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For the general public, healthcare facilities are always a safe and secure place for treatment. Generally, healthcare institutions are equipped to deal with exterior interruptions, but circumstances brought on by internal risks are more serious and frequently require an emergency evacuation of the facility. An incident happened at the radiodiagnostic setup of a tertiary care institute in North India. This fire incident created panic among staff and patients. At the place of casualty, there were around 150 persons, including staff, patients, and their attendants. Immediately after the confirmation of the fire incident, the fire department and security department took action in the form of fire control and smoke evacuation. Though six fire handling staff required minor emergency services for asphyxia due to smoke inhalation and were cured by oxygen support only, none of the patients was affected due to timely smoke evacuation. Most often, smoke management techniques implemented are compartmentation, pressurization, dilution, ventilation, buoyancy, and airflow. So, we concluded that the step of timely smoke evacuation and preventing the spread of smoke by various methods help to reduce fatality due to smoke. The training programs and mock drills give stakeholders the needed knowledge, skills, and practice they need to safeguard patients and employees.

Many nations swiftly designed and executed government policies to contain the rapid rise of SARS-CoV-2 cases. The government actions can be broadly segmented as movement and mass gathering restrictions (such as travel and lockdown), public awareness (such as facial covering and hand washing), emergency healthcare investment and social welfare provisions (such as poor welfare schemes to distribute food and shelter). The Blavatnik School of Government-Oxford university tracked various policy initiatives by governments across the globe and released them as composite indices. We assessed the overall government response using Oxford Comprehensive Health Index (CHI) and Stringency Index (SI) to combat the SARS-CoV-2 pandemic.This study aims to demonstrate the utility of CHI and SI to gauge and evaluate the government responses for containing the spread of SARS-CoV-2. We expect a significant inverse relationship between policy indices (CHI and SI) and SARS-CoV-2 severity indices (morbidity and mortality).In this ecological study, we analysed data from two publicly available data sources released between March 2020, to October 2021: Oxford Covid-19 Government Response Tracker (OxCGRT) and World Health Organization (WHO). We applied Auto-Regressive Integrated Moving Average (ARIMA) and Seasonal ARIMA (SARIMA) to model the data. The performance of different models was assessed using a combination of evaluation criteria: Adj-R2, Root Mean Square of Error (RMSE) and Bayesian Information Criteria (BIC).The strict implementation of policies by the government to contain the crises of SARS-CoV-2 resulted in higher CHI and SI in the beginning. Although the value of CHI and SI gradually fell--the same was consistently higher at values of more than 80% points. During the initial investigation, we found that Cases Per Million (CPM) and Deaths Per Million (DPM) followed the same trend. However, the final CPM and DPM model were SARIMA (3,2,1)(1,0,1) and ARIMA (1,1,1), respectively. The current study does not support the hypotheses that SARS-CoV-2 severity (CPM and DPM) is associated with stringent policy measures (CHI and SI).Our study concludes that the policy measures (CHI and SI) do not explain the change in epidemiological indicators (CPM and DPM). The study reiterates our understanding that strict policies do not necessarily lead to better compliance but may overwhelm the overstretched physical health systems. The 21st-century problems, thus, demand 21st-century solutions. The digital ecosystem was instrumental in the timely collection, curation, cloud storage and data communication. Thus, digital epidemiology can--and--should be successfully integrated into existing surveillance systems for better disease monitoring, management and evaluation.

Extensive vaccination drives undertaken globally helped in the fight against the coronavirus disease 2019 (COVID-19) pandemic, but different nations adopted different vaccination policies to tackle the disease. The vaccination drive in India began with the administration of two different vaccines: Covishield and Covaxin. We assessed the effect of vaccination status on imaging severity in patients with positive COVID-19 reverse transcription-polymerase chain reaction (RT-PCR)/antigen tests.This was a single-center retrospective observation analysis carried out over three months between March 1, 2021, to May 31, 2021. Data access was provided by the District Hospital Review Board (DHRB) and the Department of Health (DOH), District Ambala, Haryana. Appropriate statistical tools were used to analyze the data. Statistical Package for Social Sciences (SPSS) 26.0 and Python 3.9 were used for statistical analysis and visualization, and a p-value of less than 0.05 was considered statistically significant.The total sample size of the study was 1,316, out of which 371 (28.2%) were vaccinated and 945 (71.8%) were not vaccinated. The mean age of the study participants was 49.6 ± 15.7 years. Seven hundred ninety-seven (60.6%) participants were male, while 519 (39.4%) participants were female. A statistically significant reduction was observed in the computed tomography severity score (CTSS) of the vaccinated population compared to the non-vaccinated group (χEmerging COVID-19 variants challenge the effect of available vaccines, with different nations adopting different vaccination strategies to deal with the ongoing health problem. CTSS was employed as an objective marker to study the disease severity and effect of vaccination. Vaccination resulted in a significant reduction in CTSS seen on high-resolution computed tomography (HRCT) chest scans. There was a significant decrease in the incidence of severe COVID-19 pneumonia among vaccinated individuals. We need more observational data to corroborate the efficacy of vaccines presented in the randomized trials. Sharing such data between different nations can help us adopt a unifying vaccination strategy and decrease the impact of COVID-19 in subsequent disease waves.

Objective: To evaluate the impact of interventional “educational module” on knowledge and attitude regarding organ donation amongst resident doctors and nurses in the Institute of National Importance. Study Design: Interventional and prospective. Methods: We devised an interactive educational module covering various aspects of organ donation through a series of audiovisual lectures and information booklets. Resident doctors and nurses posted in those areas of the 1948-bedded Postgraduate Institute of Medical Education and Research (PGIMER), where head injury patients were treated and were subject to intervention using this module. The pre and postinterventional scores of their knowledge and attitude regarding organ donation were compared to find out impact of the intervention. Results: A total of 242 nurses and 87 resident doctors participated in this research. Higher knowledge score was observed preintervention amongst doctors as compared to nurses. Significant improvement was seen in total knowledge scores of both groups postintervention. Doctors had better scores for the “concept of organ donation,” while nurses were more familiar with “procedures and protocols.” Both had low knowledge about “clinical criteria for brain death” and “legal issues” preintervention which improved significantly postintervention. The positive impact of intervention was also observed on attitude in both categories. A significant impact of intervention was observed on overall propensity of doctors and nurses to promote organ donation, for pledging their own organs and for counseling of the patient/attendants on this cause. Conclusion: Scientifically designed educational modules have a promising role in improving awareness and attitude of health care professionals regarding organ donation and their propensity to be prospective donors, effective counselors, and advocates of organ donation.

Aim: COVID-19 has emerged as a serious global health problem in the 21st century Due to its rapid spread across the nations, the World Health Organization declared it as a Public Health Emergency of International Concern (PHEIC), and efforts are being made worldwide to find a permanent solution This disease outbreak has also shown certain gender-based impacts and has shown gender differences in vulnerability and mortality toward COVID-19 Materials and methods: A 3-month cross-sectional study aimed to study the gender differentiation among COVID-19-positive patients was conducted in one of the premier tertiary-care multispecialty hospital of North India The data pertaining to all the screened, tested, and reported positive for COVID-19 patients admitted in the "COVID hospital" of the institute was taken into analysis

Environmental surfaces are potential source of SARS-CoV2 transmission. The study assessed the efficacy of hospital disinfection policy and contamination of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) RNA in COVID management Hospital. Inanimate surfaces from both patient areas (n = 70) and non-patient areas (n = 39) were sampled through surface swabbing and subjected to Reverse transcriptase PCR. Out of the 70 samples collected from the COVID hospital, SARS-CoV2 RNA positivity of 17.5% (7/40) and 6.7% (2/30) was seen in high risk and moderate risk area respectively. Samples from Non COVID related patient area such as CD ward and administrative block were assessed and the SARS CoV-2 RNA positivity was 0% and 10% respectively. Among the total 8 environmental surface samples positive for SARS-CoV2 RNA detected from the area surrounding the SARS-CoV2 infected patients, maximum positivity of 31.8% (7/22) was found among the environmental samples collected around the patients with 20 Ct value in nasopharyngeal swab samples followed by 3.3% positivity (1/30) around patients with Ct value ranging from 20 to 25 whereas no SARS-CoV2 RNA (0/5) was detected around the patient with 25 Ct value. Nearly 50% (2/4) of the surface samples came positive from the resident PPE and mobile of the treating doctors which largely elaborates the need for stringent doffing measurement and hand hygiene policy post doffing. The study emphasizes the necessity of frequent and aggressive disinfection policy to prevent nosocomial infection in such high risk areas within close vicinity of the patients.

BACKGROUND The significance of Non-pharmaceutical Interventions by governments across the globe in containing the spread of COVID-19 is well established. The Oxford tracker keeps track of various policy initiatives to mitigate SARS-CoV-2 and release them as Comprehensive Health Index (CHI) and Stringency Index (SI). OBJECTIVE This study aims to demonstrate the utility of CHI and SI–innovative measures of Oxford university to gauge and evaluate the government responses for containing the spread of SARS-CoV-2. METHODS In this ecological study, we analyzed data from two publicly available data sources: Oxford Covid-19 Government Response Tracker (OxCGRT) and World Health Organization (WHO). The current study used data from March 4, 2020 till October 24, 2021. We applied Auto-Regressive Integrated Moving Average (ARIMA) and Seasonal ARIMA (SARIMA) to model the data. The performance of different models was assessed using a combination of evaluation criteria: Adj-R2, Root Mean Square of Error (RMSE) and Bayesian Information Criteria (BIC). RESULTS The strict implementation of policies by the government to contain the crises of SARS-CoV-2 led to a very high value of CHI and SI in the beginning. Although the value of CHI and SI gradually fell over subsequent lockdowns–the same was consistently higher at values of more than 80% points. During the initial investigation, we found that both Cases Per Million (CPM) and Deaths Per Million (DPM) were following the same trend. However, the final CPM and DPM model were SARIMA (3,2,1)(1,0,1) and ARIMA (1,1,1), respectively. CONCLUSIONS Digital epidemiology can–and–should be successfully integrated into existing surveillance systems for better disease monitoring, management, and evaluation. The wider adoption to integrate, collect and disseminate epidemiological data digitally will also facilitate individual-specific models rather than population-specific models. Therefore, the policymakers, public health experts, and programmers must come on board to design a hybrid health system that can borrow from the strengths of the existing physical surveillance system and the ever-expanding digital ecosystem.

Although hydroxychloroquine (HCQ) lacks benefit in patients with moderate-to-severe COVID-19, its role in asymptomatic and mildly symptomatic disease needs better elucidation.This multi-centre cohort study included asymptomatic and mildly symptomatic, RT-PCR confirmed COVID-19 cases between 30 March and 20 May, 2020. Patients were categorized into two groups (HCQ-treated and untreated) based on exposure to HCQ. Dose of HCQ used was 400 mg twice daily (day one) followed by once daily for seven days. HCQ-untreated patients were managed supportively without any active antiviral or immunomodulatory therapy. Nasopharyngeal SARS-CoV-2 clearance by RT-PCR (primary outcome) was compared between HCQ-treated and untreated patients using Kaplan-Meier analysis and Cox proportional-hazards regression. Clinical efficacy and safety profile of HCQ were assessed (secondary outcomes).162 patients [84 (51·9%) males; mean age 38·2 (15·2) years] were included. Forty-four (27·2%) patients had mild disease, rest 118 (72·8%) were asymptomatic. Seventy-five (46·3%) patients received HCQ. Median time to virological negativity was lesser in HCQ-treated (13 days) versus untreated patients (15 days) (logranklt;0·001) in both asymptomatic and mildly symptomatic patients. Treatment with HCQ was the only independent predictor of virological negativity (hazardratio=2·24; adjusted p-valuelt;0·001). Two (5·4%) mildly symptomatic patients progressed to severe disease within 24 hours (two doses) of HCQ initiation, compared to none in the HCQ-untreated group. Five HCQ-treated patients developed minor gastrointestinal side effects, not requiring drug discontinuation.HCQ reduced the time to virologic negativity (by 2 days) in asymptomatic and mildly symptomatic COVID-19, without any serious adverse events. However, no obvious clinical benefit was noted.

Introduction: An operating theatre (OT) is a very complex setup, which presents numerous challenges for both patients and health care providers. A safe OT environment decreases the susceptibility of patients to postoperative infections. Therefore, a study was conducted to determine microbiological air quality for establishing baseline values and to assess concurrently the effect of environment and behavioural factors in 46 OTs of a tertiary care hospital. Materials & Methods: The OTs were divided into two groups based on the type of air flow: laminar diffuser (Group I) or conventional diffuser (Group II). Two hundred and thirty-eight samples were collected with an active technique using a sieve impactor, sampling at 100 L/minute. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) Version 20 (IBM Corp., Armonk, NY). Results: In Group I OTs with the laminar diffuser, bacterial and fungal values during the lean period for environmental and behavioural factors were 47.78 colony forming units (CFM)/m3 and 0.24 CFU/m3, respectively. The bacterial and fungal values during the surgical period were 98.01 CFU/m3 and 0.40 CFU/m3, respectively. The same values for Group II OTs with the conventional diffuser were 52.83 CFU/m3 and 0.39 CFU/m3 during the lean period, and 80.06 CFU/m3 and 0.40 CFU/m3 during the surgical period. Discussion: Both environmental and behavioural factors – temperature, humidity, percentage of fresh air in circulation, door type, controlled entry, minimal door opening and proper OT attire – were seen to contribute concurrently to maintaining air quality in operating units.

Objective: Bacterial co-pathogens are common in various viral respiratory tract infections, leading to increased disease severity and mortality. Still, they are understudied during large outbreaks and pandemics. This study was conducted to highlight the overall burden of these infections in COVID-19 patients admitted to our tertiary care hospital, along with their antibiotic susceptibility patterns. Material and methods: During the six-month study period, clinical samples (blood samples, respiratory samples, and sterile body fluids, including cerebrospinal fluid [CSF]) of COVID-19 patients with suspected bacterial coinfections (at presentation) or secondary infections (after 48 hours of hospitalization) were received and processed for the same. Results: Clinical samples of 814 COVID-19 patients were received for bacterial culture and susceptibility. Out of the total patient sample, 75% had already received empirical antibiotics before the samples were sent for analysis. Overall, 17.9% of cultures were positive for bacterial infections. Out of the total patients with bacterial infection, 74% (108/146) of patients had secondary bacterial infections (after 48 hours of hospitalization) and 26% (38/146) had bacterial coinfections (at the time of admission). Out of the 143 total isolates obtained, the majority (86%) were gram-negative organisms, of which Acinetobacter species was the commonest organism (35.6%), followed by Klebsiella pneumoniae (18.1%). The majority (50.7%) of the pathogenic organisms reported were multidrug resistant. Conclusion: The overall rate of secondary bacterial infections (SBIs) in our study was lower (7.9%) than reported by other studies. A rational approach would be to adhere to the practice of initiating culture-based guidance for antibiotics and to restrict unnecessary empirical antimicrobial therapy.

Data collection and statistical analysis are integral components of research. The beauty of statistics lies in its ability to evaluate evidence in the face of uncertainty. However, lack of dedicated biostatistical consultation units, rote academic teaching and training lead to poor statistical analysis. Thus, we aim to explore and understand the challenges of establishing a Biostatistics Clinic (BC) in a tertiary care research institute. A secondary aim is to identify the stage of research at which participants approach biostatisticians.The data for the current study came from a consultancy unit named as "Biostatistics Clinic" in the department of biostatistics from Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. The residents and students who approached the department of biostatistics for consultancy regarding study design, sample size, statistical analysis and other analytical work were the sampling units.A total of 208 residents and students made 404 visits to biostatistics clinic. The male and female visits were 118 (56.7%) and 90 (43.5%), respectively. Majority of visitors approached for data analysis (171; 75%) followed by study design and sample size calculation for protocol preparation (43; 18.9%). Leading reference to approach the biostatistics clinic was through a faculty (91; 43.8%) followed by self (54; 26%).Despite the thrust and apparent advantages of contacting statistician at the beginning of the study, majority approached only at the data analysis stage. Therefore, repeated and improved efforts are required to spread the message of approaching statistician early.

To the Editor, A recent report in this journal showed N95 masks to be more effective in preventing the dissemination of SARS-CoV-2 virus from coughs of patients with COVID-19 patients than surgical...

BACKGROUND Association between human mobility and disease transmission has been established for COVID-19, but quantifying the levels of mobility over large geographical areas is difficult. Google has released Community Mobility Reports (CMRs) containing data about the movement of people, collated from mobile devices. OBJECTIVE The aim of this study is to explore the use of CMRs to assess the role of mobility in spreading COVID-19 infection in India. METHODS In this ecological study, we analyzed CMRs to determine human mobility between March and October 2020. The data were compared for the phases before the lockdown (between March 14 and 25, 2020), during lockdown (March 25-June 7, 2020), and after the lockdown (June 8-October 15, 2020) with the reference periods (ie, January 3-February 6, 2020). Another data set depicting the burden of COVID-19 as per various disease severity indicators was derived from a crowdsourced API. The relationship between the two data sets was investigated using the Kendall tau correlation to depict the correlation between mobility and disease severity. RESULTS At the national level, mobility decreased from –38% to –77% for all areas but residential (which showed an increase of 24.6%) during the lockdown compared to the reference period. At the beginning of the unlock phase, the state of Sikkim (minimum cases: 7) with a –60% reduction in mobility depicted more mobility compared to –82% in Maharashtra (maximum cases: 1.59 million). Residential mobility was negatively correlated (–0.05 to –0.91) with all other measures of mobility. The magnitude of the correlations for intramobility indicators was comparatively low for the lockdown phase (correlation ≥0.5 for 12 indicators) compared to the other phases (correlation ≥0.5 for 45 and 18 indicators in the prelockdown and unlock phases, respectively). A high correlation coefficient between epidemiological and mobility indicators was observed for the lockdown and unlock phases compared to the prelockdown phase. CONCLUSIONS Mobile-based open-source mobility data can be used to assess the effectiveness of social distancing in mitigating disease spread. CMR data depicted an association between mobility and disease severity, and we suggest using this technique to supplement future COVID-19 surveillance.

ObjectivesHealthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty.SettingOur tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless.ParticipantsWe recruited willing low-risk HCP, aged ResultsBetween 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (ConclusionA multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.

Master schedule is a document that gives first-hand information to guide and gauge the workload at the research facility. It is developed out of a thoughtfully planned project for easy tracking of work progress in relation to time. Master schedule is the document of interest for quality assurance personnel and inspection committee as they usually rely on it for their assessments. It is a managerial tool and is an index of productivity, quality, and progress of work of individual study and also the research facility as a whole. Besides serving as a benchmark for QA and a project evaluation tool for the management, it also works as a guide for the research personnel conducting the study by providing means for efficient use of time and resources to achieve their targets.

We read with interest the article by Mcleod et al 1 describing the use of a specially designed novel acrylic box (endoscopy box; EBOX) for performing endoscopic retrograde cholangiopancreatography (ERCP) as well as endoscopic ultrasound (EUS) in the current era of COVID-19 pandemic.1 We congratulate the authors for designing this enclosure that has potential of mitigating risk of transmission of infections via air droplets during endoscopy. Endoscopy can generate aerosols because of coughing or retching and it has demonstrated that COVID-19 virus can remain viable in aerosols for hours. …

The present study assessed the motivation level of nurses working in 3 highly decorated tertiary-level government hospitals of India and also underpins the factors attributing to motivation levels. A sequential mixed-method design was used in this study wherein 400 nurses working in 5 units of nursing care in the hospitals were enrolled based upon proportionate random stratified sampling techniques. A self-administered questionnaire with Likert scale was developed based upon scale used by Mbindyo et al. The attributes of motivation were then categorized into external and internal attributes. For the qualitative component, participants with varied responses in quantitative data were selected and interviewed. Overall mean motivation score of the nursing staff was found 3.57 ± 0.93, which was higher for extrinsic motivational attributes (3.67 ± 0.88) as compared with intrinsic attributes (3.47 ± 0.98). The intrinsic motivational attribute of organizational commitment was rated highest followed by general motivation, conscientiousness, and self-efficacy. Personal issues, timeliness, and burnout were prime discouraging attributes among study participants. Sociodemographic characteristics and work profile characteristics showed significant relationship with the attributes of motivation. This study underscores the significance of different attributes of motivation which needs to be considered while framing administrative strategies and policy guidelines by authorities.

With the onset of 21st century, organ donation (OD) has taken a big stride, still waiting for organ transplants is higher than its availability. Donating a life after one's death to someone you even do not know is one of the noble humanity causes. In Indian scenario, with the inception of Transplantation of Human Organs Act, 1994, multiple active initiatives were undertaken time to time for promoting OD; similarly, green corridors have also come in a big way for transfer of organs for interinstitutional transplantation. The institute undertook its first green corridor for OD in 2015 when liver was sent to one of the hospitals, and till date, 25 green corridors have been established where 27 organs have been shared with other institutes nationwide besides intrainstitute transplantations. Although this noble cause has taken its initial steps, still, innovations, and opportunities for promoting OD should be explored in a continuum for foreseeable better future.

Health care facilities are always seen as places of haven and protection for managing external incidents, but situations become difficult and challenging when such facilities themselves are affected by internal hazards. Such incidents are arguably more disruptive than external incidents, because patients are dependent on supportive measures and are neither in position to respond to such crisis situation nor do they know how to respond. Operating room fires are rare but potentially catastrophic, involving loss of costly resources and possibly lives. This case report details a true operating room fire incident in an emergency operating room and details the real-life challenges encountered by operating room staff in preserving both life and property. As a result of this work, precautionary measures may be implemented to mitigate such incidents. Careful coordination, continuous training, and fire drill exercises can improve the overall outcomes and minimize the possibility of these potentially fatal problems, thereby making a safer health care environment for every worker and patient.

Background & objectives: The COVID-19 pandemic emerged as a major public health emergency affecting the healthcare services all over the world. It is essential to analyze the epidemiological and clinical characteristics of patients with COVID-19 in different parts of our country. This study highlights clinical experience in managing patients with COVID-19 at a tertiary care centre in northern India. Methods: Clinical characteristics and outcomes of consecutive adults patients admitted to a tertiary care hospital at Chandigarh, India, from April 1 to May 25, 2020 were studied. The diagnosis of SARS-CoV-2 infection was confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) on throat and/or nasopharyngeal swabs. All patients were managed according to the institute's consensus protocol and in accordance with Indian Council of Medical Research guidelines. Results: During the study period, 114 patients with SARS-CoV-2 infection were admitted. The history of contact with COVID-19-affected individuals was available in 75 (65.8%) patients. The median age of the patients was 33.5 yr (13-79 yr), and there were 66 (58%) males. Of the total enrolled patients, 48 (42%) were symptomatic. The common presenting complaints were fever (37, 77%), cough (26, 54%) and shortness of breath (10, 20.8%). Nineteen (17%) patients had hypoxia (SpO224). Thirty four (29.8%) patients had an accompanying comorbid illness. Age more than 60 yr and presence of diabetes and hypertension were significantly associated with severe COVID-19 disease. Admission to the intensive care unit (ICU) was needed in 18 patients (52%), with three (2.6%) patients requiring assisted ventilation. Mortality of 2.6 per cent (3 patients) was observed. Interpretation & conclusions: Majority of the patients with COVID-19 infection presenting to our hospital were young and asymptomatic. Fever was noted only in three-fourth of the patients and respiratory symptoms in half of them. Patients with comorbidities were more vulnerable to complications. Triaged classification of patients and protocol-based treatment resulted in good outcomes and low case fatality.

Background: The procurement in public sector in India was revolutionized by Government e marketplace (GeM). This study was undertaken to elaborate the implementation process, identify advantages and challenges in a tertiary care institute of North India.Methods: The process of implementation of GeM was studied by reviewing the orders, records. Data related to items procured from year 2017 to 2019 was retrieved.Results: The procurement through GeM portal has steadily increased through the year. The portal offers many advanatges like simplification of procurement, paperless, time bound, transparent system with minimal human interface. Innovative approaches like GeM helpdesk, GeMmy are used. There could be better provisions for stringent quality assurance, rate contract or extended warranty or annual and comprehensive maintenance contracts on GeM..Conclusions: GeM portal is a relatively novel dynamic concept in the country and continuously evolving with a mandate to revolutionize public procurement.

Aim: Organ transplants have developed into a successful therapy to treat end-stage organ disease. Family members play a prominent role in decisions related to organ donation of brain-dead patients. Having different imaginations about brain death among the people may be highly influenced by culture, experience, and other sociodemographic variables. Thus, the study was undertaken to analyze the sociodemographic profile of the decision makers for organ donation in case of potential deceased donors and to determine the level of awareness and its relation with the sociodemographic variables. Methods: The study was conducted at a tertiary care hospital of North India from January 2016 to August 2017. The current research is a qualitative study with exploratory approach. Data were collected through interviews with 59 family members who gave consent to organ donation of their family members. A purposive sampling method was used. Results: The results showed that most (76.3%) of the decision makers were totally unaware of the concept of organ donation before they were counseled for the same. The results showed that awareness of organ donation was dependent on gender, education, and monthly income. Most of the decision makers had only primary education. Although they were initially not aware about the concept, their decision-making was not influenced by the level of education. Majority (90%) of the females were unaware about the organ donation, but eventually consented for the cause. Conclusion: The scope of mass education and awareness can be expanded to further strengthen the program and improve the outreach.

Hospital infections are one of the important factors that adversely affect the image and economy of hospitals and ICU is a hotspot of infections. A descriptive and observational study was conducted in ICUs of a Multispecialty Hospital to analyze the knowledge, awareness and practices among staff about infection control.The study was based on checklist based on Ventilator Bundles and Central Line Bundles (IHI) and WHO. Whole staff of ICU was taken as sample size. A significant gap was noticed between actual practices followed and staff know-how. More than 80 per cent of staff was aware of hand hygiene moments and hand washing steps, but less than 25 per cent actually practised it. While 86 per cent of the staff claimed to wear fresh gloves, 57 per cent (239/418 observations) wore in practice. While 68 per cent claimed to follow oral care protocol, only 44 per cent actually did it. Contrary to 67 per cent who responded that they elevate the head of a patient who requires it, 49 per cent did it. And, 57 per cent of the staff followed catheter care practices as per protocol. Lack of accountability, discipline and focus on curative aspects accounts for poor performance towards infection control practices. So, through open communication, regular trainings and self-accountability, infection control standards and patient safety can be achieved.

Summary Objective To assess the preparedness of a multispeciality teaching hospital in India in tackling the swine flu pandemic. Study design Evaluation study. Methods This cross-sectional observational study was done among paramedical staff, MBBS students and resident doctors of Government Medical College and Hospital Chandigarh (GMCH), India. Results Of the subjects selected for the study, awareness about causal agent was 89.2%. All the participants were aware of the strain of virus and 96.3% knew about its transmission by droplet method. About 1/3rd of respondents had knowledge of its infectivity. Preparedness was good (93.3%)in all aspects except for the diagnostics. Conclusions The Institute (GMCH) was well prepared for managing the swine Flu.