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1.
J Infect Dev Ctries ; 14(6): 554-558, 2020 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-32683344

RESUMO

In the early stages of the coronavirus disease 2019 (COVID-19) outbreak in Wuhan, many cross-infections occurred due to the limited number of wards and insufficient medical staff, which could not cope with the large number of patients visiting the hospital. A series of new infection control measures were implemented in our institution and a Wuhan hospital supported by our medical team, mainly including temporarily transforming the general ward into a passage for the staff to enter the infectious ward and standardizing the procedure for the wearing and removal of personal protection equipment (PPE). These measures significantly improved the situation, and no member of our medical staff was infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the middle and late stages of the disease epidemic. We hope that these experiences can provide references for medical institutions that may face an outbreak of COVID-19, especially those in underdeveloped countries and regions.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Corpo Clínico , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Arquitetura Hospitalar , Humanos , Máscaras , Quartos de Pacientes
3.
Encephale ; 46(3S): S81-S84, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32471705

RESUMO

OBJECTIVES: The sudden changes of healthcare system due to COVID-19 particularly affect the organization of psychiatry. The objective of this review is to examine the adaptations of psychiatric care in France during this pandemic. METHOD: This narrative review is based on the observation of changes made in French psychiatric hospitals and on an analysis of the literature. RESULTS: Regarding psychiatric hospitalization, the COVID-19 epidemic required rapid measures that profoundly modified the conditions of patients' reception, forcing the medical staffs to adapt their methods of care. The authors noted the creation of at least 89 wards specifically dedicated to patients with COVID-19 needing psychiatric hospitalization, allowing dual care of general medicine and psychiatry. Regarding ambulatory care, maintaining patients with long-term follow-up was a priority. Patients recalling and teleconsultation have been precious resources but cannot entirely replace face-to-face consultations. DISCUSSION: COVID-19 epidemic created unprecedented situation of large-scale upheavals in the healthcare system and in society. Despite the absence of previous recommendations on the subject, French psychiatry has shown great adaptability. Some changes could inspire post-COVID-19 care.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Reestruturação Hospitalar , Hospitais Psiquiátricos/organização & administração , Serviços de Saúde Mental/organização & administração , Pandemias , Pneumonia Viral , Psicoterapia/organização & administração , Assistência Ambulatorial/organização & administração , Conversão de Leitos , França/epidemiologia , Pessoal de Saúde/psicologia , Acesso aos Serviços de Saúde , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Serviços de Saúde Mental/provisão & distribução , Saúde do Trabalhador , Quartos de Pacientes , Psicoterapia/estatística & dados numéricos , Mudança Social , Estresse Psicológico/etiologia , Estresse Psicológico/terapia , Telemedicina
4.
Am J Infect Control ; 48(7): 822-824, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32371066
6.
Nat Commun ; 11(1): 2800, 2020 05 29.
Artigo em Inglês | MEDLINE | ID: mdl-32472043

RESUMO

Understanding the particle size distribution in the air and patterns of environmental contamination of SARS-CoV-2 is essential for infection prevention policies. Here we screen surface and air samples from hospital rooms of COVID-19 patients for SARS-CoV-2 RNA. Environmental sampling is conducted in three airborne infection isolation rooms (AIIRs) in the ICU and 27 AIIRs in the general ward. 245 surface samples are collected. 56.7% of rooms have at least one environmental surface contaminated. High touch surface contamination is shown in ten (66.7%) out of 15 patients in the first week of illness, and three (20%) beyond the first week of illness (p = 0.01, χ2 test). Air sampling is performed in three of the 27 AIIRs in the general ward, and detects SARS-CoV-2 PCR-positive particles of sizes >4 µm and 1-4 µm in two rooms, despite these rooms having 12 air changes per hour. This warrants further study of the airborne transmission potential of SARS-CoV-2.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/virologia , Microbiologia Ambiental , Quartos de Pacientes , Pneumonia Viral/virologia , Adulto , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/patologia , Infecções por Coronavirus/transmissão , Estudos Transversais , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Tamanho da Partícula , Material Particulado/análise , Material Particulado/química , Pneumonia Viral/epidemiologia , Pneumonia Viral/patologia , Pneumonia Viral/transmissão , Fatores de Tempo
7.
Artigo em Inglês | MEDLINE | ID: mdl-32326274

RESUMO

During an epidemic, almost all healthcare facilities restrict the visiting of patients to prevent disease transmission. For hospices with terminally ill patients, the trade-off between compassion and infection control becomes a difficult decision. This study aimed to survey the changes in visiting policy for all 76 hospice wards in Taiwan during the COVID-19 pandemic in March 2020. The altered visiting policies were assessed by the number of visitors per patient allowed at one time, the daily number of visiting slots, the number of hours open daily, and requisites for hospice ward entry. The differences in visiting policies between hospice wards and ordinary wards were also investigated. Data were collected by reviewing the official website of each hospital and were supplemented by phone calls in cases where no information was posted on the website. One quarter (n = 20) of hospice wards had different visiting policies to those of ordinary wards in the same hospital. Only one hospice ward operated an open policy, and in contrast, nine (11.8%) stopped visits entirely. Among the 67 hospice wards that allowed visiting, at most, two visitors at one time per patient were allowed in 46 (68.6%), one visiting time daily was allowed in 32 (47.8%), one hour of visiting per day was allowed in 29 (43.3%), and checking of identity and travel history was carried out in 12 wards (17.9%). During the COVID-19 pandemic, nearly all hospice wards in Taiwan changed their visiting policies, but the degree of restriction varied. Further studies could measure the impacts of visiting policy changes on patients and healthcare professionals.


Assuntos
Infecções por Coronavirus/prevenção & controle , Hospitais para Doentes Terminais/organização & administração , Política Organizacional , Pandemias/prevenção & controle , Quartos de Pacientes/organização & administração , Pneumonia Viral/prevenção & controle , Visitas a Pacientes , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Feminino , Pesquisas sobre Serviços de Saúde , Hospitais para Doentes Terminais/estatística & dados numéricos , Humanos , Controle de Infecções , Masculino , Pneumonia Viral/epidemiologia , Inquéritos e Questionários , Taiwan
9.
J Hosp Infect ; 105(2): 119-127, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32259546

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) was first reported in Wuhan in December 2019 and has rapidly spread across different cities within and outside China. Hong Kong started to prepare for COVID-19 on 31st December 2019 and infection control measures in public hospitals were tightened to limit nosocomial transmission within healthcare facilities. However, the recommendations on the transmission-based precautions required for COVID-19 in hospital settings vary from droplet and contact precautions, to contact and airborne precautions with placement of patients in airborne infection isolation rooms. AIM: To describe an outbreak investigation of a patient with COVID-19 who was nursed in an open cubicle of a general ward before the diagnosis was made. METHOD: Contacts were identified and risk categorized as 'close' or 'casual' for decisions on quarantine and/or medical surveillance. Respiratory specimens were collected from contacts who developed fever, and/or respiratory symptoms during the surveillance period and were tested for SARS-CoV-2. FINDINGS: A total of 71 staff and 49 patients were identified from contact tracing, seven staff and 10 patients fulfilled the criteria of 'close contact'. At the end of 28-day surveillance, 76 tests were performed on 52 contacts and all were negative, including all patient close contacts and six of the seven staff close contacts. The remaining contacts were asymptomatic throughout the surveillance period. CONCLUSION: Our findings suggest that SARS-CoV-2 is not spread by an airborne route, and nosocomial transmissions can be prevented through vigilant basic infection control measures, including wearing of surgical masks, hand and environmental hygiene.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/transmissão , Infecção Hospitalar/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Pneumonia Viral/transmissão , Busca de Comunicante , Infecções por Coronavirus/epidemiologia , Feminino , Hong Kong/epidemiologia , Hospitais , Humanos , Pessoa de Meia-Idade , Pandemias , Quartos de Pacientes , Pneumonia Viral/epidemiologia
10.
Sci Total Environ ; 725: 138401, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32283308

RESUMO

The coronavirus disease 2019 (COVID-19) emerged in Wuhan city, China, in late 2019 and has rapidly spread throughout the world. The major route of transmission of SARS-CoV-2 is in contention, with the airborne route a likely transmission pathway for carrying the virus within indoor environments. Until now, there has been no evidence for detection of airborne severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and this may have implication for the potential spread of the COVID-19. We investigated the air of patient rooms with confirmed COVID-19 in the largest hospital in Iran, on March 17, 2020. To collect the SARS-CoV-2 particles, ten air samples were collected into the sterile standard midget impingers containing 20 mL DMEM with 100 µg/mL streptomycin, 100 U/mL penicillin and 1% antifoam reagent for 1 h. Besides, indoor particle number concentrations, CO2, relative humidity and temperature were recorded throughout the sampling duration. Viral RNA was extracted from samples taken from the impingers and Reverse-Transcription PCR (RT-PCR) was applied to confirm the positivity of collected samples based on the virus genome sequence. Fortunately, in this study all air samples which were collected 2 to 5 m from the patients' beds with confirmed COVID-19 were negative. Despite we indicated that all air samples were negative, however, we suggest further in vivo experiments should be conducted using actual patient cough, sneeze and breath aerosols in order to show the possibility of generation of the airborne size carrier aerosols and the viability fraction of the embedded virus in those carrier aerosols.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Poluição do Ar em Ambientes Fechados , China , Humanos , Irã (Geográfico) , Quartos de Pacientes
12.
Ann Phys Rehabil Med ; 63(4): 376-378, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32315800
14.
PLoS One ; 15(3): e0229935, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155187

RESUMO

OBJECTIVE: Reinstitution of mechanical ventilation (MV) for tracheostomized patients after successful weaning may occur as the care setting changes from critical care to general care. We aimed to investigate the occurrence, consequence and associated factors of MV reinstitution. METHODS: We analyzed the clinical data and physiological measurements of tracheostomized patients with prolonged MV discharged from the weaning unit to general wards after successful weaning to compare between those with and without in-hospital MV reinstitution within 60 days. RESULTS: Of 454 patients successfully weaned, 116 (25.6%) reinstituted MV at general wards within 60 days; at hospital discharge, 42 (36.2%) of them were eventually liberated from MV, 51 (44.0%) remained MV dependent, and 33 (28.4%) died. Of the 338 patients without reinstitution within 60 days, only 3 (0.9%) were later reinstituted with MV before discharge (on day 67, 89 and 136 at general wards, respectively), and 322 (95.2%) were successfully weaned again at discharge, while 13 (3.8%) died. Patients with MV reinstitution had a significantly lower level of maximal expiratory pressure (PEmax) before unassisted breathing trial compared to those without reinstitution. Multivariable Cox regression analysis showed fever at RCC discharge (hazard ratio [HR] 14.00, 95% confidence interval [CI] 3.2-61.9) chronic obstructive pulmonary disease (HR 2.37, 95% CI 1.34-4.18), renal replacement therapy at the ICU (HR 2.29, 95% CI 1.50-3.49) and extubation failure before tracheostomy (HR 1.76, 95% CI 1.18-2.63) were associated with increased risks of reinstitution, while PEmax > 30 cmH2O (HR 0.51, 95% CI 0.35-0.76) was associated with a decreased risk of reinstitution. CONCLUSIONS: The reinstitution of MV at the general ward is significant, with poor outcomes. The PEmax measured before unassisted breathing trial was significantly associated with the risk of reinstituting MV at the general wards.


Assuntos
Cuidados Críticos/normas , Pressões Respiratórias Máximas , Insuficiência Respiratória/diagnóstico , Retratamento/estatística & dados numéricos , Desmame do Respirador/normas , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Protocolos Clínicos/normas , Cuidados Críticos/estatística & dados numéricos , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Quartos de Pacientes/estatística & dados numéricos , Valor Preditivo dos Testes , Prognóstico , Insuficiência Respiratória/terapia , Estudos Retrospectivos , Fatores de Tempo , Traqueostomia/efeitos adversos , Resultado do Tratamento , Desmame do Respirador/efeitos adversos , Desmame do Respirador/estatística & dados numéricos
15.
Medicine (Baltimore) ; 99(10): e19032, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150050

RESUMO

Rapid response teams have been adopted to prevent unexpected in-ward cardiac arrest. However, there is no convincing evidence of optimal operation with rapid response team. Our aim was to address the impact of focused rapid response team on the safety of patients in wards. Comparison of focused with extended rapid response teams was performed in single center. The extended team operated on adult patients in whole ward (both medical and nonmedical ward) 24 hours per day, 7 days per week during 2012. In 2015, the operational time of the focused team was office hours from Monday to Friday and study population were limited to adult patients in the nonmedical ward. Unexpected in-ward cardiac arrests were compared between the extended team and focused team periods. During the focused team period, there was significant reduction in cardiac arrest per 1000 admissions in whole ward compared to the before the rapid response team period (1.09 vs 1.67, P < .001). Compared to that of the extended team period (1.42), there was also a significant reduction in cardiac arrest rate (P = .04). The cardiac arrest rate of nonmedical ward patients was also significantly decreased in the focused team period compared to that before the rapid response team period (0.43 vs 0.95, P < .001). Compared to the extended team period (0.64), there was a marginally significant reduction in cardiac arrest of nonmedical ward patients (P = .05). The focused rapid response team was associated with a reduced incidence of unexpected in-ward cardiac arrest. Further research on the optimal composition and operational time is needed.


Assuntos
Parada Cardíaca/prevenção & controle , Equipe de Respostas Rápidas de Hospitais/normas , Avaliação de Resultados em Cuidados de Saúde , Adulto , China , Feminino , Parada Cardíaca/mortalidade , Mortalidade Hospitalar , Hospitalização , Humanos , Incidência , Unidades de Terapia Intensiva , Masculino , Quartos de Pacientes , Estudos Prospectivos , Melhoria de Qualidade
18.
Aging Clin Exp Res ; 32(1): 141-147, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30900213

RESUMO

BACKGROUND: Few studies have investigated treatment environment risk factors for delirium in geriatric patients. In March 2017, a geriatric department was moved from old hospital buildings with multiple-bed rooms (old wards) to a new hospital with single-bed rooms (new wards), with no changes regarding uptake area, staff and admission criteria. AIMS: The aim of this study was to investigate the risk of delirium among patients in single-bed rooms compared with multiple-bed rooms. METHODS: An observational prospective study included patients aged ≥ 75 years admitted between 15 September 2016 and 19 March 2017 to the old wards and between 20 March and 19 December 2017 to the new wards. Exclusion criteria were terminal illness, somnolence at admission and inability to communicate in Danish. Delirium was assessed by trained nurses, nurse assistants, occupational therapists and physiotherapists every morning and evening using the Confusion Assessment Method (CAM). RESULTS: We included 1014 patients. Patients' characteristics were similar between patients admitted to the old wards and to the new wards. Delirium was present at admission in 105 patients, with no significant difference between the old and new wards. Patients in the new wards had a significantly reduced incidence of delirium during hospital stay compared with patients in the old wards; hazard ratio 0.66 (95% CI 0.48-0.93, p < 0.02). No difference between the old and the new wards was observed in the duration of the first delirium episode. CONCLUSION: We found evidence that the risk of delirium is reduced in single-bed rooms compared with multiple-bed rooms in geriatric wards.


Assuntos
Delírio/epidemiologia , Avaliação Geriátrica , Quartos de Pacientes/estatística & dados numéricos , Idoso de 80 Anos ou mais , Delírio/etiologia , Delírio/prevenção & controle , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Estudos Prospectivos , Fatores de Risco
19.
J Hosp Infect ; 104(3): 276-282, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31785318

RESUMO

BACKGROUND: Environmental hygiene is one of the most important strategies to prevent hospital-acquired infections by reducing pathogens in haematopoietic cell transplant (HCT) patient rooms. This study was designed in response to JACIE requirements for microbiological monitoring, and aimed to assess environmental hygiene in protective isolation rooms. METHODS: Environmental cleanliness was assessed by measuring microbial loads in at-rest and operational conditions sampled from target surfaces, and in passive and active air from rooms occupied by patients with different grades of neutropenia. The study also evaluated whether microbial loads were influenced by isolation precautions. RESULTS: The failure rate of cleanliness on target surfaces in at-rest conditions was 0% compared with 37% for surfaces and 13% for passive and active air samples in operational conditions. Differences in failure rates were observed in the rooms of patients with different levels of neutropenia (P=0.036 for surfaces, 0.028% for passive air). No relationship was found between infections and microbial loads. CONCLUSIONS: Microbiological assessment integrated with an enhanced monitoring programme for hospital hygiene provides invaluable information to drive infection control policies in HCT patients. These results highlight the need to set and validate strict standards for the assessment of cleanliness in a clinical setting.


Assuntos
Infecção Hospitalar/prevenção & controle , Transplante de Células-Tronco Hematopoéticas , Controle de Infecções/métodos , Quartos de Pacientes/normas , Microbiologia do Ar , Reservatórios de Doenças , Microbiologia Ambiental , Monitoramento Ambiental/métodos , Contaminação de Equipamentos , Humanos , Higiene/normas , Controle de Infecções/legislação & jurisprudência , Isolamento de Pacientes , Medição de Risco
20.
Ann Surg ; 271(1): 100-105, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-29771722

RESUMO

BACKGROUND: The establishment of early warning systems in hospitals was strongly recommended in recent guidelines to detect deteriorating patients early and direct them to adequate care. Upon reaching predefined trigger criteria, Medical Emergency Teams (MET) should be notified and directed to these patients. The present study analyses the effect of introducing an automated multiparameter early warning score (MEWS)-based early warning system with paging functionality on 2 wards hosting patients recovering from highly complex surgical interventions. METHODS: The deployment of the system was accompanied by retrospective data acquisition during 12 months (intervention) using 4 routine databases: Hospital patient data management, anesthesia database, local data of the German Resuscitation Registry, and measurement logs of the deployed system (intervention period only). A retrospective 12-month data review using the same aforementioned databases before the deployment of the system served as control. Control and intervention phases were separated by a 6-month washout period for the installation of the system and for training. RESULTS: Data from 3827 patients could be acquired from 2 surgical wards during the two 12-month periods, 1896 patients in the control and 1931 in the intervention cohorts. Patient characteristics differed between the 2 observation phases. American Society of Anesthesiologists risk classification and duration of surgery as well as German DRG case-weight were significantly higher in the intervention period. However, the rate of cardiac arrests significantly dropped from 5.3 to 2.1 per 1000 admissions in the intervention period (P < 0.001). This observation was paralleled by a reduction of unplanned ICU admissions from 3.6% to 3.0% (P < 0.001), and an increase of notifications of critical conditions to the ward surgeon. The primary triggers for MET activation were abnormal ECG alerts, specifically asystole (n = 5), and pulseless electric activity (n = 8). CONCLUSION: In concert with a well-trained and organized MET, the early deterioration detection of patients on surgical wards outside the ICU may be improved by introducing an automated MEWS-based early warning system with paging functionality.


Assuntos
Diagnóstico Precoce , Parada Cardíaca/diagnóstico , Unidades de Terapia Intensiva/estatística & dados numéricos , Registros Médicos/normas , Quartos de Pacientes/organização & administração , Medição de Risco/métodos , Idoso , Feminino , Seguimentos , Alemanha/epidemiologia , Parada Cardíaca/epidemiologia , Parada Cardíaca/prevenção & controle , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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