Impact of COVID-19 pandemic on healthcare-associated infections at intensive care units in South Korea: data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS).

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has influenced hospital infection control practices. AIM: To evaluate the impact of the COVID-19 pandemic on healthcare-associated infections (HAIs) in intensive care units (ICUs). METHODS: A retrospective analysis using data from the Korean National Healthcare-Associated Infections Surveillance System was conducted. Comparisons between incidence rates and micro-organism distributions of bloodstream infection (BSI), central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) before and during the COVID-19 pandemic were performed according to hospital size. FINDINGS: The incidence rate of BSI significantly decreased during the COVID-19 pandemic compared to the pre-COVID-19 period (1.38 vs 1.23 per 10,000 patient-days, relative change -11.5%; P < 0.001). The incidence rate of VAP (1.03 vs 0.81 per 1000 device-days, relative change -21.4%; P < 0.001) significantly decreased during the COVID-19 pandemic compared to the pre-COVID-19 period, whereas rates of CLABSI (2.30 vs 2.23 per 1000 device-days; P = 0.19) and CAUTI (1.26 vs 1.26 per 1000 device-days; P = 0.99) were similar between the two periods. The rates of BSI and CLABSI significantly increased during the COVID-19 pandemic compared to the pre-COVID-19 period in large-sized hospitals, whereas these rates significantly decreased in small-to-medium-sized hospitals. The rates of CAUTI and VAP significantly decreased in small-sized hospitals. There were no significant changing trends in the rates of multidrug-resistant pathogens isolated from patients with HAI between the two periods. CONCLUSION: The incidence rates of BSI and VAP in ICUs decreased during the COVID-19 pandemic compared to the pre-COVID-19 period. This decrease was mainly seen in small-to-medium-sized hospitals.

Can the Narrow and Broad Money Supply Gap Be Used as an Investment Indicator for the Stock Market?

This study uses the golden cross and death cross formed by the gap between the narrow and broad money growth rates as threshold variables to estimate the threshold model and test the causal relationship between money supply and stock prices in eight emerging market economies (EMEs) in Asia;the sample periods are from January 2000 to December 2020. The results show a high-positive, bi-directional relationship between the money supply and stock prices in the golden cross regime. On the other hand, the money supply has a negative, one-way causality on stock prices in the death cross regime. We also conducted a robustness test during the COVID-19 spread, and the result shows that the mechanism still applies, but the effectiveness is reduced. Thus, our contribution is discovering the golden cross and death cross information formed by narrow and broad money, informing stock market investment.

Categorizing older adults' information technology-based learning programs using correspondence analysis

Purpose: The rapid proliferation of digital devices, population aging, and acceleration of digital technology adoption due to the COVID-19 pandemic have increased the need for information education for older adults to prevent inter-generational conflicts and digital alienation. This study aims to analyze the information technology (IT) education programs provided to older adults by age group, considering their heterogeneity. Design/methodology/approach: This study identifies IT education programs provided by public institutions in Seoul and target age groups (50 and above) through a survey using triangulation, which were then sorted and summarized into 27 keywords. Correspondence analysis was conducted using the keywords derived for the programs and age groups. Findings: IT education programs in the age group 60 and above accounted for 75.2% of the programs offered, which increased to 90% when including those aged 55 and above. Particularly, the perceptual map created based on relationship correlations indicates which IT education program keywords matched each age group. The Seoul Metropolitan Government primarily offered these programs for older adults aged 60 and above, with 5–7.5 times more education programs for those aged 60 and above than for those aged 50 and above or 55 and above. Therefore, IT education must be more evenly provided to more diverse age groups among older adults to reflect the current situation. Originality/value: This study contributes to the literature by proposing a future direction for IT education of older adults. Moreover, it has implications for the direction of IT education to target various age groups in IT education programs, thus enabling older adults to effectively enhance their digital literacy skills during the rapid digitalization caused by COVID-19. © 2022, Emerald Publishing Limited.

Impact of Coronavirus Disease 2019 pandemic on healthcare-associated infections at intensive care unit in South Korea: Data from Korean National Healthcare-associated Infections Surveillance System (KONIS)

Background. Coronavirus Disease 2019 (COVID-19) pandemic has influenced hospital infection control practices. We evaluated the impact of the COVID-19 pandemic on healthcare-associated infections (HAIs) in the intensive care unit. Methods. We conducted a retrospective analysis using data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS). KONIS has conducted nationwide prospective surveillance of HAIs in intensive care units. Comparisons of incidence rates of bloodstream infection (BSI), central lineassociated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) before (Jan 2018-Dec 2019) and during the COVID-19 pandemic (Jan 2020-Jun 2021) were performed according to hospital size. The microorganism distributions in BSI, urinary tract infection, and pneumonia were compared between the period before and during the COVID-19 pandemic. Results. The incidence rate of BSI significantly decreased during the COVID-19 pandemic than in the pre-COVID-19 period (1.38 vs. 1.19 per 10,000 patient-days;P < 0.001) [Table 1]. Incidence rates of CLABSI (2.30 vs. 2.17 per 1,000 device-days;P = 0.03) and VAP (1.03 vs. 0.81 per 1,000 device-days;P < 0.001) decreased significantly during the COVID-19 pandemic than in the pre-COVID-19 period, whereas that rate of CAUTI was similar between the two periods. The annual trends of incidence rate of CLABSI and VAP also has decreased (Figure 1). According to the hospital size, the incidence rate per 1,000 device-days of CLABSI significantly decreased during the COVID-19 pandemic than in the pre-COVID-19 period in small to medium-sized hospitals (300-699 beds). The incidence rate per 1,000 device-days of VAP significantly decreased only in small-sized hospitals (200-449 beds). The microorganism distributions in HAIs did not change significantly. Conclusion. The incidence rates of CLABSI and VAP decreased during the COVID-19 pandemic than in the pre-COVID-19 period, which was attributable to the changes in small to medium-sized hospitals. (Figure Presented).

Factors Affecting Burnout among Tertiary Hospital Nurses during the COVID-19 Outbreak

Purpose: The aim of this study was to determine burnout and its related factors among nurses working at a tertiary hospital, who had experienced caring for patients with confirmed and suspected coronavirus disease 2019 (COVID-19), including those with severe and critical conditions during the outbreak. Methods: Responses of 129 nurses, who worked in a tertiary hospital in Daegu, which was designated as a special control area for infectious disease in Korea, were analyzed. Data were collected from November 1, 2020 to December 14, 2020 using self-report questionnaires. Analysis was performed using t-test, one-way ANOVA, Pearson correlation coefficients, and stepwise multiple regression. Results: Burnout did not show any statistically significant differences in age, sex, marital status, total length of clinical experience, and the department at the time of caring for COVID-19 patients. Compassion fatigue, stress, depression, and anxiety were positively related with burnout, and compassion satisfaction was negatively related with burnout. In regression analysis, compassion satisfaction, compassion fatigue, and stress were confirmed as the predictive factors of burnout. Conclusion: The study results suggest that compassion satisfaction, compassion fatigue, and stress could play an important role in reducing burnout among tertiary hospital nurses during infectious disease outbreaks. © 2021 The Korean Academy of Psychiatric and Mental Health Nursing.

Safety, Feasibility and Healthcare Cost Differences between Inpatient and Outpatient Mobilization Chemotherapy for Autologous Hematopoietic Stem Cell Transplantation in Multiple Myeloma: A Single Center Experience

Introduction The standard of care for patients with multiple myeloma (MM) involves autologous hematopoietic stem cell transplantation (ASCT). Pre-ASCT mobilization chemotherapy for MM, vinorelbine and high dose cyclophosphamide (VC), has been historically given in the inpatient (IP) setting. Due to rising bed occupancy rates and patients' preferences for treatment in the ambulatory setting, our team has offered eligible patients an option to receive VC outpatient (OP) since 2018. Our study aims to audit the feasibility and safety of this initiative, and review potential healthcare-related cost savings. Methods Eligibility criteria for OP chemotherapy were developed by a multidisciplinary team based on patients' age, functional status, medical comorbidities and social factors (Figure 1). The chemotherapy regimen was modified for an OP setting (Figure 2), of which the main alteration involved changing the route of administration of intravenous (IV) mesna to a combination of IV and oral. A retrospective review was conducted for 35 MM patients (18 IP and 17 OP) who received VC for mobilisation at our center from 2018 to 2019. The patient characteristics were similar between the two groups (Table 1). Patient data were analyzed from the day of admission for VC (IP) or day 1 of VC (OP), to the day before admission for stem cell harvesting. Clinical charts were reviewed for unexpected complications and unplanned admissions. Costs incurred were calculated using the value-driven-outcome (VDO) informatics analysis of the hospital. Results There were no unexpected clinical complications or unplanned admissions in both groups. The median length of hospital stay for the IP cohort was 3 days, amounting to a saving of 51 hospital days over 2 years in the OP cohort. Median costs were 73% lower in the OP cohort (Figure 3). The difference was mainly due to certain costs not incurred in the OP setting. These included room charges and daily treatment fees (which accounted for an average of 46% and 19% of IP charges respectively). Investigation costs were also 55% lower in the OP cohort, which could be attributed to more investigations being performed in the IP setting such as screening for methicillin-resistant Staphylococcus aureus and nonurgent radiographs ordered after hours by the on-call physician upon admission. Conclusions Our findings show that OP mobilization chemotherapy for MM is safe, feasible and associated with improved bed utilization and cost savings. Other components of the stem cell transplantation process are also increasingly being transitioned from the IP to OP setting in our center as part of an ongoing paradigm shift in right-siting treatment services, which has been accelerated by the COVID-19 pandemic's strain on inpatient capacity. These results provide an affirmation of our efforts to optimize the utilization of healthcare resources. [Formula presented] Disclosures: Chng: Takeda: Consultancy;GlaxoSmithKline: Consultancy;Johnson & Johnson: Consultancy, Research Funding;Aslan: Research Funding;Antengene: Consultancy;Abbvie: Consultancy;Pfizer: Consultancy;Novartis: Research Funding;Sanofi: Consultancy;Amgen: Consultancy;BMS/Celgene: Consultancy, Research Funding.

COVID-19 preventive measures and restaurant customers’ intention to dine out: the role of brand trust and perceived risk

This study examined the roles of perceived preventive measures and brand trust on the intention to dine out at restaurants during the reopening period in the United States. A total of 587 participants, recruited through a market research company completed the data. Multiple regression was used for data analysis. The results indicated that perceived importance of preventive measures enhanced customers’ intention to dine out via brand trust. Perceived risk moderated the relationship between perceived importance of preventive measures and brand trust. The study provided significant implications for restaurant operation during the reopening period. © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Feasibility of Advanced Practice Nurse - Led Telehealth Service in Patients with Myeloproliferative Neoplasm in the Community: A Singapore Single-Centre Report

Introduction Telehealth is fast becoming a promising alternative service for face-to-face consultation in healthcare to improve access to healthcare in a cost effective manner. An academic medical centre (AMC) piloted a tele-consultation program for patients with myeloproliferative neoplasm (MPN), a disease with an abnormal mutation in the bone marrow leading to overproduction of any combination of white cells, red cells and platelets. The program aimed to demonstrate the feasibility and safety of the use of telehealth in managing patients with MPN. Methods For this program only patients with Essential Thrombocytosis (ET) and Polycythemia Vera (PV) who met the criteria were recruited and enrolled into the program. Workflows, logistics and education materials were developed and briefed to stakeholders prior to the commencement of the program. The program utilised the Advanced Practice Nurses' (APNs) expertise in the haematology unit to support the service. APNs were provided addition training on both clinical practice knowledge and the appropriate use of the telehealth equipment. Data was collected between January and July 2020. Prospective outcome indicators measured were i) correct treatment prescribed according to guidelines;ii) number of emergency visits due to events related to MPN and its complications, iii) deterioration in cardiovascular health (namely hypertension, diabetes mellitus and hyperlipidermia) iv) number of patient visits right-sited to the community and v) barriers and facilitators for the uptake of the program. Results A total of 21 patients with 44 tele-consults over 7 months was captured. Average age of the patients were 70.1 years. Thirteen patients were diagnosed with ET and 8 patients have PV. Only 1 patient was on a combination of hydroxyurea and anagrelide, the rest of the patients were on hydroxyurea. A total of 14 dosage adjustments were made based on patients' complete blood count, and all of patients' blood countsremained stable during the following review. Two venesections were prescribed for patients with PV. None of the patients required ED visit or admission due to events related to MPN and its complications. One patient was referred back to physician earlier due to non-compliance to telehealth review. All patients had their blood pressure reviewed within 1 year. Sixteen patients had fasting glucose/HbA1c within 2 years, and 14 patients had fasting lipid within 2 years. None of the patients required cardiovascular medication titration, thus there is no deterioration in their cardiovascular health since recruitment. For 9 of the telehealth review, patients did their blood tests concurrently with other medical appointments they had at an earlier date, hence saving a separate trip to hospital for blood test. We were also able to consolidate blood tests and reduce repetition for these 9 patients. Only 8 telehealth blood tests were done in the community, largely due to the closure of satellite blood test service during COVID pandemic. There were only 6 home medicine deliveries, largely because many of the patients had collected adequate medications lasting half a year to a year during physical consult with physicians. The MPN telehealth service has right sited a total of 67 hospital visits to the community. We determined the barriers and facilitators to the program are due to patient, physician and workflow factors. Some of our older patients do not own a mobile device, or prefer traditional, physical consultations with physicians. Some physicians are unfamiliar with telehealth referral workflow. Potential facilitators include older, immobile patients with multiple comorbiditieswanting to cut down hospital visits, as well as patients whose work schedule did not permit frequent hospital visits. Conclusions Our results show that utilising APN-led telehealth service is a feasible and safe method to deliver care to patients with myeloproliferative neoplasm in the community. Right-siting of patient care could reduce patient visits to hospitals especially during COVID pandemic. Ongoing chal enges include increasing the number of blood test facilities in the community to facilitate blood taking in the community. Other proposed intangible benefits would include improving patients' psychosocial well-being by transiting them to a new normalcy with minimal hospital visits to a haematology centre. There is potential cost- saving as well that will be explored. Disclosures: Chng: Janssen: Honoraria, Research Funding;Celgene: Honoraria, Research Funding;Novartis: Honoraria;Abbvie: Honoraria;Amgen: Honoraria, Research Funding.