Public Health England Guidance Research Articles

WE7.5 Hand trauma Tetanus Immunisation: a tertiary trauma centre experience

Abstract Aims To evaluate adherence of hand trauma service at a tertiary trauma centre to Public Health of England guidance on tetanus immunisation. Methods Prospective data collection of all adult hand trauma injuries between March and June 2021. The first cycle was conducted within the first two weeks of March followed by the introduction of a tetanus immunisation booster flowchart based on the Public Health England guidance. The second cycle was conducted within the first two weeks of June. Results Of 435 cases reviewed, 380 patients met the inclusion criteria. 69% of cases were male with a mean age of 40 years. Laceration via a sharp object was the most common mechanism of injury followed by machine-related injury representing 44% and 21% respectively. Soft tissue lacerations were by far the most common injury representing 46% of cases. This is the percentage of unnecessary prescription of tetanus booster doses in patients presented with clean wounds falls from 80% in the first cycle to 17% in the second cycle. This reflected in saving the trust £693 within just the period of the first two weeks of June. Conclusions The use of an easy-to-follow chart for tetanus immunisation when dealing with hand trauma patients led to a significant reduction of unnecessary prescriptions and costs.

Implementation of Public Health England infection prevention and control guidance in maternity units in response to the COVID-19 pandemic

BackgroundThis study aimed to explore the successes and barriers to the implementation of Public Health England (PHE) infection prevention and control guidance in English maternity units during the COVID-19 pandemic.MethodsQualitative semi-structured interviews with obstetricians, midwives and neonatologists who worked in a maternity unit in England, UK, between March 2020 and July 2021. A thematic analysis was performed.ResultsSuccesses to the implementation of PHE guidance were related to existing infrastructure, training satisfaction, and organisational culture where subthemes considered the importance of a multidisciplinary approach, COVID-19 dedicated roles and hospital-wide communication. Barriers to implementation related to the applicability of the guidance with subthemes highlighting contradictions between updates, specialties and hospitals, undesirable timings and frequency of guidance updates, reductions in staff compliance and delayed implementation. Finally, the layout of some units made it difficult to implement various aspects of the guidance (e.g., social distancing), and many detailed issues related to information technology compatibility, a lack of availability and accessibility to appropriate personal protective equipment (PPE), and variations in testing arrangements between units.ConclusionsThis research provides information on the experiences of healthcare professionals working on maternity units during the COVID-19 pandemic. Findings illustrate the importance of effective hospital-wide communication and the need for consistent, easily understood guidance. These results will be used to inform the content of an expert panel consensus meeting.

Maternity services' responses to the COVID-19 pandemic: how Public Health England guidance was implemented in practice

IntroductionThe rapidly evolving COVID-19 pandemic required systemic change in how healthcare was delivered to minimize virus transmission whilst maintaining safe service delivery. Deemed at ‘moderate-high risk’, maternity patients are an important patient group that require consideration. Public Health England (PHE) issued national guidance on how to adjust these services.AimTo explore how maternity units in England implemented PHE guidance.MethodsAn online survey of 22 items was distributed to individuals that had worked on an England-based maternity unit during the COVID-19 pandemic. The questionnaire was designed and tested by the multidisciplinary research team. Data was collected from November 2020 to July 2021.FindingsForty-four participants across 33 maternity units responded. Ninety-three percent were able to test all women requiring an overnight stay for COVID-19. Only 27% reported birth partners were tested for COVID-19. Only 73% reported they were able to isolate all COVID-19-positive patients in single rooms. Eighty-four percent stated they were aware of current PHE guidance on personal protective equipment (PPE) and 82% felt ‘confident’ in donning/doffing of PPE. Priorities for the future include rapid testing and a focus on community service provision.ConclusionsPHE COVID-19 guidance was implemented differently in maternity units across England due to the varying resources available at each trust leading to variable ability to test and isolate patients as recommended. More specific, tailored guidance for infection control measures against COVID-19 is needed for maternity settings due to their unique position.

Interval breast cancer information dissemination and action during COVID period

Background: Despite Public Health England guidance on interval breast cancer (where a patient with new diagnosis of breast cancer was reported to have a normal screening mammogram within last 3 years or normal family history screening mammogram within last 1 year), there has been no uniform policy in place locally. An initial local assessment in June 2019 showed an incidence of 31 interval breast cancers over a 12-month period. Introduction of interval breast cancer pathway, aiming for 100% improvement in dissemination of information, recording of data, and subsequent actions.

Laser toys fail to comply with safety standards – case study based on laser product classification

Abstract The article describes the laser safety classification of a laser toy for children equipped with a laser aimer/illuminator with two radiation sources. Following the rules presented in EN 60825-1: 2014 standard, the tests and measurements of the accessible emission were carried out and the class of the laser product was determined to be 3R. It was shown that the laser toy does not comply with the requirements of the EN 62115: 2020 standard and the Public Health England Guidance. The potential hazards associated with Class 3R, indicated in the EN 60825-1: 2014 standard, are also discussed.

Personal protective equipment: knowledge of the guidance.

On 11 March 2020, the World Health Organization (WHO) declared a global pandemic in the wake of the coronavirus disease 2019 (COVID-19) outbreak. The unpredictable nature of transmission of COVID-19 requires a meticulous understanding of guidance on personal protective equipment (PPE) as published by WHO and Public Health England (PHE). To assess perceived confidence and knowledge of PHE guidance relating to PPE by nursing staff. A nationwide survey was disseminated between May and June 2020 through social media platforms as well as internal mail via regulatory bodies and individual hospital trusts. Data were collated from 339 nurses. Perceived confidence as measured on a Likert scale was a mode score of 3/5, with the average score for knowledge-based questions being 5/10. Of the respondents, 47% cited insufficient training on PPE guidance, and 84% advocated further training. Conclusions: Unifying published PPE guidance and ensuring consistency in training can improve awareness, confidence, and knowledge among nursing staff.

The effects of personal protective equipment on airway management: An in-situ simulation

The novel coronavirus disease (COVID-19) was declared a pandemic by the World Health Organisation on 11th March and has led to over 41,000 deaths in the UK. Public Health England guidance for aerosol generating procedures (AGP) requires the donning of personal protective equipment (PPE). We evaluated airway management skills using an in-situ emergency simulation. The scenarios were video recorded and scored by two independent assessors using a skill specific checklist. A total of 34 airway management procedures were evaluated. The checklist involved 13 steps with a maximum score of 26. The median (IQR [range]) checklist score was 25 (24-25 [20-26]). Four teams failed to intubate the trachea and proceeded to manage the airway using a supraglottic airway device. The mean (SD) intubation time was 47.9 (16.5) seconds and two anaesthetists (7%) required a second attempt. Our results show that airway management can be carried out successfully whilst donned in PPE. However, additional training in using newly introduced devices such as a McGrath® video laryngoscope is of paramount importance.

Agile Requirements Engineering and Software Planning for a Digital Health Platform to Engage the Effects of Isolation Caused by Social Distancing: Case Study.

BackgroundSocial distancing and shielding measures have been put in place to reduce social interaction and slow the transmission of the coronavirus disease (COVID-19). For older people, self-isolation presents particular challenges for mental health and social relationships. As time progresses, continued social distancing could have a compounding impact on these concerns.ObjectiveThis project aims to provide a tool for older people and their families and peers to improve their well-being and health during and after regulated social distancing. First, we will evaluate the tool’s feasibility, acceptability, and usability to encourage positive nutrition, enhance physical activity, and enable virtual interaction while social distancing. Second, we will be implementing the app to provide an online community to assist families and peer groups in maintaining contact with older people using goal setting. Anonymized data from the app will be aggregated with other real-world data sources to develop a machine learning algorithm to improve the identification of patients with COVID-19 and track for real time use by health systems.MethodsDevelopment of this project is occurring at the time of publication, and therefore, a case study design was selected to provide a systematic means of capturing software engineering in progress. The app development framework for software design was based on agile methods. The evaluation of the app’s feasibility, acceptability and usability shall be conducted using Public Health England's guidance on evaluating digital health products, Bandura’s model of health promotion, the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework and the Nonadoption, Abandonment and Challenges to the Scale-up, Spread and Suitability (NASSS) framework.ResultsMaking use of a pre-existing software framework for health behavior change, a proof of concept was developed, and a multistage app development and deployment for the solution was created. Grant submissions to fund the project and study execution have been sought at the time of publication, and prediscovery iteration of the solution has begun. Ethical approval for a feasibility study design is being sought.ConclusionsThis case study lays the foundations for future app development to combat mental and societal issues arising from social distancing measures. The app will be tested and evaluated in future studies to allow continuous improvement of the app. This novel contribution will provide an evidence-based exemplar for future app development in the space of social isolation and loneliness.

Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic - a narrative review.

Personal protective equipment has become an important and emotive subject during the current coronavirus disease 2019 epidemic. Coronavirus disease 2019 is predominantly caused by contact or droplet transmission attributed to relatively large respiratory particles which are subject to gravitational forces and travel only approximately 1 metre from the patient. Airborne transmission may occur if patient respiratory activity or medical procedures generate respiratory aerosols. These aerosols contain particles that may travel much longer distances and remain airborne longer, but their infective potential is uncertain. Contact, droplet and airborne transmission are each relevant during airway manoeuvres in infected patients, particularly during tracheal intubation. Personal protective equipment is an important component, but only one part, of a system protecting staff and other patients from coronavirus disease 2019 cross-infection. Appropriate use significantly reduces risk of viral transmission. Personal protective equipment should logically be matched to the potential mode of viral transmission occurring during patient care - contact, droplet or airborne. Recommendations from international organisations are broadly consistent, but equipment use is not. Only airborne precautions include a fitted high-filtration mask, and this should be reserved for aerosol generating procedures. Uncertainty remains around certain details of personal protective equipment including use of hoods, mask type and the potential for re-use of equipment.

Child injury prevention: a survey of local authorities and health boards

Aims: Unintentional home injuries are a significant global public health issue and are a major cause of mortality and morbidity. Within each country, injuries disproportionately affect children from low income families. Recent guidance issued in the UK recommends actions to be taken by local authorities to reduce injury rates and inequalities. This study aimed to describe and quantify child home injury prevention activities of local authorities (LAs) in England and health boards (HBs) in Wales.Methods: A questionnaire was sent to Directors of Public Health in all 153 upper-tier LAs in England and 7 HBs in Wales. The questionnaire covered the five broad areas recommended for injury prevention activities by NICE guidelines.Results: A response rate of 58% was achieved. NICE guidance (75%) and Public Health England guidance (57%) were most commonly used to support child injury prevention decision-making. Half (50%) of respondents had a child injury prevention alliance in their area. One fifth (19%) reported that their area had a written child injury prevention strategy. Fewer than half of responders provided training to practitioners about child unintentional injury prevention (43%), home safety assessments (43%) or an equipment scheme (43%). Of the 43% of areas with equipment schemes, most (59%) were small scale, supplying up to 200 families per year with equipment.Conclusions: Although some LAs/HBs show implementation of recent guidance on preventing home injuries in childhood, most do not. LAs/HBs are likely to need support to implement guidance in order that child injury rates and inequalities can be reduced.

Nursery sickness policies and their influence on prescribing for conjunctivitis: audit and questionnaire survey.

Acute infective conjunctivitis is common among preschool children. Public Health England (PHE) recommends that children with conjunctivitis do not need to be excluded from child care, but childcare providers are required to determine their own sickness policies and prior research suggests that children are often excluded until they are treated or have recovered. How the content of these policies impacts on prescribing decisions has not been quantified. To assess the content of childcare providers' sickness policies and determine the impact they have on clinicians' prescribing. An audit of childcare providers' sickness policies and a questionnaire among primary care clinicians. Sickness policies from childcare providers across the UK were compared with PHE guidance. Clinicians completed a questionnaire on the impact that childcare provider policies have on their decision to prescribe antibiotics to preschool children with conjunctivitis. Of 164 policies examined, 86.7% excluded children with conjunctivitis and 49.4% of policies specified a requirement for antibiotics. Two-hundred clinicians completed questionnaires and 42.6% replied that they had been influenced by childcare policies when deciding whether to prescribe antibiotics in this scenario. Furthermore, 15.4% admitted that childcare policies had been the only reason they prescribed antibiotics. Most of the childcare providers' sickness policies contain requirements that are inconsistent with PHE guidance. The requirements of childcare sickness policies are likely to be resulting in unnecessary primary care consultations and thousands of prescriptions for antibiotics with little demonstrable clinical or public health benefit.

Doctors’ Knowledge of Viral Haemorrhagic Fevers

Viral Haemorrhagic Fevers (VHF) such as Ebola Virus Disease (EVD) are of increasing concern of increasing concern to clinicians and public heath bodies across Europe and America due to the on-going epidemic in West Africa. We conducted an online study to assess clinicians’ knowledge of VHF across six hospital sites in London. This showed suboptimal knowledge of Public Health England guidance, EVD epidemiology and the risk factors for acquiring VHF. Knowledge about VHF was dependent on seniority of grade with the most junior grade of doctors performing worse in several areas of the survey. Poor knowledge raises concerns that those at risk of VHF will be inappropriately risk stratified and managed. Education of doctors and other healthcare professionals about VHF is necessary to address these knowledge gaps.