Point of care testing
the decision to continue to test symptomatic children that came through the hospital. By doing this, the hospital was able to collect new clinical data that found, unexpectedly, there was a surge in RSV cases during the summer months. Historically, cases of RSV have been attributed
to the winter season with the infection causing symptoms similar to a cold, including rhinitis (runny nose, sneezing or nasal congestion), cough, and sometimes fever. Ear infections and croup (a barking cough caused by inflammation of the upper airways) can also occur in children. More than 60 percent of children have been infected with RSV by their first birthday, and over 80 percent by 2 years of age. However, if RSV is left untreated in young children, it can impact feeding or develop into bronchiolitis and pneumonia and require hospitalisation.3 The out-of-season RSV surge disrupted the seasonal rhythm, with figures showing that during September 2021, 52 percent of patients presenting with symptoms tested positive for RSV. The rate of infection then drastically dropped in January 2022, with just 5.5 percent testing positive, before gradually increasing during spring, with 26 percent of patients testing positive in April 2022. In July, the number of positive cases had reached 40 percent, and by September just 9.5 percent tested positive, before climbing again to 48 percent in November 2022, mirroring the expected winter peak. Yusuf said: “The summer surge in RSV cases
was surprising to see as RSV is predominately considered a winter illness, along with flu. Regular testing for these illnesses usually ends as we come out of the winter months but, by continuing to test people that came through the Paediatric or the Emergency Department, we were more quickly able to diagnose those with
RSV and get them access to antiviral medication, if needed. “While it was the Paediatric team that
requested the year-round testing, we know that RSV is also a real threat to those over the age of 65 and those with comorbidities. Our data on the summer surge of RSV in children is something that could therefore also be beneficial for other wards in order to help them gain a clearer picture of diagnosis in patients that present with respiratory symptoms.”
He continued: “Without ID NOW, patients
Yusuf Gray, from the University Hospitals Derby & Burton NHS Foundation Trust.
presenting with RSV symptoms would have had a sample sent off to a laboratory for analysis, which can take anywhere from 24 hours to up to a week to come back. By that stage, if they were positive, the patient would have most likely either managed through their symptoms as best they could or continued to experience worsening symptoms and, at that point, perhaps only then getting access to antiviral medication.” Rapid point of care testing for RSV is also an effective tool for Antimicrobial Stewardship initiatives, something that is becoming increasingly important in the UK as recent UK Health Security Agency data indicates the growing scale of the issue of antimicrobial resistance, with the number of severe antibiotic- resistant infections in England rising by 2.2 percent in 2021 compared to 2020.4 Yusuf said: “Being able to confirm or rule out the presence of RSV when patients come in helps clinicians to quickly understand if antibiotics may be needed or not, with more certainty. For example, if a baby comes into the Emergency Department with symptoms such as wheezing and they are tested for RSV, the clinician will be better equipped to make a decision on either antibiotic or antiviral treatment. For Royal Derby Hospital, the ID NOW machines also help with managing valuable limited resources, such as beds.” Yusuf outlines: “By providing a point of care service for RSV, the Trust has been better able to manage the resources it has. Patients with RSV can be identified and sent home on treatment, or if they do need to be admitted, due to their symptoms, they can get the appropriate treatment from the moment they arrive rather than needing to wait for a lab result to come back. That typically provides an average of about two to three days fewer bed days for every patient, which is a significant difference to a busy Trust like ours.” This year, Royal Derby Hospital plans to continue with year-round RSV testing. Yusuf said: “It is an open discussion with paediatric consultants. Given they continue to find value in point of care testing, we will continue to support them. Effectively helping our patients is our
number one priority and point of care testing helps clinicians make quicker decisions with confidence.” The hospital is also responding to the recent
outbreak of Strep A, with Yusuf commenting: “Most recently, there’s been a lot of concern in the community about Strep A, especially in children and, because of this, we have seen a rise in the number of worried parents arriving to the Emergency Department concerned about their child. In response, we are planning on introducing Strep A testing to our capabilities, meaning we will have access to the full range of capabilities from the machine.”
References 1
https://www.theguardian.com/society/2018/ jan/18/flu-outbreak-gps-under-huge- pressure-as-deaths-soar-to-120
2
https://www.globalpointofcare.abbott/en/ product-details/
id-now-rsv.html
3
https://www.gov.uk/government/ publications/respiratory-syncytial-virus- rsv-symptoms-transmission-prevention- treatment/respiratory-syncytial-virus- rsv-symptoms-transmission-prevention- treatment#:~:text=RSV%20is%20the%20 leading%20cause,as%20infection%20can%20 be%20managed.
4
https://www.gov.uk/government/news/new- data-shows-148-severe-antibiotic-resistant- infections-a-day-in-2021#:~:text=The%20 latest%20data%20published%20 by,infections%20a%20day%20in%202021.
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