Pairing gonorrhea/chlamydia with urine pregnancy tests in a large urban jail led to a nearly 5-fold increase in completed tests and a corresponding increase in positive test results.

No abstract

Background:Mycobacterium tuberculosis (TB) is one of the leading causes of morbidity and mortality worldwide. At our health system, 50–100 patients are diagnosed with tuberculosis every year. One risk factor for TB is residence within a homeless shelter. In response to an increased number of cases in local homeless shelters, the health department sought assistance with contact tracing of individuals potentially exposed to tuberculosis. We report the results of contact tracing performed at our health system. Methods: The setting is a 770-bed, safety-net, academic hospital with community clinics and a correctional health center. Name, date of birth, and social security number of contacts potentially exposed during February 2009 to July 2013 were programmed into the electronic medical records to create a decision support tool upon entering the health system. The best practice alert (BPA) informed physicians of the exposure and offered a link to a screening test, T-spot.TB, and a link to an information sheet. This intervention was implemented from July 2013 to July 2015. After excluding patients with active TB, data on the magnitude of exposure in each homeless shelter and screening test results were analyzed with ANOVA using SPSS v 26 software. Results: Of the 8,649 identified exposed contacts, 2,118 entered our health system. Of those for whom the BPA was triggered, 1,117 had a T-spot.TB done, with 313 positive results and 57 borderline results. Table 1 shows that shelter 3 was correlated with a positive T-spot.TB. Conclusions: The BPA, which prompted physicians to evaluate an individual for TB, was effective at capturing high-risk, exposed individuals. Clinical decision support tools enabled our safety-net health system to respond effectively to a local public health need.Funding: NoneDisclosures: None

Background: In the modern era, the spread of disease is very fast with the transportation allowing more than a million people a day to cross international borders. To control this spreading of disease, the health officials may have various pharmaceutical and non-pharmaceutical (wearing masks, closing schools, isolation, staying at home etc.) options. Media plays a very important role to communicate awareness in public for use of non-pharmaceutical interventions (NPIs) to control the epidemics.Methods & Materials: Determine the basic reproduction number by using a next generation matrix operator. Discuss stability criterion of the equilibrium points of the model with bifurcation theory. Carry out parameter sensitivity analysis by using the normalized forward sensitivity index. Perform the numerical simulation of the model to verify the results of qualitative analysis using MATLAB.Results: Result 1. The disease free equilibrium (DFE) is locally asymptotically stable, if R 0 <1 and unstable, if R 0 >1.Result 2. The endemic equilibrium (EE) is locally asymptotically stable for R 0 >1, but close to 1.Result 3. The coefficient of media awareness m does not effect R 0.Result 4. The level of endemic equilibrium is significantly affected by media coefficient m. Conclusion:In this paper, we proposed a SIRS epidemic model incorporating media awareness as control strategy and investigated the asymptotic stability of the model in both disease-free equilibrium and endemic equilibrium states. The disease free equilibrium is locally asymptotically stable for basic reproduction number R 0 < 1, a transcritical bifurcation occurs at R 0 = 1 and a unique locally asymptotically stable endemic equilibrium exists for R 0 > 1. We observed that the coefficient of media awareness m does not effect R 0 and hence the qualitative features of the model remain unaltered, but the level of endemic equilibrium is significantly affected by media coefficient. We calculate normalized forward sensitivity indices for the basic reproduction number and state variables at endemic equilibrium with respect to various parameters and identified respective sensitive parameters. Numerical simulations of the system justify the analytic findings and we also observed that the level of endemic equilibrium is significantly affected by media coefficient m.

Background: In the setting of global warming, natural disasters are increasing in pace and scope. Although natural disasters themselves do not cause outbreaks, the breakdowns in sanitary infrastructure and the displacement of populations, often to crowded shelters, have caused outbreaks. On August 26, 2017, category 4 hurricane Harvey made landfall near Corpus Christi, Texas, causing catastrophic flooding and displacing >30,000 residents from the Southern Gulf Coast region. Dallas accepted >3,800 evacuees at the Kay Bailey Hutchison Convention Center mega-shelter for 23 days, where a medical clinic was erected in the convention center parking garage. The medical clinic uniquely included a dedicated infection prevention team composed of local volunteer infection preventionists, healthcare epidemiologists, infectious diseases providers, and health department personnel. Methods: Evacuees were housed at the Dallas mega-shelter from August 29 through September 20. The infection prevention team maintained a presence of 3–4 members during clinical operations in shifts. The team conducted an initial needs assessment upon opening of the shelter medical clinic, facilitated acquisition of adequate numbers of hand sanitizer stations, sinks with running water, portable hand-washing stations, portable toilets and showers, and cleaning products. The infection prevention team coordinated and oversaw environmental cleaning services (EVS) carried out by local hospital EVS staff. Protocols for cleaning, disinfection, communicable disease testing, isolation, and treatment were created. In addition, education and training materials for the implementation of these protocols were distributed to volunteer staff. The infection preventionists created and provided oversight of the designated isolation units for respiratory, gastrointestinal and dermatologic infections of outbreak potential. Infection prevention rounding tools were developed and executed daily in the clinic, at the on-site daycare center, dining area, and the general shelter dormitory. Vaccination for influenza was formalized under a protocol and administered at the clinic and via mobile vaccination teams in the chronic illness section of the dormitory. Results: In tota3,829 residents were housed at the mega-shelter for 23 days. Moreover, 1,560 patients were seen in 2,654 clinic visits at the shelter medical clinic. In total, 48 (19%) clinic visits were for respiratory symptoms, 228 (9%) were for dermatologic problems, and 215 (8%) were for gastrointestinal symptoms. Also, 32 patients were referred to the isolation unit within the clinic. Overall, 98 influenza vaccines were administered. There was 1 confirmed case of influenza and 1 confirmed case of norovirus. Conclusions: No known transmission of communicable diseases occurred in this long-term, natural disaster–related mega-shelter, likely attributed to having a comprehensive infection prevention team of on-site volunteers available throughout the shelter operation. This model should be considered in future large-scale shelter settings to prevent disease transmission.Disclosures: NoneFunding: None