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Background: Antimicrobial resistance is a worldwide problem leading to increasing deaths due to intractable infections, especially in postoperative patients who have extended stays in ICUs due to other surgical complications. Carbapenem and colistin resistance has been increasing here; hence, it was decided to monitor and control antibiotic use. In the neurosurgery unit of a quaternary-care hospital in South India, surgical prophylaxis was chosen as less problematic area in which to implement antibiotic stewardship. Objective: To study the difference in the antibiogram pattern of isolates from neurosurgery postoperative patients, before and after the introduction of a surgical antimicrobial prophylaxis policy from the UK National Health Service (NHS). Methods: After the implementation of a new surgical prophylaxis protocol taken from the UK NHS guidelines, we studied its impact by analyzing the antibiogram before implementation (period 1 from January 1, 2020, to December 31, 2020) and after implementation (period 2 from April 1, 2021, to September 30, 2021). This period corresponded to the same number of isolates as the earlier period. Antibiogram criteria: All clinically relevant infections due to the ESKAPE pathogens were included in the antibiogram. The antibiotics analyzed included β-lactams, cephalosporins, β-lactam- lactamase combinations, carbapenems, aminoglycosides, colistin and tigecycline for gram-negative bacilli and penicillin, oxacillin, aminoglycosides, vancomycin, and linezolid for gram-positive cocci. For analysis, the difference was deemed significant according to the criteria stated in CLSI document M39-A4 (4th edition, January 2014). Results: In period 1, 170 isolates were tested, and in period 2, 162 isolates were tested. Among the isolates, Enterococcus spp and Enterobacter spp were too few in number for a comparison. For the gram-negative bacilli, E. coli, Klebsiella pneumoniae, and Acinetobacter baumannii, the differences were significant for the β-lactam–lactamase combinations, carbapenems, and amikacin, with higher susceptibility in period 2. For Staphylococcus aureus, oxacillin, erythromycin, and clindamycin showed a significant increase in susceptibility in period 2. Relevant tables and a graph will be included in the presentation with detailed discussion. Conclusions: Controlled surgical prophylaxis strictly implemented can lead to a significant change in the antibiotic susceptibility pattern among isolates causing healthcare-associated infections among postoperative patients in intensive care units.
Objectives: In tertiary-care settings, up to 50% of patients are prescribed at least 1 antibiotic. However, patients are often not proactively provided with information nor involved in shared decisions regarding their antibiotic therapies. Understanding inpatients’ knowledge and the extent of their involvement in antibiotic therapy help reduce inappropriate or unnecessary antibiotic use. Methods: A cross-sectional survey was conducted from March to December 2021 in a 1,600-bed, adult, acute-care, tertiary-care hospital. Patients prescribed antibiotics for the past 1 week during their hospital stay were surveyed. Ten questions assessing patients’ knowledge of their antibiotic therapy and 3 questions adapted from the NHS Care Quality Commission Inpatient survey (2013) were included in the survey questionnaire. Results: Among the 323 patients surveyed, 88% knew that they had been given antibiotics, and 80% felt that it was important to be informed of the reason, 76% felt that it was important to be informed of side effects, 74% felt that it was important to be informed of duration, and 72% felt that it was important to be informed of dosing frequency. However, only 71% knew the dosing frequency, 54% knew the side effects, 37% knew the duration, and 13% knew the name of the antibiotic agent administered. Of those unaware of the antibiotic name, 59% had indicated their desire to know. Among those aware of their antibiotic therapy, 85% had trust in their doctors but only 42% felt that they always received answers to their questions on antibiotics in an understandable manner from their doctors. Furthermore, 41% felt that they were often or always not given enough time to question their doctors. To raise their awareness on antibiotic use, 73% of respondents felt that having protected time with the doctors to understand more about their antibiotic therapy would be effective. Conclusions: Most inpatients lacked knowledge of details of their antibiotic therapy, and fewer than half were involved in it. Allocation of protected time with doctors to understand their antibiotic therapy can be a potentially effective strategy to increase patient engagement to enhance hospital antibiotic stewardship efforts.
Objectives: To determine virulence genes and sensitivity to antibacterial drugs of Staphylococcus epidermidis isolated from blood cultures of newborns. Methods: A study of сoagulase-negative Staphylococcus (CoNS) from newborns with sepsis was conducted in the regional perinatal center in Karaganda, Kazakhstan. Blood-culture identification was performed using MALDI-TOF MS. Virulence factors were determined on primers (sdrG, sdrG, atl, lip, nuc, ebh, hlb, sspA, sspB, and gehD) with PCR (Bio-Rad CFX 96). Susceptibility to antibiotics determination was carried out using the disc-diffusion method. Testing with cefoxitin was used to detect methicillin resistance in staphylococci. Results: Overall, 18 Staphylococcus epidermidis isolates from blood cultures of newborns with sepsis were investigated from January to December 2021. The frequency of detection of virulence genes was distributed as follows: atl (94.5%), sspB (94.5%), sspA (89%), gehD (89%), ebh (89%), hlb (72%), sdrG (39%), sdrF (28%), nuc (28%), and lip (13%). Also, 10 isolates (55%) were resistant to cefoxitin (MRSE). Furthermore, 72% of S. epidermidis isolates showed resistance to azithromycin and 33% were resistant to clindamycin and gentamicin. Also, 39% of strains were resistant to fluorchinolones. All isolates were susceptible to vancomycin, linezolid, and fusidic acid. Conclusions:S. epidermidis strains isolated from blood cultures had high rates of exoenzymes sspB, sspA, gehD, autolysin (atl), β-hemolysin (hlb), and cell-wall–associated fibronectin-binding protein (ebh). Among 18 neonatal sepsis pathogens, 10 (55%) were MRSE, so it is necessary to pay attention to antibiotic therapy adjustment.
Objectives: The bacteria in the ‘ESKAPE’ group are monitored due to their ability to resist antibiotic action. During the COVID-19 pandemic at our hospital, the usage of meropenem and levofloxacin as the empirical treatment for bacterial pneumonia increased and might have contributed to the antimicrobial resistance problem. In this study, we evaluated the ESKAPE group infection rates and their susceptibility to antibiotics in Dr. Sardjito Hospital, a referral and academic hospital in Yogyakarta, Indonesia. Methods: Data for ESKAPE pathogens in 2019–2021 were taken from the microbiology laboratory of Dr. Sardjito Hospital and were evaluated. Results: The proportion of ESKAPE isolates among positive cultures during 2019–2021 slightly increased from 49.4% to 48.4% to 50.7% each year (P > .05). The dominant ESKAPE infections were pneumonia, bloodstream infection, and urinary tract infection by K. pneumoniae, and wound infection by P. aeruginosa. The susceptibility pattern of ESKAPE to meropenem decreased from 72% in 2019 to 68% in 2020 but increased to 84% in 2021. To levofloxacin, the susceptibility pattern was decreased in a fluctuating trend from 68% in 2019 to 33% in 2020 and to 39% in 2021. During the COVID-19 pandemic (2020–2021), the pattern of ESKAPE infections was similar to that of 2019. In descending order, the frequency rank was K. pneumoniae, P. aeruginosa, A. baumannii, Enterobacter spp, and S. aureus. The proportions of MDR isolates increased from the prepandemic period to the COVID-19 pandemic era for E. faecium (from 5% to 24.4%), for A. baumannii (from 9.6% to 38.5%), and for P. aeruginosa (from 7.4% to 13.5%) (P < .05). These patterns did not differ between non–COVID-19 patients and COVID-19 patients. These results highlight the general impact of overused antibiotics beyond COVID-19 patients. Usage of watched and restricted antibiotics must be more controlled because bacterial coinfection and superinfection in COVID-19 patients was relatively low. Conclusions: During the COVID-19 pandemic, ESKAPE infections increased and their susceptibility to meropenem and levofloxacin decreased. Tight control of antibiotic usage is needed.
Background and objectives: Since the introduction of the COVID-19 vaccine through the National COVID-19 Immunization Program in Malaysia in February 2021, the number of cases of severe COVID-19 and mortality have progressively decreased. We explored the association between vaccination status, type of vaccine, and the highest COVID-19 clinical category. Methods: Patients were recruited via the electronic medical record (EMR) at University Malaya Medical Centre (UMMC) from July 2021 onward. Included patients were aged ≥18 years old with positive SARS-CoV-2 RT-PCR results from respiratory samples (naso-oropharyngeal swab, saliva, or sputum). Patient demographic data, COVID-19 clinical category, vaccination status, and type of vaccine received were recorded. Results: In total, 1,391 positive SARS-CoV-2 PCR results were reviewed; 1,188 patients (85%) with complete data were analyzed. These patients’ median age was 50 years. The proportions of patients COVID-19 clinical categories were as follows: category 1 (4.04%), category 2 (28.37%), category 3 (10.7%), category 4 (30.6%), and category 5 (2.6%). The mortality rate was 21.5%. As of July 2021, only 16.8% of patients were fully vaccinated, 30.3% were vaccinated, 31.5% unvaccinated, and 21.5% had unknown vaccination status. In total 364 patients with category 4 COVID-19 (4.4%; P < .001) were fully vaccinated and no patients who were fully vaccinated had category 5 COVID-19 (P = .011). Furthermore, 40.8% of patients who died had unknown vaccination status (P < .01); 28.1% of patients who died were unvaccinated (P = .015); 25.3% of patients who died were partially vaccinated (P = .036); and 0.4% of patients who died were fully vaccinated (P < .001). For category 4 and 5 illness and death, there were no significant differences between the type of vaccine received (Pfizer-BioNTechR, Astra ZenecaR and Coronavac/SinovacR) and severe COVID-19. Conclusions: The completion of 2 doses of government-approved COVID-19 vaccination is paramount in preventing severe COVID-19 disease and death. Rapid rollout and equitable distribution of vaccination should be initiated. Vaccine hesitancy should be promptly addressed to ensure vaccination uptake.
Objectives: The widespread distribution of SARS-CoV-2 and its high contagiousness pose a challenge for researchers seeking to develop a rapid and cost-effective screening method to identify carriers of this virus. RT-PCR is considered the gold standard for detecting viral RNA in nasopharyngeal swabs, but it is time-consuming and requires constant changes in the primer composition due to the mutation of SARS-CoV-2 strains. We propose a method for the detection of SARS-CoV-2 in nasopharyngeal swabs using MALDI-TOF MS and machine learning. Methods: Nasopharyngeal swabs from patients with PCR-confirmed COVID-19 and control participants were tested (130 and 80 swabs, respectively) with MALDI-TOF MS MicroFlex LT using the HCCA matrix. MALDI spectra were preprocessed in R version 4.1.2 software with the MALDIquant R package using the workflow: sqrt transformation, wavelet smoothing, SNIP-based base removal, and PQN intensity calibration. Peaks were detected with MAD algorithms with following Peak alignment on the following parameters: minFreq 70% and tolerance 0.005. Machine learning was performed with the rtemis r package on GLM, random forest, and XGBoost models. Results: These models were characterized by specificity, sensitivity, and F1 score. GLM models (specificity 1 and sensitivity 0.5) showed a low F1 score of 0.71. However, the random forest and XGBoost models demonstrated sensitivity, specificity, and F1 score equaling 1. Conclusions: We propose a screening method for SARS-CoV-2 detection (sensitivity 1 and specificity 1). This methodology combines the analysis of nasopharyngeal swab samples using MALDI-TOF-MS with machine learning. It is suitable for screening patients with COVID-19 at the first stages of diagnosis. Random forest and XGBoost models demonstrated sensitivity, specificity, and F1 scores equaling 1.
Objectives: Factors affecting COVID-19 vaccine acceptance and hesitancy among primary-care healthcare workers (HCWs) remain poorly understood. We sought to identify factors associated with vaccine acceptance and hesitancy among HCWs. Methods: A multicenter online cross-sectional survey was performed across 6 primary-care clinics from May to June 2021, after completion of the vaccination rollout. The following data were collected: demographics, profession, years working in healthcare, residential status, presence of chronic medical conditions, self-perceived risk of acquiring COVID-19, and previous influenza vaccination. HCWs who accepted the vaccine were asked to rank their 5 best reasons for vaccine acceptance. HCWs who were vaccine hesitant completed the 5C scale on psychological antecedents of vaccination. Results: Of 1,182 eligible HCWs, 557 responded (response rate, 47.1%) and 29 were excluded due to contraindications. Among 557 respondents, the vaccine acceptance rate was 94.9% (n = 501) and 5.1% were hesitant (n = 27). COVID-19 vaccine acceptance was not associated with sex, age, ethnicity, profession, number of years in healthcare, living status, presence of chronic diseases, self-perceived risk, or previous influenza vaccination. The 3 most common reasons for COVID-19 vaccine acceptance as ranked by 501 HCWs were (1) to protect their family and friends, (2) protect themselves from COVID-19, and (3) the high risk of acquiring COVID-19 because of their jobs. The 15-item questionnaire from the 5C psychological antecedents of vaccination was completed by 27 vaccine hesitant HCWs. The mean scores for the components of the 5Cs were ‘confidence’ (3.96), ‘complacency’ (3.23), ‘constraint’ (2.85), ‘calculation’ (5.79) and ‘collective responsibility’ (4.12). Conclusions: COVID-19 vaccine hesitancy is a minute issue among primary-care HCWs in Singapore, where the acceptance rate is 95% with a 5% hesitancy rate. Future studies can focus on other settings with higher hesitancy rates and acceptance of booster vaccinations with the emergence of the SARS-CoV-2 δ (delta) variant. Trial Registration: This study was approved by the National Healthcare Group (NHG) Domain Specific Review Board (DSRB), Singapore on April 26, 2021 (Reg No. 2021/00213).
Objectives: The highly transmissible SARS-CoV-2 has swept across the globe, causing large swaths of COVID-19, displacing medical resources and attention from patients with other life-threatening illnesses, and overwhelming healthcare institutions. Shifting toward endemicity, the Singapore Ministry of Health ceased issuing quarantine orders to close contacts of infected cases on October 11, 2021. However, contact tracing and exposure management within SGH continued with the same risk criteria. We have examined COVID-19 exposures in different hospital locations to determine the effectiveness of surveillance in breaking the chain of transmission. Methods: Contact tracing of COVID-19 exposures among Singapore General Hospital (SGH) staff and patients has been conducted since the first COVID-19 diagnosis in January 2020. The information collected is used to identify those at higher risk of infection for enhanced surveillance or isolation. The data analyzed in this study were collected during later periods of the SARS-CoV-2 δ (delta) pandemic wave between August 1, 2021, and December 31, 2021. Results: During the 4-month study period, there were 1,686 SARS-CoV-2 exposures in SGH. Among these 1,686 exposures, 1,157 (69%) were contacts with an infected patient. Among these infected source patients, 915 were emergency department patients, 210 were ward inpatients, and 32 were clinic outpatients. The remaining 524 exposure events (31%) were contacts with infected staff, of whom 441 were SGH employees and 83 were employees from other SingHealth institutions. The remaining 5 index cases were visitors to SGH. Of the 1,686 exposure events, 330 had associated at-risk contacts requiring exposure management. Among 330 patient index cases, 213 (64.5%) resulted in 699 exposed contacts (patients vs staff), whereas 117 staff index cases resulted in 435 exposed contacts (patients vs staff). For 434 exposed contacts who were staff, 204 (47%) of their exposures occurred in inpatient ward settings, followed by 153 (35.3%) that occurred in outpatient clinics, 36 (8%) that occurred common lounging areas, 16 (3.6%) that occurred in office sites, 15 (3.4%) that occurred in the community, 8 (1.8%) that occurred in occupation therapy, and 2 (0.5%) that occurred in the emergency department. For 688 exposed contacts who were patients, 579 (84.1%) exposures occurred in inpatient wards, 70 (10.2%) occurred in DEM, 19 (2.7%) occurred in other SingHealth institutions, 16 (2.3%) were exposures to roving porters, and 3 (0.4%) occurred in the community. During the study period, 3 hospital clusters were identified and investigated, one of which included secondary cases. Conclusions: Most SARS-CoV-2 exposures in SGH occurred in inpatient settings where patients were index cases. Despite intensive contact tracing and stringent surveillance and isolation measures, inpatient clusters could not be prevented.
Objectives: COVID-19 booster uptake has remained poor among healthcare workers (HCWs) despite evidence of improved immunity against the SARS-COV-2 δ (delta) and ο (omicron) variants. Although most studies have used a questionnaire to assess hesitancy, we aimed to identify factors affecting booster hesitancy by examining actual vaccine uptake across time. Methods: COVID-19 vaccination database records were extracted for HCWs working at 7 Singaporean public primary-care clinics between January and December 2021. Data included sex, profession, place of practice, vaccination type, and dates. Time to booster was calculated from the date of vaccination minus the date of eligibility. The χ2 test was used to compare the relationship between first dose and booster hesitancy. The Kaplan-Meier method and the log-rank test were used to evaluate differences in cumulative booster uptake. Multivariate Cox regression was used to investigate predictors of timely booster vaccination. The vaccination rate was charted across time and was corroborated with media releases pertaining to legislative changes. Results: Of 891 primary-care HCWs, 877 (98.9%) were fully vaccinated and 73.8% of eligible HCWs had taken the booster. HCWs were less booster hesitant (median, 16 days; range, 5–31.3) compared to the first dose (median, 39 days; range, 13–119.3). First-dose–hesitant HCWs were more likely to be booster hesitant (OR, 3.66; 95% CI, 2.61–5.14). Adjusting for sex, workplace, and time to first dose, ancillary HCWs (HR, 1.53; 95% CI, 1.03–2.28), medical HCWs (HR, 1.8; 95% CI, 1.18–2.74), and nursing HCWs (HR, 1.8; 95% CI, 1.18–2.37) received boosters earlier than administrative staff. No temporal relationship was observed for booster uptake, legislative changes, or COVID-19 case numbers. Conclusions: Vaccine hesitancy among HCWs had improved from first dose to booster, with timely booster vaccination among medical and nursing staff. Tailored education, risk messaging, and strategic legislation might help reduce delayed booster vaccination. This study was approved by the National Healthcare Group (NHG) Domain Specific Review Board (DSRB), Singapore on December 28, 2021 (Reg No. 2021/01120).
Objectives: Sputnik-V (Gam-COVID-Vac) is a recombinant adenoviral (rAdv) vector-based, COVID-19 vaccine now used in >70 countries. Mucosal immunity is thought to be important for protection against COVID-19. We did a prospective cohort study to assess Sputnik-V–elicited mucosal SARS-CoV-2 antibody responses. Methods: We divided 82 COVID-19–free participants into prior COVID-19 and no prior COVID-19 groups and followed them at day 21 after Sputnik-V dose 1′ (rAd5) and dose 2′ (rAd26). Nasopharyngeal swabs and blood were collected to perform SARS-CoV-2 diagnostic and immunologic assays. SARS-CoV-2 spike-specific IgG and IgA ELISAs were performed on both nasal swabs and blood. SARS-CoV-2 real-time RT-PCR testing was performed to exclude infectious influencing. Results: Nasal S-IgG levels increased 25-fold after dose 1′ (P < .001) and remained high after dose 2 in all participants. Prior COVID-19 exposure was associated with both elevated baseline mucosal IgG and IgA and higher postvaccination IgG, but not IgA, boost. Nasal IgA levels increased 16.5-fold after dose 1′ (P < .001) and remained high after dose 2’ in all participants. Compared to dose 1′, Sputnik-V dose 2′ did not further increase either mucosal IgG levels (P = .626) or IgA levels (P = .609). Conclusions: A single dose of Sputnik-V boosted mucosal SARS-CoV-2 immunity. The effects of Sputnik-V dose 2′ on mucosal immunity were minimal. These findings indicate (1) that intramuscularly administered adenoviral vaccines enhance SARS-CoV-2 immunity via both systemic and mucosal routes and (2) that cost-effectiveness and the efficacy of Sputnik-V vaccination could be improved by adjusting the current prime-booster regimen and extending the 21-day interval between the doses. Trial registration: Registered on ClinicalTrials.gov (no. NCT04871841).
Objectives: In August 2021, the Ministry of Health, Singapore revised the uniform policy in public hospitals to allow female Muslim staff, including nurses, to wear the tudung as an add-on to their uniforms. Institutions were advised that incorporation of the tudung should still align with current infection prevention guidelines. On May 2, 2021, in response to evolving evidence of SARS-CoV-2 transmission, our institution adopted the use of N95 masks for all HCWs in clinical settings. Prior to this revision in uniform policy, most female Muslim staff were mask fitted without tudungs. No existing international guidance recommends whether mask refitting of should be conducted with tudungs. As such, we looked at the N95 mask concordance for these staff undergoing mask fitting. Methods: Between November 1, 2021, and January 14, 2022, we mask fit-tested all new staff and refitted existing staff both with and without the tudung. We conducted qualitative fit-testing using their personal tudung, and we tested 2 models of N95 mask: 3MTM 1870+ and AIR+. When an HCW only passed the fitting of 1 or none of the models, additional N95 mask fit-testing was conducted with other available mask models according to our department’s existing workflow. Results: In total, 334 staff underwent N95 mask fitting. Overall, 326 (97.6%) passed with the same N95 mask models both with and without the tudung. The remaining 8 staff (2.4%) had passed 2 N95 mask models without the tudung but required a different N95 mask model while wearing the tudung. No staff required quantitative fit testing. Conclusions: N95 mask concordance for female Muslim staff undergoing fit-testing both with and without the tudung was high at 97.6%. Further evaluation of the 8 staff who did not show concordance could be retested using a quantitative fit-testing method.
Objectives: Data comparing the immunogenicity of Sputnik-V and Sinopharm vaccines in seropositive and seronegative groups are lacking. We compared the immunogenicity of Sputnik-V (Gam-COVID-Vac) and Sinopharm (BBIBP-CorV) vaccines in seronegative and seropositive groups. Methods: In total, 60 adults participated the study. The immune response after vaccination was assessed using enzyme immunoassay. IgG levels were measured in all participants at 3 time points: before vaccination, 42 days after the first vaccine dose, and 6 months after the first vaccine dose. The results of the SARS-CoV-2 antibody test were quantified according to the WHO First International Standard and expressed in international units (BAU per mL). Results: The study participants were divided into 2 groups: 30 people (50%) were vaccinated with Sputnik-V (Gam-COVID-Vac) and 30 people (50%) were vaccinated with Sinopharm (BBIBP-CorV). The groups had no difference in sex composition. The highest antibody levels were observed 42 days after vaccination in both the seronegative group (P = .006) and the seropositive group (P < .001). At 6 months after vaccination, the IgG value declined much farther among the seronegative group (P = .003) compared to those who had recovered from COVID-19 before vaccination. However, the “hybrid immunity” generated by the Sputnik-V vaccine had greater strength and duration (P < .001). Conclusions: This study showed that IgG levels in vaccinated individuals who previously recovered from SARS-CoV-2 infection (“hybrid immunity”) were higher than in SARS-CoV-2–naïve individuals. In a comparative part of the study, the Sputnik-V vaccine had greater strength and duration of immune response across the 6-month observation period (P < .001).
Objectives: Laboratory-acquired infection (LAI) of SARS-CoV is well known, but MERS-CoV or SARS-CoV-2 LAI has not yet been reported. Beginning last November, COVID-19 cases increased among laboratory staff at our 2,700-bed tertiary-care hospital. A 7-day home-quarantine policy for healthcare workers when household members were confirmed with SARS-COV-2 was lifted February 28. We investigated LAI and its risk factors. Methods: From March 21 to 25, all confirmed cases of COVID-19 among 176 laboratory staff were surveyed with questionnaire to collect the following data: symptom onset and period, SARS-CoV-2 PCR–positive sample date, age, sex, infection in household members, close contact with COVID-19 confirmed staff, work type, work unit, possibility of LAI and LAI risk factors. Results: In total, 54 laboratory staff (30.1%) were confirmed with SARS-CoV-2 infection; first 1 person on November 28 and 1 person on November 30, 2021, then 13 in February 2022 and 39 later in 2022. Overall, 22 cases had previously infected household members, and 9 cases suspected that they had had hospital contact with an infected patients through phlebotomy or bedside tests. In total, 25 cases of possible LAI mainly occurred in clusters of 3, 6, or 7 people through person-to-person transmission of a coworker who had an infected family member. The remaining 9 cases, including 1 sample receptionist, 2 urine analysis technicians, and 6 SARS-CoV-2 PCR test staff, may have been infected through an infected sample. However, person-to-person transmission was still possible because most shared a changing room and lounge in the same work unit. Conclusions: The most important cause of LAI is person-to-person transmission between coworkers; therefore, home quarantine is an effective measure to prevent LAI when a household member is infected wish SARS-CoV-2. Handling of infected specimens may be the second most common cause of LAI.
Objectives: The National University Hospital (NUH) is a tertiary-care teaching hospital in Singapore with 60% of patients in 6–8-bed cubicles. NUH recently changed to a time-based deisolation criterion for immunocompetent COVID-19 patients in cohort wards who are afebrile and improved but did not meet the antigen rapid test negative criteria at day 5–6 and who required continued hospital care. The MOH guidelines and studies of viral load trajectory from the SARS-CoV-2 δ (delta) variant suggest that by day 8 of infection, viral loads drop and the risk of transmission is low. We defined a cycle threshold (Ct) value ≥25 as the point at which virus cultures are negative. We assessed whether a time-based deisolation at day 8 correlated with Ct ≥25 during the SARS-CoV-2 ο (omicron) variant pandemic surge. Methods: Data for patients and staff with confirmed positive COVID-19 PCR between January to March 2022 were collected. These data comprised a convenience sample collected retrospectively by the epidemiology team and the obstetrics and gynecology team and were used to deisolate patients. Nasopharyngeal (NP) swabs were sent for PCR for all admissions, to confirm diagnosis, for deisolation and/or transfer, and for staff suspected to have COVID-19 as part of hospital staff policy. Results: Overall, 403 observations were obtained. For 145 NP swabs tested by SARS-CoV-2 PCR on day 1, the median Ct value was 19.55 (IQR, 9.01). The median Ct for 87 observations on day 2 was 15.95 (IQR, 3.45). The median Ct value for 14 observations on day 8 was 24.22 (IQR, 5.19). From day 9 to day 37, with 47 observations, the Ct was generally >25. Conclusions: During the SARS-CoV-2 ο (omicron) surge, NP swabs sent on day 8 had a median Ct value of 24.22. After day 8, the median Ct was >25. The discontinuation of isolation precautions on day 8 balances the use of dedicated COVID-19 beds with risk mitigation of transmission for recovered patients who require ongoing hospitalization. Small sample size and heterogeneous reasons for testing NP swabs after day 5 likely skewed our results and limits the generalizability of our results.
Objectives: At the onset of COVID-19, whenever SARS-CoV-2 was detected at Children’s Hospital 1 (CH1), the related department or building was closed for extensive tracing, testing, and medical isolation. This process disrupted hospital activities, reduced the efficiency of patient care, and used medical resources. To address this problem, CH1 implemented a system of grouping inpatients to color-coded areas from June to December 2021. Methods: In this retrospective study, we describe the system of grouping inpatients to color-coded areas based on SARS-CoV-2 test result at a 1,600-bed, national pediatric hospital in Ho Chi Minh City. Results: Inpatients were first separated into those with or without respiratory symptoms, and secondly to different color-coded areas based on SARS-CoV-2 test result and hospitalization length: red zone (days 1–3), orange zone (days 3–7), and green zone (day 7 onward). Prior to admission, all patients were tested with a SARS-CoV-2 rapid diagnostic test. If negative, the patient was admitted to the red zone. On days 3 and 7 of hospitalization, the patient was tested using a pooled RT-PCR method. Patients negative on day 3 were relocated to the orange zone; patients negative on day 7 were relocated to the green zone. A patient with a positive test result at any time point was transferred to a COVID-19 zone. One caregiver was allowed to stay with 1 patient with similar testing regimen. A mobile transportation team was set up to deliver food and other necessities; thus, movement was restricted and interaction was prevented among zones. After this system was implemented, COVID-19 cases were detected early, with most positive cases in the red zone (19.6%) and the orange zone (2.8%), with only 1 case in the green zone (0.7%). Conclusions: The system of grouping patients to color-coded areas helped prevent SARS-CoV-2 transmission within the hospital, allowing undisrupted operation.
Objectives: To describe the design process for a hospital in an exhibition center. We discuss challenges during the building process and areas in which risk assessments had to be made and practices modified to mitigate suboptimal conditions. Methods: UK National Health Service designers and military planners worked in conjunction with the infection prevention and control team (IPCT) to work with the existing infrastructure. The clinical area was deemed to be an aerosol-generating procedure (AGP) zone because it was entirely an intensive care unit. The challenges included no oxygen line, a lack of hot water, minimal access to cold water, almost no drainage, and a lack of physical space in which to carry out many necessary procedures. These challenges were overcome either by design or by changes to usual practices through mitigation measures. The IPCT had key roles in ensuring staff and patient safety and personal protective equipment (PPE) inventory management as well as donning and doffing procedures. Results: The Nightingale Hospital became a fully functioning ICU within 10 days of the build commencing, and the first patients were admitted within a few days. The hospital was used only sparingly because the national pandemic lockdown was in effect. In total, 72 patients were admitted, with a survival rate of 63%, comparable to established ICUs. Transmission rates of COVID-19 in staff were very low among those working clinically. The unit closed in June 2020 but reopened in January 2021 for rehabilitation with a smaller number of beds but better facilities as a result of our experience in the first iteration. Conclusions: A temporary hospital was built in an exhibition center to successfully manage a number of patients. Even in a temporary hospital facility that was limited in services, successful outcomes were achieved.
Objectives: Influenza vaccination is encouraged for all healthcare workers (HCWs) to reduce the risk of acquiring the infection and onward transmission to colleagues and patients during the influenza season. Thus, vaccination was introduced at Singapore General Hospital (SGH) in 2007 and has been offered to all HCWs at no cost. The HCW influenza vaccination program is conducted annually in October and biannually during years with vaccine mismatch. However, influenza vaccine uptake remained low among HCWs. We sought to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on influenza vaccine uptake among HCWs. Methods: At SGH, 2 methods of vaccine delivery are offered: centralized (1-month drop-in system during office hours) and decentralized (administered by vaccination teams in offices or ward staff in inpatient locations). In the 4-year study period between 2018 and 2021, 6 influenza vaccination exercise campaigns were conducted during 8 influenza seasons. During each exercise, ~9,000 HCWs were eligible for vaccination. Results: Prior to the COVID-19 pandemic, vaccine uptake in the Southern Hemisphere was 77.6% (6,964 of 8,977) in 2018 and 84.2% (7,296 of 8,670) in 2019. During the COVID-19 pandemic in 2020, vaccine uptake in the Southern Hemisphere increased by 10% to 94.1% (8,361 of 8,889). In the Northern Hemisphere, vaccine uptake was 79.2% (7,114 of 8,977) in 2018, and this increased by 17.9% to 97.1% (8,926 of 9,194) during the COVID-19 pandemic in 2020. During the 2021 Southern Hemisphere influenza season, no vaccination program was conducted because the risk of influenza was considered low due to the closure of international borders and the implementation of public health measures. In addition, priority was given to COVID-19 vaccination efforts. Conclusions: Increased uptake of the influenza vaccination was observed during the COVID-19 pandemic. Anxiety created by the respiratory disease pandemic and debate surrounding vaccines likely contributed to increased awareness and uptake in influenza vaccine among HCWs.
Objectives: During the COVID-19 surge, our hospital was overloaded due to the increasingly high volume of patients and lack of resources, which resulted in difficulties in complying with infection control and prevention (IPC) practices. In this study, we estimated healthcare-associated infection (HAI) incidence and relevant factors among COVID-19 patients in Hung Vuong hospital. Methods: This study included all SARS-CoV-2–positive adult patients hospitalized between September 1 and October 31, 2021. The Centers for Disease Control and Prevention definition of HAI in the acute-care setting was used. Results: Among 773 patients, 21 (2.72%) developed 26 separate HAIs. The cumulative days of hospitalization were 5,607. The incidence of HAI among COVID-19 patients was 4.64 per 1,000 days of hospitalization. The most frequent HAI was clinically defined pneumonia (46.2%), for which the ventilator-associated pneumonia (VAP) rate was 41.9 per 1,000 ventilator days. Among 21 positive cultures, the most frequently isolated microorganisms were
pseudomonas aeruginosa, Klebsiella pneumoniae, and escherichia coli. HAIs were significantly associated with the number of central-line days (OR, 1.74; 95% CI, 1.33–2.78), the number of indwelling urinary catheter days (OR, 1.46; 95% CI, 1.05–2.03), the length of administration days (OR, 1.25; 95% CI, 1.07–1.45), antibiotics use prior to HAIs (OR, 0.01; 95% CI, 0.01–0.21), and the number of nasal cannula days (OR, 0.62; 95% CI, 0.44–0.85). Conclusions: COVID-19 makes patients more vulnerable and may require more invasive procedures, increasing the infection risk by opportunistic pathogens like gram-negative Enterobacteriaceae. Hence, fundamental IPC recommendations should be strongly implemented.
Background: According to the World Health Organization (WHO), as of April 9, 2022, there had been 494,587,638 confirmed COVID-19 cases and 6,170,283 deaths reported worldwide. In Hong Kong, in recent outbreak, ~55% of confirmed cases were residential care home (RCH) residents and >800 staff were infected. In 2016, ~15% of people aged ≥80 years were living in residential care homes. Objectives: To assess healthcare worker (HCW) knowledge level and attitudes about PPE use in residential care homes. Methods: This cross-sectional study, included participants who worked in the residential care homes, registered as healthcare workers (HCWs). HCWs who were part-time staff or worked <3 months in the residential care home were excluded. Ethical review approval from the faculty research committee of the university was obtained in January 2022. The Knowledge, Attitude, Practical (KAP) questionnaire was adapted. The questionnaire has 33 items pertaining to knowledge, attitude, and practice regarding PPE. Results: In total, 50 questionnaires were received; 32 respondents (64%) were female and 18 (36%) were male. Nearly half of the participants had completed a high diploma course, and 32% had graduated from secondary school. Using ANOVA, there were no significant differences of education level of participants or participant knowledge level of PPE [F(2,47) = .181; P = .835], attitudes [F(2,47) = 1.995; P = .147] and practice [F(2,47) = .459; P = .635]. The Pearson correlation was used to measure the relationship between knowledge level and PPE practices. Our results indicated a significant difference and moderate correlation between knowledge level and PPE practice among HCWs. Conclusions: Knowledge level does not directly affect HCW practice regarding PPE. PPE practice skills have been influenced by various factors during the pandemic situation, such as availability of PPE, manpower, workload, and communication.
Objectives: In response to the COVID-19 pandemic, primary care swiftly transformed and re-established patient flow in clinics to red, orange, and green zones based on a set of screening criteria. To further manage the influx of suspected COVID-19 patients and their needs safely, a list of surveillance audit criteria was developed to ensure good infection control standards. Methods: The infection control team prepared the surveillance audit criteria based on recommended CDC/WHO guidelines for pandemic preparedness. These criteria were contextualized to the primary-care polyclinic setting. The surveillance audit criteria were grouped according to their category: screening, triage, early recognition and source control, inventory management of personal protective equipment (PPE), infection control measures in the red zone, precautionary measures during collection of nasopharyngeal swabs and environmental cleaning and disinfection for premises in the red, orange, and green zones, respectively. The infection control liaison nurses in each polyclinic were trained to use the checklist to ensure consistency in interpretation of the criteria. Results: Surveillance audits were conducted biweekly in the first 3 months then monthly once the compliance rate was steady at 90%–100% for all categories. The overall average compliance rate since commencing in March 2020 for all polyclinics was sustained at 90%–100%. Common findings included inappropriate use of PPE (eg, self-contamination during removal of gown or wrong sequence of doffing), inadequate ventilation, and inadequate cleaning processes. All findings were corrected immediately, and staff education was provided. Conclusions: Primary care plays an important role during a pandemic. It is essential that both patients and healthcare workers in the primary care setting are protected from infection risk during a pandemic. Having a good surveillance audit process helps ensure that primary care services can continue for the general population. Surveillance is an essential component of the health system’s response to a pandemic.