Preventing healthcare-associated COVID-19

The issue of preventing healthcare-associated COVID-19 is very topical right now, to say the least (see this JAMA commentary), so now is a really good time to review what happened in our hospitals during the ‘first wave’ to help us prevent hospital transmission during the second.

The study was performed during the first wave of COVID-19 in London, between March and mid-April. The focus of the study was on ‘hospital-onset definite healthcare-associated’ (HODHA) COVID-19 infections (with a sample date >14 days from the day of admission). Overall, 58 (7.1%) of 775 symptomatic COVID-19 infections in hospitalised patients were HODHA. Key findings included:

  • Compared with community-associated COVID-19, patients with HODHA were more likely to be older, Black Asian or Minority Ethnicity (BAME), have several clinical underlying conditions (e.g. malignancy), and had an increased length of stay after COVID-19 diagnosis. Surprisingly, there was no increased risk of mortality (either 7, 14, or 30-day) or ICU admission.
  • There was an interesting analysis of the impact of a delayed positive test (where there was no positive test within 48 hours of symptom development). This occurred in about a third of HODHA cases, and was associated with an increased risk of 30-day mortality.
  • A potential source patient (a positive case on the same ward within 14 days of the positive test) was identified for 44/58 HODHA cases.
  • There was a correlation between weekly self-reported sickness absence incidence and weekly HODHA incidence.

This is a similar piece of work to our analysis of healthcare-associated COVID-19. The period of time covered was almost identical (from March to mid-April) and the number of HODHAs was very similar (62 in our study compared with 58 in this study). This seems to illustrate how indiscriminate this outbreak has been regionally – a wave of healthcare-associated COVID-19 swept through our hospitals in March/April – and our job now is to reduce the size of this wave over the winter!

Face coverings, surgical masks, and face filtering piece (FFP) respirators: what’s the difference and how are they tested?

You’ll all have seen wide variety of masks and face coverings worn in a wide (and often alarming!) variety of ways. Leaving aside the (in)correct wearing of masks, it’s useful to see some comparative data on the relative respiratory protection offered by different mask materials. This study, published years ago (pre COVID!), does just that.

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Please, no gloves to prevent COVID-19

gloves thumbs down

There are rumblings that glove wearing (aka “hand coverings“) are being considered as a widespread recommendation to prevent the spread of SARS-CoV-2 in public places (e.g. shops) in the UK. The message of this post is simple – please, no gloves. Convincing clinical staff of the unintended consequences of glove overuse is tricky enough. But widespread use of gloves in public places like shops may just bring me to tears. (Unless anybody can point me in the direction of solid evidence that this is likely to have a net benefit in reducing transmission…!).

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Exploring SARS-CoV-2 hospital surface and air contamination in London

We have just had a study published in Clinical Infectious Diseases exploring the extent and magnitude of hospital surface and air contamination with SARS-CoV-2 during the (first!) peak of COVID-19 in London. The bottom line is that we identified pretty extensive surface and air contamination with SARS-CoV-2 RNA but did not culture viable virus. We concluded that this highlights the potential role of contaminated surfaces and air in the spread of SARS-CoV-2.

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The role contaminated surfaces in COVID-19 transmission: a HIS audience-led webinar

The next instalment of the HIS audience-led webinar series is on the role of contaminated surfaces in COVID-19 transmission. I was delighted to be part of the panel for this one:

  • Dr Lena Ciric – Associate Professor in Environmental Engineering, University College London
  • Dr Stephanie Dancer – Consultant Microbiologist, NHS Lanarkshire and Professor of Microbiology, Edinburgh Napier University, Scotland
  • Dr Manjula Meda – Consultant Clinical Microbiologist and Infection Control Doctor, Frimley Park Hospital
  • Dr Jon Otter – Infection prevention and control Epidemiologist, Imperial College London
  • Chair: Dr Surabhi Taori, Consultant microbiologist and infection control doctor, Kings College Hospital NHS Foundation Trust

Here’s the recording:

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Managing ventilation in the context of COVID-19: a HIS audience-led webinar

The next in the series of the HIS audience-led webinar on all-things ventilation in the management of COVID-19 went out recently. The panel consisted of:

  • Peter Hoffman – Consultant Clinical Scientist, London
  • Dr Chris Lynch – Graham Ayliffe Training Fellow, Sheffield Teaching Hospitals
  • Professor Catherine Noakes – Professor of Environmental Engineering for Buildings, University of Leeds
  • Karren Staniforth – Clinical Scientist, Nottingham University Hospitals NHS Trust
  • Dr James Price (chair) – Consultant in Infection Prevention & Control and Antimicrobial Stewardship, Imperial College Healthcare NHS Trust

The webinar video is below:

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COVID-19 & PPE / face coverings / masks / shields: personal safety depends on more than what you wear

There’s a huge amount of academic and pragmatic discussion and debate about the appropriate levels of PPE to wear in various healthcare settings to reduce the risk of spreading COVID-19 to yourself and others in healthcare settings. And more recently, when to wear face coverings / masks / shields in public areas of hospitals, on public transport, and in shops. However, there is much, much less discussion about the importance of careful doffing (removal) of PPE and face coverings etc in order to ensure the safe and effective use of PPE. This helpful Cochrane Review, updated for the COVID-19 era, covers a lot of ground and one key conclusion is that doffing is key: if it is done carefully, the risk of self-contamination is lower.

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The case for face shields in preventing the spread of COVID-19

face shield

I’ve been meaning to write this post for a while. As UK government guidance has changed, face masks and face coverings will be very much the norm on public transport and in healthcare settings soon. So, now is a good time to consider whether face shields could play a role in preventing the spread of COVID-19.

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Why I prefer ‘physical distancing’ rather than ‘social distancing’

Language is such a small thing when terms are clearly defined and I accept that ‘physical distancing’ and ‘social distancing’ are synonymous. However, the aim in my view is to remain socially connected whilst physically distancing, so that’s why I’m using physical distancing instead of social distancing.

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HIS webinar – Understanding hospital-onset and hospital-acquired COVID-19 infection

The second in the series of excellent Healthcare Infection Society (HIS) interactive audience-led webinars went out a few weeks ago. The theme for this was hospital-onset and hospital-acquired COVID-19 infections, and here’s the video.

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