Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 16 de 16
Filter
2.
Infect Control Hosp Epidemiol ; : 1-33, 2022 Feb 22.
Article in English | MEDLINE | ID: covidwho-1705783

ABSTRACT

OBJECTIVE: In response to the 2014-2016 West Africa Ebola virus disease (EVD) epidemic, the Centers for Disease Control and Prevention (CDC) designated 56 US hospitals as Ebola treatment centers (ETCs) with high-level isolation capabilities. We aimed to determine ongoing sustainability of ETCs and identify how ETC capabilities have impacted hospital, local, and regional COVID-19 readiness and response. DESIGN: An electronic survey included both qualitative and quantitative questions and was structured into two sections: operational sustainability and role in the COVID-19 response. SETTING AND PARTICIPANTS: The survey was distributed to site representatives from the 56 originally designated ETCs; 37 (66%) responded. METHODS: Data were coded and analyzed using descriptive statistics. RESULTS: Of the 37 responding ETCs, 33 (89%) reported they were still operating while 4 had decommissioned. ETCs that maintain high-level isolation capabilities incurred a mean of $234,367 in expenses per year. All but one ETC reported that existing capabilities (e.g., trained staff, infrastructure) before COVID-19 positively affected their hospital, local, and regional COVID-19 readiness and response (e.g., ETCs trained staff, donated supplies, and shared developed protocols). CONCLUSIONS: Existing high-level isolation capabilities and expertise developed following the 2014-2016 EVD epidemic were leveraged by ETCs to assist hospital-wide readiness for COVID-19 and support response for other local and regional hospitals However, ETCs face continued challenges in sustaining those capabilities for high-consequence infectious diseases.

3.
J Occup Environ Hyg ; 19(3): 129-138, 2022 03.
Article in English | MEDLINE | ID: covidwho-1619792

ABSTRACT

With the increasing number of highly infectious disease incidents, outbreaks, and pandemics in our society (e.g., Ebola virus disease, Lassa fever, coronavirus diseases), the need for consensus and best practices on highly infectious decedent management is critical. In January 2020, a workshop of subject matter experts from across the world convened to discuss highly infectious live patient transport and highly infectious decedent management best practices. This commentary focuses on the highly infectious decedent management component of the workshop. The absence of guidance or disparate guidance on highly infectious decedent management can increase occupational safety and health risks for death care sector workers. To address this issue, the authorship presents these consensus recommendations on best practices in highly infectious decedent management, including discussion of what is considered a highly infectious decedent; scalability and storage for casualty events; integration of key stakeholders; infection control and facility considerations; transport; care and autopsy; psychological, ethical, and cultural considerations as well as multi-national care perspectives. These consensus recommendations are not intended to be exhaustive but rather to underscore this overlooked area and serve as a starting point for much-needed conversations.


Subject(s)
Communicable Diseases , Hemorrhagic Fever, Ebola , Communicable Diseases/epidemiology , Consensus , Humans , Infection Control , Pandemics/prevention & control
4.
Infect Control Hosp Epidemiol ; 42(11): 1307-1312, 2021 11.
Article in English | MEDLINE | ID: covidwho-1574178

ABSTRACT

OBJECTIVE: In response to the 2013-2016 Ebola virus disease outbreak, the US government designated certain healthcare institutions as Ebola treatment centers (ETCs) to better prepare for future emerging infectious disease outbreaks. This study investigated ETC experiences and critical care policies for patients with viral hemorrhagic fever (VHF). DESIGN: A 58-item questionnaire elicited information on policies for 9 critical care interventions, factors that limited care provision, and innovations developed to deliver care. SETTING AND PARTICIPANTS: The questionnaire was sent to 82 ETCs. METHODS: We analyzed ordinal and categorical data pertaining to the ETC characteristics and descriptive data about their policies and perceived challenges. Statistical analyses assessed whether ETCs with experience caring for VHF patients were more likely to have critical care policies than those that did not. RESULTS: Of the 27 ETCs who responded, 17 (63%) were included. Among them, 8 (47%) reported experience caring for persons under investigation or confirmed cases of VHF. Most felt ready to provide intubation, chest compressions, and renal replacement therapy to these patients. The factors most cited for limiting care were staff safety and clinical futility. Innovations developed to better provide care included increased simulation training and alternative technologies for procedures and communication. CONCLUSIONS: There were broad similarities in critical care policies and limitations among institutions. There were several interventions, namely ECMO and cricothyrotomy, which few institutions felt ready to provide. Future studies could identify obstacles to providing these interventions and explore policy changes after increased experience with novel infectious diseases, such as COVID-19.


Subject(s)
COVID-19 , Hemorrhagic Fever, Ebola , Critical Illness , Disease Outbreaks , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/therapy , Humans , Organizational Policy , SARS-CoV-2
6.
Sci Rep ; 10(1): 13892, 2020 08 12.
Article in English | MEDLINE | ID: covidwho-1387449

ABSTRACT

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

7.
J Expo Sci Environ Epidemiol ; 2021 Aug 18.
Article in English | MEDLINE | ID: covidwho-1364578

ABSTRACT

BACKGROUND: Aerosol transmission of COVID-19 is the subject of ongoing policy debate. Characterizing aerosol produced by people with COVID-19 is critical to understanding the role of aerosols in transmission. OBJECTIVE: We investigated the presence of virus in size-fractioned aerosols from six COVID-19 patients admitted into mixed acuity wards in April of 2020. METHODS: Size-fractionated aerosol samples and aerosol size distributions were collected from COVID-19 positive patients. Aerosol samples were analyzed for viral RNA, positive samples were cultured in Vero E6 cells. Serial RT-PCR of cells indicated samples where viral replication was likely occurring. Viral presence was also investigated by western blot and transmission electron microscopy (TEM). RESULTS: SARS-CoV-2 RNA was detected by rRT-PCR in all samples. Three samples confidently indicated the presence of viral replication, all of which were from collected sub-micron aerosol. Western blot indicated the presence of viral proteins in all but one of these samples, and intact virions were observed by TEM in one sample. SIGNIFICANCE: Observations of viral replication in the culture of submicron aerosol samples provides additional evidence that airborne transmission of COVID-19 is possible. These results support the use of efficient respiratory protection in both healthcare and by the public to limit transmission.

8.
J Occup Environ Hyg ; 18(9): 430-435, 2021 09.
Article in English | MEDLINE | ID: covidwho-1354224

ABSTRACT

Personal protective equipment used by healthcare workers to mitigate disease transmission risks while caring for patients with high-consequence infectious diseases can impair normal body cooling mechanisms and exacerbate physiological strain. Symptoms of heat strain (e.g., cognitive impairment, confusion, muscle cramping) are especially harmful in the high-risk environment of high-consequence infectious disease care. In this pilot study, the core body temperatures of healthcare workers were assessed using an ingestible, wireless-transmission thermometer while performing patient care tasks common to a high-level isolation unit setting in powered air purifying respirator (PAPR)-level. The objective was to determine the potential for occupational health hazard due to heat stress in an environmentally controlled unit. Maximum core temperatures of the six participants ranged from 37.4 °C (99.3 °F) to 39.9 °C (103.8°F) during the 4-hr shift; core temperatures of half (n = 3) of the participants exceeded 38.5 °C (101.3 °F), the upper core temperature limit. Future investigations are needed to identify other heat stress risks both in and outside of controlled units. The ongoing COVID-19 pandemic offers unique opportunities for field-based research on risks of heat stress related to personal protective equipment in healthcare workers that can lead to both short- and long-term innovations in this field.


Subject(s)
Body Temperature/physiology , COVID-19/epidemiology , Heat Stress Disorders/etiology , Patient Isolation , Personal Protective Equipment/adverse effects , Adult , Body Mass Index , Female , Health Personnel , Humans , Male , Middle Aged , Occupational Health , Pandemics , Pilot Projects , SARS-CoV-2
9.
Clin Infect Dis ; 74(4): 729-733, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1328915

ABSTRACT

Emerging infectious disease epidemics require a rapid response from health systems; however, evidence-based consensus guidelines are generally absent early in the course of events. Formed in 2017 by 5 high-level isolation units spanning 3 continents, the experience of the Global Infectious Disease Preparedness Network (GIDPN) early in the course of coronavirus disease 2019 (COVID-19) provides a model for accelerating best practice development and improving decision-making in health emergencies. The network served as a platform for real-time, open and transparent information-sharing during unknowns of an active outbreak by clinicians caring for patients, by researchers conducting clinical trials and transmission and infection prevention studies, and by teams advising local and national policy makers. Shared knowledge led to earlier adoption of some treatment modalities as compared to most peer institutions and to implementation of protocols prior to incorporation into national guidelines. GIDPN and similar networks are integral in enhancing preparedness for and response to future epidemics/pandemics.


Subject(s)
COVID-19 , Communicable Diseases , Communicable Diseases/epidemiology , Communicable Diseases/therapy , Decision Making , Humans , Pandemics/prevention & control , SARS-CoV-2
10.
Journal of Environmental Health ; 84(1):16-25, 2021.
Article in English | CINAHL | ID: covidwho-1281159

ABSTRACT

The meatpacking industry has faced significant challenges in maintaining a safe and healthy working environment for its employees during the COVID-19 pandemic, which has resulted in worker illness and death, temporary closures of facilities, reductions in production capacity, and consequences throughout the supply chain. We sought to explore the concerns and perceptions of COVID-19 among meatpacking workers in the Midwestern part of the U.S. We conducted an online survey of meatpacking workers in Nebraska, Iowa, Kansas, and Missouri between May 7 and 25, 2020. A total of 585 workers participated (M = 41.3 years, SD = 10.3). More than 72% of workers believed that they were at "high risk" for contracting COVID-19, but less than one half had been tested (42%). Most workers (83%) reported that their employer had instituted some safety measures, but less than one half reported physical distancing on the line (39%), slowing down the line (34%), additional paid time off (28%), or restructuring of shifts (20%). Enforceable standards are needed in the meatpacking industry to reduce COVID-19 transmission. Culturally and linguistically tailored education, paid sick leave, and restructuring of work can reduce the risks of COVID-19 transmission. Transparency on workplace transmission rates is essential to developing strategies to mitigate occupational risks and foster worker trust.

11.
Am J Emerg Med ; 47: 253-257, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1213002

ABSTRACT

INTRODUCTION: As a result of the COVID-19 pandemic and highly contagious nature of SARS-CoV-2, emergency departments (EDs) have been forced to implement new measures and protocols to minimize the spread of the disease within their departments. The primary objective of this study was to determine if the implementation of a designated COVID-19 cohort area (hot zone) within a busy ED mitigated the dissemination of SARS-CoV-2 throughout the rest of the department. METHODS: In an ED of a tertiary academic medical center, with 64,000 annual visits, an eight room pod was designated for known COVID-19 or individuals with high suspicion for infection. There was a single entry and exit for donning and doffing personal protective equipment (PPE). Health care workers (HCW) changed gowns and gloves between patients, but maintained their N-95 mask and face shield, cleaning the shield with a germicidal wipe between patients. Staffing assignments designated nurses and technicians to remain in this area for 4 h, where physicians regularly moved between the hot zone and rest of the ED. Fifteen surface samples and four air samples were taken to evaluate SARS-CoV-2 contamination levels and the effectiveness of infection control practices. Samples were collected outside of patient rooms in 3 primary ED patient care areas, the reception area, the primary nurses station, inside the cohort area, and the PPE donning and doffing areas immediately adjacent. Samples were recovered and analyzed for the presence of the E gene of SARS-CoV-2 using RT-PCR. RESULTS: SARS-CoV-2 was not detected on any surface samples, including in and around the cohort area. All air samples outside the COVID-19 hot zone were negative for SARS-CoV-2, but air samples within the cohort area had a low level of viral contamination. CONCLUSION: A designated COVID-19 cohort area resulted in no air or surface contamination outside of the hot zone, and only minimal air, but no surface contamination, within the hot zone.


Subject(s)
COVID-19/prevention & control , COVID-19/transmission , Emergency Service, Hospital , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , COVID-19/epidemiology , Gloves, Protective , Health Personnel , Humans , Patients' Rooms , Personal Protective Equipment , Protective Clothing , Respiratory Protective Devices , SARS-CoV-2 , Specimen Handling , Tertiary Care Centers
12.
J Agromedicine ; 25(4): 378-382, 2020 10.
Article in English | MEDLINE | ID: covidwho-1174763

ABSTRACT

From the farms to the packing plants, essential workers in critical food production industries keep food on our tables while risking their and their families' health and well-being to bring home a paycheck. They work in essential industries but are often invisible. The disparities illuminated by COVID-19 are not new. Instead, they are the result of years of inequities built into practices, policies, and systems that reinforce societal power structures. As a society, we are now at an antagonizing moment where we can change our collective trajectory to focus forward and promote equity and justice for workers in agriculture and food-related industries. To that end, we describe our experience and approach in addressing COVID-19 outbreaks in meat processing facilities, which included three pillars of action based on public health ethics and international human rights: (1) worksite prevention and control, (2) community-based prevention and control, and (3) treatment. Our approach can be translated to promote the health, safety, and well-being of the broader agricultural workforce.


Subject(s)
COVID-19/psychology , Farmers/psychology , Meat-Packing Industry/statistics & numerical data , Occupational Health , Animals , COVID-19/epidemiology , Farmers/statistics & numerical data , Food Supply , Human Rights , Humans , Public Health/statistics & numerical data
13.
Curr Treat Options Infect Dis ; : 1-12, 2021 Apr 06.
Article in English | MEDLINE | ID: covidwho-1173372

ABSTRACT

PURPOSE OF REVIEW: Prior outbreaks of respiratory viruses have demonstrated the need for adequate personal protective equipment (PPE) for healthcare workers, particularly filtering facepiece respirators (FFR). Due to shortfalls of PPE during the SARS CoV-2 pandemic, the need for FFR decontamination and reuse (FFR-DR) strategies is paramount. This paper aims to discuss primary decontamination strategies, with an in-depth analysis of ultraviolet germicidal irradiation (UVGI), arriving at the decontamination strategy utilized at the Nebraska Medical Center (NMC). METHODS: Review of the primary literature in regard to FFR-DR as well as a synopsis of the current protocol for FFR-DR at NMC. RECENT FINDINGS: UVGI demonstrates effective decontamination of multiple pathogens-including several human respiratory viruses-while maintaining mask integrity and filtering capacity. UVGI was associated with degradation of strap integrity at higher doses than that utilized for decontamination or with reuse beyond 20 times. SUMMARY: UVGI effectively decontaminates N95 FFRs without significant reduction to fit or strap integrity and can be employed as a strategy for FFR-DR in times of emergency.

14.
Emerg Infect Dis ; 27(4): 1032-1038, 2021 04.
Article in English | MEDLINE | ID: covidwho-1085129

ABSTRACT

The coronavirus disease (COVID-19) pandemic has severely impacted the meat processing industry in the United States. We sought to detail demographics and outcomes of severe acute respiratory syndrome coronavirus 2 infections among workers in Nebraska meat processing facilities and determine the effects of initiating universal mask policies and installing physical barriers at 13 meat processing facilities. During April 1-July 31, 2020, COVID-19 was diagnosed in 5,002 Nebraska meat processing workers (attack rate 19%). After initiating both universal masking and physical barrier interventions, 8/13 facilities showed a statistically significant reduction in COVID-19 incidence in <10 days. Characteristics and incidence of confirmed cases aligned with many nationwide trends becoming apparent during this pandemic: specifically, high attack rates among meat processing industry workers, disproportionately high risk of adverse outcomes among ethnic and racial minority groups and men, and effectiveness of using multiple prevention and control interventions to reduce disease transmission.


Subject(s)
COVID-19 , Disease Transmission, Infectious/prevention & control , Food-Processing Industry , Infection Control , Meat-Packing Industry , Adult , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Female , Food-Processing Industry/methods , Food-Processing Industry/organization & administration , Food-Processing Industry/trends , Humans , Incidence , Infection Control/instrumentation , Infection Control/methods , Infection Control/organization & administration , Male , Meat-Packing Industry/methods , Meat-Packing Industry/organization & administration , Meat-Packing Industry/trends , Minority Health/statistics & numerical data , Nebraska/epidemiology , Occupational Health/standards , Outcome Assessment, Health Care , Personal Protective Equipment/standards , Risk Assessment , SARS-CoV-2/isolation & purification , Workplace/standards
15.
Sci Rep ; 10(1): 12732, 2020 07 29.
Article in English | MEDLINE | ID: covidwho-691060

ABSTRACT

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originated in Wuhan, China in late 2019, and its resulting coronavirus disease, COVID-19, was declared a pandemic by the World Health Organization on March 11, 2020. The rapid global spread of COVID-19 represents perhaps the most significant public health emergency in a century. As the pandemic progressed, a continued paucity of evidence on routes of SARS-CoV-2 transmission has resulted in shifting infection prevention and control guidelines between classically-defined airborne and droplet precautions. During the initial isolation of 13 individuals with COVID-19 at the University of Nebraska Medical Center, we collected air and surface samples to examine viral shedding from isolated individuals. We detected viral contamination among all samples, supporting the use of airborne isolation precautions when caring for COVID-19 patients.


Subject(s)
Aerosols/analysis , Betacoronavirus/genetics , Coronavirus Infections/pathology , Pneumonia, Viral/pathology , Air Pollutants/analysis , Betacoronavirus/isolation & purification , Betacoronavirus/physiology , COVID-19 , Coronavirus Infections/transmission , Coronavirus Infections/virology , Humans , Infection Control/methods , Pandemics , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Public Health , RNA, Viral/isolation & purification , RNA, Viral/metabolism , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2 , Time Factors
16.
Intensive Care Med ; 46(7): 1303-1325, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-574921

ABSTRACT

Given the rapidly changing nature of COVID-19, clinicians and policy makers require urgent review and summary of the literature, and synthesis of evidence-based guidelines to inform practice. The WHO advocates for rapid reviews in these circumstances. The purpose of this rapid guideline is to provide recommendations on the organizational management of intensive care units caring for patients with COVID-19 including: planning a crisis surge response; crisis surge response strategies; triage, supporting families, and staff.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Intensive Care Units/organization & administration , Pandemics , Pneumonia, Viral/therapy , COVID-19 , Coronavirus Infections/epidemiology , Critical Care/standards , Equipment and Supplies, Hospital , Health Care Rationing/standards , Health Workforce , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intensive Care Units/standards , Personal Protective Equipment , Pneumonia, Viral/epidemiology , Respiration, Artificial/instrumentation , Respiration, Artificial/standards , SARS-CoV-2 , Triage
SELECTION OF CITATIONS
SEARCH DETAIL