Respiratory Precautions Research Articles

Monkeypox in Pakistan-First case report

Monkeypox (mpox) is an uncommon zoonotic contagious viral ailment, resulting from the poxvirus. Symptoms include fever, headache, muscle aches, and a characteristic rash. There is no specific treatment, and only a limited number of antiviral drugs and vaccines are available. Employing stringent contact and respiratory precautions is essential to curb disease transmission. Till April 17, 2023, no mpox cases have been reported from Pakistan. Here we present the case of a 41-year-old male with a travel history to Saudi Arabia and a week-long history of multiple nodular and pustular eruptions on various parts of the body. It is essential to emphasise that due to its infrequency, a high index of clinical suspicion is imperative in facilitating an accurate diagnosis. Keywords: mpox, MPXV, Pakistan, Travel history. Orthopoxvirus. Vaccine.

Use of Respiratory and Contact Precautions to Decrease the Spread of SARS-CoV-2 Infection Was Not Associated with a Decrease in Endometritis-Intra-Amniotic Infection.

To decrease the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the Mount Sinai Hospital's obstetric service, additional contact and respiratory precautions for patients and staff were implemented. Patients were allowed only one support person, SARS-CoV-2 tested on admission, and required to mask during hospitalization. Staff were required to wear masks and eye shields, gloves for all patient care, and gowns for care with SARS-CoV-2-infected patients. This study determined if the risk of endometritis/intra-amniotic infection (IAI) changed under the new pandemic precautions. A single-center, historical cohort study via electronic medical record review compared singleton deliveries among patients who labored during the "pandemic period" (from March 1 through May 31, 2020) with those who labored during the "prepandemic period" (March 1 through May 31, 2019) to determine if the risk of endometritis/IAI differed. The analysis was done using logistic regression with inverse probability of treatment weighting (IPTW) to adjust for possible differences in obstetric practice and patient population between the two periods. Four percent (53/1,318) of patients in the pandemic period and 5.1% (82/1,596) of patients in the prepandemic period were diagnosed with endometritis/IAI (p = 0.15). Compared with patients who delivered in the prepandemic period, those who delivered during the pandemic period had a higher body mass index at delivery (median: 28.36 [interquartile range, IQR: 25.70, 32.07] vs. 28.00 [IQR: 25.23, 31.50], p = 0.01) and experienced fewer digital exams (median: 4 [range: 1, 10] vs. 4 (range: 1, 19], p = 0.004), a practice not included in the SARS-CoV-2 prevention strategy. In multivariable logistic regression with IPTW adjusting for risk factors for endometritis/IAI, period of delivery was not associated with endometritis/IAI (odds ratio = 0.76, 95% confidence interval [0.52, 1.11], p = 0.15). The use of respiratory and contact precautions to limit the spread of SARS-CoV-2 was not associated with risk of endometritis/IAI. · Pandemic infection control precautions were not associated with a decrease in endometritis/IAIs.. · The early months of the pandemic were associated with the performance of fewer digital cervical exams.. · The early months of the pandemic were associated with a higher BMI at delivery..

Effectiveness, safety, and efficiency of a drive-through care model as a response to the COVID-19 testing demand in the United States.

Here we report the clinical performance of COVID-19 curbside screening with triage to a drive-through care pathway versus main emergency department (ED) care for ambulatory COVID-19 testing during a pandemic. Patients were evaluated from cars to prevent the demand for testing from spreading COVID-19 within the hospital. We examined the effectiveness of curbside screening to identify patients who would be tested during evaluation, patient flow from screening to care team evaluation and testing, and safety of drive-through care as 7-day ED revisits and 14-day hospital admissions. We also compared main ED efficiency versus drive-through care using ED length of stay (EDLOS). Standardized mean differences (SMD)>0.20 identify statistical significance. Of 5931 ED patients seen, 2788 (47.0%) were walk-in patients. Of these patients, 1111 (39.8%) screened positive for potential COVID symptoms, of whom 708 (63.7%) were triaged to drive-through care (with 96.3% tested), and 403 (36.3%) triaged to the main ED (with 90.5% tested). The 1677 (60.2%) patients who screened negative were seen in the main ED, with 440 (26.2%) tested. Curbside screening sensitivity and specificity for predicting who ultimately received testing were 70.3% and 94.5%. Compared to the main ED, drive-through patients had fewer 7-day ED revisits (3.8%vs 12.5%, SMD=0.321), fewer 14-day hospital readmissions (4.5%vs 15.6%, SMD=0.37), and shorter EDLOS (0.56vs 5.12hours, SMD=1.48). Curbside screening had high sensitivity, permitting early respiratory isolation precautions for most patients tested. Low ED revisit, hospital readmissions, and EDLOS suggest drive-through care, with appropriate screening, is safe and efficient for future respiratory illness pandemics.

Monkeypox: Past to Present

Poxviridae ailesine ait zoonotik bir hastalık olan maymun çiçeği 1958 yılında maymunlardan izole edilmiştir. İnsanlarda çiçek hastalığına benzer bir klinik oluşturur. Enfekte hayvan ısırığı, vücut sıvıları ile temas ve damlacık yoluyla bulaş tipiktir. 2003 ve sonrasında özellikle ithalat ve turizm nedenli seyahat ile birçok ülkede salgınlara neden olmuştur. 2022 yılında görülen salgında ise bulaşın cinsel aktivite ile ilişkili olduğu düşünülmektedir. Çiçek aşısı ile bağışıklanmamış bireyler hastalık açısından risk grubunu oluşturmaktadır. İnkübasyon süresinin ortalama 6-13 gün olduğu kabul edilir. Ateş, lenfadenopati ve miyalji varlığı diğer döküntülü hastalıklardan ayırt edicidir. Ayırıcı tanıda numunelerin referans laboratuvara gönderilerek doğrulamasının yapılması şarttır. Şüphelenilen vakalar hakkında yerel halk sağlığı yetkililerine bilgi verilmesi gerekir. Destek tedavisi esastır. Özel hasta grupları için tekovirimat, brinsidofovir veya sidofovir gibi antiviral tedaviler halk sağlığı yetkilileri onayı ile başlanabilir. Ayırıcı tanı olarak düşünüldüğü her durumda tanı dışlanana kadar temas, damlacık ve solunum izolasyon önlemleri de uygulanmalıdır. Temas öncesi veya temas sonrası profilaksi için yine yerel halk sağlığı yetkilileri onayı ile çiçek aşısı uygulanabilir.

428. Assessing the Confidence, Knowledge and Preferences of Hospital Staff with Regards to Personal Protective Equipment (PPE) Practices During the COVID-19 Pandemic

BackgroundEffective use of personal protective equipment (PPE) by hospital staff is critical to prevent transmission of COVID-19. This study examines hospital staff confidence in and knowledge of effective PPE use, and their preferences for learning about PPE practices.MethodsThree isolation precautions signs were created for use in the care of those with or under investigation for COVID-19 infection: first, a special respiratory precautions sign designed by infection control; and next, two signs outlining proper donning and doffing practices – one created internally with the support of health literacy, and another developed with a design firm (IDEO) using principles of human-centered design (Figure 1). All signs were used for ≥ 10 weeks prior to distribution of a questionnaire (REDCap) to clinical and non-clinical hospital staff. Those who had not worked on hospital units during the pandemic (after March 15, 2020) were excluded. The 38-item survey was sent by supervisors over email between July 14-31, 2020, and examined demographics, confidence in and knowledge of PPE best practices, and preferences for each precaution sign with regards to trustworthiness, ease of following, informative content, and clarity of image/layout. Responses were reported using descriptive statistics. A non-parametric test of trends compared staff preferences across signs. Logistic regression examined the association between answering all knowledge-based questions correctly and staff role and confidence in PPE practices (Stata). ResultsOf the 531 respondents, 461 were eligible for inclusion. The majority were female, white, and not high risk for COVID-19 (Table 1). Most were confident about PPE use, correctly answered questions examining knowledge of PPE best practices, and found PPE signage helpful (Table 2). Staff preferred the professionally designed sign for informative content (p< 0.01) and clear imagery/layout (p=0.01) (Table 3). Confidence in PPE practices and physician or nurse roles were associated with answering all knowledge-based questions correctly (p< 0.001 and p=0.04, respectively). ConclusionIn a convenience sample of hospital staff, most were confident and knowledgeable about PPE use, found PPE signage helpful, and preferred professionally designed signs.Disclosures All Authors: No reported disclosures

The Changing Epidemiology of Respiratory Viruses in Children During the COVID-19 Pandemic: A Canary in a COVID Time.

The Changing Epidemiology of Respiratory Viruses in Children During the COVID-19 Pandemic: A Canary in a COVID Time.

Lesson learned from the pandemic: Isolation and hygiene measures for COVID-19 could reduce the nosocomial infection rates in oncology wards

It was previously demonstrated that seasonal influenza incidence was significantly decreased during the COVID-19 pandemic, possibly due to respiratory and hygiene precautions. From this point, we hypothesized that the COVID-19 precautions could lead to a decrease in nosocomial infection rates in oncology inpatient wards. We evaluated the nosocomial infection rates in an inpatient palliative oncology ward in the first 3 months of the COVID-19 pandemic in our country and compared this rate with the same time frame of the previous year in our institution. The percentage of nosocomial infections complicating the hospitalization episodes were significantly reduced in the first 3 months of the pandemic compared to the previous year (43 vs. 55 nosocomial infection episodes; 18.6% vs. 32.2%, p = 0.002). The decrease in the nosocomial infections was consistent in the different types of infections, namely pneumonia (4.8% vs. 7.6%), urinary tract infection (5.2% vs. 7.6%), bacteremia (5.2% vs. 7%) and intraabdominal infections (2.6% vs. 3.5%). The median monthly disinfectant use was significantly increased to 98 liters (interquartile range: 82 - 114) in 2020 compared to 72 L (interquartile range: 36 - 72) in 2019 (p = 0.046). The continuation of the simple and feasible hygiene and distancing measures for healthcare workers and patient relatives and adaptations for earlier discharge could be beneficial for preventing nosocomial infections in oncology wards. These measures could be implemented routinely even after the COVID-19 pandemic for patient safety, especially in settings with higher nosocomial infection rates like inpatients palliative care units.

Ongoing asthma management in children during the COVID-19 pandemic: to step down or not to step down?

A substantial reduction in asthma exacerbations in both children and adults has been seen in many countries worldwide during the COVID-19 pandemic.1,2 The cause of this reduction is likely to be multifactorial, but at least partly due to population-level public health measures, such as physical distancing, masking, and hand washing, which reduce broad viral transmission.2 This improvement in asthma control poses an interesting clinical dilemma: should clinicians consider tapering asthma medications in children during the pandemic in the face of good asthma control? Furthermore, if medicines are reduced during the COVID-19 pandemic, should clinicians return to the pre-COVID-19 schedule as respiratory precautions are gradually relaxed?

Situational Awareness Huddles in a Pediatric Cardiac Intensive Care Unit During the COVID-19 Pandemic.

The COVID-19 pandemic has created challenges for provider teams working in intensive care units, including rapidly changing patient care regulations, staffing considerations, and preservation of personal protective equipment. The need for enhanced respiratory precautions for infected patients and patients under investigation has necessitated a new process for interventions and resuscitation. Along with changing regulations and equipment, significant staff anxiety surrounded caring for infected patients and preparing for emergency situations. A huddle process was implemented in the pediatric cardiac intensive care unit for acutely ill patients who required enhanced respiratory precautions and were at risk of imminent decompensation, or who required a bedside procedure. During a huddle, the multidisciplinary team used process maps displayed in patient rooms; the huddle process created a situational awareness of events among these teams. After implementation of huddles, a survey was distributed to cardiac intensive care unit staff in order to understand their satisfaction with the huddle process. A total of 36 staff responded to the survey. They thought the huddles helped them to prepare for resuscitation scenarios, helped limit the number of personnel responding to an emergency, and reduced their anxiety surrounding caring for these patients. Staff suggested generalizing this huddle process to all patients at acute risk for decompensation in the cardiac intensive care unit. A novel huddle process created situational awareness among staff caring for patients requiring enhanced respiratory isolation because of COVID-19. Multidisciplinary huddles allowed staff from various disciplines to apply a process map for interventions and resuscitations among critically ill children with heart disease.

Mechanics and Economics of a Negative Pressure Pulmonary Function Lab in the COVID-19 Era

The 2019 viral pandemic of SARS-CoV-2 has led to enhanced respiratory precautions because of its high infectivity.1 Aerosol-generating procedures such as pulmonary function tests (PFTs) pose an increased risk for viral transmission and therefore require adaptation by clinical personnel.

Guidance for the clinical management of infants born to mothers with suspected/confirmed COVID-19 in Singapore.

In this paper, we provide guidance to clinicians who care for infants born to mothers with suspected/confirmed COVID-19 during this current pandemic. We reviewed available literature and international guidelines based on the following themes: delivery room management; infection control and prevention strategies; neonatal severe acute respiratory syndrome coronavirus 2 testing; breastfeeding and breastmilk feeding; rooming-in of mother-infant; respiratory support precautions; visiting procedures; de-isolation and discharge of infant; outpatient clinic attendance; transport of infant; and training of healthcare staff. This guidance for clinical care was proposed and contextualised for the local setting via consensus by members of this workgroup and was based on evidence available as of 31 July 2020, and may change as new evidence emerges.

Use of Industrial Filters by Health Care Workers During Shortages of N95 Respirators in Pandemic Times.

The coronavirus disease 2019 (COVID-19) pandemic has led to a significant shortage of personal protective equipment in multiple health care facilities around the world, with the highest impact on N95 respirator masks. The N95 respirator is a mask that blocks at least 95% of very small (0.3 μm) particles and is considered a standard for enhanced respiratory precautions. The N95 mask shortage has created a need for other options for nasal and oral respiratory protection with similar filtration efficiency and “medical-grade” clearance, which can be used in health care settings. However, the literature around various filter types, their filtration capabilities, and the organizations certifying their use is dense, confusing, and not easily accessible to the public. Here, we synthesize relevant literature to analyze and disseminate information on (1) alternative viable filter options to N95s, (2) the National Institute for Occupational Safety and Health certification process, (3) the relationship of National Institute for Occupational Safety and Health certification to Food and Drug Administration certification of filtration devices and surgical masks, and (4) how this relationship may affect future filtration usage in the medical community during a pandemic. Analysis of these standards is meant to inform regarding evidence of respirator efficacy but does not imply any official endorsement of these alternatives. With this article, we illuminate viable alternative respirator options during the COVID-19 pandemic to help alleviate the dependency on N95 face masks.

An Impetus for Change: How COVID-19 Will Transform the Delivery of GI Health Care

An Impetus for Change: How COVID-19 Will Transform the Delivery of GI Health Care

Respiratory Manifestations, Radiologic Findings and Respiratory Management of Hospitalized children with COVID-19 among Different Age Groups: A Systematic Review

Objective. This paper aims to determine the respiratory manifestations, radiologic findings, and management of coronavirus-19 (COVID-19) among the hospitalized children of different age groups based on a systematic review of literature. Methodology. We searched the MEDLINE, Google Scholar, Cochrane, and MedRvrix databases for relevant studies on pediatric COVID-19 done between January 1 to May 25, 2020. Data on demographic features, pulmonary symptoms, chest imaging findings, and oxygen support were extracted in a data abstraction form and analyzed among the different pediatric age groups. Results. Sixteen studies were included in this systematic review, with a total of 61 patients. Thirty-nine patients (64%) belong to the 2 to 12 year age group. Cough was the most commonly reported respiratory symptoms among children older than one month. Most of the patients, particularly adolescents, had asymptomatic or mild infection. On chest imaging, infiltrates and ground-glass opacities were the most common abnormalities. Oxygen supplementation via nasal cannula, non-invasive ventilation, and mechanical ventilation was noted in three cases. Conclusion. Our systematic review shows that COVID-19 can present with a spectrum of respiratory manifestations and disease severity as well as a variety of radiologic abnormalities across different pediatric age groups. Whilemost children do not develop hypoxemia warranting oxygen supplementation, a severe respiratory infection can still manifest in children. Asymptomatic and milder infections are common and highlight the need for appropriate respiratory precautions. More pediatric studies on the pulmonary manifestations and management of children with COVID-19 can aid in a better understanding of this novel disease.

Déjà Vu - A New Coronavirus Challenge.

Déjà Vu - A New Coronavirus Challenge.

A systematic review on disinfection, airborne precautions and biomedical waste management for prevention of infection by SARS-CoV-2: Current evidences and adoptable practices in healthcare settings

The emergence and spread of the novel corona virus SARS-CoV-2 causing pneumonia and severe respiratory tract infections has put the whole world in grave situation. The pandemicity is because the virus is highly contagious with very high transmissibility and spread from person to person by infected respiratory droplets and contacts. As no specific drug or vaccine against SARS-CoV-2 are available in the market, so preventive measures that break the chain of transmission are the mainstay to prevent COVID-19 infections. The present systematic review article highlights the current updates on preventive measures in the context of disinfection practices, droplet precautions, airborne precautions and biomedical waste management based on various research articles, national guidelines by Indian Council of Medical Research (ICMR) and Central Pollution Control Board, Government of India and international guidelines by WHO, CDC. Search was conducted in Medline, Embase and Google Scholar with articles published in English language from 1st January 2020 to 20th July 2020 and were taken for reviewing. A systematic review protocol was developed based on PRISMA checklist and the PRISMA statement and was conducted to synthesise adoptable best practices based on current evidences. Three disinfectants have become most important to combat this novel corona virus, which are 70-85% ethanol, 0.1% sodium hypochlorite for routine environmental disinfection and 0.5% sodium hypochlorite for large spillage management and >0.5% hydrogen peroxide with a minimal contact time of 1 minute for all three disinfectants. Fogging of unoccupied rooms and testing laboratories can be done by 2% hydrogen peroxide solution. UV radiation at 240-260 nm have wide applications in routine terminal disinfection of unoccupied rooms and biosafety cabinets and also used for decontamination of N95 masks for reuse. Based on available evidences from WHO and ICMR it is suggested to take respiratory droplets and contact precautions in every health care settings taking care of suspected or confirmed COVID-19 cases, and airborne precautions are recommended when aerosol generating procedures are performed. According to CDC droplets and contact precautions are essential in routine health care settings and airborne precautions are essential when aerosol generating procedures are performed and are also recommended when taking care of suspected or confirmed COVID-19 cases depending on resource availability. Whether airborne precaution is essential for all settings is debatable and is still unclear based on available evidences. Proper handling of biomedical waste, segregation at source and disposal as per classification along with proper disposal of PPE after doffing can help in preventing the disease in community and among health care providers. Evidence on the modes of transmission of COVID-19 from dead bodies to individuals is yet to be established. Steps to be followed are based on Government Guidelines. However scholarly article depicting desirable and undesirable effects of dead body handling strategy is lacking.

Can Infectious Diseases Be Prevented?

A study of infectious disease is described.The infectious disease pandemic has focused an intense spotlight on respiratory precautions for healthcare workers managing patients with respiratory viral infections.The author is discussed about the infections and recommended precautions for its prevention

COVID-19 and Breastfeeding

Background and Aim: In the current Coronavirus Disease 2019 (COVID-19) pandemic, there have been many concerns about the transmission of the virus from the mother to the infant. This is more important due to the need for the management of breastfeeding. This study aims to review the latest studies on breastfeeding during the COVID-19 pandemic. Methods &amp; Materials: This is a review study on articles about breastfeeding during the COVID-19 pandemic published from December 2019 to May 2020. The search was conducted in SID, PubMed, Scopus, Science Direct, Google Scholar, Ovid, and MagIran databases using the keywords:New coronavirus, COVID-19, breast milk, and breastfeeding Ethical Considerations: All ethical principles in writing this article have been observed according to the instructions of the National Ethics Committee and the COPE regulations. Results: So far, there is no evidence of COVID-19 virus in breast milk or its transmission through breastfeeding. All mothers with confirmed or suspected COVID-19 should continue to breastfeed their infants in accordance with the hygiene and respiratory precautions. Conclusion: Breastfeeding protects the baby against infectious diseases. Given that the studies reported the absence of COVID-19 virus in breast milk are very limited, this study can help mothers manage breastfeeding during the COVID-19 pandemic. Since there are still many unknowns of this emerging disease, more studies are needed on managing breastfeeding in this pandemic.

Preserving Elective Surgeries in the COVID-19 Pandemic and the Future

Surgery in a Time of Uncertainty—The Need for Universal Respiratory Precautions in the Operating Room

Knowledge, Attitudes, and Practices Towards COVID-19 Among Ecuadorians During the Outbreak: An Online Cross-Sectional Survey.

Preventing the transmission of SARS-CoV-2 (causative agent for COVID-19) requires implementing contact and respiratory precautions. Modifying human behavior is challenging and requires understanding knowledge, attitudes, and practices (KAPs) regarding health threats. This study explored KAPs among people in Ecuador. A cross-sectional, internet-based questionnaire was used to assess knowledge about COVID-19, attitudes toward ability to control COVID-19, self-reported practices related to COVID-19, and demographics. A total of 2399 individuals participated. Participants had moderate to high levels of knowledge. Participants expressed mixed attitudes about the eventual control of COVID-19 in Ecuador. Participants reported high levels of adoption of preventive practices. Binomial regression analysis suggests unemployed individuals, househusbands/housewives, or manual laborers, as well as those with an elementary school education, have lower levels of knowledge. Women, people over 50 years of age, and those with higher levels of schooling were the most optimistic. Men, individuals 18–29, single, and unemployed people took the riskiest behaviors. Generally, knowledge was not associated with optimism or with practices. Our findings indicate knowledge about COVID-19 is insufficient to prompt behavioral change among Ecuadorians. Since current COVID-19 control campaigns seek to educate the public, these efforts’ impacts are likely to be limited. Given attitudes determine people’s actions, further investigation into the factors underlying the lack of confidence in the ability of the world, and of Ecuador, to overcome COVID-19, is warranted. Edu-communicational campaigns should be accompanied by efforts to provide economically disadvantaged populations resources to facilitate adherence to recommendations to prevent the spread of the virus.