1. APIC Greater NY Chapter 13 Journal Club – critique for September 16, 2015 presentation By Steve Bock RN CIC NYU Langone Medical Center No disclosures other than study author is a friend and wonderful colleague

2. AJIC – July 2015

3. Is the study design/data strong? Study design was retrospective cohort (non-experimental). Data came from NORA reports. My expert opinion is that NORA reports are very accurate. NORA reports may be completed early in the course of the outbreak investigation. Full extent of the outbreak may not be known when filed. Once submitted, they cannot be edited/updated by the submitting facility. While # of participating pLTCFs was small and of limited geographic distribution, the sample size of 700 HAI pt cases is large. Conclusion – raw data in study is reasonably robust.

4. Is the study discussion valid? Study intended to describe types of infections associated with pLTCF outbreaks – among residents and staff. Outbreaks well-summarized. Findings were congruent with previous research. This study added to literature by including staff impact, 250 definite or probable HAI staff cases represented over 25% of all peds cases. Source of transmission to residents and staff unclear, not able to determine from raw data or analysis. Likely was bi-directional in at least some cases, based on literature evidence presented. While the abstract and the opening paragraph indicated the study purpose was in part to describe Infection Prevention & Control measures used to control the outbreaks, little discussion was actually included. NORA reports may not be a good source for details on outbreak control. Discussion is valid but very limited in detail.

5. Limitations and Impact of study Authors described study limitations well (I agree with them) but could have given more detail on what NORA data provided and what it cannot provide. Of note, lack of standardized case definition of suspect cases (about half of peds residents and nearly all of the HCW cases) limits strength of study. Study is large enough to offer some sense of what kind of outbreaks may and/or are occur(ing) in pLTCFs. Lack of detail about IPC control measures limits use of study to help shape IPC practice. Conclusion’s call for more study of pLTCFs is very valid given impact these outbreaks can have on facility residents. Outbreaks in pLTCFs affect acute care, too, so further study is needed, particularly about outbreak control measures. Wish authors would raise questions about IPC control measures in acute care or offer comparison to acute care peds outbreak data.

7. Thank you Marianne for being willing to present today! !