Impact of COVID-19 on environmental services workers in healthcare settings: a scoping review.

BACKGROUND: In the wake of the coronavirus disease 2019 (COVID-19) pandemic, demand for deep cleaning and environmental services workers grew exponentially. Although there is extant literature examining the impact of the COVID-19 pandemic on healthcare workers, less emphasis has been placed on environmental services workers, who play an equally important front-line role. AIM: To examine the impact of the COVID-19 pandemic on environmental services workers employed in healthcare settings. METHODS: Scoping review methodology. A search strategy was developed, in consultation with a medical information specialist, employing various combinations of the keywords [(environmental services worker OR health attendant OR housekeeping) AND (COVID OR coronavirus OR pandemic OR epidemic)]. Four bibliographical databases were searched from inception to 5th July 2022: OVID Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Database. RESULTS: In total, 24 studies were included in this review. The studies were generally cross-sectional in design. Seroprevalence studies highlighted significantly higher rates of COVID-19 among environmental services workers (housekeeping, cleaning and janitorial staff) compared with other clinical and non-clinical staff in the same institutions. In addition, based on qualitative interviews, environmental services workers experienced greater psychological stress working during the pandemic. CONCLUSIONS: Environmental services workers were particularly vulnerable to increased work stress and COVID-19 during the pandemic. Health systems need to do more to support these workers. Further research could investigate specific policy and procedural changes to benefit this under-recognized group in the greater healthcare workforce.

Management of OHCA during COVID-19: A tale of two cities

Background: Regional variations in the impact of the coronavirus disease-2019 (COVID-19) pandemic on out-of-hospital cardiac arrest (OHCA) have been reported. We aimed to examine differences in the community response, emergency medical services (EMS) interventions, and outcomes of OHCA, in Singapore (population 5.7 million) and Atlanta (population 4.16 million), before and during the pandemic. Methods: Using prospectively collected Singapore Pan-Asian Resuscitation Outcomes Study (PAROS) and Atlanta Cardiac Arrest Registry to Enhance Survival (CARES) data, we compared EMS-treated adult OHCAs (≥18 years) during the pandemic period (17weeks from the date of first confirmed COVID-19 case) and pre-pandemic period (corresponding weeks in 2019). The primary outcome was pre-hospital return of spontaneous circulation (ROSC). We reported adjusted odds ratios (aOR) for OHCA characteristics, pre-hospital interventions, and outcomes using binary logistic regression. Results: Of the 3987 EMS-treated OHCAs (overall median age 69 years, 60.1% males) in Singapore and Atlanta, 2084 occurred during the pandemic and 1903 during the pre-pandemic period. Compared with Atlanta, OHCA cases in Singapore were older (median age 72 vs 66 years), received more bystander interventions (65.1% vs 41.4% received cardiopulmonary resuscitation (CPR) and 28.4% vs 10.1% had automated external defibrillator application), yet observed less pre-hospital ROSC (11.3% vs 27.1%). When compared with the pre-pandemic period, the likelihood of residential OHCAs doubled in both cities during the pandemic;in Singapore, OHCAs were more likely to be witnessed (aOR 1.95, 95% confidence interval (CI), 1.59-2.39) yet less likely to receive CPR (aOR 0.81, 95% CI, 0.65-0.99) during the pandemic. OHCAs occurring during the pandemic, compared with pre-pandemic, were less likely to be transported in Singapore and Atlanta (aOR 0.50, 95% CI, 0.42%-0.85%, and 0.36, 95% CI, 0.26-0.50, respectively), without significant differences in overall pre-hospital ROSC. Conclusion: Changes in OHCA characteristics and pre-hospital interventions during the pandemic were likely collateral consequences, with regional variations partly reflecting differences in systems of care and other sociocultural factors. These highlight opportunities for public education and the need for further study into lower transport rates during the pandemic.

Recent trends in out-of-hospital cardiac arrest (OHCA) outcomes in Singapore in the era of covid-19

Objectives: To analyse the incidence of emergency medical serviceattended out-of-hospital cardiac arrests (OHCAs) and prehospital return of spontaneous circulation (ROSC) outcomes in Singapore from January to May 2020, as compared to the same period in 2018 and 2019. Methods: This was a retrospective observational study comparing current and previous emergency medical service (EMS) data and OHCA records maintained by the Singapore Civil Defence Force (SCDF). These figures were tabulated from data input by experienced paramedics responding to EMS calls and verified by an internal audit team. The study was conducted in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines, and examined factors that may have contributed to an increase or decrease in OHCA incidence and prehospital ROSC attainments during the different time periods. Results: Coronavirus Disease 2019 (COVID-19) is a global pandemic of unparalleled scale. Despite total EMS call volumes and overall OHCA incidence remaining comparable to pre-COVID periods, there was a concerning decrease in pre-hospital ROSC attainments between January to May 2020 (an average of 8.4%). Based on multivariable logistic regression, this was much lower when compared to previous years, where the pre-hospital ROSC rates remained around 12% (p<0.001). Further analyses did not reveal significant differences in terms of the median age of OHCA victims, the percentage of shockable rhythm or response times. However, it was noted that more OHCAs were occurring in residential homes, while those in public spaces decreased considerably compared to previous years (p<0.001). In addition, there was also a drop in the overall bystander cardiopulmonary resuscitation (CPR) rates compared to pre-COVID periods (p<0.001). Conclusion: The findings remain preliminary and follow-up data in the subsequent months are necessary to further investigate these trends. Nonetheless, they provide important lessons for public education and pandemic preparedness. To strengthen the first links in the survival chain, members of the public should be educated to initiate CPR and automated external defibrillator (AED) for any non-responsive victim (even without mouth-to-mouth ventilation).