Perioperative challenges in managing a morbidly obese patient with COVID-19 undergoing an elective tracheostomy

Tracheostomy is an aerosol-generating procedure and performing it in patients with COVID-19 requiring mechanical ventilation raises significant concerns of infection risk to healthcare workers. We herein report a case of tracheostomy in a critically ill patient with severe COVID-19 acute respiratory distress syndrome. This article depicts the use of personal protective equipment, highlighting the common challenges it presents and ways to address them.

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A Review on Methods of Face Masks Sterilization for Reuse Owing To Crisis During COVID-19

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl1.3604 ◽

2020 ◽

Vol 11 (SPL1) ◽

pp. 1240-1243

Author(s):

Pradyuman Singh Rajput ◽

Asish Kumar Saha ◽

Insiya Gangardiwala ◽

Anand Vijayakumar Palur Ramakrishnan

Keyword(s):

Healthcare Workers ◽

Health Hazard ◽

Capital City ◽

Limited Resources ◽

Protective Equipment ◽

First Line ◽

Republic Of China ◽

Enormous Amount ◽

The Face ◽

The Common

The COVID-19 pandemic initially started from the Wuhan capital city of Hubei Province in the People's Republic of China had now led to a severe public health hazard across the globe, the recorded death is approximately 958 thousand globally and counting. With the enormous amount of spread of the disease, a severe crisis for Personal Protective Equipment (PPE) is being noticed across the globe. Face masks being the first line of defence for all the healthcare workers as well for the common public. It became mandatory to wear face masks before entering the patient care area. The countries who are not manufacturing it locally had to depend on other countries for the procurement. As there is a severe supply chain disruption due to the lockdown measures taken by all the countries to contain the disease, so it had become difficult to procure the face masks from the manufacturing countries. The price for these PPEs is also rising at an alarming rate with the increase in the COVID-19 cases and the huge rate of consumption by the healthcare and other sectors. Therefore, with limited resources, the hospital has to run its services. The CDC, WHO and ICMR have released several guidelines from time to time for sterilization and reuse of face masks. This article will discuss the various methods that can be utilized to sterilize the face masks and reuse of it.

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Association between personal protective equipment and SARS-CoV-2 infection risk in emergency department healthcare workers

European Journal of Emergency Medicine ◽

10.1097/mej.0000000000000766 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Danique Schmitz ◽

Marieke Vos ◽

Renate Stolmeijer ◽

Heleen Lameijer ◽

Titus Schönberger ◽

...

Keyword(s):

Emergency Department ◽

Personal Protective Equipment ◽

Healthcare Workers ◽

Infection Risk ◽

Protective Equipment

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Airway Pressure Release Ventilation in Morbidly Obese Surgical Patients with Acute Lung Injury and Acute Respiratory Distress Syndrome

The American Surgeon ◽

10.1177/000313481307900320 ◽

2013 ◽

Vol 79 (3) ◽

pp. 242-246 ◽

Cited By ~ 3

Author(s):

George M. Testerman ◽

Igal Breitman ◽

Sarah Hensley

Keyword(s):

Critical Care ◽

Acute Lung Injury ◽

Respiratory Failure ◽

Lung Injury ◽

Respiratory Distress Syndrome ◽

Airway Pressure ◽

Distress Syndrome ◽

Morbidly Obese ◽

Morbidly Obese Patient ◽

Pressure Release Ventilation

Morbidly obese patients with body mass index greater than 40 kg/m2 and respiratory failure requiring critical care services are increasingly seen in trauma and acute care surgical centers. Baseline respiratory pathophysiology including decreased pulmonary compliance with dependent atelectasis and abnormal ventilation–perfusion relationships predisposes these patients to acute lung injury (ALI) and adult respiratory distress syndrome (ARDS) as well as prolonged stays in the intensive care unit. Airway pressure release ventilation (APRV) is an increasingly used alternative mode for salvage therapy in patients with hypoxemic respiratory failure that also provides lung protection from ventilator-induced lung injury. APRV provides the conceptual advantage of an “open lung” approach to ventilation that may be extended to the morbidly obese patient population with ALI and ARDS. We discuss the theoretical benefits and a recent clinical experience of APRV ventilation in the morbidly obese patient with respiratory failure at a Level I trauma, surgical critical care, and acute care surgery center.

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Prevention Practice of COVID-19 Using Personal Protective Equipment and Hand Hygiene Among Healthcare Workers in Public Hospitals of South Wollo Zone, Ethiopia

Frontiers in Public Health ◽

10.3389/fpubh.2021.782705 ◽

2021 ◽

Vol 9 ◽

Author(s):

Awoke Keleb ◽

Ayechew Ademas ◽

Mistir Lingerew ◽

Tadesse Sisay ◽

Gete Berihun ◽

...

Keyword(s):

Hand Hygiene ◽

Personal Protective Equipment ◽

Healthcare Workers ◽

Associated Factors ◽

Infection Risk ◽

Public Hospitals ◽

Protective Equipment ◽

Hygiene Practice ◽

Good Compliance ◽

Equipment Utilization

Objective: The use of personal protective equipment and hand hygiene are often the most recommended line of defense against coronavirus disease-19 (COVID-19). The purpose of this study is to determine the magnitude of compliance and associated factors of personal protective equipment (PPE) utilization and hand hygiene practice among healthcare workers in public hospitals of South Wollo Zone, Northeastern Ethiopia.Methods: A hospital-based cross-sectional study was conducted among 489 healthcare workers in public hospitals of South Wollo Zone, Northeastern Ethiopia from June 15 to July 30, 2021. Proportional sample size allocation to each selected hospital followed by simple random sampling techniques were used to select the study participants using human resource records from each hospital. A pre-tested and structured self-administered questionnaire with WHO's standardized hand hygiene and PPE utilization observational checklist were used to collect data. Bivariate and multivariable analyses with 95% CI and p-value < 0.05 were employed to identify the associated factors of personal protective equipment utilization.Results: About 32 and 22.3% of healthcare workers were compliant with personal protective equipment utilization and hand hygiene practice, respectively. Feedback for safety (AOR = 2.05; 95% CI: 1.26–3.35), training on COVID-19 prevention (AOR = 3.43; 95% CI: 2.01–5.86), and perception to infection risk (AOR = 1.98; 95% CI: 1.18–3.33) were significant factors of good compliance with personal protective equipment utilization.Conclusion: The magnitude of good compliance with personal protective equipment utilization and hand hygiene was low. Interventions to promote personal protective equipment utilization and hand hygiene should focus on feedback for safety, training on COVID-19 prevention, and perception of infection risk.

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Successful treatment of a critically ill patient with acute respiratory distress syndrome from COVID-19 using mechanical ventilation strategy with low levels of positive end-expiratory pressure

Medicine ◽

10.1097/md.0000000000023160 ◽

2020 ◽

Vol 99 (49) ◽

pp. e23160

Author(s):

Wei-guang Guo ◽

Bin Fang ◽

Yan-shan Xian ◽

Zhi-hui Yu ◽

Li-xin Zhou

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Critically Ill ◽

Distress Syndrome ◽

Critically Ill Patient ◽

Ventilation Strategy ◽

Positive End Expiratory Pressure ◽

Low Levels

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Perioperative challenges in a morbidly obese former COVID-19 patient undergoing elective spine surgery

BMJ Case Reports ◽

10.1136/bcr-2021-243950 ◽

2021 ◽

Vol 14 (7) ◽

pp. e243950

Author(s):

Zhen Hao Leo ◽

Fathir Fath Mohammad Iskandar ◽

Tat Boon Yeap ◽

Chin Pei Bong

Keyword(s):

Obese Patient ◽

Spine Surgery ◽

Lung Fibrosis ◽

Healthcare Workers ◽

Cross Infection ◽

Special Consideration ◽

Morbidly Obese ◽

Interesting Article ◽

Morbidly Obese Patient ◽

Severe Lung

Anaesthesia for patients with severe lung fibrosis post COVID-19 infection requires special consideration. This is due to its propensity to cause perioperative anaesthetic catastrophe and possibility of cross infection among healthcare workers if not properly managed. This interesting article elaborates in detail the anaesthetic and surgical challenges in a morbidly obese patient who had a severe COVID-19 infection presenting for an elective spine surgery.

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Attitudes and beliefs of Spanish healthcare professionals during the COVID-19 pandemic

Science Progress ◽

10.1177/00368504211003775 ◽

2021 ◽

Vol 104 (2) ◽

pp. 003685042110037

Author(s):

Borja Nicolás Santana López ◽

Yeray G. Santana-Padilla ◽

Jesús M. González-Martín ◽

Luciano Santana-Cabrera

Keyword(s):

Personal Protective Equipment ◽

Healthcare Workers ◽

Healthcare Professionals ◽

National Level ◽

Descriptive Study ◽

Infection Risk ◽

Professional Commitment ◽

Protective Equipment ◽

Attitudes And Beliefs ◽

Online Questionnaire

During the COVID-19 pandemic, healthcare professionals are taking the risk of becoming infected or infecting their families. Spain is the country with the highest number of infected healthcare professionals worldwide. Our aim was to study the attitudes and beliefs of these professionals during the current pandemic. Descriptive study conducted by using an online questionnaire—based on an earlier one—which was sent to healthcare professionals at the national level, during the week March 20-27, 2020. Healthcare professionals returned 971 completed questionnaires. A total of 803 (82.7%) participants thought that they did not have suitable PPEs (Personal Protective Equipment) to protect them from infection with COVID-19. In addition, even 229 (23.58%) agreed to go on working even if they were not. In spite of this, 606 (62.4%) of them were ready to work, even with a higher-than-usual risk of becoming infected at work and getting ill. Remarkably high professional commitment has been observed among Spanish healthcare workers in the current pandemic. They were ready to work even when many of them considered that they did not have suitable PPEs, and were thus taking a higher than usual infection risk. However, they put the health of their relatives before their duties at work.

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Drivers and mediators of healthcare workers’ anxiety in one of the most affected hospitals by COVID-19: a qualitative analysis

BMJ Open ◽

10.1136/bmjopen-2020-045048 ◽

2021 ◽

Vol 11 (3) ◽

pp. e045048 ◽

Cited By ~ 1

Author(s):

Mengling Fang ◽

Bo Xia ◽

Tian Tian ◽

Yan Hao ◽

Zhenghao Wu

Keyword(s):

Social Support ◽

Healthcare Workers ◽

Infection Risk ◽

Protective Equipment ◽

Risk Of Infection ◽

Central Hospital ◽

Financial Status ◽

Medical College ◽

Mediating Factors ◽

Severe Anxiety

ObjectiveTo report the driving and mediating factors of healthcare workers’ anxiety during the COVID-19 pandemic.DesignQualitative indepth interview study.SettingThe Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Participants53 healthcare workers who were or were not diagnosed with COVID-19.ResultsDuring the COVID-19 pandemic, healthcare workers were initially not sufficiently psychologically prepared. Then they suffered from severe anxiety and apprehension during the peak stage, regardless of whether they were infected with SARS-CoV-2 or not. These negative emotions were exacerbated by four drivers, namely infection risk, supplies, isolation and media. As the epidemic gradually came under control, healthcare workers experienced less anxiety from these factors, but became concerned about their low financial status. To reduce anxiety, healthcare workers diverted their attention from the risk of infection through personal entertainment and religious beliefs and focused on treating their patients. Furthermore, assistance from other people, including colleagues, families, friends, patients and society, helped protect healthcare workers from anxiety.ConclusionsPersonal and social support can relieve healthcare workers’ anxiety to some extent during the different stages of an epidemic. Both protective equipment and financial allowance motivate healthcare workers to focus on patient care, although the latter matters more as the epidemic comes under control.

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Common Behaviors and Faults When Doffing Personal Protective Equipment for Patients With Serious Communicable Diseases

Clinical Infectious Diseases ◽

10.1093/cid/ciz614 ◽

2019 ◽

Vol 69 (Supplement_3) ◽

pp. S214-S220 ◽

Cited By ~ 17

Author(s):

Joel M Mumma ◽

Francis T Durso ◽

Lisa M Casanova ◽

Kimberly Erukunuakpor ◽

Colleen S Kraft ◽

...

Keyword(s):

Hand Hygiene ◽

Personal Protective Equipment ◽

Healthcare Workers ◽

Failure Modes ◽

Communicable Diseases ◽

Simulated Patients ◽

Protective Equipment ◽

Hand Sanitizer ◽

The Common ◽

High Level

Abstract Background The safe removal of personal protective equipment (PPE) can limit transmission of serious communicable diseases, but this process poses challenges to healthcare workers (HCWs). Methods We observed 41 HCWs across 4 Ebola treatment centers in Georgia doffing PPE for simulated patients with serious communicable diseases. Using human factors methodologies, we obtained the details, sequences, and durations of doffing steps; identified the ways each step can fail (failure modes [FMs]); quantified the riskiness of FMs; and characterized the workload of doffing steps. Results Eight doffing steps were common to all hospitals—removal of boot covers, gloves (outer and inner pairs), the outermost garment, the powered air purifying respirator (PAPR) hood, and the PAPR helmet assembly; repeated hand hygiene (eg, with hand sanitizer); and a final handwashing with soap and water. Across hospitals, we identified 256 FMs during the common doffing steps, 61 of which comprised 19 common FMs. Most of these common FMs were above average in their riskiness at each hospital. At all hospitals, hand hygiene, removal of the outermost garment, and removal of boot covers were above average in their overall riskiness. Measurements of workload revealed that doffing steps were often mentally demanding, and this facet of workload correlated most strongly with the effortfulness of a doffing step. Conclusions We systematically identified common points of concern in protocols for doffing high-level PPE. Addressing FMs related to hand hygiene and the removal of the outermost garment, boot covers, and PAPR hood could improve HCW safety when doffing high-level PPE. We identified ways that doffing protocols for high-level personal protective equipment may fail to protect healthcare workers. Hand hygiene, removing the outermost garment, boot covers, and respirator hood harbored the greatest risk and failed in similar ways across different hospitals.

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