Availability, Use, and Satisfaction of Personal Protective Equipment Among Healthcare Workers: A Cross-Sectional Assessment of Low- and Middle-Income Countries

Adherence to Infection Prevention and Control Measures Among Health-Care Workers Serving in COVID-19 Treatment Centers in Punjab, Pakistan

OBJECTIVE

Infection prevention and control (IPC) measures are easily adoptable activities to prevent the spread of infection to patients as well as among health-care workers (HCWs).

METHODS

This cross-sectional study evaluated the adherence to IPC measures among HCWs working at coronavirus disease 2019 (COVID-19) treatment centers in Punjab, Pakistan. HCWs were recruited by means of convenient sampling through Google Form^® using the World Health Organization risk assessment tool. All data were analyzed using SPSS 20.

RESULTS

A total of 414 HCWs completed the survey (response rate = 67.8%), and majority of them were males (56.3%). Most of the HCWs were nurses (39.6%) followed by medical doctors (27.3%). Approximately 53% reported insufficiency of personal protective equipment (PPE), 58.2% did not receive IPC training and 40.8% did not have functional IPC team at their health facilities. The majority of HCWs (90%) used disposable gloves and N95 facemasks while interacting with COVID-19 patients. Nearly 45% used protective face shields and gowns before providing care to their patients. Hand hygiene practices while touching, and performing any aseptic procedure was adopted by 70.5% and 74.1% of HCWs, respectively.

CONCLUSIONS

In conclusion, the adherence to IPC measures among Pakistani HCWs working in COVID-19 treatment centers is good despite the limited availability of PPEs. Their practices can be optimized by establishing institutional IPC teams, periodic provision of IPC training, and necessary PPE.

Rwanda's community health workers at the front line: a mixed-method study on perceived needs and challenges for community-based healthcare delivery during COVID-19 pandemic

OBJECTIVE

During the COVID-19 pandemic, community health workers (CHWs) served as front-line workers in the COVID-19 response while maintaining community health services. We aimed to understand challenges faced by Rwanda's CHWs during a nationwide COVID-19 lockdown that occurred between March and May 2020 by assessing the availability of trainings, supplies and supervision while exploring perceived needs and challenges.

DESIGN AND SETTING

This study was a mixed-method study conducted in three Rwandan districts: Burera, Kirehe and Kayonza.

MAIN OUTCOME AND MEASURE

Using data collected via telephone, we assessed the availability of trainings, supplies and supervision during the first national lockdown, while exploring perceived needs and challenges of CHWs who were engaged in COVID-19 response, in addition to their existing duties of delivering health services in the community.

RESULTS

Among the 292 quantitative survey participants, CHWs were responsible for a median of 55 households (IQR: 42-79) and visited a median of 30 households (IQR: 11-52) in the month prior to the survey (July 2020). In the previous 12 months, only 164 (56.2%) CHWs reported being trained on any health topic. Gaps in supply availability, particularly for commodities, existed at the start of the lockdown and worsened over the course of the lockdown. Supervision during the lockdown was low, with nearly 10% of CHWs never receiving supervision and only 24% receiving at least three supervision visits during the 3-month lockdown. In qualitative interviews, CHWs additionally described increases in workload, lack of personal protective equipment and COVID-specific training, fear of COVID-19, and difficult working conditions.

CONCLUSION

Many challenges faced by CHWs during the lockdown predated COVID-19 and persisted or were exacerbated during the pandemic. To promote the resilience of Rwanda's CHW system, we recommend increased access to PPE; investment in training, supervision and supply chain management; and financial compensation for CHWs.

An epidemiological, strategic and response analysis of the COVID-19 pandemic in South Asia: a population-based observational study

INTRODUCTION

South Asia has had a dynamic response to the ongoing COVID-19 pandemic. The overall burden and response have remained comparable across highly-burdened countries within the South Asian Region.

METHODOLOGY

Using a population-based observational design, all eight South Asian countries were analyzed using a step-wise approach. Data were obtained from government websites and publicly-available repositories for population dynamics and key variables.

RESULTS

South Asian countries have a younger average age of their population. Inequitable distribution of resources centered in urban metropolitan cities within South Asia is present. Certain densely populated regions in these countries have better testing and healthcare facilities that correlate with lower COVID-19 incidence per million populations. Trends of urban-rural disparities are unclear given the lack of clear reporting of the gaps within these regions. COVID-19 vaccination lag has become apparent in South Asian countries, with the expected time to complete the campaign being unfeasible as the COVID-19 pandemic progresses.

CONCLUSION

With a redesigning of governance policies on preventing the rise of COVID-19 promptly, the relief on the healthcare system and healthcare workers will allow for adequate time to roll out vaccination campaigns with equitable distribution. Capacity expansion of public health within the Region is required to ensure a robust healthcare response to the ongoing pandemic and future infectious disease outbreaks.

Contact dermatitis due to personal protective equipment use and hygiene practices during the COVID-19 pandemic: A systematic review of case reports

BACKGROUND

Prolonged use of personal protective equipment (PPE) may lead to contact dermatitis during the coronavirus disease 19 (COVID-19) pandemic. This paper aims to identify the causative factors of contact dermatitis from PPE and hygiene practices.

METHODS

The search was conducted adhering to PRISMA 2020 guidelines. A Delphi process was employed to ensure that the aims of this study were met. PubMed and Web of Science databases were systematically searched through September 12, 2021, using search terms: Contact dermatitis, case report, covid-19. The findings were tabulated as author/year, gender, age, presentation, cause, dermatological diagnosis, testing modality, provided treatment, symptom resolution (time in days), prognosis, and follow-up.

RESULTS

The mean age of all individuals was 29.75 years, with 75% females. All cases presented with erythema, with 62.5% reporting pruritus and 37.5% reporting burning facial symptoms. Surgical masks and hand-hygiene products (37.5%) were the most commonly reported causative agent with 25% due to KN95/FFP type 2 use. Allergic contact dermatitis (50%) and irritant contact dermatitis (25%) were common diagnoses. Treatments included creams, emollients, and desloratadine, with restriction of irritant-causing factors. The prognosis was generally good among the cases, with 62.5% presenting complete resolution within a week and 12.5% showing moderate improvement at the fourth month after discontinuing use.

CONCLUSION

This study finds pertinent links between PPE use and contact dermatitis during the COVID-19 pandemic. While many cases are bound to go underreported in literature, well-designed, large-scale studies in the future may help promote these associations in a more comprehensive manner.

Lessons learnt from emergency medicine services during the COVID-19 pandemic: A case study of India and the United States

India and the United States have both witnessed a high burden of COVID-19 infections since the pandemic was declared in early 2020. However, the COVID-19 restrictions have met with mixed responses in India and the US. Despite recommendations to continue social isolation and personal hygiene measures, India has not been able to curb the rise in daily cases. Our findings demonstrate the difference in the manner by which India and the US differ in their emergency handling of patients. We conducted a thorough review of the existing protocols and data concerning emergency responses in India and the US. The triage and care of suspected COVID-19 positive patients is different across India and the US. We find that there is a shortage of oxygenation, vaccination and other essential supplies in India. Further, the US is able to triage patients through telemedicine and EMS before suspected COVID-19 patients arrive, which is less prevalent in India. Our study identifies the importance of the emergency department (ED) as a critical contributor to the prevention and care of suspected and confirmed COVID-19 patients. Hospitals in India have been struggling to accommodate a huge influx of patients during its second wave with the ED playing a key link in their COVID-19 response.