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This statement updates the recommendations of the American Academy of Pediatrics (AAP) for the use of influenza vaccines and antiviral medications in the prevention and treatment of influenza in child...

AbstractObjectivesTo reduce IV antibiotic use by 10% across the medical wards at an acute teaching hospital between May and July 2024.BackgroundImproving IV to oral antimicrobial switch (IVOS) rates facilitates patient flow, reduces nursing time spent reconstituting IV antibiotics, increases the use of cost-effective antibiotics, reduces the ward level carbon footprint, and decreases the risk of developing line related infections. The project aimed to reduce IV antimicrobial use across medical wards through the training of champions to implement an ABCDE protocol sticker. The protocol was developed from the ‘Antimicrobial IV-to-oral switch: criteria for prompt switch’ (gov.uk).1MethodsA small-scale test of change showed that the ABCDE protocol increased the rate of IVOS by 50% on a respiratory ward. This project set out to replicate that success across all medical wards. To ensure success of the project at least one nurse and doctor champions were identified on each of the medical wards, and a ‘train the trainer’ approach was adopted. Training materials were developed for all champions and education sessions were held to empower them to cascade the teaching to nursing and clinical staff on the target wards. Throughout the project our champions ensured there was ongoing engagement at ward level throughout the months of implementation of the test of change. To maintain motivation, updates on progress were circulated to the teams.ResultsAlthough the IV antibiotic use was not reduced by 10%, there was an overall reduction in the use of IV antibiotic usage. Over the 3-month period 555 antibiotic doses were avoided saving 185 nursing hours that would have been spent preparing IV antibiotics. There was also a saving of £395 on antibiotics, £1876 on consumables, a saving of 108/3kgCO2 and £117.71 on high temperature waste. The project also trained 15 nurse and doctor champions and the resident doctor cohort on when to appropriately switch from IV to oral antibiotics. Pre- and post-teaching questionnaires highlighted that nursing staff felt empowered by the protocol, and medical staff felt the prompt was a useful reminder to review antibiotics. We are also influencing national best practice, with the ABCDE protocol having been included in national evidence bundles for other trusts to utilize.ConclusionsAntimicrobial stewardship (AMS) interventions are even more powerful when involving the multi-disciplinary team. The ABCDE protocol empowered staff groups to take a proactive role in the reviewing of IV antibiotics.

Bioaerosol-mediated transmission of COVID-19 via building ventilation systems has yet to be convincingly demonstrated. We used the South African Airborne Infections Research (AIR) facility near Pretoria to study human to animal (H2A) transmission of SARS-CoV-2 in newly diagnosed patients. While the facility was built to study tuberculosis transmission, this was its first adaptation to study H2A virus transmission.MethodsClinically confirmed COVID-19 patients were housed for up to four days in in the AIR facility with continuously exhausting patient ward air to hamsters housed in animal exposure rooms. After a 3 week exposure period, animals were held for an additional week to allow for antibody development. Animal sera were analyzed for anti-spike and plaque reduction activities and lung samples for pathology.ResultsSeven patients provided 400+ in-residence hours over a 17-day period. Pair-housed naïve golden Syrian hamsters (n=216) received continuous exposure to mixed patient-ward exhaust. Serum analyses revealed anti-SARS-CoV-2 IgG in 58% of animals tested. Plaque reduction assays on seven high titer sera revealed neutralizing activity.ConclusionsThese results support the concept that viral bioaerosols generated from patients remain infectious over long-distance transport through a building ventilation system. The seroconversion among sentinel animals supports the long-held belief that airborne infections manifest as a stochastic rather than deterministic event that is subject to a threshold dose effect. Further confirmatory studies are necessary to characterize the relationship between the bioaerosol delivered and the infections that result in this controlled H2A transmission model.

Con una inversión aproximada de 400.000 euros, el hospital ahora cuenta con un total de siete quirófanos operativos