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BackgroundSARS-CoV-2 infection presents significant challenges to the management of children. To our knowledge, the spread in healthcare settings between children had not been reported. Leicester was the first area in the United Kingdom to undergo a localised lockdown with reports of relatively high numbers of children affected.ObjectivesOur evaluation aimed to identify the number of clinically significant SARS-COV-2 paediatric patients (age < 18 years) presenting to our Children’s Emergency Department (CED) at the Leicester Royal Infirmary (LRI), investigate the effectiveness of infection control measures and examine outcomes.MethodsWe determined clinically significant infection to be that which prompted parents/carers to bring their child to the CED and be admitted. The national guidance in England at the time determined that only admitted patients are swabbed for SARS-COV-2.Clinical information on the timelines of hospital attendance, length of hospital stay (LOS) and outcomes was gathered by retrospectively from 15.03.2020 to 31.07.2020 by looking at the attendances in Nervecentre®.National infection control policies were followed, ranging from adoption of rigorous hand washing and provision of Personal Protective Equipment (PPE) for patient contacts, to the separation of the department into ‘red’ (suspected COVID) and ‘blue’ (non-suspected COVID) zones on the basis of pre-determined criteria.The study was ratified as a service evaluation project by the trust.Results27 children (0–15 years) tested COVID positive. 22 (81.5%) of these presented to the PED among 10777 presentations.20/22 (90.9%) patients were admitted, all were eventually discharged. Nearly all of the patients came through the red zone;21/22 (95.4%). The average Length of Stay (LOS) of these patients was 120.7 hours.2 patients were felt to have the novel Paediatric Inflammatory Multisystem Syndrome temporally related to SARS-CoV-2 (PIMS-TS), both needing paediatric intensive care stay. Children presented with lower respiratory tract infection (3/22;4/27), suspected sepsis (4/22;4/27), and Bronchiolitis (2/22;2/27).There was no overlap between any SARS-CoV-2 positive patients with any other patients who subsequently tested positive in the department. Thus, no clinically relevant SARS-CoV-2 cross-infection was noted.ConclusionsOur study demonstrated that children don’t appear to be causing spread within our CED. Division of CED into two areas meant a substantial change to our working due to changes in staff allocation and challenges to CED leadership. Only a very small number of patients were SARS-CoV-2 positive- this led us to believe that the existing measures to split the departments were effective, but also perhaps, unnecessary.On the basis of this study, the splitting of the CED into red and blue zones has been abolished and the department has been merged, to avail the staffing and space resources optimally to enhance patient safety and provide best healthcare services to our patients.This study could be crucial in anticipating and managing the future PED patient flow, especially during the winters when the other seasonal viral infections are likely to overburden the services. |
