Revisiting the personal protective equipment components of transmission-based precautions for the prevention of COVID-19 and other respiratory virus infections in healthcare

The COVID-19 pandemic highlighted some potential limitations of transmission-based precautions. The distinction between transmission through large droplets vs aerosols, which have been fundamental concepts guiding infection control measures, has been questioned, leading to considerable variation in expert recommendations on transmission-based precautions for COVID-19. Furthermore, the application of elements of contact precautions, such as the use of gloves and gowns, is based on low-quality and inconclusive evidence and may have unintended consequences, such as increased incidence of healthcare-associated infections and spread of multidrug-resistant organisms. These observations indicate a need for high-quality studies to address the knowledge gaps and a need to revisit the theoretical background regarding various modes of transmission and the definitions of terms related to transmission. Further, we should examine the implications these definitions have on the following components of transmission-based precautions: (i) respiratory protection, (ii) use of gloves and gowns for the prevention of respiratory virus infections, (iii) aerosol-generating procedures and (iv) universal masking in healthcare settings as a control measure especially during seasonal epidemics. Such a review would ensure that transmission-based precautions are consistent and rationally based on available evidence, which would facilitate decision-making, guidance development and training, as well as their application in practice.</p

Revisiting the personal protective equipment components of transmission-based precautions for the prevention of COVID-19 and other respiratory virus infections in healthcare

The COVID-19 pandemic highlighted some potential limitations of transmission-based precautions. The distinction between transmission through large droplets vs aerosols, which have been fundamental concepts guiding infection control measures, has been questioned, leading to considerable variation in expert recommendations on transmission-based precautions for COVID-19. Furthermore, the application of elements of contact precautions, such as the use of gloves and gowns, is based on low-quality and inconclusive evidence and may have unintended consequences, such as increased incidence of healthcare-associated infections and spread of multidrug-resistant organisms. These observations indicate a need for high-quality studies to address the knowledge gaps and a need to revisit the theoretical background regarding various modes of transmission and the definitions of terms related to transmission. Further, we should examine the implications these definitions have on the following components of transmission-based precautions: (i) respiratory protection, (ii) use of gloves and gowns for the prevention of respiratory virus infections, (iii) aerosol-generating procedures and (iv) universal masking in healthcare settings as a control measure especially during seasonal epidemics. Such a review would ensure that transmission-based precautions are consistent and rationally based on available evidence, which would facilitate decision-making, guidance development and training, as well as their application in practice

Increasing risk of breakthrough COVID-19 in outbreaks with high attack rates in European long-term care facilities, July to October 2021

We collected data from 10 EU/EEA countries on 240 COVID-19 outbreaks occurring from July-October 2021 in long-term care facilities with high vaccination coverage. Among 17,268 residents, 3,832 (22.2%) COVID-19 cases were reported. Median attack rate was 18.9% (country range: 2.8-52.4%), 17.4% of cases were hospitalised, 10.2% died. In fully vaccinated residents, adjusted relative risk for COVID-19 increased with outbreak attack rate. Findings highlight the importance of early outbreak detection and rapid containment through effective infection prevention and control measures.S

Nationwide, population-based observational study of the molecular epidemiology and temporal trend of carbapenemase-producing Enterobacterales in Norway, 2015 to 2021

National and regional carbapenemaseproducing Enterobacterales (CPE) surveillance is essential to understand the burden of antimicrobial resistance, elucidate outbreaks, and develop infection-control or antimicrobial-treatment recommendations. Aim: This study aimed to describe CPE and their epidemiology in Norway from 2015 to 2021. Methods: A nationwide, population-based observational study of all verified clinical and carriage CPE isolates submitted to the national reference laboratory was conducted. Isolates were characterised by antimicrobial susceptibility testing, whole genome sequencing (WGS) and basic metadata. Annual CPE incidences were also estimated. Results: A total of 389 CPE isolates were identified from 332 patients of 63years median age (range:0–98). These corresponded to 341 cases, 184 (54%) being male. Between 2015 and 2021, the annual incidence of CPE cases increased from 0.6 to 1.1per 100,000person-years. For CPEisolates with available data on colonisation/infection, 58% (226/389)were associated with colonisation and 38% (149/389) with clinical infections. WGS revealed a predominance of OXA-48-like (51%; 198/389) and NDM (34%; 134/389) carbapenemases in a diversified population of Escherichia coli and Klebsiella pneumoniae, including high-risk clones also detected globally. Most CPE isolates were travel-related (63%;245/389). Although local outbreaks and healthcare-associated transmission occurred, no interregional spread was detected. Nevertheless, 18% (70/389) of isolates not directly related to import points towards potentially unidentified transmission routes. A decline in travelassociated cases was observed during the COVID-19 pandemic. Conclusions: The close-to-doubling of CPE case incidence between 2015 and 2021 was associated with foreign travel and genomic diversity. To limit further transmission and outbreaks, continued screening and monitoring is essential

Training-Induced Plasticity of Auditory Localization in Adult Mammals

Accurate auditory localization relies on neural computations based on spatial cues present in the sound waves at each ear. The values of these cues depend on the size, shape, and separation of the two ears and can therefore vary from one individual to another. As with other perceptual skills, the neural circuits involved in spatial hearing are shaped by experience during development and retain some capacity for plasticity in later life. However, the factors that enable and promote plasticity of auditory localization in the adult brain are unknown. Here we show that mature ferrets can rapidly relearn to localize sounds after having their spatial cues altered by reversibly occluding one ear, but only if they are trained to use these cues in a behaviorally relevant task, with greater and more rapid improvement occurring with more frequent training. We also found that auditory adaptation is possible in the absence of vision or error feedback. Finally, we show that this process involves a shift in sensitivity away from the abnormal auditory spatial cues to other cues that are less affected by the earplug. The mature auditory system is therefore capable of adapting to abnormal spatial information by reweighting different localization cues. These results suggest that training should facilitate acclimatization to hearing aids in the hearing impaired

Plant ecology meets animal cognition: impacts of animal memory on seed dispersal

We propose that an understanding of animal learning and memory is critical to predicting the impacts of animals on plant populations through processes such as seed dispersal, pollination and herbivory. Focussing on endozoochory, we review the evidence that animal memory plays a role in seed dispersal, and present a model which allows us to explore the fundamental consequences of memory for this process. We demonstrate that decision-making by animals based on their previous experiences has the potential to determine which plants are visited, which fruits are selected to be eaten from the plant and where seeds are subsequently deposited, as well as being an important determinant of animal survival. Collectively, these results suggest that the impact of animal learning and memory on seed dispersal is likely to be extremely important, although to date our understanding of these processes suffers from a conspicuous lack of empirical support. This is partly because of the difficulty of conducting appropriate experiments but is also the result of limited interaction between plant ecologists and those who work on animal cognition

Countrywide outbreak of Pseudomonas aeruginosa in hospitals caused by premoistened non-sterile washcloths, Norway, 2021-2022

Source at https://www.fhi.no/I november 2021 ble Folkehelseinstituttet varslet om at tre intensivpasienter hadde dødd av blodbaneinfeksjon med bakterien Pseudomonas aeruginosa ved Universitetssykehuset Nord-Norge i Tromsø i løpet av kort tid. De hadde identiske isolater forenlig med et klonalt utbrudd. Helgenomsekvensering viste at det var en ny sekvenstype, ST3875, som ikke har vært påvist i Norge eller andre land. Nye tilfeller uten epidemiologiske sammenhenger, ble etter hvert funnet i flere andre sykehus, noe som indikerte en felles smittekilde. Den 17. januar 2022 var det påvist utbruddstilfeller i tre av fire helseregioner, og det ble 19. januar erkjent som et nasjonalt utbrudd. FHI overtok da koordinering av utbruddsarbeidet, og 20. januar ble det etablert en Sentral utbruddsgruppe med fagpersoner fra alle helseregionene. Den 21. januar var det 23 tilfeller i 9 sykehus i 3 regioner. Kasusdefinisjonen var en person med laboratoriebekreftet P. aeruginosa ST3875 fra oktober 2021 i sykehus i Norge, uavhengig av avdeling. Etter systematiske laboratorieundersøkelser av over 300 produkter påviste Oslo Universitetssykehus 18. mars 2022 utbruddsbakterien i pre-fuktede engangs vaskekluter av merket Oasis BedBath Unperfumed produsert i Lancashire, England. Sykehusene sluttet umiddelbart å bruke produktene. Vaskeklutene er definert som et kosmetisk produkt, og Mattilsynet er tilsynsmyndighet. Mattilsynet avdekket at produsenten og importøren ikke hadde full oversikt over produksjonslinjene og hvilke produkter som var forurenset. Det ble også avdekket at P. aeruginosa var blitt påvist i produkter under den interne kvalitetskontrollen i september 2021, uten at produktene var blitt stanset. Den 14. april tilbakekalte den engelske produsenten Vernacare produktene fra markedet både i Norge og internasjonalt. Per 14. juni 2022 omfattet utbruddet 388 tilfeller i 40 sykehus. Gjennomsnittsalder var 68 år og median alder 70 år (interkvartilområde 59- 79 år). Flertallet (63 %) av tilfellene var menn, og seks sykehus rapporterte Pseudomonas som sterkt medvirkende årsak til død hos totalt 8 tilfeller. Til sammen hadde 15 % av tilfellene ST3875 i blodkultur, 21 % i luftveier, 38 % i urin, 19 % i sår og 7 % i andre prøvematerialer, noe som tydet på flere mulige inngangsporter for bakterien. Antall nye tilfeller falt raskt etter at kilden var identifisert, og bruk av produktet ble stoppet i sykehus