Background:
Healthcare workers (HCWs) are at increased risk of influenza exposure and represent a potential transmission source. The Department of Health and Human Services (HHS) set a goal for 2020 ...to have 90% of all HCWs in acute-care hospitals (ACHs) vaccinated. Vaccination against influenza decreases symptomatic illness and absenteeism and protects HCWs and their contacts. We assessed characteristics of facility intervention programs based on their success in meeting this benchmark.
Methods:
Data from the NHSN were utilized, including answers to the Annual Flu Survey for 2014–2022 and the rate of vaccine compliance by facility. Flu surveys detail facility-specific programs implemented for each influenza season, from October to March. We used SAS version 9.4 software for univariate analyses to determine factors significantly associated with meeting the HHS benchmark target of ≥90% vaccination among all HCWs, split into categories for employees, students or volunteers, and licensed independent practitioners. Facilities were excluded if they were not ACHs or Critical Access Hospitals (CAH), did not complete the Annual Flu Survey for at least 1 year, or required vaccination as a condition of employment.
Results:
From 2014 to 2022, 745 surveys were completed. Overall, 48.58% of respondents succeeded in meeting the HHS benchmark. Also, 306 surveys completed noted that their facility did not require influenza vaccination. Among those, only 19.93% respondents succeeded. Moreover, 80.33% of successful respondents for all HCWs required personal protective equipment (PPE) upon vaccination refusal compared to 34.29% of unsuccessful respondents (
P
< .0001). Furthermore, 98.36% successful respondents required documentation of offsite vaccination, compared to 89.39% of unsuccessful respondents (
P
= .027). For employees, 64.56% of successful respondents tracked vaccination rates in some or all units compared to 45.81% of unsuccessful respondents (
P
= .004). Also, 63.29% successful respondents had visible vaccination of leadership, compared to 43.61% of unsuccessful respondents (
P
= .003). Furthermore, 86.08% of successful respondents had mobile vaccination carts, compared to 73.57% unsuccessful respondents (
P
= .023). For the student- or volunteer-specific benchmark, 24.59% of successful respondents provided vaccination incentives compared to 14.63% of unsuccessful respondents (
P
= .035).
Conclusions:
Facilities with ≥90% vaccination among HCWs were more likely to require PPE after vaccination refusal and documentation for offsite vaccination. Other strategies for vaccination were differentially associated by employee type for Tennessee facilities. For future outreach, a multipronged approach is more likely to be successful in addressing vaccine uptake among employees with lagging rates. Strategies for influenza vaccine uptake could also improve other occupational vaccinations. More research is needed on the barriers to vaccination among HCWs specifically.
Disclosures:
None
Background:
Central-line–associated bloodstream infections (CLABSIs) significantly burden the US population and healthcare system. Reporting facilities in Tennessee consistently omit race and ...ethnicity data in the NHSN despite having the option to enter. Racial and ethnic disparities are well documented across many health outcomes, including patient safety. CLABSIs were compared among 3 racial groups to better understand the impact of race on CLABSI incidence in Tennessee.
Methods:
CLABSI data from NHSN were linked with records from the TN Hospital Discharge Data System (HDDS) for 2018–2021. A multivariable linear regression model was used to determine relative risk (RR) between racial groups for contracting a CLABSI after controlling for confounding variables including Charlson comorbidity index (CCI) and social vulnerability index (SVI) scores. Statistical significance was set at
P
< .05. Data linkage and statistical analyses were performed in SAS version 9.4 software.
Results:
In Tennessee between 2018 and 2021, 342 (17.2%) of the 1,980 CLABSI events had race documented, and no ethnicity variables exist in the NHSN. The data linkage process yielded a 72% match (1,426 CLABSIs). The remaining 28% were excluded from the analysis. Per 1,000 central-line days (CL days) for all races, white patients had the highest CLABSI rate (17.5), followed by Black patients (1.36), and Native American or Alaskan Native patients (0.68). Per 1,000 admissions by race, Black patients had a higher CLABSI rate (1.26) than Native American/Alaskan Native patients (0.85) and white patients (0.75). The risk of contracting a CLABSI was 79% higher in Black patients than in white patients (RR, 1.79; 95% CI, 1.55–2.07;
P
< .0001) when controlling for CCI, age group, and SVI.
Conclusions:
These results suggest that racial disparities between Black and white patients are present in Tennessee hospitals regarding CLABSIs. Although most CLABSI events were linked to HDDS patients, there were limitations in the ability to match all cases and calculate CL days by race. This study highlights the need for complete race and ethnicity data in the NHSN. Further studies should examine infection types at the regional and facility levels to target interventions for reducing HAI inequities in Tennessee.
Disclosures:
None
Background:
In September 2021, the CMS mandated that long-term care facility (LTCF) healthcare workers be vaccinated for COVID-19 unless medically or religiously exempt. Vaccinating healthcare ...workers reduces transmission of COVID-19 among patients and workers, reducing the risk of illness among residents and patients. We examined the relationship between COVID-19 clusters and staff vaccination rates in Tennessee LTCFs.
Methods:
COVID-19 cluster data were collected using REDCap from January 3, 2021, to September 25, 2022, and LTCF vaccination rates were collected from the NHSN. Clusters were identified in facilities with 2 or more cases. The staff vaccination rate 2 weeks prior to the cluster was used, accounting for the lag time between vaccination dose and reaching full immunity. We selected 75% as the critical immunization threshold. The facility case rate was calculated per 100 beds. A test was performed to determine whether reaching the critical vaccination threshold was associated with cluster occurrence. The relationship between vaccination rate and case number was tested using Pearson correlation. Statistical analyses were conducted using SAS version 9.4 software.
Results:
The average staff vaccination rate when NHSN first required long-term care facilities to report rates rose from 47% in June 2021 to 83% in September 2022. In total, 806 clusters were identified with 20,868 combined weeks from all facilities being reported after merging facilities’ weekly vaccine percentage rates with cluster data. Most weeks from all facilities did not identify a cluster (n = 20,064, 96.15%) and did not meet the critical immunization threshold (n = 11,050, 52.95%). The association between a cluster occurring and a facility meeting the threshold was significant (χ
2
= 5.41; df = 1;
P
95% CI, .7327–.9740). The Pearson correlation coefficient between vaccination rate and case number was 0.05560 (
P
= .2894).
Conclusions:
There was a significant association between facilities not reaching the immunization threshold and presence of a COVID-19 cluster. The facility case rate was not correlated with staff vaccination rate; however, a limitation of this analysis was that resident vaccination was not tested. Another limitation was that medical and religious exemptions could not be differentiated. Healthcare staff should consider getting vaccinated, if able, to reduce the risk of COVID-19 and to keep staff and residents safe from COVID-19.
Disclosures:
None
Public health officials are responding to an outbreak of fungal meningitis among patients who received procedures under epidural anesthesia at two clinics (River Side Surgical Center and Clinica K-3) ...in Matamoros, Mexico, during January 1-May 13, 2023. This report describes outbreak epidemiology and outlines interim diagnostic and treatment recommendations.
Interim recommendations for diagnosis and management were developed by the Mycoses Study Group Research Education and Consortium (MSGERC) based on the clinical experience of clinicians caring for patients during the current outbreak or during previous outbreaks of healthcare-associated fungal meningitis in Durango, Mexico, and the United States.
As of July 7, 2023, the situation has evolved into a multistate and multinational fungal meningitis outbreak. A total of 185 residents in 22 U.S. states and jurisdictions have been identified who might be at risk of fungal meningitis because they received epidural anesthesia at the clinics of interest in 2023. Among these patients, 11 suspected, 10 probable, and 10 confirmed U.S. cases have been diagnosed, with severe vascular complications and eight deaths occurring. Fusarium solani species complex has been identified as the causative agent, with antifungal susceptibility testing of a single isolate demonstrating poor in vitro activity for most available antifungals. Currently, triple therapy with intravenous voriconazole, liposomal amphotericin B, and fosmanogepix is recommended.
Efforts to understand the source of this outbreak and optimal treatment approaches are ongoing, but infectious diseases physicians should be aware of available treatment recommendations. New information will be available on CDC's website.
Abstract
Background
Injection drug use using nonsterile equipment can lead to transmission of viral, bacterial, and fungal infections. Frontline healthcare workers (HCW) are at high risk for ...substance use disorder due to unprecedented job stress and access to injectable controlled substances. The Tennessee Department of Health (TDH) developed a collaborative investigative process to determine the risk of bloodborne pathogen (BBP) transmission from licensed HCWs engaging in drug diversion. This program recommends public health action and provides consultation to improve drug diversion programs.
Methods
In 2019 TDH formed a drug diversion investigation team (DDIT) consisting of pharmacists, epidemiologists and medical directors from the HAI and HIV/STI/Viral Hepatitis programs. The DDIT responds to notification by the Health-Related Boards (HRB) of a licensed HCW under investigation for diversion of injectable products. The DDIT interviews the investigator and meets the facility drug diversion program to review drug diversion policies and processes. Based on the suspected method(s) and, if known, the individual’s Hepatitis B/C and HIV status, recommendations are made regarding the need for patient notification and testing.
Results
From 2020–2022 the DDIT received notification of 49 licensed HCWs under investigation for diversion of injectable products. Patient notification and testing was recommended in seven facilities for CDC Category A infection control breaches; in two cases, later HCW testing negated the need for further action. Among the 34 facilities queried, only five (14.7%) had existing policies for for-cause BBP testing. Other recommendations to improve diversion programs include infection prevention participation and releasing “not eligible for rehire” status to other facilities.
Conclusion
The TDH DDIT facilitates communication with HRB on reported cases of injectable drug diversion. Joint investigations with facilities raise awareness of the risk of BBP transmission and improve facility diversion programs. Tennessee facilities are adding for-cause BBP testing to their investigation procedures. The TDH DDIT model receives mostly positive responses from facility and health system drug diversion teams and may be considered by other public health jurisdictions.
Disclosures
All Authors: No reported disclosures
Abstract only
Obesity and metabolic syndrome are now recognized as significant health concerns for survivors of pediatric Acute Lymphoblastic Leukemia (ALL) and are consequences of their treatment. ...The majority of weight gain occurs during the induction phase of therapy (first 28 days), when patients receive various chemotherapies in addition to high dose glucocorticoids. Physiological levels of glucocorticoids are required for metabolic control, but chronic exposure to elevated doses has been linked to metabolic disease including type 2 diabetes and obesity. Nutrition plays an important role in the development of obesity and is also amongst the few adjustable parameters in the treatment of pediatric ALL. We therefore determined if a diet high in omega‐3 fatty acids provided by fish oil can reduce the weight gain and metabolic syndrome phenotype associated chronic high dose glucocorticoid treatment. 3 week old C57BL/6 male mice were fed a “Western type” diet (45% calories from fat (lard) (HFL))
ad libitum
. At 6 weeks of age, mice received the synthetic glucocorticoid, Prednisolone, at a dose of 40 mg/m
2
/day for 28 days. During the Prednisolone treatment, mice either remained on the HFL diet or were switched to an isocaloric diet containing 45% fat from fish oil (HFO). Body weight, food consumption, fat deposition in the liver, accumulation of epididymal adipose tissue and adipocyte size were determined. Mice on the HFO diet gained less weight during the treatment period (
P = 0.03
), with a dramatic decrease in fat deposition in the liver irrespective of glucocorticoid treatment. Epididymal adipose depots were smaller in mice consuming the HFO diet (
P < 0.0001
) with a concomitantly decrease in systemic Leptin levels (
P = 0.05
). Interestingly, glucocorticoid therapy caused a significant increase in adipocyte size when the mice are consuming the HFL diet (
P = 0.001
). The results from this study suggest that a dietary intervention in the form of fish oil during glucocorticoid treatment can reduce weight gain and metabolic syndrome and reduce long term consequences of ALL treatment.
Support or Funding Information
FY16 Faculty Research Grant (University of Memphis)
Abstract only
Reproduction, an energetically costly process, is subject to nutritional and metabolic control. There is a high occurrence of female infertility in obese women, and Polycystic Ovarian ...Syndrome (PCOS), a condition characterized by androgen excess and oligo‐ and amenorrhea, is highly associated with obesity and diabetes mellitus. Obesity is characterized by chronic, low‐grade inflammation, and increased circulating pro‐inflammatory cytokines. These pro‐inflammatory molecules can alter insulin signaling, thereby contributing to glucose intolerance and insulin resistance, both hallmarks of type 2 diabetes. This study seeks to elucidate the relationship between obesity, inflammation, and reproductive dysfunction through diet intervention. Diets rich in n‐3 poly‐unsaturated fatty acids (PUFAs), such as is found in fish oil, are considered to have anti‐inflammatory effects. We induced obesity and reproductive dysfunction in C57BL/6 female mice by feeding a “Western‐type” high fat diet (45% energy from fat) with lard as the source of fat. At 16 weeks of age, the experimental group was switched to a diet of identical composition but with fish oil as a source of fat for an additional 8 weeks. Changes in estrous cycle regularity were assessed by vaginal cytology. Metabolic outcomes were evaluated by measuring body weight, food consumption, glucose tolerance, fasting insulin levels, and adipose and liver histology. Inflammatory status was determined by circulating cytokine and adipokine levels and changes in regulatory immune cell populations. Reproductive irregularity was successfully established by 16 weeks of age at which time the mice also had increased glucose intolerance and higher circulating Leptin levels. At 24 weeks, mice that had remained on the lard based diet weighed more, had a dramatic increase in fat deposition in the liver, showed worse glucose tolerance response, had higher fasting insulin levels than their fish‐oil counterparts, but did not have increased systemic pro‐inflammatory cytokine levels. Consumption of the fish oil diet for 8 weeks did not restore estrous cycle regularity for all C57BL/6 female mice, however, metabolic parameters dramatically improved during the course of intervention. These findings suggest including fish oil in the diet of obese females will improve metabolic status, but a longer period of consumption may be needed to restore normal reproductive functions.
Support or Funding Information
Funded by Start Up funds from the University of Memphis
Abstract
Background
US public health officials are responding to a multinational, multistate fungal meningitis outbreak involving travelers who had primarily cosmetic procedures (e.g., liposuction) ...under epidural anesthesia at 2 Matamoros, Mexico clinics (closed 5/13/2023 by Mexican authorities). Fusarium solani species complex fungal DNA was identified in cerebral spinal fluid (CSF) by polymerase chain reaction and next-generation metagenomic sequencing; a highly resistant strain was isolated from a single tissue culture. We describe epidemiology, demographics, and clinical features to inform prevention messaging, guidance, and future responses.
Methods
Public health officials collected data on confirmed and probable cases (1/1/23–7/25/2023) using a standardized case report form; data were analyzed in Microsoft Excel.
Results
In total, 10 probable (1 death) and 10 confirmed (8 deaths) US fungal meningitis cases were identified; all involved epidural anesthesia from the same anesthesiologist at both clinics. Most cases (80%) occurred in Texas residents. Median patient age was 31 years (range: 23–52); 19 patients were women; 13 were Hispanic/Latino. None had underlying conditions reported. At least 4 patients were uninsured, with several reporting associated care-seeking delays. Common symptoms were headache (n=18), nausea (n=13), fever (n=12), and stiff neck (n=12). Median (IQR) initial CSF results were white blood cell count (498/µL 343–825), glucose (31 mg/dL 26–40), and protein (99 mg/dL 52–2140). In 8 patients, CSF (1,3)-β-D-Glucan was ≥ 500 pg/ml. From procedure date, average days (range) to symptom onset was 19 (0–58), to hospitalization was 52 (14–106).
Conclusion
In the US, the fungal meningitis outbreak has primarily affected young, healthy Hispanic/Latino women travelling to Matamoros, Mexico, for procedures and resulted in a high mortality rate (40%). CDC advises US residents against having elective procedures in Matamoros involving epidural anesthetic injection. Insurance barriers may have led to medical tourism to Mexico and subsequent delayed treatment for fungal meningitis, highlighting the need for preparation to address healthcare access disparities in future outbreaks.
Disclosures
Luis Ostrosky-Zeichner, MD, FACP, FIDSA, FSHEA, FECMM, CMQ, Astellas: Advisor/Consultant|Astellas: Grant/Research Support|Astellas: Honoraria|F2G: Advisor/Consultant|F2G: Grant/Research Support|F2G: Honoraria|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|GSK: Advisor/Consultant|GSK: Grant/Research Support|GSK: Honoraria|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Melinta: Honoraria|NIH: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Expert Testimony|Pfizer: Honoraria|Pulmocide: Advisor/Consultant|Pulmocide: Grant/Research Support|Pulmocide: Honoraria|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Scynexis: Honoraria|T2 biosystems: Advisor/Consultant|T2 biosystems: Grant/Research Support|T2 biosystems: Honoraria|Viracor: Advisor/Consultant|Viracor: Grant/Research Support|Viracor: Honoraria
