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1.
PLoS One ; 17(1): e0261365, 2022.
Article in English | MEDLINE | ID: covidwho-1643242

ABSTRACT

BACKGROUND: Cleanliness of hospital surfaces helps prevent healthcare-associated infections, but comparative evaluations of various cleaning strategies during COVID-19 pandemic surges and worker shortages are scarce. PURPOSE AND METHODS: To evaluate the effectiveness of daily, enhanced terminal, and contingency-based cleaning strategies in an acute care hospital (ACH) and a long-term care facility (LTCF), using SARS-CoV-2 RT-PCR and adenosine triphosphate (ATP) assays. Daily cleaning involved light dusting and removal of visible debris while a patient is in the room. Enhanced terminal cleaning involved wet moping and surface wiping with disinfectants after a patient is permanently moved out of a room followed by ultraviolet light (UV-C), electrostatic spraying, or room fogging. Contingency-based strategies, performed only at the LTCF, involved cleaning by a commercial environmental remediation company with proprietary chemicals and room fogging. Ambient surface contamination was also assessed randomly, without regard to cleaning times. Near-patient or high-touch stationary and non-stationary environmental surfaces were sampled with pre-moistened swabs in viral transport media. RESULTS: At the ACH, SARS-CoV-2 RNA was detected on 66% of surfaces before cleaning and on 23% of those surfaces immediately after terminal cleaning, for a 65% post-cleaning reduction (p = 0.001). UV-C enhancement resulted in an 83% reduction (p = 0.023), while enhancement with electrostatic bleach application resulted in a 50% reduction (p = 0.010). ATP levels on RNA positive surfaces were not significantly different from those of RNA negative surfaces. LTCF contamination rates differed between the dementia, rehabilitation, and residential units (p = 0.005). 67% of surfaces had RNA after room fogging without terminal-style wiping. Fogging with wiping led to a -11% change in the proportion of positive surfaces. At the LTCF, mean ATP levels were lower after terminal cleaning (p = 0.016). CONCLUSION: Ambient surface contamination varied by type of unit and outbreak conditions, but not facility type. Removal of SARS-CoV-2 RNA varied according to cleaning strategy. IMPLICATIONS: Previous reports have shown time spent cleaning by hospital employed environmental services staff did not correlate with cleaning thoroughness. However, time spent cleaning by a commercial remediation company in this study was associated with cleaning effectiveness. These findings may be useful for optimizing allocation of cleaning resources during staffing shortages.


Subject(s)
COVID-19/prevention & control , Cross Infection/prevention & control , Disinfection/methods , Health Personnel/organization & administration , Infection Control/organization & administration , Long-Term Care/organization & administration , Adenosine Triphosphate/analysis , COVID-19/epidemiology , Cross Infection/epidemiology , Disinfectants , Fomites/virology , Health Facilities , Humans , New York/epidemiology , Patients' Rooms , RNA, Viral/analysis , SARS-CoV-2/genetics , SARS-CoV-2/pathogenicity , SARS-CoV-2/radiation effects , Ultraviolet Rays
2.
J Nurs Adm ; 52(1): 57-66, 2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-1575154

ABSTRACT

OBJECTIVE: The aim of this study was to explore relationships between organizational factors and moral injury among healthcare workers and the impact of perceptions of their leaders and organizations during COVID-19. BACKGROUND: COVID-19 placed healthcare workers at risk for moral injury, which often involves feeling betrayed by people with authority and can impact workplace culture. METHODS: Secondary data from a Web-based survey of mid-Atlantic healthcare workers were analyzed using mixed methods. Data were synthesized using the Reina Trust & Betrayal Model. RESULTS: Fifty-five percent (n = 328/595) of respondents wrote comments. Forty-one percent (n = 134/328) of commenters had moral injury scores of 36 or higher. Three themes emerged: organizational infrastructure, support from leaders, and palliative care involvement. Respondents outlined organizational remedies, which were organized into 5 domains. CONCLUSIONS: Findings suggest healthcare workers feel trust was breached by their organizations' leaders during COVID-19. Further study is needed to understand intersections between organizational factors and moral injury to enhance trust within healthcare organizations.


Subject(s)
Burnout, Professional , COVID-19 , Health Personnel/organization & administration , Health Personnel/psychology , Mental Health , Morals , Workplace , Adult , Humans , Workplace/organization & administration , Workplace/psychology
3.
Diabet Med ; 39(4): e14755, 2022 04.
Article in English | MEDLINE | ID: covidwho-1550817

ABSTRACT

BACKGROUND: The COVID-19 pandemic has led to the rapid implementation of remote care delivery in type 1 diabetes. We studied current modes of care delivery, healthcare professional experiences and impact on insulin pump training in type 1 diabetes care in the United Kingdom (UK). METHODS: The UK Diabetes Technology Network designed a 48-question survey aimed at healthcare professionals providing care in type 1 diabetes. RESULTS: One hundred and forty-three healthcare professionals (48% diabetes physicians, 52% diabetes educators and 88% working in adult services) from approximately 75 UK centres (52% university hospitals, 46% general and community hospitals), responded to the survey. Telephone consultations were the main modality of care delivery. There was a higher reported time taken for video consultations versus telephone (p < 0.001). Common barriers to remote consultations were patient familiarity with technology (72%) and access to patient device data (67%). We assessed the impact on insulin pump training. A reduction in total new pump starts (73%) and renewals (61%) was highlighted. Common barriers included patient digital literacy (61%), limited healthcare professional experience (46%) and time required per patient (44%). When grouped according to size of insulin pump service, pump starts and renewals in larger services were less impacted by the pandemic compared to smaller services. CONCLUSION: This survey highlights UK healthcare professional experiences of remote care delivery. While supportive of virtual care models, a number of factors highlighted, especially patient digital literacy, need to be addressed to improve virtual care delivery and device training.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 1/therapy , Health Personnel , Self-Management/education , Telemedicine , Adult , Attitude of Health Personnel , Biomedical Technology/education , Blood Glucose Self-Monitoring/instrumentation , Delivery of Health Care/methods , Delivery of Health Care/organization & administration , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 1/epidemiology , Glycemic Control/instrumentation , Health Personnel/organization & administration , Health Personnel/psychology , Health Personnel/statistics & numerical data , Humans , Insulin Infusion Systems , Pandemics , Patient Education as Topic/methods , Patient Education as Topic/organization & administration , Remote Consultation/methods , Remote Consultation/organization & administration , Self-Management/methods , Self-Management/psychology , Surveys and Questionnaires , Telemedicine/methods , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , United Kingdom/epidemiology
4.
Nutr Hosp ; 38(Spec No1): 41-45, 2021 Apr 12.
Article in English | MEDLINE | ID: covidwho-1503007

ABSTRACT

INTRODUCTION: The debate from the course preceding the SENPE (Spanish Society of Clinical Nutrition and Metabolism) 2020 Conference gathered together well-known professionals who form part of nutritional support teams (NSTs), as well as other specialists from departments whose patients benefit from the services offered by these NSTs. In this article, relevant points from the round table, including strengths and weaknesses detected in the implementation of nutrition support teams, are summarized.


INTRODUCCIÓN: El debate del curso previo al congreso de la Sociedad Española de Nutrición Clínica y Metabolismo (SENPE) 2020 reunió en una mesa redonda a profesionales de prestigio que forman parte de unidades de nutrición y dietética, y a otros especialistas de servicios cuyos pacientes se benefician de los servicios de estas unidades. En este artículo se muestran los puntos relevantes que se trataron en el mismo y se muestran algunas fortalezas y debilidades que se han detectado en la implementación de las unidades de nutrición.


Subject(s)
Food Service, Hospital , Health Personnel/organization & administration , Nutritional Support , Patient Care Team/organization & administration , COVID-19/epidemiology , Humans , Pandemics
7.
Can J Public Health ; 112(5): 872-876, 2021 10.
Article in English | MEDLINE | ID: covidwho-1405565

ABSTRACT

The greatest human cost of the rapidly moving pandemic of SARS-CoV-2 may be due to its impact on the response to other diseases. One such other disease is tuberculosis (TB). All indications suggest that COVID-19-related diversions of healthcare resources and disruptions to public health programming will exacerbate the slower moving pandemic of TB. This is expected to set back TB elimination efforts by years. This is a prediction that is especially relevant to Canada, which has repeatedly failed to meet pre-set targets for the elimination of TB even before the COVID-19 pandemic began. A collaborative approach to achieve TB elimination, one that engages all care providers, has recently been emphasized by the STOP-TB Partnership. Among TB elimination strategies, frontline providers (e.g., family physicians, emergency room physicians, and others) are well positioned to identify candidates for the treatment of latent TB infection, and make the diagnosis of infection-spreading cases of TB in a timely manner, thereby interrupting forward-moving chains of transmission. Electronic medical records offer the promise of automating these processes. In this commentary, we promote broader engagement of the workforce across multiple sectors of medicine to reduce TB associated morbidity and mortality, interrupt transmission, and shrink the reservoir of latent TB infection.


RéSUMé: Le plus grand coût humain de la pandémie de SRAS-CoV-2, une maladie à évolution rapide, pourrait être son impact sur la riposte aux autres maladies. L'une d'elles est la tuberculose. Selon tous les indicateurs, les ressources de soins de santé détournées et les programmes de santé publique perturbés pour lutter contre la COVID-19 vont exacerber la pandémie de tuberculose, dont l'évolution est plus lente. Il faut s'attendre à une régression de plusieurs années dans les efforts pour éliminer la tuberculose. C'est une prédiction qui concerne particulièrement le Canada, qui a à maintes reprises été incapable de respecter les objectifs préétablis d'élimination de la tuberculose, même avant la pandémie de COVID-19. Le Partenariat Halte à la tuberculose promulgue depuis peu une démarche concertée, impliquant tous les prestataires de soins, pour parvenir à éliminer la tuberculose. Entre autres stratégies d'élimination, on compte sur les prestataires de première ligne (médecins de famille, médecins d'urgence et autres), bien placés pour repérer les personnes candidates au traitement de la tuberculose-infection (latente) et pour diagnostiquer les cas de tuberculose-maladie (active) dans les meilleurs délais, ce qui interromprait les chaînes de transmission en mouvement. Le dossier médical électronique recèle la promesse d'automatiser ces processus. Dans notre commentaire, nous préconisons une plus grande mobilisation de la main-d'œuvre de plusieurs secteurs de la médecine afin de réduire la morbidité et la mortalité associées à la tuberculose, d'en interrompre la transmission et de réduire la taille du réservoir d'infection tuberculeuse latente.


Subject(s)
Disease Eradication , Health Personnel , Tuberculosis , COVID-19 , Canada/epidemiology , Developed Countries , Disease Eradication/methods , Health Personnel/organization & administration , Humans , Tuberculosis/epidemiology , Tuberculosis/prevention & control
9.
Pan Afr Med J ; 39: 111, 2021.
Article in English | MEDLINE | ID: covidwho-1377120

ABSTRACT

COVID-19 has impacted health systems globally with varying impacts across regions. In Zimbabwe, a country with perennial problems of shortage of healthcare workers and resources, the pandemic has caused substantial strain on the public health system. The ability to share experiences on what has worked and what has not can be valuable as scientists, policymakers, and others determine steps forward and reflect backward to determine lessons learned in the pandemic response. We describe the setup and function of a COVID-19 rapid response team in the context of a limited resource setting. The response had to be tailored to make maximal use of the resources available and manage the outbreak. In this article, we share notes from the field and discuss the process of setting up a rapid response protocol in a limited resource provincial hospital, the challenges encountered, improvised interventions and recommendations for managing a COVID-19 resurgence and future similar pandemics.


Subject(s)
COVID-19/therapy , Delivery of Health Care/organization & administration , Hospital Rapid Response Team/organization & administration , Delivery of Health Care/economics , Health Personnel/organization & administration , Hospital Rapid Response Team/economics , Humans , Zimbabwe
10.
G Ital Cardiol (Rome) ; 22(8): 610-619, 2021 Aug.
Article in Italian | MEDLINE | ID: covidwho-1325472

ABSTRACT

The COVID-19 pandemic represents an unprecedented event that has brought deep changes in hospital facilities with reshaping of the health system organization, revealing inadequacies of current hospital and local health systems. When the COVID-19 emergency will end, further evaluation of the national health system, new organization of acute wards, and a further evolution of the entire health system will be needed to improve care during the chronic phase of disease. Therefore, new standards for healthcare personnel, more efficient organization of hospital facilities for patients with acute illnesses, improvement of technological approaches, and better integration between hospital and territorial services should be pursued. With experience derived from the COVID-19 pandemic, new models, paradigms, interventional approaches, values and priorities should be suggested and implemented.


Subject(s)
COVID-19 , Cardiology/organization & administration , Delivery of Health Care/organization & administration , Cardiovascular Diseases/therapy , Health Personnel/organization & administration , Humans , Italy , National Health Programs/organization & administration
11.
JAMA Netw Open ; 4(7): e2120295, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1300327

ABSTRACT

Importance: The COVID-19 pandemic is the greatest global test of health leadership of our generation. There is an urgent need to provide guidance for leaders at all levels during the unprecedented preresolution recovery stage. Objective: To create an evidence- and expertise-informed framework of leadership imperatives to serve as a resource to guide health and public health leaders during the postemergency stage of the pandemic. Evidence Review: A literature search in PubMed, MEDLINE, and Embase revealed 10 910 articles published between 2000 and 2021 that included the terms leadership and variations of emergency, crisis, disaster, pandemic, COVID-19, or public health. Using the Standards for Quality Improvement Reporting Excellence reporting guideline for consensus statement development, this assessment adopted a 6-round modified Delphi approach involving 32 expert coauthors from 17 countries who participated in creating and validating a framework outlining essential leadership imperatives. Findings: The 10 imperatives in the framework are: (1) acknowledge staff and celebrate successes; (2) provide support for staff well-being; (3) develop a clear understanding of the current local and global context, along with informed projections; (4) prepare for future emergencies (personnel, resources, protocols, contingency plans, coalitions, and training); (5) reassess priorities explicitly and regularly and provide purpose, meaning, and direction; (6) maximize team, organizational, and system performance and discuss enhancements; (7) manage the backlog of paused services and consider improvements while avoiding burnout and moral distress; (8) sustain learning, innovations, and collaborations, and imagine future possibilities; (9) provide regular communication and engender trust; and (10) in consultation with public health and fellow leaders, provide safety information and recommendations to government, other organizations, staff, and the community to improve equitable and integrated care and emergency preparedness systemwide. Conclusions and Relevance: Leaders who most effectively implement these imperatives are ideally positioned to address urgent needs and inequalities in health systems and to cocreate with their organizations a future that best serves stakeholders and communities.


Subject(s)
COVID-19 , Health Personnel , Leadership , Pandemics , Consensus , Disaster Planning , Health Personnel/legislation & jurisprudence , Health Personnel/organization & administration , Humans , Models, Organizational , SARS-CoV-2
12.
J Med Internet Res ; 23(7): e29240, 2021 07 26.
Article in English | MEDLINE | ID: covidwho-1302085

ABSTRACT

BACKGROUND: Telemedicine has been deployed by health care systems in response to the COVID-19 pandemic to enable health care workers to provide remote care for both outpatients and inpatients. Although it is reasonable to suspect telemedicine visits limit unnecessary personal contact and thus decrease the risk of infection transmission, the impact of the use of such technology on clinician workflows in the emergency department is unknown. OBJECTIVE: This study aimed to use a real-time locating system (RTLS) to evaluate the impact of a new telemedicine platform, which permitted clinicians located outside patient rooms to interact with patients who were under isolation precautions in the emergency department, on in-person interaction between health care workers and patients. METHODS: A pre-post analysis was conducted using a badge-based RTLS platform to collect movement data including entrances and duration of stay within patient rooms of the emergency department for nursing and physician staff. Movement data was captured between March 2, 2020, the date of the first patient screened for COVID-19 in the emergency department, and April 20, 2020. A new telemedicine platform was deployed on March 29, 2020. The number of entrances and duration of in-person interactions per patient encounter, adjusted for patient length of stay, were obtained for pre- and postimplementation phases and compared with t tests to determine statistical significance. RESULTS: There were 15,741 RTLS events linked to 2662 encounters for patients screened for COVID-19. There was no significant change in the number of in-person interactions between the pre- and postimplementation phases for both nurses (5.7 vs 7.0 entrances per patient, P=.07) and physicians (1.3 vs 1.5 entrances per patient, P=.12). Total duration of in-person interactions did not change (56.4 vs 55.2 minutes per patient, P=.74) despite significant increases in telemedicine videoconference frequency (0.6 vs 1.3 videoconferences per patient, P<.001 for change in daily average) and duration (4.3 vs 12.3 minutes per patient, P<.001 for change in daily average). CONCLUSIONS: Telemedicine was rapidly adopted with the intent of minimizing pathogen exposure to health care workers during the COVID-19 pandemic, yet RTLS movement data did not reveal significant changes for in-person interactions between staff and patients under investigation for COVID-19 infection. Additional research is needed to better understand how telemedicine technology may be better incorporated into emergency departments to improve workflows for frontline health care clinicians.


Subject(s)
COVID-19/diagnosis , COVID-19/prevention & control , Emergency Service, Hospital/organization & administration , Health Personnel/organization & administration , Telemedicine , Workflow , COVID-19/epidemiology , Cross Infection/prevention & control , Humans , Pandemics , SARS-CoV-2 , Time Factors
15.
J Oncol Pharm Pract ; 27(5): 1073-1079, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1226841

ABSTRACT

PURPOSE: In response to the COVID-19 pandemic, changes to chemotherapy services were implemented as a means of managing imposed workload strains within health services and protecting patients from contracting COVID-19. Given the rapidly evolving nature of the pandemic many changes were rapidly adopted and were not substantiated by robust evidence. This study aimed to describe the changes adopted internationally to chemotherapy services, which may be used to guide future changes to treatment delivery. METHODS: A survey was developed to understand the impact of COVID-19 on the delivery of systemic anti-cancer therapies (SACT). It comprised 22 questions and examined the strategies implemented during the pandemic to prioritise and protect patients receiving SACT and the participants' professional opinion of the strategies employed. The survey was available in English, Spanish and French and was distributed via professional bodies. RESULTS: 129 responses were obtained from healthcare professionals working across 17 different countries. 45% of institutions had to implement treatment prioritisation strategies and all hospitals implemented changes in the delivery of treatment, including: reduction in treatments (69%), using less immunosuppressive agents (50%), allowing treatment breaks (14%) and switching to oral therapies (45%). Virtual clinic visits were perceived by participants as the most effective strategy to protect patients. CONCLUSIONS: The pandemic has forced chemotherapy healthcare professionals to adopt new ways of working by reducing health interactions. Many areas of research are needed following this period, including understanding patients' perceptions of risks to treatment, utilisation of oral treatments and the impact of treatment breaks on cancer outcomes.


Subject(s)
Antineoplastic Agents/administration & dosage , COVID-19 , Health Personnel/organization & administration , Neoplasms/drug therapy , Humans , Surveys and Questionnaires , Workload
16.
Pan Afr Med J ; 38: 233, 2021.
Article in English | MEDLINE | ID: covidwho-1215727

ABSTRACT

Across Africa, there is some evidence of COVID-19 private sector activities to tackle COVID-19 which include the development of rapid diagnostic kits, deployment of e-health platforms for bespoke health workforce training, disease surveillance, reporting, auto-screening and advisories. Inequities in living and access to care by disadvantaged populations in the rural areas have been ameliorated by multi-pronged responses such as that mounted by the Joseph Ukpo Hospitals and Research Institute (JUHRI) in Nigeria. The provision, production and donation of personal protective equipment (PPE), the production of hand sanitizers and the engagement of the local community in the process represents an effective strategy to contain COVID-19, protect health workers and provide pathways for economic support for people whose sources of income have been upended during the pandemic. The JUHRI experience underpinned by Catholic medical ethics provides concrete evidence of the value of private sector participation in dealing with public health emergencies.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care/organization & administration , Private Sector , COVID-19/prevention & control , Hand Sanitizers , Health Personnel/organization & administration , Health Services Accessibility , Humans , Nigeria , Personal Protective Equipment , Public Health , Rural Population
17.
Pediatr Emerg Care ; 37(5): 286-289, 2021 May 01.
Article in English | MEDLINE | ID: covidwho-1203787

ABSTRACT

BACKGROUND: The coronavirus disease 2019 pandemic has challenged hospitals and pediatric emergency department (PED) providers to rapidly adjust numerous facets of the care of critically ill or injured children to minimize health care worker (HCW) exposure to severe acute respiratory syndrome coronavirus 2. OBJECTIVE: We aimed to iteratively devise protocols and processes that minimized HCW exposure while safely and effectively caring for children who may require unanticipated aerosol-generating procedures. METHODS: As part of our PED's initiative to optimize clinical care and HCW safety during the coronavirus disease 2019 pandemic, regular multidisciplinary systems and process simulation sessions were conducted. These sessions allowed us to evaluate and reorganize patient flow, test and improve communication modalities, alter the process for consultation in resuscitations, and teach and reinforce the appropriate donning and use of personal protective equipment. RESULTS: Simulation was a highly effective method to disseminate new practices to PED staff. Numerous workflow modifications were implemented as a result of our in situ systems and process simulations. Total number of persons in the resuscitation room was minimized, use of a "command post" with remote providers was initiated, communication devices and strategies were trialed and adopted, and personal protective equipment standards that optimized HCW safety and communication were enacted. CONCLUSIONS: Simulation can be an effective and agile tool in restructuring patient workflow and care of the most critically ill or injured patients in a PED during a novel pandemic.


Subject(s)
COVID-19/therapy , Computer Simulation , Emergency Service, Hospital/organization & administration , Health Personnel/organization & administration , Pandemics , Personal Protective Equipment/supply & distribution , Resuscitation/methods , COVID-19/epidemiology , Child , Humans
18.
Am J Manag Care ; 27(4): e135-e136, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1196204

ABSTRACT

OBJECTIVES: To describe a complete panel of actions of the Service de Santé des Armées (SSA) (ie, French Military Health Service) that together contributed to prevent French health system saturation during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: Observational retrospective study. METHODS: Actions taken by military practitioners in the Parisian military hospitals, which contained 500 beds, to fight COVID-19 were listed and described. RESULTS: The Parisian military hospitals were fully reorganized to offer 147% more intensive care unit beds and took care of 665 inpatients with COVID-19 while continuing their core mission of war-wounded military care. A strategy to prioritize the use of medicine and medical devices was designed to avoid shortages. Field intensive care unit deployment and airborne collective medical evacuation by the SSA's MoRPHEE system avoided hospital saturation. CONCLUSIONS: Key facets of this achievement were interunit collaboration, esprit de corps, and health workers' adaptability. Small hospitals can provide a coherent answer to the COVID-19 pandemic, as long as they organize and prioritize the patients' care.


Subject(s)
COVID-19/prevention & control , Hospitals, Military/organization & administration , France/epidemiology , Health Personnel/organization & administration , Humans , Intensive Care Units/organization & administration , Retrospective Studies , SARS-CoV-2
19.
Pan Afr Med J ; 38: 129, 2021.
Article in English | MEDLINE | ID: covidwho-1175751

ABSTRACT

COVID-19 is the disease caused by SARS-CoV-2, one of a large family of coronaviruses. Severe forms of the disease can lead to respiratory failure with multiple organ failure necessitating rehabilitation in both acute and long-term care. With the increasing prevalence of COVID-19 and rehabilitation needs, the African Rehabilitation Network (AFRENET) produced a guidance document to assist in reducing variation in clinical practice among rehabilitation professionals in the Africa Region. This report outlines the process of the guideline development.


Subject(s)
COVID-19/rehabilitation , Health Personnel/organization & administration , Practice Guidelines as Topic , Africa , Humans
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