scholarly journals Development and Delivery of a Real-time Hospital-onset COVID-19 Surveillance System Using Network Analysis

2020 ◽  
Author(s):  
James Richard Price ◽  
Siddharth Mookerjee ◽  
Eleonora Dyakova ◽  
Ashleigh Myall ◽  
Wendy Leung ◽  
...  
Keyword(s):  
Network Analysis ◽  
Real Time ◽  
Surveillance System ◽  
Healthcare Setting ◽  
Prevention Measures ◽  
Patient Pathways ◽  
Prevention Interventions ◽  
Target Prevention ◽  
Trends Over Time ◽  
Over Time

Abstract Background Understanding nosocomial acquisition, outbreaks, and transmission chains in real time will be fundamental to ensuring infection-prevention measures are effective in controlling coronavirus disease 2019 (COVID-19) in healthcare. We report the design and implementation of a hospital-onset COVID-19 infection (HOCI) surveillance system for an acute healthcare setting to target prevention interventions. Methods The study took place in a large teaching hospital group in London, United Kingdom. All patients tested for SARS-CoV-2 between 4 March and 14 April 2020 were included. Utilizing data routinely collected through electronic healthcare systems we developed a novel surveillance system for determining and reporting HOCI incidence and providing real-time network analysis. We provided daily reports on incidence and trends over time to support HOCI investigation and generated geotemporal reports using network analysis to interrogate admission pathways for common epidemiological links to infer transmission chains. By working with stakeholders the reports were co-designed for end users. Results Real-time surveillance reports revealed changing rates of HOCI throughout the course of the COVID-19 epidemic, key wards fueling probable transmission events, HOCIs overrepresented in particular specialties managing high-risk patients, the importance of integrating analysis of individual prior pathways, and the value of co-design in producing data visualization. Our surveillance system can effectively support national surveillance. Conclusions Through early analysis of the novel surveillance system we have provided a description of HOCI rates and trends over time using real-time shifting denominator data. We demonstrate the importance of including the analysis of patient pathways and networks in characterizing risk of transmission and targeting infection-control interventions.

scholarly journals Klebsiella pneumoniae ST307 with OXA-181: threat of a high-risk clone and promiscuous plasmid in a resource-constrained healthcare setting

2020 ◽  
Vol 75 (4) ◽  
pp. 896-902 ◽  
Author(s):  
K A Strydom ◽  
L Chen ◽  
M M Kock ◽  
A C Stoltz ◽  
G Peirano ◽  
...  
Keyword(s):  
South Africa ◽  
High Risk ◽  
Klebsiella Pneumoniae ◽  
Healthcare Setting ◽  
Tertiary Hospital ◽  
Prevention Measures ◽  
Resource Constrained ◽  
Over Time

Abstract Introduction Klebsiella pneumoniae with OXA-48-like enzymes were introduced into Tshwane Tertiary Hospital (TTH) (Pretoria, South Africa) during September 2015, causing nosocomial outbreaks. Methods PCR methodologies and WGS were used to characterize K. pneumoniae with carbapenemases (n = 124) from TTH (July 2015–December 2016). Results PCR was used to track K. pneumoniae ST307 with OXA-181 among 60% of carbapenemase-positive isolates in different wards/units over time and showed the transmission of IncX3 plasmids to other K. pneumoniae clones. WGS identified different ST307 clades: 307_OXA181 (consisting of two lineages, A and B) with OXA-181 on IncX3 plasmids (named p72_X3_OXA181) and clade 307_VIM with VIM-1 on IncFII plasmids. Clade 307_OXA181 lineage B was responsible for the rapid increase and transmission of OXA-181 K. pneumoniae in various wards/units throughout TTH, while the numbers of clade 307_OXA181 lineage A and clade 307_VIM remained low. Separate outbreaks were due to K. pneumoniae ST17 and ST29 with p72_X3_OXA181 plasmids. Conclusions The high-risk clone K. pneumoniae ST307 with OXA-181 rapidly spread to different wards/units despite infection and prevention measures. ST307 clades and lineages seemingly acted differently in outbreak situations. This study also highlighted the threat of promiscuous plasmids such as p72_X3_OXA181.

scholarly journals 2464. Partnerships in the Field: Using Real-time Sequencing to Enhance Epidemiologic Investigation and Response to a Norovirus Outbreak

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S853-S853
Author(s):  
Handy K Lori ◽  
Erin H Graf ◽  
Linda Brostowski ◽  
Lindsay Cunnigham ◽  
Caitlin Dougherty ◽  
...  
Keyword(s):  
Real Time ◽  
Epidemiologic Methods ◽  
Infection Prevention ◽  
Control Measures ◽  
Prevention Measures ◽  
Epidemic Curve ◽  
Epidemiologic Surveillance ◽  
Infectious Gastroenteritis ◽  
Prevention Interventions ◽  
Stool Samples

Abstract Background Norovirus is a common cause of infectious gastroenteritis and frequently leads to hospital-based outbreaks of gastrointestinal (GI) illness. We utilized hospital-wide surveillance to detect outbreaks of GI illness among patients and healthcare workers (HCW). Real-time norovirus sequencing was applied to establish conclusive links between patient cases. Methods Patient cases of healthcare-associated GI illness were detected through house-wide microbiologic surveillance. HCW cases were defined as acute episodes of vomiting and/or diarrhea that began within 48 hours of the last shift. Outbreak procedures were implemented on a unit when 3 or more cases were identified within 48 hours. Traditional epidemiologic methods were used, including an epidemic curve and line listing, while instituting local control measures. De-identified clinical stool samples positive for norovirus from any hospital unit during the defined outbreak time period were analyzed. Sanger sequencing was performed using primer sets targeting the norovirus VP1 capsid and polymerase regions. Capillary electrophoresis was implemented on a 3500 Genetic Analyzer (Applied Biosystems) and analysis was performed via MEGA7. Results Epidemiologic surveillance identified a norovirus outbreak involving 11 patients on a single unit. Sequencing was performed on 20 norovirus positive stool samples, of which 13 shared 100% identity across both the VP1 and polymerase regions. Of these 13, 10 specimens were from patients epidemiologically linked to the outbreak; 3 specimens were from patients located on 2 geographically separate floors, not epidemiologically linked to the outbreak. Identification of cases outside of the outbreak unit prompted additional hospital-wide infection prevention interventions, including increased education and messaging, changes in hand hygiene practice, and prohibition of shared food for staff. Conclusion Real-time sequencing confirmed epidemiologically linked cases of norovirus during an outbreak and identified additional transmission events not detected by conventional epidemiologic methods. Partnership between hospital epidemiology and the laboratory identified the need for hospital-wide infection prevention measures to halt ongoing transmission. Disclosures All authors: No reported disclosures.

Developing a sustainable Digital Health Innovation Ecosystem in a rural and resource-poor region: A monitored networking approach (Preprint)

2020 ◽  
Author(s):  
Arunangsu Chatterjee ◽  
Sebastian Stevens ◽  
Sheena Asthana ◽  
Ray B Jones
Keyword(s):  
Social Network ◽  
Network Analysis ◽  
Data Collection ◽  
Digital Health ◽  
Resource Poor Setting ◽  
Quadruple Helix ◽  
Innovation Ecosystem ◽  
Resource Poor ◽  
Quadruple Helix Model ◽  
Over Time

BACKGROUND Digital health (DH) innovation ecosystems (IE) are key to the development of new e-health products and services. Within an IE, third parties can help promote innovation by acting as knowledge brokers and the conduits for developing inter-organisational and interpersonal relations, particularly for smaller organisations. Kolehmainen’s quadruple helix model suggests who the critical IE actors are, and their roles. Within an affluent and largely urban setting, such ecosystems evolve and thrive organically with minimal intervention due to favourable economic and geographical conditions. Facilitating and sustaining a thriving DH IE within a resource-poor setting can be far more challenging even though far more important for such peripheral economics and the health and well-being of those communities. OBJECTIVE Taking a rural and remote region in the UK, as an instance of an IE in a peripheral economy, we adapt the quadruple helix model of innovation, apply a monitored social networking approach using McKinsey’s Three Horizons of growth to explore: • What patterns of connectivity between stakeholders develop within an emerging digital health IE? • How do networks develop over time in the DH IE? • In what ways could such networks be nurtured in order to build the capacity, capability and sustainability of the DH IE? METHODS Using an exploratory single case study design for a developing digital health IE, this study adopts a longitudinal social network analysis approach, enabling the authors to observe the development of the innovation ecosystem over time and evaluate the impact of targeted networking interventions on connectivity between stakeholders. Data collection was by an online survey and by a novel method, connection cards. RESULTS Self-reported connections between IE organisations increased between the two waves of data collection, with Small and Medium-sized Enterprises (SMEs) and academic institutions the most connected stakeholder groups. Patients involvement improved over time but still remains rather peripheral to the DH IE network. Connection cards as a monitoring tool worked really well during large events but required significant administrative overheads. Monitored networking information categorised using McKinsey’s Three Horizons proved to be an effective way to organise networking interventions ensuring sustained engagement. CONCLUSIONS The study reinforces the difficulty of developing and sustaining a DH IE in a resource-poor setting. It demonstrates the effective monitored networking approach supported by Social Network Analysis allows to map the networks and provide valuable information to plan future networking interventions (e.g. involving patients or service users). McKinsey’s Three Horizons of growth-based categorisation of the networking assets help ensure continued engagement in the DH IE contributing towards its long-term sustainability. Collecting ongoing data using survey or connection card method will become more labour intensive and ubiquitous ethically driven data collection methods can be used in future to make the process more agile and responsive.

Conclusion

2018 ◽  
Author(s):  
Manuel Fröhlich ◽  
Abiodun Williams
Keyword(s):  
Security Council ◽  
International Context ◽  
Peace And Security ◽  
Executive Action ◽  
Trends Over Time ◽  
The Impact ◽  
Over Time ◽  
The Way ◽  
Guiding Questions

The Conclusion returns to the guiding questions introduced in the Introduction, looking at the way in which the book’s chapters answered them. As such, it identifies recurring themes, experiences, structures, motives, and trends over time. By summarizing the result of the chapters’ research into the interaction between the Secretaries-General and the Security Council, some lessons are identified on the changing calculus of appointments, the conditions and relevance of the international context, the impact of different personalities in that interaction, the changes in agenda and composition of the Council as well as different formats of interaction and different challenges to be met in the realm of peace and security, administration, and reform, as well as concepts and norms. Taken together, they also illustrate the potential and limitations of UN executive action.

Eternal Today

2018 ◽  
Author(s):  
Jenni Myllykoski ◽  
Anniina Rantakari
Keyword(s):  
Real Time ◽  
Constitutive Relation ◽  
Human Agency ◽  
Fundamental Characteristic ◽  
Time Study ◽  
Software Company ◽  
Present Experience ◽  
Managerial Strategy ◽  
Over Time ◽  
Strategy Making

This chapter focuses on temporality in managerial strategy making. It adopts an ‘in-time’ view to examine strategy making as the fluidity of the present experience and draws on a longitudinal, real-time study in a small Finnish software company. It shows five manifestations of ‘in-time’ processuality in strategy making, and identifies a temporality paradox that arises from the engagement of managers with two contradictory times: constructed linear ‘over time’ and experienced, becoming ‘in time’. These findings lead to the re-evaluation of the nature of intention in strategy making, and the authors elaborate the constitutive relation between time as ‘the passage of nature’ and human agency. Consequently, they argue that temporality should not be treated merely as an objective background or a subjective managerial orientation, but as a fundamental characteristic of processuality that defines the dynamics of strategy making.

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