Concerns and desires of healthcare workers caring for patients with COVID-19 in April and July 2020 in Japan: a qualitative study of open-ended survey comments

ObjectivesThe prolonged effects of the COVID-19 pandemic continue to have a serious impact on healthcare workers. We described and compared the experiences of healthcare workers in Japan during the first wave of the COVID-19 pandemic from March to May 2020, and during the lull from June to July 2020.DesignIn this qualitative study, we used a web-based survey to obtain comments from healthcare workers about their experiences during the pandemic, and explored these using inductive content analysis.SettingA tertiary emergency hospital in Tokyo, in April and July 2020.ParticipantsParticipants were staff in the hospital, including physicians, nurses, pharmacists, radiological technicians and laboratory medical technicians. Many, but not all, had directly cared for patients with COVID-19.ResultsIn total, 102 participants in the first survey and 154 in the second survey provided open-ended comments. Three themes were extracted: concerns, requests and gratitude. There were four subthemes under concerns: the hospital infection control system, fear of spreading infection to others, uncertainty about when the pandemic would end and being treated as a source of infection. There were 53 requests in the first survey and 106 in the second survey. These requests were divided into seven subthemes: compensation, staffing, information, facilities, leave time, PCR tests and equitable treatment. The theme on gratitude had two subthemes: information and emotional support, and material support. The fears and desires of healthcare workers included two types of uncertainty-related concerns, and requests were very different across the two surveys.ConclusionsIt is important to apply a balance of information to help staff adjust to their new work environment, as well as support to minimise the burden of infection and impact on their families.

Methicillin-resistant Staphylococcus aureus screening in healthcare workers: should a new protocol be introduced?

Background: In recent times, emerging resistance to majority of antibiotic classes seen in Methicillin-resistant Staphylococcus aureus (MRSA) isolates is of concern in hospital-acquired infection. MRSA carriage by healthcare workers (HCWs) has been documented to be as high as 50% in some studies. Higher carrier rate increases the risk of developing active infection as well as transmission of infection to the patients. The study aims to establish a relationship between MRSA carrier rate and healthcare workers of a tertiary care hospital in Pune and understand the need for screening regimens, based on the outcome.Methods: A cross-sectional study including health care workers from a tertiary care hospital working in different clinical departments was carried out. Data was collected by taking samples of nasal swabs of 115 HCWs and inoculated immediately on blood agar. Culture plates were incubated at 37°C for 24 hours and colonies were tested by routine diagnostic techniques. Antibiotic sensitivity was tested using cefoxitin discs on Mueller Hinton medium.Results: Prevalence of Staphylococcus aureus carriage was reported in 19 out of 115 (16.52%) healthcare workers, of which 63.2% were MRSA and 36.8% were MSSA. Prevalence of MRSA among Orthopaedic surgeons and General surgeons showed a carrier rate of 25% and 18.2% respectively. Nurses had a prevalence rate of 0.39 %. Overall prevalence of MRSA carriage in healthcare workers was reported to be 10.4%Conclusions: MRSA carriage among HCWs at the hospital is considerably high. The high prevalence of MRSA carriage emphasizes the need for stringent hospital infection control and regular screening regimen of HCWs.

Drug Utilization Evaluation of Vancomycin among Patients in Jafar Ibn Auf Pediatric Hospital, 2018

Background: Vancomycin is an antibiotic of growing importance in the treatment of hospital-acquired infections; with a particular emphasis on its value in the fight against Methicillin-resistant Staphylococcus aureus. Increasing reports of Vancomycin resistance have raised concerns about the effectiveness of this drug. Drug utilization evaluation has an important role in controlling rational use of antibiotics to prevent the emergence of resistance. Methods: We conducted a retrospective 6-months study at Jafar Ibn Auf pediatric hospital. Data including patient's demographics, diagnosis, Dosage regimen, and treatment duration were reviewed. The concordance of practice with the Hospital Infection Control Practices Advisory Committee (HICPAC) guidelines and principles of antibiotic therapy was assessed. Results: 127 medical records were reviewed in this study. Sepsis (29%) and Pneumonia (19.6%) were the most common indications. Culture test was requested in 20.5% of patients. Monitoring of serum creatinine was carried in 81.1% of patients. Based on HICPAC guidelines vancomycin was administered appropriately in 67.7% percent of cases. Considering the infusion rate, most of patients with specific order were received vancomycin in 1 hour. Conclusions: The results showed that vancomycin was used empirically without subsequent adjustment of the antimicrobial agent according to culture and sensitivity data and lack of paying enough attention to the infusion rate and serum creatinine monitoring.

Clinical Spectrum and Resistance Profile of Staphylococcus Infections in a Peri Urban Tertiary Care Hospital

Staphylococcus may be evaluated to be a serious microorganism to colonizes and contaminate both the healthy and immuno-competent people in the community along with the hospitalized patients with decreased immunity. This bacterium has been commonly present on the skin and in the nasal cavity of the human body. In the particular sites the organisms may give rise to local diseases of the nose, urethra, vagina and gastrointestinal tract, skin however most of them are minor and not associated with any mortality. S. aureus as well as coagulase-negative staphylococcus which are gram-positive bacteria that lives on the upper respiratory, mouth and skin structure creation, are the possible element for nosocomial and opportunistic disease in humans as well as in animals. Major complications involved with staphylococcus involved SSI, bullous impetigo, skin & soft tissues infection, bacteremia, pulmonary infections etc. The situation is further complicated by methicillin resistance in staphylococcus. MRSA/MRCoNS are considered as the emerging cause of hospital-acquired infections. it is very necessary to quantify the load of infections in order to achieve good hospital infection control policies. Furthermore, the morbidity and mortality rate may also be reduced in the same manner.

810. Cardiac Pacemaker Implantation Surgery: Automated Prediction of Surgical Site Infection

Background A research focused on surgical site infection (SSI) was performed in patients undergoing cardiac pacemaker implantation surgery. The main objective is to statistically evaluate such incidences and enable a study of the prediction power of SSI through pattern recognition algorithms, in this case the Multilayer Perceptron (MLP). Methods Data were collected from five hospitals in the city of Belo Horizonte (more than 3,000,000 inhabitants), between July 2016 and June 2018, on SSI by the Hospital Infection Control Committees (CCIH) of the hospitals involved in the search. All data used in the analysis during their routine SSI surveillance procedures were collected. So, three procedures were performed: a treatment of the collected database for use of intact samples; a statistical analysis on the profile of the hospitals collected and; an assessment of the predictive power of five types of MLP (Backpropagation Standard, Momentum, Resilient Propagation, Weight Decay, and Quick Propagation) for SSI prediction. MLPs were tested with 3, 5, 7, and 10 hidden layer neurons and a database split for the resampling process (65% and 75% for testing, 35% and 25% for validation). They were compared by measuring AUC (Area Under the Curve - from 0 to 1) presented for each of the configurations. Results From 1394, 572 records were: 21% of deaths and 2.4% patients had SSI; from the confirmed SSI cases, approximately 64.3% had sites classified as “clean”; length of hospital stay ranged from 0 to 175 days (from 1 to 70 days); the average age is 67 years. The prediction power of SSI, the experiments achieved from 0.409 to 0.722. Conclusion Despite the considerable loss rate of more than 65% of the database samples due to the presence of noise, it was possible to have a relevant sampling for the profile evaluation of Belo Horizonte hospitals. Moreover, for the predictive process, although some configurations reached 0.722. To optimize data collection and enable other hospitals to use the SSI prediction tool (available in www.nois.org.br ), two mobile application were developed: one for monitoring the patient in the hospital and the other for monitoring after hospital discharge. Disclosures All Authors: No reported disclosures

Susceptible-Infected-Removed Mathematical Model under Deep Learning in Hospital Infection Control of Novel Coronavirus Pneumonia

Objective. This research aimed to explore the application of a mathematical model based on deep learning in hospital infection control of novel coronavirus (COVID-19) pneumonia. Methods. First, the epidemic data of Beijing, China, were utilized to make a definite susceptible-infected-removed (SIR) model fitting to determine the estimated value of the COVID-19 removal intensity β, which was then used to do a determined SIR model and a stochastic SIR model fitting for the hospital. In addition, the reasonable β and γ estimates of the hospital were determined, and the spread of the epidemic in hospital was simulated, to discuss the impact of basal reproductive number changes, isolation, vaccination, and so forth on COVID-19. Results. There was a certain gap between the fitting of SIR to the remover and the actual data. The fitting of the number of infections was accurate. The growth rate of the number of infections decreased after measures, such as isolation, were taken. The effect of herd immunity was achieved after the overall immunity reached 70.9%. Conclusion. The SIR model based on deep learning and the stochastic SIR fitting model were accurate in judging the development trend of the epidemic, which can provide basis and reference for hospital epidemic infection control.

Knowledge, attitude, and practices regarding COVID-19 among obstetric health care professionals in a tertiary care hospital, Karachi, Pakistan

Background: The recently ongoing pandemic COVID-19 tramp in number of healthcare professionals (HCPs). They are facing the challenge of managing pregnant patients and their unborn babies. This study was done to evaluate the knowledge, attitude, and practices (KAP) among obstetric health care workers towards the COVlD-19.Methods: This cross-sectional study was conducted among OHCP at Aga Khan University Hospital, Karachi, Pakistan. For each correct answer 2 points were assigned. Scores for each category were calculated. According to Bloom’s cut-off good knowledge was considered for >80% scores, for practice and attitude scores of 8 and 6 were considered as appropriate respectively.Results: A total of 124 responses were analyzed. Most of the responders were females (97.6%) in the age group of 25-50 years (96%). Most obstetrics healthcare professionals had good knowledge and practice scores (n=92.75%, 91.1%, respectively). We also observed positive attitude scores (n=92.7%) with a mean COVlD-19 knowledge score was 18.71±3.34 (range: 10-24) whereas the mean score of practice was 5.76±0.68 (range: 0-6) suggesting good knowledge and practice. The mean attitude score was 8.60±1.37 (range: 2-10) indicating a positive attitude. However, in univariate analysis, we did not find a significant association with categorical variables.Conclusions: There was comparatively good knowledge regarding Covid-19 among obstetric healthcare workers. Implementation and dissemination of hospital infection control guidelines and training against COVID-19 infection helped to attain appropriate knowledge translating into positive attitude and practices among healthcare workers.