Background Healthcare worker (HCW)-associated coronavirus disease 2019 (COVID-19) is of global concern due to the potential for nosocomial spread and depletion of staff numbers. However, the literature on transmission routes and risk factors for COVID-19 in HCWs is limited. Aim To examine the characteristics and transmission dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in HCWs in a university teaching hospital in London, UK. Methods Staff records and virology testing results were combined to identify staff sickness and COVID-19 rates from March to April 2020. Comparisons were made with staff professional groups, department of work, and ethnicity. Findings COVID-19 rates in our HCWs largely rose and declined in parallel with the number of community cases. White and non-White ethnic groups among our HCWs had similar rates of infection. Clinical staff had a higher rate of laboratory-confirmed COVID-19 than non-clinical staff, but total sickness rates were similar. Doctors had the highest rate of infection, but took the fewest sickness days. Critical care had lower rates than the emergency department (ED), but rates in the ED declined when all staff were advised to use personal protective equipment (PPE). Conclusion Sustained transmission of SARS-CoV-2 among our hospital staff did not occur, beyond the community outbreak, even in the absence of strict infection control measures in non-clinical areas. Current PPE appears to be effective when used appropriately. Our findings emphasize the importance of testing both clinical and non-clinical staff groups during a pandemic.

Objectives Our aims were to examine AMR‐specific and AMR‐sensitive factors associated with antibiotic consumption in Nepal between 2006 and 2016, to explore health care‐seeking patterns and the source of antibiotics. Methods Cross‐sectional data from children under five in households in Nepal were extracted from the 2006, 2011 and 2016 Demographic Health Surveys (DHS). Bivariable and multivariable analyses were carried out to assess the association of disease prevalence and antibiotic use with age, sex, ecological location, urban/rural location, wealth index, household size, maternal smoking, use of clean fuel, sanitation, nutritional status, access to health care and vaccinations. Results Prevalence of fever, acute respiratory infection (ARI) and diarrhoea decreased between 2006 and 2016, whilst the proportion of children under five receiving antibiotics increased. Measles vaccination, basic vaccinations, nutritional status, sanitation and access to health care were associated with antibiotic use. Those in the highest wealth index use less antibiotics and antibiotic consumption in rural areas surpassed urban regions over time. Health seeking from the private sector has overtaken government facilities since 2006 with antibiotics mainly originating from pharmacies and private hospitals. Adherence to WHO‐recommended antibiotics has fallen over time. Conclusions With rising wealth, there has been a decline in disease prevalence but an increase in antibiotic use and more access to unregulated sources. Understanding factors associated with antibiotic use will help to inform interventions to reduce inappropriate antibiotic use whilst ensuring access to those who need them.

Background Antibiotic resistance is an important global public health issue, perpetuated by increases in antibiotic use. In low- and middle-income countries (LMICs), tackling antibiotic resistance bacteria is especially challenging. Due to high rates of infectious disease and continuing high mortality from untreated bacterial infections, policy must balance tackling both antibiotic access and antibiotic overuse. This paper investigates the social and health-seeking determinants that impact appropriate and inappropriate antibiotic use in Vietnamese children under 5 for Acute Respiratory Illness (ARI). Methods Descriptive analyses and logistic regression models were performed on country-wide household data from UNICEF Multiple Indicator Cluster Surveys in 2006, 2011, 2014. Results Results show that antibiotic overuse is higher in those who sought care from a healthcare provider than those who self-treated. In 2014, children who sought care at private facilities and government facilities were more likely to overuse antibiotics for mild respiratory infections (OR 6.1 and OR 3.8 respectively) than those who did not seek care at private and government facilities respectively. Furthermore, higher socioeconomic level was associated with both appropriate antibiotic use for pneumonia and inappropriate for mild ARI. Children in the poorest households in 2011 and 2014 were less likely to appropriately use antibiotics than those from other socioeconomic levels (OR 0.37 and 0.025 respectively). And children in the poorest households in 2014 were less likely to inappropriately use antibiotics for mild ARI than all other socioeconomic levels (OR 0.36). Conclusions These findings support, challenge, and broaden current understandings of antibiotic usage in Vietnam. Our results suggest that inappropriate antibiotic use arises from the provider and institutional level. Consequently, we argue that community education efforts and enforcing antibiotics as prescription-only is insufficient. Instead, more focus should be made on reducing financial incentives and infrastructural weaknesses at hospitals and health centres. Furthermore, our results show the need to provide the poorest households with sufficient access to antibiotics. Health policy should tackle the issue of inappropriate use of antibiotics for mild ARI among higher socioeconomic groups.

Abstract Objectives Our aim was to examine the geographic, socio-economic and behavioural factors associated with disease and antibiotic consumption in Nepal from 2006 to 2016; as well as explore healthcare seeking patterns and the source of antibiotics. Methods Cross-sectional data on children under five in households from Nepal was extracted from the 2006, 2011 and 2016 Demographic Health Surveys (DHS). Univariate and multivariate analyses were carried out to assess the association of disease prevalence and antibiotic use with age, sex, ecological zone, urban/rural location, wealth index, maternal smoking, use of clean fuel, sanitation, nutrition, access to healthcare and vaccinations. Results Prevalence of fever, acute respiratory infection (ARI) and diarrhoea decreased from 2006 to 2016, while the proportion using antibiotics increased. Wealth, use of clean fuel, improved toilet sanitation, nutrition and access to healthcare were associated with reduced rates of disease. Those in the highest wealth index are starting to use less antibiotics and antibiotic consumption in rural areas has surpassed urban regions over time. Health-seeking from the private sector has overtaken government facilities since 2006 with source of antibiotics mainly originating from pharmacies and private hospitals. Adherence to WHO recommended antibiotics has reduced over time. Conclusions With rising wealth, there has been decline in disease prevalence but increase in antibiotic use with greater access to unregulated sources. Understanding antibiotic use and identifying associated behavioural and socio-economic factors could help to inform methods in reducing inappropriate antibiotic use whilst ensuring access to those who need them.

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Background Healthcare worker (HCW) associated COVID-19 is of global concern due to the potential for nosocomial spread and depletion of staff numbers. However, the literature on transmission routes and risk factors for COVID-19 in HCWs is limited. Aim To examine the characteristics and transmission dynamics of SARS-CoV-2 in HCWs in a university teaching hospital in London, UK. Methods Staff records and virology testing results were combined to identify staff sickness and COVID-19 rates from March to April 2020. Comparisons were made with staff professional groups, department of work and ethnicity. Analysis was performed using Microsoft ExcelTM. Findings COVID-19 rates in our HCWs largely rose and declined in parallel with the number of community cases. White and non-white ethnic groups among our HCWs had similar rates of infection. Clinical staff had a higher rate of laboratory-confirmed COVID-19 than non-clinical staff, but total sickness rates were similar. Doctors had the highest rate of infection, but took the fewest sickness days. Critical Care had lower rates than the Emergency Department (ED), but rates in the ED declined once all staff were advised to use Personal Protective Equipment (PPE). Conclusion These findings show that sustained transmission of SARS-CoV-2 among our hospital staff did not occur, beyond the community outbreak, even in the absence of strict infection control measures in non-clinical areas. The results also suggest that current PPE is effective when used appropriately. In addition, our findings emphasise the importance of testing both clinical and non-clinical staff groups during a pandemic. Keywords COVID-19, healthcare workers, testing, outbreak investigation, transmission dynamics

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