The Ethics of Infection Control: Philosophical Frameworks

Recent developments that are relevant to the ethics of infection control include the patient safety movement, the appearance of new diseases (notably, severe acute respiratory syndrome) that pose threats to healthcare workers, data confirming the suspicion that infection control measures such as isolation may compromise patient care, and, in philosophy, renewed interest in virtue ethics and communitarianism. We review general ethical frameworks and relevant vocabulary for infection control practitioners and hospital epidemiologists. Frameworks for the ethics of infection control resemble those of public health more than those of clinical medicine but embrace elements of both. The optimum framework, we suggest, takes into account a virtue-based communitarianism. The virtue ethics movement stresses the need to consider not only rules and outcomes but also the character of the individual(s) involved. Communitarianism emphasizes the well-being and values of local communities, best determined by shared, democratic decision making among stakeholders. Brief discussions of 15 consecutive cases illustrate the extent to which the daily practice of infection control poses problems heavily freighted with ethical overtones.

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Can Copper Products and Surfaces Reduce the Spread of Infectious Microorganisms and Hospital-Acquired Infections?

Materials ◽

10.3390/ma14133444 ◽

2021 ◽

Vol 14 (13) ◽

pp. 3444

Author(s):

Joji Abraham ◽

Kim Dowling ◽

Singarayer Florentine

Keyword(s):

Infection Control ◽

Hospital Admissions ◽

Copper Alloys ◽

Well Being ◽

Mortality Rates ◽

Pathogen Transmission ◽

Control Measures ◽

Traditional Use ◽

Healthcare Facilities ◽

Infection Control Measures

Pathogen transfer and infection in the built environment are globally significant events, leading to the spread of disease and an increase in subsequent morbidity and mortality rates. There are numerous strategies followed in healthcare facilities to minimize pathogen transfer, but complete infection control has not, as yet, been achieved. However, based on traditional use in many cultures, the introduction of copper products and surfaces to significantly and positively retard pathogen transmission invites further investigation. For example, many microbes are rendered unviable upon contact exposure to copper or copper alloys, either immediately or within a short time. In addition, many disease-causing bacteria such as E. coli O157:H7, hospital superbugs, and several viruses (including SARS-CoV-2) are also susceptible to exposure to copper surfaces. It is thus suggested that replacing common touch surfaces in healthcare facilities, food industries, and public places (including public transport) with copper or alloys of copper may substantially contribute to limiting transmission. Subsequent hospital admissions and mortality rates will consequently be lowered, with a concomitant saving of lives and considerable levels of resources. This consideration is very significant in times of the COVID-19 pandemic and the upcoming epidemics, as it is becoming clear that all forms of possible infection control measures should be practiced in order to protect community well-being and promote healthy outcomes.

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The Impact of the COVID-19 Pandemic and Societal Infection Control Measures on Children and Adolescents' Mental Health: A Scoping Review

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.711791 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jamile Marchi ◽

Nina Johansson ◽

Anna Sarkadi ◽

Georgina Warner

Keyword(s):

Mental Health ◽

Physical Activity ◽

Infection Control ◽

Children And Adolescents ◽

Scoping Review ◽

Well Being ◽

Control Measures ◽

Parenting Support ◽

Infection Control Measures ◽

The Impact

Background: The COVID-19 pandemic is primarily a crisis that affects people's physical health. However, it is well-known from previous epidemics and pandemics that there are other indirect negative impacts on mental health, among others. The purpose of this scoping review was to explore and summarise primary empirical research evidence on how the COVID-19 pandemic and societal infection control measures have impacted children and adolescents' mental health.Methods: A literature search was conducted in five scientific databases: PubMed, APA PsycINFO, Web of Science, CINHAL, and Social Science Premium Collection. The search string was designed using the Population (0–18 years), Exposure (COVID-19), Outcomes (mental health) framework. Mental health was defined broadly, covering mental well-being to mental disorders and psychiatric conditions.Results: Fifty-nine studies were included in the scoping review. Of these, 44 were cross-sectional and 15 were longitudinal studies. Most studies reported negative impact of the COVID-19 pandemic on child and adolescent mental health outcomes, yet the evidence was mixed. This was also the case for studies investigating societal control measures. Strong resilience, positive emotion regulation, physical activity, parental self-efficacy, family functioning and emotional regulation, and social support were reported as protective factors. On the contrary, emotional reactivity and experiential avoidance, exposure to excessive information, COVID-19 school concerns, presence of COVID-19 cases in the community, parental mental health problems, and high internet, social media and video game use were all identified as potentially harmful factors.Conclusions: Due to the methodological heterogeneity of the studies and geographical variation, it is challenging to draw definitive conclusions about the real impact of the COVID-19 pandemic on the mental health of children and adolescents. However, the existing body of research gives some insight to how parents, clinicians and policy makers can take action to mitigate the effects of COVID-19 and control measures. Interventions to promote physical activity and reduce screen time among children and adolescents are recommended, as well as parenting support programs.

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‘…you just put up with it for the sake of humanity.’: an exploratory qualitative study on causes of stress in palliative care nursing during the COVID-19 pandemic in Germany

BMJ Open ◽

10.1136/bmjopen-2021-051550 ◽

2021 ◽

Vol 11 (12) ◽

pp. e051550

Author(s):

Susann May ◽

Kerstin Stahlhut ◽

Matthew Allsop ◽

Martin Heinze ◽

Felix Mühlensiepen

Keyword(s):

Palliative Care ◽

Qualitative Study ◽

Infection Control ◽

Hospice Care ◽

Qualitative Content Analysis ◽

Daily Basis ◽

Control Measures ◽

Infection Control Measures ◽

The Individual ◽

Care Nursing

ObjectiveTo explore and analyse causes of stress among nurses in palliative and inpatient hospice care settings in Germany during the COVID-19 pandemic.DesignExplorative, qualitative study using problem-centred interviews. Interview data were analysed using structured qualitative content analysis.SettingTelephone interviews with nurses of different settings of palliative and inpatient hospice care.Participants16 nurses from inpatient hospice, palliative care units and specialised palliative home care were recruited.ResultsCOVID-19 infection control measures placed both physical and psychological strain on palliative care nurses. Due to changes in infection control information, workflows were being readjusted on a daily basis, preventing everyday routines and hindering relief from stress. There are reduced and limited opportunities for sharing and reflecting on daily working routines with team colleagues. Specific causes of stress in the individual settings of palliative and inpatient hospice care were identified. Overall, there is a tension between the nurses’ perceptions of proper palliative care nursing, in terms of closeness, psychosocial and emotional support and compliance with infection control measures.ConclusionsPalliative care nurses have been exposed to high levels of both physical and psychological stress during the COVID-19 pandemic. This requires rapid relief and support, with a need to ensure continuity of professional supervision and peer-support, which may be facilitated via digital technologies. The unique role of nurses in inpatient hospice and palliative care during COVID-19 ought to be recognised and valorised.

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Coronavirus: the science behind infection control and human exposure

British Journal of Community Nursing ◽

10.12968/bjcn.2021.26.1.14 ◽

2021 ◽

Vol 26 (1) ◽

pp. 14-17

Author(s):

Alison Phillis

Keyword(s):

Infection Control ◽

Human Exposure ◽

Control Measures ◽

Infection Control Measures ◽

Factors Influencing ◽

Viral Particles ◽

Therapeutic Development ◽

Environmental Decontamination ◽

The Individual ◽

New Reservoir

Coronavirus SARS-2 (SARS-CoV-2) is the virus responsible for the disease known as COVID-19. The global community is struggling with the health and economic repercussions of this novel disease, and this article is part of a series that seeks to explore and explain the science behind the foci of infection control measures being considered at both the individual and population health levels. Understanding the factors influencing the ability of this virus to select an appropriate host, breach initial defences and successfully assume a new reservoir from which to disseminate and disperse infective viral particles is considered here. Brief reference is made to infection control measures such as effective hand hygiene, glove usage, environmental decontamination and social distancing guidance against the context of the specific evidence around COVID-19 transmission. Predictors of poorer outcome are introduced in the light of these being target themes for therapeutic development.

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208 - Person-centred infection prevention and control during a pandemic: The Dementia Isolation Toolkit

International Psychogeriatrics ◽

10.1017/s1041610221001411 ◽

2021 ◽

Vol 33 (S1) ◽

pp. 11-11

Author(s):

Andrea Iaboni ◽

Hannah Quirt ◽

Steven Stewart ◽

Alisa Grigorovich ◽

Claudia Barned ◽

...

Keyword(s):

Infection Control ◽

Online Survey ◽

Moral Distress ◽

Well Being ◽

Control Measures ◽

Infection Prevention And Control ◽

Term Care ◽

Care Plans ◽

Infection Control Measures ◽

People With Dementia

Objectives:People working in long-term care homes (LTCH) face ethical dilemmas about how to minimize the risk of spread of COVID-19, while also minimizing psychological hardship and other harms of infection control measures on residents. The Dementia Isolation Toolkit (www.dementiaisolationtoolkit.com; DIT) was developed to address the gap in ethical guidance for LTCH on how to safely and effectively isolate people with dementia while supporting the personhood and well-being of residents. In this presentation, we will present the DIT and report on the results of a survey of LTCH staff in Ontario, Canada on their experiences isolating residents in LTCH and the use of the DIT in supporting person-centred isolation care.Methods:A link to an online survey was distributed to LTCH staff through provincial organizations and agencies as well as through social media and the DIT website. Inclusion criteria were LTCH staff working on-site at a LTCH since March 1, 2020, who had direct or indirect experience with the isolation/quarantine of LTCH residents. Results were summarized descriptively.Results:A broad sample of LTCH staff (n=207) participated in the survey, most of whom had experienced an outbreak in their LTCH. Dementia (96%) was the most important barrier to implementation of infection control measures in LTCH, followed by staff distress about the effects of isolation on residents (61%). Important facilitators for isolation included delivery of 1:1 activities in the resident’s room (81%) and designating essential caregivers to provide support (67%), while inadequate staffing levels were reported as a barrier (55%). 65% of respondents indicated some familiarity with the DIT, and of those who had used the toolkit, 62% found it helpful in supporting isolation care, particularly in developing care plans and making and communicating decisions. Of those who had used the DIT, 48% found it fairly or very helpful at reducing their level of distress.Conclusions:Isolation as an infection control and prevention (ICP) measure in LTCH environments can be harmful to residents and create moral distress in staff. ICP guidance and support of LTCH needs to address how to minimize these harms by providing dementia-specific guidance such as in the DIT.

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Risk of infection and appeal to public benefit increase compliance with infection control measures

10.31234/osf.io/myv4t ◽

2022 ◽

Author(s):

Sebastian Bjørkheim ◽

Bjørn Sætrevik

Keyword(s):

Infection Control ◽

Disease Outbreak ◽

Infection Risk ◽

Control Measures ◽

Individual Risk ◽

The Public ◽

Infection Control Measures ◽

Societal Benefits ◽

Risk Scenario ◽

The Individual

To handle an infectious outbreak, the public must be informed about the infection risk and be motivated to comply with infection control measures. Perceiving the situation as threatening and seeing public benefits to complying may increase the public’s motivation to comply. The current study used a preregistered survey experiment to investigate if emphasizing high infection risk and appealing to societal benefits impacted intention to comply with infection control measures. The results show main effects of risk and of appeals to societal benefits. There was no interaction between risk scenario and motivational emphasis. The results suggest that to maximize compliance, information about disease outbreak should emphasize the individual risk of contracting the disease, and could also underline the public value of limiting infection spread. These findings can inform communication strategies during an infectious disease outbreak and help health authorities limit transmission.

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Norovirus outbreaks in nursing homes: the evaluation of infection control measures

Epidemiology and Infection ◽

10.1017/s095026880900274x ◽

2009 ◽

Vol 137 (12) ◽

pp. 1722-1733 ◽

Cited By ~ 53

Author(s):

I. H. M. FRIESEMA ◽

H. VENNEMA ◽

J. C. M. HEIJNE ◽

C. M. de JAGER ◽

G. MORROY ◽

...

Keyword(s):

Nursing Homes ◽

Infection Control ◽

Sick Leave ◽

Intervention Study ◽

Daily Practice ◽

Control Measures ◽

Infection Control Measures

SUMMARYEffective infection control measures during norovirus outbreaks are urgently needed in places where vulnerable individuals gather. In the present study, the effect of a number of measures was investigated in daily practice. Forty-nine Dutch nursing homes were monitored prospectively for norovirus outbreaks during two winter seasons. A total of 37 norovirus outbreaks were registered. Control measures were most effective when implemented within 3 days after onset of disease of the first patient. Measures targeted at reduced transmission between persons, via aerosols, and via contaminated surfaces reduced illness in staff and in residents. Reducing illness in staff results in fewer costs for sick leave and substitution of staff and less disruption in the care of residents. The effect of control measures on outbreak duration was limited. This is the first intervention study examining the effect of control measures. Further research is needed to extend and refine the conclusions.

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COVID-19 and Mental Well-Being: Guidance on the Application of Behavioral and Positive Well-Being Strategies

Healthcare ◽

10.3390/healthcare8030336 ◽

2020 ◽

Vol 8 (3) ◽

pp. 336 ◽

Cited By ~ 4

Author(s):

Amar Kanekar ◽

Manoj Sharma

Keyword(s):

Stress Reduction ◽

National Level ◽

Well Being ◽

Coping Mechanisms ◽

Control Measures ◽

Community Members ◽

Infection Control Measures ◽

Reduction Strategies ◽

The Individual ◽

Mental Well Being

The raging COVID-19 pandemic has been a great source of anxiety, distress, and stress among the population. Along with mandates for social distancing and infection control measures, the growing importance of managing and cultivating good mental well-being practices cannot be disregarded. The purpose of this commentary is to outline and discuss some research-proven positive well-being and stress reduction strategies to instill healthy coping mechanisms among individuals and community members. The authors anticipate that usage of these strategies at the individual and the community level should greatly benefit the mental well-being not only in the current COVID-19 pandemic but also in any future epidemics at the national level.

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Adapting practice in mental healthcare settings during the COVID-19 pandemic and other contagions: systematic review

BJPsych Open ◽

10.1192/bjo.2021.20 ◽

2021 ◽

Vol 7 (2) ◽

Author(s):

Jessica Raphael ◽

Rachel Winter ◽

Katherine Berry

Keyword(s):

Mental Health ◽

Systematic Review ◽

Mental Health Services ◽

Health Services ◽

Infection Control ◽

Mental Healthcare ◽

Well Being ◽

Healthcare Services ◽

Control Measures ◽

Infection Control Measures

Background During the global COVID-19 pandemic, there has been guidance concerning adaptations that physical healthcare services can implement to aid containment, but there is relatively little guidance for how mental healthcare services should adapt service provision to better support staff and patients, and minimise contagion spread. Aims This systematic review explores service adaptations in mental health services during the COVID-19 pandemic and other contagions. Method The Allied and Complementary Medicine database (AMED), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Medline, PsycINFO and Web of Science were systematically searched for published studies from database inception to April 2020. Data were extracted focusing on changes to mental health services during contagion outbreaks. Data were analysed with thematic analysis. Results Nineteen papers were included: six correspondence/point-of-view papers, five research papers, five reflection papers, two healthcare guideline documents and one government document. Analysis highlighted four main areas for mental health services to consider during contagion outbreaks: infection control measures to minimise contagion spread, including procedural and practical solutions across different mental health settings; service delivery, including service changes, operational planning and continuity of care; staff well-being (psychological and practical support); and information and communication. Conclusions Mental health services need to consider infection control measures and implement service changes to support continuity of care, and patient and staff well-being. Services also need to ensure they are communicating important information in a clear and accessible manner with their staff and patients, regarding service delivery, contagion symptoms, government guidelines and well-being.

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Norwegian Shelters for Victims of Domestic Violence in the COVID-19 Pandemic – Navigating the New Normal

Journal of Family Violence ◽

10.1007/s10896-021-00273-6 ◽

2021 ◽

Author(s):

Solveig Bergman ◽

Margunn Bjørnholt ◽

Hannah Helseth

Keyword(s):

Domestic Violence ◽

Infection Control ◽

Control Strategies ◽

Well Being ◽

Control Measures ◽

Access To Services ◽

Web Based ◽

Infection Control Measures ◽

Victims Of Violence ◽

The Welfare State

AbstractThis study elucidates the responses of shelters and their adaptations to the COVID-19 pandemic, and the effects on their services to victims of violence, as well as how shelter managers assess the situation for victims, including changes in the rates and character of the violence observed by the shelters. A web-based survey was distributed twice to all Norwegian shelters (N = 46): first during the lockdown in spring 2020 and second during the relaxation of infection control measures in summer 2020. The shelters in Norway remained open during the COVID-19 pandemic. The majority saw a reduction in the number of requests during the lockdown, while the rates returned to normal when the strictest infection control measures were lifted. They expressed concern about the decline in requests during the lockdown as well as the well-being of some groups, such as victims from ethnic minority backgrounds, children, and victims with additional challenges. A majority of the shelters did not report changes in the content of the requests. Nevertheless, a third of them had observed instances of the virus and/or infection control measures being used by perpetrators as part of the violence and coercive control strategies. The shelters in Norway, as an integrated part of the welfare state, in general seem to have met the needs of their clients during the pandemic. Yet, the study revealed important inequalities and deficiencies in access to services for some groups, and in the general support and recognition by authorities of the shelters.

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