Reducing broad-spectrum antibiotic use in intensive care unit between first and second waves of COVID-19 did not adversely affect mortality.

BACKGROUND: The COVID-19 pandemic increased the use of broad-spectrum antibiotics due to diagnostic uncertainty, particularly in critical care. Multi-professional communication became more difficult, weakening stewardship activities. AIM: To determine changes in bacterial co-/secondary infections and antibiotics used in COVID-19 patients in critical care, and mortality rates, between the first and second waves. METHODS: Prospective audit comparing bacterial co-/secondary infections and their treatment during the first two waves of the pandemic in a single-centre teaching hospital intensive care unit. Data on demographics, daily antibiotic use, clinical outcomes, and culture results in patients diagnosed with COVID-19 infection were collected over 11 months. FINDINGS: From March 9th, 2020 to September 2nd, 2020 (Wave 1), there were 156 patients and between September 3rd, 2020 and February 1st, 2021 (Wave 2) there were 235 patients with COVID-19 infection admitted to intensive care. No significant difference was seen in mortality or positive blood culture rates between the two waves. The proportion of patients receiving antimicrobial therapy (93.0% vs 81.7%; P < 0.01) and the duration of meropenem use (median (interquartile range): 5 (2-7) vs 3 (2-5) days; P = 0.01) was lower in Wave 2. However, the number of patients with respiratory isolates of Pseudomonas aeruginosa (4/156 vs 21/235; P < 0.01) and bacteraemia from a respiratory source (3/156 vs 20/235; P < 0.01) increased in Wave 2, associated with an outbreak of infection. There was no significant difference between waves with respect to isolation of other pathogens. CONCLUSION: Reduced broad-spectrum antimicrobial use in the second wave of COVID-19 compared with the first wave was not associated with significant change in mortality.

Comparison of Antibiotic Use between the First Two Waves of COVID-19 in an Intensive Care Unit at a London Tertiary Centre: reducing broad-spectrum antimicrobial use did not adversely affect mortality

Background The COVID-19 pandemic increased the use of broad-spectrum antibiotics due to diagnostic uncertainty, particularly in critical care. Multiprofessional communication became more difficult, weakening stewardship activities. Aim To determine changes in bacterial co-/secondary infections and antibiotics used in COVID-19 patients in critical care, and mortality rates, between the first and second waves. Methods Prospective audit comparing bacterial co-/secondary infections and their treatment during the first two waves of the pandemic in a single centre teaching hospital ICU. Data on demographics, daily antibiotic use, clinical outcomes, and culture results in patients diagnosed with COVID-19 infection were collected over 11 months. Findings From 9/3/20 to 2/9/20 (Wave 1), there were 156 patients and between 3/9/20 and 1/2/21 (Wave 2) there were 235 patients with COVID-19 infection admitted to intensive care. No significant difference was seen in mortality or positive blood culture rates between the two waves. The proportion of patients receiving antimicrobial therapy (93.0% vs 81.7%;p<0.01), and the duration of meropenem use (median (interquartile range): 5 (2-7) vs 3 (2-5) days;p=0.01) was lower in Wave 2. However, the number of patients with respiratory isolates of Pseudomonas aeruginosa (4/156 vs 21/235;p<0.01) and bacteraemia from a respiratory source (3/156 vs 20/235 p<0.01) increased in Wave 2, associated with an outbreak of infection. There was no significant difference between waves with respect to isolation of other pathogens. Conclusions Reduced broad spectrum antimicrobial use in the second wave of COVID-19 compared with the first wave was not associated with significant change in mortality.

Remote training using augmented reality on surgical phantoms

Introduction & Objectives: Workshops with hands-on training using phantoms (anatomical models) are well-known methods for training clinicians and residents. However, during the Covid-19 pandemic it was not possible to attend workshops owing to the restrictions imposed by the lock-down. As a result, both the medical device industry and clinicians were not able to keep current with their skills. We introduce a novel method of education using augmented reality that virtually places the trainer (proctor) in the same room as the student during the procedure.(Figure Presented)A training simulation was created where a proctor trained a student in transperineal local anesthesia and biopsy using a prostate phantom. The hardware platform consisted of a headset containing see-through optic displays with an imbedded webcam. The image from the ultrasound machine was displayed in the optics of the headset, allowing the proctor to view the ultrasound image while looking at the phantom and his hands simultaneously (figure). A web-based software program was developed that displayed the ultrasound image and the video of the proctor’s hands (captured by the imbedded web cam) in a stacked format. These images were transmitted to the student (in a different room) who also wore a comparable headset. Both proctor and student had an ultrasound unit (BK Medical 5000 and 3000 with model 9048 probes) and prostate phantoms (SIM, Inc.). The proctor then demonstrated how to perform the local anesthesia and transperineal biopsy procedure, step by step, while the student observed these in his headset. After each step of the procedure the proctor changed the active feed so he could watch in his own headset the student performing that same step and further instruct him. s EAU22 – 37th Annual EAU Congress Eur Urol Suppl 2022;81(S 1):S1769 Results: The Remote Training Platform allowed the proctor to successfully demonstrate the prostate block and transperineal biopsy techniques to the student. The student was able to ask the proctor for instructions while the proctor was able to annotate additional information on the student’s ultrasound. Successful completion of both procedures was accomplished. Conclusions: The beta testing of this Remote Training Platform demonstrated that augmented reality combined with dedicated hardware and software could provided an efficient means of training physicians in new technology. Eliminating the need for the proctor to travel could increase the safety and efficiency for the introduction of new medical devices and resident education.

Virtual hands-on training of image-guided urologic procedures during the COVID-19 pandemic

INTRODUCTION AND OBJECTIVE: Image-guided training traditionally requires instructors and students to work in close proximity to impart skills and master new medical devices. The classical method of training has been prohibitive during the Covid-19 pandemic. We determined the value of using virtual training on inanimate models that closely replicate the prostate gland on ultrasound and MRI. METHODS: Six urologic procedures which included the injection of a rectal hydrogel spacer, transperineal biopsy, mpMRI fusion biopsy (2 different devices), Cesium-131 implant and focal brachytherapy were taught by urology and radiation oncology experts via a webinar (example in Figure 1). The prostate phantoms were designed to maximize the learning experience and included MRI visible lesions. The training lasted 30 minutes for each procedure. Seven faculty and 110 attendees participated. Survey Monkey was used to assess the education experience of both groups. RESULTS: 31 attendees and the 7 faculty completed the survey. All the faculty responded the phantom simulated human tissue, was easy to set up, and was superior to using a live patient (Table 1). 42.8% believed that 30 minutes was adequate for training. 100% of the attendees also believed the phantom simulated human tissue (Table 1). In contrast to the faculty, only 19.4% of attendee's believed 30 minutes was adequate. 90.3% of the attendees reported that the prostate phantom could substitute for training on a live patient. CONCLUSIONS: This was the first demonstration of remote learning on a physical prostate phantom. While the faculty had more confidence that 30 minutes training was adequate, the attendees requested their own phantom for training. The Covid-19 pandemic provided the opportunity to introduction a novel training approach. Expansion of this method to more complex procedures could substitute for teaching on live patients. Providing phantoms to instructors and attendees represents a future expansion of remote learning.

Occupational dermatoses during the COVID-19 pandemic: A multicentre audit in the U.K. and Ireland

Healthcare workers (HCWs) need to wear personal protective equipment (PPE) during the COVID-19 pandemic. Studies from China report high rates of irritant dermatitis in frontline HCWs (Pei S, Xue Y, Zhao S et al. Occupational skin conditions on the front line: a survey among 484 Chinese healthcare professionals caring for Covid-19 patients. J Eur Acad Dermatol Venereol 2020;Epub ahead of print). The British Society of Cutaneous Allergy conducted an audit of occupational dermatoses in HCWs. Eleven centres in the U.K. and Ireland organized occupational skin disease clinics to treat PPE-related dermatoses. A standardized proforma was completed, which included information about site, dermatological history, occupation, working environment, shift pattern, sick leave, PPE and handwashing practices. Diagnosis and treatment were advised during a virtual consultation. Each participating unit entered anonymized audit data into a spreadsheet. Data from 200 HCWs were collected in May and June 2020. Forty-three per cent (n = 86) worked in England;30.5% (n = 61) in Scotland, 13.5% (n = 27) in Ireland and 13.0% (n = 26) in Wales. Median age was 36 years. Ninety per cent (n = 180) were female;67.0% (n = 134) had nursing roles. The face was affected in 46.5% (n = 93) and hands in 46.0% (n = 92). In 94.0% of cases (n = 188) the clinical findings were felt to be occupational or partially occupational, with the most common diagnosis being irritant contact dermatitis: 59.0% of patients (n = 118). Seventeen per cent (n = 35) had required time off work (292.5 days in total;range 0.5-28). The mean number of hours of PPE wear per shift was 6.9 [median 7.5, interquartile range (IQR) 4-10]. Those who wore PPE for longer periods had more time off;each hour of wearing PPE during a shift increased the time off by 0.2 days [95% confidence interval (CI) 0.002-0.344;P = 0.048]. The mean number of handwashes with soap per day was 22.7 (median 20, IQR 10-30). Each handwash increased the expected number of days off by 0.03 (95% CI -0.013 to 0.069;P = 0.174). The mean number of uses of alcohol gel per day was 19.2 (median 10, IQR 5-30). There was an inverse association with use of alcohol gel and time off;each use of alcohol gel per day reduced the expected number of days off by 0.03 (95% CI 0.002-0.066;P = 0.04). These data indicate that the duration of wearing PPE, frequency of handwashing and use of alcohol gel have a significant effect on the time off work for HCWs.

A novel cohorting and isolation strategy for suspected COVID-19 cases during a pandemic.

BACKGROUND: The COVID-19 pandemic presents a significant infection prevention and control challenge. The admission of large numbers of patients with suspected COVID-19 disease risks overwhelming the capacity to protect other patients from exposure. The delay between clinical suspicion and confirmatory testing adds to the complexity of the problem. METHODS: We implemented a triage tool aimed at minimizing hospital-acquired COVID-19 particularly in patients at risk of severe disease. Patients were allocated to triage categories defined by likelihood of COVID-19 and risk of a poor outcome. Category A (low-likelihood; high-risk), B (high-likelihood; high-risk), C (high-likelihood; low-risk) and D (low-likelihood; low-risk). This determined the order of priority for isolation in single-occupancy rooms with Category A the highest. Patients in other groups were cohorted when isolation capacity was limited with additional interventions to reduce transmission. RESULTS: Ninety-three patients were evaluated with 79 (85%) receiving a COVID-19 diagnosis during their admission. Of those without a COVID-19 diagnosis: 10 were initially triaged to Category A; 0 to B; 1 to C and 4 to D. All high-risk patients requiring isolation were, therefore, admitted to single-occupancy rooms and protected from exposure. Twenty-eight (30%) suspected COVID-19 patients were evaluated to be low risk (groups C and D) and eligible for cohorting. No symptomatic hospital-acquired infections were detected in the cohorted patients. DISCUSSION: Application of a clinical triage tool to guide isolation and cohorting decisions may reduce the risk of hospital-acquired transmission of COVID-19 especially to individuals at the greatest of risk of severe disease.