Impact of COVID-19 outbreak on ICU nurses' mental health. An Italian multicenter study. / Impatto dell'epidemia di COVID-19 sulla salute mentale degli infermieri di Terapia Intensiva. Uno studio multicentrico Italiano.

AIM: AIM: The aim of this study was to evaluate variations in ICU nurses ' mental health status over the COVID-19 outbreak by quantifying the extent of symptoms of depression, anxiety and PTSD over time. METHODS: METHODS: This study was an Italian multicenter prospective cohort study assessing caseness of anxiety, depression and PTSD at 6 and 12 months from the beginning of the COVID-19 outbreak in Italy. RESULTS: RESULTS: A total of 359 nurses, 233 (64.9%) were males and 126 (35.1%) were females were enrolled. At 6 months the caseness prevalence for anxiety, depression and PTSD were 31.3%, 32.1% and 18.7% respectively. At 12 months the caseness prevalence for anxiety, depression and PTSD were 34.8%, 36.4% and 24.1 % respectively. No statistically significant increase between 6 and 12 months was recorded for the caseness prevalence anxiety (p= .29) and depression (p= .19). However, an increase for the caseness prevalence PTSD at 12 months was observed (p= .049). The significant risk factors for the 221 patients with at least one disorders were age 31-40 (RR= 1.44, IC= 1.25-1.89; p < .001), female gender (RR= 1.31, IC= 1.02-1.51; p=. 042) and had 0-5 years of professional experience (RR= 1.36, IC= 1.02-1.63; p = .031). CONCLUSION: The results of our study may provide support for the implementation of some interventions for well-being in COVID-19 outbreak condition.

Long-term effects of Coronavirus 2 infection after intensive care: a prospective study.

BACKGROUND: While the multi-organ manifestations of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection are now well-documented, the potential long-term implications of these manifestations remain to be uncovered. The aim was to study the level and predictors of post-traumatic stress, anxiety and depression symptoms, quality of life and functional disability in COVID-19 survivors during the first year post intensive care unit (ICU) discharge. METHODS: A prospective longitudinal study, reported following the STROBE guidance, was conducted in adult patients with SARS-CoV-2 infection admitted to an Italian ICU from March 2020 to March 2021 who were followed until March 2022. RESULTS: A total of 207 patients were included in the study, of which 145 (70.1%) were male. One hundred and six (51.2%) patients between six and 12 months after ICU discharge reported at least one physical or cognitive impairment. The concurrent prevalence of anxiety, depression and PTSD is present in 25/106 patients (23.6% of cases) at six months and increases in 29/106 patients (27.3% of cases) at 12 months. However, the prevalence of anxiety, depression and PTSD was observed in 86 patients (41.5%) at six months and it gets smaller in 78 patients (37.7%) at 12 months (p= .049). The EqVAS score (58.8 vs 72.3, p= .017) and the Barthel Index (61.5 vs 74.8, p< .001) increased significantly between six and 12 months after ICU. CONCLUSIONS: Our results show that functional and cognitive recovery improves between six and 12 months after ICU discharge with a high perception of the patients' quality of life.

Prevalence of Post Traumatic Stress Disorder, Anxiety and Depression among COVID-19 survivors 1 year after Intensive Care discharge.

BACKGROUND: Survivors of Intensive Care are known to be at increased risk of developing longer-term psychopathology issues. AIM: The aim of this study was to determine the prevalence of posttraumatic stress disorder, anxiety and depression among COVID-19 survivors 1 year after discharge from an Italian Intensive Care Unit (ICU). METHODS: We conducted a cross-sectional study between April and August 2021 among 86 adults COVID-19 survivors in Lecco (Italy). The PTSD was measured using the PTSD-checklist (PCL), HADS scale was used to measure anxiety and depression. Chi-square test or Fisher exact two-tailed tests were used to test for associations and the multiple logistic regressions model to determine factors that were independently associated with the outcome variables. RESULTS: The mean PTSD, anxiety and depression scores were (38.6 6.3), (5.1 3.8), (6.9 3.7) respectively. Based on cut-off scores, the prevalence of PTSD (PCL ≥ 45), anxiety (HADs score ≥ 8) and depression (HADs score ≥ 8) were (n = 20, 23.2%) (n = 22, 25.6%) and (n = 38, 44.2%) respectively. COVID-19 survivors who experienced a decreased level of exercise post-ICU discharge were more likely to show symptoms of depression (AOR = 2.57; 95%CI: 1.31-6.85, p = 0.027) and anxiety (AOR = 3.19; 95%CI: 1.29-8.32, p = 0.021) compared to those whose exercise remained the same post-ICU discharge. In addition Older COVID survivors were more likely to show symptoms of depression (AOR = 8.2, 95% CI: 1.97-24.45, p = 0.001) and anxiety (AOR = 3.26; 95%CI: 1.12-8.1, p = 0.022) compared to younger ones. CONCLUSIONS: Our findings show that PTSD, anxiety and depression are common among the COVID-19 survivors in Lecco. NURSING IMPLICATIONS: Nurses play a key role in the public health response to such crises, delivering direct patient care and reducing the risk of exposure to the infectious disease.

[Nosocomial infections during the COVID-19 outbreak. Observational study in an Italian ICU]. / Infezioni nosocomiali durante l'epidemia di COVID-19. Studio osservazionale in una Terapia Intensiva Italiana.

. Nosocomial infections during the COVID-19 outbreak. Observational study in an Italian ICU. INTRODUCTION: Infections are common among ICU patients. AIM: The purpose of this study is to examine the incidence of nosocomial infections among patients admitted to the ICU with SARS-CoV-2 infection. METHODS: A prospective observational study in adults with confirmed SARS-CoV-2 infection requiring intensive care unit (ICU) admission was performed. From May 2020 to October 2021, a total of 109 admitted patients were included. RESULTS: The incidence rate of new infections was 39.4%. The main infections observed were multidrug-resistant germs infections (39.5%), catheter-related blood infections(24.4%), pneumonia (VAP)(18.6%), and urinary tract infections (17.4%). The overall mortality rate was 32.1% (n= 35) and was significantly higher in patients who had a new infection during hospitalization (n= 26/43, 60.4%) than in patients who did not have a new infection (n= 9/66, 13.6%) (RR = 4.43; 95% CI = 2.31-8.52; p <.001). CONCLUSIONS: Our data suggest that secondary infections are associated with a longer duration of mechanical ventilation and hospital stay and may negatively impact patient survival. However, larger studies are needed.

Co-infections in critically ill adults with severe acute respiratory syndrome coronavirus 2 infection. An italian multi-centre prospective study.

BACKGROUND: To date, few studies have described Hospital-acquired infections (HAIs) during COVID-19 outbreak. To examine the incidence of HAIs in critically ill adult patients with SARS-COV-2 infection and to observe risk factors, and the impact on outcome of HAI. METHODS: A prospective multicenter study was conducted that included adult patients with SARS-COV-2 infection admitted to 18 Italian Intensive Care Units from September 2020 to November 2021. RESULTS: A total of 589 patients were included. A total of 233 patients were diagnosed with at least 1 HAI (39.6%). The co-infection/co-colonisation rate > 48 hours after admission was 31.0 per 1,000 person-days (95% CI 18.8 - 34.8). Age, length of ICU stay > 7 days, obesity, type 2 diabetes mellitus, cardiovascular disease, inserted central venous catheter, intubation, APACHE II score > 25, mechanical ventilation (MV) > 48 hours, obesity and inserted urinary catheter are associated outcomes for infection aquisition. The overall mortality rate of patients was found to be significantly higher in patients who had acquired a HAI (RR= 4.37; 95% CI = 3.30 - 5.78; p < .001). CONCLUSIONS: Associated factors for HAI acquisition and mortality in ICU patients were identified and cause for revision of existing infection control policies.

[Burnout syndrome among Italian nursing staff during the COVID 19 emergency. Multicentric survey study]. / Sindrome di Burnout tra il personale infermieristico italiano durante l'emergenza COVID 19. Indagine conoscitiva multicentrica.

AIM: To analyze the prevalence of Burnout defined by the MBI-GS among Italian nursing staff during the COVID-19 emergency. INTRODUCTION: The recent health emergency which in the first half of 2020 has seen Italy involved in the management of patients with COVID-19 (COronaVIrus Disease 19), has led to further stress for hospitals both in terms of beds and in terms of workload for healthcare workers. METHOD: A multicenter study was conducted. A convenience sample of 208 nurses participated in the study. Between March 20 and July 20, 2020, the Maslach Burnout Inventory-General Survey (MBI-GS) questionnaire was made available online by using the Google Forms platform in order to detect and measure the severity of Burnout Syndrome (BOS). RESULTS: BOS-related symptoms (medium or high score) for individual MBI-GS domains were identified in at least 68% of nurses. One hundred and sixty-one nurses (77.4%) had a risk of emotional exhaustion, 143 (68.7%) of depersonalization, and 162 (77.9%) of reduced professional accomplishment. High risk was observed among nurses who managed COVID patients at their own operating unit (RR = 1.27, p = 0.016). Severe BOS risk was observed in 146 nurses analyzed (70.2%) with an increased risk among Intensive Care nurses. CONCLUSIONS: Our results suggest that the nurses during the coronavirus pandemic, had high levels of work-related suffering and were at risk of physical and emotional exhaustion. Further research should be undertaken to establish causal relationships between BOS and personal and environmental risk factors among healthcare professionals in relation to the COVID-19.