COVID-19-Related Encephalitis in a Child with PIK3CD Defect

Introduction: COVID-19 related encephalitis has been reported in pediatric patients;however, there are no reports in patients with inborn errors of immunity (IEI). Activated PI3K Delta Syndrome (APDS) is a disease of immune dysregulation with immunodeficiency, autoimmunity, and abnormal lymphoproliferation resulting from autosomal dominant gain-offunction variants in PIK3CD or PIK3R1 genes. We investigate a family with APDS, one mother and three children, one of whom developed COVID-19 related encephalitis. Method(s): Patients were consented to an IRB-approved protocol at our institution. Medical records and detailed immunophenotyping were reviewed. Family members were sequenced for IEI with a targeted gene panel. Result(s): The index case is a 10-year-old female with a known pathogenic variant in PIK3CD (c.3061 G > A, p.Glu1021Lys), who contracted SARS-COV-2 despite one COVID-19 vaccination in the series. Her disease course included COVID-related encephalitis with cerebellitis and compression of the pons, resulting in lasting truncal ataxia and cerebellar mutism. At that time, the patient was not on immunoglobulin replacement therapy (IgRT), but was receiving Sirolimus. Besides the index case, 3 family members (2 brothers, 1 mother) also share the same PIK3CD variant with variable clinical and immunological phenotypes. All children exhibited high transitional B-cells, consistent with developmental block to follicular B cell stage. Increased non-class switched IgM+ memory B cells and skewing towards CD21lo B cell subset, which is considered autoreactive-like, was observed in all patients. Of note, the patient had low plasmablasts, but normal immunoglobulins. Of her family members, only one was receiving both sirolimus and IgRT. Conclusion(s): We describe a rare case of COVID-19-related encephalitis in a patient with inborn error of immunity while not on IgRT. This may indicate infection susceptibility because of a lack of sufficient immunity to SARS-CoV-2, unlike the rest of her family with the same PIK3CD variant.Copyright © 2023 Elsevier Inc.

Analysis of Quality Indicators in Molecular Laboratory of a Tertiary Care Hospital in India

Introduction: Quality indicators are important parameters to enhance the quality of the clinical laboratory services. Due to the extensive testing processes, errors cannot be completely avoided in a clinical laboratory. To minimize errors, however, adequate training, QC checks, and regular procedure evaluations are beneficial. Objective(s): The objective of the study was to establish and evaluate quality indicators on an ongoing basis as an effort to increase quality. Method(s): This retrospective study, different quality indicators in a molecular laboratory in northern Gujarat were assessed over the course of a year (September 2020-August 2021). Data of total 8176 samples were summarized. Each Quality indicator was examined at the end of the month after being divided into the pre, analytical, and post-analytical stages, respectively. Result(s): As summarization of total 8176 samples, we found a cumulative error rate for all quality indicators of 346 (4.23%). Preanalytical errors were the most common 180 (2.20%), followed by analytical errors 114 (1.39%), and post analytical errors 52 (0.63%). Conclusion(s): There is no question that by continuously striving to develop the outcome of these quality indicators through the adoption of corrective measures over time, the quality of laboratory services and patient care would be improved.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

Analysis of severe acute respiratory syndrome coronavirus 2 antibodies response in COVID-19 patients and health-care workers

Background: COVID-19 epidemic causes destructive consequences on human beings and on the global economy. Aim: The purpose of this study was to evaluate the severe acute respiratory syndrome coronavirus 2 antibodies response in COVID-19 patients and health-care providers to them in different categories and with respect to age, sex, and symptoms. Materials and Methods: Analysis of immunoglobulin (Ig) G and total COVID antibodies was done by chemiluminescent microparticle immunoassay (CMIA) and IgM antibodies by rapid card test method in 300 cases. Results: Out of 300 cases, asymptomatic were 29%, mild 26.66%, moderate 17.66%, and severe were 28.33%;percentage of males were higher than females in all. The most common age group involved was 30-40 years (20%). The most common symptom was fever (51.33%), followed by cough (38.66%), and the most common comorbidity was hypertension (16.33%). We observed that severe category had a higher percentage of symptoms as well as comorbidities. Out of 300 cases, 56.66% were IgG positive, and 89.6% were total COVID antibody positive. In rapid IgM antibodies, out of 50 cases, 13 were positive. We observed that IgM was positive mainly in severe cases compared to mild cases, while IgG level was lower in severe cases than those of mild cases. In our study, majority of cases (97 cases) are IgG positive approximately in 8-14 days after onset of symptoms. Conclusion: Quantitative analysis of antibodies is a simple, quick, and cheap method and could play major role in diagnosis and prognosis of COVID-19, and also used to pick up silent carriers (asymptomatic patients) who missed in false-negative reverse transcription polymerase chain reaction in such epidemic.

Lactulose Works in the Large Bowel: But How Does It Improve Hepatic Encephalopathy in a Patient Without a Large Bowel?

Introduction: Lactulose is a non-absorbable disaccharide which acts in the large bowel, and is commonly used in the treatment of hepatic encephalopathy. We present an interesting case of altered mental status due to hepatic encephalopathy successfully managed with lactulose in a patient with history of total colectomy. Case Description/Methods: A 67-year-old male with non-alcoholic cirrhosis and inflammatory bowel disease (IBD) post total proctocolectomy with a continent ileostomy known as a Kock-pouch (K-pouch) presented to the hospital with flu like symptoms and altered mental status. He was subsequently found to be positive for COVID-19. At the time of initial evaluation, the patient was obtunded with an elevated ammonia level of 91 umol/L. Colorectal surgery was consulted as the patient was not able to empty his K-pouch. Recently, he complained of inability to catheterize and with bleeding from the stoma. Initial catheterization with a Water's tube yielded 400 cc of effluent. Nasogastric tube was placed through which he was receiving lactulose 30 mg q8 hours. The patient's mental status improved within 24 hours. The patient ultimately underwent flexible pouchoscopy with endoscopic dilation and placement of a 22 French mushroom catheter for decompression of the K-pouch. Discussion(s): Lactulose is a non-absorbable disaccharide composed of galactose and fructose. The small intestine does not have the enzymes required to breakdown lactulose so it reaches the large bowel in its original form. In the large bowel, it is metabolized by colonic bacteria into monosaccharides and then to volatile fatty acids, hydrogen and methane. Lactulose decreases both the production and absorption of ammonia mainly through the presence of gut bacteria. The question arises as to how lactulose decreased ammonia levels in this patient without a large bowel. One proposed mechanism is the translocation of bacteria normally found in the large bowel to the small intestine. Small Intestinal Bacterial Overgrowth (SIBO), is a condition causing an increased number of bacteria in the small intestine. Patients with IBD and structural abnormalities are at increased risk of developing SIBO. Lactulose is commonly used in the diagnosis through the administration of lactulose and subsequent measurements of hydrogen and methane gas in expired air. This condition, in our patient with history of ulcerative colitis and colectomy, is a proposed mechanism of the efficacy of lactulose in the treatment of hepatic encephalopathy.

The Association Between Stool Shedding of SARS-Cov-2 Microbiome Diversity and Intestinal Inflammation

Introduction: The transmission of the etiologic virus of COVID-19 (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) is thought to occur mainly via respiratory droplets even though limited evidence has shown the virus can be found in feces and involve the gastrointestinal (GI) tract. The aim of this study was to assess if patients with COVID-19 present with fecal shedding of SARS-CoV-2, intestinal inflammation or changes in their microbiota. Method(s): This was a prospective cohort study that included outpatients that presented with symptoms of COVID-19 and were tested using a nasopharyngeal PCR test (NPT). Two cohorts were selected: one with a (1) NPT and a control group with a (-) NPT. Stool and a clinical data were collected at baseline and then, days 14, 28 and 42. SARS-CoV-2 viral loads were measured in stool using PCR and stool microbiome was analyzed using 16S rRNA gene sequencing (V3/V4 region). Fecal calprotectin levels were also measured on each sample and used as a surrogate marker of intestinal inflammation. Result(s): 101 patients were recruited (410 total samples). Of those, 55 had a (1) COVID-19 NPT. Most patients with a (1) COVID-19 NPT PCR had a detectable fecal viral load (71%). Among these patients, 23 (55%) had detectable viral stool loads only at baseline, 12 through day 14, 6 through day 28 and 1 through day 42. One patient had a (-) NPT but detectable SARS-CoV-2 in the baseline stool sample. Subjects with (1) NPT presented more commonly with myalgias (p=0.02), dysgeusia (p=0.019) and anosmia (p=0.03) when compared to those with (-) NPT but there were no differences in any other symptoms including GI manifestations.Within the group with a (1) NPT, those patient with detectable SARS-CoV-2 in the stool were younger but no differences were seen in demographic, symptoms, or fecal calprotectin levels (Table). There was no correlation between fecal SARS-CoV-2 loads and fecal calprotectin levels (rho: 0.007 [p=0.95]). Patients with a (1) NPT PCR had higher evenness when compared to those that tested (-) for a NPT PCR. However, no differences were seen in other alpha or beta diversity (Figures 1A and 1B, respectively). Conclusion(s): Even though intestinal viral shedding of SARS-CoV-2 in patients with COVID-19 is common, these patients do not present with evidence of inflammation of the GI tract, a significantly disrupted gut microbiome or a higher incidence of GI symptoms when compared to patients with respiratory symptoms and no COVID-19.

I-deals as a Human Resource Initiative: Exciting Innovation or Passing Fad?

As the workplace continuously reinvents itself due to advances in technology, changes in society, and unexpected events like COVID-19, both employers and employees are employing idiosyncratic deals (i-deals) to allow for flexibility for both sides. This chapter addresses i-deals from a human resources (HR) perspective, by focusing on three critical themes. First, we discuss how organizations effectively institutionalize i-deals, and how such i-deals impact human resource philosophy and practices, given that HR departments often lead the effort to institutionalize such deals through individualized and fair HR practices. Next, we explore how supervisors can make sure that i-deals are fair and effective. Following this, we discuss where i-deals fit in the international human resource management (IHRM) context. A total of fourteen future research directions are identified with particular emphasis on practical HR perspectives. Finally, this chapter constructs a bridge between the two disciplines through drawing upon established literatures from i-deals and IHRM, to extending our current knowledge through both theoretical and practical lenses. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

A Bayesian policy learning model of COVID-19 non-pharmaceutical interventions

This article examines the impact of non-pharmaceutical interventions on the initial exponential growth of the infected population and the final exponential decay of the infected population. We employ a Bayesian dynamic model to test whether there is learning, a random walk pattern, or another type of learning with evolving epidemiological data over time across 168 countries and 41,706 country-date observations. Although we show that Bayesian learning is not taking place, most policy measures appear to assert some effect. In particular, we show that economic policy variables are of importance for the main epidemiological parameters derived from the policy learning model. In an empirical second-stage application, we further investigate the underlying dynamics between the epidemiological parameters and household debt repayments, a key economic variable, in the UK. Results show no Bayesian learning, although a higher transmission rate would increase household debt repayments, while the recovery rate would have a negative impact. Therefore, suboptimal learning is taking place.

ATTITUDE OF POPULATION TOWARDS COVID-19 VACCINE: An Exploratory Study in Pakistan

Background: COVID-19 is a deadly viral infection that kills many people throughout the globe. The goal of this study was to find out how people in Pakistan felt about the COVID-19 vaccine.Method: Convenience and respondent-driven sampling method was used to conduct an online survey with 15 closed-and open-ended questions to a sample of 330 participants. The proportion of people who had a positive attitude towards vaccination vs. those who had a negative attitude towards vaccination was revealed by the closed-ended questions. The open-ended questions elicited qualitative data on why peo-ple accepted or rejected the vaccination.Results: 62.9% of the total number of respondents, male 1.97 times more likely (OR: 1.97, CI: 1.08-3.58) than female, 80% younger than 50 years, higher age groups, 71.3% married, 69.3% of the working population intended to get vaccinated with COVID-19 vaccine. People who held pro-vaccine health beliefs, had knowledge of, access to the COVID-19 vaccine, were employed, or under government pressure to get vaccinated, or visited public vaccination location, reported a positive attitude towards vaccination. People with safety concerns, social pressure of not getting vaccinated, low levels of awareness, trust and belonging to communities with anti-vaccination beliefs were likely to have negative attitudes towards COVID-19 vaccine.Conclusion: This study helps to identify the attitudes of people and has implications for COVID-19 immunization efforts in Pakistan for various population segments.

Wind of change brought by COVID-19: Exploring the response and the new normal from the perspectives of Indian flexpatriates

Drawing from the positive organizational change theory, this paper aims to explore how Indian flexpatriates responded to the change brought by the pandemic of COVID-19 and what is the new normal according to them. Thematic analysis of 19 in-depth interviews with flexpatriates from the IT industry revealed four explicit phases of change process – reflection, communication, collaboration, and transformation. Further, the analysis brought out four tenets of the new normal. First, it is time to blend physical and virtual work;second, the "personal” touch of Indians in international assignments is irreplaceable;third, working from home amidst the entire household being housebound is the new normal;and last, international travel will resume soon with some changed protocols. This is the first qualitative study combining the issue of global talent management with Indian flexpatriates vis-à-vis the impact of COVID-19, the findings of which expand the positive organizational change theory and have important implications. © 2022 Wiley Periodicals LLC.

A Study on drug utilization pattern of antifibrotic agents in patients with post-COVID-19 lung fibrosis

Pulmonary fibrosis after COVID-19 is a serious consequence that can result in lifelong lung damage or death. A cytokine storm induced by an abnormal immune mechanism may cause the onset and progression of pulmonary fibrosis. Early detection may assist to avoid or at least slow the progression of the disease. Anti-fibrotic agents are widely used drugs in post-COVID-19 pulmonary fibrosis. There are some well-known clinical agents including Pirfenidone and Nintedanib that can be given to COVID-19 patients to prevent further progression of fibrosis and as prophylaxis as well. This study showed the use of antifibrotic therapy in SARS-CoV-2 infection, which is very officious in minimizing and avoiding fibrotic damage induced by inflammatory immune dysfunction. Evidently, pirfenidone has shown its pleiotropic effectivity to decrease the inflammation and oxidative reactive shock associated with fibrosis. Nintedanib binds to the targeted receptors' intracellular ATP pockets, inhibiting pro-fibrotic signaling and reducing fibroblast proliferation, migration, and differentiation, as well as secretion of extracellular matrix components. Copyright © 2023, Anka Publishers. All rights reserved.

A Study of Clinical Profile and Outcome of Laboratory-Confirmed COVID-19 Cases Admitted in Intensive Care Unit (ICU) at Tertiary Health Care Center

Introduction: Coronavirus is a family of viruses that can cause illnesses such as the common cold, Severe Acute Respiratory Distress Syndrome & Middle East Respiratory Syndrome. In 2019 new coronavirus was identified, originating in China. The emergence of COVID-19 disease has led to high demand for intensive care services worldwide. Materials And Methods: It is a cross-sectional hospital-based observational study of the clinical profile and outcome of laboratory-confirmed COVID-19 cases admitted in the intensive care unit (ICU) at C.U. Shah Medical College and hospital between October 2020 to March 2021. We have taken a detailed clinical history of patients regarding symptoms of COVID-19 according to the predefined COVID-19 questionaries. Allied history from the patient's relatives was taken regarding contact with COVID-19-positive patients and recent travel history. Emphasis was also made on comorbidities, past medications, and past medical events like ischemic heart disease (IHD), stroke, diabetes mellitus, thyroid disorders, and hypertension. Result(s): In the present study, the most common symptom of COVID-19 disease is breathlessness, followed by fever and cough. Peak incidence was noted in the older age group. Diabetes and hypertension are associated with a more severe form of COVID-19 disease. Most patients have been admitted due to severe acute hypoxemia and tachypnoea. Most patients required mechanical ventilation, although most died due to severe acute respiratory syndrome. Conclusion(s): In a hospital-based cross-sectional study of laboratory-confirmed COVID-19 patients, males and females are at equal risk of COVID-19 infection, and there was no significant difference in severity among them. Hypertension and diabetes, and old age are the most common risk factors for severity and ICU admission in covid-19 patients. Proper strategies regarding covid-19 management and practical training of healthcare personnel with adequate health resources can dramatically reduce mortality in COVID-19 patients. Copyright © 2022 Ubiquity Press. All rights reserved.

A study on Instinctive Feelings, Perceived Stressors and Factors that helped in reducing Stress during COVID 19 pandemic among Health Care Workers

Background: Healthcare workers at the forefront of the battle against COVID 19 are not only putting their own health and lives at risk but are also fighting to keep their own worries and emotional stress at bay. Aim & Objective: To evaluate emotions, perceived stressors, and factors that helped in reducing stress of healthcare workers who worked during a COVID19 pandemic. Settings and Design: This cross sectional study was conducted among Health Care staff involved in COVID 19 duty in tertiary care hospital of Gujarat. Methods and Material: Google form link was shared though what's up and mail. The questionnaire was completed online. Consent for voluntarily participation was also obtained through online Google form. Statistical analysis used: Data was entered and analysed through Microsoft Excel 2010. Results: Total 106 participants responded to the questionnaire. It was extremely stressful for health care workers to see their colleagues getting infection, as well as the fear that they could transmit the disease to their families or friends. Main factors that helped to reduce the stress were positive attitude from colleagues, improvement of patients conditions and availability of protective equipment. Conclusions: Personal safety, the protection of family members and unpredictability of pandemic were the main concerns. Hospitals should prioritise stress monitoring for health care workers and provide targeted psychological guidance for HCWs during the pandemic. © 2022, Indian Association of Preventive and Social Medicine. All rights reserved.

Analysis of ophthalmic manifestations of invasive rhino-orbito-cerebral mucormycosis in COVID-19 patients in a medical college

Purpose: To analyze different ophthalmic manifestations of rhino-orbital mucormycosis (ROM) infection in COVID-19 patients. Study Design: Prospective interventional clinical study. Materials and Methods: 20 microbiologically confirmed ROCM cases with ophthalmic involvement hospitalized between May 2021 and July 2021 in our center were included in this study. Results: Among 20 cases there were 9 female and 11 male with a mean age of 57.5 years. All 20 patients had uncontrolled type 2 diabetes with a mean diagnosis duration of 3.67 years. All patients had COVID-19-associated acute respiratory distress syndrome and received corticosteroids. The mean time interval between COVID-19 diagnosis and ROM diagnosis was 3.46 days. 4 patients (20%) had orbital apex syndrome, and 16 patients (80%) presented with orbital cellulitis. CT scan/MRI revealed sino-orbital involvement in all patients, and 3 of these had cerebral involvement at initial presentation. All 20 patients received intravenous amphotericin B and 7 patients received TRAMB and all 20 patients had undergone radical debridement of involved sinuses. Despite all measures, 3 (7.5%) of 20 patients with cerebral dissemination expired. Conclusions: Severe COVID-19 is associated with a significant incidence of ROM with higher mortality rates due to immune dysregulation and the widespread use of steroids. An aggressive multidisciplinary approach can help to reduce mortality. © 2022 Innovative Publication, All rights reserved.

Unlocking happiness: people's engagement for mental well-being during the lockdown of the COVID-19 outbreak

The COVID-19 lockdown has its own set of problems for the people. However, the lockdown opened many gateways for the people to make themselves happy and active in their liking. This exploratory research study has also attended to identify the constructs related to happiness resulting from lockdown. For this expressive exploration, the research was carried out on 506 respondents from the Gujarat state of India through a structured questionnaire, followed by information processing. The data was processed by applying the Kruskal Wallis test and Mann Whitney U test to derive the conclusion. When the questionnaire was administered, open-ended questions were asked to the respondents. They revealed that even in the tough time of the COVID-19 outbreak, they identified various activities that cater to happiness and chose to keep themselves engaged in motivating themselves to fight against a hard time as a ray of hope!

A Matched-Group Comparison of Interventions for COVID-19 During the First and Second Waves of the COVID-19 Pandemic in a County Hospital in Chicago

Background. The COVID-19 pandemic continually challenges the scientific community to develop and evaluate viable treatments. In May 2020, remdesivir became the first medication to receive emergency use authorization for the treatment of COVID-19, while dexamethasone became standard of care for patients requiring supplementary oxygen in late 2020. Methods. This was a retrospective observational study of hospitalized adult patients with confirmed coronavirus disease 2019 (COVID-19) admitted in the first wave (3/2020-7/2020) and second wave (10/2020-1/2021) at Cook County Hospital. Variables on demographic, clinical data and outcomes were extracted from the EMR. The measured intervention was use of dexamethasone with remdesivir during the second wave;patients were matched by age and diabetic status to patients in the first wave who had received only remdesivir. The primary outcome was mortality;secondary outcomes were ICU admission and intubation. Conditional logistic regression was used to examine associations between use of dexamethasone and each outcome, controlling for glucose levels, use of remdesivir and severity of disease. Results. 621 patients were admitted in the first wave (3/2020-7/2020) versus 355 in the second wave (12/2020-1/2021). Median age was 55 years and 56 years, respectively. Most patients were Hispanic and Black. In the first wave, 296 patients (48%) were admitted with severe COVID-19 (defined as oxygen saturation on room air at or below 94%) versus 163 patients (46%) in the second wave. Logistic regression showed no association between use of dexamethasone and ICU admission, mortality or intubation. Use of remdesivir showed no association with any of the outcomes. Glucose and severe/critical disease were strongly associated with ICU admission (p=0.01 and p=0.003) and mortality (p=0.06 for both). Conclusion. Despite promising medications, in this study the mortality and disease severity of COVID-19 was very similar to that seen in the first wave. This could be due to patients presenting with more advanced disease and undiagnosed or poorlycontrolled comorbidities that may offset the potential benefit of these treatments. Enhancing access to care and decreasing health inequalities may be more worthwhile than finding a 'miracle drug'.

Risk Factors and Clinical Outcomes of Candidemia Associated with Severe Coronavirus Disease 2019 (COVID-19)

Background. COVID-19 can cause serious illness requiring multimodal treatment of the viral infection and its associated complications, including the potential for secondary infections. Studies have suggested an increased risk of fungal infections, including candidemia following severe COVID-19 though understanding of risk factors and clinical outcomes remains unclear. Methods. A multi-center, case-control study of patients with severe COVID-19 was conducted to evaluate risk factors and clinical outcomes in patients who developed candidemia between August 2020 to August 2021. Risk factors associated with candidemia and mortality were characterized using multivariate analyses. Results. A total of 275 patients were enrolled in the study, including 91 patients with severe COVID-19 and subsequent candidemia and 184 patients with severe COVID-19 without candidemia. Most patients received antibiotics prior to candidemia episode (93%), while approximately one-quarter of all patients received biologic for COVID-19. In-hospital mortality was significantly higher in the case group compared to the control group (68% vs 40%, P < 0.01). Multivariable logistic regression revealed that the use of central lines, biologic and paralytic therapy were independent risk factors for candidemia. The presence of candidemia, older age, central line use, and intensive care unit admission were significantly associated with mortality. Demographics and Baseline Characteristics of Study Patients with SARS-CoV-2 Positive With or Without Candidemia Hospitalization Details and Outcomes Conclusion. Clinicians should be aware of the possibility of development of candidemia in hospitalized older patients with severe COVID-19 and should closely monitor those patients at risk. Risk factors for developing candidemia in the setting of COVID-19 are largely consistent with classic risk factors previously identified.

Impact on Reduction of Blood Culture Incubation Period from Five to Four Days from Large Tertitary Care Center

Background. Hospitals have been experiencing an increasing number of acutely ill patients as well as those requiring prolonged hospitalizations, further worsened by the COVID-19 pandemic. This has resulted in increased orders for blood cultures. Once collected, the culture bottles require an incubation period, typically 5 days. The BD BACTEC Fx, a blood culture incubation automated system, holds blood culture bottles until growth is demonstrated or for 5 days, whichever occurs first. New bottles are placed in the apparatus along with older bottles awaiting growth. Capacity is reached when the machine cannot accommodate new bottles due to limited space.When this occurs,manual plating of blood cultures on agar plates is required. Manual plating adds additional responsibility to already overwhelmed microbiology labs. Methods. Following the institutional review board (IRB) approval, data were collected retrospectively at a 765-bed tertiary care center. Data was obtained from positive blood cultures from July 2017 to June 2020. We stratified positive blood cultures based on the day of positivity, from day one to day five. The charts were reviewed for positive blood culture results on day four and day five to evaluate for clinical significance. Clinical significance was determined by an Infectious Disease subspecialty team. Blood culture bottles that were positive on day 4 and day 5 in 1 bottle out of 2 bottles with coagulase-negative species of Staphylococcus, Corynebacterium spp, or Propionibacterium acnes were considered a contaminant and did not warrant further chart review. Results. On a retrospective review of data from July 2017 to June 2020, the total number of blood cultures obtained was 120,320. Among them, 7,558 blood cultures were positive. 94% were positive on day 1, 4% positive on day 2, 2% positive on day 3, 1% positive on day 4 and < 1% positive on day 5. Positive blood cultures on day 5 did not have any clinical significance, according to the chart review. Conclusion. Our study demonstrated that four days of incubation is sufficient for the BD BACTEC Fx automated blood culture incubation system without compromising clinical significance. Implementation of a 4-day incubation period will help with reducing saturation of slots and will improve readiness to accommodate more blood culture bottles.

PANDEMIC RECOVERY IN NURSING HOMES: IMPACT OF A 5-WEEK CURRICULUM ON RESILIENCE AND GROWTH IN DIRECT CARE WORKERS

The COVID-19 pandemic significantly impacted people working and living in nursing homes. A virtual five-week curriculum was developed to support recovery and foster growth in direct care workers (DCWs). We hypothesized DCWs would be interested, acquire knowledge and self-care skills, and utilize a post traumatic growth (PTG) self-assessment tool for reflection. The 5 week voluntary program was offered twice. Sessions consisted of a didactic presentation, Q&A, skill practice and action commitment. Each 30 minute session was offered twice weekly, a.m. and p.m., to accommodate shift schedules. Polls were conducted within sessions. Participants who attended all sessions received a certificate of attendance and completed a 4 question, 5-point Likert scale survey and the PTG tool. 53 DCWs participated in at least one session;30 completed the program and ranked weeks 2 (95%), 3 (65%), and 4 (60%) as most useful. Most used skills were breathing (95%), gratitude practice (91%), catch-check-change (61%), self-massage (61%), and reducing exposure to toxic news (61%). DCWs endorsed self-improvement (96%), curiosity (91%), and "having a hard time” (61%) as most common reasons for enrolling. 100% reported the course completely or almost completely met their goals. In-session polling indicated attendees "felt better or more confident” at the conclusion of each session. 100% successfully utilized the PTG tool. The curriculum was responsive to DCWs needs and interests. DCWs acquired and utilized resilience skills. Some components of the curriculum were more effective than others. Shorter staff training sessions are more attractive to staff and employers. Further study is warranted.