Passport to freedom? Immunity passports for COVID-19

The COVID-19 pandemic has led a number of countries to introduce restrictive ‘lockdown’ policies on their citizens in order to control infection spread. Immunity passports have been proposed as a way of easing the harms of such policies, and could be used in conjunction with other strategies for infection control. These passports would permit those who test positive for COVID-19 antibodies to return to some of their normal behaviours, such as travelling more freely and returning to work. The introduction of immunity passports raises a number of practical and ethical challenges. In this paper, we seek to review the challenges relating to various practical considerations, fairness issues, the risk to social cooperation and the impact on people’s civil liberties. We make tentative recommendations for the ethical introduction of immunity passports.

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The Health of Refugees

10.1093/oso/9780198814733.001.0001 ◽

2019 ◽

Cited By ~ 1

Keyword(s):

Age Groups ◽

Refugee Health ◽

Mass Movements ◽

Ethical Challenges ◽

Displaced Populations ◽

Political Landscape ◽

The Media ◽

Multidisciplinary Perspective ◽

The Impact

There have been significant changes in the numbers, patterns, and circumstances of refugees and in the political landscape to support humanitarianism since the publication of the first edition of this collection. Like the first edition, this volume provides a multidisciplinary perspective on refugee health, tracing the health repercussions on individuals and populations from the drivers of forced mass movements of populations from situations of conflict and other disasters through to the process of resettlement in countries other than their countries of origin. Drawing on the expertise of academics, practitioners, and UN frontline experts, the collection covers three main aspects of refugee health: the concepts, definitions, and context from a human rights, humanitarianism, and social determinants of health perspective; the intersection of vulnerabilities across age groups and settings; and the ethical challenges for practitioners and researchers working with forcibly displaced populations seeking to resettle. The collection concludes with an analysis of the role of the media in shaping our perceptions of refugees and the impact on policy and access to care.

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Ethics of Corporeal, Co-present Robots as Agents of Influence: a Review

Current Robotics Reports ◽

10.1007/s43154-021-00053-6 ◽

2021 ◽

Author(s):

AJung Moon ◽

Shalaleh Rismani ◽

H. F. Machiel Van der Loos

Keyword(s):

Artificial Intelligence ◽

Physical Environment ◽

Ethical Issues ◽

Human Robot Interaction ◽

Physical Interaction ◽

Ethical Challenges ◽

Natural Tendency ◽

Ai Ethics ◽

Recent Trends ◽

The Impact

Abstract Purpose of Review To summarize the set of roboethics issues that uniquely arise due to the corporeality and physical interaction modalities afforded by robots, irrespective of the degree of artificial intelligence present in the system. Recent Findings One of the recent trends in the discussion of ethics of emerging technologies has been the treatment of roboethics issues as those of “embodied AI,” a subset of AI ethics. In contrast to AI, however, robots leverage human’s natural tendency to be influenced by our physical environment. Recent work in human-robot interaction highlights the impact a robot’s presence, capacity to touch, and move in our physical environment has on people, and helping to articulate the ethical issues particular to the design of interactive robotic systems. Summary The corporeality of interactive robots poses unique sets of ethical challenges. These issues should be considered in the design irrespective of and in addition to the ethics of artificial intelligence implemented in them.

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Burden of motorcyclists without helmets in a state without a universal helmet law: a propensity score analysis

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000583 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000583

Author(s):

Michael D Jones ◽

Joel G Eastes ◽

Damjan Veljanoski ◽

Kristina M Chapple ◽

James N Bogert ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Analysis ◽

Alcohol Intoxication ◽

Civil Liberties ◽

Hospital Charges ◽

Trauma Patients ◽

Level Of Evidence ◽

Helmet Use ◽

Score Analysis ◽

The Impact

BackgroundAlthough helmets are associated with reduction in mortality from motorcycle collisions, many states have failed to adopt universal helmet laws for motorcyclists, in part on the grounds that prior research is limited by study design (historical controls) and confounding variables. The goal of this study was to evaluate the association of helmet use in motorcycle collisions with hospital charges and mortality in trauma patients with propensity score analysis in a state without a universal helmet law.MethodsMotorcycle collision data from the Arizona State Trauma Registry from 2014 to 2017 were propensity score matched by regressing helmet use on patient age, sex, race/ethnicity, alcohol intoxication, illicit drug use, and comorbidities. Linear and logistic regression models were used to evaluate the impact of helmet use.ResultsOur sample consisted of 6849 cases, of which 3699 (54.0%) were helmeted and 3150 (46.0%) without helmets. The cohort was 88.1% male with an average age of 40.9±16.0 years. Helmeted patients were less likely to be admitted to the intensive care unit (20.3% vs. 23.7%, OR 0.82 (0.72–0.93)) and ventilated (7.8% vs. 12.0%, OR 0.62 (0.52–0.75)). Propensity-matched analyses consisted of 2541 pairs and demonstrated helmet use to be associated with an 8% decrease in hospital charges (B −0.075 (0.034)) and a 56% decrease in mortality (OR 0.44 (0.31–0.58)).DiscussionIn a state without mandated helmet use for all motorcyclists, the burden of the unhelmeted rider is significant with respect to lives lost and healthcare charges incurred. Although the helmet law debate with respect to civil liberties is complex and unsettled, it appears clear that helmet use is strongly associated with both survival and less economic encumbrance on the state.Level of evidenceLevel III, prognostic and epidemiological.

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

Science ◽

10.1126/science.abf9648 ◽

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.

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Impact of Each Component of a Ventilator Bundle on Preventing Ventilator-Associated Pneumonia and Lower Respiratory Infection

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.824 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s259-s260

Author(s):

Rafaela Pinho ◽

Luciana Tanure ◽

Jussara Pessoa ◽

Leonardo Santos ◽

Braulio Couto ◽

...

Keyword(s):

Infection Control ◽

Incidence Rate ◽

Cuff Pressure ◽

Oral Care ◽

Ventilator Circuit ◽

Subglottic Secretion ◽

Subglottic Secretion Drainage ◽

The Impact ◽

Control Service ◽

Daily Sedation Interruption

Background: Ventilator-associated lower respiratory infections (LRIs) and pneumonia (VAP) are important healthcare-associated infections and are among the leading causes of death worldwide. Prevention of these infections are often based on care bundles. We investigated the incidence of VAP+LRI and the preventive efficacy of each component of our ventilator bundle. Methods: Our ventilator bundle includes 6 components that are daily checked by an infection control practitioner. These 6 evidence-based practices were implemented in 3 ICUs from a general tertiary-care private hospital in Belo Horizonte City (Brazil): (1) daily oral care with chlorhexidine; (2) elevate the head of the bed to between 30 and 45; (3) avoid scheduled ventilator circuit change; (4) monitor cuff pressure; (5) use subglottic secretion drainage; and (6) daily sedation interruption and daily assessment of readiness to extubate. VAP and ventilator-LRI definitions were obtained from the CDC NHSN. The impact of adherence rate to items in the ventilator bundle (%) on the incidence rate of VAP+LRI was assessed using linear regression and scatterplot analyses. Results: Between January 2018 and April 2019, 1,888 ventilator days were observed in the 3 ICUs, with 42 VAP and LRI events, an overall incidence rate of 22.2 cases per 1,000 ventilator days. After September 2018, the infection control service started a campaign to increase the ventilator bundle compliance (Fig. 1). Adherence rates to all 6 bundle components increased between January–August 2018 and September 2018–April 2019 from 25% to 55% for daily oral care, from 34% to 79% for elevating the head of the bed, 28% to 86% for avoiding scheduled ventilator circuit change, from 32% to 83% for cuff pressure monitoring, from 32% to 83% for subglottic secretion drainage, and from 33% to 85% for daily sedation interruption. PAV and LRI incidence decreased from 41 to 16 in ICU A, from 22 to 14 in ICU B and from 24 to 18 in ICU C. The impact of each bundle component was identified by linear regression, calculating the percentage of PAV+LRI incidence rate that is explained by bundle item adherence (r2) and correlation coefficient (r): daily sedation interruption (r2 = 48%; r = 0.69; P = .004) (Fig. 2), cuff pressure monitorization (r2 = 0.3721; r = 0.61; P = .016), subglottic secretion drainage (r2 = 36%; r = 0.60; P = .017), avoidance of scheduled ventilator circuit change (r2 = 34%; r = 0.58; P = .023), daily oral care (r2 = 25%; r = 0.50; P = .050), and elevate the head of the bed (r2 = 25%; r = 0.48; P = .067). Conclusions: The impact of each bundle component on preventing PAV+LRI was identified by the study. An educational intervention performed by the infection control service increased the adherence to the ventilator bundle, and the PAV and LRI incidence decreased.Funding: NoneDisclosures: None

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The Impact of COVID-19 on Surgical Training: the Past, the Present and the Future

Indian Journal of Surgery ◽

10.1007/s12262-021-02964-2 ◽

2021 ◽

Author(s):

Marina Yiasemidou

Keyword(s):

Infection Control ◽

Surgical Training ◽

New Technologies ◽

Negative Impact ◽

Elective Surgery ◽

Control Measures ◽

Negative Consequences ◽

Surgical Services ◽

The World ◽

The Impact

AbstractThe COVID-19 pandemic and infection control measures had an unavoidable impact on surgical services. During the first wave of the pandemic, elective surgery, endoscopy, and ‘face-to-face’ clinics were discontinued after recommendations from professional bodies. In addition, training courses, examinations, conferences, and training rotations were postponed or cancelled. Inadvertently, infection control and prevention measures, both within and outside hospitals, have caused a significant negative impact on training. At the same time, they have given space to new technologies, like telemedicine and platforms for webinars, to blossom. While the recovery phase is well underway in some parts of the world, most surgical services are not operating at full capacity. Unfortunately, some countries are still battling a second or third wave of the pandemic with severely negative consequences on surgical services. Several studies have looked into the impact of COVID-19 on surgical training. Here, an objective overview of studies from different parts of the world is presented. Also, evidence-based solutions are suggested for future surgical training interventions.

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

Infection Control and Hospital Epidemiology ◽

10.1086/658333 ◽

2011 ◽

Vol 32 (3) ◽

pp. 210-219 ◽

Cited By ~ 44

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.

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The Impact of Enhanced Antimicrobial Stewardship Support on Antibiotic Starts in Long-Term Care Facilities

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1212 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s527-s527

Author(s):

Gabriela Andujar-Vazquez ◽

Kirthana Beaulac ◽

Shira Doron ◽

David R Snydman

Keyword(s):

Public Health ◽

Pilot Study ◽

Infection Control ◽

Antimicrobial Stewardship ◽

Long Term Care ◽

Medical Center ◽

Term Care ◽

Care Facilities ◽

The Impact

Background: The Tufts Medical Center Antimicrobial Stewardship (ASP) Team has partnered with the Massachusetts Department of Public Health (MDPH) to provide broad-based educational programs (BBEP) to long-term care facilities (LTCFs) in an effort to improve ASP and infection control practices. LTCFs have consistently expressed interest in individualized and hands-on involvement by ASP experts, yet they lack resources. The goal of this study was to determine whether “enhanced” individualized guidance provided by an ASP expert would lead to antibiotic start decreases in LTCFs participating in our pilot study. Methods: A pilot study was conducted to test the feasibility and efficacy of providing enhanced ASP and infection control practices to LTCFs. In total, 10 facilities already participating in MDPH BBEP and submitting monthly antibiotic start data were enrolled, were stratified by bed size and presence of dementia unit, and were randomized 1:1 to the “enhanced” group (defined as reviewing protocols and antibiotic start cases, providing lectures and feedback to staff and answering questions) versus the “nonenhanced” group. Antibiotic start data were validated and collected prospectively from January 2018 to July 2019, and the interventions began in April 2019. Due to staff turnover and lack of engagement, intervention was not possible in 2 of the 5 LTCFs randomized to the enhanced group, which were therefore analyzed as a nonenhanced group. An incidence rate ratios (IRRs) with 95% CIs were calculated comparing the antibiotic start rate per 1,000 resident days between periods in the pilot groups. Results: The average bed sizes for enhanced groups versus nonenhanced groups were 121 (±71.0) versus 108 (±32.8); the average resident days per facility per month were 3,415.7 (±2,131.2) versus 2,911.4 (±964.3). Comparatively, 3 facilities in the enhanced group had dementia unit versus 4 in the nonenhanced group. In the per protocol analysis, the antibiotic start rate in the enhanced group before versus after the intervention was 11.35 versus 9.41 starts per 1,000 resident days (IRR, 0.829; 95% CI, 0.794–0.865). The antibiotic start rate in the nonenhanced group before versus after the intervention was 7.90 versus 8.23 antibiotic starts per 1,000 resident days (IRR, 1.048; 95% CI, 1.007–1.089). Physician hours required for ASP for the enhanced group totaled 8.9 (±2.2) per facility per month. Conclusions: Although the number of hours required for intervention by an expert was not onerous, maintaining engagement proved difficult and in 2 facilities could not be achieved. A statistically significant 20% decrease in the antibiotic start rate was achieved in the enhanced group after interventions, potentially reflecting the benefit of enhanced ASP support by an expert.Funding: This study was funded by the Leadership in Epidemiology, Antimicrobial Stewardship, and Public Health (LEAP) fellowship training grant award from the CDC.Disclosures: None

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Waves of trouble: MRSA strain dynamics and assessment of the impact of infection control

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkr392 ◽

2011 ◽

Vol 66 (12) ◽

pp. 2685-2688 ◽

Cited By ~ 37

Author(s):

D. Wyllie ◽

J. Paul ◽

D. Crook

Keyword(s):

Infection Control ◽

The Impact

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Infection control: current status. risks, research, rules and recycling

Orthodontic Update ◽

10.12968/ortu.2021.14.2.59 ◽

2021 ◽

Vol 14 (2) ◽

pp. 59-66

Author(s):

Jennifer Haworth ◽

Jonathan Sandy ◽

Anthony J Ireland

Keyword(s):

Infection Control ◽

Best Practice ◽

Mainland China ◽

Current Status ◽

Infectious Agents ◽

Emerging Infections ◽

Healthcare Waste ◽

Control Procedures ◽

The Uk ◽

The Impact

We are living through a period of immense change following the outbreak of the COVID-19 pandemic in mainland China in December 2019. Even before the pandemic, the cost of managing healthcare-associated infections in the UK was considerable. The risk of acquiring any infection from the dental environment must be reduced to a minimum. As we have observed in recent years, new infectious agents emerge frequently, and the dental profession must be ready to respond appropriately and quickly. Orthodontic practice presents unique challenges in relation to infection control procedures. The impact of healthcare waste on the environment must also be considered. CPD/Clinical Relevance: This paper describes the range of infectious agents posing a risk to dental team members and patients. The aim is to place the recent coronavirus pandemic in the context of other recent emerging infections. Some of the latest research regarding infection control procedures is reviewed. Current best practice is described.

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