IPC – ETIDIoH

Increase in #HA #Carbapenem-Resistant #Acinetobacter baumannii #Infection and #Colonization in an Acute Care #Hospital During a Surge in #COVID19 Admissions — #NJ, February–July 2020 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Increase in Hospital-Acquired Carbapenem-Resistant Acinetobacter baumannii Infection and Colonization in an Acute Care Hospital During a Surge in COVID-19 Admissions — New Jersey, February–July 2020

Early Release / December 1, 2020 / 69

Stephen Perez, PhD1,2; Gabriel K. Innes, VMD, PhD2; Maroya Spalding Walters, PhD3; Jason Mehr, MPH2; Jessica Arias2; Rebecca Greeley, MPH2; Debra Chew, MD4

Summary

What is already known about this topic?
- Carbapenem-resistant Acinetobacter baumannii (CRAB) causes health care–associated infections that are challenging to contain and often linked to infection prevention and control (IPC) breaches.
What is added by this report?
- A New Jersey hospital reported a cluster of 34 CRAB cases that peaked during a surge in COVID-19 hospitalizations. Strategies to preserve continuity of care led to deviations in IPC practices; CRAB cases decreased when normal operations resumed.
What are the implications for public health practice?
- Hospitals managing surges of patients with COVID-19 might be vulnerable to outbreaks of multidrug-resistant organism (MDRO) infections. Maintaining IPC best practices (e.g., MDRO surveillance and hand hygiene and environmental cleaning audits) to the extent possible could mitigate spread.

Abstract

Carbapenem-resistant Acinetobacter baumannii (CRAB), an opportunistic pathogen primarily associated with hospital-acquired infections, is an urgent public health threat (1). In health care facilities, CRAB readily contaminates the patient care environment and health care providers’ hands, survives for extended periods on dry surfaces, and can be spread by asymptomatically colonized persons; these factors make CRAB outbreaks in acute care hospitals difficult to control (2,3). On May 28, 2020, a New Jersey hospital (hospital A) reported a cluster of CRAB infections during a surge in patients hospitalized with coronavirus disease 2019 (COVID-19). Hospital A and the New Jersey Department of Health (NJDOH) conducted an investigation, and identified 34 patients with hospital-acquired multidrug-resistant CRAB infection or colonization during February–July 2020, including 21 (62%) who were admitted to two intensive care units (ICUs) dedicated to caring for COVID-19 patients. In late March, increasing COVID-19–related hospitalizations led to shortages in personnel, personal protective equipment (PPE), and medical equipment, resulting in changes to conventional infection prevention and control (IPC) practices. In late May, hospital A resumed normal operations, including standard IPC measures, as COVID-19 hospitalizations decreased, lessening the impact of personnel and supply chain shortages on hospital functions. CRAB cases subsequently returned to a pre–COVID-19 baseline of none to two cases monthly. The occurrence of this cluster underscores the potential for multidrug-resistant organisms (MDROs) to spread during events when standard hospital practices might be disrupted; conventional IPC strategies should be reinstated as soon as capacity and resources allow.

(…)

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Keywords: Antibiotics; Drugs Resistance; Carbapenem; Acinetobacter baumannii; SARS-CoV-2; COVID-19; Nosocomial Outbreaks; USA.

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#Incidence of #Nosocomial #COVID19 in #Patients Hospitalized at a Large #US Academic Medical Center (JAMA Netw Open, abstract)

[Source: JAMA Network Open, full page: (LINK). Abstract, edited.]

Incidence of Nosocomial COVID-19 in Patients Hospitalized at a Large US Academic Medical Center

Chanu Rhee, MD, MPH1,2,3,4,5; Meghan Baker, MD, ScD1,2,3,4,5; Vineeta Vaidya, MS3,4; Robert Tucker, MPH3,4; Andrew Resnick, MD, MBA4; Charles A. Morris, MD, MPH5; Michael Klompas, MD, MPH1,2,3,4,5; for the CDC Prevention Epicenters Program

Author Affiliations: 1 Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; 2 Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts; 3 Infection Control Department, Brigham and Women’s Hospital, Boston, Massachusetts; 4 Department of Quality and Safety, Brigham and Women’s Hospital, Boston, Massachusetts; 5 Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts

JAMA Netw Open. 2020;3(9):e2020498. doi:10.1001/jamanetworkopen.2020.20498

Key Points

Question – What is the incidence of hospital-acquired coronavirus disease 2019 (COVID-19) at a large US academic medical center?
Findings – In this cohort study of 9149 patients admitted to a large US academic medical center over a 12-week period, 697 were diagnosed with COVID-19. In the context of a comprehensive and progressive infection control program, only 2 hospital-acquired cases were detected: 1 patient was likely infected by a presymptomatic spouse before visitor restrictions were implemented, and 1 patient developed symptoms 4 days after a 16-day hospitalization but without known exposures in the hospital.
Meaning – These findings suggest that overall risk of hospital-acquired COVID-19 was low and that rigorous infection control measures may be associated with minimized risk.

Abstract

Importance

Some patients are avoiding essential care for fear of contracting coronavirus disease 2019 (COVID-19) in hospitals. There are few data, however, on the risk of acquiring COVID-19 in US hospitals.

Objective

To assess the incidence of COVID-19 among patients hospitalized at a large US academic medical center in the 12 weeks after the first inpatient case was identified.

Design, Setting, and Participants

This cohort study included all patients admitted to Brigham and Women’s Hospital (Boston, Massachusetts) between March 7 and May 30, 2020. Follow-up occurred through June 17, 2020. Medical records for all patients who first tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction (RT-PCR) on hospital day 3 or later or within 14 days of discharge were reviewed.

Exposures

A comprehensive infection control program was implemented that included dedicated COVID-19 units with airborne infection isolation rooms, personal protective equipment in accordance with US Centers for Disease Control and Prevention recommendations, personal protective equipment donning and doffing monitors, universal masking, restriction of visitors, and liberal RT-PCR testing of symptomatic and asymptomatic patients.

Main Outcomes and Measures

Whether infection was community or hospital acquired based on timing of tests, clinical course, and exposures.

Results

Over the 12-week period, 9149 patients (mean [SD] age, 46.1 [26.4] years; median [IQR] age, 51 years [30-67 years]; 5243 female [57.3%]) were admitted to the hospital, for whom 7394 SARS-CoV-2 RT-PCR tests were performed; 697 COVID-19 cases were confirmed, translating into 8656 days of COVID-19–related care. Twelve of the 697 hospitalized patients with COVID-19 (1.7%) first tested positive on hospital day 3 or later (median, 4 days; range, 3-15 days). Of these, only 1 case was deemed to be hospital acquired, most likely from a presymptomatic spouse who was visiting daily and diagnosed with COVID-19 before visitor restrictions and masking were implemented. Among 8370 patients with non–COVID-19–related hospitalizations discharged through June 17, 11 (0.1%) tested positive within 14 days (median time to diagnosis, 6 days; range, 1-14 days). Only 1 case was deemed likely to be hospital acquired, albeit with no known exposures.

Conclusions and Relevance

In this cohort study of patients in a large academic medical center with rigorous infection control measures, nosocomial COVID-19 was rare during the height of the pandemic in the region. These findings may inform practices in other institutions and provide reassurance to patients concerned about contracting COVID-19 in hospitals.

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Keywords: SARS-CoV-2; COVID-19; Nosocomial outbreaks; IPC; USA.

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#IDSA #Guidelines on #Infection #Prevention for #HCP Caring for Patients with Suspected or Known #COVID19 (Clin Infect Dis., abstract)

[Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]

Infectious Diseases Society of America Guidelines on Infection Prevention for Health Care Personnel Caring for Patients with Suspected or Known COVID-19

John B Lynch, Perica Davitkov, Deverick J Anderson, Adarsh Bhimraj, Vincent Chi-Chung Cheng, Judith Guzman-Cottrill, Jasmine Dhindsa, Abhijit Duggal, Mamta K Jain, Grace M Lee, Stephen Y Liang, Allison McGeer, Valery Lavergne, M Hassan Murad, Reem A Mustafa, Rebecca L Morgan, Yngve Falck-Ytter, Shahnaz Sultan

Clinical Infectious Diseases, ciaa1063, https://doi.org/10.1093/cid/ciaa1063

Published: 27 July 2020

Abstract

Background

SARS-CoV-2 is a highly transmissible virus that can infect health care personnel and patients in health care settings. Specific care activities, in particular aerosol-generating procedures, may have a higher risk of transmission. The rapid emergence and global spread of SARS-CoV-2 has created significant challenges in health care facilities, particularly with severe shortages of personal protective equipment (PPE) used to protect health care personnel (HCP). Evidence-based recommendations for what PPE to use in conventional, contingency, and crisis standards of care are needed. Where evidence is lacking, the development of specific research questions can help direct funders and investigators.

Objective

Develop evidence-based rapid guidelines intended to support HCP in their decisions about infection prevention when caring for patients with suspected or known COVID-19.

Methods

IDSA formed a multidisciplinary guideline panel including front-line clinicians, infectious disease specialists, experts in infection control and guideline methodologists with representation from the disciplines of preventive care, public health, medical microbiology, pediatrics, critical care medicine and gastroenterology. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations.

Results

The IDSA guideline panel agreed on eight recommendations and provided narrative summaries of other interventions undergoing evaluations.

Conclusions

Using a combination of direct and indirect evidence, the panel was able to provide recommendations for eight specific questions on the use of PPE for HCP providing care for patients with suspected or known COVID-19. Where evidence was lacking, attempts were made to provide potential avenues for investigation. There remain significant gaps in the understanding of the transmission dynamics of SARS-CoV-2 and PPE recommendations may need to be modified in response to new evidence.

Issue Section: IDSA Features

This content is only available as a PDF.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

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Keywords: SARS-CoV-2; COVID-19; HCWs; PPE.

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#Screening for #SARS-CoV-2 Infection Within a #Psychiatric #Hospital and Considerations for Limiting #Transmission Within Residential Psychiatric Facilities — #Wyoming, 2020 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Screening for SARS-CoV-2 Infection Within a Psychiatric Hospital and Considerations for Limiting Transmission Within Residential Psychiatric Facilities — Wyoming, 2020

Weekly / July 3, 2020 / 69(26);825–829

Anna W. Callaghan, MSc1; Anna N. Chard, PhD1,2; Patricia Arnold, MSN3; Cody Loveland, MPH4; Noah Hull, PhD4; Mona Saraiya, MD1; Sharon Saydah, PhD5; Wendy Dumont, MSN3; Laura G. Frakes3; Daniel Johnson, MSN3; ReaAnna Peltier3; Clayton Van Houten, MS4; A. Angelica Trujillo, MS1; Jazmyn Moore, MSc, MPH5; Dale A. Rose, PhD5; Margaret A. Honein, PhD5; David Carrington, MD3; Alexia Harrist, MD, PhD4; Susan L. Hills, MBBS1

Corresponding author: Anna W. Callaghan, ktv5@cdc.gov.

1CDC Wyoming COVID-19 Response Field Team; 2Epidemic Intelligence Service, CDC; 3Wyoming State Hospital, Evanston, Wyoming; 4Wyoming Department of Health; 5CDC COVID-19 Response Team.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Suggested citation for this article: Callaghan AW, Chard AN, Arnold P, et al. Screening for SARS-CoV-2 Infection Within a Psychiatric Hospital and Considerations for Limiting Transmission Within Residential Psychiatric Facilities — Wyoming, 2020. MMWR Morb Mortal Wkly Rep 2020;69:825–829. DOI: http://dx.doi.org/10.15585/mmwr.mm6926a4

Summary

What is already known about this topic?
- SARS-CoV-2 can spread rapidly within residential, congregate settings. Psychiatric facilities are at risk for outbreaks because of patient transfers from other high-risk residential settings and face unique challenges in implementing standard infection prevention and control (IPC) measures because of complex patient needs.
What is added by this report?
- After admitting two patients with SARS-CoV-2 infection, a psychiatric facility responded by implementing modified and expanded IPC procedures. A point prevalence survey found no evidence of further SARS-CoV-2 transmission within the facility.
What are the implications for public health practice?
- Adaption of standard IPC strategies in psychiatric facilities to meet patient and facility needs might prevent SARS-CoV-2 transmission, and point prevalence surveys can be useful to assess the likely effectiveness of any adapted IPC measures.

Abstract

In the United States, approximately 180,000 patients receive mental health services each day at approximately 4,000 inpatient and residential psychiatric facilities (1). SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), can spread rapidly within congregate residential settings (2–4), including psychiatric facilities. On April 13, 2020, two patients were transferred to Wyoming’s state psychiatric hospital from a private psychiatric hospital that had confirmed COVID-19 cases among its residents and staff members (5). Although both patients were asymptomatic at the time of transfer and one had a negative test result for SARS-CoV-2 at the originating facility, they were both isolated and received testing upon arrival at the state facility. On April 16, 2020, the test results indicated that both patients had SARS-CoV-2 infection. In response, the state hospital implemented expanded COVID-19 infection prevention and control (IPC) procedures (e.g., enhanced screening, testing, and management of new patient admissions) and adapted some standard IPC measures to facilitate implementation within the psychiatric patient population (e.g., use of modified face coverings). To assess the likely effectiveness of these procedures and determine SARS-CoV-2 infection prevalence among patients and health care personnel (HCP) (6) at the state hospital, a point prevalence survey was conducted. On May 1, 2020, 18 days after the patients’ arrival, 46 (61%) of 76 patients and 171 (61%) of 282 HCP had nasopharyngeal swabs collected and tested for SARS-CoV-2 RNA by reverse transcription–polymerase chain reaction. All patients and HCP who received testing had negative test results, suggesting that the hospital’s expanded IPC strategies might have been effective in preventing the introduction and spread of SARS-CoV-2 infection within the facility. In congregate residential settings, prompt identification of COVID-19 cases and application of strong IPC procedures are critical to ensuring the protection of other patients and staff members. Although standard guidance exists for other congregate facilities (7) and for HCP in general (8), modifications and nonstandard solutions might be needed to account for the specific needs of psychiatric facilities, their patients, and staff members.

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Keywords: SARS-CoV-2; COVID-19; Nosocomial Outbreaks; USA; Wyoming.

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#IPC #compliance in #Tanzanian #outpatient facilities: a cross-sectional study with implications for the control of #COVID19 (Lancet Glob Health, abstract)

[Source: The Lancet Global Health, full page: (LINK). Abstract, edited.]

Infection prevention and control compliance in Tanzanian outpatient facilities: a cross-sectional study with implications for the control of COVID-19

Timothy Powell-Jackson, PhD, Jessica J C King, MSc, Christina Makungu, MA, Nicole Spieker, PhD, Susannah Woodd, MSc, Peter Risha, PhD, Prof Catherine Goodman, PhD

Open Access | Published: May 06, 2020 | DOI: https://doi.org/10.1016/S2214-109X(20)30222-9

Summary

Background

As coronavirus disease 2019 (COVID-19) spreads, weak health systems must not become a vehicle for transmission through poor infection prevention and control practices. We assessed the compliance of health workers with infection prevention and control practices relevant to COVID-19 in outpatient settings in Tanzania, before the pandemic.

Methods

This study was based on a secondary analysis of cross-sectional data collected as part of a randomised controlled trial in private for-profit dispensaries and health centres and in faith-based dispensaries, health centres, and hospitals, in 18 regions. We observed provider–patient interactions in outpatient consultation rooms, laboratories, and dressing rooms, and categorised infection prevention and control practices into four domains: hand hygiene, glove use, disinfection of reusable equipment, and waste management. We calculated compliance as the proportion of indications (infection risks) in which a health worker performed a correct action, and examined associations between compliance and health worker and facility characteristics using multilevel mixed-effects logistic regression models.

Findings

Between Feb 7 and April 5, 2018, we visited 228 health facilities, and observed at least one infection prevention and control indication in 220 facilities (118 [54%] dispensaries, 66 [30%] health centres, and 36 [16%] hospitals). 18 710 indications were observed across 734 health workers (49 [7%] medical doctors, 214 [29%] assistant medical officers or clinical officers, 106 [14%] nurses or midwives, 126 [17%] clinical assistants, and 238 [32%] laboratory technicians or assistants). Compliance was 6·9% for hand hygiene (n=8655 indications), 74·8% for glove use (n=4915), 4·8% for disinfection of reusable equipment (n=841), and 43·3% for waste management (n=4299). Facility location was not associated with compliance in any of the infection prevention and control domains. Facility level and ownership were also not significantly associated with compliance, except for waste management. For hand hygiene, nurses and midwives (odds ratio 5·80 [95% CI 3·91–8·61]) and nursing and medical assistants (2·65 [1·67–4·20]) significantly outperformed the reference category of assistant medical officers or clinical officers. For glove use, nurses and midwives (10·06 [6·68–15·13]) and nursing and medical assistants (5·93 [4·05–8·71]) also significantly outperformed the reference category. Laboratory technicians performed significantly better in glove use (11·95 [8·98–15·89]), but significantly worse in hand hygiene (0·27 [0·17–0·43]) and waste management (0·25 [0·14–0·44] than the reference category. Health worker age was negatively associated with correct glove use and female health workers were more likely to comply with hand hygiene.

Interpretation

Health worker infection prevention and control compliance, particularly for hand hygiene and disinfection, was inadequate in these outpatient settings. Improvements in provision of supplies and health worker behaviours are urgently needed in the face of the current pandemic.

Funding

UK Medical Research Council, Economic and Social Research Council, Department for International Development, Global Challenges Research Fund, Wellcome Trust.

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Keywords: SARS-CoV-2; COVID-19; Tanzania; IPC.

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Initiation of a new #infection #control #system for the #COVID19 #outbreak (Lancet Infect Dis., summary)

[Source: The Lancet Infectious Diseases, full page: (LINK). Summary, edited.]

Initiation of a new infection control system for the COVID-19 outbreak

Xuejiao Chen, Junzhang Tian, Guanming Li, Guowei Li

Published: February 18, 2020 / DOI: https://doi.org/10.1016/S1473-3099(20)30110-9

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In December, 2019, a group of patients with pneumonia of unknown origin, most of whom had been exposed to the Huanan seafood wholesale market in Wuhan, China, was first reported.1 Using deep sequencing analysis, Chinese authorities identified a new betacoronavirus (severe acute respiratory syndrome coronavirus 2; SARS-CoV-2) as the cause of the outbreak, and found that SARS-CoV-2 belongs to a clade within the subgenus sarbecovirus, orthocoronavirinae subfamily.2 As of Feb 10, 2020, the ongoing outbreak of coronavirus disease 2019 (COVID-19) originating in Wuhan had caused 42 638 confirmed cases and 1016 deaths, with 32 provinces and regions of China affected.3

(…)

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We declare no competing interests.

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Keywords: COVID19; SARS-CoV; Nosocomial Outbreaks; HCWs; PPE; Guangdong; China.

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Conventional #Respiratory #Support #Therapy for #SARI: #Clinical Indications and #Nosocomial #IPC (Zhonghua Jie He He Hu Xi Za Zhi, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Zhonghua Jie He He Hu Xi Za Zhi, 43 (0), E015 2020 Feb 16 [Online ahead of print]

Conventional Respiratory Support Therapy for Severe Acute Respiratory Infections (SARI): Clinical Indications and Nosocomial Infection Prevention and Control

[Article in Chinese]

Critical care committee of Chinese Association of Chest Physician, Respiratory and critical care group of Chinese Thoracic Society, Respiratory care group of Chinese Thoracic Society

PMID: 32061199 DOI: 10.3760/cma.j.issn.1001-0939.2020.0015

Abstract in English , Chinese

Severe acute respiratory infection (SARI) diseases (such as SARS, MERS, pH1N1) can rapidly progress to acute respiratory failure with high lethality. The outbreak of a novel coronavirus infection can lead to 15% ~ 30% patients developing into acute respiratory distress syndrome (ARDS). Respiratory support is the most important therapy for SARI patients with respiratory failure. However, respiratory support is a high skilled technology, which means inappropriate application may bring related complications and cross infection of SARI pathogens among medical staff and non-medical personnel in hospital. Therefore, it is meaningful to established a standardized indication of respiratory support and to prevent related nosocomial transmission in SARI patients.

Keywords: High Flow Nasal Cannula; Noninvasive positive pressure ventilation; Novel Coronavirus Pneumonia; Respiratory support; Severe Acute Respiratory Infections.

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Keywords: SARS-CoV-2; COVID-19; SARI; ARDS.

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#Comparison of #infection #control practices in a #Dutch and #US #hospital using the infection #risk scan (#IRIS) method (Am J Infect Control, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Infect Control. 2019 Nov 5. pii: S0196-6553(19)30856-9. doi: 10.1016/j.ajic.2019.09.020. [Epub ahead of print]

Comparison of infection control practices in a Dutch and US hospital using the infection risk scan (IRIS) method.

Willemsen I1, Jefferson J2, Mermel L3, Kluytmans J4.

Author information: 1 Department of Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands. Electronic address: iwillemsen@amphia.nl. 2 Department of Epidemiology & Infection Control, Rhode Island Hospital, Providence, RI, USA. 3 Department of Epidemiology & Infection Control, Rhode Island Hospital, Providence, RI, USA; Department of Medicine, Warren Alpert Medial School of Brown University, Providence, RI, USA. 4 Department of Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands; Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, the Netherlands.

Abstract

BACKGROUND:

The infection risk scan (IRIS) is a tool to measure the quality of infection control (IC) and antimicrobial use in a standardized way. We describe the feasilibility of the IRIS in a Dutch hospital (the Netherlands, NL) and a hospital in the United States (US).

METHODS:

Cross-sectional measurements were performed. Variables included a hand hygiene indicator, environmental contamination, IC preconditions, personal hygiene of health care workers, use of indwelling medical devices, and use of antimicrobials.

RESULTS:

IRIS was performed in 2 wards in a US hospital and 4 wards in a Dutch hospital. Unjustified use of medical devices: none in the US hospital, 2.2% in the Dutch hospital; inappropriate use of antibiotics: 11.7% (US), 19% (NL); items considered not clean: 10% (US); 36% (NL); shortcomings preconditions: 6 of 20 (US), 6 of 40 (NL); health care workers with rings, watches, or long sleeves: 34 of 43 (US), none in the NL hospital; and hand hygiene actions per patient/day: 41 (US) and 10 (NL). US data judged against the Dutch guidelines and vice versa revealed remarkable differences.

CONCLUSIONS:

We showed the feasibility of using the IRIS in a US hospital. The method provided insight in IC local performance. This method could be the first step to standardize the measurement of the quality of IC and antimicrobial use. However, if the IRIS is used for benchmarking between hospitals in different regions, this should be done in the context of regional guidelines and policies.

KEYWORDS: Antimicrobial resistance; Benchmarking; Guidelines; Infection prevention

PMID: 31703820 DOI: 10.1016/j.ajic.2019.09.020

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Keywords: Antibiotics; Drugs Resistance; IPC; HCWs; Nosocomial Outbreaks; USA; Netherlands.

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#Risk of #transmission via #medical #employees and importance of routine #infection-prevention #policy in a #nosocomial #outbreak of #MERS: a descriptive analysis from a tertiary care hospital in South #Korea (BMC Pulm Med., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

BMC Pulm Med. 2019 Oct 30;19(1):190. doi: 10.1186/s12890-019-0940-5.

Risk of transmission via medical employees and importance of routine infection-prevention policy in a nosocomial outbreak of Middle East respiratory syndrome (MERS): a descriptive analysis from a tertiary care hospital in South Korea.

Ki HK1, Han SK2, Son JS3, Park SO4.

Author information: 1 Division of infectious diseases, Department of Internal Medicine, School of Medicine, Konkuk University, Konkuk University Medical Centre, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 05029, Republic of Korea. 2 Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-Dong, Jongno-Gu, Seoul, 110-746, Republic of Korea. 3 Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, Republic of Korea. 4 Department of Emergency Medicine, School of Medicine, Konkuk University, Konkuk University Medical Centre, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 05029, Republic of Korea. empso@kuh.ac.kr.

Abstract

BACKGROUND:

In 2015, South Korea experienced an outbreak of Middle East respiratory syndrome (MERS), and our hospital experienced a nosocomial MERS infection. We performed a comprehensive analysis to identify the MERS transmission route and the ability of our routine infection-prevention policy to control this outbreak.

METHODS:

This is a case-cohort study of retrospectively analysed data from medical charts, closed-circuit television, personal interviews and a national database. We analysed data of people at risk of MERS transmission including 228 in the emergency department (ED) and 218 in general wards (GW). Data of personnel location and movement, personal protection equipment and hand hygiene was recorded. Transmission risk was determined as the extent of exposure to the index patient: 1) high risk: staying within 2 m; 2) intermediate risk: staying in the same room at same time; and 3) low risk: only staying in the same department without contact.

RESULTS:

The index patient was an old patient admitted to our hospital. 11 transmissions from the index patient were identified; 4 were infected in our hospital. Personnel in the ED exhibited higher rates of compliance with routine infection-prevention methods as observed objectively: 93% wore a surgical mask and 95.6% washed their hands. Only 1.8% of personnel were observed to wear a surgical mask in the GW. ED had a higher percentage of high-risk individuals compared with the GW (14.5% vs. 2.8%), but the attack rate was higher in the GW (16.7%; l/6) than in the ED (3%; 1/33). There were no transmissions in the intermediate- and low-risk groups in the ED. Otherwise 2 patients were infected in the GW among the low-risk group. MERS were transmitted to them indirectly by staff who cared for the index patient.

CONCLUSIONS:

Our study provide compelling evidence that routine infection-prevention policies can greatly reduce nosocomial transmission of MERS. Conventional isolation is established mainly from contact tracing of patients during a MERS outbreak. But it should be extended to all people treated by any medical employee who has contact with MERS patients.

TRIAL REGISTRATION: NCT02605109 , date of registration: 11th November 2015.

KEYWORDS: Hand hygiene; Infection control; Isolation; Middle East respiratory syndrome coronavirus; Nosocomial infection

PMID: 31666061 DOI: 10.1186/s12890-019-0940-5

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Keywords: MERS-CoV; Hand hygiene; IPCs; Nosocomial Outbreaks; S. Korea.

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The #impact of Infection Prevention and control (#IPC) bundle implementationon IPC compliance during the #Ebola virus #outbreak in Mbandaka / #DRC: a before and after design (BMJ Open., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

BMJ Open. 2019 Sep 5;9(9):e029717. doi: 10.1136/bmjopen-2019-029717.

The impact of Infection Prevention and control (IPC) bundle implementationon IPC compliance during the Ebola virus outbreak in Mbandaka/Democratic Republic of the Congo: a before and after design.

Ousman K1, Kabego L2,3, Talisuna A4, Diaz J5, Mbuyi J6, Houndjo B4, Ngandu JP6, Omba G6, Aruna A6, Mossoko M6, Djingarey MH4, Balde T4, Abok P4, Diallo B4, Dovlo D7, Yao M4, Fortin A5, Formenty P5, Fall IS4.

Author information: 1 World Health Organization Regional Office for Africa, Brazzaville, Congo ousmank@who.int. 2 Infection Control Africa Network, Bukavu, Democratic Republic of the Congo. 3 Microbiology, Universite Catholique de Bukavu Faculte de Medecine, Bukavu, Democratic Republic of the Congo. 4 World Health Organization Regional Office for Africa, Brazzaville, Congo. 5 World Health Organization, Geneva, Switzerland. 6 Ministry of Health, Kinshasa, Democratic Republic of the Congo. 7 International Health System Services Expert, Accra, Ghana.

Abstract

OBJECTIVES:

To assess the impact of refresher training of healthcare workers (HCWs) in infection prevention and control (IPC), ensuring consistent adequate supplies and availability of IPC kits and carrying out weekly monitoring of IPC performance in healthcare facilities (HCFs)

DESIGN:

This was a before and after comparison study

SETTINGS:

This study was conducted from June to July 2018 during an Ebola virus disease (EVD) outbreak in Equateur Province in the Democratic Republic of the Congo (DRC).

PARTICIPANTS:

48 HCFs

INTERVENTIONS:

HCWs capacity building in basic IPC, IPC kit donation and IPC mentoring.

PRIMARY OUTCOME MEASURES:

IPC score

RESULTS:

48 HCFs were evaluated and 878 HCWs were trained, of whom 437 were women and 441 were men. The mean IPC score at baseline was modestly higher in hospitals (8%) compared with medical centres (4%) and health centres (4%), respectively. The mean IPC score at follow-up significantly increased to 50% in hospitals, 39% in medical centres and 36% in health centres (p value<0.001). The aggregate mean IPC score at baseline for all HCFs, combined was 4.41% and at follow-up it was 39.51% with a mean difference of 35.08% (p-value<0.001).

CONCLUSIONS:

Implementation of HCW capacity building in IPC, IPC kit donation to HCF and mentoring in IPC improved IPC compliance during the ninth EVD outbreak in the DRC.

KEYWORDS: Democratic Republic of the Congo; Ebola virus disease; infection prevention and control

PMID: 31492782 DOI: 10.1136/bmjopen-2019-029717

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Keywords: Ebola; DRC; IPC.

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