Category: Series by Dr Evonne T Curran

This week’s blog is the next one in the series being written by @DrEvonneTCurran.

Introduction

The first tweet is from an NHS Trust explaining their position to reduce the use of masks by staff, patients, and visitors (Figure 1). The second is from a different NHS Trust showing how they are deploying High-Efficiency Particulate Air (HEPA) filters in their wards and clinical areas (Figure 2(. Both Trusts must have assessed that no one will be harmed by their planned actions. As the actions are different, one adding and one removing controls, clearly, one of their assessments must include erroneous assumptions of safety.

The first tweet

Let’s start with the rule – what relevant Fundamental Standard does the Care Quality Commission (CQC) require for people safety:

You must not be given unsafe care or treatment or be put at risk of harm that could be avoided.

Figure 1: The first tweet

For the first NHS Trust to meet this fundamental standard, and for there to be safety going forward with reduced mask usage, there would need to be zero nosocomial covid infections at present, and an assessment that reducing controls would present no additional risk.

Continue reading “A tale of 2 tweets: 1 of which must include erroneous assumptions of safety”

This week’s blog is 6th in a series by Dr Evonne T Curran (@EvonneTCurran).

The pre-pandemic Infection Prevention and Control (IPC) model for respiratory transmission (droplets or aerosols) with droplets being the dominant mode is un-evidenced. Although this has yet to be admitted by some guidance writers – the evidence for airborne infection is overwhelming. Much of what I have been trying to do is persuade people that most respiratory infections including SARS-CoV-2 are airborne. I naively thought that if the new paradigm was accepted (everything ≤100μ being inhalable), this would naturally lead to the correction of control measures and the introduction of indoor air quality and respirators. This is yet to happen.

However, the further I investigated the existing 3 Modes of Nosocomial Transmission (MoNT), and the 3 corresponding precautions (airborne, droplet, contact), the more I realised that these modes of transmission omit another MoNT altogether – Airborne Dissemination. Having been ignored when demonstrating that the droplet or airborne paradigm needs amending, perhaps this argument – you have omitted a 4^th MoNT altogether – might yield better results.

Continue reading “The 4th Mode of Nosocomial Transmission – Airborne Dissemination”

This week’s blog is by Dr Evonne T Curran (@EvonneTCurran).

Managing an outbreak starts with data, (e.g., surveillance data: a rise in the number of x, clinical data: someone calls saying “we have 4 people with diarrhoea and vomiting”, or laboratory staff identify alert organisms). You then decide whether you can exclude an outbreak. If you can’t exclude – you immediately act. The first act is to put in place everything needed for Patient, Healthcare Worker (HCW) and Visitor (PHV) safety. For example, you might close a bay or a ward (norovirus), stop showers (Legionnaires disease), or isolate cases (infected wounds). You don’t wait for a committee – this is ‘first aid’ for PHV safety. Then you investigate. The investigations may identify the need for more control measures. Control measure implementation assurance checks are made, and the epidemic curve is monitored. This is the daily graph of new cases. If all necessary control measures are being followed, after a lag for the incubation period, the epidemic curve will fall as no new people are being exposed.  If cases continue to arise, there must be an omission of one or more control measures indicating further investigations and control measures are needed. This process continues until the outbreak ceases.

Continue reading “Patient Healthcare Worker and Visitor Safety during an outbreak (and a begging bowl)”