Looking in the Rearview Mirror and to the Road Ahead on Dementia & Living Well

The number of Americans living with Alzheimer's and all other dementias continues to increase. Most of them will need long-term and community-based services as the disease progresses. While medical research is making advances, there is more work to be done to ensure that every person receives care that is person-centered and allows them to live with dignity and respect.

Seniors' Long‐Term Care in Canada: A Continuum of Soft to Brutal Privatisation

We situate the contemporary crisis of COVID‐19 deaths in seniors' care facilities within the restructuring and privatisation of this sector. Through an ethnographic comparison in a for‐profit and nonprofit facility, we explore what we identify as brutal and soft modes of privatisation within publicly subsidised long‐term seniors' care in Vancouver, British Columbia, and their influence on the material and relational conditions of work and care. Workers in both places are explicit that they deliver only bare‐bones care to seniors with increasingly complex care needs, and we document the distinct forms and extent to which these precarious workers give gifts of their time, labour and other resources to compensate for the gaps in care that result from state withdrawal and the extraction of profits within the sector. We nonetheless locate more humane and hopeful processes in the nonprofit facility, where a history of cooperative relations between workers, management and families suggest the possibility of re‐valuing the essential work of care. [ FROM AUTHOR] Copyright of Antipode is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Long-Term Care Staffing Policies Pre-COVID-19 and Pandemic Responses: A Case Comparison of Ontario and British Columbia

À la fin de mai 2020, les cas de COVID-19 chez les résident·es des établissements de soins de longue durée (SLD) en Ontario représentaient 5 157 des 28 499 cas de la province. En Colombie-Britannique (C.-B.), il y avait 339 cas chez les résident·es de ces établissements, comparativement à un total provincial de 2 562 cas. Bien que le secteur des SLD de ces deux provinces présente certaines différences, cet article passe en revue les politiques de dotation en personnel des SLD dans chacune des deux provinces avant la pandémie et compare leurs mesures de prévention de la COVID-19 ayant trait à la dotation pour 2020. Aux politiques de l'Ontario avant 2020 correspondent des ratios personnel-patients inférieurs à ceux de la Colombie-Britannique, ce qui peut avoir eu un effet limitant sur les réactions de l'Ontario à la pandémie. L'établissement de normes ou de lignes directrices ainsi qu'une modification du financement pourraient améliorer la résilience du secteur des SLD en matière de dotation en personnel.Alternate :By late May 2020, COVID-19 cases among long-term care (LTC) residents in Ontario constituted 5,157 of the province's 28,499 cases. In British Columbia (B.C.), there were 339 cases among LTC residents compared with a provincial total of 2,562 cases. While the LTC sectors in these two provinces have some differences, this article reviews their pre-pandemic LTC staffing policies and compares their staffing-related COVID-19 prevention measures in 2020. Ontario's policies before 2020 corresponded with lower staff-to-patient ratios than B.C., which may have constrained Ontario's pandemic responses. Implementation of standards or guidelines and changes to funding could help achieve LTC sector staffing resiliency.

Predictors of COVID-19 Vaccination Uptake and Reasons for Decline of Vaccination: A Systematic Review

Background: Various COVID-19 vaccines with proven safety and effectiveness are available now but vaccine hesitancy remains a public threat. COVID-19 vaccines uptake appears to have an essential role in the successful control of the COVID-19 pandemic. Objective: To examine predictors of COVID-19 vaccination uptake and reasons for decline of vaccination. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for this systematic review. We searched Medline, PubMed, Web of Science, Scopus, ProQuest, CINAHL, and a preprint service (medRxiv). We used the following key-words: vaccin·, COVID-19, and uptake. We included all types of studies (quantitative, qualitative, and mixed methods) reporting COVID-19 vaccination uptake. The review protocol was registered with PROSPERO (CRD42021267460). Results: Twelve studies met the inclusion and exclusion criteria. COVID-19 vaccination uptake ranged from 28.6% to 98% in the general population, while among healthcare workers ranged from 33.3% to 94.5%, and among patients ranged from 36% to 80%. The main predictors of COVID-19 vaccination uptake were male gender, white race, older age, higher socioeconomic status, higher self-perceived COVID-19 vulnerability, increased information about COVID-19 vaccines, and chronic illness. The most important reasons for decline of vaccination were concerns about the safety and effectiveness of vaccines, illness, medication, pregnancy, fertility, breastfeeding, religious reasons, ethical reasons, previous COVID-19 diagnosis, self-estimation that COVID-19 is not a severe disease, and limited knowledge about the vaccines. Conclusions: Several factors affect COVID-19 vaccination uptake, while various reasons affect people's decision to refuse to take a COVID-19 vaccine. These findings are essential to further enhance our understanding of COVID-19 vaccination uptake and design specific interventions. Given the high prevalence of COVID-19 vaccine hesitancy, our findings have major implications for the delivery of COVID-19 vaccination programmes in the public with special attention to people who are undecided or unlikely to take a COVID-19 vaccine.

Guest editorial

[...]most individuals who are under correctional control serve time in the community on probation or parole. Because health care for older adults is exceedingly complex and costly when compared to younger adults, this large and growing older adult population under correctional control (prisons, jails, parole or probation) ought to sound an alarm through the public health and carceral fields. Service providers in community-based settings such as area agencies on aging, senior centers and leaders in long-term care are encouraged to prepare for an influx of elders with a criminal legal history and to examine current strengths and potential barriers in rising to the challenge of compassion in the wake of custody.

Cuidado de largo plazo para la vejez ante el Covid-19

Este artículo discute el funcionamiento de la organización social del cuidado de largo plazo para personas mayores ante la crisis pandémica en las instituciones de cuidado de largo plazo (iclp). Se presenta la descripción de las necesidades de cuidado en México en contexto de envejecimiento y el perfil de las iclp a partir de datos del Censo de Población y Vivienda de 2020. Se examinan la regulación y la organización de las iclp y las problemáticas que enfrentaron antes y durante la pandemia. Se propone el marco conocido como ciat, como una herramienta útil para apoyar a las iclp.Alternate :This article discusses how the social organization of long-term care for older persons in long-term care institutions (ltcis) functioned during the pandemic crisis. Based on data from the 2020 Population and Housing Census, it describes Mexico's care needs in the context of aging and the profile of ltcis. It then examines the regulation and organization of ltcis and the problems they faced before and during the pandemic. The framework known as ciat is proposed as a useful tool to support ltcis.

The impact of the COVID-19 pandemic on psychological service provision, mental health practitioners, and patients in long-term care settings: Results from a rapid response survey

Due to the rapid spread of COVID-19 in long-term care (LTC) settings and the subsequent mandatory visitor restrictions that were put in place, the provision of behavioral health services in LTC settings was impacted. To examine the pandemic's effect on the provision of psychological services in this setting and its impact on clinicians and their patients, we surveyed 126 licensed mental health clinicians working in LTC settings during the pandemic. The sample consisted of psychologists, social workers, and psychiatry mid-level practitioners from 31 states who had provided mental health care services in LTC settings during the initial 7 months after the COVID-19 pandemic was declared a national emergency. This exploratory study revealed that the pandemic significantly impacted the availability and use of mental health services in LTC settings. Although there was a reported increase in the use of telehealth services compared to prepandemic frequency, it was noted that LTC residents went long periods of time without access to mental health services. Government-imposed visitor restrictions and pandemic-related restrictions were perceived as negatively impacting the emotional well-being, loneliness, and quality of life of LTC residents. Perceived factors contributing to the financial and emotional impact of COVID-19 on clinicians were explored, and it was noted that more than half of the sample reported experiencing burnout and nearly one third of surveyed clinicians believed they had experienced trauma by providing mental health services in LTC settings during the COVID-19 pandemic. Understanding this impact has implications for providing mental health services during the current and future pandemics.

WHO hospital care for children guidelines: what do users need?

[...]they needed to be able to carry a book around with them. [...]the broader scope and pocket-size of the pocketbook of Hospital Care for Children. A training course was developed on how to use the guidelines in everyday clinical practice, based on principles of adult learning.3 4 WHO developed the Emergency Triage, Assessment and Training (ETAT) course, focused on the first 24 hours of admission, and in Africa, ETAT+ was a modified version which included admission care.5 Many quality improvement assessments and initiatives occurred, supported by WHO regional offices or initiated by countries.4 In 2013, the Pocketbook of Hospital Care for Children was revised, with updates in many areas. An app was produced, and training materials updated.6 By 2015, at least two-thirds of low-income and middle-income countries adopted the Hospital Care for Children guidelines, and ran training courses or other quality improvement initiatives.7 The Pocketbook of Hospital Care for Children has been used as the basis for paediatric curricula for medical students and nurses in many low-income and middle-income countries, and has been translated into at least 18 languages.3 A number of country and regional adaptations of the book have been achieved to reflect differences in disease epidemiology and local needs.

Nursing Job Stability in Ontario: Comparing Long-Term-Care Homes with Other Health Care Sectors

L'affirmation selon laquelle les foyers de soins de longue durée (FSLD) auraient connu un roulement élevé reflétant l'insatisfaction du personnel était très répandue pendant la pandémie de covid-19. À partir du recensement des infirmières et infirmiers autorisés (IA) et des infirmières et infirmiers auxiliaires autorisés (IAA) de l'Ontario entre 2014 et 2020, nous comparons les FSLD à d'autres secteurs des soins de santé relativement (a) aux caractéristiques du personnel et des emplois et (b) au taux de roulement des emplois (à distinguer du taux de roulement professionnel). Les IA des FSLD sont plus âgé·es, ont un niveau de scolarité inférieur et sont plus susceptibles d'avoir été formé·es à l'extérieur du Canada comparativement à la moyenne provinciale, tandis que les IAA se rapprochent davantage de cette norme. Les emplois en FSLD sont plus susceptibles d'être exercés en milieu rural et de reposer sur des contrats occasionnels et des heures irrégulières que les emplois dans la plupart des autres secteurs. Avant la pandémie, les IA des FSLD se situaient au milieu de la courbe de distribution du taux de roulement sectoriel, tandis que les IAA s'y situaient plus bas que tous les secteurs à l'exception des hôpitaux. Parmi les infirmières qui ont changé d'emploi, la rétention dans le secteur des FSLD est semblable à celle des autres secteurs. Dans l'ensemble, les indicateurs de roulement du personnel n'appuient pas l'idée que la satisfaction au travail dans les FSLD est moins élevée que dans les autres secteurs. Au cours de la première année de la pandémie, de petits changements dans le roulement du personnel ont été observés, mais il est difficile de distinguer les restrictions concernant l'occupation de plusieurs emplois, restrictions liées à la pandémie, des autres causes.Alternate :Claims of high turnover, reflecting worker dissatisfaction, in the long-term-care home (LTCH) sector have been common during the coronavirus disease 2019 pandemic. Using a census of registered nurses (RNs) and registered practical nurses (RPNs) in Ontario from 2014 to 2020, we compare LTCHs and other health care sectors in terms of (a) worker and job characteristics and (b) job turnover (distinct from occupational turnover). RNs in LTCHs are older, have lower levels of education, and are more likely to be trained outside of Canada compared with the provincial average, whereas RPNs are more similar to that norm. LTCH jobs are more likely to be rural and to involve casual contracts and irregular hours than those in most, but not all, sectors. Pre-pandemic, RNs in LTCHs were in the middle of the sectoral turnover distribution, whereas RPNs were lower than all sectors except hospitals. Among nurses who changed jobs, LTCH sectoral retention was similar to that in other sectors. Overall, turnover measures do not suggest lower job satisfaction in LTCHs than other sectors. During the first year of the pandemic, small changes in turnover were observed, but it is difficult to disentangle pandemic restrictions on holding multiple jobs from other causes.

COVID-19 Pandemical Period: Issues and Strategies to Make Sustainable Socialization and Recreation for Elderly People in Long-Term Care Institutions

The usual lives have been changed since the COVID-19 Outbreak took place. Elderly people suffer as much as others and their lives have been impacted a lot. This paper aims to analyze the social network use and the recreation and socialization activity participation before and after the COVID-19 pandemical appearance in long-term care institutions. In the empirical side of this research, the authors of this paper sent an email questionnaire to long-term care institutions located in Rio de Janeiro city, Brazil. In the theoretical side of this research, an investigation was carried out through the scientific databases. Data were analyzed using the programming languages Python, Excel, and IBM SPSS Statistics. As a result, this paper shows an apparent increase in social network use and a drop in recreation and socialization activity participation after the COVID-19 pandemical appearance in long-term care institutions. The presented findings are the first step, which can be part of future studies analyzing the potential growth in social network use among elderly people by comparing elderly residents with non-residents in the long-term care institutions. [ FROM AUTHOR] Copyright of COVID is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

COVID-19: Pandemic Risk, Resilience and Possibilities for Aging Research

The COVID-19 global crisis is reshaping Canadian society in unexpected and profound ways. The significantly higher morbidity and mortality risks by age suggest that this is largely a "gero-pandemic,” which has thrust the field of aging onto center stage. This editorial emphasizes that vulnerable older adults are also those most affected by COVID-19 in terms of infection risk, negative health effects, and the potential deleterious outcomes on a range of social, psychological, and economic contexts – from ageism to social isolation. We also contend that the pathogenic analysis of this pandemic needs to be balanced with a salutogenic approach that examines the positive adaptation of people, systems and society, termed COVID-19 resilience. This begs the question: how and why do some older adults and communities adapt and thrive better than others? This examination will lead to the identification and response to research and data gaps, challenges, and innovative opportunities as we plan for a future in which COVID-19 has become another endemic infection in the growing list of emerging and re-emerging pathogens.

Ethnocultural long-term care homes in Canada: a place for cultural inheritance and community building

This article discusses the overlooked role of recreation programmes in the ethnocultural and cultural-specific long-term care home from my standpoint as a recreation worker. First, the policy during the pandemic that prohibited visits by family members and volunteers revealed that they are important informal caregivers to fill in for the limitations of workers. Second, recreational programmes can also be considered as a practice of cultural inheritance: staff and volunteers learn their history and reconstruct them as collective memory. Third, the interaction between residents, volunteers, families and workers generates a sense of belonging to the ethnic community. Therefore, it can be considered a practice of community building for minority ethnic groups. By presenting the significant role of recreation workers in a long-term care home, I aim to question the meaning and value of care work in long-term care facilities.

Social Connection in Older Age

While social isolation and loneliness affect individuals of all ages and backgrounds, older adults can be affected disproportionately, and are much more likely to suffer from health complications and related healthcare expenses. The COVID-19 pandemic has highlighted and heightened the severity of social isolation and loneliness, especially for people aging at home, in long-term care facilities, and in nursing homes. This article explores meaningful interventions for older adults, including some that look outside the traditional healthcare sector and in the technology, housing, transportation, and nutrition fields.

Kurumsal Bakım Çalışanlarının Gözünden Bakım Emeği ve Pandemi Sonrası Uzun Dönemli Yaşlı Bakımı: Niteliksel Bir Araştırma

COVID-19 salgınının ortaya çıkışı ile dünya gündemine oturan uzun dönemli bakım politikası tartışmaları bakım emeğinin ve evrensel bakım hizmeti sunumunun toplumsal refah açısından önemini ortaya çıkardı. Bu makale, Türkiye'de uzun dönemli bakım hizmetleri bağlamında bakım emeğinin, bakım emeği çalışanlarının perspektifinden bir değerlendirmesini sunmakta ve evrensel sosyal bakım hizmetinin önemini bakım emeği çerçevesinde tartışmaktadır. Araştırmanın verisi kamu ve belediyeye ait ve özel uzun dönemli bakım kurumlarında çalışmakta olan 11 bakım çalışanı ile gerçekleştirilen yarı yapılandırılmış derinlemesine görüşmelerin niteliksel çözümlemesine dayanmaktadır. Bu bağlamda sosyal bakım çalışanlarının bakıma atfettikleri anlamlar, bakım emeğinin sınırlarına ilişkin algıları ve emek piyasasındaki durumları tartışılmaktadır. Araştırmanın sonucu, pandemi sonrası evrensel sosyal hizmetlerin ve bakım çalışanlarının çalışma koşullarının iyileştirilmesinin öneminin altını çizerken, toplumsal refah için temel iş olan ücretli bakım emeğinin değerli kılınarak sosyal bakım hizmetlerinin evrensel olarak sunulmasının önemini de vurgulamaktadır.Alternate :he long-term care policy debates that came to the fore with the outbreak of the COVID-19 pandemic have revealed the importance of care labour and universal social care service delivery. This article presents an evaluation of care work from the perspective of care workers in the context of long-term care services in Turkey. It discusses the importance of universal social care services within the framework of care work. The research data is based on the qualitative analysis of semi-structured in-depth interviews with 11 care workers working in public, municipal and private long-term care institutions. In this context, the meanings attributed to care by social care workers, their perceptions of the limits of care work, and their situation in the labour market are discussed. The result of the research underlines the importance of the delivery of post-pandemic universal social care services and improving the working conditions of care workers while emphasizing the importance of the universal provision of social care services by rendering paid care work valuable with a view to enhancing social welfare.

Experiences of nurses responding to the COVID-19 outbreak at a long-term care hospital in Korea: A qualitative study

Background: The COVID-19 pandemic revealed the fundamental vulnerability of long-term care hospitals (LTCHs) related to infection control and prevention (ICP). We examined the experiences of nurses who worked at a hospital where a COVID-19 outbreak occurred from February 24 to March 16, 2021. Method: This qualitative research was performed with 9 nurses who were engaged during the COVID-19 outbreak. We prepared a semistructured questionnaire based on the main question, "How was the experience among the nurses during the outbreak, and what difficulties did they encounter while resolving the situation?” The data were collected through in-depth, individual interviews from May to August 2021 after the approval of the institutional review board, and the results were analyzed thematically. Results: The average age of the participants was 52.1 years, and they had an average of 15.2 years of clinical experience. We extracted 4 themes and 16 subthemes from the results. The first theme, "sudden onset of the outbreak,” included the following subthemes: (1) found myself accustomed to COVID-19 and desensitized;(2) unavoidable occurrence despite compliance with ICP guidelines;(3) LTCHs are gradually recognized as a breeding ground for COVID-19 by the public;and (4) fear of spreading the infection in the hospital and of becoming a spreader. The second theme, "heavier workload,” included (1) daily overtime and extra shifts in violation of self-quarantine recommendations due to the shortage of nurses;(2) a barrage of phone calls from family members, other departments, public health centers, and hospitals where confirmed cases were transferred;(3) nursing assistants and private caregivers who do not have ICP knowledge as well as patients who do not cooperate due to cognitive impairment;and (4) accomplishing additional tasks while wearing personal protective equipment with some suffocation. The third theme, "emotions and lessons,” included (1) unsatisfied with the initial responses;(2) awareness of the entire infectious disease;(3) increased compassion and attachment for patients;and (4) take pride in the job and the profession as a nurse. The fourth theme, "necessary support and attention,” included (1) need to install isolation rooms and replenish infection control supplies;(2) need for ICP specialists in LTCHs;(3) need for continuous national-based monitoring on ICP for LTCHs;and (4) need to improve working environment and acknowledge nurses in LTCHs. Conclusions: Overall, participants expressed their experiences with the insufficient infection control and response system toward COVID-19 in the LTCH. To enhance ICP in LTCHs, customized policies, regulations, and financial support for infection control activities and ICP professionals must be established.Funding: NoneDisclosures: None

Long-term care facility employee infection prevention adherence and prevention of COVID-19 outbreaks in a high-incidence area

Background: Long-term care facility (LTCF) employees pose potential risk for COVID-19 outbreaks. Association between employee infection prevention (IP) adherence with facility COVID-19 outbreaks remains a knowledge gap. Methods: From April through December 2020, prior to COVID-19 vaccination, we tested asymptomatic Veterans' Affairs (VA) community living center (CLC) residents twice weekly and employees monthly, which increased to weekly with known exposure, for SARS-CoV-2 via nasopharyngeal PCR. Employees voluntarily completed multiple choice questionnaires assessing self-reported IP adherence at and outside work. Surveys were longitudinally administered in April, June, July, and October 2020. Changes in paired employee responses for each period were analyzed using the McNemar test. We obtained COVID-19 community rates from surrounding Davidson and Rutherford counties from the Tennessee Department of Health public data set. CLC resident COVID-19 cases were obtained from VA IP data. Incidence rate and number of positive tests were calculated. Results: Between April and December 2020, 444 employees completed at least 1 survey;177 completed surveys in both April and June, 179 completed surveys in both June and July, and 140 completed surveys in both July and October (Fig. 1). Across periods, employee surveys demonstrated an increase in masking at work and outside work between April and June (63% to 95% [P < .01] and 36% to 63% [P < .01], respectively), and June to July (95% to 99% [P < .05] and 71% to 84% [P < .01], respectively) that were both maintained between July and October (Fig. 2). Distancing at work and limiting social contacts outside work significantly decreased from April to June but increased in subsequent periods, although not significantly. COVID-19 community incidence peaked in July and again in December, but CLC resident COVID-19 cases peaked in August, declined, and remained low through December (Fig. 3). Discussion: Wearing a mask at work, which was mandatory, increased, and voluntary employee masking outside work also increased. CLC COVID-19 cases mirrored community increases in July and August;however, community cases increased again later in 2020 while CLC cases remained low. Employees reporting distancing at work and limiting social contacts outside work decreased preceding the initial rise in CLC cases but increased and remained high after July. Conclusions: These data from the pre–COVID-19 vaccination era suggest that widespread, increased support for and emphasis on LTCF IP adherence, especially masking, may have effectively prevented COVID-19 outbreaks in the vulnerable LTCF population.Funding: NoneDisclosures: None

Determining the effect of COVID-19 on antibiotic use in long-term care facilities across Tennessee

Background: Nationally, a decrease in total antibiotic use in nursing homes during the COVID-19 pandemic was observed with an increase in select agents used for respiratory infections. Currently there is minimal data on antibiotic use in long-term care facilities (LTCFs) in Tennessee. To address this issue, the Tennessee Department of Health (TDH) developed a monthly point-prevalence survey of antibiotic use. Utilizing this tool, we sought to determine the effect the pandemic had on antibiotic use in Tennessee LTCFs. Method: We developed a REDCap questionnaire to collect information on selected antibiotics administered in Tennessee LTCFs. Antibiotic use percentage was determined by dividing the number of residents who received an antibiotic on the day of survey by facilities' average censuses. Data were divided into a prepandemic period (January 2019–February 2020) and a period during the pandemic (March 2020–December 2021). Antibiotic prescriptions were grouped into 4 classes according to their most common uses: Clostridium difficile infections, urinary tract infections, skin and soft-tissue infections (SSTIs), and respiratory infections. Average percentage of residents on antibiotics were compared between study periods. Results: In total, 37 facilities participated in the survey during the prepandemic period and 32 facilities participated during the pandemic period;14 participated during both periods. The average percentage of residents on antimicrobials before the pandemic was 16.3%, which decreased to 11.5% during the pandemic period (P = .04). During the prepandemic period, 40.2% of antibiotics prescribed were in the common for SSTI category and 38.3% were in the common for respiratory infections category (P = .01);during the pandemic period, 64.3% of antibiotics prescribed were in the common for SSTI category and 45.8% were in the common for respiratory infections category (P = .01). The 3 most prescribed antibiotics in the prepandemic period were amoxicillin (148 prescriptions), doxycycline (140 prescriptions), and levofloxacin (135 prescriptions). The 3 most prescribed antibiotics during the pandemic were doxycycline (141 prescriptions), levofloxacin (125 prescriptions), and trimethoprim–sulfamethoxazole (115 prescriptions). Conclusions: Survey results revealed that antibiotic prescriptions commonly used for respiratory infections increased 7.5% during the pandemic study period. Additionally, the average percentage of residents on antimicrobials fell 4.8% during this period. Both statistics reflect what has been seen nationally with a decrease in antibiotic use with an increase in respiratory antibiotics. This could be due to multiple factors including decreased reporting, a change in healthcare delivery during the pandemic, and facilities seeing an increase of respiratory tract infections. These data will be used to guide future TDH antibiotic stewardship efforts in the long-term care setting.Funding: NoneDisclosures: None

Prescriptions patterns and appropriateness of usage of antibiotics in small and medium- sized hospitals in Korea

Background: Although small- and medium-sized hospitals comprise most healthcare providers in South Korea, data on antibiotic usage is limited in these facilities. We evaluated the pattern of antibiotic usage and its appropriateness in hospitals with <400 beds in South Korea. Methods: A multicenter retrospective study was conducted in 10 hospitals (6 long-term care hospitals, 3 acute-care hospitals, and 1 orthopedic hospital), with <400 beds in South Korea. We analyzed patterns of antibiotic prescription and their appropriateness in the participating hospitals. Data on the monthly antibiotic prescriptions and patient days for hospitalized patients were collected using electronic databases from each hospital. To avoid the effect of the COVID-19 pandemic, data were collected from January to December 2019. For the evaluation of the appropriateness of the prescription, 25 patients under antibiotic therapy were randomly selected at each hospital over 2 separate periods. Due to the heterogeneity of their characteristics, the orthopedics hospital was excluded from the analysis. The collected data were reviewed, and the appropriateness of antibiotic prescriptions was evaluated by 5 specialists in infectious diseases (adult and pediatric). Data from 2 hospitals were assigned to each specialist. The appropriateness of antibiotic prescriptions was evaluated from 3 aspects: route of administration, dose, and class. If the 3 aspects were ‘optimal,' the prescription was considered ‘optimal.' If only the route was ‘optimal,' and the dose and/or class was ‘suboptimal,' but not ‘inappropriate,' it was considered ‘suboptimal.' If even 1 aspect was ‘inappropriate,' it was classified as ‘inappropriate.' Results: The most commonly prescribed antibiotics in long-term care hospitals was fluoroquinolone, followed by β-lactam/β-lactamase inhibitor (antipseudomonal). In acute-care hospitals, these were third-generation cephalosporin, followed by first-generation cephalosporin and second-generation cephalosporin. The major antibiotics that were prescribed in the orthopedics hospital was first-generation cephalosporin. Only 2.3% of the antibiotics were administered inappropriately. In comparison, 15.3% of patients were prescribed an inappropriate dose. The proportion of inappropriate antibiotic prescriptions was 30.6% of the total antibiotic prescriptions. Conclusions: The antibiotic usage patterns vary between small- and medium-sized hospitals in South Korea. The proportion of inappropriate prescriptions exceeded 30% of the total antibiotic prescriptions.Funding: NoneDisclosures: None

A little education goes a long way: Decreasing antibiotics for community-acquired pneumonia in COVID-19 patients

Background: Antibiotic use was common in patients with suspected or confirmed COVID-19 infection;however, data emerged demonstrating low rates of bacterial coinfection (6%–10%). Antimicrobial stewardship best practice was challenged during this time, requiring new strategies and education to limit the inappropriate use of antibiotics. At the Veterans' Affairs Maryland Healthcare System, we evaluated the use of community acquired pneumonia (CAP) specific antibiotics in COVID-19–positive patients after successive interventions. Methods: We conducted a pre–post evaluation of common CAP antibiotics (ceftriaxone IV/IM, cefpodoxime PO, azithromycin PO/IV, ampicillin/sulbactam IV, amoxicillin-clavulanate PO, levofloxacin) during the COVID-19 pandemic. The preintervention period was April–October 2020 and the postintervention period was November 2020–April 2021. During the preintervention period, intervention A was carried out as follows: (1) inpatient weekly virtual interdisciplinary COVID-19 rounds were led by an antimicrobial stewardship champion, (2) χprocalcitonin was implemented in clinical decision making, and (3) inpatient audit and feedback of active antibiotics was conducted by the antimicrobial stewardship team. In the postintervention period, intervention B was added as follows: (1) weekly educational COVID-19 virtual seminars were conducted for providers, and (2) targeted education was provided to emergency department and hospitalist directors. Comparisons of the proportions of antibiotics prescribed were made between the pre- and postintervention periods using X2 statistic, and data were stratified by location. The rates of CAP antibiotic prescription per 100 COVID-19–positive patients were also compared using Poisson distribution. Results: During the study period, 814 unique patients had COVID-19 infection: 182 (22.4%) patients admitted to the acute-care center, 66 (8.1%) long-term care residents, and 566 (69.5%) were managed outside the hospital. Of these 814 patients, 211 (25%) were prescribed a CAP antibiotic. Of the antibiotics prescribed, 223 (61%) were ceftriaxone, cefpodoxime, amoxicillin-clavulanate, or ampicillin-sulbactam;123 (34%) were azithromycin;and 16 (4.4%) were levofloxacin. We observed a decrease in the frequency of all antibiotic prescriptions after intervention B was added: 32% (86 of 273) vs 23% (125 of 541) (P = .01). Decreases in antibiotic prescriptions were observed in all locations: acute care (57% vs 44%), long-term care (53% vs 41%) and outpatient care (19% vs 15%). The rates of CAP antibiotic prescribing per 100 COVID-19–positive patients were 114 in the preintervention period and 45 in the postintervention period, a rate difference of −70 antibiotics per 100 COVID-19–positive patients (p Conclusions: Curbing antibiotic use for CAP indication during the COVID-19 pandemic was a challenge. A multifaceted approach focusing on education was an impactful intervention leading to significant decreases in antibiotic prescribing despite COVID-19 cases increasing.Funding: NoneDisclosures: None

Beyond wastewater surveillance: refining environmental pathogen detection in the built environment: CMAJ

The swab is then processed in the laboratory using standard approaches.2 In contrast to wastewater surveillance, our approach has greater spatial resolution, fewer logistical challenges (e.g., does not require access to sewage), minimal up-front costs and does not require installation of equipment or a device for the building. The authors report funding from the Canadian Institutes of Health Research, the Natural Sciences and Engineering Research Council (an alliance grant and a discovery grant), CoVaRR-Net (rapid response research grant), The Ottawa Hospital Academic Medical Organization, the University of Ottawa and the Northern Ontario Academic Medical Association. Detection of COVID-19 outbreaks in long-term care homes using built environment testing for SARS-CoV-2: a multicentre prospective study. medRxiv 2022 June 29 [preprint].doi: 10.1101/2022.06.28.22276560.