Objective: To describe COVID-19 infections amongst healthcare workers (HCWs) at the Royal Melbourne Hospital from 1st July to 31st August 2020
Design: Prospective observational study
Setting: A 550 bed tertiary referral hospital in metropolitan Melbourne
Participants: All HCWs identified with COVID-19 infection in the period of interest
Results: 262 HCW infections were identified over 9 weeks. 68.3% of infected HCWs were nurses and the most affected locations were the geriatric and rehabilitation wards. Clusters of infection occurred in staff working in wards with patients known to have COVID-19 infection. Staff infections peaked when COVID-19 infected inpatient numbers were highest, and density of patients and certain patient behaviours were noted by staff to be linked to possible transmission events. Three small outbreaks on other wards occurred but all were recognised and brought under control. Availability of rapid turn-around staff testing, and regular review of local data and obtaining feedback from staff helped identify useful interventions which were iteratively implemented. Attention to staff wellbeing was critical to the response and a comprehensive support service was implemented.
Conclusion(s): A comprehensive multimodal approach to containment was instituted with iterative refinement based on frontline workers observations and ongoing analysis of local data in real time.
Objectives
To design and evaluate 3D‐printed nasal swabs for collection of samples for SARS‐CoV‐2 testing.
Design
An iterative design process was employed. Laboratory evaluation included in vitro assessment of mock nasopharyngeal samples spiked with two different concentrations of gamma‐irradiated SARS‐CoV‐2. A prospective clinical study compared SARS‐CoV‐2 and human cellular material recovery by 3D‐printed swabs and standard nasopharyngeal swabs.
Setting, participants
Royal Melbourne Hospital, May 2020. Participants in the clinical evaluation were 50 hospital staff members attending a COVID‐19 screening clinic and two inpatients with laboratory‐confirmed COVID‐19.
Intervention
In the clinical evaluation, a flocked nasopharyngeal swab sample was collected with the Copan ESwab and a mid‐nasal sample from the other nostril was collected with the 3D‐printed swab.
Results
In the laboratory evaluation, qualitative agreement with regard to SARS‐CoV‐2 detection in mock samples collected with 3D‐printed swabs and two standard swabs was complete. In the clinical evaluation, qualitative agreement with regard to RNase P detection (a surrogate measure of adequate collection of human cellular material) in samples collected from 50 hospital staff members with standard and 3D‐printed swabs was complete. Qualitative agreement with regard to SARS‐CoV‐2 detection in three pairs of 3D‐printed mid‐nasal and standard swab samples from two inpatients with laboratory‐confirmed SARS‐CoV‐2 was also complete.
Conclusions
Using 3D‐printed swabs to collect nasal samples for SARS‐CoV‐2 testing is feasible, acceptable to patients and health carers, and convenient.
Background
In Australia, COVID-19 diagnosis relies on RT-PCR testing which is relatively costly and time-consuming. To date, few studies have assessed the performance and implementation of rapid antigen-based SARS-CoV-2 testing in a setting with a low prevalence of COVID-19 infections, such as Australia.
Methods
This study recruited participants presenting for COVID-19 testing at three Melbourne metropolitan hospitals during a period of low COVID-19 prevalence. The Abbott PanBio
TM
COVID-19 Ag point-of-care test was performed alongside RT-PCR. In addition, participants with COVID-19 notified to the Victorian Government were invited to provide additional swabs to aid validation. Implementation challenges were also documented.
Findings
The specificity of the Abbott PanBio
TM
COVID-19 Ag test was 99.96% (95% CI 99.73 - 100%). Sensitivity amongst participants with RT-PCR-confirmed infection was dependent upon the duration of symptoms reported, ranging from 77.3% (duration 1 to 33 days) to 100% in those within seven days of symptom onset. A range of implementation challenges were identified which may inform future COVID-19 testing strategies in a low prevalence setting.
Interpretation
Given the high specificity, antigen-based tests may be most useful in rapidly triaging public health and hospital resources while expediting confirmatory RT-PCR testing. Considering the limitations in test sensitivity and the potential for rapid transmission in susceptible populations, particularly in hospital settings, careful consideration is required for implementation of antigen testing in a low prevalence setting.
Funding
This work was funded by the
. The funder was not involved in data analysis or manuscript preparation.
Background: In Australia, COVID-19 diagnosis relies on RT-PCR testing which is relatively costly and timeconsuming. To date, few studies have assessed the performance and implementation of rapid antigenbased SARS-CoV-2 testing in a setting with a low prevalence of COVID-19 infections, such as Australia.Methods: This study recruited participants presenting for COVID-19 testing at three Melbourne metropolitan hospitals during a period of low COVID-19 prevalence. The Abbott PanBio TM COVID-19 Ag point-ofcare test was performed alongside RT-PCR. In addition, participants with COVID-19 notified to the Victorian Government were invited to provide additional swabs to aid validation. Implementation challenges were also documented.
Findings:The specificity of the Abbott PanBio TM COVID-19 Ag test was 99.96% (95% CI 99.73 -100%). Sensitivity amongst participants with RT-PCR-confirmed infection was dependent upon the duration of symptoms reported, ranging from 77.3% (duration 1 to 33 days) to 100% in those within seven days of symptom onset. A range of implementation challenges were identified which may inform future COVID-19 testing strategies in a low prevalence setting.Interpretation: Given the high specificity, antigen-based tests may be most useful in rapidly triaging public health and hospital resources while expediting confirmatory RT-PCR testing. Considering the limitations in test sensitivity and the potential for rapid transmission in susceptible populations, particularly in hospital settings, careful consideration is required for implementation of antigen testing in a low prevalence setting.Funding: This work was funded by the Victorian Department of Health and Human Services. The funder was not involved in data analysis or manuscript preparation.
Objective
The primary objective was to conduct a meta-analysis on published observational cohort data describing the association between acetyl-salicylic acid (aspirin) use prior to the onset of sepsis and mortality in hospitalized patients.
Study Selection
Studies which reported mortality in patients on aspirin with sepsis with a comparison group of patients with sepsis not on prior aspirin therapy were included.
Data sources
Fifteen studies described hospital-based cohorts (n=17,065), while one was a large insurance-based database (n=683,421). Individual-level patient data were incorporated from all selected studies.
Data Extraction
Propensity analyses with 1:1 propensity score matching at the study level were performed, using the most consistently available covariates judged to be associated with aspirin. Meta-analyses were performed to estimate the pooled average treatment effect of aspirin on sepsis-related mortality.
Data Synthesis
Use of aspirin was associated with a 7% (95%CI, 2% to 12%, p=0.005) reduction in the risk of death as shown by meta-analysis with considerable statistical heterogeneity (I2=61.6%).
Conclusions
These results are consistent with effects ranging from a 2% to 12% reduction in mortality risk in patients taking aspirin prior to sepsis onset. This association anticipates results of definitive studies of the use of low-dose aspirin as a strategy for reduction of deaths in patients with sepsis.
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