Respiratory Equipment Research Articles

COMPARATIVE ASSESSMENT OF BACTERIAL PERMEABILITY OF A PERSONAL PROTECTIVE RESPIRATORY EQUIPMENT AT DIFFERENT DURATIONS OF ITS CONTINUOUS OPERATION.

The aim: To establish the level of antibacterial protection of the studied personal protective respiratory equipment set and its main components and compare antibacterial resistance of the personal protective respiratory equipment set in the presence and absence of filtering components. Materials and methods: The proposed methodology for assessing biological protection parameters is based on testing the permeability of personal respiratory protection equipment for bacteria by the method of serial dilutions. Also additional culturing of separate components of the protective set on a separate media is carried out. The experiment was also repeated in the absence of filtering elements and when they were replaced by gauze masks. Results: The use of a fully equipped pneumatic helmet counteracted the penetration of the bacterial aerosol, which was manifested in the absence of growth on the media. The results obtained with the full configuration, as well as the indicators of the spread of bacteria when removing the filter elements and replacing them with gauze masks, showed that the device creates sufficient positive air pressure inside. The latter becomes a restraining factor that does not allow microorganisms to penetrate through the lower circuit. Conclusions: Increasing the duration of continuous operation of the conceptual model up to 24 hours, increasing the bacterial load on the filters do not lead to a deterioration in the properties of antibacterial protection. Bacterial aerosol did not penetrate into the inner space of pneumatic helmet.

Infection control measures based on drug susceptibility to Acinetobacter baumannii.

In recent decades, Acinetobacter baumannii has been recognized as a nosocomial pathogen most prevalent in summer, with broad clinical manifestations and multidrug resistance posing a global threat.1, 2 We previously reported an outbreak of multidrug-resistant A. baumannii (MDR-AB) carrying oxacillinase(OXA)-51-like and ISAba1 genes.3 Therefore, we carried out screening tests in the critical care center (CCC) and intensified countermeasures against A. baumannii. Here we present the results of the drug susceptibility-based infection control measures. We included all patients in our CCC from January 2012 to December 2019 and screened a sputum or throat swab using selective medium for Acinetobacter spp. to determine the presence of A. baumannii and their drug susceptibility. Starting in January 2016, a new measure was introduced to isolate all cases in a private room for 72 h until screening results were confirmed. When private rooms were not open, CCC admission was restricted. In addition to standard precautions, patients with MDR-AB and extensively drug-resistant A. baumannii (XDR-AB) were managed by a dedicated team of physicians and nurses, and disposal of equipment following use or use of separate sets of mobile devices were implemented. Multidrug-resistant AB is defined as resistance to at least three categories of antimicrobials and XDR-AB is defined as MDR plus resistance to carbapenems.4 Data are presented as the mean and SEM of infected patients every 3 months, to observe the seasonal changes, and compared by Student's t-test. During active surveillance between January 2012 and December 2019, we identified 72 individuals with A. baumannii, including two ventilator-associated pneumonia and one bacteremia. Figure 1 shows that the number of patients with A. baumannii significantly decreased from 3.13 ± 0.50/3 months to 1.38 ± 0.41/3 months after the medical staff implemented systematic infection control measures based on the drug susceptibility in January 2016 (p = 0.01). In addition, the numbers of MDR-AB and XDR-AB patients significantly decreased from 1.94 ± 0.38/3 months to 0.38 ± 0.26/3 months (p < 0.002). We contained the outbreak by screening all patients admitted to the CCC and by focusing on MDR-AB and XDR-AB. Acinetobacter baumannii can persist in the environment of respiratory and medical equipment for several days,5 so the drug susceptibility-based isolation of the medical team and medical devices led to the end of the outbreak. However, the decrease in A. baumannii might be due not only to isolation measures based on drug susceptibility, but also years of education for health-care workers, environmental cleanup, including temporary CCC closure, and repeated audits of handwashing by the infection control team. Therefore, drug susceptibility-based infection control is one of the effective strategies because of limited medical resources, both financial and human. This work was supported by JSPS KAKENHI Grant Number JP15H04795. The authors declare no conflicts of interest. Approval of the research protocol: This study was approved by the institutional review board of the National Human Genome Research Institute and the Ethics Committee of the Faculty of Medicine, Juntendo University Urayasu Hospital (approval No. 30-004), and conducted according to the principles of the Declaration of Helsinki. Informed consent: Informed consent was obtained from guardians by opt-out in publicity documents. Registry and registration no. of the study/trial: N/A. Animal studies: N/A.

Reference Respiratory Muscle Strength Values and a Prediction Equation Using Physical Functions for Pulmonary Rehabilitation in Korea.

In Korea, tests for evaluating respiratory muscle strength are based on other countries' clinical experience or standards, which can lead to subjective evaluations. When evaluating respiratory function based on the standards of other countries, several variables, such as the race and cultures of different countries, make it difficult to apply these standards. The purpose of this study was to propose objective respiratory muscle strength standards and predicted values for healthy Korean adults based on age, height, weight, and muscle strength, by measuring maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and peak cough flow (PCF). This cross-sectional study analyzed MIP, MEP, and PCF in 360 people, each group comprising 30 adult men and women aged 20-70, diagnosed as healthy after undergoing medical check-ups at a general hospital. Hand grip strength (HGS) and the five times sit-to-stand test (FTSST) results were also recorded. Correlations among respiratory muscle strength, participant demographics, and overall muscle strength were evaluated using Pearson's correlation analysis. The predicted values of respiratory muscle strength were calculated using multiple regression analysis. Respiratory muscle strength differed from the values reported in studies from other countries. In the entire samples, both MIP and MEP had the highest correlations with peak HGS (r = 0.643, r = 0.693; P < 0.05), while PCF had the highest correlation with forced expiratory volume in 1 s (r = 0.753; P < 0.05). Age, body mass index, peak HGS, and FTSST results were independent variables affecting respiratory muscle strength. A predictive equation for respiratory muscle strength was developed using the multiple regression equation developed in this study. Respiratory muscle strength index may differ by country. For more accurate diagnoses, standard values for each country are required. This study presents reference values for Korea, and a formula for estimation is proposed when no respiratory muscle strength measurement equipment is available. Clinical Research Information Service Identifier: KCT0006778.

Noise Levels of Invasive and Non Invasive Respiratory Support used in Neonatal Intensive Care Unit of Northern India: A Cross-sectional Study

Introduction: The average noise level exposure inside Neonatal Intensive Care Unit (NICU) is more than the recommended guidelines. The source of noise exposure inside NICU is multifactorial. There is need of studies to assess the noise levels of respiratory equipment used inside the NICU. Aim: To assess the noise levels of invasive versus non invasive and respiratory support in preterm neonates admitted to NICU. Materials and Methods: This cross-sectional descriptive study was done in NICU of a tertiary health care center of Sanjay Gandhi Postgraduate Institute, Lucknow, Uttar Pradesh, India over one year duration from December 2019 to December 2020. A sample of 85 eligible neonates without major congenital anomalies (26- 36+6 weeks gestation) was enroled in this study after obtaining informed consent from parents. The noise levels of Heated Humidified High Flow Nasal Cannula (HHHFNC), Continuous Positive Airway Pressure (CPAP), conventional ventilation and High-Frequency Ventilation (HFV) were measured using a sound level meter for a period of first 24 hours of life. The median sound level from non invasive ventilation is compared with invasive ventilation. The continuous variables were expressed as median with range, while categorical data were expressed as frequencies and percentages. Results: A total of 85 neonates were enroled majority of them were born in 32-34 weeks of gestation and were with birth weight of 1501-2500 grams. The sound level exposure of HHHFNC support was 56.1 dB (52.6-60 dB) from warmer and 47.3 dB (44.6-50.8 dB) from the incubator. The median sound level exposure per hour of bubble CPAP was 59 dB (55.2-61.9 dB) with warmer and 51.4 dB (47-55 dB) with incubator. The median sound level exposure per hour of the conventional ventilator was 60 dB (57.4-63.9 dB) with warmer and 53 dB (50.2-56.1 dB) with incubator. The median sound level exposure per hour of high-frequency ventilator was 69.1 dB (66.3-71.8 dB) with warmer and 67.3 dB (66.2-68.9 dB) with incubator. Conclusion: Non invasive ventilation (HHHFNC and bubble CPAP) was less noisy than invasive ventilation. The lowest measured noise exposure was higher than the American Academy of Paediatrics (AAP) recommendation of 45 dB, even after isolation with physical barrier.

How to improve the future efficiency of Covid-19 treatment centers? A hybrid framework combining artificial neural network and congestion approach of data envelopment analysis

Covid-19 virus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) threatens the health of human beings worldwide, imposing a concern for the world and prompting governments to control the contagion. Although vaccination is a proper tool to control the transmission, the efficient allocation of limited health-care resources to massive patients can improve the effectiveness of medical services. Relying on the Artificial Neural Network (ANN), the aim of this research is to enhance the future efficiency of Covid-19 treatment centers by forecasting their efficiency and providing benchmarks. To do this, we use the congestion approach of data envelopment analysis (DEA) based on the theory of economies of scale principles. In the traditional input-oriented DEA, inefficient decision-making units (DMUs) can become efficient merely by reducing the inputs. However, this may not always be true in real-world applications such as improving the efficiency of COVID-19 treatment centers (DMUs). Meaning that the treatment centers with less congested inputs (e.g., ventilators, test equipment, pulmonologists, and nurses, etc.) normally have higher mortality rates. For this reason, in this study, we take the congested inputs approach into account to provide proper benchmarks for the inefficient treatment centers. According to the congestion approach of DEA, an optimum increase in congested inputs can lead to a greater than a proportional increment in outputs. In other words, if more respiratory equipment, pulmonologists, patient rooms, nurses and beds, etc. are allocated to Covid-19 treatment centers, not only the number of deaths (undesirable outputs) are decreased, but also the number of recoveries (desirable outputs) are increased. Such an optimal rise in the congested inputs is determined in pairwise comparisons derived from the model. Accordingly, in this study, first, considering the congestion approach of DEA and historical data of five periods, we identify the initial efficiency of Iranian Covid-19 treatment centers. Then, by running ANN, we forecast the future inputs and outputs, the overall efficiency, and rank of the treatment centers. By doing this, the prospective efficient and inefficient DMUs are identified, and appropriate benchmarks are determined.

Bridging the gap in neonatal resuscitation in Zambia.

Neonatal resuscitation has been poorly instituted in many parts of Africa and most neonatal resuscitation algorithms are adapted from environments with abundant resources. Helping Babies Breathe (HBB) is an algorithm designed for resource-limited situations and most other algorithms are designed for resource-rich countries. However, there are neonatal referral centers in resource-limited countries who may provide more advanced resuscitation. Thus, we developed a neonatal resuscitation algorithm for a resource-limited country (Zambia) which considers more advanced interventions in situations where they can be provided. The algorithm described in this paper is based on the Newborn Life Support algorithm from the UK as well as the HBB algorithm and accounts for all situations in a resource-limited country. Most importantly, it focuses on non-invasive ventilation but includes advice on more advanced resuscitation including intravenous access, fluid management, chest compressions and adrenaline for resuscitation. Although intubation skills are included in neonatal training workshops, it is not the main focus of the algorithm as respiratory support equipment is scarce or lacking in most health facilities in Zambia. A home-grown neonatal resuscitation algorithm for a resource-limited country such as Zambia is likely to bridge the gap between limited situations requiring only bag and mask ventilation and better equipped institutions where more advanced resuscitation is possible. This algorithm will be rolled out in all training institutions and delivery facilities across Zambia over the next months.

Analysis of International Standard ISO 80601-2-90:2021 for High-flow Respiratory Therapy Equipment

The international standard ISO 80601-2-90:2021 specifies basic safety and essential performance requirements, including risks associated with oxygen, flow accuracy, oxygen concentration accuracy, humidification output performance, and corresponding test methods for high-flow respiratory therapy equipment. This study focuses on the key points in ISO 80601-2-90:2021 and the key problems in the test evaluation. This study also briefly introduces the relationship between ISO 80601-2-90:2021 and other standards, and explains the countermeasures that stakeholders should take.

Research on Measurement Uncertainty of Key Parameters of Typical Respiratory Therapy Equipment

According to the measurement uncertainty requirements of the key parameters of the declared tolerances of the products in the industrial standards of respiratory therapy equipment such as GB 9706.212-2020 Medical electrical equipment-Part 2-12: Particular requirements for basic safety and essential performance of critical care ventilators, YY 9706.270-2021 Medical electrical equipment-Part 2-70: Particular requirements for basic safety and essential performance of sleep apnoea breathing therapy equipment, and YY 9706.274-2022 Medical electrical equipment-Part 2-74: Particular requirements for basic safety and essential performance of respiratory humidifying equipment, this study introduces and analyzes the evaluation process of the uncertainty of the key parameters of critical care respiratory, sleep apnoea breathing therapy equipment, and humidifier, and it gives the sources and results of measurement uncertainty. It is expected that it can provide suggestions for the medical device testing laboratory to meet the uncertainty requirements of quality management and provide references for relevant manufacturers to meet the requirements of industrial standards.

High-sensitivity RGO-TiO2 humidity sensor driven by triboelectric nanogenerators for non-contact monitoring of human respiration

Respiratory monitoring is an effective method to assess human health and provides valuable information for early warning and diagnosis of respiratory diseases. However, respiratory monitoring equipment relies on traditional power supply model, which limits real-time monitoring of breathing in fields of outdoor adventure, nomadism and long-distance running. As a solution, a triboelectric nanogenerator (TENG)-driven self-powered humidity sensor for human breath monitoring was prepared. A flexible TENG composed of Ti3C2Tx: PDMS composite film and Ni/Cu polyurethane foam sponge was used as self-powered part of the device, RGO-TiO2 humidity sensor was used as the respiratory sensing part of the device. Compared with the traditional humidity sensor, TENG-driven self-powered RGO-TiO2 (TENG-RGTO) shows high response (359.2), fast response/recovery time (1/5.2 s), good reversibility, small humidity hysteresis (0.54%) in the range from 0% RH to 95% RH. Furthermore, TENG-RGTO humidity sensor can realize recognition of breathing states at different frequencies and intensities in real time. Meanwhile, a breathing alarm device driven by humans is designed. This research not only broadens the application range of TENG but also provides a new design idea for self-powered breathing monitoring sensor.

Emergency Department Pediatric Readiness Among US Trauma Centers: A Machine Learning Analysis of Components Associated With Survival.

We used machine learning to identify the highest impact components of emergency department (ED) pediatric readiness for predicting in-hospital survival among children cared for in US trauma centers. ED pediatric readiness is associated with improved short-term and long-term survival among injured children and part of the national verification criteria for US trauma centers. However, the components of ED pediatric readiness most predictive of survival are unknown. This was a retrospective cohort study of injured children below 18 years treated in 458 trauma centers from January 1, 2012, through December 31, 2017, matched to the 2013 National ED Pediatric Readiness Assessment and the American Hospital Association survey. We used machine learning to analyze 265 potential predictors of survival, including 152 ED readiness variables, 29 patient variables, and 84 ED-level and hospital-level variables. The primary outcome was in-hospital survival. There were 274,756 injured children, including 4585 (1.7%) who died. Nine ED pediatric readiness components were associated with the greatest increase in survival: policy for mental health care (+8.8% change in survival), policy for patient assessment (+7.5%), specific respiratory equipment (+7.2%), policy for reduced-dose radiation imaging (+7.0%), physician competency evaluations (+4.9%), recording weight in kilograms (+3.2%), life support courses for nursing (+1.0%-2.5%), and policy on pediatric triage (+2.5%). There was a 268% improvement in survival when the 5 highest impact components were present. ED pediatric readiness components related to specific policies, personnel, and equipment were the strongest predictors of pediatric survival and worked synergistically when combined.

124 AN INTERDISCIPLINARY PREHABILITATION PILOT FOR FRAIL ADULTS UNDERGOING ELECTIVE ANTERIOR RESECTION AND HARTMANN’S REVERSAL SURGERIES IN AN IRISH ACUTE HOSPITAL

Abstract Background Frailty affects 21.5% of individuals aged 65 and over in Ireland (TILDA, 2017).Timely interventions can limit or reverse the impacts of frailty. Local HIPE data from 2016-2020 highlighted correlations between increased average Length of Stay (aLOS) and median age (&amp;gt;65 years) for those undergoing elective Anterior Resections and Hartmann’s reversal surgeries. Prehabilitation aims to identify and manage modifiable risk factors that may impact on LOS, as well as optimise patients’ resilience and physiological reserves to reduce postoperative complications. Modifiable factors include pre-operative function, co-morbidities and post-operative delirium. In the Republic of Ireland, surgical interdisciplinary Prehabilitation services exist only in one hospital. Methods An interdisciplinary prehabilitation pilot for individuals undergoing elective colorectal surgeries was developed. Patients are referred from surgical clinics to Physiotherapy, Occupational Therapy or Dietitian preoperatively. Interventions include respiratory optimisation, exercise prescription, discharge planning, equipment provision and pre-operative nutritional reviews. Results Three elective patients have completed the first phase of the pilot. Two underwent anterior resections and one underwent a Hartmann’s reversal. The LOS for each individual was 4 days respectively, 4 days under the KPIs. Patients received virtual assessment and individualised interventions including an interdisciplinary educational booklet. Interventions included: exercise programmes, nutritional support, discharge planning discussion and equipment as indicated. No post-operative complications were identified and no interim beds or home supports were required. Qualitative feedback surveys were completed by all participants. Subjective feedback from patients has been overwhelmingly positive. Conclusion Patients report feeling physically and psychologically better prepared for surgery with better knowledge of post-operative expectations. Patients are more proactive in their postoperative recovery meaning they can return home sooner. This pilot enhances evidence-based ERAS practice, improving the quality and safety of patients journey. Participants also had a 12 day cumulative reduction in aLOS with financial savings of €12000.

Results of a Qualitative Study on Disaster Nursing in a Coastal Region of Lower Saxony/Germany

Abstract The increase in heavy rainfall in recent years shows the need to consider disaster preparedness also for persons in need of assistance and care who are cared for at home or in old people's and nursing homes. Evacuation concepts in the event of a heavy rainfall event lasting several days with simultaneous power failure are hardly available for the vulnerable group so far. As part of the LifeGRID project funded by the Federal Ministry of Education and Research, the question is being investigated as to what regional challenges and requirements arise in the event of flooding and a prolonged power blackout in the Wesermarsch district. In addition, the question will be addressed as to how the current care situation of patients referred to electricity presents itself in such a situation. Within the framework of a qualitative design, expert interviews were conducted with care service managers in winter 2022. The four guided interviews were transcribed and their content analysed. In coping with the assumed catastrophic events, the interviewees see problem areas in the organisation, communication, form of care and target group, in addition to the regional characteristics. It became clear that there are not only unanswered questions regarding responsibilities in the event of a crisis, but also that the diversity of forms of care (e.g. private households) poses a particular challenge. The interviewees do not see any viable alternatives to secure communication in the event of a power failure and also see that respiratory patients, for example, have a special need for care (e.g. due to the limited battery life of the respiratory equipment). The results also show that the nursing experts have different views on how they should prepare for such a scenario. These range from passivity to proactivity. A clear need for action becomes visible for cooperation and networking of the relevant actors, promotion of disaster literacy as well as the necessity to adapt the training curricula. Key messages

Expert consensus on physician-pharmacist collaborative management of stable chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a common chronic airway disease. COPD patients need lifelong treatment, and long-term standardized inhalation medication is the core of stable COPD drug therapy. But, in the process of COPD stabilization management, the use accuracy rate of inhalation device is low and compliance is poor, and in addition, chronic diseases such as ischemic heart disease, heart failure, hypertension and diabetes are common in COPD patients, and these complications often involve multiple medications, which have potential drug risks associated with drug interactions that affect patient outcomes. Based on the experience of pharmacists involved in the management of other chronic diseases, experts from Respiratory Equipment Technical Committee of China Association of Medical Equipment, jointly with Chronic Obstructive Pulmonary Disease Group of Chinese Thoracic Society and Guangdong Pharmaceutical Association, developed expert consensus on physician-pharmacist collaborative management of stable chronic obstructive pulmonary disease, aiming to improve patients' treatment compliance and satisfaction, reduce the acute attack rate, and ultimately improve the treatment level of COPD.

3D-Printed Microfluidics Potential in Combating Future and Current Pandemics (COVID-19).

Coronavirus disease (COVID-19) emerged in China in December 2019. In March 2020, the WHO declared it a pandemic leading to worldwide lockdowns and travel restrictions. By May, it infected 4,789,205 and killed 318,789 people. This led to severe shortages in the medical sector besides devastating socio-economic effects. Many technologies such as artificial intelligence (AI), virtual reality (VR), microfluidics, 3D printing, and 3D scanning can step into contain the virus and hinder its extensive spread. This article aims to explore the potentials of 3D printing and microfluidic in accelerating the diagnosis and monitoring of the disease and fulfilling the shortages of personal protective equipment (PPE) and medical equipment. It highlights the main applications of 3D printers and microfluidics in providing PPE (masks, respirators, face shields, goggles, and isolation chambers/hoods), supportive care (respiratory equipment) and diagnostic supplies (sampling swabs & lab-on-chip) to ease the COVID-19 pressures. Also, the cost of such technology and regulation considerations are addressed. We conclude that 3D printing provided reusable and low-cost solutions to mitigate the shortages. However, safety, sterility, and compatibility with environmental protection standards need to be guaranteed through standardization and assessment by regulatory bodies. Finally, lessons learned from this pandemic can also help the world prepare for upcoming outbreaks.

Development and Evaluation of a Respiratory Monitoring Smart Garment Based on Notched Optical Fiber Sensing Fabric

Clothing-based respiratory monitoring can provide real-time non-invasive respiratory monitoring services for subjects, and can be used as a reference for daily health observation. In this study, an optical fiber sensing Section woven into plain fabric is produced by a hand-weaving machine, and the produced sensing fabric is then made into a respiratory monitoring garment. This paper explored the luminescence and coupling principle of notched optical fiber through theoretical analysis and simulation, and demonstrated the feasibility of making it into respiratory sensing fabric. We used this structure to make a fabric and then sew the fabric with the yoke to make a smart garment. In testing, we obtained the static respiratory waveform and the respiratory rate (R-R) during daily common movements, which were also compared with two types of commercial sensors. The results showed that the smart garment based on optical fiber sensing fabric maintains good consistency with the monitoring waveform of commercial sensors and good R-R obtained in static motion (error not more than 2 rpm). Monitoring tests showed that the garment has high monitoring accuracy and motion monitoring stability. Moreover, it was also very comfortable and can be used as daily respiratory monitoring equipment.

Respiratory outcomes in children with congenital myotonic dystrophy.

Congenital myotonic dystrophy (CDM) results in hypotonia and acute respiratory distress at birth. Previous studies show that prolonged periods of intubation (>4 weeks) correlate with increased mortality rates. The objective is to describe the use and duration of respiratory support in newborns with CDM and how these relate to mortality. A retrospective chart review was performed at a tertiary pediatric hospital among children with confirmed diagnosis of CDM. The main outcome measures were: mortality, duration of invasive mechanical ventilation (IMV) and non-invasive partial pressure ventilation (NIPPV), along with long-term use of respiratory support and equipment. A total of 18 subjects met inclusion criteria, 83%.f which had documented respiratory distress at birth, 39%.equired NIPPV, and 50%.equired intubation in the neonatal period. The earliest NIPPV was initiated at day one of life, and the latest extubation to NIPPV was at 17 days of life. This cohort required IMV for shorter periods with earlier transitions to NIPPV which suggests a possible change in practice and earlier transition to NIPPV recently. Further data are needed to determine if there is a possible correlation between the need for NIPPV/IMV and mortality rates.

Investigating an Increased Incidence of Burkholderia Cepacia Among Non-Cystic Fibrosis Pediatric Patients

<h3>Background</h3> Burkholderia cepacia Complex (BCC), commonly identified in patients with Cystic Fibrosis (CF), has been associated with outbreaks from contaminated medications (Abdelfattah 2018) and devices (Lucero, 2011). An increase of BCC in cultures of non-CF patients prompted an investigation including an assessment of commonalities such as medications, procedures, staffing, equipment, and treatment locations. Our journey to identify a source and implement control measures led to a yearlong, multi-facility outbreak investigation with support and involvement of the Massachusetts Department of Public Health and the Centers for Disease Control. <h3>Methods</h3> Literature review of past outbreaks aided in narrowing our scope of potential sources. Chart reviews helped identify commonalities across patients, however, these commonalities did not elucidate a root cause. Through the Burkholderia cepacia Research Laboratory & Repository at the University of Michigan, whole-genome sequencing identified matching isolates. Over 20 patients and 50 environmental isolates from our facility were evaluated. <h3>Results</h3> Three distinct BCC clusters were identified: a larger cluster of 10 patients with Burkholderia cenocepacia recA subgroup and two smaller clusters of 2 patients each with a matching Burkholderia cepacia indeterminate species. Despite environmental sampling not identifying a source, our Respiratory program re-educated staff on not storing respiratory equipment within the splash zone of a sink and use of sterile water for all respiratory care items. Additionally, a policy was formalized for reprocessing of custom tracheostomies, and we transitioned to single-use temperature probes for one of our ventilators. Ultimately, new information suggested the primary source was external to our facility. <h3>Conclusions</h3> Early identification of outbreaks in healthcare facilities and evaluation of all possible causes is central to Infection Prevention. Ongoing surveillance and analysis utilizing established epidemiologic methods are essential to successfully minimizing the adverse effects to patients.

Growth of home respiratory equipment from 2006 to 2019 and cost control by health policies

BackgroundHome respiratory equipment (HRE) designed for the management of chronic respiratory failure includes oxygen therapy (O2), noninvasive ventilation (NIV) and mechanical insufflation-exsufflation (MI-E). The growth of the number of patients treated by HRE, the prevalence and the associated costs in France have not been determined. MethodsThe French open access national health insurance aggregated data was used to estimate the evolution of theses parameters from 2006 to 2019. ResultsThe number of patients treated by HRE increased by 117% between 2006 and 2019, reaching a total of 245,896 patients (367/100,000). Prescriptions for O2, NIV, and MI-E increased by 88%, 189% and 162%, respectively. In 2019, 139,323 patients received long-term home O2 alone (208/100,000) with a 13% decrease for liquid O2 compared to a 44% increase for O2 concentrator. The number of patients treated by portable oxygen concentrator increased by 509% over the last 5 years. In 2019, 96,126 patients received NIV (144/100,000) and 97% of these patients were treated by NIV for less than 12 h/day. A total of 9,158 patients were treated by MI-E in 2019 (13.6/100,000). Despite the global increase in the number of patients, health costs decreased from 9% to 8% of total medical device spending in 2019 due to adjustment of health policies, such as a reduction of reimbursement rates. ConclusionOur results highlighted the high rate of HRE prescription, but with cost control as a result of adapted health policies.

Carbapenem-resistant Acinetobacter baumannii at a tertiary-care hospital in Botswana: Focus on perinatal environmental exposures

Background: Bloodstream infections (BSIs) due to carbapenem-resistant Acinetobacter baumannii (CRAB) are difficult to treat and are associated with high mortality, particularly in neonates. Healthcare-associated CRAB infections have been linked to environmental reservoirs and are associated with seasonal clustering. CRAB outbreaks are being reported more frequently in sub-Saharan Africa, but published reports from this region that incorporate comprehensive surveillance data and environmental investigations are rare. Methods: We reviewed microbiology surveillance records at a 530-bed, public, tertiary-care hospital in Botswana from January 1 to December 13, 2021, and we collected data regarding age, specimen type, and onset date for all cultures from unique patients growing Acinetobacter spp. An automated blood-culture system was used for organism detection, manual biochemical tests were used for identification, and disc and agar diffusion methods were used for antimicrobial sensitivity testing. During this time, we conducted 4 point-prevalence environmental sampling surveys at this hospital’s 36-bed neonatal unit from January through June 2021 in addition to 3 neonatal CRAB cluster investigations. Environmental samples from surfaces, hands of caregivers and healthcare workers, and equipment were collected using flocked swabs. Extended-spectrum β-lactamase–producing organisms from environmental samples were identified using selective and differential chromogenic media (CHROMagarTM ESBL). Results: Overall, 48 Acinetobacter infections were identified, including 28 BSIs (among 3,699 blood cultures processed, approximately one-third of which were from neonates). More than half of cases were perinatal, which included 16 neonatal BSIs (median age, 4 days; case fatality rate, 56%), and 1 fatal case of postpartum sepsis in a 37-year-old mother. Among isolates tested, 35 (92%) of 38 demonstrated carbapenem resistance. Treatment information was not available for all neonatal patients, but delays in appropriate antimicrobial therapy were cited in all fatal cases. Most neonatal CRAB cases clustered in time and space (Fig. 1). For example, 15 (71%) of 21 neonatal cases occurred in the same unit and same week as another case. In the neonatal unit, CRAB clusters were associated with increased Acinetobacter recovery during environmental point-prevalence surveys (Fig. 1). Acinetobacter contamination was identified on feeding equipment (breast pumps, feeding tubes), respiratory equipment (suction machines or catheters, ventilator humidifiers), and hands of caregivers and healthcare workers. Conclusions: We report hyperendemic rates of CRAB infections with evidence of spatotemporal clustering, especially among neonates. Higher CRAB incidence coincided with increased Acinetobacter recovery during environmental sampling. We identified plausible transmission vehicles (respiratory or feeding devices, hands) in the neonatal care environment highlighting the value of environmental sampling to support CRAB investigations and reinforcing the importance of comprehensive and consistent disinfection practices, especially in resource-limited settings where equipment is shared or reused.Funding: NoneDisclosures: None

Genomic investigation to identify the source of SARS-CoV-2 infection among healthcare personnel

Background: Contact tracing alone is often inadequate to determine the source of healthcare personnel (HCP) COVID-19 when SARS-CoV-2 is widespread in the community. We combined whole-genome sequencing (WGS) with traditional epidemiologic analysis to investigate the frequency with which patients or other HCP with symptomatic COVID-19 acted as the source of HCP infection at a large tertiary-care center early in the pandemic. Methods: Cohort samples were selected from patients and HCP with PCR-positive SARS-CoV-2 infection from a period with complete retention of samples (March 14, 2021–April 10, 2020) at Rush University Medical Center, a 664-bed hospital in Chicago, Illinois. During this period, testing was limited to symptomatic patients and HCP. Recommended respiratory equipment for HCP evolved under guidance, including a 19-day period when medical face masks were recommended for COVID-19 care except for aerosol-generating procedures. Viral RNA was extracted and sequenced (NovaSeq, Illumina) from remnant nasopharyngeal swab samples in M4RT viral transport medium. Genomes with &gt;90% coverage underwent cluster detection using a 2 single-nucleotide variant genetic distance cutoff. Genomic clusters were independently evaluated for valid epidemiologic links by 2 infectious diseases physicians (with a third adjudicator) using metadata extracted from the electronic medical record and according to predetermined criteria (Table 1). Results: In total, 1,031 SARS-CoV-2 sequences were analyzed, identifying 49 genomic clusters with HCP (median, 8; range, 2–43 members per cluster; total, 268 patients and 115 HCP) (Fig. 1). Also, 20,190 flowsheet activities were documented for cohort HCP and patient interactions, including 686 instances in which a cohort HCP contributed to a cohort patient’s chart. Most HCP infections were considered not healthcare associated (88 of 115, 76.5%). We did not identify any strong linkages for patient-to-HCP transmission. Moreover, 13 HCP cases (11.3%) were attributed to patient source (weak linkage). Also, 14 HCP cases (12.2%) were attributed to HCP source (11 strong and 3 weak linkages). Weak linkages were due to lack of epidemiologic data for HCP location, particularly nonclinical staff (eg, an environmental service worker who lacked location documentation to rule out patient-specific contact). Agreement for epidemiologic linkage between the 2 evaluators was high (κ, 0.91). Conclusions: Using genomic and epidemiologic data, we found that most HCP COVID-19 infections were not healthcare associated. We found weak evidence to support symptomatic patient-to-HCP transmission of SARS-CoV-2 and stronger evidence for HCP-to-HCP transmission. Large genomic clusters without plausible epidemiologic links were identified, reflecting the limited utility of genomic surveillance alone to characterize chains of transmission of SARS-CoV-2 during extensive community spread.Funding: NoneDisclosures: None