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Kim MH, Kim J, Ra H, Jeong S, Park YS, Won D, Lee H, Kim H. Identifying Contact Time Required for Secondary Transmission of Clostridioides difficile Infections by Using Real-Time Locating System. Emerg Infect Dis 2024; 30:908-915. [PMID: 38666567 PMCID: PMC11060456 DOI: 10.3201/eid3005.231588] [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] [Indexed: 05/02/2024] Open
Abstract
Considering patient room shortages and prevalence of other communicable diseases, reassessing the isolation of patients with Clostridioides difficile infection (CDI) is imperative. We conducted a retrospective study to investigate the secondary CDI transmission rate in a hospital in South Korea, where patients with CDI were not isolated. Using data from a real-time locating system and electronic medical records, we investigated patients who had both direct and indirect contact with CDI index patients. The primary outcome was secondary CDI transmission, identified by whole-genome sequencing. Among 909 direct and 2,711 indirect contact cases, 2 instances of secondary transmission were observed (2 [0.05%] of 3,620 cases), 1 transmission via direct contact and 1 via environmental sources. A low level of direct contact (113 minutes) was required for secondary CDI transmission. Our findings support the adoption of exhaustive standard preventive measures, including environmental decontamination, rather than contact isolation of CDI patients in nonoutbreak settings.
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Affiliation(s)
- Min Hyung Kim
- Hallym University Dongtan Sacred Heart Hospital, Hwasieong, South Korea (M.H. Kim)
- Yonsei University College of Medicine, Seoul, South Korea (J. Kim, D. Won, H. Lee)
- Yonsei University Yongin Severance Hospital, Yongin, South Korea (H. Ra, S. Jeong, Y.S. Park, H. Kim)
| | - Jaewoong Kim
- Hallym University Dongtan Sacred Heart Hospital, Hwasieong, South Korea (M.H. Kim)
- Yonsei University College of Medicine, Seoul, South Korea (J. Kim, D. Won, H. Lee)
- Yonsei University Yongin Severance Hospital, Yongin, South Korea (H. Ra, S. Jeong, Y.S. Park, H. Kim)
| | - Heejin Ra
- Hallym University Dongtan Sacred Heart Hospital, Hwasieong, South Korea (M.H. Kim)
- Yonsei University College of Medicine, Seoul, South Korea (J. Kim, D. Won, H. Lee)
- Yonsei University Yongin Severance Hospital, Yongin, South Korea (H. Ra, S. Jeong, Y.S. Park, H. Kim)
| | - Sooyeon Jeong
- Hallym University Dongtan Sacred Heart Hospital, Hwasieong, South Korea (M.H. Kim)
- Yonsei University College of Medicine, Seoul, South Korea (J. Kim, D. Won, H. Lee)
- Yonsei University Yongin Severance Hospital, Yongin, South Korea (H. Ra, S. Jeong, Y.S. Park, H. Kim)
| | - Yoon Soo Park
- Hallym University Dongtan Sacred Heart Hospital, Hwasieong, South Korea (M.H. Kim)
- Yonsei University College of Medicine, Seoul, South Korea (J. Kim, D. Won, H. Lee)
- Yonsei University Yongin Severance Hospital, Yongin, South Korea (H. Ra, S. Jeong, Y.S. Park, H. Kim)
| | - Dongju Won
- Hallym University Dongtan Sacred Heart Hospital, Hwasieong, South Korea (M.H. Kim)
- Yonsei University College of Medicine, Seoul, South Korea (J. Kim, D. Won, H. Lee)
- Yonsei University Yongin Severance Hospital, Yongin, South Korea (H. Ra, S. Jeong, Y.S. Park, H. Kim)
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Keskin S, Emecen AN, Ergör A. Infection Risk Prediction in Healthcare Settings: Lessons from COVID-19 Contact Tracing. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2024; 6:44-54. [PMID: 38633443 PMCID: PMC11019727 DOI: 10.36519/idcm.2024.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/19/2024] [Indexed: 04/19/2024]
Abstract
Objective Contact tracing aids epidemic control by enabling early detection and isolation without overburdening healthcare systems despite potential challenges. This study aimed to evaluate the practical application of contact and risk assessment-based models in predicting SARS-CoV-2 infection following exposure among healthcare workers in a large tertiary public university hospital in Türkiye. Materials and Methods The study was designed as a retrospective cohort study, including contact tracing data from 3389 exposed healthcare workers from March 23, 2020, to October 22, 2021. Contact-based (mask use, contact duration and distance) and exposure risk-assessment-based (low, medium, high-risk) models with and without having symptoms were generated using logistic regression. SARS-CoV-2 infection was defined as having a positive SARS-CoV-2 RT-PCR test result. Adjustments were made to the models for demographic and occupational variables, previous infection, and vaccination. Model parameters were compared. Results Of 3389 exposed healthcare workers, 2451 underwent RT-PCR testing. Among those tested, RT-PCR positivity was 5.9% (144/2451). Lack of personal protective equipment use (odds ratio [OR]=1.64, 95% confidence interval [CI]=1.03-2.66) and ≥15 minutes of contact duration (1.89, 1.21-3.09) were significantly associated with RT-PCR positivity. In the risk-assessment model, being a high-risk contact increased the odds of RT-PCR positivity (OR=2.76, 95% CI=1.61-5.03). Adding the presence of symptoms to contact-based and risk assessment models improved model parameters (Akaike information criterion [AIC]: from 1086.1 to 1083.1; Tjur's R2: from 0.016 to 0.019, respectively). Conclusion The inclusion of being symptomatic improved the contact-based and risk assessment-based models. Institutions should be encouraged to incorporate symptom inquiries into risk assessment protocols in response to newly emerging respiratory virus epidemics. Institutions lacking the capacity for extensive contact tracing are recommended, at minimum, to track symptomatic exposed workers for epidemic control.
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Affiliation(s)
- Salih Keskin
- Department of Public Health, Dokuz Eylül University School of Medicine, İzmir, Türkiye
| | - Ahmet Naci Emecen
- Dokuz Eylül University Research and Application Hospital, İzmir, Türkiye
| | - Alp Ergör
- Department of Public Health, Dokuz Eylül University School of Medicine, İzmir, Türkiye
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He K, Foerster S, Vora NM, Blaney K, Keeley C, Hendricks L, Varma JK, Long T, Shaman J, Pei S. Evaluating completion rates of COVID-19 contact tracing surveys in New York City. BMC Public Health 2024; 24:414. [PMID: 38331772 PMCID: PMC10854191 DOI: 10.1186/s12889-024-17920-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
IMPORTANCE Contact tracing is the process of identifying people who have recently been in contact with someone diagnosed with an infectious disease. During an outbreak, data collected from contact tracing can inform interventions to reduce the spread of infectious diseases. Understanding factors associated with completion rates of contact tracing surveys can help design improved interview protocols for ongoing and future programs. OBJECTIVE To identify factors associated with completion rates of COVID-19 contact tracing surveys in New York City (NYC) and evaluate the utility of a predictive model to improve completion rates, we analyze laboratory-confirmed and probable COVID-19 cases and their self-reported contacts in NYC from October 1st 2020 to May 10th 2021. METHODS We analyzed 742,807 case investigation calls made during the study period. Using a log-binomial regression model, we examined the impact of age, time of day of phone call, and zip code-level demographic and socioeconomic factors on interview completion rates. We further developed a random forest model to predict the best phone call time and performed a counterfactual analysis to evaluate the change of completion rates if the predicative model were used. RESULTS The percentage of contact tracing surveys that were completed was 79.4%, with substantial variations across ZIP code areas. Using a log-binomial regression model, we found that the age of index case (an individual who has tested positive through PCR or antigen testing and is thus subjected to a case investigation) had a significant effect on the completion of case investigation - compared with young adults (the reference group,24 years old < age < = 65 years old), the completion rate for seniors (age > 65 years old) were lower by 12.1% (95%CI: 11.1% - 13.3%), and the completion rate for youth group (age < = 24 years old) were lower by 1.6% (95%CI: 0.6% -2.6%). In addition, phone calls made from 6 to 9 pm had a 4.1% (95% CI: 1.8% - 6.3%) higher completion rate compared with the reference group of phone calls attempted from 12 and 3 pm. We further used a random forest algorithm to assess its potential utility for selecting the time of day of phone call. In counterfactual simulations, the overall completion rate in NYC was marginally improved by 1.2%; however, certain ZIP code areas had improvements up to 7.8%. CONCLUSION These findings suggest that age and time of day of phone call were associated with completion rates of case investigations. It is possible to develop predictive models to estimate better phone call time for improving completion rates in certain communities.
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Affiliation(s)
- Kaiyu He
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Steffen Foerster
- New York City Department of Health and Mental Hygiene (DOHMH), Long Island City, NY, 11001, USA
| | - Neil M Vora
- New York City Department of Health and Mental Hygiene (DOHMH), Long Island City, NY, 11001, USA
| | - Kathleen Blaney
- New York City Department of Health and Mental Hygiene (DOHMH), Long Island City, NY, 11001, USA
| | | | | | - Jay K Varma
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Theodore Long
- NYC Health + Hospitals, New York, NY, USA
- Department of Population Health, New York University, New York, NY, 10016, USA
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
- Columbia Climate School, Columbia University, New York, NY, 10025, USA
| | - Sen Pei
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA.
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Aung AH, Li AL, Kyaw WM, Khanna R, Lim WY, Ang H, Chow ALP. Harnessing a real-time location system for contact tracing in a busy emergency department. J Hosp Infect 2023; 141:63-70. [PMID: 37660888 DOI: 10.1016/j.jhin.2023.08.015] [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: 04/27/2023] [Revised: 07/31/2023] [Accepted: 08/12/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND With the persistent threat of emerging infectious diseases (EIDs), digital contact tracing (CT) tools can augment conventional CT for the prevention of healthcare-associated infectious disease transmission. However, their performance has yet to be evaluated comprehensively in the fast-paced emergency department (ED) setting. OBJECTIVE This study compared the CT performance of a radiofrequency identification (RFID)-based real-time location system (RTLS) with conventional electronic medical record (EMR) review against continuous direct observation of close contacts ('gold standard') in a busy ED during the coronavirus disease 2019 pandemic period. METHODS This cross-sectional study was conducted at the ED of a large tertiary care hospital in Singapore from December 2020 to April 2021. CT performance [sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and kappa] of the RTLS, EMR review and a combination of the two approaches (hybrid CT) was compared with direct observation. Finally, the mean absolute error (MAE) in the duration of each contact episode found via the RTLS and direct observation was calculated. RESULTS In comparison with EMR review, both the RTLS and the hybrid CT approach had higher sensitivity (0.955 vs 0.455 for EMR review) and a higher NPV (0.997 vs 0.968 for EMR review). The RTLS had the highest PPV (0.777 vs 0.714 for EMR review vs 0.712 for hybrid CT). The RTLS had the strongest agreement with direct observation (kappa=0.848). The MAE between contact durations of 80 direct observations and their respective RTLS contact times was 1.81 min. CONCLUSION The RTLS was validated to be a high-performing CT tool, with significantly higher sensitivity than conventional CT via EMR review. The RTLS can be used with confidence in time-strapped EDs for time-sensitive CT for the prevention of healthcare-associated transmission of EIDs.
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Affiliation(s)
- A H Aung
- Department of Preventive and Population Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
| | - A L Li
- Department of Preventive and Population Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - W M Kyaw
- Department of Preventive and Population Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - R Khanna
- Department of Preventive and Population Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - W-Y Lim
- Department of Preventive and Population Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - H Ang
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - A L P Chow
- Department of Preventive and Population Medicine, Tan Tock Seng Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Singapore, Singapore; Infectious Disease Research and Training Office, National Centre for Infectious Disease, Singapore, Singapore; Saw Swee Hock School of Public Health, Singapore, Singapore
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Zhang Z, Vaghefi I. Continued Use of Contact-Tracing Apps in the United States and the United Kingdom: Insights From a Comparative Study Through the Lens of the Health Belief Model. JMIR Form Res 2022; 6:e40302. [PMID: 36351080 DOI: 10.2196/40302] [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: 06/14/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To contain the spread of SARS-CoV-2, contact-tracing (CT) mobile apps were developed and deployed to identify and notify individuals who have exposure to the virus. However, the effectiveness of these apps depends not only on their adoption by the general population but also on their continued use in the long term. Limited research has investigated the facilitators of and barriers to the continued use of CT apps. OBJECTIVE In this study, we aimed to examine factors influencing the continued use intentions of CT apps based on the health belief model. In addition, we investigated the differences between users and nonusers and between the US and UK populations. METHODS We administered a survey in the United States and the United Kingdom. Respondents included individuals who had previously used CT technologies and those without experience. We used the structural equation modeling technique to validate the proposed research model and hypotheses. RESULTS Analysis of data collected from 362 individuals showed that perceived benefits, self-efficacy, perceived severity, perceived susceptibility, and cues to action positively predicted the continued use intentions of CT apps, while perceived barriers could reduce them. We observed few differences between the US and UK groups; the only exception was the effect of COVID-19 threat susceptibility, which was significant for the UK group but not for the US group. Finally, we found that the only significant difference between users and nonusers was related to perceived barriers, which may not influence nonusers' continued use intentions but significantly reduce experienced users' intentions. CONCLUSIONS Our findings have implications for technological design and policy. These insights can potentially help governments, technology companies, and media outlets to create strategies and policies to promote app adoption for new users and sustain continued use for existing users in the long run.
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Affiliation(s)
- Zhan Zhang
- School of Computer Science and Information Systems, Pace University, New York, NY, United States
| | - Isaac Vaghefi
- Zicklin School of Business, Baruch College, City University of New York, New York, NY, United States
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Liu TJ, Tokita HK, Simon BA. An Enhanced Ambulatory Surgery Experience for Patients with Cancer Through End-to-End Patient Engagement. Adv Anesth 2022; 40:33-44. [PMID: 36333050 DOI: 10.1016/j.aan.2022.07.001] [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] [Indexed: 11/05/2022]
Abstract
Ambulatory surgery centers (ASC) serve an important role for hospital systems of increasing operating capacity and offloading patient volume. When seeking to perform more complex cancer surgeries at an ASC, a systematic approach with care pathways can yield success by facilitating quick recovery for patients and reducing complication rates. End-to-end patient engagement is a key component of patient-centered care at the Josie Robertson Surgery Center and begins the moment the decision to have surgery is made and extends to the postdischarge period to track recovery. Engagement includes comprehensive education, standardization of processes, and setting clear expectations for recovery and discharge.
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Affiliation(s)
- Todd J Liu
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, M-309, New York, NY 10065, USA.
| | - Hanae K Tokita
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1133 York Avenue, New York, NY 10065, USA
| | - Brett A Simon
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1133 York Avenue, New York, NY 10065, USA
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7
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Cannaby AM, Carter V, Strobel S, Tafti EA. Measuring nursing movements using real time tracking data at the Royal Wolverhampton Hospital Trust. Spat Spatiotemporal Epidemiol 2022; 43:100543. [PMID: 36460450 DOI: 10.1016/j.sste.2022.100543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Real time location systems (RTLS) are increasingly used in healthcare with applications that include contract tracing and staffing. However, their potential to provide organizational insights requires staff compliance with the system. MATERIALS AND METHODS Our goal is to assess how many nurses are using the RTLS correctly (i.e. complying to the system). We collect RTLS data on the movements of nurses at the Royal Wolverhampton NHS Trust. We identify the number of RTLS active nurses and compare it to what expected from the nurses' rotas. RESULTS We find that a significant number of nurses appear not to be active from the RTLS data. For approximately 15% of the active users, RTLS records below 10 movements per day. Nevertheless, most of the active users have daily RTLS times consistent with the average shift length. CONCLUSION Applications of RTLS data may need to account for imperfect compliance of staff to the system.
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Affiliation(s)
| | - Vanda Carter
- The Royal Wolverhampton Hospital NHS Trust, United Kingdom
| | | | - Elena Ashtari Tafti
- Institute of Fiscal Studies and Department of Economics, University College London, London, United Kingdom
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Ng GY, Ong BC. Contact tracing using real-time location system (RTLS): a simulation exercise in a tertiary hospital in Singapore. BMJ Open 2022; 12:e057522. [PMID: 36192104 PMCID: PMC9535253 DOI: 10.1136/bmjopen-2021-057522] [Citation(s) in RCA: 0] [Impact Index Per Article: 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
OBJECTIVE We aim to assess the effectiveness of contact tracing using real-time location system (RTLS) compared with the conventional (electronic medical records (EMRs)) method via an emerging infectious disease (EID) outbreak simulation exercise. The aims of the study are: (1) to compare the time taken to perform contact tracing and list of contacts identified for RTLS versus EMR; (2) to compare manpower and manpower-hours required to perform contact tracing for RTLS versus EMR; and (3) to extrapolate the cost incurred by RTLS versus EMR. DESIGN Prospective case study. SETTING Sengkang General Hospital, a 1000-bedded public tertiary hospital in Singapore. PARTICIPANTS 1000 out of 4000 staff wore staff tags in this study. INTERVENTIONS A simulation exercise to determine and compare the list of contacts, time taken, manpower and manpower-hours required between RTLS and conventional methods of contact tracing. Cost of both methods were compared. PRIMARY AND SECONDARY OUTCOME MEASURES List of contacts, time taken, manpower required, manpower-hours required and cost incurred. RESULTS RTLS identified almost three times the number of contacts compared with conventional methods, while achieving that with a 96.2% reduction in time taken, 97.6% reduction in manpower required and 97.5% reduction in manpower-hours required. However, RTLS incurred significant equipment cost and might take many contact tracing episodes before providing economic benefit. CONCLUSION Although costly, RTLS is effective in contact tracing. RLTS might not be ready at present time to replace conventional methods, but with further refinement, RTLS has the potential to be the gold standard in contact tracing methods of the future, particularly in the current pandemic.
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Myall A, Price JR, Peach RL, Abbas M, Mookerjee S, Zhu N, Ahmad I, Ming D, Ramzan F, Teixeira D, Graf C, Weiße AY, Harbarth S, Holmes A, Barahona M. Prediction of hospital-onset COVID-19 infections using dynamic networks of patient contact: an international retrospective cohort study. Lancet Digit Health 2022; 4:e573-e583. [PMID: 35868812 PMCID: PMC9296105 DOI: 10.1016/s2589-7500(22)00093-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 03/19/2022] [Accepted: 04/25/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Real-time prediction is key to prevention and control of infections associated with health-care settings. Contacts enable spread of many infections, yet most risk prediction frameworks fail to account for their dynamics. We developed, tested, and internationally validated a real-time machine-learning framework, incorporating dynamic patient-contact networks to predict hospital-onset COVID-19 infections (HOCIs) at the individual level. METHODS We report an international retrospective cohort study of our framework, which extracted patient-contact networks from routine hospital data and combined network-derived variables with clinical and contextual information to predict individual infection risk. We trained and tested the framework on HOCIs using the data from 51 157 hospital inpatients admitted to a UK National Health Service hospital group (Imperial College Healthcare NHS Trust) between April 1, 2020, and April 1, 2021, intersecting the first two COVID-19 surges. We validated the framework using data from a Swiss hospital group (Department of Rehabilitation, Geneva University Hospitals) during a COVID-19 surge (from March 1 to May 31, 2020; 40 057 inpatients) and from the same UK group after COVID-19 surges (from April 2 to Aug 13, 2021; 43 375 inpatients). All inpatients with a bed allocation during the study periods were included in the computation of network-derived and contextual variables. In predicting patient-level HOCI risk, only inpatients spending 3 or more days in hospital during the study period were examined for HOCI acquisition risk. FINDINGS The framework was highly predictive across test data with all variable types (area under the curve [AUC]-receiver operating characteristic curve [ROC] 0·89 [95% CI 0·88-0·90]) and similarly predictive using only contact-network variables (0·88 [0·86-0·90]). Prediction was reduced when using only hospital contextual (AUC-ROC 0·82 [95% CI 0·80-0·84]) or patient clinical (0·64 [0·62-0·66]) variables. A model with only three variables (ie, network closeness, direct contacts with infectious patients [network derived], and hospital COVID-19 prevalence [hospital contextual]) achieved AUC-ROC 0·85 (95% CI 0·82-0·88). Incorporating contact-network variables improved performance across both validation datasets (AUC-ROC in the Geneva dataset increased from 0·84 [95% CI 0·82-0·86] to 0·88 [0·86-0·90]; AUC-ROC in the UK post-surge dataset increased from 0·49 [0·46-0·52] to 0·68 [0·64-0·70]). INTERPRETATION Dynamic contact networks are robust predictors of individual patient risk of HOCIs. Their integration in clinical care could enhance individualised infection prevention and early diagnosis of COVID-19 and other nosocomial infections. FUNDING Medical Research Foundation, WHO, Engineering and Physical Sciences Research Council, National Institute for Health Research (NIHR), Swiss National Science Foundation, and German Research Foundation.
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Affiliation(s)
- Ashleigh Myall
- Department of Infectious Disease, Imperial College London, London, UK; Department of Mathematics, Imperial College London, London, UK; National Institute for Health Research Health Protection Research Unit in HCAI and AMR, Imperial College London, London, UK.
| | - James R Price
- National Institute for Health Research Health Protection Research Unit in HCAI and AMR, Imperial College London, London, UK; Imperial College Healthcare NHS Trust, Imperial College London, London, UK
| | - Robert L Peach
- Department of Mathematics, Imperial College London, London, UK; Department of Brain Sciences, Imperial College London, London, UK; Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Mohamed Abbas
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK; Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland
| | - Sid Mookerjee
- National Institute for Health Research Health Protection Research Unit in HCAI and AMR, Imperial College London, London, UK; Imperial College Healthcare NHS Trust, Imperial College London, London, UK
| | - Nina Zhu
- Department of Infectious Disease, Imperial College London, London, UK; National Institute for Health Research Health Protection Research Unit in HCAI and AMR, Imperial College London, London, UK
| | - Isa Ahmad
- Department of Infectious Disease, Imperial College London, London, UK; National Institute for Health Research Health Protection Research Unit in HCAI and AMR, Imperial College London, London, UK
| | - Damien Ming
- Department of Infectious Disease, Imperial College London, London, UK; National Institute for Health Research Health Protection Research Unit in HCAI and AMR, Imperial College London, London, UK
| | - Farzan Ramzan
- Department of Infectious Disease, Imperial College London, London, UK; National Institute for Health Research Health Protection Research Unit in HCAI and AMR, Imperial College London, London, UK
| | - Daniel Teixeira
- Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Graf
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Andrea Y Weiße
- School of Biological Sciences and School of Informatics, University of Edinburgh, Edinburgh, UK
| | - Stephan Harbarth
- Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland
| | - Alison Holmes
- Department of Infectious Disease, Imperial College London, London, UK; National Institute for Health Research Health Protection Research Unit in HCAI and AMR, Imperial College London, London, UK
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Kim MH, Ryu UH, Heo SJ, Kim YC, Park YS. Potential Role of an Adjunctive Real Time Locating System in Preventing Secondary Transmission of SARS-CoV-2 in a Hospital Environment: A Retrospective Case-control Study (Preprint). J Med Internet Res 2022; 24:e41395. [PMID: 36197844 PMCID: PMC9580994 DOI: 10.2196/41395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/09/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Min Hyung Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Un Hyoung Ryu
- Division of Planning and Management, Office of Medical Information Technology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Chan Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Yoon Soo Park
- Division of Infectious Diseases, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Republic of Korea
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Francombe J, Ali GC, Gloinson ER, Feijao C, Morley KI, Gunashekar S, de Carvalho Gomes H. Assessing the Implementation of Digital Innovations in Response to the COVID-19 Pandemic to Address Key Public Health Functions: Scoping Review of Academic and Nonacademic Literature. JMIR Public Health Surveill 2022; 8:e34605. [PMID: 35605152 PMCID: PMC9301563 DOI: 10.2196/34605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/01/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background Digital technologies have been central to efforts to respond to the COVID-19 pandemic. In this context, a range of literature has reported on developments regarding the implementation of new digital technologies for COVID-19–related surveillance, prevention, and control. Objective In this study, scoping reviews of academic and nonacademic literature were undertaken to obtain an overview of the evidence regarding digital innovations implemented to address key public health functions in the context of the COVID-19 pandemic. This study aimed to expand on the work of existing reviews by drawing on additional data sources (including nonacademic sources) by considering literature published over a longer time frame and analyzing data in terms of the number of unique digital innovations. Methods We conducted a scoping review of the academic literature published between January 1, 2020, and September 15, 2020, supplemented by a further scoping review of selected nonacademic literature published between January 1, 2020, and October 13, 2020. Both reviews followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach. Results A total of 226 academic articles and 406 nonacademic articles were included. The included articles provided evidence of 561 (academic literature) and 497 (nonacademic literature) unique digital innovations. The most common implementation settings for digital innovations were the United States, China, India, and the United Kingdom. Technologies most commonly used by digital innovations were those belonging to the high-level technology group of integrated and ubiquitous fixed and mobile networks. The key public health functions most commonly addressed by digital innovations were communication and collaboration and surveillance and monitoring. Conclusions Digital innovations implemented in response to the COVID-19 pandemic have been wide ranging in terms of their implementation settings, the digital technologies used, and the public health functions addressed. However, evidence gathered through this study also points to a range of barriers that have affected the successful implementation of digital technologies for public health functions. It is also evident that many digital innovations implemented in response to the COVID-19 pandemic are yet to be formally evaluated or assessed.
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12
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Geary U, Ward ME, Callan V, McDonald N, Corrigan S. A socio-technical systems analysis of the application of RFID-enabled technology to the transport of precious laboratory samples in a large acute teaching hospital. APPLIED ERGONOMICS 2022; 102:103759. [PMID: 35413577 DOI: 10.1016/j.apergo.2022.103759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/23/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
The scale and pace of improvement in patient safety in healthcare has been unacceptably slow. A paucity of research into the application of systems-thinking concepts and a failure to appreciate health systems complexity are cited as barriers to sustainable health systems improvement. This study reports on a socio-technical systems analysis, called the CUBE, of the characteristics of a large acute teaching hospital's system for the transport of precious specimens, a system enabled by radio-frequency identification tracking technology. The CUBE proved itself to be an effective analytic tool. The analysis provided a constructive framework to link diverse data and documentation; explicitly inviting consideration of the roles and understandings of different stakeholders; as well as broader cultural factors that could influence current or future activity. The analysis also supported recommendations to improve and extend operations. This study supports the argument for systems understanding and systems thinking being at the core of new approaches to patient safety.
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Affiliation(s)
- Una Geary
- Quality and Safety Improvement Directorate, St James's Hospital, Dublin 8, D08 NHY1, Ireland.
| | - Marie E Ward
- Quality and Safety Improvement Directorate, St James's Hospital, Dublin 8, D08 NHY1, Ireland; Centre for Innovative Human Systems, Trinity College Dublin, Dublin 2, D02 PN40, Ireland.
| | - Vincent Callan
- Facilities Management, St James's Hospital, Dublin 8, D08 NHY1, Ireland.
| | - Nick McDonald
- Centre for Innovative Human Systems, Trinity College Dublin, Dublin 2, D02 PN40, Ireland.
| | - Siobhán Corrigan
- Centre for Innovative Human Systems, Trinity College Dublin, Dublin 2, D02 PN40, Ireland.
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13
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Vilendrer S, Lough ME, Garvert DW, Lambert MH, Lu JH, Patel B, Shah NH, Williams MY, Kling SMR. Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: Observational Study Using a Real-Time Locating System. J Med Internet Res 2022; 24:e36882. [PMID: 35635840 PMCID: PMC9208574 DOI: 10.2196/36882] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/13/2022] [Accepted: 05/11/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic prompted widespread implementation of telehealth, including in the inpatient setting, with the goals to reduce potential pathogen exposure events and personal protective equipment (PPE) utilization. Nursing workflow adaptations in these novel environments are of particular interest given the association between nursing time at the bedside and patient safety. Understanding the frequency and duration of nurse-patient encounters following the introduction of a novel telehealth platform in the context of COVID-19 may therefore provide insight into downstream impacts on patient safety, pathogen exposure, and PPE utilization. OBJECTIVE The aim of this study was to evaluate changes in nursing workflow relative to prepandemic levels using a real-time locating system (RTLS) following the deployment of inpatient telehealth on a COVID-19 unit. METHODS In March 2020, telehealth was installed in patient rooms in a COVID-19 unit and on movable carts in 3 comparison units. The existing RTLS captured nurse movement during 1 pre- and 5 postpandemic stages (January-December 2020). Change in direct nurse-patient encounters, time spent in patient rooms per encounter, and total time spent with patients per shift relative to baseline were calculated. Generalized linear models assessed difference-in-differences in outcomes between COVID-19 and comparison units. Telehealth adoption was captured and reported at the unit level. RESULTS Change in frequency of encounters and time spent per encounter from baseline differed between the COVID-19 and comparison units at all stages of the pandemic (all P<.001). Frequency of encounters decreased (difference-in-differences range -6.6 to -14.1 encounters) and duration of encounters increased (difference-in-differences range 1.8 to 6.2 minutes) from baseline to a greater extent in the COVID-19 units relative to the comparison units. At most stages of the pandemic, the change in total time nurses spent in patient rooms per patient per shift from baseline did not differ between the COVID-19 and comparison units (all P>.17). The primary COVID-19 unit quickly adopted telehealth technology during the observation period, initiating 15,088 encounters that averaged 6.6 minutes (SD 13.6) each. CONCLUSIONS RTLS movement data suggest that total nursing time at the bedside remained unchanged following the deployment of inpatient telehealth in a COVID-19 unit. Compared to other units with shared mobile telehealth units, the frequency of nurse-patient in-person encounters decreased and the duration lengthened on a COVID-19 unit with in-room telehealth availability, indicating "batched" redistribution of work to maintain total time at bedside relative to prepandemic periods. The simultaneous adoption of telehealth suggests that virtual care was a complement to, rather than a replacement for, in-person care. However, study limitations preclude our ability to draw a causal link between nursing workflow change and telehealth adoption. Thus, further evaluation is needed to determine potential downstream implications on disease transmission, PPE utilization, and patient safety.
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Affiliation(s)
- Stacie Vilendrer
- Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Mary E Lough
- Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Office of Research Patient Care Services, Stanford Health Care, Palo Alto, CA, United States
| | - Donn W Garvert
- Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Monique H Lambert
- Office of Research Patient Care Services, Stanford Health Care, Palo Alto, CA, United States
| | - Jonathan Hsijing Lu
- Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Birju Patel
- Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Nigam H Shah
- Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Michelle Y Williams
- Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Office of Research Patient Care Services, Stanford Health Care, Palo Alto, CA, United States
| | - Samantha M R Kling
- Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
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14
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Zhu X, Tao Y, Zhu R, Wu D, Ming WK. Impact of Hospital Characteristics and Governance Structure on the Adoption of Tracking Technologies for Clinical and Supply Chain Use: Longitudinal Study of US Hospitals. J Med Internet Res 2022; 24:e33742. [PMID: 35617002 PMCID: PMC9185348 DOI: 10.2196/33742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/14/2021] [Accepted: 04/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Despite the increasing adoption rate of tracking technologies in hospitals in the United States, few empirical studies have examined the factors involved in such adoption within different use contexts (eg, clinical and supply chain use contexts). To date, no study has systematically examined how governance structures impact technology adoption in different use contexts in hospitals. Given that the hospital governance structure fundamentally governs health care workflows and operations, understanding its critical role provides a solid foundation from which to explore factors involved in the adoption of tracking technologies in hospitals. Objective This study aims to compare critical factors associated with the adoption of tracking technologies for clinical and supply chain uses and examine how governance structure types affect the adoption of tracking technologies in hospitals. Methods This study was conducted based on a comprehensive and longitudinal national census data set comprising 3623 unique hospitals across 50 states in the United States from 2012 to 2015. Using mixed effects population logistic regression models to account for the effects within and between hospitals, we captured and examined the effects of hospital characteristics, locations, and governance structure on adjustments to the innate development of tracking technology over time. Results From 2012 to 2015, we discovered that the proportion of hospitals in which tracking technologies were fully implemented for clinical use increased from 36.34% (782/2152) to 54.63% (1316/2409), and that for supply chain use increased from 28.58% (615/2152) to 41.3% (995/2409). We also discovered that adoption factors impact the clinical and supply chain use contexts differently. In the clinical use context, compared with hospitals located in urban areas, hospitals in rural areas (odds ratio [OR] 0.68, 95% CI 0.56-0.80) are less likely to fully adopt tracking technologies. In the context of supply chain use, the type of governance structure influences tracking technology adoption. Compared with hospitals not affiliated with a health system, implementation rates increased as hospitals affiliated with a more centralized health system—1.9-fold increase (OR 1.87, 95% CI 1.60-2.13) for decentralized or independent hospitals, 2.4-fold increase (OR 2.40, 95% CI 2.07-2.80) for moderately centralized health systems, and 3.1-fold increase for centralized health systems (OR 3.07, 95% CI 2.67-3.53). Conclusions As the first of such type of studies, we provided a longitudinal overview of how hospital characteristics and governance structure jointly affect adoption rates of tracking technology in both clinical and supply chain use contexts, which is essential for developing intelligent infrastructure for smart hospital systems. This study informs researchers, health care providers, and policy makers that hospital characteristics, locations, and governance structures have different impacts on the adoption of tracking technologies for clinical and supply chain use and on health resource disparities among hospitals of different sizes, locations, and governance structures.
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Affiliation(s)
- Xiao Zhu
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China
| | - Youyou Tao
- Department of Information Systems and Business Analytics, College of Business Administration, Loyola Marymount University, Los Angeles, CA, United States
| | - Ruilin Zhu
- Management Science Department, Lancaster University Management School, Lancaster University, Lancaster, United Kingdom
| | - Dezhi Wu
- Department of Integrated Information Technology, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, Hong Kong
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15
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Mei Y, Guo X, Chen Z, Chen Y. An Effective Mechanism for the Early Detection and Containment of Healthcare Worker Infections in the Setting of the COVID-19 Pandemic: A Systematic Review and Meta-Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105943. [PMID: 35627479 PMCID: PMC9141359 DOI: 10.3390/ijerph19105943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023]
Abstract
The COVID-19 pandemic has exposed healthcare workers (HCWs) to serious infection risks. In this context, the proactive monitoring of HCWs is the first step toward reducing intrahospital transmissions and safeguarding the HCW population, as well as reflecting the preparedness and response of the healthcare system. As such, this study systematically reviewed the literature on evidence-based effective monitoring measures for HCWs during the COVID-19 pandemic. This was followed by a meta-synthesis to compile the key findings, thus, providing a clearer overall understanding of the subject. Effective monitoring measures of syndromic surveillance, testing, contact tracing, and exposure management are distilled and further integrated to create a whole-process monitoring workflow framework. Taken together, a mechanism for the early detection and containment of HCW infections is, thus, constituted, providing a composite set of practical recommendations to healthcare facility leadership and policy makers to reduce nosocomial transmission rates while maintaining adequate staff for medical services. In this regard, our study paves the way for future studies aimed at strengthening surveillance capacities and upgrading public health system resilience, in order to respond more efficiently to future pandemic threats.
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Affiliation(s)
- Yueli Mei
- School of Political Science and Public Administration, East China University of Political Science and Law, Shanghai 201620, China; (Y.M.); (X.G.); (Z.C.)
- Shanghai Jiao Tong University-Yale University Joint Center for Health Policy, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xiuyun Guo
- School of Political Science and Public Administration, East China University of Political Science and Law, Shanghai 201620, China; (Y.M.); (X.G.); (Z.C.)
| | - Zhihao Chen
- School of Political Science and Public Administration, East China University of Political Science and Law, Shanghai 201620, China; (Y.M.); (X.G.); (Z.C.)
| | - Yingzhi Chen
- School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
- Correspondence: ; Tel.: +86-135-649-90786
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16
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Murad SS, Yussof S, Badeel R. Wireless Technologies for Social Distancing in the Time of COVID-19: Literature Review, Open Issues, and Limitations. SENSORS 2022; 22:s22062313. [PMID: 35336484 PMCID: PMC8953680 DOI: 10.3390/s22062313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 11/16/2022]
Abstract
This research aims to provide a comprehensive background on social distancing as well as effective technologies that can be used to facilitate the social distancing practice. Scenarios of enabling wireless and emerging technologies are presented, which are especially effective in monitoring and keeping distance amongst people. In addition, detailed taxonomy is proposed summarizing the essential elements such as implementation type, scenarios, and technology being used. This research reviews and analyzes existing social distancing studies that focus on employing different kinds of technologies to fight the Coronavirus disease (COVID-19) pandemic. This study main goal is to identify and discuss the issues, challenges, weaknesses and limitations found in the existing models and/or systems to provide a clear understanding of the area. Articles were systematically collected and filtered based on certain criteria and within ten years span. The findings of this study will support future researchers and developers to solve specific issues and challenges, fill research gaps, and improve social distancing systems to fight pandemics similar to COVID-19.
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Affiliation(s)
- Sallar Salam Murad
- Institute of Informatics and Computing in Energy, University Tenaga Nasional, Kajang 43000, Malaysia;
- Correspondence:
| | - Salman Yussof
- Institute of Informatics and Computing in Energy, University Tenaga Nasional, Kajang 43000, Malaysia;
| | - Rozin Badeel
- Department of Network, Parallel & Distributed Computing, University Putra Malaysia, Seri Kembangan 43400, Malaysia;
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17
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Alo UR, Nkwo FO, Nweke HF, Achi II, Okemiri HA. Non-Pharmaceutical Interventions against COVID-19 Pandemic: Review of Contact Tracing and Social Distancing Technologies, Protocols, Apps, Security and Open Research Directions. SENSORS (BASEL, SWITZERLAND) 2021; 22:280. [PMID: 35009822 PMCID: PMC8749862 DOI: 10.3390/s22010280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/17/2022]
Abstract
The COVID-19 Pandemic has punched a devastating blow on the majority of the world's population. Millions of people have been infected while hundreds of thousands have died of the disease throwing many families into mourning and other psychological torments. It has also crippled the economy of many countries of the world leading to job losses, high inflation, and dwindling Gross Domestic Product (GDP). The duo of social distancing and contact tracing are the major technological-based non-pharmaceutical public health intervention strategies adopted for combating the dreaded disease. These technologies have been deployed by different countries around the world to achieve effective and efficient means of maintaining appropriate distance and tracking the transmission pattern of the diseases or identifying those at high risk of infecting others. This paper aims to synthesize the research efforts on contact tracing and social distancing to minimize the spread of COVID-19. The paper critically and comprehensively reviews contact tracing technologies, protocols, and mobile applications (apps) that were recently developed and deployed against the coronavirus disease. Furthermore, the paper discusses social distancing technologies, appropriate methods to maintain distances, regulations, isolation/quarantine, and interaction strategies. In addition, the paper highlights different security/privacy vulnerabilities identified in contact tracing and social distancing technologies and solutions against these vulnerabilities. We also x-rayed the strengths and weaknesses of the various technologies concerning their application in contact tracing and social distancing. Finally, the paper proposed insightful recommendations and open research directions in contact tracing and social distancing that could assist researchers, developers, and governments in implementing new technological methods to combat the menace of COVID-19.
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Affiliation(s)
- Uzoma Rita Alo
- Department of Computer Science and Informatics, Alex Ekwueme Federal University, Ndufu-Alike, Ikwo P.M.B 1010, Abakaliki 480211, Ebonyi State, Nigeria; (F.O.N.); (I.I.A.); (H.A.O.)
| | - Friday Onwe Nkwo
- Department of Computer Science and Informatics, Alex Ekwueme Federal University, Ndufu-Alike, Ikwo P.M.B 1010, Abakaliki 480211, Ebonyi State, Nigeria; (F.O.N.); (I.I.A.); (H.A.O.)
| | - Henry Friday Nweke
- Centre for Research in Machine Learning, Artificial Intelligence and Network Systems, Computer Science Department, Ebonyi State University, P.M.B 053, Abakaliki 480211, Ebonyi State, Nigeria;
| | - Ifeanyi Isaiah Achi
- Department of Computer Science and Informatics, Alex Ekwueme Federal University, Ndufu-Alike, Ikwo P.M.B 1010, Abakaliki 480211, Ebonyi State, Nigeria; (F.O.N.); (I.I.A.); (H.A.O.)
| | - Henry Anayo Okemiri
- Department of Computer Science and Informatics, Alex Ekwueme Federal University, Ndufu-Alike, Ikwo P.M.B 1010, Abakaliki 480211, Ebonyi State, Nigeria; (F.O.N.); (I.I.A.); (H.A.O.)
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Phatak AA, Wieland FG, Vempala K, Volkmar F, Memmert D. Artificial Intelligence Based Body Sensor Network Framework-Narrative Review: Proposing an End-to-End Framework using Wearable Sensors, Real-Time Location Systems and Artificial Intelligence/Machine Learning Algorithms for Data Collection, Data Mining and Knowledge Discovery in Sports and Healthcare. SPORTS MEDICINE - OPEN 2021; 7:79. [PMID: 34716868 PMCID: PMC8556803 DOI: 10.1186/s40798-021-00372-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 10/09/2021] [Indexed: 02/11/2023]
Abstract
With the rising amount of data in the sports and health sectors, a plethora of applications using big data mining have become possible. Multiple frameworks have been proposed to mine, store, preprocess, and analyze physiological vitals data using artificial intelligence and machine learning algorithms. Comparatively, less research has been done to collect potentially high volume, high-quality 'big data' in an organized, time-synchronized, and holistic manner to solve similar problems in multiple fields. Although a large number of data collection devices exist in the form of sensors. They are either highly specialized, univariate and fragmented in nature or exist in a lab setting. The current study aims to propose artificial intelligence-based body sensor network framework (AIBSNF), a framework for strategic use of body sensor networks (BSN), which combines with real-time location system (RTLS) and wearable biosensors to collect multivariate, low noise, and high-fidelity data. This facilitates gathering of time-synchronized location and physiological vitals data, which allows artificial intelligence and machine learning (AI/ML)-based time series analysis. The study gives a brief overview of wearable sensor technology, RTLS, and provides use cases of AI/ML algorithms in the field of sensor fusion. The study also elaborates sample scenarios using a specific sensor network consisting of pressure sensors (insoles), accelerometers, gyroscopes, ECG, EMG, and RTLS position detectors for particular applications in the field of health care and sports. The AIBSNF may provide a solid blueprint for conducting research and development, forming a smooth end-to-end pipeline from data collection using BSN, RTLS and final stage analytics based on AI/ML algorithms.
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Affiliation(s)
- Ashwin A Phatak
- Institute of Exercise Training and Sport Informatics, German Sports University, Cologne, Germany.
| | | | | | - Frederik Volkmar
- Institute of Exercise Training and Sport Informatics, German Sports University, Cologne, Germany
| | - Daniel Memmert
- Institute of Exercise Training and Sport Informatics, German Sports University, Cologne, Germany
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Shelby T, Caruthers T, Kanner OY, Schneider R, Lipnickas D, Grau LE, Manohar R, Niccolai L. Pilot Evaluations of Two Bluetooth Contact Tracing Approaches on a University Campus: Mixed Methods Study. JMIR Form Res 2021; 5:e31086. [PMID: 34586078 PMCID: PMC8555945 DOI: 10.2196/31086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/28/2021] [Accepted: 09/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many have proposed the use of Bluetooth technology to help scale up contact tracing for COVID-19. However, much remains unknown about the accuracy of this technology in real-world settings, the attitudes of potential users, and the differences between delivery formats (mobile app vs carriable or wearable devices). OBJECTIVE We pilot tested 2 separate Bluetooth contact tracing technologies on a university campus to evaluate their sensitivity and specificity, and to learn from the experiences of the participants. METHODS We used a convergent mixed methods study design, and participants included graduate students and researchers working on a university campus during June and July 2020. We conducted separate 2-week pilot studies for each Bluetooth technology. The first was for a mobile phone app ("app pilot"), and the second was for a small electronic "tag" ("tag pilot"). Participants validated a list of Bluetooth-identified contacts daily and reported additional close contacts not identified by Bluetooth. We used these data to estimate sensitivity and specificity. Participants completed a postparticipation survey regarding appropriateness, usability, acceptability, and adherence, and provided additional feedback via free text. We used tests of proportions to evaluate differences in survey responses between participants from each pilot, paired t tests to measure differences between compatible survey questions, and qualitative analysis to evaluate the survey's free-text responses. RESULTS Among 25 participants in the app pilot, 53 contact interactions were identified by Bluetooth and an additional 61 by self-report. Among 17 participants in the tag pilot, 171 contact interactions were identified by Bluetooth and an additional 4 by self-report. The tag had significantly higher sensitivity compared with the app (46/49, 94% vs 35/61, 57%; P<.001), as well as higher specificity (120/126, 95% vs 123/141, 87%; P=.02). Most participants felt that Bluetooth contact tracing was appropriate on campus (26/32, 81%), while significantly fewer participants felt that using other technologies, such as GPS or Wi-Fi, was appropriate (17/31, 55%; P=.02). Most participants preferred technology developed and managed by the university rather than a third party (27/32, 84%) and preferred not to have tracing apps on their personal phones (21/32, 66%), due to "concerns with privacy." There were no significant differences in self-reported adherence rates across pilots. CONCLUSIONS Convenient and carriable Bluetooth technology may improve tracing efficiency while alleviating privacy concerns by shifting data collection away from personal devices. With accuracy comparable to, and in this case, superior to, mobile phone apps, such approaches may be suitable for workplace or school settings with the ability to purchase and maintain physical devices.
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Affiliation(s)
- Tyler Shelby
- Epidemiology of Microbial Diseases Department, Yale School of Public Health, Yale University, New Haven, CT, United States.,Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Tyler Caruthers
- Epidemiology of Microbial Diseases Department, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Oren Y Kanner
- Information and Technology Services, Yale University, New Haven, CT, United States
| | - Rebecca Schneider
- Information and Technology Services, Yale University, New Haven, CT, United States
| | - Dana Lipnickas
- Information and Technology Services, Yale University, New Haven, CT, United States
| | - Lauretta E Grau
- Epidemiology of Microbial Diseases Department, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Rajit Manohar
- Yale School of Engineering and Applied Science, Yale University, New Haven, CT, United States
| | - Linda Niccolai
- Epidemiology of Microbial Diseases Department, Yale School of Public Health, Yale University, New Haven, CT, United States
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20
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Hong P, Herigon JC, Uptegraft C, Samuel B, Brown DL, Bickel J, Hron JD. Use of clinical data to augment healthcare worker contact tracing during the COVID-19 pandemic. J Am Med Inform Assoc 2021; 29:142-148. [PMID: 34623426 DOI: 10.1093/jamia/ocab231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/28/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This work examined the secondary use of clinical data from the electronic health record (EHR) for screening our healthcare worker (HCW) population for potential exposures to patients with coronavirus disease 2019. MATERIALS AND METHODS We conducted a cross-sectional study at a free-standing, quaternary care pediatric hospital comparing first-degree, patient-HCW pairs identified by the hospital's COVID-19 contact tracing team (CTT) to those identified using EHR clinical event data (EHR Report). The primary outcome was the number of patient-HCW pairs detected by each process. RESULTS Among 233 patients with COVID-19, our EHR Report identified 4,116 patient-HCW pairs, including 2,365 (30.0%) of the 7,890 pairs detected by the CTT. The EHR Report also revealed 1,751 pairs not identified by the CTT. The highest number of patient-HCW pairs per patient was detected in the inpatient care venue. Nurses comprised the most frequently identified HCW role overall. CONCLUSION Automated methods to screen HCWs for potential exposure to patients with COVID-19 using clinical event data from the EHR are likely to improve epidemiologic surveillance by contact tracing programs and represent a viable and readily available strategy which should be considered by other institutions.
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Affiliation(s)
- Peter Hong
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua C Herigon
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, USA, Kansas City, Missouri
| | - Colby Uptegraft
- Health Informatics Branch, Defense Health Agency, Falls Church, Virginia, USA
| | - Bassem Samuel
- Information Services Department, Boston Children's Hospital, Boston, Massachusetts, USA
| | - D Levin Brown
- Information Services Department, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jonathan Bickel
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Information Services Department, Boston Children's Hospital, Boston, Massachusetts, USA.,Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jonathan D Hron
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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21
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Thomas Craig KJ, Rizvi R, Willis VC, Kassler WJ, Jackson GP. Effectiveness of Contact Tracing for Viral Disease Mitigation and Suppression: Evidence-Based Review. JMIR Public Health Surveill 2021; 7:e32468. [PMID: 34612841 PMCID: PMC8496751 DOI: 10.2196/32468] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Contact tracing in association with quarantine and isolation is an important public health tool to control outbreaks of infectious diseases. This strategy has been widely implemented during the current COVID-19 pandemic. The effectiveness of this nonpharmaceutical intervention is largely dependent on social interactions within the population and its combination with other interventions. Given the high transmissibility of SARS-CoV-2, short serial intervals, and asymptomatic transmission patterns, the effectiveness of contact tracing for this novel viral agent is largely unknown. OBJECTIVE This study aims to identify and synthesize evidence regarding the effectiveness of contact tracing on infectious viral disease outcomes based on prior scientific literature. METHODS An evidence-based review was conducted to identify studies from the PubMed database, including preprint medRxiv server content, related to the effectiveness of contact tracing in viral outbreaks. The search dates were from database inception to July 24, 2020. Outcomes of interest included measures of incidence, transmission, hospitalization, and mortality. RESULTS Out of 159 unique records retrieved, 45 (28.3%) records were reviewed at the full-text level, and 24 (15.1%) records met all inclusion criteria. The studies included utilized mathematical modeling (n=14), observational (n=8), and systematic review (n=2) approaches. Only 2 studies considered digital contact tracing. Contact tracing was mostly evaluated in combination with other nonpharmaceutical interventions and/or pharmaceutical interventions. Although some degree of effectiveness in decreasing viral disease incidence, transmission, and resulting hospitalizations and mortality was observed, these results were highly dependent on epidemic severity (R0 value), number of contacts traced (including presymptomatic and asymptomatic cases), timeliness, duration, and compliance with combined interventions (eg, isolation, quarantine, and treatment). Contact tracing effectiveness was particularly limited by logistical challenges associated with increased outbreak size and speed of infection spread. CONCLUSIONS Timely deployment of contact tracing strategically layered with other nonpharmaceutical interventions could be an effective public health tool for mitigating and suppressing infectious outbreaks by decreasing viral disease incidence, transmission, and resulting hospitalizations and mortality.
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Affiliation(s)
- Kelly Jean Thomas Craig
- Center for AI, Research, and Evaluation, IBM Watson Health, IBM Corporation, Cambridge, MA, United States
| | - Rubina Rizvi
- Center for AI, Research, and Evaluation, IBM Watson Health, IBM Corporation, Cambridge, MA, United States
| | - Van C Willis
- Center for AI, Research, and Evaluation, IBM Watson Health, IBM Corporation, Cambridge, MA, United States
| | - William J Kassler
- Center for AI, Research, and Evaluation, IBM Watson Health, IBM Corporation, Cambridge, MA, United States
- Palantir Technologies, Denver, CO, United States
| | - Gretchen Purcell Jackson
- Center for AI, Research, and Evaluation, IBM Watson Health, IBM Corporation, Cambridge, MA, United States
- Vanderbilt University Medical Center, Nashville, TN, United States
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22
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Bailie CR, Leung VK, Orr E, Singleton E, Kelly C, Buising KL, Cowie BC, Kirk MD, Sullivan SG, Marshall C. Performance of hospital-based contact tracing for COVID-19 during Australia's second wave. Infect Dis Health 2021; 27:15-22. [PMID: 34563476 PMCID: PMC8457622 DOI: 10.1016/j.idh.2021.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/26/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hospital-based contact tracing aims to limit spread of COVID-19 within healthcare facilities. In large outbreaks, this can stretch resources and workforce due to quarantine of uninfected staff. We analysed the performance of a manual contact tracing system for healthcare workers (HCW) at a multi-site healthcare facility in Melbourne, Australia, from June-September 2020, during an epidemic of COVID-19. METHODS All HCW close contacts were quarantined for 14 days, and tested around day 11, if not already diagnosed with COVID-19. We examined the prevalence and timing of symptoms in cases detected during quarantine, described this group as proportions of all close contacts and of all cases, and used logistic regression to assess factors associated with infection. RESULTS COVID-19 was diagnosed during quarantine in 52 furloughed HCWs, from 483 quarantine episodes (11%), accounting for 19% (52/270) of total HCW cases. In 361 exposures to a clear index case, odds of infection were higher after contact with an infectious patient compared to an infectious HCW (aOR: 4.69, 95% CI: 1.98-12.14). Contact with cases outside the workplace increased odds of infection compared to workplace contact only (aOR: 7.70, 95% CI: 2.63-23.05). We estimated 30%, 78% and 95% of symptomatic cases would develop symptoms by days 3, 7, and 11 of quarantine, respectively. CONCLUSION In our setting, hospital-based contact tracing detected and contained a significant proportion of HCW cases, without excessive quarantine of uninfected staff. Effectiveness of contact tracing is determined by a range of dynamic factors, so system performance should be monitored in real-time.
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Affiliation(s)
- Christopher R Bailie
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra ACT, Australia.
| | - Vivian K Leung
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC, Australia
| | - Elizabeth Orr
- The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Cate Kelly
- The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Kirsty L Buising
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia; Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Benjamin C Cowie
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia; Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia
| | - Martyn D Kirk
- National Centre for Epidemiology and Population Health, Australian National University, Canberra ACT, Australia
| | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC, Australia; Doherty Department, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC, Australia
| | - Caroline Marshall
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia; Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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23
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Occupational Health and Safety Measures in Healthcare Settings during COVID-19: Strategies for Protecting Staff, Patients and Visitors. Disaster Med Public Health Prep 2021; 17:e48. [PMID: 34517932 PMCID: PMC8523969 DOI: 10.1017/dmp.2021.294] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The COVID-19 (SARS-CoV-2) pandemic has profoundly impacted almost every aspect of healthcare systems worldwide, placing the health and safety of frontline healthcare workers at risk, and it still continues to remain an important public health challenge. Several hospitals have put in place strategies to manage space, staff, and supplies in order to continue to deliver optimum care to patients while at the same time protecting the health and safety of staff and patients. However, the emergence of the second and third waves of the virus with the influx of new cases continue to add an additional level of complexity to the already challenging situation of containing the spread and lowering the rate of transmission, thus pushing healthcare systems to the limit. In this narrative review paper, we describe various strategies including administrative controls, environmental controls, and use of personal protective equipment, implemented by occupational health and safety departments for the protection of healthcare workers, patients, and visitors from SARS-CoV-2 virus infection. The protection and safeguard of the health and safety of healthcare workers and patients through the implementation of effective infection control measures, adequate management of possible outbreaks and minimization of the risk of nosocomial transmission is an important and effective strategy of SARS-CoV-2 pandemic management in any healthcare facility. High quality patient care hinges on ensuring that the care providers are well protected and supported so they can provide the best quality of care to their patients.
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24
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Guo H, Huang Z, Yeo JYP, Wang Y, Chow A. Psychosocial determinants of healthcare personnel's willingness to carry real-time locating system tags during daily inpatient care in hospital managing COVID-19 patients: insights from a mixed-methods analysis. JAMIA Open 2021; 4:ooaa072. [PMID: 34505000 PMCID: PMC7928885 DOI: 10.1093/jamiaopen/ooaa072] [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: 06/06/2020] [Revised: 11/16/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022] Open
Abstract
Objective Real-time locating systems (RTLS) enable contact tracing and hand hygiene reminders, to improve hospital safety. Successful implementation requires healthcare personnel (HCP) to carry RTLS tags continuously. We assessed for determinants of HCP’s willingness to use RTLS tags during routine inpatient care, and evaluated concerns using mixed-methods analysis. Materials and Methods We conducted a cross-sectional study in the 330-bed purpose-built National Centre for Infectious Diseases in Singapore, from January 15 through February 4, 2020. The anonymous survey comprised 24 questions based on constructs from behavioral models and an open-ended question. Principal component analysis was performed to derive the latent factor structure applied in the multivariable logistic regression analysis. Concerns were analyzed using thematic analysis. Results Of 260 HCP (nurses [40.8%], ancillary and administrative staff [23.1%], allied health professionals [18.5%], and physicians [17.7%]), 75% were willing to use the RTLS tag. After adjusting for age, gender, healthcare professional group, and duration of practice, the acceptance of the use of the RTLS tag (adjusted OR 11.28 [95% CI 4.39–29.00], P < .001) was highly associated with the willingness to use the RTLS tag. HCP who perceived the tag to be easy to use (adjusted OR 2.80 [95% CI 1.37–5.72], P = .005), were also more willing to use the tag. HCP were willing to carry the RTLS tag for the purpose of contact tracing despite privacy concerns. Conclusion More communications on the intentions and data protection standards of the RTLS, and accessory enhancements for HCP’s convenient and sustained use of the RTLS tag are crucial, to optimize RTLS’s usefulness during the COVID-19 pandemic.
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Affiliation(s)
- Huiling Guo
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
| | - Zhilian Huang
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
| | - Jeanette Y P Yeo
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
| | - Yinchu Wang
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
| | - Angela Chow
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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25
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Anand SV, Shuy YK, Lee PSS, Lee ES. One Year on: An Overview of Singapore's Response to COVID-19-What We Did, How We Fared, How We Can Move Forward. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179125. [PMID: 34501718 PMCID: PMC8431401 DOI: 10.3390/ijerph18179125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/30/2021] [Accepted: 08/20/2021] [Indexed: 01/28/2023]
Abstract
Background—One year has passed since the first COVID-19 case in Singapore. This scoping review commemorates Singaporean researchers that have expanded the knowledge on this novel virus. We aim to provide an overview of healthcare-related articles published in peer-reviewed journals, authored by the Singapore research community about COVID-19 during the first year of the pandemic. Methods—This was reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) protocol. It included healthcare-related articles about COVID-19 published between 23 January 2020 and 22 January 2021 with a Singapore-affiliated author. MEDLINE, Embase, Scopus, Web of Science, CINAHL, PsycINFO, Google Scholar, and local journals were searched. The articles were screened independently by two reviewers. Results—The review included 504 articles. Most of the articles narrated the changes to hospital practice (210), while articles on COVID-19 pathology (94) formed most of the non-narrative papers. Publications on public health (61) and the indirect impacts to clinical outcomes (45) were other major themes explored by the research community. The remaining articles detailed the psychological impact of the pandemic (35), adaptations of medical education (30), and narratives of events (14). Conclusion—Amidst a resurgence of community cases involving variant COVID-19 strains, the resources from the research community will provide valuable guidance to navigate these uncertain times.
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Affiliation(s)
- S Vivek Anand
- Ministry of Health Holdings, Singapore 099253, Singapore;
| | - Yao Kang Shuy
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308207, Singapore;
| | - Poay Sian Sabrina Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore 138543, Singapore;
| | - Eng Sing Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308207, Singapore;
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore 138543, Singapore;
- Correspondence:
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26
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Lim DZ, Yeo M, Dahan A, Tahayori B, Kok HK, Abbasi-Rad M, Maingard J, Kutaiba N, Russell J, Thijs V, Jhamb A, Chandra RV, Brooks M, Barras C, Asadi H. Development of a machine learning-based real-time location system to streamline acute endovascular intervention in acute stroke: a proof-of-concept study. J Neurointerv Surg 2021; 14:799-803. [PMID: 34426539 DOI: 10.1136/neurintsurg-2021-017858] [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: 06/05/2021] [Accepted: 08/05/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Delivery of acute stroke endovascular intervention can be challenging because it requires complex coordination of patient and staff across many different locations. In this proof-of-concept paper we (a) examine whether WiFi fingerprinting is a feasible machine learning (ML)-based real-time location system (RTLS) technology that can provide accurate real-time location information within a hospital setting, and (b) hypothesize its potential application in streamlining acute stroke endovascular intervention. METHODS We conducted our study in a comprehensive stroke care unit in Melbourne, Australia that offers a 24-hour mechanical thrombectomy service. ML algorithms including K-nearest neighbors, decision tree, random forest, support vector machine and ensemble models were trained and tested on a public WiFi dataset and the study hospital WiFi dataset. The hospital dataset was collected using the WiFi explorer software (version 3.0.2) on a MacBook Pro (AirPort Extreme, Broadcom BCM43x×1.0). Data analysis was implemented in the Python programming environment using the scikit-learn package. The primary statistical measure for algorithm performance was the accuracy of location prediction. RESULTS ML-based WiFi fingerprinting can accurately predict the different hospital zones relevant in the acute endovascular intervention workflow such as emergency department, CT room and angiography suite. The most accurate algorithms were random forest and support vector machine, both of which were 98% accurate. The algorithms remain robust when new data points, which were distinct from the training dataset, were tested. CONCLUSIONS ML-based RTLS technology using WiFi fingerprinting has the potential to streamline delivery of acute stroke endovascular intervention by efficiently tracking patient and staff movement during stroke calls.
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Affiliation(s)
- Dee Zhen Lim
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Melissa Yeo
- Melbourne Medical School, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Ariel Dahan
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Bahman Tahayori
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Hong Kuan Kok
- Department of Radiology, Northern Health, Epping, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | | | - Julian Maingard
- Department of Radiology, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Numan Kutaiba
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Jeremy Russell
- Department of Neurosurgery, Austin Health, Heidelberg, Victoria, Australia
| | - Vincent Thijs
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia.,Stroke Theme, Florey Neuroscience Institutes, Parkville, Victoria, Australia
| | - Ashu Jhamb
- Department of Radiology, St Vincent Health, Fitzroy, Victoria, Australia
| | - Ronil V Chandra
- Department of Radiology, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Mark Brooks
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Christen Barras
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Hamed Asadi
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Burwood, Victoria, Australia
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27
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Almanza-Reyes H, Moreno S, Plascencia-López I, Alvarado-Vera M, Patrón-Romero L, Borrego B, Reyes-Escamilla A, Valencia-Manzo D, Brun A, Pestryakov A, Bogdanchikova N. Evaluation of silver nanoparticles for the prevention of SARS-CoV-2 infection in health workers: In vitro and in vivo. PLoS One 2021; 16:e0256401. [PMID: 34411199 PMCID: PMC8375774 DOI: 10.1371/journal.pone.0256401] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/05/2021] [Indexed: 12/19/2022] Open
Abstract
SARS-CoV-2 infection in hospital areas is of a particular concern, since the close interaction between health care personnel and patients diagnosed with COVID-19, which allows virus to be easily spread between them and subsequently to their families and communities. Preventing SARS-CoV-2 infection among healthcare personnel is essential to reduce the frequency of infections and outbreaks during the pandemic considering that they work in high-risk areas. In this research, silver nanoparticles (AgNPs) were tested in vitro and shown to have an inhibitory effect on SARS-CoV-2 infection in cultured cells. Subsequently, we assess the effects of mouthwash and nose rinse with ARGOVIT® silver nanoparticles (AgNPs), in the prevention of SARS-CoV-2 contagion in health workers consider as high-risk group of acquiring the infection in the General Tijuana Hospital, Mexico, a hospital for the exclusive recruitment of patients diagnosed with COVID-19. We present a prospective randomized study of 231 participants that was carried out for 9 weeks (during the declaration of a pandemic). The "experimental" group was instructed to do mouthwash and nose rinse with the AgNPs solution; the "control" group was instructed to do mouthwashes and nose rinse in a conventional way. The incidence of SARS-CoV-2 infection was significantly lower in the "experimental" group (two participants of 114, 1.8%) compared to the "control" group (thirty-three participants of 117, 28.2%), with an 84.8% efficiency. We conclude that the mouth and nasal rinse with AgNPs helps in the prevention of SARS-CoV-2 infection in health personnel who are exposed to patients diagnosed with COVID-19.
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Affiliation(s)
| | - Sandra Moreno
- National Research Institute for Agricultural and Food Technology, Valdeolmos, Madrid, Spain
| | - Ismael Plascencia-López
- Faculty of Accounting and Administration, Autonomous University of Baja California, Tijuana, Baja California, Mexico
| | - Martha Alvarado-Vera
- Cluster de Bioeconomía de Baja California, A.C., Tijuana, Baja California, Mexico
| | - Leslie Patrón-Romero
- Faculty of Medicine and Psychology, Autonomous University of Baja California, Tijuana, Baja California, Mexico
| | - Belén Borrego
- National Research Institute for Agricultural and Food Technology, Valdeolmos, Madrid, Spain
| | | | - Daniel Valencia-Manzo
- Tijuana General Hospital, Tijuana, Baja California, Mexico
- Nursing Postgraduate, Iberoamericana University, Tijuana, Baja California, México
| | - Alejandro Brun
- National Research Institute for Agricultural and Food Technology, Valdeolmos, Madrid, Spain
| | | | - Nina Bogdanchikova
- Center of Nanoscience and Nanotechnology, Autonomous University of Mexico, Ensenada, Baja California, Mexico
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28
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Reeves JJ, Pageler NM, Wick EC, Melton GB, Tan YHG, Clay BJ, Longhurst CA. The Clinical Information Systems Response to the COVID-19 Pandemic. Yearb Med Inform 2021; 30:105-125. [PMID: 34479384 PMCID: PMC8416224 DOI: 10.1055/s-0041-1726513] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The year 2020 was predominated by the coronavirus disease 2019 (COVID-19) pandemic. The objective of this article is to review the areas in which clinical information systems (CIS) can be and have been utilized to support and enhance the response of healthcare systems to pandemics, focusing on COVID-19. METHODS PubMed/MEDLINE, Google Scholar, the tables of contents of major informatics journals, and the bibliographies of articles were searched for studies pertaining to CIS, pandemics, and COVID-19 through October 2020. The most informative and detailed studies were highlighted, while many others were referenced. RESULTS CIS were heavily relied upon by health systems and governmental agencies worldwide in response to COVID-19. Technology-based screening tools were developed to assist rapid case identification and appropriate triaging. Clinical care was supported by utilizing the electronic health record (EHR) to onboard frontline providers to new protocols, offer clinical decision support, and improve systems for diagnostic testing. Telehealth became the most rapidly adopted medical trend in recent history and an essential strategy for allowing safe and effective access to medical care. Artificial intelligence and machine learning algorithms were developed to enhance screening, diagnostic imaging, and predictive analytics - though evidence of improved outcomes remains limited. Geographic information systems and big data enabled real-time dashboards vital for epidemic monitoring, hospital preparedness strategies, and health policy decision making. Digital contact tracing systems were implemented to assist a labor-intensive task with the aim of curbing transmission. Large scale data sharing, effective health information exchange, and interoperability of EHRs remain challenges for the informatics community with immense clinical and academic potential. CIS must be used in combination with engaged stakeholders and operational change management in order to meaningfully improve patient outcomes. CONCLUSION Managing a pandemic requires widespread, timely, and effective distribution of reliable information. In the past year, CIS and informaticists made prominent and influential contributions in the global response to the COVID-19 pandemic.
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Affiliation(s)
- J. Jeffery Reeves
- Department of Surgery, University of California, San Diego, La Jolla, California, USA
| | - Natalie M. Pageler
- Department of Pediatrics, Division of Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Elizabeth C. Wick
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Genevieve B. Melton
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Yu-Heng Gamaliel Tan
- Department of Orthopedics, Chief Medical Information Officer, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Brian J. Clay
- Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA
| | - Christopher A. Longhurst
- Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA
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29
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Patel B, Vilendrer S, Kling SMR, Brown I, Ribeira R, Eisenberg M, Sharp C. Using a Real-Time Locating System to Evaluate the Impact of Telemedicine in an Emergency Department During COVID-19: Observational Study. J Med Internet Res 2021; 23:e29240. [PMID: 34236993 PMCID: PMC8315159 DOI: 10.2196/29240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/27/2021] [Accepted: 06/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Telemedicine has been deployed by health care systems in response to the COVID-19 pandemic to enable health care workers to provide remote care for both outpatients and inpatients. Although it is reasonable to suspect telemedicine visits limit unnecessary personal contact and thus decrease the risk of infection transmission, the impact of the use of such technology on clinician workflows in the emergency department is unknown. OBJECTIVE This study aimed to use a real-time locating system (RTLS) to evaluate the impact of a new telemedicine platform, which permitted clinicians located outside patient rooms to interact with patients who were under isolation precautions in the emergency department, on in-person interaction between health care workers and patients. METHODS A pre-post analysis was conducted using a badge-based RTLS platform to collect movement data including entrances and duration of stay within patient rooms of the emergency department for nursing and physician staff. Movement data was captured between March 2, 2020, the date of the first patient screened for COVID-19 in the emergency department, and April 20, 2020. A new telemedicine platform was deployed on March 29, 2020. The number of entrances and duration of in-person interactions per patient encounter, adjusted for patient length of stay, were obtained for pre- and postimplementation phases and compared with t tests to determine statistical significance. RESULTS There were 15,741 RTLS events linked to 2662 encounters for patients screened for COVID-19. There was no significant change in the number of in-person interactions between the pre- and postimplementation phases for both nurses (5.7 vs 7.0 entrances per patient, P=.07) and physicians (1.3 vs 1.5 entrances per patient, P=.12). Total duration of in-person interactions did not change (56.4 vs 55.2 minutes per patient, P=.74) despite significant increases in telemedicine videoconference frequency (0.6 vs 1.3 videoconferences per patient, P<.001 for change in daily average) and duration (4.3 vs 12.3 minutes per patient, P<.001 for change in daily average). CONCLUSIONS Telemedicine was rapidly adopted with the intent of minimizing pathogen exposure to health care workers during the COVID-19 pandemic, yet RTLS movement data did not reveal significant changes for in-person interactions between staff and patients under investigation for COVID-19 infection. Additional research is needed to better understand how telemedicine technology may be better incorporated into emergency departments to improve workflows for frontline health care clinicians.
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Affiliation(s)
- Birju Patel
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Stacie Vilendrer
- Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Samantha M R Kling
- Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Ian Brown
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Ryan Ribeira
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Matthew Eisenberg
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Christopher Sharp
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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30
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Kolasa K, Mazzi F, Leszczuk-Czubkowska E, Zrubka Z, Péntek M. State of the Art in Adoption of Contact Tracing Apps and Recommendations Regarding Privacy Protection and Public Health: Systematic Review. JMIR Mhealth Uhealth 2021; 9:e23250. [PMID: 34033581 PMCID: PMC8195202 DOI: 10.2196/23250] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/30/2020] [Accepted: 02/22/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, contact tracing apps have received a lot of public attention. The ongoing debate highlights the challenges of the adoption of data-driven innovation. We reflect on how to ensure an appropriate level of protection of individual data and how to maximize public health benefits that can be derived from the collected data. OBJECTIVE The aim of the study was to analyze available COVID-19 contact tracing apps and verify to what extent public health interests and data privacy standards can be fulfilled simultaneously in the process of the adoption of digital health technologies. METHODS A systematic review of PubMed and MEDLINE databases, as well as grey literature, was performed to identify available contact tracing apps. Two checklists were developed to evaluate (1) the apps' compliance with data privacy standards and (2) their fulfillment of public health interests. Based on both checklists, a scorecard with a selected set of minimum requirements was created with the goal of estimating whether the balance between the objective of data privacy and public health interests can be achieved in order to ensure the broad adoption of digital technologies. RESULTS Overall, 21 contact tracing apps were reviewed. In total, 11 criteria were defined to assess the usefulness of each digital technology for public health interests. The most frequently installed features related to contact alerting and governmental accountability. The least frequently installed feature was the availability of a system of medical or organizational support. Only 1 app out of 21 (5%) provided a threshold for the population coverage needed for the digital solution to be effective. In total, 12 criteria were used to assess the compliance of contact tracing apps with data privacy regulations. Explicit user consent, voluntary use, and anonymization techniques were among the most frequently fulfilled criteria. The least often implemented criteria were provisions of information about personal data breaches and data gathered from children. The balance between standards of data protection and public health benefits was achieved best by the COVIDSafe app and worst by the Alipay Health Code app. CONCLUSIONS Contact tracing apps with high levels of compliance with standards of data privacy tend to fulfill public health interests to a limited extent. Simultaneously, digital technologies with a lower level of data privacy protection allow for the collection of more data. Overall, this review shows that a consistent number of apps appear to comply with standards of data privacy, while their usefulness from a public health perspective can still be maximized.
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Affiliation(s)
- Katarzyna Kolasa
- Division of Health Economics and Healthcare Management, Kozminski University, Warsaw, Poland
| | - Francesca Mazzi
- Queen Mary University of London, London, United Kingdom
- Maastricht University, Maastricht, Netherlands
| | | | - Zsombor Zrubka
- Health Economics Research Center, Óbuda University, Budapest, Hungary
- Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
| | - Márta Péntek
- Health Economics Research Center, Óbuda University, Budapest, Hungary
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Utilizing the electronic health records to create a syndromic staff surveillance system during the COVID-19 outbreak. Am J Infect Control 2021; 49:685-689. [PMID: 33159997 PMCID: PMC7641527 DOI: 10.1016/j.ajic.2020.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/23/2022]
Abstract
Objectives Since December 2019, COVID-19 has caused a worldwide pandemic and Singapore has seen escalating cases with community spread. Aggressive contact tracing and identification of suspects has helped to identify local community clusters, surveillance being the key to early intervention. Healthcare workers (HCWs) have contracted COVID-19 infection both at the workplace and community. We aimed to create a prototype staff surveillance system for the detection of acute respiratory infection (ARI) clusters amongst our HCWs and describe its effectiveness. Methods A prototypical surveillance system was built on existing electronic health record infrastructure. Results Over a 10-week period, we investigated 10 ARI clusters amongst 7 departments. One of the ARI clusters was later determined to be related to COVID-19 infection. We demonstrate the feasibility of syndromic surveillance to detect ARI clusters during the COVID-19 outbreak. Conclusion The use of syndromic surveillance to detect ARI clusters amongst HCWs in the COVID-19 pandemic may enable early case detection and prevent onward transmission. It could be an important tool in infection prevention within healthcare institutions.
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Pandl KD, Thiebes S, Schmidt-Kraepelin M, Sunyaev A. How detection ranges and usage stops impact digital contact tracing effectiveness for COVID-19. Sci Rep 2021; 11:9414. [PMID: 33941793 PMCID: PMC8093197 DOI: 10.1038/s41598-021-88768-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/14/2021] [Indexed: 01/12/2023] Open
Abstract
To combat the COVID-19 pandemic, many countries around the globe have adopted digital contact tracing apps. Various technologies exist to trace contacts that are potentially prone to different types of tracing errors. Here, we study the impact of different proximity detection ranges on the effectiveness and efficiency of digital contact tracing apps. Furthermore, we study a usage stop effect induced by a false positive quarantine. Our results reveal that policy makers should adjust digital contact tracing apps to the behavioral characteristics of a society. Based on this, the proximity detection range should at least cover the range of a disease spread, and be much wider in certain cases. The widely used Bluetooth Low Energy protocol may not necessarily be the most effective technology for contact tracing.
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Affiliation(s)
- Konstantin D Pandl
- Institute of Applied Informatics and Formal Description Methods, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Scott Thiebes
- Institute of Applied Informatics and Formal Description Methods, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Manuel Schmidt-Kraepelin
- Institute of Applied Informatics and Formal Description Methods, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Ali Sunyaev
- Institute of Applied Informatics and Formal Description Methods, Karlsruhe Institute of Technology, Karlsruhe, Germany.
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Mathevet I, Ost K, Traverson L, Zinszer K, Ridde V. Accounting for health inequities in the design of contact tracing interventions: A rapid review. Int J Infect Dis 2021; 106:65-70. [PMID: 33716194 PMCID: PMC8026168 DOI: 10.1016/j.ijid.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022] Open
Abstract
Background Contact tracing has been a central control measure for coronavirus disease 2019 (COVID-19) transmission. However, without consideration of the needs of specific populations, public health interventions can exacerbate health inequities. Aim The purpose of this rapid review was to determine if and how health inequities were included in the design of contact tracing interventions in epidemic settings. Methods A search of the electronic databases MEDLINE and Web of Science was conducted. The following inclusion criteria were applied for article selection: (1) described the design of contact tracing interventions, (2) published between 2013 and 2020 in English, French, Spanish, Chinese, or Portuguese, (3) and included at least 50% of empiricism, according to the Automated Classifier of Texts on Scientific Studies (ATCER) tool. Various tools were used to extract data. Results Following screening of the titles and abstracts of 230 articles, 39 met the inclusion criteria. Only seven references were retained after full text review. None of the selected studies considered health inequities in the design of contact tracing interventions. Conclusions The use of tools/concepts for incorporating health inequities, such as the REFLEX-ISS tool, and ‘proportionate universalism’ when designing contact tracing interventions, would enable practitioners, decision-makers, and researchers to better consider health inequities.
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Affiliation(s)
- Isadora Mathevet
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France.
| | | | - Lola Traverson
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France
| | - Kate Zinszer
- University of Montreal, Montreal, Canada; Centre de Recherche en Santé Publique, Montreal, Canada
| | - Valéry Ridde
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France
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Ogboghodo EO, Osaigbovo II, Obarisiagbon OO, Okwara BU, Obaseki DE, Omo-Ikirodah OT, Ehinze ES, Adio F, Nwaogwugwu JC, Eseigbe EF. Facility-Based Surveillance Activities for COVID-19 Infection and Outcomes among Healthcare Workers in a Nigerian Tertiary Hospital. Am J Trop Med Hyg 2021; 104:1034-1040. [PMID: 33534753 PMCID: PMC7941853 DOI: 10.4269/ajtmh.20-1402] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/11/2021] [Indexed: 12/11/2022] Open
Abstract
COVID-19 in healthcare workers (HCWs) can result in nosocomial transmission, depletion in available workforce, and enhanced community transmission. This article describes surveillance for COVID-19 in HCWs at a tertiary healthcare facility, and documents the outcomes. A descriptive cross-sectional study of all HCWs identified from surveillance for COVID-19 from March 31 to August 31, 2020 was conducted. Healthcare workers were categorized as high risk and low risk using an adapted WHO Risk Assessment tool. Nasopharyngeal and oropharyngeal swab specimens obtained from high-risk subjects were tested by a reverse transcriptase PCR method. Data were analyzed with IBM SPSS version 25.0 software (IBM SPSS Statistics for Windows, Version 25.0, Armonk, NY), and results were presented as frequencies and percentages. The level of significance was set at P < 0.05. During 5 months of surveillance, 1,466 HCWs with a mean age of 38.1 ± 9.7 years were identified as contacts. On risk assessment, 328 (22.4%) were adjudged high risk. High risk was associated with increasing age (P < 0.001), male gender (P = 0.001), and nonclinical staff (P = 0.002). Following testing, 78 (5.3%) in the high-risk category were confirmed to have COVID-19. There was no record of COVID-19 in HCWs adjudged low risk. Forty-four (56.4%) cases were epidemiologically linked to the community, 20 (25.7%) to patients, and 14 (17.9%) to another HCW. Surveillance and risk assessment are crucial to COVID-19 response in healthcare facilities and revealed HCW infections with predominantly nonoccupational epidemiological links in this study.
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Affiliation(s)
- Esohe O Ogboghodo
- 1Department of Community Health, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Iriagbonse I Osaigbovo
- 2Department of Medical Microbiology, University of Benin Teaching Hospital, Benin City, Nigeria
| | | | - Benson U Okwara
- 3Department of Medicine, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Darlington E Obaseki
- 4Office of the Chief Medical Director/Department of Anatomic Pathology, University of Benin Teaching Hospital, Benin City, Nigeria
| | | | - Ewere S Ehinze
- 1Department of Community Health, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Funmilola Adio
- 1Department of Community Health, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Joy C Nwaogwugwu
- 1Department of Community Health, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Efeomon F Eseigbe
- 1Department of Community Health, University of Benin Teaching Hospital, Benin City, Nigeria
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35
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Parkulo MA, Brinker TM, Bosch W, Palaj A, DeRuyter ML. Risk of SARS-CoV-2 Transmission Among Coworkers in a Surgical Environment. Mayo Clin Proc 2021; 96:152-155. [PMID: 33413812 PMCID: PMC7580669 DOI: 10.1016/j.mayocp.2020.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/30/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
Health care workers are at high risk for contracting coronavirus disease 2019. However, little is known about the risk of transmission between coworkers. The objective of this study was to determine the risk of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between coworkers in a surgical environment. This was an observational study of 394 health care workers in a surgical environment who were exposed to 2 known SARS-CoV-2-positive coworkers. Standard infection precautions were in place at the time of the exposure. All 394 exposed workers initially underwent nasopharyngeal swab testing for SARS-CoV-2 using the polymerase chain reaction technique. Of the original group, 387 were tested again with the same technique 1 week later. Of 394 SARS-CoV-2-exposed health care workers initially tested, 1 was positive. No new positive cases were found on repeated testing of 387 participants 1 week later. The risk of transmission of SARS-CoV-2 in a health care unit with universal masking and appropriate hand hygiene is low. This finding should provide some reassurance to surgical practices as they reopen.
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Affiliation(s)
- Mark A Parkulo
- Division of Community Internal Medicine, Mayo Clinic, Jacksonville, FL.
| | - Todd M Brinker
- Division of Regional Medicine, Mayo Clinic, Jacksonville, FL
| | - Wendelyn Bosch
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL
| | - Arta Palaj
- Office of Access Management, Mayo Clinic, Jacksonville, FL
| | - Marie L DeRuyter
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
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36
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Masudin I, Ramadhani A, Restuputri DP, Amallynda I. The Effect of Traceability System and Managerial Initiative on Indonesian Food Cold Chain Performance: A Covid-19 Pandemic Perspective. GLOBAL JOURNAL OF FLEXIBLE SYSTEMS MANAGEMENT 2021; 22:331-356. [PMID: 36748031 PMCID: PMC8328815 DOI: 10.1007/s40171-021-00281-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/10/2021] [Indexed: 02/08/2023]
Abstract
This study aims to determine the effect of managerial initiatives on the adoption of traceability systems on food cold chain performance during the Covid-19 pandemic. Managerial initiatives are allegedly needed to improve the company's performance because it improves the traceability system in the supply chain. In addition, the effect of the traceability system adoption on the Indonesian food cold-chain performance during the Covid-19 pandemic is also discussed in this study. This study uses a quantitative approach and purposive sampling with a questionnaire research instrument obtained 250 statements of Indonesian consumers and retail employees. Partial least squares for structural equation modeling (PLS-SEM) were used to analyze latent variables' relationships. This study indicates that the traceability system has a significant effect on the performance of the food cold-chain during the Covid-19 pandemic. In addition, the adoption of electronic data exchange (EDI), radio frequency identification (RFID), and blockchain significantly impacted traceability systems during the Covid-19 pandemic. The managerial application of the initiative showed a positive and significant impact on the performance of the food cold-chain during the Covid-19 pandemic. However, the managerial initiative is not able to moderate the adoption of the traceability system.
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Affiliation(s)
- Ilyas Masudin
- University of Muhammadiyah Malang, Jalan Raya Tlogomas 246, Malang, 65144 Indonesia
| | - Anggi Ramadhani
- University of Muhammadiyah Malang, Jalan Raya Tlogomas 246, Malang, 65144 Indonesia
| | | | - Ikhlasul Amallynda
- University of Muhammadiyah Malang, Jalan Raya Tlogomas 246, Malang, 65144 Indonesia
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Barach P, Fisher SD, Adams MJ, Burstein GR, Brophy PD, Kuo DZ, Lipshultz SE. Disruption of healthcare: Will the COVID pandemic worsen non-COVID outcomes and disease outbreaks? PROGRESS IN PEDIATRIC CARDIOLOGY 2020; 59:101254. [PMID: 32837144 PMCID: PMC7274978 DOI: 10.1016/j.ppedcard.2020.101254] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Paul Barach
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, United States of America
- Jefferson College of Population Health, Philadelphia, PA, United States of America
- Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University, Vienna, Austria
| | - Stacy D Fisher
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - M Jacob Adams
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | - Gale R Burstein
- Erie County Department of Health, Buffalo, NY, United States of America
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
| | - Patrick D Brophy
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
- Golisano Children's Hospital at the University of Rochester Medical Center, Rochester, NY, United States of America
| | - Dennis Z Kuo
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Steven E Lipshultz
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- Oishei Children's Hospital, Buffalo, NY, United States of America
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
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38
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Mehta S, Grant K, Atlin C, Ackery A. Mitigating staff risk in the workplace: the use of RFID technology during a COVID-19 pandemic and beyond. BMJ Health Care Inform 2020; 27:bmjhci-2020-100230. [PMID: 33187955 PMCID: PMC7667999 DOI: 10.1136/bmjhci-2020-100230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/06/2020] [Accepted: 11/02/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Shaun Mehta
- Department of Emergency Medicine, Unity Health Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, Department of Emergency Medicine, North York General Hospital, Toronto, Ontario, Canada
| | - Kiran Grant
- University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Cori Atlin
- Faculty of Medicine, Department of Emergency Medicine, North York General Hospital, Toronto, Ontario, Canada
| | - Alun Ackery
- Department of Emergency Medicine, Unity Health Toronto, Toronto, Ontario, Canada
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Rácz-Szabó A, Ruppert T, Bántay L, Löcklin A, Jakab L, Abonyi J. Real-Time Locating System in Production Management. SENSORS 2020; 20:s20236766. [PMID: 33256090 PMCID: PMC7730894 DOI: 10.3390/s20236766] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 01/04/2023]
Abstract
Real-time monitoring and optimization of production and logistics processes significantly improve the efficiency of production systems. Advanced production management solutions require real-time information about the status of products, production, and resources. As real-time locating systems (also referred to as indoor positioning systems) can enrich the available information, these systems started to gain attention in industrial environments in recent years. This paper provides a review of the possible technologies and applications related to production control and logistics, quality management, safety, and efficiency monitoring. This work also provides a workflow to clarify the steps of a typical real-time locating system project, including the cleaning, pre-processing, and analysis of the data to provide a guideline and reference for research and development of indoor positioning-based manufacturing solutions.
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Affiliation(s)
- András Rácz-Szabó
- MTA-PE Lendület Complex Systems Monitoring Research Group, Department of Process Engineering, University of Pannonia, Egyetem u., 10, POB 158, H-8200 Veszprém, Hungary; (A.R.-S.); (L.B.); (J.A.)
| | - Tamás Ruppert
- MTA-PE Lendület Complex Systems Monitoring Research Group, Department of Process Engineering, University of Pannonia, Egyetem u., 10, POB 158, H-8200 Veszprém, Hungary; (A.R.-S.); (L.B.); (J.A.)
- Sunstone-RTLS Ltd., Kevehaza u., 1-3, H-1115 Budapest, Hungary;
- Correspondence:
| | - László Bántay
- MTA-PE Lendület Complex Systems Monitoring Research Group, Department of Process Engineering, University of Pannonia, Egyetem u., 10, POB 158, H-8200 Veszprém, Hungary; (A.R.-S.); (L.B.); (J.A.)
| | - Andreas Löcklin
- Institute of Industrial Automation and Software Engineering, University of Stuttgart, Pfaffenwaldring 47, D-70550 Stuttgart, Germany;
| | - László Jakab
- Sunstone-RTLS Ltd., Kevehaza u., 1-3, H-1115 Budapest, Hungary;
| | - János Abonyi
- MTA-PE Lendület Complex Systems Monitoring Research Group, Department of Process Engineering, University of Pannonia, Egyetem u., 10, POB 158, H-8200 Veszprém, Hungary; (A.R.-S.); (L.B.); (J.A.)
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40
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Huang Z, Guo H, Lee YM, Ho EC, Ang H, Chow A. Performance of Digital Contact Tracing Tools for COVID-19 Response in Singapore: Cross-Sectional Study. JMIR Mhealth Uhealth 2020; 8:e23148. [PMID: 33006944 PMCID: PMC7599064 DOI: 10.2196/23148] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/09/2020] [Accepted: 09/30/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Effective contact tracing is labor intensive and time sensitive during the COVID-19 pandemic, but also essential in the absence of effective treatment and vaccines. Singapore launched the first Bluetooth-based contact tracing app-TraceTogether-in March 2020 to augment Singapore's contact tracing capabilities. OBJECTIVE This study aims to compare the performance of the contact tracing app-TraceTogether-with that of a wearable tag-based real-time locating system (RTLS) and to validate them against the electronic medical records at the National Centre for Infectious Diseases (NCID), the national referral center for COVID-19 screening. METHODS All patients and physicians in the NCID screening center were issued RTLS tags (CADI Scientific) for contact tracing. In total, 18 physicians were deployed to the NCID screening center from May 10 to May 20, 2020. The physicians activated the TraceTogether app (version 1.6; GovTech) on their smartphones during shifts and urged their patients to use the app. We compared patient contacts identified by TraceTogether and those identified by RTLS tags within the NCID vicinity during physicians' 10-day posting. We also validated both digital contact tracing tools by verifying the physician-patient contacts with the electronic medical records of 156 patients who attended the NCID screening center over a 24-hour time frame within the study period. RESULTS RTLS tags had a high sensitivity of 95.3% for detecting patient contacts identified either by the system or TraceTogether while TraceTogether had an overall sensitivity of 6.5% and performed significantly better on Android phones than iPhones (Android: 9.7%, iPhone: 2.7%; P<.001). When validated against the electronic medical records, RTLS tags had a sensitivity of 96.9% and specificity of 83.1%, while TraceTogether only detected 2 patient contacts with physicians who did not attend to them. CONCLUSIONS TraceTogether had a much lower sensitivity than RTLS tags for identifying patient contacts in a clinical setting. Although the tag-based RTLS performed well for contact tracing in a clinical setting, its implementation in the community would be more challenging than TraceTogether. Given the uncertainty of the adoption and capabilities of contact tracing apps, policy makers should be cautioned against overreliance on such apps for contact tracing. Nonetheless, leveraging technology to augment conventional manual contact tracing is a necessary move for returning some normalcy to life during the long haul of the COVID-19 pandemic.
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Affiliation(s)
- Zhilian Huang
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore, Singapore
| | - Huiling Guo
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yee-Mun Lee
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Eu Chin Ho
- Department of Ear, Nose, and Throat, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hou Ang
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Angela Chow
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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41
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Ho HJ, Lim WY, Ang B, Chow A. Use of surveillance technology to enhance exposure management for healthcare workers during the COVID-19 pandemic. J Hosp Infect 2020; 107:101-102. [PMID: 32980491 PMCID: PMC7833647 DOI: 10.1016/j.jhin.2020.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- H J Ho
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore.
| | - W Y Lim
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
| | - B Ang
- Department of Infection Prevention and Control, Tan Tock Seng Hospital, Singapore; National Centre for Infectious Diseases, Singapore
| | - A Chow
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
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42
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Nuzzo A, Tan CO, Raskar R, DeSimone DC, Kapa S, Gupta R. Universal Shelter-in-Place Versus Advanced Automated Contact Tracing and Targeted Isolation: A Case for 21st-Century Technologies for SARS-CoV-2 and Future Pandemics. Mayo Clin Proc 2020; 95:1898-1905. [PMID: 32861334 PMCID: PMC7306713 DOI: 10.1016/j.mayocp.2020.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/29/2020] [Accepted: 06/16/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To model and compare effect of digital contact tracing versus shelter-in-place on severe acute respiratory syndrome - coronavirus 2 (SARS-CoV-2) spread. METHODS Using a classical epidemiologic framework and parameters estimated from literature published between February 1, 2020, and May 25, 2020, we modeled two non-pharmacologic interventions - shelter-in-place and digital contact tracing - to curb spread of SARS-CoV-2. For contact tracing, we assumed an advanced automated contact tracing (AACT) application that sends alerts to individuals advising self-isolation based on individual exposure profile. Model parameters included percentage population ordered to shelter-in-place, adoption rate of AACT, and percentage individuals who appropriately follow recommendations. Under influence of these variables, the number of individuals infected, exposed, and isolated were estimated. RESULTS Without any intervention, a high rate of infection (>10 million) with early peak is predicted. Shelter-in-place results in rapid decline in infection rate at the expense of impacting a large population segment. The AACT model achieves reduction in infected and exposed individuals similar to shelter-in-place without impacting a large number of individuals. For example, a 50% AACT adoption rate mimics a shelter-in-place order for 40% of the population and results in a greater than 90% decrease in peak number of infections. However, as compared to shelter-in-place, with AACT significantly fewer individuals would be isolated. CONCLUSION Wide adoption of digital contact tracing can mitigate infection spread similar to universal shelter-in-place, but with considerably fewer individuals isolated.
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Affiliation(s)
| | - Can Ozan Tan
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA; Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Ramesh Raskar
- Media Lab, Massachusetts Institute of Technology, Boston, MA
| | - Daniel C DeSimone
- Division of Infectious Disease, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Rajiv Gupta
- Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA
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Kassaye SG, Spence AB, Lau E, Bridgeland DM, Cederholm J, Dimolitsas S, Smart JC. Rapid Deployment of a Free, Privacy-Assured COVID-19 Symptom Tracker for Public Safety During Reopening: System Development and Feasibility Study. JMIR Public Health Surveill 2020; 6:e19399. [PMID: 32788148 PMCID: PMC7431234 DOI: 10.2196/19399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/30/2020] [Accepted: 07/28/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the number of cases of coronavirus disease (COVID-19) in the United States has exponentially increased. Identifying and monitoring individuals with COVID-19 and individuals who have been exposed to the disease is critical to prevent transmission. Traditional contact tracing mechanisms are not structured on the scale needed to address this pandemic. As businesses reopen, institutions and agencies not traditionally engaged in disease prevention are being tasked with ensuring public safety. Systems to support organizations facing these new challenges are critically needed. Most currently available symptom trackers use a direct-to-consumer approach and use personal identifiers, which raises privacy concerns. OBJECTIVE Our aim was to develop a monitoring and reporting system for COVID-19 to support institutions conducting monitoring activities without compromising privacy. METHODS Our multidisciplinary team designed a symptom tracking system after consultation with experts. The system was designed in the Georgetown University AvesTerra knowledge management environment, which supports data integration and synthesis to identify actionable events and maintain privacy. We conducted a beta test for functionality among consenting Georgetown University medical students. RESULTS The symptom tracker system was designed based on guiding principles developed during peer consultations. Institutions are provided access to the system through an efficient onboarding process that uses clickwrap technology to document agreement to limited terms of use to rapidly enable free access. Institutions provide their constituents with a unique identifier to enter data through a web-based user interface to collect vetted symptoms as well as clinical and epidemiologic data. The website also provides individuals with educational information through links to the COVID-19 prevention recommendations from the US Centers for Disease Control and Prevention. Safety features include instructions for people with new or worsening symptoms to seek care. No personal identifiers are collected in the system. The reporter mechanism safeguards data access so that institutions can only access their own data, and it provides institutions with on-demand access to the data entered by their constituents, organized in summary reports that highlight actionable data. Development of the system began on March 15, 2020, and it was launched on March 20, 2020. In the beta test, 48 Georgetown University School of Medicine students or their social contacts entered data into the system from March 31 to April 5, 2020. One of the 48 users (2%) reported active COVID-19 infection and had no symptoms by the end of the monitoring period. No other participants reported symptoms. Only data with the unique entity identifier for our beta test were generated in our summary reports. CONCLUSIONS This system harnesses insights into privacy and data sharing to avoid regulatory and legal hurdles to rapid adaption by entities tasked with maintaining public safety. Our pilot study demonstrated feasibility and ease of use. Refinements based on feedback from early adapters included release of a Spanish language version. These systems provide technological advances to complement the traditional contact tracing and digital tracing applications being implemented to limit SARS-CoV-2 transmission during reopening.
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Affiliation(s)
- Seble G Kassaye
- Department of Medicine, Georgetown University, Washington, DC, United States
| | - Amanda Blair Spence
- Department of Medicine, Georgetown University, Washington, DC, United States
| | - Edwin Lau
- LEDR Technologies Inc, Seattle, WA, United States
| | | | | | - Spiros Dimolitsas
- Office of the Senior Vice President for Research, Georgetown University, Washington, DC, United States
| | - J C Smart
- Office of the Senior Vice President for Research, Georgetown University, Washington, DC, United States
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Chari DA, Workman AD, Chen JX, Jung DH, Abdul-Aziz D, Kozin ED, Remenschneider AK, Lee DJ, Welling DB, Bleier BS, Quesnel AM. Aerosol Dispersion During Mastoidectomy and Custom Mitigation Strategies for Otologic Surgery in the COVID-19 Era. Otolaryngol Head Neck Surg 2020; 164:67-73. [PMID: 32660367 PMCID: PMC7361126 DOI: 10.1177/0194599820941835] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective To investigate small-particle aerosolization from mastoidectomy relevant to potential viral transmission and to test source-control mitigation strategies. Study Design Cadaveric simulation. Setting Surgical simulation laboratory. Methods An optical particle size spectrometer was used to quantify 1- to 10-µm aerosols 30 cm from mastoid cortex drilling. Two barrier drapes were evaluated: OtoTent1, a drape sheet affixed to the microscope; OtoTent2, a custom-structured drape that enclosed the surgical field with specialized ports. Results Mastoid drilling without a barrier drape, with or without an aerosol-scavenging second suction, generated large amounts of 1- to 10-µm particulate. Drilling under OtoTent1 generated a high density of particles when compared with baseline environmental levels (P < .001, U = 107). By contrast, when drilling was conducted under OtoTent2, mean particle density remained at baseline. Adding a second suction inside OtoTent1 or OtoTent2 kept particle density at baseline levels. Significant aerosols were released upon removal of OtoTent1 or OtoTent2 despite a 60-second pause before drape removal after drilling (P < .001, U = 0, n = 10, 12; P < .001, U = 2, n = 12, 12, respectively). However, particle density did not increase above baseline when a second suction and a pause before removal were both employed. Conclusions Mastoidectomy without a barrier, even when a second suction was added, generated substantial 1- to 10-µm aerosols. During drilling, large amounts of aerosols above baseline levels were detected with OtoTent1 but not OtoTent2. For both drapes, a second suction was an effective mitigation strategy during drilling. Last, the combination of a second suction and a pause before removal prevented aerosol escape during the removal of either drape.
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Affiliation(s)
- Divya A Chari
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Alan D Workman
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Jenny X Chen
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - David H Jung
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Dunia Abdul-Aziz
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Elliott D Kozin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron K Remenschneider
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - D Bradley Welling
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin S Bleier
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Alicia M Quesnel
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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