ABSTRACT
The goal of good toilet hygiene is minimizing the potential for pathogen transmission. Control of odours is also socially important and believed to be a societal measure of cleanliness. Understanding the need for good cleaning and disinfecting is even more important today considering the potential spread of emerging pathogens such as SARS-CoV-2 virus. While the flush toilet was a major advancement in achieving these objectives, exposure to pathogens can occur from failure to clean and disinfect areas within a restroom, as well as poor hand hygiene. The build-up of biofilm within a toilet bowl/urinal including sink can result in the persistence of pathogens and odours. During flushing, pathogens can be ejected from the toilet bowl/urinal/sink and be transmitted by inhalation and contaminated fomites. Use of automatic toilet bowl cleaners can reduce the number of microorganisms ejected during a flush. Salmonella bacteria can colonize the underside of the rim of toilets and persist up to 50 days. Pathogenic enteric bacteria appear in greater numbers in the biofilm found in toilets than in the water. Source tracking of bacteria in homes has demonstrated that during cleaning enteric bacteria are transferred from the toilet to the bathroom sinks and that these same bacteria colonize cleaning tools used in the restroom. Quantitative microbial risk assessment has shown that significant risks exist from both aerosols and fomites in restrooms. Cleaning with soaps and detergents without the use of disinfectants in public restrooms may spread bacteria and viruses throughout the restroom. Odours in restrooms are largely controlled by ventilation and flushing volume in toilet/urinals. However, this results in increased energy and water usage. Contamination of both the air and surfaces in restrooms is well documented. Better quantification of the risks of infection are needed as this will help determine what interventions will minimize these risks.
Subject(s)
Bathroom Equipment , COVID-19 , Humans , Hygiene , SARS-CoV-2 , Toilet FacilitiesABSTRACT
Background: The incidence of sports-related sudden cardiac death (SrSCD) attributable to myocarditis is unknown. With the known as-sociation between SARS-CoV-2 (COVID-19) and myocarditis, an un-derstanding of pre-pandemic rates of SrSCD due to myocarditis will be important in assessing a change of risk in the future. The objective was to ascertain the incidence of SrSCD or aborted sudden cardiac death (SCD) attributable to myocarditis in the general population. Methods: A literature search through PubMed/Medline and Ovid/ Embase was completed. Studies of SrSCD with autopsy data or clear -cause aborted SrSCD were included. SrSCD was defined as SCD which occurred within 1 hour of exercise. Data were ed by 2 independent reviewers using the MOOSE guidelines. Risk assessment was performed with the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Random-effects models were used to report the incidence and 95% CIs. The primary outcome was the incidence of SrSCD attributable to myocarditis, and the secondary outcome was SrSCD overall.Results: Fifteen studies were included comprising 347,092,437 person-years (PY). There were 1955 SrSCD or aborted SrSCD overall with an incidence of 0.93 (95% CI 0.47-1.82) per 100,000 PY. Fifty-three SrSCD were attributed to myocarditis with an incidence of 0.047 (95% CI 0.018-0.123) per 100,000 PY, or 1 death attributable to myocarditis in 2.13 million PY.Conclusions: In this meta-analysis, the overall incidence of SrSCD was low. Furthermore, SrSCD attributed to myocarditis is exceedingly rare.
ABSTRACT
Background: Despite the availability of highly effective directacting antiviral (DAA) therapies for hepatitis C virus (HCV), people who use illicit drugs or are experiencing homelessness face multiple barriers to accessing HCV treatment The aim of this project was to assess the feasibility and outcomes of offering low-threshold HCV treatment via telemedicine on a mobile HCV screening van Methods: In January 2019, we launched a mobile HCV screening van, offering free rapid HCV antibody testing followed by confirmatory HCV RNA testing and Fibroscan® for fibrosis staging at multiple sites in San Francisco (figure). In August 2019, we began offering linkage to an HCV clinician via telemedicine visits conducted with the patient utilizing a computer on the van Pre-treatment labs were drawn on the van, and DAAs were brought to the van for patients to pick-up Treatment initiation and other visits were all conducted via telemedicine on the van, and labs were drawn on the van during and after treatment Staff provided individualized appointment reminders, treatment plans, and strategies for safe medication storage Results: From 8/2019- 3/2020, 190 people were screened for HCV at 3 locations, and 32 (17%) tested positive for HCV RNA Sixteen patients elected to see a clinician via telemedicine on the van, and all initiated DAA therapy Median age of treated patients was 54 years, 56% were male, and 56 % were non-white All had a history of injection drug use, and most reported current injection or non-injection drug use Half were unstably housed, with 44% reporting staying at a shelter, outside, or in a vehicle Mental health comorbidities were common (56%), and 19% were HIV co-infected Three had compensated cirrhosis (19%), and 94% were treatment naïve All had health insurance, but those needing a hepatology visit prior authorization waited longer from time of HCV RNA testing to starting treatment compared to those who did not: mean 76 ± 52 days vs 57 ± 31 days Thirteen patients completed treatment: SVR12 was confirmed in 7, SVR12 labs were delayed in 5 due to COVID-19, and 1 is awaiting SVR12 date One patient remains on treatment, and 2 received all of their medications but were lost to followup during COVID-19 Conclusion: Community-based HCV treatment via telemedicine on a mobile van is feasible and enables clinicians to treat patients where they are This model could be adapted in other community-based settings to colocalize HCV treatment with other services. (Table Presented).
ABSTRACT
Background: Adult respiratory distress syndrome (ARDS) is a common complication of COVID-19 infection.We hypothesized that ECMO via right to left atrium (RA-LA) cannulation through an oxygenator will lead to a complete lung rest, allowing for complete recovery of the lungs. Methods: We performed bedside ICU ECMO procedure in 5 patients (3 males and 2 females) by using intracardiac echocardiography (ICE) via right common femoral vein and standard transseptal technique at bedside. Subsequently, we placed a 21F LA cannula (TandemHeart, Tandem-Heart, Pittsburgh, PA) via the right common femoral vein and a 25F RA cannula (Edwards, Irvine, CA). The oxygenerator was also TandemHeart system. Results: All 5 patients were safely cannulated and managed by ECMO. The duration of ECMO was 13 to 19 days and were successfully decannulated at bedside. Only one patient did not require tracheostomy and was discharged home on day 33. The other 4 patients were discharged from the hospital to long-term care acute care facilities. No major procedural complications occurred. One patient required dialysis (See table) Conclusion: Bedside percutaneous RA-LA cannulation is feasible with no major procedural complications. Further studies are required to evaluate short and long-term hard endpoints in all patients with ARDS compared to veno-venous ECMO cannulation.