monthly testing rate for C. difficile for children <35 months old decreased without complication after the use of a CPOE alert in those who tested positive for C. difficile. Infect Control Hosp Epidemiol 2017;38:542-546.

This case–control study in Tennessee assessed 635 persons 2 to 49 years of age with invasive pneumococcal disease and 6350 matched controls. Among those with asthma, the risk of invasive pneumococcal disease was about twice that among the controls; among those with high-risk asthma, the risk was more than three times as great. Asthma appears to be an independent risk factor for invasive pneumococcal disease. These data suggest that asthma should be an additional indication for pneumococcal vaccination. This case–control study in Tennessee showed that among those with asthma, the risk of invasive pneumococcal disease was about twice that among the controls. Among those with high-risk asthma, the risk was more than three times as great. Streptococcus pneumoniae is the cause of substantial morbidity and mortality in the United States, particularly among people who are at high risk for pneumococcal infection. 1 Among those at risk, pneumococcal vaccination has been shown to prevent invasive disease from this ubiquitous pathogen. 1 , 2 The identification and confirmation of other groups at risk as potential candidates for vaccination are key steps in the prevention of invasive pneumococcal disease. Unlike the known increase in the risk of invasive pneumococcal disease among persons with other chronic obstructive pulmonary diseases (COPDs) (e.g., emphysema and chronic bronchitis), 1 the risk among persons with asthma is unknown. . . .

Background. We sought to determine the incidence of invasive pneumococcal disease (IPD) among individuals with sickle cell disease (SCD) before and after the introduction of the pneumococcal conjugate vaccine (PCV). Methods. Individuals with SCD who were enrolled in Tennessee Medicaid from January 1995 through December 2004 were identified using SCD-specific International Classification of Diseases, Ninth Revision, Clinical Modification codes. Population-based surveillance data were used to identify individuals with IPD and were linked to patients with SCD in the Tennessee Medicaid database to determine incidence rates of IPD. Clinical data were collected on all subjects with IPD, and antibiotic susceptibility testing and serotyping were performed on all available pneumococcal isolates. Results. We identified 2026 individuals with SCD, who constituted 13,687 person-years of follow-up. During the study period, 37 individuals with SCD developed IPD, and 21 of these patients were aged <5 years. In a comparison of the pre-PCV period (1995–1999) with the post-PCV period (2001–2004), the rate of IPD decreased by 90.8% in children aged <2 years (from 3630 to 335 cases per 100,000 person-years; P < .001) and by 93.4% in children aged <5 years (from 2044 to 134 cases per 100,000 person-years; P < .001). Rates of IPD for patients with SCD who were aged ≥5 years decreased from 161 cases per 100,000 person-years during the pre-PCV period to 99 cases per 100,000 person-years during the post-PCV period (P = .36). Conclusion. The rate of IPD among children with SCD who are aged <5 years has decreased markedly since the introduction of routine administration of PCV to young children.

A cluster of Rhizobium radiobacter isolates isolated from six unique surgical tissue cultures prompted an investigation ultimately identifying a pseudo-outbreak linked to errant laboratory tissue processing with contaminated, nonsterile saline. Timely response and multidisciplinary collaboration led to tangible system-level interventions and avoidance of unnecessary antibiotic exposures.

The leading cause of climate change and global warming is the increase in greenhouse gas emissions. 1 The health impacts of climate change and extreme weather events include temperature-associated illnesses and deaths, air pollution-associated chronic respiratory illness, water-and foodborne infections, and vector-borne and zoonotic infections. 2 There is a clear link between climate change and SHEA’s mission-critical concerns, such as healthcare-associated infections, antimicrobial resistance (AMR), and the spread of Candidozyma auris within healthcare settings. 3 Moreover, climate change increases the frequency and severity of bacterial, fungal, and vector-borne diseases including gastroenteritis, skin and soft tissue infections, and respiratory illnesses. 4 Broader infectious disease and public health threats resulting from climate change include the northward spread of Vibrio vulnificus along the Atlantic coastline and a global expansion of mosquito vectors with local transmission of malaria and dengue. 5,6 Therefore, as healthcare epidemiologists, infection preventionists and antibiotic stewards concerned with public health and providing safe healthcare to all, it is incumbent on us to reduce the driving factors of climate change within our domains and mitigate adverse health impacts. Interventions to reduce excess antibiotic days of therapy, including shorter antibiotic courses, earlier de-escalation of broad-spectrum agents or intravenous (IV) to oral (PO) switch, can reduce plastic waste associated with IV administrations and have a positive and direct impact on reducing healthcare-associated carbon emissions. 8 Moreover, measures to improve diagnostic stewardship by avoiding unnecessary diagnostic testing or leveraging reflexive testing have downstream positive impacts on reducing plastic waste and energy consumption while improving patient outcomes. [...]all stewardship programs should implement and scale up proven interventions like de-escalation/cessation, IV to PO switch, and diagnostic stewardship to reduce healthcare utilization and waste and improve patient outcomes. Spivak et al measured greenhouse gas emissions from unnecessary outpatient antibiotic prescriptions. 8 13,580,000 estimated unnecessary prescriptions in the United States approximating 993,906 miles driven in a gas-powered car Hojat et al led a multi-society effort to develop a calculator to compare carbon emissions of various IV or PO antimicrobial regimens.18 Antibiotic Waste Calculator In 2023, the “Sustainabil-ID” interest group of pediatric and adult infectious diseases providers was established to promote sustainability interventions in ID. 18,19 Member Spotlight: Preeti Jaggi and Shreya Doshi—Pediatric Infectious Diseases Society Infection prevention and control Lalakea et al implemented an educational intervention on hand hygiene, appropriate glove use, and environmental impacts to reduce non-sterile glove overuse in surgical specialty outpatient clinics. 11 An average of 4719 gloves saved per month with a total savings of 56,628 gloves, 180.2 kg of waste and $3,003.17 per year, with projected 1472–1767 kg reduction in CO2 emissions, equivalent to 3766–4519 miles driven in a gas-powered car. Pearl et al conducted a SHEA Research Network survey of hospital epidemiologists, IPC directors, and infection preventionists on knowledge, attitudes, and institutional practices related to environmental sustainability and IPC. 20 Most respondents supported or had in place sustainable measures like donation of gently used or unused medical supplies, pursuit of LEED green buildings certification, water/energy conservation, reusable PPE, and “greener” chemicals for low-level disinfection Greene et al developed a conflict-based pragmatic approach to reducing single-use plastics in healthcare, which can be applied to AS, and IPC-based interventions, among others. 21 “No conflict”—immediately implementable “Context-dependent”—requires further exploration “Value conflict”—too high risk/too many safety concerns Note.