COVID-19 pandemic and the stethoscope: Do not forget to sanitize

Modeling COVID-19 transmission between age groups in the United States considering virus mutations, vaccinations, and reinfection

The in-depth understanding of the dynamics of COVID-19 transmission among different age groups is of great interest for governments and health authorities so that strategies can be devised to reduce the pandemic's detrimental effects. We developed the SIRDV-Virulence (Susceptible-Infected-Recovered-Dead-Vaccinated-Virulence) epidemiological model based on a population balance equation to study the effects virus mutants, vaccination strategies, 'Anti/Non Vaxxer' proportions, and reinfection rates to provide methods to mitigate COVID-19 transmission among the United States population. Based on publicly available data, we obtain the key parameters governing the spread of the pandemic. The results show that a large fraction of infected cases comes from the adult and children populations in the presence of a highly infectious COVID-19 mutant. Given the situation at the end of July 2021, the results show that prioritizing children and adult vaccinations over that of seniors can contain the spread of the active cases, thereby preventing the healthcare system from being overwhelmed and minimizing subsequent deaths. The model suggests that the only option to curb the effects of this pandemic is to reduce the population of unvaccinated individuals. A higher fraction of 'Anti/Non-vaxxers' and a higher reinfection rate can both independently lead to the resurgence of the pandemic.

Assessing Changes in Stethoscope Hygiene During COVID-19: A Multicentre Cross-Sectional Study

Background

The COVID-19 (SARS-CoV-2) pandemic has increased infection control vigilance across several modes of patient contact. However, it is unknown whether hygiene pertaining to stethoscopes, which carry the potential for pathogenic contamination, has also shifted accordingly.

Aim

To characterize pandemic-related changes in stethoscope hygiene.

Methods

We surveyed healthcare providers at three major medical centres. Questions quantitatively (Likert scale and frequency) assessed stethoscope hygiene beliefs and practices with two components: before and during COVID-19. Participants were grouped based on performance of optimal stethoscope hygiene (after every patient) before and during COVID-19. Groups were compared using χ² and analysis of variance (ANOVA).

Findings

Of the 515 (10%) who completed the survey, 55 were excluded (N = 460). Optimal hygiene increased from 27.4% to 55.0% (P < 0.001). There were significant increases in Likert scores for all questions pertaining to knowledge of stethoscope contamination (P < 0.001). Belief in stethoscope contamination increased (P < 0.001) despite no change in perceived hygiene education. Resident physicians were less likely compared with attending physicians and nurses to have adopted optimal hygiene during COVID-19 (P < 0.001).

Conclusion

Despite a positive shift in stethoscope hygiene during COVID-19, optimal hygiene was still only performed by around half of providers. Educational interventions, particularly targeting early-career providers, are encouraged.

Remote Prototyping of FPGA-Based Devices in the IoT Concept during the COVID-19 Pandemic

This paper presents a system for the remote design and testing of electronic circuits and devices with FPGAs during COVID-19 and similar lockdown periods when physical access to laboratories is not permitted. The system is based on the application of the IoT concept, in which the final device is a test board with an FPGA chip. The system allows for remote visual inspection of the board and the devices linked to it in the laboratory. The system was developed for remote learning taking place during the lockdown periods at Poznan University of Technology (PUT) in Poland. The functionality of the system is confirmed by two demonstration tasks (the use of the temperature and humidity DHT11 sensor and the design of a generator of sinusoidal waveforms) for students in the fundamentals of digital design and synthesis courses. The proposed solution allows, in part, to bypass the time-consuming simulations, and accelerate the process of prototyping digital circuits by remotely accessing the infrastructure of the microelectronics laboratory.

Spatiotemporal evolving patterns of bike-share mobility networks and their associations with land-use conditions before and after the COVID-19 outbreak

Recent months have seen ever-increasing levels of confirmed COVID-19 cases despite the accelerated adoption of vaccines. In the wake of the pandemic, travel patterns of individuals change as well. Understanding the changes in biking behaviors during evolving COVID-19 situations is a primary goal of this paper. It investigated usage patterns of the bike-share system in Singapore before, during, and after local authorities imposed lockdown measures. It also correlated the centrality attributes of biking mobility networks of different timestamps with land-use conditions. The results show that total ridership surprisingly climbed by 150% during the lockdown, compared with the pre-pandemic level. Biking mobility graphs became more locally clustered and polycentric as the epidemic develop. There existed a positive and sustained spatial autocorrelation between centrality measures and regions with high residential densities or levels of the land-use mixture. This study suggests that bike-share systems may serve as an alternative mode to fulfill mobility needs when public transit services are restricted due to lockdown policies. Shared-micromobility services have the potential to facilitate a disease-resilient transport system as societies may have to coexist with COVID in the future.

Stethoscope hygiene: A legal consideration for cardiologists practicing in a new era of infection control (COVID-19)

The stethoscope is a tool cherished by the field of cardiology and ubiquitous throughout medicine. However, little consideration has been given to its safe usage regarding its potential for pathogenic contamination despite thorough evidence that stethoscopes can harbor pathogens that can be transmitted to patients upon contact. The COVID-19 (SARS-COV-2) pandemic has led to increased infection control vigilance, including toward the stethoscope, as evidenced by a recent increase in literature highlighting stethoscope hygiene/contamination. A consequence of this increase in awareness is that stethoscopes may be implicated in medical malpractice lawsuits as a potential cause of healthcare-associated infections (HAIs). While there is limited evidence demonstrating a direct connection between stethoscope contamination and HAIs, malpractice lawsuits often do not require direct causative evidence. Regardless, efforts should be made to bolster stethoscope hygiene to not only mitigate patient harm, but also prevent providers from potential medical-legal conflicts. The continued relevance and utility of the stethoscope as a rapid, cost-effective diagnostic tool needs to be appropriately balanced with increased hygiene performance. Providers should anticipate increased scientific evidence and patient awareness regarding stethoscope contamination in the post-COVID-19 era.

Stethoscope hygiene: A call to action. Recommendations to update the CDC guidelines

Healthcare-acquired infections are a tremendous challenge to the US medical system. Stethoscopes touch many patients, but current guidance from the Centers for Disease Control and Prevention does not support disinfection between each patient. Stethoscopes are rarely disinfected between patients by healthcare providers. When cultured, even after disinfection, stethoscopes have high rates of pathogen contamination, identical to that of unwashed hands. The consequence of these practices may bode poorly in the coronavirus 2019 disease (COVID-19) pandemic. Alternatively, the CDC recommends the use of disposable stethoscopes. However, these instruments have poor acoustic properties, and misdiagnoses have been documented. They may also serve as pathogen vectors among staff sharing them. Disposable aseptic stethoscope diaphragm barriers can provide increased safety without sacrificing stethoscope function. We recommend that the CDC consider the research regarding stethoscope hygiene and effective solutions to contemporize this guidance and elevate stethoscope hygiene to that of the hands, by requiring stethoscope disinfection or change of disposable barrier between every patient encounter.

An Examination and Comparison of Stethoscope Hygiene in Nursing Education Programs

BACKGROUND

Improper stethoscope hygiene has been found to contribute to the development of health care associated infections, which affects approximately one in every 30 hospitalized patients. Various pathogens have been found on the stethoscopes of health care workers.

METHOD

A correlational descriptive design was used to compare stethoscopes from 117 nursing students. Sterile swab samples were obtained from four separate areas of each stethoscope. Samples were plated and incubated for 24 to 48 hours.

RESULTS

Bacteria were found on all parts of the stethoscopes from both undergraduate and graduate nursing students, with the earpiece having the highest percentage of contamination. Staphylococcus was the most prevalent microbe found on all four swab sites.

CONCLUSION

Educating students about stethoscope hygiene and consistently reinforcing it in practice are essential to reduce the transmission of pathogens in the health care environment. Nurses can model best practice with students and other disciplines to increase the likelihood of adherence. [J Nurs Educ. 2021;60(5):277-280.].

Assessment of healthcare worker's hand hygiene and infection prevention practices of their personal belongings in a healthcare setting: a survey in pre COVID-19 era and literature review on standard disinfection practices

Background

Healthcare workers’ (HCW) hands and personnel belongings are vehicles of transmission of nosocomial infections. Knowledge, attitude, and practice of hand hygiene have been extensively studied suggesting adequate knowledge but poor compliance. Similar data on aprons, mobile phone and stethoscope disinfection practices are lacking. This becomes an extensively important topic of discussion in current COVID-19 pandemic where inadequacy in hygiene practices is devastating.

Aim

To study the knowledge, attitude, and infection prevention practices of HCWs aprons, electronic devices, stethoscopes, and hands.

Methods

A cross sectional questionnaire-based survey was conducted among HCWs of Medicine ward and ICU.

Results

Sixty-six HCWs responded to the survey. Awareness that hands, aprons, mobile phones, stethoscopes could cause cross transmission and knowledge of correct practices was present in majority of the respondents. Hand hygiene was performed by 65.2% of the respondents before touching a patient and 54.5% after touching the patient surroundings while 13.6% performed only when it was visibly soiled. Mobile phones and stethoscopes were disinfected by 13.6 and 30.3% of the respondents after each patient encounter, respectively. Aprons were washed after using them at a stretch for a median duration of 5 days (1-30 days). Forgetfulness, lack of reinforcement, lack of time, inadequate awareness on standard disinfection practices and fear of damaging electronic devices from disinfectants use were reasons for poor compliance.

Conclusions

There is an urgent need to spread awareness and formulate standard guidelines on disinfection practices especially for mobile phones, stethoscopes, and aprons in addition to reinforcing hand hygiene practices.

Review of hygiene adaptations among UK doctors in controlling the spread of SARS-CoV-2 infection

BACKGROUND

A significant number of healthcare workers around the world have contracted COVID-19 from their workplace, thus there is a need to investigate common hygiene practices.

AIM

We aimed to describe the common hygiene adaptations of doctors in the hospital and at home.

METHODS

A survey of 110 doctors in UK was carried out to determine their hygiene adaptations and practices. Data were collected on demographics and personal protective equipment compliance.

RESULTS

The key findings were frequent hand washing (51%), change of clothing entering and leaving hospital (88% and 92%, respectively), taking a shower upon returning home (85%) and washing work attire at temperatures of 60-80°C (50%). A higher proportion of junior doctors washed their scrubs (p=0.004) and stethoscopes (p=0.014) compared with consultants and seniors. Female doctors cleaned their mobile phones (p=0.022) and work belongings (p=0.01) more frequently.

CONCLUSION

This study signified that junior doctors were more meticulous in hygiene adaptations and female doctors were more fastidious in personal hygiene. The observations of this study may be beneficial in preventing transmission of infection to families of healthcare professionals and are important to implement in the case of a second wave of COVID-19.

Anesthesia for GI endoscopy in the era of COVID-19

As a result of COVID-19, the last few weeks have necessitated a reevaluation of the sedation paradigm for gastrointestinal (GI) endoscopic procedures. Routine screening and some surveillance procedures have taken a backseat and likely to remain so until a vaccine or effective treatment becomes available. Anesthesia providers and endoscopists are required to adapt to this new reality rapidly. The general aim of sedation remains the same-patient comfort, reduced hypoxia, prevention of aspiration along with rapid recovery, and discharge. The present review focuses on necessary modification to reduce the risk of virus contagion for both patients (from health-care providers) and vice versa. A preprocedure evaluation and consenting should be modified and provided remotely. Unsedated GI endoscopy, sedation with minimal respiratory depression, and modification of general anesthesia are explored. Challenges with supplemental oxygen administration and monitoring are addressed. Guidelines for appropriate use of personal protective equipment are discussed. Measures for limiting aerosolization are deliberated.

Automatic Classification of Adventitious Respiratory Sounds: A (Un)Solved Problem?

(1) Background: Patients with respiratory conditions typically exhibit adventitious respiratory sounds (ARS), such as wheezes and crackles. ARS events have variable duration. In this work we studied the influence of event duration on automatic ARS classification, namely, how the creation of the Other class (negative class) affected the classifiers’ performance. (2) Methods: We conducted a set of experiments where we varied the durations of the other events on three tasks: crackle vs. wheeze vs. other (3 Class); crackle vs. other (2 Class Crackles); and wheeze vs. other (2 Class Wheezes). Four classifiers (linear discriminant analysis, support vector machines, boosted trees, and convolutional neural networks) were evaluated on those tasks using an open access respiratory sound database. (3) Results: While on the 3 Class task with fixed durations, the best classifier achieved an accuracy of 96.9%, the same classifier reached an accuracy of 81.8% on the more realistic 3 Class task with variable durations. (4) Conclusion: These results demonstrate the importance of experimental design on the assessment of the performance of automatic ARS classification algorithms. Furthermore, they also indicate, unlike what is stated in the literature, that the automatic classification of ARS is not a solved problem, as the algorithms’ performance decreases substantially under complex evaluation scenarios.

Handwashing in averting infectious diseases: Relevance to COVID-19

After officially declared as a pandemic by the World Health Organization (WHO), drastic measures to restrict human movements to contain the COVID-19 infection are employed by most of the countries. Maintaining high personal hygiene by frequent handwashing and be vigilant of clinical signs are widely recommended to reduce the disease burden. The national and international health agencies, including the Centers for Disease Control and Prevention (CDC) and the WHO, have provided guidelines for prevention and treatment suggestions. Here, in this brief article, based on available clinical information, the author discusses why handwashing could be protective of COVID-19 infections. Although a detailed and in-depth discussion of various preventive and protective measures is beyond the scope of this article, this review will focus on the utility of frequent handwashing in minimizing the risk of spreading COVID-19 infection.

Sanitization During and After COVID-19 Pandemic: A Short Review

Sanitization is a preventive and strategic method to contain the spread of SARS-CoV2. Since there is no foolproof method to tackle the present COVID-19 pandemic, sanitization has a central role to play. The present article briefly reviews various methods of sanitization for individuals, surfaces and ambience. The article reviews different approaches toward sanitization and examines the historicity of the methods employed.