Virus In Healthcare Settings Research Articles

Respiratory Viruses Causing Influenza Like Illness/Severe Acute Respiratory Infection During COVID-19 Pandemic

Background: Respiratory tract infections caused by viruses are among the most common diseases in humans worldwide. The diagnosis remains difficult as the symptoms overlap significantly with each other. Objectives: The objective of this study is to identify the respiratory viruses other than SARS-CoV- -2 causing Influenza-like illness (ILI) /severe acute respiratory infection (SARI) during COVID-19 pandemic Methods: A total of 100 samples, including COVID-19 positive (n=50) and negative (n=50), were included in the study. The detailed case record form was filled for each patient including relevant history. Nasopharyngeal and Oropharyngeal swabs were subjected to standardized RT-PCR for the detection of SARS-CoV-2 followed by Multiplex RT-PCR for other respiratory viruses. Results: Other respiratory viruses causing ILI/SARI symptoms similar to SARS-CoV2 during COVID-19 pandemic in non-COVID-19 patients aged more than 18 years were found to be Human metapneumovirus (2%), Human adenovirus (1%), Human parainfluenza virus-1 (1%). The result suggested that other respiratory viral infections are significantly higher among COVID-19 negative individuals presenting with respiratory illness as compared to COVID-19 positive individuals, possibly due to viral interference and competitive advantage of SARS-CoV-2 in modulating the host immune system. Conclusion: The other respiratory viruses in SARS-CoV-2 negative patients had mild to moderate ILI/SARI symptoms, which usually do not require hospitalization but need to be monitored, especially in high-risk patients. Human metapneumovirus, Adenovirus, Parainfluenza virus-1 most commonly occured in more than 60 years age group with comorbidity which can be useful in stratification for future surveillance of other respiratory viruses in health care settings.

Changes in Personal Protective Equipment Usage Among Healthcare Personnel From the Beginning of Pandemic to Intra-COVID-19 Pandemic in Thailand.

Personal protective equipment (PPE) use is associated with reduced risk of SARS-CoV-2 infection among healthcare personnel (HCP). There are limited data on the impact of the novel coronavirus disease 2019 (COVID-19) pandemic on the PPE use of HCP. We describe the changes in PPE use from just before the widespread of community outbreaks ('pre-pandemic') to intra-pandemic time points, and examine factors associated with not changing in PPE use behavior among HCP in four Thai hospitals. We performed a retrospective cohort evaluation using two-time points: (i) February-March 2020 (pre-pandemic period); and (ii) January-March 2021 (intra-pandemic period). Self-reported frequency of appropriate PPE use was measured by a Likert scale. We used multivariable logistic regression to identify factors associated with no increase in self-reported PPE use. Of 343 HCP, the proportion of participants reporting 'always' using PPE rose from 66% during the pre-pandemic period to 80% during the pandemic. Factors associated with HCP who did not increase in PPE use included having high baseline reported PPE, being a non-registered HCP (e.g. nurse assistants, dental assistants, porters), being male, and having a low perceived risk of becoming infected with any respiratory virus while working in the hospital. PPE education, training, and risk communication content should target all cadres of HCP, regardless of registered/non-registered status, with a focus on behavior change for improved prevention and control of SARS-CoV-2 and other respiratory viruses in healthcare settings.

The use of aerosol generating procedures (AGPs) during the COVID-19 pandemic in the diagnosis of lung cancer: a narrative review.

ObjectiveIn this article we discuss the current evidence for these concerns and highlight where further work is required to understand the risk from these procedures and how it can be mitigated for.BackgroundThe COVID-19 (coronavirus-19 or SARS-CoV-2) pandemic has impacted on many aspects of patient care both for those with the virus and those with other illnesses. Of particular concern has been the risk to staff and patients from the spread of the virus in health care settings. This has led to changes in guidelines and practice in community and hospital settings that has implications on patient diagnostic pathways in lung cancer, with a specific emphasis on aerosol generating procedures (AGPs).MethodsA literature search was carried out and 44 abstracts were initially found. Given the novel status of COVID-19, we included severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) in our search. Five papers were selected for further analysis. An additional paper was highlighted during our research and therefore included in our review.ConclusionsThe papers selected assessed the risk of transmission during AGPs. The six articles selected assessed the risk of aerosol transmission during various AGPs (bronchoscopy, pleural procedures and pulmonary function tests) and each found that the risk of viral transmission via aerosol was low. As mentioned above, at the time the paper was written, there was a paucity of evidence regarding AGPs in the era of COVID-19. There is emerging evidence that our understanding of these procedures may be outdated and the risk of transmission maybe lower than previously anticipated. However, we need further reliable evidence to change practice going forward.

Cling film for mobile phones to prevent cross-infection during the COVID-19 pandemic

Mobile phones have become an inseparable part of dermatology practice, and dermatologists use mobile phones in various ways while clinically examining patients. They are often used as a flashlight or a camera to take images of the lesions. In the COVID-19 pandemic era, mobile phones are more likely to be contaminated with the virus in health care settings, and they must be sanitized properly after use because they can be possible carriers of the virus.1Van Doremalen N. Bushmaker T. Morris D.H. et al.Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1.N Engl J Med. 2020; 382: 1564-1567Crossref PubMed Scopus (5627) Google Scholar However, it is not practically feasible to sanitize mobile phones with alcohol-containing sanitizer or chlorine solutions because these chemical solutions may have ill effects on mobile phone screens. Cling film roll can be a better solution for this challenge. These are thin, transparent plastic wraps with smooth surfaces, that can be used to wrap a mobile phone thoroughly before reaching the hospital (Fig 1). Because it is transparent, the plastic wrap gives a clear view of the mobile screen. We did not find a significant rise in temperature of the mobile phone or a marked change in the resolution of images taken with the mobile camera after applying the cling film (Fig 2). After use, the phone wrapped with cling film can be sanitized with alcohol-based sanitizer because it is waterproof. In the end, the film can be removed completely from the phone and discarded.Fig 2Temperature of a mobile phone wrapped with cling film (A) before and (B) after 6 hours of use. Resolution of an image taken with a mobile phone (C) without cling film and (D) with cling film.View Large Image Figure ViewerDownload Hi-res image Download (PPT) At a time when there is intense focus on ways to prevent the spread of the disease, cling film is a plausible and cost-effective method for preventing cross-infection of severe acute respiratory syndrome coronavirus 2. Comment on “Cling film for mobile phones to prevent cross-infection during the COVID-19 pandemic”Journal of the American Academy of DermatologyVol. 84Issue 1PreviewTo the Editor: We read with great interest the article by Sethy et al1 providing an easy solution for the safe use of mobile phones in the clinics during the coronavirus disease 19 (COVID-19) pandemic. We have used the same solution since the beginning of the outbreak in our center, and yet, we believe some shortcomings of the proposed method need to be mentioned. Full-Text PDF

Nosocomial Transmission of Emerging Viruses via Aerosol-Generating Medical Procedures.

Recent nosocomial transmission events of emerging and re-emerging viruses, including Ebola virus, Middle East respiratory syndrome coronavirus, Nipah virus, and Crimean–Congo hemorrhagic fever orthonairovirus, have highlighted the risk of nosocomial transmission of emerging viruses in health-care settings. In particular, concerns and precautions have increased regarding the use of aerosol-generating medical procedures when treating patients with such viral infections. In spite of increasing associations between aerosol-generating medical procedures and the nosocomial transmission of viruses, we still have a poor understanding of the risks of specific procedures and viruses. In order to identify which aerosol-generating medical procedures and emerging viruses pose a high risk to health-care workers, we explore the mechanisms of aerosol-generating medical procedures, as well as the transmission pathways and characteristics of highly pathogenic viruses associated with nosocomial transmission. We then propose how research, both in clinical and experimental settings, could advance current infection control guidelines.

Monogenic, polygenic, and oligogenic familial hypercholesterolemia.

Familial hypercholesterolemia has long been considered a monogenic disorder. However, recent advances in genetic analyses have revealed various forms of this disorder, including polygenic and oligogenic familial hypercholesterolemia. We review the current understanding of the genetic background of this disease. Mutations in multiple alleles responsible for low-density lipoprotein regulation could contribute to the development of familial hypercholesterolemia, especially among patients with mutation-negative familial hypercholesterolemia. In oligogenic familial hypercholesterolemia, multiple rare genetic variations contributed to more severe familial hypercholesterolemia. Familial hypercholesterolemia is a relatively common 'genetic' disorder associated with an extremely high risk of developing coronary artery disease. In addition to monogenic familial hypercholesterolemia, different types of familial hypercholesterolemia, including polygenic and oligogenic familial hypercholesterolemia, exist and have varying degrees of severity. Clinical and genetic assessments for familial hypercholesterolemia and clinical risk stratifications should be performed for accurate diagnosis, as should cascade screening and risk stratification for the offspring of affected patients.

Quantification of Influenza Virus RNA in Aerosols in Patient Rooms.

BackgroundThe potential for human influenza viruses to spread through fine particle aerosols remains controversial. The objective of our study was to determine whether influenza viruses could be detected in fine particles in hospital rooms.Methods and FindingsWe sampled the air in 2-bed patient isolation rooms for four hours, placing cyclone samplers at heights of 1.5m and 1.0m. We collected ten air samples each in the presence of at least one patient with confirmed influenza A virus infection, and tested the samples by reverse transcription polymerase chain reaction. We recovered influenza A virus RNA from 5/10 collections (50%); 4/5 were from particles>4 μm, 1/5 from 1–4 μm, and none in particles<1 μm.ConclusionsDetection of influenza virus RNA in aerosols at low concentrations in patient rooms suggests that healthcare workers and visitors might have frequent exposure to airborne influenza virus in proximity to infected patients. A limitation of our study was the small sample size. Further studies should be done to quantify the concentration of viable influenza virus in healthcare settings, and factors affecting the detection of influenza viruses in fine particles in the air.

Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: the possible role of dry surface contamination

Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: the possible role of dry surface contamination

Differences in the compliance with hospital infection control practices during the 2009 influenza H1N1 pandemic in three countries

In December 2009, the World Health Organization (WHO) issued updated guidelines on the prevention of H1N1 influenza virus in healthcare settings. In 2010, the WHO pandemic influenza alert level was still at phase 6. To study the practice of infection control measures during the 2009 influenza H1N1 pandemic among healthcare workers (HCWs) in three countries. A standardized, self-administered anonymous questionnaire survey was conducted in 2010 among doctors, nurses and allied HCWs in 120 hospital-based clinical departments in Hong Kong, Singapore and the UK. Questions were asked on demographics; previous experience and perceived severity of influenza; infection control practices; uptake of seasonal influenza vaccination and H1N1 vaccination. Multiple logistic regression was used to test the independent association with different factors. A total of 2100 HCWs in the three countries participated. They reported high compliance (>80%) with infection control procedures regarded as standard for droplet-transmitted infections including wearing and changing gloves, and washing hands before and after patient contact. However, the reported use of masks with indirect or direct patient contact (surgical or N95 as required by their hospital) varied considerably (96.4% and 70.4% for Hong Kong; 82.3% and 87.7% for Singapore; 25.3% and 62.0% for the UK). Reported compliance was associated with job title, number of patient contacts and perceived severity of pandemics. There was no association between the uptake for seasonal or 2009 H1N1 vaccines and compliance. Compliance with infection control measures for pandemic influenza appears to vary widely depending on the setting.

Hand sanitizers may increase norovirus risk

Alcohol-based hand sanitizers may not be the panacea for hand hygiene they were once supposed, as mounting research indicates they may not be effective substitutes for soap and water, and in some cases may actually increase the risk for outbreaks of highly contagious viruses in health care settings

Environmental survey to assess viral contamination of air and surfaces in hospital settings

SummaryThe presence of pathogenic viruses in healthcare settings represents a serious risk for both staff and patients. Direct viral detection in the environment poses significant technical problems and the indirect indicators currently in use suffer from serious limitations. The aim of this study was to monitor surfaces and air in hospital settings to reveal the presence of hepatitis C virus, human adenovirus, norovirus, human rotavirus and torque teno virus by nucleic acid assays, in parallel with measurements of total bacterial count and haemoglobin presence. In total, 114 surface and 62 air samples were collected. Bacterial contamination was very low (<1 cfu/cm2) on surfaces, whereas the ‘medium’ detected value in air was 282 cfu/m3. Overall, 19 (16.7%) surface samples tested positive for viral nucleic acids: one for norovirus, one for human adenovirus and 17 (14.9%) for torque teno virus (TTV). Only this latter virus was directly detected in 10 air samples (16.1%). Haemoglobin was found on two surfaces. No relationship was found between viral, biochemical or bacterial indicators. The data obtained confirm the difficulty of assessing viral contamination using bacterial indicators. The frequent detection of TTV suggests its possible use as an indicator for general viral contamination of the environment.

Transmission of measles virus in healthcare settings during a communitywide outbreak.

To describe the epidemiology of measles in medical settings and to evaluate the implementation and effectiveness of the 1989 Advisory Committee on Immunization Practices (ACIP) guidelines for measles immunization in healthcare workers (HCWs). Confirmed cases of measles reported in Clark County, Washington, from March 14 to June 2, 1996, were analyzed for characteristics of cases occurring in medical settings. A questionnaire was used to assess employee immunization (95% response rate). Reported measles cases and HCWs at community hospitals, primary-care medical facilities, a health-maintenance organization, and a multispecialty group practice. Of 31 cases of measles, 8 (26%) occurred in HCWs, and 5 (16%) occurred in patients or visitors to medical facilities. Cases of measles occurred in HCWs who were not required to have proof of measles immunity as defined by the 1989 ACIP guidelines. The relative risk of measles in HCWs compared to Clark County adults was 18.6 (95% confidence interval, 7.4-45.8; P<.001). A survey of medical facilities revealed that 47% had an employee measles immunization policy; only 21% met ACIP recommendations and enforced their policies. HCWs were at higher risk of measles than the adult population. Transmission of measles in medical settings was related to both deficiencies in, and lack of implementation of, the ACIP guidelines.