One response: Global Outbreak Alert and Response Network supporting the COVID-19 response, Kiribati.

Problem: In January 2022, Kiribati experienced widespread community transmission of COVID-19, leading to high rates of infection among health-care workers (HCWs), which reduced essential HCWs during a period of increased hospital admissions. Context: Kiribati, a Pacific island country made up of a remote group of 33 low-lying atolls in the Pacific Ocean, experienced its first surge of COVID-19 cases beginning on 24 January 2022. Action: Reports of increasing numbers of COVID-19 cases in South Tarawa prompted the Kiribati Ministry of Health and Medical Services to request assistance from the international community, including the World Health Organization's Global Outbreak Alert and Response Network (GOARN), to support national COVID-19 response operations. Specialists in infection prevention and control (IPC) were deployed to Kiribati in February 2022 to assist the Ministry's National COVID-19 Taskforce in collaboration with national partners. These specialists helped review and strengthen IPC capacities to accommodate a potential patient surge and consequent demands for medical consumables in health-care facilities in South Tarawa. Outcome: Strengthened knowledge about and processes for IPC among HCWs prevented health care-associated infections and reduced community disease transmission during the first surge of COVID-19 cases in Kiribati. Discussion: GOARN has the capacity and ability to rapidly deploy experts to support requests for assistance. Outbreak response activities can be enhanced and sustained by using GOARN's resources and collaborating with all partners, as necessary.

Paramedics' experiences of barriers to, and enablers of, responding to suspected or confirmed COVID-19 cases: a qualitative study.

BACKGROUND: Paramedics' work, even pre-pandemic, can be confronting and dangerous. As pandemics add extra stressors, the study explored paramedics' lived experience of the barriers to, and enablers of, responding to suspected or confirmed Coronavirus Disease 2019 (COVID-19) cases. METHODS: This exploratory-descriptive qualitative study used semi-structured interviews to investigate Queensland metropolitan paramedics' experiences of responding to cases during the COVID-19 pandemic. Interview transcripts were analysed using thematic analysis. Registered Paramedics were recruited by criterion sampling of staff who experienced the COVID-19 pandemic as active officers. RESULTS: Nine registered paramedics participated. Five themes emerged: communication, fear and risk, work-related protective factors, leadership, and change. Unique barriers included impacts on effective communication due to the mobile nature of paramedicine, inconsistent policies/procedures between different healthcare facilities, dispatch of incorrect information to paramedics, assisting people to navigate the changing healthcare system, and wearing personal protective equipment in hot, humid environments. A lower perceived risk from COVID-19, and increased empathy after recovering from COVID-19 were unique enablers. CONCLUSIONS: This study uncovered barriers and enablers to attending suspected or confirmed COVID-19 cases unique to paramedicine, often stemming from the mobile nature of prehospital care, and identifies the need for further research in paramedicine post-pandemic to better understand how paramedics can be supported during public health emergencies to ensure uninterrupted ambulance service delivery.

Perceptions and attitudes toward COVID-19 vaccination among health professional students in Australia: a qualitative study.

Using two qualitative data sources: free-text responses to an open-ended question of an online survey and subsequent interviews and focus groups, we explored perceptions and attitudes toward COVID-19 vaccination among health professional students enrolled in Australian universities during the pandemic with data collected from October 2021 to April 2022. Students provided free-text responses to the open-ended question (n = 313) in the online survey and participated in interviews or focus groups (n = 17). Data analysis revealed three themes, including perceptions of COVID-19 seriousness and the risk of contracting the virus, information dissemination, and attitudes toward the vaccine mandate. The study identified evolving perceptions of COVID-19 seriousness among Australian health professional students and their sentiments toward the vaccine mandate. There is a need to ensure the quality of information dissemination related to the vaccine mandate. This may not only support students' uptake of mandatory vaccination but also provide a means for them to address vaccination with healthcare consumers and patients.

Investigating socio-ecological factors influencing implementation of tuberculosis infection prevention and control in rural Papua New Guinea.

BACKGROUND: Tuberculosis (TB) is a highly transmissible infectious disease killing millions of people yearly, particularly in low-income countries. TB is most likely to be transmitted in healthcare settings with poor infection control practices. Implementing TB infection prevention and control (TB-IPC) is pivotal to preventing TB transmission in healthcare settings. This study investigated diverse stakeholders' perspectives relating to barriers and strategies for TB-IPC in rural hospitals in Papua New Guinea. METHODS: Multiple qualitative case studies were conducted with 32 key stakeholders with experience in TB services. Data collection drew on three primary sources to triangulate data: semi-structured interviews, document reviews and field notes. The data were analyzed using hybrid deductive-inductive thematic analysis. RESULTS: Our results reveal that key stakeholders perceive multiple interdependent factors that affect TB-IPC practice. The key emerging themes include strategic planning for and prioritizing TB-IPC guidelines; governance, leadership and accountability at the provincial level; community attitudes towards TB control; institutional capacity to deliver TB care, healthcare workers' safety, and long-term partnership and integration of TB-IPC programmes into the broad IPC programme. CONCLUSIONS: The evidence suggests that a multi-perspective approach is crucial for TB-IPC guidelines in healthcare institutions. Interventions focusing on addressing health systems strengthening may improve the implementation of TB-IPC guidelines.

Infection prevention and control continuous education and training in pre-registration nursing programmes.

BACKGROUND: Infection prevention and control (IPC) education and training in pre-registration nursing programmes are imperative in developing student nurses' clinical aptitudes. The IPC core competencies must be consistent amongst student nurses across different settings, asserting the need for education and training providers to respond. Continuous education and training can improve IPC core competencies through enhanced knowledge, compliance, and attitude in the academic and clinical contexts, impacting future nursing practice and patient safety. OBJECTIVE: This integrative review critically examines the reported IPC core competencies in pre-registration nursing programmes to contribute to future continuous IPC education and training. REVIEW METHODS: An integrative literature review methodology was utilised to conduct a structured literature search within the last five years using CINAHL Plus, EMBASE, ERIC, MEDLINE, and PubMed databases. The following keywords were used: infection prevention and control; pre-registration nursing; higher education; core competencies in the databases. A total of 15 articles were identified under the inclusion criteria of peer-reviewed primary research in English on the pre-registration nurse population and their nursing programmes. RESULTS: The final review of the 15 reports yielded continuous IPC education and training, knowledge, skills, and attitudes, and clinical placements as key components to develop and elevate student nurses' IPC core competencies. CONCLUSION: All reports acknowledged the challenges of maintaining IPC core competencies and seeking diversified strategies to support continuous education and training utilising interactive tools embedded with simulated scenarios and quizzes, translating knowledge and skills to exemplary professional behaviours, and consistent academic and clinical support as the IPC demand intensifies.

Effectiveness of fit testing versus fit checking for healthcare workers respiratory protective equipment: A systematic review.

Objectives: Respiratory protection is critical in healthcare to minimise the risk of airborne infections for healthcare workers (HCWs). It emphasizes the use of proper fitting of particulate filter respirators and equivalent respiratory protective equipment (RPE) to ensure a good facial seal. The systematic review aimed to compare the effectiveness of fit testing and fit checking for HCWs' respiratory protective equipment. Methods: A systematic review of the literature exploring RPE for HCWs to determine the effectiveness of fit-testing versus fit-checking from January 2003 to April 2022 was identified using CINAHL Complete via EBSCO Host, Cochrane Library, EMBASE, PubMed, and MEDLINE via Ovid electronic databases, and grey literature. The study protocol was registered with PROSPERO (registration number: CRD42020213968). Results: Of the 561 articles identified in the search, 25 articles (22 quantitative studies and three guidelines) were included in this review. Overall, these studies suggest fit-testing as a method that is more effective, widely adopted, and reliable in assessing the effectiveness of RPE; however, a respiratory program should include both fit-testing and fit-checking to maximise effectiveness of the RPE. The COVID-19 epidemic highlighted a lack of knowledge among HCWs regarding fit-checking and fit-testing, and relevant education increased the effectiveness of respiratory equipment protection. Conclusion: It is imperative that both fit-testing and fit-checking is implemented in order to ensure HCW safety. It is recommended to integrate education, fit-testing and fit-checking into a comprehensive respiratory protective program run by trained fit-testers. There is also a need for practical testing methods that incorporate the clinical environment.

Barriers and facilitators to COVID-19 vaccine uptake among Australian health professional students during the pandemic: a nationwide study.

Using a cross-sectional online survey we investigated knowledge, attitudes, and risk perception about COVID-19 vaccination and identified factors influencing vaccine uptake among Australian health professional students from October 2021 to January 2022. We analysed data from 1114 health professional students from 17 Australian universities. Most participants were enrolled in nursing programs (n = 958, 86.8%), and 91.6% (n = 858) of the participants received COVID-19 vaccination. Approximately 27% believed COVID-19 was no more serious than seasonal influenza and that they had a low risk of acquiring COVID-19. Nearly 20% disagreed that COVID-19 vaccines in Australia were safe and perceived they were at higher-risk of acquiring COVID infection than the general population. Higher-risk perception viewing vaccination as their professional responsibility, and vaccine mandate strongly predicted vaccination behaviour. Participants consider COVID-19 information from health professionals, government websites, and World Health Organization as the most trusted information sources. The findings highlight that healthcare decision-makers and university administrators need to monitor students' hesitancy with vaccination to improve students' promotion of the vaccination to the general population.

Paramedic insertion of peripheral intravenous catheters, unused catheter rates, and influencing factors: A retrospective review.

BACKGROUND: Peripheral intravenous catheters (PIVCs) are associated with adverse events such as bloodstream infections; thus clinically appropriate practice is important. However, there is limited research on PIVC use in ambulance settings. This study investigated the incidence of paramedic-inserted PIVCs, unused PIVCs, and factors that influenced practice. METHODS: Electronic patient care records for Western Australian ambulance service patients who attended between January 1 and December 31, 2020 were retrospectively reviewed. Patient, environmental, and paramedic characteristics were explored. Binominal logistical regression models were used to identify factors associated with PIVC insertion and unused PIVCs. RESULTS: A total of 187,585 records were included; 20.3% had a PIVC inserted and 44% remained unused. Factors associated with PIVC insertion were gender, age, problem urgency, chief complaint, and operational region. Age, chief complaint, and paramedic years of experience were associated with unused PIVCs. DISCUSSION: This study identified multiple modifiable factors for the unnecessary insertion of PIVCs, which may be addressed through better education and mentoring of paramedics supported by clearer clinical guidelines. CONCLUSIONS: This is, to our knowledge, the first Australian state-wide study to report unused paramedic-inserted PIVC rates. As 44% remained unused, clinical indication guidelines and intervention studies to reduce PIVC insertion are warranted.

Tuberculosis infection prevention and control in rural Papua New Guinea: an evaluation using the infection prevention and control assessment framework.

BACKGROUND: Papua New Guinea (PNG) is one of the 14 countries categorised as having a triple burden of tuberculosis (TB), multidrug-resistant TB (MDR TB), and TB-human immunodeficiency virus (HIV) co-infections. TB infection prevention and control (TB-IPC) guidelines were introduced in 2011 by the National Health Department of PNG. This study assesses the implementation of this policy in a sample of district hospitals in two regions of PNG. METHODS: The implementation of TB-IPC policy was assessed using a survey method based on the World Health Organization (WHO) IPC assessment framework (IPCAF) to implement the WHO's IPC core components. The study included facility assessment at ten district hospitals and validation observations of TB-IPC practices. RESULTS: Overall, implementation of IPC and TB-IPC guidelines was inadequate in participating facilities. Though 80% of facilities had an IPC program, many needed more clearly defined IPC objectives, budget allocation, and yearly work plans. In addition, they did not include senior facility managers in the IPC committee. 80% (n = 8 of 10) of hospitals had no IPC training and education; 90% had no IPC committee to support the IPC team; 70% had no surveillance protocols to monitor infections, and only 20% used multimodal strategies for IPC activities. Similarly, 70% of facilities had a TB-IPC program without a proper budget and did not include facility managers in the TB-IPC team; 80% indicated that patient flow poses a risk of TB transmission; 70% had poor ventilation systems; 90% had inadequate isolation rooms; and though 80% have personal protective equipment available, frequent shortages were reported. CONCLUSIONS: The WHO-recommended TB-IPC policy is not effectively implemented in most of the participating district hospitals. Improvements in implementing and disseminating TB-IPC guidelines, monitoring TB-IPC practices, and systematic healthcare worker training are essential to improve TB-IPC guidelines' operationalisation in health settings to reduce TB prevalence in PNG.

Investigation of the selection and use of "other" personal protective equipment to prevent mucous membrane exposure in nurses: A cross-sectional study.

BACKGROUND: Selection and use of personal protective equipment (PPE) to prevent non-percutaneous body fluid exposure (NP BFE) is determined by a clinical assessment of risk. The aim of this study was to explore the selection and use of PPE, particularly masks and eye protection to prevent NP BFE, by nurses. METHODS: This quantitative single-site two-phased study was guided by the Health Belief Model (HBM). Phase 1 was a retrospective electronic database audit of body fluid exposure surveillance data. Phase 2 included a cross-sectional survey. RESULTS: The highest incidence of reported NP BFE to non-intact skin and mucous membranes during the study period were identified in the emergency department (ED) at 51.3% (20/39), intensive care unit (ICU) at 30.8% (12/39), operating theatre (OT) with 12.9% (5/39), and inpatient renal ward with 5.1% (2/39). Reported PPE use during NP BFE was: 0% face shields or masks, 10% gown/apron, and 15% goggles. Survey results related to Prevention of mucocutaneous exposures were similar across all high-risk units, though ED nurses reported poorer compliance with the use of PPE to prevent exposure. Risk assessment for prevention of NP BFE was reported, yet there was a lack of compliance. The ICU results indicated a positive safety culture in contrast to the ED. CONCLUSION: The findings are consistent with research identifying inadequate prevention of NP BFE, although nurses are aware of the importance of risk assessment. The HBM has the potential to increase understanding of the differences in nurses' perceptions of risk in safety culture.

The role of online marketing to engage healthcare workers with infection prevention and control information and resources: A pilot study.

BACKGROUND: The successful adoption and application of infection prevention and control (IPC) principles in all healthcare settings is dependent on the degree to which healthcare workers (HCWs) are aware of the requirements, have access to program resources and information, and engage with the IPC program. This study investigates the impact of redesigning the Infection Control Department (ICD) intranet site based on user feedback followed by a targeted marketing campaign to improve website usability, awareness, and access. METHODS: In this systematic study, we used a survey plus two focus group interviews to elicit user requirements for the content and look of the ICD intranet page and identify the best communication platforms to use for the marketing campaign to launch the redesigned intranet page. The information was used to redesign the intranet page and develop the marketing campaign. The survey was repeated post-intervention and these results, along with a comparison of website analytics monitoring traffic, were used to determine the success of the intervention. RESULTS: The ICD intranet page redesign increased the information and resources. Post-intervention survey results demonstrated a significant improvement in user satisfaction including ease of navigation and access to IPC information and resources. The marketing campaign resulted in a significant increase in website traffic to the ICD intranet page, demonstrating enhanced engagement with HCWs. CONCLUSION: This study demonstrated that website redesign based on user feedback, combined with a marketing campaign, can increase the traffic to the website and improve the user experience when accessing and navigating the site making the information and resources more accessible to HCWs.

Mass behaviour change amid COVID-19: How public health information and social norms explain the transformation.

COVID-19 is a severe and ongoing threat globally, with the spread disrupting lives and society. Despite the developments of vaccines, the key measure to reduce the transmission of variants has stemmed from mass changes to personal behaviours. COVID-19 pandemic offers a unique context, where the protection behaviours enacted by an individual are necessary to keep the community safe. A social psychological perspective can be used to understand the reasons for adherence to policies and determine what other factors can shape preventive behaviours. To resolve this, in partnership with health consumers we use an online survey, with the findings substantiating preventive behaviours are positively related to COVID-19 information access and descriptive norms. Additionally, findings demonstrate the mediating role of injunctive norms on preventive behaviour suggesting that policy makers can influence decision-making by promoting health information that provides guidance on acceptable behaviours, but also demonstrates subsequent success. The integrity of the model is substantiated by partial least squares (PLS) testing.

Pre-hospital peripheral intravenous catheter insertion practice: An integrative review.

BACKGROUND: Peripheral intravenous catheters (PIVCs) are widely used within healthcare settings. There is substantial hospital-based research, particularly in Emergency Departments, supporting the need to reduce inappropriate PIVCs due to associated risks. However, there is limited research into pre-hospital practice. This review aims to determine the rates of pre-hospital PIVC insertions, how many remain unused, and to explore paramedic PIVC decision-making. METHODS: A systematic search of research databases was undertaken using an integrative review methodology. Articles published between 2011 and April 2022 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. RESULTS: Fifteen studies were included. Rates of PIVC insertions ranged from 21% to 58%. Up to 72% of PIVCs remained unused in the pre-hospital setting. Paramedic decision-making was not well reported, though erring of the side of caution and inserting a "just in case" PIVC was identified. CONCLUSION: There are limited articles on pre-hospital PIVC practice, particularly in Australian settings. Research is required to understand factors influencing practice and provide contemporary evidence to inform the development of guidance specific to the pre-hospital setting to reduce the numbers of inappropriate PIVCs.

Audit of essential infection prevention and control content provided within undergraduate/postgraduate public health programs across Australian and New Zealand universities.

BACKGROUND: To describe and analyse the infection prevention and control (IPC) curricula within Public Health degrees across Australian and New Zealand Universities and identify foundational IPC knowledge deficits. METHODS: A cross-sectional study of public health and related programs across tertiary education institutions within Australia and New Zealand was conducted to comprehensively illustrate the current inclusion of IPC core and elective courses and identify areas of IPC content deficit. RESULTS: Australian (n = 32) and New Zealand (n = 9) universities were audited, consisting of 217 public health/public health related degrees within Australia and 45 within New Zealand. Within Australia 41% of public health degrees and 49% in New Zealand did not offer any IPC content as core or elective subjects. CONCLUSIONS: Public health tertiary education in Australia and New Zealand is lacking in equipping and imbedding IPC skills and knowledge in public health graduates. This highlights the need for a framework guiding mandatory IPC content within Australian and New Zealand public health programs.

Barriers to, and enablers of, paramedics responding to suspected or confirmed COVID-19 cases: An integrative review.

BACKGROUND: The coronavirus pandemic (COVID-19) has focused attention on healthcare workers' concerns about working during a pandemic, yet research on the effect of the pandemic specifically on paramedics is lacking. This literature review aims to critically examine the current knowledge of paramedics' experience of barriers to, and enablers of, responding to suspected or confirmed COVID-19 cases. METHODS: An integrative review was undertaken using articles found by a systematic search of four research databases. Inclusion criteria included paramedics or emergency medical technicians who had experience of barriers or enablers responding to patients during the coronavirus pandemic. RESULTS: Nine articles met the inclusion and exclusion criteria. Barriers included communication and poor leadership, fear of infection to self and family, frequent changes in guidelines and inconsistencies across agencies, stress/burnout, and concerns with personal protective equipment. Enablers included job security, perceived social support, solidarity with other paramedics, and use of modern technologies for communication. CONCLUSIONS: There are unique experiences of working during the COVID-19 pandemic in the prehospital environment. Particular challenges occurred with leadership, communication within the organisation and between agencies, and working in an unpredictable environment.

Infection prevention and control program assessment tools: A comparative study.

BACKGROUND: Infection prevention and control program (IPCP) assessment tools help to identify the improvement needs. This study aimed to identify fit-for-purpose of 3 IPCP assessment tools. METHODS: An exploratory mixed-method study was performed from 2018-2019 in Brazil, using a convenience sample of IPC professionals with various levels of experience to evaluate the IPCP tools: (1) the WHO Infection Prevention and Control Assessment Framework at the Facility Level (IPCAF), (2) the University of Sao Paulo IPCP tool (OGIPCP), and (3) the Infection Prevention and Control Programme Evaluation (IPCPE) tool. A quantitative survey followed by a semi-structured interview accessed the participants' perceptions about these tools. Quantitative data analysis were descriptive and qualitative data were thematical. RESULTS: IPCPE was considered more complete, better for effectiveness, easy to apply, and with easily interpreted indicators. IPCAF was the best regarding to purpose, easy reporting, and interpretation; however, requires professional experience. OGIPCP have the fastest application, easy to understand, and easily calculated indicators, requiring less experience. Qualitative data endorsed the quantitative results and showed IPCPE and IPCAF tools as the most accepted. CONCLUSIONS: The 3 assessment tools for IPCP have similar potential for use to support improvements in the IPCP. The IPCPE and IPCAF were considered advantageous on the effectiveness and fit-for-purpose compared to OGIPCP, despite the higher familiarity of participants with this tool.

Novel Respiratory Viruses in the Context of Mass-Gathering Events: A Systematic Review to Inform Event Planning from a Health Perspective.

BACKGROUND: Mass-gathering events (MGEs) occur regularly throughout the world. As people congregate at MGEs, there is an increased risk of transmission of communicable diseases. Novel respiratory viruses, such as Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1), Influenza A Virus Subtype H1N1 Strain 2009 (H1N1pdm09), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), or Coronavirus Disease 2019 (COVID-19), may require specific infection prevention and control strategies to minimize the risk of transmission when planning MGEs. This literature review aimed to identify and analyze papers relating to novel respiratory viruses with pandemic potential and to inform MGE planning. METHOD: This paper used a systematic literature review method. Various health care databases were searched using keywords relating to MGEs and novel respiratory viruses. Information was extracted from identified papers into various tables for analysis. The analysis identified infection prevention and control strategies used at MGEs to inform planning before, during, and following events. RESULTS: In total, 27 papers met the criteria for inclusion. No papers were identified regarding SARS-CoV-1, while the remainder reported on H1N1pdm09 (n = 9), MERS-CoV (n = 15), and SARS-CoV-2 (n = 3). Various before, during, and after event mitigation strategies were identified that can be implemented for future events. CONCLUSIONS: This literature review provided an overview of the novel respiratory virus epidemiology at MGEs alongside related public health mitigation strategies that have been implemented at these events. This paper also discusses the health security of event participants and host communities in the context of cancelling, postponing, and modifying events due to a novel respiratory virus. In particular, ways to recommence events incorporating various mitigation strategies are outlined.

Factors Influencing Health Care Workers' Willingness to Respond to Duty during Infectious Disease Outbreaks and Bioterrorist Events: An Integrative Review.

BACKGROUND: Infectious disease emergencies are increasingly becoming part of the health care delivery landscape, having implications to not only individuals and the public, but also on those expected to respond to these emergencies. Health care workers (HCWs) are perhaps the most important asset in an infectious disease emergency, yet these individuals have their own barriers and facilitators to them being willing or able to respond. AIM: The purpose of this review was to identify factors affecting HCW willingness to respond (WTR) to duty during infectious disease outbreaks and/or bioterrorist events. METHODS: An integrative literature review methodology was utilized to conduct a structured search of the literature including CINAHL, Medline, Embase, and PubMed databases using key terms and phrases. PRISMA guidelines were used to report the search outcomes and all eligible literature was screened with those included in the final review collated and appraised using a quality assessment tool. RESULTS: A total of 149 papers were identified from the database search. Forty papers were relevant following screening, which highlighted facilitators of WTR to include: availability of personal protective equipment (PPE)/vaccine, level of training, professional ethics, family and personal safety, and worker support systems. A number of barriers were reported to prevent WTR for HCWs, such as: concern and perceived risk, interpersonal factors, job-level factors, and outbreak characteristics. CONCLUSIONS: By comprehensively identifying the facilitators and barriers to HCWs' WTR during infectious disease outbreaks and/or bioterrorist events, strategies can be identified and implemented to improve WTR and thus improve HCW and public safety.

Rethinking Mass-Gathering Domains for Understanding Patient Presentations: A Discussion Paper.

AIM: The aim of this paper is to further develop an existing data model for mass-gathering health outcomes. BACKGROUND: Mass-gathering events (MGEs) occur frequently throughout the world. Having an understanding of the complexities of MGEs is important to determine required health resources. Environmental, psychosocial, and biomedical domains may be a logical starting point to determine how data are being collected and reported in the literature; however, it may be that other factors influencing health resources are not identified within these domains. METHOD: Based on an exhaustive literature synthesis, this paper is the final paper in a series that explores the collection of variables that impact biomedical presentations associated with attendance/participation in MGEs. FINDINGS: The authors propose further evolution of the Arbon model to include the addition of several domains, including: event environment; command, control, and communication (C3); public health; health promotion; and legacy when reporting the health outcomes of an event. CONCLUSIONS: Including a variety of domains that contribute to an MGE allows for formal evaluation of the event, which in turn informs future knowledge and skill development for both the event management group and the wider community.