The Relationship Between Patient Safety Culture and the Intentions of the Nursing Staff to Report a Near-Miss Event During the COVID-19 Crisis.

BACKGROUND: Reporting a near-miss event has been associated with better patient safety culture. PURPOSE: To examine the relationship between patient safety culture and nurses' intention to report a near-miss event during COVID-19, and factors predicting that intention. METHODS: This mixed-methods study was conducted in a tertiary medical center during the fourth COVID-19 waves in 2020-2021 among 199 nurses working in COVID-19-dedicated departments. RESULTS: Mean perception of patient safety culture was low overall. Although 77.4% of nurses intended to report a near-miss event, only 20.1% actually did. Five factors predicted nurses' intention to report a near-miss event; the model explains 20% of the variance. Poor departmental organization can adversely affect the intention to report a near-miss event. CONCLUSIONS: Organizational learning, teamwork between hospital departments, transfers between departments, and departmental disorganization can affect intention to report a near-miss event and adversely affect patient safety culture during a health crisis.

Persistence and distribution of SARS-CoV-2 in the aerosol and on the surfaces.

ABSTRACT: The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has created havoc worldwide ever since its emergen-ce in December 2019. The current evidence indicates that the virus remains viable in aerosols for hours and on fomites for few days. A little information is available on the topic, the present communication reviews the perseverance and distribution of the novel coronavirus in the aerosol and on various inanimate surfaces so that the appropriate safety measures can be undertaken and the virus protection guidelines may be framed accordingly.

Experiences and Views of Domestic Summer Travelers During the COVID-19 Pandemic: Findings from a National Survey.

Domestic travel creates a serious risk of spreading COVID-19, including novel strains of the virus. Motivating potential travelers to take precautions is critical, especially for those at higher risk for severe illness. To provide an evidence base for communication efforts, we examined the experiences and views of travelers during the summer of 2020 through a telephone survey of 1,968 US adults, conducted in English and Spanish, July 2 through July 16, 2020. The survey found that more than one-quarter (28%) of adults had traveled domestically in the prior 30 days, most commonly for "vacation" (43%), and less than half wore masks (46%) or practiced social distancing (47%) "all of the time." Although high-risk adults were significantly less likely to travel than non-high-risk adults (23% vs 31%; P < .001), they were no more likely to take precautions. Many travelers did not wear a mask or practice social distancing because they felt such actions were unnecessary (eg, they were outside or with friends and family). Although a substantial share of travelers (43% to 53%) trusted public health agencies "a great deal" for information about reducing risks while traveling, more travelers (73%) trusted their own healthcare providers. Findings suggest that outreach may be improved by partnering with providers to emphasize the benefits of layering precautions and provide targeted education to high-risk individuals. Messages that are empathetic to the need to reduce stress and convey how precautions can protect loved ones may be particularly resonant after more than a year of pandemic-related restrictions.

Laser dentistry in daily practice during the COVID-19 pandemic: Benefits, risks and recommendations for safe treatments.

The COVID-19 pandemic forced dental professionals to cope with an unexpected challenge and caused an abrupt cessation of conventional care practices. The high degree of contagiousness as well as the diffusion of the virus through the air and droplets via respiratory transmission placed dental professionals at top-level risk of contracting and spreading the disease. General recommendations were announced in different countries, including patient distancing, air ventilation, surface and instrument sanitization, and the wearing of suitable masks and shields. However, many dental treatments are performed using lasers, and some specific precautions must be added to conventional procedures to ensure the advantages of this technology to patients because of the particular tissue­matter interaction effects of laser wavelengths. Based on the literature, the authors evaluated all of using laser wavelengths to analyze the risk and the benefits of using lasers in daily dental practice, and to provide safety recommendations during pandemic. An unrestricted search of indexed databases was performed. Laser use effects were categorized into: 1) explosive processes that produce tissue ablation and aerosol formation; 2) thermal actions that create vaporization and smoke plume; 3) photobiomodulation of the cells; and 4) enhanced chemical activity. Knowledge of the device functions and choice of adequate parameters will reduce aerosol and plume formation, and the application of suction systems with high flow volume and good filtration close to the surgical site will avoid virus dissemination during laser use. In the categories that involve low energy, the beneficial effects of lasers are available and sometimes preferable during this pandemic because only conventional precautions are required. Lasers maintain the potential to add benefits to dental practice even in the COVID-19 era, but it is necessary to know how lasers work to utilize these advantages. The great potential of laser light, with undiscovered limits, may provide a different path to face the severe health challenges of this pandemic.

Pivoting Dental Practice Management during the COVID-19 Pandemic-A Systematic Review.

Background and Objectives: The aims of this systematic review were to identify additional infection control measures implemented in dental practice globally to prevent cross-infection and evaluate the psychological impacts of the pandemic among dental professionals. Materials and Methods: A sequential systematic literature search was conducted from December 2019 to 30 April 2020 through PubMed, CINAHL, Scopus, Google Scholar, Embase, and Web of Science databases. The search yielded the following results: "COVID-19" (n = 12,137), "Novel corona virus" (n = 63), "COVID-19 and dentistry" (n = 46), "COVID-19 and oral health" (n = 41), "Novel Corona virus and Dentistry" (n = 0), "dental health and Novel Coronavirus" (n = 26), and "dental practice and Novel Coronavirus" (n = 6). Results: After a careful review and eliminating articles based on inclusion and exclusion criteria, the final review included 13 articles. Management of infection control is discussed extensively in the literature and remains the main theme of many Coronavirus Disease 2019 (COVID-19) articles on dentistry. Telephone triage using a questionnaire, hand hygiene, personal protective equipment (PPE) for clinical and nonclinical staff, a preprocedural mouth rinse, and aerosol management have been discussed and implemented in few countries. Three studies recommended that elective treatments for patients with a temperature of >100.4 F or 38 °C should be postponed or performed in an airborne infection isolation room (AIIR) or negative-pressure room. Limiting the number of patients in the waiting area, the removal of shared objects, proper ventilation, and physical distancing were highly recommended. Psychological distress among dental professionals in relation to existing medical conditions and self-efficacy has been discussed. Conclusions: Although the COVID-19 pandemic has had a substantial impact on the dental profession worldwide, our review highlights many practice management approaches to adopt the new norm. More research highlighting evidence-based safety practices and multisectoral collaboration is required to help dental professionals make informed decisions and make the profession safe, both for the patient and dental professionals.

A Critical Care Transport Program's Innovative Approach to Safety During the Coronavirus Disease 2019 Pandemic.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has resulted in the frequent transfer of critically ill patients, yet there is little information available to assist critical care transport programs in protecting their clinicians from disease exposure in this unique environment. The Lifeline Critical Care Transport Program has implemented several novel interventions to reduce the risk of staff exposure. METHODS: Several safety interventions were implemented at the beginning of the COVID-19 pandemic. These initiatives included the deployment of a transport safety officer, a receiving clean team for select interfacility transports, and modifications in personal protective equipment. RESULTS: From February 29, 2020, to August 29, 2020, there were 1,041 transports of persons under investigation, 660 (63.4%) of whom were ultimately found to be COVID-19 positive. Approximately one third were ground transports, 11 (1.1%) were by air, and the remainder were intrahospital transports. There were 0 documented staff exposures or illnesses during the study period. CONCLUSION: The adaptation of these safety measures resulted in 0 staff exposures or illnesses while maintaining a high-volume, high-acuity critical care transport program. These interventions are the first of their kind to be implemented during the COVID-19 pandemic and offer a framework for other organizations and future disease outbreaks.

Urgent safety considerations for dermatologic surgeons in the COVID-19 pandemic.

Dermatologic surgeons are at increased risk of contracting SARS-COV-2. At time of writing, there is no published standard for the role of pre-operative testing or the use of smoke evacuators, and personal protective equipment (PPE) in dermatologic surgery. Risks and safety measures in otolaryngology, plastic surgery, and ophthalmology are discussed. In Mohs surgery, cases involving nasal or oral mucosa are highest risk for SARS-COV-2 transmission; pre-operative testing and N95 masks should be urgently prioritized for these cases. Other key safety recommendations include strict control of patient droplets and expanded pre-clinic screening. Dermatologic surgeons are encouraged to advocate for appropriate pre-operative tests, smoke evacuators, and PPE. Future directions would include national consensus guidelines with continued refinement of safety protocols.

OSHA Voluntary Respirator Use: Challenges incurred with use of N95 filtering facepiece respirators during the COVID-19 pandemic.

This article discusses several lessons learned in dealing with the interpretation of the Occupational Health and Safety Administration (OSHA) Voluntary Use provision of the Respiratory Health Standard at health-care facilities during the COVID-19 pandemic in the United States. This includes (but is not limited to) (a) confusion about OSHA policy and procedures when health-care workers brought outside personal protective equipment (PPE; N95 filtering facepiece respirators) into the workplace; (b) challenges in adhering to guidelines stated in Appendix D of the Respiratory Protection Standard; (c) difficulty in achieving respirator fit testing for workers; and (d) vague or inconsistent determination of "non-hazardous" environments (concerning COVID-laden droplets and aerosols). The purpose was to identify gaps in knowledge to help policy makers, enforcement personnel, safety managers, and health-care workers in the United States prepare for similar future events involving PPE shortages.

[Safe management of COVID-19 dead bodies in sub-Saharan Africa: could families be allowed to bury their dead?] / Gestion sécurisée des dépouilles de personnes décédées de la COVID-19 en Afrique sub-Saharienne: et si on laissait les familles enterrer leurs morts?

Sub-Saharan African countries have been hit by the Coronavirus 2019 pandemic (COVID-19) since March 2020. Besides the resulting health and economic disasters is the psycho-socio-cultural problem related with the management of corpses of people dead from the disease, which might hinder the implementation of the response strategy. In Cameroon for instance, the current corpse management policy is very disputed. In fact, although they were recently made more flexible, the restrictions applied to burials still ban any transfer of dead bodies between cities. In light of the African cultural considerations of dead persons, the disputes observed between the families and the health personnel, the legislation and the available scientific evidence, this article analyses the risks and benefits of allowing families to bury their relatives. It thereafter suggests solutions that reconcile dignity (by allowing families to bury their dead relatives in their homes) and safety (by ensuring a sealed handling and the surveillance by a judiciary police officer). Applying these solutions could improve the population's trust towards the health system, and positively contribute to COVID-19 case prevention, identification and management.

The importance of quality and accreditation in health care services in the process of struggle against Covid-19

Background/aim: The aim of this research is to evaluate the relationship between the quality of health and accreditation standards with the Covid-19 process and to reveal the importance of quality and accreditation in health care in the process of combating coronavirus. Materials and methods: The relationship between hospital accreditation standards of Turkish Healthcare Quality and Accreditation Institute and the Covid-19 process was evaluated. The standards were analyzed within the framework of the technical guidance areas provided by the World Health Organization for countries for the Covid-19 process. Results: The standards were found to be 79,6% related to the Covid-19 process. The standard set including risk management, health and safety of employees, patient safety, end of life services, prevention of infections, drug management, sterilization management, laboratory services, waste management, outsourcing, material and device management, adverse event reporting, corporate communication, and social responsibilities sections are 100% related to the Covid-19 process. Conclusion: Studies on quality and accreditation in health services are important in terms of being prepared for Covid-19 and similar epidemic and pandemic situations, and to carry out planned and effective management of the process.

COVID-19 Pandemic: What Every Otolaryngologist-Head and Neck Surgeon Needs to Know for Safe Airway Management.

The novel coronavirus disease 2019 (COVID-19) pandemic has unfolded with remarkable speed, posing unprecedented challenges for health care systems and society. Otolaryngologists have a special role in responding to this crisis by virtue of expertise in airway management. Against the backdrop of nations struggling to contain the virus's spread and to manage hospital strain, otolaryngologists must partner with anesthesiologists and front-line health care teams to provide expert services in high-risk situations while reducing transmission. Airway management and airway endoscopy, whether awake or sedated, expose operators to infectious aerosols, posing risks to staff. This commentary provides background on the outbreak, highlights critical considerations around mitigating infectious aerosol contact, and outlines best practices for airway-related clinical decision making during the COVID-19 pandemic. What otolaryngologists need to know and what actions are required are considered alongside the implications of increasing demand for tracheostomy. Approaches to managing the airway are presented, emphasizing safety of patients and the health care team.

Assessing and managing the risks of COVID-19 in the workplace: Applying industrial hygiene (IH)/occupational and environmental health and safety (OEHS) frameworks.

As businesses attempt to reopen to varying degrees amid the current coronavirus disease (COVID-19) pandemic, industrial hygiene (IH) and occupational and environmental health and safety (OEHS) professionals have been challenged with assessing and managing the risks of COVID-19 in the workplace. In general, the available IH/OEHS tools were designed to control hazards originating in the workplace; however, attempts to tailor them specifically to the control of infectious disease outbreaks have been limited. This analysis evaluated the IH decision-making framework (Anticipate, Recognize, Evaluate, Control, and Confirm ("ARECC")) as it relates to biological hazards, in general, and to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), specifically. Available IH/OEHS risk assessment and risk management tools (e.g. control banding and the hierarchy of controls) are important components of the ARECC framework. These conceptual models, however, were primarily developed for controlling chemical hazards and must be adapted to the unique characteristics of highly infectious and virulent pathogens, such as SARS-CoV-2. This assessment provides an overview of the key considerations for developing occupational infection control plans, selecting the best available controls, and applying other emerging tools (e.g. quantitative microbial risk assessment), with the ultimate goal of facilitating risk management decisions during the current global pandemic.

Impact of labor and delivery unit policy modifications on maternal and neonatal outcomes during the coronavirus disease 2019 pandemic.

Background: In response to the coronavirus disease 2019 pandemic, hospitals nationwide have implemented modifications to labor and delivery unit practices designed to protect delivering patients and healthcare providers from infection with severe acute respiratory syndrome coronavirus 2. Beginning in March 2020, our hospital instituted labor, and delivery unit modifications targeting visitor policy, use of personal protective equipment, designation of rooms for triage and delivery of persons suspected or infected with coronavirus disease 2019, delivery management, and newborn care. Little is known about the ramifications of these modifications in terms of maternal and neonatal outcomes. Objective: The objective of this study was to determine whether labor and delivery unit policy modifications we made during the coronavirus disease 2019 pandemic were associated with differences in outcomes for mothers and newborns. Study Design: We conducted a retrospective cohort study of all deliveries occurring in our hospital between January 1, 2020, and April 30, 2020. Patients who delivered in January and February 2020 before labor and delivery unit modifications were instituted were designated as the preimplementation group, and those who delivered in March and April 2020 were designated as the postimplementation group. Maternal and neonatal outcomes between the pre- and postimplementation groups were compared. Differences between the 2 groups were then compared with the same time period in 2019 and 2018 to assess whether any apparent differences were unique to the pandemic year. We hypothesized that maternal and newborn lengths of stay would be shorter in the postimplementation group. Statistical analysis methods included Student's t-tests and Wilcoxon tests for continuous variables and chi-square or Fisher exact tests for categorical variables. Results: Postpartum length of stay was significantly shorter after implementation of labor unit changes related to coronavirus disease 2019. A postpartum stay of 1 night after vaginal delivery occurred in 48.5% of patients in the postimplementation group compared with 24.9% of the preimplementation group (P<.0001). Postoperative length of stay after cesarean delivery of ≤2 nights occurred in 40.9% of patients in the postimplementation group compared with 11.8% in the preimplementation group (P<.0001). Similarly, after vaginal delivery, 49.0% of newborns were discharged home after 1 night in the postimplementation group compared with 24.9% in the preimplementation group (P<.0001). After cesarean delivery, 42.5% of newborns were discharged after ≤2 nights in the postimplementation group compared with 12.5% in the preimplementation group (P<.0001). Slight differences in the proportions of earlier discharge between mothers and newborns were due to multiple gestations. There were no differences in cesarean delivery rate, induction of labor, or adverse maternal or neonatal outcomes between the 2 groups. Conclusion: Labor and delivery unit policy modifications to protect pregnant patients and healthcare providers from coronavirus disease 2019 indicate that maternal and newborn length of stay in the hospital were significantly shorter after delivery without increases in the rate of adverse maternal or neonatal outcomes. In the absence of long-term adverse outcomes occurring after discharge that are tied to earlier release, our study results may support a review of our discharge protocols once the pandemic subsides to move toward safely shortening maternal and newborn lengths of stay.

Lessons learned for COVID-19 in the cruise ship industry.

The coronavirus disease 2019 (COVID-19) pandemic has created widespread disruption in individuals' personal and occupational lives all around the world. Vacationers and tourism, recreation, and leisure employees were among those who experienced substantial disruption. Cruise ships, especially, faced turmoil on a global scale for both their customers and workers. COVID-19 outbreaks were reported on cruise ships beginning in February 2020, presenting new and unique challenges for the industry. Conditions on cruise ships, including close and frequent contact between passengers and crew members, use of common areas, the confined nature of the vessels, and gathering of passengers from different countries, aided in transmitting the disease both onboard and in the community. As the pandemic evolved, federal and state governments and industries worldwide, including cruise ship companies, developed response plans. In this article, we provide a high-level overview of the US government and cruise ship industry's response to the COVID-19 pandemic, as well as a brief commentary on lessons learned, and recommendations for the cruise ship sector going forward. The outlined suggestions may be used as a starting point to increase emergency preparedness and to inform outbreak response plans in the event of future infectious disease outbreaks.

Coronavirus Disease-19 and Rhinology/Facial Plastics.

This review summarizes the challenges and adaptations that have taken place in rhinology and facial plastics in response to the ongoing coronavirus disease-19 pandemic. In particular, the prolonged exposure and manipulation of the nasal and oral cavities portend a high risk of viral transmission. We discuss evidence-based recommendations to mitigate the risk of viral transmission through novel techniques and device implementation as well as increasing conservative management of certain pathologies.