Evaluating the cost implications of integrating SARS-CoV-2 genome sequencing for infection prevention and control investigation of nosocomial transmission within hospitals.

BACKGROUND: The COG-UK hospital-onset COVID-19 infection (HOCI) trial evaluated the impact of SARS-CoV-2 whole-genome sequencing (WGS) on acute infection, prevention, and control (IPC) investigation of nosocomial transmission within hospitals. AIM: To estimate the cost implications of using the information from the sequencing reporting tool (SRT), used to determine likelihood of nosocomial infection in IPC practice. METHODS: A micro-costing approach for SARS-CoV-2 WGS was conducted. Data on IPC management resource use and costs were collected from interviews with IPC teams from 14 participating sites and used to assign cost estimates for IPC activities as collected in the trial. Activities included IPC-specific actions following a suspicion of healthcare-associated infection (HAI) or outbreak, as well as changes to practice following the return of data via SRT. FINDINGS: The mean per-sample costs of SARS-CoV-2 sequencing were estimated at £77.10 for rapid and £66.94 for longer turnaround phases. Over the three-month interventional phases, the total management costs of IPC-defined HAIs and outbreak events across the sites were estimated at £225,070 and £416,447, respectively. The main cost drivers were bed-days lost due to ward closures because of outbreaks, followed by outbreak meetings and bed-days lost due to cohorting contacts. Actioning SRTs, the cost of HAIs increased by £5,178 due to unidentified cases and the cost of outbreaks decreased by £11,246 as SRTs excluded hospital outbreaks. CONCLUSION: Although SARS-CoV-2 WGS adds to the total IPC management cost, additional information provided could balance out the additional cost, depending on identified design improvements and effective deployment.

Troubled times: Canadian social workers' early adversities, mental health, and resilience during the COVID-19 pandemic

Canadian social workers were surveyed about early adversities, mental health, and resilience. Bivariate analysis (n = 236) was conducted to understand relationships between predictor and outcome variables;and logistic regression analyses were conducted for depression, post-traumatic stress disorder, anxiety, and resilience. The impact of pandemic-related factors was also investigated. The results indicate that social workers are experiencing concerning levels of mental health issues, with significantly lower levels of resilience in younger social workers. A trauma and resilience informed approach to workplace policies and practices is urgently required to support social workers' mental health needs.

Smoking and OMFS – How well are we recording tobacco use and referring to smoking cessation services?

smoking. Evidence shows that smokers who develop oral cancer have poorer outcomes than non-smokers. Additionally, smoking incidence is reported to be increased because of the COVID pandemic.We have a duty to discuss smoking with our patients and offer appropriate advice or referrals. Objectives are as follows: - To assess department compliance with the recording of smoking and tobacco history at initial consultation appointments - To aim for 100% compliance with the recording of smoking and tobacco quantity and duration - To increase number of successful referrals to smoking cessation services. Materials and Methods: Retrospective data collectionwas completed from 20 initial new patient consultations. Notes were assessed for the presence of the following: Smoking status and history, duration of smoking history, number of cigarettes smoked daily, and whether smoking cessation advice was given and/or a smoking cessation referral offered. Results of first round data collectionwere presented to the department and a ‘help to stop smoking’ referral form for smoking cessation services made readily available in the department. A second round of data collection was subsequently completed. Results: 60% of initial consultations recorded patient smoking status. Of this group, 42% are confirmed smokers. When smoking history has been recorded, the quantity of cigarettes was always recorded. The duration of smoking history was only successfully recorded in 60% of cases. No referrals were made to the smoking cessation service;however 60% of the confirmed smokers declined a referral offer. After intervention, a vast improvement is noted – 85% of clinical notes recorded patient status, with 25% confirmed smokers. There was an increase in referrals to smoking cessation referral services. Conclusions: All patients should be asked about smoking status and evidence recorded in clinical notes. Furthermore, smoking cessation advice should be given to all patients and referrals to smoking cessation services offered. Collaborative projects with the smoking cessation service have begun to further improve our patient care and oral health improvement.

ASTERIX: Adaptive stratification of COVID19 to facilitate endotype-directed intervention studies

Introduction and Objectives: Severe coronavirus 19 disease (COVID 19) has rapidly emerged as a global health threat and, despite considerable advances, outcomes remain poor in many patients. Published data infers considerable heterogeneity, with 80% suffering minimal symptoms but a minority developing life-threatening disease. COVID 19 trials to-date have been necessarily broad but the emergence of established therapies (e.g. Dexamethasone) and distinct phenotypes (e.g. immune activated, prothrombotic) suggests that early stratification to licensed or trial agents might result in improved outcomes. The ASTERIX study aims to define disease endotypes, based on baseline biological signatures associated with COVID-19 pneumonia, development of respiratory failure and death, which could be targeted in future trials. Methods: >6,000 samples of blood, urine and respiratory secretions were collected and banked during the first wave of the COVID 19 pandemic in Glasgow. The cohort is organised into Tiers 0, 1 & 2 with each tier having an increasing number of samples available for downstream translational research. All tiers have the same associated comprehensive clinical data including comorbidity, ethnicity, blood results, imaging, prescription data and outcomes, including critical care support and survival. Results: Tier 0 contains 1,512 cases, Tier 1 (defined by having at least one surplus sample banked for downstream assays) contains ~1000 cases. Tier 2 (defined as having matched samples of serum, plasma and a buffy coat) contains 421 cases. Sample collation and data analysis is ongoing but preliminary review indicates a mortality rate of 29%, which is consistent with that reported in UK-wide COVID 19 series. The project team have made extensive links with collaborators and a scientific review board has been convened. The following projects are at various stages of approval and delivery: (1) Host Epigenomics (2) Host Proteomics (3) Host Metabolomics (4) miRNA Outcome Signatures (5) Host Respiratory Microbiome (6) COVID 19 Coagulopathy. Conclusions: Data and banked samples will be used to develop endotypes (biological signatures derived from statistical models) associated with progression to key clinical outcomes. This information will be used to identify high-risk cohorts that could be targeted in future studies testing suitable interventions, as directed by the content of each signature.