Infection Control Precautions Research Articles

COVID-19 restrictions and psychological well-being of fathers with infants admitted to NICU-An exploratory cross-sectional study.

AimTo describe the impact of the COVID‐19 restrictions on the caregiving activities and psychological well‐being of fathers with infants admitted to neonatal units.MethodsCross‐sectional study using adapted COPE‐IS and COPE‐IU tools. Participants' recruitment occurred online via social media and parents' associations. Online survey in English, French and Italian were distributed and promoted via websites and social media platforms of parent's associations. The study was undertaken across 12 countries in Asia, Australia, Africa and Europe.ResultsA total of 108 fathers of NICU infants completed the survey. COVID‐19 related restrictions were categorised into 3 types: no restrictions, partial and severe restrictions. Fathers who experienced partial restrictions reported more involvement in caregiving activities but high levels of emotional difficulties and sleeping problems compared to those who experienced full or no restrictions.ConclusionGiven the impact on the psychological well‐being of fathers, restrictions should be avoided as much as possible in the neonatal unit and fathers given free access to their infants if they follow appropriate infection control precautions.

First experience of implementing Candida auris real-time PCR for surveillance in the UK: detection of multiple introductions with two international clades and improved patient outcomes

Candida auris has been associated with rapid transmission and high mortality. A novel PCR-based surveillance programme was initiated at a London teaching hospital from January 2018. The results of this implementation until March 2019 are presented along with the clinical, transmission and phylogenetic characteristics encountered in that setting. A real-time PCR assay for C.auris was developed, validated, and implemented for direct use on skin swabs and urine. Environmental swabs were also tested by PCR as an emergency outbreak-control measure. Clinical risk factors and outcomes of patients were determined. Environmental dispersal was assessed using 24h settle plate cultures around nine colonized patients followed by air sampling around one colonized patient during high- and low-turbulence activities. Sequencing was performed using Illumina HiSeq and maximum likelihood phylogenies were constructed using rapid bootstrap analysis. Twenty-one C.auris colonized patients were identified. Median turnaround time of colonization detection reduced from 141h (5.8 days) to approximately 24h enabling rapid infection-control precautions. Settle plates detected 70-600cfu/m2 around colonized patients over 24h and air sampling suggested dispersal during turbulent activities. C.auris DNA was detected from 35.7% environmental swabs. Despite being in a high-risk setting, no patients developed invasive infection. Sequencing analysis of isolates from this centre identified two introductions of the South Asian (Clade I) and one of the South African (Clade III) strain. The PCR offers a rapid, scalable method of screening and supports clinical risk reduction in settings likely to encounter multiple introductions.

Unmasked: The Impact of the COVID-19 Pandemic on Reported Cases of Legionnaires’ Disease

BackgroundAn increasing public health concern has been the rising incidence of Legionnaires’ disease (LD). The rate of reported cases has increased nearly 9 times since 2000. The emergence of SARS-CoV-2 (COVID-19) in December 2019 constituted a major epidemiological event and has the potential to influence reported cases of LD. Both are respiratory diseases sharing similar clinical presentations and risk groups, which may have confounded the diagnosis of LD — The aim of this study was to investigate the impact of the COVID-19 pandemic on reported cases of LD in 2020 compared to the previous three years (2017-2019).MethodsWe conducted a retrospective descriptive study. A two-sample t-test was used to compare nationally reported cases of LD in 2020 (COVID-19 intervention year) to 2017-2019 (pre-intervention). Syphilis was used as a non-respiratory bacterial disease control. We analyzed data from the Centers for Disease Control and Prevention's (CDC) National Notifiable Disease Surveillance System (NNDSS).ResultsAt the conclusion of 2020 there were 4,245 reported cases of LD. Average monthly cases decreased >50% in the post-intervention period compared to the pre-intervention period (353.75 from 730 respectively; p< 0.005). We did not observe significant changes in reported cases of syphilis post-intervention.ConclusionsReported cases of LD decreased in 2020. Infection control precautions intended to reduce COVID-19 likely contributed to this reduction. Other factors may include delayed reporting, underdiagnosis and low building occupancy. Relaxing precautions and increasing building occupancy may portend spikes in cases in the “post-pandemic” period. Our findings demonstrate the need to better understand the consequences of major epidemiological events on other reportable diseases.

Utility of SARS-CoV-2 rapid antigen testing for patient triage in the emergency department: A clinical implementation study in Melbourne, Australia

SummaryBackgroundEarly, rapid detection of SARS-CoV-2 is essential in healthcare settings in order to implement appropriate infection control precautions and rapidly assign patients to care pathways. Rapid testing methods, such as SARS-CoV-2 rapid antigen testing (RAT) may improve patient care, despite a lower sensitivity than real-time PCR (RT-PCR) testing.MethodsPatients presenting to an Emergency Department (ED) in Melbourne, Australia, were risk-stratified for their likelihood of active COVID-19 infection, and a non-randomised cohort of patients were tested by both Abbott Panbio™ COVID-19 Ag test (RAT) and SARS-CoV-2 RT-PCR. Patients with a positive RAT in the ‘At or High Risk’ COVID-19 group were moved immediately to a COVID-19 ward rather than waiting for a RT-PCR result. Clinical and laboratory data were assessed to determine test performance characteristics; and length of stay in the ED was compared for the different patient cohorts.FindingsAnalysis of 1762 paired RAT/RT-PCR samples demonstrated an overall sensitivity of 75.5% (206/273; 95% CI: 69·9-80·4) for the Abbott Panbio™ COVID-12 Ag test, with specificity of 100% (1489/1489; 95% CI: 99·8-100). Sensitivity improved with increasing risk for COVID-19 infection, from 72·4% (95% CI: 52·8-87·3) in the ‘No Risk’ cohort to 100% (95% CI: 29·2-100) in the ‘High Risk’ group. Time in the ED for the ‘At/High Risk’ group decreased from 421 minutes (IQR: 281, 525) for those with a positive RAT result to 274 minutes (IQR:140, 425) for those with a negative RAT result, p = 0.02.InterpretationThe positive predictive value of a positive RAT in this setting was high, allowing more rapid instigation of COVID-19 care pathways and an improvement in patient flow within the ED.FundingRoyal Melbourne Hospital, Melbourne, Australia.

Optimizing and Unifying Infection Control Precautions for Respiratory Viral Infections

Optimizing and Unifying Infection Control Precautions for Respiratory Viral Infections

Incidence of Methicillin Resistant Staphylococcus Aureus (MRSA) Among Patients Necessitating Reconstructive Surgery

Purpose: Staphylococcus aureus is an important nosocomial pathogen and the progression of methicillin resistance stances a most important threat for its control. The current study was directed to govern the MRSA prevalence and its susceptibility to various antibiotics given for anti-staphylococcal strains in OPD treated patients. Study design: Prospective descriptive study. Place and duration: This study was conducted in the East Surgical Ward of Mayo Hospital, Lahore for two-year duration from January 2020 to December 2021. Methods: A total of 200 patients with septic wounds of both sexes were encompassed in the study. Swabs were taken from wounds which were infected and Stuart's medium was used to transport them. The samples were grown onto MacConkey agar, nutrient agar and blood agar and for 24 hours; incubated at 37 ° C. All MRSA isolates were biochemically and morphologically identified using standard procedures of laboratory by processing clinical specimens submitted to a microbiology laboratory. All isolates were tested for patterns of resistance and sensitivity. Results: A total of 200 patients were included, 115 (57.5%) were men and 85 (42.5%) were women with 27.3 years of mean age and age range from 15-70 years. The incidence of positive cases confirmed by culture was 118 (59%) and the MRSA incidence was 78 (39%). Of the 78 cases of MRSA, 50 (64.10%) are men and 28 (35.90%) are women. The incidence of other microorganisms was 40 (33.8%). MRSA was 100% sensitive to vancomycin, teicoplanin and linezolid. Of these, 24.4% were sensitive to cotrimoxazole, 47.4% were sensitive to fucidic acid and 28.2% were sensitive tetracycline antibiotics. Cultured MRSAs were resistant 100% to main antibiotic groups including penicillin, macrolides, cephalosporins, fluoroquinolones, meropenem, imipenem, gentamicin, and tazobactum/ pipracillin. Of all 78 MRSA patients, &gt; 50% were from general surgery and orthopaedics departments, and the remainder from other related specialties, such as Gynecology, pediatric surgery, maxillofacial surgery, neurosurgery and otolaryngology. Of 78 patients with MRSA, 70 (89.7%) were hospitalized with a history of hospitalization, and 60 (76.9%) were hospitalized for &gt;1-week. The organism was institute to be hundred percent resistant to the generally directed antibiotics. Conclusions: The incidence of MRSA is increasing. The organism spreads readily in a hospital setting, causing morbidity, mortality and higher costs. Special infection control actions and precautions should be taken to stop and prevent the MRSA spreading. Keywords: Nosocomial infections, MRSA and Antibiotic resistance

Occupational Prevention of COVID-19 Among Healthcare Workers in Primary Healthcare Settings: Compliance and Perceived Effectiveness of Personal Protective Equipment.

It is crucial for healthcare workers (HCWs) to comply with infection prevention and control precautions such as the appropriate use of personal protective equipment (PPE) for their safety and the safety of patients. In this study, we aimed to assess HCWs' compliance with the appropriate use of PPE in primary healthcare settings in Qatar along with its associated factors and explore their perceived effectiveness of different PPE items in protecting against COVID-19 infection. A Web-based survey was conducted between November 2020 and January 2021 targeting all clinical HCWs under the umbrella of Primary Health Care Corporation. A total of 757 HCWs completed the survey, and most were between 30 and 39 years of age (50.2%), females (62.7%), and nurses (35.3%). Eighty eight percent of participants believed that PPE could provide high or very high protection against COVID-19. About one-half (53%) were found to be fully compliant with PPE use during patient interactions with suspected or confirmed COVID-19 cases, whereas three-quarters (76.3%) were fully compliant while performing aerosol-generating procedures. Healthcare workers' age, nationality, health center region, area of work, clinical experience, frequency of interaction with suspected or confirmed COVID-19 cases, and the perceived effectiveness of PPE were significant predictors of full compliance with PPE. Shortage of PPE was the commonest reported barrier to appropriate use. Despite HCWs' high perceived effectiveness for PPE in protecting against COVID-19 infection, their full compliance rate with using PPE was moderate and needs further improvement.

A Survey of Knowledge, Attitude, and Adherence to Standard Precautions of Infection Control among Khoy Nursing Students during the COVID-19 Pandemic in 2021: A Short Report

A Survey of Knowledge, Attitude, and Adherence to Standard Precautions of Infection Control among Khoy Nursing Students during the COVID-19 Pandemic in 2021: A Short Report

The use of core genome multilocus sequence typing to determine the duration of vancomycin-resistant Enterococcus faecium outbreaks.

The prevalence of vancomycin-resistant Enterococcus faecium has increased rapidly, and in Denmark, we are facing an endemic outbreak situation in hospitals. The aim of this study was to use whole-genome sequencing (WGS) and core genome multilocus sequencing typing (cgMLST) to determine the duration of VREfm outbreaks and thereby evaluate the effect of our infection control strategies. We included all VREfm isolates from six hospitals in the Capital Region of Denmark that were sequenced between 2012 and 2020. Ward data were collected from our laboratory information system. A ward outbreak was defined as two patient samples from the same ward within a period of 30 days belonging to the same cgMLST cluster. cgMLST complex types were determined using Ridom SeqSphere v7.2.3, where a maximum of 20 allelic differences between isolates defines a cluster. We included 1690 patient isolates between 2012 and 2020. Our collection consisted of 45 unique clusters and 227 ward outbreaks. The median duration of outbreaks was 20 days. We reported a median outbreak duration of VREfm outbreaks based on WGS data to be 20 days, and thus concluded that our infection control precautions are adequate.

758 Constant evolution: Early experiences treating COVID-19 in a burn center

IntroductionThe COVID-19 pandemic came as an unexpected challenge to many healthcare systems around the world. Many centers struggled to provide COVID-19 ICU-level care while also maintaining adequate care for non-COVID-19-related conditions, especially in critical care specialty units like trauma and burn. We present a case series of our early experiences treating COVID-19 in a burn center.MethodsWe present a case.ResultsSee Table 1. Though one case was admitted prior to initiation of universal testing, routine infection-control protocols limited exposure to personnel and prevented transmission to staff. In May 2020, we implemented the use of N95 mask and eye protection during all aerosolizing procedures, N95 mask use in all ORs, and universal surgical mask use in all rooms regardless of COVID-19 status. An in-house risk-stratification system was used to screen patients based on symptoms and exposure. Burn-center admissions were screened at a lower threshold than throughout the institution given the unique nature of burn injury. Eventually, because of increasing community spread, all admissions to the hospital were universally screened with RT-PCR prior to admission. To minimize exposure to non-COVID patients and Burn Center staff, COVID-19 positive burn admissions were assessed on a case-by-case basis. High acuity patients were admitted to the Burn Center and followed by the COVID consult team. Lower acuity patients were admitted to the Burn Center but were treated on the medical COVID unit and followed by the burn consult service.ConclusionsThe COVID 19 pandemic has strained healthcare systems worldwide. Development and implementation of universal screening, testing, infection-control precautions, and triage strategies are critical elements of burn care during the COVID-19 pandemic. As we prepare for future surges due to more transmissible variants, implementation of standard protocols enables continued provision of quality care, preservation of the healthcare workforce, and efficient use of resources.

Longitudinal SARS-CoV-2 Testing among the Unvaccinated Is Punctuated by Intermittent Positivity and Variable Rates of Increasing Cycle Threshold Values.

ABSTRACTThe coronavirus disease 2019 (COVID-19) pandemic is complicated by cases of vaccine breakthrough and reinfection and widespread transmission of variants of concern (VOCs). Consequently, the need to interpret longitudinal positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests is crucial in guiding clinical decisions regarding infection control precautions and treatment. Although diagnostic real-time reverse transcription (RT)-PCR tests yield CT values that are inversely correlated with RNA quantity, these tests are only approved for qualitative interpretation. In this study, we performed a retrospective review of 72,217 SARS-CoV-2 positive tests and identified 264 patients with longitudinal positivity prior to vaccination and VOC circulation. Patients with longitudinal positivity fell into two categories: short-term (207, 78%) or prolonged (57, 22%) positivity, defined as ≤28 (range, 1 to 28; median, 16) days and >28 (range, 29 to 152; median, 41) days, respectively. In general, CT values increased over time in both groups; however, 11 short-term-positive patients had greater amounts of RNA detected at their terminal test than at the first positive test, and 6 patients had RNA detected at CT values of <35 at least 40 days after initial infection. Oscillating positive and negative results occurred in both groups, although oscillation was seen three times more frequently in prolonged-positive patients. Patients with prolonged positivity had diverse clinical characteristics but were often critically ill and were discharged to high-level care or deceased (22%). Overall, this study demonstrates that caution must be emphasized when interpreting CT values as a proxy for infectivity, a predictor of severity, or a guide for patient care decisions in the absence of additional clinical context, particularly among the unvaccinated population.IMPORTANCE We describe the duration of positivity and the COVID-19 treatment and outcome characteristics of an unvaccinated population of patients with prolonged SARS-CoV-2 positivity. This investigation serves to highlight challenges in using CT values to guide clinical decisions among unvaccinated individuals.

Recognizing and responding to clinical deterioration in adult patients in isolation precautions for infection control: a retrospective cohort study.

Patient isolation is widely used as a strategy for prevention and control of infection but may have unintended consequences for patients. Early recognition and response to acute deterioration is an essential component of safe, quality patient care and has not been explored for patients in isolation. The primary aims of this study were to (i) describe the timing, frequency and nature of clinical deterioration during hospital admission for patients with isolation precautions for infection control and (ii) compare the characteristics of patients who did and did not deteriorate during their initial period of isolation precautions for infection control. This retrospective cohort study was conducted across three sites of a large Australian health service. The study sample were adult patients (≥18 years) admitted into isolation precautions within 24 h of admission from 1 July 2019 to 31 December 2019. There were 634 patients who fulfilled the study inclusion criteria. One in eight patients experienced at least one episode of clinical deterioration during their time in isolation with most episodes of deterioration occurring within the first 2 days of admission. Timely Medical Emergency Team calls occurred in almost half the episodes of deterioration; however, the same proportion (47.2%) of deterioration episodes resulted in no Medical Emergency Team activation (afferent limb failure). In the 24 h preceding each episode of clinical deterioration (n = 180), 81.6% (n = 147) of episodes were preceded by vital signs fulfilling pre-Medical Emergency Team criteria. Patients who deteriorated during isolation for infection control were older (median age 74.0 vs 71.0 years, P = 0.042); more likely to live in a residential care facility (21.0% vs 7.2%, P = 0.006); had a longer initial period of isolation (4.0 vs 2.9 days, P = < 000.1) and hospital length-of-stay (median 4.9 vs 3.2 days, P = < 0.001) and were more likely to die in hospital (12.3% vs 4.3%, P < 0.001). Patients in isolation precautions experienced high Medical Emergency Team afferent limb failure and most fulfilled pre-Medical Emergency Team criteria in the 24 h preceding episodes of deterioration. Timely recognition and response to clinical deterioration continue to be essential in providing safe, quality patient care regardless of the hospital-care environment.

Nurses' Compliance with Standard Precautions Based on Health Belief Model in Emergency Departments

Introduction: Nurses' compliance with standard precautions is a viable tool for decreasing health hazards in health centers. Objective: This study aimed to identify factors affecting compliance with standard precautions (SPs) of infection control based on the health belief model (HBM) among emergency department nurses employed in the educational-therapeutic centers affiliated with Guilan University Medical Sciences in Rasht City, Iran. Materials and Methods: This cross-sectional study included 252 nurses working in the emergency departments of hospitals in Rasht City. The study samples were recruited using the convenience sampling method from September to October 2020. Nurses completed questionnaires, including demographics data, HBM constructs, knowledge, and compliance with standard precautions. A hierarchical multiple linear regression analysis was used to identify factors related to compliance with SPs. Results: The mean ±SD age of the nurses was 32.77±7.05 years, and the majority of them were females (88.9%). Their mean ±SD score for compliance with SPs was 63.2 ±16.0 (out of 100). The multivariable analysis results showed that the knowledge (β=0.47, 95%CI; 0.30-0.64, P=0.001), perceived benefits (β =0.19, 95%CI; 0.03-0.36, P=0.022) and perceived susceptibility (β =0.25, 95%CI; 0.13-0.36, P=0.001) constructs of HBM were positively correlated with the compliance with SPs. Furthermore, the level of education was significantly related to the compliance with SPs (β =9.51, 95%CI; 0.02-18.99, P=0.049). The final model accounted for 39.8% of the variance in compliance with SPs. Conclusion: Results indicated improvement in activity and safety level of the healthcare workers and also an increase in the overall level of compliance among nurses through education, regular training, and use of encouragement and punishment policies. It is suggested to follow the World Health Organization protocols. Also, the support management could have a better effect on perceived benefits and cues to action.

The Effect of Implementing COVID-19 Infection Control Precautions on Conducting Simulation-Based Training Activities.

IntroductionDue to the coronavirus disease 2019 (COVID-19) pandemic, onsite simulation training required infection control precautions. This study aimed to investigate the effect of implementing the infection control protocol on the participants' evaluation of simulation activities.Materials and methodsThe study included undergraduate female students from healthcare colleges in Princess Nourah University (PNU) who have attended simulation training events in the simulation and skills development center (SSDC). The study design was a cohort retrospective where data were retrieved from the SSDC participant evaluation database. The data included information related to participants' characteristics, simulation activities type, and learners' evaluation. The simulation activities included in the study were procedural simulation (PS) and full simulation (FS).ResultsThe study included 837 subjects that were randomly chosen from January 2019 to December 2021. All participant's evaluations of simulation events conducted in the SSDC during the specified period were reviewed and randomly selected to be included in the study. Due to the COVID-19 pandemic, the activities were conducted under infection control protocol measures. There was a significant difference in evaluation results of FS and PS activities before and after implementing the COVID-19 infection control protocol (p-value < 0.001).ConclusionThe study showed that conducting simulation activities in a simulation center under the infection control protocol does not negatively affect participants' evaluation of simulation events.

Barriers to and facilitators for supporting patient communication in the adult ICU during the COVID-19 pandemic: A qualitative study.

AbstractAimTo explore barriers to and facilitators for supporting communication with and for patients treated with invasive mechanical ventilation in the intensive care unit during the COVID‐19 pandemic.DesignA qualitative descriptive study reported according to the Consolidated Criteria for Reporting Qualitative Research.MethodsAdult intensive care unit patients treated with an advanced airway for mechanical ventilation, their family members and healthcare providers (nurses, intensivists and allied health) were recruited for interviews between January and April 2021. Interviews were audio‐recorded, transcribed verbatim and analysed using content analysis methods. Reported communication barriers and facilitators were mapped to the theoretical framework of acceptability to identify potentially modifiable clinical and institutional practices.ResultsWe recruited 29 participants (20 healthcare providers, four patients and five family member). Provider communication barriers included isolation procedures, lack of personal protective equipment and inadequate communication tools/training, which reduced perceived communication frequency and effectiveness. Patients and families reported infrequent proactive provision of communication tools, which contributed to a crisis of unmet needs. Reported facilitators included adequate access to personal protective equipment to mitigate the risk of patient proximity and communication tools/training to improve communication effectiveness. Authentic unit leadership helped to assuage pandemic work stressors and encourage humanistic care. Our analysis indicates low acceptability of existing communication practices during the COVID‐19 pandemic and the importance of leadership to reduce the burden of communication through provision of key necessary resources.ConclusionCOVID‐19 conditions have precipitated a communication crisis in the ICU. The results of this study have practice and policy implications and will be used to co‐design a communication intervention for use during and beyond the COVID‐19 pandemic.ImpactThe study contributes a better understanding of resources necessary to support patient communication. Results apply beyond the pandemic to routine use of infection prevention and control precautions in the intensive care unit.

Web-Based Intervention Improves Surgical Units Nurses' Performance about Infection Control Precautions during Coronavirus Outbreaks

Web-Based Intervention Improves Surgical Units Nurses' Performance about Infection Control Precautions during Coronavirus Outbreaks

Nurses’ Compliance with Universal Precautions for Infection Control in Health Care Centers in Shoubra El Kheimah

Nurses’ Compliance with Universal Precautions for Infection Control in Health Care Centers in Shoubra El Kheimah

Evaluation of the QIAstat-Dx Respiratory SARS-CoV-2 panel, a rapid multiplex PCR method for the diagnosis of COVID-19

IntroductionRapid, simple, and accurate methods are required to diagnose coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to evaluate the performance of the QIAstat-Dx Respiratory SARS-CoV-2 Panel (QIAstat-SARS-CoV-2), a rapid multiplex PCR assay for SARS-CoV-2 detection. MethodsNasopharyngeal swabs (NPS) that were obtained from patients with COVID-19 who were diagnosed at the National Center for Global Health and Medicine were used in this study. When the NPS samples were found to be negative for SARS-CoV-2 after treatment, they were used as negative samples. We evaluated the performance of the QIAstat-SARS-CoV-2 comparing SARS-CoV-2 detection with the National Institute of Infectious Diseases in Japan-recommended real-time polymerase chain reaction (RT-PCR) method (NIID-RT-PCR). ResultsIn total, 45 NPS samples were analyzed. The proportion of overall agreement between QIAstat-SARS-CoV-2 and NIID-RT-PCR on 45 samples was 91.0% with a sensitivity of 84.0% (21/25), specificity at 100% (20/20), negative predictive value at 83.3% (20/24), and positive predictive value at 100% (21/21). There were no patients with co-infections with pathogens other than SARS-CoV-2. ConclusionsQIAstat-SARS-CoV-2 showed a high agreement in comparison with the NIID-RT-PCR for the detection of SARS-CoV-2. The QIAstat-SARS-CoV-2 also provided a rapid and accurate diagnosis for COVID-19, even when the concurrent detection of other respiratory pathogens was desired, and therefore, has the potential to direct appropriate therapy and infection control precautions.

In Situ Simulation as a Tool to Longitudinally Identify and Track Latent Safety Threats in a Structured Quality Improvement Initiative for SARS-CoV-2 Airway Management: A Single-Center Study.

In situ simulation has emerged as a powerful tool for identifying latent safety threats (LSTs). After the first wave of the SARS-CoV-2 pandemic, an urban community emergency department (ED) identified opportunities for improvement surrounding acute airway management and particularly focused on infection control precautions, equipment availability, and interprofessional communication during acute resuscitation. Using the Model for Improvement, a hybrid in situ/quality improvement initiative was implemented using Plan-Do-Study-Act (PDSA) cycles to enhance systems for intubating patients with SARS-CoV-2. Three PDSA cycles consisting of 10 simulations each were conducted from June 2020 through February 2021. Latent safety threats (LST) were identified through an in situ simulation scenario involving a patient with SARS-CoV-2 in acute respiratory failure. LSTs were collected through structured debriefs focused on (1) infection control, (2) equipment availability, and (3) communication. The SAFER-Matrix was used to score LSTs according to frequency and likelihood of harm by members of the ED QI team (SAFER score). The research team worked with the same QI leaders to implement action plans based on scored threats using cause-and-effect and driver diagrams. The Donabedian model was used to conceptually evaluate the quality of interventions upon conclusion of the third PDSA cycle. The median SAFER score decreased from 10.94 in PDSA cycle 1 to 6.77 in PDSA cycle 2 to 4.71 in PDSA cycle 3. Across all identified LSTs, the SAFER score decreased by 3.114 for every additional PDSA cycle ( P = 0.0167). When evaluating for threats identified as being primarily structure based, there was a decrease in SAFER score of 1.28 per every additional PDSA cycle ( P = 0.001). There was a decrease in total count of LST of 0.20 per additional simulation run ( P = 0.02) after controlling for shift type, census, perceived workload, team size, and prior attendance in simulations across all PDSA cycles. This study presents a blueprint for the utilization of in situ simulation through multiple waves of the SARS-CoV-2 pandemic to identify LSTs and use the SAFER score as a surrogate marker to monitor the impact of interventions for a safer environment for both medical staff and patients.

Infection control, hand hygiene practice and PPE use among phoniatricians and ENT specialists during the COVID-19 pandemic, a UEP survey

BackgroundCaring for our patients while taking care of our own safety as well as theirs is a major concern during the current pandemic. Therefore, many societies developed guidance documents to educate clinicians about the required precautions. This study aims to assess personal protective equipment (PPE) usage, hand hygiene practice and infection control training among phoniatricians and otolaryngologists during the pandemic. An online survey was administered during the first wave of the COVID-19 pandemic in June 2020. Data collected included PPE availability, infection control training, adopted infection control precautions, hand hygiene practice, and use of different PPE elements as well as adherence to its use during potential aerosol generating procedures.ResultsBased on their country of residences, eligible 154 participants were grouped into 4 groups and their responses were compared.ConclusionFollowing the suggested recommendations, while adequate for some precautions, was still not satisfactory. Certain defects that are specific to particular groups had also been identified.