In-hospital Transmission Research Articles

Burden of hospital-acquired SARS-CoV-2 infections in Germany: occurrence and outcomes of different variants

BackgroundAvoiding in-hospital transmissions has been crucial in the COVID-19 pandemic. Little is known on the extent to which hospital-acquired SARS-CoV-2 variants have caused infections in Germany.AimTo analyse the occurrence and the outcomes of HAI with regard to different SARS-CoV-2 variants.MethodsPatients with SARS-CoV-2 infections hospitalized between March 1st, 2020 and May 17th, 2022 in 79 hospitals of the Helios Group were included. Information on patients' characteristics and outcomes were retrieved from claims data. In accordance with the Robert Koch Institute, infections were classified as hospital-acquired when tested positive >6 days after admission and if no information hinted at a different source.FindingsIn all, 62,875 SARS-CoV-2 patients were analysed, of whom 10.6% had HAI. HAIs represented 14.7% of SARS-CoV-2 inpatients during the Wildtype period, 3.5% during Alpha (odds ratio: 0.21; 95% confidence interval: 0.19–0.24), 8.8% during Delta (2.70; 2.35–3.09) and 10.1% during Omicron (1.10; 1.03–1.19). When age and comorbidities were accounted for, HAI had lower odds for death than community-acquired infections (0.802; 0.740–0.866). Compared to the Wildtype period, HAIs during Omicron were associated with lower odds for ICU (0.78; 0.69–0.88), ventilation (0.47; 0.39–0.56), and death (0.33; 0.28–0.40).ConclusionHospital-acquired SARS-CoV-2 infections occurred throughout the pandemic, affecting highly vulnerable patients. Although transmissibility increased with newer variants, the proportion of HAIs decreased, indicating improved infection prevention and/or the effect of immunization. Furthermore, the Omicron period was associated with improved outcomes. However, the burden of hospital-acquired SARS-CoV-2 infections remains high.

False-positive Serum IgM/IgG to SARS-CoV-2 in a Rare Pulmonary Neuroendocrine Carcinoma with Ocular Metastasis: A Case Report

The Coronavirus disease 2019 (COVID-19) pandemic impacts pulmonary cancer management since it shares similar clinical features and creates fear among patients to visit hospitals due to possible in-hospital disease transmission. We report a patient who presented with a rare case of a pulmonary neuroendocrine tumor with an ocular involvement, which, unfortunately, experienced a delay in diagnostics. The first hospitalization was due to superior vena cava syndrome, pleural and pericardial effusions, and swollen left eye. The patient was diagnosed with pulmonary cancer, released after the symptoms were relieved, and expected to visit a referral hospital for further diagnostics and treatments. The patient returned two weeks later with progressing disease, an ocular metastasis, and a reactive serum IgM/IgG to SARS-CoV-2; serial qPCR tests consistently returned negative. The patient was treated with the best supportive care before succumbing to death. Biopsy showed pulmonary tumor cells consistent with a neuroendocrine tumor. Fear of the pandemic makes patients reluctant to seek help from medical facilities. Pulmonary TBC has similar symptoms to pulmonary cancer, which can pose another challenge in diagnosing pulmonary cancer in TB-endemic countries. Thus, patients often present with advanced-stage pulmonary cancer with rare ocular metastasis, as in this report.

EPH121 A Descriptive Study on Hospital-Related Coronavirus Disease 2019 (HRCOVID-19) Among Chronic Kidney Disease Patients during the Pandemic at a Tertiary Center in the Philippines

ObjectivesThe study aimed to determine the incidence of hospital-related COVID-19 (HrCOVID-19) among chronic kidney disease (CKD) patients in a specialty medical center in the Philippines.MethodsA retrospective descriptive cross-sectional design with record review was done. The hospital’s list of confirmed COVID-19 was used to determine cases who developed signs and symptoms more than 14 days of hospital stay. Outcome categories, either discharged alive or mortality, were also identified.ResultsTwenty-nine patients were included, predominantly males (55%) with mean age of 47 ± 14 years. Length of hospital stay to HrCOVID-19 confirmation was 24 days. An overall incidence rate of 1.26% (95% CI: 0.84-1.80) was seen, and peaked at 2.35% (95% CI: 1.13 – 4.28) in June 2020. Overall mortality rate was 45%.ConclusionIncidence of HrCOVID-19 among CKD patients was low but has high mortality rates. Active identification, containment and prevention of in-hospital transmissions to achieve zero cases is desirable. ObjectivesThe study aimed to determine the incidence of hospital-related COVID-19 (HrCOVID-19) among chronic kidney disease (CKD) patients in a specialty medical center in the Philippines. The study aimed to determine the incidence of hospital-related COVID-19 (HrCOVID-19) among chronic kidney disease (CKD) patients in a specialty medical center in the Philippines. MethodsA retrospective descriptive cross-sectional design with record review was done. The hospital’s list of confirmed COVID-19 was used to determine cases who developed signs and symptoms more than 14 days of hospital stay. Outcome categories, either discharged alive or mortality, were also identified. A retrospective descriptive cross-sectional design with record review was done. The hospital’s list of confirmed COVID-19 was used to determine cases who developed signs and symptoms more than 14 days of hospital stay. Outcome categories, either discharged alive or mortality, were also identified. ResultsTwenty-nine patients were included, predominantly males (55%) with mean age of 47 ± 14 years. Length of hospital stay to HrCOVID-19 confirmation was 24 days. An overall incidence rate of 1.26% (95% CI: 0.84-1.80) was seen, and peaked at 2.35% (95% CI: 1.13 – 4.28) in June 2020. Overall mortality rate was 45%. Twenty-nine patients were included, predominantly males (55%) with mean age of 47 ± 14 years. Length of hospital stay to HrCOVID-19 confirmation was 24 days. An overall incidence rate of 1.26% (95% CI: 0.84-1.80) was seen, and peaked at 2.35% (95% CI: 1.13 – 4.28) in June 2020. Overall mortality rate was 45%. ConclusionIncidence of HrCOVID-19 among CKD patients was low but has high mortality rates. Active identification, containment and prevention of in-hospital transmissions to achieve zero cases is desirable. Incidence of HrCOVID-19 among CKD patients was low but has high mortality rates. Active identification, containment and prevention of in-hospital transmissions to achieve zero cases is desirable.

To Retest or Not to Retest the Experience of a Cardiology Emergency Clinic During the COVID-19 Pandemic

Abstract Acute cardiovascular pathology can frequently resemble the clinical and paraclinical picture of SARS-CoV-2 infection. The present paper aims to present the experience of a cardiology clinic during this pandemic and describe the way in which the clinical station was organized in order to limit in-hospital transmission of the virus. Methods Patients admitted to an emergency cardiology department between May 1, 2020 and December 31, 2020 were retrospectively identified and divided into two groups: (1) those positive for SARS-CoV2 infection and (2) those with an initial negative test, but high suspicion for the infection, who were tested at least twice by RT-PCR. We followed the motivation for retesting as well as possible correlations between clinical and paraclinical parameters and the decision to retest. Results A number of 334 patients were identified, 51 with a first positive RT-PCR test for SARS-CoV2 infection, and 276 who were tested for infection at least twice. The most common reasons for retesting were lung imaging and existence of subfever. The best predictive model for the outcome of the second RT-PCR test included the presence of lymphopenia, subpleural condensation, highest temperature during hospitalization, and the presence of at least two COVID-19 symptoms. Conclusion The balance between prompt detection of patients with high suspicion of SARS-CoV2 infection (through PCR re-testing) and misuse of material resources should be guided by clinical algorithms.

System dynamic modelling of healthcare associated influenza -a tool for infection control

BackgroundThe transmission dynamics of influenza virus within healthcare settings are not fully understood. Capturing the interplay between host, viral and environmental factors is difficult using conventional research methods. Instead, system dynamic modelling may be used to illustrate the complex scenarios including non-linear relationships and multiple interactions which occur within hospitals during a seasonal influenza epidemic. We developed such a model intended as a support for health-care providers in identifying potentially effective control strategies to prevent influenza transmission.MethodsBy using computer simulation software, we constructed a system dynamic model to illustrate transmission dynamics within a large acute-care hospital. We used local real-world clinical and epidemiological data collected during the season 2016/17, as well as data from the national surveillance programs and relevant publications to form the basic structure of the model. Multiple stepwise simulations were performed to identify the relative effectiveness of various control strategies and to produce estimates of the accumulated number of healthcare-associated influenza cases per season.ResultsScenarios regarding the number of patients exposed for influenza virus by shared room and the extent of antiviral prophylaxis and treatment were investigated in relation to estimations of influenza vaccine coverage, vaccine effectiveness and inflow of patients with influenza. In total, 680 simulations were performed, of which each one resulted in an estimated number per season. The most effective preventive measure identified by our model was administration of antiviral prophylaxis to exposed patients followed by reducing the number of patients receiving care in shared rooms.ConclusionsThis study presents an system dynamic model that can be used to capture the complex dynamics of in-hospital transmission of viral infections and identify potentially effective interventions to prevent healthcare-associated influenza infections. Our simulations identified antiviral prophylaxis as the most effective way to control in-hospital influenza transmission.

The impact of public health interventions on the future prevalence of ESBL-producing Klebsiella pneumoniae: a population based mathematical modelling study

BackgroundFuture prevalence of colonization with extended-spectrum betalactamase (ESBL-) producing K. pneumoniae in humans and the potential of public health interventions against the spread of these resistant bacteria remain uncertain.MethodsBased on antimicrobial consumption and susceptibility data recorded during > 13 years in a Swiss region, we developed a mathematical model to assess the comparative effect of different interventions on the prevalence of colonization.ResultsSimulated prevalence stabilized in the near future when rates of antimicrobial consumption and in-hospital transmission were assumed to remain stable (2025 prevalence: 6.8% (95CI%:5.4–8.8%) in hospitals, 3.5% (2.5–5.0%) in the community versus 6.1% (5.0–7.5%) and 3.2% (2.3–4.2%) in 2019, respectively). When overall antimicrobial consumption was set to decrease by 50%, 2025 prevalence declined by 75% in hospitals and by 64% in the community. A 50% decline in in-hospital transmission rate led to a reduction in 2025 prevalence of 31% in hospitals and no reduction in the community. The best model fit estimated that 49% (6–100%) of observed colonizations could be attributable to sources other than human-to-human transmission within the geographical setting.ConclusionsProjections suggests that overall antimicrobial consumption will be, by far, the most powerful driver of prevalence and that a large fraction of colonizations could be attributed to non-local transmissions.

Analysis of patient outcomes after urological surgery during the second and third waves of SARS-CoV-2 pandemic in a high incidence area

ObjectiveTo analyze surgical safety through postoperative COVID-19 incidence and mortality at the urology department of a tertiary hospital located in Madrid (Spain). MethodsObservational, prospective study including all patients undergoing urological surgery from 1st March 2020 to 28th February 2021. According to the hospital organization and local epidemiological situation we delimitate three epidemic waves. A set of screening and protective measures was applied from 4th May onwards. Demographic, baseline, surgical and perioperative variables, as well as postoperative outcomes, were collected. Telephone follow-up was performed at least 3 weeks after hospital discharge. Results940 urological surgeries were performed, 12 of them had to be rescheduled due to active or recent SARS-CoV-2 infection identified by the screening protocol. Thirty-one patients developed COVID-19 (3.3% incidence) and 7 died (22.6% mortality). The average time to onset of symptoms was 62.6 days after discharge, being 25 cases attributable to community transmission. The remaining 6 cases, due to in-hospital transmission, had worse outcomes. Five of them were identified during the first wave, especially when no preoperative PCR was obtained. In contrast, during the second and third waves, fewer and milder cases were diagnosed, with just 1 in-hospital transmission among 857 urological patients. ConclusionsAfter implementing complete protective measures, postoperative in-hospital COVID-19 cases almost disappeared, even during the second and third waves. Most of the cases were due to community transmission and thus driven by the general epidemiological situation. While hospitals follow recommendations to avoid COVID-19 infection, urological surgery remains safe and can be maintained.

Infection control of COVID-19 in pediatric tertiary care hospitals: challenges and implications for future pandemics

BackgroundMore than 2 years into the COVID-19 pandemic, SARS-CoV-2 still impacts children’s health and the management of pediatric hospitals. However, it is unclear which hygiene and infection control measures are effective and useful for pediatric hospitals. Here, we report infection control measures implemented at a tertiary care children’s hospital. We evaluated frequency of SARS-CoV-2 detection in admitted patients, in-hospital transmission and infection related findings. Furthermore, we aimed to capture perspectives of health-care workers and caregivers on effectiveness and burden of infection control measures. Knowledge gained can inform management of the ongoing and future pandemics.MethodsWe designed a retrospective observational study and survey at a pediatric tertiary care referral center. Local infection control measures and respective guidelines regarding COVID-19 were reviewed. Three thousand seven hundred sixteen children under 18 years were tested for SARS-CoV-2 at the University Children’s Hospital Tuebingen and data on SARS-CoV-2 transmission were retrieved from internal records. Two surveys were conducted among 219 staff members and 229 caregivers.ResultsLocal infection control measures comprised the formation of a task force, triage, protective hygiene measures and an adaptable SARS-CoV-2 test strategy. Between January 2020 and March 2021, SARS-CoV-2 infection was detected in 37 children presenting to our hospital, 21 of these were admitted. One hospital-acquired infection occurred. About 90% of health-care staff perceived the majority of measures as effective and appropriate. However, visitor restrictions and cancellation of scheduled treatments were perceived least effective by hospital staff and as a particular burden for patients and their caregivers. Visits at the pediatric emergency department significantly decreased during the pandemic. We drafted a pandemic action plan by ranking infection control measures according to local transmission stages.ConclusionsSARS-CoV-2 infection control measures implemented in our tertiary care children’s hospital were evaluated by health-care workers as mostly effective and appropriate. In particular, good communication, transparency of decision-making as well as universal masking and infection screening were assessed as successful measures of infection control management. Visitor restrictions and cancellation of routine appointments, in contrast, were perceived as a particular burden on patient care and should be avoided. An established pandemic action plan may guide children’s hospitals in the future.

Incidence of SARS-CoV-2 Infection among Healthcare Personnel after Restarting an Elective Cataract Surgery during the First COVID-19 Wave

Background: During the COVID-19 pandemic, most elective surgeries were postponed, including cataract surgery. However, patients with severe and disabling visual impairment may have required urgent correction. Objective: To report the incidence of SARS-CoV-2 infection among healthcare personnel working with the patients requiring cataract surgery, under a pre-operative screening protocol. Materials and Methods: A retrospective observational study was conducted in the Suddhavej Hospital, Mahasarakham University, Mahasarakham, Thailand during the early unlocked phase in May 2020. The local pre-operative screening protocol used during the period included questionnaires and pre-operative nucleic acid testing to screen for COVID-19 infection among patients. A combination of serial single nucleic acid test and SARSCoV-2 IgG antibody testing were used to screen SARS-CoV-2 infection among healthcare personnel. Mask wearing and physical distancing were required during hospitalization. Results: One hundred fifty-eight patients underwent cataract surgery under local anesthesia. Thirty-three healthcare personnel were included. All tests for SARS-CoV-2 were negative for both patients and healthcare personnel. The incidence rate of COVID-19 infection among healthcare personnel was 0 (95% CI 0.000 to 0.003) per 100 person-hours. There were no reported symptoms compatible with COVID-19 during the observed period and follow-up. Conclusion: Due to a very low incidence rate of hospital-acquired SARS-CoV-2 infection among healthcare personnel, elective cataract surgery under local anesthesia could be continued during COVID-19 pandemic with strict adherence to screening protocol and other preventive measures. SARS-CoV-2 screening method by questionnaire alone may be feasible in a low COVID-19 incidence rate. Keywords: Cataract surgery; COVID-19; Pre-operative SARS-CoV-2 screening; Pool PCR testing; In-hospital transmission

Still a hospital hazard: Varicella-Zoster virus infection in a health-care worker after exposure to Herpes Zoster

Varicella-Zoster Virus (VZV), a highly contagious herpesvirus, remains a hospital hazard and nosocomial transmission of VZV, despite vaccine availability, is well documented. Although World Health Organization (WHO) recommends immunization for all health-care providers, cases of in-hospital VZV transmission are still reported and summarized here, indicating the existence of susceptible individuals. Here in we present a case of a health-care worker, infected by a patient with disseminated herpes zoster and discuss aspects that generally may contribute to this event like the inadequacy of hospital infection control unit interventions, the risk of reinfection despite immunity, the complacency of employees concerning their immunity status to VZV and unfortunately the anti-vaccination movement. Adherence to published recommendations for reduction of serosusceptible hosts is of primary importance, especially in the era of increased immunocompromised population.

Risk of SARS-CoV-2 transmission upon return to work in RNA-positive healthcare workers

BackgroundHealthcare workers (HCWs) are at risk for coronavirus disease 2019 (COVID-19), and for spreading severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) amongst colleagues and patients.AimTo study the presence of SARS-CoV-2 RNA and possible onward transmission by HCWs upon return to work after COVID-19, and association with disease severity and development of antibodies over time.MethodsUnvaccinated HCWs with positive SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) were recruited prospectively. Data on symptoms were collected via telephone questionnaires on days 2, 7, 14 and 21 after a positive test. Upon return to work, repeat SARS-CoV-2 RT-PCR was performed and serum was collected. Repeat serum samples were collected at weeks 4, 8, 12 and 16 to determine antibody dynamics over time. Phylogenetic analysis was conducted to investigate possible transmission events originating from HCWs with a positive repeat RT-PCR.FindingsSixty-one (84.7%) participants with mild/moderate COVID-19 had a repeat SARS-CoV-2 RT-PCR performed upon return to work (median 13 days after symptom onset), of which 30 (49.1%) were positive with a median cycle threshold (Ct) value of 29.2 (IQR 26.9–29.9). All HCWs developed antibodies against SARS-CoV-2. No significant differences in symptomatology and presence of antibodies were found between repeat RT-PCR-positive and -negative HCWs. Eleven direct colleagues of six participants with a repeat RT-PCR Ct value <30 tested positive after the HCW returned to work. Phylogenetic and epidemiologic analysis did not indicate onward transmission through HCWs who were SARS-CoV-2 RNA positive upon return to work.ConclusionsHCWs regularly return to work with substantial SARS-CoV-2 RNA loads. However, this study found no evidence for subsequent in-hospital transmission.

Preoperative Anxiety among Adult Patients Undergoing Elective Surgeries at a Tertiary Teaching Hospital: A Cross-Sectional Study during the Era of COVID-19 Vaccination.

Anxiety in the perioperative period has significant impact on both the flow of surgery and the post-operative recovery process. The aim of this cross-sectional study is to determine the prevalence of preoperative anxiety among adult patients undergoing elective surgical procedures at a tertiary teaching hospital and the effect of COVID-19 and COVID-19 vaccines on preoperative anxiety. We used the Amsterdam Preoperative Anxiety and Information Scale (APAIS) to assess patients’ anxiety toward surgery and their need for more information. Patients with APAIS about anesthesia and surgery (APAIS-A-T) total score <10 were considered as the low preoperative anxiety group, while patients with APAIS-A-T ≥11 were considered as the high preoperative anxiety group. The overall APAIS-A-T score of the 794 included patients was 8.5 ± 4.5. The mean APAIS-A-T score was 7.0 ± 3.8 among males and 9.6 ± 4.6 among female patients (p < 0.001). The APAIS-A-T score for those who had previously underwent surgery under anesthesia was 8.3 ± 4.4, compared to 9.5 ± 4.8 for those who had not (p = 0.002). No significant difference was found between those with a previous history of COVID-19 and those without (p = 0.105), nor between those who were vaccinated and those who were not (p = 0.550). Sixty-four (26.8%) highly anxious patients were afraid of becoming infected with COVID-19 during their hospital stay (p = 0.009). This fear of COVID-19 in-hospital transmission made 19 (7.9%) highly anxious patients and 36 (4.5%) of the total sample hesitant to undergo this surgery (p = 0.002). In conclusion, this study demonstrated that 30.1% of patients had high preoperative anxiety, with fear of pain after surgery being the most common factor related to anxiety on the day of surgery. Controlling the spread of COVID-19 can play a crucial role in decreasing preoperative anxiety during this pandemic.

Using a Combined Lean and Person-Centred Approach to Support the Resumption of Routine Hospital Activity following the First Wave of COVID-19.

The unexpected advent of the COVID-19 pandemic led to a sudden disruption of routine medical care, with a subsequent reorganization of hospital structures and of care. Case studies are becoming available in the literature referring to the logistical difficulties involved in a hospital resuming normal activity following the first COVID-19 lockdown period. This paper details the experience of a study site, a private hospital in Dublin, Ireland, in the redesign of service delivery in compliance with new COVID-19 prevention regulations to facilitate the resumption of routine hospital activity following the first wave of COVID-19. The aim was to resume routine activity and optimize patient activity, whilst remaining compliant with COVID-19 guidelines. We employed a pre-/post-intervention design using Lean methodology and utilised a rapid improvement event (RIE) approach underpinned by person-centred principles. This was a system-wide improvement including all hospital staff, facilitated by a specific project team including the chief operation officer, allied therapy manager (encompassing health and social care professionals), infection prevention and control team, head of surgical services, clinical nurse managers, patient services manager and the head of procurement. Following our intervention, hospital services resumed successfully, with the initial service resumption meeting the organizational target of a 75% bed occupancy rate, while the number of resumed surgeries exceeded the target by 13%. Our outpatient visits recovered to exceed the attendance numbers pre-COVID-19 in 2019 by 10%. In addition, patient satisfaction improved from 93% to 95%, and importantly, we had no in-hospital patient COVID-19 transmission in the study period of July to December 2020.

Safety, Efficacy, and Cost-Effectiveness of Same-Day Discharge for Left Atrial Appendage Occlusion.

Percutaneous left atrial appendage occlusion (LAAO) with the Watchman device is FDA approved for stroke prevention in patients with nonvalvular atrial fibrillation who have an appropriate indication. During the COVID-19 pandemic, a same-day discharge protocol (SDDP) was employed to improve resource utilization, relieve hospital occupation, and reduce the possible risk of in-hospital virus transmission. We sought to analyze the safety, feasibility, and cost effectiveness for SDDP in patients receiving LAAO. A prospective analysis of 142 consecutive patients, 119 treated prior to SDDP and 23 who underwent SDDP following LAAO with cardiac computed tomography angiography (CTA)-guided pre-procedural planning and intracardiac echocardiogram (ICE). Procedures were performed in a single, large academic hospital in the United States. In-hospital and 45-day procedural success, adverse events, length of procedure, and length-of-stay were evaluated. Baseline patient characteristics including mean CHA2DS2VASc scores and mean HAS-BLED scores were similar in both groups. All procedures were successful. There was no significant difference in rates of procedural complications or in-hospital adverse events. The mean procedure time in the SDDP group was 11 minutes longer than in the conventional group (62.1 ± 5.9 vs 51.1 ± 21; P=.01). Outcomes at 45-day follow-up were similar. SDDP was associated with a reduced length of stay compared with conventional strategy and a 15% reduction in total costs. Same-day discharge strategy for LAAO appears safe, feasible and could become the new standard approach for LAAO. A protocol including CTA pre-procedural planning, ICE-guided deployment and conscious sedation reduces hospital occupation and lowers costs.

Near Future Perspective of ESBL-Producing Klebsiella pneumoniae Strains Using Mathematical Modeling

While antibiotic resistance is becoming increasingly serious today, there is almost no doubt that more challenging times await us in the future. Resistant microorganisms have increased in the past decades leading to limited treatment options, along with higher morbidity and mortality. Klebsiella pneumoniae is one of the significant microorganisms causing major public health problems by acquiring resistance to antibiotics and acting as an opportunistic pathogen of healthcare-associated infections. The production of extended spectrum beta-lactamases (ESBL) is one of the resistance mechanisms of K. pneumoniae against antibiotics. In this study, the future clinical situation of ESBL-producing K. pneumoniae was investigated in order to reflect the future scenarios to understand the severity of the issue and to determine critical points to prevent the spread of the ESBL-producing strain. For evaluation purposes, SIS-type mathematical modeling was used with retrospective medical data from the period from 2016 to 2019. Stability of the disease-free equilibrium and basic reproduction ratios were calculated. Numerical simulation of the SIS model was conducted to describe the dynamics of non-ESBL and ESBL-producing K. pneumoniae. In order to determine the most impactful parameter on the basic reproduction ratio, sensitivity analysis was performed. A study on mathematical modeling using data on ESBL-producing K. pneumoniae strains has not previously been performed in any health institution in Northern Cyprus, and the efficiency of the parameters determining the spread of the relevant strains has not been investigated. Through this study, the spread of ESBL-producing K. pneumoniae in a hospital environment was evaluated using a different approach. According to the study, in approximately seventy months, ESBL-producing K. pneumoniae strains will exceed non-ESBL K. pneumoniae strains. As a result, the analyses showed that hospital admissions and people infected with non-ESBL or ESBL-producing K. pneumoniae have the highest rate of spreading the infections. In addition, it was observed that the use of antibiotics plays a major role in the spread of ESBL-producing K. pneumoniae compared to other risk factors such as in-hospital transmissions. As a matter of course, recoveries from Klebsiella infections were seen to be the most effective way of limiting the spread. It can be concluded from the results that although the use of antibiotics is one of the most effective factors in the development of the increasing ESBL-producing K. pneumoniae, regulation of antibiotic use policy could be a remedial step together with effective infection control measures. Such steps may hopefully lead to decreased morbidity and mortality rates as well as improved medical costs.

Negative Predictive Value of the Rapid Test Ag 2019-nCoV During the Predominance of Omicron over the Delta Variant and Implications in the Emergency Department

The high prevalence of asymptomatic patients infected with SARS-CoV-2 during the pandemic peaks and the common occurrence of in-hospital transmission urges the need for SARS-CoV-2 testing before admission of all patients with non-COVID-related symptoms. RT-PCR testing however is costly, time-consuming, and increases the length of stay in the emergency department. For the aforementioned reasons, we propose that the admission of non-suspected COVID-19 patients to the appropriate department should be based on the sole use of the rapid test result. In order to assess the safety of this suggestion, we assessed the negative predictive value of our rapid antigen tests that was calculated at 96.38%. This value was considered acceptable and the proposed strategy was applied in our hospital improving the overall turnaround times. However, since various rapid tests may perform differently, we propose that hospitals assess their own methodologies before implementing our proposal.

Short-Term Impact of Temporary Shutdown of a University-Affiliated Hospital on Patients With Colorectal Cancer During the Coronavirus Disease 2019 Pandemic.

Owing to in-hospital transmission of coronavirus disease 2019 (COVID-19), Uijeongbu St. Mary’s Hospital, a university-affiliated hospital in South Korea, was temporarily closed for disinfection in March 2020. This study aimed to investigate the impact of both the hospital shutdown and the prolonged COVID-19 pandemic on short-term outcomes of colorectal cancer (CRC) patients. We retrospectively reviewed the clinicopathologic data of 607 patients who were surgically treated for CRC from May 2018 to September 2021. Nodal upstaging, higher lymphatic invasion and abdominoperineal resection rates for 3 months after the hospital resumed surgery following the shutdown in the first wave of the COVID-19 pandemic were detected, without worse short-term morbidity or mortality. The incidence of adverse pathologic features of CRC such as lymphatic, venous, and perineural invasion was higher throughout the COVID-19 pandemic era. Further follow-up of CRC patients treated in the pandemic era for long-term oncologic outcomes is needed.

Outbreak of COVID-19 among children and young adults in a cancer centre daycare unit.

Nosocomial transmission of COVID-19 among immunocompromised hosts can have a serious impact on COVID-19 severity, underlying disease progression and SARS-CoV-2 transmission to other patients and healthcare workers within hospitals. We experienced a nosocomial outbreak of COVID-19 in the setting of a daycare unit for paediatric and young adult cancer patients. Between 9 and 18 November 2020, 473 individuals (181 patients, 247 caregivers/siblings and 45 staff members) were exposed to the index case, who was a nursing staff. Among them, three patients and four caregivers were infected. Two 5-year-old cancer patients with COVID-19 were not severely ill, but a 25-year-old cancer patient showed prolonged shedding of SARS-CoV-2 RNA for at least 12 weeks, which probably infected his mother at home approximately 7-8 weeks after the initial diagnosis. Except for this case, no secondary transmission was observed from the confirmed cases in either the hospital or the community. To conclude, in the day care setting of immunocompromised children and young adults, the rate of in-hospital transmission of SARS-CoV-2 was 1.6% when applying the stringent policy of infection prevention and control, including universal mask application and rapid and extensive contact investigation. Severely immunocompromised children/young adults with COVID-19 would have to be carefully managed after the mandatory isolation period while keeping the possibility of prolonged shedding of live virus in mind.

Surgical Approach and Management Strategies in a Pediatric Cardiovascular Surgery Clinic During the COVID-19 Outbreak.

IntroductionThe coronavirus disease 2019 (COVID-19) pandemic has required changes in the management of pediatric cardiac surgery. We would like to share the patient treatment and surgical management strategies employed in our Pediatric Cardiovascular Surgery Clinic during the COVID-19 pandemic.MethodsA total of 112 patients were followed up in our clinic between 11.03.2020 and 02.07.2020. Their mean age was 1,118 (4-5,740) days. Management and treatment were performed by our pediatric heart team (pediatric cardiac anesthetists, general pediatricians, pediatric cardiologists, pediatric cardiac surgeons, and an infectious diseases specialist). We prepared new protocols and a surveillance system specific to the pandemic to prevent in-hospital transmission and reduce postoperative mortality and morbidity; our operations were performed according to these protocols. All decisions pertaining to the operation timing and treatment strategy of our COVID-19-positive patients were made by the same team.ResultsDuring the study period, a total of 112 patients, 69 boys and 43 girls, were hospitalized in our clinic. A total of 333 COVID-19 real-time polymerase chain reaction tests were performed on patients and accompanying persons; positive results were found in three patients and two accompanying individuals.ConclusionBy employing new protocols and a surveillance system throughout the healthcare system, we think that early diagnosis and treatment of the pediatric congenital heart disease population, which is susceptible to infections, can continue unperturbed. This and similar approaches can increase postoperative success and prevent transmission in the pediatric population - which are frequently COVID-19 asymptomatic.

An Early Warning Mobile Health Screening and Risk Scoring App for Preventing In-Hospital Transmission of COVID-19 by Health Care Workers: Development and Feasibility Study.

BackgroundHospitals have been identified as very high-risk places for COVID-19 transmission between health care workers and patients who do not have COVID-19. Health care workers are the most at-risk population to contract and transmit the infection, especially to already vulnerable patients who do not have COVID-19. In low-income countries, routine testing is not feasible due to the high cost of testing; therefore, presenting the risk of uncontrolled transmission within non–COVID-19 treatment wards. This challenge necessitated the development of an affordable intermediary screening tool that would enable early identification of potentially infected health care workers and for early real time DNA–polymerase chain reaction testing prioritization. This would limit the contact time of potentially infected health care workers with the patients but also enable efficient use of the limited testing kits.ObjectiveThe aims of this study are to describe an early warning in-hospital mobile risk analysis app for screening COVID-19 and to determine the feasibility and user-friendliness of the app among health care workers.MethodsThe primary result of this research project was the development of a mobile-based daily early warning system for in-hospital transmission of COVID-19. Overall, the Early Warning System for In-Hospital Transmission of COVID-19 (EWAS) mobile app was found to be feasible, with over 69% of the health care workers having logged more than 67% of the required times. Over 93% of the participants reported that the tool was easy to use.ResultsThe primary result of this research project was the development of a mobile-based daily early warning system for in-hospital transmission of COVID-19. Overall, the Early Warning System for In-Hospital Transmission of COVID-19 (EWAS) mobile app was found to be feasible, with 69% of the health care workers (69/100) having logged more than 67% of the required times. Of the 100 participants, 93 reported that the tool was easy to use.ConclusionsThe EWAS mobile app is a feasible and user-friendly daily risk scoring tool for preventing in-hospital transmission of COVID-19. Although it was not designed to be a diagnostic tool but rather a screening tool, there is a need to evaluate its sensitivity in predicting persons likely to have contracted COVID-19.