Limited implementation of measures to reduce nosocomial spread of COVID-19 in hip-fracture patients in the North West of England

Mastan, Saleem; Cash, T; Malik, Rayaz A.; Charalambous, Charalambos Panayiotou

doi:10.1016/j.jhin.2020.11.007

Cited by 4 publications

(5 citation statements)

References 3 publications

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“…Nevertheless, our results demonstrate substantial variation in PPE use by orthopaedic specialist trainees caring for hip fracture patients in the NW of England during the 2nd surge of the COVID-19 pandemic [2]. This study calls for a significant improvement in the provision of PPE in NW England, given the potentially grave impact of COVID-19 infection in hip fracture patients.…”

Section: Discussionmentioning

confidence: 69%

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COVID-19 infection is related to differences in the use of personal protective equipment by orthopaedic specialist trainees caring for hip fracture patients during the second surge of COVID-19 in the North West of England

Mastan

Malik

Charalambous

et al. 2021

Eur J Orthop Surg Traumatol

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Introduction Personal protective equipment (PPE) may protect health-care workers from COVID-19 infection and limit nosocomial spread to vulnerable hip fracture patients. Methods We performed a cross-sectional survey amongst orthopaedic trainees to explore PPE practice in 19 hospitals caring for hip fracture patients in the North West of England. Results During the second wave of the pandemic, 14/19 (74%) hospitals experienced an outbreak of COVID-19 amongst staff or patients on the orthopaedic wards. An FFP3 respirator mask was used by doctors in only 6/19 (32%) hospitals when seeing patients with COVID-19 and a cough and in 5/19 (26%) hospitals when seeing asymptomatic patients with COVID-19. A COVID-19 outbreak was reported in 11/13 (85%) orthopaedic units where staff wore fluid resistant surgical masks compared to 3/6 (50%) units using an FFP3 respirator mask (RR 1.69, 95% CI 0.74-3.89) when caring for symptomatic patients with COVID-19. Similarly, a COVID-19 outbreak was reported in more orthopaedic units caring for asymptomatic patients with COVID-19 where staff wore fluid resistant surgical masks (12/14 (86%)) as compared to an FFP3 respirator mask (2/5 (40%)) (RR 2.14, 95% CI 0.72-6.4). Conclusion Urgent re-evaluation of PPE use is required to reduce nosocomial spread of COVID-19, amongst highly vulnerable patients with hip fracture.

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Section: Discussionmentioning

confidence: 69%

“…High rates of nosocomial COVID-19 infection have been reported in health-care workers (HCWs) and patients. We recently demonstrated very limited implementation of measures to prevent nosocomial spread during the second surge of the COVID-19 pandemic in orthopaedic units across NW England [2].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 infection is related to differences in the use of personal protective equipment by orthopaedic specialist trainees caring for hip fracture patients during the second surge of COVID-19 in the North West of England

Mastan

Malik

Charalambous

et al. 2021

Eur J Orthop Surg Traumatol

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“…In a recent study we have shown substantial deficiencies in the measures adopted to limit nosocomial COVID-19 infection in hip fracture patients in hospitals in the North West of England. 30 Public Health England (PHE) published guidelines for hospital care with high, medium and low COVID-19 risk pathways. 31 Acute hip fracture patients would qualify as high risk patients and therefore should be nursed in a single room or specific area until their laboratory test results is known.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Is Associated With a 4 Fold Increase in 30-day Mortality Risk in Hip Fracture Patients in the United Kingdom: A Systematic Review and Meta-analysis

Mastan

Hodhody

Sajid

et al. 2022

Geriatr Orthop Surg Rehabil

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Background Hip fracture in elderly patients is associated with a significant mortality which may be worsened by COVID-19 infection. Objective To undertake a systematic review and meta-analysis of studies assessing the effect of COVID-19 infection and mortality rates in hip fracture patients in the United Kingdom (UK) during the first surge of the pandemic. Design A systematic literature search of 9 online databases was undertaken independently by 2 reviewers using the Cochrane methodology for systematic reviews. Eligibility criteria were any study of an adult population with a hip fracture that assessed the relationship between COVID-19 infection and 30-day mortality in the UK. Meta-analysis was conducted using a random-effects model. Results Out of 309 identified articles, 10 studies reporting on 2448 hip fracture patients met the inclusion criteria. Meta-analysis showed that the estimated mortality rate in patients with laboratory confirmed COVID-19 infection was 32.5% (95% CI= 28.3 to 37.0) compared to 8.6% (95% CI= 6.3 to 11.6) in COVID-19 negative patients. Meta-analysis of 9 comparative studies showed a significantly higher mortality in patients with laboratory confirmed COVID-19 infection as compared to patients without (RR=3.937, 95% CI= 2.867 to 5.406, P<.001). Similar findings were obtained when comparing mortality in COVID-19 laboratory confirmed or clinically suspected infected vs non-infected patients (RR=4.576, 95% CI = 3.589 to 5.835, P <.001). Conclusions COVID-19 infection is associated with a 4-fold increase in mortality risk in hip fracture patients. Every effort should be made to avoid COVID-19 infection and nosocomial exposure in this highly vulnerable patient group.

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“…Surveillance should ideally be accompanied with other preventive measures and hospitals should be prepared not only for the large influx of community-acquired COVID-19 cases, but also to protect those patients requiring urgent or semi-urgent care, as well as HCWs [ 32 , 33 ]. At the time when the review was conducted, none of the identified HOCI surveillance systems matched the surveillance definition developed by the Centers for Disease Control and Prevention (CDC) in that the results of the surveillance were not provided by a central network [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Hospital-onset COVID-19 infection surveillance systems: a systematic review

Abbas

Zhu

Mookerjee

et al. 2021

Journal of Hospital Infection

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Hospital-onset COVID-19 infections (HOCIs) are associated with excess morbidity and mortality in patients and healthcare workers. The aim of this review was to explore and describe the current literature in HOCI surveillance. Medline, EMBASE, the Cochrane Database of Systematic Reviews, the Cochrane Register of Controlled Trials, and MedRxiv were searched up to 30 November 2020 using broad search criteria. Articles of HOCI surveillance systems were included. Data describing HOCI definitions, HOCI incidence, types of HOCI identification surveillance systems, and level of system implementation were extracted. A total of 292 citations were identified. Nine studies on HOCI surveillance were included. Six studies reported on the proportion of HOCI among hospitalized COVID-19 patients, which ranged from 0 to 15.2%. Six studies provided HOCI case definitions. Standardized national definitions provided by the UK and US governments were identified. Four studies included healthcare workers in the surveillance. One study articulated a multimodal strategy of infection prevention and control practices including HOCI surveillance. All identified HOCI surveillance systems were implemented at institutional level, with eight studies focusing on all hospital inpatients and one study focusing on patients in the emergency department. Multiple types of surveillance were identified. Four studies reported automated surveillance, of which one included real-time analysis, and one included genomic data. Overall, the study quality was limited by the observational nature with short follow-up periods. In conclusion, HOCI case definitions and surveillance methods were developed pragmatically. Whilst standardized case definitions and surveillance systems are ideal for integration with existing routine surveillance activities and adoption in different settings, we acknowledged the difficulties in establishing such standards in the short-term.

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Limited implementation of measures to reduce nosocomial spread of COVID-19 in hip-fracture patients in the North West of England

Cited by 4 publications

References 3 publications

COVID-19 infection is related to differences in the use of personal protective equipment by orthopaedic specialist trainees caring for hip fracture patients during the second surge of COVID-19 in the North West of England

COVID-19 infection is related to differences in the use of personal protective equipment by orthopaedic specialist trainees caring for hip fracture patients during the second surge of COVID-19 in the North West of England

COVID-19 Is Associated With a 4 Fold Increase in 30-day Mortality Risk in Hip Fracture Patients in the United Kingdom: A Systematic Review and Meta-analysis

Hospital-onset COVID-19 infection surveillance systems: a systematic review

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