South Carolina Department of Health and Environmental Control

About: South Carolina Department of Health and Environmental Control is a government organization based out in Columbia, South Carolina, United States. It is known for research contribution in the topics: Population & Public health. The organization has 334 authors who have published 315 publications receiving 11187 citations.

Healthcare infections associated with care and treatment of humans and animals.

Abstract: On May 14–15, 2008, the Southeastern Center for Emerging Biologic Threats convened a conference in Atlanta, Georgia, of more than 60 public health officials, clinicians, and researchers from its 7 member states to discuss infections associated with the care and treatment of humans and animals (1). Participants discussed hospital infection reporting laws, research on the epidemiology and prevention of healthcare-associated infections (HAIs), and current infection control practices. Conference presentations are available online at www.secebt.org. HAIs refer to the 1.7 million infections that are acquired, introduced, or propagated by personnel, visitors, and patients in human healthcare facilities. Key prevention methods include mandatory vaccination of personnel (unless a medical contraindication exists), consistent and appropriate infection control practices such as appropriate hand hygiene and judicious use of antimicrobial drugs, prompt detection of and responses to potential outbreaks, and routine surveillance. Surveillance is essential to appropriately focus resources and to evaluate effectiveness of prevention measures. More than half of the 50 states have passed mandatory reporting laws, many of which are unfunded mandates that threaten to overburden infection control professionals. These professionals are essential to conduct surveillance and to assist in the implementation and evaluation of prevention measures. Public health and hospital professionals from 6 states described their experiences with mandatory hospital reporting; all collect data by using the National Healthcare Safety Network (NHSN). Of concern is the public’s emphasis on measuring HAIs versus measuring implementation of recommended infection control guidelines, given the variation of risks from institution to institution and the limitations of risk-adjustment in making reported infection rates comparable. Furthermore, postdischarge surveillance to determine infections with onset after hospitalization remains challenging. The experiences of these states demonstrate the importance of interacting with key stakeholders and legislators before enactment of the law. In addition to the use of process measures (e.g., Institute for Health Improvement “bundles,” which are evidence-based combinations of processes for infection prevention) to reduce ventilator-associated pneumonia and central catheter–related bloodstream infections, the group recommended securing dedicated time and resources for piloting data collection before statewide implementation and producing reports that are fair to hospitals and useful to consumers, third-party payers, and hospital personnel. Compliance with data collection and reporting requirements requires substantial institutional resources. Validation studies performed by South Carolina and New York have demonstrated that, overall, hospitals were not underreporting infections during the initial inpatient stay or required readmission. There were, however, inconsistencies between medical records and NHSN data entry. Inconsistencies were particularly prominent in the following data elements: American Society for Anesthesiologists score, duration of procedure, endoscope use, and extent of surgical site infection (superficial, deep, organ-space). New York found that the following variables not taken into account for risk-adjustment by NSHN were associated with infection: body mass index, diabetes, female gender, immunodeficiency, and emergency procedure. Thirty-two percent of surgical site infections (SSIs) in patients who underwent coronary artery bypass graft surgery were detected during initial admission, 63% were detected on readmission, and 5% were detected by postdischarge surveillance. In contrast, 63% of colon surgery SSIs were detected during the initial admission, 24% upon readmission, and 13% on postdischarge surveillance (2). Several legal-ethical issues regarding mandatory surveillance and the value-based purchasing process of Centers for Medicare and Medicaid Services (CMS) are of great concern. These issues include the potential for public misinterpretation of data; incentivizing “gaming” of the system (e.g., underreporting of infections, possible reluctance of clinicians to perform high-risk procedures); diverting resources from prevention and care to reporting; inappropriate use of antimicrobial drugs for patients for whom they are not recommended; and using benchmarks (e.g., administrative claims data) that have not been validated. Nevertheless, the ethical concern of preventing patient and personnel harm remains primary. A strong business case can be made for reducing HAIs, which are costly because of increased lengths of hospital stay and associated opportunity costs (3). Measures of cost-effectiveness demonstrate that, at $2,000–$8,000/quality-adjusted life-year, infection control methods are cost-effective relative to other preventive health interventions (4). In addition, reported HAIs may become a factor in healthcare consumer decision-making and, therefore, practitioner revenues. The business case for improving HAI prevention measures is strengthened by 2 factors. First, beginning in October 2008, CMS will refuse to pay for 6 conditions that qualify as infections not present on admission. Second, recent research demonstrates that the preventable fraction of HAIs may be much larger than previously thought. Emerging research suggests that implementation of effective infection control practices is crucial for reducing HAIs and is a topic that warrants further study. Multisite studies such as the Michigan Keystone Collaborative suggest that local adaptation of implementation methods, environments characterized by strong teamwork among clinicians, administrators, and care providers, and emphasis on best practices such as removing unnecessary lines are factors that can reduce HAIs (5,6). These studies also demonstrate the extent of HAI preventability. Implementation research requires a multidisciplinary approach including open-mindedness about social/behavioral science and methods, e.g., using complexity theory instead of randomized controlled trials (7). Collaborative approaches should be expanded beyond intensive care units and prevention of infection. There needs to be increased focus on prevention of transmission (e.g., Clostridium difficile, multidrug-resistant organisms). Although research on HAIs in human healthcare settings requires innovation, research on HAIs in veterinary settings demands even more effort. Veterinary HAI research lacks consistent definitions, prevalence data, infection control guidelines, and measures of practice and other core elements of surveillance. Conducting research on veterinary HAIs is increasingly important, given the documentation in North America of pathogens of serious concern to humans and animals, including multidrug-resistant Salmonella spp., various herpesviruses and influenza viruses, C. difficile, and methicillin-resistant Staphylococcus aureus, including the USA300 strain. Research is needed in several areas, such as variation in critical care unit infection rates, preventable fraction of HAIs, and infection control (e.g., hand hygiene). We need better methods for validating results; better measures for process, implementation, and risk adjustment; better methods to measure hand hygiene; and standardization of formats and codes for efficient electronic data exchange. In addition, studies of public reporting, including effects of reporting on quality of care, antimicrobial drug use and resistance, and patient outcome, will be valuable in responding to mandatory reporting legislation.

Creating a Cadre of Junior Investigators to Address the Challenges of Cancer-Related Health Disparities: Lessons Learned from the Community Networks Program

Abstract: Community-based participatory research (CBPR) initiatives such as the National Cancer Institute’s Community Networks Program (CNP) (2005–2010) often emphasize training of junior investigators from underrepresented backgrounds to address health disparities. From July to October 2010, a convenience sample of 80 participants from the 25 CNP national sites completed our 45-item, web-based survey on the training and mentoring of junior investigators. This study assessed the academic productivity and CBPR-related experiences of the CNP junior investigators (n = 37). Those from underrepresented backgrounds reported giving more presentations in non-academic settings (nine vs. four in the last 5 years, p = 0.01), having more co-authored publications (eight vs. three in the last 5 years, p = 0.01), and spending more time on CBPR-related activities than their non-underrepresented counterparts. Regardless of background, junior investigators shared similar levels of satisfaction with their mentors and CBPR experiences. This study provides support for the success of the CNP’s training program, especially effort directed at underrepresented investigators.

Quantifying the roles of vomiting, diarrhea, and residents vs. staff in norovirus transmission in U.S. nursing home outbreaks.

Abstract: The role of individual case characteristics, such as symptoms or demographics, in norovirus transmissibility is poorly understood. Six nursing home norovirus outbreaks occurring in South Carolina, U.S. from 2014 to 2016 were examined. We aimed to quantify the contribution of symptoms and other case characteristics in norovirus transmission using the reproduction number (REi) as an estimate of individual case infectivity and to examine how transmission changes over the course of an outbreak. Individual estimates of REi were calculated using a maximum likelihood procedure to infer the average number of secondary cases generated by each case. The associations between case characteristics and REi were estimated using a weighted multivariate mixed linear model. Outbreaks began with one to three index case(s) with large estimated REi's (range: 1.48 to 8.70) relative to subsequent cases. Of the 209 cases, 155 (75%) vomited, 164 (79%) had diarrhea, and 158 (76%) were nursing home residents (vs. staff). Cases who vomited infected 2.12 (95% CI: 1.68, 2.68) times the number of individuals as non-vomiters, cases with diarrhea infected 1.39 (95% CI: 1.03, 1.87) times the number of individuals as cases without diarrhea, and resident-cases infected 1.53 (95% CI: 1.15, 2.02) times the number of individuals as staff-cases. Index cases tended to be residents (vs. staff) who vomited and infected considerably more secondary cases compared to non-index cases. Results suggest that individuals, particularly residents, who vomit are more infectious and tend to drive norovirus transmission in U.S. nursing home norovirus outbreaks. While diarrhea also plays a role in norovirus transmission, it is to a lesser degree than vomiting in these settings. Results lend support for prevention and control measures that focus on cases who vomit, particularly if those cases are residents.