Monitoring the Temporal Trajectory of Sars-Cov-2 in Hong Kong - Daily Antigen Rapid Testing Surveillance (Darts) System

Intro: The number of PCR-confirmed cases may serve poorly as a surveillance data for a representative disease activity, due to its bias towards symptomatic cases or people having an identifiable risk exposure, and the high dependency on changing testing policy. We reported a large-scale ad-hoc community surveillance initiative, Daily Antigen Rapid Testing Surveillance (DARTS) System, using self-performed rapid antigen tests(RAT). Method(s): A representative cohort of 10000+ individuals was enrolled over the territory. Participants were divided into 7 sub-cohorts to achieve a rolling schedule with 1400+ individuals on a daily basis. Participant performed the RAT regularly irrespective of symptom or exposure history, with a self-sampled throat-and-nasal swab. RAT result and photo were reported on the same day of testing through an online platform. Daily point prevalence was disseminated on a real-time dashboard to inform the situation awareness(https://covid19.sph.hku.hk/dashboard). Finding(s): Since its launch during the peak of the fifth wave in March 2022, the system has tracked the changing trajectory of different phases of the Omicron pandemic, including the rapidly subsiding daily prevalence from an initial high value of 12.7% (8.4-18.7) in early March to a baseline of 0.6% (0.2-1.4) in early April, maintained with a non-zero baseline (0.1-0.3%) over May, and subsequent stepwise increase to 0.5% (0.2-1.2) in June. The reproduction number increased from 0.66(0.63,0.70) to 1.23(1.14,1.33) from March to June, signifying the gradual increase of residual Omicron transmission. Conclusion(s): Our DARTS system has demonstrated the feasibility of a participatory surveillance system using self-performed RAT, and its utility as an ad-hoc surveillance to timely reflect the rapidly changing epidemic trajectory. Regular testing irrespective of symptom and exposure risk helps to give more representative picture, including subclinical cases who also carried an implication of disease transmission. The use of RAT also helps to avoid the constraint of manpower and testing capacity, and has been quickly adopted for case definition.Copyright © 2023

Evaluation of the antimicrobial prescribing pattern and the stewardship programs among COVID-19 hospitals in the capital city of Kurdistan-Northern Iraq: A multicenter point prevalence study

Antimicrobial resistance (AMR) is a significant threat to healthcare system as making infections difficult to be cured and enhances disease transmission and death. Thus, prudent antimicrobial use is crucial to combat AMR, particularly in Erbil City/Northern Iraq because of the high rate of multidrug-resistance microorganisms. There is limited data on the extent and quality of antimicrobial use in Kurdistan, including COVID-19 hospitals. This study aimed to assess the prevalence and quality indicators of antimicrobial use, the status of antimicrobial stewardship program (ASP), and hospital capacity infrastructures. From September 30th 2021 to February 8th 2022, all COVID-19 hospitals in Erbil/Northern Iraq were surveyed using the Global point prevalence survey methodology. Prevalence of antimicrobial use was at the top (100%, n = 71/71), and carbapenem was the most used antimicrobial class (44.0%, n = 55/125). The majority of the prescribed antimicrobials were in WHO Watch class (88.4%, n = 76/86), high use of parenteral therapy (99.2%, n = 124/125), low targeted therapy (2.4%, n = 3/125) and neither stop/review dates documented, nor local guidelines were available. ASP was not implemented while most of the hospitals had a priority for the medium or long term to implement ASP (66.7%, n = 2/3) out of 11 hospital capacity infrastructures, only four of them were present adequately. The findings demonstrated a high and sub-optimal quality of antimicrobial prescriptions, lack of ASP, and inadequate hospital capacity infrastructures. Quick action is necessary to establish ASP to combat antimicrobial resistance, and the critical target areas include development of the local guidelines and documenting stop/review date. © University of Garmian. All Rights Reserved.

A snapshot of pediatric inpatients and outpatients with COVID-19: a point prevalence study from Turkey.

This multi-center point prevalence study evaluated children who were diagnosed as having coronavirus disease 2019 (COVID-19). On February 2nd, 2022, inpatients and outpatients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included in the study from 12 cities and 24 centers in Turkey. Of 8605 patients on February 2nd, 2022, in participating centers, 706 (8.2%) had COVID-19. The median age of the 706 patients was 92.50 months, 53.4% were female, and 76.7% were inpatients. The three most common symptoms of the patients with COVID-19 were fever (56.6%), cough (41.3%), and fatigue (27.5%). The three most common underlying chronic diseases (UCDs) were asthma (3.4%), neurologic disorders (3.3%), and obesity (2.6%). The SARS-CoV-2-related pneumoniae rate was 10.7%. The COVID-19 vaccination rate was 12.5% in all patients. Among patients aged over 12 years with access to the vaccine given by the Republic of Turkey Ministry of Health, the vaccination rate was 38.7%. Patients with UCDs presented with dyspnea and pneumoniae more frequently than those without UCDs (p < 0.001 for both). The rates of fever, diarrhea, and pneumoniae were higher in patients without COVID-19 vaccinations (p = 0.001, p = 0.012, and p = 0.027).  Conclusion: To lessen the effects of the disease, all eligible children should receive the COVID-19 vaccine. The illness may specifically endanger children with UCDs. What is Known: • Children with COVID-19 mainly present with fever and cough, as in adults. • COVID-19 may specifically threaten children with underlying chronic diseases. What is New: • Children with obesity have a higher vaccination rate against COVID-19 than children without obesity. • Among unvaccinated children, fever and pneumoniae might be seen at a higher ratio than among vaccinated children.

High Prevalence of SARS-CoV-2 Omicron Infection Despite High Seroprevalence, Sweden, 2022.

We performed 2 surveys during 2022 to estimate point prevalences of SARS-CoV-2 infection compared with overall seroprevalence in Sweden. Point prevalence was 1.4% in March and 1.5% in September. Estimated seroprevalence was >80%, including among unvaccinated children. Continued SARS-CoV-2 surveillance is necessary for detecting emerging, possibly more pathogenic variants.

Things that dropped off during COVID

Introduction: The COVID-19 pandemic placed a renewed focus on transmission of respiratory infections in healthcare settings. However, little is known about the direct and indirect impacts on surveillance and infection prevention and control activities to limit transmission of other communicable diseases such as multidrug-resistant organisms (MDROs). Method(s): We conducted retrospective cross-sectional audits of compliance with routine screening and cleaning practices for MDROs (including vancomycin-resistant enterococci [VRE] and extended-spectrum beta-lactamase-[ESBL]-producing and carbapenemase-producing [CPE] Enterobacterales) in a tertiary hospital, where patients admitted to high-risk wards are screened upon admission and weekly. We correlated this with observed transmission events and an organisation-wide point-prevalence survey for MDRO colonisation. Result(s): Compliance with routine MDRO screening practices was lower than pre-pandemic. Additionally, interventions to limit environmental contamination with CPE had been neglected during the pandemic. This corresponded with an increase in CPE transmission. Audits of clinical staff infection prevention and control practices found missed opportunities to screen and identify colonised patients, as well as curtailed control measures during the pandemic, both correlating with MDRO transmission. Conclusion(s): Ongoing engagement of staff and senior decision makers in healthcare facilities is critical to maintaining infection control standards. At our institution, we found a lapse in standards during the COVID-19 pandemic was associated with an increase in MDRO transmission.Copyright © 2022

Point prevalence study on the use of antibiotics at a tertiary healthcare institution during the absence of the COVID-19 wave

Aim: The COVID-19 pandemic still continues in waves. In this study, we aimed to identify the antibiotic prescribing approach and inappropriate antibiotic ratio, and to improve antimicrobial stewardship. Material(s) and Method(s): This study is single-center, cross-sectional, and retrospective.We evaluated antibiotic usage using one-day point prevalence. The study was conducted on patients admitted to surgical wards, internal wards and intensive care units. Result(s): Of the study participants, 120 (52%) used antibiotics. Of the patients using antibiotics, 52 (43%) were male, and 68 (57%) were female. Of these patients, 65 (54%) were hospitalized in surgical units, 35 (30%) in internal units, and 20 (16%) in intensive care units. In 77 patient, antibiotics were started correctly and on the spot, and in 43, inappropriate antibiotic use was found. In these patients, 45% of antibiotics were started empirically, 21.7% based on culture, and 33.3% prophylactically. Discussion(s): The misuse of antibiotics, which is one of the most commonly consumed drugs, is a global problem that threatens not only the health of the patient, but also the health of the entire community. When antibiotics are used too much, especially in health institutions, resistant strains may cause selection and spread. Improving antimicrobial prescribing will help control antimicrobial resistance.Copyright © 2023, Derman Medical Publishing. All rights reserved.

A pilot surveillance report of SARS-CoV-2 rapid antigen test results among volunteers in Germany, 1st week of July 2022.

PURPOSE: We hypothesized that SARS-CoV-2 infection numbers reported by governmental institutions are underestimated due to high dark figures as only results from polymerase chain reaction (PCR) tests are incorporated in governmental statistics and testing capacities were further restricted as of July, 2022. METHODS: A point prevalence investigation was piloted by rapid antigen testing (RAT) among participants of the VACCELERATE volunteer registry. 2400 volunteers were contacted, of which 500 received a RAT including instructions for self-testing in the first week of July, 2022. Results were self-reported via e-mail. RESULTS: 419 valid RAT results were collected until July 7th, 2022. Between July-1 and July-7, 2022, 7/419 (1.67%) tests were positive. Compared to reports of the German Federal Government, our results suggest a more than twofold higher prevalence. Three out of seven positive individuals did not have a PCR test and are therefore likely not to be displayed in governmental statistics. CONCLUSION: Our findings imply that the actual prevalence of SARS-CoV-2 may be higher than detected by current surveillance systems, so that current pandemic surveillance and testing strategies may be adapted.

Antibiotic point prevalence survey at a tertiary healthcare hospital in India: Identifying strategies to improve the antibiotic stewardship program immediately after a COVID-19 wave.

Background: The COVID-19 pandemic has substantially affected the antibiotic stewardship activities in most hospitals of India. Aims: We conducted an antibiotic point prevalence survey (PPS) immediately after the decline of a major COVID-19 wave at a dedicated COVID-19 hospital. By doing so we aimed to identify the antibiotic prescription patterns, identify factors influencing the choice of antibiotics, and identify/develop strategies to improve the antibiotic stewardship program in such setups. Methods: The PPS was single-centred, cross-sectional, and retrospective in nature. Patients admitted in various wards and intensive care units (ICUs) between September 2021 to October 2021 were included in our PPS. Results: Of the included 460 patients, 192 were prescribed antibiotics. Of these 192 patients, ICU-admitted patients had the highest number of antibiotics prescribed i.e. 2.09 ± 0.92. Only a minor fraction (7.92 %) of antibiotics prescriptions were on the basis of culture reports. Most of the antibiotics were prescribed empirically by the parenteral route. The most common group of antibiotics prescribed were third-generation cephalosporins. Carbapenems were the most common designated antibiotics prescribed. A large number of patients (22.40 %) were prescribed a double anaerobic coverage. Conclusion: The strategies that we identified to improve the antibiotic stewardship program at our institute included reviving the culture of sending culture reports to prescribe antibiotics, improving surgical prophylaxis guidelines, training resident doctors to categorize antibiotic prescriptions appropriately, closely monitoring prescriptions providing double anaerobic coverage, and improving the electronic medical record system for improving prescription auditing.

Commonwealth Pharmacist Partnership develops antimicrobial stewardship and infection control in Zambia

Background: Misuse of antimicrobials combined with poor infection prevention and control (IPC) can result in antimicrobial resistance (AMR). Health partnerships are ideally placed to enhance antimicrobial stewardship (AMS) through sharing up-to-date evidence and implementing best practice. Purpose(s): Brighton Lusaka Pharmacy Link (BLPL) was awarded a Commonwealth Partnerships for Antimicrobial Stewardships Scheme (CwPAMS) grant to implement AMS at University Teaching Hospital (UTH) (THET, 2020). Pharmacists-led AMS prescribing and monitoring activities aim to implement a robust data collection system and measure the impact of interventions reducing misuse and overuse of antibiotics while increasing knowledge about on IPC and AMS. Method(s): BLPL conducted a three-day workshop in Zambia for pharmacists, physicians, nurses and allied healthcare professionals at UTH to enhance AMS and point prevalence surveillance (PPS). IPC training was provided by the experienced Ndola IPC team. Train the trainer workshops enables UTH to disseminate AMS, PPS, IPC and data collection standards. Result(s): Proactive MDT committee to manage AMS and IPC activities at UTH was established Specialist AMS pharmacist appointed Two Global-PPS undertaken Modified antibiotic prescribing chart introduced and audited-UTH antimicrobial guidelines updated AMS modular training programme for health care accredited by UNZAforCPD recognition-34 IPC trainers trained Bare-below-the-elbow dress code (BBE) adopted nationally by HOPAZ WHO hand-rub production expanded Conclusion(s): This model of pharmacist-led AMS demonstrates sustainability in locally driven AMS knowledge and seeded national IPC capacity-building whilst instigating behavioural change pertinent during the COVID-19 pandemic.

Point Prevalence Survey of Antimicrobial Use during the COVID-19 Pandemic among Different Hospitals in Pakistan: Findings and Implications.

The COVID-19 pandemic has significantly influenced antimicrobial use in hospitals, raising concerns regarding increased antimicrobial resistance (AMR) through their overuse. The objective of this study was to assess patterns of antimicrobial prescribing during the current COVID-19 pandemic among hospitals in Pakistan, including the prevalence of COVID-19. A point prevalence survey (PPS) was performed among 11 different hospitals from November 2020 to January 2021. The study included all hospitalized patients receiving an antibiotic on the day of the PPS. The Global-PPS web-based application was used for data entry and analysis. Out of 1024 hospitalized patients, 662 (64.64%) received antimicrobials. The top three most common indications for antimicrobial use were pneumonia (13.3%), central nervous system infections (10.4%) and gastrointestinal indications (10.4%). Ceftriaxone (26.6%), metronidazole (9.7%) and vancomycin (7.9%) were the top three most commonly prescribed antimicrobials among surveyed patients, with the majority of antibiotics administered empirically (97.9%). Most antimicrobials for surgical prophylaxis were given for more than one day, which is a concern. Overall, a high percentage of antimicrobial use, including broad-spectrums, was seen among the different hospitals in Pakistan during the current COVID-19 pandemic. Multifaceted interventions are needed to enhance rational antimicrobial prescribing including limiting their prescribing post-operatively for surgical prophylaxis.

Antimicrobial Prescribing before and after the Implementation of a Carbapenem-Focused Antimicrobial Stewardship Program in a Greek Tertiary Hospital during the COVID-19 Pandemic.

BACKGROUND: Irrational use of antimicrobials poses a significant risk for public health by aggravating antimicrobial resistance. The aim of this repeated point prevalence survey (PPS) was to evaluate the impact of a carbapenem-focused antimicrobial stewardship program (ASP) on overall antimicrobial use and quality of antimicrobial prescribing during the COVID-19 pandemic. METHODS: All adult inpatients in the University Hospital of Heraklion in Greece were audited twice, before and after the implementation of the ASP, in October 2019 and October 2020, respectively. Patient characteristics, indications and diagnoses for antimicrobial administration, antimicrobials prescribed, and compliance with treatment guidelines were recorded. RESULTS: Of 743 adult inpatients on the days of the two surveys, 398 (53.6%) were on antimicrobials for 437 diagnoses. Following implementation of the ASP, there was substantial decrease in the utilization of carbapenems (4.9% of all antibacterials prescribed in the second PPS compared to 10.3% in the first PPS). A significant improvement was observed for all indicators of the quality of antimicrobial prescribing. CONCLUSIONS: Our study demonstrated a positive impact of an ASP implementation during the first stages of the COVID-19 pandemic on reducing the use of last-line antimicrobials and improving overall quality of antimicrobial prescribing.

Healthcare-associated infections in Africa: a systematic review and meta-analysis of point prevalence studies.

BACKGROUND: There is limited data to describe the point-prevalence of healthcare-associated infections (HAIs) among patients at a regional level in Africa. This study estimated the pooled prevalence of HAIs and described the distribution of HAIs as well as the pathogens identified from African studies. METHODS: PubMed, Scopus and Google Scholar databases were searched to find point-prevalence studies of HAIs in Africa. Studies conducted in Humans that reported the prevalence of HAIs among hospitalized patients and published in English language from January 2010 to March 2022 were selected. Longitudinal studies of HAIs and unpublished studies were excluded. The reference list of the selected studies was checked to find additional studies. A meta-analysis was conducted using RevMan 5.4 and the pooled prevalence of HAIs was determined using a random effect model. RESULTS: Of the 6094 articles identified from the databases, fifteen eligible articles were selected. The studies were conducted in the North, South, East and West African regions with Tunisia (n = 4) and South Africa (n = 2) having the highest number of studies. Most of the studies (n = 12, 80.0%) had good quality. The pooled prevalence of HAIs was 12.76% (95% confidence interval [CI] 10.30-15.23) with a high degree of heterogeneity (I2 = 90.0%). The prevalence of HAIs varied between wards with the highest rate found in the ICU (25.2%-100%), followed by neonatal ICU/ward (7.0%-53.6%) and paediatric medical ward (2.7%-33.0%). Surgical site infection was the most common HAIs and accounted for 41.6% of all HAIs (95% CI 23.55-59.80), followed by bloodstream infection (17.07%, 95% CI 11.80-22.33) and respiratory tract infections/pneumonia (17.04%, 95% CI 13.21-20.87). Recent hospitalization (adjusted odds ratio [AOR]: 4.17, 95% CI 1.85-9.41), presence of peripheral vascular catheter (AOR: 2.87, 95% CI 1.54-5.36) and having diabetes mellitus (AOR: 2.46, 95% CI 1.45-4.17) were the strongest predictors of HAIs in Africa. Only 37.9% of HAIs had documented positive microbiological culture result with gram negative bacteria including Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii and Citrobacter been the most common microorganisms and accounted for 40%-100% of the pathogens. CONCLUSIONS: The pooled point-prevalence of HAIs in Africa is more than two times higher than the rate reported in developed countries. The prevalence varied between the countries and was highest in the ICU and neonatal ICU/ward. Surgical site infection and bloodstream infection were the most common HAIs reported in African studies. Recent hospitalization, presence of peripheral vascular catheter and having diabetes mellitus were the strongest predictors of HAIs in African studies. Most of the HAIs are preventable with appropriate infection control measures and antimicrobial stewardship. Additional studies are needed especially in the Central African region. Future studies should be designed using standardized protocol and standardized definition to reduce heterogeneity among the studies.

Respiratory support of adults in the emergency department: A protocol for a prospective, observational, multicenter point prevalence study

Background and AimsProviding respiratory support (RS) to patients may improve their oxygenation and ventilation, reducing the work of breathing. Emergency department (ED) patients often need RS;COVID-19 has heightened this need. Patients receiving RS may need escalation of their treatment;hence, studies considering the prevalence of escalation are warranted. MethodThis is a protocol for a prospective, observational, multicenter point prevalence study (PPS). Researchers will collect data over 2 days. All participants are adult ED patients needing RS. The setting is four EDs in New Zealand. The primary research question asks, "Which patients receiving RS require escalation of therapy in the ED?" For example, transitioning from conventional oxygen therapy (COT) to intubation is deemed an escalation of therapy. A sample size of 80 participants is required to resolve the primary research question. Secondary research questions: (1) Which patients receive nasal high flow (NHF) in the ED? (2) How is NHF therapy delivered in the ED? (3) What are the effects of NHF therapy on physiological and patient-centered outcomes? Research Electronic Data Capture (REDCap) will be used for data organization. Data will be imported for analysis from REDCap to IBM SPSS software (Statistics for Windows, Version 27.0). Data reporting on the primary outcome shall be considered by analysis of variance, regression modeling, and determination of two treatment effects: Odds Ratio and Number Needed to Treat. Statistical significance for inferential statistics shall use a two-sided alpha with p-values fixed at <= 0.05 level of significance and 95% confidence intervals. This protocol has ethical approval from Massey University, New Zealand. ConclusionThis novel PPS may reduce the evidence and clinical practice gap on RS delivery and ED patient outcomes, as evidenced by the emergence of COVID-19.

Point prevalence of SARS-CoV-2 infection in Sweden at six time points during 2020.

BACKGROUND: In order to estimate the prevalence and understand the spread of SARS-CoV-2 in Sweden, the Public Health Agency of Sweden, with support from the Swedish Armed Forces, conducted a series of point prevalence surveys between March and December 2020. METHODS: Sampling material and instructions on how to perform self-sampling of the upper respiratory tract were delivered to the homes of the participants. Samples were analysed by real-time PCR, and the participants completed questionnaires regarding symptoms. FINDINGS: The first survey in the Stockholm region in March 2020 included 707 participants and showed a SARS-CoV-2 prevalence of 2.5%. The following five surveys, performed on a national level, with between 2461 and 2983 participants, showed SARS-CoV-2 prevalences of 0.9% (April), 0.3% (May), 0.0% (August), 0.0% (September), and 0.7% (December). All positive cases who responded to questionnaires reported experiencing symptoms that occurred from 2 weeks before the date of sampling up to and including the date of sampling. INTERPRETATION: None of the individuals shown to be PCR-positive were asymptomatic at the time of sampling or in the 14 days prior to sampling. This is in contrast to many other surveys in which a substantial proportion of positive cases have been reported to be asymptomatic. Our surveys demonstrate a decreasing ratio between notified cases and the observed prevalence throughout the year, in line with increasing testing capacity and the consecutive inclusion of all symptomatic individuals in the case definition for testing.

Survey of Current Transplant Center Practices Regarding Covid-19 Vaccine Mandates in the United States

Purpose: We surveyed current policies of transplant centers regarding a COVID-19 vaccine mandate, and rationales for or against a mandate policy. Method(s): An electronic survey was distributed to clinicians at U.S. solid organ transplant programs from 2020-2021. Result(s): 56.4% of transplant programs representing 78.5% of all kidney transplant volume and 82.4% of liver transplant volume in the US from 9/1/20-9/1/21 responded to the survey. 35.7% of centers reported implementing a vaccine mandate, while 60.7% reported not that vaccination was not required and 3.6% were uncertain. Centers without a vaccine mandate policy cited administrative, equity, and legal considerations (Figure A). Centers with a vaccine mandate cited clinical evidence supporting the efficacy of pre-transplant vaccination (82.0%) and stewardship obligations to ensure organs were transplanted into the lowest risk patients (64.0%) (Figure B). Among centers with a mandate, few required confirmation of vaccine responsiveness through antibody testing (2.6%), required a support person (10.0%) or co-habitants (5.0%) to be vaccinated. 42.5% of centers with a mandate also required living donor candidates to be vaccinated. There was no correlation between the presence or absence of a vaccine mandate and the point prevalence rate of COVID-19 vaccination by the home State of the transplant center. Conclusion(s): Solid organ transplant centers in the US exhibit significant heterogeneity in the requirement for a COVID-19 vaccination prior to receiving an organ. While all centers encourage vaccination, most programs do not require all candidates and living donors to receive the COVID-19 vaccine prior to surgery, citing administrative opposition, legal prohibitions, and concern about equity in access to transplants. Among the minority of centers mandating COVID-19 vaccination for candidates, few centers also mandate vaccination for support persons or co-habitants, require additional testing to demonstrate adequate vaccine responsiveness, and less than half of these centers also mandate vaccination for living donor candidates. (Figure Presented).

A Point Prevalence Survey of Healthcare-Associated Infections and Antimicrobial Use in Public Acute Care Hospitals in Crete, Greece.

BACKGROUND: Both healthcare-associated infections (HAIs) and antimicrobial resistance are associated with an increased length of stay and hospital costs, while they have also been linked to high morbidity and mortality rates. In 2016 and 2017, the latest point prevalence survey (PPS) of HAIs and antimicrobial use in European acute care hospitals highlighted an HAI prevalence of 6.5%, while Greece had a higher HAI prevalence of 10%. The aim of this PPS was to record the prevalence of HAIs and antimicrobial use in all eight public acute care hospitals in Crete, Greece during the COVID-19 pandemic in order to highlight the types of infections and antimicrobial practices that need to be prioritized for infection control initiatives. METHODS: The PPS was conducted between 30 March and 15 April 2022, according to the ECDC standardized relevant protocol (version 5.3). Statistics were extracted using the ECDC Helics.Win.Net application (software version 4.1.0). RESULTS: A total of 1188 patients were included. The overall point prevalence of patients with at least one HAI was 10.6%. The most frequent types of infections were pneumonia (34.3%), bloodstream infections (10.5%), systemic infections and urinary tract infections (10.5% and 9.1%, respectively). In 14 (12.4%) cases, the pathogen responsible for HAI was SARS-CoV-2 following onsite spread, accounting for almost 10% of all HAIs. Microorganisms were identified in 60.1% of HAIs. Antimicrobials were administered in 711 (59.8%) patients, with 1.59 antimicrobials used per patient. CONCLUSION: The prevalence of HAI and antimicrobial use among hospitalized patients in Crete, Greece was similar to the national HAI prevalence in 2016 despite the enormous pressure on public hospitals due to the COVID-19 pandemic. Nevertheless, both HAI prevalence and antimicrobial use remain high, underlining the need to implement adequate infection control and antimicrobial stewardship interventions.

Clinical pharmacist's views on the role of alpha-2-agonists in practice and research for the management of agitation, sedation and delirium (ASD)

Introduction: Patients in the intensive care (ICU) commonly receive analgesics and sedatives to facilitate mechanical ventilation. Recommendations suggest patients are kept as lightly sedated as feasible. Studies report an inconsistent association between deep sedation, prolonged ventilation and ICU stay.1 Opinions around patients 'wakefulness' include discomfort and the potential increased prevalence of psychological morbidity.2 Alpha-2-agonists (clonidine and dexmedetomidine) are agents used in ASD management and reported to produce lighter sedation. The aim of this project was to explore ICU pharmacist's perspective on ASD practice over UK. Objectives: • Explore ICU pharmacist's views on: ASD practices, sedation research priority, importance of A2B clinical trial and the impact of Covid19. • Determine the prevalence of clonidine and dexmedetomidine prescribing. Methods: An online survey was devised on SurveyMonkey. The survey was designed in 2 sections: -1. Respondents provided responses based on a 'point prevalence' of clonidine and dexmedetomidine prescriptions, on day of completion. 2. Their local ICU sedation practice, their views on priority of sedation research, the A2B study and whether they believed ASD was more challenging during the Covid19 pandemic. The online survey was distributed via the UK Clinical Pharmacy Association Critical Care Group (UKCPA CCG), the NIHR Critical Care National Speciality Group (NSG), the UK Critical Care Research Group and Twitter. The survey remained active for 12 weeks from 30.3.2021 with reminders sent for completion every fortnight. Results: There were 121 respondents, all but 1 were ICU pharmacists. There are approximately 243 ICU pharmacist posts in the UK, this represents a response rate of approximately 50%. 37 (30%) of respondent reported clonidine (but not dexmedetomidine) was prescribed in their ICU;7 (6%) described dexmedetomidine only;and 76 (63%) reported both. In describing ASD during Covid-19 pandemic, 107 (88%) respondents reported it had become more challenging. 83 (69%) of respondents stated that clonidine usage increased during the pandemic (27 (22%) no change). 46 (39%) stated that dexmedetomidine usage increased during the pandemic (50 (42%) no change). Among the respondents 98 (81%) 'strongly agreed', and 20 (17%) 'agreed' that research involving ASD is a priority. A2B is set to compare clinical and cost effectiveness of propofol, clonidine, and dexmedetomidine as primary sedative for ICU patients. 49 (40%) of respondents reported participating in A2B. 65 (54%) respondents felt that A2B was a 'very important', and 63 (52%) said it was an 'important' research question. Conclusion: This survey reported widespread use of alpha-2-agonists in ASD practice. Almost two-thirds of ICUs report using both agents. Clonidine use is the most prevalent. Given the paucity of high quality clinical effectiveness and safety data for this drug, clinical trials which assess clinical effectiveness, including ASD are a priority. Respondents endorsed that ASD research is a priority, with ASD management much more challenging during the Covid19 pandemic. Limitations include that the design was a brief online survey;although had a high pharmacist response it did not incorporate the views of other members of the ICU team.

Atopic dermatitis: epidemiology, lifestyle factors and COVID-19-related impact in the Dutch general population

Background: Atopic dermatitis (AD) causes a considerable public health burden, especially among patients with moderate-to-severe disease. A large epidemiological study has not been conducted in the Netherlands. Objectives: To investigate the prevalence and severity of AD in the Dutch general population and its associations with lifestyle factors and COVID-19-related impact. Methods: A cross-sectional study was conducted within the Lifelines Cohort Study by sending an AD questionnaire in 2020 and multiple COVID-19 questionnaires between 2020 and 2021, to 139 735 adults. Lifestyle factors were collected at baseline between 2006 and 2013. Associations between AD, lifestyle factors, and COVID-19-related impact, were analysed using binary logistic regression and/or linear regression models. Results: 57643 subjects (42.5%) responded to the AD questionnaire, of those 53 545 responded to at least one COVID-19 questionnaire. The lifetime prevalence was 9.3%, and the point prevalence of moderate-to-severe AD was 2.3%. Moderate-to-severe AD was associated with smoking pack-years, >2 alcoholic drinks per day, chronic stress, and obesity. Moreover, the COVID-19 pandemic had a greater psychological impact on the subjects with moderate-to-severe AD, who were also more concerned about COVID-19 vaccines and healthcare system and tended to take more precautions for prevention. Conclusions: Moderate-to-severe AD represents a large proportion of AD patients and shows positive associations with lifestyle factors and a profound COVID-19-related impact. More attention to lifestyle factors and patient's overall welling appears warranted in those severely affected. Further longitudinal studies are required to better characterize the direction of these associations and develop strategies for coping.

BÍRÍNCÍ BASAMAK SAĞLIK ÇALIŞANLARINDA COVID-19 GÖRÜLME SIKLIĞI

COVID-19 pandemisiyle mücadelede ön safta görev yapan sağlık çalışanlarında hastalığa yakalanma riski toplumun birçok kesimine kıyasla daha yüksektir. Risk altındaki bazı grupların zaman zaman taranması vakaların erken dönemde tespiti için önemlidir. Ülkemizde filyasyon, vaka ve temaslı takibi uygulamaları ilçe sağlık müdürlüğü (Ílçe SM) ve aile sağlığı merkezi (ASM) çalışanları tarafından yürütülmektedir. Bu çalışmanın amacı, birinci basamak sağlık çalışanlarında COVID-19 görülme sıklığının incelenmesidir. Tanımlayıcı kesitsel türde olan bu araştırmanın evrenini Nisan 2020 itibariyle Ístanbul ili Üsküdar ilçesinde görev yapmakta olan 627 birinci basamak sağlık hizmeti çalışanı oluşturmaktadır. 13-30 Nisan 2020 tarihlerinde Ílçe SM tarafından yapılan SARS-CoV-2 PCR testi taramasına katılan 586 sağlık çalışanına ait veriler dahil edilerek, tarama dönemine ait nokta prevalans ve Nisan 2020-Nisan 2021 dönemine ait süre prevalans hesaplanmıştır. Katılımcıların yaş ortalaması 38,5±10,3 olup %73,7’si kadındır ve %68,3’ü ASM’de görev yapmaktadır. Tarama sonucuna göre tüm grupta %8,5 olan nokta prevalans;Ílçe SM’de %15,1 ve ASM’de %5,5’tir (p<0,001). Süre prevalans ise tüm grupta %25,9 olup Ílçe SM’de %34,9 ve ASM’de %21,8’dir (p=0,001). 30.04.2021 itibariyle katılımcıların %17,1’i hiç aşı yaptırmamıştır. ASM çalışanlarına göre daha kalabalık bir ortamda görev yapan Ílçe SM çalışanlarında hastalığın daha sık görülmesi hem kurum içi temas ve vaka kümelenmesi açısından dikkatli olunması hem de vakalarla temas edilirken kişisel koruyucu önlemlere üst düzeyde uyulması gerektiğine işaret etmektedir. Aşı uygulamasının başlangıcından 3,5 ay geçmesine rağmen aşı yaptırmayan sağlık çalışanlarının azımsanmayacak düzeyde olması dikkat çekicidir.Alternate : Healthcare workers have been fighting against the COVID-19 pandemic with a higher risk than many parts of the population. Screening of some specific groups at regular intervals is important to detect cases earlier. Case and contact tracing (filiation) in Turkey are carried out by the district health directorates (DHD) and family health centers (FHC). The aim of this study is to examine the COVID-19 prevalence among primary healthcare workers. The population of this cross-sectional study consists of 627 primary healthcare workers in Uskudar, Istanbul as of April 2020, including the data on 586 healthcare workers who participated in the SARS-CoV-2 PCR test screening on 13-30 April 2020. The point prevalence of the screening period and the period prevalence of April 2020-April 2021 were calculated. 68.3% of the participants were working in FHC. According to the screening results, the point prevalence was 8.5% in the whole group, 15.1% in DHD, and 5.5% in FHC (p<0.001). The period prevalence was 25.9% in the whole group, 34.9% in DHD, and 21.8% in FHC (p=0.001). As of 2021/4/30, 17.1% of the participants have never been vaccinated. The fact that the disease is more common among the DHD staff, it is necessary to be careful regarding workplace contact and case clustering and to maintain personal protective measures strictly during contact tracing. It is noteworthy that the level of health workers who did not get vaccinated despite the fact that 3.5 months have passed since the start of the vaccination is not to be underestimated.