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Background: Acute myocarditis (AM) is a heart inflammatory disease that may also rarely occur as a complication of COVID-19 vaccines. Inflammation is involved in arrhythmogenic cardiomyopathy (ACM) pathogenesis. Little is known regarding the COVID-19 vaccines influence on ACM relapses. We present two cases of vaccine related AM revealing a pre-existent (silent) ACM. Cases presentation: Table shows a summary of the patients' main clinical characteristics. Discussion(s): We presented 2 cases of arrhythmic myocarditis-like clinical presentation in patients without previous cardiovascular history, whose timing was temporally related to a dose of vaccine against COVID-19. Subsequent diagnostic workup suggested the possible presence of an underlying silent ACM. In our case series, tissue characterization provided by CMR played a fundamental role as a diagnostic tool, showing in all cases a prominent left ventricle involvement and identifying both the underlying ACM disease and the superimposed myocardial inflammation. We hypothesize that a vaccine-induced AM could have revealed the presence of a pre-existent ACM, on which an inflammatory acute phase triggered the arrhythmic manifestation. Conclusion(s): Vaccine-induced AM could reveal the presence of a pre-existent ACM. Our report suggests that a high index of suspicion and a multidisciplinary approach is required, in order to continue the diagnostic process once the acute event has been resolved, as it may have fundamental implication in the patient management. Further studies are required to verify if some of the vaccine-triggered AM represent the ACM first manifestation..
ABSTRACT
Background Hand hygiene (HH) is the leading measure for preventing the transmission of healthcare-associated infections (HAI), and a cornerstone to prevent COVID-19 spread. Aim of the research was the assessment of HCWs’ adherence to the application of WHO optimal practices, with the goal to promote a culture of safety and quality infection prevention and control (IPC) activities. Methods Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, implemented a HH monitoring plan in which HCWs’ adherence to HH procedures is evaluated using WHO guidelines, technical manual and observation form. Direct field observations took place in March and April 2022 by trained personnel. Process index was HH adherence, stratified by profession, opportunity and unit, which has been visited at least twice. Results Overall, 302 HCWs were observed from 18 hospital units (105 physicians, 108 nurses, 84 healthcare assistants and 5 students). Out of 1382 opportunities, global adherence was 52% with 190 handwashing and 598 hand rubbing. The indication with the highest adherence was “after body fluid exposure risk” (76%), whereas the lowest were “after touching the patient's setting” (40%) and “before touching a patient” (43%). Adherence was higher in specialistic surgeries and haematology units, while the worst performances were reported in general medicine ward (29%). Physicians’ and nurses’ adherence was respectively 45% and 61%. Audits occasionally revealed non-conformities in glove use (i.e., unnecessary use, not changed between patients, hand rubbing on gloves). Conclusions These preliminary findings could be directly linked to habits acquired during the pandemic, when HW tended to consider COVID-19 patients as a unique block to shield themselves from infections, rather than safeguarding individual patient units. HH awareness could have changed in the wake of COVID-19 pandemic and our study described how HCWs’ adherence to optimal practices needs specific initiatives to promote correct HH. Key messages • The COVID‐19 pandemic reinforced the importance of handwashing and IPC, showing the key role of the HCWs’ adherence to hand hygiene (HH) procedures. • HH audits play a leading part in clinical governance and IPC, aiming at enhancing the quality of care and patient safety, particularly to strengthen health system resilience in post-COVID era.
Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/complications , Child , Humans , Systemic Inflammatory Response Syndrome/diagnosisABSTRACT
Background: Crowding has been defined as a global problem and causes a reduction in the quality of care and patient satisfaction. It is due and identified by means of three orders of factors: those at access (input);those referable to the patient's process (throughput);and those leaving the PS (output). The latter are held to be the main culprits of Crowding. Purpose: To assess the impact of the second wave of the CoViD pandemic on the population who went to the emergency room for heartache. Materials and Methods: We evaluated all patients who accessed our emergency room for heartbeat from 20 October to 30 November 2020 and in the same period of 2019. Results and Discussion: We enrolled 744 patients. There was a severe reduction in the total number of accesses for acute neurological disorders: 101 in the CoViD period and 208 in 2019. The vital signs were comparable. Patients in the CoViD pandemic are more frequently accompanied by ambulance (49% vs 30%). Patients of the CoViD pandemic have priority codes at the medical examination similar to those of 2019 while they have high severity codes at discharge (yellow and red) more frequently (16% vs 10%) and more frequently need hospitalization (14% vs 10%). Crowding input factors are lower in the period of the pandemic: reduced attenders (101 vs 208) and reduced average waiting times (83min vs 117 min). The percentage of patients who exceeded the waiting time target set by priority code for the medical examination also decreased (49% vs 35%). Crowding throughput factors worsened: LOS (449 vs 379 min). Crowding output factors also worsened: the percentage of access blocks, low for this disease, however doubled during the pandemic (5% vs 2%). The Total Access Block Time is significantly higher in the CoViD period for the examination rooms (2.331 vs 1.859 min). Conclusion: the epidemic has led to a reduction in access for heart disease, especially of self-reported. Patients have more frequent hospitalization needs and more severe exit codes. The period of the pandemic presented a worse crowding for these patients due to the Exit Block resulting in an increased workload for the emergency room operators.
ABSTRACT
Introduction: Crowding has been defined as a global problem and causes a reduction in the quality of care and patient satisfaction. It is due to three orders of factors: those of access (input);those referable to the patient's process (throughput);and those leaving the PS (output). The latter are held to be the main culprits of Crowding. Purpose: To evaluate the impact of the CoViD pandemic on the population who went to the emergency room for chest pain. Materials and Methods: We evaluated all patients who accessed our PS for chest pain from 22 February to 1 May 2020 and in the same period of the previous year Results and discussion: We enrolled 1611 patients. There is a severe reduction in the total number of accesses for chest pain: 593 in the CoViD period and 1,018 in 2019. The vital parameters are comparable. Patients in the CoViD pandemic are most frequently accompanied by ambulance in 118 (68% vs 41%, the remaining half autonomous). The priority codes for the medical examination are no different. Patients in the CoViD pandemic have higher discharge severity codes (yellow and red) more frequently (24% vs 17%) and more frequently need hospitalization (25% vs 18%). Crowding input factors are lower in the pandemic period: reduced attenders (593 vs 1.018) and reduced average waiting times (70min vs 94 min). The percentage of patients who exceeded the waiting time target set by priority code at the medical examination is also lower during the pandemic (35% vs 50%). Crowding throughput factors have worsened: LOS (540 vs 430 min). Crowding output factors have also worsened: the percentage of access blocks is higher during the pandemic (10% vs 6%). Total Access Block Time is significantly higher in the CoViD period both for the examination rooms (53,796 vs 41,451 min) and for the holding area (15,266 vs 8,419 min). The interpretation of the data must also take into account the increased finding of late heart attacks highlighted by the literature in the period of the epidemic and also published by a group of our Polyclinic. Conclusion: The epidemic has led to a reduction in accesses for chest pain, especially in self-reported ones. Patients had more frequent hospitalization needs and more severe exit codes. The period of the pandemic presented a worse crowding for these patients due to the Access Block.
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Background: During the first wave of the CoViD-19 pandemic, we witnessed a drastic reduction in the total number of accesses, in the face of more serious cases and a exorbitant increase in crowding, especially linked to the access block. It is due by three orders of factors: those at the access (input);those related to the patient's process (throughput);and those at the exit from the PS (output). The latter are considered the main responsible for Crowding. Purpose: Evaluated the population who went to ED for neurological disorders between the first and second wave of the pandemic. Materials and Methods: We evaluated all the patients who were accessing our emergency room for neurological disorders from May 1 to October 20, 2020 and during the same period of the previous year. Results and discussion: We have enrolled 3297 patients. There was a light reduction in the total number of accesses for acute neurological disorders: 1589 in the CoViD period and 1708 in the previous year. The vital parameters, age and sex were overlapping without statistically significant differences. The higher code (yellow and red) of priority to doc and the exit severity codes were stackable (59% vs 50% and 34% vs 30% respectively) and also the need of hospitalization (42% vs 38%). Crowding input factors are slightly lower, in a not statistically significant way, in the pandemic period: number of patients (1589 vs 1708) and average waiting times (80min vs 85 min) accesses. The percentage of patients who exceeded the waiting time target by code of priority to the medical visit was also overlapping (21% vs 22%). Crowding throughput factors worsened: LOS (593 vs 487min). Crowding output factors also worsened: the percentage of access block is higher during the pandemic (14% vs 9%). The Total Access Block Time is significantly higher in the CoViD period both for the examination rooms (116.373 vs 65.027 min) and for the holding area (64.640 vs 41.959 min). Conclusion: In the period between the two pandemic peaks we had a slight reduction in ED accesses for acute neurological disorders. Patients were found to have comparable severity, need for hospitalization, and need for high-intensity care. The pandemic period however, it has changed the way the whole hospital works for the necessary execution of swabs on entry and exit. In the period between the two waves the exit block phenomenon persisted, albeit relieved, and the process time was longer with a consequent workload on EDs.
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Background: Crowding has been defined as a global problem and causes a reduction in the quality of care and patient satisfaction. It is due and identified by means of three orders of factors: those at access (input);those referable to the patient's process (throughput);and those leaving the PS (output). The latter are held to be the main culprits of Crowding. Purpose: To evaluate whether the second wave of the CoViD pandemic on time- dependent diseases also assessed the population that went to the emergency room for neurological disorders Materials and Methods: We evaluated all patients who accessed our emergency room for neurological disorders from 20 October to 30 November 2020 and in the same period of 2019. Results and discussion: We enrolled 744 patients. There was a severe reduction in the total number of accesses for acute neurological disorders: 330 in the CoViD period and 414 in 2019. The vital signs were comparable. Patients in the CoViD pandemic are more frequently accompanied by ambulance (74% vs 39%). Patients in the CoViD pandemic have high priority codes at doctor's visit and severity at discharge (yellow and red) more frequently (66% vs 47% and 47% vs 29% respectively) and more frequently need hospitalization (53% vs 40%). Crowding input factors are lower during the pandemic period: reduced attenders (330 vs 414) and reduced average waiting times (54min vs 101 min) accesses. The percentage of patients who exceeded the waiting time target set for the priority code for the medical examination also decreased (18% vs 28%). Crowding throughput factors have worsened: LOS (620 vs 540 min). Crowding output factors have also worsened: the percentage of access blocks is higher during the pandemic (13% vs 10%). The Total Access Block Time is significantly higher in the CoViD period for the examination rooms (38,308 vs 23,708 min), not for the holding area (11,210 vs 12,103 min) which nevertheless received a significantly lower number of patients (-30%) Conclusion: The epidemic has led to a reduction in access for acute neurological disorders, especially of self-reported ones. Patients have more frequent hospitalization needs and more severe exit codes. The period of the pandemic presented a worse crowding for these patients due to the Exit Block resulting in a greater workload for emergency room operators.