Key lessons from the establishment of a nurse-led infection prevention and control program for COVID-19 in an Australian hotel quarantine and isolation service.

BACKGROUND: A key aspect of Australia's response to the COVID-19 pandemic was to control transmission through legislated quarantine and isolation of overseas returning travellers and potentially infectious community members. In New South Wales, Special Health Accommodation (SHA) was rapidly established as a comprehensive health service for individuals that were at risk of having COVID-19, were confirmed to have COVID-19 or for those with complex health needs that were deemed inappropriate for management in Police managed Quarantine Hotels. SHA services were later expanded to care for community members who were COVID-19 positive and unable to effectively isolate, or contacts of individuals who were unable to quarantine effectively in their homes. SHA's unique nurse-led Infection Prevention and Control (IPC) program offers key lessons that may impact future programs. METHODS: A reflection on the experience of leading an Infection Prevention and Control program in SHA was undertaken. This was supported by a review of SHA admission, workforce and transmission data and data obtained from a cross-sectional questionnaire aimed to better understand the experiences of a novel population of health workers (HW) in a comprehensive health-led quarantine and isolation service. RESULTS: SHA program data demonstrates how its IPC program implementation prevented transmission of COVID-19 to SHA staff and patients. Responses from the questionnaire suggested staff felt safe and well-prepared through the IPC education they received. They also gained transferrable knowledge and skills, which they intend to use in future healthcare roles. CONCLUSION: The SHA nurse-led IPC program offered successful quarantine and isolation for COVID-19 in non-purpose-built facilities. A review of IPC strategies and key lessons from the establishment of the SHA IPC program are of critical importance to planning and management of current and future pandemics.

Capillary and venous haemoglobin levels in blood donors: a 42-month study of 36,258 paired samples.

BACKGROUND: EU law requires a haemoglobin of > or = 12.5 g/dl for women or > or = 13.5 g/dl for men at the time of donation. As capillary and venous haemoglobin values may differ in the same subject, we examined whether a capillary haemoglobin level of 12.0 g/dl for women or 13.0 g/dl for men, is equivalent to a venous haemoglobin level of > or = 12.5 g/dl and > or = 13.5 g/dl, respectively, to avoid unnecessary loss of blood donations. METHODS: Over a continuous 42-month period, 36 258 paired capillary and venous samples were taken from 25 762 females and 10 496 males, when the capillary haemoglobin was < 12.5 g/dl and < 13.5 g/dl respectively. RESULTS: Venous haemoglobin levels were higher than capillary levels, with a mean difference of 1.07 g/dl (SD 0.68 g/dl), range -2.2 to +3.25 g/dl for men (P < 0.001), and a mean difference of 0.67 g/dl (SD 0.65 g/dl), range -2.5 to +5.4 g/dl for women (P < 0.001). The difference for the three consecutive winters was 0.78 g/dl (SD 0.081 g/dl) for females and 1.26 g/dl (SD 0.162 g/dl) for males and for the three consecutive summers was 0.56 g/dl (SD 0.089 g/dl) for females and 0.88 g/dl (SD 0.134 g/dl) for males: P < 0.001. CONCLUSIONS: Capillary haemoglobin levels of 12.0-12.5 g/dl in healthy females or 13.0-13.5 g/dl in healthy males are substantively equivalent to venous haemoglobin levels of > or = 12.5 and > or = 13.5 g/dl for women and men respectively. This finding has permitted an additional 32 990 blood units to be collected over the period of the study, a gain of 9.4%.

An audit of anti-D sensitisation in Yorkshire.

OBJECTIVE: To determine the likely factors that contribute to RhD sensitisation. DESIGN: Retrospective study of all new cases of RhD sensitisation occurring between 1988 and 1991. SETTING: Leeds Blood Centre, National Blood Service, Yorkshire. POPULATION: One hundred and forty-seven cases of RhD sensitisation from 15 obstetric units within the Yorkshire region, of which 129 (312 pregnancies) could be assessed. MAIN OUTCOME MEASURE: S Identification of potential immunising events and adherence with recommendations on anti-D immunoglobulin administration. RESULTS: Twenty-eight women (22%) had immune anti-D antibodies during their first pregnancy or at delivery and 50 (39%) in their second pregnancy. Overall, 98 potential immunising events were identified in 62 women, excluding delivery; 67 women (52%) had no events, other than delivery. Miscarriages and medical terminations of pregnancy accounted for 81% of all identified events. Iatrogenic failure to adhere to recommendations for the administration of anti-D immunoglobulin occurred in a significant proportion of women who subsequently developed immune anti-D antibodies. Anti-D immunoglobulin failed to protect against immunisation despite adherence to the protocol in 20 events (20%), 13 of which involved miscarriages or termination of pregnancy < 20 weeks of gestation. Potentially, antenatal prophylaxis might have prevented 86% of immunisations that were identified during the first pregnancy. CONCLUSIONS: The introduction of antenatal administration of anti-D immunoglobulin could significantly reduce the level of sensitisation in primigravidae, and adherence to recommendations for administration of anti-D immunoglobulin could be improved. Consideration should be given to reviewing the current recommendation that a dose of 250 IU of anti-D immunoglobulin is adequate following termination of pregnancy before a gestational age of 20 weeks.

An assessment of the comparative utility of functional and molecular level analyses in the investigation of patients with thrombophilia.

Aim-To determine the relation of the low anticoagulant response phenotype with the Factor V Q506 (Leiden) mutation in a cohort of patients with thrombophilia.Methods-Fifty four patients with either a personal or family history of deep vein thrombosis were investigated both for their anticoagulant response by the activated protein C resistance test (APCR) and their genetic status in respect of the Leiden mutation by means of a PCR-RFLP method.Results-Low APCR ratios do not necessarily predict possession of the Leiden mutation. Conversely, normal ratios do not exclude the mutation. Of 14 individuals with low APCR ratios, the Leiden mutation was absent in five. Of the remainder, three were heterozygous and six homozygous. Of nine heterozygote individuals, only three had low APCR ratios. All patients homozygous for the defect had low APCR ratios.Conclusions-These results lend further weight to the hypothesis that the APC resistant phenotype results from more than one genetic defect and indicate the value of combined functional and molecular investigations in all patients with thrombophilia.

Infant luminance and chromatic contrast sensitivity: optokinetic nystagmus data on 3-month-olds.

Infant color vision is poor, and most psychophysical experiments agree that infant color vision emerges between ages 3 weeks and 3 months. Presumably, the color vision of infants is poor during the months immediately after it has emerged. We have tested two alternative explanations for the poor color vision of infants: (1) there is a special critical immaturity within the color pathways of infants; (2) infants have poor infant color vision because they are insensitive to contrast. Luminance and chromatic contrast thresholds were measured on 3-month-olds using optokinetic nystagmus (OKN), and adult luminance and chromatic contrast thresholds were measured using OKN and two forced-choice methods: direction-of-motion discrimination and grating detection. The infant chromatic-to-luminance contrast threshold ratio shows that infants are as sensitive or even more sensitive than adults to color, depending on the testing method used on adults. This result suggests that the general contrast insensitivity hypothesis is correct. Conservative "worst-case" quantitative analysis strongly suggests that this result is not the consequence of a luminance artifact.

Noninvasive evaluation of the collateral circulation to the hand.

OBJECTIVE: To compare four methods of evaluating collateral blood flow to the hand. METHODS: The hands of 74 volunteers on the faculty or staff of a university hospital were studied prospectively. Only subjects without known peripheral vascular disease were included. Four tests were used in random order to assess radial and ulnar artery flow. Results of the assessments using the modified Allen's test, pulse oximetry, plethysmography, and laser Doppler perfusion monitoring were compared. RESULTS: No interrupted palmar arch was found. The modified Allen's test was normal in all cases. Pulse oximetry detected a 5% incidence of noticeably reduced blood flow in one artery compared with the other artery. This dominance of one artery was identified in 69% of the hands by plethysmography. The laser Doppler noted a dominant artery in 64% of the hands. Plethysmography and the laser Doppler disagreed in their findings in only 9% of the hands evaluated. Numerical values of blood flow, attainable only by the laser Doppler, were significantly lower upon occlusion of the radial vs the ulnar arteries (p < 0.05; paired t-test). CONCLUSION: All of the tests provide information about the collateral circulation to the hand. Only the laser Doppler provides quantitative blood flow. Further studies involving subjects most at risk for post-cannulation ischemic injury are needed to guide the clinical application of these findings.

Autologous bone marrow transplantation in multiple myeloma: a single centre experience of 23 patients.

We report the complications and outcome of high-dose melphalan and TBI combined with ABMT used in the treatment of multiple myeloma at a single centre. Twenty-three patients, aged 65 years or less, who underwent the procedure are reviewed. All had chemosensitive disease. Response to ABMT assessed at 3 months showed 75% of evaluable patients to have further tumour cytoreduction of at least 50%, with 24% of patients who entered ABMT with residual disease eventually achieving CR. There was one toxic death. The overall survival is 60% and the progression-free survival is 49.8% at a median follow-up time of 17 months. Relapse or disease progression has occurred in 27% of patients, of whom half have died. No significant prognostic factors affecting survival were found although those patients with IgG myeloma had a better outcome. Patients transplanted in first plateau appeared to do significantly better if they had been resistant to their first-line chemotherapy but had then responded to further conventional chemotherapy (p = 0.029).

Recombinant interferon alfa 2a in the treatment of patients with early stage B chronic lymphocytic leukaemia.

18 patients with early stage, previously untreated B-CLL were given interferon alfa (IFN alpha) 2a. 3 MU thrice weekly, subcutaneously. The peripheral lymphocyte count decreased in all patients. Response was delayed in three patients until they had received a median of 5 months therapy, one of whom had an initial transient increase in lymphocytes. Two patients normalized their blood lymphocyte counts, but neither achieved complete remission (CR). Responses were transient in eight patients lasting a median of 5 months (3-21). Binding anti-IFN alpha antibodies were present in 9/17 patients tested (53%). Low titre binding antibodies (< 533 IBU/ml) were not associated with LHR, but high titre antibodies (> 4401 IBU/ml) were. Two of 12 patients assessed had a > 3 g/l increase in baseline serum IgG levels during IFN alpha therapy, one of whom reverted to pretreatment levels in association with LHR. Haematological toxicity was moderate, other than in two patients, one of whom developed autoimmune haemolytic anaemia and the other thrombocytopenia. We conclude that IFN alpha lowers the lymphocyte count in early stage CLL, that the response may be delayed and that anti-IFN alpha antibodies may play a role in a proportion of those in whom the response is transient.

Double hemibody irradiation (DHBI) in the management of relapsed and primary chemoresistant multiple myeloma.

In view of increasing controversy regarding the role of double hemibody irradiation (DHBI) in the treatment of multiple myeloma, we have analysed the use of this technique at our institution over a 6-year period. Fifty-five patients with multiple myeloma were treated with both upper and lower hemibody irradiation between January 1985 and January 1991; 42 had relapsed post-plateau and 13 were chemoresistant to initial therapy. Fifteen patients received alpha IFN-2b maintenance therapy post-DHBI, at a dose of 3 Mu three times per week, as part of a randomized trial. Ninety-five per cent of patients experienced symptomatic improvement in bone pain post-DHBI, 21% of whom discontinued opiate analgesics altogether; 63% had a minor biochemical response and 38% had a partial biochemical response. The overall survival (OS) and progression free survivals (PFS) in all patients were 11 months and 8 months respectively. No significant difference was noted in either OS or PFS, according to whether patients were chemoresistant or had relapsed post-plateau. alpha IFN did not appear to prolong survival (OS or PFS) post-DHBI. Cytopenia was a significant problem, such that only 60% of patients had counts adequate enough to be eligible for alpha IFN. We conclude that DHBI is an effective treatment in patients with relapsed multiple myeloma and in those who are chemoresistant to initial therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Low-dose recombinant alfa-2a-interferon: a feasible maintenance therapy in acute myeloid leukaemia in the older patient.

Eleven patients with acute myeloid leukaemia (AML) in first complete remission (CR) were treated with alfa-2a-interferon (for short 'interferon') maintenance therapy, at a dose of 3 MU twice to thrice weekly subcutaneously. Adjustments were made to maintain neutrophil counts > 1 x 10(9)/l and platelet counts > 100 x 10(9)/l. A transient fall in haemoglobin, neutrophil and platelet counts was noted in all 9 evaluable patients. Median time to nadir was 7 weeks. Initial dosage reductions were necessary in 5 patients, 3 of whom were later able to tolerate the starting dose. No episodes of infection or bleeding were documented during therapy and no red cell or platelet transfusions were necessary. At the time of writing (median follow-up of 31 weeks), 7 patients continue in CR, 6 of whom remain on interferon. One patient discontinued interferon on developing sicca syndrome. Other than in this patient, side effects were minor. Mean dose administered was 6.7 MU/patient/week. We conclude that low-dose IFN maintenance therapy is well tolerated in older patients with AML in first CR.

Prospective randomised study of double hemi-body irradiation with and without subsequent maintenance recombinant alpha 2b interferon on survival in patients with relapsed multiple myeloma.

Immediately before first hemi-body irradiation, 59 patients with relapsed multiple myeloma were randomised to receive or not to receive subsequent alpha-2b interferon maintenance. 13 patients (22%) [8 of 31 (26%) controls, 5 of 28 (18%) in the interferon arm] received single hemi-body irradiation alone due to progressive disease and/or persistent cytopoenias following the initial procedure. Mean time between upper and lower hemi-body irradiation was 69 days (range 35-294). Of 23 patients randomised to receive interferon and completing double hemi-body irradiation, 15 (65%) achieved peripheral blood counts adequate to allow interferon administration as per study criteria commencing at a mean 116 days (61-241) from time of study entry. The mean period of interferon therapy, starting at a mean 65 days (26-160) post second hemi-body irradiation, is 16.4 months (2-33.5). There was no significant difference in median survival durations (10 months) from time of initial radiotherapy between control and interferon patients.

Plasma and platelet norepinephrine in normal and preeclamptic pregnancy.

Catecholamines accumulate in platelets, and platelet catecholamine concentrations may give a more stable index of sympathoadrenal activity than do random plasma values. We measured norepinephrine in plasma and platelets from normal, nonpregnant women and from normal and preeclamptic pregnant women with a radioenzymatic assay. Plasma and platelet norepinephrine was not markedly different in normal, pregnant women during the third trimester, intrapartum or postpartum when compared with those levels in nonpregnant women. Platelet norepinephrine was significantly elevated in women with mild preeclampsia, but plasma norepinephrine was not. A linear relationship existed between platelet count and platelet norepinephrine concentrations in women with preeclampsia. These findings are compatible with the hypothesis of increased sympathoadrenal activity in women with mild preeclampsia and normal platelet counts. The lower platelet norepinephrine in thrombocytopenic patients suggests that platelet activation and degranulation have occurred and indicate that platelet catecholamine concentration does not provide a stable index of sympathoadrenal activity when platelets are being consumed.

Hyperplastic G cell responsiveness in vitro.

To evaluate the responsiveness of isolated, hyperplastic antral gastrin-producing G cells to a variety of secretagogues, hyperplastic hypergastrinemia was produced in Sprague-Dawley rats by fundusectomy. Mean serum immunoreactive gastrin (IRG) concentration was elevated fivefold above controls 4 days after operation and rose steadily to an eightfold increase at 66 days. Mean antral G cell density remained at control levels for as long as 7 days, increased twofold at 14 days, then remained between twofold and threefold greater than controls for as long as 66 days after operation. Antral mucosa IRG content increased from 141 +/- 38 (control) to 262 +/- 58 ng IRG/gm mucosa (4 to 6 weeks after fundusectomy). Crude fractions of dispersed antral mucosa cells enriched in G cells from fundusectomized rats contained 6.5% +/- 1.4% G cells with 0.19 +/- 0.6 pg IRG/G cell. Corresponding preparations from nonoperated rats contained 5.1% +/- 0.5% G cells with 0.07 +/- 0.02 pg IRG/G cell. Viability averaged greater than 95% for all preparations. Gastrin secretion was monitored in cell preparations further enriched in G cells (9% to 10%) by Percoll density gradient centrifugation either in the absence (basal) or presence of bombesin (1 mumol, 1 nmol/L), carbachol (1 mmol/L), leucine (10 mmol/L), and ethylamine (10 mmol/L). The basal secretory rate of hyperplastic G cell populations averaged 250% greater than normal G cell basal rates. Hyperplastic G cell preparations had an increased IRG secretory rate in the presence of bombesin (1 mumol/L, 750%; 1 nmol/L, 191%), leucine (120%), ethylamine (236%), and carbachol (183%). These conditions failed to increase the IRG secretory rate above basal in preparations from normal antra. Viable, dispersed, hyperplastic G cells have increased IRG content and basal IRG secretory rate and are functionally responsive to a variety of secretagogues.

Identification of gastrin-producing cells in cell cultures and smears: an avidin-biotin-peroxidase complex (ABC) technique.

A method is described that uses the avidin-biotin complex (ABC) immunoperoxidase technique to provide a rapid, sensitive, and specific means to quantitate isolated G cells in cultures and suspensions.