Investigating the impact of an online hydration intervention in care homes using the COM-B model: a mixed methods study.

BACKGROUND: Antimicrobial resistance is a serious threat to public health. To reduce antimicrobial resistance, interventions to reduce gram-negative infections, specifically urinary tract infections, are vital. Early evidence suggests increased fluid intake is linked with a reduction in UTIs and subsequently has potential to reduce antibiotic usage. Care homes have a high prevalence of UTIs and provide an opportunity in a closed setting to deliver an intervention focused on increasing fluid intake, where it is supported and monitored by health care workers. The study aimed to evaluate the impact and feasibility of an online staff focused intervention over a 30 day period to increase the hydration of care home residents with a view to reducing the burden of AMR in this setting. METHODS: The study was a pre and post intervention with a sequential explanatory mixed methods design. The intervention was delivered online in 3 care homes, containing 3 main components underpinned by the COM-B model including hydration training, 7 structured drinks rounds and a hydration champion to change behaviour of care home staff. A pre and post questionnaire assessed the impact of the intervention on staff and data was collected on fluid intake, drinks rounds delivered to residents, UTIs, antibiotic used to treat UTIs, falls and hospitalisation. Descriptive statistics summarised and assessed the impact of the study. Focus groups with care home staff provided qualitative data which was thematically analysed. RESULTS: Staff increased in self-perceived knowledge across the six components of hydration care. 59% of residents had an increase in median fluid intake post intervention. During the time of the intervention, a 13% decrease in UTIs and antibiotic usage to treat UTIs across the 3 care homes was recorded, however falls and hospitalisations increased. Themes arising from focus groups included the role of information for action, accessibility of online training, online training content. CONCLUSIONS: This study demonstrates that a brief, low cost, online multi-component intervention focused on care home staff can increase the fluid intake of residents. A reduction in UTIs and antibiotic consumption was observed overall. Empowering care home staff could be a way of reducing the burden of infection in this setting.

Increased reports of severe myocarditis associated with enterovirus infection in neonates, United Kingdom, 27 June 2022 to 26 April 2023.

Enteroviruses are a common cause of seasonal childhood infections. The vast majority of enterovirus infections are mild and self-limiting, although neonates can sometimes develop severe disease. Myocarditis is a rare complication of enterovirus infection. Between June 2022 and April 2023, twenty cases of severe neonatal enteroviral myocarditis caused by coxsackie B viruses were reported in the United Kingdom. Sixteen required critical care support and two died. Enterovirus PCR on whole blood was the most sensitive diagnostic test. We describe the initial public health investigation into this cluster and aim to raise awareness among paediatricians, laboratories and public health specialists.

A paediatric hospital care AMC report for Northern Ireland.

BACKGROUND: Antimicrobial stewardship (AMS) is high on the agenda of healthcare policymakers and measurement of its impact is reliant on antimicrobial consumption (AMC) and antimicrobial resistance (AMR) data. Recent AMC reports have identified high antimicrobial prescribing rates in Northern Ireland (NI), compared with UK and European countries, but no separate paediatric data were reported. OBJECTIVES: To describe AMC trends in paediatric and neonatal inpatient care in NI between September 2015 and September 2020, in order to: (i) create a paediatric-specific AMC report and benchmark for future AMS interventions; and (ii) develop an action plan for establishing paediatric AMC/AMR surveillance in NI. METHODS: AMC data, measured in monthly DDD, as well as hospital bed occupancy and admissions statistics were analysed. Hospital AMC was measured using several metrics and subdivided by level of paediatric and neonatal care, and by proportion of antibiotic use according to the WHO AWaRe classification. RESULTS: Paediatric-specific consumption in hospital care was 0.3-0.42 DDD per 1000 inhabitants per day, representing approximately 10% of total AMC. There was variation in AMC rates between similar units. In some areas, an increasing proportion of Watch and Reserve antibiotic consumption was observed. CONCLUSIONS: A baseline AMC dataset for paediatric and neonatal units across NI has been created. Continuous prospective collection and analysis of these data, along with AMR surveillance, would strengthen paediatric AMS programmes and provide crucial information for their resourcing. It is hoped that this report will act as a catalyst to galvanize paediatric AMS efforts regionally.