Safety Of Healthcare Providers Research Articles

Effect of COVID-19 Precautions on Neonatal Resuscitation Practice: A Balance Between Healthcare Provider Safety, Infection Control, and Effective Neonatal Care.

Adaptations have been proposed for resuscitation of infants born to women with COVID-19, to protect health care providers, maintain infection control, and limit post-natal transmission. Changes especially impact respiratory procedures, personal protective equipment (PPE) use, resuscitation environments, teamwork, and family involvement. Adding viral filters to ventilation devices and modifications to intubation procedures might hinder effective ventilation. PPE could delay resuscitation, hinder task performance, and degrade communication. Changes to resuscitation locations and team composition alter workflow and teamwork. Physical distancing measures and PPE impede family-integrated care. These disruptions need to be considered given the uncertainty of vertical transmission of SARS-CoV-2.

Pediatric Resuscitation Practices During the Coronavirus Disease 2019 Pandemic.

While most pediatric coronavirus disease 2019 cases are not life threatening, some children have severe disease requiring emergent resuscitative interventions. Resuscitation events present risks to healthcare provider safety and the potential for compromised patient care. Current resuscitation practices and policies for children with suspected/confirmed coronavirus disease 2019 are unknown. Multi-institutional survey regarding inpatient resuscitation practices during the coronavirus disease 2019 pandemic. Internet-based survey. U.S. PICU representatives (one per institution) involved in resuscitation system planning and oversight. None. Of 130 institutions surveyed, 78 (60%) responded. Forty-eight centers (62%) had admitted coronavirus disease 2019 patients; 26 (33%) reported code team activation for patients with suspected/confirmed coronavirus disease 2019. Sixty-seven respondents (86%) implemented changes to inpatient emergency response systems. The most common changes were as follows: limited number of personnel entering patient rooms (75; 96%), limited resident involvement (71; 91%), and new or refined team roles (74; 95%). New or adapted technology is being used for coronavirus disease 2019 resuscitations in 58 centers (74%). Most institutions (57; 73%) are using enhanced personal protective equipment for all coronavirus disease 2019 resuscitation events; 18 (23%) have personal protective equipment policies dependent on the performance of aerosol generating procedures. Due to coronavirus disease 2019, most respondents are intubating earlier during cardiopulmonary resuscitation (56; 72%), utilizing video laryngoscopy (67; 86%), pausing chest compressions during laryngoscopy (56; 72%), and leaving patients connected to the ventilator during cardiopulmonary resuscitation (56; 72%). Responses were varied regarding airway personnel, prone cardiopulmonary resuscitation, ventilation strategy during cardiopulmonary resuscitation without an airway in place, and extracorporeal cardiopulmonary resuscitation. Most institutions (46; 59%) do not have policies regarding limitations of resuscitation efforts in coronavirus disease 2019 patients. Most U.S. pediatric institutions rapidly adapted their resuscitation systems and practices in response to the coronavirus disease 2019 pandemic. Changes were commonly related to team members and roles, personal protective equipment, and airway and breathing management, reflecting attempts to balance quality resuscitation with healthcare provider safety.

COVID-19 and Laparoscopic Surgery: Scoping Review of Current Literature and Local Expertise.

BackgroundThe current coronavirus disease (COVID-19) pandemic is holding the world in its grip. Epidemiologists have shown that the mortality risks are higher when the health care system is subjected to pressure from COVID-19. It is therefore of great importance to maintain the health of health care providers and prevent contamination. An important group who will be required to treat patients with COVID-19 are health care providers during semiacute surgery. There are concerns that laparoscopic surgery increases the risk of contamination more than open surgery; therefore, balancing the safety of health care providers with the benefit of laparoscopic surgery for the patient is vital.ObjectiveWe aimed to provide an overview of potential contamination routes and possible risks for health care providers; we also aimed to propose research questions based on current literature and expert opinions about performing laparoscopic surgery on patients with COVID-19.MethodsWe performed a scoping review, adding five additional questions concerning possible contaminating routes. A systematic search was performed on the PubMed, CINAHL, and Embase databases, adding results from gray literature as well. The search not only included COVID-19 but was extended to virus contamination in general. We excluded society and professional association statements about COVID-19 if they did not add new insights to the available literature.ResultsThe initial search provided 2007 records, after which 267 full-text papers were considered. Finally, we used 84 papers, of which 14 discussed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Eight papers discussed the added value of performing intubation in a low-pressure operating room, mainly based on the SARS outbreak experience in 2003. Thirteen papers elaborated on the risks of intubation for health care providers and SARS-CoV-2, and 19 papers discussed this situation with other viruses. They conclude that there is significant evidence that intubation and extubation is a high-risk aerosol-producing procedure. No papers were found on the risk of SARS-CoV-2 and surgical smoke, although 25 papers did provide conflicting evidence on the infection risk of human papillomavirus, hepatitis B, polio, and rabies. No papers were found discussing tissue extraction or the deflation risk of the pneumoperitoneum after laparoscopic surgery.ConclusionsThere seems to be consensus in the literature that intubation and extubation are high-risk procedures for health care providers and that maximum protective equipment is needed. On the other hand, minimal evidence is available of the actual risk of contamination of health care providers during laparoscopy itself, nor of operating room pressure, surgical smoke, tissue extraction, or CO2 deflation. However, new studies are being published daily from current experiences, and society statements are continuously updated. There seems to be no reason to abandon laparoscopic surgery in favor of open surgery. However, the risks should not be underestimated, surgery should be performed on patients with COVID-19 only when necessary, and health care providers should use logic and common sense to protect themselves and others by performing surgery in a safe and protected environment.

Cardiopulmonary resuscitation in COVID-19 patients.

COVID-19 is extremely transmissible. Cardiopulmonary resuscitation (CPR) is associated with multiple aerosol-generating procedures including chest compression, positive pressure ventilation, and airway manipulation. Healthcare providers who perform CPR are at high risk of contracting COVID-19. CPR in patients with suspected or proven COVID-19 must be performed without compromising the safety of healthcare providers. An overview of special considerations.

COVID-19 Preoperative Assessment and Testing: From Surge to Recovery.

COVID-19 Preoperative Assessment and Testing: From Surge to Recovery.

Endoscopic Skull Base Surgery Protocol From the Frontlines: Transnasal Surgery During the COVID‐19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic disrupted the standard management paradigms for care of patients with sinus and skull base presentations due to concern for patient and health care provider safety, given the high aerosol-generating potential of endonasal procedures. We reviewed the relevant literature complied from available sources, including PubMed, Google Scholar, and otolaryngology journals providing electronic manuscripts ahead of indexing or publication. Incorporating available evidence and the projected infection control and resource limitations at our institution, we collectively authored a dynamic set of protocols guiding (1) case stratification, (2) preoperative assessment, (3) operative setup, and (4) postoperative care of patients with sinus or skull base presentations. Due to the rapidly evolving nature of COVID-19 publications, lack of rigorous data, and urgent necessity of standardized protocols, strict inclusion and exclusion criteria were not employed. As scarce hospital resources are diverted to COVID-19 care and staff are redeployed to forward-facing roles, endonasal procedures have largely ceased, leaving patients with ongoing sinonasal and skull base complaints untreated. Skull base teams now weigh the urgency of surgery in this population with the regional availability of resources. The COVID-19 pandemic will have an enduring and unpredictable impact on hospital operations and surgical skull base practices and will require a dynamic set of management protocols responsive to new evidence and changing resources. In the current resource-limited environment, clinicians may utilize these protocols to assist with stratifying patients by acuity, performing preoperative assessment, and guiding peri- and postoperative care.

COVID‐19 associated coagulopathy and thromboembolic disease: Commentary on an interim expert guidance

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is the causative pathogen of a new infectious disease, COVID-19, that first occurred in late December 2019 in the city of Wuhan in Hubei Province, China. It has since spread globally, resulting in a WHO declared pandemic, with as yet (17/4/20) more than two million confirmed cases and about 150.000 confirmed deaths. As for every new disease, clinicians, hospitals and governments struggle to find optimal clinical and public health measures to contain its spread and burden. For this, information from scientific research is crucial and fortunately we see a rapidly accumulating output of studies.

Personal protective equipment (PPE) for both anesthesiologists and other airway managers: principles and practice during the COVID-19 pandemic.

Healthcare providers are facing a coronavirus disease pandemic. This pandemic may last for many months, stressing the Canadian healthcare system in a way that has not previously been seen. Keeping healthcare providers safe, healthy, and available to work throughout this pandemic is critical. The consistent use of appropriate personal protective equipment (PPE) will help assure its availability and healthcare provider safety. The purpose of this communique is to give both anesthesiologists and other front-line healthcare providers a framework from which to understand the principles and practices surrounding PPE decision-making. We propose three types of PPE including: 1) PPE for droplet and contact precautions, 2) PPE for general airborne, droplet, and contact precautions, and 3) PPE for those performing or assisting with high-risk aerosol-generating medical procedures.

Code Blue During the COVID-19 Pandemic.

The surging COVID-19 pandemic has raised ethical and moral dilemmas that Western nations with first-rate medical care facilities rarely confront-how to best allocate standard life-saving medical resources when escalating demand outstrips supply. Sadly, these quandaries are familiar challenges in resource-poor countries. What makes this pandemic notable is that the scope and number of reported cases have been primarily in First World nations, raising questions in some settings about the use of emergency treatments like resuscitation care for in-hospital cardiac arrest (IHCA). This perspective reviews the debate around these ethical and moral dilemmas more broadly but focuses specifically on IHCA and the response of the medical community.

Role of duties related to COVID-19 suspected, probable and confirmed fatality cases

The outbreak caused by SARS-CoV-2 beta-coronavirus, first identified in Wuhan, China, was declared a pandemic by the World Health Organization on 11th March, 2020. In Hungary, the first confirmed COVID-19 case was reported on 4th March, 2020, and on 15th March, the first fatality related to the infection was announced. At the moment of the latter event, there was no central, standardized guideline, which could explain the necessary precautions, and provide an unequivocal description on how to handle the dead body. The procedure of transportation, storage, occurent autopsy or final disposition of the deceased raise a lot of questions, especially on how to carry out these tasks. Legislation related to infectious diseases and decedent management in general do not provide enough information on how to perform duties in a COVID-19 fatality case. The chief medical officer suspended the execution of autopsies, except in cases of unnatural death, since 19th March, however, the transportation and storage of fatalities can still be a problem. The Department of Pathology of the Healthcare Professional College of the Ministry of Human capacities published a procedure on recommended post-mortem duties on 21st March, but the suggested protocols only represent a narrow spectrum of international recommendations. Therefore supplementation may be necessary. Sadly, post-mortem protocols, in spite of their importance, are also underrepresented in the international literature. A further problem, wich makes adoptability difficult, is that available foreign guidelines and algorithms are optimized for different legislation, and organisations, resources not available in our country. In this article, besides providing a summary of literature, we would also like to make practical recommendations which may increase the safety of healthcare providers participating in the treatment or pathological duties with COVID-19 suspected, probable and confirmed cases. Orv Hetil. 2020; 161(17): 713–722.

Preparedness to combat COVID-19 via structured online training program regarding specific airway management: A prospective observational study.

Preparedness to combat COVID-19 via structured online training program regarding specific airway management: A prospective observational study.

NNJ Journal Club - Support for Nurses During the Global COVID-19 Pandemic

Managing stress & self-care during COVID-19: Information for nurses. https://www.apna.org/i4a/pages/index.cfm? pageid=6685 The American Psychiatric Nurses Association (APNA) notes that during COVID-19 pandemic, nurses are experiencing pressure, fear, exhaustion, isolation and ongoing emotional trauma and that this stress and trauma affects nurses mental health, safety, and ability to provide best possible care (APNA, 2020, p. 1). The well-being initiative. https://<www.nursingworld.org/practice-policy/work-environ ment/health-safety/disaster-preparedness/corona virus/what-you-need-to-know/the-well-being-initiative/ The ANA Enterprise has an open access site on response to coronavirus that advocates for evidence-based guidelines and resources to promote safety for health care providers to effectively provide care to public. [...]it offers tracking for sleep, exercise, nutrition, medication, and other activities. Uniformed Services University. https://www. cstsonline.org/assets/media/documents/CSTS_FS_ Psychological_Effects_Quarantine_During_Corona virus_Outbreak_Providers.pdf Quarantine is defined as the separation of individuals who may have been exposed to an infectious disease risk from rest of population to determine if they are ill and to reduce their risk of infecting others (Center for Traumatic Studies, 2020, p. 1).

Importance of Nurses&amp;apos; Eye Witness in Health Care System of Pakistan

Background: Eye witness is an act that helps to provide justice, beneficence, non-maleficence and autonomy to any victim thus prevents misconduct and crimes from the society. Crime is an act of planning, preparing, stealing, harming and destroying individuals, groups or societies rights. Crime is one of the social and ethical issue that is prohibited in every religion and society. Healthcare professionals are suffering from different kind of workplace violence, harassments and abuses by patient attendants. Moreover, taking medicines or equipments from wards, and errors during surgical procedure is again consider crime. Nurses usually deal with issues and situations that have elements of ethical and moral uncertainty. Unfortunately such kind of crimes are not reported and remain unnoticed. It is our responsibility to become eye witness and report all those act which can prevent deviation from the standard of care as well as insure safety of health care providers. Methodology: Data were collected through systematic data search technique. Publication from 2001 to 2018 regarding eye witness were included in this study for review. After in depth screening, 22 articles were finally selected for review. Quality analyses were done according to pre-identified criteria. Result: Findings from retrieved and analyzed articles revealed that individuals cognitive power, confident level and theoretical knowledge is essential to become eye witness of any crime and misdeed. It is also evident from literatures that the outcome of telling lie and become fake eye witness has contextual consequences and punishment is different from context to context and person to person. According to three articles in this review, providing accurate and truth information regarding any crime is our responsibility and every religion possess and direct to provide correct information and become eye witness to prevent such acts which harm others. Conclusion: Nursing profession is facing number of challenges thus bulling and leg pulling is one of the issue which we seen in nursing profession. To take any decision and sharing any misconduct and immoral act by any person or health care providers we must have enough knowledge, confident, cognitive integrity to identify our personal values, moral development and knowledge of ethical theories for decision making in nursing to be a eye witness or not.

Facility preparedness for an obstetric unit during the Covid-19 pandemic.

Covid-19 infection has placed health systems under unprecedented strain and foresight for preparedness is the key factor to avert disaster. Every facility that provides obstetric service needs a certain level of preparedness to be able to handle at least Covid-suspect pregnant women awaiting test reports, who need to be managed as Covid-positive patients till reports are available. Thus, these facilities need to have triage areas and Covid-suspect labour rooms. Healthcare facilities can have designated areas for Covid-positive patients or have referral linkages with designated Covid-positive hospitals. Preparation includes structural reorganization with setting up a Covid-suspect and Covid-positive facility in adequate space, as well as extensive training of staff about infection control practices and rational use of personal protective equipment (PPE). A systematic approach involving five essential steps of making standard operating procedures, infrastructural reorganization for a triage area and a Covid-suspect labour ward, procurement of PPE, managing the personnel and instituting appropriate infection control practices can ensure uninterrupted services to patients without compromising the safety of healthcare providers.

Comparison of fit factors among healthcare providers working in the Emergency Department Center before and after training with three types of N95 and higher filter respirators.

N95 or higher filtering respirators have been recommended in healthcare settings, although there is still a risk of infection due to the improper selection and wearing of respirators. We aimed to assess the effects of training with N95 or higher filter respirators on the protection performance of respirators among healthcare providers in the emergency medical center (EMC). This randomized crossover study evaluated 23 healthcare providers. Quantitative fit tests (QNFTs) were performed before and after training using three types of N95 or higher filter respirators (cup-type, fold-type, valve-type). Training was performed by lecture, real-time feedback, and fit check. The primary outcome was the fit factor, and the secondary outcomes were overall fit factor, adequate protection rate, and respiratory preference. Fit factors, overall fit factor, and adequate protection rate were higher after training than before training for the 3 types of respirators (all P < .05). For normal breathing, fit factors before and after training were 121 (10-185) vs 192 (161-200) for cup-type, 200 (39-200) vs 200 (200-200) for fold-type, and 85 (18-157) vs 173 (117-200) for valve-type. For normal breathing, the adequate protection rates before and after training were 62 (0-100) vs 100 (90-100) for cup-type, 100 (0-100) vs 100 (100-100) for fold-type, and 19 (0-100) vs 100 (44-100) for valve-type (all P < .05). The most preferred respirator type was the valve-type (10 persons, 45.5%). Training on wearing an N95 or higher respirator improved the protection performance of respirators among healthcare providers working in the EMC. The selection of proper respirators and training would be beneficial to the safety of healthcare providers.

Relating Almutairi’s critical cultural competence model for healthcare providers transitioning to Qatar

Healthcare providers can be enticed to work in the Middle East due to fascinations with the culture, wealth, and opportunities for personal and professional development. Working in multicultural healthcare environments requires addressing complexities with cultural hierarchies, religion, class systems, and gender. It also requires understanding of the region’s history, as well as knowledge about cultural and social norms. The authors use qualitative accounts, from lived experiences to illuminate their transition to work in Qatar. Upon reflection of their experiences, the authors recommend using a Critical Cultural Competence model as a guide for healthcare providers undergoing transition and longer-term adaptation for promoting cultural safety for healthcare providers and their patients. Some authors of this article have previously published “Recommendations for healthcare providers preparing to work in the Middle East: A Campinha-Bacote cultural competence model approach” (Journal of Nursing Education and Practice, 2017). However, after reflecting upon their experiences as nurse educators living in the Middle East, the authors concluded that Almutairi, Dahinten, and Rodney’s (2015) Critical Cultural Competence Model is more suitable for health care providers transitioning to Qatar. This model addresses necessary elements needed to transition to a new culture, but also includes personal narratives and experiences, which maybe helpful to transitioning to work in another culture. Almutairi et al.’s model (2015) reconceptualises and enriches the concept of transitioning to Middle Eastern multicultural contexts. The aim of this paper is to provide recommendations using Almutairi et al.’s Cultural Competence Model to assist healthcare providers in transitioning to work in Qatar. Another aim is to provide guidance for healthcare professional development in multicultural contexts. Discussion as to how the model may foster a more relevant approach will ensue. Experiential knowledge and narratives are threaded throughout the paper to provide a lived account of the use of this Critical Cultural Competence model by healthcare workers, who have transitioned to the Middle East.

Process Development for the Care of the Person Under Investigation for Ebola Virus Disease: a Collaboration of Biocontainment Unit and Emergency Medicine Personnel.

Opinion StatementPatients presenting with epidemiological risk factors for Ebola virus disease (EVD) and symptoms consistent with the disease require screening with a molecular assay. If the initial test is negative, but the patient has been symptomatic for less than 3 days, a follow-up test is required to reliably exclude the disease. During this time, persons under investigation (PUI) for EVD may have illnesses other than EVD that require further evaluation and management and well-defined processes are essential to the delivery of consistent, high-quality care for these patients while preserving the safety of healthcare providers.

Almutairi's Critical Cultural Competence model for a multicultural healthcare environment

The increasing demographic changes of populations in many countries require an approach for managing the complexity of sociocultural differences. Such an approach could help healthcare organizations to address healthcare disparities and inequities, and promote cultural safety for healthcare providers and patients alike. Almutairi's critical cultural competence (CCC) is a comprehensive approach that holds great promise for managing difficulties arising from sociocultural and linguistic issues during cross-cultural interactions. CCC has addressed the limitations of many other cultural competence approaches that have been discussed in the literature. Therefore, the purpose of this study is to define the construct of CCC and the theoretical components of the CCC.

Essentials for emergency care: Lessons from an inventory assessment of an emergency centre in Sub-Saharan Africa

Introduction The World Health Organization (WHO) has published lists of essential equipment and supplies for delivering emergency care in resource-limited settings. The objective of this study was to assess material resources available for adult emergency care at a major academic tertiary care referral centre in Accra, Ghana, to determine quality improvement needs. Methods A spot inventory of emergency centre equipment and supplies was conducted in Korle-Bu Teaching Hospital (KBTH) and compared to the WHO essential emergency equipment list released in 2006. Results Most items considered essential were available at the time of inventory. Notable exceptions included: equipment and supplies for healthcare provider safety and infection control, advanced airway management, and ophthalmologic or gynaecological examinations. Several additional items, such as glucometers and pulse oximeters, were available and often used for patient care. Conclusion Beyond pointing out specific material resource deficiencies at the Surgical Medical Emergency (SME) centre, our inventory assessment indicated a need to develop better implementation strategies for infection control policies, to collaborate with other departments on coordination of patient care, and to set a research agenda to develop emergency and acute care protocols that are both effective and sustainable in our setting. Equipment and supplies are essential elements of emergency preparedness that must be both available and ‘ready-to-hand'. Consequently, key factors in determining readiness to provide quality emergency care include supply-chain, healthcare financing, functionality of systems, and a coordinated institutional vision. Lessons learnt may be useful for others facing similar challenges to emergency medicine development.

Long-Acting Reversible Contraception: A Review in Special Populations

Almost half of the pregnancies in the United States are unintended. Currently available contraceptive methods are highly efficacious, but the most commonly used methods rely on patients for appropriate use. There has been a push to advocate for long-acting reversible contraceptives (LARCs) as first-line methods because they are placed by medical professionals and are the most effective form of reversible contraception available. There are four LARCs currently available in the United States: the Copper T intrauterine device, two forms of the levonorgestrel intrauterine system, and the etonogestrel subdermal implant. Once inserted, they can be left in place for 3-10years, depending on the device. Some of these devices have been available for a number of years, but their use is limited in the United States due to controversies and misconceptions. A MEDLINE search from 1990-2012 was conducted to identify articles describing the use of LARCs in populations with limited data, including postpartum women, adolescents and nulliparous women, and women with sexually transmitted infections, including human immunodeficiency virus (HIV). Health care provider safety concerns surrounding intrauterine device (IUD) expulsions and infection are issues for use in adolescents and nulliparous women. Concern regarding IUD expulsion in the postpartum population questions the benefit of immediate versus delayed insertion, and the progestin effect in the levonorgestrel IUD and etonogestrel implant is of theoretic concern for breastfeeding women. In women with HIV, concerns have been raised about increased viral shedding with the IUD and drug interactions with the progestin methods. Many misconceptions surrounding LARCs are unfounded, but individual risk factors may leave LARC users at risk of unintended pregnancy if not addressed properly.