Prevalence of SARS-CoV-2 among Belgian workers in long-term care facilities

Background

Healthcare workers (HCWs) can be a source of SARS-CoV-2 within long-term care facilities (LTCFs); therefore, we analysed the data from a testing programme among LTCF employees.

Aims

The aim of this study was to investigate the prevalence of SARS-CoV-2 and its determinants among employees of LTCFs and the risk for fellow workers and residents.

Methods

Testing started at week 15, the first wave’s peak, using nasopharyngeal swabs for PCR up to week 23. At the start of the second wave (week 32), testing resumed.

Results

A total of 32 457 test results were available from 446 LTCFs: 2% were positive: 1% in men, 2% in women, 2% in HCWs (=having patient contact), 1% in non-HCWs, higher in younger age groups. In total, 30 729 employees were tested once, 823 twice, 66 thrice and 4 four times. Prevalence was 13% during the first week of testing (week 15) and declined to 7% (week 16) to stay at around 1% (from week 17 until week 23). At the start of the second wave (week 31–33), the prevalence was around 3%. In 70% of positive tests, the employee was asymptomatic.

Conclusions

Our study confirms the presence of HCWs with SARS-CoV-2 as a possible source of infection in LTCFs even when the incidence in the general population was low; 70% were asymptomatic. To control the spread of SARS-CoV-2 in LTCFs vaccination, infection prevention and control measures are necessary as well as testing of all LTCF HCWs during possible outbreaks, even if asymptomatic.

Arthroscopic double-row cuff repair with suture-bridging: a structural and functional comparison of two techniques

PURPOSE

The aim of this study was to compare the functional and structural outcomes of 2 techniques for double-row, suture-bridging cuff repair.

METHODS

A consecutive series of 73 patients who underwent arthroscopic, double-row, suture-bridge primary rotator cuff repair of full-thickness supraspinatus tear were evaluated. Thirty-eight shoulders were repaired by the arthroscopic, tied, suture-bridging technique (group A), and 35 shoulders by knot-less bridging with suture tape material (group B). Constant scores, pain, range of motion, strength, and complications were measured after a minimum follow-up period of 12 months post-operatively. Structural integrity of the repairs was evaluated systematically by either magnetic resonance imaging or computed tomography arthrography.

RESULTS

Median follow-up after surgery was 29 (23-32) months in group A, and 21 (12-23) months in group B. Mean pain relief, range of motion, strength, and constant score improved significantly in both groups. No statistical differences were found between groups in the post-operative period. According to control imaging, the re-tear rate trended to be higher in group A (23.4 %) than in group B (17.1 %), although not significantly.

CONCLUSION

Both bridging repair techniques achieved successful functional outcomes. In terms of structural outcome, the knot-less tape-bridging construct showed a lower but not significant re-tear rate. Longer follow-up is needed to confirm these results and to evaluate potential differences between the two techniques.

LEVEL OF EVIDENCE

A prospective, non-randomized, comparative study, Level III.

Results of angular-stable locked intramedullary nails in the treatment of distal tibia fractures

INTRODUCTION

Intramedullary nailing in distal tibial fracture is controversial because of a lack of stability. The present study sought to assess radiological and clinical results for a new "angular-stable" locking system in difficult indications for intramedullary nailing.

MATERIAL AND METHOD

A prospective study recruited 41 patients (41 tibias) with distal tibial fracture consecutively managed using angular-stable locked intramedullary nails. Radiologic assessment comprised AP and lateral lower-limb views, taken postoperatively and through to last follow-up. The mean distance was measured between fracture and joint line. Fusion, with or without malunion, primary reduction defect, non-union and secondary displacement were recorded, as were all complications.

RESULTS

Mean follow-up was 18 ± 5 months; 3 patients were lost to follow-up. Mean fracture distance from the joint line was 63 ± 25 mm. Fusion was achieved within 3 months in 29 cases (76%); delayed fusion in 7 patients (18%) required secondary dynamization at a mean 3 months, with favorable evolution. Revision surgery was required in 2 cases: 1 for secondary displacement exceeding 10°, and 1 for non-union at 7 months. Other complications mainly comprised 4 malunions of less than 10° due to primary reduction defect.

CONCLUSION

Angular-stable locked lower-limb intramedullary nailing provided a very satisfactory fusion rate, with few complications. It is, however, a demanding procedure, especially as regards fracture reduction and nail positioning in the distal fragment.

PROSPECTIVE COHORT STUDY

level IV.

Analysing and interpreting routinely collected data on sharps injuries in assessing preventative actions

BACKGROUND

Sharps injuries (SI) occur frequently in hospitals and are a risk for exposure to bloodborne pathogens. During the 1990s, the safety service of a university general hospital introduced, in collaboration with the occupational health service, specific measures to reduce the number of SI.

AIM

The aim of this study was to assess the occurrence and evolution of SI during this period and to evaluate the effectiveness of the preventative measures taken, making use of routinely collected data.

METHOD

In a retrospective study, we analysed the number of SI recorded from 1990 to 1997. The study population was all employees at risk of SI. Because the introduction of intensive preventative measures dates from 1996, an effect on the incidence of SI can be expected from 1996. To assess this effect, mean incidence rates for 1990-1995 and for 1996-1997 were compared.

RESULTS

In the study period, a total of 4230 SI were recorded. The global SI incidence rate decreased from 33.4 SI per 100 occupied beds per year in 1990-1995 to 30.1 in 1996-1997 (P < 0.01). In the same period, among nurses a decrease in incidence rate from 17.2 to 12.7 SI per 100 person-years was noted (P < 0.0001) and for the hotel service from 4.8 to 3.7 (not significant).

CONCLUSION

Although this study has various restraints, these results suggest that intensive preventative actions, in combination with technological advances, may have contributed to a drop of 67 SI cases per year.