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Aaron Nathan Barksdale, Wood MG, Branecki CE, Zimmerman B, Lyden E, Nguyen TT, Hatfield A, Koepsell S, Langenfeld J, Zeger WG, Wadman MC. Incidence of unknown COVID-19 infection in a cohort of emergency physicians and advance practice providers. Am J Emerg Med 2023; 64:155-160. [PMID: 36563499 PMCID: PMC9749378 DOI: 10.1016/j.ajem.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION In United States, health care workers have been immersed in the COVID-19 pandemic since February 2020. Since availability of COVID-19 vaccines, there is limited literature investigating the incidence of unknown COVID-19 infections in physicians and Advanced Practitioner Providers (APPs) working in emergency departments (EDs). The primary objective is to determine the incidence unknown COVID-19 infection within a cohort of emergency physicians (EPs) and APPs. METHODS Prospective observational study at a tertiary academic center with emergency medicine residency and 64,000 annual ED visits. EPs/APPs providing care to ED patients over the prior 12 months were eligible. Serum samples were collected between May 1 and June 30, 2022. Analysis utilized Luminex xMAP® SARS-CoV-2 Multi-Antigen IgG Assay for antibodies to Nucleocapsid, Receptor-binding domain, and Spike subunit 1. Mean Fluorescent Intensity (MFI) ≥ 700 was considered positive. Subjects completed 12 question survey assessing demographics and previously confirmed COVID-19 infection. Fisher's exact test evaluated associations of demographics and clinical characteristics with confirmed COVID-19 status. Analyses performed using SAS, Version 9.4. P < 0.05 considered statistically significant. RESULTS Sixty-nine of 81 eligible subjects (85.2%) participated, 58.0% were male, 97.1% white, with mean age of 37. Eighteen subjects had MFI ≥ 700 strongly suggestive of prior infection, with 17.7% unknown. No statistically significant difference between age, gender, race, children in home, or household member with previously COVID-19 infection. CONCLUSION Unknown previous COVID-19 infection was less then expected in this cohort of EPs/APPs, and no association with individual characteristics, previously infected household member, or children in the home.
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Affiliation(s)
- Aaron Nathan Barksdale
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America,Corresponding author at: 981150 Nebraska Medical Center, Omaha, NE 68198-1150, United States of America
| | - Macy G. Wood
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Chad E. Branecki
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Brooklin Zimmerman
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Elizabeth Lyden
- Research Design and Analysis, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Thang T. Nguyen
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Andrew Hatfield
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Scott Koepsell
- Clinical Operations, Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Jason Langenfeld
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Wesley G. Zeger
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Michael C. Wadman
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
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Narowski TM, Raphel K, Adams LE, Huang J, Vielot NA, Jadi R, de Silva AM, Baric RS, Lafleur JE, Premkumar L. SARS-CoV-2 mRNA vaccine induces robust specific and cross-reactive IgG and unequal neutralizing antibodies in naive and previously infected people. Cell Rep 2022; 38:110336. [PMID: 35090596 PMCID: PMC8769879 DOI: 10.1016/j.celrep.2022.110336] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 12/01/2021] [Accepted: 01/12/2022] [Indexed: 12/02/2022] Open
Abstract
Understanding vaccine-mediated protection against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is critical to overcoming the global coronavirus disease 2019 (COVID-19) pandemic. We investigate mRNA-vaccine-induced antibody responses against the reference strain, seven variants, and seasonal coronaviruses in 168 healthy individuals at three time points: before vaccination, after the first dose, and after the second dose. Following complete vaccination, both naive and previously infected individuals developed comparably robust SARS-CoV-2 spike antibodies and variable levels of cross-reactive antibodies to seasonal coronaviruses. However, the strength and frequency of SARS-CoV-2 neutralizing antibodies in naive individuals were lower than in previously infected individuals. After the first vaccine dose, one-third of previously infected individuals lacked neutralizing antibodies; this was improved to one-fifth after the second dose. In all individuals, neutralizing antibody responses against the Alpha and Delta variants were weaker than against the reference strain. Our findings support future tailored vaccination strategies against emerging SARS-CoV-2 variants as mRNA-vaccine-induced neutralizing antibodies are highly variable among individuals.
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Affiliation(s)
- Tara M Narowski
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Kristin Raphel
- Department Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA
| | - Lily E Adams
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA; Department of Epidemiology, University of North Carolina at Chapel Hill School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jenny Huang
- Department Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA
| | - Nadja A Vielot
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ramesh Jadi
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Aravinda M de Silva
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Ralph S Baric
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA; Department of Epidemiology, University of North Carolina at Chapel Hill School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - John E Lafleur
- Department Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA.
| | - Lakshmanane Premkumar
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
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Lynch JB, Davitkov P, Anderson DJ, Bhimraj A, Cheng VCC, Guzman-Cottrill J, Dhindsa J, Duggal A, Jain MK, Lee GM, Liang SY, McGeer A, Varghese J, Lavergne V, Murad MH, Mustafa RA, Sultan S, Falck-Ytter Y, Morgan RL. Infectious Diseases Society of America Guidelines on Infection Prevention for Healthcare Personnel Caring for Patients with Suspected or Known COVID-19. Clin Infect Dis 2021:ciab953. [PMID: 34791102 PMCID: PMC8767890 DOI: 10.1093/cid/ciab953] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Since its emergence in late 2019, SARS-CoV-2 continues to pose a risk to healthcare personnel (HCP) and patients in healthcare settings. Although all clinical interactions likely carry some risk of transmission, human actions like coughing and care activities like aerosol-generating procedures likely have a higher risk of transmission. The rapid emergence and global spread of SARS-CoV-2 continues to create significant challenges in healthcare facilities, particularly with shortages of personal protective equipment (PPE) used by HCP. Evidence-based recommendations for what PPE to use in conventional, contingency, and crisis standards of care continue to be needed. Where evidence is lacking, the development of specific research questions can help direct funders and investigators. OBJECTIVE Develop evidence-based rapid guidelines intended to support HCP in their decisions about infection prevention when caring for patients with suspected or known COVID-19. METHODS IDSA formed a multidisciplinary guideline panel including frontline clinicians, infectious disease specialists, experts in infection control, and guideline methodologists with representation from the disciplines of public health, medical microbiology, pediatrics, critical care medicine and gastroenterology. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. RESULTS The IDSA guideline panel agreed on eight recommendations, including two updated recommendations and one new recommendation added since the first version of the guideline. Narrative summaries of other interventions undergoing evaluations are also included. CONCLUSIONS Using a combination of direct and indirect evidence, the panel was able to provide recommendations for eight specific questions on the use of PPE for HCP providing care for patients with suspected or known COVID-19. Where evidence was lacking, attempts were made to provide potential avenues for investigation. There remain significant gaps in the understanding of the transmission dynamics of SARS-CoV-2 and PPE recommendations may need to be modified in response to new evidence. These recommendations should serve as a minimum for PPE use in healthcare facilities and do not preclude decisions based on local risk assessments or requirements of local health jurisdictions or other regulatory bodies.
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Affiliation(s)
- John B Lynch
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Perica Davitkov
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
| | - Adarsh Bhimraj
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Vincent Chi-Chung Cheng
- Queen Mary Hospital, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Judith Guzman-Cottrill
- Department of Pediatrics, Division of Infectious Diseases, Oregon Health and Science University, Portland, Oregon
| | | | - Abhijit Duggal
- Department of Critical Care, Cleveland Clinic, Cleveland, Ohio
| | - Mamta K Jain
- Department of Internal Medicine, Division of Infectious Diseases, UT Southwestern Medical Center, Dallas, Texas
| | - Grace M Lee
- Department of Pediatrics-Infectious Disease, Stanford University School of Medicine, Stanford, California
| | - Stephen Y Liang
- Division of Infectious Diseases and Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Allison McGeer
- Department of Microbiology, Sinai Health System, University of Toronto, Toronto, Ontario
| | - Jamie Varghese
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - Valery Lavergne
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Yngve Falck-Ytter
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
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Sacks OA, Barnato AE, Skinner JS, Birkmeyer JD, Fowler A, Birkmeyer N. Elevated Risk of COVID-19 Infection for Hospital-Based Health Care Providers. J Gen Intern Med 2021; 36:3642-3643. [PMID: 34405347 PMCID: PMC8370456 DOI: 10.1007/s11606-021-07088-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/28/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Olivia A Sacks
- Department of Surgery, Boston Medical Center, Boston, MA, USA.
| | - Amber E Barnato
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Jonathan S Skinner
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Economics, Dartmouth College, Hanover, NH, USA
| | | | | | - Nancy Birkmeyer
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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He S, Hecimovic A, Matijasevic V, Mai HT, Heslop L, Foster J, Alexander KE, Pal N, Alexandrou E, Davidson PM, Frost SA. Prevalence of SARS-CoV-2 antibodies among nurses: A systematic review and meta-analysis. J Clin Nurs 2021; 31:1557-1569. [PMID: 34570947 PMCID: PMC8661824 DOI: 10.1111/jocn.16009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/10/2021] [Accepted: 08/05/2021] [Indexed: 12/12/2022]
Abstract
Aims and Objectives This systematic review and meta‐analysis reports the seroprevalence of SARS‐CoV‐2 antibodies among nurses. Background With a growing body of literature reporting the positive serology for SARS‐CoV‐2 antibodies among healthcare workers, it remains unclear whether staff at the point of direct patient care are more prone to developing and transmitting the virus. Given nurses make up the majority of the global health workforce, outbreaks among these workers could severely undermine a health system’s capability to manage the pandemic. We aimed to summarise and report the seroprevalence of SARS‐CoV‐2 antibodies among nurses globally. Design Systematic review and meta‐analyses. Methods This systematic review was developed, undertaken and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guideline. We searched the electronic medical literature databases: MEDLINE; CINAHL; and EMBASE for studies reporting the seroprevalence of SARS‐CoV‐2 antibodies among nursing staff. Studies that reported nursing specific data were included in this review. Study quality was evaluated using the Joanna Briggs Institute checklist for studies reporting prevalence data. Studies were stratified according to the World Health Organisation region classifications, and results were presented using forest plots and summary prevalence and variance was estimated using a random effects model. Results Our electronic search identified 1687 potential studies, of which 1148 were screened for eligibility after duplicates were removed, and 51 of the studies were included in our meta‐analysis. The overall seroprevalence of SARS‐CoV‐2 antibodies among nurses was estimated to be 8.1% (95% CI 6.9%–9.4%) among the 60,571 participants included in the studies. Seropositivity was highest in the African region (48.2%, 95% CI 39.2%–57.3%), followed by the European region (10.3%, 95% CI 8.0%–12.5%), the Region of the Americas (8.4%, 95% CI 6.0%–10.7%), the South‐East Asia region (3.0%, 95% CI 0.00%–6.5%) and the Western Pacific region (0.5%, 95% CI 0.0%–1.0%). Pooled estimates were unable to be calculated in the Eastern Mediterranean region due to insufficient studies. Conclusion The seroprevalence of SARS‐CoV‐2 antibodies among nurses is comparable to other healthcare workers, and possibly similar to the general population. Early adoption and adherence to personal protective equipment and social distancing measures could explain these similarities, meaning the majority of staff contracted the virus through community transmission and not in a healthcare setting. Relevance to clinical practice Fear and uncertainty have been features of this pandemic, including among nurses. This meta‐analysis should provide some comfort to nurses that risks are similar to community exposure when adequate PPE is available and there is an adherence to infection control measures.
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Affiliation(s)
- Steven He
- South Western Sydney Nursing and Midwifery Research, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,Western Sydney University, Sydney, New South Wales, Australia
| | - Anthony Hecimovic
- South Western Sydney Nursing and Midwifery Research, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Local Health District Primary and Community Health, Sydney, New South Wales, Australia
| | - Vesna Matijasevic
- South Western Sydney Nursing and Midwifery Research, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Local Health District Primary and Community Health, Sydney, New South Wales, Australia
| | - Ha Thi Mai
- South Western Sydney Nursing and Midwifery Research, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,Western Sydney University, Sydney, New South Wales, Australia
| | - Linda Heslop
- Ken Merten Library, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Jann Foster
- South Western Sydney Nursing and Midwifery Research, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,Western Sydney University, Sydney, New South Wales, Australia.,NSW Centre for Evidence Based Health Care: A JBI Affiliated Group, Sydney, New South Wales, Australia
| | - Kate E Alexander
- South Western Sydney Local Health District Public Health Unit, Sydney, New South Wales, Australia
| | - Naru Pal
- South Western Sydney Local Health District Public Health Unit, Sydney, New South Wales, Australia
| | - Evan Alexandrou
- South Western Sydney Nursing and Midwifery Research, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,Western Sydney University, Sydney, New South Wales, Australia.,Department of Intensive Care, Liverpool Hospital, Sydney, New South Wales, Australia.,Griffith University, Brisbane, Queensland, Australia
| | | | - Steven A Frost
- South Western Sydney Nursing and Midwifery Research, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,Western Sydney University, Sydney, New South Wales, Australia.,Department of Intensive Care, Liverpool Hospital, Sydney, New South Wales, Australia
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Estimating salivary carriage of severe acute respiratory syndrome coronavirus 2 in nonsymptomatic people and efficacy of mouthrinse in reducing viral load: A randomized controlled trial. J Am Dent Assoc 2021; 152:903-908. [PMID: 34561086 PMCID: PMC8193024 DOI: 10.1016/j.adaj.2021.05.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/02/2021] [Accepted: 05/27/2021] [Indexed: 12/23/2022]
Abstract
Background Many people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) never develop substantial symptoms. With more than 34 million people in the United States already infected and highly transmissible variants rapidly emerging, it is highly probable that post- and presymptomatic people will form an important fraction of those seeking dental care. Salivary carriage rates in these populations are not known. Moreover, although preventing transmission is critical for controlling spread, the efficacy of mouthrinses in reducing oral viral load is poorly studied. Methods The authors recruited 201 asymptomatic, presymptomatic, postsymptomatic, and symptomatic people and measured copy numbers of SARS-CoV-2 in unstimulated saliva using real-time reverse transcriptase quantitative polymerase chain reaction. Subsequently, the authors inducted 41 symptomatic people into a randomized, triple-blinded study and instructed them to rinse with saline, 1% hydrogen peroxide, 0.12% chlorhexidine, or 0.5% povidone-iodine for 60 seconds. The authors measured viral load 15 and 45 minutes after rinsing. Results Salivary SARS-CoV-2 was detected in 23% of asymptomatic, 60% of postsymptomatic, and 28% of presymptomatic participants. Neither carriage rate nor viral load correlated with COVID-19 symptomatology, age, sex, or race or ethnicity. All 4 mouthrinses decreased viral load by 61% through 89% at 15 minutes and by 70% through 97% at 45 minutes. The extent of reduction correlated significantly with initial viral load. Conclusions Nonsymptomatic people can pose a risk of transmitting the virus, and mouthrinses are simple and efficacious means of reducing this risk, especially when the load is less than 104 copies per milliliter. Practical Implications At a time when resources are stretched, the findings of this study contribute to evidence-based selection of personal protection equipment and simple infection-control practices to reduce contagion at source. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT04603794.
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Bak A, Mugglestone MA, Ratnaraja NV, Wilson JA, Rivett L, Stoneham SM, Bostock J, Moses SE, Price JR, Weinbren M, Loveday HP, Islam J, Wilson APR. SARS-CoV-2 routes of transmission and recommendations for preventing acquisition: joint British Infection Association (BIA), Healthcare Infection Society (HIS), Infection Prevention Society (IPS) and Royal College of Pathologists (RCPath) guidance. J Hosp Infect 2021; 114:79-103. [PMID: 33940093 PMCID: PMC8087584 DOI: 10.1016/j.jhin.2021.04.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023]
Affiliation(s)
- A Bak
- Healthcare Infection Society, UK.
| | | | - N V Ratnaraja
- British Infection Association, UK; University Hospitals Coventry & Warwickshire NHS Trust, UK
| | - J A Wilson
- Infection Prevention Society, UK; Richard Wells Research Centre, University of West London, UK
| | - L Rivett
- Healthcare Infection Society, UK; Cambridge University NHS Hospitals Foundation Trust, UK
| | - S M Stoneham
- Healthcare Infection Society, UK; Brighton and Sussex University Hospitals NHS Trust, UK
| | | | - S E Moses
- British Infection Association, UK; Royal College of Pathologists, UK; East Kent Hospitals University NHS Foundation Trust, UK
| | - J R Price
- Healthcare Infection Society, UK; Imperial College Healthcare NHS Trust, UK
| | - M Weinbren
- Healthcare Infection Society, UK; Sherwood Forest Hospitals NHS Foundation Trust, UK
| | - H P Loveday
- Infection Prevention Society, UK; Richard Wells Research Centre, University of West London, UK
| | - J Islam
- Healthcare Infection Society, UK; Brighton and Sussex University Hospitals NHS Trust, UK
| | - A P R Wilson
- Healthcare Infection Society, UK; University College London Hospitals NHS Foundation Trust, UK
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