Control of an outbreak of carbapenem-resistant Acinetobacter baumannii in Australia after introduction of environmental cleaning with a commercial oxidizing disinfectant

In the midst of an outbreak, carbapenem-resistant Acinetobacter baumannii was grown from samples of multiple environmental sites in an intensive care unit. A commercial oxidizing disinfectant (potassium peroxomonosulphate 50%, sodium alkyl benzene sulphonate 15%, and sulphamic acid 5%) was introduced throughout the intensive care unit, and its use coincided with cessation of the outbreak

Unconscious bias in the suppressive policing of Black and Latino men and boys: neuroscience, Borderlands theory, and the policymaking quest for just policing

his article applies neuroscience and Borderlands theory to reveal how unconscious bias currently stabilizes suppressive policing practices in America despite new efforts at reform. Illustrative cases are offered from Oakland and Santa Barbara, California, with a focus on civil gang injunctions (CGIs) and youth gang suppression. Theoretical analysis of these cases reveals how the unconscious biases of validity illusions and framing effects operate despite the best intentions of law enforcement personnel. Such unconscious or implicit biases create contradictions between the stated beliefs and actions of law enforcement. In turn, these unintended self-contradictions then work to the detriment of Latino and Black boys. The analysis here also extends to how unconscious biases and unintended self-contradictions can influence municipal policymaking in favor of suppressive police tactics such as CGIs, thereby displacing evidence-based policies that are proven to be far more effective. The article concludes with brief discussion of some of the means by which the unconscious biases – effects to which everyone is involuntarily prone – can be disrupted

Evaluating the economic effects of genomic sequencing of pathogens to prioritise hospital patients competing for isolation beds

Objective. This study compared the costs and patient movements of a new hospital protocol to discontinue contact precautions for patients with non-multiresistant methicillin-resistant Staphylococcus aureus (nmMRSA), based on wholegenome sequencing (WGS) of pathogens with current practice. Methods. A hybrid simulation model was constructed and analysed over a 12-month time horizon. Six multidrugresistant organisms and influenza were modelled concurrently where infected patients competed for isolation beds. Model inputs included pathogen incidence, resources for WGS, staff and contact precautions, hospital processes, room allocations and their associated costs. Data were sourced from aggregated records of patient admissions during 2017-18, clinical records and published reports. Results. The WGS protocol resulted in 389 patients isolated (44% of current practice), 5223 'isolation bed days' (56%) and 268 closed-bed days (88%). Over 1 year, the mean (±s.d.) total cost for the WGS protocol was A$749 243 ± 126 667; compared with current practice, the overall cost savings were A$690 864 ± 300 464. Conclusion. Using WGS to inform infection control teams of pathogen transmission averts patients from isolation rooms and reduces significant resources involved in implementing contact precautions

Cost-effectiveness analysis of whole-genome sequencing during an outbreak of carbapenem-resistant Acinetobacter baumannii

Background: Whole-genome sequencing (WGS) shotgun metagenomics (metagenomics) attempts to sequence the entire genetic content straight from the sample. Diagnostic advantages lie in the ability to detect unsuspected, uncultivatable, or very slow-growing organisms. Objective: To evaluate the clinical and economic effects of using WGS and metagenomics for outbreak management in a large metropolitan hospital. Design: Cost-effectiveness study. Setting: Intensive care unit and burn unit of large metropolitan hospital. Patients: Simulated intensive care unit and burn unit patients. Methods: We built a complex simulation model to estimate pathogen transmission, associated hospital costs, and quality-adjusted life years (QALYs) during a 32-month outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB). Model parameters were determined using microbiology surveillance data, genome sequencing results, hospital admission databases, and local clinical knowledge. The model was calibrated to the actual pathogen spread within the intensive care unit and burn unit (scenario 1) and compared with early use of WGS (scenario 2) and early use of WGS and metagenomics (scenario 3) to determine their respective cost-effectiveness. Sensitivity analyses were performed to address model uncertainty. Results: On average compared with scenario 1, scenario 2 resulted in 14 fewer patients with CRAB, 59 additional QALYs, and $75,099 cost savings. Scenario 3, compared with scenario 1, resulted in 18 fewer patients with CRAB, 74 additional QALYs, and$93,822 in hospital cost savings. The likelihoods that scenario 2 and scenario 3 were cost-effective were 57% and 60%, respectively. Conclusions: The use of WGS and metagenomics in infection control processes were predicted to produce favorable economic and clinical outcomes.</p