Special Issue "Hospital Epidemiology and Infection Control in the Era of the COVID-19 Pandemic"

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Infectious Disease".

Deadline for manuscript submissions: 28 February 2022.

Special Issue Editors

Prof. Evangelos I. Kritsotakis
E-Mail
Guest Editor
1. School of Medicine, Division of Social Medicine, University of Crete, Crete, Greece
2. School of Health and Related Research, Section of Public Health, University of Sheffield, Sheffield, UK
Interests: medical statistics; epidemiological methods; healthcare epidemiology; infection control; antimicrobial resistance; surveillance; public health
Special Issues and Collections in MDPI journals
Prof. Dr. Achilleas Gikas
E-Mail Website
Guest Editor
School of Medicine, University of Crete, Giofirakia 715 00, Greece
Interests: infectious diseases; infection control; clinical microbiology; healthcare-associated infections; antimicrobial resistance; antibiotic stewardship; surveillance; public health

Special Issue Information

Dear Colleagues,

The coronavirus disease 2019 (COVID-19) pandemic has had major operational and organizational impacts on healthcare systems globally. Traditional infection prevention resources at the hospital level (both infrastructure and personnel) have been largely diverted to help manage COVID-19 outbreaks at the health system level. Although this shift of resources has understandably taken immediate priority, it may have disrupted or even compromised conventional infection prevention duties (e.g., surveillance), especially in areas of high severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) activity and/or low resource settings. We are beginning to see reports, for example, of high and inappropriate use of broad-spectrum antibiotics, shortages of staff, shortages of personal protective equipment, and overcrowded facilities due to the rapid increase of hospital admissions of COVID-19 patients. Of concern, the pandemic is occurring in parallel with an antimicrobial resistance crisis of alarming pace worldwide. Severe COVID-19, which particularly affects multi-morbid elderly patients, may be an important factor in increasing the spread of multi-drug-resistant bacteria in the hospital setting. On the other hand, infection prevention and control are playing a crucial role in the management of COVID-19, and a unique opportunity is arising to reevaluate and strengthen areas that may have been previously overlooked, as well as implement innovative approaches necessitated by the pandemic.

This Special Issue of Medicina seeks to collate original research papers, systematic reviews, and meta-analyses investigating potential implications or impacts (either negative or positive) of the COVID-19 pandemic on healthcare epidemiology and infection control, including changes in the epidemiology of healthcare-associated infections and antimicrobial resistance in hospital settings.

Prof. Evangelos I. Kritsotakis
Prof. Achilleas Gikas
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • infection prevention
  • infection control
  • antimicrobial resistance
  • antimicrobial stewardship
  • healthcare epidemiology
  • hospital
  • covid-19
  • sars-cov-2
  • pandemic

Published Papers (6 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Review

Article
Performance of Antigen-Based Testing as Frontline Diagnosis of Symptomatic COVID-19
Medicina 2021, 57(8), 852; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57080852 - 21 Aug 2021
Viewed by 491
Abstract
Background and Objectives: To evaluate the performance of antigen-based detection tests as the frontline diagnosis of coronavirus disease 2019 (COVID-19). Materials and Methods: We conducted a nationwide retrospective cohort study in Mexico. A cross-sectional analysis of a cohort study was conducted [...] Read more.
Background and Objectives: To evaluate the performance of antigen-based detection tests as the frontline diagnosis of coronavirus disease 2019 (COVID-19). Materials and Methods: We conducted a nationwide retrospective cohort study in Mexico. A cross-sectional analysis of a cohort study was conducted in Mexico and data from 15,408 suspected (all of them symptomatic) cases of COVID-19 were analyzed. The results of antigen-based tests were compared with those obtained by molecular (polymerase chain reaction-based) assays. Results: The antigen-based tests showed sensitivity below 50% and high specificity in all the analyzed age groups. The highest Youden index (J) was observed among adults aged 25–44 years old (45.5, 95% CI 43.7–47.3). Conclusions: We documented the poor performance of serologic techniques as frontline diagnosis of symptomatic COVID-19 and inaccurate results may impact negatively on pandemic progression. Full article
Article
The Prospect of Lactoferrin Use as Adjunctive Agent in Management of SARS-CoV-2 Patients: A Randomized Pilot Study
Medicina 2021, 57(8), 842; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57080842 - 19 Aug 2021
Viewed by 656
Abstract
Background and Objectives: Preventive, adjunctive and curative properties of lactoferrin have been evaluated since the first wave of severe acute respiratory syndrome coronavirus (SARS-CoV), a viral respiratory disease, emerged 18 years ago. Despite the discovery of new vaccine candidates, there is currently [...] Read more.
Background and Objectives: Preventive, adjunctive and curative properties of lactoferrin have been evaluated since the first wave of severe acute respiratory syndrome coronavirus (SARS-CoV), a viral respiratory disease, emerged 18 years ago. Despite the discovery of new vaccine candidates, there is currently no widely approved treatment for SARS-CoV-2 (COVID-19). Strict adherence to infection prevention and control procedures, as well as vaccines, can, however, prevent the spread of SARS-CoV-2. This study aimed to evaluate the efficacy of lactoferrin treatment in improving clinical symptoms and laboratory indices among individuals with mild to moderate coronavirus disease-19 (COVID-19). Materials and Method: A randomized, prospective, interventional pilot study conducted between 8 July and 18 September 2020 used a hospital-based sample of 54 laboratory-confirmed participants with mild to moderate symptoms of COVID-19. Randomization into a control and two treatment groups ensured all groups received the approved Egyptian COVID-19 management protocol; only treatment group participants received lactoferrin at different doses for seven days. Clinical symptoms and laboratory indices were assessed on Days 0, 2 and 7 after starting treatments. Mean values with standard deviation and one-way analysis of variance with least significant difference of demographic and laboratory data between control and treatment groups were calculated. Results: Our study showed no statistically significant difference among studied groups regarding recovery of symptoms or laboratory improvement. Conclusions: Further research into therapeutic properties particularly related to dosage, duration and follow-up after treatment with lactoferrin in individuals with COVID-19 is required. Full article
Show Figures

Figure 1

Communication
Effectiveness of BNT162b2 COVID-19 Vaccine in Preventing Severe Symptomatic Infection among Healthcare Workers
Medicina 2021, 57(8), 746; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57080746 - 23 Jul 2021
Viewed by 742
Abstract
Background and Objectives: This study aims to evaluate the effectiveness of the BNT162b2 COVID-19 (coronavirus disease 2019) in preventing severe symptomatic laboratory-confirmed infection among healthcare workers in a real-world scenario. Materials and Methods: A cross-sectional analysis of a prospective cohort study was conducted. [...] Read more.
Background and Objectives: This study aims to evaluate the effectiveness of the BNT162b2 COVID-19 (coronavirus disease 2019) in preventing severe symptomatic laboratory-confirmed infection among healthcare workers in a real-world scenario. Materials and Methods: A cross-sectional analysis of a prospective cohort study was conducted. Subjects with onset illness from January to February 2021 were eligible and classified according to the number of vaccine doses received (single-shot, n = 8; two-shot, n = 12; unvaccinated, n = 290). Results: The vaccine effectiveness against severe illness was 100% in the single and two-shot group. The presented results suggest that vaccination reduces the frequency of severe symptomatic COVID-19 in working-age adults. Conclusions: Efforts focusing on maximizing the number of immunized subjects in the study population may reduce associated economic and social burdens. Full article
Show Figures

Figure 1

Article
Evaluation of Mortality and Morbidity According to Initial Symptoms in COVID-19 Patients Using Clinical Epidemiologic Data from the Korea Centers for Disease Control & Prevention
Medicina 2021, 57(7), 688; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57070688 - 06 Jul 2021
Viewed by 497
Abstract
Background and Objectives: This study aimed to investigate whether initial symptoms of COVID-19 are associated with mortality and morbidity. Materials and Methods: The data of 5628 laboratory-confirmed COVID-19 patients were collected by the Korea Centers for Disease Control and Prevention. The maximum [...] Read more.
Background and Objectives: This study aimed to investigate whether initial symptoms of COVID-19 are associated with mortality and morbidity. Materials and Methods: The data of 5628 laboratory-confirmed COVID-19 patients were collected by the Korea Centers for Disease Control and Prevention. The maximum level of morbidity during hospital admission was classified as mild or severe, and patient mortality was recorded. Clinical symptoms were categorized as respiratory, gastrointestinal, general, and neurologic symptoms. The hazard ratios (HRs) for clinical symptoms associated with mortality were analyzed using the Cox proportional hazards model. The odds ratios (ORs) for clinical symptoms associated with morbidity were analyzed using the logistic regression model. Results: Of the included COVID-19 patients, 15.4% (808/5253) were classified as having severe morbidity. Morbidity was related to the clinical symptoms of cough, sputum, shortness of breath, vomiting/nausea, diarrhea, fever, and altered mental status or confusion. According to the symptom categories, respiratory and general symptoms were related to high morbidity (OR = 1.41, 95% CI = 1.30–1.53, p < 0.001 for respiratory symptom and OR = 1.37, 95% CI = 1.18–1.59, p < 0.001 for general symptom). Mortality was associated with the clinical symptoms of shortness of breath, fever, and altered mental status or confusion. Among the symptom categories, respiratory symptoms were associated with a 1.17-fold increased HR for mortality (95% CI = 1.04–1.32, p = 0.008). Conclusions: Initial respiratory symptoms were related to high morbidity and mortality in COVID-19 patients. Full article
Show Figures

Figure 1

Article
Stroke Patients’ Characteristics and Clinical Outcomes: A Pre-Post COVID-19 Comparison Study
Medicina 2021, 57(5), 507; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57050507 - 19 May 2021
Viewed by 823
Abstract
Background and Objectives: The Coronavirus disease 2019 (COVID-19) pandemic caused significant disruption to established medical care systems globally. Thus, this study was aimed to compare the admission and outcome variables such as number of patient and its severity, acute recanalisation therapy given [...] Read more.
Background and Objectives: The Coronavirus disease 2019 (COVID-19) pandemic caused significant disruption to established medical care systems globally. Thus, this study was aimed to compare the admission and outcome variables such as number of patient and its severity, acute recanalisation therapy given pre-post COVID-19 at a primary stroke centre located in Malaysia. Methods: This cross-sectional hospital-based study included adult ischaemic stroke patients. Variables of the study included the number of ischaemic stroke patients, the proportions of recanalisation therapies, stroke severity during admission based on the National Institutes of Health Stroke Scale, functional outcome at discharge based on the modified Rankin Scale, and relevant workflow metrics. We compared the outcome between two six-month periods, namely the pre-COVID-19 period (March 2019 to September 2019) and the COVID-19 period (March 2020 to September 2020). Results: There were 131 and 156 patients, respectively, from the pre-COVID-19 period and the COVID-19 period. The median door-to-scan time and the median door-to-reperfusion time were both significantly shorter in the COVID-19 period (24.5 min versus 12.0 min, p = 0.047) and (93.5 min versus 60.0 min, p = 0.015), respectively. There were also significantly more patients who received intravenous thrombolysis (7.6% versus 17.3%, p = 0.015) and mechanical thrombectomy (0.8% versus 6.4%, p = 0.013) in the COVID-19 period, respectively. Conclusions: The COVID-19 pandemic may not have caused disruptions of acute stroke care in our primary stroke centre. Our data indicated that the number of ischaemic stroke events remained stable, with a significant increase of recanalisation therapies and better in-hospital workflow metrics during the COVID-19 pandemic period. However, we would like to highlight that the burden of COVID-19 cases in the study area was very low. Therefore, the study may not have captured the true burden (and relevant delays in stroke patient management) during the COVID-19 pandemic. The effect of the pandemic crisis is ongoing and both pre-hospital and in-hospital care systems must continue to provide optimal, highly time-dependent stroke care services. Full article
Show Figures

Figure 1

Review

Jump to: Research

Review
Skeletal Muscle Damage in COVID-19: A Call for Action
Medicina 2021, 57(4), 372; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57040372 - 12 Apr 2021
Cited by 6 | Viewed by 1711
Abstract
Both laboratory investigations and body composition quantification measures (e.g., computed tomography, CT) portray muscle loss in symptomatic Coronavirus disease 2019 (COVID-19) patients. Muscle loss is associated with a poor prognosis of the disease. The exact mechanism of muscle damage in COVID-19 patients, as [...] Read more.
Both laboratory investigations and body composition quantification measures (e.g., computed tomography, CT) portray muscle loss in symptomatic Coronavirus disease 2019 (COVID-19) patients. Muscle loss is associated with a poor prognosis of the disease. The exact mechanism of muscle damage in COVID-19 patients, as well as the long-term consequences of muscle injury in disease survivors, are unclear. The current review briefly summarizes the literature for mechanisms, assessment measures, and interventions relevant to skeletal muscle insult in COVID-19 patients. Muscle injury is likely to be attributed to the cytokine storm, disease severity, malnutrition, prolonged physical inactivity during intensive care unit (ICU) stays, mechanical ventilation, and myotoxic drugs (e.g., dexamethasone). It has been assessed by imaging and non-imaging techniques (e.g., CT and electromyography), physical performance tests (e.g., six-minute walk test), anthropometric measures (e.g., calf circumference), and biomarkers of muscle dystrophy (e.g., creatine kinase). Interventions directed toward minimizing muscle loss among COVID-19 patients are lacking. However, limited evidence shows that respiratory rehabilitation improves respiratory function, muscle strength, quality of life, and anxiety symptoms in recovering older COVID-19 patients. Neuromuscular electrical stimulation may restore muscle condition in ICU-admitted patients, albeit empirical evidence is needed. Given the contribution of malnutrition to disease severity and muscle damage, providing proper nutritional management for emaciated patients may be one of the key issues to achieve a better prognosis and prevent the after-effects of the disease. Considerable attention to longer-term consequences of muscle injury in recovering COVID-19 patients is necessary. Full article
Show Figures

Figure 1

Back to TopTop