ABSTRACT
Introduction: The assessment of COVID-19 associated mortality is crucial to evaluate the impact of the pandemic and to assess the effectiveness of measures. Objectives: We aimed to investigate trends in COVID-19 related mortality over time in Switzerland, using data from the COVID-19 Hospitalbased Surveillance (CH-SUR) database. Methods: Considering four different time periods of COVID-19 epidemic, we calculated crude and adjusted mortality rates and performed competing risks survival analyses for all patients and for patients admitted to intensive care (ICU). Results: Overall, 16,967 COVID-19 related hospitalizations and 2,307 deaths of adult patients were recorded. Crude hospital mortality rates were 15.6% in the 1st and 14.4% in the 2nd wave;for ICU patients it was 24% and 31.3%, respectively. The overall adjusted risk of death was lower for hospitalised patients during the 2nd compared to the 1st wave (HR 0.75, 95% CI 0.73 - 0.77). In contrast, patients admitted to ICU as well as patients with invasive ventilation presented a higher risk of death during the 2nd wave (HR 1.62, 95% CI 1.54-1.70 and HR 2.10, 95% CI 1.99-2.20, respectively). Conclusion: Our findings may be explained by various changes in the COVID-19 patient management in Swiss hospitals, e.g. with the use of effective drugs against complications or with different guidelines for ICU admission and invasive ventilation use.
ABSTRACT
Introduction: Hand hygiene with alcohol-based handrub (ABHR) is the standard of care against healthcare-associated infections, which represents a major adverse event when providing care at hospitals. Continuous monitoring of hand hygiene compliance is one of the main components of the WHO multimodal hand hygiene improvement strategy. Measuring the consumption of ABHRs is considered as a surrogate marker of hand hygiene compliance. Objectives: To study the impact of the most recent major pandemics, H1N1 and coronavirus disease 2019 (COVID-19), on ABHR consumption at University of Geneva Hospitals (HUG). Methods: We analyzed the ABHR consumption amounts at HUG from 1994 to 2020. The hospital pharmacy gathers data regarding the volume of ABHR consumption as L/1000 patient-days, first started in 1994. The data provided from the pharmacy refers to the hospital as a whole. Results: We observed two peaks in the consumption of ABHR at HUG, in 2009 and 2020. The consumption of ABHR increased from 35.38 L/1000 patient-days in 2008 to 50.33 L/1000 patient-days in 2009, when H1N1 pandemic emerged. The rise in using ABHRs was even more significant during the COVID-19 pandemic, which increased from 41.75 L/1000 patient-days in 2019 to 99.33 L/1000 patient-days in 2020 with the emergence of the current pandemic. Conclusion: ABHRs are increasingly used at HUG and more than 99% of hand hygiene actions are currently performed with ABHRs. During major infectious disease outbreaks, the consumption of ABHR increases dramatically, considering its efficacy against cross-transmission of various microorganisms. Therefore, ensuring the global and equitable access to high quality ABHRs and considering local production in times of crisis are necessary in order to prevent lack of supplies, especially during pandemics.
ABSTRACT
Introduction: Since the beginning of the COVID-19 pandemic, HUG are taking care of patients suspected of having or affected with COVID- 19. The majority of the HUG wards became COVID wards;CONTACT and DROPLETS measures replaced SP. When the situation returned to normal, the use of personal protective equipment was inappropriate. A corrective program was implemented. One of its objectives was to address the role of the MED/NURS leaders of the non-COVID wards. In the initial phase of the program, the PCI knowledge of these managers was assessed and updated. The majority of the wards became COVID wards;CONTACT and DROPLETS measures replaced SP. Objectives: To assess the knowledge of MED/NURS leaders of non- COVID wards regarding hand hygiene and wearing of gloves and to evaluate the choice of personal protective equipment by MED/NURS managers in non-COVID wards for frequent clinical situations. Methods: The MED/NURS managers of the non-COVID wards were invited to participate in a training session. 3 ICP professionals and 1 adult education specialist: 1. described the context and presented the project;2.tested the participants' knowledge about hand hygiene, gloves' wearing and personal protective equipment to be used in frequent clinical situations. The quiz was built with an educational purpose. The participants' answers were recorded anonymously by an online survey software. Aggregated responses were presented and commented during the session. Results: 11 training sessions were held from 27.01.2021 to 26.02.2021;286 MED/NURS leaders were invited: 177 (61.8%) attended. More than 75% of the participants appreciated this type of training. Conclusion: Knowledge about hand hygiene and gloves' wearing is satisfactory: it was enough to answer true or false to a statement. The percentage of correct answers given to clinical situations is insufficient: knowing which personal protective equipment to use with regard on transmission risk remains complicated. This is one of the topics on which our program must focus.
ABSTRACT
Introduction: Since the beginning of the COVID-19 pandemic, HUG hospital is mandated to care for patients suspected of having or affected by COVID-19. The majority of the wards (W) at HUG became COVID W;CONTACT and DOPLETS measures replaced standard precautions (SP). Additional measures were implemented to prevent nosocomial (NOSO) cases: control of visitors and staff at the entrance of the hospital, surgical mask wearing, screening of patients and staff, epidemiological surveillance. Vaccination started in January 2021. On 26.05.2021, 17.3% of the general population and 57.5% of the hospital staff received at least one dose. Objectives: To reduce the occurrence of NOSO cases in non-COVID W Methods: The program covers the period from 01.01 to 30.06.2021 and concerns non-COVID units. It is based on several axes of intervention, including: 1.Training: medical-nursing managers of the non-COVID W were invited to participate in a training session on the topic “SP”. Trainers were 3 IPC professionals and 1 adult education specialist. 2. Monitoring of compliance with hand hygiene, mask wearing and provision of alcohol based handrub at the W entrance. Observers are trained, validated and interrater reliability tested. Feedback was applied: oral immediate feedback;monthly delayed feedback using a poster for each W with SP' compliance, explaining the results with the hierarchy, and set the goal for next month. A written report was sent to the hospital management. Patients' data are from the prospective national surveillance on COVID-19 identified hospitalized COVID-19 adult cases with a laboratory confirmed infection. NOSO cases were defined as those detected > 5 days after hospital admission. Results: From 24.08.2020 to 23.05.2021, 1863 community acquired COVID cases and 497 NOSO cases were collected. The percentage of NOSO cases decreased after the introduction of the program (before 426/1589 (26.8%) after 71/771 (9.2%), p < 0.001). Conclusion: Following the intervention, the incidence of NOSO cases has markedly decreased.
ABSTRACT
Introduction: Since the beginning of the COVID-19 pandemic, HUG took care of a large number of patients suspected of having or affected by COVID;the majority of HUG wards became temporarily COVID wards. When the situation returned to normal, the practice of SP needed to be strengthened. Among SP, HH is the most important. Monitoring HH by direct observation (DO) and performance feedback are essential to improve and sustain compliance. Glove use remains a challenge for HH compliance, particularly before donning or after doffing. Immediate individual feedback (IIF) is very useful for the understanding of HH by HCWs during patient care. Objectives: To evaluate HH compliance improvement when immediate or delayed feedback is provided and to assess the impact of glove use on compliance. Methods: The study was conducted at HUG from 1 January to 30 June 2021. Trained, validated and interrater reliability-tested observers monitored HH using the WHO DO method, for a minimum of 30 opportunities/ ward/month. Feedback were applied using a series of approaches: immediate oral individual feedback (IIF) to HCW, a monthly delayed feedback by the IPC nurse through a poster figuring the average ward compliance observed and goal setting for the next month. A written report of HH compliance including the rate of missed actions while the HCW was wearing gloves was also provided. Final results for the total study period with statistical evaluation will be provided at ICPIC. Results: Between 1 Jan and 30 April 2021, a total of 10,332 opportunities were observed. Table 1 shows preliminary results of overall monthly HH compliance, levels of IIF and frequencies of missed HH actions in the presence of gloves. Conclusion: The intervention was associated with improvement in HH compliance. Glove use was associated with a high number of missed HH actions. Reduction of glove use together with individual feedback were associated with a decreased frequency of missed actions.
ABSTRACT
Introduction: Numerous reports of healthcare-associated COVID- 19 (HA-COVID-19) outbreaks have highlighted that hospitals can be a platform for SARS-CoV-2 transmission. Uncertainty remains with regards to clinical outcomes of patients who contracted SARS-CoV-2 in healthcare facilities compared to those hospitalized after community acquisition (CA-COVID-19). Objectives: The objective of this study was to describe and compare characteristics and clinical outcomes of patients with HA-COVID-19 versus CA-COVID-19. Methods: We used data from 16 hospitals included in the prospective national surveillance on COVID-19 in Switzerland. We included all hospitalized COVID-19 adult cases with a laboratory confirmed infection. HA-COVID-19 cases were defined as those detected > 5 days after hospital admission. Only the first hospital stay after diagnosis for CACOVID- 19 cases, and during diagnosis for HA-COVID-19 cases, were considered. Cases with no information on place of acquisition were excluded. Results: Between February and December 2020, 1'389 HA-COVID-19 cases and 9'139 CA-COVID-19 were included. HA-COVID-19 patients were older than CA-COVID-19 (median [IQR] age: 79 [70-86] versus 70 [57-80], predominantly female (48.2% versus 39.6%), and were more likely to have a Charlson comorbidity index > 4 (78.2% versus 54.9%). At the time of diagnosis, HA-COVID cases were most frequently hospitalized in general medical (570, 41%) and Geriatric/Rehabilitation wards (409, 29.4%). Length of stay was shorter for CA-COVID-19 cases (median 15, IQR [10-23] days from admission) than for HA-COVID-19 (17 [9-30] days from COVID-19 diagnosis). Fewer HA-COVID-19 patients stayed in intermediate or intensive care units (ICU) (223 [16.1%] versus 2'031 [22%] of CA-COVID-19 cases) (p < 0.001), and fewer HA-COVID-19 cases experienced any COVID-19 complications (770 (65.7%) versus 6665 (83.5%), p < 0.001). Overally, 350 (26.6%) HA-COVID-19 and 1225 (13.9%) CA-COVID-19 died. Conclusion: Patients who acquired COVID-19 within the hospital were older and more comorbid. They were less frequently transferred to the intermediate or ICU and experienced fewer COVID-19 complications, but suffered from higher rates of hospital mortality.
ABSTRACT
BACKGROUND: Nosocomial outbreaks of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are frequent despite implementation of conventional infection control measures. An outbreak investigation was undertaken using advanced genomic and statistical techniques to reconstruct likely transmission chains and assess the role of healthcare workers (HCWs) in SARS-CoV-2 transmission. METHODS: A nosocomial SARS-CoV-2 outbreak in a university-affiliated rehabilitation clinic was investigated, involving patients and HCWs, with high coverage of pathogen whole-genome sequences (WGS). The time-varying reproduction number from epidemiological data (Rt) was estimated, and maximum likelihood phylogeny was used to assess genetic diversity of the pathogen. Genomic and epidemiological data were combined into a Bayesian framework to model the directionality of transmission, and a case-control study was performed to investigate risk factors for nosocomial SARS-CoV-2 acquisition in patients. FINDINGS: The outbreak lasted from 14th March to 12th April 2020, and involved 37 patients (31 with WGS) and 39 employees (31 with WGS), 37 of whom were HCWs. Peak Rt was estimated to be between 2.2 and 3.6. The phylogenetic tree showed very limited genetic diversity, with 60 of 62 (96.7%) isolates forming one large cluster of identical genomes. Despite the resulting uncertainty in reconstructed transmission events, the analyses suggest that HCWs (one of whom was the index case) played an essential role in cross-transmission, with a significantly greater fraction of infections (P<2.2e-16) attributable to HCWs (70.7%) than expected given the number of HCW cases (46.7%). The excess of transmission from HCWs was higher when considering infection of patients [79.0%; 95% confidence interval (CI) 78.5-79.5%] and frail patients (Clinical Frailty Scale score >5; 82.3%; 95% CI 81.8-83.4%). Furthermore, frail patients were found to be at greater risk for nosocomial COVID-19 than other patients (adjusted odds ratio 6.94, 95% CI 2.13-22.57). INTERPRETATION: This outbreak report highlights the essential role of HCWs in SARS-CoV-2 transmission dynamics in healthcare settings. Limited genetic diversity in pathogen genomes hampered the reconstruction of individual transmission events, resulting in substantial uncertainty in who infected whom. However, this study shows that despite such uncertainty, significant transmission patterns can be observed.