Publications by authors named "Didier Pittet"

343 Publications

Comparison of Routine Replacement With Clinically Indicated Replacement of Peripheral Intravenous Catheters.

JAMA Intern Med 2021 Sep 17. Epub 2021 Sep 17.

Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.

Importance: Peripheral intravenous catheters (PVCs) are the most frequently used indwelling devices in hospitals worldwide. Peripheral intravenous catheter bloodstream infections (PVC-BSIs) are rare, but severe and preventable, adverse events.

Objective: To investigate the incidence of PVC-BSIs after changing the policy of routine PVC replacement every 96 hours to clinically indicated replacement.

Design, Setting, And Participants: This institution-wide, observational cohort study evaluated all patients hospitalized at a large university-affiliated hospital with 10 sites in Western Switzerland with a PVC insertion between January 1, 2016, and February 29, 2020.

Exposures: Peripheral intravenous catheters were routinely replaced every 96 hours until March 31, 2018 (baseline period). Between April 1 and October 15, 2018, PVCs were replaced if clinically indicated (intervention period). From October 16, 2019, PVCs were again routinely replaced every 96 hours (reversion period).

Main Outcomes And Measures: The PVC-BSI rates and PVC-BSI incidence rate ratios (IRRs) during each period.

Results: A total of 412 631 PVCs with documented catheter duration were included (164 331 patients; median [interquartile range] patient age, 51 [33-72] years; 88 928 [54.1%] female): 241 432 PVCs at baseline, 130 779 at intervention, and 40 420 at reversion. Eleven PVC-BSIs were observed during the baseline period, 46 during the intervention, and 4 during the reversion period. Although the monthly number of PVC-days remained stable during all study periods, the number of monthly inserted PVCs decreased during the intervention period. The number of PVCs still in place more than 4 or more than 7 days was higher during the intervention period compared with the baseline and reversion periods. A significantly increased IRR of PVC-BSIs was observed for the intervention period (IRR, 7.20; 95% CI, 3.65-14.22; P < .001) compared with baseline, whereas during the reversion period there was no significant increase (IRR, 1.35; 95% CI, 0.30 6.17; P = .69).

Conclusions And Relevance: The results of this cohort study using a large, prospective surveillance database suggest that replacement of PVCs only when clinically indicated may be associated with an increased risk of PVC-BSI compared with routine replacement. Even if PVC-associated BSI is a rare event, the use of PVCs in most patients makes this outcome relevant.
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http://dx.doi.org/10.1001/jamainternmed.2021.5345DOI Listing
September 2021

Explosive nosocomial outbreak of SARS-CoV-2 in a rehabilitation clinic: the limits of genomics for outbreak reconstruction.

J Hosp Infect 2021 Aug 27. Epub 2021 Aug 27.

Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Background: Nosocomial outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are frequent despite implementation of conventional infection control measures. We performed an outbreak investigation using advanced genomic and statistical techniques to reconstruct likely transmission chains and assess the role of healthcare workers (HCWs) in SARS-CoV-2 transmission.

Methods: We investigated a nosocomial SARS-CoV-2 outbreak in a university-affiliated rehabilitation clinic, involving patients and HCWs, with high coverage of pathogen whole genome sequences (WGS). We estimated the time-varying reproduction number from epidemiological data (Rt) and produced a maximum likelihood phylogeny to assess genetic diversity of the pathogen. We combined genomic and epidemiological data into a Bayesian framework to model directionality of transmission. We performed a Case-control study to investigate risk factors for nosocomial SARS-CoV-2 acquisition in patients.

Findings: The outbreak spanned from March 14 to April 12, 2020 and involved 37 patients (31 with WGS) and 39 employees (31 with WGS) of whom 37 are HCWs. We estimated a peak R between 2.2 - 3.6. The phylogenetic tree showed very limited genetic diversity, with 60/62 (96.7%) isolates forming one large cluster of identical genomes. Despite the resulting uncertainty in reconstructed transmission events, our analyses suggest that HCWs (one of whom was the index Case) played an essential role in cross-transmission, with a significantly larger fraction of infections (p < 2.2e-16) attributable to HCWs (70.7%) than expected given the number of HCWs cases (46.7%). The excess of transmission from HCWs was larger when considering infection of patients (79.0%; 95%CI 78.5% - 79.5%), and especially frail patients (Clinical Frailty Scale >5: 82.3%; 95%CI 81.8% - 83.4%). Furthermore, frail patients were found to be at greater risk for nosocomial COVID-19 than other patients (adjusted OR 6.94; 95%CI 2.13 - 22.57).

Interpretation: This outbreak report highlights the essential role of HCWs in SARS-CoV-2 transmission dynamics in healthcare settings. Limited genetic diversity in pathogen genomes hampered the reconstruction of individual transmission events, resulting in substantial uncertainty in who infected whom. However, our study shows that despite such uncertainty, significant transmission patterns can be observed.
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http://dx.doi.org/10.1016/j.jhin.2021.07.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8393517PMC
August 2021

Revisiting the evidence for physical distancing, face masks, and eye protection.

Lancet 2021 08;398(10301):661-663

Infection Control Programme, Geneva University Hospitals, Geneva, CH-1211, Switzerland. Electronic address:

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http://dx.doi.org/10.1016/S0140-6736(21)01739-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8376238PMC
August 2021

Hand hygiene in health care: 20 years of ongoing advances and perspectives.

Lancet Infect Dis 2021 08;21(8):e209-e221

Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. Electronic address:

Health-care-associated infections are the most prevalent adverse events of hospital care, posing a substantial threat to patient safety and burden on society. Hand hygiene with alcohol-based hand rub is the most effective preventive strategy to reduce health-care-associated infections. Over the past two decades, various interventions have been introduced and studied to improve hand hygiene compliance among health-care workers. The global implementation of the WHO multimodal hand hygiene improvement strategy and constant efforts to replace the use of soap and water with alcohol-based hand rub have led to a faster and more efficient hand cleaning method. These strategies have strongly contributed to the success of behaviour change and a subsequent decrease in health-care-associated infections and cross-transmission of multidrug-resistant organisms worldwide. The WHO multimodal behaviour change strategy requires a series of elements including system change as a prerequisite for behaviour, change, education, monitoring and performance feedback, reminders in the workplace, and an institutional safety climate. Successful adoption of the promotion strategy requires adaptation to available resources and sociocultural contexts. This Review focuses on the major advances and challenges in hand hygiene research and practices in the past 20 years and sets out various ways forward for improving this lifesaving action.
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http://dx.doi.org/10.1016/S1473-3099(21)00383-2DOI Listing
August 2021

Building a multisystemic understanding of societal resilience to the COVID-19 pandemic.

BMJ Glob Health 2021 07;6(7)

Bren School of Environmental Science and Management, University of California Santa Barbara, Santa Barbara, California, USA.

The current global systemic crisis reveals how globalised societies are unprepared to face a pandemic. Beyond the dramatic loss of human life, the COVID-19 pandemic has triggered widespread disturbances in health, social, economic, environmental and governance systems in many countries across the world. Resilience describes the capacities of natural and human systems to prevent, react to and recover from shocks. Societal resilience to the current COVID-19 pandemic relates to the ability of societies in maintaining their core functions while minimising the impact of the pandemic and other societal effects. Drawing on the emerging evidence about resilience in health, social, economic, environmental and governance systems, this paper delineates a multisystemic understanding of societal resilience to COVID-19. Such an understanding provides the foundation for an integrated approach to build societal resilience to current and future pandemics.
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http://dx.doi.org/10.1136/bmjgh-2021-006794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8300552PMC
July 2021

Persistence of anti-SARS-CoV-2 antibodies: immunoassay heterogeneity and implications for serosurveillance.

Clin Microbiol Infect 2021 Jul 7. Epub 2021 Jul 7.

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland. Electronic address:

Objectives: Serological studies have been critical in tracking the evolution of the COVID-19 pandemic. Data on anti-SARS-CoV-2 antibodies persistence remain sparse, especially from infected individuals with few to no symptoms. The objective of the study was to quantify the sensitivity for detecting historic SARS-CoV-2 infections as a function of time since infection for three commercially available SARS-CoV-2 immunoassays and to explore the implications of decaying immunoassay sensitivity in estimating seroprevalence.

Methods: We followed a cohort of mostly mild/asymptomatic SARS-CoV-2-infected individuals (n = 354) at least 8 months after their presumed infection date and tested their serum for anti-SARS-CoV-2 antibodies with three commercially available assays: Roche-N, Roche-RBD and EuroImmun-S1. We developed a latent class statistical model to infer the specificity and time-varying sensitivity of each assay and show through simulations how inappropriately accounting for test performance can lead to biased serosurvey estimates.

Results: Antibodies were detected at follow-up in 74-100% of participants, depending on immunoassays. Both Roche assays maintain high sensitivity, with the EuroImmun assay missing 40% of infections after 9 months. Simulations reveal that without appropriate adjustment for time-varying assay sensitivity, seroprevalence surveys may underestimate infection rates.

Discussion: Antibodies persist for at least 8 months after infection in a cohort of mildly infected individuals with detection depending on assay choice. Appropriate assay performance adjustment is important for the interpretation of serological studies in the case of diminishing sensitivity after infection.
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http://dx.doi.org/10.1016/j.cmi.2021.06.040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8261139PMC
July 2021

A Complexity Lens on the COVID-19 Pandemic.

Int J Health Policy Manag 2021 May 26. Epub 2021 May 26.

Bren School of Environmental Science and Management, University of California at Santa Barbara, Santa Barbara, CA, USA.

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http://dx.doi.org/10.34172/ijhpm.2021.55DOI Listing
May 2021

Large variation in anti-SARS-CoV-2 antibody prevalence among essential workers in Geneva, Switzerland.

Nat Commun 2021 06 8;12(1):3455. Epub 2021 Jun 8.

Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Limited data exist on SARS-CoV-2 infection rates across sectors and occupations, hindering our ability to make rational policy, including vaccination prioritization, to protect workers and limit SARS-CoV-2 spread. Here, we present results from our SEROCoV-WORK + study, a serosurvey of workers recruited after the first wave of the COVID-19 pandemic in Geneva, Switzerland. We tested workers (May 18-September 18, 2020) from 16 sectors and 32 occupations for anti-SARS-CoV-2 IgG antibodies. Of 10,513 participants, 1026 (9.8%) tested positive. The seropositivity rate ranged from 4.2% in the media sector to 14.3% in the nursing home sector. We found considerable within-sector variability: nursing home (0%-31.4%), homecare (3.9%-12.6%), healthcare (0%-23.5%), public administration (2.6%-24.6%), and public security (0%-16.7%). Seropositivity rates also varied across occupations, from 15.0% among kitchen staff and 14.4% among nurses, to 5.4% among domestic care workers and 2.8% among journalists. Our findings show that seropositivity rates varied widely across sectors, between facilities within sectors, and across occupations, reflecting a higher exposure in certain sectors and occupations.
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http://dx.doi.org/10.1038/s41467-021-23796-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187639PMC
June 2021

The COVID-19 pandemic and N95 masks: reusability and decontamination methods.

Antimicrob Resist Infect Control 2021 05 29;10(1):83. Epub 2021 May 29.

Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva 14, Switzerland.

Background: With the current SARS-CoV-2 pandemic, many healthcare facilities are lacking a steady supply of masks worldwide. This emergency situation warrants the taking of extraordinary measures to minimize the negative health impact from an insufficient supply of masks. The decontamination, and reuse of healthcare workers' N95/FFP2 masks is a promising solution which needs to overcome several pitfalls to become a reality.

Aim: The overall aim of this article is to provide the reader with a quick overview of the various methods for decontamination and the potential issues to be taken into account when deciding to reuse masks. Ultraviolet germicidal irradiation (UVGI), hydrogen peroxide, steam, ozone, ethylene oxide, dry heat and moist heat have all been methods studied in the context of the pandemic. The article first focuses on the logistical implementation of a decontamination system in its entirety, and then aims to summarize and analyze the different available methods for decontamination.

Methods: In order to have a clear understanding of the research that has already been done, we conducted a systematic literature review for the questions: what are the tested methods for decontaminating N95/FFP2 masks, and what impact do those methods have on the microbiological contamination and physical integrity of the masks? We used the results of a systematic review on the methods of microbiological decontamination of masks to make sure we covered all of the recommended methods for mask reuse. To this systematic review we added articles and studies relevant to the subject, but that were outside the limits of the systematic review. These include a number of studies that performed important fit and function tests on the masks but took their microbiological outcomes from the existing literature and were thus excluded from the systematic review, but useful for this paper. We also used additional unpublished studies and internal communication from the University of Geneva Hospitals and partner institutions.

Results: This paper analyzes the acceptable methods for respirator decontamination and reuse, and scores them according to a number of variables that we have defined as being crucial (including cost, risk, complexity, time, etc.) to help healthcare facilities decide which method of decontamination is right for them.

Conclusion: We provide a resource for healthcare institutions looking at making informed decisions about respirator decontamination. This informed decision making will help to improve infection prevention and control measures, and protect healthcare workers during this crucial time. The overall take home message is that institutions should not reuse respirators unless they have to. In the case of an emergency situation, there are some safe ways to decontaminate them.
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http://dx.doi.org/10.1186/s13756-021-00921-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164050PMC
May 2021

An Important Announcement from the World Health Organization: "Seconds Save Lives-Clean your Hands": The May 5, 2021, World Health Organization campaign.

Infect Control Hosp Epidemiol 2021 05;42(5):649-651

Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.

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http://dx.doi.org/10.1017/ice.2021.93DOI Listing
May 2021

"Seconds save lives - clean your hands": the 5 May 2021 World Health Organization SAVE LIVES: Clean Your Hands campaign.

Am J Infect Control 2021 05;49(5):533-535

Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.

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http://dx.doi.org/10.1016/j.ajic.2021.02.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062154PMC
May 2021

Nouveau-nés, sepsis et résistance antimicrobienne - Mesures pour s'attaquer aux problèmes difficiles dans notre population la plus vulnérable.

J Obstet Gynaecol Can 2021 04;43(4):427-428

Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.

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http://dx.doi.org/10.1016/j.jogc.2020.12.003DOI Listing
April 2021

Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) seroconversion and occupational exposure of employees at a Swiss university hospital: A large longitudinal cohort study.

Infect Control Hosp Epidemiol 2021 Mar 19:1-8. Epub 2021 Mar 19.

Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.

Background: The dynamics of coronavirus disease 2019 (COVID-19) seroconversion of hospital employees are understudied. We measured the proportion of seroconverted employees and evaluated risk factors for seroconversion during the first pandemic wave.

Methods: In this prospective cohort study, we recruited Geneva University Hospitals employees and sampled them 3 times, every 3 weeks from March 30 to June 12, 2020. We measured the proportion of seroconverted employees and determined prevalence ratios of risk factors for seroconversion using multivariate mixed-effects Poisson regression models.

Results: Overall, 3,421 participants (29% of all employees) were included, with 92% follow-up. The proportion of seroconverted employees increased from 4.4% (95% confidence interval [CI], 3.7%-5.1%) at baseline to 8.5% [(95% CI, 7.6%-9.5%) at the last visit. The proportions of seroconverted employees working in COVID-19 geriatrics and rehabilitation (G&R) wards (32.3%) and non-COVID-19 G&R wards (12.3%) were higher compared to office workers (4.9%) at the last visit. Only nursing assistants had a significantly higher risk of seroconversion compared to office workers (11.7% vs 4.9%; P = .006). Significant risk factors for seroconversion included the use of public transportation (adjusted prevalence ratio, 1.59; 95% CI, 1.25-2.03), known community exposure to severe acute respiratory coronavirus virus 2 (2.80; 95% CI, 2.22-3.54), working in a ward with a nosocomial COVID outbreak (2.93; 95% CI, 2.27-3.79), and working in a COVID-19 G&R ward (3.47; 95% CI, 2.45-4.91) or a non-COVID-19 G&R ward (1.96; 95% CI, 1.46-2.63). We observed an association between reported use of respirators and lower risk of seroconversion (0.73; 95% CI, 0.55-0.96).

Conclusion: Additional preventive measures should be implemented to protect employees in G&R wards. Randomized trials on the protective effect of respirators are urgently needed.
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http://dx.doi.org/10.1017/ice.2021.117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082127PMC
March 2021

"Seconds save lives-clean your hands": the 5 May 2021 World Health Organization SAVE LIVES: Clean Your Hands campaign.

Antimicrob Resist Infect Control 2021 03 17;10(1):55. Epub 2021 Mar 17.

Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.

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http://dx.doi.org/10.1186/s13756-021-00926-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967113PMC
March 2021

Effect of Wearing a Novel Electronic Wearable Device on Hand Hygiene Compliance Among Health Care Workers: A Stepped-Wedge Cluster Randomized Clinical Trial.

JAMA Netw Open 2021 02 1;4(2):e2035331. Epub 2021 Feb 1.

Infection Control Programme and World Health Organization Collaborating Centre on Patient Safety-Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.

Importance: Hand hygiene (HH) is essential to prevent hospital-acquired infections.

Objective: To determine whether providing real-time feedback on a simplified HH action improves compliance with the World Health Organization's "5 Moments" and the quality of the HH action.

Design, Setting, And Participants: This open-label, cluster randomized, stepped-wedge clinical trial was conducted between June 1, 2017, and January 6, 2018 (with a follow-up in March 2018), in a geriatric hospital of the University of Geneva Hospitals, Switzerland. All 12 wards and 97 of 306 eligible health care workers (HCWs) volunteered to wear a novel electronic wearable device that delivered real-time feedback on duration of hand rubbing and application of a hand-sized customized volume of alcohol-based handrub (ABHR).

Interventions: This study had 3 sequential periods: baseline (no device), transition (device monitoring without feedback), and intervention (device monitoring and feedback). The start of the transition period was randomly allocated based on a computer-generated block randomization.

Main Outcomes And Measures: The primary outcome was HH compliance, according to the direct observation method during intervention as compared with baseline. Secondary outcomes included the volume of ABHR and duration of hand rubbing measured by the device during intervention as compared with transition.

Results: All wards and respective HCWs were evenly assigned to group 1 (26 participants), 2 (22 participants), 3 (25 participants), or 4 (24 participants). Twelve HCWs did not fully complete the intervention but were included in the analysis. During 759 observation sessions, 6878 HH opportunities were observed. HH compliance at intervention (62.9%; 95% CI, 61.1%-64.7%) was lower than at baseline (66.6%; 95% CI, 64.8%-68.4%). After adjusting for covariates, HH compliance was not different between periods (odds ratio, 1.03; 95% CI, 0.75-1.42; P = .85). Days since study onset (OR, 0.997; 95% CI, 0.994-0.998; P < .001), older age (OR, 0.97; 95% CI, 0.95-0.99; P = .015), and workload (OR, 0.29; 95% CI, 0.20-0.41; P < .001) were independently associated with reduced HH compliance. The median (interquartile range) volume of ABHR and duration of hand rubbing in transition and intervention increased from 1.12 (0.76-1.68) mL to 1.71 (1.01-2.76) mL and from 6.5 (4.5-10.5) seconds to 8 (4.5-15.5) seconds, respectively. There were no serious adverse events.

Conclusions And Relevance: The use of this device did not change HH compliance, but increased the duration of hand rubbing and volume of ABHR used by HCWs.

Trial Registration: isrctn.org Identifier: ISRCTN25430066.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.35331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871189PMC
February 2021

Enhancing engagement beyond the conference walls: analysis of Twitter use at #ICPIC2019 infection prevention and control conference.

Antimicrob Resist Infect Control 2021 01 25;10(1):20. Epub 2021 Jan 25.

Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.

Background: Social media may provide a tool, when coupled with a patient-included™ conference, to enhance the engagement among the general public. We describe authors and potential readers of Twitter content surrounding a patient-included™ scientific congress, the International Consortium for Prevention and Infection Control (ICPIC) 2019.

Methods: Retrospective observational analysis of Twitter users posting with the #ICPIC2019 hashtag during the conference. Tweet authors, overall followers, and active followers were categorized according to their Twitter biographies using unsupervised learning. Diversity of professional backgrounds of Tweet authors and their followers was explored. Network analysis explored connectedness between the reach of authors.

Results: In total, 1264 participants attended ICPIC 2019, of which 28 were patients. From September 7 to 16, 2019, we were able to categorize 235'620 (41%) followers linked to 474 (76%) authors. Among authors and followers, respectively 34% and 14% were healthcare workers, 11% and 15% were from industry representatives, 8% and 7% were academic researchers. On average, 23% (range 9-39%) followers belonged to the same categories as authors. Among all followers categorized, only 582/235 620 (0.25%) interacted with original messages, including healthcare workers (37%), global and public health (12%), academic research (11%) and those from industry (11%). Though the similarity between Tweet authors and followers was supported by network analysis, we also observed that non-healthcare workers (including patients) appeared to have more diverse followers.

Conclusions: We observed the participation of numerous Tweet authors and followers from diverse professional backgrounds potentially supporting the benefit of including patients in conferences to reach a more general, non-specialized public.
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http://dx.doi.org/10.1186/s13756-021-00891-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830043PMC
January 2021

Nosocomial transmission and outbreaks of coronavirus disease 2019: the need to protect both patients and healthcare workers.

Antimicrob Resist Infect Control 2021 01 6;10(1). Epub 2021 Jan 6.

Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.

Objectives: To compile current published reports on nosocomial outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), evaluate the role of healthcare workers (HCWs) in transmission, and evaluate outbreak management practices.

Methods: Narrative literature review.

Short Conclusion: The coronavirus disease 2019 (COVID-19) pandemic has placed a large burden on hospitals and healthcare providers worldwide, which increases the risk of nosocomial transmission and outbreaks to "non-COVID" patients or residents, who represent the highest-risk population in terms of mortality, as well as HCWs. To date, there are several reports on nosocomial outbreaks of SARS-CoV-2, and although the attack rate is variable, it can be as high as 60%, with high mortality. There is currently little evidence on transmission dynamics, particularly using genomic sequencing, and the role of HCWs in initiating or amplifying nosocomial outbreaks is not elucidated. There has been a paradigm shift in management practices of viral respiratory outbreaks, that includes widespread testing of patients (or residents) and HCWs, including asymptomatic individuals. These expanded testing criteria appear to be crucial in identifying and controlling outbreaks.
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http://dx.doi.org/10.1186/s13756-020-00875-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787623PMC
January 2021

A Serious Game Designed to Promote Safe Behaviors Among Health Care Workers During the COVID-19 Pandemic: Development of "Escape COVID-19".

JMIR Serious Games 2020 Dec 3;8(4):e24986. Epub 2020 Dec 3.

Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.

Background: As many countries fear and even experience the emergence of a second wave of COVID-19, reminding health care workers (HCWs) and other hospital employees of the critical role they play in preventing SARS-CoV-2 transmission is more important than ever. Building and strengthening the intrinsic motivation of HCWs to apply infection prevention and control (IPC) guidelines to avoid contaminating their colleagues, patients, friends, and relatives is a goal that must be energetically pursued. A high rate of nosocomial infections during the first COVID-19 wave was detected by IPC specialists and further cemented their belief in the need for an engaging intervention that could improve compliance with COVID-19 safe behaviors.

Objective: Our aim was to develop a serious game that would promote IPC practices with a specific focus on COVID-19 among HCWs and other hospital employees.

Methods: The first 3 stages of the SERES framework were used to develop this serious game. A brainswarming session between developers and IPC specialists was used to identify the target audience and acquisition objectives. Nicholson's RECIPE mnemonic (reflection, engagement, choice, information, play, exposition) for meaningful gamification was used to guide the general design. A common and simple terminology was used to suit the broad target audience. The game was tested on various platforms (smartphones, tablets, laptops, desktop computers) by different users during each development loop and before its final release.

Results: The game was designed to target all hospital staff who could be in direct contact with patients within the Geneva University Hospitals. In total, 10 acquisition objectives were defined by IPC specialists and implemented into the game according to the principles of meaningful gamification. A simple storyboard was first created using Microsoft PowerPoint and was progressively refined through multiple iteration loops. Articulate Storyline was then used to create two successive versions of the actual game. In the final version, a unique graphic atmosphere was created with help from a professional graphic designer. Feedback mechanisms were used extensively throughout the game to strengthen key IPC messages.

Conclusions: The SERES framework was successfully used to create "Escape COVID-19," a serious game designed to promote safe IPC practices among HCWs and other hospital employees during the COVID-19 pandemic. This game can be obtained free of charge for research and educational purposes. A SCORM (shareable content object reference model) package is available to facilitate results and completion tracking on most current learning management systems.
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http://dx.doi.org/10.2196/24986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717924PMC
December 2020

WHO Year of the Nurse and Midwife: More clean and educated hands for all.

J Infect Prev 2020 Sep 9;21(5):166-169. Epub 2020 Oct 9.

Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Switzerland.

For the last 10 years, the World Health Organization has been celebrating World Hand Hygiene Day on the 5th of May, bringing together the global healthcare ecosystem to celebrate hand hygiene. This day was created to raise awareness about the importance of hand hygiene in healthcare settings, as well as to focus on a specific annual topic to be highlighted to a global audience. The World Health Assembly designated 2020 as the Year of the Nurse and Midwife, and the slogan of this year's 5 of May was "Nurses and Midwifes: Clean Care is in Your Hands". This 5th of May helped us to highlight the need for increased staffing and hand hygiene training. In this paper we aimed to raise awareness about the global impact linked to adherence to proper hand hygiene practices by nurses and midwives.
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http://dx.doi.org/10.1177/1757177420958042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607404PMC
September 2020

Correction to: Use of medical face masks versus particulate respirators as a component of personal protective equipment for health care workers in the context of the COVID-19 pandemic.

Antimicrob Resist Infect Control 2020 09 9;9(1):151. Epub 2020 Sep 9.

Colorado School of Public Health, Aurora, Colorado, USA.

An amendment to this paper has been published and can be accessed via the original article.
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http://dx.doi.org/10.1186/s13756-020-00810-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478940PMC
September 2020

Evidence for action: a One Health learning platform on interventions to tackle antimicrobial resistance.

Lancet Infect Dis 2020 12 24;20(12):e307-e311. Epub 2020 Aug 24.

Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Improving evidence for action is crucial to tackle antimicrobial resistance. The number of interventions for antimicrobial resistance is increasing but current research has major limitations in terms of efforts, methods, scope, quality, and reporting. Moving the agenda forwards requires an improved understanding of the diversity of interventions, their feasibility and cost-benefit, the implementation factors that shape and underpin their effectiveness, and the ways in which individual interventions might interact synergistically or antagonistically to influence actions against antimicrobial resistance in different contexts. Within the efforts to strengthen the global governance of antimicrobial resistance, we advocate for the creation of an international One Health platform for online learning. The platform will synthesise the evidence for actions on antimicrobial resistance into a fully accessible database; generate new scientific insights into the design, implementation, evaluation, and reporting of the broad range of interventions relevant to addressing antimicrobial resistance; and ultimately contribute to the goal of building societal resilience to this central challenge of the 21st century.
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http://dx.doi.org/10.1016/S1473-3099(20)30392-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444982PMC
December 2020

Use of medical face masks versus particulate respirators as a component of personal protective equipment for health care workers in the context of the COVID-19 pandemic.

Antimicrob Resist Infect Control 2020 08 6;9(1):126. Epub 2020 Aug 6.

Colorado School of Public Health, Aurora, Colorado, USA.

Currently available evidence supports that the predominant route of human-to-human transmission of the SARS-CoV-2 is through respiratory droplets and/or contact routes. The report by the World Health Organization (WHO) Joint Mission on Coronavirus Disease 2019 (COVID-19) in China supports person-to-person droplet and fomite transmission during close unprotected contact with the vast majority of the investigated infection clusters occurring within families, with a household secondary attack rate varying between 3 and 10%, a finding that is not consistent with airborne transmission. The reproduction number (R) for the SARS-CoV-2 is estimated to be between 2.2-2.7, compatible with other respiratory viruses associated with a droplet/contact mode of transmission and very different than an airborne virus like measles with a R widely cited to be between 12 and 18. Based on the scientific evidence accumulated to date, our view is that SARS-CoV-2 is not spread by the airborne route  to  any significant extent and the use of particulate respirators offers no advantage over medical masks as a component of personal protective equipment for the routine care of patients with COVID-19 in the health care setting. Moreover, prolonged use of particulate respirators may result in unintended harms. In conjunction with appropriate hand hygiene, personal protective equipment (PPE) used by health care workers caring for patients with COVID-19 must be used with attention to detail and precision of execution to prevent lapses in adherence and active failures in the donning and doffing of the PPE.
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http://dx.doi.org/10.1186/s13756-020-00779-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406874PMC
August 2020

Neonates, Sepsis, and Antimicrobial Resistance-Steps to Tackle Difficult Issues in Our Most Vulnerable Population.

J Obstet Gynaecol Can 2021 04 12;43(4):425-426. Epub 2020 May 12.

Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. Electronic address:

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http://dx.doi.org/10.1016/j.jogc.2020.04.011DOI Listing
April 2021

Surfing the COVID-19 scientific wave.

Lancet Infect Dis 2021 03 30;21(3):317-318. Epub 2020 Jun 30.

Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.

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http://dx.doi.org/10.1016/S1473-3099(20)30558-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326456PMC
March 2021

Critical Reliability Issues of Common Type Alcohol-Based Handrub Dispensers.

Antimicrob Resist Infect Control 2020 06 22;9(1):90. Epub 2020 Jun 22.

University Research and Innovation Center (EKIK), Óbuda University, Budapest, Hungary.

Background: Hand hygiene can only be efficient if the whole hand surface is treated with sufficient alcohol-based handrub (ABHR); therefore, the volume of handrub applied is a critical factor in patient safety. The proper amount of ABHR should be provided by handrub dispensers. The aim of this study was to investigate the dispensing performance of wall-mounted ABHR dispensers commonly employed in hospital settings.

Method: In a multicenter study, we tested 46 dispensers (22 in laboratory and 24 in clinical environments), measuring dispensed ABHR volume during continuous use and after a period of non-use. The influence of the pumping mechanism, liquid level, ABHR formats, handrub composition, temperature, and atmospheric pressure was investigated.

Results: A total of 7 out of the 22 investigated dispensers (32%) lost a significant amount of handrub; greater than 30% of the nominal volume after 8 h of non-use, thus frequently dispensing suboptimal volume, as measured in laboratory settings. Key influencing factors were found to be handrub format (gel or liquid), handrub level in the container and type of dispenser. When gel ABHR was used, after 4 h of non-use of the dispensers, the volume of the dispensed amount of ABHR insignificantly changed (97% of the original amount), while it technically decreased to zero in the case of liquid ABHR (1% of the original amount). The liquid level had a medium effect on the dispensed volume in each investigated case; the magnitude of this effect varied widely depending on the dispensing mechanism. When dispensers were in continuous use, they dispensed a cumulated 3 mL of ABHR from two consecutive pushes, while when they were not in use for 1 h, up to 4 consecutive pushes were necessary to provide a total of 3 mL ABHR. Design and production quality were also identified as important contributing factors with respect to the volume dispensed. Data collected in clinical settings confirmed these findings, for multiple types of dispensers.

Conclusion: All ABHR dispensers should be regularly audited to control the reference volume distributed, with particular attention paid to regular mechanical pump units filled with liquid handrub.
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http://dx.doi.org/10.1186/s13756-020-00735-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310242PMC
June 2020

The Crucial Role of Midwives in Preventing Maternal Sepsis: It All Started in a Maternity Ward.

J Epidemiol Glob Health 2020 06;10(2):113-114

Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.

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http://dx.doi.org/10.2991/jegh.k.200325.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310779PMC
June 2020

Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a population-based study.

Lancet 2020 08 11;396(10247):313-319. Epub 2020 Jun 11.

Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland; Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Background: Assessing the burden of COVID-19 on the basis of medically attended case numbers is suboptimal given its reliance on testing strategy, changing case definitions, and disease presentation. Population-based serosurveys measuring anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) antibodies provide one method for estimating infection rates and monitoring the progression of the epidemic. Here, we estimate weekly seroprevalence of anti-SARS-CoV-2 antibodies in the population of Geneva, Switzerland, during the epidemic.

Methods: The SEROCoV-POP study is a population-based study of former participants of the Bus Santé study and their household members. We planned a series of 12 consecutive weekly serosurveys among randomly selected participants from a previous population-representative survey, and their household members aged 5 years and older. We tested each participant for anti-SARS-CoV-2-IgG antibodies using a commercially available ELISA. We estimated seroprevalence using a Bayesian logistic regression model taking into account test performance and adjusting for the age and sex of Geneva's population. Here we present results from the first 5 weeks of the study.

Findings: Between April 6 and May 9, 2020, we enrolled 2766 participants from 1339 households, with a demographic distribution similar to that of the canton of Geneva. In the first week, we estimated a seroprevalence of 4·8% (95% CI 2·4-8·0, n=341). The estimate increased to 8·5% (5·9-11·4, n=469) in the second week, to 10·9% (7·9-14·4, n=577) in the third week, 6·6% (4·3-9·4, n=604) in the fourth week, and 10·8% (8·2-13·9, n=775) in the fifth week. Individuals aged 5-9 years (relative risk [RR] 0·32 [95% CI 0·11-0·63]) and those older than 65 years (RR 0·50 [0·28-0·78]) had a significantly lower risk of being seropositive than those aged 20-49 years. After accounting for the time to seroconversion, we estimated that for every reported confirmed case, there were 11·6 infections in the community.

Interpretation: These results suggest that most of the population of Geneva remained uninfected during this wave of the pandemic, despite the high prevalence of COVID-19 in the region (5000 reported clinical cases over <2·5 months in the population of half a million people). Assuming that the presence of IgG antibodies is associated with immunity, these results highlight that the epidemic is far from coming to an end by means of fewer susceptible people in the population. Further, a significantly lower seroprevalence was observed for children aged 5-9 years and adults older than 65 years, compared with those aged 10-64 years. These results will inform countries considering the easing of restrictions aimed at curbing transmission.

Funding: Swiss Federal Office of Public Health, Swiss School of Public Health (Corona Immunitas research program), Fondation de Bienfaisance du Groupe Pictet, Fondation Ancrage, Fondation Privée des Hôpitaux Universitaires de Genève, and Center for Emerging Viral Diseases.
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http://dx.doi.org/10.1016/S0140-6736(20)31304-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289564PMC
August 2020

Home deliveries in limited resource environments.

Am J Infect Control 2020 08 30;48(8):859-861. Epub 2020 May 30.

Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. Electronic address:

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http://dx.doi.org/10.1016/j.ajic.2020.05.033DOI Listing
August 2020
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