Hospital Infection Control Research Articles

An Integrated Strategy for the Prevention of SARS-CoV-2 Infection in Healthcare Workers: A Prospective Observational Study.

Background: Since the beginning of SARS-CoV-2 outbreak, a large number of infections have been reported among healthcare workers (HCWs). The aim of this study was to investigate the occurrence of SARS-CoV-2 infection among HCWs involved in the first management of infected patients and to describe the measures adopted to prevent the transmission in the hospital. Methods: This prospective observational study was conducted between February 21 and April 16, 2020, in the Padua University Hospital (north-east Italy). The infection control policy adopted consisted of the following: the creation of the “Advanced Triage” area for the evaluation of SARS-CoV-2 cases, and the implementation of an integrated infection control surveillance system directed to all the healthcare personnel involved in the Advance Triage area. HCWs were regularly tested with nasopharyngeal swabs for SARS-CoV-2; body temperature and suggestive symptoms were evaluated at each duty. Demographic and clinical data of both patients and HCWs were collected and analyzed; HCWs’ personal protective equipment (PPE) consumption was also recorded. The efficiency of the control strategy among HCWs was evaluated identifying symptomatic infection (primary endpoint) and asymptomatic infection (secondary endpoint) with confirmed detection of SARS-CoV-2. Results: 7595 patients were evaluated in the Advanced Triage area: 5.2% resulted positive and 72.4% was symptomatic. The HCW team was composed of 60 members. A total of 361 nasopharyngeal swabs were performed on HCWs. All the swabs resulted negative and none of the HCWs reached the primary or the secondary endpoint. Conclusions: An integrated hospital infection control strategy, consisting of dedicated areas for infected patients, strict measures for PPE use and mass surveillance, is successful to prevent infection among HCWs.

Enterococcus spp. resistentes à vancomicina e a sua disseminação em infecções no ambiente hospitalar

Objetivo: Descrever os principais fatores de virulência associado a esse patógeno, com ênfase nas espécies E. faecium e. faecalis, demostrando os principais genes de resistência envolvidos nas espécies citadas, bem como, relatar a forma de disseminação destas em ambientes hospitalares. Metodologia: O presente artigo, foi elaborado mediante Revisão da Literatura, baseando-se em materiais indexados nas bases de dados: PubMed, SciELO e Google Acadêmico, publicados entre os anos 2010 a 2020. Para seleção, os critérios foram aplicados na seguinte ordem: (a) leitura exploratória; (b) leitura seletiva, (c) seleção do material em adequação aos objetivos da pesquisa. Resultados: Foram encontrados 789 arquivos, destes, 38 foram selecionados para este artigo. Conclusão: A adoção de práticas pela equipe de Controle de Infecção Hospitalar, se faz muito importante, contribuindo para melhorias na qualidade do atendimento em saúde, aumentando assim, a segurança de toda a equipe de profissionais e pacientes.

Impact of Continuous Education and Training in Reduction of Central Line-associated Bloodstream Infection in Neurointensive Care Unit.

ABSTRACTBackgroundPatients in the neurointensive care unit have high utilization of devices, thereby increased chance of getting device-associated infection (DAI). Central line-associated bloodstream infection (CLABSI) remains one of the most important DAI. Education remains an important part of the hospital infection control and improves the infection-control practices.Materials and methodsTo evaluate the effectiveness of a quality initiative in reducing incidence of CLABSI, a prospective study (January 2017–December 2018) was done estimating CLABSI incidence before and after the intervention. Continuous teaching and training for hand hygiene practice and central-line catheter hub care were used as the tool for this study.ResultsThe quality improvement (QI) initiative achieved a 48% reduction in the CLABSI rate from the baseline rate of 8.7 to 4.5 per 1000 catheter days. The overall mortality showed a reduction from 1.5 to 0.05% during the post-intervention period. There was a significant improvement in compliance with the hand hygiene practice and catheter hub care in the post-intervention period.Discussion and conclusionThis study demonstrates adherence to hand hygiene and catheter hub care with continuous teaching, training, and supervision was highly effective in reducing the CLABSI rate.Clinical significanceCentral line-associated bloodstream infection is one of the most important DAI causing significant morbidity and mortality in critically ill patient. Our findings support that continuous educational intervention of hand hygiene with and training on the catheter hub care are two most important preventive measures in the reduction of CLABSI incidence.How to cite this articleMohapatra S, Kapil A, Suri A, Pandia MP, Bhatia R, Borkar S, et al. Impact of Continuous Education and Training in Reduction of Central Line-associated Bloodstream Infection in Neurointensive Care Unit. Indian J Crit Care Med 2020;24(6):414–417.

The assessment of knowledge, attitude and practice towards tuberculosis infection control among health professionals in Nekemte referral hospital, Nekemte, Oromia, West Ethiopia: cross sectional facility based study

Infection control remains a key challenge for Tuberculosis control program with an increased risk of Tuberculosis transmission among health care workers. Poor knowledge, poor practice and poor attitude among health care workers and inadequate infection control practices may lead to the increased risk of nosocomial Tuberculosis transmission. People living in the same household, or who otherwise are in frequent contact with an infected patient have the greatest risk of being exposed to the bacilli.
 This study was aimed to assess knowledge, attitude and practice of health professionals towards tuberculosis infection control in Nekemte referral hospital, Nekemte, west Ethiopia, 2018.
 Institutional based cross sectional study design was conducted from December 2017 to January 2018 among 223 health professionals in Nekemte referral hospital. Data was collected by using self-administered structured questionnaires which has subdivided components, and finally the analysis was done by double entry of SPSS version 21.
 Two hundred study participants responded to our current study with response rate of 200(89.6%). In this study, majority of respondents, 54% were females and 55% of them are first degree holders. From 200 participants, 14 (7%) had poor knowledge. Majority, 157(78.5%) of health care workers, had positive attitudes towards Tuberculosis infection control. Sixty (30%) of participants had poor practice.
 This study found that significantly high proportion of health workers had good knowledge and practice towards tuberculosis infection control. More than half of health workers wrongly believed that surgical mask can protect health workers from inhaling mycobacterium containing aerosols.

Feasibility and acceptance of a cloud-based mobile app for antimicrobial stewardship and infection control in Colombian hospitals.

Infection control and antimicrobial stewardship programs (ICASPs) are essential to reduce the emergence and spread of antimicrobial resistance. The primary objective of this study was to assess the feasibility of extending a commercial off-the-shelf (COTS) software for ICASPs in low- and middle-income countries (LMICs). This project involved three hospitals in Colombia, including Centro Médico Imbanaco, Clínica San Francisco, and DIME Clínica Neurocardiovascular. A COTS platform (ILÚM Health Solutions™ Kenilworth, NJ) was extended to function in a range of technology settings, and translatable to almost any language. ICASP features were added, including clinical practice guidelines, hand hygiene (HH) documentation, and isolation precaution (IP) documentation. The platform was delivered as a smartphone mobile application ("app") for both iOS and Android. The app was successfully implemented at all sites, however, full back-end data integration was not feasible at any site. In contrast to the United States, a suite of surveillance tools and physician-focused decision support without patient data proved to be valuable. Language translation processing occurred quickly and incurred minimal costs. HH and IP compliance tracking were the most used features among ICASP staff; treatment guidelines were most often used by physicians. Use of the app streamlined activities and reduced the time spent on ICASP tasks. Users consistently reported positive impressions including simplicity of design, ease of navigation, and improved efficiency. This ICASP app was feasible in limited-resource settings, highly acceptable to users, and represents an innovative approach to antimicrobial resistance prevention.

Exploration of Infection Prevention and Control Practice of Designated Hospitals in During Corona Virus Disease 2019 Epidemic Period

Corona Virus Disease 2019 (COVID-19) is a new infectious disease that appeared in wuhan in December 2019 Since January 23, the national health and fitness commission has required hospitals to be designated in accordance with the principle of "concentrating patients, experts, resources and treatment". Designated hospitals are often the strength of the general hospital and general hospital complex layers of various kinds of personnel, campus area is large, multi-channel, ordinary outpatient accepts people more, for emergency and severe cases treatment in patients with normal difficulty pressure big, suspected/confirmed cases, combined with the COVID-19 occurred when the traditional holiday, the country launched the emergency response since, process reform faces a difficult labor, shortage of manpower, protective shortages, short time limit, and many other difficulties, hospital infection prevention and control is facing unprecedented pressure. In this paper, the West China-Guang'an Hospital, Sichuan University (Guang'an people's hospital) as a designated hospital, on the basis of the relevant scheme of the national health committee, epidemic prevention and control of the actual, combined with comprehensive hospital leadership, manpower allocation, protection, security, patient management, disinfection isolation, preview triage, preventive measures, training, monitoring, etc., with practical experience summary for the COVID-19 during the hospital infection prevention and control to improve the practice exploration.

Prevalência de infecção relacionada à assistência à saúde em pacientes internados em unidade de terapia intensiva

Justification and Objectives: Healthcare-associated infections (HAI) affect thousands of people worldwide and are a major cause of complications among hospitalized patients. This study aimed to identify HAI characteristics among patients hospitalized at a cardiac intensive care unit (CICU) in a reference hospital in Santa Catarina from January to December 2017. Methods: This is a descriptive cross-sectional study conducted in the hospital infection control committee (HICC) and intensive care unit (ICU) of the institution. Data were collected from 86 HAI notification forms. All patients admitted to the CICU notified with HAI by the HICC in 2017 were included in the study. Demographic and clinical data were collected from patients’ medical records. Data were tabulated in Microsoft Excel and analyzed by the Statistical Package for the Social Sciences (SPSS) version 18.0. Results: In 2017, HAI incidence was 58.6% and mortality rate 44.8%. The infection was more prevalent among individuals aged between 71 and 80 years (39.6%), and mainly affected the respiratory tract (RTI) (58.1%), the urinary tract (43%), and the bloodstream (30.2%). Pseudomonas aeruginosa (27.9%), Klebsiella pneumoniae (26.7%) and Acinetobacter baumannii (19.8%) were the main etiological agents. Regarding the base pathology, congestive heart failure was the most frequent (19.8%). Conclusion: This study found similar results on the incidence of HAI in CICU to those reported in the literature. Studies have showed permanent education, prevention and control protocols (bundles), and appropriate hand hygiene to be effective actions in reducing infections.

A Central Sterile Processing and Hospital Epidemiology and Infection Control Collaboration to Ensure Safe Patient Care.

Cleaning, disinfection, and sterilization (CDS) practices and protocols are the cornerstone of infection control and patient safety. Central sterile processing (CSP) leaders are responsible for updating policies and procedures for sterile processing and ensuring CSP staff members process instruments correctly. Monitoring staff member practices can be a demanding and difficult task, but it is critical for safe patient outcomes. The CSP and perioperative leaders at our facility found that regular consultation and collaboration with the Department of Hospital Epidemiology and Infection Control (HEIC) is an effective way to ensure that patient safety is at the forefront of CDS practices. These leaders established an oversight committee to address a variety of infection prevention concerns, including environment of care rounds, implementation of manufacturers' instructions for use, and CDS standardization. This article highlights how CSP and HEIC leaders and staff members partnered to implement and sustain CDS best practices and protocols.

Hospital MRSA outbreaks: Multiplex PCR-reverse line blot binary typing as a screening method for WGS, and the role of the environment in transmission.

Whole-genome sequencing (WGS) can provide useful information on methicillin-resistant Staphylococcus aureus (MRSA) transmission in hospitals. However, it is expensive and laborious, especially for environmental screening programs which generate large numbers of isolates. Multiplex PCR-reverse line blot binary typing (mPCR-RLB BT) is a rapid, high throughput, inexpensive typing method which could be useful to screen isolates for WGS. This study assessed the strategy of screening isolates with mPCR-RLB BT to reduce the need for WGS; and to assess the role of the environment in transmission. MRSA transmission in a Burns Unit and its related Intensive Care Unit was studied. mPCR-RLB BT was performed on 238 isolates; this, combined with epidemiological data, was used to choose 97 isolates for WGS. Relationships between isolates by WGS demonstrated several outbreaks. There was a significant contribution of environmental isolates to transmission, and several problem areas were identified. There was a substantial cost saving from screening isolates with mPCR-RLB BT. The use of an inexpensive, rapid screening method for MRSA typing is useful to reduce expenditure and time spent on hospital infection control programs, and reductions are likely to be even more considerable in a non-outbreak setting. Environmental screening and WGS are useful to determine exact sources of transmission to focus mitigation strategies.

Challenge and strategies of infection control in psychiatric hospitals during biological disasters-From SARS to COVID-19 in Taiwan.

Psychiatric hospitals play an important role in supporting patients with mental illness to relieve symptoms and improve functioning in a physically and psychologically safe environment. However, these hospitals are also vulnerable to emerging infectious diseases. In early 2020, a psychiatric hospital and a psychiatric unit were reported to have nosocomial coronavirus disease 2019 (COVID-19) infection. A large number of patients and staff were severely impacted. This type of nosocomial infection threatens patient safety and quality of care.By learning from previous experiences of severe acute respiratory syndrome (SARS) and previous studies, psychiatric hospitals can provide safeguards to prevent nosocomial infection among patients and staff during an epidemic or biological disaster. These strategies include a series of actions such as following national guidelines for infection control, reserving adequate support for disinfection equipment, providing relevant and sufficient pro-service and in-service education and training, establishing regular surveillance of hand hygiene habits, proper communication and health education, and providing opportunities for vaccination if possible. Based on the harm reduction concept, staff division of office breaks and ward classification and shunting are recommended and should be further implemented.

Do established infection prevention and control measures prevent spread of SARS-CoV-2 to the hospital environment beyond the patient room?

SummaryThe role of the hospital environment in the transmission of infection is well described. With an emerging infection whose mode of transmission is under investigation, strict infection prevention and control measures, including patient isolation, hand hygiene, personal protective equipment that is doffed on exiting the patient room, and environmental cleaning should be implemented to prevent spread. Environmental testing demonstrated that COVID-19 patients contaminated the patient area (11/26, 42.3% of tests) but contamination of general ward areas was minimal (1/30, 3%) and the virus was detected after cleaning on one item only (1/25, 4%) which was noted to be in disrepair.

Investigation of Burkholderia cepacia complex bacteremia outbreak in a neonatal intensive care unit: a\xa0case series\xa0

IntroductionBurkholderia cepacia complex is a ubiquitous organism with a high virulence potential. It is found most commonly in moist environments. Hospital outbreaks have been reported from diverse sources such as contaminated faucets, nebulizers, disinfectant solutions, multidose antibiotic vials, tap water, bottled water, nasal sprays, and ultrasound gels. In this article, we present our experience in investigating and successfully managing an outbreak of nosocomial transmission of Burkholderia cepacia sepsis in the neonatal intensive care unit at SGT Hospital, Haryana, India.Case presentationDuring the month of March, multiple Burkholderia cepacia complex isolates were recovered from blood cultures of Caucasian babies admitted to the neonatal intensive care unit of our hospital. The organisms were multidrug-resistant, with in vitro sensitivity to meropenem alone (minimum inhibitory concentration = 4 μg/ml). An outbreak was suspected, and the neonatal intensive care unit in-charge and hospital infection control teams were alerted. Outbreak investigation was initiated, and surveillance samples were collected. Burkholderia cepacia complex was successfully isolated from suction apparatus. The isolates were phenotypically typed (biotyping and antimicrobial susceptibility testing) and found to be identical.ConclusionsIn our study, the index case might have been exposed to infection due to a physiological state of low immunity (preterm, low birth weight, and mechanical ventilation). The rest of the cases might have been exposed to this organism due to inadequate hand hygiene/improper cleaning and disinfection practices. Timely reporting and implementation of infection control measures played a significant role in curtailing this outbreak.

Evaluation of incorporation of bone allograft at the site of implantation in various clinical conditions along with its complications

<p class="abstract"><strong>Background:</strong> Bone transplants have been used routinely in the present century for diverse purposes to unite fractures, fuse joints, and repair skeletal defects.</p><p class="abstract"><strong>Methods:</strong> Twelve patients with fracture, bone defect, deformity, difficulty in the fusion of bone, etc. were taken in the study for elective surgery with fresh frozen allograft in the orthopedics department with the incorporation of inclusion and exclusion criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 12 cases in this study, 7 cases were related to spinal fusion, 3 cases were of fractures with bone defects, 1 case of non-union neck femur fracture and 1 case was of revision hip arthroplasty with the acetabular bone defect. Seventy-five percent (9 patients) and 25% (3 patients) were graded fair and poor respectively in the preoperative phase. At 6 months, excellent results were obtained in 50% (6 patients), good in 25% (3 patients), fair in 25% (3 patients), while none were graded as poor in terms of clinical evaluation.</p><p class="abstract"><strong>Conclusions:</strong> Fresh frozen bone, a good source of abundant bone allograft, can be stored in -70° freezer for use in orthopedic surgery to fill any filling defect in the bone. Also, proper storage, better surgical technique, hospital infection control policy, antibiotic policy, preoperative use of antibiotics before surgery has a good clinical outcome.</p>

Molecular surveillance of methicillin-resistant Staphylococcus aureus genomes in hospital unexpectedly reveals discordance between temporal and genetic clustering

The objective of this study was to identify sources and linkages among methicillin-resistant Staphylococcus aureus infections using whole-genome sequencing (WGS). A total of 56 samples were obtained from all patients with a confirmed MRSA infection over 6 months at University of Florida-Health Jacksonville. Samples were cultured and sequenced; data was analyzed on an automated cloud-based platform. Genetic Clusters were defined as <40 single nucleotide polymorphisms. Temporal Clusters were defined as ≥5 MRSA cases over 3 days. We found 7 Genetic Clusters comprising 15 samples. Four Genetic Clusters contained patients with non-overlapping stays (3-10 weeks apart), 3 of which contained patients who shared the same Unit. We also found 5 Temporal Clusters comprising 23 samples, although none of the samples were genetically related. Results showed that temporal clustering may be a poor indicator of genetic linkage. Shared epidemiological characteristics between patients in Genetic Clusters may point toward previously unidentified hospital sources. Repeated observation of related strains is also consistent with ongoing MRSA transmission within the surrounding high-risk community. WGS is a valuable tool for hospital infection prevention and control.

Perceptions of patients' and healthcare workers' experiences in cohort isolation units: a qualitative study

Given the scarce therapeutic options for carbapenemase-producing Enterobacterales (CPE), aggressive interventions are implemented to limit its spread among hospitalized patients. One such option is contact isolation by cohorting patients in designated units. To describe the experiences in a cohort isolation unit (CIU) due to CPE from the perspectives of patients admitted to this unit and their families, and those of healthcare workers (HCWs) who served in the same unit. Qualitative study. Face-to-face, semi-structured interviews were conducted in a large tertiary hospital. Twenty-four participants were interviewed, including 15 HCWs, three patients and six family members. Data were coded using thematic analysis. The CIU provoked negative feelings such as fear, risk, loneliness, distrust and unfairness. They also created a sense of conflict with the curative assumptions of hospital care. The poor CIU infrastructure was echoed in perceptions of crowdedness in the site. Moreover, family members described HCWs' inconsistent protective behaviours that led them to a state of vigilance. The hospital infection control unit imparted and refreshed HCWs' knowledge and expected behaviours regarding the CIU. However, patients and families expressed dissatisfaction with the information, guidance and education regarding the 'why and how' of the CIU. They were not guided consistently about recommended behaviours after discharge. In retrospect, HCWs found that the CIU took a psychological, physical and professional toll. The CIU was planned as a temporary containment mechanism. It needs to develop into a permanent system, capable of addressing the various needs of all involved.

The War Against the Coronavirus Disease (COVID-2019): Keys to Successfully Defending Taiwan

The outbreak of COVID-19 triggered the largest human-virus war in this century. Current evidence indicates that the SARS-CoV-2 strain of coronavirus is mainly transmitted by droplets either by direct or indirect contact. The duration of infectiousness of COVID-19 ranges from 1-2 days before and 7-10 days after the onset of symptoms. It is often difficult to detect the signs and symptoms of infection and to implement timely intervention during the very early stage of infection. Thus, finding and isolating symptomatic patients may not be sufficient to contain this epidemic. Therefore, it is very important to wear masks, take personal precautions, and practice recommended social distancing to achieve source control and stop transmission. Taiwan has learned from its previous experience with the SARS epidemic and prepared for the potential of new disease outbreaks for at least 17 years. This helped the government to implement a multifaceted strategy in the early stages of the COVID-19 outbreak. Taiwan's effective response has made the country a model for pandemic response policy that has been appreciated internationally. This paper examines COVID-19 epidemic prevention from the perspective of infection control strategies. In Taiwan, hospital infection control, which is practiced nationwide, emphasizes the importance to epidemic prevention of collecting and tracking travel history, occupation, contact history, cluster (TOCC) information; practicing hand hygiene; promoting the correct use of personal protective equipment; and maintaining safe distances from others. Personal control measures are recognized as critical to providing a safe environment for patients and staff.

Characterization of carbapenem‐resistant Klebsiella pneumoniae in a tertiary hospital in Fuzhou, China

AimsThe emergence of carbapenem‐resistant Klebsiella pneumoniae (CRKP) strains has led to increased mortality and morbidity rates. Tigecycline, a new class of broad‐spectrum glycyl‐tetracycline antibiotics, has been used to target multi‐ and pan‐drug‐resistant bacterial infections. This study aimed to assess the molecular characteristics of CRKP in a tertiary hospital, and its susceptibility to tigecycline, to create a reference for hospital infection control and clinical drug use.Methods and ResultsWe retrieved patient clinical information and CRKP characterization from medical records and detected the MIC of tigecycline using the micro‐broth dilution method. Multi‐locus sequence typing was performed, and antibiotic resistance genes associated with CRKP were detected by qPCR. A total of 166 CRKP strains were detected in the sputum, urine and blood among intensive care unit patients (average age, 69·6 years). The most infrequently observed resistance genes were amikacin resistance genes, followed by tobramycin resistance genes. KPC ‐2, CTX‐M9 and CTX‐M1 were the most frequently detected resistance genes.ConclusionsNo strain was resistant to tigecycline (MIC ≥ 8 µg ml−1). Twenty‐four sequence types were identified, with ST11 being the most common type.Significance and Impact of the StudyClinicians and infection control experts should be aware of CRKP prevalence to facilitate clinical treatment and improve nosocomial infection control.

Prediction of nosocomial infection incidence in the Department of Critical Care Medicine of Guizhou Province with a time series model.

BackgroundThe Department of Critical Care Medicine has the highest risk of nosocomial infection. This study used an autoregressive integrated moving average (ARIMA) model to simulate the prevalence of nosocomial infections in the Department of Critical Care Medicine of Guizhou Province. We also provided a policy basis for the prevention and control of hospital infection in the Department of Critical Care Medicine of Guizhou Province.MethodsThe data of ventilator-associated pneumonia, vascular catheter-related bloodstream infections, and urinary tract intubation-related urinary tract infections in nine tertiary A comprehensive treatment hospitals in Guizhou province from January 2014 to December 2019 were collected. The ARIMA time series model was used to evaluate the model fitting and prediction effects.ResultsAfter comparison, in the Department of Critical Care Medicine of Guizhou Province, the unsurpassed model of ventilator-associated pneumonia was the ARIMA (0,1,1) model, with a residual Ljuing-Box Q test result of Q=10.832 (P=0.865), suggesting it is a white noise sequence and its simulation and prediction effects are beneficial. The best model of vascular catheter-related bloodstream infection was the ARIMA (0,0,1) model, with a residual Ljuing-Box Q test result of Q=14.914 (P=0.602). These results suggest that it is a white noise sequence, and its simulation and prediction effects are sufficient. The optimal model of urinary tract intubation-related urinary tract infection is ARIMA (1,0,0), and the residual Ljuing-Box Q test result is Q=15.042 (P=0.592), suggesting it is a white noise sequence with an accurate simulation and prediction effect.ConclusionsThe ARIMA model can accurately simulate and predict nosocomial infection incidence rate in the Department of Critical Care Medicine of Guizhou Province, and can provide a reference for the prevention and control of nosocomial infections.

COVID-19: Literature review and learning from UK Experience

COVID19 (Corona virus disease 2019) is an illness caused by novel corona virus, first reported from Wuhan in China in December 2019. This pandemic has spread to most of the countries of the world and has already taken a huge human toll. Transmission is mostly by the respiratory droplets and also by fomites. While most infected individuals have mild symptoms, a small but significant proportion of individuals develop severe bronchopneumonia, sometimes leading to multiorgan dysfunction. Common symptoms are fever, cough, myalgia, fatigue, nausea, vomiting, diarrhoea, breathlessness etc. Diagnosis is made by clinical features in the right epidemiological setting, blood tests and usually confirmed by a PCR test with a nasopharyngeal and oropharyngeal swab. Management is mainly supportive as currently there is no proven antiviral treatment.&#x0D; Reconfiguration of services was necessary to manage a large number of patients admitted to a UK hospital with COVID 19 disease as elective admissions were cancelled and hospital admissions due to due to other diseases significantly declined. Staff were reallocated to cope with the surge in hospital admissions. A system of training was put in place to upskill the staff. All but absolutely necessary outpatient consultations were done by telephone or videoconferencing.&#x0D; COVID 19 patients were cared for in dedicated areas of the hospital and strict infection control procedures were followed. Intensive care unit facilities with ventilators were rapidly expanded with involvement of operation theatre areas. Non-invasive respiratory support was provided in respiratory wards.

Current status of healthcare-associated enteroviral (non-polio) infections

Here we present the data on foreign research publications describing healthcare-associated enteroviral (nonpolio) infections (HAI) sought in the Worldwide Database for Nosocomial Outbreaks (Institut für Hygiene und Umweltmedizin, Universitȁtmedizincomplex “Charite”, Germany) as well as PubMed search engine (The United States National Library), covering 1936–2017 timeframe. The publications retrieved contained the data on 28 nosocomial outbreaks caused by Enterovirus A (EV-A71), В (Echoviruses 11, 17, 18, 30, 31, 33, Coxsackie viruses А9, В2, В5) and D (EV-D68). It was discovered that the majority of the nosocomial enteroviral (non-polio) outbreaks occurred in obstetric hospitals and neonatal units so that children were mainly maternally infected. In addition, a case associated with intrauterine infection was described. It was shown that outbreaks might be started by an infected child at the incubation period. Single publications reported nosocomial outbreaks in geriatric hospitals. Generally, nosocomial enteroviral (non-polio) outbreaks were characterized by polymorphic clinical picture caused by any certain pathogen serotype and within a single site of the infection. Few lethal outcomes were recorded. Enterovirus B species dominated among identified etiological agents. Violated hospital hygiene and infection control contributing to spread of infection were among those found in neonatal units: putting used diapers out on baby bed prior disposal, sharing bathtub, toys and household objects as well as poor hand hygiene in medical workers. One of the measures recommended to improve diagnostics of enteroviral (non-polio) infections was virology screening of children with suspected sepsis in case of unidentified etiology. It was established that etiological decoding of nosocomial outbreaks was impossible without applying pathogen-specific diagnostic tools, mainly nested RT-PCR and direct sequencing of followed by subsequent phylogenetic analysis.