Trina Zabarsky - Academia.edu (original) (raw)

Papers by Trina Zabarsky

Infection control and hospital epidemiology, Apr 11, 2024

American Journal of Infection Control, Sep 1, 2017

To facilitate patient hand hygiene, there is a need for easy-to-use products. In a survey of 100 ... more To facilitate patient hand hygiene, there is a need for easy-to-use products. In a survey of 100 patients, a single-use ethanol hand sanitizer packet took less time to access than a single-use moist towelette packet (3 vs 23 seconds) and was preferred by 74% of patients for mealtime hand hygiene. Performance of patient hand hygiene increased when a reminder was provided at the time of meal tray delivery. Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.

Infection Control and Hospital Epidemiology, Feb 22, 2022

Objective:To investigate a cluster of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2... more Objective:To investigate a cluster of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in employees working on 1 floor of a hospital administration building.Methods:Contact tracing was performed to identify potential exposures and all employees were tested for SARS-CoV-2. Whole-genome sequencing was performed to determine the relatedness of SARS-CoV-2 samples from infected personnel and from control cases in the healthcare system with coronavirus disease 2019 (COVID-19) during the same period. Carbon dioxide levels were measured during a workday to assess adequacy of ventilation; readings >800 parts per million (ppm) were considered an indication of suboptimal ventilation. To assess the potential for airborne transmission, DNA-barcoded aerosols were released, and real-time polymerase chain reaction was used to quantify particles recovered from air samples in multiple locations.Results:Between December 22, 2020, and January 8, 2021, 17 coworkers tested positive for SARS-CoV-2, including 13 symptomatic and 4 asymptomatic individuals. Of the 5 cluster SARS-CoV-2 samples sequenced, 3 were genetically related, but these employees denied higher-risk contacts with one another. None of the sequences from the cluster were genetically related to the 17 control sequences of SARS-CoV-2. Carbon dioxide levels increased during a workday but never exceeded 800 ppm. DNA-barcoded aerosol particles were dispersed from the sites of release to locations throughout the floor; 20% of air samples had >1 log10 particles.Conclusions:In a hospital administration building outbreak, sequencing of SARS-CoV-2 confirmed transmission among coworkers. Transmission occurred despite the absence of higher-risk exposures and in a setting with adequate ventilation based on monitoring of carbon dioxide levels.

American Journal of Infection Control, Nov 1, 2020

American Journal of Infection Control, Dec 1, 2022

American Journal of Infection Control, May 1, 2017

We conducted a randomized trial of a simple educational intervention encouraging patients to perf... more We conducted a randomized trial of a simple educational intervention encouraging patients to perform hand hygiene at 5 specific moments, including on entry of health care personnel into their room as a reminder of the importance of hand hygiene. The intervention resulted in a significant increase in patient hand hygiene. Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.

Journal of Infection Prevention, Feb 22, 2023

Asymptomatic and pre-symptomatic staff and residents likely contribute to widespread transmission... more Asymptomatic and pre-symptomatic staff and residents likely contribute to widespread transmission of COVID-19 in long-term care settings. Here, we describe the successful containment of a COVID-19 outbreak on one floor of a 163-bed Veterans Affairs (VA) Community Living Center (CLC). Testing using nasopharyngeal swabs with a rapid turn-around-time identified 3 of 28 (11%) residents and 2 of 41 (5%) healthcare personnel (HCP) with COVID-19. Both HCP likely worked on the floor while pre-symptomatic. When one HCP reported a cough to the secondary (employee) screening clinic, she was erroneously advised to work. Protocols to limit the risk for HCP to import COVID-19 were reinforced with Community Living Center staff as well as with personnel in secondary screening. Further, the CLC implemented an expanded screening tool that assessed residents for typical and atypical symptoms of COVID-19. No further cases of COVID-19 were detected on the CLC floor in the subsequent 6 weeks. Swift recognition and response helped contain the outbreak and prevent further COVID-19 infections among other residents and staff.

American Journal of Infection Control, Feb 1, 2022

Poorly ventilated indoor spaces pose a risk for airborne transmission of SARS-CoV-2. We measured ... more Poorly ventilated indoor spaces pose a risk for airborne transmission of SARS-CoV-2. We measured carbon dioxide levels in a multiple areas in an acute care hospital to assess the adequacy of ventilation. Carbon dioxide levels remained below 800 parts per million in most areas but exceeded this level in a small conference room with 8 occupants, an office with 3 occupants, and a bathroom with 2 occupants. Measuring carbon dioxide levels could provide a simple means for healthcare facilities to assess the adequacy of ventilation.

Pathogens & immunity, Sep 20, 2016

Background: Recent reports suggest that infections due to fluoroquinolone-resistant Escherichia c... more Background: Recent reports suggest that infections due to fluoroquinolone-resistant Escherichia coli (E. coli) are an increasingly common complication of transrectal biopsy of the prostate (TBP) in the United States. A better understanding of the magnitude and scope of these infections is needed to guide prevention efforts. Our objective is to determine whether the incidence of infections due to fluoroquinolone-resistant E. coli after TBP has increased nationwide in the Veterans Affairs Health Care System and to identify risk factors for infection. Methods: We performed a retrospective, observational cohort study and a nested case-control study within the US Deparment of Veterans Affairs Healthcare System. The primary outcomes were the incidence of urinary tract infection (UTI) and bacteremia with E. coli and with fluoroquinolone-resistant E. coli strains within 30 days after TBP. Secondary endpoints focused on the correlation between fluoroquinolone-resistance in all urinary E. coli isolates and post-TBP infection and risk factors for infection due to fluoroquinolone-resistant E. coli infection.

Clinical Infectious Diseases, Apr 27, 2022

Background. Hospitalized patients are at risk to acquire severe acute respiratory syndrome corona... more Background. Hospitalized patients are at risk to acquire severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from roommates with unrecognized coronavirus disease 2019 (COVID-19). We hypothesized that airflow patterns might contribute to SARS-CoV-2 transmission in double-occupancy patient rooms. Methods. A device emitting condensed moisture was used to identify airflow patterns in double-occupancy patient rooms. Simulations were conducted to assess transfer of fluorescent microspheres, 5% sodium chloride aerosol, and aerosolized bacteriophage MS2 between patient beds 3 meters apart and to assess the effectiveness of privacy curtains and portable air cleaners in reducing transfer. Results. Air flowed from inlet vents in the center of the room to an outlet vent near the door, resulting in air currents flowing toward the bed adjacent to the outlet vent. Fluorescent microspheres (212-250-µm diameter), 5% sodium chloride aerosol, and aerosolized bacteriophage MS2 released from the inner bed were carried on air currents toward the bed adjacent to the outlet vent. Closing curtains between the patient beds reduced transfer of each of the particles. Operation of a portable air cleaner reduced aerosol transfer to the bed adjacent to the outlet vent but did not offer a benefit over closing the curtains alone, and in some situations, resulted in an increase in aerosol exposure. Conclusions. Airflow patterns in double-occupancy patient rooms may contribute to risk for transmission of SARS-CoV-2 between roommates. Keeping curtains closed between beds may be beneficial in reducing risk.

Infection Control and Hospital Epidemiology, Mar 1, 2013

Design.We conducted an investigation after identifying a cluster of 4 serious infections followin... more Design.We conducted an investigation after identifying a cluster of 4 serious infections following transrectal ultrasound–guided biopsy of the prostate (TRUBP) during a 2-month period.Setting.veterans Affairs medical center.Patients.Patients with urinary tract infection (UTI) after TRUBP and time-matched controls with no evidence of infection.Methods.The incidence of UTI within 30 days after TRUBP was calculated from 2002 through 2010. We evaluated the correlation between infection with fluoroquinolone-resistant gram-negative bacilli (GNB) and fluoroquinolone resistance in outpatientEscherichia coliurinary isolates and performed a case-control study to determine risk factors for infection with fluoroquinolone-resistant GNB. Processes for TRUBP prophylaxis, procedures, and equipment sterilization were reviewed.Results.An outbreak of UTI due to fluoroquinolone-resistantE. coliafter TRUBP began 2 years before the cluster was identified and was correlated with increasing fluoroquinolone resistance in outpatientE. coli. No deficiencies were identified in equipment processing or biopsy procedures. Fluoroquinolone-resistant E. coli UTI after TRUBP was independently associated with prior infection with fluoroquinolone-resistant GNB (adjusted odds ratio, 20.8;P= .005). A prediction rule including prior UTI, hospitalization in the past year, and previous infection with fluoroquinolone-resistant GNB identified only 17 (49%) of 35 cases.Conclusions.The outbreak of fluoroquinolone-resistantE. coliinfections after TRUBP closely paralleled rising rates of fluoroquinolone resistance among outpatientE. coliisolates. The delayed detection of the outbreak and the absence of sensitive predictors of infection suggest that active surveillance for infection after TRUBP is necessary in the context of increasing fluoroquinolone resistance in the United States.

American Journal of Infection Control, Sep 1, 2008

Background: In long-term care facilities, treatment of asymptomatic bacteriuria (ASB) is common. ... more Background: In long-term care facilities, treatment of asymptomatic bacteriuria (ASB) is common. However, randomized, controlled trials suggest that such treatment offers no benefit and may promote antimicrobial resistance. Methods: For 3 months before and 30 months after instituting an educational intervention, we monitored the appropriateness of urine culture collection and antibiotic treatment based on published guidelines and examined the effect on total antimicrobial use. The intervention included education of nursing staff to discourage the collection of urine cultures in the absence of symptoms suggestive of urinary tract infection and of primary care practitioners to not treat ASB. Results: In preintervention period, 23 of 38 (61%) antibiotic regimens prescribed for urinary tract indications were for ASB. In the 6 months after the intervention, inappropriate submission of urine cultures decreased from 2.6 to 0.9 per 1000 patient-days (P , .0001), overall rate of treatment of ASB was reduced from 1.7 to 0.6 per 1000 patient-days (P 5 .0017), and total antimicrobial days of therapy were reduced from 167.7 to 117.4 per 1000 patient-days (P , .001). These reductions were maintained for 30 months after beginning the intervention. Conclusion: Educational interventions requiring minimal resources can result in sustained reductions in inappropriate treatment of ASB in long-term care and decreased total antimicrobial use. Education of the nursing staff regarding appropriate criteria for requesting urine cultures should be a component of such interventions.

Journal of Infection Prevention

Antimicrobial Resistance and Infection Control, 2015

American Journal of Infection Control

Background. Health care personnel and patients are at risk to acquire severe acute respiratory sy... more Background. Health care personnel and patients are at risk to acquire severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in health care settings, including in outpatient clinics and ancillary care areas. Methods. Between May 1, 2020, and January 31, 2021, we identified clusters of 3 or more coronavirus disease 2019 (COVID-19) cases in which nosocomial transmission was suspected in a Veterans Affairs health care system. Asymptomatic employees and patients were tested for SARS-CoV-2 if they were identified as being at risk through contact tracing investigations; for 7 clusters, all personnel and/or patients in a shared work area were tested regardless of exposure history. Whole-genome sequencing was performed to determine the relatedness of SARS-CoV-2 samples from the clusters and from control employees and patients. Results. Of 14 clusters investigated, 7 occurred in community-based outpatient clinics, 1 in the emergency department, 3 in ancillary care areas, and 3 on hospital medical/surgical wards that did not provide care for patients with known COVID-19 infection. Eighty-one of 82 (99%) symptomatic COVID-19 cases and 31 of 35 (89%) asymptomatic cases occurred in health care personnel. Sequencing analysis provided support for several transmission events between coworkers and in 2 cases supported transmission from health care personnel to patients. There were no documented transmissions from patients to personnel. Conclusions. Clusters of COVID-19 with nosocomial transmission predominantly involved health care personnel and often occurred in outpatient clinics and ancillary care areas. There is a need for improved measures to prevent transmission of SARS-CoV-2 by health care personnel in inpatient and outpatient settings.

Clinical Infectious Diseases

Background Hospitalized patients are at risk to acquire severe acute respiratory syndrome coronav... more Background Hospitalized patients are at risk to acquire severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from roommates with unrecognized coronavirus disease 2019 (COVID-19). We hypothesized that airflow patterns might contribute to SARS-CoV-2 transmission in double occupancy patient rooms. Methods A device emitting condensed moisture was used to identify airflow patterns in double occupancy patient rooms. Simulations were conducted to assess transfer of fluorescent microspheres, 5% sodium chloride aerosol, and aerosolized bacteriophage MS2 between patient beds 3 meters apart and to assess the effectiveness of privacy curtains and portable air cleaners in reducing transfer. Results Air flowed from inlet vents in the center of the room to an outlet vent near the door, resulting in air currents flowing toward the bed adjacent to the outlet vent. Fluorescent microspheres (212-250 µm diameter), 5% sodium chloride aerosol, and aerosolized bacteriophage MS2 released from the i...

Infection Control & Hospital Epidemiology, 2022

JAMA Internal Medicine, 2015