42. Outbreak of SARS-CoV-2 in Hospitalized Hemodialysis Patients: an Epidemiologic and Genomic Investigation

Background Healthcare-associated transmission of SARS-CoV-2 is relatively rare and may be difficult to quantify. We performed an epidemiological investigation and SARS-CoV-2 genome sequencing to define the source and scope of a SARS-CoV-2 outbreak in a cluster of hospitalized patients Methods We conducted an outbreak investigation after identifying hospital-onset COVID-19 in patients receiving hemodialysis in January 2021. Electronic medical record review, staff interviews, review of employee schedule logs, and contact tracing were used to determine the outbreak timeline and identify exposed healthcare workers (HCW). SARS-CoV-2 genomes were sequenced from residual nasopharyngeal swab samples from 6 individuals in the outbreak investigation and compared to sequences from 14 patients in the same facility, 54 patients in nearby facilities, and 375 publicly available sequences from individuals in the state of Georgia. Results Eight patients with hospital-onset COVID-19 were identified (Cases 1-8); all were receiving hemodialysis and 5 were bedded in a single inpatient nursing unit. Among 53 potentially exposed HCW, 29 underwent testing and 5 were positive (Cases 9-13). The suspected index patient (Case 1) was found to have been coughing and inconsistently wearing a mask during a hemodialysis session on the same day that 6 of the 7 other patients and one HCW (Case 10) were in close proximity in the hemodialysis unit (Figure 1A). Further investigation revealed lack of use of curtain barriers in the hemodialysis bays, inconsistent use of personal protective equipment by HCW, and overcrowding of staff breakrooms. Among the 6 samples available for phylogenetic analysis, SARS-CoV-2 sequences from 5 (4 patients and 1 HCW, Case 9) were identical and at least 4 SNPs removed from the next closest sequence in this study, supporting a transmission cluster (Figure 1B). The sequence from the sixth sample (HCW Case 10) was phylogenetically distinct, indicating an independent source of infection. Figure 1 Exposure and onset of symptoms for the 6 cases in the outbreak with samples available for SARS-CoV-2 sequencing. Four patients with hospital-onset COVID-19 (Cases 1-4) were receiving hemodialysis and bedded in a single inpatient nursing unit, with two exposed healthcare workers (Cases 9-10). (A). Phylogenetic tree of SARS-CoV-2 genomes from individuals in this outbreak investigation (red), as well as 14 patients in the same facility and 54 patients in nearby facilities between 12/12/2020 and 1/13/2021 (blue). These were aligned with 375 publicly available sequences from individuals in the state of Georgia from the same time period using MAFFT. A maximum-likelihood phylogenetic tree was generated under a generalized time-reversible model with 1,000 bootstrap replicates using IQtree v2.0.3 and visualized and annotated using Interactive Tree of Life (iTOL) v4 (B). Conclusion Lack of appropriate respiratory hygiene led to SARS-CoV-2 transmission during a single hemodialysis session, based on clinical and genomic epidemiology. Use of appropriate PPE for both patients and HCW and other infection prevention measures are critical to prevent SARS-CoV-2 transmission. Disclosures All Authors: No reported disclosures

Using a human-centred design approach to develop a comprehensive newborn monitoring chart for inpatient care in Kenya

Introduction Job aids such as observation charts are commonly used to record inpatient nursing observations. For sick newborns, it is important to provide critical information, intervene, and tailor treatment to improve health outcomes, as countries work towards reducing neonatal mortality. However, inpatient vital sign readings are often poorly documented and little attention has been paid to the process of chart design as a method of improving care quality. Poorly designed charts do not meet user needs leading to increased mental effort, duplication, suboptimal documentation and fragmentation. We provide a detailed account of a process of designing a monitoring chart. Methods We used a Human-Centred Design (HCD) approach to co-design a newborn monitoring chart between March and May 2019 in three workshops attended by 16–21 participants each (nurses and doctors) drawn from 14 hospitals in Kenya. We used personas, user story mapping during the workshops and observed chart completion to identify challenges with current charts and design requirements. Two new charts were piloted in four hospitals between June 2019 and February 2020 and revised in a cyclical manner. Results Challenges were identified regarding the chart design and supply, and how staff used existing charts. Challenges to use included limited staffing, a knowledge deficit among junior staff, poor interprofessional communication, and lack of appropriate and working equipment. We identified a strong preference from participants for one chart to capture vital signs, assessment of the baby, and feed and fluid prescription and monitoring; data that were previously captured on several charts. Discussion Adopting a Human-Centred Design approach, we designed a new comprehensive newborn monitoring chart that is unlike observation charts in the literature that only focus on vital signs. While the new chart does not address all needs, we believe that once implemented, it can help build a clearer picture of the care given to newborns. Conclusion The chart was co-designed and piloted with the user and context in mind resulting in a unique monitoring chart that can be adopted in similar settings.

Relationship of Leadership Style to Completeness of Filling in The Early Nursing Assessment in Hospital

Initial assessment has a very important role in determining the right nursing diagnosis, planning nursing actions, implementing actions and assessing/evaluating nursing. Initial assessment data is incomplete, precise and accurate resulting in nursing care will not achieve optimal goals. This study aims to determine the relationship between leadership style and the completeness of filling out the initial inpatient nursing assessment at Bina Sehat Hospital Jember. The research design is descriptive correlation with cross sectional,data analysis chi square, total population of all inpatient nurses, with a total sample of 79 nurses (total sampling). The results showed that there was no relationship between leadership style and the completeness of filling out the initial inpatient nursing assessment at Bina Sehat Hospital Jember (p=0.772). The majority of leadership style assessments are participatory (82.3%), where from 79 nurse respondents, 47 nurses are majority with a working period of > 5 years (59.5%), while in terms of education the majority of D3 nursing graduates are 40 nurses (50.6 %). Hospital agencies can maintain a participatory leadership style carried out by the head of the inpatient room, to be able to work together in decision making that can increase the creativity and work responsibilities of nurses, one of which is the completeness of nursing documentation, so that quality nursing services will be created.

RELATIONSHIP A BETWEEN LEADERSHIP STYLE AND WORKING CONDITIONS WITH NURSES 'WORKING SATISFACTION IN INPATIENT ROOMS, BAHTERAMAS HOSPITAL

Background:From the preliminary study by the researcher with the inpatient nursing department through in-depth interviews, there were problems such as complaints from patients who were in pain, there were nurses who did not come immediately and provide nursing care. Through interviews with nurses, it was found that career development procedures had not been prepared in nursing management. In addition, there are nurses who are several times late more than the stipulated time. Then there are still complaints that the incentives received are still insufficient. Methods:This type of research uses quantitative research with a cross sectional design. The population was 257 all nurses in the inpatient room at Bahteramas Hospital, with a sample of 141 samples using simple random sampling. Results:Using the cramer coefficient, it is obtained a value of 0.732, this shows the strength of the relationship between leadership style in work and job satisfaction of nurses. And the cramer coefficient is obtained a value of 0.620, this shows the strength of the relationship between leadership style in work and job satisfaction of nurses in the inpatient room at Bahteramas Hospital in the strong relationship category. Conclusion:There is a relationship between leadership style and working conditions on the job satisfaction of nurses in the inpatient room of the Bahteramas Hospital.

Will the demands by the covid-19 pandemic increase the intent to quit the profession of long-term care managers? A repeated cross-sectional study in Germany

The Corona pandemic poses major demands for long-term care, which might have impacted the intention to quit the profession among managers of long-term care facilities. We used cross-sectional data of an online survey of long-term care managers from outpatient and inpatient nursing and palliative care facilities surveyed in April 2020 (survey cycle one; n = 532) and between December 2020 and January 2021 (survey cycle two; n = 301). The results show a significant association between the perceived pandemic-specific and general demands and the intention to leave the profession. This association was significantly stronger for general demands in survey cycle two compared with survey cycle one. The results highlight the pandemic’s immediate impact on long-term care. In view of the increasing number of people in need of care and the already existing scarcity of specialized nursing staff, the results highlight the need for initiatives to ensure the provision of long-term care, also and especially in such times of crisis.