Isolation Ward Research Articles

Assessment of anxiety and depression among professional healthcare workers during the COVID-19 pandemic – observational cross-sectional study

Aim: Evaluate the prevalence of depression among professional healthcare workers (PHCW) during the COVID-19 pandemic. Methods: A cross-sectional study was conducted during the fourth wave of COVID-19 infection in Iraq. A semi-structured questionnaire in English was used to obtain information about the study variables. Results: The study included 314 participants, with a mean age of 34.3 years, slightly higher male to female sex (55.1 to 44.9%), doctors represent (26.1%), pharmacist represent (26.4%) while 36.9% includes other PHCW (nurse, laboratory technician, doctor assistance, and paramedics). There was a high prevalence of depression in the current study (98.4%). There was no significant association between total HADS with sex, specialty, and duration of working in COVID-19 isolation wards. Meanwhile, age above 50 years appears to be associated with higher HADS scores compared to younger PHCW. Conclusion: Healthcare practitioners faced a heightened susceptibility to experiencing depression throughout the COVID-19 pandemic.

Depression, anxiety, lower sleep quality and social support in square cabin hospitals during Shanghai's COVID-19 lockdown, China.

To investigate and compare the associated factors of depression, anxiety, and other psychological differences between patients with Corona Virus Disease 2019 quarantined in square cabin hospitals (SCH) and isolation wards (IW) in China. Cluster sampling method was performed during Shanghai's Two-Month Lockdown in 2022. Hospital Anxiety and Depression Scale Depression subscale (HADS-D), 7-tiem Generalized Anxiety Disorder Scale (GAD-7), Pittsburgh sleep quality index (PSQI), and Perceived Social Support Scale (PSSS) were used to investigate psychological differences. The HADS-D and GAD-7 scores of SCH patients were significantly higher than those in IW (p < 0.001; p = 0.0295). Sleep latency (SCH-IW = -3.76, p < 0.001), sleep duration (SCH-IW = -2.22, p < 0.05), habitual sleep efficiency (SCH-IW = -4.11, p < 0.001), sleep disturbance (SCH-IW = -3.59, p < 0.001) and use of sleep medication (SCH-IW = -5.18, p < 0.001) of SCH patients were significantly worse. Depression was the main emotional problem of quarantined patients. Patients in SCH had lower social support. Sleep disorders and the lowest oxygen saturation ≤ 93% were risk factors for depression, while social support and child status were protective factors. Myalgia and constipation were risk factors for anxiety, while marital status was the protective factor. Patients quarantined in SCH had higher risks of depression and anxiety, lower sleep quality and social support. Somatic discomfort and sleep disorders exacerbated depression and anxiety, which could be ameliorated by social support and taken into consideration in future SCH construction.

Assessment of psychological status by a comprehensive approach in thyroid cancer patients undergoing radionuclide therapy: A feasibility study.

This feasibility study evaluated the psychological status of patients with differentiated thyroid cancer (DTC) before, during, and 40 days after administration of I-131 radionuclide therapy (RAI). We investigated the appropriateness of providing patient a comprehensive psychological assessment in an isolation ward. Thirty consecutive patients (Study Group; SG) who received RAI were enrolled. The tools used were the Hospital Anxiety and Depression Scale (HADS) at three different moments, and the Coping Responses Inventory (CRI) at baseline for each patient. A supportive approach was also implemented. Data were collected at the first specialist visit, at the day of admission, and at 40 days follow-up visit. A matched cohort of patients (Control Group; CG), who did not receive psycho-oncological counseling, was retrospectively studied only about their medical needs and requests. Staff exposure to radiation was also compared during SG and CG hospitalization, to assess a possible reduction of radiological risk for them. A significant difference between the basal, intermediate, and final psychological status was observed (p < 0.0001), which was found to be irrespective of the induced hypothyroidism. Patients showed a significant worsening of their status in terms of anxiety and depression after the consent, but it improved 40 days after treatment. Repeated measures analysis showed a similar trend in patients' psychological status over this period. At hospital discharge, patients showed indirect signs of increased well-being. CG required more nursing and medical interventions. Staff exposure was significantly lower during hospitalization of SG as compared to CG. This study demonstrates that timed psychological evaluation and appropriate support may help to reduce anxiety and depression of patients receiving a diagnosis of cancer and undergoing RAI. Moreover, an improvement of workplace safety was recorded.

Research on vibration response of 550 kV GIL isolation compensation unit against earthquake loading

To analyze the vibration response of Gas Insulated Transmission Lines (GIL) of urban power grid under different seismic intensity levels, based on the actual structure of the standard isolation compensation unit (isolation unit and compensation unit) of 550kV GIL, A fine 3D model of isolation compensation unit segment of 550 kV GIL was established, and the actual vibration response of each standard unit segment of GIL under different seismic conditions was studied by response spectrum analysis. This study clarified the action mechanism and law of GIL vibration characteristics under seismic conditions of urban power grids, provided the relative support for the research of shock absorption of GIL, and was great significance to the actual project of GIL.

Resilience and Overcoming Experiences of Coronavirus Disease 2019 Patients Hospitalized in a Single-Room Isolation Ward: A Mixed-Methods Study

PurposeThe COVID-19 pandemic has caused patients to suffer from various physical and psychological symptoms and social challenges, but the impact was harder for those COVID-19 patients receiving treatment in single-room isolation wards in South Korea. This study aimed to investigate resilience, anxiety, depression, and sleep quality of those patients and the relationships between those variables, and explore the patients’ experience of resilience during the COVID-19 treatment in single-room isolation wards. MethodsThis study employed a mixed-methods approach, collecting quantitative data through surveys and qualitative data through semi-structured interviews conducted between May and October 2022. Quantitative surveys encompassing disease-specific and demographic information, visual analog scales to assess anxiety, depression, and sleep quality, and the Connor–Davidson resilience scale were administered to patients (N=153). Qualitative thematic analyses were conducted following interviews with a subset of patients (N=13) belonging to the high-resilience group. ResultsResilience exhibited a negative correlation with anxiety and depression, while showing a positive correlation with sleep quality. Factors affecting resilience include having a spouse, educational attainment, and depression. The qualitative thematic analysis results were categorized into (1) facing the reality of being isolated in a room, (2) struggling to accept and adapt to isolation, and (3) seeking connections in isolation. ConclusionsThis research sheds light on the challenges faced by individuals in isolation and underscores the crucial role of resilience in overcoming such challenges. The resilience observed in these patients is grounded in both interpersonal and profound spiritual connections. These findings underscore the necessity for nurses to develop customized strategies to alleviate the impacts of social isolation.

Evaluation of relationship between TMPRSS2 p.(Val197Met) variant and COVID-19 susceptibility and severity

BackgroundThe World Health Organization (WHO) declared Coronavirus Disease 2019 (COVID-19) a global pandemic on March 11, 2020. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has killed millions of people and had a terrible effect on society. The transmembrane protease serine 2 (TMPRSS2) enzyme is essential in the initial phases of the interplay between the SARSCoV-2 and the host cells by assisting viral entrance.MethodsThis observational case–control study involved 150 participants, 100 adult patients with COVID-19, 50 of whom appeared healthy and had no history of or symptoms of COVID-19 infection when the study was conducted. Between January and April 2022, patients were taken as inpatients in isolation units or through recruitment from the COVID-19 clinic at Kasr Al-Ainy Cairo University Hospitals. According to the National Institutes of Health guidelines (2021), they were categorised into three categories: mild, moderate, and severe. TMPRSS2 p.(Val197Met) variant genotyping was evaluated using TaqMan Real-Time PCR.ResultsThe study showed a substantial difference between the mild and severe COVID-19 patient groups regarding their TMPRSS2 (p.Val197Met) genotypes (P value = 0.046). The C allele was significantly more prevalent in the mild, moderate and severe COVID-19 patient categories (77.8%, 89.7% and 91.7%, respectively) and the control group (80%). Meanwhile, the T allele was more prevalent in the mild (22.2%) and control (20%) groups. There was a statistically significant difference in allelic distribution between the mild and severe groups (P value = 0.034).ConclusionThe study showed a connection between the TMPRSS2 gene variant p.(Val197Met) and the degree of illness. We concluded that the T(mutant) allele was protective against severe COVID-19 because it was linked to lesser disease severity.

Nurses' experiences regarding nursing competence in the isolation wards during COVID-19 pandemic

During the COVID-19 pandemic, it was essential for nurses to possess the necessary skills and expertise to provide care for patients in isolation wards designated for COVID-19 cases. This recognition of a nurse's experience could serve as a basis for establishing more precise competency standards for staff working in COVID-19 isolation wards. This study aimed to explore the experience of nurses with the competencies needed to care for COVID-19 patients in the isolation ward. The research design used was a phenomenological design as outlined by van Manen's phenomenological of practice. In-depth interviews were conducted using semi-structured questions involving six nurses in the COVID-19 isolation ward at Lumajang District Hospital. This study found seven major themes, namely nurses must have altruistic thinking, critical thinking to solve problems, the ability to work with teams, problem-solving thinking, the ability to handle emergency situations, have a caring attitude, and have the motivation to learn. The competence of nurses in the COVID-19 isolation ward should be established on a foundation of both hard and soft skills, which are essential for a nurse to deliver optimal care to COVID-19 patients. Efforts aimed at enhancing nurses' competencies should take precedence, enabling them to provide improved care and assist in addressing the ongoing public health challenges.

Portable color retinography findings in COVID-19 patients admitted to the ward

Retinal lesions, including cotton-wool exudates, microbleeds, vascular occlusions and vasculitis, occur in a minority of Coronavirus Disease-19 (COVID-19) patients. Retinal assessments using retinography can help document these lesions. The objective of this work was to identify retinal changes in patients admitted to the ward with a positive Real Time Quantitative Polymerase Chain Reaction (RT-qPCR) exam for COVID-19. A cross-sectional, observational study was carried out of patients with mild and moderate symptoms admitted to the Hospital de Base in São José do Rio Preto. The Eyer® portable retinal camera (Phelcom® Technologies) was used to evaluate 30 male and 21 female patients. The ages ranged from 21 to 83 years (mean: 47 years). Systemic arterial hypertension was identified in 21 (41.2 %) and diabetes mellitus in 12 (23.5 %) patients. Six (11.7 %) reported worsening visual acuity, however, none of these patients had ocular findings to justify this complaint. Ten patients (19.6 %) had intraretinal hemorrhages; one (1.9 %) had cotton-wool exudates and seven (13.7 %) had dilations of veins. Thirteen patients (25.4 %) had vascular tortuosity and six (11.7 %) had pathological arteriovenous crossings. Portable retinography is useful to evaluate patients admitted to isolation wards due to COVID-19. It is important to remember that some of the patients investigated had comorbidities like diabetic maculopathy and systemic arterial hypertension. Hence, some care should be taken in attributing these observations uniquely to COVID-19 infection.

Spectrum of Vaccine Preventable Diseases Amongst Children in Isolation Ward of Tertiary Care Hospitals

OBJECTIVE:&#x0D; The objective of the study is to determine the spectrum of vaccine preventable diseases amongst children in pediatric medical unit of tertiary care hospitals and also determine its relationship with the vaccination status.&#x0D; METHODOLOGY: &#x0D; It was a cross sectional study held at isolation ward of pediatric therapeutic division of The Children’s Hospital and University of Child Health Sciences and Shaikh Zayed Hospital Lahore from December 2019 to November, 2020. We included children aged between 2 months to 16 years. After getting parental consent, precise history taken and examination done. Patients admitted with different vaccine preventable diseases analyzed.&#x0D; RESULTS:&#x0D; One hundred and twenty patients were enrolled. Amongst them, 55.83% were male and 44.17 % were female. Amongst spectrum of diseases, most common was chicken pox 43(35.83%) followed by measles 32(26.6 %), tetanus 20 (16.6%), diphtheria 13(10.83 %), mumps 12 (10%).&#x0D; CONCLUSION:&#x0D; Amongst diseases, chicken pox was the commonest one. Non-vaccination is the major reason that children are presenting with these potentially morbid diseases. Moreover, vaccine against varicella should be included in EPI Programme for our country.&#x0D;

Spatial and temporal distribution of bioaerosols produced by patients with different postures in a negative pressure isolation ward under different ventilation modes

The high concentration of viral bioaerosols within the negative pressure isolation wards could pose a challenge to preventing potential cross-infection amongst healthcare workers (HCWs) and patients. Using the Euler–Lagrange methodology, this study numerically simulated the spatial and temporal distribution characteristics of bioaerosols in a typical negative pressure isolation ward as well as determined the interaction of ventilation mode and patient posture on ward ventilation performance. The removal effect of particle groups produced by two respiratory behaviours (breathing and coughing) was quantitatively analyzed, and the effect of exhaust air ratio and air exchange rate on particle distribution was discussed. The results showed that the migration characteristics of bioaerosol particles were sensitive to both the ventilation pattern and patient posture, which showed significant interactions. On this basis, the ventilation pattern with the best ventilation performance was evaluated, showing a particle removal effect of 70–85%. Due to the initial momentum difference, the diffusion behaviour of cough and breath particles was not consistent, but optimizing the airflow distribution near the exhaust outlet could improve their removal efficiency in the meantime. Further studies found that equal exhaust air velocity ratio facilitated the removal of aerosol particles, and an appropriate increase in the air exchange rate could also reduce the particle content.

Modeling and Analysis of Bio-Inspired, Reconfigurable, Piezo-Driven Vibration Isolator for Spacecraft.

The positioning accuracy of spacecraft in orbit is easily affected by low-frequency micro-vibrations of the environment and internal disturbances caused by the payload. Inspired by the neck structure of birds, this study devised a piezo-driven active vibration isolation unit with high stiffness. First, a dynamic model and two-sensor feedback control method for the isolation unit were developed, and the isolation mechanism and anti-disturbance characteristics were analyzed. Further, the stability of the closed-loop was verified. Simulation models of serial and parallel systems based on the proposed vibration isolation unit were implemented to demonstrate its feasibility. The results indicate that the proposed isolation units can provide excellent low-frequency vibration isolation performance and inertial stability and that they can effectively resist the internal disturbance of the payload. Moreover, its performance can be further improved via serial or parallel reconfiguration that facilitates its adaptation to the varied isolation requirements of spacecraft.

The need for smoking cessation counselling and nicotine withdrawal therapy for hospitalised patients: A smoking point prevalence study at Groote Schuur Hospital, Cape Town, South Africa.

South Africa has high tobacco-attributable mortality and a smoking prevalence of 32.5% in males and 25.6% in females. There are limited data on smoking prevalence and desire to quit in hospitalised patients, who have limited access to smoking cessation services. To determine smoking prevalence and the extent of nicotine withdrawal symptoms, using a hospital-wide inpatient survey. A 1-day point prevalence survey was conducted at Groote Schuur Hospital, Cape Town. All wards except the haematology isolation, active labour and psychiatry lock-up wards were evaluated. Smoking status, withdrawal symptoms and desire to quit were established. Smoking status was confirmed in 85.8% of inpatients (n=501/584), of whom 31.9% (n=160) were current smokers; 43.5% (n=101/232) of male and 21.9% (n=59/269) of female inpatients were smokers. Documentation and confirmation of smoking status was highest in the maternity wards (100%) and lowest in the surgical wards (79.6%) and intensive care units (70.0%). Smoking prevalence ranged from 47.6% in male surgical patients to 15.2% in maternity patients. Of the smokers, 54.5% reported being motivated to quit, with a median (interquartile range) Fagerström test for nicotine dependence score of 4 (2 - 6), and 31.4% reported moderate to severe cravings to smoke, highest in the surgical wards. Smoking prevalence was higher in hospitalised patients than in the local general population. Many inpatients were not interested in quitting; however, a third had significant nicotine withdrawal symptoms. All inpatients who are active smokers should be identified and given universal brief smoking cessation advice. Patients with severe withdrawal symptoms should be allowed to smoke outside, and nicotine withdrawal pharmacotherapy should be provided to those who are bedbound or express a desire to stop smoking during the current admission. What the study adds. A single data point prevalence study of active smokers at Groote Schuur Hospital, Cape Town, was conducted. The prevalence of smoking was higher in the hospitalised patients than in the general community, but not all smokers were identified by the clinicians. Although symptoms of nicotine withdrawal were severe in some patients, motivation to quit smoking was not related to the degree of withdrawal being experienced. Many patients were not motivated to quit smoking.Implications of the findings. Better identification of inpatient smokers is required, and all should be given smoking cessation advice. Withdrawal symptoms can be severe in some patients, and those who are not interested in stopping smoking should allowed to smoke outside or be provided with nicotine withdrawal pharmacotherapy while in hospital. Those who are willing to quit should be supported as well as possible, including provision of nicotine replacement therapy or varenicline, and followed up after discharge as best practice.

Combination of rRT-PCR and Clinical Features to Predict Coronavirus Disease 2019 for Nosocomial Infection Control.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), immediately became a pandemic. Therefore, nosocomial infection control is necessary to screen for patients with possible COVID-19. This study aimed to investigate commonly measured clinical variables to predict COVID-19. This cross-sectional study enrolled 1087 patients in the isolation ward of a university hospital. Conferences were organized to differentiate COVID-19 from non-COVID-19 cases, and multiple nucleic acid tests were mandatory when COVID-19 could not be excluded. Multivariate logistic regression models were employed to determine the clinical factors associated with COVID-19 at the time of hospitalization. Overall, 352 (32.4%) patients were diagnosed with COVID-19. The majority of the non-COVID-19 cases were predominantly caused by bacterial infections. Multivariate analysis indicated that COVID-19 was significantly associated with age, sex, body mass index, lactate dehydrogenase, C-reactive protein, and malignancy. Some clinical factors are useful to predict patients with COVID-19 among those with symptoms similar to COVID-19. This study suggests that at least two real-time reverse-transcription polymerase chain reactions of SARS-CoV-2 are recommended to exclude COVID-19.

WGS Analysis of Staphylococcus warneri Outbreak in a Neonatal Intensive Care Unit.

Staphylococcus warneri is an opportunistic pathogen responsible for hospital-acquired infections (HAIs). The aim of this study was to describe an outbreak caused by S. warneri infection in a neonatal intensive care unit (NICU) and provide investigation, prevention and control strategies for this outbreak. We conducted an epidemiological investigation of the NICU S. warneri outbreak, involving seven neonates, staff, and environmental screening, to identify the source of infection. WGS analyses were performed on S. warneri isolates, including species identification, core genome single-nucleotide polymorphism (cgSNP) analysis, pan-genome analysis, and genetic characterization assessment of the prevalence of specific antibiotic resistance and virulence genes. Eight S. warneri strains were isolated from this outbreak, with seven from neonates and one from environment. Six clinical cases within three days in 2021 were linked to one strain isolated from environmental samples; isolates varied by 0-69 SNPs and were confirmed to be from an outbreak through WGS. Multiple infection prevention measures were implemented, including comprehensive environmental disinfection and stringent protocols, and all affected neonates were transferred to the isolation wards. Following these interventions, no further cases of S. warneri infections were observed. Furthermore, pan-genome analysis results suggested that in human S. warneri may exhibit host specificity. The investigation has revealed that the outbreak was linked to the milk preparation workbench by the WGS. It is recommended that there be a stronger focus on environmental disinfection management in order to raise awareness, improve identification, and prevention of healthcare-associated infections that are associated with the hospital environment.

Carbapenem-resistant Acinetobacter baumannii Outbreak in a COVID-19 Isolation Ward and Successful Outbreak Control with Infection Control Measures.

Even amid the coronavirus disease-19 (COVID-19) pandemic, the spread of multidrug-resistant bacteria and infection control are still important tasks. After recognizing the carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak that occurred in the isolation room for COVID-19, we would like to introduce what infection control measures were implemented to eradicate it. All COVID-19 patients with CRAB in any specimen admitted to the COVID-19 isolation ward of the tertiary hospital in Korea from October to November 2021 were analyzed. During the outbreak, 23 patients with COVID-19 and CRAB infections were identified. The index case was an 85-year-old female referred from a long-term care facility. CRAB was identified in sputum culture in most patients (91.3%). The CRAB outbreak occurred mainly in the rooms around the index case. Environmental cultures on the floor, air inlet, air outlet, and window frame of the rooms were performed. The antimicrobial resistance patterns of CRAB from patients and the environment were identical; whole-genome sequencing analyses revealed isolated clonality. Infection control measures with enhanced environmental cleaning using 1,000 ppm sodium hypochlorite and phenolic compounds, enhanced hand hygiene, additional education, and mandatory additional gowning and gloving of COVID-19 personal protective equipment (PPE) were applied on 29 October. No CRAB infection cases occurred from 2 November for two weeks. In addition to applying PPE and COVID-19 precautions in COVID-19 isolation wards, adhering to strict contact precautions along with environmental control can help prevent the spread of multidrug-resistant bacteria.

Prevalence of post traumatic stress disorder among patients discharged from COVID-19 isolation ward: Its association with medical comorbidities and length of hospital stay – A cross-sectional study

Background: Posttraumatic stress disorder (PTSD) is a common pathological consequence of a variety of traumatic events. The core symptoms of PTSD, according to the The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), include persistent intrusion symptoms, persistent avoidance of stimuli, negative alterations in cognition or mood, and marked changes in arousal and reactivity, all of which are related to the traumatic event experienced. Aim: The purpose of this study is to determine the prevalence of PTSD in coronavirus disease 2019 patients 1 month after discharge from the corona isolation unit at a tertiary care hospital. Methodology: It was a cross-sectional analytical study. The study population were individuals over 18 years of age who tested positive and had been discharged from the corona isolation ward after recovery. They were interviewed by telephone, 1 month after discharge and enquired about demographic details and the questions from the PCL-5 checklist, after obtaining their consent. Results: PTSD prevalence was 43%. A significant association (P &lt; 0.05) was obtained between PTSD and age (&gt;55), female gender, and number of initial symptoms (≥3). Linear correlation was obtained between length of stay (&gt;14 days) and PCL-5 scores. Diabetes and hypertension had a significant association with PTSD. Conclusion: Telemental health programs should be launched to screen for psychological problems, and on positive screening, mental health professionals can help reduce the patient distress level by providing stress coping skills and brief cognitive behavioral therapy. Integrated, holistic care and technology hold hope to address the bidirectional effect of physical and mental illnesses.

Frequency of Burnout Syndrome in Doctors during COVID-19 Pandemic in a Tertiary Care Hospital

Objective: To determine the frequency of burnout syndrome in junior doctors who worked in COVID 19 units of a tertiary care hospital. Study Design: Cross-sectional study. Place and Duration: The study was conducted at Liaquat National Hospital and Medical College Karachi by the Department of Community Medicine during 1st August 2020 to 30th June 2021. Methodology: The study population was house officers, interns, medical officers and junior residents working solely in COVID 19 isolation wards, high dependency units and intensive care units. The data was collected on structured questionnaire which had sections of socio-demography and Maslach Burnout Inventory-Human Services survey (MBI-HSS). MBI-HSS is reliable and validated tool for assessment of burnout syndrome. It evaluates three sub-dimensions of burnout that is emotional exhaustion (EE), depersonalization (DP) and low personal accomplishment (PA). Data analysis was done on SPSS version 21. Results: Total 106 doctors were working in different COVID 19 units and all of them had participated in the study. Majority were females and young. Around 55% of participants had high emotional exhaustion scores. All the participants had high (&gt;9) depersonalization scores, and low (&lt;32) personal accomplishment scores. Doctors working less than eight hours a day had low levels of emotional exhaustion and depersonalization scores and high personal accomplishment as compared to doctors working more than eight hours a day. There was no significant difference in scores among the designations of junior doctors. Conclusion: The health authorities need to take supportive measures to improve mental health of workers for attaining better health outcomes. Keywords: Burnout Syndrome, Maslach Burnout Inventory, Healthcare Workers, COVID 19, Doctors, Tertiary Care. How to Cite This: Siddiqui AF, Abidi SS ,Zainab S ,Quershi K ,Khoso A. Frequency of Burnout Syndrome in Doctors during COVID-19 Pandemic in a Tertiary Care Hospital. Isra Med J. 2023; 15(2): 60-64. DOI: https://doi.org/10.55282/imj.oa1357

Mortality Trends In Pre COVID And Pandemic Era In A Tertiary Care Setting

Objective: The coronavirus pandemic has emphasized stay-at-home and social distancing policies. Since the beginning of the outbreak of COVID-19, there has been a declining trend of hospital mortality indicating that the pandemic might keep patients from seeking emergency care in a hospital setting. This study was carried out to determine the mortality trends pre-COVID and pandemic periods in a tertiary care hospital. Methods: Study design: Retrospective observational study Place and Duration: 1st January 2019 to December 2021 at Federal Government Polyclinic (FGPC) Hospital Islamabad It was a retrospective review done on death data of pre-COVID (January-December 2019) and pandemic(January 2020-December 2021) period. Data on death was retrieved from medical male and female wards, medical ICU and isolation ward. The mortality rate was measured for both pre-COVID and pandemic periods along with co-morbid for the pandemic period. Descriptive statistics were measured with the SPSS software version. 23. Association with age, gender and mortality was observed using a chi-square test taking p value ≤ 0.05 as significant. Result: In this study of the 366 deaths, the average age of patients in the pre-COVID and pandemic era was57.40±17.910 and 64.31±16.065 respectively. The males and females were 50.9% and 49.1% in the pre-COVID period while 61.5% and 38.5% in the pandemic period. The frequency of deaths was 46.7% in the pre COVID and 53.3% in the pandemic period with a p-value &lt;0.05. Patients with co-morbid died more in the pandemic era. Conclusion: It was observed that hospital mortality trends were in decline during the COVID-19 pandemic in our setting which may be associated with lockdown, decreased access to the hospitals or fear of going to hospital.

Nosocomial Infections: Prevention, Control and Surveillance

Introduction: Nosocomial infections can have significant negative consequences, including extra hospitalization days, additional costs, and even deaths, depending on the site of infection. These consequences and associated costs can be substantial, and it is important to identify patients at highest risk for infection in order to prioritize prevention and control efforts. In this review, we aimed to include all preventive, control and surveillance strategies targeting nosocomial infections. Methods: A systematic review was conducted to examine the effects of modifications to hospital architecture on nosocomial infections in intensive care units (ICUs), surgical departments, isolation units, and hospitals in general. The review included experimental and nonexperimental studies published before 2022 in English. The search was conducted using a combination of keywords and abbreviated terms related to hospital architecture and nosocomial infections, and was carried out through seven medical databases, reference lists, and expert consultation. In addition, the Cochrane Controlled Trials Database and the internet were checked. The bibliographies of reviewed papers, reports, and textbooks were searched by hand and experts in the field of hospital hygiene were consulted. The principal outcome measure was the rate of nosocomial infections. Results: The search identified 178 articles that met the inclusion criteria, but only 17 of these described completed concurrent or historical cohort studies that matched the criteria. Most of the articles were categorized at the lowest level of evidence and did not include a meta-analysis, systematic review, or randomized controlled trial. The interventions in hospital architecture generally resulted in more space per hospital bed, single rooms, or easily accessible handwashing facilities. Of the 17 included studies, three documented a statistically significant decrease in nosocomial infection after the intervention. However, none of the studies addressed other types of nosocomial infection, such as postoperative pneumonia or urinary tract infection. Conclusions: To effectively control these infections, healthcare institutions should implement infection control programs and use appropriate antimicrobials, including prophylactic use when appropriate. Efficient surveillance methods, including data collection from multiple sources and regular evaluation and maintenance, are also important for effectively implementing interventions and maintaining the effectiveness of surveillance systems.

An integrated, holistic, evidence-based, interdisciplinary approach to digital monitoring and remote care in patients with highly infectious diseases: TeleCovid.

During the first waves of the SARS-CoV-2 pandemic, hospitals were overrun with patients. To cope with this high influx of infectious patients, hospitals needed to postpone elective care. Additional ICU beds had to be opened, and the number of isolation units had to be increased. All of this placed considerable strain on the nursing and medical staff. At that time, the idea was launched to keep as many patients as possible at home and prevent their hospital admission through the use of a remote care program. Based on our previous experience with transmural care programs, we quickly developed a digital monitoring program to track the health status of Covid-19 infected patients at home.&#x0D; Patients could be registered for follow-up by their primary care physician or specialist. After registration, patients received access to a secured digital platform. They first had to complete an extensive survey in order to identify their medical and surgical history, as well as the symptoms present at that time. The severity of symptoms was also evaluated at the moment of the initiation of the digital monitoring. On the basis of the responses to the introductory questionnaire, a global personalized risk score was compiled. After this initial step was concluded, the patient was contacted by the medical monitoring team to arrange for the delivery of telemetric devices (such as peripheral oxygen saturation). Patients were monitored through a 4-layer system, consisting of diaries, validated surveys, telemonitoring of vital signs, and a digital communication system included in the digital platform. This resulted in close cooperation with GPs, home nurses, physiotherapists, and other caregivers. The remote care team monitored the condition of the patients on a 24/7 basis. If needed, they contacted the home caregivers with specific demands or instructions (e.g. administration of oxygen at home, blood sampling, administration of medication). &#x0D; In the spring of 2022, Paxlovid became available in Belgium for ambulatory treatment of Covid-19 symptoms in high-risk patients. It was quickly decided that we would also include the follow-up of Paxlovid treatment regimens within our care pathway. This created an entirely new approach to our remote monitoring since we had to tackle specific problems like drug-drug interactions but also therapeutic monitoring of certain specific drugs.&#x0D; &#x0D; TeleCovid was perceived as an integrated, comprehensive remote care program for Covid-19 patients. At first, this digital care program was perceived in such a way that we could prevent the hospitalization of Covid-19 patients. But very soon after its activation, GPs started to include patients so that they focus their attention and time on other patients. They could rely on the remote care program to be notified when the medical conditions of their patients deteriorated. The care program provided support and guidance to the patients AND their families so they felt safe while staying at home. We provided all possible care right at the home of the patients. This was only possible through intensive and continuing cooperation between many different healthcare providers, such as nurses, physiotherapists, social workers, GPs, and hospital specialists.