September 2021
PMDA, More Relevant and Valuable Than Ever Before
Brian B. Kimmel, DO, CMD

It has been another difficult year. We’ve learned about a pandemic. We’ve educated ourselves, in various graduated stages, on how to identify and vaccinate against our medical combatant. We’ve learned the frustration of educating all those in our communities on the challenges of health management. We’ve even had friends and staff members express alternate opinions and, for various reasons, challenge medical know-how. Just when you thought it was safe to come out of hiding, we have yet another “spike” of Delta cases throughout our communities affecting our nursing homeworld. We now stand on the verge of a “booster vaccine” which has generated even more questions. Even as I write this article, the news may change again, further altering the pathway for recovery.

In these currents of world events, the Pennsylvania Society for Post-Acute and Long-Term Medicine is more relevant and valuable than ever before. The voices of medical leadership must be heard whether you are a medical director, nurse practitioner, attending physician, physician’s assistant, administrator, or director of nursing. You are a leader. You are a champion in your “homes.” People – staff, employees, families, or even community personnel – look to us for what to do, where to go, who to call, and when will there be something next? We must remain strong, stay unified, and be medical guidance counselors for our towns and cities. We have a responsibility to remain educated. The Latin translation of the word doctor means teacher. Beyond all frustrations, all backgrounds, and all barriers we must continue to pursue excellence in knowledge for all of those who are and have become our trusted students. It is for this main force that PMDA needs to survive and needs to continue to be an organization for all colleagues of medical leadership NOW!

It is time to join together, to become more of a force, and to cultivate your connections with PMDA at our 2021 Annual Symposium. Certainly, we would love to do the meeting in person, but for the safety of our members, speakers, guests, and staff, we are convening our annual education program via AirMeet, the state-of-the-art video conferencing platform for virtual meetings and exhibit halls.

This year’s symposium will be on Friday, October 22, and we heard you! The morning session will be “clinical heavy.” The theme will be endocrinology with topics not presented at PMDA in years. Discussions on the thyroid, both hypo and hyper, will start the morning, followed by presentations devoted to hyponatremia and parathyroid disorders. The session will finish with a panel discussion with the speakers.

In furtherance of PMDA’s commitment to addressing diversity, equity, and inclusion through education, a presentation on “Moving Towards An Equitable Long-Term Care System” will be presented after the morning break.

Following lunch and time spent with our exhibitors, there will be a lecture on “Nursing Home Psychiatry for Non-Psychiatrists with a Focus on Med Management,” a very important topic in today’s environment.
Next in the day’s agenda are two topics we all need to be focused on: “Outbreaks and Containment of Candida auris” and “Post-Acute Symptoms and Sequelae after SARS-COV-2 Infections.”

Of course, the annual business meeting for our members will occur along with an AMDA update, and we will finish our day with our Pennsylvania giant Dr. Dave Nace and his popular lecture the “Five Articles that Could Affect Your LTC Practice.”

In summary, it is extremely important that PMDA continues to be a leader in our long-term communities and a central focus of education, colleague interaction, and guidance for those who need to know. I look forward to seeing you virtually in October. It is my hope, as I’m sure it is everyone’s, that next year’s meeting be in person.

As it was said once a long, long time ago, in a galaxy, far, far away: MAY THE FORCE BE WITH US and of course, LIVE LONG and PROSPER!
Important Information from the Philadelphia Department of Public Health - Candida auris: Key Information for Pennsylvania Skilled Nursing Facilities

  • Global/national- Within the last decade, there has been a rapid expansion of geographical areas both in the U.S. and throughout the world. C. auris was made nationally notifiable in 2019. Most C. auris cases are domestically acquired now.
  • Regional- The first PA clinical case was identified in March 2020 in a patient with healthcare exposures in another state. No transmission was identified. In June 2020, a second PA clinical case led to a multi-jurisdictional public health investigation involving screening contacts and ensuring proper infection control measures by facilities. Transmission was identified. In July 2021, a patient was identified in Dauphin county with no epidemiologic links to other cases, no known history of international travel or healthcare outside the southcentral PA area. Since March 2020, there have been a total of 61 cases of infection and colonization identified from 13 healthcare facilities (including short-term and long-term acute hospitals [LTACHs] and a skilled nursing facility [SNF]) in 5 different counties in PA.

  • C. auris is often resistant to multiple antifungal drugs used to treat Candida infections leading to high mortality (30-60%). Pan-drug resistance is increasing.
  • It is difficult to identify using standard yeast laboratory detection methods leading to misidentification and inappropriate management.
  • It causes outbreaks in healthcare settings.
  • Patients at high risk include those with invasive devices (mechanical ventilation or tracheostomy), indwelling catheters (central venous catheters, feeding tubes), presence of breaks in mucocutaneous barriers (decubiti, other wounds), co-morbid conditions such as diabetes, recent surgery and receipt of broad-spectrum antibiotic and antifungal use.
  • Facilities at highest risk for C. auris patients include LTACHs and ventilator SNFs

  • Patient colonization may vary over time leading to intermittent positive and negative results. There are no established criteria for resolution of colonization, testing for clearance is therefore not recommended and testing healthcare workers is also not recommended.
  • The percentage of patients who are colonized with C. auris that will go on to develop invasive infection is not known.
  • C. auris can persist in the healthcare environment for long periods of time and requires special disinfectants.
  • Contact with the contaminated healthcare environment and colonized or infected patients leads to transmission via contaminated healthcare worker hands and equipment. Transmission risk increases with length of stay; but has occurred during periods as short as 4 hours.

  • Correct laboratory detection requires MALDI-TOF (Matrix Assisted Laser Desorption Ionization-Time of Flight mass spectrometry) or PCR
  • Many laboratories do not speciate yeast if identified from a non-sterile specimen (ex. urine, respiratory, skin). It is important to know what specimens your laboratory will perform full yeast speciation testing on and if your laboratory will properly test yeasts suspicious for C. auris or if they will send these out to a reference laboratory for testing.
  • If identified as C. auris, it is important to request antifungal susceptibility testing to confirm that the C. auris isolate is susceptible to echinocandins.

  • Increasing antifungal resistance is occurring. Approximately 85% of C. auris isolates in the U.S. are resistant to azoles, 33% to amphotericin B, and 1% to echinocandins. Echinocandins are therefore critical for treatment of C. auris infections and are recommended as first-line therapy for most invasive Candida infections
  • C. auris isolates with echinocandin resistance have been reported from NY, D.C and Texas
  • No recommendation currently to treat colonization

Infection prevention and control recommendations
  • Patient should be placed on transmission-based precautions, ideally in a private room. Can cohort with another C. auris patient, but one should ensure that patients do not have other MDROs. Can put “like with like”.
  • Staff must maintain meticulous hand hygiene, alcohol-based hand rub is effective against C. auris and is the preferred method of hand hygiene.
  • Staff should use conventional use gown and glove PPE (do not use PPE conservation/preservation practices as has sometimes been used during the COVID-19 pandemic)
  • Many common disinfectants effective against COVID-19 are not effective against C. auris especially quaternary ammonium compounds. Environmental disinfection should be performed with EPA P-list agents that have a kill claim against C. auris or can use agents active against C. difficile from the EPA K-list. All disinfectants with EPA approval for C. auris are also effective against COVID-19.

Regional containment
  • Maintain good communication regarding a patient’s C. auris status to receiving facilities and local health departments before transferring a C. auris patient so health department can educate receiving facility about C. auris.
  • Clearly document that the patient has C. auris in the patient’s medical record.
  • Verbally communicate that the patient has C. auris when giving report to a receiving facility
  • Use a C. auris patient transfer form as third layer of communication to a receiving facility

More information:
  1. PAHAN 584 Update: Outbreak and containment of Candida auris in PA Healthcare Facilities
  2. Pennsylvania Candida auris symposium- save the date
Any views or opinions presented in this article are solely those of the author and do not necessarily represent any policy or position of PAMED, PMDA, AMDA, its affiliates, and members. 

PMDA thanks Joshua Uy, MD, for sharing this important information with PMDA members.
Learn more about the outbreaks and containment of Candida auris at PMDA’s Annual Symposium on October 22, 2021. Register NOW! 
PMDA Nominating Committee Reports Out 2022 Slate of Officers and Directors

The PMDA Nominating Committee manages nominations for the Board and senior leadership positions from start to finish. It leads the process for Board appointments and recommends annually a slate of candidates to fill officer and director vacancies on the Board. Those candidates so identified stand for election at the annual business meeting of the members held in conjunction with the PMDA Annual Symposium. This year’s symposium and business meeting will be held virtually on October 22, 2021.

As of December 31, 2021, the positions of president-elect, treasurer, and secretary will be vacant.

The president-elect serves a two-year term. PMDA Secretary, Dilip K. Elangbam, MD, CMD, FACP has agreed to stand for election.

The PMDA treasurer serves a two-year term. PMDA Treasurer Daniel R. Steiner, MD, CMD-R has agreed to stand for re-election.

The PMDA secretary serves a two-year term. Former Board Director Charles M. Wasserman, DO, CMD has agreed to stand for election.

As of December 31, 2021, three Board of Director positions will be vacant. The individuals listed below have agreed to be candidates for these positions. Board Directors serve three-year terms and may serve a maximum of two consecutive three-year terms.

Licensed Practitioner Schyuler Barbour-Johnson, MSN, CRNP, ANP-BC has agreed to stand for re-election to a second three-year term.

Todd H. Goldberg, MD, CMD has agreed to stand for election.

Larry W. Spector, DO has agreed to stand for election.

Voting members attending the virtual annual business meeting will have the opportunity to nominate additional candidates from the floor. The candidates receiving the most votes will assume the office for which he or she was nominated and elected.

The Nominating Committee thanks our 2022 candidates for their commitment of time and leadership. PMDA members are reminded of the many opportunities to become actively involved with the association whether on a committee, speaker panel, or in a leadership role, your energy and talent will always be welcomed and appreciated!
Upcoming PMDA Events

2021 Fall Webinar
Electronic Death Registration System Overview 
September 22, 2021 | 6:15 p.m. - 8:00 p.m. | Virtual
This course will provide information on Pennsylvania's transition from a paper-based death reporting system to electronic reporting. Launched in 2016, EDRS is a web-based application that simplifies the death data reporting process while increasing data quality. EDRS supports the rapid-reporting of deaths that occur in Pennsylvania which is crucial for public health research purposes. Click here for more information and to register.

29th Annual Symposium
October 22, 2021 | Virtual
Join us on Friday, October 22 for a full-day of education discussing important topics such as Equity, Diversity & Inclusion, Post COVID-19 Sequelae and the Long Hauler Syndrome, the Next Global Health Threat, AMDA Updates, and more! Click here for more information and to register.
The PMDA Trainee Education Fund supports PMDA’s efforts to educate, recognize and inspire post-acute and long-term care clinicians in training in the benefits and rewards of a career in the PALTC continuum. Your contribution will allow us to continue to offer complimentary registration to the Annual Symposium for fellows, residents and students and support PMDA’s contribution to AMDA’s Futures Program. Help us invest in the future of practice in PALTC medicine.
PMDA's Archived Webinars Available to Purchase
PMDA has several archived webinars available for purchase! A recording of these webinars can be purchased using the form linked below.
Each recording is $15 plus 6% sales tax. You will need access to to receive the recordings.
EDGE21 Virtual Symposium – Recordings Now Available!
Here’s what you missed:
Purchase the full set, or individual sessions. The choice is yours!
2D Progress Check-in:
Sharing Strategies, Successes, and Secrets
Date: Thursday, September 16
Time: 4:30 PM – 5:15 PM ET

Access the D2D Meeting Archives, which includes the call playback and slide deck.
The Annual Conference Program Planning Subcommittee invites you to submit abstracts for poster presentation at PALTC22, the Society's Annual Conference to be held March 10-13, 2022 in Baltimore, MD.

Submissions should be based on the learning objectives and areas of interest noted below and include current trends and best practices in PALTC. Of special interest is emerging clinical information, research, innovative ideas and solutions to problems, emerging concepts in management and medical direction, and updates on approaches to regulatory compliance.

September 1, 2021 - Abstract Submission Opens
November 19, 2021 (11:59 PM ET) - Submission Closes
December 2021 - Notification of Acceptance
It's Awards Season
It's time to nominate a deserving colleague for one of the following awards:

Nominations are being accepted through November 12, 2021.
Recruiting Practitioners for Futures Class of 2022

The Foundation is accepting applications for the 2022 Futures Program. This workforce program is one the Foundation’s most visible programs. It brings residents, fellows and advanced practitioners to PALTC22 in Baltimore for a one-day intensive meeting and then a 3-day registration to the annual conference.
The application deadline is November 12, 2021. This is also an opportunity to engage young practitioners in state chapter activities.
AMDA On-The-Go
Podcast Series
NEW OPPORTUNITY: Evaluating the Impact of Antiviral Medication Choice on Outcomes of Influenza Outbreaks in U.S. Nursing Home Residents During the 2021-2022 Influenza Season
  • Nursing facilities that meet eligibility and agree to participate will be allocated one of two FDA-approved and CDC recommended antivirals, baloxavir and oseltamivir, for use during the seasonal management of flu outbreaks.
  • Facilities will receive an influenza outbreak e-box containing the medication and rapid influenza test kits.
  • The Foundation for PALTC Medicine will receive a donation of $100 for each facility that enrolls in this study based on their referral.
For more information on this important project, contact Insight Therapeutics, LLC, at or
757-625-6040, or access additional information at