Exploring Concurrent Approach for Respiratory Epidemiological Surveillance and Symptom Screening (CARES): a new strategy for preventing respiratory infection outbreaks in long-term care facilities.

OBJECTIVE: The Concurrent Approach for Respiratory Epidemiological Surveillance and Symptom Screening (CARES) combines symptom screening to prevent external respiratory infections by managing staff and visitor health and surveillance to monitor the infection rates within the facility and take timely decisions on activity programs based on outbreak prevalence. This study examines the efficacy of the CARES strategy in preventing respiratory infection outbreaks in long-term care facilities. DESIGN: Prospective cohort study utilizing historical controls including an intervention and control group. SETTING: This study was conducted in two long-term care facility wards (total: 110 beds) in Japan. PATIENTS: We enrolled patients aged 1-72 years from the target ward with severe intellectual and physical disabilities from October 1, 2018, to March 31, 2019, and from October 1, 2017, to March 31, 2018, for the intervention (n = 104) and control (n = 98) groups, respectively. The study included all admitted patients and excluded those hospitalized or discharged during the study period. INTERVENTION: The total number of days that activity programs, new admissions, and visitations were cancelled in the two groups was compared before and after the introduction of CARES. RESULTS: CARES reduced the duration of new admission cancellations and visitation cancellations by 16 and 23 days, respectively (α = 0.1, P value < 0.001). Additionally, the maximum duration of activity program cancellations was reduced by 2 days. Furthermore, five cases of presenteeism were prevented. CONCLUSIONS: CARES improves patients' quality of life by continuation of activity programs, new patient admission, and ongoing visitations.

Healthcare workers' presenteeism causing an outbreak of respiratory infections in a facility for patients with severe motor and intellectual disabilities.

BACKGROUND: This study aimed to identify the source of infection and medical costs for a respiratory infection outbreak in a facility for patients with severe motor and intellectual disabilities (SMID). Presenteeism refers to a situation wherein a person continues going to work despite being ill. METHODS: The cohort included 1 healthcare worker and 17 patients who developed a fever of ≥37.5°C with respiratory symptoms for nearly a month. An outbreak investigation was conducted, which determined the initial case of the outbreak to be a single healthcare worker. We performed a univariate analysis to determine the association of the healthcare worker. From the medical records, we evaluated the costs of addition treatment and laboratory tests for the respiratory infection. RESULTS: The source of infection was a healthcare worker at the facility (Odds ratio, 17.5; 95% confidential interval, 3.0-101.8). The total medical cost for hospitalized patients due to this outbreak was $12,324. DISCUSSION: The source of a respiratory infection outbreak in a facility for SMID was suggested to be a healthcare worker's presenteeism. CONCLUSIONS: The cause of this outbreak was healthcare workers' presenteeism. To prevent outbreaks, such facilities should address the causative factors.

Family Presence Restrictions and Telemedicine Use in Neonatal Intensive Care Units during the Coronavirus Disease Pandemic.

We aimed to describe parental presence policy and telemedicine use in Japanese neonatal intensive care units (NICUs) before and during the coronavirus disease (COVID-19) pandemic. This cross-sectional study was performed through an online survey in 110 level III units from 19 November 2020 to 18 December 2020. Nurses' evaluation of the current situation (during COVID-19) was compared with their retrospective pre-COVID-19 (December 2019) evaluation. Responses were received from 52 NICUs distributed across all regions in Japan. The median allowed parental presence time decreased from 12 h to 1 h, and 29 NICUs allowed entry of parents simultaneously during COVID-19. There was an increase in the number of units providing telemedicine through telephone and online visits during COVID-19 compared to that before COVID-19 (from 2% to 19%). The hybrid design NICUs, with 11-89% of beds in single-patient rooms, allowed a longer parental presence time in the NICUs than those with ≥90% of beds in multi-bed rooms. The number of units implementing kangaroo care decreased during COVID-19 compared to that before COVID-19. The need for telemedicine increased among Japanese NICUs to mitigate the adverse effect of parental restriction and limited physical contact due to the COVID-19 pandemic.

Maximal sterile barrier precautions independently contribute to decreased central line-associated bloodstream infection in very low birth weight infants: A prospective multicenter observational study.

BACKGROUND: The use of peripherally inserted central catheters (PICCs) in neonates differs among various institutions and countries because there are no random controlled trials or large observational studies regarding maximal sterile barrier (MSB) precautions in neonatal intensive care units. Our objective was to investigate the association of MSB implementation with central line-associated bloodstream infection (CLABSI) in very low birth weight infants. METHODS: This was a prospective multicenter observational study in Japan of infants with birth weight less than 1501 grams and in whom a PICC was placed for the first time between October 2014 and March 2017. Risk factors for CLABSI, both related and unrelated to MSB, were assessed by the mixed-effects Cox proportional hazards model, with the neonatal center variable as the random effect. RESULTS: In total, 33,713 catheter-days among 2383 infants were included. We observed 70 cases of CLABSI. MSB precautions were implemented in 13.9% of insertions and were associated with a lower CLABSI risk (adjusted hazard ratio, 0.20; 95% confidence interval, 0.05-0.84). CONCLUSIONS: We found that MSB implementation during PICC insertion in infants with birth weight less than 1501 grams independently contributed to a decrease in CLABSI risk.

An investigation of the risk factors for infection with methicillin-resistant Staphylococcus aureus among patients in a neonatal intensive care unit.

BACKGROUND: The aims of this study were to investigate the risk factors of methicillin-resistant Staphylococcus aureus (MRSA) infection among infants to establish effective infection control measures for neonatal intensive care unit (NICU). METHODS: Data were prospectively collected from 961 infants hospitalized in a teaching hospital in Japan, from July 2002 through December 2005. RESULTS: Among all infants, 28 (2.9%) developed MRSA infections. Multivariate logistic regression analyses demonstrated the risk factors for developing MRSA infections to include a low birth weight (odds ratio [OR], 0.91; 95% confidence interval [CI]: 0.93-0.99), the presence of eye mucous (OR, 6.78; 95% CI: 2.87-16.01), the practice of kangaroo mother care (OR, 3.82; 95% CI: 1.11-13.13), and the MRSA colonization rate (OR, 11.12; 95% CI: 1.32-93.89). CONCLUSION: The risk factors for developing a MRSA infection among infants in NICU were a low birth weight, the presence of eye mucous, the practice of kangaroo mother care, and a high MRSA colonization rate. Therefore, extra attention should be given to infants in high-risk groups demonstrating a low birth weight and the presence of eye mucous and who have undergone kangaroo mother care. As a result, the cohort isolation of infants with MRSA may therefore be an effective strategy to prevent MRSA infections.