Air and Environmental Contamination Caused by COVID-19 Patients: a MultiCenter Study

Background@#The purpose of this study was to determine the extent of air and surface contamination of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in four health care facilities with hospitalized coronavirus disease 2019 (COVID-19) patients. @*Methods@#We investigated air and environmental contamination in the rooms of eight COVID-19 patients in four hospitals. Some patients were in negative-pressure rooms, and others were not. None had undergone aerosol-generating procedures. On days 0, 3, 5, and 7 of hospitalization, the surfaces in the rooms and anterooms were swabbed, and air samples were collected 2 m from the patient and from the anterooms. @*Results@#All 52 air samples were negative for SARS-CoV-2 RNA. Widespread surface contamination of SARS-CoV-2 RNA was observed. In total, 89 of 320 (27%) environmental surface samples were positive for SARS-CoV-2 RNA. Surface contamination of SARSCoV-2 RNA was common in rooms without surface disinfection and in rooms sprayed with disinfectant twice a day. However, SARS-CoV-2 RNA was not detected in a room cleaned with disinfectant wipes on a regular basis. @*Conclusion@#Our data suggest that remote (> 2 m) airborne transmission of SARS-CoV-2 from hospitalized COVID-19 patients is uncommon when aerosol-generating procedures have not been performed. Surface contamination was widespread, except in a room routinely cleaned with disinfectant wipes.

Factors Influencing Quality of Nursing Service among Clinical Nurses: Focused on Resilience and Nursing Organizational Culture / 임상간호연구

PURPOSE: The purpose of this study was to examine nursing organizational culture and resilience and their effects on quality of nursing service. METHODS: A cross-sectional study was conducted. A convenience sampling method was used to collect data from 199 participants who worked in a tertiary hospital in G city. Demographic and work related variables, quality of nursing service, resilience, and nursing organizational culture were measured using validated self-report questionnaires. RESULTS: All of the participants were women and the majority were staff nurses and single. A statistically significant difference in quality of nursing service was found for age, marital status, educational level, clinical career, position and perceived health status. Age, educational level, clinical career, position, resilience, innovation-oriented culture, relation-oriented culture, and hierarchy-oriented culture were significant predictors of quality of nursing service, explaining 47% of total variance. Among the predictors, resilience was the strongest predictor, followed by innovation-oriented culture, and hierarchy-oriented culture. CONCLUSION: Findings indicate that quality of nursing service can be improved by raising individual nurse's resilience and advancing nursing organizational culture. Considering the identified factors, researchers and administrators need to develop and provide clinical nurses with a variety of programs to improve the quality of their nursing service.

Was 2009 Pandemic Influenza A (H1N1) Mild Among Pregnant Korean Women? / 전남의대학술지

Clinical and laboratory data from Western countries suggest that pregnant women are at an increased risk for severe illness and complications associated with 2009 pandemic influenza A (H1N1). However, previous data among Korean women suggested a less severe outcome. In this study performed at a single referral center in Korea, rates of admission, pneumonia, intensive care unit admission, and death related to 2009 pandemic influenza A (H1N1) were significantly higher in 33 pregnant women than in 723 nonpregnant women of reproductive age (p<0.05 each). We report two cases of 2009 pandemic influenza A (H1N1) in pregnant Korean women who were admitted to the intensive care unit because of severe pneumonia that led to maternal and fetal death in one of the patients. This case series suggests that pregnant Korean women were also at increased risk of severe illness and complications during the 2009 pandemic influenza A (H1N1) outbreak.

Was 2009 Pandemic Influenza A (H1N1) Mild Among Pregnant Korean Women? / 전남의대학술지

Clinical and laboratory data from Western countries suggest that pregnant women are at an increased risk for severe illness and complications associated with 2009 pandemic influenza A (H1N1). However, previous data among Korean women suggested a less severe outcome. In this study performed at a single referral center in Korea, rates of admission, pneumonia, intensive care unit admission, and death related to 2009 pandemic influenza A (H1N1) were significantly higher in 33 pregnant women than in 723 nonpregnant women of reproductive age (p<0.05 each). We report two cases of 2009 pandemic influenza A (H1N1) in pregnant Korean women who were admitted to the intensive care unit because of severe pneumonia that led to maternal and fetal death in one of the patients. This case series suggests that pregnant Korean women were also at increased risk of severe illness and complications during the 2009 pandemic influenza A (H1N1) outbreak.

Clinical characteristics of Korean acute myocardial infarction patients who are younger than 40 years old / 대한내과학회지

BACKGROUND/AIMS: It is known that mortality increases with age for patients who suffer with acute myocardial infarction (AMI). Yet there isn't much data on the clinical characteristics and long-term prognosis of young patients with AMI. METHODS: We analyzed two groups of patients with AMI who underwent coronary angiogram : 108 patients younger than 40 years as group I and 64 patients over 70 years old as group II. We compared the baseline clinical characteristics, the echocardiographic and coronary angiographic findings, and the major adverse cardiac event (MACE). RESULTS: Male gender (94.4% vs. 56.1%, respectively, p<0.001), smoking (78.7% vs. 46.9%, respectively, p<0.001) and hyperlipidemia (45.4% vs. 14.1%, respectively, p<0.001) were more frequent in group I, whereas hypertension (23.1% vs. 40.6%, respectively, p=0.015) and diabetes (11.6% vs. 34.4%, respectively, p<0.001) were more common in group II. The left ventricular ejection fraction (55.1+/-12.2% vs. 50.5+/-14.1%, respectively, p=0.042) was higher in group I. The serum levels of high sensitivity C-reactive protein (1.7+/-2.6 vs. 3.4+/-4.4 mg/L, respectively, p=0.015) and homocysteine (11.5+/-7.0 vs. 15.3+/-9.7 microgram/L, respectively, p=0.029) were higher in group II. One vessel disease (78.7% vs. 59.4%, respectively, p=0.007) and good Thrombolysis In Myocardial Infarction (TIMI) flow (TIMI II-III, 58.3% vs. 41.2%, respectively, p=0.040) were more common in group 1. There were no differences between the two groups for the development of MACE during the 28+/-21 months of clinical follow-up, but cardiac death was lower in group I than in group II (2.1% vs. 15.4%, respectively, p=0.002). CONCLUSIONS: Male gender, smoking and hyperlipidemia were the major risk factors of Korean young AMI patients. In addition, single vessel disease and good TIMI flow were more frequent and cardiac death was less frequent in the younger AMI patients.

Predictive Factors after Percutaneous Coronary Intervention in Young Patients with Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: Acute myocardial infarction (AMI) at a young age less than 40 years is an uncommon condition and it is characterized by multiple cardiovascular risk factors. We analyzed the risk factors of restenosis in AMI patients who underwent percutaneous coronary intervention (PCI), and these patients were under the age of 40 years. SUBJECTS AND METHODS: Between January 1997 and December 2006, 88 out of the 121 young AMI patients (mean age: 35.6+/-4.0 years, 115 males) who underwent follow-up coronary angiography after PCI were divided into two groups: the patients without restenosis (group I: n=62, mean age: 35.6+/-3.9 years, 60 males) and the patients with restenosis (group II: n=26, mean age: 36.3+/-3.8 years, 23 males). The clinical and coronary angiographic characteristics were compared between the two groups. RESULTS: Smoking (79.3%) was the most common risk factor in all the patients. The baseline clinical characteristics and baseline laboratory findings were not different between the two groups. There was no significant difference in the sex ratio (p=0.124). The Thrombolysis In Myocardial Infarction (TIMI) flows were not different between the two groups. The level of homocysteine (hcy) was significantly decreased from 12.4+/-8.8 micronmol/L to 9.3+/-3.8 micronmol/L in group I (p=0.011), but this was not changed significantly in group II (p=0.062). According to multiple logistic regression analysis, a high triglyceride level (>200 mg/dL) was an independent predictor of restenosis (p=0.046). CONCLUSION: A high level of serum triglyceride is a predictive factor of restenosis after PCI in young age patients with acute myocardial infarction.

The Effect of Supportive Nursing Care on the Knowledge Level and Compliance of Sick-Role Behavior in Patients with Coronary Artery Disease after Coronary Angiography / 성인간호학회지

PURPOSE: The purpose of this study was to determine the effect of supportive nursing care on the level of knowledge and compliance with sick-role behavior in patients with coronary artery disease after coronary angiography(CAG). METHODS: A quasi-experimental research was performed with 81 subjects with coronary artery disease who were admitted for CAG to a cardiovascular department. Among the selected subjects, 40 of them were assigned to experimental group and the rest of them were assigned to control group by convenience. Supportive nursing care was implemented twice by a researcher. RESULTS: 1. The mean score of knowledge related to coronary artery disease was higher in the group who received supportive nursing care than that of the control group(t=2.259, p=.027). 2. The mean score of compliance of sick role behavior was higher in the group who received supportive nursing care than that of the control group(t=4.580, p=.001). CONCLUSION: The supportive nursing care after CAG was effective in increasing the knowledge level and compliance of sick-role behavior in patients with coronary artery disease. Further studies would be recommended to identify long-term effectiveness of supportive care on patients' outcomes.

The Clinical Experience of Recannulation of Femoral Artery Following Initial Angioseal(r) Use after Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: The impact for recannulation of an artery, where a vascular closure device had been used following percutaneous coronary intervention (PCI), has not been evaluated. The aim of this study was to determine the feasibility and safety of recannulation of the femoral artery following the use of an Angioseal(r) following PCI. SUBJECTS AND METHODS: Between February 2002 and June 2004, 110 patients (Group I: 60.0+/-9.0 years, 84 male), who underwent a 6-month follow-up coronary angiography (CAG) following PCI and the use of an Angioseal(r) closure device, were compared with a further 110 randomly assigned patients (Group II: 61.4+/-9.2 years, 78 male), who received manual compression for femoral artery hemostasis following PCI during the same period. The occurrence of femoral puncture site complications, the time to active ambulation following PCI and procedural difficulties for recannulation during the follow-up CAG were analyzed. RESULTS: The baseline clinical characteristics and procedure related factors were similar between the two groups. No major complications were noted in either group. There were no differences in the incidence of minor complications, including puncture site oozing or hematoma, between the two groups. The time to active ambulation was significantly shorter in group I than II (7.2+/-2.7 vs. 17.3+/-4.2 hours, p=0.001). At the 6-month follow-up CAG, no major complications associated with re-puncture at the same site of the femoral artery were noted, and there were no differences in the incidence of minor complications between the two groups. CONCLUSION: An Angioseal(r) was a convenient method of hemostasis, which promoted early ambulation without difficulties in the reuse of the femoral artery.

Knowledge and Performance of Infection Control Guidelines / 병원감염관리

BACKGROUND: This study was purposed to identify the knowledge and performance level of the infection control guidelines and to improve their performance level of infection control for those nurses who care patients directly. METHODS: This study was based on the survey questionnaires about infection control guidelines with the total 626 nurses in Seoul and Kyunggi areas for the period between May 26, 2003 and July 14, 2003. RESULTS: The average knowledge level of infection control was 0.84 +/-0.07 (score range 0-1) and the average performance level of the infection control was 4.44+/-10.27 (score range 0-5). The correlation between knowledge and performance of the infection control showed positive correlation (r=.39; P<.001). The knowledge and performance level of the 'Prevention of the central catheter infection' were higher than other infection control guidelines. The performance levels of the 'Prevention of the surgical site infection' were lower than other infection control guidelines. The correlation between knowledge and performance of the 'Prevention of the nosocomial pneumonia' (r=.389; P<.001). 'Prevention of the urinary tract infection' (r=.325; P<.001), 'Prevention of the central catheter infection (r=.290; P<.001) and 'Intravascular infection control' (r=.446; P<.001) showed positive correlation. CONCLUSION: The study demonstrated that the nurses' knowledge and performance of infection control guidelines showed positive correlation. So the education on the infection control is required indispensably and it would contribute to reduce the hospital infection rate by performing the right treatment on the infection control with the basis of accurate knowledge.

Diagnostic Efficacy of Anorectal Manometry for the Diagnosis of Hirschsprung's Disease / 대한소아소화기영양학회지

PURPOSE: As diagnostic tools for Hirschsprung's disease (HD), barium enema and rectal biopsy have radiation exposure and invasiveness respectively; however anorectal manometry does not have these disadvantages. We therefore performed this study to evaluate the diagnostic efficacy of anorectal manometry. METHODS: We reviewed medical records of infants with one or two symptoms of vomiting, abdominal distension, chronic diarrhea or constipation who had a anorectal manometry followed by barium enema and/or biopsy from July 1995 to May 2002. We evaluated the sensitivity, specificity and predictive value of anorectal manometry and barium enema for diagnosis of HD. We also measured sphincter length, median value of balloon volume at which rectoanal inhibitory reflex (RAIR) occurred. RESULTS: All 61 patients received anorectal manometry, 33 of 61 received barium enema. 18 of 61 were diagnosed as HD according to histology and 43 of 61 were evaluated as a control. The sensitivity, specificity, positive predictive value, negative predictive value of anorectal manometry and barium enema for diagnosis of HD were 1.00, 0.91, 0.82, 1.00 and 0.93, 0.67, 0.70, 0.92 respectively. The mean value of sphincter length in control was 1.68+/-0.67 cm and correlated with age, weight and significantly longitudinal length. The median value of balloon volume at which RAIR occurred was 10 mL and did not correlated with age, weight and longitudinal length. CONCLUSION: This study suggests that anorectal manometry is an excellent initial screening test for Hirschsprung's disease because of its safety and accuracy.

A Case of Chronic Active Epstein-Barr Virus Infection with Coronary Aneurysm

Chronic active Epstein-Barr virus infection(CAEBV) is a nonfamilial syndrome that shows a specific immunodeficiency for the Epstein-Barr virus(EBV). CAEBV is characterized by fever, lymphadenopathy, splenomegaly, hepatitis, interstitial pneumonitis, interstitial nephritis, and uveitis. Cardiovascular complications are rare in EBV infection. Patients with CAEBV show characteristically high titers of anti-viral capsid antigen(VCA) IgG antibody and anti-early antigen(EA) antibody, as well as relatively low titer of anti-EB nuclear antigen(EBNA) antibody. We experienced a case of CAEBV with giant coronary aneurysms, who was a 6-year-old boy. He had 5 episodes of high fever and cervical lymphadenopathy and hepatosplenomegaly. The 6 mm sized bilateral coronary aneurysms were detected by echocardiography at second admission. IgG antibodies to EBV was positive, whereas negative for IgM antibody. Antibodies to EA and EBNA were also positive. The EBV was detected in lymph node tissue by in situ hybridization, and in the peripheral blood and bone marrow by the PCR. Treatment has been done with ganciclovir and interferon (IFN)-alpa for 5 weeks. The EBV-PCR of peripheral blood was converted to negative from 12th day of treatment. At present he has followed well for two years without fever and enlargements of lymphnode, except large coronary aneurysm.

A Case of Diffuse Aspiration Bronchiolitis in a Dysphagic Infant

Diffuse aspiration bronchiolitis is defined as a clinical entity characterized by a chronic inflammation of bronchioles caused by recurrent aspiration of foreign particles. Clinical symptoms are bronchorrhea, bronchospasm, and dyspnea, and chest radiographs show the presence of regional or disseminated srnall nodular shadows and hyperlucency. Chest CT should help in detecting diffuse nodular shadows of bronchiolitis. Pathologic findings of diffuse aspiration bronchiolitis are characterized by localization of chronic mural inflammation with foreign body reaction in bronchioles. Recurrence of small amounts of aspiration might play an important role in the pathogenesis of diffuse aspiration bronchiolitis. We report a case of diffuse aspiration bronchiolitis in a 4-month- old female infant who had recurrent aspiration due to dysphagia and presented with recurrent fever, dyspnea and wheezing. She showed typical radiologic and histologic findings compatible to diffuse aspiration bronchiolitis. She was improved with treatment of nasogastric tube feeding. We emphasize the importance of recognizing this disease entity and differentiating it from pulmonary diseases associated with bronchospasm. (J Korean Pediatr Soc 2000;43:842-845)

A Case of Bronchial Obstruction due to Right Aortic Arch and Kommerell's Diverticulum / 소아알레르기및호흡기학회지

College of Medicine, Ulsan University, Seoul, Korea The vascular rings comprise less than 1% of congenital cardiovascular malformations and can be overlooked because they are rare diseases and show nonspecific respiratory symptoms such as wheezing or airway obstruction or apnea. This case is a 2-months old infant who had been repaired patch closure due to ventricular septal defect, but failed to wean from ventilator. Chest CT showed right main stem bronchus lying between right pulmonary arery and right descending aorta, bronchoscopy showed right main bronchus was compressed by extrinsic pulsating mass which were descending aorta and Kommerell's diverticulum . After aortopexy and transfer of subclavian artery, this patient was able to be extubated and is now free of respiratory symptoms. When there is failure to weaning of ventilator and persistent bronchial obstruction and emphysema, we should have more vigorous effort to seek the cause of bronchial obstruction, using bronchoscope and chest CT.