Efficacy of rural camps in achieving vision 2020: Our contribution

: To assess the effectiveness of rural camps held under DBCS (District Blindness Control Programme) & compare the results of cataract surgery at base hospital cases. It is a retrospective observational study, medical records of patients operated for cataract in camp & patients operated in base hospital are analyzed.In our hospital outpatient department, we saw 2,08,716 patients from 2010-2019 and 7796 underwent cataract surgery. Under DBCS we conducted 262 camps from 2010-2019 & 4611 underwent cataract surgery.A total of 27,524 patients got screened in 262 rural camps and 4671 underwent small incision cataract surgery at the base hospital after detailed clinical examination and IOL (intraocular lens) power calculation for each patient. Among 2,08,716 outpatients at the base hospital, 7796 underwent cataract surgery. The rate of intraoperative complications in the base hospital was 0.885% whereas in camp cases 1.94%.IOL implantation is done in 100%cases in base hospital surgeries and 0.064%patients left aphakic among rural camps.Screening at outreach camps and surgeries at the base hospital can have excellent results. Mass surgeries in camps following standard protocol can have the least number of complications.

COVID-19 infection among health care workers: Experience in Base Hospital Wathupitiwala,Sri Lanka.

Coronavirus disease 2019 (COVID-19) is a serious global health pandemic resulting in high mortality and morbidity. Frontline health care workers (HCWs) are at an increased risk of the acquisition of severe acute respiratory syndrome coronavirus-2 infection (SARS CoV-2) due to their close interaction with infected patients (1, 2). Also, HCWs can serve as reservoirs of SARS CoV-2 cross-transmission both in community and hospital settings (1). However, the extent of COVID-19 infection among HCWs in Sri Lanka is understudied. Objectives: This study determined the incidence, demographic characteristics, and risk exposure behavior of HCWs who tested positive for SARS CoV-2 at Base Hospital Wathupitiwala. Furthermore, the rate of acquisition of SARS CoV-2 following COVISHIELD/ChAdOx1 nCoV-19 and Sinopharm /BBIBP-CorV vaccines in HCWs were studied. Methods: A retrospective cross-sectional descriptive analysis was conducted from May 2021 to August 2021 for a total of 818 HCWs. Results: Hundred and twenty-four HCWs (15.16%) were tested positive for COVID-19. The mean age of infected HCWs was 46.27 years and the majority were females (74.19%). Among all infected persons, 54 (43.55%) were nurses/midwives, 39 (31.45%) were clinical supportive staff and 12(9.68%) were medical officers. The number of infected HCWs rapidly escalated and a total of 64(51.61%) HCWs got an infection during August/2021. No source was identified in most of them (34.68%) followed by community acquisition (33.87%). Thirty-five HCWs (28.23%) had acquired infection during a hospital setting or had a high-risk exposure in recent history. Among hospital-related infections, 37.91% of HCWs had shared meals or shared sleeping rooms with an infected workmate. The majority of the HCWs were tested by the infection control unit as symptomatic screening (70.16%) followed by contact tracing (20.16%). Fifty-six (45.16%) HCWs had a history of single or multiple comorbidities. The vast majority of HCWs (95.97%) presented as mild to asymptomatic disease that followed an uneventful recovery. Body aches, headache, fever, and sore throat were the most commonly reported symptoms among them. Among the five HCWs required therapeutic oxygen supplementation, two unvaccinated HCWs succumbed to the infection. The rate of breakthrough infection among HCWs was 8.93%. The acquisition of disease was significantly higher among unvaccinated HCWs than partially (p<0.0001) or fully vaccinated (p<0.0001) HCWs with either type of vaccine. Conclusions: Protecting HCWs remains a challenge in resource-poor settings. The risk of infection fueled by very contagious circulating variants is continuously high even though vaccination has shown clear benefits in preventing mortality and severe infection. Therefore, all healthcare workers should be vaccinated while ensuring continuous infection control measures in the hospital setting.

Evaluation of Safety Climate and its associated factors in Base Hospital Avissawella

The safety climate is “the summary of molar perceptions that employees share about their work environments” and associated with several factors. A descriptive cross-sectional study was done among a randomly selected sample of medical officers (n= 109) and nursing officers (n=193) to evaluate the safety climate and its associated factors in Base Hospital Avissawella Sri Lanka. Among the six safety climate dimensions personal protective and engineering control equipment availability (mean=3.94, SD=0.67) was perceived at the highest level. The lowest scored perceptual dimension was absence of job hindrances (mean=3.27, SD=0.83). Among the respondents 219 (83.5%) had at least one exposure incident. There is no significant relationship between job category and workplace exposure incidents (p= 0.388). Only 28.3% (n=62) had reported about their injuries. Only 60.7% (n=159) were strictly compliant to safe work practices and the compliance of nursing officers was better than of medical officers (p=0.000). The safety climate had a negative association with workplace exposure incidents (OR< 1.0) and a positive association with compliance to safe work practices. (OR>1.0). The respondents had negative perceptions about some of the safety climate dimensions. Workplace exposure incidents were common and the reporting behavior about injuries was poor among both categories of staff, but comparatively the nursing officers were better. Majority were “Strict compliant” to the safe work practices and compliance was better among nursing officers. Safety climate was negatively associated with exposure incidents and positively with the compliance. The hospital managers should pay more attention on safety of employees, provide adequate training opportunities on occupational safety and encourage employees’ reporting behavior.

Surgery on the battlefield: Mobile surgical units in the Second World War and the memoirs they produced

In the Second World War, there was a flowering of the battlefield surgery pioneered in the Spanish Civil War. There were small, mobile surgical units in all the theatres of the War, working close behind the fighting and deployed flexibly according to the nature of the conflict. With equipment transported by truck, jeep or mule, they operated in tents, bunkers and requisitioned buildings and carried out abdominal, thoracic, head and neck, and limb surgery. Their role was to save life and to ensure that wounded soldiers were stable for casualty evacuation back down the line to a base hospital. There is a handful of memoirs by British doctors who worked in these units and they make enthralling reading. Casualty evacuation by air replaced the use of mobile surgical units in later wars, throwing into doubt their future relevance in the management of battle wounds. But recent re-evaluations by military planners suggest that their mobility still gives them a place, so the wartime memoirs may have more value than simply as war stories.

998 Utilisation of A “COVID-Free” Hospital in The Independent Sector - Endourology Service Provision and Outcomes During The COVID-19 Pandemic

Introduction COVID-19 may negatively affect peri-operative outcomes, requiring strategies to allow operating whilst minimising risk. We present our endourology service provision throughout the “lockdown” period. Method Endourological operations 23rd March to 11th May 2020 were designated to the base hospital or independent “green” site by urgency and comorbidity status. Base hospital emergencies underwent surgery in main theatres, whilst elective patients had dedicated “COVID-free” theatres and wards. A portable Holmium laser enabled lasertripsy at the independent site. After 27th April, elective cases required a negative swab and 2-week self-isolation pre-operatively. Results 70 operations were performed: 42 ureteroscopies, 20 stent procedures, 8 PCNLs. Mean age was 57 and 58 at base and independent sites respectively, mean ASA 2.1 and 1.9. 37 operations (53%) occurred at the base hospital, including 14 emergencies (38%). 19 patients received post-operative COVID-19 swabs: 3 positives (8%), all emergencies. 2 patients (5%) died of COVID-19 pneumonia within 35 days; both had negative pre-operative swabs. Of 33 patients at the independent site, 3 (9%) received post-operative swabs, all negative. None had COVID-19 symptoms post-operatively. Conclusions “COVID-free” hospitals, wards and theatres enable elective operating whilst minimising peri-operative virus risk. Further utilisation of independent hospitals would more safely allow operating throughout the pandemic.

The Mobile Teleophthalmology Unit in Rural and Underserved Areas of South India

Objective: Our objective was to provide an eye care service to rural and underserved areas in Chennai, Kanchipuram, and Thiruvallur districts of Tamil Nadu, South India. Design: We conducted eye camps to provide ophthalmic services to the underserved and rural areas, where people cannot afford to go to a hospital due to lack of accessibility, lack of awareness, or financial constraints. Setting: The study was conducted in rural and underserved areas of Thiruvallur, Chennai, and Kanchipuram districts from January 2015 to December 2019. Participants: Patients (N = 1,05,827) underwent comprehensive eye examination in eye camps with the state-of-art ophthalmic equipment. Main outcome measures: To report on the number of patients examined, number of eye disorders screened, and different types of ocular pathology screened, all clinical findings were recorded and all ocular images were uploaded in the electronic medical records. All patients with ocular diseases underwent teleconsultation with an ophthalmologist at the base hospital with internet connectivity. Video conferencing and teleconsultation were feasible only in areas with good internet connectivity. Results: Over the 5-year study period, 1,05,827 patients underwent eye evaluation at 1,061 eye camps. Among these, 48,354 (45.7%) patients were males, 57,473 (54.3%) patients were females, 15,515 patients were emmetropes. The most common cause of avoidable blindness was uncorrected refractive error detected in 66,137 eyes, referable cataract was seen in 13,536 eyes, 2,491 eyes were identified to have retinal diseases, and there were 789 patients with only diabetic retinopathy, thus totaling to 3,280 comprising of all retinal disease. 2424 patients received teleconsultations. For further investigations and treatment, which were provided free of cost, patients were referred to the base hospital in Chennai. There were 6,309 patients who received free spectacles and an additional 31,192 patients received spectacles at a low cost; 13,536 patients had referable cataract and were referred to the base hospital for further evaluation and surgery. Conclusions: Teleophthalmology holds great potential to overcome barriers, improve quality, access, and affordability to eye care, and has proven to be an innovative means of taking comprehensive eye care facilities to the doorsteps of rural India.

Mass food challenges in a vacant COVID-19 stepdown facility: exceptional opportunity provides a model for the future

Background: Internationally, the COVID-19 pandemic severely curtailed access to hospital facilities for those awaiting elective/semi elective procedures. For allergic children in Ireland, already waiting up to 4yr for an elective oral food challenge (OFC), the restrictions signified indefinite delay. At the time of the initiative there were approx 900 children on the Chidren’s Health Ireland(CHI) waiting list. In July 2020, a project was facilitated by short term(6wk) access to an empty COVID stepdown facility built, in a hotel conference centre, commandeered by the Health Service Executive Ireland(HSE). The aim was to the achieve rapid rollout of an off-site OFC service, delivering high throughput of long waiting patients, while aligning with hospital existing policies and quality standards, international allergy guidelines and national social distancing standards. Methods: The working group engaged key stakeholders to rapidly develop an offsite OFC facility. Consultant Paediatric Allergists, Consultant Paediatricians, trainees and Allergy Clinical Nurse Specialists were seconded from other duties. The facility was already equipped with hospital beds, bedside monitors(BP, Pulse, Oxygen saturation) bedside oxygen. All medication and supplies had to be brought from the base hospital. Daily onsite consultant anaesthetic cover was resourced and a resuscitation room equipped. Standardised food challenge protocols were created. Access to onsite hotel chef facilitated food preparation. A risk register was established. Results: After 6wks planning, the remote centre became operational on 7/9/20, with the capacity of 27 OFC/day. 474 challenges were commenced, 465 (98%) were completed, 9(2%) were inconclusive. 135(29.03%) OFC were positive, 25(5%) causing anaphylaxis. No child required advanced airway intervention. 8 children were transferred to the base hospital. The CHI allergy waiting list was reduced by almost 60% in only 24 days. Conclusions: OFCs remain a vital tool in the care of allergic children, with their cost saving and quality of life benefits negatively affected by delay in their delivery. This project has shown it is possible to have huge impacts on a waiting list efficiently, effectively and safely with good planning and staff buy in – even in a pandemic. Adoption of new, flexible and efficient models of service delivery will be important for healthcare delivery in the post-COVID-19 era.