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Kim MS, Sarcevic A, Sippel GJ, McCarthy KH, Wood EA, Riley C, Mun AH, O'Connell KJ, LaPuma PT, Burd RS. Factors associated with correction of personal protective equipment nonadherence in a multidisciplinary emergency department setting: A retrospective video review. Am J Infect Control 2024:S0196-6553(24)00635-7. [PMID: 39116999 DOI: 10.1016/j.ajic.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Despite local and national recommendations, health care provider adherence to personal protective equipment (PPE) varied during the COVID-19 pandemic. Previous studies have identified factors influencing initial PPE adherence but did not address factors influencing behaviors leading to correction after initial nonadherence. METHODS We conducted a retrospective video review of 18 pediatric resuscitations involving aerosol-generating procedures from March 2020 to December 2022 to identify factors associated with nonadherence correction. We quantified adherent and nonadherent providers, instances of PPE nonadherence, and time to correction. We also analyzed correction behaviors, including provider actions and correction locations. RESULTS Among 434 providers, 362 (83%) were nonadherent with at least 1 PPE. Only 186 of 1,832 instances of nonadherence were corrected, primarily upon room entry and during patient care. Correction time varied by PPE type and nonadherence level (incomplete vs absent). Most corrections were self-initiated, with few reminders from other providers. DISCUSSION Potential barriers to correction include a lack of social pressure and external reminders. Solutions include optimizing PPE availability, providing real-time feedback, and educating on double gloving. CONCLUSIONS Most providers were nonadherent to PPE requirements during high-risk infection transmission events. The low correction rate suggests challenges in promoting collective responsibility and maintaining protective behaviors during medical emergencies.
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Affiliation(s)
- Mary S Kim
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC
| | | | - Genevieve J Sippel
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC
| | - Kathleen H McCarthy
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC
| | - Eleanor A Wood
- College of Medicine, Drexel University Health Sciences Building, Philadelphia, PA
| | - Carmen Riley
- College of Computing and Informatics, Drexel University, Philadelphia, PA
| | - Aaron H Mun
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC
| | - Karen J O'Connell
- Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Peter T LaPuma
- Department of Environmental & Occupational Health, Milken School of Public Health, George Washington University, Washington, DC
| | - Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC.
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Zhang M, Wu S, Ibrahim MI, Noor SSM, Mohammad WMZW. Significance of Ongoing Training and Professional Development in Optimizing Healthcare-associated Infection Prevention and Control. JOURNAL OF MEDICAL SIGNALS & SENSORS 2024; 14:13. [PMID: 39100741 PMCID: PMC11296567 DOI: 10.4103/jmss.jmss_37_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 08/06/2024]
Abstract
The employees who work in infection prevention and control (IPC) are very important in the field of health-care because they are committed to protecting patients, staff, and visitors from the risk of acquiring infections while in the hospital. The complexity of infection control in hospitals is alwaysgrowing in tandem with the rapid developments that are being made in medical technology andpractices. IPC personnel are required to maintain vigilance and continually improve their monitoringof the entire health-care process due to the ongoing development of IPC guidelines and regulations, the fluctuating infection risks, and the emergence of new infectious diseases. As a result, individuals involved in the prevention and control of infections in health-care settings absolutely need to participate in continual training and professional development. This reviewemphasizes the need of relevant professionals to engage in ongoing training and professional development to maintain their skills in the area of healthcare-associated infection control and prevention. Personnel working in IPC may more effectively react to newly discovered health risks andmake certain that hospital infection (HI) management gets the appropriate attention if they have atimely and in-depth awareness of best practices. They are better able to maintain their composure, react correctly, and deliver the most effective infection control and prevention techniques for the health-care system, all while increasing awareness about the significance of effective HI management.
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Affiliation(s)
- Maojie Zhang
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Department of Infection Management, The First Affiliated Hospital of Guizhou Traditional Chinese Medicine University, Guiyang, China
| | - Shengwei Wu
- Department of Infection Management, The First Affiliated Hospital of Guizhou Traditional Chinese Medicine University, Guiyang, China
| | - Mohd Ismail Ibrahim
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Siti Suraiya Md Noor
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Wan Mohd Zahiruddin Wan Mohammad
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Somri M, Hochman O, Somri-Gannam L, Gaitini L, Paz A, Bumard T, Gómez-Ríos MÁ. Removal of Contaminated Personal Protective Equipment With and Without Supervision. A Randomized Crossover Simulation-Based Study. Simul Healthc 2024; 19:137-143. [PMID: 37185879 DOI: 10.1097/sih.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Personal protective equipment (PPE) reduces the risk of pathogens reaching the skin and clothing of health care personnel. We hypothesize that doffing PPE following verbal instructions by a supervisor is more effective in reducing contamination compared with doffing without verbal instructions. Our primary aim was to determine contamination rates with and without supervised doffing. The secondary aim was to determine the number and localization of contaminated body sites and PPE removal times in both groups. METHODS Staff members of Bnai Zion Medical Center participated in this single-center, randomized simulation study (NCT05008627). Using a crossover design, all participants donned and doffed the PPE twice, once under guidance from a trained supervisor and then independently without supervision (group A), or vice versa (group B). Participants were randomized to either group A or B using a computer-generated random allocation sequence. The PPE was "contaminated" with Glo Germ on the thorax, shoulders, arms, hands, legs, and face shield. After doffing the PPE, the participant was examined under ultraviolet light to detect traces of contamination. The following variables were collected: contamination rates, the number and localization of contaminated body sites, and PPE doffing time. RESULTS Forty-nine staff members were included. In group A, the contamination rate was significantly lower (8% vs. 47%; χ 2 = 17.19; p < 0.001). The sites most frequently contaminated were the neck and hands. Mean PPE doffing time under verbal instructions was significantly longer [mean (SD): 183.98 (3.63) vs. 68.43 (12.75) seconds, P < 0.001] compared with unsupervised doffing. CONCLUSIONS In a simulated setting, PPE doffing following step-by-step verbal instructions from a trained supervisor reduces the rate of contamination but prolongs doffing time. These findings could have important implications for clinical practice and could further protect health care workers against contamination from emerging and high-consequence pathogens.
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Affiliation(s)
- Mostafa Somri
- From the Department of Anesthesia (M.S., L.S.-G., L.G.), Bnai Zion Medical Center, Haifa, Israel; Faculty of Medicine (M.S., L.G.), Technion, Israel Institute of Technology, Haifa, Israel; Bnai Zion Medical Center (O.H.), Haifa, Israel; Infectious Disease and Infection Control Unit (A.P., T.B.), Bnai Zion Medical Center, Haifa, Israel; Department of Anesthesia and Perioperative Medicine (M.A.G.-R.), Complejo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain; and Spanish Difficult Airway Group (GEVAD) (M.A.G.-R.), A Coruña Spain
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Biering K, Kinnerup M, Cramer C, Dalbøge A, Toft Würtz E, Lund Würtz AM, Kolstad HA, Schlünssen V, Meulengracht Flachs E, Nielsen KJ. Use, failure, and non-compliance of respiratory personal protective equipment and risk of upper respiratory tract infections-A longitudinal repeated measurement study during the COVID-19 pandemic among healthcare workers in Denmark. Ann Work Expo Health 2024; 68:376-386. [PMID: 38373246 DOI: 10.1093/annweh/wxae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/31/2024] [Indexed: 02/21/2024] Open
Abstract
INTRODUCTION Upper respiratory tract infections (URTI) are common and a common cause of sick-leave for healthcare workers, and furthermore pose a threat especially for patients susceptible to other diseases. Sufficient use of respiratory protective equipment (RPE) may protect both the workers and the patients. The COVID-19 pandemic provided a unique opportunity to study the association between use of RPE and URTI in a real-life setting. The aim of this study was to examine if failure of RPE or non-compliance with RPE guidelines increases the risk of non-COVID-19 URTI symptoms among healthcare workers. METHODS In a longitudinal cohort study, we collected self-reported data daily on work tasks, use of RPE, and URTI symptoms among healthcare workers with patient contact in 2 Danish Regions in 2 time periods during the COVID-19 pandemic. The association between failure of RPE or non-compliance with RPE guidelines and URTI symptoms was analyzed separately by generalized linear models. Persons tested positive for severe acute respiratory syndrome coronavirus 2 were censored from the analyses. The 2 waves of data collection were analyzed separately, as there were differences in recommendations of RPE during the 2 waves. RESULTS We found that for healthcare workers performing work tasks with a risk of transmission of viruses or bacteria, failure of RPE was associated with an increased risk of URTI symptoms, RR: 1.65[0.53-5.14] in wave 1 and RR: 1.30[0.56-3.03] in wave 2. Also non-compliance with RPE guidelines was associated with an increased risk of URTI symptoms compared to the use of RPE in wave 1, RR: 1.28[0.87-1.87] and wave 2, RR: 1.39[1.01-1.91]. Stratifying on high- versus low-risk tasks showed that the risk related to failure and non-compliance was primarily associated with high-risk tasks, although not statistically significant. DISCUSSION The study was conducted during the COVID-19 pandemic and thus may be affected by other preventive measures in society. However, this gave the opportunity to study the use of RPE in a real-life setting, also in departments that did not previously use RPE. The circumstances in the 2 time periods of data collection differed and were analyzed separately and thus the sample size was limited and affected the precision of the estimates. CONCLUSION Failures of RPE and non-compliance with RPE guidelines may increase the risk of URTI, compared to those who reported use of RPE as recommended. The implications of these findings are that the use of RPE to prevent URTI could be considered, especially while performing high-risk tasks where other prevention strategies are not achievable.
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Affiliation(s)
- Karin Biering
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, 7400 Herning, Denmark
| | - Martin Kinnerup
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, 7400 Herning, Denmark
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Christine Cramer
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, 8000 Aarhus C, Denmark
| | - Annett Dalbøge
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Else Toft Würtz
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Occupational and Environmental Medicine, Danish Ramazzini Centre, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Anne Mette Lund Würtz
- Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, 8000 Aarhus C, Denmark
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Vivi Schlünssen
- Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, 8000 Aarhus C, Denmark
| | - Esben Meulengracht Flachs
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2400 Copenhagen NV, Denmark
| | - Kent J Nielsen
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, 7400 Herning, Denmark
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Falana ROA, Ogidan OC, Fajemilehin BR. Barriers to infection prevention and control implementation in selected healthcare facilities in Nigeria. Infect Dis Now 2024; 54:104877. [PMID: 38395258 DOI: 10.1016/j.idnow.2024.104877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/01/2023] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE While infection prevention and control are of paramount importance, up until recently an assessment of implementation challenges and performance gaps was lacking. This study explored the barriers to infection prevention and control implementation at selected healthcare facilities, the objective being to find ways to improve their programs. MATERIAL AND METHOD A qualitative approach was applied. Purposive sampling was used to select thirty-three healthcare facilities in Ekiti State, Nigeria. They were globally assessed, and an Infection Prevention and Control team, represented by the Infection Prevention and Control referent in each of the selected facilities trained the participants. Data were collected using the Key Informant Interview Guide and analyzed by means of content and thematic analyses using Atlas.ti software. RESULTS Inadequate infection prevention and control materials, poor waste management, non-compliance of patients with infection prevention and control protocols, and poor infrastructure were identified as major barriers to infection prevention and control implementation. CONCLUSION The study concluded that a number of identified factors hindering infection prevention and control implementation in healthcare facilities in Ekiti State needed to be addressed.
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Affiliation(s)
- Rachael O A Falana
- Department of Nursing Science, Obafemi Awolowo University, Osun State, Nigeria.
| | - Oluwakemi C Ogidan
- Department of Nursing Science, Ekiti State University, Ado Ekiti, Ekiti State, Nigeria
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Lazar MS, Ganesh V, Naik B N, Singh A, Puri GD, Kaur S. Efficacy of remote audio-visual system versus standard onsite buddy system to monitor the doffing of personal protective equipment during COVID-19 pandemic: An observational study. Int J Health Plann Manage 2024; 39:530-540. [PMID: 38163283 DOI: 10.1002/hpm.3754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 09/17/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES Literature states a higher self-contamination rate among healthcare workers (HCWs) while doffing personal protective equipment (PPE). During the Covid-19 pandemic, onsite trained observers were not always available to monitor PPE compliance. The remote audio-visual doffing surveillance (RADS) system has the potential to overcome this limitation. We aimed to compare the efficacy of this real-time RADS system against the onsite buddy system for monitoring the doffing of PPE. METHODS This prospective, observational study was carried out at our tertiary care centre in northern India. 200 HCWs who cared for Covid-19 patients in the intensive care units/operation theatres were included. Group A included HCWs who performed doffing with the help of an onsite trained observer and group B included HCWs who performed doffing with the RADS system. An independent observer noted the error at any step using the CDC doffing checklist, in both groups. An online questionnaire to analyse the level of satisfaction post-doffing was also surveyed. RESULTS The proportion of errors committed during doffing was significantly lower in group B compared to group A with a low relative risk of 0.34 (95% CI 0.22-0.51) (p < 0.001) (Figure 1A,B). In both groups, there was no difference in HCWs feedback regarding the ease of the system and fear of committing an error. Though the perceived quality of monitoring was felt better with onsite buddy, the overall confidence rating of being safe after doffing was better with the RADS system. CONCLUSION Real-time RADS system may be more effective than the onsite buddy system for ensuring the safety of HCWs during doffing PPE. HCWs level of satisfaction related to the ease and anxiety with the monitoring systems were comparable. RADS system can reduce reliance on HCW resources and can integrate well into existing healthcare systems.
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Affiliation(s)
- Michelle Shirin Lazar
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Venkata Ganesh
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Naik B
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Singh
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - G D Puri
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sukhpal Kaur
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Tu J, Liu F, Wang K, Mao Y, Qi Q, Zhang J. Donning and doffing of personal protective equipment for health care workers in a tertiary hospital in China: A simulation study. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2024; 21:108-118. [PMID: 37812187 DOI: 10.1080/15459624.2023.2268727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
The application and removal of personal protective equipment (PPE) by health care workers (HCWs) is pivotal to their health and safety and the comprehensive efficacy of hospital infection control measures. This investigation was orchestrated to elucidate the challenges that HCWs may encounter during the donning and doffing of PPE. A total of 110 participants from a tertiary hospital in China were engaged. The study employed fluorescent markers to mimic the exposure of HCWs to tainted body fluids, quantified the contamination outcomes, and evaluated adherence to procedures for donning and doffing. Factors including gender, educational background, and the timing of the most recent instruction on PPE donning and doffing were found to influence the occurrence of contamination points (p < 0.05). No significant differences were identified in contamination frequency when assessing age, body mass index (BMI), occupation, educational background, positional title, working tenure, and experience in managing respiratory infectious diseases (p > 0.05). Predominant contamination sites for fluorescent marker residue included the shoulder (32.73%), neck (21.82%), forearm (16.36%), chest (12.73%), and abdomen (11.82%), with the shoulder being the most contaminated body part. A majority of HCWs exhibited susceptibility to errors during the removal of protective clothing, boot covers, and gloves. The contamination frequency was observed to be correlated with the timing of the last PPE training, educational background, and gender. In acknowledging the intricacy of PPE removal and the deficiencies in HCWs' removal techniques, there emerges a perpetual necessity to refine training methodologies and perpetuate regular PPE instruction.
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Affiliation(s)
- Jiajia Tu
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Fang Liu
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Kexuan Wang
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Yiping Mao
- School of Nursing, Xuzhou Medical University, Xuzhou, China
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Qi Qi
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jie Zhang
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Doos D, Hughes AM, Pham T, Barach P, Bona A, Falvo L, Moore M, Cooper DD, Ahmed R. Front-Line Health Care Workers' COVID-19 Infection Contamination Risks: A Human Factors and Risk Analysis Study of Personal Protective Equipment. Am J Med Qual 2024; 39:4-13. [PMID: 38127677 DOI: 10.1097/jmq.0000000000000159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Infectious risks escalate with complex donning and doffing personal protective equipment (PPE) protocols. Recent studies suggest that PPE donning and doffing behaviors that deviate from protocol during PPE reuse compounded the risks of health care worker (HCW) self-contamination. This study quantified the occurrence of behaviors associated with known risks in PPE use and reuse. We conducted a prospective study of emergency department HCWs and video-recorded PPE donning and doffing 5 times in simulated patient encounters. Trained coders recorded HCW behaviors according to an evidence-based guide. All 28 participants deviated from the Centers for Disease Control and Prevention (CDC) sanctioned donning and doffing protocol order, and most were documented to have (92.85%) self-contaminated at least once during each simulated clinical encounter. Behaviors that compounded self-contamination due to PPE reuse were also observed. Wide variation in PPE donning and doffing behaviors was found among front-line, experienced HCWs. Future work is needed to determine which deviations put HCWs at increased risk for accidental self-contamination and what changes are needed to the CDC protocol for protecting HCW from infections.
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Affiliation(s)
- Devin Doos
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Ashley M Hughes
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL
- Center of Innovation for Chronic Complex Health (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL
| | - Trang Pham
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Paul Barach
- Department of Anesthesiology and City of Philadelphia, Jefferson College of Population Health, Thomas Jefferson School of Medicine, PA
- Department of Anesthesiology, Brisbane Queensland, University of Queensland, Australia
| | - Anna Bona
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Lauren Falvo
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Malia Moore
- Simulation Medicine, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Dylan D Cooper
- Clinical Emergency Medicine, Simulation Education, Department of Emergency Medicine, Simulation Center at Fairbanks Hall, Indiana University School of Medicine, Indianapolis, IN
| | - Rami Ahmed
- Division of Simulation, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
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Dehghan G, Malekpour F, Jafari-Koshki T, Mohammadian Y, Rostami H. The status of work-related COVID-19 prevention measures and risk factors in hospitals. Work 2024; 77:445-453. [PMID: 37742681 DOI: 10.3233/wor-230006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Health care workers (HCWs) in hospitals are at risk of infection with coronavirus disease 2019 (COVID-19). Prevention measures are necessary to protect HCWs against COVID-19. OBJECTIVE This study aimed to determine the status of occupational risk factors and prevention measures for COVID-19 in hospitals. METHODS This cross-sectional study was conducted in Iranian hospitals. Based on the results of reviewing the literature and guidelines, two checklists on occupational risk factors and prevention measures for COVID-19 in hospitals were designed and validated. The status of occupational risk factors and prevention measures against COVID-19 in governmental, non-governmental public, private, and military hospitals were determined using designed checklists. RESULTS Results confirmed the validity of checklists for assessing the status of COVID-19 prevention measures in hospitals. The military hospitals had the lowest mean risk factors compared to other hospitals, but there was no significant difference in occupational risk factors of infection with COVID-19 among governmental, non-governmental public, private, and military hospitals (P-value > 0.05). In the checklist of occupational risk factors of Covid-19, the type of hospital had a significant relationship with the provision and use of personal protective equipment (P-value<0.05). The mean of implementation of prevention measures among all hospitals were not statistically significant difference (P-value > 0.05). CONCLUSION The provided checklists could be a suitable tool for monitoring of status of prevention measures for COVID-19 in hospitals. Improving ventilation systems is necessary in most of the hospitals.
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Affiliation(s)
- Golnoush Dehghan
- Department of Occupational Health Engineering, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Malekpour
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tohid Jafari-Koshki
- Department of Statistics and Epidemiology, Molecular Medicine Research Center, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yousef Mohammadian
- Department of Occupational Health Engineering, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Rostami
- Research Center for Cognitive and Behavioral Sciences in Police, Directorate of Health, Rescue and Treatment, Police Headquarter, Tehran, Iran
- FARAJA Institute of Law Enforcement Sciences and Social Studies, Tehran, Iran
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Altabbaa G, Pidhorney C, Beran T, Kim J, Ledgerwood D, Cowan M, Paolucci EO. Personal protection equipment: Preliminary evidence of effectiveness from a three-phase simulation program. J Infect Prev 2023; 24:244-251. [PMID: 37969467 PMCID: PMC10638951 DOI: 10.1177/17571774231208118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/29/2023] [Indexed: 11/17/2023] Open
Abstract
Background Healthcare providers carry the occupational risk of being exposed to pathogens. Personal Protection Equipment (PPE) requires proficiency whenever used. Yet, evidence shows significant errors and variation in competency when applying PPE. Objective In this study, we developed a three-phase intervention to promote PPE proficiency. Methods Education and assessment of participants' PPE knowledge and skills occurred at a large academic university in Western Canada. Participants first completed an online module; second, they experienced one-on-one coaching and deliberate practice with infection control professionals; and third, participants managed a COVID-19 clinical simulation scenario. The measured outcomes include a 15-item pre- and post-knowledge test and a pre- and post-skills assessment of donning and doffing behaviors. These behaviors were observed from video recordings and were assessed using two standardized checklists. Results Knowledge and donning/doffing post-test scores (11.73, 0.95, and 0.96, respectively) were significantly higher after completing all three phases of the educational intervention, p < .001. Conclusions An online module alone is insufficient for PPE knowledge and skill development. Rather, a module followed by practice and simulation allows learners to gain proficiency.
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Affiliation(s)
- Ghazwan Altabbaa
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | | | - Tanya Beran
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Joseph Kim
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Donna Ledgerwood
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Michèle Cowan
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
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Salvetat ML, Musa M, Pellegrini F, Salati C, Spadea L, Zeppieri M. Considerations of COVID-19 in Ophthalmology. Microorganisms 2023; 11:2220. [PMID: 37764064 PMCID: PMC10538084 DOI: 10.3390/microorganisms11092220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
Since its emergence in early 2020, the SARS-CoV-2 infection has had a significant impact on the entire eye care system. Ophthalmologists have been categorized as a high-risk group for contracting the virus due to the belief that the eye may be a site of inoculation and transmission of the SARS-CoV-2 infection. As a result, clinical ophthalmologists, optometrists, and eyecare professionals have had to familiarize themselves with the ocular manifestations of COVID-19, as well as its treatments and vaccines. The implementation of measures to prevent the transmission of the virus, such as restrictions, lockdowns, telemedicine, and artificial intelligence (AI), have led to substantial and potentially irreversible changes in routine clinical practice, education, and research. This has resulted in the emergence of a new mode of managing patients in a routine clinical setting. This brief review aims to provide an overview of various aspects of COVID-19 in ophthalmology, including the ocular manifestations related to the disease, the modes of transmission of SARS-CoV-2 infection, precautions taken in ophthalmic practice to prevent the spread of the virus, drugs, and vaccines used in the treatment of COVID-19, the impact of the pandemic on patients, clinicians, and the eye care system as a whole, and the future of ophthalmology conditioned by this global pandemic experience.
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Affiliation(s)
- Maria Letizia Salvetat
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy
| | - Mutali Musa
- Department of Optometry, University of Benin, Benin City 300238, Edo State, Nigeria
| | - Francesco Pellegrini
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, 00142 Rome, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
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Reske KA, Park D, Bach TH, Stewart HB, Vogt LC, Arter OG, Stoeckel D, Steinkamp HM, Liang SY, Durkin MJ, Kwon JH. Assessment of dental health care personnel protocol deviations and self-contamination during personal protective equipment donning and doffing. J Am Dent Assoc 2022; 153:1070-1077.e1. [PMID: 36175202 PMCID: PMC9511115 DOI: 10.1016/j.adaj.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/24/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dental health care personnel (DHCP) may be at increased risk of exposure to severe acute respiratory syndrome coronavirus 2, the virus that causes COVID-19, as well as other clinically important pathogens. Proper use of personal protective equipment (PPE) reduces occupational exposure to pathogens. The authors performed an assessment of PPE donning and doffing practices among DHCP, using a fluorescent marker as a surrogate for pathogen transmission. METHODS Participants donned PPE (that is, disposable gown, gloves, face mask, and eye protection) and the fluorescent marker was applied to their palms and abdomen. DHCP then doffed PPE according to their usual practices. The donning and doffing processes were video recorded, areas of fluorescence were noted, and protocol deviations were assessed. Statistical analyses included frequency, type, and descriptions of protocol deviations and factors associated with fluorescence. RESULTS Seventy DHCP were enrolled. The donning and doffing steps with the highest frequency of protocol deviations were hand hygiene (66% of donning and 78% of doffing observations involved a deviation) and disposable gown use (63% of donning and 60% of doffing observations involved a deviation). Fluorescence was detected on 69% of DHCP after doffing, most frequently on hands. An increasing number of protocol deviations was significantly associated with increased risk of fluorescence. DHCP with a gown doffing deviation, excluding doffing out of order, were more likely to have fluorescence detected. CONCLUSIONS DHCP self-contamination was common with both donning and doffing PPE. PRACTICAL IMPLICATIONS Proper use of PPE is an important component of occupational health.
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Curtis SJ, Trewin A, McDermott K, Were K, Clezy K, Dempsey K, Walsh N. Electronic monitoring of doffing using video surveillance to minimise error rate and increase safety at Howard Springs International Quarantine Facility. Antimicrob Resist Infect Control 2022; 11:120. [PMID: 36175981 PMCID: PMC9522442 DOI: 10.1186/s13756-022-01155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Safe donning and doffing of personal protective equipment (PPE) are critical to prevent transmission of infectious diseases. Novel strategies to improve infection prevention and control (IPC) adherence can optimise safety. We describe and quantify video surveillance of doffing at an outdoor hotel quarantine facility led by the Australian Medical Assistance Team in the Northern Territory, Australia.
Methods
Motion-activated video cameras were installed in seven areas where personnel doffed PPE upon exit from an area dedicated to quarantined residents. Video footage was reviewed daily and compliance issues were identified using a standardised checklist and risk graded to initiate feedback. We collated audit data from 1 February to 18 April 2021 to describe trends by month, staff group, doffing component and risk.
Results
In 235 h of video footage, 364 compliance issues were identified, of which none were considered high-risk compromising to PPE integrity. Compliance issues were low risk (55/364, 15%) or moderate risk (309/364, 85%) and the most common issue was missed or inadequate hand hygiene (156/364, 43%). Compliance issues per minute of video footage reviewed decreased following introduction of the activity, from 24 per 1000 in February to 7 per 1000 in March and April.
Conclusion
Video surveillance with feedback supported rapid response to improve IPC adherence in a challenging ambient environment. The activity focused on perfection to identify compliance issues that would go unreported in most healthcare settings and contributed to a suit of activities that prevented any high-risk PPE breaches or compromises to safety.
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How Can Personal Protective Equipment Be Best Used and Reused: A Closer Look at Donning and Doffing Procedures. Disaster Med Public Health Prep 2022; 17:e272. [PMID: 36155649 DOI: 10.1017/dmp.2022.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this study was to examine safety-related contamination threats and risks to health-care workers (HCWs) due to the reuse of personal protective equipment (PPE) among emergency department (ED) personnel. METHODS We used a Participatory Design (PD) approach to conduct task analysis (TA) of PPE use and reuse. TA identified the steps, risks, and protective behaviors involved in PPE reuse. We used the Centers for Disease Control and Prevention (CDC) guidance for PPE donning and doffing specifying the recommended task order. Then, we convened subject matter experts (SMEs) with relevant backgrounds in Patient Safety, Human Factors and Emergency Medicine to iteratively identify and map the tasks, risks, and protective behaviors involved in the PPE use and reuse. RESULTS Two emerging threats were associated with behaviors in donning, doffing, and re-using PPE: (i) direct exposure to contaminant, and (ii) transmission/spread of contaminant. Protective behaviors included: hand hygiene, not touching the patient-facing surface of PPE, and ensuring a proper fit and closure of all PPE ties and materials. CONCLUSIONS TA was helpful revealed that the procedure for donning and doffing of re-used PPE does not protect ED personnel from contaminant spread and risk of exposure, even with protective behaviors present (e.g., hand hygiene, respirator use, etc.). Future work should make more apparent the underlying risks associated with PPE use and reuse.
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Horn GP, Fent KW, Kerber S, Smith DL. Hierarchy of contamination control in the fire service: Review of exposure control options to reduce cancer risk. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2022; 19:538-557. [PMID: 35853136 PMCID: PMC9928012 DOI: 10.1080/15459624.2022.2100406] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The international fire service community is actively engaged in a wide range of activities focused on development, testing, and implementation of effective approaches to reduce exposure to contaminants and the related cancer risk. However, these activities are often viewed independent of each other and in the absence of the larger overall effort of occupational health risk mitigation. This narrative review synthesizes the current research on fire service contamination control in the context of the National Institute for Occupational Safety and Health (NIOSH) Hierarchy of Controls, a framework that supports decision making around implementing feasible and effective control solutions in occupational settings. Using this approach, we identify evidence-based measures that have been investigated and that can be implemented to protect firefighters during an emergency response, in the fire apparatus and at the fire station, and identify several knowledge gaps that remain. While a great deal of research and development has been focused on improving personal protective equipment for the various risks faced by the fire service, these measures are considered less effective. Administrative and engineering controls that can be used during and after the firefight have also received increased research interest in recent years. However, less research and development have been focused on higher level control measures such as engineering, substitution, and elimination, which may be the most effective, but are challenging to implement. A comprehensive approach that considers each level of control and how it can be implemented, and that is mindful of the need to balance contamination risk reduction against the fire service mission to save lives and protect property, is likely to be the most effective.
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Affiliation(s)
- Gavin P Horn
- Fire Safety Research Institute, UL Research Institutes, Columbia, Maryland
- Illinois Fire Service Institute, Champaign, Illinois
| | - Kenneth W Fent
- National Institute for Occupational Safety & Health, Cincinnati, Ohio
| | - Steve Kerber
- Fire Safety Research Institute, UL Research Institutes, Columbia, Maryland
| | - Denise L Smith
- Illinois Fire Service Institute, Champaign, Illinois
- Skidmore College, Saratoga Springs, New York
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Lee H, Jeong IS. Effect of the Personal Protective Equipment Donning and Doffing Program for Nurses in Military Hospitals. Nurs Health Sci 2022; 24:690-698. [PMID: 35699674 DOI: 10.1111/nhs.12966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Abstract
This study aimed to develop and verify the effect of a new personal protective equipment donning and doffing program for nurses in military hospitals. A total of 40 nurses (20 experimental group, 20 control group) participated in this non-equivalent control group experimental study. The new program consisted of the description of the design modification of the inner and outer boundary marks of coveralls and a video with verbal instructions and footswitch that the participants could watch at their own pace. Data collection was carried out before, immediately after, and two weeks after the intervention. The effects of the program on accuracy, self-efficacy, and time were analyzed using a generalized estimating equation. PPE donning and doffing accuracy, self-efficacy, and time were significantly increased in the experimental group compared to those in the control group, both immediately after and two weeks after intervention. As this program has been confirmed to be effective in improving PPE donning and doffing accuracy and self-efficacy, we recommend to use this program for training nurses on donning and doffing of PPE.
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Affiliation(s)
- Hyewon Lee
- Armed Forces Capital Hospital, 81, Saemaeul-ro 177beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Ihn Sook Jeong
- College of Nursing, Pusan National University 49 Busandaehak-ro Mulgeum-eup Yangsan-si Gyeongsangnam-do, South Korea
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Edgar M, Selvaraj SA, Lee KE, Caraballo-Arias Y, Harrell M, Rodriguez-Morales AJ. Healthcare workers, epidemic biological risks - recommendations based on the experience with COVID-19 and Ebolavirus. LE INFEZIONI IN MEDICINA 2022; 30:168-179. [PMID: 35693057 PMCID: PMC9177174 DOI: 10.53854/liim-3002-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
Infectious disease outbreaks frequently cause illness and death among Healthcare Workers (HCWs). We compare strategies from recent, past and ongoing outbreak measures used to protect HCWs, including those facing additional challenges such as racial disparities, violence and stigmatization. Outbreaks and pandemics superimposed on countries with preexisting crises have also affected emergency response to these viral outbreaks. Strategies to protect HCWs include adherence to recommended infection prevention and control measures; new technology such as rapid point-of-care tests and remote monitoring; adopting national public health preparedness plans to ensure the supply and allocation of PPE, staff, and testing supplies; occupational health and mental health support services. Lessons learned from recent pandemics should be used by Infection Prevention and Control and Occupational Health staff to refine preparedness plans to protect HCWs better.
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Affiliation(s)
- Mia Edgar
- Independent Researcher, Honolulu, HI 96795, USA
| | | | - Karen E. Lee
- The Open University, Walton Hall, Kents Hill, Milton Keynes MK7 6AA, United Kingdom
| | | | - Mason Harrell
- School of Public Health, Harvard University, Boston, MA 02138, USA
| | - Alfonso J. Rodriguez-Morales
- Grupo de Investigacion Biomedicina, Faculty of Medicine, Fundacion Universitaria Autónoma de las Americas, Pereira, Risaralda, Colombia
- Universidad Cientifica del Sur, Lima, Peru
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Saber DA, Norris AE, Reinking J, Trompeter G, Sanford D. Analyzing the Cost of Hospital Contact Isolation Practices: Implications for Nursing Administrator Practice, Research, and Policy. J Nurs Adm 2022; 52:352-358. [PMID: 35608977 DOI: 10.1097/nna.0000000000001160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to determine the weekly costs of contact precaution (CP) use with medically stable patients infected/colonized with methicillin-resistant Staphylococcus aureus (MRSA) and to estimate the annual financial and environmental costs of CP. BACKGROUND The increasing use of disposables for infection control contributes to increasing hospital costs and amounts of solid waste at rates that are becoming unsustainable. METHODS A cost analysis was conducted using data from time/motion observations and previous waste audit study, along with hospital finance department values and US Department of Labor salary rates. RESULTS Weekly and annual costs were $521.67 and $557 463 (5% hospital multidrug-resistant organism [MDRO] rate assumed). Personal protective equipment accounted for 43% of the waste produced (approximately 1600 pounds annually). CONCLUSIONS Implications for nurse administrators include reevaluating activities that require personal protective equipment (PPE) and partnering with materials and human factor engineers to develop more financially and environmentally sustainable infection control practices.
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Affiliation(s)
- Deborah A Saber
- Author Affiliations: Associate Professor (Dr Saber), School of Nursing, University of Maine, Faculty Associate (Dr Saber), Senator George J. Mitchell Center for Sustainability Solutions, University of Maine, Orono, Maine; Director for Nursing Research and Evidence-Based Practice (Dr Saber), Northern Light Eastern Maine Medical Center, Bangor, Maine; Professor Emeritus (Dr Norris), School of Nursing and Health Studies, University of Miami, Coral Gables, Florida; Assistant School Director and Senior Lecturer (Dr Reinking), Professor and C.G. Avery Chair (Dr Trompeter), Dixon School of Accounting, University of Central Florida, Orlando, Florida; and Vice President of Nursing and Patient Care Services (Ms Sanford), Northern Light Eastern Maine Medical Center, Bangor, Maine
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Wang J, Wei L, Li H, Zhang H, Gu R, Zhang Y, Li Q, Sun T, Wang Y. Effectiveness of a Game-Based Phone Application in Educating Health Care Workers on the Proper Use of Personal Protective Equipment. J Contin Educ Nurs 2022; 53:212-220. [PMID: 35510925 DOI: 10.3928/00220124-20220414-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective This study explored the feasibility and effects of a game-based phone application for training health care workers to use personal protective equipment. Method A single-blind randomized controlled trial was conducted. All participants in the experimental group (n = 123) and the control group (n = 125) received 75 minutes of training and were provided with a video and a paper copy of the procedures. Participants in the experimental group used an additional game-based phone application to simulate the procedures. Results Participants in the experimental group practiced a median of 15 times (range, 14-19 times). The learning curve indicated that they needed at least 12 repetitions to master the skill. Score improvements (Z = -2.257, p = .024) in the experimental group were significantly superior to those in the control group, as were the incidences of procedural errors of hand hygiene (χ2 = 4.085, p = .043) and protective clothing (χ2 = 5.394, p = .02). Conclusion The game-based phone application simulation guided participants to practice enough times to master the skill, enhance their skill performance, and reduce the incidence of procedural errors. [J Contin Educ Nurs. 2022;53(5):212-220.].
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Arifin MT, Bunyamin J, Bakhtiar Y, Muttaqin Z. Impact of COVID-19 to Neurosurgical Education: A Systematic Review. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Coronavirus disease (COVID-19) has disrupted many aspects of healthcare and health education including medical education. Given that neurosurgical training requires direct patient contact, the social distancing policy due to COVID has impacted global neurosurgical education.
AIM: We are conducting a systematic review to determine the impact of COVID-19 on global neurosurgical education.
METHODS: This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-analyses. The literature search was conducted on three repositories (PubMed, MedRxiv, and bioRxiv) which subsequently screened by two independent reviewers.
RESULTS: Thirteen articles were processed for the systematic review. The impact of COVID-19 has been mainly negative to academic activity due to reduced case number and physical contact hours. Residents were also deployed to provide care for COVID-19-related workload. However, several studies reported a positive impact of COVID-19 on residents’ well-being such as increased personal time. Besides current residents, prospective medical students were also affected by COVID-19.
CONCLUSION: Neurosurgical program directors should initiate the introduction of a flexible policy to accommodate case reduction to meet the board standard and guard residents’ safety and well-being are required to ensure the sustainability of high-quality neurosurgical education.
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Kravitz MB, Dadario NB, Arif A, Bellido S, Arif A, Ahmed O, Gibber M, Jafri FN. The Comparative Effectiveness of Virtual Reality Versus E-Module on the Training of Donning and Doffing Personal Protective Equipment: A Randomized, Simulation-Based Educational Study. Cureus 2022; 14:e23655. [PMID: 35510011 PMCID: PMC9060736 DOI: 10.7759/cureus.23655] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 01/16/2023] Open
Abstract
Introduction Preventing errors in donning and doffing of personal protective equipment (PPE) is critical for limiting the spread of infectious diseases. Virtual reality (VR) has demonstrated itself as an effective tool for asynchronous learning, but its use in PPE training has not been tested. The objective of this study was to compare donning and doffing performance between VR and e-module PPE training. Methods A prospective randomized open-blinded controlled trial was conducted to determine differences in donning and doffing performance after VR and e-module PPE training among medical staff and medical students at a single institution. The primary outcome was donning and doffing performance with real PPE, assessed using a 64-point checklist. The secondary outcome was participant preparedness and confidence level after training. Results Fifty-four participants were randomized, mostly consisting of medical students (n=24 {44%}) or emergency medicine and otolaryngology residents (n=19 {35%}). The VR group (n=27 {50%}) performed better than the control in the overall PPE scores but this was not statistically significant (mean {SD}, VR: 55.4 {4.4} vs e-module: 53.3 {8.1}; p = 0.40). VR participants also reported higher levels of preparedness and confidence after training. Residents as a subgroup achieved the highest increases after VR training compared to their counterparts in the control training group (mean {SD}, VR: 55.6 {4.9} vs e-module 48.4 {5.5}, p = 0.009). Conclusion In this randomized trial, VR training was found to be non-inferior to e-module for asynchronous PPE training. Our results suggest that in particular residents may benefit most from VR PPE training. Additionally, VR participants felt more confident and prepared to don and doff PPE after training compared to e-module participants. These findings are particularly relevant given the ongoing coronavirus disease 2019 (COVID-19) pandemic. Future studies need to focus on VR integration into residency curriculum and monitoring for long-term skill retention.
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Affiliation(s)
- Meryl B Kravitz
- Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Wakefield Campus, Bronx, USA
| | - Nicholas B Dadario
- Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, USA
| | - Adeel Arif
- Simulation Laboratory, White Plains Hospital, White Plains, USA
| | - Simon Bellido
- Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, USA
| | - Amber Arif
- Simulation Laboratory, White Plains Hospital, White Plains, USA
| | - Oark Ahmed
- Emergency Medicine, Montefiore Medical Center, Wakefield Campus, Bronx, USA
| | - Marc Gibber
- Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Wakefield Campus, Bronx, USA
| | - Farrukh N Jafri
- Emergency Medicine, White Plains Hospital, White Plains, USA
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22
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Impact of Infection Control Education on Gastrointestinal Endoscopy Procedural Staff. Gastroenterol Nurs 2022; 45:91-100. [PMID: 35220373 DOI: 10.1097/sga.0000000000000590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/13/2021] [Indexed: 11/26/2022] Open
Abstract
To date, minimal research has been conducted on proper use of personal protective equipment and hand hygiene within endoscopy. The American Society for Gastrointestinal Endoscopy has developed guidelines for infection control within the endoscopy suite. A practice change based upon these guidelines was implemented. Education was provided to endoscopy procedural staff within a Midwestern hospital based upon the World Health Organization 5 Moments for Hand Hygiene initiative and included personal protective equipment. Knowledge, skills, and attitudes of the participant group were compared from paired pre- to posteducation surveys pertaining to hand hygiene and personal protective equipment. Observation of personal protective equipment use and hand hygiene implementation during procedures was also documented pre- to posteducation. The project results revealed both willingness to implement proper donning and doffing of personal protective equipment and improved technique as evidenced by improved observed technique with the endoscopy suite and moderately improved hand hygiene questionnaire results. Although conducted as a quality improvement project, clinical significance was found via observation following education. These practices can aid in reduction of organism transmission from patients to staff.
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Ilgen O, Saatli B, Timur T, Kula H, Kandemir S, Kurt S, Cagliyan E. Measures against COVID-19 pandemic - a single tertiary center experience. J OBSTET GYNAECOL 2022; 42:1532-1538. [PMID: 35142254 DOI: 10.1080/01443615.2021.2021506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This paper reports the measures taken to manage the impact of the COVID-19 pandemic on O&G services in a tertiary referal centre and their outcomes. All the patients included in this study received inpatient treatment and underwent surgery between March 10 2020 and end of June 2020, including obstetric or gynaecologic cases combined. Data including age, diagnosis, operation, duration of preoperative and postoperative hospital stay, COVID-19 status were recorded. COVID-19 status of the patients was diagnosed with a nasopharyngeal swab test. Thirty-seven (20%) of 177 operations were performed because of gynaecologic reasons. The rest of them were caesarean sections (C/S). In gynaecologic cases, 22 (59%) of 37 were emergent operations, nine (24%) cases were oncologic and six (16%) cases were elective gynaecological surgeries. On the other hand, 43 (30%) of 140 patients, who underwent caesarean sections, were urgent surgeries. The rest were elective and planned caesarean sections. Only five patients (2.8%) who had undergone caesarean sections were tested positive for COVID-19. No COVID-19 transmission to staff was recorded in this period. Measures against the COVID-19 pandemic must be multidisciplinary and is crucial to prevent the spread of the disease to staff in close contact.Impact StatementWhat is already known on this subject? COVID-19 pandemic has been a crucial health problem worldwide. Healthcare workers work intensely to protect people from the pandemic. It is especially important to protect healthcare professionals and hospitalized patients from virus transmission. Therefore, utilization of personal protective equipment such as masks, gloves and goggles is obligatory, and hygiene rules such as sanitization of hands are strictly followed.What the results of this study add? This study adds the experience and success of a tertiary centre regarding the measure against COVID-19 to the literature. No viral transmission was detected to healthcare workers and other patients from COVID-19 patients. Hence, measures that mentioned in the present study should be an example to other centres for protection against pandemic.What the implications are of these findings for clinical practice and/or further research? As mentioned above, measures that are explained in the present study should be an example to other centres for protection against the pandemic. Further larger size clinical studies are needed to prove the beneficial effect of the measures that still used against pandemic.
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Affiliation(s)
- Orkun Ilgen
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Bahadır Saatli
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Tunc Timur
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Hakan Kula
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Selim Kandemir
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Sefa Kurt
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Erkan Cagliyan
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Jafri FN, Shah S, Yang CJ, Restivo A, Singh M, Yoon A, Ahmed ST. Safety Considerations for In Situ Simulation in Closed SARS-CoV-2 Units. Simul Healthc 2022; 17:49-53. [PMID: 33273425 DOI: 10.1097/sih.0000000000000542] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUMMARY STATEMENT The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic placed a tremendous strain on the healthcare system, which led to the deployment of new personnel into acute care settings, early graduation of medical students, and development of new treatment spaces. Education teams at the Montefiore Health System and New York Health and Hospitals/Jacobi Medical Center found simulation, both laboratory-based and in situ, critical to the training of medical staff and investigation of latent safety threats. Through our experience, we encountered unique infection control concerns based on in situ sessions, which prompted us to redesign our programs for the treatment of SARS-CoV-2. Using this experience, we outline our rationale for the use of in situ simulation for newly developed SARS-CoV-2 spaces along with recommendations on safety checks to consider before starting.
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Affiliation(s)
- Farrukh N Jafri
- From the Albert Einstein College of Medicine (F.N.J., C.J.Y., A.R., M.S., A.Y.), New York City; Department of Emergency Medicine(F.N.J.), White Plains Hospital, White Plains; Department of Otorhinolaryngology-Head and Neck Surgery (S.S., S.T.A.), Albert Einstein College of Medicine/Montefiore Medical Center; Department of Otorhinolaryngology-Head and Neck Surgery (C.J.Y.), Montefiore Medical Center/Children's Hospital at Montefiore, Bronx; Department of Emergency Medicine (A.R.), Montefiore Medical Center Weiler Campus; Department of Emergency Medicine (M.S.), Jacobi Medical Center; and Department of Emergency Medicine (A.Y.), Montefiore Medical Center Moses Campus, New York City, NY
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Jain S, Mohanty V, Gangil N, Arora S, Bajaj A. Awareness regarding COVID-19 preparedness among dentists: A cross-sectional survey. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2022. [DOI: 10.4103/jiaphd.jiaphd_89_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Malathy PA, Daniel SJ, Venkatesan S, Priya BY. A Clinico Epidemiological Study of Adverse Cutaneous Manifestations on Using Personal Protective Equipment Among Health Care Workers During Covid Pandemic in a Tertiary Care Centre. Indian J Dermatol 2022; 67:478. [PMID: 36578707 PMCID: PMC9792000 DOI: 10.4103/ijd.ijd_1157_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background COVID-19 (Coronavirus Disease 2019) pandemic was caused by a novel coronavirus. The frontline health care workers (HCW), wearing personal protective equipment (PPE) for a longer duration can result in a spectrum of adverse skin reactions. Recognizing occupationally induced adverse skin manifestations from PPE is necessary to avoid skin damage and risk of infections and to maintain compliance. Aim This study aimed to determine the prevalence, clinical characteristics of adverse cutaneous manifestations due to PPE, and also the contributing epidemiological factors among HCW in a tertiary care institute. Materials and Methods This cross-sectional study was conducted for a period of one month. Four hundred fifteen health care workers who used PPE continuously for >4 hours voluntarily participated in this study. By using a self-administered online questionnaire, the information and clinical photographs were collected. Results The prevalence of adverse skin manifestations was 62.1% (258). The prevalence was more common in females. Mask-related facial skin problems were most commonly reported. Of 74 participants with pre-existing acne lesions, 35 (8.4%) reported acne flare-ups after using PPE. Increased sweating (22.6%) and itching (11%) were the most commonly noted symptoms. Conclusion This study provides an insight into the prevalence of adverse skin reactions due to prolonged PPE usages, such as N95 masks and latex gloves in particular. Hence dermatological screening of HCW at regular intervals is inevitable to facilitate early management and prevent inadvertent protocol breaches. Further, it proposes the importance of raising proper safety measures to effectively reduce the COVID positivity rate among HCW by minimizing and preventing occupationally induced dermatosis.
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Affiliation(s)
- Priyavathani A. Malathy
- From the Department of Dermatology, Madras Medical College and RGGGH, Chennai, Tamil Nadu, India
| | - Samuel J. Daniel
- From the Department of Dermatology, Madras Medical College and RGGGH, Chennai, Tamil Nadu, India
| | - S Venkatesan
- From the Department of Dermatology, Madras Medical College and RGGGH, Chennai, Tamil Nadu, India
| | - B Yuva Priya
- From the Department of Dermatology, Madras Medical College and RGGGH, Chennai, Tamil Nadu, India,Address for correspondence: Dr. Yuva Priya B, Department of Dermatology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu - 600 003, India. E-mail:
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Shwe S, Sharma AA, Lee PK. Personal Protective Equipment: Attitudes and Behaviors Among Nurses at a Single University Medical Center. Cureus 2021; 13:e20265. [PMID: 35004067 PMCID: PMC8735847 DOI: 10.7759/cureus.20265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction: Healthcare workers are at an increased risk of infectious disease transmission through occupational exposure. Despite this, rates of personal protective equipment (PPE) use vary among healthcare personnel. This cross-sectional study surveyed healthcare workers at a single academic center to determine how the coronavirus disease 2019 (COVID-19) pandemic affected the perceptions and behaviors of PPE usage. Methods: An anonymous online survey through the SurveyMonkey® tool (Zendesk Inc., San Francisco, California) was sent to the University of California, Irvine, Medical Center department listserv of nurses on March 20, 2021, and was closed on June 20, 2021. Results: Of 311 respondents, 23% admitted to suffering a splash injury to the face during a procedure. When compared to one year ago prior to the COVID-19 pandemic, PPE was more important (93% vs. 80%) and more frequently used (80% vs. 54%) by respondents. The recent COVID-19 pandemic had the strongest impact on increasing respondents’ perception of the importance of PPE (44%). Conclusion: The COVID-19 pandemic positively impacted rates of PPE usage and perceptions of the importance of PPE among healthcare workers at a single academic institution. Implementing clear and effective education and training programs, ensuring adequate access to protective gear, and promoting a positive safety climate can help improve adherence to safety protocols and appropriate use of PPE.
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Chasib NH, Alshami ML, Gul SS, Abdulbaqi HR, Abdulkareem AA, Al-Khdairy SA. Dentists' Practices and Attitudes Toward Using Personal Protection Equipment and Associated Drawbacks and Cost Implications During the COVID-19 Pandemic. Front Public Health 2021; 9:770164. [PMID: 34869182 PMCID: PMC8637868 DOI: 10.3389/fpubh.2021.770164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/12/2021] [Indexed: 12/23/2022] Open
Abstract
Objectives: During the COVID-19 pandemic, dentists have had to work under stressful conditions due to the nature of their work. Personal protection equipment (PPE) has become mandatory for work in the dentistry field. This study aimed to examine dentists' practices and attitudes regarding the use of PPE and the associated drawbacks and cost implications during the pandemic. Methods: A questionnaire-based survey was used and was divided into five sections dedicated to collect demographic variables and to examine the dentists' practices, attitudes toward PPE, drawbacks, and cost of using PPE. Mann-Whitney U and Kruskal-Wallis tests were used to compare different sections of the questionnaire and linear regression was used to determine the predictors of the dentists' practices and attitudes toward PPE. Results: The mean of practices regarding use of PPE was 5.41 ± 1.71 (median 6), attitude toward using PPE scored 2.26 ± 0.90 (median 2), while the means of drawbacks and cost recorded equal scores of 5.22 ± 1.24 (median 5) and 1.68 ± 0.74 (median 2), respectively. The recently graduated dentists, those with postgraduate degrees and those working in the private sector demonstrated higher levels of practices on PPE than their counterparts. Regression analysis revealed that practices of PPE can be predicted on the basis of qualifications and work place, whereas attitude toward PPE is significantly influenced by qualification only. Conclusions: The study participants demonstrated satisfactory levels of practices and positive attitudes toward PPE. While complaints from using PPE and their cost were moderately affected.
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Affiliation(s)
| | | | - Sarhang S Gul
- College of Dentistry, University of Sulaimani, Sulaymaniyah, Iraq
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Jung J, Song KH, Jeong H, Ham SY, Kim ES, Kim HB. Are coveralls required as personal protective equipment during the management of COVID-19 patients? Antimicrob Resist Infect Control 2021; 10:164. [PMID: 34838123 PMCID: PMC8626720 DOI: 10.1186/s13756-021-01017-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/01/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Few studies have investigated the contamination of personal protective equipment (PPE) during the management of patients with severe-to-critical coronavirus disease (COVID-19). This study aimed to determine the necessity of coveralls and foot covers for body protection during the management of COVID-19 patients. METHODS PPE samples were collected from the coveralls of physicians exiting a room after the management of a patient with severe-to-critical COVID-19 within 14 days after the patient's symptom onset. The surface of coveralls was categorized into coverall-only parts (frontal surface of the head, anterior neck, dorsal surface of the foot cover, and back and hip) and gown-covered parts (the anterior side of the forearm and the abdomen). Sampling of the high-contact surfaces in the patient's environment was performed. We attempted to identify significant differences in contamination with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between the coverall-only and gown-covered parts. RESULTS A total of 105 swabs from PPEs and 28 swabs from patient rooms were collected. Of the PPE swabs, only three (2.8%) swabs from the gown-covered parts were contaminated with SARS-CoV-2. However, 23 of the 28 sites (82.1%) from patient rooms were contaminated. There was a significant difference in the contamination of PPE between the coverall-only and gown-covered parts (0.0 vs 10.0%, p = 0.022). CONCLUSIONS Coverall contamination rarely occurred while managing severe-to-critical COVID-19 patients housed in negative pressure rooms in the early stages of the illness. Long-sleeved gowns may be used in the management of COVID-19 patients.
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Affiliation(s)
- Jongtak Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
| | - Hyeonju Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.,Ansung Hospital, Gyeonggi Provincial Medical Center, Ansung, Gyeonggi-do, Republic of Korea
| | - Sin Young Ham
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.,Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
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Rony MKK, Bala SD, Rahman MM, Dola AJ, Kayesh I, Islam MT, Tama IJ, Shafi EH, Rahman S. Experiences of front-line nurses caring for patients with COVID-19 in Bangladesh: A qualitative study. BELITUNG NURSING JOURNAL 2021; 7:380-386. [PMID: 37496501 PMCID: PMC10367993 DOI: 10.33546/bnj.1680] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/12/2021] [Accepted: 09/13/2021] [Indexed: 07/28/2023] Open
Abstract
Background As the incidence of COVID-19 is increasing, the Bangladesh government has announced a countrywide shutdown instead of a lockdown. Consequently, front-line healthcare workers, particularly nurses, are confronting more challenging situations at work. Objective This study aimed to explore front-line nurses' experiences caring for patients with COVID-19 in Dhaka, Bangladesh. Methods A qualitative descriptive study was conducted among front-line nurses caring for patients with COVID-19. Twenty nurses were purposively chosen from January to March 2021 to participate in semi-structured online interviews. Interviews on audio and video were collected, analyzed, interpreted, transcribed verbatim, and verified by experts. Thematic analysis was used. Results Nine themes emerged and were grouped into negative and positive experiences. The themes of negative experiences include lack of necessary medical equipment, use of non-standard personal protective equipment, work overload, long working hours, poor working environment, and lack of quality of nursing care. The positive experiences include feeling self in a patient position, nurses' coping strategy in COVID-19 patient care, and establishing emotional control. Conclusion The study results encourage national and international health care professionals to cope with adverse working environments. Also, the findings provide nurses with techniques for dealing with any critical situation, controlling patients' emotions, and how empathy increases self-confidence and patient care. The research should also be used to enhance government policy, nursing council policy, ministry of health policy, and other healthcare agencies.
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Affiliation(s)
- Moustaq Karim Khan Rony
- College of Nursing, International University of Business Agriculture and Technology, Dhaka, Bangladesh
- Master of Public Health, Bangladesh Open University, Bangladesh
| | - Shuvashish Das Bala
- College of Nursing, International University of Business Agriculture and Technology, Dhaka, Bangladesh
| | | | | | - Ibne Kayesh
- MRM Hospital & Nursing Institute, Bancharampur, Brahmmanbaria, Bangladesh
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Anaesthetic challenges in a child with perforated appendicitis and COVID-19 Co-Infection: A case report. Ann Med Surg (Lond) 2021; 71:102931. [PMID: 34659746 PMCID: PMC8506575 DOI: 10.1016/j.amsu.2021.102931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background The deadly coronavirus disease 2019 (COVID-19) wreaked havoc globally in early 2020 and caused lives to a standstill. Healthcare workers (HCW) handling patients infected with COVID-19 wore protective equipment to defend themselves from cross infection and curbing further spread. Nevertheless, these do hamper their dexterity, especially during surgical procedures. Case presentation A child presented to our centre needing an emergency open appendicectomy during the coronavirus disease 2019 (COVID-19) pandemic in June 2021. Prior to the surgery, her initial test for COVID-19 was negative but subsequently became positive on the second test. Fortunately, all HCW during the care for the patient, donned full personal protective equipment (PPE), and avoided cross-infection. Discussion HCW handling patients with COVID-19 should wear adequate PPE to. However, these pose detrimental effects to their dexterity during routine care of such patients. Good teamwork and communication among HCW and parents are important during the safe management of a young child with COVID-19. Conclusion HCW should have low index of suspicion of COVID-19 in children with upper respiratory tract infection. Prompt and pro-active measures should be rapidly taken to prevent exposure and co-infection. Wearing multi layers of PPE do negatively affect the mood and agility of HCW handling young children with COVID-19. Thus, they should practice good team work, receive regular simulation and scenario-based training to be better prepared for pressurised situations. Challenges faced during management of a child in a resource limited nation during COVID-19 pandemic. Healthcare workers are at risks of contracting COVID-19 infections from patients. Various methods were implemented to curb the spread of COVID-19 in the operating theatre and hospital.
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Bosque D, Forbes S, Ward EN, Delaney J, Meyers GT. Reconciliation and Disposal of Oral Medication: Creating a Safe Process for Clinical Research Personnel. Clin J Oncol Nurs 2021; 25:587-590. [PMID: 34533524 DOI: 10.1188/21.cjon.587-590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Clinical research nurses and non-licensed study coordinators observed variation in procedures for reconciliation and disposal of oral investigational medications across the institution. An academic medical center implemented a quality improvement project to standardize the process of reconciliation and disposal of oral investigational medications. An interprofessional collaborative workgroup was formed, which led to multiple interventions to standardize practice, including revision of three policies and procedures, redesign of specific work areas to establish drug-counting rooms, review of personal protective equipment requirements, revision of educational training, and regular cleaning of potentially contaminated workstations.
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Wiener RC, Trickett Shockey AK, Waters C, Bhandari R. Face-touching Behavior during the COVID-19 Pandemic: Self-inoculation and transmission potentials. JOURNAL OF DENTAL HYGIENE : JDH 2021; 95:41-46. [PMID: 34654714 PMCID: PMC9989772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 01/05/2021] [Indexed: 01/12/2023]
Abstract
Purpose: Face-touching behavior has the potential for self-inoculation and transmission of the SARS-2 Coronavirus. The purpose of this study was to observe unconscious face-touching behaviors of dental hygiene and dental students in a non-clinical setting.Methods: Twenty minutes of archived proctoring videos of dental and dental hygiene students (n=87) while taking final examinations were watched for incidents of face-touching behavior. Data were analyzed for descriptive frequencies; independent sample t-tests were used to determine differences between dental and dental hygiene students and between males and females.Results: There was a significant difference in face touching behaviors between the student groups. Dental hygiene students (n=42) were observed 11.9 times (SD. 11.4) and dental students (n=45) were observed 8.9 times (SD, 7.9) touching the nose, mouth, and eyes (T-zone) (p=0.049). Differences in frequencies of touching the T-zone failed to reach significance between genders.Conclusion: Findings suggest both dental hygiene and dental students frequently touch their faces in non-clinical settings and need to be aware of this unconscious behavior. Given the significance of the COVID-19 pandemic, it is important to identify and quantify known risk factors that can be easily addressed to prevent/reduce infection transmission.
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Affiliation(s)
- R Constance Wiener
- Associate professor and interim chair, Department of Dental Practice and Rural Health, School of Dentistry;
| | | | | | - Ruchi Bhandari
- Assistant professor in the Department of Epidemiology and Biostatistics, School of Public Health; all at the Robert C Byrd Health Sciences Center North, West Virginia University, Morgantown, WV, USA
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Picard C, Edlund M, Keddie C, Asadi L, O'Dochartaigh D, Drew R, Douma MJ, O'Neil CR, Smith SW, Kanji JN. The effects of trained observers (dofficers) and audits during a facility-wide COVID-19 outbreak: A mixed-methods quality improvement analysis. Am J Infect Control 2021; 49:1136-1141. [PMID: 33774100 PMCID: PMC7992300 DOI: 10.1016/j.ajic.2021.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 01/21/2023]
Abstract
Background In response to a facility-wide COVID-19 outbreak, our tertiary acute care hospital implemented an evidence-based bundle of infection control practices including the use of audits and trained observers “dofficers” to provide real-time constructive feedback. Methods We trained furloughed staff to perform the role of dofficer. They offered support and corrective feedback on proper PPE use and completed 21-point audits during a 4-week intervention period. Audits tracked appropriate signage, placement and availability of supplies (equipment), correct PPE use, enhanced environmental cleaning, along with cohorting and social distancing rates. Audit data was used to provide weekly quality improvement reports to units. Results Nine hundred and sixty two separate audits recorded 36,948 observations, over 7,696 observer-hours. The most common errors were with environmental cleaning and PPE use; the least common were with regards to equipment availability and cohorting and social distancing. Mean error rates decreased from 9.81% to 2.88% (P < .001). The largest reduction, 22.57%, occurred in the category of PPE doffing errors. Conclusions Dofficer led audits effectively identified areas for improvement. Feedback through weekly reports and real-time correction of PPE errors by dofficers led to statistically significant improvements; however, error rates remained high. Further research is needed establish if these relationships are causal.
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Affiliation(s)
- Christopher Picard
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; Covenant Health, Edmonton, Alberta, Canada.
| | | | | | - Leyla Asadi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Domhnall O'Dochartaigh
- Alberta Health Services, Calgary, Alberta, Canada; Emergency Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | | | - Matthew J Douma
- Alberta Health Services, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Conar R O'Neil
- Covenant Health, Edmonton, Alberta, Canada; Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie W Smith
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jamil N Kanji
- Covenant Health, Edmonton, Alberta, Canada; Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Public Health Laboratory, Alberta Precision Laboratories, University of Alberta Hospital, Edmonton, Alberta, Canada
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Bouchoucha SL, Phillips NM, Lucas J, Kilpatrick M, Hutchinson A. An investigation into nursing students' application of infection prevention and control precautions. NURSE EDUCATION TODAY 2021; 104:104987. [PMID: 34098422 DOI: 10.1016/j.nedt.2021.104987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/06/2021] [Accepted: 05/20/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Undergraduate education of Health Care Workers is pivotal to ensuring that frontline clinicians have appropriate knowledge and skills in Infection Prevention and Control (IPC). OBJECTIVES The aim of this study was to describe undergraduate nursing students' self-reported compliance with Standard Precautions and to explore the psychosocial factors that influence adherence in clinical practice. DESIGN A cross-sectional survey design was used. SETTING The study was conducted in the School of Nursing and Midwifery at an Australian University. PARTICIPANTS All undergraduate nursing students were invited to participate in an online survey; 321 participated, mean age 25.7 years (SD = 8.4). The majority, 196 (61%), had no healthcare work experience, 54 (17%) were patient-care assistants, 40 (13%) enrolled nurses, and 31 (9%) were nurses registered overseas. METHODS Two validated instruments were used: the Compliance with Standard Precautions Scale (CSPS) and the Factors Influencing Adherence to Standard Precautions Scale- Student version (FIASPS-SV). Linear regression was used to measure the impact of psychosocial factors on self-reported compliance. RESULTS Overall self-reported compliance with prevention of cross-infection was 83%, use of Personal Protective Equipment (81%), correct disposal of sharps (83%) and general waste (75%), and equipment decontamination (69%). The predominant factors endorsed on the FIASPS-SV were 'Leadership' (M = 15.21 SD = 5.28) and 'Contextual cues' (M = 19.09 SD = 6.37). Multivariate linear regression demonstrated that after adjusting for age, gender and years of nursing study, the Leadership factor predicted participants' self-reported compliance on the 'prevention of cross-infection' (p < .001), 'use of PPE' (p < .001), 'waste disposal' (p = .021), and 'decontamination of equipment' (p < .001) sub-domains of the CSPS. CONCLUSIONS These findings highlight that strong clinical leadership and role modelling are essential to ensure all healthcare students prioritise rigorous adherence with infection prevention and control guidelines.
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Affiliation(s)
- Stéphane L Bouchoucha
- Deakin University Geelong, Australia, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Australia.
| | - Nicole M Phillips
- Deakin University Geelong, Australia, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Australia
| | - James Lucas
- Deakin University Geelong, Australia, School of Health and Social Development, Australia
| | - Mataya Kilpatrick
- Deakin University Geelong, Australia, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Australia
| | - Ana Hutchinson
- Deakin University Geelong, Australia, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Australia; Deakin University Geelong, Centre for Quality and Patient Safety Research, Epworth Healthcare Partnership, Australia
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Lee Y, Salahuddin M, Gibson‐Young L, Oliver GD. Assessing personal protective equipment needs for healthcare workers. Health Sci Rep 2021; 4:e370. [PMID: 34522792 PMCID: PMC8425781 DOI: 10.1002/hsr2.370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/08/2021] [Accepted: 08/08/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Personal protective equipment (PPE) is critical for healthcare workers (HCWs) since it acts as a barrier to infection transmission; however, current PPE is not ideally suited to their needs due to limitations in protection and comfort. Thus, the purpose of this study was to identify major issues of current PPE for body protection and assess its needs within health care. METHODS An online survey was conducted with a convenience sample of 200 U.S. healthcare professionals who interact with patients. The survey was designed to identify the types of PPE that HCWs currently use, assess current PPE design features for body protection, examine the effect of PPE design features for body protection, and HCWs' years of work experiences on overall PPE acceptability, and explore current PPE maintenance practices. Both quantitative and qualitative data were used for analyses. RESULTS This study showed the need for current PPE improvement in terms of fit, comfort, mobility, and donning and doffing for HCWs' safety and health. Donning and doffing plays an important role in HCWs' overall acceptance of PPE for body protection. This study revealed that most HCWs dispose of their PPE in a trashcan in a healthcare unit and non-disposed PPE is laundered at home, which may expose their family members to a health risk if a proper precaution is not followed. CONCLUSION This study provides critical insights for the needs of (a) novel PPE design research and (b) proper donning and doffing training and its strict regulatory effort to ensure HCWs' safety and health.
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Affiliation(s)
- Young‐A Lee
- Department of Consumer and Design SciencesAuburn UniversityAuburnAlabamaUSA
| | - Mir Salahuddin
- Department of Consumer and Design SciencesAuburn UniversityAuburnAlabamaUSA
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Aurilio C, Sansone P, Paladini A, Barbarisi M, Coppolino F, Pota V, Pace MC. Multidrug Resistence Prevalence in COVID Area. Life (Basel) 2021; 11:601. [PMID: 34201519 PMCID: PMC8303728 DOI: 10.3390/life11070601] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 12/30/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, is often complicated by severe acute respiratory syndrome. The new coronavirus outbreak started in China in December 2019 and rapidly spread around the world. The high diffusibility of the virus was the reason for the outbreak of the pandemic viral disease, reaching more than 100 million infected people globally by the first three months of 2021. In the various treatments used up to now, the use of antimicrobial drugs for the management, especially of bacterial co-infections, is very frequent in patients admitted to intensive care. In addition, critically ill patients with SARS-CoV-2 infection are subjected to prolonged mechanical ventilation and other therapeutic procedures often responsible for developing hospital co-infections due to multidrug-resistant bacteria. Co-infections contribute to the increase in the morbidity-mortality of viral respiratory infections. We performed this study to review the recent articles published on the antibiotic bacterial resistance and viruses to predict risk factors of coronavirus disease 2019 and to assess the multidrug resistance in patients hospitalized in the COVID-19 area.
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Affiliation(s)
- Caterina Aurilio
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy; (P.S.); (F.C.); (V.P.); (M.C.P.)
| | - Pasquale Sansone
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy; (P.S.); (F.C.); (V.P.); (M.C.P.)
| | | | - Manlio Barbarisi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Francesco Coppolino
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy; (P.S.); (F.C.); (V.P.); (M.C.P.)
| | - Vincenzo Pota
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy; (P.S.); (F.C.); (V.P.); (M.C.P.)
| | - Maria Caterina Pace
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy; (P.S.); (F.C.); (V.P.); (M.C.P.)
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COVID-19 personal protective equipment protocol compliance audit. Infect Dis Health 2021; 26:273-275. [PMID: 34226166 PMCID: PMC8216868 DOI: 10.1016/j.idh.2021.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Personal protective equipment (PPE) compliance is important to reduce the rate of transmission of virulent pathogens to health care workers. Medical officer compliance with PPE protocol for COVID-19 was audited in a regional hospital in Australia early in the pandemic response. METHODS Compliance was assessed based on the order and technique of donning and doffing PPE, with medical officers from multiple departments and levels of seniority audited. RESULTS Average compliance from all participants was 58.61% with donning and 68.84% with doffing. CONCLUSION Medical Officer compliance with PPE donning and doffing was poor and additional training was required.
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Teah KM, Tsen SSY, Fong KK, Yeap TB. Perioperative challenges in managing a morbidly obese patient with COVID-19 undergoing an elective tracheostomy. BMJ Case Rep 2021; 14:14/6/e243559. [PMID: 34103307 PMCID: PMC8189925 DOI: 10.1136/bcr-2021-243559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Tracheostomy is an aerosol-generating procedure and performing it in patients with COVID-19 requiring mechanical ventilation raises significant concerns of infection risk to healthcare workers. We herein report a case of tracheostomy in a critically ill patient with severe COVID-19 acute respiratory distress syndrome. This article depicts the use of personal protective equipment, highlighting the common challenges it presents and ways to address them.
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Affiliation(s)
- Kai Ming Teah
- Medicine Based Disciplines Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Serena Shu Ying Tsen
- Department of Cardiac Anaesthesia and Perfusion, Hospital Queen Elizabeth 2, Kota Kinabalu, Sabah, Malaysia
| | - Kean Khang Fong
- Anaesthesia and Intensive Care Unit, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia
| | - Tat Boon Yeap
- Medicine Based Disciplines Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
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Kesler RM, Mayer A, Fent KW, Chen IC, Deaton AS, Ormond RB, Smith DL, Wilkinson A, Kerber S, Horn GP. Effects of firefighting hood design, laundering and doffing on smoke protection, heat stress and wearability. ERGONOMICS 2021; 64:755-767. [PMID: 33393449 PMCID: PMC9066276 DOI: 10.1080/00140139.2020.1867241] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/15/2020] [Indexed: 06/02/2023]
Abstract
Firefighter hoods must provide protection from elevated temperatures and products of combustion (e.g. particulate) while simultaneously being wearable (comfortable and not interfering with firefighting activities). The purpose of this study was to quantify the impact of (1) hood design (traditional knit hood vs particulate-blocking hood), (2) repeated laundering, and (3) hood removal method (traditional vs overhead doffing) on (a) protection from soot contamination on the neck, (b) heat stress and (c) wearability measures. Using a fireground exposure simulator, 24 firefighters performed firefighting activities in realistic smoke and heat conditions using a new knit hood, new particulate-blocking hood and laundered particulate-blocking hood. Overall, soot contamination levels measured from neck skin were lower when wearing the laundered particulate-blocking hoods compared to new knit hoods, and when using the overhead hood removal process. No significant differences in skin temperature, core temperature, heart rate or wearability measures were found between the hood conditions. Practitioner Summary: The addition of a particulate-blocking layer to firefighters' traditional two-ply hood was found to reduce the PAH contamination reaching the neck but did not affect heat stress measurements or thermal perceptions. Modifying the process for hood removal resulted in a larger reduction in neck skin contamination than design modification. Abbreviations: ANOVA: analysis of variance; B: new particulate-blocking hood and PPE (PPE configuration); FES: fireground exposure simulator; GI: gastrointestinal; K: new knit hood and PPE (PPE configuration); L: laundered particulate-blocking hood and PPE (PPE configuration); LOD: limit of detection; MLE: maximum likelihood estimation; NFPA: National fire protection association; PAH: polycyclic aromatic hydrocarbon; PPE: personal protective equipment; SCBA: self-contained breathing apparatus; THL: total heat loss; TPP: thermal protective performance.
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Affiliation(s)
- Richard M. Kesler
- University of Illinois, Fire Service Institute; Urbana-Champaign, IL, USA
| | - Alex Mayer
- National Institute for Occupational Safety & Health; Cincinnati, OH, USA
| | - Kenneth W. Fent
- National Institute for Occupational Safety & Health; Cincinnati, OH, USA
| | - I-Chen Chen
- National Institute for Occupational Safety & Health; Cincinnati, OH, USA
| | | | | | - Denise L. Smith
- University of Illinois, Fire Service Institute; Urbana-Champaign, IL, USA
- Skidmore College; Saratoga Springs, NY, USA
| | - Andrea Wilkinson
- National Institute for Occupational Safety & Health; Cincinnati, OH, USA
- Skidmore College; Saratoga Springs, NY, USA
| | - Steve Kerber
- Underwriters Laboratories Firefighter Safety Research Institute; Columbia, MD, USA
| | - Gavin P. Horn
- University of Illinois, Fire Service Institute; Urbana-Champaign, IL, USA
- Underwriters Laboratories Firefighter Safety Research Institute; Columbia, MD, USA
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Abstract
OBJECTIVE To characterize the presence and magnitude of viruses in the air and on surfaces in the rooms of hospitalized patients with respiratory viral infections, and to explore the association between care activities and viral contamination. DESIGN Prospective observational study. SETTING Acute-care academic hospital. PARTICIPANTS In total, 52 adult patients with a positive respiratory viral infection test within 3 days of observation participated. Healthcare workers (HCWs) were recruited in staff meetings and at the time of patient care, and 23 wore personal air-sampling devices. METHODS Viruses were measured in the air at a fixed location and in the personal breathing zone of HCWs. Predetermined environmental surfaces were sampled using premoistened Copan swabs at the beginning and at the end of the 3-hour observation period. Preamplification and quantitative real-time PCR methods were used to quantify viral pathogens. RESULTS Overall, 43% of stationary and 22% of personal air samples were positive for virus. Positive stationary air samples were associated with ≥5 HCW encounters during the observation period (odds ratio [OR], 5.3; 95% confidence interval [CI], 1.2-37.8). Viruses were frequently detected on all of the surfaces sampled. Virus concentrations on the IV pole hanger and telephone were positively correlated with the number of contacts made by HCWs on those surfaces. The distributions of influenza, rhinoviruses, and other viruses in the environment were similar. CONCLUSIONS Healthcare workers are at risk of contracting respiratory virus infections when delivering routine care for patients infected with the viruses, and they are at risk of disseminating virus because they touch virus-contaminated fomites.
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Stuby L, Currat L, Gartner B, Mayoraz M, Harbarth S, Suppan L, Suppan M. Impact of Face-to-Face Teaching in Addition to Electronic Learning on Personal Protective Equipment Doffing Proficiency in Student Paramedics: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e26927. [PMID: 33929334 PMCID: PMC8122292 DOI: 10.2196/26927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/01/2021] [Accepted: 04/08/2021] [Indexed: 02/06/2023] Open
Abstract
Background The COVID-19 pandemic has brought attention to the importance of correctly using personal protective equipment (PPE). Doffing is a critical phase that increases the risk of contamination of health care workers. Although a gamified electronic learning (e-learning) module has been shown to increase the adequate choice of PPE among prehospital personnel, it failed to enhance knowledge regarding donning and doffing sequences. Adding other training modalities such as face-to-face training to these e-learning tools is therefore necessary to increase prehospital staff proficiency and thus help reduce the risk of contamination. Objective The aim of this study is to assess the impact of the Peyton 4-step approach in addition to a gamified e-learning module for teaching the PPE doffing sequence to first-year paramedic students. Methods Participants will first follow a gamified e-learning module before being randomized into one of two groups. In the control group, participants will be asked to perform a PPE doffing sequence, which will be video-recorded to allow for subsequent assessment. In the experimental group, participants will first undergo face-to-face training performed by third-year students using the Peyton 4-step approach before performing the doffing sequence themselves, which will also be video-recorded. All participants will then be asked to reconstruct the doffing sequence on an online platform. The recorded sequences will be assessed independently by two investigators: a prehospital emergency medicine expert and an infection prevention and control specialist. The assessors will be blinded to group allocation. Four to eight weeks after this first intervention, all participants will be asked to record the doffing sequence once again for a subsequent skill retention assessment and to reconstruct the sequence on the same online platform to assess knowledge retention. Finally, participants belonging to the control group will follow face-to-face training. Results The study protocol has been presented to the regional ethics committee (Req-2020-01340), which issued a declaration of no objection as such projects do not fall within the scope of the Swiss federal law on human research. Study sessions were performed in January and February 2021 in Geneva, and will be performed in April and June 2021 in Bern. Conclusions This study should help to determine whether face-to-face training using the Peyton 4-step approach improves the application and knowledge retention of a complex procedure when combined with an e-learning module. International Registered Report Identifier (IRRID) PRR1-10.2196/26927
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Affiliation(s)
- Loric Stuby
- Emergency Medical Services, Genève TEAM Ambulances, Geneva, Switzerland
| | - Ludivine Currat
- ESAMB - École Supérieure de Soins Ambulanciers, College of Higher Education in Ambulance Care, Geneva, Switzerland
| | - Birgit Gartner
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Mathieu Mayoraz
- Emergency Medical Services, Genève TEAM Ambulances, Geneva, Switzerland.,MEDI - Center for Medical Education, College of Higher Education in Ambulance Care, Bern, Switzerland
| | - Stephan Harbarth
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Mélanie Suppan
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Bumpstead S, Lim ZJ, Kuhn L, Flynn D, Bakos CL, Potter E, Egerton-Warburton D. The sourcing and use of high physical resemblance personal protective equipment to train healthcare workers, improve confidence and conserve medical-grade equipment. J Hosp Infect 2021; 112:104-107. [PMID: 33864893 DOI: 10.1016/j.jhin.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
Personal protective equipment (PPE) is essential for healthcare worker (HCW) safety. Conservation of PPE for clinical use during the COVID-19 pandemic reduced its availability for training, necessitating an innovative approach to sourcing high physical resemblance PPE (HPR-PPE). We present a case study of crowd-sourcing of HPR-PPE to train HCWs. Survey results indicated that HPR-PPE enabled high-fidelity practise of PPE application and removal, aided procedure recall, improved user confidence and was sufficiently similar to medical-grade PPE. HPR-PPE provided a novel and cost-effective alternative. We also demonstrated that medical-grade PPE can be sourced from non-medical institutions and businesses during a pandemic.
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Affiliation(s)
- S Bumpstead
- Monash Medical Centre Clayton, Monash Health, Clayton, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Monash Emergency Research Collaborative, Monash Health, Clayton, Victoria, Australia.
| | - Z J Lim
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
| | - L Kuhn
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Monash Emergency Research Collaborative, Monash Health, Clayton, Victoria, Australia
| | - D Flynn
- Faculty of Art, Design and Architecture, Monash University, Caulfield, Victoria, Australia
| | - C-L Bakos
- MCI Australia Ltd, Melbourne, Victoria, Australia
| | - E Potter
- Faculty of Art, Design and Architecture, Monash University, Caulfield, Victoria, Australia
| | - D Egerton-Warburton
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Emergency Medicine Research, Monash Medical Centre, Clayton, Victoria, Australia; Design Health Collab, Faculty of Art, Design and Architecture, Monash University, Caulfield, Victoria, Australia; Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University and Monash Health, Melbourne, Victoria, Australia
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Chen F, Zang Y, Liu Y, Wang X, Lin X. Dispatched nurses' experience of wearing full gear personal protective equipment to care for COVID-19 patients in China-A descriptive qualitative study. J Clin Nurs 2021; 30:2001-2014. [PMID: 33761152 PMCID: PMC8251170 DOI: 10.1111/jocn.15753] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 12/19/2022]
Abstract
Aims and objectives We explored dispatched nurses’ experiences of wearing full gear personal protective equipment to care for patients with coronavirus disease‐2019 (COVID‐19) in Wuhan, China. Background Full gear personal protective equipment is the primary and foremost measure to prevent the contact and transmission of severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV2); however, working in full gear personal protective equipment may hinder nursing care activities and thus negatively affect patients’ and nurses’ health. Design This descriptive qualitative inquiry followed the COREQ guidelines. Methods Individual semi‐structured telephone interviews were conducted in a purposive sample of 15 frontline nurses who were dispatched to the outbreak epicentre from March to April 2020. Verbatim transcripts were content analysed. Results Four themes emerged from the data: inadequate preparedness for working with full gear personal protective equipment, full gear personal protective equipment stimulated stress responses, coping strategies and professional growth. Participants learned a great deal from problem‐focussed and emotion‐focussed strategies to tackle challenges related to the prolonged wearing of full gear personal protective equipment for quality nursing care and reduced risk of exposure. They became more vigilant to the adherence to evolving protocols and appropriate training concerning full gear personal protective equipment use. Conclusions Frontline nurses confronted various but diminishing challenges related to the use of full gear personal protective equipment when caring for patients with COVID‐19 across the approximate 40‐day period. Consistent use of coverall personal protective equipment to protect from SARS‐CoV‐2 in high exposure settings would be feasible if nurses were better prepared; therefore, scenario‐based skill training concerning the prolonged use of full gear personal protective equipment should be offered regularly and intensively. Relevance to clinical practice This study informs future decisions concerning improved full gear personal protective equipment‐related psychomotor training and promoting ways for nurses to cope with the stress that comes from working in highly contiguous environments.
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Affiliation(s)
- Feifei Chen
- Nursing Department, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, China
| | - Yuli Zang
- The Nether School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuan Liu
- Nursing Department, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, China.,Department of Geriatrics, Nursing Department, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, China
| | - Xiaomin Wang
- Department of Gastrointestinal Surgery, Nursing Department, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, China
| | - Xingfeng Lin
- Nursing Department, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, China
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Moseley TW, Conners AL, He H, Barth JE, Lightfoote JB, Parikh JR, Whitman GJ. Mitigating the Transmission of COVID-19 with the Appropriate Usage of Personal Protective Protocols and Equipment in Breast Imaging and Intervention. JOURNAL OF BREAST IMAGING 2021; 3:215-220. [PMID: 33778489 PMCID: PMC7928886 DOI: 10.1093/jbi/wbab007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Indexed: 01/13/2023]
Abstract
The integration of personal protective equipment (PPE) and procedures into breast imaging and intervention practices will mitigate the risk of transmission of COVID-19 during the pandemic. Although supply chain shortages have improved, understanding the proper use of PPE and protocols to mitigate overconsumption are important to ensure efficacious utilization of PPE. Protocols and best practices are reviewed, and guidelines and resource materials are referenced in order to support breast imaging healthcare professionals.
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Affiliation(s)
- Tanya W Moseley
- The University of Texas MD Anderson Cancer Center, Department of Breast Imaging, Houston, TX, USA
| | - Amy L Conners
- Mayo Clinic, Department of Radiology, Rochester, MN, USA
| | - Hongying He
- The University of Texas Health Science Center at Houston, Department of Diagnostic and Interventional Imaging, Houston, TX, USA
| | - Jean E Barth
- Mayo Clinic, Department of Infection Prevention and Control, Rochester, MN, USA
| | | | - Jay R Parikh
- The University of Texas MD Anderson Cancer Center, Department of Breast Imaging, Houston, TX, USA
| | - Gary J Whitman
- The University of Texas MD Anderson Cancer Center, Department of Breast Imaging, Houston, TX, USA
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Nathwani S, Rahman N. The 3 P's model enhancing patient safety during the COVID-19 pandemic. ACTA ACUST UNITED AC 2021; 14:246-254. [PMID: 33821170 PMCID: PMC8013890 DOI: 10.1111/ors.12607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 12/02/2022]
Abstract
Aim The Local Safety Standards for Invasive Procedures must now consider additional features to address patient and staff safety in light of COVID19. Material and Methods The 3 P’s model encompasses an evidence‐based approach to preparation, protection and prevention, for safety of patients and healthcare staff. A literature review was performed (keywords ‘dental’ or ‘dentistry’ and ‘COVID19’ or ‘Coronavirus’ and ‘LocSSIPs’ or ‘Local Safety Standards for Invasive Procedures’). Guidance, institutional publications and original research were considered. Limits were applied (2015 onward, English only). Conclusion The model ensures a systematic framework to aid communication among colleagues, provide and support the opportunity for learning, implement best practice guidance, monitor effectiveness of protocols and above all reduce the risk of viral transmission.
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Affiliation(s)
- Shrina Nathwani
- Dental and Maxillofacial Department East Surrey Hospital Redhill UK
| | - Naomi Rahman
- Dental and Maxillofacial Department East Surrey Hospital Redhill UK
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Noor Azhar M, Bustam A, Poh K, Ahmad Zahedi AZ, Mohd Nazri MZA, Azizah Ariffin MA, Md Yusuf MH, Zambri A, Chong JYO, Kamarudin A, Ang BT, Iskandar A, Chew KS. COVID-19 aerosol box as protection from droplet and aerosol contaminations in healthcare workers performing airway intubation: a randomised cross-over simulation study. Emerg Med J 2021; 38:111-117. [PMID: 33219133 PMCID: PMC7681799 DOI: 10.1136/emermed-2020-210514] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Concerns over high transmission risk of SARS-CoV-2 have led to innovation and usage of an aerosol box to protect healthcare workers during airway intubation in patients with COVID-19. Its efficacy as a barrier protection in addition to the use of a standard personal protective equipment (PPE) is not fully known. We performed a simulated study to investigate the relationship between aerosol box usage during intubation and contaminations on healthcare workers pre-doffing and post-doffing of PPE. METHODS This was a randomised cross-over study conducted between 9 April to 5 May 2020 in the ED of University Malaya Medical Centre. Postgraduate Emergency Medicine trainees performed video laryngoscope-assisted intubation on an airway manikin with and without an aerosol box in a random order. Contamination was simulated by nebulised Glo Germ. Primary outcome was number of contaminated front and back body regions pre-doffing and post-doffing of PPE of the intubator and assistant. Secondary outcomes were intubation time, Cormack-Lehane score, number of intubation attempts and participants' feedback. RESULTS Thirty-six trainees completed the study interventions. The number of contaminated front and back body regions pre-doffing of PPE was significantly higher without the aerosol box (all p values<0.001). However, there was no significant difference in the number of contaminations post-doffing of PPE between using and not using the aerosol box, with a median contamination of zero. Intubation time was longer with the aerosol box (42.5 s vs 35.5 s, p<0.001). Cormack-Lehane scores were similar with and without the aerosol box. First-pass intubation success rate was 94.4% and 100% with and without the aerosol box, respectively. More participants reported reduced mobility and visibility when intubating with the aerosol box. CONCLUSIONS An aerosol box may significantly reduce exposure to contaminations but with increased intubation time and reduced operator's mobility and visibility. Furthermore, the difference in degree of contamination between using and not using an aerosol box could be offset by proper doffing of PPE.
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Affiliation(s)
- Muhaimin Noor Azhar
- Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Aida Bustam
- Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khadijah Poh
- Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Mohd Hafyzuddin Md Yusuf
- Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Aliyah Zambri
- Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Johnathan Y O Chong
- Department of Emergency Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Anhar Kamarudin
- Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Bin Ting Ang
- Department of Emergency Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Affan Iskandar
- Department of Emergency Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Keng Sheng Chew
- Faculty of Medicine and Health Sciences, University of Malaysia Sarawak, Kota Samarahan, Malaysia
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Risk factors and protective measures for healthcare worker infection during highly infectious viral respiratory epidemics: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2021; 43:639-650. [PMID: 33487203 PMCID: PMC8564050 DOI: 10.1017/ice.2021.18] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate risk factors for HCW infection in viral respiratory pandemics (SARS-CoV-2, MERS, SARS CoV-1, influenza A H1N1, influenza H5N1) and improve understanding of HCW risk management amidst the COVID-19 pandemic. DESIGN Systematic review and meta-analysis. METHODS MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL databases were searched from conception until July 2020 for studies comparing infected HCWs (cases) and non-infected HCWs (controls) and risk factors for infection. Outcomes included HCW types, infection prevention practices, and medical procedures. Pooled effect estimates with pathogen-specific stratified meta-analysis and inverse variance meta-regression analysis were completed. GRADE framework was used to rate certainty of evidence. PROSPERO (CRD42020176232) 6 April 2020. RESULTS Fifty-four comparative studies were included (n=191,004 HCWs). Compared to non-frontline HCWs, frontline HCWs were at increased infection risk (OR 1.66 95%CI 1.24 to 2.22) and greater for HCWs involved in endotracheal intubations (risk difference [95%CI]: 35.2% [21.4 to 47.9]). Use of gloves, gown, surgical mask, N95 respirator, face protection, and infection training were each strongly protective against infection. Meta-regression showed reduced infection risk in frontline HCWs working in facilities with infection designated wards (OR -1.04, 95%CI -1.53 to -0.33, p=0.004) and performing aerosol-generating medical procedures in designated centres (OR -1.30 95%CI -2.52 to -0.08; p=0.037). CONCLUSIONS During highly infectious respiratory pandemics, widely available protective measures such as use of gloves, gowns, and face masks are strongly protective against infection and should be instituted, preferably in dedicated settings, to protect frontline HCW during waves of respiratory virus pandemics.
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Petrosino F, Mukherjee D, Coppola G, Gaudio MT, Curcio S, Calabro V, Marra F, Bhattacharya P, Pal U, Khélifi N, Chakraborty S. Transmission of SARS-Cov-2 and other enveloped viruses to the environment through protective gear: a brief review. EURO-MEDITERRANEAN JOURNAL FOR ENVIRONMENTAL INTEGRATION 2021; 6:48. [PMID: 33842691 PMCID: PMC8024444 DOI: 10.1007/s41207-021-00251-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/22/2021] [Indexed: 05/17/2023]
Abstract
Over the past two decades, several deadly viral epidemics have emerged, which have placed humanity in danger. Previous investigations have suggested that viral diseases can spread through contaminants or contaminated surfaces. The transmission of viruses via polluted surfaces relies upon their capacity to maintain their infectivity while they are in the environment. Here, a range of materials that are widely used to manufacture personal protective equipment (PPE) are summarized, as these offer effective disinfection solutions and are the environmental variables that influence virus survival. Infection modes and prevention as well as disinfection and PPE disposal strategies are discussed. A coronavirus-like enveloped virus can live in the environment after being discharged from a host organism until it infects another healthy individual. Transmission of enveloped viruses such as SARS-CoV-2 can occur even without direct contact, although detailed knowledge of airborne routes and other indirect transmission paths is still lacking. Ground transmission of viruses is also possible via wastewater discharges. While enveloped viruses can contaminate potable water and wastewater through human excretions such as feces and droplets, careless PPE disposal can also lead to their transmission into our environment. This paper also highlights the possibility that viruses can be transmitted into the environment from PPE kits used by healthcare and emergency service personnel. A simulation-based approach was developed to understand the transport mechanism for coronavirus and similar enveloped viruses in the environment through porous media, and preliminary results from this model are presented here. Those results indicate that viruses can move through porous soil and eventually contaminate groundwater. This paper therefore underlines the importance of proper PPE disposal by healthcare workers in the Mediterranean region and around the world.
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Affiliation(s)
- Francesco Petrosino
- Laboratory of Transport Phenomena and Biotechnology, Department of D.I.M.E.S, University of Calabria, Via- P. Bucci, Cubo-42a, 87036 Rende, CS Italy
- Department of Industrial Engineering, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, SA Italy
| | - Debolina Mukherjee
- Laboratory of Transport Phenomena and Biotechnology, Department of D.I.M.E.S, University of Calabria, Via- P. Bucci, Cubo-42a, 87036 Rende, CS Italy
| | - Gerardo Coppola
- Laboratory of Transport Phenomena and Biotechnology, Department of D.I.M.E.S, University of Calabria, Via- P. Bucci, Cubo-42a, 87036 Rende, CS Italy
| | - Maria Teresa Gaudio
- Laboratory of Transport Phenomena and Biotechnology, Department of D.I.M.E.S, University of Calabria, Via- P. Bucci, Cubo-42a, 87036 Rende, CS Italy
| | - Stefano Curcio
- Laboratory of Transport Phenomena and Biotechnology, Department of D.I.M.E.S, University of Calabria, Via- P. Bucci, Cubo-42a, 87036 Rende, CS Italy
| | - Vincenza Calabro
- Laboratory of Transport Phenomena and Biotechnology, Department of D.I.M.E.S, University of Calabria, Via- P. Bucci, Cubo-42a, 87036 Rende, CS Italy
| | - Francesco Marra
- Department of Industrial Engineering, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, SA Italy
| | - Prosun Bhattacharya
- Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology, Teknikringen 10B, 10044 Stockholm, Sweden
| | - Umapada Pal
- Instituto de Física, Benemérita Universidad Autónoma de Puebla, Apdo. Postal J-48, 72570 Puebla, Mexico
| | - Nabil Khélifi
- Springer, a Part of Springer Nature, Tiergartenstrasse 17, 69121 Heidelberg, Germany
| | - Sudip Chakraborty
- Laboratory of Transport Phenomena and Biotechnology, Department of D.I.M.E.S, University of Calabria, Via- P. Bucci, Cubo-42a, 87036 Rende, CS Italy
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Sharma S, Mohindra R, Rana K, Suri V, Bhalla A, Biswal M, Singh MP, Goyal K, Lakshmi PVM. Assessment of Potential Risk Factors for 2019-Novel Coronavirus (2019-nCov) Infection among Health Care Workers in a Tertiary Care Hospital, North India. J Prim Care Community Health 2021; 12:21501327211002099. [PMID: 33719717 PMCID: PMC7968012 DOI: 10.1177/21501327211002099] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Health care workers (HCWs) are at the forefront to fight against COVID-19 pandemic. They are at more risk of contracting the infection. This study was planned to assess potential risk factors of 2019-novel coronavirus infection among HCWs working in a health facility and to evaluate the effectiveness of infection prevention and control measures among them. METHODS A study was conducted in a tertiary care hospital among HCWs who were directly or indirectly involved in the management of a confirmed or suspected case of COVID-19. The socio-demographic characteristics, history of exposure, IPC measures followed and clinical symptoms were compared between health care workers in COVID and non-COVID areas. RESULTS Majority (45%) of HCWs were nurses, followed by hospital/sanitary/technical attendants (30%) and doctors (24%). Out of a total of 256 HCWs, 2% tested positive. Around 80% of HCWs had ever attended any IPC training. A statistically significant association was found between posting area of HCWs and their exposure to COVID patients (duration of exposure, PPE has worn by HCWs, direct contact of HCWs with the patient's material) and COVID positivity (P value <.001). CONCLUSION If health care workers were trained and take adequate precautions then the risk of getting an infection is minimized.
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