Terms Of Infection Risk Research Articles

Characterizing infection risk in a restaurant environment due to airborne diseases using discrete droplet dispersion simulations

The use of masks as a measure to control the spread of respiratory viruses has been widely acknowledged. However, there are instances where wearing a mask is not possible, making these environments potential vectors for virus transmission. Such environments can contain multiple sources of infection and are challenging to characterize in terms of infection risk. To address this issue, we have developed a methodology to investigate the role of ventilation in reducing the infection risk in such environments. We use a restaurant setting as a representative scenario to demonstrate the methodology. Using implicit large eddy simulations along with discrete droplet dispersion modeling we investigate the impact of ventilation and physical distance on the spread of respiratory viruses and the risk of infection. Our findings show that operating ventilation systems, such as mechanical mixing and increasing physical distance between subjects, can significantly reduce the average room infection risk and number of newly infected subjects. However, this observation is subject to the transmissibility of the airborne viruses. In the case of a highly transmissible virus, the use of mechanical mixing may be inconsequential when compared to only fresh air ventilation. These findings provide valuable insights into the mitigation of infection risk in situations where the use of masks is not possible.

Infektionsrisiko von Frauen für eine COVID-19- Erkrankung während der Pandemie

Risk among women of COVID-19 infection during the pandemic Objective: The proportion of women is increased in occupational SARSCoV-2 infections and is as high as 80 %. Therefore, we investigated whether women have a higher risk of infection than men or whether they carry out more risky tasks. Methods: Existing data from two studies on infection dynamics among staff of two different hospitals were combined, irrespective of occupation, and analysed for possible differences between men and women in terms of infection risk. Primary data were available for this secondary data analysis. Odds ratios with 95 % confidence intervals and chi-square tests (95 %-CI) were calculated for the correlation analysis. Results: Data from 1785 employees were available for the evaluation. Women accounted for 74.6 % of the study participants. The proportion of women among the infected participants was 81.7 % (138 out of 169). 7.4 % of men and 10.1 % of women were infected. The infection rate in exposed men was slightly lower than in exposed women (9.8 % and 13.0 %, odds ratios 3.2 [95 %-CI 1.2–8.5] and 3.6 [95 %-CI 2.2–6.0]).For unexposed workers, infection rates barely differed between men and women (3.3 % and 4.0 %). There were only small differences between men and women (16.2 % and 11.2 % respectively) in infection rates after private contact. Conclusions: We found no evidence of an increased risk of infection in women compared to men with a similar level of exposure in the hospital. Keywords: healthcare workers – gender – risk of infection – COVID-19

Social participation and mental health of immunocompromised individuals before and after COVID-19 vaccination-Results of a longitudinal observational study over three time points.

The coronavirus disease 2019 (COVID-19) pandemic impacted how people perform their daily lives in manifold and sometimes massive ways. Particularly, individuals who are at high risk for a severe disease progression, like immunocompromised people, may have experienced drastic changes in social participation during the pandemic. A COVID-19 basic vaccination may have changed the safety behavior of immunocompromised individuals in terms of infection risk and thereby influence social participation and mental wellbeing. This study aims to investigate self-perceived social participation at baseline before and at follow-up 1 and 6 months after basic vaccination. Beginning in March 2021, 274 immunocompromised persons 18 years or older were enrolled in the COVID-19 Contact Immune study (CoCo study) in Lower Saxony, Germany. Measurements were performed at three time points regarding social participation [Index for the Assessment of Health Impairments (IMET)], mental health [Patient Health Questionnaire-4 (PHQ-4)], subjective health status (five-point Likert-scale) and quality of life (five-point Likert-scale). In total, 126 participants were included in the final analysis. About 60% of the participants showed increasing social participation over time. The greatest increase in social participation was observed within the first month after basic vaccination (p < 0.001). During the following 5 months, social participation remained stable. The domains "social activities," "recreation and leisure" and "close personal relationships" were responsible for the overall change in social participation. No association was found between social participation and mental health, sociodemographic or medical factors (except hypertension). It is unclear why social participation increased after basic vaccination. Perceived vaccine efficacy and a feeling of being protected by the vaccine may have caused relaxed social distancing behaviors. Reducing safety behaviors may, however, increase the risk of a COVID-19 infection for immunocompromised individuals. Further investigations are needed to explore the health-related consequences of more social participation among immunocompromised persons.

Vaccination as an Equaliser? Evaluating COVID-19 Vaccine Prioritisation and Compensation

This article assesses the equity of COVID-19 vaccination programmes in three jurisdictions that have historically taken different approaches to the institutionalisation of equity considerations. The Sars-Cov-2 pandemic has thrown into sharp relief persistent societal inequalities and has added novel dimensions to these problems. Certain groups have proved particularly vulnerable, both in terms of infection risk and severity as well as the accompanying social fallout. Against this background the implementation of 'objective' vaccination programmes may seem like a great leveller, addressing the disparate risks that are tied to social determinants of health and the pandemic behemoth. However, implementing vaccination programmes in an equitable manner is itself essential for the realisation of such a vision. This article undertakes a comparative analysis of the English, Italian, and American jurisdictions and critically assesses two aspects of their vaccination frameworks: (i) the prioritisation of groups for vaccination and (ii) the nature of public compensation schemes for those who have suffered vaccine-related injuries. It examines whether and to what extent these measures address the inequalities raised by COVID-19 and the role of the law in this pursuit.

Occurrence and Quantitative Microbial Risk Assessment of Methicillin-Resistant Staphylococcus aureus (MRSA) in a Sub-Catchment of the Yodo River Basin, Japan.

The occurrence of Staphylococcus aureus (S. aureus) and methicillin-resistant S. aureus (MRSA) in a sub-catchment of the Yodo River Basin, a representative water system of a drinking water source in Japan, was investigated. The chromogenic enzyme-substrate medium method was used for the detection of S. aureus and MRSA by the presence or absence of antimicrobials in the medium for viable bacteria in a culture-based setting. The contributions of S. aureus and MRSA from wastewater to the rivers were estimated based on mass flux-based analysis, and quantitative microbial risk assessment (QMRA) was further conducted for S. aureus and MRSA in river environments. The mean abundance of S. aureus and MRSA was 31 and 29 CFU/mL in hospital effluent, 124 and 117 CFU/mL in sewage treatment plant (STP) influent, 16 and 13 CFU/mL in STP effluent, and 8 and 9 CFU/mL in river water, respectively. Contribution of the pollution load derived from the target STP effluent to river water ranged from 2% to 25%. The QMRA showed that to achieve the established health benchmarks, the drinking water treatment process would need to yield 1.7 log10 and 2.9 log10 inactivation in terms of infection risk and disability-adjusted life year (DALY) indexes, respectively. These findings highlight the link between medical environment and the importance of environmental risk management for antimicrobial-resistant bacteria in aquatic environments.

Population distribution by ethnicities and the disparities in health risk and coping in the United States during the pandemic: the spatial and time dynamics

BackgroundAs a multi-ethnic country, the US is increasingly concerned about ethnic minorities facing disproportionate health risks of the coronavirus disease 2019 (COVID-19) pandemic. This study attempted to provide a macro picture of the associations between population distribution by ethnicity and the vulnerability to COVID-19 in terms of infection risk and vaccination coverage in the US.MethodsThis study used multi-source data from New York Times, County Health Rankings & Roadmap Program (2020), and the Center for Disease Control and Prevention. Multiple linear regressions were performed at equidistant time points (May 2020-Jan 2021, with one-month interval between each time point) to reveal the association between population distribution by ethnicities and the infection risk and the dynamics over time. Besides, multiple linear regressions were also conducted at equidistant time points (Jan 2021-Aug 2021) to reveal whether health disparities between ethnicities would hold true for the COVID-19 vaccination coverage (in total population, and among those > 12, > 18, and > 65 years of age).ResultsBoth the COVID-19 confirmed cases (population standardized) and the vaccination coverage (in total population, and among those > 12, > 18, and > 65 years of age) were significantly associated with the population distribution by ethnicity (e.g., population percentage of ethnic minorities). Above associations were statistically significant for non-Hispanic blacks and Hispanics, but not for Asian Americans.ConclusionsA proportion of socioeconomically-disadvantageous population could be a key intuitive reflection of the risk level of this public health crisis. The policy focusing on the vulnerable population is important in this pandemic.

The Influence of Nutritional Supplementation for Iron Deficiency Anemia on Pregnancies Associated with SARS-CoV-2 Infection.

Anemia is a very common occurrence during pregnancy, with important variations during each trimester. Anemia was also considered as a risk factor for severity and negative outcomes in patients with SARS-CoV-2 infection. As the COVID-19 pandemic poses a significant threat for pregnant women in terms of infection risk and access to care, we developed a study to determine the impact of nutritional supplementation for iron deficiency anemia in correlation with the status of SARS-CoV-2 infection. In a case-control design, we identified 446 pregnancies that matched our inclusion criteria from the hospital database. The cases and controls were stratified by SARS-CoV-2 infection history to observe the association between exposure and outcomes in both the mother and the newborn. A total of 95 pregnant women were diagnosed with COVID-19, having a significantly higher proportion of iron deficiency anemia. Low birth weight, prematurity, and lower APGAR scores were statistically more often occurring in the COVID-19 group. Birth weight showed a wide variation by nutritional supplementation during pregnancy. A daily combination of iron and folate was the optimal choice to normalize the weight at birth. The complete blood count and laboratory studies for iron deficiency showed significantly decreased levels in association with SARS-CoV-2 exposure. Puerperal infection, emergency c-section, and small for gestational age were strongly associated with anemia in patients with COVID-19. It is imperative to screen for iron and folate deficiency in pregnancies at risk for complications, and it is recommended to supplement the nutritional intake of these two to promote the normal development and growth of the newborn and avoid multiple complications during pregnancy in the COVID-19 pandemic setting.

The impact of COVID-19 on the immigrant population in Italy. Context, methodology and synthesis of the main evidence from the project of the National Institute for Health, Migration and Poverty (INMP) and Italian Regions

COVID-19 acted on health inequalities in two ways: directly, in terms of infection risk and outcomes; indirectly, through effects on the economy, which exacerbated social inequalities. Immigrants have particularly suffered the effects of the pandemic.The Italian National Institute for Health, Migration and Poverty (INMP) has promoted the project "Epidemiology of SARS-CoV-2 (COVID-19) infection and use of health services in immigrant and vulnerable population groups in Italy" in collaboration with the Regions of Piedmont, Lombardy, Veneto, Emilia-Romagna, Tuscany, Lazio, and Sicily, to assess the impact of the pandemic in the immigrant population.This is an observational population-based study design, based on weekly monitoring data from the COVID-19 National Surveillance System of the Italian National Health Institute (ISS). The observation period was split into five sub-periods: February-May 2020 (wave I), June-September 2020 (intermediate period I), October 2020-January 2021 (wave II), February-April 2021 (wave III), May-July 2021 (intermediate period II).Access to diagnostic testing was higher among Italians; the incidence curve showed a lower level of infection among immigrants during the three waves and higher in the two intermediate periods. Age-standardized hospitalization rates were higher among immigrants both in noncritical care areas and in the intensive care unit, particularly in the intermediate stages of the epidemic. Immigrant standardized mortality rates were higher than those of Italians since the third period among males and in the fourth period among females.Differences were also observed on a regional basis and by the immigrants' area of origin.

Use of a protective antimicrobial coating to reduce the microbial load in public transportation – a real-scenario study

BACKGROUND AND AIM: The need to disinfect and sanitise private or public spaces, as a consequence of the pandemic caused by the Sars-Cov-2 virus, has raised new questions and demands in the sanitary field, including new cleaning and sanitising practices. Public transportation is one of the sectors most impacted by this new reality. The greatest cause for concern in terms of infection risk is related to the high flow and close contact between individuals and the constant sharing of surfaces. In fact, human pathogens have been detected on surfaces highly touched in public transportation. In this study, the antimicrobial activity of the Progen Guard Technology 24H coating (CTEQ - Indústria Química, Portugal|) on surfaces of public buses during their normal daily operating period was investigated. METHODS: Three different buses circulating in Santo Tirso (north of Porto Metropolitan Area, Portugal) between October and December 2020 were part of this study. Swab samples were taken from three surfaces treated with the product and from three untreated surfaces (treated and untreated doorbell buttons, ceiling-mounted handles, stanchions) immediately after product application and every 24 h for 4 days. Immediately after collection, samples were transported to the laboratory and enumeration of total aerobic microorganisms at 30 ºC was performed. RESULTS:For the analyzed parameter and the investigated surfaces, it was concluded that the application of Progen Guard Technology 24H significantly reduces the total microbial load on surfaces immediately after application (86.3% to 98.8%) and for at least 24 hours (72.7% to 98.7%) in a real context - naturally contaminated surfaces and non-controlled conditions. CONCLUSIONS:These are promising results concerning the prevention of the spread of contaminants in public spaces. This antimicrobial coating deserves to be further investigated in other real-life scenarios where environmental microbial contamination is a cause for concern (e.g., healthcare settings). KEYWORDS: Non-chemical stressors, microbes, Infectious diseases

COVID-19: Pandemic Risk, Resilience and Possibilities for Aging Research.

The COVID-19 global crisis is reshaping Canadian society in unexpected and profound ways. The significantly higher morbidity and mortality risks by age suggest that this is largely a "gero-pandemic," which has thrust the field of aging onto center stage. This editorial emphasizes that vulnerable older adults are also those most affected by COVID-19 in terms of infection risk, negative health effects, and the potential deleterious outcomes on a range of social, psychological, and economic contexts - from ageism to social isolation. We also contend that the pathogenic analysis of this pandemic needs to be balanced with a salutogenic approach that examines the positive adaptation of people, systems and society, termed COVID-19 resilience. This begs the question: how and why do some older adults and communities adapt and thrive better than others? This examination will lead to the identification and response to research and data gaps, challenges, and innovative opportunities as we plan for a future in which COVID-19 has become another endemic infection in the growing list of emerging and re-emerging pathogens.

Carpal tunnel decompression in primary care: what is the infection risk and is it safe and effective?

The demand for elective hand surgery in England is predicted to double by 2030 compared with 2011. With such increase in demand, the UK must seek strategies to reduce costs of treatment while still maintaining standards of care. Carpal tunnel decompression performed in a treatment room rather than in theatre may provide a safe alternative setting. As yet, there are no UK-based studies that identify the risk of infection following surgery performed in a treatment room and there are no studies whatsoever assessing the qualitative outcomes of patients undergoing hand surgery outside a theatre environment. Our aim was to assess whether carpal tunnel decompression performed in the community is safe, in terms of infection risk, and effective. Patient outcome measures were prospectively recorded following carpal tunnel decompression in one single primary care centre performed by one surgeon from 2012 to 2017. Infection following surgery was evaluated for retrospectively. A total of 460 patients underwent carpal tunnel decompression within the study time period. There were three superficial infections identified, giving an infection rate of 0.65%. There were no deep infections identified. There was a statistically significant improvement in both symptom and functional outcomes following surgery, with results comparable to other studies where surgery was performed in theatre. We believe that carpal tunnel decompressions performed in a treatment room is both safe, in terms of infection risk, and effective. Surgeons should consider this location as an alternative setting to the main operating theatre.

Knowledge of Hepatitis B Virus Infection and Infection Control Practices Among Faculty of Dentistry Workers, in Aydin

INTRODUCTION AND AIM: Hepatitis B infection which is a life-threatening infection, is a major global health problem. Occupational exposure may be an important route of transmission. The aim of this study was to evaluate Knowledge of Hepatitis B Virus Infection and infection control practices among Faculty of Dentistry Staff, in Aydin province. MATERIAL METHODS: In this cross-sectional study, hepatitis B vaccination status of the participants; knowledge levels, history of work accidents, general infection control practices were questioned. Knowledge levels were assessed with 63 propositions, each correct answer calculated as 1 point to calculate total knowledge score and then subgroup scores such as general information, information level scores for transmission routes, prevention approaches and risk groups, were calculated. RESULTS: 54.4 % of participants told that they had received education about HBV infection, 67.5% told they had been vaccinated with Hepatitis B vaccine. 46.3% of those who stated that they had been vaccinated told that they checked antibody levels after vaccination. 27.8 % of participants stated that they had periodic inspection checks and 18.8 % stated that they had an occupational accident in terms of infection risk in the previous year. The mean total knowledge score over 63 propositions was 42.3±13.3. Total knowledge score were found lower in participants who were younger or dental students, who did not receive education about general infection control precautions and hepatitis B infection, who did not vaccinated with HBV, who did not have a history of contact with HBV-infected patients, who did not had an occupational accident in the previous year and who had less than a year of occupational experience. CONCLUSION: In conclusion oral and dental health workers’ knowledge about hepatitis B infection and infection control practices were not at desired level. It is important to give educational activities regarding causes of infections and standard infection control precautions as earlier as possible in order to prevent horizontal transmission between patients and health workers.

Is surgical smoke harmful to theater staff? a systematic review

Smoke is generated by energy-based surgical instruments. The airborne byproducts may have potential health implications. This study aimed to evaluate the properties of surgical smoke and the evidence for the harmful effects to the theater staff. Cochrane Database, MEDLINE, PubMed, Embase classic and Embase, and the metaRegister of Controlled Trials were searched for studies reporting the constituents found in the smoke plume created during surgical procedures, the methods used to analyze the smoke, the implications of exposure, and the type of surgical instrument that generated the smoke. Studies were excluded if they were animal based, preclinical experimental work, or opinion-based reports. The common end points were particle size and characteristics, infection risk, malignant spread, and mutagenesis. The inclusion criteria were fulfilled by 20 studies. In terms of particle size, 5 (25%) of the 20 studies showed that diathermy and laser can produce ultrafine particles (UFP) that are respirable in size. With regard to particle characterization, 7 (35%) of the 20 studies demonstrated that a variety of volatile hydrocarbons are present in diathermy-, ultrasonic-, and laser-derived surgical smoke. These are potentially carcinogenic, but no evidence exists to support a cause-effect relationship for those exposed. In terms of infection risk, 6 (30%) of the 20 studies assessed surgical smoke for the presence of viruses, with only 1 study (5%) positively identifying viral DNA in laser-derived smoke. One study (5%) demonstrated bacterial cell culture (Staphylococcus aureus) from a laser plume after surgery. Regarding mutagenesis and malignant spread, one study (5%) reported the mutagenic effect of smoke, and one study (5%) showed the presence of malignant cells in the smoke of a patient undergoing procedures for carcinomatosis. The potentially carcinogenic components of surgical smoke are sufficiently small to be respirable. Infective and malignant cells are found in the smoke plume, but the full risk of this to the theater staff is unproven. Future work could focus on the long-term consequences of smoke exposure.

Limiting worker exposure to highly pathogenic avian influenza a (H5N1): a repeat survey at a rendering plant processing infected poultry carcasses in the UK

BackgroundCurrent occupational and public health guidance does not distinguish between rendering plant workers and cullers/poultry workers in terms of infection risk in their respective roles during highly pathogenic avian influenza poultry outbreaks. We describe an operational approach to human health risk assessment decision making at a large rendering plant processing poultry carcasses stemming from two separate highly pathogenic avian influenza A (H5N1) outbreaks in England during 2007.MethodsDuring the first incident a uniform approach assigned equal exposure risk to all rendering workers in or near the production line. A task based exposure assessment approach was adopted during the second incident based on a hierarchy of occupational activities and potential for infection exposure. Workers assessed as being at risk of infection were offered personal protective equipment; pre-exposure antiviral prophylaxis; seasonal influenza immunisation; hygiene advice; and health monitoring. A repeat survey design was employed to compare the two risk assessment approaches, with allocation of antiviral prophylaxis as the main outcome variable.ResultsTask based exposure assessment during the second incident reduced the number of workers assessed at risk of infection from 72 to 55 (24% reduction) when compared to the first incident. No cases of influenza like illness were reported in workers during both incidents.ConclusionsTask based exposure assessment informs a proportionate public health response in rendering plant workers during highly pathogenic avian influenza H5N1 outbreaks, and reduces reliance on extensive antiviral prophylaxis.

Advances in medical decision support systems for diagnosis of acute graft-versus-host disease: molecular and computational intelligence joint approaches

Acute graft-versus-host disease (aGVHD) is a serious systemic complication of allogeneic hematopoietic stem cell transplantation (HSCT) causing considerable morbidity and mortality. Acute GVHD occurs when alloreactive donor-derived T cells recognize host-recipient antigens as foreign. These trigger a complex multiphase process that ultimately results in apoptotic injury in target organs. The early events leading to GVHD seem to occur very soon, presumably within hours from the graft infusion. Therefore, when the first signs of aGVHD clinically manifest, the disease has been ongoing for several days at the cellular level, and the inflammatory cytokine cascade is fully activated. So, it comes as no surprise that progress in treatment based on clinical diagnosis of aGVHD has been limited in the past 30 years. It is likely that a pre-emptive strategy using systemic high-dose corticosteroids as early as possible could improve the outcome of aGVHD. Due to the deleterious effects of such treatment particularly in terms of infection risk posed by systemic steroid administration in a population that is already immune-suppressed, it is critical to identify biomarker signatures for approaching this very complex task. Some research groups have begun addressing this issue through molecular and proteomic analyses, combining these approaches with computational intelligence techniques, with the specific aim of facilitating the identification of diagnostic biomarkers in aGVHD. In this review, we focus on the aGVHD scenario and on the more recent state-of-the-art. We also attempt to give an overview of the classical and novel techniques proposed as medical decision support system for the diagnosis of GVHD.

Condom Versus Indwelling Urinary Catheters: A Randomized Trial

To compare condom and indwelling urinary catheters in terms of infection risk and patient satisfaction. A prospective, randomized, unblinded, controlled trial. An academically affiliated Veterans Affairs Medical Center. Hospitalized men aged 40 and older who required a urinary collection device. The incidence of adverse outcomes (bacteriuria, symptomatic urinary tract infection (UTI), or death) and patient device-related satisfaction as determined according to a questionnaire. Dementia status was recorded to assess effect modification by the presence of dementia. Seventy-five subjects were randomized: 41 receiving an indwelling catheter and 34 a condom catheter. The incidence of an adverse outcome was 131/1,000 patient-days with an indwelling catheter and 70/1,000 patient-days with a condom catheter (P=.07). The median time to an adverse event was 7 days in the indwelling group and 11 days in the condom group. After adjusting for other risk factors, it was found that condom catheter use reduced adverse outcomes (P=.04). Patients without dementia who had an indwelling catheter were approximately five times as likely to develop bacteriuria or symptomatic UTI or to die (hazard ratio=4.84, 95% confidence interval=1.46-16.02) as those with a condom catheter (P=.01). Patients reported that condom catheters were more comfortable (P=.02) and less painful (P=.02) than indwelling catheters. The use of condom catheters is less likely to lead to bacteriuria, symptomatic UTI, or death than the use of indwelling catheters. This protection is especially apparent in men without dementia.