The effect of the SARS-CoV-2 pandemic in the compliance of hand hygiene in ICU in a tertiary hospital

Background

Hand hygiene (HH) is one of the main preventive methods for healthcare-associated infections. Our aim is to compare the level of HH compliance in 2021, SARS-CoV-2 pandemic period, with the previous 2019 period.

Methods

Descriptive cross-sectional study of direct observation on compliance of HH in adult intensive care unit (AICU) and neonatal intensive care unit (NICU) in a third-level hospital in Madrid during the years 2019 and 2021. Trained healthcare workers observed and recorded hand hygiene opportunities (HHO) among staff (nurse, nurses’ aide, physicians and orderly) using the World Health Organization's “My Five Moments for Hand Hygiene” tool. All observations of professional that attended patients in SARS-CoV-2 isolation units were excluded.

Results

Overall, there was a total of 1199 HHO, 961 in AICU (2019:466; 2021:495) and 238 in NICU (2019:122; 2021:116). HH compliance in AICU improved from 57.5% in 2019 to 65.9% in 2021 (p = 0.008) and remained unchanged in NICU (2019:90.2% vs 2021:88.8%; p = 0.730). In AICU all professional categories, except nurse’s aide, improved HH compliance being statistically significant in physicians (2019:33.8% vs 2021:50.0%; p = 0.009). In relation to the 5 moments, an increase in HH compliance was observed in: before and after touching a patient/after touching patient surroundings, being only statistically significant in moment after touching a patient (2019:69.4% vs 2021:83.7%; p = 0.001). In NICU there were no significant changes between the two periods regarding to the professional category or the five moments of HH. In NICU there were no significant changes between the two periods regarding to the professional category or the five moments of HH.

Conclusions

The increase in compliance of HH within the adult ICUs demonstrates this adaptation, stating a behavioural change in the habits of professionals. This increase was no observed in the NICU since their compliance was already extremely high.

Key messages

• There has been an increase in HH compliance in the AICU.

• The HH method has varied, becoming COVID-19 specific.

Diagnostic accuracy of combining C-Reactive protein and Alvarado Score among 2-to-20-year-old patients with acute appendicitis suspected presenting to Emergency Departments

OBJECTIVE

Main objective was whether the combination of C-Reactive Protein (CRP) and Alvarado Score (AS) increase the diagnosis accuracy of AS among 2-to-20-year-old patients with suspected acute appendicitis presenting to Emergency Departments.

METHODS

This is a secondary analysis of prospective cohort study consecutively including all patients from 2 to 20 years of age attended for suspected acute appendicitis in 4 Spanish Emergency Departments during 6-month period. We collected demographic, clinical, analytic and radiographic, and surgical data. AS categories were retrospectively calculated as low (0-4 points), intermediate (5-6 points) or high (7-10 points). The cut-off levels were >0.5 mg/dl for CRP. The outcome was diagnosis of acute appendicitis within 14 days of the index visit.

RESULTS

A total of 331 patients with suspected of acute appendicitis (mean age 11.8 (SD 3.8) years; 52.9% males) were recruited. According to AS, 108 (32.6%) were at low risk, 76 at (23.0%) intermediate risk and 147 (44.4%) at high risk of acute appendicitis. One hundred and sixteen (35.0%) cases had confirmed histopathological diagnosis of acute appendicitis. The AUCs of ROC were 0.76 (0.70-0.81) for AS and 0.79 (95% CI 0.75-0.84) for CRP-AS being the difference statistically significant (p=0.003). The CRP for diagnosis acute appendicitis in low risk AS group had negative predictive value of 95.8% (95%CI 87.3-98.9) and likelihood ratio negative of 0.4 (95%CI 0.2-1.0)..

CONCLUSIONS

CRP-AS has shown to increase the diagnostic accuracy of AS for acute appendicitis. This approach may be useful to rule out the diagnosis of acute appendicitis in paediatric patients attended for abdominal pain suggestive of acute appendicitis.

[Adalimumab induction and maintenance therapy for Crohn's disease. An open-label study]

BACKGROUND

adalimumab has been shown in placebo-controlled clinical trials and uncontrolled studies to be effective in luminal and perianal fistulizing CD.

OBJECTIVE

to evaluate the efficacy and safety of adalimumab for induction and maintenance therapy in CD.

METHODS

twenty-two patients with CD treated with adalimumab (16 for luminal disease and 6 for active perianal fistulizing disease) were included. Twenty-one patients had previously received IFX. All patients received induction therapy with 160 mg s.c. at week 0, and 80 mg s.c. at week 2. Responders received maintenance therapy with 40 mg s.c. every 14 days. Response was assessed at 4 weeks after the initial dose, and classified as remission, partial response, or non-response.

RESULTS

after induction, 25% of patients with luminal disease had a complete remission, and 56.3% had a partial response. Clinical response was maintained in 71.6% of patients at 1 year, in 53.7% at 18 months, and in 35.8% at 48 months. No differences in response were observed between patients with hypersensitivity reactions or loss of response to IFX.All patients with perianal fistulizing disease (n = 6) had been previously treated with IFX. After induction 16.7% entered remission, and 66.7% had a partial response. All patients maintained remission or response over time, with a median follow-up of 15 months.

CONCLUSIONS

adalimumab is an effective and safe treatment for the induction and maintenance of response in luminal and perianal fistulizing CD. These results confirm that the findings obtained in controlled clinical trials are reproducible in clinical practice.

[Design and construction of transfer vectors in order to obtain recombinant modified vaccinia virus Ankara (MVA)]

Modified Vaccinia virus Ankara (MVA) constitutes a good candidate for the development of non-replicative expression viral vectors because it does not replicate in most of mammalian cells. It is essential, for the production of recombinant MVA, the availability of transfer vectors which allow the introduction of desired genes into non-essential regions for in vitro viral replication, by homologous recombination with the viral genome. In the present work, the transfer vectors named VT-MHA and VT-MTK were designed and obtained. They carried genomic regions corresponding to 1-303 and 608-948 positions of the MVA165R gene and 1-244 and 325-534 of the MVA086R gene, respectively, which flank a multiple cloning site for the insertion of foreign genes. In these vectors, the cassettes for the expression of lac Z or uidA genes were cloned, and the activity of the marker enzymes beta-galactosidase and beta-glucuronidase was confirmed in situ. Furthermore, the vector named VT-MTK-GUS was used to obtain and isolate pure recombinant MVA, which carried and expressed the uid A gene. The results herein constitute the basic tools for establishing the methodology to obtain recombinant MVA with the purpose of locally developing non-replicative viral vectors as candidate vaccines.