Risk of Microbial Transmission in Reusing Gloves after Alcohol-Based Hand Hygiene

Intro: The need for re-use of gloves as an alternative to single use was raised in times of resource shortages because during the coronavirus disease 2019 pandemic, marked increase in healthcare associated infection was reported, which might owing to shortage of personal protective equipment. we aimed to evaluate the risk of microbial transmission by comparing residual microorganism after multiple patient contact according to with or without gloves in clinical practice. Method(s): Three researchers made rounds of patients while touching the same area successively followed by alcohol-based hand rub: one with bare hands, one with single gloves, and one with double gloves. Hand imprints were obtained before and after rounds, and cultured to count colony-forming units (CFU). The number of colonies was compared between groups in a semi-quantitative manner by hand area. Finding(s): Mean CFU counts after round were 10.06 for bare hands, 31.22 for single-gloved hands, and 49.67 for double-gloved hands (p=0.084). The most commonly identified microorganism after rounding was coagulase-negative Staphylococci (77.8%, 42/54), followed by Bacillus species (62.9%, 34/54). Carbapenem-resistant Acinetobacter baumannii was confirmed from a pair of double-gloved hand specimens after the rounds. That round included a patient with the same organism with the same antibiotic susceptibility results. More microorganisms were remained after alcohol-based hand rub on gloved hands than on bare hands. Conclusion(s): From our results, the possibility of microbial transmission seems more likely in gloved hands than in bare hands even after alcohol-based hand rub. Therefore, we do not recommend the re-use of gloves after alcohol-based hand hygiene.Copyright © 2023

A University Collaboration in Creating a Powered Air Purifying Respirator: An Emergency Innovative Response

Purpose of Study In March of 2020, the World Health Organization declared the coronavirus (COVID-19) a global pandemic. As the number of cases increased worldwide, existing hospital infrastructure struggled to keep up with the demand for equipment and supplies.This exposed healthcare workers to contracting the disease. The purpose of this study is to demonstrate an emergency innovation response in overcoming shortages of personal protective equipment within a university hospital setting, with a special focus on powered air purifying respirators (PAPRs). Methods Used The Center for Medical Innovation (CMI)-a center designed to promote research and development of high-impact healthcare products at the University of Utah (UofU)-enlisted university engineers to develop an open source PAPR system made from readily available commercial materials. Parts were selected to meet filtration, airflow, and protection specifications as outlined by industry standards. Commercially available parts consistent with these specifications were assembled into a novel PAPR system which utilized 3D printed pieces on demand to achieve compatibility. Once assembled, each PAPR went through protection testing to demonstrate health worker safety. A fit factor of 200 is the minimum requirement needed as defined by NIOSH. Testing procedures were carried out with industry standard equipment. Summary of Results A human centered design approach was utilized in iterating versions of the product based on repeated fit testing. Failures were addressed in subsequent models. All PAPRs passed fit testing with a score of > 1000. Following the lean processing standard of just in time inventory, materials to fabricate 1000 PAPRs were procured and assembled on demand. PAPRs are now being used by the UofU Hospital as well as other affiliate entities globally and are filling the gap needed for PPE. Approximately 200 units have been donated to Navajo Nations hospitals in the state of Utah and others have been donated to university sister entities in India, Nepal, and Kenya. Conclusions The Center for Medical Innovation at the University of Utah has facilitated a rapid emergency innovative response in filling the PPE needs locally and abroad by creating this open source accessible PAPR system.

The effect of COVID-19 on oncology pharmacy services: Results of a 3 month long weekly global survey

Introduction:The COVID-19 pandemic has been felt in all areas of health care. We performed a weekly survey amongst the members of the European Society of Oncology Pharmacy (ESOP) to better understand its effects and how they evolved over time. We specifically studied alterations in the care for patients with cancer as well as in the work of oncology pharmacists. Method(s):An online survey was developed by ESOP to compile data about the effects of COVID-19 on the work practices of professionals working in the field of oncology pharmacy. The survey was distributed electronically on a weekly basis from April 6thto June 28th. Result(s):A total of 1146 responses were gathered from respondents in 60 different countries. At any given time point, between 25% and 38% of the respondents had staff infected with COVID-19. In total, 29% of hospital pharmacists reported shortages of drugs necessary for the treatment of COVID-19 patients, and almost 50% also faced shortages of drugs necessary for the treatment of cancer patients. In addition, the majority of hospital pharmacists reported a decrease in planned surgery for oncology patients, as well as a decrease in the amount of chemotherapy preparations. Community pharmacists faced shortages of personal protective equipment in 40% of cases and shortages of drugs in 60%. Conclusion(s):The work of oncology pharmacists both in the clinical setting as well as in the community has been effected profoundly by the COVID-19 pandemic.Copyright © 2021 Lippincott Williams and Wilkins. All rights reserved.

Features of Anesthesiologists-Reanimatologists' Emotional States in Different COVID-19 Pandemic Periods in Russia

Introduction: The COVID-19 pandemic is one of the most stressful events in recent times. Medical professionals, including anesthesiologists-reanimatologists, suffered the main blow in this difficult and stressful environment. Aim(s): This study aimed at identifying the features of anesthesiologists-reanimatologists' emotional states in different COVID-19 pandemic periods. Method(s): The study was conducted through an anonymous questionnaire among anesthesiologists-reanimatologists in two periods. In the First stage - which was carried out in May 2020 (during the first COVID-19 pandemic wave) - 58 anesthesiologists-reanimatologists in the Arkhangelsk region took part. During the Second segment - which took place in October 2020 (in the second COVID-19 pandemic wave) - 43 anesthesiologistsreanimatologists were examined. Repeated questioning was carried out among the same participants. Result(s): In October 2020, compared to May, the number of doctors who noted a high intensity of professional activity increased. Regardless of the study period, one-third of the subjects experienced constant pronounced anxiety. Anesthesiologists-reanimatologists, whose professional activity was directly related to the patients in COVID-19 care, noted a poorer emotional state more frequently in October, accompanied by anxiety, depressed mood, irritability and a high burnout level, which may indicate a depletion of internal resources in this group. Conclusion(s): The study results showed that for anesthesiologists-reanimatologists, a further depletion of emotional resources accompanied the second pandemic wave. The anesthesiologists-reanimatologists' emotional state was mediated by a number of social and gender factors, as well as specific labor organization features.Copyright © 2022 The Authors. Published by Semmelweis University, Institute of Mental Health, Budapest.

Challenges Faced by Hilly Hospitals during Covid-19 Second Wave Disaster: Quantitative Study in Garhwal Region, Uttarakhand

Covid -19 second wave was considered a disaster in India as it was more havoc than the first one. Shortness of breath in patients leads to more demand for oxygen and hospitalization. So, there was a challenge for the hospitals to combat this disease. In the covid second wave, moderate to severe cases were treated at three hospital levels (CHC, Sub-district, and District hospital). This disease was not limited to bigger cities but spread to rural and hilly areas. We conducted quantitative research among government hospitals in five hilly districts of Uttarakhand at three levels of hospitals. Data were collected from a close-ended questionnaire using a judgmental sampling technique and analysed with the help of tables and bar charts. Questions were set based on the pilot study. The challenges explored through this study were divided into five main headings and eleven sub-headings. The main headings were Manpower, Surge capacity, logistics, coordination, and management of non-covid patients. Sub-headings were a shortage of medical staff, shortage of paramedical staff, shortage of sweepers, shortage of ambulance drivers, shortage of ICU beds, shortage of oxygen beds, shortage of covid drugs (Remdesivir and Steroids), oxygen cylinders, PPE kits, difficulty in coordination with staff and difficulty in managing non- covid patients.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Clean air, verandas and human contact in the battle against COVID-19;A timeless approach

Architecture has played a major part in designing hospitals with layouts for space to assist in patient recovery. Rooms oriented towards the light, with large windows and openings in wide balconies were designed to let patients be in the outdoors safely in the beginning of the last century in TB hospitals. The same balconies in our hospital, in 1924 and 2020. (see pictures) A century later, in 2020, our hospital "Sotiria Thoracic Diseases Hospital of Athens" was proclaimed the central hospital in the fight against the Covid-19 pandemic in Athens. We observed, how places that used to be sanatoriums operated during the Covid-19 era and compared the basic functions of the buildings. A major problem that appeared in the first months of the pandemic, was the shortage of protective equipment, which made everyday medical visits by the whole team of doctors difficult, time consuming, and expensive. Every day, the doctors except from visiting the rooms twice a day, visited their patients by accessing the balconies from the outside, wearing only a facemask. In conclusion, in the sudden appearance of the coronavirus in 2019, the wide balconies in our hospital proved their timeless usefulness in the fight against contagious respiratory diseases, giving patients the opportunity to see their doctors more, without spending resources of the hospital. Face to face communication, family visits and socialization, in the words of our patients, played a significant role in their psychological and overall wellbeing while being hospitalized.

Challenges of COVID-19 prevention and control: A narrative review

This narrative review aims to highlight some of the factors contributing to challenges faced by many countries in controlling the spread of COVID-19 pandemic that continues to rage around the world, especially after stoppage of official prevention and control activities. A literature search was conducted on PubMed, and Google using search terms 'COVID-19', 'challenges', 'prevention', and 'control' in different combinations. COVID-19 prevention and control challenges are related to health-system, vaccines, administration, and society culture. Controlling the spread of COVID-19 necessitates cooperation between community leaders, healthcare professionals, religious leaders, and the public.

FELLOW EXPERIENCES WITH ENDOSCOPY SIMULATION BEFORE AND DURING THE COVID-19 PANDEMIC: AN INTERNATIONAL SURVEY

Background With the COVID-19 pandemic there was an acute drop in procedural volume for trainees, highlighting the need and potential of simulation-based training (SBT). Prior to the pandemic, the uptake of simulation was poorly categorized and inconsistent across programs despite the variety of endoscopic simulators available. We aimed to evaluate the current state of endoscopy training internationally in the wake of the pandemic as perceived by trainees. Methods This cross-sectional study utilized a survey composed of 21 questions eliciting demographic data, COVID-19-related training experiences, and experience with SBT. This survey was distributed internationally (USA, Canada, EU, Philippines, Singapore) to gastroenterology trainees between August 2021 to October 2021. Results The questionnaire was completed by 182 fellows, with 55 (30.2%) from the USA and 127 (69.8%) from other countries. Of the respondents, 79.1% were fellows during the first year of the pandemic. A majority (69.2%) found endoscopy training in general to be negatively impacted. Of those who reported a negative impact from the pandemic, 75.0% attributed it to a decline in endoscopic volume, 40.0% to institutional/regional guidelines, 25.0% to a shortage of personal protective equipment. Overall, 47.2% of respondents believed COVID-19 will negatively affect their endoscopic proficiency upon fellowship completion. A total of 71 respondents (39.0%) had experienced SBT before or during fellowship, with 27 from the USA (49.1% of respondents from USA) and 44 from other countries (34.6% of respondents from other countries). In the USA, 63.0% had used virtual reality (VR), 37.0% mechanical models, and 37.0% animal models compared to 47.7% VR, 68.2% mechanical models, and 27.3% animal models in other countries. Respondents agreed that SBT was most helpful with developing technical skills such as ergonomic handling, torque steering, and fine tip control. A majority (52.1%) found SBT appropriate to their level of training. Respondents believed increased access to SBT (43.7%) and mentored training (54.9%) would improve the experience. Conclusion While current data supports the use of SBT early in training, the cumulative uptake of SBT across programs before and during the COVID-19 pandemic remained low. In the USA and abroad, fellows perceive a negative impact of COVID-19 on their training and proficiency upon graduation. Compared to other countries, the USA had higher utilization of VR and lower utilization of mechanical models. Decrease in endoscopic volume was reported as the main factor negatively impacting endoscopic training. This survey highlights the potential benefit of SBT with low case volumes and further prospective evaluation of SBT in achieving endoscopic competence. (Table Presented)

Impact of Covid-19 on Infectious Disease Fellows in the United States: A National Survey to Identify Targets for Intervention

Background. The Coronavirus disease of 2019 (COVID-19) global health crisis has resulted in an unprecedented strain on healthcare systems, reorganization of medical training programs and disruption in professional and personal lives of medical trainees. The impact of COVID-19 on infectious disease (ID) fellows, who are frontline healthcare professionals, has not been assessed. Methods. We conducted a national survey of adult and pediatric ID fellows to assess impact on educational activities, availability of personal protective equipment (PPE), well-being, and career prospects. Anxiety and burnout were assessed by 7-item generalized anxiety disorder scale and abbreviated Maslach burnout inventory respectively. Invitations to participate in the survey were sent via email to all ID fellows through Accreditation Council for Graduate Medical Education (ACGME) fellowship directors. Survey responses collected from August 1 to September 30, 2020 have been reported. Results. 136 fellows completed the survey (Table 1). 84% reported their institution had provided evidence-based didactics for management of COVID-19 and 53% indicated their general ID didactics were affected by the pandemic. 86% of fellows were involved in care of patients with COVID-19, and 31% reported a shortage of PPE affecting their clinical duties. Those living in highly impacted states (CA, FL, NY, TX) at the time of the survey were 1.70 times as likely to experience moderate to severe anxiety (vs. minimal to moderate) than those in other states;similarly, those who saw ≥11 COVID-19 patients weekly and reported PPE shortages were 2.5 and 2.0 times as likely, respectively, to experience moderate to severe anxiety compared to their peers who took care of 10 or fewer COVID-19 patients and did not experience PPE shortages. Burnout scores were not significant (Table 2). Conclusion. It is imperative that ID fellows feel adequately protected and supported during this pandemic. Pandemic preparedness should be included in the ID fellowship curriculum. Interventions for anxiety and burnout reduction should be implemented. ID fellowship programs should continue to accept feedback from fellows to ensure their ongoing safety, well-being, and education as we navigate this pandemic.

Coronavirus Disease, 2019 (COVID-19) in Long-Term Care Facilities (LTCF): One Large County's Response, California 2020-2021

Background. The coronavirus-19 disease (COVID-19) outbreak has had a particularly devasting effect on skilled nursing facility (SNF) residents and healthcare workers (HCWs). While representing only 11% of COVID-19 cases, the residents accounted for 43% of deaths in the United States. Methods. We report a retrospective review of the support provided by our local health department (LHD) to long-term care facilities in response to the COVID-19 pandemic. This group comprised of staff from healthcare-associated infections (HAI);the Medical Operations Center (MOC);Testing, Tracing, and Treatment (T3);and the Healthcare Provider Status Taskforce (Table 1 outlines their functions). The HAI team with the State Public Health Department provided infection prevention and control (IPC) outbreak investigation, education, recommendations, and ongoing access to technical assistance. The T3 team focused on rapid response testing and tracing;the HPSTF team collected data and issued questionnaires;the MOC responded to staffing and PPE requests;and the Long-Term Care Facility sector presented routine telebriefings to update the facilities on public health guidance, share resources, and answer questions during and in between briefings. Table 1. Sectors and Function of Response Teams to COVID-19 Results. From March 2020 through May 2021, there were 504 outbreaks in LTCFs;the HAI team performed 281 outbreak investigations (Figure 1). In the same period, 308,264 molecular tests were performed using various platforms;laboratory services were outsourced during peak testing requests (Figure 2);"strike teams were deployed to facilitate testing on 404 occasions. Self-reported fully vaccination rate for SNF staff was 73% (March 2021) and 76% for residents (April 2021). There were 568 staff requested;total orders for PPE were 4,839 and 16,892,823 PPE items were fulfilled (Figure 3). In addition to knowledge gaps in IPC, other challenges included shifting IPC guidance, PPE shortages, timeliness of test results that impacted cohorting, community acquisition of disease with transmission to residents, interfacility spread among staff, staffing shortages, and vaccine hesitancy issues. Figure 1. Number of Outbreaks and Number of Outbreak Investigations Figure 2. Number of Tests Performed by the Public Health Laboratory and the Number of Visits by "Strike Teams" Figure 3. Personal Protective Equipment Fulfillment during COVID-19 Pandemic Conclusion. The management of the recent COVID-19 outbreaks required a multi-pronged approach. Lessons learned are applicable to other highly transmissible infectious diseases.

Elevated occupational safety risks for home care workers: Policy gaps in a pandemic

Introduction: Personal Support Workers (PSWs) regularly enter private dwellings to care for clients. The work is low-paid, insecure and physically and emotionally demanding. In Ontario, the ‘assisting occupations in support of health services’ occupation ties with ‘motor vehicle and transit drivers’ for the worst rate of lost-time workers’ compensation claims (8% according to the Workers Safety & Insurance Board). Materials and Methods: This qualitative research included in-depth, semi-structured interviews with 16 key informants in government, industry, and advocacy organisations. Data were coded thematically, and analysis drew on Interpretive Policy Analysis. This research was approved by a university Research Ethics Board. Results: We found work conditions for PSWs worsened during the pandemic. Worldwide PPE shortages led to conserving PPE so that PSWs often had to use the same mask for all sites they visited in a day. A shortage of workers led to creation of rapid PSW education programs and caused elevated concern about training adequacy for complex care needs. Remote assessments limited supervisors’ ability to evaluate client conditions or home environments. Taking public transportation between client homes, others living in the home, and clients themselves, were seen as increasing risk of exposure to COVID-19. Participants described that PSWs may feel morally obliged to work despite the right to refuse unsafe work. Conclusion: Some emergency policies had unintended consequences that elevated risk for workers and their clients.

Analysis on the evolution of the personal protective equipment proposed in catalan hospitals during the first wave of the covid-19 pandemic

INTRODUCTION: This project arose to suggest in-depth research on key topics to give our health system better tools to face future outbreaks. And in order to determine the flaws in the response given to the COVID-19 pandemic and what led to them, all to prevent them from happening in future outbreaks. MATERIAL AND METHODS: WHO’s tuberculosis laboratory biosafety manual and the tuberculosis patient insulation procedure from the Bellvitge hospital as examples of protocols before the pandemic and V2, V2.3 and V3 of Pla EPI as examples implemented during the outbreak have been used. Pla EPI was created to help distribute PPE (Personal Protective Equipment) among healthcare personnel based on their tasks and taking into consideration the lack of it due to the collapse in the supply chain faced during the first wave. By summarizing the documents of interest using data tables. A comparative between the PPE proposed in the different published versions of ‘’Pla EPI’’ has been made. RESULTS AND CONCLUSIONS: This comparison has led to the conclusion that new protocols offer a more bilateral healthcare worker/patient protection instead of only focusing on protecting the worker from patients' pathogens. In relation to pla EPI, considering the now demonstrated importance of aerosols in transmission of COVID-19, we conclude that PPE available at the moment isn’t enough to protect against this type of diseases and that more research should be done towards better PPE. We should stop relying on a few countries to provide the whole healthcare system with PPE, after all, that was the main cause of PPE shortage during the first wave.

The real impact of COVID-19 on community pharmacy professionals as part of the primary health care frontier workforce in Spain

Context: Spain was at the epicenter of the pandemic. Health centers across Spanish territory were not able to respond to non-emergency enquiries, leaving community pharmacies as the first point of patient's contact. Aims: To investigate the impact of COVID-19 on the mental and physical health of community pharmacy teams across Spain. Methods: A cross-sectional observational study was performed with community pharmacy professionals throughout Spain. A questionnaire designed by our collaborator from the United Kingdom was adapted to the Spanish population and launched between October 2020 and February 2021. Results: A total of 98 participants responded to the questionnaire. The survey showed an 80% increase in workload. The pandemic had negatively impacted the well-being of community pharmacy professionals. The survey indicated a national shortage of medicines and personal protective equipment across Spain, particularly during the first peak. To adapt to this pandora's box of COVID-19, 96% of the pharmacies changed their settings to improve patients and staff's safety. Most of these changes were self-financed by the pharmacy owner. The pharmacists kept up to date with information released from the pharmacists' college, General Pharmaceutical Council and the Spanish Society of Community Pharmacists. The Public domain purchased more (79%) immune booster supplements. Conclusions: Community pharmacy professionals have faced tremendous mental, physical and professional pressure in providing adequate personal protective equipment and medication supply to their communities. They have provided more pharmaceutical services during the crisis, although they have not been recognized as essential workers by the healthcare system.