This prognostic study compares standard readmission risk assessment scores with a machine learning score, the Baltimore score, for predicting 30-day unplanned hospital readmissions calculated in real time.

Background: The COVID-19 pandemic has led to widespread implementation of public health measures, such as stay-at-home orders, social distancing, and masking mandates. In addition to decreasing spread of SARS-CoV2, these measures also impact the transmission of seasonal viral pathogens, which are common triggers of COPD exacerbations. Whether reduced viral prevalence mediates reduction in COPD exacerbation rates is unknown. Methods: We performed retrospective analysis of data from a large, multicenter healthcare system to assess admission trends associated with community viral prevalence and with initiation of COVID-19 pandemic control measures. We applied difference-in-differences (DiD) analysis to compare season-matched weekly frequency of hospital admissions for COPD before and after implementation of public health measures for COVID-19. Community viral prevalence was estimated using regional Center for Disease Control and Prevention test positivity data and correlated to COPD admissions. Results: Data involving 4,422 COPD admissions demonstrated a season-matched 53% decline in COPD admissions during COVID-19 pandemic, which correlated to community viral burden (r=0.73; 95% CI: 0.67 to 0.78) and represented a 36% greater decline over admission frequencies observed in other medical conditions less affected by respiratory viral infections (IRR, 0.64; 95% CI, 0.57 to 0.71, p<0.001). The post-COVID-19 decline in COPD admissions was most pronounced in patients with fewer comorbidities and without recurrent admissions. Conclusion: The implementation of public health measures during the COVID-19 pandemic was associated with decreased COPD admissions. These changes are plausibly explained by reduced prevalence of seasonal respiratory viruses.

Objective To determine the utility of the Sofia® SARS rapid antigen fluorescent immunoassay (FIA) to guide hospital bed placement of patients being admitted through the emergency department (ED). Design Cross-sectional analysis of a clinical quality improvement study. Setting Two community hospitals in Maryland. From 9/21/2020 to 12/3/2020, 2887 patients simultaneously received the Sofia® SARS rapid antigen FIA and SARS-CoV-2 RT-PCR assays on admission through the ED. Methods Rapid antigen results and symptom assessment guided initial patient placement while confirmatory RT-PCR was pending. The sensitivity, specificity, positive and negative predictive values of the rapid antigen assay were calculated relative to RT-PCR, overall and separately for symptomatic and asymptomatic patients. Assay sensitivity was compared to RT-PCR cycle threshold (Ct) values. Assay turnaround times were compared. Clinical characteristics of RT-PCR positive patients and potential exposures from false-negative antigen assays were evaluated. Results Overall agreement, sensitivity, and specificity for all patients was 97.9%, 76.6% (95% confidence interval (CI): 71%, 82%), and 99.7% (95% CI: 99%, 100%), respectively. No differences in performance were seen between asymptomatic and symptomatic individuals. As RT-PCR Ct increased, sensitivity of the antigen assay decreased. Mean turnaround time for the antigen assay and RT-PCR was 1.2 (95% CI: 1.0, 1.3) and 20.1 (95% CI: 18.9, 40.3) hours, respectively (p<0.001). No transmission from antigen-negative/RT-PCR-positive patients was identified. Conclusions While not a replacement for RT-PCR for detection of all SARS-CoV-2 infections, the Sofia® SARS antigen FIA has clinical utility for potential initial timely patient placement.

AimsWhile the SARS-CoV-2 pandemic may be contained through vaccination, transfusion of convalescent plasma (CCP) from individuals who recovered from COVID-19 (CCP) is considered an alternative treatment. We investigate if CCP transfusion in patients with severe respiratory failure increases plasma titres of SARS-CoV-2 antibodies and improves clinical outcomes.MethodsPatients with COVID-19 (n=34) were consented for CCP transfusion and serial blood draws pretransfusion and post-transfusion. Plasma SARS-CoV-2 antireceptor binding domain (RBD) IgG and IgM titres were measured by ELISA serially, and compared with serial plasma titre levels from control patients (n=68). The primary outcome was survival at 30 days, and secondary outcomes were length of ventilator and/or extracorporeal membrane oxygenation (ECMO) support, length of stay (LOS) in the hospital and in the intensive care unit (ICU). Outcomes were compared with matched control patients (n=34). Kinetics of antibodies and clinical outcomes were compared using LOess regression and ORs, respectively.ResultsPrior to CCP transfusion, 74% of patients were anti-RBD seropositive for IgG (median 1:3200), and 81% were anti-RBD IgM seropositive (median 1:320), while 16% were seronegative. The kinetics of antibody titres in CCP recipients were similar to controls. CCP recipients presented with similar survival, duration on ventilatory and/or ECMO support, as well as ICU and hospital LOS compared with controls.ConclusionsCCP transfusion did not increase the kinetics of SARS-CoV2 antibodies and did not result in improved clinical outcomes in patients with COVID-19 with severe respiratory failure, suggesting that CCP may not be indicated in this category of patients.

Background Critical care nurses take care of patients with complicated, comorbid, and compromised conditions. These patients are at risk for health care–associated infections, which affect patients’ lives and health care systems in various ways. Objective To gauge the impact of routinely bathing patients with 4% chlorhexidine gluconate solution on the incidence of health care–associated infections in a medical-surgical intensive care unit and a postoperative telemetry unit; to outline the framework for a hospital-wide presurgical chlorhexidine gluconate bathing program and share the results. Methods A standard bathing protocol using a 4% chlorhexidine gluconate solution was developed. The protocol included time studies, training, monitoring, and surveillance of health care–associated infections. Results Consistent patient bathing with 4% chlorhexidine gluconate was associated with a 52% reduction in health care–associated infections in a medical-surgical intensive care unit. The same program in a postoperative telemetry unit yielded a 45% reduction in health care–associated infections. Conclusion A comprehensive daily 4% chlorhexidine gluconate bathing program can be implemented with standardized protocols and detailed instructions and can significantly reduce the incidence of health care–associated infections in intensive care unit and non–intensive care unit hospital settings.