Hospital-based Health Care Workers Research Articles

Hospital-Based Healthcare Workers' Experiences of Involvement in Perinatal Child Protection Processes: A Scoping Literature Review.

As the number of infants entering Out-of-Home Care at birth internationally continues to rise, Hospital-based healthcare workers (HBHCWs) are increasingly likely to become involved in ethically, morally, and legally complex child protection processes. This scoping review aimed to identify and synthesize qualitative literature pertaining to the perspectives of HBHCWs with experiences of involvement in child protection processes occurring in the perinatal period. JBI Methodology for Scoping Reviews guided this review. Databases Ovid MEDLINE, CINAHL Plus, PsycINFO, ProQuest, Web of Science, SCOPUS, and Informit were searched between March 1 and April 30, 2023. Eighteen sources were identified as meeting the criteria for inclusion following screening by two independent reviewers. Data extracted from the included sources are presented in narrative and tabular formats. Involvement in child protection processes is an inherently conflictual experience for HBHCWs and gives rise to internal, interpersonal, and interorganizational tensions. Involvement can have an enduring impact on the HBHCWs, particularly when an infant is removed from hospital by child protection authorities. Appropriate peer, managerial, and organizational level responses are essential to ameliorate risk to HBHCWs themselves and subsequently their practice with women, infants, and families. HBHCWs can provide valuable insight into the challenges of delivering healthcare at the interface of child protection. Future research should focus on building understanding of experiences across disciplines to ensure that interventions designed to prepare and support HBHCWs are effective and evidence-based.

Frontline healthcare workers’ lived experiences of healthcare work during the COVID-19 pandemic

Abstract Background The COVID-19 pandemic changed the face of modern healthcare, with impacts felt by staff and organisations alike. Globally, hospital-based healthcare workers have identified increased stress, anxiety, insomnia, and reduced wellbeing related to their work roles. Hospitals have been plagued by increased demand, poor staff retention and a reduction in the working hours of remaining staff. This paper sought to explore the unique experiences of frontline healthcare workers (FHWs) with parenting responsibilities working in Australian hospitals during the COVID-19 pandemic. Methods Thirty-nine FHWs with parenting responsibilities from Australian public hospitals were interviewed from October 2020 and February 2021. Reflexive thematic analysis was used to interrogate transcripts arising from extended interviews with participants regarding their experiences with healthcare work and the workplace support they received during the COVID-19 pandemic. Results Key themes indicate that workplace changes during the early stages of the pandemic were rapid and placed significant burden on healthcare staff and leaders, impacting their physical, mental and social health. Support from leaders was seen as protective for staff but placed an additional burden on staff in leadership roles. Additionally, when leaders considered family safety and were flexible when family demands surged, staff reported better wellbeing and feelings of support. While staff felt a sense of pride in their role during this time and were motivated by family members, they reported reduced career enjoyment and were concerned about long-term mental health consequences. Conclusions The challenges and fatigue associated with healthcare work during a pandemic can impact FHWs in varied ways. However, findings during the COVID-19 pandemic sheds light on important areas that can be bolstered and enhanced during pandemic planning that can prevent negative impacts in future pandemics. Key messages • The COVID-19 pandemic has demonstrated how a pandemic significantly impact healthcare roles and the wellbeing of staff, indicating a need for better pandemic planning in the future. • Important factors to consider during future pandemic planning are proper management of workplace changes, managing staff's work life balance and family safety, and enhancing support from leaders.

ASSESSMENT OF THE LEVEL OF CONCERNS REGARDING COVID-19 PANDEMIC AMONG HOSPITAL BASED HEALTHCARE WORKERS IN QUETTA, PAKISTAN

Background: The study was aimed to assess the level of concerns regarding the COVID-19 Pandemic among hospital-based healthcare workers in Quetta, Pakistan. Material and Methods: It was a cross-sectional study carried out between August to December 2020 among frontline healthcare workers who work in the emergency department of different public sector hospitals of Quetta. The questionnaire was distributed through online social forums and physically at some places. The calculated sample size was n=400. Results: The most significant findings were that n=179 (44.8%) felt themselves at risk to get Covid 19 from workplace; n=168 (42%) respondents had limited their social activities; n=125 (58.14%) respondents had access to complete Personnel Protective Equipment (PPEs) n=290 (72.5%) cumulative respondents had access to some -PPE items. Conclusion: The healthcare workers suffered much mental anguish, trauma and isolation during the covid-19 pandemic. Scarcity of resources preventing access to complete PPE further added to it. Key Words: Covid-19, Concern, Healthcare workers, Quetta

The effect of COVID-19 on workplace violence in California's hospitals: An interrupted time series analysis.

This study used California's unique Workplace Violent Incident Reporting System (WVIRS) to describe changes in workplace violence (WV) exposure for hospital-based healthcare workers during the pandemic. Interrupted time series analysis. We compared the linear trends in weekly WV incidents reported during the period before the COVID-19 pandemic (7/1/2017-3/20/2020) to the period following California's shutdown (3/21/2020-6/30/2021). We created mixed effects models for incidents reported in emergency departments (EDs) and in other hospital units. We used hospital volume data from the California Department of Health Care Access and Information. A total of 418 hospitals reported 37,561 incidents during the study period. For EDs, the number of reported incidents remained essentially constant, despite a 26% drop in outpatient visits between the first and second quarters of 2020. For other hospital units, weekly incidents initially dropped-parallel to a 13% decrease in inpatient days between the first and second quarters of 2020-but then continued parallel to the trend seen in the pre-COVID period. WV persists steadily in California's hospitals. Despite major reductions in patient volume due to COVID-19, weekly reported ED incidents remained essentially unchanged. Surveys and media reported that WV increased during the pandemic, but it has been difficult to measure these changes using a large-scale database. The absolute number of WV incidents did not increase during the pandemic; however, the trend in reported incidents remained constant in the context of dramatic decreases in patient volume. New federal WV prevention legislation is being considered in the U.S. California's experience of implementation should be considered to improve WV reporting and prevention. There was no public contribution to this study. The goal of this analysis was to summarize findings from administrative data. The findings presented can inform future discussion of public policy and action.

The Effect of Occupational Stress and Concerns about the COVID-19 Pandemic on Secondary Traumatic Stress Syndrome among Iranian Frontline Nurses: A Mediating Model.

Objective: With the increasing effects of stress caused by the COVID-19 pandemic and occupational stress on the mental health of frontline nurses, it is imperative to further investigate how these stresses affect nurses' mental health and secondary traumatic stress syndrome. This research aimed to investigate the relationship of nurses' occupational stress and concerns about COVID-19 with secondary traumatic stress syndrome, and also to investigate the mediating effect that concerns about the COVID-19 pandemic have on the relationship between nurses' occupational stress and secondary traumatic stress syndrome. Method : A cross-sectional design was adopted. The population of the study was defined as all front-line nurses in Shiraz hospitals, from which 225 nurses of two corona care hospitals were selected using convenience sampling. The degree of secondary traumatic stress, concerns about the COVID-19, and nurses' occupational stress were assessed using Bride's Secondary Traumatic Stress Scale (STSS), an adopted version of Level of Concerns about the COVID-19 questionnaire, and the Nurses' Occupational Stressor Scale (NOSS) among Hospital-based Healthcare Workers. Structural equation modeling (SEM) was used to examine the relationships among variables. Results: Results showed that nurses' occupational stresses presented a direct effect on nurses' level of concern about the COVID-19 pandemic (β = 0.85, P < 0.001), and concern about the COVID-19 pandemic was directly related to front-line nurse's secondary traumatic stress syndrome (β = 0.83, P < 0.001). In addition, nurses' level of concern about the COVID-19 pandemic fully mediated the effects of nurses' occupational stresses on their secondary traumatic stress (β = 0.70, P < 0.001). This indirect effect has explained 68% of the variance in nurses' secondary traumatic stress. Conclusion: These results emphasized the indirect effect of nurses' occupational stresses on secondary traumatic stress syndrome via mediating the level of concern about COVID-19. Therefore, to reduce the secondary traumatic stress of nurses who have dealt directly with COVID-19 patients, it seems necessary to pay serious attention to the sources of their occupational stress, which probably existed even before this pandemic and increased their concerns in pandemic conditions.

Sociodemographic and Occupational Factors Associated with Low Early Uptake of COVID-19 Vaccine in Hospital-Based Healthcare Workers, Georgia, March-July 2021.

In Georgia, an upper-middle income European country, the COVID-19 vaccine rollout began on 15 March 2021 with health workers (HWs), a priority group for vaccination. We assessed the factors associated with COVID-19 vaccination among HWs at six large hospitals in the early stages of the vaccine rollout (March–July 2021). Among 1533 HWs, 274 (17.9%) had received one dose of the COVID-19 vaccine. Strong independent predictors of early vaccine uptake were age > 40 years, especially 50–59 years old (aOR 2.40, 95% CI 1.50–3.88), considering the vaccine as “somewhat effective” or “very effective” rather than “not effective” (aOR 6.33, 95% CI 2.29–26.3 and aOR 10.9, 95% CI 3.88–45.70, respectively), and previous vaccination against seasonal influenza (aOR 2.98, 95% CI 2.19–4.08). Previous SARS-CoV-2 infection was negatively associated with receiving the vaccine (aOR 0.6, 95% CI 0.40–0.80). Compared to physicians, nurses/midwives (aOR 0.22, 95% CI 0.15–0.32), administrative staff (aOR 0.36, 95% CI 0.22–0.56), and ancillary staff (aOR 0.07, 95% CI 0.04–0.15) were less likely to have received the COVID-19 vaccine. Tailoring the COVID-19 vaccine communications campaign to younger and non-physician HWs, and emphasizing the benefits of the COVID-19 vaccine, could help further increase vaccine coverage among HWs in Georgia.

3a edizione Giornate della ricerca scientifica e delle esperienze professionali dei giovani: Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica (SItI) 25-26 marzo 2022.

INTRODUCTIONCoronavirus disease (COVID-19) was first detected in Wuhan city, China in December 2019. The followed pandemic has been one of the worst threats to healthcare systems all over the world [1,2]. Healthcare workers are at a high risk of SARS-CoV-2 infection that can result in a reduced healthcare workforce [3,4]. Therefore, measuring the seroprevalence, incidence and identifying the risk factors for hospital-related SARS-CoV-2 could provide important information to control the COVID-19 within hospitals, to protect patients and healthcare workers and to save lives. Furthermore, evaluating the real-world COVID-19 vaccine performance is critical for understanding the risks and benefits of vaccination programmes. In this framework, in 2020, the European Centre for Disease Prevention and Control (ECDC) initiated two projects, coordinated by Epiconcept, France, to support the development and implementation of two multicentre European studies to: i) conduct hospital-based transmission and seroepidemiological studies, to measure seroprevalence, incidence and identifying risk factors of SARS-CoV-2 infection among healthcare workers and ii) evaluate the effectiveness of the COVID-19 vaccine in hospital-based healthcare workers. The Azienda Ospedaliero-Universitaria Policlinico “G. Rodolico - San Marco”, University of Catania, has participated in the two studies to evaluate among healthcare workers the risk factors for COVID-19 and vaccine efficacy. The aim of this work is to describe data we collected thanks to the participation in these European studies.MATERIALS AND METHODSWe conducted simultaneously the two different prospective multicentre studies in the same cohort of healthcare workers and in the same context. One study was conducted to measure risk of SARS-CoV-2 infection and identify risk factors for SARS-CoV-2 infection and seroprevalence among healthcare workers. The other one was conducted to measure product-specific COVID-19 vaccine effectiveness among hospital healthcare workers eligible for vaccination against all laboratory-confirmed SARS-CoV-2 infection. We collected information on community and in-hospitals exposures 14 days before enrolment. Once informed consent had been obtained, healthcare workers were enrolled regardless of their individual vaccination and provided a nasopharyngeal swab for RT-PCR analysis, provided a blood sample for serology testing, completed an enrolment questionnaire that includes demographic, clinical, and epidemiological information, information about vaccination history, and occupation- and community-related behaviour. The follow-up consisted in a RT-PCR test searching for SARS-CoV-2 RNA virus once a week and a blood sample for serology once a month. Participants were followed up with a weekly survey to report changes in health or vaccination status as well as likely professional and personal exposures.RESULTSDuring the study period, from July to October 2021, a total of 231 healthcare workers from the Catania site were enrolled. A decline in seroprevalence among healthcare workers was detected. During the follow-up period, 6 COVID-19 cases were detected using RT-PCR test with an incidence of 4 per 10,000 person-days. Due to the low number of infections detected during the study results on risk factors – as age, educational level and current smoking – need to be interpreted with caution. In light of the very high COVID-19 vaccine coverage rates, with nearly all healthcare workers having received at least one dose of vaccine before enrolment, comparing the incidence of SARS-CoV-2 infection or COVID-19 disease in vaccinated and unvaccinated groups is not possible because of limited sample size.CONCLUSIONSA low number of COVID-19 infections were detected during the follow-up of HCW with the information available, all of them vaccinated with two doses of RNA messenger vaccine and no previous infection. The very high COVID-19 vaccine coverage rateseriously compromises the possibility of estimating vaccine efficacy of COVID-19 vaccines by both a reduction in the power of the study and the introduction of a selection bias as unvaccinated and partially vaccinated HCW are unlikely to be representative of HCW in general. As the study on vaccine effectiveness is still on-going in many European sites, it is expected that the sample size will increase along with infections.

Trends in burnout and psychological distress in hospital staff over 12 months of the COVID-19 pandemic: a prospective longitudinal survey

BackgroundThe mental health effects of healthcare work during the COVID-19 pandemic have been substantial, but it is not known how long they will persist. This study aimed to determine if hospital workers’ burnout and psychological distress increased monotonically over 1 year, during which waves of case numbers and hospitalizations waxed and waned, or followed some other pattern.MethodsA prospective longitudinal survey was conducted at four time-points over 1 year in a cohort of 538 hospital workers and learners, which included validated measures of burnout (emotional exhaustion scale of Maslach Burnout Inventory) and psychological distress (K6). Repeated measures ANOVA tested changes over time and differences between subjects by occupational role, age and ethnic group. The direction and magnitude of changes over time were investigated by plotting rates of high scores (using cut-offs) at each time-point compared to case rates of COVID-19 in the city in which the study took place.ResultsThere were significant effects of occupational role (F = 11.2, p < .001) and age (F = 12.8, p < .001) on emotional exhaustion. The rate of high burnout was highest in nurses, followed by other healthcare professionals, other clinical staff, and lowest in non-clinical staff. Peak rates of high burnout occurred at the second or third measurement point for each occupational group, with lower rates at the fourth measurement point. Similarly to the results for emotional exhaustion, rates of high psychological distress peaked at the spring 2021 measurement point for most occupational groups and were higher in nurses than in other healthcare professionals.ConclusionsNeither emotional exhaustion nor psychological distress was rising monotonically. Burnout and psychological distress were consistently related to occupational role and were highest in nurses. Although emotional exhaustion improved as the case rate of COVID-19 decreased, rates of high emotional exhaustion in nurses and other healthcare professionals remained higher than was typically measured in hospital-based healthcare workers prior to the pandemic. Ongoing monitoring of healthcare workers’ mental health is warranted. Organizational and individual interventions to support healthcare workers continue to be important.

The experience of European hospital-based health care workers on following infection prevention and control procedures and their wellbeing during the first wave of the COVID-19 pandemic.

Working under pandemic conditions exposes health care workers (HCWs) to infection risk and psychological strain. A better understanding of HCWs' experiences of following local infection prevention and control (IPC) procedures during COVID-19 is urgently needed to inform strategies for protecting the psychical and psychological health of HCWs. The objective of this study was therefore to capture the perceptions of hospital HCWs on local IPC procedures and the impact on their emotional wellbeing during the first wave of the COVID-19 pandemic in Europe. Participants were recruited in two sampling rounds of an international cross-sectional survey. Sampling took place between 31 March and 17 April 2020 via existing research networks and between 14 May and 31 August 2020 via online convenience sampling. Main outcome measures were behavioural determinants of HCWs' adherence to IPC guidelines and the WHO-5 Well-Being Index, a validated scale of 0-100 reflecting emotional wellbeing. The WHO-5 was interpreted as a score below or above 50 points, a cut-off score used in previous literature to screen for depression. 2289 HCWs from 40 countries in Europe participated. Mean age was 42 (±11) years, 66% were female, 47% and 39% were medical doctors and nurses, respectively. 74% (n = 1699) of HCWs were directly treating patients with COVID-19, of which 32% (n = 527) reported they were fearful of caring for these patients. HCWs reported high levels of concern about COVID-19 infection risk to themselves (71%) and their family (82%) as a result of their job. 40% of HCWs considered that getting infected with COVID-19 was not within their control. This feeling was more common among junior than senior HCWs (46% versus 38%, P value < .01). Sufficient COVID-19-specific IPC training, confidence in PPE use and institutional trust were positively associated with the feeling that becoming infected with COVID-19 was within their control. Female HCWs were more likely than males to report a WHO-5 score below 50 points (aOR 1.5 (95% confidence interval (CI) 1.2-1.8). In Europe, the COVID-19 pandemic has had a differential impact on those providing direct COVID-19 patient care, junior staff and women. Health facilities must be aware of these differential impacts, build trust and provide tailored support for this vital workforce during the current COVID-19 pandemic.

'We are largely left out': workplace and psychosocial experiences of Australian general practitioners during the initial months of the COVID-19 pandemic.

The COVID-19 pandemic continues to exert a significant toll on the Australian primary healthcare system. Although wellbeing challenges faced by hospital-based healthcare workers are widely discussed, less is known about the experiences of general practitioners (GPs) during the initial phases of the pandemic. This paper reports qualitative survey data from Australian GPs, examining their workplace and psychosocial experiences during the initial months of the pandemic. An Australia-wide, cross-sectional, online survey of frontline healthcare workers was conducted in 2020. A qualitative approach using content analysis was utilised to examine responses to four free-text questions from GPs. A total of 299 GPs provided 888 free-text responses. The findings reveal that general practice was overlooked and undervalued within the pandemic response, resulting in negative impacts on GP wellbeing. Four themes were identified: (1) marginalisation of GPs; (2) uncertainty, undersupported and undervalued in the workplace; (3) isolation and disrupted personal lives; and (4) strategies to support GPs during times of crises. Key concerns included poor access to personal protective equipment, occupational burnout and poor wellbeing, insufficient workplace support, and conflicting or confusing medical guidelines. Primary healthcare constitutes an essential pillar of the Australian healthcare system. This study presents the many factors that impacted on GP wellbeing during the COVID-19 pandemic. Enabling GP voices to be heard and including GPs in decision-making in preparation for future crises will enhance the delivery of primary care, reducing the burden on hospital services, and help sustain a safe and effective health workforce long term.

The Psychological Impact of COVID-19 on Home Based Primary Care Providers in New York: A Qualitative Study

Research on professional burnout during the pandemic has focused on hospital-based health care workers. This study examined the psychological impact of the pandemic on home-based primary care (HBPC) providers. We interviewed 13 participants from six HBPC practices in the New York including medical/clinical directors, program managers, nurse practitioners, and social workers and analyzed the transcripts using inductive qualitative analysis approach. HBPC providers experienced emotional exhaustion and a sense of reduced personal accomplishment. They reported experiencing grief of losing many patients at once and pressure to adapt to changing circumstances quickly. They also reported feeling guilty for failing to protect their patients and reduced confidence in their professional expertise. Strategies to combat burnout included shorter on-call, regular condolence meetings to acknowledge patient deaths, and peer support calls. Our study identifies potential resources to improve the well-being and reduce the risk of burnout among HBPC providers.

The Experience of Health Care Workers Caring for Older Adults During the COVID-19 Pandemic

Older adults are at increased risk for COVID-19 illness, hospitalization, and mortality. Essential health care workers became the backbone of their care during the pandemic, and their experiences are worthy of discussion. This symposium will highlight the emotional impact of COVID-19 on health care workers, and their scope of practice in various health settings. Using data from a cross-sectional survey, presenter one will describe concerns and coping strategies among nursing home social workers during COVID-19. Next, presenter two will present findings on the emotional health and wellbeing of home care workers. Then, presenter three will describe the experience of the VA’s strike teams sent into 82 Florida nursing homes most impacted by COVID. Presenter four will describe findings from a qualitative study on emotional distress experienced by hospital-based medical directors, nurse practitioners, and other health care workers. Finally, presenter five will describe findings from a scope of practice among health care social workers study, with an emphasis on how policies in their respective settings impacted their work. Taken together, the presenters’ findings in this symposium have implications for practice and policy recommendations to improve the experience of health care workers during pandemics.

Higher rate of SARS-CoV-2 IgG seropositivity in hospital-based healthcare workers compared to elderly care staff in a Swedish low-prevalence region: a cross-sectional study

Background Previous seroprevalence studies have demonstrated higher anti-SARS-CoV-2 IgG seroprevalence in healthcare workers (HCWs) than in the background population during the first phase of the 2020 COVID-19 pandemic. These studies, however, focussed mainly on hospital employees. Aim To perform a cross-sectional study comparing the seroprevalence of hospital-based HCWs with those employed in elderly care (home care and nursing homes). Methods Employees (n = 4955) in the county of Värmland, Sweden, were recruited between weeks 27 and 42 and tested for IgG antibodies against SARS-CoV-2. Serological results were combined with self-reported questionnaire data. Findings IgG seroprevalence was 5.7% in the total group of HCWs, and was higher among those employed in hospital-based healthcare than among those working in elderly care (8.4% vs. 3.7%, p < .001). Being employed as an assistant nurse, working in a COVID-19 unit, and being exposed via co-workers or private acquaintances were all associated with IgG seropositivity. Conclusion The difference in seroprevalence between HCWs in the two settings suggests that not only the profession but also factors in the workplace environment may be of importance. As all studied exposures were associated with IgG seropositivity, and asymptomatic infection was detected in 7.5% of participants, preventing outbreaks among HCWs is challenging. Adequate use of personal protective equipment when working with patients regardless of COVID-19 status, source control in situations with co-workers in which distancing is not possible, and routines enabling symptomatic staff to isolate pending PCR results are required to prevent healthcare-associated outbreaks of COVID-19.

Hospital-Based Healthcare Workers Victims of Workplace Violence in Italy: A Scoping Review.

The aim of this scoping review is to synthesize the available evidence on the prevalence rates of healthcare workers being victims of violence perpetrated by patients and visitors in Italy. PubMed, Scopus, Web of Science and CINAHL were systematically searched from their inception to April 2021. Two authors independently assessed 1182 studies. All the scientific papers written in English or in Italian reporting primary quantitative and/or qualitative data on the prevalence of aggression or sexual harassment perpetrated by patients or visitors toward healthcare workers in Italy were included. Thirty-two papers were included in the review. The data extracted were summarized in a narrative synthesis organized in the following six thematic domains: (1). Methodology and study design; (2). Description of violent behavior; (3). Characteristics of health care staff involved in workplace violence (WPV); (4). Prevalence and form of WPV; (5). Context of WPV; and (6). Characteristics of violent patients and their relatives and/or visitors. The proportion of studies on WPV differed greatly across Italian regions, wards and professional roles of the healthcare workers. In general, the prevalence of WPV against healthcare workers in Italy is high, especially in psychiatric and emergency departments and among nurses and physicians, but further studies are needed in order to gather systematic evidence of this phenomenon. In Italy, and worldwide, there is an urgent need for governments, policy-makers and health institutions to prevent, monitor and manage WPV towards healthcare professionals.

“I felt useless”: a qualitative examination of COVID-19’s impact on home-based primary care providers in New York

ABSTRACT Research on professional burnout during the pandemic has focused on hospital-based health care workers. This study examined the psychological impact of the pandemic on home-based primary care (HBPC) providers. We interviewed 13 participants from six HBPC practices in New York City including medical/clinical directors, program managers, nurse practitioners, and social workers and analyzed the transcripts using inductive qualitative analysis approach. HBPC providers experienced emotional exhaustion and a sense of reduced personal accomplishment. They reported experiencing grief of losing many patients at once and pressure to adapt to changing circumstances quickly. They also reported feeling guilty for failing to protect their patients and reduced confidence in their professional expertise. Strategies to combat burnout included shorter on-call schedules, regular condolence meetings to acknowledge patient deaths, and peer support calls. Our study identifies potential resources to improve the well-being and reduce the risk of burnout among HBPC providers.

SARS-CoV-2 RT-PCR positivity and antibody prevalence among asymptomatic hospital-based health care workers.

BackgroundThe level of asymptomatic infection with SARS-CoV-2 could be substantial and among health care workers (HCWs) a source of continuing transmission of the virus to patients and co-workers.ObjectivesMeasure the period prevalence of SARS-CoV-2 PCR positivity and seroprevalence of SARS-CoV-2 IgG antibodies among a random sample of asymptomatic health system hospital-based health care workers (HCWs) 6½ -15½ weeks after 4/5/2020, the peak of the first surge of COVID-19 admissions.ResultsOf 524 eligible and consented participants from four metropolitan hospitals, nasopharyngeal swabs were obtained from 439 (83.8 %) and blood from 374 (71.4 %). Using PCR nucleic acid-based amplification (NAAT) methods, the period prevalence of SARS-CoV-2 infection was 0.23 % (95 % confidence interval (CI) 0.01 %–1.28 %; 1/439) from 5/21/20−7/16/20. The seroprevalence of SARS-CoV-2 IgG antibodies from June 17-July 24, 2020 was 2.41 % (95 % CI 1.27 %–4.51 %; 9/374). Those who were reactive were younger (median age 36 versus 44 years; p = 0.050), and those with self-reported Hispanic/Latino ethnicity had a higher seroprevalence (2/12 = 16.7 % versus 7/352 = 2.0 %; p = 0.051). There were no significant differences by sex, race, residence, hospital, unit or job type. The one employee who was found to be PCR test positive in this study was also reactive for IgG antibodies, tested 27 days later.ConclusionsThe period prevalence of PCR positivity to SARS-CoV-2 and IgG seroprevalence was unexpectedly low in asymptomatic HCWs after a peak in COVID-19 admissions and the establishment of state and institutional infection control policies, suggesting that routine screening tests while community prevalence is relatively low would produce a minimal yield.

Rapid Design and Delivery of an Experience-Based Co-designed Mobile App to Support the Mental Health Needs of Health Care Workers Affected by the COVID-19 Pandemic: Impact Evaluation Protocol

BackgroundThe COVID-19 pandemic has highlighted the importance of health care workers’ mental health and well-being for the successful function of the health care system. Few targeted digital tools exist to support the mental health of hospital-based health care workers, and none of them appear to have been led and co-designed by health care workers.ObjectiveRMHive is being led and developed by health care workers using experience-based co-design (EBCD) processes as a mobile app to support the mental health challenges posed by the COVID-19 pandemic to health care workers. We present a protocol for the impact evaluation for the rapid design and delivery of the RMHive mobile app.MethodsThe impact evaluation will adopt a mixed methods design. Qualitative data from photo interviews undertaken with up to 30 health care workers and semistructured interviews conducted with up to 30 governance stakeholders will be integrated with qualitative and quantitative user analytics data and user-generated demographic and mental health data entered into the app. Analyses will address three evaluation questions related to engagement with the mobile app, implementation and integration of the app, and the impact of the app on individual mental health outcomes. The design and development will be described using the Mobile Health Evidence Reporting and Assessment guidelines. Implementation of the app will be evaluated using normalization process theory to analyze qualitative data from interviews combined with text and video analysis from the semistructured interviews. Mental health impacts will be assessed using the total score of the 4-item Patient Health Questionnaire (PHQ4) and subscale scores for the 2-item Patient Health Questionnaire for depression and the 2-item Generalized Anxiety Scale for anxiety. The PHQ4 will be completed at baseline and at 14 and 28 days.ResultsThe anticipated average use period of the app is 30 days. The rapid design will occur over four months using EBCD to collect qualitative data and develop app content. The impact evaluation will monitor outcome data for up to 12 weeks following hospital-wide release of the minimal viable product release. The study received funding and ethics approvals in June 2020. Outcome data is expected to be available in March 2021, and the impact evaluation is expected to be published mid-2021.ConclusionsThe impact evaluation will examine the rapid design, development, and implementation of the RMHive app and its impact on mental health outcomes for health care workers. Findings from the impact evaluation will provide guidance for the integration of EBCD in rapid design and implementation processes. The evaluation will also inform future development and rollout of the app to support the mental health needs of hospital-based health care workers more widely.International Registered Report Identifier (IRRID)DERR1-10.2196/26168

Safety and efficacy of hydroxychloroquine as a prophylactic treatment against coronavirus disease-19 in health-care workers

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a rapidly emerging virus responsible for the ongoing COVID-19 pandemic with no known effective prophylaxis. We investigated whether Hydroxychloroquine (HCQ) could prevent SARS CoV-2 in Health Care Workers (HCW) at high-risk of exposure. Method: This voluntary observational study for the prevention and treatment of COVID- 19 was conducted at a tertiary care center, from 12th June to 12th October 2020(total 16 weeks). All consented asymptomatic HCW’s of CIMS hospital were administered 400 mg HCQ twice a day on day one followed by 400 mg once weekly to be taken with meals up to 16 weeks. Data collected included OPD registration, risk assessment, medical and family history (related to COVID), physical examination and vitals, pulse oximetry, ECG (pre and post HCQ), drug adherence, side effects, adverse drug reactions. Result: The study enrolled 927 full-time, hospital-based HCWs ((including doctors, nurses, paramedical, lab technicians, sanitary workers and others), of whom 731(78.85%) initially started HCQ while 196 (21.14%) did not volunteer. The median age and weight of the study population was 27.5 years and 69.5 kg respectively. No major associated co-morbidities were present in these HCW’s. There was an increased trend towards non adherence to HCQ with each proceeding week more so after week 11. Of the 731 HCW’s taking HCQ a total of 167(22.8%) tested COVID positive at different intervals of time as against 30 HCW (15.3%) out of 196 not taking HCQ. The rate of COVID-19 positive was statistically significantly higher in the HCW’s taking HCQ (p=0.0220; 95% CI: 1.14% to 12.94%), as compared to those not on HCQ. Thus HCQ was not prophylactically effective against COVID-19 infection. No participants in this study experienced grade 3 or 4 adverse events. No significant difference in the median of ECG changes in QTC between pre and post HCQ administration of 46 HCW’s was observed. Conclusion: This clinical study did not detect a reduction in SARS CoV-2 transmission with prophylactic administration of 400 mg/HCQ in HCW’s. All participants who did contract SARS CoV-2 were either asymptomatic or had mild disease courses with full recoveries. All adverse events were self-limiting and no serious cardiovascular events were reported with use of HCQ. In the absence of robust data, it seems premature to recommend HCQ as a prophylactic panacea for COVID-19.

Establishment of a hospital-based health care workers surveillance programme to keep them safe during the COVID-19 pandemic.

Establishment of a hospital-based health care workers surveillance programme to keep them safe during the COVID-19 pandemic.

Efficacy and Safety of Hydroxychloroquine vs Placebo for Pre-exposure SARS-CoV-2 Prophylaxis Among Health Care Workers

Health care workers (HCWs) caring for patients with coronavirus disease 2019 (COVID-19) are at risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Currently, to our knowledge, there is no effective pharmacologic prophylaxis for individuals at risk. To evaluate the efficacy of hydroxychloroquine to prevent transmission of SARS-CoV-2 in hospital-based HCWs with exposure to patients with COVID-19 using a pre-exposure prophylaxis strategy. This randomized, double-blind, placebo-controlled clinical trial (the Prevention and Treatment of COVID-19 With Hydroxychloroquine Study) was conducted at 2 tertiary urban hospitals, with enrollment from April 9, 2020, to July 14, 2020; follow-up ended August 4, 2020. The trial randomized 132 full-time, hospital-based HCWs (physicians, nurses, certified nursing assistants, emergency technicians, and respiratory therapists), of whom 125 were initially asymptomatic and had negative results for SARS-CoV-2 by nasopharyngeal swab. The trial was terminated early for futility before reaching a planned enrollment of 200 participants. Hydroxychloroquine, 600 mg, daily, or size-matched placebo taken orally for 8 weeks. The primary outcome was the incidence of SARS-CoV-2 infection as determined by a nasopharyngeal swab during the 8 weeks of treatment. Secondary outcomes included adverse effects, treatment discontinuation, presence of SARS-CoV-2 antibodies, frequency of QTc prolongation, and clinical outcomes for SARS-CoV-2-positive participants. Of the 132 randomized participants (median age, 33 years [range, 20-66 years]; 91 women [69%]), 125 (94.7%) were evaluable for the primary outcome. There was no significant difference in infection rates in participants randomized to receive hydroxychloroquine compared with placebo (4 of 64 [6.3%] vs 4 of 61 [6.6%]; P > .99). Mild adverse events were more common in participants taking hydroxychloroquine compared with placebo (45% vs 26%; P = .04); rates of treatment discontinuation were similar in both arms (19% vs 16%; P = .81). The median change in QTc (baseline to 4-week evaluation) did not differ between arms (hydroxychloroquine: 4 milliseconds; 95% CI, -9 to 17; vs placebo: 3 milliseconds; 95% CI, -5 to 11; P = .98). Of the 8 participants with positive results for SARS-CoV-2 (6.4%), 6 developed viral symptoms; none required hospitalization, and all clinically recovered. In this randomized clinical trial, although limited by early termination, there was no clinical benefit of hydroxychloroquine administered daily for 8 weeks as pre-exposure prophylaxis in hospital-based HCWs exposed to patients with COVID-19. ClinicalTrials.gov Identifier: NCT04329923.