Assessment of shoreline habitats in the Kalman Preserve, Emmet County, MI

Rivers, Lakes, & WetlandsGreat lakes wetlands are important habitats for fish and other biota. They are important to the lifecycles of many floral and faunal species that are ultimately crucial to food webs in other ecosystems. The Kalman Preserve is owned by the Little Traverse Conservancy and contains wetland habitats on the shore of the Little Traverse Bay in Emmet County, MI. In 2006 a group of University of Michigan students found that the preserve, which includes cedar swamp, marsh, interdunal and shoreline sections, had a Floristic Quality Index value of 61.7, which indicates that the protected area holds an extremely rare level of pre-European characteristics. When they evaluated the interdunal and shoreline area alone, the value was considerably lower, which suggests degradation of this wetland habitat. We evaluated the same interdunal/shoreline subregion of the preserve using the Wetland Fish Index (WFIBasin) to assess its quality as a fish habitat. Our results suggest that the shoreline and inshore pond are facultative habitats. Evaluation of the bay and pond together yielded a higher index value than evaluation of the bay alone, and a lower index value than the pond alone. Our findings reinforce the importance of protecting the bay, pond, and surrounding area in maintaining the extremely rare quality of the preserve.http://deepblue.lib.umich.edu/bitstream/2027.42/61507/1/Mantey_Julia_2008_RLW.pd

ResearchCOVID‐19 Preparedness in Michigan Nursing Homes

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155466/1/jgs16490_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155466/2/jgs16490.pd

Not too close! impact of roommate status on MRSA and VRE colonization and contamination in Nursing Homes

Abstract Multiple room occupancy is common in Nursing Homes (NHs), and its role in transmission of antibiotic-resistant pathogens is unclear. We investigated prevalence of patient colonization and environmental contamination with vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) in NH roommates, compared it with expected prevalence, and determined specific body and environmental sites that may act as sources of roommate colonization. Roommate contamination was associated with index patient’s colonization (relative risk (RR): 2.57 (95% CI 1.04–6.37)) for MRSA, and index patient’s immediate environment contamination for VRE (RR: 3.60 (95% CI 1.59–8.12)). When specific index patient sites associated with roommate colonization were investigated, the side table (Fisher’s p = 0.029 and 0.047 for VRE and MRSA, respectively) and the nurse call button (p = 0.001 and 0.052) stood out, together with patient hands in the case of VRE (p = 0.026). Future studies should be carried out to establish whether these sites should be a specific target of infection prevention campaigns in NHs with multiple occupancy rooms.http://deepblue.lib.umich.edu/bitstream/2027.42/173949/1/13756_2021_Article_972.pd

Multidrug-resistant organisms in hospitals: what Is on patient hands and in their rooms?

BACKGROUND: The impact of healthcare personnel hand contamination in multidrug-resistant organism (MDRO) transmission is important and well studied; however, the role of patient hand contamination needs to be characterized further. METHODS: Patients from 2 hospitals in southeast Michigan were recruited within 24 hours of arrival to their room and followed prospectively using microbial surveillance of nares, dominant hand, and 6 high-touch environmental surfaces. Sampling was performed on admission, days 3 and 7, and weekly until discharge. Paired samples of methicillin-resistant Staphylococcus aureus (MRSA) isolated from the patients' hand and room surfaces were evaluated for relatedness using pulsed-field gel electrophoresis and staphylococcal cassette chromosome mec, and Panton-Valentine leukocidin typing. RESULTS: A total of 399 patients (mean age, 60.8 years; 49% male) were enrolled and followed for 710 visits. Fourteen percent (n = 56/399) of patients were colonized with an MDRO at baseline; 10% (40/399) had an MDRO on their hands. Twenty-nine percent of rooms harbored an MDRO. Six percent (14/225 patients with at least 2 visits) newly acquired an MDRO on their hands during their stay. New MDRO acquisition in patients occurred at a rate of 24.6/1000 patient-days, and in rooms at a rate of 58.6/1000 patient-days. Typing demonstrated a high correlation between MRSA on patient hands and room surfaces. CONCLUSIONS: Our data suggest that patient hand contamination with MDROs is common and correlates with contamination on high-touch room surfaces. Patient hand hygiene protocols should be considered to reduce transmission of pathogens and healthcare-associated infections

Interplay Between Patient Colonization and Environmental Contamination With Vancomycin-Resistant Enterococci and Their Association With Patient Health Outcomes in Postacute Care.

Background: The clinical utility of patient and environmental surveillance screening for vancomycin-resistant enterococci (VRE) in the postacute care setting has not been definitively clarified. We assessed the longitudinal relationship between patient colonization and room contamination, and we established their association with unfavorable health outcomes. Methods: Four hundred sixty-three postacute care patients were followed longitudinally from enrollment to discharge for up to 6 months. Multiple body and environmental sites were sampled at regular intervals to establish correlation between environmental contamination and patient colonization and with longer than expected stay, unplanned hospitalization, and infections adjusting for sex, age, race, Charlson\u27s comorbidity index, and physical self-maintenance score. Results: New VRE acquisition was more likely in patients residing in contaminated rooms (multivariable odds ratio [OR] = 3.75; 95% confidence interval [CI], 1.98-7.11) and vice versa (OR = 3.99; 95% CI, 2.16-7.51). New acquisition and new contamination were associated with increased length of stay (OR = 4.36, 95% CI = 1.86-10.2 and OR = 4.61, 95% CI = 1.92-11.0, respectively) and hospitalization (OR = 2.42, 95% CI = 1.39-4.22 and OR = 2.80, 95% CI = 1.52-5.12). New-onset infections were more common with higher VRE burdens (15% in the absence of VRE, 20% when after VRE isolation only on the patient or only in the room, and 29% after VRE isolation in both the patient and the room). Conclusions: Room contamination with VRE is a risk factor for patient colonization, and both are associated with future adverse health outcomes in our postacute care patients. Further research is warranted to establish whether VRE screening may contribute to better understanding of risk assessment and adverse outcome prevention in postacute care

Partnering with Local Hospitals and Public Health to Manage COVID

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/166234/1/jgs16869.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/166234/2/jgs16869-sup-0001-Supinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/166234/3/jgs16869_am.pd

Partnering with Local Hospitals and Public Health to Manage COVID‐19 Outbreaks in Nursing Homes

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/166234/1/jgs16869.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/166234/2/jgs16869-sup-0001-Supinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/166234/3/jgs16869_am.pd

Environmental contamination with SARS‐CoV‐2 in nursing homes

BackgroundSARS‐CoV‐2 outbreaks in nursing homes (NHs) have been devastating and have led to the creation of coronavirus disease 2019 (COVID‐19) units within NHs to care for affected patients. Frequency and persistence of SARS‐CoV‐2 environmental contamination in these units have not been studied.MethodsA prospective cohort study was conducted between October 2020 and January 2021 in four Michigan NHs. Swabs from high‐touch surfaces in COVID‐19‐infected patient rooms were obtained at enrollment and follow‐up. Demographic and clinical data were collected from clinical records. Primary outcome of interest was the probability of SARS‐CoV‐2 RNA detection from specific environmental surfaces in COVID‐19 patient rooms. We used multivariable logistic regression to assess patient risk factors for SARS‐CoV‐2 contamination. Pairwise Phi coefficients were calculated to measure correlation of site‐specific environmental detection upon enrollment and during follow‐up.ResultsOne hundred and four patients with COVID‐19 were enrolled (61.5% >80 years; 67.3% female; 89.4% non‐Hispanic White; 51% short stay) and followed up for 241 visits. The study population had significant disabilities in activities of daily living (ADL; 81.7% dependent in four or more ADLs) and comorbidities, including dementia (55.8%), diabetes (40.4%), and heart failure (32.7%). Over the 3‐month study period, 2087 swab specimens were collected (1896 COVID‐19 patient rooms, 191 common areas). SARS‐CoV‐2 positivity was 28.4% (538/1896 swabs) on patient room surfaces and 3.7% (7/191 swabs) on common area surfaces. Nearly 90% (93/104) of patients had SARS‐CoV‐2 contamination in their room at least once. Environmental contamination upon enrollment correlated with contamination of the same site during follow‐up. Functional independence increased the odds of proximate contamination.ConclusionsEnvironmental detection of viral RNA from surfaces in the rooms of COVID‐19 patients is nearly universal and persistent; more investigation is needed to determine the implications of this for infectiousness. Patients with greater independence are more likely than fully dependent patients to contaminate their immediate environment.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/171532/1/jgs17531_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/171532/2/jgs17531.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/171532/3/jgs17531-sup-0001-supinfo.pd

Environmental Panels as a Proxy for Nursing Facility Patients With Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus Colonization

Background: Most nursing facilities (NFs) lack methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) surveillance programs due to limited resources and high costs. We investigated the utility of environmental screening of high-touch surfaces in patient rooms as a way to circumvent these challenges. Methods: We compared MRSA and VRE culture data from high-touch surfaces in patients\u27 rooms (14450 samples from 6 NFs) and ranked each site\u27s performance in predicting patient colonization (7413 samples). The best-performing sites were included in a MRSA- and a VRE-specific panel that functioned as a proxy for patient colonization. Molecular typing was performed to confirm available concordant patient-environment pairs. Results: We identified and validated a MRSA panel that consisted of the bed controls, nurse call button, bed rail, and TV remote control. The VRE panel included the toilet seat, bed controls, bed rail, TV remote control, and top of the side table. Panel colonization data tracked patient colonization. Negative predictive values were 89%-92% for MRSA and 82%-84% for VRE. Molecular typing confirmed a strong clonal type relationship in available concordant patient-environment pairs (98% for MRSA, 91% for VRE), pointing to common epidemiological patterns for environmental and patient isolates. Conclusions: Environmental panels used as a proxy for patient colonization and incorporated into facility surveillance protocols can guide decolonization strategies, improve awareness of MRSA and VRE burden, and inform efforts to reduce transmission. Targeted environmental screening may be a viable surveillance strategy for MRSA and VRE detection in NFs

Multidrug-resistant Organisms in Hospitals: What Is on Patient Hands and in Their Rooms?

BACKGROUND: The impact of healthcare personnel hand contamination in multidrug-resistant organism (MDRO) transmission is important and well studied; however, the role of patient hand contamination needs to be characterized further. METHODS: Patients from 2 hospitals in southeast Michigan were recruited within 24 hours of arrival to their room and followed prospectively using microbial surveillance of nares, dominant hand, and 6 high-touch environmental surfaces. Sampling was performed on admission, days 3 and 7, and weekly until discharge. Paired samples of methicillin-resistant Staphylococcus aureus (MRSA) isolated from the patients\u27 hand and room surfaces were evaluated for relatedness using pulsed-field gel electrophoresis and staphylococcal cassette chromosome mec, and Panton-Valentine leukocidin typing. RESULTS: A total of 399 patients (mean age, 60.8 years; 49% male) were enrolled and followed for 710 visits. Fourteen percent (n = 56/399) of patients were colonized with an MDRO at baseline; 10% (40/399) had an MDRO on their hands. Twenty-nine percent of rooms harbored an MDRO. Six percent (14/225 patients with at least 2 visits) newly acquired an MDRO on their hands during their stay. New MDRO acquisition in patients occurred at a rate of 24.6/1000 patient-days, and in rooms at a rate of 58.6/1000 patient-days. Typing demonstrated a high correlation between MRSA on patient hands and room surfaces. CONCLUSIONS: Our data suggest that patient hand contamination with MDROs is common and correlates with contamination on high-touch room surfaces. Patient hand hygiene protocols should be considered to reduce transmission of pathogens and healthcare-associated infections