scholarly journals Evaluating the contributions of strategies to prevent SARS-CoV-2 transmission in the healthcare setting: a modelling study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044644
Author(s):  
Xueting Qiu ◽  
Joel C Miller ◽  
Derek R MacFadden ◽  
William P Hanage
Keyword(s):  
Healthcare Workers ◽  
Healthcare Setting ◽  
Stochastic Simulations ◽  
Limited Resources ◽  
Base Case ◽  
Protective Equipment ◽  
Random Testing ◽  
Weekly Basis ◽  
Force Of Infection ◽  
Effective Use

IntroductionSince its onset, the COVID-19 pandemic has caused significant morbidity and mortality worldwide, with particularly severe outcomes in healthcare institutions and congregate settings. To mitigate spread, healthcare systems have been cohorting patients to limit contacts between uninfected patients and potentially infected patients or healthcare workers (HCWs). A major challenge in managing the pandemic is the presence of currently asymptomatic/presymptomatic individuals capable of transmitting the virus, who could introduce COVID-19 into uninfected cohorts. The optimal combination of personal protective equipment (PPE), testing and other approaches to prevent these events is unclear, especially in light of ongoing limited resources.MethodsUsing stochastic simulations with a susceptible-exposed-infected-recovered dynamic model, we quantified and compared the impacts of PPE use, patient and HCWs surveillance testing and subcohorting strategies.ResultsIn the base case without testing or PPE, the healthcare system was rapidly overwhelmed, and became a net contributor to the force of infection. We found that effective use of PPE by both HCWs and patients could prevent this scenario, while random testing of apparently asymptomatic/presymptomatic individuals on a weekly basis was less effective. We also found that even imperfect use of PPE could provide substantial protection by decreasing the force of infection. Importantly, we found that creating smaller patient/HCW-interaction subcohorts can provide additional resilience to outbreak development with limited resources.ConclusionThese findings reinforce the importance of ensuring adequate PPE supplies even in the absence of testing and provide support for strict subcohorting regimens to reduce outbreak potential in healthcare institutions.

scholarly journals Evaluating the contributions of strategies to prevent SARS-CoV-2 transmission in the healthcare setting: a modelling study

2020 ◽  
Author(s):  
Joel C. Miller ◽  
Xueting Qiu ◽  
Derek R. MacFadden ◽  
William P. Hanage
Keyword(s):  
Personal Protective Equipment ◽  
Value Added ◽  
Stochastic Simulations ◽  
Base Case ◽  
Protective Equipment ◽  
Random Testing ◽  
Term Care ◽  
Force Of Infection ◽  
Asymptomatic Individuals ◽  
The Impact

SummaryBackgroundSince its onset, the COVID-19 pandemic has caused significant morbidity and mortality worldwide, with particularly severe outcomes in healthcare institutions and congregate settings. To mitigate spread, healthcare systems have been cohorting patients to limit contacts between uninfected patients and potentially infected patients or healthcare workers (HCWs). A major challenge in managing the pandemic is the presence of currently asymptomatic individuals capable of transmitting the virus, who could introduce COVID-19 into uninfected cohorts. The optimal combination of personal protective equipment (PPE) and testing approaches to prevent these events is unclear, especially in light of ongoing limitations in access to both.MethodsUsing stochastic simulations with an SEIR model we quantified and compared the impacts of PPE use, patient and HCWs testing, and cohorting.FindingsIn the base case without testing or PPE, the healthcare system was rapidly overwhelmed, and became a net contributor to the force of infection. We found that effective use of PPE by both HCWs and patients could prevent this scenario, while random testing of apparently asymptomatic individuals on a weekly basis was less effective. We also found that even imperfect use of PPE could provide substantial protection by decreasing the force of infection, and that creation of smaller patient/HCW subcohorts can provide additional resilience to outbreak development.InterpretationThese findings reinforce the importance of ensuring adequate PPE supplies even in the absence of testing, and provide support for strict subcohorting regimens to reduce outbreak potential in healthcare institutions.FundingNational Institute of General Medical Sciences, National Institutes of Health.Research in contextEvidence beforePreserving healthcare from outbreaks of respiratory viruses is a longstanding concern, brought into sharp relief by the covid-19 pandemic. Early case series and numerous anecdotal reports suggest that health care workers (HCWs) and patients receiving treatment for conditions other than SARS-CoV-2 infection are at elevated risk of becoming infected, and the consequences of infections in long term care facilities are well known. In addition, the early stages of the pandemic have been marked by shortages of personal protective equipment (PPE) and diagnostic testing, but the most effective strategies for their use given the specific characteristics of SARS-CoV-2 transmission are unclear.Value addedOur research plainly shows the importance of presymptomatic transmission. Given reasonable estimates of this, random testing of currently asymptomatic staff and patients once a week is not able to prevent large outbreaks. We show that PPE is, as expected, the most effective intervention and moreover even suboptimal PPE use is highly beneficial. To further limit transmission, we show the benefit of sub-cohorting into smaller groups of HCWs and patients. When the force of infection in the community is low, this can entirely prevent the establishment of infection in a large fraction of healthcare.ImplicationsPPE should be used throughout healthcare, on the assumption that any patient or HCWs is potentially infected. Further work should determine the most effective means of PPE for the non-COVID cohort. If PPE resources are limited, whether in general or due to a second surge, we recommend subcohorting to limit the impact of introductions from the community.

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

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.

Infection Control Practices Among Correctional Healthcare Workers: Effect of Management Attitudes and Availability of Protective Equipment and Engineering Controls

2001 ◽  
Vol 22 (9) ◽  
pp. 555-559 ◽  
Author(s):  
Judith Green-McKenzie ◽  
Robyn R.M. Gershon ◽  
Christine Karkashian
Keyword(s):  
Health Care ◽  
Infection Control ◽  
Healthcare Workers ◽  
Safety Climate ◽  
Healthcare Setting ◽  
Protective Equipment ◽  
Correctional Health Care ◽  
Engineering Controls ◽  
Correctional Health ◽  
Correctional Healthcare

AbstractObjectives:To determine the relation of the availability of personal protective equipment (PPE) and engineering controls to infection control (IC) practices in a prison healthcare setting, and to explore the effect on IC practices of a perceived organizational commitment to safety.Design:Cross-sectional survey.Setting:The study population was drawn from the 28 regional Correctional Health Care Workers Facilities in Maryland.Participants:All full-time Maryland correctional healthcare workers (HCWs) were surveyed, and 225 (64%) of the 350 responded.Method:A confidential, self-administered questionnaire was mailed to all correctional HCWs employed in the 28 Maryland Correctional Health Care Facilities. The questionnaire was analyzed psychometrically and validated through extensive pilot testing. It included items on three major constructs: IC practices, safety climate (defined as the perception of organizational commitment to safety), and availability of IC equipment and supplies.Results:A strong correlation was found between the availability of PPE and IC practices. Similarly, a strong correlation was found between IC practices and the presence of engineering controls. In addition, an equally strong association was seen between the adoption of IC practices and employee perception of management commitment to safety. Those employees who perceived a high level of management support for safety were more than twice as likely to adhere to recommended IC practices. IC practices were significantly more likely to be followed if PPE was always readily available. Similarly, IC practices were more likely to be followed if engineering controls were provided.Conclusion:These findings suggest that ready availability of PPE and the presence of engineering controls are crucial to help ensure their use in this high-risk environment. This is especially important because correctional HCWs are potentially at risk of exposure to bloodborne pathogens such as human immunodeficiency virus and hepatitis B and C viruses. Commitment to safety was found to be highly associated with the adoption of safe work practices. There is an inherent conflict of “custody versus care” in this setting; hence, it is especially important that we understand and appreciate the relation between safety climate and IC practices. Interventions designed to improve safety climate, as well as availability of necessary IC supplies and equipment, will most likely prove effective in improving employee compliance with IC practices in this healthcare setting.

scholarly journals 950 A Close Loop Audit to Assess Awareness Among Non-Consultant Hospital Doctors Re Use of Personal Protective Equipment

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Amin ◽  
M Fahad Ullah ◽  
E Hannon ◽  
G Feaney ◽  
J Khan
Keyword(s):  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
University Hospital ◽  
Protective Equipment ◽  
Age Group ◽  
Educational Session ◽  
Hospital Doctors ◽  
Limited Supply ◽  
Two Phases ◽  
Effective Use

Abstract Introduction Personal protective equipments (PPEs) are like war uniforms in the fight against Corona Pandemic. The limited supply of PPEs warrant their proper use not only to avoid shortage of supplies but also to prevent any infectious spread to healthcare workers. This study aimed at analyzing awareness among non-consultant hospital doctors re proper use of PPEs Method A questionnaire was devised using local available guidelines published by university Hospital Limerick. The study was done in 2 phases. In 1st phase 100 questionnaires were distributed to non-consultant hospital doctors(NCHDs). Results were analysed and after 1st phase and emails were sent with results and local guidelines and a zoom educational session was organized. In 2nd phase, questionnaire was redistributed in a week's time and results were re analysed to close the loop. Results 200 NCHDs participated in the study,100 in each phase. Most common age group in two phases was 21-30 yrs. Awareness about PPEs use for Covid 19 increased significantly in 2nd phase across all domains (what is included in PPEs (100% from 91%), Sequence for putting on PPEs (52% to 88% p < 0.05), steps for FIT test (57% to 74% p = 0.247) and sequence for removing PPEs (47% to 81% p < 0.05). Conclusions Though PPEs donning and doffing sessions were organized by the hospital officially, Awareness about effective use of PPEs among NCHDs further improved after organizing a Zoom educational session and auditing.

scholarly journals Challenges for Healthcare Workers Caring for COVID-19 Patients in Indonesia: A Qualitative Study

2021 ◽  
Vol 58 ◽  
pp. 004695802110602
Author(s):  
Herley Windo Setiawan ◽  
Ika Nur Pratiwi ◽  
Lailatun Nimah ◽  
Zulfayandi Pawanis ◽  
Arief Bakhtiar ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Health Workers ◽  
Limited Resources ◽  
Protective Equipment ◽  
Sampled Data ◽  
Hospital Managers ◽  
The Government ◽  
Depth Interviews

COVID-19 pandemic raises various challenges faced by health workers in hospitals. This study explored strategies for overcoming challenges in caring for COVID-19 patients at hospitals in Indonesia based on healthcare workers’ experience. In-depth interviews were employed with 28 healthcare workers (physicians and nurses) who were purposively sampled. Data were collected via phone and analysed using the Colaizzi method. Five following challenges were found: difficulties in working with personal protective equipment (PPE), offline training for handling Covid and using PPE not being implemented evenly for all health workers, physical and psychological fatigue, difficulties in carrying out health education and assessment towards patients and families, and limited resources to cope with the COVID-19 pandemic. Meanwhile, some barriers require support from the government, public and hospital managers. The information gained from research on the strategies for caring for COVID-19 patients can contribute to better preparedness for hospitals and health workers facing the COVID-19 pandemic.

scholarly journals The ‘haves’ and ‘have-nots’ of personal protective equipment during the COVID-19 pandemic: the ethics of emerging inequalities amongst healthcare workers

2021 ◽  
pp. medethics-2021-107501
Author(s):  
Clifford Shelton ◽  
Kariem El-Boghdadly ◽  
John B Appleby
Keyword(s):  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Healthcare Setting ◽  
Protective Equipment ◽  
Practical Action ◽  
Ethical Implications ◽  
Healthcare Workforce ◽  
Pandemic Planning ◽  
Operating Theatres

The COVID-19 pandemic has exacerbated inequalities, including among the healthcare workforce. Based on recent literature and drawing on our experiences of working in operating theatres and critical care in the UK’s National Health Service during the pandemic, we review the role of personal protective equipment and consider the ethical implications of its design, availability and provision at a time of unprecedented demand. Several important inequalities have emerged, driven by factors such as individuals purchasing their own personal protective equipment (either out of choice or to address a lack of provision), inconsistencies between guidelines issued by different agencies and organisations, and the standardised design and procurement of equipment required to protect a diverse healthcare workforce. These, we suggest, have resulted largely because of a lack of appropriate pandemic planning and coordination, as well as insufficient appreciation of the significance of equipment design for the healthcare setting. As with many aspects of the pandemic, personal protective equipment has created and revealed inequalities driven by economics, gender, ethnicity and professional influence, creating a division between the ‘haves’ and ‘have-nots’ of personal protective equipment. As the healthcare workforce continues to cope with ongoing waves of COVID-19, and with the prospect of more pandemics in the future, it is vital that these inequalities are urgently addressed, both through academic analysis and practical action.

A Review of Isolation Gowns in Healthcare: Fabric and Gown Properties

2015 ◽  
Vol 10 (3) ◽  
pp. 155892501501000 ◽  
Author(s):  
F. Selcen Kilinc
Keyword(s):  
Healthcare Workers ◽  
Emerging Infectious Diseases ◽  
Hemorrhagic Fever ◽  
Healthcare Setting ◽  
Critical Parameters ◽  
Protective Equipment ◽  
Bodily Fluids ◽  
Healthcare Settings ◽  
Ebola Hemorrhagic Fever ◽  
Wear And Tear

The threat of emerging infectious diseases including Ebola hemorrhagic fever, pandemic influenza, avian influenza, Hepatitis B, Hepatitis C, and SARS has highlighted the need for effective personal protective equipment (PPE) to protect healthcare workers (HCWs), patients, and visitors. PPE is a critical component in the hierarchy of controls used to protect HCWs from infectious hazards. HCW PPE may include gowns, respirators, face masks, gloves, eye protection, face shields, and head and shoe coverings. Important research has been conducted in certain areas, such as respirators and protective masks, but studies in other areas, particularly gowns, are scarce. Gowns are identified as the second-most-used piece of PPE, following gloves, in the healthcare setting. According to the Centers for Disease Control and Prevention's Guideline for Isolation Precautions, isolation gowns should be worn to protect HCWs’ arms and exposed body areas during procedures and patient-care activities when anticipating contact with clothing, blood, bodily fluids, secretions and excretions. Isolation gowns currently available on the marketplace offer varying resistance to blood and other bodily fluids depending on the type of the material, its impermeability, and wear and tear. While some studies show no benefit of the routine use of isolation gowns, others demonstrate that its use is associated with a reduced infection rate. This paper reviews isolation gowns in healthcare settings, including the fabrics used, gown design and interfaces, as well as critical parameters that affect microorganism and liquid transmission through fabrics.

scholarly journals Stress and Associated Factors among Frontline Healthcare Workers in the COVID-19 Epicenter of Da Nang City, Vietnam

2021 ◽  
Vol 18 (14) ◽  
pp. 7378
Author(s):  
Nhan Phuc Thanh Nguyen ◽  
Duong Dinh Le ◽  
Robert Colebunders ◽  
Joseph Nelson Siewe Fodjo ◽  
Trung Dinh Tran ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Stress Component ◽  
Multivariable Analysis ◽  
Working Hours ◽  
Health Facilities ◽  
Protective Equipment ◽  
Laboratory Workers ◽  
Frontline Healthcare Workers ◽  
Second Wave

Frontline healthcare workers (HCWs) involved in the COVID-19 response have a higher risk of experiencing psychosocial distress amidst the pandemic. Between July and September 2020, a second wave of the COVID-19 pandemic appeared in Vietnam with Da Nang city being the epicenter. During the outbreak, HCWs were quarantined within the health facilities in a bid to limit the spread of COVID-19 to their respective communities. Using the stress component of the 21-item Depression, Anxiety and Stress Scale (DASS-21), we assessed the level of stress among HCWs in Da Nang city. Between 30 August and 15 September 2020, 746 frontline HCWs were recruited to fill in an online structured questionnaire. Overall, 44.6% of participants experienced increased stress and 18.9% severe or extremely severe stress. In multivariable analysis, increased stress was associated with longer working hours (OR = 1.012; 95% CI: 1.004–1.019), working in health facilities providing COVID-19 treatment (OR = 1.58, 95% CI: 1.04–2.39), having direct contact with patients or their bio-samples (physicians, nurses and laboratory workers; OR = 1.42, 95% CI: 1.02–1.99), low confidence in the available personal protective equipment (OR = 0.846; 95% CI: 0.744–0.962) and low knowledge on COVID-19 prevention and treatment (OR = 0.853; 95% CI: 0.739–0.986). In conclusion, many frontline HCWs experienced increased stress during the COVID-19 outbreak in Da Nang city. Reducing working time, providing essential personal protective equipment and enhancing the knowledge on COVID-19 will help to reduce this stress. Moreover, extra support is needed for HCWs who are directly exposed to COVID-19 patients.

scholarly journals The Healthcare Sector Employer’s Duty of Care: Implications for Worker Well-Being

2021 ◽  
Vol 18 (11) ◽  
pp. 6015
Author(s):  
Melissa McDiarmid ◽  
Marian Condon ◽  
Joanna Gaitens
Keyword(s):  
Middle East ◽  
Healthcare Workers ◽  
Care Program ◽  
Well Being ◽  
Middle East Respiratory Syndrome ◽  
Worker Safety ◽  
Healthcare Sector ◽  
Duty Of Care ◽  
Protective Equipment ◽  
Extreme Risk

Pandemic diseases of this century have differentially targeted healthcare workers globally. These infections include Severe Acute Respiratory Syndrome SARS, the Middle East respiratory syndrome coronavirus Middle East respiratory syndrome coronavirus (MERS-CoV) and Ebola. The COVID-19 pandemic has continued this pattern, putting healthcare workers at extreme risk. Just as healthcare workers have historically been committed to the service of their patients, providing needed care, termed their “duty of care”, so too do healthcare employers have a similar ethical duty to provide care toward their employees arising from historical common law requirements. This paper reports on results of a narrative review performed to assess COVID-19 exposure and disease development in healthcare workers as a function of employer duty of care program elements adopted in the workplace. Significant duty of care deficiencies reported early in the pandemic most commonly involved lack of personal protective equipment (PPE) availability. Beyond worker safety, we also provide evidence that an additional benefit of employer duty of care actions is a greater sense of employee well-being, thus aiding in the prevention of healthcare worker burnout.

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