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.

Characteristics and Occurrence Scenarios of Staff Exposed to SARS-CoV-2 Omicron in Shanghai Lingang Fangcang Shelter Hospital, CHINA.

Objective: To analyze the characteristics and occurrence scenarios of occupational exposure of staff in the Shanghai Lingang Fangcang Shelter Hospital. Methods: We collected the data of 80 staff with occupational exposure (including doctors, nurses, cleaning, security guards, and maintenance staff) in the Shanghai Lingang Fangcang Shelter Hospital from April 5 to May 20, 2022. The basic information of occupational exposure, factors influencing different occupational exposure types, ways to discover occupational exposure, discovery places of occupational exposure, and specific occurrence scenarios were compiled and analyzed among these data. Results: Occupational exposure mainly occurred in nurses (37, 46.25%), and cleaning (21, 26.25%). After the occurrence of occupational exposure, 20 staff (25%) did not know the occurrence time. Moreover, occupational exposure types were listed from high to low proportion as follows: broken protective clothing (56, 70%), mask loosening or displacement (13, 16.25%), skin exposure (6, 7.5%), and sharp object injuries (5, 6.25%). Occupational exposure was discovered mainly through self-discovery (56, 70%), while other discovery ways were majorly colleague discovery (12, 15%) and infection control supervisor discovery (12, 15%). Furthermore, occupational exposure was discovered principally in the public area (53.75%) and the office area (25%) of the cabin, but the proportion of mask loosening or displacement (38.46%) and skin exposure (50%) was also high in the first unloading area. Broken protective clothing occurred in the following scenarios: scratching while working in the cabin (37, 66.07%) and not knowing its occurrence time (25%). The occurrence scenarios of mask loosening or displacement were mainly not knowing its occurrence time (6, 46.15%), self-discovery (3, 23.08%), and at the time of removal (3, 23.08%). Conclusion: Targeted training and prevention of occupational exposure should be performed to decrease infection risk and ensure staff safety in Fangcang shelter hospitals.

Impact of the COVID-19 pandemic and corresponding control measures on long-term care facilities: a systematic review and meta-analysis.

BACKGROUND: Long-term care facilities (LTCFs) were high-risk settings for COVID-19 outbreaks. OBJECTIVE: To assess the impacts of the COVID-19 pandemic on LTCFs, including rates of infection, hospitalisation, case fatality, and mortality, and to determine the association between control measures and SARS-CoV-2 infection rates in residents and staff. METHOD: We conducted a systematic search of six databases for articles published between December 2019 and 5 November 2021, and performed meta-analyses and subgroup analyses to identify the impact of COVID-19 on LTCFs and the association between control measures and infection rate. RESULTS: We included 108 studies from 19 countries. These studies included 1,902,044 residents and 255,498 staff from 81,572 LTCFs, among whom 296,024 residents and 36,807 staff were confirmed SARS-CoV-2 positive. The pooled infection rate was 32.63% (95%CI: 30.29 ~ 34.96%) for residents, whereas it was 10.33% (95%CI: 9.46 ~ 11.21%) for staff. In LTCFs that cancelled visits, new patient admissions, communal dining and group activities, and vaccinations, infection rates in residents and staff were lower than the global rate. We reported the residents' hospitalisation rate to be 29.09% (95%CI: 25.73 ~ 32.46%), with a case-fatality rate of 22.71% (95%CI: 21.31 ~ 24.11%) and mortality rate of 15.81% (95%CI: 14.32 ~ 17.30%). Significant publication biases were observed in the residents' case-fatality rate and the staff infection rate, but not in the infection, hospitalisation, or mortality rate of residents. CONCLUSION: SARS-CoV-2 infection rates would be very high among LTCF residents and staff without appropriate control measures. Cancelling visits, communal dining and group activities, restricting new admissions, and increasing vaccination would significantly reduce the infection rates.

Current situation of construction and management of infectious diseases department and fever clinics in medical institutions in Jiangsu Province

OBJECTIVE: To analyze theconstruction of infectious diseases departments and fever clinics in medical institutions at all levels in Jiangsu Province after the COVID-19 epidemic, and to provide a basis for promoting their standardized construction. METHODS: A questionnaire survey was conducted on the construction of infectious diseases departments and fever clinics in 429 medical institutions of Jiangsu Province from July to December 2020, including the overview of medical institutions, the construction status of infectious diseases departments, the construction status and future construction plans of fever clinics, etc. RESULTS: The construction rate of infectious diseases department and fever clinics in medical institutions of Jiangsu province were 33.3% and 75.3% respectively. Ventilation by opening window for was the main form of airflow organization in infectious diseases department and fever clinics, and independent ICUs and negative pressure wards were not set up in most of infectious diseases departments. The setting rate of "three zones and two channels" in fever clinics was high(96.9%), but most of them were not equipped with special CT for fever clinics patients. The proportion of air conditioning and ventilation system without air disinfection devices in the of fever clinics of medical institutions at all levels was higher than 90%. Considering the both hardware construction and quality management, the situation in tertiary medical institutions were superior to secondary medical institutions, and secondary medical institutions were superior to primary medical institutions. Various construction indicators and management systems failed to fully meet the requirements of documents and standards. CONCLUSION: Jiangsu province actively promotes the construction of infectious diseases department and fever clinic layout, but there is still a gap with the construction standard, which is necessary to further promote standardized construction. We should mend the shortages, strengthen the weakness, expand the bases, comprehensively improve the service and anti-epidemic capacity of infectious diseases departments, fever clinics and even the entire medical and health system, so as to better serve the health and life safety of the people.

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.

Effect Analysis of "Four-Step" Training and Assessment Tool in the Prevention and Control of COVID-19.

Purpose: To improve the ability of infection prevention and control (IPC) of medical staff during the COVID-19 epidemic period, the "four-step" mode of whole staff training and assessment was used. Methods: During the period from March 9 to March 18, 2020, 5425 medical staff from The First Affiliated Hospital of Nanjing Medical University were selected as the objects of this study. There are four stages in the training assessment mode. The first stage is the basic assessment stage; the second stage releases the electronic version of the knowledge point manual; the third stage conducts online exercises; the fourth stage conducts the final assessment. Results: In the first stage, the participation rate of medical staff was 95.04%. In the fourth stage, the participation rate of medical staff was 98.01%. The average score of female medical staff in the first stage and the fourth stage was higher than that of males (P< 0.001). The average score of medical staff under 30 years old in the first stage and the fourth stage was higher than that of other age groups (P< 0.05). In the fourth stage, the correct rate of each part of exercises in the knowledge points of IPC was higher than that in the first stage (P< 0.001). In the two stages, the two parts of "COVID-19 prevention and control" and "multi-drug resistant bacteria prevention and control" had the highest accuracy, while the "disinfection and sterilization" and "infectious disease management" had the lowest accuracy (P< 0.001). Conclusion: The "four-step" infection control training assessment mode has realized "full participation" and "effective training", and the level of medical staff's IPC has been significantly improved.

Effect of training of all staff and influencing factors in Huangshi, Hubei Province during prevention and control of COVID-19 in March 2020

Objective: To understand the status of acquisition of knowledge of infection control and observe the effect of training and influencing factors in Huangshi, Hubei province during prevention and control of COVID-19.

Three types of massive screening for body temperature during prevention and control of COVID-19

OBJECTIVE: To study three different large-scale body temperature screening methods during the prevention and control period of COVID-19, so as to select appropriate body temperature screening methods for medical institutions. METHODS: Body temperatures of 874 pre-diagnosed patients was screened by infrared thermography, frontal thermography (forehead measurement) and aural thermography. Each patient was measured once independently by three methods, and gender and body temperature were recorded. The screening effect of three methods on fever patients with different genders and at different environment temperatures were analyzed. RESULTS: The average body temperatures detected by thermal imager, ear thermometer and frontal thermometer were as the following: ear thermometer> frontal thermometer > thermal imager. The coefficient of variation was frontal thermometer (1.359%) > ear thermometer(1.186%) > thermal imager (1.090%). The difference between the three methods was significant (P < 0.001). When ear thermometer and frontal thermometer were used to screen body temperature, the body temperature of male was higher than that of female, and the difference was significant (P<0.001). Among the three methods of temperature measurement, the average body temperature of group C (outdoor temperature 6-19 degrees C) was significantly higher than that of group A(outdoor temperature 1-6 degrees C) and group B (outdoor temperature 1-10 degrees C). The difference was statistically significant (P < 0.001). Ten suspected febrile patients were screened by thermal imager, but no suspected febrile patients were detected by frontal thermometer and ear thermometer, and the difference was significant (P < 0.05). CONCLUSION: The thermal imager has higher stability and accuracy and less affected by sex and outdoor temperature, and it should be used in large-scale body temperature screening for febrile patients.

Sexual health (excluding reproductive health, intimate partner violence and gender-based violence) and COVID-19: a scoping review.

OBJECTIVES: The COVID-19 pandemic has exposed and exacerbated existing socioeconomic and health disparities, including disparities in sexual health and well-being. While there have been several reviews published on COVID-19 and population health disparities generally-including some with attention to HIV-none has focused on sexual health (ie, STI care, female sexual health, sexual behaviour). We have conducted a scoping review focused on sexual health (excluding reproductive health (RH), intimate partner violence (IPV) and gender-based violence (GBV)) in the COVID-19 era, examining sexual behaviours and sexual health outcomes. METHODS: A scoping review, compiling both peer-reviewed and grey literature, focused on sexual health (excluding RH, IPV and GBV) and COVID-19 was conducted on 15 September 2020. Multiple bibliographical databases were searched. Study selection conformed to Joanna Briggs Institute (JBI) Reviewers' Manual 2015 Methodology for JBI Scoping Reviews. We only included English-language original studies. RESULTS: We found that men who have sex with men may be moving back toward pre-pandemic levels of sexual activity, and that STI and HIV testing rates seem to have decreased. There was minimal focus on outcomes such as the economic impact on sexual health (excluding RH, IPV and GBV) and STI care, especially STI care of marginalised populations. In terms of population groups, there was limited focus on sex workers or on women, especially women's sexual behaviour and mental health. We noticed limited use of qualitative techniques. Very few studies were in low/middle-income countries (LMICs). CONCLUSIONS: Sexual health research is critical during a global infectious disease pandemic and our review of studies suggested notable research gaps. Researchers can focus efforts on LMICs and under-researched topics within sexual health and explore the use of qualitative techniques and interventions where appropriate.

Sexual health and COVID-19: protocol for a scoping review.

BACKGROUND: Global responses to the COVID-19 pandemic have exposed and exacerbated existing socioeconomic and health inequities that disproportionately affect the sexual health and well-being of many populations, including people of color, ethnic minority groups, women, and sexual and gender minority populations. Although there have been several reviews published on COVID-19 and health disparities across various populations, none has focused on sexual health. We plan to conduct a scoping review that seeks to fill several of the gaps in the current knowledge of sexual health in the COVID-19 era. METHODS: A scoping review focusing on sexual health and COVID-19 will be conducted. We will search (from January 2020 onwards) CINAHL, Africa-Wide Information, Web of Science Core Collection, Embase, Gender Studies Database, Gender Watch, Global Health, WHO Global Literature on Coronavirus Disease Database, WHO Global Index Medicus, PsycINFO, MEDLINE, and Sociological Abstracts. Grey literature will be identified using Disaster Lit, Google Scholar, governmental websites, and clinical trials registries (e.g., ClinicalTrial.gov , World Health Organization, International Clinical Trials Registry Platform, and International Standard Randomized Controlled Trial Number Registry). Study selection will conform to the Joanna Briggs Institute Reviewers' Manual 2015 Methodology for JBI Scoping Reviews. Only English language, original studies will be considered for inclusion. Two reviewers will independently screen all citations, full-text articles, and abstract data. A narrative summary of findings will be conducted. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., content and thematic analysis) methods. DISCUSSION: Original research is urgently needed to mitigate the risks of COVID-19 on sexual health. The planned scoping review will help to address this gap. SYSTEMATIC REVIEW REGISTRATIONS: Systematic Review Registration: Open Science Framework osf/io/PRX8E.

Multicenter investigation of current status of use of personal protective equipment among healthcare workers during diagnosis and treatment of COVID-19

OBJECTIVE: To investigate the use of personal protective equipment (PPE) of healthcare workers (HCWs) in the room where confirmed COVID-19 patients are admitted and understand the current status of prevention. METHODS: The healthcare workers who from medical aid teams in Hubei in 30 hospitals were randomly selected by the trained staff for hospital infection prevention, the basic characteristics of the enrolled subjects and the use of PPE were recorded, and the questionnaires were filled out through questionnaire star. RESULTS: The survey found that all the healthcare workers received theoretical training and practical training on the use of PPE before entering the isolation ward, 95.56% (2 433) of them were inspected or supervised by someone when they put on or took off PPE. 86.57% (2 204) of the healthcare workers wore two layers of masks at the same time, most of whom (1621, 63.67%) wore medical surgical mask and respirator at the same time. 57.50% (1 464) of the healthcare workers used goggles or face shield, 42.50% (1 082) of whom used goggles and face shield at the same time. 95.25% (2 425) of the healthcare workers wore coverall and disposable gown at the same time. 96.62% (2 460) of the healthcare workers wore boot covers and shoe covers at the same time. The proportion of the healthcare workers who wore two-layer hats was the highest (70.54%), and the proportion of the healthcare workers who wore two-layer gloves was also the highest (57.31%). CONCLUSION The use of PPE of the HCWs who are from the medical aid teams has effectively prevented the COVID-19 infection, achieving a 'zero infection' among the 42.6 thousand HCWs. However, there are excessive use of PPE, and the rational use of PPE needs to be further standardized and explored.

Preparedness and Responses Faced during the COVID-19 Pandemic in Belgium: An Observational Study and Using the National Open Data.

This study aimed to descript the Belgian COVID-19 responses process according to the WHO's (World Health Organization) Health Emergency and Disaster Risk Management Framework (Health EDRM Framework) and to present the measures taken and epidemic impact in the different phases of COVID-19 in Belgium. The WHO's EDRM Framework was used for reviewing the Belgian Public health emergency preparedness and responses in the context of COVID-19. Information on the measures taken was collected through the literature review including all government's communication, reports, and scientific papers. All epidemic data were extracted from a national open database managed and published by the Sciensano. Additionally, two authors closely followed the Belgian situation since the beginning of the pandemic and updated the data every day. During the COVID-19 pandemic, the anti-epidemic strategy was mainly to avoid medical resources exceeding the upper limit. Belgium issued a series of emergency decrees to limit the spread of the virus. An existing structure of "federal-region-municipal" as the framework of public health emergency preparedness and response was adapted. The emergency response process in Belgium was divided into four phases: information-evaluation-coordination-decision-making at the region level and the final decision-making at the federal level. Belgium also implemented a phased plan in the process of setting up and lifting the lockdown. However, it was vulnerable in early response, due to the shortage of medical equipment supplies in general, and more particularly for the long term care facilities (LTCFs). Belgium has achieved an intensive cooperation between stakeholders based on an existing multisectoral emergency organization framework. Legislation, medical insurance, and good communication also played a role in limiting the spread of viruses. However, the authorities underestimated the risk of an epidemic and did not take quarantine measures among people suspected affected by SARS-COV-2 in the early stages, resulting in insufficient medical equipment supply and a large number of deaths in the LTCF. The implementation of the lockdown measure in Belgium also encountered obstacles. The lockdown and its exit strategy were both closely related to the pandemic situation and social and economic life. The authorities should strengthen information management, improve the public awareness of the measures, and find out the balance points between the social and economic life and infection control measures.

Preparedness and Responses Faced during the COVID-19 Pandemic in Belgium: An Observational Study and Using the National Open Data

This study aimed to descript the Belgian COVID-19 responses process according to the WHO’s (World Health Organization) Health Emergency and Disaster Risk Management Framework (Health EDRM Framework) and to present the measures taken and epidemic impact in the different phases of COVID-19 in Belgium. The WHO’s EDRM Framework was used for reviewing the Belgian Public health emergency preparedness and responses in the context of COVID-19. Information on the measures taken was collected through the literature review including all government’s communication, reports, and scientific papers. All epidemic data were extracted from a national open database managed and published by the Sciensano. Additionally, two authors closely followed the Belgian situation since the beginning of the pandemic and updated the data every day. During the COVID-19 pandemic, the anti-epidemic strategy was mainly to avoid medical resources exceeding the upper limit. Belgium issued a series of emergency decrees to limit the spread of the virus. An existing structure of “federal-region-municipal”as the framework of public health emergency preparedness and response was adapted. The emergency response process in Belgium was divided into four phases: information-evaluation-coordination-decision-making at the region level and the final decision-making at the federal level. Belgium also implemented a phased plan in the process of setting up and lifting the lockdown. However, it was vulnerable in early response, due to the shortage of medical equipment supplies in general, and more particularly for the long term care facilities (LTCFs). Belgium has achieved an intensive cooperation between stakeholders based on an existing multisectoral emergency organization framework. Legislation, medical insurance, and good communication also played a role in limiting the spread of viruses. However, the authorities underestimated the risk of an epidemic and did not take quarantine measures among people suspected affected by SARS-COV-2 in the early stages, resulting in insufficient medical equipment supply and a large number of deaths in the LTCF. The implementation of the lockdown measure in Belgium also encountered obstacles. The lockdown and its exit strategy were both closely related to the pandemic situation and social and economic life. The authorities should strengthen information management, improve the public awareness of the measures, and find out the balance points between the social and economic life and infection control measures.