Amount Of Personal Protective Equipment Research Articles

Outpatient Service Provision In Tertiary Hospital During Covid-19 Pandemic

Background: The COVID-19 pandemic was a challenge for healthcare professionals globally. The outpatient department is an important part of the hospital. Service providers were facing tremendous difficulties and challenges due to sudden thrust of the pandemic. Despite these challenges service providers had to give service during COVID-19 pandemic. The purpose of this study to assess the state of outpatient service in tertiary hospital during COVID-19 pandemic.
 Methods: This cross-sectional study was conducted among conveniently selected 203 service providers including 156 doctors and 47 nurses. Data were collected through face-to-face interview using semi-structured questionnaire and observation checklist. The study was conducted at medicine, surgery, paediatric and family planning outpatient department of Shaheed Suhrawardy Medical College Hospital, Dhaka Medical College Hospital, and Bangabandhu Sheikh Mujib Medical University during the period from January to December 2021.
 Results: Among 203 service providers, 76.8% were doctors and 23.2% were nurses. All health services were available during COVID-19 pandemic in outpatient departments (OPDs) of the selected hospitals. At outpatient department there was separate entry-exit door, thermal scan was available at entry point, Patients and visitors are restricted. Number of patients were decrease in outpatient department. Among the three hospitals facility of flu-corner and triage in the OPD of ShSMCH. For the DMCH and BSMMU, flu-corner and triage center were situated at other premises of the hospitals. Outdoor surgery, vaccination service and shishu bikash kendro were open during COVID-19 pandemic. About 80.8% respondents mentioned about availability of adequate amount of personal protective equipment, 42.9% respondents mentioned about proper ventilation, 57.1% respondents said had not. About 32.5% respondent said about availability of N-95 mask and 57.6% said had not. Among the respondents 67.0% said they maintained physical distance during consult with the patients. 57.6% respondents said about lack of manpower. 61.6% respondents said about felt anxiety and high-risk during service.
 Conclusion: For more improvement of outpatient service during COVID-19 pandemic, the authority should pay special attention, to increase manpower, arrange frequent training for service providers.
 JOPSOM 2021; 41(2):20-27

Anxiety, Depression, and Associated Factors Among the Field Midwives During COVID-19 Pandemic in Sri Lanka-A Descriptive Cross-Sectional Study.

Field midwives (FMs) in Sri Lanka, who care for women and children, were challenged during the COVID-19 pandemic. During COVID-19, the majority of research found that healthcare professionals experienced anxiety and depression. This study examined anxiety, depression, and related factors among FMs during the COVID-19 pandemic in Sri Lanka. A descriptive cross-sectional approach was used with 145 FMs from randomly selected Medical Officer of Health (MOH) areas in the Matara district. The data were collected by an interviewer-administered questionnaire containing the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 tools. Descriptive statistics, chi-square test, and logistic regression examined and presented the data. Among the participants, 54.5%, 31.0%, 8.3, and 6.2% experienced minimal, mild, moderate, and severe anxiety. Whereas 46.2%, 32.4%, 17.2%, 1.4%, and 2.8% of the participants had no or minimal, mild, moderate, moderately severe, and severe depression. Being in a family of COVID-19-infected family members, relatives, or friends (OR = 0.33, p = 0.018) and being in a nuclear family (OR = 0.47, p = 0.033) were found to be risk factors against depression while having a history of chronic diseases (OR = 5.87, p = 0.002) and having a sufficient amount of personal protective equipment (OR = 2.52, p = 0.041) were found to be protective. Similarly, having a history of chronic diseases (OR = 4.89, p = 0.002) was found to be protective against anxiety. The majority of FMs had minimal anxiety and depression during the COVID-19 pandemic. The results will be valuable in formulating policies to support the psychological health of FMs in Sri Lanka.

The Potential Environmental Implications of Infection Control Prevention During the COVID-19 Pandemic: Waste Generation from a Level 2 Trauma Center in Maine, USA.

Introduction:Hospital waste in the United States (US) generates 7,000 tonnes of waste daily. During the pandemic, hospitals had to increase the amount of personal protective equipment (PPE) worn by healthcare providers. The aim of this study was to compare pre and present COVID-19 waste generation amounts in comparison with hospital census and PPE purchased.Method:This research examined the solid waste generated at a level II trauma center from January 2018-December 2021. Data examined included: the amount of solid waste generated, monthly patient census, COVID-19 census, policy changes, and the amount of purchased PPE pre and during the pandemic.Results:PPE product numbers purchased varied with a noticeable increase in mask and gown ordering. The number of admitted COVID-19 patients peaked at 46. Hospital waste tonnage fluctuated but did not show a statistically significant change.Conclusion:The COVID-19 pandemic has caused hospitals to increase their PPE posture to help safeguard its employees and patients. In our hospital setting, the use of PPE increased and overall hospital census decreased. This has profound implications for not only the hospital’s revenue, but also with less census volume, there was curiously the same amount of hospital waste generated. This work needs to be continued in other healthcare PPE heavy settings, to better understand the downstream consequences of infectious diseases on responsible hospital waste management and environmental sustainability.

IMPLEMENTATION OF OCCUPATIONAL SAFETY TRAINING FOR DOCTORS AT OHS TRAINING CENTER MEDAN

This study aims to find out the implementation of Occupational Health and Safety (OHS) training for company doctors at OHS Training Center Medan.; the obstacles in the implementation of OHS training of corporate doctors in OHS Training Center Medan.; the efforts implemented on the company's OHS doctor training. This research is a qualitative descriptive research and data collection techniques including, interviews, observations, and documentation. The subjects in the study were 10 people and the data validity technique used was source triangulation. The results showed that the implementation of OHS for company doctors at The OHS Training Center Medan has been carried out; the obstacles to the implementation of OHS from the human factor such as there are still participants who do not comply with the rules. Obstacles from environmental factors are; the amount of Personal Protective Equipment has not met the needs of trainees, there has been no OHS warning in the practice room, lack of instructor supervision during practice in the field; the efforts to overcome obstacles in the implementation of OHS, such as providing socialization, the availability of personal protective equipment and work safety equipment for participants, reprimanding participants who violate the rules and imposing strict sanctions for violators of the code of conduct who commit repeated violations.

Improving concrete fatigue resistance with COVID-19 rubber gloves: An innovative sustainable approach

Since the COVID-19 outbreak in late 2019, a surprisingly large amount of personal protective equipment, such as medical rubber gloves, have been frequently used, and this medical waste can cause very major environmental problems. A multidisciplinary collaborative approach is needed to combat the pandemic and lessen the environmental risks associated with the disposal of medical waste. This study developed an innovative approach by incorporating shredded rubber glove fibers (RGF) into aggregates to enhance the fatigue resistance of concrete. In this study, different volume contents (0.5%, 1.0%, 1.5%, 2.0%) of RGF were added to the aggregate for the first time. The effects of different RGF contents on the fatigue characteristics of concrete were examined through repeated loading tests and SEM analysis. The results show that the width and number of cracks produced by rubber glove fiber concrete (RGFC) after repeated loading are significantly reduced compared with normal concrete (NC). Following repeated loading, RGFC exhibited higher total, plastic, and elastic strain values than NC, demonstrating greater deformability and elasticity. However, the maximum total strain growth rate and the total strain growth range of the RGFC group were only 2.26 × 10−3/time and 14.0%, which were significantly smaller than the 3.8 × 10−3/time and 31.7% of the NC group, showing better stability, corresponding to enhance the fatigue resistance of concrete. The interfacial transition zone (ITZ) was abnormally smooth with a thin thickness and no visible gaps were discovered, based on the results of SEM test performed on the RGFC. The findings obtained in this study may provide new ideas for the resource utilization of medical waste.

A Bayesian susceptible-infectious-hospitalized-ventilated-recovered model to predict demand for COVID-19 inpatient care in a large healthcare system.

The COVID-19 pandemic has strained healthcare systems in many parts of the United States. During the early months of the pandemic, there was substantial uncertainty about whether the large number of COVID-19 patients requiring hospitalization would exceed healthcare system capacity. This uncertainty created an urgent need to accurately predict the number of COVID-19 patients that would require inpatient and ventilator care at the local level. As the pandemic progressed, many healthcare systems relied on such predictions to prepare for COVID-19 surges and to make decisions regarding staffing, the discontinuation of elective procedures, and the amount of personal protective equipment (PPE) to purchase. In this work, we develop a Bayesian Susceptible-Infectious-Hospitalized-Ventilated-Recovered (SIHVR) model to predict the burden of COVID-19 at the healthcare system level. The Bayesian SIHVR model provides daily estimates of the number of new COVID-19 patients admitted to inpatient care, the total number of non-ventilated COVID-19 inpatients, and the total number of ventilated COVID-19 patients at the healthcare system level. The model also incorporates county-level data on the number of reported COVID-19 cases, and county-level social distancing metrics, making it locally customizable. The uncertainty in model predictions is quantified with 95% credible intervals. The Bayesian SIHVR model is validated with an extensive simulation study, and then applied to data from two regional healthcare systems in South Carolina. This model can be adapted for other healthcare systems to estimate local resource needs.

ODP210 Impact of Continuous Glucose Monitoring (CGM) in the Intensive Care Units (ICUs): Accuracy, Reliability, Feasibility and Nurse Acceptance

Abstract Background The COVID-19 pandemic led to crisis-level shortage of hospital beds and staff, predominantly in the ICUs. Minimization of patient contact moved the FDA to issue a statement that allowed CGMs in hospitals, which were quickly adopted by ICUs. We conducted a study to better understand the use of CGM in ICUs and test for accuracy, reliability feasibility, and acceptance by care providers. Methods Patients were eligible for CGM if they had diabetes mellitus and concomitant COVID-19 infection that required ICU level of care. CGM signals were received by smart phones that were placed in a transparent biohazard bag outside patients’ rooms. Nurses were educated on the interpretation of glucose trends, alerts, and calibration. CGM alerts were set for glucose readings below 100mg/dL and above or equal to 250mg/dL. Nursing staff could obtain point-of-care (POC) glucose as scheduled and for CGM alarms. Mean Absolute Relative Difference (MARD) values were calculated for accuracy. Nurses were invited to respond to a questionnaire with 5-point Likert scales to assess their perception of CGM use, and the potential decrease in the amount of personal protective equipment (PPE) needed in the care of patients on CGM. A question on the estimated time it takes to donn and doff PPE was also included. Results 26 patients were included in the study; average age 60.8 + 13.5 years, 7 were female and 12 belonged to underrepresented minorities (Hispanic, non-Hispanic Black, or Asian); mean HbA1c was 9.2 + 2.6%. 7 patients were on intravenous insulin infusion, 6 were intubated and 5 received vasopressors. Average duration on CGM was 6 + 3.75 days.168 paired serum glucose-CGM measurements and 259 paired POC-CGM measurements were used. MARD between serum glucose and CGM measurements was 11.2%; MARD between POC glucose and CGM measurement was 11.6%. Questionnaires from 33 nursing staff were analyzed; the most frequent answer (mode) for time to donn and doff PPE was 10 minutes. The vast majority of answers were "agree" (21.2%) or "strongly agree" (78.8%) to the statements that CGM was easy to use and interpret and during the pandemic staff felt protected with use of CGM. Likewise, the answers were "agree" (18.8%) or "strongly agree" (81.8%) that CGMs could replace POC glucose in COVID-19 patients and that there was a lower need for PPE. Conclusion There is not an established acceptable MARD for patients with COVID-19 in an ICU setting. Wollersheim et al. suggested that CGM with a MARD of <14% is acceptable for ICU patients. The MARD we found in our study was well within this range. We concluded that use of CGM in the ICU setting has acceptable accuracy and is reliable, feasible and well accepted by the nursing staff. Presentation: No date and time listed

Experimental study on the monotonic mechanical behavior of completely decomposed granite soil reinforced by disposable face-mask chips

In response to the global outbreak of the coronavirus pandemic (COVID-19), a staggering amount of personal protective equipment, such as disposable face masks, has been used, leading to the urgent environmental issue. This study evaluates the feasibility of mask chips for the soil reinforcement, through triaxial tests on samples mixed with complete decomposed granite (CDG) and mask chips (0%, 0.3%, 0.5%, 1%, 5% by volume). The experimental results show that adding a moderate volumetric amount of mask chips (0.3%–1%) improves the soil strength, especially under high confining pressure. The optimum volumetric content of mask chips obtained by this study is 0.5%, raising the peak shear strength up to 22.3% under the confining stress of 120 kPa. When the volumetric content of mask chips exceeds the optimum value, the peak shear strength decreases accordingly. A limited amount of mask chips also increases the elastic modulus and makes the volumetric response more dilative. By contrast, excessive mask chips create additional voids and shift the strong soil-mask contacts to weak mask-mask contacts. The laser scanning microscope (LSM) and scanning electron microscope (SEM) images on the typical samples demonstrate the microstructure of mask fibers interlocking with soil particles, highly supporting the macro-scale mechanical behavior.

Performance of concrete containing recycled masks used for personal protection during coronavirus pandemic

After the coronavirus outbreak, a tremendous amount of personal protective equipment has been produced and used by the health service and every human. Proper medical waste management becomes an important problem, which must be solved with a minimal environmental impact. The presented manuscript introduces the recycling process, during which personal protection masks are transformed into polypropylene fibers being an addition to a concrete mixture. The designed recycling procedure provides the entire disinfection of probably contaminated medical wastes, is straightforward, and potentially enables one to modify the properties of the final product. The applied dosage referred to 1 mask per 1 L of concrete. The final product of face masks processing was studied using Fourier-transform infrared spectroscopy, thermogravimetric analysis, surface free energy, contact angle measurements, and melt flow index. The analysis indicated that polypropylene is its main component. Two concrete mixtures were composed, i.e., with the addition of processed masks and the reference one. The following properties were determined to compare the modified concrete with the reference one: compressive and tensile strength, frost resistance, water transport properties, resistance to high temperature. The obtained results indicated that the addition of processed masks slightly increased the compressive strength (by about 5%) and decreased the tensile strength (by about 3%). Simultaneously, it was reported that the addition did not affect material properties related to concrete durability as frost resistance, water permeability, and fire performance. The results evinced, that the addition of processed facemasks into concrete did not deteriorate its properties. Therefore, it is a possible way of the protective masks processing and reusing with the high recycling capacity. Further study should be conducted to optimize the dosing and to modify the properties of PP strings to improve hardened concrete properties.

Abstract 8880: Utility of Telemedicine 3d Transesophageal Echocardiography in Interventional Procedures in Covid-19 Pandemic and Its Impact on Physician Learning

Background: Three-dimensional transesophageal echocardiography (3DTEE) is a diagnostic tool in cardiac procedures, but COVID-19 has made utility challenging. Training junior (JR) attendings and fellows in 3DTEE guidance cases in procedural rooms make it tough to maintain adequate social distance. Collaboration Live (CL) is an application on the ultrasound machine that allows for live communication and access to real time images with a remote user. The study aims were to assess the usefulness of CL during 3DTEE guided procedures and its impact on physician learning. Methods: 3DTEE was obtained in 8 cohorts ranging 4 - 52 years of age on the EPIQ ultrasound machine. CL was used in transcatheter atrial/ventricular septal defect closures, transvenous pacemaker lead placement, and Fontan fenestration closure. 3DTEE was directed by a senior (SR) 3D attending over CL at a remote workstation while a JR attending, cardiac fellow, and echocardiographer performed 3DTEE in the procedural room. A CL post survey was given . Wait time from received page to the start of TEE, TEE duration, fluoroscopy time, absorbed X-ray dose, and saved amount of personal protective equipment (PPE) was noted. Results: A JR attending was in 8/8 cases. CL decreased reliance on SR attending and improved independence in 86% of cases, and no change in 14%. A fellow was in 6/8 cases. CL decreased reliance on SR 3D attending and increased independence in 67% of cases, and no change in 33%. A SR attending was remotely present in all cases. CL allowed flexibility for SR attending in 89% of cases and no flexibility in 11%. Preferred learning skill, comfort performing/giving results over CL, learning/teaching impact, remote user wait time, reduced radiation exposure, and saved amount of PPE are shown in Table 1. Conclusions: CL is valuable in 3DTEE guidance procedures. It increases cost savings by reducing PPE and promotes learner independence. CL allows flexibility and reduces radiation exposure for remote users.

The Impact of COVID-19 Vaccination on Anxiety Levels of Turkish Dental Professionals and Their Attitude in Clinical Care: A Cross-Sectional Study.

Background: The current study aimed to assess the anxiety and fear levels and the attitude towards clinical care, such as the use of personal protective equipment and number of patients examined, before and after COVID-19 vaccination among Turkish dental professionals. Methods: A questionnaire including socio-demographical characteristics and clinical data regarding the number of patients, the use of personal protective equipment, vaccine confidence interval, positive or negative COVID-19 diagnosis, and fear and anxiety levels were examined. Results: A total of 475 dentists (196 men and 279 women) participated. Overall, the vaccination had a positive effect on the decrease of fear and anxiety levels of dental professionals. It was observed that the number of interventional procedures significantly increased after vaccination. Besides that, the amount of personal protective equipment used in patients, especially after the vaccination, has decreased. Conclusion: Despite the positive effects of vaccination on the anxiety levels of dental professionals, protective measurements should further be the main concern, regardless of the vaccination status of both the dental professional and the patient.

The impact of the COVID-19 pandemic on Polish orthopedics, in particular on the level of stress among orthopedic surgeons and the education process

The Coronovirus Disease 2019 –(COVID-19) pandemic had a significant impact on the health care system and medical staff around the world. The orthopedic units were also subject to new restrictions and regulations. Therefore, the aim of our research was to assess how the COVID-19 pandemic affected orthopedic wards in the last year in Poland. We created an online survey, which was sent to 273 members of the Polish Society of Orthopedics and Traumatology. The survey contained 51 questions and was divided into main sections: Preparedness, Training, Stress, Reduction, Awareness. A total of 80 responses to the survey were obtained. In Preparedness section the vast majority of respondents (90%) replied, that they used personal protective equipment during the pandemic, however only 50% of the respondents indicated that their facility received a sufficient amount of personal protective equipment. Most of the respondents indicated that the pandemic negatively affected the quality of training of future orthopedists (69.4%) and that pandemic has had a negative impact on their operating skills (66,7%). In Reduction section most of the doctors indicated that the number of patients hospitalized in their departments decreased by 20–60% (61,2% respondents), while the number of operations performed decreased by 60–100% (60% respondents). The negative impact of pandemic on education was noticeable especially in the group of young orthopedic surgeons: 0–5 years of work experience (p = 0,029). Among the respondents, the level of stress increased over the last year from 4.8 to 6.9 (p <0.001). The greatest increase in the level of stress was observed among orthopedists working in country hospitals (p = 0,03). In section Awareness 36,3% of respondents feel well or very well informed about the latest Covid-19 regulations. In addition, most doctors (82.6%) believe that the Polish health care system was not well prepared to fight the pandemic and that the regulations applied so far are not sufficient to effectively fight the pandemic (66.2%). The COVID-19 pandemic has impact on orthopedics departments in Poland and negatively affected the quality of training of orthopedic surgeons and the level of stress.

Effect of COVID-19 pandemic on workflows and infection prevention strategies of endoscopy units in Hungary: a cross-sectional survey

BackgroundHealth care professionals in endoscopic labs have an elevated risk for COVID-19 infection, therefore, we aimed to determine the effect of current pandemic on the workflow and infection prevention and control strategies of endoscopy units in real-life setting.MethodsAll members of Hungarian Society of Gastroenterology were invited between 7 and 17 April 2020 to participate in this cross-section survey study and to complete an online, anonymous questionnaire.ResultsTotal of 120 endoscopists from 83 institutes were enrolled of which 35.83% worked in regions with high cumulative incidence of COVID-19. Only 33.33% of them had undergone training about infection prevention in their workplace. 95.83% of endoscopists regularly used risk stratification of patients for infection prior endoscopy. While indications of examinations in low risk patients varied widely, in high-risk or positive patients endoscopy was limited to gastrointestinal bleeding (95.00%), removal of foreign body from esophagus (87.50%), management of obstructive jaundice (72.50%) and biliary pancreatitis (67.50%). Appropriate amount of personal protective equipment was available in 60.85% of endoscopy units. In high-risk or positive patients, surgical mask, filtering facepiece mask, protective eyewear and two pairs of gloves were applied in 30.83%, 76.67%, 90.00% and 87.50% of cases, respectively. Personal protective equipment fully complied with European guideline only in 67.50% of cases.ConclusionsSurvey found large variability in indications of endoscopy and relative weak compliance to national and international practical recommendations in terms of protective equipment. This could be improved by adequate training about infection prevention.

Psychological Reactions of Turkish Healthcare Workers During Covid-19 Outbreak: The Impact of Stigmatization.

The Coronavirus Disease 2019 (COVID-19) outbreak has resulted in huge psychological distress, especially for people working under risky conditions, such as healthcare workers. We aimed to investigate the psychological challenges of Turkish healthcare workers during the outbreak and discuss the factors that increase their burden, including stigmatization. A cross-sectional online survey composed of sociodemographic data, questions about perceived stigma, and concerns about working conditions was completed. Depression Anxiety and Stress Scale-21 (DASS-21) was also used. 634 participants completed the survey and the prevalence of moderate to severe depression, anxiety, and stress-related symptoms were 36%, 35%, and 22%, respectively. Being female, working with close contact with patients with COVID-19 and having a psychiatric disorder history were risk factors for psychological distress. The healthcare workers with significantly higher depression, anxiety, and stress scores described having less amount of personal protective equipment, lower support from their supervisors, and more unsafe working conditions. Additionally, 7% of the participants stated that they perceived stigmatization by their families and close friends, 14% perceived stigmatization by their neighbours, relatives, and less intimate friends; and 7% perceived stigmatization by unfamiliar people. Healthcare workers who perceived other people as more dismissive had significantly higher depression and anxiety scores. Our study shows that healthcare workers are at risk of developing psychological disturbances during infectious outbreaks. To minimize the psychological impact, additional risk factors such as having a previous psychiatric disorder, working under unsafe conditions, and stigmatization should be taken into account and a more supportive and safer environment should be provided.

Risks versus Responsibilities: Critical Care Nurses Experiences’ during Their Work with Suspected or Diagnosed COVID – 19 Patients

Background: Critical care nurses are exposed to serious risk and even death while administering care for patients with COVID-19 as they are exposed to aerosol generating procedures and longer periods of patient contact. According to the American Nursing Association (ANA), “Risk exceeding limits of duty is not ethically obligatory; it is a moral option and nurses should carefully balance between their professional job responsibilities and risks.” Despite fact that nurses have a professional obligation to care for critically ill patients with diagnosed or suspected COVID - 19, many nurses experience conflicts and stressors such as fear and anxiety about risk of being infected and transmitting the infection to their family members and other contacts. Exploring experiences that nurses’ face during their battle with crisis will support them and help in developing protocols and plans to improve their preparedness (ANA, 2015a b Al Thobaity et al., 2020). Therefore, this study aimed to explore critical care nurses’ experiences during their work with diagnosed or suspected COVID – 19 patients. Methods: a descriptive –a cross-sectional design was used to conduct the current study. Sample: a convenient sample of 80 critical care nurses who worked in critical care units at Main University Hospital and agreed to participate in the study were recruited. The tool was developed by researcher based on reviewing of both quantitative and qualitative studies published during 2019 and 2020 to bring critical care nurses’ experiences together. Nurses’ experiences were identified, analyzed, tabulated, and categorized into six main themes. Results: analysis of lived experiences faced critical care nurses during their working with suspected or COVID – 19 patients revealed that for first theme, the statements I am afraid of becoming infected and infecting others) and “There is a shortage of staff” were reported as agree and strongly agree by about all of the nurses. Regarding second theme, a sense of obligation toward their profession and saving patients’ lives were agreed by majority of nurses. Moreover, near of three – a quarter of nurses claimed continuous availability of an adequate amount of personal protective equipment” however, majority of the nurses had confidence in government. They agreed that the government has strong prevention and control measures and that epidemic will be controlled very soon” (theme 3). As regard theme (4), majority of nurses was appreciated the physical and psychological support received from colleagues, families, and donations provided by companies, however, they claimed hospital, Original Article Egyptian Journal of Health Care, 2020 EJHC Vol.11 No.4 445 syndicate, and media due to inadequate support and motivation. Concerning coping strategies to alleviate moral distress (Theme 5), result revealed that the majority of nurses were used positive coping strategies such as attending webinars to enhance their knowledge about COVID – 19 & followed safety guidelines. Finally, all nurses perceived that crisis makes them stronger and nothing will beat them (Theme 6). Conclusions: risks versus responsibilities were highlighted in this study. The nurses were experienced risks that potentiated a feeling of a conflict. A conflict was raised between nurses’ obligation to protect their family members (especially their children) from transmission infection and their obligations towards job responsibilities (saving of patients’ lives). Shortage in nursing staff, medical supplies, especially personnel protective equipment, inadequate support provided by administrative nursing bodies, and sometimes, media were also claimed by majority of nurses. However, they appreciated support provided by their colleagues and families and they were having confidence regarding infection control strategies used by infection control units and ability of government to control crisis very soon.

The adjustment of neurosurgical procedures during the COVID-19 pandemic: a case study at Dr. Sardjito General Hospital as a part of an academic health system.

The recent COVID-19 outbreak has forced notable adjustments to surgical procedure preparation, including neurosurgical services. However, due to the uniqueness of the recent situation, neurosurgical centers, especially those located in low-resource settings, are facing several challenges such as a lack of coordination, poor equipment, and shortage of medical personnel. Therefore, several guidelines from local authorities and international neurosurgical bodies have been published to help clinicians manage their patients. In addition, the academic health system (AHS), which is an integrated system containing a medical institution, universities, and a teaching hospital, may play some role in the management of patients during COVID-19. The objective of this study was to describe how each hospital in the authors' network adjusted their neurosurgical practice and how the AHS of the Universitas Gadjah Mada (UGM) played its role in the adaptation process during the pandemic. The authors gathered both local and national data about the number of COVID-19 infections from the government's database. To assess the contribution of the AHS to the efforts of each hospital to address the pandemic, questionnaires were given to 6 neurosurgeons, 1 resident, and 2 general surgeons about the management of neurosurgical cases during the pandemic in their hospitals. The data illustrate various strategies to manage neurosurgical cases by hospitals within the authors' networks. The hospitals were grouped into three categories based on the transmission risk in each region. Most of these hospitals stated that UGM AHS had a positive impact on the changes in their strategies. In the early phase of the outbreak, some hospitals faced a lack of coordination between hospitals and related stakeholders, inadequate amount of personal protective equipment (PPE), and unclear regulations. As the nation enters a new phase, almost all hospitals had performed routine screening tests, had a sufficient amount of PPE for the medical personnel, and followed both national and international guidelines in caring for their neurosurgical patients. The management of neurosurgical procedures during the outbreak has been a challenging task and a role of the AHS in improving patient care has been experienced by most hospitals in the authors' network. In the future, the authors expect to develop a better collaboration for the next possible pandemic.

A Model for Estimating Amount of Personal Protective Equipment Employed within Occupational Health and Safety

İş Sağlığı ve Güvenliği (ISG) çalışmaları incelendiğinde risklerin analizi sürecinde çok farklı yöntemlerin kullanıldığı görülmekle birlikte, risk analizi sonrasında alınacak önlemlerin başında yer alan Kişisel Koruyucu Donanım (KKD) kullanımı miktarının tahminine yönelik bir çalışma literatürde görülememiştir. Bu çalışmada işletmelerin KKD kullanımlarının tahmini için Otoregresif Entegre Hareketli Ortalamalar (ARIMA) temel alınarak bir model geliştirilmiştir. Beyaz eşya sektöründe faaliyet gösteren bir işletmede 2015-2019 yıllarındaki solunum koruyucu maskelerin kullanım verileri incelenmiş, 2020-2022 yılları için ortaya çıkabilecek solunum koruyucu maskesi ihtiyacı tahmin edilmiştir. Yapılan tahminlerle KKD kullanım miktarları karşılaştırılarak yöntemimizin etkinliği incelenmiştir. Endüstri çağında insan-makine arasında artan ilişkiler, insana uyumlu işletmelerin oluşturulmasını gerektirmektedir ve bu anlamda ergonomi bilimi, verimliliği artırmak için iş sağlığı güvenliği uygulamalarından istifade edebilir. Yapılan KKD tahminleri solunum koruyucu maskelerin gerçekleşen kullanım miktarlarına yakın sonuçlar vermiştir. Koruyucu maskelerin kullanım miktarının tahmini için yapılan bu çalışma gelecekte işletme genelinde kullanılan diğer kişisel koruyucu donanımların tahmini için de uygulanabilir.

Use of the HoloLens2 Mixed Reality Headset for Protecting Health Care Workers During the COVID-19 Pandemic: Prospective, Observational Evaluation.

BackgroundThe coronavirus disease (COVID-19) pandemic has led to rapid acceleration in the deployment of new digital technologies to improve both accessibility to and quality of care, and to protect staff. Mixed-reality (MR) technology is the latest iteration of telemedicine innovation; it is a logical next step in the move toward the provision of digitally supported clinical care and medical education. This technology has the potential to revolutionize care both during and after the COVID-19 pandemic.ObjectiveThis pilot project sought to deploy the HoloLens2 MR device to support the delivery of remote care in COVID-19 hospital environments.MethodsA prospective, observational, nested cohort evaluation of the HoloLens2 was undertaken across three distinct clinical clusters in a teaching hospital in the United Kingdom. Data pertaining to staff exposure to high-risk COVID-19 environments and personal protective equipment (PPE) use by clinical staff (N=28) were collected, and assessments of acceptability and feasibility were conducted.ResultsThe deployment of the HoloLens2 led to a 51.5% reduction in time exposed to harm for staff looking after COVID-19 patients (3.32 vs 1.63 hours/day/staff member; P=.002), and an 83.1% reduction in the amount of PPE used (178 vs 30 items/round/day; P=.02). This represents 222.98 hours of reduced staff exposure to COVID-19, and 3100 fewer PPE items used each week across the three clusters evaluated. The majority of staff using the device agreed it was easy to set up and comfortable to wear, improved the quality of care and decision making, and led to better teamwork and communication. In total, 89.3% (25/28) of users felt that their clinical team was safer when using the HoloLens2.ConclusionsNew technologies have a role in minimizing exposure to nosocomial infection, optimizing the use of PPE, and enhancing aspects of care. Deploying such technologies at pace requires context-specific information security, infection control, user experience, and workflow integration to be addressed at the outset and led by clinical end-users. The deployment of new telemedicine technology must be supported with objective evidence for its safety and effectiveness to ensure maximum impact.

COVID-19 and Keeping Clean: A Narrative Review To Ascertain the Efficacy of Personal Protective Equipment To Safeguard Health Care Workers Against SARS-CoV-2.

Identifying the optimal amount of personal protective equipment (PPE) is a formidable challenge when faced with a new contagion such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Unequivocally, there are dangers to health care workers (and by extension, their patients, colleagues, and communities) if not enough equipment is donned to safeguard them. And yet, there are also dangers to patients, colleagues, and the community if resources are overconsumed and result in hoarding, shortages, and inequitable distribution, all of which are occurring as the worldwide coronavirus disease 2019 (COVID-19) pandemic continues.Research to ascertain the precise PPE required to defend specifically against SARS-CoV-2 encompasses an area of active investigation that will likely remain unresolved for some time. While awaiting more definitive conclusions, we must look to past evidence to provide a reasonable basis on which protocols and policies might be refined. What follows is a narrative review of PPE efficacy and how existing evidence might apply to protecting health care workers against COVID-19. Findings are extrapolated from investigations in 4 general domains: early investigations into SARS-CoV-2, retrospective studies about severe acute respiratory syndrome coronavirus 1, prospective studies of influenza and other common respiratory viruses, and laboratory PPE studies.Available evidence suggests that contact and droplet precautions, in addition to eye protection and standard hygiene measures, should be adequate in the vast majority of clinical settings when caring for patients with SARS-CoV-2. Adherence to guidelines promoting appropriate levels of PPE should safeguard practitioners while mitigating against resource overuse.

Review of recommendations for emergency medical teams during the SARS-CoV-2 epidemic

The aim of this work was to present the recommendations for emergency medical teams in Poland during the SARSCoV-2 epidemic. During the epidemic of the new coronavirus, health care system in the world faced the need to deal with the effects of the virus. The medical staff’s behavior has been adapted to the new reality in order to help patient best and prevent the staff from becoming infected. The result of these activities was the creation of new procedures and recommendations. Due to the huge role of pre-hospital care, it has become necessary to create procedures at the national level so that the way of dealing with an infected patient is the same. With the growing knowledge of the virus, the case definition has changed and the Ministry of Health has updated its recommendations. Emergency medical teams and air emergency services have adapted to the changes imposed by the Minister of Health. The global problem of the SARS-CoV-2 is still a challenge for healthcare systems in Poland and worldwide. It will be necessary to update previously developed guidelines and management schemes, with particular emphasis on emergency medical services. The priority is to secure a sufficient amount of personal protective equipment, disinfectants and to create such procedures that will protect the system during the next crisis. It is important that healthcare professionals adopt a universal set of guidelines that they should follow to minimize SARS-CoV-2 infection.