key: cord-277712-sx5k0m4q
authors: Hu, Ling-Qun; Wang, Jin; Huang, Anna; Wang, Danzhao; Wang, Jingping
title: COVID-19 and improved prevention of hospital-acquired infection
date: 2020-05-31
journal: Br J Anaesth
DOI: 10.1016/j.bja.2020.05.037
sha: 
doc_id: 277712
cord_uid: sx5k0m4q

nan

protective equipment; social distancing Editor -Hospital-acquired infection rate is a hallmark metric for quality of care in US hospitals, where.7 million infections occurred while being treated for other ailments in 2018 (1) . During the COVID-19 pandemic, clinicians have practiced prevention of nosocomial pneumonia vigilantly. Many hospitals in the US implemented their own protective measures as a response to the ongoing COVID-19 pandemic even before the US Centers for Disease Control (CDC) recommended voluntary mask wearing in the public. Even with these extra precautionary measures, healthcare workers have been disproportionately infected, with 9,282 reported cases of COVID-19, resulting in 27 deaths, with 55% of respondents saying they contracted the virus while at work based on a report from the CDC on April 9th, 2020 (2) . Interventions to impede early spread of COVID-19 were not nearly effective enough, and resulted in a fatality rate as high as 5.8% in some populations compared to the 0.5% fatality rate for seasonal flu in the US, which is why new protocols and early prevention need to be implemented (3).

The current threat of COVID-19 not only affects healthcare workers on the frontline but also increases exposure to their family members. According to the first 262 cases in Beijing, China, 50.8% of cases involved family clusters (4) . Because of this, many healthcare providers opt to isolate themselves from their families after work, staying in their garage or basement, or renting a hotel room or apartment to avoid spreading the virus from the hospital setting.

However, the consequences of these protective measures and physical distancing policies are detrimental to their mental health. In the last week of April 2020, there has been two documented cases of healthcare worker suicide, with an abundance of other mental health issues including anxiety, depression, post-traumatic stress disorder escalating as well. (ref) We are now entering a transition period of gradually reopening of the economy across the world. In doing so, vital questions must be acknowledged: 1) Should the use of surgical masks for both healthcare providers and patients in all our medical facilities be required until a proper vaccine or treatment is developed? And 2) Should the current universal mask policy become the new normal? Both of these protocols may prove beneficial after the pandemic to prevent hospital-acquired respiratory infections, especially during the annual flu season.

Based on data from a Johns Hopkins University study (ref), there are distinct mortality curves between geographical areas. In contrast to Europe and North America that have been especially burdened by COVID-19 and only advocated for social distancing and handwashing, countries in Asia with visibly lower mortality and infection rates shared the common practice of protective masking and handwashing [ Figure 1 ]. One explanation for the phenomenon could be that facemasks prevent or slow rates of transmission especially in dense populations.

As a result of these initial findings, the CDC began advocating for face coverings in public on April 3rd, 2020, which was contradictory to the original guidelines to not wear masks Physical contact is the primary mechanism by which healthy people are exposed to SARS-CoV-2 virus. Wearing masks is the most cost-effective way to slow viral spread and allow reopening of society. Experts in the field and lessons learned from other countries recommend that protective masks be worn by healthcare workers, patients, and their visitors should become the new normal. The director of the CDC predicts that this will be one of the most important approaches to easing the burden of a possible resurgence of COVID-19 and flu in autumn. Not all hospitals require universal mask policies for all personnel in the hospital (5) . With the shortages in proper PPE and the staunch culture of independence in the US, it is understandable that implementing these protocols is difficult. However, without radical changes in attitudes and beliefs within the hospital setting and beyond, more frontline healthcare workers and others will be infected. We urge government officials and policymakers to evaluate and promote infection control measures, prioritize frontline medical workers, their families, and their patients. We should take this opportunity to ease not only the challenges from the COVID-19 pandemic but also other hospital-acquired infections such as seasonal flu.

The authors declare no conflicts of interest.

Health care-associated infections-an overview. Infection and drug resistance

Characteristics of Health Care Personnel with COVID-19, United States

COVID-19) Deaths

Characteristics of COVID-19 infection in Beijing

Figure 1: Comparison of distinguished mortalities over time between the continentals advocating "Distancing & Handwashing" vs