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Sansone V, Miraglia del Giudice G, Della Polla G, Angelillo IF. Impact of the COVID-19 pandemic on behavioral changes in healthcare workers in Italy. Front Public Health 2024; 12:1335953. [PMID: 38384871 PMCID: PMC10879601 DOI: 10.3389/fpubh.2024.1335953] [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: 11/09/2023] [Accepted: 01/09/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction During the COVID-19 pandemic, adherence to wearing face mask and washing hands procedures and achieving high COVID-19 vaccine coverage among healthcare workers (HCWs) were essential to minimize morbidity and possible death and limit the transmission of the virus. The objectives of the cross-sectional survey were to explore the influence of COVID-19 on the use of preventive measures and vaccination willingness among HCWs in the southern part of Italy and the associated factors. Methods The survey was carried out from 15 June 2023 to 15 July 2023 among 521 HCWs who worked in three randomly selected public hospitals. All data were collected through a self-administered questionnaire. Results HCWs had a positive change in the use of preventive measures if they did not often/always use them before the pandemic, but they are using in the current epidemiologic context and they were willing to use in a future epidemic situation. A positive change in the adherence to face mask-wearing (24.6%) was more likely among those with at least 5 years of university degree, nurses/midwives, and who had worked in COVID-19 wards. A positive change in alcohol-based hand rubbing (3.1%) was more likely in HCWs in Emergency/Critical/Infectious Diseases wards compared with medical wards. HCWs who were more likely to believe that the COVID-19 vaccine should be mandatory for them (58.1%) had at least 5 years of university degree, in Emergency/Critical/Infectious Diseases wards compared with surgical and medical wards, had received more than three doses of this vaccine, were more concerned to get infected during their activity, and had received information from scientific journals. HCWs more willing to receive the COVID-19 vaccine every year (39.8%) were males, physicians, those in Emergency/Critical/Infectious Diseases wards compared with medical wards, who had received more than three doses of this vaccine, who believed that this vaccine should be mandatory for HCWs, and who needed additional information. Discussion The survey showed that the COVID-19 pandemic had an impact on the use of preventive measures among HCWs, not necessarily for the improvement or increase. Educational messages on the importance of these measures regarding the promotion and recommendation of the vaccine need to be investigated and applied among HCWs in order to reduce vaccination gaps and the spread of the infection.
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Hines SE, Thurman P, Zhuang E, Chen H, McDiarmid M, Chalikonda S, Angelilli S, Waltenbaugh H, Napoli M, Haas E, McClain C, Sietsema M, Fernando R. Elastomeric half-mask respirator disinfection practices among healthcare personnel. Am J Ind Med 2023; 66:1056-1068. [PMID: 37755824 DOI: 10.1002/ajim.23538] [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: 06/12/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Disposable N95 respirator shortages during the COVID-19 and 2009 H1N1 influenza pandemics highlighted the need for reusable alternatives, such as elastomeric half-mask respirators (EHMRs). Two US medical organizations deployed reusable EHMRs during the COVID-19 response. In addition to wipe-based disinfection following patient care episodes expected per local policies at both organizations, postshift centralized cleaning and disinfection (C&D) was expected at one site (A), permitting shared-pool EHMR use, and optional at the other (Site B), where EHMRs were issued to individuals. Using a survey, we evaluated disinfection practices reported by EHMR users and predictors of disinfection behaviors and perceptions. METHODS Surveys assessed EHMR disinfection practices, occupational characteristics, EHMR use frequency, training, and individual-issue versus shared-pool EHMR use. RESULTS Of 1080 EHMR users completing the survey, 76% reported that they disinfect the EHMR after each patient encounter, which was the expected practice at both sites. Increasing EHMR use, recall of disinfection training, and work in intensive care or emergency settings significantly influenced higher reporting of this practice. 36% of respondents reported using centralized C&D, although reporting was higher at the site (A) where this was expected (53%). Confidence in cleanliness of the EHMR following centralized C&D was not influenced by individual versus shared-pool EHMR issue. CONCLUSIONS Most EHMR users reported adherence with expected post-care individual-based disinfection of EHMRs but did not necessarily use standardized, centralized C&D. Future efforts to limit reliance on behavior related to respirator disinfection may improve EHMR implementation in healthcare to avert dependence on single-use, disposable N95 respirators.
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Affiliation(s)
- Stella E Hines
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Paul Thurman
- University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Eileen Zhuang
- University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Hegang Chen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Melissa McDiarmid
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | | | - Meghan Napoli
- Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Emily Haas
- National Personal Protective Technology Laboratory, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, USA
| | - Caitlin McClain
- National Personal Protective Technology Laboratory, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, USA
| | - Margaret Sietsema
- National Personal Protective Technology Laboratory, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, USA
| | - Rohan Fernando
- National Personal Protective Technology Laboratory, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, USA
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Straub J, Franz A, Holzhausen Y, Schumann M, Peters H. Personal protective equipment and medical students in times of COVID-19: experiences and perspectives from the final clerkship year. BMC MEDICAL EDUCATION 2023; 23:806. [PMID: 37884895 PMCID: PMC10605960 DOI: 10.1186/s12909-023-04784-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The availability and correct use of personal protective equipment (PPE) to prevent and control infections plays a critical role in the safety of medical students in clinical placements. This study explored their experiences and perspectives in their final clerkship year with PPE during the COVID-19 pandemic. METHODS This qualitative study was based on social constructivism and was conducted in 2021 at the Charité - Universitätsmedizin Berlin. In three online focus group discussions, 15 medical students in their final clerkship year reported their experiences with PPE training and use during the COVID-19 pandemic. Data were recorded, transcribed and analysed based on Kuckartz's approach to content analysis. We drew upon the a priori dimensions of the capability, opportunity, motivation - behaviour (COM-B) model as main categories as well as emergent issues raised by the study participants (subcategories). RESULTS In addition to the three main categories of the COM-B model, eleven subcategories were identified through inductive analysis. The study participants reported several factors that hindered the correct use of PPE. In the area of capabilities, these factors were related to learning experience with PPE in terms of both theoretical and practical learning together with later supervision in practice. In the area of opportunities, these factors included the limited availability of some PPE components, a lack of time for PPE instruction and supervision and inappropriate role modelling due to the inconsistent use of PPE by physicians and nursing staff. The area of motivation to use PPE was characterized by an ambivalent fear of infection by the SARS-CoV-2 virus and the prioritization of patient safety, i.e., the need to prevent the transmission of the virus to patients. CONCLUSIONS Our study revealed several limitations pertaining to the enabling factors associated with the trainable behaviour "correct use of PPE". The concept of shared responsibility for student safety was used to derive recommendations for future improvement specifically for the medical school as an organization, the teachers and supervisors, and students themselves. This study may guide and stimulate other medical schools and faculties to explore and analyse components of student safety in clinical settings in times of infectious pandemics.
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Affiliation(s)
- Janina Straub
- Dieter Scheffner Center for Medical Education und Educational Research, Dean´s Office for Study Affairs, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Anne Franz
- Dieter Scheffner Center for Medical Education und Educational Research, Dean´s Office for Study Affairs, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ylva Holzhausen
- Dieter Scheffner Center for Medical Education und Educational Research, Dean´s Office for Study Affairs, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Marwa Schumann
- Dieter Scheffner Center for Medical Education und Educational Research, Dean´s Office for Study Affairs, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Harm Peters
- Dieter Scheffner Center for Medical Education und Educational Research, Dean´s Office for Study Affairs, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Brisbine BR, Radcliffe CR, Jones MLH, Stirling L, Coltman CE. Does the fit of personal protective equipment affect functional performance? A systematic review across occupational domains. PLoS One 2022; 17:e0278174. [PMID: 36449531 PMCID: PMC9710848 DOI: 10.1371/journal.pone.0278174] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/11/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To explore the effect of personal protective equipment (PPE) fit on functional performance across a range of occupational domains. BACKGROUND PPE introduces an ergonomic, human systems integration, and mass burden to the wearer, and these factors are thought to be amplified if PPE is ill-fitting. However, few studies have considered the role of fit (static, dynamic, and cognitive) when evaluating PPE-related performance detriments in occupational settings. METHOD A systematic literature review was conducted to identify relevant studies, which were then critically appraised based on methodological quality and collated to compare key findings and present evidence-based recommendations for future research directions across a range of occupational domains. RESULTS 16 published studies met the inclusion criteria, 88% of which found that the fit of PPE had a statistically significant effect on occupational performance. Poorly sized PPE resulted in slower or increased reaction time; decreased range of motion or mobility; decreased endurance or tolerance; decreased pulmonary function; and altered muscle activation. Limited research met the inclusion criteria and those that did had risks of bias in methodology quality. CONCLUSION Future research evaluating the effect of PPE on performance in occupational settings should aim to recruit a more representative population; consider sex as a covariate; quantify and evaluate PPE fit and performance when integrated with all relevant equipment items; include outcome measures related to all three categories of fit (static, dynamic, cognitive); and assess performance of operationally relevant tasks.
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Affiliation(s)
- Brooke R. Brisbine
- University of Canberra Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Ceridwen R. Radcliffe
- University of Canberra Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Monica L. H. Jones
- University of Michigan Transportation Research Institute, University of Michigan, Ann Arbor, MI, United States of America
| | - Leia Stirling
- Industrial and Operations Engineering Department, Robotics Institute, University of Michigan, Ann Arbor, MI, United States of America
| | - Celeste E. Coltman
- University of Canberra Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Canberra, ACT, Australia
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Weston LE, Krein S, Harrod M. Using observation to better understand the healthcare context. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2022. [DOI: 10.4081/qrmh.2021.9821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Despite potential to capture rich contextual information, observation remains an underutilized data collection method. This paper provides a practical guide for using observation to understand complex issues in healthcare settings. Observation is a qualitative data collection method comprised of viewing and documenting phenomena in the usual environment. Drawing on our recent work using observation to better understand personal protective equipment use among healthcare personnel, we describe when to consider collecting data via observation, how to prepare and perform observation, and how to analyze resulting data. Observation data are documented in field notes that contain detailed information about setting, participants, and activity associated with the topic of interest. Field notes can be analyzed alone or triangulated with other types of data using theoretical or conceptual frameworks or by identifying themes. Observation is a valuable data collection method for health services researchers to identify key components involved in a topic of interest, a vital step in forming relevant questions, measuring appropriate variables, and designing effective interventions. Used with other methods or alone, observation yields the detailed data needed to address context-specific factors across a wide range of healthcare research topics and settings.
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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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7
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Engberg M, Bonde J, Sigurdsson ST, Møller K, Nayahangan LJ, Berntsen M, Eschen CT, Haase N, Bache S, Konge L, Russell L. Training non-intensivist doctors to work with COVID-19 patients in intensive care units. Acta Anaesthesiol Scand 2021; 65:664-673. [PMID: 33529356 PMCID: PMC8013477 DOI: 10.1111/aas.13789] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/22/2022]
Abstract
Background Due to an expected surge of COVID‐19 patients in need of mechanical ventilation, the intensive care capacity was doubled at Rigshospitalet, Copenhagen, in March 2020. This resulted in an urgent need for doctors with competence in working with critically ill COVID‐19 patients. A training course and a theoretical test for non‐intensivist doctors were developed. The aims of this study were to gather validity evidence for the theoretical test and explore the effects of the course. Methods The 1‐day course was comprised of theoretical sessions and hands‐on training in ventilator use, hemodynamic monitoring, vascular access, and use of personal protective equipment. Validity evidence was gathered for the test by comparing answers from novices and experts in intensive care. Doctors who participated in the course completed the test before (pretest), after (posttest), and again within 8 weeks following the course (retention test). Results Fifty‐four non‐intensivist doctors from 15 different specialties with a wide range in clinical experience level completed the course. The test consisted of 23 questions and demonstrated a credible pass–fail standard at 16 points. Mean pretest score was 11.9 (SD 3.0), mean posttest score 20.6 (1.8), and mean retention test score 17.4 (2.2). All doctors passed the posttest. Conclusion Non‐intensivist doctors, irrespective of experience level, can acquire relevant knowledge for working in the ICU through a focused 1‐day evidence‐based course. This knowledge was largely retained as shown by a multiple‐choice test supported by validity evidence. The test is available in appendix and online.
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Affiliation(s)
- Morten Engberg
- Copenhagen Academy for Medical Education and Simulation Centre for Human Resources and Education Copenhagen Denmark
- Department of Clinical Medicine Faculty of Health Sciences University of Copenhagen Copenhagen Denmark
| | - Jan Bonde
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
| | - Sigurdur T. Sigurdsson
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
- Department of Neuroanaesthesiology Neuroscience Centre, Rigshospitalet Copenhagen Denmark
| | - Kirsten Møller
- Department of Neuroanaesthesiology Neuroscience Centre, Rigshospitalet Copenhagen Denmark
| | - Leizl J. Nayahangan
- Copenhagen Academy for Medical Education and Simulation Centre for Human Resources and Education Copenhagen Denmark
| | - Marianne Berntsen
- Department of Neuroanaesthesiology Neuroscience Centre, Rigshospitalet Copenhagen Denmark
| | - Camilla T. Eschen
- Department of Cardiothoracic Anaesthesiology University of Copenhagen Copenhagen Denmark
| | - Nicolai Haase
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
| | - Søren Bache
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation Centre for Human Resources and Education Copenhagen Denmark
- Department of Clinical Medicine Faculty of Health Sciences University of Copenhagen Copenhagen Denmark
| | - Lene Russell
- Copenhagen Academy for Medical Education and Simulation Centre for Human Resources and Education Copenhagen Denmark
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
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Hou X, Hu W, Russell L, Kuang M, Konge L, Nayahangan LJ. Educational needs in the COVID-19 pandemic: a Delphi study among doctors and nurses in Wuhan, China. BMJ Open 2021; 11:e045940. [PMID: 33837108 PMCID: PMC8042588 DOI: 10.1136/bmjopen-2020-045940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/30/2021] [Accepted: 02/22/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To identify theoretical and technical aspects regarding treatment, prevention of spread and protection of staff to inform the development of a comprehensive training curriculum on COVID-19 management. DESIGN Cross-sectional study. SETTING Nine hospitals caring for patients with COVID-19 in Wuhan, China. PARTICIPANTS 134 Chinese healthcare professionals (74 doctors and 60 nurses) who were deployed to Wuhan, China during the COVID-19 epidemic were included. A two-round Delphi process was initiated between March and May 2020. In the first round, the participants identified knowledge, technical and behavioural (ie, non-technical) skills that are needed to treat patients, prevent spread of the virus and protect healthcare workers. In round 2, the participants rated each item according to its importance to be included in a training curriculum on COVID-19. Consensus for inclusion in the final list was set at 80%. PRIMARY OUTCOME MEASURES Knowledge, technical and behavioural (ie, non-technical) skills that could form the basis of a training curriculum for COVID-19 management. RESULTS In the first round 1398 items were suggested by the doctors and reduced to 67 items after content analysis (treatment of patients: n=47; infection prevention and control: n=20). The nurses suggested 1193 items that were reduced to 70 items (treatment of patients: n=49; infection prevention and control: n=21). In round 2, the response rates were 82% in doctors and 93% in nurses. Fifty-eight items of knowledge, technical and behavioural skills were agreed on by the doctors to include in the final list. For the nurses, 58 items were agreed on. CONCLUSIONS This needs assessment process resulted in a comprehensive list of knowledge, technical and behavioural skills for COVID-19 management. Educators can use these to guide decisions regarding content of training curricula not only for COVID-19 management but also in preparation for future viral pandemic outbreaks.
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Affiliation(s)
- Xun Hou
- Clinical Competence Training Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenjie Hu
- Clinical Competence Training Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Hepatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lene Russell
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR and Education, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Ming Kuang
- Department of Hepatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR and Education, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR and Education, The Capital Region of Denmark, Copenhagen, Denmark
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Omess S, Kaplow R, Green A, Kingsley-Mota W, Mota S, Paris L, Wilson K. Implementation of a Warm Zone Model During the COVID-19 Pandemic. Am J Nurs 2021; 121:48-54. [PMID: 33350697 DOI: 10.1097/01.naj.0000731664.58705.c3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT In March 2020, in response to the coronavirus disease 2019 (COVID-19) pandemic, the executive leadership of an academic medical center in Atlanta tasked an interprofessional quality improvement (QI) team with identifying ways to improve staff and patient safety while caring for patients with suspected or confirmed COVID-19 infection. Additional goals of the initiative were to improve workflow efficiency by reducing the amount of time spent donning and doffing personal protective equipment (PPE) and to conserve PPE, which could be in short supply in a prolonged pandemic. The QI team developed a "warm zone model" that allowed staff members to wear the same mask, eye protection, and gown while moving between the rooms of patients who had tested positive for COVID-19. The risk of self-contamination while doffing PPE is well documented. Staff members were trained to conserve PPE and to properly change gloves and perform hand hygiene between exiting and entering patients' rooms. The warm zone model allowed multidisciplinary team members to reduce the times they donned and doffed PPE per shift while maintaining or increasing the times they entered and exited patients' rooms. Staff members believed that the model improved workflow and teamwork while maintaining staff members' personal safety. Daily gown use decreased on the acute care unit where the model was employed, helping to preserve PPE supplies. Once the model was proven successful in acute care, it was modified and instituted on several critical care COVID-19 cohort units.
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Affiliation(s)
- Sarah Omess
- Sarah Omess , Roberta Kaplow , and Alyson Green are clinical nurse specialists; William Kingsley-Mota is a specialty director; Sérgio Mota is a unit director; and Keisa Wilson is an education coordinator, all at Emory University Hospital, Emory Healthcare, in Atlanta. Lauren Paris , a clinical nurse specialist at Emory University Hospital during this initiative, is currently the manager of professional practice at Wellstar Healthcare System in Marietta, GA. Contact author: Sarah Omess, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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10
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Baloh J, Reisinger HS, Dukes K, da Silva JP, Salehi HP, Ward M, Chasco EE, Pennathur PR, Herwaldt L. Healthcare Workers' Strategies for Doffing Personal Protective Equipment. Clin Infect Dis 2020; 69:S192-S198. [PMID: 31517970 PMCID: PMC6743502 DOI: 10.1093/cid/ciz613] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Personal protective equipment (PPE) helps protect healthcare workers (HCWs) from pathogens and prevents cross-contamination. PPE effectiveness is often undermined by inappropriate doffing methods. Our knowledge of how HCWs approach doffing PPE in practice is limited. In this qualitative study, we examine HCWs’ perspectives about doffing PPE. Methods Thirty participants at a Midwestern academic hospital were recruited and assigned to 1 of 3 doffing simulation scenarios: 3 mask designs (n = 10), 2 gown designs (n = 10), or 2 glove designs (n = 10). Participants were instructed to doff PPE as they would in routine practice. Their performances were video-recorded and reviewed with participants. Semistructured interviews about their doffing approaches were conducted and audio-recorded, then transcribed and thematically analyzed. Results Three overarching themes were identified in interviews: doffing strategies, cognitive processes, and barriers and facilitators. Doffing strategies included doffing safely (minimizing self-contamination) and doffing expediently (eg, ripping PPE off). Cognitive processes during doffing largely pertained to tracking contaminated PPE surfaces, examining PPE design cues (eg, straps), or improvising based on prior experience from training or similar PPE designs. Doffing barriers and facilitators typically related to PPE design, such as PPE fit (or lack of it) and fastener type. Some participants also described personal barriers (eg, glasses, long hair); however, some PPE designs helped mitigate these barriers. Conclusions Efforts to improve HCWs’ doffing performance need to address HCWs’ preferences for both safety and expediency when using PPE, which has implications for PPE design, training approaches, and hospital policies and procedures.
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Affiliation(s)
- Jure Baloh
- Department of Internal Medicine, University of Iowa, Iowa City.,Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock
| | - Heather Schacht Reisinger
- Department of Internal Medicine, University of Iowa, Iowa City.,Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City
| | - Kimberly Dukes
- Institute for Clinical and Translational Science, University of Iowa, Iowa City
| | | | - Hugh P Salehi
- Department of Industrial and Systems Engineering, University of Iowa, Iowa City.,Department of Engineering Management, Systems and Technology, University of Dayton, Ohio
| | - Melissa Ward
- Department of Internal Medicine, University of Iowa, Iowa City
| | - Emily E Chasco
- Department of Internal Medicine, University of Iowa, Iowa City.,Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City
| | - Priyadarshini R Pennathur
- Department of Internal Medicine, University of Iowa, Iowa City.,Department of Industrial and Systems Engineering, University of Iowa, Iowa City
| | - Loreen Herwaldt
- Department of Internal Medicine, University of Iowa, Iowa City.,Department of Epidemiology, University of Iowa, Iowa City
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11
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Pichi B, Mazzola F, Bonsembiante A, Petruzzi G, Zocchi J, Moretto S, De Virgilio A, Pellini R. CORONA-steps for tracheotomy in COVID-19 patients: A staff-safe method for airway management. Oral Oncol 2020; 105:104682. [PMID: 32278111 PMCID: PMC7136881 DOI: 10.1016/j.oraloncology.2020.104682] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 11/29/2022]
Abstract
•The recent outbreak of SARS‐CoV‐2 has assumed worldwide proportion. •Tracheostomy in intubated COVID-19 patients requires adjunctive safeguards. •A step-by-step approach named CORONA is proposed in order to recall essential recommendations during the surgical procedure. •The CORONA-method would allow a secure space in which health workers can guarantee their activity, safely.
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Affiliation(s)
- Barbara Pichi
- Department of Otolaryngology and Head & Neck Surgery, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Roma, Italy
| | - Francesco Mazzola
- Department of Otolaryngology and Head & Neck Surgery, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Roma, Italy.
| | - Anna Bonsembiante
- Ear Nose and Throat and Audiology Department, University Hospital of Ferrara, Via Aldo Moro, 44124 Ferrara, Italy
| | - Gerardo Petruzzi
- Department of Otolaryngology and Head & Neck Surgery, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Roma, Italy
| | - Jacopo Zocchi
- Department of Otolaryngology and Head & Neck Surgery, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Roma, Italy
| | - Silvia Moretto
- Department of Otolaryngology and Head & Neck Surgery, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Roma, Italy
| | - Armando De Virgilio
- Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI), Italy; Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano (MI), Italy
| | - Raul Pellini
- Department of Otolaryngology and Head & Neck Surgery, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Roma, Italy
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12
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Mi B, Xiong Y, Lin Z, Panayi AC, Chen L, Liu G. COVID-19 Orthopaedic Safe Care Toolset: Guidelines for the Diagnosis and Management of Patients with Fracture and COVID-19. J Bone Joint Surg Am 2020; 102:1116-1122. [PMID: 32618909 PMCID: PMC7396210 DOI: 10.2106/jbjs.20.00532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The SARS-CoV-2 (severe acute respiratory syndrome-coronavirus 2) was reported in Wuhan, Hubei Province, People's Republic of China, and, subsequently, in other provinces and regions across the People's Republic of China and >212 countries. COVID-19, the disease caused by this coronavirus, was declared a worldwide pandemic by the World Health Organization (WHO). The incidence of patients with fracture who are also positive for COVID-19 is on the rise. The diagnosis and management of such patients can be complicated as their clinical characteristics are heterogeneous. Furthermore, a surgical procedure can be particularly challenging given that the use of high-speed devices results in aerosol generation. In this study, we develop and propose globally applicable guidelines to fill this knowledge gap and we identify and propose the necessary protective strategies for medical personnel in an orthopaedic emergency department and in the inpatient wards. We also introduce diagnostic criteria, surgical complication management, and follow-up strategies for infected patients. These guidelines may be helpful to decrease the infection rate of orthopaedic trauma personnel and to provide diagnosis and treatment therapy for patients with fracture and COVID-19.
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Affiliation(s)
- Bobin Mi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Yuan Xiong
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Ze Lin
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Adriana C. Panayi
- Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lang Chen
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China,Email address for L. Chen:
| | - Guohui Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China,Email address for G. Liu:
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13
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Analyzing the Job Demands-Control-Support Model in Work-Life Balance: A Study among Nurses in the European Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082847. [PMID: 32326169 PMCID: PMC7215557 DOI: 10.3390/ijerph17082847] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 01/23/2023]
Abstract
The balance of personal life with professional life is a topical issue that is increasingly worrisome due to globalization, the rapid introduction of new technologies into all areas of human life, the overlap between time between work and family, new organizational systems, and changes in the nature of work. This problem is accentuated by professions subjected to intense labor demands, as is the case of nurses. Adopting the Job Demand–Control–Support model, the main purpose of this research is to analyze how these factors lead to a greater or lesser degree of work–life balance. The research proposes a logistic regression model, which was constructed with a sample of 991 nursing professionals from the V European Working Conditions Survey. The results obtained confirm, on the one hand, that there is a significant effect of physical demands (but not psychological demands) on work–life balance. On the other hand, the moderating effects of job control are partially confirmed for psychological demands, and those of supervisor support (but not co-worker support) are partially confirmed for physical demands. In conclusion, the present research shows that effective management of nurses’ work context can decisively contribute to finding the difficult balance between personal and professional time.
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Law BHY, Cheung PY, Aziz K, Schmölzer GM. Effect of COVID-19 Precautions on Neonatal Resuscitation Practice: A Balance Between Healthcare Provider Safety, Infection Control, and Effective Neonatal Care. Front Pediatr 2020; 8:478. [PMID: 33014919 PMCID: PMC7461943 DOI: 10.3389/fped.2020.00478] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/08/2020] [Indexed: 12/14/2022] Open
Abstract
Adaptations have been proposed for resuscitation of infants born to women with COVID-19, to protect health care providers, maintain infection control, and limit post-natal transmission. Changes especially impact respiratory procedures, personal protective equipment (PPE) use, resuscitation environments, teamwork, and family involvement. Adding viral filters to ventilation devices and modifications to intubation procedures might hinder effective ventilation. PPE could delay resuscitation, hinder task performance, and degrade communication. Changes to resuscitation locations and team composition alter workflow and teamwork. Physical distancing measures and PPE impede family-integrated care. These disruptions need to be considered given the uncertainty of vertical transmission of SARS-CoV-2.
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Affiliation(s)
- Brenda Hiu Yan Law
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Po-Yin Cheung
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Khalid Aziz
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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15
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Reddy SC, Valderrama AL, Kuhar DT. Improving the Use of Personal Protective Equipment: Applying Lessons Learned. Clin Infect Dis 2019; 69:S165-S170. [DOI: 10.1093/cid/ciz619] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Unrecognized transmission of pathogens in healthcare settings can lead to colonization and infection of both patients and healthcare personnel. The use of personal protective equipment (PPE) is an important strategy to protect healthcare personnel from contamination and to prevent the spread of pathogens to subsequent patients. However, optimal PPE use is difficult, and healthcare personnel may alter delivery of care because of the PPE. Here, we summarize recent research from the Prevention Epicenters Program on healthcare personnel contamination and improvement of the routine use of PPE as well as Ebola-specific PPE. Future efforts to optimize the use of PPE should include increasing adherence to protocols for PPE use, improving PPE design, and further research into the risks, benefits, and best practices of PPE use.
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Affiliation(s)
- Sujan C Reddy
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy L Valderrama
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David T Kuhar
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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