Implementation Of Isolation Measures Research Articles

Distribution and Drug Resistance of Bacterial Pathogens Associated with Lower Respiratory Tract Infection in Children and the Effect of COVID-19 on the Distribution of Pathogens

By studying the distribution and drug resistance of bacterial pathogens associated with lower respiratory tract infection (LRTI) in children in Chengdu and the effect of the COVID-19 on the distribution of pathogens and by analyzing the epidemic trend and drug resistance changes of the main pathogens of LRTI, this research is supposed to provide a useful basis for the prevention of LRTI in children and the rational use of drugs in clinical practice. Hospitalized children clinically diagnosed with LRTI in Chengdu Women and Children's Central Hospital from 2011 to 2020 were selected as the study subjects. The pathogens of LRTI in children and the distribution of pathogens in different ages, genders, seasons, years, and departments and before and after the pandemic situation of COVID-19 were counted. The drug resistance distribution of the top six pathogens with the highest infection rate in the past three years and the trend of drug resistance in the past decade were analyzed. A total of 26,469 pathogens were isolated. Among them, 6240 strains (23.6%) were Gram-positive bacteria, 20152 strains (76.1%) were Gram-negative bacteria, and 73 strains (0.3%) were fungi. Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, and Staphylococcus aureus were highly isolated in the group of infants aged 0-1 (P < 0.01), Moraxella catarrhalis and Streptococcus pneumoniae were highly isolated in children aged 1–6 (P < 0.01), and Haemophilus influenzae was highly isolated in children over 1 (P < 0.01). The isolation rates of Enterobacteriaceae, Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Staphylococcus aureus, and Candida albicans in the lower respiratory tract of 0-1 year-old male infants were higher than those of female infants (p < 0.05). Haemophilus influenzae was highly isolated in spring and summer, and Moraxella catarrhalis was highly isolated in autumn and winter, while the infection of Streptococcus pneumoniae was mainly concentrated in winter. This difference was statistically significant (P < 0.01). Affected by the COVID-19 pandemic, the isolation rates of Haemophilus influenzae and Streptococcus pneumoniae were significantly lower than those before the pandemic, and the isolation rate of Moraxella catarrhalis was significantly higher. The difference was statistically significant (P < 0.01). The proportion of isolated negative bacteria in NICU and PICU was higher than that in positive bacteria, and the infection rates of Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, and Acinetobacter baumannii were higher than those in other departments. The differences were statistically significant (P < 0.01). The results of drug sensitivity test showed that the drug resistance of Haemophilus influenzae and Moraxella catarrhalis was mainly concentrated in Ampicillin, First- and Second-generation cephalosporins, and Cotrimoxazole, with stable sensitivity to Third-generation cephalosporins, while the drug resistance of Streptococcus pneumoniae was concentrated in Macrolides, Sulfonamides, and Tetracyclines, with stable sensitivity to Penicillin. Staphylococcus aureus is highly resistant to penicillins and macrolides and susceptible to vancomycin. Enterobacteriaceae resistance is concentrated in cephalosporins, with a low rate of carbapenem resistance. From 2018 to 2020, 1557 strains of Staphylococcus aureus were isolated, of which 416 strains were MRSA, accounting for 27% of the isolates; 1064 strains of Escherichia coli were isolated, of which 423 strains were ESBL and 23 strains were CRE, accounting for 40% and 2% of the isolates, respectively; and 1400 strains of Klebsiella pneumoniae were isolated, of which 385 strains were ESBL and 402 strains were CRE, accounting for 28% and 29% of the isolates, respectively. Since 2011, the resistance of Escherichia coli and Klebsiella pneumoniae to Third-generation cephalosporins has increased, peaking in 2017, and has decreased after 2018, years after which carbapenem resistance has increased significantly, corresponding to an increase in the detection rate of Carbapenem-resistant Enterobacteriaceae CRE. Findings from this study revealed that there are significant differences in community-associated infectious pathogens before and after the COVID-19 pandemic, and there are significant age differences, seasonal epidemic trends, and high departmental correlation of pathogens related to lower respiratory tract disease infection in children. There was a significant gender difference in the isolation rate of pathogens associated with LRTI in infants under one year. Vaccination, implementation of isolation measures and social distance, strengthening of personal protective measures, aseptic operation of invasive medical treatment, hand hygiene, and environmental disinfection are beneficial to reducing community-associated pathogen infection, opportunistic pathogen infection, and an increase in resistant bacteria. The strengthening of bacterial culture of lower respiratory tract samples by pediatricians is conducive to the diagnosis of respiratory tract infections caused by different pathogens, contributing to the selection of effective drugs for treatment according to drug susceptibility results, which is important for the rational use of antibiotics and curbing bacterial resistance.

Stress, Coping, and Resilience Before and After COVID-19: A Predictive Model Based on Artificial Intelligence in the University Environment.

The COVID-19 global health emergency has greatly impacted the educational field. Faced with unprecedented stress situations, professors, students, and families have employed various coping and resilience strategies throughout the confinement period. High and persistent stress levels are associated with other pathologies; hence, their detection and prevention are needed. Consequently, this study aimed to design a predictive model of stress in the educational field based on artificial intelligence that included certain sociodemographic variables, coping strategies, and resilience capacity, and to study the relationship between them. The non-probabilistic snowball sampling method was used, involving 337 people (73% women) from the university education community in south-eastern Spain. The Perceived Stress Scale, Stress Management Questionnaire, and Brief Resilience Scale were administered. The Statistical Package for the Social Sciences (version 24) was used to design the architecture of artificial neural networks. The results found that stress levels could be predicted by the synaptic weights of coping strategies and timing of the epidemic (before and after the implementation of isolation measures), with a predictive capacity of over 80% found in the neural network model. Additionally, direct and significant associations were identified between the use of certain coping strategies, stress levels, and resilience. The conclusions of this research are essential for effective stress detection, and therefore, early intervention in the field of educational psychology, by discussing the influence of resilience or lack thereof on the prediction of stress levels. Identifying the variables that maintain a greater predictive power in stress levels is an effective strategy to design more adjusted prevention programs and to anticipate the needs of the community.

Solid Organ Transplantation During COVID-19 Pandemic: An International Web-based Survey on Resources' Allocation.

SOT-specialists, COVID-19-specialists, and medical ethicists designed an international survey according to CHERRIES guidelines. Personal opinions about continuing SOTs, safe managing of donors and recipients, as well as equity of resources' allocation were investigated. The survey was sent by e-mail. Multiple approaches were used (corresponding authors from Scopus, websites of scientific societies, COVID-19 webinars). After the descriptive analysis, univariate and multivariate ordinal regression analysis was performed. There were 1819 complete answers from 71 countries. The response rate was 49%. Data were stratified according to region, macrospecialty, and organ of interest. Answers were analyzed using univariate-multivariate ordinal regression analysis and thematic analysis. Overall, 20% of the responders thought SOTs should not stop (continue transplant without restriction); over 70% suggested SOTs should selectively stop, and almost 10% indicated they should completely stop. Furthermore, 82% agreed to shift resources from transplant to COVID-19 temporarily. Briefly, main reason for not stopping was that if the transplant will not proceed, the organ will be wasted. Focusing on SOT from living donors, 61% stated that activity should be restricted only to "urgent" cases. At the multivariate analysis, factors identified in favor of continuing transplant were Italy, ethicist, partially disagreeing on the equity question, a high number of COVID-19-related deaths on the day of the answer, a high IHDI country. Factors predicting to stop SOTs were Europe except-Italy, public university hospital, and strongly agreeing on the equity question. In conclusion, the majority of responders suggested that transplant activity should be continued through the implementation of isolation measures and the adoption of the COVID-19-free pathways. Differences between professional categories are less strong than supposed.

Analysis of COVID-19's infection model and the influence of isolation and Preventive measures on the epidemic situation

COVID-19's epidemic broke out at the beginning of 2020, and its high infection rate and difficulties in prevention and control led to its rapid spread throughout the country, and led to the death of a large number of patients suffering from COVID-19. In order to control the spread of the epidemic, quarantine measures were implemented all over the country. In view of the current epidemic prevention situation, the isolation policy is extremely correct. Based on the differential equation, this paper studies the propagation law of novel coronavirus and analyzes the function and influence of the isolation measures by establishing the propagation model in the natural state and the propagation model under the isolation measures, and using the statistical data. And compared with the implementation of isolation measures in the case of various data to verify the rationality of the model.

Impact of the beta-lacta test on the management of urinary tract infections at the emergency department

Introduction Rapid detection of extended-spectrum β-lactamases is essential. In this study, we evaluated the potential impact of β-lacta test on both the times to appropriate antibiotic therapy and to the implementation of patient isolation measures. Patients and methods We included prospectively all the patients admitted to the emergency department for clinical suspicion of urinary tract infection. Compared with physician’s decision, we analysed the potential impact of β-lacta test on the initial antibiotic therapy and on the implementation of hygiene measures. This study has been registered under number NCT02897609. Results We included 203 patients, 43% with acute pyelonephritis and 21% with acute prostatitis. The β-lacta test had a 95.2% sensitivity and a 99.5% specificity to detect extended-spectrum β-lactamases. Taking the β-lacta test results into account would have decreased significantly both the times to appropriate therapy and to isolation measures from 54 to 2.7 h and from 55.2 to 2.6 h, respectively. Conclusion The β-lacta test could reduce significantly the times to appropriate therapy and implementation of isolations measures.

Surgical treatment of patients with suspected or confirmed novel coronavirus pneumonia

When novel coronavirus pneumonia outbreak occurs, when the operating room accepts suspected or confirmed patients for surgery, in addition to the strict implementation of isolation measures by medical personnel, the department should formulate a thorough disposal process and management system based on the characteristics of the epidemic. Based on the national standard and the diagnosis and treatment plan of this epidemic, this article makes a detailed summary from the aspects of preoperative screening, personnel and environmental preparation, intraoperative attention, postoperative treatment, personnel training, department management, etc., so as to facilitate clinical implementation. Key words: Novel coronavirus pneumonia; Surgery; Treatment

Application of Quality Control Circle in Improving the Correct Implementation Rate of Multiple Drug Resistant Organism Isolation Measures in ICU Medical Personnel

Objective: Effective isolation management of multiple drug resistant organism (MDRO) patients is considered an important measure to prevent cross-infection. To reduce the spread of MDRO, there is a need to improve the correct implementation of isolation measures for intensive care unit (ICU) medical personnel. We will investigate the application of quality control circle (QCC) activities in improving the correct implementation rate of isolation measures for patients with MDRO in ICU medical personnel. Methods: A 10-member QCC activity group was established. All of the ICU medical personnel were taken as the research objects, including doctors, nurses, assistant nurses, rotation training personnel, external ICU consultants and cleaning personnel. The correct implementation of isolation measures for patients with MDRO infection were investigated and studied, which identified the problem areas and analyzed the main reasons. The quality improvement countermeasures were formulated and implemented in ICU medical personnel, while the results were compared with before and after the QCC activities. Results: After QCC activities, the correct implementation rate of isolation measures by ICU medical personnel for patients with MDRO infection increased from 57.7% to 82.4%. The incidence of MDRO infection in ICU patients decreased from 9.64% to 3.77%, with statistically significant differences (P < 0.05). Conclusion: The QCC activities improved the correct implementation rate of MDRO isolation measures by ICU medical personnel, standardizing the isolation management of MDRO patients, while the incidence of MDRO in ICU patients was also effectively reduced.

Field epidemiological study on a varicella outbreak among schoolchildren in Shenzhen

Both epidemiologic characteristics and transmission mode of a varicella outbreak among schoolchildren in Shenzhen city were studied and related control measures were discussed. Case definition was established. Case-finding and face-to-face investigation were conducted, followed by analysis on distributions of time, place and persons of the outbreak. Association between possible modes of transmission and the outbreak was explored. Retrospective cohort study was carried out. The overall attack rate of this outbreak was 4.4% (122 of 2742). The attack rate among primary schoolchildren(8.3%, 118/1419)was higher than that in the middle-school children(0.3%, 4/1323). There were no statistically significant differences on the attack rates between male and female students. A total of 22 classes from the 9 grades were affected by this outbreak and the aggregation of varicella cases was found in classes. The highest attack rates was found in the students of fifth grade(23.7%), followed by from the third grade (13.4%). The main transmission mode appeared to be close personal contact. The outbreak, with four peaks of incidence, lasted 72 days. Data from the investigation suggested that the primary case was introduced into the school during military training involved by the students. Activities related to physical examination for all the schoolchildren seemed to have contributed to the spread of this disease among classes. Delayed isolation of cases appeared to be the major factor causing the spread of disease among classes. Intensive off-school activities or free community bus for children did not seem to be associated with the spreading of the disease. 52.5% (64/122) of the cases had received one-dose of varicella vaccine, with the median of onset after the vaccination as 7 years. The results demonstrated that one single-dose vaccine or long vaccination period were factors related to the insufficient immunity that causing the outbreak of disease. Varicella outbreak has been one of the most grievous public health problems in schools, posting challenges on the implementation of isolation measures, in particular. Once the chain of transmission is in place, it is difficult to make the universal measures effective within a short period.

Brote de sarna en un hospital terciario a partir de un caso de sarna costrosa

In February 2005 we performed an epidemiological study of an outbreak of scabies in a tertiary-care hospital which started from a crusted scabies case. We detected 10 secondary cases, 8 in healthcare workers and 2 in hospitalized patients. The attack rate was 4.1%. In contrast to previously described outbreaks, the crusted scabies case was recognized at admission. The outbreak causes were: lacking adherence to contact precautions, long stay of the primary case in the hospital ward and delay of specific treatment. The main control measures were: alerting the hospital services about the outbreak, performing epidemiologic surveillance, coordinating with the Hospital Direction and the Occupational Health Department, education of healthcare workers in control measures, implementation of isolation measures and treatment of cases and contacts with 5% permethrin topical lotion.