Quantifying the direct secondary health care cost of seasonal influenza in England.

BACKGROUND: The winter pressure often experienced by NHS hospitals in England is considerably contributed to by severe cases of seasonal influenza resulting in hospitalisation. The prevention planning and commissioning of the influenza vaccination programme in the UK does not always involve those who control the hospital budget. The objective of this study was to describe the direct medical costs of secondary care influenza-related hospital admissions across different age groups in England during two consecutive influenza seasons. METHODS: The number of hospital admissions, length of stay, and associated costs were quantified as well as determining the primary costs of influenza-related hospitalisations. Data were extracted from the Hospital Episode Statistics (HES) database between September 2017 to March 2018 and September 2018 to March 2019 in order to incorporate the annual influenza seasons. The use of international classification of disease (ICD)-10 codes were used to identify relevant influenza hospitalisations. Healthcare Resource Group (HRG) codes were used to determine the costs of influenza-related hospitalisations. RESULTS: During the 2017/18 and 2018/19 seasons there were 46,215 and 39,670 influenza-related hospital admissions respectively. This resulted in a hospital cost of £128,153,810 and £99,565,310 across both seasons. Results showed that those in the 65+ year group were associated with the highest hospitalisation costs and proportion of in-hospital deaths. In both influenza seasons, the HRG code WJ06 (Sepsis without Interventions) was found to be associated with the longest average length of stay and cost per admission, whereas PD14 (Paediatric Lower Respiratory Tract Disorders without Acute Bronchiolitis) had the shortest length of stay. CONCLUSION: This study has shown that influenza-related hospital admissions had a considerable impact on the secondary healthcare system during the 2017/18 and 2018/19 influenza seasons, before taking into account its impact on primary health care.

Performance evaluation of selected n95 respirators and surgical masks when challenged with aerosolized endospores and inert particles.

The objective of this study was to assess how the relative efficiency of N95 respirators and surgical masks might vary with different challenge aerosols, utilizing a standardized manikin head form as a surrogate to human participation. A Collision nebulizer aerosolized B. anthracis Sterne strain endospores and polystyrene latex (PSL) particles to evaluate 11 models of N95 respirators and surgical masks. An automated breathing simulator, calibrated to normal tidal volume and active breathing rate, mimicked human respiration. A manikin head form with N95 respirators or surgical masks, and manikin head form without N95 respirators or surgical masks were placed in the bioaerosol chamber. An AGI-30 sampler filled with phosphate buffered water was fitted behind the mouth of each manikin head form to collect endospore bioaerosol samples. PSL aerosols concentrations were quantified by an ARTI Hand Held Particle Counter. Geometric Mean (GM) relative efficiency of N95 respirators and surgical masks challenged with endospore bioaerosol ranged from 34-65%. In PSL aerosol experiments, GM relative efficiency ranged from 35-64% for 1.3 µm particles. GM filtration efficiency of all N95 and surgical N95 respirators filter media evaluated was ≥99% when challenged with particles ≥0.1 µm. GM filtration efficiency of surgical mask filter media ranged from 70-83% with particles ≥0.1 µm and 74-92% with 1.3 µm PSL particles. Relative efficiencies of N95 respirators and surgical masks challenged with aerosolized B. anthracis endospores and PSL were similar. Relative efficiency was similar between N95 respirators and surgical masks on a manikin head form despite clear differences in filtration efficiency. This study further highlights the importance of face seal leakage in the respiratory protection provided by N95 respirators, and demonstrates it on a human surrogate.

Effectiveness of selected surgical masks in arresting vegetative cells and endospores when worn by simulated contagious patients.

OBJECTIVE: The objective of this study was to quantify the effectiveness of selected surgical masks in arresting vegetative cells and endospores in an experimental model that simulated contagious patients. SETTING: Laboratory. METHODS: Five commercially available surgical masks were tested for their ability to arrest infectious agents. Surgical masks were placed over the nose and mouth of mannequin head forms (Simulaids adult model Brad CPR torso). The mannequins were retrofitted with a nebulizer attached to an automated breathing simulator calibrated to a tidal volume of 500 mL/breath and a breathing rate of 20 breaths/min, for a minute respiratory volume of 10 L/min. Aerosols of endospores or vegetative cells were generated with a modified microbiological research establishment-type 6-jet collision nebulizer, while air samples were taken with all-glass impinger (AGI-30) samplers downstream of the point source. All experiments were conducted in a horizontal bioaerosol chamber. RESULTS: Mean arrestance of bioaerosols by the surgical masks ranged from 48% to 68% when the masks were challenged with endospores and from 66% to 76% when they were challenged with vegetative cells. When the arrestance of endospores was evaluated, statistical differences were observed between some pairs, though not all, of the models evaluated. There were no statistically significant differences in arrestance observed between models of surgical masks challenged with vegetative cells. CONCLUSIONS: The arrestance of airborne vegetative cells and endospores by surgical masks worn by simulated contagious patients supports surgical mask use as one of the recommended cough etiquette interventions to limit the transmission of airborne infectious agents.

Volume targeted versus pressure support non-invasive ventilation in patients with super obesity and chronic respiratory failure: a randomised controlled trial.

INTRODUCTION: Automatic titration modes of non-invasive ventilation, including average volume assured pressure support (AVAPS), are hybrid technologies that target a set volume by automated adjustment of pressure support (PS). These automated modes could offer potential advantages over fixed level PS, in particular, in patients who are super obese. METHODS: Consecutive patients with obesity hypoventilation syndrome were enrolled in a two-centre prospective single-blind randomised controlled trial of AVAPS versus fixed-level PS using a strict protocolised setup. MEASUREMENTS: The primary outcome was change in daytime arterial PCO(2) (PaCO(2)) at 3 months. Body composition, physical activity (7-day actigraphy) and health-related quality of life (severe respiratory insufficiency questionnaire, SRI) were secondary outcome measures. RESULTS: 50 patients (body mass index 50±7 kg/m(2); 55±11 years; 53% men) were enrolled with a mean PaCO(2) of 6.9±0.8 kPa and SRI of 53±17. 46 patients (23 AVAPS and 23 PS) completed the trial. At 3 months, improvements in PaCO(2) were observed in both groups (AVAPS 0.6 kPa, 95% CI 0.2 to 1.1, p<0.01 vs PS 0.6 kPa, 95% CI 0.1 to 1.1, p=0.02) but no between-group difference (-0.1 kPa, 95% CI -0.7 to 0.6, p=0.87). SRI also improved in both groups (AVAPS 11, 95% CI 6 to 17, p<0.001 vs PS 7, 95% CI 1 to 12, p=0.02; between groups 5, 95% CI -3 to 12, p=0.21). Secondary analysis of both groups combined showed improvements in daytime physical activity that correlated with reduction in fat mass (r=0.48; p=0.01). CONCLUSION: The study demonstrated no differences between automated AVAPS mode and fixed-level PS mode using a strict protocolised setup in patients who were super obese. The data suggest that the management of sleep-disordered breathing may enhance daytime activity and promote weight loss in super-obese patients.

Feasibility of selected prophylactic barriers in arrestance of airborne bacterial vegetative cells and endospores.

BACKGROUND: Transmission of infection by airborne agents is a risk for health care personnel, patients, and visitors. This risk is heightened in regions without access to environmental controls and personal protective equipment. The ability of 2 prophylactic barriers (ie, semitransparent netting for insect control) to arrest bioaerosols was assessed for potential use within the malarial zones. METHODS: Barriers (pore sizes of 0.8 mm and 0.25 mm) were challenged with bioaerosols of vegetative cells and endospores of Bacillus anthracis strain Sterne 34F2 using a bioaerosol chamber. Barriers were also challenged with airborne inert polystyrene latex particles of known diameters (0.1, 0.43, 0.6, 1.3, 3.2, and 8.0 µm), and the arrestance provided by barrier with the 0.25 mm pore size was expressed as a function of aerodynamic diameter of challenge aerosols. RESULTS: Barrier with the 0.8 mm pore size provided no significant arrestance of aerosols, whereas the barrier with the 0.25 mm pore size provided an 8% arrestance of vegetative cells and a 13% arrestance of endospores. No arrestance at or below the 0.6 µm particle size was observed. CONCLUSION: The level of arrestance provided by these prophylactic barriers does not justify their use as a sole method of preventing transmission.

Doing double duty. Interview by Charlotte Huff.

In a number of rural areas, one executive leads two, or even three, hospitals. They have to juggle staffs, boards of trustees and where to spend their time.

Ultraviolet germicidal irradiation disinfection of Stachybotrys chartarum.

The ultraviolet germicidal irradiation (UVGI) dose necessary to inactivate fungal spores on an agar surface and the efficacy of UVGI were determined for cultures of Stachybotrys chartarum (ATCC 208877). This study employed a UVGI testing unit consisting of four chambers with a 9-W, Phillips, low pressure, mercury UVGI lamp in each chamber. The testing unit's apertures were adjusted to provide 50, 100, 150, and 200 microW/cm2 of uniform flux to the Petri dish surfaces, resulting in a total UVGI surface dose ranging from 12 to 144 mJ/cm2. The UVGI dose necessary to inactivate 90% of the S. chartarum was greater than the maximum dose of 144 mJ/cm2 evaluated in this study. While UVGI has been used to inactivate several strains of culturable fungal spores, S. chartarum was not susceptible to an appropriate dose of UVGI. The results of this study may not correlate directly to the effect of UVGI on airborne fungal spores. However, they indicate that current technology may not be efficacious as a supplement to ventilation unless it can provide higher doses of UVGI to kill spores, such as S. chartarum, traveling through the irradiated zone.