ABSTRACT
INTRODUCTION: The problem of carbapenemase-producing Enterobacteriaceae (CPE) was exacerbated by the COVID-19 pandemic in countries with a previous high incidence, such as Argentina. This study describes the development and results of a CPE prevention program, mainly carbapenemase-producing Klebsiellas (KPC), in three critical units of two public hospitals during 6 months of the pandemic. METHODS: The objective was to reduce the incidence of KPC in clinical and colonization samples. This quasi-experimental study was based on a cycle of improvement and implementation of three measures: hand hygiene, environmental hygiene, and periodic surveillance with rectal swabs. RESULTS: Regarding the measures, all the units optimized active surveillance, and two of these also improved hand and environmental hygiene. Comparing the pre- and post-intervention periods in the three units, no significant change was observed in the rate of KPC positive clinical samples. KPC colonization was significantly reduced in two units (unit 2: 51.6-18.5 p 0.0004, unit 3: 62.5-5.2 p < 0.0000001). All units showed a downtrend in both rates towards the end of the study. CONCLUSION: Containing or reducing the advance of the KPC in our region is possible even in difficult scenarios such as the pandemic. More studies are needed in low- and middle-income countries to demonstrate the impact of KPC prevention programs in these situations.
ABSTRACT
Background: Information about COVID infection in physicians is limited. This knowledge would allow the implementation of actions to reduce its impact. The objective was determining the incidence of SARS-CoV-2 infection in physicians from health institutions in Argentina, its characteristics, and associated factors. Methods: We conducted a multicenter prospective/retrospective cohort study with nested case-control study. Physicians active at the beginning of the pandemic were included, those on leave due to risk factors were excluded. The incidence of confirmed cases was estimated. We conducted bivariate analyses with various factors and used those significant in a logistic regression. Results: Three hundred and forty three physicians with COVID-infection from 8 centers were included. The incidence of disease was 12.1% and that of global absenteeism related to COVID, 34.1%. Almost 70% of close contacts were work-related. In the multivariate analysis living in Autonomous City of Buenos Aires (CABA) (OR 0.19, p = 0.01), working in high-risk areas (OR 0.22, p = 0.01) and individual transportation (OR 0, 34, p = 0.03) reduced the risk of COVID. The odds of infection increased 5.6 times (p = 0.02) for each close contact isolation. Discussion: The number of close contact isolation increased considerably the risk of infection. Living in Buenos Aires City, individual transportation and working in high-risk areas reduced it. Given the high frequency of close contact in the workplace, we strongly recommend the reinforcement of prevention measures in rest areas and non-COVID-wards.
ABSTRACT
The COVID-19 pandemic has had an impact on public health and the global economy. The objective of this document was to update, according to the available evidence, the management of some basic elements in the Infection Control Programs (PCI) and the daily care of patients. As a result: 1. The routine use of the N95 masks is not recommended for the care of suspected or confirmed COVID-19 patients. Available data indicates that SARS-CoV-2 has spread primarily like most other common respiratory viruses, through droplet and contact transmission. In certain situations, personto- person transmission is described through the airway, observed in poorly ventilated environments, and while the individual carried out actions of greater potential transmission 2. The limited reuse and decontamination methods of N95 masks are accepted under safe and effective prot ocols in the context of limited resources. 3. The isolation of patients with COVID-19 can be lifted under a strategy based on the clinic, individual risk factors and time of evolution of the disease. 4. PCR control is not required in confirmed cases to determine epidemiological discharge. 5. Current evidence shows that there is a possibility of reinfection although its diagnosis is difficult. 6. The measurement of antibodies has a specific role in prevalence studies, diagnosis of multisystemic inflammatory syndrome and a picture compatible with negative PCR after the 7th. day.