Risk factors for a Central Line Associated Bloodstream Infection Amongst Hospitalized Patients with COVID

Background. Central line associated bloodstream infections (CLABSI) are serious healthcare associated infections. During the COVID pandemic, we observed an increased incidence of CLABSIs in our healthcare system. We sought to identify risk factors for CLABSI among patients with COVID. Methods. We performed a single-center, matched case-control study in patients admitted between Mar 2020 and Dec 2020 who were 1) diagnosed with COVID based on laboratory results or diagnosis code, and who were 2) at risk for developing a CLABSI based on the presence of a central line for >=3 days. Cases were those diagnosed, based on National Healthcare Safety Network criteria, with CLABSI;controls were patients not diagnosed with CLABSI. Cases and controls were 1:4 matched based on age at admission (+/- 5 years) and COVID diagnosis date (+/- 45 days). Descriptive statistics were calculated for continuous and categorical variables. For comparisons, p values are from generalized estimating equations accounting for clustering by casecontrol matches. All analyses were performed in SAS version 9.4 (SAS Institute Inc., Cary, NC). Approval was granted by our institutional IRB. Results. Characteristics of the patients who were diagnosed with COVID and at risk for developing a CLABSI are presented in table 1. Compared to patients with COVID and no CLABSI, patients with a CLABSI were more likely to be of a non-white race (p=0.0435). A longer length of stay was observed among CLABSI patients, (p=0.0011) and patients with CLABSI were less likely to be discharged to home (p=0.0084). There was a non-statistically significant trend toward a history of diabetes (p=0.0554), receipt of corticosteroids (p=0.052) and receipt of tocilizumab (p=0.0952) among CLABSI patients. Conclusion. Patients hospitalized for COVID who developed a CLABSI had longer hospitalizations and were less likely to be discharged home. Race other than white was a risk factor for CLABSI among patients with COVID. The relationships between race, racism, and CLABSI should be further explored. (Table Presented).

Facteurs associés à la détresse psychologique des étudiants en médecine lors de la crise sanitaire de la COVID-19 : une étude transversale Factors associated with psychological distress in medical students during the COVID-19 health crisis: A cross-sectional study

Objectifs Les modifications organisationnelles liées à la crise sanitaire COVID-19 (cours en distanciel et stage en service d'unités COVID pour certains externes) ont pu favoriser la détresse psychologique des étudiants inscrits en médecine habituellement exposés à une charge de travail intense. L'objectif de cette étude était d'évaluer la prévalence de la détresse psychologique chez les étudiants en médecine pendant la crise sanitaire du COVID-19, et d'identifier les facteurs associés à la détresse psychologique. Méthodes Une étude observationnelle transversale a été proposée à 1814 étudiants en médecine (de la première à la sixième année) dans un centre hospitalier universitaire français du 10 mars au 25 mars 2021. Un avis favorable du comité d'éthique a été obtenu (IRBN272021/CHUSTE). Des informations sociodémographiques, professionnelles et médicales (détresse psychologique mesurée sur l'échelle française GHQ12) ont été recueillies par le biais d'un questionnaire anonyme auto-administré en ligne. Les variables associées à la détresse psychologique ont été étudiées en utilisant une analyse univariée (test du Chi2 et Fisher). Les variables avec une valeur p < 0,2 ont été inclues dans un modèle de régression de Poisson modifiée et les variables avec une valeur de p < 0,05 ont été conservées dans le modèle. Résultats Au total, 832 étudiants en médecine ont répondu (46 %) et 699 ont rempli le questionnaire en entier (39 %) : 625 (75 %) ont montré des signes de détresse psychologique et 109 (15 %) ont rapporté des idées suicidaires. Le sexe féminin, un traumatisme psychologique lors de la crise sanitaire COVID-19, une modification de la consommation d'alcool et des difficultés liées à l'enseignement en distanciel étaient positivement associés à la détresse psychologique, alors qu'un sentiment d'entraide et de coopération dans le cadre des études, la reconnaissance du travail effectué étaient négativement associés à la détresse psychologique. Un stage dans une unité COVID n'apparaît pas significativement associé à la détresse psychologique. Conclusions Des soins de santé mentale intégrant la prévention du suicide devraient être proposés aux étudiants à risque dans ce contexte de crise sanitaire COVID-19. Connaître les facteurs éducatifs et médicaux associés à la détresse psychologique permet d'identifier des axes de prévention.

"The hospital of tomorrow'': a participative, holistic method to innovate health-care facilities during the COVID-19 pandemic, 2020-2021

Background: Italy was one of the first European countries to report COVID-19 cases, at the end of January 2020.1 In mid-February, the country reported community-based transmission, especially in the northern regions of Lombardia, Piemonte and Emilia-Romagna.2 The COVID-19 pandemic overstretched the structural capacity of health care facilities, and several hospitals in Emilia-Romagna undertook emergency measures to renovate, expand and reconstruct existing facilities. The Italian Ministry of Health required that emergency rooms be reorganized and restructured to separate the flow of human traffic and create permanent isolated areas for patients waiting for the results of tests for COVID-19.3 Emilia-Romagna, with WHO headquarters and the WHO regional and country offices, then launched the "hospital of tomorrow" project to set new standards to be applied to health-care facilities after COVID-19. Below, we present the preliminary results of the initial steps, covering 3 months of project (Figure 1). The case study will last one year (October 2020-November 2021) and further results will be discussed at the end of the project. Setting: St Orsola-Malpighi polyclinic, the facility selected for this pilot project, is an internationally acclaimed institution that dates back more than 4 centuries. It represents the European architectural heritage, with a mix of old and new pavilions, integrated into a city context. It is organized into 7 departments with 91 operative units. Before the COVID-19 pandemic, it was equipped with 1758 beds and had more than 5000 staff, with annual outpatient and inpatient turnovers of 400 000 and 72 000 patients, respectively. On any given day, approximately 20 000 staff, students, university lecturers and researchers, patients, visitors and suppliers are present on the hospital grounds.4 Process and outcomes: The hospital directors in collaboration with the WHO team defined the key macro areas for the intervention to enhance the facility's strengths and reduce its weaknesses in the health-care standards required to prevent the spread of SARS-CoV-2 and other infections and to improve the well-being of patients and staff and the quality of services. Working groups were established for each macro area, with representatives and group members selected by the hospital's Board of Directors. Representatives of the groups met weekly to coordinate activities and to serve as contact persons for group activities and liaison among the groups. The groups formed initially addressed staff spaces, high-tech logistics, "wayfinding", patient and visitor spaces, operational system support, user reception and access and telemedicine.

[Validation of surgical masks during COVID19 emergency: activities at the University of Napoli Federico II]

During COVID-19 pandemic crisis, Italian Government has approved Law Decree no. 18 of 17 march 2020, in which art. 15 allows enterprises to produce, import and commercialize surgical masks notwithstanding the current rules of product certification. It is just required that the interested enterprises send to the Italian National Institute of Health a selfcertification in which they declare the technical characteristics of the masks and that masks are produced according to the safety requirements. In this context, a technical-scientific unit was established at the University of Napoli Federico II to provide interested enterprises with state-of-the-art consultancy, testing and measurement services, adhering to rigorous scientific protocols. Characterization tests were carried out on 163 surgical masks and/or materials for their construction and they have enabled the identification of pre-screening criteria to simplify the procedure for evaluating surgical masks using methods for assessing the filtration efficiency of particles and aerosols. Based on experimental results, it has been observed that a filtration efficiency for particles with sizes larger that 650 nm (PFE>650) exceeding 35% might guarantees a bacterial filtration efficiency (BFE) higher than 95% while BFE values higher than 98% are obtained when the PFE>650 is larger than 40%. PFE measurement is extremely simpler with respect to BFE, the latter being time-consuming and requiring specific equipment and methods for its realization. Many tested materials have shown the capability to assure high filtration efficiencies but Spundonded-Meltblown-Spunbonded (SMS), that are layers of non-woven fabric with different weights of Meltblown, can simultaneously guarantee high particle filtration efficiencies with pressure drop values (breathability) in the limits to classify the surgical masks as Type II/IIR. In fact, the fabric products analyzed so far have not been able to simultaneously guarantee adequate BFE and breathability values. On the contrary, Spunbonds of adequate weights can virtually verify both requirements and accredit themselves as possible materials for the production of surgical masks, at least of Type I. Further studies are needed to verify the possibility of producing low-cost, reusable surgical masks that could meet the criteria of circular economy.