An outbreak within an outbreak: The impact of Infection Prevention and Control strategies on hospital-acquired infections and the occurrence of multi-drug resistant organisms during the COVID-19 pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic placed an unprecedented strain on intensive care units (ICUs) in South Africa. Infection prevention and control (IPC) strategies were highlighted to minimise the risk to healthcare workers and for the protection of patients from contracting hospital-acquired infections (HAIs). During the third wave, our institution adopted a shift system to address severe burnout among ICU personnel. We noted an upstroke in the occurrence of HAIs, specifically carbapenem-resistant Enterobacterales (CRE) and multidrug-resistant (MDR) Acinetobacter baumannii. OBJECTIVES: To report these outbreaks, compare the rate of CRE and A. baumannii infections with the first COVID-19 wave and to analyse its impact on patient outcomes. METHOD: We retrospectively analysed data from a prospectively collected registry involving all adult patients with severe COVID-19 admitted to the dedicated COVID-19 ICU from May 2021 to September 2021. Information from the admission database, including the patients' demographics, comorbidities, laboratory results and length of ICU stay were extracted. RESULTS: Ninety patients were admitted with severe COVID-19 during the third wave. There was an outbreak of both CRE (the majority Klebsiella pneumoniae) and A. baumannii. Furthermore, 18 patients cultured the same CRE organism, and 25 patients cultured the environmental organism A. baumannii. The HAI rate was significantly higher compared with the first wave published data: 59/90 (65.6%) v. 73/363 (20.1%, p<0.01). Patients with any HAI had a longer mean stay in ICU (10.1 days v. 6.7 days (p<0.01) and a higher mortality of 48/59 (81%) v. 19/31 (61%) (p=0.05). CONCLUSION: We observed a very significant rise in HAIs in the COVID-19 ICU during the third wave compared with the first, with almost three times as many patients developing HAIs. Unsurprisingly, it was associated with a longer mean stay in ICU and a higher mortality. The outbreak of both CRE and A. baumannii, and the fact that many patients cultured the same CRE organism and A. baumannii, strongly suggests that a critical breakdown in IPC measures had occurred.

Transection of the origin of the innominate artery: A rare sequela of blunt traumatic chest trauma.

Blunt traumatic transection of the innominate artery is rare. We describe a case of a 36-year-old male who presented to our Emergency & Trauma Center after being struck by a motor vehicle at high speed. Computerised Tomography (CT) scanning after the patient was stabilised facilitated the prompt diagnosis of the injury. The patient underwent open repair by midline sternotomy, with debranching of the innominate artery, using hypothermic circulatory arrest as a neuroprotective measure. The patient was successfully extubated on post-operative day 3, without neurological deficit. We provide our experience as an option for treating any patient that presents with such an injury.

Follow-up after arthroplasty of the hip and knee : are we over-servicing or under-caring?

The number of arthroplasties of the hip and knee is predicted to increase rapidly during the next 20 years. Accompanying this is the dilemma of how to follow-up these patients appropriately. Current guidelines recommend long-term follow-up to identify patients with aseptic loosening, which can occur more than a decade postoperatively. The current guidelines and practices of orthopaedic surgeons vary widely. Existing models take up much clinical time and are expensive. Pilot studies using 'virtual' clinics and advanced-practice physiotherapists have shown promise in decreasing the time and costs for orthopaedic surgeons and patients. This review discusses current practices and future trends in the follow-up of patients who have an arthroplasty. Cite this article: Bone Joint J 2018;100-B:6-10.

The migration of fragments of glass from the pockets to the surfaces of clothing.

During the last decade or so there has been some discussion in the forensic community in the United Kingdom concerning whether it is necessary to search the pockets for glass particles in garments attributed to suspects arrested for glass breaking crimes. The removal of this practice would help expedite the searching and recovery process since examining only the surfaces of clothing would reduce the cost of recovering glass evidence. However, it is believed by many scientists that some glass fragments originally acquired in pockets can migrate to the surfaces of clothing prior to examination by the forensic scientist. As glass fragments have been encountered in the pockets of garments during examinations of casework items in the LGC Laboratories, the implications of this change in practice needs to be assessed. Hence, the aim of this study was to investigate this possibility that fragments of glass migrate from a pocket of a garment to its surfaces during police and laboratory handling after a person is suspected of breaking glass during an offence. If this occurs to a significant extent then it could affect the evaluation of the glass evidence when using a Bayesian approach. Sixty fragments of glass were seeded into a pocket of a fleece jacket and a pair of denim jeans. Three experiments were performed; one examined a searching, recovery and blanking procedure, another examined the pre-laboratory 'handling' process of an item in an evidence bag, and the third experiment looked at the removal of an object from a pocket laden with glass and subsequent removal and packaging of the garment. Up to two (3.3%) fragments were recovered from the surfaces of the fleece jacket and the denim jeans via the searching, recovery and blanking procedure. Similar numbers were also recovered from the insides of the evidence bags. Up to four (6.7%) fragments were recovered from the surface of the fleece jacket and up to five (8.3%) fragments were recovered from the surface of the denim jeans after pre-laboratory 'handling'. Again similar numbers were recovered from the insides of the evidence bags. Comparable numbers to those from searching/recovery experiments were observed when garments were removed after taking an object from a pocket. In addition, up to two (3.3%) fragments were recovered from the object (a mobile phone). The findings show that some migration can occur particularly in the second experiment and therefore modification of the evaluation strategy may be required.