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Item Implementation of intermittent pulse oximetry in low-risk hospitalized bronchiolitis patients(Montana State University - Bozeman, College of Nursing, 2024) Donovan, Alaina Jean; Chairperson, Graduate Committee: Margaret Hammersla; This is a manuscript style paper that includes co-authored chapters.Background: In 2014, the American Academy of Pediatrics (AAP) updated its guidelines, which recommend the utilization of intermittent pulse oximetry (IPOx) in low-risk and non-hypoxemic bronchiolitis patients. IPOx is the utilization of pulse oximetry monitoring intermittently at specified times. The overuse of pulse oximetry has been associated with an increase of hospital length of stay (LOS), alarm burden for RNs, and parental anxiety. Methods: A two-month QI project was implemented in a large Montana hospital's 10-bed inpatient pediatric unit. The project consisted of implementing an Inpatient Bronchiolitis Pathway utilizing IPOx. When criteria were met, IPOx orders were to be placed into the EMR. After each shift, RNs were asked to self-rate their adherence to the IPOx orders. At the end of each month, RNs completed a Likert-style questionnaire that assessed their satisfaction with the pathway and alarm fatigue. Results: During the QI project there were 12 bronchiolitis patients; of those, only eight patients met the necessary criteria. Six out of the eight had IPOx orders placed into the EMR. There was a 75% rate of IPOx order placement for the short and long-term goals. Adherence to the IPOx orders had a success rate of 73% during the month of January and a 57% adherence rate during the month of February. A comparison of mean LOS showed a mean difference of -5.9 hours in January and February of 2024 compared to 2023. The RN questionnaires showed overall satisfaction with the Inpatient Bronchiolitis Pathway and a reduction of alarm fatigue. Conclusion: The implementation of IPOx for inpatient bronchiolitis patients has been shown to decrease hospital LOS, unnecessary interventions, parental anxiety, and alarm fatigue. While the QI project does show possible improvement to LOS, a study with a longer time frame and increased sample size is needed to determine any clinical significance. The questionnaire suggests decreased alarm fatigue with the implementation of IPOx, which shows that even a small change could significantly impact RN alarm burden. Well-defined guidelines and education to staff and parents should be prioritized to continue to improve adherence to IPOx in the bronchiolitis population.Item Aerosol stability of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2)(Montana State University - Bozeman, College of Agriculture, 2022) Bushmaker, Trenton John; Chairperson, Graduate Committee: Raina K. Plowright and Vincent J. Munster (co-chair); Neeltje van Doremalen and Dylan H. Morris were authors and Myndi G. Holbrook, Amandine Gamble, Brandi N. Williamson, Azaibi Tamin, Jennifer L. Harcourt, Natalie J. Thornburg, Susan I. Gerber, James O. Lloyd-Smith, Emmie de Wit and Vincent J. Munster were co-authors of the article, 'Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1' in the journal 'New England journal of medicine' which is contained within this thesis.; Claude Kwe Yinda and Dylan H. Morris were authors and Myndi G. Holbrook, Amandine Gamble, Danielle Adney, Cara Bushmaker, Neeltje van Doremalen, Raina K. Plowright, James O. Lloyd-Smith and Vincent J. Munster were co-authors of the article, 'Comparative aerosol stability of SARS-CoV-2 variants of concern' submitted to the journal 'Emerging infectious diseases - CDC' which is contained within this thesis.The routes of transmission of the zoonotic pathogen severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have been extensively studied to understand the spread at individual and population levels. Aerosol particles produced by infected individuals and the deposition patterns inhaled are known to affect the virulence of bioaerosol pathogens. Droplet nuclei particles (< 5 microns) aerosols typically deposit within the alveolar spaces of the lungs, whereas droplet (>5 microns) aerosols typically deposit within the nasopharyngeal and tracheobronchial regions of the respiratory tract. A few studies have evaluated pulmonary disease following droplet nuclei size particles of SARS-CoV-2 aerosol inhalation in African green monkeys and golden hamsters, concluding that both models have mild respiratory disease representative of human disease. More importantly, human participants with SARS-CoV-2 infections have been studied to look at the generation of particles during breathing, talking, and singing; the study concluded droplet nuclei particles accounted for 85% of the copies of virus produced and play a significant role in transmission. However, the environmental persistence of the aerosolized droplet nuclei particles, and the likely role of environmental persistence in driving transmission, is unknown for SARS-CoV-2. In these studies, we show the changing aerosol stability of SARS-CoV-2 during the supplanting waves of Variants of Concern (VOC). With the determination of viable viral particles characterized over time, we can make inferences about the role VOC and aerosol transmission have in driving population-level pathogen transmission. A secondary objective of these studies was to characterize the role those evolving mutations have had on viral entry and aerosol durability. Our work suggests that aerosol stability may be important in driving some population-level phenomena (e.g., indoor transmission, including superspreader events) but given the short infected-to-naive transmission transit time, the variation in the duration of aerosol stability among VOCs may not explain the difference in transmission rates of VOCs. This data will be useful for assessing the future evolution of aerosol transmission of SARS-CoV-2.