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1.
J Bioeth Inq ; 2022 May 06.
Article in English | MEDLINE | ID: covidwho-1820983

ABSTRACT

Meat is a multi-billion-dollar industry that relies on people performing risky physical work inside meat-processing facilities over long shifts in close proximity. These workers are socially disempowered, and many are members of groups beset by historic and ongoing structural discrimination. The combination of working conditions and worker characteristics facilitate the spread of SARS-CoV-2, the virus that causes COVID-19. Workers have been expected to put their health and lives at risk during the pandemic because of government and industry pressures to keep this "essential industry" producing. Numerous interventions can significantly reduce the risks to workers and their communities; however, the industry's implementation has been sporadic and inconsistent. With a focus on the U.S. context, this paper offers an ethical framework for infection prevention and control recommendations grounded in public health values of health and safety, interdependence and solidarity, and health equity and justice, with particular attention to considerations of reciprocity, equitable burden sharing, harm reduction, and health promotion. Meat-processing workers are owed an approach that protects their health relative to the risks of harms to them, their families, and their communities. Sacrifices from businesses benefitting financially from essential industry status are ethically warranted and should acknowledge the risks assumed by workers in the context of existing structural inequities.

3.
Infect Control Hosp Epidemiol ; : 1-33, 2022 Feb 22.
Article in English | MEDLINE | ID: covidwho-1705783

ABSTRACT

OBJECTIVE: In response to the 2014-2016 West Africa Ebola virus disease (EVD) epidemic, the Centers for Disease Control and Prevention (CDC) designated 56 US hospitals as Ebola treatment centers (ETCs) with high-level isolation capabilities. We aimed to determine ongoing sustainability of ETCs and identify how ETC capabilities have impacted hospital, local, and regional COVID-19 readiness and response. DESIGN: An electronic survey included both qualitative and quantitative questions and was structured into two sections: operational sustainability and role in the COVID-19 response. SETTING AND PARTICIPANTS: The survey was distributed to site representatives from the 56 originally designated ETCs; 37 (66%) responded. METHODS: Data were coded and analyzed using descriptive statistics. RESULTS: Of the 37 responding ETCs, 33 (89%) reported they were still operating while 4 had decommissioned. ETCs that maintain high-level isolation capabilities incurred a mean of $234,367 in expenses per year. All but one ETC reported that existing capabilities (e.g., trained staff, infrastructure) before COVID-19 positively affected their hospital, local, and regional COVID-19 readiness and response (e.g., ETCs trained staff, donated supplies, and shared developed protocols). CONCLUSIONS: Existing high-level isolation capabilities and expertise developed following the 2014-2016 EVD epidemic were leveraged by ETCs to assist hospital-wide readiness for COVID-19 and support response for other local and regional hospitals However, ETCs face continued challenges in sustaining those capabilities for high-consequence infectious diseases.

4.
J Occup Environ Hyg ; 19(3): 129-138, 2022 03.
Article in English | MEDLINE | ID: covidwho-1619792

ABSTRACT

With the increasing number of highly infectious disease incidents, outbreaks, and pandemics in our society (e.g., Ebola virus disease, Lassa fever, coronavirus diseases), the need for consensus and best practices on highly infectious decedent management is critical. In January 2020, a workshop of subject matter experts from across the world convened to discuss highly infectious live patient transport and highly infectious decedent management best practices. This commentary focuses on the highly infectious decedent management component of the workshop. The absence of guidance or disparate guidance on highly infectious decedent management can increase occupational safety and health risks for death care sector workers. To address this issue, the authorship presents these consensus recommendations on best practices in highly infectious decedent management, including discussion of what is considered a highly infectious decedent; scalability and storage for casualty events; integration of key stakeholders; infection control and facility considerations; transport; care and autopsy; psychological, ethical, and cultural considerations as well as multi-national care perspectives. These consensus recommendations are not intended to be exhaustive but rather to underscore this overlooked area and serve as a starting point for much-needed conversations.


Subject(s)
Communicable Diseases , Hemorrhagic Fever, Ebola , Communicable Diseases/epidemiology , Consensus , Humans , Infection Control , Pandemics/prevention & control
5.
Infect Control Hosp Epidemiol ; 42(11): 1307-1312, 2021 11.
Article in English | MEDLINE | ID: covidwho-1574178

ABSTRACT

OBJECTIVE: In response to the 2013-2016 Ebola virus disease outbreak, the US government designated certain healthcare institutions as Ebola treatment centers (ETCs) to better prepare for future emerging infectious disease outbreaks. This study investigated ETC experiences and critical care policies for patients with viral hemorrhagic fever (VHF). DESIGN: A 58-item questionnaire elicited information on policies for 9 critical care interventions, factors that limited care provision, and innovations developed to deliver care. SETTING AND PARTICIPANTS: The questionnaire was sent to 82 ETCs. METHODS: We analyzed ordinal and categorical data pertaining to the ETC characteristics and descriptive data about their policies and perceived challenges. Statistical analyses assessed whether ETCs with experience caring for VHF patients were more likely to have critical care policies than those that did not. RESULTS: Of the 27 ETCs who responded, 17 (63%) were included. Among them, 8 (47%) reported experience caring for persons under investigation or confirmed cases of VHF. Most felt ready to provide intubation, chest compressions, and renal replacement therapy to these patients. The factors most cited for limiting care were staff safety and clinical futility. Innovations developed to better provide care included increased simulation training and alternative technologies for procedures and communication. CONCLUSIONS: There were broad similarities in critical care policies and limitations among institutions. There were several interventions, namely ECMO and cricothyrotomy, which few institutions felt ready to provide. Future studies could identify obstacles to providing these interventions and explore policy changes after increased experience with novel infectious diseases, such as COVID-19.


Subject(s)
COVID-19 , Hemorrhagic Fever, Ebola , Critical Illness , Disease Outbreaks , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/therapy , Humans , Organizational Policy , SARS-CoV-2
6.
Workplace Health Saf ; 70(1): 31-36, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1370933

ABSTRACT

BACKGROUND: Historically, health care workers (HCWs) have exhibited marginal adherence to proper N95 respirator use. During the COVID-19 pandemic, HCWs with little to no prior training on N95 respirator use are relying on N95s as their primary respiratory protection. There is a need for simple, effective, and easily implementable just-in-time training (JITT) interventions to improve N95 respirator-related safety behavior. This study investigated two JITT interventions. METHODS: A pilot experimental pretest posttest study design was used to evaluate two training interventions for N95 respirator donning/doffing performance at a Midwestern hospital system. HCW participants were randomly assigned to an intervention: one used a 4-minute instructional video alone, while the other used the same video but added a video reflection intervention (participant watched and scored a video of their own performance). All performances were scored using a 10-point Critical Safety Behavior Scoring Tool (CSBST). FINDINGS: Sixty-two HCWs participated (32 video alone, 30 video reflection). The two groups' CSBST scores were not significantly different at pretest. Averaged participant scores on the CSBST improved immediately following both interventions. Scores were significantly higher on the posttest for the reflective practice intervention (p<.05). Years of experience and frequency of N95 respirator use did not predict pre or post scores. CONCLUSIONS/APPLICATIONS TO PRACTICE: We provide evidence to support the use of a time-efficient JITT intervention to improve HCW N95 respirator donning/doffing practices during the COVID-19 pandemic and beyond. Hospital safety professionals should consider this type of training for HCWs required to wear respiratory protection.


Subject(s)
COVID-19 , Respiratory Protective Devices , Health Personnel , Humans , N95 Respirators , Pandemics , SARS-CoV-2
7.
J Occup Environ Hyg ; 18(9): 430-435, 2021 09.
Article in English | MEDLINE | ID: covidwho-1354224

ABSTRACT

Personal protective equipment used by healthcare workers to mitigate disease transmission risks while caring for patients with high-consequence infectious diseases can impair normal body cooling mechanisms and exacerbate physiological strain. Symptoms of heat strain (e.g., cognitive impairment, confusion, muscle cramping) are especially harmful in the high-risk environment of high-consequence infectious disease care. In this pilot study, the core body temperatures of healthcare workers were assessed using an ingestible, wireless-transmission thermometer while performing patient care tasks common to a high-level isolation unit setting in powered air purifying respirator (PAPR)-level. The objective was to determine the potential for occupational health hazard due to heat stress in an environmentally controlled unit. Maximum core temperatures of the six participants ranged from 37.4 °C (99.3 °F) to 39.9 °C (103.8°F) during the 4-hr shift; core temperatures of half (n = 3) of the participants exceeded 38.5 °C (101.3 °F), the upper core temperature limit. Future investigations are needed to identify other heat stress risks both in and outside of controlled units. The ongoing COVID-19 pandemic offers unique opportunities for field-based research on risks of heat stress related to personal protective equipment in healthcare workers that can lead to both short- and long-term innovations in this field.


Subject(s)
Body Temperature/physiology , COVID-19/epidemiology , Heat Stress Disorders/etiology , Patient Isolation , Personal Protective Equipment/adverse effects , Adult , Body Mass Index , Female , Health Personnel , Humans , Male , Middle Aged , Occupational Health , Pandemics , Pilot Projects , SARS-CoV-2
8.
Clin Infect Dis ; 74(4): 729-733, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1328915

ABSTRACT

Emerging infectious disease epidemics require a rapid response from health systems; however, evidence-based consensus guidelines are generally absent early in the course of events. Formed in 2017 by 5 high-level isolation units spanning 3 continents, the experience of the Global Infectious Disease Preparedness Network (GIDPN) early in the course of coronavirus disease 2019 (COVID-19) provides a model for accelerating best practice development and improving decision-making in health emergencies. The network served as a platform for real-time, open and transparent information-sharing during unknowns of an active outbreak by clinicians caring for patients, by researchers conducting clinical trials and transmission and infection prevention studies, and by teams advising local and national policy makers. Shared knowledge led to earlier adoption of some treatment modalities as compared to most peer institutions and to implementation of protocols prior to incorporation into national guidelines. GIDPN and similar networks are integral in enhancing preparedness for and response to future epidemics/pandemics.


Subject(s)
COVID-19 , Communicable Diseases , Communicable Diseases/epidemiology , Communicable Diseases/therapy , Decision Making , Humans , Pandemics/prevention & control , SARS-CoV-2
9.
Journal of Environmental Health ; 84(1):16-25, 2021.
Article in English | CINAHL | ID: covidwho-1281159

ABSTRACT

The meatpacking industry has faced significant challenges in maintaining a safe and healthy working environment for its employees during the COVID-19 pandemic, which has resulted in worker illness and death, temporary closures of facilities, reductions in production capacity, and consequences throughout the supply chain. We sought to explore the concerns and perceptions of COVID-19 among meatpacking workers in the Midwestern part of the U.S. We conducted an online survey of meatpacking workers in Nebraska, Iowa, Kansas, and Missouri between May 7 and 25, 2020. A total of 585 workers participated (M = 41.3 years, SD = 10.3). More than 72% of workers believed that they were at "high risk" for contracting COVID-19, but less than one half had been tested (42%). Most workers (83%) reported that their employer had instituted some safety measures, but less than one half reported physical distancing on the line (39%), slowing down the line (34%), additional paid time off (28%), or restructuring of shifts (20%). Enforceable standards are needed in the meatpacking industry to reduce COVID-19 transmission. Culturally and linguistically tailored education, paid sick leave, and restructuring of work can reduce the risks of COVID-19 transmission. Transparency on workplace transmission rates is essential to developing strategies to mitigate occupational risks and foster worker trust.

10.
J Agromedicine ; 25(4): 378-382, 2020 10.
Article in English | MEDLINE | ID: covidwho-1174763

ABSTRACT

From the farms to the packing plants, essential workers in critical food production industries keep food on our tables while risking their and their families' health and well-being to bring home a paycheck. They work in essential industries but are often invisible. The disparities illuminated by COVID-19 are not new. Instead, they are the result of years of inequities built into practices, policies, and systems that reinforce societal power structures. As a society, we are now at an antagonizing moment where we can change our collective trajectory to focus forward and promote equity and justice for workers in agriculture and food-related industries. To that end, we describe our experience and approach in addressing COVID-19 outbreaks in meat processing facilities, which included three pillars of action based on public health ethics and international human rights: (1) worksite prevention and control, (2) community-based prevention and control, and (3) treatment. Our approach can be translated to promote the health, safety, and well-being of the broader agricultural workforce.


Subject(s)
COVID-19/psychology , Farmers/psychology , Meat-Packing Industry/statistics & numerical data , Occupational Health , Animals , COVID-19/epidemiology , Farmers/statistics & numerical data , Food Supply , Human Rights , Humans , Public Health/statistics & numerical data
11.
Emerg Infect Dis ; 27(4): 1032-1038, 2021 04.
Article in English | MEDLINE | ID: covidwho-1085129

ABSTRACT

The coronavirus disease (COVID-19) pandemic has severely impacted the meat processing industry in the United States. We sought to detail demographics and outcomes of severe acute respiratory syndrome coronavirus 2 infections among workers in Nebraska meat processing facilities and determine the effects of initiating universal mask policies and installing physical barriers at 13 meat processing facilities. During April 1-July 31, 2020, COVID-19 was diagnosed in 5,002 Nebraska meat processing workers (attack rate 19%). After initiating both universal masking and physical barrier interventions, 8/13 facilities showed a statistically significant reduction in COVID-19 incidence in <10 days. Characteristics and incidence of confirmed cases aligned with many nationwide trends becoming apparent during this pandemic: specifically, high attack rates among meat processing industry workers, disproportionately high risk of adverse outcomes among ethnic and racial minority groups and men, and effectiveness of using multiple prevention and control interventions to reduce disease transmission.


Subject(s)
COVID-19 , Disease Transmission, Infectious/prevention & control , Food-Processing Industry , Infection Control , Meat-Packing Industry , Adult , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Female , Food-Processing Industry/methods , Food-Processing Industry/organization & administration , Food-Processing Industry/trends , Humans , Incidence , Infection Control/instrumentation , Infection Control/methods , Infection Control/organization & administration , Male , Meat-Packing Industry/methods , Meat-Packing Industry/organization & administration , Meat-Packing Industry/trends , Minority Health/statistics & numerical data , Nebraska/epidemiology , Occupational Health/standards , Outcome Assessment, Health Care , Personal Protective Equipment/standards , Risk Assessment , SARS-CoV-2/isolation & purification , Workplace/standards
12.
J Emerg Nurs ; 46(6): 932-940, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-831171

ABSTRACT

INTRODUCTION: Efficient identification and isolation of patients with communicable diseases limits exposure to health care workers, other patients, and visitors. In August 2014, our team developed and implemented an algorithm to triage suspected cases of Ebola virus disease in a midwestern United States emergency department and outpatient clinics based on patient travel history and symptoms. Here, we present the lessons learned and modifications to update the tool. METHODS: Two strategies were developed and utilized to properly identify, isolate, and inform on patients with suspected highly hazardous communicable diseases: 1) a robust electronic symptom and travel screen with decision support tools in the electronic medical record, and 2) the availability of workflow protocols for Ebola virus disease, Middle East Respiratory Syndrome (MERS), and coronavirus 2019 (COVID-19) once a person under investigation is identified. After action reports provided opportunities to modify the algorithm and improve the identification and isolation processes. RESULTS: Since our screening and travel electronic medical record inception 5 years ago, modifications changed iteratively to further enhance the screening process. Since 2018, staff have identified 5 patients at risk for MERS; in all cases, identification occurred during the check-in process. Exposure investigations in the emergency department decreased significantly after algorithm implementation in January 2019, from 30 in 2018 to 0 in 2019. DISCUSSION: Although highly hazardous communicable diseases like Ebola virus disease and MERS are of concern due to their mortality rates and limited treatment options, these same concepts may be applied to the early identification and isolation of patients suspected of having more common communicable diseases like measles and influenza, emphasizing the importance of protocol-based screening in the healthcare environment.


Subject(s)
Coronavirus Infections/prevention & control , Electronic Health Records , Emergency Nursing/methods , Hemorrhagic Fever, Ebola/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Travel/statistics & numerical data , Triage/methods , Betacoronavirus , COVID-19 , Decision Support Techniques , Emergency Service, Hospital , Humans , Infection Control/methods , Midwestern United States , Patient Isolation/methods , SARS-CoV-2
13.
Am J Infect Control ; 48(8): 869-874, 2020 08.
Article in English | MEDLINE | ID: covidwho-232501

ABSTRACT

BACKGROUND: The N95 respirator is the most common safety tool used in hospitals to protect health care workers (HCW) from inhaling airborne particles. Focusing on HCW behavior related to respirator use is an effective route to improve HCW safety and respiratory health. METHODS: Participants were asked to perform the donning and doffing of an N95 respirator to camera. Then they were randomized to a video alone or a reflective practice intervention. After the intervention they repeated the donning and doffing to camera. A critical safety behavior scoring tool (CSBST) was developed to compare the performance of the participants over time at pretest, post-test and 1 month later for follow-up. RESULTS: The reflective practice intervention group was found to have significantly higher scores on the CSBST at post-test and follow-up than the video alone group. In the reflective practice intervention group, the participants perceived they were better at performing the N95 donning and doffing than the experts scored them. CONCLUSIONS: The CSBST is a tool to measure the performance of HCWs on a specific targeted safety behaviors. The addition of a reflective practice intervention may result in a measurable and sustained improvement in the safety behaviors demonstrated when using the N95 respirator.


Subject(s)
Respiratory Protective Devices , Health Personnel , Humans , Ventilators, Mechanical
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