scholarly journals Control of a Nosocomial Outbreak of COVID-19 in a University Hospital

2020 ◽  
Vol 7 (12) ◽  
Author(s):  
Sei Harada ◽  
Shunsuke Uno ◽  
Takayuki Ando ◽  
Miho Iida ◽  
Yaoko Takano ◽  
...  
Keyword(s):  
High Risk ◽  
Large Scale ◽  
Secondary Infection ◽  
Control Measures ◽  
University Hospital ◽  
Contact Tracing ◽  
Effective Control ◽  
Primary Case ◽  
Pcr Screening ◽  
Social Distancing

Abstract Background Nosocomial spread of coronavirus disease 2019 (COVID-19) causes clusters of infection among high-risk individuals. Controlling this spread is critical to reducing COVID-19 morbidity and mortality. We describe an outbreak of COVID-19 in Keio University Hospital, Japan, and its control and propose effective control measures. Methods When an outbreak was suspected, immediate isolation and thorough polymerase chain reaction (PCR) testing of patients and health care workers (HCWs) using an in-house system, together with extensive contact tracing and social distancing measures, were conducted. Nosocomial infections (NIs) were defined as having an onset or positive test after the fifth day of admission for patients and having high-risk contacts in our hospital for HCWs. We performed descriptive analyses for this outbreak. Results Between March 24 and April 24, 2020, 27 of 562 tested patients were confirmed positive, of whom 5 (18.5%) were suspected as NIs. For HCWs, 52 of 697 tested positive, and 40 (76.9%) were considered NIs. Among transmissions, 95.5% were suspected of having occurred during the asymptomatic period. Large-scale isolation and testing at the first sign of outbreak terminated NIs. The number of secondary cases directly generated by a single primary case found before March 31 was 1.74, compared with 0 after April 1. Only 4 of 28 primary cases generated definite secondary infection; these were all asymptomatic. Conclusions Viral shedding from asymptomatic cases played a major role in NIs. PCR screening of asymptomatic individuals helped clarify the pattern of spread. Immediate large-scale isolation, contact tracing, and social distancing measures were essential to containing outbreaks.

scholarly journals First Description of KPC-2-ProducingKlebsiella oxytocaIsolated from a Pediatric Patient with Nosocomial Pneumonia in Venezuela

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Indira Labrador ◽  
María Araque
Keyword(s):  
Pediatric Patient ◽  
Carbapenem Resistance ◽  
Control Measures ◽  
University Hospital ◽  
Conjugative Plasmid ◽  
Effective Control ◽  
Molecular Tests ◽  
The Andes ◽  
Clinically Significant ◽  
Significant Class

During the last decade, carbapenem resistance has emerged among clinical isolates of the Enterobacteriaceae family. This has been increasingly attributed to the production ofβ-lactamases capable of hydrolyzing carbapenems. Among these enzymes,Klebsiella pneumoniaecarbapenemases (KPCs) are the most frequently and clinically significant class-A carbapenemases. In this report, we describe the first nosocomial KPC-2-producingK. oxytocaisolated from a pediatric patient with pneumonia admitted to the intensive care unit at The Andes University Hospital, Mérida, Venezuela. This strain was resistant to several antibiotics including imipenem, ertapenem, and meropenem but remained susceptible to ciprofloxacin, colistin, and tigecycline. Conjugation assays demonstrated the transferability of all resistance determinants, except aminoglycosides. The isolate LMM-SA26 carried a ~21 kb conjugative plasmid that harbored theblaKPC-2,blaCTX-M-8, andblaTEM-15genes. Although carbapenem resistance in the Enterobacteriaceae is still unusual in Venezuela, KPCs have a great potential to spread due to their localization on mobile genetic elements. Therefore, rapid detection of KPC-carrying bacteria with phenotypic and confirmatory molecular tests is essential to establish therapeutic options and effective control measures.

scholarly journals First Description of Colistin and Tigecycline-Resistant Acinetobacter baumannii Producing KPC-3 Carbapenemase in Portugal

Antibiotics ◽  
2018 ◽  
Vol 7 (4) ◽  
pp. 96 ◽  
Author(s):  
Cátia Caneiras ◽  
Filipa Calisto ◽  
Gabriela Jorge da Silva ◽  
Luis Lito ◽  
José Melo-Cristino ◽  
...  
Keyword(s):  
Case Report ◽  
High Risk ◽  
Acinetobacter Baumannii ◽  
University Hospital ◽  
Virulence Determinants ◽  
Molecular Screening ◽  
Pcr Screening ◽  
Carbapenem Resistant ◽  
Antimicrobial Resistance Profile

Herein, we describe a case report of carbapenem-resistant Acinetobacter baumannii and Klebsiella pneumoniae isolates that were identified from the same patient at a Tertiary University Hospital Centre in Portugal. Antimicrobial susceptibility and the molecular characterization of resistance and virulence determinants were performed. PCR screening identified the presence of the resistance genes blaKPC-3, blaTEM-1 and blaSHV-1 in both isolates. The KPC-3 K. pneumoniae isolate belonged to the ST-14 high risk clone and accumulated an uncommon resistance and virulence profile additional to a horizontal dissemination capacity. In conclusion, the molecular screening led to the first identification of the A. baumannii KPC-3 producer in Portugal with a full antimicrobial resistance profile including tigecycline and colistin.

scholarly journals Modelling and Simulating the Novel Coronavirus with Implications of Asymptomatic Carriers

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Ghassane Benrhmach ◽  
Khalil Namir ◽  
Jamal Bouyaghroumni
Keyword(s):  
Control Strategies ◽  
World Health ◽  
Contact Tracing ◽  
Effective Control ◽  
Public Authorities ◽  
Asymptomatic Carriers ◽  
Social Distancing ◽  
Infected People ◽  
Novel Coronavirus ◽  
Health Organization

The World Health Organization declared that the total number of confirmed cases tested positive for SARS‐CoV‐2, affecting 210 countries, exceeded 3 million on 29 April 2020, with more than 207,973 deaths. In order to end the global COVID‐19 pandemic, public authorities have put in place multiple strategies like testing, contact tracing, and social distancing. Predictive mathematical models for epidemics are fundamental to understand the development of the epidemic and to plan effective control strategies. Some hosts may carry SARS‐CoV‐2 and transmit it to others, yet display no symptoms themselves. We propose applying a model (SELIAHRD) taking in consideration the number of asymptomatic infected people. The SELIAHRD model consists of eight stages: Susceptible, Exposed, Latent, Symptomatic Infected, Asymptomatic Infected, Hospitalized, Recovered, and Dead. The asymptomatic carriers contribute to the spread of disease, but go largely undetected and can therefore undermine efforts to control transmission. The simulation of possible scenarios of the implementation of social distancing shows that if we rigorously follow the social distancing rule then the healthcare system will not be overloaded.

scholarly journals Experiential learnings from the Nipah virus outbreaks in Kerala towards containment of infectious public health emergencies in India

2020 ◽  
Vol 148 ◽  
Author(s):  
Rima R. Sahay ◽  
Pragya D. Yadav ◽  
Nivedita Gupta ◽  
Anita M. Shete ◽  
Chandni Radhakrishnan ◽  
...  
Keyword(s):  
State Government ◽  
Single Case ◽  
Point Of Care ◽  
Nipah Virus ◽  
Case Fatality ◽  
Control Measures ◽  
Contact Tracing ◽  
Effective Control ◽  
Hospital Infection Control ◽  
Kerala State

Abstract Nipah virus (NiV) outbreak occurred in Kozhikode district, Kerala, India in 2018 with a case fatality rate of 91% (21/23). In 2019, a single case with full recovery occurred in Ernakulam district. We described the response and control measures by the Indian Council of Medical Research and Kerala State Government for the 2019 NiV outbreak. The establishment of Point of Care assays and monoclonal antibodies administration facility for early diagnosis, response and treatment, intensified contact tracing activities, bio-risk management and hospital infection control training of healthcare workers contributed to effective control and containment of NiV outbreak in Ernakulam.

scholarly journals Prevalence and Fluconazole Susceptibility Profile of Candida spp. Clinical Isolates in a Brazilian Tertiary Hospital in Minas Gerais, Brazil

2015 ◽  
Vol 87 (2 suppl) ◽  
pp. 1349-1359 ◽  
Author(s):  
Athayde Neves-Junior ◽  
Ana Carolina Cartágenes-Pinto ◽  
Débora A.S. Rocha ◽  
Leandro F. Reis de Sá ◽  
Maria de Lourdes Junqueira ◽  
...  
Keyword(s):  
Opportunistic Infections ◽  
Fungal Infections ◽  
Tertiary Hospital ◽  
Antifungal Drugs ◽  
Control Measures ◽  
Clinical Isolates ◽  
University Hospital ◽  
Effective Control ◽  
Candida Spp ◽  
Resistance Phenotype

Candidiasis has become an important concern for clinical practice, especially with the increasing incidence of immunocompromised patients. In this scenario, the development resistance to fluconazole presents a challenge for treating these opportunistic infections. The aim of this study was to evaluate some epidemiology features of Candidainfections in a Brazilian University Hospital using data, previously unavailable. We observed that 44% of the 93 clinical isolates tested, belonged to Candida albicansspecies and 56% belonged to non-Candida albicansspecies (mainly Candida tropicalis and Candida glabrata). Most strains were isolated from urine samples where C. albicans was predominantly detected. 29 strains presented a fluconazole resistance phenotype and of these, 22 were chemosensitised by FK506, a classical inhibitor of ABC transporters related to azoles resistance. These data suggest the probable role of efflux pumps in this resistance phenotype. Our study highlights the need for developing effective control measures for fungal infections, rational use of antifungal drugs and development of new molecules able to abrogate the active transport of antifungals.

scholarly journals COVID-19 prevention and control measures in workplace settings: a rapid review and meta-analysis

2021 ◽  
Author(s):  
Carolyn Ingram ◽  
Vicky Downey ◽  
Mark Roe ◽  
Fionn Cléirigh Büttner ◽  
Yanbing Chen ◽  
...  
Keyword(s):  
High Risk ◽  
Prevention And Control ◽  
Meta Analysis ◽  
Control Measures ◽  
Contact Tracing ◽  
Rapid Review ◽  
Cochrane Library ◽  
Infection Prevention And Control ◽  
Post Intervention ◽  
And Control

Workplaces are high-risk environments for SARS-CoV-2 outbreaks and subsequent community transmission. Identifying, understanding, and implementing effective workplace SARS-CoV-2 infection prevention and control (IPC) measures is critical to protect workers, their families, and communities. A rapid review and meta-analysis were conducted to synthesize evidence assessing the effectiveness of COVID-19 IPC measures implemented in global workplace settings through April 2021. Medline, Embase, PubMed, and Cochrane Library were searched for studies that quantitatively assessed the effectiveness of workplace COVID-19 IPC measures. Included studies comprised varying empirical designs and occupational settings. Measures of interest included surveillance measures, outbreak investigations, personal protective equipment (PPE), changes in work arrangements, and worker education. Sixty-three studies from international healthcare, nursing home, meatpacking, manufacturing, and office settings were included, accounting for ~280,000 employees. Meta-analyses showed that combined measures (0.2% positivity; 95%CI 0-0.4%) were associated with lower post-intervention employee COVID-19 positivity estimates than single measures like asymptomatic PCR testing (1.7%; 95%CI 0.9-2.9%) and universal masking (24%; 95%CI 3.4-55.5%). Modelling studies showed that combinations of (i) timely and widespread contact tracing and case isolation, (ii) facilitating smaller worker cohorts, and (iii) effective use of PPE can reduce workplace transmission. Comprehensive COVID-19 IPC measures incorporating swift contact tracing and case isolation, PPE, and facility zoning, can effectively prevent workplace outbreaks. Masking alone should not be considered as sufficient protection from SARS-CoV-2 outbreaks in workplace environments at high risk of virus transmission.

scholarly journals Control Strategies for the Third wave of COVID-19 infection in India: A Mathematical Model Incorporating Vaccine Effectiveness

2022 ◽  
Author(s):  
Ashutosh Mahajan ◽  
Namitha Sivadas ◽  
Pooja Panda
Keyword(s):  
Transmission Rate ◽  
Control Strategies ◽  
Control Measures ◽  
Disease Spread ◽  
Effective Control ◽  
Third Wave ◽  
Social Distancing ◽  
Vaccination Rates ◽  
New Variant ◽  
The Future

The waning effectiveness of the COVID-19 vaccines and the emergence of a new variant Omicron has given rise to the possibility of another outbreak of the infection in India. COVID-19 has caused more than 34 million reported cases and 475 thousand deaths in India so far, and it has affected the country at the root level, socially as well as economically. After going through different control measures, mass vaccination has been achieved to a large extent for the highly populous country, and currently under progress. India has already been hit by a massive second wave of infection in April-June, 2021 mainly due to the delta variant, and might see a third wave in the near future that needs to be controlled with effective control strategies. In this paper, we present a compartmental epidemiological model with vaccinations incorporating the dose-dependent effectiveness. We study a possible sudden outbreak of SARS-CoV2 variants in the future, and bring out the associated predictions for various vaccination rates and point out optimum control measures. Our results show that for transmission rate 30% higher than the current rate due to emergence of new variant or relaxation of social distancing conditions, daily new cases can peak to 250k in March 2022, taking the second dose effectiveness dropping to 50% in the future. A combination of vaccination and controlled lockdown or social distancing is the key to tackling the current situation and for the coming few months. Our simulation results show that social distancing measures show better control over the disease spread than the higher vaccination rates. <br>

scholarly journals Modeling the Effective Control Strategy for the Transmission Dynamics of Global Pandemic COVID-19

2020 ◽  
Author(s):  
M. H. A. Biswas ◽  
M. S. Khatun ◽  
A. K. Paul ◽  
M. R. Khatun ◽  
M. A. Islam ◽  
...  
Keyword(s):  
Maximum Principle ◽  
Control Strategies ◽  
Pontryagin’S Maximum Principle ◽  
Control Measures ◽  
Effective Control ◽  
Human Immune System ◽  
Pontryagin's Maximum Principle ◽  
Social Distancing ◽  
Novel Coronavirus ◽  
Major Factors

AbstractThe novel coronavirus disease (namely COVID-19) has taken attention because of its deadliness across the globe, causing a massive death as well as critical situation around the world. It is an infectious disease which is caused by newly discovered coronavirus. Our study demonstrates with a nonlinear model of this devastating COVID-19 which narrates transmission from human-to-human in the society. Pontryagin’s Maximum principle has also been applied in order to obtain optimal control strategies where the maintenance of social distancing is the major control. The target of this study is to find out the most fruitful control measures of averting coronavirus infection and eventually, curtailed of the COVID-19 transmission among people. The model is investigated analytically by using most familiar necessary conditions of Pontryagin’s maximum principle. Furthermore, numerical simulations have been performed to illustrate the analytical results. The analysis reveals that implementation of educational campaign, social distancing and developing human immune system are the major factors which can be able to plunge the scenario of becoming infected.

An Active Shooter in Your Hospital: A Novel Method to Develop a Response Policy Using In Situ Simulation and Video Framework Analysis

2020 ◽  
pp. 1-9 ◽  
Author(s):  
Niran Argintaru ◽  
Winny Li ◽  
Christopher Hicks ◽  
Kari White ◽  
Melissa McGowan ◽  
...  
Keyword(s):  
High Risk ◽  
Situational Awareness ◽  
Medical Personnel ◽  
Control Measures ◽  
Effective Control ◽  
Active Shooter ◽  
Framework Analysis ◽  
In Situ Simulation ◽  
Medical Response

ABSTRACT Hospital shootings (Code Silver) are events that pose extreme risk to staff, patients, and visitors. Hospitals are faced with unique challenges to train staff and develop protocols to manage these high-risk events. In situ simulation is an innovative technique that can evaluate institutional responses to emergent situations. This study highlights the design of an active shooter in situ simulation conducted at a Canadian level-1 trauma center to test a Code Silver active shooter protocol response. We further apply a modified framework analysis to extract latent safety threats (LSTs) from the simulation using ethnographic observation of the response by law enforcement, hospital security, logistics, and medical personnel. The video-based framework analysis identified 110 LSTs, which were assigned hazard scores, highlighting 3 high-risk LSTs that did not have effective control measures or were not easily discoverable. These included lack of security during patient transport, inadequate situational awareness outside the clinical area, and poor coordination of critical tasks among interprofessional team members. In situ simulation is a novel approach to support the design and implementation of similar events at other institutions. Findings from ethnographic observations and a video-based analysis form a structured framework to address safety, logistical, and medical response considerations.

scholarly journals An evaluation of COVID-19 transmission control in Wenzhou using a modified SEIR model

2021 ◽  
Vol 149 ◽  
Author(s):  
Wenning Li ◽  
Jianhua Gong ◽  
Jieping Zhou ◽  
Lihui Zhang ◽  
Dongchuan Wang ◽  
...  
Keyword(s):  
Emergency Preparedness ◽  
Close Contact ◽  
Control Measures ◽  
Contact Tracing ◽  
Seir Model ◽  
Social Distancing ◽  
Infected People ◽  
Travel Restrictions ◽  
Developmental Characteristics ◽  
Novel Coronavirus

Abstract In December 2019, the first confirmed case of pneumonia caused by a novel coronavirus was reported. Coronavirus disease 2019 (COVID-19) is currently spreading around the world. The relationships among the pandemic and its associated travel restrictions, social distancing measures, contact tracing, mask-wearing habits and medical consultation efficiency have not yet been extensively assessed. Based on the epidemic data reported by the Health Commission of Wenzhou, we analysed the developmental characteristics of the epidemic and modified the Susceptible-Exposed-Infectious-Removed (SEIR) model in three discrete ways. (1) According to the implemented preventive measures, the epidemic was divided into three stages: initial, outbreak and controlled. (2) We added many factors, such as health protections, travel restrictions and social distancing, close-contact tracing and the time from symptom onset to hospitalisation (TSOH), to the model. (3) Exposed and infected people were subdivided into isolated and free-moving populations. For the parameter estimation of the model, the average TSOH and daily cured cases, deaths and imported cases can be obtained through individual data from epidemiological investigations. The changes in daily contacts are simulated using the intracity travel intensity (ICTI) from the Baidu Migration Big Data platform. The optimal values of the remaining parameters are calculated by the grid search method. With this model, we calculated the sensitivity of the control measures with regard to the prevention of the spread of the epidemic by simulating the number of infected people in various hypothetical situations. Simultaneously, through a simulation of a second epidemic, the challenges from the rebound of the epidemic were analysed, and prevention and control recommendations were made. The results show that the modified SEIR model can effectively simulate the spread of COVID-19 in Wenzhou. The policy of the lockdown of Wuhan, the launch of the first-level Public Health Emergency Preparedness measures on 23 January 2020 and the implementation of resident travel control measures on 31 January 2020 were crucial to COVID-19 control.

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