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1.
Ann Intern Med ; 174(2): JC14, 2021 02.
Article in English | MEDLINE | ID: covidwho-1110692

ABSTRACT

SOURCE CITATION: Lynch JB, Davitkov P, Anderson DJ, et al. Infectious Diseases Society of America guidelines on infection prevention for health care personnel caring for patients with suspected or known COVID-19. Clin Infect Dis. 2020. [Epub ahead of print.] 32716496.


Subject(s)
/prevention & control , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Occupational Health , Personal Protective Equipment , Practice Guidelines as Topic , Humans , Societies, Medical , United States
2.
BMJ Open Qual ; 10(1)2021 02.
Article in English | MEDLINE | ID: covidwho-1085260

ABSTRACT

The surge in clinical demand, shortage in personal protective equipment and high-exposure risk for healthcare workers during the COVID-19 pandemic has challenged hospital common practices and forced a reassessment of care delivery models. Code blue teams are highly specialised units that partake in life-saving situations that can jeopardise the safety of team members. There is a paucity of guidance in regards to proper infection control measures to protect the responders.This study describes a methodical approach to assessing vulnerabilities to transmission of SARS-CoV-2 within existing code blue practices, modalities to limit the number of code blue team responders and modifications to the protocol at a large community teaching hospital. The effort undertaken faced challenges due to the nature of the pandemic and the increased demand on healthcare workers. Quality improvement methods facilitated our protocol design and implementation. To this date, there has been no identified COVID-19 disease in any protected code blue (PCB) team members. We recommend that similar practices be considered and adopted widely and practised periodically.


Subject(s)
/prevention & control , Health Personnel/education , Hospital Rapid Response Team/standards , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Adult , Female , Focus Groups , Health Personnel/standards , Hospitals, Teaching , Humans , Infection Control/methods , Male , Middle Aged , Personal Protective Equipment , Quality Improvement
4.
AANA J ; 89(1): 71-75, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1049350

ABSTRACT

The ongoing coronavirus disease 2019 (COVID-19) pandemic has created many changes and difficulties in healthcare, and the anesthesia specialty is no exception. Both the increased need for personal protective equipment (PPE) and the potential for infection and contamination through respiratory droplets have been sources of much concern. Policies and protocols have been adapted worldwide to help neutralize infection risk and exposure. Transmission of the virus to healthcare workers has been a major concern, and the risk of infection is exceptionally high for Certified Registered Nurse Anesthetists (CRNAs) because of their close contact with infected patients. CRNAs are in a unique position to help decrease exposure for themselves and other members of the healthcare team by taking extra precautions during airway manipulation. A great deal of focus has been placed on reducing risks during intubation, but reports describing methods of reducing contamination and exposure to respiratory droplets during emergence and extubation are scarce. The authors have reviewed techniques to reduce coughing, thereby decreasing the potential of virus exposure through contact with large respiratory droplets and aerosolized particles that may remain suspended in air.


Subject(s)
/prevention & control , Health Personnel/psychology , Infection Control/methods , Infection Control/standards , Operating Rooms/standards , Pandemics/prevention & control , Personal Protective Equipment/standards , Attitude of Health Personnel , Guidelines as Topic , Humans , Infection Control/statistics & numerical data , Personal Protective Equipment/statistics & numerical data
5.
Front Public Health ; 8: 618494, 2020.
Article in English | MEDLINE | ID: covidwho-1045482

ABSTRACT

Objective: The pandemic of coronavirus disease 2019 (COVID-19) has become a major public health challenge around the world, and outbreaks of the SARS-CoV-2 have constituted a public health emergency of international concern. Infection control measures are necessary to prevent further spread of the virus and to help control the epidemic situation. Due to the characteristics of gynecological settings, the risk of cross infection between patients and gynecologic practitioners can be high, strict and effective infection control protocols are urgently needed. This article, based on our experience and relevant guidelines and research, introduces prevention and control measures for use in gynecological outpatient clinics and provides recommended management for gynecologists in (potentially) affected areas.


Subject(s)
Ambulatory Care Facilities , Gynecology , Infection Control , Cross Infection/prevention & control , Female , Guidelines as Topic , Humans , Infection Control/organization & administration , Infection Control/standards , Public Health
7.
Pan Afr Med J ; 37(Suppl 1): 21, 2020.
Article in English | MEDLINE | ID: covidwho-1032983

ABSTRACT

Introduction: health care workers (HCWs) are on the frontline, waging war against SARS-CoV-2 and have a higher risk of infection with exposure to an infected person with SARS-CoV-2. There is a paucity of information on clinical characteristics and infection risk gradient of HCWs with SARS-CoV-2 with the view to marshal preventive measures. Methods: we conducted a multi-center case series analysis of 648 HCWs who were randomly selected in private and public hospitals across Nasarawa State, managing cases of SARS-CoV-2. Demographic and epidemiological information, were abstracted from electronic medical records of cases from February to July 2020. Throat and Nasopharyngeal swabs and real-time reverse transcriptase-polymerase chain reaction (RT-PCR) tests for SARS-CoV-2 nucleic acid were performed. Results: overall, 134 of 648 HCWs across health centers in Nasarawa State tested positive for SARS-CoV-2. Eighty male HCWs constituted 30.9% of respondents with a median (interquartile range) age of 36.7 (30.0-47.0) years. Overall, 50 of 134 HCWs (67.5%) with SAR-COV-2 had mild disease. The five most common symptoms amongst cases were fever (67 [90.5%]), myalgia or fatigue (60 [81.1%]), cough (50[67.6%]), sore throat (50 [67.6%]), and muscle ache (50 [67.6%]). Contact with index patients (65 [59.1%]) and colleagues with infection (10 [13.9%]) as well as community-acquired infection (14 [18.9%]) were the main routes of exposure for HCWs. Conclusion: HCWs in Nasarawa State face an unprecedented occupational risk of morbidity and mortality as a result of SARS-CoV-2. There is need for rapid development of sustainable infection prevention control measures that protect HCWs from the SARS-CoV-2 ongoing pandemic.


Subject(s)
/epidemiology , Health Personnel , Occupational Diseases/epidemiology , Occupational Diseases/prevention & control , Adult , Female , Humans , Infection Control/standards , Male , Middle Aged , Nigeria/epidemiology
8.
Health Place ; 64: 102398, 2020 07.
Article in English | MEDLINE | ID: covidwho-1023585

ABSTRACT

Schools have closed worldwide as part of measures to prevent SARS-CoV-2 transmission but are beginning to reopen in some countries. Various measures are being pursued to minimise transmission but existing guidance has not developed a comprehensive framework or theory of change. We present a framework informed by the occupational health hierarchy of control and a theory of change informed by realist approaches. We present measures focused on elimination, substitution, engineering, administration, education and personal protective equipment. We theorise that such measures offer a means of disrupting SARS-CoV-2 transmission via routes involving fomites, faeco-oral routes, droplets and aerosols.


Subject(s)
Coronavirus Infections/prevention & control , Evidence-Based Practice , Infection Control/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Schools/standards , Betacoronavirus/isolation & purification , Humans , Schools/organization & administration
9.
PLoS One ; 15(9): e0239113, 2020.
Article in English | MEDLINE | ID: covidwho-798750

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 , 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 , United States
10.
Medicine (Baltimore) ; 100(1): e24151, 2021 Jan 08.
Article in English | MEDLINE | ID: covidwho-1024162

ABSTRACT

ABSTRACT: Coronavirus disease 2019 (COVID-19) is still developing worldwide. The prognosis of the disease will become worse and mortality will be even higher when it is combined with cardiovascular disease. Furthermore, COVID-19 is highly infectious and requires strict isolation measures. For acute coronary syndromes (ACS), a common cardiovascular disease, infection may aggravate the occurrence and development of ACS, making the management of more difficult. It will be an enormous challenge for clinical practice to deal with ACS in this setting of COVID-19.Aim to reduce the mortality of ACS patients during the epidemic of COVID-19 by standardizing procedures as much as possible.Pubmed and other relevant databases were searched to retrieve articles on COVID-19 and articles on ACS management strategies during previous influenza epidemics. The data was described and synthesized to summarize the diagnosis and management strategy of ACS, the preparation of catheter laboratory, and the protection of the medical staff in the context of COVID-19. Ethical approval is not required in this study, because it is a review with no recourse to patient identifiable information.Standardized diagnosis and treatment advice can help reduce the mortality of COVID-19 patients with ACS. In the absence of contraindications, the third generation of thrombolytic drugs should be the first choice for thrombolytic treatment in the isolation ward. For patients who have to receive PCI, this article provides detailed protective measures to avoid nosocomial infection.


Subject(s)
Acute Coronary Syndrome/therapy , Acute Coronary Syndrome/virology , Cross Infection/prevention & control , Infection Control/standards , Pneumonia, Viral/epidemiology , Acute Coronary Syndrome/mortality , Humans , Pandemics , Pneumonia, Viral/virology
11.
Int J Qual Health Care ; 33(Supplement_1): 51-55, 2021 Jan 12.
Article in English | MEDLINE | ID: covidwho-1024111

ABSTRACT

BACKGROUND: In response to the coronavirus disease of 2019 (COVID-19) pandemic, healthcare systems worldwide have stepped up their infection prevention and control efforts in order to reduce the spread of the infection. Behaviours, such as hand hygiene, screening and cohorting of patients, and the appropriate use of antibiotics have long been recommended in surgery, but their implementation has often been patchy. METHODS: The current crisis presents an opportunity to learn about how to improve infection prevention and control and surveillance (IPCS) behaviours. The improvements made were mainly informal, quick and stemming from the frontline rather than originating from formal organizational structures. The adaptations made and the expertise acquired have the potential for triggering deeper learning and to create enduring improvements in the routine identification and management of infections relating to surgery. RESULTS: This paper aims to illustrate how adopting a human factors and ergonomics perspective can provide insights into how clinical work systems have been adapted and reconfigured in order to keep patients and staff safe. CONCLUSION: For achieving sustainable change in IPCS practices in surgery during COVID-19 and beyond we need to enhance organizational learning potentials.


Subject(s)
Infection Control/methods , Surgical Procedures, Operative/standards , Anti-Bacterial Agents/therapeutic use , Cross Infection/prevention & control , Epidemiological Monitoring , Ergonomics/methods , Hand Hygiene , Humans , Infection Control/standards
14.
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 , 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 , Surgical Wound Infection/etiology , United States/epidemiology
17.
J Crohns Colitis ; 14(Supplement_3): S798-S806, 2020 Oct 21.
Article in English | MEDLINE | ID: covidwho-963440

ABSTRACT

Our knowledge of COVID-19 is changing and evolving rapidly, with novel insights and recommendations, almost on a daily basis. It behooves the medical community to provide updated information on a regular basis, on best practice to facilitate optimal care of infected patients and on appropriate advice for the general population. This is particularly important in the case of patients with chronic conditions, such as inflammatory bowel disease [IBD]. In this review, we have compiled existing evidence on the impact of COVID-19 in IBD patients and provide guidance on the most appropriate care to adopt during the pandemic. Our review highlights that IBD, per se, is not a risk factor for COVID-19. However, all IBD patients with symptoms should be tested for SARS-CoV-2 and the procedures for disease management should be carefully adapted: [i] in SARS-CoV-2-positive IBD patients, medical treatments should be re-evaluated [with a particular focus on corticosteroids] always with the purpose of treating active disease and maintaining remission; [ii] non-urgent surgeries and endoscopic procedures should be postponed for all patients; [iii] online consultancy should be implemented; and [iv] hospitalization and surgery should be limited to life-threatening situations.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Inflammatory Bowel Diseases/therapy , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Betacoronavirus/isolation & purification , Clinical Laboratory Techniques , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Global Health , Health Care Rationing/methods , Health Care Rationing/standards , Humans , Infection Control/methods , Infection Control/standards , Inflammatory Bowel Diseases/complications , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Risk Assessment , Risk Factors
18.
J Perioper Pract ; 31(1-2): 18-23, 2021.
Article in English | MEDLINE | ID: covidwho-954999

ABSTRACT

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes 2019 novel coronavirus disease (COVID-19), has rapidly developed into a global pandemic and public health emergency. The transmission and virulence of this new pathogen have raised concern for how best to protect healthcare professionals while effectively providing care to the infected patient requiring surgery. Although negative pressure rooms are ideal for aerosol-generating procedures, such as intubation and extubation, most operating theatres are generally maintained at a positive pressure when compared with the surrounding areas. This article compares negative and positive pressure rooms and the advantages of a negative pressure environment in optimising clinical care and minimising the exposure of patients and health care professionals to SARS-CoV-2.


Subject(s)
Coronavirus Infections/prevention & control , Infection Control/methods , Infection Control/standards , Operating Rooms/standards , Patient Isolators/standards , Perioperative Care/standards , Ventilation/standards , Humans , Practice Guidelines as Topic
19.
Rev Gastroenterol Mex ; 85(4): 428-436, 2020.
Article in English, Spanish | MEDLINE | ID: covidwho-935917

ABSTRACT

The COVID-19 pandemic has forced the establishment of preventive measures against contagion during the performance of diagnostic and therapeutic tests in gastroenterology. Digestive tract motility tests involve an intermediate and elevated risk for the transmission of COVID-19 infection. Given their elective or non-urgent indication in the majority of cases, we recommend postponing those tests until significant control of the infection rate in each Latin American country has been achieved during the pandemic. When the health authorities allow the return to normality, and in the absence of an effective treatment for or preventive vaccine against COVID-19 infection, we recommend a strict protocol for classifying patients according to their infectious-contagious status through the appropriate use of tests for the detection of the virus and the immune response to it, and the following of protective measures by the healthcare personnel to prevent contagion during the performance of a gastrointestinal motility test.


Subject(s)
Coronavirus Infections/prevention & control , Gastroenterology/standards , Gastrointestinal Diseases/diagnosis , Infection Control/standards , Neurology/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Breath Tests , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Esophageal pH Monitoring/standards , Gastrointestinal Diseases/therapy , Gastrointestinal Motility , Humans , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Latin America , Manometry/standards , Patient Selection , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Societies, Medical
20.
JCO Glob Oncol ; 6: 1455-1460, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-901960

ABSTRACT

The core pillars of multimodal care of patients with cancer are surgical, radiation, and medical oncology. The global pandemic of coronavirus disease 2019 (COVID-19) has suddenly resurrected a new pillar in oncology care: teleoncology. With oncologists reaching out to patients through telemedicine, it is possible to evaluate and fulfill patients' needs; triage patients for elective procedures; screen them for influenza-like illness; provide them with guidance for hospital visits, if needed; and bridge oral medications and treatments when a hospital visit is not desirable because of any high risk-benefit ratio. Teleoncology can bring great reassurance to patients at times when reaching an oncology center is challenging, and more so in resource-constrained countries. Evidence-based treatment protocols, dispensable by teleoncology, already exist for many sites of cancer and they can provide a bridge to treatment when patients are unable to reach cancer centers for their standard treatment. The young pillar of teleoncology is going to remain much longer than COVID-19.


Subject(s)
Coronavirus Infections/prevention & control , Infection Control/organization & administration , Medical Oncology/organization & administration , Neoplasms/diagnosis , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Telemedicine/organization & administration , Betacoronavirus/pathogenicity , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Evidence-Based Medicine/methods , Evidence-Based Medicine/organization & administration , Evidence-Based Medicine/standards , Evidence-Based Medicine/trends , Humans , Infection Control/methods , Infection Control/standards , Medical Oncology/methods , Medical Oncology/standards , Medical Oncology/trends , Neoplasms/therapy , Patient Selection , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Telemedicine/standards , Telemedicine/trends , Triage/methods , Triage/organization & administration , Triage/standards
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