Background Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by a novel coronavirus (SARS-CoV-2) and first reported in Wuhan, China, in December 2019. Since the severe acute respiratory syndrome (SARS) outbreak in 2003, Tan Tock Seng Hospital (TTSH) in Singapore has routinely fit-tested staff for high-filtration N95 respirators and established Web-based staff surveillance systems. The routine systems were enhanced in response to Singapore’s first imported COVID-19 case on 23 January 2020. Methods We conducted a cross-sectional study from 23 January to 23 February 2020 among healthcare workers to evaluate the effectiveness of the staff protection and surveillance strategy in TTSH, a 1600-bed multidisciplinary acute-care hospital colocated with the 330-bed National Centre for Infectious Diseases (NCID). As of 23 February 2020, TTSH/NCID has managed 76% of confirmed COVID-19 cases in Singapore. The hospital adopted a multipronged approach to protect and monitor staff with potential COVID-19 exposures: (1) risk-based personal protective equipment, (2) staff fever and sickness surveillance, and (3) enhanced medical surveillance of unwell staff. Results A total of 10 583 staff were placed on hospitalwide fever and sickness surveillance, with 1524 frontline staff working in COVID-19 areas under close surveillance. Among frontline staff, a median of 8 staff illness episodes was seen per day; almost 10% (n = 29) resulted in hospitalization. None of the staff was found to be infected with COVID-19. Conclusions A robust staff protection and health surveillance system that is routinely implemented during non–outbreak periods and enhanced during the COVID-19 outbreak is effective in protecting frontline staff from the infection.

Nurses have the closest interaction with inpatients and could transmit influenza to patients. From a self-administered questionnaire survey among inpatient nurses at a tertiary hospital, we observed that the strongest factors associated with intention for future vaccination were perceived benefits of and motivations for vaccination (adjusted odds ratio [aOR], 3.30; 95% confidence interval [CI], 2.55-4.27), and perceived nonsusceptibility to influenza and preference for vaccination alternatives (aOR, 0.26; 95% CI, 0.20-0.34). These factors need to be addressed to increase vaccination uptake and prevent nosocomial transmission.

Li et al. reported health care worker (HCW) deaths from coronavirus disease (COVID-19) ( 1 ). HCWs are at risk of COVID-19 from nosocomial transmission and community acquisitions ( 2 ). Since the first imported case of COVID-19 from Wuhan, China, on January 23, 2020, the number of locally acquired COVID-19 cases has increased in Singapore. To break the chain of disease transmission, Singapore implemented the 'Circuit Breaker' measures between April 07, 2020 and June 01, 2020 ( 3 ). The measures included the closure of nonessential workplaces and schools, suspension of religious activities, movement restrictions, mandatory use of face masks in public areas, and safe distancing measures ( 3 ). Since the lifting of the measures on June 02, 2020, hospitals have resumed non-COVID-19related clinical services including clinically-indicated elective surgeries and chronic disease clinics. Furthermore, with the gradual resumption of economic activities and essential travel, an increase in the community transmission of COVID-19 can be expected.Early identification of COVID-19-infected HCWs can detect viral transmission, determine the effectiveness of control measures, and prevent onward transmission to patients and co-workers in healthcare settings ( 1 , 4 , 5 ). At the 1600-bed Tan Tock Seng Hospital (TTSH) and its co-located 330-bed National Centre for Infectious Disease (NCID), the designated center for emerging infectious disease outbreaks including COVID-19, a comprehensive staff sickness surveillance system has been implemented for > 10,0 0 0 HCWs ( 6 ). The system initially comprised an online temperature and sickness reporting platform and medical screening for COVID-19 in unwell HCWs working in COVID-19-related work areas at the TTSH's Emergency Department or NCID's COVID-19 Screening Center (SC). In preparation for the easing of "Circuit Breaker" measures, the HCW sickness surveillance system was enhanced to include SARS-CoV-2 swab testing for all HCWs with fever or symptoms of acute respiratory infection (ARI) from May 06, 2020 regardless of exposure risk. In addition to NCID's SC, TTSH's Occupational Health Clinic (OHC) also performed SARS-CoV-2 swab testing for all HCWs with fever or ARI symptoms. HCWs who had attended a primary care clinic near their homes were required to be tested for SARS-CoV-2 either at the clinic or the OHC. We compare the epidemiology of sick HCWs and describe the effectiveness of the enhanced HCW ARI surveillance program in COVID-19 detection, in the last month of the "Circuit Breaker" and the first month after the lifting of the "Circuit Breaker".We present data from May 06, 2020 to June 30, 2020 corresponding to the 4 weeks before (period A) and after (period B) the lifting of the 'Circuit Breaker' on June 02, 2020. A total of 997 sickness episodes from 874 HCWs (434 in period A and 440 in period B) were included ( Figure 1 ). The median age was 31

Objective: Overuse of antibiotics in the emergency department (ED) for uncomplicated acute respiratory tract infections (uARTIs) is a public health issue that needs to be addressed. We aimed to identify factors associated with antibiotic use for uARTIs in adults presenting at the ED. Design: We searched Medline, Embase, PsycINFO and the Cochrane Library for articles published from 1 January 2005 to 30 June 2017 using a predetermined search strategy. Titles and abstracts of English articles on antibiotic prescription and inappropriate antibiotic use for adult ARTI at EDs were assessed, followed by full article review, by 2 authors. Setting: Emergency departments. Participants: Adults aged 18 years and older. Results: Of the 2,591 articles retrieved, 12 articles met the inclusion criteria and 11 studies were conducted in the United States. Patients with normal C-reactive protein levels and positive influenza tests were less likely to receive antibiotic treatment. Nonclinical factors associated with antibiotic use were longer waiting time and perceived patient desire for antibiotics. Patients attended by internal medicine physicians comanaged by house staff or who visited an ED which provided education to healthcare providers on antibiotics use were less likely to receive antibiotics. Conclusions: English-language articles that fulfilled the selection criteria outside the United States were limited. Factors associated with antibiotics use are multifaceted. Education of healthcare providers presents an opportunity to improve antibiotic use.

Understanding the change in intention for influenza vaccine among health-care workers (HCWs) is important to increase influenza vaccination uptake. We aimed to investigate the psychosocial beliefs associated with a change in the intention for influenza vaccine. An anonymous cross-sectional survey was distributed to tertiary hospital HCWs in 2016. Of 3007 HCWs, 70% were compliant (vaccinated, with an intention to revaccinate), 8% were resistant (unvaccinated, without intention to vaccinate), 10% had positive change (unvaccinated, but with intention) and 12% had negative change (vaccinated, but without intention). Across HCW groups, medical staff had both the highest proportion receiving all influenza vaccinations in the last 5 years (101, 28.4%), as well as the highest proportion who had never received vaccination (41, 11.5%). With increasing age, HCWs were less likely to have a negative (p = .02) or positive change (p = .06) in intention, compared to the vaccine-resistant group. HCWs were more likely to be compliant or have a positive change in intention to receive influenza vaccine, if they perceived the vaccine as effective, safe, or had a higher frequency of influenza vaccination in the last 5 years (all with p < .05). HCWs who were medical staff, who believed that side effects of the vaccine were common, or had worked for 6 to 10 years (vs 5 years or less) were less likely to be compliant (all with p < .05). In conclusion, older HCWs were more likely to maintain the status quo in their behavior toward influenza vaccination. Influenza vaccination strategies should place emphasis on vaccine effectiveness and safety.

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Data for self-report symptoms presented as n (%). d Change from first control week in log odds (95% CI).

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