A Simple Setup to Measure the EM Tracking Accuracy of a Window Field Generator

Surgical navigation relies on the accurate intra-operative tracking of surgical tools, with the majority of available systems utilizing optical or electromagnetic methods for tool localization. Electromagnetic (EM) tracking allows the tracking of instruments near the tip of the tool, however these systems are highly susceptible to environmental influences. The aim of this work was to design and evaluate a simple setup for the assessment of EM tracking accuracy that could be easily transferred and applied in a variety of clinically relevant settings to allow simple assessment of environmental effects. The setup should allow one to ensure that the specific tracking system will function as expected (i.e. as in the lab) in specific clinical set-ting under realistic conditions. The developed setup and initial baseline measurements are described within

Candida auris - recommendations on infection prevention and control measures in Switzerland.

Candida auris, a globally emerging pathogen, has been repeatedly introduced into European healthcare settings, leading to large and long-lasting nosocomial outbreaks. The pathogen has already been isolated in Switzerland, requiring clinicians and microbiologists to become alert. This is the first comprehensive guidance document on prevention and control of C. auris in Swiss acute care hospitals. It brings to light the most recent evidence from published original articles and reviews. We emphasise the importance of quickly identifying this yeast by means of screening in order to prevent an outbreak that could be difficult to contain. Key containment strategies include reinforcing early detection, hand hygiene, application of strict contact precautions for colonised and infected patients, and thorough specific environmental cleaning and disinfection

Timing of Cefuroxime Surgical Antimicrobial Prophylaxis and Its Association With Surgical Site Infections.

IMPORTANCE World Health Organization guidelines recommend administering surgical antimicrobial prophylaxis (SAP), including cefuroxime, within 120 minutes prior to incision. However, data from clinical settings supporting this long interval is limited. OBJECTIVE To assess whether earlier vs later timing of administration of cefuroxime SAP is associated with the occurrence of surgical site infections (SSI). DESIGN, SETTING, AND PARTICIPANTS This cohort study included adult patients who underwent 1 of 11 major surgical procedures with cefuroxime SAP, documented by the Swissnoso SSI surveillance system between January 2009 and December 2020 at 158 Swiss hospitals. Data were analyzed from January 2021 to April 2023. EXPOSURES Timing of cefuroxime SAP administration before incision was divided into 3 groups: 61 to 120 minutes before incision, 31 to 60 minutes before incision, and 0 to 30 minutes before incision. In addition, a subgroup analysis was performed with time windows of 30 to 55 minutes and 10 to 25 minutes as a surrogate marker for administration in the preoperating room vs in the operating room, respectively. The timing of SAP administration was defined as the start of the infusion obtained from the anesthesia protocol. MAIN OUTCOMES AND MEASURES Occurrence of SSI according to Centers for Disease Control and Prevention definitions. Mixed-effects logistic regression models adjusted for institutional, patient, and perioperative variables were applied. RESULTS Of 538 967 surveilled patients, 222 439 (104 047 men [46.8%]; median [IQR] age, 65.7 [53.9-74.2] years), fulfilled inclusion criteria. SSI was identified in 5355 patients (2.4%). Cefuroxime SAP was administered 61 to 120 minutes prior to incision in 27 207 patients (12.2%), 31 to 60 minutes prior to incision in 118 004 patients (53.1%), and 0 to 30 minutes prior to incision in 77 228 patients (34.7%). SAP administration at 0 to 30 minutes was significantly associated with a lower SSI rate (adjusted odds ratio [aOR], 0.85; 95% CI, 0.78-0.93; P < .001), as was SAP administration 31 to 60 minutes prior to incision (aOR, 0.91; 95% CI, 0.84-0.98; P = .01) compared with administration 61 to 120 minutes prior to incision. Administration 10 to 25 minutes prior to incision in 45 448 patients (20.4%) was significantly associated with a lower SSI rate (aOR, 0.89; 95% CI, 0.82-0.97; P = .009) vs administration within 30 to 55 minutes prior to incision in 117 348 patients (52.8%). CONCLUSIONS AND RELEVANCE In this cohort study, administration of cefuroxime SAP closer to the incision time was associated with significantly lower odds of SSI, suggesting that cefuroxime SAP should be administrated within 60 minutes prior to incision, and ideally within 10 to 25 minutes

Timing of Cefuroxime Surgical Antimicrobial Prophylaxis and Its Association With Surgical Site Infections

IMPORTANCE World Health Organization guidelines recommend administering surgical antimicrobial prophylaxis (SAP), including cefuroxime, within 120 minutes prior to incision. However, data from clinical settings supporting this long interval is limited. OBJECTIVE To assess whether earlier vs later timing of administration of cefuroxime SAP is associated with the occurrence of surgical site infections (SSI). DESIGN, SETTING, AND PARTICIPANTS This cohort study included adult patients who underwent 1 of 11 major surgical procedures with cefuroxime SAP, documented by the Swissnoso SSI surveillance system between January 2009 and December 2020 at 158 Swiss hospitals. Data were analyzed from January 2021 to April 2023. EXPOSURES Timing of cefuroxime SAP administration before incision was divided into 3 groups: 61 to 120 minutes before incision, 31 to 60 minutes before incision, and 0 to 30 minutes before incision. In addition, a subgroup analysis was performed with time windows of 30 to 55 minutes and 10 to 25 minutes as a surrogate marker for administration in the preoperating room vs in the operating room, respectively. The timing of SAP administration was defined as the start of the infusion obtained from the anesthesia protocol. MAIN OUTCOMES AND MEASURES Occurrence of SSI according to Centers for Disease Control and Prevention definitions. Mixed-effects logistic regression models adjusted for institutional, patient, and perioperative variables were applied. RESULTS Of 538 967 surveilled patients, 222 439 (104 047 men [46.8%]; median [IQR] age, 65.7 [53.9-74.2] years), fulfilled inclusion criteria. SSI was identified in 5355 patients (2.4%). Cefuroxime SAP was administered 61 to 120 minutes prior to incision in 27 207 patients (12.2%), 31 to 60 minutes prior to incision in 118 004 patients (53.1%), and 0 to 30 minutes prior to incision in 77 228 patients (34.7%). SAP administration at 0 to 30 minutes was significantly associated with a lower SSI rate (adjusted odds ratio [aOR], 0.85; 95% CI, 0.78-0.93; P < .001), as was SAP administration 31 to 60 minutes prior to incision (aOR, 0.91; 95% CI, 0.84-0.98; P = .01) compared with administration 61 to 120 minutes prior to incision. Administration 10 to 25 minutes prior to incision in 45 448 patients (20.4%) was significantly associated with a lower SSI rate (aOR, 0.89; 95% CI, 0.82-0.97; P = .009) vs administration within 30 to 55 minutes prior to incision in 117 348 patients (52.8%). CONCLUSIONS AND RELEVANCE In this cohort study, administration of cefuroxime SAP closer to the incision time was associated with significantly lower odds of SSI, suggesting that cefuroxime SAP should be administrated within 60 minutes prior to incision, and ideally within 10 to 25 minutes

Evaluation of the Interprofessional Education Day 2019

Interprofessional education (IPE) means that students from different professions learn with, from and about each other. In 2019, an interprofessional education day (IPE day) was held in the canton of Zurich with 68 students and eight lecturers over eight lessons with the aim of improving interprofessional competencies. Students from six health care disciplines and PhD students with different professional backgrounds had to work together in groups on two cases with standardised patients. A pre-post online survey was conducted to evaluate the IPE day. It included self-assessment using items from the Zürcher InterProfessionelle AusbildungsStation (ZIPAS ®) competency framework and the Interprofessional Collaborative Competency Attainment Survey (ICCAS) as well as open-ended questions about the IPE day. ZIPAS ® competency framework and ICCAS were evaluated quantitatively, while the open-ended questions were evaluated qualitatively. There were statistically significant improvements in most of the subscales of the ZIPAS ® competency framework but only in one third of the ICCAS subscales. In addition, the qualitative analysis of the statements showed improvements in collaboration in particular, as well as positive statements on the exchange with students from other professions, whereby many students attributed great importance to the topic of interprofessionality and have already focused their attention on the future and their everyday lives. The IPE day could be a good method to improve the collaboration and communication with students from other professions in the health sector. Keywords - Interprofessional Education DayMixed Methods Studyinterprofessional educationInterprofessional Collaboration = Interprofessionelle Ausbildung bzw. Lehre und Zusammenarbeit gewinnen im Gesundheitswesen zunehmend an Bedeutung. Bei der interprofessionellen Lehre (IPL, engl. Interprofessional Education [IPE]) handelt es sich um das «mit-, von- und übereinander» Lernen verschiedener Professionen oder Studierender dieser (Centre for the Advancement of Interprofessional Education [CAIPE], 2016, S. 1). Ziel der IPL ist, dass die Auszubildenden unter anderem Aufgaben, Kompetenzen und Verantwortung der anderen Berufsgruppen kennenlernen und weitere Kompetenzen erwerben, die für die interprofessionelle Zusammenarbeit unabdingbar sind (Barr, 1998). Bei der Planung von interprofessionellen Ausbildungsprogrammen gibt es verschiedene Aspekte zu berücksichtigen, die Oandasan und Reeves (2005) in drei Ebenen einteilen. Auf der «Mikroebene» werden der Einfluss vorgefertigter Ansichten und die Entwicklung der Teilnehmenden zu Gesundheitsfachleuten beschrieben. Die «Mesoebene» beinhaltet Organisation und Planung sowie die Unterstützung einflussreicher institutioneller Personen. Auf der «Makroebene» wird der Politik und verschiedenen Institutionen eine wichtige Rolle beigemessen. IPL kann einen positiven Effekt auf verschiedenen Ebenen bewirken und so das Gesundheitssystem beeinflussen. So zeigten sich in der Studie von Nagge et al. (2017) durch IPL Verbesserungen in der Zusammenarbeit und im Rollenverständnis. Auch kann eine Wertschätzung gegenüber anderen Professionen gefördert werden (Singer et al., 2018). In der Studie von Strasser et al. (2008) konnte durch ihre Intervention ein gewisser positiver Einfluss auf ein Patienten-Outcome gezeigt werden. Im Review von Reeves et al. (2013), welcher letztere Studie inkludiert hat, weisen die Autoren darauf hin, dass die Ergebnisse aufgrund der großen Heterogenität der eingeschlossenen Studien keine allgemeinen Aussagen erlauben. In der Schweiz gibt es Bestrebungen, die interprofessionelle Zusammenarbeit durch gemeinsame Ausbildungsangebote, darunter die Zürcher InterProfessionelle AusbildungsStation (ZIPAS®; Ulrich et al., 2019), zu verbessern. Solche Angebote sind jedoch oft singulär und (noch) nicht fest in den Curricula verankert. Zudem sind Studierende der Gesundheits- und Medizinalberufe meist institutionell und örtlich voneinander getrennt. Im Kanton Zürich beispielsweise bietet die Zürcher Hochschule für Angewandte Wissenschaften (ZHAW) die Studiengänge «Ergotherapie», «Hebamme», «Pflege» und «Physiotherapie» an. Dagegen studiert man Humanmedizin an der Universität Zürich (UZH) und Pharmazie an der Eidgenössischen Technischen Hochschule (ETH). Die ETH bietet zudem neu Humanmedizin auf Bachelor-Stufe an. Zwischen den Studiengängen der Universitäten und Fachhochschulen gibt es bisher nur wenig gemeinsame Lehrveranstaltungen, da vielfach die entsprechenden Strukturen und Prozesse (z. B. Flexibilität der einzelnen Curricula) fehlen. Die Institutionen ZHAW und UZH haben am 12. Oktober 2019 erstmalig den Interprofessionellen Ausbildungstag (IPE-Tag) durchgeführt, mit der Zielsetzung, das gegenseitige Rollenverständnis von Studierenden verschiedener Fachrichtungen im Gesundheitswesen zu verbessern und interprofessionelle Kompetenzen zu vermitteln bzw. zu vertiefen. Das Ziel dieser Untersuchung war es, den IPE-Tag inklusive der Erwartungen, positiven Aspekte und Verbesserungsvorschläge seitens der Studierenden zu evaluieren und den Kompetenzerwerb der Studierenden zu messen

SARS-CoV-2 Vaccination is Not Associated With Involuntary Childlessness in Female Healthcare Workers: A Multicenter Cohort Study.

BACKGROUND There is debate about the causes of the recent birth rate decline in high-income countries worldwide. During the pandemic, concern about the effects on reproductive health has caused vaccine hesitancy. We investigated the association of SARS-CoV-2 vaccination and infection with involuntary childlessness. METHODS Females in fertility age within a prospective multicenter cohort of healthcare workers (HCW) were followed since August 2020. Data on baseline health, SARS-CoV-2-infection, and vaccination were obtained and regularly updated, in which serum samples were collected repetitively and screened for anti-nucleocapsid and anti-spike antibodies. In October 2023, participants indicated the presence of involuntary childlessness with onset during the pandemic, whereas those indicating an onset before the pandemic were excluded. The association of involuntary childlessness and SARS-CoV-2-vaccination and infection was investigated using univariable and multivariable analysis. Sensitivity analysis was performed to compare those reporting involuntary childlessness with those birthing a child since 2020. RESULTS Of 798 participants, 26 (3.2%) reported involuntary childlessness starting since the pandemic. Of the involuntary childless women, 73.1% (19/26) were vaccinated compared to 86.0% (664/772) without involuntary childlessness (p = 0.73). SARS-CoV-2 infection was reported by 76.9% (20/26) compared to 72.4% (559/772) of controls (p = 0.64). Neither SARS-CoV-2 vaccination (aOR 0.91 per dose, 95%CI 0.67-1.26) nor infection (aOR per infection 1.05, 95%CI 0.62-1.71) was associated with involuntary childlessness. Sensitivity analysis confirmed these results. CONCLUSIONS Among female HCW of fertility age, 3.2% indicated involuntary childlessness, which is comparable to pre-pandemic data. No association between involuntary childlessness and SARS-CoV-2 vaccination or infection was found

Post-acute sequelae after SARS-CoV-2 infection by viral variant and vaccination status: a multicenter cross-sectional study.

BACKGROUND Disentangling the effects of SARS-CoV-2 variants and vaccination on the occurrence of post-acute sequelae of SARS-CoV-2 (PASC) is crucial to estimate and reduce the burden of PASC. METHODS We performed a cross-sectional analysis (May/June 2022) within a prospective multicenter healthcare worker (HCW) cohort in North-Eastern Switzerland. HCW were stratified by viral variant and vaccination status at time of their first positive SARS-CoV-2 nasopharyngeal swab. HCW without positive swab and with negative serology served as controls. The sum of eighteen self-reported PASC symptoms was modeled with univariable and multivariable negative-binomial regression to analyse the association of mean symptom number with viral variant and vaccination status. RESULTS Among 2'912 participants (median age 44 years, 81.3% female), PASC symptoms were significantly more frequent after wild-type infection (estimated mean symptom number 1.12, p<0.001; median time since infection 18.3 months), after Alpha/Delta infection (0.67 symptoms, p<0.001; 6.5 months), and after Omicron BA.1 infections (0.52 symptoms, p=0.005; 3.1 months) compared to uninfected controls (0.39 symptoms). After Omicron BA.1 infection, the estimated mean symptom number was 0.36 for unvaccinated individuals, compared to 0.71 with 1-2 vaccinations (p=0.028) and 0.49 with ≥3 prior vaccinations (p=0.30). Adjusting for confounders, only wild-type (adjusted rate ratio [aRR] 2.81, 95% confidence interval [CI] 2.08-3.83) and Alpha/Delta infection (aRR 1.93, 95% CI 1.10-3.46) were significantly associated with the outcome. CONCLUSIONS Previous infection with pre-Omicron variants was the strongest risk factor for PASC symptoms among our HCW. Vaccination prior to Omicron BA.1 infection was not associated with a clear protective effect against PASC symptoms in this population

Impact of baseline SARS-CoV-2 antibody status on syndromic surveillance and the risk of subsequent COVID-19-a prospective multicenter cohort study.

BACKGROUND In a prospective healthcare worker (HCW) cohort, we assessed the risk of SARS-CoV-2 infection according to baseline serostatus. METHODS Baseline serologies were performed among HCW from 23 Swiss healthcare institutions between June and September 2020, before the second COVID-19 wave. Participants answered weekly electronic questionnaires covering information about nasopharyngeal swabs (PCR/rapid antigen tests) and symptoms compatible with coronavirus disease 2019 (COVID-19). Screening of symptomatic staff by nasopharyngeal swabs was routinely performed in participating facilities. We compared numbers of positive nasopharyngeal tests and occurrence of COVID-19 symptoms between HCW with and without anti-nucleocapsid antibodies. RESULTS A total of 4812 HCW participated, wherein 144 (3%) were seropositive at baseline. We analyzed 107,807 questionnaires with a median follow-up of 7.9 months. Median number of answered questionnaires was similar (24 vs. 23 per person, P = 0.83) between those with and without positive baseline serology. Among 2712 HCW with ≥ 1 SARS-CoV-2 test during follow-up, 3/67 (4.5%) seropositive individuals reported a positive result (one of whom asymptomatic), compared to 547/2645 (20.7%) seronegative participants, 12 of whom asymptomatic (risk ratio [RR] 0.22; 95% confidence interval [CI] 0.07 to 0.66). Seropositive HCWs less frequently reported impaired olfaction/taste (6/144, 4.2% vs. 588/4674, 12.6%, RR 0.33, 95% CI 0.15-0.73), chills (19/144, 13.2% vs. 1040/4674, 22.3%, RR 0.59, 95% CI 0.39-0.90), and limb/muscle pain (28/144, 19.4% vs. 1335/4674, 28.6%, RR 0.68 95% CI 0.49-0.95). Impaired olfaction/taste and limb/muscle pain also discriminated best between positive and negative SARS-CoV-2 results. CONCLUSIONS Having SARS-CoV-2 anti-nucleocapsid antibodies provides almost 80% protection against SARS-CoV-2 re-infection for a period of at least 8 months

Risk and symptoms of COVID-19 in health professionals according to baseline immune status and booster vaccination during the Delta and Omicron waves in Switzerland-A multicentre cohort study.

BACKGROUND Knowledge about protection conferred by previous Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and/or vaccination against emerging viral variants allows clinicians, epidemiologists, and health authorities to predict and reduce the future Coronavirus Disease 2019 (COVID-19) burden. We investigated the risk and symptoms of SARS-CoV-2 (re)infection and vaccine breakthrough infection during the Delta and Omicron waves, depending on baseline immune status and subsequent vaccinations. METHODS AND FINDINGS In this prospective, multicentre cohort performed between August 2020 and March 2022, we recruited hospital employees from ten acute/nonacute healthcare networks in Eastern/Northern Switzerland. We determined immune status in September 2021 based on serology and previous SARS-CoV-2 infections/vaccinations: Group N (no immunity); Group V (twice vaccinated, uninfected); Group I (infected, unvaccinated); Group H (hybrid: infected and ≥1 vaccination). Date and symptoms of (re)infections and subsequent (booster) vaccinations were recorded until March 2022. We compared the time to positive SARS-CoV-2 swab and number of symptoms according to immune status, viral variant (i.e., Delta-dominant before December 27, 2021; Omicron-dominant on/after this date), and subsequent vaccinations, adjusting for exposure/behavior variables. Among 2,595 participants (median follow-up 171 days), we observed 764 (29%) (re)infections, thereof 591 during the Omicron period. Compared to group N, the hazard ratio (HR) for (re)infection was 0.33 (95% confidence interval [CI] 0.22 to 0.50, p < 0.001) for V, 0.25 (95% CI 0.11 to 0.57, p = 0.001) for I, and 0.04 (95% CI 0.02 to 0.10, p < 0.001) for H in the Delta period. HRs substantially increased during the Omicron period for all groups; in multivariable analyses, only belonging to group H was associated with protection (adjusted HR [aHR] 0.52, 95% CI 0.35 to 0.77, p = 0.001); booster vaccination was associated with reduction of breakthrough infection risk in groups V (aHR 0.68, 95% CI 0.54 to 0.85, p = 0.001) and H (aHR 0.67, 95% CI 0.45 to 1.00, p = 0.048), largely observed in the early Omicron period. Group H (versus N, risk ratio (RR) 0.80, 95% CI 0.66 to 0.97, p = 0.021) and participants with booster vaccination (versus nonboosted, RR 0.79, 95% CI 0.71 to 0.88, p < 0.001) reported less symptoms during infection. Important limitations are that SARS-CoV-2 swab results were self-reported and that results on viral variants were inferred from the predominating strain circulating in the community at that time, rather than sequencing. CONCLUSIONS Our data suggest that hybrid immunity and booster vaccination are associated with a reduced risk and reduced symptom number of SARS-CoV-2 infection during Delta- and Omicron-dominant periods. For previously noninfected individuals, booster vaccination might reduce the risk of symptomatic Omicron infection, although this benefit seems to wane over time