ABSTRACT
Introduction: The guideline-driven and widely implemented single room isolation strategy for respiratory viral infections (RVI) such as influenza or respiratory syncytial virus (RSV) can lead to a shortage of hospital beds. Alternative strategies to prevent hospital-acquired respiratory viral infections (HARVI) are needed. Objectives: Based on promising results of a pilot study using droplet precautions on-site (DroPS) during the influenza season 2018/19, this strategy was implemented in multiple hospital wards. We assessed the "real-life" safety of DroPS by measuring the rate of HARVI after its implementation. Methods: Prospective observational study during the influenza season 2019/20 at a tertiary and secondary referral hospital. The study was prematurely stopped at the beginning of the COVID-19 pandemic (17th March 2020). DroPS was used for patients hospitalised with suspected or proven RVI. Hospitalised patients with no respiratory isolation in the two days following admission were considered "at risk" for the acquisition of HARVI. They were screened daily for the onset of new respiratory symptoms. Once an "at risk" patient developed symptoms, an influenza/RSV molecular rapid test was performed. The two main outcomes were the rate of clinical and laboratory-confirmed HARVI (influenza or RSV). Results: We included 1'996 hospitalisations with a total of 8'955 "at risk" hospital days for HARVI. Median age was 71 years [IQR 56.81]. HARVI was clinically diagnosed in 11/1'996 (0.6%) hospitalisations. All patients with clinical diagnosis were microbiologically screened and three confirmed (0.15%;2 × RSV, 1 × influenza B). Conclusion: Droplet precautions on site (DroPS) may represent a safe, simple and resource-saving alternative to the traditional pathogenbased single room strategy for RVI in non-pandemic circumstances.
ABSTRACT
Introduction: Healthcare delivery is currently undergoing radical changes and so will the demands for effective Infection prevention in healthcare (IPC). Objectives: We initiated a global collaboration among IPC professionals to imagine the status of IPC in 2030 to inform the present. Methods: In JAN 2019, a purposive sample of 44 IPC professionals around the globe were invited to answer a 10-item online questionnaire, including 2 demographics, 4 housekeeping and 4 open-ended core questions: (Q1) “status of IPC in 2030”, (Q2) “position & people in charge of IPC”, (Q3) “necessary skills”, and (Q4) “open questions”. The latter were each submitted to inductive content analysis and displayed by semi-quantitative network mapping, the remainder reported descriptively. Results: Overall, 18 of 44 (41%) invited responded JAN-MAR 2019 (6 US, 2 CA, 2 CH, 1 FR, DE, MX, NL, SG, UK, each;15 with physician, 3 with nurse, and 1 with management background;all in senior positions). The main emerging themes for Q1 were “multidrug-resistant organisms”;“automatisation of data collection, processing & feedback” with the sub-themes 'robotics', 'monitoring', 'surveillance', 'short-circuit feedback';“system integration & broadening of IPC” with 'patient participation';“global perspective” with 'low/middle income country challenges', 'outpatient';“behaviour”;and “implementation” (Figure). The views were predominantly positively (66%) oriented. Q2 and Q3 yielded a broad range of professional profiles, ranging from data, behaviour, implementation, communication know-how and skills, positioning IPC highly in healthcare institutions and beyond. Similarly, Q4 covered a large area including medicine, life-science, data science, social science, organisational and political questions. Conclusion: The first round of the Future IPC project produced a mainly positive picture of ICP in 2030. The project will continue with further rounds of multi-method inquiry with evolving participation (including an assessment of changes attributable to insights gained during the SARS-CoV-2 pandemic) to serve as a roadmap for developing this critical field of medicine.
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: 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.