An Asymptomatic Patient with COVID-19 with Hip Hemiarthroplasty Performed: A Case Report of an Orthopaedic Surgeon's Experience.

CASE: Coronavirus disease 2019 (COVID-19) is a pandemic respiratory disease. Patients typically present with fever, cough, and radiological lung changes. However, a significant proportion of these patients are asymptomatic. To date, we have limited information on the operations performed on these patients. We report our experience of a relatively asymptomatic elderly patient who underwent surgery for a hip fracture and was confirmed postoperatively to have COVID-19. CONCLUSION: Meticulous hand hygiene and use of surgical mask in daily practice is crucial to protect against asymptomatic and undiagnosed patients.

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.

Recommendations of the Spanish Society of Otolaryngology and Head and Neck Surgery for performing tracheotomies in patients infected by the coronavirus, Covid-19. / Recomendaciones de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello para la realización de traqueotomías en relación con pacientes infectados por coronavirus COVID-19.

The recent COVID-19 (coronavirus) pandemic is causing an increase in the number of patients who, due to their pulmonary ventilatory status, may require orotracheal intubation. COVID-19 infection has demonstrated a high rate of transmissibility, especially via the respiratory tract and by droplet spread. The Spanish Society of Otolaryngology and Head and Neck Surgery, based on the article by Wei et al. of 2003 regarding tracheotomies performed due to severe acute respiratory syndrome (SARS), has made a series of recommendations for the safe performance of tracheotomies.

Otolaryngology Providers Must Be Alert for Patients with Mild and Asymptomatic COVID-19.

More than half of COVID-19 patients are afebrile early in the disease course, yet mildly ill or asymptomatic patients can still spread SARS-CoV-2 with high efficiency. Atypically presenting patients may be seen in noninfectious disease settings such as otolaryngology, which is a specialty prone to occupational exposure. Otolaryngologists have been infected with COVID-19 at higher rates than other specialties in China and other countries. Otolaryngology providers should maintain high clinical suspicion for mild and asymptomatic COVID-19 patients. Protective strategies should be implemented including preappointment screening, triaging, restriction of nonurgent visits and surgeries, telemedicine, and appropriate personal protective equipment use.

Plano municipal de contingência: Coronavírus [Aparecida do Rio Negro - TO] / Municipal contingency plan: Coronavirus [Aparecida do Rio Negro - TO]

Traz recomendações e orientações para ações de combate ao Coronavírus (Covid-19) no município de Aparecida do Rio Negro no Tocantins.

It provides recommendations and guidelines for actions to combat the Coronavirus (Covid-19) in the municipality of Aparecida do Rio Negro in Tocantins.

Brinda recomendaciones y lineamientos para acciones de combate al Coronavirus (Covid-19) en el municipio de Aparecida do Rio Negro en Tocantins.

Il fournit des recommandations et des lignes directrices pour les actions de lutte contre le Coronavirus (Covid-19) dans la municipalité d'Aparecida do Rio Negro à Tocantins.

Plano de Contingência Municipal para Enfrentamento pelo Novo Coronavírus COVID-19 / Municipal Contingency Plan for Coping with the New Coronavirus COVID-19

Orienta na campanha para ações de combate ao Coronavírus (Covid-19) no município de Araguaína no Tocantins. Defini responsabilidades e prioridades na esfera municipal e local, assim como também ajuda organizar o fluxograma de resposta às emergências em saúde pública. Defini fluxos de referência para atendimento aos casos suspeitos com sintomas respiratórios leves, moderados e graves. Traz parâmetros para ajudar a detectar, identificar e notificar todos os casos suspeitos de coronavírus (COVID-19). Orienta no fluxo de vigilância epidemiológica para o diagnóstico dos casos suspeitos. Busca orientar e recomendar medidas de controle e prevenção da doença, de forma ativa, imediata e oportuna. Tenta estabelecer cuidados para redução do risco geral de contaminação pelo COVID-19 aos profissionais envolvidos nos atendimentos e protocolos relacionados. Promove ações de educação em saúde e orienta na divulgação das informações.

He guides in the campaign for actions to combat the Coronavirus (Covid-19) in the municipality of Araguaína in Tocantins. I defined responsibilities and priorities at the municipal and local level, as well as helping to organize the flowchart for responding to public health emergencies. I defined reference flows to care for suspected cases with mild, moderate and severe respiratory symptoms. It provides parameters to help detect, identify and report all suspected cases of coronavirus (COVID-19). Guides in the flow of epidemiological surveillance for the diagnosis of suspected cases. It seeks to guide and recommend disease control and prevention measures, in an active, immediate and timely manner. Attempts to establish care to reduce the general risk of contamination by COVID-19 to the professionals involved in the services and related protocols. It promotes health education actions and guides the dissemination of information.

Orienta en la campaña de acciones de combate al Coronavirus (Covid-19) en el municipio de Araguaína en Tocantins. Definí responsabilidades y prioridades a nivel municipal y local, además de ayudar a organizar el diagrama de flujo para responder a emergencias de salud pública. Definí flujos de referencia para la atención de casos sospechosos con sintomatología respiratoria leve, moderada y grave. Proporciona parámetros para ayudar a detectar, identificar y notificar todos los casos sospechosos de coronavirus (COVID-19). Guías en el flujo de vigilancia epidemiológica para el diagnóstico de casos sospechosos. Busca orientar y recomendar medidas de control y prevención de enfermedades, de manera activa, inmediata y oportuna. Intentos de establecer cuidados para reducir el riesgo general de contaminación por COVID-19 a los profesionales involucrados en los servicios y protocolos relacionados. Promueve acciones de educación para la salud y orienta la difusión de información.

Il guide dans la campagne d'actions de lutte contre le Coronavirus (Covid-19) dans la municipalité d'Araguaína à Tocantins. J'ai défini les responsabilités et les priorités aux niveaux municipal et local, ainsi que d'aider à organiser l'organigramme pour répondre aux urgences de santé publique. J'ai défini des flux de référence pour prendre en charge les cas suspects présentant des symptômes respiratoires légers, modérés et sévères. Il fournit des paramètres pour aider à détecter, identifier et signaler tous les cas suspects de coronavirus (COVID-19). Guides dans le flux de la surveillance épidémiologique pour le diagnostic des cas suspects. Il cherche à guider et à recommander des mesures de contrôle et de prévention des maladies, de manière active, immédiate et opportune. Tentative de mise en place de soins pour réduire le risque général de contamination par COVID-19 pour les professionnels impliqués dans les services et les protocoles associés. Il promeut les actions d'éducation sanitaire et guide la diffusion de l'information.

Plano municipal de contingência de Bom Jesus do Tocantins - TO ­ Novo Coronavírus (COVID-19) / Municipal contingency plan for Bom Jesus do Tocantins - TO - New Coronavirus (COVID-19)

Orienta na campanha para ações de combate ao Coronavírus (Covid-19) no município de Bom Jesus do Tocantins. Ajuda a promover a prevenção e evitar a transmissão de casos de infecção pelo COVID-19 no município e ajuda a garantir a detecção, notificação, investigação de casos suspeitos de forma oportuna. Organiza o fluxo de ações de prevenção e controle do Coronavírus. Estabelece insumos estratégicos na utilização de casos suspeitos. Traça estratégias para redução da transmissão da doença, por meio do monitoramento e controle dos pacientes já detectado. Intensificar ações de capacitação dos profissionais de saúde da rede municipal de saúde. Garante adequada assistência ao paciente, com garantia de acesso e manejo clínico adequado. Monitora e avalia a situação epidemiológica para orientar a tomada de decisão. Define as atividades de educação, mobilização social e comunicação que serão implementadas.

He guides in the campaign for actions to combat the Coronavirus (Covid-19) in the municipality of Bom Jesus do Tocantins. It helps to promote the prevention and avoid the transmission of cases of COVID-19 infection in the municipality and helps to ensure the detection, notification, investigation of suspected cases in a timely manner. Organizes the flow of Coronavirus prevention and control actions. Establishes strategic inputs in the use of suspected cases. It outlines strategies to reduce disease transmission through monitoring and control of patients already detected. Intensify training actions for health professionals in the municipal health network. Ensures adequate patient care, with guaranteed access and adequate clinical management. Monitors and evaluates the epidemiological situation to guide decision making. Defines the activities of education, social mobilization and communication that will be implemented.

Orienta en la campaña de acciones para combatir el Coronavirus (Covid-19) en el municipio de Bom Jesus do Tocantins. Ayuda a promover la prevención y evitar la transmisión de casos de infección por COVID-19 en el municipio y ayuda a asegurar la detección, notificación, investigación de casos sospechosos de manera oportuna. Organiza el flujo de acciones de prevención y control del coronavirus. Establece insumos estratégicos en el uso de casos sospechosos. Describe estrategias para reducir la transmisión de enfermedades mediante el seguimiento y control de los pacientes ya detectados. Intensificar las acciones formativas de los profesionales sanitarios de la red sanitaria municipal. Asegura una adecuada atención al paciente, con acceso garantizado y un adecuado manejo clínico. Monitorea y evalúa la situación epidemiológica para orientar la toma de decisiones. Define las actividades de educación, movilización social y comunicación que se implementarán.

Il guide dans la campagne d'actions de lutte contre le Coronavirus (Covid-19) dans la commune de Bom Jesus do Tocantins. Il aide à promouvoir la prévention et à éviter la transmission des cas d'infection au COVID-19 dans la municipalité et contribue à assurer la détection, la notification et l'enquête des cas suspects en temps opportun. Organise le flux des actions de prévention et de contrôle des coronavirus. Établit des apports stratégiques dans l'utilisation des cas suspects. Il décrit des stratégies pour réduire la transmission de la maladie par la surveillance et le contrôle des patients déjà détectés. Intensifier les actions de formation des professionnels de santé du réseau de santé municipal. Assure des soins adéquats aux patients, avec un accès garanti et une prise en charge clinique adéquate. Surveille et évalue la situation épidémiologique pour guider la prise de décision. Définit les activités d'éducation, de mobilisation sociale et de communication qui seront mises en œuvre.

Assessment of needle stick and sharp injuries among health care workers in central zone of Tigray, northern Ethiopia.

OBJECTIVE: Accidental occupational injuries to health care workers (HCWs) continue to have a significant problem in the healthcare system. Thus, the aim of this study was to assess prevalence of needle sticks and sharp injury and associated factors among health care workers working in Central Zone Tigray northern Ethiopia. RESULT: The prevalence of needle stick and sharp injury in the past 12 months preceding the study and entire job were 25.9% and 38.5% respectively. Nearly one-third (31%) of the injuries occurred in emergency unit and 122 (71.3%) of the materials caused injury were used on patients. Practice of needle recap, ever used cigarette in last 12 months, training, work hours > 40 per week, job dissatisfaction and work experience less than 5 years were found factors significantly associated with needle stick and sharp injury for health care workers. The magnitude of Needle stick and sharp injury is high in the study area. Policy makers should formulate strategies to improve the working condition for healthcare workers and increase their adherence to universal precautions.

Specific precautions: experiences of hospitalized patients / Precauciones específicas: las vivencias de pacientes internados / Precauções específicas: vivências de pacientes internados

ABSTRACT Objective: To know the perception, meanings and repercussions of specific precautions for hospitalized patients. Methods: Qualitative study with qualitative clinical methodology according to the vulnerability theoretical reference. The semi-directed interview and the Bardin content analysis were used. Results: Identification of three thematic units: (1) guidelines received, in which there was lack of information and misunderstandings about the reason for precautionary implementation; (2) perceptions about private rooms, there with both positive and negative perceptions; and (3) stigma related to the isolation condition, given patients felt constraint for being in a unit of infectious diseases and fear of being separated from the others. Final considerations: Situations of vulnerability were evidenced, both related to hospitalization and feelings aroused. The study can contribute to health services by broadening their vision beyond infection control.

RESUMEN Objetivo: Conocer la percepción, los significados y repercusiones de la precaución específica para el paciente internado. Métodos: Estudio cualitativo con metodología clínica cualitativa bajo referencial teórico de vulnerabilidad. Se utilizó la entrevista semidirigida y el análisis de contenido de Bardin. Resultados: Se identificaron tres unidades temáticas: (1) directrices recibidas, en que se observó la información insuficiente y los conceptos erróneos acerca del por qué la aplicación de precaución; (2) percepciones sobre el cuarto privado, fueron verificadas tanto percepciones positivas, como negativas; y (3) estigma relacionado a la condición de aislamiento, en la cual se identificó constreñimiento por estar en una unidad de enfermedades infecciosas y miedo por estar separados de los demás. Consideraciones finales: Las situaciones de vulnerabilidad fueron evidenciadas, relacionadas tanto a la internación ofrecida, en cuanto a los sentimientos despertados. El estudio puede contribuir con los servicios de salud, ampliando su visión más allá del control de infecciones.

RESUMO Objetivo: Conhecer a percepção, significados e repercussões da precaução específica para o paciente internado. Métodos: Estudo qualitativo com metodologia clínica qualitativa sob referencial teórico de vulnerabilidade. Utilizou-se a entrevista semidirigida e análise de conteúdo de Bardin. Resultados: Identificaram-se três unidades temáticas: (1) orientações recebidas, em que se observou insuficiência de informações e equívocos sobre o motivo da implementação da precaução; (2) percepções sobre o quarto privativo, verificou-se tanto percepções positivas, quanto negativas; e (3) estigma relacionado à condição de isolamento, na qual identificou-se constrangimento por estar em uma unidade de doenças infecciosas e medo por estarem separados dos demais. Considerações finais: Situações de vulnerabilidades foram evidenciadas, tanto relacionadas à internação ofertada, quanto aos sentimentos despertados. O estudo pode contribuir com os serviços de saúde, ampliando sua visão para além do controle de infecções.

Intelligent Network DisRuption Analysis (INDRA): A targeted strategy for efficient interruption of hepatitis C transmissions.

Hepatitis C virus (HCV) infection is a global public health problem. The implementation of public health interventions (PHI) to control HCV infection could effectively interrupt HCV transmission. PHI targeting high-risk populations, e.g., people who inject drugs (PWID), are most efficient but there is a lack of tools for prioritizing individuals within a high-risk community. Here, we present Intelligent Network DisRuption Analysis (INDRA), a targeted strategy for efficient interruption of hepatitis C transmissions.Using a large HCV transmission network among PWID in Indiana as an example, we compare effectiveness of random and targeted strategies in reducing the rate of HCV transmission in two settings: (1) long-established and (2) rapidly spreading infections (outbreak). Identification of high centrality for the network nodes co-infected with HIV or > 1 HCV subtype indicates that the network structure properly represents the underlying contacts among PWID relevant to the transmission of these infections. Changes in the network's global efficiency (GE) were used as a measure of the PHI effects. In setting 1, simulation experiments showed that a 50% GE reduction can be achieved by removing 11.2 times less nodes using targeted vs random strategies. A greater effect of targeted strategies on GE was consistently observed when networks were simulated: (1) with a varying degree of errors in node sampling and link assignment, and (2) at different levels of transmission reduction at affected nodes. In simulations considering a 10% removal of infected nodes, targeted strategies were ~2.8 times more effective than random in reducing incidence. Peer-education intervention (PEI) was modeled as a probabilistic distribution of actionable knowledge of safe injection practices from the affected node to adjacent nodes in the network. Addition of PEI to the models resulted in a 2-3 times greater reduction in incidence than from direct PHI alone. In setting 2, however, random direct PHI were ~3.2 times more effective in reducing incidence at the simulated conditions. Nevertheless, addition of PEI resulted in a ~1.7-fold greater efficiency of targeted PHI. In conclusion, targeted PHI facilitated by INDRA outperforms random strategies in decreasing circulation of long-established infections. Network-based PEI may amplify effects of PHI on incidence reduction in both settings.

Efectividad de Guía de Buenas Prácticas en la bioseguridad hospitalaria / Effectiveness of Guide of Good Practical in the hospital bioseguridad

Introducción: la bioseguridad, componente vital del sistema de garantía de la calidad, está encaminada a lograr actitudes y conductas que disminuyan el riesgo del trabajador de adquirir infecciones en el medio laboral. Objetivo: evaluar la efectividad de una guía de buenas prácticas en el manejo de la bioseguridad hospitalaria. Métodos: estudio experimental de intervención con antes y después, en unidades de mayor riesgo biológico del hospital "Mártires del 9 de abril" de Sagua la Grande, Villa Clara, durante 2015. El universo fue de 56 profesionales de enfermería, a los que se aplicó una encuesta y se les realizó una observación participante. Se recogió además el criterio de especialistas de grupos nominales. La intervención consistió en la implementación de una guía de buenas prácticas en el manejo de la bioseguridad. Resultados: consideraron tener insuficientes conocimientos sobre la bioseguridad, el 57,14 por ciento adquirió los conocimientos por cursos de capacitación, el 94,65 por ciento reflejó la necesidad de la guía. Los aspectos evaluados antes de aplicada la guía no alcanzaron más que el 46,42 por ciento, logrando después más del 80,35 por ciento. La evaluación de la guía resultó ser de 94,65 por ciento. Conclusiones: la guía de buenas prácticas en el manejo de la bioseguridad hospitalaria aplicada resultó efectiva en el mejoramiento del nivel de conocimientos de los profesionales de enfermería que trabajaban en las unidades de mayor riesgo biológico(AU)

Introduction: Biosecurity, vital system component quality assurance, is aimed at achieving attitudes and behaviors that reduce the risk of getting infections worker in the workplace. Objective: To evaluate the effectiveness of a guide of good practices in the management of hospital biosecurity. Methods: An experimental intervention study was conducted before and after in units of biological risk of Martyrs Hospital April 9, Sagua la Grande, Villa Clara, in 2015. The universe was 56 nurses, who a survey was applied and was made to a participant observation. the criterion of specialists Nominal groups were also collected. The intervention consisted of the implementation of a code of good practices in the management of biosafety. Results: They considered to have insufficient knowledge about biosecurity, 57.14 percent acquired knowledge by training courses, the 94.65 percent reflected the need for the guide. The aspects evaluated before applied the guide did not reach more than 46.42 percent, achieved after more than 80.35 percent. The evaluation guide of 94.65 percent was found to be. Conclusions: good practice guide in the management of hospital biosecurity applied was effective in improving the level of knowledge of nurses working in units greater biological risk(AU)

Universal contact precautions do not change the prevalence of antibiotic resistant organisms in a tertiary burn unit.

OBJECTIVE: The prevalence of antibiotic-resistant organisms (ARO) in burn units is increasing worldwide and contributes significantly to morbidity and mortality. Study aims are to describe the burden of AROs in burn patients admitted to a tertiary burn unit, to evaluate the impact of contact precautions implemented after an outbreak of antibiotic-resistant Acinetobacter baumannii, and to identify possible predictors of ARO acquisition. METHODS: Data of burn inpatients between 2006 and 2010 were retrospectively reviewed. The antibiotic susceptibility profiles of ARO colonization/infection at or after admission were reviewed in detail. Organisms of interest included: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), extended-spectrum beta-lactamase-producing Escherichia coli, and carbapenem-resistant Pseudomonas and Acinetobacter. Univariate and multivariate logistic regression analysis was employed with the p-value set at 0.05. RESULTS: Complete data analysis was available for 340 patients. The mean age was 41.8 years with male predominance. Among the AROs, the most prevalent was MRSA from clinical specimens. Prior to contact precaution implementation, the prevalence of all AROs was 27.9%, compared to 27.6% afterwards. There was an increase in Pseudomonas and VRE isolates and a disappearance of Acinetobacter. The most common isolate sites were the burn wounds. ICU stay, burns >20% TBSA, and surgical management were significant predictors of ARO acquisition. CONCLUSION: This study describes the ARO profile of burn patients admitted to a tertiary burn unit. The results suggest that implementation of unit-wide contact precautions may not significantly reduce the frequency of AROs among burn patients. Contact precautions for patients transferred from the ICU, undergoing surgery, and large burns may be of benefit.

Improving the Effectiveness of Medication Review: Guidance from the Health Literacy Universal Precautions Toolkit.

BACKGROUND: Although routine medication reviews in primary care practice are recommended to identify drug therapy problems, it is often difficult to get patients to bring all their medications to office visits. The objective of this study was to determine whether the medication review tool in the Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit can help to improve medication reviews in primary care practices. METHODS: The toolkit's "Brown Bag Medication Review" was implemented in a rural private practice in Missouri and an urban teaching practice in California. Practices recorded outcomes of medication reviews with 45 patients before toolkit implementation and then changed their medication review processes based on guidance in the toolkit. Six months later we conducted interviews with practice staff to identify changes made as a result of implementing the tool, and practices recorded outcomes of medication reviews with 41 additional patients. Data analyses compared differences in whether all medications were brought to visits, the number of medications reviewed, drug therapy problems identified, and changes in medication regimens before and after implementation. RESULTS: Interviews revealed that practices made the changes recommended in the toolkit to encourage patients to bring medications to office visits. Evaluation before and after implementation revealed a 3-fold increase in the percentage of patients who brought all their prescription medications and a 6-fold increase in the number of prescription medications brought to office visits. The percentage of reviews in which drug therapy problems were identified doubled, as did the percentage of medication regimens revised. CONCLUSIONS: Use of the Health Literacy Universal Precautions Toolkit can help to identify drug therapy problems.

Universal screening versus universal precautions in the context of preoperative screening for HIV, HBV, HCV in India.

In the Indian context, there is a convention of doing pre-operative screening for HIV, hepatitis B virus and hepatitis C viruses for all patients as a routine pre-intervention investigation. This approach is justified in some instances in the best interest of the patient. However, as routine screening is not the standard care internationally and as there is a significant divergence of views about the merits and demerits of this practice, this issue needs to be debated in a rational manner with an evidence-based approach. The present article is authored by a surgeon and a microbiologist from a new cancer care centre in eastern India, who has attempted to address this contentious issue. The various available options have been explored, and advantages and disadvantages of the different approach have been discussed. An algorithm for infection prevention and control has been presented so that surgeons and medical microbiologists could manage infection control challenges satisfactorily.

The treatment of maxillofacial trauma in austere conditions.

Caring for severely injured patients, whether they be in the theater of combat or after natural disasters, can be a rewarding and even life-changing experience for all involved. Sound surgical principles and an attempt to achieve a high standard of care should still guide the treating surgeon. The surgical team undoubtedly face numerous obstacles, but with careful and considerate planning, many of these can be minimized.

Prevalence of methicillin-resistant Staphylococcus aureus colonization and infection in hospitalized palliative care patients with cancer.

Little is known about the pattern of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in hospitalized palliative care (PC) patients. We reviewed 854 admissions for 289 patients with advanced cancer managed by a PC service in a tertiary care hospital. The MRSA screening was performed at least once in 228 (79%) patients, and 21 (9%) of them were MRSA positive. Other cultures were done in 251 (86.8%) patients, and 8 (3%) patients were MRSA positive. The total number of MRSA-positive admissions was 28 (3%), with a median admission duration of 8 days. A substantial proportion of hospitalized PC patients with cancer are MRSA positive. Research is required to study the impact of infection control measures on the quality of PC delivered to MRSA-positive terminally ill patients in hospitals.