Elaine Larson’s research while affiliated with Columbia University and other places

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Publications (525)


Impact of Patient Safety Climate on Infection Prevention Practices and Healthcare Worker and Patient Outcomes
  • Article

May 2023

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45 Reads

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9 Citations

American Journal of Infection Control

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Jingwen Guo

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Elaine Larson

Background Standard precautions may prevent patient health care associated infections and provider occupational exposures but are not often used by health care workers. A positive patient safety climate might contribute to improved adherence. The aim of this study was to determine the relationships among patient safety climate, standard precaution adherence, and health care worker exposures and HAIs. Methods This multi-site, cross-sectional study included survey data from nurses on patient safety climate, observational data on adherence, and existing health care worker exposure and health care associated infections data. Data were aggregated to hospital unit level for correlational and multivariable regression analyses. Results A total of 5,285 standard precaution observations and 452 surveys were collected across 43 hospital units. Observed adherence to all categories of standard precautions was 64.4%; there were significant differences by provider role. Multivariable models identified key predictors explaining sizeable variance in methicillin-resistant Staphylococcus aureus (41%), catheter associated urinary tract infections (23%), mucotaneous exposures (43%) and needlestick and sharps injuries (38%). Discussion This study produced findings not previously published thus advancing the state of the science in patient and occupational health safety. These include identifying modifiable features of the safety climate and key organizational characteristics associated better outcomes. Conclusions In this novel study we identified that a positive patient safety climate and adherence to standard precautions predict key HAI and occupational health outcomes.


The development of a long-term care infection prevention compendium during the COVID-19 pandemic

May 2023

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2 Reads

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1 Citation

American Journal of Infection Control

Mario Rubano

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Elana Kieffer

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Elaine Larson

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[...]

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Carmen Portillo

Background: Long-term care facilities (LTC) experienced significant morbidity and mortality rates among both residents and staff during the COVID-19 pandemic, for which they were ill-prepared to practice adequate infection prevention and control (IPC). Methods: Our team developed a process for creating a compendium of curated IPC resources. This process harnessed the experience and expertise of nurses actively working in LTC during the pandemic. Results: The publicly available online compendium of IPC resources relevant to all departments found within LTC settings. The compendium contains a wide array of IPC tools, research, reports, international resources, and customizable educational slide decks. Discussion: Online repositories of curated IPC resources can equip direct care workers with accurate, easily accessible resources to support the maintenance of proper IPC practice and protocol in LTC settings. Conclusion: Future research should evaluate the effectiveness and usefulness of this model and explore its utility in additional medical contexts.


Acceptability, Feasibility, and Validity of Detecting Respiratory Pathogens During Acute Respiratory Illness in Participant-Collected Swabs in a Low-Income, Community Sample
  • Article
  • Full-text available

February 2023

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23 Reads

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2 Citations

Open Forum Infectious Diseases

Background Community surveillance for acute respiratory illness (ARI) can include unsupervised participant-collected nasal swabs. Little is known about use of self-swabs in low-income populations, among households including extended family members, and the validity of self-collected swabs. We assessed the acceptability, feasibility and validity of unsupervised participant-collected nasal swabs in a low-income, community sample. Methods This sub-study of a larger prospective community-based ARI surveillance study in 405 households in New York City. Participating household members self-collected swabs on the day of a research home visit for an index case, and for three to six subsequent days. Demographics associated with agreement to participate and swab collection were assessed, and index case self- versus research-staff collected swab results were compared. Results Most households (n=292, 89.6%) agreed to participate, including 1,310 members. Being <18 years old, female, and the household reporter or member of the nuclear family (parents and children) were associated with both agreement to participate and self-swab collection. Being born in the US or immigrating ≥10 years ago was associated with participation, and being Spanish-speaking and having <high school education were associated with swab collection. In all, 84.4% collected at least one self-swabbed specimen; self-swabbing rates were highest during the first four collection days. Concordance between research-swabs and self-swabs was 88.4% for negative swabs, 75.0% for influenza and 69.4% for non-influenza pathogens. Conclusions Self-swabbing was acceptable, feasible, and valid in this low-income, minoritized population. Some differences in participation and swab collection were identified that could be noted by future researchers and modelers.

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Abstract TP168: Stroke Risk Among Those With Prior Healthcare Associated Infections: A Case Control Study

February 2023

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4 Reads

Stroke

Introduction: Younger age groups demonstrate greater heterogeneity in stroke etiology compared to the older stroke population. Identifying novel risk factors in this population is a high priority. Methods: Our study utilized patient data from three urban Manhattan hospitals and one community hospital outside of Manhattan. Cases were adults with a stoke admission. Controls were adults with a trauma or orthopedic admission randomly matched 2:1 to cases on date of admission. Odds of stroke following an infection during the prior year as compared to those with no infection was assessed using unadjusted logistic regression and as a time-varying analysis using unadjusted and adjusted generalized estimating equations controlling for time, age, sex, race, hypertension, diabetes, renal failure Results: Our study included 8,983 stroke cases and 17,966 matched controls with a mean age of 68.9 and 61.2 years, respectively. Of cases 50.6% were female. 28.8% were non-Hispanic white, 31.4% had diabetes, 61.7% had hypertension and 21.7% had renal failure. Of controls, 50.1% were female, 30.7% were non-Hispanic white, 15.3% had diabetes, 36.1% had hypertension and 15.1% had renal failure. Within the 1 year prior, 21.5% of cases and 14.5% of controls had an infection. Those with an infection in the year prior had increased odds of stroke when compared to those with no infection (Table 1) with the greatest effect size seen in those ≤45 years old. Conclusions: Odds of stroke increases following a hospital-acquired infection, particularly in the young population. Odds by type of infection will be presented.


HIV prevalence and gender identity of sexual partners a
HIV prevalence among transmasculine individuals at a New York City Community Health Centre: a cross-sectional study

October 2022

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47 Reads

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8 Citations

Introduction: Multiple studies have demonstrated elevated incidence and prevalence of HIV among transgender women; however, few studies have been conducted among transmasculine individuals. HIV prevalence among transgender men in the United States is estimated to be 0-4%; however, there have not been any US studies examining HIV prevalence that stratify by the gender of sexual partners. The aim of this research was to examine HIV prevalence and its association with socio-demographic and other factors, including the gender of sexual partners and receipt of gender-affirming care (hormones/surgery), among transmasculine individuals at the Callen-Lorde Community Health Center in New York City. Methods: The Transgender Data Project was an Institutional Review Board-approved retrospective chart review of all transgender and gender diverse clients at the clinic, ages 18+, between 1 January 2009 and 12 December 2010. Charts were reviewed manually. Data included birth sex, gender, race/ethnicity, education, employment, housing, insurance status, gender of sexual partners, HIV screening and status, and receipt of gender-affirming care. Bivariate and multivariable logistic regression models were used to assess the association between HIV status and other variables. Results and discussion: Five hundred and seventy-seven transmasculine individuals, mean age 32.1 years (18.3-70.5), were included in this analysis. A small majority were White (55% White, 13.9% Black and 11.7% Hispanic). The majority, 78.9%, had received hormones (testosterone) and 41.6% had received at least one gender-affirming surgery. The HIV screening rate was 43.4%. HIV prevalence was 2.8%, (95% CI: 1.13%, 5.68%) among those screened, notably higher than the US population prevalence. HIV prevalence was highest among transmasculine individuals who had sex exclusively with cisgender men (11.1%). In the multivariable model (age, education and gender of sexual partners), the adjusted odds ratio of HIV for those who had sex exclusively with cisgender male partners compared to no cisgender male partners was 10.58 (95% CI: 1.33, 84.17). Conclusions: Although HIV prevalence has been estimated to be low among transgender men, the analysis found heterogeneous results when stratified by gender of sexual partners. The results underscore the need to understand sexual risk among transmasculine individuals and to disaggregate HIV data for those having sex with cisgender men, thus also allowing for better inclusion in HIV prevention efforts.


Surveillance for Acute Respiratory Illnesses in Pediatric Chronic Care Facilities

October 2022

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15 Reads

Journal of the Pediatric Infectious Diseases Society

Overall, 119 (33%) of 364 pediatric chronic care facility residents experienced 182 acute respiratory illnesses (ARIs) that met the surveillance definition which led to 31 (17%) emergency room visits, 34 (19%) acute care hospitalizations, and/or 25 (14%) ICU admissions. Continued PCR-positivity was observed in 35% of ARIs during follow-up testing.


A 10-year examination of a one-on-one grant writing partnership for nursing pre- and post-doctoral trainees

April 2022

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24 Reads

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2 Citations

Nursing Outlook

Background The training and mentoring of pre- and post-doctoral trainees in nursing research is essential to feed the pipeline of nurses prepared to launch an independent program of research. Purpose The purpose of this report is to describe a one-on-one grant writing Partnership developed in a school of nursing targeting pre- and post-doctoral trainees and quantify its impact on funding rates. Methods The Partnership includes four key elements: regular meetings, setting a timeline with milestones, writing and editing support, and attention to administrative documents. Forty grant applications by pre- and post-doctoral trainees were developed and submitted from 2011 to 2020. Findings Among Partnership participants, 81.0% (17/21) received funding as compared with 42.1% (8/19) who did not participate, p = .02. Discussion Schools of nursing and other disciplines should consider investing in a Partnership to provide grant writing support their pre- and post-doctoral trainees and increase their overall research capacity.



Five-Year Community Surveillance Study for Acute Respiratory Infections Using Text Messaging: Findings From the MoSAIC Study

January 2022

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15 Reads

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11 Citations

Clinical Infectious Diseases

Background Acute respiratory infections (ARI) are the most common infectious diseases globally. Community surveillance may provide a more comprehensive picture of disease burden than medically-attended illness alone. Methods In this longitudinal study conducted from 2012-2017 in the Washington Heights/Inwood area of New York City, we enrolled 405 households with 1,915 individuals. Households were sent research text messages twice weekly inquiring about ARI symptoms. Research staff confirmed symptoms by follow-up call. If ≥2 criteria for ARI were met (fever/feverish, cough, congestion, pharyngitis, myalgias), staff obtained a mid-turbinate nasal swab in participants’ homes. Swabs were tested using the FilmArray RT-PCR respiratory panel. Results Among participants, 43.9% were children, and 12.8% had a chronic respiratory condition. During the five years, 114,724 text messages were sent; the average response rate was 78.8% +/- 6.8%. Swabs were collected for 91.4% (2756/3016) of confirmed ARI; 58.7% had a pathogen detected. Rhino/enteroviruses (51.9%), human coronaviruses (13.9%) and influenza (13.2%) were most commonly detected. The overall incidence was 0.62 ARI/person-year, highest (1.73) in <2 year-olds and lowest (0.46) in 18-49 year-olds. Approximately one-fourth of those with ARI sought healthcare; percents differed by pathogen, demographic factors, and presence of a chronic respiratory condition. Conclusions Text messaging is a novel method for community-based surveillance that could be used both seasonally as well as during outbreaks, epidemics and pandemics. The importance of community surveillance to accurately estimate disease burden is underscored by the findings of low rates of care-seeking that varied by demographic factors and pathogens.


Readmission Rates in Stroke Patients with and without Infections: Incidence and Risk Factors

January 2022

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38 Reads

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3 Citations

Journal of Stroke and Cerebrovascular Diseases

Background Stroke patients are at increased risk for acquiring infections in the hospital and risk of readmission. We aimed to examine whether an infection acquired during the initial stroke admission contributes to increased risk of readmission and infection during readmission. Methods We performed a retrospective cohort study incorporating all adult ischemic stroke patients from three New York City hospitals from 2006 to 2016. A validated computer algorithm defined infections based on electronically-available laboratory culture data. Multivariable logistic regression was used to evaluate the crude and adjusted association of infections present on admission (IPOA) and healthcare-associated infections (HAI) with 60-day readmissions, and infection during readmission. Results Among the 10,436 stroke patients, 17% had infections during initial admission of which 52% were IPOA and 48% were HAI. The risk of readmission was significantly higher for those with HAIs (OR = 1.40; 95% CI: 1.20–1.64) and IPOA (OR = 1.26; 95% CI: 1.09–1.47). The presence of infection during the 60-day readmission was also independently predicted by HAI (OR = 3.27; 95% CI: 2.60–4.12) and IPOA (OR = 2.54; 95% CI: 2.01–3.22). Patients with a Gram-negative infection were not at higher odds for readmission compared to patients with a Gram-positive infection (OR 1.07, 95%CI 0.81–1.42). Conclusion Among stroke patients, HAI and IPOA were predictors of readmission within 60 days and infection during readmission.


Citations (75)


... surveillance program within the regional, publicly employed, healthcare workforce. However, although information extracted from the surveillance program in hospitals was rather complete, information on workers employed in nursing homes was limited [7][8][9][10][11]. ...

Reference:

SARS‐CoV‐2 Infection Among Nursing Home Healthcare Workers: A Longitudinal Study in North‐Eastern Italy
The development of a long-term care infection prevention compendium during the COVID-19 pandemic
  • Citing Article
  • May 2023

American Journal of Infection Control

... Fostering a culture of patient safety in US hospitals is an important predictor of many healthcare quality metrics such as healthcare-associated infections and adherence to standard precautions among direct care clinical staff [1]. A key aspect of patient safety culture is the perceived psychological safety and safety climate of clinical team members as a collective group [2,3]. ...

Impact of Patient Safety Climate on Infection Prevention Practices and Healthcare Worker and Patient Outcomes
  • Citing Article
  • May 2023

American Journal of Infection Control

... A fourth potential limitation is that our serial PCR testing was not supervised by clinician. Participants were given clear instructions on testing and had been compliant with asymptomatic screening for excess of 12 months prior to the start of this study, so sampling variability is likely to have a minimal effect on our results [40]. The viral load trajectories we observed were remarkably consistent and closely mirrored supervised testing in the SARS-CoV-2 human challenge study [28], suggesting high quality samples were obtained at serial time points across participants. ...

Acceptability, Feasibility, and Validity of Detecting Respiratory Pathogens During Acute Respiratory Illness in Participant-Collected Swabs in a Low-Income, Community Sample

Open Forum Infectious Diseases

... Over a decade of research has reliably estimated the prevalence of HIV among primarily adult trans women in the U.S. to be at least 1 in 5 [4,52]. Although national estimates among trans masculine and nonbinary populations are not available, a few small nonprobability samples of primarily adult trans men have demonstrated rates of HIV from 2 to 10%, much higher than the national HIV prevalence of 0.4% in the U.S. [5,12,53,54]. ...

HIV prevalence among transmasculine individuals at a New York City Community Health Centre: a cross-sectional study

... Second, with its focus cast on the fundamental elements such as preparing and planning a grant proposal, little space is given to the principles of grant review and of grant member selection in the book, which are regarded as determinants in winning the grant (Smith et al., 2022). For instance, when seeking members, cross-disciplinary background is considered to be one of the potential factors that might add to the feasibility and capacity of the grant team (Kulage et al., 2022). Thus, cross-disciplinary collaboration with other disciplines such as psychology and neurosciences is suggested as one of the principles in formulating a grant team in the field of medical and healthcare. ...

A 10-year examination of a one-on-one grant writing partnership for nursing pre- and post-doctoral trainees
  • Citing Article
  • April 2022

Nursing Outlook

... Local longitudinal active sampling is an alternative to determining the ARI trend [4]. Over the last few years, the ability to detect respiratory viruses has improved owing to polymerase chain reaction (PCR) tests and their quantitative variants (qPCR and RT-qPCR). ...

Five-Year Community Surveillance Study for Acute Respiratory Infections Using Text Messaging: Findings From the MoSAIC Study
  • Citing Article
  • January 2022

Clinical Infectious Diseases

... We now have accurate models that allow us to identify higher-risk patients. 7 And many of the proposed interventions have essentially no downside risk. To me, my obligation to the patient trumps my obligation to evidence. ...

A Clinical Risk Model for Surgical Site Infection Following Pediatric Spine Deformity Surgery
  • Citing Article
  • November 2021

The Journal of Bone and Joint Surgery

... In addition, AIS has an acute onset and rapid progression, which can also increase the risk of pulmonary infection and other complications owing to the influence of the disease itself and related invasive procedures [5,6]. Stroke related infections can seriously threaten the prognosis and quality of life of patients [6,7]. ...

Readmission Rates in Stroke Patients with and without Infections: Incidence and Risk Factors
  • Citing Article
  • January 2022

Journal of Stroke and Cerebrovascular Diseases

... 4,7,8 The use of environmental scans in nursing and rehabilitation has increased considerably over the past two decades. [9][10][11][12][13][14][15] Despite the growing popularity of environmental scans in health research, 16 limited methodological support currently exists to conduct environmental scans. 3,17 Environmental scans can be useful in providing preliminary syntheses in areas in which a full systematic or scoping review is not yet justified.18 ...

Infection Prevention and Control in Nursing Homes During COVID-19: An Environmental Scan
  • Citing Article
  • November 2021

Geriatric Nursing

... They also felt stress because of the increased care load and reduction of external support. Fisher et al. interviewed care home staff in New York City, United States, about factors related to their well-being during COVID-19 [13]. They found that the stress came from the changes of the virus, workplace, home, and work-life balance. ...

Reflections from the “Forgotten Front Line”: A qualitative study of factors affecting wellbeing among long-term care workers in New York City during the COVID-19 pandemic

Geriatric Nursing