scholarly journals A how-to-guide to building a robust SARS-CoV-2 testing program at a university-based health system

2020 ◽  
Author(s):  
Stephen D. Nimer ◽  
Jennifer Chapman ◽  
Lisa Reidy ◽  
Alvaro Alencar ◽  
Yanyun Wu ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
South Florida ◽  
Contact Tracing ◽  
Government Officials ◽  
Diagnostic Laboratory ◽  
Testing Program ◽  
Detection Program ◽  
Workforce Needs ◽  
Testing Protocols ◽  
Test Ordering

AbstractWhen South Florida became a hotspot for COVID-19 disease in March 2020, we faced an urgent need to develop test capability to detect SARS-CoV-2 infection. We assembled a transdisciplinary team of knowledgeable and dedicated physicians, scientists, technologists and administrators, who rapidly built a multi-platform, PCR- and serology-based detection program, established drive-thru facilities and drafted and implemented guidelines that enabled efficient testing of our patients and employees. This process was extremely complex, due to the limited availability of needed reagents, but outreach to our research scientists and to multiple diagnostic laboratory companies and government officials enabled us to implement both FDA authorized and laboratory developed testing (LDT)-based testing protocols. We analyzed our workforce needs and created teams of appropriately skilled and certified workers, to safely process patient samples and conduct SARS-CoV-2 testing and contact tracing. We initiated smart test ordering, interfaced all testing platforms with our electronic medical record, and went from zero testing capacity, to testing hundreds of healthcare workers and patients daily, within three weeks. We believe our experience can inform the efforts of others, when faced with a crisis situation.

scholarly journals A How-to Guide to Building a Robust SARS-CoV-2 Testing Program at a University-Based Health System

2020 ◽  
Vol 7 ◽  
pp. 237428952095820
Author(s):  
Stephen D. Nimer ◽  
Jennifer Chapman ◽  
Lisa Reidy ◽  
Alvaro Alencar ◽  
YanYun Wu ◽  
...  
Keyword(s):  
Hot Spot ◽  
South Florida ◽  
Contact Tracing ◽  
Government Officials ◽  
Diagnostic Laboratory ◽  
Detection Program ◽  
Care Workers ◽  
Polymerase Chain ◽  
Workforce Needs ◽  
Testing Protocols

When South Florida became a hot spot for COVID-19 disease in March 2020, we faced an urgent need to develop test capability to detect SARS-CoV-2 infection. We assembled a transdisciplinary team of knowledgeable and dedicated physicians, scientists, technologists, and administrators who rapidly built a multiplatform, polymerase chain reaction- and serology-based detection program, established drive-through facilities, and drafted and implemented guidelines that enabled efficient testing of our patients and employees. This process was extremely complex, due to the limited availability of needed reagents, but outreach to our research scientists and multiple diagnostic laboratory companies, and government officials enabled us to implement both Food and Drug Administration authorized and laboratory-developed testing–based testing protocols. We analyzed our workforce needs and created teams of appropriately skilled and certified workers to safely process patient samples and conduct SARS-CoV-2 testing and contact tracing. We initiated smart test ordering, interfaced all testing platforms with our electronic medical record, and went from zero testing capacity to testing hundreds of health care workers and patients daily, within 3 weeks. We believe our experience can inform the efforts of others when faced with a crisis situation.

scholarly journals Broad-based SARS-CoV-2 Testing Program for Healthcare Workers in a Primary Care Hospital In France

2021 ◽  
Author(s):  
Julie Chas ◽  
Marine Nadal ◽  
Martin Siguier ◽  
Anne Fajac ◽  
Michel Denis ◽  
...  
Keyword(s):  
Primary Care ◽  
Healthcare Workers ◽  
Care Hospital ◽  
Testing Program ◽  
Primary Care Hospital

scholarly journals Methicillin-Resistant Staphylococcus aureus Prevalence Among Healthcare Workers in Contact Tracings in a Dutch Hospital

2020 ◽  
Vol 41 (S1) ◽  
pp. s316-s317
Author(s):  
Veronica Weterings ◽  
Heidi Kievits ◽  
Miranda van Rijen ◽  
Jan Kluytmans
Keyword(s):  
Staphylococcus Aureus ◽  
The Netherlands ◽  
Healthcare Workers ◽  
Index Case ◽  
Contact Tracing ◽  
Secondary Case ◽  
National Guidelines ◽  
Carriage Rate ◽  
Methicillin Resistant ◽  
Mlva Type

Background: In The Netherlands, the national guidelines on Methicillin-Resistant Staphylococcus aureus (MRSA) prevention and control advocate screening of healthcare workers (HCWs) after unprotected exposure to MRSA carriers. Although this strategy is largely successful, contact tracing of staff is a time-consuming and costly component. We evaluated our contact tracing policy for HCWs over the years 2010–2018. Methods: A retrospective, observational study was performed in a Dutch teaching hospital. All HCWs who had unprotected contact with an MRSA carrier were included in contact tracing. When there had been a long period of unprotected admission prior to an MRSA finding, or when the index case was an HCW, the entire (nursing) team was tested. All samples of HCWs who were tested for MRSA carriage as part of contact tracing from 2010 until 2018 were included. A pooled nose, throat, and perineum swab was collected using the eSwab medium (Copan) and inoculated on chromID MRSA agar plates (bioMérieux) after enrichment in a broth. Molecular typing was performed using multiple-locus variable number of tandem repeat analysis (MLVA). Results: In total, we included 8,849 samples (range, 677–1,448 samples per year) from 287 contact tracings (range, 26–55 contact tracings per year). Overall, 32 HCWs were colonized with MRSA (0.36%; 95% CI, 0.26%–0.51%). None of them developed a clinical infection. Moreover, 8 HCWs (0.10%; 95% CI, 0.05%–0.19%) were colonized with the same MLVA type as the index case and were detected in 6 of 287 contact tracings (2%). In 4 of 8 of these cases, a positive HCW was the index for undertaking contact tracing. In 3 of 8 cases, it was clear that the HCW who was identified in the contact tracing was the source of the outbreak and was the cause of invasive MRSA infections in patients. Notably, a different MLVA type as the index case was found in 24 HCWs (0.27%; 95% CI, 0.18%–0.40%) of whom 7 of 24 HCWs (29.2%) were intermittent carriers. Conclusions: This study revealed a sustained low MRSA prevalence among samples in contact tracing of HCWs over 9 years. Furthermore, it shows that when MRSA contact tracing is performed according to the national guideline, only 1 of 1,000 samples results in a secondary case. This is similar to the population carriage rate of MRSA in The Netherlands. More frequently, an unrelated strain is found. These findings raise questions regarding the efficacy of the current strategy to perform contact tracing after unprotected exposure.Funding: NoneDisclosures: None

Coronaviruses: A Scientist’s Race Against Time

2020 ◽  
Author(s):  
Saloni Chaurasia ◽  
Keyword(s):  
Healthcare Workers ◽  
Vaccine Development ◽  
Drug Repurposing ◽  
Alveolar Epithelial Cells ◽  
Contact Tracing ◽  
Medical Innovation ◽  
Alveolar Epithelial ◽  
Treatment And Prevention ◽  
Scientific World ◽  
Respiratory Droplets

As the clock ticks, more and more people are falling victim to COVID-19, and scientists are racing against time to find treatment and prevention strategies. But what’s stopping them? The answer comes from two primary problems. Firstly, coronaviruses (CoVs) are transmitted from person-to-person via respiratory droplets from an infected person’s coughs or sneezes, which makes them highly contagious (CDC, How COVID-19 Spreads, 2020). This can happen in minutes, and up to 25% of patients remain asymptomatic (Du, et al., 2020). This makes it difficult for healthcare workers and researchers to contain patients and establish contact tracing to isolate the infected population. Secondly, it is hard to target CoVs without damaging our cells. CoVs infect via spike protein, which binds to the ACE2 receptor located on the lung alveolar epithelial cells (Hoffmann, et al., 2020). Once they invade the cell, CoVs hijack the host cell’s mechanisms to replicate. Thus, it is hard to combat the virus without damaging the host cell. On the other hand, recent understanding of CoVs structure and mechanism of action enables the scientific world to create a cure or vaccine. The bad news is that these efforts will likely face the perennial hurdles of medical innovation and discovery, long timelines of clinical trials for drug repurposing, and vaccine development, sometimes fickle funding, and changing governmental priorities.

Center for disease control diagnostic immunology proficiency testing program results for 1976

1977 ◽  
Vol 6 (3) ◽  
pp. 224-232
Author(s):  
R N Taylor ◽  
K M Fulford ◽  
A Przybyszewski ◽  
V Pope
Keyword(s):  
Disease Control ◽  
Proficiency Testing ◽  
Hepatitis B Surface Antigen ◽  
Testing Program ◽  
Proficiency Levels ◽  
Clinical Laboratories ◽  
Individual Laboratory ◽  
Specific Proteins ◽  
Overall Performance ◽  
Testing Protocols

Over 900 laboratories participated in the Diagnostic Immunology portion of the 1976 Proficiency Testing Program, which was provided by the Center of Disease Control under the authority of the Clinical Laboratories Improvement Act of 1967. One hundred specimens prepared by the Center for Disease Control for analysis were distributed on a quarterly schedule or in special surveys. Feedback from participating laboratories included over 37,500 qualitative and 33,000 quantitative responses, which were analyzed to determine individual laboratory proficiency levels. In addition, information supplied by participants in each survey helped to delineate trends in testing protocols. The specimens chosen for analysis called for a broad range of tests commonly performed in diagnostic immunology laboratories, including those for rubella antibodies, hepatitis B surface antigen, bacterial antibodies, rheumatoid factor, immunoglobulins and other serum-specific proteins, and carcinoembryonic antigen. A summary of the data analysis is provided so that the laboratories can improve their overall performance levels.

scholarly journals SARS-CoV-2 transmission and control in a hospital setting: an individual-based modelling study

2020 ◽  
Author(s):  
Qimin Huang ◽  
Anirban Mondal ◽  
Xiaobing Jiang ◽  
Mary Ann Horn ◽  
Fei Fan ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Hospital Setting ◽  
Credible Interval ◽  
Contact Tracing ◽  
Global Public Health ◽  
Minimal Impact ◽  
Social Distancing ◽  
Work Related ◽  
The Impact ◽  
Outbreak Size

Background: Development of strategies for mitigating the severity of COVID-19 is now a top global public health priority. We sought to assess strategies for mitigating the COVID-19 outbreak in a hospital setting via the use of non-pharmaceutical interventions such as social distancing, self-isolation, tracing and quarantine, wearing facial masks/ personal protective equipment. Methods: We developed an individual-based model for COVID-19 transmission among healthcare workers in a hospital setting. We calibrated the model using data of a COVID-19 outbreak in a hospital unit in Wuhan in a Bayesian framework. The calibrated model was used to simulate different intervention scenarios and estimate the impact of different interventions on outbreak size and workday loss. Results: We estimated that work-related stress increases susceptibility to COVID-19 infection among healthcare workers by 52% (90% Credible Interval (CrI): 16.4% - 93.0%). The use of high efficacy facial masks was shown to be able to reduce infection cases and workday loss by 80% (90% CrI: 73.1% - 85.7%) and 87% (CrI: 80.0% - 92.5%), respectively. The use of social distancing alone, through reduced contacts between healthcare workers, had a marginal impact on the outbreak. A strict quarantine policy with the isolation of symptomatic cases and a high fraction of pre-symptomatic/ asymptomatic cases (via contact tracing or high test rate), could only prolong outbreak duration with minimal impact on the outbreak size. Our results indicated that a quarantine policy should be coupled with other interventions to achieve its effect. The effectiveness of all these interventions was shown to increase with their early implementation. Conclusions: Our analysis shows that a COVID-19 outbreak in a hospital's non-COVID-19 unit can be controlled or mitigated by the use of existing non-pharmaceutical measures.

scholarly journals Emergency Room “Opt-Out” HIV Testing Pre- and During COVID-19 Pandemic in a Large Community Health System

2021 ◽  
Vol 20 ◽  
pp. 232595822110412
Author(s):  
Paula Eckardt ◽  
Jianli Niu ◽  
Sheila Montalvo
Keyword(s):  
Hiv Infection ◽  
Hiv Testing ◽  
Healthcare System ◽  
South Florida ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Testing Program ◽  
Large Community ◽  
Opt Out ◽  
The Impact

Background: South Florida has the highest HIV rates across the country. Emergency Rooms (ERs) are optimal clinical sites for the identification of people living with HIV. We aimed to evaluate the feasibility and yield of opt-out HIV testing among ER patients in a large community healthcare system in South Florida, and determine the impact of the COVID-19 pandemic on HIV testing. Methods: This was a retrospective study conducted in the Memorial Healthcare System, Hollywood, Florida. HIV test was offered on an “opt-out” basis to patients aged 16 years or older presenting to the ER of the Memorial Regional Hospital between July 2018 and August 2020. Number of ER visits, HIV testing offered, acceptance of HIV testing, tested positive for HIV infection and linkage to care were reviewed and analyzed. Results: A total of 105,264 (53.7%) patients of 196,110 ER visits were eligible for HIV testing and 39,261 (37.3%) completed HIV testing. Of those tested, 206 (0.5%) patients tested positive, with 54 (26.2%) new infected patients and 152 (73.8%) known infected patients who had not disclosed their status. 45 (60%) of 75 patients with known HIV infections who were not engaged in HIV care were successfully relinked into care after testing, and engagement in care increased from 50.7% pre-testing to 80.3% post-testing (p = 0.001). 45 (83.3%) of 54 newly diagnosed patients were successfully linked into care. During the COVID-19 pandemic, there was a significant reduction in both the ER visits and HIV tests as compared with the pre-pandemic period (p = 0.007 and p < 0.001, respectively). Conclusion: An “Opt-out” HIV testing program was successfully implemented in a community hospital ERs. The use of this strategy successfully identified patients with undiagnosed HIV infection and improved their engagement in HIV care. Given the impact of COVID-19 pandemic on the testing program, new strategies should develop to reduce service disruption and maintain the progress of “Opt-out” HIV testing.

scholarly journals A case of respiratory toxigenic diphtheria: contact tracing results and considerations following a 30-year disease-free interval, Catalonia, Spain, 2015

2018 ◽  
Vol 23 (13) ◽  
Author(s):  
Mireia Jané ◽  
Maria José Vidal ◽  
Neus Camps ◽  
Magda Campins ◽  
Ana Martínez ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Fast Track ◽  
Index Case ◽  
Adult Population ◽  
Primary Vaccination ◽  
Contact Tracing ◽  
Timely Manner ◽  
Disease Free Interval ◽  
Free Interval ◽  
Disease Free

In May 2015, following a 30-year diphtheria-free interval in Catalonia, an unvaccinated 6-year-old child was diagnosed with diphtheria caused by toxigenic Corynebacterium diphtheriae. After a difficult search for equine-derived diphtheria antitoxin (DAT), the child received the DAT 4 days later but died at the end of June. Two hundred and seventeen contacts were identified in relation to the index case, and their vaccination statuses were analysed, updated and completed. Of these, 140 contacts underwent physical examination and throat swabs were taken from them for analysis. Results were positive for toxigenic C. diphtheriae in 10 contacts; nine were asymptomatic vaccinated children who had been in contact with the index case and one was a parent of one of the nine children. Active surveillance of the 217 contacts was initiated by healthcare workers from hospitals and primary healthcare centres, together with public health epidemiological support. Lack of availability of DAT was an issue in our case. Such lack could be circumvented by the implementation of an international fast-track procedure to obtain it in a timely manner. Maintaining primary vaccination coverage for children and increasing booster-dose immunisation against diphtheria in the adult population is of key importance.

scholarly journals 42. Outbreak of SARS-CoV-2 in Hospitalized Hemodialysis Patients: an Epidemiologic and Genomic Investigation

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S31-S31
Author(s):  
Charles E Marvil ◽  
Anne Piantadosi ◽  
Aaron Preston ◽  
Andrew Webster ◽  
Jeannette Guarner ◽  
...  
Keyword(s):  
Phylogenetic Tree ◽  
Healthcare Workers ◽  
The State ◽  
Outbreak Investigation ◽  
Contact Tracing ◽  
Nasopharyngeal Swab ◽  
Prevention Measures ◽  
Nursing Unit ◽  
Hemodialysis Session ◽  
Inpatient Nursing

Abstract Background Healthcare-associated transmission of SARS-CoV-2 is relatively rare and may be difficult to quantify. We performed an epidemiological investigation and SARS-CoV-2 genome sequencing to define the source and scope of a SARS-CoV-2 outbreak in a cluster of hospitalized patients Methods We conducted an outbreak investigation after identifying hospital-onset COVID-19 in patients receiving hemodialysis in January 2021. Electronic medical record review, staff interviews, review of employee schedule logs, and contact tracing were used to determine the outbreak timeline and identify exposed healthcare workers (HCW). SARS-CoV-2 genomes were sequenced from residual nasopharyngeal swab samples from 6 individuals in the outbreak investigation and compared to sequences from 14 patients in the same facility, 54 patients in nearby facilities, and 375 publicly available sequences from individuals in the state of Georgia. Results Eight patients with hospital-onset COVID-19 were identified (Cases 1-8); all were receiving hemodialysis and 5 were bedded in a single inpatient nursing unit. Among 53 potentially exposed HCW, 29 underwent testing and 5 were positive (Cases 9-13). The suspected index patient (Case 1) was found to have been coughing and inconsistently wearing a mask during a hemodialysis session on the same day that 6 of the 7 other patients and one HCW (Case 10) were in close proximity in the hemodialysis unit (Figure 1A). Further investigation revealed lack of use of curtain barriers in the hemodialysis bays, inconsistent use of personal protective equipment by HCW, and overcrowding of staff breakrooms. Among the 6 samples available for phylogenetic analysis, SARS-CoV-2 sequences from 5 (4 patients and 1 HCW, Case 9) were identical and at least 4 SNPs removed from the next closest sequence in this study, supporting a transmission cluster (Figure 1B). The sequence from the sixth sample (HCW Case 10) was phylogenetically distinct, indicating an independent source of infection. Figure 1 Exposure and onset of symptoms for the 6 cases in the outbreak with samples available for SARS-CoV-2 sequencing. Four patients with hospital-onset COVID-19 (Cases 1-4) were receiving hemodialysis and bedded in a single inpatient nursing unit, with two exposed healthcare workers (Cases 9-10). (A). Phylogenetic tree of SARS-CoV-2 genomes from individuals in this outbreak investigation (red), as well as 14 patients in the same facility and 54 patients in nearby facilities between 12/12/2020 and 1/13/2021 (blue). These were aligned with 375 publicly available sequences from individuals in the state of Georgia from the same time period using MAFFT. A maximum-likelihood phylogenetic tree was generated under a generalized time-reversible model with 1,000 bootstrap replicates using IQtree v2.0.3 and visualized and annotated using Interactive Tree of Life (iTOL) v4 (B). Conclusion Lack of appropriate respiratory hygiene led to SARS-CoV-2 transmission during a single hemodialysis session, based on clinical and genomic epidemiology. Use of appropriate PPE for both patients and HCW and other infection prevention measures are critical to prevent SARS-CoV-2 transmission. Disclosures All Authors: No reported disclosures

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