Elaine Flanagan

Understanding health care personnel's attitudes toward mandatory influenza vaccination

BACKGROUND This study investigated the factors influencing influenza vaccination rates among health care personnel (HCP) and explored HCPs attitudes toward a policy of mandatory vaccination. METHODS In September 2012, a 33-item Web-based questionnaire was administered to 3,054 HCP employed at a tertiary care hospital in metropolitan Detroit. RESULTS There was a significant increase in the rate of influenza vaccination, from 80% in the 2010-2011 influenza season (before the mandated influenza vaccine) to 93% in 2011-2012 (after the mandate) (P < .0001). Logistic regression showed that HCP with a history of previous influenza vaccination were 7 times more likely than their peers without this history to receive the vaccine in 2011-2012. A pro-mandate attitude toward influenza vaccination was a significant predictor of receiving the vaccine after adjusting for demographics, history of previous vaccination, awareness of the hospitals mandatory vaccination policy, and patient contact while providing care (P = .01). CONCLUSIONS The increased rate of influenza vaccination among HCP was driven by both an awareness of the mandatory policy and a pro-mandate attitude toward vaccination. The findings of this study call for better education of HCP on the influenza vaccine along with enforcement of a mandatory vaccination policy.

Infection prevention in alternative health care settings.

With the changing health care delivery, patients receive care at various settings, including acute care hospitals, skilled nursing facilities (SNFs), and ambulatory clinics, thus becoming exposed to pathogens. Various health care settings face unique challenges requiring individualized infection control programs. The programs in SNFs should address surveillance for infections and antimicrobial resistance, outbreak investigation and control plan for epidemics, isolation precautions, hand hygiene, staff education, and employee and resident health programs. In ambulatory clinics, the program should address triage and standard transmission-based precautions; cleaning, disinfection, and sterilization principles; surveillance in surgical clinics; safe injection practices; and bioterrorism and disaster planning.

Infection Control in Alternative Health Care Settings: An Update.

With changing health care delivery, patients receive care at various settings including acute care hospitals, nursing homes, outpatient primary care and specialty clinics, and at home, exposing them to pathogens in various settings. Various health care settings face unique challenges, requiring individualized infection control programs. Infection control programs in nursing homes should address surveillance for infections and antimicrobial resistance, outbreak investigation and control plan for epidemics, isolation precautions, hand hygiene, staff education, and employee and resident health programs.

First case of vaccine-strain varicella infection as manifestation of HIV in healthcare worker: a case report and review of the literature

Live-attenuated varicella vaccination is safe in non-immunocompromised populations and is associated with rare non-serious adverse events. A healthcare worker (HCW) developed varicella infection, and exposure investigation led to immunization against varicella in an exposed non-immune HCW. Subsequently, vaccine-strain-induced disseminated varicella and progressive outer retinal necrosis in the exposed HCW resulted in identification of undiagnosed human immunodeficiency virus infection. This article reviews serious adverse events from varicella vaccination, and extreme caution is advised prior to live vaccination of HCWs.

868Improving Appropriateness of Peripherally Inserted Central Catheter Utilization and Decreasing the Incidence of Central Line-Associated Blood Stream Infection

Shigehiko Karino, MD1, Tal Mann, MD1, Maria Palleschi, DNP APRN-BC, CCRN1, Sheri Testani, MSN,RN,NE-BC1, Julie Nemens, RN, BSN1, Monte Harvill MD1, Elaine Flanagan, RN, MSA, CIC1, Thomas Chevalier, RN, BSN, CIC1, Paula Robinson, RN, BSN, CIC1, Judy Moshos, MT (ASCP), CIC1, Sorabh Dhar, MD1,2, Anumpama Neelakanta, MD, MPH1, Nader Tashtoush, MD1, Mary Robinson, BSBA1, Najia Huda, MD1, Keith Kaye, MD, MPH1

944Outbreak of Colistin-Resistant Acinetobacter baumannii in Intensive Care Units in Detroit, Michigan

Background: A. baumannii is commonly recognized as an emerging multi-drug resistant (MDR) organism frequently impervious to majority of the commonly prescribed antibiotics. Colistin is one of the few therapeutic agents which possess activity against this pathogen, and its use has dramatically increased. As a result, colistin resistance is increasingly reported among A. baumannii and presents a unique challenge. Methods: A cluster of colistin-resistant A. baumannii cases at Detroit Receiving Hospital were identified from May 1st, 2013 to October 31st, 2013. Colistin resistance was defined as an MIC of >2 μg/ml (E-test). Epidemiologic data for these cases were collected and isolates assayed for clonality with Diversilab rep-PCR and multi-locus sequence typing (ST). Results: 11 cases were identified. The mean age of the patients was 48.8 years (range 17-76) and 10 (91%) resided in one of two intensive care units. All patients were treated with broad spectrum antimicrobials (but not colistin) prior to isolation of the colistin-resistant isolate. 9 (82%) patients were mechanically ventilated and the pathogen was detected from sputum specimen in 8 (73%) of patients. Other features frequently identified in these cases were the use of glucometer (73%) and tube feeds (82%). Colistin MIC ranged from 3-32. Environmental surveillance cultures were performed, but only one specimen was positive for the same organism. Genotyping was performed on 5 patient isolates which revealed 95% similarity between strains (Figure 1) and all isolates were ST281. In order to contain the outbreak, optimal infection prevention practices were reinforced, active surveillance screening of high risk patients implemented, with presumptive contact isolation. Conclusion: To our knowledge this is the first reported outbreak of colistin-resistant A. baumannii in United States. The hands of healthcare workers and environmental reservoirs are hypothesized to be the source of the outbreak. We observed a wide range of colistin MICs among outbreak strains, possibly due to 1) the emergence of heteroresistance or 2) differences in the population structure. A case-control study will help to further help delineate the cause of the outbreak. OXA23