104 The new virtual reality of CF care: Lessons learned in setting up a remote sampling service

ABSTRACT

Background: Regular microbiological sampling via cough swab or sputum collection is vital in CF care to detect early infection and implement timely optimal treatment [1]. Our service identifies on average 34 new Pseudomonas aeruginosa growths per year. Prior to the COVID-19 pandemic samples were performed routinely in pediatric CF outpatient clinic every 2-3 months by health care professionals and more frequently during pulmonary exacerbation;9 samples per patient per year on average. In March 2020 the UK went into its first lockdown, and 90% of our CF clinic appointments became virtual (video). A remote sampling service was rapidly implemented by the pediatric physiotherapy team. Methods: Sample packs with paid postage and compliant with Royal Mail regulations (UN3373) were sent out with written instructions. Parents wereaskedtotaketheirchild's sample, and avideo ofhowto complete and package the sample were provided. A physiotherapist was available virtually to guide the parent in sampling where necessary. Results: From July to December 2020, 640 sample packs were sent out to 340 children with CF in advance of their virtual clinic or following an urgent request. Only 588 (81.7%) specimens were returned, despite chasing late samples during the virtual clinic or sending reminders via text, required in approximately 25% of cases. Returned samples were received between 2 and 26 days of being taken. Conclusion: The postage delays experienced were concerning, not onlyas it increased the risk of the CF team missing the result, but also as Public Health England UK standards for microbiology investigations state that sputum should be processed promptly to reduce overgrowth with contaminants. Therefore, allresults received via post should be interpreted with caution, particularly if delayed [2]. The remote sample service was time-consuming, introduced a newcost to the service, and became harder to maintain as face-to-face services increased. However, as an urgent service improvement initiative it was successful as it picked up 35 new P. aeruginosa cases in 2020, which was in keeping with previous years' P. aeruginosa growths. This model has led to a more sustainable hospitalwide remote sampling service being established, now run by non-clinical teams. Remote sampling can now be requested electronically, saving time. Individualized QR codes are sent with the packs to be scanned by patients whenpostingthe specimen backThis informs the clinical teamso samples are not missed and can be actioned in a timely fashion.