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Manon R Haverkate, Shayna Weiner, Karen Lolans, Nicholas M Moore, Robert A Weinstein, Marc J M Bonten, Mary K Hayden, Martin C J Bootsma
Background.  High prevalence of Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae has been reported in long-term acute care hospitals (LTACHs), in part because of frequent readmissions of colonized patients. Knowledge of the duration of colonization with KPC is essential to identify patients at risk of KPC colonization upon readmission and to make predictions on the effects of transmission control measures. Methods.  We analyzed data on surveillance isolates that were collected at 4 LTACHs in the Chicago region during a period of bundled interventions, to simultaneously estimate the duration of colonization during an LTACH admission and between LTACH (re)admissions...
October 2016: Open Forum Infectious Diseases
Michael J Ray, Michael Y Lin, Robert A Weinstein, William E Trick
BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) spread regionally throughout healthcare facilities through patient transfer and cause difficult-to-treat infections. We developed a state-wide patient-sharing matrix and applied social network analyses to determine whether greater connectedness (centrality) to other healthcare facilities and greater patient sharing with long-term acute care hospitals (LTACHs) predicted higher facility CRE rates. METHODS: We combined CRE case information from the Illinois extensively drug-resistant organism registry with measures of centrality calculated from a state-wide hospital discharge dataset to predict facility-level CRE rates, adjusting for hospital size and geographic characteristics...
October 1, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Antony M Grigonis, Amanda M Dawson, Mary Burkett, Arthur Dylag, Matthew Sears, Betty Helber, Lisa K Snyder
OBJECTIVE: Evidence-based guidelines have resulted in decreases in bloodstream infections associated with central catheters (CLABSIs) in hospital intensive care units. However, relatively little is known about CLABSI incidence and prevention in long-term acute care hospitals (LTACHs). METHODS: A central catheter maintenance bundle was implemented in 30 LTACHs, and compliance with the bundle was tracked for 6 months. CLABSI rates were monitored for 14 months before and 14 months after the bundle was implemented...
March 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
Michele C Balas, John W Devlin, Avelino C Verceles, Peter Morris, E Wesley Ely
When robust clinical trials are lacking, clinicians are often forced to extrapolate safe and effective evidence-based interventions from one patient care setting to another. This article is about such an extrapolation from the intensive care unit (ICU) to the long-term acute care hospital (LTACH) setting. Chronic critical illness is an emerging, disabling, costly, and yet relatively silent epidemic that is central to both of these settings. The number of chronically critically ill patients requiring prolonged mechanical ventilation is expected to reach unprecedented levels over the next decade...
February 2016: Seminars in Respiratory and Critical Care Medicine
Giorgio R Sansone, J Dermot Frengley, John J Vecchione, Merlin G Manogaram, Robert J Kaner
OBJECTIVE: To investigate the relationships between durations of ventilator support and weaning outcomes of prolonged mechanical ventilation (PMV) patients. METHODS: Cohort study of 957 PMV patients sequentially admitted to a long-term acute care hospital (LTACH). The study population was 437 PMV patients who underwent weaning, having achieved ≥4 hours of sustained spontaneous breathing. They were divided into tertiles of mechanical ventilation (MV) durations and compared for differences (tertile A: 21-58 days, n = 146; tertile B: 59-103 days, n = 147; and tertile C: ≥104 days, n = 144)...
January 20, 2016: Journal of Intensive Care Medicine
John P Mills, Naasha J Talati, Kevin Alby, Jennifer H Han
OBJECTIVE An improved understanding of carbapenem-resistant Klebsiella pneumoniae (CRKP) in long-term acute care hospitals (LTACHs) is needed. The objective of this study was to assess risk factors for colonization or infection with CRKP in LTACH residents. METHODS A case-control study was performed at a university-affiliated LTACH from 2008 to 2013. Cases were defined as all patients with clinical cultures positive for CRKP and controls were those with clinical cultures positive for carbapenem-susceptible K...
January 2016: Infection Control and Hospital Epidemiology
Manon R Haverkate, Martin C J Bootsma, Shayna Weiner, Donald Blom, Michael Y Lin, Karen Lolans, Nicholas M Moore, Rosie D Lyles, Robert A Weinstein, Marc J M Bonten, Mary K Hayden
OBJECTIVE: Prevalence of bla KPC-encoding Enterobacteriaceae (KPC) in Chicago long-term acute care hospitals (LTACHs) rose rapidly after the first recognition in 2007. We studied the epidemiology and transmission capacity of KPC in LTACHs and the effect of patient cohorting. METHODS: Data were available from 4 Chicago LTACHs from June 2012 to June 2013 during a period of bundled interventions. These consisted of screening for KPC rectal carriage, daily chlorhexidine bathing, medical staff education, and 3 cohort strategies: a pure cohort (all KPC-positive patients on 1 floor), single rooms for KPC-positive patients, and a mixed cohort (all KPC-positive patients on 1 floor, supplemented with KPC-negative patients)...
October 2015: Infection Control and Hospital Epidemiology
Teena Chopra, Ellie J C Goldstein
Across the United States, the baby boomers are entering into their elderly years. As they are America's largest generation to do so to date, their need for care will greatly affect nursing homes, long-term care facilities, and long-term acute-care hospitals (LTACHs). Unfortunately, the rise of Clostridium difficile infection (CDI), particularly in extended-care facilities, might become the biggest obstacle in their care. Elderly extended-care-facility residents are at an elevated risk of CDI simply due to their advanced age and the fact that they are receiving care in an extended-care facility...
May 15, 2015: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
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No abstract text is available yet for this article.
November 2014: Healthcare Financial Management: Journal of the Healthcare Financial Management Association
Mary K Hayden, Michael Y Lin, Karen Lolans, Shayna Weiner, Donald Blom, Nicholas M Moore, Louis Fogg, David Henry, Rosie Lyles, Caroline Thurlow, Monica Sikka, David Hines, Robert A Weinstein
BACKGROUND: Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (hereafter "KPC") are an increasing threat to healthcare institutions. Long-term acute-care hospitals (LTACHs) have especially high prevalence of KPC. METHODS: Using a stepped-wedge design, we tested whether a bundled intervention (screening patients for KPC rectal colonization upon admission and every other week; contact isolation and geographic separation of KPC-positive patients in ward cohorts or single rooms; bathing all patients daily with chlorhexidine gluconate; and healthcare-worker education and adherence monitoring) would reduce colonization and infection due to KPC in 4 LTACHs with high endemic KPC prevalence...
April 15, 2015: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Marti Edwards, Joanne Purpura, Guy Kochvar
BACKGROUND: Reducing central line-associated bloodstream infections (CLABSIs) poses a set of unique challenges in long-term acute care hospitals (LTACHS). Patients are often admitted to LTACHs with central lines in place from the previous hospitalization; thus, LTACHs lack control over insertion techniques and respective central line care and maintenance. This study aimed to demonstrate the impact of a methodical bathing approach with 2% chlorhexidine gluconate (CHG) cloths and a correlation with a reduced prevalence of CLABSIs in our LTACH population...
July 2014: American Journal of Infection Control
Rosie D Lyles, Nicholas M Moore, Shayna B Weiner, Monica Sikka, Michael Y Lin, Robert A Weinstein, Mary K Hayden, Ronda L Sinkowitz-Cochran
OBJECTIVE: To identify differences in organizational culture and better understand motivators to implementation of a bundle intervention to control Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC). DESIGN: Mixed-methods study. SETTING: Four long-term acute care hospitals (LTACHs) in Chicago. PARTICIPANTS: LTACH staff across 3 strata of employees (administration, midlevel management, and frontline clinical workers)...
April 2014: Infection Control and Hospital Epidemiology
Amy J Mathers, Melinda Poulter, Dawn Dirks, Joanne Carroll, Costi D Sifri, Kevin C Hazen
OBJECTIVE: To compare direct laboratory costs of different methods for perirectal screening for carbapenemase-producing Enterobacteriaceae (CPE) colonization. DESIGN: Cost-benefit analysis. SETTING: A university hospital and affiliated long-term acute care hospital (LTACH). PARTICIPANTS: Inpatients from the hospital or LTACH. METHODS: Perirectal samples were collected from inpatients at risk for exposure to CPE...
April 2014: Infection Control and Hospital Epidemiology
J Dermot Frengley, Giorgio R Sansone, Kunjan Shakya, Robert J Kaner
OBJECTIVES: To investigate effects of older age, comorbidities, and physiological measures on outcomes of elderly adults requiring prolonged mechanical ventilation (PMV). DESIGN: Retrospective cohort study. SETTING: Public long-term acute care hospital (LTACH) with an active program for ventilator weaning from PMV. PARTICIPANTS: Chronically seriously ill individuals with PMV aged 65 and older divided into six cohorts (65-69, 70-74, 75-79, 80-84, 85-89, ≥ 90) for comparative purposes (n = 540)...
January 2014: Journal of the American Geriatrics Society
Michael Y Lin, Rosie D Lyles-Banks, Karen Lolans, David W Hines, Joel B Spear, Russell Petrak, William E Trick, Robert A Weinstein, Mary K Hayden
BACKGROUND: In the United States, Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae are increasingly detected in clinical infections; however, the colonization burden of these organisms among short-stay and long-term acute care hospitals is unknown. METHODS: Short-stay acute care hospitals with adult intensive care units (ICUs) in the city of Chicago were recruited for 2 cross-sectional single-day point prevalence surveys (survey 1, July 2010-January 2011; survey 2, January-July 2011)...
November 2013: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Jessica D Lewis, Matthew Bishop, Brenda Heon, Amy J Mathers, Kyle B Enfield, Costi D Sifri
Carbapenemase-producing Enterobacteriaceae (CPE) are of increasing prevalence worldwide, and long-term acute care hospitals (LTACHs) have been implicated in several outbreaks in the United States. This prospective study of routine screening for CPE on admission to a LTACH demonstrates a high prevalence of CPE colonization in central Virginia.
August 2013: Infection Control and Hospital Epidemiology
Heidi O'Connor, Nada S Al-Qadheeb, Alexander C White, Vishal Thaker, John W Devlin
INTRODUCTION: The prevalence, risk factors, treatment practices, and outcomes of agitation in patients undergoing prolonged mechanical ventilation (PMV) in the long-term acute care hospital (LTACH) setting are not well understood. We compared agitation risk factors, management strategies, and outcomes between patients who developed agitation and those who did not, in LTACH patients undergoing PMV. METHODS: Patients admitted to an LTACH for PMV over a 1-year period were categorized into agitated and nonagitated groups...
July 2014: Journal of Intensive Care Medicine
Antony M Grigonis, Lisa K Snyder, Amanda M Dawson
The relative contribution of long-term acute care hospital (LTACH) to short-term acute care hospital (STACH) Medicare patient readmissions is important because of the high acuity of LTACH patients. A retrospective cohort study was conducted to determine the magnitude of LTACH Medicare heart failure (HF) and pneumonia (PN) inpatient readmissions to STACHs within 30 days of LTACH admission and the relative contribution of LTACH patient readmissions to each STACH's total readmissions. Seventy-five for-profit LTACHs and their associated host or primary referral STACHs were studied...
November 2013: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Nada S Al-Qadheeb, Heidi H O'Connor, Alexander C White, Aura Neidhardt, Mark Albizati, Bernard Joseph, Russel J Roberts, Robin R Ruthazer, John W Devlin
BACKGROUND: Administration of scheduled antipsychotic therapy to mechanically ventilated patients to prevent or treat delirium is common, despite the lack of evidence to support its use. Among long-term acute care hospital (LTACH) patients requiring prolonged mechanical ventilation (PMV), the frequency of scheduled antipsychotic therapy use, and the factors and outcomes associated with it, have not been described. OBJECTIVE: To identify scheduled antipsychotic therapy prescribing practices, and the factors and outcomes associated with the use of antipsychotics, among LTACH patients requiring PMV...
February 2013: Annals of Pharmacotherapy
Amal Jubran, Brydon J B Grant, Lisa A Duffner, Eileen G Collins, Dorothy M Lanuza, Leslie A Hoffman, Martin J Tobin
IMPORTANCE: Patients requiring prolonged mechanical ventilation (>21 days) are commonly weaned at long-term acute care hospitals (LTACHs). The most effective method of weaning such patients has not been investigated. OBJECTIVE: To compare weaning duration with pressure support vs unassisted breathing through a tracheostomy collar in patients transferred to an LTACH for weaning from prolonged ventilation. DESIGN, SETTING, AND PARTICIPANTS: Between 2000 and 2010, a randomized study was conducted in tracheotomized patients transferred to a single LTACH for weaning from prolonged ventilation...
February 20, 2013: JAMA: the Journal of the American Medical Association
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