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Ho JW, Chao CL, Helenowski IB, Dwyer A, Vavra AK, Eskandari MK, Hekman KE, Tomita TM. Efficacy and safety of sonographer discretion to terminate a venous duplex ultrasound for diagnosis of deep vein thrombosis in coronavirus disease 2019 patients. J Vasc Surg Venous Lymphat Disord 2023; 11:10-18.e1. [PMID: 35931361 PMCID: PMC9344809 DOI: 10.1016/j.jvsv.2022.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/28/2022] [Accepted: 06/09/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Sonographers performing venous duplex ultrasound (VDUS) of patients with coronavirus disease 2019 (COVID-19) have an increased risk of exposure owing to their close contact with these patients for an extended period. The objective of the present study was to evaluate the efficacy of a modified COVID-19 VDUS protocol to reduce sonographer exposure to COVID-19 patients. METHODS We performed a single-center retrospective review. Patients who had undergone VDUS under the modified COVID-19 protocol between March 1, 2020, and June 30, 2020, with a confirmed or presumed COVID-19 diagnosis at the VDUS were included. The modified COVID-19 protocol was defined as the ability of the sonographer to terminate the examination on detection of an acute deep vein thrombosis (DVT). The primary outcome measures were the number of anatomic deep venous segments recorded by the sonographer, which was used as a surrogate measure for sonographer exposure time, and the number of acute DVTs found on follow-up examinations in segments not visualized at the index VDUS. RESULTS A total of 160 lower extremity VDUS (LEVDUS) scans and 72 upper extremity VDUS (UEVDUS) scans were performed using the modified COVID-19 protocol. The index VDUS had found an acute DVT for 44 of 160 patients (27.5%) who had undergone LEVDUS and 26 of 72 (36.6%) who had undergone UEVDUS. On follow-up imaging, 7 of 38 LEVDUS scans (17.9%) and 1 of 10 UEVDUS scans (10%) had demonstrated a new acute DVT. Malignancy and surgery 30 days before imaging were significantly associated with acute lower extremity DVT, and mechanical ventilation and extracorporeal membrane oxygenation were associated with acute upper extremity DVT. On the index VDUS, the average was 10.6 of 12 total visualized segments on LEVDUS and 6.4 of 10 total segments on UEVDUS. Of the index VDUS scans, 35.6% of the LEVDUS and 78.6% of the UEVDUS scans had been abbreviated. The index VDUS scans that were positive for acute DVT had had significantly fewer visualized segments for both lower (8.4 vs 11.5; P < .0001) and upper (4.2 vs 7.6) extremities (P < .0001). On the follow-up examinations, only one of eight new acute DVTs had been found in a patient whose index VDUS had been abbreviated and the corresponding segment not assessed. These findings did not affect the patient's clinical course. CONCLUSIONS The modified COVID-19 VDUS protocol reduced sonographers' potential exposure time to COVID-19. Additionally, the clinical efficacy was maintained, with no missed DVTs, despite the abbreviation of the VDUS examinations.
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Affiliation(s)
- Jessie W Ho
- Division of Vascular Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Calvin L Chao
- Division of Vascular Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Irene B Helenowski
- Division of Vascular Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Ann Dwyer
- Division of Vascular Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Ashley K Vavra
- Division of Vascular Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Mark K Eskandari
- Division of Vascular Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Katherine E Hekman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, GA; Atlanta VA Healthcare System, Decatur, GA.
| | - Tadaki M Tomita
- Division of Vascular Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Taskin MH, Yazici Z, Barry G. A prevalence study of COVID-19 among healthcare workers in a pandemic hospital in the Samsun province of Turkey. PLoS One 2022; 17:e0279067. [PMID: 36548268 PMCID: PMC9778555 DOI: 10.1371/journal.pone.0279067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Among populations globally, many healthcare workers have been disproportionally impacted by the COVID-19 pandemic because of their above average exposure to people infected with SARS-CoV-2. Exposure to asymptomatic or pre-symptomatic individuals is particularly challenging, if those individuals continue to work, not knowing that they are potentially infectious. This study aimed to measure the level of asymptomatic infection in a cohort of workers in a healthcare setting in Turkey during the second major wave of infection in late 2020. Blood samples were collected and tested by electrochemiluminescence immunoassay for SARS-CoV-2 IgM and IgG antibodies. Nasal and throat swabs were performed in a subset of this cohort and RT-qPCR was used to search for the presence of SARS-CoV-2 RNA. The results showed that approximately 23% of the cohort were positive for anti-SARS-CoV-2 IgM antibodies and approximately 22% were positive for anti-SARS-CoV-2 IgG antibodies despite no reported history of COVID-19 symptoms. Just less than 30% of a subset of the group were positive for the presence of SARS-CoV-2 RNA indicating the likelihood of a current or recent infection, again despite a lack of typical COVID-19 associated symptoms. This study indicates a high rate of asymptomatic infection and highlights the need for regular testing of groups such as healthcare workers when community prevalence of disease is high and there is a desire to limit entry of virus into settings where vulnerable people may be present, because symptoms cannot be relied on as indicators of infection or infectiousness.
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Affiliation(s)
- Mehmet Hakan Taskin
- Department of Medical Microbiology, Samsun Training and Research Hospital, University of Health Sciences, Samsun, Turkey
| | - Zafer Yazici
- Department of Virology, Faculty of Veterinary Medicine, Ondokuz Mayis University, Samsun, Turkey,* E-mail: (GB); (ZY)
| | - Gerald Barry
- School of Veterinary Medicine, University College Dublin, Dublin, Ireland,* E-mail: (GB); (ZY)
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Marmo R, Pascale F, Diana L, Sicignano E, Polverino F. Lessons learnt for enhancing hospital resilience to pandemics: A qualitative analysis from Italy. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2022; 81:103265. [PMID: 36061241 PMCID: PMC9419438 DOI: 10.1016/j.ijdrr.2022.103265] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has outlined the need to strengthen the resilience of healthcare systems. It has cost millions of human lives and has had indirect health impacts too. Hospital buildings have undergone extensive modifications and adaptations to ensure infection control and prevention measures, and, as it is happened following past epidemics, the COVID-19 experience might change the design of hospital buildings in the future. This paper aims to capitalise on the knowledge developed by the stakeholders directly involved with the hospital response during the pandemic to generate new evidence that will enhance resilience of hospital buildings to pandemics. The research adopted qualitative research methods, namely literature review and interviews with Italian experts including doctors and facility managers to collect data which were analysed through a thematic analysis. The findings include the identification of new needs for hospital buildings and the related actions to be taken or already performed at hospital building and service level which are viable for long term implementation and are aimed at improving hospital resilience to pandemics. The results specify how to improve resilience by means of structural modifications (e.g. placing filter zones among different wards, ensuring the presence of airborne infection isolation rooms at least in the emergency departments), technological changes (e.g. oversizing capacity such as medical gases, information technology improvement for delivering healthcare services remotely), and operational measures (e.g. assessing the risk of infection before admission, dividing acute-care from low-care assets). The needs discussed in this paper substantiate the urge to renovate the Italian healthcare infrastructures and they can be considered useful elements of knowledge for enhancing hospital resilience to pandemics in the extended and in the post-COVID-19 era.
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Affiliation(s)
- Rossella Marmo
- Department of Civil Engineering, University of Salerno, 84084, Fisciano, Italy
| | - Federica Pascale
- Faculty of Science and Engineering, Anglia Ruskin University, CM1 1SQ, Chelmsford, UK
| | - Lorenzo Diana
- Department of Civil, Building and Environmental Engineering, University of Naples "Federico II", 80138, Naples, Italy
| | - Enrico Sicignano
- Department of Civil Engineering, University of Salerno, 84084, Fisciano, Italy
| | - Francesco Polverino
- Department of Civil, Building and Environmental Engineering, University of Naples "Federico II", 80138, Naples, Italy
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Watt AE, Sherry NL, Andersson P, Lane CR, Johnson S, Wilmot M, Horan K, Sait M, Ballard SA, Crachi C, Beck DJ, Marshall C, Kainer MA, Stuart R, McGrath C, Kwong JC, Bass P, Kelley PG, Crowe A, Guy S, Macesic N, Smith K, Williamson DA, Seemann T, Howden BP. State-wide genomic epidemiology investigations of COVID-19 in healthcare workers in 2020 Victoria, Australia: Qualitative thematic analysis to provide insights for future pandemic preparedness. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2022; 25:100487. [PMID: 35677391 PMCID: PMC9168175 DOI: 10.1016/j.lanwpc.2022.100487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background COVID-19 has affected many healthcare workers (HCWs) globally. We performed state-wide SARS-CoV-2 genomic epidemiological investigations to identify HCW transmission dynamics and provide recommendations to optimise healthcare system preparedness for future outbreaks. Methods Genome sequencing was attempted on all COVID-19 cases in Victoria, Australia. We combined genomic and epidemiologic data to investigate the source of HCW infections across multiple healthcare facilities (HCFs) in the state. Phylogenetic analysis and fine-scale hierarchical clustering were performed for the entire dataset including community and healthcare cases. Facilities provided standardised epidemiological data and putative transmission links. Findings Between March-October 2020, approximately 1,240 HCW COVID-19 infection cases were identified; 765 are included here, requested for hospital investigations. Genomic sequencing was successful for 612 (80%) cases. Thirty-six investigations were undertaken across 12 HCFs. Genomic analysis revealed that multiple introductions of COVID-19 into facilities (31/36) were more common than single introductions (5/36). Major contributors to HCW acquisitions included mobility of staff and patients between wards and facilities, and characteristics and behaviours of patients that generated numerous secondary infections. Key limitations at the HCF level were identified. Interpretation Genomic epidemiological analyses enhanced understanding of HCW infections, revealing unsuspected clusters and transmission networks. Combined analysis of all HCWs and patients in a HCF should be conducted, supported by high rates of sequencing coverage for all cases in the population. Established systems for integrated genomic epidemiological investigations in healthcare settings will improve HCW safety in future pandemics. Funding The Victorian Government, the National Health and Medical Research Council Australia, and the Medical Research Future Fund.
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Affiliation(s)
- Anne E. Watt
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
| | - Norelle L. Sherry
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Patiyan Andersson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
| | - Courtney R. Lane
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
| | - Sandra Johnson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
| | - Mathilda Wilmot
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
| | - Kristy Horan
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
| | - Michelle Sait
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
| | - Susan A. Ballard
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
| | - Christina Crachi
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
| | - Dianne J. Beck
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
| | - Caroline Marshall
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Infectious Diseases, The University of Melbourne at the Doherty Institute, Melbourne, Victoria, Australia
| | - Marion A. Kainer
- Department of Infectious Diseases, Western Health, Footscray, Victoria, Australia
| | - Rhonda Stuart
- Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
- South East Public Health Unit, Monash Health, Clayton, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Christian McGrath
- Department of Infectious Diseases, The Northern Hospital, Epping, Victoria, Australia
| | - Jason C. Kwong
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Pauline Bass
- Infection Prevention and Healthcare Epidemiology Department, Alfred Health, Prahran, Victoria, Australia
| | - Peter G. Kelley
- Department of Infectious Diseases, Peninsula Health, Frankston, Victoria, Australia
| | - Amy Crowe
- Department of Microbiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Stephen Guy
- Department of Infectious Diseases, Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Nenad Macesic
- Department of Infectious Diseases, Epworth Hospital, Richmond, Victoria, Australia
| | - Karen Smith
- Centre for Research and Evaluation, Ambulance Victoria, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Deborah A. Williamson
- Department of Infectious Diseases, The University of Melbourne at the Doherty Institute, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
| | - Torsten Seemann
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
- Doherty Applied Microbial Genomics, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
| | - Benjamin P. Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Doherty Applied Microbial Genomics, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
- Corresponding author at: Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, 792 Elizabeth St, Melbourne, Victoria 3000, Australia.
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Bhattacharya A, Collin SM, Stimson J, Thelwall S, Nsonwu O, Gerver S, Robotham J, Wilcox M, Hopkins S, Hope R. Healthcare-associated COVID-19 in England: A national data linkage study. J Infect 2021; 83:565-572. [PMID: 34474055 PMCID: PMC8404398 DOI: 10.1016/j.jinf.2021.08.039] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/13/2021] [Accepted: 08/26/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Nosocomial transmission was an important aspect of SARS-CoV-1 and MERS-CoV outbreaks. Healthcare-associated SARS-CoV-2 infection has been reported in single and multi-site hospital-based studies in England, but not nationally. METHODS Admission records for all hospitals in England were linked to SARS-CoV-2 national test data for the period 01/03/2020 to 31/08/2020. Case definitions were: community-onset community-acquired, first positive test <14 days pre-admission, up to day 2 of admission; hospital-onset indeterminate healthcare-associated, first positive on day 3-7; hospital-onset probable healthcare-associated, first positive on day 8-14; hospital-onset definite healthcare-associated, first positive from day 15 of admission until discharge; community-onset possible healthcare-associated, first positive test ≤14 days post-discharge. RESULTS One-third (34.4%, 100,859/293,204) of all laboratory-confirmed COVID-19 cases were linked to a hospital record. Hospital-onset probable and definite cases represented 5.3% (15,564/293,204) of all laboratory-confirmed cases and 15.4% (15,564/100,859) of laboratory-confirmed cases among hospital patients. Community-onset community-acquired and community-onset possible healthcare-associated cases represented 86.5% (253,582/293,204) and 5.1% (14,913/293,204) of all laboratory-confirmed cases, respectively. CONCLUSIONS Up to 1 in 6 SARS-CoV-2 infections among hospitalised patients with COVID-19 in England during the first 6 months of the pandemic could be attributed to nosocomial transmission, but these represent less than 1% of the estimated 3 million COVID-19 cases in this period.
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Affiliation(s)
- Alex Bhattacharya
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Simon M Collin
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - James Stimson
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Simon Thelwall
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Olisaeloka Nsonwu
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Sarah Gerver
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; National Institute of Health Research Health Protection Research Unit, Oxford University and Public Health England, United Kingdom
| | - Julie Robotham
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; National Institute of Health Research Health Protection Research Unit, Oxford University and Public Health England, United Kingdom
| | - Mark Wilcox
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Susan Hopkins
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; National Institute of Health Research Health Protection Research Unit, Oxford University and Public Health England, United Kingdom; Department of Health and Social Care, NHS Test & Trace, London, United Kingdom
| | - Russell Hope
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; National Institute of Health Research Health Protection Research Unit, Oxford University and Public Health England, United Kingdom.
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6
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McIntosh EDG, Feemster K, Rello J. Protecting adults at risk of pneumococcal infection and influenza from exposure to SARS-CoV-2. Hum Vaccin Immunother 2021; 18:1-7. [PMID: 34406914 PMCID: PMC8920219 DOI: 10.1080/21645515.2021.1957647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There is a paucity of evidence linking pneumococcal infection and influenza with SARS-CoV-2 and COVID-19. There is circumstantial evidence of the possibility of an association between S. pneumoniae and SARS-CoV-2 such as the increased binding of S. pneumoniae to coronavirus-infected human airway epithelium, the frequent use of broad-spectrum antibiotics in the management of COVID-19 which could mask secondary bacterial infection, and the observation that pneumococcal vaccination is associated with decreased SARS-CoV-2 nasopharyngeal swab positivity. We performed a targeted literature review for the year 2020, using search terms S. pneumoniae, influenza, SARS-CoV-2, and found 25 relevant articles of a total of 291. Pneumococcal and influenza vaccinations have the potential to contribute toward efforts aimed at reducing the health burden of SARS-CoV-2, especially by reducing preventable admissions to hospital for pneumonia and the consequent risk of nosocomial SARS-CoV-2 transmission.
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Affiliation(s)
| | - K Feemster
- Medical Affairs, Pneumococcal Vaccines, Global Medical and Scientific Affairs, Merck Research Laboratories, Merck & Co., Inc, Kenilworth, NJ, USA
| | - J Rello
- Universitat Internacional de Catalunya, Head Research Group, Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES) and Head, Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
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7
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Wratil PR, Schmacke NA, Osterman A, Weinberger T, Rech J, Karakoc B, Zeilberger M, Steffen J, Mueller TT, Spaeth PM, Stern M, Albanese M, Thun H, Reinbold J, Sandmeyer B, Kressirer P, Grabein B, Falkai P, Adorjan K, Hornung V, Kaderali L, Klein M, Keppler OT. In-depth profiling of COVID-19 risk factors and preventive measures in healthcare workers. Infection 2021; 50:381-394. [PMID: 34379308 PMCID: PMC8354838 DOI: 10.1007/s15010-021-01672-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/17/2021] [Indexed: 12/12/2022]
Abstract
Purpose To determine risk factors for coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs), characterize symptoms, and evaluate preventive measures against SARS-CoV-2 spread in hospitals. Methods In a cross-sectional study conducted between May 27 and August 12, 2020, after the first wave of the COVID-19 pandemic, we obtained serological, epidemiological, occupational as well as COVID-19-related data at a quaternary care, multicenter hospital in Munich, Germany. Results 7554 HCWs participated, 2.2% of whom tested positive for anti-SARS-CoV-2 antibodies. Multivariate analysis revealed increased COVID-19 risk for nurses (3.1% seropositivity, 95% CI 2.5–3.9%, p = 0.012), staff working on COVID-19 units (4.6% seropositivity, 95% CI 3.2–6.5%, p = 0.032), males (2.4% seropositivity, 95% CI 1.8–3.2%, p = 0.019), and HCWs reporting high-risk exposures to infected patients (5.5% seropositivity, 95% CI 4.0–7.5%, p = 0.0022) or outside of work (12.0% seropositivity, 95% CI 8.0–17.4%, p < 0.0001). Smoking was a protective factor (1.1% seropositivity, 95% CI 0.7–1.8% p = 0.00018) and the symptom taste disorder was strongly associated with COVID-19 (29.8% seropositivity, 95% CI 24.3–35.8%, p < 0.0001). An unbiased decision tree identified subgroups with different risk profiles. Working from home as a preventive measure did not protect against SARS-CoV-2 infection. A PCR-testing strategy focused on symptoms and high-risk exposures detected all larger COVID-19 outbreaks. Conclusion Awareness of the identified COVID-19 risk factors and successful surveillance strategies are key to protecting HCWs against SARS-CoV-2, especially in settings with limited vaccination capacities or reduced vaccine efficacy. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01672-z.
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Affiliation(s)
- Paul R Wratil
- Faculty of Medicine, National Reference Center for Retroviruses, Max Von Pettenkofer Institute and Gene Center, Virology, LMU München, Munich, Germany.
- German Center for Infection Research (DZIF), Partner site, Munich, Germany.
| | - Niklas A Schmacke
- Department of Biochemistry and Gene Center, LMU München, Munich, Germany
| | - Andreas Osterman
- Faculty of Medicine, National Reference Center for Retroviruses, Max Von Pettenkofer Institute and Gene Center, Virology, LMU München, Munich, Germany
| | - Tobias Weinberger
- Department of Medicine I, University Hospital, LMU München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jochen Rech
- Department of Biochemistry and Gene Center, LMU München, Munich, Germany
| | - Burak Karakoc
- Faculty of Medicine, National Reference Center for Retroviruses, Max Von Pettenkofer Institute and Gene Center, Virology, LMU München, Munich, Germany
| | - Mira Zeilberger
- Department of Medicine IV, University Hospital, LMU München, Munich, Germany
| | - Julius Steffen
- Department of Medicine I, University Hospital, LMU München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Tonina T Mueller
- Department of Medicine I, University Hospital, LMU München, Munich, Germany
| | - Patricia M Spaeth
- Faculty of Medicine, National Reference Center for Retroviruses, Max Von Pettenkofer Institute and Gene Center, Virology, LMU München, Munich, Germany
| | - Marcel Stern
- Faculty of Medicine, National Reference Center for Retroviruses, Max Von Pettenkofer Institute and Gene Center, Virology, LMU München, Munich, Germany
| | - Manuel Albanese
- Faculty of Medicine, National Reference Center for Retroviruses, Max Von Pettenkofer Institute and Gene Center, Virology, LMU München, Munich, Germany
| | - Hella Thun
- Department of Communication and Media, University Hospital, LMU München, Munich, Germany
| | - Julia Reinbold
- Department of Communication and Media, University Hospital, LMU München, Munich, Germany
| | - Benedikt Sandmeyer
- Institute of Emergency Medicine and Management in Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Philipp Kressirer
- Department of Communication and Media, University Hospital, LMU München, Munich, Germany
| | - Béatrice Grabein
- Department for Clinical Microbiology and Hospital Hygiene, University Hospital, LMU München, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU München, Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU München, Munich, Germany
| | - Veit Hornung
- Department of Biochemistry and Gene Center, LMU München, Munich, Germany
| | - Lars Kaderali
- Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Klein
- Emergency Department and Department of Neurology, University Hospital, LMU München, Munich, Germany
| | - Oliver T Keppler
- Faculty of Medicine, National Reference Center for Retroviruses, Max Von Pettenkofer Institute and Gene Center, Virology, LMU München, Munich, Germany.
- German Center for Infection Research (DZIF), Partner site, Munich, Germany.
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8
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Luo T, Guo Y, Shi Y, Song Y, Xu W, You J. Risks of Occupational-Related Adverse Events (ORAEs) and Effect of Bundled Interventions Among Health Care Workers in Novel Coronavirus Pneumonia Wards. Disaster Med Public Health Prep 2021; 17:e24. [PMID: 34296669 PMCID: PMC8548049 DOI: 10.1017/dmp.2021.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 05/12/2021] [Accepted: 07/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aims of the study were to investigate the burden for health care workers (HCWs) who suffer from occupational-related adverse events (ORAEs) while working in contaminated areas in a specialized hospital for novel coronavirus pneumonia, to explore related risk factors, to evaluate the effectiveness of bundled interventions, as well as to provide scientific evidence regarding the reduction of risks concerning ORAEs and occupational exposure events. METHODS The study was completed using a special team of 138 HCWs assembled for a specialized hospital for novel coronavirus pneumonia in Wuhan, dated from February 16 to March 26, 2020. The incidence of occupational exposure was determined by data reported from the hospital, while the prevalence of ORAEs was derived from questionnaire results. The relation coefficients of ORAEs and the variable potential risk factors are analyzed by logistic regression. After the risk factors were identified, targeted organized intervention was implemented and chi-square tests were performed to compare the incidence of occupational exposure and the prevalence of ORAEs in contaminated areas before and after the interventions. RESULTS Ninety one out of 138 (65.94%) had reported ORAEs with 300 (27.96%) cases of ORAEs being recorded in a total of 1073 entries into contaminated areas. The prevalence of different ORAEs include 205 tenderness (24.73%), 182 headache/dizziness (21.95%), 138 dyspnea (16.65%), 130 blurred vision (15.68%), and 95 nausea/vomiting (11.46%). Personal protective equipment (PPE) is significantly associated with ORAEs in contaminated areas (P < 0.05). Among non-PPE-related factors, insomnia is associated with the majority of ORAEs in contaminated areas. Significant differences were achieved after organized interventions in the incidence of occupational exposure of HCWs (χ2 = 39.07, P < 0.001) and the prevalence of ORAEs in contaminated areas (χ2 = 22.95, P < 0.001). CONCLUSION During the epidemic period of novel severe respiratory infectious disease, the burden of the ORAEs in contaminated areas and the risk of occupational exposure of HCWs were relatively high. In time, comprehensive and multi-level bundled interventions may help decrease the risk of both ORAEs and occupational exposure.
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Affiliation(s)
- Tinggang Luo
- Department of Infection Control, Characteristic Medical Center of the Chinese People’s Armed Police Force, China
- The Graduate School of the Chinese PLA General Hospital, Beijing, China
| | - Yao Guo
- Institute of Neurotrauma and Repair, Characteristic Medical Center of the Chinese People’s Armed Police Force, China
| | - Ying Shi
- Department of Infection Control, Characteristic Medical Center of the Chinese People’s Armed Police Force, China
| | - Yujian Song
- The Graduate School of the Chinese PLA General Hospital, Beijing, China
| | - Wenchao Xu
- Institute for the Prevention and Treatment of Skin Diseases, Characteristic Medical Center of the Chinese People’s Armed Police Force, China
| | - Jianping You
- Department of Infectious Diseases, Southwest Hospital, Army Medical University (The Third Military Medical University), China
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Kittikraisak W, Piyaraj P, Vachiraphan A, Wongrapee T, Punjasamanvong S, Hunsawong T, Sinthuwattanawibool C, Leepiyasakulchai C, Yoocharoen P, Azziz-Baumgartner E, Mott JA, Chottanapund S. Sero-surveillance for SARS-CoV-2 infection among healthcare providers in four hospitals in Thailand one year after the first community outbreak. PLoS One 2021; 16:e0254563. [PMID: 34260638 PMCID: PMC8279322 DOI: 10.1371/journal.pone.0254563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/30/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Thailand was the first country outside China to report SARS-CoV-2 infected cases. Since the detection of the first imported case on January 12th, 2020 to the time this report was written, Thailand experienced two waves of community outbreaks (March-April 2020 and December 2020-March 2021). We examined prevalence of SARS-CoV-2 seropositivity among healthcare providers (HCPs) in four hospitals approximately one year after SARS-CoV-2 first detected in Thailand. By March 2021, these hospitals have treated a total of 709 coronavirus disease 2019 (COVID-19) patients. METHODS Blood specimens, collected from COVID-19 unvaccinated HCPs during January-March 2021, were tested for the presence of SARS-CoV-2 immunoglobulin G (IgG) antibodies to nucleocapsid (IgG-nucleocapsid) and spike (IgG-spike) proteins using Euroimmune® enzyme-linked immunosorbent assays. RESULTS Of 600 HCPs enrolled, 1 (0.2%) tested positive for the SARS-CoV-2 IgG-spike antibodies, but not the IgG-nucleocapsid. CONCLUSION The presence of SARS-CoV-2 IgG antibodies was rare in this sample of HCPs, suggesting that this population remains susceptible to SARS-CoV-2 infection.
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Affiliation(s)
- Wanitchaya Kittikraisak
- Influenza Program, Thailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | | | | | | | | | - Taweewun Hunsawong
- Virology Department, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Chalinthorn Sinthuwattanawibool
- Influenza Program, Thailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | | | - Pornsak Yoocharoen
- Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Eduardo Azziz-Baumgartner
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joshua A. Mott
- Influenza Program, Thailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Suthat Chottanapund
- Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
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The Importance of Atmospheric Microbial Contamination Control in Dental Offices: Raised Awareness Caused by the SARS-CoV-2 Pandemic. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11052359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: In the context of the Sars-CoV-2 pandemic that started in 2020, more attention is being paid to the air quality in medical offices. The medical, economic and social implications of this crisis are unprecedented. Dental offices, particularly, were significantly affected by this pandemic due to the high exposure of dental workers, limited availability of personal protective equipment (PPE) and serious financial problems. Methods: Four different procedures were compared regarding their effectiveness in air contamination reduction, both from a biological point of view and from a management point of view: Fogging, Ultraviolet C (UVC) lamps, UVC air circulation units and natural ventilation. A total of 56 Petri dishes were used to evaluate air contamination. Results: All four procedures offered good results but the decontamination time and overall effect varied depending on the chosen method. Fogging was the only method that managed to remove all the identifiable pathogens. Conclusions: Fogging proved to be superior from a medical point of view, while the UVC air circulation unit proved to be more efficient from a management point of view.
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Thibon P, Breton P, Mouet A, Bidon A, Haupais F, Darrigan C, Gautier P, Letourneur T, Perillieux E, Seguineau C, Thibon P, Henry L, Ar Gouilh M, Borgey F, Le Hello S. Healthcare associated coronavirus disease 2019 among health care workers in Normandy, France: a multi-center study. Infect Prev Pract 2021; 3:100109. [PMID: 34316571 PMCID: PMC7833033 DOI: 10.1016/j.infpip.2020.100109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/03/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION In the early phase of the coronavirus disease (COVID-19) epidemic in France, knowledge of SARS-COV-2 characteristics was limited, and personal protective equipment (PPE) was lacking. Thus, health care workers (HCWs) were exposed to nosocomial transmission. METHODS A multicenter regional descriptive study of fifty-two heath care facilities covering 30,533 HCWs in western Normandy, France, from March 3 to March 27, 2020, before the incidence threshold of 10/100,000 inhabitants was crossed in the study area. The incidence rate of COVID-19 in HCWs, the attack rates and the serial interval distribution of nosocomial transmission were computed. Demographic characteristics of HCWs, contacts with index cases, and the use of personal protective equipment were collected by a structured questionnaire. RESULTS The incidence rate of COVID-19 in HCWs was 2.7‰. Among 19 situations (13 clusters >2 cases), 10 were HCW-HCW and 9 patient-HCW transmission, the global attack rate was 13.7% (95% confidence interval, 10.6%-17.3%), and 68 HCWs were involved (10 index cases, with 58 secondary cases). Exposure of secondary cases was only in the presymptomatic phase of the index case in 29% of cases, 48% for HCW-HCW and 10% for patient-HCW transmission (P<0.001). The mean serial interval was 5.1 days (95% CI, 4.2-5.9 days). Preventative measures were not optimal. CONCLUSIONS Our investigation demonstrated that HCWs who were not assigned to the care of COVID-19 patients were not prepared for the arrival of this particularly insidious new virus, which spread rapidly from an often asymptomatic colleague or patient.
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Affiliation(s)
- Pascal Thibon
- Centre d'appui Pour la Prévention des Infections Associées aux Soins, CPias Normandie, Centre Hospitalo-Universitaire, Caen, F-14033, France
| | - Pierre Breton
- Service d’Hygiène Hospitalière, Centre Hospitalo-Universitaire, Caen, F-14033, France
| | - Audrey Mouet
- Service d’Hygiène Hospitalière, Centre Hospitalo-Universitaire, Caen, F-14033, France
| | - Antoine Bidon
- Centre d'appui Pour la Prévention des Infections Associées aux Soins, CPias Normandie, Centre Hospitalo-Universitaire, Caen, F-14033, France
| | - François Haupais
- Centre d'appui Pour la Prévention des Infections Associées aux Soins, CPias Normandie, Centre Hospitalo-Universitaire, Caen, F-14033, France
| | - Caroline Darrigan
- Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Univ, UNICAEN, UNIROUEN, EA2656, Caen, F-14033, France
| | - Pauline Gautier
- Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Univ, UNICAEN, UNIROUEN, EA2656, Caen, F-14033, France
| | - Thomas Letourneur
- Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Univ, UNICAEN, UNIROUEN, EA2656, Caen, F-14033, France
| | - Emeline Perillieux
- Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Univ, UNICAEN, UNIROUEN, EA2656, Caen, F-14033, France
| | - Charles Seguineau
- Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Univ, UNICAEN, UNIROUEN, EA2656, Caen, F-14033, France
| | - Paul Thibon
- Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Univ, UNICAEN, UNIROUEN, EA2656, Caen, F-14033, France
| | - Liliane Henry
- Centre d'appui Pour la Prévention des Infections Associées aux Soins, CPias Normandie, Centre Hospitalo-Universitaire, Caen, F-14033, France
| | - Meriadeg Ar Gouilh
- Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Univ, UNICAEN, UNIROUEN, EA2656, Caen, F-14033, France
- Laboratoire de Virologie, Centre Hospitalo-Universitaire, Caen, F-14033, France
| | - France Borgey
- Centre d'appui Pour la Prévention des Infections Associées aux Soins, CPias Normandie, Centre Hospitalo-Universitaire, Caen, F-14033, France
| | - Simon Le Hello
- Service d’Hygiène Hospitalière, Centre Hospitalo-Universitaire, Caen, F-14033, France
- Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Univ, UNICAEN, UNIROUEN, EA2656, Caen, F-14033, France
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Puliatti S, Eissa A. Editorial Comment to Nosocomial SARS-CoV-2 infection in urology departments: Results of a prospective multicentric study. Int J Urol 2020; 28:68. [PMID: 33118226 DOI: 10.1111/iju.14416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Stefano Puliatti
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Ahmed Eissa
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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