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Stoian M, Andone A, Boeriu A, Bândilă SR, Dobru D, Laszlo SȘ, Corău D, Arbănași EM, Russu E, Stoian A. COVID-19 and Clostridioides difficile Coinfection Analysis in the Intensive Care Unit. Antibiotics (Basel) 2024; 13:367. [PMID: 38667043 PMCID: PMC11047694 DOI: 10.3390/antibiotics13040367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
Since the emergence of SARS-CoV-2 in late 2019, the global mortality attributable to COVID-19 has reached 6,972,152 deaths according to the World Health Organization (WHO). The association between coinfection with Clostridioides difficile (CDI) and SARS-CoV-2 has limited data in the literature. This retrospective study, conducted at Mureș County Clinical Hospital in Romania, involved 3002 ICU patients. Following stringent inclusion and exclusion criteria, 63 patients were enrolled, with a division into two subgroups-SARS-CoV-2 + CDI patients and CDI patients. Throughout their hospitalization, the patients were closely monitored. Analysis revealed no significant correlation between comorbidities and invasive mechanical ventilation (IMV) or non-invasive mechanical ventilation (NIMV). However, statistically significant associations were noted between renal and hepatic comorbidties (p = 0.009), death and CDI-SARS-CoV-2 coinfection (p = 0.09), flourochinolone treatment and CDI-SARS-CoV-2 infection (p = 0.03), and an association between diabetes mellitus and SARS-CoV-2-CDI infection (p = 0.04), as well as the need for invasive mechanical ventilation (p = 0.04). The patients with CDI treatment were significantly younger and received immuno-modulator or corticotherapy treatment, which was a risk factor for opportunistic agents. Antibiotic and PPI (proton pump inhibitor) treatment were significant risk factors for CDI coinfection, as well as for death, with PPI treatment in combination with antibiotic treatment being a more significant risk factor.
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Affiliation(s)
- Mircea Stoian
- Department of Anesthesiology and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Adina Andone
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (A.B.); (D.D.)
| | - Alina Boeriu
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (A.B.); (D.D.)
| | - Sergio Rareș Bândilă
- Orthopedic Surgery and Traumatology Service, Marina Baixa Hospital, Av. Alcade En Jaume Botella Mayor, 03570 Villajoyosa, Spain;
| | - Daniela Dobru
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (A.B.); (D.D.)
| | - Sergiu Ștefan Laszlo
- Intensive Care Unit, Mures, County Hospital, Street Gheorghe Marinescu No 1, 540136 Targu Mures, Romania; (S.Ș.L.); (D.C.)
| | - Dragoș Corău
- Intensive Care Unit, Mures, County Hospital, Street Gheorghe Marinescu No 1, 540136 Targu Mures, Romania; (S.Ș.L.); (D.C.)
| | - Emil Marian Arbănași
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania;
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania;
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Eliza Russu
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania;
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Adina Stoian
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540136 Targu Mures, Romania;
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Voidarou C, Rozos G, Stavropoulou E, Giorgi E, Stefanis C, Vakadaris G, Vaou N, Tsigalou C, Kourkoutas Y, Bezirtzoglou E. COVID-19 on the spectrum: a scoping review of hygienic standards. Front Public Health 2023; 11:1202216. [PMID: 38026326 PMCID: PMC10646607 DOI: 10.3389/fpubh.2023.1202216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
The emergence of COVID-19 in Wuhan, China, rapidly escalated into a worldwide public health crisis. Despite numerous clinical treatment endeavors, initial defenses against the virus primarily relied on hygiene practices like mask-wearing, meticulous hand hygiene (using soap or antiseptic solutions), and maintaining social distancing. Even with the subsequent advent of vaccines and the commencement of mass vaccination campaigns, these hygiene measures persistently remain in effect, aiming to curb virus transmission until the achievement of herd immunity. In this scoping review, we delve into the effectiveness of these measures and the diverse transmission pathways, focusing on the intricate interplay within the food network. Furthermore, we explore the virus's pathophysiology, considering its survival on droplets of varying sizes, each endowed with distinct aerodynamic attributes that influence disease dispersion dynamics. While respiratory transmission remains the predominant route, the potential for oral-fecal transmission should not be disregarded, given the protracted presence of viral RNA in patients' feces after the infection period. Addressing concerns about food as a potential viral vector, uncertainties shroud the virus's survivability and potential to contaminate consumers indirectly. Hence, a meticulous and comprehensive hygienic strategy remains paramount in our collective efforts to combat this pandemic.
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Affiliation(s)
| | - Georgios Rozos
- Veterinary Directorate, South Aegean Region, Ermoupolis, Greece
| | - Elisavet Stavropoulou
- Department of Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Elpida Giorgi
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christos Stefanis
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Vakadaris
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Natalia Vaou
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christina Tsigalou
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Yiannis Kourkoutas
- Laboratory of Applied Microbiology and Biotechnology, Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Eugenia Bezirtzoglou
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Wang X, Du G, Qiao Z, Yang Y, Shi H, Zhang D, Pan X. Environmental concentrations of surfactants as a trigger for climax of horizonal gene transfer of antibiotic resistance. Heliyon 2023; 9:e17034. [PMID: 37484423 PMCID: PMC10361096 DOI: 10.1016/j.heliyon.2023.e17034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 07/25/2023] Open
Abstract
Ubiquitous antibiotic resistance genes (ARGs) is a significant global human health concern. Surfactants have been extensively used worldwide, and the consumption of surfactants containing hygiene, cleaning agents and disinfectants was multiplied during COVID-19 pandemic, which have caused significantly increased pollution of surfactants in aquatic environment. Whether such ever-increasing surfactant concentration boost dissemination risk of ARGs still remains unknown. Here the effects of three typical surfactants such as sodium dodecyl sulfate, cetyltrimethylammonium bromide and benzalkonium chloride on the transformation of pUC19 plasmid (2686 bp)-borne ARGs to recipient bacteria E. coli DH5ɑ were investigated. It was found that these surfactants at environmental concentrations facilitated horizonal gene transfer (HGT) via transformation. The transformation triggering concentrations for the three surfactants were 0.25-0.34 mg/L with a maximum increased transformation frequency of 13.51-22.93-fold. The mechanisms involved in activated HGT of ARGs via transformation triggered by surfactants could be mainly attributed to the increased production of reactive oxygen species, which further enhanced cell membrane permeability. These findings provide new sights for understanding of ARG propagation and also imply that the drastic rise of surfactant concentration in aquatic environment may significantly increase the dissemination risk of antibiotic resistance.
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Affiliation(s)
- Xiaonan Wang
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Zhejiang University of Technology, Hangzhou, 310014, China
- School of Environment Science and Spatial Information, China University of Mining and Technology, Xuzhou, 221116, China
- Key Laboratory of Pollution Exposure and Health Intervention of Zhejiang Province, Hangzhou, 310015, China
- Shaoxing Research Institute of Zhejiang University of Technology, Shaoxing, 312000, China
| | - Gaoquan Du
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Zhuang Qiao
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Yixuan Yang
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Huimin Shi
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Daoyong Zhang
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Xiangliang Pan
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Zhejiang University of Technology, Hangzhou, 310014, China
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Zouridis S, Sangha M, Feustel P, Richter S. Clostridium difficile Infection Rates During the Pandemic in New York Capital Area: A Single-Center Study. Cureus 2023; 15:e37576. [PMID: 37193428 PMCID: PMC10183223 DOI: 10.7759/cureus.37576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/18/2023] Open
Abstract
Introduction Clostridioides difficile (C. difficile) colonizes the large intestine, rendering healthy individuals asymptomatic carriers of the disease. In certain instances, C. difficile infection (CDI) occurs. Antibiotic use remains the leading risk factor for CDI. During the coronavirus disease 2019 (COVID-19) pandemic, multiple risk and protective factors for and against CDI were identified, and as such multiple studies tried to analyze the pandemic's overall effect on CDI incidence rates, with contradictory results. Our study's aim is to further characterize the CDI incidence rates trends, but for a longer period of 22 months in the pandemic. Methods We included only adult (>18 years) patients, diagnosed with CDI during their hospitalization for the following period: January 1, 2018, to December 31, 2021. Incidence was calculated as cases per 10,000 patient days. The period identified as the COVID-19 pandemic period was the following: March 1, 2020, to December 31, 2021. All analyses were performed by an expert statistician using Minitab software (Minitab Inc., State College, Pennsylvania, United States). Results The mean CDI incidence rate per 10,000 patient-days was 6.86 +/-2.1. The 95% confidence interval for the CDI incidence rate prior to the pandemic was found at 5.67 +/-0.35 while the interval during the pandemic was calculated at 8.06 +/- 0.41 per 10,000 patient days. Those results reveal a statistically significant increase in CDI incidence rates during the COVID-19 era. Conclusion Multiple risk and protective factors for and against hospital-acquired infections (including CDI) have been identified during the unprecedented COVID-19 healthcare crisis. In the literature, there is high controversy regarding the trends of CDI incidence during the pandemic. The current study analyzed an almost two-year period into the pandemic, identifying an increase in CDI rates when compared to the pre-pandemic era.
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Affiliation(s)
| | - Maheep Sangha
- Gastroenterology and Hepatology, Albany Medical Center, Albany, USA
| | - Paul Feustel
- Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, USA
| | - Seth Richter
- Gastroenterology and Hepatology, Albany Medical Center, Albany, USA
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Neumark Y, Bar-Lev A, Barashi D, Benenson S. A feasibility study of the use of medical clowns as hand-hygiene promoters in hospitals. PLoS One 2022; 17:e0279361. [PMID: 36548383 PMCID: PMC9778928 DOI: 10.1371/journal.pone.0279361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Healthcare-acquired infections (HAI) pose vast health and economic burdens. Proper hand-hygiene is effective for reducing healthcare-acquired infections (HAI) incidence, yet staff compliance is generally low. This study assessed the feasibility, acceptability and preliminary effect of employing medical clowns to enhance hand-hygiene among physicians and nurses. Staff perception of the intervention and its impact on hand-hygiene was assessed via self-report questionnaires. Nearly 1,500 hand-hygiene compliance observations were conducted in accordance with WHO guidelines before, during and after the intervention. In each of three hospitals in Israel, two departments were selected-one in which medical clowns routinely operate and one clown-naive department. Professional medical clowns acted as hand-hygiene promoters employing humorous tactics to encourage hand-sanitizing based on the WHO "5 Moments" model. The clown appeared in each department seven times during the 2-week intervention phase. Pre-intervention hand-hygiene compliance ranged from just over 50% to 80% across hospitals and departments. Overall, about 70% of nurses (N = 132) and 80% of physicians (N = 49) felt the intervention improved personal and departmental hand-hygiene, with large inter-department variation. Pre- to post-intervention hand-hygiene compliance increased by 4% -25% (3.5-14.8 percentage points) in four departments, three of which had low baseline compliance levels. Results of this feasibility study suggest that employing medical clowns as hand-hygiene promoters as a novel approach toward HAI prevention is feasible and welcome by hospital staff.
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Affiliation(s)
- Yehuda Neumark
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- * E-mail:
| | - Adina Bar-Lev
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Shmuel Benenson
- Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Si Ali A, Cherel O, Brehaut P, Garrait V, Lombardin C, Schortgen F, Constan A, Lanceleur F, El-Assali A, Poullain S, Jung C. Impact of COVID-19 pandemic waves on health-care worker hand hygiene activity in department of medicine and ICU as measured by an automated monitoring system. Infect Dis Health 2022; 28:95-101. [PMID: 36641288 PMCID: PMC9760610 DOI: 10.1016/j.idh.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hand hygiene (HH) compliance among health-care workers is important for preventing transmission of infectious diseases. AIM To describe health-care worker hand hygiene activity in ICU and non-ICU patients' rooms, using an automated monitoring system (AMS), before and after the onset of the COVID-19 pandemic. METHODS At the Intercommunal Hospital of Créteil, near Paris, France, alcohol-based hand sanitizer (ABHS) consumption in the Department of Medicine (DM) and ICU was recorded using an AMS during four periods: before, during, and after the first wave of the COVID-19 pandemic, and during its second wave. FINDINGS From 1st February to 30th November 2020, in the DM, the mean number of doses per patient-day for each of the four periods was, respectively, 5.7 (±0.3), 19.4 (±1.3), 17.6 (±0.7), and 7.9 (±0.2, P < 0.0001). In contrast, ICU ABHS consumption remained relatively constant. In the DM, during the pandemic waves, ABHS consumption was higher in rooms of COVID-19 patients than in other patients' rooms. Multivariate analysis showed ABHS consumption was associated with the period in the DM, and with the number of HCWs in the ICU. CONCLUSION An AMS allows real-time collection of ABHS consumption data that can be used to adapt training and prevention measures to specific hospital departments.
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Affiliation(s)
- Amine Si Ali
- Department of Infection Prevention and Control, Centre Hospitalier Intercommunal de Créteil (CHIC), Créteil, France,Corresponding author
| | - Olivia Cherel
- Department of Infection Prevention and Control, Centre Hospitalier Intercommunal de Créteil (CHIC), Créteil, France
| | - Paula Brehaut
- Department of Infection Prevention and Control, Centre Hospitalier Intercommunal de Créteil (CHIC), Créteil, France
| | | | | | | | | | | | | | | | - Camille Jung
- Clinical Research Centre, CHIC, Créteil, France,Corresponding author
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Boeriu A, Roman A, Dobru D, Stoian M, Voidăzan S, Fofiu C. The Impact of Clostridioides Difficile Infection in Hospitalized Patients: What Changed during the Pandemic? Diagnostics (Basel) 2022; 12:diagnostics12123196. [PMID: 36553203 PMCID: PMC9778033 DOI: 10.3390/diagnostics12123196] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/03/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Clostridioides difficile (C. difficile) and SARS-CoV-2 coronavirus represent significant health threats. Our study focused on the impact of concurrent infections on patient outcomes against the backdrop of changes imposed by the pandemic. (2) Materials and methods. We performed a retrospective analysis and included patients diagnosed with CDI who were admitted in our hospital before and during the pandemic. We compared patient exposure to risk factors for CDI in both groups and patient negative outcomes: need for ICU care, prolonged hospitalization, organ failure, toxic megacolon, and death. (3) Results. Overall, 188 patients were included, of which 100 had CDI (the pre-pandemic group), and 88 patients presented both CDI and COVID-19 (the pandemic group). Patients in the pandemic group were significantly older, with a higher Charlson Comorbidity Index (CCI) and a greater exposure to antibiotics and corticosteroids, and were more likely to develop organ dysfunction, to require ICU care and have prolonged hospitalization. The severity of COVID-19, leukocytosis and increased D-dimer levels were indicators of poor prognosis in the pandemic group. Higher CCI scores and leukocytosis increased the risk for negative outcomes in CDI alone patients. (4) Conclusions. The study highlights the negative impact of associated infections on patient outcome. The severity of COVID-19 directly influences the prognosis of patients with concurrent infections.
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Affiliation(s)
- Alina Boeriu
- Gastroenterology Department, University of Medicine Pharmacy, Sciences, and Technology “George Emil Palade” Targu Mures, 540142 Targu Mures, Romania
- Gastroenterology Department, Mureș County Clinical Hospital, 540103 Targu Mures, Romania
| | - Adina Roman
- Gastroenterology Department, University of Medicine Pharmacy, Sciences, and Technology “George Emil Palade” Targu Mures, 540142 Targu Mures, Romania
- Gastroenterology Department, Mureș County Clinical Hospital, 540103 Targu Mures, Romania
- Correspondence: (A.R.); (D.D.); Tel.: +40-(75)-2934465 (A.R.)
| | - Daniela Dobru
- Gastroenterology Department, University of Medicine Pharmacy, Sciences, and Technology “George Emil Palade” Targu Mures, 540142 Targu Mures, Romania
- Gastroenterology Department, Mureș County Clinical Hospital, 540103 Targu Mures, Romania
- Correspondence: (A.R.); (D.D.); Tel.: +40-(75)-2934465 (A.R.)
| | - Mircea Stoian
- Intensive Care Unit Department, University of Medicine Pharmacy, Sciences, and Technology “George Emil Palade” Targu Mures, 540142 Targu Mures, Romania
- Intensive Care Unit Department, Mureș County Clinical Hospital, 540103 Targu Mures, Romania
| | - Septimiu Voidăzan
- Epidemiology Department, University of Medicine Pharmacy, Sciences, and Technology “George Emil Palade” Targu Mures, 540142 Targu Mures, Romania
| | - Crina Fofiu
- Gastroenterology Department, University of Medicine Pharmacy, Sciences, and Technology “George Emil Palade” Targu Mures, 540142 Targu Mures, Romania
- Internal Medicine Department, Bistrița County Hospital, 420094 Bistrița, Romania
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Ullrich C, Luescher AM, Koch J, Grass RN, Sax H. Silica nanoparticles with encapsulated DNA (SPED) to trace the spread of pathogens in healthcare. Antimicrob Resist Infect Control 2022; 11:4. [PMID: 35012659 PMCID: PMC8743744 DOI: 10.1186/s13756-021-01041-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/06/2021] [Indexed: 01/05/2023] Open
Abstract
Background To establish effective infection control protocols, understanding pathogen transmission pathways is essential. Non-infectious surrogate tracers may safely explore these pathways and challenge pre-existing assumptions. We used silica nanoparticles with encapsulated DNA (SPED) for the first time in a real-life hospital setting to investigate potential transmission routes of vancomycin-resistant enterococci in the context of a prolonged outbreak. Methods The two study experiments took place in the 900-bed University Hospital Zurich, Switzerland. A three-run ‘Patient experiment’ investigated pathogen transmission via toilet seats in a two-patient room with shared bathroom. First, various predetermined body and fomite sites in a two-bed patient room were probed at baseline. Then, after the first patient was contaminated with SPED at the subgluteal region, both patients sequentially performed a toilet routine. All sites were consequently swabbed again for SPED contamination. Eight hours later, further spread was tested at predefined sites in the patient room and throughout the ward. A two-run ‘Mobile device experiment’ explored the potential transmission by mobile phones and stethoscopes in a quasi-realistic setting. All SPED contamination statuses and levels were determined by real-time qPCR. Results Over all three runs, the ‘Patient experiment’ yielded SPED in 59 of 73 (80.8%) predefined body and environmental sites. Specifically, positivity rates were 100% on subgluteal skin, toilet seats, tap handles, and entertainment devices, the initially contaminated patients’ hands; 83.3% on patient phones and bed controls; 80% on intravenous pumps; 75% on toilet flush plates and door handles, and 0% on the initially not contaminated patients’ hands. SPED spread as far as doctor’s keyboards (66.6%), staff mobile phones (33.3%) and nurses’ keyboards (33.3%) after eight hours. The ‘Mobile device experiment’ resulted in 16 of 22 (72.7%) positive follow-up samples, and transmission to the second patient occurred in one of the two runs. Conclusions For the first time SPED were used to investigate potential transmission pathways in a real hospital setting. The results suggest that, in the absence of targeted cleaning, toilet seats and mobile devices may result in widespread transmission of pathogens departing from one contaminated patient skin region.
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Influence of public health and infection control interventions during the severe acute respiratory syndrome coronavirus 2 pandemic on the in-hospital epidemiology of pathogens: in hospital versus community circulating pathogens. Antimicrob Resist Infect Control 2022; 11:140. [PMID: 36369056 PMCID: PMC9651880 DOI: 10.1186/s13756-022-01182-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background The first detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Germany was reported in early February 2020. In addition, extensive control measures on the coronavirus disease 2019 (COVID-19) pandemic have been placed in Germany since March 2020. These include contact and travel restrictions, distance rules, mandatory wearing of face masks and respirators, cancellation of mass events, closures of day-care centers, schools, restaurants and shops, isolation measures, and intensified infection control measures in medical and long-term care facilities. Changes in demand or access to health care services and intensified control measures can lead to changes in transmission dynamics and imply effects on the overall occurrence of infectious diseases in hospitals. Methods To analyze the impact of infection control measures implemented in public on infectious diseases in hospitals, surveillance data from Marburg University Hospital were analyzed retrospectively. The analysis was conducted from January 2019 to June 2021, referred to hospital occupancy and mobility data in the county of Marburg-Biedenkopf, and correlated to control measures in hospitals and the general population. Results The COVID-19 pandemic and associated measures immediately impacted the occurrence of infectious diseases at the Marburg University Hospital. Significant changes were detected for virus-associated respiratory and gastrointestinal diseases. The massive drop in norovirus infections was significantly affected by the onset of the pandemic (P = 0.028). Similar effects were observed for rotavirus (up to − 89%), respiratory syncytial virus (up to − 98%), and adenovirus infections (up to − 90%). The decrease in gastrointestinal and respiratory virus detection rates was significantly affected by the decline in mobility (P < 0.05). Of note, since April 2020, there have been no detected influenza cases. Furthermore, Clostridioides difficile-related infections declined after late 2020 (− 44%). In contrast, no significant changes were detected in the prevalence of susceptible and drug-resistant bacterial pathogens. In particular, the detection rates of methicillin-resistant Staphylococcus aureus isolates or multidrug resistant (MDR) and extended drug resistant (XDR) bacteria remained constant, although the consumption of hand disinfectants and protective equipment increased. Conclusions The COVID-19 pandemic and associated public health measures had a significant impact on infectious diseases and the detection of pathogens at the Marburg University Hospital. Significant changes were observed for community transmissible infections, while no such effects on pathogens primarily associated with nosocomial transmission could be detected. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01182-z.
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Filip R, Gheorghita Puscaselu R, Anchidin-Norocel L, Dimian M, Savage WK. Global Challenges to Public Health Care Systems during the COVID-19 Pandemic: A Review of Pandemic Measures and Problems. J Pers Med 2022; 12:1295. [PMID: 36013244 PMCID: PMC9409667 DOI: 10.3390/jpm12081295] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/21/2022] [Accepted: 08/05/2022] [Indexed: 12/15/2022] Open
Abstract
Beginning in December 2019, the world faced a critical new public health stressor with the emergence of SARS-CoV-2. Its spread was extraordinarily rapid, and in a matter of weeks countries across the world were affected, notably in their ability to manage health care needs. While many sectors of public structures were impacted by the pandemic, it particularly highlighted shortcomings in medical care infrastructures around the world that underscored the need to reorganize medical systems, as they were vastly unprepared and ill-equipped to manage a pandemic and simultaneously provide general and specialized medical care. This paper presents modalities in approaches to the pandemic by various countries, and the triaged reorganization of medical sections not considered first-line in the pandemic that was in many cases transformed into wards for treating COVID-19 cases. As new viruses and structural variants emerge, it is important to find solutions to streamline medical care in hospitals, which includes the expansion of digital network medicine (i.e., telemedicine and mobile health apps) for patients to continue to receive appropriate care without risking exposure to contagions. Mobile health app development continues to evolve with specialized diagnostics capabilities via external attachments that can provide rapid information sharing between patients and care providers while eliminating the need for office visits. Telemedicine, still in the early stages of adoption, especially in the developing world, can ensure access to medical information and contact with care providers, with the potential to release emergency rooms from excessive cases, and offer multidisciplinary access for patients and care providers that can also be a means to avoid contact during a pandemic. As this pandemic illustrated, an overhaul to streamline health care is essential, and a move towards greater use of mobile health and telemedicine will greatly benefit public health to control the spread of new variants and future outbreaks.
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Affiliation(s)
- Roxana Filip
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- BK Laboratory, SuceavaCounty Emergency Hospital, 720224 Suceava, Romania
| | - Roxana Gheorghita Puscaselu
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- Integrated Center for Research, Development and Innovation in Advanced Materials, Nanotechnologies, and Distributed Systems for Fabrication and Control, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
| | - Liliana Anchidin-Norocel
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
| | - Mihai Dimian
- Integrated Center for Research, Development and Innovation in Advanced Materials, Nanotechnologies, and Distributed Systems for Fabrication and Control, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- Department of Computers, Electronics and Automation, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
| | - Wesley K. Savage
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- Integrated Center for Research, Development and Innovation in Advanced Materials, Nanotechnologies, and Distributed Systems for Fabrication and Control, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
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11
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Sandbøl SG, Glassou EN, Ellermann-Eriksen S, Haagerup A. Hand hygiene compliance among healthcare workers before and during the COVID-19 pandemic. Am J Infect Control 2022; 50:719-723. [PMID: 35367321 PMCID: PMC8966111 DOI: 10.1016/j.ajic.2022.03.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Healthcare workers' (HCWs) adherence to hand hygiene is vital in combatting COVID-19 in hospitals. We aimed to investigate HCWs hand hygiene compliance before and during the COVID-19 pandemic and hypothesised that hand hygiene compliance would increase during the pandemic. METHODS We conducted a prospective observational study in three medical departments at the Regional Hospital of West Jutland, Denmark from April 2019 to August 2020. A total of 150 HCWs participated before the COVID-19 pandemic and 136 during the pandemic. Hand hygiene observations were assessed using an automated hand hygiene monitoring system. Students unpaired t-test was used to assess differences in hand hygiene compliance rates in each department. RESULTS Comparison analyses showed, that hand hygiene compliance in department A and B was significantly higher before the COVID-19 pandemic than during the pandemic; a 7% difference in department A and a 5% difference in department B. For department C, the total hand hygiene compliance was unchanged during the pandemic compared to before. CONCLUSION The COVID-19 pandemic did not raise hand hygiene compliance. Further studies are needed to verify these findings and further identify barriers to hand hygiene compliance among HCWs.
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12
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Manzoor SA, Alomari AH. Modeling the Behavioral Response of Dentists to COVID-19 and Assessing the Perceived Impacts of Pandemic on Operative Dentistry Practices in Pakistan. Front Public Health 2022; 10:904838. [PMID: 35769776 PMCID: PMC9234171 DOI: 10.3389/fpubh.2022.904838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
COVID-19 pandemic has affected dentistry in unprecedented ways. This study investigates the perceived effects of the pandemic on operative dentistry procedures and dentistry profession in Pakistan and the factors that determine the behavioral changes among dentists to adapt to the “new normal.” A Capability Opportunity Motivation-Behavioral model (COM-B) was utilized to investigate the factors that determine the behavior of dentists in Punjab, Pakistan to adhere to COVID-19 standard operating procedures (SOPs). Using social media, an online questionnaire was sent to operative dentistry professionals in Pakistan, and 312 responses were received. 81.4% of the respondents believed that the COVID-19 pandemic has severely affected the level of care provided to the patients, 66% were extremely worried about the risk of contagion during clinical practices, and more than 75% of the respondents opined that the pandemic has led to an increased emphasis on disinfection and oral hygiene instructions. The multiple regression model suggests that the behavior of Pakistani dentists to adhere to the COVID-19 SOPs is significantly affected by their Capabilities (β = 0.358) and Opportunities (β = 0.494). The study concluded that dentists in Punjab, Pakistan are concerned about the risk of contagion and report a serious concern about consequences such as financial loss and inappropriate care of patients. The current study results can feed the policymaking in Pakistan and other developing countries. Facilities and training to improve dentists' opportunities and capabilities can improve their ability to cope with the COVID-19 challenges.
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Affiliation(s)
- Syeda Afshan Manzoor
- Department of Operative Dentistry & Endodontics, Bakhtawar Amin Medical & Dental College, Multan, Pakistan
- *Correspondence: Syeda Afshan Manzoor
| | - Abdul-Hakeem Alomari
- Biomedical Engineering Department, College of Engineering, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia
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13
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Vasudevan RS, Nedjat-Haiem MA, Mahadevan A, Herbert MS, Lander L, Warsi T, Shaikh U, Harding C, Savoia MC. Assessing Changes in Stethoscope Hygiene During COVID-19: A Multicentre Cross-Sectional Study. J Hosp Infect 2022; 127:1-6. [PMID: 35671861 PMCID: PMC9167726 DOI: 10.1016/j.jhin.2022.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022]
Abstract
Background The COVID-19 (SARS-CoV-2) pandemic has increased infection control vigilance across several modes of patient contact. However, it is unknown whether hygiene pertaining to stethoscopes, which carry the potential for pathogenic contamination, has also shifted accordingly. Aim To characterize pandemic-related changes in stethoscope hygiene. Methods We surveyed healthcare providers at three major medical centres. Questions quantitatively (Likert scale and frequency) assessed stethoscope hygiene beliefs and practices with two components: before and during COVID-19. Participants were grouped based on performance of optimal stethoscope hygiene (after every patient) before and during COVID-19. Groups were compared using χ2 and analysis of variance (ANOVA). Findings Of the 515 (10%) who completed the survey, 55 were excluded (N = 460). Optimal hygiene increased from 27.4% to 55.0% (P < 0.001). There were significant increases in Likert scores for all questions pertaining to knowledge of stethoscope contamination (P < 0.001). Belief in stethoscope contamination increased (P < 0.001) despite no change in perceived hygiene education. Resident physicians were less likely compared with attending physicians and nurses to have adopted optimal hygiene during COVID-19 (P < 0.001). Conclusion Despite a positive shift in stethoscope hygiene during COVID-19, optimal hygiene was still only performed by around half of providers. Educational interventions, particularly targeting early-career providers, are encouraged.
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Affiliation(s)
- R S Vasudevan
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA.
| | - M A Nedjat-Haiem
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - A Mahadevan
- University of California Irvine School of Medicine, Irvine, CA, USA
| | - M S Herbert
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - L Lander
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - T Warsi
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - U Shaikh
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - C Harding
- University of California Irvine School of Medicine, Irvine, CA, USA
| | - M C Savoia
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
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14
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It is complicated: Potential short- and long-term impact of coronavirus disease 2019 (COVID-19) on antimicrobial resistance—An expert review. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2022; 2:e27. [PMID: 36310817 PMCID: PMC9614949 DOI: 10.1017/ash.2022.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/28/2021] [Indexed: 12/24/2022]
Abstract
As of December 2021, the coronavirus disease 2019 (COVID-19) pandemic has claimed millions of deaths and caused disruptions in health systems around the world. The short- and long-term effects of COVID-19 on antimicrobial resistance (AMR), which was already a global threat before the pandemic, are manifold and complex. In this expert review, we summarize how COVID-19 might be affecting AMR in the short term (by influencing the key determinants antibiotic use, infection control practices and international/local mobility) and which additional factors might play a role in the long term. Whereas reduced outpatient antibiotic use in high-income countries, increased awareness for hand hygiene, and reduced mobility have likely mitigated the emergence and spread of AMR in the short term, factors such as overuse of antibiotics in COVID-19 patients, shortage of personal protective equipment, lack of qualified healthcare staff, and patient overcrowding have presumably facilitated its propagation. Unsurprisingly, international and national AMR surveillance data for 2020 show ambiguous trends. Although disruptions in antibiotic stewardship programs, AMR surveillance and research might promote the spread of AMR, other developments could prove beneficial to the cause in the long term. These factors include the increased public awareness for infectious diseases and infection control issues, the strengthening of the One Health perspective as outlined by the Centers for Disease Control and Prevention, and the unprecedented number of international research collaborations and platforms. These factors could even serve as leverage and provide opportunities to better combat AMR in the future.
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15
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Suarez L, Kim J, Freedberg DE, Lebwohl B. Risk of Healthcare-Associated Clostridioides difficile Infection During Pandemic Preparation: A Retrospective Cohort Study. GASTRO HEP ADVANCES 2022; 1:8-11. [PMID: 35174368 PMCID: PMC8818443 DOI: 10.1016/j.gastha.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
Key Words
- AIDS, acquired immunodeficiency syndrome
- CCI, Charlson Comorbidity Index
- CDI, Clostridioides difficile infection
- CI, confidence interval
- COPD, chronic obstructive pulmonary disease
- ICU, intensive care unit
- IQR, interquartile range
- MRSA, methicillin-resistant Staphylococcus aureus
- OR, odds ratio
- TIA, transient ischemic attack
- VRE, vancomycin-resistant enterococci
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Affiliation(s)
- L Suarez
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - J Kim
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - D E Freedberg
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - B Lebwohl
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
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16
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Gohil SK, Quan KA, Madey KM, King-Adelsohn S, Tjoa T, Tifrea D, Crews BO, Monuki ES, Khan S, Schubl SD, Bittencourt CE, Detweiler N, Chang W, Willis L, Khusbu U, Saturno A, Rezk SA, Figueroa C, Jain A, Assis R, Felgner P, Edwards R, Hsieh L, Forthal D, Wilson WC, Stamos MJ, Huang SS. Infection prevention strategies are highly protective in COVID-19 units while main risks to healthcare professionals come from coworkers and the community. Antimicrob Resist Infect Control 2021; 10:163. [PMID: 34809702 PMCID: PMC8608236 DOI: 10.1186/s13756-021-01031-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/27/2021] [Indexed: 11/19/2022] Open
Abstract
Background Early evaluations of healthcare professional (HCP) COVID-19 risk occurred during insufficient personal protective equipment and disproportionate testing, contributing to perceptions of high patient-care related HCP risk. We evaluated HCP COVID-19 seropositivity after accounting for community factors and coworker outbreaks. Methods Prior to universal masking, we conducted a single-center retrospective cohort plus cross-sectional study. All HCP (1) seen by Occupational Health for COVID-like symptoms (regardless of test result) or assigned to (2) dedicated COVID-19 units, (3) units with a COVID-19 HCP outbreak, or (4) control units from 01/01/2020 to 04/15/2020 were offered serologic testing by an FDA-authorized assay plus a research assay against 67 respiratory viruses, including 11 SARS-CoV-2 antigens. Multivariable models assessed the association of demographics, job role, comorbidities, care of a COVID-19 patient, and geocoded socioeconomic status with positive serology. Results Of 654 participants, 87 (13.3%) were seropositive; among these 60.8% (N = 52) had never cared for a COVID-19 patient. Being male (OR 1.79, CI 1.05–3.04, p = 0.03), working in a unit with a HCP-outbreak unit (OR 2.21, CI 1.28–3.81, p < 0.01), living in a community with low owner-occupied housing (OR = 1.63, CI = 1.00–2.64, p = 0.05), and ethnically Latino (OR 2.10, CI 1.12–3.96, p = 0.02) were positively-associated with COVID-19 seropositivity, while working in dedicated COVID-19 units was negatively-associated (OR 0.53, CI = 0.30–0.94, p = 0.03). The research assay identified 25 additional seropositive individuals (78 [12%] vs. 53 [8%], p < 0.01). Conclusions Prior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission. Article summary Prior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-01031-5.
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Affiliation(s)
- Shruti K Gohil
- Epidemiology and Infection Prevention Program, Irvine Health (UC Irvine Health), University of California, Irvine, USA. .,Division of Infectious Diseases, Department of Medicine, Irvine School of Medicine, University of California, 100 Theory, Suite 120, Irvine, CA, 92617, USA.
| | - Kathleen A Quan
- Epidemiology and Infection Prevention Program, Irvine Health (UC Irvine Health), University of California, Irvine, USA
| | - Keith M Madey
- Epidemiology and Infection Prevention Program, Irvine Health (UC Irvine Health), University of California, Irvine, USA
| | | | - Tom Tjoa
- Division of Infectious Diseases, Department of Medicine, Irvine School of Medicine, University of California, 100 Theory, Suite 120, Irvine, CA, 92617, USA
| | - Delia Tifrea
- Pathology and Laboratory Medicine, UCI Health, Newport Beach, USA
| | - Bridgit O Crews
- Pathology and Laboratory Medicine, UCI Health, Newport Beach, USA
| | - Edwin S Monuki
- Pathology and Laboratory Medicine, UCI Health, Newport Beach, USA
| | - Saahir Khan
- Division of Infectious Diseases, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Sebastian D Schubl
- Department of Surgery, Irvine School of Medicine, University of California, Irvine, USA
| | | | - Neil Detweiler
- Pathology and Laboratory Medicine, UCI Health, Newport Beach, USA
| | - Wayne Chang
- Division of Occupational and Environmental Medicine, Irvine School of Medicine, University of California, Irvine, USA
| | - Lynn Willis
- Epidemiology and Infection Prevention Program, Irvine Health (UC Irvine Health), University of California, Irvine, USA
| | - Usme Khusbu
- Epidemiology and Infection Prevention Program, Irvine Health (UC Irvine Health), University of California, Irvine, USA
| | - Antonella Saturno
- Epidemiology and Infection Prevention Program, Irvine Health (UC Irvine Health), University of California, Irvine, USA
| | - Sherif A Rezk
- Pathology and Laboratory Medicine, UCI Health, Newport Beach, USA
| | - Cesar Figueroa
- Department of Surgery, Irvine School of Medicine, University of California, Irvine, USA
| | - Aarti Jain
- Department of Physiology and Biophysics, University of California, Irvine, USA
| | - Rafael Assis
- Department of Physiology and Biophysics, University of California, Irvine, USA
| | - Philip Felgner
- Department of Physiology and Biophysics, University of California, Irvine, USA
| | - Robert Edwards
- Pathology and Laboratory Medicine, UCI Health, Newport Beach, USA
| | - Lanny Hsieh
- Division of Infectious Diseases, Department of Medicine, Irvine School of Medicine, University of California, 100 Theory, Suite 120, Irvine, CA, 92617, USA
| | - Donald Forthal
- Division of Infectious Diseases, Department of Medicine, Irvine School of Medicine, University of California, 100 Theory, Suite 120, Irvine, CA, 92617, USA
| | | | - Michael J Stamos
- Department of Surgery, Irvine School of Medicine, University of California, Irvine, USA
| | - Susan S Huang
- Epidemiology and Infection Prevention Program, Irvine Health (UC Irvine Health), University of California, Irvine, USA.,Division of Infectious Diseases, Department of Medicine, Irvine School of Medicine, University of California, 100 Theory, Suite 120, Irvine, CA, 92617, USA
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17
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Chirani MR, Kowsari E, Teymourian T, Ramakrishna S. Environmental impact of increased soap consumption during COVID-19 pandemic: Biodegradable soap production and sustainable packaging. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 796:149013. [PMID: 34271380 PMCID: PMC8272010 DOI: 10.1016/j.scitotenv.2021.149013] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 05/11/2023]
Abstract
A year into the coronavirus disease 2019 pandemic, the role of washing hands with soap and hand disinfectants is unavoidable as a primary way to control the infection spread in communities and healthcare facilities. The extraordinary surge in demand for handwashing products has led to environmental concerns. Since soaps are complex mixtures of toxic and persistent active ingredients, the prudent option is to promote eco-friendly replacements for the current products. On the other hand, with the increase in soap packaging waste production, soap packaging waste management and recycling become essential to reduce environmental impact. This systematic review aimed to collect some recent methods for identifying biodegradable and sustainable raw materials to produce and package cleaning agents, especially soap.
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Affiliation(s)
- Mahboobeh Rafieepoor Chirani
- Department of Chemistry, Amirkabir University of Technology (Tehran Polytechnic), No. 424, Hafez Avenue, 1591634311 Tehran, Iran
| | - Elaheh Kowsari
- Department of Chemistry, Amirkabir University of Technology (Tehran Polytechnic), No. 424, Hafez Avenue, 1591634311 Tehran, Iran.
| | - Targol Teymourian
- Department of Civil and Environmental Engineering, Amirkabir University of Technology (Tehran Polytechnic), Hafez Avenue, 158754413 Tehran, Iran
| | - Seeram Ramakrishna
- Department of Mechanical Engineering, Center for Nanofibers and Nanotechnology, National University of Singapore, 119260, Singapore.
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18
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Sipos S, Vlad C, Prejbeanu R, Haragus H, Vlad D, Cristian H, Dumitrascu C, Popescu R, Dumitrascu V, Predescu V. Impact of COVID-19 prevention measures on Clostridioides difficile infections in a regional acute care hospital. Exp Ther Med 2021; 22:1215. [PMID: 34584560 PMCID: PMC8422384 DOI: 10.3892/etm.2021.10649] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/16/2021] [Indexed: 12/15/2022] Open
Abstract
Clostridioides difficile (C. difficile) is a common cause of nosocomial diarrhea. The multi-modal infection control strategies designed to contain the COVID-19 pandemic have had an unintended positive effect on other hospital-acquired infections. The aim of the present study was to analyze the impact of the COVID-19 prevention measures on healthcare-associated C. difficile infections in a large regional acute care center. Electronic databases were reviewed from the start of the pandemic (March) up to November 2020. Average values from the same months from 2019 and 2018 were used as controls. Using the ICD-10 discharge coding, 65 C. difficile cases per 25,124 patients were identified in 2020 compared to 151/43,126 from the 2018 and 2019 averages (P=0.0484). The C. difficile cases were found to be decreased after the implementation of COVID-19 infection control strategies compared to previous years, despite an increase in antibiotic use. Subset analysis during lockdown showed a clear decrease but the difference was not statistically significant. For the months of recovery after lockdown, the number of cases was comparable to previous years.
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Affiliation(s)
- Simona Sipos
- Department of Pharmacology, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Cristian Vlad
- Department of Pharmacology, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Radu Prejbeanu
- Department of Orthopedics and Trauma, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania.,Department of Orthopedics and Trauma, Premiere Hospital, 300643 Timisoara, Romania
| | - Horia Haragus
- Department of Orthopedics and Trauma, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Daliborca Vlad
- Department of Pharmacology, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Horia Cristian
- Department of Surgery II, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Cristian Dumitrascu
- Department of Cardiovascular Surgery, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Roxana Popescu
- Department of Cell and Molecular Biology, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Victor Dumitrascu
- Department of Pharmacology, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Vlad Predescu
- Department of Orthopedics and Trauma, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Orthopedics and Trauma, 'Ponderas' Academic Hospital, 014142 Bucharest, Romania
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19
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Laupland KB, Collignon PJ, Schwartz IS. Sleeping with the enemy: Will the COVID-19 pandemic turn the tide of antimicrobial-resistant infections? JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2021; 6:177-180. [PMID: 36337755 PMCID: PMC9615466 DOI: 10.3138/jammi-2021-05-28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 05/28/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Kevin B Laupland
- Department of Medicine, Royal Inland Hospital, Kamloops, British Columbia, Canada
- Department of Intensive Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter J Collignon
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Garran, Australian Capital Territory, Australia
- Department of Infectious Disease, Medical School, Australian National University, Acton, Australian Capital Territory, Australia
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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20
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Unterfrauner I, Hruby LA, Jans P, Steinwender L, Farshad M, Uçkay I. Impact of a total lockdown for pandemic SARS-CoV-2 (Covid-19) on deep surgical site infections and other complications after orthopedic surgery: a retrospective analysis. Antimicrob Resist Infect Control 2021; 10:112. [PMID: 34332632 PMCID: PMC8325206 DOI: 10.1186/s13756-021-00982-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/16/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND A total lockdown for pandemic SARS-CoV-2 (Covid-19) entailed a restriction of elective orthopedic surgeries in Switzerland. While access to the hospital and human contacts were limited, hygiene measures were intensified. The objective was to investigate the impact of those strict public health guidelines on the rate of intra-hospital, deep surgical site infections (SSI), wound healing disorders and non-infectious postoperative complications after orthopedic surgery during the first Covid-19 lockdown. METHODS In a single-center study, patients with orthopedic surgery during the first Covid-19 lockdown from March 16, 2020 to April 26, 2020 were compared to cohorts that underwent orthopedic intervention in the pre- and post-lockdown periods of six months each. Besides the implementation of substantial public health measures (promotion of respiratory etiquette and hand hygiene), no additional infection control bundles have been implemented. RESULTS 5791 patients were included in this study. In multivariate Cox regression analyses adjusting for the large case-mix, the lockdown was unrelated to SSI (hazard ratio (HR) 1.6; 95% confidence interval (CI) 0.6-4.8), wound healing disorders (HR 0.7; 95% CI 0.1-5.7) or other non-infectious postoperative complications (HR 0.7, 95% CI 0.3-1.5) after a median follow-up of seven months. CONCLUSION The risks for SSI, wound healing disorders and other complications in orthopedic surgery were not influenced by the extended public health measures of the total Covid-19 lockdown. Trial registration BASEC 2020-02646 (Cantonal Ethics Commission Zurich). LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ines Unterfrauner
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Laura A. Hruby
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Peter Jans
- Medical Informatics Service, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Ludwig Steinwender
- Infection Control, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Ilker Uçkay
- Infection Control, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Unit of Clinical and Applied Research, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
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21
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Ochoa-Hein E, Rajme-López S, Rodríguez-Aldama JC, Huertas-Jiménez MA, Chávez-Ríos AR, de Paz-García R, Haro-Osnaya A, González-Colín KK, González-González R, González-Lara MF, Ponce-de-León A, Galindo-Fraga A. Substantial reduction of healthcare facility-onset Clostridioides difficile infection (HO-CDI) rates after conversion of a hospital for exclusive treatment of COVID-19 patients. Am J Infect Control 2021; 49:966-968. [PMID: 33352250 PMCID: PMC7836607 DOI: 10.1016/j.ajic.2020.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 12/14/2022]
Abstract
Healthcare facility-onset Clostridioides difficile infection rates substantially dropped in a Mexican hospital after its conversion to a full COVID-19 setting, despite heavy contamination of the environment the previous year. Better adherence to hand hygiene and contact precautions may help explain this finding.
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Affiliation(s)
- Eric Ochoa-Hein
- Department of Hospital Epidemiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sandra Rajme-López
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan Carlos Rodríguez-Aldama
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Martha Asunción Huertas-Jiménez
- Department of Hospital Epidemiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alma Rosa Chávez-Ríos
- Department of Hospital Epidemiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Roxana de Paz-García
- Department of Hospital Epidemiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Anabel Haro-Osnaya
- Department of Hospital Epidemiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Karla Karina González-Colín
- Department of Hospital Epidemiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ricardo González-González
- Department of Hospital Epidemiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María Fernanda González-Lara
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alfredo Ponce-de-León
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Arturo Galindo-Fraga
- Department of Hospital Epidemiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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22
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Experiences and expectations regarding COVID-19 prevention and control measures among the hill tribe population of northern Thailand: a qualitative study. BMC Public Health 2021; 21:1060. [PMID: 34088306 PMCID: PMC8176874 DOI: 10.1186/s12889-021-11145-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background COVID-19 has been a major human threat for a year. A large number of people have been infected and killed globally, including hill tribe people living in remote and border areas between Thailand and Myanmar. Different expectations of and experiences with the implemented disease prevention and control measures by local, national and international organizations have been widely reported. This study aimed to understand the experiences and expectations regarding the disease prevention and control measures that were implemented among hill tribe people in Thailand. Methods Qualitative data were collected from participants aged 20 and older who belonged to the hill tribes living on the border of northern Thailand and Myanmar. A semistructured questionnaire was used to guide interviews. Information was extracted for thematic analysis by the NVivo program. Results Fifty-seven participants (36 female, 21 male) were interviewed; 27 participants were Thai Yai, 14 participants were Yunnan Chinese, 8 participants were Akha, and 8 participants were from other tribes. The average age was 45.8 years (min = 20 years, max = 90 years). Thirty participants had never attended school, and the other 27 participants had received education at different levels, from primary school to higher education. Forty participants were unemployed, 13 worked as agriculturists, and the other 4 were attending school. Both positive experiences, such as improving personal hygiene practices, maintaining close contact and increasing relationships among family members and demonstrating the leadership of the villager leaders, and negative experiences, including interruption of social interactions, family financial problems, poor access to medical care services, and invisible people to the government, were found. Different expectations were observed regarding organizations at the local, national, and international levels. Expectations at the local level included villagers and community leaders taking action to strongly contribute to prevention and control measures and to prevent unscreened people from entering the village. Obtaining accurate information about the disease and being financially supported were expectations at the national level, while closing borders to protect cases from overflowing into their villages was an international-level expectation. Conclusion Although hill tribes reside in very remote rural areas, they experience both positive and negative effects of the disease prevention and control measures implemented by organizations. Their expectations are formally and informally voiced to policy makers at the local, national and international levels. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11145-5.
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23
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Hawes AM, Desai A, Patel PK. Did Clostridioides difficile testing and infection rates change during the COVID-19 pandemic? Anaerobe 2021; 70:102384. [PMID: 34029702 PMCID: PMC8141342 DOI: 10.1016/j.anaerobe.2021.102384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/23/2021] [Accepted: 05/17/2021] [Indexed: 11/18/2022]
Abstract
Testing for and incidence of Clostridioides difficile infection (CDI) was examined at a single center before and during the first surge of the COVID-19 pandemic. Incidence of CDI remained stable but testing statistically significantly decreased during the first surge despite an increase in antibiotic use. There were no new CDI-focused antimicrobial stewardship interventions introduced during this time.
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Affiliation(s)
- Armani Minasian Hawes
- University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA.
| | - Angel Desai
- Assistant Clinical Professor, University of California, Davis 2315 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Payal K Patel
- Clinical Lecturer, University of Michigan, Medical Director of Antimicrobial Stewardship, VA Ann Arbor, 2215 Fuller Rd, Ann Arbor, MI, 48105, USA
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24
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Huang F, Armando M, Dufau S, Florea O, Brouqui P, Boudjema S. COVID-19 outbreak and healthcare worker behavioural change toward hand hygiene practices. J Hosp Infect 2021; 111:27-34. [PMID: 33716086 PMCID: PMC7948529 DOI: 10.1016/j.jhin.2021.03.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic has affected healthcare workers (HCWs) in their clinical practice. HCWs were challenged with new guidelines and practices to protect themselves from occupational risks. AIM To determine whether hand hygiene behaviour by real-time measurement was related to the dynamic of the epidemic, and the type of patient being cared for in France. METHODS This study used an automated hand hygiene recording system to measure HCW hand hygiene on entry to and exit from patient rooms throughout the COVID-19 pandemic. The correlation between hand hygiene compliance and COVID-19 epidemiological data was analysed. Analysis of variance was performed to compare compliance rate during the different periods of the epidemic. FINDINGS HCW hand hygiene rate on room entry decreased over time; on room exit, it increased by 13.73% during the first wave of COVID-19, decreased by 9.87% during the post-lockdown period, then rebounded by 2.82% during the second wave of the epidemic. Hand hygiene during patient care and hand hygiene on room exit had a positive relationship with the local COVID-19 epidemic; conversely, hand hygiene on room entry did not depend on the trend of the epidemic, nor on nursing of COVID-19 patients, and it decreased over time. CONCLUSION HCWs modified their behaviours to face the risk propensity of the pandemic. However, to improve the poor compliance at room entry, reducing confusion between the hand hygiene recommendation and glove recommendation may be necessary; disinfection of gloving hands might solve this issue.
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Affiliation(s)
- F Huang
- Aix Marseille Université, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France.
| | - M Armando
- Aix Marseille Université, CNRS, Laboratory of Cognitive Psychology (UMR 7290), Marseille, France
| | - S Dufau
- Aix Marseille Université, CNRS, Laboratory of Cognitive Psychology (UMR 7290), Marseille, France
| | - O Florea
- AP-HM, IHU Méditerranée Infection, Marseille, France
| | - P Brouqui
- Aix Marseille Université, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France; AP-HM, IHU Méditerranée Infection, Marseille, France
| | - S Boudjema
- Aix Marseille Université, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
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25
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Skolmowska D, Głąbska D, Guzek D. Hand Hygiene Behaviors in a Representative Sample of Polish Adolescents in Regions Stratified by COVID-19 Morbidity and by Confounding Variables (PLACE-19 Study): Is There Any Association? Pathogens 2020; 9:pathogens9121011. [PMID: 33271861 PMCID: PMC7759844 DOI: 10.3390/pathogens9121011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 12/23/2022] Open
Abstract
The hand hygiene may possibly influence the course of the COVID-19 pandemic, but the multifactorial influence on hand hygiene knowledge and behaviors is proven. The aim of the study was to analyze hand hygiene behaviors in a national representative sample of Polish adolescents in regions stratified by COVID-19 morbidity, while taking socioeconomic status of the region, as well rural or urban environment, into account as possible interfering factors. The study was conducted Polish Adolescents’ COVID-19 Experience (PLACE-19) Study population (n = 2323) that was recruited based on a random sampling of schools, while the pair-matching procedure was applied within schools and age, in order to obtain adequate number of boys and girls, representative for the general Polish population (n = 1222). The participants were asked about their handwashing habits while using Handwashing Habits Questionnaire (HHQ) and about applied procedure of washing hands. The results were compared in subgroups that were stratified by region for COVID-19 morbidity, socioeconomic status of the region, and rural/urban environment. In regions of low COVID-19 morbidity, a higher share of adolescents, than in regions of high morbidity, declared washing their hands before meals (p = 0.0196), after meals (p = 0.0041), after preparing meals (p = 0.0297), before using the restroom (p = 0.0068), after using the restroom (p = 0.0014), after combing their hair (p = 0.0298), after handshaking (p = 0.0373), after touching animals (p = 0.0007), after contacting babies (p = 0.0278), after blowing nose (p = 0.0435), after touching sick people (p = 0.0351), and after cleaning home (p = 0.0234). For the assessed steps of the handwashing procedure, in regions of low COVID-19 morbidity, a higher share of adolescents included them to their daily handwashing, than in regions of high morbidity, that was stated for removing watch and bracelets (p = 0.0052), removing rings (p = 0.0318), and drying hands with towel (p = 0.0031). For the comparison in regions stratified by Gross Domestic Product, the differences were only minor and inconsistent. For the comparison in place of residence stratified by number of residents in city, there were some minor differences indicating better hand hygiene behaviors in the case of villages and small towns when compared with medium and large cities (p < 0.05). It may be concluded that, in a population-based sample of Polish adolescents, individuals from regions of low COVID-19 morbidity presented more beneficial hand hygiene habits than those from regions of high COVID-19 morbidity.
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Affiliation(s)
- Dominika Skolmowska
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
| | - Dominika Głąbska
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
- Correspondence: ; Tel.: +48-22-593-71-34
| | - Dominika Guzek
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
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26
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Derksen C, Keller FM, Lippke S. Obstetric Healthcare Workers' Adherence to Hand Hygiene Recommendations during the COVID-19 Pandemic: Observations and Social-Cognitive Determinants. Appl Psychol Health Well Being 2020; 12:1286-1305. [PMID: 33016518 PMCID: PMC7675238 DOI: 10.1111/aphw.12240] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 01/01/2023]
Abstract
Background Hand hygiene is crucial to avoid healthcare‐associated infections and the transmission of COVID‐19. Although the WHO has issued global hand hygiene recommendations for healthcare, adherence remains challenging. Considering social‐cognitive theories such as the health action process approach (HAPA) can help to improve healthcare workers’ adherence. This study aimed to observe adherence and to assess determinants in obstetric hospitals during and after the onset of the COVID‐19 pandemic. Methods In all, 267 observations of behaviour were conducted in two German obstetric university hospitals over three time periods (pre‐COVID‐19 pandemic, heightened awareness, and strict precautions). In addition, 115 healthcare workers answered questionnaires regarding social‐cognitive determinants of hand hygiene behaviour. Multiple regression and multiple mediation analyses were used to analyse associations. Results Adherence to hand hygiene recommendations increased from 47 per cent pre‐COVID‐19 pandemic to 95 per cent just before lockdown while simple measures against the pandemic were taken. Self‐efficacy was associated with the intention to sanitise hands (β = .397, p < .001). Coping self‐efficacy mediated the association of intention with hand hygiene adherence. Conclusions Obstetric healthcare workers seem to adapt their hand hygiene behaviour to prevent infections facing the global COVID‐19 pandemic. To further improve interventions, social‐cognitive determinants should be considered, especially intention and (coping) self‐efficacy.
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Impact of the coronavirus disease 2019 (COVID-19) pandemic on nosocomial Clostridioides difficile infection. Infect Control Hosp Epidemiol 2020; 42:406-410. [PMID: 32895065 PMCID: PMC7520631 DOI: 10.1017/ice.2020.454] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has induced a reinforcement of infection control measures in the hospital setting. Here, we assess the impact of the COVID-19 pandemic on the incidence of nosocomial Clostridioides difficile infection (CDI). METHODS We retrospectively compared the incidence density (cases per 10,000 patient days) of healthcare-facility-associated (HCFA) CDI in a tertiary-care hospital in Madrid, Spain, during the maximum incidence of COVID-19 (March 11 to May 11, 2020) with the same period of the previous year (control period). We also assessed the aggregate in-hospital antibiotic use (ie, defined daily doses [DDD] per 100 occupied bed days [BD]) and incidence density (ie, movements per 1,000 patient days) of patient mobility during both periods. RESULTS In total, 2,337 patients with reverse transcription-polymerase chain reaction-confirmed COVID-19 were admitted to the hospital during the COVID-19 period. Also, 12 HCFA CDI cases were reported at this time (incidence density, 2.68 per 10,000 patient days), whereas 34 HCFA CDI cases were identified during the control period (incidence density, 8.54 per 10,000 patient days) (P = .000257). Antibiotic consumption was slightly higher during the COVID-19 period (89.73 DDD per 100 BD) than during the control period (79.16 DDD per 100 BD). The incidence density of patient movements was 587.61 per 1,000 patient days during the control period and was significantly lower during the COVID-19 period (300.86 per 1,000 patient days) (P < .0001). CONCLUSIONS The observed reduction of ~70% in the incidence density of HCFA CDI in a context of no reduction in antibiotic use supports the importance of reducing nosocomial transmission by healthcare workers and asymptomatic colonized patients, reinforcing cleaning procedures and reducing patient mobility in the epidemiological control of CDI.
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