Background: Outpatient parenteral antimicrobial therapy (OPAT) is a mechanism for delivery of antimicrobial therapy outside of inpatient care; however, risks associated with OPAT combined with transition-of-care vulnerabilities may result in unscheduled healthcare use. On 6/15/2020, our institution launched a program entailing OPAT plan review and reconciliation by infectious diseases (ID) pharmacists prior to hospital discharge. We analyzed the frequency of all-cause 90-day emergency department (ED) visits, readmissions, and mortality of patients pre-and post-implementation of OPAT plan reconciliation. Methods: Unique, adult OPAT recipients discharged to home or a post-acute care facility from an academic hospital before (6/1/2017-6/14/2020) and after (6/15/2020-6/30/2022) implementation of ID pharmacist review and reconciliation of OPAT plans were included. We performed a ⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯ # 2 propensity score-weighted analysis to compare 90-day outcomes pre-and post-intervention while adjusting for relevant clinical characteristics. We accounted for missing data by using multiple imputation. Results: A total of 2408 OPAT patients met inclusion criteria: 1650 pre-implementation and 758 post-implementation. Patients in the post-implementation group had statistically fewer ED visits (pre: 22.2%; post: 17.8%; p = 0.02) and hospital readmissions (pre: 38.9%; post: 33.4%; p = 0.01) within 90 days after discharge from index admission when compared to the pre-implementation cohort. There was no significant difference in the 90-day all-cause mortality between cohorts. Conclusions: Following implementation of OPAT plan reconciliation by ID pharmacists prior to discharge to home from acute care, OPAT recipients were significantly less likely to experience 90-day ED visits or 90-day readmissions.

Objective: Healthcare workers (HCWs) in long-term care facilities (LTCFs) are disproportionately affected by severe acute respiratory coronavirus virus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). To characterize factors associated with SARS-CoV-2 positivity among LTCF HCWs, we performed a retrospective cohort study among HCWs in 32 LTCFs in the Minneapolis-St Paul region. Methods: We analyzed the outcome of SARS-CoV-2 polymerase chain reaction (PCR) positivity among LTCF HCWs during weeks 34-52 of 2020. LTCF and HCW-level characteristics, including facility size, facility risk score for resident-HCW contact, and resident-facing job role, were modeled in univariable and multivariable generalized linear regressions to determine their association with SARS-CoV-2 positivity. Results: Between weeks 34 and 52, 440 (20.7%) of 2,130 unique HCWs tested positive for SARS-CoV-2 at least once. In the univariable model, non-resident-facing HCWs had lower odds of infection (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.36-0.70). In the multivariable model, the odds remained lower for non-resident-facing HCW (OR, 0.50; 95% CI, 0.36-0.71), and those in medium- versus low-risk facilities experienced higher odds of testing positive for SARS-CoV-2 (OR, 1.47; 95% CI, 1.08-2.02). Conclusions: Our findings suggest that COVID-19 cases are related to contact between HCW and residents in LTCFs. This association should be considered when formulating infection prevention and control policies to mitigate the spread of SARS-CoV-2 in LTCFs.