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1.
Front Public Health ; 8: 590275, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33330335

RESUMO

The COVID-19 pandemic has laid bare the inadequacy of the U.S. healthcare system to deliver timely and resilient care. According to the American Hospital Association, the pandemic has created a $202 billion loss across the healthcare industry, forcing health care systems to lay off workers and making hospitals scramble to minimize supply chain costs. However, as the demand for personal protective equipment (PPE) grows, hospitals have sacrificed sustainable solutions for disposable options that, although convenient, will exacerbate supply strains, financial burden, and waste. We advocate for reusable gowns as a means to lower health care costs, address climate change, and improve resilience while preserving the safety of health care workers. Reusable gowns' polyester material provides comparable capacity to reduce microbial cross-transmission and liquid penetration. In addition, previous hospitals have reported a 50% cost reduction in gown expenditures after adopting reusable gowns; given the current 2000% price increase in isolation gowns during COVID-19, reusable gown use will build both healthcare resilience and security from price fluctuations. Finally, with the United States' medical waste stream worsening, reusable isolation gowns show promising reductions in energy and water use, solid waste, and carbon footprint. The gowns are shown to withstand laundering 75-100 times in contrast to the single-use disposable gown. The circumstances of the pandemic forewarn the need to shift our single-use PPE practices to standardized reusable applications. Ultimately, sustainable forms of protective equipment can help us prepare for future crises that challenge the resilience of the healthcare system.


Assuntos
/prevenção & controle , Equipamentos Descartáveis/economia , Reutilização de Equipamento/economia , Pessoal de Saúde/estatística & dados numéricos , Controle de Infecções/economia , Pandemias/prevenção & controle , Roupa de Proteção/economia , Adulto , Equipamentos Descartáveis/estatística & dados numéricos , Reutilização de Equipamento/estatística & dados numéricos , Feminino , Humanos , Controle de Infecções/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/economia , Exposição Ocupacional/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Roupa de Proteção/estatística & dados numéricos , Estados Unidos
2.
Artigo em Inglês | MEDLINE | ID: mdl-33266115

RESUMO

BACKGROUND: In order to protect dental teams and their patients during the COVID-19 pandemic, dentists have had to adopt several measures (operating and post-operating procedures) which may increase the total treatment time and costs relating to individual protective measures. This paper will propose a thorough analysis of operating dentistry procedures, comparing the economic performance of the activity in a dental surgery before and after the adoption of these protective measures, which are required to contain the risk of SARS-COV-2 infections. METHODS: The economic analysis is articulated in three approaches. Firstly, it assesses a reduction in markup by maintaining current charges (A); alternatively, it suggests revised charges to adopt in order to maintain unvaried levels of markup (B). And the third Approach (C) examines available dental treatments, highlighting how to profitably combine treatment volumes to reduce markup loss or a restricted increase in dental charges. RESULTS: Maintaining dental charges could cause a loss in markup, even rising to 200% (A); attempting to maintain unvaried levels of markup will result in an increase in dental charges, even at 100% (B); and varying the volumes of the single dental treatments on offer (increasing those which current research indicates as the most profitable) could mitigate the economic impact of the measures to prevent the transmission of SARS-COV-2 (C). CONCLUSIONS: The authors of this paper provide managerial insights which can assist the dentist-entrepreneur to become aware of the boundaries of the economic consequences of governmental measures in containing the virus infection.


Assuntos
/prevenção & controle , Odontologia/métodos , Economia em Odontologia , Controle de Infecções/economia , Humanos , Pandemias
3.
PLoS One ; 15(11): e0242212, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33180833

RESUMO

BACKGROUND: Nosocomial infections place a heavy burden on patients and healthcare providers and impact health care institutions financially. Reducing nosocomial infections requires an integrated program of prevention and control using key clinical best care practices. No instrument currently exists that measures these practices in terms of personnel time and material costs. OBJECTIVE: To develop and validate an instrument that would measure nosocomial infection control and prevention best care practice costs, including estimates of human and material resources. METHODS: An evaluation of the literature identified four practices essential for the control of pathogens: hand hygiene, hygiene and sanitation, screening and additional precaution. To reflect time, materials and products used in these practices, our team developed a time and motion guide. Iterations of the guide were assessed in a Delphi technique; content validity was established using the content validity index and reliability was assessed using Kruskall Wallis one-way ANOVA of rank test. RESULTS: Two rounds of Delphi review were required; 88% of invited experts completed the assessment. The final version of the guide contains eight dimensions: Identification [83 items]; Personnel [5 items]; Additional Precautions [1 item]; Hand Hygiene [2 items]; Personal Protective Equipment [14 items]; Screening [4 items]; Cleaning and Disinfection of Patient Care Equipment [33 items]; and Hygiene and Sanitation [24 items]. The content validity index obtained for all dimensions was acceptable (> 80%). Experts statistically agreed on six of the eight dimensions. DISCUSSION/CONCLUSION: This study developed and validated a new instrument based on expert opinion, the time and motion guide, for the systematic assessment of costs relating to the human and material resources used in nosocomial infection prevention and control. This guide will prove useful to measure the intensity of the application of prevention and control measures taken before, during and after outbreak periods or during pandemics such as COVID-19.


Assuntos
Infecção Hospitalar/prevenção & controle , Controle de Infecções/economia , Estudos de Tempo e Movimento , Algoritmos , Técnica Delfos , Desinfecção , Higiene das Mãos , Humanos , Programas de Rastreamento , Equipamento de Proteção Individual , Saneamento
4.
Sci Rep ; 10(1): 18422, 2020 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-33116179

RESUMO

We use an individual based model and national level epidemic simulations to estimate the medical costs of keeping the US economy open during COVID-19 pandemic under different counterfactual scenarios. We model an unmitigated scenario and 12 mitigation scenarios which differ in compliance behavior to social distancing strategies and in the duration of the stay-home order. Under each scenario we estimate the number of people who are likely to get infected and require medical attention, hospitalization, and ventilators. Given the per capita medical cost for each of these health states, we compute the total medical costs for each scenario and show the tradeoffs between deaths, costs, infections, compliance and the duration of stay-home order. We also consider the hospital bed capacity of each Hospital Referral Region (HRR) in the US to estimate the deficit in beds each HRR will likely encounter given the demand for hospital beds. We consider a case where HRRs share hospital beds among the neighboring HRRs during a surge in demand beyond the available beds and the impact it has in controlling additional deaths.


Assuntos
Infecções por Coronavirus/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Pandemias/economia , Pneumonia Viral/economia , Fortalecimento Institucional/economia , Fortalecimento Institucional/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Instalações de Saúde/economia , Instalações de Saúde/estatística & dados numéricos , Humanos , Controle de Infecções/economia , Controle de Infecções/estatística & dados numéricos , Modelos Estatísticos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Estados Unidos
5.
Am J Trop Med Hyg ; 103(5): 1762-1764, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32996453

RESUMO

The highly infectious nature of the SARS-CoV-2 virus requires rigorous infection prevention and control (IPC) to reduce the transmission of COVID-19 within healthcare facilities, but in low-resource settings, the lack of water access creates a perfect storm for low-handwashing adherence, ineffective surface decontamination, and other environmental cleaning functions that are critical for IPC compliance. Data from the WHO/UNICEF Joint Monitoring Programme show that one in four healthcare facilities globally lacks a functional water source on premises (i.e., basic water service); in sub-Saharan Africa, half of all healthcare facilities have no basic water services. But even these data do not tell the whole story, other water, sanitation, and hygiene (WASH) assessments in low-resource healthcare facilities have shown the detrimental effects of seasonal or temporary water shortages, nonfunctional water infrastructure, and fluctuating water quality. The rapid spread of COVID-19 forces us to reexamine prevailing norms within national health systems around the importance of WASH for quality of health care, the prioritization of WASH in healthcare facility investments, and the need for focused, cross-sector leadership and collaboration between WASH and health professionals. What COVID-19 reveals about infection prevention in low-resource healthcare facilities is that we can no longer afford to "work around" WASH deficiencies. Basic WASH services are a fundamental prerequisite to compliance with the principles of IPC that are necessary to protect patients and healthcare workers in every setting.


Assuntos
/prevenção & controle , Instalações de Saúde , Controle de Infecções/normas , África , Desinfecção das Mãos/normas , Instalações de Saúde/economia , Instalações de Saúde/normas , Humanos , Controle de Infecções/economia , Saneamento/normas , Abastecimento de Água/normas
6.
Aesthetic Plast Surg ; 44(6): 2330-2334, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32910209

RESUMO

The global pandemic of coronavirus 2019, or COVID-19, has undeniably impacted all facets of healthcare, affecting both its function and provision. Due to the cessation of all non-emergent surgical cases in the USA and worldwide, the professional lives and practices of many physicians have been negatively affected. However, among different physicians and specifically plastic surgeons, cosmetic/aesthetic plastic surgeons have been disproportionately affected by the COVID-19 pandemic as the majority of their cases are semi-elective and elective. The ability to perform semi-elective and elective cases is dependent on state and local authorities' regulations, and it is currently uncertain when the ban, if ever, will be completely lifted. Financial constraints on patients and their future inability to pay for these procedures due to the COVID-19-related economic recession are things to consider. Overall, the goal of this unprecedented time for cosmetic/aesthetic plastic surgeons is for their medical practices to survive, to conserve cash flow although income is low to none, and to maintain their personal finances. In this paper, the authors review the financial impacts of the current COVID-19 pandemic on the practices of cosmetic plastic surgeons in the USA and worldwide, along with some potential approaches to maintain their practices and financial livelihoods. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
/prevenção & controle , Técnicas Cosméticas/economia , Controle de Infecções/economia , Procedimentos Cirúrgicos Reconstrutivos/economia , Gestão da Segurança/organização & administração , Procedimentos Cirúrgicos Eletivos/economia , Estética , Feminino , Humanos , Controle de Infecções/métodos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos
7.
Rev Epidemiol Sante Publique ; 68(5): 302-305, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32948360

RESUMO

Following the onset of the global COVID-19 pandemic and the alerts issued by the World Health Organization, for several months attention has been focused on Africa as a potentially severely endangered continent. A sizable number of African countries, mainly low and middle income, suffer from limited available resources, especially in critical care, and COVID-19 is liable to overwhelm their already fragile health systems. To effectively manage what is shaping up as a multidimensional crisis, the challenge unquestionably goes beyond the necessary upgrading of public health infrastructures. It is also a matter of anticipating and taking timely action with regard to factors that may mitigate the propagation of SARS-CoV2 and thereby cushion the shock of the pandemic on the African continent. While some of these factors are largely unmanageable (climate, geography…), several others (socio-cultural, religious, audio-visual, and potentially political…) could be more or less effectively dealt with by African governments and populations.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , África/epidemiologia , Vacina BCG/uso terapêutico , Betacoronavirus/fisiologia , Clima , Infecções por Coronavirus/economia , Infecções por Coronavirus/terapia , Recursos em Saúde/organização & administração , Recursos em Saúde/estatística & dados numéricos , Recursos em Saúde/provisão & distribução , História do Século XX , História do Século XXI , Humanos , Controle de Infecções/economia , Controle de Infecções/história , Controle de Infecções/organização & administração , Controle de Infecções/normas , Pandemias/economia , Pandemias/estatística & dados numéricos , Pneumonia Viral/economia , Pneumonia Viral/terapia , Áreas de Pobreza , Papel Profissional , Saúde Pública/economia , Saúde Pública/história , Saúde Pública/estatística & dados numéricos , Mídias Sociais , Responsabilidade Social , Fatores Socioeconômicos , Organização Mundial da Saúde
8.
PLoS One ; 15(9): e0239113, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32946463

RESUMO

Social distancing interventions can be effective against epidemics but are potentially detrimental for the economy. Businesses that rely heavily on face-to-face communication or close physical proximity when producing a product or providing a service are particularly vulnerable. There is, however, no systematic evidence about the role of human interactions across different lines of business and about which will be the most limited by social distancing. Here we provide theory-based measures of the reliance of U.S. businesses on human interaction, detailed by industry and geographic location. We find that, before the pandemic hit, 43 million workers worked in occupations that rely heavily on face-to-face communication or require close physical proximity to other workers. Many of these workers lost their jobs since. Consistently with our model, employment losses have been largest in sectors that rely heavily on customer contact and where these contacts dropped the most: retail, hotels and restaurants, arts and entertainment and schools. Our results can help quantify the economic costs of social distancing.


Assuntos
Comércio/tendências , Infecções por Coronavirus/prevenção & controle , Emprego/tendências , Controle de Infecções/economia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus/patogenicidade , Comércio/normas , Comércio/estatística & dados numéricos , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Conjuntos de Dados como Assunto , Emprego/economia , Emprego/estatística & dados numéricos , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Estados Unidos
9.
JAMA Netw Open ; 3(8): e2012522, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32789514

RESUMO

Importance: Clostridioides difficile infection is the most common hospital-acquired infection in the United States, yet few studies have evaluated the cost-effectiveness of infection control initiatives targeting C difficile. Objective: To compare the cost-effectiveness of 9 C difficile single intervention strategies and 8 multi-intervention bundles. Design, Setting, and Participants: This economic evaluation was conducted in a simulated 200-bed tertiary, acute care, adult hospital. The study relied on clinical outcomes from a published agent-based simulation model of C difficile transmission. The model included 4 agent types (ie, patients, nurses, physicians, and visitors). Cost and utility estimates were derived from the literature. Interventions: Daily sporicidal cleaning, terminal sporicidal cleaning, health care worker hand hygiene, patient hand hygiene, visitor hand hygiene, health care worker contact precautions, visitor contact precautions, C difficile screening at admission, and reduced intrahospital patient transfers. Main Outcomes and Measures: Cost-effectiveness was evaluated from the hospital perspective and defined by 2 measures: cost per hospital-onset C difficile infection averted and cost per quality-adjusted life-year (QALY). Results: In this agent-based model of a simulated 200-bed tertiary, acute care, adult hospital, 5 of 9 single intervention strategies were dominant, reducing cost, increasing QALYs, and averting hospital-onset C difficile infection compared with baseline standard hospital practices. They were daily cleaning (most cost-effective, saving $358 268 and 36.8 QALYs annually), health care worker hand hygiene, patient hand hygiene, terminal cleaning, and reducing intrahospital patient transfers. Screening at admission cost $1283/QALY, while health care worker contact precautions and visitor hand hygiene interventions cost $123 264/QALY and $5 730 987/QALY, respectively. Visitor contact precautions was dominated, with increased cost and decreased QALYs. Adding screening, health care worker hand hygiene, and patient hand hygiene sequentially to the daily cleaning intervention formed 2-pronged, 3-pronged, and 4-pronged multi-intervention bundles that cost an additional $29 616/QALY, $50 196/QALY, and $146 792/QALY, respectively. Conclusions and Relevance: The findings of this study suggest that institutions should seek to streamline their infection control initiatives and prioritize a smaller number of highly cost-effective interventions. Daily sporicidal cleaning was among several cost-saving strategies that could be prioritized over minimally effective, costly strategies, such as visitor contact precautions.


Assuntos
Infecções por Clostridium/prevenção & controle , Infecção Hospitalar/prevenção & controle , Controle de Infecções/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/transmissão , Análise Custo-Benefício , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Desinfecção das Mãos , Humanos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Adulto Jovem
10.
J Hosp Infect ; 106(1): 134-154, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32652215

RESUMO

Nosocomial or healthcare-associated infections (HCAIs) are associated with a financial burden that affects both patients and healthcare institutions worldwide. The clinical best care practices (CBPs) of hand hygiene, hygiene and sanitation, screening, and basic and additional precautions aim to reduce this burden. The COVID-19 pandemic has confirmed these four CBPs are critically important prevention practices that limit the spread of HCAIs. This paper conducted a systematic review of economic evaluations related to these four CBPs using a discounting approach. We searched for articles published between 2000 and 2019. We included economic evaluations of infection prevention and control of Clostridioides difficile-associated diarrhoea, meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and carbapenem-resistant Gram-negative bacilli. Results were analysed with cost-minimization, cost-effectiveness, cost-utility, cost-benefit and cost-consequence analyses. Articles were assessed for quality. A total of 11,898 articles were screened and seven were included. Most studies (4/7) were of overall moderate quality. All studies demonstrated cost effectiveness of CBPs. The average yearly net cost savings from the CBPs ranged from $252,847 (2019 Canadian dollars) to $1,691,823, depending on the rate of discount (3% and 8%). The average incremental benefit cost ratio of CBPs varied from 2.48 to 7.66. In order to make efficient use of resources and maximize health benefits, ongoing research in the economic evaluation of infection control should be carried out to support evidence-based healthcare policy decisions.


Assuntos
Infecções por Coronavirus/economia , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/economia , Infecção Hospitalar/prevenção & controle , Economia Hospitalar/estatística & dados numéricos , Controle de Infecções/economia , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/economia , Pneumonia Viral/prevenção & controle , Betacoronavirus , Canadá , Humanos , Controle de Infecções/estatística & dados numéricos
11.
J Bone Joint Surg Am ; 102(13): e66, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32618914

RESUMO

BACKGROUND: Closed reduction and percutaneous pinning (CRPP) of supracondylar humeral fractures is one of the most common procedures performed in pediatric orthopaedics. The use of full, standard preparation and draping with standard personal protective equipment (PPE) may not be necessary during this procedure. This is of particular interest in the current climate as we face unprecedented PPE shortages due to the current COVID-19 pandemic. METHODS: This is a retrospective chart review of 1,270 patients treated with CRPP of a supracondylar humeral fracture at 2 metropolitan pediatric centers by 10 fellowship-trained pediatric orthopaedic surgeons. One surgeon in the group did not wear a mask when performing CRPP of supracondylar humeral fractures, and multiple surgeons in the group utilized a semisterile preparation technique (no sterile gown or drapes). Infectious outcomes were compared between 2 groups: full sterile preparation and semisterile preparation. We additionally analyzed a subgroup of patients who had semisterile preparation without surgeon mask use. Hospital cost data were used to estimate annual cost savings with the adoption of the semisterile technique. RESULTS: In this study, 1,270 patients who underwent CRPP of a supracondylar humeral fracture and met inclusion criteria were identified. There were 3 deep infections (0.24%). These infections all occurred in the group using full sterile preparation and surgical masks. No clinically relevant pin-track infections were noted. There were no known surgeon occupational exposures to bodily fluid. It is estimated that national adoption of this technique in the United States could save between 18,612 and 22,162 gowns and masks with costs savings of $3.7 million to $4.4 million annually. CONCLUSIONS: We currently face critical shortages of PPE due to the COVID-19 pandemic. Data from this large series suggest that a semisterile technique during CRPP of supracondylar humeral fractures is a safe practice. We anticipate that this could preserve approximately 20,000 gowns and masks in the United States over the next year. Physicians are encouraged to reevaluate their daily practice to identify safe opportunities for resource preservation. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Infecções por Coronavirus , Fixação de Fratura/normas , Alocação de Recursos para a Atenção à Saúde/organização & administração , Fraturas do Úmero/cirurgia , Pandemias , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral , Infecção da Ferida Cirúrgica/prevenção & controle , Betacoronavirus , Pinos Ortopédicos , Criança , Pré-Escolar , Redução Fechada/efeitos adversos , Redução Fechada/normas , Feminino , Fixação de Fratura/efeitos adversos , Alocação de Recursos para a Atenção à Saúde/economia , Alocação de Recursos para a Atenção à Saúde/métodos , Humanos , Controle de Infecções/economia , Controle de Infecções/normas , Masculino , Equipamento de Proteção Individual/economia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia , Estados Unidos/epidemiologia
12.
Math Biosci ; 326: 108405, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32565231

RESUMO

Lockdown and social distancing restrictions have been widely used as part of policy efforts aimed at controlling the ongoing COVID-19 pandemic. Since these restrictions have a negative impact on the economy, there exists a strong incentive to relax these policies while protecting public health. Using a modified SEIR epidemiological model, this paper explores the costs and benefits associated with the sequential release of specific groups based on age and risk from lockdown and social distancing measures. The results in this paper suggest that properly designed staggered-release policies can do better than simultaneous-release policies in terms of protecting the most vulnerable members of a population, reducing health risks overall, and increasing economic activity.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/métodos , Modelos Biológicos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Simulação por Computador , Infecções por Coronavirus/economia , Análise Custo-Benefício , Feminino , Humanos , Lactente , Recém-Nascido , Controle de Infecções/economia , Controle de Infecções/estatística & dados numéricos , Masculino , Conceitos Matemáticos , Pessoa de Meia-Idade , Pandemias/economia , Pandemias/estatística & dados numéricos , Pneumonia Viral/economia , Saúde Pública , Política Pública , Quarentena/economia , Quarentena/métodos , Quarentena/estatística & dados numéricos , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
15.
J Cosmet Dermatol ; 19(8): 1826-1827, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32502318

RESUMO

The rapidly increasing number of COVID-19-infected patients and evidence of human-to-human transmission even within the asymptomatic incubation period prompted the attention of the entire world. The field of dermatology and procedural dermatology is not exempt from this global issue. We cannot deny the fact that this situation will have a lasting impact on the health-seeking behaviors of our patients. It is necessary for dermatologists and dermatologic surgeons to be aware of the potential risks and precautions when re-emerging their practices after COVID-19.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Dermatologia/tendências , Controle de Infecções/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Dermatopatias/terapia , Telemedicina/tendências , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Técnicas Cosméticas/economia , Técnicas Cosméticas/normas , Técnicas Cosméticas/tendências , Dermatologia/economia , Dermatologia/organização & administração , Dermatologia/normas , Diagnóstico Diferencial , Humanos , Controle de Infecções/economia , Controle de Infecções/organização & administração , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Dermatopatias/diagnóstico , Dermatopatias/economia , Dermatopatias/virologia , Telemedicina/economia , Telemedicina/organização & administração , Telemedicina/normas
16.
Eur J Cancer ; 135: 130-146, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32580130

RESUMO

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a new virus that has never been identified in humans before. COVID-19 caused at the time of writing of this article, 2.5 million cases of infections in 193 countries with 165,000 deaths, including two-third in Europe. In this context, Oncology Departments of the affected countries had to adapt quickly their health system care and establish new organizations and priorities. Thus, numerous recommendations and therapeutic options have been reported to optimize therapy delivery to patients with chronic disease and cancer. Obviously, while these cancer care recommendations are immediately applicable in Europe, they may not be applicable in certain emerging and low- and middle-income countries (LMICs). In this review, we aimed to summarize these international guidelines in accordance with cancer types, making a synthesis for daily practice to protect patients, staff and tailor anti-cancer therapy delivery taking into account patients/tumour criteria and tools availability. Thus, we will discuss their applicability in the LMICs with different organizations, limited means and different constraints.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Oncologia/organização & administração , Neoplasias/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Países em Desenvolvimento/economia , Carga Global da Doença , Humanos , Controle de Infecções/economia , Controle de Infecções/normas , Oncologia/economia , Oncologia/normas , Neoplasias/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Pobreza
18.
Epidemiol Infect ; 148: e176, 2020 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-32430090

RESUMO

The aim of this study was to determine the most cost-effective strategy for the prevention and control of multidrug-resistant organisms (MDROs) in intensive care units (ICUs) in areas with limited health resources. The study was conducted in 12 ICUs of four hospitals. The total cost for the prevention of MDROs and the secondary attack rate (SAR) of MDROs for each strategy were collected retrospectively from 2046 subjects from January to December 2017. The average cost-effectiveness ratio (CER), incremental cost-effectiveness ratio (ICER) and cost-effectiveness acceptability curve were calculated. Hand hygiene (HH) had the lowest total cost (2149.6 RMB) and SAR of MDROs (8.8%) while single-room isolation showed the highest cost (33 700.2 RMB) and contact isolation had the highest SAR of MDROs (31.8%). The average cost per unit infection prevention was 24 427.8 RMB, with the HH strategy followed by the environment disinfection strategy (CER = 21 314.67). HH had the highest iterative cost effect under willingness to pay less than 2000 RMB. Due to the low cost for repeatability and obvious effectiveness, we conclude that HH is the optimal strategy for MDROs infections in ICUs in developing countries. The cost-effectiveness of the four prevention strategies provides some reference for developing countries but multiple strategies remain to be examined.


Assuntos
Infecções Bacterianas/prevenção & controle , Análise Custo-Benefício , Desinfecção , Farmacorresistência Bacteriana Múltipla , Controle de Infecções/economia , Isolamento de Pacientes , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Infecções Bacterianas/microbiologia , Países em Desenvolvimento , Feminino , Humanos , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade
19.
PLoS One ; 15(5): e0233265, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32421700

RESUMO

BACKGROUND AND OBJECTIVES: Incidence rates of healthcare-associated infections (HAIs) depend upon infection control policy and practices, and the effectiveness of the implementation of antibiotic stewardship. Amongst intensive care unit (ICU) patients with HAIs, a substantial number of pathogens were reported to be multidrug-resistant bacteria (MDRB). However, impacts of ICU HAIs due to MDRB (MDRB-HAIs) remain understudied. Our study aimed to evaluate the negative impacts of MRDB-HAIs versus HAIs due to non-MDRB (non-MRDB-HAIs). METHODS: Among 60,317 adult patients admitted at ICUs of a 2680-bed medical centre in Taiwan between January 2010 and December 2017, 279 pairs of propensity-score matched MRDB-HAI and non-MRDB-HAI were analyzed. PRINCIPAL FINDINGS: Between the MDRB-HAI group and the non-MDRB-HAI group, significant differences were found in overall hospital costs, costs of medical and nursing services, medication, and rooms/beds, and in ICU length-of-stay (LOS). As compared with the non-MDRB-HAI group, the mean of the overall hospital costs of patients in the MDRB-HAI group was increased by 26%; for categorized expenditures, the mean of costs of medical and nursing services of patients in the MDRB-HAI group was increased by 8%, of medication by 26.9%, of rooms/beds by 10.3%. The mean ICU LOS in the MDRB-HAI group was increased by 13%. Mortality rates in both groups did not significantly differ. CONCLUSIONS: These data clearly demonstrate more negative impacts of MDRB-HAIs in ICUs. The quantified financial burdens will be helpful for hospital/government policymakers in allocating resources to mitigate MDRB-HAIs in ICUs; in case of need for clarification/verification of the medico-economic burdens of MDRB-HAIs in different healthcare systems, this study provides a model to facilitate the evaluations.


Assuntos
Infecção Hospitalar/economia , Unidades de Terapia Intensiva/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Infecções Relacionadas a Cateter/epidemiologia , Cuidados Críticos , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Feminino , Custos Hospitalares , Hospitalização/economia , Hospitais , Humanos , Incidência , Controle de Infecções/economia , Controle de Infecções/métodos , Unidades de Terapia Intensiva/tendências , Tempo de Internação/economia , Masculino , Staphylococcus aureus Resistente à Meticilina/metabolismo , Pessoa de Meia-Idade , Pontuação de Propensão , Infecções Estafilocócicas/economia , Infecções Estafilocócicas/epidemiologia , Taiwan
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