ABSTRACT
Background: The onset of the COVID-19 pandemic facilitated a rapid acceleration of the Subcutaneous Immunoglobulin in the Community Program (SCIg Program) in the Northern Sydney Local Health District (NSLHD) due to clinical need. SCIg may be administered at home, whilst IVIg is an intravenous infusion of 6 hours' duration administered monthly in the Day Procedure Unit. Methods: Between 1 March and 30 June 2020, all patients receiving IVIg under the supervision of our immunologists were enrolled in the SCIg Program. An allergy/immunology Clinical Nurse Specialist or Registered Nurse Year 8 provided the first training session to all patients, encompassing instruction on product inspection, draw-up, needle insertion, administration via push and pump methods, standard infection control precautions, waste/sharps disposal, record-keeping, storage, adverse event recognition, product and consumable pick-up, product reconciliation, and contact portals. Subsequent training sessions were provided by CSL Behring in the community. All product, consumables and support were funded by the NSLHD. Health economic data was obtained for the cost of IVIg and SCIg delivery. Results: Sixty-two patients were enrolled. Seven refused SCIg training citing needle phobia (n = 4), and lifestyle reasons (n = 3). Fifty-five completed training in 1 to 3 weekly training sessions. The age range of patients was 18 to 90. Four patients reverted to IVIg in the 12-month follow-up period because of lifestyle (n = 3) or inadequate manual dexterity (n = 1). There was no change in the number of infections in the 12-month period before and after SCIG transition. The cost of IVIg in the preceding 12-month period was $179,982. The cost of SCIg for 12 months was $46,019, with a cost saving of $133,963. Discussion: Fifty-five patients completed training over a 3-month period. SCIg has been shown to be an effective alternative to IVIg in preventing bacterial infection in all patients, and is associated with significant improvement to health economics.
ABSTRACT
Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document.
Subject(s)
COVID-19 , Hospitalization , Humans , Intensive Care Units , Respiration, Artificial/adverse effects , SARS-CoV-2ABSTRACT
Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document.