COVID-19 pa pandemic: Exp Experie iences fr from The he Hos - - PowerPoint PPT Presentation

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COVID-19 pa pandemic: Exp Experie iences fr from The he Hos - - PowerPoint PPT Presentation

Jan 03, 2023 164 likes •368 views

OSH protection for health care professionals April 16 th 2020 COVID-19 pa pandemic: Exp Experie iences fr from The he Hos ospitals ls San Santi i Paolo aolo an and Car arlo of of Mila ilano Prof. Claudio Colosio, Dr. Federica

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SLIDE 1

OSH protection for health care professionals April 16th 2020

COVID-19 pa pandemic: Exp Experie iences fr from The he Hos

  • spitals

ls San Santi i Paolo aolo an and Car arlo of

  • f Mila

ilano

  • Prof. Claudio Colosio,
  • Dr. Federica Masci,
  • Dr. Stefan Mandić-Rajčević & Occupational Health Unit Team
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SLIDE 2

Co Contents

  • The situation in Lombardy
  • The epidemics in our Hospital
  • Our colleagues/patients: data

collection and analysis

  • Clinical findings
  • Some conclusions
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SLIDE 3

Sit ituation report: It Italy, Lo Lombardy, Mil ilan

LAST UPDATE 12.04.2020

National Trend

PCM-DPC dati forniti dal Ministero della Salute Ricoverati con sintomi Terapia intensiva Isolamento domiciliare Totale attualmente positivi L

  • mbardia

11.969 1.176 18.120 31.265 17.166 10.621 59.052 + 1.460 205.832 Emilia Romagna 3.491 335 9.846 13.672 3.862 2.564 20.098 + 463 96.704 Piemonte 3.429 381 8.695 12.505 2.426 1.729 16.660 + 652 66.555 Veneto 1.428 249 9.052 10.729 2.492 856 14.077 + 309 198.442 Toscana 983 238 4.941 6.162 578 495 7.235 + 277 78.640 L iguria 1.032 144 2.157 3.333 1.412 749 5.494 + 118 21.983 Marche 949 114 2.051 3.114 1.489 700 5.303 + 92 21.057 L azio 1.268 201 2.348 3.817 749 279 4.845 + 122 68.954 Campania 526 82 2.449 3.057 305 242 3.604 + 87 35.448 Trento 322 61 1.699 2.082 678 293 3.053 + 83 17.797 Puglia 609 71 1772 2.452 277 260 2.989 + 85 30.973 Friuli V.G. 160 28 1.138 1.326 910 195 2.431 + 38 29.988 Sicilia 552 53 1.425 2.030 223 163 2.416 + 52 36.098 Abruzzo 346 54 1.342 1.742 206 212 2.160 + 40 20.594 Bolzano 183 45 1.287 1.515 378 205 2.098 + 141 23.246 Umbria 129 39 519 687 580 52 1.319 + 10 18.672 Sardegna 109 26 768 903 137 73 1.113 + 22 10.663 Calabria 165 14 616 795 62 66 923 + 8 18.211 Valle d'Aosta 109 16 463 588 221 112 921 + 19 3.510 Basilicata 61 12 204 277 20 18 315 + 3 4.355 Molise 27 4 171 202 40 15 257 + 11 2.471 TOTAL E 27.847 3.343 71.063 102.253 34.211 19.899 156.363 + 4.092 1.010.193 102.253 34.211 19.899 156.363 ATTUAL MENTE POSITIVI TOTAL E GUARITI TOTAL E DECEDUTI CASI TOTAL I Regione

AGGIORNAMENTO 12/ 04/2020 ORE 17.00

POSITIVI AL nCoV DIMESSI/ GUARITI DECEDUTI CASI TOTAL I INCREMENTO CASI TOTAL I

(rispetto al giorno precedente)

TAMPONI

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SLIDE 4

Su Surveillance pr prot

  • tocol for
  • r healt

healthcare pr prof

  • fessionals
  • “Close contact” = any person who had a face to face talk without PPP or

spent more than 15 minutes in a indoor environment without PPP with a Coronavirus infected person (PATIENT, COLLEAGUE, GENERAL POPULATION)

  • Worker who have recently traveled from or live in an area with ongoing

spread of COVID-19, were at the beginning considered at higher risk

  • Protocol: Nasopharyngeal swab for real-time RT PCR (rRT-PCR) detection of

2019-Novel Coronavirus (2019-nCoV) The worker is admitted to work only if the reported body temperature before the start of the shift is < 37.5 (temperature monitoring is managed by the department coordinator) A check point has been set up

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SLIDE 5

Ho How w to

  • man

manage close con

  • ntacts
  • 1. Without symptoms: NFS; remains at work waiting for the

results, In the meanwhile, mandatory use of PPP (surgical mask and, where necessary, gloves); in family: use of PPP, lives separately from the other members. Takes meals

  • separated. If Swap positive: mandatory QUARANTINE 14

DAYS.

  • 2. With Symptoms: if at work, NFS, precautionary quarantine

(same precautions as in point 1). If swab negative: re- entry after recovery. If positive mandatory quarantine 14 days after recovery.

  • 3. With symptoms, at home: when fever is less than 37.5°C
  • NFS. Positive vs negative: as points 1-2

Re-entry at work: only after having performed two swabs, both negative. Otherwise to repeat weekly this approach, remaining in mandatory quarantine

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SLIDE 6

Ho How w to

  • man

manage ab absent fr from

  • m work
  • rk at

t the the re-entry ry duri during g epi epidemic ics perio period

  • 1. Telephone interview to collect information regarding

possible contacts and symptoms. 2. If duration of absence critical (14 days or more) and/or presence of one or more of the following symptoms: fever, cough, dyspnea, anosmia, ageusia, conjunctival hyperemia, diarrhea: clinical diagnosis of Covid 19 or contact with a covid patient: readmission at work only after 14 days without symptoms and after two NPSs.

  • 3. If duration non critical, absence short, no contacts,

symptoms non typical: NPS and readmission at work with the same precautions as in point 1 of previous slide.

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SLIDE 7

In Index cas ase: : San an Carl arlo Hosp

  • spital

Case INDEX (from emergency unit): absence from work cause of sickeness (not accident at work) 40 swab 5 positive cases (MDs and nurses)

INVESTIGATION IN PROGRESS

TOTAL WABS S : ~1200 DAILY ANAMNESIS: ~50 TOTAL POSI OSITIVE CASE SES: 73 73 TOTAL ISOLATED (AWAITING CON ONF.): 4 TOTAL ACCIDEN ENT AT WOR ORK REPORTED: 12 TOTAL SICK WOR ORKERS (NO NOT OC OCCUPATIONAL INF NFEC ECTION) : 3

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SLIDE 8

Th The ep epid idemic ic in in ou

  • ur ho

hospit itals ls

Initially Worker to worker transfer (red) Most asymptomatic Later Lower „close contact“ rate, lower worker to worker transfer

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SLIDE 9

Data a col

  • llectio

ion – wor

  • rker su

submit it on

  • nli

line

Relatively good compliance (66% to 73%), lower as the time passes, but allows to analyse the symptoms

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SLIDE 10

Bo Body temperature in n the the first week

Day (0) of the positive swab

Most COVID-19 positive workers remain afebrile during the follow up-period

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SLIDE 11

Oth Other r symp ymptoms: cou

  • ugh and

and dy dyspnea

Most workers with no or light symptoms

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SLIDE 12

And And som

  • me ne

new w symp ymptoms?

Anosmia and dysgeusia are commonly reported and persist for a long time

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SLIDE 13

ACTI CTIVITIES PER ERFORMED AT T APRIL RIL 15

Total employees: 5.000 Total swabs performed: 2800 Total positive subjects: 185 Total recoveries: 74 % of positive swabs in contacts: 8-9% % of positive swabs collected without any strategy (“all workers tested”): < 1%

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SLIDE 14

Con

  • nsid

iderations

  • 90% positive healthcare workers are asymptomatic
  • General symptoms: Dry cough, dyspnea, sore throat, fever, diarrhea:

BUT also: anosmia, dysgeusia, conjunctival hyperemia

  • Our workers positive to COVD 19 did not need intensive therapy

 working age patients have not fatal outcome

  • In closed populations, such as hospitals, the risk comes mostly from

within the population (workers->workers)

  • To avoid virus spreading is important to identify immediately the

contacts and adopt preventive measures within 5 days:

  • no meetings
  • surgical mask

FFP 2 e FFP3 only for operator protection during maneuvers that create aerosols (e.g. bronchoscopy) Surgical mask: stops inlet and outlet droplets

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SLIDE 15

Crit ritic ical is issues Duration of the disease Range: 12-46 days Average: 21.5 days 12-15 days: 6.8% 16 days: 11.5% 17 days: 6.8% 12-17 days: 25%

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SLIDE 16

Fut Future pe perspectiv ives

Our group is experimenting:

  • Follow up study: symptom questionnaire

administered to positive workers

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SLIDE 17

Fut Future pe perspectiv ives

Our group is experimenting:

  • COVID-19 IgG and IgM study
  • Telemedicine: monitoring not critical

workers’ health

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SLIDE 18

Th Thank you

  • u for
  • r you
  • ur atten

entio ion

claudio.colosio@unimi.it