Lisa Saiman

The US Centers for Disease Control and Prevention (CDC) has listed vaccination as one the top 10 public health achievements, ¹ and vaccines have led to a tremendous reduction in deaths due to vaccine-preventable disease in the United States alone. ² There are over 22 million persons employed in healthcare in the United States, making healthcare personnel (HCP) an important population to target for vaccination efforts. Promoting vaccination for HCP as defined by the CDC is likely to become even more essential given the rising incidence in the United States of vaccine-preventable diseases such as measles and pertussis. ³

Background: An improved understanding of the epidemiology of hospital-onset methicillin-resistant Staphylococcus aureus bloodstream infection (HO-MRSA BSI) could inform future prevention strategies for HO-MRSA BSI. Methods: We performed a retrospective cohort study of HO-MRSA BSI reported to NHSN from 2020–2023 at a system of 9 acute care hospitals located in New York City. The primary outcome was to describe the demographic and clinical characteristics of patients with HO-MRSA BSI. Secondary outcomes included comparisons of tertiary (TH) and community (CH) hospitals, standardized infection ratio (SIR) and rates per 10,000 patient-discharges, presumptive potential infectious sources, and mortality. Results: Between 2020 and 2023, 222 patients had HO-MRSA BSI. Their median age was 65 years, 139 (63%) were male, 92 (41%) had central lines, 89 (40%) were in ICUs, and 63 (28%) were on a ventilator. These characteristics were similar across the 176 (79%) patients in TH and the 46 (21%) patients in CH. SIRs were similar across each year of the study (with cumulative SIRs of 0.815 overall, 1.412 [CH] and 0.732 [TH]). Overall HO-MRSA BSI rates ranged from 2.58–3.53 per 10,000 patient-discharges. The most common sources of HO-MRSA BSI were pneumonia (41%), SSTIs (17%), CLABSIs (13%), and PIV catheter-related issues (9%). The all-cause mortality rate was 35%. Discussion: The unchanged HO-MRSA BSI SIRs in this study support the need for additional interventions that focus on prevention of the primary sources of MRSA infections. Ongoing systematic surveillance of the primary sources of HO-MRSA BSI should be implemented to inform and monitor best practices for prevention.

Transformative changes in care for people with cystic fibrosis (CF; pwCF) have occurred, including most recently, the widespread use of CF transmembrane regulator modulator therapy. These novel therapies improve lung function, decrease pulmonary exacerbations, increase life expectancy, and improve quality of life. Changes in the CF population have also occurred. There are now more adults than children living with CF. A growing proportion of pwCF are black and/or Hispanic, many of whom are ineligible for modulator therapy due to their CF transmembrane regulator mutations, which may further exacerbate disparities in healthcare. Management of pulmonary exacerbations—including shared decision making between pwCF and providers, the limitations of antimicrobial susceptibility testing to predict treatment response, and the role of antimicrobial stewardship—is increasingly recognized by the CF community. Collaborations among infectious diseases specialists, antimicrobial stewards, CF care teams, and clinical microbiology laboratories are increasingly needed to optimize these newer care paradigms.

Healthcare facilities in the U.S. are well positioned to assist with measles control by timely identification and isolation of suspected or confirmed cases and, as measles is nationally notifiable, by informing local health departments about both suspected and confirmed cases. However, responding to measles cases in acute healthcare settings presents unique challenges, is disruptive, and requires an intense outlay of resources before, during, and afterward primarily due to exposure investigations. We describe our measles preparedness efforts to improve identification of measles cases, facilitate appropriate isolation, reduce exposures, and provide timely post-exposure prophylaxis.

Background: COVID‐19‐associated hospitalization rates by age and comorbid conditions can more precisely assess risk for severe illness and target prevention and treatment strategies.Methods: We performed a retrospective study to estimate population‐based COVID‐19‐associated hospitalization among patients by age and selected comorbid conditions in three hospital systems in Rochester and New York City (NYC), NY. Incidence rate ratios (IRR) comparing incidence rates for patients with and without these comorbidities were determined.Results: From March 2020 to December 2021, 7779 patients were hospitalized with COVID‐19 of whom 43.8% had ≥3 comorbid conditions. Overall annual incidence ranged from 325.3 to 965.8 per 100,000 persons. Age group‐specific incidence was lowest in children 10–14 years (range 4.4–58.9) and highest in adults ≥85 years (range 2790.5–5889.6). Incidence rates for comorbid conditions generally increased with increasing age while IRR decreased with increasing age. Children in NYC 5–17 years with asthma or obesity had 3.4 and 53.3 times higher hospitalization rates, respectively, than children without these conditions. Adults in all age groups with obesity, diabetes, coronary artery disease, or congestive heart failure CHF had 1.6–4.7 times, 1.7–7.2 times, 2.0–10.1 times, or 1.7–20.2 times higher hospitalization rates, respectively, than those without these conditions. Adults ≥50 years with asthma had 1.5 to 1.8 times higher hospitalization rates than those without asthma.Conclusions: The burden of hospitalization with COVID‐19 was high, particularly among adults ≥85 years and adults with obesity, diabetes, CAD, or CHF. However, the impact of comorbidities was less in older adults. Population‐based incidence rates by age and comorbidities provide more precise estimates of the benefits of vaccines and antiviral medications.

Background: Infection control guidelines for cystic fibrosis (CF) stress cleaning of environmental surfaces and patientcare equipment in CF clinics. This multicenter study measured cleanliness of frequently touched surfaces in CF clinics using an ATP bioluminescence assay to assess the effectiveness of cleaning/disinfection and the impact of feedback.Methods: Eight surfaces were tested across 19 clinics (10 pediatric, 9 adult) over 5 rounds of testing. Rounds 1 and 2 served as uncleaned baseline, and Round 3 occurring after routine cleaning. Rounds 4 and 5 were performed after feedback provided to staff and measured after cleaning. Pass rates defined as P < 0.001). In pediatric clinics, blood pressure equipment and computer keyboards in the pulmonary function lab consistently passed, but the exam room patient/visitor chairs consistently failed in all rounds. In adult clinics blood pressure equipment, keyboards in exam rooms and exam tables passed in all rounds and no surface consistently failed.Conclusion: We demonstrate the feasibility of an ATP bioluminescence assay to measure cleanliness of patient care equipment and surfaces in CF clinics. Pass rates improved after cleaning and feedback for certain surfaces. We found that surfaces are more challenging to keep clean in clinics taking care of younger patients.

To determine if healthcare-associated (HA)-RSV is associated with worse outcomes, this multicenter cohort study studied 26 children with HA-RSV and 78 matched non-HA-RSV patients of whom 58% and 55%, respectively, had >2 comorbidities. Overall, 39% of HA-RSV versus 18% of non-HA-RSV patients required respiratory support escalation (aOR 5.1, CI₉₅ 1.4,19.1).