ABSTRACT
BackgroundThe COVID-19 pandemic required medical staff to quickly adapt to new policies and rota structures. In our large tertiary children’s department, speciality paediatric consultants were redeployed to acute paediatrics. All clinical staff required training in new resuscitation protocols and personal protective equipment (PPE) guidance.ObjectivesSimulation is an acknowledged educational tool. Our aim was to run in-situ simulations to prepare staff for undertaking resuscitation with appropriate PPE precautions during the evolving pandemic.MethodsIn March 2020 we invited all clinical paediatric staff to participate in a 1-hour small group simulation. This focused on donning/doffing PPE and paediatric ABC assessment of the seriously unwell child. Feedback was undertaken using an online tool.ResultsThe main reason cited for participants to attend simulation was due to changing roles on a new rota, returning from other areas such as research and community paediatrics, and to take the opportunity to refresh skills particularly in the context of other courses being cancelled due to the pandemic.41 participants provided feedback;34.1% were non-acute paediatric consultants, 48.8% paediatric residents of all grades and 17.1% nurses. 39.2% of participants did not routinely cover an acute area where emergencies occur prior to the pandemic, and as such would not have taken the opportunity to refresh their knowledge if rota changes were not required.92.3% felt better prepared for acute paediatric shifts during the pandemic. 70.7% reported reduced stress regarding rota reconfiguration. 97.3% found this a useful educational tool.Anecdotally staff felt these sessions enhanced an overall sense of comradery, feeling more prepared for the ‘worst case scenario’.ConclusionsIn-situ simulation is a versatile tool which can help prepare medical staff following resuscitation policy changes (eg. during a pandemic)It has a positive impact on staff feeling prepared, improving staff morale and confidence during resuscitation.As access to and the landscape of educational opportunities change, small session in-situ simulations (while acknowledging physical distancing guidance) has an important role in being a key educational tool during pandemics.
ABSTRACT
Background COVID-19 poses a major challenge to infection control in care homes. SARS-CoV-2 is readily transmitted between people in close contact and causes disproportionately severe disease in older people. Methods Data and SARS-CoV-2 samples were collected from patients in the East of England (EoE) between 26th February and 10th May 2020. Care home residents were identified using address search terms and Care Quality Commission registration information. Samples were sequenced at the University of Cambridge or the Wellcome Sanger Institute and viral clusters defined based on genomic and time differences between cases. Findings 7,406 SARS-CoV-2 positive samples from 6,600 patients were identified, of which 1,167 (18.2%) were residents from 337 care homes. 30/71 (42.3%) care home residents tested at Cambridge University Hospitals NHS Foundation Trust (CUH) died. Genomes were available for 700/1,167 (60%) residents from 292 care homes, and 409 distinct viral clusters were defined. We identified several probable transmissions between care home residents and healthcare workers (HCW). Interpretation Care home residents had a significant burden of COVID-19 infections and high mortality. Larger viral clusters were consistent with within-care home transmission, while multiple clusters per care home suggested independent acquisitions.
Subject(s)
COVID-19ABSTRACT
Background The diagnosis of infectious diseases has been hampered by reliance on microbial culture. Cultures take several days to return a result and organisms frequently fail to grow. In critically ill patients this leads to the use of empiric, broad-spectrum antimicrobials and mitigates against stewardship. Methods Single ICU observational cohort study with contemporaneous comparator group. We developed and implemented a TaqMan array card (TAC) covering 52 respiratory pathogens in ventilated patients undergoing bronchoscopic investigation for suspected pneumonia. The time to result was compared against conventional culture, and sensitivity compared to conventional microbiology and metagenomic sequencing. We observed the clinician decisions in response to array results, comparing antibiotic free days (AFD) between the study cohort and comparator group. Findings 95 patients were enrolled with 71 forming the comparator group. TAC returned results 61 hours (IQR 42-90) faster than culture. The test had an overall sensitivity of 93% (95% CI 88-97%) compared to a combined standard of conventional culture and metagenomic sequencing, with 100% sensitivity for most individual organisms. In 54% of cases the TAC results altered clinical management, with 62% of changes leading to de-escalation, 30% to an increase in spectrum, and investigations for alternative diagnoses in 9%. There was a significant difference in the distribution of AFDs with more AFDs in the TAC group (p=0.02). Interpretation Implementation of a customised syndromic diagnostic for pneumonia led to faster results, with high sensitivity and measurable impact on clinical decision making. Funding Addenbrookes Charitable Trust, Wellcome Trust and Cambridge NIHR BRC
Subject(s)
Pneumonia , Gerstmann Syndrome , Enterocolitis, Pseudomembranous , Communicable DiseasesABSTRACT
Background The burden and impact of healthcare-associated COVID-19 infections is unknown. We aimed to examine the utility of rapid sequencing of SARS-CoV-2 combined with detailed epidemiological analysis to investigate healthcare-associated COVID-19 infections and to inform infection control measures. Methods We set up rapid viral sequencing of SARS-CoV-2 from PCR-positive diagnostic samples using nanopore sequencing, enabling sample-to-sequence in less than 24 hours. We established a rapid review and reporting system with integration of genomic and epidemiological data to investigate suspected cases of healthcare-associated COVID-19. Results Between 13 March and 24 April 2020 we collected clinical data and samples from 5191 COVID-19 patients in the East of England. We sequenced 1000 samples, producing 747 complete viral genomes. We conducted combined epidemiological and genomic analysis of 299 patients at our hospital and identified 26 genomic clusters involving 114 patients. 66 cases (57.9%) had a strong epidemiological link and 15 cases (13.2%) had a plausible epidemiological link. These results were fed back clinical, infection control and hospital management teams, resulting in infection control interventions and informing patient safety reporting. Conclusions We established real-time genomic surveillance of SARS-CoV-2 in a UK hospital and demonstrated the benefit of combined genomic and epidemiological analysis for the investigation of healthcare-associated COVID-19 infections. This approach enabled us to detect cryptic transmission events and identify opportunities to target infection control interventions to reduce further healthcare-associated infections.