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Article ; Online: Integrating infection control and environmental management work systems to prevent Clostridioides difficile infection.

Keating, Julie A / Parmasad, Vishala / McKinley, Linda / Safdar, Nasia

2023 Volume 51, Issue 12, Page(s) 1444–1448

Abstract: Effective infection prevention and control within health care settings requires collaboration and coordination between infection control and environmental management teams. However, the work systems of these teams can be difficult to integrate despite ... ...

Abstract	Effective infection prevention and control within health care settings requires collaboration and coordination between infection control and environmental management teams. However, the work systems of these teams can be difficult to integrate despite their shared goals. We provide results from a qualitative study of Clostridioides difficile infection prevention in Veterans Affairs facilities regarding challenges in coordination between these teams and opportunities to improve coordination and maximize infection prevention activities.
MeSH term(s)	Humans ; Conservation of Natural Resources ; Clostridium Infections/prevention & control ; Infection Control ; Qualitative Research ; Cross Infection/prevention & control
Language	English
Publishing date	2023-06-16
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	392362-9
ISSN	1527-3296 ; 0196-6553
ISSN (online)	1527-3296
ISSN	0196-6553
DOI	10.1016/j.ajic.2023.06.008
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Article ; Online: Frontline perspectives of C. difficile infection prevention practice implementation within veterans affairs health care facilities: A qualitative study.

Parmasad, Vishala / Keating, Julie / McKinley, Linda / Evans, Charlesnika / Rubin, Michael / Voils, Corrine / Safdar, Nasia

American journal of infection control

2023 Volume 51, Issue 10, Page(s) 1124–1131

Abstract: Background: In 2012, the veteran's affairs (VA) multidrug-resistant organism (MDRO) Program Office launched a national Clostridioides difficile Infection (CDI) Prevention Initiative to address CDI as the most common cause of healthcare associated ... ...

Abstract	Background: In 2012, the veteran's affairs (VA) multidrug-resistant organism (MDRO) Program Office launched a national Clostridioides difficile Infection (CDI) Prevention Initiative to address CDI as the most common cause of healthcare associated infections, mandating use of a VA CDI Bundle of prevention practices in inpatient facilities. We draw upon frontline worker perspectives to explore work system barriers and facilitators to the sustained implementation of the VA CDI Bundle using the systems engineering initiative for patient safety (SEIPS) framework. Methods: We interviewed 29 key stakeholders at 4 participating sites between October 2019-July 2021. Participants included infection prevention and control (IPC) leaders, nurses, physicians, and environmental management staff. Interviews were analyzed to identify themes and perceptions of facilitators and barriers to CDI prevention. Results: IPC leadership was most likely to know of the specific VA CDI Bundle components. Other participants demonstrated general knowledge of CDI prevention practices, with role-based variation in the depth of awareness of specific practices. Facilitators included leadership support, mandated CDI training and prevention practices, and readily available training from multiple sources. Barriers included limits to communication about facility or unit-level CDI rates, ambiguous communications about CDI prevention practice updates and VA mandates, and role-hierarchies that may limit team members' clinical contributions. Discussion: Recommendations include improving centrally-mandated clarity about and standardization of CDI prevention policies, including testing. Regular IPC training updates for all clinical stakeholders are also recommended. Conclusions: A work system analysis using SEIPS identified barriers and facilitators to CDI prevention practices that could be addressed both nationally at the system level and locally at the facility level, specifically in the areas of communication and coordination.
MeSH term(s)	Humans ; Clostridioides difficile ; Veterans ; Infection Control ; Cross Infection/prevention & control ; Clostridium Infections/prevention & control ; Delivery of Health Care
Language	English
Publishing date	2023-03-26
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	392362-9
ISSN	1527-3296 ; 0196-6553
ISSN (online)	1527-3296
ISSN	0196-6553
DOI	10.1016/j.ajic.2023.03.014
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Article ; Online: Physical distancing for care delivery in health care settings: Considerations and consequences.

Parmasad, Vishala / Keating, Julie A / Carayon, Pascale / Safdar, Nasia

American journal of infection control

2020 Volume 49, Issue 8, Page(s) 1085–1088

Abstract: As health care systems explore new ways of delivering care for patients with and without COVID-19, they must consider how to maintain physical distancing among health care workers and patients. Physical distancing in high complexity systems such as ... ...

Abstract	As health care systems explore new ways of delivering care for patients with and without COVID-19, they must consider how to maintain physical distancing among health care workers and patients. Physical distancing in high complexity systems such as health care is particularly challenging and may benefit from a human factors and systems engineering perspective. We discuss challenges to implementing and maintaining physical distancing in health care settings and present possible solutions from a human factors and systems engineering perspective.
MeSH term(s)	COVID-19 ; Delivery of Health Care ; Health Facilities ; Humans ; Physical Distancing ; SARS-CoV-2
Language	English
Publishing date	2020-12-24
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	392362-9
ISSN	1527-3296 ; 0196-6553
ISSN (online)	1527-3296
ISSN	0196-6553
DOI	10.1016/j.ajic.2020.12.014
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Article ; Online: Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: A systematic review and meta-analysis.

Musuuza, Jackson S / Watson, Lauren / Parmasad, Vishala / Putman-Buehler, Nathan / Christensen, Leslie / Safdar, Nasia

PloS one

2021 Volume 16, Issue 5, Page(s) e0251170

Abstract: Introduction: The recovery of other pathogens in patients with SARS-CoV-2 infection has been reported, either at the time of a SARS-CoV-2 infection diagnosis (co-infection) or subsequently (superinfection). However, data on the prevalence, microbiology, ...

Abstract	Introduction: The recovery of other pathogens in patients with SARS-CoV-2 infection has been reported, either at the time of a SARS-CoV-2 infection diagnosis (co-infection) or subsequently (superinfection). However, data on the prevalence, microbiology, and outcomes of co-infection and superinfection are limited. The purpose of this study was to examine the occurrence of co-infections and superinfections and their outcomes among patients with SARS-CoV-2 infection. Patients and methods: We searched literature databases for studies published from October 1, 2019, through February 8, 2021. We included studies that reported clinical features and outcomes of co-infection or superinfection of SARS-CoV-2 and other pathogens in hospitalized and non-hospitalized patients. We followed PRISMA guidelines, and we registered the protocol with PROSPERO as: CRD42020189763. Results: Of 6639 articles screened, 118 were included in the random effects meta-analysis. The pooled prevalence of co-infection was 19% (95% confidence interval [CI]: 14%-25%, I2 = 98%) and that of superinfection was 24% (95% CI: 19%-30%). Pooled prevalence of pathogen type stratified by co- or superinfection were: viral co-infections, 10% (95% CI: 6%-14%); viral superinfections, 4% (95% CI: 0%-10%); bacterial co-infections, 8% (95% CI: 5%-11%); bacterial superinfections, 20% (95% CI: 13%-28%); fungal co-infections, 4% (95% CI: 2%-7%); and fungal superinfections, 8% (95% CI: 4%-13%). Patients with a co-infection or superinfection had higher odds of dying than those who only had SARS-CoV-2 infection (odds ratio = 3.31, 95% CI: 1.82-5.99). Compared to those with co-infections, patients with superinfections had a higher prevalence of mechanical ventilation (45% [95% CI: 33%-58%] vs. 10% [95% CI: 5%-16%]), but patients with co-infections had a greater average length of hospital stay than those with superinfections (mean = 29.0 days, standard deviation [SD] = 6.7 vs. mean = 16 days, SD = 6.2, respectively). Conclusions: Our study showed that as many as 19% of patients with COVID-19 have co-infections and 24% have superinfections. The presence of either co-infection or superinfection was associated with poor outcomes, including increased mortality. Our findings support the need for diagnostic testing to identify and treat co-occurring respiratory infections among patients with SARS-CoV-2 infection.
MeSH term(s)	Bacterial Infections/epidemiology ; Bacterial Infections/mortality ; Bacterial Infections/therapy ; COVID-19/epidemiology ; COVID-19/mortality ; COVID-19/therapy ; Coinfection/epidemiology ; Coinfection/mortality ; Coinfection/therapy ; Hospitalization ; Humans ; Mycoses/epidemiology ; Mycoses/mortality ; Mycoses/therapy ; Prevalence ; SARS-CoV-2/isolation & purification ; Superinfection/epidemiology ; Superinfection/mortality ; Superinfection/therapy ; Treatment Outcome ; Virus Diseases/epidemiology ; Virus Diseases/mortality ; Virus Diseases/therapy
Language	English
Publishing date	2021-05-06
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Research Support, N.I.H., Extramural ; Systematic Review
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0251170
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Understanding clinical implementation coordinators' experiences in deploying evidence-based interventions.

Hernandez, Sara E / Solomon, Demetrius / Moon, Jukrin / Parmasad, Vishala / Wiegmann, Douglas / Bennett, Nick T / Ferren, Ryan S / Fitzsimmons, Alec J / Lepak, Alexander J / O'Horo, John C / Pop-Vicas, Aurora E / Schulz, Lucas T / Safdar, Nasia

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

2023 Volume 81, Issue 4, Page(s) 120–128

Abstract: Purpose: The fluoroquinolone restriction for the prevention of Clostridioides difficile infection (FIRST) trial is a multisite clinical study in which sites carry out a preauthorization process via electronic health record-based best-practice alert (BPA) ...

Abstract	Purpose: The fluoroquinolone restriction for the prevention of Clostridioides difficile infection (FIRST) trial is a multisite clinical study in which sites carry out a preauthorization process via electronic health record-based best-practice alert (BPA) to optimize the use of fluoroquinolone antibiotics in acute care settings. Our research team worked closely with clinical implementation coordinators to facilitate the dissemination and implementation of this evidence-based intervention. Clinical implementation coordinators within the antibiotic stewardship team (AST) played a pivotal role in the implementation process; however, considerable research is needed to further understand their role. In this study, we aimed to (1) describe the roles and responsibilities of clinical implementation coordinators within ASTs and (2) identify facilitators and barriers coordinators experienced within the implementation process. Methods: We conducted a directed content analysis of semistructured interviews, implementation diaries, and check-in meetings utilizing the conceptual framework of middle managers' roles in innovation implementation in healthcare from Urquhart et al. Results: Clinical implementation coordinators performed a variety of roles vital to the implementation's success, including gathering and compiling information for BPA design, preparing staff, organizing meetings, connecting relevant stakeholders, evaluating clinical efficacy, and participating in the innovation as clinicians. Coordinators identified organizational staffing models and COVID-19 interruptions as the main barriers. Facilitators included AST empowerment, positive relationships with staff and oversight/governance committees, and using diverse implementation strategies. Conclusion: When implementing healthcare innovations, clinical implementation coordinators facilitated the implementation process through their roles and responsibilities and acted as strategic partners in improving the adoption and sustainability of a fluoroquinolone preauthorization protocol.
MeSH term(s)	Humans ; Evidence-Based Medicine ; Delivery of Health Care ; COVID-19 ; Models, Organizational ; Fluoroquinolones/therapeutic use
Chemical Substances	Fluoroquinolones
Language	English
Publishing date	2023-10-28
Publishing country	England
Document type	Multicenter Study ; Journal Article
ZDB-ID	1224627-x
ISSN	1535-2900 ; 1079-2082
ISSN (online)	1535-2900
ISSN	1079-2082
DOI	10.1093/ajhp/zxad272
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Article ; Online: Decreasing ICU-associated

Safdar, Nasia / Parmasad, Vishala / Brown, Roger / Carayon, Pascale / Lepak, Alexander / O'Horo, John C / Schulz, Lucas

BMJ open

2021 Volume 11, Issue 6, Page(s) e046480

Abstract: Introduction: Clostridioides difficile: Methods and analysis: This is a multisite, stepped-wedge, cluster, effectiveness-implementation clinical trial. The trial will take place in 12 adult medical-surgical ICUs with ≥10 beds, using Epic as ... ...

Abstract	Introduction: Clostridioides difficile Methods and analysis: This is a multisite, stepped-wedge, cluster, effectiveness-implementation clinical trial. The trial will take place in 12 adult medical-surgical ICUs with ≥10 beds, using Epic as electronic health record (EHR) and pre-existing AS programmes. Sites will receive facilitated implementation support over the 15-month trial period, succeeded by 9 months of follow-up. The intervention comprises a clinical decision support system for FQ PPA, integrated into the site EHRs. Each ICU will be considered a single site and all ICU admissions included in the analysis. Clinical data will be extracted from EHRs throughout the trial and compared with the corresponding pretrial period, which will constitute the baseline for statistical analysis. Outcomes will include ICU-onset CDI rates, FQ days of therapy (DOT), alternative antibiotic DOT, average length of stay and hospital mortality. The study team will also collect implementation data to assess implementation effectiveness using the Systems Engineering Initiative for Patient Safety model. Ethics and dissemination: The trial was approved by the Institutional Review Board at the University of Wisconsin-Madison (2018-0852-CP015). Results will be made available to participating sites, funders, infectious disease societies, critical care societies and other researchers. Trial registration number: NCT03848689.
MeSH term(s)	Adult ; Clostridioides ; Clostridioides difficile ; Clostridium Infections/drug therapy ; Clostridium Infections/epidemiology ; Clostridium Infections/prevention & control ; Fluoroquinolones/therapeutic use ; Humans ; Intensive Care Units
Chemical Substances	Fluoroquinolones
Language	English
Publishing date	2021-06-29
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2020-046480
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Implementation of An Antibiotic Stewardship Intervention to Reduce Prescription of Fluoroquinolones: A Human Factors Analysis in Two Intensive Care Units.

Carayon, Pascale / Thuemling, Teresa / Parmasad, Vishala / Bao, Songtao / O'Horo, John / Bennett, Nicholas T / Safdar, Nasia

Journal of patient safety and risk management

2021 Volume 26, Issue 4, Page(s) 161–171

Abstract: Antibiotic use is often the target of interventions in health care organizations that aim to decrease healthcare-associated infections (HAI) such ... ...

Abstract	Antibiotic use is often the target of interventions in health care organizations that aim to decrease healthcare-associated infections (HAI) such as
Language	English
Publishing date	2021-06-22
Publishing country	England
Document type	Journal Article
ZDB-ID	2922116-X
ISSN	2516-0443 ; 2516-0435
ISSN (online)	2516-0443
ISSN	2516-0435
DOI	10.1177/25160435211025417
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Article ; Online: Prevalence and outcomes of co-infection and super-infection with SARS-CoV-2 and other pathogens: A Systematic Review and Meta-analysis

Musuuza, Jackson Ssentalo / Watson, Lauren / Parmasad, Vishala / Putman-Buehler, Nathan / Christensen, Leslie / Safdar, Nasia

Abstract: IntroductionThe recovery of other respiratory viruses in patients with SARS-CoV-2 infection has been reported, either at the time of a SARS-CoV-2 infection diagnosis (co-infection) or subsequently (superinfection). However, data on the prevalence, ... ...

Abstract	IntroductionThe recovery of other respiratory viruses in patients with SARS-CoV-2 infection has been reported, either at the time of a SARS-CoV-2 infection diagnosis (co-infection) or subsequently (superinfection). However, data on the prevalence, microbiology and outcomes of co-infection and super infection are limited. The purpose of this study was to examine occurrence of respiratory co-infections and superinfections and their outcomes among patients with SARS-CoV-2 infection. Patients and MethodsWe searched literature databases for studies published from October 1, 2019, through June 11, 2020. We included studies that reported clinical features and outcomes of co-infection or super-infection of SARS-CoV-2 and other pathogens in hospitalized and non-hospitalized patients. We followed PRISMA guidelines and we registered the protocol with PROSPERO as: CRD42020189763. ResultsOf 1310 articles screened, 48 were included in the random effects meta-analysis. The pooled prevalence of co-infection was 12% (95% confidence interval (CI): 6%-18%, n=29, I2=98%) and that of super-infection was 14% (95% CI: 9%-21%, n=18, I2=97%). Pooled prevalence of pathogen type stratified by co- or super-infection: viral co-infections, 4% (95% CI: 2%-7%); viral super-infections, 2% (95% CI: 0%-7%); bacterial co-infections, 4% (95% CI: 1%-8%); bacterial super-infections, 6% (95% CI: 2%-11%); fungal co-infections, 4% (95% CI: 1%-8%); and fungal super-infections, 4% (95% CI: 0%-11%). Compared to those with co-infections, patients with super-infections had a higher prevalence of mechanical ventilation [21% (95% CI: 13%-31%) vs. 7% (95% CI: 2%-15%)] and greater average length of hospital stay [mean=12.5 days, standard deviation (SD) =5.3 vs. mean=10.2 days, SD= 6.7]. ConclusionsOur study showed that as many as 14% of patients with COVID-19 have super-infections and 12% have co-infections. Poor outcomes were associated with super-infections. Our findings have implications for diagnostic testing and therapeutics, particularly in the upcoming respiratory virus season in the Northern Hemisphere.
Keywords	covid19
Publisher	MedRxiv; WHO
Document type	Article ; Online
Note	WHO #Covidence: #20220566
DOI	10.1101/2020.10.27.20220566
Database	COVID19

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Article ; Online: Prevalence and outcomes of co-infection and super-infection with SARS-CoV-2 and other pathogens: A Systematic Review and Meta-analysis

Musuuza, Jackson Ssentalo / Watson, Lauren / Parmasad, Vishala / Putman-Buehler, Nathan / Christensen, Leslie / Safdar, Nasia

medRxiv

Abstract: Introduction: The recovery of other respiratory viruses in patients with SARS-CoV-2 infection has been reported, either at the time of a SARS-CoV-2 infection diagnosis (co-infection) or subsequently (superinfection). However, data on the prevalence, ... ...

Abstract	Introduction: The recovery of other respiratory viruses in patients with SARS-CoV-2 infection has been reported, either at the time of a SARS-CoV-2 infection diagnosis (co-infection) or subsequently (superinfection). However, data on the prevalence, microbiology and outcomes of co-infection and super infection are limited. The purpose of this study was to examine occurrence of respiratory co-infections and superinfections and their outcomes among patients with SARS-CoV-2 infection. Patients and Methods: We searched literature databases for studies published from October 1, 2019, through June 11, 2020. We included studies that reported clinical features and outcomes of co-infection or super-infection of SARS-CoV-2 and other pathogens in hospitalized and non-hospitalized patients. We followed PRISMA guidelines and we registered the protocol with PROSPERO as: CRD42020189763. Results: Of 1310 articles screened, 48 were included in the random effects meta-analysis. The pooled prevalence of co-infection was 12% (95% confidence interval (CI): 6%-18%, n=29, I2=98%) and that of super-infection was 14% (95% CI: 9%-21%, n=18, I2=97%). Pooled prevalence of pathogen type stratified by co- or super-infection: viral co-infections, 4% (95% CI: 2%-7%); viral super-infections, 2% (95% CI: 0%-7%); bacterial co-infections, 4% (95% CI: 1%-8%); bacterial super-infections, 6% (95% CI: 2%-11%); fungal co-infections, 4% (95% CI: 1%-8%); and fungal super-infections, 4% (95% CI: 0%-11%). Compared to those with co-infections, patients with super-infections had a higher prevalence of mechanical ventilation [21% (95% CI: 13%-31%) vs. 7% (95% CI: 2%-15%)] and greater average length of hospital stay [mean=12.5 days, standard deviation (SD) =5.3 vs. mean=10.2 days, SD= 6.7]. Conclusions: Our study showed that as many as 14% of patients with COVID-19 have super-infections and 12% have co-infections. Poor outcomes were associated with super-infections. Our findings have implications for diagnostic testing and therapeutics, particularly in the upcoming respiratory virus season in the Northern Hemisphere.
Keywords	covid19
Language	English
Publishing date	2020-10-28
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2020.10.27.20220566
Database	COVID19

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Article ; Online: Physician behaviour for antimicrobial prescribing for paediatric upper respiratory tract infections

Ramdhanie Joseph / Parmasad Vishala / Mathur Deepti / Dindial Ria / Dharamraj Kavita / Mohan Shaun / Matthew Jason / Pinto Pereira Lexley M

Annals of Clinical Microbiology and Antimicrobials, Vol 3, Iss 1, p

a survey in general practice in Trinidad, West Indies

2004 Volume 11

Abstract: Abstract Background Upper respiratory tract infections (URTIs) are among the most frequent reasons for physician office visits in paediatrics. Despite their predominant viral aetiology, URTIs continue to be treated with antimicrobials. We explored ... ...

Abstract	Abstract Background Upper respiratory tract infections (URTIs) are among the most frequent reasons for physician office visits in paediatrics. Despite their predominant viral aetiology, URTIs continue to be treated with antimicrobials. We explored general practitioners' (GPs) prescribing behaviour for antimicrobials in children (≤ 16 years) with URTIs in Trinidad, using the guidelines from the Centers for Disease Control and Prevention (CDC) as a reference. Methods A cross-sectional study was conducted on 92 consenting GPs from the 109 contacted in Central and East Trinidad, between January to June 2003. Using a pilot-tested questionnaire, GPs identified the 5 most frequent URTIs they see in office and reported on their antimicrobial prescribing practices for these URTIs to trained research students. Results The 5 most frequent URTIs presenting in children in general practice, are the common cold, pharyngitis, tonsillitis, sinusitis and acute otitis media (AOM) in rank order. GPs prescribe at least 25 different antibiotics for these URTIs with significant associations for amoxicillin, co-amoxiclav, cefaclor, cefuroxime, erythromycin, clarithromycin and azithromycin (p < 0.001). Amoxicillin alone or with clavulanate was the most frequently prescribed antibiotic for all URTIs. Prescribing variations from the CDC recommendations were observed for all URTIs except for AOM (50%), the most common condition for antibiotics. Doctors practicing for >30 years were more likely to prescribe antibiotics for the common cold (p = 0.014). Severity (95.7%) and duration of illness (82.5%) influenced doctors' prescribing and over prescribing in general practice was attributed to parent demands (75%) and concern for secondary bacterial infections (70%). Physicians do not request laboratory investigations primarily because they are unnecessary (86%) and the waiting time for results is too long (51%). Conclusions Antibiotics are over prescribed for paediatric URTIs in Trinidad and amoxicillin with co-amoxiclav were preferentially prescribed. Except for AOM, GPs' prescribing varied from the CDC guidelines for drug and duration. Physicians recognise antibiotics are overused and consider parents expecting antibiotics and a concern for secondary bacterial infections are prescribing pressures. Guidelines to manage URTIs, ongoing surveillance programs for antibiotic resistance, public health education on non-antibiotic strategies, and postgraduate education for rational pharmacotherapy in general practice would decrease inappropriate antibiotic use in URTIs.
Keywords	Microbiology ; QR1-502 ; Science ; Q ; DOAJ:Microbiology ; DOAJ:Biology ; DOAJ:Biology and Life Sciences ; Therapeutics. Pharmacology ; RM1-950 ; Infectious and parasitic diseases ; RC109-216
Subject code	360
Language	English
Publishing date	2004-06-01T00:00:00Z
Publisher	BioMed Central
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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