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Blog - Learning from HSIB Covid-19 reports (27 January 2022)
Patient-Safety-Learning posted an article in Blogs
This blog summarises investigations about Covid-19 and its impact on the healthcare system carried out by the Healthcare Safety Investigation Branch (HSIB). It highlights learning from five HSIB reports: COVID-19 transmission in hospitals: management of the risk – a prospective safety investigation Early warning scores to detect deterioration in COVID-19 inpatients Oxygen issues during the COVID-19 pandemic Treating COVID-19 patients using continuous positive airway pressure (CPAP) Personal protective equipment (PPE): care workers delivering homecare during the COVID-19 response- Posted
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Content ArticleOzSAGE has created this infographic for creating safer indoor air for workspaces. It should be used with masks as a complete strategy. OzSAGE is a multi-disciplinary network of Australian experts from a broad range of sectors relevant to the well-being of the Australian population during and after the COVID-19 pandemic.
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Content ArticleIn this study the authors characterised the dynamics of SARS-CoV-2 transmission within a hospital setting, identifying key differences across the two pandemic waves, as well as the relative contribution of different groups and hospital locations to within-hospital transmission. They found the prevention and control measures that evolved during the COVID-19 pandemic may have had a significant impact on reducing infections between healthcare workers, but were insufficient during the second wave to prevent a high number of patient-to-patient transmissions. As hospital-acquired cases appeared to drive most onward transmissions, more frequent and rapid identification and isolation of these cases will be required to break hospital transmission chains in subsequent pandemic waves.
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Content ArticleA new analysis of the risks and benefits of offering two doses of COVID-19 vaccination to all 12-17 year olds in England shows that the benefits clearly outweigh the risks, given the current high case rates. In the UK currently a single dose of vaccine is recommended for all 12-17 year olds. The research, which is in press with the Journal of the Royal Society of Medicine, estimates hospital and ICU admissions, deaths and cases of long COVID averted over a 16-week period by vaccinating all 12-17 year olds in England. The analysis includes high and low case rate scenarios.
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Content ArticleREACT-1 is the largest population surveillance study being undertaken in England that examines the prevalence of the virus causing COVID-19 in the general population. It uses test results and feedback from over 150,000 participants each month. The findings will provide the government with a better understanding of the virus’s transmission and the risks associated with different population subgroups throughout England. This will inform government policies to protect health and save lives.
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Content ArticleScientific and policy bodies’ failure to acknowledge and act on the evidence base for airborne transmission of SARS-CoV-2 in a timely way is both a mystery and a scandal. In this study, Greenhalgh et al. applied theories from Bourdieu to address the question, “How was a partial and partisan scientific account of SARS-CoV-2 transmission constructed and maintained, leading to widespread imposition of infection control policies which de-emphasised airborne transmission?”.
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Content ArticleThere is no longer any scientific doubt about how Covid spreads through the air. Covid spreads like any other airborne respiratory disease. The virus is carried in tiny particles called aerosols, which we breathe out constantly — especially when speaking loudly or singing. The particles stay in the room air like smoke, and if someone has Covid, their exhaled aerosols contain the virus and can infect someone who breathes them in. We stop the disease spreading by stopping people inhaling infected aerosol. In this article for the Guardian, Dr Adam Squires and Prof Christina Pagel detail what we can do to protect ourselves from the airborne spread of Covid. “Filtering facepiece respirator” masks, social distancing and opening windows are short term solutions. Additionally, much can be done by cleaning the air in the room, removing infectious aerosol before it can be inhaled through ventilation and supplement the clean air by filtering out the respiratory aerosol particles using small portable HEPA (“High Efficiency Particle Air”) filter unit.. Longer term, new developments in ultraviolet (UV) technology can safely and efficiently kill airborne pathogens in large spaces such as canteens, gyms or theatre. Infrastructure upgrades and new builds, necessary for zero carbon targets, can combine more energy-efficient ventilation with filtration to lower pollution. In the classroom and the workplace, clean fresh air has wider benefits on health and wellbeing far beyond our current airborne pandemic.
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Content ArticleThe evidence for preventing COVID-19 is lost in translation, writes Dancer et al. in a BMJ Editorial. The world is finally coming to terms with the realisation that transmission of SARS-CoV-2 is airborne. While keeping your distance, wearing a mask, and getting vaccinated have provided much protection, one intervention that would have a significant impact is adequate indoor ventilation. Healthcare, homes, schools, and workplaces should have been encouraged to improve ventilation at the very beginning of the pandemic, but tardy recognition of the airborne route by leading authorities in 2020 stalled any progress that could have been made at that stage.This was compounded by controversies over the terms “droplet” and “aerosol,” as the definition of these dictates different infection prevention strategies, including type of mask. Inserting the term “ventilation” into a COVID-19 policy document might appease readers, but ensuring people get enough fresh air in indoor environments seems to have fallen by the wayside. Why is this? Can we establish the reasons for this seemingly lethargic response to improving indoor air quality?
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Content ArticleIn this article for The BMJ, Ingrid Torjesen looks at new data from Japan that suggest patients with the omicron variant of Covid-19 shed virus for longer after symptoms emerge, than with other Covid-19 variants. This has a potentially significant impact on hopes of shortening the period of isolation for people testing positive. The article examines new evidence from Japan that suggests that with omicron, the peak of virus shedding may be two or three days later than with other variants. It also looks at the relative value of self-isolation in the UK while omicron is circulating so widely in the community, with up to two-thirds of cases now undetected by testing.
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Content ArticleThe National Care Forum (NCF) represents not-for-profit organisations providing care and support services to adults in the UK. The NCF conducted a survey of its members over a five day period from 5-10 January 2022, considering the impact of the Covid-19 Omicron variant. Its results highlighted increased pressure faced by the care sector in this period, with staff absence being compounded by existing high vacancy rates and difficulties and delays with testing.
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Content ArticleIn this article for The Conversation, the authors discuss their latest research findings regarding Covid-19 transmission, outlining the likelihood of catching Covid-19 in different indoor and outdoor scenarios. They demonstrate that speaking, shouting, singing and heavy exercise all increase the likelihood of transmission, and illustrate the impact of ventilation, face coverings and number of people on the risk of catching the virus. The article includes an table summarising their findings and a link to the Covid-19 Aerosol Transmission Estimator developed by the authors. View the full research paper
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Content ArticleWhen Addenbrooke’s Hospital in Cambridge upgraded its face masks for staff working on COVID-19 wards to filtering face piece 3 (FFP3) respirators, it saw a dramatic fall – up to 100% – in hospital-acquired SARS-CoV-2 infections among these staff. Healthcare workers – particularly those working on COVID-19 wards – are much more likely to be exposed to coronavirus, so it’s important we understand the best ways of keeping them safe The findings are reported by a team at the University of Cambridge and Cambridge University Hospitals (CUH) NHS Foundation Trust. The research has not yet been peer-reviewed, but is being released early because of the urgent need to share information relating to the pandemic.
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Content ArticleThe emergence of the omicron variant has raised concerns that the pandemic is not yet over. In this BMJ opinion piece, William et al. outline four key lessons that governments need to learn from to protect against future pandemics
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Content ArticleDuring the rapid rise in COVID-19 illnesses and deaths globally, and notwithstanding recommended precautions, questions are voiced about routes of transmission for this pandemic disease. Inhaling small airborne droplets is probable as a third route of infection, in addition to more widely recognised transmission via larger respiratory droplets and direct contact with infected people or contaminated surfaces. While uncertainties remain regarding the relative contributions of the different transmission pathways, Morawska et al. argue that existing evidence is sufficiently strong to warrant engineering controls targeting airborne transmission as part of an overall strategy to limit infection risk indoors. Appropriate building engineering controls include sufficient and effective ventilation, possibly enhanced by particle filtration and air disinfection, avoiding air recirculation and avoiding overcrowding. Often, such measures can be easily implemented and without much cost, but if only they are recognised as significant in contributing to infection control goals. The authors believe that the use of engineering controls in public buildings, including hospitals, shops, offices, schools, kindergartens, libraries, restaurants, cruise ships, elevators, conference rooms or public transport, in parallel with effective application of other controls (including isolation and quarantine, social distancing and hand hygiene), would be an additional important measure globally to reduce the likelihood of transmission and thereby protect healthcare workers, patients and the general public.
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Content ArticleAs public health teams respond to the Covid-19 pandemic, containment and understanding of the modes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is of utmost importance for policy making. During this time, governmental agencies have been instructing the community on handwashing and physical distancing measures. However, there is no agreement on the role of aerosol transmission for SARS-CoV-2. Tang et al. aimed to review the evidence of aerosol transmission of SARS-CoV-2. Several studies support that aerosol transmission of SARS-CoV-2 is plausible, and the plausibility score (weight of combined evidence) is 8 out of 9. Precautionary control strategies should consider aerosol transmission for effective mitigation of SARS-CoV-2.
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Content ArticleThis study in the BMJ Open examines the links between between adverse childhood events and trust in Covid-19 health information, attitudes towards and compliance with Covid-19 restrictions and vaccine hesitancy. The study found correlations between adverse childhood events and: low trust in NHS Covid-19 information feeling unfairly restricted by government supporting removal of social distancing and ending of mandatory face coverings breaking Covid-19 restrictions vaccine hesitancy. The authors concluded that as adverse childhood events are common across many populations, there is a need to understand how they impact trust in health advice and uptake of medical interventions. This could play a critical role in the continuing response to Covid-19 and approaches to controlling future pandemics. In addition, as individuals with adverse childhood events suffer greater health risks throughout life, better compliance with public health advice is another reason to invest in safe, secure childhoods for all children.
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Community Post
Covid-19 safety of GP practices
Katharine Tylko posted a topic in Coronavirus (COVID-19)
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HOW SAFE ARE OUR GP PRACTICES during covid-19? For the health care professionals, their patients, and families of patients? I'm a 65-yr old diabetic needing routine B12 injections. My GP tells me to turn up as normal so I don't develop neurological problems. I don't think anyone in the practice has been tested for covid-19. I'm refusing to turn up since I suspect the GP practice to be a covid-19 hot-spot. I don't want to transmit this virus to my frail, elderly asthmatic husband who's undergone cancer treatment and a lot of surgery. I've persuaded the GP to give me a precription for oral B12. Have I done the right thing? How can I help GPs and patients in far worse dilemmas than mine?- Posted
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News Article
Lack of hospital beds makes Covid spread 'inevitable'
Patient Safety Learning posted a news article in News
A lack of beds in Welsh hospitals meant it was "inevitable" Covid patients would come into contact with others, a doctor has said. "Seeing patients in bed at the time of admission is becoming a rarity," Dr Nicky Leopold said. Some patients, including those with Covid, have had to spend nights on chairs in A&E due to a lack of beds. The Welsh government said it aimed to deliver 12,000 more staff by 2024-25. Health Minister Eluned Morgan and the chief executive of the Welsh NHS are due to give evidence to the Senedd's health committee on winter pressures.. Dr Leopold, a consultant geriatrician, who is a member of the BMA union in Wales, said there had been recent improvements since the number of NHS staff testing positive for Covid fell, but the flow of patients through hospital was still a problem. She said: "So many patients are stranded in hospital and that's very difficult and frustrating. There just aren't the staff in the community to support the increased level of need." Outpatient appointments had also been affected by shortages, she added. A lot of patients were in "dire need" and staff were "desperately" trying to keep clinics running. Read full story Source: BBC News, 10 February 2022- Posted
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Growing number of trusts defy system leaders on FFP3 guidance
Patient Safety Learning posted a news article in News
Over 30 trusts are now mandating FFP3 masks are used beyond settings stipulated in national rules, amid calls for system leaders to clarify the national position on the key staff and patient safety issue. Fresh Air NHS, a group of frontline staff who campaign for better protection against Covid-19, said it now knows of 32 trusts which have already introduced enhanced infection prevention control policies that mandate FFP3 use beyond national guidance. News that a growing number of trusts are mandating more stringent PPE use comes amid fresh confusion around the national guidance after small but potentially significant alterations were made last week. A new line has been added to guidance which says:: “FFP3 respirator or equivalent must be worn by staff when caring for patients with a suspected or confirmed infection spread by the airborne route.” David Tomlinson, consultant cardiologist and also a member of Fresh Air NHS, said NHS trusts were “in fear of going beyond the guidance and allowing non-ICU staff to wear FFP3 respirators”. “The guidance doesn’t mandate respirators for staff in highest risk of transmission areas, for example, medical wards housing symptomatic patients at a time in their disease when they are releasing greatest amounts of infectious aerosols,” Dr Tomlinson said. “Real world data has consistently shown far greater rates of SARS2 infection comparing non-ICU healthcare workers to those on ICU.” Alison Leary, chair of healthcare and workforce modelling at London Southbank University, said: “Trusts choosing to implement evidence based safety interventions is a positive move towards workforce safety.” Read full story Source: HSJ, 27 January 2022- Posted
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A quarter of inpatients at mental health trust have Covid
Patient Safety Learning posted a news article in News
More than one in four inpatients at one of England’s largest mental health trusts were reported as covid-positive this week, according to data seen by HSJ. Around 160 inpatients across South London and Maudsley (SLAM) Foundation Trust’s sites, or 28% of its total open beds, were reported as positive at the beginning of the week. Several other London mental health trusts have seen high rates of covid cases in recent weeks, as there has been enormous spread of the omicron variant in the capital, although rates have not been as high as at SLAM. SLAM told HSJ that infection rates rose and fell in a reflection of community transmission, with covid-positive people being admitted, and there being spread within inpatient units. While no wards have been closed and all of the trust’s services are open, visiting was suspended in mid-December due to what the organisation described on its website as a “high number of [covid] outbreaks”. Several sources in the sector told HSJ there had been widespread omicron outbreaks in mental health units across England. They said the nature of psychiatric wards and use of restraints meant adhering to stringent social distancing measures, in the face of a highly infectious variant, was more difficult than in other settings. Read full story (paywalled) Source: HSJ, 6 January 2022- Posted
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News Article
Suspected Covid outbreaks in UK hospitals double in a week
Patient Safety Learning posted a news article in News
Suspected Covid outbreaks in hospitals across the UK have doubled in a week, official figures reveal – though the number of people admitted to wards with the virus is falling across much of England. As parts of the NHS battle to cope with a surge in infected staff and patients, UK Health Security Agency (UKHSA) data show there were 66 acute respiratory infection incidents in UK hospitals in the seven days to 16 December. Coronavirus was confirmed in most of these incidents, according to a UKHSA document reviewed, by the Guardian. It represents a doubling in outbreaks compared with the previous week (33) and is the highest total recorded since the third week of January 2020. Most of the outbreaks happened in London, with 28 recorded in the last week, almost half of all those in England (62). Nine were recorded in West Midlands hospitals, six in the east of England and five in the east Midlands. Hospitals are scrambling to try to stop the highly transmissible Omicron variant spreading between patients and staff, NHS leaders said, while trying to cope with more pressure than last year. Saffron Cordery, deputy chief executive of NHS Providers, said: “The safety of staff and patients is a key priority of trust leaders, and trusts are doing everything they can to keep nosocomial [hospital-acquired] infections to a minimum, including following stringent infection control measures and social distancing rules.” Read full story Source: The Guardian, 22 December 2021 -
News ArticlePoliticians and doctors in Germany have called for urgent action to control the spread of COVID-19 after a record number of cases were reported on 11 November. Germany had 50 196 new confirmed Covid cases on 11 November, up from 39 676 cases on 10 November and 9658 on 1 November, showed figures from the Robert Koch Institute. A total of 235 Covid related deaths were reported on 11 November, up from 23 on 1 November. Speaking in the Bundestag, Germany’s lower house of parliament, the federal vice chancellor, Olaf Scholz, said that immediate steps must be taken to “winterproof” Germany against what is being described as the nation’s fourth wave of Covid-19. Scholz will meet next week with the prime ministers of Germany’s 16 states to discuss new measures to fight the pandemic. “The virus is still with us and threatens the health of citizens,” Scholz said, adding that efforts must be intensified to convince unvaccinated Germans to become fully vaccinated and encourage those already vaccinated to have the booster shot." Everything must be done, he said, to ensure “that millions of citizens get a booster—that is the task of the next weeks and months.” Read full story Source: BMJ, 12 November 2021
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News ArticleDeaths from COVID-19 in England in the first half of 2021 could exceed those seen in the whole of 2020 unless the vaccination programme is vastly increased and a national lockdown implemented—with educational settings closed for at least a month—researchers have warned. In a preprint released on 24 December, researchers from the London School of Hygiene and Tropical Medicine used modelling to compare the effects of varying COVID-19 restrictions on the virus spread, hospital and intensive care admissions, and deaths from 15 December 2020 to 30 June 2021. The model took account of the new variant spreading rapidly in southern England, which it estimated to be 56% more transmissible than non-variant COVID-19. The study, which has yet to be peer reviewed, said that control measures similar to the November national lockdown would be “unlikely to reduce the effective reproduction number to less than 1, unless primary schools, secondary schools, and universities are also closed.” It added that it would be necessary to “greatly accelerate vaccine rollout to have an appreciable impact in suppressing the resulting disease burden.” Read full story Source: BMJ, 29 December 2020
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Hospital acquired covid infections hit record high
Patient Safety Learning posted a news article in News
The number of COVID-19 infections likely to have been acquired in hospital are rising again for the first time in three weeks and their proportion of all cases has reached record levels for the second wave, HSJ can reveal. NHS England data covering the week to 6 December (the latest available) shows 1,787 COVID-19 cases were acquired in-hospital – a rise of almost 14% on the week before. The number of hospital-acquired, or “nosocomial”, infections had been falling since the week to 15 November, when 1,794 were recorded. This week, hospital acquired covid infections amounted to 21% of the 8,337 new cases which were recorded in hospitals – the highest proportion in the second wave. On 6 December alone, 24% of infections had probably been acquired in hospital rather than the community. Read full story (paywalled) Source: HSJ, 11 December 2020