Factors associated with access and use of PPE during COVID-19: A cross-sectional study of Italian physicians

Healthcare workers' knowledge, attitude and practices on infection prevention and control in the context of the COVID-19 pandemic at the Faranah regional hospital and associated healthcare centers, Guinea

BACKGROUND

In response to the COVID-19 pandemic, WHO launched a strategic preparedness and response plan, outlining public health measures to support countries worldwide. Healthcare workers have an increased risk of becoming infected and their behaviour regarding infection prevention and control (IPC) influences infection dynamics. IPC strategies are important across the globe, but even more in low-resource settings where capacities for testing and treatment are limited. Our study aimed to assess and implement COVID-19 pandemic preparedness and response measures in Faranah, Guinea, primarily focusing on healthcare workers' IPC knowledge, attitude and practice (KAP).

METHODS

The study was conducted between April 2020 and April 2021 assessing IPC pandemic preparedness and response measures such as healthcare workers' KAP, alcohol-based handrub (ABHR) consumption and COVID-19 triaging in the Faranah Regional Hospital and two associated healthcare centres. The assessment was accompanied by IPC training and visual workplace reminders and done in pre- and post- phases to evaluate possible impact of these IPC activities.

RESULTS

The overall knowledge score in the Faranah Regional Hospital was 32.0 out of 44 at baseline, and did not change in the first, but increased significantly by 3.0 points in the second follow-up. The healthcare workers felt closer proximity to SARS-CoV-2 overtime in addition to higher stress levels in all study sites. There was significant improvement across the observed triaging practices. Hand hygiene compliance showed a significant increase across study sites leading to 80% in Faranah Regional Hospital and 63% in healthcare centers. The average consumption of ABHR per consultation was 3.29 mL with a peak in February 2020 of 23 mL.

CONCLUSION

Despite increased stress levels among HCWs, the ongoing IPC partnership well prepared the FRH in terms of triaging processes with a stronger impact on IPC practice than on theoretical knowledge. Throughout the pandemic, global shortages and surges in consumption did not affect the continuous ABHR provision of the FRH. This highlights local ABHR production as a key pandemic preparedness strategy.

Healthcare Providers' Adherence to COVID-19 Prevention and Control Practices in Health Records and Information Management, Ghana

Background

The impact of contracting coronavirus on healthcare providers (HCPs) affects their ability to combat the infection. The virus can be transmitted through droplets from sneezing, coughing, and yelling, making it essential for HCPs to plan ahead when dealing with patients with respiratory symptoms. The need to assess healthcare providers' perceived adherence to COVID-19 Prevention and Control Practices (PCP) in Health Records and Information Management is vital for optimizing healthcare operations and ensuring the safety of both patients and providers. This study assesses healthcare providers' perceived adherence to COVID-19 PCP in Health Records and Information Management. Subjects and Method. A cross-sectional survey was conducted to collect data from 1268 HCPs working in eight randomly selected hospitals across five regions in Ghana. The survey was carried out from May 15, 2022, to August 13, 2022. Simple random sampling was used to choose these eight facilities from a total of 204 hospitals. Within each facility, HCPs from various departments were selected using simple random sampling. The EpiInfo 7 software's StatCalc tool was used to choose a total sample size of 1268 from an estimated 4482 HCP-PR from the eight hospitals. Compliance with COVID-19 PCP was assessed using a 3-point scale, ranging from one (Yes always) to three (No). Cronbach's alpha reliability coefficient was used to examine the statistical reliability of the variables in the dataset. Cronbach's alpha was 0.73 overall, suggesting strong reliability. Bartlett's test for equal variances was used for comparative analysis of health facility and overall mean COVID-19 PCP in different areas of health facilities. IBM SPSS (version 23) statistical software was used for the data analysis process.

Results

A total of 1268 HCP-PR participated in the survey, resulting in a 99.6% response rate. Findings reveal that 760 healthcare professionals who handle patients' records (HCP-PR), constituting 60%, consistently followed COVID-19 protocols in the registration and clinic preparation zones. Another 390 individuals (30.7%) adhered to these protocols occasionally, while 119 (9.4%) failed to comply. Similarly, in the filing area, 739 respondents (58.3%) consistently adhered to COVID-19 protocols, 358 (28.3%) occasionally did so, and 170 (13.4%) did not follow the protocols at all. Regarding handling health records cautiously, 540 participants (42.5%) always did, 448 (35.3%) did so sometimes, and 280 (22.2%) neglected these precautions. Additionally, 520 respondents (41.0%) consistently followed COVID-19 precautions when handling computers and other equipment, 393 (31.0%) did so occasionally, and 355 (28.0%) did not adhere to these precautions.

Conclusion

The majority of respondents showed good compliance with COVID-19 protocol in the registration and clinic preparation areas. However, in the filing area, just over four out of every seven respondents consistently adhered to COVID-19 PCP. Additionally, four out of every seven participants did not comply with COVID-19 PCP when handling patients' records. Analysis reveals diverse adherence to COVID-19 PCP, and statistical tests show variable performance, highlighting standout health facilities.

Under Armour - Use of personal protective equipment for simulated CPR of COVID-19 patients: an observational study

BACKGROUND

Personal protective equipment (PPE) protects healthcare workers and patients. Data on guideline compliance on how to dress (donning) or remove (doffing) PPE and the assistance among multiple participants (buddying) are limited. This study assesses the quality of donning, doffing, and buddying of PPE in a simulated medical emergency.

METHOD

Physicians handling a simulated cardiac arrest of a COVID-19 patient. Adjacent to the victim, PPE was available. The appropriateness of PPE choice was assessed by using video recordings, with each individual participant being analyzed from the beginning of the simulation scenario from two perspectives regarding the selection of items during donning and doffing, hygiene aspects, time, and team support (buddying). The primary outcome was the number of participants being appropriately protected, defined as both wearing (a) all PPE items provided, and (b) all PPE items correctly at the time of first patient contact (FPC). Secondary outcomes included the timing of participants being appropriately protected. Statistical analysis was performed using SPSS (version 28). Mann-Whitney test, chi-square test, and linear regression analysis were performed as appropriate.

RESULTS

At first patient contact 21% (91/437) were correctly protected. One or more incorrect PPE items were found in 4% (19/437), whereas 61% (265/437) wore one or more PPE items incorrectly. In 14% (62/437), one or more PPE items were missing. The time interval between donning start and FPC was 66 (55-78) sec. Time to FPC was longer in correctly than in incorrectly protected participants 77 (66-87) vs. 64 (54-75) sec; p < 0.001) and decreased by 7 ± 2 s per PPE item omitted (P = 0.002). Correct doffing was observed in 192/345 (56%), while buddying occurred in 120 participants (27%), indicating that they either assisted other participants in some manner (verbally or physically) or received assistance themselves.

CONCLUSIONS

Our findings imply a need for education in correct and timely PPE donning and doffing. Donning PPE as intended delayed FPC. This and the influence of buddying needs further investigation (German study register number DRKS00023184).

Healthcare Workers' Adherence and Attitudes Toward the Adherence to COVID-19 Precautionary Guidelines Post-Vaccination: A Cross-Sectional Pilot Study

BACKGROUND

Healthcare workers (HCWs) have shown increased adherence to infection control practices during the COVID-19 pandemic. However, there is a need to assess their adherence to and attitude toward COVID-19 guidelines after being vaccinated. The purpose of this pilot study is to assess the adherence to and attitudes toward the adherence to COVID-19 guidelines among HCWs who have been vaccinated.

METHODS

A retrospective cross-sectional design was employed. One hundred and eight participants were recruited via email from a medical center in the Midwest United States. The participants completed online surveys measuring the level of adherence to and attitudes toward the adherence to COVID-19 guidelines. The response rate was 5.4%.

FINDINGS

Most participants were female (73.1%) and white (82.4%). The participants adhered to COVID-19 guidelines 79.7% of the time. The most frequently followed guidelines were performing hand hygiene, wearing a respirator or well-fitting mask in areas where patients may be present, and wearing eye protection when entering the room for a patient with suspected or confirmed COVID-19 infection. The least performed precautions were performing COVID-19 testing after exposure to a suspected or confirmed COVID-19 case and maintaining social distancing. There was a significant decrease in the perceived importance of adherence to COVID-19 precautions post-vaccination (p <.001, 95% CI [-0.78, -0.35]).

CONCLUSIONS

The increased perception of safety after receiving COVID-19 vaccination may negatively influence HCWs' adherence to COVID-19 precautionary guidelines. Continuous education and monitoring of HCWs' safety practices are important to influence HCWs' attitudes to adhere to COVID-19 precautions, particularly after vaccination.

Healthcare workers safety in the COVID-19 era: the impact of pre-pandemic personal protective equipment (PPE) training in Pakistan

BACKGROUND

The COVID-19 pandemic has revealed vulnerabilities in healthcare systems worldwide, emphasizing the importance of healthcare worker safety through adequate utilization of personal protective equipment (PPE). This study aims to assess the impact of pre-pandemic PPE training on the practices and other associated factors among frontline healthcare workers during the COVID-19 pandemic in Pakistan and provide insights into the implications of such training programs for future initiatives.

METHODS

A cross-sectional study from May 9th to June 5th, 2020 was conducted among the frontline healthcare workers against COVID-19 in Pakistan, utilizing an online structured questionnaire shared via WhatsApp and Facebook by using purposive sampling. Statistical analyses, including chi-square tests for proportion and logistic regression for the association while multi-logistic regression for potential confounders, were performed using SPSS version 22.

RESULTS

A total of 453 healthcare staff participated, with 68.9% (n = 312) reporting no prior PPE training and 31.1% (n = 141) having received training. Significant associations were found between prior training and healthcare group distribution (p = 0.006), with doctors exhibiting the highest proportion of training 82 (37.61%), followed by nurses 50 (27.32%) and paramedics 9 (17.31%). Those who didn't receive any prior training in PPEs showed a higher perceived professional risk of 216 (69.23%) compared to those who received prior PPE training 96 (30.77%, p-value 0.005). Similarly, a higher frequency 137 (63.72%) of Perceived Personal risk was observed in those who didn't receive training, labeled as "high risk" compared to those who were trained 78 (36.28%, P value 0.02). Multi-logistic regression analysis identified paramedics as 0.26 times less likely to have received prior PPE training (Adjusted OR 0.26, 95% CI 0.10-0.65, p = 0.01) compared to medical doctors. Healthcare workers in tertiary care hospitals were 0.46 times less likely to undergo PPE training (Adjusted OR 0.46, 95% CI 0.25-0.87,p = 0.01) compared to those working at COVID-19 facilities/hospitals/quarantine centers. Likewise, individuals who doffed disposable gowns [Adjusted OR 3.86, (95% CI, 1.23-12.08, p = 0.02] were 3.86 times more interested in getting prior training in PPE compared to those who don't have skills to wear them.

CONCLUSION

Our findings highlight that healthcare levels, type of healthcare, and doffing skills are important predictors of whether healthcare workers have taken prior training in PPE. These findings imply developing effective training programs for healthcare workers to ensure safety while providing care during pandemics like COVID-19.

Prediction of compliance with preventive measures among teachers in the context of the COVID-19 pandemic

The objective of this study is to examine, in primary and high schools, teachers' compliance with preventive infection control measures (in the context of the COVID-19 pandemic). Inspired by the technology acceptance model (TAM) and occupational health and safety (OHS) literature on personal protective equipment (PPE) use, we propose a model of compliance with preventive measures among teachers. Data were collected following an observational, cross-sectional design. The data for the study were collected via a questionnaire survey of teachers working in the province of Quebec, Canada. To study the impact of the explanatory variables on the dependent variable, we developed a multiple linear regression model. This model was estimated to assess the preventive measures as a whole (six items). Results show that having tested positive for a COVID test in the last year, judging that the situation does not require the use of the mask or the protective glasses, training received on preventive measures, factors related to comfort and use of protective eyewear, as well as age influence teacher compliance with COVID-19 preventive measures.

Pandemic-related factors predicting physician burnout beyond established organizational factors: cross-sectional results from the COPING survey

The COVID-19 pandemic has increased physician burnout beyond high baseline levels. We aimed to determine whether pandemic-related factors contribute to physician burnout beyond known organizational factors. This was a cross-sectional survey of Canadian physicians using a convenience sample. Eligible participants included any physician currently holding a license to practice in Canada. Responses were gathered from May 13 to 12 June 2020. Risk factors measured included the newly developed Pandemic Experiences and Perceptions Scale (PEPS) subscales, contact with virus, pandemic preparation, and provincial caseload. The primary outcome was the Maslach Burnout Inventory (MBI). The primary outcome was completed by 309 respondents. Latent profile analysis found 107 (34.6%) respondents were burned out. In multivariate analysis, exhaustion was independently associated with PEPS adequacy, risk perception, and worklife subscales (adjusted R2 = 0.236, P < 0.001). Cynicism was associated with exhaustion, and PEPS worklife (adjusted R2 = 0.543, P < 0.001). Efficacy was associated with cynicism, PEPS worklife, and active cases (adjusted R2 = 0.152, P < 0.001). Structural equation modelling showed statistically significant direct paths between PEPS areas of worklife and all MBI subscales. Contact with virus, preparation, and PEPS risk perception added to the prediction of MBI exhaustion. Among a sample of Canadian physicians during the COVID-19 pandemic, adequacy of resources, risk perception, and quality of worklife were associated with burnout indices. To mitigate physician burnout organizations should work to improve working conditions, ensure adequate resources, and foster perceived control of risk of transmission.Trial Registration: NCT04379063.

Occupational risk perception and its associated factors among nurses and physicians in Peruvian health facilities

Introduction

A high perceived risk is related to lower rates of occupational accidents in the health personnel.

Objectives

To determine the levels of occupational risk perception and its associated factors in nurses and physicians from health facilities in Peru during 2016.

Methods

An analytical cross-sectional study was conducted with secondary data from the National Survey of Health Users Satisfaction (Encuesta Nacional de Satisfacción de Usuarios en Salud) 2016. The problem variable was the occupational risk perception, and sociodemographic variables and variables related to occupational risk exposure were included as possible associated factors. Crude and adjusted ordinal logistic regression models were developed to determine the associated factors. All estimates were weighted according to the National Survey of Health Users Satisfaction 2016 complex sampling.

Results

Levels of perceived occupational risk were similar between nurses and physicians. Weekly working hours, having a previous work accident, and receiving protective equipment were found to be associated with occupational risk perception in nurses. Age, institution of origin, having a specialty, suffering from a chronic disease, and receiving occupational risk training were found to be associated with occupational risk perception in physicians.

Conclusions

In Peru, the levels of occupational risk perception in nurses and physicians are similar. However, the associated factors differ according to the profession. These findings may contribute to the norms or laws related to the occupational safety of health personnel.

Adherence of healthcare workers to COVID-19 infection prevention practices and its relationship with SARS-CoV-2 seropositivity

Background

Infection prevention and control (IPC) practices against COVID-19 should be adopted by healthcare workers (HCWs) at their workplaces to protect themselves, their patients, and their families from infection.

Purpose

This study aimed to describe the relationship between the healthcare-related COVID-19 infection prevention measures adopted by HCWs and their SARS-CoV-2 seropositivity.

Research Design

This cross-sectional study was conducted during the second and third COVID-19 waves in Egypt.

Study Sample

The study included 416 unvaccinated HCWs from 39 hospitals in Egypt.

Data Collection

Sociodemographic data, as well as COVID-19 IPC measures done at work, and protective measures performed by their healthcare facilities were collected. SARS-CoV-2 spike protein antibodies were measured by ELISA.

Results

58.2% of participants were seropositive for SARS-CoV-2. Among the previously undiagnosed HCWs, 125/271 (46.1%) were seropositive. Predictors of seropositivity were rural residence (aOR = 5.096; 95% CI: 1.583-16.403, p = 0.006), previous COVID-19 infection (aOR = 4.848, 95% CI: 2.933-8.015, p = 0.000), and examining 10-20 suspected COVID-19 patients daily (aOR = 2.329; 95% CI: 1.331-4.077, p = 0.003. Reporting low satisfaction (25-50%) with infection control implementation, working more than 40 h per week, reporting to "sometimes abiding by hand hygiene" compared to those who reported to "always" adhere to hand hygiene and shorter duration of hand washing (<20 s) were associated with significantly higher odds of seropositivity.

Conclusions

Poor infection control measures and the high workload of HCWs (longer working hours and examining more patients) were modifiable risk factors for SARS-CoV-2 seropositivity among HCWs. Hand hygiene was better among HCWs working in urban versus rural areas.

Working conditions during the COVID-19 pandemic in primary and tertiary healthcare: a comparative cross-sectional study

OBJECTIVES

The COVID-19 pandemic has globally affected healthcare workers' (HCWs) health and wellbeing. Most studies on COVID-19 have focused on tertiary healthcare. The aim of this study was to increase the knowledge on the effects of the pandemic on working conditions in tertiary and primary healthcare.

MATERIAL AND METHODS

The comparative cross-sectional study consisted of an online questionnaire sent to HCWs of the City of Helsinki (primary healthcare) and Helsinki University Hospital (tertiary healthcare). Altogether 1580 HCWs with direct patient contact participated in the study: 895 from tertiary and 685 from primary healthcare. Statistical analysis used SPSS 25 from IBM. The tests used were the χ2 test, Fisher's exact test, and binary logistic regression analysis.

RESULTS

Primary HCWs were less likely to treat COVID-19 patients (OR = 0.45, 95% CI: 0.37-0.56). However, both groups reported a similar number of COVID-19 infections, primary HCWs 4.9% and tertiary HCWs 5.0%, and workrelated quarantine was significantly more prevalent (OR = 1.96, 95% CI: 1.38-2.79) among primary HCWs. In addition, work-related wellbeing was poorer among primary HCWs than tertiary HCWs in terms of feeling more stressed at work (OR = 3.20, 95% CI: 2.55-4.02), not recovering from work (OR = 0.49, 95% CI: 0.39-0.62), reported mental wellbeing below normal levels (OR: 1.59, 95% CI: 1.26-2.00), and increased working hours (OR = 1.63, 95% CI: 1.25-2.12).

CONCLUSIONS

The study demonstrates how the pandemic has affected the wellbeing and working conditions of not only tertiary but also less studied primary HCWs. The authors' findings suggest that the challenges identified during the COVID-19 pandemic in the health and wellbeing of healthcare workers are even greater in primary care than in tertiary care. Int J Occup Med Environ Health. 2023;36(1):139-50.

Personal protective equipment: Analysis of supply among midwives during the COVID-19 pandemic in Peru

OBJECTIVE

To report the details of provision of personal protective equipment to midwives during the COVID-19 pandemic in Peru METHODS: This is a non-experimental, descriptive, cross-sectional study. An online survey of 679 midwives working at public healthcare centres was conducted via questionnaires. The following aspects were outlined: method of supply and frequency of delivery of personal protective equipment, type of personal protective equipment provided by the institution, and self-purchase. Furthermore, features of the midwives' workplace were described. For statistical analysis, absolute frequencies and relative proportions were used for categorical variables, and mean and standard deviation were used for numerical variables.

MEASUREMENTS AND FINDINGS

The most important finding of this study is that a large proportion of midwives (66.6%) did not receive new personal protective equipment for each shift; 41.9% of midwives who received personal protective equipment during each shift exclusively provided services in the COVID-19 ward, whereas 27.6% did not. The least received supplies were of N95 respirator masks (41.7%) and disposable isolation suit gown (50.5%). Only a certain proportion of midwives (38.6%) were trained by their own institutions on the use of personal protective equipment.

KEY CONCLUSIONS

The provision of personal protective equipment to midwives and training on personal protective equipment were insufficient at all workplaces. Therefore, measures must be taken to increase the supply of this material to midwives who are essential workers in reproductive health.

Survey of healthcare worker perceptions of changes in infection control and antimicrobial stewardship practices in India and South Africa during the COVID-19 pandemic

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.

Factors Influencing Compliance With Personal Protective Equipment (PPE) Use Among Healthcare Workers

Introduction Accurate and appropriate use of personal protective equipment (PPE) is an integral component in infection prevention and control policy to ensure healthcare workers' safety. Poor compliance with personal protective behaviours and inconsistent use of PPE has been identified as the main cause of transmission of nosocomial infections in healthcare settings and this reduced compliance is linked to many individual, environmental, and organizational factors. Therefore, the current study was carried out to identify various factors influencing PPE use among healthcare workers.  Materials and methods A descriptive cross-sectional survey has been carried out among healthcare workers selected from two selected tertiary care hospitals in central India. Data on compliance with PPE and factors influencing compliance were collected using a three-point rating scale and structured questionnaire. Quantile regression was performed to identify the factors associated with adherence to PPE use among healthcare workers. Results The median score for compliance with PPE use among healthcare workers was found to be 22 with an interquartile range (IQR) of 16-24. The multiple quantile regression found that variables such as occupation (p<0.001), institutional policy (p=0.003), quality of PPE (p=0.002), availability of PPE (p<0.001), and improper size (p=0.042) were significantly associated with PPE compliance by healthcare workers. Conclusion The current study highlights the importance of taking adequate measures by the government and healthcare organizations to eliminate various factors hindering PPE compliance levels among healthcare workers to ensure consistent use of PPE by healthcare workers to safeguard themselves and patients.

The magnitude of standard precautions practice and its associated factors among healthcare workers in governmental hospitals of northeastern Ethiopia

Background

Non-compliance with infection control guidelines of healthcare workers may increase their risk of exposure to infectious diseases but can be prevented through adherence to standard precautionary practices in healthcare settings.

Objective

This study aimed to assess the magnitude of standard precautions practice and its associated factors among healthcare workers in government hospitals of South Wollo Zone, northeastern Ethiopia.

Methods

An institutional-based cross-sectional study was conducted among 1,100 healthcare workers. Proportional sample size allocation for each selected government hospital was conducted followed by simple random sampling to select study participants using human resource records from each hospital. Data were collected using structured and self-administered pretested questionnaires. The data were analyzed using descriptive statistics, bivariable binary, and multivariable logistic regression models. Variables with a p-value <0.05 with a 95% CI were considered as having statistical significance.

Results

The overall magnitude of compliance with standard precautions among healthcare workers was 19.2%. The result indicated that work experience of <5 years (AOR = 2.51; 95% CI: 1.07-5.89), absence of continuous water supply (AOR = 2.24; 95% CI: 1.95-5.29), and negative attitude (AOR = 2.37; 95% CI: 1.17-4.79) were significantly associated with poor compliance of standard precautions practice.

Conclusion

The overall magnitude of compliance with standard precautions among healthcare workers was low compared to the national magnitude of infection prevention practice. Interventions including consistent and effective training on infection prevention healthcare workers should be given regularly. Providing continuous water supply and building a positive attitude toward infection prevention practices among healthcare workers are also required.

Experience and perspectives of infection prevention staff of the COVID-19 response in Australian hospitals

Background

Hospital infection prevention and control (IPC) staff have played a key role in adapting and implementing jurisdictional COVID-19 policy during the current pandemic. We aimed to describe the experiences of IPC staff in Australian hospitals during the COVID-19 pandemic to inform future pandemic preparedness plans.

Methods

A cross-sectional study involving an online survey distributed to IPC practitioners employed in Australian hospitals. Survey content was informed by in-depth interviews, and addressed work conditions, redeployed workforce, personal protective equipment, communication, and guidelines. Participants were recruited through the mailing lists of Australasian College of Infection Prevention and Control and the Australasian Society of Infectious Diseases.

Results

We received fully or partially completed responses from 160 participants, including 38 (24%) and 122 (76%) with nursing and medical backgrounds, respectively. Respondents reported access to sufficient information about PPE (75%, 114/152), PPE was of sufficient quantity (77%, 117/152) and was of sufficient quality (70%, 106/152). Barriers to infection prevention guideline implementation included frequently changing guidelines (57%, 84/148), timing of updates (65%, 96/148) and contradictory sources of information (64%, 95/148). Respondents described a need for better communication channels from government authorities to hospital IPC teams. All respondents described an increase in workload leading to difficulty completing work (63%, 97/154) and feeling burnt out (48%, 74/154).

Conclusions

These data identify avoidable barriers to implementation of COVID-19 infection prevention guidance in Australian hospitals. These findings can inform future national preparedness strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13756-022-01116-9.

Challenges and experiences of general practitioners during the course of the Covid-19 pandemic: a northern Italian observational study-cross-sectional analysis and comparison of a two-time survey in primary care

BACKGROUND

General practitioners (GPs) have been among the frontline workers since the outbreak of the Covid-19 pandemic. Reflecting and analyzing the ongoing pandemic response of general practice provides essential information and serves as a precondition for outlining future health policy strategies.

OBJECTIVE

To investigate the effects of the pandemic on GPs' daily work and well-being and to describe needs for improvement in primary care highlighted by the pandemic.

METHODS

A 2-time cross-sectional online survey involving GPs in a northern Italian region was conducted in September 2020 and March/April 2021.

RESULTS

Eighty-four GPs (29.6% of invited GPs) participated in the first survey, and 41 GPs (14.4%) in the second survey. Most GPs experienced a notable workload increase which was tendentially higher during the advanced stages of the pandemic. A notable increase between the first and the second survey was noted regarding the frequency of Covid-related patient contacts and phone calls. Communication with health authorities and hospitals was rated as improvable. Psychological distress among GPs tended to increase over time; female GPs were more affected in the first survey. Most practices introduced major changes in their workflow, mainly appointment-based visits and separating Covid-19-suspected patients. Availability of protective equipment considerably increased over time. In the second survey, the GPs felt more prepared to self-protection and outpatient treatment of Covid-affected patients.

CONCLUSION

The work of GPs has been substantially impacted by the ongoing Covid-19 pandemic. Efforts should be undertaken to efficiently strengthen primary care which plays an important role in pandemic events.

"As protective gear began to run low, guidance on protection became looser" - Healthcare workers' perspectives on infection prevention and control during the COVID-19 pandemic

Objectives

The COVID-19 pandemic has posed several risk factors to healthcare workers' (HCWs') emotional distress. The purpose of the study was to enhance understanding of the experiences and feelings of HCWs during the COVID-19 pandemic, with specific reference to infection prevention and control (IPC) practices and guidance, focusing on the quality and availability of personal protective equipment (PPE), guidelines, and management. With a qualitative approach, we aimed to enable a wider narrative; to gain a more detailed understanding related to PPE use and identify experiences that can be overlooked in forced-choice questionnaires.

Methods

An online questionnaire was conducted among HCWs of the City of Helsinki and Helsinki University Hospital between 12.6.2020 and 5.4.2021. Altogether 1,580 HCWs participated in the study, from whom 579 shared 1,666 free-text responses. These responses were analyzed qualitatively, and the results were combined with statistical data on the participants' working conditions and backgrounds.

Results

We identified problems in PPE availability and changing guidelines as factors causing the most distress in the participants. Regarding availability, running out of masks and respirators emerged as the most worrying issue, and inadequate PPE was associated with the excessive workload (OR 1.51, CI 95% 1.01-2.25). The results also highlight the importance of transparent and clear communication regarding IPC instructions and guidance, and clear IPC guidance was associated with better levels of reported recovery from work (OR 1.51, CI 95% 1.06-2.14).

Conclusions

Our study highlights the importance of adequate PPE provision, transparent communication, clear guidance, and supportive supervisory work in this ongoing pandemic and potential new ones. We suggest more rigorous preparation, with crisis communication planning and emergency storage of PPE.

Changes in Anxiety Level and Personal Protective Equipment Use Among Healthcare Workers Exposed to COVID-19

BACKGROUND

The relationship between changes in anxiety levels and personal protective equipment (PPE) use is yet to be evaluated. The present study assessed this relationship among healthcare workers (HCWs) involved in the care of patients with coronavirus disease 2019 (COVID-19).

METHODS

An online survey was conducted in a municipal hospital with 195 nationally designated negative pressure isolation units in Korea. Anxiety level was measured using the self-rating anxiety scale (SAS), and changes in anxiety levels were assessed based on the time when COVID-19 vaccine was introduced in March 2021 in Korea. Monthly PPE usage between June 2020 and May 2021 was investigated.

RESULTS

The mean SAS score (33.25 ± 5.97) was within normal range and was lower than those reported in previous studies conducted before COVID-19 vaccination became available. Among the 93 HCWs who participated, 64 (68.8%) answered that their fear of contracting COVID-19 decreased after vaccination. The number of coveralls used per patient decreased from 33.6 to 0. However, a demand for more PPE than necessary was observed in situations where HCWs were exposed to body fluids and secretions (n = 38, 40.9%). Excessive demand for PPE was not related to age, working experience, or SAS score.

CONCLUSION

Anxiety in HCWs exposed to COVID-19 was lower than it was during the early period of the pandemic, and the period before vaccination was introduced. The number of coveralls used per patient also decreased although an excessive demand for PPE was observed.

Personal protective equipment used by obstetricians and obstetric nurses during the COVID-19 pandemic in Mansoura, Egypt

Background: This study was done to describe the pattern of personal protective equipment (PPE) use, associated factors, and adverse events among obstetricians and obstetric nurses in obstetrics & gynecology departments.  Methods: A cross sectional study was conducted in Obstetrics & Gynecology departments in three hospitals (physician & nurses n=252) using an online Google form including demographic and occupational health data, type of available personal protective equipment during usual care, CS and emergency labor, infection control measures and hazards of full PPE use. Results Full PPE use was 37.7% during CS and 34.9% during emergency labor. The significant predictors of wearing full PPE during CS were daily work hours > 8 hours and receiving formal training about PPE use. During CS & emergency labor most of HCws used sterile gloves and sterile fluid resistant gowns and surgical mask.to less extent used face shields or tight fitting googles and one tenth (11.8%) only used N95. The most common health effects of full PPE use was sense of heat (79.5%) .Conclusion: During the COVID-19 pandemic more vigorous respiratory (N95 mask) and eye protection is required during aerosol-generating procedures. Formal training is an evident predictor for full PPE use.

Personal protective equipment used by obstetricians and obstetric nurses during the COVID-19 pandemic in Mansoura, Egypt

Background: This study was done to describe the pattern of personal protective equipment (PPE) use, associated factors, and adverse events among obstetricians and obstetric nurses in obstetrics & gynecology departments.  Methods: A cross sectional study was conducted in Obstetrics & Gynecology departments in three hospitals (physician & nurses n=252) using an online Google form including demographic and occupational health data, type of available personal protective equipment during usual care, CS and emergency labor, infection control measures and hazards of full PPE use. Results Full PPE use was 37.7% during CS and 34.9% during emergency labor. The significant predictors of wearing full PPE during CS were daily work hours > 8 hours and receiving formal training about PPE use. During CS & emergency labor most of HCws used sterile gloves and sterile fluid resistant gowns and surgical mask.to less extent used face shields or tight fitting googles and one tenth (11.8%) only used N95. The most common health effects of full PPE use was sense of heat (79.5%) .Conclusion: During the COVID-19 pandemic more vigorous respiratory (N95 mask) and eye protection is required during aerosol-generating procedures. Formal training is an evident predictor for full PPE use.

Characterization and evolution of infection control practices among severe acute respiratory coronavirus virus 2 (SARS-CoV-2)-infected healthcare workers in acute-care hospitals and long-term care facilities in Québec, Canada, Spring 2020

OBJECTIVES

In this study, we aimed to (1) estimate the severe acute respiratory coronavirus 2 (SARS-CoV-2) infection rate and the secondary attack rate among healthcare workers (HCWs) in Québec, the most affected province of Canada during the first wave; (2) describe the evolution of work-related exposures and infection prevention and control (IPC) practices in infected HCWs; and (3) compare the exposures and practices between acute-care hospitals (ACHs) and long-term care facilities (LTCFs).

DESIGN

Survey of cases.

PARTICIPANTS

The study included Québec HCWs from private and public institutions with laboratory-confirmed coronavirus disease 2019 (COVID-19) diagnosed between March 1 and June 14, 2020. HCWs aged ≥18 years who worked during the exposure period and survived their illness were eligible for the survey.

METHODS

After obtaining consent, 4,542 HCWs completed a standardized questionnaire. COVID-19 rates and proportions of exposures and practices were estimated and compared between ACHs and LTCFs.

RESULTS

HCWs represented 13,726 (25%) of 54,005 reported COVID-19 cases in Québec and had an 11-times greater rate of COVID-19 than non-HCWs. Their secondary household attack rate was 30%. Most affected occupations were healthcare support workers, nurses and nurse assistants working in LTCFs (45%) and ACHs (30%). Compared to ACHs, HCWs in LTCFs had less training, higher staff mobility between working sites, similar PPE use, and better self-reported compliance with at-work physical distancing. Suboptimal IPC practices declined over time but were still present at the end of the first wave.

CONCLUSION

Québec HCWs and their families were severely affected during the first wave of COVID-19. Insufficient pandemic preparedness and suboptimal IPC practices likely contributed to high transmission in both LTCFs and ACHs.

Impact of Face-to-Face Teaching in Addition to Electronic Learning on Personal Protective Equipment Doffing Proficiency in Student Paramedics: Randomized Controlled Trial

Personal protective equipment doffing is a complex procedure that needs to be adequately performed to prevent health care worker contamination. During the COVID-19 pandemic, junior health care workers and students of different health care professions who had not been trained to carry out such procedures were often called upon to take care of infected patients. To limit direct contact, distance teaching interventions were used, but different trials found that their impact was rather limited. We therefore designed and carried out a randomized controlled trial assessing the impact of adding a face-to-face intervention using Peyton's four-step approach to a gamified e-learning module. Sixty-five student paramedics participated in this study. The proportion of doffing sequences correctly performed was higher in the blended learning group (33.3% (95%CI 18.0 to 51.8) versus 9.7% (95%CI 2.0 to 25.8), p = 0.03). Moreover, knowledge and skill retention four to eight weeks after the teaching intervention were also higher in this group. Even though this study supports the use of a blended learning approach to teach doffing sequences, the low number of student paramedics able to adequately perform this procedure supports the need for iterative training sessions. Further studies should determine how often such sessions should be carried out.

COVID-19 Radiology Preparedness, Challenges & Opportunities: Responses From 18 Countries

PURPOSE

Radiology departments around the world have been faced with the challenge to adapt, and recover to the COVID-19 pandemic. This study is part of a worldwide survey of radiologists' responses to COVID-19 in 18 different countries in Africa, Asia, Europe, and Latin America. The purpose of this study is to analyze the changes made in international radiology departments and practices in response to the pandemic.

METHODS

The 18-item survey was sent via email from April to May 2020 to radiologists in Africa, Asia, Europe, and Latin America to assess their response to COVID-19. Our survey included questions regarding imaging, workforce adjustments, testing availability, staff and patient safety, research and education, and infrastructure availability.

RESULTS

Twenty-eight survey responses were reviewed. Of the 28 respondents, 42.9% have shortages of infrastructure and 78.6% responded that COVID-19 testing was available. Regarding the use of Chest CT in COVID-19 patients, 28.6% respondents used Chest CT as screening for COVID-19. For staff safety, interventions included encouraging use of masks in patient encounters, social distancing and PPE training. To cope with their education and research mission, radiology departments are doing online lectures, reducing the number of residents in rotations, and postponing any non-urgent activities.

CONCLUSION

In conclusion, there are disparities in infrastructure, research, and educational initiatives during COVID-19 which also provides opportunity for the global radiology community to work together on these issues.

First responder systems can stay operational under pandemic conditions: results of a European survey during the COVID-19 pandemic

Background

Dispatching first responders (FR) to out-of-hospital cardiac arrest in addition to the emergency medical service has shown to increase survival. The promising development of FR systems over the past years has been challenged by the outbreak of COVID-19. Whilst increased numbers and worse outcomes of cardiac arrests during the pandemic suggest a need for expansion of FR schemes, appropriate risk management is required to protect first responders and patients from contracting COVID-19. This study investigated how European FR schemes were affected by the pandemic and what measures were taken to protect patients and responders from COVID-19.

Methods

To identify FR schemes in Europe we conducted a literature search and a web search. The schemes were contacted and invited to answer an online questionnaire during the second wave of the pandemic (December 2020/ January 2021) in Europe.

Results

We have identified 135 FR schemes in 28 countries and included responses from 47 FR schemes in 16 countries. 25 schemes reported deactivation due to COVID-19 at some point, whilst 22 schemes continued to operate throughout the pandemic. 39 schemes communicated a pandemic-specific algorithm to their first responders. Before the COVID-19 outbreak 20 FR systems did not provide any personal protective equipment (PPE). After the outbreak 19 schemes still did not provide any PPE. The majority of schemes experienced falling numbers of accepted call outs and decreasing registrations of new volunteers. Six schemes reported of FR having contracted COVID-19 on a mission.

Conclusions

European FR schemes were considerably affected by the pandemic and exhibited a range of responses to protect patients and responders. Overall, FR schemes saw a decrease in activity, which was in stark contrast to the high demand caused by the increased incidence and mortality of OHCA during the pandemic. Given the important role FR play in the chain of survival, a balanced approach upholding the safety of patients and responders should be sought to keep FR schemes operational.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13049-022-00998-3.

Health care workers' experience of personal protective equipment use and associated adverse effects during the COVID-19 pandemic response in Singapore

Aim

One of the greatest challenges in responding to the COVID‐19 pandemic is preventing staff exposure and infection by ensuring consistent and effective use of personal protective equipment (PPE). This study explored health care workers' experience of prolonged PPE use in clinical practice settings and their concerns regarding PPE supply, effectiveness and training needs.

Design

A descriptive cross‐sectional design was adopted in this study.

Methods

Health care workers (N = 592) from an acute care hospital completed an online survey from July to September 2020 assessing: (i) usage frequencies, side effects and interference with patient care; and (ii) perceptions of access to PPE, likelihood of exposure to infection and adequacy of PPE training.

Results

PPE‐related side effects were reported by 319 (53.8%) participants, the majority being nurses (88.4%) and those working in high‐risk areas such as the emergency department (39.5%), respiratory wards (acute 22.3% and non‐acute 23.8%) and COVID‐19 isolation ward (13.8%). The average time wearing PPE per shift was 6.8 h (SD 0.39). The most commonly reported symptoms were from donning N95 masks and included: pressure injuries (45.5%), mask‐induced acne (40.4%) and burning/pain (24.5%). Some 31.3% expressed that PPE‐related side effects had negatively affected their work. The odds of having PPE‐associated side effects was higher in women (OR 2.10, 95% CI [1.29–03.42], p = .003) and those working in high‐risk wards (OR 3.12, 95% CI [2.17–4.60], p < .001]. Most (90.1%) agreed that PPE supplies were readily available, sufficient for all (86.1%) and there was sufficient training in correct PPE use (93.6%). Only 13.7% of participants reported being ‘highly confident’ of overall PPE protection.

Conclusions

Prevention and management of PPE‐related adverse effects is vital to: preserve the integrity of PPE, improve adherence and minimize viral transmission.

Impact

The high incidence of PPE‐associated pressure injuries and perception that PPE use can interfere with clinical care should inform future development of PPE products, and strategies to better equip health care workers to prevent and manage PPE‐related side effects.

The Thought of Death in a Pandemic Era: Can Anxiety Determine the Nexus between the Accessibility, Availability and Use of Personal Protective Equipment (PPE) for COVID-19 and Work Behaviour among Aviation Workers?

Since the emergence of COVID-19, the aviation sector has been one of the numerous industries which have been affected the most. In this present paper, the thought of death among aviation workers as an indicator of anxiety at a time when the availability, access to, and use of Personal Protective Equipment (PPE) remains paramount to the survival of work in the line of duties and its influence on different work behaviors was assessed. The theoretical foundation of the study was built on the process efficiency theory, attentional interference theory, and the terror management theory (TMT), which focuses on both the psychological and emotional responses exhibited by people due to fear or worry about a specific situation. The study adopted an exploratory study design that incorporates a cross-sectional and self-reported survey among 646 frontline workers across 12 international airlines and the Ghana Airport Company Limited (GACL), Accra, Ghana using simple random sampling and convenient sampling techniques. After all the preliminary tests were performed, the path analysis estimated by Structural Equation Modelling (SEM) indicated that anxiety has a significant influence on workers’ stress-adaptive performance and task performance, but recorded no significant causal link with interpersonal performance. The findings indicated that all three proxies of employee work behaviours, which focus on both adaptive and task performance, were significantly related to workers’ access, availability, and use of PPE (APPE). The association between anxiety and APPE was also found to be significant. Bootstrapping mediation analysis shows that anxiety partially mediates the influence APPE has on both stress-adaptive performance and task performance, but did not show any mediating effect on the association between APPE and interpersonal performance. Among the three dimensions of death anxiety, both the fear of death (FDE) and death intrusion (DINT) indicated a significant partial mediating effect on the influence APPE has on all three multidimensional constructs of work behaviours. The findings literally prove that worrying about the fatality risk associated with COVID-19 is highly predictive.

Critical Issues of Working during the COVID-19 Pandemic: Italian Healthcare Workers' Experience

Background: The COVID-19 pandemic has strongly impacted on healthcare services’ organization and healthcare workers’ mental health, increasing the risk of psychological symptoms and burnout. Italy has been one of the most affected countries, especially the northern regions, even with exceptions in some rural provinces. Aim: We chose to investigate the mental health conditions of healthcare workers operating in the rural province of Rovigo (a small town in Veneto, northern Italy), where relatively few deaths and contagions were reported during the pandemic, even if Veneto—globally—was one of the most affected regions of Italy. We wanted to verify the psychological outcomes of health workers operating in a context where the impact of the pandemic appeared to be relatively mild. Methods: Through an online survey, we investigated perceived difficulties at work and in daily life, perceived loneliness and social support, coping strategies, and level of psychological distress (sample size: 749; mean age = 48.04 years, SD = 10.66). The questionnaire had both open- (2) and close-ended questions (5 single-choice and 13 multiple-choice). We verified possible associations between sex, age group, work department and percentage of responses with chi-square tests of independence on each question. Data cleaning excluded all contradictory answers from the multiple-choice questions from the analyses (final sample size: 640). Results: Frontliners and non-frontliners reported a similar experience of the COVID-19 pandemic (without significant differences in perceived difficulties, coping strategies and sources of support). Nevertheless, they still reported various forms of negative emotions (e.g., helplessness—40.94%; sadness—36.56%; frustration—32.66%) and lack of support from the health organization (especially frontliners—28.72%). However, psychological help was scarcely requested. Conclusions: Despite the province not being massively affected by the pandemic, healthcare workers felt the need for clearer and more supportive guidance. They seem to perceive collective opportunities to share needs and difficulties as more useful than individual interventions (as those provided by the ad hoc created listening service).

Psychopathological states among Congolese health workers during the first wave of COVID-19 pandemic: links with emotion regulation and social support

Background: The COVID-19 pandemic is an unprecedented stressor for frontline healthcare workers, notably increasing acute stress disorder and depression rates. Emotion regulation and social support could be major protective factors against such psychopathological states, but their role has not been explored outside Western contexts. Objective: To assess the association between emotion regulation, social support, acute stress disorder, and depression among healthcare workers directly confronted with the first wave of COVID-19 pandemic in the eastern Democratic Republic of the Congo. Method: A cross-sectional study assessed acute stress disorder, depression, adaptive (i.e. acceptance, positive refocusing, …) and maladaptive (i.e. self-blame, rumination, catastrophizing, …) emotion regulation strategies, social support (instrumental, emotional, and informational levels), as well as self-reported situations and feelings related to COVID-19, in a population of 252 frontline healthcare workers (121 women; 131 men; mean age: 39 ± 11 years old) at the Referral General Hospital of Bukavu. We also explored the relations between these variables through bivariate and multivariate logistic regression. Results: Forty percent of participants presented symptoms of depression, and 16% presented acute stress disorder. In bivariate logistic regression, these psychiatric outcomes were associated with the availability of a COVID-19 protection kit [OR = 0.24 (0.12-0.98)], hostility toward health workers [OR = 3.21 (1.23-4.21)], putting into perspective [OR = 0.91 (0.43-0.98)], self-blame [OR = 1.44 (1.11-2.39)], catastrophizing [OR = 1.85 (1.01-4.28)], blaming others [OR = 1.77 (1.04-3.32)], emotional support [OR = 0.83 (0.49-0.98)], instrumental support [OR = 0.74 (0.28-0.94)], and informational support [OR = 0.73 (0.43-0.98)]. In multivariate logistic regression, hostility [OR = 2.21 (1.54-3.78)], self-blame [OR = 1.57 (1.02-2.11)], rumination [OR = 1.49 (1.11-3.13)] and emotional support [OR = 0.94 (0.65-0.98)] remained significantly associated with psychiatric outcomes. Conclusion: Depression and acute stress disorder were highly prevalent among Congolese healthcare workers during the first wave of the COVID-19 health pandemic. Hostility, self-blame, rumination, and social support were associated with depression and/or acute stress disorder and should be targeted by interventions aiming to support health workers' wellbeing.

HIGHLIGHTS

Frontline health workers presented high prevalence of acute stress disorder (16%) and depression (40%) during the first wave of COVID-19 pandemic in the Eastern Democratic Republic of the Congo, as they were working in hostile environment without enough protection kits.Acute stress disorder and depression were negatively associated with adaptive emotion regulation and social support; and positively with maladaptive emotion regulation.Intervention aiming to support health workers in pandemics should target emotion regulation and social support.

The Use of Personal Protective Equipment among Frontline Nurses in a Nationally Designated COVID-19 Hospital during the Pandemic

Background

The appropriate use of personal protective equipment (PPE) can significantly reduce the risk of infection associated with caring for patients. This study aimed to investigate the knowledge, awareness, and behaviors related to the PPE usage among frontline nurses in a nationally designated coronavirus disease 2019 (COVID-19) hospital during the COVID-19 pandemic.

Materials and Methods

The study was performed in two phases: (1) a questionnaire survey to assess the knowledge, awareness, and behaviors related to PPE use, and (2) in-depth personal interviews to elaborate the survey findings. The questionnaires were distributed to all 121 registered nurses in three isolation wards and an intensive care unit which dedicated for patients with COVID-19 and 102 nurses completed survey (84.3% response rate). In-depth interviews were conducted with a total of 7 nurses.

Results

Among the survey participant, 100% stated that they knew how to protect themselves while providing nursing care and 93.1% stated that they knew the recommended PPE by task. Most survey participant mainly wore gloves, face shield, N95 or equivalent respirator, and a long-sleeved gown, but one-third of the participants sometimes used coveralls instead of long-sleeved gown. In-depth interviews, the importance of timely updated and specific guidelines for selecting the appropriate type of PPE was highlighted. The adequate supply of PPE, convenience at work, and the role of responsible leadership mainly determined behaviors related to the PPE.

Conclusion

As new information on COVID-19 continues to emerge, the up-to-date and specific PPE guideline with evidence should be prepared. The spread of accurate information, the role of accountable leadership, and the active communication under positive organizational culture are important for the proper use of PPE.

Primary healthcare physicians' satisfaction towards work safety and personal protective equipment during the COVID-19 pandemic in Qatar: A cross-sectional study

Background

During COVID-19 pandemic, healthcare workers are experiencing unprecedented pressure from stressors including enormous workload, virus exposure, and inadequate PPE. This study aimed to assess primary healthcare physicians’ satisfaction towards work safety and personal protective equipment and their predictors during early stages of COVID-19 pandemic in Qatar.

Methods

A cross-sectional web-based survey was conducted in 27 primary healthcare centers in Qatar from 1st June to 30 July 2020. Descriptive and analytical statistics were used when appropriate. A multivariable linear regression analysis was done to identify predictors of satisfaction among participants.

Results

A total of 262 participants completed the questionnaire with a response rate of 58.2%. 51.9% were males and 68.3% were family physicians. Only 14.9% and 17.2% of respondents were satisfied or highly satisfied about the overall safety of work and the clinical guidelines on the use of PPE in the context of COVID-19 respectively. Participants who were general practitioners were significantly more likely to be satisfied with maintaining work safety and local PPE guidelines compared to family physicians by 2.93 scores (95% CI 1.43, 4,43 p -value <0.001), and 2.82 scores (95% CI 1.19, 4,44 p -value 0.001) respectively. Also, physicians who had more than ten years of experience in practice were significantly more likely to be satisfied with the PPE use guidelines compared to those who had fewer years of experience by 1.93 scores (95% CI 0.45, 3.41 p -value 0.011).

Conclusion

Overall satisfaction of participants with the safety of work and PPE clinical practice guidelines was low.

Prevention Practice of COVID-19 Using Personal Protective Equipment and Hand Hygiene Among Healthcare Workers in Public Hospitals of South Wollo Zone, Ethiopia

Objective: The use of personal protective equipment and hand hygiene are often the most recommended line of defense against coronavirus disease-19 (COVID-19). The purpose of this study is to determine the magnitude of compliance and associated factors of personal protective equipment (PPE) utilization and hand hygiene practice among healthcare workers in public hospitals of South Wollo Zone, Northeastern Ethiopia. Methods: A hospital-based cross-sectional study was conducted among 489 healthcare workers in public hospitals of South Wollo Zone, Northeastern Ethiopia from June 15 to July 30, 2021. Proportional sample size allocation to each selected hospital followed by simple random sampling techniques were used to select the study participants using human resource records from each hospital. A pre-tested and structured self-administered questionnaire with WHO's standardized hand hygiene and PPE utilization observational checklist were used to collect data. Bivariate and multivariable analyses with 95% CI and p-value < 0.05 were employed to identify the associated factors of personal protective equipment utilization. Results: About 32 and 22.3% of healthcare workers were compliant with personal protective equipment utilization and hand hygiene practice, respectively. Feedback for safety (AOR = 2.05; 95% CI: 1.26-3.35), training on COVID-19 prevention (AOR = 3.43; 95% CI: 2.01-5.86), and perception to infection risk (AOR = 1.98; 95% CI: 1.18-3.33) were significant factors of good compliance with personal protective equipment utilization. Conclusion: The magnitude of good compliance with personal protective equipment utilization and hand hygiene was low. Interventions to promote personal protective equipment utilization and hand hygiene should focus on feedback for safety, training on COVID-19 prevention, and perception of infection risk.

Assessing the Role of Trust in Information Sources, Adoption of Preventive Practices, Volunteering and Degree of Training on Biological Risk Prevention, on Perceived Risk of Infection and Usage of Personal Protective Equipment Among Italian Medical Students During the SARS-CoV-2 Pandemic

Background: During the initial phase of the COVID-19 pandemic, the University of Bologna Medical School surveyed medical students to learn more about their preparation to confront challenges posed by the pandemic and whether it affects perceptions of viral infection risk. This information could help design risk-reduction interventions with training to mitigate possible viral exposure. Method: A cross-sectional online survey examining students' characteristics, volunteer status, adoption of evidence-based preventive measures, trust in information sources used, infectious disease training, and knowledge of PPE usage in relation to perceived risk of infection from SARS-CoV-2 in daily living, academic, and healthcare activities. A multivariate path model estimated the simultaneous influences of all exogenous factors on perceived risk. A Poisson regression model assessed the same multivariate effects on knowledge of PPE usage. Results: The analysis sample included 537 respondents. Perceived risk of infection was highest in hospital activities. On average, students were able to use only four out of seven types of PPE albeit they adopted most of the evidence-based preventive measures. Adoption of preventive measures was positively associated with perceived risk of COVID infection. Conversely, training on PPE usage and volunteer work were associated with lower perceived risk in healthcare setting and higher PPE knowledge. Conclusion: Implementing early safety-based educational programs remedy students' lack of knowledge in infectious disease prevention and mitigate their risk of infection. Voluntary work should be encouraged with potential benefit for both their continued medical training and strengthening the healthcare system's response to public health emergencies.

Personal Protective Equipment Adherence of Pediatric Resuscitation Team Members During the COVID-19 Pandemic

STUDY OBJECTIVE

During the COVID-19 pandemic, health care workers have had the highest risk of infection among essential workers. Although personal protective equipment (PPE) use is associated with lower infection rates, appropriate use of PPE has been variable among health care workers, even in settings with COVID-19 patients. We aimed to evaluate the patterns of PPE adherence during emergency department resuscitations that included aerosol-generating procedures.

METHODS

We conducted a retrospective, video-based review of pediatric resuscitations involving one or more aerosol-generating procedures during the first 3 months of the COVID-19 pandemic in the United States (March to June 2020). Recommended adherence (complete, inadequate, absent) with 5 PPE items (headwear, eyewear, masks, gowns, gloves) and the duration of potential exposure were evaluated for individuals in the room after aerosol-generating procedure initiation.

RESULTS

Among the 345 health care workers observed during 19 resuscitations, 306 (88.7%) were nonadherent (inadequate or absent adherence) with the recommended use of at least 1 PPE type at some time during the resuscitation, 23 (6.7%) of whom had no PPE. One hundred and forty health care workers (40.6%) altered or removed at least 1 type of PPE during the event. The aggregate time in the resuscitation room for health care workers across all events was 118.7 hours. During this time, providers had either absent or inadequate eyewear for 46.4 hours (39.1%) and absent or inadequate masks for 35.2 hours (29.7%).

CONCLUSION

Full adherence with recommended PPE use was limited in a setting at increased risk for SARS-CoV-2 virus aerosolization. In addition to ensuring appropriate donning, approaches are needed for ensuring ongoing adherence with PPE recommendations during exposure.

Caring for Caregivers: Italian Health Care Workers' Needs during the COVID-19 Pandemic

Aim: An online survey was proposed to the health workers of a public hospital of an Italian northern city. This was done with the aim of assessing the unmet needs of a special population under strain (the health carers) due to the fight against the coronavirus disease 19 (COVID-19). Results: By answering the survey, five hundred and nine people provided their observations, complaints and suggestions. This qualitative material was organised into three main areas: (1) relationship with the health organization management; (2) needs of the health workers; and (3) perceived consequences of the pandemic. Discussion: Overall, respondents expressed dissatisfaction for the unpreparedness of their health units and the confusion created by frequent changes in operational guidelines. Many participants felt abandoned, unheard and unprotected by the health organization, whilst the psychological support service formally set up by the hospital for its health workers was grossly under-utilised. Instead, support from colleagues and family constituted the main protective factor to counteract negative emotions. Restrictions in social contacts and recreational opportunities were frequently mentioned. Several respondents reported a sense of pride for their work and commitment; many others saw in the pandemic an opportunity for personal growth and better focus on important life values, like family and solidarity.

The Year of the Nurse during the COVID-19 Pandemic

The year 2020 was established by the World Health Organization as The Year of the Nurse and Midwife to emphasize the importance of this profession to the healthcare system. Strange but true, nurses around the world celebrated it by being frontline workers during the COVID-19 pandemic. Thus, the phrase "Nursing Now" has become more important than ever. The main aim of this article was to draw attention to the fact that 2020 was the Year of the Nurse and Midwife and, indeed, their role in the fight against the pandemic is difficult overlook. Through the use of available scientific databases, documents and scientific publications related to the subject were collected and analyzed. Nurses are able to fulfill their duties as long as they are properly rewarded and provided not only with support but also better terms and conditions of employment. The investment in nurses should also be treated as an investment in the healthcare system.

Safety Trade-Offs in Home Care During COVID-19: A Mixed Methods Study Capturing the Perspective of Frontline Workers

Background: Home care workers help older individuals and those with disabilities with a variety of functional tasks. Despite their core role providing essential care to vulnerable populations, home care workers are often an invisible sector of the healthcare workforce. The transmission of COVID-19 and the nature of home care work raise several questions about the overall safety of these workers during the pandemic. Objective: To examine the experiences of home care workers during COVID-19, particularly their access to information about infection status, to testing, and to personal protective equipment (PPE); their understanding of guidelines; and trade-offs associated with protecting workers’ safety. Methods: A mixed methods study including qualitative analysis of guided discussion questions and quantitative analysis of multiple-choice survey questions was conducted. Eleven virtual focus groups in October and November 2020 involved 83 home care workers who care for clients/consumers in Massachusetts. Thirty-nine participants worked as personal care attendants (PCAs) employed directly by a consumer and 44 participants worked for an agency. Ninety percent self-identified as female and 54% had worked in home care for more than five years. Qualitative data was analyzed using thematic analysis, with identification of major and minor themes. Likert scale survey question data on perceptions of COVID-19 exposure, access to resources to prevent transmission, and perceptions of safety at work were dichotomized into agree or disagree. Results: PCAs and agency-employed home care workers were regularly faced with trade-offs between meeting client/consumer needs and protecting themselves from COVID-19 exposure. Twenty-five percent of participants reported serving a client/consumer who had COVID-19, 75% reported worrying about getting COVID-19 at work, and 29% reported thinking about stopping their work in home care. Despite a low pay structure, participants reported opting to risk exposure rather than to leave their clients/consumers without essential care. However, workers often lacked the resources (e.g., PPE, testing) to feel truly protected. This scarcity of resources combined with insufficient guidance and policies specific to home care settings led many workers to informally collaborate with clients/consumers to assess exposure risks and agree upon safety protocols. Focus group participants expressed uncertainty as to whether workers were truly empowered to ask for changes if conditions seemed unsafe. The burden of determining safety protocols was felt more strongly by PCAs who operate more independently than agency-employed workers who have supervisors to consult. Conclusions: Home care workers expressed deep commitment to continuing to care for their clients/consumers during COVID-19, but often had to operate with insufficient resources and under conditions that made their work environments feel unsafe. Their ability to identify exposure risks and make decisions on how to protect themselves often hinged on a transparent and trusting relationship with their clients/consumers. These relationships were particularly important for PCAs who did not have access to safety guidance from a home care agency.

Assessment of Perceived Compliance and Barriers to Personal Protective Equipment Use Among Healthcare Workers During the COVID-19 Pandemic's Second Wave Surge: "Walk to Talk" Cross-Sectional Correlational Study

OBJECTIVE

This study aimed at investigating HCWs' perceptions of PPE compliance and barriers, as well as influencing factors, in order to develop methods to combat the rise in their infection rates.

METHODS

During the 'second wave' surge, a cross-sectional correlational analysis was conducted over a 1-month period. It consists of HCWs from various hospital sectors that admit COVID-19 patients using an online self-administered predesigned tool.

RESULTS

Out of the 285 recruited participants, 36.1% had previously been diagnosed with COVID-19. Around 71% received training on PPE use. The perceived compliance was good for (PPE) usage (mean 2.60 ± 1.10). A significant higher compliance level was correlated with previous diagnosis with COVID-19, working with patients diagnosed with COVID-19, and having a direct contact with a family member older than 45 years old (P < 0.01). The main perceived barriers to the use of PPEs were unavailability of full PPEs (35%), interference with their ability to provide patient care (29%), not enough time to comply with the rigors of PPEs (23.2%) and working in emergency situations (22.5%). With regards to perceived barriers, those working with patients diagnosed with COVID-19 and those who reported having a direct contact with a family member older than 45 years old showed significantly higher level of barriers.

CONCLUSION

A series of measures, including prioritization of PPE acquisition, training, and monitoring to guarantee appropriate resources for IPC, are necessary to reduce transmission.

Using a Critical Safety Behavior Scoring Tool for Just-in-Time Training for N95 Respirator Use

BACKGROUND

Historically, health care workers (HCWs) have exhibited marginal adherence to proper N95 respirator use. During the COVID-19 pandemic, HCWs with little to no prior training on N95 respirator use are relying on N95s as their primary respiratory protection. There is a need for simple, effective, and easily implementable just-in-time training (JITT) interventions to improve N95 respirator-related safety behavior. This study investigated two JITT interventions.

METHODS

A pilot experimental pretest posttest study design was used to evaluate two training interventions for N95 respirator donning/doffing performance at a Midwestern hospital system. HCW participants were randomly assigned to an intervention: one used a 4-minute instructional video alone, while the other used the same video but added a video reflection intervention (participant watched and scored a video of their own performance). All performances were scored using a 10-point Critical Safety Behavior Scoring Tool (CSBST).

FINDINGS

Sixty-two HCWs participated (32 video alone, 30 video reflection). The two groups' CSBST scores were not significantly different at pretest. Averaged participant scores on the CSBST improved immediately following both interventions. Scores were significantly higher on the posttest for the reflective practice intervention (p<.05). Years of experience and frequency of N95 respirator use did not predict pre or post scores.

CONCLUSIONS/APPLICATIONS TO PRACTICE

We provide evidence to support the use of a time-efficient JITT intervention to improve HCW N95 respirator donning/doffing practices during the COVID-19 pandemic and beyond. Hospital safety professionals should consider this type of training for HCWs required to wear respiratory protection.

Compliance of healthcare workers to the proper use of personal protective equipment during the first wave of COVID-19 pandemic

Background

In limited resource settings, compliance to proper personal protective equipment (PPE) use is challenging. This study aims to characterize the pattern of PPE use among healthcare workers (HCWs) during the first wave of coronavirus diseases-2019 (COVID-19) in Egypt and to determine the factors associated with compliance to the proper use of PPE.

Methods

A cross-sectional study was conducted among Egyptian HCWs using an online self-administered questionnaire. Participants were classified as “Compliant” or “Non-compliant” according to their score.

Results

A total of 404 responses were analyzed, with a mean age of 36.6 ± 8.4 years, and 56.4% were females. Non-compliant HCWs represented 53.2% of participants. The majority reported shortage in N95 respirators (91.3%) and practiced extended PPE use (88.1%). Better compliance to proper PPE use was reported: females (51.3%, p = 0.05), Physicians (54.2 %, p = 0.005), medical specialities (34.7 %, p < 0.001), <10 years’ work experience (42.9%, p = 0.05) and working > eight hours/day (71.3%, p < 0.001). The significant predictors for compliance were; receiving prior training on the proper use of PPE (OR: 4.59, CI: 2.22–9.47, p ≤ 0.001), exposure to COVID-19 patients (OR: 2.75, CI: 1.19–6.35, p = 0.02) and performing procedures that pose HCWs at a high risk of exposure to Severe Acute Respiratory Syndrome Coronavirus 2 (OR: 2.21, CI: 1.04–4.71, p = 0.04). The high percentage of non-compliant HCWs turns on a warning signal. Increase the availability of PPE, prioritize their use, provide more focus on training of HCWs and monitor their compliance is highly recommended.

Investigating the Effective Factors of Using Personal Protective Equipment from the Perspective of Nurses Caring for COVID-19 Patients: A Cross-Sectional Study

Considering the importance of appropriate personal protective equipment (PPE) for preventing COVID-19 transmission, the aim of this study was to investigate the factors affecting the use of PPE from the perspective of the nurses caring for COVID-19 patients. This descriptive cross-sectional study surveyed 240 nurses working in the central COVID-19 hospitals of Arak, Iran. Nurses were enrolled in the study by a convenience sampling method. The data collection tool was a validated questionnaire. Data were analyzed by SPSS 16 software using descriptive statistics, analysis of variance (ANOVA), and independent sample t-test. Environmental (4.24 ± 0.45), personal (4.16 ± 0.42), and organizational (4.04 ± 0.50) factors all contribute significantly to nursing attitudes about PPE use (p < 0.05). The average score, combining all identified factors, was 4.15 ± 0.31. The most influential factor contributing to appropriate use of PPE was environmental, while the least impactful parameters were related to rules and regulations. Environmental factors have the greatest impact on the use of PPE from the perspective of the nurses caring for patients with COVID-19. Managers and healthcare organizations should provide appropriate and adequate PPE to nurses, educate them on proper use, and monitor the process to resolve barriers.

Infection control, prophylactic antibiotics, and testing for SARS-CoV-2 and PPE on German intensive care units: results from a national mixed methods survey

Aim: Recommendations on hygiene measures, personal protective equipment (PPE), isolation, and antibiotic prophylaxis were developed during the coronavirus 2019 disease (COVID-19) pandemic and have been revised several times to date. Some of the underlying literature indicates a large evidence gap. We suspect that this leads to a large variance of measures on German intensive care units (ICU). Methods: A mixed methods online survey among intensive-care specialists in Germany caring for COVID-19 patients was conducted in December 2020. Results: We received responses from 205 German ICUs that had treated COVID-19 patients to date. There was wide variation in the use of PPE. Polymerase Chain reaction (PCR) testing for severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) was used by 94.8% of the units, with an average waiting time of 12 hours for the result. 18.7% of the respondents prescribed antibiotic prophylaxis in COVID-19 patients. Conclusion: We found a high variance in essential care strategies for COVID-19 patients on German intensive care units. This included differences in infection prophylaxis, personal protective equipment, and the indication of prophylactic antibiotic therapy. Based on our results, we recommend further studies to quantify and improve guideline adherence.

Differential perceptions regarding personal protective equipment use during the COVID-19 pandemic by NHS healthcare professionals based on ethnicity, sex and professional experience

Objectives

To capture perceptions regarding personal protective equipment (PPE) among healthcare professionals during the COVID-19 pandemic, including staff subgroups at high risk for severe COVID-19, such as black and minority ethnic (BAME) groups.

Design

Electronically distributed survey with semi-quantitative analysis. Survey distributed at a major academic NHS tertiary referral centre in the West Midlands with a diverse medical workforce to medically qualified staff who completed COVID-19 redeployment training. (N=121; 47% female; 49% of BAME background; 26% international medical graduates).

Results

All demographic groups reported overall good awareness of when and how to use PPE during COVID-19 pandemic. Statistically significant differences in the perceptions regarding PPE use during COVID-19 were noted between BAME vs non-BAME staff, international vs UK medical graduates, and male vs female participants, as well as between professionals at different stages of their career. The differences related to perceptions around availability, degree of protection provided, perceived inconvenience, ability to raise concerns about availability, confidence in sharing underlying health conditions with managers and the impact of full PPE in emergency situations causing delay patient care.

Conclusions

Amongst medically qualified staff, significant differences exist in the perceptions relating to the, availability and effectiveness of PPE during the COVID-19 pandemic depending on country of training, ethnic background and sex.

GAFREC Study Approval

Study ID GF0392.

Environmental aspect and applications of nanotechnology to eliminate COVID-19 epidemiology risk

Herein, we discuss fast development of the new coronavirus disease COVID-19, emerged in late 2019 in Wuhan, Hubei Province, China, the ground zero of the coronavirus pandemic, and associated with relatively high mortality rate. COVID-19 risk originates from its ability to transmit easily from person to person through the respiratory droplets released during sneezing, breathing, talking, singing, or coughing within a range of nearly 1.5–2 m. The review begins with an overview of COVID-19 origin and symptoms that range from common cold to severe respiratory illnesses and death. Then, it sheds light on the role of nanotechnology as an effective tool for fighting COVID-19 via contributions in diagnosis, treatment, and manufacture of protective equipment for people and healthcare workers. Emergency-approved therapeutics for clinical trial and prospective vaccines are discussed. Additionally, the present work addresses the risk of severe acute respiratory syndrome coronavirus transmission via wastewater and means of wastewater treatment and disinfection via nanoscale materials. The review concludes with a brief assessment of the government's efforts and contemporary propositions to minimize COVID-19 hazard and spreading.

Applying the lessons learned from coronavirus disease 2019 to improve pneumonia management

PURPOSE OF REVIEW

Coronavirus disease 2019 (COVID-19) has produced an extraordinary amount of literature in a short time period. This review focuses on what the new literature has provided in terms of more general information about the management of community-acquired pneumonia (CAP).

RECENT FINDINGS

Measures taken to reduce the spread of COVID-19 have caused a significant drop in influenza worldwide. Improvements in imaging, especially ultrasound, and especially in the application of rapid molecular diagnosis are likely to have significant impact on the management of CAP. Therapeutic advances are so far limited.

SUMMARY

COVID-19 has taught us that we can do far more to prevent seasonal influenza and its associated mortality, morbidity and economic cost. Improvements in imaging and pathogen diagnosis are welcome, as is the potential for secondary benefits of anti-COVID-19 therapies that may have reach effect on respiratory viruses other than severe acute respiratory syndrome coronavirus 2. As community-transmission is likely to persist for many years, recognition and treatment of severe acute respiratory syndrome coronavirus 2 will need to be incorporated into CAP guidelines moving forward.

Management of first responder programmes for out-of-hospital cardiac arrest during the COVID-19 pandemic in Europe

AIM

First responder (FR) programmes dispatch professional FRs (police and/or firefighters) or citizen responders to perform cardiopulmonary resuscitation (CPR) and use automated external defibrillators (AED) in out-of-hospital cardiac arrest (OHCA). We aimed to describe management of FR-programmes across Europe in response to the Coronavirus Disease 2019 (COVID-19) pandemic.

METHODS

In June 2020, we conducted a cross-sectional survey sent to OHCA registry representatives in 18 European countries with active FR-programmes. The survey was administered by e-mail and included questions regarding management of both citizen responder and FR-programmes. A follow-up question was conducted in October 2020 assessing management during a potential "second wave" of COVID-19.

RESULTS

All representatives responded (response rate = 100%). Fourteen regions dispatched citizen responders and 17 regions dispatched professional FRs (9 regions dispatched both). Responses were post-hoc divided into three categories: FR activation continued unchanged, FR activation continued with restrictions, or FR activation temporarily paused. For citizen responders, regions either temporarily paused activation (n = 7, 50.0%) or continued activation with restrictions (n = 7, 50.0%). The most common restriction was to omit rescue breaths and perform compression-only CPR. For professional FRs, nine regions continued activation with restrictions (52.9%) and five regions (29.4%) continued activation unchanged, but with personal protective equipment available for the professional FRs. In three regions (17.6%), activation of professional FRs temporarily paused.

CONCLUSION

Most regions changed management of FR-programmes in response to the COVID-19 pandemic. Studies are needed to investigate the consequences of pausing or restricting FR-programmes for bystander CPR and AED use, and how this may impact patient outcome.

General Practitioners' Experiences During the First Phase of the COVID-19 Pandemic in Italy: A Critical Incident Technique Study

Since February 2020, when coronavirus disease began to spread in Italy, general practitioners (GPs) were called to manage a growing number of health situations. The challenges experienced by Italian GPs remained unrevealed. This study aimed at exploring Italian GPs' care experiences and practices associated with critical incidents during the first wave of the pandemic. A qualitative study design involving the critical incident technique through an online survey was applied. Sociodemographic data and open-ended responses were collected. While participants' characteristics were analyzed through descriptive statistics, qualitative data were thematically analyzed employing the framework method. 149 GPs responded to the survey and 99 participants completed the survey (dropout rate = 33%). Eight themes emerged indicating factors related to the organization of the healthcare system and factors related to the clinical management of patients, that were perceived as impacting on the GPs' care provision. The analysis revealed difficulties in communicating with other local services. This, together with the lack of coordination among services, was reported as a major challenge. Primary care was perceived as having been undervalued and criticalities in the organization of GP courses, led in a bureaucratic fashion, posed at risk some trainees to be infected. The digital technologies adopted for remote patient consultations were seen as useful tools for daily practice helping the GPs to stay emotionally connected with their patients. Besides, the improvement in the GP–patient relationship in terms of solidarity between patients and doctors and compliance to rules, had a positive impact. Moreover, many respondents addressed the importance of professional collaboration and teamwork, in terms of both support in practical issues (to find PPE, diagnostics and guidelines) and emotional support. At the same time, the lack of resources (e.g., PPE, swabs) and of specific guidelines and protocols impacted on the care provision. Our findings suggest that GPs in Italy are at risk of being left behind within the epidemic management. Communication and coordination among services are essential and should be substantially improved, and primary care research should be initiated to collect the context-specific evidence necessary to enhance the system's preparedness to public health emergencies and the quality of primary care services.

COVID-19: estudo de protocolos de proteção individual para profissionais da saúde

Resumo Objetivo: realizar comparação interpaíses e entre estados brasileiros quanto ao conteúdo dos protocolos de proteção para profissionais de saúde que atuam na assistência aos doentes da COVID-19 e desenvolver análise crítica ao modelo de prevenção que adota indicação e uso de equipamentos de proteção individual (EPI) como resposta única a um problema de caráter multidimensional. Métodos: estudo exploratório com base em revisões disponíveis na biblioteca Cochrane, articuladas com a análise dos protocolos nacionais de Argentina, Brasil, China e Estados Unidos da América e as normas previstas nos estados do Amazonas, Bahia, Minas Gerais e São Paulo, todos selecionados por critérios de conveniência. Resultados: observou-se dissensos quanto aos tipos de proteção recomendados. Somente na China eram indicados respiradores de alta eficiência de filtragem, além de modelos para o rosto inteiro nos casos de procedimentos invasivos. O reuso de equipamentos não é indicado, mas estava autorizado no protocolo brasileiro. Quanto aos dispositivos de vestuário, também não há convergência. Conclusão: os resultados reforçam a necessidade de revisão dos protocolos de proteção dos profissionais da saúde que atuam no enfrentamento da Covid-19. Ações em busca de debate institucional, interpaíses e interestaduais sobre modelos de prevenção são essenciais para alcançar consistência nas recomendações.

Personal protective equipment use by healthcare workers in intensive care unit during the early phase of COVID-19 pandemic in Italy: a secondary analysis of the PPE-SAFE survey

BACKGROUND

Italy was the first Western country to be heavily affected by COVID-19. Healthcare workers (HCWs) were exposed to a high risk of occupational infection, partially due to insufficient personal protective equipment (PPE) supplies. This study aimed to describe the practices, availability, training, confidence in PPE use and the adverse effects due to extended PPE use, as reported by HCWs in Italy. We also aimed to provide a comparison between Italian data and those from other countries.

METHODS

This study was a secondary analysis of a previously published international study, the PPE-SAFE Survey, conducted in April 2020. Data were analysed from the original study database.

RESULTS

We analysed the responses from 380 healthcare workers based in Italy, out of the 2711 respondents to the international survey. Among the Italian respondents, FFP2 and FFP3 respirators or equivalent were the most used masks for routine tasks (respectively 188/380, 50%; and 163/380, 43%). The median time of wearing PPE without taking a break was 5 h [interquartile range (IQR) 4-6], with statistically significant difference from other countries [median 4 h (IQR 2-5) p < 0.0001]. In Italy, 249 out of 380 (65%) HCWs had never performed a formal fit test for a N95 mask or equivalent and 91/380 (24%) never had a partner for donning and doffing procedures. Most of the respondents (299/380, 79%) had received formal training in PPE use at any time.

CONCLUSION

Most of the surveyed Italian HCWs reported working at above usual capacity, long shifts with PPE without breaks and routine use in intensive care unit of aerosol protection (e.g. FFP2/FFP3), hazmat suits and face shields/visors. The correct adherence to safety procedures (e.g. donning/doffing in pairs, performing fit test) has substantial scope for improvement in the future.

Perceptions and experiences of the public regarding the COVID-19 pandemic in Nepal: a qualitative study using phenomenological analysis

OBJECTIVES

Perceptions of people regarding COVID-19 influences their health behaviour in terms of seeking public health services. This helps the government in planning appropriate public health strategies. Therefore, this study intends to explore the perceptions of people towards COVID-19 and their experiences during the pandemic in Nepal.

DESIGN, SETTING AND PARTICIPANTS

This qualitative study was conducted among the public in Kathmandu, Kanchanpur, Bajura and Jhapa districts of Nepal. Eight focus group discussions and 40 in-depth interviews were conducted by using a maximum variation sampling method.

RESULTS

The findings were organised into the following themes: General understanding of COVID-19, Disease prevention, Source of information and misconceptions, Expectation and challenges; and Personal and societal consequences of COVID-19, social distancing and lockdown. There was a good general understanding among respondents about COVID-19, personal preventive measures and population-level strategies. They responded that the use of masks, sanitisers, handwashing and proper lockdown would help to prevent the disease. The respondents acknowledged the vital role of media in increasing awareness. Participants also expressed concerns over the misleading news spread by some media. The lack of social interaction, isolation and loss of income were raised as pertinent issues by the participants as potentially leading to psychological consequences. Health workers and public both raised concerns over inadequate Personal Protective Equipment, under-prepared health system, unorganised public quarantine centres, and public violation of lockdown CONCLUSIONS: This study reports participants' views on disease prevention measures such as maintaining personal hygiene, adhering to physical distancing, and using personal protective equipments. Additionally, it illuminates the confusion among public due to conflicting public health messages from different sources of information which was deemed as misleading by the participants. This research sheds light on people's perspectives and experiences that can inform population-targeted policies in the future.

Access and Use Experience of Personal Protective Equipment Among Frontline Healthcare Workers in Pakistan During the COVID-19 Emergency: A Cross-Sectional Study

Healthcare workers are at the highest risk of contracting novel coronavirus disease 2019 (COVID-19) and, therefore, require constant protection. This study assesses access to personal protective equipment (PPE), availability of adequate information about PPE use, self-reported ability to correctly wear and remove (donning and doffing) PPE, and risk perceptions associated with COVID-19 among frontline healthcare workers in Pakistan. Using a structured and validated questionnaire, an online survey was conducted from May 9 to June 5, 2020. Responses were received from 453 healthcare workers. Of these, 218 (48.12%) were doctors, 183 (40.40%) were nurses, and 52 (11.48%) were paramedical staff. Only 129 (28.48%) healthcare workers reported having adequate access to PPE at all times, whereas 156 (34.44%) never had access to PPE and 168 (37.09%) had access to PPE occasionally. Lack of access to PPE led the majority (71.74%) of healthcare workers to use coping strategies such as reuse of N95 and surgical masks. A total of 312 (68.87%) respondents believed that the risk of contracting COVID-19 in the work environment was high and the majority (62.69%) adopted precautionary measures at home to keep their families safe. A significantly high (n = 233, 51.43%, P = .03) number of respondents reported self-medicating. Of all the respondents, only 136 (30.02%) were tested for COVID-19 at least once, of which 32 (23.53%) ever tested positive. These findings suggest that healthcare workers in Pakistan had limited access to PPE. Adequate provision and training is vital to protect the healthcare workforce during the COVID-19 pandemic.