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1.
Orv Hetil ; 163(46): 1814-1822, 2022 Nov 13.
Article in English | MEDLINE | ID: covidwho-2162673

ABSTRACT

INTRODUCTION: COVID-19 significantly affects endoscopic labs' workflow. Endoscopic examinations are considered high-risk for virus transmission. OBJECTIVES: To determine impact of COVID-19 pandemic on Hungarian endoscopic labs' workflow and on infection risk of endoscopic staff. METHOD: A nation-wide, cross-sectional online questionnaire was sent to heads of endoscopic labs in Hungary. The average number (with 95% confidence intervals) of upper and lower gastrointestinal endoscopies performed in 2020 was compared to that in 2019. The number of SARS-CoV-2-infected endoscopic staff members and the source of infection was also investigated. RESULTS: Completion rate was 30% (33/111). Neither the number of upper (1.593 [743-1.514] vs. 1.129 [1.020-2.166], p = 0.053), nor that of lower gastrointestinal endoscopies (1.181 [823-1.538] vs. 871 [591-1.150], p = 0.072) decreased in 2020, but both upper and lower gastrointestinal endoscopies' number decreased by 80% during peak phases. Separate examination room was available in 12% of institutes. Appropriate quality personal protective equipment (PPE) was available during the first and second peak phase in 70% and 82%, respectively. Infection risk stratification by questionnaire and PCR testing was routinely performed in 85% and 42%, respectively. Employee number decreased by 33% and 26% for physicians, and by 19% and 21% for assistants during peak phases, mainly due to age restrictions and COVID care assignments. 32% of assistants and 41% of physicians were infected (associated with inappropriate PPE use in 16% and 18%, respectively). CONCLUSION: Peak phases' restrictions increase endoscopic workload afterwards. Despite PPE availability, 15% of employees' COVID infection resulted from inappropriate PPE use in pre-vaccination era. Orv Hetil. 2022; 163(46): 1814-1822.


Subject(s)
COVID-19 , SARS-CoV-2 , Humans , Pandemics , COVID-19/epidemiology , Cross-Sectional Studies , Personal Protective Equipment
2.
AORN J ; 116(3): 219-228, 2022 09.
Article in English | MEDLINE | ID: covidwho-2157696

ABSTRACT

The spread of coronavirus disease 2019 posed a public health crisis beginning in January 2020, affecting hospitals and health care personnel worldwide and disrupting perioperative services. Organization leaders at Xijing Hospital, Xi'an, China, developed a mitigation system for the OR that involved creating a pandemic response team to identify and implement appropriate infection control practices to prevent virus transmission. The leaders addressed managing the daily surgery schedule through patient screening and a focus on the urgency and volume of procedures. They required increased use of personal protective equipment and more stringent cleaning and disinfection protocols and ensured that the physical and mental health of staff members were monitored and prioritized. This article describes how leaders implemented these enhanced processes to protect personnel from infection as they continued to provide patient care. It also describes how high-risk procedures involving patients with confirmed or suspected infections were managed and discusses lessons learned.


Subject(s)
COVID-19 , Humans , Infection Control/methods , Pandemics/prevention & control , Personal Protective Equipment , SARS-CoV-2
4.
Anesthesiology ; 134(1): 61-71, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-2161186

ABSTRACT

BACKGROUND: Disease severity in coronavirus disease 2019 (COVID-19) may be associated with inoculation dose. This has triggered interest in intubation barrier devices to block droplet exposure; however, aerosol protection with these devices is not known. This study hypothesized that barrier devices reduce aerosol outside of the barrier. METHODS: Aerosol containment in closed, semiclosed, semiopen, and open barrier devices was investigated: (1) "glove box" sealed with gloves and caudal drape, (2) "drape tent" with a drape placed over a frame, (3) "slit box" with armholes and caudal end covered by vinyl slit diaphragms, (4) original "aerosol box," (5) collapsible "interlocking box," (6) "simple drape" over the patient, and (7) "no barrier." Containment was investigated by (1) vapor instillation at manikin's right arm with video-assisted visual evaluation and (2) submicrometer ammonium sulfate aerosol particles ejected through the manikin's mouth with ventilation and coughs. Samples were taken from standardized locations inside and around the barriers using a particle counter and a mass spectrometer. Aerosol evacuation from the devices was measured using standard hospital suction, a surgical smoke evacuator, and a Shop-Vac. RESULTS: Vapor experiments demonstrated leakage via arm holes and edges. Only closed and semiclosed devices and the aerosol box reduced aerosol particle counts (median [25th, 75th percentile]) at the operator's mouth compared to no barrier (combined median 29 [-11, 56], n = 5 vs. 157 [151, 166], n = 5). The other barrier devices provided less reduction in particle counts (133 [128, 137], n = 5). Aerosol evacuation to baseline required 15 min with standard suction and the Shop-Vac and 5 min with a smoke evacuator. CONCLUSIONS: Barrier devices may reduce exposure to droplets and aerosol. With meticulous tucking, the glove box and drape tent can retain aerosol during airway management. Devices that are not fully enclosed may direct aerosol toward the laryngoscopist. Aerosol evacuation reduces aerosol content inside fully enclosed devices. Barrier devices must be used in conjunction with body-worn personal protective equipment.


Subject(s)
Aerosols/analysis , COVID-19/prevention & control , Occupational Exposure/analysis , Occupational Exposure/prevention & control , Personal Protective Equipment , Aerosols/adverse effects , Cough/prevention & control , Cough/virology , Health Personnel , Humans , Intubation, Intratracheal/adverse effects
6.
Front Public Health ; 10: 982738, 2022.
Article in English | MEDLINE | ID: covidwho-2142333

ABSTRACT

Objectives: The COVID-19 pandemic has posed several risk factors to healthcare workers' (HCWs') emotional distress. The purpose of the study was to enhance understanding of the experiences and feelings of HCWs during the COVID-19 pandemic, with specific reference to infection prevention and control (IPC) practices and guidance, focusing on the quality and availability of personal protective equipment (PPE), guidelines, and management. With a qualitative approach, we aimed to enable a wider narrative; to gain a more detailed understanding related to PPE use and identify experiences that can be overlooked in forced-choice questionnaires. Methods: An online questionnaire was conducted among HCWs of the City of Helsinki and Helsinki University Hospital between 12.6.2020 and 5.4.2021. Altogether 1,580 HCWs participated in the study, from whom 579 shared 1,666 free-text responses. These responses were analyzed qualitatively, and the results were combined with statistical data on the participants' working conditions and backgrounds. Results: We identified problems in PPE availability and changing guidelines as factors causing the most distress in the participants. Regarding availability, running out of masks and respirators emerged as the most worrying issue, and inadequate PPE was associated with the excessive workload (OR 1.51, CI 95% 1.01-2.25). The results also highlight the importance of transparent and clear communication regarding IPC instructions and guidance, and clear IPC guidance was associated with better levels of reported recovery from work (OR 1.51, CI 95% 1.06-2.14). Conclusions: Our study highlights the importance of adequate PPE provision, transparent communication, clear guidance, and supportive supervisory work in this ongoing pandemic and potential new ones. We suggest more rigorous preparation, with crisis communication planning and emergency storage of PPE.


Subject(s)
COVID-19 , Humans , COVID-19/prevention & control , Pandemics , Infection Control/methods , Health Personnel , Personal Protective Equipment
7.
BMJ Open ; 12(11): e061029, 2022 11 23.
Article in English | MEDLINE | ID: covidwho-2137708

ABSTRACT

INTRODUCTION: This study aims to measure how transmission of SARS-CoV-2 occurs in communities and to identify conditions that lend to increased transmission focusing on congregate situations. We will measure SARS-CoV-2 in exhaled breath of asymptomatic and symptomatic persons using face mask sampling-a non-invasive method for SARS-CoV-2 detection in exhaled air. We aim to detect transmission clusters and identify risk factors for SARS-CoV-2 transmission in presymptomatic, asymptomatic and symptomatic individuals. METHODS AND ANALYSIS: In this observational prospective study with daily follow-up, index cases and their respective contacts are identified at each participating institution. Contact definitions are based on Centers for Disease Control and Prevention and local health department guidelines. Participants will wear masks with polyvinyl alcohol test strips adhered to the inside for 2 hours daily. The strips are applied to all masks used over at least 7 days. In addition, self-administered nasal swabs and (optional) finger prick blood samples are performed by participants. Samples are tested by standard PCR protocols and by novel antigen tests. ETHICS AND DISSEMINATION: This study was approved by the Colorado Multiple Institutional Review Board and the WHO Ethics Review Committee. From the data generated, we will analyse transmission clusters and risk factors for transmission of SARS-CoV-2 in congregate settings. The kinetics of asymptomatic transmission and the evaluation of non-invasive tools for detection of transmissibility are of crucial importance for the development of more targeted control interventions-and ultimately to assist with keeping congregate settings open that are essential for our social fabric. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (#NCT05145803).


Subject(s)
COVID-19 , Masks , Humans , SARS-CoV-2 , Prospective Studies , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , Personal Protective Equipment , Observational Studies as Topic
8.
Health Secur ; 20(S1): S107-S113, 2022 06.
Article in English | MEDLINE | ID: covidwho-2134703
9.
Infect Dis Clin North Am ; 36(1): 15-37, 2022 03.
Article in English | MEDLINE | ID: covidwho-2130978

ABSTRACT

COVID-19 is a nonspecific viral illness caused by a novel coronavirus, SARS-CoV-2, and led to an ongoing global pandemic. Transmission is primarily human-to-human via contact with respiratory particles containing infectious virus. The risk of transmission to health care personnel is low with proper use of personal protective equipment, including gowns, gloves, N95 or surgical mask, and eye protection. Additional measures affecting the risk of transmission include physical distancing, hand hygiene, routine cleaning and disinfection, appropriate air handling and ventilation, and public health interventions such as universal masking and stay-at-home orders.


Subject(s)
COVID-19 , Infection Control , Pandemics , COVID-19/prevention & control , Humans , Infection Control/instrumentation , Infection Control/methods , Masks , Personal Protective Equipment
11.
J Infect Dev Ctries ; 16(10): 1578-1587, 2022 10 31.
Article in English | MEDLINE | ID: covidwho-2110322

ABSTRACT

Since December 2019, the global outbreak of coronavirus disease had a significant impact on humanity. Because of the large number of casualties worldwide, the WHO (World Health Organization) declared the coronavirus disease caused by SARS-CoV-2 a pandemic. Since the start of the pandemic, facial masks have become essential as well as mandatory to protect ourselves from COVID-19. As a result of the pandemic, healthcare professionals (HCPs) have been required to wear personal protective equipment (PPE) for extended periods. Wearing face masks for an extended period has been shown to have several negative effects on HCPs. Additionally, face masks have hampered the use of digital techniques for facial identification. This paper examines the effects of wearing face masks for an extended period, as well as the effect of wearing face masks on facial identification technology. The Web of Science, PubMed, and Scopus databases were searched and screened for relevant studies. According to the current review, prolonged use of masks was found to be associated with adverse effects on the face and skin, including acne, redness, rashes, and itching. The use of masks also resulted in headaches, hypoxic conditions, and changes in voice and speech parameters. This communication in no way intends to advocate the discontinuation of wearing masks, on the contrary, the primary goal of this article is to spread awareness about the adverse effects associated with prolonged use of facial masks (N95, KF94, or surgical). This will help in increasing compliance with mask mandates by helping to develop preventive solutions to the problems that tend to deter the general public. This also demonstrates how the use of masks has become a challenge for facial recognition technologies.


Subject(s)
COVID-19 , Masks , Humans , SARS-CoV-2 , COVID-19/prevention & control , Pandemics/prevention & control , Personal Protective Equipment
12.
BMJ Glob Health ; 7(11)2022 11.
Article in English | MEDLINE | ID: covidwho-2108269

ABSTRACT

The COVID-19 pandemic will not be the last of its kind. As the world charts a way towards an equitable and resilient recovery, Public Health and Social Measures (PHSMs) that were implemented since the beginning of the pandemic need to be made a permanent feature of health systems that can be activated and readily deployed to tackle sudden surges in infections going forward. Although PHSMs aim to blunt the spread of the virus, and in turn protect lives and preserve health system capacity, there are also unintended consequences attributed to them. Importantly, the interactions between PHSMs and their accompanying key indicators that influence the strength and duration of PHSMs are elements that require in-depth exploration. This research employs case studies from six Asian countries, namely Indonesia, Singapore, South Korea, Thailand, the Philippines and Vietnam, to paint a comprehensive picture of PHSMs that protect the lives and livelihoods of populations. Nine typologies of PHSMs that emerged are as follows: (1) physical distancing, (2) border controls, (3) personal protective equipment requirements, (4) transmission monitoring, (5) surge health infrastructure capacity, (6) surge medical supplies, (7) surge human resources, (8) vaccine availability and roll-out and (9) social and economic support measures. The key indicators that influence the strength and duration of PHSMs are as follows: (1) size of community transmission, (2) number of severe cases and mortality, (3) health system capacity, (4) vaccine coverage, (5) fiscal space and (6) technology. Interactions between PHSMs can be synergistic or inhibiting, depending on various contextual factors. Fundamentally, PHSMs do not operate in silos, and a suite of PHSMs that are complementary is required to ensure that lives and livelihoods are safeguarded with an equity lens. For that to be achieved, strong governance structures and community engagement are also required at all levels of the health system.


Subject(s)
COVID-19 , Humans , Pandemics/prevention & control , Public Health , Personal Protective Equipment , Philippines
13.
Niger Postgrad Med J ; 29(4): 303-309, 2022.
Article in English | MEDLINE | ID: covidwho-2100052

ABSTRACT

Background: Every workplace has got hazards in many different forms, ranging from sharps, falling objects, chemicals, infections, noise and a lot of other potentially dangerous situations. The occupational safety and health administration mandates employers to protect their employees from such potentially dangerous workplace hazards. Personal protective equipment (PPE) plays an important role in preventing and ensuring health safety amongst industrial workers. This study aimed to determine the use of PPE and rules compliance amongst Industrial Workers in Kano State. Methods: A cross-sectional study design was used to assess 150 workers selected from the Sharada Industrial Estate, Kano, Nigeria, using a multistage sampling technique. Data were obtained using semi-structured interviewer-administered questionnaires and analysed using SPSS version 22.0. Results: The response rate was 88.2%, and the mean age of respondents was 28.1 ± 7.4. About 72% were male, 74.7% had secondary education and 16.4% reported ever having a child with a congenital anomaly. Up to 25% reported using PPE always, 62% used PPE occasionally and 12% never used PPE. Factors significantly associated with the use of PPE at bivariate level were: Gender, 'provision of statutory regulation by the management', 'provision of PPE on worksite' and 'provision of training to staff' respectively. However, on multivariable regression analysis, only 'provision of statutory regulation by the management' and 'provision of PPE on worksite' were found to be independent (intrinsic) predictors of the use of PPE. Conclusions: Training alone does not necessarily increase the uptake of PPE amongst industrial workers. There is a need to ensure the availability of PPE at the worksite, as well as statutory regulations by industries.


Subject(s)
Occupational Health , Personal Protective Equipment , Female , Humans , Male , Cross-Sectional Studies , Health Personnel , Nigeria , Surveys and Questionnaires
14.
Nurs Res ; 71(6): 421-431, 2022.
Article in English | MEDLINE | ID: covidwho-2097526

ABSTRACT

BACKGROUND: Nursing professional organizations and media sources indicated early in the pandemic that the physical and psychological effects of COVID-19 might be distinct and possibly greater in nurses than in other types of healthcare workers (HCWs). OBJECTIVES: Based on survey data collected in Healthcare Worker Exposure Response and Outcomes (HERO), a national registry of U.S. HCWs, this study compared the self-reported experiences of nurses with other HCWs during the first 13 months of the pandemic. METHODS: Nurse responses were compared to responses of nonnurse HCWs in terms of viral exposure, testing and infection, access to personal protective equipment (PPE), burnout, and well-being. Logistic regression models were used to examine associations between nurse and nonnurse roles for the binary end points of viral testing and test positivity for COVID-19. We also examined differences by race/ethnicity and high-risk versus low-risk practice settings. RESULTS: Of 24,343 HCWs in the registry, one third self-identified as nurses. Nurses were more likely than other HCWs to report exposure to SARS-CoV-2, problems accessing PPE, and decreased personal well-being, including burnout, feeling tired, stress, trouble sleeping, and worry. In adjusted models, nurses were more likely than nonnurse HCWs to report viral testing and test positivity for COVID-19 infection. Nurses in high-risk settings were more likely to report viral exposure and symptoms related to well-being; nurses in low-risk settings were more likely to report viral testing and test positivity. Black or Hispanic nurses were most likely to report test positivity. DISCUSSION: Differences were identified between nurses and nonnurse HCWs in access to PPE, physical and mental well-being measures, and likelihood of reporting exposure and infection. Among nurses, testing and infection differed based on race and ethnicity, and type of work setting. Our findings suggest further research and policy are needed to elucidate and address social and occupational disparities.


Subject(s)
Burnout, Professional , COVID-19 , Humans , SARS-CoV-2 , Pandemics , Personal Protective Equipment , Health Personnel/psychology , Burnout, Professional/epidemiology , Registries
16.
Health Secur ; 20(S1): S31-S38, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-2097253

ABSTRACT

In February 2015, the US Department of Health and Human Services developed a tiered hospital network to deliver safe and effective care to patients with Ebola virus disease (EVD) and other special pathogens. The tiered network consisted of regional special pathogen treatment centers, state- or jurisdiction-designated treatment centers, assessment hospitals able to safely isolate a patient until a diagnosis of EVD was confirmed and transfer the patient, and frontline healthcare facilities able to identify and isolate patients with EVD and facilitate transport to higher-tier facilities. The National Emerging Special Pathogens Training and Education Center (NETEC) was established in tandem to support the development of healthcare facility special pathogen management capabilities. In August 2020, 20 hospitals that previously received an onsite readiness consultation by NETEC were surveyed to assess how special pathogen programs were leveraged for COVID-19 response. All surveyed facilities indicated their programs were leveraged for COVID-19 response in at least 1 of the following ways: NETEC-sponsored resources and training, utilization of patient isolation spaces, specially trained staff, and supplies. Personal protective equipment shortages were experienced by 95% of facilities, with 80% of facilities reporting that special pathogens program personal protective equipment was used to support facility response to COVID-19 admissions. More than half of facilities (63%) reported leveraging biocontainment unit staff to provide training and education to frontline staff during initial response to COVID-19. These findings have implications for planning and investments to avoid the panic-then-forget cycle that hinders sustained preparedness for future special pathogens.


Subject(s)
COVID-19 , Hemorrhagic Fever, Ebola , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/prevention & control , Hospitals , Humans , Patient Isolation , Personal Protective Equipment
17.
Health Secur ; 20(S1): S54-S59, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-2097248

ABSTRACT

Staff safety is paramount when managing an infectious disease event. However, early data from the COVID-19 pandemic suggested that staff compliance with personal protective equipment and other safety protocols was poor. In response to patient surges, many hospitals created dedicated "biomode" units to provide care for patients infected with SARS-CoV-2, the virus that causes COVID-19. To enhance staff safety on biomode units and during patient transports, our hospital created a safety officer/transport safety officer (SO/TSO) program. The first SOs/TSOs were nurses, clinical technicians, and other support staff who were redeployed from their home units when the units closed during the initial surge. During subsequent COVID-19 surges, dedicated SOs/TSOs were hired to maintain the program. SOs/TSOs provided just-in-time personal protective equipment training and helped staff safely enter and exit COVID-19 clinical units. SOs/TSOs participated in the transport of over 1,000 COVID-19 patients with no safety incidents reported. SOs/TSOs conducted safety audits throughout the hospital and observed 86% compliance with COVID-19 precautions across 32,500 activities. During contact tracing of frontline staff who became infected with SARS-CoV-2, potential deviations from COVID-19 precautions were identified in only 7.7% of cases. The SO/TSO program contributed to a culture of safety in the biomode units and helped to enhance infection prevention throughout the hospital. This program can serve as a model for other health systems during the response to the current pandemic and during future infectious disease threats.


Subject(s)
COVID-19 , COVID-19/prevention & control , Hospitals , Humans , Pandemics/prevention & control , Personal Protective Equipment , SARS-CoV-2
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