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1.
Universal Access in the Information Society ; 2022.
Article in English | PMC | ID: covidwho-1797608

ABSTRACT

Digital resources—which include devices, internet connection and digital literacy—have become basic needs. Thus with the global COVID-19 pandemic having accelerated digitalization, the urgency for universal digital inclusion has hastened. Otherwise, digital inequality will lead to social inequality and impede social mobility. Using Singapore as a case study, this article applies the insights learned from a participatory action research to recommend a policy framework for universal digital access, with practical humanistic steps towards full digital inclusion. Singapore is a digitally advanced nation with almost universal digital availability, yet when COVID-19 forced rapid digital adoption, gaps in access by vulnerable groups such as low-income households, elderly and migrant workers were found. From the learning points on gaps and measures taken by community groups, volunteers and policy-makers in our research, we recommend making access to all three digital resources automatic and affordable, with an undergirding principle to implement technology among the most digitally excluded first before national roll out. A public-community-corporate funding and partnership model is also proposed to sustain universal provision.

2.
Australas Psychiatry ; 30(2): 212-222, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1741845

ABSTRACT

OBJECTIVE: This longitudinal study examined changes in psychological outcomes of perioperative frontline healthcare workers at one of Australia's most COVID-19 affected hospitals, following the surge and decline of a pandemic wave. METHOD: A single-centred longitudinal online survey was conducted between 26 May and 17 November 2020. Recruitment was via poster advertisement and email invitation. The survey was sent out every 4 weeks, resulting in seven time-points. RESULTS: In total, 385 survey results were analysed from 193 staff (about 64% response rate), 72 (37%) of whom completed the survey more than once. The prevalence of moderate-to-severe anxiety and depressive symptoms peaked at 27% and 25%, respectively, during the pandemic surge. Up to 35% displayed post-traumatic stress disorder (PTSD) symptoms. Although not statistically significant, the trend of depressive and PTSD symptoms worsened over time, especially among females and anaesthetic/surgical trainees, despite subsidence of the pandemic curve. Technicians and anaesthetic/scrub nurses were the at-risk groups with worst psychological outcomes. CONCLUSION: We found persistent mental health impacts on frontline perioperative HCWs despite subsidence of the pandemic wave. Further research is needed to determine the extent and trajectory of such impacts with larger sample sizes to determine generalisability to frontline HCWs in general.


Subject(s)
COVID-19 , Pandemics , Australia/epidemiology , Delivery of Health Care , Depression/epidemiology , Female , Health Personnel/psychology , Hospitals, Public , Humans , Longitudinal Studies , SARS-CoV-2
3.
Infect Dis Health ; 2022 Feb 10.
Article in English | MEDLINE | ID: covidwho-1676751

ABSTRACT

BACKGROUND: Facial hair under a tight fitting P2/N95 respirator diminishes respiratory protection. There is limited guidance with respect to the threshold to be clean shaven in readiness to wear N95 respirators. METHODS: We performed a cross sectional audit in late August 2021 to observe whether staff had facial hair that could decrease respiratory protection of tight fitting respirators. The audit was conducted in three critical care areas at a major tertiary public hospital in Australia during a period of moderate-to-high community prevalence of COVID-19. All staff observed had previously successfully completed quantitative fit testing with a clean shaven face in the preceding 12 months. RESULTS: 110 consecutive male critical care staff were observed including thirty staff who were required to wear a N95/P2 respirator at the time. Forty - five percent of male staff observed were not clean shaven in the face seal zone of their respirators. CONCLUSIONS: The readiness to wear a tight-fitting respirator and hence the need to be clean shaven, should be guided by both state and local COVID-19 risk ratings, as well as the specific respiratory biohazard risks present in the clinical area at that time. During periods of significant community transmission of COVID-19, critical care clinical staff should be clean shaven, so they are fit-for-purpose and ready to wear a tight fitting respirator at short notice. Respiratory protection preparedness in critical care healthcare workers: An observational audit of facial hair at a major tertiary hospital in Australia.

4.
ACORN ; 34(4):E12-E18,S1-S3, 2021.
Article in English | ProQuest Central | ID: covidwho-1529356

ABSTRACT

The COVID-19 pandemic presents significant concerns surrounding the risk of transmission to health care workers involved in airway management of patients with suspected or known infection. Limited evidence has been available to guide the preparation of staff, intubation environments, team structure and personal protective equipment. Our study invited Victorian hospitals to complete a survey on their airway management practices and protocols, in order to assess the degree of variability in practice and preparedness. Twenty hospitals responded in September 2020, during Victoria's second wave of COVID-19. Forty percent had dedicated COVID-19 intubation teams, aLL including consultant anaesthetists. Seventy-five percent had negatively pressured dedicated intubation rooms. ALL provided airborne precautions including N95 masks for airway and cardiac arrest management of suspected or confirmed COVID-19 positive patients, with 35 per cent providing N95 mask fit testing and 15 per cent providing powered air purifying respirators or elastomeric respirators. Thirty-five percent provided airborne precautions for cardiac arrest management of patients not suspected to be COVID-19 positive. Significant inter-hospitaL variations were reported in airway management practices, such as preoxygenation, bag-mask ventilation, medications and techniques to minimise aerosoLisation. Although some of this variation was Likely due to individual hospital infrastructure and resource Limitations, it would be ideaL to achieve a more consistent, standardised approach across Victorian hospitals. This study may highlight areas for improvement for some hospitals. These areas for improvement may include consideration of the establishment of COVID-19 intubation teams in at Least major metropolitan hospitals, N95 mask fit testing and the use of airborne precautions for cardiac arrest management during times of increased community prevalence of COVID-19.

5.
JMIR Perioper Med ; 4(2): e27166, 2021 Sep 29.
Article in English | MEDLINE | ID: covidwho-1443950

ABSTRACT

BACKGROUND: The rapid spread of the novel coronavirus (COVID-19) has presented immeasurable challenges to health care workers who remain at the frontline of the pandemic. A rapidly evolving body of literature has quantitatively demonstrated significant psychological impacts of the pandemic on health care workers. However, little is known about the lived experience of the pandemic for frontline medical staff. OBJECTIVE: This study aimed to explore the qualitative experience of perioperative staff from a large trauma hospital in Melbourne, Australia. METHODS: Inductive thematic analysis using a critical realist approach was used to analyze data from 9 semistructured interviews. RESULTS: Four key themes were identified. Hospital preparedness related to the perceived readiness of the hospital to respond to the pandemic and encompassed key subthemes around communication of policy changes, team leadership, and resource availability. Perceptions of readiness contributed to the perceived psychological impacts of the pandemic, which were highly varied and ranged from anger to anxiety. A number of coping strategies were identified in response to psychological impacts which incorporated both internal and external coping mechanisms. Finally, adaptation with time reflected change and growth over time, and encompassed all other themes. CONCLUSIONS: While frontline staff and hospitals have rapidly marshalled a response to managing the virus, relatively less consideration was seen regarding staff mental health in our study. Findings highlight the vulnerability of health care workers in response to the pandemic and reinforce the need for a coordinated approach to managing mental health.

6.
ACORN ; 34(3):E42-E45,S1, 2021.
Article in English | ProQuest Central | ID: covidwho-1411269

ABSTRACT

In the era of the COVID-19 pandemic, the avoidance of aerosol generating procedures (AGPs) is paramount to reduce the risk of viral transmission to staff and other patients. Perioperative management of a new tracheostomy is challenging as routine care, such as suctioning, frequently involves AGPs. We developed and implemented an apparatus called the heat and moisture exchanger (HME) filter-protected open circuit. This enabled closed suctioning to be performed and allowed spontaneously breathing patients to be managed with an open circuit in a shared environment while reducing the risk of viral aerosolisation. We performed a prospective observational study of 20 cases, recording the incidence of desaturation (<90%), apparatus disconnection, apparatus dislodgement and apparatus replacement. The ease of use of the apparatus for recovery nursing staff and patient comfort were measured on a Likert scale. There were no incidents of desaturation. There were two circuit disconnections. Apparatus replacement with an alternate circuit was not required for any patient. Most recovery nursing staff agreed or strongly agreed that the apparatus was easy to use and that the apparatus bulk or weight did not interfere with patient care activities. Ninety-five per cent of patients reported that their breathing was comfortable prior to discharge from the Post Anaesthesia Care Unit. In conclusion, the HME filter-protected open circuit is a relatively safe, acceptable and practical device to use for spontaneously breathing patients with newly created tracheostomies in the perioperative environment.

7.
Gen Psychiatr ; 34(5): e100577, 2021.
Article in English | MEDLINE | ID: covidwho-1405225

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had a profound and prolonged impact on healthcare services and healthcare workers. AIMS: The Australian COVID-19 Frontline Healthcare Workers Study aimed to investigate the severity and prevalence of mental health issues, as well as the social, workplace and financial disruptions experienced by Australian healthcare workers during the COVID-19 pandemic. METHODS: A nationwide, voluntary, anonymous, single timepoint, online survey was conducted between 27 August and 23 October 2020. Individuals self-identifying as frontline healthcare workers in secondary or primary care were invited to participate. Participants were recruited through health organisations, professional associations or colleges, universities, government contacts and national media. Demographics, home and work situation, health and psychological well-being data were collected. RESULTS: A total of 9518 survey responses were received; of the 9518 participants, 7846 (82.4%) participants reported complete data. With regard to age, 4110 (52.4%) participants were younger than 40 years; 6344 (80.9%) participants were women. Participants were nurses (n=3088, 39.4%), doctors (n=2436, 31.1%), allied health staff (n=1314, 16.7%) or in other roles (n=523, 6.7%). In addition, 1250 (15.9%) participants worked in primary care. Objectively measured mental health symptoms were common: mild to severe anxiety (n=4694, 59.8%), moderate to severe burnout (n=5458, 70.9%) and mild to severe depression (n=4495, 57.3%). Participants were highly resilient (mean (SD)=3.2 (0.66)). Predictors for worse outcomes on all scales included female gender; younger age; pre-existing psychiatric condition; experiencing relationship problems; nursing, allied health or other roles; frontline area; being worried about being blamed by colleagues and working with patients with COVID-19. CONCLUSIONS: The COVID-19 pandemic is associated with significant mental health symptoms in frontline healthcare workers. Crisis preparedness together with policies and practices addressing psychological well-being are needed.

8.
Gen Hosp Psychiatry ; 72: 124-130, 2021.
Article in English | MEDLINE | ID: covidwho-1364025

ABSTRACT

OBJECTIVES: The Australian COVID-19 Frontline Healthcare Workers Study investigated coping strategies and help-seeking behaviours, and their relationship to mental health symptoms experienced by Australian healthcare workers (HCWs) during the COVID-19 pandemic. METHODS: Australian HCWs were invited to participate a nationwide, voluntary, anonymous, single time-point, online survey between 27th August and 23rd October 2020. Complete responses on demographics, home and work situation, and measures of health and psychological wellbeing were received from 7846 participants. RESULTS: The most commonly reported adaptive coping strategies were maintaining exercise (44.9%) and social connections (31.7%). Over a quarter of HCWs (26.3%) reported increased alcohol use which was associated with a history of poor mental health and worse personal relationships. Few used psychological wellbeing apps or sought professional help; those who did were more likely to be suffering from moderate to severe symptoms of mental illness. People living in Victoria, in regional areas, and those with children at home were significantly less likely to report adaptive coping strategies. CONCLUSIONS: Personal, social, and workplace predictors of coping strategies and help-seeking behaviour during the pandemic were identified. Use of maladaptive coping strategies and low rates of professional help-seeking indicate an urgent need to understand the effectiveness of, and the barriers and enablers of accessing, different coping strategies.


Subject(s)
Adaptation, Psychological , COVID-19 , Health Personnel , Pandemics , Psychological Distress , Adult , Australia/epidemiology , COVID-19/epidemiology , COVID-19/psychology , COVID-19/therapy , Female , Health Personnel/psychology , Health Personnel/statistics & numerical data , Help-Seeking Behavior , Humans , Male , Mental Disorders/epidemiology , Middle Aged , Surveys and Questionnaires , Young Adult
9.
JMIR Perioper Med ; 4(2): e27166, 2021 Sep 29.
Article in English | MEDLINE | ID: covidwho-1341581

ABSTRACT

BACKGROUND: The rapid spread of the novel coronavirus (COVID-19) has presented immeasurable challenges to health care workers who remain at the frontline of the pandemic. A rapidly evolving body of literature has quantitatively demonstrated significant psychological impacts of the pandemic on health care workers. However, little is known about the lived experience of the pandemic for frontline medical staff. OBJECTIVE: This study aimed to explore the qualitative experience of perioperative staff from a large trauma hospital in Melbourne, Australia. METHODS: Inductive thematic analysis using a critical realist approach was used to analyze data from 9 semistructured interviews. RESULTS: Four key themes were identified. Hospital preparedness related to the perceived readiness of the hospital to respond to the pandemic and encompassed key subthemes around communication of policy changes, team leadership, and resource availability. Perceptions of readiness contributed to the perceived psychological impacts of the pandemic, which were highly varied and ranged from anger to anxiety. A number of coping strategies were identified in response to psychological impacts which incorporated both internal and external coping mechanisms. Finally, adaptation with time reflected change and growth over time, and encompassed all other themes. CONCLUSIONS: While frontline staff and hospitals have rapidly marshalled a response to managing the virus, relatively less consideration was seen regarding staff mental health in our study. Findings highlight the vulnerability of health care workers in response to the pandemic and reinforce the need for a coordinated approach to managing mental health.

11.
Anaesth Intensive Care ; 49(2): 112-118, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1255771

ABSTRACT

N95 particulate respirator masks are currently recommended for all healthcare workers who care for patients with suspected or confirmed coronavirus disease (COVID-19) when performing aerosol-generating procedures. The protection provided by N95 particulate respirator masks is dependent on the filter's efficiency and seal quality. In this prospective randomised crossover study, we conducted the user seal check and the quantitative fit test on two readily available duckbill models of N95 masks, the Halyard Fluidshield® N95 (Halyard, Alpharetta, GA, USA) and the BSN Medical ProShield® N-95 (BSN Medical, Mount Waverley, Victoria) particulate respirator masks. We recruited a total of 96 anaesthetic staff, of whom 26% were of South-East Asian ethnicity. We found that both types of masks provided reasonably high fit test pass rates among our participants and there was no significant difference between the two brands (77% for the Fluidshield and 65% for the ProShield, P = 0.916). Ninety-two percent of the participants could find at least one well-fitted mask among these two types of masks. We also demonstrated that the user seal check had low accuracy and low concordance (kappa coefficient of 0.16 for the Fluidshield and 0.08 for the ProShield) when compared to the quantitative fit test, and hence was not a reliable method to test seal quality.


Subject(s)
COVID-19 , Occupational Exposure , Cross-Over Studies , Humans , Masks , Prospective Studies , SARS-CoV-2 , Ventilators, Mechanical
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