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1.
PLoS One ; 17(3): e0264644, 2022.
Article in English | MEDLINE | ID: covidwho-1793511

ABSTRACT

INTRODUCTION: Patients with high-consequence infectious diseases (HCID) are rare in Western Europe. However, high-level isolation units (HLIU) must always be prepared for patient admission. Case fatality rates of HCID can be reduced by providing optimal intensive care management. We here describe a single centre's preparation, its embedding in the national context and the challenges we faced during the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic. METHODS: Ten team leaders organize monthly whole day trainings for a team of doctors and nurses from the HLIU focusing on intensive care medicine. Impact and relevance of training are assessed by a questionnaire and a perception survey, respectively. Furthermore, yearly exercises with several partner institutions are performed to cover different real-life scenarios. Exercises are evaluated by internal and external observers. Both training sessions and exercises are accompanied by intense feedback. RESULTS: From May 2017 monthly training sessions were held with a two-month and a seven-month break due to the first and second wave of the SARS-CoV-2 pandemic, respectively. Agreement with the statements of the questionnaire was higher after training compared to before training indicating a positive effect of training sessions on competence. Participants rated joint trainings for nurses and doctors at regular intervals as important. Numerous issues with potential for improvement were identified during post processing of exercises. Action plans for their improvement were drafted and as of now mostly implemented. The network of the permanent working group of competence and treatment centres for HCID (Ständiger Arbeitskreis der Kompetenz- und Behandlungszentren für Krankheiten durch hochpathogene Erreger (STAKOB)) at the Robert Koch-Institute (RKI) was strengthened throughout the SARS-CoV-2 pandemic. DISCUSSION: Adequate preparation for the admission of patients with HCID is challenging. We show that joint regular trainings of doctors and nurses are appreciated and that training sessions may improve perceived skills. We also show that real-life scenario exercises may reveal additional deficits, which cannot be easily disclosed in training sessions. Although the SARS-CoV-2 pandemic interfered with our activities the enhanced cooperation among German HLIU during the pandemic ensured constant readiness for the admission of HCID patients to our or to collaborating HLIU. This is a single centre's experience, which may not be generalized to other centres. However, we believe that our work may address aspects that should be considered when preparing a unit for the admission of patients with HCID. These may then be adapted to the local situations.


Subject(s)
Communicable Diseases/therapy , Critical Care/organization & administration , Intensive Care Units/organization & administration , Patient Isolation/organization & administration , COVID-19/epidemiology , Clinical Competence , Communicable Diseases/epidemiology , Education, Medical, Continuing/methods , Education, Medical, Continuing/organization & administration , Education, Nursing, Continuing/methods , Education, Nursing, Continuing/organization & administration , Environment Design , Germany/epidemiology , History, 21st Century , Humans , Pandemics , Patient Admission , Patient Care Team/organization & administration , Patient Isolation/methods , SARS-CoV-2/physiology , Simulation Training/organization & administration , Workflow
2.
PLoS One ; 16(12): e0261381, 2021.
Article in English | MEDLINE | ID: covidwho-1638694

ABSTRACT

The Covid-19 pandemic has brought forth a major landscape shock in the mobility sector. Due to its recentness, researchers have just started studying and understanding the implications of this crisis on mobility. We contribute by combining mobility data from various sources to bring a novel angle to understanding mobility patterns during Covid-19. The goal is to expose relations between mobility and Covid-19 variables and understand them by using our data. This is crucial information for governments to understand and address the underlying root causes of the impact.


Subject(s)
COVID-19/economics , COVID-19/prevention & control , Marketing/statistics & numerical data , Pandemics/economics , Pandemics/prevention & control , Patient Isolation/methods , SARS-CoV-2 , Travel/statistics & numerical data , COVID-19/epidemiology , COVID-19/mortality , Humans , Netherlands/epidemiology
3.
Am J Nurs ; 122(2): 36-43, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1625512

ABSTRACT

ABSTRACT: The COVID-19 pandemic has created unique challenges for health care workers, who have demonstrated dedication, collaboration, and innovation in response. In this article, the authors describe an important nursing innovation they employed at Montefiore Medical Center in the Bronx, New York, during the spring 2020 COVID-19 surge: the relocation of smart IV infusion pumps outside of patient rooms. The goals of this innovation were to improve delivery of care, conserve personal protective equipment, limit the spread of the virus, and protect staff from exposure. The authors discuss the initial concerns that arose regarding the safety and efficacy of this practice; the research they conducted with other colleagues in nursing, pharmacy, infection control, and patient safety in the face of scant clinical literature relevant to the difficult circumstances the pandemic created; and the strategies they ultimately employed to ensure that this practice maintained safety and efficacy.


Subject(s)
COVID-19/transmission , Infusion Pumps , Patient Isolation/methods , Patients' Rooms/organization & administration , COVID-19/therapy , Humans , Pandemics , Personal Protective Equipment/supply & distribution , SARS-CoV-2
4.
Medicine (Baltimore) ; 100(47): e27948, 2021 Nov 24.
Article in English | MEDLINE | ID: covidwho-1605804

ABSTRACT

ABSTRACT: South Korean studies on coronavirus disease-2019 (COVID-19) treatment have described the use of community treatment centers (CTCs), which combine elements of the home and hospital, to isolate and treat mild COVID-19 patients. While the number of South Koreans diagnosed with COVID-19 cases has varied greatly by season, the number of confirmed cases in foreign nationals has shown no seasonality, with an average of around 25 to 30 per day. For foreign patients, accommodation arrangements and travel routes may be difficult; they may also have difficulty accessing medical care, so require careful management.We discuss our experience in operating and managing a CTC for foreign COVID-19 patients arriving in South Korea with mild symptoms. We also propose guidelines for efficient use of resources with respect to treating these patients in CTCs.We present the clinical findings of patients treated at the CTC between 7 October and 22 November 2020, and make some recommendations. We quarantined and treated foreign patients with mild symptoms of COVID-19 at the Ansan CTC. Discharge is determined based on clinical symptoms rather than polymerase chain reaction results. Medical and administrative staff use building A, while building B is used for isolating patients. Medical rounds are in the form of twice-daily video calls. Three kinds of foods with medication are served according to the patient's country of origin.In total, 315 patients were admitted to the Ansan CTC between 7 October and 22 November 2020; 145 of them were discharged from the CTC and 26 were transferred to other hospitals.To utilize medical resources efficiently during the pandemic, it is desirable to reserve CTCs exclusively for foreign patients.


Subject(s)
COVID-19 , Community Health Centers/organization & administration , Pandemics/prevention & control , Patient Isolation/methods , Patient Transfer , Telemedicine/methods , Humans , Quarantine/methods , Republic of Korea , SARS-CoV-2
5.
CMAJ Open ; 9(4): E1114-E1119, 2021.
Article in English | MEDLINE | ID: covidwho-1547694

ABSTRACT

BACKGROUND: The detailed extent of neuroinvasion or deleterious brain changes resulting from COVID-19 and their time courses remain to be determined in relation to "long-haul" COVID-19 symptoms. Our objective is to determine whether there are alterations in functional brain imaging measures among people with COVID-19 after hospital discharge or self-isolation. METHODS: This paper describes a protocol for NeuroCOVID-19, a longitudinal observational study of adults aged 20-75 years at Sunnybrook Health Sciences Centre in Toronto, Ontario, that began in April 2020. We aim to recruit 240 adults, 60 per group: people who contracted COVID-19 and were admitted to hospital (group 1), people who contracted COVID-19 and self-isolated (group 2), people who experienced influenza-like symptoms at acute presentation but tested negative for COVID-19 and self-isolated (group 3, control) and healthy people (group 4, control). Participants are excluded based on premorbid neurologic or severe psychiatric illness, unstable cardiovascular disease, and magnetic resonance imaging (MRI) contraindications. Initial and 3-month follow-up assessments include multiparametric brain MRI and electroencephalography. Sensation and cognition are assessed alongside neuropsychiatric assessments and symptom self-reports. We will test the data from the initial and follow-up assessments for group differences based on 3 outcome measures: MRI cerebral blood flow, MRI resting state fractional amplitude of low-frequency fluctuation and electroencephalography spectral power. INTERPRETATION: If neurophysiologic alterations are detected in the COVID-19 groups in our NeuroCOVID-19 study, this information could inform future research regarding interventions for long-haul COVID-19. The study results will be disseminated to scientists, clinicians and COVID-19 survivors, as well as the public and private sectors to provide context on how brain measures relate to lingering symptoms.


Subject(s)
Brain/physiopathology , COVID-19/complications , Patient Discharge , Adult , Aged , Brain/diagnostic imaging , COVID-19/diagnostic imaging , COVID-19/physiopathology , Electroencephalography/methods , Female , Hospitalization , Hospitals , Humans , Longitudinal Studies , Magnetic Resonance Imaging/methods , Male , Middle Aged , Ontario , Patient Isolation/methods , SARS-CoV-2 , Young Adult
6.
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
10.
AJR Am J Roentgenol ; 217(4): 883-887, 2021 10.
Article in English | MEDLINE | ID: covidwho-1365500

ABSTRACT

OBJECTIVE. To reduce staff exposure to infection and maintain operational efficiency, we have developed a protocol to image patients using portable chest radiography through the glass of an isolation room. This technique is safe and easy to implement. Images are of comparable quality to standard portable radiographs. CONCLUSION. This protocol, used routinely by our department during the COVID-19 pandemic, can be applied to any situation in which the patient is placed in isolation.


Subject(s)
COVID-19/diagnostic imaging , Patient Isolation/methods , Point-of-Care Systems , Radiography, Thoracic/methods , COVID-19/prevention & control , Humans , Lung/diagnostic imaging , Pandemics , SARS-CoV-2
11.
Elife ; 102021 07 27.
Article in English | MEDLINE | ID: covidwho-1328262

ABSTRACT

Since the start of the COVID-19 pandemic, two mainstream guidelines for defining when to end the isolation of SARS-CoV-2-infected individuals have been in use: the one-size-fits-all approach (i.e. patients are isolated for a fixed number of days) and the personalized approach (i.e. based on repeated testing of isolated patients). We use a mathematical framework to model within-host viral dynamics and test different criteria for ending isolation. By considering a fixed time of 10 days since symptom onset as the criterion for ending isolation, we estimated that the risk of releasing an individual who is still infectious is low (0-6.6%). However, this policy entails lengthy unnecessary isolations (4.8-8.3 days). In contrast, by using a personalized strategy, similar low risks can be reached with shorter prolonged isolations. The obtained findings provide a scientific rationale for policies on ending the isolation of SARS-CoV-2-infected individuals.


Subject(s)
COVID-19/epidemiology , COVID-19/virology , Patient Isolation , Practice Guidelines as Topic , Quarantine , SARS-CoV-2 , COVID-19/diagnosis , COVID-19/transmission , Humans , Models, Theoretical , Molecular Diagnostic Techniques , Pandemics , Patient Isolation/methods , Patient Isolation/standards , Precision Medicine/methods , Quarantine/methods , Quarantine/standards , SARS-CoV-2/physiology , Viral Load
12.
J Microbiol Immunol Infect ; 54(5): 987-991, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1293987

ABSTRACT

We described a strategy for preventing virus transmission within hospitals through screening and advanced isolation during the coronavirus pandemic. Patients were screened and admitted to the adult advanced isolation unit from February to April 2020. Our process minimized exposure without delaying proper treatment and prevented virus transmission within the hospital.


Subject(s)
COVID-19/prevention & control , Cross Infection/prevention & control , Infection Control/methods , Pandemics/prevention & control , Patient Isolation/methods , Aged , Aged, 80 and over , Female , Health Personnel , Hospitalization , Hospitals , Humans , Male , Middle Aged , Patient Isolation/standards , Patient Safety , Retrospective Studies , SARS-CoV-2
13.
HERD ; 14(3): 34-48, 2021 07.
Article in English | MEDLINE | ID: covidwho-1255871

ABSTRACT

OBJECTIVE: This case study examines the implementation of inpatient telemedicine in COVID-19 intensive care units (ICUs) and explores the impact of shifting forms of visibility on the management of the unit, staff collaboration, and patient care. BACKGROUND: The COVID-19 crisis drove healthcare institutions to rapidly develop new models of care based on integrating digital technologies for remote care with transformations in the hospital-built environment. The Sheba Medical Center in Israel created COVID-19 ICUs in an underground structure with an open-ward layout and telemedicine control rooms to remotely supervise, communicate, and support the operations in the contaminated zones. One unit had a physical visual connection between the control room and the contaminated zone through a window, while the other had only a virtual connection with digital technologies. METHODS: The findings are based on semistructured interviews with Sheba medical staff, telemedicine companies, and the architectural design team and observations at the COVID-19 units during March-August 2020. RESULTS: The case study illustrates the implications of virtual and physical visibility on the management of the unit, staff collaboration, and patient care. It demonstrates the correlations between patterns of visibility and the users' sense of control, orientation in space, teamwork, safety, quality of care, and well-being. CONCLUSIONS: The case study demonstrates the limitations of current telemedicine technologies that were not designed for inpatient care to account for the spatial perception of the unit and the dynamic use of the space. It presents the potential of a hybrid model that balances virtual and physical forms of visibility and suggests directions for future research and development of inpatient telemedicine.


Subject(s)
COVID-19/therapy , Intensive Care Units/organization & administration , Telemedicine/methods , COVID-19/prevention & control , Facility Design and Construction/methods , Facility Design and Construction/standards , Humans , Infection Control/methods , Israel , Organizational Case Studies , Patient Isolation/methods , SARS-CoV-2 , Telemedicine/organization & administration
14.
Laryngoscope ; 131(11): E2749-E2754, 2021 11.
Article in English | MEDLINE | ID: covidwho-1242749

ABSTRACT

OBJECTIVES/HYPOTHESIS: Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is transmitted by droplet as well as airborne infection. Surgical patients are vulnerable to the infection during their hospital admission. Some surgical procedures are classified as aerosol generating (AGP). STUDY DESIGN: Retrospective observational study of four specialties associates with known AGP's during the 4 months of the first wave of UK COVID-19 epidermic to identify post-surgical cross-infection with SARSCoV-2 within 14 days of a procedure. METHODS: Retrospective observational study in a tertiary healthcare center of four specialties associates with known AGP's during the 4 months of the first wave of UK COVID-19 epidermic to identify post-surgical cross-infection with SARSCoV-2 within 14 days of a procedure. RESULTS: There were 3,410 procedures reported during this period. The overall cross-infection rate from tested patients was 1.3% (4 patients), that is, 0.11% of all operations over 4 months. Ear, nose, and throat carried slightly higher rate of infection (0.4%) than gastroenterology (0.08%). The mortality rate was 0.3% (one gastroenterology patient from 304 positive cases) compared to 0% if surgery performed after recovery from SARSCoV-2 and 37.5% when surgery was conducted during the incubation period of the disease. Routine preoperative rapid screening tests and self-isolation are crucial to avoid the risk of cross-infection. Patients with underlying malignancy or receiving chemotherapy were more prone to pulmonary complications and mortality. CONCLUSION: The risk of SARS-COV-2 cross-infection after surgical procedure is very low. Preoperative screening and self-isolation together with personal protective measures should be in place to minimize the cross-infection. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2749-E2754, 2021.


Subject(s)
COVID-19/transmission , Cross Infection/epidemiology , Disease Transmission, Infectious/prevention & control , Surgical Procedures, Operative/adverse effects , Aerosols , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Cross Infection/prevention & control , Disease Transmission, Infectious/statistics & numerical data , Female , Humans , Incidence , Male , Mass Screening/methods , Middle Aged , Mortality/trends , Outcome Assessment, Health Care , Particulate Matter/adverse effects , Patient Isolation/methods , Personal Protective Equipment/standards , Preoperative Period , Retrospective Studies , Risk Assessment/methods , SARS-CoV-2/genetics , Surgical Procedures, Operative/classification , Surgical Procedures, Operative/statistics & numerical data , United Kingdom/epidemiology
15.
J Gynecol Obstet Hum Reprod ; 50(9): 102166, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1240456

ABSTRACT

OBJECTIVE: This study examined the impact of lockdown for SARS-CoV-2 on breast cancer management via an online survey in a French multicentre setting. MATERIAL AND METHODS: This is a multicentre retrospective study, over the strict lockdown period from March 16th to May 11th, 2020 in metropolitan France. 20 centres were solicited, of which 12 responded to the survey. RESULTS: 50% of the centres increased their surgical activity, 33% decreased it and 17% did not change it during containment. Some centres had to cancel (17%) or postpone (33%) patient-requested interventions due to fear of SARS-CoV-2. Four and 6 centres (33% and 50%) respectively cancelled and postponed interventions for medical reasons. In the usual period, 83% of the centres perform their conservative surgeries on an outpatient basis, otherwise the length of hospital stay was 24 to 48 h. All the centres except one performed conservative surgery on an outpatient basis during the lockdown period, for which. 8% performed mastectomies on an outpatient basis during the usual period. During lockdown, 50% of the centres reduced their hospitalization duration (25% outpatient /25% early discharge on Day 1). CONCLUSION: This study explored possibilities for management during the first pandemic lockdown. The COVID-19 pandemic required a total reorganization of the healthcare system, including the care pathways for cancer patients.


Subject(s)
Breast Neoplasms/surgery , Breast Neoplasms/therapy , COVID-19/prevention & control , SARS-CoV-2 , Surgical Procedures, Operative/statistics & numerical data , Ambulatory Surgical Procedures/statistics & numerical data , Conservative Treatment/statistics & numerical data , Female , France , Humans , Length of Stay , Mammaplasty/statistics & numerical data , Mastectomy/statistics & numerical data , Patient Isolation/methods , Retrospective Studies , Surveys and Questionnaires
16.
Sci Prog ; 104(2): 368504211009670, 2021.
Article in English | MEDLINE | ID: covidwho-1195898

ABSTRACT

As the coronavirus disease 2019 (COVID-19) spreads globally, hospital departments will need take steps to manage their treatment procedures and wards. The preparations of high-risk departments (infection, respiratory, emergency, and intensive care unit) were relatively well within this pandemic, while low-risk departments may be unprepared. The spine surgery department in The First Affiliated Hospital of Anhui Medical University in Hefei, China, was used as an example in this study. The spine surgery department took measures to manage the patients, medical staff and wards to avoid the cross-infection within hospital. During the outbreak, no patients or healthcare workers were infected, and no treatment was delayed due to these measures. The prevention and control measures effectively reduced the risk of nosocomial transmission between health workers and patients while providing optimum care. It was a feasible management approach that was applicable to most low-risk and even high-risk departments.


Subject(s)
COVID-19/prevention & control , Infection Control/methods , Pandemics , Patient Isolation/organization & administration , Patient Isolators/supply & distribution , SARS-CoV-2/pathogenicity , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , China/epidemiology , Cross Infection/prevention & control , Disinfection/methods , Disinfection/organization & administration , Health Personnel/education , Humans , Infection Control/organization & administration , Monitoring, Physiologic/instrumentation , Monitoring, Physiologic/methods , Orthopedic Procedures/instrumentation , Orthopedic Procedures/methods , Patient Isolation/methods , Patients' Rooms/organization & administration , Personal Protective Equipment/supply & distribution , Spine/surgery
20.
Epidemiol Infect ; 149: e61, 2021 02 24.
Article in English | MEDLINE | ID: covidwho-1124622

ABSTRACT

A fever clinic within a hospital plays a vital role in pandemic control because it serves as an outpost for pandemic discovery, monitoring and handling. As the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan was gradually brought under control, the fever clinic in the West Campus of Wuhan Union Hospital introduced a new model for construction and management of temporary mobile isolation wards. A traditional battlefield hospital model was combined with pandemic control regulations, to build a complex of mobile isolation wards that used adaptive design and construction for medical operational, medical waste management and water drainage systems. The mobile isolation wards allowed for the sharing of medical resources with the fever clinic. This increased the capacity and efficiency of receiving, screening, triaging and isolation and observation of patients with fever. The innovative mobile isolation wards also controlled new sudden outbreaks of COVID-19. We document the adaptive design and construction model of the novel complex of mobile isolation wards and explain its characteristics, functions and use.


Subject(s)
Fever/therapy , Models, Organizational , Patient Isolation/methods , COVID-19/complications , COVID-19/epidemiology , China/epidemiology , Fever/epidemiology , Humans , Infection Control/instrumentation , Infection Control/methods , Patient Isolation/trends
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