A5031772073- Antibiotic Use and Resistance
- Patient Satisfaction in Healthcare
- Surgical site infection prevention
- Orthopedic Infections and Treatments
- Infection Control and Ventilation
- Antimicrobial Resistance in Staphylococcus
- Chronic Disease Management Strategies
- Infection Control in Healthcare
- Healthcare Policy and Management
- Healthcare Systems and Technology
- Palliative Care and End-of-Life Issues
- Primary Care and Health Outcomes
- Medical Device Sterilization and Disinfection
- Antibiotics Pharmacokinetics and Efficacy
- Nosocomial Infections in ICU
- Bacterial Identification and Susceptibility Testing
- Orthopaedic implants and arthroplasty
- Clinical practice guidelines implementation
- Health Services Management and Policy
- Listeria monocytogenes in Food Safety
- Qualitative Research Methods and Ethics
- HIV/AIDS oral health manifestations
- Health Policy Implementation Science
- Focus Groups and Qualitative Methods
- Dental Anxiety and Anesthesia Techniques
University of Iowa
2012-2025
Iowa City VA Health Care System
2021-2025
Iowa City VA Medical Center
2022-2025
VA Puget Sound Health Care System
2021
Kaiser Permanente Washington Health Research Institute
2021
University of Washington
2021
Museum of Heilongjiang Province
2021
Boston University
2020
Chesapeake Bay Program
2003
To evaluate the representativeness of controls in an ongoing, population-based, case-control study birth defects 10 centers across United States, researchers compared 1997–2003 certificate data linked to selected (n = 6,681) and control participants 4,395) with those from their base populations 2,468,697). Researchers analyzed differences population characteristics (e.g., percentage births at ≥2,500 g) for each group. Compared populations, did not differ distributions maternal or paternal...
Abstract Background Ultraviolet-C (UV-C) disinfection has been increasingly used to enhance terminal room cleaning and prevent hospital pathogen transmissions. We reported that UV-C implementation in Veterans Affairs (VA) hospitals was associated with a 17% reduction Gram-negative bloodstream infections (BSI), but significant facility-level variation. To investigate this variation, we evaluated facilitators barriers implementing at VA hospitals. Methods interviewed environmental management...
Abstract Background The SHEA/IDSA/APIC Strategies to Prevent MRSA Transmission and Infection Practice Recommendations advised that facilities consider decolonizing patients on hemodialysis. We implemented a nasal decolonization intervention in which self-administered povidone-iodine (PVI) at each dialysis session. aimed assess safety effectiveness. Methods performed stepped wedge cluster randomized trial 16 outpatient hemodialysis units affiliated with 5 academic medical centers between...
Abstract Background Environmental disinfection reduces the risk of hospital infections. Prior evidence from Veterans Affairs (VA) healthcare system suggests that adding UV-C systems to manual processes significantly reduced nosocomial infection rates. Many VAs have added disinfection, but with wide variation in implementation, effectiveness, and use. To address this, we developed, piloted, implemented a national VA toolkit. Methods Our multicenter implementation science program project grant...
Importance Indefinite suppressive antibiotic therapy (SAT) is sometimes prescribed after initial treatment for prosthetic joint infection (PJI). Limited evidence on outcomes SAT exists, and using patients at low risk who may not need it could be associated with resistance adverse events. Objectives To characterize clinical decision-making about PJI identify stewardship intervention opportunities to stop or reduce benefit. Design, Setting, Participants In this qualitative study, interviews...
Use of complementary and alternative medicine by males with Duchenne or Becker muscular dystrophy was examined using interview reports from caregivers enrolled in the population-based Muscular Dystrophy Surveillance, Tracking, Research Network. Of 200 interviewed, 160 (80%) reported "ever" for their affected children. Mind-body (61.5%) most frequently used, followed biologically based practices (48.0%), manipulative body-based (29.0%), whole medical systems (8.5%). Caregivers reporting use...
Abstract Background: We assessed the implementation of telehealth-supported stewardship activities in acute-care units and long-term care (LTC) Veterans’ Administration medical centers (VAMCs). Design: Before-and-after, quasi-experimental effectiveness study with a baseline period (2019–2020) an intervention (2021). Setting: The was conducted 3 VAMCs without onsite infectious disease (ID) support. Participants: included inpatient providers at participating sites who prescribe antibiotics....
Abstract Background Patients with multiple chronic conditions (multimorbidity) and additional psychosocial complexity are at higher risk of adverse outcomes. Establishing treatment or care plans for these patients must account their disease interactions, finite self-management abilities, even conflicting recommendations from clinical practice guidelines. Despite existing insight into how primary physicians (PCPs) approach decisions in general, less is known about PCPs make planning more...
Contaminated surfaces in healthcare settings contribute to the transmission of nosocomial pathogens. Adequate environmental cleaning is important for preventing pathogens and reducing healthcare-associated infections. However, effective practices vary considerably. We examined management services (EMS) staff experiences perceptions surrounding describe perceived challenges ideas promote an program.Qualitative study.Frontline EMS staff.From January June 2019, we conducted individual...
Many epidemiological and public health surveys report increasing difficulty obtaining high participation rates. We conducted a pilot follow-up study to determine whether mailed or telephone survey would better facilitate data collection in subset of respondents an earlier as part the National Birth Defects Prevention Study. randomly assigned 392 eligible mothers receive self-administered, questionnaire (MQ) computer-assisted interview (CATI) using similar recruitment protocols. If gave...
To develop a fully automated algorithm using data from the Veterans' Affairs (VA) electrical medical record (EMR) to identify deep-incisional surgical site infections (SSIs) after cardiac surgeries and total joint arthroplasties (TJAs) be used for research studies.Retrospective cohort study.This study was conducted in 11 VA hospitals.Patients who underwent coronary artery bypass grafting or valve replacement between January 1, 2010, March 31, 2018 (cardiac cohort) patients hip arthroplasty...
Abstract Objective: Antibiotic overuse is common across walk-in clinics, but it unclear which stewardship metrics are most effective for audit and feedback. In this study, we assessed the validity of a metric that captures antibiotic prescribing respiratory tract diagnoses (RTDs). Design: We performed mixed-methods study to evaluate an RTD metric, quantified frequency at provider prescribed antibiotics visits after excluding with complicating factors. Setting: Seven clinics integrated...
Importance While current evidence has demonstrated a surgical site infection (SSI) prevention bundle consisting of preoperative Staphylococcus aureus screening, nasal and skin decolonization, use appropriate perioperative antibiotic based on screening results can decrease rates SSI caused by S , it is well known that interventions may need to be modified address facility-level factors. Objective To assess the association between implementation an allowing for facility discretion regarding...
Abstract Objective: To assess the effectiveness and acceptability of antimicrobial stewardship-focused implementation strategies on inpatient fluoroquinolones. Methods: Stewardship champions at 15 hospitals were surveyed regarding use to improve fluoroquinolone prescribing. Antibiotic days therapy (DOT) per 1,000 present (DP) for sites with without prospective audit feedback (PAF) and/or prior approval compared. Results: Among all sites, 60% had PAF or implemented Compared using neither...
As part of a multicenter evidence-based intervention for surgical site infection prevention, qualitative study was conducted with control teams and staff members at three Department Veterans Affairs Healthcare Systems in the USA. This aimed to identify strategies used by nurses other facility champions implementation nasal decolonization intervention. Site visit observations field notes provided contextual information. Interview data were analyzed inductive deductive content analysis. mapped...
Abstract Introduction The optimal method for implementing hospital-level restrictions antibiotics that carry a high risk of Clostridioides difficile infection has not been identified. We aimed to explore barriers and facilitators fluoroquinolones third/fourth-generation cephalosporins. Methods This mixed-methods study across purposeful sample 15 acute-care, geographically dispersed Veterans Health Administration hospitals included electronic surveys semi-structured interviews (September 2018...
Narrative Abstract We evaluated barriers and facilitators to patient adherence with a bundled intervention including chlorhexidine gluconate (CHG) bathing decolonizing Staphylococcus aureus nasal carriers in real-world setting. Survey data identified 85.5% home use of CHG as directed 52.9% mupirocin directed.
Abstract Background: Environmental cleaning is important in the interruption of pathogen transmission. Although prevention initiatives have targeted environmental cleaning, practice variations exist and compliance low. Evaluation human factors influencing practices can be valuable developing interventions to standardized practices. We conducted a work-system analysis using human-factors engineering (HFE) framework identify barriers facilitators acute long-term care settings within Veterans’...
The prevalence of patients with multimorbidity (ie, multiple chronic conditions) is increasing. Clinical decision-making guided by patients' values, health priorities and goals, treatment preferences particularly important in the context interacting diseases psychosocial needs. Physicians face challenges incorporating patient perspectives into care plans. We examined primary physician (PCP) views on influence clinical decisions for increased complexity.We conducted semi-structured telephone...
Abstract Background: A substantial proportion of patients undergoing hemodialysis carry Staphylococcus aureus in their noses, and carriers are at increased risk S. bloodstream infections. Our pragmatic clinical trial implemented nasal povidone-iodine (PVI) decolonization for the prevention infections novel setting units. Objective: We aimed to identify strategies implementing PVI among outpatient Design: Qualitative descriptive study. Setting: Outpatient units affiliated with five US...
Background: Patients undergoing hemodialysis are at high risk for healthcare-associated infections; they 100 times the of Staphylococcus aureus bloodstream infections (BSI) compared with U.S. adults not on hemodialysis. Prior studies found that nasal decolonization mupirocin prevented S. BSI among patients. We implemented a intervention in which patients self-administered povidone-iodine (PVI) each dialysis session. aimed to assess: 1) patients’ knowledge their infection and willingness take...
Colonization with Staphylococcus aureus (SA) increases the risk of surgical site infection (SSI) and de-colonization reduces this depending on level patient adherence. Our VA facility’s participation in a multi-site study to identify best strategies for implementing peri-operative SA provided an opportunity examine reliability existing internal processes. The objectives single-site were asses self-reported adherence, barriers recommended procedures, as well if current educational materials...
To investigate factors that influence antibiotic prescribing decisions, we interviewed 49 stewardship champions and stakeholders across 15 hospitals. We conducted thematic analysis subcoding of decisional factors. identified 31 decisions. These may help programs identify educational targets design more effective interventions.
Abstract Background 2-stage exchange (2SE) surgery is often used to treat chronic prosthetic joint infections (PJI). IDSA guidelines do not recommend oral antibiotic suppression after 2SE. However, a recent randomized trial suggested that antibiotics for 3 months arthroplasty reimplantation may prevent recurrent PJI. Objective: To compare rates of treatment failure (i.e., PJI) and adverse reactions (ARs) among patients who received < 1 month directly those 1-3 following (extended...