Stress, COVID-19 related knowledge, attitude, and infection control performance of nurses at long-term care hospitals.

This study aimed to identify the stress level, knowledge, attitude, and infection control performance of nurses at long-term care hospitals (LTCHs) designated for infectious disease management and to investigate factors contributing to infection control performance. A total of 178 nurses who had worked for at least 1 month at seven LTCHs designated for infectious disease management and provided care for patients confirmed with COVID-19 were enrolled in the study. Data were collected from February to March 2022 using written and online self-report questionnaires. COVID-19 infection control performance was higher among married than among single participants (t = -3.71, p < 0.001), among those aged 40-49 versus 30-39 years (F = 4.10, p = 0.003), and those with 1-2, 3-4, or ≥5 sessions versus no prior education (F = 6.41, p < 0.001). COVID-19 infection control performance was negatively correlated with stress (r = 0.26, p < 0.001) and positively correlated with knowledge (r = 0.40, p < 0.001) and attitude toward COVID-19 (r = -0.36, p < 0.001). Stress (ß = -0.17, p = 0.012), knowledge of COVID-19 (ß = 0.28, p < 0.001), attitude toward COVID-19 (ß = 0.20, p = 0.004), and marital status (ß = 0.18, p = 0.009) were identified as predictors of COVID-19 infection control performance.

Factors Associated with the Level of Knowledge about Biosafety against COVID-19 in Peruvian Dental Students: A Cross-Sectional Study under a Multivariable Regression Model.

AIM: Biosafety is a set of preventive measures aimed at controlling risk factors arising from biological, physical, and/or chemical agents. This topic is particularly important in the dental field since saliva is the main biological agent of the transmission of coronavirus. The present study aimed to determine the factors associated with the level of knowledge about biosafety against COVID-19 in Peruvian dentistry students. MATERIALS AND METHODS: The present observational, cross-sectional, and analytical study evaluated 312 Peruvian dentistry students. A validated 20-question questionnaire was used to measure the level of knowledge. The nonparametric Mann-Whitney U and Kruskal-Wallis tests were used to compare levels of knowledge between categories of each variable. A logit model was used to evaluate associated factors such as sex, age, marital status, place of origin, academic year of study, being in the academic upper third, history of COVID-19, and living with vulnerable family members. A significance level of p < 0.05 was considered. RESULTS: 36.2%, 31.4%, and 32.4% presented poor, fair, and good knowledge levels, respectively. Students under 25 years of age were 64% less likely to pass the biosafety against COVID-19 questionnaire than students 25 years of age and older (OR = 0.36; CI: 0.20-0.66). Students in the academic upper third were nine times more likely to pass the test than other students (OR = 9.38; CI: 4.61-19.07). Finally, third-year students were 52% less likely to pass the exam than fifth-year students (OR = 0.48; CI: 0.28-0.83). CONCLUSION: Only a minority of dentistry students had a good level of knowledge about biosafety against COVID-19. Younger and less educated students were more likely to fail the questionnaire. On the other hand, those students with outstanding academic performance were more likely to pass the questionnaire.

"Nurse-The Archer" Fighting Against the Hidden Enemy.

Background and aim: The coronavirus disease-2019 (COVID-19) pandemic is a global threat spreading like a wildfire and taking the world by its storm. It has challenged the healthcare delivery systems and disrupted them in a way no one ever imagined before. We at Apollo Hospitals, Chennai, Tamil Nadu, India received many patients in the COVID critical care unit (CCU) and found a gradual lack of bundle care compliance resulting in an upsurge of central line-associated bloodstream infection (CLABSI) amid the patients. Materials and methods: A qualitative research approach and quasi-experimental research design were selected to assess the knowledge of the 150 frontline COVID CCU nurses regarding the CLABSI bundle and its prevention strategies. Results: This study revealed that 57% [mean (M) = 12.6; standard deviation (SD) = 2.37] of nurses had inadequate knowledge of the CLABSI bundle and its prevention strategies, in the pretest and scored 80% (M = 6.7; SD = 2.28) in the post-test, with "t" = 22.06 at p < 0.00001 after the hands-on training. The percentage of compliance to CLABSI bundle care increased to 83% and thereafter in an increasing trend. This was clearly evident through the reduction in the preventable CLABSI rate among critically ill COVID-19 patients. Conclusion: Nurses are on the frontline in preventing and controlling healthcare-associated infections (HAIs). Fighting with all the visible and invisible challenges, our research focused on hands-on training for frontline warriors to adhere to the CLABSI bundle care which drove us to the reduction in preventable CLABSI rate in our hospital through improved CLABSI bundle compliance. How to cite this article: Premkumar S, Ramanathan Y, Varghese JJ, Morris B, Nambi PS, Ramakrishnan N, et al. "Nurse-The Archer" Fighting Against the Hidden Enemy. Indian J Crit Care Med 2023;27(4):246-253.

Bubble-PAPR: a phase 1 clinical evaluation of the comfort and perception of a prototype powered air-purifying respirator for use by healthcare workers in an acute hospital setting.

OBJECTIVES: We aimed to design and produce a low-cost, ergonomic, hood-integrated powered air-purifying respirator (Bubble-PAPR) for pandemic healthcare use, offering optimal and equitable protection to all staff. We hypothesised that participants would rate Bubble-PAPR more highly than current filtering face piece (FFP3) face mask respiratory protective equipment (RPE) in the domains of comfort, perceived safety and communication. DESIGN: Rapid design and evaluation cycles occurred based on the identified user needs. We conducted diary card and focus group exercises to identify relevant tasks requiring RPE. Lab-based safety standards established against British Standard BS-EN-12941 and EU2016/425 covering materials; inward particulate leakage; breathing resistance; clean air filtration and supply; carbon dioxide elimination; exhalation means and electrical safety. Questionnaire-based usability data from participating front-line healthcare staff before (usual RPE) and after using Bubble-PAPR. SETTING: Overseen by a trial safety committee, evaluation progressed sequentially through laboratory, simulated, low-risk, then high-risk clinical environments of a single tertiary National Health Service hospital. PARTICIPANTS: 15 staff completed diary cards and focus groups. 91 staff from a range of clinical and non-clinical roles completed the study, wearing Bubble-PAPR for a median of 45 min (IQR 30-80 (15-120)). Participants self-reported a range of heights (mean 1.7 m (SD 0.1, range 1.5-2.0)), weights (72.4 kg (16.0, 47-127)) and body mass indices (25.3 (4.7, 16.7-42.9)). OUTCOME MEASURES: Preuse particulometer 'fit testing' and evaluation against standards by an independent biomedical engineer.Primary:Perceived comfort (Likert scale).Secondary: Perceived safety, communication. RESULTS: Mean fit factor 16 961 (10 participants). Bubble-PAPR mean comfort score 5.64 (SD 1.55) vs usual FFP3 2.96 (1.44) (mean difference 2.68 (95% CI 2.23 to 3.14, p<0.001). Secondary outcomes, Bubble-PAPR mean (SD) versus FFP3 mean (SD), (mean difference (95% CI)) were: how safe do you feel? 6.2 (0.9) vs 5.4 (1.0), (0.73 (0.45 to 0.99)); speaking to other staff 7.5 (2.4) vs 5.1 (2.4), (2.38 (1.66 to 3.11)); heard by other staff 7.1 (2.3) vs 4.9 (2.3), (2.16 (1.45 to 2.88)); speaking to patients 7.8 (2.1) vs 4.8 (2.4), (2.99 (2.36 to 3.62)); heard by patients 7.4 (2.4) vs 4.7 (2.5), (2.7 (1.97 to 3.43)); all p<0.01. CONCLUSIONS: Bubble-PAPR achieved its primary purpose of keeping staff safe from airborne particulate material while improving comfort and the user experience when compared with usual FFP3 masks. The design and development of Bubble-PAPR were conducted using a careful evaluation strategy addressing key regulatory and safety steps. TRIAL REGISTRATION NUMBER: NCT04681365.

[Recommendations for action for SARS-CoV-2 testing concepts for asymptomatic healthcare workers]. / Handlungsempfehlungen für SARS-CoV-2-Testkonzepte für asymptomatische Beschäftigte im Gesundheitswesen.

Background and objective: When implementing SARS-CoV­2 testing concepts in healthcare facilities, different laws and regulations of equal rank apply. In the light of experienced impediments in translating legal requirements appropriately into legally secure concepts on an operational level, the objective of this paper was to develop corresponding specific recommendations for action. Methods: On the basis of guiding questions on previously identified fields of action, a focus group consisting of representatives of administration, different medical disciplines, and special interest groups discussed critical aspects of implementation using a holistic approach. The transcribed contents were analyzed through inductive development and deductive application of categories. Results: All contents of discussion could be matched with the identified categories legal backgrounds, requirements and objectives of testing concepts in healthcare facilities, responsibilities for implementing in operational decision-making chains, and implementing SARS-CoV­2 testing concepts. Implications: The correct implementation of the legal requirements into legally compliant SARS-CoV­2 testing concepts in healthcare facilities previously required the involvement of ministries, representatives of different medical disciplines and professional associations, employer and employee representatives and data privacy experts as well as representatives of possible cost bearers. In addition, an integrative and enforceable composition of laws and regulations is necessary. Defining objectives for testing concepts is significant for the following operational process flows that need to consider aspects of employee data privacy as well as providing additional personnel for fulfilling the tasks. Also, in future one central issue of healthcare facilities concerns the finding of solutions for IT interfaces for information transfer to employees in accordance with data privacy.

Practical infection control training for Victoria's aged care workforce at the time of COVID-19 pandemic: a community case study.

The need to improve career development and training for residential aged care workers in Australia to achieve required essential competencies, including infection prevention and control competencies, has been repeatedly highlighted. In Australia long-term care settings for older adults are known as residential aged care facilities (RACFs). The COVID-19 pandemic has brought to light the lack of preparedness of the aged care sector to respond to emergencies, and the urgent need to improve the infection prevention and control training in residential aged care facilities. The government in the Australian State of Victoria allocated funds to support older Australians in RACFs, including funds toward infection prevention and control training of RACF staff. The School of Nursing and Midwifery at Monash University addressed some of these challenges in delivering an education program on effective infection prevention and control practices to the RACF workforce in Victoria, Australia. This was the largest state-funded program delivered to RACF workers to date in the State of Victoria. The aim of this paper is to provide a community case study, where we share our experience of program planning and implementation during early stages of the COVID-19 pandemic and lessons learned.

Respiratory Viral Infections in Recipients of Cellular Therapies: A Review of Incidence, Outcomes, Treatment, and Prevention.

Respiratory viral infections (RVIs) are of major clinical importance in immunocompromised patients and represent a substantial cause of morbidity and mortality in patients with hematologic malignancies and those who have undergone hematopoietic cell transplantation. Similarly, patients receiving immunotherapy with CD19-targeted chimeric antigen receptor-modified T cells, natural killer cells, and genetically modified T-cell receptors are susceptible to RVIs and progression to lower respiratory tract infections. In adoptive cellular therapy recipients, this enhanced susceptibility to RVIs results from previous chemotherapy regimens such as lymphocyte-depleting chemotherapy conditioning regimens, underlying B-cell malignancies, immune-related toxicities, and secondary prolonged, profound hypogammaglobulinemia. The aggregated risk factors for RVIs have both immediate and long-term consequences. This review summarizes the current literature on the pathogenesis, epidemiology, and clinical aspects of RVIs that are unique to recipients of adoptive cellular therapy, the preventive and therapeutic options for common RVIs, and appropriate infection control and preventive strategies.

Virtual family-centered rounds: a quality improvement initiative to adapt inpatient care during COVID-19 using a human-centred participatory design approach.

BACKGROUND: Family-centered rounds (FCR) are fundamental to pediatric inpatient care. During the COVID-19 pandemic, we aimed to design and implement a virtual family-centered rounds (vFCR) process that allowed continuation of inpatient rounds while following physical distancing guidelines and preserving personal protective equipment (PPE). METHODS: A multidisciplinary team developed the vFCR process using a participatory design approach. From April through July 2020, quality improvement methods were used to iteratively evaluate and improve the process. Outcome measures included satisfaction, perceived effectiveness, and perceived usefulness of vFCR. Data were collected via questionnaire distributed to patients, families, staff and medical staff, and analyzed using descriptive statistics and content analysis. Virtual auditors monitored time per patient round and transition time between patients as balancing measures. RESULTS: Seventy-four percent (51/69) of health care providers surveyed and 79% (26/33) of patients and families were satisfied or very satisfied with vFCR. Eighty eight percent (61/69) of health care providers and 88% (29/33) of patients and families felt vFCR were useful. Audits revealed an average vFCR duration of 8.4 min (SD = 3.9) for a single patient round and transition time between patients averaged 2.9 min (SD = 2.6). CONCLUSION: Virtual family-centered rounds are an acceptable alternative to in-person FCR in a pandemic scenario, yielding high levels of stakeholder satisfaction and support. We believe vFCR are a useful method to support inpatient rounds, physical distancing, and preservation of PPE that may also be valuable beyond the pandemic. A rigorous process evaluation of vFCR is underway.

Cycle Threshold (Ct) Values of SARS-CoV-2 Detected with the GeneXpert® System and a Mutation Associated with Different Target Gene Failure.

SARS-CoV-2 nucleic acid detection tests enable rapid virus detection; however, it is challenging to identify genotypes to comprehend the local epidemiology and infection routes in real-time qRT-PCR. At the end of June 2022, our hospital experienced an in-hospital cluster of COVID-19. When examined using the GeneXpert® System, the cycle threshold (Ct) value of the N2 region of the nucleocapsid gene of SARS-CoV-2 was approximately 10 cycles higher than that of the envelope gene. Sanger sequencing revealed a G29179T mutation in the primer and probe binding sites. A review of past test results revealed differences in Ct values in 21 of 345 SARS-CoV-2-positive patients, of which 17 cases were cluster-related and 4 were not. Including these 21 cases, 36 cases in total were selected for whole-genome sequencing (WGS). The viral genomes in the cluster-related cases were identified as BA.2.10, and those in the non-cluster cases were closely related and classified as being downstream of BA.2.10 and other lineages. Although WGS can provide comprehensive information, its use is limited in various laboratory settings. A measurement platform reporting and comparing Ct values of different target genes can improve test accuracy, enhance our understanding of infection spread, and be applied to the quality control of reagents.

Analysis of social and psychological factors influencing the treatment of patients with chronic kidney disease under the regular epidemic prevention and control of coronavirus disease 2019.

Objective To explore the sociodemographic and psychological factors influencing the continuity of treatment of patients with chronic kidney disease under the regular epidemic prevention and control of coronavirus disease 2019 (COVID-19). Methods A total of 277 patients with chronic kidney disease who were admitted to Department of Nephrology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Apr. 2020 to Mar. 2021 were enrolled and divided into 3 groups: non-dialysis group (n=102), hemodialysis (HD) group (n=108), and peritoneal dialysis (PD) group (n=67). All patients were investigated by online and offline questionnaires, including self-designed basic situation questionnaire, self-rating anxiety scale (SAS), and self-rating depression scale (SDS). The general sociodemographic data, anxiety and depression of the 3 groups were compared, and the influence of sociodemographic and psychological factors on the interruption or delay of treatment was analyzed by binary logistic regression model. Results There were significant differences in age distribution, marital status, occupation, medical insurance type, caregiver type, whether there was an urgent need for hospitalization and whether treatment was delayed or interrupted among the 3 groups (all P0.05). The average SAS score of 65 PD patients was 38.15+/-15.83, including 53 (81.5%) patients without anxiety, 7 (10.8%) patients with mild anxiety, and 5 (7.7%) patients with moderate to severe anxiety. The average SAS score of 104 patients in the HD group was 36.86+/-14.03, including 81 (77.9%) patients without anxiety, 18 (17.3%) patients with mild anxiety, and 5 (4.8%) patients with moderate to severe anxiety. There were no significant differences in the mean score of SAS or anxiety severity grading between the 2 groups (both P0.05). The mean SDS scores of 65 PD patients were 53.42+/-13.30, including 22 (33.8%) patients without depression, 21 (32.3%) patients with mild depression, and 22 (33.8%) patients with moderate to severe depression. The mean SDS scores of 104 patients in the HD group were 50.79+/-10.76, including 36 (34.6%) patients without depression, 56 (53.8%) patients with mild depression, and 12 (11.6%) patients with moderate to severe depression. There were no significant differences in mean SDS scores or depression severity grading between the 2 groups (both P0.05). The results of intra-group comparison showed that the incidence and severity of depression were higher than those of anxiety in both groups. Multivariate binary logistic regression analysis showed that high school education level (odds ratio OR=5.618, 95% confidence interval CI) 2.136-14.776, P0.01), and unmarried (OR=6.916, 95% CI 1.441-33.185, P=0.016), divorced (OR= 5.588, 95% CI 1.442-21.664, P=0.013), urgent need for hospitalization (OR=8.655, 95% CI 3.847-19.476, P0.01) could positively promote the continuity of treatment in maintenance dialysis patients under the regular epidemic prevention and control of COVID-19. In the non-dialysis group, no sociodemographic and psychological factors were found to be associated with the interruption or delay of treatment (P0.05). Conclusion Education, marital status, and urgent need for hospitalization are correlated with the continuity of treatment in patients with chronic kidney disease on maintenance dialysis.Copyright © 2022, Second Military Medical University Press. All rights reserved.

Prevention of Infection in Kidney Patients

Renal patients are particularly vulnerable to infection in part because they are relatively, or significantly, immunocompromised, undergo numerous invasive procedures and typically have frequent contact with healthcare institutions putting them at much higher risk of nosocomial infections. In addition, they are typically exposed to multiple antibiotics, which may select out resistant organisms or damage protective microbiomes. The Covid-19 pandemic has brought the life and death importance of infection control to every renal unit and forced a, perhaps overdue, appreciation of the issues and responsibilities associated with nosocomial infections. In addition, our patients are disproportionately impacted by the growing emergence of antimicrobial resistance. This chapter reviews the key aspects of nosocomial infections in renal patients and the important elements of infection control and antibiotic stewardship that can protect our patients. © Springer Nature Switzerland AG 2014, 2022.

Ozone use in surface disinfection: an integrative review

Objective: To analyze the scientific evidence regarding the effectiveness of using ozone to disinfect surfaces based on an integrative literature review.Methods: A search was carried out in the SciELO, MEDLINE, LILACS, PubMed, Science Direct databases. Eleven articles published January 2010 to August 2021 were analyzed. All employed the experimental laboratory research model and achieved different levels of disinfection by O3, however, with varied surfaces and products tested, in addition to different methodological procedures.Results: The majority had an inhibition rate by O3 equal to or greater than 90%, thus proving the effectiveness of this agent as a surface disinfectant, even with variations in parameter values such as concentration and exposure time, in all selected articles, even those that did not prove the effectiveness of O3.Conclusion: This review shows the inhibitory power that O3 has on different pathogens, even if there are variables in the factors used for this purpose, highlighting it in front of other disinfectants. Thus, it corroborates the composition of surface disinfection protocols and decision-making among managers and committees about sanitizing technologies.

Cross Infection Control Awareness During 5th Wave of Covid 19 Pandemic, Omicron Variant Amongst the Dental Health Care Professionals of Government Sector University in Karachi, Pakistan

Objective: The objective of this study is to evaluate the awareness of cross-infection control measures followed by DHCPs during the 5th wave of Covid-19 pandemic, Omicron variant in a government sector university of Karachi, Pakistan. Method(s): A Cross-sectional study was conducted from June till September 2022 at Sindh Institute of Oral Health Science during the 5th wave of Covid 19 pandemic, Omicron variant. Data was collected from 153 DHCPs from government sector university using a self-administered questionnaire, comprising of 20 closed ended question to assess the awareness and practice of cross infection protocols by DHCPs. Result(s): 98.7% of the participants were vaccinated against Covid 19. 96% of the participants used surgical gowns, face shields, and face masks as part of PPE during examining patients and while performing procedure. After treatment 99.3% of participants washed hands with hand wash, soap or used antiseptic solution. 77.1% of participants asked for Covid 19 test report and 68.6% of participants asked for proof of vaccination against covid 19 before treating patients. 96.1% of participants recommended disinfection of dental unit after every patient. 98% of participants changed glove after every patient. 88.2% of the participants said they would carry all elective and emergency procedures. Conclusion(s): The results of this study show that DHCPs practicing at government sector university have adequate knowledge regarding prevention of cross infection protocols and their importance to limit spread of infections. But their practice of prevention of cross infection during Covid 19 pandemic is not ideal as percentage of DHCPs requiring proof of vaccination or negative reports for Covid 19 were rather low and the percentage of DHCPs willing to carry elective procedures along with emergency ones was rather high.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Epidemics, pandemics and dentistry: a commentary

There is no doubt that epidemics and pandemics have transformed dentistry beyond recognition. In this commentary we recapitulate the possible reasons for the emergence of major global epidemics and pandemics, how and why they emerge, and the successful attempts of the dental profession to mitigate infectious transmission in the clinic, which in turn has metamorphosed our profession today. We also peer into the future of dentistry through the prism of the new conceptual approach of 'one world, one health' recently declared by the Centers for Disease Control (CDC). Finally, we discuss five realms of dentistry that have been irretrievably impacted by the recent COVID-19 pandemic, viz vaccines, point of care diagnostics, teledentistry, reinforced infection control, and dental pedagogy. CPD/Clinical Relevance: Vaccines and vaccinations have become integral to societal wellbeing and the prevention of global pandemics.

24th Collegium Ramazzini Statement: Prevention of Work-Related Infection in the COVID-19 Pandemic

Background: Workers whose occupations put them in contact with infected persons and the public are at increased risk of coronavirus disease (COVID-19) infection. Recommendations: The Collegium Ramazzini calls on governments at all levels to protect worker health by strengthening public health systems;maintaining comprehensive social insurance systems;establishing policies that presume all COVID-19 infections in high-risk workers are work-related;enforcing all occupational health standards;and developing pandemic preparedness plans. The Collegium Ramazzini calls on all employers-large and small, public and private-to protect the health of all workers by developing disease preparedness plans;implementing basic infection control measures;establishing disease identification and isolation policies;reducing hazardous exposures;supporting personal protective equipment (PPE) programs;and restricting unnecessary travel. Conclusion(s): Governments and employers have legal obligations to protect worker health. They are not relieved of these duties during pandemics.Copyright © 2020 American College of Occupational and Environmental Medicine.

Burnout and Wellbeing during the Second Covid-19 Wave: Are There Differences between Medical Specialties?

Introduction: Burnout is common amongst clinical staff. Critical Care is widely accepted to have amongst the highest rates, with an incidence of >38%.1 The Covid-19 pandemic placed unprecedented pressures on staff, making them vulnerable to burnout.2 Although stressors were similar across medical teams, we suspected there were differences in burnout between medical specialties. Objective(s): This study aimed to examine burnout amongst the hospital MDT, focussing on three higher care clinical areas: Coronary Care (CCU), Respiratory (RSU) and Critical Care (ICU) and identify recurring positive and negative experiences. Method(s): Between March and April 2021 staff were invited to complete a two-part survey. Part one investigated demographic data and free text answers on feelings towards Covid-19. Part two questioned recipients on the 22 questions of the MBI -HSS (Maslach Burnout Index- Human Services Survey).3 This survey assesses burn-out in three domains: Emotional Exhaustion (EE), Depersonalisation (DP), and lack of Personal Accomplishment (PA). MBI-HSS results were analysed and a previously used 'high-risk' cut-off was used to calculate percentages per domain and overall. Free text analysis was conducted by two researchers to identify common themes, protective factors and negative factors which may increase burnout. Result(s): 148 staff members responded to the survey: 53% of respondents met the criteria for burnout in at least one domain. 58% of ICU staff, 42% of RSU staff and 44% of CCU staff were burnt out in one domain or more. ICU had the highest percentage of staff at high risk of EE and lack of PA. RSU had the highest percentage of staff scoring highly for DP. Free text analysis demonstrated some positive experiences from the Covid-19 pandemic: teamwork, communication, resilience, and opportunities to learn new skills were highlighted by staff across all areas. All areas found staffing and workload a negative factor. In ICU, workspace organisation and long shifts in PPE were key stressors which made communication and taking breaks safely difficult. Managing stress and uncertainty were highlighted by the ICU teams. In RSU, a significant proportion of staff found the lack of established treatments and poor outcomes difficult to manage, potentially highlighting the differences in Covid-19 management compared with ICU. As nursing staff work with higher ratios in RSU, some found managing patients' needs difficult: "Not having enough time to care for patients' basic needs . . . patients in side-rooms were left feeling isolated and scared". In CCU, there was a shift towards fear of catching the virus, PPE provision and poor infection control guidance, possibly arising from lower exposure to Covid-19: "It felt like the trust didn't give a s**t about their staff with regard to PPE and vaccinations." Conclusion(s): All clinical areas highlighted increased teamwork as a positive outcome of the Covid-19 pandemic, and good relationships have been built, a known protective factor against burnout. Many negative factors have impacted the rate of burnout, including high workload, staffing issues, redeployment and managing death and uncertainty. We hope to resurvey the same areas to assess wellbeing one year on, and address key factors to improve wellbeing.

Anesthesia management of athletes' operation in Beijing Olympic Winter Games.

According to literature reports, the injury rate of the athletes in Olympic Winter Games recent years was as high as 10%-14%. Combined with the background of corona virus disease 2019 (COVID-19), the medical insurance work of the 24th Olympic Winter Games held in Beijing had put forward more complicated requirements and more severe challenges. In order to better optimize anesthesia management, this article summarized the perioperative treatment of athletes in Olympic Winter Games, the safety protection strategy of medical staff under general anesthesia, and the potential impact of peri-operative drugs on athletes. Anesthesiologists, as the core members of the rescue team, should be familiar with the particularity of operative anesthesia of athletes, sum up relevant experience to ensure the safety of perioperative patients. So all kinds of technical measures should be taken in the process of operation to minimize the indoor pollution caused by the patient's cough. For example, all the patients should wear N95 masks from the ward to the operating room, and after the operation, wear the N95 masks back to the ward. Although the International Olympic Committee had banned more than 200 drugs for participants and athletes who had to strictly follow International Olympic Committee requirements during anesthesia, the athletes were no longer participating in this Olympic Winter Games, so opioids (sufentanil and remifentanil) and glucocorticoid (dexamethasone) could be used according to the actual needs of surgery and anesthesia. Five athletes in Yanqing competition area underwent surgical anesthesia in Peking University Third Hospital Yanqing Hospital. All the five patients received general anesthesia, of whom four underwent orthopaedic surgery and one underwent laparoscopic cholecystectomy. General anesthesia with laryngeal mask airway was the first choice in the five patients. And the pain after orthopaedic surgery was severe and nerve block technique could effectively relieve the pain after surgery. Three patients received ultrasound-guided nerve block analgesia, the postoperative analgesia lasted 36 h. After the operation, non-steroidal anti-inflammatory drug (NSAID) was infused intravenously in the ward and all the patients recovered uneventfully. As the core member of the trauma rescue team, anesthesiologists should be familiar with the particularity of the athletes' surgical anesthesia, do a good job in medical security, and summarize relevant experience to ensure the life safety of the perioperative patients.

Designing the post-pandemic hospice environment: "The last place"

Where and how people die is a significant concern of human life and society (Worpole, 2009). In these days, people die either in their home or in an end-of-life care facility, such as hospice. Hospice is a place to provide end-of-life care to individuals certified as "terminal." Hospice care or end-of-life care is a multidisciplinary care and support (non-curative) system designed to address the physical, emotional, psychosocial, and spiritual concerns of terminal patients and their families. Thus, the facility design is significantly different in various dimensions. For example, hospice patients are mostly bed-bound, and a patient's family accommodation plays a significant role in the patient's dying experience. Providing a supportive physical environment of hospice has an imperative impact on the patient "quality of life" and the possibility of a "good death." With the COVID-19 challenges, it has become significant to explore the best possible solutions of hospice facility design. This chapter discusses the 11 therapeutic goals of hospice care environment which was developed by Kader and Diaz Moore in 2015 considering dying experiences. The physical settings of hospice along with the carefully designed organizational environment can contribute to the realization of desired therapeutic goals and have a positive effect on the lives of dying patients. This chapter discusses each therapeutic goal and how hospice facility design can support these goals with a few examples and presents six major design-related challenges of post-pandemic (COVID-19) hospice care facilities. Lastly, several prospective design concepts have explored considering pandemic resiliency. (PsycInfo Database Record (c) 2023 APA, all rights reserved)