Effect of a strict hygiene bundle for the prevention of nosocomial transmission of SARS-CoV-2 in the hospital: a practical approach from the field

Abstract

Background During the novel coronavirus disease (COVID-19) pandemic it is crucial for hospitals to implement infection prevention strategies to reduce nosocomial transmission to the lowest possible number. This is all the more important because molecular tests for identifying SARS-CoV-2 infected patients are uncertain, and the resources available for them are limited. In this view, a monocentric, retrospective study with an interventional character was conducted to investigate the extent to which the introduction of a strict hygiene bundle including a general mask requirement and daily screening for suspicious patients has an impact on the SARS-CoV-2 nosocomial rate in the pandemic environment. Methods All inpatients from a maximum care hospital in Regensburg (Bavaria) between March 1 st and June 10 th 2020 were included. Patient with respiratory symptoms were tested for SARS-CoV-2 at admission, patients were managed according to a standard hygiene protocol. At the end of March a strict hygiene bundle was introduced including a general mask obligation and a daily clinical screening of inpatients for respiratory symptoms. Nosocomial infection rate for COVID-19 and the risk for infection transmission estimated by the nosocomial incidence density before and after introduction the hygiene bundle were compared. The infection pressure for the hospital during the entire observational period was characterized by the infection reports in the region in relation to the number of hospitalized COVID-19 patients and the number of infected employees. Results In fact, after the introduction of a strict hygiene bundle including a general mouth and nose protection obligation and a daily clinical screening of suspicious patients, a significant reduction of the nosocomial rate from 0.28 to 0.06 (p = 0.026) was observed. Furthermore, the risk of spreading hospital-acquired infections also decreased dramatically from 0.0007 to 0.00018 (p = 0.031; rate ratio after/before 0.25 (95%CI 0.06, 1.07) despite a slow decrease of the hospital COVID 19-prevalence and an increase of infected employees. Conclusion The available data underline that a strict hygiene bundle seem to be associated with a decrease of nosocomial SARS-CoV-2 transmission in the pandemic situation.

Hospital acquired COVID-19 infections amongst patients before the rollout of COVID-19 vaccinations, a scoping review

“…In other hospital settings, such as haemodialysis, the risk of COVID-19 HAI spread was high but adherence to strict prevention protocols appeared to be feasible and very effective in reducing HAIs [37][38][39]. General care wards in well-resourced academic hospitals also appeared to achieve effective control measures and significant reductions in HAIs [40][41][42]. However, in some cases it may not be as straightforward, such as in a psychiatric hospital attempting to follow CDC guidelines, where infection rates decreased but the levels remained of public health concern and as high as in a similar setting prior to implementing NPPIs [43].…”

“…Strategies to reduce airborne transmission included use of portable particulate filters in wards and regular meticulous cleaning of non-invasive ventilation apparatus which have been reported to spark super-spreading events [32,46,47]. Universal testing of COVID-19 infection on admission appeared to be effective in lowering HAIs, with some hospitals recommending daily screening and testing of symptomatic hospital habitants [41,45]. This requires properly designed holding wards while waiting for results, without promoting spread amongst these waiting patients.…”

Patients with Chronic Pain Prefer Maintenance of Pain Treatment Despite COVID-19 Pandemic Restrictions

“…Conversely, the experience from Bergamo shows that hospitals in particular can also play a major role in the spread of the disease (54). A dramatic decrease of the nosocomial COVID-19 infection rate after introduction of a strict hygiene bundle was reported by Ambrosch et al (55). In order to make an appropriate decision, not only the risk of a hospital-acquired infection must be assessed, but also the degree of pain aggravation or psychological distress due to lack of treatment.…”

Immunogenic SARS-CoV-2 S and N Protein Peptide and Cytokine Combinations as Biomarkers for Early Prediction of Fatal COVID-19

“…Evidence shows that the immune response to SARS-CoV-2 infection contributes to COVID-19 outcomes ( 32 , 33 ). Reactivity to S and N proteins appears to differ between non-fatal and fatal cases ( 34 ); however, little is known about the location of immunogenic regions in these proteins. We identified multiple N protein peptides reacting with fatal COVID-19 IgM.…”