ABSTRACT
BACKGROUND: Respiratory viral illness (RVI)-e.g., influenza, COVID-19-is a serious threat in long-term care (LTC) facilities. Standard infection control measures are suboptimal in LTC facilities because of residents' cognitive impairments, care needs, and susceptibility to loneliness and mental illness. Further, LTC residents living with high degrees of frailty who contract RVIs often develop the so-called atypical symptoms (e.g., delirium, worse mobility) instead of typical cough and fever, delaying infection diagnosis and treatment. Although far-UVC (222 nm) light devices have shown potent antiviral activity in vitro, clinical efficacy remains unproven. METHODS: Following a study to assay acceptability at each site, this multicenter, double-blinded, cluster-randomized, placebo-controlled trial aims to assess whether far-UVC light devices impact the incidence of RVIs in LTC facilities. Neighborhoods within LTC facilities are randomized to receive far-UVC light devices (222 nm) or identical placebo light devices that emit only visible spectrum light (400-700 nm) in common areas. All residents are monitored for RVIs using both a standard screening protocol and a novel screening protocol that target atypical symptoms. The 3-year incidence of RVIs will be compared using intention-to-treat analysis. A cost-consequence analysis will follow. DISCUSSION: This trial aims to inform decisions about whether to implement far-UVC light in LTC facilities for RVI prevention. The trial design features align with this pragmatic intent. Appropriate additional ethical protections have been implemented to mitigate participant vulnerabilities that arise from conducting this study. Knowledge dissemination will be supported through media engagement, peer-reviewed presentations, and publications. TRIAL REGISTRATION: ClinicalTrials.gov NCT05084898. October 20, 2021.
Subject(s)
COVID-19 , SARS-CoV-2 , Humans , Long-Term Care , Health Facilities , Skilled Nursing Facilities , Treatment Outcome , Randomized Controlled Trials as Topic , Multicenter Studies as TopicABSTRACT
BACKGROUND: Many individuals and organizations experience vicarious trauma, defined as exposure to traumatic experiences of others. Those who work with children traumatized by abuse and/or neglect, including, but not limited to, child welfare, child protection, counselors, healthcare providers, advocates, law enforcement, and prosecutors investigating crimes against children, are exposed to traumatic stories daily in their work. Negative reactions to this witnessing of other people's trauma results in vicarious traumatization (also referred to as secondary traumatic stress) which can manifest as mental, physical, emotional, spiritual, work-related and/or social consequences. METHODS: A review of research literature on the epidemiology of vicarious traumatization among child welfare professionals was conducted. A systematic search strategy was employed using relevant research databases (PubMed, PsychInfo, PILOTS, and EBSCO) for publications from 1995 to 2018. A four-phase PRISMA selection process was employed. Search terms included vicarious trauma/related terms and child welfare/child protection professions. Trained reviewers considered articles meeting inclusion criteria including: (1) child welfare professions; (2) vicarious traumatization/related terms; and (3) analysis of epidemiological data on prevalence, risk/protective factors, or manifestation of vicarious traumatization. RESULTS: Initially 7,895 unique manuscripts were identified. After multi-stage screening, a total of 39 articles were included. Findings regarding the epidemiology of vicarious traumatization are summarized. CONCLUSIONS: While exposure to traumatic narratives of those they serve is inevitable for those working in child welfare and child protection professions, the growing research base shows potential for preventing negative impacts and promoting positive outcomes of this empathic work. Identification of additional risk/protective factors and future development and evaluation of evidence-based interventions are important next steps.
