Infection control strategy and primary care assistance in Campania region during the national lockdown due to COVID-19 outbreak: the experience of two tertiary emergency centers.
Identifieur interne : 000003 ( Main/Corpus ); précédent : 000002; suivant : 000004Infection control strategy and primary care assistance in Campania region during the national lockdown due to COVID-19 outbreak: the experience of two tertiary emergency centers.
Auteurs : Angela Mauro ; Nicola Improda ; Letizia Zenzeri ; Francesco Valitutti ; Erica Vecchione ; Sara Esposito ; Vincenzo TipoSource :
- Italian journal of pediatrics [ 1824-7288 ] ; 2021.
Abstract
BACKGROUND
COVID-19 pandemic has markedly affected emergency care, due to sudden limitation of health care capacity by general practitioners (GP) and urgent need for infection control strategies. We evaluated the activity of the Emergency Department (ED) during the national lockdown (March 8-April 30), as well as the outcomes of our infection control strategy.
RESULTS
Despite a reduction in access by one fifth, a proportion of febrile patients comparable to 2019 was seen (829/2492, 33.3% vs 4580/13.342, 34.3%, p = 0.3). Diagnostic swab for COVID-19 was performed in 25% of patients, especially in subjects with co-morbidities or multiple access. Six infected cases were identified, all presenting with febrile disease. Only two positive patients fulfilled the criteria for diagnostic swab provided by the Italian Health Authorities, because of close contact with suspected or confirmed cases. The rate of admission for febrile or respiratory conditions was higher than the same period of 2019 (33.4% vs 25.9%, p < 0.0001). None of the 105 health-care professionals working during the study time lapse exhibited anti-SARS-CoV-2 seroconversion. Among the 589 patients with information available, 54.9% declared no medical consultation at all prior to coming to ED, while only 40 (of which 27 with fever) had been examined by their GP before coming to ED. Nevertheless, 35.6% of the cases were already taking medications. None of the 9 patients requiring intensive care reported recent pediatric consultation, despite symptoms duration up to 30 days.
CONCLUSION
Our results provide evidence that the reduced capacity of primary care facilities during the national lockdown may have caused a high rate of self-medication as well as a delayed provision of care in some patients. Identification of pediatric patients affected with SARS-CoV-2 infection remains a challenge because of the absence of reliable predictive factors. Finally, the use of specific triage centers, with dedicated pathways to diagnose SARS-CoV-2 infection, trace contacts and allow adequate care after swabs, is effective in preventing spreading of the infection.
DOI: 10.1186/s13052-021-00963-3
PubMed: 33514406
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Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Pediatric Section, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Zenzeri, Letizia" sort="Zenzeri, Letizia" uniqKey="Zenzeri L" first="Letizia" last="Zenzeri">Letizia Zenzeri</name><affiliation><nlm:affiliation>Emergency Pediatric Department, Pediatric Emergency Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Valitutti, Francesco" sort="Valitutti, Francesco" uniqKey="Valitutti F" first="Francesco" last="Valitutti">Francesco Valitutti</name><affiliation><nlm:affiliation>EBRIS (European Biomedical Research Institute of Salerno), Salerno, Italy.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Pediatric Unit, AOU San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Vecchione, Erica" sort="Vecchione, Erica" uniqKey="Vecchione E" first="Erica" last="Vecchione">Erica Vecchione</name><affiliation><nlm:affiliation>Emergency Pediatric Department, Pediatric Emergency Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Esposito, Sara" sort="Esposito, Sara" uniqKey="Esposito S" first="Sara" last="Esposito">Sara Esposito</name><affiliation><nlm:affiliation>Pediatric Section, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Tipo, Vincenzo" sort="Tipo, Vincenzo" uniqKey="Tipo V" first="Vincenzo" last="Tipo">Vincenzo Tipo</name><affiliation><nlm:affiliation>Emergency Pediatric Department, Pediatric Emergency Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2021">2021</date><idno type="RBID">pubmed:33514406</idno><idno type="pmid">33514406</idno><idno type="doi">10.1186/s13052-021-00963-3</idno><idno type="wicri:Area/Main/Corpus">000003</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000003</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Infection control strategy and primary care assistance in Campania region during the national lockdown due to COVID-19 outbreak: the experience of two tertiary emergency centers.</title><author><name sortKey="Mauro, Angela" sort="Mauro, Angela" uniqKey="Mauro A" first="Angela" last="Mauro">Angela Mauro</name><affiliation><nlm:affiliation>Emergency Pediatric Department, Pediatric Emergency Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy. angela.mauro84@gmail.com.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>EBRIS (European Biomedical Research Institute of Salerno), Salerno, Italy. angela.mauro84@gmail.com.</nlm:affiliation></affiliation></author><author><name sortKey="Improda, Nicola" sort="Improda, Nicola" uniqKey="Improda N" first="Nicola" last="Improda">Nicola Improda</name><affiliation><nlm:affiliation>Emergency Pediatric Department, Pediatric Emergency Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Pediatric Section, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Zenzeri, Letizia" sort="Zenzeri, Letizia" uniqKey="Zenzeri L" first="Letizia" last="Zenzeri">Letizia Zenzeri</name><affiliation><nlm:affiliation>Emergency Pediatric Department, Pediatric Emergency Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Valitutti, Francesco" sort="Valitutti, Francesco" uniqKey="Valitutti F" first="Francesco" last="Valitutti">Francesco Valitutti</name><affiliation><nlm:affiliation>EBRIS (European Biomedical Research Institute of Salerno), Salerno, Italy.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Pediatric Unit, AOU San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Vecchione, Erica" sort="Vecchione, Erica" uniqKey="Vecchione E" first="Erica" last="Vecchione">Erica Vecchione</name><affiliation><nlm:affiliation>Emergency Pediatric Department, Pediatric Emergency Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Esposito, Sara" sort="Esposito, Sara" uniqKey="Esposito S" first="Sara" last="Esposito">Sara Esposito</name><affiliation><nlm:affiliation>Pediatric Section, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Tipo, Vincenzo" sort="Tipo, Vincenzo" uniqKey="Tipo V" first="Vincenzo" last="Tipo">Vincenzo Tipo</name><affiliation><nlm:affiliation>Emergency Pediatric Department, Pediatric Emergency Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Italian journal of pediatrics</title><idno type="eISSN">1824-7288</idno><imprint><date when="2021" type="published">2021</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>COVID-19 pandemic has markedly affected emergency care, due to sudden limitation of health care capacity by general practitioners (GP) and urgent need for infection control strategies. We evaluated the activity of the Emergency Department (ED) during the national lockdown (March 8-April 30), as well as the outcomes of our infection control strategy.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Despite a reduction in access by one fifth, a proportion of febrile patients comparable to 2019 was seen (829/2492, 33.3% vs 4580/13.342, 34.3%, p = 0.3). Diagnostic swab for COVID-19 was performed in 25% of patients, especially in subjects with co-morbidities or multiple access. Six infected cases were identified, all presenting with febrile disease. Only two positive patients fulfilled the criteria for diagnostic swab provided by the Italian Health Authorities, because of close contact with suspected or confirmed cases. The rate of admission for febrile or respiratory conditions was higher than the same period of 2019 (33.4% vs 25.9%, p < 0.0001). None of the 105 health-care professionals working during the study time lapse exhibited anti-SARS-CoV-2 seroconversion. Among the 589 patients with information available, 54.9% declared no medical consultation at all prior to coming to ED, while only 40 (of which 27 with fever) had been examined by their GP before coming to ED. Nevertheless, 35.6% of the cases were already taking medications. None of the 9 patients requiring intensive care reported recent pediatric consultation, despite symptoms duration up to 30 days.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>Our results provide evidence that the reduced capacity of primary care facilities during the national lockdown may have caused a high rate of self-medication as well as a delayed provision of care in some patients. Identification of pediatric patients affected with SARS-CoV-2 infection remains a challenge because of the absence of reliable predictive factors. Finally, the use of specific triage centers, with dedicated pathways to diagnose SARS-CoV-2 infection, trace contacts and allow adequate care after swabs, is effective in preventing spreading of the infection.</p></div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">33514406</PMID><DateRevised><Year>2021</Year><Month>01</Month><Day>30</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1824-7288</ISSN><JournalIssue CitedMedium="Internet"><Volume>47</Volume><Issue>1</Issue><PubDate><Year>2021</Year><Month>Jan</Month><Day>29</Day></PubDate></JournalIssue><Title>Italian journal of pediatrics</Title><ISOAbbreviation>Ital J Pediatr</ISOAbbreviation></Journal><ArticleTitle>Infection control strategy and primary care assistance in Campania region during the national lockdown due to COVID-19 outbreak: the experience of two tertiary emergency centers.</ArticleTitle><Pagination><MedlinePgn>19</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1186/s13052-021-00963-3</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">COVID-19 pandemic has markedly affected emergency care, due to sudden limitation of health care capacity by general practitioners (GP) and urgent need for infection control strategies. We evaluated the activity of the Emergency Department (ED) during the national lockdown (March 8-April 30), as well as the outcomes of our infection control strategy.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">Despite a reduction in access by one fifth, a proportion of febrile patients comparable to 2019 was seen (829/2492, 33.3% vs 4580/13.342, 34.3%, p = 0.3). Diagnostic swab for COVID-19 was performed in 25% of patients, especially in subjects with co-morbidities or multiple access. Six infected cases were identified, all presenting with febrile disease. Only two positive patients fulfilled the criteria for diagnostic swab provided by the Italian Health Authorities, because of close contact with suspected or confirmed cases. The rate of admission for febrile or respiratory conditions was higher than the same period of 2019 (33.4% vs 25.9%, p < 0.0001). None of the 105 health-care professionals working during the study time lapse exhibited anti-SARS-CoV-2 seroconversion. Among the 589 patients with information available, 54.9% declared no medical consultation at all prior to coming to ED, while only 40 (of which 27 with fever) had been examined by their GP before coming to ED. Nevertheless, 35.6% of the cases were already taking medications. None of the 9 patients requiring intensive care reported recent pediatric consultation, despite symptoms duration up to 30 days.</AbstractText><AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">Our results provide evidence that the reduced capacity of primary care facilities during the national lockdown may have caused a high rate of self-medication as well as a delayed provision of care in some patients. Identification of pediatric patients affected with SARS-CoV-2 infection remains a challenge because of the absence of reliable predictive factors. Finally, the use of specific triage centers, with dedicated pathways to diagnose SARS-CoV-2 infection, trace contacts and allow adequate care after swabs, is effective in preventing spreading of the infection.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y" EqualContrib="Y"><LastName>Mauro</LastName><ForeName>Angela</ForeName><Initials>A</Initials><Identifier Source="ORCID">http://orcid.org/0000-0002-7008-3409</Identifier><AffiliationInfo><Affiliation>Emergency Pediatric Department, Pediatric Emergency Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy. angela.mauro84@gmail.com.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>EBRIS (European Biomedical Research Institute of Salerno), Salerno, Italy. angela.mauro84@gmail.com.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y" EqualContrib="Y"><LastName>Improda</LastName><ForeName>Nicola</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Emergency Pediatric Department, Pediatric Emergency Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Pediatric Section, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zenzeri</LastName><ForeName>Letizia</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Emergency Pediatric Department, Pediatric Emergency Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Valitutti</LastName><ForeName>Francesco</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>EBRIS (European Biomedical Research Institute of Salerno), Salerno, Italy.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Pediatric Unit, AOU San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Vecchione</LastName><ForeName>Erica</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Emergency Pediatric Department, Pediatric Emergency Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Esposito</LastName><ForeName>Sara</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Pediatric Section, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tipo</LastName><ForeName>Vincenzo</ForeName><Initials>V</Initials><AffiliationInfo><Affiliation>Emergency Pediatric Department, Pediatric Emergency Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2021</Year><Month>01</Month><Day>29</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Ital J Pediatr</MedlineTA><NlmUniqueID>101510759</NlmUniqueID><ISSNLinking>1720-8424</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">Emergency care</Keyword><Keyword MajorTopicYN="N">Infection control strategy</Keyword><Keyword MajorTopicYN="N">Triage</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>11</Month><Day>03</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2021</Year><Month>01</Month><Day>04</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2021</Year><Month>1</Month><Day>30</Day><Hour>5</Hour><Minute>23</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2021</Year><Month>1</Month><Day>31</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2021</Year><Month>1</Month><Day>31</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">33514406</ArticleId><ArticleId IdType="doi">10.1186/s13052-021-00963-3</ArticleId><ArticleId IdType="pii">10.1186/s13052-021-00963-3</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>Castagnoli R, Votto M, Licari A, Brambilla I, Bruno R, Perlini S, et al. 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