scholarly journals The COVID-19 infection control arms race

2020 ◽  
Vol 41 (11) ◽  
pp. 1323-1325 ◽  
Author(s):  
Chanu Rhee ◽  
Meghan A. Baker ◽  
Michael Klompas
Keyword(s):  
Infection Control ◽  
Asymptomatic Infection ◽  
Arms Race ◽  
International Standards ◽  
Test Results ◽  
Personal Safety ◽  
Control Approach ◽  
Professional Groups ◽  
Asymptomatic Patients ◽  
N95 Respirators

AbstractUS hospitals are engaged in an infection control arms race. Hospitals, specialties, and professional groups are spurring one another on to adopt progressively more aggressive measures in response to COVID-19 that often exceed federal and international standards. Examples include universal masking of providers and patients; decreasing thresholds to test asymptomatic patients; using face shields and N95 respirators regardless of symptoms and test results; novel additions to the list of aerosol-generating procedures; and more comprehensive personal protective equipment including hair, shoe, and leg covers. Here, we review the factors underlying this arms race, including fears about personal safety, ongoing uncertainty around how SARS-CoV-2 is transmitted, confusion about what constitutes an aerosol-generating procedure, increasing recognition of the importance of asymptomatic infection, and the limited accuracy of diagnostic tests. We consider the detrimental effects of a maximal infection control approach and the research studies that are needed to eventually de-escalate hospitals and to inform more evidence-based and measured strategies.

scholarly journals The prevalence of asymptomatic carriers of COVID-19 as determined by routine preoperative testing

2020 ◽  
pp. 175717742096709
Author(s):  
Joshua A Bloom ◽  
Zachary Erlichman ◽  
Tina Tian ◽  
Shira Doron ◽  
Lilian Chen ◽  
...  
Keyword(s):  
Surgical Patients ◽  
Test Results ◽  
Preoperative Testing ◽  
Academic Medical Centre ◽  
Asymptomatic Carriers ◽  
Asymptomatic Patients ◽  
Time Period ◽  
Academic Medical ◽  
N95 Respirators ◽  
The Impact

Background: The coronavirus disease SARS-CoV-2 (COVID-19) has swiftly spread throughout the globe, greatly influencing all aspects of life. As in previous pandemics, concerns for limited resources and a sustainable medical workforce have been on the forefront of infrastructure modifications. Consequently, surgical specialties have needed to consider each surgical case for necessity and safety during the COVID-19 outbreak. At our institution, availability of SARS-CoV-2 assay has allowed preoperative testing of asymptomatic surgical patients. Aim/Objective: To better define the prevalence of asymptomatic carriers in a surgical population and to better understand the impact of testing on our personal protective equipment (PPE) supply. Methods: We began routine, preoperative testing for all asymptomatic patients coming to our academic medical centre on 30 March 2020. Scheduled surgeries were deemed urgent by the surgeon with a review for appropriateness by a novel surgical committee. A retrospective patient chart review was performed. Emergency surgeries were excluded. Asymptomatic patients with positive test results had their surgeries rescheduled at the discretion of the surgeon and patient. Patients who tested negative underwent surgery with staff using standard PPE. Results: Eighty-four asymptomatic surgical patients were tested preoperatively with three (3.6%) testing positive for SARS-CoV-2. Preoperative testing saved 498 N95 respirators over this time period. Discussion: This is the first report of routine COVID-19 preoperative testing in an asymptomatic surgical population. Within this population, there is a 3.6% rate of asymptomatic SARS-CoV-2 carriers. Through this practice, personnel exposure can be minimised and access to PPE can be preserved.

scholarly journals Implementation of an Antimicrobial Stewardship Program in Five Colombian Hospitals in 2018

2020 ◽  
Vol 41 (S1) ◽  
pp. s273-s273
Author(s):  
Christian Pallares ◽  
María Virginia Villegas Botero
Keyword(s):  
Infection Control ◽  
Antimicrobial Stewardship ◽  
Control Strategies ◽  
Education And Training ◽  
Public Hospitals ◽  
International Standards ◽  
International Consensus ◽  
Stewardship Program ◽  
And Training

Background: More than 50% of antibiotics used in hospitals are unnecessary or inappropriate. The antimicrobial stewardship programs (ASPs) are coordinated efforts to promote the rational and effective use of antibiotics including appropriate selection, dosage, administration, and duration of therapy. When an ASP integrates infection control strategies, it is possible to decrease the transmission of multidrug-resistant pathogens. Methods: In 2018, 5 Colombian hospitals were selected to implement an ASP. Private and public hospitals from different cities were included in the study, ranging from 200 to 700 beds. Our team, consisting of an infectious disease and hospital epidemiologist, visited each hospital to establish the baseline of their ASP program, to define the ASP outcomes according to each hospital’s needs, and to set goals for ASP outcomes in the following 6–12 months. Follow-up was scheduled every 2 months through Skype video conference. The baseline diagnosis or preintervention evaluation was done using a tool adapted from previous reports (ie, international consensus and The Joint Commission international standards). Documentation related to ASPs, such as microbiological profiles, antimicrobial guidelines (AMG) and indicators for the adherence to them as well as antimicrobial resistance (AMR) prevention through protocols, were written and/or updated. Prevention and infection control requirements and protocols were also updated, and cleaning and antiseptic policies were created. Training in rational use of antibiotic, infection control and prevention, and cleaning and disinfection were carried out with the healthcare workers in each institution. Results: Before the intervention, the development of the ASP according to the tool was 27% (range, 5%–47%). The lowest institutional scores were the item related to ASP feedback and reports (11% on average), followed by education and training (14%), defined ASP responsibilities (23%), ASP function according to priorities (26%), and AMR surveillance (27%). After the intervention, the ASP development increased to 57% (range, 39%–81%) in the hospitals. The highest scores achieved were for education and training (90%), surveillance (75%), and the activities of the infection control committee (70%). The items that made the greatest contribution to ASP development were the individual antibiogram, including the bacteria resistance profile, and the development of the AMG based on the local epidemiology in each hospital. Conclusions: The implementation of an ASP should include training and education as well as defining outcomes according to the hospital’s needs. Once the strategy is implemented, follow-up is key to achieving the goals.Funding: NoneDisclosures: None

scholarly journals Sources of SARS-CoV-2 and Other Microorganisms in Dental Aerosols

2021 ◽  
pp. 002203452110159
Author(s):  
A.P. Meethil ◽  
S. Saraswat ◽  
P.P. Chaudhary ◽  
S.M. Dabdoub ◽  
P.S. Kumar
Keyword(s):  
Infection Control ◽  
Dental Treatment ◽  
Quantitative Polymerase Chain Reaction ◽  
The United States ◽  
Control Measures ◽  
Personal Protection ◽  
Personal Protection Equipment ◽  
Linear Discriminant ◽  
16S Sequencing ◽  
Asymptomatic Patients

On March 16, 2020, 198,000 dentists in the United States closed their doors to patients, fueled by concerns that aerosols generated during dental procedures are potential vehicles for transmission of respiratory pathogens through saliva. Our knowledge of these aerosol constituents is sparse and gleaned from case reports and poorly controlled studies. Therefore, we tracked the origins of microbiota in aerosols generated during ultrasonic scaling, implant osteotomy, and restorative procedures by combining reverse transcriptase quantitative polymerase chain reaction (to identify and quantify SARS-CoV-2) and 16S sequencing (to characterize the entire microbiome) with fine-scale enumeration and source tracking. Linear discriminant analysis of Bray-Curtis dissimilarity distances revealed significant class separation between the salivary microbiome and aerosol microbiota deposited on the operator, patient, assistant, or the environment ( P < 0.01, analysis of similarities). We also discovered that 78% of the microbiota in condensate could be traced to the dental irrigant, while saliva contributed to a median of 0% of aerosol microbiota. We also identified low copy numbers of SARS-CoV-2 virus in the saliva of several asymptomatic patients but none in aerosols generated from these patients. Together, the bacterial and viral data encourage us to conclude that when infection control measures are used, such as preoperative mouth rinses and intraoral high-volume evacuation, dental treatment is not a factor in increasing the risk for transmission of SARS-CoV-2 in asymptomatic patients and that standard infection control practices are sufficiently capable of protecting personnel and patients from exposure to potential pathogens. This information is of immediate urgency, not only for safe resumption of dental treatment during the ongoing COVID-19 pandemic, but also to inform evidence-based selection of personal protection equipment and infection control practices at a time when resources are stretched and personal protection equipment needs to be prioritized.

Automatic Flight Control of Unmanned Helicopter Based on Nonlinear Model

2012 ◽  
Vol 472-475 ◽  
pp. 1492-1499
Author(s):  
Run Xia Guo
Keyword(s):  
Nonlinear Model ◽  
Flight Control ◽  
Attitude Control ◽  
Lyapunov Stability Theory ◽  
Test Results ◽  
Unmanned Helicopter ◽  
Control Laws ◽  
Control Approach ◽  
State Dependent ◽  
Compensation Technique

The Unmanned helicopter (UMH) movement was divided into two parts, namely, attitude and trajectory motion. And then a two-timescale nonlinear model was established. The paper improved and expanded state dependent riccati equation (SDRE) control approach, deriving analytical conditions for achieving global asymptotic stability with lyapunov stability theory. Proof was given. By combining improved SDRE control with nonlinear feed-forward compensation technique, the full envelop flight attitude control laws could be designed. On the basis of attitude control, trajectory controller was developed. Actual flight tests were carried out. Test results show that the control strategy is highly effective.

Design and Compliant Control of a Piggyback Transfer Robot

2021 ◽  
pp. 1-54
Author(s):  
Yuxin Liu ◽  
Shijie Guo ◽  
Yuting Yin ◽  
Zhiwen Jiang ◽  
Teng Liu
Keyword(s):  
Subjective Evaluation ◽  
Objective Evaluation ◽  
Patient Transfer ◽  
Test Results ◽  
Passive Stiffness ◽  
Control Approach ◽  
Challenging Tasks ◽  
Compliant Control ◽  
Stiffness Control ◽  
Transfer Tasks

Abstract Patient transfer, such as lifting and moving a bedridden patient from a bed to a wheelchair or a pedestal pan, is one of the most physically challenging tasks in nursing care. Although many transfer devices have been developed, they are rarely used because of the large time consumption in performing transfer tasks and the lack of safety and comfortableness. We developed a piggyback transfer robot that can conduct patient transfer by imitating the motion when a person holds another person on his/her back. The robot consisted of a chest holder that moves like a human back. In this paper, we present an active stiffness control approach for the motion control of the chest holder, combined with a passive cushion, for lifting a care-receiver comfortably. A human-robot dynamic model was built and a subjective evaluation was conducted to optimize the parameters of both the active stiffness control and the passive cushion of the chest holder. The test results of 10 subjects demonstrated that the robot could transfer a subject safely and the combination of active stiffness and passive stiffness were essential to a comfortable transfer. The objective evaluation demonstrated that an active stiffness of k= 4 kPa/mm along with a passive stiffness lower than the stiffness of human chest was helpful for a comfort feeling.

scholarly journals Thoracic surgery during the coronavirus disease 2019 (COVID-19) pandemic in Madrid, Spain: single-centre report

2020 ◽  
Vol 58 (5) ◽  
pp. 991-996
Author(s):  
Lucas Hoyos Mejía ◽  
Alejandra Romero Román ◽  
Mariana Gil Barturen ◽  
Maria del Mar Córdoba Pelaez ◽  
José Luis Campo-Cañaveral de la Cruz ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Infection Control ◽  
Thoracic Surgery ◽  
Hospital Care ◽  
Test Results ◽  
Single Centre ◽  
Emergency Procedures ◽  
Related Symptom ◽  
Hospital Stays ◽  
Lung Transplants

Abstract OBJECTIVES We reviewed the incidence of coronavirus disease 2019 cases and the postoperative outcomes of patients who had thoracic surgery during the beginning and at the highest point of transmission in our community. METHODS We retrospectively reviewed patients who had undergone elective thoracic surgery from 12 February 2020 to 30 April 2020 and were symptomatic or tested positive for severe acute respiratory syndrome coronavirus 2 infection within 14 days after surgery, with a focus on their complications and potential deaths. RESULTS Out of 101 surgical procedures, including 57 primary oncological resections, 6 lung transplants and 18 emergency procedures, only 5 cases of coronavirus disease 2019 were identified, 3 in the immediate postoperative period and 2 as outpatients. All 5 patients had cancer; the median age was 64 years. The main virus-related symptom was fever (80%), and the median onset of coronavirus disease 2019 was 3 days. Although 80% of the patients who had positive test results for severe acute respiratory syndrome coronavirus 2 required in-hospital care, none of them were considered severe or critical and none died. CONCLUSIONS These results indicate that, in properly selected cases, with short preoperative in-hospital stays, strict isolation and infection control protocols, managed by a dedicated multidisciplinary team, a surgical procedure could be performed with a relatively low risk for the patient.

scholarly journals Covid-19 Positive Antenatal Patients in Obstetrics and Gynea Unit, Peshawar

2021 ◽  
Vol 8 (2) ◽  
pp. 14-18
Author(s):  
Rabeea Sadaf ◽  
Muhammed Zahid ◽  
Nasreen Kishwar ◽  
Umaiyma Farhad ◽  
Behzad Khan Khalil
Keyword(s):  
Well Being ◽  
Cross Sectional Study ◽  
Positive Test ◽  
Test Results ◽  
Cross Sectional ◽  
Cesarean Birth ◽  
Asymptomatic Patients ◽  
Primary Responsibility ◽  
Polymerase Chain ◽  
Antenatal Visits

OBJECTIVES: The study aimed to determine the frequency of COVID-19 positive antenatal patients admitted in Obstetrics & Gynecology unit Hayatabad Medical Complex Peshawar with the concerns that pregnant women may be more susceptible to COVID-19 as they may be more vulnerable to respiratory infection. METHODOLOGY: This was a descriptive cross-sectional study conducted at Obstetrics & Gynecology units Hayatabad Medical Complex Peshawar from May 12th, 2020, to November 29th, 2020, screening and testing of patients admitted for childbirth was in HMC. Screening consisted of questions related to travel, contacts, and symptoms of COVID-19. All patients without a prior diagnosis of COVID-19 underwent SARS-CoV-2 polymerase chain reaction (PCR) testing of nasopharyngeal swabs, with rapid testing available. Patients scheduled for cesarean birth were screened and tested at preoperative visits RESULTS:  One hundred eighty-two patients presenting for antenatal visits were screened; 6.5% (12 out of 182) were previously diagnosed with COVID-19. The remaining 170 patients were tested at admission, and 17.6% (30 out of 170) tested positive for SARS-CoV-2. Twenty-two of the 30 who tested positive for SARS-CoV-2 (73.3%) were asymptomatic. The overall prevalence of positive test results among asymptomatic patients was 14.1% (22 out of 156). The prevalence of positive test results among asymptomatic patients increased from 1.29% (2 out of 155). CONCLUSION: The evidence on this novel infection is changing almost daily, although it will likely be many months before, we can determine the true impact it will have on both maternal and fetal well‐being. In the interim, our primary responsibility is to ensure all women have access to safe maternity services. KEYWORDS: Asymptomatic, COVID-19 Positive, Antenatal Patients, Obstetrics & Gynecology, Infection

scholarly journals A1254 HOW FREQUENTLY DO ASYMPTOMATIC PATIENTS BENEFIT FROM THE PURSUIT OF ABNORMALITIES IN THEIR PREOPERATIVE TEST RESULTS?

1990 ◽  
Vol 73 (3A) ◽  
pp. NA-NA ◽  
Author(s):  
J. Apfelbaum ◽  
M. F. Roizen ◽  
D. Robinson ◽  
W. J. Murray ◽  
A. W. Grogono ◽  
...  
Keyword(s):  
Test Results ◽  
Asymptomatic Patients ◽  
Preoperative Test

Design of On-Deck Container Securing Systems

1977 ◽  
Vol 14 (02) ◽  
pp. 175-191
Author(s):  
King-Tao Liu ◽  
R. Keith Michel
Keyword(s):  
International Standards ◽  
Test Results ◽  
Strength Criteria ◽  
Optimum Balance ◽  
Actual Test

Elements of marine freight container strength which form an integral part of on-deck container lashing systems are evaluated. Actual test results for these strength elements are presented and compared with current international standards. Proposed strength criteria are established for both containers and securing hardware that offer optimum balance between the two. Forces and motions affecting stowed containers are discussed, and a procedure to analyze container lashing systems is presented. A brief comparison between typical lashing configurations is also included.

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