Winter pressures

Helping fight infections this winter using diagnostics tests

The more widespread use of diagnostic tests during the winter season can not only help relieve winter pressures within the NHS, but also assist in the fight against antimicrobial resistance (AMR).1

During the winter the NHS is under even more pressure than usual. In addition to their daily workload, seasonal conditions significantly increase the number of people seeking medical assistance. During the winter of 2017/2018:

·        400,000 more people called NHS 111

·        290,000 more people attended A&E departments 

·        100,000 more people were admitted to hospital as an emergency2

Roche Diagnostics has patients and our partners in healthcare delivery at the heart of everything that we do. This is why we have developed a suite of tests, ideal for use with seasonal conditions, which can help to relieve the pressure on the NHS during this acute period.

1.      cobas® Liat® system – for diagnosing Flu A, B and RSV at the point of care

2.      cobas® B101 CRP – for helping to discriminate between viral and bacterial infections

3.      FLOW – for flexible lab-based testing of infectious diseases

The aim of all of these tests is to ensure patients receive an accurate diagnosis to enable the right treatment to be administered at the right time.

These tests can also help alleviate the pressures on the NHS from seasonal conditions by enabling quick and confident discharge of patients who do not need specialist care.

In addition, these tests play a key role in the fight against antimicrobial resistance by helping to ensure only those who need them are prescribed antibiotics. 

 

cobas® Liat® system – diagnosing Flu and RSV infections at the point of care

The cobas® Liat® is a small bench-top system that can be used at the point of care, close to the patient. It analyses a single nasopharyngeal swab for the presence of 43 strains of Flu A and B, the two main types of flu virus as well as seven strains of respiratory syncytial virus (RSV).3

The young and old are particularly vulnerable to infection from RSV. It is the leading cause of lower respiratory disease for children younger than 4 years.4 RSV is also common in adults older than 65 and their risk of serious infection increases with age.5

The test for all three viruses takes around 20 minutes to provide a result and following this the healthcare professional can take the appropriate action for the patient, whether that is isolating a patient testing positive or sending a patient testing negative back to the comfort of their home. Either way, the cobas® Liat® system can help healthcare professionals make informed prescribing decisions.

Previously, patients had to wait for their tests to be sent to a laboratory, and results could take several days to come back. For those patients in hospital, this often meant they were put into unnecessary isolation, with a hospital’s ability to manage beds significantly affected. And while other rapid tests exist, they often have a lower rate of accuracy leading to the need to confirm via traditional, more time-consuming methods. 

cobas® B101 CRP – helping discriminate viral and bacterial infections

The cobas® B101 is a small bench-top analyser that can be used at the point of care, either in the hospital or at the GP surgery. It measures the levels of C-reactive protein (CRP) - a marker of infection and inflammation in the body – in a simple blood sample.3 CRP levels are high in bacterial infections, but low or close to zero in viral infections. Since antibiotics only work with bacterial infections and not those caused by viruses, it can be invaluable for the healthcare professional to know the type of infection to help decide whether a patient requires antibiotics. Not only does this help prevent unnecessary prescribing and reduce waste, but it helps in the fight against antimicrobial resistance (AMR).

AMR is recognised as one of the most serious global threats to human health in the 21st century, with bacteria’s resistance to antibiotics spreading from one country to the next.6 Although the emergence of resistant bacteria is a natural phenomenon, the overuse or inappropriate use of antibiotics has had a great effect on its evolution.1 This is incredibly concerning because, without effective antibiotics, most medical practice, including routine surgery, emergency operations, transplants or chemotherapy will be less safe and even minor infections could prove fatal.

Ensuring we only use antibiotics when necessary and appropriate is one of the solutions to AMR. In fact the National Institute for Health and Care Excellence (NICE) recommends point of care testing for CRP when clinical assessment is inconclusive. If the CRP level is less than 20mg/L, no antibiotics should be offered; if 20–100mg/L delayed prescriptions should be considered; and if over 100mg/L an antibiotic should be offered immediately.7

The FLOW Solution

The FLOW solution is a flexible lab-based system that can be used to test for a wide variety of infectious diseases. It even has the facility for labs to create their own tests if they need to. The flexibility of the FLOW system enables several different sample types and tests for several different diseases to be conducted in the same run. It provides workflow standardisation and data automation for labs performing laboratory-developed or commercially validated tests with a high number of samples and a high variety of conditions.3

The FLOW solution can be particularly helpful during the winter as the pressure on the NHS resources increase due to seasonal conditions. It enables labs to be able to support with tests for winter infections as the system can be set up to run hundreds of samples each day.    

*for general laboratory use   

References

  1. Carey-Ann D. Burnham, Jennifer Leeds, Patrice Nordmann, Justin O'Grady & Jean Patel Diagnosing antimicrobial resistance Nature Reviews Microbiology volume 15, pages 697–703 (2017)
  2. https://improvement.nhs.uk/resources/nhs-review-winter-201718/
  3. Source: product package insert
  4. Collins PL and Grahm BS. Viral and host factors in human respiratory syncytial virus pathogenesis. J. Virol. 2008:82(5);2040-2055. 
  5. Falsey AR, Hennessey PA, Formica MA, Cox C, Walsh EE. Respiratory Syncytial Virus Infection in Elderly and High-Risk Adults. NEJM. 2005:352(17); 1749-59.
  6. https://mrc.ukri.org/research/spotlights/antimicrobial-resistance/what-is-amr/
  7. NICE (2015) CG191. Pneumonia: Diagnosis and management of community- and hospital-acquired pneumonia in adults. Available at: www.nice.org.uk/guidance/cg191