COVID-19 Surveillance Testing of Healthcare Personnel Drives Universal Masking Practice

Health Care Professionals (HCP) are at increased risk of COVID-19 infection due to the unpredictable clinical presentation of COVID-19 disease, limited SARS-CoV-2 testing, personal protective equipment (PPE) shortages, and the inherent inability to distance from patients. Infected HCP may infect others including coworkers leading to a simultaneous increase of number of infections and decreased availability of HCP in a community. [1] Due to PPE shortages, many healthcare systems have faced difficult decisions regarding utilization of PPE to protect HCP and patients and the communities they serve. We describe Norton Healthcare’s success utilizing surveillance COVID-19 testing of HCP to inform the decision to increase the use of PPE during a PPE shortage in the form of universal masking. Many healthcare systems could benefit from surveillance COVID-19 testing of HCP and universal masking of HCP

Antimicrobial Stewardship Meets Transitions of Care: Defining Length of Therapy for Community-Acquired Pneumonia (CAP)

Introduction: Hospital-based antimicrobial stewardship efforts have traditionally focused on inpatient settings. Antibiotic prescribing at discharge is often an overlooked area of focus for antimicrobial stewardship programs. Discharge prescribing optimization is necessary to combat antibiotic overuse. Methods: This was an observational, retrospective cohort study at a four–adult community hospital system. Four hundred adult patients admitted with community-acquired pneumonia and discharged with antibiotics were included. The primary outcome was overall (inpatient and discharge) antibiotic length of therapy. The secondary outcome was percentage of patients discharged on a fluoroquinolone who had not received one in the hospital. Descriptive statistics were utilized. Results: The median total antibiotic length of therapy was 9.5 days (IQR 8, 11). The median inpatient and discharge antibiotic lengths of therapy were 4 days (IQR 3, 5) and 5 days (IQR 5, 7), respectively. Of the 108 patients prescribed a fluoroquinolone at discharge, 43% (46/108) had not previously received a fluoroquinolone while hospitalized. Conclusion: Both length of therapy and fluoroquinolone stewardship at discharge may represent possible antimicrobial stewardship targets in community-acquired pneumonia patients

The Development of Self-Efficacy to Work with Suicidal Clients

Suicide is a public health crisis which counselors must be prepared to address. In this grounded theory study, the researchers advance a model to show how counselors develop self-efficacy to work with suicidal clients. Counselor educators may use this model to improve programmatic training and supervision of students

Concomitant invasive pneumococcal disease in a patient with COVID-19 – A case report from the Louisville Epidemiology Study

A 60-year-old male presented to the Emergency Department (ED) with a one-two day history of confusion, headache, and subjective fever. Because he had met with a contact two days prior to admission who had recently traveled from the Bahamas, a COVID-19 nasopharyngeal (NP) and oropharyngeal (OP) polymerase chain reaction (PCR) test was ordered. He was diagnosed with bacterial meningitis based on presenting neurologic symptoms and the identification of Streptococcus pneumoniae from blood cultures. The COVID-19 NP and OP test returned positive, although he never developed shortness of breath, cough, other respiratory symptoms, diarrhea, abdominal pain, nausea, vomiting, or any change in sense of smell or taste. On day three of admission, the patient had improved clinically on intravenous (IV) antibiotics and was discharged home with instructions to self-quarantine. This case demonstrates the possibility of co-infections with COVID-19 and raises the possibility of an association between COVID-19 and patient susceptibility to invasive pneumococcal disease (IPD)

False-negative SARS-CoV-2 Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) is an Important Consideration for Patient Management and Infection Prevention: A Case Report from The Louisville COVID-19 Epidemiology Study

We report a case of false negative SARS-CoV-2 RT-PCR on nasopharyngeal swab. Treating clinicians and infection preventionists should maintain a high suspicion for COVID-19 in the appropriate clinical setting despite negative test results. Utilization of chest CT should be strongly considered in the diagnostic work-up for suspected COVID-19, particularly in areas with limited RT-PCR availability

Why Every Hospital Needs a COVID-19 Clinical Case Review Team

A hospital’s response to a global pandemic requires a coordinated effort to provide consistent guidance as information rapidly changes. In the early months of the COVID-19 pandemic, diagnosis and subsequent containment was challenging due to unfamiliarity with disease presentation, unknown reverse transcription-polymerase chain reaction sensitivity and inconsistent access to testing supplies. A centralized COVID-19 clinical case review team can provide guidance on test interpretation, isolation, resource coordination and more

A Patient with Escherichia coli Bacteremia and COVID-19 Co-Infection: A Case Report for the Louisville COVID-19 Epidemiology Study

Patients with COVID-19 may have co-infections with other microorganisms. Here we report a case of a patient with an E. coli bacteremia secondary to a urinary tract infection, who experienced fevers while on active antimicrobial therapy. The patient was eventually tested for COVID-19 and found to be positive. This case emphasizes the need to suspect COVID-19 even in patients with documented bacterial infection

The Incidence of Common Respiratory Viruses During the COVID-19 Pandemic: Results From the Louisville COVID-19 Epidemiology Study

Introduction: Social distancing has been utilized during the COVID-19 pandemic to reduce the spread of SARS-CoV-2, which is also expected to reduce the spread of common respiratory viruses. Methods: This retrospective, descriptive study assessed the rate of positivity of common respiratory viruses from commercially available respiratory pathogen panel, across a five-hospital health-system, during four-week periods within March to April of 2019 and 2020. Results: During the four-week period in 2019, the percent positivity of common respiratory viruses from week one to week four decreased from 6 to 32% among the four included viruses. In the comparator period in 2020, a decrease ranging from 74 to 100% was observed from week one to week four. Conclusions: These data indicate that the social distancing efforts implemented in Louisville, Kentucky, may be associated with a decrease in incidence of common respiratory viruses. This decrease in positivity of common respiratory viruses may serve as a surrogate marker for the effect of social distancing on the transmission of SARS-CoV-2

A global collaboration to study intimate partner violence-related head trauma: The ENIGMA consortium IPV working group

Intimate partner violence includes psychological aggression, physical violence, sexual violence, and stalking from a current or former intimate partner. Past research suggests that exposure to intimate partner violence can impact cognitive and psychological functioning, as well as neurological outcomes. These seem to be compounded in those who suffer a brain injury as a result of trauma to the head, neck or body due to physical and/or sexual violence. However, our understanding of the neurobehavioral and neurobiological effects of head trauma in this population is limited due to factors including difficulty in accessing/recruiting participants, heterogeneity of samples, and premorbid and comorbid factors that impact outcomes. Thus, the goal of the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium Intimate Partner Violence Working Group is to develop a global collaboration that includes researchers, clinicians, and other key community stakeholders. Participation in the working group can include collecting harmonized data, providing data for meta- and mega-analysis across sites, or stakeholder insight on key clinical research questions, promoting safety, participant recruitment and referral to support services. Further, to facilitate the mega-analysis of data across sites within the working group, we provide suggestions for behavioral surveys, cognitive tests, neuroimaging parameters, and genetics that could be used by investigators in the early stages of study design. We anticipate that the harmonization of measures across sites within the working group prior to data collection could increase the statistical power in characterizing how intimate partner violence-related head trauma impacts long-term physical, cognitive, and psychological health