Implementation of Public Health England infection prevention and control guidance in maternity units in response to the COVID-19 pandemic.

BACKGROUND: This study aimed to explore the successes and barriers to the implementation of Public Health England (PHE) infection prevention and control guidance in English maternity units during the COVID-19 pandemic. METHODS: Qualitative semi-structured interviews with obstetricians, midwives and neonatologists who worked in a maternity unit in England, UK, between March 2020 and July 2021. A thematic analysis was performed. RESULTS: Successes to the implementation of PHE guidance were related to existing infrastructure, training satisfaction, and organisational culture where subthemes considered the importance of a multidisciplinary approach, COVID-19 dedicated roles and hospital-wide communication. Barriers to implementation related to the applicability of the guidance with subthemes highlighting contradictions between updates, specialties and hospitals, undesirable timings and frequency of guidance updates, reductions in staff compliance and delayed implementation. Finally, the layout of some units made it difficult to implement various aspects of the guidance (e.g., social distancing), and many detailed issues related to information technology compatibility, a lack of availability and accessibility to appropriate personal protective equipment (PPE), and variations in testing arrangements between units. CONCLUSIONS: This research provides information on the experiences of healthcare professionals working on maternity units during the COVID-19 pandemic. Findings illustrate the importance of effective hospital-wide communication and the need for consistent, easily understood guidance. These results will be used to inform the content of an expert panel consensus meeting.

Simulated reflux and laryngotracheal reconstruction: a rabbit model.

OBJECTIVES: (1) To test the feasibility of a rabbit model using a pharyngostomy tube to simulate gastroesophageal reflux and (2) to study the effects of gastroesophageal reflux on laryngotracheal reconstruction using a new rabbit model. DESIGN: Prospective randomized trial. SUBJECTS: Thirty-three New Zealand white rabbits. INTERVENTIONS: Anterior cartilage laryngotracheoplasty and pharyngostomy tube placement into the pyriform sinus were performed in 33 rabbits, 22 of which are included in this analysis. Beginning postoperative day 1, hydrochloric acid at a pH of 1.5 with pepsin (n = 7) or at a pH of 4.0 with pepsin (n = 8) was irrigated twice daily through the pharyngostomy tube to simulate gastroesophageal reflux, and a control group received twice-daily isotonic sodium chloride solution irrigations (n = 7). MAIN OUTCOME MEASURES: Specimens were scored by a pathologist masked to individual groups using a newly modified inflammation scoring system. In addition, cross-sectional areas of the cartilage grafts and subglottic airway lumina were compared. RESULTS: Inflammation scores were significantly higher in rabbits receiving hydrochloric acid and pepsin irrigations at a pH of 4.0 (P =.04) but not in those in the pH 1.5 group. Cartilage necrosis was prominent in all groups, and airway sizes and cross-sectional areas of the grafts were not significantly different among the 3 groups. CONCLUSIONS: Cartilage necrosis is prominent during the early stages after laryngotracheoplasty. Inflammation can be increased using hydrochloric acid and pepsin irrigations but is difficult to predict based on this study. Although we confirmed the feasibility of this model, further modifications of this study are proposed to improve animal survival and data collection.

Retinal complications of gas myelography.

Bilateral retinal and preretinal hemorrhages with an acute and permanent partial loss of visual acuity developed in a 60-year-old man after an oxygen myelogram. In order to increase the contrast of the myelogram, a greater volume of oxygen was injected in the subarachnoid space than the volume of CSF that was removed. It is believed that the hemorrhages and visual loss were secondary to the sudden increase in CSF pressure caused by the excess volume of oxygen injected.