Universal Masking to Control Healthcare-Associated Transmission of SARS-CoV-2

Abstract Objective: To assess extent of a healthcare-associated outbreak of SARS-CoV-2 and evaluate effectiveness of infection control measures, including universal masking Design: Outbreak investigation including 4 large-scale point-prevalence surveys Setting: Integrated VA Health Care System with 2 facilities and 330 beds Participants: Index patient and 250 exposed patients and staff Methods: We identified exposed patients and staff and classified them as probable and confirmed cases based on symptoms and testing. We performed a field investigation and assessment of patient and staff interactions to develop probable transmission routes. Infection prevention interventions implemented included droplet and contact precautions, employee quarantine, and universal masking with medical and cloth facemasks. Four point-prevalence surveys of patient and staff subsets were conducted using real-time reverse-transcriptase polymerase chain reaction for SARS-CoV-2. Results: Among 250 potentially exposed patients and staff, 14 confirmed cases of Covid-19 were identified. Patient roommates and staff with prolonged patient contact were most likely to be infected. The last potential date of transmission from staff to patient was day 22, the day universal masking was implemented. Subsequent point-prevalence surveys in 126 patients and 234 staff identified 0 patient cases and 5 staff cases of Covid-19, without evidence of healthcare-associated transmission. Conclusions: Universal masking with medical facemasks was effective in preventing further spread of SARS-CoV-2 in our facility in conjunction with other traditional infection prevention measures.

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510. Exposure Investigation Following a Confirmed Case of Candida auris and Multiple Carbapenemase-Producing Carbapenem-Resistant Organisms

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.579 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S247-S247

Author(s):

Frances Nicholson ◽

Melanie Curless ◽

Maggie Schiffhauer ◽

Sean Zhang ◽

Patricia Simner ◽

...

Keyword(s):

Infection Control ◽

Index Patient ◽

The United States ◽

Point Prevalence ◽

Control Measures ◽

Candida Auris ◽

Infection Control Measures ◽

Carbapenem Resistant ◽

Surveillance Cultures ◽

Routine Surveillance

Abstract Background Co-infections of Candida auris and carbapenemase-producing carbapenem-resistant Gram-negative organisms (CP-CRO) are an increasing global concern and rarely seen in the United States. We report the case of a 59-year-old male, with recent hospitalization in India, admitted to our facility with C. auris isolated from urine and axilla/groin specimens and CP-CRO from five body sites. Methods Travel screening in the emergency department identified a patient at high risk for colonization/infection with multidrug-resistant organisms (MDRO). Contact precautions were initiated. Eight CP-CRO isolates were subsequently identified from clinical and routine surveillance cultures from five separate sites. Of the isolates, seven contained one or more carbapenemase-producing genes detected by Xpert Carba-R assay (Cepheid, Sunnyvale, CA) (Table 1). The microbiology laboratory alerted the infection control department of a presumptive positive C. auris from a clinical urine culture from the same patient. Enhanced mitigation strategies were initiated in regards to cleaning and disinfection. An exposure investigation was also conducted using a point prevalence approach. Surveillance cultures were obtained from inpatients currently admitted to the same unit as the index patient. Axilla/groin specimens were collected for C. auris testing, and rectal specimens were collected for CP-CRO gene testing (CRE Real-Time PCR). Results Eighteen patients in addition to the index patient were hospitalized on the acute medicine unit. One patient refused testing for CP-CRO; therefore, 17 patients were tested for CP-CRO, and 18 patients were tested for C. auris. Neither CP-CRO nor C. auris were recovered from any patient. Conclusion A patient co-infected with C. auris and multiple CP-CRO was identified by clinical and routine surveillance cultures at Johns Hopkins Hospital. Travel screening allowed proactive isolation upon presentation. Enhanced infection control measures were implemented and a point prevalence surveillance study was conducted on the general acute care medicine inpatient unit. No transmission of either C. auris or CP-CRO was detected, likely due in part to rapid identification and strict infection control measures. Disclosures All authors: No reported disclosures.

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Nosocomial Outbreak of SARS-CoV-2 in a Non-COVID Zone of a Tertiary Care Hospital of North India: Need to Upgrade Infection Control Practices

Journal of Primary Care & Community Health ◽

10.1177/21501327211050753 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110507

Author(s):

Kirtan Rana ◽

Bhawna Sharma ◽

Pinnaka Venkata Maha Lakshmi ◽

ManharPreet Kaur ◽

Mini P. Singh ◽

...

Keyword(s):

Infection Control ◽

Infection Prevention ◽

Tertiary Care Hospital ◽

Ventilation System ◽

Tertiary Care ◽

Control Measures ◽

North India ◽

Care Hospital ◽

Prevention Measures ◽

Infection Control Measures

Background Hospital acquired infections are preventable cause for morbidity and mortality worldwide. In the current pandemic era proper implementation of infection control measures can prevent the spread of such infections including SARS-CoV 2. The study was done to identified the source and reason for spread of COVID-19 infection and devise recommendations to halt the progress of infection in a non-COVID area. Methods An outbreak in a non-COVID area of a tertiary care hospital was investigated by the infection control team along with the epidemiologist when they were notified about the rising cases of COVID-19 from Advanced Trauma Center’s (ATC) disaster ward. The time, place and person distribution of the cases were studied. Recommendations based on gaps identified were developed onsite and implemented to control the outbreak. Results The outbreak lasted from 19th December 2020 to 12th January 2021, affecting 34 people (25 patients and 9 health care workers). The attack rate was 9.2%. We identified the causes of current outbreak as compromises in infection prevention measures, high bed patient ratio, irregularities in the ventilation system, overcrowding by patient attendants and communication gaps between nursing officers and doctors. Measures required to control the outbreak were implemented and no cases were reported for 2 weeks following the last positive case. Conclusion Non-COVID areas of hospitals are also at risk of nosocomial outbreaks of SARS-CoV 2 and therefore strict infection prevention measures those designated to COVID areas should be followed in non-COVID zones also to prevent such outbreaks.

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Mosques in Japan Responding to COVID-19 Pandemic: Infection Prevention and Support Provision

10.21203/rs.3.rs-333662/v3 ◽

2021 ◽

Author(s):

Hitomu Kotani ◽

Mari Tamura ◽

Susumu Nejima

Keyword(s):

Large Scale ◽

Infection Prevention ◽

Early Stage ◽

Close Contact ◽

Physical Distance ◽

Control Measures ◽

Religious Communities ◽

Prevention Measures ◽

Religious Activities ◽

Support Provision

Abstract Religious activities tend to be conducted in enclosed, crowded, and close-contact settings, which have a high potential of transmitting the coronavirus disease, 2019 (COVID-19); therefore, religious communities are expected to take appropriate infection prevention measures. Meanwhile, during past disasters, religious communities have provided various types of support to affected people; hence, their role in disaster risk reduction has received much attention. In this study, we aimed to identify the infection prevention measures and support provision implemented by mosques—Islamic institutions managed and operated mainly by foreign Muslims living in Japan—during the one year from January 2020. We collected information from newspaper articles (18 articles on 19 mosques) and interviews with representatives of three mosques. We found that various infection control measures were implemented in mosques—refraining from mass prayers and closing buildings from an early stage (around February 2020); canceling large-scale events during the month of Ramadan; moving some activities online; and ensuring indoor ventilation and safe physical distance even when continuing face-to-face prayer activities. We also found that various types of support were provided by mosques—donating masks to the local government; listening to problems of people affected by COVID-19 regardless of their nationality; providing financial support to them; translating and disseminating information to foreign Muslims; and providing religious meals for them. This study provides actual examples of infection prevention measures taken by mosques in a Muslim-minority society and suggests that mosques appropriately responded to the needs of religious minorities during disasters, including COVID-19.

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Mosques in Japan Responding to COVID-19 Pandemic: Infection Prevention and Support Provision

10.21203/rs.3.rs-333662/v1 ◽

2021 ◽

Author(s):

Hitomu Kotani ◽

Mari Tamura ◽

Susumu Nejima

Keyword(s):

Large Scale ◽

Infection Prevention ◽

Early Stage ◽

Close Contact ◽

Physical Distance ◽

Control Measures ◽

Religious Communities ◽

Prevention Measures ◽

Religious Activities ◽

Support Provision

Abstract Religious activities tend to be conducted in enclosed, crowded, and close-contact settings, which have a high potential of transmitting the coronavirus disease, 2019 (COVID-19); therefore, religious communities are expected to take appropriate infection prevention measures. Meanwhile, during past natural disasters, religious communities have provided various types of support to affected people; hence, their role in disaster risk reduction has received much attention. In this study, we aimed to identify the infection prevention measures and support provision implemented by mosques—Islamic institutions managed and operated mainly by foreign Muslims living in Japan—during the one year from January 2020. We collected qualitative information from newspaper articles (18 articles on 19 mosques) and interviews with representatives of three mosques. We found that various infection control measures were implemented in mosques—refraining from mass prayers and closing buildings from an early stage (around February 2020); canceling large-scale events during the month of Ramadan; moving some activities online; and ensuring indoor ventilation and safe physical distance even when continuing face-to-face prayer activities. We also found that various types of support were provided by mosques—donating masks to the local government; listening to problems of people affected by COVID-19 regardless of their nationality; providing financial support to them; translating and disseminating information to foreign Muslims; and providing religious meals for them. This study provides actual examples of infection prevention measures taken by mosques in a Muslim-minority society and suggests that mosques appropriately responded to the needs of religious minorities during disasters, including COVID-19.

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Mosques in Japan Responding to COVID-19 Pandemic: Infection Prevention and Support Provision

10.21203/rs.3.rs-333662/v2 ◽

2021 ◽

Author(s):

Hitomu Kotani ◽

Mari Tamura ◽

Susumu Nejima

Keyword(s):

Large Scale ◽

Infection Prevention ◽

Early Stage ◽

Close Contact ◽

Physical Distance ◽

Control Measures ◽

Religious Communities ◽

Prevention Measures ◽

Religious Activities ◽

Support Provision

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Infection prevention measures for patients undergoing hemodialysis during the COVID-19 pandemic in Japan: a nationwide questionnaire survey

Renal Replacement Therapy ◽

10.1186/s41100-021-00350-y ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yuka Sugawara ◽

◽

Masao Iwagami ◽

Kan Kikuchi ◽

Yoko Yoshida ◽

...

Keyword(s):

Infection Control ◽

Questionnaire Survey ◽

Infection Prevention ◽

Control Measures ◽

Nosocomial Transmission ◽

Third Wave ◽

Prevention Measures ◽

Infection Control Measures ◽

Before And After ◽

Dialysis Facilities

Abstract Background Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic affecting a variety of medical treatments, including hemodialysis. This study aims to investigate the implementation of infection control measures, to examine the shortage of personal protective equipment (PPE) and disinfectants, and to quantify the number of nosocomial COVID-19 transmissions in hemodialysis facilities in Japan during the pandemic. Methods We conducted a nationwide questionnaire survey between 20 October and 16 November 2020 (i.e., between the “second wave” and “third wave” in Japan) in the 4198 dialysis facilities of the Japanese Association of Dialysis Physicians and the Japanese Society for Dialysis Therapy. A total of 2227 facilities (53.0%) responded. The questionnaire consisted of (i) characteristics of facilities, (ii) infection prevention measures in routine dialysis practices, (iii) shortage of PPE, (iv) feasibility of various isolation measures, and (v) nosocomial transmission. Results Half of the responding facilities were hospitals with multiple departments, and the other half were clinics specialized in dialysis. Several infection prevention measures such as health checks of staff and patients, donning of masks before and after hemodialysis, and disinfection of frequently contacted areas were implemented during the COVID-19 pandemic. There was a significant improvement in the implementation rate of these measures during the pandemic, compared to before it, which reached over 90%. More than half of the facilities reported a shortage of disposable masks (67.2%) and hand sanitizer alcohol (56.7%). Isolation of COVID-19 patients in private rooms was possible only in 52.7% of the facilities. The majority of facilities (73.3%) could not accept COVID-19 dialysis patients due to lack of space and manpower. Nosocomial transmission of COVID-19 occurred in 4.0% of the facilities. Of those infected, 51.9% were staff. Conclusions This survey revealed that most hemodialysis facilities in Japan had improved implementation of infection control measures and had shortage of PPEs and disinfectants, though some facilities did not implement infection prevention measures adequately, mainly due to the limited space of the facility. It may be recommended that each facility immediately establishes isolation measures to prepare for the pandemic of COVID-19.

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Control of Vancomycin-Resistant Enterococci at a Community Hospital: Efficacy of Patient and Staff Cohorting

Infection Control and Hospital Epidemiology ◽

10.1086/501598 ◽

1999 ◽

Vol 20 (2) ◽

pp. 106-109 ◽

Cited By ~ 58

Author(s):

Elise M. Jochimsen ◽

Laurie Fish ◽

Kelly Manning ◽

Sally Young ◽

Daniel A. Singer ◽

...

Keyword(s):

Community Hospital ◽

Point Prevalence ◽

Control Measures ◽

Prevalence Survey ◽

Infection Control Measures ◽

Contact Isolation ◽

Point Prevalence Survey ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant ◽

The Impact

AbstractObjective:To evaluate the efficacy of patient and staff cohorting to control vancomycin-resistant enterococci (VRE) at an Indianapolis community hospital.Design:To interrupt transmission of VRE, a VRE point-prevalence survey of hospital inpatients was conducted, and VRE-infected or -colonized patients were cohorted on a single ward with dedicated nursing staff and patient-care equipment. To assess the impact of the intervention, staff compliance with contact isolation procedures was observed, and the VRE point-prevalence survey was repeated 2 months after the cohort ward was established.Results:Following the establishment of the cohort ward, VRE prevalence among all hospitalized inpatients decreased from 8.1% to 4.7% (25 positive cultures among 310 patients compared to 13 positive cultures among 276 patients,P=.14); VRE prevalence among patients whose VRE status was unknown before cultures were obtained decreased from 5.9% to 0.8% (18 positive cultures among 303 patients compared to 2 positive cultures among 262 patients,P=.002); and observed staff-patient interactions compliant with published isolation recommendations increased (5 [22%] of 23 interactions compared to 36 [88%] of 41 interactions,P<.0001).Conclusions:Our data suggest that, in hospitals with endemic VRE or continued VRE transmission despite implementation of contact isolation measures, establishing a VRE cohort ward may be a practical and effective method to improve compliance with infection control measures and thereby to control epidemic or endemic VRE transmission.

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A nosocomial cluster of vancomycin resistant enterococci among COVID-19 patients in an intensive care unit

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-020-00820-8 ◽

2020 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Stefanie Kampmeier ◽

Hauke Tönnies ◽

Carlos L. Correa-Martinez ◽

Alexander Mellmann ◽

Vera Schwierzeck

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Infection Prevention ◽

Control Measures ◽

Whole Genome Sequence ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant ◽

Healthcare Associated

Abstract Background Currently, hospitals have been forced to divert substantial resources to cope with the ongoing coronavirus disease 2019 (COVID-19) pandemic. It is unclear if this situation will affect long-standing infection prevention practices and impact on healthcare associated infections. Here, we report a nosocomial cluster of vancomycin-resistant enterococci (VRE) that occurred on a COVID-19 dedicated intensive care unit (ICU) despite intensified contact precautions during the current pandemic. Whole genome sequence-based typing (WGS) was used to investigate genetic relatedness of VRE isolates collected from COVID-19 and non-COVID-19 patients during the outbreak and to compare them to environmental VRE samples. Methods Five VRE isolated from patients (three clinical and two screening samples) as well as 11 VRE and six vancomycin susceptible Enterococcus faecium (E. faecium) samples from environmental sites underwent WGS during the outbreak investigation. Isolate relatedness was determined using core genome multilocus sequence typing (cgMLST). Results WGS revealed two genotypic distinct VRE clusters with genetically closely related patient and environmental isolates. The cluster was terminated by enhanced infection control bundle strategies. Conclusions Our results illustrate the importance of continued adherence to infection prevention and control measures during the COVID-19 pandemic to prevent VRE transmission and healthcare associated infections.

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Surveillance for Healthcare associated Infections in Indian NICUs: Researchable Issues

Journal of Neonatology ◽

10.1177/097321790902300411 ◽

2009 ◽

Vol 23 (4) ◽

pp. 331-336

Author(s):

Ashwani Kumar ◽

Praveen Kumar

Keyword(s):

Developed Countries ◽

Control Measures ◽

Surveillance Systems ◽

Healthcare Associated Infections ◽

Infection Control Measures ◽

Infection Surveillance ◽

Healthcare Associated ◽

Symptoms And Signs ◽

Local Research ◽

Underlying Risk

Systematic surveillance is the first and integral step of all infection control measures, especially in intensive care settings. Surveillance systems started evolving in developed countries nearly 40 years ago. With experience and wisdom gained, the surveillance methods have improved and become more standardized. It is now clearly recognized that all patients are not at equal risk. For fair comparisons over time within an unit and in between units, the denominator must take the underlying risk into account. Infection surveillance in the NICU presents a number of unique challenges regarding definitions and differing symptoms and signs in the neonate. Although the importance of surveillance is being increasingly recognized in our country and the methods of developed countries are being adopted, there are numerous issues which need local research. This is in view of the limited manpower and financial resources and different profile of organisms and their epidemiology.

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