Preventing Infection of Patients and Healthcare Workers Should Be the New Normal in the Era of Novel Coronavirus Epidemics

Comparison of barriers to effective nurse-patient communication in COVID-19 and non-COVID-19 wards

BACKGROUND

Communication is a basic need of humans. Identifying factors that prevent effective nurse-patient communication allows for the better implementation of necessary measures to modify barriers. This study aims to compare the barriers to effective nurse-patient communication from the perspectives of nurses and patients in COVID-19 and non-COVID-19 wards.

MATERIALS AND METHODS

This cross-sectional descriptive study was conducted in 2022. The participants included 200 nurses (by stratified sampling method) and 200 patients (by systematic random sampling) referred to two conveniently selected hospitals in Shahroud, Iran. The inclusion criteria for nurses were considered having at least a bachelor's degree and a minimum literacy level for patients to complete the questionnaires. Data were collected by the demographic information form and questionnaire with 30 and 15 questions for nurses and patients, which contained similar questions to those for nurses, based on a 5-point Likert scale. Data were analysis using descriptive indices and inferential statistics (Linear regression) in SPSS software version 18.

RESULTS

The high workload of nursing, excessive expectations of patients, and the difficulty of nursing work were identified by nurses as the main communication barriers. From the patients' viewpoints, the aggressiveness of nurses, the lack of facilities (welfare treatment), and the unsanitary conditions of their rooms were the main communication barriers. The regression model revealed that the mean score of barriers to communication among nurses would decrease to 0.48 for each unit of age increase. Additionally, the patient's residence explained 2.3% of the nurses' barriers to communication, meaning that native participants obtained a mean score of 2.83 units less than non-native nurses, and there was no statistically significant difference between the COVID and non-COVID wards.

CONCLUSION

In this study, the domain of job characteristics was identified by nurses as the major barrier, and patients emphasized factors that were in the domain of individual/social factors. There is a pressing need to pay attention to these barriers to eliminate them through necessary measures by nursing administrators.

Prevention of contamination after endotracheal intubation using a dedicated sleeve

Background

Contamination of work surfaces by used laryngoscopes after endotracheal intubation is a serious infection control concern but no strategies are available to address it. We assessed if contamination of the surfaces after endotracheal intubation would be reduced when providers used a dedicated, self-erected, disposable plastic sleeve (BladePouch) to store the used laryngoscope as compared to using single gloves or double gloves and sheathing the laryngoscope with the outer gloves.

Methods

Twenty participants were recruited including attending physicians, trainees and allied health care professionals. They performed endotracheal intubation on a mannequin with oral cavity coated with a dye and stored the used laryngoscope blade using single gloves, double gloves or BladePouch. Each participant used both direct and video laryngoscopes. Following intubation, dye contamination of gloves, gown and work surface was evaluated.

Results

There was no difference in the contamination of gloves or gowns between the single gloves, double gloves or BladePouch groups. However, work surface contamination was significantly reduced when using BladePouch compared to single or double gloves (13% vs. 100% vs. 80% respectively, P<0.001). The odds of work surface contamination were significantly lower with BladePouch vs. single or double gloves, even when adjusted for intubation device, role and experience of participants with an adjusted odds ratio of 0.0054 (95% confidence interval: 0.0009-0.0314), P<0.001.

Conclusions

In conjunction with standard precautions, the use of a dedicated plastic sleeve to store contaminated laryngoscope blade after endotracheal intubation may reduce the work surface contamination, independent of intubation device, role and experience of providers.

Evaluation of Health Care Professionals' Knowledge, Attitudes, and Practice to Prevent the Pandemic Spread of COVID-19: A Questionnaire-Based Cross-Sectional Study from Abha, Saudi Arabia

BACKGROUND

Pharmacists and other healthcare professionals (HCPs) are at risk of transmitting the lethal COVID-19 virus globally and increasing its prevalence.

AIM

The aim of this study was to assess knowledge, attitudes, and practices (KAP) about coronavirus disease 2019 (COVID-19) among HCPs in the Asir region for the first time.

METHODOLOGY

A cross-sectional analysis with 491 healthcare professionals was tested using a pre-tested questionnaire in a tertiary care facility. The association between research variables and questions was determined using Chi-square tests and Kruskal-Wallis tests.

RESULTS

Pharmacists and other HCPs exhibited good knowledge, a positive attitude, and a negative practice pattern regarding COVID-19. There was a strong association between knowledge and attitude (correlation coefficient: 0.17; p < 0.001). However, healthcare practitioners had a suboptimal practice score of 2.09 ± 0.62 regarding COVID-19.

CONCLUSION

This study discovered that despite relatively insufficient practices for adherence to recommended techniques regarding COVID-19 prevention during the outbreak, pharmacists and other healthcare professionals have a high level of awareness and a positive attitude towards COVID-19 as a medical condition. There is a need for more involved HCPs, improved COVID-19 management training, and approaches to make healthcare providers feel less anxious.

Occupational health in the framework of the COVID-19 pandemic: a scoping review

OBJECTIVE

To collect the available evidence related to occupational health in the face of the introduction of the new SARS-CoV-2 coronavirus pandemic.

METHODS

Scoping review developed from the Arksey and O'Malley framework. The search was performed in the databases PubMed, Academic Search Complete, Science Direct, Medline, Scopus, Web of Science and Google Scholar. Documents on COVID-19 and its relationship with occupational health published in English, Portuguese and Spanish were included. The review, selection and characterization of the studies was carried out by five reviewers.

RESULTS

The search and selection identified 43 documents published between December 2019 and April 2020. The topics covered include occupational exposure, protection measures, psychosocial affectations of workers, particularly health, as well as conditions of work organization that can influence contagion.

CONCLUSIONS

Health workers are the most exposed workforce. Accompaniment, coaching and training in relation to patient care and the use of personal protection equipment are essential to reduce contagion among health personnel. In other work activities, social distancing is the standard measure for the mitigation of transmission, as well as the continuous disinfection of workplaces.

Surgical Site Infections During the Covid-19 Era: A Retrospective, Multicenter Analysis

Background

Surgical site infections (SSIs) are an undesired perioperative outcome. Recent studies have shown increases in hospital acquired infections during the coronavirus disease 2019 (COVID-19) pandemic. The objective of this study was to evaluate postoperative SSIs in the COVID-19-era compared to a historical cohort at a large, multicenter, academic institution.

Methods

A retrospective review of all patients who underwent National Health and Safety Network (NHSN) inpatient surgical procedures between January 1, 2018 and December 31, 2020. Patients from the COVID-19-era (March-December 2020) were compared and matched 1:1 with historical controls (2018/2019) utilizing the standardized infection ratio (SIR) to detect difference.

Results/Discussion

During the study period, 29,904 patients underwent NHSN procedures at our institution. When patients from the matched cohort (2018/2019) were compared to the COVID-19-era cohort (2020), a decreased risk of SSI was observed following colorectal surgery (RR = 0.94, 95% CI [0.65, 1.37], P = .76), hysterectomy (RR = 0.88, 95% CI [0.39, 1.99], P = .75), and knee prothesis surgery (RR = 0.95, 95% CI [0.52, 1.74], P = .88), though not statistically significant. An increased risk of SSI was observed following hip prosthesis surgery (RR 1.09, 95% CI [0.68, 1.75], P = .72), though not statistically significant.

Conclusions

The risk of SSI in patients who underwent NHSN inpatient surgical procedures in 2020 with perioperative COVID-19 precautions was not significantly different when compared to matched controls at our large, multicenter, academic institution.

Advances in the development of superhydrophobic and icephobic surfaces

Superhydrophobicity and icephobicity are governed by surface chemistry and surface structure. These two features signify a potential advance in surface engineering and have recently garnered significant attention from the research community. This review aims to simulate further research in the development of superhydrophobic and icephobic surfaces in order to achieve their wide-spread adoption in practical applications. The review begins by establishing the fundamentals of the wetting phenomenon and wettability parameters. This is followed by the recent advances in modeling and simulations of the response of superhydrophobic surfaces to static and dynamic droplets contact and impingement, respectively. In view of their versatility and multifunctionality, a special attention is given to the development of these surfaces using nanocomposites. Furthermore, the review considers advances in icephobicity, its comprehensive characterization and its relation to superhydrophobicity. The review also includes the importance of the use of superhydrophobic surface to combat viral and bacterial contamination that exist in fomites.

Impact of COVID-19 pandemic on audiology practice: A scoping review

Background

COVID-19 has significantly impacted the professional practice of health care professionals including audiological practice. Audiologists had to adopt to changes and modify their practice to deal with the pandemic. Reasonable published work has been seen since the onset of the pandemic, depicting impact on the audiology practice across the globe in different practice settings and contexts. The present scoping review was carried out to explore the impact of COVID-19 pandemic on audiology practice and the challenges faced.

Material & methods

A literature search was carried out to identify the studies exploring the impact of COVID-19 pandemic on audiology practice. Three electronic databases namely Scopus, PubMed/Medline, and Cochrane Library were searched using keywords. After title and abstract screening, suitable studies were identified.

Results

Of the total 172, nine studies focusing on impact of COVID-19 pandemic on audiology practice COVID-19, published between January 2020 to June 2021 were included. Overall, the COVID-19 pandemic and the subsequent restrictions, caused changes in routine clinical practices in audiology. These changes were with respect to stringent infection control measures, mode of service delivery, changes in routines with reduced services or prioritizing services. Challenges included issues with remote services, experience, and support.

Conclusion

The present review reveals the changes in audiology practice during COVID –19 and challenges encountered by audiologists. These findings would help in better planning of audiology practice in the post pandemic world.

"Surviving to thriving": a meta-ethnography of the experiences of healthcare staff caring for persons with COVID-19

BACKGROUND

The emergence of the Coronavirus disease has heightened the experience of emotional burden among healthcare staff. To guide the development of support programmes, this review sought to aggregate and synthesise qualitative studies to establish a comparative understanding of the experiences of healthcare staff caring for persons with the disease.

DESIGN

A meta-ethnography approach was used to aggregate and synthesise primary qualitative studies. Database search was undertaken from January to November 2020. A standardised tool was used to extract data from the identified primary studies. The studies were translated into each other to formulate overarching concepts/ metaphors which formed the basis of undertaking a narrative synthesis.

RESULTS

Eight qualitative studies met the inclusion criteria. Two overarching metaphors/ concepts were formulated from the primary studies: 1) surviving to thriving in an evolving space and 2) support amid the new normal. The initial phase of entering the space of caring during the outbreak was filled with psychological chaos as healthcare staff struggled to survive within the context of an illness which was not fully understood. Gradually, healthcare staff may transition to a thriving phase characterised by resilience but still experienced heavy workload and physical/ emotional exhaustion predisposing them to burnout and compassion fatigue. Fear persisted throughout their experiences: fear of contracting the disease or infecting one's family members/ loved ones remained a key concern among healthcare staff despite infection precaution measures. Healthcare staff who contracted the disease felt isolated with additional fears of dying alone. The sources of support were varied with a strong emphasis on peer support.

CONCLUSIONS

Healthcare staff caring for persons infected with the Coronavirus disease are at risk of burnout and compassion fatigue and require ongoing mental health support commensurate to their needs. Staff who contract the disease may require additional support to navigate through the illness and recovery. Policies and concerted efforts are needed to strengthen support systems and build resilience among healthcare staff.

The Case against Antibiotics and for Anti-Virulence Therapeutics

Although antibiotics have been indispensable in the advancement of modern medicine, there are downsides to their use. Growing resistance to broad-spectrum antibiotics is leading to an epidemic of infections untreatable by first-line therapies. Resistance is exacerbated by antibiotics used as growth factors in livestock, over-prescribing by doctors, and poor treatment adherence by patients. This generates populations of resistant bacteria that can then spread resistance genes horizontally to other bacterial species, including commensals. Furthermore, even when antibiotics are used appropriately, they harm commensal bacteria leading to increased secondary infection risk. Effective antibiotic treatment can induce bacterial survival tactics, such as toxin release and increasing resistance gene transfer. These problems highlight the need for new approaches to treating bacterial infection. Current solutions include combination therapies, narrow-spectrum therapeutics, and antibiotic stewardship programs. These mediate the issues but do not address their root cause. One emerging solution to these problems is anti-virulence treatment: preventing bacterial pathogenesis instead of using bactericidal agents. In this review, we discuss select examples of potential anti-virulence targets and strategies that could be developed into bacterial infection treatments: the bacterial type III secretion system, quorum sensing, and liposomes.

Workplace challenges and nurses recovered from COVID-19

Background:

Although many studies have addressed COVID-19, the challenges faced by nurses in their workplace after recovering from this disease have not been investigated. As the backbone of the health system and at the forefront of the fight against COVID-19, nurses are exposed to serious risks of infection and even death. They may also face numerous challenges in their workplace after recovering from COVID-19. It is therefore ethically recommended that the problems of these nurses be solved to increase their job satisfaction and encourage them to remain in their profession.

Objectives:

The present research was conducted to determine the workplace challenges faced by nurses who had recovered from COVID-19.

Methods:

This qualitative study was conducted using the interpretive phenomenological approach proposed by van Manen. The data collected through 17 in-depth semi-structured interviews with 14 eligible nurses at different occupational levels were analyzed using the six steps proposed by van Manen. These nurses had also recovered from COVID-19.

Ethical considerations:

This study was approved by the Ethics Committee of Urmia University of Medical Sciences (IR.UMSU.REC.1399.318).

Findings:

Four themes and 20 subthemes extracted from analyzing the data explained the challenges faced by the nurses after their return to work. The themes included declined ethical values (four subthemes), infected nurses, forgotten patients (three subthemes), gradually leaving the job (six subthemes), and corona phobia (seven subthemes).

Conclusion:

The present findings can be used to lay the foundations for adopting humanitarian policies in health organizations in terms of ethical care provision during future pandemics.

Sleep deficit in COVID-19 health-care workers may increase the infection risk

The COVID-19 pandemic has had negative effects on health-care workers. The rapid growth of the disease has led to overwhelmed health-care systems, overcrowded hospitals, an insufficient number of health-care professionals and shortages of medical equipment. The potential exposure of front-line health-care workers during the COVID-19 outbreak has led to self-isolation and the appearance of adverse feelings such as stress, anxiety and fear. All these factors, combined with an increased workload and extra and changed shifts, are determinants of a sleep-loss process that may result in insomnia. The exacerbated pro-inflammatory milieu caused by insomnia and sleep deprivation present in health professionals may therefore make them more prone to developing severe COVID-19 if infected and/or aggravate the symptoms of the disease. Keeping these professionals healthy and doing everything possible to prevent them from being infected with COVID-19 should be a top priority. As part of this effort, we must be aware of the important effects of insomnia on the immune systems of these professionals and take all possible measures to counter these effects.

Serosurveillance of Health Care Workers in a COVID Hospital: Immune Response, and Its Longevity

Objective: We aimed to study the seroprevalence of coronavirus disease 2019 (COVID-19) and sustainability of the immune response in health care workers (HCWs). A cross-sectional study was conducted between October 7 and November 30, 2020, in a multi-specialty hospital in Eastern India designated as COVID hospital during this pandemic. Study participants included 2,110 HCWs, including those who have recovered from COVID infection.

Method: HCWs were required to complete a questionnaire and give written consent to participate in the study. Their venous blood sample was collected for serum analysis of IgG antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by chemiluminescent immunoassay.

Results: Positive IgG antibodies were seen in 924 participants with a point prevalence of 43.79%. Slightly higher reactivity was seen in males. History of COVID-19 infection was noted in 10.9%, with the highest antibody response in 81% cases. A maximum of 87.9% reactivity was seen in the first two months, and a significant fall was noted in the fourth month, with reactivity seen in only 50% of the study participants.

Conclusion: SARS-CoV-2 infection is associated with a variable immune response in the infected population. The declining trend of the antibodies correlates with short-lived protective immunity and the possibility of re-infection. Further studies are needed to explore the probable reasons for varied seroprevalence.

Changes in Neuroanesthesia Practice During the Early Stages of the COVID-19 Pandemic: Experiences From a Single Center in China

BACKGROUND

Coronavirus disease 2019 (COVID-19), caused by a novel coronavirus, is highly contagious. Global medical systems have been heavily impacted by the COVID-19 pandemic. Although the majority of patients with intracranial disease require time-sensitive surgery, how to conduct neurosurgery and prevent and control nosocomial infection during a pandemic is challenging.

MATERIALS AND METHODS

We retrospectively reviewed the clinical data of patients undergoing neurosurgical and neurointerventional procedures at Beijing Tiantan Hospital, China during the early stages of the COVID-19 pandemic between January 21 and July 31, 2020. A 3-level system of COVID-19 risk was established based on medical conditions, epidemiologic, and symptom inquiry and the results of triage. A transitional unit was established for patients in whom COVID-19 had not been ruled out on admission to hospital.

RESULTS

A total of 4025 patients underwent neurosurgery during the study period, including 768 emergent and 3257 nonemergent procedures. Of these patients, 3722 were low-risk for COVID-19, 303 were moderate-risk, and none were high-risk. In addition, 1419 patients underwent neurointerventional procedures, including 114 emergent and 1305 nonemergent interventions, of which 1339 were low-risk patients, 80 were moderate-risk and none were high-risk. A total of 895 patients (neurosurgical and neurointerventional) were admitted to the transitional unit. Forty-five patients were diagnosed with COVID-19 and transferred to the COVID-19 designated hospital. There were no cases of COVID-19 nosocomial infections among surgical patients or health care workers.

CONCLUSION

On the basis of our single-center experience, developing a full screening protocol for COVID-19, establishing a risk level, and using a transitional unit for those with unknown COVID-19 status are effective measures to provide a safe environment for patients and health care workers.

How Should We Prepare Ourselves for New Normal Related to Stopped Competitions? Public Health and Athletes

The article's abstract is not available.  

Pregnancy and COVID-19: what anesthesiologists should know

INTRODUCTION

Anesthetic management of parturients with COVID-19 is a big challenge to anesthesiologists. Limited data are available about COVID-19 during pregnancy; however, information on illnesses associated with SARS and MERS might provide insights into COVID-19's effects during pregnancy.

EVIDENCE ACQUISITION

Evidence from previous reports from SARS and MERS, and from COVID-19 cases were reviewed. Concepts from guidelines from the government and academic societies were collected as well.

EVIDENCE SYNTHESIS

The evidence was described and summarized.

CONCLUSIONS

Principles to minimize the risk of infection as well as optimize patients' safety during obstetric anesthesia were found to include careful evaluation, tight protection, and multi-discipline-based strategy. Though vertical transmission of COVID-19 still needs more definitive evidence, strict isolation is necessary for the newborn of COVID-19 mothers. Psychological support for the parturients is also an important issue during COVID-19 pandemic.

A Risk-Based Approach to the COVID-19 Pandemic: The Experience in National Dental Centre Singapore

The emergence of a highly infectious coronavirus strain, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a major global public health emergency. The increasing number of infected cases and fatalities worldwide forced several countries into lockdown in a bid to control virus transmission. The practice of dentistry is considered high-risk due to the generation of aerosols associated with most dental procedures, and healthcare professionals must take appropriate precautions whilst working in this challenging environment. This review aims to provide an overview on transmission routes and shares a risk-based approach to coronavirus disease 2019 (COVID-19) in a specialty tertiary center. Risk assessment and mitigation focussed on staff and patient safety, adopting a wide safety margin, and responding dynamically to the level of risk at the workplace. As the severity of the pandemic depends on many still-unknown factors and shows little sign of abating, the routine practice of dentistry will continue to be disrupted in the near future. We describe a color-coded framework to maximize safety and to minimize disease spread. Areas covered include healthcare team management, personal protective equipment, clinical work, and dental education. Guidelines in each category change with the corresponding severity of the situation, and we believe it will be useful for the safer practice of dentistry in this current climate and can be modified for future similar disease outbreaks.

Safety measures for COVID-19: a review of surgical preparedness at four major medical centres in Saudi Arabia

In view of the worldwide coronavirus disease 2019 (COVID-19) pandemic, hospitals need contingency planning. This planning should include preparation for an unexpected patient surge. This measure is evolving concomitantly with the implementation of the needed infection control rules. Here, we present our experience in contingency planning at four large tertiary hospitals in Saudi Arabia during this global pandemic, with a focus on dealing with COVID-19 patients who need to undergo surgery. The planning covers response measures required in the operating room and supporting units, including the administrative department, intensive care unit, and different sections of the surgical department. Furthermore, it covers the role of education and simulation in preparing health care providers and ensuring smooth workflow between all sections. We additionally discuss the guidelines and policies implemented in different surgical specialties. These measures are necessary to prevent the transmission of COVID-19 within healthcare facilities. Throughout the COVID-19 pandemic, the healthcare system should develop a comprehensive pandemic plan and set guidelines addressing the management of urgent and malignant cases. The guidelines should be in concordance with internal guidelines.

Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: a scoping review and narrative synthesis

Exposure of healthcare providers to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a significant safety concern during the coronavirus disease 2019 (COVID-19) pandemic, requiring contact/droplet/airborne precautions. Because of global shortages, limited availability of personal protective equipment (PPE) has motivated the development of barrier-enclosure systems, such as aerosol boxes, plastic drapes, and similar protective systems. We examined the available evidence and scientific publications about barrier-enclosure systems for airway management in suspected/confirmed COVID-19 patients. MEDLINE/Embase/Google Scholar databases (from December 1, 2019 to May 27, 2020) were searched for all articles on barrier enclosures for airway management in COVID-19, including references and websites. All sources were reviewed by a panel of experts using a Delphi method with a modified nominal group technique. Fifty-two articles were reviewed for their results and level of evidence regarding barrier device feasibility, advantages, protection against droplets and aerosols, effectiveness, safety, ergonomics, and cleaning/disposal. The majority of analysed papers were expert opinions, small case series, technical descriptions, small-sample simulation studies, and pre-print proofs. The use of barrier-enclosure devices adds to the complexity of airway procedures with potential adverse consequences, especially during airway emergencies. Concerns include limitations on the ability to perform airway interventions and the aid that can be delivered by an assistant, patient injuries, compromise of PPE integrity, lack of evidence for added protection of healthcare providers (including secondary aerosolisation upon barrier removal), and lack of cleaning standards. Enclosure barriers for airway management are no substitute for adequate PPE, and their use should be avoided until adequate validation studies can be reported.

Airway Management in the Operating Room and Interventional Suites in Known or Suspected COVID-19 Adult Patients: A Practical Review

Current evidence suggests that coronavirus disease 2019 (COVID-19) spread occurs via respiratory droplets (particles >5 µm) and possibly through aerosol. The rate of transmission remains high during airway management. This was evident during the 2003 severe acute respiratory syndrome epidemic where those who were involved in tracheal intubation had a higher risk of infection than those who were not involved (odds ratio 6.6). We describe specific airway management principles for patients with known or suspected COVID-19 disease for an array of critical care and procedural settings. We conducted a thorough search of the available literature of airway management of COVID-19 across a variety of international settings. In addition, we have analyzed various medical professional body recommendations for common procedural practices such as interventional cardiology, gastroenterology, and pulmonology. A systematic process that aims to protect the operators involved via appropriate personal protective equipment, avoidance of unnecessary patient contact and minimalization of periprocedural aerosol generation are key components to successful airway management. For operating room cases requiring general anesthesia or complex interventional procedures, tracheal intubation should be the preferred option. For interventional procedures, when tracheal intubation is not indicated, cautious conscious sedation appears to be a reasonable approach. Awake intubation should be avoided unless it is absolutely necessary. Extubation is a high-risk procedure for aerosol and droplet spread and needs thorough planning and preparation. As updates and modifications in the management of COVID-19 are still evolving, local guidelines, appraised at regular intervals, are vital in optimizing clinical management.

Reducing Aerosol-Related Risk of Transmission in the Era of COVID-19: An Interim Guidance Endorsed by the International Society of Aerosols in Medicine

National and international guidelines recommend droplet/airborne transmission and contact precautions for those caring for coronavirus disease 2019 (COVID-19) patients in ambulatory and acute care settings. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, an acute respiratory infectious agent, is primarily transmitted between people through respiratory droplets and contact routes. A recognized key to transmission of COVID-19, and droplet infections generally, is the dispersion of bioaerosols from the patient. Increased risk of transmission has been associated with aerosol generating procedures that include endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, manual ventilation before intubation, turning the patient to the prone position, disconnecting the patient from the ventilator, noninvasive positive-pressure ventilation, tracheostomy, and cardiopulmonary resuscitation. The knowledge that COVID-19 subjects can be asymptomatic and still shed virus, producing infectious droplets during breathing, suggests that health care workers (HCWs) should assume every patient is potentially infectious during this pandemic. Taking actions to reduce risk of transmission to HCWs is, therefore, a vital consideration for safe delivery of all medical aerosols. Guidelines for use of personal protective equipment (glove, gowns, masks, shield, and/or powered air purifying respiratory) during high-risk procedures are essential and should be considered for use with lower risk procedures such as administration of uncontaminated medical aerosols. Bioaerosols generated by infected patients are a major source of transmission for SARS CoV-2, and other infectious agents. In contrast, therapeutic aerosols do not add to the risk of disease transmission unless contaminated by patients or HCWs.

The Perioperative Management of Subarachnoid Hemorrhage During the Coronavirus Disease 2019 Pandemic in China

Background

For most of the international community outside the epicenter, coronavirus disease 2019 (COVID-19) containment is normalizing, and daily medical practice runs parallel to preventing and treating COVID-19. This experience of simultaneously conducting emergent surgery and infection control for COVID-19 disease is useful outside the epicenter during the pandemic.

Case Description

In this single-center retrospective observational study, we enrolled patients with subarachnoid hemorrhage (SAH) who were emergently admitted from January 23 to April 8, 2020. Based on the COVID-19 triage, patients with SAH were divided into 3 categories: positive, negative, and under investigation. During 77 days, 90 patients with SAH were admitted at the center. The median age was 55 years (range, 18–80 years) and 40 patients (44.4%) were male. None was positive, 42 patients were negative, and 48 patients were under investigation for COVID-19 before surgery. During the same period, 9 patients were diagnosed with COVID-19 without nosocomial infection.

Conclusions

Rescuing patients with SAH and containment of COVID-19 benefit from joint prevention and control, a centralized system of equipment distribution and personnel assignment, and quick workflow establishment.

Potential of combating transmission of COVID-19 using novel self-cleaning superhydrophobic surfaces: part I-protection strategies against fomites

According to the World Health Organisation, one of the main concerns of COVID-19 virus is its tenacity to spread from droplets that either land directly on a surface or are transmitted to a surface by an infected person. In this study, we report the potential of using superhydrophobic surfaces to combat the transmission and spread of fomites infected by COVID-19 virus strand. Fomites include clothes, utensils, furniture, regularly touched objects and personal protective equipment used by Health Care Workers to act as barriers against fluid transmission and/or fluid penetration. In this effort, we propose three strategies to combat the transmission and the spread of the virus: encapsulation, contamination suppression, and elimination. We believe that this can be achieved by the use of our recently developed superhydrophobic coating and regenerative monolith to encapsulate and suppress the virus. The newly developed superhydrophobic coating and monolith are scalable, economical, and facile with the monolith capable of regeneration. The elimination of the virus will be through the use of antiviral and antibacterial copper nanoparticles or dedicated copper surfaces.

Anesthesiologist and COVID-19-current perspective

In the current situation when the world is grappling with COVID-19 that has taken a toll on humanity and is continuing to affect multiples of health-care workers all over the world in vast numbers, the pandemonium (mayhem) has led to grim concerns. We have made an effort to compile and present a review that provides an insight into the management of patients for the front-line anesthesiologists of the medical war, which is being fought to curb and contain this COVID-19 pandemic. We have tried to incorporate the operating room locations, as well as the remote locations where anesthesiologist may be called upon for providing their services. Needless to say, it is of utmost importance to ensure the safety of the patient, as well as of the anesthesiologist who are involved in the patient care at this crucial juncture. The present article provides valuable information to anesthesiologists regarding handling the current pandemic in a protocolized and evidence-based manner.

Pediatric Mental and Behavioral Health in the Period of Quarantine and Social Distancing With COVID-19

The coronavirus disease (COVID-19) pandemic has spread rapidly throughout the world and has had a long-term impact. The pandemic has caused great harm to society and caused serious psychological trauma to many people. Children are a vulnerable group in this global public health emergency, as their nervous systems, endocrine systems, and hypothalamic-pituitary-adrenal axes are not well developed. Psychological crises often cause children to produce feelings of abandonment, despair, incapacity, and exhaustion, and even raise the risk of suicide. Children with mental illnesses are especially vulnerable during the quarantine and social distancing period. The inclusion of psychosocial support for children and their families are part of the health responses to disaster and disaster recovery. Based on the biopsychosocial model, some children may have catastrophic thoughts and be prone to experience despair, numbness, flashbacks, and other serious emotional and behavioral reactions. In severe cases, there may be symptoms of psychosis or posttraumatic stress disorder. Timely and appropriate protections are needed to prevent the occurrence of psychological and behavioral problems. The emerging digital applications and health services such as telehealth, social media, mobile health, and remote interactive online education are able to bridge the social distance and support mental and behavioral health for children. Based on the psychological development characteristics of children, this study also illustrates interventions on the psychological impact from the COVID-19 pandemic. Even though the world has been struggling to curb the influences of the pandemic, the quarantine and social distancing policies will have long-term impacts on children. Innovative digital solutions and informatics tools are needed more than ever to mitigate the negative consequences on children. Health care delivery and services should envision and implement innovative paradigms to meet broad well-being needs and child health as the quarantine and social distancing over a longer term becomes a new reality. Future research on children's mental and behavioral health should pay more attention to novel solutions that incorporate cutting edge interactive technologies and digital approaches, leveraging considerable advances in pervasive and ubiquitous computing, human-computer interaction, and health informatics among many others. Digital approaches, health technologies, and informatics are supposed to be designed and implemented to support public health surveillance and critical responses to children's growth and development. For instance, human-computer interactions, augmented reality, and virtual reality could be incorporated to remote psychological supporting service for children's health; mobile technologies could be used to monitor children's mental and behavioral health while protecting their individual privacy; big data and artificial intelligence could be used to support decision making on whether children should go out for physical activities and whether schools should be reopened. Implications to clinical practices, psychological therapeutic practices, and future research directions to address current effort gaps are highlighted in this study.

Rigorous Hand Hygiene Practices Among Health Care Workers Reduce Hospital-Associated Infections During the COVID-19 Pandemic

The experiences of these recent months have left us with as many new questions as they have given us new solutions. The main question that infection prevention and control department is having these days is “Why have hospital-associated infections (HAIs) reduced during COVID-19 pandemic?” What is the one unique strategy that has brought decline in increasing HAIs? Would it be appropriate to say that rigorous hand hygiene practices among health care workers (HCWs) have reduced HAIs in a tertiary care hospital of Pakistan? This commentary is written to understand the effect of rigorous hand hygiene among HCWs on number of HAIs during COVID-19 pandemic. Given the seriousness of this outbreak, it was observed that the hand hygiene has occupied a new place of importance in the minds of HCWs. We observed 4 times increase in the consumption of hand sanitizers after COVID-19 outbreak. The increased consumption of hand sanitizers was reflected in improved hand hygiene practices. A reduction was observed in the number of HAIs after the COVID-19 outbreak, and we assume that the dip in HAIs is associated with the improvement in hand hygiene practices in the recent months. In the wake of COVID-19 pandemic, these trends reassure us that hand hygiene compliance by HCWs alone can be effective in reducing HAIs in a hospital setting.

Filtration performances of non-medical materials as candidates for manufacturing facemasks and respirators

The recent outbreak of the coronavirus disease (COVID-19) is causing a shortage of personal protective equipment (PPE) in different countries around the world. Because the coronavirus can transmit through droplets and aerosols, facemasks and N95 respirators that require complex certification, are urgently needed. Given the situation, the U.S. Centers for Disease Control and Prevention (CDC) recommends that “in settings where facemasks are not available, healthcare personnel might use homemade masks (e.g., bandana, scarf) for the care of patients with COVID-19 as a last resort.” Although aerosols and droplets can be removed through the fibers of fabrics through a series of filtration mechanisms, their filtration performances have not been evaluated in detail. Moreover, there are a series of non-medical materials available on the market, such as household air filters, coffee filters, and different types of fabrics, which may be useful when facemasks and respirators are not available. In this study, we comprehensively evaluated the overall and size-dependent filtration performances of non-medical materials. The experiments were conducted under different face velocities to study its influence on size-dependent filtration performances. The flow resistance across these filter materials is measured as an indicator of the breathability of the materials. The results illustrate that multiple layers of household air filters are able to achieve similar filtration efficiencies compared to the N95 material without causing a significant increase in flow resistance. Considering that these air filters may shed micrometer fibers during the cutting and folding processes, it is recommended that these filters should be inserted in multiple layers of fabrics when manufacturing facemasks or respirators.

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Agencies suggest the manufacturing of homemade face masks during COVID-19.

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This work examined a wide range of non-medical materials for their filtration performance.

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We studied the influences of face velocity, number of filter material layers, and the size-dependent filtration efficiency.

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Several layers of household air filters can achieve similar filtration performance compared to N95 materials.

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The information will be crucial for healthcare personnel and the general public in manufacturing homemade face masks.

Considerations and Recommendations for Obstetric Anesthesia Care During COVID-19 Pandemic - Saudi Anesthesia Society Guidelines

INTRODUCTION

Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) emerged in Wuhan, China late 2019 and became a pandemic causing coronavirus disease 2019 (COVID-19). Despite its lower mortality rate compared to the other coronaviruses, it has a higher human-to-human transmission rate. Anesthesiologists may benefit from a review of the current evidence related to the obstetric patient with COVID-19.

METHODS

We reviewed the literature for relevant articles as well as experts' opinions from related medical societies' websites.

CONCLUSION

There are several anesthetic considerations in the care of pregnant women with COVID-19 due to their unique physiological changes. We provide considerations and recommendations for departmental and institutional leadership as well as the obstetric anesthesia providers. These recommendations may apply and can be edited, for future droplet or airborne based pandemics. The rapidly evolving literature makes it important to get updates directly from the relevant medical societies' websites.

The role of environmental factors to transmission of SARS-CoV-2 (COVID-19)

The current outbreak of the novel coronavirus disease 2019 (COVID-19) in more than 250 countries has become a serious threat to the health of people around the world. Human-to-human transmission of the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurs most often when people are in the incubation stage of the disease or are carriers and have no symptoms. Therefore, in this study, was discussed the role of environmental factors and conditions such as temperature, humidity, wind speed as well as food, water and sewage, air, insects, inanimate surfaces, and hands in COVID-19 transmission. The results of studies on the stability of the SARS-CoV-2 on different levels showed that the resistance of this virus on smooth surfaces was higher than others. Temperature increase and sunlight can facilitate the destruction of SARS-COV-2 and the stability of it on surfaces. When the minimum ambient air temperature increases by 1 °C, the cumulative number of cases decreases by 0.86%. According to the latest evidence, the presence of coronavirus in the sewer has been confirmed, but there is no evidence that it is transmitted through sewage or contaminated drinking water. Also, SARS-COV-2 transmission through food, food packages, and food handlers has not been identified as a risk factor for the disease. According to the latest studies, the possibility of transmitting SARS-COV-2 bioaerosol through the air has been reported in the internal environment of ophthalmology. The results additionally show that infectious bio-aerosols can move up to 6 feet. There have been no reports of SARS-COV-2 transmission by blood-feeding arthropods such as mosquitoes.

Biosafety measures for preventing infection from COVID-19 in clinical laboratories: IFCC Taskforce Recommendations

Coronavirus disease 2019 (COVID-19) is the third coronavirus outbreak that has emerged in the past 20 years, after severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). One important aspect, highlighted by many global health organizations, is that this novel coronavirus outbreak may be especially hazardous to healthcare personnel, including laboratory professionals. Therefore, the aim of this document, prepared by the COVID-19 taskforce of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), is to provide a set of recommendations, adapted from official documents of international and national health agencies, on biosafety measures for routine clinical chemistry laboratories that operate at biosafety levels 1 (BSL-1; work with agents posing minimal threat to laboratory workers) and 2 (BSL-2; work with agents associated with human disease which pose moderate hazard). We believe that the interim measures proposed in this document for best practice will help minimazing the risk of developing COVID-19 while working in clinical laboratories.

Internet Hospitals Help Prevent and Control the Epidemic of COVID-19 in China: Multicenter User Profiling Study

BACKGROUND

During the spread of the novel coronavirus disease (COVID-19), internet hospitals in China were engaged with epidemic prevention and control, offering epidemic-related online services and medical support to the public.

OBJECTIVE

The aim of this study is to explore the role of internet hospitals during the prevention and control of the COVID-19 outbreak in China.

METHODS

Online epidemic-related consultations from multicenter internet hospitals in China during the COVID-19 epidemic were collected. The counselees were described and classified into seven type groups. Symptoms were recorded and compared with reported patients with COVID-19. Hypochondriacal suspicion and offline visit motivation were detected within each counselees' group to evaluate the social panic of the epidemic along with the consequent medical-seeking behaviors. The counselees' motivation and the doctors' recommendation for an offline visit were compared. Risk factors affecting the counselees' tendency of hypochondriacal suspicion and offline visit motivation were explored by logistic regression models. The epidemic prevention and control measures based on internet hospitals were listed, and the corresponding effects were discussed.

RESULTS

A total of 4913 consultations were enrolled for analysis with the median age of the counselees at 28 years (IQR 22-33 years). There were 104 (2.12%) healthy counselees, 147 (2.99%) hypochondriacal counselees, 34 (0.69%) exposed counselees, 853 (17.36%) mildly suspicious counselees, 42 (0.85%) moderately suspicious counselees, 3550 (72.26%) highly suspicious counselees, and 183 (3.72%) severely suspicious counselees. A total of 94.20% (n=4628) of counselees had epidemic-related symptoms with a distribution similar to those of COVID-19. The hypochondriacal suspicion (n=2167, 44.11%) was common. The counselees' motivation and the doctors' recommendation for offline visits were inconsistent (P<.001) with a Cohen kappa score of 0.039, indicating improper medical-seeking behaviors. Adult counselees (odds ratio [OR]=1.816, P<.001) with epidemiological exposure (OR 7.568, P<.001), shortness of breath (OR 1.440, P=.001), diarrhea (OR 1.272, P=.04), and unrelated symptoms (OR 1.509, P<.001) were more likely to have hypochondriacal suspicion. Counselees with severe illnesses (OR 2.303, P<.001), fever (OR 1.660, P<.001), epidemiological exposure history (OR 1.440, P=.01), and hypochondriacal suspicion (OR 4.826, P<.001) were more likely to attempt an offline visit. Reattending counselees (OR 0.545, P=.002) were less motivated to go to the offline clinic.

CONCLUSIONS

Internet hospitals can serve different types of epidemic counselees, offer essential medical supports to the public during the COVID-19 outbreak, reduce the social panic, promote social distancing, enhance the public's ability of self-protection, correct improper medical-seeking behaviors, reduce the chance of nosocomial cross-infection, and facilitate epidemiological screening, thus, playing an important role on preventing and controlling COVID-19.

Specific Considerations for the Protection of Patients and Echocardiography Service Providers When Performing Perioperative or Periprocedural Transesophageal Echocardiography during the 2019 Novel Coronavirus Outbreak: Council on Perioperative Echocardiography Supplement to the Statement of the American Society of Echocardiography Endorsed by the Society of Cardiovascular Anesthesiologists

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TEE carries a high risk for SARS-CoV-2 spread.

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TEE should be performed when clinical benefits outweigh the risks.

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Proper handling and cleaning of equipment is critical.

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Airborne precautions should be used in patients suspected or confirmed COVID-19.