Reducing Hospital-Onset C. diff with a Provider-Driven Emergency Department Ordering Algorithm

Background. Clostridoides difficile (C. diff) can cause diarrhea and inflammation of the colon. It is one of the most common causes of heathcare-associated infections (HAIs), estimated to cause almost half a million illnesses and thousands of deaths in the United States each year. Studies have estimated that this HAI costs up to $4.8 billion each year in excess healthcare costs for acute care facilities. Early identification, treatment and initiation of isolation precautions is crucial to patient care and transmission reduction, making the Emergency Department ideal partners in efforts to reduce C. diff infections. Methods. A C. diff testing algorithm was introduced specific to the Emergency Department in March, 2021, promoting earlier testing and isolation of patients suspected of having C. diff. Emergency medicine clinicians were awarded the "Golden Spore" Award weekly when appropriately initiating the C. diff testing and isolation, provided the patients met criteria, or were clinically suspected of having a C. diff infection. C. diff ordering algorithm Ordering algorithms were printed and placed in the clinician's work area to facilitate increased ordering of isolation and testing of potentially infected patients. GoldenSporeAward The Golden Spore is awarded weekly to emergency clinicians who successfully identify and isolate C. diff patients prior to admission. Results. As a result of the COVID-19 pandemic, there were varying degrees of challenges for implementation of the program. Emergency clinicians sent 199 C. diff tests pre-intervention (3/15/20-3/14/21) and 234 tests post-intervention (3/ 15/21-3/14/22). Pre-intervention, 44 patients were found to be C. diff positive prior to admission, compared to 62 post-intervention. Clinicians enjoyed the "golden spore" award and were excited to participate. Conclusion. The program is ongoing, though the initial results are encouraging. There was an immediate increase in the testing and subsequent isolation of patients while in the ED. Infection prevention and emergency medicine clinicians worked together to boost their numbers, and the "golden spore" continues to be awarded in weekly newsletters. Clinicians indicated they enjoyed the engagement, and found that the small change in a routine process improved their baseline awareness of potential C. diff patients, leading to an increase in the number of tests and subsequent discovery of C. diff positive patients. C. diff champions were also named and the algorithm will be shared with additional emergency departments within our system to continue to improve detection and prevention of hospital associated infections.

Infectious disease risk communication and engagement using puppetry and related approaches for improving handwashing with soap in an informal settlement of Nairobi

Handwashing with soap (HWWS) has been estimated to have the potential to prevent 35% of the 704,880 deaths per year caused by diarrhoeal infectious diseases (UN Millennium Project, 2018), its wider risk reduction influence subsequently accentuated in times of COVID-19. However, this depends on place specific risk communication that leads to behaviour change, particularly amongst children in economically poor neighbourhoods. A study centred on five schools in the in -formal settlement of Kawangware, Nairobi found that puppetry, shadow shows and school model making produced effective risk communication and engagement spaces. Increased HWWS oc-curred when children designed, owned, and were able to apply risk communication.

Education and equalities in Britain, 2010–2022: due regard and disregard in a time of pandemic

This article recalls the key concept of due regard in the Equality Act 2010 and outlines how it was increasingly ignored by the Department for Education (DfE) in England in the following decade. Further, it speculates that if the concept of due regard had been observed more rigorously across all government departments, the COVID-19 pandemic would have been less tragic and traumatising in its effects, and less responsible for deepening inequalities throughout British society. It concludes that the Act should be revisited, revised and re-emphasised. © 2022, Robin Richardson.

Supporting surgeons in their return to training

Aim: t any one time, approximately 10% of the junior doctor workforce (∼5000 doctors) take time out of training. Following the Bawa Gaba case, and with trainees shielding during the COVID pandemic, there is greater scrutiny and demand to support trainees returning to the frontline. Supported Return to Training (SuppoRTT) is a Health Education England Program designed to improve the Return-To-Training (RTT) experience. For surgical specialties there are additional challenges of reintroducing trainees to practical skills. Method: e designed and facilitated the first regional SuppoRTT course for Orthopaedic Specialist Registrars, which consisted of peer and consultant- led clinical updates, forum discussions and externally commissioned professional coaching. A pre-course survey established participants' concerns and expectations about RTT and formed the basis of discussions. A post-course survey assessed value of the course and impact on participants. Results: Eight participants (6 female) attended. Grade of training on return ranged from ST3 to ST8. Main areas of concern related to colleague perception, reduced confidence with decision-making, operative skill fade, and frustrations with organisational elements of managing worklife balance. There was an overwhelmingly positive response to the support offered on our course, particularly to the discussions around RTT concerns and returning to on-calls. All respondents strongly agreed that sharing their concerns and hearing about peer experience was valuable. Conclusions: High numbers of trainees take approved time out of training. RTT is associated with anxiety around performance and safety. Surgical trainees can be supported with a targeted course that offers clinical update, peer support and professional coaching.

Incidence of candidaemia in prolonged venovenous extracorporeal membrane oxygenation.

This single-centre retrospective study reports the dynamics of the incidence of candida bloodstream infection (CBSI) in 145 patients receiving venovenous extracorporeal membrane oxygenation (ECMO) for respiratory support between January 2014 and December 2018. The incidence rate and odds ratio (OR) of CBSI were calculated, stratified by week of ECMO exposure. Weekly incidence increased throughout the ECMO run, with an increasing trend in OR (P=0.005), and a window of continued risk after decannulation was observed. Of the 13 patients who developed CBSI, five (38%) received empirical micafungin treatment before positive culture due to clinical suspicion. There is a need for prospective studies aiming to improve ECMO diagnostic stewardship practices and discourage unnecessary antifungal prophylaxis or empiric management.

The development and implementation of a virtual discharge ward for patients with covid-19 pneumonia: Data on the first 300 patients

Introduction There is little described in the current COVID-19 literature about the outcomes of patients discharged from hospital following COVID-19 pneumonia. We describe the rapid establishment of a 'virtual ward' (VW) for followup of patients with a suspected or confirmed diagnosis of COVID-19 pneumonia or pneumonitis upon hospital discharge, characteristics and outcomes for the first 300 patient referrals. Methods Admitted patients with a confirmed/suspected diagnosis of COVID-19 pneumonia/pneumonitis were referred electronically to the VW on discharge. Pulse oximeters were provided if oxygen saturations were <92%. The 'tracking board' was reviewed daily and phone calls carried out to assess patients for symptom improvement, stability or deterioration. If cause for concern was raised, same-day review for the patient at home was arranged via predetermined community pathways or patients were transferred urgently to hospital. Results The M:F ratio was 2:1 and 25% of patients were of black and minority ethnic origin. 71% of patients had at least 1 co-morbidity. 31% of patients were SARS-CoV-2 PCR negative on respiratory tract samples but had high clinical suspicion of COVID-19. 70% of patients had radiological changes on CXR/CT formally reported as being consistent with COVID-19. Median Length of stay (LOS) on the VW was 3.5 days [range 0-19], 85% of patients had a LOS £7 days. Around half (158, 53%) of patients had required oxygen during admission. Pulse oximeters were provided to 31 (10%) of patients. Outcomes are shown in figure 1. Thirty-eight (13%) patients re-attended the Emergency Department;28 were readmitted;of these, 3 were ventilated for respiratory failure, 5 had increasing oxygen requirements and 8 had confirmed pulmonary embolism. 12 had other reasons for admission. 2 patients readmitted by the VW died, both had underlying terminal diagnoses. Conclusions To our knowledge, this is the first description of the characteristics of patients discharged from UK hospitals with COVID-19. We have demonstrated that a virtual COVID-19 ward allowed early discharge of patients, offering a safety net and reassurance for patients and clinicians at the time of discharge. Use of pulse oximeters allowed for early identification of clinical deterioration, enabling prompt readmission when required.

VECMAtk: a scalable verification, validation and uncertainty quantification toolkit for scientific simulations.

We present the VECMA toolkit (VECMAtk), a flexible software environment for single and multiscale simulations that introduces directly applicable and reusable procedures for verification, validation (V&V), sensitivity analysis (SA) and uncertainty quantication (UQ). It enables users to verify key aspects of their applications, systematically compare and validate the simulation outputs against observational or benchmark data, and run simulations conveniently on any platform from the desktop to current multi-petascale computers. In this sequel to our paper on VECMAtk which we presented last year [1] we focus on a range of functional and performance improvements that we have introduced, cover newly introduced components, and applications examples from seven different domains such as conflict modelling and environmental sciences. We also present several implemented patterns for UQ/SA and V&V, and guide the reader through one example concerning COVID-19 modelling in detail. This article is part of the theme issue 'Reliability and reproducibility in computational science: implementing verification, validation and uncertainty quantification in silico'.