Effective use of an advanced isolation unit during the COVID-19 pandemic: A retrospective cohort study.

We described a strategy for preventing virus transmission within hospitals through screening and advanced isolation during the coronavirus pandemic. Patients were screened and admitted to the adult advanced isolation unit from February to April 2020. Our process minimized exposure without delaying proper treatment and prevented virus transmission within the hospital.

Revisiting the guidelines for ending isolation for COVID-19 patients.

Since the start of the COVID-19 pandemic, two mainstream guidelines for defining when to end the isolation of SARS-CoV-2-infected individuals have been in use: the one-size-fits-all approach (i.e. patients are isolated for a fixed number of days) and the personalized approach (i.e. based on repeated testing of isolated patients). We use a mathematical framework to model within-host viral dynamics and test different criteria for ending isolation. By considering a fixed time of 10 days since symptom onset as the criterion for ending isolation, we estimated that the risk of releasing an individual who is still infectious is low (0-6.6%). However, this policy entails lengthy unnecessary isolations (4.8-8.3 days). In contrast, by using a personalized strategy, similar low risks can be reached with shorter prolonged isolations. The obtained findings provide a scientific rationale for policies on ending the isolation of SARS-CoV-2-infected individuals.

Parental access to hospitalised children during infectious disease pandemics such as COVID-19.

The COVID-19 pandemic has resulted in many hospitals severely limiting or denying parents access to their hospitalised children. This article provides guidance for hospital managers, healthcare staff, district-level managers and provincial managers on parental access to hospitalised children during a pandemic such as COVID-19. It: (i) summarises legal and ethical issues around parental visitation rights; (ii) highlights four guiding principles; (iii) provides 10 practical recommendations to facilitate safe parental access to hospitalised children; (iv) highlights additional considerations if the mother is COVID-19-positive; and (v) provides considerations for fathers. In summary, it is a child's right to have access to his or her parents during hospitalisation, and parents should have access to their hospitalised children; during an infectious disease pandemic such as COVID-19, there is a responsibility to ensure that parental visitation is implemented in a reasonable and safe manner. Separation should only occur in exceptional circumstances, e.g. if adequate in-hospital facilities do not exist to jointly accommodate the parent/caregiver and the newborn/infant/child. Both parents should be allowed access to hospitalised children, under strict infection prevention and control (IPC) measures and with implementation of non-pharmaceutical interventions (NPIs), including handwashing/sanitisation, face masks and physical distancing. Newborns/infants and their parents/caregivers have a reasonably high likelihood of having similar COVID-19 status, and should be managed as a dyad rather than as individuals. Every hospital should provide lodger/boarder facilities for mothers who are COVID-19-positive, COVID-19-negative or persons under investigation (PUI), separately, with stringent IPC measures and NPIs. If facilities are limited, breastfeeding mothers should be prioritised, in the following order: (i) COVID-19-negative; (ii) COVID-19 PUI; and (iii) COVID-19-positive. Breastfeeding, or breastmilk feeding, should be promoted, supported and protected, and skin-to-skin care of newborns with the mother/caregiver (with IPC measures) should be discussed and practised as far as possible. Surgical masks should be provided to all parents/caregivers and replaced daily throughout the hospital stay. Parents should be referred to social services and local community resources to ensure that multidisciplinary support is provided. Hospitals should develop individual-level policies and share these with staff and parents. Additionally, hospitals should ideally track the effect of parental visitation rights on hospital-based COVID-19 outbreaks, the mental health of hospitalised children, and their rate of recovery.

Nota Técnica N. 09/2021 - CESPCISS/GVSPSS/SUVISA/SES - Recomendações para medidas de isolamento e implementação de coortes durante a pandemia da COVID-19 / Technical Note N. 09/2021 - CESPCISS/GVSPSS/SUVISA/SES - Recommendations for isolation measures and implementation of cohorts during the COVID-19 pandemic

O objetivo dos isolamentos e precauções é prevenir a transmissão de microrganismos a partir de pacientes infectados ou colonizados por estes patógenos para outros pacientes, visitantes e profissionais da saúde, durante toda a assistência prestada: na chegada, na triagem, na espera, no atendimento e na internação (enfermaria, quarto privativo ou Unidades de Terapia Intensiva - UTI)

The objective of isolations and precautions is to prevent the transmission of microorganisms from patients infected or colonized by these pathogens to other patients, visitors and health professionals, during all the assistance provided: on arrival, in triage, in waiting, in attendance and during hospitalization (ward, private room or of Intensive Care - ICU)

Built Environment Airborne Infection Control Strategies in Pandemic Alternative Care Sites.

OBJECTIVES, PURPOSES, OR AIM: To identify design strategies utilized in airborne infection isolation and biocontainment patient rooms that improve infection control potential in an alternative care environment. BACKGROUND: As SARS-CoV-2 spreads and health care facilities near or exceed capacity, facilities may implement alternative care sites (ACSs). With COVID-19 surges predicted, developing additional capacity in alternative facilities, including hotels and convention centers, into patient care environments requires early careful consideration of the existing space constraints, infrastructure, and modifications needed for patient care and infection control. Design-based strategies utilizing engineering solutions have the greatest impact, followed by medical and operational strategies. METHODS: This article evaluates infection control and environmental strategies in inpatient units and proposes system modifications to ACS surge facilities to reduce infection risk and improve care environments. RESULTS: Although adequate for an acute infectious disease outbreak, existing capacity in U.S. biocontainment units and airborne infection isolation rooms is not sufficient for widespread infection control and isolation during a pandemic. To improve patients' outcomes and decrease infection transmission risk in the alternative care facility, hospital planners, administrators, and clinicians can take cues from evidence-based strategies implemented in biocontainment units and standard inpatient rooms. CONCLUSIONS: Innovative technologies, including optimized air-handling systems with ultraviolet and particle filters, can be an essential part of an infection control strategy. For flexible surge capacity in future ACS and hospital projects, interdisciplinary design and management teams should apply strategies optimizing the treatment of both infectious patients and minimizing the risk to health care workers.

COVID-19: concern about interrupting social isolation of healthcare workers and professionals. What should be done with the results of the available COVID-19 diagnostic tests?

Management of SARS-CoV-2 requires safe decision-making to minimize contamination. Healthcare workers and professionals in confined areas are affected by the risk of the activity and the environment. Isolation of contaminated workers and healthcare professionals requires clinical and diagnostic criteria. On the other hand, interrupting the isolation of healthcare employees and professionals is critical because diagnostic tests do not support clinical decisions. In addition to defining the best test in view of its accuracy, it is necessary to consider aspects such as the stage of the disease or cure, the viral load and the individual's own immunity. Uncertainty about natural and herd immunity to the disease leads to the development of appropriate antivirals, diagnostic tests and vaccines.

Good Practice Recommendations from the Brazilian Society of Nephrology to Dialysis Units Concerning the Pandemic of the New Coronavirus (Covid-19).

Dialysis units are environments potentially prone to the spread of Covid-19. Patients cannot suspend treatment, and they often have comorbidities, which assigns them a higher risk and worse prognosis. The Brazilian Society of Nephrology prepared this document of good practices, whose technical recommendations deal with general measures that can be implemented to reduce the risk of transmission and prevent the spread of the disease in the unit.

Good practices recommendations from the Brazilian Society of Nephrology to Peritoneal Dialysis Services related to the new coronavirus (Covid-19) epidemic.

Considering the new coronavirus epidemic (Covid-19), the Brazilian Society of Nephrology, represented by the Peritoneal Steering Committee, in agreement with the and the Dialysis Department, developed a series of recommendations for good clinical practices for peritoneal dialysis (PD) clinics, to be considered during the period of the Covid-19 epidemic. We aim to minimize the disease spread, protecting patients and staff, and ensuring the quality of the treatment provided and adequate follow-up for PD patients. The recommendations suggested at this moment must be adapted to each clinic's reality and the conditions of the structural and human resources, dependent on the adequate financial provision of the public health system for its full implementation.

Practical recommendations in the obstetrical patient with a COVID-19 infection. / Recomendaciones prácticas en la paciente obstétrica con infección por COVID-19.

COVID-19 infection also affects obstetric patients. Regular obstetric care has continued despite the pandemic. Case series of obstetric patients have been published. Neuroaxial techniques appear to be safe and it is important to obtain the highest possible rate of success of the blocks before a cesarean section. For this reason, it is recommended that the blocks be carried out by senior anesthesiologists. The protection and safety of professionals is a key point and in case of general anesthesia, so it is also recommended to call to the most expert anesthesiologist. Seriously ill patients should be recognized quickly and early, in order to provide them with the appropriate treatment as soon as possible. Susceptibility to thrombosis makes prophylactic anticoagulation a priority.

Medical Isolation and Solitary Confinement: Balancing Health and Humanity in US Jails and Prisons During COVID-19.

In the face of the continually worsening COVID-19 pandemic, jails and prisons have become the greatest vectors of community transmission and are a point of heightened crisis and fear within the global crisis. Critical public health tools to mitigate the spread of COVID-19 are medical isolation and quarantine, but use of these tools is complicated in prisons and jails where decades of overuse of punitive solitary confinement is the norm. This has resulted in advocates denouncing the use of any form of isolation and attorneys litigating to end its use. It is essential to clarify the critical differences between punitive solitary confinement and the ethical use of medical isolation and quarantine during a pandemic. By doing so, then all those invested in stopping the spread of COVID-19 in prisons can work together to integrate medically sound, humane forms of medical isolation and quarantine that follow community standards of care rather than punitive forms of solitary confinement to manage COVID-19.

COVID-19 infection: Strategies on when to discontinue isolation, a retrospective study.

OBJECTIVE: Add to available understanding of COVID-19 to help decrease further spread of SARS-CoV-2 by providing protocol providers can consider when giving patients recommendations to retest as well as length of time for self-isolation. METHODS: We retrospectively collected data from the electronic medical record of patients in the Mayo Clinic Florida's COVID Virtual Clinic. Hundred and eighteen patients with detectable results for the virus were followed. Data reviewed in this study included (1) length of time from detectable to undetectable results; (2) length of time from onset of symptoms to undetectable result; (3) length of time from resolution of fever to undetectable result. RESULTS: Fifty-three percent of studied patients eligible for discontinuation of self-isolation had detectable viral RNA, and therefore, underwent repeat testing. In these patients, the mean from the date of their first detectable result to attaining an undetectable result was 14.89 days. The mean time for onset of symptoms to undetectable testing was 21.5 days. CONCLUSIONS: Hundred and eighteen patients with detectable results for SARS-CoV-2 were followed in the Mayo Clinic Florida COVID Virtual Clinic; 53% of patients still showed detectable viral RNA despite meeting CDC guidelines for discontinuation of self-isolation, prompting us to propose following a more cautious guideline that other providers could consider as a strategy to discontinue self-isolation, including increasing length of days since symptom onset.

Are positive-pressure ventilation lobby rooms effective for protective and source isolation?

High-efficiency particulate air supplied to a positive-pressure ventilation lobby (PPVL) in isolation rooms offers the dual advantage of protective and source isolation. This study demonstrates the in-use validity of PPVL rooms for protective isolation of patients. Of the 48 PPVL air samples investigated, Aspergillus fumigatus was detected from only one (2%) sample. Local and remote monitoring of the PPVL rooms is essential for the safety of patients and healthcare workers. Remote and point-of-use engineering controls are essential for ongoing ventilation monitoring, but this should be complemented by visual inspection of the isolation suite. Periodic microbiological monitoring should also be considered with other control measures.

Primeras medidas de salud pública para la contención del COVID-19: cuarentena de un hotel / First public health measures for the containment of COVID-19: a hotel in quarantine

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COVID-19: Diretora da OPAS pede ‘extrema cautela’ na transição para medidas de distanciamento social mais flexíveis

A diretora da Organização Pan-Americana da Saúde (OPAS), Carissa F. Etienne, disse que as medidas de distanciamento social estão dando às sociedades a oportunidade de se preparar e responder a pandemia da COVID-19 e que qualquer tentativa posterior de fazer a transição para medidas mais flexíveis deve ser tomada com extrema cautela.

Drug-resistant tuberculosis: an experience from Qatar.

This study was conducted to evaluate the characteristics, treatment outcome and risk factors associated with 223 drug-resistant tuberculosis (DR-TB) cases in the State of Qatar. A descriptive records-based retrospective study was conducted on patients registered at Communicable Disease Centre (CDC), Qatar to all consecutive microbiologically confirmed tuberculosis cases for the period January 2010 - March 2015. Demographic, clinical data, drug-resistance pattern of isolated mycobacteria and treatment outcome was assessed for the patient who completed their treatment in Qatar. Of 3301 patients with positive M. tuberculosis culture were analyzed; 223 (6.7%) were resistant to at least one drug. The overall prevalence of multi-d rug resistant TB (MDR-TB) was 1.2% (n = 38) of patients. A former resident of Indian sub contents was the most common demographic characteristic observed (64.1%). The outcome of treatment was assessed for 85 resistant cases with follow-up after completion of treatment. Cure and relapse rates were 97.6%, and 2.4%, respectively. Drug-resistant TB in Qatar is influenced by migration where the patients were probably infected. Rapid sputum sampling performed in the early stages of the disease, patient isolation, and drug-susceptibility testing should be the standard of care.