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1.
Arch Argent Pediatr ; 119(2): 76-82, 2021 04.
Artículo en Inglés, Español | MEDLINE | ID: covidwho-1183983

RESUMEN

INTRODUCTION: The objective of this study was to analyze available resources, guidelines in use, and preparedness to care for newborn infants at maternity centers in Argentina during the COVID-19 pandemic. METHOD: Cross-sectional study based on a survey administered to medical and nursing staff. In May 2020, Argentine facilities with more than 500 annual births were contacted; 58 % of these were from the public sector. RESULTS: In total, 104/147 facilities answered (71 %). All had guidelines for care during the pandemic, and 93 % indicated they had been trained on how to use them. A companion was not allowed during childbirth in 26 % of private facilities and in 60 % of public ones (p < 0.01). Deferred cord clamping was recommended in 87 %; rooming-in with asymptomatic newborns was promoted in 62 %; breastfeeding using protective measures was recommended in 70 %; and breast milk using a bottle, in 23 %. In 94 %, family visiting in the Neonatology Unit was restricted. Difficulties included the unavailability of individual rooms for symptomatic newborn infants and a potential shortage of health care staff and personal protective equipment. CONCLUSIONS: All facilities are aware of the national guidelines to fight the pandemic. Most have the resources to comply with the recommended protective measures. There is uncertainty as to whether personal protective equipment, staff, and physical space available at the different facilities would be enough if cases increased significantly.


Asunto(s)
/prevención & control , Recursos en Salud/provisión & distribución , Cuidado del Lactante/organización & administración , Control de Infecciones/organización & administración , Servicios de Salud Materna/organización & administración , Argentina/epidemiología , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Política de Salud , Humanos , Cuidado del Lactante/estadística & datos numéricos , Recién Nacido , Control de Infecciones/instrumentación , Control de Infecciones/métodos , Control de Infecciones/estadística & datos numéricos , Masculino , Servicios de Salud Materna/estadística & datos numéricos , Pandemias , Equipo de Protección Personal/provisión & distribución , Guías de Práctica Clínica como Asunto , Embarazo
2.
BMC Health Serv Res ; 21(1): 88, 2021 Jan 26.
Artículo en Inglés | MEDLINE | ID: covidwho-1055818

RESUMEN

BACKGROUND: Hand hygiene (HH) among healthcare workers (HCWs) is critical for infection prevention and control (IPC) in healthcare facilities (HCFs). Nonetheless, it remains a challenge in HCFs, largely due to lack of high-impact and efficacious interventions. Environmental cues and mobile phone health messaging (mhealth) have the potential to improve HH compliance among HCWs, however, these remain under-studied. Our study will determine the impact of mhealth hygiene messages and environmental cues on HH practice among HCWs in the Greater Kampala Metropolitan Area (GKMA). METHODS: The study is a cluster-randomized trial, which will be guided by the behaviour centred design model and theory for behaviour change. During the formative phase, we shall conduct 30 key informants' interviews and 30 semi-structured interviews to explore the barriers and facilitators to HCWs' HH practice. Besides, observations of HH facilities in 100 HCFs will be conducted. Findings from the formative phase will guide the intervention design during a stakeholders' insight workshop. The intervention will be implemented for a period of 4 months in 30 HCFs, with a sample of 450 HCWs who work in maternity and children's wards. HCFs in the control arm will receive innovatively designed HH facilities and supplies. HCWs in the intervention arm, in addition to the HH facilities and supplies, will receive environmental cues and mhealth messages. The main outcome will be the proportion of utilized HH opportunities out of the 9000 HH opportunities to be observed. The secondary outcome will be E. coli concentration levels in 100mls of hand rinsates from HCWs, an indicator of recent fecal contamination and HH failure. We shall run multivariable logistic regression under the generalized estimating equations (GEE) framework to account for the dependence of HH on the intervention. DISCUSSION: The study will provide critical findings on barriers and facilitators to HH practice among HCWs, and the impact of environmental cues and mhealth messages on HCWs' HH practice. TRIAL REGISTRATION: ISRCTN Registry with number ISRCTN98148144 . The trial was registered on 23/11/2020.


Asunto(s)
Higiene de las Manos/métodos , Telemedicina , Actitud del Personal de Salud , Señales (Psicología) , Adhesión a Directriz , Personal de Salud , Humanos , Control de Infecciones/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Uganda
4.
A A Pract ; 15(3): e01417, 2021 Mar 09.
Artículo en Inglés | MEDLINE | ID: covidwho-1151700

RESUMEN

Health care workers performing aerosolizing procedures on patients with transmissible infections such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are at high-risk for disease acquisition. Current guidelines designed to protect health care workers during aerosolizing procedures prioritize personal protective equipment and enhanced infection control techniques, in particular during procedures such as intubation. To date, little emphasis has been placed on risk mitigation in the setting of bronchoscopy, a procedure that has significant aerosolization potential. Herein, we present an innovative closed bronchoscopy system designed to reduce aerosolization during bronchoscopy.


Asunto(s)
Broncoscopía/métodos , Control de Infecciones/métodos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Invenciones , Maniquíes , Broncoscopía/instrumentación , Personal de Salud , Humanos , Equipo de Protección Personal
5.
Emerg Infect Dis ; 27(4): 1229-1231, 2021 04.
Artículo en Inglés | MEDLINE | ID: covidwho-1147201

RESUMEN

Severe acute respiratory syndrome coronavirus 2 can persist on surfaces, suggesting possible surface-mediated transmission of this pathogen. We found that fomites might be a substantial source of transmission risk, particularly in schools and child daycares. Combining surface cleaning and decontamination with mask wearing can help mitigate this risk.


Asunto(s)
Transmisión de Enfermedad Infecciosa/prevención & control , Fómites/virología , Control de Infecciones , /aislamiento & purificación , Anciano , Número Básico de Reproducción , /prevención & control , /virología , Niño , Jardines Infantiles/normas , Descontaminación/métodos , Contaminación de Equipos/prevención & control , Desinfección de las Manos/métodos , Humanos , Control de Infecciones/instrumentación , Control de Infecciones/métodos , Máscaras , Casas de Salud/normas , Instituciones Académicas/normas , Estados Unidos/epidemiología
6.
JAMA Netw Open ; 4(3): e212618, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1146714

RESUMEN

Importance: This study assesses the role of telehealth in the delivery of care at the start of the COVID-19 pandemic. Objectives: To document patterns and costs of ambulatory care in the US before and during the initial stage of the pandemic and to assess how patient, practitioner, community, and COVID-19-related factors are associated with telehealth adoption. Design, Setting, and Participants: This is a cohort study of working-age persons continuously enrolled in private health plans from March 2019 through June 2020. The comparison periods were March to June in 2019 and 2020. Claims data files were provided by Blue Health Intelligence, an independent licensee of the Blue Cross and Blue Shield Association. Data analysis was performed from June to October 2020. Main Outcomes and Measures: Ambulatory encounters (in-person and telehealth) and allowed charges, stratified by characteristics derived from enrollment files, practitioner claims, and community characteristics linked to the enrollee's zip code. Results: A total of 36 568 010 individuals (mean [SD] age, 35.71 [18.77] years; 18 466 557 female individuals [50.5%]) were included in the analysis. In-person contacts decreased by 37% (from 1.63 to 1.02 contacts per enrollee) from 2019 to 2020. During 2020, telehealth visits (0.32 visit per person) accounted for 23.6% of all interactions compared with 0.3% of contacts in 2019. When these virtual contacts were added, the overall COVID-19 era patient and practitioner visit rate was 18% lower than that in 2019 (1.34 vs 1.64 visits per person). Behavioral health encounters were far more likely than medical contacts to take place virtually (46.1% vs 22.1%). COVID-19 prevalence in an area was associated with higher use of telehealth; patients from areas within the top quintile of COVID-19 prevalence during the week of their encounter were 1.34 times more likely to have a telehealth visit compared with those in the lowest quintile (the reference category). Persons living in areas with limited social resources were less likely to use telehealth (most vs least socially advantaged neighborhoods, 27.4% vs 19.9% usage rates). Per enrollee medical care costs decreased by 15% between 2019 and 2020 (from $358.32 to $306.04 per person per month). During 2020, those with 1 or more COVID-19-related service (1 470 721 members) had more than 3 times the medical costs ($1701 vs $544 per member per month) than those without COVID-19-related services. Persons with 1 or more telehealth visits in 2020 had considerably higher costs than persons having only in-person ambulatory contacts ($2214.10 vs $1337.78 for the COVID-19-related subgroup and $735.87 vs $456.41 for the non-COVID-19 subgroup). Conclusions and Relevance: This study of a large cohort of patients enrolled in US health plans documented patterns of care at the onset of COVID-19. The findings are relevant to policy makers, payers, and practitioners as they manage the use of telehealth during the pandemic and afterward.


Asunto(s)
Atención Ambulatoria , Pautas de la Práctica en Medicina , Telemedicina , Adulto , Atención Ambulatoria/economía , Atención Ambulatoria/métodos , Atención Ambulatoria/estadística & datos numéricos , /prevención & control , Estudios de Cohortes , Costos y Análisis de Costo , Femenino , Humanos , Control de Infecciones/métodos , Seguro de Salud/estadística & datos numéricos , Masculino , Innovación Organizacional/economía , Pautas de la Práctica en Medicina/economía , Pautas de la Práctica en Medicina/organización & administración , Pautas de la Práctica en Medicina/estadística & datos numéricos , Telemedicina/economía , Telemedicina/organización & administración , Telemedicina/estadística & datos numéricos , Estados Unidos/epidemiología
7.
J Trauma Acute Care Surg ; 90(4): e72-e80, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1145212

RESUMEN

BACKGROUND: Health care facilities in low- and middle-income countries are inadequately resourced to adhere to current COVID-19 prevention recommendations. Recommendations for surgical emergency trauma care measures need to be adequately informed by available evidence and adapt to particular settings. To inform future recommendations, we set to summarize the effects of different personal protective equipment (PPE) on the risk of COVID-19 infection in health personnel caring for trauma surgery patients. METHODS: We conducted an umbrella review using Living Overview of Evidence platform for COVID-19, which performs regular automated searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and more than 30 other sources. Systematic reviews of experimental and observational studies assessing the efficacy of PPE were included. Indirect evidence from other health care settings was also considered. Risk of bias was assessed with the AMSTAR II tool (Assessing the Methodological Quality of Systematic Reviews, Ottawa, ON, Canada), and the Grading of Recommendations, Assessment, Development, and Evaluation approach for grading the certainty of the evidence is reported (registered in International Prospective Register of Systematic Reviews, CRD42020198267). RESULTS: Eighteen studies that fulfilled the selection criteria were included. There is high certainty that the use of N95 respirators and surgical masks is associated with a reduced risk of COVID-19 when compared with no mask use. In moderate- to high-risk environments, N95 respirators are associated with a further reduction in risk of COVID-19 infection compared with surgical masks. Eye protection also reduces the risk of contagion in this setting. Decontamination of masks and respirators with ultraviolet germicidal irradiation, vaporous hydrogen peroxide, or dry heat is effective and does not affect PPE performance or fit. CONCLUSION: The use of PPE drastically reduces the risk of COVID-19 compared with no mask use in health care workers. N95 and equivalent respirators provide more protection than surgical masks. Decontamination and reuse appear feasible to overcome PPE shortages and enhance the allocation of limited resources. These effects are applicable to emergency trauma care and should inform future recommendations. LEVEL OF EVIDENCE: Review, level II.


Asunto(s)
/prevención & control , Personal de Salud , Control de Infecciones , Máscaras , Servicio de Cirugía en Hospital , Centros Traumatológicos , /epidemiología , Descontaminación/métodos , Equipo Reutilizado , Humanos , Control de Infecciones/instrumentación , Control de Infecciones/métodos , Máscaras/normas , Máscaras/virología , /virología , Equipo de Protección Personal/clasificación , Equipo de Protección Personal/normas
8.
Int J Qual Health Care ; 33(Supplement_1): 51-55, 2021 Jan 12.
Artículo en Inglés | MEDLINE | ID: covidwho-1139994

RESUMEN

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.


Asunto(s)
Control de Infecciones/métodos , Procedimientos Quirúrgicos Operativos/normas , Antibacterianos/uso terapéutico , Infección Hospitalaria/prevención & control , Monitoreo Epidemiológico , Ergonomía/métodos , Higiene de las Manos , Humanos , Control de Infecciones/normas
10.
J Transl Med ; 19(1): 109, 2021 03 16.
Artículo en Inglés | MEDLINE | ID: covidwho-1136231

RESUMEN

BACKGROUND: No versatile web app exists that allows epidemiologists and managers around the world to comprehensively analyze the impacts of COVID-19 mitigation. The http://covid-webapp.numerusinc.com/ web app presented here fills this gap. METHODS: Our web app uses a model that explicitly identifies susceptible, contact, latent, asymptomatic, symptomatic and recovered classes of individuals, and a parallel set of response classes, subject to lower pathogen-contact rates. The user inputs a CSV file of incidence and, if of interest, mortality rate data. A default set of parameters is available that can be overwritten through input or online entry, and a user-selected subset of these can be fitted to the model using maximum-likelihood estimation (MLE). Model fitting and forecasting intervals are specifiable and changes to parameters allow counterfactual and forecasting scenarios. Confidence or credible intervals can be generated using stochastic simulations, based on MLE values, or on an inputted CSV file containing Markov chain Monte Carlo (MCMC) estimates of one or more parameters. RESULTS: We illustrate the use of our web app in extracting social distancing, social relaxation, surveillance or virulence switching functions (i.e., time varying drivers) from the incidence and mortality rates of COVID-19 epidemics in Israel, South Africa, and England. The Israeli outbreak exhibits four distinct phases: initial outbreak, social distancing, social relaxation, and a second wave mitigation phase. An MCMC projection of this latter phase suggests the Israeli epidemic will continue to produce into late November an average of around 1500 new case per day, unless the population practices social-relaxation measures at least 5-fold below the level in August, which itself is 4-fold below the level at the start of July. Our analysis of the relatively late South African outbreak that became the world's fifth largest COVID-19 epidemic in July revealed that the decline through late July and early August was characterised by a social distancing driver operating at more than twice the per-capita applicable-disease-class (pc-adc) rate of the social relaxation driver. Our analysis of the relatively early English outbreak, identified a more than 2-fold improvement in surveillance over the course of the epidemic. It also identified a pc-adc social distancing rate in early August that, though nearly four times the pc-adc social relaxation rate, appeared to barely contain a second wave that would break out if social distancing was further relaxed. CONCLUSION: Our web app provides policy makers and health officers who have no epidemiological modelling or computer coding expertise with an invaluable tool for assessing the impacts of different outbreak mitigation policies and measures. This includes an ability to generate an epidemic-suppression or curve-flattening index that measures the intensity with which behavioural responses suppress or flatten the epidemic curve in the region under consideration.


Asunto(s)
/epidemiología , Control de Infecciones , Internet , Aplicaciones Móviles , /etiología , Simulación por Computador , Modificador del Efecto Epidemiológico , Inglaterra/epidemiología , Epidemias , Predicción/métodos , Humanos , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Control de Infecciones/normas , Israel/epidemiología , Cadenas de Markov , Vigilancia de la Población/métodos , Factores de Riesgo , Sudáfrica/epidemiología
11.
J Med Internet Res ; 23(3): e23231, 2021 03 08.
Artículo en Inglés | MEDLINE | ID: covidwho-1127908

RESUMEN

BACKGROUND: Given the public health responses to previous respiratory disease pandemics, and in the absence of treatments and vaccines, the mitigation of the COVID-19 pandemic relies on population engagement in nonpharmaceutical interventions. This engagement is largely driven by risk perception, anxiety levels, and knowledge, as well as by historical exposure to disease outbreaks, government responses, and cultural factors. OBJECTIVE: The aim of this study is to compare psychobehavioral responses in Hong Kong and the United Kingdom during the early phase of the COVID-19 pandemic. METHODS: Comparable cross-sectional surveys were administered to adults in Hong Kong and the United Kingdom during the early phase of the epidemic in each setting. Explanatory variables included demographics, risk perception, knowledge of COVID-19, anxiety level, and preventive behaviors. Responses were weighted according to census data. Logistic regression models, including effect modification to quantify setting differences, were used to assess the association between the explanatory variables and the adoption of social distancing measures. RESULTS: Data from 3431 complete responses (Hong Kong, 1663; United Kingdom, 1768) were analyzed. Perceived severity of symptoms differed by setting, with weighted percentages of 96.8% for Hong Kong (1621/1663) and 19.9% for the United Kingdom (366/1768). A large proportion of respondents were abnormally or borderline anxious (Hong Kong: 1077/1603, 60.0%; United Kingdom: 812/1768, 46.5%) and regarded direct contact with infected individuals as the transmission route of COVID-19 (Hong Kong: 94.0%-98.5%; United Kingdom: 69.2%-93.5%; all percentages weighted), with Hong Kong identifying additional routes. Hong Kong reported high levels of adoption of various social distancing measures (Hong Kong: 32.6%-93.7%; United Kingdom: 17.6%-59.0%) and mask-wearing (Hong Kong: 98.8% (1647/1663); United Kingdom: 3.1% (53/1768)). The impact of perceived severity of symptoms and perceived ease of transmission of COVID-19 on the adoption of social distancing measures varied by setting. In Hong Kong, these factors had no impact, whereas in the United Kingdom, those who perceived their symptom severity as "high" were more likely to adopt social distancing (adjusted odds ratios [aORs] 1.58-3.01), and those who perceived transmission as "easy" were prone to adopt both general social distancing (aOR 2.00, 95% CI 1.57-2.55) and contact avoidance (aOR 1.80, 95% CI 1.41-2.30). The impact of anxiety on adopting social distancing did not vary by setting. CONCLUSIONS: Our results suggest that health officials should ascertain baseline levels of risk perception and knowledge in populations, as well as prior sensitization to infectious disease outbreaks, during the development of mitigation strategies. Risk should be communicated through suitable media channels-and trust should be maintained-while early intervention remains the cornerstone of effective outbreak response.


Asunto(s)
/epidemiología , Brotes de Enfermedades/prevención & control , Transmisión de Enfermedad Infecciosa/prevención & control , Opinión Pública , Adolescente , Adulto , /virología , Estudios Transversales , Femenino , Hong Kong/epidemiología , Humanos , Control de Infecciones/métodos , Masculino , Persona de Mediana Edad , Pandemias , Encuestas y Cuestionarios , Reino Unido/epidemiología , Adulto Joven
12.
J Med Internet Res ; 23(3): e19473, 2021 03 10.
Artículo en Inglés | MEDLINE | ID: covidwho-1127901

RESUMEN

BACKGROUND: COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, has become a global pandemic, affecting most countries worldwide. Digital health information technologies can be applied in three aspects, namely digital patients, digital devices, and digital clinics, and could be useful in fighting the COVID-19 pandemic. OBJECTIVE: Recent reviews have examined the role of digital health in controlling COVID-19 to identify the potential of digital health interventions to fight the disease. However, this study aims to review and analyze the digital technology that is being applied to control the COVID-19 pandemic in the 10 countries with the highest prevalence of the disease. METHODS: For this review, the Google Scholar, PubMed, Web of Science, and Scopus databases were searched in August 2020 to retrieve publications from December 2019 to March 15, 2020. Furthermore, the Google search engine was used to identify additional applications of digital health for COVID-19 pandemic control. RESULTS: We included 32 papers in this review that reported 37 digital health applications for COVID-19 control. The most common digital health projects to address COVID-19 were telemedicine visits (11/37, 30%). Digital learning packages for informing people about the disease, geographic information systems and quick response code applications for real-time case tracking, and cloud- or mobile-based systems for self-care and patient tracking were in the second rank of digital tool applications (all 7/37, 19%). The projects were deployed in various European countries and in the United States, Australia, and China. CONCLUSIONS: Considering the potential of available information technologies worldwide in the 21st century, particularly in developed countries, it appears that more digital health products with a higher level of intelligence capability remain to be applied for the management of pandemics and health-related crises.


Asunto(s)
/epidemiología , Prestación de Atención de Salud/métodos , Control de Infecciones/métodos , Tecnología de la Información/normas , Telemedicina/organización & administración , Humanos , Pandemias , Prevalencia , /aislamiento & purificación
13.
Medicine (Baltimore) ; 100(5): e24503, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: covidwho-1125447

RESUMEN

ABSTRACT: Recently, the coronavirus disease 2019 (COVID-19) epidemic has greatly threatened global public health. The responsibility of healthcare-associated infection control professionals (ICPs) is to prevent and control the nosocomial infections. The mental health status of ICPs deserves more attention, however, the correlational research is still lacking. This study aims to investigate the incidence and risk factors of mental health status among ICPs in China during the outbreak of COVID-19.A national cross-sectional survey was performed. The online questionnaire was completed by 9228 ICPs from 3776 hospitals throughout China. Data collection tools were used, including demographics data questionnaire, the Chinese version of the 12-item general health questionnaire (GHQ-12) and the Chinese version of the psychological capital questionnaire (PCQ) for medical staff. Univariate and multivariable analyses were conducted.The total score of mental health of Chinese ICPs was 3.45 ±â€Š2.57. 5608 (60.77%) ICPs might have mental health problems. The psychological capital was in the upper-middle level with an average score of 3.72 ±â€Š0.38. An increased mental health problem risk was associated with the greater self-efficacy and working in the public hospital; a significantly lower risk was obtained by working in the second-class hospital rather than in the third-class hospitals. Besides, mental health problem risk of ICPs working in hospitals of the western economic region or northeast economic region was more significant than that in hospitals of the central economic region. However, a lower risk was caused by the unmarried than married, and working years in department ≤1 year contributed to the lower risk than that >20 years. Moreover, fewer working hours per week, higher values of hope, and optimism each were contributed to a lower risk.Chinese healthcare-associated ICPs were under different levels of mental health problems in fighting against COVID-19. More importantly, we should actively deal with the mental health problem of ICPs and help them get rid of psychological disorders.


Asunto(s)
Infección Hospitalaria , Profesionales para Control de Infecciones , Control de Infecciones , Exposición Profesional , Estrés Laboral , Adulto , /prevención & control , China/epidemiología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Estudios Transversales , Femenino , Humanos , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Profesionales para Control de Infecciones/psicología , Profesionales para Control de Infecciones/estadística & datos numéricos , Masculino , Salud Mental/estadística & datos numéricos , Exposición Profesional/prevención & control , Exposición Profesional/estadística & datos numéricos , Estrés Laboral/epidemiología , Estrés Laboral/etiología , Estrés Laboral/prevención & control , Medición de Riesgo , Encuestas y Cuestionarios
14.
Medicine (Baltimore) ; 100(5): e24409, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: covidwho-1125185

RESUMEN

ABSTRACT: Infection with the SARS-CoV-2 virus seems to contribute significantly to increased postoperative complications and mortality after emergency surgical procedures. Additionally, the fear of COVID-19 contagion delays the consultation of patients, resulting in the deterioration of their acute diseases by the time of consultation. In the specific case of urgent digestive surgery patients, both factors significantly worsen the postoperative course and prognosis. Main working hypothesis: infection by COVID-19 increases postoperative 30-day-mortality for any cause in patients submitted to emergency/urgent general or gastrointestinal surgery. Likewise, hospital collapse during the first wave of the COVID-19 pandemic increased 30-day-mortality for any cause. Hence, the main objective of this study is to estimate the cumulative incidence of mortality at 30-days-after-surgery. Secondary objectives are: to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for COVID-19-infected patients.A multicenter, observational retrospective cohort study (COVID-CIR-study) will be carried out in consecutive patients operated on for urgent digestive pathology. Two cohorts will be defined: the "pandemic" cohort, which will include all patients (classified as COVID-19-positive or -negative) operated on for emergency digestive pathology during the months of March to June 2020; and the "control" cohort, which will include all patients operated on for emergency digestive pathology during the months of March to June 2019. Information will be gathered on demographic characteristics, clinical and analytical parameters, scores on the usual prognostic scales for quality management in a General Surgery service (POSSUM, P-POSSUM and LUCENTUM scores), prognostic factors applicable to all patients, specific prognostic factors for patients infected with SARS-CoV-2, postoperative morbidity and mortality (at 30 and 90 postoperative days). The main objective is to estimate the cumulative incidence of mortality at 30 days after surgery. As secondary objectives, to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for SARS-CoV-2 infected patients.The protocol (version1.0, April 20th 2020) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation-Committee, code PR169/20, date 05/05/20). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings.ClinicalTrials.gov Identifier: NCT04479150 (July 21, 2020).


Asunto(s)
Enfermedades del Sistema Digestivo , Procedimientos Quirúrgicos del Sistema Digestivo , Tratamiento de Urgencia , Control de Infecciones , Complicaciones Posoperatorias , Tiempo de Tratamiento , Adulto , /prevención & control , Enfermedades del Sistema Digestivo/diagnóstico , Enfermedades del Sistema Digestivo/epidemiología , Enfermedades del Sistema Digestivo/mortalidad , Enfermedades del Sistema Digestivo/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Procedimientos Quirúrgicos del Sistema Digestivo/mortalidad , Urgencias Médicas/epidemiología , Tratamiento de Urgencia/efectos adversos , Tratamiento de Urgencia/métodos , Tratamiento de Urgencia/mortalidad , Femenino , Humanos , Incidencia , Control de Infecciones/métodos , Control de Infecciones/estadística & datos numéricos , Masculino , Mortalidad , Estudios Multicéntricos como Asunto , Estudios Observacionales como Asunto , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Proyectos de Investigación , Medición de Riesgo/métodos
15.
PLoS One ; 16(3): e0248282, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1124945

RESUMEN

Compliance with infection prevention and control (IPC) protocols is critical in minimizing the risk of coronavirus disease (COVID-19) infection among healthcare workers. However, data on IPC compliance among healthcare workers in COVID-19 treatment centers are unknown in Ghana. This study aims to assess IPC compliance among healthcare workers in Ghana's COVID-19 treatment centers. The study was a secondary analysis of data, which was initially collected to determine the level of risk of COVID-19 virus infection among healthcare workers in Ghana. Quantitative data were conveniently collected using the WHO COVID-19 risk assessment tool. We analyzed the data using descriptive statistics and logistic regression analyses. We observed that IPC compliance during healthcare interactions was 88.4% for hand hygiene and 90.6% for Personal Protective Equipment (PPE) usage; IPC compliance while performing aerosol-generating procedures (AGPs), was 97.5% for hand hygiene and 97.5% for PPE usage. For hand hygiene during healthcare interactions, lower compliance was seen among nonclinical staff [OR (odds ratio): 0.43; 95% CI (Confidence interval): 0.21-0.89], and healthcare workers with secondary level qualification (OR: 0.24; 95% CI: 0.08-0.71). Midwives (OR: 0.29; 95% CI: 0.09-0.93) and Pharmacists (OR: 0.15; 95% CI: 0.02-0.92) compliance with hand hygiene was significantly lower than registered nurses. For PPE usage during healthcare interactions, lower compliance was seen among healthcare workers who were separated/divorced/widowed (OR: 0.08; 95% CI: 0.01-0.43), those with secondary level qualifications (OR 0.08; 95% CI 0.01-0.43), non-clinical staff (OR 0.16 95% CI 0.07-0.35), cleaners (OR: 0.16; 95% CI: 0.05-0.52), pharmacists (OR: 0.07; 95% CI: 0.01-0.49) and among healthcare workers who reported of insufficiency of PPEs (OR: 0.33; 95% CI: 0.14-0.77). Generally, healthcare workers' infection prevention and control compliance were high, but this compliance differs across the different groups of health professionals in the treatment centers. Ensuring an adequate supply of IPC logistics coupled with behavior change interventions and paying particular attention to nonclinical staff is critical in minimizing the risk of COVID-19 transmission in the treatment centers.


Asunto(s)
/psicología , Adhesión a Directriz/tendencias , Personal de Salud/psicología , Adulto , Infecciones por Coronavirus/prevención & control , Infección Hospitalaria/prevención & control , Estudios Transversales , Femenino , Ghana/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Control de Infecciones/métodos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Conocimiento , Masculino , Pandemias/prevención & control , Equipo de Protección Personal/tendencias , Encuestas y Cuestionarios , Virosis/transmisión
16.
BMC Nephrol ; 22(1): 81, 2021 03 06.
Artículo en Inglés | MEDLINE | ID: covidwho-1119416

RESUMEN

BACKGROUND: Emory Dialysis serves an urban and predominantly African American population at its four outpatient dialysis facilities. We describe COVID-19 infection control measures implemented and clinical characteristics of patients with COVID-19 in the Emory Dialysis facilities. METHODS: Implementation of COVID-19 infection procedures commenced in February 2020. Subsequently, COVID-19 preparedness assessments were conducted at each facility. Patients with COVID-19 from March 1-May 31, 2020 were included; with a follow-up period spanning March-June 30, 2020. Percentages of patients diagnosed with COVID-19 were calculated, and characteristics of COVID-19 patients were summarized as medians or percentage. Baseline characteristics of all patients receiving care at Emory Dialysis (i.e. Emory general dialysis population) were presented as medians and percentages. RESULTS: Of 751 dialysis patients, 23 (3.1%) were diagnosed with COVID-19. The median age was 67.0 years and 13 patients (56.6%) were female. Eleven patients (47.8%) were residents of nursing homes. Nineteen patients (82.6%) required hospitalization and 6 patients (26.1%) died; the average number of days from a positive SARS-CoV-2 (COVID) test to death was 16.8 days (range 1-34). Two patients dialyzing at adjacent dialysis stations and a dialysis staff who cared for them, were diagnosed with COVID-19 in a time frame that may suggest transmission in the dialysis facility. In response, universal masking in the facility was implemented (prior to national guidelines recommending universal masking), infection control audits and re-trainings of PPE were also done to bolster infection control practices. CONCLUSION: We successfully implemented recommended COVID-19 infection control measures aimed at mitigating the spread of SARS-CoV-2. Most of the patients with COVID-19 required hospitalizations. Dialysis facilities should remain vigilant and monitor for possible transmission of COVID-19 in the facility.


Asunto(s)
Afroamericanos , Instituciones de Atención Ambulatoria/normas , Control de Infecciones/métodos , Diálisis Renal/normas , Poblaciones Vulnerables/etnología , Anciano , /etnología , Susceptibilidad a Enfermedades , Femenino , Georgia , Humanos , Masculino , Persona de Mediana Edad , Telemedicina , Población Urbana
17.
Soc Sci Med ; 274: 113794, 2021 04.
Artículo en Inglés | MEDLINE | ID: covidwho-1118684

RESUMEN

The role of socio-economic conditions has been largely implicit in mathematical epidemiological models. However, measures to address the current pandemic, specifically the relevant interventions proposing physical distancing, have highlighted how social determinants affect contagion and mortality dynamics of COVID-19. For the most part, these social determinants are not present in either policy discussions or in epidemiological models. We argue for the importance of incorporating social determinants of health into the modelling dynamics of COVID-19, and show how global variation of these conditions may be integrated into relevant models. In doing so, we also highlight a key political economy aspect of reproduction dynamics in epidemics.


Asunto(s)
/prevención & control , Control de Enfermedades Transmisibles , Control de Infecciones/métodos , Modelos Teóricos , Determinantes Sociales de la Salud , Humanos , Pandemias/prevención & control , Cuarentena , Factores Socioeconómicos
19.
PLoS One ; 16(3): e0247865, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1115305

RESUMEN

COVID-19 is a global threat with an increasing number of infections. Research on IgG seroprevalence among health care workers (HCWs) is needed to re-evaluate health policies. This study was performed in three pandemic hospitals in Istanbul and Kocaeli. Different clusters of HCWs were screened for SARS-CoV-2 infection. Seropositivity rate among participants was evaluated by chemiluminescent microparticle immunoassay. We recruited 813 non-infected and 119 PCR-confirmed infected HCWs. Of the previously undiagnosed HCWs, 22 (2.7%) were seropositive. Seropositivity rates were highest for cleaning staff (6%), physicians (4%), nurses (2.2%) and radiology technicians (1%). Non-pandemic clinic (6.4%) and ICU (4.3%) had the highest prevalence. HCWs in "high risk" group had similar seropositivity rate with "no risk" group (2.9 vs 3.5 p = 0.7). These findings might lead to the re-evaluation of infection control and transmission dynamics in hospitals.


Asunto(s)
/epidemiología , Personal de Salud/tendencias , /inmunología , /inmunología , Hospitales/tendencias , Humanos , Control de Infecciones/métodos , Control de Infecciones/tendencias , Pandemias , Prevalencia , Factores de Riesgo , Estudios Seroepidemiológicos , Turquia/epidemiología
20.
BMJ Open ; 11(3): e044644, 2021 03 02.
Artículo en Inglés | MEDLINE | ID: covidwho-1115143

RESUMEN

INTRODUCTION: Since its onset, the COVID-19 pandemic has caused significant morbidity and mortality worldwide, with particularly severe outcomes in healthcare institutions and congregate settings. To mitigate spread, healthcare systems have been cohorting patients to limit contacts between uninfected patients and potentially infected patients or healthcare workers (HCWs). A major challenge in managing the pandemic is the presence of currently asymptomatic/presymptomatic individuals capable of transmitting the virus, who could introduce COVID-19 into uninfected cohorts. The optimal combination of personal protective equipment (PPE), testing and other approaches to prevent these events is unclear, especially in light of ongoing limited resources. METHODS: Using stochastic simulations with a susceptible-exposed-infected-recovered dynamic model, we quantified and compared the impacts of PPE use, patient and HCWs surveillance testing and subcohorting strategies. RESULTS: In the base case without testing or PPE, the healthcare system was rapidly overwhelmed, and became a net contributor to the force of infection. We found that effective use of PPE by both HCWs and patients could prevent this scenario, while random testing of apparently asymptomatic/presymptomatic individuals on a weekly basis was less effective. We also found that even imperfect use of PPE could provide substantial protection by decreasing the force of infection. Importantly, we found that creating smaller patient/HCW-interaction subcohorts can provide additional resilience to outbreak development with limited resources. CONCLUSION: These findings reinforce the importance of ensuring adequate PPE supplies even in the absence of testing and provide support for strict subcohorting regimens to reduce outbreak potential in healthcare institutions.


Asunto(s)
/prevención & control , Control de Infecciones/instrumentación , Control de Infecciones/métodos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Prestación de Atención de Salud , Personal de Salud , Humanos , Modelos Teóricos , Pandemias , Equipo de Protección Personal
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