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We evaluated the added value of infection control-guided, on demand, and locally performed severe acute respiratory coronavirus virus 2 (SARS-CoV-2) genomic sequencing to support outbreak investigation and control in acute-care settings.
Design and setting:
This 18-month prospective molecular epidemiology study was conducted at a tertiary-care hospital in Montreal, Canada. When nosocomial transmission was suspected by local infection control, viral genomic sequencing was performed locally for all putative outbreak cases. Molecular and conventional epidemiology data were correlated on a just-in-time basis to improve understanding of coronavirus disease 2019 (COVID-19) transmission and reinforce or adapt control measures.
Between April 2020 and October 2021, 6 outbreaks including 59 nosocomial infections (per the epidemiological definition) were investigated. Genomic data supported 7 distinct transmission clusters involving 6 patients and 26 healthcare workers. We identified multiple distinct modes of transmission, which led to reinforcement and adaptation of infection control measures. Molecular epidemiology data also refuted (n = 14) suspected transmission events in favor of community acquired but institutionally clustered cases.
SARS-CoV-2 genomic sequencing can refute or strengthen transmission hypotheses from conventional nosocomial epidemiological investigations, and guide implementation of setting-specific control strategies. Our study represents a template for prospective, on site, outbreak-focused SARS-CoV-2 sequencing. This approach may become increasingly relevant in a COVID-19 endemic state where systematic sequencing within centralized surveillance programs is not available.
To describe barriers and facilitators to the adoption of recommended infection prevention and control (IPC) practices among healthcare workers (HCWs).
A qualitative research design was used. Individual semistructured interviews with HCWs and observations of clinical practices were conducted from February to May 2018 in 8 care units of 2 large tertiary-care hospitals in Montreal (Québec, Canada).
We interviewed 13 managers, 4 nurses, 2 physicians, 3 housekeepers, and 2 medical laboratory technologists. We conducted 7 observations by following IPC nurses (n = 3), nurses (n = 2), or patient attendants (n = 2) in their work routines. Barriers to IPC adoption were related to the context of care, workplace environment issues, and communication issues. The main facilitator of the IPC adoption by HCWs was the “development of an IPC culture or safety culture.” The “IPC culture” relied upon leadership support by managers committed to IPC, shared belief in the importance of IPC measures to limit healthcare-associated infections (HAIs), collaboration and good communication among staff, as well as proactivity and ownership of IPC measures (ie, development of local solutions to reduce HAIs and “working together” toward common goals).
Adoption of recommended IPC measures by HCWs is strongly influenced by the “IPC culture.” The IPC culture was not uniform within hospital and differences in IPC culture were identified between care units.
The thiophenes alpha-terthienyl and methyl-alpha-terthienyl are found in many species of the family Asteraceae and are highly phototoxic to mosquito larvae. These compounds and a synthetic analogue, cyano-alpha-terthienyl, controlled Aedes intrudens Dyar (Diptera: Culicidae) larvae at application rates between 10 and 40 g per hectare in field trials. These concentrations are similar to those currently used with chemical control agents. Piperonyl butoxide, a synergist used with pyrethrin, greatly increased the mortality of mosquito larvae at low application rates of the most potent phototoxin, cyano-alpha-terthienyl.Although we have demonstrated previously that these phototoxic defences are effective against some phytophagous insects, more recently we studied insects that are able to feed on a phototoxic plant, in order to examine modes of resistance to phototoxins. Chrysolina spp. (Coleoptera: Chrysomelidae) larvae are susceptible to phototoxicity but avoid it by feeding on Hypericum perforatum L. (Hypericaceae) at dawn and by hiding during the day. Chrysolina adults avoid phototoxicity by the presence of opaque cuticles that block the sunlight. First-instar larvae of Anaitis plagiata (L.) (Lepidoptera: Geometridae) avoid feeding on the glands that contain the phototoxin. Later-instar larvae feed on the entire leaf, yet are not susceptible to phototoxicity, indicating they have biochemical defenses against photo-induced damage.
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