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Article ; Online: Discontinuation of Contact Precautions for Methicillin-resistant Staphylococcus aureus in a Pediatric Healthcare System.

Most, Zachary M / Phillips, Bethany / Sebert, Michael E

Journal of the Pediatric Infectious Diseases Society

2024 Volume 13, Issue 2, Page(s) 123–128

Abstract: Background: Many hospitals caring for adult patients have discontinued the requirement for contact precautions (CP) for patients with methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization without reported negative effects. It is ... ...

Abstract	Background: Many hospitals caring for adult patients have discontinued the requirement for contact precautions (CP) for patients with methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization without reported negative effects. It is not clear whether this experience can be extrapolated to pediatric facilities. Methods: CP for MRSA were discontinued in all locations except the neonatal intensive care unit at a 3-hospital pediatric healthcare system in September 2019. All hospitalized patients underwent surveillance for LabID healthcare facility-onset MRSA infections. Analysis was done using interrupted time series (ITS) from September 2017 through August 2023 and aggregate before-and-after rate ratios. Results: There were 234 incident healthcare facility-onset MRSA infections during 766 020 patient days of surveillance. After discontinuation of CP for MRSA there was no change in the ITS slope (0.06, 95% CI: -0.35 to 0.47, P = .78) or intercept (0.21, 95% CI: -0.36 to 0.78, P = .47) of the LabID healthcare facility-onset MRSA infection incidence density rate. Additionally, there was no change in the aggregate incidence density rate of these MRSA LabID events (aggregate rate ratio = 0.98, 95% CI: 0.74 to 1.28). MRSA nasal colonization among patients being screened before cardiac surgery did not change (aggregate rate ratio = 0.94, 95% CI: 0.60 to 1.48). The prevalence rate of contact isolation days decreased by 14.0%. Conclusions: Discontinuation of CP for pediatric patients with MRSA was not associated with increased MRSA infection over 4 years. Our experience supports considering discontinuation of CP for MRSA in similar pediatric healthcare settings in the context of good adherence to horizontal infection prevention measures.
MeSH term(s)	Adult ; Infant, Newborn ; Humans ; Child ; Methicillin-Resistant Staphylococcus aureus ; Cross Infection/epidemiology ; Cross Infection/prevention & control ; Staphylococcal Infections/epidemiology ; Staphylococcal Infections/prevention & control ; Infection Control ; Intensive Care Units, Neonatal
Language	English
Publishing date	2024-01-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2668791-4
ISSN	2048-7207 ; 2048-7193
ISSN (online)	2048-7207
ISSN	2048-7193
DOI	10.1093/jpids/piae001
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Beyond personal protective equipment: adjunctive methods for control of healthcare-associated respiratory viral infections.

Most, Zachary M

Current opinion in infectious diseases

2020 Volume 33, Issue 4, Page(s) 312–318

Abstract: ... of effectiveness in observational or quasi-experimental studies.: Summary: Most of the studies evaluating ... controlled trials are needed. Multimodal infection prevention policies are likely to be most effective ...

Abstract	Purpose of review: Prevention of nosocomial transmission of respiratory viruses is a priority in all healthcare settings and often achieved with the use of personal protective equipment. Several adjunctive infection prevention methods are in common use but their effectiveness in reducing healthcare-associated respiratory viral infections is unclear. In this review, recent advances regarding the effectiveness of several adjunctive infection prevention methods to reduce healthcare-associated respiratory viral infections are discussed. Recent findings: Training and education on hand hygiene guidelines, mandatory influenza vaccination for healthcare personnel, access to paid sick leave to reduce ill presenteeism, cohorting of patients with the same infection or clinical syndrome, neuraminidase inhibitor chemoprophylaxis during influenza outbreaks, and enhanced visitor restrictions in pediatric hospitals all have shown some degree of effectiveness in observational or quasi-experimental studies. Summary: Most of the studies evaluating the effect of adjunctive infection prevention methods on healthcare-associated respiratory viral infections are observational or quasi-experimental and are often combined with other interventions. Therefore, it is difficult to determine the precise effectiveness or efficacy of these interventions and more controlled trials are needed. Multimodal infection prevention policies are likely to be most effective in reducing healthcare-associated respiratory viral infections.
MeSH term(s)	Cross Infection/prevention & control ; Cross Infection/transmission ; Cross Infection/virology ; Disease Transmission, Infectious/prevention & control ; Hand Hygiene ; Health Personnel ; Health Policy ; Humans ; Infection Control/methods ; Infectious Disease Transmission, Patient-to-Professional/prevention & control ; Influenza Vaccines/therapeutic use ; Influenza, Human/prevention & control ; Influenza, Human/transmission ; Personal Protective Equipment ; Respiratory Tract Infections/prevention & control ; Respiratory Tract Infections/transmission ; Respiratory Tract Infections/virology ; Sick Leave
Chemical Substances	Influenza Vaccines
Keywords	covid19
Language	English
Publishing date	2020-07-28
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	645085-4
ISSN	1473-6527 ; 1535-3877 ; 0951-7375 ; 1355-834X
ISSN (online)	1473-6527 ; 1535-3877
ISSN	0951-7375 ; 1355-834X
DOI	10.1097/QCO.0000000000000655
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Article ; Online: Healthcare-associated respiratory viral infections after discontinuing universal masking.

Most, Zachary M / Phillips, Bethany / Sebert, Michael E

Infection control and hospital epidemiology

2023 Volume 45, Issue 2, Page(s) 247–249

Abstract: In November 2022, our pediatric hospital replaced the requirement for universal masking of all healthcare personnel and visitors in all clinical buildings with a requirement for masking only during patient encounters. Following this change, we observed ... ...

Abstract	In November 2022, our pediatric hospital replaced the requirement for universal masking of all healthcare personnel and visitors in all clinical buildings with a requirement for masking only during patient encounters. Following this change, we observed an immediate, substantial, and sustained increase in healthcare-associated respiratory viral infections.
MeSH term(s)	Child ; Humans ; Cross Infection/epidemiology ; Cross Infection/prevention & control ; SARS-CoV-2 ; Health Personnel ; Respiratory Tract Infections/diagnosis ; Respiratory Tract Infections/epidemiology ; Virus Diseases/diagnosis ; Virus Diseases/epidemiology ; Virus Diseases/prevention & control ; Delivery of Health Care
Language	English
Publishing date	2023-09-25
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.2023.200
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Zs.A 1714: Show issues

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Article: Beyond personal protective equipment: adjunctive methods for control of healthcare-associated respiratory viral infections

Most, Zachary M

Curr Opin Infect Dis

Abstract: ... of effectiveness in observational or quasi-experimental studies. SUMMARY: Most of the studies evaluating the effect ... Multimodal infection prevention policies are likely to be most effective in reducing healthcare-associated ...

Abstract	PURPOSE OF REVIEW: Prevention of nosocomial transmission of respiratory viruses is a priority in all healthcare settings and often achieved with the use of personal protective equipment. Several adjunctive infection prevention methods are in common use but their effectiveness in reducing healthcare-associated respiratory viral infections is unclear. In this review, recent advances regarding the effectiveness of several adjunctive infection prevention methods to reduce healthcare-associated respiratory viral infections are discussed. RECENT FINDINGS: Training and education on hand hygiene guidelines, mandatory influenza vaccination for healthcare personnel, access to paid sick leave to reduce ill presenteeism, cohorting of patients with the same infection or clinical syndrome, neuraminidase inhibitor chemoprophylaxis during influenza outbreaks, and enhanced visitor restrictions in pediatric hospitals all have shown some degree of effectiveness in observational or quasi-experimental studies. SUMMARY: Most of the studies evaluating the effect of adjunctive infection prevention methods on healthcare-associated respiratory viral infections are observational or quasi-experimental and are often combined with other interventions. Therefore, it is difficult to determine the precise effectiveness or efficacy of these interventions and more controlled trials are needed. Multimodal infection prevention policies are likely to be most effective in reducing healthcare-associated respiratory viral infections.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #682985
Database	COVID19

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Article ; Online: Contrasting definitions and incidence of healthcare-associated respiratory viral infections in a pediatric hospital.

Most, Zachary M / Jackson, Patricia / Sebert, Michael / Perl, Trish M

Infection control and hospital epidemiology

2022 Volume 44, Issue 1, Page(s) 55–61

Abstract: ... respiratory syncytial virus were the most identified viruses (58% and 10%, respectively). The median time from admission ...

Abstract	Objective: To determine the difference in the incidence of healthcare-associated respiratory viral infection (HARVI) in a pediatric hospital depending on the definition used. Design: Descriptive historical cohort study. Setting and participants: Patients aged 0-21 years old who were admitted between July 2013 and June 2018 to a 490-bed primary to quaternary-care pediatric hospital serving northern Texas. Methods: HARVI was defined using microbiologic confirmation, development of new symptoms while hospitalized, and exposure time greater than the minimum incubation period for each specific virus. Events that occurred following the maximum incubation period for that virus were classified as definite, otherwise they were classified as possible. This definition was compared to definitions using alternate timing of onset and symptomatology requirements. Data pertaining to demographics, diagnoses, and illness severity were collected. Results: In total, 498 HARVIs (320 definite and 178 possible) were identified, with an incidence rate of 0.98 per 1,000 patient days (0.63 and 0.35, respectively). Rhinovirus or enterovirus and respiratory syncytial virus were the most identified viruses (58% and 10%, respectively). The median time from admission until HARVI was 10.5 days (interquartile range [IQR], 5-30 days). When alternate definitions were employed, the incidence of HARVI ranged from 0.96 to 2.00 per 1,000 admitted patient days. Conclusions: HARVI remain a common nosocomial infection in pediatric hospitals and the measured incidence is dependent on the definition used. Because of the endemic and pandemic potential of respiratory viruses, standardized definitions are needed to facilitate intra- and interhospital comparisons.
MeSH term(s)	Child ; Humans ; Infant ; Infant, Newborn ; Child, Preschool ; Adolescent ; Young Adult ; Adult ; Hospitals, Pediatric ; Incidence ; Cohort Studies ; Cross Infection/epidemiology ; Respiratory Syncytial Viruses ; Virus Diseases ; Delivery of Health Care ; Respiratory Tract Infections/epidemiology ; Respiratory Syncytial Virus Infections/epidemiology
Language	English
Publishing date	2022-03-23
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	639378-0
ISSN	1559-6834 ; 0195-9417 ; 0899-823X
ISSN (online)	1559-6834
ISSN	0195-9417 ; 0899-823X
DOI	10.1017/ice.2022.33
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Zs.A 1714: Show issues

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Article ; Online: A Silver Lining? Fewer Non-Severe Acute Respiratory Syndrome Coronavirus 2 Respiratory Viruses During the Coronavirus Disease 2019 Pandemic.

Most, Zachary M / Holcomb, Michael / Jamieson, Andrew R / Perl, Trish M

The Journal of infectious diseases

2021 Volume 224, Issue 10, Page(s) 1751–1755

Abstract: Nonpharmaceutical interventions (NPIs) have "flattened the curve" of the coronavirus disease 2019 pandemic; however the effect of these interventions on other respiratory viruses is unknown. We used aggregate level case count data for 8 respiratory ... ...

Abstract	Nonpharmaceutical interventions (NPIs) have "flattened the curve" of the coronavirus disease 2019 pandemic; however the effect of these interventions on other respiratory viruses is unknown. We used aggregate level case count data for 8 respiratory viruses and compared the institutional and statewide case counts before and during the period that NPIs were active. We observed a 61% decrease (incidence rate ratio, 0.39; 95% confidence interval, .37-.41; P < .001) in non-severe acute respiratory syndrome coronavirus 2 respiratory viral infections when NPIs were implemented. This finding, if further verified, should guide future public health initiatives to mitigate viral epidemics.
MeSH term(s)	COVID-19/epidemiology ; Humans ; Incidence ; Pandemics ; Public Health ; SARS-CoV-2
Language	English
Publishing date	2021-04-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	3019-3
ISSN	1537-6613 ; 0022-1899
ISSN (online)	1537-6613
ISSN	0022-1899
DOI	10.1093/infdis/jiab191
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Uh II Zs.50: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 445: Show issues

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Article: Analyzing an Emerging Pandemic on Twitter: Monkeypox.

Cooper, Lauren N / Radunsky, Alexander P / Hanna, John J / Most, Zachary M / Perl, Trish M / Lehmann, Christoph U / Medford, Richard J

Open forum infectious diseases

2023 Volume 10, Issue 4, Page(s) ofad142

Abstract: ... comprised 39% of tweets. The most common emotions expressed were fear and sadness. Topic modeling identified ...

Abstract	Background: Social media platforms like Twitter provide important insights into the public's perceptions of global outbreaks like monkeypox. By analyzing tweets, we aimed to identify public knowledge and opinions on the monkeypox virus and related public health issues. Methods: We analyzed English-language tweets using the keyword "monkeypox" from 1 May to 23 July 2022. We reported gender, ethnicity, and race of Twitter users and analyzed tweets to identify predominant sentiment and emotions. We performed topic modeling and compared cohorts of users who self-identify as LGBTQ+ (an abreviation for lesbian, gay, bisexual, transgender, queer, and/or questioning) allies versus users who do not, and cohorts identified as "bots" versus humans. Results: A total of 48 330 tweets were written by LGBTQ+ self-identified advocates or allies. The mean sentiment score for all tweets was -0.413 on a -4 to +4 scale. Negative tweets comprised 39% of tweets. The most common emotions expressed were fear and sadness. Topic modeling identified unique topics among the 4 cohorts analyzed. Conclusions: The spread of mis- and disinformation about monkeypox was common in our tweet library. Various conspiracy theories about the origins of monkeypox, its relationship to global economic concerns, and homophobic and racial comments were common. Conversely, many other tweets helped to provide information about monkeypox vaccines, disease symptoms, and prevention methods. Discussion of rising monkeypox case numbers globally was also a large aspect of the conversation. Conclusions: We demonstrated that Twitter is an effective means of tracking sentiment about public healthcare issues. We gained insight into a subset of people, self-identified LGBTQ+ allies, who were more affected by monkeypox.
Language	English
Publishing date	2023-03-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofad142
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Article ; Online: Striking Similarities of Multisystem Inflammatory Syndrome in Children and a Myocarditis-Like Syndrome in Adults: Overlapping Manifestations of COVID-19.

Most, Zachary M / Hendren, Nicholas / Drazner, Mark H / Perl, Trish M

Circulation

2020 Volume 143, Issue 1, Page(s) 4–6

MeSH term(s)	Adult ; COVID-19/metabolism ; COVID-19/pathology ; Child ; Child, Preschool ; Female ; Humans ; Male ; Myocarditis/metabolism ; Myocarditis/pathology ; SARS-CoV-2/metabolism ; Syndrome ; Systemic Inflammatory Response Syndrome/metabolism ; Systemic Inflammatory Response Syndrome/pathology
Keywords	covid19
Language	English
Publishing date	2020-08-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	80099-5
ISSN	1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
ISSN (online)	1524-4539
ISSN	0009-7322 ; 0069-4193 ; 0065-8499
DOI	10.1161/CIRCULATIONAHA.120.050166
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Article ; Online: Incidence and Risk Factors for Severe Outcomes in Pediatric Patients With COVID-19.

Ho, Milan / Most, Zachary M / Perl, Trish M / Diaz, Marlon I / Casazza, Julia A / Saleh, Sameh / Pickering, Madison / Radunsky, Alexander P / Hanna, John J / Thakur, Bhaskar / Lehmann, Christoph U / Medford, Richard J / Turer, Robert W

Hospital pediatrics

2023 Volume 13, Issue 5, Page(s) 450–462

Abstract: Objectives: Throughout the pandemic, children with COVID-19 have experienced hospitalization, ICU admission, invasive respiratory support, and death. Using a multisite, national dataset, we investigate risk factors associated with these outcomes in ... ...

Abstract	Objectives: Throughout the pandemic, children with COVID-19 have experienced hospitalization, ICU admission, invasive respiratory support, and death. Using a multisite, national dataset, we investigate risk factors associated with these outcomes in children with COVID-19. Methods: Our data source (Optum deidentified COVID-19 Electronic Health Record Dataset) included children aged 0 to 18 years testing positive for COVID-19 between January 1, 2020, and January 20, 2022. Using ordinal logistic regression, we identified factors associated with an ordinal outcome scale: nonhospitalization, hospitalization, or a severe composite outcome (ICU, intensive respiratory support, death). To contrast hospitalization for COVID-19 and incidental positivity on hospitalization, we secondarily identified patient factors associated with hospitalizations with a primary diagnosis of COVID-19. Results: In 165 437 children with COVID-19, 3087 (1.8%) were hospitalized without complication, 2954 (1.8%) experienced ICU admission and/or intensive respiratory support, and 31 (0.02%) died. We grouped patients by age: 0 to 4 years old (35 088), and 5 to 11 years old (75 574), 12 to 18 years old (54 775). Factors positively associated with worse outcomes were preexisting comorbidities and residency in the Southern United States. In 0- to 4-year-old children, there was a nonlinear association between age and worse outcomes, with worse outcomes in 0- to 2-year-old children. In 5- to 18-year-old patients, vaccination was protective. Findings were similar in our secondary analysis of hospitalizations with a primary diagnosis of COVID-19, though region effects were no longer observed. Conclusions: Among children with COVID-19, preexisting comorbidities and residency in the Southern United States were positively associated with worse outcomes, whereas vaccination was negatively associated. Our study population was highly insured; future studies should evaluate underinsured populations to confirm generalizability.
MeSH term(s)	Humans ; Child ; United States/epidemiology ; Child, Preschool ; Infant, Newborn ; Infant ; Adolescent ; COVID-19/epidemiology ; COVID-19/therapy ; Incidence ; SARS-CoV-2 ; Hospitalization ; Risk Factors
Language	English
Publishing date	2023-04-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2154-1671
ISSN (online)	2154-1671
DOI	10.1542/hpeds.2022-006833
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: The Striking Similarities of Multisystem Inflammatory Syndrome in Children and a Myocarditis-like Syndrome in Adults: Overlapping Manifestations of COVID-19

Most, Zachary M / Hendren, Nicholas / Drazner, Mark H / Perl, Trish M

Circulation

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #713892
Database	COVID19

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