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Methicillin-Resistant Staphylococcus aureus: HELP
Articles by Anthony D. Harris
Based on 22 articles published since 2008
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Between 2008 and 2019, A. D. Harris wrote the following 22 articles about Methicillin-Resistant Staphylococcus aureus.
 
+ Citations + Abstracts
1 Guideline Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. 2014

Calfee, David P / Salgado, Cassandra D / Milstone, Aaron M / Harris, Anthony D / Kuhar, David T / Moody, Julia / Aureden, Kathy / Huang, Susan S / Maragakis, Lisa L / Yokoe, Deborah S / Anonymous5450796. ·Weill Cornell Medical College, New York, New York. ·Infect Control Hosp Epidemiol · Pubmed #24915205.

ABSTRACT: -- No abstract --

2 Review Systematic review of measurement and adjustment for colonization pressure in studies of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and clostridium difficile acquisition. 2011

Ajao, Adebola O / Harris, Anthony D / Roghmann, Mary-Claire / Johnson, J Kristie / Zhan, Min / McGregor, Jessina C / Furuno, Jon P. ·Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 West Baltimore Street, MSTF Room 360 Baltimore, Maryland 21201, USA. aajao@epi.umaryland.edu ·Infect Control Hosp Epidemiol · Pubmed #21515979.

ABSTRACT: OBJECTIVE: Colonization pressure is an important infection control metric. The aim of this study was to describe the definition and measurement of and adjustment for colonization pressure in nosocomial-acquisition risk factor studies of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Clostridium difficile. METHODS: We performed a computerized search of studies of nosocomial MRSA, VRE, and C. difficile acquisition published before July 1, 2009, through MEDLINE. Studies were included if a study outcome was MRSA, VRE, or C. difficile acquisition; the authors identified risk factors associated with MRSA, VRE, or C. difficile acquisition; and the study measured colonization pressure. RESULTS: The initial MEDLINE search yielded 505 articles. Sixty-six of these were identified as studies of nosocomial MRSA, VRE, or C. difficile acquisition; of these, 18 (27%) measured colonization pressure and were included in the final review. The definition of colonization pressure varied considerably between studies: the proportion of MRSA- or VRE-positive patients (5 studies), the proportion of MRSA- or VRE-positive patient-days (6 studies), or the total or mean number of MRSA-, VRE-, or C. difficile-positive patients or patient-days (7 studies) in the unit over periods of varying length. In 10 of 13 studies, colonization pressure was independently associated with MRSA, VRE, or C. difficile acquisition. CONCLUSION: There is a need for a simple and consistent method to quantify colonization pressure in both research and routine clinical care to accurately assess the effect of colonization pressure on cross-transmission of antibiotic-resistant bacteria.

3 Article The Importance of Contact Precautions for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci. 2018

Rubin, Michael A / Samore, Matthew H / Harris, Anthony D. ·Salt Lake Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah. · Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City. · VA Maryland Healthcare System, Baltimore. · Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore. ·JAMA · Pubmed #29435582.

ABSTRACT: -- No abstract --

4 Article Establishing a Research Agenda for Preventing Transmission of Multidrug-Resistant Organisms in Acute-Care Settings in the Veterans Health Administration. 2018

Perencevich, Eli N / Harris, Anthony D / Pfeiffer, Christopher D / Rubin, Michael A / Hill, Jennifer N / Baracco, Gio J / Evans, Martin E / Klutts, J Stacey / Streit, Judy A / Nelson, Richard E / Khader, Karim / Reisinger, Heather Schacht. ·1Iowa City Veterans Affairs (VA) Health Care System,Iowa City,Iowa. · 3Maryland VA Health Care System,Baltimore,Maryland. · 5Department of Hospital and Specialty Medicine,VA Portland Health Care System,Portland Oregon. · 7VA Salt Lake City Health Care System,Salt Lake City,Utah. · 9Department of Veterans Affairs,Center of Innovation for Complex Chronic Healthcare,Edward Hines Jr VA Hospital,Hines,Illinois. · 10Miami VA Health Care System,Miami,Florida. · 12MRSA/MDRO Prevention Office,National Infectious Diseases Service,Patient Care Services,Veterans Health Administration,Washington,DC. ·Infect Control Hosp Epidemiol · Pubmed #29417927.

ABSTRACT: -- No abstract --

5 Article Can National Healthcare-Associated Infections (HAIs) Data Differentiate Hospitals in the United States? 2017

Masnick, Max / Morgan, Daniel J / Sorkin, John D / Macek, Mark D / Brown, Jessica P / Rheingans, Penny / Harris, Anthony D. ·1Department of Epidemiology and Public Health,University of Maryland School of Medicine,Baltimore,Maryland. · 3Veterans Affairs Maryland Healthcare System Geriatrics Research,Education, and Clinical Center,Baltimore,Maryland. · 4University of Maryland School of Dentistry,Baltimore,Maryland. · 5Department of Computer Science and Electrical Engineering,University of Maryland Baltimore County,Baltimore,Maryland. ·Infect Control Hosp Epidemiol · Pubmed #28903802.

ABSTRACT: OBJECTIVE To determine whether patients using the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website (http://medicare.gov/hospitalcompare) can use nationally reported healthcare-associated infection (HAI) data to differentiate hospitals. DESIGN Secondary analysis of publicly available HAI data for calendar year 2013. METHODS We assessed the availability of HAI data for geographically proximate hospitals (ie, hospitals within the same referral region) and then analyzed these data to determine whether they are useful to differentiate hospitals. We assessed data for the 6 HAIs reported by hospitals to the Centers for Disease Control and Prevention (CDC). RESULTS Data were analyzed for 4,561 hospitals representing 88% of registered community and federal government hospitals in the United States. Healthcare-associated infection data are only useful for comparing hospitals if they are available for multiple hospitals within a geographic region. We found that data availability differed by HAI. Clostridium difficile infections (CDI) data were most available, with 82% of geographic regions (ie, hospital referral regions) having >50% of hospitals reporting them. In contrast, 4% of geographic regions had >50% of member hospitals reporting surgical site infections (SSI) for hysterectomies, which had the lowest availability. The ability of HAI data to differentiate hospitals differed by HAI: 72% of hospital referral regions had at least 1 pair of hospitals with statistically different risk-adjusted CDI rates (SIRs), compared to 9% for SSI (hysterectomy). CONCLUSIONS HAI data generally are reported by enough hospitals to meet minimal criteria for useful comparisons in many geographic locations, though this varies by type of HAI. CDI and catheter-associated urinary tract infection (CAUTI) are more likely to differentiate hospitals than the other publicly reported HAIs. Infect Control Hosp Epidemiol 2017;38:1167-1171.

6 Article Effect of meteorological factors and geographic location on methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci colonization in the US. 2017

Blanco, Natalia / Perencevich, Eli / Li, Shan Shan / Morgan, Daniel J / Pineles, Lisa / Johnson, J Kristie / Robinson, Gwen / Anderson, Deverick J / Jacob, Jesse T / Maragakis, Lisa L / Harris, Anthony D / Anonymous410986. ·Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, United States of America. · Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, United States of America. · Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, United States of America. · VA Maryland Healthcare System, Baltimore, United States of America. · Department of Pathology, University of Maryland School of Medicine, Baltimore, United States of America. · Department of Medicine, Duke University School of Medicine, Durham, United States of America. · Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America. · Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, United States of America. ·PLoS One · Pubmed #28558010.

ABSTRACT: BACKGROUND: Little is known about the effect of meteorological conditions and geographical location on bacterial colonization rates particularly of antibiotic-resistant Gram-positive bacteria. We aimed to evaluate the effect of season, meteorological factors, and geographic location on methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) colonization. METHODS: The prospective cohort included all adults admitted to 20 geographically-dispersed ICUs across the US from September 1, 2011 to October 4, 2012. Nasal and perianal swabs were collected at admission and tested for MRSA and VRE colonization respectively. Poisson regression models using monthly aggregated colonization counts as the outcome and mean temperature, relative humidity, total precipitation, season, and/or latitude as predictors were constructed for each pathogen. RESULTS: A total of 24,704 ICU-admitted patients were tested for MRSA and 24,468 for VRE. On admission, 10% of patients were colonized with MRSA and 12% with VRE. For MRSA and VRE, a 10% increase in relative humidity was associated with approximately a 9% increase in prevalence rate. Southerly latitudes in the US were associated with higher MRSA colonization, while northerly latitudes were associated with higher VRE colonization. In contrast to MRSA, the association between VRE colonization and latitude was observed only after adjusting for relative humidity, which demonstrates how this effect is highly driven by this meteorological factor. CONCLUSIONS: To our knowledge, we are the first to study the effect of meteorological factors and geographical location/latitude on MRSA and VRE colonization in adults. Increasing humidity was associated with greater MRSA and VRE colonization. Southerly latitudes in the US were associated with greater MRSA and less VRE. The effect of these factors on MRSA and VRE rates has the potential not only to inform patient management and treatment, but also infection prevention interventions.

7 Article Deconstructing the relative benefits of a universal glove and gown intervention on MRSA acquisition. 2017

Harris, A D / Morgan, D J / Pineles, L / Perencevich, E N / Barnes, S L. ·Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: aharris@epi.umaryland.edu. · Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; Veterans Affairs Maryland Healthcare System, Baltimore, MD, USA; Center for Disease Dynamics, Economics and Policy, Washington, DC, USA. · Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA. · University of Iowa Health Care, Iowa City, IA, USA. · Robert H. Smith School of Business, University of Maryland, College Park, MD, USA. ·J Hosp Infect · Pubmed #28410760.

ABSTRACT: BACKGROUND: The 20-site Benefits of Universal Glove and Gown (BUGG) study found that wearing gloves and gowns for all patient contacts in the intensive care unit (ICU) reduced acquisition rates of meticillin-resistant Staphylococcus aureus (MRSA). The relative importance of gloves and gowns as a barrier, improved hand hygiene, and reduced healthcare worker (HCW)-patient contact rates is unknown. AIM: To determine what proportion of the reduction in acquisition rates observed in the BUGG study was due to improved hand hygiene, reduced contact rates, and universal glove and gown use using agent-based simulation modelling. METHODS: An existing agent-based model to simulate MRSA transmission dynamics in an ICU was modified, and the model was calibrated using site-specific data. Model validation was completed using data collected in the BUGG study. A full 2 FINDINGS: Across 40 simulated replications for each factorial design point and intervention site, approximately 44% of the decrease in MRSA acquisition rates was due to universal glove and gown use, 38.1% of the decrease was due to improvement in hand hygiene compliance on exiting patient rooms, and 14.5% of the decrease was due to the reduction in HCW-patient contact rates. CONCLUSION: Using mathematical modelling, the decrease in MRSA acquisition in the BUGG study was found to be due primarily to the barrier effects of gowns and gloves, followed by improved hand hygiene and lower HCW-patient contact rates.

8 Article Is There a Correlation Between Infection Control Performance and Other Hospital Quality Measures? 2017

O'Hara, Lyndsay M / Morgan, Daniel J / Pineles, Lisa / Li, Shanshan / Sulis, Carol / Bowling, Jason / Drees, Marci / Jacob, Jesse T / Anderson, Deverick J / Warren, David K / Harris, Anthony D. ·1Department of Epidemiology and Public Health,University of Maryland School of Medicine,Baltimore,Maryland. · 2Department of Biostatistics,Indiana University R.M. Fairbanks School of Public Health,Indianapolis,Indiana. · 3Boston Medical Center,Boston,Massachusetts. · 4University of Texas Health Science Center,San Antonio,Texas. · 5Christiana Care Health System,Wilmington,Delaware. · 7Division of Infectious Diseases,Department of Medicine,Emory University School of Medicine,Atlanta,Georgia. · 8Duke Center for Antimicrobial Stewardship and Infection Prevention,Duke University,Durham,North Carolina. · 9Department of Medicine,Washington University,St. Louis,Missouri. ·Infect Control Hosp Epidemiol · Pubmed #28376943.

ABSTRACT: Quality measures are increasingly reported by hospitals to the Centers for Medicare and Medicaid Services (CMS), yet there may be tradeoffs in performance between infection control (IC) and other quality measures. Hospitals that performed best on IC measures did not perform well on most CMS non-IC quality measures. Infect Control Hosp Epidemiol 2017;38:736-739.

9 Article The Impact of Reducing Antibiotics on the Transmission of Multidrug-Resistant Organisms. 2017

Barnes, Sean L / Rock, Clare / Harris, Anthony D / Cosgrove, Sara E / Morgan, Daniel J / Thom, Kerri A. ·1Robert H. Smith School of Business,University of Maryland,College Park,Maryland. · 2Department of Medicine,Division of Infectious Diseases,The Johns Hopkins University School of Medicine,Baltimore,Maryland. · 3Department of Epidemiology and Public Health,University of Maryland School of Medicine,Baltimore,Maryland. ·Infect Control Hosp Epidemiol · Pubmed #28270258.

ABSTRACT: OBJECTIVE Antibiotic resistance is a major threat to public health. Resistance is largely driven by antibiotic usage, which in many cases is unnecessary and can be improved. The impact of decreasing overall antibiotic usage on resistance is unknown and difficult to assess using standard study designs. The objective of this study was to explore the potential impact of reducing antibiotic usage on the transmission of multidrug-resistant organisms (MDROs). DESIGN We used agent-based modeling to simulate interactions between patients and healthcare workers (HCWs) using model inputs informed by the literature. We modeled the effect of antibiotic usage as (1) a microbiome effect, for which antibiotic usage decreases competing bacteria and increases the MDRO transmission probability between patients and HCWs and (2) a mutation effect that designates a proportion of patients who receive antibiotics to subsequently develop a MDRO via genetic mutation. SETTING Intensive care unit INTERVENTIONS Absolute reduction in overall antibiotic usage by experimental values of 10% and 25% RESULTS Reducing antibiotic usage absolutely by 10% (from 75% to 65%) and 25% (from 75% to 50%) reduced acquisition rates of high-prevalence MDROs by 11.2% (P<.001) and 28.3% (P<.001), respectively. We observed similar effect sizes for low-prevalence MDROs. CONCLUSIONS In a critical care setting, where up to 50% of antibiotic courses may be inappropriate, even a moderate reduction in antibiotic usage can reduce MDRO transmission. Infect Control Hosp Epidemiol 2017;38:663-669.

10 Article Effect of chlorhexidine bathing and other infection control practices on the Benefits of Universal Glove and Gown (BUGG) trial: a subgroup analysis. 2015

Morgan, Daniel J / Pineles, Lisa / Shardell, Michelle / Sulis, Carol / Kett, Daniel H / Bowling, Jason / Belton, Beverly M / Harris, Anthony D / Anonymous6140821. ·1University of Maryland School of Medicine,Baltimore,Maryland. · 3Section of Infectious Diseases,Boston University School of Medicine,Boston,Massachusetts. · 4Department of Medicine,University of Miami Miller School of Medicine,Miami,Florida. · 5Division of Infectious Diseases,Department of Medicine,University Health System,University of Texas Health Science Center at San Antonio,San Antonio,Texas. · 6Yale New Haven Health System-Center for Healthcare Solutions,New Haven,Connecticut. Members of the study group are listed at the end of the text. ·Infect Control Hosp Epidemiol · Pubmed #25707404.

ABSTRACT: We report the results of a subgroup analysis of the Benefits of Universal Glove and Gown trial. In 20 intensive care units, the reduction in acquisition of methicillin-resistant Staphylococcus aureus observed in this trial was observed in units also using chlorhexidine bathing and in those that previously performed active surveillance.

11 Article Preventing the transmission of multidrug-resistant organisms: modeling the relative importance of hand hygiene and environmental cleaning interventions. 2014

Barnes, Sean L / Morgan, Daniel J / Harris, Anthony D / Carling, Phillip C / Thom, Kerri A. ·Robert H. Smith School of Business, University of Maryland, College Park, Maryland. ·Infect Control Hosp Epidemiol · Pubmed #25111924.

ABSTRACT: OBJECTIVE: Hand hygiene and environmental cleaning are essential infection prevention strategies, but the relative impact of each is unknown. This information is important in assessing resource allocation. METHODS: We developed an agent-based model of patient-to-patient transmission-via the hands of transiently colonized healthcare workers and incompletely terminally cleaned rooms-in a 20-patient intensive care unit. Nurses and physicians were modeled and had distinct hand hygiene compliance levels on entry and exit to patient rooms. We simulated the transmission of Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci for 1 year using data from the literature and observed data to inform model input parameters. RESULTS: We simulated 175 parameter-based scenarios and compared the effects of hand hygiene and environmental cleaning on rates of multidrug-resistant organism acquisition. For all organisms, increases in hand hygiene compliance outperformed equal increases in thoroughness of terminal cleaning. From baseline, a 2∶1 improvement in terminal cleaning compared with hand hygiene was required to match an equal reduction in acquisition rates (eg, a 20% improvement in terminal cleaning was required to match the reduction in acquisition due to a 10% improvement in hand hygiene compliance). CONCLUSIONS: Hand hygiene should remain a priority for infection control programs, but environmental cleaning can have significant benefit for hospitals or individual hospital units that have either high hand hygiene compliance levels or low terminal cleaning thoroughness.

12 Article Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. 2013

Harris, Anthony D / Pineles, Lisa / Belton, Beverly / Johnson, J Kristie / Shardell, Michelle / Loeb, Mark / Newhouse, Robin / Dembry, Louise / Braun, Barbara / Perencevich, Eli N / Hall, Kendall K / Morgan, Daniel J / Anonymous3160771 / Shahryar, Syed K / Price, Connie S / Gadbaw, Joseph J / Drees, Marci / Kett, Daniel H / Muñoz-Price, L Silvia / Jacob, Jesse T / Herwaldt, Loreen A / Sulis, Carol A / Yokoe, Deborah S / Maragakis, Lisa / Lissauer, Matthew E / Zervos, Marcus J / Warren, David K / Carver, Robin L / Anderson, Deverick J / Calfee, David P / Bowling, Jason E / Safdar, Nasia. · ·JAMA · Pubmed #24097234.

ABSTRACT: IMPORTANCE: Antibiotic-resistant bacteria are associated with increased patient morbidity and mortality. It is unknown whether wearing gloves and gowns for all patient contact in the intensive care unit (ICU) decreases acquisition of antibiotic-resistant bacteria. OBJECTIVE: To assess whether wearing gloves and gowns for all patient contact in the ICU decreases acquisition of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) compared with usual care. DESIGN, SETTING, AND PARTICIPANTS: Cluster-randomized trial in 20 medical and surgical ICUs in 20 US hospitals from January 4, 2012, to October 4, 2012. INTERVENTIONS: In the intervention ICUs, all health care workers were required to wear gloves and gowns for all patient contact and when entering any patient room. MAIN OUTCOMES AND MEASURES: The primary outcome was acquisition of MRSA or VRE based on surveillance cultures collected on admission and discharge from the ICU. Secondary outcomes included individual VRE acquisition, MRSA acquisition, frequency of health care worker visits, hand hygiene compliance, health care–associated infections, and adverse events. RESULTS: From the 26,180 patients included, 92,241 swabs were collected for the primary outcome. Intervention ICUs had a decrease in the primary outcome of MRSA or VRE from 21.35 acquisitions per 1000 patient-days (95% CI, 17.57 to 25.94) in the baseline period to 16.91 acquisitions per 1000 patient-days (95% CI, 14.09 to 20.28) in the study period, whereas control ICUs had a decrease in MRSA or VRE from 19.02 acquisitions per 1000 patient-days (95% CI, 14.20 to 25.49) in the baseline period to 16.29 acquisitions per 1000 patient-days (95% CI, 13.48 to 19.68) in the study period, a difference in changes that was not statistically significant (difference, −1.71 acquisitions per 1000 person-days, 95% CI, −6.15 to 2.73; P = .57). For key secondary outcomes, there was no difference in VRE acquisition with the intervention (difference,  0.89 acquisitions per 1000 person-days; 95% CI, −4.27 to 6.04, P = .70), whereas for MRSA, there were fewer acquisitions with the intervention (difference, −2.98 acquisitions per 1000 person-days; 95% CI, −5.58 to −0.38; P = .046). Universal glove and gown use also decreased health care worker room entry (4.28 vs 5.24 entries per hour, difference, −0.96; 95% CI, −1.71 to −0.21, P = .02), increased room-exit hand hygiene compliance (78.3% vs 62.9%, difference, 15.4%; 95% CI, 8.99% to 21.8%; P = .02) and had no statistically significant effect on rates of adverse events (58.7 events per 1000 patient days vs 74.4 events per 1000 patient days; difference, −15.7; 95% CI, −40.7 to 9.2, P = .24). CONCLUSIONS AND RELEVANCE: The use of gloves and gowns for all patient contact compared with usual care among patients in medical and surgical ICUs did not result in a difference in the primary outcome of acquisition of MRSA or VRE. Although there was a lower risk of MRSA acquisition alone and no difference in adverse events, these secondary outcomes require replication before reaching definitive conclusions. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT0131821.

13 Article A randomized controlled trial of enhanced cleaning to reduce contamination of healthcare worker gowns and gloves with multidrug-resistant bacteria. 2013

Hess, Aaron S / Shardell, Michelle / Johnson, J Kristie / Thom, Kerri A / Roghmann, Mary-Claire / Netzer, Giora / Amr, Sania / Morgan, Daniel J / Harris, Anthony D. ·Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201, USA. aaron.hess@som.umaryland.edu ·Infect Control Hosp Epidemiol · Pubmed #23571365.

ABSTRACT: OBJECTIVE. To determine whether enhanced daily cleaning would reduce contamination of healthcare worker (HCW) gowns and gloves with methicillin-resistant Staphylococcus aureus (MRSA) or multidrug-resistant Acinetobacter baumannii (MDRAB). DESIGN. A cluster-randomized controlled trial. SETTING. Four intensive care units (ICUs) in an urban tertiary care hospital. PARTICIPANTs. ICU rooms occupied by patients colonized with MRSA or MDRAB. INTERVENTION. Extra enhanced daily cleaning of ICU room surfaces frequently touched by HCWs. RESULTS. A total of 4,444 cultures were collected from 132 rooms over 10 months. Using fluorescent dot markers at 2,199 surfaces, we found that 26% of surfaces in control rooms were cleaned and that 100% of surfaces in experimental rooms were cleaned (P < .001). The mean proportion of contaminated HCW gowns and gloves following routine care provision and before leaving the rooms of patients with MDRAB was 16% among control rooms and 12% among experimental rooms (relative risk, 0.77 [95% confidence interval, 0.28-2.11]; P = .23). For MRSA, the mean proportions were 22% and 19%, respectively (relative risk, 0.89 [95% confidence interval, 0.50-1.53]; P = .16). DISCUSSION. Intense enhanced daily cleaning of ICU rooms occupied by patients colonized with MRSA or MDRAB was associated with a nonsignificant reduction in contamination of HCW gowns and gloves after routine patient care activities. Further research is needed to determine whether intense environmental cleaning will lead to significant reductions and fewer infections.

14 Article Association between methicillin-resistant Staphylococcus aureus colonization and infection may not differ by age group. 2013

Ajao, Adebola O / Harris, Anthony D / Johnson, J Kristie / Roghmann, Mary-Claire / Perencevich, Eli N / Schweizer, Marin L / Zhan, Min / Chen, Wilbur H / Furuno, Jon P. ·Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA. ·Infect Control Hosp Epidemiol · Pubmed #23221199.

ABSTRACT: We assessed whether age modified the association between methicillin-resistant Staphylococcus aureus (MRSA) anterior nares colonization and subsequent infection. Among 7,405 patients (9,511 admissions), MRSA colonization was significantly associated with infection (adjusted odds ratio, 13.7 [95% confidence interval, 7.3-25.7]) but did not differ significantly by age group.

15 Article Healthcare-associated infection and hospital readmission. 2012

Emerson, Carley B / Eyzaguirre, Lindsay M / Albrecht, Jennifer S / Comer, Angela C / Harris, Anthony D / Furuno, Jon P. ·Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA. ·Infect Control Hosp Epidemiol · Pubmed #22561707.

ABSTRACT: OBJECTIVE: Hospital readmissions are a current target of initiatives to reduce healthcare costs. This study quantified the association between having a clinical culture positive for 1 of 3 prevalent hospital-associated organisms and time to hospital readmission. DESIGN: Retrospective cohort study. PATIENTS AND SETTING: Adults admitted to an academic, tertiary care referral center from January 1, 2001, through December 31, 2008. METHODS: The primary exposure of interest was a clinical culture positive for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), or Clostridium difficile obtained more than 48 hours after hospital admission during the index hospital stay. The primary outcome of interest was time to readmission to the index facility. Multivariable Cox proportional hazards models were used to model the adjusted association between positive clinical culture result and time to readmission and to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Among 136,513 index admissions, the prevalence of hospital-associated positive clinical culture result for 1 of the 3 organisms of interest was 3%, and 35% of patients were readmitted to the index facility within 1 year after discharge. Patients with a positive clinical culture obtained more than 48 hours after hospital admission had an increased hazard of readmission (HR, 1.40; 95% CI, 1.33-1.46) after adjusting for age, sex, index admission length of stay, intensive care unit stay, Charlson comorbidity index, and year of hospital admission. CONCLUSIONS: Patients with healthcare-associated infections may be at increased risk of hospital readmission. These findings may be used to impact health outcomes after discharge from the hospital and to encourage better infection prevention efforts.

16 Article Survival of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus spp. for an extended period of transport. 2012

Robinson, Gwen L / Harris, Anthony D / Morgan, Daniel J / Pineles, Lisa / Belton, Beverly M / Johnson, J Kristie / Anonymous3430724. ·University of Maryland, Department of Pathology, Baltimore, MD, USA. ·J Clin Microbiol · Pubmed #22535993.

ABSTRACT: This study determined the survivability of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) for extended periods of time and temperatures using a standard swab for assessment. Our study showed that transportation in Liquid Amies medium could be performed at room temperature or 4°C for up to 14 days without a decrease in recovery of MRSA or VRE.

17 Article Contribution of interfacility patient movement to overall methicillin-resistant Staphylococcus aureus prevalence levels. 2011

Barnes, Sean L / Harris, Anthony D / Golden, Bruce L / Wasil, Edward A / Furuno, Jon P. ·Department of Mathematics, School of Computer, Mathematical, and Natural Sciences, University of Maryland, College Park, Maryland, USA. ·Infect Control Hosp Epidemiol · Pubmed #22011533.

ABSTRACT: OBJECTIVES: The effect of patient movement between hospitals and long-term care facilities (LTCFs) on methicillin-resistant Staphylococcus aureus (MRSA) prevalence levels is unknown. We investigated these effects to identify scenarios that may lead to increased prevalence in either facility type. METHODS: We used a hybrid simulation model to simulate MRSA transmission among hospitals and LTCFs. Transmission within each facility was determined by mathematical model equations. The model predicted the long-term prevalence of each facility and was used to assess the effects of facility size, patient turnover, and decolonization. RESULTS: Analyses of various healthcare networks suggest that the effect of patients moving from a LTCF to a hospital is negligible unless the patients are consistently admitted to the same unit. In such cases, MRSA prevalence can increase significantly regardless of the endemic level. Hospitals can cause sustained increases in prevalence when transferring patients to LTCFs, where the population size is smaller and patient turnover is less frequent. For 1 particular scenario, the steady-state prevalence of a LTCF increased from 6.9% to 9.4% to 13.8% when the transmission rate of the hospital increased from a low to a high transmission rate. CONCLUSIONS: These results suggest that the relative facility size and the patient discharge rate are 2 key factors that can lead to sustained increases in MRSA prevalence. Consequently, small facilities or those with low turnover rates are especially susceptible to sustaining increased prevalence levels, and they become more so when receiving patients from larger, high-prevalence facilities. Decolonization is an infection-control strategy that can mitigate these effects.

18 Article Comparison of the methicillin-resistant Staphylococcus aureus acquisition among rehabilitation and nursing home residents. 2011

Furuno, Jon P / Shurland, Simone M / Zhan, Min / Johnson, J Kristie / Venezia, Richard A / Harris, Anthony D / Roghmann, Mary-Claire. ·Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. jfuruno@epi.umaryland.edu ·Infect Control Hosp Epidemiol · Pubmed #21460509.

ABSTRACT: OBJECTIVE: To assess risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition among extended care residents focusing on level of care (residential vs rehabilitation) and room placement with an MRSA-positive resident. DESIGN: Prospective cohort study. SETTING: Extended care units at 2 healthcare systems in Maryland. PARTICIPANTS: Four hundred forty-three residents with no history of MRSA and negative MRSA surveillance cultures of the anterior nares and areas of skin breakdown at enrollment. METHODS: Follow-up cultures were collected every 4 weeks and/or at discharge for a period of 12 weeks. Study data were collected by a research nurse from the medical staff and the electronic medical records. Cox proportional hazards modeling was used to calculate adjusted hazards ratios (aHRs) and 95% confidence intervals (CIs). RESULTS: Residents in rehabilitation care had 4-fold higher risk of MRSA acquisition compared with residents in residential care (hazard ratio [HR], 4. [95% CI, 2.2-8.8]). Being bedbound was significantly associated with MRSA acquisition in both populations (residential care, aHR, 4.3 [95% CI, 1.5-12.2]; rehabilitation care, aHR, 4.8 [95% CI, 1.2-18.7]). Having an MRSA-positive roommate was not significantly associated with acquisition in either population (residential care, aHR, 1.4 [95% CI, 0.5-3.9]; rehabilitation care, aHR, 0.5 [95% CI, 0.1-2.2]); based on concordant spa typing, only 2 of 8 residents who acquired MRSA and had room placement with an MRSA-positive resident acquired their MRSA isolate from their roommate. CONCLUSION: Residents in rehabilitation care appear at higher risk and have different risk factors for MRSA acquisition compared to those in residential care.

19 Article Staphylococcus aureus infections in US veterans, Maryland, USA, 1999-2008. 2011

Tracy, LaRee A / Furuno, Jon P / Harris, Anthony D / Singer, Mary / Langenberg, Patricia / Roghmann, Mary-Claire. ·University of Maryland, Department of Epidemiology and Public Health, 685 W Baltimore St, MSTF 336, Baltimore, MD 21201, USA. laree.tracy@fda.hhs.gov ·Emerg Infect Dis · Pubmed #21392435.

ABSTRACT: Trends in Staphylococcus aureus infections are not well described. To calculate incidence in overall S. aureus infection and invasive and noninvasive infections according to methicillin susceptibility and location, we conducted a 10-year population-based retrospective cohort study (1999-2008) using patient-level data in the Veterans Affairs Maryland Health Care System. We found 3,674 S. aureus infections: 2,816 (77%) were noninvasive; 2,256 (61%) were methicillin-resistant S. aureus (MRSA); 2,517 (69%) were community onset, and 1,157 (31%) were hospital onset. Sixty-one percent of noninvasive infections were skin and soft tissue infections; 1,112 (65%) of these were MRSA. Ten-year averaged incidence per 100,000 veterans was 749 (± 132 SD, range 549-954) overall, 178 (± 41 SD, range 114-259) invasive, and 571 (± 152 SD, range 364-801) noninvasive S. aureus infections. Incidence of all S. aureus infections significantly increased (p<0.001), driven by noninvasive, MRSA, and community-onset infections (p<0.001); incidence of invasive S. aureus infection significantly decreased (p<0.001).

20 Article Targeted surveillance of methicillin-resistant Staphylococcus aureus and its potential use to guide empiric antibiotic therapy. 2010

Harris, Anthony D / Furuno, Jon P / Roghmann, Mary-Claire / Johnson, Jennifer K / Conway, Laurie J / Venezia, Richard A / Standiford, Harold C / Schweizer, Marin L / Hebden, Joan N / Moore, Anita C / Perencevich, Eli N. ·Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 685 W. Baltimore St., Room 330, Baltimore, MD 21201, USA. aharris@epi.umaryland.edu ·Antimicrob Agents Chemother · Pubmed #20479207.

ABSTRACT: The present study aimed to determine the frequency of methicillin-resistant Staphylococcus aureus (MRSA)-positive clinical culture among hospitalized adults in different risk categories of a targeted MRSA active surveillance screening program and to assess the utility of screening in guiding empiric antibiotic therapy. We completed a prospective cohort study in which all adults admitted to non-intensive-care-unit locations who had no history of MRSA colonization or infection received targeted screening for MRSA colonization upon hospital admission. Anterior nares swab specimens were obtained from all high-risk patients, defined as those who self-reported admission to a health care facility within the previous 12 months or who had an active skin infection on admission. Data were analyzed for the subcohort of patients in whom an infection was suspected, determined by (i) receipt of antibiotics within 48 h of admission and/or (ii) the result of culture of a sample for clinical analysis (clinical culture) obtained within 48 h of admission. Overall, 29,978 patients were screened and 12,080 patients had suspected infections. A total of 46.4% were deemed to be at high risk on the basis of the definition presented above, and 11.1% of these were MRSA screening positive (colonized). Among the screening-positive patients, 23.8% had a sample positive for MRSA by clinical culture. Only 2.4% of patients deemed to be at high risk but found to be screening negative had a sample positive for MRSA by clinical culture, and 1.6% of patients deemed to be at low risk had a sample positive for MRSA by clinical culture. The risk of MRSA infection was far higher in those who were deemed to be at high risk and who were surveillance culture positive. Targeted MRSA active surveillance may be beneficial in guiding empiric anti-MRSA therapy.

21 Article Bacterial contamination of health care workers' white coats. 2009

Treakle, Amy M / Thom, Kerri A / Furuno, Jon P / Strauss, Sandra M / Harris, Anthony D / Perencevich, Eli N. ·Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA. ·Am J Infect Control · Pubmed #18834751.

ABSTRACT: BACKGROUND: Patient-to-patient transmission of nosocomial pathogens has been linked to transient colonization of health care workers, and studies have suggested that contamination of health care workers' clothing, including white coats, may be a vector for this transmission. METHODS: We performed a cross-sectional study involving attendees of medical and surgical grand rounds at a large teaching hospital to investigate the prevalence of contamination of white coats with important nosocomial pathogens, such as methicillin-sensitive Stapylococcus aureus, methicillin-resistant S aureus (MRSA), and vancomycin-resistant enterococci (VRE). Each participant completed a brief survey and cultured his or her white coat using a moistened culture swab on lapels, pockets, and cuffs. RESULTS: Among the 149 grand rounds attendees' white coats, 34 (23%) were contaminated with S aureus, of which 6 (18%) were MRSA. None of the coats was contaminated with VRE. S aureus contamination was more prevalent in residents, those working in inpatient settings, and those who saw an inpatient that day. CONCLUSION: This study suggests that a large proportion of health care workers' white coats may be contaminated with S aureus, including MRSA. White coats may be an important vector for patient-to-patient transmission of S aureus.

22 Minor Assessing sensitivity and specificity in new diagnostic tests: the importance and challenges of study populations. 2012

Strassle, Paula / Hess, Aaron S / Thom, Kerri A / Harris, Anthony D. · ·Infect Control Hosp Epidemiol · Pubmed #23041823.

ABSTRACT: -- No abstract --