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Holland SM. Challenges and Solutions to Patient Safety During a Pandemic. Crit Care Nurs Clin North Am 2024; 36:323-336. [PMID: 39069353 DOI: 10.1016/j.cnc.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
When exploring the realm of Patient Safety in the context of a COVID-19 global pandemic, the traditional methods of assessment may not be sufficient. This was a crisis that could not be isolated to intensive care units or the hospital environment. In addition to patient safety, one must consider the safety of health care providers and others. Understanding human behavior when faced with a novel disease such as COVID-19 may help prepare for the future when society may once again face a public health crisis together.
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Affiliation(s)
- Susan M Holland
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
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2
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Bartsch SM, O'Shea KJ, Weatherwax C, Strych U, Velmurugan K, John DC, Bottazzi ME, Hussein M, Martinez MF, Chin KL, Ciciriello A, Heneghan J, Dibbs A, Scannell SA, Hotez PJ, Lee BY. What Is the Economic Benefit of Annual COVID-19 Vaccination From the Adult Individual Perspective? J Infect Dis 2024; 230:382-393. [PMID: 38581432 PMCID: PMC11326810 DOI: 10.1093/infdis/jiae179] [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: 01/19/2024] [Revised: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND With coronavirus disease 2019 (COVID-19) vaccination no longer mandated by many businesses/organizations, it is now up to individuals to decide whether to get any new boosters/updated vaccines going forward. METHODS We developed a Markov model representing the potential clinical/economic outcomes from an individual perspective in the United States of getting versus not getting an annual COVID-19 vaccine. RESULTS For an 18-49 year old, getting vaccinated at its current price ($60) can save the individual on average $30-$603 if the individual is uninsured and $4-$437 if the individual has private insurance, as long as the starting vaccine efficacy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is ≥50% and the weekly risk of getting infected is ≥0.2%, corresponding to an individual interacting with 9 other people in a day under Winter 2023-2024 Omicron SARS-CoV-2 variant conditions with an average infection prevalence of 10%. For a 50-64 year old, these cost-savings increase to $111-$1278 and $119-$1706 for someone without and with insurance, respectively. The risk threshold increases to ≥0.4% (interacting with 19 people/day), when the individual has 13.4% preexisting protection against infection (eg, vaccinated 9 months earlier). CONCLUSIONS There is both clinical and economic incentive for the individual to continue to get vaccinated against COVID-19 each year.
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Affiliation(s)
- Sarah M Bartsch
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Kelly J O'Shea
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Colleen Weatherwax
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Ulrich Strych
- National School of Tropical Medicine, Department of Pediatrics, and Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, Texas, USA
| | - Kavya Velmurugan
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Danielle C John
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Maria Elena Bottazzi
- National School of Tropical Medicine, Department of Pediatrics, and Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, Texas, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Mustafa Hussein
- Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
| | - Marie F Martinez
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Kevin L Chin
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Allan Ciciriello
- National School of Tropical Medicine, Department of Pediatrics, and Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, Texas, USA
| | - Jessie Heneghan
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Alexis Dibbs
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Sheryl A Scannell
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Peter J Hotez
- National School of Tropical Medicine, Department of Pediatrics, and Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, Texas, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Bruce Y Lee
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
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Minehmorad M, Nemati-Vakilabad R, Badpeyma M, Mirzaei A. Examining nurses' understanding and knowledge about preparation for COVID-19 in Ardabil hospitals in Iran. BMC Health Serv Res 2024; 24:312. [PMID: 38454446 PMCID: PMC10921800 DOI: 10.1186/s12913-024-10826-2] [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: 02/08/2024] [Accepted: 03/05/2024] [Indexed: 03/09/2024] Open
Abstract
AIMS The purpose of this study was to evaluate the preparedness of Iranian nurses for potential pandemics. BACKGROUND Nurses play a critical role in managing pandemics. They require adequate training, proper equipment, and organizational support to be well-prepared. METHODS A descriptive cross-sectional study was conducted in Ardabil, Iran, from July to September 2023, involving 233 nurses from five hospitals. The number of nurses required for each hospital was calculated based on the proportion of nurses in each hospital. Data was collected through a paper-based form that included information about the participants' demographic characteristics and their level of pandemic preparedness in health services. The collected data was analyzed using descriptive statistics to determine the demographic characteristics and levels of pandemic preparedness. Pearson's test was also conducted to establish a relationship between different dimensions of pandemic preparedness. RESULTS Most participants relied on clinical measures and supported using human resources and environmental methods to curb the transmission of a pandemic. They felt assured in their ability to explain the preventive measures against the pandemic. However, fewer respondents had access to healthcare improvement programs, and only a few worked remotely from home. CONCLUSIONS According to our study, 90.1% of nurses believe hand washing is the most effective way to prevent spreading infections. Additionally, healthcare professionals can use various tools to respond to the pandemic, including screening for COVID-19 at work, health and wellness programs, telecommuting, COVID-19 Safe programs, social media, and posters. Nurses need continuous education in hand hygiene, health programs, remote work options, and pandemic-safe programs to control infections, reduce risks, and optimize patient care during the pandemic.
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Affiliation(s)
- Milad Minehmorad
- Students Research Committee, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Reza Nemati-Vakilabad
- Students Research Committee, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
- Student Research Committee, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Badpeyma
- Students Research Committee, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Alireza Mirzaei
- Department of Emergency Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran.
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Linsenmeyer K, Mohr D, Gupta K, Doshi S, Gifford AL, Charness ME. Sickness presenteeism in healthcare workers during the coronavirus disease 2019 (COVID-19) pandemic: An observational cohort study. Infect Control Hosp Epidemiol 2023; 44:1693-1696. [PMID: 37039605 PMCID: PMC10587373 DOI: 10.1017/ice.2023.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/03/2023] [Accepted: 02/17/2023] [Indexed: 04/12/2023]
Abstract
Sickness presenteeism among healthcare workers (HCW) risks nosocomial infection, but its prevalence among HCW with COVID-19 is unknown. Contemporaneous interviews revealed a sickness presenteeism prevalence of 49.8% among 255 HCW with symptomatic COVID-19. Presenteeism prevalence did not differ among HCW with and without specific COVID-19 symptoms or direct patient care.
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Affiliation(s)
- Katherine Linsenmeyer
- Veterans' Affairs (VA) Boston Healthcare System, West Roxbury, Massachusetts
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - David Mohr
- Veterans' Affairs (VA) Boston Healthcare System, West Roxbury, Massachusetts
- Department of Health Law Policy & Management, Boston University School of Public Health, Boston, Massachusetts
- VA Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
| | - Kalpana Gupta
- Veterans' Affairs (VA) Boston Healthcare System, West Roxbury, Massachusetts
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Sucheta Doshi
- Veterans' Affairs (VA) Boston Healthcare System, West Roxbury, Massachusetts
- Department of Medicine, Harvard Medical School, BostonMassachusetts
| | - Allen L Gifford
- Veterans' Affairs (VA) Boston Healthcare System, West Roxbury, Massachusetts
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Health Law Policy & Management, Boston University School of Public Health, Boston, Massachusetts
- VA Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
| | - Michael E Charness
- Veterans' Affairs (VA) Boston Healthcare System, West Roxbury, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Haanappel CP, Oude Munnink BB, Sikkema RS, Voor In 't Holt AF, de Jager H, de Boever R, Koene HHHT, Boter M, Chestakova IV, van der Linden A, Molenkamp R, Osbak KK, Arcilla MS, Vos MC, Koopmans MPG, Severin JA. Combining epidemiological data and whole genome sequencing to understand SARS-CoV-2 transmission dynamics in a large tertiary care hospital during the first COVID-19 wave in The Netherlands focusing on healthcare workers. Antimicrob Resist Infect Control 2023; 12:46. [PMID: 37165456 PMCID: PMC10170429 DOI: 10.1186/s13756-023-01247-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/29/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Healthcare facilities have been challenged by the risk of SARS-CoV-2 transmission between healthcare workers (HCW) and patients. During the first wave of the COVID-19 pandemic, infections among HCW were observed, questioning infection prevention and control (IPC) measures implemented at that time. AIM This study aimed to identify nosocomial transmission routes of SARS-CoV-2 between HCW and patients in a tertiary care hospital. METHODS All SARS-CoV-2 PCR positive HCW and patients identified between 1 March and 19 May 2020, were included in the analysis. Epidemiological data were collected from patient files and HCW contact tracing interviews. Whole genome sequences of SARS-CoV-2 were generated using Nanopore sequencing (WGS). Epidemiological clusters were identified, whereafter WGS and epidemiological data were combined for re-evaluation of epidemiological clusters and identification of potential transmission clusters. HCW infections were further classified into categories based on the likelihood that the infection was acquired via nosocomial transmission. Secondary cases were defined as COVID-19 cases in our hospital, part of a transmission cluster, of which the index case was either a patient or HCW from our hospital. FINDINGS The study population consisted of 293 HCW and 245 patients. Epidemiological data revealed 36 potential epidemiological clusters, with an estimated 222 (75.7%) HCW as secondary cases. WGS results were available for 195 HCW (88.2%) and 20 patients (12.8%) who belonged to an epidemiological cluster. Re-evaluation of the epidemiological clusters, with the available WGS data identified 31 transmission clusters with 65 (29.4%) HCW as secondary cases. Transmission clusters were all part of 18 (50.0%) previously determined epidemiological clusters, demonstrating that several larger outbreaks actually consisted, of several smaller transmission clusters. A total of 21 (7.2%) HCW infections were classified as from confirmed nosocomial, of which 18 were acquired from another HCW and 3 from a patient. CONCLUSION The majority of SARS-CoV-2 infections among HCW could be attributed to community-acquired infection. Infections among HCW that could be classified as due to nosocomial transmission, were mainly caused by HCW-to-HCW transmission rather than patient-to-HCW transmission. It is important to recognize the uncertainties of cluster analyses based solely on epidemiological data.
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Affiliation(s)
- Cynthia P Haanappel
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, 3000 CA, Rotterdam, The Netherlands
| | - Bas B Oude Munnink
- Department of Viroscience, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Reina S Sikkema
- Department of Viroscience, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, 3000 CA, Rotterdam, The Netherlands
| | - Herbert de Jager
- Department of Occupational Health Services, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rieneke de Boever
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, 3000 CA, Rotterdam, The Netherlands
| | - Heidy H H T Koene
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, 3000 CA, Rotterdam, The Netherlands
| | - Marjan Boter
- Department of Viroscience, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irina V Chestakova
- Department of Viroscience, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anne van der Linden
- Department of Viroscience, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Richard Molenkamp
- Department of Viroscience, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kara K Osbak
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, 3000 CA, Rotterdam, The Netherlands
| | - Maris S Arcilla
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, 3000 CA, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, 3000 CA, Rotterdam, The Netherlands
| | - Marion P G Koopmans
- Department of Viroscience, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Juliëtte A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, 3000 CA, Rotterdam, The Netherlands.
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Scanferla G, Héquet D, Graf N, Münzer T, Kessler S, Kohler P, Nussbaumer A, Petignat C, Schlegel M, Flury D. COVID-19 burden and influencing factors in Swiss long-term-care facilities: a cross-sectional analysis of a multicentre observational cohort. Swiss Med Wkly 2023; 153:40052. [PMID: 37011609 DOI: 10.57187/smw.2023.40052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVES: To describe the burden of COVID-19 in Swiss long-term care facilities in 2020, to identify its influencing factors, and to assess vaccination rates among residents and healthcare workers at the end of the vaccine campaign in Switzerland in May 2021.
DESIGN: Cross-sectional survey.
SETTING AND PARTICIPANTS: Long-term care facilities from two Swiss cantons (St. Gallen / Eastern Switzerland and Vaud / Western Switzerland).
METHODS: We collected numbers of COVID-19 cases and related deaths and all-cause mortality for 2020, potential risk factors at the institutional level (e.g. size, infection prevention and control measures, and resident characteristics), and vaccination rates among residents and healthcare workers. Univariate and multivariate analyses were used to identify factors associated with resident mortality in 2020.
RESULTS: We enrolled 59 long-term care facilities with a median of 46 (interquartile range [IQR]: 33–69) occupied beds. In 2020, the median COVID-19 incidence was 40.2 (IQR: 0–108.6) per 100 occupied beds, with higher rates in VD (49.9%) than in SG (32.5%; p = 0.037). Overall, 22.7% of COVID-19 cases died, of which 24.8% were COVID-19-related deaths. In the univariate analysis, higher resident mortality was associated with COVID-19 rates among residents (p < 0.001) and healthcare workers (p = 0.002) and age (p = 0.013). Lower resident mortality was associated with the proportion of single rooms (p = 0.012), isolation of residents with COVID-19 in single rooms (p = 0.003), symptom screening of healthcare workers (p = 0.031), limiting the number of visits per day (p = 0.004), and pre-scheduling visits (p = 0.037). In the multivariate analysis, higher resident mortality was only associated with age (p = 0.03) and the COVID-19 rate among residents (p = 0.013). Among 2936 residents, 2042 (69.9%) received ≥1 dose of the COVID-19 vaccine before 31 May 2021. Vaccine uptake among healthcare workers was 33.8%.
CONCLUSION AND IMPLICATIONS: COVID-19 burden was high but also highly variable in Swiss long-term care facilities. severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers was a modifiable factor associated with increased resident mortality. Symptom screening of healthcare workers appeared to be an effective preventive strategy and should be included in routine infection prevention and control measures. Promoting COVID-19 vaccine uptake among healthcare workers should be a priority in Swiss long-term care facilities.
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Affiliation(s)
- Giulia Scanferla
- Department of Infectious Diseases/Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Delphine Héquet
- Unité cantonale hygiène, prévention et contrôle de l'infection, Canton de Vaud, Switzerland
| | - Nicole Graf
- Clinical Trials Unit (CTU), Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | - Simone Kessler
- Department of Infectious Diseases/Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Philipp Kohler
- Department of Infectious Diseases/Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Andres Nussbaumer
- Department of Infectious Diseases/Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Christiane Petignat
- Department of Infectious Diseases/Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Matthias Schlegel
- Department of Infectious Diseases/Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Domenica Flury
- Department of Infectious Diseases/Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
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Giubilini A, Savulescu J, Pugh J, Wilkinson D. Vaccine mandates for healthcare workers beyond COVID-19. JOURNAL OF MEDICAL ETHICS 2023; 49:211-220. [PMID: 35636917 PMCID: PMC9985724 DOI: 10.1136/medethics-2022-108229] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/12/2022] [Indexed: 05/06/2023]
Abstract
We provide ethical criteria to establish when vaccine mandates for healthcare workers are ethically justifiable. The relevant criteria are the utility of the vaccine for healthcare workers, the utility for patients (both in terms of prevention of transmission of infection and reduction in staff shortage), and the existence of less restrictive alternatives that can achieve comparable benefits. Healthcare workers have professional obligations to promote the interests of patients that entail exposure to greater risks or infringement of autonomy than ordinary members of the public. Thus, we argue that when vaccine mandates are justified on the basis of these criteria, they are not unfairly discriminatory and the level of coercion they involve is ethically acceptable-and indeed comparable to that already accepted in healthcare employment contracts. Such mandates might be justified even when general population mandates are not. Our conclusion is that, given current evidence, those ethical criteria justify mandates for influenza vaccination, but not COVID-19 vaccination, for healthcare workers. We extend our arguments to other vaccines.
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Affiliation(s)
- Alberto Giubilini
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jonathan Pugh
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Care, John Radcliffe Hospital, Oxford, UK
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Survey of healthcare worker perceptions of changes in infection control and antimicrobial stewardship practices in India and South Africa during the COVID-19 pandemic. IJID REGIONS 2023; 6:90-98. [PMID: 36466212 PMCID: PMC9703863 DOI: 10.1016/j.ijregi.2022.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/24/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
Objective To identify perceptions and awareness of changes in infection prevention and control (IPC) and antimicrobial stewardship (AMS) practices among healthcare workers (HCWs) during the COVID-19 pandemic in India and South Africa (SA). Method A self-administered online survey which included participant demographics, knowledge and sources of COVID-19 infection, perceived risks and barriers, and self-efficacy. Data were analysed using descriptive statistics. Results The study received 321 responses (response rate: 89.2%); 131/321 (40.8%) from India and 190/321 (59.2%) from SA; male to female response rate was 3:2, with majority of respondents aged 40-49 (89/321, 27.7%) and 30-39 (87/321, 27.1%) years. Doctors comprised 47.9% (57/119) of respondents in India and 74.6% (135/181) in SA. Majority of respondents in India (93/119, 78.2%) and SA (132/181, 72.9%) were from the private and public sectors, respectively, with more respondents in SA (123/174, 70.7%) than in India (38/104, 36.5%) involved in antimicrobial prescribing.Respondents reported increased IPC practices since the pandemic and noted a need for more training on case management, antibiotic and personal protective equipment (PPE) use. While they noted increased antibiotic prescribing since the pandemic, they did not generally associate their practice with such an increase. A willingness to be vaccinated, when vaccination becomes available, was expressed by 203/258 (78.7%) respondents. Conclusions HCWs reported improved IPC practices and changes in antibiotic prescribing during the COVID-19 pandemic. Targeted education on correct use of PPE was an identified gap. Although HCWs expressed concerns about antimicrobial resistance, their self-perceived antibiotic prescribing practices seemed unchanged. Additional studies in other settings could explore how our findings fit other contexts.
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Blanchet Zumofen MH, Frimpter J, Hansen SA. Impact of Influenza and Influenza-Like Illness on Work Productivity Outcomes: A Systematic Literature Review. PHARMACOECONOMICS 2023; 41:253-273. [PMID: 36515814 PMCID: PMC9748403 DOI: 10.1007/s40273-022-01224-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Influenza is a persistent public health problem with a significant burden on patients, employers, and society. A systematic review by Keech and Beardsworth (2008) characterized the burden of influenza/influenza-like illness (ILI) on absenteeism. We conducted a systematic literature review evaluating the impact of influenza/ILI on work productivity among adults as an update to the work of Keech and Beardsworth. METHODS This systematic review identified studies evaluating the impact of influenza/ILI on absenteeism, presenteeism, or related work productivity measures for employees and employed caregivers based on laboratory confirmation, physician diagnosis, and/or self-reported illness. Eligible studies were in English, French, or German published from 7 March 2007 through 15 February 2022, in PubMed, Embase, or BIOSIS. Two reviewers completed screening and full-text review, with conflicts resolved by a third advisor. Summary data were extracted by two analysts; all records were quality checked by one analyst. Work productivity outcomes were summarized qualitatively, and risk of bias was not evaluated. RESULTS A total of 14,387 records were retrieved; 12,245 titles/abstracts were screened and 145 full-text publications were reviewed, of which 63 were included in the qualitative assessment. Studies of self-reported ILI were most frequent (49%), followed by laboratory-confirmed cases (37%) and physician diagnoses (11%). Overall, approximately 20-75% of employees missed work due to illness across study settings and populations. Mean time out of work among ill employees varied widely across study designs and populations, ranging from < 1 to > 10 days, and was often reported to be approximately 2-3 days. Considerable heterogeneity was observed across study designs, populations, and outcomes. Most employees (≈ 60-80%) reported working while experiencing influenza/ILI symptoms. Reporting of costs was sparse and heterogeneous; one study reported annual costs of influenza-related absences equating to $42,851 per 100,000 employee health plan members. Results were partitioned based on the following categories. Among otherwise healthy adults, 1-74% of workers missed ≥1 workday due to influenza/ILI, for a mean [standard deviation (SD)] of 0.5 (1.44) to 5.3 (4.50) days, and 42-89% reported working while ill, for a mean (SD) of 0.3 (0.63) to 4.4 (3.73) days. Among working caregivers, 50-75% missed work to care for children/household members with influenza/ILI, for 1-2 days on average. Similarly, the mean absenteeism among healthcare workers ranged from 0.5 to 3.2 days. Across studies evaluating vaccination status, generally smaller proportions of vaccinated employees missed time from work due to influenza/ILI. CONCLUSIONS This systematic review summarized the productivity burden of influenza/ILI on the worldwide working-age population. Despite notable heterogeneity in study designs, influenza/ILI case definitions, and productivity outcome measures, this review highlighted the substantial productivity burden that influenza/ILI may have on employees, employers, and society, consistent with the findings of Keech and Beardsworth (2008).
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10
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Walker NF, Byrne RL, Howard A, Nikolaou E, Farrar M, Glynn S, Cheliotis KS, Cubas Atienzar AI, Davies K, Reiné J, Rashid-Gardner Z, German EL, Solórzano C, Blandamer T, Hitchins L, Myerscough C, Gessner BD, Begier E, Collins AM, Beadsworth M, Todd S, Hill H, Houlihan CF, Nastouli E, Adams ER, Mitsi E, Ferreira DM. Detection of SARS-CoV-2 infection by saliva and nasopharyngeal sampling in frontline healthcare workers: An observational cohort study. PLoS One 2023; 18:e0280908. [PMID: 36706119 PMCID: PMC9882898 DOI: 10.1371/journal.pone.0280908] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic has caused an unprecedented strain on healthcare systems worldwide, including the United Kingdom National Health Service (NHS). We conducted an observational cohort study of SARS-CoV-2 infection in frontline healthcare workers (HCW) working in an acute NHS Trust during the first wave of the pandemic, to answer emerging questions surrounding SARS-CoV-2 infection, diagnosis, transmission and control. METHODS Using self-collected weekly saliva and twice weekly combined oropharyngeal/nasopharyngeal (OP/NP) samples, in addition to self-assessed symptom profiles and isolation behaviours, we retrospectively compared SARS-CoV-2 detection by RT-qPCR of saliva and OP/NP samples. We report the association with contemporaneous symptoms and isolation behaviour. RESULTS Over a 12-week period from 30th March 2020, 40·0% (n = 34/85, 95% confidence interval 31·3-51·8%) HCW had evidence of SARS-CoV-2 infection by surveillance OP/NP swab and/or saliva sample. Symptoms were reported by 47·1% (n = 40) and self-isolation by 25·9% (n = 22) participants. Only 44.1% (n = 15/34) participants with SARS-CoV-2 infection reported any symptoms within 14 days of a positive result and only 29·4% (n = 10/34) reported self-isolation periods. Overall agreement between paired saliva and OP/NP swabs was 93·4% (n = 211/226 pairs) but rates of positive concordance were low. In paired samples with at least one positive result, 35·0% (n = 7/20) were positive exclusively by OP/NP swab, 40·0% (n = 8/20) exclusively by saliva and in only 25·0% (n = 5/20) were the OP/NP and saliva result both positive. CONCLUSIONS HCW are a potential source of SARS-CoV-2 transmission in hospitals and symptom screening will identify the minority of infections. Without routine asymptomatic SARS-CoV-2 screening, it is likely that HCW with SARS-CoV-2 infection would continue to attend work. Saliva, in addition to OP/NP swab testing, facilitated ascertainment of symptomatic and asymptomatic SARS-CoV-2 infections. Combined saliva and OP/NP swab sampling would improve detection of SARS-CoV-2 for surveillance and is recommended for a high sensitivity strategy.
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Affiliation(s)
- Naomi F. Walker
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Rachel L. Byrne
- Centre for Drugs and Diagnostics, Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ashleigh Howard
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elissavet Nikolaou
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Infection and Immunity, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Madlen Farrar
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sharon Glynn
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Ana I. Cubas Atienzar
- Centre for Drugs and Diagnostics, Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kelly Davies
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jesús Reiné
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Zalina Rashid-Gardner
- NIHR Liverpool and Broadgreen Clinical Research Facility, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Esther L. German
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Carla Solórzano
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Tess Blandamer
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Lisa Hitchins
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | | | - Elizabeth Begier
- Pfizer Vaccines, Collegeville, Pennsylvania, United States of America
| | - Andrea M. Collins
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- National Institute for Health Research North West Coast, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Mike Beadsworth
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Stacy Todd
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Liverpool Health Partners, Liverpool, United Kingdom
| | - Helen Hill
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Catherine F. Houlihan
- Department of Clinical Virology, University College London Hospitals, London, United Kingdom
- Department of Infection, Immunity and inflammation, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Eleni Nastouli
- Department of Clinical Virology, University College London Hospitals, London, United Kingdom
| | - Emily R. Adams
- Centre for Drugs and Diagnostics, Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elena Mitsi
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Daniela M. Ferreira
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
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11
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Sibanda M, Meyer JC, Godman B, Burnett RJ. Low influenza vaccine uptake by healthcare workers caring for the elderly in South African old age homes and primary healthcare facilities. BMC Public Health 2023; 23:91. [PMID: 36635715 PMCID: PMC9834679 DOI: 10.1186/s12889-022-14926-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/21/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The elderly bear the highest burden of South Africa's estimated annual > 10 million influenza cases and > 11,000 influenza-related deaths. Unvaccinated healthcare workers (HCWs) are at high occupational risk of contracting influenza, and may transmit influenza to elderly patients in their care. Thus, the South African National Department of Health recommends that HCWs receive annual influenza vaccination. This study aimed to determine influenza vaccination coverage among HCWs; identify reasons for their vaccination status; and investigate if HCWs recommend vaccination to their elderly patients. METHODS A descriptive study was conducted in 18 community health centres and 44 private sector and non-governmental organisation managed old age homes across South Africa, using a self-administered structured questionnaire, which was distributed to 360 HCWs present on the day of data collection. Data were captured using Microsoft Excel® and imported to Epi Info™ 7 (Centers for Disease Control and Prevention, USA) for descriptive statistical analysis. Ethics approval (SMUREC/P/36/2018: PG) and permission to conduct the study at the facilities were obtained. All participants provided informed consent. RESULTS The response rate was 76.7% (276/360). Most participants were female (90.9% [251/276]), nursing professionals (81.2% [224/276]) with a mean age of 41.1 ± 11.7 years. Although 62.7% of participants indicated having ever received at least one dose of the influenza vaccine, influenza vaccine uptake for 2017 and 2018 was 24.36% (41/276) and 33.3% (92/276) respectively. The main reasons given for never being vaccinated against influenza were related to the unavailability of the vaccine (70.9%) and vaccine hesitancy (27.2%). Most participants (67.8% [187/276]) recommended vaccines to elderly patients in their care. CONCLUSION The main reasons behind low influenza vaccine uptake by HCWs in South Africa who care for the elderly were related to unavailability of the vaccine and vaccine hesitancy. Strategies to educate HCWs on the importance of influenza vaccination, while concurrently increasing sustained and easy access to the vaccine by HCWs are needed to preserve public health.
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Affiliation(s)
- Mncengeli Sibanda
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Rosemary J. Burnett
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
- Department of Virology, School of Medicine, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
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12
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Chiu SK, Hornsby-Myers J, Iverson C, Trout D. A Cluster of Health Symptoms After a Law Enforcement Operation: A Case Study. Saf Health Work 2022; 13:507-511. [PMID: 36579004 PMCID: PMC9772466 DOI: 10.1016/j.shaw.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/07/2022] [Accepted: 08/15/2022] [Indexed: 12/31/2022] Open
Abstract
Law enforcement officers (LEOs) often encounter rapidly changing and uncontrolled situations that expose them to various hazards. A law enforcement agency requested an evaluation by the National Institute for Occupational Safety and Health (NIOSH) when multiple LEOs reported illness after executing a search warrant and taking a suspect into custody. NIOSH investigators interviewed LEOs and reviewed medical records, forensic laboratory results for collected evidence, and environmental testing results of samples taken after the operation. Two-thirds (25 of 38) of LEOs who participated in the operation reported ≥1 symptom. Eleven LEOs met a case definition for influenza-like illness (ILI). Members of one unit were more likely to have ILI than non-members (prevalence ratio (PR), 4.1; 95% confidence interval (CI): 1.3-13.0; p = 0.01). Influenza vaccination was associated with a lower prevalence of ILI (PR, 0.2; 95% CI, 0.1-0.9; p = 0.02). Preventing employees from working while ill and annual influenza vaccination might prevent similar occurrences.
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Affiliation(s)
- Sophia K. Chiu
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
- Corresponding author. National Institute for Occupational Safety and Health, 1090 Tusculum Ave, Mailstop R-9, Cincinnati, OH 45226-1938, USA.
| | - Jennifer Hornsby-Myers
- Emergency Preparedness and Response Office, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Christopher Iverson
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
- Division of Pulmonary, Critical Care, and Occupational Medicine, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Douglas Trout
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
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13
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Borg BM, Osadnik C, Adam K, Chapman DG, Farrow CE, Glavas V, Hancock K, Lanteri CJ, Morris EG, Romeo N, Schneider‐Futschik EK, Selvadurai H. Pulmonary function testing during SARS-CoV-2: An ANZSRS/TSANZ position statement. Respirology 2022; 27:688-719. [PMID: 35981737 PMCID: PMC9539179 DOI: 10.1111/resp.14340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022]
Abstract
The Thoracic Society of Australia and New Zealand (TSANZ) and the Australian and New Zealand Society of Respiratory Science (ANZSRS) commissioned a joint position paper on pulmonary function testing during coronavirus disease 2019 (COVID-19) in July 2021. A working group was formed via an expression of interest to members of both organizations and commenced work in September 2021. A rapid review of the literature was undertaken, with a 'best evidence synthesis' approach taken to answer the research questions formed. This allowed the working group to accept findings of prior relevant reviews or societal document where appropriate. The advice provided is for providers of pulmonary function tests across all settings. The advice is intended to supplement local infection prevention and state, territory or national directives. The working group's key messages reflect a precautionary approach to protect the safety of both healthcare workers (HCWs) and patients in a rapidly changing environment. The decision on strategies employed may vary depending on local transmission and practice environment. The advice is likely to require review as evidence grows and the COVID-19 pandemic evolves. While this position statement was contextualized specifically to the COVID-19 pandemic, the working group strongly advocates that any changes to clinical/laboratory practice, made in the interest of optimizing the safety and well-being of HCWs and patients involved in pulmonary function testing, are carefully considered in light of their potential for ongoing use to reduce transmission of other droplet and/or aerosol borne diseases.
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Affiliation(s)
- Brigitte M. Borg
- Respiratory MedicineThe AlfredMelbourneVictoriaAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Christian Osadnik
- Department of PhysiotherapyMonash UniversityFrankstonVictoriaAustralia
- Monash Lung Sleep Allergy & ImmunologyMonash HealthClaytonVictoriaAustralia
| | - Keith Adam
- Sonic HealthPlusOsborne ParkWestern AustraliaAustralia
| | - David G. Chapman
- Respiratory Investigation Unit, Department of Respiratory MedicineRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
- Airway Physiology & Imaging Group, Woolcock Institute of Medical ResearchThe University of SydneyGlebeNew South WalesAustralia
- Discipline of Medical Science, School of Life Sciences, Faculty of ScienceUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Catherine E. Farrow
- Airway Physiology & Imaging Group, Woolcock Institute of Medical ResearchThe University of SydneyGlebeNew South WalesAustralia
- Respiratory Function Laboratory, Department of Respiratory and Sleep MedicineWestmead HospitalWestmeadNew South WalesAustralia
- Westmead Clinical School, Sydney Medical School, Faculty of Medicine and Health SciencesThe University of SydneySydneyNew South WalesAustralia
| | | | - Kerry Hancock
- Chandlers Hill SurgeryHappy ValleySouth AustraliaAustralia
| | - Celia J. Lanteri
- Department of Respiratory & Sleep MedicineAustin HealthHeidelbergVictoriaAustralia
- Institute for Breathing and SleepAustin HealthHeidelbergVictoriaAustralia
| | - Ewan G. Morris
- Department of Respiratory MedicineWaitematā District Health BoardAucklandNew Zealand
| | - Nicholas Romeo
- Department of Respiratory MedicineNorthern HealthEppingVictoriaAustralia
| | - Elena K. Schneider‐Futschik
- Cystic Fibrosis Pharmacology Laboratory, Department of Biochemistry & PharmacologyUniversity of MelbourneParkvilleVictoriaAustralia
- School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - Hiran Selvadurai
- Department of Respiratory MedicineThe Children's Hospital, Westmead, Sydney Childrens Hospital NetworkSydneyNSWAustralia
- Discipline of Child and Adolescent HealthSydney Medical School, The University of SydneySydneyNSWAustralia
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14
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Shattuck EC, Ramos Herrera IM, Sunil T. Presenteeism Among Healthcare Providers, Staff, and Students in Jalisco, Mexico: A Descriptive Study. Cureus 2022; 14:e28533. [PMID: 36185928 PMCID: PMC9517951 DOI: 10.7759/cureus.28533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2022] [Indexed: 11/25/2022] Open
Abstract
Objective We measured presenteeism (continuing to attend work or other activities while sick) in a sample of healthcare workers in Jalisco, Mexico to better understand the phenomenon, which can place patients at risk of infection. Methods An online survey link was distributed to all healthcare professionals, staff, and students registered with the Jalisco Ministry of Health starting in March 2020. Completed surveys (n = 196) collected between March and July 2020 were analyzed using bivariate and descriptive statistics including Kruskal-Wallis rank sum tests and Fisher’s tests. Results Most participants (67.5%) reported working while sick. Primary reasons included concerns about patients and continuity of care. Approximately 97% of respondents believed that working while sick could put patients at risk but still attended work with multiple symptoms. Conclusion These presenteeism rates and motivations are comparable to data from the US and other countries. We suggest that state and federal medical organizations address presenteeism to prevent nosocomial outbreaks.
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15
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Chrissian AA, Oyoyo UE, Patel P, Lawrence Beeson W, Loo LK, Tavakoli S, Dubov A. Impact of COVID-19 vaccine-associated side effects on health care worker absenteeism and future booster vaccination. Vaccine 2022; 40:3174-3181. [PMID: 35465979 PMCID: PMC9013647 DOI: 10.1016/j.vaccine.2022.04.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/24/2022] [Accepted: 04/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Short-term side effects related to mRNA vaccines against SARS-CoV-2 are frequent and bothersome, with the potential to disrupt work duties and impact future vaccine decision-making. OBJECTIVE To identify factors more likely to lead to vaccine-associated work disruption, employee absenteeism, and future vaccine reluctance among healthcare workers (HCWs). HYPOTHESIS Side effects related to COVID vaccination: 1- frequently disrupt HCW duties, 2- result in a significant proportion of HCW absenteeism, 3- contribute to uncertainty about future booster vaccination, 4- vary based on certain demographic, socioeconomic, occupational, and vaccine-related factors. METHODS Using an anonymous, voluntary electronic survey, we obtained responses from a large, heterogeneous sample of COVID-19-vaccinated HCWs in two healthcare systems in Southern California. Descriptive statistics and regression models were utilized to evaluate the research questions. RESULTS Among 2,103 vaccinated HCWs, 579 (27.5%) reported that vaccine-related symptoms disrupted their professional responsibilities, and 380 (18.1%) missed work as a result. Independent predictors for absenteeism included experiencing generalized and work-disruptive symptoms, and receiving the Moderna vaccine [OR = 1.77 (95% CI = 1.33 - 2.36), p < 0.001]. Physicians were less likely to miss work due to side effects (6.7% vs 21.2% for all other HCWs, p < 0.001). Independent predictors of reluctance toward future booster vaccination included lower education level, younger age, having received the Moderna vaccine, and missing work due to vaccine-related symptoms. CONCLUSION Symptoms related to mRNA vaccinations against SARS-CoV-2 may frequently disrupt work duties, lead to absenteeism, and impact future vaccine decision-making. This may be more common in Moderna recipients and less likely among physicians. Accordingly, health employers should schedule future booster vaccination cycles to minimize loss of work productivity.
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Affiliation(s)
- Ara A Chrissian
- Division of Pulmonary, Critical Care, Hyperbaric, Allergy, and Sleep Medicine, Loma Linda University, Loma Linda, CA, USA.
| | | | - Pranjal Patel
- Division of Pulmonary, Critical Care, Hyperbaric, Allergy, and Sleep Medicine, Loma Linda University, Loma Linda, CA, USA
| | - W Lawrence Beeson
- School of Public Health, Epidemiology and Biostatistics, Loma Linda University, Loma Linda, CA, USA
| | - Lawrence K Loo
- Department of Medicine, Loma Linda University, Loma Linda, CA, USA
| | | | - Alex Dubov
- School of Behavioral Health, Loma Linda University, Loma Linda, CA, USA
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16
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Pasfield K, Gottlieb T, Tartari E, Ward MP, Quain A. Sickness presenteeism associated with influenza-like illness in veterinarians working in New South Wales: Results of a state-wide survey. Aust Vet J 2022; 100:243-253. [PMID: 35168290 PMCID: PMC9304280 DOI: 10.1111/avj.13153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sickness presenteeism in the veterinary profession potentially jeopardises the wellbeing of veterinary team members and endangers quality of patient care. In veterinary team members with influenza-like illness (ILI), sickness presenteeism poses a risk to the health and wellbeing of colleagues and clients, particularly in the context of the COVID-19 pandemic. This study aimed to evaluate factors associated with sickness presenteeism in NSW registered veterinarians suffering from ILI, both before and since the beginning of the COVID-19 pandemic. METHODS Veterinarians registered in NSW were invited to complete an anonymous online mixed-methods survey between 31 March 2021 and 31 June 2021, regarding sickness presenteeism and absenteeism associated with ILI. The questionnaire was distributed through online and print newsletters of the Australian Veterinary Association NSW Branch and the NSW Veterinary Practitioners Board. RESULTS From a total of 122 participants, 81 veterinarians (66.4%) reported that they would attend work despite displaying symptoms of ILI. Most veterinarians would stay at home with a fever alone (n = 108, 88.5%), however, many would still attend work with a sore throat (n = 121, 99.2%) or a dry cough (n = 91, 74.6%). Sickness presenteeism was significantly associated with lack of staff to cover workers. Although sickness presenteeism remained common, participants reported that they were less likely to attend work with symptoms of ILI since the beginning of the COVID-19 pandemic. DISCUSSION The data are discussed in relation to sickness presenteeism in healthcare workers. These findings underscore an urgent need for relief staff to decrease sickness presenteeism.
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Affiliation(s)
- K Pasfield
- Sydney School of Veterinary Science, University of Sydney, Camperdown, New South Wales, Australia
| | - T Gottlieb
- Department of Microbiology and Infectious Diseases, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - E Tartari
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland.,Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Faculty of Health Sciences, University of Malta, Msida, Malta
| | - M P Ward
- Sydney School of Veterinary Science, University of Sydney, Camperdown, New South Wales, Australia
| | - A Quain
- Sydney School of Veterinary Science, University of Sydney, Camperdown, New South Wales, Australia
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17
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Mody L, Akinboyo IC, Babcock HM, Bischoff WE, Cheng VCC, Chiotos K, Claeys KC, Coffey KC, Diekema DJ, Donskey CJ, Ellingson KD, Gilmartin HM, Gohil SK, Harris AD, Keller SC, Klein EY, Krein SL, Kwon JH, Lauring AS, Livorsi DJ, Lofgren ET, Merrill K, Milstone AM, Monsees EA, Morgan DJ, Perri LP, Pfeiffer CD, Rock C, Saint S, Sickbert-Bennett E, Skelton F, Suda KJ, Talbot TR, Vaughn VM, Weber DJ, Wiemken TL, Yassin MH, Ziegler MJ, Anderson DJ. Coronavirus disease 2019 (COVID-19) research agenda for healthcare epidemiology. Infect Control Hosp Epidemiol 2022; 43:156-166. [PMID: 33487199 PMCID: PMC8160487 DOI: 10.1017/ice.2021.25] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 02/07/2023]
Abstract
This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to coronavirus disease 2019 (COVID-19) with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplementary materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.
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Affiliation(s)
- Lona Mody
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
- Geriatrics Research Education and Clinical Center, Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - Ibukunoluwa C. Akinboyo
- Division of Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States
| | - Hilary M. Babcock
- Washington University School of Medicine, St. Louis, Missouri, United States
| | - Werner E. Bischoff
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States
| | - Vincent Chi-Chung Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Kathleen Chiotos
- Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Kimberly C. Claeys
- University of Maryland School of Pharmacy, Baltimore, Maryland, United States
| | - K. C. Coffey
- University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Daniel J. Diekema
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Curtis J. Donskey
- Infectious Diseases Section, Louis Stokes Cleveland Veterans’ Affairs Medical Center, Cleveland, Ohio, United States
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Katherine D. Ellingson
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson, Arizona, United States
| | - Heather M. Gilmartin
- Veterans’ Affairs Eastern Colorado Healthcare System, Aurora, Colorado, United States
- Colorado School of Public Health, University of Colorado, Aurora, Colorado, United States
| | - Shruti K. Gohil
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California, United States
- Epidemiology and Infection Prevention, UC Irvine Health, Irvine, California, United States
| | - Anthony D. Harris
- University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Sara C. Keller
- Division of Infectious Diseases, John Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Eili Y. Klein
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, Unites States
| | - Sarah L. Krein
- Veterans’ Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Jennie H Kwon
- Washington University School of Medicine, St. Louis, Missouri, United States
| | - Adam S. Lauring
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Daniel J. Livorsi
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
- Iowa City Veterans’ Affairs Health Care System, Iowa City, Iowa, United States
| | - Eric T. Lofgren
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States
| | | | - Aaron M. Milstone
- Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Elizabeth A. Monsees
- Children’s Mercy Kansas City, Kansas City, Missouri, United States
- University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States
| | - Daniel J. Morgan
- University of Maryland School of Medicine, Baltimore, Maryland, United States
- Veterans’ Affairs Maryland Healthcare System, Baltimore, Maryland, United States
| | - Luci P. Perri
- Infection Control Results, Wingate, North Carolina, United States
| | - Christopher D. Pfeiffer
- Veterans’ Affairs Portland Health Care System, Portland, Oregon, United States
- Oregon Health & Science University, Portland, Oregon, United States
| | - Clare Rock
- Division of Infectious Diseases, John Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Sanjay Saint
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
- Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - Emily Sickbert-Bennett
- Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, North Carolina, United States
| | - Felicia Skelton
- Michael E. DeBakey Veterans’ Affairs Medical Center, Houston, Texas, United States
- H. Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas, United States
| | - Katie J. Suda
- Center for Health Equity Research and Promotion, Veterans’ Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Thomas R. Talbot
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Valerie M. Vaughn
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - David J. Weber
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Timothy L. Wiemken
- Division of Infectious Diseases, Allergy, and Immunology, Department of Medicine, Saint Louis University School of Medicine, St Louis, Missouri, United States
| | - Mohamed H. Yassin
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Matthew J. Ziegler
- Infectious Diseases Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Deverick J. Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina, United States
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18
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Klompas M. New Insights into the Prevention of Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia Caused by Viruses. Semin Respir Crit Care Med 2022; 43:295-303. [PMID: 35042261 DOI: 10.1055/s-0041-1740582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A fifth or more of hospital-acquired pneumonias may be attributable to respiratory viruses. The SARS-CoV-2 pandemic has clearly demonstrated the potential morbidity and mortality of respiratory viruses and the constant threat of nosocomial transmission and hospital-based clusters. Data from before the pandemic suggest the same can be true of influenza, respiratory syncytial virus, and other respiratory viruses. The pandemic has also helped clarify the primary mechanisms and risk factors for viral transmission. Respiratory viruses are primarily transmitted by respiratory aerosols that are routinely emitted when people exhale, talk, and cough. Labored breathing and coughing increase aerosol generation to a much greater extent than intubation, extubation, positive pressure ventilation, and other so-called aerosol-generating procedures. Transmission risk is proportional to the amount of viral exposure. Most transmissions take place over short distances because respiratory emissions are densest immediately adjacent to the source but then rapidly dilute and diffuse with distance leading to less viral exposure. The primary risk factors for transmission then are high viral loads, proximity, sustained exposure, and poor ventilation as these all increase net viral exposure. Poor ventilation increases the risk of long-distance transmission by allowing aerosol-borne viruses to accumulate over time leading to higher levels of exposure throughout an enclosed space. Surgical and procedural masks reduce viral exposure but do not eradicate it and thus lower but do not eliminate transmission risk. Most hospital-based clusters have been attributed to delayed diagnoses, transmission between roommates, and staff-to-patient infections. Strategies to prevent nosocomial respiratory viral infections include testing all patients upon admission, preventing healthcare providers from working while sick, assuring adequate ventilation, universal masking, and vaccinating both patients and healthcare workers.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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19
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Daniels S, Wei H, Han Y, Catt H, Denning DW, Hall I, Regan M, Verma A, Whitfield CA, van Tongeren M. Risk factors associated with respiratory infectious disease-related presenteeism: a rapid review. BMC Public Health 2021; 21:1955. [PMID: 34711208 PMCID: PMC8552205 DOI: 10.1186/s12889-021-12008-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 08/29/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Workplace transmission is a significant contributor to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks. Previous studies have found that infectious illness presenteeism could contribute to outbreaks in occupational settings and identified multiple occupational and organisational risk factors. Amid the COVID-19 pandemic, it is imperative to investigate presenteeism particularly in relation to respiratory infectious disease (RID). Hence, this rapid review aims to determine the prevalence of RID-related presenteeism, including COVID-19, and examines the reported reasons and associated risk factors. METHODS The review followed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) search approach and focused on studies published in English and Chinese. Database searches included MEDLINE, EMBASE, Web of Science, China Knowledge Resource Integrated Database (CNKI) and preprint databases MedRxiv and BioRxiv. RESULTS The search yielded 54 studies, of which four investigated COVID-19-related presenteeism. Prevalence of work presenteeism ranged from 14.1 to 55% for confirmed RID, and 6.6 to 100% for those working with suspected or subclinical RID. The included studies demonstrated that RID-related presenteeism is associated with occupation, sick pay policy, age, gender, health behaviour and perception, vaccination, peer pressure and organisational factors such as presenteeism culture. CONCLUSIONS This review demonstrates that presenteeism or non-adherence to isolation guidance is a real concern and can contribute to workplace transmissions and outbreaks. Policies which would support workers financially and improve productivity, should include a range of effective non-pharmaceutical inventions such as workplace testing, promoting occupational health services, reviewing pay and bonus schemes and clear messaging to encourage workers to stay at home when ill. Future research should focus on the more vulnerable and precarious occupational groups, and their inter-relationships, to develop comprehensive intervention programs to reduce RID-related presenteeism.
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Affiliation(s)
- Sarah Daniels
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, England.
- Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, England.
| | - Hua Wei
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, England
- Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, England
| | - Yang Han
- Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, England
- Department of Mathematics, The University of Manchester, Manchester, England
| | - Heather Catt
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, England
- Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, England
| | - David W Denning
- Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, England
- Division of Evolution, Infection and Genomics, School of Biological Sciences, The University of Manchester, Manchester, England
| | - Ian Hall
- Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, England
- Department of Mathematics, The University of Manchester, Manchester, England
- Public Health, Advice, Guidance and Expertise, London, England
| | - Martyn Regan
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, England
- Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, England
- United Kingdom Health Security Agency National COVID-19 Response Centre, London, England
| | - Arpana Verma
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, England
- Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, England
| | - Carl A Whitfield
- Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, England
- Department of Mathematics, The University of Manchester, Manchester, England
| | - Martie van Tongeren
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, England
- Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, England
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20
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Preston-Suni K, Celedon MA, Cordasco KM. Patient Safety and Ethical Implications of Health Care Sick Leave Policies in the Pandemic Era. Jt Comm J Qual Patient Saf 2021; 47:673-676. [PMID: 34420856 PMCID: PMC8457980 DOI: 10.1016/j.jcjq.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/11/2021] [Accepted: 06/21/2021] [Indexed: 11/21/2022]
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21
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Collignon P. COVID-19 and future pandemics: is isolation and social distancing the new norm? Intern Med J 2021; 51:647-653. [PMID: 33960091 PMCID: PMC8206944 DOI: 10.1111/imj.15287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 01/07/2023]
Abstract
The coronavirus, named SARS‐CoV‐2, is the cause of COVID‐19. This virus spreads readily from person to person and predominantly to and from the respiratory route and through droplets. There are many different interventions that can be and are used to decrease successfully the risk and spread of COVID‐19. Most of the principles underpinning these interventions relate to isolation and social distancing. These will need to be continued, at least in part, until safe and very effective vaccines become widely available and are delivered extensively and successfully globally. This new norm is isolation, plus social and physical distancing, and this new norm will likely be with us for some time to come. It will also be with us in any future pandemics, whether caused by bacteria or viruses, but especially when the causative pathogen spreads predominantly through the respiratory route. However, lockdowns and restrictions also cause many adverse but unintended economic, social and health consequences. Therefore, what is put into place needs to be proportionate to levels of risk of disease as well as spread, and which will vary in different localities and with time.
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Affiliation(s)
- Peter Collignon
- Microbiology and Infectious Disease, Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
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22
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Quain A, Mullan S, McGreevy PD, Ward MP. Frequency, Stressfulness and Type of Ethically Challenging Situations Encountered by Veterinary Team Members During the COVID-19 Pandemic. Front Vet Sci 2021; 8:647108. [PMID: 33912607 PMCID: PMC8071942 DOI: 10.3389/fvets.2021.647108] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/11/2021] [Indexed: 12/22/2022] Open
Abstract
Ethically challenging situations (ECS) are common in veterinary settings and can lead to moral stress. However, there is no published information about how a global pandemic affects the frequency and types of ECS encountered by veterinary team members. An online mixed methods survey was developed to determine the frequency, stressfulness and types of ECS experienced by veterinarians, animal health technicians and veterinary nurses since the advent of the global COVID-19 pandemic in March 2020. Responses from 540 veterinary team members from 22 countries were analyzed. With the advent of the COVID-19 pandemic, the median frequency of ECS encountered by respondents increased from several times per month to several times per week (Spearman Rank Correlation 0.619, P < 0.0001). The most common ECS (encountered at least several times per week) were: challenging decisions about how to proceed when clients have limited finances (64.4%), conflict between personal well-being and professional role (64.3%), conflict between the interests of clients and the interests of their animals (59.6%). These were followed by challenging decisions about what counts as an essential veterinary service (48.1%); conflict between well-being of family/household members and professional role (46.3%); and challenging decisions about whether to perform non-contact veterinary visits (46.3%). The most stressful ECS (reported to be very or maximally stressful) were: conflicts between the interests of clients and the interests of their animals (50.2%), other (42.9%), conflicts between the interests of my employer and my own interests (42.5%), challenging decisions about how to proceed when clients have limited finances (39.4%), conflict between personal well-being and professional role (38.0%), and conflict between well-being of family/household members and professional role (33.6%). Thematic analysis of free-text responses revealed biosecurity, client financial limitations, animal welfare, working conditions, and client relations as prominent themes. This is, to the best of our knowledge, the first study to describe the impacts of the pandemic on ECS experienced by veterinary teams globally. It identifies an increase in the frequency of ECS associated with the COVID-19 pandemic, and a number of stressors unique to the pandemic. We identified a number of resources and strategies that may help veterinary team members navigate ethical challenges that may emerge in their daily work, as well as in the context of global crises.
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Affiliation(s)
- Anne Quain
- Faculty of Science, Sydney School of Veterinary Science, University of Sydney, Camperdown, NSW, Australia
| | - Siobhan Mullan
- Bristol Veterinary School, University of Bristol, Langford, United Kingdom
- University of College Dublin School of Veterinary Medicine, Dublin, Ireland
| | - Paul D. McGreevy
- Faculty of Science, Sydney School of Veterinary Science, University of Sydney, Camperdown, NSW, Australia
| | - Michael P. Ward
- Faculty of Science, Sydney School of Veterinary Science, University of Sydney, Camperdown, NSW, Australia
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23
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Gur-Arie R, Katz MA, Hirsch A, Greenberg D, Malosh R, Newes-Adeyi G, Davidovitch N, Rosenthal A. "You Have to Die Not to Come to Work": A Mixed Methods Study of Attitudes and Behaviors regarding Presenteeism, Absenteeism and Influenza Vaccination among Healthcare Personnel with Respiratory Illness in Israel, 2016-2019. Vaccine 2021; 39:2366-2374. [PMID: 33789798 DOI: 10.1016/j.vaccine.2021.03.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/23/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Healthcare personnel (HCP) have an increased risk of exposure to influenza and other respiratory pathogens. Increased presenteeism, decreased absenteeism, and low uptake of the influenza vaccine can contribute to the spread of influenza among HCP in healthcare settings. We used a mixed methods approach to investigate attitudes and behaviors of HCP in Israel towards influenza vaccination, presenteeism, and absenteeism. METHODS The study took place over three influenza seasons (2016-2017, 2017-2018, 2018-2019) at the largest hospital in southern Israel. We administered a Knowledge, Attitudes and Practices (KAP) questionnaire and conducted semi-structured interviews with HCP who had been recently ill with respiratory symptoms. The KAP questionnaire included closed-ended questions about attitudes and behaviors regarding influenza, working while sick, and influenza vaccination. The interviews investigated HCP's perceptions of influenza infection and attitudes about absenteeism, presenteeism, and the influenza vaccine. RESULTS We conducted 74 semi-structured interviews over three influenza seasons. Four HCP were interviewed twice, in separate seasons for different illness episodes. The 70 individuals interviewed included 16 physicians, 45 nurses or technicians, and 9 administrative staff. The median age was 42.5 years (range: 25-60), and most (79%) were female. Half (50%) got vaccinated against influenza before their illness episode. In interviews, most HCP said they come to work while sick (presenteeism) due to a strong personal work ethic and an institutional culture that discourages taking sick leave (absenteeism). HCP expressed skepticism about the effectiveness of the influenza vaccine as well as concern that the influenza vaccine causes severe illness. DISCUSSION Over three influenza seasons in Israel, HCP cited a number of reasons for working while sick, and doubted the usefulness of influenza vaccine. Addressing reasons for presenteeism and vaccine hesitancy among HCP is crucial to protect HCP and patients from influenza virus infection and other viral respiratory illnesses, such as COVID-19.
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Affiliation(s)
- Rachel Gur-Arie
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA; Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Mark A Katz
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel; School of Public Health, Medical School for International Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Avital Hirsch
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - David Greenberg
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Ryan Malosh
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Nadav Davidovitch
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Anat Rosenthal
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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24
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Tartaglia A, Matos MAA, Silva MG. Do you work while sick? EINSTEIN-SAO PAULO 2021; 19:eCE6150. [PMID: 33787662 PMCID: PMC7971152 DOI: 10.31744/einstein_journal/2021ce6150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/29/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Mary Gomes Silva
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
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25
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Lombardi A, Mangioni D, Consonni D, Cariani L, Bono P, Cantù AP, Tiso B, Carugno M, Muscatello A, Lunghi G, Pesatori AC, Riboldi L, Ceriotti F, Bandera A, Gori A. Seroprevalence of anti-SARS-CoV-2 IgG among healthcare workers of a large university hospital in Milan, Lombardy, Italy: a cross-sectional study. BMJ Open 2021; 11:e047216. [PMID: 33619203 PMCID: PMC7902322 DOI: 10.1136/bmjopen-2020-047216] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To assess the seroprevalence of anti-SARS-CoV-2 IgG among health careworkers (HCWs) in our university hospital and verify the risk of acquiring the infection according to work area. DESIGN Cross-sectional study. SETTING Monocentric, Italian, third-level university hospital. PARTICIPANTS All the employees of the hospital on a voluntary base, for a total of 4055 participants among 4572 HCWs (88.7%). PRIMARY AND SECONDARY OUTCOME MEASURES Number of anti-SARS-CoV-2 positive serology according to working area. Association of anti-SARS-CoV-2 positive serology to selected variables (age, gender, country of origin, body mass index, smoking, symptoms and contact with confirmed cases). RESULTS From 27 April 2020 to 12 June 2020, 4055 HCWs were tested and 309 (7.6%) had a serological positive test. No relevant difference was found between men and women (8.3% vs 7.3%, p=0.3), whereas a higher prevalence was observed among foreign-born workers (27/186, 14.5%, p<0.001), employees younger than 30 (64/668, 9.6%, p=0.02) or older than 60 years (38/383, 9.9%, p=0.02) and among healthcare assistants (40/320, 12.5%, p=0.06). Working as frontline HCWs was not associated with an increased frequency of positive serology (p=0.42). A positive association was found with presence and number of symptoms (p<0.001). The symptoms most frequently associated with a positive serology were taste and smell alterations (OR 4.62, 95% CI: 2.99 to 7.15) and fever (OR 4.37, 95% CI: 3.11 to 6.13). No symptoms were reported in 84/309 (27.2%) HCWs with positive IgG levels. Declared exposure to a suspected/confirmed case was more frequently associated (p<0.001) with positive serology when the contact was a family member (19/94, 20.2%) than a patient or colleague (78/888, 8.8%). CONCLUSIONS SARS-CoV-2 infection occurred undetected in a large fraction of HCWs and it was not associated with working in COVID-19 frontline areas. Beyond the hospital setting, exposure within the community represents an additional source of infection for HCWs.
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Affiliation(s)
- Andrea Lombardi
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy
| | - Davide Mangioni
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Consonni
- Epidemiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lisa Cariani
- Clinical Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore, Milan, Italy
| | - Patrizia Bono
- Clinical Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore, Milan, Italy
| | - Anna Paola Cantù
- Medical Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Basilio Tiso
- Medical Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Carugno
- Epidemiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Lunghi
- Clinical Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore, Milan, Italy
| | - Angela Cecilia Pesatori
- Epidemiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Luciano Riboldi
- Occupational Health Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ferruccio Ceriotti
- Clinical Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
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26
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Abbas M, Robalo Nunes T, Martischang R, Zingg W, Iten A, Pittet D, Harbarth S. Nosocomial transmission and outbreaks of coronavirus disease 2019: the need to protect both patients and healthcare workers. Antimicrob Resist Infect Control 2021; 10:7. [PMID: 33407833 PMCID: PMC7787623 DOI: 10.1186/s13756-020-00875-7] [Citation(s) in RCA: 171] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/22/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To compile current published reports on nosocomial outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), evaluate the role of healthcare workers (HCWs) in transmission, and evaluate outbreak management practices. METHODS Narrative literature review. SHORT CONCLUSION The coronavirus disease 2019 (COVID-19) pandemic has placed a large burden on hospitals and healthcare providers worldwide, which increases the risk of nosocomial transmission and outbreaks to "non-COVID" patients or residents, who represent the highest-risk population in terms of mortality, as well as HCWs. To date, there are several reports on nosocomial outbreaks of SARS-CoV-2, and although the attack rate is variable, it can be as high as 60%, with high mortality. There is currently little evidence on transmission dynamics, particularly using genomic sequencing, and the role of HCWs in initiating or amplifying nosocomial outbreaks is not elucidated. There has been a paradigm shift in management practices of viral respiratory outbreaks, that includes widespread testing of patients (or residents) and HCWs, including asymptomatic individuals. These expanded testing criteria appear to be crucial in identifying and controlling outbreaks.
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Affiliation(s)
- Mohamed Abbas
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
- Health Protection Research Unit, Imperial College London, London, UK.
| | - Tomás Robalo Nunes
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Infectious Diseases Service, Hospital Garcia de Orta, EPE, Almada, Portugal
| | - Romain Martischang
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Walter Zingg
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Infectious Diseases Service, Hospital Garcia de Orta, EPE, Almada, Portugal
- University of Geneva, Geneva, Switzerland
| | - Anne Iten
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Infectious Diseases Service, Hospital Garcia de Orta, EPE, Almada, Portugal
- University of Geneva, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Infectious Diseases Service, Hospital Garcia de Orta, EPE, Almada, Portugal
- University of Geneva, Geneva, Switzerland
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Rovers JJE, van de Linde LS, Kenters N, Bisseling EM, Nieuwenhuijse DF, Oude Munnink BB, Voss A, Nabuurs-Franssen M. Why psychiatry is different - challenges and difficulties in managing a nosocomial outbreak of coronavirus disease (COVID-19) in hospital care. Antimicrob Resist Infect Control 2020; 9:190. [PMID: 33261660 PMCID: PMC7705849 DOI: 10.1186/s13756-020-00853-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/18/2020] [Indexed: 01/04/2023] Open
Abstract
Objective Coronavirus disease (COVID-19) was officially declared a pandemic in March 2020. Many cases of COVID-19 are nosocomial, but to the best of our knowledge, no nosocomial outbreaks on psychiatric departments of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported in Europe. The different nature of psychiatry makes outbreak management more difficult. This study determines which psychiatry specific factors contributed to a nosocomial outbreak taking place in a psychiatric department. This will provide possible interventions in future outbreak management.
Method A case series describing a nosocomial outbreak in a psychiatric department of an acute care hospital in the Netherlands between March 13, 2020 and April, 14 2020. The outbreak was analyzed by combining data from standardized interviews, polymerase chain reaction (PCR) tests and whole genome sequencing (WGS). Results The nosocomial outbreak in which 43% of staff of the psychiatric department and 19% of admitted patients were involved, was caused by healthcare worker (HCW)-to-HCW transmissions, as well as patient-to-HCW-to-patient transmission. We identified four aspects associated with the mental health care system which might have made our department more susceptible to an outbreak. Conclusions Infection control measures designed for hospitals are not directly applicable to psychiatric departments. Psychiatric patients should be considered a high-risk group for infectious diseases and customized measures should be designed and implemented. Extra attention for psychiatric departments is necessary during a pandemic as psychiatric HCWs are less familiar with outbreak management. Clear communication and governance is crucial in correctly implementing these measures.
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Affiliation(s)
- J J E Rovers
- Department of Psychiatry, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6534 SZ, Nijmegen, The Netherlands.
| | - L S van de Linde
- Department of Psychiatry, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6534 SZ, Nijmegen, The Netherlands
| | - N Kenters
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.,Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - E M Bisseling
- Department of Psychiatry, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6534 SZ, Nijmegen, The Netherlands
| | - D F Nieuwenhuijse
- Department of Viroscience, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - B B Oude Munnink
- Department of Psychiatry, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6534 SZ, Nijmegen, The Netherlands.,Department of Viroscience, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - A Voss
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.,Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M Nabuurs-Franssen
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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Khanna R, Murnane T, Kumar S, Rolfe T, Dimitrieski S, McKeown M, Ejareh Dar M, Gavson L, Gandhi C. Making working from home work: reflections on adapting to change. Australas Psychiatry 2020; 28:504-507. [PMID: 32910690 DOI: 10.1177/1039856220953701] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES During the COVID-19 pandemic, our mental health service experimented with working from home. The flexibility of this practice can enable improved efficiency, staff well-being and expanded operating hours in the longer term. This paper shares our experiences and makes recommendations for being a part of and leading distributed clinical teams. CONCLUSIONS We saw a 3% increase in total appointment bookings and a 7% reduction in cancellations/non-attendance compared to the same period in 2019. Based on our experience and the literature, effective distributed teams have leaders that connect via video at least weekly; focus on transparency and output over micromanagement; prioritise staff relationships and err towards overcommunication.
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Affiliation(s)
- Rahul Khanna
- Mental Health Division, Austin Health, Australia.,Department of Psychiatry, University of Melbourne, Australia
| | - Tess Murnane
- Mental Health Division, Austin Health, Australia
| | | | | | | | | | - Maryam Ejareh Dar
- Mental Health Division, Austin Health, Australia.,Department of Psychiatry, University of Melbourne, Australia
| | - Laura Gavson
- Mental Health Division, Austin Health, Australia
| | - Charu Gandhi
- Mental Health Division, Austin Health, Australia
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Affiliation(s)
- Vincent Chi-Chung Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Shuk-Ching Wong
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Kwok-Yung Yuen
- Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
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