scholarly journals TP10.2.14Safe elective & emergency surgery: experience of a large tertiary centre during the first wave of the COVID-19 pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Joseph Thompson ◽  
Andrea Giorga ◽  
Terence Lo ◽  
Richard Baker
Keyword(s):  
Infection Prevention ◽  
Operative Mortality ◽  
Elective Surgery ◽  
Transmission Rate ◽  
Nosocomial Transmission ◽  
Prevention Measures ◽  
Transmission Rates ◽  
Emergency Procedures ◽  
Tertiary Centre ◽  
The Impact

Abstract Aims To evaluate the impact of Trust infection prevention measures (including relocation of elective patients into a protected cold wing, vigilant testing and staff test and trace) on elective and emergency nosocomial transmission rates and to analyse post-operative mortality in COVID-19 patients. Additionally, we compared the numbers of elective and emergency procedures in 2020 to 2019. Method Retrospective analysis of 5069 consecutive patients who underwent procedures in theatre from 11/03/20 – 08/09/20. COVID-19 infection was defined by PCR and/or radiological confirmation. Analysis of nosocomial transmission of COVID-19 and mortality was conducted using patient notes and death certificates. The number of procedures was compared with the same study dates in 2019. Results Nosocomial transmission rate was 0.27% in elective admissions (10/3773) and 0.97% in acute admissions (20/2052). The overall mortality in 2020 was 2.7% (135/5069). Covid-negative mortality was 2.36% (119/5033). 74 patients tested positive for COVID-19 at any time (1.3%); mortality in patients who tested positive seven days pre- to 30 days post-procedure was 5.4% (4/74). There were 10282 elective procedures in 2019 compared with 3773 in the same period in 2020, representing a 63.3% reduction in elective activity. Conclusion Our hospital infection prevention measures have kept nosocomial transmission rates low, particularly for elective admissions. We have observed lower rates of post-operative mortality in COVID-19 patients than published in other centres. There has been a predictably significant reduction in elective activity, however based on our findings we believe our infection prevention measures could provide reassurances to safely increase elective surgery activity.

scholarly journals 902 Safe Elective & Emergency Surgery During the COVID-19 Crisis: Experience of a Large Tertiary Centre During the First Wave of the Pandemic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Giorga ◽  
J Thompson ◽  
T Lo ◽  
R Baker
Keyword(s):  
Infection Prevention ◽  
Operative Mortality ◽  
Elective Surgery ◽  
Transmission Rate ◽  
Nosocomial Transmission ◽  
Prevention Measures ◽  
Surgical Services ◽  
Tertiary Centre ◽  
Acute Admissions ◽  
Overall Mortality

Abstract Aim In addition to a reduction in elective surgery, the COVID-19 pandemic has been associated with concerning rates of post-operative mortality in COVID-19 patients highlighting the threat of nosocomial transmission. Relocation of elective patients into a protected cold wing of a tertiary centre, vigilant testing and staff test, and trace were implemented to address these issues. Method Retrospective analysis of 5069 consecutive patients who underwent procedures in theatre from 11/03/20 – 08/09/20 was performed. Comparison of numbers of procedures was compared with the same study dates in 2019. Detailed analysis of nosocomial transmission of COVID-19 and mortality was performed using patient notes and death certificates. Results 5854 procedures were performed in 2020 compared with 13219 in 2019, representing a reduction of 55.7%. The overall mortality in 2020 was 2.7% (135/5069). COVID-19 negative mortality was 2.36% (119/5033). 74 patients tested positive for COVID-19 at any time (1.3%); mortality amongst patients who tested positive seven days pre- to 30 days post-procedure was 5.4% (4/74). Nosocomial transmission rate was 0.27% in elective admissions (10/3773) and 0.97% in acute admissions (20/2052). Conclusions The first wave of the pandemic has predictably caused a significant reduction in elective activity. Our hospital infection prevention measures have kept nosocomial transmission rates low, particularly for elective admissions. We have observed lower rates of post-operative mortality in COVID-19 patients than published in other centres. Continuation of surgical services is important for patient outcomes, and essential for training the surgeons of tomorrow.

The impact of a multimodel approach to designing a new orthopedic department

2020 ◽  
pp. 1-6
Author(s):  
Elad Keren ◽  
Abraham Borer ◽  
Lior Nesher ◽  
Tali Shafat ◽  
Rivka Yosipovich ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Antibiotic Stewardship ◽  
Infection Prevention ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Prevention Measures ◽  
Orthopedic Department ◽  
Before And After ◽  
The Impact

Abstract Objective: To determine whether a multifaceted approach effectively influenced antibiotic use in an orthopedics department. Design: Retrospective cohort study comparing the readmission rate and antibiotic use before and after an intervention. Setting: A 1,000-bed, tertiary-care, university hospital. Patients: Adult patients admitted to the orthopedics department between January 2015 and December 2018. Methods: During the preintervention period (2015–2016), 1 general orthopedic department was in operation. In the postintervention period (2017–2018), 2 separate departments were created: one designated for elective “clean” surgeries and another that included a “complicated wound” unit. A multifaceted strategy including infection prevention measures and introducing antibiotic stewardship practices was implemented. Admission rates, hand hygiene practice compliance, surgical site infections, and antibiotic treatment before versus after the intervention were analyzed. Results: The number of admissions and hospitalization days in the 2 periods did not change. Seven-day readmissions per annual quarter decreased significantly from the preintervention period (median, 7 days; interquartile range [IQR], 6–9) to the postintervention period (median, 4 days; IQR, 2–7; P = .038). Hand hygiene compliance increased and surgical site infections decreased in the postintervention period. Although total antibiotic use was not reduced, there was a significant change in the breakdown of the different antibiotic classes used before and after the intervention: increased use of narrow-spectrum β-lactams (P < .001) and decreased use of β-lactamase inhibitors (P < .001), third-generation cephalosporins (P = .044), and clindamycin (P < .001). Conclusions: Restructuring the orthopedics department facilitated better infection prevention measures accompanied by antibiotic stewardship implementation, resulting in a decreased use of broad-spectrum antibiotics and a significant reduction in readmission rates.

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

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.

scholarly journals The impact of testing and infection prevention and control strategies on within-hospital transmission dynamics of COVID-19 in English hospitals

2021 ◽  
Vol 376 (1829) ◽  
pp. 20200268
Author(s):  
Stephanie Evans ◽  
Emily Agnew ◽  
Emilia Vynnycky ◽  
James Stimson ◽  
Alex Bhattacharya ◽  
...  
Keyword(s):  
Prevention And Control ◽  
Infection Prevention ◽  
Control Strategies ◽  
Nosocomial Transmission ◽  
Transmission Model ◽  
Infection Prevention And Control ◽  
The Uk ◽  
Hospital Acquired ◽  
And Control ◽  
The Impact

Nosocomial transmission of SARS-CoV-2 is a key concern, and evaluating the effect of testing and infection prevention and control strategies is essential for guiding policy in this area. Using a within-hospital SEIR transition model of SARS-CoV-2 in a typical English hospital, we estimate that between 9 March 2020 and 17 July 2020 approximately 20% of infections in inpatients, and 73% of infections in healthcare workers (HCWs) were due to nosocomial transmission. Model results suggest that placing suspected COVID-19 patients in single rooms or bays has the potential to reduce hospital-acquired infections in patients by up to 35%. Periodic testing of HCWs has a smaller effect on the number of hospital-acquired COVID-19 cases in patients, but reduces infection in HCWs by as much as 37% and results in only a small proportion of staff absences (approx. 0.3% per day). This is considerably less than the 20–25% of staff that have been reported to be absent from work owing to suspected COVID-19 and self-isolation. Model-based evaluations of interventions, informed by data collected so far, can help to inform policy as the pandemic progresses and help prevent transmission in the vulnerable hospital population. This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK’.

scholarly journals Elective orthopaedic surgery with a designated COVID-19-free pathway results in low perioperative viral transmission rates

2020 ◽  
Vol 1 (9) ◽  
pp. 562-567 ◽  
Author(s):  
Justin S. Chang ◽  
Warran Wignadasan ◽  
Raj Pradhan ◽  
Christina Kontoghiorghe ◽  
Babar Kayani ◽  
...  
Keyword(s):  
Orthopaedic Surgery ◽  
Elective Surgery ◽  
Transmission Rate ◽  
Patient Characteristics ◽  
Viral Transmission ◽  
Transmission Rates ◽  
Orthopaedic Patients ◽  
Grade Ii ◽  
American Society ◽  
A Prospective Study

Aims The safe resumption of elective orthopaedic surgery following the peak of the COVID-19 pandemic remains a significant challenge. A number of institutions have developed a COVID-free pathway for elective surgery patients in order to minimize the risk of viral transmission. The aim of this study is to identify the perioperative viral transmission rate in elective orthopaedic patients following the restart of elective surgery. Methods This is a prospective study of 121 patients who underwent elective orthopaedic procedures through a COVID-free pathway. All patients underwent a 14-day period of self-isolation, had a negative COVID-19 test within 72 hours of surgery, and underwent surgery at a COVID-free site. Baseline patient characteristics were recorded including age, American Society of Anaesthesiologists (ASA) grade, body mass index (BMI), procedure, and admission type. Patients were contacted 14 days following discharge to determine if they had had a positive COVID-19 test (COVID-confirmed) or developed symptoms consistent with COVID-19 (COVID-19-presumed). Results The study included 74 females (61.2%) and 47 males (38.8%) with a mean age of 52.3 years ± 17.6 years (18 to 83 years). The ASA grade was grade I in 26 patients (21.5%), grade II in 70 patients (57.9%), grade III in 24 patients (19.8%), and grade IV in one patient (0.8%). A total of 18 patients (14.9%) had underlying cardiovascular disease, 17 (14.0%) had pulmonary disease, and eight (6.6%) had diabetes mellitus. No patients (0%) had a positive COVID-19 test in the postoperative period. One patient (0.8%) developed anosmia postoperatively without respiratory symptoms or a fever. The patient did not undergo a COVID-19 test and self-isolated for seven days. Her symptoms resolved within a few days. Conclusion The development of a COVID-free pathway for elective orthopaedic patients results in very low viral transmission rates. While both surgeons and patients should remain vigilant, elective surgery can be safely restarted using dedicated pathways and procedures. Cite this article: Bone Joint Open 2020;1-9:562–567.

scholarly journals Experience of patients diagnosed as asymptomatic COVID-19 after dental treatment

2021 ◽  
Vol 43 (1) ◽  
Author(s):  
Ju-Yeon Seo ◽  
Sung-Tak Lee ◽  
So-Young Choi ◽  
Jin-Wook Kim ◽  
Tae-Geon Kwon
Keyword(s):  
Infection Prevention ◽  
Dental Treatment ◽  
Close Contact ◽  
Secondary Infection ◽  
Maxillofacial Surgery ◽  
Healthcare Personnel ◽  
Oral And Maxillofacial Surgery ◽  
Prevention Measures ◽  
Case Presentation ◽  
The Impact

Abstract Background The potential risk of coronavirus disease 2019 (COVID-19) transmission from asymptomatic COVID-19 patients is a concern in dental practice. However, the impact of this risk is not well documented to date. This report describes our dental clinical experience with patients who did not exhibit symptoms of COVID-19 but were later confirmed as positive for COVID-19. Case presentation Of the 149,149 patients who visited the outpatient clinic of KNUDH and the 3291 patients who visited the Oral and Maxillofacial Surgery Clinic of KNUH, 3 were later confirmed as having COVID-1 between 1 February 2020 and 28 February 2021. Owing to close contact with these patients during their treatments, 46 dental and medical staff had to undergo quarantine from the date of the patients’ confirmation of COVID-19 infection. Conclusion The presented cases showed the potential existence of asymptomatic COVID-19 patients after dental treatment with aerosol-generating procedures. Clinicians should be aware of the infection prevention measures and try to protect healthcare personnel from secondary infection of COVID-19 during dental treatments.

Pandemic (H1N1) 2009 Influenza in Hospitalized Children in Manitoba: Nosocomial Transmission and Lessons Learned from the First Wave

2011 ◽  
Vol 32 (5) ◽  
pp. 435-443 ◽  
Author(s):  
Sergio T. Fanella ◽  
Michelle A. Pinto ◽  
Natalie A. Bridger ◽  
Jared M. P. Bullard ◽  
Jennifer M. L. Coombs ◽  
...  
Keyword(s):  
Prevention And Control ◽  
Infection Prevention ◽  
Seasonal Influenza ◽  
Tertiary Care ◽  
Nosocomial Transmission ◽  
Infection Prevention And Control ◽  
Pandemic H1n1 ◽  
Pandemic H1n1 2009 ◽  
And Control ◽  
The Impact

Objective.To review the experiences at Winnipeg Children's Hospital (WCH) during the 2009 influenza season, with an emphasis on nosocomial transmission and infection prevention and control responses.Design.A case series of patients admitted to WCH who had laboratory-confirmed cases of influenza between January 1 and July 31, 2009, with a comparison of patients with seasonal influenza and those with pandemic (H1N1) 2009 influenza; a review of the impact of infection prevention and control modifications on nosocomial transmission.Patients and Setting.A total of 104 inpatients with influenza, 81 of whom had pandemic (H1N1) 2009 influenza, were reviewed at a large Canadian pediatric tertiary care center.Results.There were no differences in risk factors, presentation, or outcome between patients with seasonal influenza and those with pandemic (H1N1) 2009 influenza. There were 8 nosocomial cases of pandemic (H1N1) 2009 influenza. Excluding patients with nosocomial cases, mean length of hospital stay was significantly shortened to 3.7 days for individuals who had pandemic (H1N1) 2009 influenza and who received empiric oseltamivir on admission to the hospital, compared with 12.0 days for patients for whom treatment was delayed (P = .02). Treatment with oseltamivir of all patients with suspected cases of influenza and prompt modifications to infection control practices, including playroom closures and enhanced education of visitors and staff, terminated nosocomial transmission.Conclusions.Infection with pandemic (H1N1) 2009 influenza virus resulted in a substantial number of hospitalizations of pediatric patients in Manitoba, including those with nosocomial cases, thereby stressing the capacity of WCH. Immediate therapy with oseltamivir on admission to the hospital resulted in a significantly reduced length of hospitalization. This, coupled with intensified infection prevention and control practices, halted nosocomial transmission. These strategies should be considered in future pandemic influenza or other respiratory viral outbreaks.

scholarly journals Clinical and psycho-socio-economic impact of COVID-19 pandemic on patients of the Indian Progressive Systemic Sclerosis Registry (IPSSR)

2021 ◽  
Author(s):  
Chengappa Kavadichanda ◽  
Vineeta Shobha ◽  
Parasar Ghosh ◽  
Anupam Wakhlu ◽  
Devender Bairwa ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Prescription Drugs ◽  
Infection Prevention ◽  
Financial Burden ◽  
Healthcare Providers ◽  
Progressive Systemic Sclerosis ◽  
Adverse Outcomes ◽  
Prevention Measures ◽  
Socio Economic Impact ◽  
The Impact

Abstract Objectives To determine the impact of COVID-19 pandemic on access to healthcare among the patients with Scleroderma. To analyse the economic and psychosocial impact and the infection prevention measures taken by them during the pandemic. Methods A 25 item questionnaire designed to assess the components of the objectives was tele-administered between October 2020 and January 2021 to the patients enrolled in the Indian Progressive Systemic Sclerosis Registry registry. Results Out of the 428 patients in the registry, 336 took part in the study. Scheduled outpatient visit was missed by 310 (92.3%) patients and 75 (22.3%) skipped prescription drugs. During the pandemic, 75 (22.3%) had a family member lose jobs. Financial difficulties were reported by 155 (46.1%) with 116 (34.5%) patients having to spend an additional of INR 4000 (2000 to 10000) [USD 54.9 (27.0– 137.4)] to continue treatment. Though 35 patients (10.4%) had at least one symptom suggestive of COVID-19, confirmed infection was only in 4. None of them needed hospitalisation or had adverse outcomes. Worsening of Scleroderma was seen in 133 (39.6%) individuals with 15(4.5%) requiring hospitalisation. Most (96%) of the patients were aware about infection prevention measures and 91(27.1%) had taken unproven prophylactic medications. Conclusion Individuals with Scleroderma in India have been affected during the pandemic due to closure of hospital services, lack of transport, loss of job and the additional financial burden. Healthcare providers should continue to educate patients to stay on their medications and encourage them to get vaccinated for COVID-19.

scholarly journals The impact of testing and infection prevention and control strategies on within-hospital transmission dynamics of COVID-19 in English hospitals

2020 ◽  
Author(s):  
Stephanie Evans ◽  
Emily Agnew ◽  
Emilia Vynnycky ◽  
Julie V Robotham
Keyword(s):  
Infection Prevention ◽  
Control Strategies ◽  
Nosocomial Transmission ◽  
Infection Prevention And Control ◽  
Periodic Testing ◽  
Hospital Acquired ◽  
And Control ◽  
The Impact ◽  
Patient Burden ◽  
Hospital Transmission

Nosocomial transmission of SARS-CoV-2 is a key concern and evaluating the effect of testing and infection prevention control strategies is essential for guiding policy in this area. Using a within-hospital SEIR transition model of SARS-CoV-2 in a typical UK hospital, we predict that approximately 20% of infections in inpatients, and 89% of infections in HCWs were due to nosocomial transmission. Placing suspected COVID-19 patients in single rooms or bays has the potential to reduce hospital-acquired infections in patients by up to 80%. Periodic testing of HCWs has a smaller effect on the patient-burden of COVID-19 but would considerably reduce infection in HCWs by as much as 64% and result in only a small proportion of staff absences (approximately 1% per day). This is considerably fewer than currently observed due to suspected COVID-19 and self-isolation.

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