Rama Co-RADS: Categorical Assessment Scheme of Chest Radiographic Findings  for Diagnosing Pneumonia in Patients With Confirmed COVID-19

Due to the rapid spread of COVID-19 during the third wave of infection in Thailand, the number of confirmed COVID-19 cases has increased exponentially since April 2021. As a result, the country’s healthcare facilities and personnel are overwhelmed. Hence, many new intervention strategies have been designed and implemented. In such a resource-constrained condition, multiple alternate care sites, such as converted hotels (the so-called hospitels) and mobile field medical units, have been established for quarantine and taking care of confirmed COVID-19 cases having no or mild symptoms. In this context, it is essential to have clinical and chest radiographic assessment as a baseline screening for an accurate and rapid triage of patients and early detection of COVID-19 pneumonia, which significantly impacts patient outcomes. Therefore, a clear, concise and standardized chest radiographic report is mandatory. To facilitate this process, the authors have introduced Rama Co-RADS for the categorical assessment scheme of pulmonary involvement in COVID-19. After the pilot implementation of Rama Co-RADS in the routine radiology workflow for chest radiography screening in patients with confirmed COVID-19 at the Ramathibodi Hospitels, there is a 24% reduction in the median turnaround radiology reporting time. It also enhances the radiologist’s performance in establishing the diagnosis of COVID-19 pneumonia (especially in the early phase). Furthermore, the categorical assessment scheme in Rama Co-RADS facilitates communication among healthcare personnel, guiding effective management, triage, consultation and treatment of patients with confirmed COVID-19.

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Rapid Spread of the SARS-CoV-2 Variant of Concern 202012/01 in Southern Italy (December 2020–March 2021)

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094766 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4766

Author(s):

Daniela Loconsole ◽

Francesca Centrone ◽

Caterina Morcavallo ◽

Silvia Campanella ◽

Anna Sallustio ◽

...

Keyword(s):

Clinical Characteristics ◽

Large Scale ◽

Southern Italy ◽

Whole Genome ◽

Third Wave ◽

Gene Target ◽

The Third ◽

Rapid Spread ◽

Pharmaceutical Interventions ◽

Over Time

Epidemiological and virological studies have revealed that SARS-CoV-2 variants of concern (VOCs) are emerging globally, including in Europe. The aim of this study was to evaluate the spread of B.1.1.7-lineage SARS-CoV-2 in southern Italy from December 2020–March 2021 through the detection of the S gene target failure (SGTF), which could be considered a robust proxy of VOC B.1.1.7. SGTF was assessed on 3075 samples from week 52/2020 to week 10/2021. A subset of positive samples identified in the Apulia region during the study period was subjected to whole-genome sequencing (WGS). A descriptive and statistical analysis of the demographic and clinical characteristics of cases according to SGTF status was performed. Overall, 20.2% of samples showed SGTF; 155 strains were confirmed as VOC 202012/01 by WGS. The proportion of SGTF-positive samples rapidly increased over time, reaching 69.2% in week 10/2021. SGTF-positive cases were more likely to be symptomatic and to result in hospitalization (p < 0.0001). Despite the implementation of large-scale non-pharmaceutical interventions (NPIs), such as the closure of schools and local lockdowns, a rapid spread of VOC 202012/01 was observed in southern Italy. Strengthened NPIs and rapid vaccine deployment, first among priority groups and then among the general population, are crucial both to contain the spread of VOC 202012/01 and to flatten the curve of the third wave.

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Sharp Decrease of Reported Occupational Blood and Body Fluid Exposures in French Hospitals, 2003–2012: Results of the French National Network Survey, AES-RAISIN

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.80 ◽

2015 ◽

Vol 36 (8) ◽

pp. 963-968 ◽

Cited By ~ 5

Author(s):

N. Floret ◽

O. Ali-Brandmeyer ◽

F. L’Hériteau ◽

C. Bervas ◽

S. Barquins-Guichard ◽

...

Keyword(s):

Body Fluid ◽

Sharp Decrease ◽

Healthcare Personnel ◽

Significant Drop ◽

Healthcare Facilities ◽

National Network ◽

The Past ◽

Personnel Safety ◽

Voluntary Basis

OBJECTIVETo assess the temporal trend of reported occupational blood and body fluid exposures (BBFE) in French healthcare facilities.METHODRetrospective follow-up of reported BBFE in French healthcare facilities on a voluntary basis from 2003 to 2012 with a focus on those enrolled every year from 2008 to 2012 (stable cohort 2008–12).FINDINGSReported BBFE incidence rate per 100 beds decreased from 7.5% in 2003 to 6.3% in 2012 (minus 16%). Percutaneous injuries were the most frequent reported BBFE (84.0% in 2003 and 79.1% in 2012). Compliance with glove use (59.1% in 2003 to 67.0% in 2012) and sharps-disposal container accessibility (68.1% in 2003 to 73.4% in 2012) have both increased. A significant drop in preventable BBFE was observed (48.3% in 2003 to 30.9% in 2012). Finally, the use of safety-engineered devices increased from 2008 to 2012.CONCLUSIONOf the 415,209 hospital beds in France, 26,158 BBFE could have occurred in France in 2012, compared with 35,364 BBFE in 2003. Healthcare personnel safety has been sharply improved during the past 10 years in France.Infect. Control Hosp. Epidemiol. 2015;36(8):963–968

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Smart Management of Healthcare Professionals Involved in COVID-19 Contrast With SWAPS

Frontiers in Sustainable Cities ◽

10.3389/frsc.2021.638743 ◽

2021 ◽

Vol 3 ◽

Author(s):

Paolo Bellavista ◽

Marco Torello ◽

Antonio Corradi ◽

Luca Foschini

Keyword(s):

Health Department ◽

Contact Tracing ◽

Healthcare Personnel ◽

High Concentration ◽

Regional Health ◽

Positive Health ◽

Risk Area ◽

Healthcare Facilities ◽

Infected People ◽

The University

The recent COVID-19 pandemic in Italy has highlighted several critical issues in the management process of infected people. At the health level, the management of the COVID-19 positive was mainly delegated to the regional authorities and centrally monitored by the State. Despite requested common activities (such as diagnosis of virus positivity, active surveillance of infected people and contact tracing), Regional Health Departments were able to issue specific directives in their territories and establish priority levels for each activity according to the specific needs related to the emergency in their area. The development of novel digital tools for the management of infected people become an urgent necessity to foster more organized and integrated solutions, able to quickly process large amounts of data. Mobile Crowdsensing methodologies could effectively facilitate needed lateral interviewing activities as well as the monitoring of crowds in environments with a high concentration of virus-positive subjects (such are hospital wards but also other locations), facilitating the tracing of possible outbreaks of contagion due to advanced geolocation techniques and big data analysis methods. This paper analyzes the functionality of SWAPS (Supporting Workflows for Healthcare Personnel management), a modular and scalable web platform which facilitate and reduces the management time of COVID positive health personnel within healthcare facilities. It also analyzes the possible integrations between SWAPS and ParticipACT, an advanced MCS platform developed by the University of Bologna that can help set up the alert notification in case of entry into a COVID risk area. This article surveys the current literature on software platforms to address COVID-19 and related tracing issues and presents the practical issues and on-the-field results obtained from the research developed by the University of Bologna by assisting the deployment of the proposed solution for a big Regional Health Department in the city of Bologna.

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1058. Decreases in Antibiotic Use Associated with the Implementation of Electronic Antibiotic Visualization Tools for Stewards at Eight Veterans Affairs (VA) Healthcare Facilities

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.922 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S374-S374

Author(s):

Christopher J Graber ◽

Makoto M Jones ◽

Matthew B Goetz ◽

Karl Madaras-Kelly ◽

Yue Zhang ◽

...

Keyword(s):

Broad Spectrum ◽

Antibiotic Use ◽

Antimicrobial Use ◽

Post Intervention ◽

Healthcare Facilities ◽

Use Of Data ◽

Patterns Of Use ◽

Learning Collaboratives ◽

Visualization Tools ◽

Pilot Implementation

Abstract Background To identify areas for improved antibiotic use, we developed and pilot-tested visualization tools to quantify antibiotic use at 8 VA facilities. These tools allow a facility to review its patterns of total use, and use by antibiotic class, compared with patterns of use at VA facilities with similar (or user-selected) complexity levels. Methods Antibiotic stewards from 8 VA facilities participated in iterative report development and implementation, with the final product consisting of two components: an interactive web-based antibiotic dashboard and a standardized antibiotic usage report updated at user-selected intervals. Stewards also participated in monthly learning collaboratives. The percent change in average monthly antimicrobial use (all antibiotics; anti-methicillin-resistant S. aureus agents (anti-MRSA); and broad-spectrum agents predominantly used for hospital-onset/multi-drug-resistant organisms (anti-MDRO)) was analyzed using a pre-post (January 2014–January 2016 vs. July 2016–January 2018) with un-involved controls (all other inpatient VA facilities, n = 132) design modeled using Generalized Estimation Equations segmented regression. Results Intervention sites had a 2.1% decrease (95% CI = [−5.7%,1.6%]) in all antibiotic use pre-post-intervention, vs. a 2.5% increase (95% CI = [0.8%, 4.1%]) in nonintervention sites (P = 0.025 for difference). Anti-MRSA antibiotic use decreased 11.3% (95% CI = [−16.0%,−6.3%]) at intervention sites vs. a 6.6% decrease (95% CI=[−9.1%, −3.9%]) at nonintervention sites (P = 0.092 for difference). Anti-MDRO antibiotic use decreased 3.4% (95% CI = [−8.2%,1.7%]) at intervention sites vs. a 3.6% increase (95% CI = [0.8%,6.5%]) at nonintervention sites (P = 0.018 for difference) (Figure 1). Examples of graphs include overall antibacterial use (Figure 2), and usage of broad-spectrum Gram-negative therapy (Figure 3) in intensive care units. Conclusion The use of data visualization tools use and participation in monthly learning collaboratives by antimicrobial stewards in a pilot implementation project at eight VA facilities was associated with decreases in antimicrobial use relative to uninvolved sites. Disclosures All authors: No reported disclosures.

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Infectious Diseases Society of America Guidelines on Infection Prevention for Healthcare Personnel Caring for Patients With Suspected or Known Coronavirus Disease 2019

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1063 ◽

2020 ◽

Cited By ~ 10

Author(s):

John B Lynch ◽

Perica Davitkov ◽

Deverick J Anderson ◽

Adarsh Bhimraj ◽

Vincent Chi-Chung Cheng ◽

...

Keyword(s):

Infectious Diseases ◽

Infection Prevention ◽

Indirect Evidence ◽

Standards Of Care ◽

Healthcare Personnel ◽

Evidence Based ◽

Healthcare Facilities ◽

Guideline Panel ◽

Evaluation Approach ◽

Specific Care

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmissible virus that can infect healthcare personnel (HCP) and patients in healthcare settings. Specific care activities, in particular, aerosol-generating procedures, may have a higher risk of transmission. The rapid emergence and global spread of SARS-CoV-2 has created significant challenges in healthcare facilities, particularly with severe shortages of personal protective equipment (PPE) used to protect HCP. Evidence-based recommendations for what PPE to use in conventional, contingency, and crisis standards of care are needed. Where evidence is lacking, the development of specific research questions can help direct funders and investigators. Objective Our objective was to develop evidence-based rapid guidelines intended to support HCP in their decisions about infection prevention when caring for patients with suspected or known coronavirus disease 2019 (COVID-19). Methods The Infectious Diseases Society of America (IDSA) formed a multidisciplinary guideline panel that included front-line clinicians, infectious diseases specialists, experts in infection control, and guideline methodologists with representation from the disciplines of preventive care, public health, medical microbiology, pediatrics, critical care medicine, and gastroenterology. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then, a systematic review of the peer-reviewed and gray literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the certainty of evidence and make recommendations. Results The IDSA guideline panel agreed on 8 recommendations and provided narrative summaries of other interventions undergoing evaluations. Conclusions Using a combination of direct and indirect evidence, the panel was able to provide recommendations for 8 specific questions on the use of PPE for HCP who provide care for patients with suspected or known COVID-19. Where evidence was lacking, attempts were made to provide potential avenues for investigation. Significant gaps in the understanding of the transmission dynamics of SARS-CoV-2 remain, and PPE recommendations may need to be modified in response to new evidence.

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Chest Computed Tomography Findings in Asymptomatic Patients with COVID-19

Respiration ◽

10.1159/000509334 ◽

2020 ◽

Vol 99 (9) ◽

pp. 748-754 ◽

Cited By ~ 3

Author(s):

Min Cheol Chang ◽

Wonho Lee ◽

Jian Hur ◽

Donghwi Park

Keyword(s):

Computed Tomography ◽

South Korea ◽

Respiratory System ◽

Ground Glass Opacity ◽

Chest Ct ◽

Effective Management ◽

Radiographic Findings ◽

Chest Computed Tomography ◽

Asymptomatic Patients ◽

The Right

Background: Little is known about the damage to the respiratory system in asymptomatic patients with coronavirus disease (COVID-19). Objective: Herein, we evaluate the findings of chest computed tomography (CT) and radiography in patients with COVID-19 who were asymptomatic. Methods: We retrospectively investigated patients with a confirmed diagnosis of COVID-19 but who did not show any symptoms. Among the 139 patients with COVID-19 who were hospitalized in Yeungnam University Hopistal in Daegu, South Korea, 10 (7.2%) were asymptomatic. Their chest CT and radiographic findings were analyzed. Results: In the results, all patients (100%) had ground-glass opacity (GGO) on chest CT. Further, the GGO lesions were predominantly distributed peripherally and posteriorly in all patients. In 9 (90%) patients, the GGO lesions were combined with reticular opacity. Air bronchogram due to bronchiolectasis surrounded by GGO was observed in 8 patients (80%). Additionally, the lung lesions were dominant on the right side in all patients. Conclusions: In conclusion, considering our results that the lung is affected in asymptomatic patients, it will be necessary to extend the indications of COVID-19 testing for effective management of COVID-19 during the pandemic.

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Ilioinguinal Neurectomy and Chronic Post-Operative Pain After Inguinal Hernia Repair

10.52916/jcbi214005 ◽

2020 ◽

pp. 1-7

Author(s):

Aliya Ishaq ◽

Muhammad Shadab Khan ◽

Mariya Ishaq ◽

Ayesha Saba ◽

Turab Pishori

Keyword(s):

Inguinal Hernia ◽

P Value ◽

Third Wave ◽

Brisk Walking ◽

Healthcare Facilities ◽

Nerve Preservation ◽

Post Operative Pain ◽

Group A ◽

Group B

Objective: This study aims to determine the effect of preservation /division of ilioinguinal nerve in patients undergoing lichenstein hernioraphy on severity of chronic post operative pain as well well as presence /absence of groin numbness. Method: A randamised control trial was conducted for a period of six months on 60 patient fulfilling inclusion criteria who underwent lichenstein hernioraphy at general surgery department of Liaquat National university hospital Karachi , Pakistan. Result: A total of 60 patients undergoing elective inguinal hernia mesh repair were Included in study and divided in two groups with 30 patients each. Only male patients were included in the study as female gender was one of the exclusion criteria so gender stratification was no considered. Patients between 17 to 77 yrs of age were included in study and randomly divided in two groups. Mean age of population in group A is 42.96 +/- 17.76 an in group B is 54.23 +/- 15.0. The minimum age of the patient in Group A is 17 years and maximum age is 73 years whereas minimum age of the patient in Group B is 20 years and maximum age is 77 years. 45.9% Patients in group A (Nerve preservation group) have right inguinal hernia. 54.0%% Patients in group B (Nerve Division group) have right inguinal hernia. 56.5%% Patients in group A (Nerve Preservation group) have left inguinal hernia. 43.4% Patients in group B (Nerve Division group) have left inguinal hernia. Chronic groin pain while different physical activities and groin numbness in nerve preservation and nerve division group was assessed at three and six months follow ups in all patients of the study population. 3% of the patients from nerve preservation group had mild pain during climbing stairs at three and six months follow up and the P-Value was 0.313 which is statistically not significant. 10% of the patients from nerve division group and 50% patients from nerve preservation group had pain during brisk walking at three months follow up and the P-Value was 0.001 which is statistically significant. 23% of the patients from nerve division group and 60% patients from nerve preservation group had pain during brisk walking at six months follow up and the P-Value was 0.004 which is statistically significant. 13.3% patients from nerve preservation group had moderate pain during brisk walking at three months follow up while none of the patient from nerve division group had pain and P-Value was 0.038 which is statistically significant. 6.6% of the patients from nerve preservation group had moderate pain during brisk walking at six months follow up while none of the patient from nerve division group had pain and p-value was 0.150 which is statistically in significant. 20% of the patients from nerve division group and 30% of the patients from nerve preservation group had mild groin numbness at three months follow up with P-Value of 0.371 which is statistically in significant. 33.3% of the patients from nerve division group and 30% of the patients from nerve preservation group had groin numbness at six months follow up with a p-value of 0.781 which is statistically in significant. Conclusion: Prophylactic ilioinguinal neurectomy during Lichtenstein tension free inguinal hernia repair decreases the incidence of exertional chronic post operative pain as compare to the nerve preservation group. However the cutaneous neurosensory disturbance/groin numbness between the two groups has no difference in term of outcome. In order to prepare ourselves from a expected third wave of Covid-19, we should not repeat mistakes that we made during previos waves. We should refrain ourselves from dismantling our enhanced healthcare facilities, there should not be any sorts of shortage of oxygen , hospital beds, and drug that we have already witnessed. We must have an aggressive containment measure comprising of a really strong and pro-active surveillance system. This can be achieved by increasing the capacity of the existing surveillance system by identifying active cases early. We must ensure that we should follow “social vaccine” of proper masking, avoid indoor gatherings, and proper sanitization. Our vaccination programme needs a boost. We should vaccinate a large section of people before any third wave hits us. The more we vaccinate, the better prepared we are. As medical professionals, it must be ensured that proper scientific protocol must be implemented while handling Covid-19 cases. And last but not the least efforts must be made to fill up vacancies seen in our public health system, especially for frontline healthcare workers. As it is anticipated that the young children are more vulnerable to the forthcoming third wave, efforts are to be sought in order to start vaccination of the younger children in our country. Trials for which has already been started in India and across the world. Till the time vaccine is made available, the resources are to be mobilized to build up healthcare facilities catering the vulnerable age group in this third wave such as building up of more paediatric wards, paediatric ICU’s , training of healthcare personals in handling the emergencies for expected third wave .In addition to these efforts , more and more paediatric covid care centers must be set up at various parts of the country. Equally important is making arrangements for rehabilitation centers for the orphans. Countries like US, Singapore and UAE have already started vaccinating the children in age group between 12 to 15 years with Pfizer-BioNTech Covid vaccine. It’s a high time that the government in India must consider for allowing “expedited approval pathway” to the companies like Pfizer for their Covid-19 vaccine for children. All these combined efforts from everyone may ensure that the country and world may remain well equipped against these subsequent waves of this deadly virus and pave the path of the triumph in the near future.

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Increased Work Experience Associated with Less Stigmatizing Attitudes towards People Living with HIV among Thai Healthcare Personnel

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189830 ◽

2021 ◽

Vol 18 (18) ◽

pp. 9830

Author(s):

Kriengkrai Srithanaviboonchai ◽

Porntip Khemngern ◽

Jarun Chuayen ◽

Taweesap Siraprapasiri

Keyword(s):

Work Experience ◽

Role Models ◽

Professional Staff ◽

Healthcare Personnel ◽

People Living With Hiv ◽

Staff Support ◽

Stigma Reduction ◽

Healthcare Facilities ◽

Related Stigma ◽

Stigmatizing Attitudes

HIV-related stigma in health facilities has been suggested as a primary target for HIV-related stigma reduction. The objective of this study was to describe negative attitudes among Thai healthcare personnel (HCP) toward PLHIV. This nationwide probability sampled survey was conducted in 2019 in 12 provinces in Thailand and Bangkok, the capital. Participants were considered to have stigmatizing attitudes toward PLHIV if they had a stigmatizing view in response to at least one of the four questions. Eighty-two percent of the 3056 respondents had at least one stigmatizing attitude. Younger HCP, ages < 30 (AOR = 1.60; 95%CI: 1.18–2.18) and 30–39 (AOR = 1.60; 95%CI: 1.21–2.12) were more likely to have stigmatizing attitudes towards PLHIV compared to those aged 50 and older. Being support staff, support-clinical (AOR = 1.89; 95%CI: 1.44–2.49) and support-nonclinical (AOR = 1.71; 95%CI: 1.24–2.36) as opposed to professional staff also increased the likelihood of having stigmatizing attitudes. Stigma was also more likely to be present in HCPs who did not work at HIV-focused clinics (AOR = 1.97; 95%CI: 1.57–2.48). HCP who had more work experience, especially related to PLHIV care, were less likely to have stigmatizing attitudes. These personnel could be good peer educators or role models for a stigma reduction campaign within their healthcare facilities.

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Routine procedures and preventive measures in tissue banking and cell therapy during COVID-19 pandemic

Molecular and experimental biology in medicine ◽

10.33602/mebm.3.2.7 ◽

2020 ◽

Vol 3 (2) ◽

pp. 50-55

Author(s):

Marija Zekusic ◽

Marina Bujic Mihica ◽

Anamarija Jularic ◽

Tamara Dolenec ◽

Marija Skoko ◽

...

Keyword(s):

Cell Therapy ◽

Preventive Measures ◽

Tissue Banking ◽

Work Conditions ◽

University Hospital ◽

Healthcare Personnel ◽

Rapid Spread ◽

The Republic ◽

And Control ◽

Routine Procedures

Following the rapid spread of SARS-CoV-2 worldwide, this article describes routine procedures and preventive measures for tissue banking and cell therapy in University Hospital Centre “Sestre milosrdnice” in the Republic of Croatia. This paper describes our current practice for preventing contamination and microbiological environmental monitoring of cleanrooms, the protection of healthcare personnel as well as patients from SARS-CoV-2. These measures are based on the recommendations obtained from the Ministry of Health of the Republic of Croatia, the Croatian Institute of Public Health and the European Centre for Disease Prevention and Control. We also present data on samples collected and treated in this period in comparison to normal work conditions before COVID-19.

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Emotional commitment and organizational citizenship culture in healthcare facilities

Global Journal of Sociology Current Issues ◽

10.18844/gjs.v5i1.428 ◽

2016 ◽

Vol 6 (1) ◽

pp. 09

Author(s):

Haluk Şengün

Keyword(s):

Organizational Commitment ◽

Organizational Citizenship ◽

Organizational Citizenship Behavior ◽

Healthcare Services ◽

Healthcare Personnel ◽

Citizenship Behavior ◽

Healthcare Facilities ◽

Role Behavior ◽

Emotional Commitment ◽

Willingness To Cooperate

Success in healthcare services can be achieved with the creation of an organizational culture, which can provide and sustain healthcare personnel, who have a high organizational commitment, and who internalize organizational citizenship behavior. Personnel, who have high organizational commitment, adopt the aims and values of the organization, of which they are a member. They put a lot of effort into the organization and have a greater desire to remain part of it. Organizational commitment can be defined as identifying oneself with the organization and its aims, and having the desire to remain part of it. Organizational citizenship behavior is the behavior of the personnel with regard to cooperation, sharing and their willingness to cooperate, in order to provide and maintain personnel and group and organizational composure. Organizational commitment and organizational citizenship concepts are closely related and precessor to each other. According to research, it is noted that emotional commitment has a strong positive relation with organizational citizenship behavior. Individuals with a high emotional commitment have better skills in coping with problems at their institutions; they internalize the problems of their institutions as personal matters and volunteer to create a solution. Contrary to this attachment, personnel, who do not feel an emotional commitment to their institutions, but maintain continuity secondary to different reasons, avoid facing problems and do not feel responsible for creating solutions. The vital importance of the service provided by healthcare personnel requires a high emotional commitment, as voluntary and loyalty emotions are at the forefront of emotional commitment. Lately, the cases of violence against healthcare personnel have greatly increased, and patient-physician relations are at a worse state than ever before. The need for personnel, who have an emotional commitment, who internalize the behavior of organizational citizenship and who contribute to their institutions, is higher than ever. Though, the healthcare personnel cannot expose this act secondary to the the deteriorating working conditions conditions and occurring adverse events. These conditions bring adverse results in the delivery of healthcare services. This research aims to draw attention to this problem, which is gradually worsening each day.Keywords: Organizational Commitment, Organizational Citizenship, Extra Role Behavior, Healthcare Personnel

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