scholarly journals Performance and impact of disposable and reusable respirators for healthcare workers during pandemic respiratory disease: a rapid evidence review

2020 ◽  
Author(s):  
Chris Burton ◽  
Briana Coles ◽  
Anil Adisesh ◽  
Simon Smith ◽  
Elaine Toomey ◽  
...  
Keyword(s):  
Patient Care ◽  
Healthcare Workers ◽  
Performance Test ◽  
Clinical Skills ◽  
Careful Consideration ◽  
International Standards ◽  
Rapid Review ◽  
Cross Sectional ◽  
Wide Range ◽  
The Impact

AbstractObjectivesIn the context of the Covid-19 pandemic, to identify the range of filtering respirators that can be used in patient care and synthesise evidence to guide the selection and use of different respirator types.DesignComparative analysis of international standards for filtering respirators and rapid review of their performance and impact in healthcare.Data sourcesWebsites of international standards organisations, Medline and EMBASE (final search 11th May 2020), with hand-searching of references and citations.Study selectionGuided by the SPIDER tool, we included studies whose sample was healthcare workers (including students). The phenomenon of interest was respirators, including disposable and reusable types. Study designs including cross-sectional, observational cohort, simulation, interview and focus group. Evaluation approaches included test of respirator performance, test of clinician performance or adherence, self-reported comfort and impact, and perceptions of use. Research types included quantitative, qualitative and mixed methods. We excluded studies comparing the effectiveness of respirators with other forms of protective equipment.Data extraction, analysis and synthesisTwo reviewers extracted data using a template. Suitability for inclusion in the analysis was judged by two reviewers. We synthesised standards by tabulating data according to key criteria. For the empirical studies, we coded data thematically followed by narrative synthesis.ResultsWe included relevant standards from 8 authorities across Europe, North and South America, Asia and Australasia. 39 research studies met our inclusion criteria. There were no instances of comparable publications suitable for quantitative comparison. There were four main findings. First, international standards for respirators apply across workplace settings and are broadly comparable across jurisdictions. Second, effective and safe respirator use depends on proper fitting and fit-testing. Third, all respirator types carry a burden to the user of discomfort and interference with communication which may limit their safe use over long periods; studies suggest that they have little impact on specific clinical skills in the short term but there is limited evidence on the impact of prolonged wearing. Finally, some clinical activities, particularly chest compressions, reduce the performance of filtering facepiece respirators.ConclusionA wide range of respirator types and models is available for use in patient care during respiratory pandemics. Careful consideration of performance and impact of respirators is needed to maximise protection of healthcare workers and minimise disruption to the delivery of care.

scholarly journals Performance and impact of disposable and reusable respirators for healthcare workers during pandemic respiratory disease: a rapid evidence review

2021 ◽  
pp. oemed-2020-107058
Author(s):  
Christopher Burton ◽  
Briana Coles ◽  
Anil Adisesh ◽  
Simon Smith ◽  
Elaine Toomey ◽  
...  
Keyword(s):  
Patient Care ◽  
Healthcare Workers ◽  
Clinical Skills ◽  
Careful Consideration ◽  
International Standards ◽  
Rapid Review ◽  
Wide Range ◽  
Fit Testing ◽  
And Performance ◽  
The Impact

ObjectivesTo synthesise evidence concerning the range of filtering respirators suitable for patient care and guide the selection and use of different respirator types.DesignComparative analysis of international standards for respirators and rapid review of their performance and impact in healthcare.Data sourcesWebsites of international standards organisations, Medline and Embase, hand-searching of references and citations.Study selectionStudies of healthcare workers (including students) using disposable or reusable respirators with a range of designs. We examined respirator performance, clinician adherence and performance, comfort and impact, and perceptions of use.ResultsWe included standards from eight authorities across Europe, North and South America, Asia and Australasia and 39 research studies. There were four main findings. First, international standards for respirators apply across workplace settings and are broadly comparable across jurisdictions. Second, effective and safe respirator use depends on proper fitting and fit testing. Third, all respirator types carry a burden to the user of discomfort and interference with communication which may limit their safe use over long periods; studies suggest that they have little impact on specific clinical skills in the short term but there is limited evidence on the impact of prolonged wearing. Finally, some clinical activities, particularly chest compressions, reduce the performance of filtering facepiece respirators.ConclusionA wide range of respirator types and models is available for use in patient care during respiratory pandemics. Careful consideration of performance and impact of respirators is needed to maximise protection of healthcare workers and minimise disruption to care.

scholarly journals The Functional Impacts of the Covid-19 Pandemic: A Rapid Review

2020 ◽  
Author(s):  
Danielle Hitch ◽  
Emma Cramer ◽  
Emily Adcock ◽  
Taylah Sayers ◽  
Helen Nelson ◽  
...  
Keyword(s):  
Health Service ◽  
Health Services ◽  
Healthcare Workers ◽  
Quantitative Methods ◽  
Systems Approach ◽  
Rapid Review ◽  
Cross Sectional ◽  
Functional Impact ◽  
To Come ◽  
The Impact

Abstract Background: The Covid-19 pandemic is having a severe and unprecedented impact on human functioning, due to its influence on bodily functions and structures, the activities we participate in and the environments in which we live. The aim of this rapid review is to inform health services planning and decision making, by identifying and synthesizing the potential functional impact of the Covid-19 pandemic on human health and wellbeing.Methods: This rapid review was completed within four weeks during April – May 2020. The review focused on primary sources describing and evaluating the functional impact of the SARS, MERS and Covid-19 coronavirus pandemics, published since January 2000 in peer reviewed journal articles. All included sources were evaluated for quality, and the International Classification of Function provided a theoretical structure for synthesizing the available evidence.Results: A total of 65 sources met the inclusion criteria for this review. The majority (n=42, 61.6%) were related to the SARS pandemic, and originated from Asia for North America. Almost half of the reviewed sources (n=32, 49.2%) investigated the impact of coronavirus pandemics on the community, with smaller evidence bases related to people with coronaviruses and their families (n=19, 29.2%) and healthcare workers (n=17, 26.1%). Of the research sources available, the majority utilized descriptive quantitative methods via cross sectional data collection.The functional impact of the Covid-19 pandemic is likely to spread far beyond infected patients, to influence the wellbeing of healthcare workers and the entire community in both positive and negative ways. The findings of this review indicate that health services must engage with the inter-sectionality of pandemic experiences, collaborate with other sectors as part of society-wide responses and prioritize function as a key outcome.Conclusions:Based on the experience of past coronavirus pandemics, and the experience to date of the current Covid-19 outbreak, every health service in all health systems must be prepared to prevent and manage the functional impacts of the Covid-19 pandemic, possibly for decades to come. This review highlights the multitude of avenues available for health service prioritization and planning, and emphasized that a multi-dimensional, multi-service (and ideally multi-systems) approach is needed.

Assessing the Preparedness of Healthcare Facilities for Disasters and Emergencies in Damghan, Iran

2021 ◽  
pp. 1-7
Author(s):  
Behrad Pourmohammadi ◽  
Ahad Heydari ◽  
Farin Fatemi ◽  
Ali Modarresi
Keyword(s):  
Health Care ◽  
Cross Sectional Study ◽  
Health Care Facilities ◽  
Mitigation Measures ◽  
Health Staff ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Wide Range ◽  
Care Facilities ◽  
The Impact

Abstract Objectives: Iran is exposed to a wide range of natural and man-made hazards. Health-care facilities can play a significant role in providing life-saving measures in the minutes and hours immediately following the impact or exposure. The aim of this study was to determine the preparedness of health-care facilities in disasters and emergencies. Methods: This cross-sectional study was conducted in Damghan, Semnan Province, in 2019. The samples consisted of all the 11 health-care facilities located in Damghan County. A developed checklist was used to collect the data, including 272 questions in 4 sections: understanding threatening hazards, functional, structural, and nonstructural vulnerability of health-care facilities. The data were analyzed using SPSS 21. Results: The results revealed that the health-care facilities were exposed to 22 different natural and man-made hazards throughout the county. The total level of preparedness of the health-care centers under assessment was 45.8%. The average functional, structural, and nonstructural vulnerability was assessed at 49.3%, 31.6%, and 56.4%, respectively. Conclusions: Conducting mitigation measures is necessary for promoting the functional and structural preparedness. Disaster educational programs and exercises are recommended among the health staff in health-care facilities.

Tuning the Mechanical and Geometric Properties of Electrochemically Aligned Collagen Threads Towards Applications in Biohybrid Robotics

2021 ◽  
Author(s):  
Wenhuan Sun ◽  
Jason Paulovich ◽  
Victoria Webster-Wood
Keyword(s):  
Tensile Modulus ◽  
Solution Concentration ◽  
Cross Sectional ◽  
Geometric Properties ◽  
Wide Range ◽  
Crosslinker Concentration ◽  
High Degree ◽  
The Impact ◽  
Fabrication Parameters ◽  
Manufacturing Parameters

Abstract Electrochemically Aligned Collagen (ELAC) threads fabricated by the isoelectric focusing (IF) of collagen have previously shown potential in tissue engineering and more recently in the fabrication of biohybrid robot structures. For applications in biohybrid robotics, ELAC structures are needed that are both robust and compliant enough to facilitate muscle actuation. However, studies on the effects of IF parameters, and the interactions of such fabrication parameters, on the mechanical and geometric properties of resulting ELAC threads have not been previously found in literature. Understanding the impact of these manufacturing parameters on the material properties is critical to facilitate biohybrid robot design. In this study, the effects of IF duration, IF voltage, and collagen solution concentration were investigated and showed statistically significant effects on adjusting ELAC properties via single-factor experiments. The interactions between parameters exhibited significant joint effects on ELAC property tuning through two-factor experiments. Scanning electron microscopy and 2,4,6-trinitrobenzenesulfonic assays revealed the correlation between high mechanical properties and a combination of low porosity and high degree of crosslinking. By simply tuning IF parameters without changing other fabrication steps, such as crosslinker concentration, ELAC threads with a wide range of mechanical and geometric properties were fabricated. The average tensile modulus of the resulting ELAC threads ranged from 198±90 to 758±138 MPa. The average cross-sectional area ranged from 7756±1000 to 1775±457 µm2. The resultant mapping between IF parameters and ELAC thread properties enabled the production of strong and flexible threads with customizable properties.

scholarly journals Regional Integration: Do Intra-African Trade and Migration Improve Income in Africa?

2019 ◽  
Vol 43 (6) ◽  
pp. 587-631 ◽  
Author(s):  
Blaise Gnimassoun
Keyword(s):  
Regional Integration ◽  
Capita Income ◽  
Per Capita Income ◽  
Cross Sectional ◽  
Wide Range ◽  
Per Capita ◽  
Migration Flows ◽  
And Migration ◽  
The Impact

Regional integration in Africa is a subject of great interest, but its impact on income has not been studied sufficiently. Using cross-sectional and panel estimations, this article examines the impact of African integration on real per capita income in Africa. Accordingly, we consider intra-African trade and migration flows as quantitative measures reflecting the intensity of regional integration. To address the endogeneity concerns, we use a gravity-based, two-stage least-squares strategy. Our results show that, from a long-term perspective, African integration has not been strong enough to generate a positive, significant, and robust impact on real per capita income in Africa. However, it does appear to be significantly income-enhancing in the short and medium terms but only through intercountry migration. These results are robust to a wide range of specifications.

scholarly journals Culture of Blame—An Ongoing Burden for Doctors and Patient Safety

2019 ◽  
Vol 16 (23) ◽  
pp. 4826 ◽  
Author(s):  
Ognjen Brborović ◽  
Hana Brborović ◽  
Iskra Alexandra Nola ◽  
Milan Milošević
Keyword(s):  
Patient Safety ◽  
Healthcare Workers ◽  
Health Workers ◽  
Patient Safety Culture ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Single Item ◽  
Shortage Of Doctors ◽  
The Impact

Introduction: Every procedure in healthcare carries a certain degree of inherent unsafety resulting from problems in practice, which might lead to a healthcare adverse event (HAE). It is very important, and even mandatory, to report HAE. The point of HAE reporting is not to blame the person, but to learn from the HAE in order to prevent future HAEs. Study question: Our aim was to examine the prevalence and the impact of culture of blame on health workers’ health. Methods: A cross-sectional study on healthcare workers at two Croatian hospitals was conducted using the Hospital Survey on Patient Safety Culture (PSC). Results: The majority of PSC dimensions in both hospitals were high. Among the dimensions, Hospital Handoffs and Transitions and Overall Perceptions of Safety had the highest values. The Nonpunitive Response to Error dimension had low values, indicating the ongoing culture of blame. The Staffing dimension had low values, indicating the ongoing shortage of doctors and nurses. Discussion: We found inconsistencies between a single-item measure and PSC dimensions. It was expected that Frequency of Events Reported (PSC dimension) relates to Number of Events Reported (single-item measure). However, in our study, the relations between these pairs of measures were different between hospitals. Our results indicate the ongoing culture of blame. Healthcare workers do not report HAE because they fear they will be punished by management or by law.

scholarly journals Impact of enhanced personal protective equipment on the physical and mental well-being of healthcare workers during COVID-19

2020 ◽  
pp. postgradmedj-2020-139150 ◽  
Author(s):  
Ramanathan Swaminathan ◽  
Bimantha Perera Mukundadura ◽  
Shashi Prasad
Keyword(s):  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Healthcare Professionals ◽  
Negative Impact ◽  
Well Being ◽  
Cross Sectional Study ◽  
Protective Equipment ◽  
Cross Sectional ◽  
The Impact ◽  
Mental Well Being

BackgroundThe COVID-19 pandemic has necessitated the use of enhanced personal protective equipment (PPE) in healthcare workers in patient-facing roles. We describe the impact on the physical and mental well-being of healthcare professionals who use enhanced PPE consistently.MethodsWe conducted a single-centre, cross-sectional study among healthcare professionals who use enhanced PPE. A web-based questionnaire was disseminated to evaluate the effects on individuals’ physical and mental well-being. Physical and mental impact was assessed through a visual analogue scale.ResultsProspective analysis of the views of 72 respondents is reported. 63.9% were women and 36.1% were men. Physical impact included exhaustion, headache, skin changes, breathlessness and a negative impact on vision. Communication difficulties, somnolence, negative impact on overall performance and difficulties in using surgical instrumentation were reported.ConclusionOur study demonstrates the undeniable negative impact on the front-line healthcare workers using enhanced PPE and lays the ground for larger multicentric assessments given for it to potentially be the norm for the foreseeable future.

scholarly journals Determinants of Good Adherence to Hand Hygiene Among Healthcare Workers Who Have Extensive Exposure to Hand Hygiene Campaigns

2007 ◽  
Vol 28 (11) ◽  
pp. 1267-1274 ◽  
Author(s):  
Hugo Sax ◽  
Ilker Uçkay ◽  
Hervé Richet ◽  
Benedetta Allegranzi ◽  
Didier Pittet
Keyword(s):  
Hand Hygiene ◽  
Healthcare Workers ◽  
Peer Pressure ◽  
University Teaching ◽  
Control Beliefs ◽  
Good Adherence ◽  
Cross Sectional ◽  
Behavioral Beliefs ◽  
Female Sex ◽  
The Impact

Objective.To quantify the different behavioral components of healthcare workers' motivation to comply with hand hygiene in a healthcare institution with a 10-year history of hand hygiene campaigning.Design.Cross-sectional study, by use of an anonymous, self-administered questionnaire.Setting.A 2,200-bed university teaching hospital.Participants.A stratified random sample of 2,961 medical and nursing staff.Results.A total of 1,042 questionnaires (35.2%) were returned. Of the respondents, 271 (26.0%) were physicians, 629 (60.4%) were nurses, and 141 (13.5%) were nursing assistants. Overall, 1,008 respondents provided information about sex; 718 (71.2%) of these were women. Respondents provided demographic information and data about various behavioral, normative, and control beliefs that determined their intentions with respect to performing hand hygiene. Among behavioral beliefs, the perception that healthcare-associated infections are severe for patients was highly ranked as a determinant of behavior by 331 (32.1%) of the respondents, and the perception that hand hygiene is effective at preventing these infections was ranked highly by 891 respondents (86.0%). Among normative beliefs, perceived social pressure from patients to perform hand hygiene was ranked highly by 760 respondents (73.7%), pressure from superiors was ranked highly by 687 (66.8%), pressure from colleagues was ranked highly by 596 (57.9%), and pressure from the person perceived to be most influential was ranked highly by 687 (68.8%). Among control beliefs, the perception that hand hygiene is relatively easy to perform was rated highly by 670 respondents (65.1%). High self-reported rates of adherence to hand hygiene (defined as performance of proper hand hygiene during 80% or more of hand hygiene opportunities) was independently associated with female sex, receipt of training in hand hygiene, participation in a previous hand hygiene campaign, peer pressure from colleagues, perceived good adherence by colleagues, and the perception that hand hygiene is relatively easy to perform.Conclusions.In a setting with a long tradition of hand hygiene campaigns, behavioral beliefs are strongly in favor of hand hygiene, but adherence is driven by peer pressure and the perception of high self-efficacy, rather than by reasoning about the impact of hand hygiene on patient safety. Female sex, training, and campaign exposure increased the likelihood of compliance with hand hygiene. This additional insight can help to shape future promotional activity.

Changes in Hospital Financing and Organization and Their Impact on Hospital Performance

2019 ◽  
Author(s):  
Jonas Schreyögg
Keyword(s):  
Financial Performance ◽  
Financial Incentives ◽  
Hospital Performance ◽  
Unintended Effects ◽  
Natural Experiments ◽  
Cross Sectional ◽  
Trade Offs ◽  
Wide Range ◽  
Improve Hospital ◽  
The Impact

Since the 1980s policymakers have identified a wide range of policy interventions to improve hospital performance. Some of these have been initiated at the level of government, whereas others have taken the form of decisions made by individual hospitals but have been guided by regulatory or financial incentives. Studies investigating the impact that some of the most important of these interventions have had on hospital performance can be grouped into four different research streams. Among the research streams, the strongest evidence exists for the effects of privatization. Studies on this topic use longitudinal designs with control groups and have found robust increases in efficiency and financial performance. Evidence on the entry of hospitals into health systems and the effects of this on efficiency is similarly strong. Although the other three streams of research also contain well-conducted studies with valuable findings, they are predominantly cross-sectional in design and therefore cannot establish causation. While the effects of introducing DRG-based hospital payments and of specialization are largely unclear, vertical and horizontal cooperation probably have a positive effect on efficiency and financial performance. Lastly, the drivers of improved efficiency or financial performance are very different depending on the reform or intervention being investigated; however, reductions in the number of staff and improved bargaining power in purchasing stand out as being of particular importance. Several promising avenues for future investigation are identified. One of these is situated within a new area of research examining the link between changes in the prices of treatments and hospitals’ responses. As there is evidence of unintended effects, future studies should attempt to distinguish between changes in hospitals’ responses at the intensive margin (e.g., upcoding) versus the extensive margin (e.g., increase in admissions). When looking at the effects of entering into a health system and of privatizations, there is still considerable need for research. With privatizations, in particular, the underlying processes are not yet fully understood, and the potential trade-offs between increases in performance and changes in the quality of care have not been sufficiently examined. Lastly, there is substantial need for further papers in the areas of multi-institutional arrangements and cooperation, as well as specialization. In both research streams, natural experiments carried out using program evaluation design are lacking. One of the main challenges here, however, is that cooperation and specialization cannot be directly observed but rather must be constructed based on survey or administrative data.

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