bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhancing respiratory protection in skilled nursing facilities during the COVID-19 pandemic: A public health fit-test training program
Authors: Scully Jenna , Menanno Mariah , Gould Jane , Peritz Tiina 
Published: May 2022

Background: The Occupational Safety and Health Administration (OSHA) Respiratory Protection standard (29 CFR 1910.134) states that it is an employer’s responsibility to establish and maintain a respiratory protection program when a respirator is necessary to protect the health of employees, including annual assessment of adequate respirator fit. Prior to the COVID-19 pandemic, N95 respirators were rarely used in Philadelphia skilled-nursing facilities (SNFs), and many facilities did not have programs in place or materials to fit test their staff. Methods: The Philadelphia Department of Public Health’s (PDPH) Healthcare Associated Infections/Antimicrobial Resistance (HAI/AR) Program designed and pilot-tested 1.5-hour “train-the-trainer” sessions on OSHA-compliant fit-testing requirements and qualitative procedures. This training was offered to all 47 SNFs beginning May 2021. Training covered the role N95 respirators play in healthcare, proper donning and doffing, OSHA training requirements, medical clearances, record keeping, fit-testing procedure, and demonstrated competency to perform fit testing. Resources that were provided after training included templates of a respiratory protection policy for SNFs, a fit-test record, the OSHA medical clearance form, and a competency checklist. This bundle was designed to help SNFs establish self-sustaining respiratory protection programs. Post-training evaluations were administered on a 6-point Likert scale as well as qualitative, open-ended questions to evaluate the overall quality and effectiveness of the training session. Results: In total, 50 employees (clinical and nonclinical) from 13 Philadelphia SNFs received N95 fit-test training from June through December 2021. The average rating for the training overall was very high (5.9 of 6 points). On average, participants strongly agreed that content presented was directly applicable to their work (5.9 of 6 points), and most strongly agreed that information they learned would alter practices and procedures (5.79 of 6 points). When asked qualitatively what the participant would do differently in practice as a result of the training, the most frequent responses were fit test staff (58%) and educate staff on proper N95 use (60%). Conclusions: The PDPH HAI/AR program created a successful pilot fit-test training program for SNFs, demonstrated by program enrollment and high ratings by participants. This relatively low-cost intervention has provided tools to enhance respiratory protection during the COVID-19 pandemic and has increases the capacity of SNFs to provide essential services for their staff and residents. The PDPH will continue to offer these training sessions to SNFs, with plans to expand to other care settings, such as inpatient behavioral health facilities, outpatient clinics, and emergency medical services.Funding: Funded by the CDC ELC Project FirstlineDisclosures: None
The role and relevance of asymptomatic healthcare worker testing in COVID-19 hospital outbreaks
Authors: Garrod Matthew , Short Katy , Zlosnik James , Prystajecky Natalie 
Published: May 2022

Background: Many healthcare facilities have faced the decision of conducting point prevalence testing (PPT) of healthcare workers (HCW) during COVID-19 outbreaks. As a containment strategy, PPT can identify asymptomatic or presymptomatic cases for isolation. It is less clear how useful testing asymptomatic HCW is in understanding the spread and possible routes of transmission in an outbreak. This study investigated HCW cases identified through PPT during acute-care outbreaks in Fraser Health (FH), British Columbia, incorporating both epidemiological and whole-genome sequencing (WGS) data to determine their epidemiological source. Methods: This study was a retrospective review of cases associated with COVID-19 acute-care outbreaks in FH occurring between December 2020 and June 2021, when most of these infections were of the alpha and gamma lineages. All patients and HCWs with a positive COVID-19 test and epidemiologically linked to the outbreaks were included in the study. WGS results supported determination of epidemiological source for cases. The proportion of patient and HCW cases related to the outbreak was compared. All analyses were conducted using SAS version 4.3 software with the PROC GLM package. Results: Between December 2020 and June 2021, 49 acute-care COVID-19 outbreaks were declared. Point-prevalence testing of HCWs, in addition to routine patient PPT, was conducted in 28 outbreaks (57%), with 2,167 eligible HCWs (63%) tested. Testing identified 14 previously unknown HCW cases, representing 12.96% of all HCW cases epidemiologically linked to the outbreaks. None of these HCWs were determined to be the index case for their associated outbreak. There was no statistically significant difference between HCWs and patients regarding WGS failure rate, and all failed samples were removed from further analysis. Patients were 3.8 times as likely as HCWs to present as symptomatic when testing positive. HCWs were 2.2 times as likely as patients to have WGS results unrelated to the outbreak. Discussion: Although point-prevalence testing of HCW identified previously unknown cases, these cases were more likely than patients to be unrelated to the outbreak and therefore less useful in understanding the epidemiology of the outbreak. It is difficult to determine whether HCW PPT was effective at preventing transmission, especially with robust infection prevention measures already in place. Patients were more likely than HCWs to present as asymptomatic, however this may be due to the attribution of symptoms to other conditions. Conclusions: Point prevalence testing of HCWs during COVID-19 outbreaks may assist with preventing transmission but is less likely to contribute meaningful information to the investigation.Funding: NoneDisclosures: None
Duration of exposure is the most important risk factor for nosocomial COVID-19 in open multibed wards
Authors: Chan Hwang Ching , Ang Alicia , Fauzi Nazira , Sridhar Revathi , Poh Annie , Low Isaac , Fisher Dale , Tambyah Paul , Somani Jyoti 
Published: May 2022

Background: The National University Hospital (NUH) is a 1,200 bed tertiary-care hospital with no documented nosocomial transmission of COVID-19 among patients for the first year and a half of the pandemic, despite 65% of the patients being housed in 4- to 8-bedded open cubicles with shared bathrooms. However, this arrangement changed in late September 2021 with large community clusters including in healthcare institutions nationally associated with the spread of the δ (delta) variant of SARS-CoV-2. We conducted a retrospective review of hospital epidemiology data to determine risk factors for SARS-COV-2 transmission during this period. Methods: Index patients were defined as the first patient in an open cubicle with a confirmed positive SARS-CoV-2 PCR test. Contacts were defined as being in the same cubicle as a patient before isolation from 2 days before symptom onset, up to 7 days from positive test if asymptomatic. Clinical and patient movement data were obtained manually from routine clinical records. Proximity of the contact from the index was classified as within, or more than, 2 m away, according to the prevailing definition from the Singapore Ministry of Health. A univariate analysis was performed to identify risk factors for nosocomial acquisition of SARS-CoV-2. The analysis was deemed exempt from ethics review (reference no. NHG-DSRB-2021/01026). Results: From October 1 to November 30, 2021, 30 index cases occurred in open cubicles identified (median, 9 days after admission; IQR, 19 days). Contact tracing yielded 211 contacts, of whom 10 (4.7%) were infected. Linear regression analysis found the duration of contact for each hour spent in the same room as the index case was the only statistically significant risk variable for contracting COVID-19, with an odds ratio 1.02 (Table 1). Conclusions: Patients in open cubicles are at risk for nosocomial transmission of COVID-19 and other infections. The duration of contact appeared to be more important than vaccination status of index or ward ventilation status. Larger multicentered studies are needed to validate this finding, which has significant implications for infection prevention strategies and pandemic planning.Funding: NoneDisclosures: None
Fitted containment efficiency of face masks for reducing emission of aerosols in the indoor environment
Authors: Bennett William , Prince Steven , Zeman Kirby , Samet James 
Published: May 2022

Background: Face masks are a major tool for reducing the spread of COVID-19 has been the use of face masks because (1) they protect the wearer from aerosol laden virus in the environment and (2) they reduce aerosol emissions to the environment from infected individuals. Methods that quantify the fitted mask filtration efficiency for protection of the wearer are well established (eg, Sickbert-Bennett et al, JAMA Intern Med 2020;180:1607). In contrast, current methods for assessing face-mask containment efficiency are generally semiquantitative and rely on measurement of a very low concentration of aerosols emitted from a healthy or infected human, or the use of mannequins in which a high concentration of surrogate aerosols can be introduced inside the mask. Methods: Expanding on our standard methods used for fitted face-mask filtration efficiency, we designed a small-volume, low-ventilation chamber to accommodate a seated study participant. The study participant wore a ported face mask to allow introduction of a stream of 0.05 μm NaCl particles at a constant concentration (TSI 8026 particle generator) into the mask space. The ambient chamber concentration was continuously measured by a TSI 3775 condensation particle counter sampling 2 feet (~2 m) in front of the participant’s head over a series of three 3-minute periods: (1) resting, (2) reading out loud, and (3) repeated forceful coughing (2 × 10 coughs) (~450 L/min peak flows). Figure 1 shows a raw data sample for the coughing procedure. Containment efficiency (%) for each mask and procedure were determined as 100 × (1 – the average of all 1 − second ambient concentration values between 30 and 180 seconds divided by the same for the “no mask” condition). Results: Table 1 shows the average % containment efficiency for 2 study days with each mask or procedure in an adult male. The 2-ear-loop masks (KN95 and procedure) tested during coughing had the greatest reduction in % containment efficiency compared to that during resting breathing, likely owing to a decreased mask fit with transient pressure increase inside the mask associated with the coughs. The N95 was least affected by the introduction of reading and/or coughing, maintaining near 95% containment efficiency throughout. Conclusions: Our preliminary data on fitted containment efficiency of masks under different conditions suggest that the fitted containment efficiency closely mimics their performance for personal protection. This information that may aid in providing optimum source control in indoor environments.Funding: NoneDisclosures: None
SARS-CoV-2 breakthrough infections among hospitalized patients in southeastern Michigan
Authors: Fine Sydney , Necaise Kellee , Hayward Alexandra , Malani Anurag 
Published: May 2022

Background: As of January 2022, more than 57 million cases of COVID-19 have been reported in the United States. Three primary COVID-19 vaccines are widely available: Pfizer (BNT162b2), Moderna (mRNA-1273), and Johnson & Johnson’s-Janssen (JNJ-78436735). The vaccines are effective but do not prevent all infections. We investigated trends in type of vaccine receipt, demographic characteristics, and disease outcomes in COVID-19 breakthrough infections among hospitalized patients. Methods: A breakthrough case is defined as the detection of SARS-CoV-2 ≥14 days after completion of all doses of an FDA-authorized COVID-19 vaccine. An electronic medical record report in EPIC EHR software identified 85 fully vaccinated patients with a documented positive SARS-CoV-2 result between February and September 2021 at 2 hospitals in southeastern Michigan. Demographic information and hospitalization characteristics, including length of stay and oxygen requirements, were collected from the report. Patients were classified into disease severity categories: nonsevere, severe, or critical. A case was considered severe if the patient’s oxygen saturation level (SpO2) was ≤94% on room air or if the patient required supplemental oxygen. Illness was considered critical if the patient developed respiratory failure, including mechanical ventilation or extracorporeal membrane oxygenation. All other cases were classified as nonsevere. Cycle threshold (Ct) values, the number of PCR cycles required to reach a threshold of SARS-CoV-2 genomic material, were collected from the hospital microbiology lab. Results: We identified 85 breakthrough infections (Fig. 1). The average patient age was 69.9±15.7 years, and 44 (51.8%) were female. Severe disease was most common (n = 73, 85.9%) followed by nonsevere disease (n = 7, 8.24%), and 9 patients (10.6%) in this cohort died. Most patients received either the Moderna (n = 35, 41.2%) or Pfizer (n = 38, 44.7%) vaccines. Pfizer vaccine receipt was most common among patients with severe illness (n = 33 of 73, 45.2%), and Moderna vaccine receipt was most common among patients with critical illness (n = 4 of 5, 80.0%). Average time from last vaccination to positive test was longest among Moderna vaccine recipients (181.9±43.1 days) and shortest among J&J vaccine recipients (91.0±61.1 days). The average Ct value was 23.8±7.5 and ranged from 13.0 to 41.3. There were no appreciable differences in the average Ct value by vaccine manufacturer. Conclusions: Breakthrough infections among hospitalized patients were uncommon, but incidence increased with time after vaccine receipt in all vaccines. Further study is needed to examine differences and severity in breakthrough infections by vaccine type and in individuals who completed booster vaccines.Funding: NoneDisclosures: None
assessment of Vaccine Interest in Unvaccinated COVID-19–positive inpatients
Authors: Stancill Lisa , DiBiase Lauren , Vavalle Emily Sickbert-Bennett 
Published: May 2022

Background: Although vaccine hesitancy has been an issue for many years, it has become a major point of contention in the effort to mitigate the COVID-19 pandemic. In August 2021, a large academic medical facility began capturing the vaccination status of admitted COVID-19–positive patients, as well as their interest in the COVID-19 vaccine. We performed a descriptive analysis on the characteristics of unvaccinated patients who contracted COVID-19 and their interest in receiving the COVID-19 vaccine. Methods: Patient history and physical (H&P) notes and demographic data were collected using the internal data warehouse sourced from the electronic medical record for all SARS-COV-2–positive inpatient admissions to UNC Medical Center and UNC Chatham from August 1, 2021, to January 11, 2022. Manual chart reviews of progress notes were completed for patients whose history was not recorded in the initial H&P. Demographic data were summarized by vaccine status overall and by interest in COVID-19 vaccine among unvaccinated patients. We performed χ2 to determine demographic differences between the interested and uninterested unvaccinated groups. Results: In total, 536 patients were admitted with COVID-19 from August 1, 2021, to January 11, 2022. Of these, 15% were fully vaccinated (2 doses mRNA plus 1 dose J&J); 5.4% were partially vaccinated; 75.7% were unvaccinated; and 2.9% had an unknown vaccination status. Demographic characteristics are presented in Table 1. The most common demographics were consistent among the fully vaccinated and unvaccinated groups, with the exception of sex and age group (Table 1). For those whose interest data were available (n = 164), 34% were uninterested in receiving the COVID-19 vaccine. Importantly, race and age were statistically significantly different (P < .05) between the unvaccinated interested and unvaccinated uninterested groups. Conclusions: Even after experiencing COVID-19 firsthand and being hospitalized, some people who remain uninterested in receiving the COVID-19 vaccine. This population had a statistically higher proportion of white and older individuals than the unvaccinated interested group. Recommendations from healthcare providers might not be effective in persuading this population to be vaccinated. Instead, grassroots alternatives might be more successful. Additional analysis should be considered on whether patients who expressed interest in COVID-19 vaccine received immunization.Funding: NoneDisclosures: None
Stay home, save lives: Characterizing sickness presenteeism and motives among healthcare personnel in the COVID-19 pandemic
Authors: Marusiak Amanda Brown , Weber David , Culbreth Cynthia , Pettigrew Erica , Stancill Lisa , Sickbert-Bennett Emily 
Published: May 2022

Background: Working while ill, or presenteeism, has been documented at substantial levels among healthcare personnel (HCP) along with its consequences for both patient and HCP safety. Limited literature has been published on HCP presenteeism during the COVID-19 pandemic, and specific motivations for this behavior are not well described. Understanding both individual and systemic factors that contribute to presenteeism is key to reducing respiratory illness transmission in the healthcare setting. We characterized the frequency of and motivations for presenteeism in the workforce of a large academic medical center during the COVID-19 pandemic. Method: We deployed a voluntary, anonymous electronic survey to HCP at University of North Carolina (UNC) Medical Center in December 2021, which was approved by the UNC Institutional Review Board. We received 591 responses recruited through employee newsletters. Respondents recounted their frequency of presenteeism since March 2020, defined as coming to work feeling feverish plus cough and/or sore throat. In total, 24.6% reported presenteeism at least once, with 8.1% reporting twice and 5.3% 3 or more times. Asking more generally about any symptoms while working, the following were most common: headache (26%), sinus congestion (20%), sore throat (13%), cough (13%), and muscle aches (9.3%). Results: Motivations for presenteeism fell broadly into 4 categories: (1) perception of low risk for COVID-19 infection, (2) concerns about workplace culture and operations, (3) issues with sick leave, and (4) concerns about employment record and status. Among HCP reporting at least 1 instance, the most common motivations for presenteeism included feeling low risk for COVID-19 infection due to mild symptoms (59.9%), being vaccinated (50.6%), avoiding increasing colleagues’ workload (48.3%), avoiding employment record impact (39.6%), and saving sick days for other purposes (37.9%). Asked to identify a primary motivation, 40.3% reported feeling low risk for COVID-19 infection due to mild symptoms or vaccination, 21.2% reported a workplace culture issue (ie, increasing colleague workload, perception of weakness, responsibility for patients), 20.6% reported sick leave availability and use (including difficulty finding coverage) and 17.8% reported employment record ramifications including termination. Conclusions: This survey coincided with 2the onset of the SARS-CoV-2 ο (omicron) variant locally, and as such, risk perceptions and motivations for presenteeism may have changed. Responses were self-reported and generalizability is limited. Still, these results highlight the importance of risk messaging and demonstrate the many factors to be considered as potential presenteeism motivators. Mitigating these drivers is particularly critical during high-risk times such as pandemics or seasonal peaks of respiratory illness.Funding: NoneDisclosures: None
Assessment of the effects of rapid diagnostic biofire blood culture identification panel in hospitalized patients
Authors: Cohen Amy , Erwes Thomas , Wiskirchen Dora , Abrantes-Figueiredo Jessica 
Published: May 2022

Background: Bloodstream infections (BSIs) have life-threatening consequences; they contribute to increased global morbidity and mortality, particularly in critically ill patients. Consequently, early implementation of effective antimicrobial therapy is crucial. Microbiology stewardship efforts, such as rapid diagnostic testing, streamline healthcare resources while also optimizing clinical outcomes. These outcomes include decreased mortality, fewer days of hospitalization, and more efficient time to appropriate anti-infective regimens. Biofire Blood Culture Identification (BCID) is a 2-stage multiplexed PCR system yielding multiple pathogen etiologies, as well as antimicrobial resistance genes. Results are published ~60 minutes after a blood-culture Gram stain turns positive. The purpose of this study was to assess the clinical impact of rapid diagnostic PCR testing, which was introduced at Saint Francis Hospital in March 2020. Methods: We conducted a single-center, retrospective observational chart review before and after implementation of Biofire BCID, surveying all positive cultures from December 2019 through June 2020. Medical records were more thoroughly reviewed for patients who met study inclusion criteria. The primary outcome of interest, time to appropriate antimicrobial therapy, included both days to targeted therapy in the setting of a probable pathogen, and days to antibiotic discontinuation in the case of a likely contaminant (nonpathogenic normal skin flora introduced into culture at the time of collection or processing). Secondary outcomes included in-hospital mortality (death during hospitalization), and inpatient length of stay (LOS). Wilcoxon rank-sum tests were used for primary outcomes and Fisher exact tests were used for secondary outcomes. Results: Among 643 patients with positive blood cultures, 410 (63.8%) met the criteria. In the study, 220 patients before the intervention and 190 patients after the intervention were reviewed. The difference in mean days to targeted therapy with a probable pathogen and days to antibiotic discontinuation with a likely contaminant were both observed at a significance level (3.62 vs 1.79, P Inpatient mortality rates were higher prior to launching Biofire BCID, but they were not statistically significant (15.5% vs 14.2 %; P = .782). The average LOS before and after implementation was 12.6 days (range, 2–92 days), and 10 days (range, 2–68 days), respectively. This parameter was also not statistically significant (P = .597). Conclusions: We detected a trend toward a significant reduction in time to appropriate antimicrobial therapy following the launch of Biofire BCID. Incorporation of molecular rapid diagnostics for BSI evaluation should be the standard of care in hospital settings.Funding: NoneDisclosures: None