1
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Dörr T, Güsewell S, Flury D, Süveges M, Gaza Valera CB, Botero-Mesa S, Zanella MC, Iten A, Balmelli C, Troillet N, Tschudin-Sutter S, W Schreiber P, Jent P, Damonti L, Sommerstein R, Portmann L, Vuichard-Gysin D, Cusini A, Nussbaumer-Ochsner Y, Heininger U, Berger C, Zimmermann P, Gardiol C, Keiser O, Schlegel M, Kohler P, P Kuster S. Association of institutional masking policies with healthcare-associated SARS-CoV-2 infections in Swiss acute care hospitals during the BA.4/5 wave (CH-SUR study): a retrospective observational study. Antimicrob Resist Infect Control 2024; 13:64. [PMID: 38886813 PMCID: PMC11184728 DOI: 10.1186/s13756-024-01422-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND In the initial phase of the SARS-CoV-2 pandemic, masking has been widely accepted in healthcare institutions to mitigate the risk of healthcare-associated infection. Evidence, however, is still scant and the role of masks in preventing healthcare-associated SARS-CoV-2 acquisition remains unclear.We investigated the association of variation in institutional mask policies with healthcare-associated SARS-CoV-2 infections in acute care hospitals in Switzerland during the BA.4/5 2022 wave. METHODS SARS-CoV-2 infections in hospitalized patients between June 1 and September 5, 2022, were obtained from the "Hospital-based surveillance of COVID-19 in Switzerland"-database and classified as healthcare- or community-associated based on time of disease onset. Institutions provided information regarding institutional masking policies for healthcare workers and other prevention policies. The percentage of healthcare-associated SARS-CoV-2 infections was calculated per institution and per type of mask policy. The association of healthcare-associated SARS-CoV-2 infections with mask policies was tested using a negative binominal mixed-effect model. RESULTS We included 2'980 SARS-CoV-2 infections from 13 institutions, 444 (15%) were classified as healthcare-associated. Between June 20 and June 30, 2022, six (46%) institutions switched to a more stringent mask policy. The percentage of healthcare-associated infections subsequently declined in institutions with policy switch but not in the others. In particular, the switch from situative masking (standard precautions) to general masking of HCW in contact with patients was followed by a strong reduction of healthcare-associated infections (rate ratio 0.39, 95% CI 0.30-0.49). In contrast, when compared across hospitals, the percentage of health-care associated infections was not related to mask policies. CONCLUSIONS Our findings suggest switching to a more stringent mask policy may be beneficial during increases of healthcare-associated SARS-CoV-2 infections at an institutional level.
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Affiliation(s)
- Tamara Dörr
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland
| | - Sabine Güsewell
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland
| | - Maria Süveges
- Faculté de Médecine de l'Université de Genève, Institut de Santé Globale, 24 rue du Général- Dufour, Genève 4, 1211, Switzerland
| | - Camille Beatrice Gaza Valera
- Faculté de Médecine de l'Université de Genève, Institut de Santé Globale, 24 rue du Général- Dufour, Genève 4, 1211, Switzerland
| | - Sara Botero-Mesa
- Faculté de Médecine de l'Université de Genève, Institut de Santé Globale, 24 rue du Général- Dufour, Genève 4, 1211, Switzerland
| | - Marie-Céline Zanella
- Service de prévention et contrôle de l'infection, Direction médicale et qualité, Hôpitaux universitaires Genève, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland
- Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland
| | - Anne Iten
- Service de prévention et contrôle de l'infection, Direction médicale et qualité, Hôpitaux universitaires Genève, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland
| | - Carlo Balmelli
- Infection Control Programme, EOC Hospitals, Viale Officina 3, Bellinzona, 6500, Switzerland
| | - Nicolas Troillet
- Service of Infectious Diseases, Central Institute, Valais Hospitals, Av. Grand-Champsec 80, Sion, 1951, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Petersgraben 4, Basel, 4031, Switzerland
| | - Peter W Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Philipp Jent
- Department of Infectious Diseases, Bern University Hospital (Inselspital), University of Bern, Länggassstrasse 122, Bern, 3012, Switzerland
| | - Lauro Damonti
- Department of Infectious Diseases, Bern University Hospital (Inselspital), University of Bern, Länggassstrasse 122, Bern, 3012, Switzerland
| | - Rami Sommerstein
- Department of Infectious Diseases, Bern University Hospital (Inselspital), University of Bern, Länggassstrasse 122, Bern, 3012, Switzerland
- Faculty of Health Sciences and Medicine, Clinic St. Anna, University of Lucerne, Alpenquai 4, Lucerne, 6005, Switzerland
| | - Lea Portmann
- Faculty of Health Sciences and Medicine, Clinic St. Anna, University of Lucerne, Alpenquai 4, Lucerne, 6005, Switzerland
| | - Danielle Vuichard-Gysin
- Department of Infectious Diseases, Thurgau Cantonal Hospital, Spitalcampus 1, Muensterlingen, 8596, Switzerland
| | - Alexia Cusini
- Department of Infectious Diseases, Cantonal Hospital Graubuenden, Loëstrasse 170, Chur, 7000, Switzerland
| | - Yvonne Nussbaumer-Ochsner
- Klinik für Innere Medizin, Kantonsspital Spitäler Schaffhausen, Geissbergstrasse 81, Schaffhausen, 8208, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Spitalstrasse 33, Basel, 4056, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Children's Research Centre, University Children's Hospital Zurich, Steinwiesstrasse 75, Zurich, 8032, Switzerland
| | - Petra Zimmermann
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée 8, Fribourg, 1700, Switzerland
- Department of Paediatrics, Fribourg Hospital HFR, Chemin des Pensionnats 2-6, Fribourg, Villars-sur-Glâne, 1752, Switzerland
| | - Céline Gardiol
- Swiss Federal Office of Public Health, Schwarzenburgstrasse 157, Bern, 3003, Switzerland
| | - Olivia Keiser
- Faculté de Médecine de l'Université de Genève, Institut de Santé Globale, 24 rue du Général- Dufour, Genève 4, 1211, Switzerland
| | - Matthias Schlegel
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland
| | - Philipp Kohler
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland.
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Epstein L, Diekema DJ, Morgan DJ, Fakih MG, Lee F, Gottlieb L, Leung E, Yen C, Sullivan KV, Hayden MK. Diagnostic stewardship and the coronavirus disease 2019 (COVID-19) pandemic: Lessons learned for prevention of emerging infectious diseases in acute-care settings. Infect Control Hosp Epidemiol 2024; 45:277-283. [PMID: 37933951 DOI: 10.1017/ice.2023.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has demonstrated the importance of stewardship of viral diagnostic tests to aid infection prevention efforts in healthcare facilities. We highlight diagnostic stewardship lessons learned during the COVID-19 pandemic and discuss how diagnostic stewardship principles can inform management and mitigation of future emerging pathogens in acute-care settings. Diagnostic stewardship during the COVID-19 pandemic evolved as information regarding transmission (eg, routes, timing, and efficiency of transmission) became available. Diagnostic testing approaches varied depending on the availability of tests and when supplies and resources became available. Diagnostic stewardship lessons learned from the COVID-19 pandemic include the importance of prioritizing robust infection prevention mitigation controls above universal admission testing and considering preprocedure testing, contact tracing, and surveillance in the healthcare facility in certain scenarios. In the future, optimal diagnostic stewardship approaches should be tailored to specific pathogen virulence, transmissibility, and transmission routes, as well as disease severity, availability of effective treatments and vaccines, and timing of infectiousness relative to symptoms. This document is part of a series of papers developed by the Society of Healthcare Epidemiology of America on diagnostic stewardship in infection prevention and antibiotic stewardship.1.
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Affiliation(s)
- Lauren Epstein
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
- Atlanta VA Healthcare System, Atlanta, Georgia, United States
| | - Daniel J Diekema
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine and VA Maryland Healthcare System, Baltimore, Maryland, United States
| | - Mohamad G Fakih
- Quality Department, Ascension Health Care, and Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Francesca Lee
- Departments of Pathology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Lindsey Gottlieb
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Elizabeth Leung
- Department of Pharmacy, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Christina Yen
- Departments of Pathology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kaede V Sullivan
- Department of Pathology & Laboratory Medicine, Lewis Katz School of Medicine at Temple University and Temple University Health System, Philadelphia, Pennsylvania, United States
| | - Mary K Hayden
- Division of Infectious Diseases, Department of Internal Medicine, Rush University, Chicago, Illinois, United States
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Klousnitzer J, Tatar JM, Snyder AH, Snyder GM. A retrospective review of COVID-19 testing and mitigation strategies at a psychiatric hospital and subsequent COVID-19 acquisition. Am J Infect Control 2023; 51:1360-1365. [PMID: 37263420 PMCID: PMC10228166 DOI: 10.1016/j.ajic.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Behavioral health settings present increased challenges in preventing the transmission of infectious agents. Characterizing the relative effectiveness of various strategies, including testing for asymptomatic carriage of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, will inform transmission reduction efforts in behavioral health settings. METHODS A single-center retrospective study was conducted in an inpatient behavioral health hospital by reviewing COVID-19 mitigation and testing strategies with information collected from discharges between July 1, 2020 and February 28, 2021. RESULTS During the study period, there were 3,694 total discharges and 3,229 unique admitted patients, including 86 (2.7%) patients who had positive SARS-CoV-2 polymerase chain reaction test results. Preadmission testing from noncongregate care settings (38, 44.1%), and testing after an in-hospital exposure (27, 31.4%) were the most common indications for testing among patients with a positive test. Up to 29 (33.7%) potentially acquired the infection during their hospitalization. Asymptomatic screening tests identified approximately two-thirds (55, 64.0%) of potentially contagious patients. CONCLUSION Asymptomatic screening testing on admission and after exposure and universal masking were strong interventions to prevent SARS-CoV-2 transmission in this investigation Future studies of SARS-CoV-2 and other pathogens in behavioral health settings should endeavor to characterize the effectiveness of infection prevention interventions.
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Affiliation(s)
- Jessie Klousnitzer
- University of Pittsburgh School of Public Health, Department of Epidemiology, Pittsburgh, PA
| | - Janina-Marie Tatar
- UPMC Western Psychiatric Hospital, Infection Prevention and Control, Department of Nursing, Pittsburgh, PA
| | - Amy H Snyder
- UPMC Western Psychiatric Hospital, Infection Prevention and Control, Department of Nursing, Pittsburgh, PA
| | - Graham M Snyder
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian, Pittsburgh, PA.
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El Abdellati K, Lucas A, Perron H, Tamouza R, Nkam I, Richard JR, Fried S, Barau C, Djonouma N, Pinot A, Fourati S, Rodriguez C, Coppens V, Meyer U, Morrens M, De Picker L, Leboyer M. High unrecognized SARS-CoV-2 exposure of newly admitted and hospitalized psychiatric patients. Brain Behav Immun 2023; 114:500-510. [PMID: 37741299 DOI: 10.1016/j.bbi.2023.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/28/2023] [Accepted: 09/16/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Patients with pre-existing mental disorders are at higher risk for SARS-CoV-2 infection and adverse outcomes, and severe mental illness, including mood and psychosis spectrum disorders, is associated with increased mortality risk. Despite their increased risk profile, patients with severe mental illness have been understudied during the pandemic, with limited estimates of exposure in inpatient settings. OBJECTIVE The aim of this study was to describe the SARS-CoV-2 seroprevalence and antibody titers, and pro-inflammatory cytokine concentrations of newly admitted or hospitalized psychiatric inpatients without known history of COVID-19 infection, using robust quantitative multi-antigen assessments, and compare patients' exposure to that of hospital staff. METHODS This multi-centric, cross-sectional study compared SARS-CoV-2 seroprevalence and titers of 285 patients (University Psychiatric Centre Duffel [UPCD] N = 194; Assistance-Publique-Hopitaux de Paris [AP-HP] N = 91), and 192 hospital caregivers (UPCD N = 130; AP-HP N = 62) at two large psychiatric care facilities between January 1st and the May 30th 2021. Serum levels of SARS-CoV-2 antibodies against Spike proteins (full length), spike subunit 1 (S1), spike subunit 2 (S2), spike subunit 1 receptor binding domain (S1-RBD) and Nucleocapsid proteins were quantitatively determined using an advanced capillary Western Blot technique. To assess the robustness of the between-group seroprevalence differences, we performed sensitivity analyses with stringent cut-offs for seropositivity. We also assessed peripheral concentrations of IL-6, IL-8 and TNF-a using ELLA assays. Secondary analyses included comparisons of SARS-CoV-2 seroprevalence and titers between patient diagnostic subgroups, and between newly admitted (hospitalization ≤ 7 days) and hospitalized patients (hospitalization > 7 days) and correlations between serological and cytokines. RESULTS Patients had a significantly higher SARS-CoV-2 seroprevalence (67.85 % [95% CI 62.20-73.02]) than hospital caregivers (27.08% [95% CI 21.29-33.77]), and had significantly higher global SARS-CoV-2 titers (F = 29.40, df = 2, p < 0.0001). Moreover, patients had a 2.51-fold (95% CI 1.95-3.20) higher SARS-CoV-2 exposure risk compared to hospital caregivers (Fisher's exact test, P < 0.0001). No difference was found in SARS-CoV-2 seroprevalence and titers between patient subgroups. Patients could be differentiated most accurately from hospital caregivers by their higher Spike protein titers (OR 136.54 [95% CI 43.08-481.98], P < 0.0001), lower S1 (OR 0.06 [95% CI 0.02-0.15], P < 0.0001) titers and higher IL-6 (OR 3.41 [95% CI 1.73-7.24], P < 0.0001) and TNF-α (OR 34.29 [95% CI 5.00-258.87], P < 0.0001) and lower titers of IL-8 (OR 0.13 [95% CI 0.05-0.30], P < 0.0001). Seropositive patients had significantly higher SARS-COV-2 antibody titers compared to seropositive hospital caregivers (F = 19.53, df = 2, P < 0.0001), while titers were not different in seronegative individuals. Pro-inflammatory cytokine concentrations were not associated with serological status. CONCLUSION Our work demonstrated a very high unrecognized exposure to SARS-CoV-2 among newly admitted and hospitalized psychiatric inpatients, which is cause for concern in the context of highly robust evidence of adverse outcomes following COVID-19 in psychiatric patients. Attention should be directed toward monitoring and mitigating exposure to infectious agents within psychiatric hospitals.
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Affiliation(s)
- K El Abdellati
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium; Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium.
| | - A Lucas
- Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), plateau We-Met, Inserm UMR1297 and Université Paul Sabatier, Toulouse, France
| | - H Perron
- GeNeuro, Plan-les-Ouates, Geneva, Switzerland; Geneuro-Innovation, Lyon, France
| | - R Tamouza
- INSERM U955 IMRB, Translational Neuropsychiatry laboratory, AP-HP, Hôpital Henri Mondor, DMU IMPACT, Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris Est Créteil University, Fondation FondaMental, 94010 Créteil, France; ECNP Immuno-NeuroPsychiatry Network
| | - I Nkam
- INSERM U955 IMRB, Translational Neuropsychiatry laboratory, AP-HP, Hôpital Henri Mondor, DMU IMPACT, Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris Est Créteil University, Fondation FondaMental, 94010 Créteil, France
| | - J-R Richard
- INSERM U955 IMRB, Translational Neuropsychiatry laboratory, AP-HP, Hôpital Henri Mondor, DMU IMPACT, Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris Est Créteil University, Fondation FondaMental, 94010 Créteil, France
| | - S Fried
- Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), plateau We-Met, Inserm UMR1297 and Université Paul Sabatier, Toulouse, France
| | - C Barau
- Plateforme de resources biologiques, Hôpital Universitaire Henri Mondor, Université Paris Est Créteil, Créteil, France
| | - N Djonouma
- Département Hospitalo-Universitaire de psychiatrie et d'addictologie des hopitaux Henri Mondor, Créteil, France
| | - A Pinot
- INSERM U955 IMRB, Translational Neuropsychiatry laboratory, AP-HP, Hôpital Henri Mondor, DMU IMPACT, Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris Est Créteil University, Fondation FondaMental, 94010 Créteil, France
| | - S Fourati
- Department of Virology, INSERM U955, Team « Viruses, Hepatology, Cancer », Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - C Rodriguez
- Department of Virology, INSERM U955, Team « Viruses, Hepatology, Cancer », Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - V Coppens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium; Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium
| | - U Meyer
- ECNP Immuno-NeuroPsychiatry Network; Institute of Pharmacology and Toxicology, University of Zürich-Vetsuisse, Zürich, Switzerland; Neuroscience Center Zürich, Zürich, Switzerland
| | - M Morrens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium; Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium
| | - L De Picker
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium; Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium; ECNP Immuno-NeuroPsychiatry Network
| | - M Leboyer
- INSERM U955 IMRB, Translational Neuropsychiatry laboratory, AP-HP, Hôpital Henri Mondor, DMU IMPACT, Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris Est Créteil University, Fondation FondaMental, 94010 Créteil, France; ECNP Immuno-NeuroPsychiatry Network
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Jaywant A, Aulitzky W, Avari J, Buchheim A, Dubin M, Galffy M, Khoodoruth MAS, Maytal G, Skelin M, Sperner-Unterweger B, Barnhill JW, Fleischhacker WW. Multinational perspectives on changes to psychiatric care during the COVID-19 pandemic: a survey of practicing psychiatrists. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2023; 37:115-121. [PMID: 36600105 PMCID: PMC9812354 DOI: 10.1007/s40211-022-00452-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/11/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant upheaval in psychiatric care. Despite survey data collected from psychiatric patients and broad samples of individuals in single countries, there is little quantitative or qualitative data on changes to psychiatric care from the perspective of mental health providers themselves across developing countries. METHODS To address this gap, we surveyed 27 practicing psychiatrists from Central and Eastern Europe, as well as Africa, the Middle East, and Latin America. RESULTS Respondents observed a marked increase in anxiety in their patients, with increased (though less prominent) symptoms of depression, somatization, and addiction. They reported largescale changes in the structure of psychiatric treatment, chiefly a decline in psychiatric admissions and closing/repurposing of psychiatric beds. Results supported strong "buy in" from clinicians regarding the use of telehealth, though some clinicians perceived a reduction in the ability to connect with, and build alliances with, their patients. Finally, clinicians described an improvement in the image and meaning of psychiatry in society, increased awareness of mental illness, and greater value placed on mental health in the general population. CONCLUSIONS These changes warrant further empirical study as to their potential long-term ramifications, particularly as the COVID-19 pandemic persists and new waves of infection occur periodically throughout the world. The increased psychiatric burden on the population coupled with the apparent salience of mental health and well-being in the public consciousness represents a global opportunity for psychiatry to advocate for further treatment, research, and education.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.
- Weill Cornell Medicine/NewYork-Presbyterian Hospital, 525 E 68th St, Baker F-1232, 10065, New York, NY, USA.
| | | | - Jimmy Avari
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | | | - Marc Dubin
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Guy Maytal
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Marta Skelin
- University Psychiatric Hospital Vrapce, Zagreb, Croatia
| | | | - John W Barnhill
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
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6
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Shaffer CW, Wyka K, Ewing J, Russ MJ, Kanellopoulos D, Brody BD. Low COVID-19 Vaccination Rates Among Psychiatric Inpatients: Implications for Institutional Settings and Outreach Efforts. Psychiatr Serv 2023; 74:320-323. [PMID: 36065578 DOI: 10.1176/appi.ps.20220222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study sought to determine COVID-19 vaccination rates for individuals with serious mental illness admitted to a large health system in New York State. METHODS Vaccination rates among 12,714 patients admitted to psychiatric units and to medical and surgical units were compared between April 6, 2021, and September 30, 2021. RESULTS Only 40% (N=416 of 1,029) of patients admitted to psychiatric services had at least one COVID-19 vaccination, whereas 64.4% (7,523 of 11,685) of patients admitted to medical and surgical services had at least one vaccination. After adjustment for differences in key demographic and clinical characteristics, patients admitted to psychiatric services had a significantly lower likelihood of vaccination during the study period (risk ratio=0.78, 95% confidence interval=0.73-0.85, p<0.001). Black psychiatric patients had the lowest vaccination rate (28%). CONCLUSIONS Psychiatric patients with acute illness had low COVID-19 vaccination rates. Targeted outreach for COVID-19 vaccination is necessary to reach this population.
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Affiliation(s)
- Charles W Shaffer
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Katarzyna Wyka
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Julie Ewing
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Mark J Russ
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Dora Kanellopoulos
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Benjamin D Brody
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
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7
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Meltzer L, Amit S, Gilboa M, Tal I, Mechnik B, Irony A, Engelrad H, Epstein A, Frenkel-Nir Y, Levy Y, Kreiss Y, Regev-Yochay G. The Use of Rapid COVID-19 Antigen Test in the Emergency Department as a Decision-Support Tool. Microorganisms 2023; 11:microorganisms11020284. [PMID: 36838249 PMCID: PMC9961521 DOI: 10.3390/microorganisms11020284] [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: 11/28/2022] [Revised: 01/04/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
The emergency department (ED) is the initial point of contact between hospital staff and patients potentially infected with SARS-CoV-2, thus, prevention of inadvertent exposure to other patients is a top priority. We aimed to assess whether the introduction of antigen-detecting rapid diagnostic tests (Ag-RDTs) to the ED affected the likelihood of unwanted SARS-CoV-2 exposures. In this retrospective single-center study, we compared the rate of unwarranted exposure of uninfected adult ED patients to SARS-CoV-2 during two separate research periods; one before Ag-RDTs were introduced, and one with Ag-RDT used as a decision-support tool. The introduction of Ag-RDTs to the ED significantly decreased the relative risk of SARS-CoV-2-negative patients being incorrectly assigned to the COVID-19 designated site ("red ED"), by 97%. There was no increase in the risk of SARS-CoV-2-positive patients incorrectly assigned to the COVID-19-free site ("green ED"). In addition, duration of ED admission was reduced in both the red and the green ED. Therefore, implementing the Ag-RDT-based triage protocol proved beneficial in preventing potential COVID-19 nosocomial transmission.
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Affiliation(s)
- Lilac Meltzer
- Infection Control & Prevention Unit, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Sharon Amit
- Clinical Microbiology, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Mayan Gilboa
- Infection Control & Prevention Unit, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ilana Tal
- Infection Control & Prevention Unit, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Bella Mechnik
- Infection Control & Prevention Unit, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Avi Irony
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Emergency Department, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Hindi Engelrad
- Emergency Department, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Avi Epstein
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Emergency Department, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Yael Frenkel-Nir
- The General Management, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Yuval Levy
- The General Management, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Yitshak Kreiss
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The General Management, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Gili Regev-Yochay
- Infection Control & Prevention Unit, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Correspondence: ; Tel.: +97-25-2666-6197
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Asymptomatic screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) as an infection prevention measure in healthcare facilities: Challenges and considerations. Infect Control Hosp Epidemiol 2023; 44:2-7. [PMID: 36539917 DOI: 10.1017/ice.2022.295] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Testing of asymptomatic patients for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) (ie, "asymptomatic screening) to attempt to reduce the risk of nosocomial transmission has been extensive and resource intensive, and such testing is of unclear benefit when added to other layers of infection prevention mitigation controls. In addition, the logistic challenges and costs related to screening program implementation, data noting the lack of substantial aerosol generation with elective controlled intubation, extubation, and other procedures, and the adverse patient and facility consequences of asymptomatic screening call into question the utility of this infection prevention intervention. Consequently, the Society for Healthcare Epidemiology of America (SHEA) recommends against routine universal use of asymptomatic screening for SARS-CoV-2 in healthcare facilities. Specifically, preprocedure asymptomatic screening is unlikely to provide incremental benefit in preventing SARS-CoV-2 transmission in the procedural and perioperative environment when other infection prevention strategies are in place, and it should not be considered a requirement for all patients. Admission screening may be beneficial during times of increased virus transmission in some settings where other layers of controls are limited (eg, behavioral health, congregate care, or shared patient rooms), but widespread routine use of admission asymptomatic screening is not recommended over strengthening other infection prevention controls. In this commentary, we outline the challenges surrounding the use of asymptomatic screening, including logistics and costs of implementing a screening program, and adverse patient and facility consequences. We review data pertaining to the lack of substantial aerosol generation during elective controlled intubation, extubation, and other procedures, and we provide guidance for when asymptomatic screening for SARS-CoV-2 may be considered in a limited scope.
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Russ MJ, Sombrotto LB, Brody BD. Inpatient psychiatry response to the SARS-CoV-2 Omicron variant surge. Psychiatry Res 2022; 316:114746. [PMID: 35917649 PMCID: PMC9327184 DOI: 10.1016/j.psychres.2022.114746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 11/17/2022]
Abstract
The increased transmissibility of the omicron variant of the SARS-CoV-2 virus resulted in a rapid increase in infection among many psychiatric inpatients in our hospital between December 2021 and February 2022. This required our institution to close affected units to new admissions. In response, we implemented a model utilizing universal SARS-CoV-2 polymerase chain reaction (PCR) testing at the time of admission, the development of "admitting units" where all patients were quarantined for four days followed by repeat PCR testing, and subsequent transition to COVID-19 negative and COVID-19 positive "receiving units" based on the results of the second test. No unit closures occurred following full implementation of the model.
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10
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Carrara E, Ong DSY, Hussein K, Keske S, Johansson AF, Presterl E, Tsioutis C, Tschudin-Sutter S, Tacconelli E. ESCMID guidelines on testing for SARS-CoV-2 in asymptomatic individuals to prevent transmission in the healthcare setting. Clin Microbiol Infect 2022; 28:672-680. [PMID: 35124258 PMCID: PMC8812094 DOI: 10.1016/j.cmi.2022.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 12/20/2022]
Abstract
Scope This guideline addresses the indications for direct testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in asymptomatic individuals in health care facilities, with the aim to prevent SARS-CoV-2 transmissions in these settings. The benefit of testing asymptomatic individuals to create a safe environment for patients and health care workers must be weighed against potential unintended consequences, including delaying necessary treatments owing to false positive results and lower quality of care owing to strict isolation measures. Methods A total of nine PICOs (population, intervention, comparison, outcome) on the topic of testing asymptomatic individuals was selected by the panel members. Subsequently, a literature search for existing guidelines and systematic reviews was performed on PubMed, Epistemonikos, and RecMap using relevant filters available in each database. Data on article/recommendation type, setting, target population, intervention, and quality of the evidence were extracted. Credibility of the systematic reviews was evaluated using the AMSTAR tool, and level of agreement with available recommendation was evaluated with the AGREE II score. Because the evidence available from systematic reviews was deemed insufficiently updated to formulate relevant recommendations, an additional search targeting relevant guidance documents from major public health institutions and original studies was performed. Provisional recommendations were discussed via web conferences until agreement was reached, and final recommendations were formulated according to the GRADE approach. Recommendations Recommendations were formulated regarding systematic testing in asymptomatic individuals upon admission to a health care setting, during hospital stay, before elective procedures, and before scheduled nonsurgical procedures. Moreover, recommendations regarding testing of asymptomatic visitors, personal caregivers, and health care workers in health care facilities were presented. Recommendations also were given on contact tracing in asymptomatic patients or health care workers and the possibility of a negative screening test to shorten the quarantine period. Furthermore, if applicable, recommendations were specified to transmission rate and vaccination coverage.
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Affiliation(s)
- Elena Carrara
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy; European Committee on Infection Control (EUCIC), Basel, Switzerland.
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; ESCMID Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland
| | - Khetam Hussein
- European Committee on Infection Control (EUCIC), Basel, Switzerland; The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Infection Control Unit, Rambam Health Care Campus, Haifa, Israel
| | - Siran Keske
- European Committee on Infection Control (EUCIC), Basel, Switzerland; Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Turkey
| | - Anders F Johansson
- European Committee on Infection Control (EUCIC), Basel, Switzerland; Department of Clinical Microbiology and the Laboratory for Molecular Infection Medicine Sweden, Umeå University, Umeå, Sweden
| | - Elisabeth Presterl
- European Committee on Infection Control (EUCIC), Basel, Switzerland; Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Constantinos Tsioutis
- European Committee on Infection Control (EUCIC), Basel, Switzerland; School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy; European Committee on Infection Control (EUCIC), Basel, Switzerland
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