Assessing COVID-19 cohorting strategies in a UK district general hospital during the first wave of COVID-19

Introduction Patient-to-patient transmission has a well-recognised role in nosocomial COVID-19 infections,1 but identifying and isolating infectious individuals is challenging, due to limitations in the speed and accuracy of testing.2 To mediate this, many hospitals attempted to cohort patients based on suspicion of COVID-19 infection.3 We aimed to assess whether this strategy was successful at a district general hospital (DGH) in Oxfordshire. Patients are triaged at admission according to their likelihood of COVID-19 infection, with high/medium risk patients being admitted to EAU and low risk patients being admitted ward A. Patients requiring longer stays are then moved to ward B (high risk) or C (medium risk), depending on risk. By contrast, there were significant periods of exposure in EAU (Table 1), with over a quarter of the hours susceptible patients spent in six of the eight bays being exposed to at least one other infectious patient.

The effects of personal protective equipment on airway management: An in-situ simulation

The novel coronavirus disease (COVID-19) was declared a pandemic by the World Health Organisation on 11th March and has led to over 41,000 deaths in the UK. Public Health England guidance for aerosol generating procedures (AGP) requires the donning of personal protective equipment (PPE). We evaluated airway management skills using an in-situ emergency simulation. The scenarios were video recorded and scored by two independent assessors using a skill specific checklist. A total of 34 airway management procedures were evaluated. The checklist involved 13 steps with a maximum score of 26. The median (IQR [range]) checklist score was 25 (24-25 [20-26]). Four teams failed to intubate the trachea and proceeded to manage the airway using a supraglottic airway device. The mean (SD) intubation time was 47.9 (16.5) seconds and two anaesthetists (7%) required a second attempt. Our results show that airway management can be carried out successfully whilst donned in PPE. However, additional training in using newly introduced devices such as a McGrath® video laryngoscope is of paramount importance.