Infection Control Issues Research Articles

Role of CXR and HRCT in diagnosing COVID-19, a descriptive cross-sectional study, at a tertiary care hospital in Pakistan

ABSTRACT 
 Objectives: Objectives of this study are to do the analysis of chest X-ray and High-resolution CT scan findings in patients who are clinical suspects of COVID-19 infection. The other objective is to classify the radiological findings in mild, moderate or severe diseases according to BSTI criteria for chest X-ray and CTSS for high-resolution CT scan.
 Methods: This is a cross-sectional descriptive study. A group of 50 patients who were clinically suspected cases of COVID-19 infection, presented to Corona flu filter clinic of Holy Family Hospital (HFH) or admitted to corona isolation wards were included. The time duration of the study was from 15 May 2020 to 15 June 2020. Patients labelled as clinically suspected cases were having positive contact with confirmed positive (based upon positive PCR) patients. Recent travel history from the area having an outbreak. They were having clinical signs/symptoms of fever, cough, and shortness of breath, lethargy and loss of sense of smell or taste. CXR and HRCT was the investigation of choice for all the 50 patients. I also did PCR to make a correlation with the other two tests. All radiological findings were analyzed based upon Fleischner society glossary of terms for thoracic imaging. Two radiologists then assessed CXRs findings based upon BSTI criteria. They marked those CXR findings as low, moderate and high probability for COVID-19 infection. HRCT findings were analyzed using CT-SS, and researchers labelled outcomes as mild, moderate and severe disease. 
 Results: Out of 50 patients, 33(66%) were males, and 17(34%) were females. Mean age was 51 with ages ranging from 30-72 years. Presenting complaints were fever in 42(84%) patients, cough in 37(74%), lethargy in 33(66%), shortness of breath in 41(82%) and loss of sense of smell and taste in 21(42%) patients. Out of these 50, 32(72%) were having positive PCR for COVID-19 infection. On CXR 5(10%) patients showed classic findings which were highly probable for COVID-19. 19(38%) patients showed intermediate results for COVID-19, 7(14%) patients had a low probability of COVID-19 infection on CXRS. Out of 50, 19(38%), patients showed normal CXR with no evidence of COVID-19 infection. We did HRCT of the same patients on the same day; it showed 21(42%)patients with mild disease,23(46%)patients with moderate disease and 6(12%)patients with the severe disease according to CTSI.HRCT of 3(6%)patients was ok with no evidence of illness in bilateral lungs. 
 
 Conclusion: The role of radiology is crucial in the diagnosis of this viral illness. CXR, with its ability to detect changes of COVID-19 in lungs, should be used as a first-line imaging modality in clinically suspected patients. Moreover, it should also be used for follow up of patients with COVID-19. HRCT is very sensitive in the diagnosis of COVID-19 infection in its milder forms. Due to lack of its widespread availability in countries with inadequate medical facilities, it was not the primary imaging tool/screening tool. Due to risk of infection to radiological staff as well as non-covid-19 patients due to surface contact, due to reduced infection control issues, due to increased burden of ionizing radiations in patients. All these factors limit the role of HRCT as a primary imaging modality for COVID-19 infection

Application of Nanomaterials as an Advanced Strategy for the Diagnosis, Prevention, and Treatment of Viral Diseases.

The coronavirus disease (COVID-19) pandemic poses serious global health concerns with the continued emergence of new variants. The periodic outbreak of novel emerging and re-emerging infectious pathogens has elevated concerns and challenges for the future. To develop mitigation strategies against infectious diseases, nano-based approaches are being increasingly applied in diagnostic systems, prophylactic vaccines, and therapeutics. This review presents the properties of various nanoplatforms and discusses their role in the development of sensors, vectors, delivery agents, intrinsic immunostimulants, and viral inhibitors. Advanced nanomedical applications for infectious diseases have been highlighted. Moreover, physicochemical properties that confer physiological advantages and contribute to the control and inhibition of infectious diseases have been discussed. Safety concerns limit the commercial production and clinical use of these technologies in humans; however, overcoming these limitations may enable the use of nanomaterials to resolve current infection control issues via application of nanomaterials as a platform for the diagnosis, prevention, and treatment of viral diseases.

4) Issues in Nosocomial Infection Control and Recommendations for the Future

4) Issues in Nosocomial Infection Control and Recommendations for the Future

A review of simulation training and new 3D computer-generated synthetic organs for robotic surgery education

We conducted a comprehensive review of surgical simulation models used in robotic surgery education. We present an assessment of the validity and cost-effectiveness of virtual and augmented reality simulation, animal, cadaver and synthetic organ models. Face, content, construct, concurrent and predictive validity criteria were applied to each simulation model. There are six major commercial simulation machines available for robot-assisted surgery. The validity of virtual reality (VR) simulation curricula for psychomotor assessment and skill acquisition for the early phase of robotic surgery training has been demonstrated. The widespread adoption of VR simulation has been limited by the high cost of these machines. Live animal and cadavers have been the accepted standard for robotic surgical simulation since it began in the early 2000s. Our review found that there is a lack of evidence in the literature to support the use of animal and cadaver for robotic surgery training. The effectiveness of these models as a training tool is limited by logistical, ethical, financial and infection control issues. The latest evolution in synthetic organ model training for robotic surgery has been driven by new 3D-printing technology. Validated and cost-effective high-fidelity procedural models exist for robotic surgery training in urology. The development of synthetic models for the other specialties is not as mature. Expansion into multiple surgical disciplines and the widespread adoption of synthetic organ models for robotic simulation training will require the ability to engineer scalability for mass production. This would enable a transition in robotic surgical education where digital and synthetic organ models could be used in place of live animals and cadaver training to achieve robotic surgery competency.

ROLE OF SOCIAL MEDIA IN COVID PANDEMIC; A BOON OR BANE ???

The Covid-19 pandemic has struck at a moment when the natural world is more intertwined than ever before. It's the rst pandemic of the digital era, and never before has it been possible to communicate and stay connected so swiftly during a pandemic.Though physical connectivity has hastened the disease's spread over the globe due to extensive travel, social media connectivity is a tool that, when utilised properly and judiciously, can inuence people's behaviour and enhance individual’s and global health.These social media portals may be used to quickly broadcast signicant new information, relevant new scientic results, discuss diagnosis, treatment, and follow-up protocols, and evaluate alternative techniques globally, removing potential geographic barriers. Simultaneously, a massive volume of potentially harmful misinformation is spreading at a faster rate via social media than the disease itself. As a result, it is vital to give timely, reliable, and trustworthy information addressing critical infection control issues. In this review, we present the most signicant facts on the impact, benets, and drawbacks of using social networks during the COVID-19 pandemic .

Assessment of Infection Control Measures at Primary Health Care Facilities in Egypt

BACKGROUND: Primary care facilities (primary health cares [PHCs]) in Egypt are public sector facilities and the issue of infection control (IC) in public sector facilities is important because public sector facilities are the only option available to most low-income groups, who constitute most of Egypt’s population. AIM: The aim of the study is to the assessment of IC measures in PHC by national and international assessment tools. STUDY DESIGN: Health system operation research, observational study. METHODOLOGY: Sample: 3 Egyptian PHCs, all health care providers (HCPs) in each facility were interviewed with a total number (55 doctors and 34 nurses). using a national assessment tool, interview questionnaire derived from the international assessment tool, and hand hygiene observation checklist. RESULTS: Although the availability of supplies, presence of administrative activities, and good infrastructure, items related to manpower practice (cleaning activities and procedures) had the lowest percent score (57.9% and 68.5%, respectively). Almost all doctors and nurses did not have a pre-employment tuberculin skin test. Hand hygiene compliance was very low among HCPs during the observation time (1.6% for doctors and 10% for nurses). CONCLUSION: The national IC assessment tool of PHC facilities in Egypt is well structured, but defective in the assessment of employee health activities related to IC. Tuberculin skin test as screening of tuberculosis for the HCPs is neither done pre-employment nor periodically. Despite the availability of supplies for hand hygiene practice and good IC knowledge, the compliance was very low during the observation time.

Chest Computed Tomography Findings in a Case Series of Coronavirus Disease 2019 (COVID-19) Patients at Siriraj Hospital

Background: Recent evidence has demonstrated the high sensitivity of chest computed tomography (CT) in coronavirus disease 2019 (COVID-19) case detection. However, considering the cost and infection control issues, the experience of chest CT for COVID-19 diagnosis in Thailand is still limited. Objective: To present the characteristics of chest CT findings in COVID-19 patients at Siriraj Hospital and compare them with other reports. Materials and Methods: The authors retrospectively reviewed the COVID-19 patients’ medical records between April and May 2020. All cases with the presence of chest CT performed during admission were recruited. Clinical data were retrieved from the patients’ medical records. All chest imaging results were reported by consensus between the authors. Results: From 103 cases, four cases with a chest CT scan during the admission were recruited. Consistent with previous reports, the common chest CT findings included a ground-glass opacity and consolidation with bilateral involvement. A round-shaped ground-glass opacity or consolidation was evidenced in half of the cases. The only case with the presence of chest CT scan, which was done 77 days after the onset of COVID-19 symptoms, revealed resolution of the abnormal findings. Conclusion: Chest CT findings in four COVID-19 cases at Siriraj Hospital are consistent with previous reports. Common findings include bilateral ground-glass opacity and consolidation. Keywords: COVID-19, SARS-CoV-2, Computed tomography, Case series

Detection of Extended Spectrum Beta Lactamases (ESBLs) Producing Enterobacteriaceae Family from Urinary Tract Infection (UTI) Patients

Background: Extended spectrum beta lactamase (ESBLs) are betalactamase capable of conferring bacterial resistance to the first, second and third-generation Cephalosporin’s but these are inhibited by lactamase inhibitors such as clavulanic acid. The ESBLs are typically plasmidmediated enzymes, mostly produced by E. coli and Klebsiella pneumonia Enterobacteriaceae family. ESBLs enzymes were discovered in Germany in 1983 from Klebsiella pneumonia. ESBL-producing gram negative bacteria have been responsible for numerous outbreaks of infection throughout the several counties and region challenging infection control issues. Different phenotypic test for ESBL detection have been developed, which are easy to use and cost effective. Materials and Methods: In this study, 10 Urine samples were collected from Government Hospital, Dharmapuri, Tamil Nadu. Collected clinical samples were isolated and identified by standard microbiological method. The antibiotic susceptibility testing was performed by the disc-diffusion method. The preliminary phenotypic detection of ESBLs was carried out by combination disc-diffusion test (CDDT) Performed using Kirby- bauer disc diffusion method on muller hinton agar. Results: Totally 10 clinical samples were collected and investigated Among 7 clinical samples of positive of Urinary tract infection (UTI), 20 micro-organisms belonging to 3 genus were isolated. Of the patients, 7 were female and 3 were male. E. coli and Klebsiella pneumonia were most prevalent species. E. coli and Klebsiella pneumonia were multidrug-resistant (resistance to five or more antibiotics) among the isolates. Of the isolated in Uro pathogens such as E. coli and Klebsiella pneumonia were ESBLs positive. Conclusion: Based on the results, E. coli and Klebsiella pneumonia predominated in the samples, giving the maximum frequency of ESBLs producing followed by E. coli (70%) and Klebsiella pneumonia (30%) from the combined disk diffusion method. Herbal medicine should be perform for UTI patients to prevent the spread of more. Only limited therapeutically options for ESBL-PE.

Editorial: Coronavirus disease 2019 (COVID-19) - advances in epidemiology, diagnostics, treatments, host-directed therapies, pathogenesis, vaccines, and ongoing challenges.

Editorial: Coronavirus disease 2019 (COVID-19) - advances in epidemiology, diagnostics, treatments, host-directed therapies, pathogenesis, vaccines, and ongoing challenges.

Are the Current Guidelines Sufficient to Establish Infection Control Strategies for COVID-19 Related Issues in Hospitals?

As hospitals cater to elderly and vulnerable patients, a high mortality rate is expected if a coronavirus disease 2019 (COVID-19) outbreak occurs. Consequently, policies to prevent the spread of COVID-19 in hospital settings are essential. This study was conducted to investigate how effectively national and international guidelines provide recommendations for infection control issues in hospitals. After selecting important issues in infection control, we performed a systematic review and analysis of recommendations and guidelines for preventing COVID-19 transmission within medical institutions at national and international levels. We analyzed guidelines from the World Health Organization, Centers for Disease Control and Prevention, European Centre for Disease Prevention and Control, and Korea Disease Control and Prevention Agency. Recent guidelines do not provide specific solutions to infection control issues. Therefore, efforts need to be made to devise consistent advice and guidelines for COVID-19 control.

Nasal Brushing Sampling and Processing using Digital High Speed Ciliary Videomicroscopy - Adaptation for the COVID-19 Pandemic.

Primary Ciliary Dyskinesia (PCD) is a genetic motile ciliopathy, leading to significant otosinopulmonary disease. PCD diagnosis is often missed or delayed due to challenges with different diagnostic modalities. Ciliary videomicroscopy, using Digital High-Speed Videomicroscopy (DHSV), one of the diagnostic tools for PCD, is considered the optimal method to perform ciliary functional analysis (CFA), comprising of ciliary beat frequency (CBF) and beat pattern (CBP) analysis. However, DHSV lacks standardized, published operating procedure for processing and analyzing samples. It also uses living respiratory epithelium, a significant infection control issue during the COVID-19 pandemic. To continue providing a diagnostic service during this health crisis, the ciliary videomicroscopy protocol has been adapted to include adequate infection control measures. Here, we describe a revised protocol for sampling and laboratory processing of ciliated respiratory samples, highlighting adaptations made to comply with COVID-19 infection control measures. Representative results of CFA from nasal brushing samples obtained from 16 healthy subjects, processed and analyzed according to this protocol, are described. We also illustrate the importance of obtaining and processing optimal quality epithelial ciliated strips, as samples not meeting quality selection criteria do now allow for CFA, potentially decreasing the diagnostic reliability and the efficiency of this technique.

COVID-19 Thrombosis: Understanding the Negative Predictive Value in a Pandemic

A test's negative predictive value-the probability that a negative result is a true negative result-is dependent on the prevalence of the condition. The present pandemic circumstances present us with unique challenges. False negatives in current testing methodology are to be expected.[1] Thus, a rigorous and contextual interpretation of a negative test result is necessary. Blood hypercoagulability and the risk of thrombosis are well documented in cases of the novel SARS-CoV-2 coronavirus (COVID-19) pandemic.[2] The systemic inflammatory response is associated with endothelial upregulation of proinflammatory mediators that lead to in situ thrombi, as well as a generalized disseminated intravascular coagulation. As many as 31% of ICU patients with COVID-19 have been reported to have thrombotic complications. More specifically, cerebral thrombotic complications confined to the arterial bed have been well described.[3, 4]. The case described shows that milder forms of coronavirus infection may lead to other types of critical and unusual thrombotic complications. An otherwise healthy 47-year-old Caucasian woman developed fever and respiratory signs and symptoms consistent with a possible case of COVID-19 infection in late March of 2020. Interstitial opacities were seen on radiographic examination. Two COVID-19 PCR nasopharyngeal tests were negative, and she recovered at home over the following 2 weeks. Three weeks later, she developed headaches, expressive aphasia, and a generalized tonic-clonic seizure. The patient was treated for a possible ischemic stroke with alteplase thrombolysis at a local hospital. After subsequent transfer and evaluation, a diagnosis of a left transverse and sigmoid sinus thrombosis with adjacent cortical edema was made. On review of her history, the patient denied taking any form of hormonal contraception, and did not have personal, or family history indicative of thrombophilia. She recovered fully after anticoagulation with enoxaparin and subsequent dabigatran. Prior to discharge a COVID-19, IgG antibody test was reported as positive. Decontextualized and overly simplistic interpretation of COVID-19 negative tests amidst a pandemic is problematic. In addition to the obvious infection control issues associated with the resulting lack of isolation and contract tracing, it may deprive some patients of the opportunity to receive antithrombotic therapy. Prophylactic and therapeutic regimens for hospitalized patients are in evolution, and have been associated with improved clinical outcomes.[5] We are aware that the role of anticoagulation in outpatient cases is not well studied, but we believe it deserves proper investigation.

Trauma Resuscitation Using in situ Simulation Team Training (TRUST) study: latent safety threat evaluation using framework analysis and video review

IntroductionTrauma resuscitation is a complex and time-sensitive endeavour with significant risk for error. These errors can manifest from sequential system, team and knowledge-based failures, defined as latent safety threats (LSTs)....

Competency of Infection Preventionists in Japan

Backgrounds: In the United States, the Association for Professionals in Infection Control and Epidemiology (APIC) announced a competency model for infection preventionists (IP) in 2011. On the other hand, IPs in Japan must develop their career by themselves because there are no guidelines of career development for Japanese IPs. In recent years, infectious diseases and infection control issues have become more global. Objective: Aiming for international collaboration among IPs, the purpose of this study were to clarify the actual competencies of IPs in Japan and the United States and to compare the competencies of both. We report on the competencies of IPs in Japan. Methods: Semistructured interviews were conducted with 67 certified nurses in infection control (CNIC) who responded to the translated version of the APIC Competency Model Assessment Tool. From the qualitative descriptive analysis of interview verbatim records, we extracted the behavioral characteristics and completed the questionnaire “Survey of Competency for Infection Preventionist,” which consisted of 130 items. A survey form was created using Survey Monkey. We sent e-mails to ask anonymous survey collaboration, including the URL of the survey form, to 2,284 CNIC and CNS in infection control professionals. The research was approved by the research ethics committee at the facility to which the researcher belongs (Juntendo University, approval no. 30–49). Results: The number of responses was 648 and the response rate was 28.4%. The mean years of experience as nurses of 648 respondents was 24.7 (SD, 6.9), and >60% belonged to general hospitals. The scores of mean and standard deviation of each category were as follows: “Clarification of infectious disease process” (mean, 79.1; SD, 13.2); “HAI surveillance and epidemiological survey” (mean, 49.3; SD, 12.3); “Prevention and control of transmission of infectious microorganisms” (mean, 93.8; SD, 17.3); “Management and communication” (mean, 128.5; SD, 23.7); “Education and Research” (mean, 56.8; SD, 11.0); “Employee and occupational health” (mean, 40.6; SD, 9.6); and the total score of all categories (mean, 449.4; SD, 74.4). Based on years of experience as infection preventionists, we divided them into 3 groups: beginners, competent, and experts. As the career level increased, each category score for competency increased (ANOVA, P < .001). However, the mean scores of competency did not reach 70% of the total score for the following categories: “Prevention and control of transmission of infectious microorganisms.” “Education and research,” and “Employee and occupational health.” Conclusions: The competencies that need to be strengthened for the career development of Japanese IPs have been clarified.Funding: This study was supported by JSPS KAKENHI.Disclosures: None

COVID-19 Emergency Department Protocols: Experience of Protocol Implementation Through in-situ Simulation.

PurposeDuring the outbreak of Coronavirus disease of 2019 (COVID-19), the preparedness of emergency departments (EDs) for triaging of the patients and safety of staff is of utmost importance. The aim of our study was to develop and implement COVID-19 ED triage and protected intubation protocols for COVID-19 patients with in-situ simulation (ISS) training. The latent safety threats (LST) detection also served as a platform to test new system amendments and refine the protocols and workflows with infection control issues. We also explored the effectiveness of this approach based on Kirkpatrick’s model of evaluating training outcomes.Participants and MethodsThe protocols and simulation scenarios were developed and validated. A total of 22 triage and 13 intubation simulation sessions were conducted in the ED with multidisciplinary staff (physicians=18, nurses=20) during a period of four months. Each simulation was followed by a debriefing session to discuss the team performance. Pre- and post-simulation performances were compared. LSTs were identified and remediated. An online voluntary feedback was collected from the participants to explore the opinion about the ISS sessions and confidence level using a 5-point Likert scale.ResultsThere was a significant improvement in triage knowledge score after ISS [5.5/10 (IQR 4–6) versus 8.5/10 (IQR 8–9), p<0.001]. There was a desirable proportion of correct responses (>75%) following the ISS for triage case scenarios. A pre-designed checklist was used during protective intubation simulations. Some important LSTs were missing medications, lack of mechanism to deliver patient samples to lab and faulty airway maneuvers. The participants’ feedback on ISS showed increased skills and confidence level on triaging and protected intubation (p<0.001). They found the protocols easy to follow and they recommended for more such modules in future.ConclusionISS is a quick and efficient tool to implement the ED protocols for preparation of outbreaks like COVID-19. It helps the ED staff to triage and manage the airway safely. We recommend such an approach to train the multidisciplinary staff and continue to improve ourselves through ISS addressing the changing nature of the pandemic.

The Sixth Decennial International Conference on Healthcare-Associated Infections Abstracts, March 2020

Global Solutions to Antibiotic Resistance in HealthcareHeld once every 10 years, the Decennial International Conference on Healthcare-Associated Infections reviews the advances of the previous decade as well as the opportunities and trends for the fields of healthcare epidemiology, infectious diseases, and infection prevention and control in the future. Due to the coronavirus disease 2019 (COVID-19) global pandemic, the SHEA Board and the Decennial 2020 Steering and Program Committee made the difficult decision to cancel the Sixth Decennial International Conference on Healthcare-Associated Infections (Decennial 2020), which was slated to take place in March 2020.Given the ongoing global situation with COVID-19, it is essential that healthcare and public health professionals remain in their workplaces and continue to direct and implement the national and international response activities related to COVID-19. Both the SHEA and the Centers for Disease Control and Prevention are aware of the challenges our country is facing at this moment as leaders in public health and infection prevention and control. We understand the vital need to direct time and energy to the critical situation we are facing in this rapidly changing environment.Although the conference has been canceled, we are pleased to present to you this supplemental issue of Infection Control and Hospital Epidemiology featuring select Scientific Abstracts from the Decennial 2020. The program for the Decennial 2020 intended to highlight 3 narrative themes that encapsulate many of the imperatives for driving progress forward in the field:(1) Innovation: The development of novel prevention tools, strategies, diagnostics, and therapeutics has been critical in the progress of infection prevention and in addressing the threat of antibiotic resistance. Further innovation related to healthcare technology, practices, policies, and programs are needed to continue to move toward the goal of eliminating healthcare-associated infections (HAIs) and slowing antibiotic resistance.(2) Data for action: Facilities, states, clinicians, and other stakeholders need data to drive detection and prevention strategies to eliminate HAIs and to combat antibiotic resistance. Improvements in use of surveillance, epidemiologic, clinical, and laboratory data are critical to closing knowledge gaps and allowing the implementation of effective strategies to provide safe care.(3) Addressing AMR without borders: Many factors impact the local and global burden and transmission of antibiotic resistance. To prevent resistant pathogens from spreading within and between healthcare facilities and the environment, constant vigilance and action are needed. The spread of antibiotic resistance does not respect borders. The antibiotic resistance experience of any given facility, region, or country is directly influenced by the movement of colonized or infected patients with its neighboring facilities, regions, and countries. Global success in containing the spread of HAIs and antibiotic resistance will require coordinated responses at the local, regional, and international levels. Public health and healthcare systems must work together to share information to detect and to implement effective practices to prevent infections from occurring and spreading.The abstracts presented in this supplement highlight these themes, and we are excited to share with you all of the exciting research taking place to advance efforts to prevent infections, combat antibiotic resistance, and provide safe healthcare at every encounter.We thank the Abstract Subcommittee for reviewing and selecting the abstracts presented in this supplement. We received a record number of abstracts, and we appreciate the effort each author contributed. The hours of work that our volunteer reviewers contributed was invaluable in selecting high-quality research for the Decennial 2020.Disclaimer: The large number of submitted abstracts and the deadlines associated with publication do not permit full author communication, abstract revisions, or ICHE editorial review. The abstracts are presented, as they were submitted to the Decennial 2020 Program Committee. Although efforts were made to ensure accuracy, some information related to disclosures and funding may be omitted.The Society for Healthcare Epidemiology of America and The Centers for Disease Control and Prevention

Transmissible Spongiform Encephalopathies: An Underrecognized Infection Control Issue

Background: Transmissible spongiform encephalopathies comprise a class of rapidly progressive and inevitably fatal degenerative brain disorders. The pathogenesis of these diseases is thought to be due to a change in the structure of the normal prion protein to an abnormal structure, leading to propagation of the abnormal protein. This abnormal protein is highly transmissible; thus, appropriate infection control measures should be put in place if the diagnosis is suspected. However, the diagnosis is often not considered at all, and many hospitals do not have protocols in place. Our hospital missed a case of familial fatal insomnia in a 45-year-old male. He was diagnosed with fatal familial insomnia by autopsy. The autopsy was performed without appropriate infection control measures, leading to costly contamination of medical instruments and exposure of multiple staff. This occurrence led our institution to re-evaluate hospital protocols and guidelines regarding workup and management of transmissible spongiform encephalopathies (TSEs). Methods: We reviewed cases of TSEs or Creutzfeldt-Jakob Disease (CJD)-like illness presenting to our hospital over a 30-month period. Patients were considered for inclusion based on clinical suspicion. CDC diagnostic criteria were used. Infection control measures were employed, including an alert in the EMR. MRI was then performed. If clinical or diagnostic suspicion was high, the patient underwent lumbar puncture. CSF results were reviewed based on criteria Creutzfeldt-Jakob Disease Foundation criteria. Infection control measures were maintained throughout hospitalization. Results: In total, 34 patients met the inclusion criteria: 8 patients had confirmed CJD and 25 were negative. Medical records were not available for 1 patient, who was excluded. Lumbar puncture was performed on all suspected cases. Of those confirmed cases, the 7 patients who underwent lumber puncture had a positive result for 14-3-3 protein. Also, 5 patients underwent RT-QuIC testing and were found to have a positive result. No further cases of contamination occurred using our protocol. Additionally, 1 patient with suspected CJD underwent a brain biopsy with appropriate precautions after an inconclusive lumbar puncture. Although biospy was negative, the case exemplifies how the initiation of a protocol can optimize the workflow and prevent potentially dangerous exposure. Conclusion: Diagnosis of TSEs remains difficult and is often missed. In our case, lack of suspicion for TSE led to a waste of resources and unnecessary exposure of staff member. It is of utmost importance to consider TSEs in rapidly progressive dementia and to employ appropriate sterile guidelines to prevent contamination of equipment and potential subsequent transmission. Healthcare providers should consider a similar protocol in cases suspicious for TSEs.Funding: NoneDisclosures: None

A Study of Occupational Exposure to Patient's Blood and Saliva among Dental Students of Shahid Sadoughi Yazd University in 2016-2017

Introduction: Occupational exposure in dentistry is defined as exposing the skin or mucosa to blood, saliva, or infectious discharge of the patient. Dentists are in contact with sharp and high-speed rotary devices that increase the chance of occupational exposure. The purpose of this study was to determine the occupational exposure to blood and saliva of patients in dental students of Shahid Sadoughi University of Medical Sciencesin 2016-2017. Methods: A descriptive analytical study was conducted on 70 senior dental students at the School of Dentistry of Shahid Sadoughi University of Medical Sciences in Yazd, Iran. A standard questionnaire was used for collecting the data. After collecting the data, they were coded and entered into the SPSS 20 software and analyzed using descriptive statistics, Chi-square and Fisher exact test. Results: Based on the results, 49 (70%) of 70 students have been suffered from sharp devices. The skin or mucosa of the 62 students (88.6%) infected with saliva or other body fluids of the patients. Only 15.7% of the injuries were reported with sharp objects and 14.3% of mucosal-skin contamination with blood or saliva. Conclusion: Occupational exposure in dentistry environment is a common problem and many cases, which are related to these subjects were not reported. In order to reduce the risks of this, infection control issues should be taught to dental students. Therefore, occupational exposure management, follow-up centers and guidelines should be established for dental schools.

Novel coronavirus (COVID-19) pneumonia: Portable chest X-ray or computed tomography? An Italian perspective.

As the new COVID-19 pandemic spreads, radiologists are at the forefront playing an important role in the initial positive/differential diagnosis, the assessment of disease severity, and in searching for progression to acute respiratory syndrome and possible complications.[1] Chest computed tomography (CT) has an unquestionable role in this setting, with a better sensitivity and specificity than chest X-Ray (CXR) and its role is growing, especially in the early detection with a low rate of missed diagnoses (3.9%), since real-time reverse transcription-polymerase chain reaction (rRT-PCR) may produce false-negative results.[2] Furthermore, it allows to follow the temporal changes of lung abnormalities throughout specific pattern, indicating the progression and recovery of the illness.[345] At the time of this writing, the search string “chest CT AND COVID-19” produces 351 articles on PubMed, whereas 235 articles appear if we search for “chest X-ray AND COVID-19,” and among these, only 39 articles report CXR features (several of these as case reports). CT is definitely the technique of excellence to be used in case of complicated pneumonia and for demonstrating vascular involvement in these patients.[6] However, other issues should be considered in the radiological management of known and suspected COVID-19 patients such as infection control issues related to patient transport to CT suites, infection containment in medical staffs (radiographers, radiologists, and nurses), sanitization of imaging equipment and rooms, and sparing of personal protective equipment. In this scenario, also considering that not all COVID-19 patients experience a complicated lung disease, chest CT could be used “sparingly” and reserved for hospitalized patients with specific clinical indications, as already suggested by ACR recommendations, or in suspected COVID-19 patients requiring both chest imaging and time-based emergency care by priority CT.[78] This case series aims to share in brief an Italian perspective on CXR findings of COVID-19 pneumonia patients from diagnosis until patient recovery. In our case series, of 76 COVID-19 patients (male 48, age range 22–97, mean age 66; 8 died and 59 discharged at the time we are writing) with rRT-PCR confirmation admitted to our University Hospital from February 24 to May 30, 2020 (hospitalization time: median 22 days, range 3–57), we performed 448 baseline and serial portable CXRs (median for patient 6, range 1–29) and 16 chest CT in 10 patients with complicated illness (range 1–6 per patient). According to the onset of symptoms, four stages of pneumonia were identified (early Stage = 0–4 days, progressive Stage = 5–8 days, peak Stage = 9–13 days, and recovering stage ≥14 days) and distribution of CXR findings were evaluated.[49] We found that “hazy densities,” which correspond to ground-glass opacities (GGOs) on CT, were mostly present in early stage (92%), whereas consolidation and parenchymal band in peak (83%) and recovering stage (96%), respectively [Table 1], whereas regarding the topographical distribution of lesions, peripheral hazy densities, or air space opacities, lower lobe and bilateral involvement were the most common findings (78.4%, 75.2%, and 84%, respectively). Lung abnormalities showed the greatest severity approximately 12 days from the onset (peak Stage)[1] [Figure 1a–d]. In one patient, the only CXRs finding, confirmed by CT, was unilateral pleural effusion, resulted positive for COVID-19 infection at rRT-PCR examination.Table 1: Chest X-rav findings according to the stage of illness in COVID-19 pneumonia patientsFigure 1: (a-d) baseline (Stage 1) and serial (Stages 2–4) chest X-rays of a 68-year-old COVID-19 patient. Stage 1 chest X-ray (a) shows a subtle ground-glass opacities in both lower lung zone (left > right). In Stage 2 chest X-ray (b) the ground-glass opacities are more diffuse in the left lung, mixed to septal thickening in the lower zone (crazy paving appearance). Stage 3 chest X-ray (c) shows peripheral consolidation in the middle and lower zone on the left and in the lower zone on the right, which resolve in Stage 4 chest X-ray (d) where smaller consolidation and parenchymal band take placeEven if chest CT allows detecting subtle diffuse GGOs that are variable identified by CXRs for several reasons such as GGO's density, technical factors (including imaging quality, acquisition parameters, and patient's positioning), and radiologist's experience, we agree with Jacobi et al. that COVID-19 lung involvement, including both lesion type and distribution, can be identified on conventional CXRs as well as on chest CT.[1011] Nevertheless, CXRs have numerous advantages such as low radiation exposure and costs, constant availability and mobility, especially for intensive care unit, and greater ease in the equipment sanitization process. In our clinical experience, we were able to accurately manage COVID-19 pneumonia, integrating clinical and functional data with the time course of lung changes obtained by CXRs, limiting chest CT to specific clinical conditions. In conclusion, even if chest CT remains “the Empress” in imaging COVID-19 pneumonia, accurately depicting both parenchymal and vascular injury, CXRs may represent “the Queen,” allowing a careful treatment and above all, a bedside management of noncomplicated illness.

Recommendations for Testing and Treating Outpatient Cancer Patients in the Era of COVID-19.

The clinical spectrum of coronavirus disease 2019 (COVID-19) is still not fully understood. Cancer patients are uniquely vulnerable to COVID-19, and many have been or will be infected. Although an unfortunate minority will die from the infection, most will recover. This poses a challenge in which clinicians must weigh the benefits of initiation or resumption of antineoplastic therapy against the risks that antineoplastic treatment may worsen outcomes related to COVID-19 infection. A recent study of 423 patients at our institution found that patients in active cancer treatment who develop COVID-19 infection did not fare any worse than other hospitalized patients, yet guidance as to who requires testing prior to antineoplastic therapy and when to resume therapy post–COVID-19 diagnosis remains unknown. Our institution, therefore, commissioned a task force to help create guidelines for treating oncologists using available published literature. The task force focused on the ambulatory care testing guidelines only, because all inpatients receiving antineoplastic therapy are tested for COVID-19 prior to hospital admission. The guidelines focus solely on the safety and well-being of the individual patient undergoing antineoplastic therapy and are not designed to address infection control issues.