ABSTRACT
The psychological impact of COVID-19 on Health Care Workers (HCWs) has been widely reported. Few studies have sought to examine HCWs personal models of COVID-19 utilising an established theoretical framework. We undertook a mixed methods study of beliefs about COVID-19 held by HCWs in the Mid-West and South of Ireland during the first and third waves of COVID-19. Template analysis was undertaken on the free text responses of 408 HCWs about their perceptions of the Cause of COVID-19 as assessed by the Brief Illness Perception Questionnaire (B-IPQ). Responses were re-examined in the same cohort for stability at 3 months follow-up (n = 100). This analytic template was subsequently examined in a new cohort (n = 253) of HCWs in the third wave. Female HCWs perceived greater emotional impact of COVID-19 than men (t = -4.31, df405, p < 0.01). Differences between occupational groups were evident in relation to Timeline (F4,401 = 3.47, p < 0.01), Treatment Control (F4,401 = 5.64, p < 0.001) and Concerns about COVID-19 (F4,401 = 3.68, p < 0.01). Administration staff believed that treatment would be significantly more helpful and that COVID-19 would last a shorter amount of time than medical/nursing staff and HSCP. However, administration staff were significantly more concerned than HSCP about COVID-19. Template analysis on 1059 responses to the Cause items of the B-IPQ identified ten higher order categories of perceived Cause of COVID-19. The top two Causes identified at both Waves were 'individual behavioural factors' and 'overseas travel'. This study has progressed our understanding of the models HCWs hold about COVID-19 over time, and has highlighted the utility of the template analysis approach in analysing free-text questionnaire data. We suggest that group and individual occupational identities of HCWs may be of importance in shaping HCWs responses to working through COVID-19.
ABSTRACT
Background: COVID-19 made it necessary to establish telemedicine as a first default for reviews in a previously telemedicine-naive clinic. Objectives: To establish and assess telemedicine in the first 6 months of COVID-19 pandemic. Methods: Utilising a multidisciplinary team (MDT) approach, we established a ‘Covid Pack’ of medical equipment (sent to each patient) and a suitable video conference platform to replicate the in-person clinic format. The virtual clinic was then rolled out (94 patients reviewed in the first 6 months). A retrospective chart review comparing patients’ clinical metrics pre- and post-rollout was then conducted. Usability and Acceptance were also measured with patients (p) and staff (s) via a number of standardised surveys: System Usability Scale (SUS), TeleHealth Usability Questionnaire (TUQ), IT Familiarity, and our own quality-survey. Results: The Covid Pack permits adequate spirometric assessment of patients (mean bias −2.5%). Preliminary data collected from 52 patients and 11 staff members show an overall positive response to our remoteclinics. The SUS received a median score of 90 (p) and 87.5 (s) out of 100. The TUQ received a total score of 6.52 (p) and 6.1 (s) out of 7, with ease of Use and Learnability as the highest-rated category in the TUQ (median 7, range 3.6–7) and Reliability as the lowest-rated category (median 5.33, range 2–7). The IT Familiarity questionnaire received an average median score of 1 (very familiar) from both groups. Qualitative data collected via a custom survey show that while patients and staff are positive to the convenience of the remote clinic, the facility for an in-person. face-to-face review remains important, as does good WiFi connection. Conclusion: Initial 6-month data are positive for the remote clinic as a first default during the pandemic. Preliminary data shows a positive trend for the usability and acceptance by all stakeholders, but it is not a replacement for physical clinics.
ABSTRACT
This study analysed the effectiveness of plasma treatment on airborne bacteria and surface counts during a 14-day intervention within a four-bedded bay in an adult respiratory ward at Cork University Hospital, Ireland. One-hundred-litre air samples were collected twice daily every weekday for 4 weeks, with settle plates and surface swabs. The plasma treatment did not have an effect on airborne bacteria and fungi that was detectable by culture. However, the possibility that culture-based sampling may be insufficiently sensitive to detect an effect, or that the duration of the study was insufficient for plasma treatment to affect a complex environment, cannot be excluded.
Subject(s)
Air Microbiology , Air Pollution/prevention & control , Hospitals , Plasma Gases , Environmental Monitoring , Fungi , IrelandABSTRACT
Aim To examine the characteristics and outcomes of hospitalised older adults with COVID-19. Methods Retrospective, multi-centre, cohort observational study. Data from sixty-nine hospitalised patients aged over 70 years with reverse transcriptase polymerase chain reaction-confirmed COVID-19 at three Irish hospitals were collected from health records. Symptom profile, COVID-19 severity level based on Irish Thoracic Society guidelines, Clinical Frailty Scale (CFS), Cumulative Illness Rating Scale-Geriatric (CIRS-G) scores, laboratory and radiological data were reviewed. Results Patient mortality rate was 23.2% (n=16). Median survivor age was 81.5 years (IQR 76.5-86.5). Mean CFS and CIRS-G scores were 5;(SD1.6) and 8.19;(SD4.4). Most patients (n=56, 81.1%) were categorised as mild COVID-19 cases. Five patients (n=5, 7%) were asymptomatic. Atypical symptom presentation was 7%(n=5). Delirium was noted in almost one-third of patients (n=21, 30.4%). Seven patients (n=7,10.1%) required intubation and intensive care unit admission. Over 1/3 of delirious patients died (n=8, 38%). Frail patients were older (P= 0.005), more likely to have dementia (P=0.04) and required less ventilatory support than non-frail patients (P=0.001) but were categorised as mild COVID-19 on admission (P=0.004). Conclusion Despite mild COVID-19 symptoms, mortality and delirium rates remained high. Low co-morbidity burden & atypical symptom rates were recorded despite high frailty rates.
ABSTRACT
Healthcare providers at the forefront of the COVID-19 response are at constant risk of infection. International guidance recommends frequent handwashing and personal protective equipment (PPE) to help prevent contraction and transmission of the virus. However, evidence is emerging that these practices are causing adverse effects on the skin integrity of frontline healthcare workers (HCWs). This study aims to evaluate the degree of COVID-19-related dermatitis among frontline staff members from a large tertiary hospital in Ireland. A single-centre cross-sectional study of HCWs from a university hospital in Ireland was undertaken between 29 April and 13 May 2020. Approximately, 1000 online and paper surveys were distributed to hospital staff. Participants reported on the duration of PPE exposure, change in handwashing practices, symptoms of dermatitis and alleviating measures trialled. Data were collected in Microsoft Excel and the results were analysed using SPSS. Of the 270 participants in this study, 223 (82.6%) reported signs and symptoms of dermatitis. Hands were the most commonly affected site (76.5%) followed by the nose (13.7%) and cheeks (12.5%). The most frequently reported symptom was dry skin, with 75.4% of staff affected. Redness was described by 36.9% and 27.6% complained of itching. Virtually all (n = 268;99.2%) HCWs reported an increase in frequency of handwashing;however, 122 (45.2%) staff members denied using emollients or other topical treatment. Atopy was not related to the development of dermatitis, but a personal history of dermatitis contributed significantly, with 55 (24.7%) of the dermatitis group citing a history of dermatitis vs. 4.3% of unaffected staff (P < 0.001). The dermatitis group recorded wearing PPE for an average of 3.15 h in comparison with the nondermatitis group using continuous PPE for 1.97 h;however, this fell short of significance (P = 0.211). COVID-19 healthcare-related dermatitis is emerging as a significant problem. It is vital to promote awareness of this issue in order to provide appropriate prevention and timely treatment for our healthcare staff on the front line.
ABSTRACT
Aims The aim of this study was to provide an early interval evaluation of laboratory characteristics and clinical outcomes of adult patients with qRT-PCR-confirmed SARS-CoV-2 infection. Methods We performed a single-centre retrospective cohort study. All patients with qRT-PCR-confirmed SARS-CoV-2 infection admitted from March 6th to April 2nd were included. Daily laboratory, radiological and clinical parameters were manually collected on every patient. Results Forty-six patients were included in the analysis. Thirty-three (72%) of patients were male. The majority of patients (n=33, 89%) had at least one baseline comorbidity. Bilateral consolidation on chest x-ray (n=24, 52%) correlated with level of respiratory support required but not with mortality. Documented fever (n=33, 48%) and hypotension (n=4, 9%) correlated with highest level of respiratory support required. Older age, obesity and more than one baseline comorbid condition were associated with mortality. Regarding laboratory markers, degree of neutrophilia, lymphopenia (n=33, 73%) and raised CRP were significantly associated with death. Raised LDH, ferritin and D-dimer concentrations correlated with degree of oxygen requirement. There was no association between an early PCR cycle quantification (Cq) value (used as a proxy for viral load) and patient outcome. Conclusions We found multiple characteristics that correlated with outcome. These findings give an indication as to those patients that are at risk of a poor clinical outcome. © 2020, Irish Medical Association. All rights reserved.
ABSTRACT
Aims There is increasing concern amongst clinicians of a possible increase in venous thromboembolism (VTE) events in patients with COVID-19. There remains limited data defining the incidence of VTE in this population and thus also a paucity of research examining the impact of targeted treatment in patients with thrombotic complications. Methods We examined the number of symptomatic VTE events amongst proven COVID-19 patients admitted to a tertiary level academic hospital, over a one-month period. Patient characteristics, admission and discharge inflammatory and coagulation markers were included in the analysis. Results Sixty-one patients were identified. Twelve patients (19.6%) admitted with COVID-19 were treated for a suspected PE. Of these patients, 3 patients were discharged on anticoagulation, 3 died and 6 remain inpatients at the end of the study period. Discussion COVID-19 patients are at increased risk of VTE. This risk may extend beyond the period of admission. Further research examining the role of extending the duration of thromboprophylaxis in COVID-19 patients beyond hospital discharge is warranted. © 2020, Irish Medical Association. All rights reserved.
ABSTRACT
COVID-19 healthcare workers (HCWs) require frequent handwashing and use of personal protective equipment (PPE) to prevent infection. However, evidence is emerging that these practices are causing adverse effects on their skin integrity. A single-centre, cross-sectional study of HCWs from an Irish hospital was undertaken to evaluate the degree of COVID-19-related irritant contact dermatitis (ICD) between April and May 2020. Of 270 participants surveyed, 223 (82.6%) reported symptoms of ICD. The hands were the most commonly affected site (76.47%) and the most frequently reported symptom was dry skin (75.37%). Nearly all (268; 99.26%) HCWs had increased hand-washing frequency, but 122 (45.35%) did not use emollients. In the ICD group, 24.7% cited a history of dermatitis compared with 4.3% of unaffected staff (P < 0.001). The ICD group recorded PPE usage for an average of 3.15 h compared with the non-ICD group at 1.97 h (P = 0.21). Promoting awareness of COVID-19-related ICD is vital to highlight prevention and treatment for frontline staff.