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To assess whether measurement and feedback of chlorhexidine gluconate (CHG) skin concentrations can improve CHG bathing practice across multiple intensive care units (ICUs).
A before-and-after quality improvement study measuring patient CHG skin concentrations during 6 point-prevalence surveys (3 surveys each during baseline and intervention periods).
The study was conducted across 7 geographically diverse ICUs with routine CHG bathing.
Adult patients in the medical ICU.
CHG skin concentrations were measured at the neck, axilla, and inguinal region using a semiquantitative colorimetric assay. Aggregate unit-level CHG skin concentration measurements from the baseline period and each intervention period survey were reported back to ICU leadership, which then used routine education and quality improvement activities to improve CHG bathing practice. We used multilevel linear models to assess the impact of intervention on CHG skin concentrations.
We enrolled 681 (93%) of 736 eligible patients; 92% received a CHG bath prior to survey. At baseline, CHG skin concentrations were lowest on the neck, compared to axillary or inguinal regions (P < .001). CHG was not detected on 33% of necks, 19% of axillae, and 18% of inguinal regions (P < .001 for differences in body sites). During the intervention period, ICUs that used CHG-impregnated cloths had a 3-fold increase in patient CHG skin concentrations as compared to baseline (P < .001).
Routine CHG bathing performance in the ICU varied across multiple hospitals. Measurement and feedback of CHG skin concentrations can be an important tool to improve CHG bathing practice.
Sexual and gender minority (SGM) college students endorsed higher psychological distress and worsened mental health outcomes than their cisgender heterosexual peers. Such disparity is exacerbated during the COVID-19 pandemic, during which SGM youth may be sent home to unaccepting environments or presented with fewer healthcare options. The “Black lives matter (BLM)” and “Anti-Asian Hate” also exposed college students disproportionally to more witnessed discrimination and poorer social cohesion, which in turn, might negatively affect the mental health outcomes.
The present study aims to explore the mental health outcome profile within SGM college students by (1) identify mental health disparities across different sexual and gender identities and (2) evaluating the impacts of discrimination, social cohesion and other factors on mental health outcomes of college students with different sexual and gender identities.
The study utilizes the 2020-2021 Healthy Minds Study data with 139,470 college students across 60 U.S. campuses. Multivariable regression models are built with minority status to predict mental health outcome (depression, anxiety, and suicidal ideation).
SGM students reported higher symptoms of depression, anxiety, and suicidal ideation. Besides, SGM individuals having experienced or witnessed discrimination or hostile behaviors due to their race/ethnicity also showed worse mental health outcomes. Noted, perceived stronger social cohesion is a protective factor for lower depression (OR: 0.59; 95%CI: 0.45, 0.78) and anxiety (OR: 0.69; 95%CI: 0.51, 0.93) symptoms in SGM, while perceived weaker social cohesion is a risk factor for depression (OR: 1.37; 95%CI: 1.14, 1.64) and anxiety symptoms (OR:1.32; 95%CI:1.09-1.59) in cisgender heterosexual individuals.
These findings acknowledge the negative impact of discrimination on mental health, highlight the importance of recognizing social cohesion affect differently in SGM and their peers, and enhance the understanding of differential impact of social cohesion to inform public policy and early intervention in vulnerable populations during COVID-19 pandemic.
According to CEOWORLD Magazine‘s 2019 “Health Care Indicators” rating of 89 countries in the world, Taiwan ranks first in the world. The coverage of the National Health Insurance covers all necessary medical treatment, including outpatient, hospitalization, and prescription drugs etc. The psychiatrist was wondering which item with the highest service cost–performance (CP) ratio of the psychiatrist performance in a general hospital and used proportion of PPF as performance indicator. He used allocation to distribute the hours across job activities.
The purpose of this study is to investigate items allocation proportion for outpatient and inpatient ward in a specific month, examining the distribution of performance and figure out an appropriate model to optimal medical service.
Demographic data were collected through PPF projects included 15 outpatient items and 19 inpatient ward items from the third-month of the psychiatrist’s employment in the general hospital, as shown in Table 1. Items related to physiological examination has been excluded. The performance is calculated by combining outpatient and inpatient wards.
Demographic data analysis found that proportion of inpatient ward PPF (67.01%) was significantly greater than proportion of outpatient PPF (32.99%) (Figure 1). The inpatient ward performance was 2 times the outpatient performance. This result showed that most performance came from inpatient ward. Among all items of the proportion of PPF unit, the highest two for inpatient ward items were general hospital bed inpatient consultation (32.58%) and special treatment for psychiatric inpatients (14.35%), and for outpatient, the highest was psychiatric outpatient consultation - more than two (11.31%) (Table 1).
National Health Insurance is an important system to assist in epidemic prevention during the COVID-19 period. The most PPF of psychiatrist service in a general hospital came from the service of inpatient ward items, including the general hospital bed inpatient consultation with the highest CP ratio. These findings may suggest that the inpatient service could offer psychiatrists fair PPF, and the hospital environment could be favorable for recruitment.
Bipolar disorder (BD) is a severe psychotic disease repeats depression, hypomania or mania. Using mobile applications to record emotions can help BD patients to self-manage and reduce emotional symptoms. Gamification applied in health-manage applications can improve the using frequency and satisfaction. Nurturing and horticultural therapy could increase the using frequency and alleviate the depression and anxiety.
This study chose plants-nurturing to add to a self-management application, and explored the users’ experiences.
A one-group pretest-posttest design with qualitative interview was used. Analysis included the frequency of usage, emotional changes, and users’ feedback of the plants-nurturing in the first three months and after three months.。
A total of 26 participants were included. In the frequency of usage, the times and ratio of days were increased but no significant difference. The emotional symptoms were no significant difference. Positive experiences were novelty and interesting, while negative experiences were the slow rate of growth.Table 1.
There was a preliminary increase when adding plants-nurturing to the self-manage application, whereas the effect should be examined by further research. The more delicate elements of gamification could be included in self-manage application, considered the users’ other sensory perception in the future. Meanwhile, to improve the frequency of usage and self-management in BD patients, the subjective experiences should be explored in-depth.
While the role of benzodiazepines (BZDs) has been well established for anxiety and related disorders, there are significant concerns about BZD dependence, withdrawal, and tolerance. There is a lot of ambiguity regarding the potential long-term effects of BZDs on mental health. However, the risk of developing subsequent other substance use disorders is in question.
In this electronic medical record (EMR) based retrospective cohort study, the study cohort was defined as patients between the ages of 18 and 65 with anxiety disorders (ICD-10-CM: F40-F48) prescribed with at least one BZD; the control cohort was defined as patients between the ages of 18 and 65 with anxiety disorders (ICD-10-CM: F40-F48) with no BZD prescription during the five-year timeframe examined. We excluded patients with pre-existing substance use disorders (ICD-10-CM: F10-F19), et al.
We collected data from TriNetX Research database, a real-time international EMR network, from September 2017 to September 2022. Patients in the two cohorts were matched by gender, age, race, ethnicity, and common medical conditions at a 1:1 ratio by propensity scoring and then underwent Kaplan–Meier analysis and association analysis.
A total of 626,754 patients were identified and matched for analysis. Patients in the study cohort were more likely to be female (67.6% vs. 66.7%, p < 0.001), non-Hispanic (65.8% vs. 62.5%, p < 0.001) and white (72.8% vs. 69.1%, p < 0.001). Kaplan–Meier analysis showed the survival probability at the end of the time window was 94.1% for the control cohort and 89.5% for the study cohort (Hazard ratio, 2.20; 95% CI, 2.16-2.25; P < 0.001) in all type of substance use disorders. (Table 1)Table 1.
Hazard ratio of substance use disorders difference in BZD cohort versus the control cohort.
Substance use disorders was defined as Mental and behavioral disorders due to psychoactive substance use (ICD-10-CM: F10-F19).
Patients with an anxiety disorder who were prescribed BZDs are at higher risk of not only BZD dependence but all types of substance use disorders than a matched cohort not prescribed BZDs. Given this notable association, clinicians should be cautious while prescribing BZDs and inform the patient about the risks associated with their utilization.
Undergraduate students encounter developmental challenges during their transition into adulthood. Previous studies have claimed that adults with later chronotypes usually manifest negative psychological effects: poor sleep quality, greater stress, depression, and cognitive dysfunction. However, knowledge about the relationship between chronotype, stress, and sleep quality among young adults is lacking.
The present study investigated the relationship between undergraduates’ chronotypes and perceived stress on sleep quality.
An online survey with a descriptive, cross-sectional design was conducted with a convenience sample of undergraduate students at a university in southern Taiwan. Those who were 20-25 years old and enrolled as a student were included; but who had been suspended or had deferred graduation were excluded. Students’ chronotype, stress, and sleep quality were assessed with three self-reported instruments: Munich Chronotype Questionnaire (MCTQ), Perceived Stress Scale (PSS), and Pittsburgh Sleep Quality Index (PSQI).
Of 161 undergraduates who completed the questionnaires, 51 reported using an alarm clock to wake and were removed from data analysis. One hundred and ten students’ mean age is 20.3 and perceived moderate stress. Sixty-one percent were poor-quality sleepers. The mean chronotype score was 5.7, and 85.5% had an intermediate chronotype, while 13.6% had an evening chronotype. Chronotype and perceived stress were positively correlated with sleep quality (p < .001). Social jetlag was positively correlated with chronotype (p =.036). Undergraduate’s later chronotype and higher stress perception predicted 30% of poorer sleep quality (p < .001).
Undergraduate students’ chronotype and perceived stress were positively correlated and acted as predictors of the sleep quality. The findings could help to develop health-promotion interventions for these emerging adults to adjust their daily routines; and reduce their social jetlag, stress levels, and sleep disturbance.
Most of the research explored the attrition rate and predictive factors for the smartphone application of emotion monitoring in bipolar disorder patients. However, there is less focus on the efficacy of maintaining the retention rate if the incentive system is employed.
The aim of our research is to evaluate the efficacy of two different kinds of incentive systems on improving frequency of using the Smartphone Mood Relapse Warning application (MRW-APP) (Su et al., 2021) in bipolar patients.
A one-group pretest-posttest pilot study was conducted. Participants with bipolar disorder (n = 63) recorded their moods and symptoms through MRW-APP for 29 weeks with the attrition rate of 44%. Two different kinds of incentive systems, reward and lottery, were implemented. To know whether incentive implementation could play a role in motivating the participants to better adhere to the app, we used Friedman’s test and paired sample t-test to analyze the participants’ app-using frequency in the corresponding weeks.
There was no significant difference in the participants’ app-using frequency (p>.05) before and after we implemented the first incentive system, reward (n=63). For the second incentive system, lottery (n=41), a significant difference in app-using frequency was still not observed (p>.05) after the intervention. But, for those who both had experienced two kinds of incentive systems (n=35), there were significant changes in their app-using frequency (p<.05).Table 1.
Onset age (n=48)
Educational level (n=54)
SD= Standard deviation
This research found the two incentive systems, award and lottery, may help increase the using frequency of the smartphone monitoring app for participants with bipolar disorder. The results from our study can be a reference for mood monitoring apps development in the future, and it also suggested that incentive system has its potential on encouraging patients’ adherence to e-healthcare.
In Taiwan, National Health Insurance has been implemented for 27 years and continues to receive international recognition. People pay part of the quota at the time of medical treatment, and the rest of the medical expenses will be paid by the national health insurance. In this study, the researcher, a psychiatrist in the general hospital, investigated the correlation between service and revenue. He has started to work in this hospital since November 1st, 2021, without any other psychiatrist peers.
This study used proportion of PPF as performance indicator and aimed to observe the changes of PPF unit from November 1st, 2021, to January 31st, 2022, examining the trend of PPF growth. The purpose is to figure out an appropriate model to optimize medical services and performance outcomes.
Demographic data were collected through PPF projects, consisting of 17 inpatient ward items and 14 outpatient items from November 1st, 2021, to January 31st, 2022, and items with no performance or related to physiological examination has been excluded. In addition, items with a ratio of greater than 1.5% are presented in the bar graphs, as shown in Figure 2 and 3. The performance proportion of inpatient ward and outpatient were calculated separately.
Demographic data found PPF rises significantly over time (Figure 1). The 2nd month PPF unit (27.09%) was 2.5 times the 1st month PPF unit (10.70%), and the 3rd month PPF unit (62.21%) was 2.2 times the 2nd month PPF unit (27.085%). The highest proportion of PPF items were general hospital bed inpatient consultation fee for inpatient ward item (Figure 2) and psychiatric outpatient consultation fee for outpatient item (Figure 3). Furthermore, only the proportion of psychiatric outpatient consultation – more than two consecutive transfers increased continuously and the proportion of psychiatric outpatient consultation – adjusted by the hospital decreased, the other items has not changed significantly.
In the first three months of the psychiatrist employment, the performance showed an increasing trend. These findings may suggest that the psychiatrist could be competent in a general hospital with patients’ confidence. In addition, under an optimal model of PPF and medical service, psychiatrists would more like to work in the general hospital, to serve acute psychiatric patients in need.
Insomnia is a prevalent global health problem that affects 11.7% - 36% of the population (Grewal et al. Clinical Handbook of Insomnia Int 2017; 13 - 25). It is a risk factor for depression, poor quality of life, and accidents. Increasingly, insomnia has been identified as a suicide risk factor (Lin et al. BMC Psychiatry 2018: 18; 117) We present a case report of a 43-year-old male patient with insomnia-induced suicidal ideation (SI).
1. Learn the mechanism of insomnia-induced SI
2. Understand the current insomnia treatments
3. Discuss the possible mechanism of ECT treating insomnia-induced SI
A 43-year-old single male with past psychiatric diagnoses of social anxiety, borderline personality disorder, chronic SI, and severe recurrent depression was admitted to inpatient due to intractable SI from insomnia. He failed trials on SSRIs/SNRIs, bupropion, trazodone, lithium, vortioxetine, quetiapine, zolpidem, and ketamine. The patient was initiated on electroconvulsive therapy (ECT) three times a week with 20mg vortioxetine and 100mg quetiapine for sleep initiation.
After 6-sessions, the patient’s mood, affect and sleep had improved considerably, and his suicidal ideations resolved. The patient was discharged with outpatient follow-up and ECT as rescue therapy. His sleep gradually improved to 4-6hrs/night and his mood was back at baseline.
ECT is an effective treatment for refractory insomnia-induced SI, likely due to persistent REM suppression and reduced dendritic arborization and excitatory synapses in the amygdala (Doghramji et al. Sleep 2000; 23 - S16 - S20; Lahmeyer et al. Sleep Respiratory 1989; 18 346). Possible mechanisms for insomnia-induced SI include impaired decision-making, abnormalities in 5-HT function, or HPA dysfunction leading to a hyperarousal state and cortisol release (Chatzittofis et al. Euro Neuropsychopharmacology 2013; Elmenhorst et al. Sleep 2012; 35 1615 - 1623; Keilp et al. Psychol Medicine 2013; 43 539-551; Novati et al. 2008 Sleep; 31 1579 - 1585). Current insomnia treatments address underlying medical/psychological problems and non-pharmacologic and pharmacologic strategies. The predominant non-pharmacologic approach is Cognitive Behavioral Therapy Insomnia (CBT-I), such as relaxation techniques, sleep hygiene education, cognitive structuring, and sleep restriction (Rossman et al. American Journal of Lifestyle Medicine 2019; 13 544 - 547). Pharmacologic options include benzodiazepines, non-benzodiazepine hypnotics, tricyclic antidepressants, trazodone, and antihistamines (Saddichha et al. Annals of Indian Academy of Neurology 2010; 13 94-102). ECT should be strongly considered for the treatment of refractory insomnia-induced SI, and its early application may avoid rapid deterioration improving the quality of life.
This serial work presents a linear-time-invariance (LTI) notion to the Koopman analysis, finding consistent and physically meaningful Koopman modes and addressing a long-standing problem of fluid mechanics: deterministically relating the fluid excitations and corresponding structure reactions. Part 1 (Li et al., Phys. Fluids, vol. 34, no. 12, p. 125136) developed the Koopman-LTI architecture and applied it to a pedagogical prism wake. By a systematic analytical procedure, the Koopman-LTI generated sampling-independent linear models that captured all the recurring dynamics embedded in the input data, finding six corresponding, orthogonal, and in-synch fluid–structure mechanisms. This Part 2 analyses the six modal duplets to underpin their physical implications, providing a phenomenological analysis of the subcritical prism wake. Visualizing the newly proposed dynamic Koopman modes, results show that two mechanisms at St1 = 0.1242 and St5 = 0.0497 describe shear layer dynamics, the associated Bérnard–Kármán shedding and turbulence production, which together overwhelm the upstream and crosswind walls by instigating a reattachment-type of reaction. The on-wind walls’ dynamical similarity renders them a spectrally unified fluid–structure interface. Another four harmonic counterparts, namely the subharmonic at St7 = 0.0683, the second harmonic at St3 = 0.2422, and two ultra-harmonics at St7 = 0.1739 and St13 = 0.1935, govern the downstream wall. Finally, this work discovered the vortex breathing phenomenon, describing the constant energy exchange in the wake's circulation-entrainment-deposition processes. With the Koopman-LTI, one may pinpoint the exact excitations responsible for a specific structure reaction, benefiting future investigations into fluid–structure interactions and nonlinear, stochastic systems.
This paper presents an account of a Welfare Quality® assessment of 92 dairy farms carried out by seven experienced assessors. The aim was to evaluate the potential of the Welfare Quality® assessment protocol with respect to its uptake by UK farm assurance schemes. Data collection, and measure aggregation were performed according to the Welfare Quality® protocol for dairy cows. This study examined the data itself, by the testing of how hypothetical interventions might be reflected in changes in the aggregated scores, and also investigated human-related aspects, through inter-assessor standardisation sessions to evaluate reliability, and an assessor focus group to collect feedback. Overall, three main ‘challenges’ were identified. The first challenge related to the large amount of missing data. Unexpectedly, this was such that it was only possible to calculate an overall classification for 7% of farms. The second challenge concerned the way in which aggregated scores did not always reflect hypothetical interventions. The final challenge was inter-assessor reliability, where not all assessors were found to achieve acceptable levels of agreement on a number of outcome measures by the third training session. Suggestions for managing these challenges included, follow-up to assessor training, the use of multiple imputation methods to fill in missing data, and, where applicable, not aggregating the scores. The conclusion of the study was that the protocol provided useful information from which to make an informed selection of measures, but that the challenges, combined with the lengthy assessment time, were too great for its use as a certification tool.
Visitors to zoos are a source of potential stress to certain captive-housed animals. Much research has focused on Europe and America, whereas the effect of human audiences on the behaviour of captive animals in Chinese parks has so far not been investigated. Sika deer (Cervus nippon) housed in Zhu-Yu-Wan Park, Yangzhou City, Jiangsu Province, China, were studied to determine the effect of different visitor density levels on the animals’ activity. From June 21 to December 10, 2006, and again from February 21 to July 10, 2007, 21 subjects were observed for 10 h per week for a total of 44 weeks. Continuous focal animal sampling was used to quantify behaviours, and visitor density was recorded every minute. Friedman's tests were used to examine the effects of visitor density on the behaviour of sika deer. Results showed that high visitor density was significantly related to foraging, resting, watching and ‘non-visible’ behaviours. The findings demonstrate that high numbers of visitors have an effect on the welfare of sika deer.
Central glucocorticoid receptor (GR) has been found to play an important role in the interpretation of cognitive abnormalities of posttraumatic stress disorder (PTSD), particularly focused on the extinction failure of fear memory. Potential of using GR antagonist as a pharmacological agent to prevent PTSD-related fear memory disruption is worth investigating.
We aimed to examine whether GR antagonist Mifepristone (RU486) administered before single prolonged stress (SPS) can prevent rats from fear memory extinction impairment.
In the present study, SPS was employed in rats to induce a rodent model of PTSD. 60 minutes before SPS, RU486 (20 mg/kg) was administered by intraperitoneal injection. Seven days after SPS, rats received a protocol of behavioral testing to measure their abilities of specific fear memory (by a cue-dependent fear conditioning paradigm) and nonspecific spatial memory (by T-maze). Neurochemically, we measured plasma corticosterone with or without dexamethasone suppression, activation ratio of GR and levels of norepinephrine, dopamine, and serotonin in amygdala, paraventricular nucleus, dorsal and ventral hippocampus.
Our results found that RU486 exerted protective effects on SPS-induced fear extinction impairment. Corticosterone of SPS-RU486 rats was less suppressed by dexamethasone. GR became less activated in dorsal hippocampus of SPS-RU486 rats.
The findings supported the utility of GR antagonism in preventing the development of PTSD.
Nursing students’ attitudes towards mental illness will affect their perception about caring patients with mental illness and their willingness to work in the field of mental health. Evidence supported that contact with recovery patients can change people’s perception of mental illness.
The study aims to explore the undergraduate nursing students’ encountering experience with recovery patients as educators.
A qualitative study using purposive sampling was conducted with undergraduate nursing students in southern Taiwan. Content analysis was used to identify the students’ experience as encountering with the recovery patient as an educator.
As recovery patients participated in class, sharing their recovery journey and learning with students to produce a recovery story, it provided recovery patients and students an equal and mutually beneficial partnership. Four main themes about undergraduate nursing students’ attitudes were identified as. (1)Changing the mindset to patients with mental illness — We are human beings. There’s not much difference between us. (2)Turning positive attitudes towards patients with mental illness — We can compose a better life together! (3)Closing the distance between students and patients with mental illness — I am willing to be close to you. (4)Reflecting and growing in self-understanding and values — I am recovered, too.
This study found that the strategy of recovery patients as educators can improve future nurses’ attitudes towards mental illness, help them deeply learn about patient’ recovery journey. It might beneficial to help students developing their competency in patient-centered care. Future study could examine the effect of the recovery patients as educators.
Focusing on human capacity to design, the volume's final chapter draws attention to the fascinating role imagination can play in human life. The relationship between human consciousness and the evolution of the species continues to captivate and puzzle scholars. By revisiting the dialogue between consciousness and evolution, the authors demonstrate how enigmas often necessitate dynamic collaboration between sciences, arts, and humanities. Archaeology provides evidence that the drive for diverse conscious experiences is no new phenomenon, while neuroscience illuminates the ways in which altered states of consciousness can enhance the variety of mental experience. Art, design, and cognitive technologies can build on this picture by providing innovative ways of exploring conscious experience. Inspired by insights from a range of academic disciplines and reflecting on personal experience, this chapter proposes the role of ‘harmony’ as another enigmatic angle of research with potential to shed further light on the functioning both of human society and of the human mind.
The impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health is still being unravelled. It is important to identify which individuals are at greatest risk of worsening symptoms. This study aimed to examine changes in depression, anxiety and post-traumatic stress disorder (PTSD) symptoms using prospective and retrospective symptom change assessments, and to find and examine the effect of key risk factors.
Online questionnaires were administered to 34 465 individuals (aged 16 years or above) in April/May 2020 in the UK, recruited from existing cohorts or via social media. Around one-third (n = 12 718) of included participants had prior diagnoses of depression or anxiety and had completed pre-pandemic mental health assessments (between September 2018 and February 2020), allowing prospective investigation of symptom change.
Prospective symptom analyses showed small decreases in depression (PHQ-9: −0.43 points) and anxiety [generalised anxiety disorder scale – 7 items (GAD)-7: −0.33 points] and increases in PTSD (PCL-6: 0.22 points). Conversely, retrospective symptom analyses demonstrated significant large increases (PHQ-9: 2.40; GAD-7 = 1.97), with 55% reported worsening mental health since the beginning of the pandemic on a global change rating. Across both prospective and retrospective measures of symptom change, worsening depression, anxiety and PTSD symptoms were associated with prior mental health diagnoses, female gender, young age and unemployed/student status.
We highlight the effect of prior mental health diagnoses on worsening mental health during the pandemic and confirm previously reported sociodemographic risk factors. Discrepancies between prospective and retrospective measures of changes in mental health may be related to recall bias-related underestimation of prior symptom severity.
We quantified hospital-acquired coronavirus disease 2019 (COVID-19) during the early phases of the pandemic, and we evaluated solely temporal determinations of hospital acquisition.
Retrospective observational study during early phases of the COVID-19 pandemic, March 1–November 30, 2020. We identified laboratory-detected severe acute respiratory coronavirus virus 2 (SARS-CoV-2) from 30 days before admission through discharge. All cases detected after hospital day 5 were categorized by chart review as community or unlikely hospital-acquired cases, or possible or probable hospital-acquired cases.
The study was conducted in 2 acute-care hospitals in Chicago, Illinois.
The study included all hospitalized patients including an inpatient rehabilitation unit.
Each hospital implemented infection-control precautions soon after identifying COVID-19 cases, including patient and staff cohort protocols, universal masking, and restricted visitation policies.
Among 2,667 patients with SARS-CoV-2, detection before hospital day 6 was most common (n = 2,612; 98%); detection during hospital days 6–14 was uncommon (n = 43; 1.6%); and detection after hospital day 14 was rare (n = 16; 0.6%). By chart review, most cases after day 5 were categorized as community acquired, usually because SARS-CoV-2 had been detected at a prior healthcare facility (68% of cases on days 6–14 and 53% of cases after day 14). The incidence rates of possible and probable hospital-acquired cases per 10,000 patient days were similar for ICU- and non-ICU patients at hospital A (1.2 vs 1.3 difference, 0.1; 95% CI, −2.8 to 3.0) and hospital B (2.8 vs 1.2 difference, 1.6; 95% CI, −0.1 to 4.0).
Most patients were protected by early and sustained application of infection-control precautions modified to reduce SARS-CoV-2 transmission. Using solely temporal criteria to discriminate hospital versus community acquisition would have misclassified many “late onset” SARS-CoV-2–positive cases.