ABSTRACT
Pseudomonas aeruginosa is a Gram-negative bacterial pathogen that is a common cause of nosocomial infections, particularly pneumonia, infection in immunocompromised hosts, and in those with structural lung disease such as cystic fibrosis. Epidemiological studies have identified increasing trends of antimicrobial resistance, including multi-drug resistant (MDR) isolates in recent years. P. aeruginosa has several virulence mechanisms that increase its ability to cause severe infections, such as secreted toxins, quorum sensing and biofilm formation. Management of P. aeruginosa infections focuses on prevention when possible, obtaining cultures, and prompt initiation of antimicrobial therapy, occasionally with combination therapy depending on the clinical scenario to ensure activity against P. aeruginosa. Newer anti-pseudomonal antibiotics are available and are increasingly being used in the management of MDR P. aeruginosa.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Drug Resistance, Multiple, Bacterial/physiology , Pseudomonas Infections/drug therapy , Pseudomonas Infections/epidemiology , Biofilms/drug effects , Bronchiectasis/epidemiology , Cross Infection/drug therapy , Cross Infection/epidemiology , Cystic Fibrosis/epidemiology , Humans , Immunocompromised Host , Infection Control/organization & administration , Microbial Sensitivity Tests , Pseudomonas Infections/prevention & control , Pseudomonas aeruginosa , Quorum Sensing/drug effectsABSTRACT
WHAT IS KNOWN AND OBJECTIVE: The purpose of this study was to investigate the effect of imposing infection control programmes (ICPs) and antimicrobial stewardship (AMS) by monitoring the antimicrobial resistance of Pseudomonas aeruginosa. METHODS: Antimicrobial susceptibility testing was performed in accordance with the Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing guidelines. ICPs and AMS were initiated at the Fourth Hospital from 2013 to 2018. RESULTS AND DISCUSSION: A total of 2,886 P. aeruginosa isolates were assessed. The antimicrobial resistance trends of the P. aeruginosa strains improved after the intervention measures. Multidrug-resistant (MDR) and extensively drug-resistant (XDR) P. aeruginosa contributed to 18.5% and 3.5% of the total P. aeruginosa strains, respectively. Colistin was the most effective antibiotic against 97.6% of XDR-P. aeruginosa and 99.41% of MDR-P. aeruginosa. The consumption of alcohol-based hand gel (ABHG) increased from 0.6 L to 10.8 L per 1,000 patient-days (PD) (p = 0.005). The yearly consumption of antibiotics decreased from 45 to 37.5 defined daily doses (DDD) per 1,000 PD(p = 0.04). After 2013, the incidence rate of MDR-P. aeruginosa showed a significant decrease from 22% to 14.1% (p = 0.04), and XDR-P. aeruginosa decreased from 5.8% to 0.9%. The use of ABHG was negatively related to MDR-P. aeruginosa morbidity (r = -0.86; p = 0.021). The consumption of antibiotics was positively related to MDR-P. aeruginosa morbidity (r = 0.86; p = 0.021). WHAT IS NEW AND CONCLUSION: Successful control of MDR-P. aeruginosa resistance was achieved by imposing comprehensive ICPs and AMS.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Antimicrobial Stewardship/organization & administration , Hospitals, University/organization & administration , Infection Control/organization & administration , Pseudomonas Infections/epidemiology , Pseudomonas aeruginosa/isolation & purification , Anti-Bacterial Agents/administration & dosage , China , Drug Resistance, Multiple, Bacterial , Hand Sanitizers/administration & dosage , Humans , Microbial Sensitivity Tests , Pseudomonas Infections/prevention & controlABSTRACT
BACKGROUND: On March 11, 2020, the World Health Organization (WHO) declared Coronavirus Disease (COVID-19) a pandemic. Hospitals around the world began to implement infection prevention and control (IPC) measures to stop further spread and prevent infections within their facilities. Healthcare organizations were challenged to develop response plans, procure personal protective equipment (PPE) that was in limited supply while continuing to provide quality, safe care. METHODS: As a comprehensive cancer center with immunocompromised patients, our efforts began immediately. Preventative measures were established and, as of September 2020, over 14,000 patients have been tested within the facility. From March 2020 through September 2020, only one case of hospital acquired (HA) COVID-19 was identified among our patients. Two cases of suspected community acquired (SCA) cases were also identified. Following the Centers for Disease Control (CDC) guidance, IPC measures were implemented within the facility as information science about the virus developed. This article addresses the IPC measures taken, such as enhancing isolation precautions, implementing screening protocols, disinfecting and reusing N95 respirators, by the center throughout the pandemic as well as the challenges that arouse with a new and emerging infectious disease. CONCLUSIONS: The infection control measures implemented at our comprehensive cancer center during the COVID-19 pandemic allowed our center to continue to provide world class cancer care with minimal COVID-19 infection transmission among patients and team members.
Subject(s)
COVID-19/prevention & control , Cancer Care Facilities , Disease Transmission, Infectious/prevention & control , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , Disease Transmission, Infectious/statistics & numerical data , Humans , Incidence , Infection Control/methods , Infection Control/organization & administration , Infection Control/standards , Medical Oncology , SARS-CoV-2/isolation & purificationABSTRACT
BACKGROUND AND OBJECTIVES: During the worldwide pandemic of coronavirus disease 2019 (COVID-19), oncological procedures considered to be urgent could not be delayed, and a specific procedure was required to continue surgical activity. The objective was to assess the efficacy of our preoperative screening algorithm. METHODS: This observational retrospective study was performed between the 25th of March and the 12th of May 2020 in a comprehensive cancer center in France. Patients undergoing elective oncologic surgery were tested by preoperative nasopharyngeal reverse-transcription polymerase chain reaction (RT-PCR) that could be associated with a chest computerized tomography (CT) scan. RESULTS: Of the 510 screening tests (in 477 patients), only 5% (15/477) were positive for COVID-19 in 24 patients (18 RT-PCR+ and 7 CT scan+/RT-PCR-). Four patients were ultimately false positives based on the CT scan. In total, only 4.2% (20/477) of the patients were COVID-19+. The positivity rate decreased with time after the containment measures were implemented (from 7.4% to 0.8%). In the COVID-19+ group, 20% of the patients had postoperative pulmonary complications, whereas this was the case for 5% of the patients in the COVID-19 group. CONCLUSIONS: Maintaining secure surgical activity is achievable and paramount in oncology care, even during the COVID-19 pandemic, with appropriate screening based on preoperative RT-PCR.
Subject(s)
COVID-19 Nucleic Acid Testing , COVID-19/diagnosis , Infection Control/organization & administration , Neoplasms/surgery , Postoperative Complications/epidemiology , Reverse Transcriptase Polymerase Chain Reaction , Adult , Aged , Aged, 80 and over , Algorithms , Cancer Care Facilities , Female , France , Humans , Incidence , Male , Middle Aged , Neoplasms/complications , Neoplasms/pathology , Predictive Value of Tests , Preoperative Care , Reproducibility of Results , Retrospective Studies , Tomography, X-Ray Computed , Young AdultABSTRACT
PURPOSE: We present the strategy of a comprehensive cancer center organized to make operations pandemic proof and achieve continuity of cancer care during the COVID-19 pandemic. METHODS: Disease Outbreak Response (DORS) measures implemented at our center and its satellite clinics included strict infection prevention, manpower preservation, prudent resource allocation, and adaptation of standard-of-care treatments. Critical day-to-day clinical operations, number of persons screened before entry, staff temperature monitoring, and personal protection equipment stockpile were reviewed as a dashboard at daily DORS taskforce huddles. Polymerase chain reaction swab tests performed for patients and staff who met defined criteria for testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were tracked. Descriptive statistics of outpatient attendances and treatment caseloads from February 3 to May 23, 2020, were compared with the corresponding period in 2019. RESULTS: We performed COVID-19 swabs for 80 patients and 93 staff, detecting three cancer patients with community-acquired COVID-19 infections with no nosocomial transmission. Patients who required chemotherapy, radiotherapy, or surgery and patients who are on maintenance treatment continued to receive timely treatment without disruption. The number of intravenous chemotherapy treatments was maintained at 97.8% compared with 2019, whereas that of weekly radiotherapy treatments remained stable since December 2019. All cancer-related surgeries proceeded without delay, with a 0.3% increase in workload. Surveillance follow-ups were conducted via teleconsultation, accounting for a 30.7% decrease in total face-to-face clinic consultations. CONCLUSION: Through the coordinated efforts of a DORS taskforce, it is possible to avoid nosocomial SARS-CoV-2 transmissions among patients and staff without compromising on care delivery at a national cancer center.
Subject(s)
Advisory Committees , COVID-19/prevention & control , Cancer Care Facilities/organization & administration , Continuity of Patient Care/organization & administration , Infection Control/organization & administration , Ambulatory Care/organization & administration , COVID-19/epidemiology , COVID-19/transmission , COVID-19 Nucleic Acid Testing , Community-Acquired Infections/epidemiology , Cross Infection/epidemiology , Health Care Rationing , Health Personnel , Hospitalization , Humans , Mass Screening , Personal Protective Equipment/supply & distribution , SARS-CoV-2 , Singapore/epidemiologyABSTRACT
The coronavirus disease 2019 (COVID-19) cases was on an increasing trend, including in Malaysia. The Malaysian Ministry of Health had implemented a range of measures, such as the use of masks and social distancing, to reduce the risk of transmission. Traditionally, newborns are evaluated for neonatal jaundice using visual assessment, a capillary heel prick and serum bilirubin (SB) sampling in primary health-care clinics. This approach requires the physical presence of both parents and their newborns in the primary health-care clinics, causing crowding and increasing the risk of COVID-19 infections. To alleviate crowding, we implemented the transcutaneous bilirubin drive-through (DT) service, which is an established, non-invasive, painless and rapid method to determine the bilirubin levels. Throughout the screening, both parents and baby will be confined to their car. A total of 1842 babies were screened in our DT setting from April to July 2020. Of the total babies, 298 (16.1%) required venesection for SB measurement and 85 required admission for phototherapy. None with severe jaundice were missed since the implementation of this service. The average test duration per neonate was less than 5 min, while conventional venous bilirubin laboratory testing required an average of 1.5 h per neonate. The cost of the SB laboratory test and consumables was approximately USD 5 per test, with an estimated cost savings of USD 7720. DT screening may be introduced in health-care settings to reduce crowding and eliminate the need of painful blood sampling in newborns.
Subject(s)
Ambulatory Care/methods , Bilirubin/blood , COVID-19/prevention & control , Infection Control/methods , Jaundice, Neonatal/diagnosis , Neonatal Screening/methods , Ambulatory Care/organization & administration , Biomarkers/blood , COVID-19/epidemiology , Female , Humans , Infant, Newborn , Infection Control/organization & administration , Jaundice, Neonatal/blood , Malaysia/epidemiology , Male , Neonatal Screening/organization & administration , PandemicsABSTRACT
The delivery of cancer care has never changed as rapidly and dramatically as we have seen with the coronavirus disease 2019 (COVID-19) pandemic. During the early phase of the pandemic, recommendations for the management of oncology patients issued by various professional societies and government agencies did not recognize the significant regional differences in the impact of the pandemic. California initially experienced lower than expected numbers of cases, and the health care system did not experience the same degree of the burden that had been the case in other parts of the country. In light of promising trends in COVID-19 infections and mortality in California, by late April 2020, discussions were initiated for a phased recovery of full-scale cancer services. However, by July 2020, a surge of cases was reported across the nation, including in California. In this review, the authors share the response and recovery planning experience of the University of California (UC) Cancer Consortium in an effort to provide guidance to oncology practices. The UC Cancer Consortium was established in 2017 to bring together 5 UC Comprehensive Cancer Centers: UC Davis Comprehensive Cancer Center, UC Los Angeles Jonsson Comprehensive Cancer Center, UC Irvine Chao Family Comprehensive Cancer Center, UC San Diego Moores Cancer Center, and the UC San Francisco Helen Diller Family Comprehensive Cancer Center. The interventions implemented in each of these cancer centers are highlighted, with a focus on opportunities for a redesign in care delivery models. The authors propose that their experiences gained during this pandemic will enhance pre-pandemic cancer care delivery.
Subject(s)
COVID-19 , Cancer Care Facilities/organization & administration , Delivery of Health Care/organization & administration , Neoplasms/therapy , COVID-19/complications , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Testing , California/epidemiology , Global Health , Humans , Infection Control/methods , Infection Control/organization & administration , Neoplasms/complications , Neoplasms/diagnosis , Pandemics , Telemedicine/methods , Telemedicine/organization & administrationABSTRACT
Frontline hospitals are at the forefront of all travel-related, emerging and reemerging infectious diseases and special pathogens. Yet, the readiness of frontline hospitals and their ability to identify, isolate, and inform on Ebola and other special pathogens is uncertain. This article addresses the resources necessary to support screening for Ebola and other special pathogens and presents the decision-making algorithm for the transport of patients with high-consequence infectious diseases within the New York City Health + Hospitals integrated healthcare delivery network, which includes 10 frontline hospitals and the Region 2 Ebola and Other Special Pathogen Treatment Center.
Subject(s)
Communicable Disease Control/organization & administration , Disease Outbreaks/prevention & control , Hemorrhagic Fever, Ebola/prevention & control , Communicable Disease Control/standards , Ebolavirus , Hospitals , Humans , Infection Control/organization & administration , New York City , Patient Isolation/organization & administrationABSTRACT
BACKGROUND: Current evidence indicates that children are relatively spared from direct COVID-19-related morbidity and mortality, but that the indirect effects of the pandemic pose significant risks to their health and wellbeing. OBJECTIVES: To assess the impact of the local COVID-19 outbreak on routine child health services. METHODS: The District Health Information System data set for KwaZulu-Natal (KZN) provincial health services was accessed, and monthly child health-related data were extracted for the period January 2018 - June 2020. Chronological and geographical variations in sentinel indicators for service access, service delivery and the wellbeing of children were assessed. RESULTS: During April - June 2020, following the start of the COVID-19 outbreak in KZN, significant declines were seen for clinic attendance (36%; p=0.001) and hospital admissions (50%; p=0.005) of children aged <5 years, with a modest recovery in clinic attendance only. Among service delivery indicators, immunisation coverage recovered most rapidly, with vitamin A supplementation, deworming and food supplementation remaining low. Changes were less pronounced for in- and out-of-hospital births and uptake rates of infant polymerase chain reaction testing for HIV at birth, albeit with wide interdistrict variations, indicating inequalities in access to and provision of maternal and neonatal care. A temporary 47% increase in neonatal facility deaths was reported in May 2020 that could potentially be attributed to COVID-19-related disruption and diversion of health resources. CONCLUSIONS: Multiple indicators demonstrated disruption in service access, service delivery and child wellbeing. Further studies are needed to establish the intermediate- and long-term impact of the COVID-19 outbreak on child health, as well as strategies to mitigate these.
Subject(s)
COVID-19 , Child Health Services , Health Services Accessibility , Infection Control , Perinatal Care , COVID-19/epidemiology , COVID-19/prevention & control , Child Health/standards , Child Health Services/organization & administration , Child Health Services/statistics & numerical data , Child, Preschool , Health Resources/standards , Health Services Accessibility/statistics & numerical data , Health Services Accessibility/trends , Health Services Needs and Demand , Humans , Infant , Infant Mortality , Infant, Newborn , Infection Control/methods , Infection Control/organization & administration , Perinatal Care/standards , Perinatal Care/statistics & numerical data , SARS-CoV-2 , South Africa/epidemiologySubject(s)
Clinical Trials as Topic/organization & administration , Coronavirus Infections , Delivery of Health Care, Integrated/organization & administration , Infection Control/organization & administration , Pandemics , Pneumonia, Viral , Research Design , Research Personnel/organization & administration , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Occupational Health , Patient Safety , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Pneumonia, Viral/transmission , Psychological Distance , Risk FactorsABSTRACT
BACKGROUND AND PURPOSE: Since the declaration of the Novel Coronavirus Disease (COVID-19) pandemic, ensuring the safety of our medical team while delivering timely management has been a challenge. Acute stroke patients continue to present to the emergency department and they may not have the usual symptoms of COVID-19 infection. Stroke team response and management must be done within the shortest possible time to minimize worsening of the functional outcome without compromising safety of the medical team. METHODS: Infection control recommendations, emergency department protocols and stroke response pathways utilized prior to the COVID 19 pandemic within our institution were evaluated by our stroke team in collaboration with the multidisciplinary healthcare services. Challenges during the COVID-19 scenario were identified, from which a revised acute stroke care algorithm was formulated to adapt to this pandemic. RESULTS: We formulated an algorithm that incorporates practices from internationally devised protocols while tailoring certain aspects to suit the available resources in our system locally. We highlighted the significance of the following: team role designation, coordination among different subspecialties and departments, proper use of personal protective equipment and resources, and telemedicine use during this pandemic. CONCLUSIONS: This pandemic has shaped the stroke team's approach in the management of acute stroke patients. Our algorithm ensures proper resource management while optimizing acute stroke care during the COVID-19 pandemic in our local setting. This algorithm may be utilized and adapted for local practice and other third world countries who face similar constraints.
Subject(s)
Algorithms , Coronavirus Infections/therapy , Critical Pathways/organization & administration , Delivery of Health Care, Integrated/organization & administration , Developing Countries , Hospitals, Private/organization & administration , Pneumonia, Viral/therapy , Stroke/therapy , Tertiary Care Centers/organization & administration , COVID-19 , Cooperative Behavior , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Humans , Infection Control/organization & administration , Interdisciplinary Communication , Occupational Health , Pandemics , Patient Care Team/organization & administration , Patient Safety , Philippines/epidemiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Risk Factors , Stroke/diagnosis , Stroke/epidemiology , Treatment Outcome , WorkflowSubject(s)
Coronavirus Infections , Infection Control , Infectious Disease Transmission, Vertical/prevention & control , Maternal Health Services/organization & administration , Midwifery/methods , Pandemics , Pneumonia, Viral , Pregnancy Complications, Infectious , Betacoronavirus , Birth Setting/nursing , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Critical Pathways/trends , Europe/epidemiology , Female , Humans , Infection Control/methods , Infection Control/organization & administration , Infection Control/trends , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data , Organizational Innovation , Pandemics/prevention & control , Perinatal Care/methods , Perinatal Care/organization & administration , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/prevention & control , SARS-CoV-2Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Thoracic Neoplasms/surgery , Thoracic Surgery/organization & administration , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Health Care Reform/organization & administration , Humans , Infection Control/organization & administration , Italy/epidemiology , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Surgery Department, Hospital/organization & administration , Thoracic Surgical Procedures/standardsABSTRACT
OBJECTIVE: During the COVID-19 pandemic, central venous access line teams were implemented at many hospitals throughout the world to provide access for critically ill patients. The objective of this study was to describe the structure, practice patterns, and outcomes of these vascular access teams during the COVID-19 pandemic. METHODS: We conducted a cross-sectional, self-reported study of central venous access line teams in hospitals afflicted with the COVID-19 pandemic. To participate in the study, hospitals were required to meet one of the following criteria: development of a formal plan for a central venous access line team during the pandemic; implementation of a central venous access line team during the pandemic; placement of central venous access by a designated practice group during the pandemic as part of routine clinical practice; or management of an iatrogenic complication related to central venous access in a patient with COVID-19. RESULTS: Participants from 60 hospitals in 13 countries contributed data to the study. Central venous line teams were most commonly composed of vascular surgery and general surgery attending physicians and trainees. Twenty sites had 2657 lines placed by their central venous access line team or designated practice group. During that time, there were 11 (0.4%) iatrogenic complications associated with central venous access procedures performed by the line team or group at those 20 sites. Triple lumen catheters, Cordis (Santa Clara, Calif) catheters, and nontunneled hemodialysis catheters were the most common types of central venous lines placed by the teams. Eight (14%) sites reported experience in placing central venous lines in prone, ventilated patients with COVID-19. A dedicated line cart was used by 35 (59%) of the hospitals. Less than 50% (24 [41%]) of the participating sites reported managing thrombosed central lines in COVID-19 patients. Twenty-three of the sites managed 48 iatrogenic complications in patients with COVID-19 (including complications caused by providers outside of the line team or designated practice group). CONCLUSIONS: Implementation of a dedicated central venous access line team during a pandemic or other health care crisis is a way by which physicians trained in central venous access can contribute their expertise to a stressed health care system. A line team composed of physicians with vascular skill sets provides relief to resource-constrained intensive care unit, ward, and emergency medicine teams with a low rate of iatrogenic complications relative to historical reports. We recommend that a plan for central venous access line team implementation be in place for future health care crises.
Subject(s)
Catheterization, Central Venous , Coronavirus Infections/therapy , Delivery of Health Care, Integrated/organization & administration , Health Services Needs and Demand/organization & administration , Iatrogenic Disease/prevention & control , Infection Control/organization & administration , Pneumonia, Viral/therapy , Betacoronavirus/pathogenicity , COVID-19 , Catheterization, Central Venous/adverse effects , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Cross-Sectional Studies , Health Care Surveys , Host-Pathogen Interactions , Humans , Iatrogenic Disease/epidemiology , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Risk Assessment , Risk Factors , SARS-CoV-2ABSTRACT
OBJECTIVE: The coronavirus disease-2019 (COVID-19) pandemic has strained all levels of healthcare and it is not known how chiropractic practitioners have responded to this crisis. The purpose of this report is to describe responses by a sample of chiropractors during the early stages of the COVID-19 pandemic. METHODS: We used a qualitative-constructivist design to understand chiropractic practice during the COVID-19 pandemic, as described by the participants. A sample of chiropractic practitioners (doctors of chiropractic, chiropractors) from various international locations were invited to participate. Each described the public health response to COVID-19 in their location and the actions that they took in their chiropractic practices from April 20 through May 4, 2020. A summary report was created from their responses and common themes were identified. RESULTS: Eighteen chiropractic practitioners representing 17 locations and 11 countries participated. A variety of practice environments were represented in this sample, including, solo practice, mobile practice, private hospital, US Veterans Administration health care, worksite health center, and group practice. They reported that they recognized and abided by changing governmental regulations. They observed their patients experience increased stress and mental health concerns resulting from the pandemic. They adopted innovative strategies, such as telehealth, to do outreach, communicate with, and provide care for patients. They abided by national and World Health Organization recommendations and they adopted creative strategies to maintain connectivity with patients through a people-centered, integrated, and collaborative approach. CONCLUSION: Although the chiropractors in this sample practiced in different cities and countries, their compliance with local regulations, concern for staff and patient safety, and people-centered responses were consistent. This sample covers all 7 World Federation of Chiropractic regions (ie, African, Asian, Eastern Mediterranean, European, Latin American, North American, and Pacific) and provides insights into measures taken by chiropractors during the early stages of the COVID-19 pandemic. This information may assist the chiropractic profession as it prepares for different scenarios as new evidence about this disease evolves.
Subject(s)
Chiropractic , Coronavirus Infections/epidemiology , Infection Control/organization & administration , Office Management/organization & administration , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , Government Regulation , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics , SARS-CoV-2 , Surveys and Questionnaires , TelemedicineSubject(s)
Betacoronavirus/pathogenicity , Cardiac Surgical Procedures , Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Delivery of Health Care, Integrated/organization & administration , Heart Defects, Congenital/surgery , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Attitude of Health Personnel , COVID-19 , Cardiac Surgical Procedures/adverse effects , Clinical Decision-Making , Cooperative Behavior , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Cross Infection/epidemiology , Cross Infection/transmission , Cross Infection/virology , Heart Defects, Congenital/epidemiology , Humans , Infection Control/organization & administration , Interdisciplinary Communication , Leadership , Occupational Health , Patient Care Team/organization & administration , Patient Safety , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Risk Assessment , Risk Factors , SARS-CoV-2 , Triage/organization & administration , VirulenceSubject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Hand Injuries/therapy , Health Services Accessibility/organization & administration , Infection Control/organization & administration , Outpatient Clinics, Hospital/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Anesthesia, Local , COVID-19 , Hand Injuries/diagnosis , Humans , Infection Control/methods , London , Models, Organizational , Orthopedic Procedures , Perioperative Care/methods , Plastic Surgery Procedures , SARS-CoV-2 , Triage/methods , Triage/organization & administrationSubject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Health Education/methods , Health Personnel/psychology , Occupational Stress/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , COVID-19 , Canada , Diet , Emergency Medicine/organization & administration , Exercise/physiology , Female , Humans , Infection Control/organization & administration , Life Style , Male , Meditation/methods , Mental Health , Occupational Health , Pandemics/statistics & numerical dataABSTRACT
We established the Co-Operative Vascular Intervention Disease (COVID) Team of Greater Philadelphia because national guidelines may not apply to different geographic areas of the United States owing to varying penetrance of the virus. On April 10, 2020, a 10-question survey regarding issues and strategies dealing with COVID-19 was e-mailed to 58 vascular surgeons (VSs) in the Greater Philadelphia area. Fifty-four VSs in 18 surgical groups covering 28 hospitals responded. All groups accepted transfers because of continued availability of intensive care unit beds. Thirteen groups were asked to "redeploy" if the need arose to function outside of the usual duties of a VS. None imposed age restrictions regarding older VSs continuing clinical hospital work. The majority restricted noninvasive vascular laboratory studies to those studies for which findings might mandate intervention within 2 or 3 weeks, restricted dialysis access operations to urgent revisions of arteriovenous fistulas or grafts that were failing or had ulcerations, converted from in-person to telemedicine clinic interactions, and experienced moderate-severe anxiety or fear about personal COVID-19 exposure in the hospital. The majority of VSs in the Philadelphia area dramatically adjusted their clinical practices before the COVID-19 crisis reached peak levels experienced in other metropolitan areas.