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1.
Antimicrob Resist Infect Control ; 10(1): 150, 2021 10 21.
Article in English | MEDLINE | ID: covidwho-1484322

ABSTRACT

BACKGROUND: Healthcare-associated infections (HCAIs) present a major public health problem that significantly affects patients, health care providers and the entire healthcare system. Infection prevention and control programs limit HCAIs and are an indispensable component of patient and healthcare worker safety. The clinical best practices (CBPs) of handwashing, screening, hygiene and sanitation of surfaces and equipment, and basic and additional precautions (e.g., isolation, and donning and removing personal protective equipment) are keystones of infection prevention and control (IPC). There is a lack of rigorous IPC economic evaluations demonstrating the cost-benefit of IPC programs in general, and a lack of assessment of the value of investing in CBPs more specifically. OBJECTIVE: This study aims to assess overall costs associated with each of the four CBPs. METHODS: Across two Quebec hospitals, 48 healthcare workers were observed for two hours each shift, for two consecutive weeks. A modified time-driven activity-based costing framework method was used to capture all human resources (time) and materials (e.g. masks, cloths, disinfectants) required for each clinical best practice. Using a hospital perspective with a time horizon of one year, median costs per CBP per hour, as well as the cost per action, were calculated and reported in 2018 Canadian dollars ($). Sensitivity analyses were performed. RESULTS: A total of 1831 actions were recorded. The median cost of hand hygiene (N = 867) was 20 cents per action. For cleaning and disinfection of surfaces (N = 102), the cost was 21 cents per action, while cleaning of small equipment (N = 85) was 25 cents per action. Additional precautions median cost was $4.1 per action. The donning or removing or personal protective equipment (N = 720) cost was 76 cents per action. Finally, the total median costs for the five categories of clinical best practiced assessed were 27 cents per action. CONCLUSIONS: The costs of clinical best practices were low, from 20 cents to $4.1 per action. This study provides evidence based arguments with which to support the allocation of resources to infection prevention and control practices that directly affect the safety of patients, healthcare workers and the public. Further research of costing clinical best care practices is warranted.


Subject(s)
Cross Infection/prevention & control , Disinfection/economics , Hand Hygiene/economics , Hygiene/economics , Infection Control/economics , Adult , Canada , Female , Humans , Infection Control/statistics & numerical data , Male , Masks , Middle Aged , Practice Guidelines as Topic , Prospective Studies
2.
Br J Surg ; 108(10): 1162-1180, 2021 10 23.
Article in English | MEDLINE | ID: covidwho-1462296

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues' experiences and published evidence. METHODS: In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. RESULTS: BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. CONCLUSION: The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era.


Subject(s)
COVID-19/prevention & control , Perioperative Care/trends , Practice Patterns, Physicians'/trends , Surgical Procedures, Operative/trends , Adult , Biomedical Research/organization & administration , COVID-19/diagnosis , COVID-19/economics , COVID-19/epidemiology , Education, Medical, Graduate/methods , Education, Medical, Graduate/trends , Female , Global Health , Health Resources/supply & distribution , Health Services Accessibility/trends , Humans , Infection Control/economics , Infection Control/methods , Infection Control/standards , International Cooperation , Male , Middle Aged , Pandemics , Perioperative Care/education , Perioperative Care/methods , Perioperative Care/standards , Practice Patterns, Physicians'/standards , Surgeons/education , Surgeons/psychology , Surgeons/trends , Surgical Procedures, Operative/education , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/standards
3.
PLoS One ; 16(9): e0257107, 2021.
Article in English | MEDLINE | ID: covidwho-1394556

ABSTRACT

Due to COVID-19, many countries including Japan have implemented a suspension of economic activities for infection control. It has contributed to reduce the transmission of COVID-19 but caused severe economic losses. Today, several promising vaccines have been developed and are already being distributed in some countries. Therefore, we evaluated various vaccine and intensive countermeasure strategies with constraint of economic loss using SEIR model to obtain knowledge of how to balance economy with infection control in Japan. Our main results were that the vaccination strategy that prioritized younger generation was better in terms of deaths when a linear relationship between lockdown intensity and acceptable economic loss was assumed. On the other hand, when a non-linearity relationship was introduced, implying that the strong lockdown with small economic loss was possible, the old first strategies were best in the settings of small basic reproduction number. These results indicated a high potential of remote work when prioritizing vaccination for the old generation. When focusing on only the old first strategies as the Japanese government has decided to do, the strategy vaccinating the young next to the old was superior to the others when a non-linear relationship was assumed due to sufficient reduction of contact with small economic loss.


Subject(s)
Algorithms , COVID-19 Vaccines/immunology , COVID-19/immunology , Infection Control/economics , Models, Economic , SARS-CoV-2/immunology , Vaccination/methods , Adolescent , Adult , Aged , COVID-19/prevention & control , COVID-19/virology , COVID-19 Vaccines/administration & dosage , Computer Simulation , Humans , Infection Control/methods , Japan , Middle Aged , SARS-CoV-2/drug effects , SARS-CoV-2/physiology , Young Adult
4.
PLoS One ; 15(9): e0239113, 2020.
Article in English | MEDLINE | ID: covidwho-1383734

ABSTRACT

Social distancing interventions can be effective against epidemics but are potentially detrimental for the economy. Businesses that rely heavily on face-to-face communication or close physical proximity when producing a product or providing a service are particularly vulnerable. There is, however, no systematic evidence about the role of human interactions across different lines of business and about which will be the most limited by social distancing. Here we provide theory-based measures of the reliance of U.S. businesses on human interaction, detailed by industry and geographic location. We find that, before the pandemic hit, 43 million workers worked in occupations that rely heavily on face-to-face communication or require close physical proximity to other workers. Many of these workers lost their jobs since. Consistently with our model, employment losses have been largest in sectors that rely heavily on customer contact and where these contacts dropped the most: retail, hotels and restaurants, arts and entertainment and schools. Our results can help quantify the economic costs of social distancing.


Subject(s)
Commerce/trends , Coronavirus Infections/prevention & control , Employment/trends , Infection Control/economics , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Betacoronavirus/pathogenicity , COVID-19 , Commerce/standards , Commerce/statistics & numerical data , Coronavirus Infections/economics , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Datasets as Topic , Employment/economics , Employment/statistics & numerical data , Humans , Infection Control/methods , Infection Control/standards , Pandemics/economics , Pneumonia, Viral/economics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , SARS-CoV-2 , United States
9.
PLoS One ; 16(2): e0246235, 2021.
Article in English | MEDLINE | ID: covidwho-1081810

ABSTRACT

This study reports on the application of a Portfolio Decision Analysis (PDA) to support investment decisions of a non-profit funder of vaccine technology platform development for rapid response to emerging infections. A value framework was constructed via document reviews and stakeholder consultations. Probability of Success (PoS) data was obtained for 16 platform projects through expert assessments and stakeholder portfolio preferences via a Discrete Choice Experiment (DCE). The structure of preferences and the uncertainties in project PoS suggested a non-linear, stochastic value maximization problem. A simulation-optimization algorithm was employed, identifying optimal portfolios under different budget constraints. Stochastic dominance of the optimization solution was tested via mean-variance and mean-Gini statistics, and its robustness via rank probability analysis in a Monte Carlo simulation. Project PoS estimates were low and substantially overlapping. The DCE identified decreasing rates of return to investing in single platform types. Optimal portfolio solutions reflected this non-linearity of platform preferences along an efficiency frontier and diverged from a model simply ranking projects by PoS-to-Cost, despite significant revisions to project PoS estimates during the review process in relation to the conduct of the DCE. Large confidence intervals associated with optimization solutions suggested significant uncertainty in portfolio valuations. Mean-variance and Mean-Gini tests suggested optimal portfolios with higher expected values were also accompanied by higher risks of not achieving those values despite stochastic dominance of the optimal portfolio solution under the decision maker's budget constraint. This portfolio was also the highest ranked portfolio in the simulation; though having only a 54% probability of being preferred to the second-ranked portfolio. The analysis illustrates how optimization modelling can help health R&D decision makers identify optimal portfolios in the face of significant decision uncertainty involving portfolio trade-offs. However, in light of such extreme uncertainty, further due diligence and ongoing updating of performance is needed on highly risky projects as well as data on decision makers' portfolio risk attitude before PDA can conclude about optimal and robust solutions.


Subject(s)
Infection Control/economics , Investments/statistics & numerical data , Vaccines/economics , Uncertainty
10.
PLoS One ; 15(11): e0242212, 2020.
Article in English | MEDLINE | ID: covidwho-1067391

ABSTRACT

BACKGROUND: Nosocomial infections place a heavy burden on patients and healthcare providers and impact health care institutions financially. Reducing nosocomial infections requires an integrated program of prevention and control using key clinical best care practices. No instrument currently exists that measures these practices in terms of personnel time and material costs. OBJECTIVE: To develop and validate an instrument that would measure nosocomial infection control and prevention best care practice costs, including estimates of human and material resources. METHODS: An evaluation of the literature identified four practices essential for the control of pathogens: hand hygiene, hygiene and sanitation, screening and additional precaution. To reflect time, materials and products used in these practices, our team developed a time and motion guide. Iterations of the guide were assessed in a Delphi technique; content validity was established using the content validity index and reliability was assessed using Kruskall Wallis one-way ANOVA of rank test. RESULTS: Two rounds of Delphi review were required; 88% of invited experts completed the assessment. The final version of the guide contains eight dimensions: Identification [83 items]; Personnel [5 items]; Additional Precautions [1 item]; Hand Hygiene [2 items]; Personal Protective Equipment [14 items]; Screening [4 items]; Cleaning and Disinfection of Patient Care Equipment [33 items]; and Hygiene and Sanitation [24 items]. The content validity index obtained for all dimensions was acceptable (> 80%). Experts statistically agreed on six of the eight dimensions. DISCUSSION/CONCLUSION: This study developed and validated a new instrument based on expert opinion, the time and motion guide, for the systematic assessment of costs relating to the human and material resources used in nosocomial infection prevention and control. This guide will prove useful to measure the intensity of the application of prevention and control measures taken before, during and after outbreak periods or during pandemics such as COVID-19.


Subject(s)
Cross Infection/prevention & control , Infection Control/economics , Time and Motion Studies , Algorithms , Delphi Technique , Disinfection , Hand Hygiene , Humans , Mass Screening , Personal Protective Equipment , Sanitation
12.
Int J Environ Res Public Health ; 17(23)2020 11 30.
Article in English | MEDLINE | ID: covidwho-1024566

ABSTRACT

BACKGROUND: In order to protect dental teams and their patients during the COVID-19 pandemic, dentists have had to adopt several measures (operating and post-operating procedures) which may increase the total treatment time and costs relating to individual protective measures. This paper will propose a thorough analysis of operating dentistry procedures, comparing the economic performance of the activity in a dental surgery before and after the adoption of these protective measures, which are required to contain the risk of SARS-COV-2 infections. METHODS: The economic analysis is articulated in three approaches. Firstly, it assesses a reduction in markup by maintaining current charges (A); alternatively, it suggests revised charges to adopt in order to maintain unvaried levels of markup (B). And the third Approach (C) examines available dental treatments, highlighting how to profitably combine treatment volumes to reduce markup loss or a restricted increase in dental charges. RESULTS: Maintaining dental charges could cause a loss in markup, even rising to 200% (A); attempting to maintain unvaried levels of markup will result in an increase in dental charges, even at 100% (B); and varying the volumes of the single dental treatments on offer (increasing those which current research indicates as the most profitable) could mitigate the economic impact of the measures to prevent the transmission of SARS-COV-2 (C). CONCLUSIONS: The authors of this paper provide managerial insights which can assist the dentist-entrepreneur to become aware of the boundaries of the economic consequences of governmental measures in containing the virus infection.


Subject(s)
COVID-19/prevention & control , Dentistry/methods , Economics, Dental , Infection Control/economics , Humans , Pandemics
13.
Eur J Pediatr ; 180(5): 1631-1635, 2021 May.
Article in English | MEDLINE | ID: covidwho-1014135

ABSTRACT

In the aftermath of the SARS-CoV-2 pandemic, we revised the cost-effectiveness of the exploited interventions in neonatal intensive care unit, to redefine future strategies for hospital management. Costs were revised with respect to the lockdown R0 or under different R0 scenarios to estimate the cost-effectiveness of the screening program adopted. Weekly nasopharyngeal swabs for parents, neonates, and personnel were the major cost during the pandemic, although they effectively reduced the number of cases in our unit.Conclusion: Parents and healthcare personnel testing appears to be an effective strategy due to the high number of contact they have within the hospital environment and outside, able to minimize the cases within our unit. What is Known: • Costs of universal COVID-19 tests for parents, neonates, and NICU personnel have not been evaluated during the COVID-19 pandemic in neonatal intensive care unit in Europe. What is New: • Weekly nasopharyngeal swabs for parents, neonates, and personnel were the major cost during the COVID-19 pandemic in NICU. • Parents and healthcare personnel testing was effective to reduce costs related to COVID-19 due to the high number of contact they have within the hospital environment and outside.


Subject(s)
COVID-19 Testing/economics , COVID-19/diagnosis , Cost-Benefit Analysis , Hospital Costs , Intensive Care Units, Neonatal/economics , COVID-19/economics , Europe , Humans , Infant, Newborn , Infection Control/economics , Pandemics/prevention & control
14.
Front Public Health ; 8: 590275, 2020.
Article in English | MEDLINE | ID: covidwho-983747

ABSTRACT

The COVID-19 pandemic has laid bare the inadequacy of the U.S. healthcare system to deliver timely and resilient care. According to the American Hospital Association, the pandemic has created a $202 billion loss across the healthcare industry, forcing health care systems to lay off workers and making hospitals scramble to minimize supply chain costs. However, as the demand for personal protective equipment (PPE) grows, hospitals have sacrificed sustainable solutions for disposable options that, although convenient, will exacerbate supply strains, financial burden, and waste. We advocate for reusable gowns as a means to lower health care costs, address climate change, and improve resilience while preserving the safety of health care workers. Reusable gowns' polyester material provides comparable capacity to reduce microbial cross-transmission and liquid penetration. In addition, previous hospitals have reported a 50% cost reduction in gown expenditures after adopting reusable gowns; given the current 2000% price increase in isolation gowns during COVID-19, reusable gown use will build both healthcare resilience and security from price fluctuations. Finally, with the United States' medical waste stream worsening, reusable isolation gowns show promising reductions in energy and water use, solid waste, and carbon footprint. The gowns are shown to withstand laundering 75-100 times in contrast to the single-use disposable gown. The circumstances of the pandemic forewarn the need to shift our single-use PPE practices to standardized reusable applications. Ultimately, sustainable forms of protective equipment can help us prepare for future crises that challenge the resilience of the healthcare system.


Subject(s)
COVID-19/prevention & control , Disposable Equipment/economics , Equipment Reuse/economics , Health Personnel/statistics & numerical data , Infection Control/economics , Pandemics/prevention & control , Protective Clothing/economics , Adult , Disposable Equipment/statistics & numerical data , Equipment Reuse/statistics & numerical data , Female , Humans , Infection Control/statistics & numerical data , Male , Middle Aged , Occupational Exposure/economics , Occupational Exposure/statistics & numerical data , Pandemics/statistics & numerical data , Protective Clothing/statistics & numerical data , United States
15.
J Bone Joint Surg Am ; 102(13): e66, 2020 Jul 01.
Article in English | MEDLINE | ID: covidwho-981469

ABSTRACT

BACKGROUND: Closed reduction and percutaneous pinning (CRPP) of supracondylar humeral fractures is one of the most common procedures performed in pediatric orthopaedics. The use of full, standard preparation and draping with standard personal protective equipment (PPE) may not be necessary during this procedure. This is of particular interest in the current climate as we face unprecedented PPE shortages due to the current COVID-19 pandemic. METHODS: This is a retrospective chart review of 1,270 patients treated with CRPP of a supracondylar humeral fracture at 2 metropolitan pediatric centers by 10 fellowship-trained pediatric orthopaedic surgeons. One surgeon in the group did not wear a mask when performing CRPP of supracondylar humeral fractures, and multiple surgeons in the group utilized a semisterile preparation technique (no sterile gown or drapes). Infectious outcomes were compared between 2 groups: full sterile preparation and semisterile preparation. We additionally analyzed a subgroup of patients who had semisterile preparation without surgeon mask use. Hospital cost data were used to estimate annual cost savings with the adoption of the semisterile technique. RESULTS: In this study, 1,270 patients who underwent CRPP of a supracondylar humeral fracture and met inclusion criteria were identified. There were 3 deep infections (0.24%). These infections all occurred in the group using full sterile preparation and surgical masks. No clinically relevant pin-track infections were noted. There were no known surgeon occupational exposures to bodily fluid. It is estimated that national adoption of this technique in the United States could save between 18,612 and 22,162 gowns and masks with costs savings of $3.7 million to $4.4 million annually. CONCLUSIONS: We currently face critical shortages of PPE due to the COVID-19 pandemic. Data from this large series suggest that a semisterile technique during CRPP of supracondylar humeral fractures is a safe practice. We anticipate that this could preserve approximately 20,000 gowns and masks in the United States over the next year. Physicians are encouraged to reevaluate their daily practice to identify safe opportunities for resource preservation. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Subject(s)
Coronavirus Infections , Fracture Fixation/standards , Health Care Rationing/organization & administration , Humeral Fractures/surgery , Pandemics , Personal Protective Equipment/supply & distribution , Pneumonia, Viral , Surgical Wound Infection/prevention & control , Betacoronavirus , Bone Nails , COVID-19 , Child , Child, Preschool , Closed Fracture Reduction/adverse effects , Closed Fracture Reduction/standards , Female , Fracture Fixation/adverse effects , Health Care Rationing/economics , Health Care Rationing/methods , Humans , Infection Control/economics , Infection Control/standards , Male , Personal Protective Equipment/economics , Retrospective Studies , SARS-CoV-2 , Surgical Wound Infection/etiology , United States/epidemiology
16.
Sci Rep ; 10(1): 18422, 2020 10 28.
Article in English | MEDLINE | ID: covidwho-894412

ABSTRACT

We use an individual based model and national level epidemic simulations to estimate the medical costs of keeping the US economy open during COVID-19 pandemic under different counterfactual scenarios. We model an unmitigated scenario and 12 mitigation scenarios which differ in compliance behavior to social distancing strategies and in the duration of the stay-home order. Under each scenario we estimate the number of people who are likely to get infected and require medical attention, hospitalization, and ventilators. Given the per capita medical cost for each of these health states, we compute the total medical costs for each scenario and show the tradeoffs between deaths, costs, infections, compliance and the duration of stay-home order. We also consider the hospital bed capacity of each Hospital Referral Region (HRR) in the US to estimate the deficit in beds each HRR will likely encounter given the demand for hospital beds. We consider a case where HRRs share hospital beds among the neighboring HRRs during a surge in demand beyond the available beds and the impact it has in controlling additional deaths.


Subject(s)
Coronavirus Infections/economics , Health Care Costs/statistics & numerical data , Pandemics/economics , Pneumonia, Viral/economics , COVID-19 , Capacity Building/economics , Capacity Building/statistics & numerical data , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Health Facilities/economics , Health Facilities/statistics & numerical data , Humans , Infection Control/economics , Infection Control/statistics & numerical data , Models, Statistical , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , United States
17.
Rev Epidemiol Sante Publique ; 68(5): 302-305, 2020 Sep.
Article in French | MEDLINE | ID: covidwho-888892

ABSTRACT

Following the onset of the global COVID-19 pandemic and the alerts issued by the World Health Organization, for several months attention has been focused on Africa as a potentially severely endangered continent. A sizable number of African countries, mainly low and middle income, suffer from limited available resources, especially in critical care, and COVID-19 is liable to overwhelm their already fragile health systems. To effectively manage what is shaping up as a multidimensional crisis, the challenge unquestionably goes beyond the necessary upgrading of public health infrastructures. It is also a matter of anticipating and taking timely action with regard to factors that may mitigate the propagation of SARS-CoV2 and thereby cushion the shock of the pandemic on the African continent. While some of these factors are largely unmanageable (climate, geography…), several others (socio-cultural, religious, audio-visual, and potentially political…) could be more or less effectively dealt with by African governments and populations.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Africa/epidemiology , BCG Vaccine/therapeutic use , Betacoronavirus/physiology , COVID-19 , Climate , Coronavirus Infections/economics , Coronavirus Infections/therapy , Health Resources/organization & administration , Health Resources/statistics & numerical data , Health Resources/supply & distribution , History, 20th Century , History, 21st Century , Humans , Infection Control/economics , Infection Control/history , Infection Control/organization & administration , Infection Control/standards , Pandemics/economics , Pandemics/statistics & numerical data , Pneumonia, Viral/economics , Pneumonia, Viral/therapy , Poverty Areas , Professional Role , Public Health/economics , Public Health/history , Public Health/statistics & numerical data , SARS-CoV-2 , Social Media , Social Responsibility , Socioeconomic Factors , World Health Organization
18.
Endoscopy ; 53(2): 156-161, 2021 02.
Article in English | MEDLINE | ID: covidwho-882960

ABSTRACT

BACKGROUND: Infection prevention strategies to protect healthcare workers in endoscopy units during the post-peak phase of the COVID-19 pandemic are currently under intense discussion. In this paper, the cost-effectiveness of routine pre-endoscopy testing and high risk personal protective equipment (PPE) is addressed. METHOD: A model based on theoretical assumptions of 10 000 asymptomatic patients presenting to a high volume center was created. Incremental cost-effectiveness ratios (ICERs) and absolute costs per endoscopy were calculated using a Monte Carlo simulation. RESULTS: ICER values for universal testing decreased with increasing prevalence rates. For higher prevalence rates (≥ 1 %), ICER values were lowest for routine pre-endoscopy testing coupled with use of high risk PPE, while cost per endoscopy was lowest for routine use of high risk PPE without universal testing. CONCLUSION: In general, routine pre-endoscopy testing combined with high risk PPE becomes more cost-effective with rising prevalence rates of COVID-19.


Subject(s)
COVID-19/prevention & control , Cost-Benefit Analysis , Endoscopy/economics , Occupational Exposure/prevention & control , Personal Protective Equipment , COVID-19/diagnosis , Humans , Infection Control/economics , Occupational Exposure/economics , Pandemics
19.
Am J Trop Med Hyg ; 103(5): 1762-1764, 2020 11.
Article in English | MEDLINE | ID: covidwho-809306

ABSTRACT

The highly infectious nature of the SARS-CoV-2 virus requires rigorous infection prevention and control (IPC) to reduce the transmission of COVID-19 within healthcare facilities, but in low-resource settings, the lack of water access creates a perfect storm for low-handwashing adherence, ineffective surface decontamination, and other environmental cleaning functions that are critical for IPC compliance. Data from the WHO/UNICEF Joint Monitoring Programme show that one in four healthcare facilities globally lacks a functional water source on premises (i.e., basic water service); in sub-Saharan Africa, half of all healthcare facilities have no basic water services. But even these data do not tell the whole story, other water, sanitation, and hygiene (WASH) assessments in low-resource healthcare facilities have shown the detrimental effects of seasonal or temporary water shortages, nonfunctional water infrastructure, and fluctuating water quality. The rapid spread of COVID-19 forces us to reexamine prevailing norms within national health systems around the importance of WASH for quality of health care, the prioritization of WASH in healthcare facility investments, and the need for focused, cross-sector leadership and collaboration between WASH and health professionals. What COVID-19 reveals about infection prevention in low-resource healthcare facilities is that we can no longer afford to "work around" WASH deficiencies. Basic WASH services are a fundamental prerequisite to compliance with the principles of IPC that are necessary to protect patients and healthcare workers in every setting.


Subject(s)
COVID-19/prevention & control , Health Facilities , Infection Control/standards , Africa , Hand Disinfection/standards , Health Facilities/economics , Health Facilities/standards , Humans , Infection Control/economics , Sanitation/standards , Water Supply/standards
20.
Am J Infect Control ; 49(5): 536-541, 2021 05.
Article in English | MEDLINE | ID: covidwho-792857

ABSTRACT

BACKGROUND: Prevention of healthcare-associated infections (HAIs) is critical to reduce preventable deaths and healthcare costs. Variable success with HAI prevention efforts has suggested that management practices are critical to support clinical infection prevention practices. This study examined hospital leaders' management practices around the prevention of catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSIs) to identify actions that leaders can take to promote HAI prevention efforts. METHODS: We conducted interviews with 420 key informants, including managers and frontline staff, in 18 hospitals across the United States. Interviewees were asked about management practices supporting HAI prevention. We analyzed interview transcripts using rigorous qualitative methods to understand how management practices were operationalized in infection prevention efforts. RESULTS: Across hospitals and interviewees, three management practices were characterized as important facilitators of HAI prevention: (1) engagement of executive leadership; (2) information sharing; and (3) manager coaching. We found that visible executive leadership, efficient communication, and frequent opportunities to provide and promote learning from feedback were perceived to promote and sustain HAI prevention efforts. CONCLUSIONS: Our findings provide insight into management practices for leaders that support successful HAI prevention. In practice, these tactics may need to be adjusted to accommodate the current restrictions caused by the COVID-19 pandemic, in order to maintain HAI prevention efforts as a priority.


Subject(s)
COVID-19/prevention & control , Communication , Cross Infection/prevention & control , Leadership , Pandemics/prevention & control , COVID-19/epidemiology , Humans , Infection Control/economics , Infection Control/statistics & numerical data , Interviews as Topic , Qualitative Research , SARS-CoV-2 , United States
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