Practical experiences and suggestions for the 'eagle-eyed observer': a novel promising role for controlling nosocomial infection in the COVID-19 outbreak

Detection of SARS-CoV-2 in Cancellous Bone of Patients with COVID-19 Disease Undergoing Orthopedic Surgery: Laboratory Findings and Clinical Applications

An emerging issue for orthopedic surgeons is how to manage patients with active or previous COVID-19 disease, avoiding any major risks for the surgeons and the O.R. personnel. This monocentric prospective observational study aims to assess the prevalence of SARS-CoV-2 viral RT-PCR RNA in cancellous bone samples in patients with active or previous COVID-19 disease. We collected data about 30 consecutive patients from our institution from January 2021 to March 2021 with active or previous COVID-19 disease. The presence of SARS-CoV-2 in the samples was determined using two different PCR-based assays. Eighteen of the thirty patients included in the study had a positive nasopharyngeal swab at the time of surgery. Twelve patients had a negative nasopharyngeal swab with a mean days since negativization of 138 ± 104 days, ranging from 23 to 331 days. Mean days of positivity to the nasal swab were 17 ± 17. Twenty-nine out of thirty (96.7%) samples were negative for the presence of SARS-CoV-2 RNA. In one sample, low SARS-CoV-2 load (Cycle threshold (Ct) 36.6.) was detected but not confirmed using an additional confirmatory assay. The conducted study demonstrates the absence of the viral genome within the analyzed cancellous bone. We think that the use of personal protection equipment (PPE) to only protect from aerosol produced during surgery, both in active and recovered patients, is not strictly necessary. We think that the use of PPE should not be employed by surgeons and the O.R. personnel to protect themselves from aerosols produced from the respiratory tract. Moreover, we think that our results could represent a valid basis for further studies related to the possibility of bone donation in patients that suffered and recovered from COVID-19.

A retrospective observational insight into COVID-19 exposures resulting from personal protective equipment (PPE) breaches

Background

Healthcare workers (HCWs) stand the risk of acquiring infection directly, while attending to patients or indirectly while handling and testing patient specimens. Considering this, the present study was planned to assess Personal Protective Equipment (PPE) breaches and exposures among HCWs working in COVID-19 wards/ screening areas and to evaluate their COVID-19 positivity rates post-exposure concerning the level of exposure, type of PPE breach, and the cadre of HCWs exposed in COVID-19 wards.

Methods

This retrospective cross-sectional study involved the analysis of all instances of PPE breaches which occurred during a period of nine months from June 2020 to February 2021 at a tertiary care level hospital in Central India. The analysis included all exposures involving any cadre of HCWs that occurred while handling the patients or while doffing the contaminated PPE in COVID -19 wards.

Results

A total of 347 PPE breaches were analyzed from the available records of the Hospital Infection Control team repository. Amongst the 347 breaches, 268 (77.2%) were classified as low-risk exposures and 79 (22.8%) as high-risk exposures. Cadre wise distribution of high and low-risk exposures revealed that, PPE breaches occurred most commonly in the category of nursing officers (n = 174, 50.1%). Among all of the breaches, 15.2% of high-risk exposures and 2.6% of low-risk exposures resulted in COVID-19 positivity with a cumulative positivity of 5.4%. Collectively, non-mask related breaches accounted for the majority (63.2%) of the positive COVID-19 cases.

Conclusion

Appropriate use of PPE by HCWs is vital for their protection. However, breaches in the use of PPE may occur while managing COVID-19 patients due to physical and mental exhaustion among HCWs resulting from work overload. Early identification and appropriate management of HCWs with high-risk exposures can help prevent transmission to other hospital staff and patients, thus preserving resources and workforce.

Feasibility of using a mobile App to monitor and report COVID-19 related symptoms and people's movements in Uganda

BACKGROUND

Feasibility of mobile Apps to monitor diseases has not been well documented particularly in developing countries. We developed and studied the feasibility of using a mobile App to collect daily data on COVID-19 symptoms and people's movements.

METHODS

We used an open source software "KoBo Toolbox" to develop the App and installed it on low cost smart mobile phones. We named this App "Wetaase" ("protect yourself"). The App was tested on 30 selected households from 3 densely populated areas of Kampala, Uganda, and followed them for 3 months. One trained member per household captured the data in the App for each enrolled member and uploaded it to a virtual server on a daily basis. The App is embedded with an algorithm that flags participants who report fever and any other COVID-19 related symptom.

RESULTS

A total of 101 participants were enrolled; 61% female; median age 23 (interquartile range (IQR): 17-36) years. Usage of the App was 78% (95% confidence interval (CI): 77.0%-78.8%). It increased from 40% on day 1 to a peak of 81% on day 45 and then declined to 59% on day 90. Usage of the App did not significantly vary by site, sex or age. Only 57/6617 (0.86%) records included a report of at least one of the 17 listed COVID-19 related symptoms. The most reported symptom was flu/runny nose (21%) followed by sneezing (15%), with the rest ranging between 2% and 7%. Reports on movements away from home were 45% with 74% going to markets or shops. The participants liked the "Wetaase" App and recommended it for use as an alert system for COVID-19.

CONCLUSION

Usage of the "Wetaase" App was high (78%) and it was similar across the three study sites, sex and age groups. Reporting of symptoms related to COVID-19 was low. Movements were mainly to markets and shops. Users reported that the App was easy to use and recommended its scale up. We recommend that this App be assessed at a large scale for feasibility, usability and acceptability as an additional tool for increasing alerts on COVID-19 in Uganda and similar settings.

Healthcare workers during the COVID-19 pandemic: Experiences of doctors and nurses in Bangladesh

Healthcare workers, who are in low-resource settings, are critically vulnerable during the COVID-19 pandemic. The increasing rate of coronavirus infection in a developing country such as Bangladesh caused the highest death rate of doctors among frontline service providers and resulted in fear and anxiety among healthcare workers. Even with the preliminary measures of hospitals and clinics to protect healthcare workers, the growing casualties are alarming. This research uses case study approach to explore the issues doctors and nurses face in 'priority intervention areas' (PIA) in order to improve the health system quality. Qualitative in-depth semi-structured interviews were conducted from 12 May to 4 June 2020 among doctors and nurses from two different private hospitals in Dhaka city. Data were analysed using thematic content analysis. The two significant areas that required immediate attention were identified from the PIA framework as 'patient and staff safety, infection control' and 'cultural aspects and community engagement'. Each area of the PIA framework showed previously ignored issues in the current health system. The adaptation of the PIA framework helped identify critical health system issues. Possible corrective actions including proper planning and management of isolating the infected patients and provision of adequate personal protective equipment are recommended to management and policymakers to save the lives of healthcare workers and to minimise the spread of infection.

Nosocomial infection of COVID‑19: A new challenge for healthcare professionals (Review)

Nosocomial infections, also known as hospital-acquired infections, pose a serious challenge to healthcare professionals globally during the Coronavirus disease 2019 (COVID‑19) pandemic. Nosocomial infection of COVID‑19 directly impacts the quality of life of patients, as well as results in extra expenditure to hospitals. It has been shown that COVID‑19 is more likely to transmit via close, unprotected contact with infected patients. Additionally, current preventative and containment measures tend to overlook asymptomatic individuals and superspreading events. Since the mode of transmission and real origin of COVID‑19 in hospitals has not been fully elucidated yet, minimizing nosocomial infection in hospitals remains a difficult but urgent task for healthcare professionals. Healthcare professionals globally should form an alliance against nosocomial COVID‑19 infections. The fight against COVID‑19 may provide valuable lessons for the future prevention and control of nosocomial infections. The present review will discuss some of the key strategies to prevent and control hospital‑based nosocomial COVID‑19 infections.

Measuring Awareness of Infection Control Guidelines for Patients with COVID-19 in Radiology Departments in Saudi Arabia

Due to the contagious nature of the COVID-19 virus, healthcare workers are at a great risk of infection. Since medical imaging plays a significant part in the healthcare system and is often used in the diagnosis of potential COVID-19 patients, the radiology personnel are at a very high risk of becoming infected. Purpose: This study aims to assess the enforcement of infection control guidelines for patients with COVID-19 during medical imaging procedures and raise awareness of infection control in different hospitals in Saudi Arabia. Methods: A total of 128 responses were collected from four hospitals across Saudi Arabia using a new structured questionnaire, which was created for health workers by the WHO specifically for this purpose. Data were collected during the COVID-19 pandemic in April 2020. Results: Most participants correctly followed the guidelines of the WHO and Centers for Disease Control and Prevention (CDC) on infection control in the X-ray and general radiology departments. Guideline awareness was higher among magnetic resonance imaging (MRI) and computerised tomography (CT) radiographers, which reduced the risk of future infections. Out of the total respondents, 98.4% stated that they had received formal training in hand hygiene. Only 40.6% of participants, however, knew that respiratory droplets are the primary mode of transmission of the virus from person to person. Conclusion: The knowledge of healthcare professionals in the radiology department regarding infection control needs to be continually assessed. A focus on educational interventions on infection control is required in order to maintain well-informed medical staff.

Fractures in Patients With COVID-19 Infection: Early Prognosis and Management. A Case Series of 20 Patients in a Single Institution in Lombardy, Northern Italy

Fifty-eight percent of the total infections in Italy of COVID-19 were found in northern Italy, in particular, Lombardy. From February 21, 2020, to March 23, 2020, 20 patients with a fracture and a diagnosis of COVID-19 were hospitalized. Demographic data, COVID-19 symptoms, laboratory and radiographic examinations, and treatment methods were recorded. At 1-month follow-up, patients were assessed with the SF-36 score. This case series includes 20 patients (16 women and 4 men), with an average age of 82.35 years (range 59-95). Eleven patients (55%) had a femur fracture. Fourteen patients (70%) had 3 or more comorbidities or previous pathologies. Three patients with severe comorbidities died during the hospitalization. Thirteen patients (65%) had fever, 18 patients (90%) asthenia, and 17 patients (85%) dyspnea. All patients (100%) were given antibiotic therapy, whereas 16 patients (80%) underwent hydroxychloroquine therapy and 8 (40%) were treated with corticosteroids. Eighteen patients (90%) underwent antithromboembolic prophylaxis. Eighteen patients (90%) had lymphopenia. All 20 patients (100%) required noninvasive mechanical ventilation. High D-dimer and polymerase chain reaction values were found in all patients (100%), whereas lactate dehydrogenase was increased in 18 patients (90%). Patients with fractures, especially in the lower limbs, frequently require hospitalization, making these patients more subjected to the risk of COVID-19 infection. COVID-19 infection therefore does not seem to influence the fracture pattern in the elderly population but can lead to health deterioration with increased mortality. The typical symptoms of COVID-19 disease have not changed when associated with a fracture or trauma. Laboratory data are in line with what is reported in recent studies, whereas a more invasive assisted ventilation is associated with a poor prognosis. Finally, analyzing the data obtained from the SF-36 score, significantly lower values emerged when compared with those reported in the literature. LEVEL OF EVIDENCE:: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Adaptation of an Obstetric Anesthesia Service for the Severe Acute Respiratory Syndrome Coronavirus-2 Pandemic: Description of Checklists, Workflows, and Development Tools

Supplemental Digital Content is available in the text.

Care of the pregnant patient during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic presents many challenges, including creating parallel workflows for infected and noninfected patients, minimizing waste of materials, and ensuring that clinicians can seamlessly transition between types of anesthesia. The exponential community spread of disease limited the time for development and training.

Infection Prevention and Control Challenges With First Pregnant Woman Diagnosed With COVID-19: A Case Report in Al Ahssa, Saudi Arabia

This study report focuses on facts on a pregnant woman of COVID-19 who admitted to Al Ahsa Maternity and Children Hospital on March 2020, with suspicion of COVID-19 infection. The patient was complaining of labor pain prior to presentation.

The objective of this study is to report the case and to describe the challenges that are faced while dealing with a case of COVID-19 pregnant patient, during labor, delivery, and surgical intervention. This case reports a patient in labor pain with suspicion of COVID-19 infection due to contact with a positive COVID-19 family member. With no clinical signs or symptoms consistent with the disease, and positive polymerase chain reaction (PCR) outcome for COVID-19 later on, the hospital main departments conducted an active contact tracing and reviewed the preparation and infection prevention control precautions.

The most common problem with COVID-19 is the low level of awareness between healthcare workers related to infection prevention and transmission of the COVID-19 virus. The illness can be better handled and the medical team can be more secure by enhancing the education, case triage, proper guideline and protocols to be implemented appropriately.

The practice of oral and maxillofacial radiology during COVID-19 outbreak

The current coronavirus disease 2019 (COVID-19) outbreak has brought substantial challenges to the world health system, including the practice of dental and maxillofacial radiology (DMFR). DMFR will carry on an imperative role in healthcare during this crisis. This rapid communication has collected and evaluated all the best current evidence and published guidelines as well as professional recommendations to help maxillofacial radiologists and dental practitioners for safer radiological and imaging examinations on healthy, suspected, or confirmed COVID-19 patients during outbreak. Some strategies have been depicted including procedural indications, infection control, and correct employment of personal protection equipment along with evoking the proper practice environment during and after the COVID-19 outbreak.

Concerns for low-resource countries, with under-prepared intensive care units, facing the COVID-19 pandemic

BACKGROUND

Low-resource countries with fragile healthcare systems lack trained healthcare professionals and specialized resources for COVID-19 patient hospitalization, including mechanical ventilators. Additional socio-economic complications such as civil war and financial crisis in Libya and other low-resource countries further complicate healthcare delivery.

METHODS

A cross-sectional survey evaluating hospital and intensive care unit's capacity and readiness was performed from 16 leading Libyan hospitals in March 2020. In addition, a survey was conducted among 400 doctors who worked in these hospitals to evaluate the status of personal protective equipment.

RESULTS

Out of 16 hospitals, the highest hospital capacity was 1000 in-patient beds, while the lowest was 25 beds with a median of 200 (IQR 52-417, range 25-1000) hospital beds. However, a median of only eight (IQR 6-14, range 3-37) available functioning ICU beds were reported in these hospitals. Only 9 (IQR 4.5-14, range 2-20) mechanical ventilators were reported and none of the hospitals had a reverse transcription-polymerase chain reaction machine for COVID-19 testing. Moreover, they relied on one of two central laboratories located in major cities. Our PPE survey revealed that 56.7% hospitals lacked PPE and 53% of healthcare workers reported that they did not receive proper PPE training. In addition, 70% reported that they were buying the PPE themselves as hospitals did not provide them.

CONCLUSION

This study provides an alarming overview of the unpreparedness of Libyan hospitals for detecting and treating patients with COVID-19 and limiting the spread of the pandemic.

Establishing a standardized FUO emergency department: design and practice in dealing with COVID-19

Background

Since the outbreak of COVID-19 in January, 2020, the fever of unknown origin (FUO) emergency department has become the first station for disease prevention and identification in hospitals. Establishing a standardized FUO emergency department within a short period of time has become the key to preventing and controlling COVID-19 in densely populated Chinese cities.

Methods

Based on the lean management model, the research group established a process of less-link visits, which sees reduced contact between patients and physicians during diagnosis and treatment, and zero-contact consultation through lean workflow and value stream analysis. Three steps were implemented to improve the operations of the FUO emergency department: the rapid establishment of an isolation zone, the refinement of duty and protection configuration, and the use of Internet and technology to establish a full-process follow-up consultation system.

Results

(I) Tests related to COVID-19 screening are all completed in the FUO emergency department; (II) 12 new isolated observation rooms have been built; (III) hospital visiting time, waiting time for consultation, and the time from pre-examination to virus screening has been shortened from 18 to 8 hours, from 2 hours to 10 minutes, and from 34 to 3 hours, respectively; (IV) the transfer distance has been shortened from 450 to 20 m, and the observation time has been shortened from 72 to 26 hours. The median waiting time for image examination has been reduced from 40 to 3 minutes, and the moving distance has been shortened from 800 to 10 m; (V) the diagnosis and treatment process is facilitated by 5G, achieving zero contact between doctors and patients.

Conclusions

Through the implantation of information technology, the local transformation of the site, the rational allocation of medical teams and the planned distribution of protective equipment, in a short period of time, individual medical institutions can set up a safe FUO emergency department to provide 24-hour screening and detention services. Establishing an FUO emergency department with lean management and realizing the management approach of combining daily operation with prevention and control could help China and other countries to handle the outbreak of fulminant infectious diseases.

Infection Control against COVID-19 in Departments of Radiology

The COVID-19 epidemic, which is caused by the novel coronavirus SARS-CoV-2, has spread rapidly to become a world-wide pandemic. Chest radiography and chest CT are frequently used to support the diagnosis of COVID-19 infection. However, multiple cases of COVID-19 transmission in radiology department have been reported. Here we summarize the lessons we learned and provide suggestions to improve the infection control and prevention practices of healthcare workers in departments of radiology.

COVID-19 from mysterious enemy to an environmental detection process: a critical review

The recent global emergence of an unusual viral pneumonia of COVID-19 epidemic was firstly started in Wuhan city, Hubei province in China in December 2019. Regrettably, it is still sweeping the planet, and it cannot be controlled up till now. By May 2020, the unexpected spread of this disaster had caused more than 3,759,967 cases and 259,474 deaths in 114 countries from Asia to the Middle East, Europe, and the USA. Considering its fatal nature, it has evolved as a major challenge for the world. This is necessitating a quick and steep intervention in order to save millions of people’s lives across the globe. The knowledge about the nature and evolution of the COVID-19 virus in water, soils, and other environmental compartments can be addressed through wastewater and sewage. Wastewater-based epidemiology approach can be used as an early indicator of the infection within a specific population. The basic aim of this review article is trying to provide a prompt, and valuable reference guides about COVID-19. Some important questions were addressed, such as, its origin, transmission, clinical symptoms, diagnosis, environmental aspects, and the possible indoors and outdoors airborne transmission minimization strategies that may benefit specialists.