Integrating mental health into emergency preparedness and response: lessons learned from Covid-19 : Muhammad Alkasaby

Introduction The COVID-19 crisis has disrupted health systems all over the world. In a survey by the WHO, 93% of the countries reported disruption in their mental health services. This research assessed the extent to which mental health was included in the national response to the COVID-19 pandemic in African countries. It also explored barriers and enablers to mental health integration into the COVID-19 response. Lessons learned from COVID-19 can help improve the response to future public health emergencies. Methods A web-based survey was sent to mental health focal points in 55 African countries. The survey assessed the perceived degree of implementation of the Inter-Agency Standing Committee (IASC) “14 Globally Recommended Activities” for mental health response to COVID-19. This was followed by in-depth interviews to explore barriers and enablers to mental health integration into the COVID-19 response. Results Responses were received from 28 countries. Lack of political will, poor funding, limited human resources, and weak pre-existing mental health systems were the key challenges in addressing mental health needs during COVID-19. Participants highlighted the need to capitalize on the increased attention to mental health during COVID-19 to support its integration into the emergency preparedness and response plans and strengthen health systems in the longer term. They have also stressed the importance of sustaining and strengthening the new partnerships and service delivery models that emerged during the COVID-19 pandemic. Conclusions The number of recommended mental health activities implemented during the COVID-19 pandemic varied considerably across African countries. Several factors limit mental health integration into emergency response. However, there are signs of optimism, as mental health gained some attention during COVID-19, which can be built on to integrate mental health into emergency response and strengthen health systems in the long term. Key messages • Capitalize on the increased attention to mental health during COVID-19 to support its integration into the emergency preparedness and response plans and strengthen health systems in the long term. • Sustain and strengthen the new partnerships and service delivery models that emerged during the COVID-19 pandemic.

RISK OF CANNULA-SITE INFECTION FOR BEDSIDE PERCUTANEOUS CANNULATIONS PERFORMED BY INTENSIVISTS: A RETROSPECTIVE, SINGLE-INSTITUTION CASE SERIES

SESSION TITLE: Not the Normal Host: Infections Still Matter SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Utilization of ECMO support for refractory cardiogenic, and respiratory failure has increased exponentially over the last 20 years. The advent of miniaturized and portable machines has led to a shift of cannulation strategies in the operating room/cath lab to the bedside. Transitioning to bedside cannulation has been previously reported as safe, with minimal risk for mortality or catheter site infections. However, bedside cannulations in the critically ill crashing patient raises concern for sterility. The aim of this study was to assess the risk of ECMO cannula site infections in bedside vs operating room/catheterization suite. METHODS: It is a retrospective single institution case series review of 52 adult and pediatric patients who were required either Veno-Venous (VV) or Veno-Arterial (VA) ECMO. Data gathering was used to quantify the rate of catheter site infections after initiation of extracorporeal support. Catheter site infections were defined as localized erythema, fluctuance, or purulence from the cannula site within 7 days of of ECMO cannula placement. RESULTS: A total of 42 (81%) pts had bedside cannulation, and the other 10 (19%), were done in IR suite/cath lab. The total number of catheter site infections was 1 (2.4%) in the bedside cannulation group. There were no infections in the non-bedside cannulation groups. 13 (30%) of the bedside cannulations, and 3 (30%) of the non-bedside cannulation group were on antibiotics during or prior to cannula insertion. CONCLUSIONS: Current literature suggests that the prevalence of infections on ECMO is 10-12%,. Traditionally, this has predisposed most cannulations to be performed in the surgical setting rather than at bedside. During the recent COVID pandemic, the frequency of bedside cannulation for ECMO had increased and was not associated with significant morbidity, and mortality. The risk of infection from the catheter site had also been determined to be minimal to none. From the data gathered above, it can be safely assumed that the risk of catheter site infection with bedside cannulation is minimal. However, the major contributing factor to decreased infection risk appears to be meticulous cannula site nursing care. The current ECMO nursing protocol utilized at our hospital required twice daily dressing changes with stringent chlorhexidine cleanses prior to redressing. The only case of catheter site infection we experienced was when this protocol was deviated. CLINICAL IMPLICATIONS: Utilizations of bedside ECMO cannulation techniques carries minimal risk for catheter site infections. It is important to state that nursing driven protocols for cannula site dressing changes, has one of the biggest implications on the risk of catheter site infections. Therefore, with the employment of appropriate nursing protocols, the concern for catheter site infections should not preclude the decision to proceed with bedside cannulation. DISCLOSURES: No relevant relationships by Ajit Alexander No relevant relationships by Melodie Blackmon Scientific Medical Advisor relationship with ALung Technologies, Inc. Please note: $5001 - $20000 by Steven Conrad, value=Consulting fee No relevant relationships by ANIBAL DOMINGUEZ no disclosure on file for Jonathan Eaton;No relevant relationships by Laurie Grier No relevant relationships by Rajkamal Hansra No relevant relationships by Prathik Krishnan No relevant relationships by Nathaniel LSUHSC-Shreveport No relevant relationships by Alex Manuel No relevant relationships by Jonathan Packer No relevant relationships by arunima sharma no disclosure on file for Chris Trosclair;No relevant relationships by Gregory Vo No relevant relationships by Robert Walter

Development of an Inter-hospital transfer network for patients requiring extracorporeal membrane oxygenation during the COVID-19 Pandemic

Extracorporeal membrane oxygenation (ECMO) is a life-saving treatment modality for patients with severe respiratory and cardiac failure. During the COVID-19 pandemic, the ability to utilize this service worldwide was limited by the number of facilities capable of providing ECMO support and their patient capacity. We describe an institution rapidly deploying an ECMO transport program to improve access to this service and optimize its capacity. As the only ELSO Center of Excellence in the state of Louisiana, and one of the few facilities that can provide this service in the state, our center had an obligation to expand our ability to provide access to ECMO support in our region. However, as we had not performed ECMO transport before the pandemic, we were faced with challenges in developing the infrastructure for a transport program. Due to limited resources and our emphasis on treating the maximum number of patients, we had to create and implement protocols simultaneously, refining them as we went. We relied on programs that had previously developed transport protocols and procedures for guidance, adapting their templates for our program's specific characteristics. Less than one month after obtaining our first CardiohelpTM system we performed our first ECMO transport by air. Over the next twelve months, we performed more than ten transports by air and ground successfully with no mortalities or complications during transport. Despite various obstacles, we succeeded in creating a transport service and improved our ability to provide ECMO support to patients throughout the state of Louisiana.

Reducing stigma and discrimination associated with COVID-19: early stage pandemic rapid review and practical recommendations.

AIMS: To develop recommendations for strategies and interventions to reduce stigma and discrimination related to coronavirus disease 2019 (COVID-19), through reviewing and synthesising evidence in relation to COVID-19 and other disease outbreaks and infectious/stigmatised conditions from systematic reviews and primary studies and recommendations from additional materials. METHODS: Rapid review, drawing on the World Health Organization's (WHO) methodology for developing interim guidelines during health emergencies. PubMed/MEDLINE, PsycINFO, Cochrane Central and Campbell Collaboration searched up to mid-April 2020. Searches were supplemented by reference-searching and expert recommendations. Searches were designed to identify: (1) systematic reviews (<10 years), or (2) primary intervention studies (no date limit) reporting evidence on anti-stigma interventions (in relation to COVID-19 or other infectious/stigmatised conditions) or (3) additional relevant materials. Data were extracted on population, intervention, outcome and results. These data were compiled into evidence summary tables and narrative overviews. Recommendations on strategies for COVID-19 stigma-reduction were developed using the WHO 'Evidence to Decision' framework approach. The review protocol was registered with PROSPERO (registration ID: CRD42020177677). RESULTS: The searches identified a total of 4150 potentially relevant records, from which 12 systematic reviews and 29 additional articles were included. Overarching considerations and specific recommendations focus on: (1) language/words used in relation to COVID-19 and affected people; (2) media/journalistic practices; (3) public health interventions; (4) targeted public health interventions for key groups and (5) involving communities and key stakeholders. CONCLUSIONS: These recommendations represent the first consolidated evidence-based guidance on stigma and discrimination reduction in relation to COVID-19. Mitigating the impact of stigma is critical in reducing distress and negative experiences, and strengthening communities' resolve to work together during exceptional circumstances. Ultimately, reducing stigma helps addressing structural inequalities that drive marginalisation and exacerbate both health risks and the impact of stigma. Administrations and decision makers are urged to consider integrating these recommendations into the ongoing COVID-19 response.

Stories from the Field: Mapping Innovation in Mental Health During the COVID-19 Pandemic

The COVID-19 pandemic has raised significant concerns for individual and population mental health. Physical health consequences of the virus, public health prevention measures and economic slowdown negatively impact mental health and pose challenges for the continuation of mental health services. To learn how healthcare workers responded to these difficulties, the Mental Health Innovation Network in collaboration with the World Health Organization Department of Mental Health and Substance Use launched a global call for stories from healthcare workers. Published submissions highlighted innovations and adaptations in mental health support, representing a range of geographical regions, resource settings and target populations. This article summarises key lessons learnt and recommendations from the project, including (1) promote access to basic needs, (2) prioritise care for vulnerable groups and people with severe mental health conditions, (3) support staff mental health, especially frontline health workers, (4) engage hard-to-reach groups through informal communication channels and collaboration with caregivers and (5) support central decision-making mechanisms and cross-sectoral coordination. Using case study examples from the submissions, this field report aims to inform and inspire mental health and psychosocial support providers striving to continue services during the pandemic.

Wellbeing and mental health during the COVID-19 outbreak

Acknowledging distress is often the first step to recovery. By recognising this - and putting simple measures in place to support the population, patients and staff members - health services can contribute to greater resilience and capacity to recover following major epidemics and other emergencies. © 2020, International Centre for Eye Health.