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Article ; Online: Category A waste processing and disposal is a critical weakness in the United States response plans for outbreaks of high consequence infectious diseases.

Gibbs, Shawn G / Schwedhelm, Michelle M / Lowe, John J / Tennill, Patricia / Persson, Caroline C / Carrasco, Sharon V / Biddinger, Paul D

American journal of infection control

2023 Volume 52, Issue 1, Page(s) 136–138

MeSH term(s)	United States/epidemiology ; Humans ; Communicable Diseases/epidemiology ; Disease Outbreaks ; Hemorrhagic Fever, Ebola/epidemiology
Language	English
Publishing date	2023-09-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	392362-9
ISSN	1527-3296 ; 0196-6553
ISSN (online)	1527-3296
ISSN	0196-6553
DOI	10.1016/j.ajic.2023.08.022
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Article ; Online: Emergency preparedness: What is the future?

Herstein, Jocelyn J / Schwedhelm, Michelle M / Vasa, Angela / Biddinger, Paul D / Hewlett, Angela L

Antimicrobial stewardship & healthcare epidemiology : ASHE

2021 Volume 1, Issue 1, Page(s) e29

Abstract: Emergency preparedness programs have evolved over the last several decades as communities have responded to natural, intentional, and accidental disasters. This evolution has resulted in a comprehensive all-hazards approach centered around 4 fundamental ... ...

Abstract	Emergency preparedness programs have evolved over the last several decades as communities have responded to natural, intentional, and accidental disasters. This evolution has resulted in a comprehensive all-hazards approach centered around 4 fundamental phases spanning the entire disaster life cycle: mitigation, preparedness, response, and recovery. Increasing frequency of outbreaks and epidemics of emerging and reemerging infectious diseases in the last decade has emphasized the significance of healthcare emergency preparedness programs, but the coronavirus disease 2019 (COVID-19) pandemic has tested healthcare facilities' emergency plans and exposed vulnerabilities in healthcare emergency preparedness on a scale unexperienced in recent history. We review the 4 phases of emergency management and explore the lessons to be learned from recent events in enhancing health systems capabilities and capacities to mitigate, prepare for, respond to, and recover from biological threats or events, whether it be a pandemic or a single case of an unknown infectious disease. A recurring cycle of assessing, planning, training, exercising, and revising is vital to maintaining healthcare system preparedness, even in absence of an immediate, high probability threat. Healthcare epidemiologists and infection preventionists must play a pivotal role in incorporating lessons learned from the pandemic into emergency preparedness programs and building more robust preparedness plans.
Language	English
Publishing date	2021-10-13
Publishing country	England
Document type	Journal Article ; Review
ISSN	2732-494X
ISSN (online)	2732-494X
DOI	10.1017/ash.2021.190
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: The utility and sustainability of US Ebola treatment centers during the coronavirus disease 2019 (COVID-19) pandemic.

Herstein, Jocelyn J / Biddinger, Paul D / Gibbs, Shawn G / Hewlett, Angela L / Le, Aurora B / Schwedhelm, Michelle M / Lowe, John J

Infection control and hospital epidemiology

2022 Volume 44, Issue 4, Page(s) 643–650

Abstract: Objective: In response to the 2014-2016 West Africa Ebola virus disease (EVD) epidemic, the Centers for Disease Control and Prevention (CDC) designated 56 US hospitals as Ebola treatment centers (ETCs) with high-level isolation capabilities. We sought ... ...

Abstract	Objective: In response to the 2014-2016 West Africa Ebola virus disease (EVD) epidemic, the Centers for Disease Control and Prevention (CDC) designated 56 US hospitals as Ebola treatment centers (ETCs) with high-level isolation capabilities. We sought to determine the ongoing sustainability of ETCs and to identify how ETC capabilities have affected hospital, local, and regional coronavirus disease 2019 (COVID-19) readiness and response. Design: An electronic survey included both qualitative and quantitative questions and was structured into 2 sections: operational sustainability and role in the COVID-19 response. Setting and participants: The survey was distributed to site representatives from the 56 originally designated ETCs, and 37 (66%) responded. Methods: Data were coded and analyzed using descriptive statistics. Results: Of the 37 responding ETCs, 33 (89%) reported that they were still operating, and 4 had decommissioned. ETCs that maintain high-level isolation capabilities incurred a mean of $234,367 in expenses per year. All but 1 ETC reported that existing capabilities (eg, trained staff, infrastructure) before COVID-19 positively affected their hospital, local, and regional COVID-19 readiness and response (eg, ETC trained staff, donated supplies, and shared developed protocols). Conclusions: Existing high-level isolation capabilities and expertise developed following the 2014-2016 EVD epidemic were leveraged by ETCs to assist hospital-wide readiness for COVID-19 and to support responses by other local and regional hospitals However, ETCs face continued challenges in sustaining those capabilities for high-consequence infectious diseases.
MeSH term(s)	Humans ; Hemorrhagic Fever, Ebola/prevention & control ; Pandemics ; COVID-19/epidemiology ; Communicable Diseases/epidemiology ; Hospitals
Language	English
Publishing date	2022-02-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	639378-0
ISSN	1559-6834 ; 0195-9417 ; 0899-823X
ISSN (online)	1559-6834
ISSN	0195-9417 ; 0899-823X
DOI	10.1017/ice.2022.43
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Zs.A 1714: Show issues

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Article ; Online: Emergency preparedness

Jocelyn J. Herstein / Michelle M. Schwedhelm / Angela Vasa / Paul D. Biddinger / Angela L. Hewlett

Antimicrobial Stewardship & Healthcare Epidemiology, Vol

What is the future?

2021 Volume 1

Abstract	Emergency preparedness programs have evolved over the last several decades as communities have responded to natural, intentional, and accidental disasters. This evolution has resulted in a comprehensive all-hazards approach centered around 4 fundamental phases spanning the entire disaster life cycle: mitigation, preparedness, response, and recovery. Increasing frequency of outbreaks and epidemics of emerging and reemerging infectious diseases in the last decade has emphasized the significance of healthcare emergency preparedness programs, but the coronavirus disease 2019 (COVID-19) pandemic has tested healthcare facilities’ emergency plans and exposed vulnerabilities in healthcare emergency preparedness on a scale unexperienced in recent history. We review the 4 phases of emergency management and explore the lessons to be learned from recent events in enhancing health systems capabilities and capacities to mitigate, prepare for, respond to, and recover from biological threats or events, whether it be a pandemic or a single case of an unknown infectious disease. A recurring cycle of assessing, planning, training, exercising, and revising is vital to maintaining healthcare system preparedness, even in absence of an immediate, high probability threat. Healthcare epidemiologists and infection preventionists must play a pivotal role in incorporating lessons learned from the pandemic into emergency preparedness programs and building more robust preparedness plans.
Keywords	Infectious and parasitic diseases ; RC109-216 ; Public aspects of medicine ; RA1-1270
Subject code	710
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Cambridge University Press
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Access, socioeconomic environment, and death from COVID-19 in Nebraska.

Bai, He / Schwedhelm, Michelle / Lowe, John-Martin / Lookadoo, Rachel E / Anderson, Daniel R / Lowe, Abigail E / Lawler, James V / Broadhurst, M Jana / Brett-Major, David M

Frontiers in public health

2022 Volume 10, Page(s) 1001639

Abstract: Our study assesses whether factors related to healthcare access in the first year of the pandemic affect mortality and length of stay (LOS). Our cohort study examined hospitalized patients at Nebraska Medicine between April and October 2020 who were ... ...

Abstract	Our study assesses whether factors related to healthcare access in the first year of the pandemic affect mortality and length of stay (LOS). Our cohort study examined hospitalized patients at Nebraska Medicine between April and October 2020 who were tested for SARS-CoV-2 and had a charted sepsis related diagnostic code. Multivariate logistic was used to analyze the odds of mortality and linear regression was used to calculate the parameter estimates of LOS associated with COVID-19 status, age, gender, race/ethnicity, median household income, admission month, and residential distance from definitive care. Among 475 admissions, the odds of mortality is greater among those with older age (OR: 1.04, 95% CI: 1.02-1.07) and residence in an area with low median household income (OR: 2.11, 95% CI: 0.52-8.57), however, the relationship between mortality and wealth was not statistically significant. Those with non-COVID-19 sepsis had longer LOS (Parameter Estimate: -5.11, adjusted 95% CI: -7.92 to -2.30). Distance from definitive care had trends toward worse outcomes (Parameter Estimate: 0.164, adjusted 95% CI: -1.39 to 1.97). Physical and social aspects of access to care are linked to poorer COVID-19 outcomes. Non-COVID-19 healthcare outcomes may be negatively impacted in the pandemic. Strategies to advance patient-centered outcomes in vulnerable populations should account for varied aspects (socioeconomic, residential setting, rural populations, racial, and ethnic factors). Indirect impacts of the pandemic on non-COVID-19 health outcomes require further study.
MeSH term(s)	Humans ; COVID-19/epidemiology ; SARS-CoV-2 ; Cohort Studies ; Nebraska/epidemiology ; Income ; Health Services Accessibility ; Sepsis
Language	English
Publishing date	2022-10-06
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2711781-9
ISSN	2296-2565 ; 2296-2565
ISSN (online)	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2022.1001639
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Article ; Online: Can You Catch It? Lessons Learned and Modification of ED Triage Symptom- and Travel-Screening Strategy.

Schwedhelm, Michelle M / Herstein, Jocelyn J / Watson, Suzanne M / Mead, Amy L / Maddalena, Leo / Liston, Devon D / Hewlett, Angela L

Journal of emergency nursing

2020 Volume 46, Issue 6, Page(s) 932–940

Abstract: Introduction: Efficient identification and isolation of patients with communicable diseases limits exposure to health care workers, other patients, and visitors. In August 2014, our team developed and implemented an algorithm to triage suspected cases ... ...

Abstract	Introduction: Efficient identification and isolation of patients with communicable diseases limits exposure to health care workers, other patients, and visitors. In August 2014, our team developed and implemented an algorithm to triage suspected cases of Ebola virus disease in a midwestern United States emergency department and outpatient clinics based on patient travel history and symptoms. Here, we present the lessons learned and modifications to update the tool. Methods: Two strategies were developed and utilized to properly identify, isolate, and inform on patients with suspected highly hazardous communicable diseases: 1) a robust electronic symptom and travel screen with decision support tools in the electronic medical record, and 2) the availability of workflow protocols for Ebola virus disease, Middle East Respiratory Syndrome (MERS), and coronavirus 2019 (COVID-19) once a person under investigation is identified. After action reports provided opportunities to modify the algorithm and improve the identification and isolation processes. Results: Since our screening and travel electronic medical record inception 5 years ago, modifications changed iteratively to further enhance the screening process. Since 2018, staff have identified 5 patients at risk for MERS; in all cases, identification occurred during the check-in process. Exposure investigations in the emergency department decreased significantly after algorithm implementation in January 2019, from 30 in 2018 to 0 in 2019. Discussion: Although highly hazardous communicable diseases like Ebola virus disease and MERS are of concern due to their mortality rates and limited treatment options, these same concepts may be applied to the early identification and isolation of patients suspected of having more common communicable diseases like measles and influenza, emphasizing the importance of protocol-based screening in the healthcare environment.
MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections/prevention & control ; Decision Support Techniques ; Electronic Health Records ; Emergency Nursing/methods ; Emergency Service, Hospital ; Hemorrhagic Fever, Ebola/prevention & control ; Humans ; Infection Control/methods ; Midwestern United States ; Pandemics/prevention & control ; Patient Isolation/methods ; Pneumonia, Viral/prevention & control ; SARS-CoV-2 ; Travel/statistics & numerical data ; Triage/methods
Keywords	covid19
Language	English
Publishing date	2020-04-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	604632-0
ISSN	1527-2966 ; 0099-1767
ISSN (online)	1527-2966
ISSN	0099-1767
DOI	10.1016/j.jen.2020.03.006
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Zs.B 2509: Show issues

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Article ; Online: Improving antibiotic prescribing for acute bronchitis in the ambulatory setting using a multifaceted approach.

Chung, Philip / Nailon, Regina / Ashraf, M Salman / Bergman, Scott / Micheels, Teresa / Rupp, Mark E / Schwedhelm, Michelle / Tierney, Maureen / Tyner, Kate / Van Schooneveld, Trevor C / Marcelin, Jasmine R

Infection control and hospital epidemiology

2021 Volume 43, Issue 9, Page(s) 1235–1237

Abstract: Antibiotics are frequently prescribed inappropriately for acute respiratory infections in the outpatient setting. We report the implementation of a multifaceted outpatient antimicrobial stewardship initiative resulting in a 12.3% absolute reduction of ... ...

Abstract	Antibiotics are frequently prescribed inappropriately for acute respiratory infections in the outpatient setting. We report the implementation of a multifaceted outpatient antimicrobial stewardship initiative resulting in a 12.3% absolute reduction of antibiotic prescribing for acute bronchitis in primary care clinics receiving active interventions.
MeSH term(s)	Acute Disease ; Ambulatory Care Facilities ; Anti-Bacterial Agents/therapeutic use ; Antimicrobial Stewardship ; Bronchitis/drug therapy ; Humans ; Inappropriate Prescribing/prevention & control ; Practice Patterns, Physicians' ; Respiratory Tract Infections/drug therapy
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2021-05-14
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639378-0
ISSN	1559-6834 ; 0195-9417 ; 0899-823X
ISSN (online)	1559-6834
ISSN	0195-9417 ; 0899-823X
DOI	10.1017/ice.2021.164
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Zs.A 1714: Show issues

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Article ; Online: Nebraska biocontainment unit design and operations.

Lenaghan, Patricia A / Schwedhelm, Michelle

The Journal of nursing administration

2015 Volume 45, Issue 6, Page(s) 298–301

Abstract: Planning and design of a unique biocontainment unit specifically for care of patients with rare and highly infectious diseases presented an opportunity for nurse leaders to engage staff in crucial groundbreaking decisions. The Magnet® philosophy and ... ...

Abstract	Planning and design of a unique biocontainment unit specifically for care of patients with rare and highly infectious diseases presented an opportunity for nurse leaders to engage staff in crucial groundbreaking decisions. The Magnet® philosophy and framework were used to structure committees with key stakeholders and staff to ensure best and safe practices. Members of the biocontainment unit are engaged in active research and outreach training.
MeSH term(s)	Communicable Disease Control/instrumentation ; Communicable Disease Control/methods ; Communicable Diseases/transmission ; Containment of Biohazards/instrumentation ; Containment of Biohazards/methods ; Disease Transmission, Infectious/prevention & control ; Equipment Design ; Hospital Design and Construction ; Humans ; Nebraska ; Patient Safety ; Protective Devices/standards
Keywords	covid19
Language	English
Publishing date	2015-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	193141-6
ISSN	1539-0721 ; 1539-073X ; 0002-0443
ISSN (online)	1539-0721 ; 1539-073X
ISSN	0002-0443
DOI	10.1097/NNA.0000000000000202
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Zs.A 1008: Show issues

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Article ; Online: Characteristics of SARS-CoV-2 Transmission among Meat Processing Workers in Nebraska, USA, and Effectiveness of Risk Mitigation Measures.

Herstein, Jocelyn J / Degarege, Abraham / Stover, Derry / Austin, Christopher / Schwedhelm, Michelle M / Lawler, James V / Lowe, John J / Ramos, Athena K / Donahue, Matthew

Emerging infectious diseases

2021 Volume 27, Issue 4, Page(s) 1032–1038

Abstract: The coronavirus disease (COVID-19) pandemic has severely impacted the meat processing industry in the United States. We sought to detail demographics and outcomes of severe acute respiratory syndrome coronavirus 2 infections among workers in Nebraska ... ...

Abstract	The coronavirus disease (COVID-19) pandemic has severely impacted the meat processing industry in the United States. We sought to detail demographics and outcomes of severe acute respiratory syndrome coronavirus 2 infections among workers in Nebraska meat processing facilities and determine the effects of initiating universal mask policies and installing physical barriers at 13 meat processing facilities. During April 1-July 31, 2020, COVID-19 was diagnosed in 5,002 Nebraska meat processing workers (attack rate 19%). After initiating both universal masking and physical barrier interventions, 8/13 facilities showed a statistically significant reduction in COVID-19 incidence in <10 days. Characteristics and incidence of confirmed cases aligned with many nationwide trends becoming apparent during this pandemic: specifically, high attack rates among meat processing industry workers, disproportionately high risk of adverse outcomes among ethnic and racial minority groups and men, and effectiveness of using multiple prevention and control interventions to reduce disease transmission.
MeSH term(s)	Adult ; COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19/transmission ; Disease Transmission, Infectious/prevention & control ; Female ; Food-Processing Industry/methods ; Food-Processing Industry/organization & administration ; Food-Processing Industry/trends ; Humans ; Incidence ; Infection Control/instrumentation ; Infection Control/methods ; Infection Control/organization & administration ; Male ; Meat-Packing Industry/methods ; Meat-Packing Industry/organization & administration ; Meat-Packing Industry/trends ; Minority Health/statistics & numerical data ; Nebraska/epidemiology ; Occupational Health/standards ; Outcome Assessment, Health Care ; Personal Protective Equipment/standards ; Risk Assessment ; SARS-CoV-2/isolation & purification ; Workplace/standards
Language	English
Publishing date	2021-02-16
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1380686-5
ISSN	1080-6059 ; 1080-6040
ISSN (online)	1080-6059
ISSN	1080-6040
DOI	10.3201/eid2704.204800
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Zs.A 4778: Show issues

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Article ; Online: Characteristics of SARS-CoV-2 Transmission among Meat Processing Workers in Nebraska, USA, and Effectiveness of Risk Mitigation Measures

Jocelyn J. Herstein / Abraham Degarege / Derry Stover / Christopher Austin / Michelle M. Schwedhelm / James V. Lawler / John J. Lowe / Athena K. Ramos / Matthew Donahue

Emerging Infectious Diseases, Vol 27, Iss 4, Pp 1032-

2021 Volume 1038

Abstract	The coronavirus disease (COVID-19) pandemic has severely impacted the meat processing industry in the United States. We sought to detail demographics and outcomes of severe acute respiratory syndrome coronavirus 2 infections among workers in Nebraska meat processing facilities and determine the effects of initiating universal mask policies and installing physical barriers at 13 meat processing facilities. During April 1–July 31, 2020, COVID-19 was diagnosed in 5,002 Nebraska meat processing workers (attack rate 19%). After initiating both universal masking and physical barrier interventions, 8/13 facilities showed a statistically significant reduction in COVID-19 incidence in <10 days. Characteristics and incidence of confirmed cases aligned with many nationwide trends becoming apparent during this pandemic: specifically, high attack rates among meat processing industry workers, disproportionately high risk of adverse outcomes among ethnic and racial minority groups and men, and effectiveness of using multiple prevention and control interventions to reduce disease transmission.
Keywords	coronavirus disease ; COVID-19 ; infection prevention ; masks ; meat processing industries ; occupational exposures ; Medicine ; R ; Infectious and parasitic diseases ; RC109-216
Language	English
Publishing date	2021-04-01T00:00:00Z
Publisher	Centers for Disease Control and Prevention
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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