Systematic evaluating and modeling of SARS-CoV-2 UVC disinfection.

The ongoing COVID-19 global pandemic has necessitated evaluating various disinfection technologies for reducing viral transmission in public settings. Ultraviolet (UV) radiation can inactivate pathogens and viruses but more insight is needed into the performance of different UV wavelengths and their applications. We observed greater than a 3-log reduction of SARS-CoV-2 infectivity with a dose of 12.5 mJ/cm2 of 254 nm UV light when the viruses were suspended in PBS, while a dose of 25 mJ/cm2 was necessary to achieve a similar reduction when they were in an EMEM culture medium containing 2%(v/v) FBS, highlighting the critical effect of media in which the virus is suspended, given that SARS-CoV-2 is always aerosolized when airborne or deposited on a surface. It was found that SARS-CoV-2 susceptibility (a measure of the effectiveness of the UV light) in a buffer such as PBS was 4.4-fold greater than that in a cell culture medium. Furthermore, we discovered the attenuation of UVC disinfection by amino acids, vitamins, and niacinamide, highlighting the importance of determining UVC dosages under a condition close to aerosols that wrap the viruses. We developed a disinfection model to determine the effect of the environment on UVC effectiveness with three different wavelengths, 222 nm, 254 nm, and 265 nm. An inverse correlation between the liquid absorbance and the viral susceptibility was observed. We found that 222 nm light was most effective at reducing viral infectivity in low absorbing liquids such as PBS, whereas 265 nm light was most effective in high absorbing liquids such as cell culture medium. Viral susceptibility was further decreased in N95 masks with 222 nm light being the most effective. The safety of 222 nm was also studied. We detected changes to the mechanical properties of the stratum corneum of human skins when the 222 nm accumulative exposure exceeded 50 J/cm2.The findings highlight the need to evaluate each UV for a given application, as well as limiting the dose to the lowest dose necessary to avoid unnecessary exposure to the public.

Viscoelastic testing in COVID-19 infection demonstrates a resistance to low molecular weight heparin

Introduction: A significant degree of mortality and morbidity in COVID-19 is due to thromboembolic disease. We use viscoelastic testing to investigate changes to coagulation profile over the progression of COVID-19 infection. Methods: Patients presenting to a single large University Teaching Hospital ED were recruited at presentation. Those with positive COVID- 19 PCR test were included for analysis. Whole blood samples were taken for viscoelastic tests. Fractal Dimension ( Df) and Time to Gel Point ( TGP) are biomarkers of thrombogenicity which measure the biomechanical properties of the incipient clot [1]. Patients were followed up throughout their hospital stay, with sampling taken at arrival, after 24 h, 3-5 days and 7 days. Length of stay and patient outcome were recorded and used for subgroup analysis. Once admitted to the hospital all patients received low molecular weight heparin (LMWH) as per standard treatment pathways, if commenced before the first sample was taken, this was recorded and controlled for. Results: Df and TGP showed no changes over time in COVID-19 infection. Subgroup analysis also showed no differences in Df or TGP in different outcome groups. Patients who received LMWH from the clinical team before recruitment to the study demonstrated no significant difference in Df (1.715 ± 0.061 no LMWH vs 1.699 ± 0.068 with LMWH), but TGP was prolonged in those receiving LMWH(445.0 ± 195.2 vs 307.6 ± 91.6). Additionally there was no correlation between Anti-Xa level and Df. Conclusions: The therapeutic efficacy of LMWH appears to be blunted in COVID-19 infection. This may be due to the inflammatory state creating a resistance to the activity of LMWH, and may in part explain why LMWH appears to have less effect in reducing thromboembolic disease in COVID-19 than it does in other disease states.

Capturing patient experience to support quality improvement initiatives

Background: Patient experience is core to understanding and improving care. Implementation Science recommends that stakeholders be included in all aspects of Quality Improvement (QI), and extensive involvement of both patients and staff were prioritized in all stages of implementation to date. Patient experience has enhanced QI initiatives of one site within the Spinal Cord Injury (SCI) Implementation and Evaluation Quality Care Consortium. Objective: To describe how patient experience and perspectives were integral to implementation of QI initiatives to support best practices in a tertiary SCI rehabilitation centre. Design: Five Implementation and Evaluation Specialist (IESs) were identified from a range of clinical disciplines to facilitate QI efforts in working with leaders, frontline staff and persons with lived experience. QI in each domain of SCI rehab was started with an iterative process which included patient experience as integral to development and implementation of clinical tools and education materials. It was important to include methods beyond satisfaction ratings, and patient experience was gathered through surveys, interviews, working groups, as well as direct feedback. Participants: Patients in a tertiary academic rehabilitation hospital as well as community members with lived experience. Findings: 106 individuals undergoing inpatient SCI rehabilitation were approached to share their experience, perspectives and personal knowledge of care, to influence QI initiatives and ongoing improvement cycles. Patient experience supported QI in domains of sexual health, tissue integrity and wheeled mobility, as well as for Covid-19 clinical adaptations. Early evidence of success was evident in the documentation completion rates regarding sexual health education, which rose from 30% to 80% upon initial implementation. Tissue integrity and wheeled mobility domains are currently in progress, and patient experience continues to shape QI processes. An unanticipated outcome of IESs' ability to gather patient perspectives in a timely manner was that patient experience could more easily be incorporated into the rapid adaptations in clinical care required during the Covid-19 challenges. Conclusion: Intentionally seeking patient perspectives enabled more meaningful QI activities resulting in a robust foundation for implementing successful practice change and greater staff and patient engagement to ultimately maximize patient and family centred care.

Patient perspectives regarding a 7-day therapy model during the onset of COVID-19

Background: COVID-19 presented unique challenges for patient wellbeing in tertiary SCI rehabilitation settings. Patients had long evening and weekend stretches to occupy themselves while isolated from their family and support network without access to volunteers, peer mentors, recreational outings or weekend passes. Objective: To describe the outcomes of a 7-day therapy model implemented during COVID-19 (Apr-Aug2020) from a patient perspective. Method: The pandemic provided an opportunity to redeploy outpatient staff to the inpatient program, and provide therapy services 7-days/week for 12 hours/day (vs. 5 days/week for 8 hrs) to: 1) enhance physical distancing ;2) intensify inpatient therapy;3) create opportunity to practice skills prior to discharge;4) facilitate daily e-visits (visitor restrictions);5) increase recreation/leisure offerings;and, 6) increase supportive care on units. In total 6 PT's, 4 OT's, 2 Assistive Technology Staff (ATS) were redeployed. Enhanced recreation therapy evening programs (bocce, movies, relaxation, adapted sport, etc.) and extended gym hours were provided. Supports for feeding, laundry, activities of daily living (ADL), 2, and e-visits were established. Leadership team worked extended hours and weekends. Seating clinic staff supported wheelchair prescription and ADP processes. Patient surveys were designed and piloted by the Toronto IES team to evaluate the effectiveness and impact of the enhanced therapy schedule. Data were analyzed by postdoctoral fellows (GJ and RA) using appropriate descriptive statistics or qualitative methods. Participants: Patients & tertiary academic staff. supported wheelchair prescription and ADP processes. Patient surveys were designed and piloted by the Toronto IES team to evaluate the effectiveness and impact of the enhanced therapy schedule. Data were analyzed by postdoctoral fellows (GJ and RA) using appropriate descriptive statistics or qualitative methods. Participants: Patients & tertiary academic staff. Findings: Thirty inpatients, 77% male, 6 paraplegics and 24 tetraplegics, majority of non-traumatic etiology, with a median 57-80 day LOS indicated their preference for a 6-day (vs 7-day) therapy model.Weekend recreational programs had the best attendance, while recreational programming attendance was a predictor of greater program satisfaction. A majority of inpatients indicated their preference for 6-day per week programming indicating they would appreciate a day of relaxation (which could still be therapeutic, just less physical and more recreational perhaps). Conclusion: Temporary redeployment of staff resulted in increased inpatient support services and therapy availability. Study results underscore the importance of role clarity and goal setting, therapeutic recreation services, especially on weekends;the potential value of a 6-day therapy model;and, our reliance on volunteer and family caregiver services, therapeutic and weekend passes as essential components of care.