The next round of hospital acquired infections is here...

Updated | Posted

Specializes in Long term care; med-surg; critical care. Has 10 years experience.

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During the first round of COVID, we had a particularly sad in hospital outbreak involving patients on our cancer floor. It's unclear the exact etiology, but it appears that an asymptomatic positive patient was admitted to that floor and required a sitter for behaviors. This patient had sitters that worked on the floor as PCTs and obviously had a nurse with other patients. When the surveillance COVID test came back (three days later), the patient was moved to another floor but by then the damage had been done. We know of at least eight patients that died because of those exposures, and they were IN the hospital.

We just recently had a patient who was discharged from the hospital and then returned two days later with a positive COVID test. This patient was in the hospital greater than three weeks and upon discharge was only at home with services, hadn't even been out in the community yet.

Another patient is now on COVID precautions because after being in the hospital since the first week of December, family members decided to come and visit last week. When leaving it somehow came to the attention of staff that more than one person that had visited the patient came to visit because they were home from work with COVID. 

We have staff out all over the place getting tested, with symptoms, or asymptomatic positives. We're back to N95s in place at all times. I've heard the projections that this wave will peak by the end of January. We're being mandated an average of once every two weeks in my unit and as more people call out that will go up. I've had an assignment with three vented patients four times in the past two weeks. Last night two were proned and two were on titrating pressors. When pressors go to KVO there may or may not be a nurse at the station that hears it, there's going to be someone maxed on levophed who dies of a KVO. 

I pray that the end of January really brings some sort of end to this. Best wishes to everyone out there impacted in any way. 

toughcookie, ADN, BSN

Specializes in Corrections. Has 7 years experience. 18 Posts

Hospitals just do not care anymore. Well... maybe they never did. It's sad that this is reality right now.

macawake, MSN

Has 14 years experience. 2,079 Posts

We are seeing more and more research that the vaccines do offer some protection against transmission and susceptibility to infection, even with the Omicron variant, but that the level of protection appears to be lower than what the vaccines offer against the Delta variant. A booster dose appears to increase the protection against infection. So everyone who is eligible for a booster shot, ought to get one. We don’t yet have enough data to be certain how well/to what degree the vaccines protect against severe disease and death when it comes to the new variant.

If I allow myself to speculate a bit, I think that the problem we face is that since the protection against transmission waned with time with the initial doses, we don’t really know how long the booster dose will offer its increased protection. I suspect that we can look forward to another booster adapted to fit Omicron better. Several pharmaceutical companies are already working on developing them. The current vaccines have worked very well against the Delta variant and have saved countless lives. The current vaccines will in all likelihood save many lives even with the Omicron variant. 

This is a Danish study (preprint, not peer-reviewed yet) that looks at secondary infections in households where one person has become infected with either the Delta or the Omicron variant.

It indicates that even though the vaccines don’t appear to protect as well against Omicron transmission as they do against Delta, they still do protect individuals who have received a booster dose.

(I should probably add the following in case someone looks at Table 3 and thinks it means that ”boostered” individuals get infected a lot more by the Omicron variant than unvaccinated folks do, that’s not what Table 3 shows. Table 3 shows the relative effect of the Omicron variant within each specific group. What you can see is that the current vaccines offer very good protection against the Delta variant and the relative difference between the two variants might indicate that there is significant immune escape with the new variant. That does not translate to it being a good idea to be unvaccinated). 


https://www.medrxiv.org/content/10.1101/2021.12.27.21268278v1.full.pdf

The risk of a household member being infected by the primary case appears to be higher if the primary case is unvaccinated, compared to if s/he has received a booster dose. And the risk of a household member of becoming infected is lower if they have received a booster dose, compared to just the initial dose/s. 

SmilingBluEyes

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 25 years experience. 20,878 Posts

On 1/3/2022 at 2:39 PM, macawake said:

We are seeing more and more research that the vaccines do offer some protection against transmission and susceptibility to infection, even with the Omicron variant, but that the level of protection appears to be lower than what the vaccines offer against the Delta variant. A booster dose appears to increase the protection against infection. So everyone who is eligible for a booster shot, ought to get one. We don’t yet have enough data to be certain how well/to what degree the vaccines protect against severe disease and death when it comes to the new variant.

If I allow myself to speculate a bit, I think that the problem we face is that since the protection against transmission waned with time with the initial doses, we don’t really know how long the booster dose will offer its increased protection. I suspect that we can look forward to another booster adapted to fit Omicron better. Several pharmaceutical companies are already working on developing them. The current vaccines have worked very well against the Delta variant and have saved countless lives. The current vaccines will in all likelihood save many lives even with the Omicron variant. 

This is a Danish study (preprint, not peer-reviewed yet) that looks at secondary infections in households where one person has become infected with either the Delta or the Omicron variant.

It indicates that even though the vaccines don’t appear to protect as well against Omicron transmission as they do against Delta, they still do protect individuals who have received a booster dose.

(I should probably add the following in case someone looks at Table 3 and thinks it means that ”boostered” individuals get infected a lot more by the Omicron variant than unvaccinated folks do, that’s not what Table 3 shows. Table 3 shows the relative effect of the Omicron variant within each specific group. What you can see is that the current vaccines offer very good protection against the Delta variant and the relative difference between the two variants might indicate that there is significant immune escape with the new variant. That does not translate to it being a good idea to be unvaccinated). 


https://www.medrxiv.org/content/10.1101/2021.12.27.21268278v1.full.pdf

The risk of a household member being infected by the primary case appears to be higher if the primary case is unvaccinated, compared to if s/he has received a booster dose. And the risk of a household member of becoming infected is lower if they have received a booster dose, compared to just the initial dose/s. 

This is a helpful post. I don't wish to,  nor  necessarily expect to, get sick. Thank you for this information. I hope for the best. I have family members who have refused to get any vaccinations and all have had COVID by now.  Fortunately, all but one have avoided hospitalization. The one exception is in ICU now. Hope she does not wind up on a vent........ How sad. I would still recommended getting all those shots and boosters! The unvaccinated in my family are the ones passing it around and getting pretty sick so far.

subee, MSN, CRNA

Specializes in CRNA, Finally retired. Has 50 years experience. 3,539 Posts

Italy has mandated the vaccine for all citizens over 50.  That's a good start.  We will never get anywhere until the unvaxxed get vaxxed.

klone, MSN, RN

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership. Has 16 years experience. 14,116 Posts

1 hour ago, subee said:

Italy has mandated the vaccine for all citizens over 50.  That's a good start.  We will never get anywhere until the unvaxxed get vaxxed.

To offer a little hope - our vaccine clinic, where we see anywhere from 80-250 patients per day, is still seeing 1st dose appointments. Tomorrow we have 8 adults coming in to get their 1st dose of Pfizer.