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: 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.