SARS-CoV-2 environmental contamination from hospitalised patients with COVID-19 receiving aerosol-generating procedures.

BACKGROUND: Continuous positive airways pressure (CPAP) and high-flow nasal oxygen (HFNO) are considered 'aerosol-generating procedures' in the treatment of COVID-19. OBJECTIVE: To measure air and surface environmental contamination with SARS-CoV-2 virus when CPAP and HFNO are used, compared with supplemental oxygen, to investigate the potential risks of viral transmission to healthcare workers and patients. METHODS: 30 hospitalised patients with COVID-19 requiring supplemental oxygen, with a fraction of inspired oxygen ≥0.4 to maintain oxygen saturation ≥94%, were prospectively enrolled into an observational environmental sampling study. Participants received either supplemental oxygen, CPAP or HFNO (n=10 in each group). A nasopharyngeal swab, three air and three surface samples were collected from each participant and the clinical environment. Real-time quantitative polymerase chain reaction analyses were performed for viral and human RNA, and positive/suspected-positive samples were cultured for the presence of biologically viable virus. RESULTS: Overall 21/30 (70%) participants tested positive for SARS-CoV-2 RNA in the nasopharynx. In contrast, only 4/90 (4%) and 6/90 (7%) of all air and surface samples tested positive (positive for E and ORF1a) for viral RNA respectively, although there were an additional 10 suspected-positive samples in both air and surfaces samples (positive for E or ORF1a). CPAP/HFNO use or coughing was not associated with significantly more environmental contamination than supplemental oxygen use. Only one nasopharyngeal sample was culture positive. CONCLUSIONS: The use of CPAP and HFNO to treat moderate/severe COVID-19 did not appear to be associated with substantially higher levels of air or surface viral contamination in the immediate care environment, compared with the use of supplemental oxygen.

The Impact of United Kingdom and Malaysia's Inherent Health Systems on Their COVID-19 Responses: A Comparison of Containment Strategies.

In March 2020, the outbreak of COVID-19 was officially declared a global pandemic by the World Health Organization. Given the novelty of the virus, and hence, lack of official guidance on effective containment strategies, individual countries opted for different containment approaches ranging from herd immunity to strict lockdown. The opposing strategies followed by the United Kingdom and its former colony, Malaysia, stand exemplary for this. Real-time polymerase chain reaction was implemented for testing in both counties. Malaysia acted with strict quarantining rules and infection surveillance. The United Kingdom followed an initially lenient, herd-immunity approach with strict lockdown only enforced weeks later. Although based on the same health-care structure historically, Malaysia developed a more unified health system compared with the United Kingdom. We suggest that this more centralized structure could be one possible explanation for why Malaysia was able to react in a more timely and efficient manner, despite its closer geographic proximity to China. We further explore how the differences in testing and quarantining strategy, as well as political situation and societal compliance could account for the discrepancy in the United Kingdom's versus Malaysia's relative success of COVID-19 containment.

A quality improvement project to assess and refine the handover process at morning trauma meetings.

BACKGROUND: Poor handover and inadequate transmission of clinical information between shifts can result in patient harm. This study was designed to evaluate the impact of implementing a handover protocol on the quality of information exchanged in the trauma handover meetings in a UK district general hospital. METHODS: A prospective single centre observational study was performed at an acute NHS trust, using the define, measure, analyse, improve and control (DMAIC) methodology. Ten consecutive weekday trauma meetings, involving 43 patients, were observed to identify poor practices in handover. This data was used in conjunction with the Royal College of Surgeon's recommendations for effective handover (2007) to create a standard operating protocol (SOP). Following the implementation of the SOP, a further eight consecutive weekday trauma meetings, involving a further 47 patients, were observed. The data collection was performed by five trained independent observers. The data was analysed using t-test for quantitative variables and chi-square or Fisher's exact tests for categorical variables. RESULTS: An improvement in the trauma handover was demonstrated in multiple aspects of trauma handover including patient's past medical history, date of injury, results, diagnosis, consent, mark and starvation status (all p < 0.001). Subgroup analyses showed that handover of neck of femur patients including information on baseline mobility (p = 0.04), Nottingham Hip Fracture Score (p = 0.01), next of kin discussion (p = 0.075) and resuscitation status (p = 0.001) all improved following our interventions. CONCLUSION: These results demonstrate that the implementation of a well-structured handover protocol can improve the transmission of critical information in trauma meetings.