ABSTRACT
BACKGROUND: Hospital transmission of SARS-CoV-2 has proved difficult to control, with healthcare-associated infections troublesome throughout. AIM: To understand factors contributing to hospital transmission of infections, which is necessary for containing spread. METHODS: An outbreak of 56 staff and patient cases of COVID-19 over a 31-day period in a tertiary referral unit is presented, with at least a further 29 cases identified outside of the unit and the hospital by whole genome sequencing (WGS). FINDINGS: Transmission is documented from staff to staff, staff to patients, and patients to staff, showing disruption of a tertiary referral service, despite implementation of nationally recommended control measures, superior ventilation, and use of personal protective equipment. There was extensive spread from the index case, despite this patient spending only 10 h bed bound on the ward in strict cubicle isolation and with an initial single target low level (CT = 32) polymerase chain reaction test. CONCLUSION: This investigation highlights how effectively and rapidly SARS-CoV-2 can spread in certain circumstances. It raises questions about infection control measures in place at the time and calls into question the premise that transmissibility can be reliably detected by using lower sensitivity rapid antigen lateral flow tests. We also highlight the value of early intervention in reducing impact as well as the value of WGS in understanding outbreaks.
ABSTRACT
We present an outbreak of 56 staff and patient cases of COVID-19 over a 31 day period in a tertiary referral unit, with at least a further 29 cases identified outside of the unit and the hospital by whole genome sequencing (WGS). We document transmission from staff-to-staff, staff-to-patients and patients-to-staff and show disruption of a tertiary referral service, despite implementation of nationally recommended control measures, superior ventilation and use of PPE. We demonstrate extensive spread from the index case, despite them spending only 10 hours bed bound on the ward in strict cubicle isolation and with an initial single target low level (CT=32) PCR test. This investigation highlights critical issues including how effectively and explosively SARS-CoV-2 can spread in certain circumstances. It raises questions about infection control measures in place at the time and calls into question the premise that transmissibility can be reliably detected using lower sensitivity rapid antigen lateral flow tests. We also highlight the value of early intervention in reducing impact as well as the value of WGS in understanding outbreaks.
ABSTRACT
Background: People living with and after cancer may experience complex physical and psychosocial issues requiring multidisciplinary support. While adults over the age of 65 are the group most commonly diagnosed with cancer, they also represent the group most under-represented in research. Therefore, this study aims to explore older adults' perceptions of priorities for research in cancer and haematological malignancies. Methods: A descriptive qualitative study was undertaken with sixteen older adults over the age of 65 who were living with or after a diagnosis of cancer. Participants were purposively recruited via a regional cancer centre and cancer advocacy organisations. Participants engaged in a one-to-one semi-structured telephone interview, which discussed their experiences of cancer, and their perceptions of cancer-related issues which they believed were priorities for research in the future. Qualitative data were thematically analysed. Results: Participants were overwhelmingly satisfied with the cancer-related care they received, but discussed a variety of issues related to their experiences of information, symptoms, and support beyond the hospital setting which warranted further research. Forty-two priorities for future research were categorised within six themes, containing a total of eleven sub-themes. Priorities for future research included the recognition of the signs and symptoms of cancer in older adulthood;research about cancer treatments for older adults;supporting the assessment and management of co-morbidities;the unmet needs of older adults living with and after cancer;the impact of COVID-19 on people living with or after cancer and on cancer services;and the impact of cancer on caregivers and family members. Conclusions: The results of this study represent a basis for future priority setting for research in the field of geriatric oncology. The results of this study have the potential to underpin priorities for research which are driven by the population who are most affected by, and most in need of research to address the complex issues associated with diagnosis, treatment, survivorship, and end of life care for people living with or after cancer in older adulthood. Legal entity responsible for the study: University College Dublin. Funding: Irish Research Council. Disclosure: A. Drury: Financial Interests, Personal, Full or part-time Employment: University College Dublin;Financial Interests, Institutional, Research Grant, I am a collaborator on the Pfizer-funded project ABC4Nurses, which is coordinated and managed by EONS: Pfizer;Non-Financial Interests, Invited Speaker: European Oncology Nursing Society;Non-Financial Interests, Advisory Role, I am an advisor on several EONS projects, including ABC4Nurses and RCC & HCC PROMS: European Oncology Nursing Society. All other authors have declared no conflicts of interest.