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Moa A, Kunasekaran M, Akhtar Z, Costantino V, MacIntyre CR. Systematic review of influenza vaccine effectiveness against laboratory-confirmed influenza among older adults living in aged care facilities. Hum Vaccin Immunother 2023; 19:2271304. [PMID: 37929779 PMCID: PMC10629430 DOI: 10.1080/21645515.2023.2271304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
We estimated the effectiveness of influenza vaccines in preventing laboratory-confirmed influenza among older adults in aged care. Electronic database searches were conducted using search terms, and studies were selected as per the selection criteria. Fourteen studies were included for final review. The studies exhibited considerable variation in reported vaccine effectiveness (VE) across different seasons. Among the observational studies, VE ranged from 7.2% to 89.8% against laboratory-confirmed influenza across different vaccines. Randomized clinical trials demonstrated a 17% reduction in infection rates with the adjuvanted trivalent vaccine. The limitations include the small number of included studies conducted in different countries or regions, varied seasons, variations in diagnostic testing methods, a focus on the A/H3N2 strain, and few studies available on the effectiveness of enhanced influenza vaccines in aged care settings. Despite challenges associated with achieving optimal protection, the studies showed the benefits of influenza vaccination in the elderly residents.
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Affiliation(s)
- Aye Moa
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Zubair Akhtar
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Valentina Costantino
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - C. Raina MacIntyre
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
- College of Public Service and Community Solutions, Arizona State University, Phoenix, AZ, USA
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2
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Cole M. Impact of dry hydrogen peroxide on environmental bioburden reduction in a long-term care facility. Am J Infect Control 2023; 51:1344-1349. [PMID: 37295673 DOI: 10.1016/j.ajic.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Environmental infection transmission is a perennial problem in long-term care facilities (LTCFs), exacerbated by shared living arrangements, residents with cognitive deficits, staffing shortages, and suboptimal cleaning and disinfection. This study evaluates the impact of dry hydrogen peroxide (DHP), as a supplement to manual decontamination, on bioburden within an LTCF neurobehavioral unit. METHODS In this prospective environmental cohort study utilizing DHP in an LTCF's 15-bed neurobehavioral unit, 264 surface microbial samples (44 per time point) were collected in 8 patient rooms, 2 communal areas on 3 consecutive days pre-DHP deployment and on days 14, 28, and 55 post-DHP deployments. The microbial reduction was evaluated by characterizing bioburden as total colony-forming units in each sampling site pre- and post-DHP deployment. Volatile organic compound levels were also measured in each patient area on all sampling dates. Multivariate regression was used to analyze microbial reductions associated with DHP exposure, controlling for sample and treatment sites. RESULTS A statistically significant relationship was detected between exposure to DHP and surface microbial load (P ≤ .00001). Additionally, the average volatile organic compound level postintervention was significantly lower than baseline levels (P = .0031). CONCLUSIONS DHP can significantly reduce surface bioburden in occupied spaces, potentially enhancing infection prevention, and control efforts in LTCFs.
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Affiliation(s)
- Mary Cole
- The Highlands at Brighton part of UR Medicine, Rochester, NY.
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3
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Zissette S, Kiti MC, Bennett BW, Liu CY, Nelson KN, Zelaya A, Kellogg JT, Johnson Ii TM, Clayton P, Fridkin SK, Omer SB, Lopman BA, Adams C. Social contact patterns among employees in U.S. long-term care facilities during the COVID-19 pandemic, December 2020 to June 2021. BMC Res Notes 2023; 16:294. [PMID: 37884967 PMCID: PMC10604856 DOI: 10.1186/s13104-023-06563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE We measured contact patterns using social contact diaries for 157 U.S. long-term care facility employees from December 2020 - June 2021. These data are crucial for analyzing mathematical transmission models and for informing healthcare setting infection control policy. RESULTS The median number of daily contacts was 10 (IQR 8-11). Household contacts were more likely partially masked than fully masked, more likely to involve physical contact, and longer in duration compared to facility contacts.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pam Clayton
- Georgia Health Care Association, Atlanta, GA, USA
| | | | - Saad B Omer
- Peter O'Donnell Jr. School of Public Health at UT Southwestern, Dallas, TX, USA
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Bloch N, Männer J, Gardiol C, Kohler P, Kuhn J, Münzer T, Schlegel M, Kuster SP, Flury D. Effective infection prevention and control measures in long-term care facilities in non-outbreak and outbreak settings: a systematic literature review. Antimicrob Resist Infect Control 2023; 12:113. [PMID: 37853477 PMCID: PMC10585745 DOI: 10.1186/s13756-023-01318-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Healthcare-associated infections in long-term care are associated with substantial morbidity and mortality. While infection prevention and control (IPC) guidelines are well-defined in the acute care setting, evidence of effectiveness for long-term care facilities (LTCF) is missing. We therefore performed a systematic literature review to examine the effect of IPC measures in the long-term care setting. METHODS We systematically searched PubMed and Cochrane libraries for articles evaluating the effect of IPC measures in the LTCF setting since 2017, as earlier reviews on this topic covered the timeframe up to this date. Cross-referenced studies from identified articles and from mentioned earlier reviews were also evaluated. We included randomized-controlled trials, quasi-experimental, observational studies, and outbreak reports. The included studies were analyzed regarding study design, type of intervention, description of intervention, outcomes and quality. We distinguished between non-outbreak and outbreak settings. RESULTS We included 74 studies, 34 (46%) in the non-outbreak setting and 40 (54%) in the outbreak setting. The most commonly studied interventions in the non-outbreak setting included the effect of hand hygiene (N = 10), oral hygiene (N = 6), antimicrobial stewardship (N = 4), vaccination of residents (N = 3), education (N = 2) as well as IPC bundles (N = 7). All but one study assessing hand hygiene interventions reported a reduction of infection rates. Further successful interventions were oral hygiene (N = 6) and vaccination of residents (N = 3). In outbreak settings, studies mostly focused on the effects of IPC bundles (N = 24) or mass testing (N = 11). In most of the studies evaluating an IPC bundle, containment of the outbreak was reported. Overall, only four articles (5.4%) were rated as high quality. CONCLUSION In the non-outbreak setting in LTCF, especially hand hygiene and oral hygiene have a beneficial effect on infection rates. In contrast, IPC bundles, as well as mass testing seem to be promising in an outbreak setting.
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Affiliation(s)
- Nando Bloch
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland.
| | - Jasmin Männer
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | | | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Jacqueline Kuhn
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Thomas Münzer
- Geriatrische Klinik St.Gallen, St.Gallen, Switzerland
| | - Matthias Schlegel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
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Newman C, Mulrine S, Brittain K, Dawson P, Mason C, Spencer M, Sykes K, Underwood F, Young-Murphy L, Waring J, Scott J. Challenges and improvements associated with transitions between hospitals and care homes during the COVID-19 pandemic: a qualitative study with care home and healthcare staff in England. Age Ageing 2023; 52:afad146. [PMID: 37740896 PMCID: PMC10517646 DOI: 10.1093/ageing/afad146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Care home residents transitioning from hospital are at risk of receiving poor-quality care with their safety being challenged by the SARS-CoV-2 virus (COVID-19) pandemic. Little is known about how care home staff worked with hospital staff and other healthcare professionals to address these challenges and make improvements to increase patient safety. OBJECTIVE To gain insight into how the COVID-19 pandemic influenced the safety of transitions between hospital and care home. METHOD Semi-structured interviews were conducted with care home staff and healthcare professionals involved in hospital to care home transitions including doctors, nurses, paramedics, pharmacists, social workers, and occupational therapists. Commonalities and patterns in the data were identified using thematic analysis. RESULTS Seventy participants were interviewed. Three themes were developed, first, 'new challenges', described care homes were pressurised to receive hospital patients amidst issues with COVID-19 testing, changes to working practices and contentious media attention, which all impacted staff negatively. Second, 'dehumanisation' described how care home residents were treated, being isolated from others amounted to feelings of being imprisoned, caused fear and engendered negative reactions from families. Third, 'better ways of working' described how health and social care workers developed relationships that improved integration and confidence and benefited care provision. CONCLUSION The COVID-19 pandemic contributed to and compounded high-risk hospital-to-care home discharges. Government policy failed to support care homes. Rapid discharge objectives exposed a myriad of infection control issues causing inhumane conditions for care home residents. However, staff involved in transitions continued to provide and improve upon care provision.
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Affiliation(s)
- Craig Newman
- Department of Social Work, Education & Community Wellbeing, Faculty of Health & Life Sciences, Northumbria University, Newcastle-upon-Tyne NE7 7XA, UK
| | | | | | | | - Celia Mason
- Department of Social Work, Education & Community Wellbeing, Faculty of Health & Life Sciences, Northumbria University, Newcastle-upon-Tyne NE7 7XA, UK
| | | | - Kate Sykes
- Department of Social Work, Education & Community Wellbeing, Faculty of Health & Life Sciences, Northumbria University, Newcastle-upon-Tyne NE7 7XA, UK
| | | | - Lesley Young-Murphy
- Department of Social Work, Education & Community Wellbeing, Faculty of Health & Life Sciences, Northumbria University, Newcastle-upon-Tyne NE7 7XA, UK
| | | | - Jason Scott
- Department of Social Work, Education & Community Wellbeing, Faculty of Health & Life Sciences, Northumbria University, Newcastle-upon-Tyne NE7 7XA, UK
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Sullivan SG, Sadewo GRP, Brotherton JM, Kaufman C, Goldsmith JJ, Whiting S, Wu L, Canevari JT, Lusher D. The spread of coronavirus disease 2019 (COVID-19) via staff work and household networks in residential aged-care services in Victoria, Australia, May-October 2020. Infect Control Hosp Epidemiol 2023; 44:1334-1341. [PMID: 36263465 DOI: 10.1017/ice.2022.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Morbidity and mortality from coronavirus disease 2019 (COVID-19) have been significant among elderly residents of residential aged-care services (RACS). To prevent incursions of COVID-19 in RACS in Australia, visitors were banned and aged-care workers were encouraged to work at a single site. We conducted a review of case notes and a social network analysis to understand how workplace and social networks enabled the spread of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) among RACS. DESIGN Retrospective outbreak review. SETTING AND PARTICIPANTS Staff involved in COVID-19 outbreaks in RACS in Victoria, Australia, May-October 2020. METHODS The Victorian Department of Health COVID-19 case and contact data were reviewed to construct 2 social networks: (1) a work network connecting RACS through workers and (2) a household network connecting to RACS through households. Probable index cases were reviewed to estimate the number and size (number of resident cases and deaths) of outbreaks likely initiated by multisite work versus transmission via households. RESULTS Among 2,033 cases linked to an outbreak as staff, 91 (4.5%) were multisite staff cases. Forty-three outbreaks were attributed to multisite work and 35 were deemed potentially preventable had staff worked at a single site. In addition, 99 staff cases were linked to another RACS outbreak through their household contacts, and 21 outbreaks were attributed to staff-household transmission. CONCLUSIONS Limiting worker mobility through single-site policies could reduce the chances of SARS-CoV-2 spreading from one RACS to another. However, initiatives that reduce the chance of transmission via household networks would also be needed.
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Affiliation(s)
- Sheena G Sullivan
- Public Health Division, Victorian Department of Health, Melbourne, Victoria, Australia
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Giovanni Radhitio P Sadewo
- Social Network Research Laboratory, Centre for Transformative Innovation, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Julia M Brotherton
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Victoria, Australia
| | - Claire Kaufman
- Public Health Division, Victorian Department of Health, Melbourne, Victoria, Australia
| | - Jessie J Goldsmith
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | | | - Logan Wu
- Public Health Division, Victorian Department of Health, Melbourne, Victoria, Australia
| | - Jose T Canevari
- Public Health Division, Victorian Department of Health, Melbourne, Victoria, Australia
| | - Dean Lusher
- Social Network Research Laboratory, Centre for Transformative Innovation, Swinburne University of Technology, Melbourne, Victoria, Australia
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Dix S, Rawson H, Russo P, Team V, Griffiths D, Morphet J. Practical infection control training for Victoria's aged care workforce at the time of COVID-19 pandemic: a community case study. Front Public Health 2023; 11:1155980. [PMID: 37304118 PMCID: PMC10248151 DOI: 10.3389/fpubh.2023.1155980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/05/2023] [Indexed: 06/13/2023] Open
Abstract
The need to improve career development and training for residential aged care workers in Australia to achieve required essential competencies, including infection prevention and control competencies, has been repeatedly highlighted. In Australia long-term care settings for older adults are known as residential aged care facilities (RACFs). The COVID-19 pandemic has brought to light the lack of preparedness of the aged care sector to respond to emergencies, and the urgent need to improve the infection prevention and control training in residential aged care facilities. The government in the Australian State of Victoria allocated funds to support older Australians in RACFs, including funds toward infection prevention and control training of RACF staff. The School of Nursing and Midwifery at Monash University addressed some of these challenges in delivering an education program on effective infection prevention and control practices to the RACF workforce in Victoria, Australia. This was the largest state-funded program delivered to RACF workers to date in the State of Victoria. The aim of this paper is to provide a community case study, where we share our experience of program planning and implementation during early stages of the COVID-19 pandemic and lessons learned.
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8
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Lyman M, Forsberg K, Sexton DJ, Chow NA, Lockhart SR, Jackson BR, Chiller T. Worsening Spread of Candida auris in the United States, 2019 to 2021. Ann Intern Med 2023; 176:489-495. [PMID: 36940442 DOI: 10.7326/m22-3469] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
BACKGROUND Candida auris is an emerging fungal threat that has been spreading in the United States since it was first reported in 2016. OBJECTIVE To describe recent changes in the U.S. epidemiology of C auris occurring from 2019 to 2021. DESIGN Description of national surveillance data. SETTING United States. PATIENTS Persons with any specimen that was positive for C auris. MEASUREMENTS Case counts reported to the Centers for Disease Control and Prevention by health departments, volume of colonization screening, and antifungal susceptibility results were aggregated and compared over time and by geographic region. RESULTS A total of 3270 clinical cases and 7413 screening cases of C auris were reported in the United States through 31 December 2021. The percentage increase in clinical cases grew each year, from a 44% increase in 2019 to a 95% increase in 2021. Colonization screening volume and screening cases increased in 2021 by more than 80% and more than 200%, respectively. From 2019 to 2021, 17 states identified their first C auris case. The number of C auris cases that were resistant to echinocandins in 2021 was about 3 times that in each of the previous 2 years. LIMITATION Identification of screening cases depends on screening that is done on the basis of need and available resources. Screening is not conducted uniformly across the United States, so the true burden of C auris cases may be underestimated. CONCLUSION C auris cases and transmission have risen in recent years, with a dramatic increase in 2021. The rise in echinocandin-resistant cases and evidence of transmission is particularly concerning because echinocandins are first-line therapy for invasive Candida infections, including C auris. These findings highlight the need for improved detection and infection control practices to prevent spread of C auris. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Meghan Lyman
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
| | - Kaitlin Forsberg
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
| | - D Joseph Sexton
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
| | - Nancy A Chow
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
| | - Shawn R Lockhart
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
| | - Brendan R Jackson
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
| | - Tom Chiller
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
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Tesini BL, Dumyati G. Health Care-Associated Infections in Older Adults: Epidemiology and Prevention. Infect Dis Clin North Am 2023; 37:65-86. [PMID: 36805015 DOI: 10.1016/j.idc.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Health care-associated infections (HAIs) are a global public health threat, which disproportionately impact older adults. Host factors including aging-related changes, comorbidities, and geriatric syndromes, such as dementia and frailty, predispose older individuals to infection. The HAI risks from medical interventions such as device use, antibiotic use, and lapses in infection control follow older adults as they transfer among a network of interrelated acute and long-term care facilities. Long-term care facilities are caring for patients with increasingly complex needs, and the home-like communal environment of long-term care facilities creates distinct infection prevention challenges.
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Affiliation(s)
- Brenda L Tesini
- Division of Infectious Diseases, Department of Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA.
| | - Ghinwa Dumyati
- Division of Infectious Diseases, Department of Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
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Tsang CC, Holroyd-Leduc JM, Ewa V, Conly JM, Leslie MM, Leal JR. Barriers and Facilitators to the Use of Personal Protective Equipment in Long-Term Care: A Scoping Review. J Am Med Dir Assoc 2023; 24:82-89.e2. [PMID: 36473522 DOI: 10.1016/j.jamda.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Christian C Tsang
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Jayna M Holroyd-Leduc
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Vivian Ewa
- Department of Family Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - John M Conly
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada; Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - Myles M Leslie
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jenine R Leal
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
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Elbehiry A, Marzouk E, Abalkhail A, El-Garawany Y, Anagreyyah S, Alnafea Y, Almuzaini AM, Alwarhi W, Rawway M, Draz A. The Development of Technology to Prevent, Diagnose, and Manage Antimicrobial Resistance in Healthcare-Associated Infections. Vaccines (Basel) 2022; 10:2100. [PMID: 36560510 PMCID: PMC9780923 DOI: 10.3390/vaccines10122100] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
There is a growing risk of antimicrobial resistance (AMR) having an adverse effect on the healthcare system, which results in higher healthcare costs, failed treatments and a higher death rate. A quick diagnostic test that can spot infections resistant to antibiotics is essential for antimicrobial stewardship so physicians and other healthcare professionals can begin treatment as soon as possible. Since the development of antibiotics in the last two decades, traditional, standard antimicrobial treatments have failed to treat healthcare-associated infections (HAIs). These results have led to the development of a variety of cutting-edge alternative methods to combat multidrug-resistant pathogens in healthcare settings. Here, we provide an overview of AMR as well as the technologies being developed to prevent, diagnose, and control healthcare-associated infections (HAIs). As a result of better cleaning and hygiene practices, resistance to bacteria can be reduced, and new, quick, and accurate instruments for diagnosing HAIs must be developed. In addition, we need to explore new therapeutic approaches to combat diseases caused by resistant bacteria. In conclusion, current infection control technologies will be crucial to managing multidrug-resistant infections effectively. As a result of vaccination, antibiotic usage will decrease and new resistance mechanisms will not develop.
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Affiliation(s)
- Ayman Elbehiry
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukayriyah 52741, Saudi Arabia
- Department of Bacteriology, Mycology and Immunology, Faculty of Veterinary Medicine, University of Sadat City, Sadat City 32511, Egypt
| | - Eman Marzouk
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukayriyah 52741, Saudi Arabia
| | - Adil Abalkhail
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukayriyah 52741, Saudi Arabia
| | - Yasmine El-Garawany
- Clinical Pharmacy Program, Faculty of Pharmacy, Alexandria University, Alexandria 21521, Egypt
| | - Sulaiman Anagreyyah
- Department of Preventive Medicine, King Fahad Armed Hospital, Jeddah 23311, Saudi Arabia
| | - Yaser Alnafea
- Department of Statistics, King Fahad Armed Hospital, Jeddah 23311, Saudi Arabia
| | - Abdulaziz M. Almuzaini
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, Qassim University, Buraydah 52571, Saudi Arabia
| | - Waleed Alwarhi
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohammed Rawway
- Biology Department, College of Science, Jouf University, Sakaka 42421, Saudi Arabia
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Assiut 71524, Egypt
| | - Abdelmaged Draz
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, Qassim University, Buraydah 52571, Saudi Arabia
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Tchouaket EN, Kruglova K, Beogo I, Sia D, Robins S, Bélanger E, Jubinville M, Séguin C, Kilpatrick K, Boivin S, Létourneau J. Economic evaluation of healthcare-associated infection prevention and control in long-term care: a systematic review protocol. Syst Rev 2022; 11:261. [PMID: 36463274 PMCID: PMC9719189 DOI: 10.1186/s13643-022-02128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/08/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Given the high risk of contracting a healthcare-associated infection in long-term care facilities, infection prevention and control are essential for the quality of care and safety of residents and staff. To develop more effective infection prevention and control interventions in long-term care facilities, it is important to assess the cost-effectiveness and cost-benefit of existing interventions. There are only a few reviews on this subject, but these are not recent and most do not perform an economic evaluation. Moreover, none uses a discounting approach which limits inter-study comparison. To address these gaps, we will conduct a systematic review of economic evaluations related to healthcare-associated infection prevention and control in long-term care facilities using a discounting approach. METHODS We will query MEDLINE, Embase, Web of Science, Cochrane, CINAHL, EconLit, JSTOR, and Scopus, as well as the gray literature databases CORDIS and ProQuest. We will include quantitative studies that evaluate four clinical best practices associated with infection prevention and control (hand hygiene, hygiene and sanitation, screening, basic, and additional precautions) and use at least one of five economic analyses (cost-effectiveness, cost-benefit, cost-minimization, cost-utility, cost-consequences). Primary outcomes will include net cost savings, incremental cost-effectiveness ratio, incremental cost per quality-adjusted life year, and incremental cost per disability-adjusted life year. Two co-authors will independently screen and select articles, extract data, and assess the quality of selected articles using the Scottish Intercollegiate Guidelines Network criteria, the Economic Evaluation criteria, and the Cochrane criteria for economic evaluation. Extracted data will be synthesized, and values will be adjusted to 2022 Canadian dollars using the discount rates of 3%, 5%, and 8%. DISCUSSION Information obtained through this systematic review may help researchers and policy makers make more efficient use of limited healthcare resources to ensure the safety and quality of long-term care. SYSTEMATIC REVIEW REGISTRATION Research registry ID: reviewregistry1210.
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Affiliation(s)
- Eric Nguemeleu Tchouaket
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada.
| | - Katya Kruglova
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Idrissa Beogo
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Drissa Sia
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Stephanie Robins
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Emilie Bélanger
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Maripier Jubinville
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Catherine Séguin
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Kelley Kilpatrick
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
| | - Sandra Boivin
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Josiane Létourneau
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
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13
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Crnich CJ. Reimagining Infection Control in U.S. Nursing Homes in the Era of COVID-19. J Am Med Dir Assoc 2022; 23:1909-1915. [PMID: 36423677 PMCID: PMC9666375 DOI: 10.1016/j.jamda.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022]
Abstract
Residents of nursing homes (NHs) are susceptible to infection, and these facilities, particularly those that provide post-acute care services, are high-risk settings for the rapid spread of communicable respiratory and gastrointestinal illnesses, as well as antibiotic-resistant bacteria. The complexity of medical care delivered in most NHs has increased dramatically over the past 2 decades; however, the structure and resources supporting the practice of infection prevention and control in these facilities has failed to keep pace. Rising numbers of infections caused by Clostridioides difficile and multidrug-resistant organisms, as well as the catastrophic effects of COVID-19 have pushed NH infection control resources to a breaking point. Recent changes to federal regulations require NHs to devote greater resources to the facility infection control program. However, additional changes are needed if sustained improvements in the prevention and control of infections and antibiotic resistance in NHs are to be achieved.
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Affiliation(s)
- Christopher J Crnich
- School of Medicine & Public Health, University of Wisconsin-Madison, Madison, WI, USA; William S. Middleton Veterans Hospital Geriatric Research Education and Clinical Center, Madison, WI, USA.
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14
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O’Neill ET, Bosco E, Persico E, Silva JB, Riester MR, Moyo P, van Aalst R, Loiacono MM, Chit A, Gravenstein S, Zullo AR. Correlation of long-term care facility vaccination practices between seasons and resident types. BMC Geriatr 2022; 22:835. [PMID: 36333667 PMCID: PMC9635204 DOI: 10.1186/s12877-022-03540-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Background Influenza vaccination varies widely across long-term care facilities (LTCFs) due to staff behaviors, LTCF practices, and patient factors. It is unclear how seasonal LTCF vaccination varies between cohabitating but distinct short-stay and long-stay residents. Thus, we assessed the correlation of LTCF vaccination between these populations and across seasons. Methods The study design is a national retrospective cohort using Medicare and Minimum Data Set (MDS) data. Participants include U.S. LTCFs. Short-stay and long-stay Medicare-enrolled residents age ≥ 65 in U.S. LTCFs from a source population of residents during October 1st-March 31st in 2013–2014 (3,042,881 residents; 15,683 LTCFs) and 2014–2015 (3,143,174, residents; 15,667 LTCFs). MDS-assessed influenza vaccination was the outcome. Pearson correlation coefficients were estimated to assess seasonal correlations between short-stay and long-stay resident vaccination within LTCFs. Results The median proportion of short-stay residents vaccinated across LTCFs was 70.4% (IQR, 50.0–82.7%) in 2013–2014 and 69.6% (IQR, 50.0–81.6%) in 2014–2015. The median proportion of long-stay residents vaccinated across LTCFs was 85.5% (IQR, 78.0–90.9%) in 2013–2014 and 84.6% (IQR, 76.6–90.3%) in 2014–2015. Within LTCFs, there was a moderate correlation between short-stay and long-stay vaccination in 2013–2014 (r = 0.50, 95%CI: 0.49–0.51) and 2014–2015 (r = 0.53, 95%CI: 0.51–0.54). Across seasons, there was a moderate correlation for LTCFs with short-stay residents (r = 0.54, 95%CI: 0.53–0.55) and a strong correlation for those with long-stay residents (r = 0.68, 95%CI: 0.67–0.69). Conclusions In LTCFs with inconsistent influenza vaccination across seasons or between populations, targeted vaccination protocols for all residents, regardless of stay type, may improve successful vaccination in this vulnerable patient population. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03540-3.
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Affiliation(s)
- Emily T. O’Neill
- grid.40263.330000 0004 1936 9094Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI 02912 USA ,grid.40263.330000 0004 1936 9094Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI USA
| | - Elliott Bosco
- grid.40263.330000 0004 1936 9094Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI 02912 USA ,grid.40263.330000 0004 1936 9094Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI USA
| | - Erin Persico
- grid.20431.340000 0004 0416 2242University of Rhode Island College of Pharmacy, Kingston, RI USA
| | - Joe B. Silva
- grid.40263.330000 0004 1936 9094Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI 02912 USA ,grid.40263.330000 0004 1936 9094Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI USA
| | - Melissa R. Riester
- grid.40263.330000 0004 1936 9094Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI 02912 USA ,grid.40263.330000 0004 1936 9094Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI USA
| | - Patience Moyo
- grid.40263.330000 0004 1936 9094Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI 02912 USA ,grid.40263.330000 0004 1936 9094Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI USA
| | - Robertus van Aalst
- grid.417555.70000 0000 8814 392XSanofi, Swiftwater, PA USA ,grid.4494.d0000 0000 9558 4598Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Ayman Chit
- grid.417555.70000 0000 8814 392XSanofi, Swiftwater, PA USA ,grid.17063.330000 0001 2157 2938Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Canada
| | - Stefan Gravenstein
- grid.40263.330000 0004 1936 9094Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI 02912 USA ,grid.40263.330000 0004 1936 9094Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI USA ,grid.413904.b0000 0004 0420 4094Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI USA ,grid.40263.330000 0004 1936 9094Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI USA
| | - Andrew R. Zullo
- grid.40263.330000 0004 1936 9094Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI 02912 USA ,grid.40263.330000 0004 1936 9094Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI USA ,grid.413904.b0000 0004 0420 4094Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI USA ,grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
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Pandemic response gaps: Infection prevention and control lessons learned during coronavirus disease 2019 (COVID-19) outbreaks in skilled nursing facilities in Detroit, Michigan. Infect Control Hosp Epidemiol 2022:1-5. [DOI: 10.1017/ice.2022.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background:
Hospitalizations among skilled nursing facility (SNF) residents in Detroit increased in mid-March 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. Outbreak response teams were deployed from local healthcare systems, the Centers for Disease Control and Prevention (CDC), and the Detroit Health Department (DHD) to understand the infection prevention and control (IPC) gaps in SNFs that may have accelerated the outbreak.
Methods:
We conducted 2 point-prevalence surveys (PPS-1 and PPS-2) at 13 Detroit SNFs from April 8 to May 8, 2020. The DHD and partners conducted facility-wide severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing of all residents and staff and collected information regarding resident cohorting, staff cohorting, and personnel protective equipment (PPE) utilized during that time.
Results:
Resident cohorting had been implemented in 7 of 13 (58.3%) SNFs prior to point-prevalence survey 1 (PPS-1), and other facilities initiated cohorting after obtaining PPS-1 results. Cohorting protocols of healthcare practitioners and environmental service staff were not established in 4 (31%) of 13 facilities, and in 3 facilities (23.1%) the ancillary staff were not assigned to cohorts. Also, 2 SNFs (15%) had an observation unit prior to PPS-1, 2 (15%) had an observation unit after PPS-1, 4 (31%) could not establish an observation unit due to inadequate space, and 5 (38.4%) created an observation unit after PPS-2.
Conclusion:
On-site consultations identified gaps in IPC knowledge and cohorting that may have contributed to ongoing transmission of SARS-CoV-2 among SNF residents despite aggressive testing measures. Infection preventionists (IPs) are critical in guiding ongoing IPC practices in SNFs to reduce spread of COVID-19 through response and prevention.
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Sarwar S, Muhammad J, Shahzad F. A modified hand washing method for resource limited settings. Front Public Health 2022; 10:965853. [PMID: 35991070 PMCID: PMC9386356 DOI: 10.3389/fpubh.2022.965853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
The Good Microbiological Practices & Procedures (GMPP) is the most significant risk control measure as per the fourth edition of the WHO laboratory biosafety manual. Among GMPP, one of the best practices is hand washing. WHO and other public health agencies have published several guidance documents on hand washing, that describe closing the tap using a disposable paper towel/tissue paper at the end of hand washing as one of the critical steps. In resource-limited settings, where disposable paper towels cannot be provided at all times, the staff is left with ambiguous instructions on how to close the tap. In this paper, a modified hand washing method is documented that doesn't necessitate the use of disposable paper towels. In this method, both hands and faucets remain in contact with soap for at least 40–60 s. The method was validated by the use of Glo Germ. A survey questionnaire was also designed and conducted for the lab staff (n = 12) of the two laboratories, where this method was implemented, to assess whether this hand washing method brought any improvement in their hand washing practices and implementation. All (100%) of the survey respondents reported that this method of hand washing is more applicable and implementable than the WHO-recommended hand washing technique. Eighty three percentage reported that this modified method of hand washing raised their hand washing compliance. The authors suggest that this hand washing method can be used in resource-limited laboratory settings as an effective GMPP to ensure infection control.
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Affiliation(s)
- Samreen Sarwar
- Health Security Partners, Lahore, Pakistan
- *Correspondence: Samreen Sarwar
| | - Javed Muhammad
- Department of Microbiology, University of Haripur, Haripur, Pakistan
| | - Faheem Shahzad
- Department of Immunology, University of Health Sciences, Lahore, Pakistan
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17
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Decreased Antibiotic Consumption Coincided with Reduction in Bacteremia Caused by Bacterial Species with Respiratory Transmission Potential during the COVID-19 Pandemic. Antibiotics (Basel) 2022; 11:antibiotics11060746. [PMID: 35740153 PMCID: PMC9219721 DOI: 10.3390/antibiotics11060746] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 01/27/2023] Open
Abstract
Nonpharmaceutical interventions implemented during the COVID-19 pandemic (2020−2021) have provided a unique opportunity to understand their impact on the wholesale supply of antibiotics and incidences of infections represented by bacteremia due to common bacterial species in Hong Kong. The wholesale antibiotic supply data (surrogate indicator of antibiotic consumption) and notifications of scarlet fever, chickenpox, and tuberculosis collected by the Centre for Health Protection, and the data of blood cultures of patients admitted to public hospitals in Hong Kong collected by the Hospital Authority for the last 10 years, were tabulated and analyzed. A reduction in the wholesale supply of antibiotics was observed. This decrease coincided with a significant reduction in the incidence of community-onset bacteremia due to Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, which are encapsulated bacteria with respiratory transmission potential. This reduction was sustained during two pandemic years (period 2: 2020−2021), compared with eight pre-pandemic years (period 1: 2012−2019). Although the mean number of patient admissions per year (1,704,079 vs. 1,702,484, p = 0.985) and blood culture requests per 1000 patient admissions (149.0 vs. 158.3, p = 0.132) were not significantly different between periods 1 and 2, a significant reduction in community-onset bacteremia due to encapsulated bacteria was observed in terms of the mean number of episodes per year (257 vs. 58, p < 0.001), episodes per 100,000 admissions (15.1 vs. 3.4, p < 0.001), and per 10,000 blood culture requests (10.1 vs. 2.1, p < 0.001), out of 17,037,598 episodes of patient admissions with 2,570,164 blood culture requests. Consistent with the findings of bacteremia, a reduction in case notification of scarlet fever and airborne infections, including tuberculosis and chickenpox, was also observed; however, there was no reduction in the incidence of hospital-onset bacteremia due to Staphylococcus aureus or Escherichia coli. Sustained implementation of non-pharmaceutical interventions against respiratory microbes may reduce the overall consumption of antibiotics, which may have a consequential impact on antimicrobial resistance. Rebound of conventional respiratory microbial infections is likely with the relaxation of these interventions.
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18
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Cohen-Mansfield J. The impact of COVID-19 on long-term care facilities and their staff in Israel: Results from a mixed methods study. J Nurs Manag 2022; 30:2470-2478. [PMID: 35538706 PMCID: PMC9348504 DOI: 10.1111/jonm.13667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 11/30/2022]
Abstract
AIMS We examined the impact of COVID-19 regarding organizational and management issues at Israeli long-term care facilities. BACKGROUND Residents in facilities were very vulnerable to significant disease and mortality during COVID-19. METHODS A survey of 52 facilities in Israel was conducted in 2020, consisting of closed- and open-ended questions. Mixed methods were used to analyze data both quantitively and qualitatively. RESULTS Three main effects emerged: worsened financial status of long-term-care facilities resulting from high expenditures for preventive measures and reduced revenue due to deaths and fewer resident admissions; increased workload due to decreased workforce and additional duties; and negative mental health effects on staff because of increased workload and the conflict between maintaining good clinical practice and following COVID-19 regulations. CONCLUSION The development of government directives needs to take into account potential conflicts between the directives and quality care principles and to provide a balanced approach that assures humane care. Facilities and their staff lacked adequate pandemic-related guidance and support. IMPLICATIONS FOR NURSING MANAGEMENT The results highlight the need to address staff shortages and training, to provide more support and clearer guidance to facilities and their staff, and to devise a framework and strategies for future health crises.
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Affiliation(s)
- Jiska Cohen-Mansfield
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Minerva Center for Interdisciplinary Study of End of Life, Tel Aviv University, Tel Aviv, Israel.,Igor Orenstein Chair for the Study of Geriatrics, Tel Aviv University, Tel Aviv, Israel
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19
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Kunasekaran M, Quigley A, Rahman B, Chughtai AA, Heslop DJ, Poulos CJ, MacIntyre CR. Factors associated with SARS-COV-2 attack rates in aged care– a meta-analysis. Open Forum Infect Dis 2022; 9:ofac033. [PMID: 35194554 PMCID: PMC8807324 DOI: 10.1093/ofid/ofac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant morbidity and mortality in aged-care facilities worldwide. The attention of infection control in aged care needs to shift towards the built environment, especially in relation to using the existing space to allow social distancing and isolation. Physical infrastructure of aged care facilities has been shown to present challenges to the implementation of isolation procedures. To explore the relationship of the physical layout of aged care facilities with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) attack rates among residents, a meta-analysis was conducted. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P), studies were identified from 5 databases using a registered search strategy with PROSPERO. Meta-analysis for pooled attack rates of SARS-CoV-2 in residents and staff was conducted, with subgroup analysis for physical layout variables such as total number of beds, single rooms, number of floors, number of buildings in the facility, and staff per 100 beds. Results We included 41 articles across 11 countries, reporting on 90 657 residents and 6521 staff in 757 facilities. The overall pooled attack rate was 42.0% among residents (95% CI, 38.0%–47.0%) and 21.7% in staff (95% CI, 15.0%–28.4%). Attack rates in residents were significantly higher in single-site facilities with standalone buildings than facilities with smaller, detached buildings. Staff-to-bed ratio significantly explains some of the heterogeneity of the attack rate between studies. Conclusions The design of aged care facilities should be smaller in size, with adequate space for social distancing.
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Affiliation(s)
- Mohana Kunasekaran
- Biosecurity Program, Kirby Institute, The University of New South Wales Sydney, New South Wales, Australia
| | - Ashley Quigley
- Biosecurity Program, Kirby Institute, The University of New South Wales Sydney, New South Wales, Australia
| | - Bayzidur Rahman
- Biosecurity Program, Kirby Institute, The University of New South Wales Sydney, New South Wales, Australia
- School of Medicine, The University of Notre Dame, Australia
| | - Abrar A Chughtai
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - David J Heslop
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - Christopher J Poulos
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
- HammondCare, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- Biosecurity Program, Kirby Institute, The University of New South Wales Sydney, New South Wales, Australia
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20
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van den Besselaar JH, Spaargaren M, Smalbrugge M, Koene FMHPA, Termeulen L, Hertogh CMPM, Buurman BM. Implementation of a national testing policy in Dutch nursing homes during SARS-CoV-2 outbreaks. J Am Geriatr Soc 2022; 70:940-949. [PMID: 35080774 PMCID: PMC9305839 DOI: 10.1111/jgs.17687] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/10/2022] [Accepted: 01/16/2022] [Indexed: 11/30/2022]
Abstract
Background To evaluate how a national policy of testing for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) regardless of symptoms was implemented during outbreaks in Dutch nursing homes in the second wave of the pandemic and to explore barriers and facilitators to serial testing. Methods We conducted a mixed‐method study of nursing homes in the Netherlands with a SARS‐CoV‐2 outbreak after 15 September 2020. Direct care staff and management from 355 healthcare organizations were invited to participate in a digital survey. A total of 74 out of 355 (20.9%) healthcare organizations participated and provided information about 117 nursing homes. We conducted 26 in‐depth interviews on the outbreak and the testing strategy used. We also conducted four focus group meetings involving managers, physicians, nurses, and certified health assistants. Recordings were transcribed and data were thematically analyzed. Results One hundred and four nursing homes (89%) tested residents regardless of their symptoms during the outbreak, and 85 nursing homes (73%) tested the staff regardless of their symptoms. However, interviews showed testing was sometimes implemented during later stages of the outbreak and was not always followed up with serial testing. Barriers to serial testing regardless of symptoms were lack of knowledge of local leaders with decisional making authority, lack of a cohort ward or skilled staff, and insufficient collaboration with laboratories or local public health services. Important facilitators to serial testing were staff willingness to undergo testing and the availability of polymerase chain reaction (PCR) tests. Conclusions Serial testing regardless of symptoms was only partially implemented. The response rate of 21% of nursing home organizations gives a risk of selection bias. Barriers to testing need to be addressed. A national implementation policy that promotes collaboration between public health services and nursing homes and educates management and care staff is necessary.
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Affiliation(s)
- Judith H van den Besselaar
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, Amsterdam, the Netherlands
| | - Marije Spaargaren
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, Amsterdam, the Netherlands
| | - Fleur M H P A Koene
- Department of Medical Microbiology, Amsterdam UMC, Meibergdreef 9, Amsterdam, the Netherlands.,Department of Infectious Diseases, Public Health Laboratory, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Loes Termeulen
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, Amsterdam, the Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, Amsterdam, the Netherlands.,Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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21
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Iaboni A, Quirt H, Engell K, Kirkham J, Stewart S, Grigorovich A, Kontos P, McMurray J, Levy A, Bingham K, Rodrigues K, Astell A, Flint AJ, Maxwell C. Barriers and facilitators to person-centred infection prevention and control: results of a survey about the Dementia Isolation Toolkit. BMC Geriatr 2022; 22:74. [PMID: 35078424 PMCID: PMC8786624 DOI: 10.1186/s12877-022-02759-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/05/2022] [Indexed: 12/19/2022] Open
Abstract
Abstract
Background
People working in long-term care homes (LTCH) face difficult decisions balancing the risk of infection spread with the hardship imposed on residents by infection control and prevention (ICP) measures. The Dementia Isolation Toolkit (DIT) was developed to address the gap in ethical guidance on how to safely and effectively isolate people living with dementia while supporting their personhood. In this observational study, we report the results of a survey of LTCH staff on barriers and facilitators regarding isolating residents, and the impact of the DIT on staff moral distress.
Methods
We completed an online cross-sectional survey. Participants (n = 207) were staff working on-site in LTCH in Ontario, Canada since March 1, 2020, with direct or indirect experience with the isolation of residents. LTCH staff were recruited through provincial LTCH organizations, social media, and the DIT website. Survey results were summarized, and three groups compared, those: (1) unfamiliar with, (2) familiar with, and (3) users of the DIT.
Results
61% of respondents identified distress of LTCH staff about the harmful effects of isolation on residents as a major barrier to effective isolation. Facilitators for isolation included delivery of 1:1 activity in the resident’s room (81%) and designating essential caregivers to provide support (67%). Almost all respondents (84%) reported an increase in moral distress. DIT users were less likely to report an impact of moral distress on job satisfaction (odds ratio (OR) 0.41, 95% CI 0.19-0.87) with 48% of users reporting the DIT was helpful in reducing their level of moral distress.
Conclusions
Isolation as an ICP measure in LTCH environments creates moral distress among staff which is a barrier to its effectiveness. ICP guidance to LTCH would be strengthened by the inclusion of a dementia-specific ethical framework that addresses how to minimize the harms of isolation on both residents and staff.
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22
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Yoshimura A, Sasahara T, Ae R, Kosami K, Akine D, Ogawa M, Hamabata K, Hatakeyama S, Morisawa Y, Cui L. Influenza Outbreak and a Group Meal in a Geriatric Long-term Care Facility in Japan. Biocontrol Sci 2022; 26:207-210. [PMID: 35013017 DOI: 10.4265/bio.26.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Influenza outbreaks at geriatric long-term care facilities (g-LTCFs) can be deadly and their prevention is important. However, the factors influencing disease transmission in g-LTCFs remain controversial. In this descriptive study, we tried to identify the potential risk factors influencing influenza outbreaks that occurred in different influenza seasons within a single g-LTCF with 100 residents in Gunma Prefecture. We reviewed the detailed facility records for all influenza cases in both residents and staff between January 2012 and June 2020. Facility preventive measures were also reviewed. We found that community meals may have been a potential source of transmission leading to the outbreaks. When influenza infection is noted, implementation of strict preventive measures and restriction of meal provision to resident rooms may help to prevent disease transmission and the development of an outbreak. Such measures may also be useful to prevent the transmission of other serious droplet-borne diseases within g-LTCFs.
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Affiliation(s)
| | - Teppei Sasahara
- Division of Clinical Infectious Diseases, School of Medicine, Jichi Medical University.,Division of Public Health, Center for Community Medicine, Jichi Medical University.,Division of Bacteriology, School of Medicine, Jichi Medical University
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University
| | - Koki Kosami
- Division of Public Health, Center for Community Medicine, Jichi Medical University
| | - Dai Akine
- Health Service Center, Jichi Medical University.,Division of Infectious Diseases, Jichi Medical University Hospital
| | | | - Kenji Hamabata
- Gerontological Nursing, School of Nursing, Jichi Medical University
| | - Shuji Hatakeyama
- Division of Infectious Diseases, Jichi Medical University Hospital
| | - Yuji Morisawa
- Division of Clinical Infectious Diseases, School of Medicine, Jichi Medical University.,Division of Infectious Diseases, Jichi Medical University Hospital
| | - Longzhu Cui
- Division of Bacteriology, School of Medicine, Jichi Medical University
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23
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Karmarkar EN, O'Donnell K, Prestel C, Forsberg K, Gade L, Jain S, Schan D, Chow N, McDermott D, Rossow J, Toda M, Ruiz R, Hun S, Dale JL, Gross A, Maruca T, Glowicz J, Brooks R, Bagheri H, Nelson T, Gualandi N, Khwaja Z, Horwich-Scholefield S, Jacobs J, Cheung M, Walters M, Jacobs-Slifka K, Stone ND, Mikhail L, Chaturvedi S, Klein L, Vagnone PS, Schneider E, Berkow EL, Jackson BR, Vallabhaneni S, Zahn M, Epson E. Rapid Assessment and Containment of Candida auris Transmission in Postacute Care Settings-Orange County, California, 2019. Ann Intern Med 2021; 174:1554-1562. [PMID: 34487450 PMCID: PMC10984253 DOI: 10.7326/m21-2013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Candida auris, a multidrug-resistant yeast, can spread rapidly in ventilator-capable skilled-nursing facilities (vSNFs) and long-term acute care hospitals (LTACHs). In 2018, a laboratory serving LTACHs in southern California began identifying species of Candida that were detected in urine specimens to enhance surveillance of C auris, and C auris was identified in February 2019 in a patient in an Orange County (OC), California, LTACH. Further investigation identified C auris at 3 associated facilities. OBJECTIVE To assess the prevalence of C auris and infection prevention and control (IPC) practices in LTACHs and vSNFs in OC. DESIGN Point prevalence surveys (PPSs), postdischarge testing for C auris detection, and assessments of IPC were done from March to October 2019. SETTING All LTACHs (n = 3) and vSNFs (n = 14) serving adult patients in OC. PARTICIPANTS Current or recent patients in LTACHs and vSNFs in OC. INTERVENTION In facilities where C auris was detected, PPSs were repeated every 2 weeks. Ongoing IPC support was provided. MEASUREMENTS Antifungal susceptibility testing and whole-genome sequencing to assess isolate relatedness. RESULTS Initial PPSs at 17 facilities identified 44 additional patients with C auris in 3 (100%) LTACHs and 6 (43%) vSNFs, with the first bloodstream infection reported in May 2019. By October 2019, a total of 182 patients with C auris were identified by serial PPSs and discharge testing. Of 81 isolates that were sequenced, all were clade III and highly related. Assessments of IPC identified gaps in hand hygiene, transmission-based precautions, and environmental cleaning. The outbreak was contained to 2 facilities by October 2019. LIMITATION Acute care hospitals were not assessed, and IPC improvements over time could not be rigorously evaluated. CONCLUSION Enhanced laboratory surveillance and prompt investigation with IPC support enabled swift identification and containment of C auris. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Ellora N Karmarkar
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia, and the California Department of Public Health, Richmond, California (E.N.K.)
| | - Kathleen O'Donnell
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Christopher Prestel
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.)
| | - Kaitlin Forsberg
- Centers for Disease Control and Prevention and IHRC, Atlanta, Georgia (K.F.)
| | - Lalitha Gade
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Seema Jain
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Douglas Schan
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Nancy Chow
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Darby McDermott
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - John Rossow
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.)
| | - Mitsuru Toda
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.)
| | - Ryan Ruiz
- Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.)
| | - Sopheay Hun
- Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.)
| | - Jennifer L Dale
- Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.)
| | - Annastasia Gross
- Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.)
| | - Tyler Maruca
- Maryland Department of Health Laboratories Administration, Baltimore, Maryland (T.M., L.K.)
| | - Janet Glowicz
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Richard Brooks
- Centers for Disease Control and Prevention, Atlanta, Georgia, and the Maryland Department of Health, Infectious Disease Epidemiology and Outbreak Response Bureau, Baltimore, Maryland (R.B.)
| | - Hosniyeh Bagheri
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Teresa Nelson
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Nicole Gualandi
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Zenith Khwaja
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Sam Horwich-Scholefield
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Josh Jacobs
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Michele Cheung
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Maroya Walters
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Kara Jacobs-Slifka
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Nimalie D Stone
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Lydia Mikhail
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | | | - Liore Klein
- Maryland Department of Health Laboratories Administration, Baltimore, Maryland (T.M., L.K.)
| | - Paula Snippes Vagnone
- Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.)
| | - Emily Schneider
- Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.)
| | - Elizabeth L Berkow
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Brendan R Jackson
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Snigdha Vallabhaneni
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Matthew Zahn
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Erin Epson
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
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24
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Sood G, Perl TM. Outbreaks in Health Care Settings. Infect Dis Clin North Am 2021; 35:631-666. [PMID: 34362537 DOI: 10.1016/j.idc.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Outbreaks and pseudo-outbreaks in health care settings are complex and should be evaluated systematically using epidemiologic and molecular tools. Outbreaks result from failures of infection prevention practices, inadequate staffing, and undertrained or overcommitted health care personnel. Contaminated hands, equipment, supplies, water, ventilation systems, and environment may also contribute. Neonatal intensive care, endoscopy, oncology, and transplant units are areas at particular risk. Procedures, such as bronchoscopy and endoscopy, are sources of infection when cleaning and disinfection processes are inadequate. New types of equipment can be introduced and lead to contamination or equipment and medications can be contaminated at the manufacturing source.
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Affiliation(s)
- Geeta Sood
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Mason F. Lord Building, Center Tower, 3rd Floor, 5200 Eastern Avenue, Baltimore, MD 21224, USA.
| | - Trish M Perl
- Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Y7;302, Dallas, TX 75390, USA
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25
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Healthcare personnel experiences implementing carbapenem-resistant Enterobacterales infection control measures at a ventilator-capable skilled nursing facility-A qualitative analysis. Infect Control Hosp Epidemiol 2021; 43:1010-1016. [PMID: 34154697 DOI: 10.1017/ice.2021.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Ventilator-capable skilled nursing facilities (vSNFs) are critical to the epidemiology and control of antibiotic-resistant organisms. During an infection prevention intervention to control carbapenem-resistant Enterobacterales (CRE), we conducted a qualitative study to characterize vSNF healthcare personnel beliefs and experiences regarding infection control measures. DESIGN A qualitative study involving semistructured interviews. SETTING One vSNF in the Chicago, Illinois, metropolitan region. PARTICIPANTS The study included 17 healthcare personnel representing management, nursing, and nursing assistants. METHODS We used face-to-face, semistructured interviews to measure healthcare personnel experiences with infection control measures at the midpoint of a 2-year quality improvement project. RESULTS Healthcare personnel characterized their facility as a home-like environment, yet they recognized that it is a setting where germs were 'invisible' and potentially 'threatening.' Healthcare personnel described elaborate self-protection measures to avoid acquisition or transfer of germs to their own household. Healthcare personnel were motivated to implement infection control measures to protect residents, but many identified structural barriers such as understaffing and time constraints, and some reported persistent preference for soap and water. CONCLUSIONS Healthcare personnel in vSNFs, from management to frontline staff, understood germ theory and the significance of multidrug-resistant organism transmission. However, their ability to implement infection control measures was hampered by resource limitations and mixed beliefs regarding the effectiveness of infection control measures. Self-protection from acquiring multidrug-resistant organisms was a strong motivator for healthcare personnel both outside and inside the workplace, and it could explain variation in adherence to infection control measures such as a higher hand hygiene adherence after resident care than before resident care.
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26
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Isoflavonoid-Antibiotic Thin Films Fabricated by MAPLE with Improved Resistance to Microbial Colonization. Molecules 2021; 26:molecules26123634. [PMID: 34198596 PMCID: PMC8231875 DOI: 10.3390/molecules26123634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
Staphylococcus aureus (Gram-positive) and Pseudomonas aeruginosa (Gram-negative) bacteria represent major infectious threats in the hospital environment due to their wide distribution, opportunistic behavior, and increasing antibiotic resistance. This study reports on the deposition of polyvinylpyrrolidone/antibiotic/isoflavonoid thin films by the matrix-assisted pulsed laser evaporation (MAPLE) method as anti-adhesion barrier coatings, on biomedical surfaces for improved resistance to microbial colonization. The thin films were characterized by Fourier transform infrared spectroscopy, infrared microscopy, and scanning electron microscopy. In vitro biological assay tests were performed to evaluate the influence of the thin films on the development of biofilms formed by Gram-positive and Gram-negative bacterial strains. In vitro biocompatibility tests were assessed on human endothelial cells examined for up to five days of incubation, via qualitative and quantitative methods. The results of this study revealed that the laser-fabricated coatings are biocompatible and resistant to microbial colonization and biofilm formation, making them successful candidates for biomedical devices and contact surfaces that would otherwise be amenable to contact transmission.
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27
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Rao S, Rohilla KK, Kathrotia R, Naithani M, Varghese A, Bahadur A, Dhar P, Aggarwal P, Gupta M, Kant R. Rapid Workforce Development to Combat the COVID-19 Pandemic: Experience From a Tertiary Health Care Centre in North India. Cureus 2021; 13:e15585. [PMID: 34277206 PMCID: PMC8272882 DOI: 10.7759/cureus.15585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction During a large-scale disease outbreak, one needs to respond to the situation quickly towards capacity building, by identifying areas that require training and planning a workable strategy and implementing it. There are limited studies focused on fast-track workforce creation under challenging circumstances that demand mandatory social distancing and discouragement of gatherings. This study was conducted to analyze the planning process and implementation of fast-track training during the Coronavirus disease (COVID-19) pandemic, and evaluate its effectiveness in building a rapid, skilled, and massive workforce. Methods A cross-sectional study was conducted to evaluate rapid preparedness training delivered from March to June 2020, based on documents and data regarding the process, planning, and implementation for large-scale capacity building. Pre-test and post-test scores were compared to assess the effectiveness of training. The number of personnel trained was evaluated to determine the efficiency of the training program. Data on COVID-19 among health care workers (HCWs) were analyzed. Results The Advanced Center of Continuous Professional Development acted as the central facility, quickly responding to the situation. A total of 327 training sessions were conducted, including 76 online sessions with 153 instructors. The capacity-building of 2,706 individuals (913 clinicians and 1,793 nurses, paramedics, and non-medical staff) was achieved through multiple parallel sessions on general precautionary measures and specialized skills within four months. The rate of hospital staff infected with COVID-19 was found to be 0.01% over five months. Conclusions A fast-track, efficient, large-scale workforce can be created through a central facility even under challenging circumstances which restrict gatherings and require physical distancing. A training action plan for disease outbreaks would be a useful resource to tackle such medical emergencies affecting substantial populations in future.
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Affiliation(s)
- Shalinee Rao
- Pathology, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
- Advanced Center of Continuous Professional Development, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Kusum K Rohilla
- College of Nursing, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Rajesh Kathrotia
- Physiology, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
- Advanced Center of Continuous Professional Development, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Manisha Naithani
- Biochemistry, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
- Advanced Center of Continuous Professional Development, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Arun Varghese
- College of Nursing, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Anupama Bahadur
- Obstetrics and Gynecology, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Puneet Dhar
- Surgical Gastroenterology, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Pradeep Aggarwal
- Community & Family Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Manoj Gupta
- Radiation Oncology, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Ravi Kant
- Director, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
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28
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Thomas RE. Reducing Morbidity and Mortality Rates from COVID-19, Influenza and Pneumococcal Illness in Nursing Homes and Long-Term Care Facilities by Vaccination and Comprehensive Infection Control Interventions. Geriatrics (Basel) 2021; 6:48. [PMID: 34066781 PMCID: PMC8162358 DOI: 10.3390/geriatrics6020048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic identifies the problems of preventing respiratory illnesses in seniors, especially frail multimorbidity seniors in nursing homes and Long-Term Care Facilities (LCTFs). Medline and Embase were searched for nursing homes, long-term care facilities, respiratory tract infections, disease transmission, infection control, mortality, systematic reviews and meta-analyses. For seniors, there is strong evidence to vaccinate against influenza, SARS-CoV-2 and pneumococcal disease, and evidence is awaited for effectiveness against COVID-19 variants and when to revaccinate. There is strong evidence to promptly introduce comprehensive infection control interventions in LCFTs: no admissions from inpatient wards with COVID-19 patients; quarantine and monitor new admissions in single-patient rooms; screen residents, staff and visitors daily for temperature and symptoms; and staff work in only one home. Depending on the vaccination situation and the current risk situation, visiting restrictions and meals in the residents' own rooms may be necessary, and reduce crowding with individual patient rooms. Regional LTCF administrators should closely monitor and provide staff and PPE resources. The CDC COVID-19 tool measures 33 infection control indicators. Hand washing, social distancing, PPE (gowns, gloves, masks, eye protection), enhanced cleaning of rooms and high-touch surfaces need comprehensive implementation while awaiting more studies at low risk of bias. Individual ventilation with HEPA filters for all patient and common rooms and hallways is needed.
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Affiliation(s)
- Roger E Thomas
- Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, AB T2M 1M1, Canada
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29
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Gholamzadeh M, Abtahi H, Safdari R. Suggesting a framework for preparedness against the pandemic outbreak based on medical informatics solutions: a thematic analysis. Int J Health Plann Manage 2021; 36:754-783. [PMID: 33502766 PMCID: PMC8014158 DOI: 10.1002/hpm.3106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/05/2020] [Accepted: 12/14/2020] [Indexed: 11/15/2022] Open
Abstract
Background When an outbreak emerged, each country needs a coherent and preventive plan to deal with epidemics. In the era of technology, adopting informatics‐based solutions is essential. The main objective of this study is to propose a conceptual framework to provide a rapid and responsive surveillance system against pandemics. Methods A three‐step approach was employed in this research to develop a conceptual framework. These three steps comprise (1) literature review, (2) extracting and coding concepts, and determining main themes based on thematic analysis using ATLAS.ti® software, and (3) mapping concepts. Later, all of the results synthesized under expert consultation to design a conceptual framework based on the main themes and identified strategies related to medical informatics. Results In the literature review phase, 65 articles were identified as eligible studies for analysis. Through line by line coding in thematic analysis, more than 46 themes were extracted as potential foremost themes. Based on the key themes and strategies were employed by studies, the proposed framework designed in three main components. The most appropriate strategies that can be used in each section were identified based on the demands of each part and the available solutions. These solutions were employed in the final framework. Conclusion The presented model in this study can be the first step for a better understanding of the potential of medical informatics solutions in promoting epidemic disease management. It can be applied as a reference model for designing intelligent surveillance systems to prepare for probable future pandemics.
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Affiliation(s)
- Marsa Gholamzadeh
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Abtahi
- Pulmonary and Critical care Medicine Department, Thoracic Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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30
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COVID-19 outbreaks in care homes during the first wave: are Care Quality Commission ratings a good predictor of at-risk homes? J Hosp Infect 2021; 111:96-101. [PMID: 33453350 PMCID: PMC7831635 DOI: 10.1016/j.jhin.2020.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022]
Abstract
Background COVID-19 placed a significant burden on the care home population during the first wave. Care Quality Commission’s care quality ratings are given to all English care homes and could be used to identify whether care homes are at risk of COVID-19 outbreaks. Methods An audit was performed, April 2020, of Liverpool care homes to identify associations between COVID-19 status and care quality ratings from the Care Quality Commission. Univariable logistic regression was performed to identify whether the Care Quality Commissions ratings were associated with a care home experiencing a COVID-19 outbreak, or a home having asymptomatic cases. Findings Over half of the care homes (53.2%, n=41), had laboratory-confirmed clinical cases and 39 (95.1%) of these were reported as outbreaks. A small number of care homes (10.4%, n=8) had asymptomatic cases and over a third had no clinical or asymptomatic cases (36.4%, n=28). There was no significant difference between the overall Care Quality Commission rating of Liverpool and English care homes (p=0.57). There was no significant association between any of the Care Quality Commission rating domains and the presence of COVID-19 outbreaks and/or asymptomatic cases. Conclusions During the first wave of the COVID-19 pandemic, Care Quality Commission ratings were not associated with COVID-19 outbreaks or asymptomatic cases in care homes. Infection prevention and control components of Care Quality Commission ratings need to be strengthened to identify care homes at a potential risk of infectious disease outbreaks that may require targeted support. Further large-scale studies will be required to test the findings from this study.
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31
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Gravenstein S, McConeghy KW, Saade E, Davidson HE, Canaday DH, Han L, Rudolph J, Joyce N, Dahabreh IJ, Mor V. Adjuvanted influenza vaccine and influenza outbreaks in U.S. nursing homes: Results from a pragmatic cluster-randomized clinical trial. Clin Infect Dis 2021; 73:e4229-e4236. [PMID: 33400778 DOI: 10.1093/cid/ciaa1916] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/04/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Influenza outbreaks in nursing homes pose a threat to frail residents and occur even in vaccinated populations. We conducted a pragmatic cluster-randomized trial comparing adjuvanted trivalent influenza vaccine (aTIV) versus trivalent influenza vaccine (TIV). Here, we report an exploratory analysis to compare the effect of aTIV versus TIV on facility-reported influenza outbreaks. METHODS Nursing homes were randomized to offer older residents either aTIV or TIV for the 2016-17 influenza season. The impact of the intent-to-treat vaccine assignment was evaluated for the total number of outbreaks reported from November-March. We collected data according to standard CDC definitions for both suspected outbreaks and those with a laboratory-confirmed case in nursing homes, and adjusted for facility-level vaccination rates and resident characteristics. RESULTS Of 823 randomized nursing homes, 777 (aTIV, n=387; TIV, n=390) reported information on influenza outbreaks. The treatment groups had similar characteristics at baseline except for race/ethnicity: homes assigned to TIV had a higher percentage of African-American residents (18.0% versus 13.7%). There were 133 versus 162 facility-reported suspected influenza outbreaks in aTIV versus TIV facilities respectively, of these 115 versus 140 were laboratory confirmed. The aTIV group experienced a 17% reduction in suspected (rate ratio, RR, 0.83, 95% confidence interval, CI: 0.65, 1.05) and laboratory-confirmed influenza outbreaks (RR 0.83, 95%CI: 0.63, 1.06). Covariate adjustment increased the estimated reduction for suspected outbreaks to 21% (RR 0.79, 95%CI: 0.61, 0.99) and 22% for laboratory confirmed (RR 0.78, 95%CI: 0.60, 1.02). CONCLUSIONS In an exploratory analysis of a cluster-RCT we observed 17-21% fewer outbreaks with aTIV than TIV.ClinicalTrials.gov number, NCT02882100.
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Affiliation(s)
- Stefan Gravenstein
- Division of Geriatrics and Palliative Care, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States.,Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, Rhode Island, United States
| | - Kevin W McConeghy
- Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, Rhode Island, United States.,Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Elie Saade
- University Hospitals Cleveland Medical Center, Cleveland Ohio, United States.,Louis Stokes Veterans Administration Center, Cleveland Ohio, United States.,Department of Medicine, Case Western Reserve University, Cleveland Ohio, United States
| | | | - David H Canaday
- University Hospitals Cleveland Medical Center, Cleveland Ohio, United States.,Louis Stokes Veterans Administration Center, Cleveland Ohio, United States.,Department of Medicine, Case Western Reserve University, Cleveland Ohio, United States
| | - Lisa Han
- Insight Therapeutics, LLC, Norfolk, Virginia, United States
| | - James Rudolph
- Division of Geriatrics and Palliative Care, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States.,Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, Rhode Island, United States.,Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Nina Joyce
- Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island, United States.,Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States.,Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Issa J Dahabreh
- Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island, United States.,Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States.,Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Vince Mor
- Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, Rhode Island, United States.,Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island, United States.,Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island, United States.,Center for Long-Term Quality & Innovation, Brown University School of Public Health, Providence, Rhode Island, United States
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Baral S, Bond A, Boozary A, Bruketa E, Elmi N, Freiheit D, Ghosh SM, Goyer ME, Orkin AM, Patel J, Richter T, Robertson A, Sutherland C, Svoboda T, Turnbull J, Wong A, Zhu A. Seeking shelter: homelessness and COVID-19. Facets (Ott) 2021. [DOI: 10.1139/facets-2021-0004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Those experiencing homelessness in Canada are impacted inequitably by COVID-19 due to their increased exposure, vulnerability of environment and medical comorbidities, and their lack of access to preventive care and treatment in the context of the pandemic. In shelter environments one is unable to effectively physically distance, maintain hygiene, obtain a test, or isolate. As a result, unique strategies are required for this population to protect them and those who serve them. Recommendations are provided to reduce or prevent further negative consequences from the COVID-19 pandemic for people experiencing homelessness. These recommendations were informed by a systematic review of the literature, as well as a jurisdictional scan. Where evidence did not exist, expert consensus from key providers and those experiencing homelessness throughout Canada was included. These recommendations recognize the need for short-term interventions to mitigate the immediate risk to this community, including coordination of response, appropriate precautions and protective equipment, reducing congestion, cohorting, testing, case and contact management strategies, dealing with outbreaks, isolation centres, and immunization. Longer-term recommendations are also provided with a view to ending homelessness by addressing the root causes of homelessness and by the provision of adequate subsidized and supportive housing through a Housing First strategy. It is imperative that meaningful changes take place now in how we serve those experiencing homelessness and how we mitigate specific vulnerabilities. These recommendations call for intersectoral, collaborative engagement to work for solutions targeted towards protecting the most vulnerable within our community through both immediate actions and long-term planning to eliminate homelessness.
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Affiliation(s)
- Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Inner City Health Associates, Toronto, ON M5C 1K6, Canada
| | - Andrew Bond
- Inner City Health Associates, Toronto, ON M5C 1K6, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Andrew Boozary
- Population Health and Social Medicine, University Health Network, Toronto, ON M5G 2C4, Canada
- University of Toronto, Toronto, ON M5S 1A8, Canada
- Columbia University, New York, NY 10032, USA
| | - Eva Bruketa
- Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Nika Elmi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | | | - S. Monty Ghosh
- Department of General Internal Medicine & Neurology, University of Alberta, Edmonton, AB T6G 2G3, Canada
- Department of Medicine & Psychiatry, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Marie Eve Goyer
- Family Medicine and Emergency Department, University of Montréal, Montréal, QC H3T 1J4, Canada
| | - Aaron M. Orkin
- Inner City Health Associates, Toronto, ON M5C 1K6, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Department of Emergency Medicine, St. Joseph’s Health Centre, Toronto, ON M6R 1B5, Canada
- Department of Emergency Medicine, Humber River Hospital, Toronto, ON M3M 0B2, Canada
| | - Jamie Patel
- Faculty of Community Services, Ryerson University, Toronto, ON M5B 2K3, Canada
| | - Tim Richter
- Canadian Alliance to End Homelessness, Calgary, AB T3H 0N8, Canada
| | - Angela Robertson
- Parkdale Queen West Community Health Centre, Toronto, ON M6K 1L2, Canada
| | - Christy Sutherland
- PHS Community Services Society, Vancouver, BC V6A 1M9, Canada
- Department of Family Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Tomislav Svoboda
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Jeffrey Turnbull
- University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Ottawa Inner City Health, Ottawa, ON K1N 5N7, Canada
| | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Regina, SK S4T 0H8, Canada
| | - Alice Zhu
- University of Toronto, Toronto, ON M5S 1A8, Canada
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Timely intervention and control of a novel coronavirus (COVID-19) outbreak at a large skilled nursing facility-San Francisco, California, 2020. Infect Control Hosp Epidemiol 2020; 42:1173-1180. [PMID: 33308357 PMCID: PMC8144818 DOI: 10.1017/ice.2020.1375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: To describe epidemiologic and genomic characteristics of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in a large skilled-nursing facility (SNF), and the strategies that controlled transmission. Design, setting, and participants: This cohort study was conducted during March 22–May 4, 2020, among all staff and residents at a 780-bed SNF in San Francisco, California. Methods: Contact tracing and symptom screening guided targeted testing of staff and residents; respiratory specimens were also collected through serial point prevalence surveys (PPSs) in units with confirmed cases. Cases were confirmed by real-time reverse transcription–polymerase chain reaction testing for SARS-CoV-2, and whole-genome sequencing (WGS) was used to characterize viral isolate lineages and relatedness. Infection prevention and control (IPC) interventions included restricting from work any staff who had close contact with a confirmed case; restricting movement between units; implementing surgical face masking facility-wide; and the use of recommended PPE (ie, isolation gown, gloves, N95 respirator and eye protection) for clinical interactions in units with confirmed cases. Results: Of 725 staff and residents tested through targeted testing and serial PPSs, 21 (3%) were SARS-CoV-2 positive: 16 (76%) staff and 5 (24%) residents. Fifteen cases (71%) were linked to a single unit. Targeted testing identified 17 cases (81%), and PPSs identified 4 cases (19%). Most cases (71%) were identified before IPC interventions could be implemented. WGS was performed on SARS-CoV-2 isolates from 4 staff and 4 residents: 5 were of Santa Clara County lineage and the 3 others were distinct lineages. Conclusions: Early implementation of targeted testing, serial PPSs, and multimodal IPC interventions limited SARS-CoV-2 transmission within the SNF.
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Kavaliunas A, Ocaya P, Mumper J, Lindfeldt I, Kyhlstedt M. Swedish policy analysis for Covid-19. HEALTH POLICY AND TECHNOLOGY 2020; 9:598-612. [PMID: 32904437 PMCID: PMC7455549 DOI: 10.1016/j.hlpt.2020.08.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has challenged health care systems and put societies to the test in the world beyond expectations. OBJECTIVE Our aim is to describe and analyze the Swedish approach in combating the pandemic. METHODS We present and discuss data collated from various sources - published scientific studies, pre-print material, agency reports, media communication, public surveys, etc. - with specific focus on the approach itself, Covid-19 trends, healthcare system response, policy and measures overview, and implications. RESULTS The main intervention to manage the curve has been the general recommendations to adhere to good hand hygiene, beware of physical distance to others, to refrain from large gatherings and restrain from non-essential travel. Persons with suspected Covid-19 infection were recommended to stay at home and avoid social contacts. Additionally, visits to the elderly care homes and meetings with more than 50 people were forbidden. As a result, the healthcare system in the country has so far, never been overwhelmed. However, the relatively high mortality among the elderly, together with the vulnerability of some migrants, points out the drawbacks. CONCLUSIONS Many countries have both marvelled and criticized the Swedish strategy that is formed in a close partnership between the government and the society based on a mutual trust giving the responsibility to individuals. It already highlights how much can be achieved with voluntary measures (recommendations) - something that was noticed and proposed as a future model by the World Health Organization.
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Affiliation(s)
- Andrius Kavaliunas
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Pauline Ocaya
- Department of Clinical Microbiology, Section of Infection and Immunology, University Hospital of Umeå, Umeå, Sweden
| | - Jim Mumper
- Independent Consultant, Norrköping, Sweden
| | - Isis Lindfeldt
- Department of Sociology and Uppsala Antibiotic Center, Uppsala University, Uppsala, Sweden
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Abstract
Congregate settings such as psychiatric units have an increased risk of disease transmission because of the milieu setting and the inability to isolate patients. Interventions to prevent infection and cross-contamination are discussed including monitoring of patient temperatures, personal protective equipment, remote care, monitoring of human resources, and reinforcement of infection prevention strategies. We discuss the effectiveness of those interventions and the lessons learned, including implications for psychiatric clinical care, during future pandemics or a next wave of COVID-19.
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Wang L, Ma H, Yiu KCY, Calzavara A, Landsman D, Luong L, Chan AK, Kustra R, Kwong JC, Boily MC, Hwang S, Straus S, Baral SD, Mishra S. Heterogeneity in testing, diagnosis and outcome in SARS-CoV-2 infection across outbreak settings in the Greater Toronto Area, Canada: an observational study. CMAJ Open 2020; 8:E627-E636. [PMID: 33037070 PMCID: PMC7567509 DOI: 10.9778/cmajo.20200213] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Congregate settings have been disproportionately affected by coronavirus disease 2019 (COVID-19). Our objective was to compare testing for, diagnosis of and death after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across 3 settings (residents of long-term care homes, people living in shelters and the rest of the population). METHODS We conducted a population-based prospective cohort study involving individuals tested for SARS-CoV-2 in the Greater Toronto Area between Jan. 23, 2020, and May 20, 2020. We sourced person-level data from COVID-19 surveillance and reporting systems in Ontario. We calculated cumulatively diagnosed cases per capita, proportion tested, proportion tested positive and case-fatality proportion for each setting. We estimated the age- and sex-adjusted rate ratios associated with setting for test positivity and case fatality using quasi-Poisson regression. RESULTS Over the study period, a total of 173 092 individuals were tested for and 16 490 individuals were diagnosed with SARS-CoV-2 infection. We observed a shift in the proportion of cumulative cases from all cases being related to travel to cases in residents of long-term care homes (20.4% [3368/16 490]), shelters (2.3% [372/16 490]), other congregate settings (20.9% [3446/16 490]) and community settings (35.4% [5834/16 490]), with cumulative travel-related cases at 4.1% (674/16490). Cumulatively, compared with the rest of the population, the diagnosed cases per capita was 64-fold and 19-fold higher among long-term care home and shelter residents, respectively. By May 20, 2020, 76.3% (21 617/28 316) of long-term care home residents and 2.2% (150 077/6 808 890) of the rest of the population had been tested. After adjusting for age and sex, residents of long-term care homes were 2.4 (95% confidence interval [CI] 2.2-2.7) times more likely to test positive, and those who received a diagnosis of COVID-19 were 1.4-fold (95% CI 1.1-1.8) more likely to die than the rest of the population. INTERPRETATION Long-term care homes and shelters had disproportionate diagnosed cases per capita, and residents of long-term care homes diagnosed with COVID-19 had higher case fatality than the rest of the population. Heterogeneity across micro-epidemics among specific populations and settings may reflect underlying heterogeneity in transmission risks, necessitating setting-specific COVID-19 prevention and mitigation strategies.
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Affiliation(s)
- Linwei Wang
- MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences Centre, University of Toronto; Dalla Lana School of Public Health (Kustra), University of Toronto; Department of Family and Community Medicine (Kwong), Faculty of Medicine, University of Toronto, Toronto, Ont.; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology (Boily), Faculty of Medicine, Imperial College, London, UK; Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Bloomberg School of Public Health (Baral), Johns Hopkins University, Baltimore, Md
| | - Huiting Ma
- MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences Centre, University of Toronto; Dalla Lana School of Public Health (Kustra), University of Toronto; Department of Family and Community Medicine (Kwong), Faculty of Medicine, University of Toronto, Toronto, Ont.; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology (Boily), Faculty of Medicine, Imperial College, London, UK; Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Bloomberg School of Public Health (Baral), Johns Hopkins University, Baltimore, Md
| | - Kristy C Y Yiu
- MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences Centre, University of Toronto; Dalla Lana School of Public Health (Kustra), University of Toronto; Department of Family and Community Medicine (Kwong), Faculty of Medicine, University of Toronto, Toronto, Ont.; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology (Boily), Faculty of Medicine, Imperial College, London, UK; Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Bloomberg School of Public Health (Baral), Johns Hopkins University, Baltimore, Md
| | - Andrew Calzavara
- MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences Centre, University of Toronto; Dalla Lana School of Public Health (Kustra), University of Toronto; Department of Family and Community Medicine (Kwong), Faculty of Medicine, University of Toronto, Toronto, Ont.; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology (Boily), Faculty of Medicine, Imperial College, London, UK; Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Bloomberg School of Public Health (Baral), Johns Hopkins University, Baltimore, Md
| | - David Landsman
- MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences Centre, University of Toronto; Dalla Lana School of Public Health (Kustra), University of Toronto; Department of Family and Community Medicine (Kwong), Faculty of Medicine, University of Toronto, Toronto, Ont.; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology (Boily), Faculty of Medicine, Imperial College, London, UK; Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Bloomberg School of Public Health (Baral), Johns Hopkins University, Baltimore, Md
| | - Linh Luong
- MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences Centre, University of Toronto; Dalla Lana School of Public Health (Kustra), University of Toronto; Department of Family and Community Medicine (Kwong), Faculty of Medicine, University of Toronto, Toronto, Ont.; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology (Boily), Faculty of Medicine, Imperial College, London, UK; Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Bloomberg School of Public Health (Baral), Johns Hopkins University, Baltimore, Md
| | - Adrienne K Chan
- MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences Centre, University of Toronto; Dalla Lana School of Public Health (Kustra), University of Toronto; Department of Family and Community Medicine (Kwong), Faculty of Medicine, University of Toronto, Toronto, Ont.; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology (Boily), Faculty of Medicine, Imperial College, London, UK; Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Bloomberg School of Public Health (Baral), Johns Hopkins University, Baltimore, Md
| | - Rafal Kustra
- MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences Centre, University of Toronto; Dalla Lana School of Public Health (Kustra), University of Toronto; Department of Family and Community Medicine (Kwong), Faculty of Medicine, University of Toronto, Toronto, Ont.; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology (Boily), Faculty of Medicine, Imperial College, London, UK; Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Bloomberg School of Public Health (Baral), Johns Hopkins University, Baltimore, Md
| | - Jeffrey C Kwong
- MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences Centre, University of Toronto; Dalla Lana School of Public Health (Kustra), University of Toronto; Department of Family and Community Medicine (Kwong), Faculty of Medicine, University of Toronto, Toronto, Ont.; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology (Boily), Faculty of Medicine, Imperial College, London, UK; Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Bloomberg School of Public Health (Baral), Johns Hopkins University, Baltimore, Md
| | - Marie-Claude Boily
- MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences Centre, University of Toronto; Dalla Lana School of Public Health (Kustra), University of Toronto; Department of Family and Community Medicine (Kwong), Faculty of Medicine, University of Toronto, Toronto, Ont.; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology (Boily), Faculty of Medicine, Imperial College, London, UK; Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Bloomberg School of Public Health (Baral), Johns Hopkins University, Baltimore, Md
| | - Stephen Hwang
- MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences Centre, University of Toronto; Dalla Lana School of Public Health (Kustra), University of Toronto; Department of Family and Community Medicine (Kwong), Faculty of Medicine, University of Toronto, Toronto, Ont.; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology (Boily), Faculty of Medicine, Imperial College, London, UK; Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Bloomberg School of Public Health (Baral), Johns Hopkins University, Baltimore, Md
| | - Sharon Straus
- MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences Centre, University of Toronto; Dalla Lana School of Public Health (Kustra), University of Toronto; Department of Family and Community Medicine (Kwong), Faculty of Medicine, University of Toronto, Toronto, Ont.; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology (Boily), Faculty of Medicine, Imperial College, London, UK; Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Bloomberg School of Public Health (Baral), Johns Hopkins University, Baltimore, Md
| | - Stefan D Baral
- MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences Centre, University of Toronto; Dalla Lana School of Public Health (Kustra), University of Toronto; Department of Family and Community Medicine (Kwong), Faculty of Medicine, University of Toronto, Toronto, Ont.; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology (Boily), Faculty of Medicine, Imperial College, London, UK; Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Bloomberg School of Public Health (Baral), Johns Hopkins University, Baltimore, Md
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences Centre, University of Toronto; Dalla Lana School of Public Health (Kustra), University of Toronto; Department of Family and Community Medicine (Kwong), Faculty of Medicine, University of Toronto, Toronto, Ont.; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology (Boily), Faculty of Medicine, Imperial College, London, UK; Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Bloomberg School of Public Health (Baral), Johns Hopkins University, Baltimore, Md.
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Iaboni A, Cockburn A, Marcil M, Rodrigues K, Marshall C, Garcia MA, Quirt H, Reynolds KB, Keren R, Flint AJ. Achieving Safe, Effective, and Compassionate Quarantine or Isolation of Older Adults With Dementia in Nursing Homes. Am J Geriatr Psychiatry 2020; 28:835-838. [PMID: 32430111 PMCID: PMC7196899 DOI: 10.1016/j.jagp.2020.04.025] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 12/19/2022]
Abstract
Nursing homes are facing the rapid spread of COVID-19 among residents and staff and are at the centre of the public health emergency due to the COVID-19 pandemic. As policy changes and interventions designed to support nursing homes are put into place, there are barriers to implementing a fundamental, highly effective element of infection control, namely the isolation of suspected or confirmed cases. Many nursing home residents have dementia, associated with impairments in memory, language, insight, and judgment that impact their ability to understand and appreciate the necessity of isolation and to voluntarily comply with isolation procedures. While there is a clear ethical and legal basis for the involuntary confinement of people with dementia, the potential for unintended harm with these interventions is high, and there is little guidance for nursing homes on how to isolate safely, while maintaining the human dignity and personhood of the individual with dementia. In this commentary, we discuss strategies for effective, safe, and compassionate isolation care planning, and present a case vignette of a person with dementia who is placed in quarantine on a dementia unit.
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Affiliation(s)
- Andrea Iaboni
- Toronto Rehab, University Health Network (AL, AC, MM, KR, CM, MAG, HQ, KBR, RK, and AJF), Toronto, ON, Canada; Centre for Mental Health, University Health Network (AL, KBR, RK, and AJF), Toronto, ON, Canada; Department of Psychiatry (AL, KBR, RK, and AJF), University of Toronto, Toronto, ON, Canada.
| | - Amy Cockburn
- Toronto Rehab, University Health Network (AL, AC, MM, KR, CM, MAG, HQ, KBR, RK, and AJF), Toronto, ON, Canada
| | - Meghan Marcil
- Toronto Rehab, University Health Network (AL, AC, MM, KR, CM, MAG, HQ, KBR, RK, and AJF), Toronto, ON, Canada
| | - Kevin Rodrigues
- Toronto Rehab, University Health Network (AL, AC, MM, KR, CM, MAG, HQ, KBR, RK, and AJF), Toronto, ON, Canada,Department of Bioethics (KR), University Health Network, Toronto, ON, Canada
| | - Cecelia Marshall
- Toronto Rehab, University Health Network (AL, AC, MM, KR, CM, MAG, HQ, KBR, RK, and AJF), Toronto, ON, Canada
| | - Mary Anne Garcia
- Toronto Rehab, University Health Network (AL, AC, MM, KR, CM, MAG, HQ, KBR, RK, and AJF), Toronto, ON, Canada
| | - Hannah Quirt
- Toronto Rehab, University Health Network (AL, AC, MM, KR, CM, MAG, HQ, KBR, RK, and AJF), Toronto, ON, Canada
| | - Katelyn B. Reynolds
- Toronto Rehab, University Health Network (AL, AC, MM, KR, CM, MAG, HQ, KBR, RK, and AJF), Toronto, ON, Canada,Centre for Mental Health, University Health Network (AL, KBR, RK, and AJF), Toronto, ON, Canada,Department of Psychiatry (AL, KBR, RK, and AJF), University of Toronto, Toronto, ON, Canada
| | - Ron Keren
- Toronto Rehab, University Health Network (AL, AC, MM, KR, CM, MAG, HQ, KBR, RK, and AJF), Toronto, ON, Canada,Centre for Mental Health, University Health Network (AL, KBR, RK, and AJF), Toronto, ON, Canada,Department of Psychiatry (AL, KBR, RK, and AJF), University of Toronto, Toronto, ON, Canada
| | - Alastair J. Flint
- Toronto Rehab, University Health Network (AL, AC, MM, KR, CM, MAG, HQ, KBR, RK, and AJF), Toronto, ON, Canada,Centre for Mental Health, University Health Network (AL, KBR, RK, and AJF), Toronto, ON, Canada,Department of Psychiatry (AL, KBR, RK, and AJF), University of Toronto, Toronto, ON, Canada
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Munanga A. Critical Infection Control Adaptations to Survive COVID-19 in Retirement Communities. J Gerontol Nurs 2020; 46:3-5. [DOI: 10.3928/00989134-20200511-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Albert Munanga
- Regional Director of Health and Wellness Era Living, Affiliate Faculty, Department of Biobehavioral Nursing and Health Informatics, University of Washington Seattle, Washington
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[Practitioners specialized in oral health and coronavirus disease 2019: Professional guidelines from the French society of stomatology, maxillofacial surgery and oral surgery, to form a common front against the infectious risk]. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:e3-e6. [PMID: 32307086 PMCID: PMC7194851 DOI: 10.1016/j.jormas.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Practitioners specialized in oral health and coronavirus disease 2019: Professional guidelines from the French society of stomatology, maxillofacial surgery and oral surgery, to form a common front against the infectious risk. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:155-158. [PMID: 32307085 PMCID: PMC7194703 DOI: 10.1016/j.jormas.2020.03.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Medical as well as non-medical practitioners specialized in oral health are at high risk of infection with the Coronavirus-19 (Covid-19) because of the proximity with potentially infected biological fluids. This risk is permanent, especially during examination, care and transfer of patients. Regarding the pandemic progression of Covid-19, efficient protocols of prevention are urgently needed. Based on our experience and on the recently reported guidelines from the French National Agency for Public Health (ARS, March 5, 2020), the French Society of Hospital Hygiene (SFHH, March 4, 2020) and the Department of Infectious Risk Prevention of the Hospitals of Paris-Public Assistance (APHP, March 6, 2020), we provide several recommendations for practitioners specialized in oral health, to protect themselves from nosocomial infections, especially Covid-19.
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