A New Model for a Sustainable Healthcare Supply Chain Prioritizes Patient Safety: Using the Fuzzy Delphi Method to Identify Healthcare Workers' Perspectives

The pandemic crisis and the resulting global uncertainties have obviously had a severe impact on the healthcare supply chain (HSC), leading scholars, healthcare executives, and policymakers to focus on the sustainability of the HSC. Technologies have emerged and developed rapidly in recent years, especially in the healthcare industry, for coping with the pandemic crisis and supporting the "new normal" for humankind. Within this context, various new technologies have been implemented to maximize the supply chain process, ensure patient and healthcare worker safety, and improve the quality of care. Hence, the integration of a technological dimension with the traditional three pillars of sustainability may aid in attempts to define the potential attributes of these dimensions of sustainability. Therefore, this study aimed to identify the key attributes of a sustainable healthcare supply chain (SHSC), and this paper presents a new, four-dimensional model for SHSCs, consisting of social, environmental, economic, and technological dimensions. A systematic literature review was conducted, resulting in the identification of 35 potential SHSC attributes. The Fuzzy Delphi Method (FDM) was then applied to determine the appropriateness of these potential attributes according to the consensus of 13 experts, including healthcare workers in a variety of medical specialties, who profoundly understand HSC sustainability. The results yielded 22 appropriate attributes, which were then categorized across the four dimensions. Consequently, a new model of an SHSC, which prioritizes patient safety, was constructed and is proposed here. This SHSC model can be applied strategically to the healthcare industry to enhance the safety of both medical personnel and patients in a sustainable manner.

Rigidity in crisis: The impact of OHSAS 18001 certification on production repurposing during COVID-19

It is important for firms to repurpose production responsively during a crisis such as the COVID-19 pandemic, to seize the market opportunity and create social value. However, occupational health and safety (OHS) can also be a concern in a crisis, and adherence to OHS management systems can undermine a firm's responsiveness in repurposing decision making. We adopt the "capability-rigidity" lens to construct a connection between OHS management standards (i.e., OHSAS 18001) and firms' adaptation responsiveness. After sampling 734 listed Chinese manufacturing firms, our match-based analysis reveals that firms certified with OHSAS 18001 were less responsive during COVID-19 in terms of production repurposing than those without the certification. Yet, certain experience, namely, prepandemic manufacturing of related products, experience of the severe acute respiratory syndrome (SARS) epidemic, and being geographically located close to firms that produced medical supplies, could attenuate this effect. We discuss the implications of our findings in the context of and adding to the literature on safety management, certified management standards, and organizational adaptation and learning.

The role of extracorporeal membrane oxygenation in COVID-19.

An extracorporeal membrane oxygenation (ECMO) program is an important component in the management of patients with COVID-19, but it is imperative to implement a system that is well-supported by the institution and staffed with well-trained clinicians to both optimize patient outcomes and to keep providers safe. There are many unknowns related to COVID-19, and one of the most challenging aspects for clinicians is the lack of predictive knowledge as to why some patients fail medical therapy and require advanced support such as ECMO. These factors can create challenges during a time of resource scarcity and interruptions in the supply chain. In the current environment, in which resources are limited and an ongoing pandemic, healthcare practitioners need to focus on evidence-based best practice for supportive care of patients with COVID-19 in refractory respiratory or cardiac failure. with As experience is gained, a greater understanding will develop in this cohort of patients regarding need and timing of ECMO. As this pandemic continues, it will be important to compile and analyze multicentered data pertaining to patient-specific outcomes to help guide clinicians caring for patients with COVID-19 undergoing ECMO support. In this paper, the authors demonstrate the strategies utilized by a major quaternary care center in the utilization and management of ECMO for patients with COVID-19.

Hazmat Cooling Vest Temperature Using Heat Pipe and Thermoelectric

Corona Virus (COVID-19) is a virus that is endemic almost all over the world, including Indonesia. COVID-19 was first confirmed by the World Health Organization (WHO) on December 31, 2019, in Wuhan City, Hubei Province, China, and then rapidly expanded outside of China. To suppress the Covid-19 case, medical volunteers are needed as the main actors in efforts to handle Covid-19 patients. This makes health care facilities also need to focus on the principles of health worker safety, not only focus on the principles of patient safety. This also makes health care facilities also need to focus on the principles of health worker safety, not only focus on the principles of patient safety. The use of hazmat clothes is one of the efforts to protect health workers when in contact with Covid-19 patients. Hazmat clothes are technically referred to as "encapsulated waterproof protective clothing” which is PPE that must be used for officers from the risk of contracting the Covid-19 virus through airborne droplets and contact with patients and patient body fluids. Although hazmat clothing is an important PPE for health workers to stay protected, the use of hazmat clothing for a long time often makes medical personnel feel uncomfortable when providing services. Based on the problems above, the researchers conducted a study on the heat pipe - thermoelectric hazmat suit cooling vest. This technology can absorb more heat than other methods by simply applying the principle of capillarity to the wicks on the pipe walls. schematic of testing a cooling vest on a hazmat suit. The loading on the thermoelectric is given through the DC - Power supply. The temperature data read by the sensor will be detected by the computer system using the NI 9123 and C-DAQ 9174 modules. The test results can be viewed using the NI LabView 2017 software. The temperature used in this experiment is the result of tests carried out for 30 min. Based on the tests that have been carried out, the heat pipe-based thermoelectric hazmat suit cooling vest has been able to reach the lowest thermoelectric temperature of 24,42 ∘C, which is distributed through heat pipes to body parts. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Droplet nuclei are generated during colonoscopy and are decreased by the use of carbon dioxide and water immersion technique.

OBJECTIVES: The COVID-19 pandemic has raised concerns on whether colonoscopies (CS) carry a transmission risk. The aim was to determine whether CS are aerosol-generating procedures. METHODS: This was a prospective observational trial including all patients undergoing CS at the Prince of Wales Hospital from 1 June to 31 July 2020. Three particle counters were placed 10 cm from each patient's anus and near the mouth of endoscopists and nurses. The particle counter recorded the number of particles of size 0.3, 0.5, 0.7, 1, 5, and 10 µm. Patient demographics, seniority of endoscopists, use of CO2 and water immersion technique, and air particle count (particles/cubic foot, dCF) were recorded. Multilevel modeling was used to test all the hypotheses with a post-hoc analysis. RESULTS: A total of 117 patients were recruited. During CS, the level of 5 µm and 10 µm were significantly higher than the baseline period (P = 0.002). Procedures performed by trainees had a higher level of aerosols when compared to specialists (0.3 µm, P < 0.001; 0.5 µm and 0.7 µm, P < 0.001). The use of CO2 and water immersion techniques had significantly lower aerosols generated when compared to air (CO2 : 0.3, 0.5, and 0.7 µm: P < 0.001; water immersion: 0.3 µm: P = 0.048; 0.7 µm: P = 0.03). There were no significant increases in any particle sizes during the procedure at the endoscopists' and nurses' mouth. However, 8/117 (6.83%) particle count tracings showed a simultaneous surge of all particle sizes at the patient's anus and endoscopists' and nurses' level during rectal extubation. CONCLUSION: Colonoscopy generates droplet nuclei especially during rectal extubation. The use of CO2 and water immersion techniques may mitigate these risks.

SARS-CoV-2 (COVID-19) Clinical Manifestations and Risk Factors among Healthcare Workers In Palestine

Background: Healthcare workers are the White army compacted the COVID-19 epidemic, and reports worldwide have shown an increase in SARS-CoV-2 among healthcare workers due to their direct interactions with infected patients. This study aimed to examine the clinical manifestations and risk factors for SARS-CoV-2 infection among healthcare workers in Palestine and offer recommendations to ensure health workers' safety and adopt workplace safety policies. Method(s): This questionnaire-based cross-sectional observational study was conducted using an online questionnaire to collect information about SARS-CoV-2 transmission, signs, symptoms, and treatment reported by healthcare workers. Furthermore, we explored policies, protocols, and practices that make health workers vulnerable to SARS-CoV-2 infection. Result(s): A total of 389 healthcare workers were included, 216 (55.5%) were exposed to the SARS-CoV-2 virus, 173 (44.5%) were infected with the virus, and the prevalence of hospitalization was 16%. The most commonly reported symptoms are fatigue, weakness, and muscle pain. Female healthcare workers experienced a significantly extended duration of symptoms than male workers. Direct contact (working less than 1.5 m) with suspected or confirmed COVID-19 patients and lack of COVID-19 and PPE training were risk factors for COVID-19 infection among HCWs. Conclusion(s): The healthcare system must ensure a safe work environment and adopt policies and procedures to ensure HCW safety, proper training, and resource availability to cope with crises. Copyright © 2022 Abukhalil et al.

Hazmat Cooling Vest Temperature Using Heat Pipe and Thermoelectric

Corona Virus (COVID-19) is a virus that is endemic almost all over the world, including Indonesia. COVID-19 was first confirmed by the World Health Organization (WHO) on December 31, 2019, in Wuhan City, Hubei Province, China, and then rapidly expanded outside of China. To suppress the Covid-19 case, medical volunteers are needed as the main actors in efforts to handle Covid-19 patients. This makes health care facilities also need to focus on the principles of health worker safety, not only focus on the principles of patient safety. This also makes health care facilities also need to focus on the principles of health worker safety, not only focus on the principles of patient safety. The use of hazmat clothes is one of the efforts to protect health workers when in contact with Covid-19 patients. Hazmat clothes are technically referred to as “encapsulated waterproof protective clothing” which is PPE that must be used for officers from the risk of contracting the Covid-19 virus through airborne droplets and contact with patients and patient body fluids. Although hazmat clothing is an important PPE for health workers to stay protected, the use of hazmat clothing for a long time often makes medical personnel feel uncomfortable when providing services. Based on the problems above, the researchers conducted a study on the heat pipe - thermoelectric hazmat suit cooling vest. This technology can absorb more heat than other methods by simply applying the principle of capillarity to the wicks on the pipe walls. schematic of testing a cooling vest on a hazmat suit. The loading on the thermoelectric is given through the DC - Power supply. The temperature data read by the sensor will be detected by the computer system using the NI 9123 and C-DAQ 9174 modules. The test results can be viewed using the NI LabView 2017 software. The temperature used in this experiment is the result of tests carried out for 30 min. Based on the tests that have been carried out, the heat pipe-based thermoelectric hazmat suit cooling vest has been able to reach the lowest thermoelectric temperature of 24,42 ∘C, which is distributed through heat pipes to body parts. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

The dangers of reused personal protective equipment: healthcare workers and workstation contamination.

BACKGROUND: Personal protective equipment (PPE) is essential to protect healthcare workers (HCWs). The practice of reusing PPE poses high levels of risk for accidental contamination by HCWs. Scarce medical literature compares practical means or methods for safe reuse of PPE while actively caring for patients. METHODS: In this study, observations were made of 28 experienced clinical participants performing five donning and doffing encounters while performing simulated full evaluations of patients with coronavirus disease 2019. Participants' N95 respirators were coated with a fluorescent dye to evaluate any accidental fomite transfer that occurred during PPE donning and doffing. Participants were evaluated using blacklight after each doffing encounter to evaluate new contamination sites, and were assessed for the cumulative surface area that occurred due to PPE doffing. Additionally, participants' workstations were evaluated for contamination. RESULTS: All participants experienced some contamination on their upper extremities, neck and face. The highest cumulative area of fomite transfer risk was associated with the hook and paper bag storage methods, and the least contamination occurred with the tabletop storage method. Storing a reused N95 respirator on a tabletop was found to be a safer alternative than the current recommendation of the US Centers for Disease Control and Prevention to use a paper bag for storage. All participants donning and doffing PPE were contaminated. CONCLUSION: PPE reusage practices pose an unacceptably high level of risk of accidental cross-infection contamination to healthcare workers. The current design of PPE requires complete redesign with improved engineering and usability to protect healthcare workers.

Iris: A Low-Cost Telemedicine Robot to Support Healthcare Safety and Equity During a Pandemic

The COVID-19 pandemic exacerbated problems of already overwhelmed healthcare ecosystems. The pandemic worsened long-standing health disparities and increased stress and risk of infection for frontline healthcare workers (HCWs). Telemedical robots offer great potential to both improve HCW safety and patient access to high-quality care, however, most of these systems are prohibitively expensive for under-resourced healthcare organizations, and difficult to use. In this paper, we introduce Iris, a low-cost, open hardware/open software telemedical robot platform. We co-designed Iris with front-line HCWs to be usable, accessible, robust, and well-situated within the emergency medicine (EM) ecosystem. We tested Iris with 15 EM physicians, who reported high usability, and provided detailed feedback critical to situating the robot within a range of EM care delivery contexts, including under-resourced ones. Based on these findings, we present a series of concrete design suggestions for those interested in building and deploying similar systems. We hope this will inspire future work both in the current pandemic and beyond. © 2022, ICST Institute for Computer Sciences, Social Informatics and Telecommunications Engineering.

A Deep Learning-based Predication of Fall Portents for Lone Construction Worker

As construction projects resume worldwide and workers return to the job site, the possibility of transmitting the Covid-19 could be added to the extensive list of risks confronting workers in the construction sites;thus, the workers need to work alone in an assigned activity. Many workers are already working alone in the construction sites, such as utility workers, repair technicians, teleworkers, operators, and drivers. Lone workers in construction are subjected to greater safety risks compared with those working alongside others. Considering the accidents faced by lone workers, it’s less likely that another person would be there to aid them - and if they don’t get treatment quickly enough, serious injuries might prove deadly. Currently, the construction sites depend on physical inspections to the construction sites and manual observation of video streams generated through close circuit television (CCTV). To solve this issue, this research work presents an automated deep learning-based fall detection system of a lone worker to provide information of severe situations and help the workers in their golden time. A diverse dataset of multiple scenarios having workers with the excavator, forklift, ladder, and mobile scaffold is established, and a deep learning algorithm has been trained to validate the concept. The developed system is expected to reduce the efforts being made in manual inspection, enhance the timely access of the due aid from co-workers and supervisors, which is more easily obtainable in non-lone working situations. © 2021 Proceedings of the International Symposium on Automation and Robotics in Construction. All rights reserved.

Factors Associated with an Outbreak of COVID-19 in Oilfield Workers, Kazakhstan, 2020.

From March to May 2020, 1306 oilfield workers in Kazakhstan tested positive for SARS-CoV-2. We conducted a case-control study to assess factors associated with SARS-CoV-2 transmission. The cases were PCR-positive for SARS-CoV-2 during June-September 2020. Controls lived at the same camp and were randomly selected from the workers who were PCR-negative for SARS-CoV-2. Data was collected telephonically by interviewing the oil workers. The study had 296 cases and 536 controls with 627 (75%) men, and 527 (63%) were below 40 years of age. Individual factors were the main drivers of transmission, with little contribution by environmental factors. Of the twenty individual factors, rare hand sanitizer use, travel before shift work, and social interactions outside of work increased SARS-CoV-2 transmission. Of the twenty-two environmental factors, only working in air-conditioned spaces was associated with SARS-CoV-2 transmission. Communication messages may enhance workers' individual responsibility and responsibility for the safety of others to reduce SARS-CoV-2 transmission.

Performing cardiac surgery during COVID-19 pandemic in Surabaya, Indonesia: A single-center retrospective observational study.

BACKGROUND: Healthcare workers are still the front liners in health care services, and have major roles during the COVID-19 pandemic. In a resource-limited country like Indonesia, it is necessary to provide safe screening and management both for patients and healthcare workers to minimize the transmission. We report our experience in the cardiac surgery department on how to provide safe management during the COVID-19 pandemic. METHODS: A retrospective observational study was performed in a single-tertiary-center cardiac surgery department in Surabaya and included all patients who underwent cardiac surgery during the first year of the COVID-19 pandemic. We also collected the patients from a 1-year period before the pandemic as the comparison data. Analysis of the patient characteristics, operative data, and postoperative outcome, was performed. This study also provides our experience in changes of admission in the cardiac surgery preoperative system that can be utilized for others. RESULTS: A total of 179 patients were admitted to and had cardiac surgery. Of these, 3.80% (n = 7) were COVID-19 confirmed by a real-time polymerase chain reaction. Five patients were delayed to have cardiac surgery with no mortality or morbidity reported in these patients. During the period after changes of admission procedural in cardiac surgery patients, there were no healthcare workers infected by COVID-19 by patient transmission in our center (0%). CONCLUSION: Our study reported a systematic screening and that possible delay in cardiac surgery appears to be feasible and safe, both for patients and for healthcare workers during the COVID-19 pandemic.

NIOSH Responds to the U.S. Drug Overdose Epidemic.

The United States is experiencing an evolving and worsening drug overdose epidemic. Although the rate of drug use among workers has remained relatively stable, the risk of overdose and death among drug users has not, as illicit drugs have increased in potency and lethality. The cumulative impacts of COVID-19 and the opioid crisis increase the likelihood of illness and death among workers with opioid use disorder. Workplaces represent a critical point of contact for people living in the United States who are struggling with or recovering from a substance use disorder, and employment is a vital source of recovery "capital." The benefits of addressing substance use in the workplace, supporting treatment, and employing workers in recovery are evident. The National Institute for Occupational Safety and Health has published research to inform policy and practice toward prevention efforts and has developed accessible resources and toolkits to support workers, employers, and workplaces in combatting the opioid overdose crisis and creating safer, healthier communities.

A Safe Approach to Percutaneous Tracheostomy for COVID-19 Patients in Intensive Care.

The novel coronavirus disease 2019 (COVID-19) has placed a burden on critical care facilities worldwide. Patients who remain critically unwell with COVID-19 require prolonged periods of ventilation, and the burden of both the resources during a pandemic and the slow respiratory wean must be managed. Percutaneous tracheostomies are commonplace in long-term intensive care patients, yet little is known about their role in COVID-19, particularly how operator safety is maintained during the procedure. Here, we describe an approach designed to minimize cross-infection of the operators undertaking percutaneous tracheostomies within this subset of patients. Focus should be on non-technical skills, prolonged periods of pre-oxygenation, and minimal ventilation during the procedure to minimize the risk of aerosolization generated from an open breathing system. Our modified technique demonstrates successful early experiences with no operators testing positive for COVID-19 or developing symptoms following any performed procedure.

Needlestick Injuries Among Healthcare Workers Administering COVID-19 Vaccinations in the United States.

As mass COVID-19 vaccination programs roll out across the country, we are potentially faced with compromising workers' health for the sake of the broader public health, as it relates to occupational exposure to contaminated needles and syringes. We have the opportunity to provide recommendations that advance protection of workers through the industrial hygiene hierarchy of controls, especially in light of the twentieth anniversary of the Needlestick Safety and Prevention Act. Specifically, greater focus on institutional controls that can dictate the safety culture and climate of institutions that roll out COVID-19 vaccination programs, while maintaining careful focus on preventing sharps injuries and blood exposure. In addition, we provide suggestions for the role that engineering controls, such as devices with sharps injury prevention features play in protecting workers from exposure to bloodborne pathogens, as well as the importance of ongoing injury incident surveillance.

COVID-19: leadership on the frontline is what matters when we support healthcare workers.

The implications of severe acute respiratory syndrome coronavirus (SARS-CoV-2, henceforth described as COVID-19) on healthcare systems globally are proving to be immense, with unforeseen impacts that are still to fully emerge. Local and national healthcare systems, hospitals and healthcare workers have been overwhelmed by the needs of patients and limited by weaknesses in resources, staff capacity and distribution networks. These circumstances impact the ergonomic conditions within which healthcare staff work and subsequently their behavioural responses.In this commentary, we argue that urgent research is needed globally to bridge the evidence gap that exists on how best to support healthcare workers with the repercussions of working on the frontline of a pandemic. Leadership on the frontline is what matters. It is not only what policies, guidelines and checklists are in place to support nurses, doctors and healthcare workers, it is the actions and behaviours of their frontline and local leaders in implementing initiatives that really make the difference.Recognizing that the leadership style, organizational culture and model of successful implementation are inextricable is the first step to ensure sustainable interventions to support healthcare workers' well-being will follow.

Early Impacts of the COVID-19 Pandemic on the United States Construction Industry.

The COVID-19 pandemic has been the largest global health crisis in decades. Apart from the unprecedented number of deaths and hospitalizations, the pandemic has resulted in economic slowdowns, widespread business disruptions, and significant hardships. This study focused on investigating the early impacts of the COVID-19 pandemic on the U.S. construction industry since the declaration of the national emergency on 13 March 2020. The study objectives were achieved through 34 telephone interviews with project managers, engineers, designers, and superintendents that represented different states and distinct industry sectors in the United States (U.S.). The interviewees offered information on their experience with the pandemic, including the general and adverse effects experienced, new opportunities created, and risk management efforts being undertaken. The reported adverse effects included significant delays on projects, inability to secure materials on time, reduction in productivity rates, material price escalations, and others. The new opportunities that were created included projects involving the fast-track construction of medical facilities, construction of residential buildings, transportation-related work, and opportunities to recruit skilled workers. The risk management measures that were widely adopted included measures to enhance safety and reduce other project risks. The safety measures adopted included requiring employees to wear cloth face masks, adoption of social distancing protocols, staggering of construction operations, offering COVID-19-related training, administering temperature checks prior to entry into the workplace, and others. Measures to manage other project risks included the formation of a task force team to review the evolving pandemic and offer recommendations, advocating that construction businesses be deemed essential to combat delays and taking advantage of government relief programs. The study findings will be useful to industry stakeholders interested in understanding the early impacts of the pandemic on the construction industry. Industry stakeholders may also build upon the reported findings and establish best practices for continued safe and productive operations.

SARS-CoV-2 Infection and Mitigation Efforts among Office Workers, Washington, DC, USA.

Despite mitigation efforts, 2 coronavirus disease outbreaks were identified among office workers in Washington, DC. Moderate adherence to workplace mitigation efforts was reported in a serologic survey; activities outside of the workplace were associated with infection. Adherence to safety measures are critical for returning to work during the pandemic.

Evaluating Healthcare Worker Competence in the Correct Use of Personal Protective Equipment in the COVID Era: A Quality Improvement Project.

INTRODUCTION: Throughout the coronavirus disease 2019 pandemic, personal protective equipment (PPE) guidance has rapidly evolved. Healthcare workers (HCWs) should use PPE correctly to reduce the risk of nosocomial transmission of the coronavirus. We predict a lack of training regarding correct PPE usage amongst HCWs and introduce a low-resource method of training. METHODS: HCWs from various disciplines at a District General Hospital self-rated their ability in utilising PPE using uncontrolled pre- and post-session 16-item questionnaires following a single PPE training session. Participant responses were analysed using Student's t-test for independent (unpaired) samples. RESULTS: Of 64 participants, 37 participants (59%) received any prior PPE training. Six participants (9%) previously received specific severe acute respiratory syndrome coronavirus 2 PPE training. Survey scores were higher in the post-test than the pre-test group. CONCLUSION: This study highlights the lack of formal PPE training amongst HCWs and the need for establishing PPE training as part of the mandatory training of HCWs.

COVID-19: through the eyes through the front line, an international perspective.

COVID-19 is continuing to ravage the globe. In many Western Countries, the populous has not embraced public health advice which has resulted in a resurgence of the COVID-19 virus. In the United States, there is an absence of a coordinated Federal response. Instead, frontline workers and average citizens are having to cope with extensive mixed messaging regarding mask usage and social distancing from the highest levels of government. This has resulted in the United States not being able to achieve a low level of infection since the pandemic began. In addition, many citizens hold a profound belief that individual freedoms must be preserved, even at the expense of public health; and view the wearing of masks as renouncing this right. These engrained political beliefs can be traced back to the late 1800s. The response of the United States has also been hampered by a highly cost-efficient healthcare system, which does not provide universal care and has a just-in-time supply chain, with far too few supplies in reserve. This efficiency prevented a rapid scaling up of the healthcare response, which resulted in severe deficiencies in available personal protective equipment (PPE) and healthcare staff. To compound issues many healthcare staff are not provided an economic or healthcare safety net. Other frontline workers, such as those who work in transportation and food services, are working under even greater adversities. Many of these workers are from diverse backgrounds, who, along with their families, are at even greater risk for COVID-19. This vulnerable population of frontline workers are faced with a choice of going to work with inadequate PPE or placing food on their families' table. In the United States, official recommendations seem to be ever changing, based more upon supply and test availability, than on science. We must rely on science and learn from the lessons of past pandemics or we will relive, even to a greater degree, the deaths and devastations experienced by our ancestors over 100 years ago.