Study notes high rate of COVID-infected healthcare workers still caring for patients

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Nurse at COVID patient's bedsideHalf of all healthcare workers (HCWs) with symptomatic COVID-19 continued to go to work, even if they were involved with direct patient care, according to the results of a study yesterday on presenteeism among HCWs in Infection Control & Hospital Epidemiology.

Working while ill contributes to nosocomial transmission of respiratory viruses. Previous studies on HCWs with symptomatic influenza showed that a significant proportion—14% to 68%—still worked while sick.

The new observational cohort study included all HCWs at the Veterans Affairs Boston Healthcare System who tested positive for SARS-CoV-2 infection from December 1, 2020, to September 30, 2021.

All HCWs were required to perform a daily self-review of COVID-19 symptoms and to stay home or leave work if symptomatic, the authors said. During the study period, 327 HCWs tested positive for COVID-19, and 127 (49.8%) of 255 HCWs who had symptomatic infections reported presenteeism at the time of diagnosis.

HCWs cited a high workload burden for coworkers and personal responsibility as the main reasons for continuing to work while sick.

"Of the 127 HCWs with presenteeism, 66 (26% of 255 symptomatic HCW) worked at least part of a day and then returned to work for second and/or additional days with COVID-19 symptoms. HCWs with presenteeism did not differ significantly from those without presenteeism with respect to age, sex, race, vaccination status, or direct patient care," the authors wrote.

HCWs cited a high workload burden for coworkers and personal responsibility as the main reasons for continuing to work while sick, compared to limits on paid leave or perceived expectations to work while sick.

Inappropriate antibiotic prescribing persists at US children's hospitals

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Sick child and IV dripAn analysis of quarterly surveys of 28 US children's hospitals found that inappropriate antibiotic prescribing remains common and varies by specialty, researchers reported today in Infection Control & Hospital Epidemiology.

The point-prevalence surveys from the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative, conducted from January 2019 to September 2020, collected data on all eligible antibiotic orders and asked antimicrobial stewardship program (ASP) physicians and pharmacists to evaluate the appropriateness of those orders. The surveys also collected additional detail on orders deemed inappropriate, the patient's clinical service, and whether the patient's chart had a consultation note from an infectious disease (ID) physician. The primary outcome of the analysis was the percentage of inappropriate antibiotics.

A total of 13,344 antibiotic orders were assessed for inappropriateness. Of these, 1,847 (13.8%) were considered inappropriate, and 17.5% of patients receiving antibiotics were prescribed one or more inappropriate antibiotic. Pediatric intensive care units (PICUs) and hospitalists contributed the most inappropriate orders (384 and 314, respectively), while surgical subspecialists had the highest percentage of inappropriate orders (22.5%).

This study specifically highlighted opportunities for improvement among surgical specialties with prolonged or unnecessary surgical prophylaxis and for the PICU and hospitalists with the use of broad-spectrum antibiotics and overtreatment of infections.

For PICUs and hospitalists, the most common reasons antibiotic orders were deemed inappropriate were that treatment for a bacterial infection was not indicated or the antibiotic spectrum was too broad. For surgical subspecialists, most inappropriate orders were tied to prolonged or unnecessary surgical prophylaxis. ID consultation in the previous 7 days was associated with fewer inappropriate orders (15% vs 10%; P < .001); this association was most pronounced for hospitalist, PICU, and surgical and medical subspecialty services.

Although inappropriate use was not defined in the 2016-2017 SHARPS survey, the study authors estimate that 15.4% to 18.3% of orders in that survey would have been considered inappropriate under the current definition.

"This study specifically highlighted opportunities for improvement among surgical specialties with prolonged or unnecessary surgical prophylaxis and for the PICU and hospitalists with the use of broad-spectrum antibiotics and overtreatment of infections," they wrote. "ASPs should consider stratifying antibiotic use data by clinical services to further refine and target ASP guidelines and interventions."

Survey reveals high antibiotic use in Nigerian poultry production

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A survey of poultry farmers in two Nigerian states found that 98% gave prophylactic (preventive) antibiotics to day-old chicks, with 47 different products used across seven drug classes. The Nigeria-based researchers reported their findings this week in Antimicrobial Resistance & Infection Control.

Using a questionnaire adapted from the United Nations Food and Agriculture Organization (FAO) office in Ghana, they collected information on attitudes and practices regarding antimicrobial resistance (AMR) and antimicrobial use (AMU). Participants were from 50 farms in Plateau and Oyo states, chosen to represent northern and southern Nigeria. Researchers held a focus group in Plateau state with farmers and veterinary officials to fine-tune the questions.

Most farmers were aware of biosecurity practices but didn't understand the rationale behind them, which the researchers said contributed to the use of antibiotic prophylaxis. All farmers reported issues with poultry diseases, with Newcastle disease reported most frequently.

Most had heard about AMR and thought it would have a great impact on them, but most didn't know about antibiotic residues. Most thought that antibiotics were no longer effective because of the companies that made them, reduced strength of the drugs, and that diseases were becoming untreatable. "This highlights the low perception of AMR among farmers and the need for awareness creation and sensitization," the researchers wrote.

This highlights the low perception of AMR among farmers.

Antibiotics were easily accessible, and 74% of farmers bought them from poultry drug stores, commonly without a prescription and not based on lab tests.

Over the 3-month study period, 351 kilograms of active ingredients from seven classes were recorded: tetracyclines, penicillins, aminoglycosides, polypeptide, fluoroquinolones, amphenicol, and macrolides. Some products included a cocktail of antibiotics, with some including as many as six antibiotic classes at high concentrations and others not on the list of registered antimicrobials reported to the World Organization for Animal Health.

The team said the survey method could be used to help flesh out antimicrobial use and surveillance data elsewhere. "There is also the need to increase awareness among poultry farmers on the importance of biosecurity, disease preventive measures such as vaccination, and promote the use of probiotics to enhance production," they wrote.

CWD detected at deer facilities in 2 more Texas counties

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Animal health officials in Texas yesterday announced that chronic wasting disease (CWD) has been detected in deer at farms in two more counties, Hamilton in the central part of the state and Frio in the south.

Both detections involved deer-breeding facilities, according to a statement from the Texas Parks and Wildlife Department and the Texas Animal Health Commission. The groups said the Hamilton County detection involved a single case from a live animal that was tested to see if it could be transferred to a registered release site. The Frio County detection came from routine postmortem surveillance sampling after the death of a deer.

The samples were sent to the Texas A&M Veterinary Medical Diagnostic Laboratory, with results confirmed by the National Veterinary Services Laboratory in Ames, Iowa. Texas officials said antemortem testing provides a baseline that can clarify where outbreaks originate and that early, proactive testing can greatly cut the risk of further spread.

CWD was first detected in Texas in 2012 and has since been found in captive and free-ranging cervids. The new detections follow a March announcement of similar detections in three separate deer-breeding facilities in Zavala, Washington, and Gonzales counties.

Highly contagious and always fatal, CWD affects cervids such as deer, elk, moose, and caribou. The disease has a long incubation period, so the first sign of infection may be through testing rather than clinical signs. CWD is a prion disease similar to bovine spongiform encephalopathy (mad cow disease). So far, CWD hasn't been detected in humans, but health officials recommend against eating meat from infected animals.

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