LIMITING THE INTRODUCTION OF COVID-19 IN HEALTHCARE SETTINGS - CARLOS MAGNO CASTELO BRANCO FORTALEZA, MD, PHD
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Limiting the Introduction of
COVID-19 in Healthcare Settings
Carlos Magno Castelo Branco Fortaleza, MD, PhD
Botucatu Medical School, São Paulo State University (UNESP)
São Paulo State Association for Infection Control (APECIH)
Ad hoc advisor of São Paulo
State Committee for
Response to COVID-19
* COI disclosure
ü To describe COVID-19 in Brazil and
threats to hospitals.
ü To present the strategy of a teaching
hospital in inner Brazil for limiting
COVID-19 introduction.
* Objectives
https://covid.saude.gov.br/
205 million inhabitants; 6.5 Thousand hospitals June 30th, 2020
Laboratory- Laboratory-
confirmed cases confirmed deaths
Health is a right for
every citizen and a
duty for the State
(1988 constitution)
São Paulo State Botucatu
276,000 cases 625 cases
16 deaths, 6 from a Nursing
14,000 deaths Home Outbreak
5th 1rst phase:
Metropolitan área
March-April
4th
July?
May-June
3rd
2nd
Universal, free-of-charge RT-
PCR COVID-19 tests for each
and every flu-like syndrome
Botucatu Medical School Hospital Complex: 800 beds
Focused IPC
• Healtcare workers approach • Training human
• Patients: COVID-19 resources
• Identifying high-risk
and other diagnosis. • Structure for
wards
isolation precautions.
• Implementing
collective approach
Preventive Safe COVID-19
Screening care
What we are doing
ID COVID
outpatients
4th Floor
Separate
entry
Symptomatic and
elevators
patient
RT-PCREmergency
Primary
Care Units Room
What is coming soon
Non-COVID
elective
admission
RT-PCR ID COVID
outpatients
4th Floor
Positive
Separate
Negative entry
Admission and
elevators
What is coming soon
Emergency
Room
Non-COVID
emergency ER: Rapid Response Team
admission
Positive
Negative RT-PCR
Medical- COVID-ICU
surgical ICUWhat is coming soon
Healthcare
Workers Pool Saliva
RT-PCR (up to 16)
No Positive? Yes
Negative Individual
sector testing
Weekly for COVID-19 areas
Every 2 weeks for other areas
Negative Positive
Millioni R, Mortarino C. medRxiv 2020; doi:
https://doi.org/10.1101/2020.04.24.20077966 14 days
Daily
To et al. Lancet Infect Dis. 2020;20(5):565-574. follow up Off work
doi:10.1016/S1473-3099(20)30196-1Focused IPC
• Healtcare workers approach • Training human
• Patients: COVID-19 resources
• Identifying high-risk
and other diagnosis. • Structure for
wards
isolation precautions.
• Implementing
collective approach
Preventive Safe COVID-19
Screening careWhat is coming soon
High risk
areas Pool Saliva
RT-PCR (up to 16)
No Positive? Yes
Negative Individual
sector testing
Repeat test in colleagues
Test patients in the ward
Negative Positive
Millioni R, Mortarino C. medRxiv 2020; doi:
https://doi.org/10.1101/2020.04.24.20077966 14 days
Daily
To et al. Lancet Infect Dis. 2020;20(5):565-574. follow up Off work
doi:10.1016/S1473-3099(20)30196-1Infected
HCWs
March
April
May
JuneFocused IPC
• Healtcare workers approach • Training human
• Patients: COVID-19 resources
• Identifying high-risk
and other diagnosis. • Structure for
wards
isolation precautions.
• Implementing
collective approach
Preventive Safe COVID-19
Screening careOnline tutorial for isolation precautions
Tablet based visits to COVID-19 patients
Increase Negative Pressure Rooms
Thus far no
HCW outbreak
March
April
May
JuneFINAL COMMENTS
The
Cochrane
church
won’t
save us
Djulbegovic et al. in: Gifford F. Philosophy of Medicine. Elsevier, 2012.FINAL COMMENTS Peer-review has provided the basis for continuous (…) criticism, and at least in theory it provides a scientific quality badge to information. Both peer review and editing processes take time, which we do not have in the current pandemics. Hundred of studies are either published in preprint repositories or submitted to fast-track peer review. This obviously means loosening the critical parameters, a choice of speed over rigor. This (…) requires a permanent critical attitude from the readers and a constant state of alert in the scientific community.
References Cao Y, Shan J, Gong Z, Kuang J, Gao Y. Status and Challenges of Public Health Emergency Management in China Related to COVID-19. Front Public Health. 2020;8:250. Published 2020 May 29. doi:10.3389/fpubh.2020.00250 Centers for Diseases Control and Prevention. Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic. CDC: Atlanta, 2020a (updated June 19, 2020). Centers for Diseases Control and Prevention. Strategies to Mitigate Healthcare Personnel Staffing Shortages. CDC: Atlanta, 2020b (updated April 30, 2020). Dantes RB, Jones TT, Neujahr DC. Delayed Recognition of Community Transmission of COVID-19 Resulting in Healthcare Worker Infections [published online ahead of print, 2020 Jun 10]. Infect Control Hosp Epidemiol. 2020;1-6. doi:10.1017/ice.2020.285. Escombe AR, Oeser CC, Gilman RH, et al. Natural ventilation for the prevention of airborne contagion. PLoS Med. 2007;4(2):e68. doi:10.1371/journal.pmed.0040068. Fortaleza CMCB, Guimarães RB, de Almeida GB, Pronunciate M, Ferreira CP. Taking the inner route: spatial and demographic factors affecting vulnerability to COVID-19 among 604 cities from inner São Paulo State, Brazil. Epidemiol Infect 2020 [ahead of print], DOI 10.1017/S095026882000134X. Houghton C, Meskell P, Delaney H, et al. Barriers and facilitators to healthcare workers' adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis. Cochrane Database Syst Rev. 2020;4(4):CD013582. Published 2020 Apr 21. doi:10.1002/14651858.CD013582 Jayaweera M, Perera H, Gunawardana B, Manatunge J. Transmission of COVID-19 virus by droplets and aerosols: A critical review on the unresolved dichotomy [published online ahead of print, 2020 Jun 13]. Environ Res. 2020;188:109819. doi:10.1016/j.envres.2020.109819
References Li L, Xv Q, Yan J. COVID-19: the need for continuous medical education and training. Lancet Respir Med. 2020;8(4):e23. doi:10.1016/S2213-2600(20)30125-9 Liang M, Gao L, Cheng C, et al. Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis [published online ahead of print, 2020 May 28]. Travel Med Infect Dis. 2020;101751. doi:10.1016/j.tmaid.2020.101751 Millioni R, Mortarino C. Sequential informed pooling approach to detect SARS-CoV2 infection. medRxiv 2020.04.24.20077966; doi: https://doi.org/10.1101/2020.04.24.20077966 Pavelchak N, DePersis RP, London M, , et al. Identification of factors that disrupt negative air pressurization of respiratory isolation rooms. Infect Control Hosp Epidemiol 2000; 21: 191–195. Rickman HM, Rampling T, Shaw K, et al. Nosocomial transmission of COVID-19: a retrospective study of 66 hospital- acquired cases in a London teaching hospital [published online ahead of print, 2020 Jun 20]. Clin Infect Dis. 2020;ciaa816. doi:10.1093/cid/ciaa816 Tan W, Ye Y, Yang Y, et al. Whole-Process Emergency Training of Personal Protective Equipment Helps Healthcare Workers Against COVID-19: Design and Effect. J Occup Environ Med. 2020;62(6):420-423. doi:10.1097/JOM.0000000000001877 To KK, Tsang OT, Leung WS, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect Dis. 2020;20(5):565-574. doi:10.1016/S1473-3099(20)30196-1
References Wee LE, Sim XYJ, Conceicao EP, et al. Containment of COVID-19 cases among healthcare workers: The role of surveillance, early detection, and outbreak management [published online ahead of print, 2020 May 11]. Infect Control Hosp Epidemiol. 2020;1-7. doi:10.1017/ice.2020.219 World Health Organization. Maintaining essential health services: operational guidance for the COVID-19 context. WHO: Geneva, 2020a. World Health Organization. Advice on the use of masks in the context of COVID-19. WHO: Geneva, 2020b. Wu Z, McGoogan JM. Asymptomatic and Pre-Symptomatic COVID-19 in China. Infect Dis Poverty. 2020;9(1):72. Zhang M, Zhou M, Tang F, et al. Knowledge, attitude, and practice regarding COVID-19 among healthcare workers in Henan, China. J Hosp Infect. 2020;105(2):183-187. doi:10.1016/j.jhin.2020.04.012 Zhao Y, Cui C, Zhang K, et al. COVID19: A Systematic Approach to Early Identification and Healthcare Worker Protection. Front Public Health. 2020;8:205. Published 2020 May 19. doi:10.3389/fpubh.2020.00205
You can also read
