scholarly journals A cohort study of the effect of SARS-CoV-2 point of care rapid RT-PCR at the Emergency Department on targeted admission

2021 ◽  
Author(s):  
Susanne E Mortazavi ◽  
Malin Inghammar ◽  
Claus Christiansen ◽  
Anne-Katrine Pesola ◽  
Mikael Stenkilsson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Rapid Detection ◽  
Medical Condition ◽  
Point Of Care ◽  
Control Measures ◽  
Test Results ◽  
Rt Pcr ◽  
Reliable Test ◽  
Infection Control Measures ◽  
Hospital Wards

(ii)AbstractBackgroundTo prevent nosocomial transmission of SARS-CoV-2, infection control measures are implemented for patients with symptoms compatible with COVID-19 until reliable test results are available. This delay targeted admission to the most appropriate ward based on the medical condition. SARS-CoV-2 rapid antigen detection (RAD) tests and point of care (POC) rapid RT-PCR were introduced at emergency departments (EDs) in late 2020, but the consequence on targeted admission is unknown.ObjectivesTo assess the effect of RAD tests and POC rapid RT-PCR (VitaPCR, Credo Diagnostics, Singapore) on targeted admission.MethodsPatients presenting at the ED of a referral hospital (N = 2,940) between 13-Nov-2020 and 12-Jan-2021 were included. The study period was delimited by introduction of RAD tests and VitaPCR. Participant data was collected retrospectively, and outcome variables were length-of-stay (LoS), intrahospital transfers and targeted admission to COVID-19 ward.ResultsRAD tests reduced ED LoS for participants with positive tests or that were not tested. Negative VitaPCR results reduced mean hospital LoS by 1.5 (95%CI: 0.3–2.7) days and admissions to COVID-19 wards from 34.5 (95%CI: 28.9-40.5) to 14.7 (95%CI: 11.1-19.1) per 100 admissions. Introduction of VitaPCR reduced transfers between hospital wards in the first 5 days from 50.0 (95%CI: 45.0-55.0) to 34.0 (95%CI: 30.3-37.9) per 100 admissions.ConclusionRAD tests enabled rapid detection of SARS-CoV-2 infection which had pronounced effects on LoS at the ED. VitaPCR added the possibility of exclusion of the infection which increased targeted admissions, reduced intrahospital transfers and lead to shorter stay at the hospital.

scholarly journals Seroprevalence of SARS-CoV-2 Antibodies Among Health Care Personnel at a Health Care System in Pakistan

2021 ◽  
pp. 101053952110110
Author(s):  
Salma Abbas ◽  
Aun Raza ◽  
Ayesha Iftikhar ◽  
Aamir Khan ◽  
Shahzaib Khan ◽  
...  
Keyword(s):  
Health Care ◽  
Control Measures ◽  
Health Care Personnel ◽  
Test Results ◽  
Antibody Testing ◽  
Chain Reaction ◽  
Past Infection ◽  
Infection Control Measures ◽  
History Of ◽  
Polymerase Chain

Health care personnel (HCP) are at high risk for coronavirus disease-2019 acquisition. Serum antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) indicate past infection. Our institution offered SARS-CoV-2 antibody testing to HCP. We surveyed HCP with positive test results to explore past exposure to SARS-CoV-2, details of symptoms during the preceding 6 months, and a history of SARS-CoV-2 polymerase chain reaction testing. A total of 2162 HCP underwent antibody testing. Eight hundred fifty-seven (39.6%) employees tested positive and, of these, 820 (95.7%) participated in the survey. When adjusted for age, males had higher odds of testing positive for SARS-CoV-2 antibodies compared with females (OR = 1.68; 95% CI = 1.37-2.05; P = .00) and clinical staff had higher odds of SARS-CoV-2 seropositivity compared with nonclinical staff (OR = 1.273; 95% CI = 1.06-1.53; P = .01). Implementation of effective infection control measures is essential to protect HCP from coronavirus disease-2019.

scholarly journals Preventing SARS-CoV-2 transmission in the emergency department by implementing a separate pathway for patients with respiratory conditions

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Fulwah Alqahtani ◽  
Marzouqah Alanazi ◽  
Wajdan Alassaf ◽  
Fadilah Sfouq Aleanizy ◽  
Muna Aljahany ◽  
...  
Keyword(s):  
Emergency Department ◽  
Longitudinal Study ◽  
Healthcare Workers ◽  
Respiratory Symptoms ◽  
Control Measures ◽  
University Hospital ◽  
Respiratory Pathway ◽  
Infection Control Measures ◽  
Separate Pathway ◽  
Respiratory Conditions

Abstract Objectives This study aimed to describe the development and implementation of a separated pathway to check and treat patients with a suspected/confirmed coronavirus disease 2019 (COVID-19) in the emergency department (ED) at King Abdullah bin Abdulaziz University Hospital in Riyadh. Methods We conducted a retrospective, descriptive longitudinal study from March to July 2020 by analyzing data of all confirmed cases of COVID-19 among ED visitors and healthcare workers in King Abdullah bin Abdulaziz University Hospital. Results During the study period, a total of 1,182 swab samples were collected for testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), of which 285 (24.1%) tested positive. Of the 285 cases of confirmed SARS-CoV-2 infection, 18 were healthcare workers and 267 were patients. As a result of using the respiratory pathway for COVID-19 patients, the hospital managed to limit transmission of SARS-CoV-2 not only between patients but also between patients and healthcare workers, while also containing the pandemic. There were no cases of nosocomial SARS-CoV-2 infection recorded among the patients who visited the ED or the flu clinic. All confirmed cases were community acquired and patients were cared for under constrained measures. Conclusions Implementing infection control measures and restricting those with respiratory symptoms to the ED pathway prevented nosocomial spread of SARS-CoV-2 infection in the ED.

scholarly journals Changes in Emergency Department Responses Between SARS and COVID-19 in Taiwan

2020 ◽  
Author(s):  
Chia Wei Lin ◽  
Kuan-Ho Lin ◽  
Hong-Mo Shih ◽  
Kai-Wei Yang ◽  
Kao-Pin Hwang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Rating Scale ◽  
Early Stage ◽  
Control Measures ◽  
Protective Equipment ◽  
Policy Reforms ◽  
Policy Changes ◽  
Hospital Level ◽  
Fever Patient ◽  
Infection Control Measures

Abstract Background: After SARS outbreak, infectious control polices had been reformed in Taiwan, but there was no evidence to prove its effectiveness. This study compared emergency department (ED) responses to the SARS and COVID-19 epidemics and investigate how policy changes affect infection prevention.Methods: A 2003 questionnaire regarding the responses of EDs to SARS was resent to EDs during the COVID-19 epidemic in 2020. The use of personal protective equipment (PPE), implementation of infection control measures (ICMs), and difficulties in performance were compared. Data collection included hospital level, different PPE types provided and ICMs implemented, timing for using PPE and ICMs, and a difficulty rating scale for ICM implementation.Results: In total, 100 EDs responded to the questionnaire in 2003 was reviewed and compared with 131 EDs in 2020. In COVID-19 epidemic, the use of basic PPEs and ICMs was mostly significantly improved, but the percentage of preparedness in high grade PPEs was still low. Quarantine of fever patients outside of EDs was less performed in small to medium sized hospitals (p=0.008 and 0.004). All of the additional ICMs were significantly less implemented in local hospitals. The timing to use PPE and implement ICMs were simultaneously and significantly performed at early stage. Instituting a fever triage ward and restricting fever patient admission became less necessary. The closure of EDs remained the most difficult to perform in both outbreaks. Conclusion: After the policy reforms, ED responses became earlier and more consistent. However, inadequate quarantine resources at EDs in low- and middle-grade hospitals may lead to breaches in future epidemics.

scholarly journals ASSESSMENT OF PERFORMANCE AND IMPLEMENTATION CHARACTERISTICS OF RAPID POINT OF CARE SARS-CoV-2 ANTIGEN TESTING IN KENYA

2021 ◽  
Author(s):  
Jesse Gitaka ◽  
Eva Muthamia ◽  
Samuel Mbugua ◽  
Mary Mungai ◽  
Gama Bandawe ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Test Performance ◽  
Gold Standard ◽  
Point Of Care ◽  
Turnaround Time ◽  
Ease Of Use ◽  
Control Measures ◽  
Antigen Test ◽  
Rt Pcr ◽  
Predictive Values

Abstract Background: The COVID-19 pandemic has resulted in a need for rapid identification of infectious cases. Testing barriers have prohibited adequate screening for SARS COV2, resulting in significant delays in treatment provision and commencement of outbreak control measures. This study aimed to generate evidence on the performance and implementation characteristics of the BD Veritor rapid antigen test as compared to the gold standard test for diagnosis of SARS COV2 in Kenya. Methods: This was a field test performance evaluation in symptomatic and asymptomatic adults undergoing testing for SARS COV2. Recruited participants were classified as SARS-CoV2-positive based on the locally implemented gold standard reverse transcription polymerase chain reaction (RT-PCR) test performed on nasopharyngeal swabs. 272 antigen tests were performed with simultaneous gold standard testing, allowing us to estimate sensitivity, specificity, positive and negative predictive values for the BD Veritor rapid antigen test platform. Implementation characteristics were assessed using the Consolidated Framework for Implementation Research for feasibility, acceptability, turn-around time, and ease-of-use metrics. Results and Discussion: We enrolled 97 PCR negative symptomatic and 128 PCR negative asymptomatic, and 28 PCR positive symptomatic and 19 PCR positive asymptomatic participants. Compared to the gold standard, the sensitivity of the BD Veritor antigen test was 94% (95% confidence interval [CI] 86.6 to 100.0) while the specificity was 98% (95% confidence interval [CI] 96 to 100). The sensitivity of BD Veritor antigen test was higher among symptomatic (100%) compared to asymptomatic (84%) participants, although this difference was not statistically significant. There was also a lack of association between cycle threshold value and sensitivity of BD Veritor test. The BD Veritor test had quick turnaround time and minimal resource requirements, and laboratory personnel conducting testing felt that it was easier to use than the gold standard RT-PCR. Conclusion: The BD Veritor rapid antigen test exhibited excellent sensitivity and specificity when used to detect SARS-CoV-2 infection among both symptomatic and asymptomatic individuals in varied population settings in Kenya. It was feasible to implement and easy to use, with rapid turnaround time.

scholarly journals Evaluation of the Liat Cdiff Assay for Direct Detection of Clostridioides difficile Toxin Genes within 20 Minutes

2019 ◽  
Vol 57 (6) ◽  
Author(s):  
David J. Hetem ◽  
Ingrid Bos-Sanders ◽  
Roel H. T. Nijhuis ◽  
Sven Tamminga ◽  
Livia Berlinger ◽  
...  
Keyword(s):  
Infection Control ◽  
Direct Detection ◽  
Point Of Care ◽  
Reference Method ◽  
Turnaround Time ◽  
Control Measures ◽  
Content Type ◽  
Infection Control Measures ◽  
Clostridioides Difficile ◽  
The Difference

ABSTRACT Clostridioides difficile is the main causative agent of antibiotic-associated diarrhea. Prompt diagnosis is required for initiation of timely infection control measures and appropriate adjustment of antibiotic treatment. The cobas Cdiff assay for use on the cobas Liat system enables a diagnostic result in 20 minutes. A total of 252 prospective (n = 150) and retrospective (n = 102) stool specimens from The Netherlands, France, and Switzerland were tested on the cobas Cdiff assay using the Xpert C. difficile assay as a reference method. The overall positive and negative percent agreement (PPA and NPA, respectively) of the cobas Cdiff assay compared with the Xpert C. difficile assay was 98.0% (100/102; 95% confidence interval [CI], 93.1% to 99.5%) and 94.0% (141/150; 95% CI, 89.0% to 96.8%), respectively. When comparing the PPAs of cobas Cdiff and Xpert C. difficile with culture, the results were 91.7% (55/60; 95% CI, 81.9% to 96.4%) and 85.0% (51/60; 95% CI, 73.9% to 91.9%), respectively. The difference was not statistically significant. The cobas Cdiff assay offers a very rapid alternative for diagnosing C. difficile infection. The 20-minute turnaround time provides the potential for point-of-care testing so that adequate infection control measures can be initiated promptly.

scholarly journals Atypical symptoms, SARS-CoV-2 test results, and immunization rates in 456 residents from eight nursing homes facing a COVID-19 outbreak

2021 ◽  
Author(s):  
Hubert Blain ◽  
Lucie Gamon ◽  
Edouard Tuaillon ◽  
Amandine Pisoni ◽  
Nadia Giacosa ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Behavioural Change ◽  
Testing Temperature ◽  
Control Measures ◽  
Test Results ◽  
Atypical Symptoms ◽  
Infection Control Measures ◽  
Immunization Rates ◽  
Before And After ◽  
Frail Older Persons

Abstract Background Frail older persons may have an atypical presentation of COVID-19. The value of rRT-PCR testing for identifying SARS-CoV-2 nursing homes (NH) residents is not known. Objective To determine whether (i) atypical symptoms may predict rRT-PCR results and (ii) rRT-PCR results may predict immunization against SARS-CoV-2 in NH residents. Design A retrospective longitudinal study. Setting eight NHs with at least ten rRT-PCR-positive residents. Subjects 456 residents. Methods Typical and atypical symptoms recorded in residents’ files during the 14 days before and after rRT-PCR testing were analyzed. Residents underwent blood testing for IgG-SARS-CoV-2 nucleocapsid protein 6 to 8 weeks after testing. Univariate and multivariate analyses compared symptoms and immunization rates in rRT-PCR-positive and negative residents. Results 161 residents had a positive rRT-PCR (35.3%), 17.4% of whom were asymptomatic before testing. Temperature > 37.8°C, oxygen saturation < 90%, unexplained anorexia, behavioural change, exhaustion, malaise, and falls before testing were independent predictors of a further positive rRT-PCR. Among the rRT-PCR-positive residents, 95.2% developed SARS-CoV-2 antibodies vs 7.6% in the rRT-PCR-negative residents. Among the residents with a negative rRT-PCR, those who developed SARS-CoV-2 antibodies more often had typical or atypical symptoms (p = 0.02 and < 0.01, respectively). Conclusion This study supports a strategy based on (i) testing residents with typical or unexplained atypical symptoms for an early identification of the first SARS-CoV-2 cases, (ii) rT-PCR testing for identifying COVID-19 residents, (iii) repeated wide-facility testing (including asymptomatic cases) as soon as a resident is tested positive for SARS-CoV-2, and (iv) implementing SARS-CoV-2 infection control measures in rRT-PCR-negative residents when they have unexplained typical or atypical symptoms.

scholarly journals The lockdown and its consequences—Perspectives and needs of people at increased risk of severe illness from COVID-19

2021 ◽  
Author(s):  
Erika Mosor ◽  
Valentin Ritschl ◽  
Margaret R. Andrews ◽  
Maisa Omara ◽  
Paul Studenic ◽  
...  
Keyword(s):  
Medical Condition ◽  
Well Being ◽  
Health Condition ◽  
Control Measures ◽  
Physical Contact ◽  
Chronic Medical Condition ◽  
Severe Illness ◽  
Infection Control Measures ◽  
Lack Of Information ◽  
Increased Risk

Summary Background There is a lack of knowledge on how people at increased risk of severe illness from Coronavirus disease 2019 (COVID-19) experienced the infection control measures. This study aimed to explore their perspectives and needs during the coronavirus outbreak. Methods A qualitative longitudinal interview study was conducted in Austria during lockdown due to COVID-19 containment and afterwards. People older than 65 years of age and/or affected by a chronic medical condition participated in individual telephone interviews at two time points. Thematic analysis was used to analyze the data and saturation was defined as no new emerging concepts in at least 10 subsequent interviews. Results Thematic saturation was reached when 33 individuals (75.8% female, mean age ± standard deviation [SD] 73.7±10.9 years) were included. A total of 44 lower level concepts were extracted and summarized into 6 higher level concepts. They included (i) a general positive attitude toward COVID-19 measures, (ii) challenges of being isolated from the community, (iii) deterioration of health status, (iv) difficulties with measures due to their health condition, (v) lack of physical contact and (vi) lack of information versus overload. Participants suggested environmental adaptations for strengthening resilience in people at increased risk of severe illness from COVID-19. Conclusion Strategies and interventions are needed to support people at risk under pandemic conditions. Their perceptions and needs should be addressed to reduce the potential deterioration of health conditions and ensure well-being even during prolonged periods of crisis.

scholarly journals Use of the FebriDx point-of-care assay as part of a triage algorithm for medical admissions with possible COVID-19

2021 ◽  
Author(s):  
Hamish Houston ◽  
Ankur Gupta-Wright ◽  
Gavin Deas ◽  
Shivam Naik ◽  
Kamal Shah ◽  
...  
Keyword(s):  
Emergency Department ◽  
Point Of Care ◽  
Good Sensitivity ◽  
Reference Standard ◽  
Rt Pcr ◽  
Clinical Criteria ◽  
Emergency Department Triage ◽  
Isolation Facilities ◽  
Triage Algorithm ◽  
Rule Out

AbstractBackgroundPatients admitted to hospital with COVID-19 must be rapidly identified and isolated to prevent nosocomial transmission. However, isolation facilities are often limited, and SARS-CoV-2 RT-PCR results are too slow to inform emergency department triage. We evaluated a pragmatic triage algorithm to isolate patients with suspected COVID-19 using simple clinical criteria and the FebriDx assay.MethodsAll medical admissions in a large UK hospital were triaged as likely, possible or unlikely COVID-19 based on clinical criteria. Patients triaged as possible COVID-19 underwent FebriDx lateral flow assay on capillary blood, and those who tested MxA positive were isolated. We evaluated the accuracy of the algorithm and the FebriDx assay compared to SARS-CoV-2 RT-PCR from nasopharyngeal swabs as the reference standard.ResultsBetween 10th August 2020 and 4th November 2020, 136/3,443 medical admissions (4.0%) were diagnosed with RT-PCR confirmed COVID-19. Prevalence of COVID-19 was 45.7% (80/175) in those triaged as likely, 4.1% (50/1,225) in possible and 6/2,033 (0.3%) in unlikely COVID-19. Compared to SARS-CoV-2 RT-PCR, clinical triage had sensitivity of 95.6% (130/136) and specificity of 61.5% (2027/3297), whilst the triage algorithm including FebriDx had sensitivity of 92.6% (126/136) and specificity of 86.4% (2849/3297). The triage algorithm reduced the need for 2,859 patients to be admitted to isolation rooms. The patients missed by the algorithm had mild or asymptomatic COVID-19.ConclusionsA simple triage algorithm including FebriDx assay had good sensitivity and is a useful ‘rule-out’ for COVID-19. The algorithm is useful for managing medical admissions from the emergency department.SummaryWe studied a COVID-19 triage algorithm for hospital medical admissions using clinical parameters and the FebriDx assay. The algorithm had good sensitivity and negative-predictive value compared to SARS-CoV-2 PCR. FebriDx improved triage specificity allowing fewer isolation rooms to be used.

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