Staff Illness Research Articles

Incidence of staff injury and illness at the Tokyo 2020 and Beijing 2022 Olympic and Paralympic Games

ObjectiveTo report epidemiological data regarding injury and illness among the Team USA staff during the Tokyo 2020 Summer Olympic and Paralympic Games and Beijing 2022 Winter Olympic and Paralympic Games.MethodsA...

Sustainable Aspects of Multiple-Use Woven Fabric in the Hospital Environment: Comfort and Textile Dust Generation Perspectives

Textile dust released from hospital textiles is a considerable food source for pathogenic microorganisms and can lead to infections and illness in patients and medical staff. In addition, it often causes malfunctions in sophisticated medical equipment. The structural parameters of the fabric, such as the raw material composition, the thread density and the fabric weave, can influence the amount of dust produced. Friction between threads in a woven fabric plays a crucial role in dust generation, and friction is influenced by the surface structure of fibres, yarns and fabric. Understanding these factors can help in the development of fabrics with lower release of textile dust, which can reduce the risk of spreading infections in healthcare facilities. In this paper, the influence of the washing cycle on the change in morphological properties of fabrics in satin weave made of cotton–polyester blends was investigated. The study showed that as the number of maintenance washing cycles increases, the waviness, roughness and average amplitude of the surface roughness profile of the wove fabrics increases. Damage to the fibres during washing results in dust release, with synthetic fibres releasing less dust than cotton fibres. These results provide important information about the change in fabric properties during the washing process, which may be useful for further research and development of materials for use in a hospital environment.

Investigation of an unusual cluster of illness among staff at a wildlife rescue centre

Abstract When two previously fit and well staff from a wildlife rescue centre were hospitalised in early September 2018 with severe pneumonia and meningitis symptoms, the Health Protection Team began an investigation. Possible diagnoses included influenza and legionella, although it was not flu season, and initial testing proved negative. There were reports of other staff illness over the preceding weeks. The centre had accepted a wide range species over the Summer, including high numbers of gulls and pigeons, and an outbreak of psittacosis was suspected; the patients responded rapidly to doxycycline. An incident management team was rapidly convened to investigate and determine control measures. A testing algorithm was developed: including for Influenza A&B, Urine legionella & pneumococcal antigen; reference laboratory serology testing and real-time PCR for Chlamydia.psittaci; and pan-corona viruses. Case finding was conducted by telephone interviews and a select-survey of all 55 staff gained 46 responses. A series of site visits examined working practices at the site. Avian and environmental sampling was undertaken. A total of 22 staff met the agreed case definition for psittacosis, five of whom were later confirmed. Clinical features ranged from mild to severe. The onset dates of illness ranged from July to September. There was no evidence of person-to-person transmission. Analysis did not show a clear correlation between PPE use and illness. Clinical, microbiological, environmental, veterinary, and epidemiological evidence indicated zoonotic transmission of psittacosis. Variable compliance with PPE, hygiene when handling birds, and disinfection had likely contributed via aerosolization of dust. This was likely exacerbated by very high bird stocks and unusually warm weather conditions. Comprehensive recommendations were made to reduce the chances of future outbreaks, which are generalisable to other countries. Key messages • This was one of the largest clusters of human psittacosis described in a workplace in England. • Biosecurity in animal rescue centres is crucial to limit the chance of psittacosis and other zoonoses.

Health and social care workers experiences of coping while working in the frontline during the COVID-19 pandemic: One year on.

The unprecedented pressure of working on the frontline during the Covid-19 pandemic had a demonstrable impact on the mental health and wellbeing of health and social care workers in the early stages of the pandemic, however, less research has focused on workers' experiences over the longer course of the pandemic. We set out to develop an explanatory model of the processes that helped and hindered the coping of HSCWs working over the course of the Covid-19 pandemic. Twenty HSCWs based in the UK took part in the study. They completed semi-structured interviews 12-18 months after the peak of the first wave in the UK. Interviews were transcribed and analysed using grounded theory methodology. The analysis identified eleven theoretical codes: personal context, organisational resources, organisational response, management, colleagues, decision-making and responsibilities, internal impacts, external impactors, safety, barriers to accessing support and temporal factors. The findings suggest that factors related to the individual themselves, their personal context, the organisation they work in, their managers, the support structures around them and their sense of safety impacted on HSCWs; ability to cope. Some factors changed over time throughout the first year of the pandemic, such as workload and staff illness, which further impacted HSCWs' coping. There were many barriers to accessing support that also impacted coping, including availability, awareness and time. The relationship between the factors that impacted coping are represented in an explanatory model. The findings extend previous studies on the mental health impact on frontline HSCWs working during Covid-19, providing novel insight by developing an explanatory model illustrating the underlying factors that impacted their coping experiences over the course of the pandemic in the UK. The findings from this study may assist in the development of improved and more effective support for HSCWs going forwards.

Association of COVID-19 Vaccination Rates of Staff and COVID-19 Illness and Death Among Residents and Staff in US Nursing Homes

It is important to understand the association between staff vaccination rates and adverse COVID-19 outcomes in nursing homes. To assess the extent to which staff vaccination was associated with preventing COVID-19 cases and deaths among residents and staff in nursing homes. This longitudinal cohort study used data on COVID-19 outcomes in Medicare- and Medicaid-certified nursing homes in the US between May 30, 2021, and January 30, 2022. Participants included the residents of 15 042 US nursing homes that reported COVID-19 data to the Centers for Disease Control and Prevention and passed Centers for Medicare & Medicaid Services data quality checks in the National Healthcare Safety Network. Weekly staff vaccination rates. Main outcomes are weekly COVID-19 cases and deaths among residents and weekly COVID-19 cases among staff. The treatment variable is the primary 2-dose staff vaccination rate in each facility each week. In the primary analysis of 15 042 nursing homes before the Omicron variant wave (May 30 to December 5, 2021) using fixed effects of facility and week, increasing weekly staff vaccination rates by 10 percentage points was associated with 0.13 (95% CI, -0.20 to -0.10) fewer weekly COVID-19 cases per 1000 residents, 0.02 (95% CI, -0.03 to -0.01) fewer weekly COVID-19 deaths per 1000 residents, and 0.03 (95% CI, -0.04 to -0.02) fewer weekly COVID-19 staff cases. In the secondary analysis of the Omicron wave (December 5, 2021, to January 30, 2022), increasing staff vaccination rates were not associated with lower rates of adverse COVID-19 outcomes in nursing homes. The findings of this cohort study suggest that before the Omicron variant wave, increasing staff vaccination rates was associated with lower incidence of COVID-19 cases and deaths among residents and staff in US nursing homes. However, as newer, more infectious and transmissible variants of the virus emerged, the original 2-dose regimen of the COVID-19 vaccine as recommended in December 2020 was no longer associated with lower rates of adverse COVID-19 outcomes in nursing homes. Policy makers may want to consider longer-term policy options to increase the uptake of booster doses among staff in nursing homes.

Dodging the bundle—Persistent healthcare-associated rhinovirus infection throughout the pandemic

Healthcare-associated viral infections (HAVI) are a common cause of patient harm in the pediatric population. We implemented a HAVI prevention bundle in 2015, which included 6 core elements: caregiver screening, symptom-based isolation, personal protective equipment (PPE), hand hygiene, staff illness procedures, and monitoring of environmental cleanliness. Enhanced bundle elements were introduced at the start of the COVID-19 pandemic, which provided an opportunity to observe the effectiveness of the bundle with optimal adherence to prevention practices, and to measure the impact on respiratory HAVI epidemiology. Respiratory HAVIs were confirmed through review of medical records and application of the National Health Safety Network (NHSN) surveillance criteria for upper respiratory infections (URIs) with predetermined incubation periods for unit attribution. Descriptive statistics of the study population were examined, and comparative analyses were performed on demographic and process metrics. Data analysis was conducted using R statistical software. We observed an overall decrease in respiratory HAVI of 68%, with prepandemic rates of 0.19 infections per 1,000 patient significantly decreased to a rate of 0.06 per 1,000 patient days in the pandemic period (P < .01). Rhinovirus made up proportionally more of our respiratory HAVI in the pandemic period (64% vs 53%), with respiratory HAVI secondary only to rhinovirus identified during 8 of 16 months in the pandemic period. Compliance with our HAVI prevention bundle significantly improved during pandemic period. Enhancement of our HAVI bundle during the COVID-19 pandemic contributed toward significant reduction in nosocomial transmission of respiratory HAVI. Even with prevention practices optimized, respiratory HAVIs secondary to rhinovirus continued to be reported, likely due to the capacity of rhinovirus to evade bundle elements in hospital, and infection prevention efforts at large in the community, leaving vulnerable patients at continued risk.

Radiotherapy treatment interruptions during the Covid-19 pandemic: The UK experience and implications for radiobiology training

Unintended treatment interruptions during a course of radiotherapy can lead to extended overall treatment times which allow increased tumour cell repopulation to occur. Extra dose may therefore be required to offset any loss of tumour control. However, the manner in which the extra dose is delivered requires careful consideration in order to avoid the risk of increased normal tissue toxicity. Radiobiological modelling techniques can allow quantitative examination of such problems and may be used to derive revised pattens of radiation delivery which can help restore a degree of tumour control whilst limiting the likelihood of excess normal tissue morbidity. Unintended treatment interruptions can occur in any radiotherapy department but the rapid spread of the Covid-19 pandemic caused a major increase in the frequency of such interruptions due to staff and patient illness and the consequent self-isolation requirements. This article summarises the radiobiological considerations and caveats involved in assessing treatment interruptions and outlines the UK experience of dealing with the new challenges posed by Covid-19. The world-wide need for more education programmes in cancer radiobiology is highlighted.

MO537: Effects of COVID-19 on Mineral and Bone Disease Outcomes in Hemodialysis Patients: A Retrospective Study From Qatar

BACKGROUND AND AIMSManagement of end-stage renal disease (ESRD) on dialysis has been challenging during the COVID19 epidemic. Staff illness led to a shortage of manpower that affected patient care. We established a specialty nursing management for mineral and bone disease (MBD) in the ambulatory dialysis service in Qatar in 2016. We are presenting a retrospective study about the effects of the COVID-19 epidemic on MBD outcomes in ambulatory dialysis patients in the State of Qatar.METHODA retrospective cohort study in all adult patients with ESRD on chronic hemodialysis therapy (>1 month) in ambulatory dialysis clinics in the State of Qatar. Data collected were patient's characteristics, laboratory and diagnostic investigations for each patient through our electronic data system (nationwide). We focused on parathyroid hormone (PTH), calcium and phosphorus levels done routinely on monthly basis. The study duration was 31 months (January 2019–September 2021).RESULTSWe included 623 patients. Age was 56 ± 11 years old and 61% were male. The main comorbidities were diabetes mellitus (63%), hypertension (92%) and cardiovascular disease (22%). The percentage of patients with PTH levels within targets ranged from 63 to 74%. It was stable before and during the first wave of COVID-19 in Qatar (March–June 2020) then dropped afterward briefly for 3 months (October–December 2020) (74% versus 63% respectively P = 0.0003). PTH level in target improved afterward and also during the second wave of COVID-19 (February–May 2021) but then dropped again for 3 months (July–September 2021) [72% versus 66% respectively P = 0.02 (graph below with details)]. Patients with phosphorus and calcium in the target were mostly stable [79% (77–83%) and 76% (74–79%), respectively].CONCLUSIONOur retrospective study regarding the effect of the COVID-19 epidemic on MBD outcomes in hemodialysis (HD) showed a temporary drop in PTH level in the target without affecting calcium and phosphorus targets. The delayed drop after COVID-19 waves in PTH in target could be related to the routine quarterly measurement of PTH. We think that establishing a solid management system for MBD led to reasonably stable outcomes despite all challenges during the COVID-19 epidemic.

Mental and Behavioral Health Needs of Transition Age Youth Experiencing Homelessness During the COVID-19 pandemic

Research ObjectivesFor the agencies interviewed, what were the best practices utilized for the behavioral and mental health issues in TAYEH before the COVID-19 pandemic?How has the COVID-19 pandemic affected TAYEH ability to access services and supports to address their behavioral and mental health needs?What programs/processes/procedures are being utilized now to assist TAYEH in the time of the COVID-19 pandemic?DesignQualitative Method were utilized to conduct a content analysis of the data collected via recorded virtual Interviews.SettingThe study was conducted on a virtual platform focusing on multiple agencies across the United States.ParticipantsThree organizations agreed to be interviewed, with four representatives being interviewed in total.InterventionsThere was no intervention. This was a qualitative content analysis.Main Outcome MeasuresFindings from the interviews indicated increased numbers of youth trying to access services during the pandemic. In addition, the agencies interviewed were seeing increased numbers of youth with mental and behavioral health issues, including substance abuse, PTSD, anxiety, and depression.ResultsThe increase in need from TAYEH resulted in permanent services being added to their organization to help this population. The increase in need of services during the COVID-19 pandemic from TAYEH may have been due to limitations on the number of individuals allowed to occupy a space. It was agreed through the interviews that there could be ways to improve the services and resources for the behavioral needs of youth in their agencies.ConclusionsAlthough there were challenges to accessing services like virtual meetings and staff illness, agencies developed strategies to meet the needs of the youth. These included creating virtual drop in centers and providing more telehealth services .Author(s) DisclosuresNone.

Are we reliving the past?

I find myself writing this just before Christmas, a good time for reflection. We are uncertain about the latest Covid variant and settings are struggling to stay open due to staff and child illness. It is clear that, whatever is said centrally, the pandemic is not yet over. By the time you read this I hope the news is better.

The Changing Epidemiology of Respiratory Viruses in Children During the COVID-19 Pandemic: A Canary in a COVID Time.

The Changing Epidemiology of Respiratory Viruses in Children During the COVID-19 Pandemic: A Canary in a COVID Time.

Working While Ill During COVID-19: Ethics, Guilt, and Moral Community.

Working While Ill During COVID-19: Ethics, Guilt, and Moral Community.

Management of open fractures of the lower limb during the COVID-19 pandemic: are the standards of treatment being maintained? A study from a major trauma centre in England

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Coronavirus disease 2019 (COVID 19) has created an immense strain on the NHS. During the height of the pandemic, trauma services were affected by redeployment, reduced theatre capacity and staff illness, and COVID BOAST guidelines were introduced.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study aimed to evaluate the standards of management of open fractures of the lower limb at a Major Trauma Centre in the United Kingdom during the COVID-19 pandemic and compare the same with the pre-pandemic period. Patient demographics, mechanism of injury, timing and mechanism of initial debridement and definitive soft tissue and skeletal fixation were noted. Outcomes including duration of hospital stay, 30 day and 1 year mortality were also assessed.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;There was an overall 21% reduction in admissions with open lower limb fractures during the pandemic period with a 48% reduction during the first lockdown. There was a significant reduction in time taken from Emergency Department presentation to first debridement as well as a notable increase in operating outside of regular theatre hours. There was little difference in operative technique used for skeletal or soft tissue management at initial and definitive surgery, though fewer cases were performed as a two stage procedure. There was no difference in amputation rate in the two years. Length of stay was reduced from 21 days to 17, and 30 day mortality remained the same.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our study shows this Major Trauma Centre was able to provide a trauma service in accordance to the BOAST4 guidelines despite the increased pressures of the COVID-19 pandemic.&lt;/p&gt;

Well-Being of Health Care Professionals Treating Opioid Use Disorder During the COVID-19 Pandemic: Results From a National Survey.

The COVID-19 pandemic has dramatically affected health care delivery, effects that are juxtaposed with health care professional (HCP) burnout and mental distress. The Opioid Use Disorder Provider COVID-19 Survey was conducted to better understand the impact of COVID-19 on clinical practice and HCP well-being. The cross-sectional survey was e-mailed to listservs with approximately 157,000 subscribers of diverse professions between July 14 and August 15, 2020. Two dependent variables evaluated HCP functioning and work-life balance. Independent variables assessed organizational practices and HCP experiences. Covariates included participant demographic characteristics, addiction board certification, and practice setting. Multilevel multivariate logistic regression models were used. Among 812 survey respondents, most were men, White, and physicians, with 46% located in urban settings. Function-impairing anxiety was reported by 17%, and 28% reported more difficulty with work-life balance. Difficulty with functioning was positively associated with having staff who were sick with COVID-19 and feeling close to patients, and was negatively associated with being male and having no staff changes. Difficulty with work-life balance was positively associated with addiction board certification; working in multiple settings; having layoffs, furloughs, or reduced hours; staff illness with COVID-19; and group well-being check-ins. It was negatively associated with male gender, older age, and no staff changes. Demographic, provider, and organizational-practice variables were associated with reporting negative measures of well-being during the COVID-19 pandemic. These results should inform HCPs and their organizations on factors that may lead to burnout, with particular focus on gender and age-related concerns and the role of well-being check-ins.

Bioterrorism

Terrorism that involves the deliberate release or distribution of biological agents is called bioterrorism. These pathogens are bacteria, viruses, fungi, other microorganisms and their related toxins, insects, and they can be natural or human-modified forms, which are roughly the same way as in biological warfare that can sicken or kill people, livestock, or crops.&#x0D; These high-priority means include organisms or toxins that pose the greatest risk to the public and national security: Anthrax (Bacillus anthracis) Botulism (Clostridium botulinum toxin) Plague (Yersinia pestis). They have the ability to have harmful effects on human health in many ways, from relatively mild allergic reactions to serious medical conditions and even death. Bacillus anthracis, the bacterium that produces anthrax, and is one of the pathogens most likely to be used for biological attacks.Bioterrorism cancausemass deaths, epidemics, medical staff illness, environmental pollution, legal issues, and cause anxiety in the medical community and the wider community (1).&#x0D; Unfortunately, bioterrorism agents are difficult to control and affect military personnel and civilian men, women and children. In the past 100 years, the United States and the international community have experienced various acts of bioterrorism against civilians. The model shows that the economic impact of bioterrorism attacks ranges from an estimated US$477.7 million per 100,000 people exposed (brucellosis scenario) to US$26.2 billion per 100,000 people exposed (anthrax scenario). The possibility of bioterrorism is particularly worrying because it causes disease, death and panic, disproportionate to the resources consumed (2).&#x0D; The purpose of bioterrorism is usually to create fear and / or threaten the government or society in order to obtain political, religious or ideological objectives. Compared to weapons like explosives, it can have a unique impact on society. Depending on the situation, wear a mask to reduce inhalation or spread of bacteria. If you have been in contact with biological agents, remove and store your clothing and personal things. Follow official instructions for disposing of contaminated items. Wash with soap and water and put on clean clothes.&#x0D; Bioterrorism agents can be spread through the air or into food or water, and are extremely difficult to detect. The outbreak of biological weapons’ diseases may lead to the extinction of endangered wild animal species, the erosion of genetic diversity of domesticated animals and plants, and the destruction of traditional human livelihoods (3). Symptoms of exposure to biological agents may include sore throat, fever, blurred vision or diplopia, rash or blistering, exhaustion, slurred speech, confusion, muscle weakness, nausea, abdominal pain, vomiting, diarrhoea, and cough. The occurrence of a weapon attack may be impossible, but planning and preparation can greatly reduce the death and suffering caused by it.&#x0D; Only 16 countries plus Taiwan possess or presumably possess biological weapons programs: Canada, China, Cuba, France, Germany, Iran, Iraq, Israel, Japan, Libya, North Korea, Russia, South Africa, Syria, and the United States. Britain and the United States. The way to deal with such threats is through international law and carefully negotiated treaties and verification mechanisms. An important protection measure against biological weapons is currently being negotiated in Geneva. Available protective equipment includes respiratory protection devices, full-face protective masks and surgical masks for respiratory protection, combat suits, protective gloves, and skin-protecting boots. Full protection is required when the agent is not recognized. The inherent characteristics of biological agents that affect their potential for use as weapons include: virulence; toxicity; pathogenicity; incubation period; transmissibility; lethality and stability.&#x0D; Now regarding the COVID19 pandemic, there is a game of blame between the two superpowers, the United States and China. It is not clear whether the spread of COVID19 is intentional or unintentional, whether it is a natural virus threatening the world or an artificial virus. Two conspiracy theories about the origin of COVID19 are widely circulated in China and the West, one accusing the United States and the other accusing the higher-level biological containment laboratory in Wuhan, the epicentre of the pandemic (4).&#x0D; However, this has caused pain, death, mental distress, depression, and billions of dollars in treatment and vaccine costs all over the world. This whole process reminds us of Frankenstein's sci-fi monster. The moral lesson learned from this is that people need to blend in and feel connected to others in order to survive. In addition, humans must carefully consider the cost of scientific progress.

Referring for echocardiography: when not to test.

The COVID-19 pandemic has prompted a reassessment of the traditional pathways and processes involved in the delivery of health care. This is especially true for diagnostic services, which have been profoundly affected during the pandemic as a result of an increase in demand and the reduction in workforce availability that followed staff illness, isolation, and redeployment. This has led to a dramatic increase in the number of patients waiting for key investigations; this is a problem felt acutely by echocardiography services across the UK. The effects of the pandemic have also exacerbated pre-existing tensions for echocardiography services, where an increasing incidence of cardiovascular pathology has not been matched by the number of sonographers trained to perform the scans.1 This presents clinicians and healthcare providers with the potential for significant risk as large numbers of patients wait for a test with no meaningful framework available to easily determine which of them …

POS-513 RISK OF COVID-19 DISEASE, DIALYSIS UNIT ATTRIBUTES AND INFECTION CONTROL STRATEGY AMONG LONDON IN-CENTRE HAEMODIALYSIS PATIENTS: A RETROSPECTIVE COHORT STUDY

Patients with end-stage kidney disease experience some of the highest rates of COVID-19 disease. Alongside demographic and cardio-metabolic risks, those receiving in-centre haemodialysis (ICHD) treatment face a unique set of challenges surrounding the requirement to regularly attend for life-extending treatment, thereby preventing self-isolation. We aimed to characterise the impact of community disease burden, dialysis unit attributes and the range of infection control strategies, on rates of COVID-19 disease among patients receiving ICHD in London, UK. We used data collected by the Pan-London COVID-19 Renal Audit Group which included all adult patients receiving long-term ICHD provided by all seven London renal centres on 2 March 2020. A discrete-time multi-variable multi-level time-to-event analysis was used to examine associations with the risk of testing positive for SARS-Cov-2 infection, and admission to hospital with COVID-19 over 13 weeks. Data on 5,755 patients dialysing in 51 ICHD units from the 7 London renal centres were analysed. Of these, 981 (17.0%) patients tested positive and 465 (8.2%) were admitted with suspected COVID-19. Alongside established risk factors for disease, we observed a strong relationship between ICHD infection rates and rates reported in patients’ local communities. In addition, dialysis unit size was associated with outcomes, as was layout, specifically the number of side rooms (hazard ratio, HR: 0.86, 95%CI: 0.80 to 0.93 for test positivity or admission per side room/20 stations). Reduced risk of admission was observed two weeks following institution of mask wearing in asymptomatic patients (HR: 0.63, 95%CI: 0.43 to 0.93). Rates of staff illness paralleled that of patients, but no associations were seen between rates of disease in patients and the different units’ mitigation strategies. Figure: Geographical distribution of cases by dialysis unit by week for the first 8 weeks of the pandemic and at the final follow-up week. Each ICHD unit is represented by a circle. Circle size: number of patients dialysed; Circle colour: cumulative proportion of patients test positive for COVID-19 or admitted with suspected COVID-19. Underlying green intensity reflects number of cases in each middle layer super output area (not necessarily reflective of patients' home locality as, most, but not all, patients dialyse in their closest unit). Three units are not represented as they fall outside the area of the map. Dates represent the first day of the week represented.. These findings suggest the high risk of COVID-19 in the ICHD population relates to individual factors, and underlying community transmission, along with increased unit size and unfavourable unit layout. The results support interventions aimed at reducing transmission from asymptomatic patients and highlight the importance of preventing infection in nursing staff.

High Seroprevalence of Antibodies Against SARS-CoV-2 Among Healthcare Workers 8 Months After the First Wave in Aden, Yemen

Background: The true burden of COVID-19 in Yemen is underestimated as testing remains limited. MSF needed to rapidly identify and manage staff illness in the MSF Aden Trauma Centre. In this study we aimed to screen staff, offer PCR testing to symptomatic individuals, and conduct serological rapid tests to determine past infection. Methods: Four months after the peak of the first wave, we offered all the staff at the MSF Aden Trauma Centre PCR if symptomatic, and a baseline SARS-CoV-2 serology screening followed by follow-up screenings. A final round was scheduled four months after the baseline. A rapid serology lateral flow test, NG-Test® IgM-IgG was used in all rounds and in the final round, an electrochemiluminescence immunoassay (ECLIA) (Elecsys® Anti-SARS-CoV-2 assay). Univariate and multivariate analyses were used to identify risk factors for seropositivity. The level of agreement between the different serology assays used was investigated. Findings: Overall 69 out of 356 participants (19.4%, 95% CI 17.9 – 20.8) tested positive by NG-Test® between September and November 2020. A sub-sample of 161 staff was retested in January 2021. Of these, the NG-Test® detected only 13 positive cases, whereas the ECLIA detected 109 positive cases. The adjusted seroprevalence by ECLIA was 59% (95%CI 52.2 – 65.9). Those who were non-medical had significantly lower odds of seropositivity compared to the medical staff (AOR 0.43, 95% CI 0.15 – 0.7, p<0.001). The positive percent agreement between the two tests was very low (11%). Interpretation: Our results suggest a very high SARS-CoV-2 seroprevalence in healthcare workers in Yemen, highlighting the need for regular testing and rapid vaccination of all healthcare workers in the country. Rapid serological tests are likely to under-estimate true infection rates. Funding Information: Medecins Sans Frontieres, Epicentre Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: Written informed consent was obtained. This protocol was approved by the MSF Ethics Review Board on July 30, 2020, reference number 2056a, and by Aden University Institutional Review Board on August 9, 2020 (Research Code: REC-79-2020).

872. Burden of Influenza Outbreaks in Long-Term Care Facilities in Philadelphia, 2012-2020

BackgroundIn the United States, influenza and other acute respiratory viruses contribute to a high burden of disease in long-term care facility (LTCF) residents. We aim to characterize the disease patterns and inter-seasonal variation of influenza virus outbreaks in LTCFs and identify institutional, environmental, and public health interventions associated with differences in outbreak outcomes and characteristics.MethodsWe conducted a retrospective, longitudinal study of influenza outbreaks in LTCFs reported to the Philadelphia Department of Public Health (PDPH) over eight consecutive seasons (November 2012 through March 2020). Characteristics of individual outbreaks, facilities, and infection control measures were reported in the PDPH Influenza Outbreak database, while quality measures and other facility-level data were extracted from the CMS Nursing Home Compare (NHC) database. Cases of influenza-like illness (ILI) in residents and staff were reported.Results131 influenza outbreaks were reported among 56 facilities, leading to 1196 cases of ILI, 227 influenza-related hospitalizations and 20 deaths. The median number of facility residents affected per outbreak was 4 (range, 0-52), and the resident attack rate was 3.0% (IQR, 1.6-7.4). Facility staff were affected in 56 (43%) of outbreaks. A greater number of facility beds was associated with sites reporting 3 or more outbreaks compared to those that did not (180 vs 133 beds, p=0.019). Public health measures were associated with lower total attack rates for surveillance (1.9% vs 4.3%, p=0.0015), education (1.9% vs 5.1%, p=0.0004), visitation restrictions (1.8% vs 3.1%, p=0.049), and vaccination policies of staff and/or residents (1.6% vs 2.7%, p=0.047). Smaller outbreaks were associated with the implementation of droplet precautions (3 vs 6, p=0.0071), antiviral treatment and prophylaxis (3 vs 6, p=0.024), and admission restrictions (4 vs 7, p=0.015).ConclusionLarger facility size was associated with an increased frequency of outbreaks. Public health measures may reduce the size and severity of influenza outbreaks in LTCFs. These results emphasize the importance of ensuring consistent utilization of recommended infection prevention strategies.Disclosures All Authors: No reported disclosures

Healthy farmer presenting with chest pain and bradycardia during peak COVID season

This was a patient who got admitted with three related cardiological presentations during the same admission. Initially he presented with an Inferior ST-elevation myocardial infarction (STEMI) and bradycardia. Following primary percutaneous coronary intervention (PPCI) to the right coronary artery (RCA), he was found to be in complete heart block and new onset atrial fibrillation was noted. This case proved to be interesting and challenging at the same time in view of constantly evolving factors during the peak coronavirus disease (COVID-19) pandemic. There was a great deal of uncertainty over the course of patient's illness not only due to cardiological issues, particularly arrhythmias relating to COVID, but also due to high levels of staff illness, rapidly evolving clinical guidance and emergence of data introducing new variables to consider. The clinical team not only dealt with his initial presenting symptom (chest pain- PPCI) promptly and effectively, but also carefully evaluated his subsequent new unexpected symptoms (bradycardia- pacemaker insertion) and new onset angina (further PCI to LAD) with equal vigour and seriousness, resulting in excellent final results for all of his three conditions with complete and total resolution of all symptoms. We therefore managed to discharge him successfully in spite of unusual challenges noted due to the pandemic situation. We managed to observe highest level protective measures, preventing him from acquiring COVID whilst surrounded by COVID positive and suspected patients and staff.