Infection Prevention And Control Measures Research Articles

O03 The impact of COVID-19 infection prevention and control measures on transmission of hospital-acquired infections and antimicrobial resistance in Africa

BackgroundPatients who develop serious illness due to COVID-19 are more likely to have bacterial coinfections, for which WHO recommends treatment with antibiotics. As a result, many countries are observing a change in antimicrobial stewardship (AMS), in addition to changes in infection prevention and control (IPC) practices such as the use of personal protective equipment, on COVID-19 wards. Few data on COVID-19 and its impact on nosocomial infections and antimicrobial resistance (AMR) are available from low and middle-income countries (LMICs). As these countries often have high rates of AMR, it is vital to report the effects of COVID-19 on AMS so as to inform clinical practice and IPC guidelines. This study aims to compare prevalence of AMR in COVID-19 wards with general non-COVID-19 hospital wards.MethodsThis pilot hospital-based study is being conducted in two sites in both Sudan and Zambia. IPC and AMS guidelines for COVID-19 and non-COVID-19 wards were identified for each institution. This study is comparing bacterial isolates and AMR patterns of nosocomial associated infections acquired on COVID-19 and non-COVID-19 wards were compared, using microbiological and sequencing methods. A total of 200 patients have been recruited: 100 per country, 50 COVID-19 patients and 50 non-COVID-19 patients. AMR transmission patterns are being identified using Oxford Nanopore Technologies sequencing for phylogenetic analysis.ResultsThe study began recruiting in May 2021 and completed recruitment of patients in October 2021. The majority of microbiological laboratory work will be completed within Q3 2021, with analysis of the results and sequencing completed in Q4 2021. A half-way point summary analysis of the data suggests differences in patient profiles, both between COVID-19 and non-COVID-19 wards at both sites, as well as differences between the two countries. Preliminary analysis also suggests a significant difference between the prevalence of MDR infections in Gram-negatives seen between COVID-19 (53% in Sudan and 83% in Zambia) and non-COVID-19 (14% Sudan, 33% Zambia) (t-test, P=0.0032 Sudan, P=0.0455 Zambia) ward patients in both countries (see Figure 1).Figure 1.Percentage of Gram-negative bacteria isolated from patients on COVID-19 and non-COVID-19 wards in Sudan and Zambia, showing significant difference between the wards in both countries (t-test, P = 0.0032 Sudan, P = 0.0455 Zambia).ConclusionsThe study is providing evidence to inform policy on IPC and AMS measures to be implemented on COVID-19 wards. In addition, the outcomes of the study will be used to create a pragmatic sequencing pipeline for potential AMR outbreaks suitable for use in LMICs clinical settings.

Occupational Risk Factors for SARS-CoV-2 Infection in Hospital Health Care Workers: A Prospective Nested Case-Control Study.

Introduction: Health Care Workers (HCWs) are at a particular high risk of SARS-CoV-2 infection due to direct and indirect exposure to COVID-19 patients and Aerosol-Generating Procedures (AGPs). The aim of the study was to assess the risk factors for SARS-CoV-2 infection in HCWs exposed to COVID-19 patients, to evaluate the adherence and effectiveness of Infection Prevention and Control (IPC) measures, to describe the clinical presentation for SARS-CoV-2 infection in HCWs and to determine serological responses in HCWs. Methods: HCWs exposed to COVID-19 patients during the previous 14 days with a confirmed case status were recruited as cases; HCWs exposed to COVID-19 patients during the previous 14 days in the same ward without a suspected/probable/confirmed case status were recruited as controls. Serum samples were collected as soon as possible and after 21–28 days from all participants. Data were collected with a WHO standardized questionnaire as soon as possible and after 21–28 days. Results: All social, occupational and personal variables considered were not associated with an increased risk of SARS-CoV-2 infection. Conclusions: Our study showed a high knowledge of IPC measures and very high PPE use among HCWs.

Antimicrobial Stewardship and Infection Prevention and Control in Low- and Middle-income Countries: Current Status and Best Practices.

Antimicrobial Stewardship and Infection Prevention and Control in Low- and Middle-income Countries: Current Status and Best Practices.

Preparedness of tertiary care hospitals to implement the national TB infection prevention and control guidelines in Bangladesh: A qualitative exploration.

In high tuberculosis (TB) burden countries, health settings, including non-designated TB hospitals, host many patients with pulmonary TB. Bangladesh's National TB Control Program aims to strengthen TB infection prevention and control (IPC) in health settings. However, there has been no published literature to date that assessed the preparedness of hospitals to comply with the recommendations. To address this gap, our study examined healthcare workers knowledge and attitudes towards TB IPC guidelines and their perceptions regarding the hospitals' preparedness in Bangladesh. Between January to December 2019, we conducted 16 key-informant interviews and four focus group discussions with healthcare workers from two public tertiary care hospitals. In addition, we undertook a review of 13 documents [i.e., hospital policy, annual report, staff list, published manuscript]. Our findings showed that healthcare workers acknowledged the TB risk and were willing to implement the TB IPC measures but identified key barriers impacting implementation. Gaps were identified in: policy (no TB policy or guidelines in the hospital), health systems (healthcare workers were unaware of the guidelines, lack of TB IPC program, training and education, absence of healthcare-associated TB infection surveillance, low priority of TB IPC, no TB IPC monitoring and feedback, high patient load and bed occupancy, and limited supply of IPC resources) and behavioural factors (risk perception, compliance, and self and social stigma). The additional service-level gap was the lack of electronic medical record systems. These findings highlighted that while there is a demand amongst healthcare workers to implement TB IPC measures, the public tertiary care hospitals have got key issues to address. Therefore, the National TB Control Program may consider these gaps, provide TB IPC guidelines to these hospitals, assist them in developing hospital-level IPC manual, provide training, and coordinate with the ministry of health to allocate separate budget, staffing, and IPC resources to implement the control measures successfully.

Assessment of Risk Factors for Coronavirus Disease-2019 in Healthcare Workers: A Case-Control Study.

Background and aimsWith the rise of coronavirus disease-2019 (COVID-19) cases globally, the infection among frontline healthcare workers (HCWs) escalates many folds. There is, however, limited literature from low middle-income countries regarding risk factors for COVID-19 infection in HCWs. We conducted a case–control study to evaluate the risk factors of COVID-19 infection to HCWs.Materials and methodsThis case–control study was conducted in a designated COVID-19 hospital. Eighty-one HCWs involved in direct care of COVID-19 patients, identified as cases, and 266 were recruited as controls. Telephonic interviews with participants were conducted, and information regarding demographic variables, chemoprophylaxis, exposure to infected patients, and adherence to infection prevention and control (IPC) measures was collected.ResultsWe observed a statistically significant difference in the number of times training session for IPC measures attended by HCWs (p = 0.02), performance of aerosol-generating medical procedures (AGMPs) (p <0.001), practices of donning and doffing of personal protective equipment (PPE) (p <0.001), hand hygiene (p <0.001), and decontamination of highly touched surfaces (p <0.001). Logistic regression analysis revealed if the decontamination of highly touched surfaces is decreased by one unit, the odds of getting COVID-19 infection is multiplied by a factor of 0.41 and AGMPs decrease the risk of being a case by 0.76.ConclusionThis study highlighted that inadequate observation of IPC methods increases the risk of COVID-19 infection to frontline HCWs, whereas performance of AGMPs does not enhance the risk. In this study, HCWs undertaking an AGMP, because of concern of acquiring infection, were more diligent during procedures and hence had lesser infection.How to cite this articleKerai S, Singh R, Saxena KN, Desai SD. Assessment of Risk Factors for Coronavirus Disease-2019 in Healthcare Workers: A Case–Control Study. Indian J Crit Care Med 2022;26(1):76–84.

An appraisal of knowledge, attitude and practices of anganwadi workers under integrated child development services scheme on infection prevention and control in the initial months of COVID-19 pandemic in District Lucknow, UP, India

Background: During the COVID-19 pandemic, Anganwadi workers (AWWs) were repositioned for community support, community surveillance, community awareness on infection prevention and mitigating stigma/discrimination entailing infection, going door to door. The job entailed good knowledge, attitude and practices (KAP) with regard to infection prevention and control (IPC). Aims: To assess the KAP of AWW with regard to IPC in context of COVID-19 in Lucknow district. Methods: A cross-sectional survey was conducted using Google form between 30 June and 28 July 2020. AWWs were recruited from Lucknow district irrespective of their training status; data analysis was done on 137 participants. The mean KAP score was calculated and student t-test was applied. Chi-square test was performed between categorical variables and KAP. Univariate and multivariate logistic regression was applied between independent and dependent variables. Results: The mean score of knowledge was 7.22 ± 2.64, attitude was 4.34 ± 1.14 and practice was 4.44 ± 1.11. There was a significant difference between good and poor score for KAP. Participants with older age, good knowledge and attitude scores were more likely to have good practices. Conclusion: AWWs had good attitude and practices, but lacked adequate knowledge on IPC measures. Ensuring training for AWW on IPC is important.

Compliance to infection prevention and control interventions for slowing down COVID-19 in early phase of disease transmission in Dar es Salaam, Tanzania.

Introductionon 16th March 2020, Tanzania announced its first COVID-19 case. The country had already developed a 72-hour response plan and had enacted three compulsory infection prevention and control interventions. Here, we describe public compliance to Infection Prevention and Control (IPC) public health measures in Dar es Salaam during the early COVID-19 response and testing of the feasibility of an observational method.Methodsa cross sectional study was conducted between April and May 2020 in Dar es Salaam City. At that time, Dar es Salaam was the epi centre of the epidemic. Respondents were randomly selected from defined population strata (high, medium and low). Data were collected using a structured questionnaire and through observations.Resultsa total of 390 subjects were interviewed, response rate was 388 (99.5%). Mean age of the respondents was 34.8 years and 168 (43.1%) had primary level education. Out of the 388 respondents, 384 (98.9%) reported to have heard about COVID-19 public health and social measures, 90.0% had heard from the television and 84.6% from the radio. Covering coughs and sneezes using a handkerchief was the most common behaviour observed among 320 (82.5%) respondents; followed by hand washing hygiene practice, 312 (80.4%) and wearing face masks, 240 (61.9%). Approximately 215 (55.4%) adhered to physical distancing guidance. Age and gender were associated with compliance to IPC measures (both, p<0.05).Conclusioncompliance to public health measures during the early phase of COVID-19 pandemic in this urban setting was encouraging. As the pandemic continues, it is critical to ensure compliance is sustained and capitalize on risk communication via television and radio.

Infection prevention and control: Practice, uptake, and administrative control among primary health-care workers in enugu metropolis, Southeast Nigeria

Introduction: Administrative supervision of infection prevention and control (IPC) is the most important aspect of IPC/hazard controls. The practice, uptake, and compliance to IPC is a documented, cost-effective method of interrupting the infection transmission pathways. Poor or nonadherence to this has led to disabilities and loss of lives among health-care workers, especially in the face of emerging and re-emerging infections. The present study evaluated the practice of IPC as well as its uptake and administrative control among the primary health-care workers in Enugu metropolis, Southeast Nigeria. Methodology: This was an analytical cross-sectional study using semi-structured self-administered questionnaires and an observation checklist. Eligible health-care workers (HCWs) were selected using simple random sampling from ten primary health-care (PHC) facilities. Chi-square test was used to examine associations of interest. Binary logistic regression was employed to identify predictors of good IPC practices. Results: Three hundred eligible health-care workers participated in this study. More than a fifth (n = 65, 21.7%) of HCWs exhibited good practice of IPC measures. Correct practice of handwashing was noted among 275 (95.7%) respondents. Majority (n = 224, 74.7%) reported recapping of needles and engaged in unsanitary disposal of health-care wastes (n = 257, 85.7%). The prevalence of needlestick injuries 3 months prior to the study period was 53.3% (n = 160). Majority of those sampled reported a lack of IPC committee (n = 220, 73.3%), conspicuous signage to aid movement (n = 230, 76.7%), and an IPC policy (n = 217, 72.3%) in their respective centers. Identified predictors of good practice of IPC were age <40 years (adjusted odds ratios [AORs] 0.57; 95% confidence interval [CI] 0.38–0.57), being a community health extension worker or community health officer (AOR 3.76; 95% CI 1.56–9.03), and working for <20 years (AOR 5.10;95% CI 5.00-5.73). Conclusion: Poor practice of IPC and poor compliance to administrative control among PHC workers, in addition to lack of administrative facilities, remains a great challenge. There is an urgent need for capacity building on IPC and administrative support to reverse this trend.

Knowledge and Perceived Effectiveness of Infection Prevention and Control Measures Among Health Care Workers During the COVID-19 Pandemic: A National Survey.

Background:Being the first line of defense against COVID-19 infection, health care workers (HCWs) are at an increased risk of getting infected. Infection prevention and control (IPC) measures were deemed to be instrumental in protecting them and their patients against infection.Purpose:To assess HCWs' knowledge of IPC measures and their perceived effectiveness in protecting against COVID-19.Methods:A national web-based survey was conducted in different health care sectors in Qatar.Results:A total of 1757 HCWs completed the survey. HCWs believed in applying stricter IPC precautions while dealing with confirmed COVID-19 cases than with suspected cases. Males and physicians were more likely to have high perceived effectiveness of IPC measures than females, nurses, and pharmacists. Higher proportions of HCWs believed in the effectiveness of hand hygiene than most types of personal protective equipment.Conclusion:Further research is recommended to assess the impact of HCWs' knowledge and perceived effectiveness of IPC measures on their compliance.

An outbreak of livestock-associated meticillin-resistant Staphylococcus aureus (LA-MRSA) clonal complex 398 in a regional burns centre

Meticillin-resistant Staphylococcus aureus (MRSA) outbreaks have been reported previously in burns centres with resulting mortality and morbidity. This article describes the first human-associated outbreak in the UK caused by a strain of mupirocin-resistant (MuR) livestock-associated MRSA clonal complex 398 (LA-MRSA CC398) in an adult burns centre. The centre historically had a very low prevalence of MRSA infections. To describe the clinical and epidemiological context of how the outbreak was identified and contained using a range of infection prevention and control (IPC) measures guided by both traditional and genetic methods. A cluster of MuR-MRSA led to an outbreak investigation. Cases were detected via retrospective search and real-time laboratory surveillance. Isolates were sent continuously for whole-genome sequencing (WGS). A live timeline of cases and interventions was produced throughout the period. The outbreak consisted of 12 cases (seven males and five females) aged between 22 and 70 years. Patients were identified between May and October 2020. All patients were colonized rather than infected. The strain acquired the plasmid bearing MupA while colonizing the index case before dissemination. The index case was found to be a chicken farmer. This outbreak was eventually controlled using IPC measures, audits, and blind staff decolonization guided by insight from WGS. It was not possible to determine how the strain entered the centre, or if a staff carrier was involved. The outbreak demonstrated the potential for continued transmissions for months despite active surveillance and stringent control measures.

753 Facilitators and barriers in adherence to infection prevention and control recommendations among healthcare providers in cardiac settings

Abstract Aims The infection prevention and control (IPC) represents a global issue. In cardiac settings, it is a fundamental aspect, mostly in interventional procedures (PMK and valves implantation, angiography procedures), even if with different levels of incidence, mortality, and morbidity. Different guidelines and recommendations have been published to reduce complications related to cardiac procedures infections. Although there are several recommendations, the presence of specific protocols and the adherence to them in medical treatment facilities are controversial. The aim is to identify facilitators and barriers to IPC guidelines in health care providers of cardiac settings. Methods and results The research will be conducted in three phases: (1) an integrative review, to identify the main IPC recommendations related to the most common invasive procedures in cardiac interventional settings and the most cited facilitator and barriers; (2) the information collected by the review will help to conduct an explorative survey, involving health care providers from cardiac settings, to better understand what are the most helpful facilitators and the hardest barriers to face; and (3) a qualitative study, using explorative interviews will be held to analyze the experiences of health care providers in their professional action. Conclusions Generally, the adherence to IPC recommendations results difficult and time-consuming. For example, even if healthcare workers may value the use of IPC guidelines, such as wearing PPE, these are not always available, adequate for purpose, or comfortable. Identifying which factors could be considered facilitators or barriers will help authorities and healthcare facilities in developing effective strategies to support health care providers to undertake IPC measures.

432. An Outbreak of Coronavirus Disease, 2019 (COVID-19) in a Skilled Nursing Facility – California, 2021: Description, Mitigation, Challenges, and Opportunities

BackgroundSkilled nursing facility (SNF) residents comprised 11% of all COVID-19 cases in the United States; however, they account for 43% of deaths with case fatality rates (CFR) of 26.0-33.7%. MethodsWe report an outbreak of COVID-19, from June 15 to July 21, 2020 in a 159-bed SNF with a staff of 172 that resulted in an infection rate of 97% in residents and 23% in HCWs (Figure 1). A retroactive review outlined mitigation efforts, discussed challenges, identified risk factors among residents and health care workers (HCW) for acquisition of COVID-19, and reviewed opportunities for improvement (Figure 2). Figure 1. Epi Curve of COVID-19 Outbreak in a Skilled Nursing Facility Figure 2. Timeline of COVID-19 Outbreak in a Skilled Nursing FacilityResultsFactors that contributed to the outbreak: delay in test results had an impact on cohorting; suboptimal adherence to the principles of infection prevention and control (IPC) and minimal adherence monitoring; strict criteria were used to screen for infection; the underappreciated transmissibility of COVID-19 from presymptomatic and asymptomatic persons; symptomatic HCWs who continued to work; the changing guidance on, the suboptimal use of, and an inadequate supply of personal protective equipment; poor indoor air quality due to ventilation challenges; and the important role of community/family/interfacility spread on the outbreak. Whole genome sequencing, performed in 52 samples, identified a common strain that was also found in clusters of 2 other facilities: 1 in the same geographic location, the other in a different geographic location but whose HCWs had the same zip codes as the facility (Figure 3). Certified nursing and restorative nursing assistants had the highest risk of infection with an odds ratio (OR) of 4.02 (confidence interval 1.29-12.55, p value: 0.02) when compared to registered and licensed vocational nurses. The residents’ CFR was 24%. The OR for death was increased by 10.5 (10.20-11.00) for every decade of life as was morbid obesity (BMI > 35) with an OR of 8.50. BMI as a continuous variable increased risk of mortality for every additional unit, OR 1.07 (Tables 1, 2). Whole Genome Sequencing of Isolates from a Skilled Nursing Facility Outbreak Univariate Analysis of Selected Variables Associated with Mortality among Residents at Facility A during COVID-19 Outbreak, June 19 - July 21, 2021 Multivariate Analysis of Factors Associated with Mortality from COVID-19 after Adjusting for Age among Residents (N =124) of Facility A, June 15 - July 21, 2020ConclusionWhile implementation of optimal IPC measures in the pre-COVID-19 vaccination era had no impact on the infections in residents who were likely already infected or exposed at the onset of the outbreak, these measures along with non-pharmacologic strategies were effective in halting the spread among HCWs.Disclosures All Authors: No reported disclosures

De la détection d'une bactérie hautement résistante aux antibiotiques émergente à la gestion d'une épidémie

AbstractIn France, as soon as the bacteriology laboratory detects emerging extensively drug-resistant bacteria (eXDR), a bundle of infection prevention and control (IPC) measures must be implemented with regard to the different transmission routes of eXDR. The modes of transmission are varied, from the transport of eXDR by the contaminated hands of caregivers, to the transport of eXDR by a carrier patient transferred from one facility to another, to the environmental contamination. Controlling the spread of eXDR essentially involves followup and screening of contact patients and carrier patients. Screening should be performed within the department but also after transfer to another department or facility, involving another operational hygiene team and another bacteriology laboratory for the application of IPC measures. This implies a close follow-up of cases and contacts as well as organization and communication between the different actors.

Effectiveness of infection prevention and control interventions, excluding personal protective equipment, to prevent nosocomial transmission of SARS-CoV-2: a systematic review and call for action

SummaryMany infection prevention and control (IPC) interventions have been adopted by hospitals to limit nosocomial transmission of SARS-CoV-2. The aim of this systematic review is to identify evidence on the effectiveness of these interventions. We conducted a literature search of five databases (OVID MEDLINE, Embase, CENTRAL, COVID-19 Portfolio (pre-print), Web of Science). SWIFT ActiveScreener software was used to screen English titles and abstracts published between 1st January 2020 and 6th April 2021. Intervention studies, defined by Cochrane Effective Practice and Organisation of Care, that evaluated IPC interventions with an outcome of SARS-CoV-2 infection in either patients or healthcare workers were included. Personal protective equipment (PPE) was excluded as this intervention had been previously reviewed. Risks of bias were assessed using the Cochrane tool for randomised trials (RoB2) and non-randomized studies of interventions (ROBINS-I). From 23,156 screened articles, we identified seven articles that met the inclusion criteria, all of which evaluated interventions to prevent infections in healthcare workers and the majority of which were focused on effectiveness of prophylaxes. Due to heterogeneity in interventions, we did not conduct a meta-analysis. All agents used for prophylaxes have little to no evidence of effectiveness against SARS-CoV-2 infections. We did not find any studies evaluating the effectiveness of interventions including but not limited to screening, isolation and improved ventilation. There is limited evidence from interventional studies, excluding PPE, evaluating IPC measures for SARS-CoV-2. This review calls for urgent action to implement such studies to inform policies to protect our most vulnerable populations and healthcare workers.

Factors associated with transmission of COVID-19 in long-term care facility outbreaks

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a disproportionate impact on residents in long-term care facilities (LTCFs).AimTo identify risk factors associated with outbreak severity to inform current outbreak management and future pandemic preparedness planning efforts.MethodsA retrospective cohort study design was used to evaluate the association between non-modifiable factors (facility building, organization level, and resident population characteristics), modifiable factors (measured through an assessment tool for infection prevention and control (IPC) and pandemic preparedness), and severity of COVID-19 outbreaks (attack rate) in LTCFs.FindingsFrom March 1st, 2020 to January 10th, 2021, a total of 145 exposures to at least one confirmed case of COVID-19 in 82 LTCFs occurred. Risk factors associated with increased outbreak severity were older facility age, a resident (vs staff) index case, and poorer assessment tool performance. Specifically, for every item not met in the assessment tool, a 22% increase in the adjusted rate ratio was observed (1.2; 95% confidence interval: 1.1–1.4) after controlling for other risk factors.ConclusionScores from an assessment tool, older building age, and the index case being a resident were associated with severity of COVID-19 outbreaks in our jurisdiction. The findings reinforce the importance of regularly assessing IPC measures and outbreak preparedness in preventing large outbreaks. Regular, systematic assessments incorporating IPC and outbreak preparedness measures may help mitigate impacts of future outbreaks and inform future pandemic preparedness planning.

COVID-19 prevention and control measures in workplace settings: a rapid review and meta-analysis

Workplaces are high-risk environments for SARS-CoV-2 outbreaks and subsequent community transmission. Identifying, understanding, and implementing effective workplace SARS-CoV-2 infection prevention and control (IPC) measures is critical to protect workers, their families, and communities. A rapid review and meta-analysis were conducted to synthesize evidence assessing the effectiveness of COVID-19 IPC measures implemented in global workplace settings through April 2021. Medline, Embase, PubMed, and Cochrane Library were searched for studies that quantitatively assessed the effectiveness of workplace COVID-19 IPC measures. Included studies comprised varying empirical designs and occupational settings. Measures of interest included surveillance measures, outbreak investigations, personal protective equipment (PPE), changes in work arrangements, and worker education. Sixty-three studies from international healthcare, nursing home, meatpacking, manufacturing, and office settings were included, accounting for ∼280,000 employees. Meta-analyses showed that comprehensive measures (0.2% positivity; 95%CI 0-0.4%) were associated with lower post-intervention employee COVID-19 positivity estimates than single measures like asymptomatic PCR testing (1.7%; 95%CI 0.9-2.9%) and universal masking (24%; 95%CI 3.4-55.5%). Modelling studies showed that combinations of (i) timely and widespread contact tracing and case isolation, (ii) facilitating smaller worker cohorts, and (iii) effective use of PPE can reduce workplace transmission. Comprehensive COVID-19 IPC measures incorporating swift contact tracing and case isolation, PPE, and facility zoning, can effectively prevent workplace outbreaks. Masking alone should not be considered as sufficient protection from SARS-CoV-2 outbreaks in workplace environments at high risk of virus transmission.Key messages Comprehensive contact tracing, syndromic surveillance, regular testing, PPE, and zoning measures can prevent COVID-19 outbreaks in the workplace.Masking alone should not be considered as sufficient protection from SARS-CoV-2 outbreaks in workplace environments at high risk of virus transmission.

Mental health among people in prison at the time of COVID-19: all bad news?

Abstract Introduction Institutional changes in prisons in response to the COVID-19 pandemic have affected the mental health of those who live and work in prisons. Infection prevention and control (IPC) measures have been implemented in prisons throughout the world to protect imprisoned people from COVID-19 and minimise harm to them and the communities in which they are situated. These efforts have been focused on minimising the risk of infection with an emphasis on individual's physical health. The current international evidence on the broader aspects of imprisoned people's wellbeing during the pandemic mostly comprises opinion pieces. These emphasise the likely negative effects of isolating imprisoned people; the picture however is likely to be more nuanced. Methods One national study across England used quantitative and qualitative methods to examine rates of self-harm in prisons and understand some of the underlying reasons. Another national study measured mental wellbeing, using the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), in staff and imprisoned people during the pandemic. Results and discussion Self-harm rates have varied across the prison estate with the most notable differences seen between men and women's prisons and this is explained by several factors, including perceived safety and support networks. There are notable differences between the mental wellbeing of prison residents and staff. Conclusions The implementation of IPC measures has been essential to control the spread of infection in prisons and so minimise morbidity and mortality. However, for many (but not all) imprisoned people, these measures have resulted in isolation for much of the day with negative impacts on wellbeing. In future it will be important to ensure mental wellbeing is maintained and to involve the imprisoned people themselves in the development of effective interventions.

Infection control measures to prevent outbreaks of COVID-19 in Quebec hemodialysis units: a cross-sectional survey.

Background:Limited space and resources are potential obstacles to infection prevention and control (IPAC) measures in in-centre hemodialysis units. We aimed to assess IPAC measures implemented in Quebec’s hemodialysis units during the spring of 2020, describe the characteristics of these units and document the cumulative infection rates during the first year of the COVID-19 pandemic.Methods:For this cross-sectional survey, we invited leaders from 54 hemodialysis units in Quebec to report information on the physical characteristics of the unit and their perceptions of crowdedness, which IPAC measures were implemented from Mar. 1 to June 30, 2020, and adherence to and feasibility of appropriate IPAC measures. Participating units were contacted again in March 2021 to collect information on the number of COVID-19 cases in order to derive the cumulative infection rate of each unit.Results:Data were obtained from 38 of the 54 units contacted (70% response rate), which provided care to 4485 patients at the time of survey completion. Fourteen units (37%) had implemented appropriate IPAC measures by 3 weeks after Mar. 1, and all 38 units had implemented them by 6 weeks after. One-third of units were perceived as crowded. General measures, masks and screening questionnaires were used in more than 80% of units, and various distancing measures in 55%–71%; reduction in dialysis frequency was rare. Data on cumulative infection rates were obtained from 27 units providing care to 4227 patients. The cumulative infection rate varied from 0% to 50% (median 11.3%, interquartile range 5.2%–20.2%) and was higher than the reported cumulative infection rate in the corresponding region in 23 (85%) of the 27 units.Interpretation:Rates of COVID-19 infection among hemodialysis recipients in Quebec were elevated compared to the general population during the first year of the pandemic, and although hemodialysis units throughout the province implemented appropriate IPAC measures rapidly in the spring of 2020, many units were crowded and could not maintain physical distancing. Future hemodialysis units should be designed to minimize airborne and droplet transmission of infection.

Modelling the effect of infection prevention and control measures on rate of Mycobacterium tuberculosis transmission to clinic attendees in primary health clinics in South Africa

BackgroundElevated rates of tuberculosis in healthcare workers demonstrate the high rate of Mycobacterium tuberculosis (Mtb) transmission in health facilities in high-burden settings. In the context of a project taking a...

Overcoming Current and Preventing Future Nosocomial Outbreaks during the COVID-19 Pandemic: Lessons Learned at Three Hospitals in Japan.

Hospitals are increasingly challenged by nosocomial infection (NI) outbreaks during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Although standardized guidelines and manuals regarding infection prevention and control (IPC) measures are available worldwide, case-studies conducted at specified hospitals that are required to cope with real settings are limited. In this study, we analyzed three hospitals in Japan where large-scale NI outbreaks occurred for hints on how to prevent NI outbreaks. We reviewed openly available information from each hospital and analyzed it applying a three domain framework: operation management; identification of infection status; and infection control measures. We learned that despite having authorized infection control teams and using existing standardized IPC measures, SARS-CoV-2 may still enter hospitals. Early detection of suspected cases and confirmation by PCR test, carefully dealing with staff-to-staff transmission were the most essential factors to prevent NI outbreaks. It was also suggested that ordinary training on IPC for staff does not always provide enough practical knowledge and skills; in such cases external technical and operational supports are crucial. It is expected that our results will provide insights into preventing NI outbreaks of COVID-19, and contribute to mitigate the damage to health care delivery systems in various countries.