Impact of routine chlorhexidine bathing and nasal iodophor on MDRO colonization and environmental contamination in nursing homes.

Background: Nursing homes residents have a high prevalence of multidrug-resistant organism (MDRO) colonization. Recent trials demonstrated that decolonizing residents reduces infection. However, decolonization's impact on environmental MDRO contamination is not well understood.

Infrared Dermal Thermometry in Active Charcot Neuro-Osteoarthropathy of Foot.

Introduction: The 'acclimatization time' before temperature assessment for diagnosis and monitoring of active unilateral Charcot neuro-osteoarthropathy (CNO) of foot is not known. Therefore, we aimed to assess the appropriate acclimatization time for foot temperature at diagnosis and during follow-up assessment of patients with active CNO.

Methods: Patients of diabetes with active unilateral CNO of foot were assessed for inter-feet temperature difference [affected foot-unaffected foot (°C)] at 10-, 30- and 45-minutes following shoe-off with a handheld infrared dermal thermometer.

Ankle brachial index and brachial-ankle pulse wave velocity as predictor for major adverse limb events and all-cause mortality in diabetes.

Background: Ankle-brachial index (ABI) is not a reliable index predicting cardiovascular events, as a significant number of patients with normal ABI do have cardiovascular events. Brachial-ankle pulse wave velocity (BaPWV), a non-invasive vascular assessment index for predicting CV events in normal ABI is not studied in type 2 diabetes (T2D).

Methods: This prospective study included people with T2D from year 2013 until December 2022 or death.

COVID-19 prevention training with video-based feedback in nursing homes: impact on staff safety behaviors.

Objective: Evaluate impact of COVID-19 prevention training with video-based feedback on nursing home (NH) staff safety behaviors.

Design: Public health intervention.

Setting & Participants: Twelve NHs in Orange County, California, 6/2020-4/2022.

Improving central line-associated bloodstream infection prevention practices in oncology clinic patients: mobile-app based surveillance & response.

Objectives: To evaluate the impact of a mobile-app-based central line-associated bloodstream infection (CLABSI) prevention program in oncology clinic patients with peripherally inserted central catheters (PICCs).

Design: Pre-post prospective cohort study with baseline (July 2015-December 2016), phase-in (January 2017-April 2017), and intervention (May 2017-November 2018). Generalized linear mixed models compared intervention with baseline frequency of localized inflammation/infection and dressing peeling.

Failure of timely removal of central and peripheral venous catheters after antibiotic therapy in nursing homes.

Each day a venous catheter is retained poses unnecessary safety risks. In a retrospective evaluation of central/peripheral lines in nursing home residents receiving antibiotics, 80% were retained beyond antibiotic treatment end and nearly one third were retained longer than a week. Interventions for timely catheter removal are urgently needed.

A telehealth approach to central line-associated bloodstream infection prevention activities in nursing homes: the SAFER lines program.

Objectives: To evaluate the impact of a mobile-app-based central line-associated bloodstream infection (CLABSI) prevention program in nursing home residents with peripherally inserted central catheters (PICCs).

Design: Pre-post prospective cohort study with baseline (September 2015-December 2016), phase-in (January 2017-April 2017), and intervention (May 2017-December 2018). Generalized linear mixed models compared intervention with baseline frequency of localized inflammation/infection, dressing peeling, and infection-related hospitalizations.

The cascade of cadmium toxicity: from cellular damage to pyroptotic responses in fish Channa punctatus.

Cadmium pollution is a major environmental issue threatening aquatic ecosystems and the health of aquatic organisms. Our study examines cadmium toxicity at different levels, highlighting pyroptotic cell death in the freshwater fish Channa punctatus (spotted snakehead). For this purpose, 90 well-acclimatized fish were categorized into three groups: one control and two treatment groups, i.

Trabecular and cortical bone microarchitecture using high-resolution peripheral quantitative computed tomographic imaging in diabetic peripheral neuropathy.

Context: Type 2 Diabetes Mellitus (T2D) is associated with an increased risk of fragility fracture despite normal areal bone mineral density (BMD). The contribution of diabetic peripheral neuropathy (PN) to volumetric BMD (vBMD) and bone microarchitecture in T2D is not explored.

Objective: To assess vBMD and microarchitectural properties of bone using high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients of T2D with or without PN.

Anti-RANKL Antibody For Active Charcot Foot Neuro-Osteoarthropathy in Patients with Diabetes and Chronic Kidney Disease.

Background: Charcot neuroosteoarthropathy (CNO) is characterized with increased osteoclastic activity that can be curbed with antiresorptive agents. Chronic kidney disease (CKD) precludes bisphosphonates but anti-receptor activator of nuclear factor-B ligand (anti-RANKL) antibody, denosumab, can be contemplated in CKD. We investigated denosumab for active CNO of foot in CKD for CNO remission.

Modeling Nursing Home Harms From COVID-19 Staff Furlough Policies.

Importance: Current guidance to furlough health care staff with mild COVID-19 illness may prevent the spread of COVID-19 but may worsen nursing home staffing shortages as well as health outcomes that are unrelated to COVID-19.

Objective: To compare COVID-19-related with non-COVID-19-related harms associated with allowing staff who are mildly ill with COVID-19 to work while masked.

Design, Setting, And Participants: This modeling study, conducted from November 2023 to June 2024, used an agent-based model representing a 100-bed nursing home and its residents, staff, and their interactions; care tasks; and resident and staff health outcomes to simulate the impact of different COVID-19 furlough policies over 1 postpandemic year.

Impact of universal chlorhexidine bathing with or without COVID-19 intensive training on staff and resident COVID-19 case rates in nursing homes.

We evaluated whether universal chlorhexidine bathing (decolonization) with or without COVID-19 intensive training impacted COVID-19 rates in 63 nursing homes (NHs) during the 2020-2021 Fall/Winter surge. Decolonization was associated with a 43% lesser rise in staff case-rates ( < .001) and a 52% lesser rise in resident case-rates ( < .

How the Timing of Annual COVID-19 Vaccination of Nursing Home Residents and Staff Affects Its Value.

Objectives: To evaluate the epidemiologic, clinical, and economic value of an annual nursing home (NH) COVID-19 vaccine campaign and the impact of when vaccination starts.

Design: Agent-based model representing a typical NH.

Setting And Participants: NH residents and staff.

Cost-effectiveness of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing and isolation strategies in nursing homes.

Objective: Nursing home residents may be particularly vulnerable to coronavirus disease 2019 (COVID-19). Therefore, a question is when and how often nursing homes should test staff for COVID-19 and how this may change as severe acute respiratory coronavirus virus 2 (SARS-CoV-2) evolves.

Design: We developed an agent-based model representing a typical nursing home, COVID-19 spread, and its health and economic outcomes to determine the clinical and economic value of various screening and isolation strategies and how it may change under various circumstances.

Rapid Environmental Contamination With Candida auris and Multidrug-Resistant Bacterial Pathogens Near Colonized Patients.

Background: Environmental contamination is suspected to play an important role in Candida auris transmission. Understanding speed and risks of contamination after room disinfection could inform environmental cleaning recommendations.

Methods: We conducted a prospective multicenter study of environmental contamination associated with C.

Evaluating barriers and potential solutions to speaking up about coronavirus disease 2019 (COVID-19) symptoms: A survey among nursing home workers.

Objective: Quantify the frequency and drivers of unreported coronavirus disease 2019 (COVID-19) symptoms among nursing home (NH) staff.

Design: Confidential telephone survey.

Setting: The study was conducted in 70 NHs in Orange County, California, December 2020-February 2022.

Decolonization in Nursing Homes to Prevent Infection and Hospitalization.

Background: Nursing home residents are at high risk for infection, hospitalization, and colonization with multidrug-resistant organisms.

Methods: We performed a cluster-randomized trial of universal decolonization as compared with routine-care bathing in nursing homes. The trial included an 18-month baseline period and an 18-month intervention period.

Not as simple as it seems: extensive facility and training gaps in nursing home bathing.

Standardized observation of bed baths and showers for 100 residents in 8 nursing homes revealed inadequate cleansing of body sites (88%-100% failure) and >90% process failure involving lather, firm massage, changing dirty wipes or cloths, and following clean-to-dirty sequence. Insufficient water warmth affected 86% of bathing opportunities. Bathing training and adequate resources are needed.

Impact of Alzheimer's disease and related dementias (ADRD) on the quality of room cleaning in nursing homes.

Persons with Alzheimer's disease and related dementias (ADRD) are prone to receiving reduced quality of care. We compared the quality of room cleaning of rooms with ADRD residents and rooms with non-ADRD residents in nursing homes using an ultraviolet (UV) marker. ADRD status was associated with greater failure of UV marker removal (odds ratio, 1.

Beyond Costs: Pragmatic Considerations for Pooling of SARS-CoV-2 Test Samples for Nursing Home Surveillance.

Pooling of samples can increase throughput and reduce costs for large-scale SARS-CoV-2 testing when incidence is low. In a cross-sectional study of serial SARS-CoV-2 sampling of staff and residents at three nursing homes, laboratory labor constraints limited the feasibility of pooling prior to the maximal incidence that favored cost savings. This study highlights the pragmatic considerations surrounding SARS-CoV-2 sample pooling beyond accuracy and costs.