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Jeong H, Choi Y, Kim H. Nonface-to-Face Visitation to Restrict Patient Visits for Infection Control: Integrative Review. Interact J Med Res 2023; 12:e43572. [PMID: 38015595 PMCID: PMC10686251 DOI: 10.2196/43572] [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: 10/16/2022] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND In the COVID-19 pandemic, a visit restriction policy for patients has been implemented in medical institutions worldwide and visits are being made using alternative communication technologies. This shift has also required the use of platforms to prevent negative consequences of these restrictions. OBJECTIVE The purpose of this review was to comprehensively explore nonface-to-face visits as an alternative during infection prevention and to synthesize the scientific evidence of their benefits and disadvantages. METHODS A comprehensive search was conducted via the PubMed, Embase, CINAHL, Cochrane, and Web of Science electronic databases; unpublished trials in the clinical trials register ClinicalTrials.gov; and Virginia Henderson International Nursing Library up to September 10, 2021. The search query was developed according to the guidelines of the Peer Review of Electronic Search Strategies and included keywords on the topics of telemedicine and visitation restrictions. The inclusion criteria were a nonface-to-face modality using telemedicine with family in a hospital setting, experimental and observational studies, and articles written in English. The exclusion criteria were inaccessible in full text, not related to patient or family involvement, mainly focused on the study protocol, or only discussing the pros and cons of telemedicine. RESULTS Overall, patients' families experienced emotional distress due to restrictions on face-to-face visits. Nonface-to-face virtual visits compensating for these restrictions had a positive effect on reducing the risk of infection to the patient and the family. This further encouraged psychological and physical recovery and decreased psychological distress. However, nonface-to-face virtual technology could not replace the existence of actual families, and technical problems with networks and devices are reported as limitations. CONCLUSIONS Ensuring the availability of technology and educating on the same in alignment with the characteristics of patients and their families, nonface-to-face virtual visits need to show more potential as an effective patient-centered treatment strategy based on more research and advanced practice.
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Affiliation(s)
- Hyunwoo Jeong
- College of Nursing, Yonsei University, Seoul, Republic of Korea
- Department of Internal Medicine Nursing, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yonsu Choi
- Department of Surgical Nursing, Seoul National University Hospital, Seoul, Republic of Korea
| | - Heejung Kim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
- Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
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Maurand A, Le Guen R, Sakr C, Sabourin N, Hacquin B, Boulmier S, Bonnin C, Gobe L, Fourreau F, Decousser JW. Volunteers, religious communities and users representatives as an alternative for visiting hospitalized patients: The importance of an infection control training. PLoS One 2023; 18:e0286002. [PMID: 37216333 DOI: 10.1371/journal.pone.0286002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/05/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the suspension of relatives' visits was a common measure in healthcare facilities to prevent the spread of the virus among patients. This measure caused significant adverse consequences for hospitalized patients. Volunteers' intervention was an alternative but could also lead to cross transmission events. AIMS in order to secure their intervention with patients, we implemented an infection control training to evaluate and to improve the knowledge of volunteers about infection control measures. METHOD We performed a before-after study in a group of five tertiary referral teaching hospitals in the suburbs of Paris. A total of 226 volunteers from three groups (religious representatives, civilian volunteers and users' representatives) were included. Basic theoretical and practical knowledge about infection control, hand hygiene, and glove and mask use were evaluated just before and immediately after a three-hour training program. The contribution of the characteristics of the volunteers to the results was studied. FINDINGS The initial conformity rate for theoretical and practical infection control measures ranged from 53% to 68%, depending on the participants' activity status and education level. Some critical shortcomings in hand hygiene as well as mask and glove wearing putatively endangered the patients and volunteers. Surprisingly, serious gaps were also identified among volunteers who experienced care activities. Regardless of their origin, the program significantly improved both their theoretical and practical knowledge (p<0.001). Real-life observance and long-term sustainability should be monitored. CONCLUSIONS To become a secure alternative to relatives' visits, volunteers' interventions must be preceded by the assessment of their theoretical knowledge and practical skills in infection control. Additional study, including practice audit, must confirm the implementation of the acquired knowledge in the real-life.
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Affiliation(s)
- Audrey Maurand
- Infection Control Team, Microbiology Department, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Ronan Le Guen
- Infection Control Team, Microbiology Department, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Celine Sakr
- Infection Control Team, Microbiology Department, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
- University Paris Est Créteil, Health Faculty, EA 7380 DYNAMYC, Créteil, France
| | - Nadine Sabourin
- Infection Control Team, Microbiology Department, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Bruno Hacquin
- Infection Control Team, Microbiology Department, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Stéphanie Boulmier
- Infection Control Team, Microbiology Department, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Christèle Bonnin
- Infection Control Team, Microbiology Department, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Lamnakhone Gobe
- Infection Control Team, Microbiology Department, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Frédéric Fourreau
- Infection Control Team, Microbiology Department, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Jean-Winoc Decousser
- Infection Control Team, Microbiology Department, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
- University Paris Est Créteil, Health Faculty, EA 7380 DYNAMYC, Créteil, France
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Fiest KM, Krewulak KD, Hernández LC, Jaworska N, Makuk K, Schalm E, Bagshaw SM, Bernet X, Burns KEA, Couillard P, Doig CJ, Fowler R, Kho ME, Kupsch S, Lauzier F, Niven DJ, Oggy T, Rewa OG, Rochwerg B, Spence S, West A, Stelfox HT, Parsons Leigh J. Evidence-informed consensus statements to guide COVID-19 patient visitation policies: results from a national stakeholder meeting. Can J Anaesth 2022; 69:868-879. [PMID: 35359262 PMCID: PMC8970637 DOI: 10.1007/s12630-022-02235-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/22/2021] [Accepted: 02/11/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Hospital policies forbidding or limiting families from visiting relatives on the intensive care unit (ICU) has affected patients, families, healthcare professionals, and patient- and family-centered care (PFCC). We sought to refine evidence-informed consensus statements to guide the creation of ICU visitation policies during the current COVID-19 pandemic and future pandemics and to identify barriers and facilitators to their implementation and sustained uptake in Canadian ICUs. METHODS We created consensus statements from 36 evidence-informed experiences (i.e., impacts on patients, families, healthcare professionals, and PFCC) and 63 evidence-informed strategies (i.e., ways to improve restricted visitation) identified during a modified Delphi process (described elsewhere). Over two half-day virtual meetings on 7 and 8 April 2021, 45 stakeholders (patients, families, researchers, clinicians, decision-makers) discussed and refined these consensus statements. Through qualitative descriptive content analysis, we evaluated the following points for 99 consensus statements: 1) their importance for improving restricted visitation policies; 2) suggested modifications to make them more applicable; and 3) facilitators and barriers to implementing these statements when creating ICU visitation policies. RESULTS Through discussion, participants identified three areas for improvement: 1) clarity, 2) accessibility, and 3) feasibility. Stakeholders identified several implementation facilitators (clear, flexible, succinct, and prioritized statements available in multiple modes), barriers (perceived lack of flexibility, lack of partnership between government and hospital, change fatigue), and ways to measure and monitor their use (e.g., family satisfaction, qualitative interviews). CONCLUSIONS Existing guidance on policies that disallowed or restricted visitation in intensive care units were confusing, hard to operationalize, and often lacked supporting evidence. Prioritized, succinct, and clear consensus statements allowing for local adaptability are necessary to guide the creation of ICU visitation policies and to optimize PFCC.
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Affiliation(s)
- Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute of Public Health, Calgary, AB, Canada.
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Karla D Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Laura C Hernández
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Natalia Jaworska
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Kira Makuk
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Emma Schalm
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Xavier Bernet
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Physiotherapy, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Philippe Couillard
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Christopher J Doig
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Robert Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - François Lauzier
- Departments of Medicine and Anesthesiology & Critical Care, Université Laval, Québec City, QC, Canada
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Québec City, QC, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, Calgary, AB, Canada
| | - Taryn Oggy
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Sean Spence
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Ottawa, ON, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, Calgary, AB, Canada
| | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
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Perform hand hygiene and the doors will open - the effectiveness of new system implementation on Paediatric Intensive Care Unit visitors' handwashing compliance. Epidemiol Infect 2021; 150:e3. [PMID: 34915960 PMCID: PMC8755529 DOI: 10.1017/s0950268821002582] [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] [Indexed: 11/15/2022] Open
Abstract
Hand hygiene (HH) performance on entering intensive care units (ICUs) is commonly accepted but often inadequately performed. We developed a simple, inexpensive module that connects touchless dispensers of alcohol sanitiser (TDAS) to the automatic doors of a paediatric ICU, and assessed the impact of this intervention on HH compliance of hospital staff and visitors. A prospective observational study was conducted over a 3-week period prior to the intervention, followed by a 4-week period post intervention. HH performance was monitored by a research assistant whose office location enabled direct and video-assisted observation of the ICU entrance. A total of 609 entries to the ICU was recorded. Overall HH performance was 46.9% (92/196) before and 98.5% (406/413) after the intervention. Our findings suggest that HH performance on entering an ICU can be improved via a mechanism that makes operation of an automatic door dependent on use of a TDAS system, and thus contribute to infection control.
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Equitable and Holistic Public Health Measures During the Singaporean COVID-19 Pandemic. Ann Glob Health 2021; 87:45. [PMID: 34046308 PMCID: PMC8139311 DOI: 10.5334/aogh.3244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This Covid-19 pandemic has been a trying time for all countries, governments, societies, and individuals. The physical, social, and organizational infrastructure of healthcare systems across the world is being stressed. This pandemic has highlighted that the healthcare of the country is as strong as its weakest link and that no aspect of life, be it social or economic, is spared from this pandemic. The authors would like to highlight some of the lessons learned from Singapores management of the Covid-19 pandemic. During the Singaporean Covid-19 pandemic, public health policy planning was all encompassing in its coverage, involving various stakeholders in government and society. The important role of individuals, governments, industry, and primary healthcare practitioners when tackling COVID-19 are highlighted. Singapores management of the Covid-19 pandemic involved an approach that involved the whole of society, with a particular focus on supporting the vulnerable foreign worker population, which formed the majority of Covid-19 cases in the country. Hopefully amidst the trying times, valuable lessons are learnt that will be etched into medical history and collective memory. We hope to highlight these lessons for future generations, both for members of the public and fellow healthcare practitioners.
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Virani AK, Puls HT, Mitsos R, Longstaff H, Goldman RD, Lantos JD. Benefits and Risks of Visitor Restrictions for Hospitalized Children During the COVID Pandemic. Pediatrics 2020; 146:peds.2020-000786. [PMID: 32430441 DOI: 10.1542/peds.2020-000786] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 11/24/2022] Open
Abstract
To control the spread of severe acute respiratory syndrome coronavirus 2, the virus responsible for coronavirus disease 2019, many hospitals have strict visitor restriction policies. These policies often prohibit both parents from visiting at the same time or having grandparents or other family members visit at all. We discuss cases in which such policies created ethical dilemmas and possibly called for compassionate exceptions from the general rules.
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Affiliation(s)
- Alice K Virani
- Ethics Service, Provincial Health Services Authority, Vancouver, British Columbia, Canada; .,Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Henry T Puls
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri; and
| | - Rebecca Mitsos
- Department of Child Life Services, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Holly Longstaff
- Ethics Service, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Ran D Goldman
- Pediatric Research in Emergency Therapeutics Program, Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - John D Lantos
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri; and
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Liu YA, Hsu YC, Lin MH, Chang HT, Chen TJ, Chou LF, Hwang SJ. Hospital visiting policies in the time of coronavirus disease 2019: A nationwide website survey in Taiwan. J Chin Med Assoc 2020; 83:566-570. [PMID: 32502119 PMCID: PMC7199773 DOI: 10.1097/jcma.0000000000000326] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), a novel infectious coronavirus disease, has become a worldwide pandemic. Infection control precautions for hospital visitors are needed to avoid cluster outbreaks, so this study investigated the visiting policies of all the hospitals in Taiwan in the time of COVID-19. METHODS From March 15, 2020, to March 18, 2020, we searched the official websites of all 472 National Health Insurance-contracted hospitals to determine their visiting policies. For those hospitals that had posted new visiting policies and still allowed visits to ordinary wards, we recorded the relevant details shown on their websites, including the number of visitors allowed at one time, the number of visiting slots per day, the total visiting hours per day, and the rules provided to visitors before visiting. RESULTS During the study period, 276 (58.5%) hospitals had posted new visiting policies on their websites, with higher proportions of academic medical centers (92.0%, 23/25) and metropolitan hospitals (91.5%, 75/82) than local community hospitals (48.8%, 178/365) doing so. Visits to ordinary wards were forbidden in 83 hospitals among those. Among the 193 hospitals that had new visiting policies and still allowed visits to ordinary wards, 73.1% (n = 141) restricted visitors to two at a time and 54.9% (n = 106) restricted visits to two visiting slots per day. Furthermore, history taking regarding travel, occupation, contacts, and cluster information was mentioned by 82.4% (n = 159) of these 193 hospitals, body temperature monitoring by 78.2% (n = 151), hand hygiene by 63.2% (n = 122), and identity checks by 51.8% (n = 100). CONCLUSION In the time of COVID-19 covered by this study, about three-fifths of the hospitals in Taiwan had posted their visiting policies for ordinary wards on their websites. Furthermore, the thoroughness with which such visiting policies have been enforced also requires investigation.
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Affiliation(s)
- Ya-An Liu
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ya-Chuan Hsu
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Big Data Center, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- *Address correspondence. Dr. Tzeng-Ji Chen, Department of Family Medicine, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: (T.-J. Chen)
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, Taipei, Taiwan, ROC
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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Hsu YC, Liu YA, Lin MH, Lee HW, Chen TJ, Chou LF, Hwang SJ. Visiting Policies of Hospice Wards during the COVID-19 Pandemic: An Environmental Scan in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082857. [PMID: 32326274 PMCID: PMC7215665 DOI: 10.3390/ijerph17082857] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/16/2022]
Abstract
During an epidemic, almost all healthcare facilities restrict the visiting of patients to prevent disease transmission. For hospices with terminally ill patients, the trade-off between compassion and infection control becomes a difficult decision. This study aimed to survey the changes in visiting policy for all 76 hospice wards in Taiwan during the COVID-19 pandemic in March 2020. The altered visiting policies were assessed by the number of visitors per patient allowed at one time, the daily number of visiting slots, the number of hours open daily, and requisites for hospice ward entry. The differences in visiting policies between hospice wards and ordinary wards were also investigated. Data were collected by reviewing the official website of each hospital and were supplemented by phone calls in cases where no information was posted on the website. One quarter (n = 20) of hospice wards had different visiting policies to those of ordinary wards in the same hospital. Only one hospice ward operated an open policy, and in contrast, nine (11.8%) stopped visits entirely. Among the 67 hospice wards that allowed visiting, at most, two visitors at one time per patient were allowed in 46 (68.6%), one visiting time daily was allowed in 32 (47.8%), one hour of visiting per day was allowed in 29 (43.3%), and checking of identity and travel history was carried out in 12 wards (17.9%). During the COVID-19 pandemic, nearly all hospice wards in Taiwan changed their visiting policies, but the degree of restriction varied. Further studies could measure the impacts of visiting policy changes on patients and healthcare professionals.
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Affiliation(s)
- Ya-Chuan Hsu
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan; (Y.-C.H.); (Y.-A.L.); (M.-H.L.); (H.-W.L.); (S.-J.H.)
| | - Ya-An Liu
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan; (Y.-C.H.); (Y.-A.L.); (M.-H.L.); (H.-W.L.); (S.-J.H.)
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan; (Y.-C.H.); (Y.-A.L.); (M.-H.L.); (H.-W.L.); (S.-J.H.)
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan
| | - Hsiao-Wen Lee
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan; (Y.-C.H.); (Y.-A.L.); (M.-H.L.); (H.-W.L.); (S.-J.H.)
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan; (Y.-C.H.); (Y.-A.L.); (M.-H.L.); (H.-W.L.); (S.-J.H.)
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan
- Big Data Center, Department of Medical Research, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan
- Correspondence: ; Tel.: +886-2-2875-7458; Fax: +886-2-2873-7901
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, Taipei 116, Taiwan;
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan; (Y.-C.H.); (Y.-A.L.); (M.-H.L.); (H.-W.L.); (S.-J.H.)
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan
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Kennedy B, Shobo CO, Zishiri OT, Bester LA. Surveillance of Salmonella spp. in the environment of public hospitals in KwaZulu-Natal, South Africa. J Hosp Infect 2020; 105:205-212. [PMID: 32114055 DOI: 10.1016/j.jhin.2020.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
AIM To investigate the dissemination of Salmonella spp. within four levels of government hospitals in KwaZulu-Natal, South Africa. METHODS The identification of Salmonella spp. was performed by amplification of the invA gene. Isolates were subjected to antimicrobial susceptibility testing and molecular characterization of eight resistance genes (qnrA, qnrB, qnrS, tetA, tetB, tetC, tetG, ermB) and three virulence genes (sitC, spvA, spv). Genetic relatedness between isolates was determined using enterobacterial repetitive intergenic consensus (ERIC) polymerase chain reaction. FINDINGS Ninety-four isolates were obtained. The largest source of isolates was the regional hospital. Paediatric wards had the highest prevalence of isolates. Nurses' tables contained the most isolates out of all sites sampled. Twenty-two clusters indicating diverse isolates were obtained via molecular typing. Four main ERIC types were identified, each unique to a specific hospital. A possibility of dissemination across the wards was noted as highly related isolates were present at various sites within the wards. Many of these sites were highly trafficked areas by healthcare staff. Ten multi-drug-resistant isolates were found. CONCLUSIONS This study suggests that infection prevention and control strategies that involve environmental cleaning and decontamination may not be enough, or adhered to sufficiently, to prevent the dissemination of Salmonella spp.
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Affiliation(s)
- B Kennedy
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - C O Shobo
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - O T Zishiri
- Genetics Department, School of Life Sciences, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa
| | - L A Bester
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
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A new approach to infection prevention: A pilot study to evaluate a hand hygiene ambassador program in hospitals and clinics. Am J Infect Control 2020; 48:246-248. [PMID: 31917012 DOI: 10.1016/j.ajic.2019.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND A pilot study was conducted to assess the perceptions of visitors, patients, and staff to the presence of a hand hygiene ambassador (HHA). METHODS Two hundred and twenty-five entrants to various health care settings were surveyed. Only entrants who failed to clean their hands at the alcohol-based handrub (ABHR) station on entry to the lobby were offered application of ABHR by an HHA. Several questions were also asked to assess their attitudes about the presence of an HHA. RESULTS When asked whether they think it is a good idea to have an HHA place ABHR on an entrant's hands, the majority of staff, visitors, and patients agreed. No one refused administration of handrub by the HHA. DISCUSSION HHA programs have direct and indirect benefits. Although the cost of such an initiative should be considered prior to implementation, it should be weighed against the annual spending for health care-associated infections. CONCLUSIONS Considering that hand hygiene compliance and health care-associated infection are clearly linked, a new approach using an HHA may help reduce infection, acting as a source of hand hygiene on entry to the hospital and possibly as a reminder to perform hand hygiene elsewhere in the hospital and clinics.
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11
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The learning hospital: From theory to practice in a hospital infection prevention program. Infect Control Hosp Epidemiol 2020; 41:86-97. [DOI: 10.1017/ice.2019.318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractThe learning hospital is distinguished by ceaseless evolution of erudition, enhancement, and implementation of clinical best practices. We describe a model for the learning hospital within the framework of a hospital infection prevention program and argue that a critical assessment of safety practices is possible without significant grant funding. We reviewed 121 peer-reviewed manuscripts published by the VCU Hospital Infection Prevention Program over 16 years. Publications included quasi-experimental studies, observational studies, surveys, interrupted time series analyses, and editorials. We summarized the articles based on their infection prevention focus, and we provide a brief summary of the findings. We also summarized the involvement of nonfaculty learners in these manuscripts as well as the contributions of grant funding. Despite the absence of significant grant funding, infection prevention programs can critically assess safety strategies under the learning hospital framework by leveraging a diverse collaboration of motivated nonfaculty learners. This model is a valuable adjunct to traditional grant-funded efforts in infection prevention science and is part of a successful horizontal infection control program.
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Ragusa R, Giorgianni G, Faro G, Lazzara A, Bellia MA, Marranzano M. Are Visitors Dangerous Carriers of Pathogens in The Hospital? an Observational Study in an University Hospital in Sicily. Hosp Top 2019; 97:80-86. [PMID: 31124745 DOI: 10.1080/00185868.2019.1616511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The hospital environment has been suggested as having an important role in the transmission of health care-associated infections. The aim of this work is to clarify the possible role of visitors in environmental contamination at our hospital. The microbial load was determined by Rodac plate contact on flat surfaces and by swabs on uneven surfaces. A total of 137 samples were taken from four different areas of the hospital unit. The results were divided into two groups according to the types of subjects that most often frequented those environments. We found that the transmission of health care-associated infections (HAIs) occurs mainly in areas where visitors are not allowed.
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Affiliation(s)
- Rosalia Ragusa
- a Health Technology Assessment Committee, University Hospital "G. Rodolico," Catania , Italy
| | - Gabriele Giorgianni
- b School of Specialization in Hygiene, University of Catania , Catania , Italy
| | - Giuseppina Faro
- c Department of Advanced Medical, Surgical and Advanced Sciences , University of Catania , Catania , Italy
| | - Antonio Lazzara
- d Medical Directorate Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele , Catania , Italy
| | | | - Marina Marranzano
- f Department of Advanced Medical, Surgical and Advanced Sciences , University of Catania , Catania , Italy
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Wilson KE, Wood SM, Schaecher KE, Cromwell KB, Godich J, Knapp MH, Sklar MJ, Ewing D, Raviprakash K, Defang G, Whitman TJ. Nosocomial outbreak of influenza A H3N2 in an inpatient oncology unit related to health care workers presenting to work while ill. Am J Infect Control 2019; 47:683-687. [PMID: 30616930 PMCID: PMC7115309 DOI: 10.1016/j.ajic.2018.10.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe an outbreak of influenza A in an oncology unit, highlighting infection control methods implemented, and examining reasons health care workers (HCWs) present to work with influenza-like illness (ILI). METHODS Confirmed cases were defined by the presence of ILI and a positive nasopharyngeal polymerase chain reaction swab for influenza A H3. Probable cases were defined as exposed HCWs with ILI who were unavailable for polymerase chain reaction testing. Infection prevention measures included closing the ward for new admissions, oseltamivir prophylaxis for all exposed groups, and dismissal from work of HCWs with ILI until resolution of symptoms. An anonymous survey of the cases in our HCWs was conducted to better elucidate reasons behind presenteeism. RESULTS Over the course of 8 days (November 16, 2017, to November 22, 2017), influenza was diagnosed in 7 of 10 inpatients on the oncology ward, 16 HCWs (14 confirmed, 2 probable), and 2 visitors. The suspected index case was an HCW. Of the surveyed HCWs, 64% presented to work despite feeling ill (ie, presenteeism). The most common reason was "sense of duty as a health care worker." CONCLUSIONS This nosocomial outbreak of influenza highlights the challenges of protecting inpatients from viral respiratory tract infections. HCWs and patient visitors with ILI should avoid work or visiting until resolution of peak respiratory symptoms and adhere to strict respiratory etiquette.
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Affiliation(s)
- Kerry E Wilson
- Infectious Diseases Service, Walter Reed National Military Medical Center, Bethesda, MD.
| | - Shannon M Wood
- Infectious Diseases Service, Walter Reed National Military Medical Center, Bethesda, MD
| | - Kurt E Schaecher
- Department of Microbiology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Karen B Cromwell
- Infectious Diseases Service, Walter Reed National Military Medical Center, Bethesda, MD
| | - Joan Godich
- Infectious Diseases Service, Walter Reed National Military Medical Center, Bethesda, MD
| | - Melissa H Knapp
- Department of Emergency Management, Walter Reed National Military Medical Center, Bethesda, MD
| | - Marvin J Sklar
- Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD
| | - Daniel Ewing
- Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD
| | - Kanakatte Raviprakash
- Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD
| | - Gabriel Defang
- Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD
| | - Timothy J Whitman
- Infectious Diseases Service, Walter Reed National Military Medical Center, Bethesda, MD
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Darby J, Falco C. Infection Control and the Need for Family-/Child-Centered Care. HEALTHCARE-ASSOCIATED INFECTIONS IN CHILDREN 2019. [PMCID: PMC7122132 DOI: 10.1007/978-3-319-98122-2_4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient- and family-centered care (FCC) has become central to the delivery of medical care over the last 20 years and has been shown to improve patient outcomes. Infection control practices have the potential to greatly influence family centeredness and care providers, and hospital personnel must consider the potential impacts of isolation and the use of personal protective equipment (PPE). Approaching infection control with the perspective of FCC requires balancing patient safety and overall patient well-being. In this chapter, authors consider infection control and the benefits of FCC, family and sibling visitation, the use of playrooms, animals in healthcare settings including animal-assisted interventions, the potential adverse effects of infection control practices, and strategies to mitigate these impacts.
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Development of a novel prevention bundle for pediatric healthcare-associated viral infections. Infect Control Hosp Epidemiol 2018; 39:1086-1092. [DOI: 10.1017/ice.2018.149] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo reduce the healthcare-associated viral infection (HAVI) rate to 0.70 infections or fewer per 1,000 patient days by developing and sustaining a comprehensive prevention bundle.SettingA 546-bed quaternary-care children’s hospital situated in a large urban area.PatientsInpatients with a confirmed HAVI were included. These HAVIs were identified through routine surveillance by infection preventionists and were confirmed using National Healthcare Safety Network definitions for upper respiratory infections (URIs), pneumonia, and gastroenteritis.MethodsQuality improvement (QI) methods and statistical process control (SPC) analyses were used in a retrospective observational analysis of HAVI data from July 2012 through June 2016.ResultsIn total, 436 HAVIs were identified during the QI initiative: 63% were URIs, 34% were gastrointestinal infections, and 2.5% were viral pneumonias. The most frequent pathogens were rhinovirus (n=171) and norovirus (n=83). Our SPC analysis of HAVI rate revealed a statistically significant reduction in March 2014 from a monthly average of 0.81 to 0.60 infections per 1,000 patient days. Among HAVIs with event reviews completed, 15% observed contact with a sick primary caregiver and 15% reported contact with a sick visitor. Patient outcomes identified included care escalation (37%), transfer to ICU (11%), and delayed discharge (19%).ConclusionsThe iterative development, implementation, and refinement of targeted prevention practices was associated with a significant reduction in pediatric HAVI. These practices were ultimately formalized into a comprehensive prevention bundle and provide an important framework for both patient and systems-level interventions that can be applied year-round and across inpatient areas.
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Koutlakis-Barron I, Hayden TA. Essentials of infection prevention in the pediatric population. Int J Pediatr Adolesc Med 2016; 3:143-152. [PMID: 30805485 PMCID: PMC6372437 DOI: 10.1016/j.ijpam.2016.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 10/13/2016] [Indexed: 11/24/2022]
Abstract
Application of infection prevention and control (IP&C) measures is synonymous with safety, quality, resource saving, and the rights of all patients, staff and visitors. An extensive literature review was undertaken to identify key IP&C measures that address pediatric-specific requirements, taking into account age-related factors, diseases that occur most frequently among pediatric populations, and the important role of the caregiver in prevention and disease transmission. IP&C initiatives that target and incorporate both human (intrinsic) and environmental (extrinsic) sources of infection are population specific and guide practices and provide safe caring environments when used appropriately. Categories of care specifically geared to the pediatric age-group (0-14 years) are divided into two categories: within-the-healthcare system and outside-of-the-healthcare setting. By taking into account the child's developmental age; physiological, psycho-social and immunological development; differing impacts on the body's natural defense mechanisms, including procedural, device type and length of utilization; and availability of specific technologies and disciplines, the caregiver IP&C strategies can be developed and tailored to address specific needs. Within-the-healthcare setting strategies focus on surveillance, standard and transmission-based precautions, the immune system, age-related factors, institutional regulations, the family and visitation. Outside the healthcare setting preventative and protective measures are vital for providing maximum and comprehensive care. Care provided within and outside the healthcare setting can either be independent of each other or work together to maximize the health and safety of the child. This review article highlights the importance of IP&C knowledge, need for strict adherence to approved standards, and need for auditing compliance to achieve the ultimate goal of providing safe, quality care as well as an infection-free environment.
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Affiliation(s)
- Irene Koutlakis-Barron
- KFSH&RC, Infection Control & Hospital Epidemiology, Takassussi Street, Riyadh, 11211, Saudi Arabia
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Kim KH, Tandi TE, Choi JW, Moon JM, Kim MS. Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in South Korea, 2015: epidemiology, characteristics and public health implications. J Hosp Infect 2016; 95:207-213. [PMID: 28153558 PMCID: PMC7114867 DOI: 10.1016/j.jhin.2016.10.008] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/07/2016] [Indexed: 12/31/2022]
Abstract
Background Since the first case of Middle East respiratory syndrome coronavirus (MERS-CoV) in South Korea was reported on 20th May 2015, there have been 186 confirmed cases, 38 deaths and 16,752 suspected cases. Previously published research on South Korea's MERS outbreak was limited to the early stages, when few data were available. Now that the outbreak has ended, albeit unofficially, a more comprehensive review is appropriate. Methods Data were obtained through the MERS portal by the Ministry for Health and Welfare (MOHW) and Korea Centres for Disease Control and Prevention, press releases by MOHW, and reports by the MERS Policy Committee of the Korean Medical Association. Cases were analysed for general characteristics, exposure source, timeline and infection generation. Sex, age and underlying diseases were analysed for the 38 deaths. Findings Beginning with the index case that infected 28 others, an in-depth analysis was conducted. The average age was 55 years, which was a little higher than the global average of 50 years. As in most other countries, more men than women were affected. The case fatality rate was 19.9%, which was lower than the global rate of 38.7% and the rate in Saudi Arabia (36.5%). In total, 184 patients were infected nosocomially and there were no community-acquired infections. The main underlying diseases were respiratory diseases, cancer and hypertension. The main contributors to the outbreak were late diagnosis, quarantine failure of ‘super spreaders’, familial care-giving and visiting, non-disclosure by patients, poor communication by the South Korean Government, inadequate hospital infection management, and ‘doctor shopping’. The outbreak was entirely nosocomial, and was largely attributable to infection management and policy failures, rather than biomedical factors.
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Affiliation(s)
- K H Kim
- Institute for Occupational and Environmental Health, Korea University, Seoul, Korea
| | - T E Tandi
- Institute for Occupational and Environmental Health, Korea University, Seoul, Korea; Graduate School of Public Health, Korea University, Seoul, Korea; Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea; Ministry of Public Health Yaounde, Yaounde, Cameroon
| | - J W Choi
- Institute for Occupational and Environmental Health, Korea University, Seoul, Korea; Graduate School of Public Health, Korea University, Seoul, Korea; Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea; MERS Policy Committee of the Korean Medical Association, Seoul, Korea.
| | - J M Moon
- Institute for Occupational and Environmental Health, Korea University, Seoul, Korea; Graduate School of Public Health, Korea University, Seoul, Korea
| | - M S Kim
- Institute for Occupational and Environmental Health, Korea University, Seoul, Korea; Graduate School of Public Health, Korea University, Seoul, Korea
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