COVID-19 ain’t what it used to be

As the COVID-19 pandemic has swept through various epidemic waves each characterised by a different variant, the trend has been towards more transmissibility but less virulence of SARS-CoV-2. The emergence of the Omicron variant continued this trend, and we are now seeing some data to compare the clinical outcomes of COVID-19 with other variants. A huge Lancet study (1.5m patients!) demonstrates clearly that the risk of hospital attendance, hospitalisation, and death is significantly lower with Omicron compared with Delta. This is important because the consequences of SARS-CoV-2 acquisition are an important factor in deciding on our management strategy – as a hospital group and in general.  

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Everybody’s talking about the Lancet Commission on COVID-19

The Lancet has published a hard-hitting piece on lessons learned from the COVID-19 pandemic. The report includes a blow-by-blow account of the pandemic and the lessons that have emerged, and some important recommendations from a global public health viewpoint. Unsurprisingly, this piece has generated a lot of interest and people are talking about it, which is no bad thing!

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Improving environmental hygiene reduces HCAI: but which monitoring method is most effective?

A superb cluster randomised trial has just been published in Clinical Infectious Diseases testing whether improved environmental hygiene via objective monitoring and feedback reduces HCAI. The study also tests whether ATP or UV fluorescent marker monitoring is more effective. The findings reinforce that improving environmental hygiene reduces HCAI, and (I think surprisingly) suggest that ATP is more effective than UV monitoring.

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Beware reusable PPE!

A new JHI study highlights the dangers associated with reusable PPE, and related to PPE doffing in general. The study used a clinical simulation suite to monitor the spread of fluorescent material added to the outside of an N95 respirator during routine care for mannequin adult patients (with COVID-19!). Whilst some modes of PPE reuse were better than others, all of the clinicians involved in the study ended up contaminating the clinical environment with fluorescent material originating from the mask.

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Stand-alone air decontamination units: some questions…

I’ve been involved recently in a comparative evaluation of several stand-alone air decontamination units. Please feel free to take a look at our (very!) preliminary findings here. I also attended the HIS Spring Meeting today, which was all about ventilation in healthcare settings. Whilst I found the day interesting and thought provoking, I’ve left with more questions than I had before!

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COVID-19 – what have we learned?

I did a talk at an IPC conference the other day trying to summarise what we’ve learned from the COVID-19 pandemic. You can see my slides here. I think (hope) we have learned a lot – and still have more to learn – about (in no particular order): PPE, transmission routes, testing and laboratory factors, vaccination, organizational transformation, guidelines and policy development, regulatory framework, outbreaks, non-COVID pathogens, antimicrobial stewardship, digital transformation, applied research, and the mental health of our workforce.

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We need to talk about gloves…

As we warm up for world hand hygiene day tomorrow, it’s a good time to have a talk about gloves. I challenge you to go onto a hospital ward and time how long it takes before you see some questionable glove practice. It won’t be long before you see somebody coming out of a room used by a patient on some transmission based precautions with gloves on. Or somebody commuting around the ward with gloves on. Or somebody putting gloves on in preparation for patient care who can’t quite articulate why. So, as many of us launch new patient care pathways in the next phase of the pandemic, and as the national IPC manual has just been published in England, it’s a really good time to talk about when we don’t need to use gloves, which is most of the time!

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Do stand-alone air disinfection units reduce HCAI?

Wow, it’s been ages since I’ve posted – sorry about that. I’m blaming the Omicron wave and my own personal dose of COVID-19 recently (you can see my reflections about that on Twitter…)

And so to today’s blog. Lots of interest in air disinfection systems. And some important research articles coming through. This one in JHI caught my attention, because there’s a suggestion of a link between improved air hygiene and reduced HCAI. However, I am unconvinced (from this study) that this link has been demonstrated – so a key opportunity for applied research!

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Lateral flow or PCR?

As England moves away from confirmatory PCR testing following a positive lateral flow test in the absence of COVID-19 symptoms, it’s a good time to look at what these two different testing strategies can offer us. There’s an excellent short review in NEJM combined with a case study to help illustrate the impact of pre-test probability plays out. Both lateral flow testing and PCR testing have their place, and in some ways lateral flow testing is a better correlate for infectivity (as well as being cheaper and easier!).

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Omicron: things are moving quickly and looking better…but we’re not there yet

My last post on Omicron was on 22/12/2021, 15 days ago, which seems like a lifetime ago! Back then, there was a great deal of uncertainty about how Omicron would manifest clinically, and how this would translate into hospitalisations and deaths. We now known more, but there is still considerable uncertainty. The latest technical briefing from UKHSA provides additional epidemiological updates. And the latest ONS study on prevalence in the UK gives us some eye-watering figures: in the week ending 31/12/2021, 1 in 25 people in England were infected with COVID-19, and 1 in 15 people in London. There’s a lot of it about. Overall, the outlook is looking better, but it’s going to be a very bumpy ride for those working in healthcare over the next month or so.

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