Expert consensus on prevention and control of infection in COVID-19 designated hospitals

OBJECTIVE: To further standardize and guide the infection prevention and control(IPC) in designated hospitals so as to effectively ensure the stability, order and safety of medical treatment, ensure the safety of health care workers and patients, and reduce cross infections caused by the transmission of COVID-19. METHODS: The experts who repeatedly participated in the national COVID-19 medical treatment and IPC were invited to compile the consensus based on latest national norms, characteristics of the omicron and situation of epidemic prevention and control. RESULTS: The consensus consisted of two major parts: comprehensive coverage and control of infections in designated hospitals, with 47 recommendations involved. CONCLUSION: The expert consensus will provide guidance for the upcoming prevention and control of infection in designated hospitals.

Association between the overall burden of comorbidity and Ct values among the older patients with Omicron infection: Mediated by inflammation.

Objectives: To investigate the associations between the overall burden of comorbidity, inflammatory indicators in plasma and Ct values among the elderly with COVID-19. Methods: We conducted a retrospective observational study. The results of each nucleic acid test of during hospitalization were obtained. Linear regression models assessed the associations between the overall burden of comorbidity, inflammatory indicators in plasma and Ct values among the elderly. A causal mediation analysis was performed to assess the mediation effects of inflammatory indicators on the association between the overall burden of comorbidity and Ct values. Results: A total of 767 COVID-19 patients aged ≥ 60 years were included between April 2022 and May 2022. Patients with a high burden of comorbidity had significantly lower Ct values of the ORF gene than subjects with a low burden of comorbidity (median, 24.81 VS 26.58, P < 0.05). Linear regression models showed that a high burden of comorbidity was significantly associated with higher inflammatory responses, including white blood cell count, neutrophil count and C-reactive protein. Also, white blood cell count, neutrophil count, C-reactive protein and the overall burden of comorbidity assessed by age-adjusted Charlson comorbidity index were independent risk factors for the Ct values. A mediation analysis detected the mediation effect of white blood cells on the association between the burden of comorbidity and Ct values, with the indirect effect estimates of 0.381 (95% CI: 0.166, 0.632, P < 0.001). Similarly, the indirect effect of C-reactive protein was -0.307 (95% CI: -0.645, -0.064, P = 0.034). White blood cells and C-reactive protein significantly mediated the relationship between the burden of comorbidity and Ct values by 29.56% and 18.13% of the total effect size, respectively. Conclusions: Inflammation mediated the association between the overall burden of comorbidity and Ct values among elderly with COVID-19, which suggests that combined immunomodulatory therapies could reduce the Ct values for such patients with a high burden of comorbidity.

Contamination of personal protective equipment and environmental surfaces in Fangcang shelter hospitals.

BACKGROUND: Fangcang shelter hospitals emerged as a new public health concept after COVID-19. Data regarding contamination of Fangcang shelter environments remains scarce. This study aims to investigate the extent of SARS-CoV-2 contamination on personal protective equipment and surfaces in Fangcang hospitals. METHODS: Between March and May 2022, during wave of omicron variant, a prospective study was conducted in two Fangcang hospitals in Shanghai, China. Swabs of personal protective equipment worn and environmental surfaces of contaminated areas, doffing rooms, and potentially contaminated areas were collected. SARS-CoV-2 RNA was detected by reverse transcription quantitative polymerase chain reaction. If viral RNA was detected, sampling was repeated after cleaning and disinfection. RESULTS: A total of 602 samples were collected. 13.3% of the personal protective equipment were contaminated. Positive rate was higher in the contaminated areas (48.4%) than in the doffing rooms (11.7%) and the potentially contaminated areas (0; P<0.05). Contamination was highest in patient occupied areas 67.5%. After cleaning, samples taken at previously contaminated surfaces are all negative. CONCLUSIONS: SARS-CoV-2 RNA contamination is prevalent in Fangcang hospitals and healthcare workers are under risk of infection. Potentially contaminated areas and surfaces after cleaning and disinfection are negative, underlying the importance of infection control policy.

Prolonged Use of Surgical Masks and Respirators Affects the Protection and Comfort for Healthcare Workers.

This study explored the ideal period for wearing masks to prevent the physiological and psychological problems associated with long-term face mask use during respiratory infections by healthcare workers. Breathing simulators, surgical masks (SM) and medical respirators (PM) were prepared for two to eight hours. Changes in the comfort of masks (facial skin temperature, breathing resistance, and moisture permeability) and protection (filtration efficiency, resistance to blood penetration, and colony count) were assessed. The results demonstrated that the masks offered efficient liquid-particle filtering even after eight hours of use. However, the number of bacterial colonies using PM and SM grew significantly after two and four hours, respectively. Concerning comfort, the inspiratory resistance of masks rose dramatically after two hours, whereas the moisture permeability declined considerably after four hours. In addition, skin temperature had a significant increase within two hours, which may result in facial discomfort. When conditions permitted, the hospital staff was instructed to replace their masks every two hours.

Expert consensus on prevention and control of infection in makeshift hospitals

Makeshift hospitals have played an important role in responding to the spread of the epidemic caused by the Omicron coronavirus variant, one of the novel coronavirus(SARS-CoV-2) strains with significantly enhanced infectiousness. In order to prevent the patients, healthcare workers and other staff against from infection, Healthcare-associated Infection Management Committee of Chinese Hospital Association organized domestic experts to jointly formulate this consensus according to the comprehensive consideration of national guidelines as well as the actual characteristics and needs of makeshift hospitals. This consensus is mainly applicable for makeshift hospitals where a large number of asymptomatic and mild cases of novel coronavirus disease 2019(COVID-19) are treated. It provides guidance for the managers and staff to implement prevention and control work in line with local conditions in makeshift hospitals based on a perfect organizational structure and efficient working mechanism, the prevention and control work includes training and assessment of infection control knowledge and skills, flowing in and out of the makeshift hospitals for staff and materials, infection monitoring and feedback, implementation of infection prevention and control measures, requirements for infection management in key areas, occupational protection of staff and terminal disinfection, etc. Meanwhile, this consensus particularly emphasizes that the infection prevention and control in makeshift hospitals is a systematic project, which requires not only multi-system and multi-department collaboration, but also uniting in a concrete effort among leaders and staff. In accordance with the national guidelines and evidence-based experiences, it is very important to combine theory with practice for ensuring efficient operation and safety of makeshift hospitals.

Research on efficacy of masks under different simulated wearing modes

OBJECTIVE: To study the relationship between the comfort and protection of masks under different simulated wearing methods, so as to provide reasonable suggestions for medical staff on how to wear masks. METHODS: The N95 mask and disposable mask commonly used by medical staff were choose to design five wearing methods are designed: Single layer disposable mask(Single-D), Double layer disposable mask(Double-DD), Single layer N95 mask(Single-N), N95 mask inside + Disposable mask outside(Double-ND), Disposable mask inside + N95 mask outside(Double-DN). According to the mask standard GB 19083-2010, the filter efficiency, moisture permeability, respiratory resistance, resistance to synthetic blood penetration and moisture resistance of masks under different wearing modes were tested. RESULTS: Compared with Single-N methods, the filtration efficiency, moisture resistance and anti-synthetic blood penetration of the Double-ND and Double-DN methods had no significant difference, the moisture permeability was significantly lower than that of Single-N mode(P<0.05), and the respiratory resistance was significantly higher than that of Single-N mode(P<0.05). Compared with Single-D modes, the moisture resistance and synthetic blood penetration of Double-DD had no significant difference, the filtration efficiency was significantly higher than that of Single-D mode(P<0.05), the moisture permeability was significantly lower than that of Single-D mode(P<0.05), and the respiratory resistance was significantly higher than that of Single-D mode(P<0.05). CONCLUSION: The Single-layer N95 wearing mode(Single-N) is sufficient to meet the protection requirements. The double-layer wearing mode(Double-ND, Double-DN, Double-DD) seriously affects the wearing comfort and increases the risk of infection and leakage, which is not recommended for use.

Research progress on characteristics, epidemiology and control measure of SARS-CoV-2 Delta VOC

COVID-2019 has become a global pandemic, and a variety of SARS-CoV-2 variants have emerged with the continuous evolution and variation. SARS-CoV-2 Delta VOC (B.1.617.2) has the characteristics of strong transmission, short incubation period of infection, high pathogenicity and rapid disease progression, which has gradually become the main epidemic strain in India and even in the world, leading to countries and regions of the epidemic rebound. In this paper, the current epidemic characteristics and core control measures of SARS-CoV-2 Delta VOC was reviewed.

Incidence and outcomes of patients with COVID-19 associated pulmonary aspergillosis (CAPA) in intensive care units: a systematic review and meta-analysis of 31 cohort studies.

BACKGROUND: We aimed to identify studies systematically that describe the incidence and outcome of COVID-19-related pulmonary aspergillosis (CAPA). METHODS: We searched ScienceDirect, PubMed, CNKI, and MEDLINE (OVID) from December 31, 2019 to November 20, 2021 for all eligible studies. Random-model was used to reported the incidence, all-cause case fatality rate (CFR) and 95% confidence intervals (CIs). The meta-analysis was registered with PROSPERO (CRD42021242179). RESULTS: In all, thirty-one cohort studies were included in this study. A total of 3,441 patients with severe COVID-19 admitted to an intensive care unit (ICU) were investigated and 442 cases of CAPA were reported (30 studies). The pooled incidence rate of CAPA was 0.14 (95% CI: 0.11-0.17, I2=0.0%). Twenty-eight studies reported 287 deceased patients and 269 surviving patients. The pooled CFR of CAPA was 0.52 (95% CI: 0.47-0.56, I2=3.9%). Interestingly, patients with COVID19 would develop CAPA at 7.28 days after mechanical ventilation (range, 5.48-9.08 days). No significant publication bias was detected in this meta-analysis. DISCUSSION: Patients with COVID-19 admitted to an ICU might develop CAPA and have high all-cause CFR. We recommend conducting prospective screening for CAPA among patients with severe COVID-19, especially for those who receive mechanical ventilation over 7 days.

Consideration of the infection prevention and control mode in designated hospitals in response to local outbreaks of COVID-19

OBJECTIVE: To investigate the mode of prevention and control during local outbreaks of Corona virus disease 2019 (COVID-19), and to provide a basis for effective prevention of nosocomial infection. METHODS: Based on the working mode of the state council to prevent and control local outbreaks of COVID-19, the national technical guidelines on COVID-19 prevention and control, and the experience of fighting against COVID-19, working mode of nosocomial infection prevention and control team under the new mode were explored and analyzed. RESULTS: COVID-19 nosocomial infection prevention and control required scientific standards, multiple measures and precise control. Infection prevention and control teams should focus on environmental safety and personnel safety. Therefore, the effectiveness of the work should focus on improving the organizational structure, infection risk assessment in designated hospitals, establishing rules and regulations and working processes, establishing working mechanisms, standardizing information reporting and other aspects, and ensuring the implementation of prevention and control measures through supervision, monitoring, training and guidance. CONCLUSION: Nosocomial infection has a serious impact on COVID-19 response. Infection prevention and control teams need to establish a scientific and effective working mode to implement precise policies and scientific prevention and control, which can effectively prevent and control nosocomial infection incidents in COVID-19 response.

COVID-19 Vaccines: Particulate Alum via Pickering Emulsion for an Enhanced COVID-19 Vaccine Adjuvant (Adv. Mater. 40/2020)

For enhanced COVID-19 vaccines, in article number 2004210, Yufei Xia, Guanghui Ma, and co-workers pack licensed alum on a squalene/water interphase. Thereby, this century-old adjuvant ?travels through time? in a new form of alum-stabilized Pickering emulsion (PAPE), which not only inherits the clinically acknowledged biosafety, but also demonstrates enhanced cellular uptake and cross-presentation of antigens for potent humoral and cellular responses.

Particulate Alum via Pickering Emulsion for an Enhanced COVID-19 Vaccine Adjuvant.

For rapid response against the prevailing COVID-19 (coronavirus disease 19), it is a global imperative to exploit the immunogenicity of existing formulations for safe and efficient vaccines. As the most accessible adjuvant, aluminum hydroxide (alum) is still the sole employed adjuvant in most countries. However, alum tends to attach on the membrane rather than entering the dendritic cells (DCs), leading to the absence of intracellular transfer and process of the antigens, and thus limits T-cell-mediated immunity. To address this, alum is packed on the squalene/water interphase is packed, forming an alum-stabilized Pickering emulsion (PAPE). "Inheriting" from alum and squalene, PAPE demonstrates a good biosafety profile. Intriguingly, with the dense array of alum on the oil/water interphase, PAPE not only adsorbs large quantities of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) antigens, but also harbors a higher affinity for DC uptake, which provokes the uptake and cross-presentation of the delivered antigens. Compared with alum-treated groups, more than six times higher antigen-specific antibody titer and three-fold more IFN-γ-secreting T cells are induced, indicating the potent humoral and cellular immune activations. Collectively, the data suggest that PAPE may provide potential insights toward a safe and efficient adjuvant platform for the enhanced COVID-19 vaccinations.