Modified office practice in COVID-19 pandemic - an otorhinolaryngologist perspective

COVID-19 spreads through contact, minute droplets and aerosol from infected person which may be symptomatic or asymptomatic. Nose and throat had very high load of severe acute respiratory syndrome (SARS-CoV-2) virus. Otorhinolaryngologists by virtue of their work which requires close examination of these part are at very high risk of infection. Many studies are available for precautions to be taken in patient management related to COVID-19 in wards and surgical intervention in operation theaters but very little information is available regarding precautions in working in outpatient clinic setting. Our article highlights some changes we made in ear, nose and throat (ENT) outpatient clinics after going through various guidelines to make it safe in current scenario. These changes may inspire others to move toward safer work practices in their outpatient area to provide ENT consultations. The main changes were categorized into infrastructural changes, identification of frugal but effective personal protective equipment (PPE) for ENT, training for use of different level of PPE as per risk, new modus operandi, and new infection prevention measures. These changes had taken into account safety guidelines by Ministry of health and family welfare (MOHFW) government of India and various international associations specific to specialty. The modification and its advantages were presented.

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St George's COVID shield for use by ENT surgeons performing tracheostomies

10.1101/2020.05.04.20087072 ◽

2020 ◽

Author(s):

Sabrina Brar ◽

Jahan Daya ◽

James Schuster-Bruce ◽

Sanjeev Krishna ◽

Hamid Daya

Keyword(s):

Healthcare Workers ◽

Infection Prevention ◽

Protective Equipment ◽

Prevention Measures ◽

Clinical Investigations ◽

Increased Risk ◽

Global Demand ◽

Risk Of Exposure ◽

Operating Surgeon ◽

Number Of Particles

Healthcare workers are at increased risk of exposure to COVID-19. The majority of cases are acquired through inhalation of infected respiratory particles, contamination with infected surfaces or whilst performing aerosol-generating procedures. Basic infection prevention measures are essential to protect healthcare workers from contracting the disease when managing patients; consequently global demand for personal protective equipment (PPE) has exceeded supply in many regions. We present a novel, innovative polycarbonate shield designed for ENT clinicians performing tracheostomies. Clinical investigations using the shield demonstrated a sixteen-fold decrease in the number of particles detected at the position of the operating surgeon when the shield was used (particle size 0.3μm; with shield 27,000 versus 439,000 without shield). The shield, used with appropriate PPE, could therefore help to minimise exposure to aerosol generated particles such as during tracheostomies on patients with COVID-19.

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Local hospital experience of emergency management in the response to SARS (Preprint)

10.2196/preprints.20287 ◽

2020 ◽

Author(s):

Ying Yan

Keyword(s):

Emergency Management ◽

Infection Prevention ◽

Public Health Emergency ◽

The Novel ◽

Prevention Measures ◽

Hospital Emergency ◽

Local Hospital ◽

Referral Network ◽

Novel Coronavirus ◽

Hospital Transmission

UNSTRUCTURED The ongoing outbreak of SARS-CoV-2 infection was first identified in Wuhan, China at the late of 2019. Following the acceleration of the novel coronavirus spreading, person-person transmissions in family residences, hospitals and other public environments have led to a major public hazard in China. Currently, the SARS-CoV-2 outbreak has been further developed into a public health emergency of international concern. In response to an occurring pandemic, hospitals need an emergency strategy and plan to manage their space, staff, and other essential resources, therefore, to provide optimum care to patients involved. In addition, infection prevention measures urgently need to be implemented to reduce in-hospital transmission and avoid the occurrence of virus super-spreading. For hospitals without capacity to manage severe patients, a referral network is often needed. We present our successful field experience regarding hospital emergency management and local hospitals network model in response to SARS-CoV-2 emerging epidemic.

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Infection control practices and challenges in Pakistan during the COVID-19 pandemic: a multicentre cross-sectional study

Journal of Infection Prevention ◽

10.1177/17571774211012761 ◽

2021 ◽

pp. 175717742110127

Author(s):

Salma Abbas ◽

Faisal Sultan

Keyword(s):

Personal Protective Equipment ◽

Prevention And Control ◽

Infection Prevention ◽

Hospital Staff ◽

Cross Sectional Study ◽

Infection Prevention And Control ◽

Protective Equipment ◽

Cross Sectional ◽

Healthcare Facilities ◽

And Control

Background: Patient and staff safety at healthcare facilities during outbreaks hinges on a prompt infection prevention and control response. Physicians leading these programmes have encountered numerous obstacles during the pandemic. Aim/objective: The aim of this study was to evaluate infection prevention and control practices and explore the challenges in Pakistan during the coronavirus disease 2019 pandemic. Methods: We conducted a cross-sectional study and administered a survey to physicians leading infection prevention and control programmes at 18 hospitals in Pakistan. Results: All participants implemented universal masking, limited the intake of patients and designated separate triage areas, wards and intensive care units for coronavirus disease 2019 patients at their hospitals. Eleven (61%) physicians reported personal protective equipment shortages. Staff at three (17%) hospitals worked without the appropriate personal protective equipment due to limited supplies. All participants felt overworked and 17 (94%) reported stress. Physicians identified the lack of negative pressure rooms, fear and anxiety among hospital staff, rapidly evolving guidelines, personal protective equipment shortages and opposition from hospital staff regarding the choice of recommended personal protective equipment as major challenges during the pandemic. Discussion: The results of this study highlight the challenges faced by physicians leading infection prevention and control programmes in Pakistan. It is essential to support infection prevention and control personnel and bridge the identified gaps to ensure patient and staff safety at healthcare facilities.

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Use of Respiratory Protection Devices by Medical Students During the COVID-19 Pandemic

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115834 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5834

Author(s):

Ekaterina A. Shashina ◽

Valentina V. Makarova ◽

Denis V. Shcherbakov ◽

Tatiana S. Isiutina-Fedotkova ◽

Nadezhda N. Zabroda ◽

...

Keyword(s):

Medical Students ◽

Face Mask ◽

Protective Measure ◽

Protective Equipment ◽

Respiratory Protection ◽

Prevention Measures ◽

Protection Devices ◽

Individual Use

The use of face masks has assumed a leading spot among nonspecific prevention measures during the coronavirus pandemic. The effectiveness of this protective measure depends on the specifics of individual use. The purpose of our study was to analyze the use of respiratory protective equipment (RPE) by medical students during the COVID-19 pandemic. The evaluation of face mask use was based on the results of a survey of medical students at Sechenov University. There were 988 participants in the study: 97.5% used RPE during the pandemic, 89.1% used disposable medical and hygienic face masks, 27.4% used reusable cloth face masks, and 13.2% used respirators. The majority of respondents (75.2%) were found to wear face masks correctly. However, 17.0% of the respondents were found to cover only their mouths with a face mask, while 7.8% reported often shifting their face mask under the chin due to perceived discomfort. Only 25.1% of respondents changed their disposable face mask after 2-3 h of wearing, while 13.0% decontaminated and used it several times. Most cloth face mask users (93.7%) decontaminated their marks, but only 55.7% of respondents did so daily. Face masks were most often worn in medical organizations (91.5%), and 1.4% of respondents did not use respiratory protection anywhere. In conclusion, we consider it necessary to introduce a special module on nonspecific prevention in the discipline of hygiene.

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Universal Masking to Control Healthcare-Associated Transmission of SARS-CoV-2

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.127 ◽

2021 ◽

pp. 1-24

Author(s):

Eliza R. Thompson ◽

Faith S. Williams ◽

Pat A. Giacin ◽

Shay Drummond ◽

Eric Brown ◽

...

Keyword(s):

Large Scale ◽

Infection Prevention ◽

Index Patient ◽

Field Investigation ◽

Point Prevalence ◽

Control Measures ◽

Prevention Measures ◽

Infection Control Measures ◽

Va Health Care System ◽

Healthcare Associated

Abstract Objective: To assess extent of a healthcare-associated outbreak of SARS-CoV-2 and evaluate effectiveness of infection control measures, including universal masking Design: Outbreak investigation including 4 large-scale point-prevalence surveys Setting: Integrated VA Health Care System with 2 facilities and 330 beds Participants: Index patient and 250 exposed patients and staff Methods: We identified exposed patients and staff and classified them as probable and confirmed cases based on symptoms and testing. We performed a field investigation and assessment of patient and staff interactions to develop probable transmission routes. Infection prevention interventions implemented included droplet and contact precautions, employee quarantine, and universal masking with medical and cloth facemasks. Four point-prevalence surveys of patient and staff subsets were conducted using real-time reverse-transcriptase polymerase chain reaction for SARS-CoV-2. Results: Among 250 potentially exposed patients and staff, 14 confirmed cases of Covid-19 were identified. Patient roommates and staff with prolonged patient contact were most likely to be infected. The last potential date of transmission from staff to patient was day 22, the day universal masking was implemented. Subsequent point-prevalence surveys in 126 patients and 234 staff identified 0 patient cases and 5 staff cases of Covid-19, without evidence of healthcare-associated transmission. Conclusions: Universal masking with medical facemasks was effective in preventing further spread of SARS-CoV-2 in our facility in conjunction with other traditional infection prevention measures.

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Implementing a Massive Personal Protective Equipment Education—A Multidisciplinary Team Approach

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.851 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s280-s281

Author(s):

Mayar Al Mohajer ◽

Megan Fischer ◽

Melissa Rouse ◽

Takei Pipkins ◽

John Byrne

Keyword(s):

Nursing Education ◽

Personal Protective Equipment ◽

Multidisciplinary Team ◽

Infection Prevention ◽

Just In Time ◽

Protective Equipment ◽

Team Approach ◽

Online Video ◽

Staff Members ◽

Multidisciplinary Team Approach

Background: Personal protective equipment (PPE) is defined by the Occupational Safety and Health Administration as specialized clothing or equipment worn by an employee for protection against infectious materials. They include gloves, gowns, masks, respirators, googles and face shields. The CDC has issued guidelines on appropriateness of when, what, and how to use PPE. Despite these guidelines, compliance with PPE remains challenging. Methods: We implemented a massive hospital-wide rapid education program on PPE donning and doffing of all employees and staff. This program included an online video, return demonstration and just-in-time training. To develop the program, we recorded PPE training video, reviewed PPE validation checklist, developed new isolation precaution signage with quick response (QR) code to video, developed a nutrition tray removal video and a equipment cleaning video, developed family and visitor guidelines for isolation precautions, and created an audit tool for PPE donning and doffing practices. The program required interdisciplinary collaboration including administration, infection prevention, nursing education, central supply, environmental services, facility maintenance, and security. Results: The first phase of the program was implemented through 30 separate 4-hour PPE skills fair offered over 48 hours. In total, 500 staff members were trained in the first 48 hours; 6 additional 3-hour sessions were provided on site in the following 3 month. Additionally, training was provided in off-site clinics, physician leadership meetings, new-hire orientation for nursing staff, and monthly resident and fellow training through graduate medical education. As needed, training was provided by infection prevention, nursing education, and floor nurses. In total, 5,237 staff members were trained within 3 months after implementation. Actual audit results (50 audits per week) showed improved and sustained compliance to >94%. Conclusions: A massive hospital-wide educational program including online video, return demonstration, and just-in-time training is a feasible and very effective method to improve compliance with PPE donning and doffing. A multidisciplinary team approach, administration support, and continuous education and audits are key factors in successful implementation.Funding: NoneDisclosures: None

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

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1345 ◽

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.

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COVID – 19 related knowledge and preventive practices early in the outbreak among health care workers in selected public health facilities of Illu aba Bor and Buno Bedelle zones, Southwest Ethiopia

BMC Infectious Diseases ◽

10.1186/s12879-021-06218-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dereje Tsegaye ◽

Muluneh Shuremu ◽

Dereje Oljira ◽

Sileshi Dubale ◽

Getachew Befekadu ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Health Care Workers ◽

Personal Protective Equipment ◽

Infection Prevention ◽

Health Facilities ◽

Protective Equipment ◽

Southwest Ethiopia ◽

Preventive Practices ◽

Care Workers

Abstract Background Novel-coronavirus 2019 (COVID-19) disease is currently a worldwide health risk and public health emergency concern. The virus is transmitted from an infected person to another person through close contact and droplets. Frontline health care workers are the most at risk of infection, and so a WHO interim guidance document was issued by the World Health Organization (WHO) which underscores the importance of proper sanitation and waste management practices for COVID- 19 in health-care settings. This study aimed at assessing knowledge and preventive practices towards Covid-19 among health care providers in selected health facilities of Illu Aba Bor and Buno Bedele zones, Southwest Ethiopia. Methods An institution-based cross-sectional study was conducted from April to May 2020 among 330 health workers in selected health facilities of Illu Aba Bor and Buno-Bedelle Zones, Southwest Ethiopia. Data were collected using a self-administered structured questionnaire. The collected data were entered into Epidata version 3.1 and exported to SPSS version 23 for analysis. Bivariate and multivariable logistic regression analysis was used to identify independent predictors of preventive practices towards Covid-19. Statistical significance was declared at a p-value of < 0.05. Result The majority of respondents (93.3%) demonstrated good knowledge of COVID-19, and the mean (SD) knowledge score was 9.04 ± 1.06. Nearly two-thirds (64.2%) of the study participants had good infection prevention practices. Being male (AOR = 3.65, 95% CI: (1.96, 6.80)), education level (AOR = 1.82, 95% CI (1.02, 3.22)), profession (AOR = 3.17, 95% CI (1.08, 9.33)), service year (5–10 years) (AOR = 2.00 (1.02, 3.92)) and more than 10 years (AOR = 3.14 (1.51, 6.52)), availability of personal protective equipment (AOR = 1.96 (1.06, 3.61)) and Knowledge level (AOR = 2.61 (1.48, 4.62)) were independent predictors of COVID-19 preventive practices. Conclusion The overall level of knowledge of HCWs was good. However, the practice was relatively low. Gender, educational status, profession, year of service, knowledge towards COVID-19, and availability of personal protective equipment were independent predictors of good infection prevention practices. Optimizing the infection prevention and control loop of the health facilities is recommended.

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Impact of joint management of a COVID-19 mother and her newborn on the virus transmission: a case report

Virology Journal ◽

10.1186/s12985-021-01598-w ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Maria Chiara De Nardo ◽

Anna Rita Bellomo ◽

Francesca Perfetti ◽

Francesco Antonino Battaglia ◽

Miriam Lichtner ◽

...

Keyword(s):

Infection Prevention ◽

Virus Transmission ◽

The Novel ◽

Transplacental Transmission ◽

Prevention Measures ◽

Infected Mother ◽

Case Presentation ◽

Joint Management ◽

Healthy Neonate

Abstract Background Since last year, COVID-19, the disease caused by the novel Sars-Cov-2 virus, has been globally spread to all the world. COVID-19 infection among pregnant women has been described. However, transplacental transmission of Sars-Cov-2 virus from infected mother to the newborn is not yet established. The appropriate management of infants born to mothers with confirmed or suspected COVID-19 and the start of early breastfeeding are being debated. Case presentation We report a case of the joint management of a healthy neonate with his mother tested positive for Covid-19 before the delivery and throughout neonatal follow-up. The infection transmission from the mother to her baby is not described, even after a long period of contact between them and breastfeeding. Conclusion It may consider an appropriate practice to keep mother and her newborn infant together in order to facilitate their contact and to encourage breastfeeding, although integration with infection prevention measures is needed.

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