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How hospitals, Intensive Care Units and nursing care of critically ill patients have changed during the Covid-19 outbreak? Results from an exploratory research in some European countries

During the Covid-19 outbreak, the health care institutions and the Intensive Care Units (ICUs) have been reorganized with significant consequences at both organizational and clinical levels. To investigate (1) the organizational changes of hospitals and ICUs in dealing with the Covid-19 outbreak; (2) the characteristics of the nursing care; (3) the most important challenges perceived by nurses in caring for Covid-19 patients. Cross-sectional online survey, available from May 11th and July 10th, 2020. Participants were nurses caring for Covid-19 patients in European ICUs. A total of 62 nurses responded to the survey; average age 37.5 years, 31 (60.8%) were female, mostly from Italy, France and United Kingdom. All hospitals underwent many changes, such as the opening of new dedicated wards and the restriction of family visits. The number of ICU beds doubled during the pandemic (p<0.01), as well as the number of nurses per shift from 10.2 (SD 7.3) before to 17.9 (SD 13.6) during the pandemic (p<0.01). However, changes in the nurse-to-patient ratio were not significant: from 1:1.5 to 1:2 (p=0.05). Among nursing care activities, clinical risk management (n=14, 22.6%), psychological support for patients (n=22, 35.5%) and family's involvement (n=31, 50%) resulted as more challenging; 64.5% of nurses suffered from protective equipment shortages, and 66.1% experienced psychological burden. These findings can help to reflect on how to better prepare both nurses and health care institutions for other events that may threaten clinical practice and require major and innovative efforts.

Care path for non-deferred elective hospitalizations in cardiology in the Covid-19 period

The novel coronavirus-19 (Covid-19) has rapidly resulted in a global pandemic. Our hospital had to postpone all elective admissions to increase capacity for COVID-19 patients. Therefore, a rearrangement of the elective admissions was necessary to guarantee a restart of ordinary procedures. To describe the organizational model adopted for elective procedures during the Covid-19 pandemic, to guarantee maximum safety for patients and healthcare workers. Patients on waiting list for cardiac procedures were rearranged based on risks prioritization. Procedure of coronary angiography and cardiac devices (PM and ICD) implants or replacement took priority upon other cardiac procedures. Each patient underwent a telephone nurse triage to assess for any covid-19 symptoms. The hospital admissions were organized in accordance with health and safety measures declared by the National Institute of Health, with different paths according to the swab results. A total of 66 patients were contacted and 40 accepted the hospital admission (26 refused it, for fear of infection or covid-19 related family problems). No patient resulted positive to the nasal swab. In view of the impact on the health care system of this new pandemic, the choice of an appropriate pathway which can preserve patients' safety is essential, while guaranteeing the treatment of problems, such as cardiovascular diseases, with a high mortality rate.

The reorganization of the strategies of a surgical department and the nosocomial diffusion of Covid-19

During the SARS-CoV2 pandemic, preventive measures and patients' selection were adopted to allow the treatment of non-deferrable oncological and trauma cases and to contain hospital diffusion of the virus. The reorganization of the ward management associated to the training of healthcare providers are the first available interventions. To describe the interventions implemented to limit the spread of virus during the peak of pandemic in a high daily turn-over 25 beds surgical ward (9 patient admitted per day/mean duration of hospital stay 2.3 days). Description of the interventions implemented and of the admissions from March 9 to May 18 2020, and the swab results. 392 patients were treated in the period considered (342 were scheduled cases - 50 urgent cases; 364 were adults and 28 children). All scheduled patients underwent a screening survey, 5% of those contacted showed a risk factor at the interview and were rescheduled; 190 patients underwent a preoperative screening swab, all with negative results. None of healthcare providers was positive to swabs. The prompt application of preventive measures and patients screening (preoperative interview and screening swab) possibly allowed to control the spread of SARS-CoV2 in our hospital. Sharing our experience would allow to find consensus to guarantee the safety for patients and healthcare workers.

I promotori di salute come attori-protagonisti delle cure primarie nel controllo delle malattie comunicabili e non comunicabili e nell' empowerment delle comunità. Esperienza e risultati di lungo periodo in aree marginali in Ecuador dal 1980 al 2018.

Against the increasing recognition of the critical importance of a direct participation of community members to assure effective health care in peripheral areas of Middle and Low Income Countries (MLIC), representative field experiences of their essential role are only occasionally available. We report a narrative, factual documentation of a spectrum of projects covering the basic and specific health needs of the disperse communities in Ecuador, a model MLIC, and discuss the broader implications of the role and performance of HPs over a long period, 1980-2018, in the project activation, implementation and monitoring. The role of 60 HPs, with the coordination of a small core group of professionals of the Centro de Epidemiologia Comunitaria y Medicina Tropical (CECOMET) is documented through their main achievements which include: infectious diseases and in particular Neglected Tropical Diseases (eradication of onchocerciasis and yaws; virtual elimination of malaria and of strongyloidiasis; identification and control of a new focus of Chagas Disease; control of tuberculosis), mother and child health, reproductive health, hypertension (as model of the emergence of non-transmissible, chronic diseases). The most effective and sustainable strategies and methods are discussed also in terms of their more general transferability, already partially tested in programs in Bolivia, Burkina Faso, undeserved areas of Argentina. The systematic availability of non-professional, trained HPs should be recommended as a sustainable and reliable component of health care strategies and interventions targeted to marginalized settings, to assure a concrete accessibility to the fundamental human right to life.

The ubiquitous use of the mobile phone in operating rooms: what we know about the risks and what can be done

Mobile phones are often used in the operating theatres, with possible health risks for patients. Phone surfaces can be contaminated with pathogens causing infections (infectious risk). In addition, mobile phones can interfere with attention by becoming a possible cause of error (risk of error). Finally, electromagnetic waves can interfere with equipment (risk of interference). This paper consists of two parts, the first dedicated to the review of the literature regarding the three risks associated with the use of mobile phones in the operating room. The second presents the results of a field observation carried out during surgery in 4 hospital facilities with the aim of describing the use of the mobile phone by health professionals. The literature review highlights that a. several resistant Methicillin bacteria and negative Grams survive on phone surfaces, but effective disinfection protocols are available; b. the presence of the mobile phone is a source of distraction during the performance of a task. However, mobile phone communication can improve care and reduce communication errors. Field observations have confirmed both the tendency to bring mobile phones into the operating room and the habit of using them (especially by anesthetists and nurses). Ninety per cent of interviewed personnel admitted to take with them mobile phones. The presence of the mobile phone exposes to risks that can be controlled through appropriate procedures. It is essential to regulate the entry of the mobile phone into the operating room and provide for treatment protocols, as well as to plan training activities on their correct use.