Risk stratification as a tool to rationalize quarantine among health care workers exposed to COVID-19 cases - Evidence from a tertiary healthcare centre in India

BackgroundQuarantine of healthcare workers (HCWs) exposed to COVID -19 confirmed cases is a well-known strategy for limiting the transmission of infection. However, there is need of evidence-based guidelines for quarantine of HCWs in COVID -19. MethodsWe describe our experience of contact tracing and risk stratification of 3853 HCWs who were exposed to confirmed COVID-19 cases in a tertiary health care institution in India. We developed an algorithm, on the basis of risk stratification, to rationalize quarantine among HCWs. Risk stratification was based on the duration of exposure, distance from the patient, and appropriateness of personal protection equipment (PPE) usage. Only high-risk contacts were quarantined for 14 days. They underwent testing for COVID-19 after five days of exposure, while low-risk contacts continued their work with adherence to physical distancing, hand hygiene, and appropriate use of PPE. The low-risk contacts were encouraged to monitor for symptoms and report for COVID-19 screening if fever, cough, or shortness of breath occurred. We followed up all contacts for 14 days from the last exposure and observed for symptoms of COVID-19 and test positivity. Results and interpretationOut of total 3853 contacts, 560 (14.5%) were categorized as high-risk contacts, and 40 of them were detected positive for COVID-19, with a test positivity rate of 7.1% (95% CI = 5.2 - 9.6). Overall, 118 (3.1%) of all contacts tested positive. Our strategy prevented 3215 HCWs from being quarantined and saved 45,010 person-days of health workforce until June 8, 2020, in the institution. We conclude that exposure-based risk stratification and quarantine of HCWs is a viable strategy to prevent unnecessary quarantine, in a healthcare institution. SummaryO_ST_ABSWhat is already known about this subject?C_ST_ABSO_LIQuarantine of HCWs is a well-known strategy for community and HCWs to prevent the transmission of COVID-19. C_LIO_LIThough success stories of prompt contact tracing and quarantine to control COVID-19 are available from countries like South Korea, Singapore, and Hong Kong, there is a scarcity of evidence that could guide targeted quarantine of HCWs exposed to COVID -19 in India. C_LI What does this study add?O_LIOnly 14.5% HCWs exposed to COVID-19 cases were stratified "high risk" contacts, and the most common reason for high-risk contacts was non-formal workplace interactions such as having meals together. C_LIO_LIThe overall test positivity rate among the high-risk contacts was 7.1%, while it was higher in symptomatic high-risk contacts as compared to those who were asymptomatic (10.2% vs. 6.3%). C_LI How might this impact on clinical practice?O_LIContact tracing and risk stratification can be used to minimize unnecessary quarantine of COVID-19 exposed health care workers and prevent the depletion of healthcare workers amidst the pandemic to continue the healthcare services optimally. C_LI

Assessment of core capacities for antimicrobial stewardship practices in indian hospitals: Report from a multicentric initiative of global health security agenda.

Introduction: Antimicrobial-resistant HAI (Healthcare associated infection) are a global challenge due to their impact on patient outcome. Implementation of antimicrobial stewardship programmes (AMSP) is needed at institutional and national levels. Assessment of core capacities for AMSP is an important starting point to initiate nationwide AMSP. We conducted an assessment of the core capacities for AMSP in a network of Indian hospitals, which are part of the Global Health Security Agenda-funded work on capacity building for AMR-HAIs. Subjects and Methods: The Centers for Disease Control and Prevention's core assessment checklist was modified as per inputs received from the Indian network. The assessment tool was filled by twenty hospitals as a self-administered questionnaire. The results were entered into a database. The cumulative score for each question was generated as average percentage. The scores generated by the database were then used for analysis. Results and Conclusion: The hospitals included a mix of public and private sector hospitals. The network average of positive responses for leadership support was 45%, for accountability; the score was 53% and for key support for AMSP, 58%. Policies to support optimal antibiotic use were present in 59% of respondents, policies for procurement were present in 79% and broad interventions to improve antibiotic use were scored as 33%. A score of 52% was generated for prescription-specific interventions to improve antibiotic use. Written policies for antibiotic use for hospitalised patients and outpatients were present on an average in 72% and 48% conditions, respectively. Presence of process measures and outcome measures was scored at 40% and 49%, respectively, and feedback and education got a score of 53% and 40%, respectively. Thus, Indian hospitals can start with low-hanging fruits such as developing prescription policies, restricting the usage of high antibiotics, enforcing education and ultimately providing the much-needed leadership support.

Fosphomycin: A ray of hope against multidrug resistant uropathogens

Aims@#Urinary Tract Infection (UTI) is one of the common infections in clinical practice. Increasing incidence of Multi Drug Resistant (MDR) uropathogens limited the therapeutic options; thereby prompted the interest in old drugs like Fosphomycin. The current study was undertaken for the comparative evaluation of vitro activity of Fosphomycin and Nitrofurantoin against ESBL producing and carbapenem resistant uropathogens. We also tried to compare the coexistence of resistance of both the drugs with another commonly used oral drug for UTI, i.e. Flouroquinolone. @*Methodology and results@#A total 101 MDR uropathogens were tested for ESBL production, carbapenem resistance, Fosphomycin susceptibility and Nitrofurantoin susceptibility as per the CLSI guidelines. Fosphomycin susceptibility testing was carried out by disc diffusion test. Klebsiella pneumoniae was the commonest MDR uropathogen followed by Pseudomonas aeruginosa and Escherichia coli. Susceptibility to Fosphomycin among the ESBL producer and carbapenem resistant uropathogen was found uniformly higher (91.8%, 90.1%) in comparison to Nitrofurantion (27.5%, 21.3%). Coexistence of resistance to Fosphomycin was much less than Nitrofurantoin in presence of resistance to Flouroquinolone. @*Conclusion, significance and impact of study@#Fosphomycin showed excellent in vitro susceptibility against both ESBL producing and carbapenem resistant MDR uropathogens. Fosphomycin has excellent in vitro action of Fosphomycin against ESBL producing and carbapenem resistance uropathogen in comparison to Nitrofurantoin, hence will be useful for the treatment of drug resistsant uropathogens.

Utility of 16S rRNA PCR in the Synovial Fluid for the Diagnosis of Prosthetic Joint Infection

No abstract available.