Universal Admission Screening for SARS-CoV-2 Infections among Hospitalized Patients, Switzerland, 2020.

Switzerland began a national lockdown on March 16, 2020, in response to the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We assessed the prevalence of SARS-CoV-2 infection among patients admitted to 4 hospitals in the canton of Zurich, Switzerland, in April 2020. These 4 acute care hospitals screened 2,807 patients, including 2,278 (81.2%) who did not have symptoms of coronavirus disease (COVID-19). Overall, 529 (18.8%) persons had >1 symptom of COVID-19, of whom 60 (11.3%) tested positive for SARS-CoV-2. Eight asymptomatic persons (0.4%) also tested positive for SARS-CoV-2. Our findings indicate that screening on the basis of COVID-19 symptoms, regardless of clinical suspicion, can identify most SARS-CoV-2-positive persons in a low-prevalence setting.

Universal Precautions Provide Appropriate Protection during Autopsies of Patients with Infectious Diseases.

The current coronavirus disease 2019 (COVID-19) pandemic has raised concerns about the safety of laboratory personnel who handle tissue samples that harbor pathogens, including those performing autopsies. While pathologists have performed autopsies on infected decedents for centuries, universal precaution protocols for limiting exposure to pathogens were not developed until the 20th century. This article reviews the history and effectiveness of universal precautions, with an emphasis on performing autopsies on COVID-19 decedents.

Postoperative fever in the time of COVID-19.

Summary: Postoperative fever is common following orthopedic trauma surgery. As the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increases in the community, migration into the acute care hospital setting intensifies, creating confusion when fever develops postoperatively. The transmission dynamics of SARS-CoV-2 make it difficult to adequately gauge and pinpoint risk groups with questionnaires at the time of hospital admission. This is particularly problematic when asymptomatic or presymptomatic patients infected with SARS-CoV-2 require urgent surgery and cannot be screened effectively. One approach is to treat every patient as though they were SARS-CoV-2-positive in preparation for surgery, but doing so could exacerbate shortages of personal protective equipment and staffing limitations. Uncertainty regarding the etiology of postoperative fever could be significantly reduced by universal SARS-CoV-2 testing of all surgical patients at the time of hospital admission in addition to routine screening, but testing capacity and a rapid turnaround time would be required.

[The conditions and the character of the work of the mortuary personnel in the Great Britain: the problems of health protection, anti-infectious prophylaxis, and reduction of the risk of contamination]. / Usloviia i kharakter raboty meditsinskogo personala morgov Velikobritanii: voprosy okhrany zdorov'ia, obespecheniia infektsionnoi bezopasnosti i snizheniia riskov zarazheniia.

The objective of the present work was to study the specific approaches to the organization of the work of the foreign specialists performing post-mortem autopsies of the subjects who died from infectious pathology and consider the proposals of the representatives of the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) concerning accreditation of mortuaries in the Great Britain. It is shown that the algorithm for the evaluation of the possible risks of contamination of the medical personnel suggests the solution of five problems that envisages obtaining the answers to the following questions: (1) what biological agents can be present in a particular case? (2) what is their virulence factor? (3) what are the transmission routes (mechanisms)? (4) what are the manner of their realization? (5) what is the amount of the pathogen(s) needed to cause a given infectious disease? The anti-infectious prophylactic measures and the prevention of the contamination risks for the medical personnel of the British mortuaries are designed to safeguard the people against the infection with the causative agents of tuberculosis, viral hepatitis B and C, HIV, and Kreutsfield- Jacob's disease. All the employees engaged in the pathological studies must wear specialized clothing in a mandatory manner and make use of the equipment for the personal and collective protection. An indispensable condition for the safe work in a mortuary is the efficient ventilation system, the special viewing equipment, and separate premises. The NCEPOD experts maintain that the general approach to the investigations of the cases of infectious diseases presently adopted in the country needs to be radically re-considered and standardized. Diagnostics of contamination and morbidity of the medical personnel from the corpses has not yet become a routine practice. The principal recommendation to be implemented at the national level consists of the strict observance of the safety precautions as opposed to the total pre-mortem testing of the suspicious cases.

Co-prescription of naloxone as a Universal Precautions model for patients on chronic opioid therapy-Observational study.

BACKGROUND: The epidemic of lethal prescription opioid overdose is one of the most pressing public health problems in the United States. In an ambulatory clinic setting, current practice guidelines suggest that health care providers should screen patient's aberrant drug-related behaviors. Given the difficulty of predicting which patients on chronic opioid therapy (COT) will experience opioid overdose, a new paradigm of harm reduction is called for. In previous studies, naloxone, an opioid antagonist, was given only to high-risk patients. However, if naloxone is co-prescribed in a Universal Precautions manner for all patients receiving COT, this may have a significant impact on intentional and unintentional opioid overdose deaths. METHODS: Adult patients treated with COT for chronic noncancer pain are eligible study participants at the University of New Mexico Pain Center. The primary goal of this 1-year study was to develop an efficient Universal Precautions model for co-prescribing of naloxone with COT in the ambulatory clinic setting. Outcome measures included demographic data, detailed medical and substance use history, current morphine equivalent dose (MED), other "high-risk" medications used, and opioid misuse risk. RESULTS: One hundred and sixty-four patients were enrolled in this study. All subjects were educated about the risks of opioid overdose and provided naloxone rescue kits. No overdoses occurred in the study population. Follow-up data illustrated that approximately 57% of the cohort had depressive disorder, the median MED was 90 mg/day, and the median Current Opioid Misuse Measure score (COMM) was 5.0. CONCLUSIONS: The ambulatory co-prescribing of naloxone in a Universal Precautions model for all patients prescribed COT can be adopted as a useful public health intervention. This study illustrates a model that can be used to educate patients, caregivers, and an interdisciplinary team of health care professionals in an academic medical center.

EMS provider compliance with infection control recommendations is suboptimal.

INTRODUCTION: Standard precautions are disease transmission prevention strategies recommended by both the World Health Organization (WHO) and by the Centers for Disease Control and Prevention (CDC). Emergency medical services (EMS) personnel are expected to utilize standard precautions. METHODS: This was a prospective observational study of the use of standard precautions by EMS providers arriving at a large urban emergency department (ED). Research assistants (RAs) observed EMS crews throughout their arrival and delivery of patients and recorded data related to the use of gloves, hand hygiene, and equipment disinfection. RESULTS: A total of 423 EMS deliveries were observed, allowing for observation of 899 EMS providers. Only 512 (56.9%) EMS providers arrived wearing gloves. Hand washing was observed in 250 (27.8%) of providers. Reusable equipment disinfection was noted in only 31.6% of opportunities. The most commonly disinfected item was the stretcher (55%). CONCLUSION: EMS provider compliance with standard precautions and equipment disinfection recommendations is suboptimal. Strategies must be developed to improve EMS provider compliance with internationally recognized infection control guidelines. Key words: Emergency medical services, hand washing, hygiene, disinfection, disease prevention.

Stigma in AIDS nursing care in sub-saharan Africa and the Caribbean.

Some nurses who provide AIDS care, in addition to experiencing stigma themselves, also exhibit negative attitudes and perpetrate stigma and discrimination toward persons living with HIV (PLWHAs). We used a participatory research approach to explore the nature, context, and influence of stigma on the nursing care provided to PLWHAs in four low- and middle-income countries: Jamaica, Kenya, South Africa, and Uganda. Eighty-four registered nurses, enrolled nurses, and midwives participated in interviews and 79 participated in 11 focus groups. Nurses were very aware of the stigma and discrimination that AIDS evoked, and made adjustments to their care to decrease the manifestation of AIDS stigma. Despite the assurance that PLWHAs were treated equally, and that universal precautions were used consistently, we found that in reality, nurses sometimes made decisions about nursing care that were based on the appearance of the patient or knowledge of his or her status.

[Knowledge of aseptics and antisepsis and following their rules as elements of infection prevention in the work of paramedics]. / Wiedza dotyczica aseptyki i antyseptyki oraz przestrzeganie ich zasad jako elementy profilaktyki zakazen w pracy ratownika medycznego.

BACKGROUND: Tlhe health-care professionals, particularly paramedics are exposed to bloodborne infections during medical rescue operations. The aim of this study was to assess knowledge of bloodborne infections, their prevention and interrupted routes of infection transmission among paramedics. MATERIALS AND METHODS: The study comprised 220 paramedics employed in emergency departments and ambulance services. Material was collected using an anonymus questionnaire, developed for the purpose of this study. RESULTS: As many as 80% of the surveyed people reported frequent contact with patients' blood; 65% of the paramedics before establishing the intravenous access palpates the conduct of the vein; 81% introduce peripheral venous catheter directly after disinfection of the skin; and 98% apply personal protection measures. CONCLUSIONS: The analysis of knowledge of asepsis and antisepsis of bloodborne infections among paramedics points to a series of shortcomings in their adequate preparation to reduce the effects of exposure to infectious material. However, it should be emphasized that people with higher education presented a higher level of knowledge than those with postsecondary vocational education. In the opinion of the study group mandatory training in the discussed area would prove to be the most effective method for reducing the number of bloodborne infections.

[Cleaning and disinfection in nursing homes. Data on quality of structure, process and outcome in nursing homes in Frankfurt am Main, Germany, 2011]. / Flächenreinigung und -desinfektion in Altenpflegeheimen. Struktur-, Prozess- und Ergebnisqualität in Altenpflegeheimen in Frankfurt am Main, 2011.

Due to the Infectious Disease Prevention Act, public health services in Germany are obliged to check the infection prevention in hospitals and other medical facilities as well as in nursing homes. In Frankfurt/Main, Germany, standardized control visits have been performed for many years. In 2011 focus was laid on cleaning and disinfection of surfaces. All 41 nursing homes were checked according to a standardized checklist covering quality of structure (i.e. staffing, hygiene concept), quality of process (observation of the cleaning processes in the homes) and quality of output, which was monitored by checking the cleaning of fluorescent marks which had been applied some days before and should have been removed via cleaning in the following days before the final check. In more than two thirds of the homes, cleaning personnel were salaried, in one third external personnel were hired. Of the homes 85% provided service clothing and all of them offered protective clothing. All homes had established hygiene and cleaning concepts, however, in 15% of the homes concepts for the handling of Norovirus and in 30% concepts for the handling of Clostridium difficile were missing. Regarding process quality only half of the processes observed, i.e. cleaning of hand contact surfaces, such as handrails, washing areas and bins, were correct. Only 44% of the cleaning controls were correct with enormous differences between the homes (0-100%). The correlation between quality of process and quality of output was significant. There was good quality of structure in the homes but regarding quality of process and outcome there was great need for improvement. This was especially due to faults in communication and coordination between cleaning personnel and nursing personnel. Quality outcome was neither associated with the number of the places for residents nor with staffing. Thus, not only quality of structure but also quality of process and outcome should be checked by the public health services.

A quantitative assessment of facial protection systems in elective hip arthroplasty.

We aimed to assess the risk to surgeons of blood splatter during total hip arthroplasty. Hoods from personal protection systems used in 34 consecutive total hip replacements were collected and the area of blood splatter was measured and compared to goggles and visors. Thirty one primary THA's (13 cemented, 4 hybrid, 14 uncemented) and 3 revisions (1 hybrid, 2 uncemented) were collected. Splashes were detected on all of the masks with a mean of 034% cover. Splatter was greatest for the operating surgeon, followed by the first assistant, though the difference was not statistically significant. Operating personnel were at greater risk of contamination during uncemented arthroplasty (p < 0.0001; 95% CI). On average 50.60% and 45.40% of blood cover was outside the area protected by goggles and visors respectively. There was a significant difference between the Personal Protection Systems (PPS) and goggles (p = 0.0231; 95% CI) as well as between the PPS and visors (p = 0.0293; 95% CI).

Knowledge, Attitude and Practices of Health Care Workers about Corona Virus Disease 2019 in Saudi Arabia.

BACKGROUND AND OBJECTIVES: Corona Virus Disease 2019 (COVID-19) pandemic is a global health emergency. Health Care Workers (HCWs) with sound knowledge and practices can help curb the pandemic. This study aimed to assess the knowledge, attitude and practices of HCWs about COVID-19 and compare physicians and non-physicians in Saudi Arabia. METHODS: An online survey was conducted among HCWs in Saudi Arabia in March and April 2020. Data were collected using a structured questionnaire having four sections including; socio-demographic and professional profile, knowledge, attitude and practices regarding COVID-19. Questionnaire link was sent through social media. Descriptive analysis was used for assessment of knowledge, attitude and practice and Chi-square test was used for comparing physicians and non-physicians. Data were analyzed using SPSS version 21.0. RESULTS: A total of 398 HCWs completed the questionnaire. Only 45% of the participants had correct knowledge about the agent while about 97% knew that close contact with infected person is the most important risk factor. Only 63% had correct knowledge about the role of antibiotics in COVID-19 treatment. Majority of the HCWs were worried and most frequently reported worry was risk to family. Carrying infection to home was most commonly reported fear, 92%. Cleaning hands often or always was 11.5% and 87% respectively. About 71% wore mask during work. Knowledge was better among physicians compared to non-physicians while attitude and practices were comparable between the two groups. CONCLUSION: We found that there was poor knowledge about causative agent and role of antibiotics for COVID-19 but for mode of transmission and prevention there was good knowledge. There were widely prevalent worries and fears among the participants. Overall, there were good infection control practices among the HCWs. Interventions are needed to improve knowledge and address worries and fears of HCW.

Adherence to Public Health Measures Mitigates the Risk of COVID-19 Infection in Older Adults: A Community-Based Study.

OBJECTIVE: To assess the prevalence and characteristics of coronavirus disease 2019 (COVID-19) cases during the reopening period in older adults, given that little is known about the prevalence of COVID-19 after the stay-at-home order was lifted in the United States, nor the actual effects of adherence to recommended public health measures (RPHM) on the risk of COVID-19. PATIENTS AND METHODS: This was a cross-sectional study nested in a parent prospective cohort study, which followed a population-based sample of 2325 adults 50 years and older residing in southeast Minnesota to assess the incidence of viral infections. Participants were instructed to self-collect both nasal and oropharyngeal swabs, which were tested by reverse transcription polymerase chain reaction-based severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) assay between May 8, 2020, and June, 30, 2020. We assessed the prevalence of COVID-19 cases and characteristics of study subjects. RESULTS: A total of 1505 eligible subjects participated in the study whose mean age was 68 years, with 885 (59%) women, 32 (2%) racial/ethnic minorities, and 906 (60%) with high-risk conditions for influenza. The prevalence of other Coronaviridae (human coronavirus [HCoV]-229E, HCoV-NL63, and HCoV-OC43) during the 2019 to 2020 flu season was 109 (7%), and none tested positive for SARS-CoV-2. Almost all participants reported adhering to the RPHM (1,488 [99%] for social distancing, 1,438 [96%] for wearing mask in a public space, 1,476 [98%] for hand hygiene, and 1,441 (96%) for staying home mostly). Eighty-six percent of participants resided in a single-family home. CONCLUSION: We did not identify SARS-COV-2 infection in our study cohort. The combination of participants' behavior in following the RPHM and their living environment may considerably mitigate the risk of COVID-19.

Improving universal precautions and client teaching for rural health workers: a peer-group intervention.

Health workers can contribute to HIV prevention by minimizing HIV transmission in health facilities and increasing client teaching. We offered a peer-group intervention for Malawian rural health workers to build their universal precautions and teaching skills. A quasi-experimental design using independent sample surveys and observations compared health workers in an intervention and delayed intervention control district at baseline and at 15 and 30 months post-intervention. Controlling for demographic factors, the intervention district had more reported HIV teaching at 15 and 30 months and also had higher universal precautions knowledge and fewer needle stick injuries at 30 months. Observations at 15 and 30 months post-intervention showed higher levels of teaching in the intervention district. Observed glove wearing and hand washing were also higher at 30 months. This intervention should be made available for health workers in Malawi and provides a potential model for other high-HIV prevalence countries.

Occupational injury history and universal precautions awareness: a survey in Kabul hospital staff.

BACKGROUND: Health staff in Afghanistan may be at high risk of needle stick injury and occupational infection with blood borne pathogens, but we have not found any published or unpublished data. METHODS: Our aim was to measure the percentage of healthcare staff reporting sharps injuries in the preceding 12 months, and to explore what they knew about universal precautions. In five randomly selected government hospitals in Kabul a total of 950 staff participated in the study. Data were analyzed with Epi Info 3. RESULTS: Seventy three percent of staff (72.6%, 491/676) reported sharps injury in the preceding 12 months, with remarkably similar levels between hospitals and staff cadres in the 676 (71.1%) people responding. Most at risk were gynaecologist/obstetricians (96.1%) followed by surgeons (91.1%), nurses (80.2%), dentists (75.4%), midwives (62.0%), technicians (50.0%), and internist/paediatricians (47.5%). Of the injuries reported, the commonest were from hollow-bore needles (46.3%, n = 361/780), usually during recapping. Almost a quarter (27.9%) of respondents had not been vaccinated against hepatitis B. Basic knowledge about universal precautions were found insufficient across all hospitals and cadres. CONCLUSION: Occupational health policies for universal precautions need to be implemented in Afghani hospitals. Staff vaccination against hepatitis B is recommended.