Navigating Infection Control Processes in a COVID-19 Only Safety-Net Hospital at the Height of the Pandemic.

Hospitals faced extraordinary challenges during the pandemic. Some of these were directly related to patient care-expanding capacities, adjusting services, and using new knowledge to save lives in a dynamically changing situation. Other challenges were regulatory. The COVID-19 pandemic significantly disrupted routine hospital infection control practices. We report the results of an interview study with 13 individuals associated with infection control in a small independent hospital. We employed the Systems Engineering Initiative for Patient Safety (SEIPS) model as a theoretical framework and as a basis to analyze data. The findings revealed how routine practices and protocols were displaced in notable ways. Due to COVID-19, clinical activities were modified, and the increased demands of regulatory reporting became laborious, and punitive if reports were late. Strategies are needed to mitigate increases in healthcare-associated infections. Our examination of the information flows, transformation, and needs shows areas in which digital tool creation and the use of a trained informatics workforce could ameliorate and automate many processes.

Simulating a Vertical Evacuation of a NICU and PICU to Examine the Relationship Between Training and Preparedness.

OBJECTIVE: The aim of this study was to implement pediatric vertical evacuation disaster training and evaluate its effectiveness by using a full-scale exercise to compare outcomes in trained and untrained participants. METHODS: Various clinical and nonclinical staff in a tertiary care university hospital received pediatric vertical evacuation training sessions over a 6-wk period. The training consisted of disaster and evacuation didactics, hands-on training in use of evacuation equipment, and implementation of an evacuation toolkit. An unannounced full-scale simulated vertical evacuation of neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) patients was used to evaluate the effectiveness of the training. Drill participants completed a validated evaluation tool. Pearson chi-squared testing was used to analyze the data. RESULTS: Eighty-four evaluations were received from drill participants. Forty-three (51%) of the drill participants received training and 41 (49%) did not. Staff who received pediatric evacuation training were more likely to feel prepared compared with staff who did not (odds ratio, 4.05; confidence interval: 1.05-15.62). CONCLUSIONS: There was a statistically significant increase in perceived preparedness among those who received training. Recently trained pediatric practitioners were able to achieve exercise objectives on par with the regularly trained emergency department staff. Pediatric disaster preparedness training may mitigate the risks associated with caring for children during disasters.

Factors Influencing the Prioritization of Injured Patients for Transfer to a Burn or Trauma Center Following a Mass Casualty Event.

OBJECTIVES: In New York City, a multi-disciplinary Mass Casualty Consultation team is proposed to support prioritization of patients for coordinated inter-facility transfer after a large-scale mass casualty event. This study examines factors that influence consultation team prioritization decisions. METHODS: As part of a multi-hospital functional exercise, 2 teams prioritized the same set of 69 patient profiles. Prioritization decisions were compared between teams. Agreement between teams was assessed based on patient profile demographics and injury severity. An investigator interviewed team leaders to determine reasons for discordant transfer decisions. RESULTS: The 2 teams differed significantly in the total number of transfers recommended (49 vs 36; P = 0.003). However, there was substantial agreement when recommending transfer to burn centers, with 85.5% agreement and inter-rater reliability of 0.67 (confidence interval: 0.49-0.85). There was better agreement for patients with a higher acuity of injuries. Based on interviews, the most common reason for discordance was insider knowledge of the local community hospital and its capabilities. CONCLUSIONS: A multi-disciplinary Mass Casualty Consultation team was able to rapidly prioritize patients for coordinated secondary transfer using limited clinical information. Training for consultation teams should emphasize guidelines for transfer based on existing services at sending and receiving hospitals, as knowledge of local community hospital capabilities influence physician decision-making.

Universal Prenatal Screening and Testing and Chlamydia trachomatis Conjunctivitis in Infants.

ABSTRACT: We retrospectively reviewed all infant Chlamydia trachomatis eye cultures submitted to the Chlamydia Research Laboratory from 1986 to 2002. The positivity rate was 15.6% during the period before the implementation of universal prenatal screening (1986-1993) compared with 1.8% during the screening period (1994-2002).

Comparing Training Techniques in Personal Protective Equipment Use.

INTRODUCTION: Physicians' management of hazardous material (HAZMAT) incidents requires personal protective equipment (PPE) utilization to ensure the safety of victims, facilities, and providers; therefore, providing effective and accessible training in its use is crucial. While an emphasis has been placed on the importance of PPE, there is debate about the most effective training methods. Circumstances may not allow for a traditional in-person demonstration; an accessible video training may provide a useful alternative. HYPOTHESIS: Video training of Emergency Medicine (EM) residents in the donning and doffing of Level C PPE is more effective than in-person training. NULL HYPOTHESIS: Video training of EM residents in the donning and doffing of Level C PPE is equally effective compared with in-person training. METHODS: A randomized, controlled pilot trial was performed with 20 EM residents as part of their annual Emergency Preparedness training. Residents were divided into four groups, with Group 1 and Group 2 viewing a demonstration video developed by the Emergency Preparedness Team (EPT) and Group 3 and Group 4 receiving the standard in-person demonstration training by an EPT member. The groups then separately performed a donning and doffing simulation while blinded evaluators assessed critical tasks utilizing a prepared evaluation tool. At the drill's conclusion, all participants also completed a self-evaluation survey about their subjective interpretations of their respective trainings. RESULTS: Both video and in-person training modalities showed significant overall improvement in participants' confidence in doffing and donning PPE equipment (P <.05). However, no statistically significant difference was found in the number of failed critical tasks in donning or doffing between the training modalities (P >.05). Based on these results, the null hypothesis cannot be rejected. However, these results were limited by the small sample size and the study was not sufficiently powered to show a difference between training modalities. CONCLUSION: In this pilot study, video and in-person training were equally effective in training for donning and doffing Level C PPE, with similar error rates in both modalities. Further research into this subject with an appropriately powered study is warranted to determine whether this equivalence persists using a larger sample size.

The Challenges of a Vertical Evacuation Drill.

INTRODUCTION: Recent natural and infrastructural disasters, such as Hurricanes Sandy (2012) and Katrina (2005) and the Northeastern power outage of 2003, have emphasized the need for hospital staff to be trained in disaster management and response. Even an internal hospital disaster may require the safe and efficient evacuation and transfer of patients with varying medical conditions and complications. A notably susceptible population is renal transplant patients, including those with post-transplant complications. HYPOTHESIS: This descriptive study evaluated staff performance of a vertical evacuation drill of renal transplant patients at State University of New York (SUNY) Downstate Medical Center - University Hospital Brooklyn (UHB; Brooklyn, New York USA). METHODS: Thirteen standardized patients, 12 of whom received a renal transplant, with varying medical histories, ambulatory ability, and mental status were vertically evacuated by the transplant staff from the eighth floor to the ambulance entrance on the ground floor. Non-ambulatory patients were transported on portable evacuation sleds. RESULTS: All patients were evacuated successfully within 3.5 hours. On a post-drill evaluation form, drill participants self-reported largely positive results concerning their own role in the drill and the evacuation drill itself. Drill evaluators observed very different results, including staff reticence, poor training retention, and lack of leadership. CONCLUSION: Despite encouraging post-drill evaluation results from the participants, the evacuation drill highlighted several immediate deficiencies. It also demonstrated a significant discrepancy in performance perception between the drill participants and the drill evaluators.SalwayRJ, AdlerZ, WilliamsT, NwokeF, RoblinP, ArquillaB. The challenges of a vertical evacuation drill. Prehosp Disaster Med. 2019;34(1):25-29.

Evaluation of the association between disaster training and confidence in disaster response among graduate medical trainees: A cross-sectional study.

OBJECTIVE: Disasters by definition overwhelm the resources of a hospital and may require a response from a range of practitioners. Disaster training is part of emergency medicine (EM) resident curricula, but less emphasized in other training programs. This study aimed to compare disaster educational training and confidence levels among resident trainees from multiple specialties. DESIGN: A structured questionnaire assessed graduate medical training in disaster education and self-perceived confidence in disaster situations. Cross-sectional sampling of resident trainees from the departments of surgery, pediatrics, internal medicine, and EM was performed. SETTING: The study took place at a large urban academic medical center during March 2013. PARTICIPANTS: Among 331 available residents, a convenience sample of 157 (47.4 percent) was obtained. MAIN OUTCOME MEASURES: Outcomes investigated include resident confidence in various disaster scenarios, volume of disaster training currently received, and preferred education modality. RESULTS: EM trainees reported 7.3 hours of disaster instruction compared to 1.3 hours in non-EM trainees (p < 0.001). EM residents reported significantly more confidence in disaster scenarios compared to non-EM residents except for overall low confidence levels for mega mass casualty incidents. The preferred education modality for both EM and non-EM residents was simulation exercises followed by lecture. CONCLUSIONS: This study demonstrated relatively lower confidence among non-EM residents in disaster response as well as lower number of disaster education time. These data report a learner preference for simulation training.

Use of Medical Reserve Corps Volunteers in a Hospital-based Disaster Exercise.

UNLABELLED: Introduction The Medical Reserve Corps (MRC) is a national network of community-based volunteer groups created in 2002 by the Office of the United States Surgeon General (Rockville, Maryland USA) to augment the nation's ability to respond to medical and public health emergencies. However, there is little evidence-based literature available to guide hospitals on the optimal use of medical volunteers and hesitancy on the part of hospitals to use them. Hypothesis/Problem This study sought to determine how MRC volunteers can be used in hospital-based disasters through their participation in a full-scale exercise. METHODS: A full-scale exercise was designed as a "Disaster Olympics," in which the Emergency Medicine residents were divided into teams tasked with completing one of the following five challenges: victim decontamination, mass casualty/decontamination tent assembly, patient triage and registration during a disaster, point of distribution (POD) site set-up and operation, and infection control management. A surge of patients potentially exposed to avian influenza was the scenario created for the latter three challenges. Some MRC volunteers were assigned clinical roles. These roles included serving as members of the suit support team for victim decontamination, distributing medications at the POD, and managing infection control. Other MRC volunteers functioned as "victim evaluators," who portrayed the potential avian influenza victims while simultaneously evaluating various aspects of the disaster response. The MRC volunteers provided feedback on their experience and evaluators provided feedback on the performance of the MRC volunteers using evaluation tools. RESULTS: Twenty-eight (90%) MRC volunteers reported that they worked well with the residents and hospital staff, felt the exercise was useful, and were assigned clearly defined roles. However, only 21 (67%) reported that their qualifications were assessed prior to role assignment. For those MRC members who functioned as "victim evaluators," nine identified errors in aspects of the care they received and the disaster response. Of those who evaluated the MRC, nine (90%) felt that the MRC worked well with the residents and hospital staff. Ten (100%) of these evaluators recommended that MRC volunteers participate in future disaster exercises. CONCLUSION: Through use of a full-scale exercise, this study was able to identify roles for MRC volunteers in a hospital-based disaster. This study also found MRC volunteers to be uniquely qualified to serve as "victim evaluators" in a hospital-based disaster exercise. Gist R , Daniel P , Grock A , Lin C , Bryant C , Kohlhoff S , Roblin P , Arquilla B . Use of Medical Reserve Corps volunteers in a hospital-based disaster exercise. Prehosp Disaster Med. 2016;31(3):259-262.

Exposure to cigarette smoke and Chlamydia pneumoniae infection in mice: Effect on infectious burden, systemic dissemination and cytokine responses: A pilot study.

Cigarette smoke exposure has been considered a risk factor for infection with Chlamydia pneumoniae. C. pneumoniae infection is associated with respiratory tract infection and chronic respiratory disease, which is a serious public health concern. To determine whether prior exposure to cigarette smoke worsens C. pneumoniae infection (specifically, increases infectious burden and systemic dissemination) as well as alters cytokine responses in mice, adult female C57BL/6 mice were exposed to either filtered air (FA) or mainstream cigarette smoke (MCS) (15 mg/m(3), total suspended particulates) for 5 days/week for 2 weeks and then infected with C. pneumoniae (10(5) IFU) via intratracheal instillation. Mice were euthanized on Days 7, 14 or 26 post-infection (p.i.). Chlamydial burdens in the lungs and spleen were quantified by quantitative PCR (qPCR) and histologic analyses were performed; cytokine levels (TNFα, IL-4, IFNγ) in bronchoalveolar lavage fluid and serum were assayed by enzyme-linked immunosorbent assay (ELISA). The results indicated that: (1) mice exposed to either FA or MCS had similar chlamydial burdens in the lungs and spleen on Days 14 and 26 p.i.; (2) proximal and distal airway inflammation was observed on Day 14 p.i. in both FA and MCS mice, but persisted in MCS mice until Day 26 p.i.; FA exposed mice demonstrated resolution of distal airway inflammation; and (3) MCS mice displayed higher serum levels of IFNγ and IL-4 on Day 26 p.i. These findings indicate that exposure of mice to MCS (at a concentration equivalent to smoking < 1 pack cigarettes/day) led to greater C. pneumoniae-induced inflammation, as indicated by prolonged inflammatory changes.

Mass-casualty Response to the Kiss Nightclub in Santa Maria, Brazil.

On January 27, 2013, a fire at the Kiss Nightclub in Santa Maria, Brazil led to a mass-casualty incident affecting hundreds of college students. A total of 234 people died on scene, 145 were hospitalized, and another 623 people received treatment throughout the first week following the incident.1 Eight of the hospitalized people later died.1 The Military Police were the first on scene, followed by the state fire department, and then the municipal Mobile Prehospital Assistance (SAMU) ambulances. The number of victims was not communicated clearly to the various units arriving on scene, leading to insufficient rescue personnel and equipment. Incident command was established on scene, but the rescuers and police were still unable to control the chaos of multiple bystanders attempting to assist in the rescue efforts. The Municipal Sports Center (CDM) was designated as the location for dead bodies, where victim identification and communication with families occurred, as well as forensic evaluation, which determined the primary cause of death to be asphyxia. A command center was established at the Hospital de Caridade Astrogildo de Azevedo (HCAA) in Santa Maria to direct where patients should be admitted, recruit staff, and procure additional supplies, as needed. The victims suffered primarily from smoke inhalation and many required endotracheal intubation and mechanical ventilation. There was a shortage of ventilators; therefore, some had to be borrowed from local hospitals, neighboring cities, and distant areas in the state. A total of 54 patients1 were transferred to hospitals in the capital city of Porto Alegre (Brazil). The main issues with the response to the fire were scene control and communication. Areas for improvement were identified, namely the establishment of a disaster-response plan, as well as regularly scheduled training in disaster preparedness/response. These activities are the first steps to improving mass-casualty responses.

Impact of Hurricane Sandy on hospital emergency and dialysis services: a retrospective survey.

OBJECTIVE: Hurricane Sandy forced closures of many free-standing dialysis centers in New York City in 2012. Hemodialysis (HD) patients therefore sought dialysis treatments from nearby hospitals. The surge capacity of hospital dialysis services was the rate-limiting step for streamlining the emergency department flow of HD patients. The aim of this study was to determine the extent of the HD patients surge and to explore difficulties encountered by hospitals in Brooklyn, New York (USA) due to Hurricane Sandy. METHODS: A retrospective survey on hospital dialysis services was conducted by interviewing dialysis unit managers, focusing on the influx of HD patients from closed dialysis centers to hospitals, coping strategies these hospitals used, and difficulties encountered. RESULTS: In total, 347 HD patients presented to 15 Brooklyn hospitals for dialysis. The number of transient HD patients peaked two days after landfall and gradually decreased over a week. Hospital dialysis services reported issues with lack of dialysis documentation from transient dialysis patients (92.3%), staff shortage (50%), staff transportation (71.4%), and communication with other agencies (53.3%). Linear regression showed that factors significantly associated with enhanced surge capacity were the size of inpatient dialysis unit (P = .040), having affiliated outpatient dialysis centers (P = .032), using extra dialysis machines (P = .014), and having extra workforce (P = .007). Early emergency plan activation (P = .289) and shortening treatment time (P = .118) did not impact the surge capacity significantly in this study. CONCLUSION: These findings provide potential improvement options for receiving hospitals dialysis units to prepare for future events.

Waterworks, a full-scale chemical exposure exercise: interrogating pediatric critical care surge capacity in an inner-city tertiary care medical center.

INTRODUCTION: Pediatric Intensive Care Unit (PICU) resources are overwhelmed in disaster as the need to accommodate influx of critically-ill children is increased. A full-scale chlorine overexposure exercise was conducted by the New York Institute for All Hazard Preparedness (NYIAHP) to assess the appropriateness of response of Kings County Hospital Center's (KCHC's) PICU surge plan to an influx of critically-ill children. The primary endpoint that was assessed was the ability of the institution to follow the PICU surge plan, while secondary endpoints include the ability to provide appropriate medical management. METHODS: Thirty-six actors/patients (medical students or emergency medicine residents) were educated on presentations and appropriate medical management of patients after a chlorine overexposure, as well as lectures on drill design and expected PICU surge response. Victims presented to the hospital after simulated accidental chlorine overexposure at a public pool. Twenty-two patients with 14 family members needed evaluation; nine of these patients would require PICU admission. Three of nine PICU patients were low-fidelity mannequins. In addition to the 36 actor/patient evaluators, each area had two to four expert evaluators (disaster preparedness experts) to assess appropriateness of global response. Patients were expected to receive standard of care. Appropriateness of medical decisions and treatment was assessed retrospectively with review of electronic medical record. RESULTS: The initial PICU census was three of seven; two of these patients were transferred to the general ward. Of the nine patients that required Intensive Care Unit (ICU) admission, six actor/patients were admitted to the PICU, one was admitted to the Surgical Intensive Care Unit (SICU), one went to the Operating Room (OR), and one was admitted to a monitored-surge general pediatric bed. The remaining 13 actor/patients were treated and released. Medical, nursing, and respiratory staffing in the PICU and the general ward were increased by two main mechanisms (extension of work hours and in-house recruitment of additional staff). Emergency Department (ED) staffing was artificially increased prior to the drill. With the exception of ocular fluid pH testing in patients with ocular pruritus, all necessary treatments were given; however, an unneeded albuterol treatment was administered to one patient. Chart review showed adequate discharge instructions in four of 13 patients. Nine patients without respiratory complaints in the ED were not instructed to observe for dyspnea. All patients were in the PICU or alternate locations within 90 minutes. Discussion The staff was well versed in the major details of KCHC's PICU surge plan, which allowed smooth transition of patient care from the ED to the PICU. The plan provided for a roadmap to achieve adequate medical, nursing, and respiratory therapists. Medical therapy was appropriate in the PICU; however, in the ED, patients with ocular complaints did not receive optimal care. In addition, written discharge instruction and educational material regarding chlorine overexposure to all patients were not consistently provided. The PICU surge plan was immediately accessible through the KCHC intranet; however, not all participants were cognizant of this fact; this decreased the efficiency with which the roadmap was followed. An exaggerated ED staff facilitated evaluation and transfer of patients. CONCLUSION: During disasters, the ability to surge is paramount and each hospital addresses it differently. Hospitals and departments have written surge plans, but there is no literature available which assesses the validity of said plans through a rigorous, structured, simulated disaster drill. This study is the first to assess validity and effectiveness of a hospital's PICU surge plan. Overall, the KCHC PICU surge plan was effective; however, several deficiencies (mainly in communication and patient education in the ED) were identified, and this will improve future response.

Assessing hospital preparedness: comparison of an on-site survey with a self-reported, internet-based, long-distance tabletop drill.

BACKGROUND: Methods of defining hospital disaster preparedness are poorly defined in the literature, leaving wide discrepancies between a hospital's self-reported preparedness and that assessed by an objective reviewer. OBJECTIVES: This study compared self-reported surge capacity data from individual hospitals, obtained from a previously reported long-distance tabletop drill (LDTT) prior to the 2010 FIFA World Cup tournament in Cape Town, South Africa, with surge capacity data assessed by an on-site survey inspection team. METHODS: In this prospective, observational study, contact persons used in the prior LDTT assessing hospital disaster preparedness in the lead-up to the 2010 FIFA World Cup made surge capacity assessments (licensed bed capacity plus surge capacity beds) for the respiratory intensive care unit (RICU), neonatal intensive care unit (NICU), medical intensive care unit (MICU), and general medical/surgical beds in each hospital. Following the 2010 World Cup, this data was then re-evaluated by an on-site survey team consisting of two of the authors. RESULTS: The contact persons for the individual hospitals from the LDTT underreported their individual hospital's surge capacity in 86% (95% CI, 46%-99%) of RICU beds; 100% (95% CI, 63%-100%) of MICU beds; 75% (95% CI, 40%-94%) of NICU beds; and 71% (95% CI, 35%-92%) of medical/surgical beds compared with the on-site inspection team. CONCLUSIONS: The contact persons for the LDTT overwhelmingly underreported surge capacity beds compared with the surge capacity determined by the on-site inspection team.

Addressing the gaps in preparation for quarantine.

INTRODUCTION: In the event of an outbreak of a communicable respiratory illness, quarantine may become necessary. The New York Institute for All Hazard Preparedness (NYIAHP) of the State University of New York (SUNY) Downstate Medical Center, in cooperation with the New York City Department of Health and Mental Hygiene's Healthcare Emergency Preparedness Program, (NYC DOHMH-HEPP) quarantine working group, has developed a series of clinical protocols to help health care facilities respond to such an event. PROBLEM: Two full-scale exercises (FSEs) were designed and conducted a year apart in the quarantine unit at Kings County Hospital Center (KCHC) to test the efficacy and feasibility of these quarantine protocols. The goal of these exercises was to identify the gaps in preparedness for quarantine and increase hospital readiness for such an event. METHODS: Evaluators monitored for efficient management of critical physical plants, personnel and material resources. Players were expected to integrate and practice emergency response plans and protocols specific to quarantine. In developing the exercise objectives, five activities were selected for evaluation: Activation of the Unit, Staffing, Charting/Admission, Symptom Monitoring and Infection Control, and Client Management. RESULTS: The results of the initial FSE found that there were incomplete critical tasks within all five protocols: These deficiencies were detailed in an After Action Report and an Improvement Plan was presented to the KCHC Disaster Preparedness Committee a month after the initial FSE. In the second FSE a year later, all critical tasks for Activation of the unit, Staffing and Charting/Admission were achieved. Completion of critical tasks related to Symptom Monitoring and Infection Control and Client Management was improved in the second FSE, but some tasks were still not performed appropriately. CONCLUSION: In short, these exercises identified critical needs in disaster preparedness of the KCHC Quarantine Unit. The lessons learned from this logistical exercise enabled the planning group to have a better understanding of leadership needs, communication capabilities, and infection control procedures. Kings County Hospital Center performed well during these exercises. It was clear that performance in the second exercise was improved, and many problems noted in the first exercise were corrected. Staff also felt better prepared the second time. This supports the idea that frequent exercises are vital to maintain disaster readiness.

Evaluation of hospital mass screening and infection control practices in a pandemic influenza full-scale exercise.

OBJECTIVE: Nonpharmacologic interventions such as limiting nosocomial spread have been suggested for mitigation of respiratory epidemics at health care facilities. This observational study tested the efficacy of a mass screening, isolation, and triage protocol in correctly identifying and placing in a cohort exercise subjects according to case status in the emergency departments at 3 acute care hospitals in Brooklyn, New York, during a simulated pandemic influenza outbreak. METHODS: During a 1-day, full-scale exercise using 354 volunteer victims, variables assessing adherence to the mass screening protocol and infection control recommendations were evaluated using standardized forms. RESULTS: While all hospitals were able to apply the suggested mass screening protocol for separation based on case status, significant differences were observed in several infection control variables among participating hospitals and different hospital areas. CONCLUSIONS: Implementation of mass screening and other infection control interventions during a hospital full-scale exercise was feasible and resulted in measurable outcomes. Hospital drills may be an effective way of detecting and addressing variability in following infection control recommendations.

Assessment of hospital disaster preparedness for the 2010 FIFA World Cup using an internet-based, long-distance tabletop drill.

INTRODUCTION: The State University of New York at Downstate (SUNY) conducted a web-based long-distance tabletop drill (LDTT) designed to identify vulnerabilities in safety, security, communications, supplies, incident management, and surge capacity for a number of hospitals preceding the 2010 FIFA World Cup. The tabletop drill simulated a stampede and crush-type disaster at the Green Point Stadium in Cape Town, South Africa in anticipation of 2010 FIFA World Cup. The LDTT, entitled "Western Cape-Abilities", was conducted between May and September 2009, and encompassed nine hospitals in the Western Cape of South Africa. The main purpose of this drill was to identify strengths and weaknesses in disaster preparedness among nine state and private hospitals in Cape Town, South Africa. These hospitals were tasked to respond to the ill and injured during the 2010 World Cup. METHODS: This LDTT utilized e-mail to conduct a 10-week, scenario-based drill. Questions focused on areas of disaster preparedness previously identified as standards from the literature. After each scenario stimulus was sent, each hospital had three days to collect answers and submit responses to drill controllers via e-mail. RESULTS: Data collected from the nine participating hospitals met 72% (95%CI = 69%-75%) of the overall criteria examined. The highest scores were attained in areas such as equipment, with 78% (95%CI = 66%-86%) positive responses, and development of a major incident plan with 85% (95% CI = 77%-91%) of criteria met. The lowest scores appeared in the areas of public relations/risk communications; 64% positive responses (95% CI = 56%-72%), and safety, supplies, fire and security meeting also meeting 64% of the assessed criteria (95% CI = 57%-70%). Surge capacity and surge capacity revisited both met 76% (95% CI = 68%-83% and 68%-82%, respectively). CONCLUSIONS: This assessment of disaster preparedness indicated an overall good performance in categories such as hospital equipment and development of major incident plans, but improvement is needed in hospital security, public relations, and communications ahead of the 2010 FIFA World Cup.

Computer-facilitated assessment of disaster preparedness for remote hospitals in a long-distance, virtual tabletop drill model.

INTRODUCTION: Emergency preparedness experts generally are based at academic or governmental institutions. A mechanism for experts to remotely facilitate a distant hospital's disaster readiness is lacking. OBJECTIVE: The objective of this study was to develop and examine the feasibility of an Internet-based software tool to assess disaster preparedness for remote hospitals using a long-distance, virtual, tabletop drill. METHODS: An Internet-based system that remotely acquires information and analyzes disaster preparedness for hospitals at a distance in a virtual, tabletop drill model was piloted. Nine hospitals in Cape Town, South Africa designated as receiving institutions for the 2010 FIFA World Cup Games and its organizers, utilized the system over a 10-week period. At one-week intervals, the system e-mailed each hospital's leadership a description of a stadium disaster and instructed them to login to the system and answer questions relating to their hospital's state of readiness. A total of 169 questions were posed relating to operational and surge capacities, communication, equipment, major incident planning, public relations, staff safety, hospital supplies, and security in each hospital. The system was used to analyze answers and generate a real-time grid that reflected readiness as a percent for each hospital in each of the above categories. It also created individualized recommendations of how to improve preparedness for each hospital. To assess feasibility of such a system, the end users' compliance and response times were examined. RESULTS: Overall, compliance was excellent with an aggregate response rate of 98%. The mean response interval, defined as the time elapsed between sending a stimuli and receiving a response, was eight days (95% CI = 8-9 days). CONCLUSIONS: A web-based data acquisition system using a virtual, tabletop drill to remotely facilitate assessment of disaster preparedness is efficient and feasible. Weekly reinforcement for disaster preparedness resulted in strong compliance.

In vitro activity of CEM-101, a new fluoroketolide antibiotic, against Chlamydia trachomatis and Chlamydia (Chlamydophila) pneumoniae.

The in vitro activities of CEM-101, telithromycin, azithromycin, clarithromycin, and doxycycline against 10 isolates each of Chlamydia trachomatis and Chlamydia (Chlamydophila) pneumoniae were tested. The MIC at which 90% of the isolates of both C. trachomatis and C. pneumoniae were inhibited and the minimal bactericidal concentration at which 90% of the isolates were killed by CEM-101 were 0.25 microg/ml (ranges, 0.125 to 0.5 microg/ml for C. trachomatis and 0.25 to 1.0 microg/ml for C. pneumoniae).