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.

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.

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.

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.

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.

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.

Plastic Surgeons and COVID-19 Pandemic.

The world is suffering from the unprecedented problem of the COVID-19 pandemic. As healthcare professionals, we face the imminent danger of exposure. For Plastic, Reconstructive and Burn surgeons, safety and smooth functioning of day-to-day work during this pandemic is of the utmost priority. However, it is also our responsibility to stop the human-to-human transmission chain and conserve the medical resources for rational use. The disease has spread throughout the country, and with the number of infections increasing day by day, it is very important to adhere to the safety principles. This document aims to provide some insights into the world of plastic, reconstructive and burn surgeons in the time of the COVID-19 outbreak.

The "Intubox": Enhancing Frontline Healthcare Worker Safety During Coronavirus Disease 2019 (COVID-19).

There has been a substantial burden of healthcare worker infection during the current coronavirus (COVID-19) pandemic, likely due to a lack of adequate preparedness, suboptimal institutional infection control measures, atypical patient presentation, poor compliance with personal protective equipment (PPE) and exposure to high-risk aerosol generating procedures, such as endotracheal intubation. There is significant concern that developing countries will face heightened levels of staff exposure during the COVID-19 pandemic. To mitigate this exposure risk during procedures, such as endotracheal intubation, various "aerosol boxes" have been designed by frontline healthcare workers. However, in practice these boxes were found to hamper endotracheal intubation and other procedures due to the limited space and manoeuvrability they allow. To further reduce particle dispersion and to improve on the practicality and ergonomic design of the prototype "aerosol box", the Intubox was developed by staff at the Charlotte Maxeke Johannesburg Academic Hospital after instituting several changes to the prototype design.

Strategies for Rational Use of Personal Protective Equipment (PPE) Among Healthcare Providers During the COVID-19 Crisis.

As the coronavirus 2019 (COVID-19) began spreading globally with no clear treatment in sight, prevention became a major part of controlling the disease and its effects. COVID-19 spreads from the aerosols of an infected individual whether they are showing any symptoms or not. Therefore, it becomes nearly impossible to point exactly where the patient is. This is where personal protective equipment (PPE) comes in. These are masks, respirators, gloves, and in hospitals where the contact with the infected and confirmed patient is direct, also gowns or body covers. The PPEs play a major role in the prevention and control of the COVID-19. The PPE is able to prevent any invasion of the virus particles into the system of an individual which is why it is an essential item to have for healthcare workers. Due to the high demand for PPEs all around the world, it is important to optimize the use of protective gear and ration the supplies so that the demand are met. However, there are guidelines recommended by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) to maintain the supply in the wake of this increased demand of PPE, how the manufacturers should track their supplies, and how the recipients should manage them. Various strategies can be used to increase the re-use of PPEs during the COVID-19 pandemic that has modified the donning and doffing procedure.

Personal Protective Equipment N95 Facemask Shortage Quick Fix: The Modified Airway From VEntilatoR Circuit (MAVerIC).

We are in a crisis where healthcare providers on the frontlines are running out of the appropriate personal protective equipment including N95 masks and power air-purifying respirators. Here, we propose a makeshift filter mask that we call the Modified Airway from VEntilatoR Circuit (MAVerIC) that can be assembled within seconds using widely available supplies routinely utilized by anesthesia providers in the operating room to provide practitioners on the frontlines with the high standard of protection of a N95 mask during the coronavirus disease 2019 (COVID-19) pandemic, and can be easily quantitatively "fit tested" to ensure no significant leak to optimize safety and efficacy.