scholarly journals SARS-CoV-2 Infection in Healthcare Personnel and Their Household Contacts at a Tertiary Academic Medical Center: Protocol for a Longitudinal Cohort Study (Preprint)

2020 ◽  
Author(s):  
Emily J Ciccone ◽  
Paul N Zivich ◽  
Evans K Lodge ◽  
Deanna Zhu ◽  
Elle Law ◽  
...  
Keyword(s):  
Risk Factors ◽  
Personal Protective Equipment ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Well Being ◽  
Healthcare Personnel ◽  
Protective Equipment ◽  
Household Contacts ◽  
Tertiary Care Medical Center

BACKGROUND Healthcare personnel are at high risk for exposure to the SARS-CoV-2 virus. While personal protective equipment may mitigate this risk, prospective data collection on its use and other risk factors for seroconversion in this population is needed. OBJECTIVE The primary objectives of this study are to (1) determine the incidence of and risk factors for SARS-CoV-2 infection among healthcare personnel at a tertiary medical center and (2) actively monitor personal protective equipment use, interactions between study participants via electronic sensors, secondary cases in households, and participant mental health and well-being. METHODS To achieve these objectives, we designed a prospective, observational study of SARS-CoV-2 infection among healthcare personnel and their household contacts at an academic tertiary care medical center. Enrolled healthcare personnel completed frequent surveys on symptoms and work activities and provided serum and nasal samples for SARS-CoV-2 testing every two weeks. Additionally, interactions between participants and their movement within the clinical environment were captured with a smartphone app and Bluetooth sensors. Finally, a subset of participants' households was randomly selected every two weeks for further investigation, and enrolled households provided serum and nasal samples via at-home collection kits. RESULTS As of September 30, 2020, 164 healthcare personnel and 33 household participants have been enrolled. Recruitment and follow-up are ongoing and expected to continue until March 2021. CONCLUSIONS Much remains to be learned regarding risk of SARS-CoV-2 infection among healthcare personnel and their household contacts. Through use of a multi-faceted study design enrolling a well-characterized cohort, we will collect critical information regarding SARS-CoV-2 transmission in the healthcare setting and its linkage to the community.

scholarly journals Evaluation of Healthcare Personnel Exposures to Patients with SARS-CoV-2 Associated with Personal Protective Equipment Use

2021 ◽  
pp. 1-14
Author(s):  
Vishal P. Shah ◽  
Laura E. Breeher ◽  
Caitlin M. Hainy ◽  
Melanie D. Swift
Keyword(s):  
Personal Protective Equipment ◽  
Medical Center ◽  
Tertiary Care ◽  
Healthcare Personnel ◽  
Protective Equipment ◽  
Critical Aspect ◽  
Eye Protection ◽  
Post Exposure ◽  
Healthcare Settings ◽  
Tertiary Care Medical Center

Abstract Objective: Personal Protective Equipment (PPE) is a critical aspect of preventing transmission of SARS-CoV-2 in healthcare settings. We aimed to identify factors related to lapses in PPE usage that may influence transmission of SARS-CoV-2 from patients to healthcare personnel (HCP). Design: Retrospective cohort study Setting: Tertiary care medical center in Minnesota Participants: A total of 345 HCP that sustained a significant occupational exposure to a patient with Coronavirus Disease 2019 (COVID-19) from May 13th, 2020 through November 30th, 2020 were evaluated. Results: Eight HCP (2.3%) were found to have SARS-CoV-2 infection during their 14-day post-exposure quarantine. A lack of eye protection during the care of a patient with COVID-19 was associated with HCP testing positive for SARS-CoV-2 by RT-PCR during the post-exposure quarantine (RR 10.25 (95% Confidence Interval (CI) 1.28-82.39), p=.009). Overall, the most common reason for a significant exposure was the usage of a surgical facemask instead of a respirator during an aerosolizing generating procedure (AGP) (55.9%). However, this was not associated with HCP testing positive for SARS-CoV-2 during the post-exposure quarantine (RR 0.99 (95% CI 0.96-1), p=1). Notably, transmission primarily occurred in units that did not regularly care for patients with COVID-19. Conclusions: The use of universal eye protection is a critical aspect of PPE to prevent patient to HCP transmission of SARS-CoV-2.

scholarly journals Understanding Workflow and Personal Protective Equipment Challenges Across Different Healthcare Personnel Roles

2019 ◽  
Vol 69 (Supplement_3) ◽  
pp. S185-S191 ◽  
Author(s):  
Molly Harrod ◽  
Laura Petersen ◽  
Lauren E Weston ◽  
Lynn Gregory ◽  
Jeanmarie Mayer ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Physical Therapists ◽  
Medical Center ◽  
Academic Medical Center ◽  
Geographic Location ◽  
Physical Contact ◽  
Healthcare Personnel ◽  
Protective Equipment ◽  
Effective Strategies ◽  
Field Notes

Abstract Background Hospitals use standard and transmission-based precautions, including personal protective equipment (PPE), to prevent the spread of infectious organisms. However, little attention has been paid to the potentially unique challenges of various healthcare personnel (HCP) in following precaution practices. Methods From September through December 2016, 5 physicians, 5 nurses, and 4 physical therapists were shadowed for 1 hour 30 minutes to 3 hours 15 minutes at an academic medical center. Observers documented activities using unstructured field notes. Focus groups were conducted to better understand HCP perspectives about precautions and PPE-related challenges. Data were analyzed by comparing workflow and challenges (observed and stated) in precaution practices across HCP roles. Results Precaution patients were interspersed throughout physician rounds, which covered a broad geographic range throughout the hospital. Patient encounters were generally brief, and appropriate use of gowns and cleaning of personal stethoscopes varied among observed physicians. Nurses were unit based and frequently entered/exited rooms. Frustration with donning/doffing was especially apparent when needing supplies while in a precaution room, which nurses acknowledged was a time when practice lapses could occur. The observed physical therapists worked in one geographic location, spent extended periods of time with patients, and noted that given their close physical contact with patients, gowns do not fully protect them. Conclusions Movement patterns, time with patients, care activities, and equipment use varied across HCP, leading to a diverse set of challenges in following precaution practices and PPE use. Attention to these differences among HCP is important for understanding and developing effective strategies to prevent the potential spread of infectious organisms.

scholarly journals Independent risk factors for surgical site infection after cesarean delivery in a rural tertiary care medical center

2016 ◽  
Vol 31 (1) ◽  
pp. 120-126 ◽  
Author(s):  
Manuel C. Vallejo ◽  
Ahmed F. Attaallah ◽  
Robert E. Shapiro ◽  
Osama M. Elzamzamy ◽  
Michael G. Mueller ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Cesarean Delivery ◽  
Medical Center ◽  
Tertiary Care ◽  
Site Infection ◽  
Tertiary Care Medical Center ◽  
Independent Risk Factors

Risk Factors for Inpatient Hypoglycemia in a Tertiary Care Medical Center

2011 ◽  
pp. P3-450-P3-450
Author(s):  
Jeremy R Grogg ◽  
Pooja Singal ◽  
Abhilasha Jarori ◽  
James P Walsh
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Tertiary Care ◽  
Tertiary Care Medical Center

Imipenem Resistance Among Pseudomonas aeruginosa Isolates Risk Factors for Infection and Impact of Resistance on Clinical and Economic Outcomes

2006 ◽  
Vol 27 (9) ◽  
pp. 893-900 ◽  
Author(s):  
Ebbing Lautenbach ◽  
Mark G. Weiner ◽  
Irving Nachamkin ◽  
Warren B. Bilker ◽  
Angela Sheridan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Medical Center ◽  
Tertiary Care ◽  
Economic Outcomes ◽  
Control Group ◽  
Case Group ◽  
Tertiary Care Medical Center ◽  
Imipenem Resistance ◽  
The Impact

Objectives.To identify risk factors for infection with imipenem-resistant Pseudomonas aeruginosa and determine the impact of imipenem resistance on clinical and economic outcomes among patients infected with P. aeruginosa.Designs.An ecologic study, a case-control study, and a retrospective cohort study.Setting.A 625-bed tertiary care medical center.Patients.All patients who had an inpatient clinical culture positive for P. aeruginosa between January 1, 1999, and December 31, 2000.Results.From 1991 through 2000, the annual prevalence of imipenem resistance among P. aeruginosa isolates increased significantly (P<.001 by the χ2 test for trend). Among 879 patients infected with P. aeruginosa during 1999-2000, a total of 142 had imipenem-resistant P. aeruginosa infection (the case group), whereas 737 had imipenem-susceptible P. aeruginosa infection (the control group). The only independent risk factor for imipenem-resistant P. aeruginosa infection was prior fluoroquinolone use (adjusted odds ratio, 2.52 [95% confidence interval {CI}, 1.61-3.92]; P<.001). Compared with patients infected with imipenem-susceptible P. aeruginosa, patients infected with imipenem-resistant P. aeruginosa had longer subsequent hospitalization durations (15.5 days vs 9 days; P = .02) and greater hospital costs ($81,330 vs $48,381; P<.001). The mortality rate among patients infected with imipenem-resistant P. aeruginosa was 31.1%, compared with 16.7% for patients infected with imipenem-susceptible P. aeruginosa (relative risk, 1.86 [95% CI, 1.38-2.51]; P<.001). In multivariable analyses, there remained an independent association between infection with imipenem-resistant P. aeruginosa and mortality.Conclusions.The prevalence of imipenem resistance among P. aeruginosa strains has increased markedly in recent years and has had a significant impact on both clinical and economic outcomes. Our results suggest that curtailing use of other antibiotics (particularly fluoroquinolones) may be important in attempts to curb further emergence of imipenem resistance.

scholarly journals PGI1 PREVALENCE AND RISK FACTORS FOR DIARRHEA AT A LARGE TERTIARY CARE MEDICAL CENTER

2005 ◽  
Vol 8 (3) ◽  
pp. 369-370
Author(s):  
S Kachroo ◽  
N Kumar ◽  
G Graham ◽  
L Gerard ◽  
T Dao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Tertiary Care ◽  
Tertiary Care Medical Center ◽  
Large Tertiary Care

Extended-Spectrum β-Lactamase–ProducingEscherichia coliandKlebsiellaSpecies: Risk Factors for Colonization and Impact of Antimicrobial Formulary Interventions on Colonization Prevalence

2002 ◽  
Vol 23 (5) ◽  
pp. 254-260 ◽  
Author(s):  
Gregory Bisson ◽  
Neil O. Fishman ◽  
Jean Baldus Patel ◽  
Paul H. Edelstein ◽  
Ebbing Lautenbach
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Tertiary Care ◽  
Healthcare Facility ◽  
System A ◽  
Extended Spectrum ◽  
Tertiary Care Medical Center ◽  
Duration Of Hospitalization ◽  
Third Generation Cephalosporins ◽  
Control Study

Objective:The incidence of extended-spectrum β-lactamase (ESβL)–mediated resistance has increased markedly during the past decade. Risk factors for colonization with ESβL-producingEscherichia coliand Klebsiella species(ESβL-EK) remain unclear, as do methods to control their further emergence.Design:Case–control study.Setting:Two hospitals within a large academic health system: a 725-bed academic tertiary-care medical center and a 344-bed urban community hospital.Patients:Thirteen patients with ESβL-EK fecal colonization were compared with 46 randomly selected noncolonized controls.Results:Duration of hospitalization was the only independent risk factor for ESβL-EK colonization (odds ratio, 1.11; 95% confidence interval, 1.02 to 1.21). Of note, 8 (62%) of the patients had been admitted from another healthcare facility. In addition, there was evidence for dissemination of a singleK. oxytocaclone. Finally, the prevalence of ESβL-EK colonization decreased from 7.9% to 5.7% following restriction of third-generation cephalosporins (P= .51).Conclusions:ESβL-EK colonization was associated only with duration of hospitalization and there was no significant reduction following antimicrobial formulary interventions. The evidence for nosocomial spread and the high percentage of patients with ESβL-EK admitted from other sites suggest that greater emphasis must be placed on controlling the spread of such organisms within and between institutions.

scholarly journals Analysis of SteraMist ionized hydrogen peroxide technology in the sterilization of N95 respirators and other PPE: a quality improvement study

2020 ◽  
Author(s):  
Avilash K. Cramer ◽  
Deborah Plana ◽  
Helen Yang ◽  
Mary M. Carmack ◽  
Enze Tian ◽  
...  
Keyword(s):  
Hydrogen Peroxide ◽  
Personal Protective Equipment ◽  
Occupational Safety ◽  
Medical Center ◽  
Academic Medical Center ◽  
Biological Indicator ◽  
Protective Equipment ◽  
Pre Treatment ◽  
Environment Chamber ◽  
N95 Respirators

AbstractObjectiveThe COVID-19 pandemic has led to widespread shortages of personal protective equipment (PPE) for healthcare workers, including filtering facepiece respirators (FFRs) such as N95 masks. These masks are normally intended for single use, but their sterilization and subsequent reuse could substantially mitigate a world-wide shortage.DesignQuality assurance.SettingA sealed environment chamber installed in the animal facility of an academic medical center.InterventionsOne to five sterilization cycles using ionized hydrogen peroxide (iHP), generated by SteraMist® equipment (TOMI; Frederick, MD).Main outcome measuresPersonal protective equipment, including five N95 mask models from three manufacturers, were evaluated for efficacy of sterilization following iHP treatment (measured with bacterial spores in standard biological indicator assemblies). Additionally, N95 masks were assessed for their ability to efficiently filter particles down to 0.3µm and for their ability to form an airtight seal using a quantitative fit test. Filtration efficiency was measured using ambient particulate matter at a university lab and an aerosolized NaCl challenge at a National Institute for Occupational Safety and Health (NIOSH) pre-certification laboratory.ResultsThe data demonstrate that N95 masks sterilized using SteraMist iHP technology retain function up to five cycles, the maximum number tested to date. Some but not all PPE could also be sterilized using an iHP environmental chamber, but pre-treatment with a handheld iHP generator was required for semi-enclosed surfaces such as respirator hoses.ConclusionsA typical iHP environment chamber with a volume of ~80 m3 can treat ~7000 masks per day, as well as other items of PPE, making this an effective approach for a busy medical center.

Risk Factors for Otolaryngological Foreign Bodies in Eastern Poland

2012 ◽  
Vol 147 (5) ◽  
pp. 889-893 ◽  
Author(s):  
Beata Rybojad ◽  
Artur Niedzielski ◽  
Grażyna Niedzielska ◽  
Paweł Rybojad
Keyword(s):  
Risk Factors ◽  
Foreign Body ◽  
Elementary Education ◽  
Urban Areas ◽  
Foreign Bodies ◽  
Medical Center ◽  
Tertiary Care ◽  
Case Series ◽  
Psychomotor Development ◽  
Tertiary Care Medical Center

Objective To identify the sociodemographic characteristics and risk factors associated with suspected foreign bodies in the ear, nose, throat, airway, and esophagus among Polish children. Study Design Case series with chart review. Setting Tertiary care medical center. Subjects and Methods A retrospective analysis of the medical records of patients hospitalized for a suspected foreign body (FB) between 1998 and 2008 was conducted. Data regarding place of residence, presence of siblings, parents’ educational status, seasonality, psychomotor development, age, and sex were collected and statistically analyzed. Results Of the 1011 patients with suspected foreign body insertion, 849 (84%) had a positive diagnosis. Of the confirmed foreign bodies, 96 were found in the tracheobronchial tree, 142 were found in the esophagus, and 611 were located in the external auditory canals, nasopharyngeal passage, tonsils, auricles, or lips. Sociodemographically, 596 of the children came from urban areas, with a preponderance of males (55%). Objects were removed more frequently in summer and autumn (60%). Children with siblings (53%) predominated. The majority of patients (52%) had parents with an elementary education. Food was the most frequent foreign body in children under 3 years of age. Patients with delayed psychomotor development constituted 1.6% of the analyzed population. Conclusions Being male, 1 to 3 years of age, belonging to an urban family with siblings, and having parents with an elementary education increased the risk of foreign body insertion. Training caregivers about proper nutrition and safety rules when playing with children can reduce the risk of accidents related to foreign body insertion.

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