Infection Prevention Protocols Research Articles

A challenging response to a Lassa fever outbreak in a non endemic area of Sierra Leone in 2019 with export of cases to The Netherlands

IntroductionOn November 20, 2019, the Sierra Leone International Health Regulations (IHR) National Focal Point was notified of an exported case of Lassa fever in The Netherlands, by a Dutch doctor who previously practiced in a rural hospital in Sierra Leone. This report describes the extent of the outbreak, possible sources of infection, and the outbreak response measures taken.MethodsResponse measures implemented to control the outbreak included coordination across multiple countries and cities, outbreak investigation, active case finding, contact tracing and monitoring, laboratory investigation, and isolation and treatment of cases.ResultsWe report a hospital-associated outbreak that resulted in 3 confirmed cases (health workers) and 2 probable cases (patients). The case fatality rate was 60%, whereas the secondary attack rate was 14%. Two cases involved exportations to The Netherlands. Failure to detect the index case and poor adherence to infection prevention and control (IPC) protocols contributed to disease spread. Pregnancy status and nonspecific signs and symptoms of the index case contributed to failure in early case detection.ConclusionsRapid activation of national and subnational incident management systems resulted in rapid outbreak control. We recommend regular training for clinicians on surveillance and IPC protocols and strengthening in-country Lassa virus diagnostic capacity.

Linked nosocomial COVID-19 outbreak in three facilities for people with intellectual and developmental disabilities due to SARS-CoV-2 variant B.1.1.519 with spike mutation T478K in the Netherlands

BackgroundIndividuals with intellectual and developmental disabilities (IDD) living in congregated settings have increased risk of COVID-19 infection and mortality. Little is known about variant B.1.1.519 with spike mutation T478K, dominant in Mexico. We describe a linked SARS-CoV-2 B.1.1.519 outbreak in three IDD facilities in the Netherlands.MethodsFollowing notification of the index, subsequent cases were identified through serial PCR group testing. Positive specimens were submitted for whole-genome-sequencing. Clinical information was gathered through interviews with staff members of the three facilities.ResultsAttack rate (AR) in clients of the index facility was 92% (23/25), total AR in clients 45% (33/73) and in staff members 24% (8/34). 55% (18/33) of client cases were asymptomatic, versus 25% (2/8) of staff members. Five client cases (15%) were hospitalized, two died (6%). Sequencing yielded the same specific B.1.1.519 genotype in all three facilities. No significant difference in median viral load was established comparing the B.1.1.519 variant with other circulating variants. The index of the linked outbreak reported no travel history or link to suspected or confirmed cases suggesting regional surveillance. Observed peak regional prevalence of B.1.1.519 during the outbreak supports this.ConclusionAR, morbidity and mortality prior to control measures taking effect were high, probably related to the specific characteristics of the IDD setting and its clients. We assessed no evidence for intrinsic contributing properties of variant B.1.1.519. Our study argues for enhanced infection prevention protocols in the IDD setting, and prioritization of this group for vaccination against COVID-19.

Infection prevention and control protocols in dentistry - Canadian guidelines

Introduction. A risk of transmission of infectious diseases has always been an inherent part of dental practice. Easily communicable respiratory and blood borne diseases have prompted dental communities to establish, evaluate, update and monitor infection prevention and control (IPAC) protocols and strategies (guidelines). The aim of this paper was to present Canadian standard protocols of infection prevention and control in dental offices, and compare them with similar guidelines available to dentists in Serbia. Method. A detailed overview of the most current IPAC guidelines and protocols provided by the College of Dental Surgeons of British Columbia in Canada has been summarized. In addition, the effect of the most recent Covid-19 pandemic on the current infection prevention and control measures in dental offices and future perspectives has been reviewed. Conclusion. Implementing infection prevention and control guidelines is essential part of practicing dentistry. Regulatory authorities have responsibility to establish and provide dentist with the most current IPAC protocols while dentists need to adopt up-to-date procedures and appropriately and consistently use them in everyday practice.

Knowledge, attitude, and practices regarding sterilization protocol among dental students at Kanpur, Uttar Pradesh

Context: Infection control and prevention is an major part of patient care. Concerns about the possible spread of blood-borne diseases and the impact of emerging highly contagious respiratory and other illnesses require practitioners to establish, evaluate, continually update, and monitor their infection prevention and control strategies and protocols. Aims: The aim of this study was to assess the level of knowledge, attitude, and practice among dental students about sterilization protocol. Settings and Design: A questionnaire-based survey was conducted. Subjects and Methods: A total of 220 dental students comprising undergraduates and postgraduates participated in the survey where they were provided to fill a modified pretested, self-administered questionnaire consisting of 10 questions. Statistical Analysis Used: The data were collected, compiled, arranged systematically, and analyzed in terms of percentage and frequencies. Participant's response was calculated and expressed as percentages and frequency. Results: The clinical dental students showed a positive level of awareness, knowledge, and practice toward the sterilization protocols and infection control in their day-to-day practice. Conclusions: Dental care professionals are at an increased risk of cross-infection as well as its transmission while treating the patients. This study is based on to assess the level of knowledge, attitude, and practice among dental students about sterilization protocol.

Combating New Challenge in Coronavirus Disease-2019 Management: Assessment of Factors Affecting Testing Refusal

Background: The coronavirus disease-2019 (COVID-19) pandemic has introduced new ethical challenges in the care of patients and people who may have been exposed to severe acute respiratory syndrome coronavirus-2 or have mild to moderate COVID-19. Refusal to get tested for COVID-19 and having poor adherence to infection prevention protocols are the areas of concern for the ongoing pandemic. Such situations increase the risk of infection to other patients and staff. The factors affecting testing refusal were studied with the help of the Google questionnaire. Methodology: The cross-sectional survey tool was developed and distributed after pilot testing. The study population was selected using mix sampling method, snowball, and random sampling using the mobile number of the participants. All the participants were informed about the purpose of the study and included after taking consent. Results: Of the 176 study participants, the majority were male (112, 63.6%), with a mean age of 37.2 years (standard deviation 10.4). Forty-one (23.3%) were health-care workers and 74 (42.1%) were private company employees. Seventy-one (40.3%) refused to get tested for COVID-19 when asked whether they will get tested in the presence of any COVID-19 symptoms and 81 (46.8%) refused to get tested in the absence of any symptoms. Conclusion: Health policy-makers should utilize the study results to formulate the policy regarding any future pandemic to reduce the level of stigma associated with an unknown disease. These clarifications and excuses asked to the study participants are meant to provide a deeper understanding to address the pandemic better.

A Cross-Sectional Evaluation of Self-Perceived Orthodontic Treatment Needs Amongst Tribal Adolescent With Remote Access to Orthodontic Treatment Using a Simplified Malocclusion Index

Background: Self-perceived orthodontic treatment need is strongly influenced by what is perceived to be the esthetic norm amongst a community, and reluctance toward treatment amongst adolescents with clinically ascertained malocclusion may often be due to readily remediable factors. Of particular interest is the prevalence of malocclusion amongst such communities as a probable indicator of the role of diet and genetics in establishing a predominant clinical phenotype that may also play a role in the construct of what is perceived as the esthetic norm amongst the community, thereby influencing the self-perceived need for treatment. Studies aimed at evaluating the association between self-perceived esthetics, and self-perceived treatment need have not been performed amongst a population with no prior exposure to orthodontic treatment Objectives: The purpose of this study was to evaluate the self-perceived orthodontic treatment need amongst the tribal adolescents belonging to regions with remote access to orthodontic treatment by way of a verbally assigned index and to also identify the reasons of reluctance toward treatment to better understand how to make orthodontic treatment readily accessible to such populations. Participants, Materials, and Methods: The agency areas of Paderu located at 18.0833°N 82.667°E and Parvathipuram located at 18°46'N 83°25'E are 2 revenue districts of Visakhapatnam and Vizianagaram, respectively, in the state of Andhra Pradesh, India, that are home to various tribal populations with remote access to orthodontic treatment. A total of 2,016 school-going tribal adolescents of the Paderu revenue division and 819 tribal adolescents of the Parvathipuram revenue division were examined to ascertain the prevalence of malocclusion. Necessary consent and permissions were obtained from the tribal authorities, the school authorities, parents, and the institutional ethical clearance committee. The screening was done utilizing natural daylight in compliance with infection prevention and control protocol. Clinical examination aimed at categorizing the observed occlusion into either ideal occlusion or one of the three classes of Angle’s class I, II, and III malocclusions. The Simplified Malocclusion Index For Layperson Evaluation (SMILE) was verbally assigned in the vernacular language while interacting with each child and the findings made note of for calculation of relevant scores related to their orthodontic awareness, self-esteem as related to self-perceived esthetics, and their self-perceived need for treatment. Reasons for reluctance to undergo treatment were noted down if expressed. An initial group of 31 adolescents categorized as presenting with clinical malocclusion were randomly picked up and assigned the SMILE index a second time to assess the reliability of the index by way of Cohen’s kappa statistic. Results: The initial test group of 31 individuals assigned the SMILE twice showed a Cohen’s kappa of 0.93 validating almost perfect intraoperator agreement. The SMILE index revealed that 80.95% of the adolescents of Paderu revenue division had orthodontic awareness and 79.51% had self-perceived esthetics but only 15.97% felt a need for orthodontic treatment. Pearson’s Chi squared statistical analysis indicated a gender bias related to the self-perceived need for orthodontic treatment ( X 2 [1, N = 1,371] = 19.71, P < .001). The Index assigned to the Parvathipuram division revealed that 77.04% had orthodontic awareness and 78.38 had self-perceived esthetics but only 6.95% felt the need for orthodontic treatment. Pearson’s Chi squared statistical analysis indicated a gender bias related to the self-perceived need for orthodontic treatment ( X 2 [1, N = 764] = 4.95, P = .02). Conclusion: The self-perceived need for orthodontic treatment is often based on the self-perceived esthetics of an individual or the self-esteem as influenced by the perceived esthetic norm of the community. Orthodontic treatment of adolescents with borderline malocclusion derangements requires careful ascertaining of the actual perceived need of the patient to enable the rendering of a justifiable orthodontic treatment with the complete trust of the young patient. This helps build community trust in regions where orthodontic treatment has not yet made in roads and may help ensure higher end of treatment satisfaction levels.

Operationalizing the emergent management of psychiatric patients during the COVID-19 pandemic at an academic public hospital

Background: While the volume of Emergency Department (ED) visits has declined during the 2019 novel coronavirus disease or COVID-19, the opposite has been observed with mental-health related visits. The need to screen and manage potential COVID-19 symptoms in parallel with psychiatric complaints have imposed new challenges in the ED at an academic public hospital.Objective: The objective is to share operational modifications in addressing the challenges related to the influx of ED mentalhealth related complaints at the departmental, hospital-wide, and city-wide level within an academic, public hospital.Methods: At the departmental level, a triage algorithm for screening patients with concerning symptoms was developed. A dedicated Respiratory Decision Unit with psychiatrically safe rooms that adhered to infection prevention protocol was also created. All staff were trained to utilize personal protective equipment through lectures, asynchronous learning, and multidisciplinary simulations. The ED team worked with hospital leadership to increase inpatient medical psychiatric bed capacity and to develop testing protocols for patients being admitted to allow for cohorting of symptomatic patients. At the city level, leadership within the three main organizations that provide mental health services to the city met regularly to address operational issues.Conclusions: The COVID-19 pandemic has imposed new challenges in terms of increased psychosocial needs while limiting transmission risks. Based on the experiences shared, a multitier approach is necessary. At all levels, the goals were to screen appropriately, decrease transmission risk, and maintain throughput. The purpose of this descriptive manuscript is to encourage dialogue and to raise awareness about the unique needs of the mental health system.

Use of an intraoperative sodium oxychlorosene-based infection prevention protocol to safely decrease postoperative wound infections after spine surgery.

Postoperative infection remains prevalent after spinal surgical procedures. Institutional protocols for infection prevention have improved rates of infection after spine surgery. However, prior studies have focused on only elective surgical patients. The aim of this study was to determine the efficacy of a multiinstitutional intraoperative sodium oxychlorosene-based infection prevention protocol for decreasing rate of infection after instrumented spinal surgery. A retrospective analysis was performed at two tertiary care institutions with level I trauma programs, and patients who underwent posterior instrumented spinal fusion between January 1, 2011, and May 31, 2019, were included. Postoperative deep wound infection rates were captured before and after implementation of a multiinstitutional infection prevention protocol. Possible adverse outcomes related to infection prevention techniques were also examined. In addition, consecutive patients treated from January 1, 2018, to May 31, 2019, were prospectively included in a database to collect preoperative and postoperative spine-specific quality of life measures and to assess the impact of postoperative infection on quality of life. A total of 5047 patients fit the inclusion criteria. Of these, 1043 patients underwent surgery prior to protocol implementation. The infection rate of this cohort (3.5%) decreased significantly after protocol implementation (1.2%, p < 0.001). Postoperative sterile seroma rates did not differ between the preprotocol and postprotocol groups (0.7% vs 0.7%, p = 0.5). In the 1031 patients who underwent surgery between January 2018 and May 2019, the fusion rate was 89.2%. Quality of life outcomes between patients with infection and those without infection were similar, although statistical power was limited owing to the low rate of infection. Notably, 2 of 10 patients who developed deep wound infection died of infection-related complications. An intraoperative sodium oxychlorosene-based infection prevention protocol helped to significantly decrease the rate of infection after spine surgery without negatively impacting other postoperative procedure-related metrics. Postoperative wound infection may be associated with higher-than-expected rate of postoperative mortality.

Infection prevention strategies are highly protective in COVID-19 units while main risks to healthcare professionals come from coworkers and the community

BackgroundEarly evaluations of healthcare professional (HCP) COVID-19 risk occurred during insufficient personal protective equipment and disproportionate testing, contributing to perceptions of high patient-care related HCP risk. We evaluated HCP COVID-19 seropositivity after accounting for community factors and coworker outbreaks.MethodsPrior to universal masking, we conducted a single-center retrospective cohort plus cross-sectional study. All HCP (1) seen by Occupational Health for COVID-like symptoms (regardless of test result) or assigned to (2) dedicated COVID-19 units, (3) units with a COVID-19 HCP outbreak, or (4) control units from 01/01/2020 to 04/15/2020 were offered serologic testing by an FDA-authorized assay plus a research assay against 67 respiratory viruses, including 11 SARS-CoV-2 antigens. Multivariable models assessed the association of demographics, job role, comorbidities, care of a COVID-19 patient, and geocoded socioeconomic status with positive serology.ResultsOf 654 participants, 87 (13.3%) were seropositive; among these 60.8% (N = 52) had never cared for a COVID-19 patient. Being male (OR 1.79, CI 1.05–3.04, p = 0.03), working in a unit with a HCP-outbreak unit (OR 2.21, CI 1.28–3.81, p < 0.01), living in a community with low owner-occupied housing (OR = 1.63, CI = 1.00–2.64, p = 0.05), and ethnically Latino (OR 2.10, CI 1.12–3.96, p = 0.02) were positively-associated with COVID-19 seropositivity, while working in dedicated COVID-19 units was negatively-associated (OR 0.53, CI = 0.30–0.94, p = 0.03). The research assay identified 25 additional seropositive individuals (78 [12%] vs. 53 [8%], p < 0.01).ConclusionsPrior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission.Article summaryPrior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission.

A qualitative assessment of factors affecting nursing home caregiving staff experiences during the COVID-19 pandemic.

BackgroundA large portion of COVID-19 cases and deaths in the United States have occurred in nursing homes; however, current literature including the frontline perspective of staff working in nursing homes is limited. The objective of this qualitative assessment was to better understand what individual and facility level factors may have contributed to the impact of COVID-19 on Certified Nursing Assistants (CNAs) and Environmental Services (EVS) staff working in nursing homes.MethodsBased on a simple random sample from the National Healthcare Safety Network (NHSN), 7,520 facilities were emailed invitations requesting one CNA and/or one EVS staff member for participation in a voluntary focus group over Zoom. Facility characteristics were obtained via NHSN and publicly available sources; participant demographics were collected via SurveyMonkey during registration and polling during focus groups. Qualitative information was coded using NVIVO and Excel.ResultsThroughout April 2021, 23 focus groups including 110 participants from 84 facilities were conducted homogenous by participant role. Staffing problems were a recurring theme reported. Participants often cited the toll the pandemic took on their emotional well-being, describing increased stress, responsibilities, and time needed to complete their jobs. The lack of consistent and systematic guidance resulting in frequently changing infection prevention protocols was also reported across focus groups.ConclusionsAddressing concerns of low wages and lack of financial incentives may have the potential to attract and retain employees to help alleviate nursing home staff shortages. Additionally, access to mental health resources could help nursing home staff cope with the emotional burden of the COVID-19 pandemic. These frontline staff members provided invaluable insight and should be included in improvement efforts to support nursing homes recovering from the impact of COVID-19 as well as future pandemic planning.

Rapid Practice Change During COVID-19 Leads to Enduring Innovations and Expansion of Integrative Oncology Services

The COVID-19 pandemic forced cancer programs and practices to rapidly adapt how they deliver integrative oncology services that help patients manage symptoms and optimize their quality of life. Additional stressors imposed by COVID-19 increased the need for mind-body practices, natural products, and lifestyle modifications. However, literature on best practices for the provision of integrative oncology services during a pandemic is sparse. Our article seeks to describe strategies, challenges, and enduring innovations for successful integrative oncology practice during and beyond the COVID-19 crisis. Effective strategies include expanded telemedicine, online resource libraries, virtual interactive groups and classes, and additional infection prevention protocols. We also describe telemedicine challenges, such as technical difficulties and access to technology, “Zoom fatigue,” inability to perform hands-on physical exams, distractions outside the clinical environment, and obstacles to maintaining a virtual therapeutic relationship. Leveraging its skilled facilitators, Levine Cancer Institute in Charlotte, N.C., overcame many of these challenges through proactive responses, flexibility—demonstrated by staff and patients—and the use of virtual platforms. Our experience led to enduring telehealth expansion, livestream groups and classes, on-demand digital repositories of integrative practices, and targeted services delivered at the most clinically appropriate time(s). These insights may be adapted by other institutions to maintain integrative oncology services during and after unprecedented events, like a global pandemic.

Dysphagia Characteristics of Patients Post SARS-CoV-2 During Inpatient Rehabilitation

ObjectiveTo investigate dysphagia in patients recovering from SARS-CoV-2 admitted to acute inpatient rehabilitation by summarizing clinical swallow evaluation and videofluoroscopic swallow study findings. DesignRetrospective cohort study. SettingUrban inpatient rehabilitation hospital. ParticipantsThe first inpatients admitted with SARS-CoV-2 (N=40) who participated in a videofluoroscopic swallow study. InterventionsNot applicable. Main Outcome MeasuresPatient characteristics upon admission (duration of intubation, tracheostomy status, comorbidities, videofluoroscopic swallow study (VFSS) completion at previous level of care); admission International Dysphagia Diet level (IDDSI); Mann Assessment of Swallowing Ability (MASA), Functional Oral Intake Scale (FOIS), dysphagia severity rating; penetration aspiration scale (PAS) rated during VFSS; and IDDSI level recommended after completion of VFSS. ResultsTwenty percent of patients had been evaluated by videofluoroscopy in acute care. Nineteen of 37 (51%) individuals were upgraded to IDDSI level 7 regular diet with level 0 thin liquids and achieved a FOIS of 7 after the completion of the VFSS. Five individuals (13%) received a diet downgrade or remained on the same diet recommendations from their admission. Total numerical score (TNS) of less than 170 on the MASA predicted presence of aspiration in 27% of patients (6 of 22). Seventy-two percent of the sample (16 of 22) had a TNS less than 170 but did not demonstrate any instances of aspiration. The odds of patients having a PAS of 3 or greater increased by approximately 15% (odds ratio, 1.15; 95% confidence interval, 1.03-1.27; P=.013). Thus, with each additional day of intubation during acute care stay, there was a 15% greater likelihood of having airway invasion. ConclusionsInstrumental swallow evaluations are imperative to diagnose and treat dysphagia in the post-coronavirus disease population. Because of the heterogeneity of this population, high incidence of prolonged intubation, and limitations of the clinical swallowing evaluation, instrumental assessments need to be performed on a more consistent basis as infection prevention protocols evolve.

COVID 19 and obstetrics: anaesthetic challenges, co-morbid conditions and critical care

The WHO has declared severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) as a pandemic; it affected approximately 44.5million people since its first breakout in December 2019. COVID-19 can present with wide spectrum of clinical manifestations which range from mild illness with myalgia only to acute respiratory distress syndrome with or without multi-organ dysfunction syndrome necessitating the advance critical care and life support. Pregnant women presenting to emergency department needs to be triaged based on imminent risk factors for maternal and fetal compromise, present haemodynamic status of mother with consideration of gestational age. Pregnant women with comorbid conditions require multidisciplinary team approach for better pregnancy outcomes, resource management and minimizing the risk infection to health care providers. This review emphasizes on management of labour, pregnancy outcomes, co-morbidities and complex critical situations associated with COVID-19 infected pregnant women. Development of safe medical practices and infection prevention protocols with involvement of multidisciplinary team including anaesthesiologist, obstetrician, neonatologist, critical care specialist, infectious disease experts and nursing staff for the perioperative management; is required to optimize the patient outcome and mitigate the infection risk to health personnel and their families.

In‐hospital respiratory viral infections for patients with established BPD in the SARS‐CoV‐2 era

ObjectiveOur objective was to test the hypothesis that in‐hospital respiratory viral infections (RVI) would be significantly lower in a cohort of patients with established bronchopulmonary dysplasia (BPD) exposed to a severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection prevention protocol when compared to historical controls.Study DesignOn April 1, 2020, we implemented a universal infection prevention protocol to minimize the risk of nosocomial SARS‐CoV‐2 transmission in a dedicated BPD intensive care unit. We performed a retrospective cohort study and included patients with established BPD, as defined by the 2019 Neonatal Research Network criteria, admitted to our center who underwent real‐time polymerase‐chain‐reaction RVI testing between January 1, 2015 and March 31, 2021. We excluded patients readmitted from home. We compared the proportion of positive tests to the number of tests performed and the distribution of viral respiratory pathogens in the pre‐ and post‐SARS‐CoV‐2 eras.ResultsAmong 176 patients included in the study, 663 RVI tests were performed and 172 (26%) tests were positive. The median number of tests performed, measured in tests per patient per month, in the SARS‐CoV‐2 era was not significantly different compared to the pre‐SARS‐CoV‐2 era (0.45 vs. 0.34 tests per patient per month, p = .07). The proportion of positive RVI tests was significantly lower in the SARS‐CoV‐2 era when compared to the pre‐SARS‐CoV‐2 era (0.06 vs. 0.30, p < .0001). No patients tested positive for SARS‐CoV‐2 in the SARS‐CoV‐2 era.ConclusionsInfection prevention measures developed in response to the SARS‐CoV‐2 pandemic may reduce the risk of RVIs in hospitalized patients with established BPD.

CORR Insights®: Do Adhesive Drapes Have an Effect on Infection Rates in Orthopaedic Surgery? A Systematic Review and Meta-analysis.

Where Are We Now? For ideal surgical skin preparation and draping, plastic adhesive incisional drapes are placed on the skin directly over the incision site, and surgeons then make their incisions through the adhesive drape [7]. In orthopaedic surgery, these drapes are widely used in total joint arthroplasty because of their potential to reduce the risk of surgical site infections [4]. But despite improved infection prevention protocols, little progress has been made in decreasing the incidence of periprosthetic joint infection (PJI). In one population-based study, no improvement in infection rates was observed over a 15-year period [5]. The fact that the incidence of PJI remains unchanged over time means we have more work to do. Things seem no more promising on the treatment side; the survivorship of arthroplasties after irrigation and debridement, and after two-stage revisions, has not improved over the last two decades or so [8]. In the current study, Mundi et al. [6] performed a meta-analysis of MEDLINE and Embase databases and gathered evidence from randomized controlled trials that compared drapes with controls from 2000 to 2021. They had relatively little to work with; appropriately, they restricted the study to randomized trials, but only four were available in this massive database review that employed a 20-year data pull. Based on data from pooled wound swab cultures, Mundi et al. [6] found that four studies showed a reduction in wound contamination with the use of adhesive drapes. The findings of this meta-analysis suggest that adhesive drapes, including those with antimicrobial properties, decrease the risk of wound contamination during orthopaedic procedures. In circumstances where drape adhesion is compromised and peel back occurs at the wound edge, there is an increased risk of wound contamination with the use of adhesive drapes. In light of these findings, it’s fair to conclude that the best-available evidence is indeterminate as to the effect of adhesive drapes on the risk of surgical site infections; however, if used, care should be taken to avoid or minimize drape peel back. Where Do We Need To Go? Meta-analyses are most helpful when the source studies disagree. In my large, busy group practice, we generally use adhesive drapes in trauma, total joint arthroplasty, and sports medicine procedures. Do we have the data to justify this practice in these areas? The current study [6] found that two of the studies supported routine use of adherent drapes, while two randomized clinical trials showed no difference. The authors could not definitively prove that peeling back the drapes for closure or inadvertent peel back during the procedure was adverse. How might postoperative dressings protect against inadvertent skin contamination that occurs during surgery or dressing peel back? We don’t have a lot of experience to go on, despite this extensive meta-analysis. Personally, I have concerns that we are missing something, because in my practice, I am seeing an increase in unusual skin flora infections. Future studies need to further examine these gaps in our knowledge. Surgeons should look at all the ways to reduce infection. We need to be vigilant about antibiotic stewardship and draping. How Do We Get There? Randomized draping studies are realistically difficult to do because it would take a second study of more than 4000 patients to demonstrate a reduction from 2% PJI to 1% PJI by changing drapes. In our practice, we utilize barrier draping for trauma, adult reconstruction, and sports medicine procedures to try and isolate the skin flora from the deep wound. However, there is a paucity of data to support this practice. Other studies should focus on antibiotic stewardship, other barrier drapes, wound vacs, or antibiotic impregnated barriers to reduce contamination at the time of surgery [3]. There are few surgical draping studies available, but future studies should focus on decreasing the skin contamination, reducing risk of peel back, and combating the higher more insidious skin flora infections that seem to be on the rise.

Infection preventionists’ experiences during the first nine months of the COVID-19 pandemic: Findings from focus groups conducted with Association of Professionals in Infection Control & Epidemiology (APIC) members

IntroductionA novel human Coronavirus (SARS CoV-2) was identified in January, 2020 and developed into a pandemic by March, 2020. This rapid, enormous, and unanticipated event had major implications for healthcare. Infection preventionists (IP) have a critical role in worker and patient safety. IPs’ lessons learned can guide future pandemic response.MethodsSeven focus groups were conducted with APIC members in September and October, 2020 via Zoom to elicit IPs’ experiences during the COVID-19 pandemic. Sessions were recorded then transcribed verbatim. Major themes were identified through content analysis.ResultsIn total, 73 IPs participated (average of 10 IPs per focus group) and represented all geographical areas and work settings. Participating IPs described multiple challenges they have faced during the COVID-19 pandemic, including rapidly changing and conflicting guidance, a lack of infection prevention recommendations for nonacute care settings, insufficient personal protective equipment, healthcare personnel complacency with personal protective equipment and infection prevention protocols, and increases in healthcare associated infections and workload.ConclusionsThe identified gaps in pandemic response need to be addressed in order to minimize healthcare associated infections and occupational illness. In addition, the educational topics identified by the participating IPs should be developed into new educational programs and resources.

Efficacy of disinfecting inanimate surfaces against coronavirus: a systematic review

Human coronaviruses tend to persist on dry surfaces for 2 to 9 days, necessitating infection control and prevention protocols using biocidal agents. This systematic review aimed to answer the following focused question: What is the effectiveness of disinfectants on inanimate surfaces against the coronavirus? The acronym “PICOS” was used to represent the eligibility of studies: P = population (inanimate surfaces contaminated with coronavirus); I = intervention (disinfectants); C = comparison (studies with any type of control or studies that used a control group); O = outcomes (coronavirus inactivation on different types of inanimate surfaces); and S = study design (in vitro studies). The seven databases used were PubMed/Medline, EMBASE, Latin American and Caribbean Literature on Health Sciences (LILACS), Web of Science, Scopus, LIVIVO, and Cochrane Library. The gray literature was also used as an information source through Google Scholar, ProQuest, and Open Gray. The search resulted in 6639 references, and 21 articles were used in the qualitative analysis. The results showed that all studied biocidal solutions provided some degree of decontamination and inactivation of the coronavirus, depending on the concentration of the disinfectant solution, the time of exposure of the product to the pathogen and the type of surface.

Recommendations for specimen collection for detection and diagnosis of COVID-19

Introduction: The spread of SARS-CoV-2 has caused a global public health crisis (pandemic). One of the most important measures to control the transmission chain of the new coronavirus is to identify those infected through laboratory testing. Objective: Synthesize the recommendations for the specimen collection for detection and diagnosis of COVID-19. Methods: This is an integrative review, considering the publications of the following databases: PubMed and Google Academic from January 2020. Results: 468 publications were identified, 20 of which were considered eligible. The publications recommend that technical training for specimen collection and careful observation of infection prevention protocols are fundamental. This manuscript highlights the steps for specimen collection as materials for collection, storage, transportation, individual protection, and laboratory analysis of samples. Currently, the Reverse Transcription - Polymerase Chain Reaction test is the recommended and gold standard method of identifying COVID-19 cases. Serological tests play an important role in research and surveillance. Conclusion: In summary, the documents ensure that the RT-PCR is the gold standard for SARS-CoV-2 detection and recommend standardization of collection and conditioning methods to avoid errors related to the collection and false negative results.

Hospital Onset Vancomycin-Resistant Enterococci Infections in a Northern California Tertiary-Care Center From 2019 to 2020

Background: Understanding the epidemiology and risk factors for nosocomial infections with vancomycin-resistant enterococci (VRE) is necessary for the prevention and control of VRE infections in the hospital setting. We sought to determine the incidence of nosocomial infections of VRE and to ascertain predictors associated with nosocomial infection. Methods: In this retrospective cohort study, data were collected from patients with VRE infection from January 2019 to December 2020 at a tertiary-care center in northern California. VRE infections were designated as hospital onset (HO) if the specimen was collected &gt;3 days after hospital admission or community onset (CO) if the specimen was collected ≤3 days after admission. Associations between HO infections with time, unit, and specimen were identified. Results: Over the 2-year period, 214 unique VRE infections were identified in hospitalized patients; 115 infections were CO and 99 were HO. HO-VRE were associated most frequently with stay in medical/telemetry units (68%), followed by oncology–transplant units (15%) and ICUs (12%). There were ~4.7 and ~3.6 HO-VRE infections per month in 2019 and 2020, respectively. No differences were identified between HO-VRE infections in 2 medical units regarding glycopeptide and cephalosporin use in those units. The sources of VRE infections were urinary 45%, bloodstream 15%, stool 10%, and other 30%. Of the 45 infections in urine, 51% were identified from catheters (Foley and straight) and 27% were identified from clean-catch urine. Interestingly, 71% of patients with VRE identified from urine did not report urinary tract infection (UTI) symptoms at the time of collection. Urine was most often collected for urinalysis and culture from patients with nonspecific symptoms such as fever, leukocytosis, hypotension, tachycardia, or altered mental status. All urine collected from patients who reported UTI symptoms grew &gt;100,000 CFU/mL in culture, while only 75% of cultures from patients without symptoms grew &gt;100,000 CFU/mL. The most common antibiogram was resistance to ampicillin, cefazolin, levofloxacin, minocycline, penicillin, tetracycline, and/or vancomycin (42% of cases) and susceptibility to both daptomycin and linezolid (60% of cases). Conclusions: HO-VRE infections were frequently identified with urinary sources and were often associated with catheter use. However, the frequent lack of concurrent UTI symptoms suggests VRE colonization rather than infection in many cases. Understanding the epidemiology and risk factors for HO-VRE infections is essential for developing infection prevention protocols to reduce the incidence of those infections.Funding: NoDisclosures: None

Vancomycin resistant Enterococci and its associated factors among HIV infected patients on anti-retroviral therapy in Ethiopia.

The emergence of vancomycin resistant Enterococci (VRE) has alarmed the global community due to its tendency for colonization of the gastrointestinal tract. Human Immunodeficiency Virus (HIV) patients are colonized by vancomycin resistant Enterococci than other groups. The aim of this study was to determine the incidence of vancomycin resistant Enterococci and its associated factors among HIV infected patients on Anti-Retroviral Therapy (ART). Institution based cross sectional study was conducted among HIV infected patients on ART at from June 1 to August 30, 2020. Socio-demographic and clinical data were collected by pre-tested structured questionnaire. Stool sample was collected and processed by standard microbiological techniques. Kirby Bauer Disc diffusion method was used to perform antimicrobial susceptibility testing. Data were entered by Epi data version 4.6.0.2 and analyzed by SPSS version 25. Bivariable and multivariable logistic regression model was used to analyze the association between dependent and independent variables. P-values in the multivariable analysis, adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to determine the strength of association. P-value ≤0.05 was considered as significant. Enterococci spp was isolated on 123/200 (61.50%) patients. Among these isolates, the incidence of vancomycin resistant Enterococci was 11.4% [95% CI: (6.0-17.0)]. Antimicrobial susceptibility patterns against Enterococci showed highest rate of resistance to ampicillin (69.9%). Multidrug resistances were observed in 49.59% of Enterococci isolates. Study participants who had prior antibioticexposurer more than two weeks [AOR = 7.35; 95% CI: (1.2144.64)] and hospitalization for the last six months [AOR = 5.68; 95% CI: (1.09 29.74)] were significantly associated with vancomycin resistant Enterococci. In our study high incidence of vancomycin resistant Enterococci was found. Previous exposure to antibiotics for more than two weeks and hospitalization for more than six months were significantly associated with vancomycin resistant Enterococci. The isolated Enterococci had variable degrees of resistance to commonly prescribed antibiotics. Therefore, periodic surveillance on antimicrobial resistance pattern, adhering to rational use of antibiotics and implementing infection prevention protocols may reduce colonization by VRE.