Hand care: it's time to take the gloves off

The increased incidence of hand dermatitis (HD) is well documented in healthcare professionals (HCPs) (Flyvholm MA, Bach B, Rose M, Jepsen KF. Self-reported hand eczema in a hospital population. Contact Dermatitis 2007;57: 110-15). It is reported that HD accounts for 95% of all occupational dermatitis (Bains SN, Nash P, Fonacier L. Irritant contact dermatitis. Clinic Rev Allergy Immunol 2019;56: 99-109). We sought to better understand the prevalence of HD in HCPs in a large teaching hospital, identify any associated risk factors and assess their knowledge of hand care. Additionally, we aimed to assess the availability of ward facilities and posters for hand hygiene and hand care. The survey was conducted between November 2015 and January 2016. A review of ward facilities and posters for hand care and hand hygiene was conducted in October 2020. A total of 820 HCPs responded to the survey. Altogether, 444 respondents (54 1%) reported a previous history of HD and 226 (27 6%) reported active dermatitis. These included 153 (18 6%) doctors/ dentists, 76 (9 3%) allied health professionals (AHPs), 46 (5 6%) nurses/midwives, 27 (3 3%) administrative staff, 16 (1 9%) other, five (0 6%) technicians and 108 (13 2%) medical/ dental/nursing/midwifery/AHP students. Only 10 (1 2%) took time off work owing to their HD, with five (0 6%) requiring > 5 days off work, but 67 (8 2%) wished they had taken time off work. In total, 416 (50 7%) respondents washed their hands > 20 times daily and 229 (27 9%) used disinfectants > 20 times per day. Those with a prior history of atopic dermatitis (AD) were at higher risk of developing HD [relative risk (RR) 1 69, 95% confidence interval (CI) 1 52-1 89;P < 0 001], and within 6 months of starting their job/placement (RR 1 82, 95% CI 1 3-2 5;P < 0 002). Only 107 (13 0%) respondents were able to identify all 11 correct statements regarding hand care. Two hundred and twenty (49 5%) of the 444 HCPs with a history of HD never received hand care advice when they started their current role. The 24 adult wards surveyed had a total of 162 general-use sinks, all with hand soap and disinfectant, and 154 hand hygiene posters. In contrast, only 22 sinks had emollients available. No posters were seen regarding hand care and skin health. This survey highlights the high prevalence of HD among HCPs, especially those with AD, but many are still not aware of good hand care measures. Additionally, our survey reflects the need for early education and equal facilities for hand care and hand hygiene, as both are important when delivering good clinical care, to protect patients and staff, especially in the midst of the COVID-19 pandemic.

COVID-19 Vaccine Literacy and Vaccine Hesitancy Level Among Healthcare Professionals in Turkiye, Their Relationship and Influencing Factors: A Cross-Sectional Study

Objective: Healthcare professionals (HP) play a role in vaccine acceptance as they influence people's decisions by sharing their personal experiences. The study was aimed to determine the coronavirus disease-2019 (COVID-19) vaccine literacy (VL) and vaccine hesitancy (VH) level among HP in Turkiye, their relationship and influencing factors. Material(s) and Method(s): This cross-sectional online study was applied to 1,111 HP between 15.02.2022-15.03.2022. The sociodemographic data form, COVID-19 Vaccine Literacy Scale (CVLS), and Vaccine Hesitancy Scale-long form (VHS) were used. Sociodemographic characteristics, questions about COVID-19 and COVID-19 vaccines were considered as independent variables, while VL and VH were considered as dependent variables. Result(s): Of the participants, 33.8% (n=376) were physicians, 25.2% (n=280) were nurses/midwives and 41.0% (n=455) were other HP. The CVLS functional mean score of HP was 2.6+/-0.7 and the interactivecritical mean score was 3.0+/-0.6. The VHS mean score was 44.6+/-16.3. Being a physician (p<0.001 for functional, p=0.002 for interactive-critical) and thinking that the origin of the coronavirus is a natural source from animals (p=0.029 for functional, p<0.001 for interactive-critical) were the factors that increased VL. Being a physician (p<0.001) and having high CVLS mean scores (p<0.001 for functional and interactive-critical) were the factors that decreased the VH. There was a weak negative correlation between VL and VH levels (r=-0.223 for functional, r=-0.323 for interactive-critical) (p<0.001). Conclusion(s): Considering that high VL level decreased VH level, it is obvious that the knowledge level of HP about COVID-19 vaccines should be increased.Copyright © 2023 by Turkiye Klinikleri.

Promoting respectful maternal and newborn care using the Dignity game: A quasi-experimental study.

AIM: This study assessed a) the impact of playing the Dignity board game on participants' understanding of respectful maternal and newborn care and b) participants' perceptions of how the game influenced their subsequent practice in Malawi and Zambia. BACKGROUND: Nurse-midwives' poor understanding of respectful maternal and newborn care can lead to substandard practice; thus, effective education is pivotal. Used in several disciplines, game-based learning can facilitate skills acquisition and retention of knowledge. DESIGN: a quasi-experimental study, using mixed-methods of data collection. METHODS: Data were collected between January and November 2020. Nurse-midwives (N = 122) and students (N = 115) were recruited from public hospitals and nursing schools. Completion of paper-based questionnaires, before and after game-playing, assessed knowledge of respectful care principles and perceptions around behaviours and practice. Face-to-face interviews (n = 18) explored perceived impact of engaging with the game in clinical practice. Paired and unpaired t-test were used to compare scores. Qualitative data were analysed and reported thematically. RESULTS: The study was completed by 215 (90.7 %) participants. Post-test scores improved significantly for both groups combined; from 25.91 (SD 3.73) pre-test to 28.07 (SD 3.46) post-test (paired t = 8.67, 95 % confidence interval 1.67-2.65), indicating an increased knowledge of respectful care principles. Nurse-midwives performed better than students, both before and after. In Malawi, the COVID pandemic prevented a third of nurse-midwives' from completing post-game questionnaires. Qualitative findings indicate the game functioned as a refresher course and helped nurse-midwives to translate principles of respectful care into practice. It was also useful for self-reflection. CONCLUSIONS: The Dignity board game has the potential to enhance understanding and practice of respectful maternal and newborn care principles in low-resource settings. Integration into nursing and midwifery curricula and in-service training for students and healthcare workers should be considered.

A novel virtual simulation training improves providers' knowledge and confidence to manage obstetric emergencies

Objective: Maternal mortality in the United States (US) is rising and many deaths are preventable. We sought to determine the efficacy of virtual simulation training to optimize management of obstetric emergencies within low and moderate volume delivery hospitals that are disproportionately affected by adverse maternal outcomes. Study Design: The educational platform was designed and deployed within urban non-teaching and rural hospitals, with low and moderate delivery volumes, in the US during the COVID-19 pandemic. Self-paced, interactive, online didactics on postpartum hemorrhage and hypertensive disorders of pregnancy were followed by two, 2-hour live virtual simulation trainings and debriefings. In this innovative simulation modality, participants verbalized actions to their co-participants and the simulation faculty as scenarios evolved with images, vitals and videos displayed on a PowerPoint. Participants completed multiple-choice questionnaires and confidence and attitude surveys prior to, immediately after and 3-months post-training. The multiple-choice questions were evidence-based using information from published guidelines and were validated by local experts. Paired t-tests were performed to asses for changes in knowledge and confidence. Result(s): From December 2021 to March 2022, four hospitals received training (Table 1). Participants (n=22) were comprised of nurses (59%), certified nurse midwives (14%) and attending physicians (23%) in Obstetrics, Family Practice or Anesthesiology. The survey response rate was 59%. The mean difference in knowledge and confidence scores significantly improved immediately post-training compared to baseline (P < 0.05 for all, Table 2). This improvement was maintained 3 months following the training. Participants reported their preferred training format was hybrid (43%), virtual (35.7%) or in-person (21.4%). Conclusion(s): Virtual obstetric simulation is feasible and improves knowledge and confidence, which can be retained over time. This educational modality is sustainable, scalable and an accessible format to enhance education and training. [Formula presented] [Formula presented] Copyright © 2022

2022 Adult Immunization Schedule Updates

Each year, the U.S. Centers for Disease Control and Prevention (CDC) releases the adult vaccine schedule. The 2022 adult vaccine schedule has several changes which will be discussed in the following manuscript. The Advisory Committee on Immunization Practices reviews the preliminary schedules usually at their October or November meetings. The following professional societies also approve the adult schedules prior to the 2022 publications: American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG), American College of Nurse-Midwives (ACNM), American Academy of Physician Assistants (AAPA) and the Society for Healthcare Epidemiology of America (SHEA). Once the final draft is approved by the CDC, it is published in the Morbidity and Mortality Weekly Report (MMWR) and released to healthcare providers and the general public with a cover page, tables, notes and—new for the 2022 schedule—an appendix with contraindications and precautions for the different approved vaccines.

Burnout and sleep quality among community health workers during the pandemic in selected city of Andhra Pradesh.

Background: This pandemic has resulted in physical and emotional exhaustion among everyone, especially among community healthcare workers (CHWs), resulting in increased burnout and poor sleep quality. This pandemic has increased responsibilities for Accredited Social Health Activist (ASHA) workers and Auxiliary Nurse Midwife (ANM) at the grassroots. Previous studies have shown that infectious diseases like SARS and MERS directly affect sleep. With the COVID-19 pandemic, burnout and poor sleep among healthcare workers are expected to increase. Aim: To determine the prevalence of burnout and sleep quality among community health workers. Settings: and Design: This Cross-sectional study was conducted from February to April 2020 in Urban Primary Health care centres of Guntur city, Andhra Pradesh. Methods and material: Copenhagen Burnout Inventory scale (CBI) with a 5-point Likert scale and Pittsburgh Sleep Quality Index (PSQI) Questionnaire were used among four hundred and ten study participants. Descriptive statistics and the Chi-square test were used; a p-value of ≤0.05 is considered significant. Results: The prevalence of personal burnout was 16.8%, while work-related and pandemic-related burnouts were 10.5% and 25.4%, respectively. The prevalence of poor sleep quality was 35.09%. Fear of contracting the virus was present among 38.3%. Fear of infecting the family members because of their exposure was reported by 36.6% of the respondents; 71.7% and 79.3% reported receiving support from the organisation and colleagues, respectively. Conclusions: The provision of necessary equipment, regular check-ups and timely interventions will minimise the risk of stress and burnout.

Knowledge, Attitude and Anxiety Levels about COVID-19 among Healthcare Workers at Ankara City Hospital, Türkiye

Introduction: We aimed to assess the present knowledge, attitude and anxiety levels of coronavirus disease 2019 (COVID-19) among healthcare workers at Ankara City Hospital. Materials and Methods: The study was implemented in the form of an online survey, based on voluntary participation and conducted on healthcare workers at the Ministry of Health Ankara City Hospital by using convenience sampling and snowball method between 30 May-2 July 2020. There were 28 questions on knowledge and 8 questions on attitude. The Beck Anxiety Inventory (BAI) was used to measure the anxiety level of the participants. The results were analyzed using the SPSS program. Results: Of the participants, 75% were females, 61.25% were nurses/midwives, and mean age was 34.5 ± 10.1 years. A significant portion of the participants (84.50%) had a moderate or adequate level of knowledge. The highest knowledge score in terms of their professions are doctors, followed by nurses/midwives. The most used resource (71.25%) by our participants was the Ministry of Health’s web page, posters and brochures. The knowledge adequacy of those who have a case algorithm is 1.8 times. Of the participants, 61.0 % demonstrated a positive attitude. 25.25% were gauged to have severe and moderate anxiety. Of the participants, 42.39% stated that anxiety causing reason was the future of their family in case of death in our study. The anxiety score of the female participants was higher than that of the men, young people were higher than the other age groups. There was no significant correlation between the level of knowledge and attitude;whereas a negative, weak correlation was identified between the level of knowledge and anxiety, and between attitude and anxiety. Conclusion: Although the knowledge level of the participants was found to be adequate, in-service training on infection control measures, especially on the use of personal protective equipment should be continued using official information, such as algorithms are designed and other sources by the Ministry of Health. Health workers, especially women and young people, should be monitored psychologically, treated and social support for them should be increased during the pandemic. Increasing knowledge and positive attitudes may be contribute to decrease anxiety scores.

How have health systems in Gambia, Senegal and Burkina Faso managed COVID-19 from May 2020 to September 2021?

Introduction/ Background: Known for their weakness, health systems in West Africa have been the subject of pessimistic predictions. We were interested in understanding how the Senegalese, Gambian and Burkinabe health systems have coped with the shock of the pandemic. Methods: We conducted interviews with 75 doctors, nurses, midwives, and other medical personnel working in four selected healthcare institutions per country. We also interviewed six healthcare managers in charge of coordinating COVID-19 activities in each of the three countries, including a nation-wide COVID-19 decision-maker, a COVID-19 treatment centre coordinator and a COVID-19 testing laboratory manager. We used the theory of resilient health systems (Fridell et al., 2020) to analyse our data. Results: Health professionals reported leadership support. Solidarity between colleagues improves the working environment although the working conditions are difficult. To cope with the lack of training, health professionals go to colleagues or to the Internet. The availability and quality of Personal protective equipments varies between countries and services. COVID-19 treatment centre and laboratory staff felt more protected within their department than outside it, whereas maternal health workers.. About delivery services, the first patients were taken care of with a lot of pressure because of providers lack's of experience. In addition, health professionals find themselves playing the role of carer in their absence. Impact: This study shows that health systems in West Africa, although weak and often under-resourced, have a workforce capable of using the resources available to deal with the shock of a pandemic. Conclusion: Human resources of health are strong and committed, despite difficult working conditions with insufficient preparation, providers have drawn on their own resources to train themselves to the point of taking over the role of the carer.

Identification of Latent Safety Threats in an Interprofessional Training Involving On-Site Simulation in a Birthing Unit in Response to the COVID-19 Pandemic

Objectives: We aimed to detect different types of latent safety threats (LSTs) in the setting of suspected or positive COVID-19 pregnant patients in the Birthing Unit using a training program involving on-site simulations. We hypothesized that providing simulation-based training in the actual care areas would greatly help identify high risk events that could affect staff and patient safety. Methods: We conducted a prospective observational study between April 15 and May 06 2020 involving 65 interprofessional health care workers (eg. obstetricians, residents, nurses, midwives) over the course of 8 training sessions. Training scenarios involved presentation of suspected COVID-19 patient to the Birthing Unit, donning & doffing with observer and lastly, transportation of a suspected COVID-19 patient to the operating room for non-urgent cesarean section. LSTs were recorded by two facilitators and further subcategorized into themes;Gaps in Knowledge & Training, Maintenance & Equipment and System & Processes. Areas of improvement and proposed solutions were documented after each simulation and post-simulation surveys were sent to participants. Results: The number of participants involved in on-site simulations was 65. Eighty-one LSTs were observed across all the 3 scenarios amongst any theme: scenario 1 (n = 42, 51.8%), scenario 2 (n = 14, 17.2%) and scenario 3 (n = 25, 30.9%). Amongst the different themes of LSTs, Gaps in Training & Knowledge comprised (n = 29, 35.8%), Maintenance & Equipment comprised (n = 46, 56.8%) and Systems & Processes comprised (n = 6, 7.4%) of total LSTs. There were 80 Areas of Improvement and Proposed Solutions drawn from these recorded LSTs. Fifty participants completed post-simulation surveys. Pre-simulation surveys revealed only 10% of participants felt very prepared to care for a suspected or positive COVID-19 patient in the birthing unit, while 92% responded in the same way post-simulation. Conclusions: Pregnant women with suspected or confirmed COVID-19 presenting to birthing units pose numerous infection control issues. Simulation-based exercises may greatly help units prepare by identifying LSTs. Post-simulation surveys further allowed us to see the benefits. Keywords: COVID-19;simulation;latent safety threats