Development and operation of the defence COVID-19 lab as a SARS-CoV-2 diagnostic screening capability for UK military personnel.

BACKGROUND: In the face of the COVID-19 pandemic, the Defence Science and Technology Laboratory (Dstl) and Defence Pathology combined to form the Defence Clinical Lab (DCL), an accredited (ISO/IEC 17025:2017) high-throughput SARS-CoV-2 PCR screening capability for military personnel. LABORATORY STRUCTURE AND RESOURCE: The DCL was modular in organisation, with laboratory modules and supporting functions combining to provide the accredited SARS-CoV-2 (envelope (E)-gene) PCR assay. The DCL was resourced by Dstl scientists and military clinicians and biomedical scientists. LABORATORY RESULTS: Over 12 months of operation, the DCL was open on 289 days and tested over 72 000 samples. Six hundred military SARS-CoV-2-positive results were reported with a median E-gene quantitation cycle (Cq) value of 30.44. The lowest Cq value for a positive result observed was 11.20. Only 64 samples (0.09%) were voided due to assay inhibition after processing started. CONCLUSIONS: Through a sustained effort and despite various operational issues, the collaboration between Dstl scientific expertise and Defence Pathology clinical expertise provided the UK military with an accredited high-throughput SARS-CoV-2 PCR test capability at the height of the COVID-19 pandemic. The DCL helped facilitate military training and operational deployments contributing to the maintenance of UK military capability. In offering a bespoke capability, including features such as testing samples in unit batches and oversight by military consultant microbiologists, the DCL provided additional benefits to the UK Ministry of Defence that were potentially not available from other SARS-CoV-2 PCR laboratories. The links between Dstl and Defence Pathology have also been strengthened, benefitting future research activities and operational responses.

A user's view of commercial mobile applications designed to measure hand hygiene compliance by direct observation.

BACKGROUND: Mobile applications (apps) that facilitate the measurement of hand hygiene (HH) compliance rates by direct observation (DO) are widely available. Their usefulness for infection prevention and control (IPC) professionals has neither been recently reviewed nor formally assessed. AIM: To present a critical analysis of hand hygiene measurement apps. METHODS: Mobile apps were identified from four sources: PubMed, Apple app store, Google Play app store, Google search engine. Individual apps were then evaluated against a novel scoring system using seven key criteria considered relevant for IPC professionals. These included availability, price, automated data analysis, training requirement, compliance measured against the World Health Organization (WHO) 5 moments of HH, recent updates, and average app store rating. For each criterion, possible scores ranged from zero to two, with a maximum available score of 14 per app. FINDINGS: A total of 32 apps were identified of which 13 were suitable for analysis. Only three apps (19%) scored ≥12. Twelve apps (92%) allowed compliance to be measured against the WHO 5 moments of HH. Five apps (38%) were completely free to use, seven apps (54%) allowed for automatic analysis and reporting of HH data and only six apps (46%) had high app store ratings. CONCLUSION: The current mobile apps available for DO of HH generally scored poorly. In order to make these apps more useful to IPC professionals, they should be user-friendly and require less training prior to use. National IPC organizations should develop core standards for these apps to guide future development.

A survey of commercially available electronic hand hygiene monitoring systems and their impact on reducing healthcare-associated infections.

BACKGROUND: Although the benefits of electronic hand hygiene monitoring systems (EHHMSs) are well described, uptake has been poor since they were first introduced over 10 years ago. There is considerable published evidence on the association between the introduction of EHHMSs and improved hand hygiene (HH) compliance rates. However, their impact on healthcare-associated infection (HCAI) reduction is much less clear-cut. METHODS: Commercial EHHMS identification was undertaken using a Google internet search and all relevant websites and marketing materials were reviewed. A structured literature search was undertaken to identify evidence of HCAI reduction through EHHMS implementation. Structured interviews were undertaken with a number of Directors of Infection Prevention and Control (DIPCs) from acute NHS Trusts in the North West of England to seek opinions on HH improvement strategies and the use of EHHMSs. RESULTS: Twenty-nine commercial EHHMSs were identified, 20 of which are currently market active. Six EHHMSs had supporting evidence, across nine published studies, demonstrating their ability to reduce HCAIs. However, most evaluation designs were quasi-experimental with only one study using a high-quality stepped-wedge cluster randomized controlled trial design. In this study the EHHMS was part of a wider HH multi-modal improvement strategy. Structured interviews were undertaken with five DIPCs who consistently expressed a reluctance to support financial investment into this type of technology until EHHMS cost-effectiveness was better established. CONCLUSIONS: The evidence base for the ability of EHHMSs to reduce HCAIs needs to improve before NHS trusts will consider procuring them.

Healthcare workers' attitudes to how hand hygiene performance is currently monitored and assessed.

Engagement of healthcare workers (HCWs) is critical to maintaining high levels of hand hygiene (HH). However, attitudes of HCWs to how compliance is monitored has been poorly described. This study explored the HCW perspective on direct observation (DO) as a gold standard for HH monitoring. It also sought their opinions on innovative technology. A survey was emailed to all staff in two NHS trusts: 1120 responses were analysed. Nursing staff and doctors accounted for the largest quantity of responses; 58% of HCWs did not strongly endorse DO assessment of HH compliance. Staff were open to considering alternative innovative technologies.