key: cord-1029788-cqrbslhd authors: Igawa, Y.; Sugimoto, T.; Horimoto, H.; Moriya, Y.; Okada, M.; Yamada, Y. title: Impact of COVID-19 Pandemic on Inpatient Rehabilitation and the Original Infection Control Measures for Rehabilitation Team date: 2021-01-26 journal: nan DOI: 10.1101/2021.01.20.21250145 sha: a921d8ddfd48d2cd2b50392d1b017bc3e4ab874f doc_id: 1029788 cord_uid: cqrbslhd Objective: This study aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on inpatient rehabilitation, and to determine the effectiveness of the original infection control measures implemented for the rehabilitation team. Methods: In this single-center, retrospective, observational study, we calculated multiple rehabilitation indices of patients discharged from our rehabilitation ward between February 28 and May 25, 2020 when Hokkaido was initially affected by COVID-19, and compared them with those calculated during the same period in 2019. The Fisher exact test and the Mann-Whitney U test were used for statistical analysis. We also verified the impact of implementing the original infection control measures for the rehabilitation team on preventing nosocomial infections. Results: A total of 93 patients (47 of 2020 group, 46 of 2019 group) were included. The median age was 87 and 88 years, respectively, with no differences in age, sex, and main disease between the groups. Training time per day in the ward in 2020 was significantly lower than that in 2019 (p = 0.013). No significant differences were found in the qualitative evaluation indices of Functional Independence Measure (FIM) score at admission, FIM gain, length of ward stay, FIM efficiency, and rate of discharge to home. None of the patients or staff members had confirmed COVID-19 during the study period. Conclusions: Early COVID-19 pandemic in Hokkaido affected the quantitative index for inpatient rehabilitation but not the qualitative indices. No symptomatic nosocomial COVID-19 infections were observed with our infection control measures. In December 2019, an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was reported from China, 1) . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 26, 2021. ; https://doi.org/10.1101/2021.01.20.21250145 doi: medRxiv preprint Single-center, retrospective, observational study. Rehabilitation ward of a hospital in the central city of Hokkaido, Japan, which did not treat patients with COVID-19. The detailed evaluation indices obtained from discharged patients between February 28, 2020, and May 25, 2020, were compared with those obtained for the same period in 2019. The study period in 2020 started from the declaration of Hokkaido's state of emergency and ended with the lifting of the nationwide state of emergency. Patients who were transferred to another hospital or ward because of worsening condition or adverse events and the ones that expired during the study period were excluded. We used the Functional Independence Measure (FIM) to measure changes in functional ability. The tool consists of 18 items, each of which is a 7-point ordinal scale. 6) The evaluation items were age, sex, main disease name, FIM score at admission, gain of FIM, length of ward stay, FIM efficiency, rate of discharge to home, and training time per day. Discharge to home was defined as discharge to the patient's own residence or residential facility. The Fisher exact test was used to analyze sex, main disease, and rate of discharge to home of the subjects. The Mann-Whitney U test was used to analyze the subjects' age, FIM score at admission, FIM gain, FIM efficiency, and training time. The . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted January 26, 2021. ; https://doi.org/10.1101/2021.01.20.21250145 doi: medRxiv preprint level of significance was set at p < 0.05, and the statistical software program used was EZR. 7) The infection control committee in the hospital formulated nosocomial infection control measures based on the knowledge provided by related academic societies and public institutions. The nature of rehabilitation medicine was also taken into consideration, with rehabilitation staff meetings in the hospital to consider the formulation of the original infection control measures for the rehabilitation team. Table 1 shows the infection control measures for the rehabilitation team assembled by the staff. The handling of suspected cases and polymerase chain reaction (PCR) testing for COVID-19 was supposed to be carried out by a local governmental healthcare center upon request from attending clinicians, based on the guidelines of the central government. 8) This was a retrospective, observational study, conducted in accordance with the tenets of the Declaration of Helsinki, guaranteeing complete anonymity. This study was approved by the Ethics Committee of Aizen Hospital (permission number: 2020-003). . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted January 26, 2021. ; https://doi.org/10.1101/2021.01.20.21250145 doi: medRxiv preprint Fifty-four patients in 2020 and 58 in 2019 were discharged from the rehabilitation ward. Forty-seven study subjects in 2020 and 46 in 2019 ultimately met the inclusion criteria. Table 2 shows the demographic information for the subjects, their main diagnoses, and their evaluation index data. No significant differences in demographics and diagnoses were observed between the two groups (p > 0.05). No significant differences were found in FIM score at admission, FIM gain, length of ward stay, FIM efficiency, or rate of discharge to home (p > 0.05). Only the training time per day showed a significant decrease (p = 0.013) in the 2020 group compared with that in the 2019 group. Figure 1 shows a dot plot of the distribution of the training time per patient per day. The distribution of dots in the 2020 group was moved down compared with that in the 2019 group. No patients or staff members in the hospital had confirmed or suspected cases of COVID-19 during the study period. None of the staff members were eligible for PCR test based on case definitions in the guidelines, including the criteria for consultation and reporting to the local governmental healthcare center. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted January 26, 2021. ; https://doi.org/10.1101/2021.01.20.21250145 doi: medRxiv preprint based on FIM, which were designed to quantify the degree of disability. 6,9) Adding length of ward stay, rate of discharge to home, and training time as the evaluation indices in this study allowed a more detailed and multi-layered assessment. The use of surgical masks and face shields by healthcare professionals has previously been recommended and reviewed, mainly with the purpose of protecting healthcare professionals' own body from exposure to sources of infection. 15) In the case of COVID-19, however, non-first-line healthcare workers had a higher infection rate . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 26, 2021. ; https://doi.org/10.1101/2021.01.20.21250145 doi: medRxiv preprint than first-line healthcare workers, which differed from the observations in the previous viral disease epidemics. 16) In the clinical setting of rehabilitation medicine, young medical staff providing care to older patients is quite common. The older the patient and the more chronic diseases they have, the more vulnerable they are to the virus, 17) and therefore, protecting hospitalized older adults from staff-mediated infections has been an urgent issue. 18 In the epicenter of the global pandemic, such as the United States and Europe, some rehabilitation wards were converted to COVID-19 treatment wards due to an outbreak of the infection in the surrounding areas, interrupting the usual medical care for rehabilitation. 22,23) In contrast, the impact on inpatient rehabilitation in Hokkaido, Japan, in the early stages of the pandemic as shown in this study was limited. We were able to achieve good patient outcomes even with the reduced hours of rehabilitation . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 26, 2021. ; https://doi.org/10.1101/2021.01.20.21250145 doi: medRxiv preprint training that came with COVID-19 restrictions. However, these outcomes achieved with the staffing constraints resulted in longer hours and physical and mental burnout for medical personnel. Our observations correspond closely with the reports from other epidemic areas of the world and need to be addressed in a world with COVID-19. 24) This study has some important limitations. First, the prevalence and impact of COVID-19 were dependent on regionality and national insurance systems. Second, this study was a retrospective observational design and was conducted at a single facility in the early epidemic area of Japan. Third, this emerging infectious disease is expected to last long. The results of this study reflect the situation during the very early stages of the pandemic, when PPEs were extremely scarce, and are descriptive of the response process and its results. The response to the upcoming waves of COVID-19 might improve significantly as the issues of low PPE supply and COVID-19 management strategy have improved over time. In this study, we demonstrated that early COVID-19 pandemic in Hokkaido, Japan, did not negatively affect the qualitative outcomes of inpatient rehabilitation. This study suggests that it is possible to provide conventional rehabilitation outcomes with minimal negative influences during the pandemic if appropriate infection control measures are implemented. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 26, 2021. ; https://doi.org/10.1101/2021.01.20.21250145 doi: medRxiv preprint COI This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. No conflict of interest needs to be declared regarding the content published in this paper. We gratefully acknowledge all members of the infection control team in Aizen hospital for their dedicated work under the pandemic situation of COVID-19. The authors also thank Dr. Shuji Dohi, head of the hospital, for his kind support and advice. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 26, 2021. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 26, 2021. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 26, 2021. ; https://doi.org/10.1101/2021.01.20.21250145 doi: medRxiv preprint Table and Figure legend Table 1 Standard precautions and staff quarantine are to be managed by the infection control committee in the hospital. The 3Cs †: Closed spaces with poor ventilation, Crowded places with many people nearby, and Close-contact settings such as close-range conversations The distribution of training time of a discharged patient per day is shown. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 26, 2021. ; https://doi.org/10.1101/2021.01.20.21250145 doi: medRxiv preprint PPE * should be used in accordance with the supply and availability. All circumstances, including conferences, must be designed to avoid the 3Cs † . Keep appropriate physical distance from patients or staff during functional training. Wear both face mask and face shield during functional training. Avoid face to face conversations with patients as much as possible. Patients should be asked to wear a face mask if the supply is enough. Functional training should be provided around a patient's bedside or in-ward. Avoid careless touching of environment around patients' beds. The 3Cs †: Closed spaces with poor ventilation, Crowded places with many people nearby, and Close-contact settings such as close-range conversations . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 26, 2021. ; https://doi.org/10.1101/2021.01.20.21250145 doi: medRxiv preprint . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted January 26, 2021. ; https://doi.org/10.1101/2021.01.20.21250145 doi: medRxiv preprint . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted January 26, 2021. ; https://doi.org/10.1101/2021.01.20.21250145 doi: medRxiv preprint Healthcare Professionals about Coronavirus Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing Coronavirus Disease 2019 (COVID-2019) Infection Among Health Care Workers and Implications for Prevention Measures in a Tertiary Hospital in Wuhan, China