scholarly journals From natural disaster to pandemic: A health-system pharmacy rises to the challenge

2020 ◽  
Vol 77 (23) ◽  
pp. 1986-1993 ◽  
Author(s):  
Autumn D Zuckerman ◽  
Pratish C Patel ◽  
Mark Sullivan ◽  
Amy Potts ◽  
Molly Knostman ◽  
...  
Keyword(s):  
Health System ◽  
Patient Care ◽  
Natural Disaster ◽  
Personal Protective Equipment ◽  
Care Delivery ◽  
Protective Equipment ◽  
Staff Members ◽  
Quality Patient Care ◽  
Pharmacy Department ◽  
Virus Exposure

Abstract Purpose This report describes a health-system pharmacy’s response to a natural disaster while staff members simultaneously prepared for the coronavirus disease 2019 (COVID-19) pandemic. By detailing our experience, we hope to help other institutions that are current facing or could encounter similar crises. Summary In early March 2020, a tornado destroyed the health system’s warehouse for storage of most clinical supplies, including personal protective equipment and fluids. The pharmacy purchasing team collaborated with suppliers and manufacturers to recover losses and establish alternative storage areas. Days later, the pharmacy department was forced to address the impending COVID-19 pandemic. Key elements of the COVID-19 response included reducing the potential for virus exposure for patients and staff; overcoming challenges in sourcing of staff, personal protective equipment, and medications; and changing care delivery practices to maintain high-quality patient care while maximizing social distancing. The pharmacy department also created distance learning opportunities for 70 pharmacy students on rotations. After an initial plan, ongoing needs include adjustment in patient care activities if significant staff losses occur, when and how to resume clinical activities, and how to best utilize the resources accumulated. Elements of practice changes implemented to reduce COVID-19 threats to patients and pharmacy personnel have proven beneficial and will be further evaluated for potential continuation. Conclusion The pharmacy department’s efforts to respond to a natural disaster and unprecedented pandemic have proven successful to this point and have illuminated several lessons, including the necessity of cohesive department communication, staff flexibility, prioritization of teamwork, and external collaboration.

scholarly journals Elimination of Routine Contact Precautions for Endemic Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcus: A Retrospective Quasi-Experimental Study

2016 ◽  
Vol 37 (11) ◽  
pp. 1323-1330 ◽  
Author(s):  
Elise M. Martin ◽  
Dana Russell ◽  
Zachary Rubin ◽  
Romney Humphries ◽  
Tristan R. Grogan ◽  
...  
Keyword(s):  
Experimental Study ◽  
Health System ◽  
Personal Protective Equipment ◽  
Care Delivery ◽  
Protective Equipment ◽  
Nursing Time ◽  
Contact Precautions ◽  
Before And After ◽  
Quasi Experimental ◽  
The Impact

OBJECTIVETo evaluate the impact of discontinuation of contact precautions (CP) for methicillin-resistantStaphylococcus aureus(MRSA) and vancomycin-resistantEnterococcus(VRE) and expansion of chlorhexidine gluconate (CHG) use on the health system.DESIGNRetrospective, nonrandomized, observational, quasi-experimental study.SETTINGTwo California hospitals.PARTICIPANTSInpatients.METHODSWe compared hospital-wide laboratory-identified clinical culture rates (as a marker of healthcare-associated infections) 1 year before and after routine CP for endemic MRSA and VRE were discontinued and CHG bathing was expanded to all units. Culture data from patients and cost data on material utilization were collected. Nursing time spent donning personal protective equipment was assessed and quantified using time-driven activity-based costing.RESULTSAverage positive culture rates before and after discontinuing CP were 0.40 and 0.32 cultures/100 admissions for MRSA (P=.09), and 0.48 and 0.40 cultures/100 admissions for VRE (P=.14). When combining isolation gown and CHG costs, the health system saved $643,776 in 1 year. Before the change, 28.5% intensive care unit and 19% medicine/surgery beds were on CP for MRSA/VRE. On the basis of average room entries and donning time, estimated nursing time spent donning personal protective equipment for MRSA/VRE before the change was 45,277 hours/year (estimated cost, $4.6 million).CONCLUSIONDiscontinuing routine CP for endemic MRSA and VRE did not result in increased rates of MRSA or VRE after 1 year. With cost savings on materials, decreased healthcare worker time, and no concomitant increase in possible infections, elimination of routine CP may add substantial value to inpatient care delivery.Infect Control Hosp Epidemiol2016;1–8

scholarly journals Personal protective equipment in the COVID-19 pandemic and the use of cooling-wear as alleviator of thermal stress

2020 ◽  
Author(s):  
Hanna Luze ◽  
Sebastian P. Nischwitz ◽  
Petra Kotzbeck ◽  
Julia Fink ◽  
Judith C. J. Holzer ◽  
...  
Keyword(s):  
Thermal Stress ◽  
Patient Care ◽  
Personal Protective Equipment ◽  
Human Performance ◽  
Medical Personnel ◽  
Pilot Project ◽  
Negative Control ◽  
Physiological Parameters ◽  
Protective Equipment ◽  
Staff Members

Summary Background High temperatures at workplaces lead to health-related risks and premature exhaustion. The coronavirus disease 2019 (COVID-19) pandemic requires many health professionals to perform under unfavorable conditions. Personal protective equipment (PPE) causes thermal stress and negatively affects performance. Patients, materials and methods This pilot project investigated the effects of PPE and additional cooling wear on physiological parameters and concentration of six healthy staff members of the Plastic Surgery Department of the Medical University of Graz, Austria during simulated patient care. In this study two 1‑hour cycles with patient care-related tasks with PPE and PPE + cooling-wear, respectively, were conducted. A third cycle with scrubs exclusively served as baseline/negative control. The assessment occurred immediately pre-cycles and post-cycles. Results Pre-cycle assessments showed no significant differences between the cycles. After PPE cycle, increased physical stress levels and decrements in concentration capacity were observed. Physiological parameters were significantly less affected in the cooling cycle, while concentration capacity slightly increased. Conclusion COVID-19 PPE causes considerable thermal stress, ultimately affecting human performance. As opportunity to withstand thermal stress, and improve patients’ and professionals’ safety, cooling-wear can be considered relevant. Medical personnel performing in exceptional situations may particularly benefit from further development and investigation of cooling strategies.

scholarly journals Implementation of SHEA/CDC Outbreak Response Training Program Tools to Develop a Dedicated COVID-19 Hospital in Lucas County, Ohio

2021 ◽  
pp. 1-8
Author(s):  
Jennifer Hanrahan ◽  
Joel Kammeyer ◽  
Deana Sievert ◽  
Brenda Naylor ◽  
Sadik Khuder ◽  
...  
Keyword(s):  
Health System ◽  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Care Delivery ◽  
Protective Equipment ◽  
Conservation Of Resources ◽  
Outbreak Response ◽  
Response Training ◽  
Care Delivery Model ◽  
Lucas County

Abstract We describe a care delivery model in which one hospital in a larger health system was dedicated exclusively to treatment of COVID-19 patients. This allowed for rapid training, conservation of resources and promoted safety of healthcare workers, demonstrated by no healthcare worker exposures due to improper personal protective equipment use.

scholarly journals Rapid implementation of Inpatient eConsult Programme addresses new challenges for patient care during COVID-19 pandemic

2021 ◽  
pp. bmjinnov-2020-000557
Author(s):  
Sharon Rikin ◽  
Eric J Epstein ◽  
Inessa Gendlina
Keyword(s):  
Palliative Care ◽  
Infectious Diseases ◽  
Patient Care ◽  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Qualitative Feedback ◽  
The Usa ◽  
New Challenges ◽  
Science Framework ◽  
Context Specific

IntroductionAt the early epicentre of the COVID-19 crisis in the USA, our institution saw a surge in the demand for inpatient consultations for areas impacted by COVID-19 (eg, infectious diseases, nephrology, palliative care) and shortages in personal protective equipment (PPE). We aimed to provide timely specialist input for consult requests during the COVID-19 pandemic by implementing an Inpatient eConsult Programme.MethodsWe used the reach, effectiveness, adoption, implementation and maintenance implementation science framework and run chart analysis to evaluate the reach, adoption and maintenance of the Inpatient eConsult Programme compared with traditional in-person consults. We solicited qualitative feedback from frontline physicians and specialists for programme improvements.ResultsDuring the study period, there were 46 available in-person consult orders and 21 new eConsult orders. At the peak of utilisation, 42% of all consult requests were eConsults, and by the end of the study period, utilisation fell to 20%. Qualitative feedback revealed subspecialties best suited for eConsults (infectious diseases, nephrology, haematology, endocrinology) and influenced improvements to the ordering workflow, documentation, billing and education regarding use.DiscussionWhen offered inpatient eConsult requests as an alternative to in-person consults in the context of a surge in patients with COVID-19, frontline physicians used eConsult requests and decreased use of in-person consults. As the demand for consults decreased and PPE shortages were no longer a major concern, eConsult utilisation decreased, revealing a preference for in-person consultations when possible.ConclusionsLessons learnt can be used to develop and implement inpatient eConsults to meet context-specific challenges at other institutions.

scholarly journals Implementing a Massive Personal Protective Equipment Education—A Multidisciplinary Team Approach

2020 ◽  
Vol 41 (S1) ◽  
pp. s280-s281
Author(s):  
Mayar Al Mohajer ◽  
Megan Fischer ◽  
Melissa Rouse ◽  
Takei Pipkins ◽  
John Byrne
Keyword(s):  
Nursing Education ◽  
Personal Protective Equipment ◽  
Multidisciplinary Team ◽  
Infection Prevention ◽  
Just In Time ◽  
Protective Equipment ◽  
Team Approach ◽  
Online Video ◽  
Staff Members ◽  
Multidisciplinary Team Approach

Background: Personal protective equipment (PPE) is defined by the Occupational Safety and Health Administration as specialized clothing or equipment worn by an employee for protection against infectious materials. They include gloves, gowns, masks, respirators, googles and face shields. The CDC has issued guidelines on appropriateness of when, what, and how to use PPE. Despite these guidelines, compliance with PPE remains challenging. Methods: We implemented a massive hospital-wide rapid education program on PPE donning and doffing of all employees and staff. This program included an online video, return demonstration and just-in-time training. To develop the program, we recorded PPE training video, reviewed PPE validation checklist, developed new isolation precaution signage with quick response (QR) code to video, developed a nutrition tray removal video and a equipment cleaning video, developed family and visitor guidelines for isolation precautions, and created an audit tool for PPE donning and doffing practices. The program required interdisciplinary collaboration including administration, infection prevention, nursing education, central supply, environmental services, facility maintenance, and security. Results: The first phase of the program was implemented through 30 separate 4-hour PPE skills fair offered over 48 hours. In total, 500 staff members were trained in the first 48 hours; 6 additional 3-hour sessions were provided on site in the following 3 month. Additionally, training was provided in off-site clinics, physician leadership meetings, new-hire orientation for nursing staff, and monthly resident and fellow training through graduate medical education. As needed, training was provided by infection prevention, nursing education, and floor nurses. In total, 5,237 staff members were trained within 3 months after implementation. Actual audit results (50 audits per week) showed improved and sustained compliance to >94%. Conclusions: A massive hospital-wide educational program including online video, return demonstration, and just-in-time training is a feasible and very effective method to improve compliance with PPE donning and doffing. A multidisciplinary team approach, administration support, and continuous education and audits are key factors in successful implementation.Funding: NoneDisclosures: None

A Statewide Voluntary Movement Addressing the Shortage of Medical Supplies During the COVID-19 Pandemic

2021 ◽  
Vol 111 (9) ◽  
pp. 1595-1599
Author(s):  
Martin Krause ◽  
Andrew Henderson ◽  
Daniel Griner ◽  
Olivia S. Rissland ◽  
Jeremy Beard ◽  
...  
Keyword(s):  
Health Care ◽  
Additive Manufacturing ◽  
Patient Care ◽  
Health Care Workers ◽  
Personal Protective Equipment ◽  
Laser Cutting ◽  
Voluntary Movement ◽  
Protective Equipment ◽  
Medical Supplies ◽  
Care Workers

During the COVID-19 pandemic, a shortage of personal protective equipment compromised efficient patient care and provider safety. Volunteers from many different backgrounds worked to meet these demands. Additive manufacturing, laser cutting, and alternative supply chains were used to produce, test, and deliver essential equipment for health care workers and first responders. Distributed equipment included ear guards, face shields, and masks. Contingent designs were created for powered air-purifying respirator hoods, filtered air pumps, intubation shields, and N95 masks.

scholarly journals Compounding sterile products during a personal protective equipment shortage

2021 ◽  
Author(s):  
Amanda Danielle Wollitz ◽  
Christine Hong ◽  
Fernando Blanco
Keyword(s):  
Patient Care ◽  
Personal Protective Equipment ◽  
Patient Population ◽  
Conservation Strategies ◽  
Protective Equipment ◽  
Pandemic Response

Abstract Purpose To describe our pharmacy department’s plan for conservation of personal protective equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic to ensure continued availability of sterile compounded products. Summary PPE shortages impacted hospitals throughout the nation in the early months of the COVID-19 pandemic response. The PPE requirement for sterile compounding and need to maintain supplies within the pharmacy cleanroom is often overlooked. A sustained supply of PPE is critical to ensure an uninterrupted supply of compounded medications to our patient population. Multiple conservation strategies, including staffing changes, communication, adjustments to training, and even reuse of select PPE, can assist with conservation. Conclusion PPE in pharmacy cleanrooms is critical for the continued provision of sterile compounds with appropriate beyond-use dates and effective patient care. Pharmacy departments must employ multiple conservation strategies to ensure PPE is available for continued compounding of sterile products, and early planning and implementation of conservation strategies are key.

scholarly journals COVID-19: A systematic evaluation of personal protective equipment (PPE) performance during restraint

2021 ◽  
pp. 002580242110008
Author(s):  
Roland Dix ◽  
David Straiton ◽  
Peter Metherall ◽  
James Laidlaw ◽  
Lisa McLean ◽  
...  
Keyword(s):  
Mental Health ◽  
Personal Protective Equipment ◽  
Systematic Evaluation ◽  
Protective Equipment ◽  
Risk Of Infection ◽  
Team Members ◽  
Staff Members ◽  
Inpatient Mental Health ◽  
Risk Areas ◽  
New Procedures

Background Restraint is widely practised within inpatient mental health services and is considered a higher-risk procedure for patients and staff. There is a sparsity of evidence in respect of the efficacy of personal protective equipment (PPE) used during restraint for reducing risk of infection. Methods A series of choreographed restraint episodes were used to simulate contact contamination in research participants playing the roles of staff members and a patient. For comparison, one episode of simulated recording of physical observations was taken. Ultraviolet (UV) fluorescent material was used to track the simulated contact contamination, with analysis undertaken using established image registration techniques of UV photographs. This was repeated for three separate sets of PPE. Results All three PPE sets showed similar performance in protecting against contamination transfer. For teams not utilising coveralls, this was dependent upon effective cleansing as part of doffing. There were similar patterns of contamination for restraint team members assigned to specific roles, with hands and upper torso appearing to be higher-risk areas. The restraint-related contamination was 23 times higher than that observed for physical observations. Discussion A second layer of clothing that can be removed showed efficacy in reducing contact contamination. PPE fit to individual is important. Post-restraint cleansing procedures are currently inadequate, with new procedures for face and neck cleansing required. These findings leave scope for staff to potentially improve their appearance when donning PPE and engaging with distressed patients.

scholarly journals Personal protective equipment does not sufficiently protect against virus aerosol unless combined with advanced air purification or ventilation techniques

2021 ◽  
Author(s):  
Shane A Landry ◽  
Dinesh Subedi ◽  
Jeremy J Barr ◽  
Martin I MacDonald ◽  
Samantha Dix ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Hospital Capacity ◽  
Degree Of Protection ◽  
Aerosol Exposure ◽  
Skin Contamination ◽  
The Face ◽  
Close Range ◽  
Virus Exposure ◽  
High Virus

ABSTRACTBackgroundHealthcare workers (HCWs) are at risk from nosocomial transmission of SARS-CoV-2 from virus laden aerosols. This study aimed to: 1) quantify the degree of protection from virus aerosol provided by different types of mask (surgical, N95, fit-tested N95) and personal protective equipment (PPE); 2) determine if the use of a portable HEPA filter can enhance the effectiveness of PPE; 3) determine the effectiveness of a decontamination shower to remove virus aerosol contamination of a HCW.MethodsVirus aerosol exposure experiments were conducted using bacteriophage PhiX174 (108copies/mL). A HCW wearing PPE (mask, gloves, gown, faceshield) was exposed to nebulised viruses for 40mins in a sealed clinical room. After exiting, the HCW doffed PPE. Virus exposure was quantified via skin swabs applied to the face and nostrils, forearms, neck, and forehead. Experiments were performed with and without the presence of a portable HEPA filter (set to 470m3/hr).FindingsSwabs quantified significant virus exposure under the surgical and N95 mask. Only the fit-tested N95 resulted in lower virus counts compared to no mask control (p=0.027). Nasal swabs demonstrated very high virus exposure, which was not mitigated by the surgical or N95 masks, although there was a trend for the fit-tested N95 mask to reduce virus counts (p=0.058). The addition of HEPA filtration substantially reduced virus counts from all swab sites, and to near zero levels when combined with a fit-tested N95 mask, gloves, gown and faces shield. Virus counts were substantially reduced to near zero levels following a shower.InterpretationThese data demonstrate that quantitatively fit tested N95 masks combined with a HEPA filter can offer protection against high virus aerosol loads at close range and for prolonged periods of time. Skin contamination from virus aerosol can be effectively by removed by showering.FundingEpworth Hospital Capacity Building Research Grant ID: EH2020-654

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