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The Covid-19 pandemic has focused attention on airborne transmission of viruses. Using realistic air flow simulation, we model droplet dispersion from coughing and study the transmission risk related to SARS-CoV-2. Although this model defines most airborne droplets as 8–16 µm in diameter, we infer that larger droplets of 32–40 µm in diameter may potentially be more infectious due to higher viral content. Use of face masks is therefore recommended for both personal and social protection. We found social distancing effective at reducing transmission potential across all droplet sizes. However, the presence of a human body 1 m away modifies the aerodynamics so that downstream droplet dispersion is enhanced, which has implications on safe distancing in queues. At 1 m distance, we found that an average of 0.55 viral copies is inhaled for a cough at median loading, scalable up to 340 copies at peak loading. Droplet evaporation results in significant reduction in droplet counts, but airborne transmission remains possible even under low humidity conditions.

Background: Vancomycin-resistant Enterococcus (VRE) has emerged as a major nosocomial pathogen. A recent surveillance of our hospital identified a concerning rise in VRE bacteremia since 2020, despite the stable use of broad-spectrum antibiotics. This trend, coupled with the increased use of daptomycin and linezolid for drug-resistant Gram-positive bacteremia (GPB), prompted an evaluation of their usage beyond approved hospital indications. Methods: A retrospective analysis was carried out from 1 February 2023 to 31 July 2023, during which 100 and 195 patients received linezolid and daptomycin, respectively. Patients’ data were extracted from the hospital’s electronic medical records, and the appropriateness of the antibiotics prescribed was assessed. The amount of daptomycin and linezolid utilization during the study period was also retrieved, as was the incidence of VRE bacteremia. Results: A total of 295 courses of VRE-active agents, linezolid (n = 100) and daptomycin (n = 195), were assessed for appropriateness in this study. Linezolid and daptomycin use were judged as inappropriate 5.0% and 9.2% of the time, respectively. The primary reason for inappropriate linezolid use was overly broad empirical therapy where first-line options like cefazolin and vancomycin could have been prescribed. Daptomycin was often used inappropriately in non-VRE infections, and surgical prophylaxis or use was extended unnecessarily without microbiological justification. Conclusions: Linezolid and daptomycin were prescribed appropriately. Nevertheless, our findings suggest the need to re-evaluate the empirical treatment strategies especially in VRE-colonized patients. Implementation of robust risk-based criteria as well as in-house hospital guidelines or protocols on the initiation of VRE-active agents may help support more judicious prescribing practices of these agents.

The increasing prevalence of infectious diseases in recent decades has posed a serious threat to public health. Routes of transmission differ, but the respiratory droplet or airborne route has the greatest potential to disrupt social intercourse, while being amenable to prevention by the humble face mask. Different types of masks give different levels of protection to the user. The ongoing COVID-19 pandemic has even resulted in a global shortage of face masks and the raw materials that go into them, driving individuals to self-produce masks from household items. At the same time, research has been accelerated towards improving the quality and performance of face masks, e.g., by introducing properties such as antimicrobial activity and superhydrophobicity. This review will cover mask-wearing from the public health perspective, the technical details of commercial and home-made masks, and recent advances in mask engineering, disinfection, and materials and discuss the sustainability of mask-wearing and mask production into the future.

Staff surveillance is crucial during the containment phase of a pandemic to help reduce potential healthcare-associated transmission and sustain good staff morale. During an outbreak of SARS-COV-2 with community transmission, our institution used an integrated strategy for early detection and containment of COVID-19 cases among healthcare workers (HCWs). Our strategy comprised 3 key components: (1) enforcing reporting of HCWs with acute respiratory illness (ARI) to our institution's staff clinic for monitoring; (2) conducting ongoing syndromic surveillance to obtain early warning of potential clusters of COVID-19; and (3) outbreak investigation and management. Over a 16-week surveillance period, we detected 14 cases of COVID-19 among HCWs with ARI symptoms. Two of the cases were linked epidemiologically and thus constituted a COVID-19 cluster with intrahospital HCW-HCW transmission; we also detected 1 family cluster and 2 clusters among HCWs who shared accommodation. No transmission to HCWs or patients was detected after containment measures were instituted. Early detection minimized the number of HCWs requiring quarantine, hence preserving continuity of service during an ongoing pandemic. An integrated surveillance strategy, outbreak management, and encouraging individual responsibility were successful in early detection of clusters of COVID-19 among HCWs. With ongoing local transmission, vigilance must be maintained for intrahospital spread in nonclinical areas where social mingling of HCWs occurs. Because most individuals with COVID-19 have mild symptoms, addressing presenteeism is crucial to minimize potential staff and patient exposure.

Patients with COVID-19 may present with respiratory syndromes indistinguishable from those caused by common viruses. Early isolation and containment is challenging. Although screening all patients with respiratory symptoms for COVID-19 has been recommended, the practicality of such an effort has yet to be assessed. Over a 6-week period during a SARS-CoV-2 outbreak, our institution introduced a \"respiratory surveillance ward\" (RSW) to segregate all patients with respiratory symptoms in designated areas, where appropriate personal protective equipment (PPE) could be utilized until SARS-CoV-2 testing was done. Patients could be transferred when SARS-CoV-2 tests were negative on 2 consecutive occasions, 24 hours apart. Over the study period, 1,178 patients were admitted to the RSWs. The mean length-of-stay (LOS) was 1.89 days (SD, 1.23). Among confirmed cases of pneumonia admitted to the RSW, 5 of 310 patients (1.61%) tested positive for SARS-CoV-2. This finding was comparable to the pickup rate from our isolation ward. In total, 126 HCWs were potentially exposed to these cases; however, only 3 (2.38%) required quarantine because most used appropriate PPE. In addition, 13 inpatients overlapped with the index cases during their stay in the RSW; of these 13 exposed inpatients, 1 patient subsequently developed COVID-19 after exposure. No patient-HCW transmission was detected despite intensive surveillance. Our institution successfully utilized the strategy of an RSW over a 6-week period to contain a cluster of COVID-19 cases and to prevent patient-HCW transmission. However, this method was resource-intensive in terms of testing and bed capacity.

Patients can be immunocompromised from a diverse range of disease and treatment factors, including malignancies, autoimmune disorders and their treatments, and organ and stem-cell transplantation. Infections are a leading cause of morbidity and mortality in immunocompromised patients, and the disease treatment landscape is continually evolving. Despite being a critical but preventable and curable adverse event, the reporting of infection events in randomised trials lacks sufficient detail while inconsistency of categorisation and definition of infections in observational and registry studies limits comparability and future pooling of data. A core reporting dataset consisting of category, site, severity, organism, and endpoints was developed as a minimum standard for reporting of infection events in immunocompromised patients across study types. Further additional information is recommended depending on study type. The standardised reporting of infectious events and attributable complications in immunocompromised patients will improve diagnostic, treatment, and prevention approaches and facilitate future research in this patient group.

A 63-year-old man post-renal transplantation on immunosuppressants presented with reflux symptoms for one month. Significant medical history included a history of upper gastrointestinal bleeding, insulin-dependent diabetes mellitus and ischemic heart disease. Barium meal showed a large plaque-like lesion along greater curvature suspicious of malignancy. Gastroscopy revealed a large polyploidal gastric mass which was biopsied. Histological result showed numerous cytomegalovirus (CMV) viral inclusions within hyperplastic gastric mucosa without dysplasia or neoplasm. The findings were consistent with CMV gastric polyp. Following treatment with antiviral therapy and reduction in immunosuppressants, the CMV gastric polyp became smaller. This highlights the importance of considering CMV as a differential of gastric mass in an immunosuppressed host as treatment options varied between surgery and antiviral therapy.

Pseudomonas aeruginosa (P. aeruginosa) is among the most common pathogens associated with healthcare-acquired infections, and is often antibiotic resistant, causing significant morbidity and mortality in cases of P. aeruginosa bacteremia. It remains unclear how the incidence of P. aeruginosa bacteremia changed during the Coronavirus Disease 2019 (COVID-19) pandemic, with studies showing almost contradictory conclusions despite enhanced infection control practices during the pandemic. This systematic review sought to examine published reports with incidence rates for P. aeruginosa bacteremia during (defined as from March 2020 onwards) and prior to the COVID-19 pandemic. A systematic literature search was conducted in accordance with PRISMA guidelines and performed in Cochrane, Embase, and Medline with combinations of the key words (pseudomonas aeruginosa OR PAE) AND (incidence OR surveillance), from database inception until 1 December 2022. Based on the pre-defined inclusion criteria, a total of eight studies were eligible for review. Prior to the pandemic, the prevalence of P. aeruginosa was on an uptrend. Several international reports found a slight increase in the incidence of P. aeruginosa bacteremia during the COVID-19 pandemic. These findings collectively highlight the continued importance of good infection prevention and control and antimicrobial stewardship during both pandemic and non-pandemic periods. It is important to implement effective infection prevention and control measures, including ensuring hand hygiene, stepping up environmental cleaning and disinfection efforts, and developing timely guidelines on the appropriate prescription of antibiotics.

Introduction To report the progress of the human living uterus transplant research project in Singapore. Material and Methods The uterus transplant research project began in 2012 with a collaboration between the Swedish and Singapore teams. Ethics approval was obtained from the SingHealth Centralised Institutional Review Board, the SingHealth Transplant and the Singapore General Hospital Biomedical Ethics Committee to perform 5 uterus transplant procedures in a collaborative multi‐site research study at the Singapore General Hospital. Regulatory approval was obtained from the Ministry of Health, Singapore. A suitable recipient–donor pair was identified. The living donor was the perimenopausal mother‐in‐law of the recipient who had Mayer–Rokitansky–Kuster–Hauser syndrome. They underwent the requisite matching process as well as robust medical, psychiatric and psychosocial assessments. The recipient then underwent in vitro fertilization (IVF) treatment resulting in 6 frozen blastocysts. Preparations were made for the transplant surgery on 25 November 2023 in Singapore General Hospital, aided by the 3 Uterus transplant experts from the Swedish Team, for whom temporary registration was granted by the Singapore Medical Council. Results This first uterus transplant procedure involved an operative time of 10 h and 30 min for the donor. The synchronized recipient surgery lasted 6 h and 20 min. Surgery was by midline laparotomy in both the living donor and recipient. The total warm ischemic time of the graft was 45 min, and the cold ischemic time was 1 h 45 min (total ischemic time 2 h 30 min). The patient's first menstruation occurred 38 days after the uterus transplant procedure. Cytomegalovirus infection was detected 6 weeks postoperatively for which she was aggressively treated. Serial cervical biopsies showed no rejection and Doppler ultrasound of the transplanted uterus showed good uterine blood flow. Conclusions To date the Living Donor Uterus Transplant Research Project in Singapore has progressed with a uterus transplant surgery involving a living donor performed by a multidisciplinary team. The recipient had a menstrual period 38 days postoperatively. Further study of the outcomes from this procedure will inform the safety and efficacy of uterus transplant in the Singapore context. Living Donor Uterus Transplant Research Project in Singapore: Progress of the First Case.