IDSI Co-Director, Dr. Shruti Gohil MD, MPH, of UC Irvine's School of Medicine Infectious Disease Department, shares her research with COVID-19.
Project 1: Use of signature COVID-19 features to identify earliest cases in the US and assess impact on antibiotic use, length of stay, and ICU transfer, length of stay, readmission, and death.
Lead investigator: Dr. Shruti Gohil
Hypothesis and Implications: We hypothesize that COVID-19 was present in U.S. communities weeks or months before testing was available and that its presence impacted antibiotic use, ICU transfers, hospital length-of-stay, readmissions, and mortality. Understanding the earliest introduction of COVID-19 into U.S. hospitals can provide insights into early detection methods to signal future recurrences of COVID as well as the arrival of new communicable diseases into the U.S. The INSPIRE PNA Trial is a large national trial currently in intervention phase, spanning time before and after COVID-19. This also provides a unique opportunity to evaluate the impact of COVID on antibiotic prescribing and clinical outcomes in these trials.
Study Design & Population: Retrospective case-control and cohort studies and time series analyses of non-ICU adult patients admitted for pneumonia (PNA) or UTI in 59 HCA hospitals participating in the INSPIRE PNA and UTI trials, evaluating data streams from May 2014-June 2020.
Project 2: Evaluation of COVID-19 among healthcare workers (HCW) and the estimated attribution to community, patient, or co-worker sources, including the impact of delayed recognition of COVID-19 on HCW infections.
Lead investigator: Dr. Shruti Gohil
Hypothesis and Implications: We hypothesize that the risk of work-associated COVID-19 among HCP is low relative to their risk of acquiring infection in the community and that staff-to-staff infections may be more common than patient-to-staff infections even following delayed diagnoses of COVID-19 associated with underutilization of PPE. While national attention centers on risk of transmission from patients (necessitating personal protective equipment use), we seek to raise awareness about the role of community acquisition and coworker transmission to highlight infection prevention strategies needed to mitigate HCW cases from non-patient based sources. We also seek to demonstrate that universal infection prevention strategies, including masking and hand hygiene, can provide meaningful protection from infection for many patient encounters.
Study Design & Population: We will conduct both local and distributed analyses of HCW infections in our own hospitals and amongst interested Prevention Epicenter hospitals to determine potential sources of HCW infections as well as mitigating and exacerbating factors using semi-quantitative methods. Our studies will include a survey of U.S. hospitals in which we expect at least 20 hospitals will participate.
Project 3: Assessment of the unintended consequences of an “abundance of caution” rationale to avoid healthcare worker COVID exposure on clinical decision-making and quality of patient care.
Lead investigator: Dr. Shruti Gohil
Hypothesis and implications: An “abundance of caution” approach to minimize HCW concern over COVID exposure can result in unintended consequences on the quality of patient care delivered. “Abundance of caution” approaches to reducing HCW exposures must be balanced with the need to deliver timely, high quality patient care. The frequency of avoiding care vs using protective PPE will be described as an indicator of HCW fear that needs to be addressed so that patient care can be optimized during a pandemic.
Study Design & Population: Qualitative cross-sectional survey of an estimated 20 hospital infection prevention programs to capture early experiences with patient care approaches and policies to prevent HCW exposure. UC and Prevention Epicenter hospitals will be invited to participate in this study.
Project 4: STOP COVID-19 – Orange County Nursing Home Infection Prevention Collaborative.
Provide infection prevention expertise to county nursing homes on how to prevent COVID-19 transmission, develop guidance and protocols for COVID prevention, provide in-person and online training on prevention strategies (e.g., hand hygiene, appropriate PPE, stocking and readiness for pandemic surge, etc.).
