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Kim E, Park Y, Choi H. Factors influencing nurses' compliance related to the use of personal protective equipment during the COVID-19 pandemic: A descriptive cross-sectional study. Nurs Open 2024; 11:e2235. [PMID: 38958036 PMCID: PMC11220485 DOI: 10.1002/nop2.2235] [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: 08/03/2023] [Revised: 06/11/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024] Open
Abstract
AIM To determine how nurses' experiences with the coronavirus disease (COVID-19) pandemic affected their knowledge, awareness, and compliance related to the use of personal protective equipment (PPE) during the COVID-19 pandemic in South Korea. DESIGN A descriptive cross-sectional study. METHODS A total of 247 nurses in South Korea participated in this study between May 10 and 19, 2023. An online self-report questionnaire was used to collect data on demographic and occupational characteristics, COVID-19 experience, knowledge, awareness, and compliance related to the use of PPE. Factors affecting compliance were analysed using hierarchical multiple linear regression. RESULTS Mean age of the nurses was 31.92, and 94.3% were women. Most had a bachelor's degree or higher and the mean clinical experience as a nurse was 6.45 years. Knowledge of the use of PPE was 8.45 out of 10, awareness was 3.52 out of 5, and compliance was 4.28 out of 5. Knowledge and awareness were correlated with compliance related to PPE use. Awareness (β = 0.234, p < 0.001), knowledge (β = 0.218, p < 0.001), experience caring for COVID-19 patients (β = 0.234, p = 0.004), optional fourth dose vaccine (β = 0.150, p = 0.017), clinical experience (β = 0.140, p = 0.022), and COVID-19 infection control education (β = 0.115, p = 0.037) were found to have a significant impact on compliance. CONCLUSION During the COVID-19 pandemic, nurses' knowledge and awareness of PPE use was a crucial factor in compliance. factors such as clinical experience, experience in caring for COVID-19 patients, optional vaccination, and completion of COVID-19 education also influenced compliance. We hope that these factors can provide a basis for developing training programs for nurses to respond to future emerging infectious diseases.
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Affiliation(s)
- Eun‐Jin Kim
- Department of NursingSeoul National University HospitalSeoulRepublic of Korea
| | - Yeon‐Hwan Park
- College of Nursing, The Research Institute of Nursing ScienceSeoul National UniversitySeoulRepublic of Korea
| | - Hye‐Ran Choi
- Department of Clinical NursingUniversity of UlsanSeoulRepublic of Korea
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Bubalo P, Nestic M, Martinovic S, Bakovic M, Mayer D, Mihic AG. Death by accidental intravenous administration of gasoline. Int J Legal Med 2024; 138:1315-1321. [PMID: 38332349 DOI: 10.1007/s00414-024-03181-8] [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: 11/23/2023] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
Herein, we present the case of accidental intravenous injection of gasoline in a 62-year-old male who was admitted to a dialysis center for his regular hemodialysis. Due to previous contact with another SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) positive patient, the hemodialysis was conducted in an isolated room. At the end of the procedure, the nurse, wearing all necessary personal protective equipment (PPE), in the intent to clean the dialysis catheter, applied medical gasoline, instead of 0.9% sodium chloride, intravenously to the patient. Soon afterwards, the patient's clinical condition deteriorated, and cardiopulmonary resuscitation was started. Despite the immediate reaction of the medical staff, after two successful cardiopulmonary reanimation and necessary intensive care measures, the patient suffered respiratory, metabolic, and lactic acidosis, hypotension, and tachyarrhythmia and ultimately died 7 h after the incident. The autopsy was conducted under the order of the district attorney. Main autopsy findings were marked congestion; right pleural and pericardial effusion; brain and lung edema; enlarged heart with left ventricle thickening and mild perivascular fibrosis; nephrosclerosis; tubular thyroidization; and interstitial fibrosis with inflammation. Gasoline presence was indisputably proven by conducted toxicology analysis in lung, bile, and brain samples. Traces of gasoline could be noted in the patient's blood sample in comparison to the blood that did not contain gasoline, but it was not possible to confidently claim that gasoline was present in the blood. Based on relevant findings, we concluded that the death of the patient was violent and that the cause of death was acute intoxication by gasoline.
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Affiliation(s)
- Pero Bubalo
- School of Medicine, University of Zagreb, Šalata 11, Zagreb, Croatia
| | - Marina Nestic
- School of Medicine, University of Zagreb, Šalata 11, Zagreb, Croatia
| | | | - Marija Bakovic
- School of Medicine, University of Zagreb, Šalata 11, Zagreb, Croatia
| | - Davor Mayer
- School of Medicine, University of Zagreb, Šalata 11, Zagreb, Croatia
| | - Anita Galic Mihic
- School of Medicine, University of Zagreb, Šalata 11, Zagreb, Croatia.
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Lee S, Hwang S, Kwon KT, Nam E, Chung US, Kim SW, Chang HH, Kim Y, Bae S, Shin JY, Bae SG, Ryoo HW, Jeong J, Oh N, Lee SH, Kim Y, Kang CK, Park HY, Park J, Park SY, Kim B, Cheong HS, Son JW, Lim SJ, Yun S, Oh WS, Park KH, Lee JY, Heo ST, Lee JY. Prevalence and Associated Factors of Depression and Anxiety Among Healthcare Workers During the Coronavirus Disease 2019 Pandemic: A Nationwide Study in Korea. J Korean Med Sci 2024; 39:e120. [PMID: 38599597 PMCID: PMC11004773 DOI: 10.3346/jkms.2024.39.e120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/05/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND A healthcare system's collapse due to a pandemic, such as the coronavirus disease 2019 (COVID-19), can expose healthcare workers (HCWs) to various mental health problems. This study aimed to investigate the impact of the COVID-19 pandemic on the depression and anxiety of HCWs. METHODS A nationwide questionnaire-based survey was conducted on HCWs who worked in healthcare facilities and public health centers in Korea in December 2020. Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to measure depression and anxiety. To investigate factors associated with depression and anxiety, stepwise multiple logistic regression analysis was performed. RESULTS A total of 1,425 participating HCWs were included. The mean depression score (PHQ-9) of HCWs before and after COVID-19 increased from 2.37 to 5.39, and the mean anxiety score (GAD-7) increased from 1.41 to 3.41. The proportion of HCWs with moderate to severe depression (PHQ-9 ≥ 10) increased from 3.8% before COVID-19 to 19.5% after COVID-19, whereas that of HCWs with moderate to severe anxiety (GAD-7 ≥ 10) increased from 2.0% to 10.1%. In our study, insomnia, chronic fatigue symptoms and physical symptoms after COVID-19, anxiety score (GAD-7) after COVID-19, living alone, and exhaustion were positively correlated with depression. Furthermore, post-traumatic stress symptoms, stress score (Global Assessment of Recent Stress), depression score (PHQ-9) after COVID-19, and exhaustion were positively correlated with anxiety. CONCLUSION In Korea, during the COVID-19 pandemic, HCWs commonly suffered from mental health problems, including depression and anxiety. Regularly checking the physical and mental health problems of HCWs during the COVID-19 pandemic is crucial, and social support and strategy are needed to reduce the heavy workload and psychological distress of HCWs.
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Affiliation(s)
- Shinwon Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Soyoon Hwang
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ki Tae Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - EunKyung Nam
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Un Sun Chung
- Department of Psychiatry, Kyungpook National University Children's Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Shin-Woo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun-Ha Chang
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yoonjung Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sohyun Bae
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ji-Yeon Shin
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang-Geun Bae
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Wook Ryoo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Juhwan Jeong
- Division of Infectious Diseases, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - NamHee Oh
- Hospital Infection Control Team, Daegu Medical Center, Daegu, Korea
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul, Korea
| | - Yeonjae Kim
- Division of Infectious Disease, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Yoon Park
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jiho Park
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Se Yoon Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hae Suk Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Woong Son
- Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea
| | - Su Jin Lim
- Division of Respiratory Diseases, Department of Internal Medicine, Masan Medical Center, Changwon, Korea
| | - Seongcheol Yun
- Department of Internal Medicine, Andong Medical Center, Andong, Korea
| | - Won Sup Oh
- Division of Infectious Diseases, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Kyung-Hwa Park
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Taek Heo
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Jeju National University, Jeju, Korea
| | - Ji-Yeon Lee
- Department of Counseling Psychology, Hankuk University of Foreign Studies, Seoul, Korea
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Dempster P, Hutchinson A, Oldland E, Bouchoucha SL. Australian emergency nurses' experiences of working with personal protective equipment during the COVID-19 pandemic. A qualitative study. Australas Emerg Care 2024; 27:63-70. [PMID: 37679286 DOI: 10.1016/j.auec.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/16/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has exposed a need to understand the challenges associated with wearing Personal protective Equipment (PPE). The aim in this study was to explore emergency nurses' experiences early in the COVID-19 pandemic in Australia and the impact of PPE use on their practice. METHODS An explorative descriptive qualitative study was conducted between January 2022 and April 2022. Eighteen emergency nurses and six leaders participated. Semi-structured interviews (n = 21) and one focus group were conducted. Interview transcripts were analysed using Braun and Clarke's framework. RESULTS Two major themes were identified. The first theme was: (1) The shifting ground of the COVID-19 pandemic response. Associated sub-themes were: i) What's the go with PPE today? ii) In the beginning we were scrambling for masks; iii) Emergency is the true frontline. The second theme was: (2) Physical and emotional impacts of emergency nursing work. Sub-themes were: (i) Facing the fear of exposure; (ii) By the end of the shift I am just absolutely spent; iii) Discomfort of wearing PPE impacts on compliance. CONCLUSIONS Healthcare leaders need to secure PPE supply chains and evaluate the effectiveness and side-effects of different PPE designs to minimise occupational harms associated with prolonged PPE use.
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Affiliation(s)
- Penelope Dempster
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Australia; Holmesglen Institute of TAFE.
| | - Ana Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research, Epworth Healthcare Partnership, Deakin University, Geelong, Australia; Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Deakin University, Geelong, Australia
| | - Elizabeth Oldland
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Stéphane L Bouchoucha
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Australia; Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Deakin University, Geelong, Australia
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Candido G, Tortù C, Seghieri C, Tartaglia R, Baglioni C, Citti P, Raciti IM, La Regina M, Simonini S, Urbani M, Parretti C, Barach P. Physical and stressful psychological impacts of prolonged personal protective equipment use during the COVID-19 pandemic: A cross-sectional survey study. J Infect Public Health 2023; 16:1281-1289. [PMID: 37329608 DOI: 10.1016/j.jiph.2023.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/19/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Healthcare workers (HCWs) caring for COVID-19 infected patients are exposed to stressful and traumatic events with potential for severe and sustained adverse mental and physical health consequences. Our aim was to assess the magnitude of physical and mental health outcomes of HCWs due to the prolonged use of personal protective equipment (PPE) treating COVID-19 patients. METHODS This cross-sectional study assessed the symptoms of stress, anxiety, insomnia, and psychological resilience using the Stress and Anxiety to Viral Epidemics (SAVE) scale, Insomnia Severity Index (ISI), and Resilience Scale (RS), respectively, in Italy between 1st February and 31st March 2022. The physical outcomes reported included vertigo, dyspnea, nausea, micturition desire, retroauricular pain, thirst, discomfort at work, physical fatigue, and thermal stress. The relationships between prolonged PPE use and psychological outcomes and physical discomforts were analyzed using Generalized Linear Models (GLMs). We calculated the factor mean scores and a binary outcome to measure study outcomes. FINDINGS We found that 23% of the respondents reported stress related symptoms, 33% anxiety, 43% moderate to severe insomnia, and 67% reported moderate to very low resilience. The GLMs suggested that older people (>55 years old) are less likely to suffer from stress compared to younger people (<35 y.o); conversely, HCW aged more than 35 years are more inclined to suffer from insomnia than younger people (<35 y.o). Female HCW reported a lower probability of resilience than males. University employed HCWs were less likely to report anxiety than those who worked in a community hospital. The odds of suffering from insomnia for social workers was significantly higher than for other HCWs. Female HCW>3 years old, enrolled in training programs for nursing, social work, technical training and other healthcare professionals increased the probability of reported physical discomforts. HCW that worked on non COVID-19 wards and used PPE for low-medium exposure level, were at lower risks for lasting physical side effects as compared to the HCW who worked in high-risk PPE intense, COVID-19 environments. INTERPRETATION The study suggests that frontline HCWs who had extensive PPE exposure while directly engaged in the diagnosis, treatment, and care for patients with COVID-19 are at significant risks for lasting physical and psychological harm and distress.
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Affiliation(s)
- Giuseppe Candido
- Department of Engineering Sciences, Guglielmo Marconi University, Rome, Italy
| | - Costanza Tortù
- Institute of Management, Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Chiara Seghieri
- Institute of Management, Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Riccardo Tartaglia
- Department of Engineering Sciences, Guglielmo Marconi University, Rome, Italy
| | - Chiara Baglioni
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Clinic for Sleep Psychotherapy, School of Cognitive Psychotherapy, Rome, Italy
| | - Paolo Citti
- Department of Engineering Sciences, Guglielmo Marconi University, Rome, Italy
| | | | | | | | | | - Chiara Parretti
- Department of Engineering Sciences, Guglielmo Marconi University, Rome, Italy
| | - Paul Barach
- Wayne State University, School of Medicine, Children's Hospital, Detroit, United States; Jefferson College of Population Health, Philadelphia, United States; University of Queensland, Queensland, Australia.
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Harris ML, McLeod A, Titler MG. Health Experiences of Nurses during the COVID-19 Pandemic: A Mixed Methods Study. West J Nurs Res 2023; 45:443-454. [PMID: 36625341 PMCID: PMC9834626 DOI: 10.1177/01939459221148825] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This study characterizes the impact of the COVID-19 pandemic on the mental and physical health of nurses. Qualitative data (collected using semi-structured interviews) were integrated with quantitative data (collected concurrently using the SF-12 Health Survey). Nurses (N = 30) compared their health prior to and during the first pandemic wave (March-May 2020). Interviews were analyzed thematically; descriptive statistics and t-tests compared pre-pandemic to current SF-12 scores. Qualitative findings demonstrated an impact on nurses' mental health expressed as isolation, loss, intense emotions, and feelings of being expendable. Impact on nurses' physical health included exhaustion, personal protective equipment skin breakdown, limited breaks from work, and virus exposure. Quantitative results show nurses' experienced declines in overall mental health (p < .001), and multiple physical health domains: role limitations due to physical problems (p < .0001), bodily pain (p < .0001), and general health (p < .0001). Promotion of nurses' well-being and safety, as well as education in emergency preparedness, must be given precedence to protect nurses' health.
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Affiliation(s)
- Melissa L. Harris
- Center of Innovation to Accelerate
Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham,
NC, USA,Clinical and Translational Science
Institute, Duke University, Durham, NC, USA,University of Michigan School of
Nursing, Ann Arbor, MI, USA,Melissa L. Harris, Clinical and
Translational Science Institute, Duke University, 710 W. Main St. Durham NC
27701, USA.
| | - Anne McLeod
- University of Michigan School of
Nursing, Ann Arbor, MI, USA,University of Michigan, Michigan
Medicine, Transplant Center, Ann Arbor, MI, USA
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Chen JQ, Zhang XQ, Shen JH, Guo YF, Lei GF, Tong L, Wang H, Li DH. The Relationship Between Mindfulness, Fatigue, and Perceived Symptoms Among Frontline Nurses Who Performed Nucleic Acid Sample Collection During the COVID-19 in China: A Cross-Sectional Study. Psychol Res Behav Manag 2023; 16:1165-1180. [PMID: 37077763 PMCID: PMC10108863 DOI: 10.2147/prbm.s401764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/05/2023] [Indexed: 04/21/2023] Open
Abstract
Objective Given the immense stress faced by medical staff during the COVID-19 pandemic, this study aimed to evaluate the relationship between mindful attention awareness, fatigue, and perceived symptoms among frontline nurses who performed nucleic acid sample collection during the COVID-19 pandemic, to reduce their fatigue and help them cope with perceived uncomfortable symptoms. Methods A convenience sampling method was used to survey nurses who travelled to Hainan for nucleic acid sampling in August 2022 using an online (WeChat) questionnaire. A total of 514 frontline nurses who performed nucleic acid tests completed the questionnaire. The questionnaire covered basic demographic information, Mindful Attention Awareness Scale (MAAS) ratings, and Fatigue Severity Scale (FSS) ratings. Spearman correlation analysis was used to separate the relationship between MASS and FSS, and univariate and multivariate factor analyses were used to explore the relevant influences contributing to the occurrence of fatigue. Results A total of 514 individuals completed the survey,93.97% (n=483) were female, mean age was 31.15 ± 5.7, MASS score was 69.01 ± 13.53, and 296 (57.59%) nurses experienced symptoms of fatigue during the auxiliary period. Spearman correlation analysis showed that FSS was associated with MASS. Multifactorial analysis showed that sex, age, marital status, fertility status, years of work, adaptation to dietary habits, hidrorrhea, and MAAS scores affected the presence of fatigue symptoms among the medical staff in Hainan (P<0.05). Conclusion The psychological status of frontline nurses undergoing nucleic acid testing during the pandemic was poor, and the appearance of fatigue symptoms could be effectively reduced by increasing levels of positive thinking among medical staff to help them cope with public health emergencies.
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Affiliation(s)
- Jian-qin Chen
- Department of Nursing, The First People’s Hospital of Changde City, Changde, Hunan Province, People’s Republic of China
| | - Xue-qing Zhang
- Department of Nursing, The First People’s Hospital of Changde City, Changde, Hunan Province, People’s Republic of China
| | - Jin-hua Shen
- Department of Nursing, The First People’s Hospital of Changde City, Changde, Hunan Province, People’s Republic of China
| | - Ya-fen Guo
- Department of Nursing, The First People’s Hospital of Changde City, Changde, Hunan Province, People’s Republic of China
| | - Guang-feng Lei
- Department of Nursing, The First People’s Hospital of Changde City, Changde, Hunan Province, People’s Republic of China
| | - Li Tong
- Department of Nursing, The First People’s Hospital of Changde City, Changde, Hunan Province, People’s Republic of China
| | - Hui Wang
- Department of Nursing, The First People’s Hospital of Changde City, Changde, Hunan Province, People’s Republic of China
| | - De-hui Li
- Department of Infectious Diseases, The First People’s Hospital of Changde City, Changde, Hunan Province, People’s Republic of China
- Correspondence: De-hui Li, Department of Infectious Diseases, The First People’s Hospital of Changde City, 818 Ren min Road, Changde, Hunan Province, People’s Republic of China, Email
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