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Simonović M, Stojanović NM, Novak S, Radisavljević M, Žikić O, Milenković T. Choosing a COVID-19 vaccination site might be driven by anxiety and body vigilance. Open Med (Wars) 2024; 19:20240958. [PMID: 38799253 PMCID: PMC11117450 DOI: 10.1515/med-2024-0958] [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: 02/09/2024] [Revised: 03/14/2024] [Accepted: 03/27/2024] [Indexed: 05/29/2024] Open
Abstract
Background The occurrence of COVID-19 led to the rapid development of several vaccines which were distributed around the world. Even though there had been a vast amount of information about both virus and vaccination, this process was potentially related to increased anxiety and thus affected the vaccination process. Objective The present study examined anxiety levels and body vigilance in subjects reporting for COVID-19 vaccination at different vaccination sites. Methods Instruments used included general socio-demographic questionnaires and specifically constructed ones such as generalized anxiety disorder (GAD), body vigilance scale (BVS), and coronavirus anxiety scale (CAS). Results A total of 227 subjects enrolled in the study reported mild GAD and CAS scores and relatively low scores on BVS. When the subjects were divided according to a vaccination site (under supervision and non-supervised), it turned out that subjects vaccinated under supervision were more anxious (higher GAD and CAS) and had their body vigilance increased. Conclusion In conclusion, there is a need for highlighting the importance of efficient planning and organization of vaccination process, since to a certain extent it is driven by both anxiety and body vigilance.
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Affiliation(s)
- Maja Simonović
- Department of Psychiatry, Faculty of Medicine, University of Niš, 18000Niš, Serbia
- Center for Mental Health Protection, Department for Diagnose and Treatment, University Clinical Center, 18000Niš, Serbia
| | - Nikola M. Stojanović
- Department of Physiology, Faculty of Medicine, University of Niš, 18000Niš, Serbia
| | - Sonja Novak
- Department of Epidemiology, Public Health Institute, 18000Niš, Serbia
| | | | - Olivera Žikić
- Department of Psychiatry, Faculty of Medicine, University of Niš, 18000Niš, Serbia
- Center for Mental Health Protection, Department for Diagnose and Treatment, University Clinical Center, 18000Niš, Serbia
| | - Tatjana Milenković
- Center for Mental Health Protection, Department for Diagnose and Treatment, University Clinical Center, 18000Niš, Serbia
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Leis JA, Chan CK, Tan C, Callahan J, Serapion V, Pascual B, Lee W, O'Brien J, Thomas NR, Candon H, Crittenden M, Kiss A, Chan AK, Ofner M, Powis JE. Predictors of SARS-CoV-2 transmission in congregate living settings: a multicenter prospective study. Infect Control Hosp Epidemiol 2024:1-6. [PMID: 38562085 DOI: 10.1017/ice.2024.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Older adults residing in congregate living settings (CLS) such as nursing homes and independent living facilities remain at increased risk of morbidity and mortality from coronavirus disease 2019. We performed a prospective multicenter study of consecutive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) exposures to identify predictors of transmission in this setting. METHODS Consecutive resident SARS-CoV-2 exposures across 17 CLS were prospectively characterized from 1 September 2022 to 1 March 2023, including factors related to environment, source, and exposed resident. Room size, humidity, and ventilation were measured in locations where exposures occurred. Predictors were incorporated in a generalized estimating equation model adjusting for the correlation within CLS. RESULTS Among 670 consecutive exposures to SARS-CoV-2 across 17 CLS, transmission occurred among 328 (49.0%). Increased risk was associated with nursing homes (odds ratio (OR) = 90.8; 95% CI, 7.8-1047.4), Jack and Jill rooms (OR = 2.2; 95% CI, 1.3-3.6), from source who was pre-symptomatic (OR = 11.2; 95% CI, 4.1-30.9), symptomatic (OR = 6.5; 95% CI, 1.4-29.9), or rapid antigen test positive (OR = 35.6; 95% CI, 5.6-225.6), and in the presence of secondary exposure (OR = 6.3; 95% CI, 1.6-24.0). Exposure in dining room was associated with reduced risk (OR = 0.02; 95% CI, 0.005-0.08) as was medium room size (OR = 0.3; 95% CI, 0.2-0.6). Recent vaccination of exposed resident (OR = 0.5; 95% CI, 0.3-1.0) and increased ventilation of room (OR = 0.9; 95% CI, 0.8-1.0) were marginally associated with reduced risk. CONCLUSION Prospective assessment of SARS-CoV-2 exposures in CLS suggests that source characteristics and location of exposure are most predictive of resident transmission. These findings can inform risk assessment and further opportunities to prevent transmission in CLS.
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Affiliation(s)
- Jerome A Leis
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Sunnybrook Research Institute and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada
| | | | - Charlie Tan
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | | | - Wayne Lee
- Michael Garron Hospital, Toronto, ON, Canada
| | | | | | | | | | - Alex Kiss
- Sunnybrook Research Institute and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Adrienne K Chan
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Sunnybrook Research Institute and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Jeff E Powis
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada
- Michael Garron Hospital, Toronto, ON, Canada
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Edwards AJ, King MF, Noakes CJ, Peckham D, López-García M. The Wells-Riley model revisited: Randomness, heterogeneity, and transient behaviours. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2024. [PMID: 38501447 DOI: 10.1111/risa.14295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 03/20/2024]
Abstract
The Wells-Riley model has been widely used to estimate airborne infection risk, typically from a deterministic point of view (i.e., focusing on the average number of infections) or in terms of a per capita probability of infection. Some of its main limitations relate to considering well-mixed air, steady-state concentration of pathogen in the air, a particular amount of time for the indoor interaction, and that all individuals are homogeneous and behave equally. Here, we revisit the Wells-Riley model, providing a mathematical formalism for its stochastic version, where the number of infected individuals follows a Binomial distribution. Then, we extend the Wells-Riley methodology to consider transient behaviours, randomness, and population heterogeneity. In particular, we provide analytical solutions for the number of infections and the per capita probability of infection when: (i) susceptible individuals remain in the room after the infector leaves, (ii) the duration of the indoor interaction is random/unknown, and (iii) infectors have heterogeneous quanta production rates (or the quanta production rate of the infector is random/unknown). We illustrate the applicability of our new formulations through two case studies: infection risk due to an infectious healthcare worker (HCW) visiting a patient, and exposure during lunch for uncertain meal times in different dining settings. Our results highlight that infection risk to a susceptible who remains in the space after the infector leaves can be nonnegligible, and highlight the importance of incorporating uncertainty in the duration of the indoor interaction and the infectivity of the infector when estimating risk.
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Affiliation(s)
- Alexander J Edwards
- EPSRC Centre for Doctoral Training in Fluid Dynamics, University of Leeds, Leeds, UK
| | | | | | - Daniel Peckham
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Edwards AJ, King MF, López-García M, Peckham D, Noakes CJ. Assessing the effects of transient weather conditions on airborne transmission risk in naturally ventilated hospitals. J Hosp Infect 2024; 148:1-10. [PMID: 38447806 DOI: 10.1016/j.jhin.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Many UK hospitals rely heavily on natural ventilation as their main source of airflow in patient wards. This method of ventilation can have cost and energy benefits, but it may lead to unpredictable flow patterns between indoor spaces, potentially leading to the unexpected transport of infectious material to other connecting zones. However, the effects of weather conditions on airborne transmission are often overlooked. METHODS A multi-zone CONTAM model of a naturally ventilated hospital respiratory ward, incorporating time-varying weather, was proposed. Coupling this with an airborne infection model, this study assessed the variable risk in interconnected spaces, focusing particularly on occupancy, disease and ventilation scenarios based on a UK respiratory ward. RESULTS The results suggest that natural ventilation with varying weather conditions can cause irregularities in the ventilation rates and interzonal flow rates of connected zones, leading to infrequent but high peaks in the concentration of airborne pathogens in particular rooms. This transient behaviour increases the risk of airborne infection, particularly through movement of pathogens between rooms, and highlights that large outbreaks may be more likely under certain conditions. This study demonstrated how ventilation rates achieved by natural ventilation are likely to fall below the recommended guidance, and that the implementation of supplemental mechanical ventilation can increase ventilation rates and reduce the variability in infection risks. CONCLUSION This model emphasizes the need for consideration of transient external conditions when assessing the risk of transmission of airborne infection in indoor environments.
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Affiliation(s)
- A J Edwards
- EPSRC Centre for Doctoral Training in Fluid Dynamics, University of Leeds, Leeds, UK.
| | - M-F King
- School of Civil Engineering, University of Leeds, Leeds, UK
| | | | - D Peckham
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - C J Noakes
- School of Civil Engineering, University of Leeds, Leeds, UK
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van der Zwet W, Klomp-Berens E, Demandt A, Dingemans J, van der Veer B, van Alphen L, Dirks J, Savelkoul P. Analysis of two sequential SARS-CoV-2 outbreaks on a haematology-oncology ward and the role of infection prevention. Infect Prev Pract 2024; 6:100335. [PMID: 38292209 PMCID: PMC10826166 DOI: 10.1016/j.infpip.2023.100335] [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: 10/18/2023] [Accepted: 12/04/2023] [Indexed: 02/01/2024] Open
Abstract
Two SARS-CoV-2 nosocomial outbreaks occurred on the haematology ward of our hospital. Patients on the ward were at high risk for severe infection because of their immunocompromised status. Whole Genome Sequencing proved transmission of a particular SARS-CoV-2 variant in each outbreak. The first outbreak (20 patients/31 healthcare workers (HCW)) occurred in November 2020 and was caused by a variant belonging to lineage B.1.221. At that time, there were still uncertainties on mode of transmission of SARS-CoV-2, and vaccines nor therapy were available. Despite HCW wearing II-R masks in all patient contacts and FFP-2 masks during aerosol generating procedures (AGP), the outbreak continued. Therefore, extra measures were introduced. Firstly, regular PCR-screening of asymptomatic patients and HCW; positive patients were isolated and positive HCW were excluded from work as a rule and they were only allowed to resume their work if a follow-up PCR CT-value was ≥30 and were asymptomatic or having only mild symptoms. Secondly, the use of FFP-2 masks was expanded to some long-lasting, close-contact, non-AGPs. After implementing these measures, the incidence of new cases declined gradually. Thirty-seven percent of patients died due to COVID-19. The second outbreak (10 patients/2 HCW) was caused by the highly transmissible omicron BA.1 variant and occurred in February 2022, where transmission occurred on shared rooms despite the extra infection control measures. It was controlled much faster, and the clinical impact was low as the majority of patients was vaccinated; no patients died and symptoms were relatively mild in both patients and HCW.
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Affiliation(s)
- W.C. van der Zwet
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
| | - E.A. Klomp-Berens
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
| | - A.M.P. Demandt
- Division of Hematology, Department of Internal Medicine, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J. Dingemans
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
| | - B.M.J.W. van der Veer
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
| | - L.B. van Alphen
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
| | - J.A.M.C. Dirks
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
| | - P.H.M. Savelkoul
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
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Madhusudanan A, Iddon C, Cevik M, Naismith JH, Fitzgerald S. Non-pharmaceutical interventions for COVID-19: a systematic review on environmental control measures. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2023; 381:20230130. [PMID: 37611631 PMCID: PMC10446906 DOI: 10.1098/rsta.2023.0130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 08/25/2023]
Abstract
The purpose of this review was to identify the effectiveness of environmental control (EC) non-pharmaceutical interventions (NPIs) in reducing transmission of SARS-CoV-2 through conducting a systematic review. EC NPIs considered in this review are room ventilation, air filtration/cleaning, room occupancy, surface disinfection, barrier devices, [Formula: see text] monitoring and one-way-systems. Systematic searches of databases from Web of Science, Medline, EMBASE, preprint servers MedRxiv and BioRxiv were conducted in order to identify studies reported between 1 January 2020 and 1 December 2022. All articles reporting on the effectiveness of ventilation, air filtration/cleaning, room occupancy, surface disinfection, barrier devices, [Formula: see text] monitoring and one-way systems in reducing transmission of SARS-CoV-2 were retrieved and screened. In total, 13 971 articles were identified for screening. The initial title and abstract screening identified 1328 articles for full text review. Overall, 19 references provided evidence for the effectiveness of NPIs: 12 reported on ventilation, 4 on air cleaning devices, 5 on surface disinfection, 6 on room occupancy and 1 on screens/barriers. No studies were found that considered the effectiveness of [Formula: see text] monitoring or the implementation of one-way systems. Many of these studies were assessed to have critical risk of bias in at least one domain, largely due to confounding factors that could have affected the measured outcomes. As a result, there is low confidence in the findings. Evidence suggests that EC NPIs of ventilation, air cleaning devices and reduction in room-occupancy may have a role in reducing transmission in certain settings. However, the evidence was usually of low or very low quality and certainty, and hence the level of confidence ascribed to this conclusion is low. Based on the evidence found, it was not possible to draw any specific conclusions regarding the effectiveness of surface disinfection and the use of barrier devices. From these results, we further conclude that community agreed standards for well-designed epidemiological studies with low risk of bias are needed. Implementation of such standards would enable more confident assessment in the future of the effectiveness of EC NPIs in reducing transmission of SARS-CoV-2 and other pathogens in real-world settings. This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence'.
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Affiliation(s)
| | - Christopher Iddon
- Department of Civil, Environmental and Geomatic Engineering, University College London, WC1E 6BT, London, UK
| | - Muge Cevik
- Department of Infection and Global Health, School of Medicine, University of St Andrews, KY16 9TF, St Andrews, UK
| | | | - Shaun Fitzgerald
- Department of Engineering, University of Cambridge, CB2 1PZ, Cambridge, UK
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7
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Hare D, Dembicka KM, Brennan C, Campbell C, Sutton-Fitzpatrick U, Stapleton PJ, De Gascun CF, Dunne CP. Whole-genome sequencing to investigate transmission of SARS-CoV-2 in the acute healthcare setting: a systematic review. J Hosp Infect 2023; 140:139-155. [PMID: 37562592 DOI: 10.1016/j.jhin.2023.08.002] [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: 05/30/2023] [Revised: 07/03/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Whole-genome sequencing (WGS) has been used widely to elucidate transmission of SARS-CoV-2 in acute healthcare settings, and to guide infection, prevention, and control (IPC) responses. AIM To systematically appraise available literature, published between January 1st, 2020 and June 30th, 2022, describing the implementation of WGS in acute healthcare settings to characterize nosocomial SARS-CoV-2 transmission. METHODS Searches of the PubMed, Embase, Ovid MEDLINE, EBSCO MEDLINE, and Cochrane Library databases identified studies in English reporting the use of WGS to investigate SARS-CoV-2 transmission in acute healthcare environments. Publications involved data collected up to December 31st, 2021, and findings were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. FINDINGS In all, 3088 non-duplicate records were retrieved; 97 met inclusion criteria, involving 62 outbreak analyses and 35 genomic surveillance studies. No publications from low-income countries were identified. In 87/97 (90%), WGS supported hypotheses for nosocomial transmission, while in 46 out of 97 (47%) suspected transmission events were excluded. An IPC intervention was attributed to the use of WGS in 18 out of 97 (18%); however, only three (3%) studies reported turnaround times ≤7 days facilitating near real-time IPC action, and none reported an impact on the incidence of nosocomial COVID-19 attributable to WGS. CONCLUSION WGS can elucidate transmission of SARS-CoV-2 in acute healthcare settings to enhance epidemiological investigations. However, evidence was not identified to support sequencing as an intervention to reduce the incidence of SARS-CoV-2 in hospital or to alter the trajectory of active outbreaks.
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Affiliation(s)
- D Hare
- UCD National Virus Reference Laboratory, University College Dublin, Ireland; School of Medicine, University of Limerick, Limerick, Ireland.
| | - K M Dembicka
- School of Medicine, University of Limerick, Limerick, Ireland
| | - C Brennan
- UCD National Virus Reference Laboratory, University College Dublin, Ireland
| | - C Campbell
- UCD National Virus Reference Laboratory, University College Dublin, Ireland
| | | | | | - C F De Gascun
- UCD National Virus Reference Laboratory, University College Dublin, Ireland
| | - C P Dunne
- School of Medicine, University of Limerick, Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
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Liu Z, Li H, Chu J, Huang Z, Xiao X, Wang Y, He J. The impact of high background particle concentration on the spatiotemporal distribution of Serratia marcescens bioaerosol. JOURNAL OF HAZARDOUS MATERIALS 2023; 458:131863. [PMID: 37354722 DOI: 10.1016/j.jhazmat.2023.131863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
Airborne transmission is a well-established mode of dissemination for infectious diseases, particularly in closed environments. However, previous research has often overlooked the potential impact of background particle concentration on bioaerosol characteristics. We compared the spatial and temporal distributions of bioaerosols under two levels of background particle concentration: heavily polluted (150-250 μg/m3) and excellent (0-35 μg/m3) in a typical ward. Serratia marcescens bioaerosol was adopted as a bioaerosol tracer, and the bioaerosol concentrations were quantified using six-stage Andersen cascade impactors. The results showed a significant reduction (over at least 62.9%) in bioaerosol concentration under heavily polluted levels compared to excellent levels at all sampling points. The temporal analysis also revealed that the decay rate of bioaerosols was higher (at least 0.654 min-1) under heavily polluted levels compared to excellent levels. These findings suggest that background particles can facilitate bioaerosol removal, contradicting the assumption made in previous research that background particle has no effect on bioaerosol characteristics. Furthermore, we observed differences in the size distribution of bioaerosols between the two levels of background particle concentration. The average bioaerosols size under heavily polluted levels was found to be higher than that under excellent levels, and the average particle size under heavily polluted levels gradually increased with time. In conclusion, these results highlight the importance of considering background particle concentration in future research on bioaerosol characteristics.
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Affiliation(s)
- Zhijian Liu
- School of Energy and Power Engineering, North China Electric Power University, Baoding 071003, China
| | - Haochuan Li
- School of Energy and Power Engineering, North China Electric Power University, Baoding 071003, China
| | - Jiaqi Chu
- School of Energy and Power Engineering, North China Electric Power University, Baoding 071003, China
| | - Zhenzhe Huang
- School of Energy and Power Engineering, North China Electric Power University, Baoding 071003, China
| | - Xia Xiao
- School of Energy and Power Engineering, North China Electric Power University, Baoding 071003, China
| | - Yongxin Wang
- School of Energy and Power Engineering, North China Electric Power University, Baoding 071003, China
| | - Junzhou He
- School of Energy and Power Engineering, North China Electric Power University, Baoding 071003, China.
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Lu TL, Chuang Y, Huang C. Nosocomial Omicron Outbreak in a Medical Ward During the Coronavirus Disease 2019 Pandemic. Risk Manag Healthc Policy 2023; 16:309-315. [PMID: 36879826 PMCID: PMC9985400 DOI: 10.2147/rmhp.s398668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/18/2023] [Indexed: 03/04/2023] Open
Abstract
Background The Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is 2 to 3 times more contagious than the Delta variant and poses a new challenge in containing transmission in community and health care settings. Transmission in hospitals can cause nosocomial outbreak infections and affect patients and health care workers. This study describes a coronavirus disease 2019 (COVID-19) outbreak in a medical ward. The purpose of the investigation was to determine the transmission source of the outbreak, as well as the measures implemented to prevent and control it. Methods A cluster of SARS-CoV-2 infections that affected health care workers, inpatients, and caregivers was thoroughly researched in a medical ward. There were several strict outbreak measures implemented in our hospital, and these measures controlled the nosocomial COVID-19 outbreak in this study. Results Seven cases of SARS-CoV-2 infection were diagnosed within 2 days in the medical ward. The infection control team declared a nosocomial outbreak of the COVID-19 Omicron variant. Several strict outbreak measures were implemented as follows: 1. The medical ward was closed and cleaning and disinfection were performed. 2. All patients and caregivers with negative test results were transferred to a spare COVID-19 isolation ward. 3. Relatives' visits were not allowed, and no new patient was admitted during the outbreak period. 4. Health care workers were retrained on wearing personal protective equipment and enhanced techniques and practices of hand hygiene, social distancing, and self-monitoring of fever and respiratory symptoms. Conclusion This outbreak occurred in a non-COVID-19 ward during the COVID-19 Omicron variant phase of the pandemic. Our strict outbreak measures halted and contained the nosocomial COVID-19 outbreak in 10 days. Future studies are needed to establish a standard policy of COVID-19 outbreak measure implementation.
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Affiliation(s)
- Tsung-Lung Lu
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan
| | - Yiling Chuang
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan
| | - Chienhsiu Huang
- Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan
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Bouza E, Martin M, Alés JE, Aragonés N, Barragán B, de la Cámara R, Pozo JLD, García-Gutiérrez V, García-Sanz R, Gracia D, Guillem V, Jiménez-Yuste V, Martin-Delgado MC, Martínez J, López R, Rodríguez-Lescure Á, Galiana JR, Sureda AM, Tejerina-Picado F, Trilla A, Zapatero A, Palomo E, San-Miguel J. Impact of the COVID-19 pandemic on the diagnosis and treatment of onco-hematologic patients: a discussion paper. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2023; 36:1-25. [PMID: 36322133 PMCID: PMC9910677 DOI: 10.37201/req/087.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We do not know the precise figure for solid organ tumors diagnosed each year in Spain and it is therefore difficult to calculate whether there has been a decrease in cancer diagnoses as a consequence of the pandemic. Some indirect data suggest that the pandemic has worsened the stage at which some non-hematological neoplasms are diagnosed. Despite the lack of robust evidence, oncology patients seem more likely to have a poor outcome when they contract COVID-19. The antibody response to infection in cancer patients will be fundamentally conditioned by the type of neoplasia present, the treatment received and the time of its administration. In patients with hematological malignancies, the incidence of infection is probably similar or lower than in the general population, due to the better protective measures adopted by the patients and their environment. The severity and mortality of COVID-19 in patients with hematologic malignancies is clearly higher than the general population. Since the immune response to vaccination in hematologic patients is generally worse than in comparable populations, alternative methods of prevention must be established in these patients, as well as actions for earlier diagnosis and treatment. Campaigns for the early diagnosis of malignant neoplasms must be urgently resumed, post-COVID manifestations should be monitored, collaboration with patient associations is indisputable and it is urgent to draw the right conclusions to improve our preparedness to fight against possible future catastrophes.
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Affiliation(s)
- Emilio Bouza
- CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), España. Patrono de la Fundación de Ciencias de la Salud. Servicio de Microbiología y Enfermedades Infecciosas Hospital General Universitario Gregorio Marañón. Catedrático de Medicina. Universidad Complutense. Madrid.,Correspondence: Emilio Bouza MD, PhD. Instituto de Investigación Sanitaria Gregorio Marañón. C/ Dr. Esquerdo, 46 28007 Madrid, España E-mail:
| | - Miguel Martin
- Universidad Complutense de Madrid. Jefe de Servicio de Oncología del Hospital Gregorio Marañón de Madrid
| | | | | | | | | | - José Luis Del Pozo
- Servicio de Enfermedades Infecciosas. Servicio de Microbiología. Clínica Universidad de Navarra. Pamplona España
| | | | - Ramón García-Sanz
- Laboratorio de HLA y biología molecular en hematología, Universidad de Salamanca. Sociedad Española de Hematología y Hemoterapia
| | | | - Vicente Guillem
- Servicio de Oncología Médica del Instituto Valenciano de Oncología (IVO)
| | | | - Mari Cruz Martin-Delgado
- Servicio Medicina Intensiva Hospital Universitario Torrejón. Universidad Francisco de Vitoria. Federación Panamericana e Ibérica de Medicina Crítica y Terapia Intensiva
| | - Joaquín Martínez
- Servicio de Hematología y Hemoterapia, Hospital 12 de Octubre, Madrid. Universidad Complutense. Madrid
| | - Rafael López
- Oncología Médica del Hospital Clínico Universitario, Santiago de Compostela
| | | | | | - Ana María Sureda
- Servicio de Hematología en Hospital Universitario Quiron Dexeus, Grupo Español de Trasplante y Terapia Celular, Electa del EBMT
| | | | - Antoni Trilla
- Servicio de Medicina Preventiva y Epidemiología del Hospital Clínic de Barcelona. Catedrático de Medicina (Salud Pública) Universidad de Barcelona
| | | | | | - Jesús San-Miguel
- Medicina Clínica y Traslacional de la Clínica Universidad de Navarra
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11
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Park JY, Pardosi JF, Respati T, Nurhayati E, Islam MS, Chowdhury KIA, Seale H. Exploring factors influencing the compliance of patients and family carers with infection prevention and control recommendations across Bangladesh, Indonesia, and South Korea. Front Public Health 2022; 10:1056610. [PMID: 36620289 PMCID: PMC9815766 DOI: 10.3389/fpubh.2022.1056610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Background Poor compliance with infection prevention and control (IPC) measures has been a longstanding issue globally. To date, healthcare workers (HCWs) have been the primary target for policy and strategy revisions. Recent studies exploring the contributing factors to the spread of COVID-19 across countries in Asia have suggested that the scope of focus should be extended to family carers who provide patient care activities. This study aimed to explore factors affecting patients' and their family carers' IPC compliance in hospitals in Bangladesh, Indonesia, and South Korea. Method A qualitative study incorporating 57 semi-structured interviews was conducted in five tertiary-level hospitals across the three focus countries between July 2019 and February 2020. Interviews were undertaken with: (1) patients, family carers and private carers; and (2) healthcare workers, including nurses, doctors, and hospital managers. Drawing upon the principles of grounded theory, data were inductively analyzed using thematic analysis. Results A total of three main themes and eight subthemes are identified. Key themes focused on the assumptions made by healthcare workers regarding the family/private carers' level of understanding about IPC and training received; uncertainty and miscommunication regarding the roles of family/private carers; variations in carer knowledge toward IPC and healthcare-associated infections, and the impact of cultural values and social norms. Conclusion This exploratory study offers novel findings regarding the factors influencing IPC compliance among patients and their family/private carers across various cultural settings, irrespective of resource availability. The role of cultural values and social norms and their impact on IPC compliance must be acknowledged when updating or revising IPC policies and guidelines.
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Affiliation(s)
- Ji Yeon Park
- School of Population Health, University of New South Wales, Sydney, NSW, Australia,*Correspondence: Ji Yeon Park
| | - Jerico Franciscus Pardosi
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Titik Respati
- Faculty of Medicine, Universitas Islam Bandung, Bandung, West Java, Indonesia
| | - Eka Nurhayati
- Faculty of Medicine, Universitas Islam Bandung, Bandung, West Java, Indonesia
| | - Md. Saiful Islam
- School of Population Health, University of New South Wales, Sydney, NSW, Australia,Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Kamal Ibne Amin Chowdhury
- School of Population Health, University of New South Wales, Sydney, NSW, Australia,Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Holly Seale
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
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12
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Nham E, Kim YE, Jung J, Kim DW, Jang H, Hyun H, Seong H, Yoon JG, Noh JY, Song JY, Kim WJ, Cheong HJ. COVID-19 Vaccination Rates in Patients With Chronic Medical Conditions: A Nationwide Cross-Sectional Study. J Korean Med Sci 2022; 37:e325. [PMID: 36413798 PMCID: PMC9678655 DOI: 10.3346/jkms.2022.37.e325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
As most individuals acquire immunity to severe acute respiratory syndrome coronavirus 2, South Korea declared a return to normalcy a few months ago. However, epidemic waves continue because of endlessly emerging variants and waning immunity. Health authorities are focusing on those at high risk of severe coronavirus disease 2019 to minimize damage to public health and the economy. In this regard, we investigated the vaccination rates in patients with various chronic medical conditions by examining the national health insurance claims data and the national immunization registry. We found that patients with chronic medical conditions, especially those of higher severity, such as malignancy, had vaccination rates approximately 10-20% lower than those of the general population. Public health authorities and healthcare providers should try to vaccinate these patients to avoid preventable morbidity and mortality.
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Affiliation(s)
- Eliel Nham
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young-Eun Kim
- Department of Big Data Strategy, National Health Insurance Service, Wonju, Korea
| | - Jaehun Jung
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Dong Wook Kim
- Department of Information and Statistics, Research Institute of Natural Science, Gyeongsang National University, Jinju, Korea
| | - Hoyeon Jang
- Department of Big Data Strategy, National Health Insurance Service, Wonju, Korea
| | - Hakjun Hyun
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hye Seong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jin Gu Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
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13
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McCallum MK, Patriquin G, Davis IR, MacDonald T, Gaston D, LeBlanc JJ, Shabi Y, Johnston BL. Factors contributing to a coronavirus disease 2019 (COVID-19) outbreak on a mixed medical-surgical unit in a Canadian acute-care hospital. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e151. [PMID: 36483428 PMCID: PMC9726552 DOI: 10.1017/ash.2022.288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To identify preventable factors that contribute to the cross transmission of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) to patients in healthcare facilities. DESIGN A case-control study was conducted among inpatients on a coronavirus disease 2019 (COVID-19) outbreak unit. SETTING This study was conducted in a medical-surgical unit of a tertiary-care hospital in Nova Scotia in May 2021. PATIENTS Patients hospitalized on the unit for at least 12 hours and healthcare workers (HCW) working on the unit within 2 weeks of outbreak declaration were included. METHODS Risk factors for SARS-CoV-2 infection were analyzed using simple and multiple logistic regression. Whole-genome sequencing (WGS) was performed to identify SARS-CoV-2 strain relatedness. Network analysis was used to describe patient accommodation. RESULTS SARS-CoV-2 infections were identified in 21 patients (29.6%) and 11 HCWs (6.6%). WGS data revealed 4 distinct clades of related sequences. Several factors likely contributed to the outbreak, including failure to identify SARS-CoV-2, a largely incomplete or unvaccinated population, and patient wandering behaviors. The most significant risk factor for SARS-CoV-2 infection was room sharing with an infectious patient, which was the only factor that remained statistically significant following multivariate analysis (odds ratio [OR], 9.2l; 95% confidence interval [CI], 2.04-41.67; P = .004). CONCLUSIONS This outbreak likely resulted from admission of 2 patients with COVID-19, with subsequent transmissions to 17 patients and 11 staff. WGS and bioinformatics analyses were critical to identifying previously unrecognized nosocomial transmissions of SARS-CoV-2. This study supports strategies to reduce nosocomial transmissions of SARS-CoV-2, such as single-patient rooms, promotion of COVID-19 vaccination, and infection prevention and control measures including management of wandering behaviors.
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Affiliation(s)
- Megan K. McCallum
- Infection Prevention and Control, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Glenn Patriquin
- Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Nova Scotia Health and Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ian R.C. Davis
- Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Nova Scotia Health and Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tammy MacDonald
- Infection Prevention and Control, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Daniel Gaston
- Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason J. LeBlanc
- Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Nova Scotia Health and Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yahya Shabi
- Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - B. Lynn Johnston
- Department of Medicine, Nova Scotia Health and Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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14
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Park JY, Pardosi JF, Islam MS, Respati T, Chowdhury K, Seale H. What does family involvement in care provision look like across hospital settings in Bangladesh, Indonesia, and South Korea? BMC Health Serv Res 2022; 22:922. [PMID: 35841023 PMCID: PMC9286761 DOI: 10.1186/s12913-022-08278-7] [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: 12/28/2021] [Accepted: 06/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Family members provide care whilst staying in the patient's room across a range of cultural settings, irrespective of resource availability in many Asian countries. This has been reported as a contributing factor to the spread of several outbreaks, including COVID-19. Despite these reports, very little is known about the risk of healthcare-associated infection (HAI) transmission related to the involvement of family and private carers in the clinical setting. As a starting point to understanding this issue, this study aimed to provide insights regarding the patient care activities undertaken by family and private carers and the guidance provided to these carers around infection control measures in hospitals located in Bangladesh, Indonesia, and South Korea. METHOD A qualitative study involving 57 semi-structured interviews was undertaken in five tertiary level hospitals across the selected countries. Two groups of individuals were interviewed: (1) patients and their family carers and private carers; and (2) healthcare workers, including doctors, nurses, hospital managers and staff members. Drawing upon the principles of grounded theory, an inductive approach to data analysis using thematic analysis was adopted. RESULTS Five main themes were generated from the analysis of the data: (1) expectation of family carers staying with a patient; (2) residing in the patient's environment: (3) caring activities undertaken by family carers; (4) supporting and educating family carers and (5) communication around healthcare-associated infection and infection prevention and control. CONCLUSION Based on the types of activities being undertaken, coupled with the length of time family and private carers are residing within the clinical setting, coupled with an apparent lack of guidance being given around IPC, more needs to be done to ensure that these carers are not being inadvertently exposed to HAI's or other occupational risks.
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Affiliation(s)
- J Y Park
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - J F Pardosi
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - M S Islam
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - T Respati
- Faculty of Medicine, Universitas Islam Bandung, Bandung, Indonesia
| | - K Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - H Seale
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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15
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Klompas M. New Insights into the Prevention of Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia Caused by Viruses. Semin Respir Crit Care Med 2022; 43:295-303. [PMID: 35042261 DOI: 10.1055/s-0041-1740582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A fifth or more of hospital-acquired pneumonias may be attributable to respiratory viruses. The SARS-CoV-2 pandemic has clearly demonstrated the potential morbidity and mortality of respiratory viruses and the constant threat of nosocomial transmission and hospital-based clusters. Data from before the pandemic suggest the same can be true of influenza, respiratory syncytial virus, and other respiratory viruses. The pandemic has also helped clarify the primary mechanisms and risk factors for viral transmission. Respiratory viruses are primarily transmitted by respiratory aerosols that are routinely emitted when people exhale, talk, and cough. Labored breathing and coughing increase aerosol generation to a much greater extent than intubation, extubation, positive pressure ventilation, and other so-called aerosol-generating procedures. Transmission risk is proportional to the amount of viral exposure. Most transmissions take place over short distances because respiratory emissions are densest immediately adjacent to the source but then rapidly dilute and diffuse with distance leading to less viral exposure. The primary risk factors for transmission then are high viral loads, proximity, sustained exposure, and poor ventilation as these all increase net viral exposure. Poor ventilation increases the risk of long-distance transmission by allowing aerosol-borne viruses to accumulate over time leading to higher levels of exposure throughout an enclosed space. Surgical and procedural masks reduce viral exposure but do not eradicate it and thus lower but do not eliminate transmission risk. Most hospital-based clusters have been attributed to delayed diagnoses, transmission between roommates, and staff-to-patient infections. Strategies to prevent nosocomial respiratory viral infections include testing all patients upon admission, preventing healthcare providers from working while sick, assuring adequate ventilation, universal masking, and vaccinating both patients and healthcare workers.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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16
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Greenhalgh T, Katzourakis A, Wyatt TD, Griffin S. Rapid evidence review to inform safe return to campus in the context of coronavirus disease 2019 (COVID-19). Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17270.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted predominantly through the air in crowded and unventilated indoor spaces, especially among unvaccinated people. Universities and colleges are potential settings for its spread. Methods: An interdisciplinary team from public health, virology, and biology used narrative methods to summarise and synthesise evidence on key control measures, taking account of mode of transmission. Results: Evidence from a wide range of primary studies supports six measures. Vaccinate (aim for > 90% coverage and make it easy to get a jab). Require masks indoors, especially in crowded settings. If everyone wears well-fitting cloth masks, source control will be high, but for maximum self-protection, respirator masks should be worn. Masks should not be removed for speaking or singing. Space people out by physical distancing (but there is no “safe” distance because transmission risk varies with factors such as ventilation, activity levels and crowding), reducing class size (including offering blended learning), and cohorting (students remain in small groups with no cross-mixing). Clean indoor air using engineering controls—ventilation (while monitoring CO2 levels), inbuilt filtration systems, or portable air cleaners fitted with high efficiency particulate air [HEPA] filters). Test asymptomatic staff and students using lateral flow tests, with tracing and isolating infectious cases when incidence of coronavirus disease 2019 (COVID-19) is high. Support clinically vulnerable people to work remotely. There is no direct evidence to support hand sanitising, fomite controls or temperature-taking. There was no evidence that freestanding plastic screens, face visors and electronic air-cleaning systems are effective. Conclusions: The above evidence-based measures should be combined into a multi-faceted strategy to maximise both student safety and the continuation of in-person and online education provision. Those seeking to provide a safe working and learning environment should collect data (e.g. CO2 levels, room occupancy) to inform their efforts.
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17
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Jaime‐Pérez JC, González‐Treviño M, Meléndez‐Flores JD, Ramos‐Dávila EM, Colunga‐Pedraza JE, Colunga‐Pedraza PR, Jiménez‐Antolinez V, Gómez‐Almaguer D. Safety and feasibility of outpatient hematopoietic cell transplantation in pediatric patients during the COVID-19 pandemic: A single-center experience. Pediatr Blood Cancer 2021; 68:e29252. [PMID: 34291876 PMCID: PMC8441788 DOI: 10.1002/pbc.29252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/11/2021] [Indexed: 11/11/2022]
Affiliation(s)
- José Carlos Jaime‐Pérez
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - Mariana González‐Treviño
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - Jesús D. Meléndez‐Flores
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - Eugenia M. Ramos‐Dávila
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - Julia E. Colunga‐Pedraza
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - Perla R. Colunga‐Pedraza
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - Valentine Jiménez‐Antolinez
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - David Gómez‐Almaguer
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
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18
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Zhan Y, Chen X, Guan W, Guan W, Yang C, Pan S, Wong SS, Chen R, Ye F. Clinical impact of nosocomial infection with pandemic influenza A (H1N1) 2009 in a respiratory ward in Guangzhou. J Thorac Dis 2021; 13:5851-5862. [PMID: 34795934 PMCID: PMC8575854 DOI: 10.21037/jtd-21-897] [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: 05/29/2021] [Accepted: 09/09/2021] [Indexed: 11/17/2022]
Abstract
Background Nosocomial outbreaks of pandemic influenza A (H1N1) 2009 virus [A(H1N1)pdm09] easily develop due to its high transmissibility. This study aimed to investigate the clinical impacts of a nosocomial outbreak of A(H1N1)pdm09 between 21 January and 17 February 2016. Methods Patients who developed influenza-like illness (ILI) more than 48 hours after hospitalization in the index ward were enrolled as suspected patients, defined as group A and quarantined. Patients in other wards were defined as group B. A phylogenetic tree was constructed to determine the origins of the hemagglutinin and neuraminidase genes. Results After the implementation of an infection control measure bundle, the outbreak was limited to eight patients with ILIs in group A. Nasal swabs from seven patients were positive for A(H1N1)pdm09. All the patients recovered after treatment. Prolonged viral shedding was observed in a patient with bronchiectasis and Penicillium marneffei infection. Compared to the expected duration of hospitalization in patients without fever, those with fever had a median 7-day delay in discharge and a mean excess cost of 3,358 RMB. The four influenza strains identified were genetically identical to the A/California/115/2015 strain. Six of the 54 patients in group B who underwent bronchoscopy developed transient fever. These patients were hospitalized in various wards of the hospital and recovered after a short-term course of empirical antibiotics. Conclusions After the implementation of infection control measures, the nosocomial A(H1N1)pdm09 outbreak was rapidly contained; infected patients had a delay in discharge and excess costs, but no deaths occurred.
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Affiliation(s)
- Yangqing Zhan
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Xiaojuan Chen
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Weijie Guan
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wenda Guan
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Chunguang Yang
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Sihua Pan
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Sook-San Wong
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Rongchang Chen
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.,Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen Institute of Respiratory Diseases, Shenzhen, China
| | - Feng Ye
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
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19
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Jung J, Lee J, Kim E, Namgung S, Kim Y, Yun M, Lim YJ, Kim EO, Bae S, Kim MN, Lee SM, Park MS, Kim SH. Frequent Occurrence of SARS-CoV-2 Transmission among Non-close Contacts Exposed to COVID-19 Patients. J Korean Med Sci 2021; 36:e233. [PMID: 34427062 PMCID: PMC8382565 DOI: 10.3346/jkms.2021.36.e233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/05/2021] [Indexed: 11/21/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission among non-close contacts is not infrequent. We evaluated the proportion and circumstances of individuals to whom SARS-CoV-2 was transmitted without close contact with the index patient in a nosocomial outbreak in a tertiary care hospital in Korea. From March 2020 to March 2021, there were 36 secondary cases from 14 SARS-CoV-2 infected individuals. Of the 36 secondary cases, 26 (72%) had been classified as close contact and the remaining 10 (28%) were classified as non-close contact. Of the 10 non-close contact, 4 had short conversations with both individuals masked, 4 shared a space without any conversation with both masked, and the remaining 2 entered the space after the index had left. At least one quarter of SARS-CoV-2 transmissions occurred among non-close contacts. The definition of close contact for SARS-CoV-2 exposure based on the mode of droplet transmission should be revised to reflect the airborne nature of SARS-CoV-2 transmission.
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Affiliation(s)
- Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Office for Infection Control, Asan Medical Center, Seoul, Korea
| | - Jungmin Lee
- Department of Microbiology, Institute for Viral Diseases, Biosafety Center, College of Medicine, Korea University, Seoul, Korea
| | - Eunju Kim
- Office for Infection Control, Asan Medical Center, Seoul, Korea
| | - Songhee Namgung
- Office for Infection Control, Asan Medical Center, Seoul, Korea
| | - Younjin Kim
- Office for Infection Control, Asan Medical Center, Seoul, Korea
| | - Mina Yun
- Office for Infection Control, Asan Medical Center, Seoul, Korea
| | - Young Ju Lim
- Office for Infection Control, Asan Medical Center, Seoul, Korea
| | - Eun Ok Kim
- Office for Infection Control, Asan Medical Center, Seoul, Korea
| | - Seongman Bae
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Na Kim
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Mi Lee
- Department of Microbiology, Institute for Viral Diseases, Biosafety Center, College of Medicine, Korea University, Seoul, Korea
| | - Man Seong Park
- Department of Microbiology, Institute for Viral Diseases, Biosafety Center, College of Medicine, Korea University, Seoul, Korea.
| | - Sung Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Office for Infection Control, Asan Medical Center, Seoul, Korea.
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