# ent

id: cord-262653-v1to1mrp
type: DNA
entity:
  cubicles 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66


id: cord-262653-v1to1mrp
type: GGP
entity:
  social 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 distancing compliance with infection prevention


id: cord-264522-u61m4x9l
type: ORG
entity:
  influenza Recommendations of the Advisory Committee on Immunization Practices ACIP Department of Health Human Services Healthcare Personnel Initiative


id: cord-264522-u61m4x9l
type: ORG
entity:
  Improve Influenza Vaccination Toolkit National Foundation for Infectious Diseases Call to Action Influenza Immunization Among Health Care Personnel Prevention


id: cord-264522-u61m4x9l
type: ORG
entity:
  Infectious Diseases Society of America IDSA IDSA Policy Mandatory Immunization of Health Care Workers Against Seasonal and Pandemic Influenza Committee on Infectious Diseases Policy Statement Recommendation for Mandatory Influenza Immunization of All Health Care Personnel Pediatrics


id: cord-264522-u61m4x9l
type: ORG
entity:
  Pediatric Infectious Disease Infectious Diseases Department of Internal Medicine is Administrator Department of Emergency Medicine


id: cord-297879-6xb25uhx
type: ORG
entity:
  Failures to Protect Health and Humans A Detailed Protocol for a Serological Assay Antigen Production and Test


id: cord-286932-2gjnpqqa
type: ORG
entity:
  the West African Oubreak Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure


id: cord-311151-mrsjhjh4
type: ORG
entity:
  the American Hospital Association the Federation of American Hospitals the Association of American Medical Colleges


id: cord-316266-6m9g3bdr
type: GGP
entity:
  Australas DOI 10 1111 1742 6723 13581 sha 8ca37ec3ff181586f772d7b6ef451d4572192d27 doc_id 316266 cord_uid 6m9g3bdr BACKGROUND


id: cord-284640-tl9nmvog
type: WORK_OF_ART
entity:
  Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID 19 Pandemic N95 FFP2


id: cord-282675-s4zmffj3
type: PROTEIN
entity:
  cord 282675 s4zmffj3 authors Sagaon Teyssier Luis Kamissoko Aliou Yattassaye Adam Diallo Fodié Rojas Castro Daniela Delabre Rosemary Pouradier Fabrice Maradan Gwenaëlle Bourrelly Michel Cissé Mamadou Vidal Laurent Dembélé Keïta Bintou Spire Bruno title Assessment of mental health outcomes and associated factors


id: cord-282280-5pggpbrq
type: ORG
entity:
  The Theory of Planned Behavior In Organizational Behavior and Human Decision Processes Social Cognitive Theory Predictors


id: cord-322451-cwpz4akv
type: CELL_LINE
entity:
  Threat Scope Note U United States National Intelligence Center Severe acute respiratory syndrome SARS


# bib

id: cord-028273-22swinc6
title: Yesterday heroes, today plague doctors: the dark side of celebration
author: Cabrini, Luca
date: 2020-07-01
txt: ./txt/cord-028273-22swinc6.txt
cache: ./cache/cord-028273-22swinc6.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328643/
doi: 10.1007/s00134-020-06166-4
abstract: nan
summary:
  The Coordinating Center of the "COVID-19 Lombardy ICU-Network", therefore, promoted an exploratory survey to assess the incidence of episodes of discrimination experienced by specialists and trainees in Anesthesiology and in Intensive Care Medicine. Overall, 159 HCWs (25%) reported at least 1 episode of discrimination involving themselves, their colleagues or family members. Sadly, the "not in my backyard" principle seems to apply to HCWs, who are celebrated as long as they stay confined in hospitals, and this discrimination is also being extended to their families. Healthcare systems administrators and policy-makers should employ every means to minimize the risk of infection among HCWs by providing adequate PPE and training. There is a good chance that as long as we are presented as heroes continuously facing death, we will suffer discrimination; such portrayal erroneously belabours the risk of being infected by HCWs, making it seem a very probable option.


id: cord-252250-hhdawwjf
author: Menon, Vikas
date: 2020-04-28
txt: ./txt/cord-252250-hhdawwjf.txt
cache: ./cache/cord-252250-hhdawwjf.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1876201820302276
doi: 10.1016/j.ajp.2020.102116
abstract: nan
summary:
  title: Ethical dilemmas faced by health care workers during COVID-19 pandemic: Issues, implications and suggestions In this regard, we point out a few moral and ethical dilemmas that can be faced by health care workers (HCW) while attending the call of duty: J o u r n a l P r e -p r o o f 2. 4. Setting up of a COVID support cell in every institution would serve as a one stop resource for mental and physical health care needs of HCW''s. We hope that the measures outlined above would assist institutions and team leaders in providing the best possible working conditions for their staff and health care workers. Mental Health Needs of Health Care Workers Providing Frontline COVID-19 Care Managing mental health challenges faced by healthcare workers during covid-19 pandemic

title:
  Ethical dilemmas faced by health care workers during COVID-19 pandemic: Issues, implications and suggestions


id: cord-253833-0lajhqn5
author: Misra-Hebert, Anita D
date: 2020-08-19
txt: ./txt/cord-253833-0lajhqn5.txt
cache: ./cache/cord-253833-0lajhqn5.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.21203/rs.3.rs-61235/v1
doi: 10.21203/rs.3.rs-61235/v1
summary:
  [7] [8] [9] 11 A recent prospective study in the United Kingdom and US suggested a ve-fold increased risk for HCW caring for patients with COVID-19 compared to HCW not caring for patients with COVID-19, even with the use of PPE 12 while another study of HCW in a large healthcare system showed a decrease in positive tests for SARS-CoV-2 associated with a universal masking recommendation. In this study, we aimed to assess whether HCW are at higher risk for COVID-19 infection, COVID-19 related hospitalization, and intensive care unit (ICU) admission compared to non-HCW using advanced statistical methodology to account for various confounders. [7] [8] [9] [10] 12 The fact that HCW identi ed as patient-facing had a signi cantly higher odds for SARS-CoV-2 test positivity suggests an increased risk of COVID-19 infection with work exposure.

title:
  Impact of the COVID-19 pandemic on healthcare workers risk of infection and outcomes in a large, integrated health system.

abstract:
  Background: Understanding the impact of the COVID-19 pandemic on healthcare workers (HCW) is crucial. Objective: Utilizing a health system COVID-19 research registry, we assessed HCW risk for COVID-19 infection, hospitalization and intensive care unit (ICU) admission. Design: Retrospective cohort study with overlap propensity score weighting. Participants: Individuals tested for SARS-CoV-2 infection in a large academic healthcare system (N=72,909) from March 8-June 9 2020 stratified by HCW and patient-facing status. Main Measures: SARS-CoV-2 test result, hospitalization, and ICU admission for COVID-19 infection. Key Results: Of 72,909 individuals tested, 9.0% (551) of 6,145 HCW tested positive for SARS-CoV-2 compared to 6.5% (4353) of 66,764 non-HCW. The HCW were younger than non-HCW (median age 39.7 vs. 57.5, p<0.001) with more females (proportion of males 21.5 vs. 44.9%, p<0.001), higher reporting of COVID-19 exposure (72 vs. 17 %, p<0.001) and fewer comorbidities. However, the overlap propensity score weighted proportions were 8.9 vs. 7.7 for HCW vs. non-HCW having a positive test with weighted odds ratio (OR) 1.17, 95% confidence interval (CI) 0.99-1.38. Among those testing positive, weighted proportions for hospitalization were 7.4 vs.15.9 for HCW vs. non-HCW with OR of 0.42 (CI 0.26-0.66) and for ICU admission: 2.2 vs.4.5 for HCW vs. non-HCW with OR of 0.48 (CI 0.20 -1.04). Those HCW identified as patient-facing compared to not had increased odds of a positive SARS-CoV-2 test (OR 1.60, CI 1.08-2.39, proportions 8.6 vs. 5.5), but no statistically significant increase in hospitalization (OR 0.88, CI 0.20-3.66, proportions 10.2 vs. 11.4) and ICU admission (OR 0.34, CI 0.01-3.97, proportions 1.8 vs. 5.2). Conclusions: In a large healthcare system, HCW had similar odds for testing SARS-CoV-2 positive, but lower odds of hospitalization compared to non-HCW. Patient-facing HCW had higher odds of a positive test. These results are key to understanding HCW risk mitigation during the COVID-19 pandemic.


id: cord-256705-gexh2wtd
title: COVID-19: how prepared are front-line healthcare workers in England?
author: Prescott, K.
date: 2020-04-24
txt: ./txt/cord-256705-gexh2wtd.txt
cache: ./cache/cord-256705-gexh2wtd.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0195670120302061
doi: 10.1016/j.jhin.2020.04.031
summary:
  In view of this, a cross-sectional survey of front-line healthcare workers (HCWs) at two large acute NHS hospital trusts in England was undertaken to assess their confidence and perceived level of preparedness for the virus. As such we carried out an online cross sectional questionnaire based survey of front line HCW at two large acute NHS hospital Trusts in England to ascertain how prepared they felt to manage COVID-19. We designed an online cross-sectional questionnaire-based survey using Online Surveys (formerly BOS) to ascertain how confident and prepared front line HCW felt in managing potential COVID-19 cases. At the time the survey went live work in both hospital Trusts had already begun to prepare front line HCW for COVID-19. As the threat of COVID-19 grows, we wanted to assess how confident our front line HCW felt to manage possible cases.

abstract:
  National efforts are underway to prepare the UK National Health Service (NHS) for the COVID-19 pandemic; however, the efficacy of these interventions is unknown. In view of this, a cross-sectional survey of front-line healthcare workers (HCWs) at two large acute NHS hospital trusts in England was undertaken to assess their confidence and perceived level of preparedness for the virus. The survey found that there has been moderate success in readying HCWs to manage COVID-19, but that more still needs to be done, particularly in relation to educating HCWs about laboratory diagnostics.


id: cord-261173-lnjh56ts
author: Misra-Hebert, Anita D.
date: 2020-09-01
txt: ./txt/cord-261173-lnjh56ts.txt
cache: ./cache/cord-261173-lnjh56ts.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s11606-020-06171-9
doi: 10.1007/s11606-020-06171-9
summary:
  In this study, we aimed to assess whether HCW are at higher risk for COVID-19 infection, COVID-19-related hospitalization, and intensive care unit (ICU) admission compared to non-HCW using advanced statistical methodology to account for various confounders. 23 For the outcomes of hospital and intensive care unit (ICU) admission of COVID-19 testpositive patients, the propensity score covariates are those that were found associated with COVID-19 hospitalization outcome in our previous work including age, race, ethnicity, gender, smoking history, body mass index, median income, population per housing unit, presenting symptoms (including fever, fatigue, shortness of breath, diarrhea, vomiting), comorbidities (including asthma, hypertension, diabetes, immunosuppressive disease), medications (including immunosuppressive treatment, nonsteroidal anti-inflammatory drugs [NSAIDs]), and laboratory values (including pre-testing platelets, aspartate aminotransferase, blood urea nitrogen, chloride, and potassium). [7] [8] [9] [10] 12 The fact that HCW identified as patient facing had a significantly higher odds for SARS-CoV-2 test positivity suggests an increased risk of COVID-19 infection with work exposure.

title:
  Impact of the COVID-19 Pandemic on Healthcare Workers’ Risk of Infection and Outcomes in a Large, Integrated Health System

abstract:
  BACKGROUND: Understanding the impact of the COVID-19 pandemic on healthcare workers (HCW) is crucial. OBJECTIVE: Utilizing a health system COVID-19 research registry, we assessed HCW risk for COVID-19 infection, hospitalization, and intensive care unit (ICU) admission. DESIGN: Retrospective cohort study with overlap propensity score weighting. PARTICIPANTS: Individuals tested for SARS-CoV-2 infection in a large academic healthcare system (N = 72,909) from March 8–June 9, 2020, stratified by HCW and patient-facing status. MAIN MEASURES: SARS-CoV-2 test result, hospitalization, and ICU admission for COVID-19 infection. KEY RESULTS: Of 72,909 individuals tested, 9.0% (551) of 6145 HCW tested positive for SARS-CoV-2 compared to 6.5% (4353) of 66,764 non-HCW. The HCW were younger than the non-HCW (median age 39.7 vs. 57.5, p < 0.001) with more females (proportion of males 21.5 vs. 44.9%, p < 0.001), higher reporting of COVID-19 exposure (72 vs. 17%, p < 0.001), and fewer comorbidities. However, the overlap propensity score weighted proportions were 8.9 vs. 7.7 for HCW vs. non-HCW having a positive test with weighted odds ratio (OR) 1.17, 95% confidence interval (CI) 0.99–1.38. Among those testing positive, weighted proportions for hospitalization were 7.4 vs. 15.9 for HCW vs. non-HCW with OR of 0.42 (CI 0.26–0.66) and for ICU admission: 2.2 vs. 4.5 for HCW vs. non-HCW with OR of 0.48 (CI 0.20–1.04). Those HCW identified as patient facing compared to not had increased odds of a positive SARS-CoV-2 test (OR 1.60, CI 1.08–2.39, proportions 8.6 vs. 5.5), but no statistically significant increase in hospitalization (OR 0.88, CI 0.20–3.66, proportions 10.2 vs. 11.4) and ICU admission (OR 0.34, CI 0.01–3.97, proportions 1.8 vs. 5.2). CONCLUSIONS: In a large healthcare system, HCW had similar odds for testing SARS-CoV-2 positive, but lower odds of hospitalization compared to non-HCW. Patient-facing HCW had higher odds of a positive test. These results are key to understanding HCW risk mitigation during the COVID-19 pandemic. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-020-06171-9) contains supplementary material, which is available to authorized users.


id: cord-262653-v1to1mrp
title: Health Care Workers and Patients as Trojan Horses: a COVID19 ward outbreak
author: Asad, H.
date: 2020-07-04
txt: ./txt/cord-262653-v1to1mrp.txt
cache: ./cache/cord-262653-v1to1mrp.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S2590088920300378
doi: 10.1016/j.infpip.2020.100073
summary:
  Subsequent investigation over a 14 day period revealed symptoms in 23 staff members and five linked cases in patients on the same ward. Staff members and patients can act as Trojan horses carrying infection into and around the hospital, setting up unexpected transmission events. An in house real time PCR assay for COVID-19 was carried out on dry throat swabs taken from symptomatic patients and staff members working on the ward. HCW cases were defined as (A) a member of staff from the affected ward and (B) compatible symptoms for COVID-19 (C) onset of infection during the outbreak period. Four of the five staff members with very early onset of infection were working with the index case during the likely infectious period ( Figure 3 ). In this case infection was most likely introduced by an asymptomatic or minimally symptomatic HCW and then transferred via a longstanding patient from ITU to a previously negative medical ward.

abstract:
  Summary Background Transmission in healthcare settings can result in significant infections in healthcare workers and patients. Understanding infection dynamics has important implications for methods employed in hospitals to prevent nosocomial-transmission events. Methods In this case series report we describe a cluster of COVID-19 (Coronavirus disease 2019) in a tertiary care university hospital, in the early phases of the epidemic, after hospital visiting had been stopped and when the UK lockdown was in place. Findings A 48 year old patient developed COVID-19 31 days post-admission and four days after admission to a medical ward from ITU. Infection was likely acquired from an asymptomatic or minimally symptomatic healthcare worker (HCW). Subsequent investigation over a 14 day period revealed symptoms in 23 staff members and five linked cases in patients on the same ward. Nine of the 23 affected staff members provided care for and had direct exposure with the index case. Four staff reported caring for the index case without use of personal protective equipment. One was coughed on directly by the patient 24 hours prior to the onset of symptoms. Conclusion SARS CoV2 infection can be introduced to a ward area by asymptomatic and minimally symptomatic healthcare workers. Staff members and patients can act as Trojan horses carrying infection into and around the hospital, setting up unexpected transmission events. Transmission of infection from pre-symptomatic, asymptomatic and minimally symptomatic individuals means that universal use of measures to prevent transmission is required for successful reduction of transmission events in the hospital setting.


id: cord-264522-u61m4x9l
author: Crupi, Robert S.
date: 2016-11-16
txt: ./txt/cord-264522-u61m4x9l.txt
cache: ./cache/cord-264522-u61m4x9l.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/21090019/
doi: 10.1016/s1553-7250(10)36073-9
summary:
  In the 2008–2009 influenza season, Flushing Hospital Medical Center (FHMC; New York) adopted a "push/pull" point-of-dispensing (POD) vaccination model that was derived from emergency preparedness planning for mass vaccination and/or prophylaxis to respond to an infectious disease outbreak, whether occurring naturally or due to bioterrorism. In the 2008-2009 influenza season, Flushing Hospital Medi cal Center (FHMC; New York) adopted a "push/pull" point-ofdispensing (POD) vaccination model that was derived from emergency preparedness planning for mass vaccination and/or prophylaxis to respond to an infectious disease outbreak, whether occurring naturally or due to bioterrorism. Conclusions: This model provides a novel approach for institutions to improve their HCW influenza vaccination rates within a limited period through exercising emergency preparedness plans for infectious disease outbreaks. Conclusions: This model provides a novel approach for institutions to improve their HCW influenza vaccination rates within a limited period through exercising emergency preparedness plans for infectious disease outbreaks.

title:
  Linking Emergency Preparedness and Health Care Worker Vaccination Against Influenza: A Novel Approach

abstract:
  BACKGROUND: Health care workers (HCWs) can acquire and transmit influenza to their patients and coworkers, even while asymptomatic. The U.S. Healthy People 2010 initiative set a national goal of 60% coverage for HCW influenza vaccination by 2010. Yet vaccination rates remain low. In the 2008–2009 influenza season, Flushing Hospital Medical Center (FHMC; New York) adopted a “push/pull” point-of-dispensing (POD) vaccination model that was derived from emergency preparedness planning for mass vaccination and/or prophylaxis to respond to an infectious disease outbreak, whether occurring naturally or due to bioterrorism. LAUNCH OF THE HCW VACCINATION PROGRAM: In mid-September 2008, a two-week HCW vaccination program was launched using a sequential POD approach. In Push POD, teams assigned to specific patient units educated all HCWs about influenza vaccination and offered on-site vaccination; vaccinated HCWs received a 2009 identification (ID) validation sticker. In Pull POD, HCWs could enter the hospital only through one entrance; all other employee entrances were “locked down.” A 2009 ID validation sticker was required for entry and to punch in for duty. Employees without the new validation sticker were directed to a nearby vaccination team. After the Push/Pull POD was completed, the employee vaccination drive at FHMC was continued for the remainder of the influenza season by the Employee Health Service. RESULTS: Using this model, in two days 72% of the employees were reached, with 54% of those reached accepting vaccination. CONCLUSIONS: This model provides a novel approach for institutions to improve their HCW influenza vaccination rates within a limited period through exercising emergency preparedness plans for infectious disease outbreaks.


id: cord-266261-6h7c26xg
title: COVID‐19 pandemic in limited‐resource countries: Strategies for challenges in a dialysis unit
author: Bharati, Joyita
date: 2020-07-12
txt: ./txt/cord-266261-6h7c26xg.txt
cache: ./cache/cord-266261-6h7c26xg.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32656874/
doi: 10.1111/nep.13748
abstract: nan
summary:
  key: cord-266261-6h7c26xg authors: Bharati, Joyita; Ramachandran, Raja; Kumar, Vivek; Kohli, Harbir Singh title: COVID‐19 pandemic in limited‐resource countries: Strategies for challenges in a dialysis unit cord_uid: 6h7c26xg The rapid surge of novel coronavirus disease 2019 (COVID-19) pandemic has brought unique challenges. In the absence of universal testing, apprehensions related to inadvertent exposure to COVID-19 positive patient was increasing among health-care workers (HCW) and patients, which was crucial to be addressed to maintain functionality of the unit. A risk stratification algorithm after inadvertent exposure to COVID-19 positive patient was adapted from the U.S. Centers for Disease Control and Prevention (CDC) to educate HCW. 1,2 A flow-chart simplified the interpretation of CDC tables for risk stratification which were found intricate by HCW. Protocol for hemodialysis unit during COVID-19 pandemic. guidance for risk assessment and public health management of healthcare personnel with potential exposure in a healthcare setting to patients with coronavirus disease The authors declare no conflicts of interest.


id: cord-282280-5pggpbrq
title: Determinants of Vaccination Uptake in Risk Populations: A Comprehensive Literature Review
author: Doornekamp, Laura
date: 2020-08-27
txt: ./txt/cord-282280-5pggpbrq.txt
cache: ./cache/cord-282280-5pggpbrq.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32867126/
doi: 10.3390/vaccines8030480
summary:
  The following concepts are used: (1) predisposing factors, including baseline characteristics of studied populations; (2) information factors, including information retrieved via media, social contacts and HCW; (3) awareness, of the infectious agent being present or a vaccine being available; (4) knowledge (either examined or self-evaluated), about the consequences of the infection, or about the efficacy and duration of protection of vaccination; (5a) perceived risk of the infection, which is divided into perceived severity of the disease and perceived susceptibility to get infected; (5b) perceived risk of vaccination, including vaccine-specific considerations such as fear of side-effects and trust in the effectiveness of the vaccine; (6) attitude, defined as a person''s disposition to respond favourably or unfavourably to vaccinations [14] , often reflected by a person''s general believes about vaccinations; (7) social influence, which can be social norms imposed by family, friends or religion, but also recommendations from a healthcare professional or tour guide; (8) self-efficacy, defined as beliefs in one''s own capacity to perform certain behaviour [15] ; (9) intention to behaviour, expressed by people before they perform the behaviour; (10) barriers and facilitators, that withhold individuals from or enable them to certain behaviour, such as time, costs, or accessibility.

abstract:
  Vaccination uptake has decreased globally in recent years, with a subsequent rise of vaccine-preventable diseases. Travellers, immunocompromised patients (ICP), and healthcare workers (HCW) are groups at increased risk for (severe) infectious diseases due to their behaviour, health, or occupation, respectively. While targeted vaccination guidelines are available, vaccination uptake seems low. In this review, we give a comprehensive overview of determinants—based on the integrated change model—predicting vaccination uptake in these groups. In travellers, low perceived risk of infection and low awareness of vaccination recommendations contributed to low uptake. Additionally, ICP were often unaware of the recommended vaccinations. A physician’s recommendation is strongly correlated with higher uptake. Furthermore, ICP appeared to be mainly concerned about the risks of vaccination and fear of deterioration of their underlying disease. For HCW, perceived risk of (the severity of) infection for themselves and for their patients together with perceived benefits of vaccination contribute most to their vaccination behaviour. As the determinants that affect uptake are numerous and diverse, we argue that future studies and interventions should be based on multifactorial health behaviour models, especially for travellers and ICP as only a limited number of such studies is available yet.


id: cord-282675-s4zmffj3
author: Sagaon-Teyssier, Luis
date: 2020-10-15
txt: ./txt/cord-282675-s4zmffj3.txt
cache: ./cache/cord-282675-s4zmffj3.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S2590229620300150?v=s5
doi: 10.1016/j.hpopen.2020.100017
summary:
  title: Assessment of mental health outcomes and associated factors among workers in community-based HIV care centers in the early stage of the COVID-19 outbreak in Mali Mental health in ARCAD Santé PLUS''s CHW in Mali seemed to be associated with uncertainty about COVID-19 at the beginning of the outbreak, as suggested by the relationship between the (un)availability of face masks and insomnia, depression, and anxiety. The relationship discovered between the density of nurses in HIV care services and workers'' psychological outcomes not only highlights areas for improvement in the management of mental health among ARCAD Santé PLUS''s HCW during the current COVID-19 outbreak, but also provides insight into how these workers'' performance in HIV-related care could be improved in the short and long terms.

title:
  Assessment of mental health outcomes and associated factors among workers in community-based HIV care centers in the early stage of the COVID-19 outbreak in Mali

abstract:
  • Malian healthcare workers presented mental disorders in the early stage of COVID-19. • Nurses were at lower risk of mental health disorders than other worker categories. • Women were at greater risk of mental health disorders than men. • A lack of protection equipment and nurses was associated with mental disorders.


id: cord-284640-tl9nmvog
author: Tabah, Alexis
date: 2020-06-13
txt: ./txt/cord-284640-tl9nmvog.txt
cache: ./cache/cord-284640-tl9nmvog.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32570052/
doi: 10.1016/j.jcrc.2020.06.005
summary:
  PURPOSE: To survey healthcare workers (HCW) on availability and use of personal protective equipment (PPE) caring for COVID-19 patients in the intensive care unit (ICU). While pain, heat stress and fluid loss with using Powered Air-Purifying Respirators (PAPR) were predicted by experimental data (14) , there are no real-life reports of this issue when using PPE that is available to HCWs. The objective of this study was to describe the current reported practices, availability, training, confidence in the use and adverse effects due to extended use of PPE by HCWs from around the world caring for COVID-19 patients who require ICU management. This survey provides a snapshot of the reported availability, perceived adequacy of training and provided protection, adverse effects and usage of PPE among HCW managing COVID-19 patients in critical care environments from across the globe.

title:
  Personal protective equipment and intensive care unit healthcare worker safety in the COVID-19 era (PPE-SAFE): An international survey

abstract:
  PURPOSE: To survey healthcare workers (HCW) on availability and use of personal protective equipment (PPE) caring for COVID-19 patients in the intensive care unit (ICU). MATERIALS AND METHOD: A web-based survey distributed worldwide in April 2020. RESULTS: We received 2711 responses from 1797 (67%) physicians, 744 (27%) nurses, and 170 (6%) Allied HCW. For routine care, most (1557, 58%) reportedly used FFP2/N95 masks, waterproof long sleeve gowns (1623; 67%), and face shields/visors (1574; 62%). Powered Air-Purifying Respirators were used routinely and for intubation only by 184 (7%) and 254 (13%) respondents, respectively. Surgical masks were used for routine care by 289 (15%) and 47 (2%) for intubations. At least one piece of standard PPE was unavailable for 1402 (52%), and 817 (30%) reported reusing single-use PPE. PPE was worn for a median of 4 h (IQR 2, 5). Adverse effects of PPE were associated with longer shift durations and included heat (1266, 51%), thirst (1174, 47%), pressure areas (1088, 44%), headaches (696, 28%), Inability to use the bathroom (661, 27%) and extreme exhaustion (492, 20%). CONCLUSIONS: HCWs reported widespread shortages, frequent reuse of, and adverse effects related to PPE. Urgent action by healthcare administrators, policymakers, governments and industry is warranted.


id: cord-286932-2gjnpqqa
author: Lee, Yung
date: 2020-11-12
txt: ./txt/cord-286932-2gjnpqqa.txt
cache: ./cache/cord-286932-2gjnpqqa.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S000296102030742X
doi: 10.1016/j.amjsurg.2020.11.019
summary:
  title: Impact of hospital lockdown secondary to COVID-19 and past pandemics on surgical practice: A living rapid systematic review We included studies that assessed postoperative patient outcomes or protection measures for surgical personnel during epidemics. CONCLUSIONS: This review highlights postoperative patient outcomes during worldwide epidemics including the COVID-19 pandemic and identifies specific safety measures to minimize infection of healthcare workers. Studies reporting outcomes of patients undergoing surgery during an epidemic-caused hospital lockdown and studies investigating the impact of lockdown on surgical HCW and surgical practice were included. 23,29,35 Fourteen studies described modifying the roles of HCW during epidemics, including formation of an "Emergency Incident Command Team" to identify and separate infected patients from other patients, allowing only essential personnel to be present during procedures, and assigning staff to conduct patient screening full-time. 21 No infections or adverse outcomes were reported for HCW during the SARS epidemics (0/128) from the included studies.

title:
  Impact of hospital lockdown secondary to COVID-19 and past pandemics on surgical practice: A living rapid systematic review

abstract:
  BACKGROUND: The COVID-19 pandemic has disrupted surgical practice worldwide. There is widespread concern for surgeon and provider safety, and the implications of hospital lockdown on patient care during epidemics. METHODS: Medline, EMBASE, CENTRAL, and PubMed were systematically searched from database inception to July 1, 2020 and ongoing monthly surveillance will be conducted. We included studies that assessed postoperative patient outcomes or protection measures for surgical personnel during epidemics. RESULTS: We included 61 studies relevant to the COVID-19 pandemic and past epidemics. Lockdown measures were noted globally including cancellation of elective surgeries and outpatient clinics. The pooled postoperative complication rate during epidemics was 21.0% among 2095 surgeries. 31 studies followed the health of surgical workers with the majority noting no adverse outcomes with proper safety measures. CONCLUSIONS: This review highlights postoperative patient outcomes during worldwide epidemics including the COVID-19 pandemic and identifies specific safety measures to minimize infection of healthcare workers.


id: cord-291810-eq7pjltx
author: Reusken, Chantal B
date: 2020-03-26
txt: ./txt/cord-291810-eq7pjltx.txt
cache: ./cache/cord-291810-eq7pjltx.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.2807/1560-7917.es.2020.25.12.2000334
doi: 10.2807/1560-7917.es.2020.25.12.2000334
summary:
  To rapidly assess possible community transmission in Noord-Brabant, the Netherlands, healthcare workers (HCW) with mild respiratory complaints and without epidemiological link (contact with confirmed case or visited areas with active circulation) were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To rapidly assess possible community transmission in Noord-Brabant, the Netherlands, healthcare workers (HCW) with mild respiratory complaints and without epidemiological link (contact with confirmed case or visited areas with active circulation) were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Furthermore, in hospital B in Breda, which has offered low-threshold testing for employees with respiratory complaints since 2 March 2020, several healthcare workers (HCW) had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A focus on HCW would simplify sampling, at such short notice, of adequate numbers of people with mild respiratory symptoms (coughing and/or sore throat and/or common cold) and without a known epidemiological link for SARS-CoV-2 exposure (travel to high-risk areas, close contact with confirmed case).

title:
  Rapid assessment of regional SARS-CoV-2 community transmission through a convenience sample of healthcare workers, the Netherlands, March 2020

abstract:
  To rapidly assess possible community transmission in Noord-Brabant, the Netherlands, healthcare workers (HCW) with mild respiratory complaints and without epidemiological link (contact with confirmed case or visited areas with active circulation) were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Within 2 days, 1,097 HCW in nine hospitals were tested; 45 (4.1%) were positive. Of six hospitals with positive HCW, two accounted for 38 positive HCW. The results informed local and national risk management.


id: cord-296306-xcomjvaa
author: Rivett, Lucy
date: 2020-05-11
txt: ./txt/cord-296306-xcomjvaa.txt
cache: ./cache/cord-296306-xcomjvaa.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32392129/
doi: 10.7554/elife.58728
summary:
  Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Table 3 outlines the total number of SARS-CoV-2 tests performed in each screening group (HCW asymptomatic, HCW symptomatic, and HCW symptomatic household contact) categorised according to the ward with the highest anticipated risk of exposure to high; ''amber'', medium; ''green'', low; . Three subgroups of SARS-CoV-2 positive asymptomatic HCW Each individual in the HCW asymptomatic screening group was contacted by telephone to establish a clinical history, and COVID-19 probability criteria ( Table 1) were retrospectively applied to categorise any symptoms in the month prior to testing ( Figure 2 ). 12/30 (40%) individuals from the HCW asymptomatic screening group reported symptoms > 7 days prior to testing, and the majority experiencing symptoms consistent with a high probability of COVID-19 had appropriately self-isolated during that period.

title:
  Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission

abstract:
  Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Over a 3 week period (April 2020), 1032 asymptomatic HCWs were screened for SARS-CoV-2 in a large UK teaching hospital. Symptomatic staff and symptomatic household contacts were additionally tested. Real-time RT-PCR was used to detect viral RNA from a throat+nose self-swab. 3% of HCWs in the asymptomatic screening group tested positive for SARS-CoV-2. 17/30 (57%) were truly asymptomatic/pauci-symptomatic. 12/30 (40%) had experienced symptoms compatible with coronavirus disease 2019 (COVID-19)>7 days prior to testing, most self-isolating, returning well. Clusters of HCW infection were discovered on two independent wards. Viral genome sequencing showed that the majority of HCWs had the dominant lineage B∙1. Our data demonstrates the utility of comprehensive screening of HCWs with minimal or no symptoms. This approach will be critical for protecting patients and hospital staff.


id: cord-297879-6xb25uhx
author: Moncunill, G.
date: 2020-08-25
txt: ./txt/cord-297879-6xb25uhx.txt
cache: ./cache/cord-297879-6xb25uhx.txt
extension: .txt
mime: text/plain
url: http://medrxiv.org/cgi/content/short/2020.08.23.20180125v1?rss=1
doi: 10.1101/2020.08.23.20180125
summary:
  A follow-up survey one month after the baseline (April-May 2020) measured SARS-CoV-2 infection by real time reverse-transcriptase polymerase chain reaction (rRT-PCR) and IgM, IgA, IgG and subclasses to the receptor-binding domain of the SARS-CoV-2 spike protein by Luminex. We found that 9.3% (95% CI: 7.1-12.0) of the participants were seropositive and the cumulative prevalence of SARS-CoV-2 infection (considering a past or current positive result to either antibody testing or rRT-PCR) was 11.2% (95% CI: 8.8-14.1). We measured IgM, IgG, and IgA isotypes and subclasses, and assessed the factors associated with new infections as well as levels and kinetics of antibodies. Levels (median fluorescence intensity, MFI) of IgM, IgG, and IgA against receptor-binding domain (RBD) of the SARS-CoV-2 spike glycoprotein stratified by asymptomatic participants and participants who reported COVID-19 compatible symptoms at recruitment (month 0, M0), month 1 (M1) or at both visits (M0&M1).

title:
  SARS-CoV-2 infections and antibody responses among health care workers in a Spanish hospital after a month of follow-up

abstract:
  Background. At the peak of the COVID-19 pandemic in Spain, cumulative prevalence of SARS-CoV-2 infection in a cohort of 578 randomly selected health care workers (HCW) from Hospital Clinic de Barcelona was 11.2%. Methods. A follow-up survey one month after the baseline (April-May 2020) measured SARS-CoV-2 infection by real time reverse-transcriptase polymerase chain reaction (rRT-PCR) and IgM, IgA, IgG and subclasses to the receptor-binding domain of the SARS-CoV-2 spike protein by Luminex. Prevalence of infection was defined by a positive SARS-CoV-2 rRT-PCR and/or antibody seropositivity. Results. The cumulative prevalence of infection at month 1 was 14.9% (84/565) and the seroprevalence 14.5% (82/565) for IgM and/or IgG and/or IgA. We found 25 (5%) new infections in participants without previous evidence of infection at baseline (501) and two participants seroreverted for IgM and/or IgG and/or IgA. Among seropositive participants at baseline, IgM and IgA levels generally declined at month 1 (antibody decay rates of 0.49 (95% CI, 0.40-0.60) and 0.34 (95% CI, 0.26-0.44)), respectively. Eight percent of the participants seroreverted for IgM and 11% for IgA. Subjects reporting COVID-19-like symptoms and laboratory and other technicians had higher risk of infection. The most frequent subclass responses were IgG1 and IgG2, followed by IgG3, with higher levels of IgG1, and only IgA1 but no IgA2 was detected. Conclusions. Our findings highlight the importance of a continuous and improved surveillance of SARS-CoV-2 infections in HCW, particularly in high risk groups. The decay of IgA and IgM levels have implications for seroprevalence studies using these isotypes.


id: cord-301299-flb5wwzg
title: SARS-CoV-2 infection among healthcare workers in a hospital in Madrid, Spain
author: García, Inés Suárez
date: 2020-07-21
txt: ./txt/cord-301299-flb5wwzg.txt
cache: ./cache/cord-301299-flb5wwzg.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0195670120303510
doi: 10.1016/j.jhin.2020.07.020
summary:
  AIM: The aim of this study was to describe the epidemiological and clinical characteristics of COVID-19 among healthcare workers (HCWs) between February 24(th) to April 30(th), 2020 in a hospital in Madrid, Spain. Therefore, we designed a retrospective cohort study whose aim was to describe the epidemiological and clinical characteristics of SARS-CoV-2 infection among HCWs in a hospital in Madrid, Spain. During the study period, HCWs experiencing symptoms consistent with probable COVID-19 were instructed to present at the Occupational Health outpatient clinic, where they were managed according to the hospital protocol: a nasopharyngeal swab was collected and analysed with polymerase chain reaction (PCR) for SARS-CoV-2. A case of COVID-19 was defined as any HCW presenting to the Occupational Health outpatient clinic with symptoms consistent with COVID-19 and with positive SARS-CoV-2 PCR.

abstract:
  AIM: The aim of this study was to describe the epidemiological and clinical characteristics of COVID-19 among healthcare workers (HCWs) between February 24(th) to April 30(th), 2020 in a hospital in Madrid, Spain. METHODS: We designed a retrospective cohort study. Cumulative COVID-19 incidence was calculated for all HCWs and categorized according to presumed level of COVID-19 exposure (high, medium and low). RESULTS: Among 1,911 HCW, 213 (11.1%) had COVID-19 during the study period. Cases increased gradually from March 8(th), peaking in March 17(th) and declining thereafter. The peak of cases among HCWs was reached 14 days before the peak in admitted COVID-19 cases in the hospital. There were no significant differences in the proportion of COVID-19 cases according to level of occupational exposure (p=0.123). There were 5 departments and 2 professions in which more than 20% of the workers had confirmed COVID-19. We identified temporal clusters in three of these departments and one profession, with most of the cases occurring over a period of less than 5 days. The prevalence of comorbidities was low and 91.5% of patients had mild or moderate symptoms. Eleven patients were admitted to the hospital and 1 patient needed intensive care. None of the patients died. The median time of sick leave was 20 (IQR: 15 – 26) days. CONCLUSIONS: Our results suggest that HCW-to-HCW transmission accounted for part of the cases. In spite of a low prevalence of comorbidities and a mild clinical course in most cases, COVID-19 caused long periods of sick leave.


id: cord-306247-259zacce
title: COVID-19 in hematology: data from a hematologic and transplant unit
author: Garnica, Marcia
date: 2020-09-06
txt: ./txt/cord-306247-259zacce.txt
cache: ./cache/cord-306247-259zacce.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.htct.2020.08.004
doi: 10.1016/j.htct.2020.08.004
summary:
  We addressed our preparation to face COVID-19 pandemic in a Hematological and Stem Cell Transplant Unit in Brazil during the first two months of COVID-19 pandemic and described COVID-19 cases in patients and health care workers (HCW). Despite a decrease in the number of procedures, the Transplant Program performed 8 autologous and 4 allogeneic SCT during the period, and 49 onco-hematological patients were admitted to continuing their treatments. Although we observed a high frequency of COVID-19 among patients and HCW, showing that SARS-CoV-2 is disseminated in Brazil, hematological patients were safely treated during pandemic times. 8 In this manuscript, we address our preparation to face the COVID-19 pandemic during the first two months and describe COVID-19 documented cases in patients and health care workers (HCW): from diagnosis to outcomes. This is a case series study from hematological patients treated from March 12 th to May 21 th in Complexo Hospitalar de Niterói, a quaternary level hospital, reference for stem cell transplantation (SCT), and solid organ transplant in Rio de Janeiro, Brazil.

abstract:
  During the COVID-19 pandemic, special attention has been addressed in cancer care to mitigate the impact on the patient’s prognosis. We addressed our preparation to face COVID-19 pandemic in a Hematological and Stem Cell Transplant Unit in Brazil during the first two months of COVID-19 pandemic and described COVID-19 cases in patients and health care workers (HCW). Modifications in daily routines included a separation of area and professionals, SARS-CoV-2 screening protocols, and others. A total of 47 patients and 54 HCW were tested for COVID-19, by PCR-SARS-CoV-2. We report 11 cases of COVID-19 in hematological patients (including 2 post stem cell transplant) and 28 cases in HCW. Hematological cases were most severe or moderate and presented with several poor risk factors. Among HCW, COVID-19 were mostly mild, and all recovered without hospitalization. A cluster was observed among HCW. Despite a decrease in the number of procedures, the Transplant Program performed 8 autologous and 4 allogeneic SCT during the period, and 49 onco-hematological patients were admitted to continuing their treatments. Although we observed a high frequency of COVID-19 among patients and HCW, showing that SARS-CoV-2 is disseminated in Brazil, hematological patients were safely treated during pandemic times.


id: cord-310508-zgqbfmzl
author: Alavi-Moghaddam, Mostafa
date: 2020-02-02
txt: ./txt/cord-310508-zgqbfmzl.txt
cache: ./cache/cord-310508-zgqbfmzl.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32185368/
doi: nan
abstract: nan
summary:
  This report to World Health Organization (WHO), raised global public health concern because this is the third coronavirus âȂŞassociated acute respiratory illness outbreak. Clinical care of patients with suspected 2019-nCoV should focus on early recognition, immediate isolation (separation), implementation of appropriate infection prevention and control (IPC) measures and provision optimized supportive care. Both the health care worker (HCW) and the suspected case of acute respiratory illness (ALI) should wear a medical mask and the patient should better be directed to a separate area, an isolation room if available. At the time being, emergency preparedness and response for providing appropriate care to the patients suspected to coronavirus-associated acute respiratory illness (abovementioned plans) should be developed and implemented in the emergency departments, as the frontline of treating human infections of 2019-nCov in the hospitals. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance

title:
  A Novel Coronavirus Outbreak from Wuhan City in China, Rapid Need for Emergency Departments Preparedness and Response; a Letter to Editor


id: cord-311151-mrsjhjh4
author: Zhang, Yuemei
date: 2020-03-20
txt: ./txt/cord-311151-mrsjhjh4.txt
cache: ./cache/cord-311151-mrsjhjh4.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1101/2020.03.18.20037952
doi: 10.1101/2020.03.18.20037952
summary:
  Methods: Using previously published information on elective ambulatory or outpatient surgical procedures and publicly available data on COVID19 infections in the US and on the Diamond Princess cruise ship, we calculated a transmission rate and generated a mathematical model to predict a lower bound for the number of healthcare-acquired COVID19 infections that could be prevented by canceling or postponing elective outpatient surgeries in Washington state. 11 Given the current status of the COVID19 outbreak, the US Surgeon General, 12 Centers for Disease Control and Prevention (CDC), 13 American College of Surgeons (ACS), 14 American Society of Anesthesiologists (ASA), and Anesthesia Patient Safety Foundation (APSF) 15 have recommended considering rescheduling or postponing some elective surgeries with the goal of conserving limited resources, such as ventilators and ICU beds, and mitigating the risk of "exposing other inpatients, outpatients, and health care providers to the risk of contracting COVID-19" from asymptomatic but infectious patients.

title:
  Estimating Preventable COVID19 Infections Related to Elective Outpatient Surgery in Washington State: A Quantitative Model

abstract:
  Background: As the number of suspected and confirmed COVID19 cases in the US continues to rise, the US surgeon general, Centers for Disease Control and Prevention, and several specialty societies have issued recommendations to consider canceling elective surgeries. However, these recommendations have also faced controversy and opposition. Objective: The goal of this study is to provide a quantitative analysis and model for preventable COVID19 infections from elective outpatient or ambulatory surgery cases, which can also be adapted to analyze COVID19 transmission in other healthcare settings. Furthermore, given the controversy over the appropriate handling of elective surgical cases during this pandemic, we hope that our results may have a positive impact on health policy and public health. Methods: Using previously published information on elective ambulatory or outpatient surgical procedures and publicly available data on COVID19 infections in the US and on the Diamond Princess cruise ship, we calculated a transmission rate and generated a mathematical model to predict a lower bound for the number of healthcare-acquired COVID19 infections that could be prevented by canceling or postponing elective outpatient surgeries in Washington state. Results: Our model predicts that over the course of 30 days, at least 2445 preventable patient infections and at least 1557 preventable healthcare worker (HCW) infections would occur in WA state alone if elective outpatient procedures were to continue as usual. The majority of these infections are caused by transmission from HCW who became infected at work. Conclusion: Given the large numbers of COVID19 infections that could be prevented by canceling elective outpatient surgeries, our findings support the recommendations of the US Surgeon General, CDC, American College of Surgeons (ACS), American Society of Anesthesiologists (ASA), and Anesthesia Patient Safety Foundation (APSF) to consider rescheduling or postponing elective surgeries until the COVID19 pandemic is under better control in the US.


id: cord-311539-pbzb0jjt
author: Puro, V.
date: 2006
txt: ./txt/cord-311539-pbzb0jjt.txt
cache: ./cache/cord-311539-pbzb0jjt.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/16896581/
doi: 10.1007/s15010-006-5604-8
summary:
  BACKGROUND: The World Health Organization (WHO) has recommended that a severe acute respiratory syndrome (SARS) alert should be raised when two or more healthcare workers (HCW) in the same health care unit fulfil the SARS clinical criteria, with onset of illness in the same 10-day period. To detect the possible re-emergence of severe acute respiratory syndrome (SARS), the World Health Organization (WHO) has recommended the implementation of an alert system based on the surveillance of healthcare workers (HCW): an alert should be raised when two or more HCW in the same health care unit fulfil the clinical criteria for SARS, with onset of illness in the same 10-day period [1] . To try to determine the minimum number of pneumonia alert cases that should define a SARS alert cluster in Italy, we analyzed sickness absences longer than 7 days, which occurred among HCW employed in three Italian hospitals in 2003.

title:
  Clustered Cases of Pneumonia among Healthcare Workers over a 1-year Period in Three Italian Hospitals: Applying the WHO SARS Alert

abstract:
  BACKGROUND: The World Health Organization (WHO) has recommended that a severe acute respiratory syndrome (SARS) alert should be raised when two or more healthcare workers (HCW) in the same health care unit fulfil the SARS clinical criteria, with onset of illness in the same 10-day period. However, in a number of European countries (including Italy) data on reasons for sickness absence are not routinely collected within current HCW worker sickness reporting systems, because of concerns about privacy. To help plan for the implementation of the proposed alert system in Italy, we aimed to determine the minimum number of alert cases defining a cluster. PATIENTS AND METHODS: Sickness absences longer than 7 days in HCW employed in three hospitals in 2003, were identified by checking the hospitals’ administrative databases. HCW with onset of illness in the same 10-day period were contacted and asked whether they have been diagnosed with pneumonia. RESULTS: Overall, 273 absences > 7 days were recorded and 36 clusters of at least two absences > 7 days were identified; a total of 94 HCW were involved in these clusters. Only two HCW involved in different clusters, reported pneumonia. CONCLUSION: The occurrence of clusters of two or more cases of pneumonia in HCW in the same hospital unit appears to be an uncommon event, and thus the alert system proposed is not likely to result in large numbers of false positive alerts. However, it may be difficult to implement this alert system in countries where clinical data on sickness absences are not routinely collected, and alternative mechanisms should be considered.


id: cord-316266-6m9g3bdr
title: What proportion of healthcare worker masks carry virus? A systematic review
author: Jones, Peter
date: 2020-06-24
txt: ./txt/cord-316266-6m9g3bdr.txt
cache: ./cache/cord-316266-6m9g3bdr.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1111/1742-6723.13581
doi: 10.1111/1742-6723.13581
summary:
  CONCLUSIONS: Although limited, current evidence suggests that viral carriage on the outer surface of surgical masks worn by HCW treating patients with clinical respiratory illness is low and there was not strong evidence to support the assumption that mask use may increase the risk of viral transmission. During the current novel coronavirus disease 2019 (SARS-CoV-2, COVID-19) pandemic, the Ministry of Health (MOH) and District Health Boards (DHB) have not recommended routine use of surgical masks for healthcare workers (HCW) in emergency departments (ED) in New Zealand (NZ). Articles were included if they were clinical studies that reported virus detection on masks worn by HCW. Systematic review evidence from a previous coronavirus pandemic suggests that general use of masks may be protective for HCW in this setting, 20 21 with a Number Needed to Treat (NNT) of six to prevent one HCW infection (meta-analysis of case control studies).

abstract:
  BACKGROUND: Concerns have been raised by healthcare organisations in New Zealand that routine mask use by healthcare workers (HCW) may increase the risk of transmission of SARS‐CoV‐2 through increased face touching. Routine mask use by frontline HCW was not recommended when seeing ‘low risk’ patients. The aim of this review was to determine the carriage of respiratory viruses on facemasks used by HCW. METHODS: A systematic review was conducted with structured searches of medical and allied health databases. Two authors independently screened articles for inclusion, with substantial agreement (k=0.66, 95%CI 0.54 to 0.79). Studies that at least one author recommended for full text review were reviewed in full for inclusion. Two authors independently extracted data from included studies including the setting, method of analysis and results. There was exact agreement on the proportion of virus detected on masks. RESULTS: 1233 titles were retrieved, 47 underwent full text review and five studies reported in four articles were included. The studies were limited by small numbers and failure to test all eligible masks in some studies. The proportion in each study ranged from 0 (95% CI 0‐10) to 25% (95%CI 8‐54). No study reported clinical respiratory illness as a result of virus on the masks. CONCLUSIONS: Although limited, current evidence suggests that viral carriage on the outer surface of surgical masks worn by HCW treating patients with clinical respiratory illness is low and there was not strong evidence to support the assumption that mask use may increase the risk of viral transmission. This article is protected by copyright. All rights reserved.


id: cord-322451-cwpz4akv
title: Heroes of SARS: professional roles and ethics of health care workers
author: Hsin, Dena Hsin-Chen
date: 2004-07-27
txt: ./txt/cord-322451-cwpz4akv.txt
cache: ./cache/cord-322451-cwpz4akv.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0163445304001410
doi: 10.1016/j.jinf.2004.06.005
summary:
  To examine the professional moral duty of health care workers (HCWs) in the outbreak of severe acute respiratory syndrome (SARS) in 2003. In a number of countries in order to encourage HCW, the government and the public started to give the title of ''hero'' to nurses and doctors who are working in the frontline of SARS outbreak. While the ethical ideal of self-less sacrifice of life for curing disease is promoted in the public image and media, discussions with HCW in several countries suggests that being a hero is not what modern medical practice is for some HCWs. Most HCWs in Taiwan are working in the commercial hospital, where the hirer pushes them to focus their effort of work on business competition rather than the basic role of helpers to human''s health. Nurses'' professional care obligation and their attitudes towards SARS infection control measures in Taiwan during and after the 2003 epidemic

abstract:
  Objectives. To examine the professional moral duty of health care workers (HCWs) in the outbreak of severe acute respiratory syndrome (SARS) in 2003. Methods. Descriptive discussion of media reports, analysis of ethical principles and political decisions discussed in the outbreak, with particular emphasis on the events in mainland China and Taiwan. Results. There were differences in the way that Taiwan and mainland China responded to the SARS epidemic, however, both employed techniques of hospital quarantine. After early policy mistakes in both countries HCWs were called heroes. The label ‘hero’ may not be appropriate for the average HCW when faced with the SARS epidemic, although a number of self-less acts can be found. The label was also politically convenient. Conclusions. A middle ground for reasonable expectations from HCW when treating diseases that have serious risk of infection should be expected. While all should act according to the ethic of beneficence not all persons should be expected to be martyrs for society.


id: cord-325778-y5miy24f
title: Estimating the Burden of COVID-19 on the Australian Healthcare Workers and Health System
author: Quigley, Ashley L.
date: 2020-10-29
txt: ./txt/cord-325778-y5miy24f.txt
cache: ./cache/cord-325778-y5miy24f.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0020748920302972
doi: 10.1016/j.ijnurstu.2020.103811
summary:
  We aimed to estimate the burden of COVID-19 on Australia healthcare workers and the health system by obtaining and organizing data on HCW infections, analyzing national HCW cases in regards to occupational risk and analyzing healthcare outbreak. METHODS: We searched government reports and websites and media reports to create a comprehensive line listing of Australian healthcare worker infections and nosocomial outbreaks between January 25(th) and July 8(th), 2020. Many studies have also shown that hospitals not only present a high exposure setting for respiratory infections in HCW 17, 18 but that presenteeism is a key risk factor in disease transmission and extension of an outbreak 19 . Analysis of the infection status of the health care workers in Wuhan during the COVID-19 outbreak: A cross-sectional study COVID-19 and the Risk to Health Care Workers: A Case Report COVID-19: the case for health-care worker screening to prevent hospital transmission

abstract:
  INTRODUCTION: There is no publicly available national data on healthcare worker infections in Australia. It has been documented in many countries that healthcare workers are at increased occupational risk of COVID-19. We aimed to estimate the burden of COVID-19 on Australia healthcare workers and the health system by obtaining and organizing data on HCW infections, analyzing national HCW cases in regards to occupational risk and analyzing healthcare outbreak. METHODS: We searched government reports and websites and media reports to create a comprehensive line listing of Australian healthcare worker infections and nosocomial outbreaks between January 25(th) and July 8(th), 2020. A line list of healthcare worker related COVID-19 reported cases was created and enhanced by matching data extracted from media reports of healthcare related COVID-19 relevant outbreaks and reports, using matching criteria. Rates of infections and odds ratios (ORs) for healthcare workers were calculated per state, by comparing overall cases to healthcare worker cases. To investigate the sources of infection amongst healthcare workers, transmission data were collated and graphed to show distribution of sources. RESULTS: We identified 36 hospital outbreaks or outbreaks between January 25(th) and July 8(th), 2020. According to our estimates, at least 536 healthcare workers in Australia have been infected with COVID-19, comprising 6.03% of all reported infections. The rate of healthcare worker infection was 72/100,000 and of community infection 34/100,000. healthcare workers were 2.76 times more likely to contract COVID-19 (95% CI 2.53 to 3.01; P<0.001). The timing of hospital outbreaks did not always correspond to community peaks. Where data were available, a total of 131 healthcare workers across 21 outbreaks, led to 1656 healthcare workers being furloughed for quarantine. One hospital was closed and had 1200 workers quarantined in one outbreak. CONCLUSION: The study shows that HCWs were at nearly 3 times the risk of infection. Of concern, this nearly tripling of risk occurred during a period of low community prevalence suggesting failures at multiple hazard levels including PPE policies within the work environment. Even in a country with relatively good control of COVID-19, healthcare workers are at greater risk of infection than the general community and nosocomial outbreaks can have substantial effects on workforce capacity by the quarantine of numerous workers during an outbreak. The occurrence of hospital outbreaks even when community incidence was low, highlights the high risk setting that hospitals present. Australia faces a resurgence of COVID-19 since late June 2020, with multiple hospital outbreaks. We recommend formal reporting of healthcare worker infections, testing protocols for nosocomial outbreaks, cohorting of workforce to minimize the impact, and improved PPE guidelines to provide precautionary and optimal protection for healthcare workers.


id: cord-329350-qrxl5o1e
author: Pan, Angelo
date: 2020-06-09
txt: ./txt/cord-329350-qrxl5o1e.txt
cache: ./cache/cord-329350-qrxl5o1e.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1198743X20303360?v=s5
doi: 10.1016/j.cmi.2020.05.038
abstract: nan
summary:
  We have had to care for high numbers of severely ill patients with limited resources, i.e. ventilators and specialists in respiratory failure management, often with a lack of health-care workers (HCW): a terrible situation. 1. Education first: it is difficult to organize continuing HCW education in an emergency setting, but it is necessary to implement courses on infection control and prevention (ICP) and on COVID-19 management. HCW need to be rapidly updated on necessary competencies required to manage highly infectious patients with respiratory failure. C. COVID-19 management: "fast and dirty" courses on should be organized on general principles of respiratory insufficiency, blood gas analysis, oxygen therapy, venous thromboembolism prevention, antivirals and anti-inflammatory drugs use (7) . while waiting for possible new waves, we are working on education on PPE, HH, and ventilation, and programming how to dedicate general ward and ICU to manage new COVID-19 patients.

title:
  Suggestions from Cremona, Italy - two months into the pandemic at the frontline of COVID-19 in Europe


id: cord-332083-135iic7m
author: Xia, Wei
date: 2020-09-29
txt: ./txt/cord-332083-135iic7m.txt
cache: ./cache/cord-332083-135iic7m.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32994038/
doi: 10.1016/j.jen.2020.08.004
summary:
  INTRODUCTION: The purpose of this study was to rapidly quantify the safety measures regarding donning and doffing personal protective equipment, complaints of discomfort caused by wearing personal protective equipment, and the psychological perceptions of health care workers in hospitals in Wuhan, China, responding to the outbreak. Detailed donning and doffing procedures are described in the Supplementary Figure The purpose of this study was to rapidly quantify the safety measures of donning and doffing PPE, complaints of discomfort caused by wearing PPE, and the psychological perceptions of HCWs in hospitals in Wuhan, China, responding to the COVID-19 outbreak. Because our participants were all HCWs in Wuhan hospitals, we divided their demographic information as follows: the demographic variables included sex (male or female); age (20-30 years, 30-40 years, 40-50 years, and >50 years); occupation (physician, nurse, pharmacist, medical technician, or other); workplace (a designated hospital for patients critically ill with severe COVID-19; an undesignated hospital for patients uninfected with COVID-19; and Fangcang Hospital for patients with mild symptoms of COVID-19); and department (general isolation ward, intensive care unit [ICU], emergency department for patients with fevers, and other).

title:
  The Physical and Psychological Effects of Personal Protective Equipment on Health Care Workers in Wuhan, China: A Cross-Sectional Survey Study

abstract:
  INTRODUCTION: The purpose of this study was to rapidly quantify the safety measures regarding donning and doffing personal protective equipment, complaints of discomfort caused by wearing personal protective equipment, and the psychological perceptions of health care workers in hospitals in Wuhan, China, responding to the outbreak. METHODS: A cross-sectional online questionnaire design was used Data were collected from March 14, 2020, to March 16, 2020, in Wuhan, China. Descriptive statistics and χ square analyses testing were used. RESULTS: Standard nosocomial infection training could significantly decrease the occurrence of infection (3.6% vs 13.0%, χ(2) = 4.47, P < 0.05). Discomfort can be classified into 7 categories. Female sex (66.0% vs 50.5%, χ(2) = 6.37), occupation (62.7% vs 30.8%, χ(2) = 5.33), working at designated hospitals (44.8% vs 26.7%, χ(2) = 5.17) or in intensive care units (70.4% vs 57.9%, χ(2) = 3.88), and working in personal protective equipment for > 4 hours (62.2% vs 39.2%, χ(2) = 9.17) led to more complaints about physical discomfort or increased occurrence of pressure sores (all P < 0.05). Psychologically, health care workers at designated hospitals (60.0% vs 42.1%, χ(2) = 4.97) or intensive care units (55.9% vs 41.5%, χ(2) = 4.40) (all P < 0.05) expressed more pride. DISCUSSION: Active training on infection and protective equipment could reduce the infection risk. Working for long hours increased the occurrence of discomfort and skin erosion. Reducing the working hours and having adequate protective products and proper psychological interventions may be beneficial to relieve discomfort.


id: cord-333460-4ui8i9u5
author: Li, Qing
date: 2020-09-18
txt: ./txt/cord-333460-4ui8i9u5.txt
cache: ./cache/cord-333460-4ui8i9u5.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33042955/
doi: 10.3389/fpubh.2020.562885
summary:
  title: The Psychological Health Status of Healthcare Workers During the COVID-19 Outbreak: A Cross-Sectional Survey Study in Guangdong, China Similar to SARS and MERS, front-line healthcare workers (HCW) may be in direct contact with and have to care for patients and suspected cases of COVID-19; they are therefore at a particularly high risk of infection. The aim of our study was to assess the psychological status of HCW in Guangdong Province, China, and to identify coping strategies during the outbreak of COVID-19. However, surprisingly, the mean scores of the SAS (42.9) and SDS (47.8) of HCW indicated that they were in the normal range for both anxiety and depression, which seemed to differ from the results of previous studies on SARS and MERS (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) .

title:
  The Psychological Health Status of Healthcare Workers During the COVID-19 Outbreak: A Cross-Sectional Survey Study in Guangdong, China

abstract:
  Background: The sudden outbreak of COVID-19 has caused mental stress on healthcare workers (HCW). This study aimed to assess their psychological health status at the peak of COVID-19 and to identify some coping strategies. Methods: A cross-sectional survey study was conducted during the outbreak of COVID-19. The survey was completed by 908/924 HCW (response rate 98.27%) in government-designated hospitals in Guangdong, China. A quality of life (QoL) scale, the Zung Self-Rating Anxiety Scale (SAS), and the Zung Self-Rating Depression Scale (SDS) were used to evaluate their psychological status. Logistic regression models were used to identify the occupational factors related to anxiety or depression. Results: A total of 221 (24.34%) respondents had varying levels of anxiety, and 299 (32.93%) of them had depression. The mean SAS (42.9) and SDS (47.8) scores of HCW indicated that they were in the normal range for both anxiety and depression. Contact with COVID-19 cases or suspected cases, worry about suffering from COVID-19, worry about their family, and dismission during the COVID-19 period were significant work-related contributing factors to the psychological health problems of HCW (all p<0.01). Conclusions: The overall psychological health status of HCW in Guangdong, China, during the outbreak of COVID-19 was not overly poor. Updating and strengthening training in disease information, the provision of adequate medical supplies, and care about the life and health of medical staff and their family members may reduce their mental stress.


id: cord-335638-p84nmtfp
author: Swaminathan, Ashwin
date: 2007-10-17
txt: ./txt/cord-335638-p84nmtfp.txt
cache: ./cache/cord-335638-p84nmtfp.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3201/eid1310.070033
doi: 10.3201/eid1310.070033
summary:
  This study aimed to estimate the resource needs that a hospital might face in the fi rst few hours of management of a single patient who sought treatment with possible avian or pandemic infl uenza (API) or similar highly virulent respiratory infection. The study outcome measures were the following: 1) number of close contacts associated with the API patient during the initial 6 hours of patient management, including how many of these were HCW close contacts; 2) the total number of exposures experienced by close contacts; 3) overall quantity and type of PPE items (gowns, gloves, N95 masks, eyewear) actually used during the simulation by HCW close contacts and ancillary HCWs; 4) overall "opportunities for PPE item use" for HCW close contacts and ancillary HCWs (i.e., actual use plus missed opportunities for appropriate PPE use); and 5) stratifi cation of HCW close contacts into medium-or low-risk groups for the purpose of recommending antiviral postexposure prophylaxis.

title:
  Personal Protective Equipment and Antiviral Drug Use during Hospitalization for Suspected Avian or Pandemic Influenza(1)

abstract:
  For pandemic influenza planning, realistic estimates of personal protective equipment (PPE) and antiviral medication required for hospital healthcare workers (HCWs) are vital. In this simulation study, a patient with suspected avian or pandemic influenza (API) sought treatment at 9 Australian hospital emergency departments where patient–staff interactions during the first 6 hours of hospitalization were observed. Based on World Health Organization definitions and guidelines, the mean number of “close contacts” of the API patient was 12.3 (range 6–17; 85% HCWs); mean “exposures” were 19.3 (range 15–26). Overall, 20–25 PPE sets were required per patient, with variable HCW compliance for wearing these items (93% N95 masks, 77% gowns, 83% gloves, and 73% eye protection). Up to 41% of HCW close contacts would have qualified for postexposure antiviral prophylaxis. These data indicate that many current national stockpiles of PPE and antiviral medication are likely inadequate for a pandemic.


id: cord-336837-rerp1g1w
author: Jones, Nick K
date: 2020-06-19
txt: ./txt/cord-336837-rerp1g1w.txt
cache: ./cache/cord-336837-rerp1g1w.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32558644/
doi: 10.7554/elife.59391
summary:
  These data demonstrate how infection prevention and control measures including staff testing may help prevent hospitals from becoming independent ''hubs'' of SARS-CoV-2 transmission, and illustrate how, with appropriate precautions, organizations in other sectors may be able to resume on-site work safely. Testing for SARS-CoV-2 RNA was performed with real-time RT-PCR using throat and nose swab samples of HCWs from Cambridge University Hospitals NHS Foundation Trust (CUHNFT) and their symptomatic household contacts. In the HCW symptomatic and HCW symptomatic household contact screening arms combined (reflecting all individuals with self-reported symptoms at the time of testing), 13/771 (1.7%) tests were positive, which was significantly lower than 30/221 (13%) in the original study period (Fisher''s exact test p<0.0001). In particular, during the last 2 weeks of the study period (11th to 24th May 2020), we identified only four positive SARS-CoV-2 samples from 2016 tests performed, two from the HCW asymptomatic and two from the HCW symptomatic/symptomatic household contact arms.

title:
  Effective control of SARS-CoV-2 transmission between healthcare workers during a period of diminished community prevalence of COVID-19

abstract:
  Previously, we showed that 3% (31/1032)of asymptomatic healthcare workers (HCWs) from a large teaching hospital in Cambridge, UK, tested positive for SARS-CoV-2 in April 2020. About 15% (26/169) HCWs with symptoms of coronavirus disease 2019 (COVID-19) also tested positive for SARS-CoV-2 (Rivett et al., 2020). Here, we show that the proportion of both asymptomatic and symptomatic HCWs testing positive for SARS-CoV-2 rapidly declined to near-zero between 25th April and 24th May 2020, corresponding to a decline in patient admissions with COVID-19 during the ongoing UK ‘lockdown’. These data demonstrate how infection prevention and control measures including staff testing may help prevent hospitals from becoming independent ‘hubs’ of SARS-CoV-2 transmission, and illustrate how, with appropriate precautions, organizations in other sectors may be able to resume on-site work safely.


id: cord-351022-8y43jhmu
author: Schwartz, Carmela
date: 2020-09-01
txt: ./txt/cord-351022-8y43jhmu.txt
cache: ./cache/cord-351022-8y43jhmu.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1093/ofid/ofaa384
doi: 10.1093/ofid/ofaa384
summary:
  title: A dynamic response to exposures of healthcare workers to newly diagnosed COVID-19 patients or hospital personnel, in order to minimize cross transmission and need for suspension from work during the outbreak Jerusalem and its surroundings is the area with the highest prevalence of COVID-19 patients in Israel (2) .Health care workers (HCWs) are at increased risk of exposure to infected persons (3) , and concern aroused early in the course of the epidemic that a substantial number of HCWs might need to be suspended from work. After two weeks (on March 20), during which over 250 HCWs were sustained from work, the need A c c e p t e d M a n u s c r i p t 8 for home isolation was redefined according to the following principles: 1) if the index case was symptomatic at the time of exposure (e.g., fever or chills, respiratory symptoms, loss of smell or taste), all close contacts were sent to home isolation for 14 days following exposure date.

title:
  A dynamic response to exposures of healthcare workers to newly diagnosed COVID-19 patients or hospital personnel, in order to minimize cross transmission and need for suspension from work during the outbreak

abstract:
  BACKGROUND: During the corona virus disease (COVID-19) epidemic, many healthcare workers (HCWs) were exposed to infected persons, leading to suspension from work. We describe a dynamic response to exposures of HCWs at the Hadassah Hospital, Jerusalem, to minimize the need for suspension from work. METHODS: We performed an epidemiological investigation following each exposure to a newly diagnosed COVID-19 patient or HCW; close contacts were suspended from work. During the course of the epidemic, we adjusted our isolation criteria according to the timing of exposure related to symptoms onset, use of personal protective equipment and duration of exposure. In parallel, we introduced universal masking and performed periodic SARS-CoV-2 screening for all hospital personnel. We analyzed the number of HCWs suspended weekly from work and those who subsequently acquired infection. RESULTS: In the 51 investigations conducted during March-May 2020, we interviewed 1095 HCWs and suspended 400 (37%) from work, most of them, 251 (63%), during the first two weeks of the outbreak. The median duration of exposure was 30 minutes (IQR, 15-120). Only 5/400 (1.3%) developed infection, all in the first two weeks of the epidemic. After introduction of universal masking and despite loosening the isolation criteria, none of the exposed HCWs developed COVID-19. CONCLUSIONS: Relatively short exposures of HCWs, even if only either the worker or the patient wore a mask, probably poses a very low risk for infection. This allows us to perform strict follow-up of exposed HCWs in these exposures, combined with repeated testing, instead of suspension from work.


id: cord-353988-xoxmugi8
title: Tuberculose em profissionais de saúde de um serviço hospitalar
author: Saleiro, Sandra
date: 2007-12-31
txt: ./txt/cord-353988-xoxmugi8.txt
cache: ./cache/cord-353988-xoxmugi8.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0873215915303767
doi: 10.1016/s0873-2159(15)30376-7
summary:
  Material and methods: All HCW (73) from Hospital São João''s ENT Unit who had been in contact with two in-patients with active TB underwent TB screening. Material and methods: All HCW (73) from Hospital São João''s ENT Unit who had been in contact with two in-patients with active TB underwent TB screening. Microbiology diagnosis was obtained in 7 cases by sputum smear, n=2; culture exam in bronchial lavage, n=4 and histological exam of pleural tissue, n=1. The HCW with suspected TB were evaluated via chest X-ray, mycobacteriological sputum smear, bronchofibroscopy with bronchial lavage, diagnostic thoracocentesis and pleural biopsy. Um dos 9 casos de tuberculose apresentava derrame pleural esquerdo, que foi estudado, tendo para esse efeito sido realizada toracocentese diagnóstica (ADA: 119 U/L; exame directo e cul-in 6 patients, pulmonary nodules in 2 and pleural effusion in 1 (Fig. 3) . Risk of Mycobacterium tuberculosis infection and disease among health care workers

abstract:
  Abstract Introduction: Tuberculosis (TB) is considered an occupational disease in health care workers (HCW) and its transmission in health care facilities is an important concern. Some hospital departments are at higher risk of infection. Objective: To describe TB cases detected after TB screening in HCW from a hospital department (Ear, Nose and Throat – ENT) who had had contact with active TB cases. Material and methods: All HCW (73) from Hospital São João’s ENT Unit who had been in contact with two in-patients with active TB underwent TB screening. Those who had symptoms underwent chest X-ray and mycobacteriological sputum exam. Results: Of 73 HCW who underwent TB screening, TB diagnosis was established in 9 (8 female; median age: 30 years; 1 doctor, 6 nurses, 2 nursing auxiliaries). Pulmonary TB was found in 8 and extra-pulmonary TB in 1. Microbiology diagnosis was obtained in 7 cases by sputum smear, n=2; culture exam in bronchial lavage, n=4 and histological exam of pleural tissue, n=1. In 4 cases, Mycobacterium tuberculosis genomic DNA was extracted from cultures and molecular typing was done. All cases had identical MIRU types, which allowed identification of the epidemiological link. Conclusion: Nosocomial TB is prominent and efforts should be made to implement successful infection control measures in health care facilities and an effective TB screening program in HCW. Molecular typing of Mycobacterium tuberculosis facilitates cluster identification. Rev Port Pneumol 2007; XIII (6): 789-799


