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1.
J Hosp Infect ; 121: 75-81, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1851508

ABSTRACT

BACKGROUND: The SARS-CoV-2 pandemic has critically challenged healthcare systems globally. Examining the experiences of healthcare workers (HCWs) is important for optimizing ongoing and future pandemic responses. OBJECTIVES: In-depth exploration of Australian HCWs' experiences of the SARS-CoV-2 pandemic, with a focus on reported stressors vis-à-vis protective factors. METHODS: Individual interviews were performed with 63 HCWs in Australia. A range of professional streams and operational staff were included. Thematic analysis was performed. RESULTS: Thematic analysis identified stressors centred on paucity of, or changing, evidence, leading to absence of, or mistrust in, guidelines; unprecedented alterations to the autonomy and sense of control of clinicians; and deficiencies in communication and support. Key protective factors included: the development of clear guidance from respected clinical leaders or recognized clinical bodies, interpersonal support, and strong teamwork, leadership, and a sense of organizational preparedness. CONCLUSIONS: This study provides insights into the key organizational sources of emotional stress for HCWs within pandemic responses and describes experiences of protective factors. HCWs experiencing unprecedented uncertainty, fear, and rapid change, rely on clear communication, strong leadership, guidelines endorsed by recognized expert groups or individuals, and have increased reliance on interpersonal support. Structured strategies for leadership and communication at team, service group and organizational levels, provision of psychological support, and consideration of the potential negative effects of centralizing control, would assist in ameliorating the extreme pressures of working within a pandemic environment.


Subject(s)
COVID-19 , Health Personnel , Protective Factors , SARS-CoV-2 , Australia/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Health Personnel/psychology , Humans , Infection Control/organization & administration , Infection Control/standards , Pandemics/prevention & control
2.
Turk J Med Sci ; 51(SI-1): 3215-3220, 2021 12 17.
Article in English | MEDLINE | ID: covidwho-1726143

ABSTRACT

Background/aim: Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been appeared first in China since December 2019. Transmission of SARS-CoV-2 occurs primarily with droplets through coughing and sneezing and also occurs through inhalation of aerosolized secretions, which travel, remain suspended in the air longer. Materials and methods: Since early stages of the outbreak, COVID-19 cases have been described in healthcare workers (HCWs). However, in the early stages, the disease may be asymptomatic. This may lead to incorrect diagnosis or delayed diagnosis and may lead to the nosocomial spread of the virus. One of the most important causes of transmission among HCWs is being exposed to an aerosolized virus in a closed environment for a long time. It is possible to prevent and control the spread of COVID-19 in hospitals with outpatient treatment and triage. Results: Infection control measures, including wearing surgical masks, hand hygiene, and social distance are considered essential in preventing human-to-human transmissions of SARS-CoV-2. Immediate response and practices of infection control measures are critical for saving lives during an epidemic inside and outside the hospital. Conclusion: Analyzing current knowledge about the features of SARS-CoV-2 infection, screening, personal protection protocols, triage and psychological support practices for healthcare professionals can be promising in terms of controlling the infection.


Subject(s)
COVID-19/prevention & control , Hand Hygiene , Infection Control/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Adult , Asymptomatic Infections/epidemiology , Body Temperature , COVID-19/epidemiology , Hand Hygiene/methods , Health Personnel , Hospitals , Humans , Infection Control/methods , Infection Control/standards , Masks , Physical Distancing , SARS-CoV-2
4.
BMC Microbiol ; 21(1): 352, 2021 12 20.
Article in English | MEDLINE | ID: covidwho-1635390

ABSTRACT

BACKGROUND: Infection control had many developments in the COVID 19 (Coronavirus Disease 2019) pandemic, despite this, there were many complications in different health care facilities as well as dentists' clinics due to the lack of infection control knowledge and compliance failure. This study aimed to assess the level of knowledge and compliance with the infection control measures in the dental clinics in the Nablus and Tulkarm districts. RESULTS: The results showed that the total positive response regard all infection control domains were (70.0 %). Whereas the participants gave the highest positive response for personnel protective equipment i.e. gloving was (96.10 %). They gave the instruments related to controls the lowest responses, i.e. instruments sterilization was (59.40 %). The analyzed data showed significant statistical differences in the compliance with infection control measures between Nablus and Tulkarm districts "p < 0.05" in the interest of dentists from Tulkarm. CONCLUSIONS: In conclusion, the findings of this study showed that there is moderate compliance to infection control protocol in Nablus and Tulkarm dental clinics. Thus, there is a need to strengthen adherence to infection control measures. METHOD: A universal sampling was used to assess the infection control program at the dental clinics in Nablus and Tulkarm Districts. The study sample involved 265 dentists. Data was collected using a questionnaire which has been sent via email between July and August 2020. Descriptive statistics, Chi-square test, One-way ANOVA and Post-Hock tests have been used. Statistical significance was set at ″P <0.05″. Cronbach's alpha has been conducted to ensure the reliability and validity of the questionnaire.


Subject(s)
Cross Infection/prevention & control , Dental Clinics/organization & administration , Guideline Adherence/statistics & numerical data , Infection Control/standards , COVID-19 , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Middle East , Pandemics , Surveys and Questionnaires
5.
Epidemiol Infect ; 150: e3, 2021 12 17.
Article in English | MEDLINE | ID: covidwho-1616906

ABSTRACT

Hand hygiene (HH) performance on entering intensive care units (ICUs) is commonly accepted but often inadequately performed. We developed a simple, inexpensive module that connects touchless dispensers of alcohol sanitiser (TDAS) to the automatic doors of a paediatric ICU, and assessed the impact of this intervention on HH compliance of hospital staff and visitors. A prospective observational study was conducted over a 3-week period prior to the intervention, followed by a 4-week period post intervention. HH performance was monitored by a research assistant whose office location enabled direct and video-assisted observation of the ICU entrance. A total of 609 entries to the ICU was recorded. Overall HH performance was 46.9% (92/196) before and 98.5% (406/413) after the intervention. Our findings suggest that HH performance on entering an ICU can be improved via a mechanism that makes operation of an automatic door dependent on use of a TDAS system, and thus contribute to infection control.


Subject(s)
Guideline Adherence/statistics & numerical data , Hand Hygiene/methods , Visitors to Patients/statistics & numerical data , Hand Hygiene/standards , Humans , Infection Control/methods , Infection Control/standards , Intensive Care Units, Pediatric/standards , Personnel, Hospital/statistics & numerical data , Prospective Studies
6.
Breast Dis ; 41(1): 1-3, 2022.
Article in English | MEDLINE | ID: covidwho-1604128

ABSTRACT

During the first hit of SARS-COVID pandemic, an important reorganization of Healthcare Services has been done, and new protocols and pathways to protect frail patients like oncological patients were designed. The second hit of pandemic had stressed these new pathways and suggests to health-workers some improvements for safer management of patents.We reported our experience in organizing the clinical pathway of neoadjuvant therapy candidate patients based on the execution of sentinel lympho-node biopsy and the placement of implantable venous access port in the same access to operating room before neoadjuvant chemotherapy suggesting a possible organizational model. In the period October-December 2020 we have included in this new type of path twelve patients and we have not registered any cases of COVID among the patients included. We think this new path, adopted amid the second hit, will be useful for all Breast Units that are facing the challenge of guaranteeing the highest standards of care in a historical moment where the health emergency occupies the efforts of health workers and the economic resources of health systems.


Subject(s)
Antineoplastic Agents/administration & dosage , Breast Neoplasms/drug therapy , COVID-19/prevention & control , Catheterization, Central Venous/methods , Infection Control/methods , Patient Safety , Sentinel Lymph Node Biopsy/methods , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/therapeutic use , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Catheterization, Central Venous/instrumentation , Catheterization, Central Venous/standards , Central Venous Catheters , Chemotherapy, Adjuvant , Critical Pathways , Female , Humans , Infection Control/standards , Mastectomy , Middle Aged , Neoadjuvant Therapy , Neoplasm Staging , Sentinel Lymph Node Biopsy/standards
7.
Ind Health ; 59(5): 318-324, 2021 Oct 05.
Article in English | MEDLINE | ID: covidwho-1547178

ABSTRACT

COVID-19 is around the world. We attempt to apply three-step method in ISO/IEC Guide 51: 2014 to COVID-19 infection control in the workplace. The results show that the COVID-19 infection control measures include the eradication of the virus, the destruction of infectivity, the detoxification and weakening and the elimination of opportunities for infection as "Inherently Safe Design Measures", the avoidance of contact as "Safeguarding and Complementary Protective Measures" and the reduction of contact and the avoidance of seriousness as "Information for Use". Among these specific measures, the New Normal, especially in the manufacturing industries, would be "telecommuting" and "unmanned workplaces", which are part of the elimination of opportunities for infection, and "changes in flow lines" and "changes in airflow", which are part of the avoidance of contact. Where "telecommuting" and "unmanned workplaces" are feasible, they should be implemented as much as possible, and where they are not, attempts should be made to minimize human-to-human contact by "changes in flow lines". In addition, in the area of "changes in airflow", there are high expectations for future research on how to establish a ventilation design for COVID-19, in which but also the source would be workers themselves, not only combustible gases and toxic gases.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Infection Control/organization & administration , Occupational Health/standards , Workplace/organization & administration , Global Health , Humans , Infection Control/standards , Manufacturing and Industrial Facilities/standards , SARS-CoV-2 , Teleworking , Ventilation/standards , Workplace/standards
8.
Am J Phys Med Rehabil ; 100(11): 1031-1032, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1537604

ABSTRACT

ABSTRACT: This brief report summarizes the comparative experience of an inpatient rehabilitation facility dealing with two episodes of COVID-19 infection, one before and one after the availability of vaccination, which was deployed to staff. The experience exemplifies the high rate of infection and potential for asymptomatic presentation of COVID-19 as well as the protective advantage of the vaccine for healthcare workers in this report. With a significant reduction in the rate of infection, from nearly 30% before vaccination to only 2.5% after vaccination. The data presented should serve as an encouragement for vaccination across all populations.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Health Personnel , Infection Control/standards , Pneumonia, Viral/prevention & control , Rehabilitation Centers , Adult , COVID-19/epidemiology , Disease Outbreaks/prevention & control , Female , Guideline Adherence , Humans , Inpatients , Male , Mass Screening , Pennsylvania/epidemiology , Pneumonia, Viral/virology , SARS-CoV-2
9.
Lancet Infect Dis ; 22(3): e74-e87, 2022 03.
Article in English | MEDLINE | ID: covidwho-1510480

ABSTRACT

During the current COVID-19 pandemic, health-care workers and uninfected patients in intensive care units (ICUs) are at risk of being infected with SARS-CoV-2 as a result of transmission from infected patients and health-care workers. In the absence of high-quality evidence on the transmission of SARS-CoV-2, clinical practice of infection control and prevention in ICUs varies widely. Using a Delphi process, international experts in intensive care, infectious diseases, and infection control developed consensus statements on infection control for SARS-CoV-2 in an ICU. Consensus was achieved for 31 (94%) of 33 statements, from which 25 clinical practice statements were issued. These statements include guidance on ICU design and engineering, health-care worker safety, visiting policy, personal protective equipment, patients and procedures, disinfection, and sterilisation. Consensus was not reached on optimal return to work criteria for health-care workers who were infected with SARS-CoV-2 or the acceptable disinfection strategy for heat-sensitive instruments used for airway management of patients with SARS-CoV-2 infection. Well designed studies are needed to assess the effects of these practice statements and address the remaining uncertainties.


Subject(s)
COVID-19 , Consensus , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intensive Care Units/standards , SARS-CoV-2/isolation & purification , COVID-19 Vaccines/administration & dosage , Delphi Technique , Health Personnel/standards , Humans , Personal Protective Equipment/standards
10.
PLoS One ; 16(10): e0258701, 2021.
Article in English | MEDLINE | ID: covidwho-1496513

ABSTRACT

BACKGROUND: Care institutions are recognised to be a high-risk setting for the emergence and spread of infections and antimicrobial-resistant organisms, which stresses the importance of infection prevention and control (IPC). Accurate implementation is crucial for optimal IPC practice. Despite the wide promotion of IPC and research thereof in the hospital and nursing home setting, similar efforts are lacking in disability care settings. Therefore, this study aimed to assess perceived barriers and facilitators to IPC among professionals working at residential care facilities (RCFs) for people with intellectual and developmental disabilities (IDD), as well as to identify professional-reported recommendations to improve IPC. METHODS: This qualitative study involved semi-structured interviews (before COVID-19) with twelve professionals from five Dutch RCFs for people with IDD. An integrated theoretical approach was used to inform data collection and analysis. Thematic analysis using inductive and deductive approaches was conducted. This study followed the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines. RESULTS: Our findings revealed barriers and facilitators at the guideline, client, professional, professional interaction, professional client interaction, client interaction, organisational, community, and societal level. Six main themes covering multiple barriers and facilitators were identified: (1) guidelines' applicability to (work)setting; (2) professionals' cognitions and attitude towards IPC (related to educational background); (3) organisational support and priority; (4) educational system; (5) time availability and staff capacity; and (6) task division and change coaches. The main professional-reported recommendations were the introduction of tailored and practical IPC guidelines, structural IPC education and training among all professionals, and client participation. CONCLUSIONS: To promote IPC, multifaceted and multilevel strategies should be implemented, with a preliminary need for improvements on the guideline, professional, and organisational level. Given the heterogeneous character, i.e., different professionals, clients and care needs, there is a need for a tailored approach to implement IPC and sustain it successfully in disability care. Our findings can inform future IPC practice improvements.


Subject(s)
Assisted Living Facilities/standards , Infection Control/standards , Denmark , Developmental Disabilities , Health Personnel , Humans , Intellectual Disability , Qualitative Research , Surveys and Questionnaires
11.
Am J Nurs ; 121(11): 14, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1493970

ABSTRACT

Some states seek to limit health officials' powers to act in disease outbreaks.


Subject(s)
Infection Control/standards , Politics , Public Health Nursing , Public Health/legislation & jurisprudence , State Government , COVID-19 , Federal Government , Humans , United States
12.
Infect Dis Clin North Am ; 35(4): 1055-1075, 2021 12.
Article in English | MEDLINE | ID: covidwho-1487740

ABSTRACT

Health care-acquired viral respiratory infections are common and cause increased patient morbidity and mortality. Although the threat of viral respiratory infection has been underscored by the coronavirus disease 2019 (COVID-19) pandemic, respiratory viruses have a significant impact in health care settings even under normal circumstances. Studies report decreased nosocomial transmission when aggressive infection control measures are implemented, with more success noted when using a multicomponent approach. Influenza vaccination of health care personnel furthers decrease rates of transmission; thus, mandatory vaccination is becoming more common. This article discusses the epidemiology, transmission, and control of health care-associated respiratory viral infections.


Subject(s)
Cross Infection/prevention & control , Cross Infection/virology , Respiratory Tract Infections/prevention & control , Respiratory Tract Infections/virology , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Cross Infection/epidemiology , Cross Infection/transmission , Guideline Adherence , Health Personnel/standards , Humans , Infection Control/standards , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/transmission , SARS-CoV-2/pathogenicity , Vaccination , Viruses/classification , Viruses/pathogenicity
13.
J Infect Dev Ctries ; 15(9): 1252-1256, 2021 09 30.
Article in English | MEDLINE | ID: covidwho-1478143

ABSTRACT

INTRODUCTION: The COVID-19 pandemic highlights the role of environmental cleaning in controlling infection transmission in hospitals. However, cleaning practice remains inadequate. An important component of effective cleaning is to obtain feedback on actual cleaning practice. This study aimed to evaluate the cleaning process quality from an implementation perspective. METHODOLOGY: An observational study was conducted in a tertiary public hospital in Wuhan, China and 92 cleaning processes of units housing patients with multidrug-resistant organism infections were recorded. The bed unit cleaning quality and floor cleaning quality were measured by six and five process indicators respectively. Descriptive statistics were used to describe the cleaning quality. RESULTS: For bed unit cleaning quality, the appropriate rates of cleaning sequence, adherence to cleaning unit principle, use of cloth, use of cloth bucket, separation of clean and contaminated tools, and disinfectant concentration were 35.9%, 71.7%, 89.7%, 11.5%, 65.4%, and 48.7%, respectively. For floor cleaning quality, the appropriate rates of adherence to cleaning unit principle, use of cloth, use of cloth bucket, separation of clean and contaminated tools, and disinfectant concentration were 13.4%, 50.0%, 35.5%, 11.0%, and 36.7%, respectively. CONCLUSIONS: The cleaning staff showed poor environmental cleaning quality, especially the floor cleaning quality. The findings can help reveal deficiencies in cleaning practices, raise awareness of these deficiencies, and inform targeted strategies to improve cleaning quality and hospital safety.


Subject(s)
Disinfection/methods , Infection Control/methods , China , Cross Infection/prevention & control , Cross-Sectional Studies , Disinfection/standards , Drug Resistance, Multiple, Bacterial , Guideline Adherence/statistics & numerical data , Hospitals, Public , Hospitals, Teaching , Infection Control/standards , Tertiary Care Centers
14.
Br J Surg ; 108(10): 1162-1180, 2021 10 23.
Article in English | MEDLINE | ID: covidwho-1462296

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues' experiences and published evidence. METHODS: In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. RESULTS: BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. CONCLUSION: The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era.


Subject(s)
COVID-19/prevention & control , Perioperative Care/trends , Practice Patterns, Physicians'/trends , Surgical Procedures, Operative/trends , Adult , Biomedical Research/organization & administration , COVID-19/diagnosis , COVID-19/economics , COVID-19/epidemiology , Education, Medical, Graduate/methods , Education, Medical, Graduate/trends , Female , Global Health , Health Resources/supply & distribution , Health Services Accessibility/trends , Humans , Infection Control/economics , Infection Control/methods , Infection Control/standards , International Cooperation , Male , Middle Aged , Pandemics , Perioperative Care/education , Perioperative Care/methods , Perioperative Care/standards , Practice Patterns, Physicians'/standards , Surgeons/education , Surgeons/psychology , Surgeons/trends , Surgical Procedures, Operative/education , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/standards
16.
Ghana Med J ; 54(4 Suppl): 104-106, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1436202

ABSTRACT

The COVID-19 pandemic has impacted healthcare negatively across the globe. The practice of gastroenterology has been affected especially gastrointestinal (GI) endoscopy which is considered high risk for transmission of the virus. As a community of practitioners there is the need to share information and make evidence-based statements to guide GI practice in Ghana. This GASLIDD position statement based on the growing and rapidly evolving body of knowledge is to provide up to date information on the COVID-19 disease and guidance for the practice of gastroenterology in Ghana and beyond. It is to help the GI community of practice to maintain the highest level of health delivery and safety for our patients, staff, community and GI practitioners. FUNDING: Self-funded.


Subject(s)
COVID-19/prevention & control , Endoscopy, Gastrointestinal/standards , Gastroenterology/standards , Infection Control/standards , Practice Guidelines as Topic , Ghana , Humans , SARS-CoV-2 , Societies, Medical
17.
Work ; 66(4): 717-729, 2020.
Article in English | MEDLINE | ID: covidwho-1435948

ABSTRACT

BACKGROUND: COVID-19 is a highly contagious acute respiratory syndrome and has been declared a pandemic in more than 209 countries worldwide. At the time of writing, no preventive vaccine has been developed and tested in the community. This study was conducted to review studies aimed at preventing the spread of the coronavirus worldwide. METHODS: This study was a review of the evidence-based literature and was conducted by searching databases, including Google Scholar, PubMed, and ScienceDirect, until April 2020. The search was performed based on keywords including "coronavirus", "COVID-19", and "prevention". The list of references in the final studies has also been re-reviewed to find articles that might not have been obtained through the search. The guidelines published by trustworthy organizations such as the World Health Organization and Center for Disease Control have been used in this study. CONCLUSION: So far, no vaccine or definitive treatment for COVID-19 has been invented, and the disease has become a pandemic. Therefore, observation of hand hygiene, disinfection of high-touch surfaces, observation of social distance, and lack of presence in public places are recommended as preventive measures. Moreover, to control the situation and to reduce the incidence of the virus, some of the measures taken by the decision-making bodies and the guidelines of the deterrent institutions to strengthen telecommuting of employees and reduce the presence of people in the community and prevent unnecessary activities, are very important.


Subject(s)
Betacoronavirus/pathogenicity , COVID-19/prevention & control , Coronavirus Infections/prevention & control , Infection Control/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Workplace/organization & administration , COVID-19/epidemiology , COVID-19/transmission , COVID-19 Testing , Clinical Laboratory Techniques/standards , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Decision Making, Organizational , Disinfection/organization & administration , Disinfection/standards , Guidelines as Topic , Hand Hygiene/organization & administration , Hand Hygiene/standards , Humans , Incidence , Infection Control/methods , Infection Control/organization & administration , Mass Screening/organization & administration , Mass Screening/standards , Physical Distancing , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , SARS-CoV-2 , Telecommunications/organization & administration , Telecommunications/standards , Workplace/standards
18.
J Am Geriatr Soc ; 69(10): 2766-2777, 2021 10.
Article in English | MEDLINE | ID: covidwho-1434765

ABSTRACT

BACKGROUND/OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has taken a disproportionate toll on long-term care facility residents and staff. Our objective was to review the empirical evidence on facility characteristics associated with COVID-19 cases and deaths. DESIGN: Systematic review. SETTING: Long-term care facilities (nursing homes and assisted living communities). PARTICIPANTS: Thirty-six empirical studies of factors associated with COVID-19 cases and deaths in long-term care facilities published between January 1, 2020 and June 15, 2021. MEASUREMENTS: Outcomes included the probability of at least one case or death (or other defined threshold); numbers of cases and deaths, measured variably. RESULTS: Larger, more rigorous studies were fairly consistent in their assessment of risk factors for COVID-19 outcomes in long-term care facilities. Larger bed size and location in an area with high COVID-19 prevalence were the strongest and most consistent predictors of facilities having more COVID-19 cases and deaths. Outcomes varied by facility racial composition, differences that were partially explained by facility size and community COVID-19 prevalence. More staff members were associated with a higher probability of any outbreak; however, in facilities with known cases, higher staffing was associated with fewer deaths. Other characteristics, such as Nursing Home Compare 5-star ratings, ownership, and prior infection control citations, did not have consistent associations with COVID-19 outcomes. CONCLUSION: Given the importance of community COVID-19 prevalence and facility size, studies that failed to control for these factors were likely confounded. Better control of community COVID-19 spread would have been critical for mitigating much of the morbidity and mortality long-term care residents and staff experienced during the pandemic. Traditional quality measures such as Nursing Home Compare 5-Star ratings and past deficiencies were not consistent indicators of pandemic preparedness, likely because COVID-19 presented a novel problem requiring extensive adaptation by both long-term care providers and policymakers.


Subject(s)
COVID-19 , Homes for the Aged/organization & administration , Long-Term Care , Nursing Homes/organization & administration , Risk Adjustment , Skilled Nursing Facilities/organization & administration , Aged , COVID-19/mortality , COVID-19/prevention & control , Civil Defense/organization & administration , Humans , Infection Control/methods , Infection Control/standards , Long-Term Care/methods , Long-Term Care/trends , Outcome Assessment, Health Care , SARS-CoV-2
19.
Med Pr ; 72(3): 327-334, 2021 Jun 30.
Article in Polish | MEDLINE | ID: covidwho-1413301

ABSTRACT

Generally, COVID-19 is an acute contagious disease caused by the SARS­CoV-2 virus. The main route of human-to-human transmission is through contact with infectious secretions from the respiratory tract. Clinical manifestations vary from mild non-specific symptoms to life-threatening conditions. Since WHO declared COVID-19 a pandemic in March 2020, it has affected many medical, legal, social and economic aspects of everyday life in countries around the world. In this article, the authors present a summary of recommendations for taking care of otorhinolaryngology patients in outpatient settings and the legal basis referring to a risk of infection in doctor's office. In the selection of articles, the authors used English- and Polish-language online medical databases, typing the following keywords: SARS­CoV-2, COVID-19, otolaryngology, endoscopy, personal protective equipment, and legal responsibility of the physician. The mucosa of the upper respiratory tract is a potential site of virus replication. The specificity of an ear, nose and throat (ENT) examination and a direct patient-doctor contact favor the transmission of the infection. The authors discussed the elements of self-protection of medical personnel and the legal aspects a risk of the patient contracting the infection in the otolaryngology office. In the case of a direct contact with the patient, the following medical personal protective equipment is required: a cap, a mask with an FFP-2 filter, goggles, an apron and gloves. If, during the visit, exposure to secretions or aerosol from the respiratory tract is expected, the personnel should additionally wear a visor and a waterproof apron. The patient's visit in the clinic should be preceded by telemedicine consultation. Patients should be screened prior to having a direct contact with a physician, using a short patient questionnaire. The questionnaire may consist of simple questions about the characteristic symptoms of the SARS­CoV-2 infection and exposure to a sick person in the past 14 days. The question of staying in the areas of a high infection risk appears of little importance in view of the whole of Poland being perceived as constituting such an area. Due to the spread of the SARS­CoV-2 virus, new procedures for providing medical services have been introduced. In the case of claims on the part of the patient, the only protection the medical personnel or facility can provide is confirmation of scrupulous compliance with medical procedures . Med Pr. 2021;72(3):327-34.


Subject(s)
COVID-19/prevention & control , Infection Control/standards , Otolaryngology/standards , COVID-19/transmission , Health Personnel , Humans , Infection Control/legislation & jurisprudence , Otolaryngology/legislation & jurisprudence , Personal Protective Equipment
20.
Anesth Analg ; 133(4): 876-890, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1412364

ABSTRACT

The coronavirus disease 2019 (COVID-19) disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), often results in severe hypoxemia requiring airway management. Because SARS-CoV-2 virus is spread via respiratory droplets, bag-mask ventilation, intubation, and extubation may place health care workers (HCW) at risk. While existing recommendations address airway management in patients with COVID-19, no guidance exists specifically for difficult airway management. Some strategies normally recommended for difficult airway management may not be ideal in the setting of COVID-19 infection. To address this issue, the Society for Airway Management (SAM) created a task force to review existing literature and current practice guidelines for difficult airway management by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. The SAM task force created recommendations for the management of known or suspected difficult airway in the setting of known or suspected COVID-19 infection. The goal of the task force was to optimize successful airway management while minimizing exposure risk. Each member conducted a literature review on specific clinical practice section utilizing standard search engines (PubMed, Ovid, Google Scholar). Existing recommendations and evidence for difficult airway management in the COVID-19 context were developed. Each specific recommendation was discussed among task force members and modified until unanimously approved by all task force members. Elements of Appraisal of Guidelines Research and Evaluation (AGREE) Reporting Checklist for dissemination of clinical practice guidelines were utilized to develop this statement. Airway management in the COVID-19 patient increases HCW exposure risk. Difficult airway management often takes longer and may involve multiple procedures with aerosolization potential, and strict adherence to personal protective equipment (PPE) protocols is mandatory to reduce risk to providers. When a patient's airway risk assessment suggests that awake tracheal intubation is an appropriate choice of technique, and procedures that may cause increased aerosolization of secretions should be avoided. Optimal preoxygenation before induction with a tight seal facemask may be performed to reduce the risk of hypoxemia. Unless the patient is experiencing oxygen desaturation, positive pressure bag-mask ventilation after induction may be avoided to reduce aerosolization. For optimal intubating conditions, patients should be anesthetized with full muscle relaxation. Videolaryngoscopy is recommended as a first-line strategy for airway management. If emergent invasive airway access is indicated, then we recommend a surgical technique such as scalpel-bougie-tube, rather than an aerosolizing generating procedure, such as transtracheal jet ventilation. This statement represents recommendations by the SAM task force for the difficult airway management of adults with COVID-19 with the goal to optimize successful airway management while minimizing the risk of clinician exposure.


Subject(s)
Airway Management/standards , COVID-19/prevention & control , Health Personnel/standards , Infection Control/standards , Personal Protective Equipment/standards , Societies, Medical/standards , Adult , Advisory Committees/standards , Airway Extubation/methods , Airway Extubation/standards , Airway Management/methods , COVID-19/epidemiology , Humans , Infection Control/methods , Intubation, Intratracheal/methods , Intubation, Intratracheal/standards , Practice Guidelines as Topic/standards
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