scholarly journals COVID-19 Nosocomial Transmission Dynamics, a Retrospective Cohort Study of Two Healthcare Associated Clusters in a District Hospital in England during March and April 2020

2021 ◽  
pp. 1-18
Author(s):  
David Leeman ◽  
Thomas Ma ◽  
Melanie Pathiraja ◽  
Jennifer Taylor ◽  
Tahira Adnan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Infection Control ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Control Measures ◽  
Transmission Dynamics ◽  
Healthcare Associated Infection ◽  
Hospital Outbreak ◽  
Respiratory Exposure ◽  
Healthcare Associated

Summary Objective: To understand the transmission dynamics of SARS-CoV-2 in a hospital outbreak to inform infection control actions. Design: Retrospective cohort study. Setting: General medical and elderly inpatient wards in a hospital in England. Methods: COVID-19 patients were classified as community or healthcare-associated by time from admission to onset/positivity using European Centre for Disease Prevention and Control definitions. COVID-19 symptoms were classified as asymptomatic, non-respiratory or respiratory. Infectiousness was calculated from 2 days prior to 14 days post symptom onset or positive test. Cases were defined as healthcare-associated COVID-19 patients where infection was acquired from the wards under investigation. COVID-19 exposures were calculated based on symptoms and bed proximity to an infectious patient. Risk ratios and adjusted odds ratios (aOR) were calculated from univariable and multivariable logistic regression. Results: Of 153 patients: 65 were COVID-19 patients (45 healthcare-associated). Exposure to a COVID-19 patient with respiratory symptoms was associated with healthcare-associated infection irrespective of proximity (aOR 3.81; 95%CI 1.6.3-8.87), non-respiratory exposure was only significant within 2.5m (aOR 5.21; 95%CI 1.15-23.48). A small increase in risk ratio was observed for exposure to a respiratory patient for >1 day compared to 1 day from 2.04 (95%CI 0.99-4.22) to 2.36 (95%CI 1.44-3.88) Discussion: Respiratory exposure anywhere within a 4-bedded bay was a risk whereas non-respiratory exposure required bed distance ≤2.5m. Standard Infection control measures required beds to be >2m apart; our study suggests this may be insufficient to stop SARS-CoV-2 spread. We recommend improving cohorting and further studies into bed distance and transmission factors.

scholarly journals Incidence of Secondary Microorganism Infections Following Utilization of Tocilizumab for the Treatment of COVID‑19 - A Matched Retrospective Cohort Study

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Joanna L. Moore ◽  
Stephanie J. Stroever ◽  
Patricia E. Rondain ◽  
Robyn N. Scatena
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Secondary Infection ◽  
World Health ◽  
Quantitative Relation ◽  
Secondary Outcome ◽  
Healthcare Associated Infection ◽  
Kaplan Meier ◽  
Healthcare Associated

Introduction: immunological disorder agent’s area unit theorized to focus on the protein storm syndrome in COVID‑19. However, the downstream effects concerning susceptibilities to secondary infection risk stay unknown. This study seeks to work out risk variations for secondary infections among COVID‑19 patients World Health Organization did and failed to receive tocilizumab. Methods: we have a tendency to conducted a matched retrospective cohort study from 2 giants, acute care hospitals in Western Connecticut from March 1 to May 31, 2020. we have a tendency to collected variables exploitation manual case history abstraction. the first exposure variable was any dose of tocilizumab. the first outcome was any healthcare‑associated microorganism or mycosis as outlined by the National Care Safety Network. we have a tendency to performed a Kaplan–Meier analysis to assess the crude distinction within the additive likelihood of healthcare‑associated infection (HAI) across exposure teams. we have a tendency to conjointly performed a multivariable Cox multivariate analysis to work out the hazard quantitative relation for HAI by exposure group whereas dominant for potential confounders. Results: The Kaplan–Meier analysis incontestable no distinction within the additive likelihood of HAI across teams. The adjusted hazard of HAI for patients given tocilizumab was zero.85 times that of patients not given tocilizumab (95% confidence interval = zero.29, 2.52, P = 0.780) once dominant for relevant confounders. Conclusions: Tocilizumab failed to increase the incidence of secondary infection among COVID‑19 patients. Larger, irregular trials ought to valuate infection as a secondary outcome to validate this finding.

scholarly journals There is no Dose-response Relationship between Allogeneic Blood Transfusion and Healthcare-associated Infection: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Yu Lv ◽  
Qian Xiang ◽  
Jia Lin ◽  
Ying Zong Jin ◽  
Ying Fang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Dose Response ◽  
Retrospective Cohort ◽  
Response Relationship ◽  
Spline Regression ◽  
Blood Products ◽  
Healthcare Associated Infection ◽  
Dose Response Relationship ◽  
Healthcare Associated

Abstract BackgroundThe association between allogeneic blood transfusion (ABT) and healthcare-associated infection (HAI) is considered dose-dependent. However, this association may be confounded by transfusion duration, as prolonged hospitalization stay increases the risk of HAI. Also, it is not clear whether specific blood products have different dose-response risks.MethodsIn this retrospective cohort study, a logistic regression was used to identify confounding factors, and the association between specific blood products and HAI were analyzed. Then Cox regression and restricted cubic spline regression was used to visualize the hazard of HAI per transfusion product.ResultsOf 215338 inpatients observed, 4.16% were transfused with a single component blood product. With regard to these transfused patients, 480 patients (5.36 %) developed a HAI during their hospitalization stay. Logistic regression showed that red blood cells (RBCs) transfusion, platelets transfusion and fresh-frozen plasmas (FFPs) transfusion were risk factors for HAI [odds ratio (OR) 1.893, 95% confidence interval (CI) 1.656–2.163; OR 8.903, 95% CI 6.646–11.926 and OR 1.494, 95% CI 1.146–1.949, respectively]. However, restricted cubic spline regression analysis showed that there was no statistically dose-response relationship between different transfusion products and the onset of HAI.ConclusionsRBCs transfusion, platelets transfusion and FFPs transfusion were associated with HAI, but there was no dose-response relationship between them.

scholarly journals There is no Dose-response Relationship between Allogeneic Blood Transfusion and Healthcare-associated Infection: A Retrospective Cohort Study

2019 ◽  
Author(s):  
Yu Lv ◽  
Ying Fang ◽  
Qian Xiang ◽  
Jia Lin ◽  
Yu J Wu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Dose Response ◽  
Retrospective Cohort ◽  
Response Relationship ◽  
Spline Regression ◽  
Blood Products ◽  
Healthcare Associated Infection ◽  
Dose Response Relationship ◽  
Healthcare Associated

Abstract Background The association between allogeneic blood transfusion (ABT) and healthcare-associated infection (HAI) is considered dose-dependent. However, this association may be confounded by transfusion duration, as prolonged hospitalization stay increases the risk of HAI. Also, it is not clear whether specific blood products have different dose-response risks. Methods In this retrospective cohort study, a logistic regression was used to identify confounding factors, and the association between specific blood products and HAI were analyzed. Then Cox regression and restricted cubic spline regression was used to visualize the hazard of HAI per transfusion product. Results Of 215338 inpatients observed, 4.16% were transfused with a single component blood product. With regard to these transfused patients, 480 patients (5.36 %) developed a HAI during their hospitalization stay. Logistic regression showed that red blood cells (RBCs) transfusion, platelets transfusion and fresh-frozen plasmas (FFPs) transfusion were risk factors for HAI [odds ratio (OR) 1.893, 95% confidence interval (CI) 1.656–2.163; OR 8.903, 95% CI 6.646–11.926 and OR 1.494, 95% CI 1.146–1.949, respectively]. However, restricted cubic spline regression analysis showed that there was no statistically dose-response relationship between different transfusion products and the onset of HAI. Conclusions RBCs transfusion, platelets transfusion and FFPs transfusion were associated with HAI, but there was no dose-response relationship between them.

Outbreak of Healthcare-Associated Infection and Colonization With Multidrug-ResistantSalmonella entericaSerovar Senftenberg in Florida

2007 ◽  
Vol 28 (7) ◽  
pp. 805-811 ◽  
Author(s):  
Robyn S. Kay ◽  
Alexander G. Vandevelde ◽  
Paul D. Fiorella ◽  
Rebecca Crouse ◽  
Carina Blackmore ◽  
...  
Keyword(s):  
Infection Control ◽  
Chronically Ill ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Healthcare Associated Infection ◽  
Healthcare Facilities ◽  
Infection Control Measures ◽  
Healthcare Associated ◽  
Chronically Ill Patients

Background.In July 1999, a rare strain of multidrug-resistantSalmonella entericaserovar Senftenberg was isolated from the sputum of a trauma patient. Over a 6-year period (1999-2005) in northeast Florida, thisSalmonellaserovar spread to 66 other patients in 16 different healthcare facilities as a result of frequent transfers of patients among institutions. To our knowledge, this is the first outbreak of healthcare-associated infection and colonization with a fluoroquinolone-resistant strain of S. Senftenberg in the United States.Objectives.To investigate an outbreak of infection and colonization with an unusual strain of S. Senftenberg and assist with infection control measures.Design.A case series, outbreak investigation, and microbiological study of all samples positive forS.Senftenberg on culture.Setting.Cases ofS.Senftenberg infection and colonization occurred in hospitals and long-term care facilities in 2 counties in northeast Florida.Results.The affected patients were mostly elderly persons with multiple medical conditions. They were frequently transferred between healthcare facilities. ThisSalmonellaserovar was capable of long-term colonization of chronically ill patients. AllS.Senftenberg isolates tested shared a similar pulsed-field gel electrophoresis (PFGE) pattern.Conclusion.A prolonged outbreak of infection and colonization with multidrug-resistantS.Senftenberg was identified in several healthcare facilities throughout the Jacksonville, Florida, area and became established when infection control measures failed. The bacterial agent was capable of long-term colonization in chronically ill patients. Because the dispersal pattern of this strain suggested a breakdown of infection control practices, a multipronged intervention approach was undertaken that included intense education of personnel in the different institutions, interinstitutional cooperation, and transfer paperwork notification.

A Retrospective Cohort Study into Acquisition of MRSA and Associated Risk Factors after Implementation of Universal Screening in Scottish Hospitals

2011 ◽  
Vol 32 (9) ◽  
pp. 889-896 ◽  
Author(s):  
E. V. H. van Velzen ◽  
J. S. Reilly ◽  
K. Kavanagh ◽  
A. Leanord ◽  
G. F. S. Edwards ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Universal Screening ◽  
Population Level ◽  
Control Measures ◽  
Infection Prevention And Control ◽  
Cross Transmission ◽  
Associated Risk Factors

Objective.To estimate the proportion of patients who acquire methicillin-resistantStaphylococcus aureus(MRSA) while in hospital and to identify risk factors associated with acquisition of MRSA.Design.Retrospective cohort study.Patients.Adult patients discharged from 36 general specialty wards of 2 Scottish hospitals that had implemented universal screening for MRSA on admission.Methods.Patients were screened for MRSA on discharge from hospital by using multisite body swabs that were tested by culture. Discharge screening results were linked to admission screening results. Genotyping was undertaken to identify newly acquired MRSA in MRSA-positive patients on admission.Results.Of the 5,155 patients screened for MRSA on discharge, 2.9% (95% confidence interval [CI], 2.43–3.34) were found to be positive. In the subcohort screened on both admission and discharge (n= 2,724), 1.3% of all patients acquired MRSA while in hospital (incidence rate, 2.1/1,000 hospital bed-days in this cohort [95% CI, 1.5–2.9]), while 1.3% remained MRSA positive throughout hospital stay. Three risk factors for acquisition of MRSA were identified: age above 64 years, self-reported renal failure, and self-reported presence of open wounds. On a population level, the prevalence of MRSA colonization did not differ between admission and discharge.Conclusions.Cross-transmission of MRSA takes place in Scottish hospitals that have implemented universal screening for MRSA. This study reinforces the importance of infection prevention and control measures to prevent MRSA cross-transmission in hospitals; universal screening for MRSA on admission will in itself not be sufficient to reduce the number of MRSA colonizations and subsequent MRSA infections.

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