key: cord-0974080-dey2jdin authors: Prescott, K.; Gray, J.; Mahida, N.; Winzor, G.; Wilkinson, M. title: Lessons learned from the COVID-19 pandemic through the JHI and IPIP date: 2022-01-21 journal: J Hosp Infect DOI: 10.1016/j.jhin.2021.12.013 sha: 040750b8cfdcdf3fb8e8caa7eed2e57b5936cfe0 doc_id: 974080 cord_uid: dey2jdin nan articles in the history of either journal, exemplifying the importance of making information about disinfectants as widely available as possible. The next challenge presented by the pandemic was the ability to rapidly upscale production and distribution of essential PPE. Shortages left healthcare facilities looking at alternative options including re-using existing single use items, using non-CE marked products and items that were beyond their shelf life. A systematic review concluded they were unable to draw conclusions on the most efficacious and safe methods for decontaminating surgical masks due to the heterogeneous methods used in studies [11] . Although the technology that appears to offer the best prospects for decontamination of PPE is hydrogen peroxide vapour [12, 13] , we strongly support the opinion of Alt et al. that this is an area that should be further explored and developed so that institutions can not only turn to effective decontamination methods that are accessible to them, but can also develop operational plans addressing matters such as user acceptance, traceability and stock management [14] . Earlier in the pandemic the difficulties of setting up rapid and accurate diagnostics meant that infection control precautions and patient placement were vital to help contain COVID-19 spread in hospitals [15] . However, isolating or cohorting patients for many hours is disruptive to the operation of hospitals, and risks exposing uninfected patients to infection. We have recently published several papers that show how rapid diagnostics can be used to direct patient pathways: Hinson et al. reported that using the Cepheid GeneXpert to screen patients in an isolation cohort allowed a 65.6% reduction in the median time to removal of patients with a negative test result from the isolation cohort [16] . Drawbacks of rapid PCR-based testing are the cost and the fact that most platforms have limited testing capacity. For these reasons, there is increasing interest in the use of rapid antigen tests, or (for elective admissions at least) stepping away from universal testing. Van Honacker et al. suggested that rapid antigen tests may have an adequate performance, especially in high prevalence settings [17] . Indeed, Merrick et al. recently reported in Infection Prevention in Practice that universal rapid antigen testing resulted in 93% of COVID-19 patients leaving ED with a virological diagnosis, compared with 77% when PCR testing was used. The PPV (97.7%) and NPV (86.4%) of rapid antigen testing were high with a disease prevalence of 34.7% [18] . Moreno-Pérez suggested for elective surgical patients a selective screening strategy to identify patients for PCR testing might be appropriate, at least in lower prevalence settings [19] . However testing is implemented it is important that it is part of a patient pathway that is reliably followed. A study by Mastan et al. compared management of hip fractures across 23 orthopaedic trauma units in Northwest England, and found a great deal of heterogeneity in patient pathways, with some involving risks of exposure to COVID-19 from patients and medical staff [20] . One matter that will be judged over time is whether many of the seroprevalence studies that were performed were anything other than an unnecessary distraction: studies of healthcare workers do not appear to have provided any new insights into the epidemiology of COVID-19 [21] . Moreover, the fundamental value of seroprevalence studies were questioned by Lippi, owing to the variable accuracy of tests [22] . Robbins et al. also made an interesting observation in a survey of HCW attitudes to antibody testing, expressing concern HCW might misinterpret their seropositivity as a reason to be less compliant with IPC precautions [23] . Earlier in this article we discussed re-use of single use PPE items during the pandemic. Another issue that PPE shortages presented was the use of non-CE-marked, or date-expired PPE items. Van Wezel et al. designed a verification protocol to check the quality of non-CE marked respirators; worryingly 67% of respirators tested did not meet their quality criteria [24] . Brun et al. described the methods they used to test the compliance of face masks that are beyond their shelf-life; they found only 49% of FFP2 masks and 58% of surgical face masks were fully-compliant [25] . Kampf et al. proposed risk-adapted versions of the current standards for alcohol-based hand rubs, face masks and medical gloves/gowns for when supplies are limited [26] . We suspect that the assessment of expired and/or non-CE-marked PPE items will be incorporated into many organisations' pandemic plans in the future. As the pandemic progressed it became evident it had caused collateral damage to other areas of IPC and antimicrobial stewardship. Sturdy et al. shared their experience on a COVID-19 intensive care unit of an increase in nosocomial Gram-negative bacteraemias with evidence of cross transmission between patients. They postulated that the reasons for this were multifactorial but are in part due to a lack of focus on IPC basics during the pandemic, with a shift from using PPE to prevent nosocomial infections to focussing on it primarily protecting HCW [27] . Conversely, measures used to prevent transmission of SARS-Cov-2 will surely become routine practice to protect against nosocomial transmission of other respiratory viruses, as Anton-Vazquez et al. recently effectively described in controlling an outbreak of parainfluenza 3 infection pre-pandemic [28] . Donà et al. described the possible negative impact the pandemic may have had on multidrug-resistant infections due to PPE and staff shortages in addition to hospital overcrowding [29] . Moreover, Ruiz highlighted that in some countries not only were antibiotics being prescribed widely in hospital for COVID-19 patients, but there was an additional problem from antibiotic use before admission to hospital, including selfadministration by up to one third of patients [30] . These areas need to be addressed if we are to be successful in returning to business as usual, and lessons learned need to inform future pandemic-planning. We must learn lessons from the pandemic, both to ensure that internationally, nationally and institutionally we are as prepared as possible for any future pandemics. Key themes that have emerged from the pages of the JHI are assuring HCWs about their own safety and ensuring that they have adequate training and support; better preparation for the inevitable shortages of PPE; and more focus on safe patient pathways for patients who require hospital contact and who are not infected. We also suggest that more thought needs to be given on whether and how infection prevention and control and antibiotic stewardship can be maintained during a pandemic, and also on how hospitals can begin to reinstate planned clinical and surgical activities as the pandemic progresses. Novel coronavirus is putting the whole world on alert Understanding the emerging coronavirus: what it means for health security and infection prevention COVID-19: how prepared are front-line healthcare workers in England? 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