Donna Armellino - Academia.edu (original) (raw)

Papers by Donna Armellino

Emerging Infectious Diseases, Apr 1, 2012

al. Improved assay to detect neutralizing-antibody following vaccination with diluted or undilute... more al. Improved assay to detect neutralizing-antibody following vaccination with diluted or undiluted vaccinia (Dryvax) vaccine.

American Journal of Infection Control, Feb 1, 2020

Background: This non-randomized comparative observational study evaluated the performance of a st... more Background: This non-randomized comparative observational study evaluated the performance of a standard manual-chemical disinfection process with an automated process employing focused multivector ultraviolet (FMUV) light technology during operating room (OR) terminal cleaning. Methods: An Association of periOperative Registered Nurses terminal cleaning protocol was modified to incorporate the use of automated FMUV technology that allows workers to occupy the room during operation. This modified protocol was compared with a standard manual-chemical cleaning and disinfection protocol. Equipment surfaces were pre-sampled before and after terminal cleaning. A total of 165 objects were sampled in each process using a 5-point multisided sampling method. Results: The parallel process employing FMUV reduced the active microbial burden by 96.5% from baseline (P < .0001), which was over 2.5 times better than the standard process. The standard terminal manual-chemical disinfection process reduced the active microbial burden on sampled objects by 38.4% from baseline (P < .0001). Conclusions: The data demonstrates that the performance of standard manual-chemical disinfection alone is variable in a live clinical setting even under the most ideal conditions. By comparison, automated FMUV treatment incorporated in a parallel process consistently produced thorough and significant reductions of microbial contamination levels on all visibly clean patient care equipment.

Joint Commission journal on quality and patient safety, Jun 1, 2016

American Journal of Infection Control, Oct 1, 2016

Influenza vaccine health care personnel vaccine acceptance rates Achieving high vaccination rates... more Influenza vaccine health care personnel vaccine acceptance rates Achieving high vaccination rates of health care personnel (HCP) is critical in preventing influenza transmission from HCP to patients and from patients to HCP; however, acceptance rates remain low. In 2013, New York State adopted the flu mask regulation, requiring unvaccinated HCP to wear a mask when in areas where patients are present. The purpose of this study assessed the impact of the flu mask regulation on the HCP influenza vaccination rate. A 13-question survey was distributed electronically and manually to the HCP to examine their knowledge of influenza transmission and the influenza vaccine and their personal vaccine acceptance history and perception about the use of the mask while working if not vaccinated. There were 1,905 respondents; 87% accepted the influenza vaccine, and 63% were first-time recipients who agreed the regulation influenced their vaccination decision. Of the respondents who declined the vaccine, 72% acknowledge HCP are at risk for transmitting influenza to patients, and 56% reported they did not receive enough information to make an educated decision. The flu mask protocol may have influenced HCP's choice to be vaccinated versus wearing a mask. The study findings supported that HCP may not have adequate knowledge on the morbidity and mortality associated with influenza. Regulatory agencies need to consider an alternative approach to increase HCP vaccination, such as mandating the influenza vaccine for HCP.

American Journal of Infection Control, May 1, 2014

Chlorhexidine gluconate (CHG) decreases hospital-acquired methicillin-resistant Staphylococcus au... more Chlorhexidine gluconate (CHG) decreases hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) that can cause colonization and infection. A standard approach is the bathing of all patients with CHG to prevent MRSA transmission. To decrease CHG utilization, this study assessed selective daily administration of CHG bathing to intensive care unit patients who had an MRSA-positive result or a central venous catheter. This risk-based approach was associated with a 72% decrease in hospitalacquired MRSA transmission rate.

American Journal of Infection Control, Apr 1, 2019

Background: The aim of this study was to evaluate the performance of a focused multivector ultrav... more Background: The aim of this study was to evaluate the performance of a focused multivector ultraviolet (FMUV) system employing shadowless delivery with a 90-second disinfection cycle for patient care equipment inside and outside the operating room (OR) suite without manual-chemical disinfection. Methods: A 5-point multisided sampling protocol was utilized to measure the microbial burden on objects inside and outside the OR environment in a 3-phase nonrandomized observational study. Surface sampling was performed pre-and postdisinfection in between cases (IBCs) to assess the performance of manual-chemical disinfection. FMUV system performance was separately assessed pre-and postdisinfection before the first case and IBCs. Additionally, visibly clean high-touch objects were sampled outside the OR, and the microbial burden reductions after FMUV disinfection were quantified without manual-chemical disinfection. Results: Manual-chemical disinfection reduced the active microbial burden on sampled objects IBCs by 52.8%-90.9% (P < .05). FMUV reduced the active microbial burden by 92%-97.7% (P < .0001) before the first case and IBCs combined, and 96.3%-99.6% (P < .0001) on objects outside the OR without chemical disinfection. Conclusions: Five-point multisided sampling proved effective for assessing disinfection performance on all exterior sides of equipment. FMUV produced significant overall reductions of the microbial burden on patient care equipment in all study phases and independent of manual cleaning and chemical disinfection.

American Journal of Infection Control, Jun 1, 2015

Pediatric Research, Apr 1, 1997

Journal of Bone and Joint Surgery, American Volume, Mar 29, 2022

Background: Immediate-use steam sterilization (IUSS), formerly termed “flash” sterilization, has ... more Background: Immediate-use steam sterilization (IUSS), formerly termed “flash” sterilization, has been historically used to sterilize surgical instruments in emergency situations. Strict guidelines deter its use, as IUSS has been theorized to increase the risk of surgical site infections (SSIs), leading to increased health-care costs and poor patient outcomes. We sought to examine the association between the use of IUSS and the rate of orthopaedic SSIs. Methods: The cases of 70,600 patients who underwent orthopaedic surgery—total knee or hip arthroplasty, laminectomy, or spinal fusion—from January 2014 to December 2020, were retrospectively reviewed for IUSS use. Of this group, 3,526 patients had had IUSS used during surgery. A propensity score-matched (PSM) analysis was conducted to account for known predictors of SSIs and included a total of 7,052 patients. The risk difference (RD), relative risk (RR), odds ratio (OR), and McNemar test compared the SSI risk for patients whose procedure had included the use of IUSS and those whose procedure had not included IUSS. Results: After propensity score matching, 111 (1.57%) of the 7,052 matched patients developed an SSI. Of the 111 patients, 61 (54.95%) were in the IUSS group and 50 (45.05%) were in the non-IUSS group. The estimated probability for developing an SSI was 1.42% for the patients in the non-IUSS group versus 1.73% for the patients in the IUSS group (RR = 0.82 [95% confidence interval (CI)]: 0.57 to 1.19], RD = –0.3% [95% CI: –0.9% to 0.27%]).There was no evidence that the proportion of SSI was greater in the IUSS group (McNemar test, p > 0.29). Conclusions: SSI rates were not significantly different between IUSS and non-IUSS patients undergoing orthopaedic surgery. Future prospective studies are warranted to further explore the utility of IUSS during orthopaedic procedures. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

JAMA Surgery, 2020

Importance To help prevent surgical site infections (SSIs), recommendations by a national organiz... more Importance To help prevent surgical site infections (SSIs), recommendations by a national organization led to implementation of a mandatory operating room policy in a large multicenter health care organization of required use of disposable perioperative jackets. Objective To assess whether the use of perioperative disposable jackets is associated with the incidence of SSIs. Design, Setting, and Participants Surgical site infection data for patients undergoing clean surgical procedures were retrospectively reviewed from 12 hospitals in a large multicenter health care organization during a 55-month period from January 1, 2014, to July 31, 2018. The incidence of SSI was analyzed for all National Healthcare Safety Network monitored and reported procedures. The patient population was split into 2 groups; the preintervention group consisted of 29 098 patients within the 26 months before the policy starting March 1, 2016, and the postintervention group consisted of 30 911 patients within 26 months after the policy. Main Outcome and Measures Comparison of the incidence of SSIs before and after intervention periods underwent statistical analysis. The total number of disposable jackets purchased and total expenditures were also calculated. Exposures Implementation of the mandated perioperative attire policy. Results A total of 60 009 patients (mean [SD] age, 62.8 [13.9] years; 32 139 [53.6%] male) were included in the study. The overall SSI incidence for clean wounds was 0.87% before policy implementation and 0.83% after policy implementation, which was not found to be significant (odds ratio [OR], 0.96; 95% CI, 0.80-1.14; P = .61). After accounting for possible confounding variables, a multivariable analysis demonstrated no significant reduction in SSIs (OR, 0.85; 95% CI, 0.71-1.01; P = .07). During the postintervention study period (26 months), a total of 2 010 040 jackets were purchased, which amounted to a cost of $1 709 898.46. Conclusions and Relevance The results of this study suggest that the use of perioperative disposable jackets is not associated with reductions in SSI for clean wounds in a large multicenter health care organization and presents a fiscal burden.

Open Forum Infectious Diseases, Oct 1, 2019

American Journal of Infection Control, Aug 1, 2019

A focused multivector ultraviolet (FMUV) light system was used in a parallel process with manual ... more A focused multivector ultraviolet (FMUV) light system was used in a parallel process with manual chemical disinfection during operating room (OR) turnovers to assess the impact on cleaning time. The average time to disinfect an OR using only chemical wipes and mops was 19.0 minutes (n = 68); for the FMUV process, the average time was 18.8 minutes (n = 61). The mean cleaning times were equivalent within a 7% margin (P < .17), and total turnover time was not significantly affected.

American Journal of Infection Control, Mar 1, 2019

Background: Hospitalized patients on isolation precautions are reported to have less frequent hea... more Background: Hospitalized patients on isolation precautions are reported to have less frequent health care provider (HCP) visits owing to time required to don and doff personal protective equipment (PPE). Thus, placement on isolation precautions leads to negative patient perception and affects their care. Methods: A "Red Box" that extended 3 feet beyond the door was marked in 50 patient rooms of a tertiary care hospital and used for patient communication by HCPs without PPE. HCP and patient perceptions of the Red Box were studied via a survey and personal interviews. Compliance was also observed by "secret shoppers." Rates of health care−associated infections (HAIs) were monitored. Results: Over a 1-year period, HCPs reported improved patient communication, utilization of time, and increased interactions. HCPs used the Red Box to communicate with patients 76% of the time. In 92% of the cases, HCPs remembered not to use PPE while in the Red Box and were observed 80% of the time using PPE when venturing beyond the Red Box. Patients reported improved frequency of HCP contact and satisfaction. HAIs in these units did not show any increase compared with those in prior years. Conclusions: HCP interaction and communication with patients on isolation precautions improved with the reengineering of the patient environment in the form of the Red Box. HAI rates did not increase with this intervention.

Surgical Endoscopy and Other Interventional Techniques, May 5, 2022

Applied Biosafety, Dec 1, 2017

Background: The utilization of live biological agents as vectors for gene delivery systems is bec... more Background: The utilization of live biological agents as vectors for gene delivery systems is becoming more prevalent in clinical research. Often, these agents are handled in patient care environments, such as hospitals and ambulatory sites. While expanding the use of these agents from nonclinical to clinical research, Northwell Health first established a robust process to standardize biological agent research and protect patients, employees, and visitors. Methods: A collaborative, multidisciplinary approach was employed to develop an organizational-wide approach to using live biological agents in clinical research. The needs of both investigators and patient subjects were addressed while outlining a process to safely conduct clinical research, which was rapidly established with project management support and methodologies. Results: An organizational-wide Institutional Biosafety Committee (IBC) was established within 6 months. In addition, a comprehensive Biosafety Program standardized Northwell Health's approach to biological agent research, including agent handling and containment, training and education of providers and subjects, and an audit process for compliance. Conclusion: During clinical research involving biological agents, potential risks must be assessed throughout the agent's chain of custody. Northwell Health successfully implemented a robust process in a large organization that other health systems can replicate to safely conduct research in this rapidly expanding area.

Journal of Nursing Management, Aug 4, 2010

Structural empowerment and patient safety culture among registered nurses working in adult critic... more Structural empowerment and patient safety culture among registered nurses working in adult critical care units Aim The aim of the present study was to examine the relationship between structural empowerment and patient safety culture among staff level Registered Nurses (RNs) within adult critical care units (ACCU). Background There is literature to support the value of RNsÕ structurally empowered work environments and emerging literature towards patient safety culture; the link between empowerment and patient safety culture is being discovered. Methods A sample of 257 RNs, working within adult critical care of a tertiary hospital in the United States, was surveyed. Instruments included a background data sheet, the Conditions of Workplace Effectiveness and the Hospital Survey on Patient Safety Culture. Results Structural empowerment and patient safety culture were significantly correlated. As structural empowerment increased so did the RNsÕ perception of patient safety culture. Conclusion To foster patient safety culture, nurse leaders should consider providing structurally empowering work environments for RNs. Implications for nursing management This study contributes to the body of knowledge linking structural empowerment and patient safety culture. Results link structurally empowered RNs and increased patient safety culture, essential elements in delivering efficient, competent, quality care. They inform nursing management of key factors in the nursesÕ environment that promote safe patient care environments.

American Journal of Infection Control, Jun 1, 2014

Emerging Infectious Diseases, 2010

AORN Journal, Dec 1, 2017

Surgical site infections are unintended consequences of surgery that can cause harm to patients a... more Surgical site infections are unintended consequences of surgery that can cause harm to patients and place financial burdens on health care organizations. Extrinsic factors in the ORdincluding health care providers' behavior and practices that modify air movement, the physical environment, equipment, or surgical instrumentsdcan increase microbial contamination. Microbes can be transported into the surgical incision by airborne or contact routes and contribute to a surgical site infection. Simple practices to prevent infectiondsuch as minimizing airborne particles and contaminants, maintaining equipment according to the manufacturer's recommendations, cleaning and disinfecting the environment and surgical instruments, and performing proper hand hygienedcan reduce the degree of microbial contamination. Perioperative leaders and health care providers can help decrease the patient's risk of surgical site infection with proactive preventive practices that break the chain of infection.