Hospital-based Health Care Workers Research Articles

Applying Psychotherapeutic Principles to Bolster Resilience Among Health Care Workers During the COVID-19 Pandemic.

The COVID-19 pandemic has affected the entire globe with overwhelming speed and impact. The pandemic is both highly threatening and poorly understood, typical of deeply distressing conditions. Stress associated with uncertain recommendations from authorities, fear of illness and contagion for oneself and one's loved ones, extended periods of isolation, moral conflicts, financial instability, perception of discrimination and/or stigma, and ongoing loss and grief imperil mental health and resilience among the general population and high-risk groups. Health care workers (HCWs) face additional challenges that increase their vulnerability to distress and burnout. Bolstering resilience among HCWs can allow them to continue working with the intensity and focus their jobs require, which in turn supports the overall functioning of the health care system. Given their training in understanding wellness, distress, and psychotherapeutic treatment, mental health clinicians are well positioned to respond to this need. By studying the lessons from past and present experiences with public health emergencies and by incorporating principles from psychotherapeutic literature and training, clinicians can help facilitate an informed and effective response. The goal of this article is to discuss the development of a resilience coaching model that is rooted in principles from psychotherapeutic literature and practice to support psychological well-being among hospital-based HCWs. This model, developed to support the authors' health care colleagues working in a Toronto hospital, is generalizable, can be adapted for use by any mental health clinician, and makes explicit how previous training in psychotherapy may be applied to coaching and supporting frontline HCWs.

Systematic Review of Clinician-Reported Barriers to Provision of Smoking Cessation Interventions in Hospital Inpatient Settings

Background: Although the hospital inpatient setting arguably provides an ideal opportunity to engage patients in smoking cessation interventions, this is done infrequently. We therefore aimed to systematically review the perceived barriers to the implementation of smoking cessation interventions in the hospital inpatient setting.Methods: A systematic literature search was conducted specific to hospital-based healthcare workers’ perceived barriers to implementing smoking cessation interventions. Reported barriers were categorised using the capability, opportunity and motivation (COM-B) framework.Results: Eighteen studies were selected for inclusion, which consisted of cross-sectional surveys and interviews. The most commonly identified barrier in capability was lack of knowledge (56% of studies); in Opportunity, it was a lack of time (78%); while in Motivation, a lack of perceived patient motivation to quit smoking (44%). Seventeen other barriers were also endorsed, but less frequently.Conclusion: Healthcare workers report a plethora of barriers to providing smoking cessation interventions in hospital settings, which cover all aspects of the COM-B framework. These impediments need to be addressed in a multidisciplinary approach, at clinical, educational, and administrative levels, to improve intervention provision.

Infectious disease transmission: survey of contacts between hospital-based healthcare workers and working adults from the general population

SummaryBackgroundHealthcare workers (HCWs) may be the inadvertent interface between the healthcare setting and the community for infectious diseases transmission.AimTo investigate HCWs' contacts during a work day and compare these against working adults from the general population.MethodsProspective survey of contacts through 24 h self-reported diary in three public sector tertiary care hospitals and community-based working adults in Singapore. Participants were HCWs and working adults from the community.FindingsIn all, 211 HCWs and 1028 working adults reported a total of 4066 and 9206 contacts. HCWs reported more work-related contacts than community-based working adults (median of 13 versus 4), and more contacts that were neither household nor work-related (1 versus 0) but fewer household contacts (2 versus 3). HCWs reported more work-related contacts involving physical contacts, and more new contacts particularly with short duration (≤15 min) compared to community-based working adults. Among different HCW types, doctors reported the highest whereas ward-based nurses reported the lowest total work-related contacts. Around half of ward-based and clinic-based nurses' contacts involved physical touch. Work-related contacts reported by clinic-based nurses, doctors, and assorted HCWs were shorter than in ward-based nurses, with a substantial number effectively occurring with new contacts. Institutional effects significant on univariate analyses were much reduced and non-significant after adjusting for confounding by HCW type.ConclusionHCWs' contacts differ substantially from those of community-based working adults. HCWs may thus be at higher risk of acquiring and spreading contact-transmissible and respiratory infections due to the nature of their work. Whereas total number of contacts was fairly similar between HCW types, the characteristics of their contacts differed substantively.

Sharp instrument injuries among hospital healthcare workers in mainland China: a cross-sectional study

ObjectivesTo determine the prevalence of sharp instrument injuries in hospital-based healthcare workers (HCWs) in mainland China and the contributing factors.DesignCross-sectional study.SettingThe data were derived from public hospitals.ParticipantsA total of 360...

A large-scale survey on sharp injuries among hospital-based healthcare workers in China

A multi-center survey on sharp injuries (SIs) among hospital-based healthcare workers (HCWs) in seven provinces of China between August and December 2011 was performed. In each province, HCWs from at least 30 hospitals were surveyed by completing a SI report form adapted from the EPINet. The HCWs who declared SIs during the period were interviewed by local infection control practitioners. The survey included 361 hospitals and 206,711 HCWs, most of whom were nurses (47.5%) or doctors (28.4%). In the previous month, 17,506 SI incidents were declared by 13,110 (6.3%) HCWs, corresponding to 1,032 incidents per 1,000 HCWs per year and 121.3 per 100 occupied beds per year. The majority of the SIs was caused by a hollow-bore needle (63.0%). The source patient was identified in 73.4% of all SIs but only 4.4% of all exposures involved a source patient who tested positive for HBV (3.3%), HCV (0.4%) or HIV (0.1%). Only 4.6% of SIs were reported to the infection control team in the hospitals. In conclusion, the rate of SI among HCWs is high in China and SI represents a severe but largely neglected problem. Awareness and safety climate should be promoted to protect the safety of HCWs in China.

An assessment of the level of concern among hospital-based health-care workers regarding MERS outbreaks in Saudi Arabia

BackgroundMiddle East Respiratory Syndrome (MERS) is caused by MERS coronavirus (MERS-CoV). More than 80% of reported cases have occurred in Saudi Arabia, with a mortality exceeding 50%. Health-care workers (HCWs) are at risk of acquiring and transmitting this virus, so the concerns of HCWs in Saudi Arabia regarding MERS were evaluated.MethodsAn anonymous, self-administered, previously validated questionnaire was given to 1031 HCWs at three tertiary hospitals in Saudi Arabia from October to December, 2014. Concerns regarding the disease, its severity and governmental efforts to contain it, as well as disease outcomes were assessed using 31 concern statements in five distinct domains. A total concern score was calculated for each HCW. Multiple regression analyses were used to identify predictors of high concern scores.ResultsThe average age of participants was 37.1 ± 9.0 years, 65.8% were married and 59.1% were nurses. The majority of respondents (70.4%) felt at risk of contracting a MERS-CoV infection at work, 69.1% felt threatened if a colleague contracted MERS-CoV, 60.9% felt obliged to care for patients infected with MERS-CoV and 87.8% did not feel safe at work using standard precautions. In addition, 87.7% believed that the government should isolate patients with MERS in specialized hospitals, 73.7% agreed with travel restriction to and from areas affected by MERS and 65.3% agreed with avoiding inviting expatriates from such areas. After adjustment for covariates, high concern scores were significantly associated with being a Saudi national (p < 0.001), a non-physician (p < 0.001) and working in the central region (p < 0.001).ConclusionsThe majority of respondents reported concern regarding MERS-CoV infection from exposure at work. The overall level of concern may be influenced by previous experience of MERS outbreaks and related cultural issues. The concerns of HCWs may affect their overall effectiveness in an outbreak and should be addressed by incorporating management strategies in outbreak planning.

Patients under investigation for Ebola virus disease in the United States: hospital preparedness planning and alternate care facilities.

Patients under investigation for Ebola virus disease in the United States: hospital preparedness planning and alternate care facilities.

Occupational vaccination of health care workers: uptake, attitudes and potential solutions

ObjectivesOccupational vaccination of health care workers is strongly recommended to prevent health care associated transmission but coverage in general remains suboptimal. The aim of this survey was to: 1. Estimate levels vaccination coverage for annual flu and MMR vaccines among hospital-based health care workers; 2. Explore the reasons behind low vaccination rates; and 3. Identify potential practical and policy solutions. Study designA cross-sectional study. MethodsAn opportunistic survey was used to estimate MMR and flu vaccination coverage, and review attitudes and explore solutions. Staff from eight randomly selected wards, stratified by ward-level patient susceptibility, were invited to participate. ResultsIn total 133 staff responded, an approximate response rate of 68%. Seventy one percent had ever received an MMR and 42% had received the most recent flu vaccination. Actively declining vaccination was more common for flu than MMR (29% and 7% respectively). Side-effects, insufficient knowledge and vaccine ineffectiveness were popular justifications for declining flu vaccination but not MMR. Not seeing vaccination as a professional responsibility was associated with declining flu vaccination (P < 0.001). Improving vaccination coverage with booster vaccines for new staff and immunity testing received strong support from staff working with vulnerable groups (82% and 74% respectively); 70% of this staff group also supported compulsory vaccination. ConclusionsImproving staff education may increase coverage. Clarification of the benefits of vaccination in specific staff groups may also improve uptake. Routine booster vaccinations and immunity testing were generally acceptable and compulsory vaccination of certain staff groups warrants further investigation.

Current practices and barriers to the use of facemasks and respirators among hospital-based health care workers in Vietnam

BackgroundThis study aimed to examine the knowledge, attitudes, and practices towards the use of facemasks among hospital-based health care workers (HCWs) in Hanoi, Vietnam.MethodsA qualitative study incorporating 20 focus groups was conducted between August 2010 and May 2011. HCWs from 7 hospitals in Vietnam were invited to participate.ResultsIssues associated with the availability of facemasks (medical and cloth masks) and respirators was the strongest theme to emerge from the discussion. Participants reported that it is not unusual for some types of facemasks to be unavailable during nonemergency periods. It was highlighted that the use of facemasks and respirators is not continuous, but rather is limited to selected situations, locations, and patients. Reuse of facemasks and respirators is also common in some settings. Finally, some participants reported believing that the reuse of facemasks, particularly cloth masks, is safe, whereas others believed that the reuse of masks put staff at risk of infection.ConclusionsIn low and middle-income countries, access to appropriate levels of personal protective equipment may be restricted owing to competing demands for funding in hospital settings. It is important that issues around reuse and extended use of medical masks/respirators and decontamination of cloth masks are addressed in policy documents to minimize the risk of infection.

Physical activity and body mass index: the contribution of age and workplace characteristics.

The workplace is an important domain for adults, and many effective interventions targeting physical activity and weight reduction have been implemented in the workplace. However, the U.S. workforce is aging, and few studies have examined the relationship of BMI, physical activity, and age as they relate to workplace characteristics. This paper reports on the distribution of physical activity and BMI by age in a population of hospital-based healthcare workers and investigates the relationships among workplace characteristics, physical activity, and BMI. Data from a survey of patient care workers in two large academic hospitals in the Boston area were collected in late 2009 and analyzed in early 2013. In multivariate models, workers reporting greater decision latitude (OR=1.02, 95% CI=1.01, 1.03) and job flexibility (OR=1.05, 95% CI=1.01, 1.10) reported greater physical activity. Overweight and obesity increased with age (p<0.01), even after adjusting for workplace characteristics. Sleep deficiency (OR=1.56, 95% CI=1.15, 2.12) and workplace harassment (OR=1.62, 95% CI=1.20, 2.18) were also associated with obesity. These findings underscore the persistent impact of the work environment for workers of all ages. Based on these results, programs or policies aimed at improving the work environment, especially decision latitude, job flexibility, and workplace harassment should be included in the design of worksite-based health promotion interventions targeting physical activity or obesity.

Tuberculosis in Healthcare Workers and Infection Control Measures at Primary Healthcare Facilities in South Africa

BackgroundChallenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers.MethodsOne hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained.ResultsThe standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08).ConclusionThe high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB.

Visualizing the invisible: applying an arts-based methodology to explore how healthcare workers and patient representatives envisage pathogens in the context of healthcare associated infections

Background: While efforts to enhance healthcare workers' knowledge and behaviours in the prevention and control of healthcare-associated infections (HAIs) have been considerable, little is known about how staff visualize pathogens and their relationship to HAIs. This study, therefore, sought to explore how healthcare workers envisage pathogens in the context of HAIs. Method: Ten hospital-based healthcare workers and two patient representatives participated in a workshop combining risk identification, making activities and in-depth interviews. This methodology was informed by Sullivan's Dimensions of Visualization framework. A descriptive cross-case analysis approach was used to summarize and synthesize the data. Results: Few of the participants reported actively visualizing pathogens in their mind's eye; however, the study elicited mental images of pathogens from all participants and all were able to create related models during the making activity. Conceptions appeared to be influenced primarily by microbiology and infection control campaigns. Conclusion: Our adaptation of Sullivan's Dimensions of Visualization framework proved useful in structuring this initial enquiry and merits wider application and evaluation by qualitative health researchers.

A Randomized Clinical Trial of Three Options for N95 Respirators and Medical Masks in Health Workers

We compared three policy options for the use of medical masks and N95 respirators in healthcare workers (HCWs). A cluster randomized clinical trial of 1,669 hospital-based HCWs in Beijing, China in the winter of 2009-2010. Participants were randomized to medical masks, N95 respirators, or targeted use of N95 respirators while doing high-risk procedures or barrier nursing. Outcomes included clinical respiratory illness (CRI) and laboratory-confirmed respiratory pathogens in symptomatic subjects. The rate of CRI was highest in the medical mask arm (98 of 572; 17%), followed by the targeted N95 arm (61 of 516; 11.8%), and the N95 arm (42 of 581; 7.2%) (P < 0.05). Bacterial respiratory tract colonization in subjects with CRI was highest in the medical mask arm (14.7%; 84 of 572), followed by the targeted N95 arm (10.1%; 52 of 516), and lowest in the N95 arm (6.2%; 36 of 581) (P = 0.02). After adjusting for confounders, only continuous use of N95 remained significant against CRI and bacterial colonization, and for just CRI compared with targeted N95 use. Targeted N95 use was not superior to medical masks. Continuous use of N95 respirators was more efficacious against CRI than intermittent use of N95 or medical masks. Most policies for HCWs recommend use of medical masks alone or targeted N95 respirator use. Continuous use of N95s resulted in significantly lower rates of bacterial colonization, a novel finding that points to more research on the clinical significance of bacterial infection in symptomatic HCWs. This study provides further data to inform occupational policy options for HCWs. Clinical trial registered with Australian New Zealand Clinical Trials Registry http://www.anzctr.org.au (ACTRN 12609000778280).

Seasonal Influenza Vaccine Compliance among Hospital-Based and Nonhospital-Based Healthcare Workers

Influenza vaccination among nonhospital healthcare workers (HCWs) is imperative, but only limited data are available for factors affecting their compliance. To examine the factors influencing influenza vaccine compliance among hospital and nonhospital HCWs. Design and Setting. A vaccine compliance questionnaire was administered to HCWs working in myriad healthcare settings in March-June 2011. Online and paper surveys were used to assess compliance with the 2010/2011, 2009/2010, and H1N1 influenza vaccines and to examine factors that predicted the uptake of the 2010/2011 seasonal influenza vaccine. In all, 3,188 HCWs completed the survey; half of these ([Formula: see text]) reported no hospital work time. Compliance rates for all 3 vaccines were significantly higher ([Formula: see text]) among hospital versus nonhospital HCWs. In logistic regression stratified by hospital versus nonhospital setting, and when controlling for demographics and past behavior, the determinants of vaccination against the 2010/2011 seasonal influenza among nonhospital-based HCWs included having a mandatory vaccination policy, perceived importance, no fear of vaccine adverse effects, free and on-site access, and perceived susceptibility to influenza. Determinants of hospital-based HCW vaccine compliance included having a mandatory vaccination policy, belief that HCWs should be vaccinated every year, occupational health encouragement, perceived importance of vaccination, on-site access, and no fear of vaccine adverse effects. The strongest predictor of compliance for both worker groups was existence of a mandatory vaccination policy. The reasons for vaccine uptake among nonhospital-based versus hospital-based HCWs differed. Targeted interventions should be aimed at workers in these settings to increase their vaccine compliance, including implementing a mandatory vaccination policy.

Symptoms and responses to critical incidents in paramedics who have experienced childhood abuse and neglect

BackgroundMental and physical symptoms are common in paramedics, which may relate to high work stress, including critical incidents. As previous trauma is a risk factor for psychological symptoms after exposure...

Determination of factors required to increase uptake of influenza vaccination among hospital-based healthcare workers

A questionnaire study was performed in all eight University Medical Centers in The Netherlands to determine the predictors of influenza vaccination compliance in hospital-based healthcare workers (HCWs). Demographical, behavioural and organisational determinants were assessed based on behavioural and implementation models. Multivariable regression analysis was applied to assess the independent predictors for influenza vaccine uptake. Age >40 years, the presence of a chronic illness, awareness of personal risk and awareness of risk of infecting patients, trust in the effectiveness of the vaccine to reduce the risk of infecting patients, the HCWs' duty to do no harm and their duty to ensure continuity of care, finding vaccination useful despite the constant flow of visitors and having knowledge of the Health Council's advice, social influence and convenient time for vaccination were all independently associated with vaccine uptake. The accuracy of the prediction model was very high (area under the receiver operating curve: 0.95). Intervention programmes to increase influenza vaccine uptake among HCWs should target the relevant determinants identified in this study.

The impact of attachment insecurity and sleep disturbance on symptoms and sick days in hospital-based health-care workers

Objective Adult attachment insecurity is associated with many health outcomes and may be associated with sleep disturbance. The purpose of this study was to test the hypothesis that sleep disturbance mediates the relationship between attachment insecurity and three measures of health (perceived general health, physical symptoms and sick days) in a group that is at high risk of sleep disturbance: hospital based health-care workers. Methods One hundred thirty-one nondepressed female hospital workers completed self-report measures of adult attachment, sleep disturbance, depressive symptoms (excluding sleep-related items) and health outcomes. The hypothesis of mediation was tested with sequential regression analyses. Results Both attachment anxiety and attachment avoidance were significantly associated with impairment in global sleep quality ( ρ=.20 and .19, respectively, P<.05) and physical symptoms ( ρ=.21 and .19, P<.05). Attachment anxiety was also associated with depressive symptoms ( ρ=.33, P<.001) and sick days ( ρ=.21, P<.05). For both physical symptoms and sick days, mediation analyses were consistent with global sleep quality acting as a partial mediator of the relationship between attachment anxiety and physical health. Non-sleep-related depressive symptoms were a stronger mediator. Conclusions This study corroborates evidence that attachment insecurity is associated with sleep disturbance and extends this association to the occurrence of physical symptoms and time off work due to sickness among workers in a high-stress occupation.

Seasonal Influenza Vaccination Coverage Among Local Health Department Personnel in North Carolina, 2007–2008

National estimates indicate that a low proportion of institutional and hospital-based healthcare workers obtain influenza vaccine. Information on seasonal influenza vaccination coverage in county-level public healthcare workers is lacking, including knowledge, attitudes, and perceptions regarding seasonal influenza vaccination. The purpose of this study was to investigate the percentage of employees receiving seasonal influenza vaccination, including perceptions and attitudes of employees of 17 health agencies in a 25-county region in eastern, rural North Carolina. Prior to the H1N1 pandemic, an 18-item voluntary, self-administered survey (pen-and-paper or web-based) was provided to 1653 employees of 15 local health departments and two health jurisdictions in 25 counties of eastern North Carolina in May 2008, obtaining vaccination information for 2007-2008 influenza season. Analysis was conducted in summer 2008 and October 2009. A total of 1209 respondents completed the survey (73% response proportion). Seventy-two percent of valid survey respondents voluntarily received free influenza vaccine for the 2007-2008 season. Gender, ethnicity, and >or=10 years working in public health were significantly associated with obtaining vaccine. Using logistic regression, positive significant predictors were having a vaccination last year and perceived importance of vaccine. Cost to obtain vaccination was a deterrent. The most common reason stated was to protect people (66%), while the most common reason for not receiving the vaccine was belief that the vaccine can cause illness (19%). Almost 60% of employees reported support for a mandatory seasonal influenza vaccination program at their health department. The percentage of county public health workers obtaining seasonal influenza vaccination is almost twice that of healthcare workers in other settings. This study provides evidence that efforts may be successful in increasing influenza vaccination coverage of healthcare workers.

The prevalence of childhood adversity among healthcare workers and its relationship to adult life events, distress and impairment

Objective We investigated the prevalence of childhood adversity among healthcare workers and if such experiences affect responses to adult life stress. Methods A secondary analysis was conducted of a 2003 study of 176 hospital-based healthcare workers, which surveyed lifetime traumatic events, recent life events, psychological distress, coping, social support, and days off work due to stress or illness. Results Sixty eight percent (95% CI 61.1–74.9) of healthcare workers had one or more experience of violence, abuse or neglect, 33% (95% CI 26.1–40.0) before the age of 13. Compared to healthcare workers who did not experience childhood adversity, those who did reported more recent life events (median 11 vs. 5 over the previous 6 months, p < .001) and greater psychological distress (median score 17 vs. 13, p < .001). The relationship between life events and psychological distress was not linear. Most healthcare workers without childhood adversity (73%) reported a low number of life events which were not associated with psychological distress. Most healthcare workers with childhood adversity (81%) reported a higher number of life events, for which the correlation between events and distress was moderately strong (Spearman's rho = .50, p < .001). Childhood adversity was also associated with more missed work days. Each of these outcomes was higher in 22 healthcare workers (13%) who had experienced more than one type of childhood adversity. Conclusions Childhood adversity is common among healthcare workers and is associated with a greater number of life events, more psychological distress and impairment.

Wristwatch use and hospital-acquired infection

The wrists and hands of hospital-based healthcare workers (HCWs) were sampled for bacterial contamination in two consecutive cross-sectional cohort studies of wristwatch wearers and non-wristwatch wearers. In the first study (N=100), wrists were sampled by skin swabs and hands by direct plate inoculation. In the second study (N=155) wrists were sampled after each HCW removed the watch immediately prior to sampling. Staphylococcus aureus was found on the hands of 25% of wristwatch wearers and 22.9% of non-wristwatch wearers in the first study. Watch wearers had higher counts of bacteria on their wrist (P<0.001) but not on their hands. In the second study, removal of the watch prior to sampling resulted in increased counts of bacteria on both hands as well as on the watch wrist compared with non-watch wearers (P<0.001). In conclusion, wearing a wristwatch results in an increase in bacterial contamination of the wrist but excess hand contamination does not occur unless the watch is manipulated.