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Objective: To characterize hospital-onset COVID-19 cases and to investigate the associations between these rates and population and hospital-level rates including trends in healthcare worker infections (HCW), community cases, and COVID-19 wastewater data. Design: Retrospective cohort study from January 1, 2021, to November 23, 2022. Setting: This study was conducted at a 589-bed urban Midwestern tertiary-care hospital system. Participants and interventions: The infection prevention team reviewed the electronic medical records (EMR) of patients who were admitted for >48 hours and subsequently tested positive for SARS-CoV-2 to determine whether COVID-19 was likely to be hospital-onset illness. Each case was further categorized as definite, probable, or possible based on viral sequencing, caregiver tracing analysis, symptoms, and cycle threshold values. Patients were excluded if there was a known exposure prior to admission. Clinical data including vaccination status were collected from the EMR. HCW case data were collected via our institution’s employee health services. Community cases and wastewater data were collected via the Wisconsin Department of Health Services database. Additionally, we evaluated the timing of changes in infection prevention guidance such as visitor restrictions. Results: In total, 156 patients met criteria for hospital-onset COVID-19. Overall, 6% of cases were categorized as definite, 24% were probable, and 70% were possible hospital-onset illness. Most patients were tested prior to a procedure (31%), for new symptoms (30%), and for discharge planning (30%). Also, 53% were symptomatic and 41% received treatment for their COVID-19. Overall, 38% of patients were immunocompromised and 27% were unvaccinated. Overall, 12% of patients died within 1 month of their positive SARS-CoV-2 test, and 11% required ICU admission during their hospital stay. Hospital-onset COVID-19 increased in fall of 2022. Specifically, October 2022 had 16 cases, whereas fall of 2021 (September–November) only had 3 cases total. Finally, similar peaks were observed in total cases by week between healthcare workers, county cases, and COVID-19 wastewater levels. These peaks correspond with the SARS-CoV-2 delta and omicron variant surges, respectively. Conclusions: Hospital-onset cases followed similar trends as population and hospital-level data throughout the study period. However, hospital-onset rate did not correlate as strongly in the second half of 2022 when cases were disproportionately high. Given that hospital-onset cases can result in significant morbidity, continued enhanced infection prevention efforts and low threshold for testing are warranted in the inpatient environment.

Background: Amid the COVID-19 pandemic, healthcare systems were stretched thin, with staffing shortages posing substantial challenges. Limiting spread of COVID-19 among healthcare professionals (HCP) is paramount to preventing exacerbation of such shortages, but strategies are highly dependent on HCP self-screening for symptoms and isolating when present. We examined HCP perceptions of barriers and factors that facilitate staying home when experiencing respiratory symptoms. Methods: At an academic tertiary-care referral center, in inpatient and ambulatory settings, we conducted an anonymous electronic survey between March 11, 2022, and April 12, 2022. Using logistic regression analysis, we analyzed predictors of employees reporting to work with respiratory symptoms using STATA and SAS software. Results: In total, 1,185 individuals including 829 clinical staff and 356 nonclinical staff responded to the survey. When excluding participants who reported working “remotely” (N = 381) and those who reported being unsure of whether they had worked with symptoms (N = 14), the prevalence of working with respiratory symptoms was 63%. There was no significant difference between clinical and nonclinical staff (OR, 1.1; 95% CI, 0.8–1.5; P = .60). Increasing number of years of service was protective against working with symptoms, achieving statistically significance in multivariable analysis after 16 years. Compared to those having worked

Background: Povidone-iodine and chlorhexidine gluconate are commonly used antiseptics that have broad antiviral properties, including against SARS-CoV-2. Nasal and oral antisepsis is a possible option to reduce viral transmission; however, effectiveness data are limited. The acceptability of this method for adjunct infection control is also unknown. We are conducting a clinical randomized controlled trial (NCT04478019) to evaluate the effectiveness and feasibility of nasal and oral antisepsis to prevent COVID-19. Methods: Healthcare and other essential workers with in-person job duties were recruited into a 10-week clinical trial. Participation did not require in-person activities: all communication was web- or telephone-based, supplies were shipped directly to the participant, and participants self-collected specimens. Participants completed a 3-week intervention and 3-week control phases and were randomized to the timing of these phases (Fig. 1). During the 3-week intervention phase, participants applied povidone-iodine nasal swabs 2 times per day and chlorhexidine gluconate oral rinse 4 times per day following the manufacturers’ instructions for use. Participants continued all usual infection control measures (eg, face masks, eye protection, gowns, hand hygiene) as required by their workplace. To measure effectiveness against viral transmission, participants collected midturbinate nasal swabs 3 times per week to measure SARS-CoV-2 viral load. Participants also self-reported COVID-19 tests they received and why (eg, symptoms or exposure). To assess acceptability, participants completed pre- and post-surveys about their perceived and actual experience with the interventions. Participants also self-reported adverse effects due to the intervention. Results: As of December 3, 2021, 221 participants (148 healthcare workers and 73 non–healthcare essential workers) had enrolled. Moreover, 20 adverse effects have been reported, including skin irritation, epistaxis, and mouth discoloration; 9 participants withdrew due to side effects. Laboratory analyses are ongoing to measure effectiveness in reducing SARS-CoV-2 viral load. We performed an interim analysis of intervention acceptability. Survey responses were given on a Likert scale of 1 (not at all) to 5 (extremely). Although 36% of respondents (n = 74) reported on the postsurvey that the intervention was less acceptable than they had expected on the presurvey, the overall acceptability measure was still relatively high (3.76) (Fig. 2). In addition, 76% of respondents reported that they would use the intervention in the future (n = 56). Conclusions: Participant recruitment is ongoing, and data continue to be collected to analyze effectiveness and feasibility. Preliminary data suggest that participants find the nasal and oral antisepsis intervention to be an acceptable option to complement standard infection control methods to prevent COVID-19.

Abstract Objective: Surgical site infections (SSIs) greatly burden healthcare systems around the world, particularly in low- and middle-income countries. We sought to employ the Systems Engineering Initiative for Patient Safety (SEIPS) model to better characterize SSI prevention practices and factors affecting adherence to prevention guidelines at Jimma University Medical Center (JUMC). Design: Our cross-sectional study consisted of semistructured interviews designed to elicit perceptions of and barriers and facilitators to SSI prevention among surgical staff and observations of current preoperative, perioperative, and postoperative SSI prevention practices in surgical cases. Interviews were recorded, manually transcribed, and thematically coded within the SEIPS framework. Trained observers recorded compliance with the World Health Organization’s SSI prevention recommendations. Setting: A tertiary-care hospital in Jimma, Ethiopia. Participants: Surgical nurses, surgeons, and anesthetists at JUMC. Results: Within 16 individual and group interviews, participants cited multiple barriers to SSI prevention including shortages of water and antiseptic materials, lack of clear SSI guidelines and training, minimal Infection Prevention Control (IPC) interaction with surgical staff, and poor SSI tracking. Observations from nineteen surgical cases revealed high compliance with antibiotic prophylaxis (94.7%), hand scrubbing (100%), sterile gloves and instrument use (100%), incision site sterilization (100%), and use of surgical safety checklist (94.7%) but lower compliance with preoperative bathing (26.3%), MRSA screening (0%), and pre- and postoperative glucose (0%, 10.5%) and temperature (57.9%, 47.3%) monitoring. Conclusions: Utilizing the SEIPS model helped identify institution-specific barriers and facilitators that can inform targeted interventions to increase compliance with currently underperformed SSI prevention practices at JUMC.