Burden of nosocomial COVID-19 in Wales: results from a multicentre retrospective observational study of 2508 hospitalised adults.

The burden of nosocomial SARS-CoV-2 infection remains poorly defined. We report on the outcomes of 2508 adults with molecularly-confirmed SARS-CoV-2 admitted across 18 major hospitals, representing over 60% of those hospitalised across Wales between 1 March and 1 July 2020. Inpatient mortality for nosocomial infection ranged from 38% to 42%, consistently higher than participants with community-acquired infection (31%-35%) across a range of case definitions. Those with hospital-acquired infection were older and frailer than those infected within the community. Nosocomial diagnosis occurred a median of 30 days following admission (IQR 21-63), suggesting a window for prophylactic or postexposure interventions, alongside enhanced infection control measures.

Strategies to promote guideline adoption: lessons learned from the implementation of a national COVID-19 hospital guideline across NHS Wales.

There is little understanding about what proportion of the target audience have read guidelines published through the traditional approach. The COVID-19 pandemic created a particularly difficult scenario for healthcare professionals (HCP) since the evidence base rapidly changed. In response, we established a freely accessible, video-based online resource, which was formally implemented requiring user registration. The guideline rapidly gained more than 4,500 registrants in the first wave alone, including nearly 100% of respiratory, intensive care or emergency unit consultants in Wales. During the first wave, there were nearly 170,000 page views with over 31,000 video plays and an average of 5.8 visits to the site per registrant. Acceptability using an online survey showed widespread support and that the unsubscribe rates were remarkably low. We suggest that this novel approach to guideline implementation achieved its aim of widespread engagement and acceptability and serves as a potential model for future medical guidelines and education beyond COVID-19.

A retrospective pilot study of the use of a new algorithm to improve quality control in bronchodilator studies.

Reversibility testing is used to identify a positive or negative response to bronchodilators. Results from a reversibility test can not only support a diagnosis of asthma but can alter a patient's treatment plan, so its clinical importance should not be understated. With multiple guidelines published classifying a 'positive response' it becomes unclear on how to categorise certain individuals. This study looks into the discrepancies between the guidelines, and introduces a new algorithm to help clinicians. This retrospective pilot study was completed across four hospitals in South Wales. Data were collected from a total of 117 patients referred for a reversibility study during November 2013 and April 2014. An algorithm was created to improve flow-volume loop (FVL) quality control when assessing airways bronchodilation in symptomatic patients. Each patient result was placed through four major reversibility guidelines [British Thoracic Society (BTS), National Institute for Clinical Excellence (NICE), Association for Respiratory Technology Physiologists (ARTP) and Global Lung Initiative (GLI)] and the new algorithm. When comparing published guidelines, 75% of patients would receive the same bronchodilator response decision, positive or negative, irrespective of the guideline followed. Variability between the numbers of positive responders in each guideline varied by up to 58%, with NICE found to give the least number of positive responses (7%), and BTS giving the greatest (65%). Using the new algorithm, over one third (38%) of patients required a repeat FVL, as baseline and/or post-bronchodilator FVLs did not meet the quality control specification. Further investigation is needed to establish the clinical impact of the new algorithm, and its approach to using the whole of the FVL in bronchodilator analysis; however, quality control during reversibility testing needs to be improved to ensure that bronchodilator responses are correctly identified.