176 Did Hand Washing and Use of Personal Protective Equipment (PPE) Reduce Transmission of Surgical Site Infections During the SARS-CoV-2 Pandemic?

Aim

A retrospective case-control study comparing Surgical Site Infections (SSIs) following primary hip and knee arthroplasty before and during the SARS-CoV-2 pandemic across East Sussex NHS Trust (ESHT). The aim of this study was to evaluate whether the government advice relating to increased vigilance surrounding hand hygiene and use of personal protective equipment (PPE) reduced SSIs following elective arthroplasty.

Method

Data was obtained from Public Health England website relating to SSIs following primary hip and knee arthroplasty between April 2019 and March 2020 (pre-pandemic) performed at ESHT and compared to April 2020 to March 2021 (pandemic).

Results

A total of 454 patients underwent a total hip replacement (THR) during the pre-pandemic period with 12 patients developing an SSI (2.6%). Comparatively, during the pandemic period, 146 patients underwent a THR with 4 reporting an SSI (2.7%). A total of 449 patients underwent a total knee replacement (TKR) during the pre-pandemic period with 11 reporting an SSI (2.5%). In contrast, 9 of the 138 patients undergoing a TKR during the pandemic group developed an SSI (6.5%).

Conclusions

As the data shows, there was no significant difference observed between SSIs following THR performed at ESHT prior to and during the pandemic. Surprisingly, there was a 2.6-fold increase in SSI following TKR during the pandemic period compared with pre-pandemic. Both of these findings seemingly reject the null hypothesis that increased vigilance to hand hygiene and use of PPE mandated by the government and echoed by healthcare trusts during this time would reduce transmission of infections.

Patient outcomes following transfer between intensive care units during the COVID-19 pandemic

Transferring critically ill patients between intensive care units (ICU) is often required in the UK, particularly during the COVID-19 pandemic. However, there is a paucity of data examining clinical outcomes following transfer of patients with COVID-19 and whether this strategy affects their acute physiology or outcome. We investigated all transfers of critically ill patients with COVID-19 between three different hospital ICUs, between March 2020 and March 2021. We focused on inter-hospital ICU transfers (those patients transferred between ICUs from different hospitals) and compared this cohort with intra-hospital ICU transfers (patients moved between different ICUs within the same hospital). A total of 507 transfers were assessed, of which 137 met the inclusion criteria. Forty-five patients underwent inter-hospital transfers compared with 92 intra-hospital transfers. There was no significant change in median compliance 6 h pre-transfer, immediately post-transfer and 24 h post-transfer in patients who underwent either intra-hospital or inter-hospital transfers. For inter-hospital transfers, there was an initial drop in median PaO₂ /F_I O₂ ratio: from median (IQR [range]) 25.1 (17.8-33.7 [12.1-78.0]) kPa 6 h pre-transfer to 19.5 (14.6-28.9 [9.8-52.0]) kPa immediately post-transfer (p < 0.05). However, this had resolved at 24 h post-transfer: 25.4 (16.2-32.9 [9.4-51.9]) kPa. For intra-hospital transfers, there was no significant change in PaO₂ /F_I O₂ ratio. We also found no meaningful difference in pH; PaCO₂ ;_, base excess; bicarbonate; or norepinephrine requirements. Our data demonstrate that patients with COVID-19 undergoing mechanical ventilation of the lungs may have short-term physiological deterioration when transferred between nearby hospitals but this resolves within 24 h. This finding is relevant to the UK critical care strategy in the face of unprecedented demand during the COVID-19 pandemic.

Prevalence of elevated blood lead levels and risk factors among children living in Patna, Bihar, India 2020

Childhood lead exposure remains a key health concern for officials worldwide, contributing some 600,000 new cases of intellectually disabled children annually. Most children affected by high exposure to lead live in low- and middle-income countries. The leaded gasoline phase out in India was completed in 2000. Yet, in 2020, an estimated 275 million children aged 0 to 9 years had blood lead levels (BLLs) ≥ 5 μg/dL known to adversely affect intelligence and behavior. Lead sources reported in India include spices, cookware, paint, traditional medicines and cosmetics, and lead-acid battery recycling and repair. However, their relative contribution has not been characterized. More than 200 lead pollution sites related to battery recycling and repair activities were identified in Bihar and Jharkhand, India. Ninety percent of the recycling sites had soil lead concentrations exceeding the US Environmental Protection Agency's standards. We compared blood and environmental lead levels in two groups of children in Patna, Bihar. Households in proximity to battery recycling operations (Proximal n = 67) versus households distal to these operations (Distal n = 68). The average age of children was 40 months; 46% were female. Overall, the geometric mean (GM) BLL was 11.6 μg/dL. GM BLLs of children in Proximal and Distal households were not significantly different (10.2 μg/dL vs. 13.1 μg/dL respectively; p≤0.07). About 87% children, 56 Proximal and 62 Distal had BLLs ≥5 μg/dl. Lead concentrations in environmental samples were significantly higher in Proximal households (soil mean 9.8 vs. 1.6 μg/ft2; dust mean 52.9 vs. 29.9 μg/ft2 p<0.001; Proximal vs. Distal respectively) whereas concentrations in all spices were higher in Distal households (mean 46.8 vs 134.5 ppm p<0.001; Proximal vs. Distal respectively), and turmeric (mean 59.4 vs. 216.9 ppm Proximal vs. Distal respectively). In multivariate analyses for all children lead in spices and turmeric and number of rooms in the house were significant while for the Proximal group only lead in spices remained in the model. The predictive value of these models was poor. For the Distal group, a model with lead concentration in spices, turmeric and soil and number of rooms in the house was a much better fit. Of the 34 water samples collected, 7 were above the Indian standard of 10 ppb for lead in drinking water (2 in the Proximal area, 5 in the Distal area). Children in Patna, Bihar, India are exposed to multiple sources of lead, with lead levels in house dust and loose, locally sourced spices the most likely to increase blood lead levels. A holistic approach to blood lead testing and source identification and remediation are necessary to prevent lead exposure.

Superresolution Linear Optical Imaging in the Far Field

The resolution of optical imaging devices is ultimately limited by the diffraction of light. To circumvent this limit, modern superresolution microscopy techniques employ active interaction with the object by exploiting its optical nonlinearities, nonclassical properties of the illumination beam, or near field probing. Thus, they are not applicable whenever such interaction is not possible, for example, in astronomy or noninvasive biological imaging. Far field, linear optical superresolution techniques based on passive analysis of light coming from the object would cover these gaps. In this Letter, we present the first proof-of-principle demonstration of such a technique for 2D imaging. It works by accessing information about spatial correlations of the image optical field and, hence, about the object itself via measuring projections onto Hermite-Gaussian transverse spatial modes. With a basis of 21 spatial modes in both transverse dimensions, we perform two-dimensional imaging with twofold resolution enhancement beyond the diffraction limit.

The role of thalidomide in dermatology

Thalidomide is a medication that has been in existence for over half a century, and has proven to be useful and effective in severe dermatological conditions. For dermatologists, the ability of thalidomide to reduce the levels of the cytokine tumour necrosis factor-α, along with its immunomodulatory and anti-angiogenic properties, is of great significance, with the added advantage of being an oral medication. Its use is of course strictly monitored, owing to its potential adverse effects (AEs), particularly teratogenicity, with precautions taken to ensure its safe and correct use by both prescriber and patient. In this review, we look at the background and mechanism of action of thalidomide, provide an overview of conditions it can be used for with case examples, explain the potential AEs and monitoring requirements, and discuss future developments.

Survey of Healthcare Providers Utilization and Perception of Telehealth On-Treatment Visits During COVID-19 Pandemic

Purpose/Objective(s)

Materials/Methods

Results

Conclusion

1350 Wide-Awake Local Anaesthetic No Tourniquet (WALANT) Vs General/Regional Anaesthetic for Flexor Tendon Injuries: A Single-Centre, Retrospective Cohort Study

Aim

Flexor tendon repairs are commonly performed under general/regional anaesthesia. Wide-awake local anaesthetic no tourniquet (WALANT) has potential advantages including the ability to test the repair intra-operatively; removal of the risks of general anaesthesia; no aerosol generation, thus reducing COVID-19 transmission risk. An ongoing systematic review identified no comparative studies. This study aimed to compare the functional outcomes and complications of flexor tendon repairs under WALANT and general/regional anaesthetic.

Method

A single-centre, retrospective cohort study was undertaken (July 2019-August 2020). Consecutive adult patients undergoing flexor tendon repair were included. Exclusion criteria were ≥ 3 injured fingers; concurrent hand fracture; revascularisation; replantation. Data were collected on demographics, injuries, operative technique, and outcomes.

Results

Overall, 139 patients with 165 injured digits were included. Most (60%) were repaired under general anaesthesia. Local anaesthetic (was used for 46 patients (21 with tourniquet, 25 WALANT). Only 30% (42/139) patients had range of motion data at 6-weeks, dropping to 19% (26/139) at 12-weeks. WALANT patients had fewer ruptures (8% vs 14%), fewer adhesions requiring tenolysis (0% vs 4%) and less complications overall than the general/regional anaesthesia group. The results were not found to be statistically significant.

Conclusions

The lack of data due to patients not attending follow-up, makes meaningful research on flexor tendon injuries very challenging. This study suggests WALANT may reduce complications but is limited by the inherent bias of a retrospective, non-randomised study, and small numbers. Adequately designed and powered studies are recommended in future to further investigate the potential benefits of wide-awake surgery.

347 Read the First Page: An Audit on Medicine Reconciliation in General Surgery Inpatients at London District General Hospital

Aim

Medication-related incidents occur more frequently when medicine reconciliation happens more than 24 hours after admission. The National Institute for Health and Care Excellence recommends a complete reconciliation within 24 hours of admission. General Surgery is a busy specialty with a high patient turnover rate. Hence, this audit was conducted to assess the extent of a problem and mitigate it.

Method

Every adult General Surgery inpatient who were admitted for over 24 hours were included. Patients on intensive care or high dependency unit were excluded. Drug charts were reviewed every Thursday for nine weeks between October and December 2020. Data from the first three weeks were used to establish baseline. Three interventions were introduced, each lasting two weeks. Any significant harm to patients due to incomplete reconciliation was recorded.

Results

At baseline (n = 100), 38.0% of patients had incomplete reconciliation. This significantly reduced to 23.4% (n = 64, p-value=0.037) between Weeks 4 and 5 after baseline data was presented at a team meeting and posters were put up. Allowing pharmacists to flag up missing medications on a daily job’s list did not significantly reduce the incompletion rate (23.0%, n = 74, p-value&gt;0.999). Finally, performing a medicine reconciliation ward round on Weeks 8 and 9 further reduced the incompletion rate to 2.8% (n = 74, p-value=0.001). One significant harm was noted on Week 1.

Conclusions

Medicine reconciliation is a vital aspect of patient safety. Raising awareness of the issue significantly reduced the incompletion rate. However, the most effective intervention is conducting a medicine reconciliation ward round.

Altered electrochemical properties of iron oxide nanoparticles by carbon enhance molecular biocompatibility through discrepant atomic interaction

Recent advancement in nanotechnology seeks exploration of new techniques for improvement in the molecular, chemical, and biological properties of nanoparticles. In this study, carbon modification of octahedral-shaped magnetic nanoparticles (MNPs) was done using two-step chemical processes with sucrose as a carbon source for improvement in their electrochemical application and higher molecular biocompatibility. X-ray diffraction analysis and electron microscopy confirmed the alteration in single-phase octahedral morphology and carbon attachment in Fe3O4 structure. The magnetization saturation and BET surface area for Fe3O4, Fe3O4/C, and α-Fe2O3/C were measured as 90, 86, and 27 emu/g and 16, 56, and 89 m2/g with an average pore size less than 7 nm. Cyclic voltammogram and galvanostatic charge/discharge studies showed the highest specific capacitance of carbon-modified Fe3O4 and α-Fe2O3 as 213 F/g and 192 F/g. The in vivo biological effect of altered physicochemical properties of Fe3O4 and α-Fe2O3 was assessed at the cellular and molecular level with embryonic zebrafish. Mechanistic in vivo toxicity analysis showed a reduction in oxidative stress in carbon-modified α-Fe2O3 exposed zebrafish embryos compared to Fe3O4 due to despaired influential atomic interaction with sod1 protein along with significant less morphological abnormalities and apoptosis. The study provided insight into improving the characteristic of MNPs for electrochemical application and higher biological biocompatibility.