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Aim To assess the prevalence of burnout, secondary traumatic stress, and compassion satisfaction and explore their impacts on self‐reported hand hygiene among medical aid teams in the COVID‐19 period in Wuhan, China. Design Cross‐sectional study. Method A total of 1,734 healthcare workers from 17 medical aid teams were surveyed. The survey included burnout, secondary traumatic stress and compassion satisfaction measured by the professional quality of life scale and self‐reported hand hygiene. Data were collected between 5–7 March 2020. Multiple regression analyses were performed. Results Burnout and secondary trauma stress were at low and average levels, and compassion satisfaction was at average and high levels. Burnout was negatively associated with hand hygiene, while compassion satisfaction was positively associated. Hospital administrators should pay attention to burnout and compassion satisfaction to improve infection control behaviours. Management of healthcare workers in our study may be constructive in emerging infectious diseases.

Ying Wang,1 Xinping Zhang,1 Xuemei Wang,1 Xiaoquan Lai2 1School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, People’s Republic of China; 2Department of Nosocomial Infection Management, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, People’s Republic of ChinaCorrespondence: Xinping ZhangSchool of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of ChinaTel +86 133 4995 0095Email xpzhang602@hust.edu.cnPurpose: Empirical antibiotic therapy should follow the local bacterial susceptibility, and the breakpoints revisions of the antimicrobial susceptibility testing can reflect the changes in the antimicrobial susceptibility of bacteria. This study aimed to analyze whether the changes in the antimicrobial susceptibility to antibiotics caused by the breakpoint revision will affect the empirical antibiotic therapy and its appropriateness.Patients and Methods: A retrospective study was conducted among 831 hospitalized patients infected by Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa from April 10, 2018, to April 11, 2020. We evaluated the appropriateness of empirical therapy based on the antimicrobial susceptibility testing results. The rate of empirical use and appropriateness of fluoroquinolones was calculated, and logistic regression was used to analyze influencing factors of empirical use of fluoroquinolones.Results: The susceptibility rate of the three bacteria to levofloxacin (50.78% vs 32.06%) and ciprofloxacin (48.45% vs 21.90%) was decreased (P< 0.001), while the resistance rate to levofloxacin (45.74% vs 58.73%) and ciprofloxacin (46.90% vs 66.67%) was increased (P< 0.001) after the breakpoints revision. The empirical usage rate of fluoroquinolones in patients infected with Escherichia coli, Klebsiella pneumoniae, or Pseudomonas aeruginosa was 20.94%, which was influenced by the breakpoint revision (P=0.022), age (P=0.007), and the department (P=0.006); the appropriateness rate was 28.74%, affected by the pathogenic bacteria (P=0.001) and multidrug-resistant microorganism (P=0.001), department (P=0.024), and the length of stay before the empirical therapy (P=0.016).Conclusion: The susceptibility of bacteria to antibiotics has changed significantly after the breakpoint revision while the clinicians’ empirical therapy failure to change accordingly, which results in the decrease of the appropriateness of empirical use. It is enlightened that we should conduct more research to evaluate the rational use of antibiotics from the laboratory perspective and carry out interventions such as education and supervision to strengthen the collaboration between the microbiology laboratories and clinicians to improve the empirical antibiotic therapy and slow down the antimicrobial resistance.Keywords: empirical antibiotic therapy, appropriateness, fluoroquinolones, antimicrobial resistance, breakpoint revision, antimicrobial susceptibility testing

Highlights • We tested 12 air and 355 surface samples in a hospital for SARS-CoV-2. • Only one air sample taken during the intubation procedure tested positive. • Low level of surface contamination was found, most occurred in high-touch surfaces. • No association was found between surface contamination and patient characteristics., Background Few studies have explored the air and surface contamination by SARS-CoV-2 virus in healthcare settings. Methods We collected air and surface samples from the isolation wards and intensive care units designated for COVID-19 patients. The clinical data and tests result of nasopharyngeal specimens and serum antibodies were also collected from the sampling patients. Results A total of 367 air and surface swabbing samples were collected from the patient care areas of 15 mild and 9 severe/critical COVID-19 patients. Only one air sample taken during the intubation procedure tested positive. High-touch surfaces were slightly more likely contaminated by the RNA of the SARS-CoV-2 virus than low-touch surfaces. Contamination rates was slightly higher near severe/critical patients compared to those near mild patients, although not statistically significant (p

Highlights • A high proportion of COVID-19 patients were co-infected with influenza in Tongji Hospital (Wuhan). • Critically ill COVID-19 patients with influenza were more prone to cardiac injury than those without influenza. • Co-infection with the influenza virus may induce an earlier and more frequently occurring cytokine storm in critically ill COVID-19 patients. • Do not ignore detection of the influenza virus in patients with COVID-19., Objective To delineate the clinical characteristics of critically ill COVID-19 patients co-infected with influenza. Methods In this study, we included adult patients with laboratory-confirmed COVID-19 form Tongji Hospital (Wuhan, China), with or without influenza, and compared their clinical characteristics. Results Among 93 patients, 44 died and 49 were discharged. Forty-four (47.3%) were infected with influenza virus A and 2 (2.2%) with influenza virus B. Twenty-two (50.0%) of the non-survivors and 24 (49.0%) of the survivors were infected with the influenza virus. Critically ill COVID-19 patients with influenza were more prone to cardiac injury than those without influenza. For the laboratory indicators at admission, white blood cell counts, neutrophil counts, levels of tumor necrosis factor-α, D-dimer value, and proportion of elevated creatinine were higher in non-survivors with influenza than in those without influenza. Conclusion The results showed a high proportion of COVID-19 patients were co-infected with influenza in Tongji Hospital, with no significant difference in the proportion of co-infection between survivors and non-survivors. The critically ill COVID-19 patients with influenza exhibited more severe inflammation and organ injury, indicating that co-infection with the influenza virus may induce an earlier and more frequently occurring cytokine storm.

Background Searching the risk factors for carbapenem-resistant Enterobacteriaceae (CRE) infection is important in clinical practice. In the present study, we aim to investigate bacterial characteristics of colonizing strains and their correlation with subsequent CRE infection. Methods Between May 2018 and January 2019, patients hospitalized in the department of haematology and intensive care unit (ICU) were screened for CRE by rectal swabs and monitored for the outcome of infection. We identified the species and carbapenemase-encoding genes of colonizing strains and performed antimicrobial susceptibility tests and multilocus sequence typing (MLST). Risk factors for subsequent CRE infections were ascertained by univariate and multivariable analysis. Results We collected a total of 219 colonizing strains from 153 patients. Klebsiella pneumoniae was the most abundant species, and MLST analysis showed rich diversity. K. pneumoniae carbapenemase (KPC) was predominant in the infection group (72.4%). In the non-infection group, 35.4% of strains were non-carbapenemase-producing CRE (NCP-CRE), and New Delhi metallo-β-lactamase (NDM) was predominant (42.2%). The rate of high-level carbapenem resistance (minimum inhibitory concentration [MIC] ≥ 64 mg/L for meropenem and ertapenem, ≥ 32 mg/L for imipenem) was remarkably higher in the infection group than in the non-infection group (P K. pneumoniae, high-level carbapenem resistance, CP-CRE and KPC-CRE were infection risk factors after CRE colonization. On multivariable analysis with different carbapenemase dichotomizations, KPC-CRE (adjusted odds ratio [aOR], 4.507; 95% confidence interval [CI], 1.339–15.171; P = 0.015) or imipenem MIC ≥ 32 mg/L (aOR, 9.515; 95% CI, 1.617–55.977; P = 0.013) were respectively identified as independent risk factors for subsequent infection. Conclusions Patients colonized with KPC-CRE or strains with an imipenem MIC ≥ 32 mg/L were at particularly high risk of subsequent CRE infections during their hospital stay.

Background Infection prevention and control (IPC) measures are crucial to combat the COVID-19 pandemic. This study aimed to explore the levels and determinants of HCWs’ IPC behaviors based on the theoretical domains framework (TDF), which has been shown to be effective in guiding behavior change. Methods A cross-sectional survey was conducted in Wuhan, China in January 2020. Self-reported hand hygiene and droplet isolation behaviors (including the use of masks, gloves, goggles and gowns) were set as dependent variables. TDF domains and HCWs’ characteristics were independent variables. Negative binomial regression analyses were performed to explore their relationships. Results HCWs reported good IPC behaviors, while the compliance with goggle and gown use was relatively low (below 85%). Environmental context and resources domain was significantly related to hand hygiene (β = 0.018, p = 0.026), overall droplet isolation behaviors (β = 0.056, p = 0.001), goggle (β = 0.098, p = 0.001) and gown use (β = 0.101. p p = 0.005) and gown use (β = 0.053, p = 0.013). Emotion domain was a predictor of overall droplet isolation behaviors (β = 0.043, p = 0.016), goggle (β = 0.074, p = 0.026) and gown use (β = 0.106, p p = 0.029) and gown use (β = 0.039, p = 0.035). HCWs in high-risk departments had better behaviors of gown use (β = 0.158, p = 0.032). HCWs who had encountered confirmed or suspected patients reported worse behaviors of goggle (β = − 0.127, p = 0.050) and gown use (β = − 0.153, p = 0.003). Conclusions Adequate personal protective materials and human resources, education and training, as well as supervision and role model setting are necessary to improve IPC behaviors regarding the COVID-19 pandemic.

Highlight • Hand hygiene compliance varied based on different criteria and moments. • Duration and hand drying method of hand hygiene should be strengthened. • Area and motivation are observed factors influencing hand hygiene. • Sufficient human resources, supervision and education are important to improve hand hygiene., Background Higher requirement is put forward in the measurement of hand hygiene (HH) during a pandemic. This study aimed to describe HH compliance measurement and explore observed influencing factors with respect to coronavirus disease 2019 (COVID-19) guidelines in China. Methods Compliance was measured as the percentage of compliant opportunities based on criteria for 17 moments. The criteria for compliance included HH behavior, procedure, duration, hand drying method, and the overall that counts them all. The observed influencing factors included different departments and areas and protection motivation. Descriptive analysis and logistic regression were performed. Results The compliance of overall criteria, HH behavior, procedure, duration, and hand drying method were 79.44%, 96.71%, 95.74%, 88.93%, and 88.42%, respectively, which were significantly different from each other (P < .001). Meanwhile, the overall and hand drying method compliance in semi-contaminated areas (odds ratio [OR] = 1.829, P < .001; OR = 2.149, P = .001) and hygienic areas (OR = 1.689, P = .004; OR = 1.959, P = .015) were significantly higher than those in contaminated area. The compliance with HH behavior for the motivation of patient-protection (OR = 0.362, P < .001) was lower than that for the motivation of self-protection. Conclusions HH compliance was firstly measured using different criteria for 17 moments according to COVID-19 guidelines in China. The measurement of HH compliance needs clearer definition and comprehensive practice. Contaminated areas and motivation of patient-protection contribute to lower compliance, which may be addressed by allocating more human resources and increasing supervision and education.

OBJECTIVES: To explore the level and influencing factors of help-seeking behavior of returning to work in healthcare workers (HCWs). METHODS: A total of 861 HCWs were surveyed. A structured self-administered questionnaire was used to collect data. Multivariable logistic regression was performed to examine the influencing factors of help-seeking behavior. RESULTS: HCWs sought help with respect to COVID-19-diagnosized problem most. Help-seeking intention, problems encountered after return, test for return, work condition during COVID-19, relatives or friends diagnosed or suspected as COVID-19, and socio-demographic characteristics such as occupation, education, title, and marriage status are predictors of help-seeking behavior. CONCLUSIONS: Education and intervention should lay particular stress on HCWs featured rest at home before return, doctor, lower education and lower title to ensure the safety, accuracy, and quality of work after they return to work for a better occupational environment.

Background: Isolation is important in the prevention and control of infection with multidrug-resistant organisms(MDROs) but implementation is weak. We aim to analyze the impact of multidisciplinary collaborative intervention on isolation in multidrug-resistant organism(MDRO) infection and determine the factors affecting the implementation of isolation measures.Methods: A retrospective analysis of the issuance of isolation orders for 1338 patients with MDRO infection and colonization in 10 months before and after multidisciplinary collaborative interventions carried out on November 1, 2018 at a teaching tertiary hospital in central China. Univariate analysis and multivariate logistic regression analysis were used to analyze factors affecting isolation implementation. Results: The overall issuance rate of isolation orders was 66.12%, which increased from 33.12% before the intervention to 75.88% after the intervention (P 15d (OR = 0.459) and department (P Conclusions: Multidisciplinary collaborative interventions related to isolation can promote doctors to issue isolation orders in accordance with regulations.

Background Healthcare workers suffered mental burden, especially in the period of COVID-19. Professional quality of life quality is suitable to measure how healthcare workers feel in medical aid team. Current evidence of impact of professional quality of life on hand hygiene behavior or even IPC measures was limited, especially in emerging infectious disease period. This study aimed to assess the prevalence of burnout, secondary traumatic stress and compassion satisfaction and explore their impact on self-reported hand hygiene behavior among medical aid team in Wuhan, China, where strict management was conducted to prevent COVID-19 spread and guarantee healthcare workers’ health. Results A cross-sectional study was conducted using online questionnaire covering professional quality of life and self-reported hand hygiene behavior based on COVID-19 guideline. A total of 1,734 healthcare workers were surveyed. The prevalence of burnout, secondary trauma and compassion satisfaction were low and average levels (69.61 and 30.39%), low and average levels (33.33 and 66.21%), average and high levels (49.65 and 49.71%), respectively. Burnout was negatively associated with overall hand hygiene (Coef. =-0.088, p

The epidemic of the Coronavirus Disease 2019 (COVID-19) has presented as a grim and complex situation recently. More than 77,000 cases of COVID-19 has been confirmed in China until February 25th, 2020, which are causing great impact on economy and society, as well as seriously interfering with ordinary medical practice in the department of otorhinolaryngology head and neck surgery. This article discussed medical precautions required in the clinic, inpatient ward and operation room of otorhinolaryngology head and neck department, which aims to protect health care workers from COVID-19.

Introduction: The outbreak of COVID-19 has spread worldwide. The evidence about risk factors of healthcare workers who infected COVID-19 is limited. This study aims to describe characteristics and influencing factors of the COVID-19 infection in healthcare workers. Methodology: The study was performed among COVID-19 infected and uninfected healthcare workers in three hospitals in Wuhan. A total of 325 healthcare workers participated; among them 151 COVID-19-infected healthcare workers were included. Characteristics of infected healthcare workers, and influencing factors including exposure histories, the use of protective equipment in different risk conditions and areas, perceptions, emotions, satisfactions and educations were described and analyzed. Results: Healthcare workers got infected clustered mostly in the physical examination center. When performing general operations on confirmed or suspected patients, the use of protective equipment including the effectiveness of masks (p < 0.001), gloves (p < 0.001); and the use of gloves (p < 0.001), suits (p < 0.001), gowns (p < 0.001), shoe covers (p < 0.001), and hats (p < 0.001) were protective factors. The use of protective equipment was a protective factor in most cases. Negative emotions and dissatisfaction to the hospital response were associated with the increased risk of infection. Conclusions: The use of protective equipment, emotions and satisfactions to hospital responses are key COVID-19-infected factors. The awareness, the supply and the use of protective equipment, the layout of departments and other environmental and management factors should be strictly equipped. In addition, hospitals should also pay attention to emotions and satisfaction of healthcare workers.

Background COVID-19 arise global attention since their first public reporting. Infection prevention and control (IPC) is critical to combat COVID-19, especially at the early stage of pandemic outbreak. This study aimed to measure level of healthcare workers’ (HCW’) self-reported IPC behaviors with the risk of COVID-19 emerges and increases. Methods A cross-sectional study was conducted in two tertiary hospitals. A structured self-administered questionnaire was delivered to HCWs in selected hospitals. The dependent variables were self-reported IPC behavior compliance; and independent variables were outbreak risk and three intent of infection risk (risk of contact with suspected patients, high-risk department, risk of affected area). Chi-square tests and multivariable negative binomial regression models were employed. Results A total of 1386 participants were surveyed. The risk of outbreak increased self-reported IPC behavior on each item (coefficient varied from 0.029 to 0.151). Considering different extent of risk, HCWs from high-risk department had better self-reported practice in most IPC behavior (coefficient ranged from 0.027 to 0.149). HCWs in risk-affected area had higher self-reported compliance in several IPC behavior (coefficient ranged from 0.028 to 0.113). However, HCWs contacting with suspected patients had lower self-reported compliance in several IPC behavior (coefficient varied from − 0.159 to − 0.087). Conclusions With the risk of COVID-19 emerges, HCWs improve IPC behaviors comprehensively, which benefits for better combat COVID-19. With the risk (high-risk department and affected area) further increases, majority of IPC behaviors achieved improvement. Nevertheless, under the risk of contact with suspected patients, HCWs show worse IPC behaviors. Which may result from higher work load and insufficient supplies and resources among these HCWs. The preparedness system should be improved and medical assistance is urgently needed.

To compare the clinical effect of prophylactic cervical cerclage and therapeutic cervical cerclage on pregnancy outcome and operative factors in cervical insufficiency pregnant women. A retrospective study was conducted between June 2014 and September 2016 in a maternity ward, which included women who have had a single pregnancy and have been carried out a McDonald cerclage. All maternal medical records were reviewed. The efficacy of cerclage for preventing late foetal loss was assessed using multivariable logistic regression analysis. The results showed that there were significant associations between cerclage operations and pregnancy outcomes in the duration of pregnancy prolongation in terms of live births, gestation age, live birth and cesarean section rate. In prophylactic cervical cerclage, compared with therapeutic cervical cerclage, cervical length before surgery was significantly longer (32.7 ± 5.8 vs 19.9 ± 7.3 mm, p

Background The current evidence of extra length of stay (LOS) attributable to healthcare-associated infection (HCAI) scarcely takes time-dependent bias into consideration. Plus, limited evidences were from developing countries. We aim to estimate the extra LOS and risk factors of mortality attributable to HCAI for inpatients. Methods Multi-state model (MSM) was adopted to estimate the extra LOS attributable to HCAI of each type and subgroup. COX regression model was used to examine the risk of mortality. Results A total of 51,691 inpatients were included and 1709 (3.31%) among them developed HCAI. Lower respiratory tract infection and Acinetobacter baumannii were the most prevalent HCAI and causative pathogen in surveyed institute. Generally, the expected extra LOS attributable to HCAI was 2.56 days (95% confidence interval: 2.54–2.61). Patients below 65 had extra LOS attributable to HCAI longer about 2 days than those above. The extra LOS attributable to HCAI of male patients was 1.33 days longer than female. Meanwhile, age above 65 years old and HCAI were the risk factors of mortality for inpatients. Conclusions HCAI contributes to an increase in extra LOS of inpatients in China. The effect of HCAI on extra LOS is different among subgroups, with the age below 65, male and medicine department more sensitive.

Background: Public report of surgical site infections (SSI) rates has been an important component of SSI reduction strategies, and risk adjustment is needed before SSI rates are publicly reported. Improving the risk adjustment model facilitates meaningful comparison in the public reporting of SSIs. This research aimed to explore an optimal risk adjustment model for the public reporting of cesarean section (CS) SSI. Methods: Information on 2506 cases of CS performed at T hospital, a tertiary general hospital located in the W City of H Province in China, from 01 January 2013 to 31 December 2014 was collected. The data were used to construct the multivariate risk adjustment models of CS SSI through logistic and Poisson stepwise regression. The c-index was used to compare the predictive power between the new logistic regression and the National Nosocomial Infections Surveillance (NNIS) risk index model. Pearson goodness-of-fit was determined to compare the goodness-of-fit between the new Poisson regression and the NNIS risk index model. The two new regression models were also compared. Results: The logistic and Poisson regression models included two patient-related risk factors, namely, BMI (OR = 1.085, P = 0.006; RR = 1.081, P = 0.006) and ASA score (OR = 1.522, P = 0.044; RR = 1.501, P = 0.047). The c-index of the logistic regression model (0.628) was higher than that of the NNIS risk index model (0.600). The goodness-of-fit of the Poisson regression model (0.946) was better than that of the NNIS risk index model (0.851). Conclusions: The logistic and Poisson regression risk models are better than the NNIS risk index model, implying that a multifactorial risk adjustment model is needed for the public reporting of CS SSI. The advantage of logistic regression model is that the predictive power of model can be evaluated by c-index, however, Poisson regression may offer more advantages on model accuracy than logistic regression does when the infection rate decreases. Keywords: Cesarean section, Surgical site infections, Public reporting, Risk adjustment

summary Aims: To examine whether beta-carotene supplementation had a similar effect on vitamin A deficient children as retinol supplementation. Methods: The study was a randomized, double-blind, placebo-controlled, clinical trial. It was divided into two parts including surveying and intervening stages. 225 children in two villages in rural China were surveyed and 132 vitamin A deficient children included were randomly divided into retinol intervening group, beta-carotene intervening group and placebo group. Detailed dietary assessment and physical examination were evaluated. The baseline and follow-up serum vitamin A level of the children in the three intervention groups were compared. Results: The total proportion of severe and marginal vitamin A deficient children was 23.1% and 44.4%, respectively. After intervention, children with retinol and beta-carotene supplementation significantly increased serum vitamin A level (p < 0.001). The morbidity days of children with retinol and betacarotene supplementation were significantly less than of children given placebo (p < 0.05). The mean increased value of weight of vitamin A and beta-carotene intervening groups was both significantly higher than placebo group (p < 0.05). No significant difference in increased value of height was observed between the three intervening groups. Conclusions: We found that beta-carotene supplementation had a similar effect on correcting childhood vitamin A deficiency as retinol supplementation. Considering the health risk of vitamin A supplementation and the easier acquisition and antioxidant value of dietary beta-carotene, we recommended dietary beta-carotene supplementation for intervening high prevalent of children vitamin A deficiency in China rural areas. 2008 Published by Elsevier Ltd on behalf of European Society for Clinical Nutrition and Metabolism.

Background & aims Nutritional support for patients in the intensive-care unit (ICU) is a part of standard care which promotes medical quality and decreases nosocomial infection. Supplemental parenteral nutrition (SPN) approach (enteral nutrition (EN) combined with parenteral nutrition (PN) when EN alone is insufficient) has become one major concern in nutrition research field. This research aims to explore the following relationships: (i) the relationship between SPN and nosocomial infection, (ii) the relationship between early and late SPN initiation and the development of nosocomial infection. Methods A retrospective study was conducted in patients who met the inclusion criteria from February 2012 to February 2015 in Pediatric ICU (PICU). Patients were classified into two groups according to nutrition delivery approach-SPN group and EN alone group. Then SPN group were further divided into two subgroups by initiation timing, which were defined as early-initiation SPN and late-initiation SPN group respectively. Age, gender, serum albumin at admission, severity of disease, length of stay in PICU, nutrition delivery approach, amounts of delivered caloric intake and occurence of nosocomial infection were recorded. Univariate analysis and binary logistic regression analysis were performed to identify the risk factors and assess the independent effect of SPN approach on nosocomial infection in PICU of Emergency Department. Results 204 patients were included in our study. Compared with EN alone group, patients delivered by SPN approach had a higher nosocomial infection rate (34.0 vs.10.9 %, p

A hemispherical lens is often used in Visible Light Communication (VLC) systems to provide a wide field of view (FOV) and spatial multiplexing gain. Depending on the way of placing the lens, in practice there are generally two kinds of receivers, namely the flat-surface and curved-surface receivers, where the former one uses the flat surface of lens to collect light from the LED while the latter one uses the curved surface. We first derive the channel gain of the single-input single-output (SISO) VLC system with a finite receiving area, and then compare the channel gains of the two receivers in various scenarios. It is shown that the flat-surface receiver could provide a wider FOV than the curved-surface receiver. We further study the performance of two receivers in multiple-input multiple-output (MIMO) VLC systems. Through the BER performance analysis, we find that high spatial multiplexing gain could be achieved by both receivers if the receiving plane is properly located.