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2.
BMC Infect Dis ; 20(1): 837, 2020 Nov 12.
Artículo en Inglés | MEDLINE | ID: mdl-33183253

RESUMEN

PURPOSES: Surgical site infection (SSI) after colorectal surgery is a frequent complication associated with the increase in morbidity, medical expenses, and mortality. To date, there is no nationwide large-scale database of SSI after colorectal surgery in China. The aim of this study was to determine the incidence of SSI after colorectal surgery in China and to further evaluate the related risk factors. METHODS: Two multicenter, prospective, cross-sectional studies covering 55 hospitals in China and enrolling adult patients undergoing colorectal surgery were conducted from May 1 to June 30 of 2018 and the same time of 2019. The demographic and perioperative characteristics were collected, and the main outcome was SSI within postoperative 30 days. Multivariable logistic regressions were conducted to predict risk factors of SSI after colorectal surgery. RESULTS: In total, 1046 patients were enrolled and SSI occurred in 74 patients (7.1%). In the multivariate analysis with adjustments, significant factors associated with SSI were the prior diagnosis of hypertension (OR, 1.903; 95% confidence interval [CI], 1.088-3.327, P = 0.025), national nosocomial infection surveillance risk index score of 2 or 3 (OR, 3.840; 95% CI, 1.926-7.658, P < 0.001), laparoscopic or robotic surgery (OR, 0.363; 95% CI, 0.200-0.659, P < 0.001), and adhesive incise drapes (OR, 0.400; 95% CI, 0.187-0.855, P = 0.018). In addition, SSI group had remarkably increased length of postoperative stays (median, 15.0 d versus 9.0d, P < 0.001), medical expenses (median, 74,620 yuan versus 57,827 yuan, P < 0.001), and the mortality (4.1% versus 0.3%, P = 0.006), compared with those of non-SSI group. CONCLUSION: This study provides the newest data of SSI after colorectal surgery in China and finds some predictors of SSI. The data presented in our study can be a tool to develop optimal preventive measures and improve surgical quality in China.


Asunto(s)
Cirugía Colorrectal/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Anciano , China/epidemiología , Infección Hospitalaria/epidemiología , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Tiempo de Internación , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo
3.
BMJ Open ; 10(10): e039088, 2020 10 22.
Artículo en Inglés | MEDLINE | ID: mdl-33093033

RESUMEN

INTRODUCTION: The newly identified SARS-CoV-2 can cause serious acute respiratory infections such as pneumonia. In France, mortality rate in the general population was approximately 10% and could reach higher levels at the hospital. In the current context of high incidence rates of SARS-CoV-2 in the community, a significant increase in the rate of nosocomial transmission is expected. The risk of nosocomial transmission could even be higher in low-income countries that have fragile healthcare systems. This protocol is intended to estimate the prevalence and incidence of suspected or confirmed cases of nosocomial SARS-CoV-2 infection, the clinical spectrum and the determinants (risk factors/protective) at participating hospitals. METHODS AND ANALYSIS: This will be an international multicentre prospective, observational, hospital-based study in adults and children. It will include volunteer patients and healthcare professionals in France and hospitals affiliated with the GABRIEL network. Demographic and clinical data will be collected using case report forms designed especially for the purpose of the project. A nasopharyngeal swab will be collected and tested for SARS-CoV-2 by reverse-transcriptase PCR. Characteristics of the study participants, the proportion of confirmed nosocomial SARS-CoV-2 infections relative to all patients with syndromes suggestive of SARS-CoV-2 infection, will be analysed. Appropriate multivariate modelling will be used to identify the determinants associated with nosocomial onset. ETHICS AND DISSEMINATION: This study was approved by the clinical research and committee of all participating countries. The findings will be submitted to peer-reviewed journal for publication and shared with national health authorities. TRIAL REGISTRATION NUMBER: NCT04290780.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/transmisión , Infección Hospitalaria/epidemiología , Hospitales/estadística & datos numéricos , Pandemias , Neumonía Viral/transmisión , Adolescente , Adulto , Niño , Infecciones por Coronavirus/epidemiología , Femenino , Francia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/epidemiología , Estudios Prospectivos , Factores de Riesgo , Adulto Joven
4.
PLoS One ; 15(10): e0241169, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33104736

RESUMEN

Novel coronavirus (named SARS-CoV-2) can spread widely in confined settings including hospitals, cruise ships, prisons, and places of worship. In particular, a healthcare-associated outbreak could become the epicenter of coronavirus disease (COVID-19). This study aimed to evaluate the effects of different intervention strategies on the hospital outbreak within a tertiary hospital. A mathematical model was developed for the COVID-19 transmission within a 2500-bed tertiary hospital of South Korea. The SEIR (susceptible-exposed-infectious-recovered) model with a compartment of doctor, nurse, patient, and caregiver was constructed. The effects of different intervention strategies such as front door screening, quarantine unit for newly admitted patients, early testing of suspected infected people, and personal protective equipment for both medical staff and visitors were evaluated. The model suggested that the early testing (within eight hours) of infected cases and monitoring the quarantine ward for newly hospitalized patients are effective measures for decreasing the incidence of COVID-19 within a hospital (81.3% and 70% decrease of number of incident cases, respectively, during 60 days). Front door screening for detecting suspected cases had only 42% effectiveness. Screening for prohibiting the admission of COVID-19 patients was more effective than the measures for patients before emergency room or outpatient clinic. This model suggests that under the assumed conditions, some effective measures have a great influence on the incidence of COVID-19 within a hospital. The implementation of the preventive measures could reduce the size of a hospital outbreak.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/transmisión , Infección Hospitalaria/transmisión , Control de Infecciones/métodos , Modelos Teóricos , Pandemias , Neumonía Viral/transmisión , Centros de Atención Terciaria , Cuidadores , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Diagnóstico Precoz , Servicio de Urgencia en Hospital , Departamentos de Hospitales , Humanos , Incidencia , Tamizaje Masivo , Cuerpo Médico de Hospitales , Personal de Enfermería en Hospital , Servicio Ambulatorio en Hospital , Pandemias/prevención & control , Pacientes , Habitaciones de Pacientes , Equipo de Protección Personal , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , República de Corea/epidemiología , Sensibilidad y Especificidad , Evaluación de Síntomas , Visitas a Pacientes
5.
PLoS One ; 15(10): e0241030, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33108381

RESUMEN

BACKGROUND/OBJECTIVES: To analyze mortality, costs, residents and personnel characteristics, in six long-term care facilities (LTCF) during the outbreak of COVID-19 in Spain. DESIGN: Epidemiological study. SETTING: Six open LTCFs in Albacete (Spain). PARTICIPANTS: 198 residents and 190 workers from LTCF A were included, between 2020 March 6 and April 5. Epidemiological data were also collected from six LTCFs of Albacete for the same period of time, including 1,084 residents. MEASUREMENTS: Baseline demographic, clinical, functional, cognitive and nutritional variables were collected. 1-month and 3-month mortality was determined, excess mortality was calculated, and costs associated with the pandemics were analyzed. RESULTS: The pooled mortality rate for the first month and first three months of the outbreak were 15.3% and 28.0%, and the pooled excess mortality for these periods were 564% and 315% respectively. In facility A, the percentage of probable COVID-19 infected residents were 33.6%. Probable infected patients were older, frail, and with a worse functional situation than those without COVID-19. The most common symptoms were fever, cough and dyspnea. 25 residents were transferred to the emergency department, 21 were hospitalized, and 54 were moved to the facility medical unit. Mortality was higher upon male older residents, with worse functionality, and higher comorbidity. During the first month of the outbreak, 65 (24.6%) workers leaved, mainly with COVID-19 symptoms, and 69 new workers were contracted. The mean number of days of leave was 19.2. Costs associated with the COVID-19 in facility A were estimated at € 276,281/month, mostly caused by resident hospitalizations, leaves of workers, staff replacement, and interventions of healthcare professionals. CONCLUSION: The COVID-19 pandemic posed residents at high mortality risk, mainly in those older, frail and with worse functional status. Personal and economic costs were high.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Instituciones de Salud/estadística & datos numéricos , Cuidados a Largo Plazo , Pandemias , Neumonía Viral/epidemiología , Absentismo , Anciano , Anciano de 80 o más Años , Comorbilidad , Infecciones por Coronavirus/economía , Costo de Enfermedad , Infección Hospitalaria/economía , Infección Hospitalaria/epidemiología , Anciano Frágil , Instituciones de Salud/economía , Personal de Salud/estadística & datos numéricos , Mortalidad Hospitalaria , Hospitalización/economía , Humanos , Cuidados a Largo Plazo/economía , Masculino , Mortalidad , Enfermedades Profesionales/epidemiología , Pandemias/economía , Neumonía Viral/economía , España/epidemiología
6.
BMC Public Health ; 20(1): 1561, 2020 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-33066745

RESUMEN

BACKGROUND: With many medical equipment in hospitals coming in direct contact with healthcare workers, patients, technicians, cleaners and sometimes care givers, it is important to pay close attention to their capacity in harboring potentially harmful pathogens. The goal of this study was to assess the role that medical equipment may potentially play in hospital acquired infections in four public health facilities in Uganda. METHODS: A cross-sectional study was conducted from December 2017 to January 2018 in four public health facilities in Uganda. Each piece of equipment from the neonatal department, imaging department or operating theatre were swabbed at three distinct points: a location in contact with the patient, a location in contact with the user, and a remote location unlikely to be contacted by either the patient or the user. The swabs were analyzed for bacterial growth using standard microbiological methods. Seventeen bacterial isolates were randomly selected and tested for susceptibility/resistance to common antibiotics. The data collected analyzed in STATA version 14. RESULTS: A total of 192 locations on 65 equipment were swabbed, with 60.4% of these locations testing positive (116/192). Nearly nine of ten equipment (57/65) tested positive for contamination in at least one location, and two out of three equipment (67.7%) tested positive in two or more locations. Of the 116 contaminated locations 52.6% were positive for Bacillus Species, 14.7% were positive for coagulase negative staphylococcus, 12.9% (15/116) were positive for E. coli, while all other bacterial species had a pooled prevalence of 19.8%. Interestingly, 55% of the remote locations were contaminated compared to 66% of the user contacted locations and 60% of the patient contacted locations. Further, 5/17 samples were resistant to at least three of the classes of antibiotics tested including penicillin, glycylcycline, tetracycline, trimethoprim sulfamethoxazole and urinary anti-infectives. CONCLUSION: These results provides strong support for strengthening overall disinfection/sterilization practices around medical equipment use in public health facilities in Uganda. There's also need for further research to make a direct link to the bacterial isolates identified and cases of infections recorded among patients in similar settings.


Asunto(s)
Infección Hospitalaria/epidemiología , Contaminación de Equipos/estadística & datos numéricos , Equipos y Suministros/microbiología , Hospitales Públicos , Centros de Atención Terciaria , Estudios Transversales , Humanos , Uganda/epidemiología
7.
Urologe A ; 59(11): 1407-1416, 2020 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-33078262

RESUMEN

Infections caused by multidrug-resistant pathogens and their inpatient (nosocomial) and outpatient spread, pose increasing challenges to our healthcare system. Control strategies are derived from vertical (individual, pathogen-specific) and horizontal (general, pathogen-unspecific) preventive measures. The discussion of a competing "either or" has not proven to be effective in the past. In addition, the problem of multidrug-resistant pathogens cannot be solved solely in inpatient health care: the goals are a seamless communication and transparent cooperation between all actors in the healthcare system. Nowadays, modern molecular methods for pathogen typing are available, with the help of which transmission pathways can be clarified and hospital hygiene measures can be efficiently controlled. These procedures will be used increasingly more in the future to combat the problem of multidrug resistance across interfaces within regional network structures.


Asunto(s)
Infección Hospitalaria , Antibacterianos/uso terapéutico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Hospitales , Humanos , Higiene
8.
Surgery ; 168(5): 770-776, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32943203

RESUMEN

BACKGROUND: Many hospitals have implemented visitor restriction policies in response to the coronavirus disease 2019 pandemic. Because caregivers serve an important role in postoperative recovery, the purpose of this study was to evaluate the impact of visitor restrictions on the postoperative experience of coronavirus disease 2019-negative patients undergoing surgery. METHODS: Patients who underwent surgery immediately before or after the implementation of a visitor restriction policy were enrolled. Patients were surveyed on their inpatient experience and preparedness for discharge using items adapted from validated questionnaires. RESULTS: Among 128 eligible patients, 117 agreed to participate (91.4% response rate): 58 (49.6%) in the Visitor Cohort and 59 (50.4%) in the No-Visitor Cohort. Mean age was 57.5 years (standard deviation 13.9) and 66 (56.4%) were female. Among all patients, 47.8% underwent oncologic surgery, 31.6% transplant, and 20.5% general or other. Patients in the No-Visitor Cohort were less likely to report complete satisfaction with the hospital experience (80.7% vs 66.0%, P = .044), timely receipt of medications (84.5% vs 69.0%, P = .048), and assistance getting out of bed (70.7% vs 51.7%, P = .036). No-Visitor Cohort patients were less likely to feel that their discharge preferences were adequately considered (79.3% vs 54.2%, P = .004). Qualitative analysis of patient responses highlighted the consistent psychosocial support provided by visitors after surgery (84.5%), and patients in the No-Visitor Cohort reported social isolation due to lack of psychosocial support (50.8%). CONCLUSION: The implementation of hospital visitor restriction policies may adversely impact the postoperative experience of coronavirus disease 2019-negative patients undergoing surgery. These findings highlight the urgent need for novel patient-centered strategies to improve the postoperative experience of patients during ongoing or future disruptions to routine hospital practice.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infección Hospitalaria/prevención & control , Hospitales/estadística & datos numéricos , Pandemias , Neumonía Viral/epidemiología , Visitas a Pacientes/estadística & datos numéricos , Infecciones por Coronavirus/transmisión , Infección Hospitalaria/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Ohio/epidemiología , Alta del Paciente/tendencias , Neumonía Viral/transmisión , Periodo Posoperatorio , Encuestas y Cuestionarios
9.
JAMA Netw Open ; 3(9): e2020498, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-32902653

RESUMEN

Importance: Some patients are avoiding essential care for fear of contracting coronavirus disease 2019 (COVID-19) in hospitals. There are few data, however, on the risk of acquiring COVID-19 in US hospitals. Objective: To assess the incidence of COVID-19 among patients hospitalized at a large US academic medical center in the 12 weeks after the first inpatient case was identified. Design, Setting, and Participants: This cohort study included all patients admitted to Brigham and Women's Hospital (Boston, Massachusetts) between March 7 and May 30, 2020. Follow-up occurred through June 17, 2020. Medical records for all patients who first tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction (RT-PCR) on hospital day 3 or later or within 14 days of discharge were reviewed. Exposures: A comprehensive infection control program was implemented that included dedicated COVID-19 units with airborne infection isolation rooms, personal protective equipment in accordance with US Centers for Disease Control and Prevention recommendations, personal protective equipment donning and doffing monitors, universal masking, restriction of visitors, and liberal RT-PCR testing of symptomatic and asymptomatic patients. Main Outcomes and Measures: Whether infection was community or hospital acquired based on timing of tests, clinical course, and exposures. Results: Over the 12-week period, 9149 patients (mean [SD] age, 46.1 [26.4] years; median [IQR] age, 51 years [30-67 years]; 5243 female [57.3%]) were admitted to the hospital, for whom 7394 SARS-CoV-2 RT-PCR tests were performed; 697 COVID-19 cases were confirmed, translating into 8656 days of COVID-19-related care. Twelve of the 697 hospitalized patients with COVID-19 (1.7%) first tested positive on hospital day 3 or later (median, 4 days; range, 3-15 days). Of these, only 1 case was deemed to be hospital acquired, most likely from a presymptomatic spouse who was visiting daily and diagnosed with COVID-19 before visitor restrictions and masking were implemented. Among 8370 patients with non-COVID-19-related hospitalizations discharged through June 17, 11 (0.1%) tested positive within 14 days (median time to diagnosis, 6 days; range, 1-14 days). Only 1 case was deemed likely to be hospital acquired, albeit with no known exposures. Conclusions and Relevance: In this cohort study of patients in a large academic medical center with rigorous infection control measures, nosocomial COVID-19 was rare during the height of the pandemic in the region. These findings may inform practices in other institutions and provide reassurance to patients concerned about contracting COVID-19 in hospitals.


Asunto(s)
Centros Médicos Académicos , Infecciones por Coronavirus/epidemiología , Infección Hospitalaria/epidemiología , Hospitalización , Pandemias , Neumonía Viral/epidemiología , Adulto , Anciano , Betacoronavirus , Boston/epidemiología , Coronavirus , Infecciones por Coronavirus/etiología , Infecciones por Coronavirus/virología , Infección Hospitalaria/virología , Femenino , Humanos , Incidencia , Control de Infecciones/métodos , Masculino , Persona de Mediana Edad , Neumonía Viral/etiología , Neumonía Viral/virología , Medición de Riesgo , Síndrome Respiratorio Agudo Grave , Visitas a Pacientes , Adulto Joven
10.
Antimicrob Resist Infect Control ; 9(1): 148, 2020 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-32887658

RESUMEN

BACKGROUND: Healthcare workers (HCWs) are on the front line of the COVID-19 outbreak, and their constant exposure to infected patients and contaminated surfaces puts them at risk of acquiring and transmitting the infection. Therefore, they must employ protective measures. In practice, HCWs in Israel were not fully prepared for this sudden COVID-19 outbreak. This research aimed to identify and compare: (1) Israeli HCWs' perceptions regarding the official COVID-19 guidelines' applicability and their protective value, and (2) HCWs executives' response to HWCs' concern regarding personal protective equipment (PPE) shortage. METHODS: A mixed-methods sequential explanatory design consists of: (1) An online survey of 242 HCWs about the application of the guidelines and PPE, and (2) Personal interviews of 15 HCWs executives regarding PPE shortage and the measures they are taking to address it. RESULTS: A significant difference between the perceived applicability and protective value was found for most of the guidelines. Some of the guidelines were perceived as more applicable than protective (hand hygiene, signage at entrance, alcohol rub sanitizers at entrance, and mask for contact with symptomatic patients). Other were perceived as less applicable than protective (prohibited gathering of over 10 people, maintaining a distance of 2 m', and remote services). CONCLUSIONS: HCWs need the support of the healthcare authorities not only to provide missing equipment, but also to communicate the risk to them. Conveying the information with full transparency, while addressing the uncertainty element and engaging the HCWs in evaluating the guidelines, are critical for establishing trust.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Personal de Salud/psicología , Control de Infecciones/métodos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Adulto , Actitud del Personal de Salud , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Infección Hospitalaria/transmisión , Infección Hospitalaria/virología , Femenino , Adhesión a Directriz/normas , Adhesión a Directriz/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Israel/epidemiología , Masculino , Persona de Mediana Edad , Equipo de Protección Personal , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Neumonía Viral/virología , Encuestas y Cuestionarios
11.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32883806

RESUMEN

BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are a leading cause of health care-associated infection. Catheter insertion bundles (IBs) and maintenance bundles (MBs) have been developed to prevent CAUTIs but have not been extensively validated for use in pediatric populations. We report the CAUTI prevention efforts of a large network of children's hospitals. METHODS: Children's hospitals joined the Children's Hospitals' Solutions for Patient Safety engagement network from 2011 to 2017, using an open start time engagement approach, and elected to participate in CAUTI prevention efforts, with 26 submitting data initially and 128 at the end. CAUTI prevention recommendations were first released in May 2012, and IBs and MBs were released in May 2014. Hospitals reported on CAUTIs, patient-days, and urinary catheter-line days and tracked reliability to each bundle. For the network, run charts or control charts were used to plot CAUTI rates, urinary catheter use, and reliability to each bundle component. RESULTS: After the introduction of the pediatric CAUTI IBs and MBs, CAUTI rates across the network decreased 61.6%, from 2.55 to 0.98 infections per 1000 catheter-line days. Centerline shifts occurred both before and after the 2015 Centers for Disease Control and Prevention CAUTI definition change. Urinary catheter use rates did not decline during the intervention period. Network reliability to the IBs and MBs increased to 95.4% and 86.9%, respectively. CONCLUSIONS: IBs and MBs aimed at preventing CAUTIs were introduced across a large network of children's hospitals. Across the network, the rate of urinary tract infections among hospitalized children with indwelling urinary catheters decreased 61.6%.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Catéteres de Permanencia/efectos adversos , Infección Hospitalaria/prevención & control , Paquetes de Atención al Paciente , Cateterismo Urinario/efectos adversos , Infecciones Urinarias/prevención & control , Infecciones Relacionadas con Catéteres/epidemiología , Niño , Infección Hospitalaria/epidemiología , Hospitales Pediátricos , Humanos , Seguridad del Paciente , Mejoramiento de la Calidad/organización & administración , Reproducibilidad de los Resultados , Estados Unidos/epidemiología , Infecciones Urinarias/epidemiología
12.
S Afr Med J ; 110(8): 783-790, 2020 Jul 29.
Artículo en Inglés | MEDLINE | ID: mdl-32880307

RESUMEN

BACKGROUND: Rates of healthcare-associated infections (HAIs) among babies born in developing countries are higher than among those born in resource-rich countries, as a result of suboptimal infection prevention and control (IPC) practices. Following two reported deaths of neonates with carbapenem-resistant Klebsiella pneumoniae bloodstream infections (BSIs), we conducted an outbreak investigation in a neonatal unit of a regional hospital in Gauteng Province, South Africa. OBJECTIVES: To confirm an outbreak of K. pneumoniae BSIs and assess the IPC programme in the neonatal unit. METHODS: We calculated total and organism-specific BSI incidence risks for culture-confirmed cases in the neonatal unit for baseline and outbreak periods. We conducted a clinical record review for a subset of cases with K. pneumoniae BSI that had been reported to the investigating team by the neonatal unit. An IPC audit was performed in different areas of the neonatal unit. We confirmed species identification and antimicrobial susceptibility, and used polymerase chain reaction for confirmation of carbapenemase genes and pulsed-field gel electrophoresis (PFGE) for typing of submitted clinical isolates. RESULTS: From January 2017 to August 2018, 5 262 blood cultures were submitted, of which 11% (560/5 262) were positive. Of 560 positive blood cultures, 52% (n=292) were positive for pathogenic organisms associated with healthcare-associated BSIs. K. pneumoniae comprised the largest proportion of these cases (32%; 93/292). The total incidence risk of healthcare-associated BSI for the baseline period (January 2017 - March 2018) was 6.8 cases per 100 admissions, and that for the outbreak period (April - September 2018) was 10.1 cases per 100 admissions. The incidence risk of K. pneumoniae BSI for the baseline period was 1.6 cases per 100 admissions, compared with 5.0 cases per 100 admissions during the outbreak period. Average bed occupancy for the entire period was 118% (range 101 - 133%), that for the baseline period was 117%, and that for the outbreak period was 121%. In a subset of 12 neonates with K. pneumoniae bacteraemia, the median (interquartile range (IQR)) gestational age at birth was 27 (26 - 29) weeks, and the median (IQR) birth weight was 1 100 (880 - 1 425) g. Twelve bloodstream and 31 colonising K. pneumoniae isolates were OXA-48-positive. All isolates were genetically related by PFGE analysis (89% similarity). Inadequate IPC practices were noted, including suboptimal adherence to aseptic technique and hand hygiene (57% overall score in the neonatal intensive care unit), with poor monitoring and reporting of antimicrobial use (pharmacy score 55%). CONCLUSIONS: Overcrowding and inadequate IPC and antimicrobial stewardship contributed to a large outbreak of BSIs caused by genetically related carbapenemase-producing K. pneumoniae isolates in the neonatal unit.


Asunto(s)
Bacteriemia/microbiología , Infección Hospitalaria/microbiología , Brotes de Enfermedades , Unidades Hospitalarias , Infecciones por Klebsiella/epidemiología , Programas de Optimización del Uso de los Antimicrobianos , Bacteriemia/epidemiología , Proteínas Bacterianas/metabolismo , Auditoría Clínica , Infección Hospitalaria/epidemiología , Aglomeración , Humanos , Incidencia , Recién Nacido , Control de Infecciones , Klebsiella pneumoniae/enzimología , Klebsiella pneumoniae/aislamiento & purificación , Programas Médicos Regionales , Sudáfrica/epidemiología , beta-Lactamasas/metabolismo
13.
Epidemiol Infect ; 148: e217, 2020 09 21.
Artículo en Inglés | MEDLINE | ID: mdl-32951627

RESUMEN

Coronavirus disease 2019 (COVID-19) has had a tremendous impact in China and abroad since its onset in December 2019 and poses a major threat to human health. Healthcare workers (HCWs) are at the forefront of the response to outbreaks. This study reviewed literature data and found that HCWs were at high risk of infection during the COVID-19 pandemic, especially at the early stage of the epidemic, and many factors greatly affected their occupational safety. Although SARS-CoV-2 transmission was controlled in China, the Chinese experience can help protect HCWs from COVID-19 and other respiratory diseases.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/prevención & control , Infección Hospitalaria/prevención & control , Exposición Profesional/prevención & control , Pandemias/prevención & control , Grupo de Atención al Paciente , Neumonía Viral/prevención & control , Betacoronavirus/genética , China/epidemiología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infección Hospitalaria/epidemiología , Salud Global , Comunicación en Salud , Humanos , Equipo de Protección Personal , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Reacción en Cadena de la Polimerasa , Salud Pública
14.
Antimicrob Resist Infect Control ; 9(1): 154, 2020 09 22.
Artículo en Inglés | MEDLINE | ID: mdl-32962759

RESUMEN

BACKGROUND: Currently, hospitals have been forced to divert substantial resources to cope with the ongoing coronavirus disease 2019 (COVID-19) pandemic. It is unclear if this situation will affect long-standing infection prevention practices and impact on healthcare associated infections. Here, we report a nosocomial cluster of vancomycin-resistant enterococci (VRE) that occurred on a COVID-19 dedicated intensive care unit (ICU) despite intensified contact precautions during the current pandemic. Whole genome sequence-based typing (WGS) was used to investigate genetic relatedness of VRE isolates collected from COVID-19 and non-COVID-19 patients during the outbreak and to compare them to environmental VRE samples. METHODS: Five VRE isolated from patients (three clinical and two screening samples) as well as 11 VRE and six vancomycin susceptible Enterococcus faecium (E. faecium) samples from environmental sites underwent WGS during the outbreak investigation. Isolate relatedness was determined using core genome multilocus sequence typing (cgMLST). RESULTS: WGS revealed two genotypic distinct VRE clusters with genetically closely related patient and environmental isolates. The cluster was terminated by enhanced infection control bundle strategies. CONCLUSIONS: Our results illustrate the importance of continued adherence to infection prevention and control measures during the COVID-19 pandemic to prevent VRE transmission and healthcare associated infections.


Asunto(s)
Coinfección/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/epidemiología , Enterococos Resistentes a la Vancomicina/efectos de los fármacos , Betacoronavirus , Coinfección/microbiología , Infecciones por Coronavirus/patología , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Brotes de Enfermedades , Genoma Bacteriano/genética , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Control de Infecciones , Unidades de Cuidados Intensivos , Tipificación de Secuencias Multilocus , Pandemias , Neumonía Viral/patología , Prevención Primaria , Enterococos Resistentes a la Vancomicina/genética , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Secuenciación Completa del Genoma
15.
Acta Biomed ; 91(3): e2020016, 2020 09 07.
Artículo en Inglés | MEDLINE | ID: mdl-32921712

RESUMEN

The paper wants to present the data of infection of the Health Care Workers of a research and teaching hospital in Milan, Italy. The majority (2554, 55.9%) of 4572 HCWs were tested for SARS-CoV-2 and 8.8% were found positive. Most of the tested workers were women, but we found higher relative frequency of positivity for men, even after adjustment for age, working area, and occupation. The higher frequency of positive tests in the medicine area is probably explained by the higher concentration in that area of COVID-19 patients. Conversely, the low frequency of positive HCWs in intensive care units is  probably explained by the diffuse and continuous use of PPD. Our results show that HCWs in a research and teaching hospital in the most hit Region in Italy had a similar pattern of infection as all other HCWs all over the world. The problem of SARS-CoV-2 infections among the hospital personnel HCWs should remind us  the concerns about hospital acquired infections both for patients and HCWs.


Asunto(s)
Anticuerpos Antivirales/análisis , Betacoronavirus/inmunología , Infecciones por Coronavirus/transmisión , Infección Hospitalaria/epidemiología , Personal de Salud/estadística & datos numéricos , Hospitales de Enseñanza/estadística & datos numéricos , Neumonía Viral/transmisión , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología
16.
Acta Biomed ; 91(3): e2020017, 2020 09 07.
Artículo en Inglés | MEDLINE | ID: mdl-32921713

RESUMEN

The aim of this study is to assess the association among species of bacteria and to identify the presence of clusters of patients in sub intensive care unit with different profiles of infection, and to study the relationship between such profiles and patient demographics (gender, age), kind of investigations and  material used to detect the infection. The findings need to analyse a bigger amount of data in the same setting to make evident that it is constant the infection only with Escherichia coli and Staphylocossus epidemidis and a third case in which more bacteria are inlvolved.


Asunto(s)
Antibacterianos/uso terapéutico , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infección Hospitalaria/epidemiología , Unidades de Cuidados Intensivos/estadística & datos numéricos , Pandemias , Neumonía Viral/epidemiología , Anciano , Infección Hospitalaria/tratamiento farmacológico , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad
17.
Ann Ist Super Sanita ; 56(3): 359-364, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32959802

RESUMEN

Current literature shows that secondary bacterial infections, although less frequent than in previous influenza pandemics, affect COVID-19 patients. Mycoplasma pneumoniae, Staphylococcus aureus, Legionella pneumophila, Streptococcus pneumoniae, Haemophilus and Klebsiella spp. are the main species isolated. Of note, Mycobacterium tuberculosis-COVID-19 coinfections are also reported. However, bacterial coinfection rates increase in patients admitted in the intensive care units, and those diseases can be due to super-infections by nosocomial antibiotic-resistant bacteria. This highlights the urgency to revise frequent and empiric prescription of broad-spectrum antibiotics in COVID-19 patients, with more attention to evidence-based studies and respect for the antimicrobial stewardship principles.


Asunto(s)
Infecciones Bacterianas/epidemiología , Betacoronavirus , Coinfección/epidemiología , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , Programas de Optimización del Uso de los Antimicrobianos , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/transmisión , Infección Hospitalaria/epidemiología , Infección Hospitalaria/transmisión , Farmacorresistencia Microbiana , Diagnóstico Precoz , Humanos , Unidades de Cuidados Intensivos , Italia/epidemiología , Micosis/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/microbiología , Especificidad de la Especie , Tuberculosis/epidemiología
18.
J Hosp Infect ; 106(3): 621-625, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32841703

RESUMEN

Transmission of coronavirus disease 2019 (COVID-19) in healthcare settings has significant implications for patients and healthcare workers, may amplify local outbreaks, and may place additional burden on already stretched resources. Risk of missed or late diagnosis of COVID-19 was high during the UK's initial 'containment phase', because of strict criteria for testing. The risk remains due to asymptomatic/pre-symptomatic transmission, complicated by challenges faced with laboratory testing. We present a case study of potential nosocomial transmission associated with the first case of COVID-19 at a large acute NHS Trust in South-West London, and we describe the prevailing burden of nosocomial infections.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Enfermería de Cuidados Críticos/estadística & datos numéricos , Infección Hospitalaria/epidemiología , Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Medicina Estatal/estadística & datos numéricos , Adulto , Betacoronavirus , Femenino , Humanos , Londres/epidemiología , Masculino , Persona de Mediana Edad , Pandemias/estadística & datos numéricos
20.
PLoS One ; 15(8): e0237692, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32797094

RESUMEN

BACKGROUND: Our hospital experienced the first healthcare-associated COVID-19 outbreak in Seoul at the time the first COVID-19 cases were confirmed in Korea. The first confirmed COVID-19 patient was a hospital personnel who was in charge of transferring patients inside our hospital. To contain the virus spread, we shutdown our hospital, and tested all inpatients, medical staff members, and employees. METHODS: We retrospectively analyzed the results of SARS-CoV-2 RT-PCR testing according to the contact history, occupation, and presence of respiratory symptoms. Closed-circuit television (CCTV) was reviewed in the presence of an epidemiologist to identify individuals who came into contact with confirmed COVID-19 patients. RESULTS: A total of 3,091 respiratory samples from 2,924 individuals were obtained. Among 2,924 individuals, two inpatients, and one caregiver tested positive (positivity rate, 0.1%). Although all confirmed cases were linked to a general ward designated for pulmonology patients, no medical staff members, medical support personnel, or employees working at the same ward were infected. Contact with confirmed COVID-19 cases was frequent among inpatients and medical support personnel. The most common contact area was the general ward for pulmonology patients and medical support areas, including clinical and imaging examination rooms. Finally, the total number of hospital-associated infections was 14, consisting of four diagnosed at our hospital and ten diagnosed outside the hospital. CONCLUSIONS: The robust control of the COVID-19 outbreak further minimized the transmission of SARS-CoV-2 in the hospital and local communities. However, there was also a debate over the appropriate period of hospital shutdown and testing of all hospital staff and patients. Future studies are required to refine and establish the in-hospital quarantine and de-isolation guidelines based on the epidemiological and clinical settings.


Asunto(s)
Betacoronavirus/genética , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Transmisión de Enfermedad Infecciosa/prevención & control , Hospitales Universitarios , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/virología , Infección Hospitalaria/virología , Femenino , Personal de Salud , Humanos , Masculino , Persona de Mediana Edad , Habitaciones de Pacientes , Neumonía Viral/diagnóstico , Neumonía Viral/virología , Cuarentena/métodos , Estudios Retrospectivos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Seúl/epidemiología , Adulto Joven
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