ABSTRACT
Healthcare-associated infections (HAIs) are the most common adverse outcomes due to delivery of medical care. HAIs increase morbidity and mortality, prolong hospital stay, and are associated with additional healthcare costs. Contaminated surfaces, particularly those that are touched frequently, act as reservoirs for pathogens and contribute towards pathogen transmission. Therefore, healthcare hygiene requires a comprehensive approach whereby different strategies may be implemented together, next to targeted, risk-based approaches, in order to reduce the risk of HAIs for patients. This approach includes hand hygiene in conjunction with environmental cleaning and disinfection of surfaces and clinical equipment. This review focuses on routine environmental cleaning and disinfection including areas with a moderate risk of contamination, such as general wards. As scientific evidence has not yet resulted in universally accepted guidelines nor led to universally accepted practical recommendations pertaining to surface cleaning and disinfection, this review provides expert guidance for healthcare workers in their daily practice. It also covers outbreak situations and suggests practical guidance for clinically relevant pathogens. Key elements of environmental cleaning and disinfection, including a fundamental clinical risk assessment, choice of appropriate disinfectants and cleaning equipment, definitions for standardized cleaning processes and the relevance of structured training, are reviewed in detail with a focus on practical topics and implementation.
Subject(s)
Cross Infection , Disinfectants , Cross Infection/prevention & control , Delivery of Health Care , Disinfection , Equipment Contamination/prevention & control , Humans , HygieneABSTRACT
Data on the signs and symptoms of severe acute respiratory syndrome coronavirus (SARS-CoV)-2 infection in preterm neonates are limited. We describe a case of premature twins with gastrointestinal (GI) symptoms, both testing positive for SARS-CoV-2 infection. After 7 days of birth, the first of the twins had classic clinical signs of necrotizing enterocolitis (NEC) Bell’s stage 1B. Both the nasopharyngeal and fecal reverse transcription-polymerase chain reaction tests for SARS-CoV-2 were positive, and a few days later, she developed mild respiratory symptoms. Her twin sister also tested positive for SARS-CoV-2 on the same day (both nasopharyngeal and fecal). One day after the positive RT-PCR report, she had slight distension of the abdomen and started vomiting. Later, she developed mild respiratory symptoms. GI symptoms are the common presenting symptoms of the SARS-CoV-2 infection, especially in children. To our knowledge, we are the first to report NEC as the presenting symptom of SARS-CoV-2 infection in premature twins. The link between SARS-CoV-2 infection and NEC seems plausible in this case. During the current pandemic, NEC should not automatically be attributed to prematurity alone, as it could also be triggered by a SARS-CoV-2 infection. This justifies lowering the threshold for testing preterm neonates for SARS-CoV-2.
ABSTRACT
RATIONALE: There is an increasing need for remote monitoring in childhood respiratory disease, however many tools rely on active adherence, technique, or subjectivity. Respiratory rate (RR) is an important and objective sign, yet is underutilized;no reliable methods for long-term monitoring exist. Current gold-standards-wearable polysomnography devices (PSG)-measure nocturnal RR using uncomfortable sensors such as effort belts and nasal cannulae and are suitable only for discrete, single-night recordings, particularly in children. In the post-COVID-19 era, reliable and accepted RR monitoring in the home will have significant potential for improving respiratory clinical care and research. METHODS: In a healthy pediatric population, we evaluated accuracy of a passive, non-contact bedside device (Albus Home RD) that uses wireless motion sensors to capture RR, as compared to a goldstandard, wearable PSG (SOMNOtouch™ RESPIRATORY, by Somnomedics). The table-top Albus Home RD was positioned adjacent to participants in their home bedroom environment. Sleeping conditions were normal and varied in bed-size, presence of bed-or room-sharers, clothing, and bedding. Gold-standard PSG RR data were recorded using manual count of the raw respiratory traces derived from thoracoabdominal respiratory-effort belts. 10-minute periods from each hour of monitoring were chosen, where sufficient data were available and free from confounding movement and artefacts. Data from Albus Home RD were then analyzed using proprietary signal processing algorithms to output corresponding 30-second RR segments (as breaths/minute). RR results for each device for the selected segments were time-synchronized and compared for each 30-second segment. As per previous respiratory rate validation literature, accuracy was reported as proportion of RR measurements within +/-10% or +/-2 breaths/minute of the PSG RR. RESULTS: 9 healthy children (6 males, 3 females) participated in overnight monitoring;ages and BMI ranged 6-16 years and 13.3-20.0 respectively. Albus Home RD RR measurements for 1220 thirty-second RR segments were compared against the gold-standard with overall accuracy of 93%. Mean Absolute Percentage Error was 0.05 (SD=0.06). CONCLUSIONS: Albus Home RD passively measured nocturnal RR with 93% accuracy in 610 minutes of analysis in real-world environments compared to the current gold-standard. Using wireless sensors and proprietary signal processing algorithms, the Albus Home RD is a valid bedside, non-contact monitor of RR for children aged 6-16 years-old. The nontouch, passive nature of this monitor could enable previously infeasible longitudinal home monitoring in clinical care and research. This low-burden system has significant potential to facilitate longer-term, remote monitoring in pediatric respiratory disease.
ABSTRACT
RATIONALE: Reliable remote respiratory monitoring that is acceptable to patients is crucial for healthcare systems and clinical research in the post-COVID-19 era. Existing methods (such as peak-flow, diaries, and pulse oximetry) are limited by adherence and technique or confounded by subjectivity and recall bias. Nocturnal periods provide important signs in respiratory disease activity, yet accurate and unobtrusive methods for home monitoring are lacking. Current gold-standard tools - wearable polysomnography (PSG) devices - capture objective signs such as respiratory rate (RR) but require uncomfortable sensors, which are unsuitable for use beyond a few nights. Emerging monitoring solutions must minimize patient-burden to facilitate long-term engagement in clinical care and research. METHODS: In healthy adults, we evaluated accuracy of a passive, non-contact bedside device (Albus Home RD), that uses wireless motion sensors to capture RR, compared to gold-standard, wearable PSG (SOMNOtouch™ RESPIRATORY, Somnomedics). The table-top Albus Home RD was positioned on the bedside adjacent to the participant in their normal home bedroom environment. Participants slept with usual clothing and bedding;sleeping arrangements ranged from single- to king-size beds with single- and co-sleepers. Gold-standard PSG RR data were recorded using manual count of the raw respiratory traces derived from thoracoabdominal respiratory-effort belts. 10-minute periods from each hour of monitoring were chosen, where sufficient data were available and free from confounding movement and artefacts. Data from Albus Home RD were then analyzed using proprietary signal processing algorithms to output corresponding 30-second RR segments (as breaths/minute). RR results for each device for the selected periods were time-synchronized and compared for each 30-second segment. As per previous validation literature, accuracy was reported as proportion of RR measurements within +/-10% or +/-2 breaths/minute of the PSG RR. RESULTS: 16 healthy adults (9 males, 7 females) participated in overnight monitoring;ages and BMI ranged 20-74 years and 19-38 respectively. Albus Home RD RR measurements for 1540 thirty-second segments were compared against the gold-standard with overall accuracy of 92.4%. Mean Absolute Percentage Error was 0.06 (SD=0.07). CONCLUSIONS: Albus Home RD passively measured RR with 92% accuracy in adults compared to gold-standard in 770 minutes of analysis. Using wireless sensors and proprietary signal processing algorithms, the Albus Home RD is a valid bedside, non-contact monitor of RR in real-world environments. The non-touch, passive nature of this monitor can enable low-burden, long-term home nocturnal monitoring. This system provides new possibilities for remote clinical care and objective data gathering in longitudinal research studies. .
ABSTRACT
Objective: The COVID-19 pandemic has an impact on daily life as well as fertility care. Evidence supports the notion that infertility causes substantial emotional distress and has a significant impact on a person’s quality of life. The effects of the COVID-19 pandemic on experiencing emotional distress in subfertile patients compared with their pre pandemic situation are unclear. In this study the impact of the restrictive consequences of COVID-19 in terms of emotional distress and infertility related quality of life is investigated, by comparing the pre pandemic emotional distress in a cohort of men and women at time of the first consultation in our fertility clinic with distress and quality of life during the COVID-19 pandemic. Design: An online questionnaire study regarding couples with an indication for IVF, whose treatment was, due to the restrictive measures of the COVID-19 pandemic, interrupted or postponed without knowledge of the length of time. Materials and Methods: Pre pandemic, all patients in our clinic received the SCREENIVF questionnaire during their first consult as a standard procedure (T0). After closure of our clinic in March due to the restrictive consequences, were patients invited by email, on the 16th of June 2020, to participate in an online questionnaire study (T1). Consenting participants provided demographic information and completed the validated FertiQoL and SCREENIVF questionnaires. Mean scores were compared using the Paired-Samples T Test, while the McNemar test was used on paired nominal data. Results: From the 336 invited patients, 120 responded. More women (n=79) than men (n=41) agreed to participate in the study. Of the 120 participants, 72 (60%) completed the SCREENIVF at T0. We analyzed the difference between scores at T0 and T1 of those 72 participants. At T1, the mean score of the SCREENIVF was higher in the domains Anxiety, (mean score T0 4.0±3.2 vs T1 5.3±3.5, p=0.002), and Helplessness (mean score T0 10.7±3.0 vs T1 12.7±4.7, p<0.001). There was no significant difference in the domains Social support and Acceptance. In the domain depression, the mean score was higher at T0 (mean score T0 6.2±4.7 vs T1 3.7±3.2, p<0.001). The number of participants scoring high at risk of emotional distress on the different domains of the SCREENIVF was higher at risk on T0 (29.2% vs 11.1%, p=0.011). During COVID-19 pandemic, the total score of the FertiQoL off all participants was 71.1(± 12.5). Women had lower total FertiQoL scores (68.7 ± 11.4) than men (75.8 ± 13.8;P = 0.003);this was true for each domain (except Relational). Conclusions: This study shows the impact of the COVID-19 pandemic on emotional distress, especially revealed by more feelings of anxiety and helplessness. Meanwhile, patients’ level of depression showed a decrease in times of pandemic compared to the time of the first consultation. Those results might be explained with the thought that due to the pandemic there is more loss of control (i.e. related to anxiety) than loss of hope (i.e. related to depression). We need to address the increased feelings of anxiety and helplessness in our patients.