Rapid Workforce Development to Combat the COVID-19 Pandemic: Experience From a Tertiary Health Care Centre in North India

Emergency infection prevention and control training in fragile, conflict-affected or vulnerable settings: a scoping review

BACKGROUND

It is uncertain what could be the best training methods for infection prevention and control when an infectious disease threat is active or imminent in especially vulnerable or resource-scarce settings.

METHODS

A scoping review was undertaken to find and summarise relevant information about training modalities, replicability and effectiveness of IPC training programmes for clinical staff as reported in multiple study designs. Eligible settings were conflict-affected or in countries classified as low-income or lower-middle income (World Bank 2022 classifications). Search terms for LILACS and Scopus were developed with input of an expert working group. Initially found articles were dual-screened independently, data were extracted especially about infection threat, training outcomes, needs assessment and teaching modalities. Backwards and forwards citation searches were done to find additional studies. Narrative summary describes outcomes and aspects of the training programmes. A customised quality assessment tool was developed to describe whether each study could be informative for developing specific future training programmes in relevant vulnerable settings, based on six questions about replicability and eight questions about other biases.

FINDINGS

Included studies numbered 29, almost all (n = 27) were pre-post design, two were trials. Information within the included studies to enable replicability was low (average score 3.7/6). Nearly all studies reported significant improvement in outcomes suggesting that the predominant study design (pre-post) is inadequate to assess improvement with low bias, that any and all such training is beneficial, or that publication bias prevented reporting of less successful interventions and thus a informative overview.

CONCLUSION

It seems likely that many possible training formats and methods can lead to improved worker knowledge, skills and / or practice in infection prevention and control. Definitive evidence in favour of any specific training format or method is hard to demonstrate due to incomplete descriptions, lack of documentation about unsuccessful training, and few least-biased study designs (experimental trials). Our results suggest that there is a significant opportunity to design experiments that could give insights in favour of or against specific training methods. "Sleeping" protocols for randomised controlled trials could be developed and then applied quickly when relevant future events arise, with evaluation for outcomes such as knowledge, practices, skills, confidence, and awareness.

Rapid Critical Care Training for Nurses Deployed to Intensive Care Units During the COVID-19 Surge

BACKGROUND

During the first COVID-19 pandemic wave, non-intensive care unit (non-ICU) nurses were deployed to temporary ICUs to provide critical care for the patient surge. A rapid critical care training program was designed to prepare them to care for patients in either temporary or permanent ICUs.

OBJECTIVE

To evaluate the effectiveness of this training program in preparing non-ICU nurses to provide critical care for COVID-19 patients in temporary ICUs.

METHODS

A survey was used to evaluate the impact of rapid critical care training on nurses' critical care skills and compare the experiences of nurses deployed to temporary versus permanent ICUs. Data were analyzed with χ2 and Spearman ρ tests with α = .05.

RESULTS

Compared with nurses in other locations, nurses deployed to temporary ICUs were less likely to report improved capability in managing mechanical ventilation; infusions of sedative, vasoactive, and paralytic agents; and continuous renal replacement therapy. Nurses in temporary ICUs also reported being less prepared to care for critically ill patients (all P < .05).

CONCLUSIONS

The rapid training program provided basic critical care knowledge for nurses in temporary ICUs, but experiences differed significantly between those deployed to temporary versus permanent ICUs. Although participants believed they provided safe care, nurses with no critical care experience cannot be expected to learn comprehensive critical care from expedited instruction; more formal clinical support is needed for nurses in temporary ICUs. Rapid critical care training can meet emergency needs for nurses capable of providing critical care.

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.

The trend in density of skilled health personnel in BRICS countries: Implication for China and India

OBJECTIVE

The similarities and differences in workforce trends in BRICS (Brazil, Russia, India, China, and South Africa) may offer reciprocal lessons for emerging economies.

METHODS

We used the Global Health Observatory data to assess the secular trends between 2001 and 2017 in the number of skilled health personnel (SHP: doctors, nurses/midwives) in BRICS compared to the average of Organization for Economic Co-operation and Development (OECD) countries.

RESULTS

Substantial efforts have been made in BRICS to increase SHP availability, as demonstrated by an average exponential growth rate (AEGR) > 0.03 in Brazil, China, and India compared to 0.01 in OECD. With an AEGR as high as 0.07 after 2008, China reached the level of SHP availability commensurate with the sustainable development goals (SDGs) in 2017. Other than China, BRICS countries had a mean number of nurses and midwives per doctor between 2001 and 2017 higher than or comparable to the OECD average (2.78). The corresponding number in China was 1.04 in 2017, lower than 2.21 in India in 2001.

CONCLUSIONS

With China as the exception, BRICS countries maintained a sustainable skills mix of SHPs. China reached the level of SHP availability commensurate with the SDGs, but SHP's skill mix was imbalanced.

Development and implementation of a sustainable COVID-19 training package for healthcare workers: Experience from a teaching hospital of North India

Background

With the impending threat of future COVID-19 waves, it is imperative that teaching hospitals develop, implement, and evaluate a systematic training program to render HCW elastic in delivering COVID-19 related services. We present our experience in developing, implementing, and evaluating a sustainable and scalable COVID-19 patient management training package for healthcare workers.

Materials and Methods

A mixed-methods study design was used. Rapid assessment to understand the need of the trainees and identify the available resources was done followed by planning of the training module and its implementation. The program was evaluated for effectiveness and sustainability. Data analysis was done using descriptive statistics and qualitative data generated from open-ended questions in the feedback forms and the discussions were analyzed using rapid content analysis.

Results

A total of 66.8% of the doctors and 18.9% of the nurses were trained by online synchronous mode while 55.0% of the nursing officers and 47.1% of the nursing orderlies and paramedical staff were trained in onsite skill development sessions. Need assessment identified that healthcare workers were ill-prepared to use medical devices such as Bipap machines, ventilators, and oxygen delivery devices. The participants mentioned that the multidisciplinary approach and video-based demonstrations facilitated their online learning while the incremental learning approach, easy-to-understand terminology and hands-on experience facilitated their onsite skill development sessions.

Conclusion

The COVID-19 training package developed was multidisciplinary, effective, sustainable, and scalable in a resource-limited setting. We suggest that this model can be adapted by healthcare organizations to develop and implement such training packages for their healthcare workers.

COVID-19 Infodemic: Evaluating Information-Seeking Behaviour Among Healthcare Workers During a Pandemic

Introduction

With the surge in coronavirus disease 2019 (COVID-19) cases across nations worldwide, World Health Organization (WHO) declared it a pandemic on March 11, 2020. Besides various policy guidelines and directions issued from time to time to combat the menace, there was the dissemination of a lot of misinformation and disinformation through social media or otherwise. This led to emotional, psychological, and mental agonies in the general population as well as Healthcare Workers (HCWs).

Methods

A cross-sectional quantitative study using purposive sampling techniques was done to assess the health-seeking behavior during the pandemic among HCWs of a tertiary care hospital in North India, designated as a dedicated COVID-19 hospital by the Ministry of Health and Family Welfare, India. A semi-structured questionnaire validated by experts with a reliability value (r=0.92) was taken. To maintain minimal contact and to follow COVID-19 Appropriate Behavior (CAB), a web-based link was used to obtain the data. Privacy of the participants and confidentiality of data obtained was maintained.

Results

Out of the total 250 participants enrolled in the study, the response rate was 81% (203). For 123 (60%) respondents, social media was one of the sources of access to information during the pandemic. The most common social media app(s) accessed were WhatsApp 82 (40%), Facebook, and Instagram 67 (33%). Social media had both positive as well as negative impacts on the mindset of respondents as 147 (72%) agreed that social media networks helped to further improve their understanding, whereas 178 (88%) stated that it aroused fear and panic among them.

Conclusion

During epidemics, timely, accurate, and authentic information is vital in shaping public opinion; on the contrary, an infodemic can pose a serious threat and panic in society by disseminating false and wrong information as was seen in the COVID-19 pandemic.