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The COVID-19 pandemic led to a rapid increase in unemployment and business closures, leaving many families in psychosocial distress, and putting the well-being and healthy development of children at risk. There has been a sharp increase in cases of child abuse presenting to our institution during the year 2020. Thus, we sought to quantify whether the confluence of pandemic-related social changes would result in an increase in child abuse cases severe enough to warrant emergency medical attention in the West Texas region. Through this report, we hope to underscore the need for continued vigilance by healthcare providers and educators in identifying cases of child abuse, as well as the need for additional initiatives to mitigate child maltreatment during times of socioeconomic stress.

Influenza affects many lives worldwide each year during the months of October through February. The 2020-2021 influenza season saw a sharp decline in the cases reported in the United States and in other countries like Great Britain in comparison to previous influenza seasons. The most likely explanations for this decline are the safety measures taken during the COVID-19 pandemic, such as physical distancing, face mask use, and better hand hygiene in the mass population, which likely reduced the transmission and infection rates of influenza this season. Key words: influenza, surveillance, pandemic, transmission

Nutrition has evolved into an integral part of modern critical care for both medical and surgical patients. Multiple international societies now issue evidence-based guidelines to help clinician optimize their patients’ Nutrition. However, adherence to these guidelines throughout the country is poor, and education in nutrition is still lagging in medical school. The authors also highlight four key areas where evidence-based recommendations exist – timing of initiation of enteral feeding, calculating and meeting total daily requirements, use of gastric residual volumes to guide delivery, and interuption of feeding for procedures – but are currently often not followed. Reasons for this lack of adherence are explored, and potential solutions discussed.

Objective: To assess the rate and burden of bacterial contamination on unused, nonsterile gloves found in glove boxes in three different specialty intensive care units (ICUs). Design: Descriptive, cross-sectional study Setting: A burn, trauma/surgical, and medical ICU in a 412-bed tertiary care hospital. Subjects: Convenience sample of 90 non-sterile vinyl exam glove pairs Methods: Thirty occupied rooms in each ICU were utilized for collection of glove pair samples. Gloves from opened glove boxes placed in wall-mounted racks for use by healthcare staff were donned by one investigator in a routine, aseptic fashion. The surfaces of both gloves were swabbed, plated onto a contact agar plate and incubated for 48 hours. Resulting colony forming units (CFUs) were counted and recorded for each glove pair sample. Results: Bacterial contaminants were cultured from 73 of 90 (81.1%) glove pairs sampled across all ICUs. Contamination rates of glove samples from the BICU, SICU and MICU were 66.7%, 86.7% and 90.0% respectively. The differences in contamination rate among units was statistically significant (p=0.044). The average contamination burden was 5.83 CFU per glove pair and was not significantly different among units. Conclusions: Despite differences in infection control practices and the composition of pathologies managed in each ICU, the average bioburden of gloves left exposed in the environment was not significantly different. Further research is needed to assess for an association of glove bioburden with nosocomial infection rates and the effects of different infection control practices on the reduction of glove bioburdens.

Background: Necrotizing soft tissue infections (NSTI) are potentially severe infections that have a high morbidity and mortality even with modern medical care. This study examines factors associated with outcomes in patients with NSTI in an academic tertiary care hospital. Design: This is a retrospective cohort study of patients admitted with NSTI between 2003 and 2008. Baseline demographics and comorbid conditions, laboratory and clinical parameters, timing of surgery, and outcomes, including length of stay and mortality, were compared with univariate analysis; significant factors were then analyzed for their effects on mortality using binary logistic regression analysis. Results: Sixty-nine patients with NSTI were analyzed; 61% were men. Diabetes (39%) was the most common comorbid condition. Most infections (55%) were polymicrobial. The most common organism in monomicrobial infections was Staphylococcus aureus, and 50 % of these isolates were methicillin resistant. Nine patients (13%) required amputation. Mortality was 20%, and the most significant predictor of mortality was a higher respiratory rate on admission (p=0.02). Conclusion: Patients in this series frequently had diabetes, usually had polymicrobial infections, and had a 20% mortality rate.