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Background: Nosocomial outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are frequent despite implementation of conventional infection control measures. We performed an outbreak investigation using advanced genomic and statistical techniques to reconstruct likely transmission chains and assess the role of healthcare workers (HCWs) in SARS-CoV-2 transmission. Methods: We investigated a nosocomial SARS-CoV-2 outbreak in a university-affiliated rehabilitation clinic, involving patients and HCWs, with high coverage of pathogen whole genome sequences (WGS). We estimated the time-varying reproduction number from epidemiological data (Rt) and produced a maximum likelihood phylogeny to assess genetic diversity of the pathogen. We combined genomic and epidemiological data into a Bayesian framework to model directionality of transmission. We performed a case-control study to investigate risk factors for nosocomial SARS-CoV-2 acquisition in patients. Findings: The outbreak spanned from March 14 to April 12, 2020 and involved 37 patients (31 with WGS) and 39 employees (31 with WGS) of whom 37 are HCWs. We estimated a peak Rt between 2·2 – 3·6. The phylogenetic tree showed very limited genetic diversity, with 60/62 (96·7%) isolates forming one large cluster of identical genomes. Despite the resulting uncertainty in reconstructed transmission events, our analyses suggest that HCWs (one of whom was the index case) played an essential role in cross-transmission, with a significantly larger fraction of infections (p 5: 82·3%; 95%CI 81·8% - 83·4%). Furthermore, frail patients were found to be at greater risk for nosocomial COVID-19 than other patients (adjusted OR 6·94; 95%CI 2·13 – 22·57). Interpretation: This outbreak report highlights the essential role of HCWs in SARS-CoV-2 transmission dynamics in healthcare settings. Limited genetic diversity in pathogen genomes hampered the reconstruction of individual transmission events, resulting in substantial uncertainty in who infected whom. However, our study shows that despite such uncertainty, significant transmission patterns can be observed. Funding: This work was supported by a grant from the Swiss National Science Foundation under the NRP78 Covid-19 funding scheme (Grant no. 4078P0_198363). Declaration of Interests: All authors have no conflicts of interest to declare. Ethics Approval Statement: Outbreak investigations are within the purview of the IPC programme. For additional investigations, the local Ethic Committee approved this study (no. 2020-01330).

Background We developed SmartRub® powered by iQati®, an electronic device composed of a wristband and an alcohol-based handrub pocket-sized dispenser that measures and provides feedback on the duration of hand friction and the volume poured during each hand hygiene action. We aimed to assess the accuracy of SmartRub®. Methods The specificity, sensitivity, positive and negative predictive values (PPV and NPV) of SmartRub® were assessed in a 3-phased experiment: (1) laboratory-controlled conditions with volunteers; (2) pre-planned clinical path with volunteers and (3) real clinical conditions with healthcare workers. The accuracy of SmartRub® was evaluated by quantifying its ability to correctly capture true hand hygiene actions and to not record other actions performed while wearing the device. Results In the laboratory, 7 volunteers performed 816 actions. Overall sensitivity was 94.1% (95% CI 91.4–96.2%) with a PPV of 99.0% (95% CI 97.3–99.6%) and specificity was 99.0% (95% CI 97.5–99.7%) with a NPV of 94.4% (95% CI 91.9–96.1%). During the pre-planned clinical path phase, 13 volunteers performed 98 planned paths and a total of 967 actions were performed. Overall sensitivity was 94.6% (95% CI 92.2–96.5%) with a PPV of 84.3% (95% CI 81.6–86.7%) and specificity was 82.4% (95% CI 78.7–85.7%) with a NPV of 93.9% (95% CI 91.3–95.7%). During the real clinical conditions phase, 17 healthcare workers were observed for a total of 15 h and 3 min while they performed 485 actions. Sensitivity was 96.8% (95% CI 93.8–98.6%) with a PPV of 98.3% (95% CI 95.6–99.3%) and specificity was 98.3% (95% CI 95.7–99.5%) with a NPV of 96.8% (95% CI 93.9–98.4%). Conclusions Smartrub® is a highly reliable device for capturing hand hygiene actions under a range of conditions, from the laboratory to clinical care activities.

Background: WHO core components for infection prevention and control (IPC) are important building blocks for effective IPC programmes. To our knowledge, we did the first WHO global survey to assess implementation of these programmes in health-care facilities. Methods: In this cross-sectional survey, IPC professionals were invited through global outreach and national coordinated efforts to complete the online WHO IPC assessment framework (IPCAF). The survey was created in English and was then translated into ten languages: Arabic, Chinese, English, French, German, Italian, Japanese, Russian, Spanish, and Thai. Post-stratification weighting was applied and countries with low response rates were excluded to improve representativeness. Weighted median scores and IQRs as well as weighted proportions (Nw) meeting defined IPCAF minimum requirements were reported. Indicators associated with the IPCAF score were assessed using a generalised estimating equation. Findings: From Jan 16 to Dec 31, 2019, 4440 responses were received from 81 countries. The overall weighted IPCAF median score indicated an advanced level of implementation (605, IQR 450·4–705·0), but significantly lower scores were found in low-income (385, 279·7–442·9) and lower-middle-income countries (500·4, 345·0–657·5), and public facilities (515, 385–637·8). Core component 8 (built environment; 90·0, IQR 75·0–100·0) and core component 2 (guidelines; 87·5, 70·0–97·5) scored the highest, and core component 7 (workload, staffing, and bed occupancy; 70·0, 50–90) and core component 3 (education and training; 70 ·0, 50·0–85·0) scored the lowest. Overall, only 15·2% (Nw: 588 of 3873) of facilities met all IPCAF minimum requirements, ranging from 0% (0 of 417) in low-income countries to 25·6% (278 of 1087) in primary facilities, 9% (24 of 268) in secondary facilities, and 19% (18 of 95) in tertiary facilities in high-income countries. Interpretation: Despite an overall high IPCAF score globally, important gaps in IPC facility implementation and core components across income levels hinder IPC progress. Increased support for more effective and sustainable IPC programmes is crucial to reduce risks posed by outbreaks to global health security and to ensure patient and health worker safety. Funding: WHO and the Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine. Translations: For the French and Spanish translations of the abstract see Supplementary Materials section.

IMPORTANCE: Peripheral intravenous catheters (PVCs) are the most frequently used indwelling devices in hospitals worldwide. Peripheral intravenous catheter bloodstream infections (PVC-BSIs) are rare, but severe and preventable, adverse events. OBJECTIVE: To investigate the incidence of PVC-BSIs after changing the policy of routine PVC replacement every 96 hours to clinically indicated replacement. DESIGN, SETTING, AND PARTICIPANTS: This institution-wide, observational cohort study evaluated all patients hospitalized at a large university-affiliated hospital with 10 sites in Western Switzerland with a PVC insertion between January 1, 2016, and February 29, 2020. EXPOSURES: Peripheral intravenous catheters were routinely replaced every 96 hours until March 31, 2018 (baseline period). Between April 1, 2018, and October 15, 2019, PVCs were replaced if clinically indicated (intervention period). From October 16, 2019, PVCs were again routinely replaced every 96 hours (reversion period). MAIN OUTCOMES AND MEASURES: The PVC-BSI rates and PVC-BSI incidence rate ratios (IRRs) during each period. RESULTS: A total of 412 631 PVCs with documented catheter duration were included (164 331 patients; median [interquartile range] patient age, 51 [33-72] years; 88 928 [54.1%] female): 241 432 PVCs at baseline, 130 779 at intervention, and 40 420 at reversion. Eleven PVC-BSIs were observed during the baseline period, 46 during the intervention, and 4 during the reversion period. Although the monthly number of PVC-days remained stable during all study periods, the number of monthly inserted PVCs decreased during the intervention period. The number of PVCs still in place more than 4 or more than 7 days was higher during the intervention period compared with the baseline and reversion periods. A significantly increased IRR of PVC-BSIs was observed for the intervention period (IRR, 7.20; 95% CI, 3.65-14.22; P

BackgroundUp-to-date seroprevalence estimates are critical to describe the SARS-CoV-2 immune landscape in the population and guide public health measures. We aimed to estimate the seroprevalence of anti-SARS-CoV-2 antibodies 15 months into the COVID-19 pandemic and six months into the vaccination campaign.MethodsWe conducted a population-based cross-sectional serosurvey between June 1 and July 7, 2021, recruiting participants from age- and sex-stratified random samples of the general population. We tested participants for anti-SARS-CoV-2 antibodies targeting the spike (S) or nucleocapsid (N) proteins (Roche Elecsys immunoassays). We estimated the anti-SARS-CoV-2 antibodies seroprevalence following vaccination and/or infection (anti-S antibodies), or infection only (anti-N antibodies).ResultsWe included 3355 individuals, of which 1814 (54.1%) were women, 697 (20.8%) were aged ConclusionsMost adults have developed anti-SARS-CoV-2 antibodies, while most teenagers and children remain vulnerable to infection. As the SARS-CoV-2 Delta variant spreads and vaccination rates stagnate, efforts are needed to address vaccine hesitancy, particularly among younger individuals and socioeconomically disadvantaged groups, and to minimize spread among children.

BackgroundThe COVID-19 pandemic has affected billions of people around the world both directly through the infection itself and indirectly through its economic, social and sanitary impact. Collecting data over time is essential for the understanding of the disease spread, the incidence of COVID19-like symptoms, the level and dynamics of immunity, as well as the long-term impact of the pandemic.ObjectiveThe objective of the study was to set up a longitudinal follow-up of adult participants of serosurveys carried out in the Canton of Geneva, Switzerland, during the COVID-19 pandemic.MethodsSerosurvey participants were invited to create an account on the dedicated digital platform Specchio-COVID19 (https://www.specchio-covid19.ch/). Upon registration, an initial questionnaire assessed socio-demographic and lifestyle characteristics (including housing conditions, physical activity, diet, alcohol and tobacco consumption), anthropometry, general health, and experience related to COVID-19 (symptoms, COVID-19 test results, quarantines, hospitalizations). Weekly, participants were invited to fill in a short questionnaire with updates on self-reported COVID-19-compatible symptoms, SARS-CoV-2 infection testing and vaccination. A more detailed questionnaire about mental health, well-being, risk perception, and changes in working conditions was proposed monthly. Supplementary questionnaires were proposed at regular intervals to assess more in depth the impact of the pandemic on physical and mental health, vaccination adherence, health care consumption and changes in health behaviors. At baseline, serology testing allowed to assess the spread of SARS-CoV-2 infection among the general population and subgroups of workers. Additionally, seropositive participants and a sample of randomly selected participants were invited for serologic testing at regular intervals in order to monitor both the seropersistance of anti-SARS-CoV-2 antibodies and the seroprevalence of anti-SARS-CoV-2 antibodies in the population of the Canton of Geneva.Ethics and disseminationThe study was approved by the Cantonal Research Ethics Commission of Geneva, Switzerland (CCER Project ID 2020-00881). Results will be disseminated in a variety of ways, via the Specchio-COVID19 platform, social media posts, press releases, and through regular scientific dissemination methods (open-access articles, conferences).Article summaryStrengths and limitationsThis is a large study with a diversified recruitment among the general population and mobilized workers. It will contribute to obtain a clearer picture of the impact of the COVID-19 pandemic, for both the general population and targeted subpopulations.A major strength of the study is the combined use of serological testing and questionnaires. While regular serological testing will help us to model evolution of the pandemic, self-reported data on socioeconomic characteristics, COVID-19-compatible symptoms, and general and mental health will allow us to monitor the progression of the COVID-19 pandemic as well as to thoroughly analyze its effects on several dimensions of health.The longitudinal component of the study will provide insight into the extent and duration of immunity, as well as the long-term impact of the pandemic and the sanitary, social and economic measures associated with it.The main limitation is that Specchio-COVID19 is based on self-reports with a risk of information bias. However, considering the pandemic context, participants are generally engaged to participate and to contribute to COVID-19 research. Further, at least half of the sample is based on random selection in the general population.The study is primarily being conducted online, which may limit the generalizability of the findings, especially for the elderly and vulnerable populations, although internet access is extensive in Switzerland. Nonetheless, participants can use paper questionnaires to contribute to the major assessments.

Limited data exist on SARS-CoV-2 infection rates across sectors and occupations, hindering our ability to make rational policy, including vaccination prioritization, to protect workers and limit SARS-CoV-2 spread. Here, we present results from our SEROCoV-WORK + study, a serosurvey of workers recruited after the first wave of the COVID-19 pandemic in Geneva, Switzerland. We tested workers (May 18—September 18, 2020) from 16 sectors and 32 occupations for anti-SARS-CoV-2 IgG antibodies. Of 10,513 participants, 1026 (9.8%) tested positive. The seropositivity rate ranged from 4.2% in the media sector to 14.3% in the nursing home sector. We found considerable within-sector variability: nursing home (0%–31.4%), homecare (3.9%–12.6%), healthcare (0%–23.5%), public administration (2.6%–24.6%), and public security (0%–16.7%). Seropositivity rates also varied across occupations, from 15.0% among kitchen staff and 14.4% among nurses, to 5.4% among domestic care workers and 2.8% among journalists. Our findings show that seropositivity rates varied widely across sectors, between facilities within sectors, and across occupations, reflecting a higher exposure in certain sectors and occupations., Many job sectors classified as ‘essential’ have continued operating with limited restrictions during the COVID-19 pandemic, potentially placing workers at higher risk of infection. Here, the authors show that seropositivity rates in workers vary widely across and between job sectors in Geneva, Switzerland.

The World Health Organization (WHO) has declared 2020 the “Year of the Nurse and Midwife”. On May 5th of this year, for the annual celebration of the SAVE LIVES: Clean Your Hands campaign, the WHO will focus on the critical role of nurses and midwives in promoting public health. The brain drain of healthcare workers (HCWs) leads to unequal distribution of nurses and midwives around the world, which affects the quality of care provided to patients. This phenomenon should be addressed as a global problem as it highlights staff shortages in the health system.

Most vaccines are so effective that they could lead to the control/elimination of the diseases they target and directly impact on intensive care admissions or complications. This is best illustrated by the use of vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, zoster, yellow fever, Ebola virus, influenza or measles—but also by third party strategies such as maternal, toddler and care-giver immunization. However, each of these vaccine-induced protection is threatened by insufficient vaccine uptake. Here, we briefly discuss how vaccine hesitancy has led to the resurgence of diseases that were considered as controlled and explore the effect of vaccine-hesitant healthcare workers on nosocomial infections. As intensive care physicians are in charge of polymorbid patients, we briefly summarize the current recommendations for vaccinations in high-risk patients. We finally give some perspective on ongoing research, and discuss how institutional policies and intensive care physicians could play a role in increasing the impact of vaccination, overall and in intensive care units.

A panel of experts was convened by the International Society for Infectious Diseases (ISID) to overview evidence based strategies to reduce the transmission of pathogens via the hands of healthcare workers and the subsequent incidence of hospital acquired infections with a focus on implementing these strategies in low- and middle-income countries. Existing data suggests that hospital patients in low- and middle-income countries are exposed to rates of healthcare associated infections at least 2-fold higher than in high income countries. In addition to the universal challenges to the implementation of effective hand hygiene strategies, hospitals in low- and middle-income countries face a range of unique barriers, including overcrowding and securing a reliable and sustainable supply of alcohol-based handrub. The WHO Multimodal Hand Hygiene Improvement Strategy and its associated resources represent an evidence-based framework for developing a locally-adapted implementation plan for hand hygiene promotion. Keywords: Hand hygiene, Infection prevention and control, Low- and middle-income countries

Although misinformation has always existed, the scope and speed at which fake news can reach even the most remote corners of the globe is a modern phenomenon. In the field of infection prevention and control (IPC), we like to believe that our dedication to the field and the process of conducting science protects us from the ravages of 'bad buzz' and fake news. This misconception leads medical professionals to underestimate the negative effects of misinformation on public health. This paper focuses on the nexus of what is happening between the field of IPC and the public. Its aim is to examine how information gets distorted and amplified between the medical community and the public, and outline some of the issues that deserve further attention. It looks at a number of case studies which show that even one badly conducted study can have a severe negative impact on public health, and that a well-conducted study can be distorted to make people believe something fallacious. In the current system of publishing and the proliferation of online journals that publish without peer review, 'bad buzz' and fake news can quickly do a good deal of damage.

The most striking feature of the coronavirus disease 2019 (COVID-19) pandemic and associated responses is its social and ecological complexity. Applying a complexity lens can improve our understanding of the current COVID-19 pandemic but how can this best be done? Complexity science is not a unified theory but rather a collection of concepts, theories, and methods that are increasingly influencing a range of scholarly disciplines. Complex systems can be simply defined as “co-evolving multilayer networks.”1 This definition stresses the dynamic nature of causality as well as the emergent and difficult to predict behaviour in networks that can adapt to a changing environment. Based on this definition, we describe key features of the COVID-19 pandemic, draw insights from complexity science about the nature of these features, and understand the implications for effective response and governance. This framework offers a relevant approach for shaping future research on the social ecological impact of the pandemic including comparative measures of resilience of different health systems to future events.

Health-care-associated infections are the most prevalent adverse events of hospital care, posing a substantial threat to patient safety and burden on society. Hand hygiene with alcohol-based hand rub is the most effective preventive strategy to reduce health-care-associated infections. Over the past two decades, various interventions have been introduced and studied to improve hand hygiene compliance among health-care workers. The global implementation of the WHO multimodal hand hygiene improvement strategy and constant efforts to replace the use of soap and water with alcohol-based hand rub have led to a faster and more efficient hand cleaning method. These strategies have strongly contributed to the success of behaviour change and a subsequent decrease in health-care-associated infections and cross-transmission of multidrug-resistant organisms worldwide. The WHO multimodal behaviour change strategy requires a series of elements including system change as a prerequisite for behaviour, change, education, monitoring and performance feedback, reminders in the workplace, and an institutional safety climate. Successful adoption of the promotion strategy requires adaptation to available resources and sociocultural contexts. This Review focuses on the major advances and challenges in hand hygiene research and practices in the past 20 years and sets out various ways forward for improving this lifesaving action.

Background With the current SARS-CoV-2 pandemic, many healthcare facilities are lacking a steady supply of masks worldwide. This emergency situation warrants the taking of extraordinary measures to minimize the negative health impact from an insufficient supply of masks. The decontamination, and reuse of healthcare workers’ N95/FFP2 masks is a promising solution which needs to overcome several pitfalls to become a reality. Aim The overall aim of this article is to provide the reader with a quick overview of the various methods for decontamination and the potential issues to be taken into account when deciding to reuse masks. Ultraviolet germicidal irradiation (UVGI), hydrogen peroxide, steam, ozone, ethylene oxide, dry heat and moist heat have all been methods studied in the context of the pandemic. The article first focuses on the logistical implementation of a decontamination system in its entirety, and then aims to summarize and analyze the different available methods for decontamination. Methods In order to have a clear understanding of the research that has already been done, we conducted a systematic literature review for the questions: what are the tested methods for decontaminating N95/FFP2 masks, and what impact do those methods have on the microbiological contamination and physical integrity of the masks? We used the results of a systematic review on the methods of microbiological decontamination of masks to make sure we covered all of the recommended methods for mask reuse. To this systematic review we added articles and studies relevant to the subject, but that were outside the limits of the systematic review. These include a number of studies that performed important fit and function tests on the masks but took their microbiological outcomes from the existing literature and were thus excluded from the systematic review, but useful for this paper. We also used additional unpublished studies and internal communication from the University of Geneva Hospitals and partner institutions. Results This paper analyzes the acceptable methods for respirator decontamination and reuse, and scores them according to a number of variables that we have defined as being crucial (including cost, risk, complexity, time, etc.) to help healthcare facilities decide which method of decontamination is right for them. Conclusion We provide a resource for healthcare institutions looking at making informed decisions about respirator decontamination. This informed decision making will help to improve infection prevention and control measures, and protect healthcare workers during this crucial time. The overall take home message is that institutions should not reuse respirators unless they have to. In the case of an emergency situation, there are some safe ways to decontaminate them.

Serologic studies have been critical in tracking the evolution of the COVID-19 pandemic. The reliability of serologic studies for quantifying the proportion of the population that have been infected depends on the extent of antibody decay as well as on assay performance in detecting both recent and older infections. Data on anti-SARS-CoV-2 antibodies persistence remain sparse, especially from infected individuals with few to no symptoms. In a cohort of mostly mild/asymptomatic SARS-CoV-2-infected individuals tested with three widely-used immunoassays, antibodies persisted for at least 8 months after infection, although detection depended on immunoassay choice, with one of them missing up to 40% of past infections. Simulations reveal that without appropriate adjustment for time-varying assay sensitivity, seroprevalence surveys may underestimate infection rates. As the immune landscape becomes more complex with naturally-infected and vaccinated individuals, assay choice and appropriate assay-performance-adjustment will become even more important for the interpretation of serologic studies.

Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author upon request. Supplementary information: Additional file 1 of Enhancing engagement beyond the conference walls: analysis of Twitter use at #ICPIC2019 infection prevention and control conference, includes: File 1: Supplementary tables. File 2: Definitions. File 3: Latent-dirichlet allocation. File 4: Supplementary figures. File 5: Label and validation of categories. File 6: R Code and crude data, available online at https://static-content.springer.com/esm/art%3A10.1186%2Fs13756-021-00891-1/MediaObjects/13756_2021_891_MOESM1_ESM.docx Copyright © The Author(s) 2021. Background: Social media may provide a tool, when coupled with a patient-included™ conference, to enhance the engagement among the general public. We describe authors and potential readers of Twitter content surrounding a patient-included™ scientific congress, the International Consortium for Prevention and Infection Control (ICPIC) 2019. Methods: Retrospective observational analysis of Twitter users posting with the #ICPIC2019 hashtag during the conference. Tweet authors, overall followers, and active followers were categorized according to their Twitter biographies using unsupervised learning. Diversity of professional backgrounds of Tweet authors and their followers was explored. Network analysis explored connectedness between the reach of authors. Results: In total, 1264 participants attended ICPIC 2019, of which 28 were patients. From September 7 to 16, 2019, we were able to categorize 235′620 (41%) followers linked to 474 (76%) authors. Among authors and followers, respectively 34% and 14% were healthcare workers, 11% and 15% were from industry representatives, 8% and 7% were academic researchers. On average, 23% (range 9–39%) followers belonged to the same categories as authors. Among all followers categorized, only 582/235 620 (0.25%) interacted with original messages, including healthcare workers (37%), global and public health (12%), academic research (11%) and those from industry (11%). Though the similarity between Tweet authors and followers was supported by network analysis, we also observed that non-healthcare workers (including patients) appeared to have more diverse followers. Conclusions: We observed the participation of numerous Tweet authors and followers from diverse professional backgrounds potentially supporting the benefit of including patients in conferences to reach a more general, non-specialized public. Infection Prevention and Control Programme & WHO Collaborating Centre on Patient Safety (IPC/WCC); University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.

Background Up-to-date seroprevalence estimates are critical to describe the SARS-CoV-2 immune landscape and to guide public health decisions. Aim We estimate seroprevalence of anti-SARS-CoV-2 antibodies 15 months into the COVID-19 pandemic and 6 months into the vaccination campaign. Methods We conducted a population-based cross-sectional serosurvey between 1 June and 7 July 2021, recruiting participants from age- and sex-stratified random samples of the general population. We tested participants for anti-SARS-CoV-2 antibodies targeting the spike (S) or nucleocapsid (N) proteins using the Roche Elecsys immunoassays. We estimated the anti-SARS-CoV-2 antibodies seroprevalence following vaccination and/or infection (anti-S antibodies), or infection only (anti-N antibodies). Results Among 3,355 individuals (54.1% women; 20.8% aged Conclusion Most of the population has developed anti-SARS-CoV-2 antibodies, despite most teenagers and children remaining vulnerable to infection. As the SARS-CoV-2 Delta variant spreads and vaccination rates stagnate, efforts are needed to address vaccine hesitancy, particularly among younger individuals and to minimise spread among children.

The current COVID-19 pandemic has presented unprecedented challenges for health care facilities worldwide. Global production and shipping routes were disrupted, and health care institutions, even in high resource areas, found themselves lacking the basic supplies for effective infection prevention and control. One major hurdle was the global access to supplies, particularly N95/FFP2 masks and alcohol-based hand rub (ABHR) for performing hand hygiene. This chapter explores how the lack of masks and ABHR were addressed through local production and the disinfection and reuse of disposable N95 masks. Although the global situation is no longer dire, the pandemic is currently still underway, and access to sufficient and high-quality supplies still is an important challenge faced by health care institutions. Previously, local production was mainly promoted by the World Health Organization (WHO) as a social business venture for helping developing countries. Disposable mask reuse was barely studied until this pandemic, because there was never really a need to. Thus the literature in these fields are mostly quite new. This chapter reviews the introduction and state of the art of the field, the evidence for hand hygiene and masking in the literature, the global situation since the pandemic and strategies that countries have taken to adapt. It then concentrates further on the specifics of local production, both for ABHR and for masks, and on the issues surrounding mask reuse. The chapter concludes with putting these technologies in the larger context of the pandemic, and how learning how the world tried to implement solutions can teach us lessons for future emergencies.

The 2015 World Health Organization Global Action Plan and other international policy documents have stressed the need for a 'whole of United Nations approach' in addressing antimicrobial resistance (AMR). As several years have passed, the goal of this paper is to take stock of the current role, mandate, and activities of international organisations and other global stakeholders on AMR. Relevant information is identified through a web-based search and a review of policy documents from international organisations. Based on the assessment of 78 organisations, 21 have AMR-specific activities in the broader sense, although for many of these organisations, their involvement is limited in scope, and 36 have AMR-sensitive activities reflecting the wide scope of AMR. An interdisciplinary framework based on six relevant challenges of global collective actions regarding AMR as well as the main functions of international organisations in global governance is used to organise the findings into several ‘clusters’. AMR is not a priority for many international organisations, but some of them can leverage current efforts to tackle AMR while contributing to their core agenda. Overall, a ‘whole of UN approach’ to AMR within the framework of Sustainable Development Goals is critical to move the global governance of AMR forward.

BACKGROUND As many countries fear and even experience the emergence of a second wave of COVID-19, reminding health care workers (HCWs) and other hospital employees of the critical role they play in preventing SARS-CoV-2 transmission is more important than ever. Building and strengthening the intrinsic motivation of HCWs to apply infection prevention and control (IPC) guidelines to avoid contaminating their colleagues, patients, friends, and relatives is a goal that must be energetically pursued. A high rate of nosocomial infections during the first COVID-19 wave was detected by IPC specialists and further cemented their belief in the need for an engaging intervention that could improve compliance with COVID-19 safe behaviors. OBJECTIVE Our aim was to develop a serious game that would promote IPC practices with a specific focus on COVID-19 among HCWs and other hospital employees. METHODS The first 3 stages of the SERES framework were used to develop this serious game. A brainswarming session between developers and IPC specialists was used to identify the target audience and acquisition objectives. Nicholson’s RECIPE mnemonic (reflection, engagement, choice, information, play, exposition) for meaningful gamification was used to guide the general design. A common and simple terminology was used to suit the broad target audience. The game was tested on various platforms (smartphones, tablets, laptops, desktop computers) by different users during each development loop and before its final release. RESULTS The game was designed to target all hospital staff who could be in direct contact with patients within the Geneva University Hospitals. In total, 10 acquisition objectives were defined by IPC specialists and implemented into the game according to the principles of meaningful gamification. A simple storyboard was first created using Microsoft PowerPoint and was progressively refined through multiple iteration loops. Articulate Storyline was then used to create two successive versions of the actual game. In the final version, a unique graphic atmosphere was created with help from a professional graphic designer. Feedback mechanisms were used extensively throughout the game to strengthen key IPC messages. CONCLUSIONS The SERES framework was successfully used to create “Escape COVID-19,” a serious game designed to promote safe IPC practices among HCWs and other hospital employees during the COVID-19 pandemic. This game can be obtained free of charge for research and educational purposes. A SCORM (shareable content object reference model) package is available to facilitate results and completion tracking on most current learning management systems.

Summary Improving evidence for action is crucial to tackle antimicrobial resistance. The number of interventions for antimicrobial resistance is increasing but current research has major limitations in terms of efforts, methods, scope, quality, and reporting. Moving the agenda forwards requires an improved understanding of the diversity of interventions, their feasibility and cost–benefit, the implementation factors that shape and underpin their effectiveness, and the ways in which individual interventions might interact synergistically or antagonistically to influence actions against antimicrobial resistance in different contexts. Within the efforts to strengthen the global governance of antimicrobial resistance, we advocate for the creation of an international One Health platform for online learning. The platform will synthesise the evidence for actions on antimicrobial resistance into a fully accessible database; generate new scientific insights into the design, implementation, evaluation, and reporting of the broad range of interventions relevant to addressing antimicrobial resistance; and ultimately contribute to the goal of building societal resilience to this central challenge of the 21st century.

SUMMARY Background Strengthening infection prevention and control (IPC) is essential to combat healthcare-associated infections, antimicrobial resistance, and to prevent and respond to outbreaks. Aim To assess national IPC programmes worldwide according to the World Health Organization (WHO) IPC core components. Methods Between June 1st, 2017 and November 30th, 2018, a multi-country, cross-sectional study was conducted, based on semi-structured interviews with national IPC focal points of countries that pledged to the WHO ‘Clean Care is Safer Care’ challenge. Results and differences between regions and national income levels were summarized using descriptive statistics. Findings Eighty-eight of 103 (85.4%) eligible countries participated; 22.7% were low-income, 19.3% lower-middle-income, 23.9% upper-middle-income, and 34.1% high-income economies. A national IPC programme existed in 62.5%, but only 26.1% had a dedicated budget. National guidelines were available in 67.0%, but only 36.4% and 21.6% of countries had an implementation strategy and evaluated compliance with guidelines, respectively. Undergraduate IPC curriculum and in-service and postgraduate IPC training were reported by 35.2%, 54.5%, and 42% of countries, respectively. Healthcare-associated infection surveillance was reported by 46.6% of countries, with significant differences ranging from 83.3% (high-income) to zero (low-income) (P < 0.001); monitoring and feedback of IPC indicators was reported by 65.9%. Only 12.5% of countries had all core components in place. Conclusion Most countries have IPC programme and guidelines, but many less have invested adequate resources and translated them in implementation and monitoring, particularly in low-income countries. Leadership support at the national and global level is needed to achieve implementation of the core components in all countries.

The World Health Organization has declared 2020 the “Year of the Nurse and Midwife”. On May 5th of this year, for the annual celebration of the SAVE LIVES: Clean Your Hands campaign, the WHO highlighted the critical role of nurses and midwives in promoting public health. Increasing well-trained nurse staffing will enable nurses and midwives to improve quality of care and prevent infections. The implications for improved nursing and health policy are many. Investing in nurses ensures better care for patients, reduces infections and the economic burden of healthcare-associated infections on countries' economies.

Background Hand hygiene can only be efficient if the whole hand surface is treated with sufficient alcohol-based handrub (ABHR); therefore, the volume of handrub applied is a critical factor in patient safety. The proper amount of ABHR should be provided by handrub dispensers. The aim of this study was to investigate the dispensing performance of wall-mounted ABHR dispensers commonly employed in hospital settings. Method In a multicenter study, we tested 46 dispensers (22 in laboratory and 24 in clinical environments), measuring dispensed ABHR volume during continuous use and after a period of non-use. The influence of the pumping mechanism, liquid level, ABHR formats, handrub composition, temperature, and atmospheric pressure was investigated. Results A total of 7 out of the 22 investigated dispensers (32%) lost a significant amount of handrub; greater than 30% of the nominal volume after 8 h of non-use, thus frequently dispensing suboptimal volume, as measured in laboratory settings. Key influencing factors were found to be handrub format (gel or liquid), handrub level in the container and type of dispenser. When gel ABHR was used, after 4 h of non-use of the dispensers, the volume of the dispensed amount of ABHR insignificantly changed (97% of the original amount), while it technically decreased to zero in the case of liquid ABHR (1% of the original amount). The liquid level had a medium effect on the dispensed volume in each investigated case; the magnitude of this effect varied widely depending on the dispensing mechanism. When dispensers were in continuous use, they dispensed a cumulated 3 mL of ABHR from two consecutive pushes, while when they were not in use for 1 h, up to 4 consecutive pushes were necessary to provide a total of 3 mL ABHR. Design and production quality were also identified as important contributing factors with respect to the volume dispensed. Data collected in clinical settings confirmed these findings, for multiple types of dispensers. Conclusion All ABHR dispensers should be regularly audited to control the reference volume distributed, with particular attention paid to regular mechanical pump units filled with liquid handrub.

BackgroundAssessing the burden of COVID-19 based on medically-attended case counts is suboptimal given its reliance on testing strategy, changing case definitions and the wide spectrum of disease presentation. Population-based serosurveys provide one avenue for estimating infection rates and monitoring the progression of the epidemic, overcoming many of these limitations.MethodsTaking advantage of a pool of adult participants from population-representative surveys conducted in Geneva, Switzerland, we implemented a study consisting of 8 weekly serosurveys among these participants and their household members older than 5 years. We tested each participant for anti-SARS-CoV-2-IgG antibodies using a commercially available enzyme-linked immunosorbent assay (Euroimmun AG, Lübeck, Germany). We estimated seroprevalence using a Bayesian regression model taking into account test performance and adjusting for the age and sex of Geneva’s population.ResultsIn the first three weeks, we enrolled 1335 participants coming from 633 households, with 16% InterpretationAssuming that the presence of IgG antibodies is at least in the short-term associated with immunity, these results highlight that the epidemic is far from burning out simply due to herd immunity. Further, no differences in seroprevalence between children and middle age adults are observed. These results must be considered as Switzerland and the world look towards easing restrictions aimed at curbing transmission.