Availability of personal protective equipment and infection prevention supplies during the first month of the COVID-19 pandemic: A national study by the APIC COVID-19 task force

Evaluation of a Point-of-Use Kiosk for Improving the Fit of N95/P2 Respirators in Healthcare Settings: A Randomized Controlled Trial

INTRODUCTION

Verifying the fit of disposable N95/P2 half-face respirators is critical. There are currently no objective ways to evaluate the implementation when used. Previously, we showed that only 26% of healthcare workers achieve appropriate fit at the point of use.

METHODS

657 quantitative fit tests were conducted on 166 subjects, using four different respirator styles. Randomization was performed; controls employing standard 'fit-check' and intervention using a custom built infra-red video kiosk. Primary outcome was passing rates of quantitative fit, with secondary outcomes of respirator type, gender, race, and previous experience.

RESULTS

Intervention demonstrated significantly higher pass rate (50.6%) compared to controls (30.8%). The odds of passing with IR Kiosk compared to control was 2.3 (OR 2.3 95%CI 1.8 to 2.9, p<0.001). Duckbill style improved the greatest (OR 4.1 95%CI 2.1 to 7.9, p<0.001), and Tri-fold also showing substantial benefit (OR 2.66 95%CI 1.4 to 5.2, p<0.001). Gender and race did not influence the outcomes when using the kiosk, nor did previous experience.

CONCLUSION

A custom point of use kiosk improved the odds of achieving a satisfactory fit of common respirator styles, independent of participant demographics. These findings open the door to addressing a critical gap in respiratory protection programs by providing individual assessment and interventions that improve worker safety at the time of highest risk.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

Headache and Associated Psychological Variables in Intensive Care Unit Nurses during the COVID-19 Pandemic: A Prospective Study

(1) Background: Headaches in health professionals have been studied over the years. This has become even more relevant during the COVID-19 pandemic, due to their link with the use of masks, being female or working in highly complex units. However, their association with different personality traits has not been studied in healthcare workers (HCWs). The aim of this study was to assess the prevalence and evolution of headaches throughout the pandemic in Intensive Care Unit (ICU) nurses and to analyze their association with sociodemographic, occupational and personality variables as well as with other symptoms. (2) Methods: This was an observational, descriptive, longitudinal, prospective study with two periods of data collection (at the end of the containment phase and six months thereafter). A non-probabilistic convenience sampling was performed (n = 131). (3) Results: A high percentage of ICU nurses reported headaches during the first (71%) or second (79.4%) time point; more than half of the sample (58.8%) reported headaches over time (chronic headache). Although a higher prevalence of headaches was observed in women at both assessment points, no significant gender-related relationships were observed for headaches maintained across the two time points. Regarding the symptoms and personality variables, positive relationships were found between headaches and anxiety (p = 0.005), insomnia (p = 0.030) and emotional exhaustion (p = 0.022), and a negative relationship was found between headaches and hardiness (p = 0.031). (4) Conclusions: Our study highlights the importance of assessing occupational, psychological and emotional aspects in order to decrease the prevalence of headaches and thus improve the quality of the work life of nurses in such demanding environments as the ICU.

Global Health Commodities Supply Chain in the Era of COVID-19 Pandemic: Challenges, Impacts, and Prospects: A Systematic Review

Background

The COVID-19 pandemic led to the most substantial health crisis in the 21st Century. This pandemic interrupted the supply of essential commodities for human beings. Among the essential commodities for human survival, disruption of the supply of essential health commodities has become a global concern.

Objective

The study aimed to systematically analyze published articles on the challenges, impacts, and prospects of the global health commodities' supply chain in the era of the COVID-19 pandemic.

Methods

A standard searching strategy was conducted in seven research databases to retrieve pertinent articles. Finally, 459 articles were retrieved for further screening, and only 13 articles were selected for final synthesis.

Results

Almost 38.5% of the studies targeted the supply chain of health commodities used to treat HIV, TB, and malaria. Lockdown policies, travel restrictions, lack of transportation, low manufacturing capacity, and rising costs were the significant challenges indicated for the supply interruption of essential health commodities and COVID-19 vaccines. Findings indicated that the supply interruption of essential health commodities leads to a devastating impact on global health.

Conclusion

Global medicine shortages due to the pandemic crisis can have a devastatingly harmful impact on patient outcomes and might result in a devastatingly long-lasting effect on the health of the world community. Supply-related challenges of the COVID-19 vaccine affect countries' ambitions for achieving herd immunity quickly. Monitoring the pandemic's effect on the health commodities' supply system and designing a short-term and long-term resilient health supply chain system that can cope with current and future health catastrophes is pivotal.

Do-Not-Resuscitate Orders by COVID-19 Status Throughout the First Year of the COVID-19 Pandemic

BACKGROUND

At the beginning of the COVID-19 pandemic, whether performing CPR on patients with COVID-19 would be effective or increase COVID-19 transmission to health care workers was unclear.

RESEARCH QUESTION

Did the prevalence of do-not-resuscitate (DNR) orders by COVID-19 status change over the first year of the pandemic as risks such as COVID-19 transmission to health care workers improved?

STUDY DESIGN AND METHODS

This cross-sectional study assessed DNR orders for all adult patients admitted to ICUs at two academic medical centers in Chicago, IL, between April 2020 and April 2021. DNR orders by COVID-19 status were assessed using risk-adjusted mixed-effects logistic regression and propensity score matching by patient severity of illness.

RESULTS

The study population of 3,070 critically ill patients were 46% Black, 53% male, with median age (interquartile range [IQR]) 63 (50-73) years. Eighteen percent were COVID-19 positive and 27% had a DNR order. Black and Latinx patients had higher absolute rates of DNR orders than White patients (30% vs 29% vs 23%; P = .006). After adjustment for patient characteristics, illness severity, and hospital location, DNR orders were more likely in patients with COVID-19 in the nonpropensity score-matched (n = 3,070; aOR, 2.01; 95% CI, 1.64-2.38) and propensity score-matched (n = 1,118; aOR, 1.91; 95% CI, 1.45-2.52) cohorts. The prevalence of DNR orders remained higher for patients with COVID-19 than patients without COVID-19 during all months of the study period (difference in prevalence over time, P = .751).

INTERPRETATION

In this multihospital study, DNR orders remained persistently higher for patients with COVID-19 vs patients without COVID-19 with similar severity of illness during the first year of the pandemic. The specific reasons why DNR orders remained persistently elevated for patients with COVID-19 should be assessed in future studies, because these changes may continue to affect COVID-19 patient care and outcomes.

Identifying a competency improvement strategy for infection prevention and control professionals: A rapid systematic review and cluster analysis

Remarkable progress has been made in infection prevention and control (IPC) in many countries, but some gaps emerged in the context of the coronavirus disease 2019 (COVID-19) pandemic. Core capabilities such as standard clinical precautions and tracing the source of infection were the focus of IPC in medical institutions during the pandemic. Therefore, the core competences of IPC professionals during the pandemic, and how these contributed to successful prevention and control of the epidemic, should be studied. To investigate, using a systematic review and cluster analysis, fundamental improvements in the competences of infection control and prevention professionals that may be emphasized in light of the COVID-19 pandemic. We searched the PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Data, and CBM databases for original articles exploring core competencies of IPC professionals during the COVID-19 pandemic (from January 1, 2020 to February 7, 2023). Weiciyun software was used for data extraction and the Donohue formula was followed to distinguish high-frequency technical terms. Cluster analysis was performed using the within-group linkage method and squared Euclidean distance as the metric to determine the priority competencies for development. We identified 46 studies with 29 high-frequency technical terms. The most common term was "infection prevention and control training" (184 times, 17.3%), followed by "hand hygiene" (172 times, 16.2%). "Infection prevention and control in clinical practice" was the most-reported core competency (367 times, 34.5%), followed by "microbiology and surveillance" (292 times, 27.5%). Cluster analysis showed two key areas of competence: Category 1 (program management and leadership, patient safety and occupational health, education and microbiology and surveillance) and Category 2 (IPC in clinical practice). During the COVID-19 pandemic, IPC program management and leadership, microbiology and surveillance, education, patient safety, and occupational health were the most important focus of development and should be given due consideration by IPC professionals.

Postpandemic Evaluation of the Eco-Efficiency of Personal Protective Equipment Against COVID-19 in Emergency Departments: Proposal for a Mixed Methods Study

BACKGROUND

The COVID-19 pandemic has had a profound impact on emergency department (ED) care in Canada and around the world. To prevent transmission of COVID-19, personal protective equipment (PPE) was required for all ED care providers in contact with suspected cases. With mass vaccination and improvements in several infection prevention components, our hypothesis is that the risks of transmission of COVID-19 will be significantly reduced and that current PPE use will have economic and ecological consequences that exceed its anticipated benefits. Evidence is needed to evaluate PPE use so that recommendations can ensure the clinical, economic, and environmental efficiency (ie, eco-efficiency) of its use.

OBJECTIVE

To support the development of recommendations for the eco-efficient use of PPE, our research objectives are to (1) estimate the clinical effectiveness (reduced transmission, hospitalizations, mortality, and work absenteeism) of PPE against COVID-19 for health care workers; (2) estimate the financial cost of using PPE in the ED for the management of suspected or confirmed COVID-19 patients; and (3) estimate the ecological footprint of PPE use against COVID-19 in the ED.

METHODS

We will conduct a mixed method study to evaluate the eco-efficiency of PPE use in the 5 EDs of the CHU de Québec-Université Laval (Québec, Canada). To achieve our goals, the project will include four phases: systematic review of the literature to assess the clinical effectiveness of PPE (objective 1; phase 1); cost estimation of PPE use in the ED using a time-driven activity-based costing method (objective 2; phase 2); ecological footprint estimation of PPE use using a life cycle assessment approach (objective 3; phase 3); and cost-consequence analysis and focus groups (integration of objectives 1 to 3; phase 4).

RESULTS

The first 3 phases have started. The results of these phases will be available in 2023. Phase 4 will begin in 2023 and results will be available in 2024.

CONCLUSIONS

While the benefits of PPE use are likely to diminish as health care workers' immunity increases, it is important to assess its economic and ecological impacts to develop recommendations to guide its eco-efficient use.

TRIAL REGISTRATION

PROSPERO CRD42022302598; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302598.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50682.

Impacts of the COVID-19 pandemic on the infection prevention and control field: Findings from focus groups conducted with association for professionals in infection control & epidemiology (APIC) members in fall 2021

INTRODUCTION

Emergence of the Delta variant in 2021 changed the pandemic landscape and led to healthcare surges across the US, despite availability of COVID-19 vaccine. Anecdotal information indicated that the infection prevention and control (IPC) field was changing, but formal assessment was needed.

METHODS

Focus groups (6) were conducted with APIC members in November and December, 2021 to elicit infection preventionists' (IP) opinions changes to the IPC field due to the pandemic. Focus groups were audio recorded via Zoom and transcribed. Content analysis was used to identify major themes.

RESULTS

Ninety IPs participated. IPs described multiple changes to the IPC field during the pandemic, including being more involved in policy development, the challenge of transitioning back to routine IPC while still responding to COVID-19, increased need for IPs across practice settings, difficulties in recruiting and retaining IPs, presenteeism in healthcare, and extensive burnout. Participants suggested approaches to improve IPs' wellbeing.

CONCLUSIONS

The ongoing pandemic has brought significant changes to the IPC field, including a shortage of IPs just as the field is expanding rapidly. The continued overwhelming workload and stress due to the pandemic has resulted in burnout among IPs and the need for initiatives to improve their wellbeing.

Nurse-Patient Communication and Relationship When Wearing Personal Protective Equipment: Nurses' Experience in a COVID-19 Ward

Little is known about which communication strategies nurses carried out and whether the nurse-patient relationship has been altered due to the mandated use of personal protective equipment during the COVID-19 pandemic. This study describes how nurse-patient communication and relationships took place from the point of view of nurses engaged in caring for patients with COVID-19. A qualitative descriptive study design following COREQ guidelines was conducted. Semi-structured telephone interviews with nurses working in the COVID ward of an Italian university hospital were performed between September 2020 and June 2021. Ten nurses were recruited using convenience sampling. One overarching theme, three main themes, and nine sub-themes were identified. The overarching theme 'The in-out relationship: 'in here and out there' and 'inside me and out of me' included the main themes 'A closed system different from normal', 'Uncovering meaningful human gestures', and 'A deep experience to live''. The relational nature of nursing-where 'me and you' and the context are the main elements-leads nurses to find new ways of interacting and communicating with patients, even in a new situation that has never been experienced. Enhancing human gestures, thinking about new contexts of care, and educating new generations to maintain human-to-human interaction, regardless of the context of care, are the directives to be explored for creating the future of nursing care.

Hospital response challenges and strategies during COVID-19 pandemic: a qualitative study

Background

At the beginning of the COVID-19 pandemic, healthcare managers at hospitals did not have sufficient experiences to appropriately respond to the COVID-19 outbreak. Due to a lack of preparedness, many challenges arose in the healthcare system, and each country developed and implemented strategies depending on national policies. This study aimed to understand challenges during the COVID-19 pandemic and strategies used in Iranian hospitals.

Methods

A qualitative research was conducted in four hospitals in an urban area of Iran. In-depth semi-structured interviews were performed with 32 participants including healthcare managers, nurses, and medical doctors. Data underwent qualitative content analysis.

Results

Four categories were developed: 'capacity expansion', 'management affairs', 'diagnostic services," and therapeutic services'. Each category consisted of 2-3 subcategories.

Conclusion

Hospitals should be prepared to intelligently respond to future epidemics. It is necessary to develop a comprehensive epidemic plan for the management of disasters to reduce the impact of the epidemic and minimize the risk to public health and ensure that resources are allocated in an efficient and effective manner.

Race and COVID-19 among Social Workers in Health Settings: Physical, Mental Health, Personal Protective Equipment, and Financial Stressors

Social work is an essential workforce integral to the United States' public health infrastructure and response to COVID-19. To understand stressors among frontline social workers during COVID-19, a cross-sectional study of U.S-based social workers (N = 1,407) in health settings was collected (in June through August 2020). Differences in outcome domains (health, mental health, personal protective equipment [PPE] access, financial stress) were examined by workers' demographics and setting. Ordinal logistic, multinomial, and linear regressions were conducted. Participants reported moderate or severe physical (57.3 percent) and mental (58.3 percent) health concerns; 39.3 percent expressed PPE access concerns. Social workers of color were more likely to report significantly higher levels of concern across all domains. Those identifying as Black, American Indian/Alaska Native (AIAN), Asian American/Pacific Islander (AAPI), multiracial, or Hispanic/Latinx were over 50 percent more likely to experience either moderate or severe physical health concerns, 60 percent more likely to report severe mental health concerns, and over 30 percent more likely to report moderate PPE access concerns. The linear regression model was significantly associated with higher levels of financial stress for social workers of color. COVID-19 has exposed racial and social injustices that that hold true for social workers in health settings. Improved social systems are critical not just for those impacted by COVID-19, but also for the protection and sustainability of the current and future workforce responding to COVID-19.

The role of pandemic planning in the management of COVID-19 in England from an infection prevention and control perspective: results of a national survey

OBJECTIVES

This national survey aimed to explore how existing pandemic preparedness plans (PPP) accounted for the demands placed on infection prevention and control (IPC) services in acute and community settings in England during the first wave of the COVID-19 pandemic.

STUDY DESIGN

This was a cross-sectional survey of IPC leaders working within National Health Service Trusts or clinical commissioning groups/integrated care systems in England.

METHODS

The survey questions related to organisational COVID-19 preparedness pre-pandemic and the response provided during the first wave of the pandemic (January to July 2020). The survey ran from September to November 2021, and participation was voluntary.

RESULTS

In total, 50 organisations responded. Seventy-one percent (n = 34/48) reported having a current PPP in December 2019, with 81% (n = 21/26) indicating their plan was updated within the previous 3 years. Around half of IPC teams were involved in previous testing of these plans via internal and multi-agency tabletop exercises. Successful aspects of pandemic planning were identified as command structures, clear channels of communication, COVID-19 testing, and patient pathways. Key deficiencies were lack of personal protective equipment, difficulties with fit testing, keeping up to date with guidance, and insufficient staffing.

CONCLUSIONS

Pandemic plans need to consider the capability and capacity of IPC services to ensure they can contribute their critical knowledge and expertise to the pandemic response. This survey provides a detailed evaluation of how IPC services were impacted during the first wave of the pandemic and identifies key areas, which need to be included in future PPP to better manage the impact on IPC services.

Impact of COVID-19 pandemic on multidrug resistant gram positive and gram negative pathogens: A systematic review

BACKGROUND

There is paucity of data describing the impact of COVID-19 pandemic on antimicrobial resistance. This review evaluated the changes in the rate of multidrug resistant gram negative and gram positive bacteria during the COVID-19 pandemic.

METHODS

A search was conducted in PubMed, Science Direct, and Google Scholar databases to identify eligible studies. Studies that reported the impact of COVID-19 pandemic on carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Enterobacteriaceae (CRE), extended-spectrum beta-lactamase inhibitor (ESBL)-producing Enterobacteriaceae, vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Pseudomonas aeruginosa (CPE) were selected. Studies published in English language from the start of COVID-19 pandemic to July 2022 were considered for inclusion.

RESULTS

Thirty eligible studies were selected and most of them were from Italy (n = 8), Turkey (n = 3) and Brazil (n = 3). The results indicated changes in the rate of multidrug resistant bacteria, and the changes varied between the studies. Most studies (54.5%) reported increase in MRSA infection/colonization during the pandemic, and the increase ranged from 4.6 to 170.6%. Five studies (55.6%) reported a 6.8-65.1% increase in VRE infection/colonization during the pandemic. A 2.4-58.2% decrease in ESBL E. coli and a 1.8-13.3% reduction in ESBL Klebsiella pneumoniae was observed during the pandemic. For CRAB, most studies (58.3%) reported 1.5-621.6% increase in infection/colonization during the pandemic. Overall, studies showed increase in the rate of CRE infection/colonization during the pandemic. There was a reduction in carbapenem-resistant E. coli during COVID-19 pandemic, and an increase in carbapenem-resistant K. pneumoniae. Most studies (55.6%) showed 10.4 - 40.9% reduction in the rate of CRPA infection during the pandemic.

CONCLUSION

There is an increase in the rate of multidrug resistant gram positive and gram negative bacteria during the COVID-19 pandemic. However, the rate of ESBL-producing Enterobacteriaceae and CRPA has decrease during the pandemic. Both infection prevention and control strategies and antimicrobial stewardship should be strengthen to address the increasing rate of multidrug resistant gram positive and gram negative bacteria.

Delays in gender affirming healthcare due to COVID-19 are mitigated by expansion of telemedicine

BACKGROUND

Gender-affirming healthcare is vital for transgender and gender diverse (TGD) patients, and during the pandemic, accessing healthcare became challenging. Hypothesizing that many had procedures postponed, we sought to characterize the impact of the pandemic on TGD patients.

METHODS

A mixed-methods approach was employed, combining surveys and interviews; Duke patients were identified by ICD-10 codes, while non-Duke (national) patients were recruited through online social media.

RESULTS

All specialties increased telemedicine usage during the pandemic. Duke surgical patients reported a nearly three-fold increase in telemedicine access. COVID-19 symptoms were reported by 24% of Duke and 20% of national patients; barriers to urgent care included the fear of discrimination (27%).

CONCLUSION

Delays were experienced in all domains of care, mitigated in part by telemedicine. Nearly one-third of patients cite discrimination as a barrier to care. Though pandemic-related expansion of telemedicine may be a marker of success, significant barriers still complicate delivery of healthcare.

Barriers and Facilitators to the Use of Personal Protective Equipment in Long-Term Care: A Scoping Review

OBJECTIVE

To review existing literature evaluating barriers and facilitators to the use of personal protective equipment (PPE) by health care workers in long-term care (LTC).

DESIGN

Scoping review.

SETTING AND PARTICIPANTS

Health care workers in LTC settings.

METHODS

Several online databases were searched and a gray literature search was conducted. Study inclusion criteria were (1) conducted in nursing homes or LTC settings, (2) focused on LTC health care workers as the study population, and (3) identified barriers and/or facilitators to PPE use. The Theoretical Domains Framework (TDF), which assesses barriers to implementation across 14 behavioral change domains, was used to extract and organize data about barriers and facilitators to appropriate use of PPE from the included studies.

RESULTS

A total of 5216 references were screened for eligibility and 10 studies were included in this review. Eight of the 10 studies were conducted during the COVID-19 pandemic. Several barriers and facilitators to PPE use were identified. The most common TDF domain identified was environmental context and resources, which was observed in 9 of the 10 studies. Common barriers to PPE use included supply issues (n = 7 studies), the cost of acquisition (n = 3 studies), unclear guidelines on appropriate use of PPE (n = 2 studies), difficulty providing care (n = 2 studies), and anxiety about frightening patients (n = 2 studies). Having PPE readily available facilitated the use of PPE (n = 2 studies).

CONCLUSIONS AND IMPLICATIONS

Further research is necessary to identify barriers and facilitators more extensively across behavior change domains to develop effective strategies to improve PPE use and prevent infection transmission within LTC.

Remote infection control assessments in long-term care facilities during COVID-19 pandemic in Texas, 2020

BACKGROUND

The Texas Department of State Health Services (DSHS) Healthcare Safety Unit (HCSU) conducts remote infection control assessments (tele-ICARs) in long-term care facilities (LTCFs) to evaluate COVID-19 infection prevention and control (IPC) knowledge and practices using a standardized assessment tool. Tele-ICARs are used to gauge different IPC measures specific to SARS-CoV-2 and are either proactive--conducted prior to identified cases--or responsive to an outbreak, which is defined as a new SARS-CoV-2 infection in any staff or any facility-onset infection in a resident. State and local partners use findings from the assessments to aid LTCFs by providing targeted and timely resources and support to mitigate identified gaps.

METHODS

Data from tele-ICARs conducted between March 1 and October 30, 2020 were analyzed to assess major gaps across LTCF types. A major gap was defined as 10% or more of facilities not satisfying a specific IPC measure, excluding missing data. Gaps were also assessed by tele-ICAR type: proactive or responsive. Fisher's exact tests and univariate logistic regression were used to characterize significant associations between major IPC gaps and LTCF or tele-ICAR type.

RESULTS

DSHS conducted tele-ICARs in 438 LTCFs in Texas during 8 months; 191 were nursing homes/skilled nursing facilities (NH/SNFs), 206 were assisted living facilities (ALFs) and 41 were other settings. Of the assessments, 264 were proactive and 174 responsive. Major gaps identified were: (1) 22% did not have a preference for alcohol-based hand sanitizer (ABHS) over soap and water; (2) 18.1% were not aware of the contact time for disinfectants in use; (3) 17.9% had not stopped resident communal dining; (4) 16.8% did not audit hand hygiene and PPE compliance; and (5) 11.8% had not stopped inter-facility group activities and extra-facility field trips. When restricting analyses to proactive tele-ICARs, one additional gap was identified: 11.1% of facilities lacked a dedicated space to care for or cohort residents with confirmed SARS-CoV-2 infection. Significantly more ALFs than NH/SNFs had not suspended resident communal dining (P < .001) nor identified a dedicated space to cohort residents with confirmed SARS-CoV-2 infection (P < .001). Significantly more LTCFs that received a responsive ICAR compared to a proactive ICAR reported a preference for ABHS over soap and water (P = .008) and reported suspending communal dining (P < .001) and group activities (P < .001). Also, significantly more LTCFs that received a responsive ICAR compared to a proactive ICAR had identified a dedicated space to cohort residents with confirmed SARS-CoV-2 (P = .009).

CONCLUSIONS

Increased facility education and awareness of federal and state guidelines for group activities and communal dining is warranted in Texas, emphasizing the importance of social distancing for preventing the transmission of SARS-CoV-2 in LTCFs, particularly ALFs. CDC recommendations for ABHS versus hand washing should be emphasized, as well as the importance of monitoring and auditing HCP hand hygiene and PPE compliance. Facilities may benefit from additional education and resources about disinfection, to ensure proper selection of disinfectants and understanding of the contact time required for efficacy. Analysis by tele-ICAR type suggests facilities may benefit from identifying space for dedicated COVID-19 units in advance of an outbreak in their facility. Conducting tele-ICARs in LTCFs enables public health agencies to provide direct and individualized feedback to facilities and identify state-wide opportunities for effective interventions in response to SARS-CoV-2.

Seasonal COVID-19 surge related hospital volumes and case fatality rates

BACKGROUND

Seasonal and regional surges in COVID-19 have imposed substantial strain on healthcare systems. Whereas sharp inclines in hospital volume were accompanied by overt increases in case fatality rates during the very early phases of the pandemic, the relative impact during later phases of the pandemic are less clear. We sought to characterize how the 2020 winter surge in COVID-19 volumes impacted case fatality in an adequately-resourced health system.

METHODS

We performed a retrospective cohort study of all adult diagnosed with COVID-19 in a large academic healthcare system between August 25, 2020 to May 8, 2021, using multivariable logistic regression to examine case fatality rates across 3 sequential time periods around the 2020 winter surge: pre-surge, surge, and post-surge. Subgroup analyses of patients admitted to the hospital and those receiving ICU-level care were also performed. Additionally, we used multivariable logistic regression to examine risk factors for mortality during the surge period.

RESULTS

We studied 7388 patients (aged 52.8 ± 19.6 years, 48% male) who received outpatient or inpatient care for COVID-19 during the study period. Patients treated during surge (N = 6372) compared to the pre-surge (N = 536) period had 2.64 greater odds (95% CI 1.46-5.27) of mortality after adjusting for sociodemographic and clinical factors. Adjusted mortality risk returned to pre-surge levels during the post-surge period. Notably, first-encounter patient-level measures of illness severity appeared higher during surge compared to non-surge periods.

CONCLUSIONS

We observed excess mortality risk during a recent winter COVID-19 surge that was not explained by conventional risk factors or easily measurable variables, although recovered rapidly in the setting of targeted facility resources. These findings point to how complex interrelations of population- and patient-level pandemic factors can profoundly augment health system strain and drive dynamic, if short-lived, changes in outcomes.

Work-based concerns of Australian frontline healthcare workers during the first wave of the COVID-19 pandemic

OBJECTIVE

This research sought to gauge the extent to which doctors, nurses and paramedics in Australia were concerned about contracting SARS-CoV-2 during the country's first wave of the virus in April 2020.

METHODS

Australian registered doctors, nurses and paramedics (n=580) completed an online questionnaire during April 16-30, 2020 (period immediately following the highest four-week period (first wave) of SARS-CoV-2 confirmed cases in Australia).

RESULTS

During April 2020, two-thirds of participants felt it was likely they would contract SARS-CoV-2 at work. Half the participants suggested Personal Protective Equipment (PPE) supplies were inadequate for them to safely perform their job, with two-thirds suggesting management advised them to alter normal PPE use. One-third of participants suggested they were dissatisfied with their employer's communication of COVID-19 related information. Conclusions and implications for public health: After reports of PPE shortages during Australia's first SARS-CoV-2 wave, and suggestions access to PPE was still limited during Australia's second wave five months later, we must forecast for this and future pandemics ensuring adequate access to PPE for frontline healthcare workers. Further, ensuring consistent and standardised pathways for communication to staff (acknowledging the reality that information may rapidly change) will help alleviate frustration and anxiety.

Factors associated with infection and hospitalization due to COVID-19 in Nursing professionals: a cross-sectional study

Abstract Objective: to identify factors associated with infection and hospitalization due to COVID-19 in nursing professionals. Method: a cross-sectional study carried out with 415 nursing professionals in a hospital specialized in cardiology. The sociodemographic variables, comorbidities, working conditions and issues related to illness due to COVID-19 were evaluated. Chi-Square, Fisher’s, Wilcoxon, Mann-Whitney and Brunner Munzel tests were used in data analysis, as well as Odds Ratio for hospitalization, in addition to binary logistic regression. Results: the rate of nursing professionals affected by COVID-19 was 44.3% and the factors associated with infection were the number of people living in the same household infected by COVID-19 (OR 36.18; p<0.001) and use of public transportation (OR 2.70; p=0.044). Having severe symptoms (OR 29.75), belonging to the risk group (OR 3.00), having tachypnea (OR 6.48), shortness of breath (OR 5.83), tiredness (OR 4.64), fever (OR 4.41) and/or myalgia (OR 3.00) increased the chances of hospitalization in professionals with COVID-19. Conclusion: living in the same household as other people with the disease and using public transportation increased the risk of infection by the new coronavirus. The factors associated with the hospitalization of contaminated professionals were presence of risk factors for the disease, severity and type of the symptoms presented.

Factores asociados al contagio y la hospitalización por COVID-19 en profesionales de enfermería: estudio transversal

Resumen Objetivo: identificar los factores asociados al contagio y la hospitalización por COVID-19 en los profesionales de enfermería. Método: estudio transversal, realizado en un hospital especializado en cardiología, con 415 profesionales de enfermería. Se evaluaron las variables sociodemográficas, comorbilidades, condiciones de trabajo y preguntas relacionadas con la enfermedad por COVID-19. En el análisis de los datos, se utilizaron las pruebas de Chi-Cuadrado, Fisher, Wilcoxon, Mann-Whitney y Brunner Munzel, la razón de chance para la hospitalización, además de la regresión logística binaria. Resultados: la tasa de profesionales de enfermería afectados por el COVID-19 fue del 44,3% y los factores asociados al contagio fueron el número de personas en una misma vivienda con COVID-19 (OR 36,18; p<0,001) y el uso de transporte público (OR 2,70; p=0,044). Presentar síntomas graves (OR 29,75), pertenecer al grupo de riesgo (OR 3,00), tener taquipnea (OR 6,48), dificultad para respirar (OR 5,83), cansancio (OR 4,64), fiebre (OR 4,41) y/o mialgia (OR 3,00) aumentó las chances de hospitalización de los profesionales con COVID-19. Conclusión: vivir en el mismo domicilio que otras personas que tienen la enfermedad y utilizar el transporte público aumentó el riesgo de contagio por el nuevo coronavirus. Los factores asociados a la hospitalización de los profesionales contagiados fueron la presencia de factores de riesgo para enfermarse, la gravedad y el tipo de síntomas presentados.

Factors associated with infection and hospitalization due to COVID-19 in Nursing professionals: a cross-sectional study

OBJECTIVE

to identify factors associated with infection and hospitalization due to COVID-19 in nursing professionals.

METHOD

a cross-sectional study carried out with 415 nursing professionals in a hospital specialized in cardiology. The sociodemographic variables, comorbidities, working conditions and issues related to illness due to COVID-19 were evaluated. Chi-Square, Fisher's, Wilcoxon, Mann-Whitney and Brunner Munzel tests were used in data analysis, as well as Odds Ratio for hospitalization, in addition to binary logistic regression.

RESULTS

the rate of nursing professionals affected by COVID-19 was 44.3% and the factors associated with infection were the number of people living in the same household infected by COVID-19 (OR 36.18; p<0.001) and use of public transportation (OR 2.70; p=0.044). Having severe symptoms (OR 29.75), belonging to the risk group (OR 3.00), having tachypnea (OR 6.48), shortness of breath (OR 5.83), tiredness (OR 4.64), fever (OR 4.41) and/or myalgia (OR 3.00) increased the chances of hospitalization in professionals with COVID-19.

CONCLUSION

living in the same household as other people with the disease and using public transportation increased the risk of infection by the new coronavirus. The factors associated with the hospitalization of contaminated professionals were presence of risk factors for the disease, severity and type of the symptoms presented.

Comparison of clinical, laboratory and radiological features in confirmed and unconfirmed COVID-19 patients

Background: We aimed to compare the clinical, laboratory and radiological findings of confirmed COVID-19 and unconfirmed patients. Methods: This was a single-center, retrospective study. Results: Overall, 620 patients (338 confirmed COVID-19 and 282 unconfirmed) were included. Confirmed COVID-19 patients had higher percentages of close contact with a confirmed or probable case. In univariate analysis, the presence of myalgia and dyspnea, decreased leukocyte, neutrophil and platelet counts were best predictors for SARS-CoV-2 RT-PCR positivity. Multivariate analyses revealed that only platelet count was an independent predictor for SARS-CoV-2 RT-PCR positivity. Conclusion: Routine complete blood count may be helpful for distinguishing COVID-19 from other respiratory illnesses at an early stage, while PCR testing is unique for the diagnosis of COVID-19.

Willingness to Work amongst Australian Frontline Healthcare Workers during Australia's First Wave of Covid-19 Community Transmission: Results of an Online Survey

OBJECTIVES

The majority of research investigating healthcare workers' (HCWs) willingness to work during public health emergencies, asks participants to forecast their perceptions based on hypothetical emergencies, rather than in response to the actual public health emergencies they have experienced. This research explored frontline HCWs willingness to work during Australia's first wave of the COVID-19 pandemic among frontline HCWs.

METHODS

Participants (n = 580) completed an online questionnaire regarding their willingness to work during the pandemic.

RESULTS

A total of 42% of participants reported being less willing to work during the pandemic compared to before. Availability of personal protective equipment (PPE), concern expressed by family members, and viral exposure were significant barriers. A third of participants disagreed that some level of occupational risk for exposure to infectious disease was acceptable while a quarter of participants had received communications from their workplace concerning obligations to work during COVID-19.

CONCLUSIONS

The COVID-19 pandemic has impacted Australian frontline HCWs' willingness to work. Scarcity of PPE and exposure to the virus were the most cited reasons impacting on willingness to work. Appropriate policies and practices should be implemented and communicated efficiently to frontline HCW's. This research provides insight into the lived experiences of Australian healthcare professionals' willingness to work during a pandemic.

Infection preventionists' experiences during the first nine months of the COVID-19 pandemic: Findings from focus groups conducted with Association of Professionals in Infection Control & Epidemiology (APIC) members

INTRODUCTION

A novel human Coronavirus (SARS CoV-2) was identified in January, 2020 and developed into a pandemic by March, 2020. This rapid, enormous, and unanticipated event had major implications for healthcare. Infection preventionists (IP) have a critical role in worker and patient safety. IPs' lessons learned can guide future pandemic response.

METHODS

Seven focus groups were conducted with APIC members in September and October, 2020 via Zoom to elicit IPs' experiences during the COVID-19 pandemic. Sessions were recorded then transcribed verbatim. Major themes were identified through content analysis.

RESULTS

In total, 73 IPs participated (average of 10 IPs per focus group) and represented all geographical areas and work settings. Participating IPs described multiple challenges they have faced during the COVID-19 pandemic, including rapidly changing and conflicting guidance, a lack of infection prevention recommendations for nonacute care settings, insufficient personal protective equipment, healthcare personnel complacency with personal protective equipment and infection prevention protocols, and increases in healthcare associated infections and workload.

CONCLUSIONS

The identified gaps in pandemic response need to be addressed in order to minimize healthcare associated infections and occupational illness. In addition, the educational topics identified by the participating IPs should be developed into new educational programs and resources.

Rural infection preventionists' experiences during the COVID-19 pandemic: Findings from focus groups conducted with association of professionals in infection control & epidemiology (APIC) members

Background

SARS CoV-2, the virus that causes COVID-19, was identified and quickly developed into a pandemic in spring, 2020. This event posed immense difficulties for healthcare nationally, with rural areas experiencing different challenges than other regions.

Methods

The Association of Professionals in Infection Control & Epidemiology conducted focus groups with infection preventionist (IP) members in September and October, 2020. Zoom sessions were recorded and transcribed. Content analysis was used to identify themes.

Results

In all, 38 IPs who work at a critical access hospital or a healthcare facility in a rural location participated. Major challenges identified by IPs in this study included addressing the lack of access to personal protective equipment (PPE), overwhelming workloads caused by the pandemic and multiple roles/responsibilities, inaccurate social media messages, and generalized disbelief and disregard about the pandemic among rural community members.

Conclusions

Gaps in preparedness identified in this study, such as the lack of PPE, need to be addressed to prevent occupational illness. In addition, health disparities and inaccurate beliefs about COVID-19 heard by IPs in this study need to be addressed in order to increase compliance with public health safeguards among rural community members and minimize morbidity and mortality in these regions.

Impact of COVID-19 on Czech Dentistry: A Nationwide Cross-Sectional Preliminary Study among Dentists in the Czech Republic

This work evaluates the impact of the COVID-19 pandemic on Czech dentistry from March 2020 to March 2021. The assessment was based on questionnaires filled out by 3674 Czech dentists representing 42.6% of practicing dentists in the country. During March-May, 2020 (the first COVID-19 wave), 90.7% of dental practices remained open; however, only 22.8% of the practices continued to operate with no changes, 46.5% had fewer patients, 21.4% treated only acute cases, and 3.8% were closed. During September 2020-May 2021 (the second wave of COVID-19), 96.1% of dental practices remained open, 60.8% operated with no changes, 34.5% had fewer patients, 0.8% treated only acute cases, and 0.5% were closed. The reasons leading to the closure of Czech dental practices during the whole pandemic were a shortage of personal protective equipment (50.5%), a COVID-19 outbreak in the workplace (24.5%), fear of a possible self-infection (24.0%), and quarantine (20.5%). The time range of Czech dental practices closure during the whole pandemic was: 1-2 weeks (49.9%), 2-4 weeks (21.2%), and >1 month (0.8%). The greatest professional difficulties of Czech dentists during the pandemic were crisis operating management (55%), health safety and hygiene concerns (21%), shortage of personal protective equipment (21%), and difficulty working with the protective equipment (15%). In addition, 47.3% of dentists also observed a declining interest in preventive dental care, and 16.9% of them observed worse oral care of patients. These results show that despite the lack of protective equipment, dental care was maintained throughout the pandemic. Additionally, the pandemic negatively affected the patients' approach to dental care, indicating a deterioration in oral health as a possible delayed outcome of the COVID-19 pandemic.

Food Handling Practices in the Era of COVID-19: A Mixed-Method Longitudinal Needs Assessment of Consumers in the United States

ABSTRACT

At present, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not been shown to be transmitted through food. Even so, the coronavirus disease 2019 (COVID-19) pandemic has changed how consumers view food and food safety. This study assessed consumer food safety practices during the COVID-19 pandemic using (i) surveys and (ii) online focus group discussions. From April to August 2020, five waves of surveys were distributed to an online U.S. consumer panel and screened to include only primary food preparers and grocery shoppers. The online focus groups were conducted via WebEx from May to July 2020. Focus group participants were recruited from the first wave of survey respondents. Both survey respondents and focus group participants reported higher levels of hand washing in response to the pandemic. However, survey participants' anticipated levels of hand washing after the pandemic decreased; some focus group participants noted that human nature "kicking in" could lead to lower levels of hand hygiene practice. For each of the 5 months, the surveys reported increased produce washing, both with water only and with water plus soap. Most focus group participants mentioned using water to wash their produce, but some reported using soap and even vinegar to "kill" the virus. Since consumers were worried that SARS-CoV-2 could survive on food, they started to mishandle food to address these concerns. However, this study also reported an increase in food thermometer use during the pandemic. Social determinants like gender, income, education, and age may have also influenced changes in levels of practice throughout the pandemic. The COVID-19 pandemic drove consumers to practice proper and improper food safety practices, which may or may not continue after the pandemic. This study's findings provide timely information to guide future food safety education and communication during health crises and pandemics.

HIGHLIGHTS

Contagion Management at the Méditerranée Infection University Hospital Institute

The Méditerranée Infection University Hospital Institute (IHU) is located in a recent building, which includes experts on a wide range of infectious disease. The IHU strategy is to develop innovative tools, including epidemiological monitoring, point-of-care laboratories, and the ability to mass screen the population. In this study, we review the strategy and guidelines proposed by the IHU and its application to the COVID-19 pandemic and summarise the various challenges it raises. Early diagnosis enables contagious patients to be isolated and treatment to be initiated at an early stage to reduce the microbial load and contagiousness. In the context of the COVID-19 pandemic, we had to deal with a shortage of personal protective equipment and reagents and a massive influx of patients. Between 27 January 2020 and 5 January 2021, 434,925 nasopharyngeal samples were tested for the presence of SARS-CoV-2. Of them, 12,055 patients with COVID-19 were followed up in our out-patient clinic, and 1888 patients were hospitalised in the Institute. By constantly adapting our strategy to the ongoing situation, the IHU has succeeded in expanding and upgrading its equipment and improving circuits and flows to better manage infected patients.

Availability and crisis standards of care for personal protective equipment during fall 2020 of the COVID-19 pandemic: A national study by the APIC COVID-19 task force

Background

The COVID-19 pandemic resulted in personal protective equipment (PPE) shortages in spring 2020, necessitating crisis protocols.

Methods

An online survey was administered to all Association for Professionals in Infection Control and Epidemiology members in October, 2020 to assess PPE availability and crisis standards utilized in fall, 2020.

Results

In total, 1,081 infection preventionists participated. A quarter lacked sufficient disinfection supplies, N95s, isolation gowns, and gloves; 10%-20% lacked eye protection and hand hygiene supplies. Significantly more were reusing respirators than masks (65.6% vs 46.8%, respectively; P < .001); a third (32.0%, n = 735) were reusing isolation gowns. About half (45.9%, n = 496) were decontaminating respirators. Determinants of believing current PPE reuse protocols were safe and evidence-based included the infection preventionists being involved in developing COVID-19 protocols (both), having respirator reuse protocols that involve ≤ 5 reuses (both), using reusable respiratory protection (both), decontaminating respirators (perceived safe), and not reusing masks (perceived safe; P < .05 for all).

Conclusions

Although most health care facilities had adequate PPE in fall 2020, PPE supply chains were still disrupted, resulting in the need to reuse or decontaminate PPE. Ongoing gaps in PPE access need to be addressed in order to minimize health care associated infections and occupational illness.

Severe Acute Respiratory Syndrome Coronavirus 2 Seropositivity among Healthcare Personnel in Hospitals and Nursing Homes, Rhode Island, USA, July-August 2020

Healthcare personnel are recognized to be at higher risk for infection with severe acute respiratory syndrome coronavirus 2. We conducted a serologic survey in 15 hospitals and 56 nursing homes across Rhode Island, USA, during July 17-August 28, 2020. Overall seropositivity among 9,863 healthcare personnel was 4.6% (95% CI 4.2%-5.0%) but varied 4-fold between hospital personnel (3.1%, 95% CI 2.7%-3.5%) and nursing home personnel (13.1%, 95% CI 11.5%-14.9%). Within nursing homes, prevalence was highest among personnel working in coronavirus disease units (24.1%; 95% CI 20.6%-27.8%). Adjusted analysis showed that in hospitals, nurses and receptionists/medical assistants had a higher likelihood of seropositivity than physicians. In nursing homes, nursing assistants and social workers/case managers had higher likelihoods of seropositivity than occupational/physical/speech therapists. Nursing home personnel in all occupations had elevated seropositivity compared with hospital counterparts. Additional mitigation strategies are needed to protect nursing home personnel from infection, regardless of occupation.