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1.
Viruses ; 14(2)2022 02 21.
Article in English | MEDLINE | ID: covidwho-1705332

ABSTRACT

Coinfection rates with other pathogens in coronavirus disease 2019 (COVID-19) varied during the pandemic. We assessed the latest prevalence of coinfection with viruses, bacteria, and fungi in COVID-19 patients for more than one year and its impact on mortality. A total of 436 samples were collected between August 2020 and October 2021. Multiplex real-time PCR, culture, and antimicrobial susceptibility testing were performed to detect pathogens. The coinfection rate of respiratory viruses in COVID-19 patients was 1.4%. Meanwhile, the rates of bacteria and fungi were 52.6% and 10.5% in hospitalized COVID-19 patients, respectively. Respiratory syncytial virus, rhinovirus, Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans were the most commonly detected pathogens. Ninety percent of isolated A. baumannii was non-susceptible to carbapenem. Based on a multivariate analysis, coinfection (odds ratio [OR] = 6.095), older age (OR = 1.089), and elevated lactate dehydrogenase (OR = 1.006) were risk factors for mortality as a critical outcome. In particular, coinfection with bacteria (OR = 11.250), resistant pathogens (OR = 11.667), and infection with multiple pathogens (OR = 10.667) were significantly related to death. Screening and monitoring of coinfection in COVID-19 patients, especially for hospitalized patients during the pandemic, are beneficial for better management and survival.


Subject(s)
Bacterial Infections/epidemiology , COVID-19/epidemiology , Coinfection/microbiology , Coinfection/virology , Mycoses/epidemiology , Virus Diseases/epidemiology , Adolescent , Adult , Bacteria/classification , Bacteria/pathogenicity , COVID-19/microbiology , COVID-19/virology , Coinfection/epidemiology , Coinfection/mortality , Cross Infection/epidemiology , Cross Infection/microbiology , Cross Infection/virology , Female , Fungi/classification , Fungi/pathogenicity , Humans , Male , Middle Aged , Prevalence , Republic of Korea/epidemiology , Viruses/classification , Viruses/pathogenicity , Young Adult
2.
BMC Infect Dis ; 22(1): 139, 2022 Feb 10.
Article in English | MEDLINE | ID: covidwho-1690952

ABSTRACT

BACKGROUND: Individuals with intellectual and developmental disabilities (IDD) living in congregated settings have increased risk of COVID-19 infection and mortality. Little is known about variant B.1.1.519 with spike mutation T478K, dominant in Mexico. We describe a linked SARS-CoV-2 B.1.1.519 outbreak in three IDD facilities in the Netherlands. METHODS: Following notification of the index, subsequent cases were identified through serial PCR group testing. Positive specimens were submitted for whole-genome-sequencing. Clinical information was gathered through interviews with staff members of the three facilities. RESULTS: Attack rate (AR) in clients of the index facility was 92% (23/25), total AR in clients 45% (33/73) and in staff members 24% (8/34). 55% (18/33) of client cases were asymptomatic, versus 25% (2/8) of staff members. Five client cases (15%) were hospitalized, two died (6%). Sequencing yielded the same specific B.1.1.519 genotype in all three facilities. No significant difference in median viral load was established comparing the B.1.1.519 variant with other circulating variants. The index of the linked outbreak reported no travel history or link to suspected or confirmed cases suggesting regional surveillance. Observed peak regional prevalence of B.1.1.519 during the outbreak supports this. CONCLUSION: AR, morbidity and mortality prior to control measures taking effect were high, probably related to the specific characteristics of the IDD setting and its clients. We assessed no evidence for intrinsic contributing properties of variant B.1.1.519. Our study argues for enhanced infection prevention protocols in the IDD setting, and prioritization of this group for vaccination against COVID-19.


Subject(s)
Assisted Living Facilities , COVID-19 , Cross Infection , COVID-19/epidemiology , COVID-19/virology , Cross Infection/epidemiology , Cross Infection/virology , Developmental Disabilities , Disease Outbreaks , Humans , Mutation , Netherlands/epidemiology , SARS-CoV-2 , Spike Glycoprotein, Coronavirus/genetics
4.
Epidemiol Infect ; 150: e18, 2021 09 15.
Article in English | MEDLINE | ID: covidwho-1665657

ABSTRACT

Nosocomial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks among health care workers have been scarcely reported so far. This report presents the results of an epidemiologic and molecular investigation of a SARS-CoV-2 outbreak among laundromat facility workers in a large tertiary centre in Israel. Following the first three reported cases of SARS-CoV-2 among laundromat workers, all 49 laundromat personnel were screened by qRT-PCR tests using naso- and oropharingeal swabs. Epidemiologic investigations included questionnaires, interviews and observations of the laundromat facility. Eleven viral RNA samples were then sequenced, and a phylogenetic analysis was performed using MEGAX.The integrated investigation defined three genetic clusters and helped identify the index cases and the assumed routes of transmission. It was then deduced that shared commute and public showers played a role in SARS-CoV-2 transmission in this outbreak, in addition to improper PPE use and social gatherings (such as social eating and drinking). In this study, we present an integrated epidemiologic and molecular investigation may help detect the routes of SARS-CoV-2 transmission, emphasising such routes that are less frequently discussed. Our work reinforces the notion that person-to-person transmission is more likely to cause infections than environmental contamination (e.g. from handling dirty laundry).


Subject(s)
COVID-19/epidemiology , Disease Outbreaks , Laundry Service, Hospital , SARS-CoV-2 , Adult , COVID-19/transmission , Cohort Studies , Contact Tracing , Cross Infection/epidemiology , Cross Infection/transmission , Cross Infection/virology , Disease Outbreaks/statistics & numerical data , Female , Humans , Israel/epidemiology , Male , Middle Aged , Phylogeny , RNA, Viral/chemistry , RNA, Viral/isolation & purification , SARS-CoV-2/classification , SARS-CoV-2/genetics
5.
Microbiol Spectr ; 10(1): e0153221, 2022 02 23.
Article in English | MEDLINE | ID: covidwho-1607174

ABSTRACT

COVID-19 vaccination has proven to be effective at preventing symptomatic disease but there are scarce data to fully understand whether vaccinated individuals can still behave as SARS-CoV-2 transmission vectors. Based on viral genome sequencing and detailed epidemiological interviews, we report a nosocomial transmission event involving two vaccinated health care-workers (HCWs) and four patients, one of them with fatal outcome. Strict transmission control measures, as during the prevaccination period, must be kept between HCWs and HCWs-patients in nosocomial settings. IMPORTANCE COVID-19 vaccination has proven to be effective at preventing symptomatic disease. Although some transmission events involving vaccinated cases have also been reported, scarce information is still available to fully understand whether vaccinated individuals may still behave as vectors in SARS-CoV-2 transmission events. Here, we report a SARS-CoV-2 nosocomial transmission event, supported on whole genome sequencing, in early March 2021 involving two vaccinated HCWs and four patients in our institution. Strict transmission control measures between HCWs and HCWs - patients in nosocomial settings must not be relaxed, and should be kept as strictly as during the prevaccination period.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Cross Infection/transmission , SARS-CoV-2/immunology , COVID-19/transmission , COVID-19/virology , Cross Infection/epidemiology , Cross Infection/prevention & control , Cross Infection/virology , Health Personnel/statistics & numerical data , Humans , Phylogeny , SARS-CoV-2/classification , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Vaccination , Whole Genome Sequencing
7.
PLoS One ; 16(12): e0260714, 2021.
Article in English | MEDLINE | ID: covidwho-1546965

ABSTRACT

The first confirmed case of COVID-19 in Quebec, Canada, occurred at Verdun Hospital on February 25, 2020. A month later, a localized outbreak was observed at this hospital. We performed tiled amplicon whole genome nanopore sequencing on nasopharyngeal swabs from all SARS-CoV-2 positive samples from 31 March to 17 April 2020 in 2 local hospitals to assess viral diversity (unknown at the time in Quebec) and potential associations with clinical outcomes. We report 264 viral genomes from 242 individuals-both staff and patients-with associated clinical features and outcomes, as well as longitudinal samples and technical replicates. Viral lineage assessment identified multiple subclades in both hospitals, with a predominant subclade in the Verdun outbreak, indicative of hospital-acquired transmission. Dimensionality reduction identified two subclades with mutations of clinical interest, namely in the Spike protein, that evaded supervised lineage assignment methods-including Pangolin and NextClade supervised lineage assignment tools. We also report that certain symptoms (headache, myalgia and sore throat) are significantly associated with favorable patient outcomes. Our findings demonstrate the strength of unsupervised, data-driven analyses whilst suggesting that caution should be used when employing supervised genomic workflows, particularly during the early stages of a pandemic.


Subject(s)
COVID-19/virology , Cross Infection/virology , Disease Outbreaks , Genome, Viral/genetics , SARS-CoV-2/genetics , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/mortality , Child , Child, Preschool , Cross Infection/epidemiology , Disease Outbreaks/statistics & numerical data , Female , Haplotypes/genetics , Humans , Male , Middle Aged , Phylogeny , Quebec/epidemiology , SARS-CoV-2/pathogenicity , Sequence Analysis, RNA , Treatment Outcome , Young Adult
8.
Ann Intern Med ; 174(12): 1710-1718, 2021 12.
Article in English | MEDLINE | ID: covidwho-1506230

ABSTRACT

Policies to prevent respiratory virus transmission in health care settings have traditionally divided organisms into Droplet versus Airborne categories. Droplet organisms (for example, influenza) are said to be transmitted via large respiratory secretions that rapidly fall to the ground within 1 to 2 meters and are adequately blocked by surgical masks. Airborne pathogens (for example, measles), by contrast, are transmitted by aerosols that are small enough and light enough to carry beyond 2 meters and to penetrate the gaps between masks and faces; health care workers are advised to wear N95 respirators and to place these patients in negative-pressure rooms. Respirators and negative-pressure rooms are also recommended when caring for patients with influenza or SARS-CoV-2 who are undergoing "aerosol-generating procedures," such as intubation. An increasing body of evidence, however, questions this framework. People routinely emit respiratory particles in a range of sizes, but most are aerosols, and most procedures do not generate meaningfully more aerosols than ordinary breathing, and far fewer than coughing, exercise, or labored breathing. Most transmission nonetheless occurs at close range because virus-laden aerosols are most concentrated at the source; they then diffuse and dilute with distance, making long-distance transmission rare in well-ventilated spaces. The primary risk factors for nosocomial transmission are community incidence rates, viral load, symptoms, proximity, duration of exposure, and poor ventilation. Failure to appreciate these factors may lead to underappreciation of some risks (for example, overestimation of the protection provided by medical masks, insufficient attention to ventilation) or misallocation of limited resources (for example, reserving N95 respirators and negative-pressure rooms only for aerosol-generating procedures or requiring negative-pressure rooms for all patients with SARS-CoV-2 infection regardless of stage of illness). Enhanced understanding of the factors governing respiratory pathogen transmission may inform the development of more effective policies to prevent nosocomial transmission of respiratory pathogens.


Subject(s)
Infection Control/methods , Respiratory Tract Infections/transmission , Respiratory Tract Infections/virology , Aerosols , COVID-19/prevention & control , COVID-19/transmission , COVID-19/virology , Cross Infection/prevention & control , Cross Infection/virology , Health Policy , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Influenza, Human/prevention & control , Influenza, Human/transmission , Influenza, Human/virology , Masks , Personnel, Hospital , SARS-CoV-2 , United States/epidemiology , Ventilation
9.
Infect Dis Clin North Am ; 35(4): 1055-1075, 2021 12.
Article in English | MEDLINE | ID: covidwho-1487740

ABSTRACT

Health care-acquired viral respiratory infections are common and cause increased patient morbidity and mortality. Although the threat of viral respiratory infection has been underscored by the coronavirus disease 2019 (COVID-19) pandemic, respiratory viruses have a significant impact in health care settings even under normal circumstances. Studies report decreased nosocomial transmission when aggressive infection control measures are implemented, with more success noted when using a multicomponent approach. Influenza vaccination of health care personnel furthers decrease rates of transmission; thus, mandatory vaccination is becoming more common. This article discusses the epidemiology, transmission, and control of health care-associated respiratory viral infections.


Subject(s)
Cross Infection/prevention & control , Cross Infection/virology , Respiratory Tract Infections/prevention & control , Respiratory Tract Infections/virology , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Cross Infection/epidemiology , Cross Infection/transmission , Guideline Adherence , Health Personnel/standards , Humans , Infection Control/standards , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/transmission , SARS-CoV-2/pathogenicity , Vaccination , Viruses/classification , Viruses/pathogenicity
10.
PLoS One ; 16(10): e0257513, 2021.
Article in English | MEDLINE | ID: covidwho-1463306

ABSTRACT

BACKGROUND: Coronavirus disease (COVID-19) is associated with a high mortality rate in older adults; therefore, it is important for medical institutions to take measures to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. This study aimed to assess the risk of SARS-CoV-2 infection among healthcare workers (HCWs) and the effectiveness of infection control measures. METHODS: This study had a cross-sectional component and a prospective cohort component. The cross-sectional component comprised an anti-SARS-CoV-2 antibody survey among HCWs at a medical center in Saitama City, Japan. In the prospective cohort component, HCWs at the same medical center were tested for anti-SARS-CoV-2 antibodies monthly over a 3-month period (May to July 2020) to assess the effectiveness of infection prevention measures, including personal protective equipment use. All participants in the cohort study also participated in the antibody survey. The primary outcome was anti-SARS-CoV-2 antibody (measured using Elecsys® Anti-SARS-CoV-2) positivity based on whether participants were engaged in COVID-19-related medical care. Other risk factors considered included occupational category, age, and sex. RESULTS: In total, 607 HCWs participated in the antibody survey and 116 doctors and nurses participated in the cohort study. Only one of the 607 participants in the survey tested positive for anti-SARS-CoV-2 antibodies. All participants in the cohort study were anti-SARS-CoV-2 antibody negative at baseline and remained antibody negative. Engaging in the care of COVID-19 patients did not increase the risk of antibody positivity. During the study period, a total of 30 COVID-19 in-patients were treated in the hospital. CONCLUSIONS: The infection control measures in the hospital protected HCWs from nosocomially acquired SARS-CoV-2 infection; thus, HCWs should engage in COVID-19-related medical care with confidence provided that they adhere to infectious disease precautions.


Subject(s)
COVID-19/prevention & control , COVID-19/transmission , Cross Infection/prevention & control , Health Personnel , Infection Control/methods , SARS-CoV-2/immunology , Adult , Antibodies, Viral/blood , Antibodies, Viral/immunology , COVID-19/epidemiology , COVID-19/virology , Cross Infection/blood , Cross Infection/virology , Cross-Sectional Studies , Female , Hospitals , Humans , Immunoglobulin G/blood , Immunoglobulin G/immunology , Incidence , Japan/epidemiology , Male , Prospective Studies , Risk Factors , Seroepidemiologic Studies
11.
Ann Vasc Surg ; 79: 114-121, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1458689

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has become a global pandemic which may compromise the management of vascular emergencies. An uncompromised treatment for ruptured abdominal aortic aneurysm (rAAA) during such a health crisis represents a challenge. This study aimed to demonstrate the treatment outcomes of rAAA and the perioperative prevention of cross-infection under the COVID-19 pandemic. METHODS: In cases of rAAA during the pandemic, a perioperative workflow was applied to expedite coronavirus testing and avoid pre-operative delay, combined with a strategy for preventing cross-infection. Data of rAAA treated in 11 vascular centers between January-March 2020 collected retrospectively were compared to the corresponding period in 2018 and 2019. RESULTS: Eight, 12, and 14 rAAA patients were treated in 11 centers in January-March 2018, 2019, and 2020, respectively. An increased portion were treated at local hospitals with a comparable outcome compared with large centers in Guangzhou. With EVAR-first strategy, 85.7% patients with rAAA in 2020 underwent endovascular repair, similar to that in 2018 and 2019. The surgical outcomes during the pandemic were not inferior to that in 2018 and 2019. The average length of ICU stay was 1.8 ± 3.4 days in 2020, tending to be shorter than that in 2018 and 2019, whereas the length of hospital stay was similar among 3 years. The in-hospital mortality of 2018, 2019, and 2020 was 37.5%, 25.0%, and 14.3%, respectively. Three patients undergoing emergent surgeries were suspected of COVID-19, though turned out to be negative after surgery. CONCLUSIONS: Our experience for emergency management of rAAA and infection prevention for healthcare providers is effective in optimizing emergent surgical outcomes during the COVID-19 pandemic.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Aortic Rupture/surgery , COVID-19/prevention & control , Cross Infection/prevention & control , Infection Control , Vascular Surgical Procedures , Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/diagnosis , Aortic Rupture/diagnosis , COVID-19/diagnosis , COVID-19/transmission , COVID-19/virology , COVID-19 Testing , China , Cross Infection/diagnosis , Cross Infection/transmission , Cross Infection/virology , Emergencies , Female , Humans , Male , Middle Aged , Patient Safety , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Vascular Surgical Procedures/adverse effects , Workflow
12.
Antimicrob Resist Infect Control ; 10(1): 137, 2021 09 26.
Article in English | MEDLINE | ID: covidwho-1440955

ABSTRACT

We describe the lessons learned during a SARS-CoV-2 variant-of-concern Alpha outbreak investigation at a normal care unit in a university hospital in Amsterdam in December 2020. The outbreak consisted of nine nurses and two roomed-in patient family members. (attack rate 18%). One nurse tested positive with a phylogenetically distinct variant, after a documented infection 83 days prior. Three key points were taken from this investigation. First, it was controlled by adherence to existing guidelines, despite increased transmissibility of the variant. Second, viral sequencing can inform transmission cluster inference, but the epidemiological context is essential to draw appropriate conclusions. Third, reinfections with Alpha variants can occur rapidly after primary infection.


Subject(s)
COVID-19/epidemiology , Reinfection/virology , COVID-19/virology , Cross Infection/epidemiology , Cross Infection/virology , Disease Outbreaks , Guideline Adherence , Humans , Infection Control , Inpatients , Netherlands , Nurses , Phylogeny , Reinfection/epidemiology , SARS-CoV-2/genetics
13.
J Infect Dev Ctries ; 15(8): 1074-1079, 2021 08 31.
Article in English | MEDLINE | ID: covidwho-1405468

ABSTRACT

INTRODUCTION: Public life in China is gradually returning to normal with strong measures in coronavirus 2019 (COVID-19) control. Because of the long-term effects of COVID-19, medical institutions had to make timely adjustments to control policies and priorities to balance between COVID-19 prevention and daily medical services. METHODOLOGY: The framework for infection prevention and control in the inpatient department was effectively organized at both hospital and department levels. A series of prevention and control strategies was implemented under this leadership: application of rigorous risk assessment and triage before admission through a query list; classifying patients into three risk levels and providing corresponding medical treatment and emergency handling; establishing new ward visiting criteria for visitors; designing procedures for PPE and stockpile management; executing specialized disinfection and medical waste policies. RESULTS: Till June 2020, the bed occupancy had recovered from 20.0% to 88.1%. In total, 13045 patients were received in our hospital, of which 54 and 127 patients were identified as high-risk and medium-risk, respectively, and 2 patients in the high-risk group were eventually laboratory-confirmed with COVID-19. No hospital-acquired infection of COVID-19 has been observed since the emergency appeared. CONCLUSIONS: The strategies ensured early detection and targeted prevention of COVID-19 following the COVID-19 pandemic, which improved the recovery of medical services after the pandemic.


Subject(s)
COVID-19/prevention & control , Cross Infection/prevention & control , Hospitals/statistics & numerical data , Infection Control/methods , COVID-19/epidemiology , China/epidemiology , Cross Infection/epidemiology , Cross Infection/virology , Hospitalization/statistics & numerical data , Hospitals/standards , Humans , Infection Control/instrumentation , Inpatients/statistics & numerical data , Patient Isolation/methods , Personal Protective Equipment , Risk Assessment , Triage
14.
Virol J ; 18(1): 109, 2021 06 02.
Article in English | MEDLINE | ID: covidwho-1388777

ABSTRACT

BACKGROUND: The ongoing SARS-CoV-2 pandemic has spread rapidly worldwide and disease prevention is more important than ever. In the absence of a vaccine, knowledge of the transmission routes and risk areas of infection remain the most important existing tools to prevent further spread. METHODS: Here we investigated the presence of the SARS-CoV-2 virus in the hospital environment at the Uppsala University Hospital Infectious Disease ward by RT-qPCR and determined the infectivity of the detected virus in vitro on Vero E6 cells. RESULTS: SARS-CoV-2 RNA was detected in several areas, although attempts to infect Vero E6 cells with positive samples were unsuccessful. However, RNase A treatment of positive samples prior to RNA extraction did not degrade viral RNA, indicating the presence of SARS-CoV-2 nucleocapsids or complete virus particles protecting the RNA as opposed to free viral RNA. CONCLUSION: Our results show that even in places where a moderate concentration (Ct values between 30 and 38) of SARS-CoV-2 RNA was found; no infectious virus could be detected. This suggests that the SARS-CoV-2 virus in the hospital environment subsides in two states; as infectious and as non-infectious. Future work should investigate the reasons for the non-infectivity of SARS-CoV-2 virions.


Subject(s)
COVID-19/transmission , Cross Infection/epidemiology , Disease Transmission, Infectious/statistics & numerical data , Environmental Monitoring/methods , Animals , Cell Line , Chlorocebus aethiops , Confined Spaces , Cross Infection/virology , Hospitals , Humans , Risk , SARS-CoV-2/growth & development , Ventilation/methods , Vero Cells
16.
Sci Rep ; 11(1): 12999, 2021 06 21.
Article in English | MEDLINE | ID: covidwho-1387481

ABSTRACT

An ever-increasing number of medical staff use mobile phones as a work aid, yet this may pose nosocomial diseases. To assess and report via a survey the handling practices and the use of phones by paediatric wards healthcare workers. 165 paediatric healthcare workers and staff filled in a questionnaire consisting of 14 questions (including categorical, ordinal and numerical data). Analysis of categorical data used non-parametric techniques such as the Chi-squared test. Although 98% of respondents (165 in total) report that their phones may be contaminated, 56% have never cleaned their devices. Of the respondents that clean their devices, 10% (17/165) had done so with alcohol swabs or disinfectant within that day or week; and an additional 12% respondents (20/165) within that month. Of concern, 52% (86/165) of the respondents use their phones in the bathroom, emphasising the unhygienic environments in which mobile phones/smartphones are constantly used. Disinfecting phones is a practice that only a minority of healthcare workers undertake appropriately. Mobile phones, present in billions globally, are therefore Trojan Horses if contaminated with microbes and potentially contributing to the spread and propagation of micro-organisms as per the rapid spread of SARS-CoV-2 virus in the world.


Subject(s)
Bathroom Equipment/virology , COVID-19/prevention & control , Cell Phone/instrumentation , Cross Infection/prevention & control , Delivery of Health Care/methods , Disinfection/methods , Hospitals, Pediatric , Personnel, Hospital , SARS-CoV-2 , COVID-19/virology , Cross Infection/virology , Emergency Service, Hospital , Female , Hand Hygiene , Humans , Intensive Care Units, Neonatal , Male , Risk Factors , Self Report
17.
Infect Control Hosp Epidemiol ; 41(10): 1209-1211, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1387076

ABSTRACT

We investigated potential transmissions of a symptomatic SARS-CoV-2-positive physician in a tertiary-care hospital who worked for 15 cumulative hours without wearing a face mask. No in-hospital transmissions occurred, despite 254 contacts among patients and healthcare workers. In conclusion, exposed hospital staff continued work, accompanied by close clinical and virologic monitoring.


Subject(s)
Coronavirus Infections/diagnosis , Infectious Disease Transmission, Professional-to-Patient , Physicians , Pneumonia, Viral/diagnosis , Betacoronavirus/isolation & purification , COVID-19 , Contact Tracing , Coronavirus Infections/transmission , Cross Infection/transmission , Cross Infection/virology , Female , Germany , Hospitals , Humans , Masks , Pandemics , Pneumonia, Viral/transmission , SARS-CoV-2
18.
Antimicrob Resist Infect Control ; 10(1): 114, 2021 08 05.
Article in English | MEDLINE | ID: covidwho-1346265

ABSTRACT

BACKGROUND: In healthcare facilities, nosocomial transmissions of respiratory viruses are a major issue. SARS-CoV-2 is not exempt from nosocomial transmission. Our goals were to describe COVID-19 nosocomial cases during the first pandemic wave among patients in a French university hospital and compliance with hygiene measures. METHODS: We conducted a prospective observational study in Grenoble Alpes University Hospital from 01/03/2020 to 11/05/2020. We included all hospitalised patients with a documented SARS-CoV-2 diagnosis. Nosocomial case was defined by a delay of 5 days between hospitalisation and first symptoms. Hygiene measures were evaluated between 11/05/2020 and 22/05/2020. Lockdown measures were effective in France on 17/03/2020 and ended on 11/05/2020. Systematic wearing of mask was mandatory for all healthcare workers (HCW) and visits were prohibited in our institution from 13/03/2021 and for the duration of the lockdown period. RESULTS: Among 259 patients included, 14 (5.4%) were considered as nosocomial COVID-19. Median time before symptom onset was 25 days (interquartile range: 12-42). Eleven patients (79%) had risk factors for severe COVID-19. Five died (36%) including 4 deaths attributable to COVID-19. Two clusters were identified. The first cluster had 5 cases including 3 nosocomial acquisitions and no tested HCWs were positive. The second cluster had 3 cases including 2 nosocomial cases and 4 HCWs were positive. Surgical mask wearing and hand hygiene compliance were adequate for 95% and 61% of HCWs, respectively. CONCLUSIONS: The number of nosocomial COVID-19 cases in our hospital was low. Compliance regarding mask wearing, hand hygiene and lockdown measures drastically reduced transmission of the virus. Monitoring of nosocomial COVID-19 cases during the first wave enabled us to determine to what extent the hygiene measures taken were effective and patients protected. Trial registration Study ethics approval was obtained retrospectively on 30 September 2020 (CECIC Rhône-Alpes-Auvergne, Clermont-Ferrand, IRB 5891).


Subject(s)
COVID-19/epidemiology , Cross Infection/epidemiology , SARS-CoV-2/isolation & purification , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/virology , COVID-19 Testing/methods , Cross Infection/virology , Female , France/epidemiology , Hand Hygiene/methods , Health Personnel , Hospitals, University/statistics & numerical data , Humans , Infection Control/methods , Male , Masks/microbiology , Middle Aged , Pandemics , Prospective Studies , Retrospective Studies
19.
mSphere ; 6(4): e0038921, 2021 08 25.
Article in English | MEDLINE | ID: covidwho-1341306

ABSTRACT

SARS-CoV-2 nosocomial outbreaks in the first COVID-19 wave were likely associated with a shortage of personal protective equipment and scarce indications on control measures. Having covered these limitations, updates on current SARS-CoV-2 nosocomial outbreaks are required. We carried out an in-depth analysis of a 27-day nosocomial outbreak in a gastroenterology ward in our hospital, potentially involving 15 patients and 3 health care workers. Patients had stayed in one of three neighboring rooms in the ward. The severity of the infections in six of the cases and a high fatality rate made the clinicians suspect the possible involvement of a single virulent strain persisting in those rooms. Whole-genome sequencing (WGS) of the strains from 12 patients and 1 health care worker revealed an unexpected complexity. Five different SARS-CoV-2 strains were identified, two infecting a single patient each, ruling out their relationship with the outbreak; the remaining three strains were involved in three independent, overlapping, limited transmission clusters with three, three, and five cases. Whole-genome sequencing was key to understand the complexity of this outbreak. IMPORTANCE We report a complex epidemiological scenario of a nosocomial COVID-19 outbreak in the second wave, based on WGS analysis. Initially, standard epidemiological findings led to the assumption of a homogeneous outbreak caused by a single SARS-CoV-2 strain. The discriminatory power of WGS offered a strikingly different perspective consisting of five introductions of different strains, with only half of them causing secondary cases in three independent overlapping clusters. Our study exemplifies how complex the SARS-CoV-2 transmission in the nosocomial setting during the second COVID-19 wave occurred and leads to extending the analysis of outbreaks beyond the initial epidemiological assumptions.


Subject(s)
COVID-19/epidemiology , COVID-19/transmission , Cross Infection/epidemiology , Cross Infection/transmission , SARS-CoV-2/pathogenicity , Adolescent , Adult , Aged , COVID-19/virology , Cross Infection/virology , Disease Outbreaks/prevention & control , Female , Genome, Viral/genetics , Health Personnel , Hospitals , Humans , Male , Middle Aged , Phylogeny , SARS-CoV-2/genetics , Whole Genome Sequencing/methods , Young Adult
20.
JSLS ; 25(2)2021.
Article in English | MEDLINE | ID: covidwho-1305863

ABSTRACT

BACKGROUND AND OBJECTIVES: Operating-room procedures canceled due to the COVID-19 pandemic depleted hospital revenue and potentially worsened patient outcomes through disease progression. Despite safeguards to resume elective procedures, patients remain apprehensive of contracting COVID-19 during hospitalization and recovery. We investigated symptomatic COVID-19 infection in patients undergoing operating-room procedures during the spring 2020 outbreak in Fairfield County, CT, a heavily affected New York Metropolitan area. METHODS: We retrospectively analyzed 419 operating-room patients in Danbury and Norwalk Hospitals between 3/16/20 and 5/19/20. COVID-19 infection was assessed through test results or documented well-being within 2 weeks postdischarge. Variables studied were procedure classification, length of stay, and discharge disposition. Postprocedural COVID-19 infection was analyzed using binomial tests comparing rates to state-mandated infection data. RESULTS: Six patients developed COVID-19 after 212 urgent-elective and 207 emergent procedures. Overall postprocedural infection risk was equivalent to community infection risk (P > .05). No infections occurred in 1-2 day stays or urgent-elective procedures with discharge home (both P < .05). Discharges home reduced the risk to one-sixth of community spread (P = .03). Risk of infection doubled in hospitalizations > 5 days (P = .05) and quadrupled in discharges to extended care facilities (P = .01). DISCUSSION: Operating-room procedures did not increase the risk of symptomatic COVID-19 infection during an outbreak. Urgent-elective and emergent procedures during further outbreaks appear safe when anticipating short stays with discharges home. When anticipating prolonged hospitalization or discharges to facilities, appropriate delay of urgent-elective procedures may minimize risk of infection.


Subject(s)
COVID-19/epidemiology , Cross Infection/epidemiology , Disease Transmission, Infectious/statistics & numerical data , Elective Surgical Procedures/adverse effects , Patient Discharge/statistics & numerical data , Postoperative Complications/epidemiology , Aged , Aged, 80 and over , COVID-19/transmission , Connecticut/epidemiology , Cross Infection/virology , Female , Humans , Male , Middle Aged , New York City/epidemiology , Operating Rooms , Postoperative Complications/virology , Retrospective Studies , SARS-CoV-2
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