ABSTRACT
Introduction: With the evolution of centralised ‘hub and spoke’ microbiology services, the expansion of infectious diseases as a medical specialty and the advent of joint infection training pathways, the infection services within the United Kingdom (UK) are experiencing a period of rapid change. Despite this, to date there has been no comprehensive description of the distribution of specialty staffing and service provision across the country. To this end, the British Infection Association (BIA), in conjunction with the Royal College of Pathologists (RCPath), has undertaken a national survey of National Health Service (NHS) infection services. Methods: Questions were compiled following consultation with an expert panel including BIA Council members. An online survey was distributed to clinical leads at all UK NHS acute trusts or health boards with inpatient beds and data were collected between April and August 2021. Results: The overall response rate was 72% (108 respondents). The median number of infection consultant full time equivalents (FTE) per service was 6.1 overall (5.6 per 1000 acute beds) although this varied between the devolved nations and was lowest in centres with microbiology specialists only. Forty-three services had three or fewer FTE medically qualified infection specialists. Overall, 17.5% of all funded FTE consultant-level posts were vacant, although this was markedly higher for microbiology-accredited posts (20.3%) than for infectious diseases (ID) (9.3%) or medical virology (14.6%). There were fewer vacancies in centres with ID-accredited consultants;median 1.0 (IQR 0–2.2) versus those with microbiology only;1.8 (IQR 0–2.9). Distribution of non-consultant staff was extremely heterogenous with 44 services having none and 25 having one or less FTE (most of which employed microbiology-only accredited consultants). 30% of organisations reported at least one vacant training post. Half of the responding organisations reported at least one consultant accredited in ID but only 28 provided inpatient care with a total of 520 ‘dedicated’ ID beds, of which 235 were negative pressure side-rooms. Geographically, several large areas of the country lacked inpatient ID capacity and/or ID-accredited consultant expertise. The burden of laboratory-related and reporting work in relation to staffing levels is disproportionately greater at smaller centres;there are a median 7.7 (IQR 5.9–9.5) hours/person/week at centres with three or fewer consultants and 4.0 (IQR 2.1–6.3) at larger centres. Conclusion: Microbiology specialists continue to provide the bulk of infection services across the UK and there is marked geographical variation in staffing with regards to other specialities. With Core Infection Training now producing dual-accredited consultants, there is an untapped potential to expand inpatient ID service provision although the requirement for placements on an existing inpatient ID unit may be limiting this currently. There are extremely high vacancies rates across the country but smaller, microbiology-only centres are hardest-hit with many barely attaining the consultant numbers required to staff a safe on-call rota. Workforce planning with utilisation of the valuable expertise of non-medically-trained staff, such as Clinical Scientists, is urgently needed. The results of this survey, in conjunction with Best Practice Standards recently published by the BIA, RCPath and Royal College of Physicians can inform commissioning and delivery of infection expertise in the context of the aftermath of the COVID-19 pandemic.
ABSTRACT
There is no proven preventative therapy or vaccine against COVID-19. Theinfection has spread rapidly and there has already been a substantial adverse impact on the global economy. Healthcare workers have been affected disproportionately in the continuing pandemic. Significant infection rates in this critical group have resulted in a breakdown of health services in some countries. Chloroquine, and the closely related hydroxychloroquine, are safe and well tolerated medications which can be given for years without adverse effects. Chloroquine and hydroxychloroquine have significant antiviral activity against SARS-CoV-2, and despite the lack of benefit of hydroxychloroquine treatment in patients hospitalised with severe COVID-19, these drugs could still work in prevention. The emerging infection paradigm of an early viral peak, and late inflammation where there is benefit from corticosteroids. If these direct actiing antivirals are to work, they have the best chance given either early in infection infection occurs. We describe the study protocol for multi-centre, multi-country randomised, double blind, placebo controlled trial to answer the question can chloroquine/ hydroxychloroquine prevent COVID-19. 40,000 participants working in healthcare facilities or involved in the management of COVID-19 will be randomised 1:1 to receive chloroquine/ hydroxychloroquine or matched placebo as daily prophylaxis for three months. The primary objective is the prevention of symptomatic, virological or serologically proven coronavirus disease (COVID-19). The study could detect a 23% reduction from an incidence of 3% in the placebo group for either drug with 80% power. Secondary objectives are to determine ifchloroquine/hydroxychloroquine prophylaxis attenuates severity, prevents asymptomaticCOVID-19 and symptomatic acute respiratory infections of another aetiology (non-SARS-CoV-2). © 2020. Schilling WH et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
BACKGROUND: The risk of transmission of SARS-CoV-2 from aerosols generated by medical procedures is a cause for concern. AIM: To evaluate the evidence for aerosol production and transmission of respiratory infection associated with procedures that involve airway suctioning or induce coughing/sneezing. METHODS: The review was informed by PRISMA guidelines. Searches were conducted in PubMed for studies published between January 1st, 2003 and October 6th, 2020. Included studies examined whether nasogastric tube insertion, lung function tests, nasendoscopy, dysphagia assessment, or suctioning for airway clearance result in aerosol generation or transmission of SARS-CoV-2, SARS-CoV, MERS, or influenza. Risk of bias assessment focused on robustness of measurement, control for confounding, and applicability to clinical practice. FINDINGS: Eighteen primary studies and two systematic reviews were included. Three epidemiological studies found no association between nasogastric tube insertion and acquisition of respiratory infections. One simulation study found low/very low production of aerosols associated with pulmonary lung function tests. Seven simulation studies of endoscopic sinus surgery suggested significant increases in aerosols but findings were inconsistent; two clinical studies found airborne particles associated with the use of microdebriders/drills. Some simulation studies did not use robust measures to detect particles and are difficult to equate to clinical conditions. CONCLUSION: There was an absence of evidence to suggest that the procedures included in the review were associated with an increased risk of transmission of respiratory infection. In order to better target precautions to mitigate risk, more research is required to determine the characteristics of medical procedures and patients that increase the risk of transmission of SARS-CoV-2.