On-going impact of the SARS-CoV-2 pandemic on the evolution of carbapenemase-producing Enterobacterales in Ontario, Canada

Background. The spread of carbapenemase-producing Enterobacterales (CPE) is global threat. Numerous outbreaks of CPE have been reported during the COVID-19 pandemic. We describe the impact of of the SARS-CoV-2 pandemic on the emergence of CPE in south-central Ontario, Canada. Incidence of clinical isolates of CPE and isolates with different CPE genes in Toronto/Peel region, 2017-2021. The upper panel shows the incidence of patients with clinical isolates of CPE by year and quarter from q4 2007 to q1 2022. The lower panel shows the incidence of patients with clinical isolates with different carbapenemase genes by fiscal year during the same period. Methods. TIBDN has performed population-based surveillance for CPE in Toronto/Peel region (pop 4.5M) from first identified isolate in 2007. All laboratories test/refer all carbapenem non-susceptible Enterobacterial isolates for identification of CPE. Hospital charts are reviewed and patients/physicians interviewed. Population data are obtained from Statistics Canada. Results. From 10/2007 to 3/31/2022, 1367 persons colonized or infected with CPE were identified. Theirmedian age was 68.7yrs (IQR 54-78yrs);761 (56%) weremale. 772 (56%) were colonized when first identified;115 (8.4%) were bacteremic at identification or subsequently developed bacteremia. The most common organisms were E. coli (651, 48%), K. pneumoniae (436, 32%), Enterobacter spp. (146, 11%), Citrobacter spp (62, 5%);the most common genes were NDM+/-OXA-48 (722, 53%), OXA-48-like (341, 25%), KPC (225, 16%), VIM(44, 3%). The incidence of CPE infections increased steadily until 3/2020 then declined by 61%and remained stable until 3/2022 (Figure, upper panel). The declinewas greater for E. coli (56%decrease), K. pneumoniae (62%) than for Enterobacter spp. (30%) and other species (19%). It occurred in all genes in 2020;however, KPC containing organisms increased again in 2021 (Figure, lower panel). Conclusion. The advent of the COVID-19 pandemic was associated with an immediate, substantial decline in the incidence of patients with CPE in our population area. This decline occurred in both isolates with genes usually occurring in cases imported from other countries, and in those usually occurring in cases associated with transmission within Canadian hospitals. Decreased travel and enhanced infection prevention and control in hospitals may both have contributed to reductions in CPE during the pandemic. (Figure Presented).

Sustainability of Improvements to Hand Hygiene Performance Throughout the COVID-19 Pandemic

Background. Hand hygiene (HH) is a standard infection prevention and control precaution to be applied in healthcare settings to prevent transmission of COVID-19. Many healthcare institutions observed significant improvements in HH performance during wave one of the COVID-19 pandemic but the sustainability of this change is unknown. Our aim was to evaluate long-term HH performance throughout subsequent waves of the pandemic across acute care hospitals in Ontario, Canada. Methods. HH adherence was measured using a previously validated group electronic monitoring system which was installed on all alcohol handrub and sink soap dispensers inside and outside each patient room across 56 inpatient units (35 wards and 21 critical care units) spanning 13 acute care hospitals (6 university and 7 community teaching hospitals) from 1 November 2019 to 31 May 2021. Daily HH adherence was compared with daily COVID-19 case count across Ontario. During this period, weekly performance continued to be reported to units but unit-based quality improvement discussions were inconsistent due to the COVID-19 response. Results. Figure 1 depicts daily aggregate HH adherence plotted against the new daily COVID-19 case count across Ontario. An elevation in HH adherence was seen prior to the start of the first wave, rising almost to 80% and then remained above 70% for the peak of wave one. During waves two and three, peak COVID-19 case counts were associated with a maximum HH adherence of 51%, only marginally above the pre-pandemic baseline. After the end of wave one (from 1 July 2020 to 31 May 2021) the median HH performance was only 49% (interquartile range 47%-50%). Conclusion. Initial improvements in HH adherence preceding the start of the COVID-19 pandemic were not sustained, possibly due to increasing comfort and reduced anxiety associated with providing care to COVID-19 patients leading to a perception of reduced COVID-19 transmission risk. These findings highlight the need for HH monitoring to be tied to longitudinal unit-led quality improvement in order to achieve durable changes in practice.

The impact of COVID-19 on therapeutic recreation practice in long-term care homes across Canada. (Leisure and aging in difficult times.)

In Canada, adults aged 70 and over account for more than 20% of COVID-19 cases [Public Health Agency of Canada (PHAC). (2020 Public Health Agency of Canada (PHAC). (2020). Coronavirus disease 2019 (COVID-19): Epidemiology update. Retrieved September 7, 2020, from https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html?stat=num&measure=deaths#a2 [Google Scholar]). Coronavirus disease 2019 (COVID-19): Epidemiology update. Retrieved September 7, 2020, from https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html?stat=num&measure=deaths#a2]. Those residing in long-term care (LTC) homes are particularly vulnerable, with hundreds of outbreaks occurring in LTC across the country. By the end of May 2020, more than 80% of COVID-19 deaths were residents of LTC [Canadian Institute for Health Information (CIHI). (2020 Canadian Institute for Health Information (CIHI). (2020). Pandemic experience in the long-term care sector: How does Canada compare with other countries? [Google Scholar]). Pandemic experience in the long-term care sector: How does Canada compare with other countries?]. In order to protect residents, restrictions on activities and visitors were implemented, and therapeutic recreation (TR) professionals adapted programming in keeping with COVID-19 restrictions. The purpose of this article is to describe professionals' perspectives and experiences during the COVID-19 pandemic. More specifically, we explored how TR professionals adapted their practice in accordance with public health measures and restrictions;and we explored their perspectives regarding the implications of the restrictions on resident well-being. Thematic analysis generated three themes: shifting TR practice;perceived impact on resident quality of life;and drawing on strengths and resources. Findings suggest that as a direct result of COVID-19 restrictions, professionals were challenged to meet residents' needs as they had pre-pandemic, but instead, through creativity and an emphasis on person-centered care ideals, managed to contribute to resident quality of life.

Influence of the COVID-19 pandemic on the burnout rates of graduating Canadian urology residents

INTRODUCTION AND OBJECTIVE: Burnout is a work-related psychologic syndrome characterized by emotional exhaustion decreased sense of personal accomplishment, and depersonalization.1 Burnout among surgeons is increasing with prevalence rates exceeding 50%.2COVID-19 has affected the medical system with evidence of increased stress and levels of depression in our medical trainees. This study aims to assess the influence COVID-19 is having on burnout rates in Canadian Urology trainees. METHODS: Thirty-seven chief residents among the Canadian Urology residency programs attended the Queen's Urology Exam Skills Test (QUEST) on December, 2019 pre-pandemic and thirty-nine chief residents attended virtually on November, 2020 during the pandemic. The Maslach Burnout Inventory (MBI) questionnaire was administered anonymously. The MBI covers emotional exhaustion, depersonalization and personal accomplishment.4 Descriptive statistics were used to analyze the data. RESULTS: There was 100% response rate in the convenience sample (n=37) in 2019 and 64.1% response rate (n=25) in 2020. 70% of chief residents in Canadian Urology programs showed evidence of burnout in 2019 compared to 88% in 2020. There was a statistically significant difference between the two cohorts in emotional exhaustion (45.9% in 2019 and 68% in 2020, p=0.005) and depersonalization scores (62.2% in 2019 and 80% in 2020, p=0.02). CONCLUSIONS: This study is the first to examine the impact of the pandemic on burnout rates in urology trainees. Burnout rates are high in trainees at baseline, and the pandemic appears to have exacerbated this problem. Vigilance and proactive steps need to be implemented to alleviate this crisis.

COVID-19 mass vaccination campaign for healthcare workers in a low-resource setting: A clinician-driven initiative.

COVID-19 vaccination has been globally accepted as a critical public health response measure to prevent severe disease and death, alleviate strain on healthcare systems, and prevent onward transmission of SARS-CoV-2. The South African Department of Health's plan to vaccinate 1.25 million healthcare workers through the Sisonke Early Access Vaccine Rollout for Healthcare Workers presented both opportunities and challenges in terms of designing and implementing a mass vaccination roll-out in the resource-limited state sector. We present our experiences and challenges from the largest hospital in Africa, and hope that this will assist other institutions with planning successful COVID-19 mass vaccination campaigns.

COVID-19 epidemiology in Canada from January to December 2020: the pre-vaccine era

This paper summarizes COVID-19 disease epidemiology in Canada in the pre-vaccine era-from January through to December 2020. Canadian case numbers, risk factors, disease presentations (including severe and critical disease), and outcomes are described. Differences between provinces and territories in geography, population size and density, health demographics, and pandemic impact are highlighted. Key concepts in public health response and mitigation are reviewed, including masking, physical distancing, hand washing, and the promotion of outdoor interactions. Adequate investment in public health infrastructure is stressed, and regional differences in screening and testing strategies are highlighted. The spread of COVID-19 in Canadian workplaces, long-term care homes, and schools is described and lessons learned emphasized. The impact of COVID-19 on vulnerable populations in Canada-including Indigenous Peoples, ethnic minorities and newcomers, people who use drugs, people who are homeless, people who are incarcerated, and people with disabilities-is described. Sex and gender disparities are also highlighted. Author recommendations include strategies to reduce transmission (such as test-trace-isolate), the establishment of nationally standardized definitions and public reporting, the protection of high risk and vulnerable populations, and the development of a national strategy on vaccine allocation.

Meeting the challenge of providing nutrition services during the COVID-19 pandemic

We, registered dietitian nutritionists (RDNs), could have sat on the sidelines in the early days of the pandemic when many RDNs were not considered "essential" workers. Instead, RDNs used their abilities to innovate and adapt to ensure the public, their patients, and clients received continuous nutrition services. Some of the strategies adopted were possible because of temporary or emergency flexibilities in policies. We present examples primarily from our outpatient practices, with efforts by public health and inpatient RDNs acknowledged. We hope these examples will inspire all to do the work needed to provide increased access to medical nutrition therapy and nutrition education for all.