Preparedness, Risk Perception, Concerns and Risk Acceptance among Hospital Healthcare Workers (HCWs) in facing the emerging new Corona Virus (COVID-19) Outbreak in Najran Hospitals, Saudi Arabia, at the early phase of the pandemic (Preprint)

BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic extended to reach most countries in the globe during a few months. The preparedness of healthcare institutions and healthcare workers is crucial for applying effective prevention and control measures. OBJECTIVE This study aimed to assess HCWs and institutional preparedness in facing the new emerging coronavirus (COVID-19) infection at the early phase of the pandemic, and to explore HCWs' risk perception, concerns, and risk acceptance. METHODS A cross-sectional survey was conducted among hospital HCWs in the main hospitals, in Najran city, southwestern Saudi Arabia, at the early phase of the pandemic, during March-April, 2020. RESULTS Overall, 563 completed questionnaires were received (382; 67.9% from KKH and 181; 32.1% from NNH). The majority were females (78.6%), nurses constituted (74.7%). The age range of the participants was 20-63 years, with the mean age of physicians 36.5±9.15 years and 31.8±7.48 years for nurses. Among participants, 65.8% attended training program/s for COVID-19 infection, of whom 69.9% were satisfied with this training. Almost all (97.4%) of the participants reported reading the official circulars assigned for guidelines, case definition and, infection control measures regarding COVID-19 infection, 97.1% received basic infection control training, 98.9% checked for the best-fitted size of N95 mask, and 89.4% were influenza vaccinated. Of the participants, 82.6% reported that they have sufficient knowledge about t COVID-19 pandemic, 82.0% being confident that they can protect themselves and their patients when dealing with COVID-19 cases, 92.9% reported that they understand the risk of COVID-19 infection for patients and healthcare staff and 83.2% reported agreement of accepting the risk of getting the infection being a part of their job. The study participants attained a 20.26±2.60 knowledge score on a scale of 26 maximum points (77.9%), of them 74.5% attained 20 points or more (>75%) indicating good working knowledge about the COVID-19 pandemic. Exploring the participants’ perception about the preparedness of their institutions towards the COVID-19 pandemic, 70.8% agreed that institutional precautionary measures to COVID-19 in the workplace are sufficient, 71.6% agreed that all personal protective equipment (PPE) are provided and always available in the workplace, and 90.6% mentioned that the staff in their institutions have had adequate training. Exploring risk perception and the affective aspect of the pandemic on HCWs, 79.0%, 35.2%, 64.2% of the participants felt that they, their families, and the Najran community are at high risk of getting an infection with the COVID-19 virus respectively, and 54.7% and 55.1% were concerned about their personal and family health respectively. CONCLUSIONS Findings revealed good knowledge about the COVID-19 pandemic among HCWs in Najran hospitals, Saudi Arabia. Concerns and worries were expressed regard working with the highly infectious COVID-19 patients. Participants appreciated important aspects of institutional preparedness. Experience gained from the previous MERS-CoV outbreak may explain good knowledge, risk acceptance, self-efficacy, and good and rapid institutional preparedness at the early stage of the pandemic.

Comparison of Three Expanded-Spectrum Cephalosporin Hydrolysis Assays and the NG-Test CTX-M Multi Assay That Detects All CTX-M-Like Enzymes

Rapid detection of expanded-spectrum cephalosporins (ESC) hydrolysing enzymes is crucial to implement infection control measures and antibiotic stewardship. Here, we have evaluated three biochemical ESC hydrolysis assays (ESBL NDP test, β-LACTA™ test, LFIA-CTX assay) and the NG-Test® CTX-M MULTI that detects CTX-M enzymes, on 93 well-characterized Gram-negative isolates, including 60 Enterobacterales, 21 Pseudomonas spp. and 12 Acinetobacter spp. The performances were good for all three hydrolysis assays, with the LFIA-CTX being slightly more sensitive and specific on the tested panel of isolates especially with Enterobacterales, without ambiguous results. This study showed that LFIA-CTX may be used for the detection of ESC hydrolysis as a competitive alternative to already available assays (β-LACTA™ test and ESBL NDP test) without any specific equipment and reduced hands-on-time. The lateral flow immunoassay NG-Test® CTX-M MULTI has proven to be a useful, easy, rapid, and reliable confirmatory test in Enterobacterales for detection of CTX-M-type ESBLs, which account for most of the resistance mechanisms leading to ESC resistance in Enterobacterales, but it misses rare ESC hydrolysing β-lactamases (AmpC, minor ESBLs, and carbapenemases). Combining it with the LFIA-CTX assay would yield an assay detecting the most frequently-encountered ESBLs (CTX-M-like β-lactamases) together with ESC hydrolysis.

COVID-19 policies in practice and their direct and indirect impacts in Northern California jails

Context: Although the increased risk of COVID-19 in carceral facilities is well documented, little is known about the practical barriers to infection control and indirect impacts of pandemic policies in these settings. Evidence in jails is especially scarce. Methods: Between July 8, 2020 and April 30, 2021 we performed SARS-CoV-2 serology testing and administered a questionnaire among residents and staff in four Northern California jails. We analyzed seroprevalence in conjunction with demographic factors and survey responses of self-perceived COVID-19 risk, recent illness, COVID-19 test results, and symptom reporting behaviors. We additionally assessed COVID-19 policies in practice and evaluated their impacts on court dates, mental health, and routine health care. We engaged stakeholder representatives, including incarcerated individuals and their advocates, to guide study design, conduct, and interpretation. Findings: We enrolled 788 incarcerated individuals and 380 staff across four county jails. Most seropositive individuals had not previously tested positive for COVID-19, despite many suspecting prior infection. Among incarcerated participants, we identified deficient access to face masks and prevalent symptom underreporting associated with fears of isolation and perceptions of medical neglect in jail. Incarcerated participants also reported substantial hindrances to court cases and reductions in routine health care due to COVID-19. Incarcerated individuals and staff both cited worsened mental health due to COVID-19, which for incarcerated individuals was largely attributable to further isolation from loved ones and other pandemic restrictions on recreation and programming. Conclusions: Perceptions of inadequate protection from COVID-19 were pervasive among incarcerated individuals. Simultaneously, restrictive measures compounded poor mental health and fostered fears of isolation that undermined effective infection control. Custody officials should work to systematically improve provision of masks, understand and mitigate fears and mistrust, and take proactive steps to minimize the detrimental impacts of restrictive policies on residents' mental health and well-being.

Risk of infection and appeal to public benefit increase compliance with infection control measures

To handle an infectious outbreak, the public must be informed about the infection risk and be motivated to comply with infection control measures. Perceiving the situation as threatening and seeing public benefits to complying may increase the public’s motivation to comply. The current study used a preregistered survey experiment to investigate if emphasizing high infection risk and appealing to societal benefits impacted intention to comply with infection control measures. The results show main effects of risk and of appeals to societal benefits. There was no interaction between risk scenario and motivational emphasis. The results suggest that to maximize compliance, information about disease outbreak should emphasize the individual risk of contracting the disease, and could also underline the public value of limiting infection spread. These findings can inform communication strategies during an infectious disease outbreak and help health authorities limit transmission.

NDM-1 Introduction in Portugal through a ST11 KL105 Klebsiella pneumoniae Widespread in Europe

The changing epidemiology of carbapenem-resistant Klebsiella pneumoniae in Southern European countries is challenging for infection control, and it is critical to identify and track new genetic entities (genes, carbapenemases, clones) quickly and with high precision. We aimed to characterize the strain responsible for the first recognized outbreak by an NDM-1-producing K. pneumoniae in Portugal, and to elucidate its diffusion in an international context. NDM-1-producing multidrug-resistant K. pneumoniae isolates from hospitalized patients (2018–2019) were characterized using FTIR spectroscopy, molecular typing, whole-genome sequencing, and comparative genomics with available K. pneumoniae ST11 KL105 genomes. FT-IR spectroscopy allowed the rapid (ca. 4 h after incubation) identification of the outbreak strains as ST11 KL105, supporting outbreak control. Epidemiological information supports a community source but without linkage to endemic regions of NDM-1 producers. Whole-genome comparison with previous DHA-1-producing ST11 KL105 strains revealed the presence of different plasmid types and antibiotic resistance traits, suggesting the entry of a new strain. In fact, this ST11 KL105 clade has successfully disseminated in Europe with variable beta-lactamases, but essentially as ESBL or DHA-1 producers. We expand the distribution map of NDM-1-producing K. pneumoniae in Europe, at the expense of a successfully established ST11 KL105 K. pneumoniae clade circulating with variable plasmid backgrounds and beta-lactamases. Our work further supports the use of FT-IR as an asset to support quick infection control.

The Effect of Race and Dementia Prevalence on a COVID-19 Infection Control Intervention in Massachusetts Nursing Homes

Background Nursing home (NH) residents, especially those who were Black or with dementia, had the highest infection rates during the COVID-19 pandemic. A 9-week COVID-19 infection control intervention in 360 Massachusetts NHs showed adherence to an infection control checklist with proper personal protective equipment (PPE) use and cohorting was associated with declines in weekly infection rates. NHs were offered weekly webinars, answers to infection control questions, resources to acquire PPE, backup staff, and SARS-CoV-2 testing. We asked whether the effect of this intervention differed by racial and dementia composition of the NHs. Methods Data were obtained from 4 state audits using infection control checklists, weekly infection rates, and Minimum Data Set variables on race and dementia to determine whether adherence to checklist competencies was associated with decline in average weekly rates of new COVID-19 infections. Results Using a mixed-effects hurdle model, adjusted for county COVID-19 prevalence, we found the overall effect of the intervention did not differ by racial composition, but proper cohorting of residents was associated with a greater reduction in infection rates among facilities with ≥20% non-Whites (n = 83). Facilities in the middle (>50%–62%; n = 121) and upper (>62%; n = 115) tertiles of dementia prevalence had the largest reduction in infection rates as checklist scores improved. Cohorting was associated with greater reductions in infection rates among facilities in the middle and upper tertiles of dementia prevalence. Conclusions Adherence to proper infection control procedures, particularly cohorting of residents, can reduce COVID-19 infections, even in facilities with high percentages of high-risk residents (non-White and dementia).

Perspectives on Light-Based Disinfection to Reduce the Risk of COVID-19 Transmission during Dental Care

Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) is a positive-sense single-stranded RNA coronavirus capable of causing potentially lethal pneumonia-like infectious diseases in mammals and birds. The main mechanisms by which SARS-CoV-2 spreads include airborne transmission (aerosols and droplets) and the direct exposure of tissues (conjunctival, nasal, and oral mucosa) to contaminated fluids. The aerosol formation is universal in dentistry due to the use of rotary instruments (handpieces), ultrasonic scalers, and air–water syringes. Several layers of infection control should protect key stakeholders such as dentists, dental staff, and patients. These include the utilization of personal protective equipment, high-volume evacuation systems, pre-procedural mouthwashes, rubber dam, and more recently, antimicrobial photodynamic therapy and intra-oral visible light irradiation. These non-specific light-based approaches are relatively simple, inexpensive, and effective against viruses, bacteria, and fungi. Therefore, the present perspective review discusses the current efforts and limitations on utilizing biophotonic approaches as adjunct infection control methods to prevent the transmission of SARS-CoV-2 in dental settings. In addition, the present perspective review may positively impact subsequent developments in the field, as it offers relevant information regarding the intricacies and complexities of infection control in dental settings.