Nosocomial COVID-19 Infection Research Articles

Impact of Nosocomial COVID-19 Infection Among Hospitalized Patients with Respiratory Diseases

Impact of Nosocomial COVID-19 Infection Among Hospitalized Patients with Respiratory Diseases

Randomized trial of the safety and efficacy of anti-SARS-CoV-2 mAb in the treatment of patients with nosocomial COVID-19 (CATCO-NOS).

Patients with nosocomial acquisition of COVID-19 have poor outcomes but have not been included in therapeutic trials to date. A pragmatic open-label randomized controlled trial of anti-SARS-CoV-2 monoclonal antibodies (mAb) was performed in hospitalized patients with nosocomial COVID-19 infection in acute care hospitals spanning a provincial health care network. Participants within 5 days of first positive test or symptom onset were randomized to standard of care (SOC) plus a single dose intravenous mAb treatment (bamlanivimab or casirivimab/imdevimab) or SOC alone on a 2:1 basis. The primary study endpoint was the need for invasive mechanical ventilation (IMV) or inpatient mortality by day 60 after randomization. Forty-six participants were enrolled from 13 hospitals between February 14 and October 8, 2021: 31 in the mAb and 15 in the SOC arm. IMV or inpatient mortality up to day 60 occurred in 4 (12.9%) participants in the mAb versus 3 in the SOC arm (20.0%), difference of -7.1% (95% CI -22.5 to 13.4, p = 0.67). The study was terminated early due to lack of equipoise as effectiveness of anti-viral therapies and mAb was published in similar high-risk patient populations. The trial was underpowered to detect meaningful differences given its early termination. The study does highlight the feasibility of undertaking trials in this patient population using a pragmatic approach allowing for trial participation and treatment access across a large health care network and may serve as a template for future designs.

Real-World Outcomes of Neutralizing Monoclonal Antibody Treatment in Patients Affected by Nosocomial Coronavirus Disease 2019

Introduction Neutralizing monoclonal antibodies (NmAbs) are a treatment option in patients with early SARS-CoV-2 infection. In this study, we examined the role of NmAbs therapies in a cohort of patients affected by nosocomial COVID-19 infection and high risk of illness progression. Methods A retrospective, single-center analysis was performed including all patients affected by nosocomial SARS-CoV-2 infection receiving NmAbs treatment between April 2021 and March 2022. Results The overall included patients were 75. Mortality rate was 13.3%; disease progression was observed in 22 patients (29.3%); clinical improvement was reported in 49 subjects (65.3%). In multivariate logistic regression, the presence of immunosuppression risk factor and late administration of therapies were recognized as independent predictors of treatment failure. Conclusions In this real-world analysis, the treatment with NmAbs was safety and effectiveness in high-risk patients with nosocomial COVID-19 infection, but the timing of administration and the role of viral variants are the main limiting factors of this approach.

Identifying Adverse Events in Patients Hospitalized in Isolation or Quarantine Due to COVID-19.

This study evaluated the adverse events of COVID-19 isolation or quarantine in patients with nosocomial SARS-CoV-2 infection admitted to the Hospital Universitario Insular de Gran Canaria. This is a retrospective cohort study with 30-day follow-up of 126 patients diagnosed with nosocomial COVID-19 through polymerase chain reaction test, between May 1 and June 30, 2022, in a 500-bed university hospital in the island of Gran Canaria. Between May 1 and July 30, 2022, a total of 2250 patients were admitted to the Hospital Universitario Insular de Gran Canaria; 126 of them were diagnosed with nosocomial COVID-19 through a polymerase chain reaction test. The rate of nosocomial COVID-19 infection was 5.6%. From the 126 patients of the study population, 27 experienced an adverse event (21.4%) and 2 experienced 2 adverse events (1.6%) due to COVID-19 isolation or quarantine. Thus, a total of 31 adverse events occurred in 29 patients. These events included the following: delay in transfer to other centers of 11 patients who were pending of receiving a negative COVID-19 test result (35.5%), delay or cancellation of diagnostic tests in 9 patients (29%), delay or cancellation of doctor visit in 7 patients (22.6%), and delay or cancellation of surgical or other interventions in 4 patients (12.9%). Because of the adverse consequences of nosocomial COVID-19 infection in hospitalized patients, measures should be observed for the prevention and control of nosocomial infection transmission, and adverse events related to patient safety issues in health care in isolated or quarantined COVID-19 patients should be prevented.

RESTARTING ELECTIVE ORTHOPAEDIC SERVICES ACROSS SCOTLAND DURING A YEAR OF COVID-19

COVID 19 led to massive disruption of elective services across Scotland. This study was designed to assess the impact on elective service that the COVID-19 pandemic had, to what extent services have been restarted and the associated risks are in doing so.This is a retrospective observational study. The primary outcomes are the number of operations completed, 30-day mortality, 30-day complication rates and nosocomial infection with COVID-19 compared to previous years. Data was collected from 4 regions across Scotland from 27th March 2020 - 26th March 2021. This was compared to the same time period the previous year.3431 elective operations were completed in the year post-pandemic compared with 12255, demonstrating a reduction of 72%. Both groups had comparable demographics. Major joint arthroplasty saw a 72% reduction, with TKR seeing a reduction of 82%. Each of the 4 health boards were affected in a similar fashion. Nosocomial COVID-19 infection was 0.4% in the post covid group. 30 day mortality was the same at 0.1%. Total complications rose from 5.7% to 10.1% post covid.This study shows that there has been a substantial reduction in elective activity across Scotland that is disproportionate to the level of COVID-19. The risk of developing COVID-19 from elective surgery is low at 0.4%, however all complications saw a significant rise. This is likely multifactorial. This study will inform decision makers in future pandemics, that it is safe to continue elective orthopaedic surgery and of the potential impact of cessation of services.

Factors Associated With Nosocomial COVID-19 Infection Among Health Care Workers in an Urban-Setting Malaysia Hospital

This single-center study aimed to explore the factors associated with coronavirus disease (COVID-19) transmission in a hospital. All laboratory-confirmed COVID-19 cases among health care workers (HCWs) in a tertiary hospital in Malaysia were analyzed cross-sectionally from January 25, 2020, to September 10, 2021. A total of 897 HCWs in the hospital had laboratory-confirmed COVID-19 infection during the study period. Around 37.4% of HCWs were suspected to acquire COVID-19 infection from the hospital workplace. Factors associated with lower odds of workplace COVID-19 transmission were being females, ≥30 years old, fully vaccinated, and working as clinical support staff. Involvement in COVID-19 patient care was significantly associated with higher odds (adjusted odds ratio = 3.53) of workplace COVID-19 transmission as compared with non-workplace transmission. Most HCWs in the tertiary hospital acquired COVID-19 infection from non-workplace settings. During a pandemic, it is important to communicate with HCWs about the risk of both workplace and non-workplace COVID-19 transmission and to implement measures to reduce both workplace and non-workplace COVID-19 transmission.

Possible Colchicine Poisoning: Case Study

We have experienced a case of colchicine toxicity presenting with rapidly progressive gastrointestinal symptoms, hemodynamic instability, and multiple organ failure.
 An 86-year-old Japanese man presented to our hospital with subarachnoidal hemorrhage transferring from another hospital where he had been treated with colchicine 0.5 mg three times daily for an elevated uric acid level. During his admission, he had a nosocomial COVID-19 infection. Then, he developed loss of appetite, and significant diarrhea, which continued for two days. He then developed shock and hypoxia and was transferred to intensive care unit (ICU). The laboratory data revealed pancytopenia, acute kidney injury, lactic acidosis, marked coagulopathy, elevated troponin I, and C-reactive protein with poor cardiac function and hypotension refractory to vasopressors. Despite intensive care, he expired on 2nd day of ICU admission. Because his cardiac function was depressed from the beginning and was not respond to inotropic support, direct myocardial damage, rather than septic cardiomyopathy was suspected. We, therefore, emphasize that colchicine poisoning should be suspected in patients with access to the drug and the typical toxidrome.

Contributory conditions for unexpected COVID-19 cases and nosocomial COVID-19 infection cases identified from systematic investigation in a French University Hospital

IntroductionNosocomial case (NC) of COVID-19 infections is a challenge for hospitals. We report the results of a seven-month prospective cohort study investigating COVID-19 patients to assess unexpected cases (UC) (no COVID-19 precautionary measure application since admission) and NC. Patients and methodsInvestigation by an infection control team of 844 patients with COVID-19 infection hospitalized for more than 24 hours (cases). ResultsA total of 301 UC were identified (31% after contact tracing) with a total of 129 contact patients, and 27 secondary cases for 59 of them. In geriatric wards, 50% of cases were UC. NC represented 18% of cases (37% in geriatric wards), mainly identified after contact tracing of wandering cases. ConclusionA rapid infection control response is essential to contain nosocomial transmission, along with detailed contact tracing and screening policy. Dealing with wandering elderly patients remain challenging for HCWs.

Nosocomial COVID-19: A Nationwide Spanish Study

Introduction: SARS-CoV-2 is a highly contagious virus, and despite professionals’ best efforts, nosocomial COVID-19 (NC) infections have been reported. This work aimed to describe differences in symptoms and outcomes between patients with NC and community-acquired COVID-19 (CAC) and to identify risk factors for severe outcomes among NC patients. Methods: This is a nationwide, retrospective, multicenter, observational study that analyzed patients hospitalized with confirmed COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry) from March 1, 2020, to April 30, 2021. NC was defined as patients admitted for non-COVID-19 diseases with a positive SARS-CoV-2 test on the fifth day of hospitalization or later. The primary outcome was 30-day in-hospital mortality (IHM). The secondary outcome was other COVID-19-related complications. A multivariable logistic regression analysis was performed. Results: Of the 23,219 patients hospitalized with COVID-19, 1,104 (4.8%) were NC. Compared to CAC patients, NC patients were older (median 76 vs. 69 years; p < 0.001), had more comorbidities (median Charlson Comorbidity Index 5 vs. 3; p < 0.001), were less symptomatic (p < 0.001), and had normal chest X-rays more frequently (30.8% vs. 12.5%, p < 0.001). After adjusting for sex, age, dependence, COVID-19 wave, and comorbidities, NC was associated with lower risk of moderate/severe acute respiratory distress syndrome (ARDS) (adjusted odds ratio [aOR]: 0.72; 95% confidence interval [CI]: 0.59–0.87; p < 0.001) and higher risk of acute heart failure (aOR: 1.40; 1.12–1.72; p = 0.003), sepsis (aOR: 1.73; 1.33–2.54; p < 0.001), and readmission (aOR: 1.35; 1.03–1.83; p = 0.028). NC was associated with a higher case fatality rate (39.1% vs. 19.2%) in all age groups. IHM was significantly higher among NC patients (aOR: 2.07; 1.81–2.68; p < 0.001). Risk factors for increased IHM in NC patients were age, moderate/severe dependence, malignancy, dyspnea, moderate/severe ARDS, multiple organ dysfunction syndrome, and shock; odynophagia was associated with lower IHM. Conclusions: NC is associated with greater mortality and complications compared to CAC. Hospital strategies to prevent NC must be strengthened.

Prevention of Nosocomial COVID-19 Infections in a Designated Hospital for Children in Guangzhou, China

Background: Guangzhou Women and Children’s Medical Center was chosen as the designated facility for screening, diagnosing, and treating children in Guangzhou with SARS-CoV-2 infection after the COVID-19 outbreak in China. From January 23 to March 20, 2020, the center opened new wards for screening and treatment, taking measures to prevent and control nosocomial infections. This article summarizes and evaluates measures for preventing and controlling nosocomial infections to provide reference information during the pandemic. Methods: The COVID-19 nosocomial infection prevention and control strategies were summarized and analyzed, including the formulation of the hospital partition, the improvement of the hospitalization process, environmental cleaning and disinfection, graded protection based on risk assessment, enhanced training on-site quality control inspection, data monitoring and evaluation, among others, and evaluating the effects by comparing before and after the intervention. Results: There were 159 patients admitted to the screening wards, including 98 males and 61 females, with a median age of 34 years (interquartile range (IQR): 15, 60) months. There were no abnormal findings in these patients and their families during follow-up. During the screening ward opening period, hand hygiene compliance was significantly improved. Fifty staff members in close contact with the contaminated area had tested for SARS-CoV-2 nucleic acid by polymerase chain reaction (PCR), which showed zero infections and no nosocomial infections occurred. Conclusions: For SARS-CoV-2 nosocomial infections, taking the “standard prevention & contact isolation & droplet isolation & air isolation” strategies can prevent patients and staff effectively.

Management of Femur Fractures during COVID-19 Pandemic Period: The Influence of Vaccination and Nosocomial COVID-19 Infection.

The COVID-19 pandemic management has led to a significant change in orthopedic surgical activity. During the pandemic, femur fractures in patients over 65 years of age have maintained a constant incidence. Our study will focus on this fragile population, analyzing the incidence of SARS-CoV-2 infection during hospital stays and the clinical and radiographic orthopedic outcomes. We also evaluated the va\riation of COVID-19 infection after health professionals' vaccinations, and the influence of inter-hospital transfers caused by logistical and organizational aspects of the pandemic. Material and Methods: This is a descriptive and prospective study from 13 October 2020 to 15 March 2021. Participants were patients over 65 years of age with diagnoses of proximal femoral fractures with r surgical treatments indicated. We compared the SARS-CoV-2 infected patients during the stay with non-infected cases. A second evaluation was carried out dividing the patients into those who underwent inter-hospital transfers and a group without transfers. We subdivided the study period into two, according to the percentage of healthcare workers vaccinated against SARS-CoV-2. The reported clinical variables included the Parker and Palmer Score, the Nottingham Hip Fracture Score, the Harris Hip Score, mortality, the Rush Score, and evaluation of reduction in radio-lucent lines in prosthetic implants. Results: Ninety-three patients were studied. The whole positive COVID cohort (11.83%) was hospitalized during the period when less than 80% of health workers were vaccinated (p = 0.02). The COVID cohort and the patients transferred before surgery had longer stays in the Emergency Room (p = 0.019; p = 0.00007) and longer lengths of stay compared to the other patients (p = 0.00001; p = 0.001). Mortality was higher both in the infected group and in the patients who underwent a transfer before the surgical procedure (18.18% vs. 1.22 %; p = 0.003. 25% vs. 6.85%; p = 0.02). In terms of orthopedic outcomes measured through the third month of follow-up, we found worse score results in functional and radiographic outcomes in the COVID positive cohort and in the transferred patients' cohort. Conclusions: The impact of the COVID-19 pandemic on patients treated for proximal femur fracture was statistically significant. Patients with Coronavirus during hospitalization obtained poor short-term radiographic and functional results and increased peri-operative mortality. The incidence of intra-hospital infection was high during the period in which health professionals were not yet covered by the anti-COVID vaccination cycle. Patients who were transferred between two hospitals due to pandemic-related management issues also achieved reduced outcomes compared to non-transferred cases, with increased mortality.

COVID-protected pathways for image-guided lung cancer intervention during the COVID-19 pandemic: A cohort study.

To compare the experience of COVID-protected and mixed cohort pathways in COVID-19 transmission at a tertiary referral hospital for elective CT-guided lung biopsy and ablation during the COVID-19 pandemic. From September 2020 to August 2021, patients admitted for elective thoracic intervention were treated at a tertiary hospital (Site 1). Site 1 received patients for extracorporeal membrane oxygenation (ECMO) and invasive ventilation in the treatment of COVID-19. Shared imaging, theater, and hallway facilities were used.From April 2020 to August 2020, patients admitted for elective thoracic intervention were treated at a COVID-protected hospital (Site 2). No patients with suspected or confirmed COVID-19 were treated at Site 2.Patients were surveyed for clinical and laboratory signs of COVID-19 infection up to 30 days post-procedure. At Sites 1 and 2, patients (2.4%) were tested positive for COVID-19 at 10 and 14 days post-procedure.At Site 2, there were no COVID-19 positive cases within 30 days of undergoing elective thoracic intervention. A mixed-site method for infection control could represent a pragmatic approach to the management of elective procedures during the COVID-19 pandemic or for similar illnesses. Mixed-cohort infection control is possible in the prevention of nosocomial COVID-19 infection.

Postoperative nosocomial COVID-19 infection in surgical patients during pandemic: A prospective observational cohort study.

Background: increased pressure on healthcare systems and possible risk of nosocomial COVID-19 infection during pandemic urged many guidelines to severely restrict the number of operations. The aim of this study was to investigate the risk of COVID-19 infection and its complications in patients undergoing urgent or elective operations.Methods: a prospective observational cohort study was conducted in a tertiary surgical center and all patients with no preoperative history of COVID-19 undergoing elective or emergent surgeries were included in this investigation. chest computed tomography (CT) scan or polymerase chain reaction (PCR) test were performed on patients before and after surgery.Results183 patients who underwent an operation were enrolled in this study. In postoperative follow-up, 12 patients were positive for COVID-19 infection as identified by RT-PCR and non-contrasted chest CT scans. Regrettably, 2 individuals passed with one of these individuals dying as a direct result of COVID-19 infection. All the 12 cases of post-operative COVID-19 patients underwent elective surgeries.Conclusionthe gathered results indicate a need for the re-evaluation of the risks of operation during the COVID-19 pandemic. If operations are performed while observing protective and preventative protocols, the risk of post-operative nosocomial COVID-19 is significantly reduced. Hence, the consequences imposed on patients by the delay or cancellation of operations (most notably in cancer cases) may outweigh the risk of post-operative COVID-19 infections.

67 Tele-Emergency Care May Improve Access to Emergency Care Resources While Reducing Need for In-Person Emergency Department Evaluation

Access to timely emergency medical care is essential to the US health care system but can be particularly challenging for individuals in rural communities and those with physical impediments, strained economic resources, and increased susceptibility to nosocomial COVID-19 infection. Emergency care access is further impacted by emergency department (ED) crowding and limited resources. Telemedicine presents an innovative solution towards improving this access. We aim to evaluate the final disposition of patients utilizing the Veterans Health Administration Desert Pacific Veterans Integrated Service Network’s (VISN 22) novel Tele-Emergency Care program (TEC) to describe the efficacy of this innovative option in increasing Veterans’ access to care and conserving ED resource utilization.

Corona virus pandemic response among health workers in selected health facilities in Meru County

Corona virus pandemic response among health workers in selected health facilities in Meru County

Effect of waiting time for COVID-19 screening on postoperative outcomes of type A aortic dissection: An institutional study.

BackgroundSince November 2020, all patients undergoing emergency surgery at our hospital have been subjected to preoperative reverse transcription polymerase chain reaction (RT-PCR) screening to prevent nosocomial COVID-19 infection, with admission to the operating room requiring a negative result. Herein, we compared the pre- and postoperative outcomes of acute type A aortic dissection surgery before and after implementing the RT-PCR screening for all patients.MethodsWe compared the postoperative results of 105 patients who underwent acute type A aortic dissection emergency surgery from January 2019 to October 2020 (Group I) and 109 patients who underwent the surgery following RT-PCR screening from November 2020 to March 2022 (Group II).ResultsThe average waiting time from arrival at the hospital to admission to the operating room was 36 and 81 min in Groups I and II, respectively. Ruptured cardiac tamponade was observed preoperatively in 26.6% and 21.1% of Groups I and II patients, respectively. The preoperative waiting time due to RT-PCR screening did not contribute to the cardiac tamponade. Surgical complications such as bleeding (reopened chest), respiratory failure, cerebral neuropathy, or mediastinitis did not increase significantly. The number of deaths 30 days after surgery (Group I = 13 and Group II = 3) showed no significant difference between the groups. There were no cases of nosocomial COVID-19 infections.ConclusionsPreoperative COVID-19 screening is an important method to prevent nosocomial infections. The associated waiting time did not affect the number of preoperative ruptures or affect postoperative complications or mortality.

Multi-disciplinary community respiratory team management of patients with chronic respiratory illness during the COVID-19 pandemic

The Greater Glasgow & Clyde NHS Trust Community Respiratory Response Team was established to manage patients with chronic respiratory disease at home during the COVID-19 pandemic. The team aimed to avert hospital admission while maximally utilising remote consultations. This observational study analysed outcomes of the triage pathway used, use of remote consultations, hospital admissions and mortality among patients managed by the team. Patients’ electronic health records were retrospectively reviewed. Rates of emergency department attendance, hospital admission and death within 28 days of referral were compared across triage pathways. Segmented linear regression was carried out for emergency admissions in Greater Glasgow and Clyde pre- and post- Community Respiratory Response Team implementation, using emergency admissions for chronic obstructive pulmonary disease in the rest of Scotland as control and adjusting for all-cause emergency admissions. The triage category correlated with hospital admission and death. The red pathway had the highest proportion attending the emergency department (21%), significantly higher than the amber and green pathways (p = 0.03 and p = 0.004, respectively). The highest number of deaths were in the blue “end-of-life” pathway (p < 0.001). 87% of interactions were undertaken remotely. Triage severity appropriately led to targeted home visits. No nosocomial COVID-19 infections occurred among patients or staff. The Community Respiratory Response Team was associated with a significant decrease in emergency admissions (RR = 0.96 for each additional month under the Poisson model) compared to the counterfactual if the service had not been in place, suggesting a benefit in reducing secondary care pressures. The Community Respiratory Response Team effectively managed patients with chronic respiratory disease in the community, with an associated reduction in secondary care pressures during the COVID-19 pandemic.

Influence of vitamin D levels on outcomes and nosocomial COVID-19 infection in patients undergoing total knee arthroplasty- a cohort study

PurposeThis study aimed to audit the effects of vitamin D3 on the early functional outcomes, the incidence of nosocomial COVID-19 infection and complications in patients undergoing elective Total Knee Arthroplasty (TKA). MethodsThis was a retrospective study involving patients undergoing primary unilateral TKA between January 2020 to May 2021 operated by a single surgeon using a single implant. Participants were divided into two cohorts, Deficient-vitamin D3 level <20 ng/ml and Sufficient-vitamin D3 level ≥20 ng/ml. Assessment for Knee Society Score and Oxford Knee Score (OKS) was done preoperatively and one year after TKA. Nosocomial COVID-19 infection rate, 30-day re-admissions and complications were noted during the study. Results235 patients were divided into 2 cohorts matched by age, gender and ASA grades. 74 patients belonged to the deficient group and 161 belonged to the sufficient group. The mean preoperative scores in the sufficient group were higher than the deficient group (OKS = 15.74 vs 12.95; KSS = 88.91vs 85.62). Similarly, the one-year postoperative scores in the sufficient group were significantly higher (OKS = 36.54 vs 35.16; KSS = 164.01 vs 161.22). A linear correlation was present between preoperative score (r = 0.273) & post-operative scores (r = 0.141) with serum vitamin D3 levels. Vitamin D3 deficient individuals had higher nosocomial COVID-19 infection rate (10.81% vs 4.96%,p = 0.16). The incidence of complications like DVT, embolism, stroke, infection and fracture were not statistically different in the two groups. ConclusionVitamin D positively influences the outcomes of TKA and protects against nosocomial COVID-19 infection in patients undergoing elective TKA.

Nicotine replacement therapy for COVID-19 patients – a quality improvement project to reduce nosocomial COVID-19 infection

Nicotine replacement therapy for COVID-19 patients – a quality improvement project to reduce nosocomial COVID-19 infection

Clinical characteristics and outcome analysis of COVID-19 patients with pulmonary tuberculosis

Coronavirus disease (COVID-19) and tuberculosis (TB) are two respiratory infectious diseases with a high incidence of transmission, mainly via respiratory droplets and both can weaken the immune system and lower the number of CD4+T cells in patients. COVID-19 can occur before, at the same time or after the diagnosis of TB. Patients with pulmonary TB are more likely to have co-infection when they have a history of epidemiological exposure to COVID-19. At present, many cases of nosocomial infection of COVID-19 caused by ineffective prevention and control measures in tuberculosis hospitals have been reported successively at domestic and overseas. Therefore, it is urgent to strengthen the prevention and control of nosocomial infections in tuberculosis hospitals. The superposition of the two diseases can lead to a worsening prognosis, aggravating the patient's condition and making treatment more difficult. In addition, in the context of the new coronavirus epidemic, early recognition of co-infection with new coronavirus should be made when TB patients in chest hospitals present with symptoms such as aggregated fever or progressive disease. At the same time, we should focus on identifying the clinical and imaging manifestations of TB and COVID-19 co-infection. At present, research on COVID-19 complicated with pulmonary TB is scarce, and there are disputes on many aspects. As a country with a high prevalence of tuberculosis, it is of great practical significance to identify the clinical characteristics, outcomes, and treatment of the two infectious diseases in China.