Knowledge, perception of risk of disease, and infection prevention and control practices among healthcare workers and support staff toward COVID-19 in an Ethiopian referral hospital: a cross-sectional survey

Coronavirus disease 2019 (COVID-19) is a pandemic affecting over 106 million and killing over 2.3 million people. Inadequate knowledge of the disease coupled with scarce or improper use of infection prevention and control (IPC) measures by healthcare workers (HCWs) and support staff may be contributing to the rapid spread of infection. This survey aims to assess knowledge, risk perception, and precaution practices of HCWs and support staff toward COVID-19 under resource-constrained circumstances at a major referral hospital in Ethiopia. An institution-based survey was conducted in April 2020 using 422 subjects selected by stratified random sampling. A five-section survey instrument was distributed, and the collected responses were cleaned and entered into Epi data (v3.1) and exported to SPSS (v.26) for further statistical analysis. The survey found that about 58% of the HCWs and support staff in the hospital appear to have adequate awareness and perceive COVID-19 to be a high-risk disease. Seven out of 10 subjects practice some form of IPC measures. However, the knowledge among allied HCWs and support staff appears to be inadequate. Gender, occupation, and years in service correlated with the level of awareness. Of those surveyed, 78% were concerned about the lack of personal protective equipment and perceived public transportation to be a high-risk factor for the transmission of infection. Additional campaigns may be necessary to reinforce existing knowledge of HCWs, but more emphasis should be geared toward educating allied HCWs and support staff.

Self-medication practice and associated factors among adults in Wolaita Soddo town, Southern Ethiopia

Background: Self-medication is the selection and use of medicines by individuals to treat their self-recognized illnesses or symptoms. Self-medication can decrease costs and enable health professionals to concentrate on more serious health problems. Aim: To assess self-medication practice and associated factors among adults in Wolaita Soddo town, Southern Ethiopia, 2017. Methods: An institution-based cross-sectional study was conducted from September 30 to October 30, 2017. A multi-stage sampling technique of drug retail outlets in Wolaita Soddo town was employed to identify 623 individuals that came to buy drugs in the past three months. Data was collected using a structured questionnaire. Results: About 33.7% of the respondents had practiced self-medication in the past 3 months. Multivariate analysis revealed that female sex (adjusted odds ratio (AOR) = 2.22, 95% confidence interval (CI): 1.47–3.36), low income (AOR = 3.95, 95% CI: 2.32–6.73) and higher educational level (AOR = 5.79, 95% CI: 2.47–13.58) were the independent factors significantly affecting the practice of self-medication with drugs. Headache/fever (32.4%), respiratory tract infections (31.4%) and gastrointestinal diseases (16.2%) were the most frequently reported illnesses or symptoms of illnesses that prompted self-medication of study participants. Conclusion: Health education campaigns, strict legislations on dispensing drugs from private pharmacies, and improving accessibility and affordability of health care are among the important interventions required to change people’s health-seeking behavior and prevent the potential risks of self-medication.

Investigation of the effectiveness of antimicrobial photocatalyst-coated hand-contact surfaces in passenger transport vehicles under everyday conditions

The coronavirus disease-2019 pandemic affects all aspects of public life. Measures for infection prevention are implemented in various sectors, in businesses, as well as in private life. Public transport is important and indispensable in daily life for both children and adults. Public transport companies have to take necessary actions to protect passengers and drivers from infections. Skin contact is one of the ways of transmitting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This research study was designed to evaluate the effectiveness of a photocatalytic, antimicrobial active surface coating under everyday – not hospital – conditions. To date, such coatings have been used in hospitals as an additional measure to regular cleaning and disinfection in order to reduce the risk of infection. We collected samples for bacterial cultures in three classes of public transport vehicles: bus, underground, and tram. Seven different hand-contact surfaces in one vehicle of each class were coated, while the other vehicles remained uncoated. All vehicles were in regular use. The number of colony-forming bacterial units per cm2 (CFUs/cm2) was measured. A representative number of isolates were differentiated at the pathogen level. Data collected were entered into GraphPad Prism (GraphPad Software, San Diego, USA) and analyzed. Overall, no statistically significant reduction in the number of colony-forming units (CFUs) was observed for coated versus uncoated surfaces. Samples with a very high colony count (>250 CFU/25 cm2) were equally distributed in both groups, coated and uncoated vehicles. Within one vehicle type, there was no significant difference between the coated and the uncoated vehicle. No relevant infection-preventive effect could be proven.

Patient risk factor stratification is essential for the hospital antibiogram

Empiric antimicrobial therapy in hospitalized patients is guided by an institution’s cumulative antibiogram, which may not be adequate in giving information on decision-making for optimal treatment in different patient populations. Adding patient risk factors can make it more useful for clinicians in guiding empiric therapy and for antimicrobial stewardship. Cumulative data were obtained for blood culture and urine isolates from the laboratory information system of a tertiary care hospital for 6 months (January to June 2019). Further stratification of organism types and resistance rates on the basis of patient risk factors (Patient Types 1, 2, and 3) was performed and analyzed. Salmonella spp. was seen in community-acquired ward patients (Types 1 and 2). Streptococcus pneumoniae was seen in Type 1 patients, and Acinetobacter spp. was seen in Type 3 patients. Extended-spectrum beta-lactamase-producing gram-negative infection rates were higher in community patients than in hospital patients. Carbapenem-resistant Enterobacteriaceae rates were high in Type 3 hospitalized patients. Cumulative blood methicillin-resistant Staphylococcus aureus rates were 43% but stratification showed it only in Type 2 and Type 3 ICU patients with 0% in ward patients. Stratified antibiograms based on patient risk factors are valuable for antimicrobial stewardship and help to optimize empiric therapy and increase the understanding of antimicrobial resistance trends.

Reuse of disposable gowns for COVID-19 personal protective equipment purposes in times of scarcity: results of an experimental study with hydrogen peroxide vaporization

During the coronavirus disease 2019 (COVID-19) pandemic, many health organizations faced shortages of personal protective equipment for their personnel. In case of extreme urgency, re-using disposable materials might offer a temporary solution. Hydrogen peroxide vaporization (HPV) has been used for disinfection of patient rooms for more than a decade. We investigated HPV as a method for disinfecting disposable gowns. After HPV, gowns proved to be free of bacteria and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA while their functionality and water-repellency remained intact. We conclude that, in case of emergency and lack of available alternatives, HPV is a suitable and relatively inexpensive method for one-time reuse of disposable gowns.

Development and operation of an indoor mass COVID-19 vaccination clinic

During the coronavirus disease 2019 (COVID-19) pandemic, many public response activities were conducted outdoors to reduce the risk of transmission. This was in adherence to existing infection prevention recommendations. We report the development and safe, efficient operation of a mass COVID-19 vaccination clinic during a time when guidelines for indoor clinics were limited.

Feasibility and safety of a symptom-based strategy to discontinue infection control precautions for patients hospitalised with COVID-19 – a retrospective study

Background: Various recommendations exist concerning the discontinuation of contact and droplet precautions (CDP) for patients hospitalised with coronavirus disease 2019 (COVID-19). Some are based on repeated negative real-time polymerase chain reaction (RT-PCR) results, whereas other are based on clinical criteria. The feasibility and safety of these recommendations are poorly documented. Method: We conducted a retrospective study to assess the feasibility and safety of a symptom-based strategy to discontinue CDP for patients hospitalised with COVID-19. We reviewed the clinical charts of all symptomatic patients hospitalised in our institution with RT-PCR-confirmed COVID-19 to assess the application of a symptom-based strategy for the implementation and discontinuation of CDP. The patients with discontinuation of CDP in accordance with the symptom-based strategy were cross-referenced with patients with potential hospital-acquired COVID-19 in order to assess the safety of this strategy. Results: Among the 147 patients included in our study, our symptom-based strategy was respected in 95 cases (64.6%). Discontinuation of CDP in accordance with the recommendations occurred in 39 patients (26.5%). After the discontinuation of CDP, patients remained hospitalised for a median time of 18 days, with exposure to a median number of three patients, resulting in a total number of 588 days ‘patient-day-exposition’. No hospital-acquired COVID-19 was detected in contact patients. Discussion: The use of a symptom-based strategy to discontinue CDP is applicable and safe. This symptom-based strategy was applicable regardless of patient’s age or COVID-19 severity.

Antimicrobial drug resistance and infection prevention/control: lessons from tuberculosis

Antimicrobial drug resistance (AMR) is increasing rapidly worldwide, causing an estimated 700,000 deaths annually over the past decade, en route to becoming the leading global threat to public health by 2050 with an estimated 10 million deaths per year (more than heart disease, cancer, and stroke), while reducing global wealth by US$100 trillion. Yet AMR has not received the attention and action required to change this trajectory. Appropriate infection prevention and control (IPC) measures are needed to prevent transmission of infections to healthcare workers (HCWs), other patients, families, and the general public. In this review, we discuss a notable case study of AMR: highly drug-resistant tuberculosis (TB) has emerged repeatedly over the past 70 years as new drugs have been introduced, leading to new diagnostics, therapeutics, funding, public health strategies, and, in high-income countries, effective IPC measures that curtailed transmission. We review current efforts to control and prevent AMR using the example of drug-resistant tuberculosis to highlight important themes including laboratory systems, surveillance, control and prevention of healthcare-associated infections (especially among HCWs), better coordination across disciplines and diseases, and powerful advocacy/social change initiatives grounded in social and behavioral sciences. These strategies are the foundation of an effective response to the AMR threat to public health.

Pharmacovigilance quality system for vaccine monitoring (COVID-19) using quality indicators: a scoping review

This scoping review responds to the appeal of the scientific community for collaboration between different entities for pharmacovigilance and active surveillance of coronavirus disease 2019 (COVID-19) vaccines. The objective is to identify, systematically evaluate, and synthesize the best scientific evidence available on the indicators used in pharmacovigilance systems. Our results demonstrate that approximately 50% of the 25 studies used in this review have been carried out in the past 5 years. Of these, only four used the pharmacovigilance indicators proposed by the World Health Organization (WHO). Eighty-seven pharmacovigilance indicators were identified, of which seven (8.0%) related to signal detection. While the WHO advocates signal detection as routine pharmacovigilance, in special situations – such as accelerated clinical studies where adverse events are not yet well known – other indicators related to signal detection appear to be good options for maintaining quality pharmacovigilance and active surveillance in the development of the COVID-19 vaccine. However, the less robust pharmacovigilance systems in low-income countries will necessitate greater involvement of health professionals from public and private sectors, pharmaceutical companies, academic institutions, and the general public, to ensure information security and detection of signals for the COVID-19 vaccine.