Impact of the COVID-19 pandemic on the incidence, etiology, and antimicrobial resistance of healthcare-associated infections in a critical care unit in Western Qatar.

BACKGROUND: Healthcare-associated infections (HAIs) in critical patients affect the quality and safety of patient care and increase patient morbidity and mortality. During the COVID-19 pandemic, an increase in the incidence of HAIs, particularly device-associated infections (DAIs), was reported worldwide. In this study, we aimed to estimate the incidence of HAIs in an intensive care unit (ICU) during a 10-year period and compare HAI incidence during the preCOVID-19 and COVID-19 periods. METHODS: A retrospective, observational study of HAIs in the medical-surgical ICU at The Cuban Hospital was conducted. DAIs included central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonia (VAP). Data included the annual incidence of HAIs, etiology, and antimicrobial resistance, using definitions provided by the Centers for Disease Control and Prevention, except for other respiratory tract infections (RTIs). RESULTS: 155 patients with HAI infections were reported, from which 130 (85.5%) were identified during the COVID-19 period. The frequencies of DAIs and non-DAIs were higher during the COVID-19 period, except for Clostridium difficile infections. Species under Enterobacter, Klebsiella, and Pseudomonas dominated in both periods, and higher frequencies of Acinetobacter, Enterococcus, Candida, Escherichia coli, Serratia marcescens, and Stenotrophoma maltophila were noted during COVID-19 period. Device utilization ratio increased to 10.7% for central lines and 12.9% for ventilators, while a reduction of 15% in urinary catheter utilization ratio was observed. DAI incidence was higher during the COVID-19 pandemic, with risks for CLABSI, VAP, and CAUTI increased by 2.79 (95% confidence interval, 0.93-11.21; p < 0.0050), 15.31 (2.53-625.48), and 3.25 (0.68-31.08), respectively. CONCLUSION: The incidence of DAIs increased during the pandemic period, with limited evidence of antimicrobial resistance observed. The infection control program should evaluate strategies to minimize the impact of the pandemic on HAIs.

The critical component as part of the strategies for medical care, prevention and control of COVID-19

RESUMEN Introducción: La educación médica es un elemento de vital importancia para mejorar el desempeño de los profesionales de la salud en la lucha contra la pandemia de COVID-19. Objetivo: Identificar los elementos fundamentales relacionados con la educación médica en su relación con la atención médica a pacientes con COVID-19, y las estrategias de prevención y control. Desarrollo: Los aspectos relacionados con la atención médica de pacientes sospechosos y confirmados, y con la prevención y el control de la transmisión de infecciones en entornos comunitarios o en centros de salud, se describen como áreas fundamentales para la educación médica. Asimismo, después de controlar la pandemia, los educadores de salud tienen el desafío de evaluar la modificación requerida en los programas de capacitación de profesionales de la salud para lograr un alto rendimiento en los nuevos entornos epidemiológicos. Por este motivo se realizó una sistematización del conocimiento relacionado con los desafíos y el papel de la educación médica en la lucha contra la COVID-19. Conclusiones: Los educadores han tenido un desafío durante la epidemia de COVID-19 en la educación de los profesionales de la salud para enfrentar la epidemia, que será un mayor en el futuro debido a la necesidad de lograr la sostenibilidad de la educación y la revisión de los programas de capacitación para enfrentar la nueva realidad epidemiológica. ABSTRACT Introduction: Medical education is vitally important for improving the performance of health professionals in the fight against the COVID-19 pandemic. Objective: To identify the fundamental elements related to medical education in its relationship with medical care of patients with COVID-19, as well as prevention and control strategies. Development: Aspects related to medical care of suspected and confirmed patients, as well as to the prevention and control of infection transmission in the community settings or in health centers, are described as fundamental areas for medical education. Furthermore, after controlling the pandemic, health educators are challenged to assess the required modification to health professional training programs in order to achieve high performance in new epidemiological settings. Therefore, a systematization was carried out of knowledge related to the challenges and the role of medical education in the fight against COVID-19. Conclusions: Educators have faced a challenge during the COVID-19 epidemic in educating health professionals to face the epidemic, which will be even greater in the future due to the need to achieve sustainability of education and revision of training programs to face the new epidemiological reality.

COVID-19 and the problem of the times in the control strategies

RESUMEN Introducción: En el proceso de cuidados de paciente con sospecha de infección por el nuevo coronavirus (COVID-19) se incluyen elementos que deben ser considerados en las estrategias de prevención de la transmisión. Objetivo: Describir, a partir de la presentación de un caso confirmado con COVID-19, la cronología de los cuidados del paciente sospechoso o confirmado con la enfermedad y la necesidad de optimizar los tiempos de diagnóstico en la prevención de su transmisión. Presentación de caso: Paciente masculino de 59 años de edad con antecedentes de Hipertensión arterial y gota, y de profesión taxista. Siete días anteriores al ingreso comienza con los síntomas clínicos y se le realiza prueba rápida para COVID-19, la cual resultó negativa. Al quinto día de ingreso de aislamiento en habitación privada se le realiza PCR y se confirma la infección por coronavirus. Se traslada a institución dedicada a la atención de estos pacientes donde presenta recuperación sin complicaciones. Se describen los intervalos de tiempo en relación con los cuidados en especial énfasis a la demora diagnóstica. Conclusiones: Se requiere un monitoreo de la dinámica de los cuidados de los pacientes sospechosos de COVID-19 con un especial enfoque en el fortalecimiento de la prevención de la transmisión nosocomial y en la comunidad. ABSTRACT Introduction: In the process of caring for patients with suspected coronavirus infection (COVID-19), elements that must be considered in transmission prevention strategies are included. Objective: To describe, based on the presentation of a case confirmed with COVID-19, the chronology of patients suspected or confirmed with the disease and the need to optimize diagnosis times in the transmission prevention. Case presentation: Fifty-nine-year-old male patient with a history of high blood pressure and gout, working as a taxi driver. Seven days before admission, he began with symptoms. A rapid test for COVID-19 was performed, which was negative. On the fifth day of isolation in a private room, PCR was performed and coronavirus infection was confirmed. He was moved to an institution dedicated to the care of these patients where he recovered without complications. Time intervals concerning care are described with special emphasis on diagnostic delay. Conclusion: Monitoring of the care dynamics of patients suspected of COVID-19 is required with a special focus on strengthening the prevention of nosocomial transmission and the prevention of the spreading of the disease in the community.