Objective: The seroprevalence of Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-COV-2) IgG antibody was evaluated among employees of a Veterans Affairs Healthcare System to assess potential risk factors for transmission and infection. Methods: All employees were invited to participate in a questionnaire and serological survey to detect antibodies to SARS-CoV-2 M protein as part of a facility-wide quality improvement and infection prevention initiative regardless of clinical or non-clinical duties. The initiative was conducted from June 8 to July 8, 2020. Results: Of the 2900 employees, 50.9% participated in the study, revealing a positive SARS-COV-2 seroprevalence of 4.9% (72/1476), [95% CI of 4.04% - 5.89%]. There were no statistically significant differences in the presence of antibody based on gender, age, frontline worker status, job title, performance of aerosol generating procedures or exposure to known patients with coronavirus infectious disease 2019 (COVID-19) within the hospital. Employees who reported exposure to a known COVID-19 case outside of work had a significantly higher seroprevalence at 14.84% (23/155) compared to those that did not 3.70% (48/1296), OR 4.53 [95% CI 2.67-7.68] p<0.0001. Notably, 29% of seropositive employees reported no history of symptoms for SARS-CoV-2 infection. Conclusions: Seroprevalence of SARS-COV-2 among employees was not significantly different among those who provided direct patient care and those who did not, suggesting facility-wide infection control measures based were effective. Employees who reported direct personal contact with COVID-19 positive persons outside of work were more likely to have SARS-CoV-2 antibodies. Employee exposure to SARS-CoV-2 outside of work may introduce infection into hospitals.

Background: Hands of health care personnel (HCP) can transmit multidrug-resistant organisms (MDROs), resulting in infections. Our aim was to determine MDRO prevalence on HCP hands in adult acute care and nursing facility settings. Methods: A systematic search of PubMed/MEDLINE, Web of Science, CINAHL, Embase, and Cochrane CEN-TRAL was performed. Studies were included if they reported microbiologic culture results following HCP hands sampling; included prevalent MDROs, such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus, Clostridium difficile, Acinetobacter baumannii, or Pseudomonas aeruginosa, and were conducted in acute care or nursing facility settings. Results: Fifty-nine articles comprising 6,840 hand cultures were included. Pooled prevalence for MRSA, P aeruginosa, A baumannii, and vancomycin-resistant Enterococcus were 4.26%, 4.59%, 6.18%, and 9.03%, respectively. Substantial heterogeneity in rates of pathogen isolation were observed across studies (I 2 = 81%-95%). Only 4 of 59 studies sampled for C difficile, with 2 of 4 finding no growth. Subgroup analysis of MRSA revealed the highest HCP hand contamination rates in North America (8.28%). Sample collection methods used were comparable for MRSA isolation (4%-7%) except for agar direct contact (1.55%). Conclusions: Prevalence of common MDROs on HCP hands vary by pathogen, care setting, culture acquisition method, study design, and geography. When obtained at an institutional level, these prevalence data can be utilized to enhance knowledge, practice, and research to prevent health care−associated infections.

Background: Survival outcomes following in-hospital cardiac arrest (IHCA) vary significantly across hospitals. Research suggests clinician education and training may play a role. We sought to identify best practices related to the education and training of resuscitation teams. Methods: We conducted a descriptive qualitative analysis of semi-structured interview data obtained from in-depth site visits conducted from 2016-2017 at 9 diverse hospitals within the American Heart Association "Get With The Guidelines" registry, selected based on IHCA survival performance (5 top-, 1 middle-, 3 low-performing). We assessed coded data related to education and training including systems learning, informal feedback and debrief, and formal learning through ACLS and mock codes. Thematic analysis was used to identify best practices. Results: In total, 129 interviews were conducted with a variety of hospital staff including nurses, chaplains, security guards, respiratory therapists, physicians, pharmacists, and administrators, yielding 78 hours and 29 minutes of interview time. Four themes related to training and education were identified: engagement, clear communication, consistency, and responsive leadership. Top-performing hospitals encouraged employee engagement with creative marketing of new programs and prioritizing hands-on learning over passive didactics. Clear communication was accomplished with debriefing, structured institutional review, and continual, frequent education for departments. Consistency was a cornerstone to culture change and was achieved with uniform policies for simulation practice as well as reinforced, routine practice (weekly, monthly, quarterly). Finally, top-performing hospitals had responsive leadership teams across multiple disciplines (nursing, respiratory therapy, pharmacy and medicine), who listened and adapted programs to fit the needs of their staff. Conclusions: Among top-performing hospitals excelling in IHCA survival, we identified core elements for education and training of resuscitation teams. Developing tools to expand these areas for hospitals may improve IHCA outcomes.