Flow impacts of hot/cold zone infection control procedures during the COVID-19 pandemic in the emergency department.

BACKGROUND: The COVID-19 pandemic forced emergency departments (EDs) to change operations to minimize nosocomial infection risk. Many EDs cohort patients using provincial screening tools at triage. Despite cohorting, staff exposures occurred in the 'cold zone' due to lack of personal protective equipment (PPE) use with patients deemed low risk, resulting in staff quarantines. The cohorting strategy was perceived to lengthen time to physician initial assessment and ED length of stay times in our ED without protecting staff well enough due to varying PPE use. The objective of this study was to assess the impact of hot/cold zones for patient cohorting during a viral pandemic on ED length of stay. METHODS: We conducted an interrupted time series analysis 3 weeks before and after the removal of hot/cold zone care space cohorting in our ED. In the before period, staff did not routinely wear full PPE to see cold zone patients. After removal, staff wore full PPE to see almost all patients. We collected data on ED length of stay, physician initial assessment times, arrival-to-room times, patient volumes, Canadian Triage Acuity Score (CTAS), admissions, staff hours of coverage, as well as proportions of patients on droplet/contact precautions and COVD-19 positive patients. The primary outcome was median ED length of stay. RESULTS: After the removal of the hot/cold divisions, there was a decrease in the adjusted median ED length of stay by 24 min (95% CI 14; 33). PPE use increased in the after arm of the study. The interrupted time series analysis suggested a decrease in median ED length of stay after removal, although the change in slope and difference did not reach statistical significance. CONCLUSION: Cohorted waiting areas may provide a safety benefit without operational compromise, but cohorting staff and care spaces is likely to compromise efficiency and create delays.

RéSUMé: CONTEXTE: La pandémie de COVID-19 a contraint les services d'urgence (SU) à modifier leur fonctionnement afin de minimiser le risque d'infection nosocomiale. De nombreux SU regroupaient des patients à l'aide d'outils de dépistage provinciaux au triage. Malgré la constitution de cohortes, les expositions du personnel se sont produites dans la "zone froide" en raison du manque d'utilisation d'équipements de protection individuelle (EPI) avec des patients jugés à faible risque, ce qui a entraîné la mise en quarantaine du personnel. Dans notre service d'urgence, la stratégie de cohorte a été perçue comme prolongeant l'évaluation initiale des médecins et la durée du séjour dans le service sans pour autant protéger suffisamment le personnel en raison de l'utilisation variable des EPI. L'objectif de cette étude était d'évaluer l'impact des zones chaudes/froides pour le regroupement de patients lors d'une pandémie virale sur la durée du séjour à l'urgence. MéTHODES: Nous avons réalisé une analyse de séries chronologiques interrompues trois semaines avant et après la suppression de la cohorte d'espace de soins en zone chaude/froide dans nos urgences. Au cours de la période précédente, le personnel ne portait pas systématiquement un EPI complet pour voir les patients des zones froides. Après le retrait, le personnel a porté un EPI complet pour voir presque tous les patients. Nous avons recueilli des données sur la durée du séjour aux urgences, les délais d'évaluation initiale par les médecins, les délais d'arrivée en salle, le volume de patients, L'échelle canadienne de triage et de gravité (ÉTG), les admissions, les heures de couverture du personnel, ainsi que les proportions de patients ayant reçu des précautions contre les gouttelettes et les contacts et de patients positifs au COVD-19. Le critère de jugement principal était la durée médiane du séjour aux urgences. RéSULTATS: Après la suppression des divisions chaudes/froides, la durée médiane ajustée du séjour aux urgences a diminué de 24 minutes (IC à 95 % : 14 ; 33). L'utilisation des EPI a augmenté dans le groupe suivant de l'étude. L'analyse des séries chronologiques interrompues suggère une diminution de la durée médiane de séjour aux urgences après le retrait, bien que le changement de la pente et de la différence n'ait pas atteint la signification statistique. CONCLUSION: Les zones d'attente en cohorte peuvent offrir un avantage en matière de sécurité sans compromis sur le plan opérationnel, mais le regroupement du personnel et des espaces de soins est susceptible de compromettre l'efficacité et de créer des retards.

Implementation of the Abbott ID Now COVID-19 assay at a tertiary care center: a prospective pragmatic implementation study during the third wave of SARS-CoV-2 in Ontario.

The Abbott ID Now COVID-19 assay is a point-of-care molecular diagnostic tool for the detection of SARS-CoV-2. We prospectively monitored implementation of the assay in a tertiary care hospital emergency department (ED) for the diagnosis of early symptomatic patients. A total of 269 paired nasopharyngeal swabs were tested in parallel with the ID Now and laboratory-based molecular methodologies, 191 of which met selection criteria for testing based on symptoms description and duration. Forty-six and 48 samples were positive for SARS-CoV-2 with the ID Now and reference molecular assays respectively. Percent positive and negative agreement were high (93.8% and 99.6% respectively), as were the sensitivity and specificity (93.8% and 99.5%). ID Now results were available 17.47 hours earlier than qRT-PCR. In symptomatic patients seen in ED within 7 to 10 days of symptoms onset, the ID Now COVID-19 assay allows for rapid and accurate detection of infection.

A Multi-Site Analysis of the Prevalence of Food Insecurity in the United States, before and during the COVID-19 Pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support and identify long-term impacts and needs. OBJECTIVE: The National Food Access and COVID research Team (NFACT) was formed to assess food security over different US study sites throughout the pandemic, using common instruments and measurements. This study presents results from 18 study sites across 15 states and nationally over the first year of the COVID-19 pandemic. METHODS: A validated survey instrument was developed and implemented in whole or part through an online survey of adults across the sites throughout the first year of the pandemic, representing 22 separate surveys. Sampling methods for each study site were convenience, representative, or high-risk targeted. Food security was measured using the USDA 6-item module. Food security prevalence was analyzed using ANOVA by sampling method to assess statistically significant differences. RESULTS: Respondents (n = 27,168) indicate higher prevalence of food insecurity (low or very low food security) since the COVID-19 pandemic, compared with before the pandemic. In nearly all study sites, there is a higher prevalence of food insecurity among Black, Indigenous, and People of Color (BIPOC), households with children, and those with job disruptions. The findings demonstrate lingering food insecurity, with high prevalence over time in sites with repeat cross-sectional surveys. There are no statistically significant differences between convenience and representative surveys, but a statistically higher prevalence of food insecurity among high-risk compared with convenience surveys. CONCLUSIONS: This comprehensive study demonstrates a higher prevalence of food insecurity in the first year of the COVID-19 pandemic. These impacts were prevalent for certain demographic groups, and most pronounced for surveys targeting high-risk populations. Results especially document the continued high levels of food insecurity, as well as the variability in estimates due to the survey implementation method.

Message Delivery Strategy Influences Willingness to Comply With Biosecurity.

As the Covid-19 pandemic continues worldwide, it has become increasingly clear that effective communication of disease transmission risks associated with protective behaviors is essential, and that communication tactics are not ubiquitously and homogenously understood. Analogous to Covid-19, communicable diseases in the hog industry result in millions of animal deaths and in the United States costs hundreds of millions of dollars annually. Protective behaviors such as preventative biosecurity practices are implemented to reduce these costs. Yet even with the knowledge of the importance of biosecurity, these practices are not employed consistently. The efficacy of biosecurity practices relies on consistent implementation and is influenced by a variety of behavioral factors under the umbrella of human decision-making. Using an experimental game, we collected data to quantify how different messages that described the likelihood of a disease incursion would influence willingness to follow biosecurity practices. Here we show that graphical messages combined with linguistic phrases demarking infection risk levels are more effective for ensuring compliance with biosecurity practices, as contrasted with either simple linguistic phrases or graphical messages with numeric demarcation of risk levels. All three of these delivery methods appear to be more effective than using a simple numeric value to describe probability of infection. Situationally, we saw greater than a 3-fold increase in compliance by shifting message strategy without changing the infection risk, highlighting the importance of situational awareness and context when designing messages.