Multihospital Outbreak ofClostridium difficileRibotype 027 Infection: Epidemiology and Analysis of Control Measures

2011 ◽  
Vol 32 (3) ◽  
pp. 210-219 ◽  
Author(s):  
Mamoon A. Aldeyab ◽  
Michael J. Devine ◽  
Peter Flanagan ◽  
Michael Mannion ◽  
Avril Craig ◽  
...  
Keyword(s):  
Infection Control ◽  
Action Plan ◽  
Essential Element ◽  
Control Measures ◽  
Environmental Hygiene ◽  
Ribotype 027 ◽  
Infection Control Measures ◽  
Health And Social Care ◽  
Large Outbreak ◽  
The Impact

Objective.To report a large outbreak ofClostridium difficileinfection (CDI; ribotype 027) between June 2007 and August 2008, describe infection control measures, and evaluate the impact of restricting the use of fluoroquinolones in controlling the outbreak.Design.Outbreak investigation in 3 acute care hospitals of the Northern Health and Social Care Trust in Northern Ireland.Interventions.Implementation of a series of CDI control measures that targeted high-risk antibiotic agents (ie, restriction of fluoroquinolones), infection control practices, and environmental hygiene.Results.A total of 318 cases of CDI were identified during the outbreak, which was the result of the interaction betweenC. difficileribotype 027 being introduced into the affected hospitals for the first time and other predisposing risk factors (ranging from host factors to suboptimal compliance with antibiotic guidelines and infection control policies). The 30-day all-cause mortality rate was 24.5%; however, CDI was the attributable cause of death for only 2.5% of the infected patients. Time series analysis showed that restricting the use of fluoroquinolones was associated with a significant reduction in the incidence of CDI (coefficient, —0.054; lag time, 4 months;P= .003).Conclusion.These findings provide additional evidence to support the value of antimicrobial stewardship as an essential element of multifaceted interventions to control CDI outbreaks. The present CDI outbreak was ended following the implementation of an action plan improving communication, antibiotic stewardship, infection control practices, environmental hygiene, and surveillance.

scholarly journals The impact of population-wide rapid antigen testing on SARS-CoV-2 prevalence in Slovakia

Science ◽  
2021 ◽  
pp. eabf9648
Author(s):  
Martin Pavelka ◽  
Kevin Van-Zandvoort ◽  
Sam Abbott ◽  
Katharine Sherratt ◽  
Marek Majdan ◽  
...  
Keyword(s):  
Infection Control ◽  
Control Measures ◽  
Infection Control Measures ◽  
Household Members ◽  
The Impact ◽  
Antigen Testing

Slovakia conducted multiple rounds of population-wide rapid antigen testing for SARS-CoV-2 in late 2020, combined with a period of additional contact restrictions. Observed prevalence decreased by 58% (95% CI: 57-58%) within one week in the 45 counties that were subject to two rounds of mass testing, an estimate that remained robust when adjusting for multiple potential confounders. Adjusting for epidemic growth of 4.4% (1.1-6.9%) per day preceding the mass testing campaign, the estimated decrease in prevalence compared to a scenario of unmitigated growth was 70% (67-73%). Modelling indicated that this decrease could not be explained solely by infection control measures, but required the additional impact of isolation and quarantine of household members of those testing positive.

scholarly journals Retrospective Study on Personal Protective Equipment During Pandemic Link to Outbreak of Carbpenem-Resistant Enterobacteriace

2021 ◽  
Vol 1 (S1) ◽  
pp. s9-s10
Author(s):  
Kenisha Evans ◽  
Jennifer LeRose ◽  
Angela Beatriz Cruz ◽  
Lavina Jabbo ◽  
Teena Chopra
Keyword(s):  
Retrospective Study ◽  
Infection Control ◽  
Personal Protective Equipment ◽  
Horizontal Transmission ◽  
Control Measures ◽  
Protective Equipment ◽  
Local Health ◽  
Infection Rates ◽  
Infection Control Measures ◽  
The Impact

Background: In 2019, according to the Centers for Disease Control and Prevention, carbapenem-resistant Enterobacteriaceae (CRE), had cost the lives of >35,000 patients, particularly the most virulent plasmid-mediated New Delhi metallo-β-lactamase (NDM). Although healthcare systems normally have strict surveillance and infection control measures for CRE, the rapid emergence of novel SAR-CoV-2 and COVID-19 led to a shortage of personal protective equipment (PPE) and medical supplies. As a result, routine infection practices, such as contact precautions, were violated. Studies have shown this depletion and shift in resources compromised the control of infections such CRE leading to rising horizontal transmission. Method: A retrospective study was conducted at a tertiary healthcare system in Detroit, Michigan, to determine the impact of PPE shortages during the COVID-19 pandemic on NDM infection rates. The following periods were established during 2020 based on PPE availability: (1) pre-PPE shortage (January–June), (2) PPE shortage (July–October), and (3) post-PPE shortage (November–December). Rates of NDM per 10,000 patient days were compared between periods using the Wilcoxon signed rank-sum test. Isolates were confirmed resistant by NDM by molecular typing performed by the Michigan State Health Department. Patient characteristics were gathered by medical chart review and patient interviews by telephone. Results: Overall, the average rate of NDM infections was 1.82 ±1.5 per 10,000 patient days. Rates during the PPE shortage were significantly higher, averaging 3.6 ±1.1 cases per 10,000 patient days (P = .02). During this time, several infections occurred within patients on the same unit and/or patients with same treating team, suggesting possible horizontal transmission. Once PPE stock was replenished and isolation practices were reinstated, NDM infection rates decreased to 0.77 ±1.1 per 10,000 patient days. Conclusion: Control of CRE requires strategic planning with active surveillance, antimicrobial constructs, and infection control measures. The study illustrates that in times of crisis, such as the COVID-19 pandemic, the burden of effective infection control requires much more multidisciplinary efforts to prevent unintentional lapses in patient safety. A swift response by the state and local health departments at a tertiary-care healthcare center conveyed a positive mitigation of the highest clinical threats and decreased horizontal transmission of disease.Funding: NoDisclosures: None

Transmission and control in an institutional pandemic influenza A(H1N1) 2009 outbreak

2011 ◽  
Vol 140 (6) ◽  
pp. 1102-1110 ◽  
Author(s):  
N. ARINAMINPATHY ◽  
N. RAPHAELY ◽  
L. SALDANA ◽  
C. HODGEKISS ◽  
J. DANDRIDGE ◽  
...  
Keyword(s):  
High Risk ◽  
Infection Control ◽  
Pandemic Influenza ◽  
Summer School ◽  
Influenza A ◽  
Control Measures ◽  
Infection Control Measures ◽  
Influenza A H1n1 ◽  
Hygiene Measures ◽  
The Impact

SUMMARYA pandemic influenza A(H1N1) 2009 outbreak in a summer school affected 117/276 (42%) students. Residential social contact was associated with risk of infection, and there was no evidence for transmission associated with the classroom setting. Although the summer school had new admissions each week, which provided susceptible students the outbreak was controlled using routine infection control measures (isolation of cases, basic hygiene measures and avoidance of particularly high-risk social events) and prompt treatment of cases. This was in the absence of chemoprophylaxis or vaccination and without altering the basic educational activities of the school. Modelling of the outbreak allowed estimation of the impact of interventions on transmission. These models and follow-up surveillance supported the effectiveness of routine infection control measures to stop the spread of influenza even in this high-risk setting for transmission.

scholarly journals The Impact of the COVID-19 Pandemic and Societal Infection Control Measures on Children and Adolescents' Mental Health: A Scoping Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Jamile Marchi ◽  
Nina Johansson ◽  
Anna Sarkadi ◽  
Georgina Warner
Keyword(s):  
Mental Health ◽  
Physical Activity ◽  
Infection Control ◽  
Children And Adolescents ◽  
Scoping Review ◽  
Well Being ◽  
Control Measures ◽  
Parenting Support ◽  
Infection Control Measures ◽  
The Impact

Background: The COVID-19 pandemic is primarily a crisis that affects people's physical health. However, it is well-known from previous epidemics and pandemics that there are other indirect negative impacts on mental health, among others. The purpose of this scoping review was to explore and summarise primary empirical research evidence on how the COVID-19 pandemic and societal infection control measures have impacted children and adolescents' mental health.Methods: A literature search was conducted in five scientific databases: PubMed, APA PsycINFO, Web of Science, CINHAL, and Social Science Premium Collection. The search string was designed using the Population (0–18 years), Exposure (COVID-19), Outcomes (mental health) framework. Mental health was defined broadly, covering mental well-being to mental disorders and psychiatric conditions.Results: Fifty-nine studies were included in the scoping review. Of these, 44 were cross-sectional and 15 were longitudinal studies. Most studies reported negative impact of the COVID-19 pandemic on child and adolescent mental health outcomes, yet the evidence was mixed. This was also the case for studies investigating societal control measures. Strong resilience, positive emotion regulation, physical activity, parental self-efficacy, family functioning and emotional regulation, and social support were reported as protective factors. On the contrary, emotional reactivity and experiential avoidance, exposure to excessive information, COVID-19 school concerns, presence of COVID-19 cases in the community, parental mental health problems, and high internet, social media and video game use were all identified as potentially harmful factors.Conclusions: Due to the methodological heterogeneity of the studies and geographical variation, it is challenging to draw definitive conclusions about the real impact of the COVID-19 pandemic on the mental health of children and adolescents. However, the existing body of research gives some insight to how parents, clinicians and policy makers can take action to mitigate the effects of COVID-19 and control measures. Interventions to promote physical activity and reduce screen time among children and adolescents are recommended, as well as parenting support programs.

scholarly journals Impact of Changes in Infection Control Measures on the Dynamics of COVID-19 Infections in Schools and Pre-schools

2021 ◽  
Vol 9 ◽  
Author(s):  
Martina Sombetzki ◽  
Petra Lücker ◽  
Manja Ehmke ◽  
Sabrina Bock ◽  
Martina Littmann ◽  
...  
Keyword(s):  
Infection Control ◽  
Regression Model ◽  
Multivariate Regression ◽  
Face Mask ◽  
Multivariate Model ◽  
Control Measures ◽  
Infection Control Measures ◽  
Factors Influencing ◽  
The Impact ◽  
Index Cases

Introduction: With the increased emergence of SARS-CoV-2 variants, the impact on schools and preschools remains a matter of debate. To ensure that schools and preschools are kept open safely, the identification of factors influencing the extent of outbreaks is of importance.Aim: To monitor dynamics of COVID-19 infections in schools and preschools and identify factors influencing the extent of outbreaks.Methods: In this prospective observational study we analyzed routine surveillance data of Mecklenburg-Western Pomerania, Germany, from calendar week (CW) 32, 2020 to CW19, 2021 regarding SARS-CoV-2 infection events in schools and preschools considering changes in infection control measures over time. A multivariate linear regression model was fitted to evaluate factors influencing the number of students, teachers and staff tested positive following index cases in schools and preschools. Due to an existing multicollinearity in the common multivariate regression model between the variables “face mask obligation for children” and “face mask obligation for adults”, two further separate regression models were set up (Multivariate Model Adults and Multivariate Model Children).Results: We observed a significant increase in secondary cases in preschools in the first quarter of 2021 (CW8 to CW15, 2021), and simultaneously a decrease in secondary cases in schools. In multivariate regression analysis, the strongest predictor of the extent of the outbreaks was the teacher/ caregiver mask obligation (B = −1.9; 95% CI: −2.9 to −1.0; p < 0.001). Furthermore, adult index cases (adult only or child+adult combinations) increased the likelihood of secondary cases (B = 1.3; 95% CI: 0.9 to 1.8; p < 0.001). The face mask obligation for children also showed a significant reduction in the number of secondary cases (B = −0.6; 95% CI: −0.9 to −0.2; p = 0.004.Conclusion: The present study indicates that outbreak events at schools and preschools are effectively contained by an obligation for adults and children to wear face masks.

scholarly journals Which policies most effectively reduce SARS-CoV-2 transmission in schools?

2020 ◽  
Author(s):  
Anna Bershteyn ◽  
Hae-Young Kim ◽  
Jessica McGillen ◽  
R. Scott Braithwaite
Keyword(s):  
New York ◽  
Infection Control ◽  
Primary Source ◽  
The United States ◽  
Control Measures ◽  
Infection Control Measures ◽  
Symptom Screening ◽  
Local Case ◽  
Transmission Reduction ◽  
The Impact

AbstractIntroductionNew York City (NYC) has the largest public school system in the United States (US). During the SARS-CoV-2 pandemic, NYC was the first major US city to open schools for in-person learning in the 2020-2021 academic year. Several policies were implemented to reduce the risk of in-school transmission, including infection control measures (facemasks, physical distancing, enhanced indoor ventilation, cohorting of small groups, and hand hygiene), option of all-remote instruction, alternative options for how class schedules would rotate in-person and remote instruction, daily symptom screening, and testing 10-20% of students and staff weekly or monthly depending on local case rates. We sought to determine which of these policies had the greatest impact on reducing the risk of in-school transmission.MethodsWe evaluated the impact of each policy by referring to global benchmarks for the secondary attack rate (SAR) of SARS-CoV-2 in school settings and by simulating the potential for transmission in NYC’s rotating cohort schedules, in which teachers could act as “bridges” across rotating cohorts. We estimated the impact of (1) infection control measures, (2) providing an option of all-remote instruction, (3) choice of class scheduling for in-person learners, (4) daily symptom screening, (5) testing to curtail transmission, and (6) testing to identify school outbreaks. Each policy was assessed independently of other policies, with the exception of symptom screening and random testing, which were assessed both independently and jointly.ResultsAmong the policies analyzed, the greatest transmission reduction was associated with the infection control measures, followed by small class cohorts with an option for all-remote instruction, symptom screening, and finally randomly testing 10-20% of school attendees. Assuming adult staff are the primary source of within-school SARS-CoV-2 transmission, weekly testing of staff could be at least as effective as symptom screening, and potentially more so if testing days occur in the beginning of the workweek with results available by the following day. A combination of daily symptom screening and testing on the first workday of each week could reduce transmission by 70%.ConclusionsAdherence to infection control is the highest priority for safe school re-opening. Further transmission reduction can be achieved through small rotating class cohorts with an option for remote learning, widespread testing at the beginning of the work week, and daily symptom screening and self-isolation. Randomly testing 10-20% of attendees weekly or monthly does not meaningfully curtail transmission and may not detect outbreaks before they have spread beyond a handful of individuals. School systems considering re-opening during the SARS-CoV-2 pandemic or similarly virulent respiratory disease outbreaks should consider these relative impacts when setting policy priorities.

Control of Simultaneous Outbreaks of Carbapenemase-Producing Enterobacteriaceae and Extensively Drug-ResistantAcinetobacter baumanniiInfection in an Intensive Care Unit Using Interventions Promoted in the Centers for Disease Control and Prevention 2012 Carbapenemase-Resistant Enterobacteriaceae Toolkit

2014 ◽  
Vol 35 (7) ◽  
pp. 810-817 ◽  
Author(s):  
Kyle B. Enfield ◽  
Nujhat N. Huq ◽  
Megan F. Gosseling ◽  
Darla J. Low ◽  
Kevin C. Hazen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Control ◽  
Disease Control ◽  
Control Measures ◽  
Surgical Trauma ◽  
Infection Control Measures ◽  
Resistance Plasmids ◽  
Centers For Disease Control ◽  
The Impact

ObjectiveWe describe the efficacy of enhanced infection control measures, including those recommended in the Centers for Disease Control and Prevention’s 2012 carbapenem-resistant Enterobacteriaceae (CRE) toolkit, to control concurrent outbreaks of carbapenemase-producing Enterobacteriaceae (CPE) and extensively drug-resistantAcinetobacter baumannii(XDR-AB).DesignBefore-after intervention study.SettingFifteen-bed surgical trauma intensive care unit (ICU).MethodsWe investigated the impact of enhanced infection control measures in response to clusters of CPE and XDR-AB infections in an ICU from April 2009 to March 2010. Polymerase chain reaction was used to detect the presence ofblaKPCand resistance plasmids in CRE. Pulsed-field gel electrophoresis was performed to assess XDR-AB clonality. Enhanced infection-control measures were implemented in response to ongoing transmission of CPE and a new outbreak of XDR-AB. Efficacy was evaluated by comparing the incidence rate (IR) of CPE and XDR-AB before and after the implementation of these measures.ResultsThe IR of CPE for the 12 months before the implementation of enhanced measures was 7.77 cases per 1,000 patient-days, whereas the IR of XDR-AB for the 3 months before implementation was 6.79 cases per 1,000 patient-days. All examined CPE shared endemicblaKPCresistance plasmids, and 6 of the 7 XDR-AB isolates were clonal. Following institution of enhanced infection control measures, the CPE IR decreased to 1.22 cases per 1,000 patient-days (P= .001), and no more cases of XDR-AB were identified.ConclusionsUse of infection control measures described in the Centers for Disease Control and Prevention’s 2012 CRE toolkit was associated with a reduction in the IR of CPE and an interruption in XDR-AB transmission.

scholarly journals Impact of COVID-19 Pandemic on Inpatient Rehabilitation and the Original Infection Control Measures for Rehabilitation Team

2021 ◽  
Author(s):  
Yukimasa Igawa ◽  
Takahiro Sugimoto ◽  
Hiromasa Horimoto ◽  
Yusuke Moriya ◽  
Masaki Okada ◽  
...  
Keyword(s):  
Infection Control ◽  
Functional Independence Measure ◽  
Qualitative Evaluation ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Control Measures ◽  
Rehabilitation Team ◽  
Training Time ◽  
Infection Control Measures ◽  
The Impact

AbstractObjectiveThis study aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on inpatient rehabilitation, and to determine the effectiveness of the original infection control measures implemented for the rehabilitation team.MethodsIn this single-center, retrospective, observational study, we calculated multiple rehabilitation indices of patients discharged from our rehabilitation ward between February 28 and May 25, 2020 when Hokkaido was initially affected by COVID-19, and compared them with those calculated during the same period in 2019. Fisher’s exact test and the Mann-Whitney U test were used for statistical analysis. We also verified the impact of implementing the original infection control measures for the rehabilitation team on preventing nosocomial infections.ResultsA total of 93 patients (47 of 2020 group, 46 of 2019 group) were included. The median age was 87 and 88 years, respectively, with no differences in age, sex, and main disease between the groups. Training time per day in the ward in 2020 was significantly lower than that in 2019 (p = 0.013). No significant differences were found in the qualitative evaluation indices of Functional Independence Measure (FIM) score at admission, FIM gain, length of ward stay, FIM efficiency, and rate of discharge to home. None of the patients or staff members had confirmed COVID-19 during the study period.ConclusionsEarly COVID-19 pandemic in Hokkaido affected the quantitative index for inpatient rehabilitation but not the qualitative indices. No symptomatic nosocomial COVID-19 infections were observed with our infection control measures.

scholarly journals C.1 Time Metrics and Clinical Outcomes of Thrombectomy in Acute Stroke Patients Before and After Implementation of COVID-19 Infection Protocols in Nine Canadian Stroke Centres

2021 ◽  
Vol 48 (s3) ◽  
pp. S18-S18
Author(s):  
S Zhu ◽  
V Tsehmaister-Abitbul ◽  
G Stotts ◽  
R Fahed ◽  
H Pettem ◽  
...  
Keyword(s):  
Infection Control ◽  
Clinical Outcomes ◽  
Control Measures ◽  
Hospital Arrival ◽  
Infection Control Measures ◽  
Significant Difference ◽  
Before And After ◽  
Baseline Characteristics ◽  
Stroke Center ◽  
The Impact

Background: The coronavirus disease 2019 (COVID-19) pandemic has led an implementation of institutional infection control protocols. This study will determine the effects of these protocols on outcomes of acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT). Methods: Uninterrupted time series analysis of the impact of COVID-19 safety protocols on AIS patients undergoing EVT. We analyze data from prospectively collected quality improvement databases at 9 centers from March 11, 2019 to March 10, 2021. The primary outcome is 90-day modified Rankin Score (mRS). The secondary outcomes are angiographic time metrics. Results: Preliminary analysis of one stroke center included 214 EVT patients (n=144 pre-pandemic). Baseline characteristics were comparable between the two periods. Time metrics “last seen normal to puncture” (305.7 vs 407.2 min; p=0.05) and “hospital arrival to puncture” (80.4 vs 121.2 min; p=0.04) were significantly longer during pandemic compared to pre-pandemic. We found no significant difference in 90-day mRS (2.0 vs 2.2; p=0.506) or successful EVT rate (89.6% vs 90%; p=0.93). Conclusions: Our results indicate an increase in key time metrics of EVT in AIS during the pandemic, likely related to infection control measures. Despite the delays, we found no difference in clinical outcomes between the two periods.

scholarly journals Effects of COVID-19 Infection Control Measures on the Festival and Event Sector in Poland and Norway

2021 ◽  
Vol 13 (23) ◽  
pp. 13265
Author(s):  
Dorota Janiszewska ◽  
Vilde Hannevik Lien ◽  
Dariusz Kloskowski ◽  
Luiza Ossowska ◽  
Christian Dragin-Jensen ◽  
...  
Keyword(s):  
Infection Control ◽  
Secondary Data ◽  
Control Measures ◽  
Strong Impact ◽  
Mutual Trust ◽  
The Sustainable Development ◽  
Infection Control Measures ◽  
Work From Home ◽  
The Government ◽  
The Impact

The COVID-19 pandemic has had a strong impact on the functioning of the event industry. This article aims to present the impact of infection control measures on the event sector. In addition, the article compares the infection control measures implemented in Poland and Norway. The COVID-19 infection measures analysis is the first stage of a project to build the resilience of the event sector. The study was conducted based on secondary data (analysis of documents and public statistics, with the support of the literature). The research used the descriptive method and comparisons. The results of the study confirmed the following research hypotheses according to which: (1) uncertainty is conducive to overreactions, both of the government and entities from the event sector; (2) mutual trust between government and society reduces the need for restrictions; and (3) the lack of mutual trust between government and society increases uncertainty. Furthermore, the inability to meet people, limited access to culture, and the need to work from home contributed to the deterioration of societies’ quality of life and mental health. This means that the pandemic has an adverse impact on achieving the Sustainable Development Goals (SDG 3 and 8).

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