BackgroundThe emergence of the highly transmissible COVID-19 variant, omicron, has resulted in high numbers of breakthrough infections, including among healthcare workers (HCW). Recent CDC recommendations now allow healthcare workers to return to work after day 5 if symptoms have improved, without a requirement for a negative rapid antigen test (RAT).MethodsFully vaccinated and non-immunocompromised HCW at a large, urban, academic medical center who tested positive for COVID-19 starting in late December, 2021 (when omicron was the predominant circulating strain) were allowed to return to work early if all symptoms had resolved excepting mild, intermittent cough and/or lingering loss of taste/smell, provided a rapid antigen test was negative upon return. Those with negative tests were allowed to return to work with the stipulations that they wear an N95 at all times and take breaks and eat meals apart from others. Those with positive tests on first attempt could return 24-48 hours later to test again for as many days as needed to achieve a negative result or until they completed 10 days of restriction from work.ResultsBetween January 2, 2022 and January 12, 2022 there were 309 total RAT done on 260 separate HCW on day 5-10 of illness. Overall, 43% (134 of 309) of all RAT were positive between days 5-10. The greatest percent positive RAT was noted among HCW returning for their first test on day 6 (58%). The rate of positivity was greatest (58%) among HCW returning for their first test on day 6. HCW returning on day 8 and 9 were less likely to have a positive test (26%, 19/74). In RAT positive HCW returning for their first test on days 5 or 6 (and for which line intensity was recorded) 49% (25/51) were recorded as having the darkest intensity on their RAT. HCW who test positive on their first test most often remained positive on their second test, with 56% of second tests, aggregated across all days 6-10, remaining positive. Over all first tests performed on days 5-10, boosted HCW were nearly twice as likely to test RAT positive: 53% (75 out of 141) of boosted HCW tested positive.DiscussionMore than 40% of vaccinated HCW who felt well enough to work still had positive RAT tests when presenting for a first test between days 5 and 10. Boosted individuals were nearly 3x as likely to result positive on day 5, their first day eligible for return, and ∼2x as likely to result positive on first RAT overall. New guidance provides clearance to exit isolation after 5 days from symptom onset, without the need for a negative rapid antigen test to exit, as long as symptoms are beginning to resolve. Per CDC, the guidance was driven by prior studies, mostly collected before Omicron and before most people were vaccinated or infected, that reported on symptom onset beginning one or more days after peak virus loads. In such an instance, where isolation based on symptom onset often did not begin until peak virus load was already attained, then release from isolation at 5 days would be appropriate. However, reports showing much earlier onset of symptoms, coupled with our own results here demonstrate that the relationship between symptom onset and peak virus load has changed, and 5 days from symptom onset may no longer be an appropriate window to end isolation without a negative rapid antigen test to support safe exit.ConclusionThese results indicate that a substantial proportion of individuals with COVID-19 are likely still contagious after day 5 of illness regardless of symptom status. Early liberation from isolation should be undertaken only with the understanding that inclusion of individuals on day 6-10 of illness in community or work settings may increase the risk of COVID-19 spread to others which, in turn, may undermine the intended benefits to staffing by resulting in more sick workers.
Nearly half of HCWs with influenza were afebrile prior to their diagnosis. HCWs with respiratory symptoms but no fever may pose a risk of influenza transmission to patients and coworkers.
An outbreak of SARS-CoV-2 in a skilled nursing facility (SNF) can be devastating for residents and staff. Difficulty identifying asymptomatic and pre-symptomatic cases and lack of vaccination or treatment options make management challenging. We created, implemented and now present a guide to rapidly deploy point prevalence testing and three-tiered cohorting in a SNF to mitigate an outbreak. We outline key challenges to SNF cohorting.
BackgroundWe aimed to use weekly PI calls in conjunction with 24/7 hand hygiene monitoring technology (HHMT) to engage front-line Intensive Care Unit (ICUs) clinicians in improving Hand Hygiene (HH) complianceMethodsHHMT is used to monitor aggregate, unit-based HH compliance in real time and displayed on monitors at the nursing stations at our academic medical center. After installation and validation were completed, unit-based teams of nursing and physician leadership joined weekly 15-minute HH PI calls to discuss their previous week’s compliance rate, next steps in their own PI plan, and share successes and failures. Calls were suspended for 6 months and restarted in early 2017.ResultsGraph representation of weekly HH compliance rates for the ICUs are shown in figure 1. Units AandB underwent physical moves during the break, Unit C had no change, and Unit D moved and consolidated with other ICUs constituting a major change in personnel and patient population. Each ICU participated in 84 calls and recorded approx. 50,000–100,000 HH opportunities during each month resulting in over 8 million opportunities for HH compliance recorded during the call-in periods. Unit A had an average compliance of 39% for the first 4 weeks of calls and 64% during the same 4 week period one year later (P < 0.0001). After 6 months without the calls, HH compliance was 48% (P < 0.0001 compared with baseline compliance) and unit A implemented 20 separate PI interventions over the course of the calls. Compliance was also significantly improved (P < 0.0001 for all comparison to baseline) for units B, C, and D (Unit B: 42% baseline, 71% at 1 year, 67% after the break, 23 interventions; Unit C: 54% baseline, 58% at 1 year, 59% after the break, 19 interventions; Unit D: 41% at baseline, 56% after 1 year, 49% after the break, 19 interventions). Attendance was >90% for nursing leadership and <25% for physician leadership.ConclusionWeekly 15-minute calls were successful in engaging local nursing leadership to undertake performance improvement interventions and significantly improved HH compliance that was sustained over 18 months of calls and did not drop back to baseline even after a 6 month break.Disclosures E. Landon, GOJO: Speaker, travel expenses for speaking; J. P. Ridgway, Gilead FOCUS: Grant Investigator, Grant recipient; A. H. Bartlett, CVS Caremark: Consultant, Consulting fee
We implemented universal inpatient Clostridioides difficile screening at an 800-bed hospital. Over 3 years, 2,010 of 47,048 screening tests (4.2%) were positive, with significantly higher rates of C. difficile colonization on transplant units than medical-surgical units: 5.4% (152 of 2,801) versus 4.3% (880 of 20,564), respectively (P = .005). Compliance with screening ranged from 79% to 96%.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
334 Leonard St
Brooklyn, NY 11211
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.