某定点医院COVID-19前接转运病例结局分析

目的　分析COVID-19前接转运病例的特征及转运工作经验,为新突发呼吸道传染病前接转运工作提供参考。方法　收集2020年1月22日—3月22日我中心34例COVID-19前接转运病例的就诊与排查流程信息,对病例年龄及性别分布特征、确诊与排除情况进行统计分析。结果　34例病例中,确诊8例,排除26例,确诊病例均有流行病学史,1例住院确诊病例出院后出现核酸检测“复阳”。结论　前接转运医师须高度重视病例流行病学史的询问与排查,关注疫情初期核酸检测假阳性现象。病例转运、留观和住院诊疗等各环节均严格落实院内感染防控措施,有效防止交叉感染的发生。     

Association between Influenza Vaccination and severe COVID-19 outcomes at a designated COVID-only hospital in Brooklyn

Maintaining influenza vaccination at high coverage has the potential to prevent a proportion of COVID-19 morbidity and mortality. We examined whether flu-vaccination is associated with severe corona virus disease 2019 (COVID-19) disease, as measured by intensive care unit (ICU)-admission, ventilator-use, and mortality. Other outcome measures included hospital length of stay and total ICU days. Our findings showed that flu-vaccination was associated with a significantly reduced likelihood of an ICU admission especially among aged <65 and non-obese patients. Public health promotion of flu-vaccination may help mitigate the overwhelming demand for critical COVID-19 care pending the large-scale availability of COVID-19 vaccines.     

新型冠状病毒肺炎疫情期间医疗救治定点医院妇产科孕产妇心理状况调查

目的　通过分析新型冠状病毒肺炎（新冠肺炎）救治定点医院的妇产科住院孕产妇心理状况,为其实施有针对性、个性化的干预措施提供依据,以调整其心理状态,避免发生新冠肺炎的院内感染,确保母婴安全。方法　选取2020年1月23日—2月17日在中国人民解放军总医院第五医学中心妇产科住院孕产妇（均为非新型冠状病毒感染者）41例为调查对象,自主设计心理状况的调查问卷,对其进行问卷调查。结果　41名被调查孕产妇的陪护人员中,丈夫占最大比例,为85.4%;照顾住院孕产妇或新生儿有经验的仅占24.4%;获取疫情相关信息和疾病知识来源主要为微信、网站和电视;对新冠肺炎疾病传染源、传播途径、临床症状等知识掌握程度非常了解的仅占7.3%;对预防和保护措施掌握程度非常了解的仅占4.9%;从医务人员处获取更多新冠肺炎相关知识需要程度的为100%;对新冠肺炎疫情非常关注的占100%。41例孕产妇中,对住院环境安全性不同程度担心者占97.6%,对诊疗环境不同程度担心者占95.1%;对自身健康受到威胁不同程度担心者占100%,对胎儿/新生儿健康受到威胁不同程度担心者占100%;对陪护照顾能力不同程度担心者占90.3%,对护士照顾能力不同程度担心者占85.3%;对产后自我康复管理能力不同程度担心者占87.8%,对新生儿管理能力不同程度担心者占95.1%。结论　新冠肺炎疫情流行期间,早期识别住院孕产妇心理状况,及时给予有针对性、个性化的干预措施具有重要意义。护理人员在疫情期间须要格外关注孕产妇这一重点人群的心理状况和需求。     

SARS-CoV-2 RNA persists on surfaces following terminal disinfection of COVID-19 hospital isolation rooms

We evaluated the effect of terminal cleaning on SARS-CoV-2 RNA contamination of COVID-19 isolation rooms in an acute care hospital. SARS-CoV-2 RNA was detected on 32.1% of room surfaces after cleaning; the odds of contamination increased with month. The prevalence of elevated high-touch surface contamination was lower in terminally cleaned rooms than patient-occupied rooms.     

在新型冠状病毒肺炎疫情形势下消化内镜中心清洗消毒建议方案

自2019年12月新型冠状病毒(Corona virus disease 2019,COVID-19)在武汉发现以来,全国感染数量日益增加,国家已将新型冠状病毒肺炎(新冠肺炎,NCP)纳入乙类法定传染病甲类管理,也被世界卫生组织(world health organization,WHO)列为“国际关注的突发公共卫生事件”(public health emergency of international concern,PHEIC)。中华医学会消化内镜学分会从此次疫情开始出现之时,就积极组织业内专家按照国家权威机构公开的资料,并结合消化内镜中心诊疗特点和感控实际,起草针对该时期消化内镜中心清洗消毒方面的建议方案。相关专家不分昼夜、集思广议、查阅文献,紧急制定了以下建议案,期望能对在新冠肺炎流行期间的消化内镜中心清洗消毒工作起到指导作用。鉴于目前较为严峻的疫情防控形势,分会建议对于因病情需要而确需行内镜诊疗的情况,一律尽最大努力采取最为有效的清洗消毒方案。由于时间仓促,可能存在不全之处,我们分会将根据该病流行病学变化情况,及时调整以下方案。     

NDM-producing Enterobacterales prevalence associated to COVID-19 in a tertiary hospital

Colonizations/Infections caused by carbapenem-resistant Enterobacterales are of great clinical and epidemiological importance due to their rapid dissemination and high mortality rates. In this scenario, the use of antibiotics intensified by the COVID-19 pandemic has brought about a great warning on the real impact that this pandemic could have on antimicrobial management programs and long-term antimicrobial resistance rates. The objective of this study was to evaluate the increase of New Delhi Metallo β-Lactamase (NDM)-producing Enterobacterales cases in COVID-19 units of a complex Brazilian tertiary hospital. This retrospective observational study included all patients admitted to the hospital identified as colonized or infected by NDM-producing Gram negative bacilli (GNB), from January 2017 to April 2021. Forty-two NDM-producing Enterobacterales were identified in 39 patients. The rate of NDM cases per total surveillance cultures increased progressively between 2017 and 2021 (chi-2 for trend, p < 0.0001) and was associated with a higher occurrence specifically in COVID units (Fisher exact, p < 0.0001). The molecular investigation of the NDM-producing Klebsiella pneumoniae strains revealed the emergence of diverse clones during the COVID-19 period, also with possible evidence of horizontal transmission among patients within COVID units. NDM-producing Enterobacterales with multiple and different clonalities in the COVID-19 units also raised questions about the importance of other factors besides horizontal clonal transfer, including the increase of antimicrobial consumption by these patients.     

Bacteremia during COVID-19 pandemic in a tertiary hospital in Spain

IntroductionThe reasons for the decrease in blood cultures were investigated and the rate and aetiology of bacteremia and contaminated blood cultures collected from COVID and non-COVID patients were assessed.MethodsWe performed a retrospective analysis in a tertiary hospital in Spain during the COVID period from 4th March 2020 to 21st June 2020.ResultsThe number of blood cultures processed was 5313, representing 22.7% and 18.8% of decrease compared to the same months of 2019 and 2018, respectively (p = 0.173). The rate of bacteremia was 1.2% higher among COVID-patients than among non-COVID patients (p < 0.001). COVID patients had a higher proportion of nosocomial bacteremia (95.5%) than non-COVID patients (30.5%) (p < 0.001). In COVID-positive patients, the contamination rate was 12.3% vs 5.7% in non-COVID patients (p < 0.001).ConclusionThere was a decrease in the number of blood cultures collected during the COVID period compared to previous years. Bacteremia in COVID patients was mainly nosocomial and catheter-related.     

Real-world outcomes of COVID-19 treatment with remdesivir in a Spanish hospital

Remdesivir is the only antiviral approved for lower respiratory tract infection produced by SARS-CoV-2. The main objective of this study was to determine the mortality rate, readmissions, mean hospital stay, need for higher levels of oxygen support, and adverse effect-induced abandonment rate in hospitalized patients diagnosed with COVID-19 and treated with remdesivir (RDSV). The secondary objective was to determine mortality-related risk factors in these patients.The study included a prospective cohort of patients admitted to a third level Spanish hospital between July 5, 2020 and February 3, 2021 for COVID-19 diagnosed by SARS-CoV-2 polymerase chain reaction and/or antigen test and treated with RDSV.Remdesivir was received by 185 patients (69.7% males) with a mean age of 62.5 years, median Charlson index of 3 (interquartile range [IQR]: 1–4), and median ambient air oxygen saturation of 91% (IQR: 90–93); 61.6% of patients had hyper-inflammatory syndrome at admission. Median time with symptoms before RDSV treatment was 5 days (IQR: 3–6) and the median hospital stay was 10 days (IQR: 7–15); 19 patients (10.3%) died after a median stay of 13.5 days (IQR: 9.7–24 days), 58 patients (12.9%) were admitted to ICU, 58 (31.4%) needed higher levels of oxygen support, 0.5% abandoned the treatment due to adverse effects, and there were no readmissions. The only mortality-related factor was the need for higher levels of oxygen support (odds ratio 12.02; 95% confidence interval 2.25–64.2).All studied patients were admitted to hospital with a diagnosis of COVID-19 and in respiratory failure, needing initial low-flow oxygen support, and all received RDSV within 1 week of symptom onset. The percent mortality was lower in these patients than was observed in all patients with severe COVID-19 admitted to our center (10.3% vs 20.3%, respectively). Despite receiving RDSV, 1 in 3 patients needed higher levels of oxygen support, the sole mortality-related factor.     

Focused multivector ultraviolet (FMUV) technology rapidly eradicates SARS-CoV-2 in-vitro: Implications for hospital disinfection of COVID-19 environments

Focused Multivector Ultraviolet technology rapidly killed the SARS-CoV-2 coronavirus in-vitro. Plates were inoculated with a mean of greater than 10⁶ plaque forming units of USA-WA1 Washington index patient strain of SARS-CoV-2 and exposed to ultraviolet, resulting in mean reductions of 99.99% within 30 seconds, 99.999% within 60 seconds, and 99.9999% within 90 seconds. These results support the effectiveness of Focused Multivector Ultraviolet technology for SARS-CoV-2 disinfection.     

Preparedness for establishing COVID-19 services during acute emergency of COVID-19 pandemic: Experience of a tertiary care TB and respiratory diseases hospital

BackgroundThe ongoing coronavirus disease 2019 (COVID-19) calls for setting up of well-equipped and dedicated health facilities to manage sick patients while protecting healthcare workers and the environment. An ideal high-level isolation unit requires a high level of administrative commitment, availability of space, human resource and logistics.MethodThe experience of setting up COVID-19 care facilities on a noticeably short period in a tertiary TB and respiratory diseases institute in wake of the COVID-19 pandemic is being shared here.ResultAll the essential COVID-19 services were set up in record time of 8 days. A total of 115 COVID-19 patients were admitted. Out of these 89 patients were discharged in a satisfactory condition. There were 19 deaths, and 4 patients became critical and had to be referred to level 3 facility for ICU care.ConclusionThis experience will help other hospitals in planning out the strategies and solve the difficulties they may face while opening a COVID-19 care facility under limited resources on an urgent basis.     

Biosafety risk assessment and risk control of clinical laboratory in designated hospitals for treating COVID-19 in Chongqing,China

BackgroundIf a nucleic acid preservation solution containing viral inactivators is used, the biosafety risk in the process of detecting the nucleic acid of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will be low. Patients infected with SARS-CoV-2 are sent to designated hospitals for treatment in China, except for detecting nucleic acid of SARS-CoV-2, other laboratory tests such as bacterial culture may also be carried out while the patients are being treated. However, in addition to nucleic acid testing, biosafety risks in the testing of these items for patients with coronavirus disease 2019 (COVID-19) might be ignored. Therefore, we identified and evaluated risks in these detection processes and formulated appropriate, but not excessive control measures for biosafety risk, to improve the work efficiency and prevent biosafety accidents.MethodsBiosafety risks in all laboratory tests for COVID-19 patients were identified and evaluated according to the risk severity and occurrence probability. Subsequently, the corresponding control measures for biosafety risk were formulated according to the identified risk. Hereafter, risk monitoring was carried out.ResultsMore than 32 risks in the entire laboratory testing process were identified and evaluated, and the residual risk after the implementation of the control measures was acceptable.ConclusionsThe biosafety risk assessment of laboratories in designated hospitals for treating COVID-19 should be re-implemented before testing specimens for COVID-19 patients. Risk management by risk monitoring is even more important, as it can prevent the occurrence of biosafety incidents and can continuously improve risk management.