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Purpose: The SARS-CoV-2 virus continues to mutate, and the COVID-19 pandemic remains a global health crisis. The purpose of this longitudinal study was to continue to analyze the use of infection prevention and control practices (IPC) and personal protective equipment (PPE) by dental hygienists in the United States (US) during the COVID-19 pandemic.Methods: Web-based surveys on COVID-19 related health, IPC, and PPE were administered monthly to a panel of US licensed dental hygienists (n=6,976) from September 2020 to August 2021. Trends over time and predictors of IPC and PPE use were estimated using Stata 17.0 xt commands and multilevel multivariable logistic regression. Linear regression modeling for trends in time and tests for changes in trends were conducted (Joinpoint Regression Program, Version 4.9.0.0).Results: Almost all practicing dental hygienists (99.9%, 14,926 observations) reported COVID-19 specific IPC in place at their primary dental practice. Consistently >96% of dental hygienists reported operatory disinfection and staff masking over the study period. Patient face masking and physical protections such as barriers or air filtration increased in use over time, then declined in spring 2021. Screening or interviewing patients before appointments, checking patient temperatures before treatment, checking staff temperatures at shift start, disinfecting frequently touched surfaces, and encouraging distance between patients were reported by >85% of respondents until March 2021, at which point significant decreases were observed. Wearing a mask or respirator and eye protection during patient care consistently rose over time from September 2020 (77.1%) to August 2021 (81.4%). Always wearing a N95 or equivalently protective respirators during aerosol generating procedures peaked in 2/2021 and declined thereafter. Dental practice setting, supply of respirators, COVID-19 vaccination, and COVID-19 community transmission level were significantly associated with IPC and PPE use.Conclusion: Most US dental hygienists reported always wearing masks and eye protection during patient care and a variety of IPC types have been instituted to reduce the risk of COVID-19 transmission in dental practice settings. However, the use of N95 or equivalent respirators and some additional IPC methods declined during 2021.
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Purpose: Vaccinations represent an important public health tool for mitigating dangerous diseases;nevertheless, there is concern and hesitancy regarding vaccinations including those for COVID-19. The purpose of this study was to determine the intentions and hesitancy among dental hygienists in the United States (US) toward COVID-19 vaccination.Methods: Dental hygienists in the US were surveyed from 1/4/21 to 8/16/21 regarding their intentions to get vaccinated and whether they received a COVID-19 vaccine. The vaccination questions were part of an anonymous, ongoing longitudinal web-based survey of dental hygienists' employment and infection control trends. Willingness or actual COVID-19 vaccination versus vaccine hesitancy were analyzed by differences in demographic characteristics using multivariable logistic regression and X2 and Fisher's exact tests.Results: Full COVID-19 vaccination rates in US dental hygienists rose sharply from 2/5/21 to 3/5/21 (26.0% to 53.9%) and leveled off to 75.4% by 8/30/21. The highest rates of vaccine hesitancy were among dental hygienists aged 26-39 years and those who had contracted COVID-19 during the time of the survey. The lowest vaccination hesitancy rates were seen among Non-Hispanic Asians and individuals 65+. When controlling for age, race/ethnicity, and years practiced, dental hygienists who had contracted COVID-19 had higher odds of being vaccine hesitant (adjusted Odds Ratio (aOR): 1.847, 95% Confidence Interval (CI): 1.274, 2.678). Having contracted COVID-19 was also associated with respondents changing from being hesitant to be vaccinated to being willing to be vaccinated (aOR: 4.071, 95% CI: 1.652, 10.030).Conclusion: Although vaccine acceptance is high among dental hygienists in the US, vaccine hesitancy remains an ongoing concern. Dental hygienists are key prevention specialists who should promote adherence to vaccination recommendations for the health of the public. Further education in virology, epidemiology, and vaccination education is recommended.
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INTRODUCTION: Dyspnea is common and distressing in patients with acute critical illness who require mechanical ventilation (MV), and is often a presenting symptom for COVID-19. However, little is known about the long-term persistence of dyspnea or its impact on patients recovering from mechanical ventilation. This study sought to evaluate early and persistent dyspnea, and its emotional impact, among survivors of respiratory failure due to COVID-19. METHODS: We conducted a prospective observational cohort study at Beth Israel Deaconess Medical Center. We identified ICU survivors who underwent at least 48 hours of MV for COVID-19. We contacted eligible patients via telephone at 6 months post-hospital discharge. We assessed the presence and severity of dyspnea throughout their illness (ICU, hospital floor, hospital discharge, 6 months post-discharge) using components of the Multidimensional Dyspnea Profile (MDP), a validated instrument. Additionally, we asked patients with persistent dyspnea at the time of follow up whether dyspnea triggered specific emotional responses, using the MDP. Data are means + standard deviation or number (percent). RESULTS: Forty of 43 patients contacted by telephone completed interviews and 3 declined. Twenty-three patients (58%) were male, 7 (18%) had COPD, 9 (22%) had obstructive sleep apnea, and 11 (28%) had active tobacco use. The duration of invasive MV was 14+7.1 days and hospital length of stay was 24.7+9.6 days. Six-month post-discharge data revealed 25 patients (62.5%) with any dyspnea, and 10 (25%) with moderate to severe dyspnea (10-point severity scale score > 4). Among patients with persistent dyspnea at 6 months, the majority reported fear (60%), anxiety (57.5%), or frustration (52.5%). Depression was the most common severe emotional response accompanying dyspnea (10-point severity scale score of 7-10), reported by 9 patients (22.5%). CONCLUSIONS: Six months after COVID-19-associated respiratory failure, dyspnea was persistent in the majority of patients and commonly associated with negative emotions. Fear and anxiety were most commonly reported. Prior to COVID-19, long-term dyspnea had been described in up to 40% of patients after respiratory failure, though data are limited. Thus dyspnea appears as, or more, common after COVID-19. In addition to the typical components of post-intensive care syndrome (PICS), dyspnea and the negative emotional states it evokes may impair quality-of-life for COVID-19 survivors and should be specifically assessed during post-hospital care visits.
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RATIONALE: Prior to the emergence of coronavirus disease 2019 (COVID-19), critical illness survivors were known to suffer long-term impairments in physical function, mental health, and cognition. These deficits, collectively termed the post-intensive care syndrome (PICS), impact health-related quality-of-life. Survivors of COVID-19-associated respiratory failure may be at particularly high risk of PICS due to delirium and prolonged mechanical ventilation, and factors unique to the pandemic, including physical isolation from medical staff, lack of in-hospital family presence, limited post-acute care rehabilitation, and widespread economic recession. Given this context, we describe the prevalence of PICS 6 months following hospital discharge among survivors of COVID-19-associated respiratory failure. METHODS: We conducted a multicenter prospective cohort study from March to December 2020 at Beth Israel Deaconess Medical Center and the Hospital of the University of Pennsylvania. We identified ICU survivors who underwent at least 48 hours of mechanical ventilation for COVID-19. We contacted eligible patients via telephone at 6 months post-hospital discharge. Sample size was determined by thematic saturation of interviews within a concurrent qualitative assessment. We used the Society of Critical Care Medicine international consensus recommendations for PICS assessment. We assessed anxiety, depression, and post-traumatic stress disorder (PTSD) using the Hospital Anxiety and Depression Scale and Impact-of-Events Scale, respectively. We assessed physical impairment with the EQ-5D questionnaire, and cognitive impairment using the Montreal Cognitive Assessment-Blind. Data are means + standard deviation or number (percent). RESULTS: We completed telephone interviews with 50 of 173 eligible patients (53 contacted, 3 declined). Age was 57+13 years, duration of invasive mechanical ventilation was 14+8.2 days and PaO2:FiO2 ratio at intubation was 174±46. Delirium developed in 35 patients (70%). Six months post-discharge, 38 patients (76%) met criteria for PICS, with 1 or more domains impaired. Among patients with PICS, 22 (44%) were impaired in at least 2 domains, and 9 (18%) impaired in all 3 domains. PTSD was present in 17 patients (34%), anxiety in 19 (38%), and depression in 20 (40%). Twenty-four patients (48%) had impairments in activities of daily living. Nineteen patients (37%) demonstrated cognitive impairment. CONCLUSIONS Over three quarters of COVID-19-associated respiratory failure survivors demonstrated PICS 6 months after hospital discharge. Patients were commonly impaired in at least two domains. These estimates of PICS prevalence appear broadly similar to those reported in the pre-COVID-19 literature and should drive focused efforts to identify COVID-19 survivors at high risk for PICS prior to discharge.
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INTRODUCTION: To describe the epidemiology of Coronavirus Disease 2019 (COVID-19)-related critical illness at a diverse academic health system. METHODS: We performed a single-health system, multihospital retrospective cohort study of patients with COVID- 19-related critical illness who were admitted to an intensive care unit (ICU) at any of five hospitals within the University of Pennsylvania Health System. We report descriptive statistics for patient demographics, comorbidities, acute physiology parameters, receipt of ICU therapies, hospital outcomes, and survivorship. Using multivariable linear and logistic regression, we evaluated trends over time in all-cause 28-day in-hospital mortality, the primary outcome, and in patient acuity, and we evaluated candidate prognostic risk factors for association with mortality. RESULTS: 468 patients with COVID-19-related critical illness had a median age of 65 years (interquartile range [IQR] 54-74), were more likely male (57.7%), were more likely Black race (52.8%), and had a high co-morbidity burden (71.8% with ≥ 2 points on the Charlson Comorbidity Index). At least once during their hospitalization, 319 (68.2%) patients were treated with mechanical ventilation and 121 (25.9%) with vasopressors. Outcomes were notable for 29.9% all-cause 28-day in-hospital mortality (37.0% among those who received mechanical ventilation and 14.8% among those who did not receive mechanical ventilation), 8-day (IQR 3-17) median ICU length of stay, 13-day (IQR 7-25) median hospital length of stay, and 10.8% all-cause 30-day readmission rate. Mortality decreased over time from 43.5% (95% confidence interval 31.3%-53.8%) to 19.2% (11.6%- 26.7%) between the first and last 15-day periods in the fully adjusted model. Risk factors at ICU admission prognostic for mortality included increasing age, peripheral vascular disease, low or high body mass index, abnormal mental status, hypoxemia, tachypnea, and thrombocytopenia. CONCLUSIONS: Among patients with COVID-19-related critical illness admitted to the ICU at an academic health system in the U.S., a finite set of patient-level factors were prognostic for mortality and mortality decreased over time.