Specificity
Specificity is an important criterion in diagnostic procedures. Specificity indicates the percentage of people without an illness who are actually identified by a test as being healthy. If, for example, the test correctly identifies 99% of the healthy people, it has a specificity of 99%.
Sensitivity
Sensitivity is an important criterion in diagnostic procedures. Sensitivity indicates the percentage of people with an illness who are actually identified by a test as being ill, i.e. the test result is positive. If, for example, the test picks up 90 out of 100 people who have the illness, it has a sensitivity of 90%. The remaining 10% are so-called false negatives.
Aerosol
An aerosol is a mixture of a gas and microscopic particles from a liquid or a finely dispersed solid. Steam and smoke are aerosols, for example. Droplets that are released when someone coughs, sneezes or vomits form an aerosol in the air.
Coronaviruses
Coronaviruses belong to the family Coronaviridae and were named after their characteristic crown-shaped appearance (the Latin word “corona” translates as wreath or crown). The enveloped viruses cause various illnesses in humans, ranging from the common cold to dangerous or even potentially fatal diseases.
COVID-19
This is the term for the medical condition triggered by SARS-CoV-2. The symptoms are non-specific and are similar to influenza, including fever, dry cough, shortness of breath, muscle aches and fatigue, among other things. In rare cases, people may cough up blood or phlegm or experience headaches and diarrhea. Since the pathogens mainly cause inflammation of the lower respiratory tract and can cause pneumonia, COVID‑19 is described as a pulmonary disease.
Epidemic
A highly clustered, temporary occurrence of an infectious disease in a localized area.
Ethanol
Ethanol is a short-chain, water-soluble alcohol. Along with 1-propanol and 2-propanol, ethanol is one of the most important alcohols used in hand sanitizers. Ethanol is the only active ingredient that is effective against non-enveloped viruses when used in high concentrations.
FFP Classes
The FFP classes are part of a classification system for particle filtering half-masks that protect against particulate pollutants such as dust, smoke and aerosol. The abbreviation FFP stands for “filtering face piece”. The half masks are standardized according to EN 149 and are divided into the three protection classes FFP1, FFP2 and FFP3. The FFP class depends on the total leakage and the filtration of particle sizes up to 0.6 μm. The total leakage is caused by the filter passage and possible leaks at the nose, chin or eyes.
FFP1 Masks
FFP1 masks protect against non-toxic and non-fibrogenic dusts. The total leakage may not exceed 25%. The masks must capture at least 80% of airborne particles up to a size of 0.6 μm and may be used if the occupational exposure limit value does not exceed 4 times the concentration.
FFP2 Masks
FFP2 masks protect against solid and liquid harmful dusts, smoke and aerosols. The total leakage may not exceed 11%. The masks must capture at least 94% of airborne particles up to a size of 0.6 μm and may be used if the occupational exposure limit value does not exceed 10 times the concentration.
FFP3 Masks
FFP3 masks protect against toxic and harmful dust, smoke and aerosols. The total leakage may not exceed 5%. The masks must capture at least 99% of airborne particles up to a size of 0.6 μm and may be used if the occupational exposure limit value does not exceed 30 times the concentration.
Herd Immunity
Herd immunity means that an entire population is protected from a contagious disease as a high percentage of the population is immune to it, whether that be through infection or vaccination. This means that even individuals who are not immune are protected because the pathogen cannot spread.
Hydrophilicity
Hydrophilicity means water-receptive and describes the property of substances to dissolve or absorb water when placed in water or other polar substances.
Hygienic hand disinfection
Hygienic hand disinfection refers to applying a sanitizer onto the hands in order to eliminate the transient (volatile) skin flora. For this purpose, approx. 3 ml of alcoholic preparation is placed in the palm of a dry hand and rubbed in for 30 seconds. According to the Robert Koch Institute, hygienic hand disinfection is considered to be the most effective single measure for interrupting chains of infection.
Hand Disinfection
Hand disinfection is a procedure that reduces the number of pathogens on your hands by using hand sanitizers.
Chain of infection
The chain of infection describes the path of a pathogen from one host to another target organism.
Contact infection
Contact infection is the transmission of pathogens through direct physical contact (touch, injury, sexual contact, infectious droplets) with an infectious living organism.
Log10 Units
A log10 unit is a unit for measuring germ reduction by one power of ten.
MERS
MERS (Middle East Respiratory Syndrome) refers to an infection of the respiratory tract. The infection is triggered by the MERS coronavirus (MERS-CoV), which was identified for the first time in 2012. Healthy people usually only display mild, flu-like symptoms. However, particularly in people with chronic, pre-existing health conditions, very serious and sometimes fatal respiratory diseases may occur. Infections with MERS-CoV were predominantly reported in Saudi Arabia and other countries in the region. Dromedary camels are considered to be the reservoir of infection.
Pandemic
A pandemic is the transnational, worldwide spread of an infectious disease with high morbidity rates.
RNA
Ribonucleic acid (RNA) is a nucleic acid found in the cells of all living organisms. As an information carrier, RNA plays a vital role in converting genetic information into proteins.
SARS-CoV-2
In the past, coronaviruses sometimes have led to dangerous diseases such as Middle East Respiratory Syndrome (MERS) or Severe Acute Respiratory Syndrome (SARS). The novel coronavirus, which has been spreading since December 2019 and causes pneumonia, was named SARS-CoV-2 in February 2020 due to its close relationship to the SARS virus.
Droplet Infection
Droplet infection is the transmission of pathogens via small droplets that are released when someone speaks, coughs or sneezes and then these are inhaled by other people.
Viruses
Enveloped viruses have a lipid membrane, such as. B. HBV, HCV, HIV and influenza viruses. The lipid membrane of enveloped viruses can be destroyed by alcohols such as ethanol or 2-propanol. Enveloped viruses are more unstable to disinfectants than non-enveloped viruses. Enveloped viruses can be killed with disinfectants that have a limited range of virucidal activity.
Bare viruses have no lipid membrane. Enveloped viruses include, for example, enteroviruses, noroviruses, rota and adenoviruses. Unwrapped viruses are more stable against disinfectants than enveloped viruses. They can be killed with disinfectants that have a virucidal spectrum of activity.
Virucidal
The virucidal efficacy spectrum describes the effectiveness against enveloped and non-enveloped viruses.
The limited virucidal efficacy spectrum refers to the effectiveness against enveloped viruses. These include the new Coronavirus, SARS-CoV-2, as well as the human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV).
The limited virucidal PLUS efficacy spectrum refers to the effectiveness against enveloped viruses as well as the non-enveloped noroviruses, rotaviruses and adenoviruses.
The efficacy spectrum was introduced in 2016 in addition to the previously known virucidal efficacy spectra and limited virucidal agent. Disinfectants from the category limited virucidal agent PLUS inactivate all enveloped viruses as well as the non-enveloped noroviruses, rotaviruses and adenoviruses.
Noroviruses, rotaviruses and adenoviruses often cause outbreaks in hospitals, nursing homes and also in public institutions. Noroviruses, rotaviruses and adenoviruses belong to the group of non-enveloped viruses, but are easier for disinfectants to inactivate compared to other non-enveloped viruses due to their lower hydrophilicity.
WHO
The World Health Organization (WHO) was founded on April 7th as a specialized agency of the United Nations with its headquarters in Geneva. 194 countries are members of WHO, which coordinates international public health and global health issues on behalf of the United Nations. The WHO is tasked with developing and defining globally applicable norms and standards for areas relating to health, as well as unifying these and implementing them across the world. Important fields of action include the global coordination of national and international activities against communicable diseases such as AIDS, malaria, SARS and influenza, the initiation of global vaccination programs and activities against health risk factors such as smoking or being overweight.
The WHO employs more than 7,000 staff and is divided into 6 regions, each of which is managed by a Regional Office. The highest decision-making body of the World Health Organization is the World Health Assembly (WHA), which meets every year in Geneva.
Source:
Bundesministerium für Gesundheit. https://www.bundesgesundheitsministerium.de/service/begriffe-von-a-z/w/weltgesundheitsorganisation-who.html.
Practise examples
16.12.2020
COVID-19 risk stratification in the emergency department
Emergency departments are facing enormous challenges during the coronavirus pandemic. A new triage model at the Göttingen-Weende Hospital ensures early detection of COVID-19 as well as patient isolation. This efficient risk stratification also succeeds in protecting vulnerable groups in all areas of the hospital.
How can an emergency department (ED) with around 30,000 emergencies per year operate efficiently in the context of SARS-CoV-2 while ensuring protection against nosocomial spread of the pathogen? Marc Wieckenberg, Head Physician of the ED at the Evangelisches Krankenhaus Göttingen-Weende, and his colleagues answered this question with a model for risk stratification of suspected SARS-CoV-2 and COVID-19 cases [1]. Based on the epidemiological criteria of the Robert Koch Institute and internal case definitions, the emergency physicians defined five risk categories.
COVID-19 risk categories I-V:
RK I = Confirmed SARS-CoV-2 infection
RK II= COVID-19 Reasonable Suspicion
RK III=COVID-19 Differential diagnosis
RK IV= COVID-19 19 Low probability
RK V = COVID-19 No suspicion
Aim: Comprehensive protection against infection
A standardized treatment procedure for emergency diagnostics and therapy has been established for all emergency patients on the basis of the system of risk categories I-IV. This procedure is used to strictly separate COVID-19/non-COVID-19 emergencies, thereby protecting staff and patients against nosocomial infection. The focus is on particularly vulnerable groups, such as patients with risk factors including advanced age, immunodeficiency, lung, heart and kidney diseases and malignancies.
In order to establish risk stratification, considerable structural changes within the hospital building were necessary, for example to enable CT and conventional X-ray diagnostics for accident victims with an increased risk of COVID-19. The changes were implemented by measures such as
- Installing a walk-through tent to protect waiting patients from the weather
- Expanding the available space by means of movable partitions
- Integrating the trauma room CT into the isolation area
- Separating the isolation ED from the routine ED by means of a rolling grille and airlock system
- Relocating the main entrance and closure of all side entrances
- A Plexiglas-protected space for patient interviews and administration
Standardized procedure for all emergency patients
Risk stratification becomes the central means of controlling patient flows in the ED by linking the respective risk category to criteria such as
- Symptoms and/or occupational group
- Specific hygiene protection measures
- Specific treatment room within the ED
- Specifying the room used for further inpatient care
Treatment Procedure in the ED
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Treatment Procedure in the Emergency Department
1. Initial coronavirus screening by the doctor in charge and the ED nurse according to the dual-control principle.
2. Determining the COVID-19 risk status.
3. Triage using the Manchester Triage System (MTS) to determine the urgency of treatment.
4. Allocation of the primary, appropriately labeled treatment and isolation site in the ED.
5. Determining hygiene protection measures according to risk category.
6. Emergency diagnostics (vital signs, laboratory diagnostics, nasopharyngeal swab/gargle test, thoracic ultrasound, low-dose CT in cases of reasonable suspicion).
7. Re-evaluation of the COVID-19 risk status if the patient is to be hospitalized.
8. Selection of the appropriate ward according to risk category:
RC I = COVID-19 ward NC/IMC/ICU
RC II and RC III = suspected COVID-19 ward NC/IMC/ICU
RC IV and RC V = Pre-isolation NC/IMC/ICU
(Barrier measures; no further functional diagnostics until test result)
Source:
Wieckenberg M, Meier V, Pfeiffer S, Blaschke S. Risikostratifizierung von Notfällen während der COVID-19-Pandemie in der Zentralen Notaufnahme. Med Klin Intensivmed Notfmed, Springer, https://doi.org/10.1007/s00063-020-00748-2. Eingegangen: 4. Juni 2020. Überarbeitet: 21. August 2020. Angenommen: 12. September 2020.
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