ABSTRACT
Objective: To analyze the diagnostic accuracy of lung ultrasonography (LUS) and high-resolution computed tomography (HRCT), to detect COVID-19. Materials and Methods: This study recruited all patients admitted to the emergency medicine unit, due to a suspected COVID-19 infection, during the first wave of the COVID-19 pandemic. These patients also who underwent a standardized LUS examination and a chest HRCT. The signs detected by both LUS and HRCT were reported, as well as the sensitivity, specificity, positive predictive value, and negative predictive value for LUS and HRCT. Results: This cohort included 159 patients, 101 (63%) were diagnosed with COVID-19. COVID-19 patients showed more often confluent subpleural consolidations and parenchymal consolidations in lower lung regions of LUS. They also had "ground glass” opacities and "crazy paving” on HRCT, while pleural effusion and pulmonary consolidations were more common in non-COVID-19 patients. LUS had a sensitivity of 0.97 (95% CI 0.92–0.99) and a specificity of 0.24 (95% CI 0.07–0.5) for COVID-19 lung infections. HRCT abnormalities resulted in a 0.98 sensitivity (95% CI 0.92–0.99) and 0.1 specificity (95% CI 0.04–0.23) for COVID-19 lung infections. Conclusion: In this cohort, LUS proved to be a noninvasive, diagnostic tool with high sensitivity for lung abnormalities that were likewise detected by HRCT. Furthermore, LUS, despite its lower specificity, has a high sensitivity for COVID-19, which could prove to be as effective as HRCT in excluding a COVID-19 lung infection.
ABSTRACT
SUMMARY: SARS-CoV-2-related infection can determine hospital-acquired infections among patients and healthcare workers. Aim of this paper was to review the literature for developing a strategy for protecting healthcare workers, patients, and visitors by COVID-19 hospital infection. A critical and rapid revision of the literature and international standards and Regulations on this topic allowed us to propose an evidencebased strategy in the framework of the workplace risk assessment for preventing nosocomial COVID-19 outbreaks. The virus' high transmissibility, the high prevalence of asymptomatic carriers and false-negative Covid-19 rates on naso- and oropharingeal swabs, put hospitals at high-risk of COVID-19 outbreaks. A comprehensive strategy based on standard precautions, administrative, environmental, and engineering controls, a screening protocol for patients on their admission to hospital, and a testing-based strategy for HCWs within health surveillance programs may prevent the onset of hospital outbreaks, which are a threat to community, patients and HCWs, compromising the sustainability of healthcare facilities. Copyright© by GIMLE. SARS-CoV-2 pu determinare infezioni acquisite in ospedale tra pazienti e operatori sanitari. Lo scopo di questo studio rivedere la letteratura per lo sviluppo di una strategia per la protezione di operatori sanitari, pazienti e visitatori dall’infezione ospedaliera da COVID-19. Una revisione critica e rapida della letteratura e degli standard e regolamenti internazionali su questo argomento, ci ha permesso di proporre una strategia basata sull’evidenza nel quadro della valutazione del rischio sul posto di lavoro per prevenire le epidemie nosocomiali da COVID-19. L’elevata trasmissibilit del virus, l’elevata prevalenza di portatori asintomatici e di tamponi naso e orofaringei falsi negativi, mettono gli ospedali ad alto rischio per lo sviluppo di focolai da COVID-19. Una strategia globale, basata su precauzioni standard, controlli amministrativi, ambientali e tecnici, su un protocollo di screening per i pazienti al momento del ricovero in ospedale, insieme ad una strategia operativa basata sui test di screening per gli operatori sanitari all’interno dei programmi di sorveglianza sanitaria, possono prevenire l’insorgenza di epidemie ospedaliere che rappresentano una minaccia per la comunit , per i pazienti e per gli operatori sanitari, compromettendo la sostenibilit delle stesse strutture sanitarie.