Infection prevention
been widely used to target specific pathogens in a care setting, to support infection prevention measures on a local basis. During the pandemic, there was increasing
interest in using WBE to detect the presence of SARS-CoV-2 in communities. While SARS-CoV-2 is primarily thought of as a respiratory virus, it also affects the digestive system. SARS-CoV-2 can be shed in the stool of individuals up to 3 to 5 days before the onset of classic symptoms, as well as in asymptomatic individuals. “We developed a commercial model to
monitor pathogens in near source settings and received funding to evaluate an indicator of COVID infection, by using quantitative reverse transcription PCR (RT-qPCR). We have developed a cost-effective approach and have recently received a positive recommendation from UKAS for accreditation of our method,” Laughton commented.
20/30 Labs conducted research as part of the Accelerated Capability Environment (ACE) trials – with the backing of the UK Home Office and UKHSA. They conducted a trial at two care homes, testing for the presence or absence of COVID in wastewater samples over a period of three months. “We were able to detect the presence of COVID
and other pathogens in wastewater, prior to symptoms or any cases being identified. Over a three-month period, we identified a significant change in the RNA in the wastewater on four occasions. This correlated with a subsequent increase in infections in the homes. The lateral flow tests had been negative, so the wastewater testing identified cases that would not have been identified otherwise. The wastewater testing picked up the infections earlier than lateral flow testing, providing an early warning,” Laughton explained. By following up with PCR testing, the research identified 14 residents that tested positive for COVID, along with five members of staff. The care home provider implemented controls,
including removing infected staff from the site and isolating infected residents. This reduced the size and duration of the outbreak. “Modelling analysed what would have happened with and without the intervention, and it shows that WBE prevented infection spread and saved lives. We believe we have developed a tool to reduce infection spread,” commented Laughton. “Care homes see the value,” she added, “But
it requires investment at a national level. We will be the first accredited lab to offer this capability.”
In addition to detecting COVID, the test can
also detect norovirus, influenza A and B, and RSV. Norovirus was also detected at the care homes on several occasions during the trial. Stringent
cleaning measurements were adopted upon communication of a detection in wastewater and no norovirus outbreaks have been reported since the start of the trial. Approximately 3,000 people a year are
admitted to hospital with norovirus in England and the incidence in the community is thought to be about 16.5% of the 17 million cases of Infectious Intestinal Disease in England per year. Norovirus poses a significant threat to the health of the residents in care homes, yet staff currently rely on the appearance of symptoms to detect an outbreak. An earlier warning, before symptoms appear, could have an important role to play in breaking the cycle of transmission between care homes and hospitals – by triggering an increase in cleaning protocols, use of PPE and isolation measures, for short periods. “In the US, WBE testing is performed at
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state level for hospital forecasting, to enable predictions around capacity, then make decisions around what needs to be done at a community level to prevent an increase in admissions or prepare in terms of staffing levels. The application for this is huge. “The UK is currently lagging behind the rest of the world in terms of this approach to making healthcare decisions. This is exactly what this testing method should be used for. This is about population monitoring, informing services and managing demand on services. It is about preparedness,” commented Laughton. “Right now, the healthcare sector knows that
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