Impact of 24 h shifts on urinary catecholamine in emergency physicians: a cross-over randomized trial

24-h shift (24 hS) exposed emergency physicians to a higher stress level than 14-h night shift (14 hS), with an impact spreading on several days. Catecholamines are supposed to be chronic stress biomarker. However, no study has used catecholamines to assess short-term residual stress or measured them over multiple shifts. A shift-randomized trial was conducted to study urinary catecholamines levels of 17 emergency physicians during a control day (clerical work on return from leave) and two working day (14 hS and 24 hS). The Wilcoxon matched-pairs test was utilized to compare the mean catecholamine levels. Additionally, a multivariable generalized estimating equations model was employed to further analyze the independent relationships between key factors such as shifts (compared to control day), perceived stress, and age with catecholamine levels. Dopamine levels were lower during 24 hS than 14 hS and the control day. Norepinephrine levels increased two-fold during both night shifts. Epinephrine levels were higher during the day period of both shifts than on the control day. Despite having a rest day, the dopamine levels did not return to their normal values by the end of the third day after the 24 hS. The generalized estimating equations model confirmed relationships of catecholamines with workload and fatigue. To conclude, urinary catecholamine biomarkers are a convenient and non-invasive strong measure of stress during night shifts, both acutely and over time. Dopamine levels are the strongest biomarker with a prolonged alteration of its circadian rhythm. Due to the relation between increased catecholamine levels and both adverse psychological effects and cardiovascular disease, we suggest that emergency physicians restrict their exposure to 24 hS to mitigate these risks.

Respecting patients' rights in hospitals: patients' and health-care workers' perspectives

Considering the importance of respecting and observing patients' rights, this study aimed to assess the level of observance of hospitalized patients' rights from both patients' and health-care workers' (HCWs) perspectives. This cross-sectional descriptive-analytic study reports the responses of 486 patients and 887 HCWs in a public referral university hospital. The study illustrates that patients and HCWs think patients' rights are respected at a medium level; however, HCWs reported lower levels of respect for patients' rights than patients, and senior HCWs reported even lower levels than their younger colleagues. Older patients and those hospitalized in internal medicine wards reported lower respect for autonomy and responsiveness, and patients' companions reported lower levels of respect for patients' rights than the patients themselves.

Health care workers' perceptions of their hospitals' preparedness during the COVID-19 virus pandemic in three different world regions

Introduction

Pandemics are extraordinary circumstances that necessitate a multifaceted approach to getting the most out of healthcare systems. Health authorities should be aware of the beliefs and attitudes of healthcare professionals before adopting control measures and communication campaigns. We aimed to find out how hospital staff members in three economically diverse regions perceive their facility's preparedness for pandemics.

Methodology

A hospital-based cross sectional study was done in three separate world regions, classified according to the World Bank's economics, using a web-based questionnaire. A convenience sample of 450 healthcare workers was collected and analyzed using SPSS version 20.

Results

Physicians made up 94.4% of the 450 participants, with 50.3% from High-Income Foreign Countries (HIFC), 20.4% from High-Income Arab Countries (HIAC), and 29.3% from Lower Middle-Income Countries (LMIC). 81.5% of participants from HIAC had formal PPE training, compared to 22.7% and 64.4% of participants from LMIC and HIFC, respectively. Evidently, 39.4% of the HIFC's participants stated that the level of their hospital precautions during the pandemic was above average, as compared to 50% and 14.4% of participants from HIAC and LMIC, respectively. Compared to 42.4% of HIAC participants and 36.4% of LMIC participants, 44.6% of HIFC participants reported feeling at risk because of their clinical role.

Conclusion

In all three regions, hospital readiness was well viewed by healthcare professionals; nevertheless, more needs to be done to provide them with psychological and social support. This research may help health authorities put up a suitable preparedness plan to face emerging pandemics. Further research is needed to determine the best course of action to combat comparable pandemics at various economic levels.

Influenza vaccination coverage among health-care workers during the COVID-19 epidemic in 2020/2021 influenza season: Evidence from a web-based survey in northwestern China

Vaccinating health-care workers against influenza during the COVID-19 pandemic can effectively prevent and control influenza and reduce COVID-19 strain on health systems. This study was conducted to explore influenza vaccination coverage and determinants among health-care workers during the COVID-19 pandemic in 2020/2021 influenza season in Ningxia. This cross-sectional survey included demographic characteristics of health-care workers, influenza vaccination status, reasons for not getting vaccinated, and whether influenza vaccination was recommended for others. We found that influenza vaccine rate of health-care workers was 39.6%. A binary logistic regression analysis showed that health-care workers' vaccination coverage was higher when the individuals were aware of the effect of the influenza vaccine (OR = 0.624, 95% CI: 0.486-0.802). Health-care workers who from internal medicine (OR = 1.494, 95% CI: 1.146-1.948), pediatrics (OR = 2.091, 95% CI: 1.476-2.962), and surgery departments (OR = 1.373, 95% CI: 1.014-1.859) had a lower coverage than those who worked in vaccination and infectious disease departments. The main reasons that some stated for not getting vaccinated were that they felt it was unnecessary (52.22%). Health-care workers who were vaccinated against influenza were more likely to recommend influenza vaccination to their patients than health-care workers who had not been vaccinated. The incidence of influenza among health-care workers was higher than that of the general population in Ningxia. Under the policy of voluntary and self-pay influenza vaccination in Ningxia, the coverage rate of influenza vaccine among health-care workers was far below the vaccination requirements of influenza vaccine in influenza season even during the COVID-19 epidemic.

Health-care worker retention in post-conflict settings: a systematic literature review

Conflicts affect health-care systems not only during but also well beyond periods of violence and immediate crises by draining resources, destroying infrastructure and perpetrating human resource shortages. Improving health-care worker (HCW) retention is critical to limiting the strain placed on health systems already facing infrastructure and financial challenges. We reviewed the evidence on the retention of HCWs in fragile, conflict-affected and post-conflict settings and evaluated strategies and their likely success in improving retention and reducing attrition. We conducted a systematic review of studies, following PRISMA guidelines. Included studies (1) described a context that is post-conflict, conflict-affected or was transformed by war or a crisis; (2) examined the retention of HCWs; (3) were available in English, Spanish or French and (4) were published between 1 January 2000 and 25 April 2021. We identified 410 articles, of which 25 studies, representing 17 countries, met the inclusion criteria. Most of the studies (22 out of 25) used observational study designs and qualitative methods to conduct research. Three studies were literature reviews. This review observed four main themes: migration intention, return migration, work experiences and conditions of service and deployment policies. Using these themes, we identify a consolidated list of six push and pull factors contributing to HCW attrition in fragile, conflict-affected and post-conflict settings. The findings suggest that adopting policies that focus on improving financial incentives, providing professional development opportunities, establishing flexibility and identifying staff with strong community links may ameliorate workforce attrition.

The Mental Health of Health Care Workers in the UK During COVID-19: The Prevalence of Anxiety, Depression, and Stress

Introduction

The COVID-19 pandemic had a significant impact on the mental health of health care workers (HCWs).

Aim

This study investigated the mental health of HCWs working in Leicester, UK during COVID-19.

Settings

Two hospital trusts in Leicester, UK.

Methods

An online survey was sent to HCWs in two trusts in July 2020. The Generalized Anxiety Disorder-7 scale (GAD-7) and the Patient Health Questionnaire-9 scale (PHQ-9) were used to measure the prevalence rates of anxiety and depression. The Perceived Stress Scale-14 (PSS-14) was used to measure levels of perceived stress. Other questions were used to identify the prevalence of increased alcohol intake and possible risk factors.

Statistical Analysis Used

Chi-square test, independent sample t-test, ANOVA, and logistic regression.

Results

A total of 1009 HCWs completed the survey. Using a cutoff score of 5 (mild symptoms), for both GAD-7 and PHQ-9, 80.2% of participants had at least one condition and 71.5% had both. Using the cutoff score of 10 (moderate/severe symptoms), 27.2% had at least one condition and 27.25% had both conditions. In addition, 37.5% of those who did not report pre-existing mental health conditions now have at least one condition. About 33.6% of participants reported an increase in alcohol consumption. A number of risk factors were identified: having less social support, not feeling supported at work, and poor pre-existing mental health.

Conclusions

The pandemic had a significant impact on mental health of HCWs. Health organizations need to monitor and address these emerging effects.

Long-term antibody response following SPUTNIK V primary vaccination in healthcare workers with and without history of SARS-CoV-2 infection: Prospective cohort study from a hospital in Argentina

•

After completing a two-dose Sputnik V schedule, all vaccinees developed antibodies.

•

Prior infection was associated with higher antibody concentrations.

•

Antibodies decreased significantly after 6 months in naïve subjects.

•

In subjects without infection, 17% were negative at day 180.

•

SARS-CoV2 infection after vaccination increased antibody concentrations.

Background

In December 2020, Sputnik V was incorporated to the National COVID-19 Immunization Plan in Argentina. Studies had shown 98% of antibody response rate. To date, data on immunogenicity and antibody persistence in Argentina are scarce.

The objective was to assess humoral immune response after two doses of Sputnik V in Health Care Workers (HCWs) at the Ricardo Gutierrez Children’s Hospital (RGCH).

Methods

A prospective, cohort study in HCWs immunized with two doses of Sputnik V between February and March 2021. The following variables were assessed: age, gender, risk factors for severe COVID-19 or mortality, immunosuppressive therapy and history of SARS-CoV-2. Blood samples were drawn on the day of the first dose, 28 days and 180 days after the second. Anti-Spike IgG was measured using an ELISA assay. Differences in immune response were evaluated according to study variables. Comparison analyses between groups with or without history of infection were performed, with T-test and ANOVA or Mann-Whitney tests. For each subject, we compared baseline values with 28 days and 180 days after the second vaccine.

STATA version 14 and R Sofware were used for data analyses.

Results

We included 528 individuals, mean age 41.5 years, 82.9% female, 14.4% (76/528) reported previous SARS-CoV-2 infection.

All subjects developed antibodies post-vaccination. At day 28, concentrations were significantly higher in previously infected than naïve subjects (p < 0.001) with no differences according to age, gender and comorbidities.

At day 180, 17% (95% CI 13.17–21.53) of naïve subjects were negative. Antibody concentrations decreased significantly in all subjects except in those who reported SARS-CoV-2 infection after vaccination (n = 31). This last group had significantly higher antibody concentrations.

Conclusion

This study assessed immune response to a new COVID-19 vaccine in real life in a cohort of subjects. Antibody concentrations varied according to history of SARS-COV-2 infection and decreased over time.

Pre-exposure prophylaxis with hydroxychloroquine for COVID-19: a double-blind, placebo-controlled randomized clinical trial

BACKGROUND

Pre-exposure prophylaxis (PrEP) is a promising strategy to break COVID-19 transmission. Although hydroxychloroquine was evaluated for treatment and post-exposure prophylaxis, it is not evaluated for COVID-19 PrEP yet. The aim of this study was to evaluate the efficacy and safety of PrEP with hydroxychloroquine against placebo in healthcare workers at high risk of SARS-CoV-2 infection during an epidemic period.

METHODS

We conducted a double-blind placebo-controlled randomized clinical trial in three hospitals in Barcelona, Spain. From 350 adult healthcare workers screened, we included 269 participants with no active or past SARS-CoV-2 infection (determined by a negative nasopharyngeal SARS-CoV-2 PCR and a negative serology against SARS-CoV-2). Participants allocated in the intervention arm (PrEP) received 400 mg of hydroxychloroquine daily for the first four consecutive days and subsequently, 400 mg weekly during the study period. Participants in the control group followed the same treatment schedule with placebo tablets.

RESULTS

52.8% (142/269) of participants were in the hydroxychloroquine arm and 47.2% (127/269) in the placebo arm. Given the national epidemic incidence decay, only one participant in each group was diagnosed with COVID-19. The trial was stopped due to futility and our study design was deemed underpowered to evaluate any benefit regarding PrEP efficacy. Both groups showed a similar proportion of participants experiencing at least one adverse event (AE) (p=0.548). No serious AEs were reported. Almost all AEs (96.4%, 106/110) were mild. Only mild gastrointestinal symptoms were significantly higher in the hydroxychloroquine arm compared to the placebo arm (27.4% (39/142) vs 15.7% (20/127), p=0.041).

CONCLUSIONS

Although the efficacy of PrEP with hydroxychloroquine for preventing COVID-19 could not be evaluated, our study showed that PrEP with hydroxychloroquine at low doses is safe.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04331834 . Registered on April 2, 2020.

A hospital-wide cohort study

OBJECTIVES

To evaluate the effect of mRNA severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination on the incidence of new SARS-CoV-2 infections in health-care workers (HCW).

METHODS

The evolution of the incident rate of microbiologically confirmed SARS-CoV-2 infection in a cohort of 2590 HCW after BNT162b2 mRNA SARS-CoV-2 vaccination, compared with the rate in the community (n = 170 513) was evaluated by mixed Poisson regression models.

RESULTS

A total of 1820 HCW (70.3% of total) received the first dose of the BNT162b2 mRNA vaccine between 10 January and 16 January 2021, and 296 (11.4%) received it the following week. All of them completed vaccination 3 weeks later. Incidence rates of SARS-CoV-2 infection after the first dose of mRNA SARS-CoV-2 vaccine declined by 71% (Incidence Rate Ratio (IRR) 0.286, 95% CI 0.174-0.468; p < 0.001) and by 97% (IRR 0.03, 95% CI 0.013-0.068; p < 0.001) after the second dose, compared with the perivaccine time. SARS-CoV-2 incidence rates in the community (with a negligible vaccination rate) had a much lower decline: 2% (IRR 0.984, 95% CI 0.943-1.028; p 0.47) and 61% (IRR 0.390, 95% CI 0.375-0.406; p < 0.001) for equivalent periods. Adjusting for the decline in the community, the reduction in the incident rates among HCW were 73% (IRR 0.272, 95% CI 0.164-0.451 p < 0.001) after the first dose of the vaccine and 92% (IRR 0.176, 95% CI 0.033-0.174; p < 0.001) after the second dose.

CONCLUSIONS

mRNA SARS-CoV-2 vaccination is associated with a dramatic decline in new SARS-CoV-2 infection among HCW, even before the administration of the second dose of the vaccine.

No SARS-CoV-2 reinfection among staff health-care workers: Prospective hospital-wide screening during the first and second waves in Paris

Objectives

Risk of reinfection with SARS-CoV-2 among health-care workers (HCWs) is unknown. We assessed the incidence rate of SARS-CoV-2 reinfection in the real-life setting of a longitudinal observational cohort of HCWs from the Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, France, during the first and second waves of COVID-19 epidemic.

Methods

From March to December 2020, HCWs were subjected to molecular and serology testing of SARS-CoV-2. Reinfection was defined as a positive test result during the first wave, either by serology or PCR, followed by a positive PCR during the second wave. Evolution of COVID-19 status of HWCs was assessed by a Sankey diagram.

Results

A total of 7765 tests (4579 PCR and 3186 serology) were carried out and 4168 HCWs had at least one test result during the follow-up period with a positivity rate of 15.9%. No case of reinfection during the second wave could be observed among 102 positive HCWs of the first wave, nor among 175 HCWs found positive by PCR during the second wave who were negative during the first wave.

Conclusions

SARS-CoV-2 reinfection was not observed among HCWs, suggesting a protective immunity against reinfection that lasts at least 8 months post infection.

Factors associated with needlestick injuries among healthcare workers: implications for prevention

BACKGROUND

Our study sought to determine the frequency of Needlestick injuries (NSIs) among Healthcare Workers (HCWs) working at governmental hospital and to study the factors that associated with occurrence of NSIs, and to develop recommendations for a comprehensive program for prevention.

METHODS

Retrospective study of all reported cases of NSIs in the period from April 2016 to May 2018 among healthcare workers at a governmental hospital.

RESULTS

Incidence of NSIs over 26 months was 8.4% among all participants. Nurses were the most affected staff (52.5%) resulted commonly from disposing syringes (58.9%). In contrast, the incidence of NSIs among physicians was 24.9% where surgical devices were the primary source of NSIs among them (40%). Failure to complete all required hepatitis B vaccination was common among expatriates of the participants of this study.

CONCLUSIONS

NSIs was common among HCWs participated in this study. Preventive measures should be implemented including adequate hepatitis B immunization.

Importance of mitigation measures for hospital transmission of SARS-CoV-2 at the onset of the epidemic: the experience of Brescia, Northern Italy

Purpose

Since the first Italian case of SARS-CoV-2 was detected in Lombardy (Northern Italy)  Italy quickly became one of the worst-affected European countries, with a severe impact on health-care workers (HCWs). In the first epidemic, HCWs accounted for 12% of all national COVID-19 cases. We evaluated the burden of COVID-19 among HCWs and other non-health-care workers (nHCWs) in a large Italian hospital.

Methods

From March 1st to May 31st 2020, we performed a retrospective study at ASST Civil Hospital, in the Province of Brescia, Lombardy. The study population included all hospital personnel (n = 9265), categorized by professional status.

Results

A SARS-CoV-2 test was performed in 3572 workers (38.5%), with a positive result in 552 (5.9% of all hospital personnel). The temporal trend of SARS-CoV-2 cases in hospital staff broadly reflected that in the community, with a great majority of infections occurred during March 2020 (87.7%). From April onward, a steep decrease of positive cases was observed among hospital personnel, while in the community the decrease was much slower. Medical doctors (8.9%) and nurses (8.5%) were the most affected professional categories with a significantly higher risk of SARS-CoV-2 infection (OR 1.436 and OR 1.410, respectively p < 0.0001). HCWs in COVID-19 units presented a significantly higher risk of infection compared to HCWs in non-COVID units (p < 0.001).

Conclusion

HCWs were severely affected by the COVID-19 epidemic, probably associated with an overwhelming burden of work and lack of preparedness in prevention of nosocomial transmission of the infection. The rapid decrease of COVID-19 spread in the hospital, registered before the one in the community, suggests that the adopted preventive measures were effective.

Association between SARS-CoV-2 exposure and antibody status among healthcare workers in two London hospitals: a cross-sectional study

BACKGROUND

Patient-facing (frontline) health-care workers (HCWs) are at high risk of repeated exposure to SARS-CoV-2.

AIM

We sought to determine the association between levels of frontline exposure and likelihood of SARS-CoV-2 seropositivity amongst HCW.

METHODS

A cross-sectional study was undertaken using purposefully collected data from HCWs at two hospitals in London, United Kingdom (UK) over eight weeks in May-June 2020. Information on sociodemographic, clinical and occupational characteristics was collected using an anonymised questionnaire. Serology was performed using split SARS-CoV-2 IgM/IgG lateral flow immunoassays. Exposure risk was categorised into five pre-defined ordered grades. Multivariable logistic regression was used to examine the association between being frontline and SARS-CoV-2 seropositivity after controlling for other risks of infection.

FINDINGS

615 HCWs participated in the study. 250/615 (40.7%) were SARS-CoV-2 IgM and/or IgG positive. After controlling for other exposures, there was non-significant evidence of a modest association between being a frontline HCW (any level) and SARS-CoV-2 seropositivity compared to non-frontline status (OR 1.39, 95% CI 0.84-2.30, P=0.200). There was 15% increase in the odds of SARS-CoV-2 seropositivity for each step along the frontline exposure gradient (OR 1.15, 95% CI 1.00-1.32, P=0.043).

CONCLUSION

We found a high SARS-CoV-2 IgM/IgG seropositivity with modest evidence for a dose-response association between increasing levels of frontline exposure risk and seropositivity. Even in well-resourced hospital settings, appropriate use of personal protective equipment, in addition to other transmission-based precautions for inpatient care of SARS-CoV-2 patients could reduce the risk of hospital-acquired SARS-CoV-2 infection among frontline HCW.

Antibody response induced by the BNT162b2 mRNA COVID-19 vaccine in a cohort of health-care workers, with or without prior SARS-CoV-2 infection: a prospective study

Objectives

To assess the antibody response to BNT162b2 mRNA COVID-19 vaccine in a cohort of health-care workers (HCW), comparing individuals with previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and SARS-CoV-2-naive individuals.

Methods

HCW were tested at T0 (day of first dose), T1 (day of second dose) and T2 (2–3 weeks after second dose) for IgG anti-nucleocapsid protein, IgM anti-spike protein and IgG anti-receptor binding domain (IgG-RBD-S). The antibody response was compared between four main groups: group A, individuals with previous infection and positive antibodies at baseline; group B, individuals with the same history but negative antibodies; group C, individuals with no infection history but positive antibodies; group D, naive individuals. Repeated measures analysis was used to compare results over time-points.

Results

A total of 1935 HCW were included. Median IgG-RBD-S titre was significantly higher for group A (232 individuals) than for group B (56 individuals) both at T1 (A: 22 763 AU/mL, interquartile range (IQR) 14 222–37 204 AU/mL; B: 1373 AU/mL, IQR 783–3078 AU/mL, p 0.0003) and T2 (A: 30 765 AU/mL, IQR 19 841–42 813 AU/mL; B: 13 171 AU/mL, IQR 2324–22 688 AU/mL, p 0.0038) and for group D (1563 individuals; 796 AU/mL, IQR 379–1510 AU/mL at T1; 15 494 AU/mL, IQR 9122–23 916 AU/mL at T2, p < 0.0001 for both time-points). T1 values of group A were also significantly higher than T2 values of group D (p < 0.0001). Presence of symptoms, younger age and being female were associated with stronger antibody response. HCW infected in March showed a significantly stronger response (T1: 35 324 AU/mL, IQR 22 003–44 531 AU/mL; T2: 37 648 AU/mL, IQR 27 088–50 451 AU/mL) than those infected in November (T1: 18 499 AU/mL, IQR 11 492–27 283 AU/mL; T2: 23 210 AU/mL, IQR 18 074–36 086 AU/mL, p < 0.0001 for both time-points.

Conclusions

Individuals with past SARS-CoV-2 infection had a strong antibody response after one single vaccine shot. A single dose might be sufficient for this group, regardless of the time elapsed since infection; however, the clinical correlation with antibody response needs to be studied.

COVID-19 in otolaryngologists: a cross-sectional multicenter study

INTRODUCTION

The nose and throat are areas of high viral load, which could place otolaryngologists at an even higher risk for COVID-19 than other health-care workers.

OBJECTIVE

To investigate the prevalence of antibodies against SARS-CoV-2 in otorhinolaryngologists in southern Brazil, its relationship to demographic data, professional practice and reported symptoms of COVID-19, and compare it with official data on other health-care workers of the state and the general population in the same period.

METHODS

In this cross-sectional multicenter study, otolaryngologists actively practicing officially registered in Rio Grande do Sul were screened for IgM and IgG antibodies against SARS-CoV-2 from August 1 to September 15, 2020. A questionnaire was also applied.

RESULTS

We screened 358 (80.1%) of 447 actively practicing otolaryngologists (195 [54.5%] male; mean [SD] age, 47.77 [13.57] years; range, 26-84 years). Twenty-three were positive for IgM and/or IgG (6.4%). This result was significantly associated with reports of infected household contacts (19/315 negatives and 8/23 positives; p < 0.001). From 23 seropositive participants, 14 were asymptomatic (60.9%; p < 0.001). There were no significant associations between seroconversion and age, sex, number of patient appointments and surgical procedures, workplace (hospital or private practice), patients with or without respiratory symptoms, or level of personal protective equipment used. The rate of COVID-19 in all health-care workers in the state was 7.69% at the end of the same period. Data from state government seroprevalence was 5.26 (risk ratio [RR]; 95% CI 3.27-8.45) and 4.66 (RR; 95% CI 2.93-7.43) times higher in otolaryngologists than in the general population in August and September, respectively.

CONCLUSION

Otolaryngologists had a higher seroconversion rate than the general population. Using personal protective equipment, the level of occupational exposure did not result in higher rates of infection than other health-care workers, but the presence of infected household contacts was associated with higher rates of seroconversion.

Responding to the Psychological Needs of Health-Care Workers During the COVID-19 Pandemic: Case Study from the Medical College of Wisconsin

With the advent of the novel coronavirus (COVID-19) pandemic, health-care workers have been faced with an inordinately high level of trauma as frontline providers. The Medical College of Wisconsin (MCW) partnered with affiliate hospitals and community partners to mobilize a matrix of available support and interventions to deliver psychological services to reach all levels of health-care providers in timely, accessible formats. While virtual peer support groups were the most utilized resource among the support group options, other opportunities also provided unique benefits to learners whose education had been disrupted by the pandemic. Mental health must be prioritized for health-care workers in the event of future public health crises. Lessons learned from this pandemic indicate that it is critical to involve learners early on in the process in order to meet their educational needs and to increase access to evidence-based care.

Vaccination coverage among health-care workers: pre-post intervention study to assess impact of an on-site vaccination-dedicated clinic

BACKGROUND

Several studies have revealed low vaccinations coverage among health-care workers (HCWs) for all vaccinations. The aim of our study was to evaluate the impact of the implementation of an on-site vaccination-dedicated clinic on the vaccination coverage rates of HCWs.

RESEARCH DESIGN AND METHODS

A quasi-experimental pre-post intervention study was carried out among undergraduate and postgraduate students attending medical and health-care professions schools.

RESULTS

We enrolled 804 students, 404 in the control and 400 in the experimental group. A significantly higher increase of vaccination coverage in the experimental group than in the control group for all the investigated vaccinations (p < 0.001) was found. The odds of adherence to vaccinations in the experimental group, compared to the control group, ranged from 6.9-fold (95% CI 3.51-13.44) to 18.9-fold (95% CI 10.85-32.96). The increase in the coverage rate in the control group was between 2.5% and 3.5%, whereas in the experimental group, higher increases were found, ranging from 34.8% to 71%.

CONCLUSIONS

The extraordinary increase in the adherence to HCWs recommended vaccinations found in the study seems to indicate a significant role of enabling factors in the complex process of decision-making and implementation of health-related behaviors.

Suggested modifications in oncology/hematology inpatient service in Saudi Arabia during coronavirus disease-2019 (COVID-19) pandemic

Background:

Management of cancer patients in the current era of coronavirus disease-2019 (COVID-19) pandemic poses significant challenges on health-care systems. However, it is mandatory to keep the required level of care of cancer patients while taking the necessary precautions to maintain the safety of both patients and health-care professionals (HCPs). The present survey explores suggested modifications of inpatient oncology/hematology care during the COVID-19 pandemic.

Materials and Methods:

A web-based questionnaire using SurveyMonkey was distributed to HCPs taking care of inpatient hematology/oncology service including oncologists, hematologists, and inpatient nurses in Saudi Arabia. The 25 items selected for the survey focused on five domains including characteristics of HCPs, COVID-19 infection risk among admitted patients, possible modifications related to physicians/nursing practice, and suggested infection control measures. Clinical sensibility assessment was conducted to evaluate the comprehensiveness, clarity, and face validity of our instrument on a scale of 1–5. The percentages of HCP responses to the suggested modifications in the survey were assessed in descriptive statistics to summarize data and report views of participants.

Results:

Of 215 HCPs, 195 responded and completed the survey. Of the respondents, 30.4% were medical oncologists, whereas hematologists and nurses constituted 6.7% and 62.9% of the participants, respectively. The majority of respondents (87.6%) work in governmental hospitals. The majority of participants (82%) have diagnosed patients with COVID-19 in their hospitals and modifications in inpatient practice during the COVID-19 pandemic were supported by 95% of respondents. The supported modifications by participants include enhanced use of oral medications (83.5%), phone calls to admitted stable patients by physicians, instead of physical interview (77%), decreasing frequency of vital signs assessment in stable patients (91%), decreasing the duration of stay in patients rooms (89%), using peripheral instead of central lines (76%), using video-based educational materials to patients through hospital TV network (91%), testing for COVID -19 before scheduled radiology imaging and procedures (74%), and performing routine nasopharyngeal swabs for HCPs (67%).

Conclusion:

Several modifications in inpatient oncology/hematology practice were supported by the survey participants. These suggestions need to be discussed on local basis considering local infrastructure, available resources, and level of required care.

The Sheba Medical Center healthcare workers' children's school: can we open schools safely?

Objective

The role of school closure in mitigating coronavirus disease 2019 (COVID-19) transmission has been questioned. In our medical centre, during a 9-week national lockdown, an alternative school was opened for health-care workers' (HCW) children with a small number of children per class and strict symptom surveillance. After lockdown was lifted we screened children and their parents for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology.

Methods

We conducted a cross-sectional study of HCW parents and their children after one teacher contracted COVID-19 following exposure at home and 53 children were exposed, isolated and tested by RT-PCR. We compared families with children attending the alternative school with families whose children who remained at home during the 9-week lockdown. Epidemiological and medical data were collected using a short questionnaire; nasopharyngeal and oropharyngeal swabs were obtained and tested for SARS-CoV-2 by RT-PCR, and blood was collected for SARS-CoV-2 IgA and IgG titres.

Results

A total of 435 children attended the Sheba alternative school. Among the 53 children exposed to the infected teacher, none tested positive by RT-PCR. Of these, 18 children–parent pairs were tested for serology and all were negative. A total of 106/435 (24%) children and their 78 parents were recruited for the cross-sectional study; 70 attended the Sheba school and 36 did not. Approximately 16% of children in either group reported symptoms (11/70 in the school group and 6/36 in the ‘stay home’ group), but SARS-CoV-2 was not detected by PCR in any, and previous exposure, as determined by serological tests, was low and not significantly different between the groups.

Conclusion

In an alternative school for children of HCWs, active during COVID-19 national outbreak, we found no evidence of increased infection compared with children that stayed home.

A super-spreader of SARS-CoV-2 in incubation period among health-care workers

Since the coronavirus disease 2019 (COVID-19) identified in Wuhan, Hubei, China in December 2019, it has been characterized as a pandemic by World Health Organization (WHO). It was reported that asymptomatic persons are potential sources of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We present an outbreak among health-care workers incited by a doctor who cared a patient with COVID-19 in a Hospital in Wuhan, Hubei, China, which indicates existence of super-spreader even during incubation period.

Development and psychometric validation of a comprehensive end-of-life care competence scale: A study based on three-year surveys of health and social care professionals in Hong Kong

OBJECTIVE

This study aimed to develop an assessment tool measuring comprehensive interdisciplinary competence in end-of-life care (EoLC) and investigate its content, construct validity, reliability, and their correlates.

METHOD

Items of the Comprehensive End-of-Life Care Competence Scale (CECCS) were developed according to a comprehensive core competence framework in EoLC and refined by a multi-disciplinary panel of experts. The psychometric properties were further tested through region-wide surveys of self-administered questionnaires completed by health and social care professionals in Hong Kong.

RESULTS

Participants comprised social workers, nurses, physicians, and allied health care professionals (445 participants in 2016, 410 in 2017, and 523 in 2018). Factor analysis validated the construct of the questionnaire which encompassed 26 items describing EoLC core competences in seven domains with satisfactory internal reliability (confirmatory factor analysis: χ2/df = 3.12, GFI = 0.85, TLI = 0.93, CFI = 0.94, RMSEA = 0.07; Cronbach's alphas ranged from 0.89 to 0.97): overarching value & knowledge, communication skills, symptom management, psychosocial and community care, end-of-life decision-making, bereavement care, and self-care. Higher perceived levels in these competences were correlated with a higher level of job meaningfulness and satisfaction (r ranged from 0.17 to 0.39, p < 0.01) and correlated with lower perceived stress (r ranged from -0.11 to -0.28, p < 0.05). Regression analysis found that age and work involvement in EoLC were positively associated with the perceived competences in all domains; professionals working in hospices reported higher levels of competence than workers in other settings; social workers showed lower perceived competences in symptom management, but higher levels in bereavement care than other health care professionals.

SIGNIFICANCE OF RESULTS

The validity and internal reliability of CECCS were demonstrated. The levels of perceived competences working in EoLC were significantly associated with professionals' job-related well-being. Practically, there is still room for improvement in comprehensive competences among health and social care workers in Hong Kong.

[Protection of nephrology health professionals during the COVID-19 pandemic]

The COVID-19 epidemic represents a special risk for kidney patients due to their comorbidities and advanced age, and the need for hemodialysis treatment in group rooms. It also represents a risk for professionals responsible for their attention. This manuscript contains a proposal for action to prevent infection of professionals in the Nephrology Services, one of the most valuable assets at the present time.

Smoking cessation interventions on health-care workers: a systematic review and meta-analysis

Objective

The authors carried out a systematic review and a meta-analysis on smoking cessation interventions on health -care workers to clarify the state of the art interventions and to identify the best one.

Materials and Methods

This review was registered with PROSPERO: CRD42019130117. The databases PubMed, Scopus, Web of Science and CINAHL were searched until December 2018. Quality of all studies included in the systematic review was assessed according to the Newcastle-Ottawa Scale (NOS) on cohort or cross-sectional studies and to the Cochrane Risk of Bias Tool for Randomized Controlled Trials. Meta-analysis and meta-regression analyses were also carried out for cohort studies (quasi-experimental or a before-after studies design) and clinical trials.

Results

Twenty–four studies have been included in the analysis: four before-after, 13 cross-sectional, three quasi-experimental studies and four clinical trials. Articles were heterogeneous (P for homogeneity <0.01), but they have all shown positive results since they reached the goal of smoking cessation among health-care workers, even if with different proportions. Meta-analysis was performed on 10 studies (six cohort studies and four clinical trials), showing a 21% of success rate from the application of smoking cessation interventions, either pharmacological or behavioral ones. The resulted pooled RR (Risk Ratio) was 1.21 (95% CI [1.06–1.38]), being 24% of success rate from clinical trials (pooled RR 1.244; 95% CI [1.099–1.407]) and 19% of success rate from cohort studies (pooled RR 1.192; 0.996–1.426). However, two studies have confidence intervals which include unity and one study has a wide confidence interval; as a consequence, the meta-analysis for its results depends heavily on one single study. Meta-regression analysis revealed that results were influenced by the number of participants.

Conclusion

Both policy and pharmaceutical interventions can obtain positive results in quitting smoking among health-care workers. However, as shown by our review, combination approaches can produce better results in terms of cessation percentages and smoking abstinence.

Do Low Self-Esteem and High Stress Lead to Burnout Among Health-Care Workers? Evidence From a Tertiary Hospital in Bangalore, India

Background

Low self-esteem can be an issue among health-care workers due to the hierarchical medical system. Health-care workers are also in a high pressure environment that can lead to stress and burnout. This study was conducted to estimate the proportion of health-care workers with low self-esteem, high stress, and burnout and the factors associated with these in a private hospital in Bangalore city.

Methods

This cross-sectional study included a random sample of health-care workers of various cadres - doctors, nurses, nursing aides, technicians, and workers in ancillary departments such as laundry, dietary, central sterile supply department, and pharmacy, with probability proportional to size. Rosenberg Scale for Self-esteem, Cohen's Perceived Stress Scale, and Shirom-Melamed Burnout Measure were used as study tools.

Results

Among the 306 health-care workers, there were high levels of low self-esteem (48.4%), stress (38.6%), and burnout (48.7%), with the lowest levels being among doctors. Those aged younger than 30 years had significantly lower self-esteem and greater stress.

Conclusions

Health-care workers with low self-esteem were nearly thrice more likely to suffer high stress, Odds Ratio (OR) = 2.84 (1.36-5.92), and those who were stressed had more than three times higher chance of experiencing burnout, OR = 3.6 (2.02-6.55). Path analysis showed that low self-esteem among health-care workers had a direct effect on burnout, as well as an indirect effect through stress (mediator variable). This study indicates the need for screening and counseling for low self-esteem, stress, and burnout as part of a periodic medical examination of all cadres of health workers.

The role of the Community Pharmacist in promoting vaccinations among general population according to the National Vaccination Plan 2017-2019: results from a survey in Sicily, Italy

INTRODUCTION

The 2017-2019 Italian National Vaccination Plan promotes the improvement of knowledge and attitudes of healthcare workers about vaccine prevention, in order to spread a vaccination culture among general population. Similarly to the General Practitioner, the Pharmacist represents a fundamental forefront for both patients and healthy people, also in promoting vaccine acceptance. This research aims to analyze knowledge and attitudes about vaccines of Community Pharmacists and to evaluate the burden of vaccination counselling during their work activities.

MATERIAL AND METHODS

A standardized, self-administered and previously validated questionnaire, including 5 sections and 28 items, was submitted to a sample of Community Pharmacists working in Western Sicily. The survey was carried out through an online questionnaire, that investigated socio-demographic data, knowledge and attitudes towards vaccination and the role of the Pharmacist as vaccination counselor during his work.

RESULTS

A total of 120 Pharmacists were surveyed. 99.2% of them were definitely agreed with the Regional Vaccination Schedule. A large majority (n = 114, or 95%) were fully vaccinated and have vaccinated, or would vaccinate in future, their children. According to Community Pharmacists interviewed, at least 90% of clients asked for further explanations about vaccination, and the citizens' trust towards vaccination increased (30%) or remained stable (54.2%) over time in the last 5 years. Finally, as reported by interviewed Pharmacists, a correct counselling provided by General Practitioners (GPs) and Family Pediatricians was the main boost in increasing vaccination confidence, instead of mass-media and web misinformation that has led to skepticisms among general population.

CONCLUSION

The study demonstrated the key role of the Community Pharmacist for their consumers in vaccination counselling. In future, a strong collaboration between Community Pharmacists and all the actors promoting vaccination themes (GPs, family Pediatricians, public health workers) will be essential, as well as a uniform and standardized University training on vaccination themes for all these categories.

Risk factors of the efficacy of hepatitis B vaccine in health-care workers

Background

Conventional hepatitis B virus vaccination fails to achieve efficient protection in about 5%-10% of the world population. Different factors influence the immunogenicity of hepatitis B vaccine. This study aimed to evaluate these factors in health-care workers.

Materials and Methods

This was a descriptive study which was implemented among 140 of medical and dental staff working as health-care workers who were low responder after vaccination entered the study.

Results

Age (>40 years), weight (body mass index >25), immunodeficiency diseases, (primary immune deficiency and immunosuppressant drugs), diabetes mellitus, and smoking were the important factors.

Conclusion

In the high-risk group of hepatitis B disease, the risk factors of immunogenicity must be evaluated at vaccination and check titers of antibody after vaccination.

Prospective multicentre study of rectal carriage of multidrug-resistant Enterobacteriaceae among health-care workers in Spain

OBJECTIVES

To investigate the rectal carriage of multidrug-resistant Enterobacteriaceae (colistin-resistant, extended-spectrum β-lactamase (ESBL) -producers and/or carbapenemase-producers) among health-care workers (HCWs) from six Spanish hospitals.

METHODS

Rectal swabs from 258 HCWs, employed in intensive care units, haematology wards and clinical microbiology laboratories from six hospitals in northern Spain were studied. They were cultured in selective media for Gram-negative resistant bacteria. Detection of antimicrobial resistance genes and multilocus sequence typing were performed by PCR and further sequencing. A questionnaire including data related to risk factors of colonization/infection by resistant bacteria (age, gender, chronic diseases, immunosuppressive therapies, invasive procedures or antimicrobial treatments) was given to each participant.

RESULTS

No carbapenemase-producing Enterobacteriaceae were recovered. However, 8/258 HCWs (3.1%) were positive for ESBL-producing isolates. This rate was not higher than the colonization rate previously reported in Spain for healthy people in the community. Five isolates showed high-level resistance to colistin (MICs ranging from 8 to 128 mg/L) but all of them were negative for the mcr genes tested. No statistically significant risk factors for gut colonization by ESBL-producing or colistin-resistant Enterobacteriaceae were identified among the HCWs participating in the study.

CONCLUSIONS

Our data suggest that working in hospitals does not represent a risk for rectal carriage of multidrug-resistant Enterobacteriaceae.

Psychological impact of COVID-19 pandemic on health care professionals and workers

The outbreak of a novel coronavirus starting from December 2019 and reaching pandemic proportions has raised concerns as to the ability of the current protective measures and the health-care system to handle such a threat. Health-care workers may experience considerable psychological distress as a result of the coronavirus disease-19 pandemic due to providing direct patient care, vicarious trauma, quarantine, or self-isolation.

Workplace violence against resident doctors: A multicentric study from government medical colleges of Uttar Pradesh

According to the World Health Organization, between 8% and 38% of health workers suffer physical violence at some point in their careers. This multicentric study was conducted to find the prevalence, perceived risk factors, and measures to prevent workplace violence among doctors. The sample consisted of all 2^nd- and 3^rd-year resident doctors (n = 305) from three colleges in Uttar Pradesh. An anonymous, pretested in a similar setting, self-administered questionnaire was used. 69.5% of doctors reported to have experienced violence in one or other form in the past 1 year. In most incidents, relatives and attendants (69.3%) were involved in violence. No action was taken immediately in regard to violence in 35.3% of instances; 60.3% of study participants reported that they had repeated disturbing memories, thoughts, or images of the attack. Nonavailability of medicines (38.6%) and less staff (36.7%) were cited as top reasons behind violence.

Prevalence of Psychosocial Stress and Its Risk Factors among Health-care Workers in Nigeria: A Systematic Review and Meta-Analysis

Context:

Health-care workers experience psychosocial stress in their workplace. Available statistics are at variance, and hence, the need to know the overall prevalence of psychosocial stress among Nigerian health-care workers and associated risk factors.

Aims:

The aim of this study was to determine the prevalence of psychosocial stress and its risk factors among health-care workers in Nigeria through meta-analysis.

Materials and Methods:

PubMed, CINAHL, and Google Scholar databases were searched for articles. Search terms include “psychosocial stress,” “occupational health,” and “Nigerian health-care worker.” Articles were included if they used validated psychosocial stress assessment instruments. Of the 17 articles with data on psychosocial stress prevalence, eight met all inclusion criteria. Each article independently reviewed by the authors and relevant data abstracted. Statistical analysis was done using MedCalc version 18.10.

Results:

Overall, the prevalence of psychosocial stress was 61.97% (95% confidence interval [CI]: 41.013–80.823) based on analyzed eight articles with the sample size of 1763. Work overload rate at 67.72% (95% CI: 33.24–93.76) was the most prevalent psychosocial stress risk factor. Other risk factors were poor communication and staff attitude and lack of resources and equipment at 50.37% (95% CI: 13.35–87.16) and 62.4% (95% CI: 7.70–99.9), respectively. Headache, with neck and back pain, was the most prevalent psychosocial stress-related health outcome at 73.26% (95% CI: 66.14–79.82).

Conclusion:

Prevalence of psychosocial stress is high among health-care workers in Nigeria, necessitating preventive measures

Primary Health-Care Staff Barriers to Immunization

Background

Missed opportunities for immunization (MOI) is considered as the most important preventable reason for underimmunization. Health-care workers stand beyond more than half the children's missed opportunities due to gaps in their knowledge, attitudes, and practices (KAP) regarding immunization.

Objectives

This study assessed immunization staff at primary health-care centers in Baghdad/Al-Karkh for KAP that may lead to MOI.

Materials and Methods

KAP survey was conducted on field immunization service providers at primary health-care centers in Baghdad/Al-Karkh. Barriers are considered to present whenever scores found <80 in any of KAP. Data were collected using a self-administered structured questionnaire analyzed by SPSS 24.

Results

Among 217 respondent health professionals, 69 (31.8%) were physicians and 148 (68.2%) were nurses. The studied sample got mean scores for KAP of 84.7 ± 11.4, 71.1 ± 22.7, and 74.8 ± 20.3, respectively. Physicians had higher mean knowledge score compared to nurses (P < 0.05). Both physicians and nurses got mean scores below 80 for both attitudes and practices.

Conclusion

Attitudes and practices in both physicians and nurses need to be improved to avoid MOI.

Low reporting of violence against health-care workers in India in spite of high prevalence

Background

Violence against health-care workers has become a great issue in health-care organizations. This study was conceptualized with the aim to know the prevalence of violence and to identify gap between rate of reporting of an incident of violence at a tertiary care hospital in India.

Methods

The study was descriptive and cross-sectional; a validated questionnaire was used as a tool. Reported incidents of violence against workers were collected. P value <0.05 was considered statistically significant in the analysis. A Z test for proportion at 95% confidence interval was applied to analyze the level of difference between prevalence, rate of reporting, and their level of awareness.

Results

Of 394 respondents, 136(34.5%) workers had experienced workplace violence in the last 12 months. It was found that total 32 incidents of workplace violence were reported to the concerned authority. The reporting rate of violence is significantly low (23.5%), in spite of high prevalence (34.5%). Level of awareness regarding the reporting mechanism and regulations for the safeguard of health-care workers against workplace violence is only 24.6 %.

Conclusion

This study concluded that the prevalence of violence among health-care workers is quite high, but the reporting rate is significantly low. The low rate of reporting is because of lack of awareness about the reporting mechanism of workplace violence. It is recommended that sensitizing workshops should be conducted to increase the level of awareness, which will result in reduction in the prevalence of violence and building a safe and secured workplace for health-care providers.

Why people engage in a weight loss intervention at their workplace - a stratified case study

Background

The prevalence of obesity has increased significantly worldwide within the last decade. As obesity is recognised as a contributing factor when developing various health threatening chronic diseases, prevention initiatives focusing on weight loss are becoming more important. Because of the time spent at the workplace, workplaces can be optimal arenas for weight loss programs and these programs have been effective to decrease body weight. Thus, reasons for engaging in weight loss interventions needs exploring, in order to engage more workplaces in weight loss interventions. Such information provides important knowledge that may help to inform decisions of municipalities, employers and other public health decision makers, when and if implementing weight loss interventions. The aim of this study was therefore to explore reasons for employee engagement in weight loss projects at the workplace and the incentives a municipality, a manager at a home-care centre, and a project manager have to launch such project.

Methods

A stratified case study was conducted. A representative from the municipality, the manager at a home-care centre, the project manager of the weight loss intervention and six health-care workers were interviewed at the end of a one-year weight loss intervention at the workplace. Data were analysed using Systematic Text Condensation.

Results

Analysis identified different views and considerations for engaging in a weight loss intervention at the workplace. For the representative of the municipality the possible economical gain of the project was in focus. The project manager and the manager of the home-care centre both reflected mainly on improvement of the healthcare workers health. For the project manager, achieving good scientific results was highlighted as well. However, the employees were influenced by several factors, such as their own health and weight loss, the pressure from the environment and their struggle for recognition.

Conclusions

This study concluded that if targeting the increasing worldwide obesity problem through workplace initiated weight loss programs, the sales pitch to managements and employers have to be tailored in order to increase the participation and the motivation for the initiative.

Trial registration

ClinicalTrial.gov: NCT01015716, registration data 14.12.2010 (Prospectively registered).

Methicillin-resistant Staphylococcus aureus tracking spread among health-care workers and hospitalized patients in critical wards at a university hospital, Tehran, Iran

Health-care workers may serve as a reservoir for dissemination of methicillin-resistant Staphylococcus aureus (MRSA) to patients in hospital settings. The present study aimed to screen MRSA in nasal swabs of health-care workers and clinical specimens from patients and investigate the possible relationship between these isolates at a university hospital in Tehran, Iran. Additionally, we aimed to identify potential risk factors for MRSA colonization in health-care workers. Staphylococcus aureus strains were isolated from health-care workers and inpatients who completed a questionnaire on risk factors. Cefoxitin disc diffusion test was also used for detection of MRSA. Moreover, all of the MRSA isolates were subjected to pulsed-field gel electrophoresis (PFGE). Colonization rate of MRSA among health-care workers was 22.5%. Furthermore, out of 24 S. aureus isolates obtained from patients, nine (37.5%) were MRSA. Regarding risk factors, the prevalence of nasal MRSA carriage among hospital personnel who used masks was significantly lower than in those without masks (p 0.007). Using PFGE, 10 clusters and 14 singletons were identified among the MRSA isolates. In this regard, most of the MRSA isolates recovered from health-care carriers and patients in intensive care wards, especially general intensive care units, were grouped in certain clusters, indicating intra-ward transmission of the mentioned isolates in these restricted areas. We concluded that screening and decolonization of carriers, contact precautions, prudent use of antibiotics and implementation of active surveillance are recommended strategies for the prevention and control of MRSA transmission in hospital settings.

Seroepidemiology of HBV infection among health-care workers in South Sulawesi, Indonesia

BACKGROUND

Hepatitis B virus (HBV) infection is a world health problem with an estimated 257 million chronically infected people. Indonesia, with 7.1% prevalence of hepatitis B surface antigen (HBsAg), is classified as a moderately endemic country. Healthcare workers (HCWs) are at high occupational risk for HBV infection and potentially becoming transmitters for further infections. In Indonesia, the extent of hepatitis B among HCWs and specific control strategy are not available. This study evaluated the seroprevalence of HBV infection and associated risk factors in HCWs from four areas in South Sulawesi, Indonesia.

METHODS

A total of 467 HCWs (median age 28 years, male/female 89/378) were recruited. All HCWs were classified into three age groups (< 20-29, 30-39, and ≥ 40 years old), three work types (administration, non-intervention, and intervention), and three service periods (< 5, 5-9, and ≥ 10 years). Data on socio-demographic characteristics and risk factors were obtained by questionnaire and serum samples were tested for HBV markers (HBsAg, its antibody [anti-HBs], and antibody to core antigen [anti-HBc]. Chi-square or Fisher's exact test was used to determine differences in categorical variables, while risk factors were reported as odds ratios (OR).

RESULTS

The prevalence of current HBV infection (HBsAg+), exposure to HBV (anti-HBc+), and immunity to HBV (anti-HBs+) was 6.2, 19.2, and 26.1%, respectively. Two thirds (66.17%) of all HCWs did not express any of HBV markers. In relation to the age groups, intervention work-type, and service period of HCWs, increasing trends were observed in the exposure to HBV (p < 0.001, p < 0.001, and p < 0.010, respectively) and the immunity to HBV by natural infection (HBsAg-, anti-HBc+, anti-HBs+) (p = 0.004, p < 0.001, and p < 0.010, respectively). Needlestick injury contributed the highest risk factor (OR = 1.71; 95% CI: 1.05-2.77; p = 0.029) for infection acquisition, which mostly occurred in the intervention group (p = 0.046).

CONCLUSION

Exposure to HBV showed significant association with HCWs' age, work type, and service period. Needlestick injury was the highest risk factor for the acquisition of HBV, with highest events in the intervention work-type. Two thirds of HCWs were still susceptible to HBV infection. Intervention strategies at the national level are required to mount prevention, control, and management of HBV infection in HCWs.

Knowledge and attitudes on influenza vaccination among Italian physicians specialized in respiratory infections: an Italian Respiratory Society (SIP/IRS) web-based survey

INTRODUCTION

Influenza epidemics are one of the main causes of morbidity and mortality worldwide. Influenza vaccination is considered the most important public health intervention to prevent seasonal influenza infection. European health authority policies focus on patient protection by vaccinating both these subjects and their care-givers, including health-care workers (HCWs). The aim of this survey is to investigate knowledge about influenza vaccination and intention to get vaccinated among Italian HCWs who take care patients with respiratory disease.

METHODS

An anonymous web-based survey was addressed to members of the Italian Respiratory Society (IRS).

RESULTS

Among the 1,776 IRS members who have been invited to the survey, 144 (8.1%) completed the survey (97 men; median age 59 years; 85.4% Respiratory Disease). The vast majority recommended vaccination to all their patients (81%). More than two thirds of respondents considered influenza vaccination safe for immunocompromised patients. More than 50% of respondents underwent seasonal influenza vaccination in 2015 and 68% declared the intention to undergo vaccination in 2016 epidemic season. Reasons for having vaccination mainly referred to 'protect oneself from influenza' (63%), 'protect patients' (31%) or household members' (6%). The main reasons for vaccination refusal were 'lack of time' (45%), 'concerns about side effects' (22%), 'do not get influenza easily and/or not afraid of influenza infection' (22%) and 'disagreement with indication of vaccination for HCWs' (9%).

CONCLUSIONS

The promotion of better knowledge and attitude towards influenza vaccination among Italian specialists remains an unmet goal and should be addressed by appropriate multifaceted interventions.

Annual Burden of Occupationally-Acquired Influenza Infections in Hospitals and Emergency Departments in the United States

Infections among health-care personnel (HCP) occur as a result of providing care to patients with infectious diseases, but surveillance is limited to a few diseases. The objective of this study is to determine the annual number of influenza infections acquired by HCP as a result of occupational exposures to influenza patients in hospitals and emergency departments (EDs) in the United States. A risk analysis approach was taken. A compartmental model was used to estimate the influenza dose received in a single exposure, and a dose-response function applied to calculate the probability of infection. A three-step algorithm tabulated the total number of influenza infections based on: the total number of occupational exposures (tabulated in previous work), the total number of HCP with occupational exposures, and the probability of infection in an occupational exposure. Estimated influenza infections were highly dependent upon the dose-response function. Given current compliance with infection control precautions, we estimated 151,300 and 34,150 influenza infections annually with two dose-response functions (annual incidence proportions of 9.3% and 2.1%, respectively). Greater reductions in infectious were achieved by full compliance with vaccination and IC precautions than with patient isolation. The burden of occupationally-acquired influenza among HCP in hospitals and EDs in the United States is not trivial, and can be reduced through improved compliance with vaccination and preventive measures, including engineering and administrative controls.

A comparative study on the level of satisfaction among regular and contractual health-care workers in a Northern city of India

Introduction:

Job satisfaction greatly determines the productivity and efficiency of human resources for health. The current study aims to assess the level of satisfaction and factors influencing the job satisfaction among regular and contractual health-care workers.

Materials and Methods:

A cross-sectional quantitative study was conducted from January to June 2015 among health care workers (n = 354) at all levels of public health-care facilities of Chandigarh. The correlation between variables with overall level of satisfaction was computed for regular and contractual health-care workers. Stepwise multiple linear regression was done to elucidate the major factors influencing job satisfaction.

Results:

Majority of the regular health-care staff was highly satisfied (86.9%) as compared to contractual staff (10.5%), which however was moderately satisfied (55.9%). Stepwise regression model showed that work-related matters (β = 1.370, P < 0.01), organizational facilities (β = 1.586, P < 0.01), privileges attached to the job (β = 0.530, P < 0.01), attention to the suggestions (β = 0.515, P < 0.01), chance of promotion (β = 0.703, P < 0.01), and human resource issues (β = 1.0721, P < 0.01) are strong predictors of overall satisfaction level.

Conclusion:

Under the National Rural Health Mission, contract appointments have improved the overall availability of health-care staff at all levels of public health facilities. However, there are concerns regarding their level of motivation with various aspects related to the job, which need to be urgently addressed so as to improve the effectiveness and efficiency of health services.

Effect of Shift Work on Sleep, Health, and Quality of Life of Health-care Workers

Background:

Shift work is associated with sleep disruption, impaired quality of life, and is a risk factor for several health conditions. Aim of this study was to investigate the impact of shift work on sleep and quality of life of health-care workers (HCW).

Settings:

Tertiary University hospital in Greece.

Study Design:

Cross-sectional study.

Materials and Methods:

Included were HCW, working either in an irregular shift system or exclusively in morning shifts. All participants answered the WHO-5 Well-Being Index (WHO-5) and a questionnaire on demographics and medical history. Shift workers filled the Shift Work Disorders Screening Questionnaire (SWDSQ).

Statistical Analysis:

Descriptive statistics, Student's t-test, one-way analysis of variance (ANOVA), Pearson's r correlation coefficient, and multivariate stepwise linear regression analysis were applied.

Results:

Included were 312 employees (87.9% females), 194 working in irregular shift system and 118 in morning shifts. Most shift-workers (58.2%) were somehow or totally dissatisfied with their sleep quality. Regression analysis revealed the following independent determinants for sleep impairment: parenthood (P < 0.001), age 36–45 years (P < 0.001), >3 night shifts/week (P < 0.001), work >5 years in an irregular shift system (P < 0.001). Diabetes mellitus was the most common medical condition reported by shift workers (P = 0.008). Comparison between the two groups revealed a significantly impairment in WHO-5 total score, as well as in 4 of 5 of its items (P < 0.001).

Conclusion:

Shift-work impairs quality of life, whereas its duration and frequency, along with age and family status of employees can have adverse effects on sleep.

Study of quality of life among health workers and psychosocial factors influencing it

BACKGROUND

To cope with the challenges in the health-care delivery system and to guarantee the quality of care rendered and client satisfaction on the care received, it is important to know how satisfied health-care workers are with their quality of life, job and what characteristics influence their quality of life. This study was undertaken in a tertiary care hospital to assess the same using validated questionnaires.

AIM

This study aims to study the quality of life among the health workers (doctors and nurses) of a large multispecialty tertiary care hospital and the psychosocial factors influencing it.

MATERIALS AND METHODS

A total of 200 health-care workers with their background demographic data were assessed using quality of life questionnaire and occupational stress inventory. The data compiled were analyzed with appropriate statistical methods.

RESULTS

The overall quality of life among the study population was average, and the mean prevalence of occupational stress level was of mild level. There was a correlation between domains of occupational stress and domains of quality of life of health-care workers.

CONCLUSION

Study findings revealed that overall perception of quality of life was average, overall stress level of health-care workers was moderately elevated and majority showed average coping resources.

Determinants of appropriate knowledge on human immunodeficiency virus postexposure prophylaxis among professional health-care workers in Sokoto, Nigeria

Introduction:

The prevention of human immunodeficiency virus (HIV/AIDS) among health-care workers (HCWs) has remained a major topical issue worldwide. Accidental transmission of HIV infection to HCWs during occupational exposure is a real threat today. The study aimed to assess the knowledge, attitude, and practice of postexposure prophylaxis (PEP) among HCWs in a tertiary health institution in Sokoto, Northwestern Nigeria.

Methodology:

The study was carried out at Usmanu Danfodiyo University Teaching Hospital, Sokoto, through a cross-sectional descriptive study design; a total of 156 participants were recruited using a stratified sampling technique. Data were collected using a semi-structured, self-administered questionnaire and analyzed using SPSS computer software after obtaining ethical clearance from the Health Ethics and Research Committee of the teaching hospital.

Results:

A total of 87.2% (136) of the respondents had heard of PEP and 71.8% (112) thought that HIV/AIDs could be prevented through PEP. A total of 71.2% (111) had good knowledge about PEP, whereas 86.8% (118) had a positive attitude toward PEP.

Conclusion:

Although the study demonstrated high knowledge and positive attitude toward PEP, the observance of safety measures against needlestick injuries that could result in HIV infections was abysmally low. There is the need to create more awareness and strengthen the use of PEP protocol by all cadres of health workers as this will go a long way in minimizing blood-borne infections.

The Attitude of Psychiatric and Non-psychiatric Health-care Workers Toward Suicide in Malaysian Hospitals and Its Implications for Training

OBJECTIVES

This research is aimed to examine the attitude of health-care workers toward suicidal patients in Malaysian hospitals, comparing responses from psychiatric and non-psychiatric workers, and to identify specific needs in suicide prevention and management training.

METHOD

This is a multi-site cross-sectional study. The authors conducted a survey based on a translated self-administered questionnaire to participants from seven core hospital departments.

RESULTS

While most health-care workers regardless of department and specialty took their duty to prevent suicide seriously, a large majority of them expressed negative attitudes such as finding suicidal behavior irritating, and more than half believed suicidal attempts were a way of making others sorry. However, psychiatric workers were less likely to have judgmental attitudes that included believing suicide attempters as being selfish or trying to get sympathy from others.

CONCLUSIONS

As there were more similarities than differences in health-care workers' attitudes toward suicide, recommendations on basic and continuous suicide prevention and management training among hospital workers were made. The interventions focused on improving knowledge, affective, and skill-based areas that were aimed to correct the wrongful understanding of and to minimize the negative attitudes toward suicidal individuals indicated by the study results.

Occurrence of Needlestick and Injuries among Health-care Workers of a Tertiary Care Teaching Hospital in North India

INTRODUCTION

Occupational hazards such as accidental exposure to sharp, cuts, and splashes are common among health-care workers (HCWs).

AIMS AND OBJECTIVES

To determine the occurrence of self-reported occupational exposures to these hazards and to know the prevalent practices following the exposure. The second aim was to know the baseline antibody levels against hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) immediately after these accidents.

METHODS

An observational prospective study was done in the HCWs of a tertiary care academic health organization of North India from January 2011 to December 2013. At the time of self-reporting of injury, a questionnaire was administered. Blood sample of HCWs and of the source, if identified, was collected for baseline HBV, HCV, and HIV serum markers. The exposed HCWs were followed up and repeat testing was done after 3-4 weeks for seroconversion up to 6 months.

RESULTS

A total of 476 injuries were reported. Needlestick injury of fingers was the most common. Doctors were found to have the highest exposure rate (73.7%) distantly followed by nurses (19.1%). A significant number of the HCWs (125, 26.3%) vaccinated in past had hepatitis B surface antibody (anti-HBs) titers <10 mIU/mL (protection defined as anti-HBs level ≥10 mIU/ml). Only 44 sources were found to be seropositive (11 for HIV, 9 for HCV, and 24 for HBV). No seroconversion was seen in any of the exposed HCWs after 6 months.

CONCLUSIONS

The incidence of needlestick and sharp injuries is most often encountered in emergency wards. Anti-HBs titers were suboptimal in many of the HCWs requiring a booster dose of HBV vaccination.

[Prevalence of cardiovascular risk factors in a population of health-care workers]

BACKGROUND

To determine the prevalence of cardiovascular risk factors (CVRF) in healthcare workers from two tertiary-care hospitals of the Mexican Institute of Social Security, as well as their association with professional activities (PA).

METHODS

Descriptive study. One-thousand eighty-nine health-care workers ≥ 18 years were included. Clinical history, physical exam, and blood tests were performed.

RESULTS

Mean age 41 ± 9 years, 76% women. Hypertension prevalence was 19%, diabetes mellitus 9.6%, dyslipidemia 78%, overweight and obesity 73%, metabolic syndrome (MS) 32.5%, and smoking 19%. The following significant associations (p < 0.05) were found: MS with medical asisstants (OR: 2.73, CI 95%: 1.31-5.69) and nutritionist (OR: 2.6, CI 95%: 1.31-5.24); obesity with administrative personnel (OR: 3.64, CI 95%: 1.40-7.46); dyslipidemia with medical asisstants (OR: 2.58, CI 95%: 1.15-6.34). In the whole sample, the probability to have a vascular event in the following 10 years was 10%.

CONCLUSION

Prevalence of CVRF was high in this sample of health-care workers and did not seem to be different from those in general population. Medical assistants, nutritionist, and administrative personnel displayed a higher risk. It is necessary to create programs to promote healthy lifestyle and to improve the epidemiological profile of health-care workers.

Knowledge and Attitudes toward HIV, Hepatitis B Virus, and Hepatitis C Virus Infection among Health-care Workers in Malawi

Objective:

The highest prevalence of HIV infection occurs in Sub-Saharan Africa and hepatitis B virus (HBV), and hepatitis C virus (HCV) prevalence are the second highest in Sub-Saharan Africa including Malawi. Health-care workers (HCWs) play an important role in the prevention of, response to, and management of these infectious diseases. There is, however, no published research about the level of knowledge and attitudes toward HIV, HBV, and HCV infection among Malawian HCWs. The purpose of this study was to explore and determine the knowledge of and attitudes toward HIV, HBV, and HCV among a targeted population of Malawian HCWs.

Methods:

A cross-sectional community-based participatory research with 194 HCWs was completed employing health survey method. The project was a collaborative effort between nursing faculties in the USA and Malawian. A one-way analysis of variance (ANOVA) with the Bonferroni adjustment for multiple comparisons was used to assess the differences in knowledge and attitude among three subgroups of HCWs.

Results:

Of 194 of Malawian HCWs surveyed, 41% were support staff, 37% were nursing students, and 22% were health-care professionals. Both health-care professionals and support staff had high knowledge scores related to HIV/AIDS, and their attitudes were mainly positive. However, a series of one-way ANOVAs revealed significant differences in knowledge and attitude toward HIV/AIDs, HBV, and HCV among HCWs (P < 0.01). The majority had less knowledge about HBV and HCV and more negative attitudes toward hepatitis.

Conclusions:

This study highlights the ongoing need for reducing negative attitudes toward HIV, HBV, and HCV; and providing health education among HCWs, especially focusing on HBV and HCV prevention. The findings of the research project can be used to develop interventions addressing low HBV- and HCV-related knowledge and attitudes.

Vaccination status, knowledge and awareness towards hepatitis B among students of health professions in Vientiane, Lao PDR

Health care workers (HCW) are a population at high risk of hepatitis B virus (HBV) infection, especially in endemic countries such as Lao PDR. Effective vaccines are available since over 10 years, but many HCWs are not aware of the risk of infection and are still not immunized against hepatitis B. This study aimed to assess immunization coverage against hepatitis B among the students of the University of Health Sciences (UHS) of Lao PDR in 2013 and to look for the causes of non-vaccination. A cross-sectional survey was conducted by self-administered questionnaire on a representative stratified sample of each academic year in each faculty. In total, 961 questionnaires were collected, Basic Sciences: 143, Medicine: 167, Pharmacy: 148, Dentistry: 139, Nursing Sciences: 159, Medical Technology: 99, and Postgraduate Studies: 106. Respondents were predominantly female (59.1%), mean age 25.1±7.0 years, single (76.3%), from the provinces (68.0%), of the Lao Loum ethnic group (84.4%). Among them, 21% were fully vaccinated against hepatitis B and 9.5% partially. Immunization coverage rates were significantly higher among women (p=0.01), students aged over 25 years, married or belonging to the post-graduate faculty (p<0.001). The most common reason (38.6%) given for non-vaccination was not knowing where to get vaccinated. Knowledge about hepatitis B, scored from 0 to 5, was poor (0-1) for 86.5% of the students, but 77.5% were aware of the hepatitis B vaccine. The knowledge scores were significantly higher for students aged over 25 years, married or post-graduated (p<0.001). Vaccination coverage against hepatitis B is dramatically low among students of health professions in Laos, largely because of their lack of knowledge and awareness. Upon admission to the University, all future HCWs should receive information about the occupational risks of blood-borne viruses transmission and be encouraged to get vaccinated against hepatitis B.

Attitudes and Awareness Regarding Hepatitis B and Hepatitis C Amongst Health-care Workers of a Tertiary Hospital in India

Background:

Hepatitis is an inflammatory disease of the liver. In sever cases, it may lead to permanent liver damage including liver cirrhosis or hepato-cellular carcinoma and may ultimately lead to death. Health-care workers (HCWs), due to their regular contact with patients are at a high-risk of acquiring this disease.

Aim:

The aim of this study was to assess the knowledge and attitude toward hepatitis B and C infection among the health-care interns and correlate the level of awareness to the attitude they behold toward the disease.

Subjects and Methods:

A closed ended questionnaire consisting of questions to evaluate the knowledge regarding hepatitis B and C infection and attitude of the (HCWs/interns) was duly filled by 255 participants including, 100 dental, 100 medical, and 55 nursing interns. Statistical analysis was carried out using the Chi-square test, ANOVA test, post-hoc test and Pearson's correlation.

Results:

Although most of the interns were aware of the existence of hepatitis B and C infection, the level of awareness regarding the modes of transmission and vaccination was found to be dissatisfactory. Awareness level regarding the infection among nursing interns was statistically significantly lower than the dental and medical interns. A direct positive correlation as found between awareness score and behavior score, which reveals that interns with better awareness level had better attitudes toward the infection and prevention of its transmission.

Conclusion:

There is an urgent need to increase the level and quality of training among HCWs to prevent the spread of hepatitis B virus and hepatitis C virus.

The Self-Rating Scale of Self-Directed Learning (SRSSDL): a factor analysis of the Italian version

BACKGROUND

The development of self-directed learning (SDL) is a growing priority among nurses and other health care workers: they need to be prepared in order for their university education to be effective and relevant to their lifelong learning. To learn in a self-directed manner, it is necessary to develop an awareness of one's ability to self-learn and then to implement appropriate and effective strategies; progress must be assessed using validated measurement tools.

OBJECTIVES

The aim of this study was to examine the factor structure of the Italian version of the Self-Rating Scale of Self-directed Learning (SRSSDL(Ita)), and to provide evidence of its validity.

DESIGN

A cross-sectional design was undertaken.

PARTICIPANTS

Given that the instrument is composed of 60 items, a total of 600 to 900 participants were targeted. In addition, according to the theoretical assumption that self-directed learning - as a crucial component of lifelong learning - is a measurable skill that is developed across the individual's professional life, a maximum variation sample was examined. Therefore, 847 participants were involved, including 453 nurses, 141 radiology technicians, 182 nursing students and 68 radiology technician students.

METHODS

Principal component analysis and factor analysis were performed.

RESULTS

The Italian version of the SRSSDL Scale consists of 40 items composed of eight factors: Awareness (α=0.805), Attitudes (α=0.778), Motivation (α=0.789), Learning Strategies (α=0.789), Learning Methods (α=0.781), Learning Activities (α=0.676), Interpersonal Skills (α=0.684), and Constructing Knowledge (α=0.732).

CONCLUSIONS

The SRSSDLIta consists of 40 items across eight factors. The shorter Italian version might reduce the time needed to complete, thereby making the tool faster and easier to use.