Refugees who settle in Western countries exhibit a high rate of mental health issues, which are often related to experiences throughout the pre-displacement, displacement, and post-displacement processes. Early detection of mental health symptoms could increase positive outcomes in this vulnerable population. The rates and predictors of positive screenings for mental health symptoms were examined among a large sample of refugees, individuals with special immigrant visas, and parolees/entrants (N = 8149) from diverse nationalities. Logistic regression analyses were used to determine if demographic factors and witnessing/experiencing violence predicted positive screenings. On a smaller subset of the sample, we calculated referral acceptance rate by country of origin. Refugees from Syria, Iraq, and Afghanistan were most likely to exhibit a positive screening for mental health symptoms. Refugees from Sudan, Iraq, and Syria reported the highest rate of experiencing violence, whereas those from Iraq, Sudan, and the Democratic Republic of Congo reported the highest rate of witnessing violence. Both witnessing and experiencing violence predicted positive Refugee Health Screener-15 (RHS-15) scores. Further, higher age and female gender predicted positive RHS-15 scores, though neither demographic variable was correlated with accepting a referral for mental health services. The findings from this study can help to identify characteristics that may be associated with risk for mental health symptoms among a refugee population.

Improper infection prevention practice associated with ultrasound probe use has been linked to increased infection risk, outbreaks, and death. Although guidelines for reprocessing and use of probes exist, it is unclear how extensively these have been adopted in practice. Infection preventionists from U.S. health care facilities were surveyed (N = 358). The anonymous survey had 31 multiple choice, sliding scale, and text response questions. The survey was developed and deployed and the data were stored in the REDCap system. A high degree of noncompliance with U.S. guidelines was identified. Surface probes used in invasive procedures were not high-level disinfected or sterilized 15% (intraoperative) to 78% (peripheral line placements) of the time. Of invasive procedures, 5%-47% did not use sterile gel (same procedures, respectively). Of the participants, 20% were aware of instances where an ultrasound probe was used but was not correctly reprocessed. Extensive breaches of infection control guidelines were reported. The rapid expansion in use of ultrasound has brought clinical benefit but may be exposing patients to preventable infection risk. Infection preventionists are well placed to act as major drivers of change based on their expertise and experience in the management of infection risk across facilities and health systems. They, along with clinicians responsible for probe use and reprocessing, should review practices relating to ultrasound in their facilities. Where practice does not comply with guidelines, policy and training should be updated to ensure patient safety.

Background: Most epidemiologic studies and clinical testing use single nasal/nasopharyngeal swab (NPS) for respiratory syncytial virus (RSV) detection. Studies document that RSV detection improves if another specimen is added to NPS, but the impact of using multiple specimen types has not been assessed. We quantified RSV detection increase using multiple-specimen testing versus NPS alone. Methods: Hospitalized adults aged ≥40 years with acute respiratory illness were prospectively enrolled in 7 US/Canadian hospitals. NPS, saliva, sputa, and acute/convalescent sera were collected and tested. Results: Among 3669 participants, 100% had NPS, 97.7% saliva, 33.0% sputum, and 33.4% paired serology. RSV detection was 112% higher (95% CI, 86%–141%) using all specimen types as compared with NPS alone. Serology test sensitivity was the highest (73.0%; 95% CI, 65.1%–80.8%), followed by sputum (70.1%; 95% CI, 62.1%–78.0%), saliva (61.4%; 95% CI, 55.4%–67.5%), and NPS (47.2%; 95% CI, 41.1%–53.4%). Among those with congestive heart failure exacerbations, additional specimens increased detection by 267% (95% CI, 85%–625%), and saliva detected more infections than NPS. Among 1013 participants with paired NPSs from different time points, specimens collected on average 1 day later detected 30% fewer RSV infections. Conclusions: RSV detection increased >100% using 4 specimen types, suggesting a 2-fold correction factor is appropriate for incidence and prevalence studies relying on NPS alone. Saliva was more sensitive than NPS, warranting further study, particularly in cardiac cases.