Perilous games: Gendered moral disengagement, winning culture, and COVID-19 safety in NCAA division I athletics

ince its emergence in December 2019, Coronavirus Disease 2019 (COVID-19) has profoundly affected healthcare systems worldwide.No aspect of medical practice has been untouched, and each area of practice has unique considerations to be taken into account. 1-9COVID-19 is associated with increased risks in patients with cardiovascular disease and provides unique challenges for their care, as well as for the care of all patients in healthcare facilities and the staff in these facilities. 10,11As prevention is of utmost importance to contain the spread of COVID-19, all non-urgent nuclear cardiology studies should be postponed and only urgent studies performed whenever clinically appropriate to expedite management of outpatients, as well as assessment and disposition of inpatients and emergency department patients, and expand hospital capacity, with precautions to minimize exposure of healthcare professionals and patients.In this Information Statement, the American Society of Nuclear Cardiology (ASNC) and Society of Nuclear Medicine and Molecular Imaging (SNMMI) address the practice of nuclear cardiology in the setting of the current COVID-19 pandemic reflecting the perspectives of diverse practices across the United States and worldwide.The document is organized around steps for protection of healthcare personnel and the patient, using the patient's journey through the nuclear cardiology laboratory, for inpatients, outpatients, and emergency department patients.We emphasize that many of these recommendations are practice based, and not systematically tested, and must be considered in the context of following state, local public health, and institutional infection control policies which may change day by day in this rapidly changing outbreak.This guidance is provided as an initial response to this pandemic and changes could be necessary if this becomes chronic or seasonal.

BackgroundCorrect personal protective equipment (PPE) use is key to prevent infection. Observations on a single unit at the Veterans Affairs (VA) Tennessee Valley Healthcare System (TVHS) prior to COVID-19 (October 2019-February 2020) showed low rates of correct PPE use among healthcare workers (HCWs) (Figure 1). In response to the COVID-19 epidemic, the VA implemented new PPE protocols. Based on our initial observations, we were concerned that incorrect use of PPE may increase the risk of COVID-19 exposure among HCWs. Resident physicians, who work at many sites, may be at high-risk for incorrect PPE use due to rapid turnover and limited site-specific PPE training. We aimed to assess and improve COVID-19 PPE use among internal medicine residents rotating at the VA TVHS.Figure 1: Pre-COVID-19 Observations of Adherence to Contact Precaution Protocols at the Veterans Affairs Tennessee Valley Healthcare SystemMethodsWe used the plan, do, study, act (PDSA) model. Prior to starting VA rotations, residents were emailed PPE education to review. We implemented a 1-hour video conference PPE protocol review at rotation start followed by in-person PPE use evaluations for residents performed by infectious diseases fellows on day 2 and day 5-6 post-review to provide just-in-time educational intervention. Errors at each PPE don/doff step were tracked. Correct PPE use data from both observations were compared using McNemar’s test. Baseline and post-implementation resident surveys assessed PPE use knowledge and comfort.ResultsPre-implementation survey response rate was 72% (21/29); 19/21(91%) reported knowing which PPE to use and 16/21(76%) reported knowing how to safely don/doff PPE. Twenty of 29 (69%) residents completed both observations. Errors decreased by 55% (p=0.0045) from 17/20 (85%) to 6/20 (30%) between initial and follow up observations. Errors in hand hygiene, inclusion of all donning/doffing steps, and PPE reuse decreased, but PPE don/doff order errors increased (Figure 2). Post-project survey response rate was 16/29 (55%). All 16 reported knowing which PPE to use and how to safely don/doff PPE, and 11/16 (69%) residents felt both online and in-person interventions were helpful.Figure 2: COVID-19 PPE Errors and Correction Types by ObservationConclusionCorrect COVID-19 PPE use is essential to protect HCWs and patients. Just-in-time education intervention for PPE training may yield higher correct use compared to pre-recorded or online training.DisclosuresAll Authors: No reported disclosures

ASE Statement on the Reintroduction of Echocardiographic Services during the COVID-19 Pandemic

One form in avoiding the occurrence of occupational diseases and workplace accidents is to understand the use of PPE and wear personal protective equipment. Use of the intended personal protective equipment in which the scavenger conditions in the Tamangapa TPA while working with masks, boots, gloves and protective helmets. With the aim of preventing contamination of the disease and protecting the part or whole body there is a potential danger. This study aims to determine the relationship of knowledge and social economy to the use of personal protective equipment in garbage scavengers in TPA Tamangapa Makassar City. This research was conducted in TPA Tamangapa Kota Makassar. The research was conducted in January until February 2018. The research design used was analytic observational method is a research design that aims to see the relationship of two variables or without any treatment or intervention with cross sectional approach with the number of samples was 99 respondents according to the inclusion and exclusion criteria. Data collection using questionnaire and data analysis using statistic with chi square test. The result of bivariate analysis showed that there was a correlation of knowledge with the use of self-protective device p = 0.024, and there was an economic status relationship with the use of Personal Protective Equipment (p = 0,029). Conclusion there is a relationship between knowledge, and economic status of garbage scavengers in TPA Tamangapa Makassar City. It is advisable to garbage collectors to further improve their understanding and discipline of using Personal Protective Equipment when working.
 
 One form in avoiding the occurrence of occupational diseases and workplace accidents is to understand the use of PPE and wear personal protective equipment. Use of the intended personal protective equipment in which the scavenger conditions in the Tamangapa TPA while working with masks, boots, gloves and protective helmets. With the aim of preventing contamination of the disease and protecting the part or whole body there is a potential danger. This study aims to determine the relationship of knowledge and social economy to the use of personal protective equipment in garbage scavengers in TPA Tamangapa Makassar City. This research was conducted in TPA Tamangapa Kota Makassar. The research was conducted in January until February 2018. The research design used was analytic observational method is a research design that aims to see the relationship of two variables or without any treatment or intervention with cross sectional approach with the number of samples was 99 respondents according to the inclusion and exclusion criteria. Data collection using questionnaire and data analysis using statistic with chi square test. The result of bivariate analysis showed that there was a correlation of knowledge with the use of self-protective device p = 0.024, and there was an economic status relationship with the use of Personal Protective Equipment (p = 0,029). Conclusion there is a relationship between knowledge, and economic status of garbage scavengers in TPA Tamangapa Makassar City. It is advisable to garbage collectors to further improve their understanding and discipline of using Personal Protective Equipment when working.

Use of personal protective equipment among health care personnel: Results of clinical observations and simulations.

Introduction: The increasing use of fluoroscopy-guided procedures raises concerns about occupational radiation exposure, underscoring the need for effective radiation protection (RP) practices among healthcare professionals. The primary objective was to evaluate compliance with the use of personal protective equipment (PPE) and dosimeters, and to identify factors influencing safety behaviors among exposed workers. Methods: A cross-sectional, exploratory quantitative study was conducted at a hospital centre using a self-administered questionnaire in fluoroscopy-guided operating and interventional settings. The questionnaire collected sociodemographic and professional data, information on RP training, compliance with personal and collective protective equipment, and dosimeter use, as well as perceptions of occupational risk. Results: The study included 52 workers. Compliance with PPE use varied across professions, with radiographers reporting significantly higher use of lead aprons/skirt-coats and thyroid shields than other professionals (p < 0.05). The RP training was significantly associated with compliance with PPE and dosimeter use (odds ratios: 4.2–8.9). Older age groups reported lower compliance with PPE use. Overall, risk perception of radiation-related diseases was low (46.2%), and no statistically significant association was found between risk perception and reported PPE use. Regarding protection practices, 67% reported appropriate use of the apron/skirt-coat, 65% of the thyroid shield, and 62% of the dosimeter. The main barriers to PPE use were discomfort, weight, and inadequate cleaning, while forgetfulness was the most reported reason for not using the dosimeter. Conclusions: Inconsistent use of protective equipment and dosimeters may lead to unnecessary exposure and underestimation of occupational radiation doses, whereas RP training is a key determinant of compliance and a strong safety culture.

BackgroundDoctors and healthcare workers (HCW) are at frontline in control of the pandemic caused by the novel coronavirus infection (COVID‐19). The virus is transmitted by contact, droplet, and airborne transmission; hence, hand hygiene, social distancing, environmental disinfection, and use of appropriate personal protective equipment (PPE) form important components to protect HCWs from cross‐infection. Appropriate use of PPE is of paramount importance not only to reduce the risk of transmission but also to maintain adequate stock for those who are dealing directly with COVID‐19 patients.AimsIn this article, we aim to provide the rationale for appropriate use of PPE in the dermatology setting in the current scenario. We have also discussed the scientific evidence for use of each component of protection and the practical problems faced in our COVID referral tertiary hospital.MethodsOur review was based on articles that have studied or analyzed the efficacy of various protective measures being utilized by health workers against spread of COVID‐19. This was done by carrying out a PUBMED search with terms “coronavirus, COVID‐19, personal protective equipment (PPE), transmission, mask, face shields, goggles, gloves.” We also scrutinized the various pragmatic issues being faced by doctors in our setup while using PPE.ResultsIn order to maximize the appropriate use of PPE, the rationale for use needs to be understood and problems encountered in daily practice need to be addressed.ConclusionAdherence to protective measures and use of PPE is of utmost importance for HCWs to prevent cross‐infection in this pandemic. The use of PPE can limit transmission to a great extent, but appropriate use and avoiding misuse is equally important in the dermatology setting in order to avoid depletion of stock. It is also essential to consider various practical issues with use of PPE and device measures to avoid them so that breach in protocols can be prevented and spread of infection minimized.

Determine the frequency of personal protective equipment (PPE) use in adolescent inline skaters, skateboarders, and snowboarders; explore factors influencing PPE use; identify factors that would influence use; and examine the association of high-risk behaviors and PPE use. Cross-sectional survey. Central/southeast Wisconsin. Participants 13-18 years-old. None. Independent variables = age, gender, sport. None. Dependent variables = PPE use, factors influencing use, and frequency of other high-risk behaviors. The mean age of 333 participiants was 14.9 years. Adolescents wore considerably less PPE than recommended. Inline skaters wore the most; snowboarders the least. The most common reasons adolescents wore PPE were parents, peers, and rule/requirement. Younger adolescents cited parents more often than older adolescents as a factor for PPE use. Discomfort and lack of perceived need were the most common reasons for nonuse. Sustaining/witnessing an accident was the most common reason that would convince adolescents to wear PPE. Almost half of adolescents reported nothing would convince them to wear PPE. Younger adolescents wore more PPE than older adolescents. An association was seen between PPE use in all sports and bicycle helmets. An inverse relationship was found for tobacco and helmet use among skaters, as well as alcohol and helmet use in skateboarders. Adolescents underuse PPE. PPE reinforcement by parents/peers, encouraging bike helmets, manufacturing more comfortable gear, educating adolescents, and instituting PPE requirements in public areas may increase compliance. This could lead to decreased injuries. Physicians should discuss PPE with their patients/families. There may be an association between PPE use in extreme sports and decreased high-risk health behaviors.

The COVID-19 pandemic created unprecedented challenges for nursing homes (NHs), particularly challenges related to personal protective equipment (PPE). This analysis explored PPE access and use by NH staff, residents, and visitors during the pandemic. As part of a larger study aimed at developing recommendations to improve NHs’ preparedness for infectious disease outbreaks, 116 interviews were conducted with leaders (n = 43), staff (n = 140), infection preventionists (n = 16) and residents/families (n = 63) from 24 Missouri NHs. Data were analyzed using directed content analysis to examine patterns of PPE access, usage, and challenges. To further verify challenges related to PPE access and use during the pandemic, a systematic review of 31 articles published between 2020 and 2023 was conducted. Interview findings revealed that all 24 NHs experienced PPE shortages due to supply chain disruptions and had to rely on corporate, state, and community support. Despite federal mandates, PPE use was inconsistent due to supply shortages, staff resistance, and communication difficulties with residents with dementia and hearing impairments. Training staff on PPE use and adapting care during shortages were key concerns. The systematic review findings echoed the interview findings, revealing a lack of streamlined PPE acquisition systems for NHs, significantly affecting supply and use. Few innovative solutions for maintaining resident care during PPE shortages were documented. Recommendations include ensuring NHs have reliable access to PPE, awareness of supply resources, and inclusive implementation processes. Special consideration for PPE use should be given to residents with memory and/or hearing impairment challenges.

Background: Hospital is one of the health services demanded according to standards by the community. But hospitals also have a high risk of infection, both due to treatment and medication. Of the many health workers, nurses are one who plays a role in the quality of service. In improving quality, nurses' behavior needs to be considered as a form of hospital prevention against infection. Measures that can prevent infection by washing hands and using PPE properly. Objective: Knowing the description of hand washing behavior and the use of nurses' personal protective equipment about the risk of spreading nasocomial infections. Method: Descriptive research using quantitative descriptive methods with total sampling techniques and using univariate test analysis. The subjects of this study were 67 respondents. Data collection was carried out by observation method regarding hand washing behavior and the use of nurses' personal protective equipment in hospitals.Results: The results of the study of 59 respondents studied found that 30 nurses behaved obediently (50.8%) while nurses who did not comply with the moment of hand washing amounted to 29 people (49.2%). With respondents who had a handwashing step behavior adhering to six steps amounted to 31 people (52.5%), while nurses who did not comply with six steps of hand washing amounted to 28 people (47.5%). While respondents who had compliant behavior in the use of PPE amounted to 34 people (57.6%), while nurses who did not comply in the use of PPE amounted to 25 people (42.4%). Conclusion: Inpatient nurses in hospitals have the majority of behaviors that comply with hand washing and the use of PPE (personal protective equipment) Keyword: Personal Protective Equipment; Hand Washing; Nasocomial Infection; Behavior Abstrak Latar Belakang : Pelayanan kesehatan yang diberikan oleh rumah sakit harus mematuhi standar yang diharapkan oleh Masyarakat.. Namun fasilitas kesehatan tersebut juga memiliki resiko tinggi terhadap infeksi, baik karena perawatan maupun pengobatan. Dari banyaknya petugas kesehatan, perawat ialah salah satu yang berperan dalam mutu pelayanan. Dalam meningkatkan mutu, perilaku perawat perlu diperhatikan sebagai bentuk dari pencegahan rumah sakit terhadap infeksi. Tindakan yang dapat mencegah terjadinya infeksi dengan cuci tangan serta penggunaan APD dengan benar. Tujuan : Mengetahui Gambaran Perilaku Cuci Tangan dan Penggunaan Alat pelindung diri Perawat Tentang Risiko Penyebaran Infeksi Nasokomial. Metode : Studi deskriptif dilakukan dengan metode deskriptif kuantitatif, teknik total sampling, serta analisis uji univariat pada 67 responden. Pengambilan data dilakukan dengan metode observasi mengenai perilaku cuci tangan dan penggunaan Alat pelindung diri perawat di Rumah sakit.Hasil : Hasil penelitian dari 59 responden yang diteliti didapatkan 30 orang perawat berperilaku patuh (50.8%) sedangkan perawat yang tidak patuh terhadap momen cuci tangan berjumlah 29 orang (49.2%). Dengan responden yang memiliki perilaku langkah cuci tangan patuh terhadap enam langkah berjumlah 31 orang (52.5%), sedangkan perawat yang tidak patuh terhadap enam langkah cuci tangan berjumlah 28 orang (47.5%). Sedangkan responden yang memiliki perilaku patuh dalam penggunaan APD berjumlah 34 orang (57.6%), sedangkan perawat yang tidak patuh dalam penggunaan APD berjumlah 25 orang (42.4%). Kesimpulan : Perawat rawat inap yang ada di Rumah Sakit memiliki perilaku mayoritas patuh terhadap cuci tangan maupun penggunaan APD (alat pelindung diri) Kata kunci: Alat Pelindung Diri; Cuci Tangan;Infeksi Nasokomial;Perilaku;

Purpose The purpose of this research is to examine the influence of the Dark Triad personality traits (Machiavellianism, narcissism and psychopathy) on consumers’ purchase intentions for counterfeit luxury products via the mediating effect of moral disengagement, drawing on moral disengagement theory. Furthermore, descriptive norms are tested as a moderators of the mediated relationships between the Dark Triad personality traits and purchase intentions via moral disengagement based on trait activation theory. Design/methodology/approach To test the hypotheses, a survey design is employed to gather primary data from 205 consumers. The final data are analysed using partial least squares structural equation modelling. Findings This study finds that moral disengagement mediates the relationships between (1) Machiavellianism, (2) psychopathy and purchase intentions. Descriptive norms are found to moderate the indirect effect of moral disengagement between psychopathy and purchase intentions. Originality/value Dark Triad personality traits are linked to various unethical behaviours. However, no studies have explored how Dark Triad personality traits influence consumers’ purchase intentions for counterfeit luxury products. This study sheds light on how consumers with high Dark Triad personality traits are more likely to be morally disengaged, thereby leading to purchase intentions for counterfeit luxury products, drawing on moral disengagement theory. Furthermore, this study demonstrates descriptive norms as the boundary condition for the mediating relationship between Dark Triad personality traits and purchase intentions via moral disengagement, drawing on trait activation theory. The findings can be used to formulate better strategies to counteract the phenomenon of counterfeit luxury consumption.

Trends in personal protective equipment use by clinicians performing airway procedures for patients with coronavirus disease 2019 in the USA from the intubateCOVID registry

BackgroundPPE (gowns, gloves and masks) is used in standard precautions (SP) as well as for contact, droplet or airborne isolation. Improper PPE use can lead to self-contamination and transmission of infectious agents, and at our institution the quality of PPE use has not been well assessed. For quality improvement purposes, we conducted an evaluation of healthcare worker (HCW) PPE use and knowledge of SP.MethodsTwo phases, direct observations and a survey, were completed between December 2018 and February 2019 in inpatient areas. Direct observations of PPE use were done by Infection Prevention nurses (IPs) in contact and droplet isolation rooms during daytime hours using an internally developed observation tool (Figure 1). Observations focused on 3 stages of PPE use: donning, in room clean/dirty activities and doffing. A survey consisting of 15 questions was developed to assess staff knowledge of SP in specific clinical scenarios, perceptions of current practices and barriers to use. The survey was distributed by IPs to HCWs during their regular rounds. Data were recorded and tabulated using RedCap electronic survey tool.Results106 observations and 107 surveys were completed. Observations showed appropriate PPE worn in 84% (n = 83) and hand hygiene (HH) post doffing in 95% (n = 79). Common gaps included no HH pre-donning [33% n = 43], PPE not changed between dirty and clean tasks (29% n = 2), incorrect mask removal (20% n = 16) and doffing gloves post-gowns [19% n = 69]. In the survey, answers to SP questions suggest PPE is overused in patients with diarrhea or respiratory illness but underused in draining wound management (Figure 2). HCW felt more compliant than their colleagues in both HH and PPE (Figure 3). The largest misperception was that gowns should be doffed pre-gloves (40% n = 40). Reasons for not using PPE included time (26%, n = 27), and perception that PPE is unnecessary (16%, n = 10). 75% (n = 80) of HCW felt adequately educated about PPE.ConclusionAt our institution, significant gaps still exist in HCW knowledge and use of PPE. Future QI work should focus on increasing HCW knowledge of standard precautions, HH pre-donning, changing PPE when appropriate in room as well as proper doffing order. The perception that HCW felt adequately educated despite significant gaps may be a barrier.DisclosuresAll authors: No reported disclosures.

Safe Reintroduction of Cardiovascular Services During the COVID-19 Pandemic: From the North American Society Leadership

Personal protective equipment (PPE) use is associated with reduced risk of SARS-CoV-2 infection among healthcare personnel (HCP). There are limited data on the impact of the novel coronavirus disease 2019 (COVID-19) pandemic on the PPE use of HCP. We describe the changes in PPE use from just before the widespread of community outbreaks ('pre-pandemic') to intra-pandemic time points, and examine factors associated with not changing in PPE use behavior among HCP in four Thai hospitals. We performed a retrospective cohort evaluation using two-time points: (i) February-March 2020 (pre-pandemic period); and (ii) January-March 2021 (intra-pandemic period). Self-reported frequency of appropriate PPE use was measured by a Likert scale. We used multivariable logistic regression to identify factors associated with no increase in self-reported PPE use. Of 343 HCP, the proportion of participants reporting 'always' using PPE rose from 66% during the pre-pandemic period to 80% during the pandemic. Factors associated with HCP who did not increase in PPE use included having high baseline reported PPE, being a non-registered HCP (e.g. nurse assistants, dental assistants, porters), being male, and having a low perceived risk of becoming infected with any respiratory virus while working in the hospital. PPE education, training, and risk communication content should target all cadres of HCP, regardless of registered/non-registered status, with a focus on behavior change for improved prevention and control of SARS-CoV-2 and other respiratory viruses in healthcare settings.