Implementation of a successful statewide fit testing program: Breaking down the challenges and barriers

Background: Since its emergence, millions of people have acquired and died from SARS-CoV-2 infections. A key controversy has been how to protect health workers (HWs) when there is ambiguous evidence on the adequacy of personal protective equipment and fit testing. Operationalizing these requirements was very challenging as fit testing had not been routine practice in New South Wales (NSW) Health. Furthermore, it is impractical to fit test 140,000 HWs in the middle of a pandemic. Method(s): A multidisciplinary Respiratory Protection Program (RPP) board was convened with representatives from work health and safety, workplace relations and clinical teams along with legal and union delegates with the aim of providing strategic advice and guidance on implementation, monitoring, and outcomes of RPP. Result(s): Local implementation was led by Infection Prevention and Control and by experienced nurses and work health and safety experts. The program included the more complex aspects of managing HWs who are unable to pass a fit test due to religious, cultural, or medical conditions. During 2021 NSW Health performed 234,499 fit tests on 84,685 HWs with overall, 98% of HWs (n=83210) achieving a fit test pass, demonstrating the success of the program. Conclusion(s): Fit testing is now well established and continues as new staff enter the workforce, new respirators become available as well as repeat testing for those many frontline HWs who were fit tested early in the pandemic. The RPP board is progressing with an evaluation of the program to determine its impact, effectiveness, and sustainability in coming years.Copyright © 2022

Australia's pathway to a national centres for diseases control - Comparing the current infection prevention and control structures

Background: The COVID-19 pandemic has provided a focus for Infection Prevention and Control and unprecedented interest from all walks of the healthcare and non-healthcare system. There is little research information on state and national structures for Infection Prevention and Control across Australia. In Australia state and national programs were created to respond to healthcare associated infections (HAIs) and their prevention, however understanding the structures, connection or lack there off possibly the cause for historical disengagement by clinicians. This study compared the jurisdictional programs to begin to understand the complexities and need for improvement. Method(s): This study examined the characteristics of the HAI Programs across Australian national, states and territories and level of focus placed on IPC through publicly available. websites followed by a qualitative survey of jurisdictional program leads using a questionnaire. Result(s): There were variations to websites and consistent complexity for navigation. Differences were reported on staffing levels, resources, competency levels. governance, title of programs and focus areas, however themes within programs mostly consistent. Conclusion The complex nature, varied governance, staffing, resources, expertise and program priority differences and the lack of a consistent statewide governance structure has potentially contributed to a disconnected approach to IPC programs that fails to adequately support the notion of clinician engagement to IPC and also raises additional questions around national approach and narrative for an Australian CDC.Copyright © 2022

Prevotella differentially regulates the inflammatory response of human monocytes to SARS-CoV-2 spike glycoproteins

Patients suffering severe COVID-19 show an aggressive and excessive immune response against the SARS-CoV-2 coronavirus, known as a cytokine storm. If left untreated these patients face the risk of tissue damage, multi-organ failure and death. A high relative abundance of Prevotella copri has been reported in patients with newly diagnosed rheumatoid arthritis (RA). On the other hand, it has been observed that Prevotella histicola can modulate the inflammatory manifestations of autoimmune diseases like multiple sclerosis, and it is now being evaluated as a monoclonal microbial treatment in COVID-19. We observed that pre-treatment with P. histicola decreased NF-kB activation, while pre-treatment with P. histicola and P. copri decreased IRF activation in monocytes upon SARS-CoV-2 glycoprotein. Our findings suggest that exposure of blood immune cells, such as monocytes, to commensal species of Prevotella may reduce the inflammatory response to SARS-CoV-2 glycoprotein. Besides treatments targeting the viral infection, other treatments such as immunomodulation by bacteria aiming to reduce or regulate the inflammatory process in COVID-19 to avoid the development of related complications may be considered.

Fit testing and comfort evaluation of prophylactic dressing use for healthcare workers under N95/P2 respirators in one health service district in Australia.

BACKGROUND: This study evaluated the use of prophylactic dressings (silicone foam, silicone tape, hydrocolloid) under N95/P2 respirators to determine which dressings fit successfully. AIM: The aim was to develop a health service protocol for one state in Australia. METHODS: Data were collected during August and September 2021 as part of the Respiratory Protection Programme on 600 health workers using three types of prophylactic dressings. Five different types of respirators were used. Participant healthcare workers rated comfort on a four-point Likert scale. RESULTS: Successful fit was achieved by 63.6% of the respirator-dressing combinations. The best-performing respirator-dressing combination was the Trident® respirator with dressing Mepilex® Lite silicone foam (90.2% pass rate). High pass rates were found in the Trident® respirator with Mepilex® Border Lite with SofSicure silicone tape (79.1%); the 3M™ 1860 respirator with Mepilex® Border Lite with SofSicure silicone tape (74%); and the BSN orange duckbill respirator with Mepilex® Lite silicone foam (69.8%). The poorest-performing combination was the BYD™ respirator with Mepilex® Border Lite with SofSicure silicone tape (25.9% pass rate). Uncorrected chi-squared tests for association revealed significant associations between dressing type and outcome (P=0.004) and respirator type and outcome (P<0.001). Most respondents (82%) found the dressing combination markedly comfortable. CONCLUSIONS: When using prophylactic dressings under N95/P2 respirators, it is necessary to perform a fit test. In this study Trident® respirators had the highest probability of successful fit, while BYD™ respirators had the lowest. Combining Trident® respirators with Mepilex® Lite dressing was optimal. Most participants reported greater comfort with the dressings under the respirators.

Maintaining intravenous anti-cancer systemic therapy during COVID: Pharmacy and nursing factors

Background: The COVID-19 pandemic has impacted many aspects of the practice of oncology around the world. COVID was first detected in Ireland on 29/2/20. Many oncology units saw dramatic changes in activity in the face of rising infection rates. We aim to assess compare pharmacy activity, day unit systemic therapy adminstration and nursing staffing levels during the pre- and COVID periods. Methods: Hospital information systems were used to retrieve numbers of patients attending, numbers and types of items dispensed by pharmacy, and available nurses to deliver the systemic therapies from March 2019 to Feb. 2021. The data was analysed to identify trends in prescribing and dispensing practices for this period. Supportive medications such as anti-emetics, bisphosphosphonates were not included. Subgroup analysis on numbers of chemotherapy, immunotherapy, monoclonal antibody drugs dispensed per month was performed. A paired t-test was used to compare means. Results: 9410 non-clinical trials and 411 clinical trials items were dispensed from March 2019 until February 2020 (pre-COVID) for 11,606 patient attendances. From March 2020 until February 2021 (COVID period), 8931 non-clinical trials and 826 clinical trials items were dispensed for 10818 patient attendances. The mean number of non-clinical trials items dispensed per month were 784 and 744 respectively, with no statistical difference being found (p=0.11). There was a doubling in the number of clinical trials agents dispensed. The mean number of nurses available to administer therapies per day was 5.7 (SD=0.78) compared to the projected 7.8 WTE (whole time equivalents) ideally required. [Formula presented] Conclusions: Despite COVID restrictions it was possible to administer comparable numbers of cancer treatments throughout the COVID period, when compared to the previous year despite modest nursing staff numbers due to the dedication and selflessness of nursing, oncologists and oncology pharmacy staff. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.