Background/Aims: Infection of a transplanted kidney with the polyomavirus, BK, is associated with poor allograft survival. Methods: In an attempt to prevent this transplant complication, we studied 144 consecutive transplant recipients for the presence of BK infection with plasma and urine PCR testing at 1, 2, 3, 6 and 12 months. Viruria alone was followed by serial studies. If plasma PCR became positive at >2.6 log copies, mycophenolate was reduced until there was no detectable plasma viral load. Results: Urine PCR was positive in 34 (24%), while plasma PCR turned positive in 22 cases (15%). No patients developed viremia with <6.8 log copies in the urine. Viremia resolved within 3 months or less in 20 of 22 patients after reduction of immunosuppression. Surveillance biopsies at 2 and 6 months revealed no BK nephropathy. Eight patients had acute rejection during reduced immunosuppression; however, all of these reversed with pulse steroids. Patient and graft survival at 1 year was 99 and 98%, respectively. Use of the cell-mediated immunity assay (ImmuKnow®, Columbia, Md., USA) was not useful in identifying infected patients. Conclusion: Active surveillance for BK virus by urine/plasma PCR with prompt reduction in immunosuppression can prevent BK nephropathy.

Purpose Leadership development may be a key strategy to enhance job satisfaction, reduce burnout and improve patient safety in health-care systems. This study aims to assess feasibility of a leadership development series in an effort to invigorate a collaborative culture, create peer networks and elevate autonomy in daily work. Design/methodology/approach The authors implemented a collectivistic leadership development series titled Fueling Leadership in Yourself. The series was designed for all types of health-care workers in the medicine service at a tertiary referral center for veterans. Two series of leadership development sessions with varied experiential learning methods were facilitated by content experts. Subjects focused on leadership approaches and attributes applicable to all roles within a health-care system. The authors collected participant perceptions using pre- and post-series surveys. Primary outcomes were understanding and applicability of leadership concepts, employee engagement in leadership, satisfaction with training and work environment and qualitative reflections. Findings A total of 26 respondents (of 38 participants) from 8 departments and several role types increased their knowledge of leadership techniques, were highly satisfied with and would recommend the series and found leadership principles applicable to their daily work. Participants continued to use skills years after the series. Practical implications Short, intermittent, collectivistic leadership development sessions appear effective in expanding knowledge, satisfaction and skills used in daily practice for a diverse group of health-care workers. Originality/value Novel programmatic aspects included inviting all types of health-care workers, practicing universally applicable content and using a variety of active, experiential learning methods.

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Background: SARS-CoV-2, the virus causing COVID-19 infection, can significantly contaminate environmental surfaces and can remain viable on surfaces for up to 9 days. Although respiratory route remains the most significant mode of transmission, fomites and environmental sources of infection remain a concern for healthcare personnel who are working in dedicated COVID-19 units. We investigated the extent of detectable SARS-CoV-2 contamination in the environment of COVID-19 patients at a single VA hospital, with the intent of identifying potential high-touch surfaces at risk for viral contamination, which could be used to inform the development of simple COVID-19 prevention strategies. Methods: We conducted a cohort study at 1 VA hospital in a unit housing adult veterans admitted with COVID-19 between October and December 2020. In total, 11 swab specimens were collected for PCR analysis (SARS-CoV-2 env gene) from environmental surfaces inside and just outside the rooms of COVID-19 patients one time. Retrospective chart reviews were conducted to provide the SARS-CoV-2 epidemiologic context for environmental detection. Results: In total, 297 swabs were collected from the unit and environmental areas surrounding 27 hospitalized patients: average age, 72.5 years (range, 34–94); 100% male; 92% non-Hispanic white; average comorbidities, 1.8 (SD, 1.1). Of 297 swabs, 80 (27%) were positive for SARS-CoV-2 and 19 (70%) of 27 patients had at least 1 positive site. The most contaminated site was the floor just outside the patient room (78% positive samples), followed by the patient’s bedrail (37%) and chair handle (37%) (Fig. 1). Traditionally high-touch surfaces, such as the door handle (outside patient room) and the light switch, did not have high positivity rates (<15%). Interestingly, both the personal protective equipment (PPE) cart outside patient’s room (33%) and the double doors leading out of the unit (19%) were positive, which are surfaces often touched with bare hands after handwashing. Analyses of clinical data are underway to examine whether specific care needs, based on activities of daily living disability, comorbidities, and clinical presentation of COVID-19, predict SARS-CoV-2 environmental contamination. Conclusions: The presence of environmental contamination by SARS-CoV-2 highlights the importance of transmission via direct or indirect contact. Studies targeting high-risk populations are needed to better understand the transmission of SARS-CoV-2 between infected patients and their environment. Our findings also suggest that handwashing and attention to using disinfecting wipes may mitigate the risk of transmission of virus from surfaces that one might consider safe to touch.Funding: NoneDisclosures: None