Infection Control Precautions Research Articles

“KNOWLEDGE AND PRACTICE OF STANDARD OPERATINGPROCEDURE ON INFECTION PREVENTION ANDCONTROLOF COVID-19 AMONG ICU NURSES OF KAMRUP (M) ASSAM; A DESCRIPTIVE STUDY”

According to WHO the outbreak of coronavirus disease (COVID- 19) that was rst reported from Wuhan , China, on 31st Dec 2019. As we are aware , Covid- 19 is widely spreading across the country rising beyond 4000 positive cases in a day of the rst wave. In India according to R. Gangakhedar , the head of the epidemiology division at ICMR, said at the press conference on April 20th , 2020 of 80 out of 100 conrmed COVID-19 cases were asymptomatic. It is the responsibility of the staff to ensure that they constantly maintain a high standard of infection control practice. SOP in infection control means the standard infection control precautions must be used by all nurses , in all care settings, at all time, for all patients whether infection is known to be present or not but to ensure the safety of those of being cared for , as well as the staffs and the visitors. OBJECTIVE1. To assess the knowledge of SOP on infection prevention and control of COVID- 19 among nurses . 2. To evaluate the practice of SOP on infection prevention and control of COVID-19 among nurses. 3. To nd the correlation between the knowledge and practice of SOP on infection prevention and control among nurses . 4. To nd out the association between the knowledge and practice with selected demographic variables ( age, qualication, gender, education, experience, type of ICU, training attended ) among nurses. METHODS AND MATERIALS- the research approach adopted for the study was quantitative approach. A descriptive research design was used in this study to accomplish the objectives using non-probability purposive sampling technique for obtaining adequate sample for the study. Study was undertaken on 60 ICU nurses in selected hospitals of Kamrup (M) Assam. Participants were selected on the basis of those who fullled the inclusion criteria. The tool used for the study was structured knowledge questionnaire was used to assess the knowledge, and observation checklist was used to evaluate the practice of SOP on infection prevention and control of COVID-19 D RESULTS- ata analysis was done by calculating mean, standard deviation and chi square. In knowledge, the study revealed that out of 60 respondents , majority 38 (63 %) had moderately adequate knowledge, 14(23%) had inadequate knowledge and 8(14%) had adequate knowledge of Standard Operating Procedure on infection prevention and control of COVID-19. In practice , the study revealed that out of 60 respondents , majority 51(85%) had moderately adequate practice and 9 (15%) had adequate practice of Standard Operating Procedure on infection prevention and control of COVID-19.The corelationship between knowledge and practice were 0.331 which was moderately positive correlation. There was signicant association of knowledge with total years of working experience among nurses working in CTVS, ICCU and post-COVID- 19 ICU and none of the demographic variables had shown statistically signicant association with level of practice of Standard Operating Procedure on infection prevention and control of COVID-19 among nurses . - After analyzing the collected data CONCLUSION .This study gives the area to improve in knowledge of the nurses and practice of ICU nurses regarding SOP on infection prevention and control of COVID-19. Therefore, continual education to the nurses does go long way in increasing their knowledge and practice to prevent infection which can help in controlling the rate of Hospital acquired infections .

Vancomycin-resistant Enterococcus species: Antimicrobial resistance and virulence genes profile

BackgroundIn this study, antimicrobial resistance, virulence genes profile, and genetic relatedness among Enterococcus isolates obtained from a hospital in Ardabil were studied. MethodsE. faecalis and E. Faecium isolates were identified using microbiological and molecular methods. Vancomycin minimum inhibitory concentrations (MICs) were determined by agar dilution assay. Antimicrobial resistance pattern was evaluated by the disk diffusion method. Vancomycin resistance and virulence genes were detected by polymerase chain reaction (PCR). Genetic relatedness among the vancomycin-resistant Enterococcus (VRE) isolates was evaluated by enterobacterial repetitive intergenic consensus (ERIC)-PCR. ResultsTotally, 96 Enterococcus isolates were collected. Of these, 72 (75%) and 24 (25%) cases belonged to E. faecalis and E. faecium species, respectively. One (1.4%) and 10 (41.7%) isolates of E. faecalis and E. faecium were found to be resistant to vancomycin, respectively. All the VRE isolates were positive for the vanA gene. Both E. faecalis and E. faecium species showed high rates of resistance to erythromycin (58.3%, 87.5%), tetracycline (50%, 79.16%), rifampicin (47.2%, 95.8%), and ciprofloxacin (38.9%, 75%), respectively. The resistance rates were significantly higher in VRE isolates compared to vancomycin-sensitive isolates (P ≤ 0.05). The lowest values were observed for resistance to nitrofurantoin (1.4% and 0.0%) and chloramphenicol (1.4% and 12.5%) in E. faecalis and E. faecium isolates, respectively. Most of the VRE isolates were recovered from urine specimens obtained from patients admitted to internal ward. gelE and asa1 were the major virulence genes in VRE isolates. High genetic diversity was observed among VRE isolates. ConclusionThe high prevalence of genetically versatile and multidrug resistant E. faecium in our study indicates the need for careful infection control precautions.

Prevalence of Klebsiella Pnuemonia and their In-Vitro Susceptibility Studies among Cattle Traders in Maiduguri Cattle Market, Borno State, Nigeria

This study was undertaken to assess the occurrence of Klebsiella pneumoniae and there in-vitro susceptibility among cattle traders, herdsmen and butchers in Maiduguri cattle market, Borno state, Nigeria. Two hundred and twelve sample (212) sputum samples were collected using wide mouth sterile universal container and transported immediately to Medical Micro-Biology laboratory department, Centre of Excellence, university of Maiduguri teaching hospital (U.M.T.H.) for Laboratory diagnosed. The Sputum samples were culture on MacConkey and Blood agar media and isolated then, identified using Biochemical test which include indole, citrate utilization and urease tests, but only 15 sputum samples were found infected or positive to Klebsiella pneumoniae. And their Antimicrobial susceptibility of the Klebsiella pneumoniae isolate by disc diffusion method shows that Klebsiella pneumoniae are susceptible to these Antimicrobial Drugs: Pefloxacin (93.3%), Tarivid (100%), Sparfloxacin (80%), Ciprofloxacin (93.3%) and on the other hand Klebsiella pneumoniae are resistance to these Antimicobial drugs; Streptomycin (73.3%), Septrin (80%), Augumentin (73.3%), Gentamycin (66.7%), and Amoxacillin (60%). In conclusion, recommendation have been made on how to curtail the spread of infection caused by Klebsiella in the environment, homes, and between patients. Healthcare providers are advice to follow the specific infection-control precautions.

SARS-CoV-2 Shedding in Dialysis Patients With COVID-19

SARS-CoV-2 Shedding in Dialysis Patients With COVID-19

Assessment of Health Care Workers’ Knowledge and Practice Toward Infection Standard Precautions in Primary Health Care setting, Buraidah, Saudi Arabia

Background: This study aimed to assess knowledge of standard precautions (SPs) and infection control by healthcare workers (HCWs) at the primary healthcare level in Buraidah City, Qassim Region, Saudi Arabia. Methods: A cross sectional study enrolled HCWs (doctors, nurses, lab workers) from 20 primary healthcare (PHC) centers in Buraidah. Two-hundred participants were selected randomly to participate in this study. Data was collected by a pretested, self-administered questionnaire, containing 29 items about basic knowledge of components of SPs and infection control including hand hygiene, personal protective equipment, sharps disposal, environmental sanitation and care of healthcare providers. Data was entered and analyzed using SPSS. Results: The mean age of HCWs was 35.7 (SD±6.6) years. Females represented (51.5%) of the study participants. History of receiving formal training in standard infection control precaution in the last three years was mentioned by almost two-thirds (68.5%) of them. About 102 (51.0%) of the HCWs had adequate level of knowledge (>5 correct answers) regarding standard precautions(SPs) of infection control. The younger (p=0.020), non-Saudi healthcare workers (p<0.001), physicians (p<0.001); particularly consultants (p=0.018), were more knowledgeable than their counterparts. The barriers of improper use of PPEs reported by HCWs were uncomfortable (61.5%), some patients feel stigmatized when PPEs are used (60.5%), shortage in items at PHCC (54%) and workload due to patients’ over-crowding (49%). Conclusion: Generally the study finding revealed adequate knowledge of SPs among the study participants. However, inadequate knowledge particularly concerning the disposal of sharp instruments and hand hygiene were also detected. These findings highlighted the necessity of the provision of a comprehensive training program to ensure compliance with infection control measures by HCWs. Key words: knowledge, practice, infection standard precautions, primary health care

Infusing Standard Precautions for Infection Control in Occupational Therapy Telehealth With Children

Infusing Standard Precautions for Infection Control in Occupational Therapy Telehealth With Children

Reverse Transcription Loop-Mediated Isothermal Amplification Assay-Based Infection Control Strategies for COVID-19 in a Hospital Under the State of Emergency in Tokyo, Japan in Spring 2020.

Studies describing reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay-based infection control strategies (LAMP-based ICSs) for coronavirus disease 2019 (COVID-19) are limited. We reviewed the medical records of cases in which RT-LAMP was performed. Standard ICSs and LAMP-based ICSs were implemented during the study period. The strategies were intended to impose longer periods of infection control precautions (ICPs) for specific patients, such as those with a history of exposure to COVID-19 patients and/or bilateral ground glass opacities (bGGO) on chest computed tomography (CT). Of 212 patients, which included 13 confirmed COVID-19 patients in the diagnostic cohort, exposure to COVID-19 patients (P <0.0001) and chest CT bGGO (P = 0.0022) were identified as significant predictors of COVID-19. In the 173 hospitalized patients in which the results of the first RT-LAMP were negative, the duration of ICPs was significantly longer in patients with exposure to COVID-19 and/or a high clinical index of suspicion and patients with bGGO than in the remaining patients (P = 0.00046 and P = 0.0067, respectively). Additionally, no confirmed COVID-19 cases indicating nosocomial spread occurred during the study period. Establishing a comprehensive system that combines rational LAMP-based ICSs with standard ICSs might be useful for preventing nosocomial spread.

Nurse-Led Model of Care That Helps a Community Heal: Curbside Immunizations With Assistance in Social Determinants.

The COVID-19 pandemic has overwhelmed communities. Physical, emotional, and financial struggles have heightened, especially with our vulnerable populations. People have been afraid to return to their provider's office. For children, there has been an interruption of well-visits and immunizations. As the nation saw a decline in immunization uptake, a pilot nurse-led program was designed to increase vaccinations and address the social determinant needs during a global pandemic. The purpose of this article is to describe the planning and implementation of a curbside immunization event. The Logic model was used as a framework to ensure an efficient and replicable process. Initial observations showed an overall increase in immunization uptake and 97% of participants current with recommended vaccinations. Most parents (93%) would attend again and recommend it to others. They also felt that infection control precautions helped make the care delivered safe and efficient. Social determinants of health were assessed and addressed. This method of vaccine delivery is a viable model going into the future. Others may replicate this model, and it may also serve as a platform regarding flu or COVID-19 vaccine distribution.

Knowledge, Attitude, and Practice of Dentists towards Coronavirus Disease (COVID-19): A cross-sectional study

Objective: To assess the knowledge, attitude, and practice of dentists towards coronavirus disease (covid-19) in Egypt. Material and methods: A total of 374 Egyptian dentists participated in this cross-sectional survey following the outbreak of COVID-19 in Egypt. A validated well-constructed online questionnaire consisting of four sections (32 questions) was distributed through different social networking websites to measure the knowledge, attitude, and practice of Egyptian dentists regarding the pandemic. Results: Regarding the knowledge, a significantly higher percentage of dentists thought that the infection was caused by coronavirus (95.0%). Considering attitude, dentists agreed that COVID-19 transmission can be prevented by using the WHO standard isolation precautions (43.5%), and their practice was with a higher percentage of respondents deferred dental treatment of suspicious patients (83.77%), did not think surgical mask was sufficient to prevent cross-infection (80.63%), and favored the wear of N-95 mask (84.55%). Conclusion: Egyptian dentists were aware of the COVID-19 virus, mode of transmission, and infection control precautions in the dental clinic, and showed a positive attitude towards the importance of education about COVID-19.

Outpatient healthcare personnel knowledge and attitudes towards infection prevention measures for protection from respiratory infections

Healthcare personnel (HCP) knowledge and attitudes toward infection control measures are important determinants of practices that can protect them from transmission of infectious diseases. Healthcare personnel were recruited from Emergency Departments and outpatient clinics at seven sites. They completed knowledge surveys at the beginning and attitude surveys at the beginning and end of each season of participation. Attitudes toward infection prevention and control measures, especially medical masks and N95 respirators, were compared. The proportion of participants who correctly identified all components of an infection control bundle for seven clinical scenarios was calculated. The proportion of participants in the medical mask group who reported at least one reason to avoid using medical masks fell from 88.5% on the pre-season survey to 39.6% on the post-season survey (odds ratio [OR] for preseason vs. postseason 0.11, 95% CI 0.10-0.14). Among those wearing N95 respirators, the proportion fell from 87.9% to 53.6% (OR 0.24, 95% CI 0.21-0.28). Participants correctly identified all components of the infection control bundle for 4.9% to 38.5% of scenarios. Attitudes toward medical masks and N95 respirators improved significantly between the beginning and end of each season. The proportion of HCP who correctly identified the infection control precautions needed for clinical scenarios was low, but it improved over successive years of participation in the study.

Adapting active case-finding for TB during the COVID-19 pandemic in Yogyakarta, Indonesia.

The COVID-19 pandemic and response measures, including lockdowns and the reorientation of health services, have disrupted essential health services for other diseases, including TB, HIV and malaria. For TB, reductions in case detection due to the COVID-19 pandemic are projected to result in increased TB transmission, morbidity and mortality. Active case-finding (ACF) for TB using community-based approaches is a potential strategy to offset reductions in TB detection by obviating the need for patients to seek care at a health facility. A number of approaches can be used to conduct TB ACF safely and screen designated target populations while managing the risks of SARS-CoV-2 transmission for staff, individuals and the community. We present a framework of options for and experience of adapting TB ACF services in response to the challenges of COVID-19 in our programme in Yogyakarta, Indonesia. Key changes have included revised prioritisation of target populations focusing on household contacts, reducing case-finding throughput, implementation of additional infection control measures and precautions, and integration of COVID-19 screening among those being screened for TB. Our approach could inform other programmes seeking to adapt TB ACF services to mitigate the negative impact of COVID-19 on TB case detection.

Telerehabilitation for Lung Transplant Candidates and Recipients During the COVID-19 Pandemic: Program Evaluation.

BackgroundThe COVID-19 pandemic resulted in a rapid shift from center-based rehabilitation to telerehabilitation for chronic respiratory disease and lung transplantation due to infection control precautions. Clinical experience with this delivery model on a large scale has not been described.ObjectiveThe aim of this study is to describe usage and satisfaction of providers and lung transplant (LTx) candidates and recipients and functional outcomes following the broad implementation of telerehabilitation with remote patient monitoring during the first wave of the COVID-19 pandemic.MethodsThis study was a program evaluation of providers, LTx candidates, and early LTx recipients who used a web-based, remote monitoring app for at least four weeks between March 16 and September 1, 2020, to participate in telerehabilitation. Within-subjects analysis was performed for physical activity, Self-efficacy For Exercise (SEE) scale score, aerobic and resistance exercise volumes, 6-minute walk test results, and Short Physical Performance Battery (SPPB) results.ResultsIn total, 78 LTx candidates and 33 recipients were included (57 [51%] males, mean age 58 [SD 12] years, 58 [52%] with interstitial lung disease, 34 [31%] with chronic obstructive pulmonary disease). A total of 50 (64%) LTx candidates and 17 (51%) LTx recipients entered ≥10 prescribed exercise sessions into the app during the study time frame. In addition, 35/42 (83%) candidates agreed the app helped prepare them for surgery and 18/21 (85%) recipients found the app helpful in their self-recovery. The strongest barrier perceived by physiotherapists delivering the telerehabilitation was patient access to home exercise and monitoring equipment. Between the time of app registration and ≥4 weeks on the waiting list, 26 LTx candidates used a treadmill, with sessions increasing in mean duration (from 16 to 22 minutes, P=.002) but not speed (from 1.7 to 1.75 mph, P=.31). Quadriceps weight (pounds) for leg extension did not change (median 3.5, IQR 2.4-5 versus median 4.3, IQR 3-5; P=.08; n=37). On the Rapid Assessment of Physical Activity questionnaire (RAPA), 57% of LTx candidates scored as active, which improved to 87% (P=.02; n=23). There was a decrease in pretransplant 6-minute walk distance (6MWD) from 346 (SD 84) meters to 307 (SD 85) meters (P=.002; n=45) and no change in the SPPB result (12 [IQR 9.5-12] versus 12 [IQR 10-12]; P=.90; n=42). A total of 9 LTx recipients used a treadmill that increased in speed (from 1.9 to 2.7 mph; P=.003) between hospital discharge and three months posttransplant. Quadriceps weight increased (3 [IQR 0-3] pounds versus 5 [IQR 3.8-6.5] pounds; P<.001; n=15). At three months posttransplant, 76% of LTx recipients scored as active (n=17), with a high total SEE score of 74 (SD 11; n=12). In addition, three months posttransplant, 6MWD was 62% (SD 18%) predicted (n=8).ConclusionsWe were able to provide telerehabilitation despite challenges around exercise equipment. This early experience will inform the development of a robust and equitable telerehabilitation model beyond the COVID-19 pandemic.

Effect of An Educational Guidelines on Compliance level Regarding Standard Precautions Measures among the Operating Room Nurses

Background: The Operating Room (OR) is considered one of the high-risk areas in hospital that encounter high rate of infection and mortality. Standard precautions considered as barriers and work practice controls established to prevent sharp injuries and blood exposure. Aim: This study aims to assess the effect of an educational guideline on compliance level regarding standard precautions measures among the operating room nurses. Research design: A quasi- experimental design was used in this study. Setting: The present study was conducted at the operating room unit at El-Hussein University Hospital. Subjects: A convenience sample of all available nurses (40) who are working in operating room unit at El-Hussein University Hospital and accept to be in the study was selected as a study sample. Data collection tools: Nurses' structured self-administered questionnaire, nurses' compliance self-reported scale and nurses' practices observational checklist. Results: Regarding the total level of knowledge and practices regarding to infection control among operating room nurses the present study reported that all of the study nurses had unsatisfactory level of total knowledge and practices at pre educational guidelines implementation phase, while this level was improved at post and follow up phases. Regarding the total compliance level with standard precautions, the present study revealed that all of the study nurses had low level of total compliance pre educational guidelines implementation phase, while compliance level was improved at post and follow up phases. Regarding correlation between total level of knowledge, practice and compliance with standard precautions measures post educational guidelines implementation, the present study showed that there was highly positive correlation between total level of knowledge, practices and compliance with standard precautions measures among the operating room nurses post educational guidelines implementation. Conclusion: This study concluded that the educational guidelines for nurses’ in the operating room was effective in improving their compliance level (knowledge, practices and self-reported compliance) regarding standard precaution measures, so the study results supporting the hypothesis of the present study. Recommendation: The importance of periodic in-service training program for nurses in OR regarding compliance standard precautions of infection control for continues updating their knowledge and focusing on areas of non-compliance and close supervision is needed to ensure that quality of care is provided by nurses while compliance standard precautions of infection control.

RARE-12. PITUITARY ADENOMA SURGERIES IN COVID-19 ERA: EARLY LOCAL EXPERIENCE FROM EGYPT

BackgroundThe pandemic of COVID-19 has a great impact on all health-care services worldwide. Neurosurgical recommendations are to postpone the endoscopic endonasal pituitary surgeries during the pandemic. We would like to express our experience with urgent pituitary adenomas during the current COVID-19 pandemic. MethodsIn our country, COVID-19 has started to become a paramount problem by March 2020. Nine cases of pituitary adenomas have presented with urgent manifestations. The endoscopic endonasal approach was performed in eight patients, while a craniotomy was selected for a recurrent pituitary adenoma. Pre- and postoperative thorough clinical evaluations with chest CT scans were performed. Other strict infection control measures have been applied. ResultsIn 8 weeks duration starting from the past days of February 2020, we have operated on four females and five males of pituitary adenomas. Visual deterioration was the main presenting symptom. The driving factor for surgery was saving vision in eight patients. Fortunately, the postoperative course was uneventful for all patients. No suspected COVID-19 infection has been reported in any patient or health-care team except one patient. In our city, PCR test was routinely not available. ConclusionIn the era of COVID-19, strict infection control precautions should be employed to limit the possibility of transmission of any possible infection to patient or any of the surgical team. We believe that the risk of getting such infection is not increased by the endonasal approach. Long-term follow-up and large numbers of prospective studies are recommended to delineate the impact of COVID-19 infection on pituitary surgeries.

Investigation of an outbreak of Elizabethkingia meningoseptica on a pediatric intensive care unit.

Objective: This paper reports an Elizabethkingia meningoseptica outbreak on a pediatric intensive care unit with emphasis on investigation of outbreak source, infection control interventions, patient characteristics and comparative antimicrobial susceptibility results.Methods: This was an ambidirectional cohort study conducted in a university hospital 20-bed pediatric intensive care unit. Patient ages ranged from 4 to 11 months, with a median age of 9 months. 83% of the patients had severe underlying conditions. Samples from staff and environmental surfaces were obtained to identify a common source of infection. Antimicrobial susceptibility tests of isolated bacteria were done using the disk diffusion method and the Vitek®2 automated system.Results: Environmental surveillance revealed contamination of the water reservoirs of two different mechanical ventilators. In-vitro antimicrobial susceptibility testing results with two different methods (Vitek®2 and disk diffusion) were coherent for most of the investigated antibiotics, but without coherence for ciprofloxacin and levofloxacin. Resistance was found to the relatively new antibiotics ceftaroline and ceftazidime-avibactam.Conclusions: E. meningoseptica is a significant cause of nosocomial infections, with high mortality especially in children. Investigation of the outbreak source and continuation of intensive infection control precautions are vital to handle E. meningoseptica outbreaks in PICUs. Using quinolones according to testing results of automated AST systems may lead to inadequate treatment and foster the selection of resistant strains.

An investigation into nursing students' application of infection prevention and control precautions

BackgroundUndergraduate education of Health Care Workers is pivotal to ensuring that frontline clinicians have appropriate knowledge and skills in Infection Prevention and Control (IPC). ObjectivesThe aim of this study was to describe undergraduate nursing students' self-reported compliance with Standard Precautions and to explore the psychosocial factors that influence adherence in clinical practice. DesignA cross-sectional survey design was used. SettingThe study was conducted in the School of Nursing and Midwifery at an Australian University. ParticipantsAll undergraduate nursing students were invited to participate in an online survey; 321 participated, mean age 25.7 years (SD = 8.4). The majority, 196 (61%), had no healthcare work experience, 54 (17%) were patient-care assistants, 40 (13%) enrolled nurses, and 31 (9%) were nurses registered overseas. MethodsTwo validated instruments were used: the Compliance with Standard Precautions Scale (CSPS) and the Factors Influencing Adherence to Standard Precautions Scale– Student version (FIASPS-SV). Linear regression was used to measure the impact of psychosocial factors on self-reported compliance. ResultsOverall self-reported compliance with prevention of cross-infection was 83%, use of Personal Protective Equipment (81%), correct disposal of sharps (83%) and general waste (75%), and equipment decontamination (69%). The predominant factors endorsed on the FIASPS-SV were ‘Leadership’ (M = 15.21 SD = 5.28) and ‘Contextual cues’ (M = 19.09 SD = 6.37). Multivariate linear regression demonstrated that after adjusting for age, gender and years of nursing study, the Leadership factor predicted participants' self-reported compliance on the ‘prevention of cross-infection’ (p < .001), ‘use of PPE’ (p < .001), ‘waste disposal’ (p = .021), and ‘decontamination of equipment’ (p < .001) sub-domains of the CSPS. ConclusionsThese findings highlight that strong clinical leadership and role modelling are essential to ensure all healthcare students prioritise rigorous adherence with infection prevention and control guidelines.

Awareness and knowledge of COVID-19 infection control precautions and waste management among healthcare workers: Saudi cross-sectional study.

Healthcare workers (HWs) perform a critical role not only in the clinical management of patients but also in providing adequate infection control and prevention measures and waste management procedures to be implemented in healthcare facilities. The aim of this study was to evaluate the awareness and knowledge of COVID-19 infection control precautions and waste management procedures among HWs in Saudi Arabian hospitals.This was a descriptive, cross-sectional study. Information on knowledge, awareness, and practice of infection control and waste management procedures were obtained from the HWs using a structured questionnaire. A thematic analysis was used to analyze the data.Our findings indicated that most of the study participants were knowledgeable, with a mean score of 78.3%. In total, 92.5%, 90.3%, and 91.7% of the participants were aware of the infection control precautions, COVID-19 waste management procedures, the availability of infection control supplies, respectively. HWs’ Knowledge regarding waste management and infection control procedures correlated significantly with sex (P ≤ .001 and <.001), education (P = .024 and .043), and working experience (P = .029 and .009), respectively.Most participants appreciated the importance of their role in infection control, surveillance, and monitoring of the ongoing safety practices in their patients as well as their facilities and communities.

Non-Respiratory Droplet Transmission of COVID-19 in the Isolation Ward of a Secondary Hospital in Oman: A Return to Isolation Basics.

Front-line health care workers are among the most vulnerable groups at risk for acquiring COVID-19, yet the exact mechanisms of how infections occur in health care settings are yet to be identified.ObjectivesTo review the epidemiologic and environmental factors surrounding a cluster of nosocomially acquired COVID-19 cases with possible non respiratory droplet transmission indicating the importance of strict adherence with isolation procedures for patients and staff.MethodsContact and environmental investigations were completed to determine the source and possible routes of hospital transmission of COVID-19.ResultsSeven cases of COVID-19 occurred in the COVID-19 isolation ward of a secondary hospital from 12/04/2020 to 01/05/2020. Analysis also included first four COVID-19 patients admitted to this facility. Epidemiologic links included exposure to massive bowel movements of two infected patients in adjoining rooms on the same day. Serious gaps in infection control practices lead to further spread the virus and cross infection between the staff.ConclusionDespite preparedness to combat pandemics, the infection control precautions taken at this facility were found not sufficient to prevent nosocomial spread of COVID-19. Issues were identified with compliance, enforcement, and failure to update to the most current guidance. Urgent review of ongoing hygiene and isolation practices in hospitals of this type is indicated. Further studies are required to better understand the role of fecal oral transmission and environmental contamination in the transmission of COVID-19.

A fatal rabies case and experiences of a mass post exposure prophylaxis among healthcare workers.

We aimed to monitor the adverse effects (AE) and efficacy of post exposure prophylaxis (PEP) in health care workers (HCWs) exposed to a rabies patient. In this study 109 HCWs and eight household contacts were PEP candidates. Contact persons without infection control precautions were in Group I (high risk-82 cases). HCWs indirectly exposed to environmental surfaces were classified in Group II (low risk-35 cases). PEP schedule was rabies vaccine (RBV) + equine rabies immunoglobulin (eRIG) in Group I and only RBV in Group II. Local and systemic AE were observed in all cases. Efficacy of post exposure prophylaxis (PEP) was determined by rabies development in a six month follow-up. 585 doses of RBV have been used in 117 cases and eRIG has been used in 82 cases. 32 Nurses (39%); 22 emergency medicine technicians (26.8%); 12 doctors (14%); six laboratory technicians (0.07%); six radiology technicians (0.07%); four cleaners (0.05%) were in Group I (82 cases), respectively. One doctor, laboratory technician, nurse and radiology technician (0.02%); two emergency medicine technicians (0.04%) and nine cleaners (25.7%) were in Group II (35 cases), respectively. Routes of transmission were blood in five (0.06%); saliva in 14 (17%); sweat in 50 (61%); CSF/serum in five (0.06%); sexual intercourse in one (0.01%); personal equipment in seven (0.09%) in Group I, respectively. Indirect contact was the only route in Group II. The most common local and systemic AE were seen in Group I; pain at injection side (19 cases) and fever (13 cases). Both of them showed statistically significant difference (P<0.05). Allergic rash has been seen at only one case. PEP failed in one case where the possible exposure way was sexual intercourse. PEP is the safest way to prevent rabies. Infection control precautions were still not enough applied. eRIGs are also safe and have rare AE.

Case Report: Diagnostic challenge of COVID-19 associated pulmonary aspergillosis (CAPA)

Background: Coronavirus disease 2019 (COVID-19) was declared a pandemic in March 2020 by the World Health Organization (WHO). Severe COVID-19 is represented with acute respiratory distress syndrome (ARDS) that requires mechanical ventilation. Moreover, recent studies are reporting invasive fungal infection associated with severe COVID-19. It is unclear whether the prescription of immunotherapies such as corticosteroids, or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection itself is risk factor for COVID-19-associated invasive pulmonary aspergillosis (CAPA). Hence, fungal infections present an additional uncertainty in managing COVID-19 patients and further compromise the outcome. Case study: Here we report a case of SARS-CoV-2 complicated by invasive pulmonary aspergillosis (IPA) in a patient with no traditional risk factors for IPA. Admitted to ICU due to ARDS on mechanical ventilation, the patient deteriorated clinically with unexplained increased of fraction of inspired oxygen (FiO2) requirement from 50% to 80%. Investigations showed borderline serum galactomannan, nonspecific radiological findings reported to be atypical for COVID-19, and the respiratory sample grew Aspergillus spp. Main diagnosis: COVID-19 related fungal infection. The patient was treated with antifungal therapy for four weeks. He improved clinically after one week of starting antimicrobial treatment. After a prolonged ICU stay (87 days) due to infection control precaution, he was discharged from the ICU and moved to a long-term facility for further management and support. Conclusions: This case highlights the diagnostic challenge in such cases. and the importance of early recognition of CAPA which can optimize therapy by administration of appropriate antifungal agents that may impact mortality.