Insufficient Personal Protective Equipment Research Articles

A Comparative Policy for the COVID-19 Emergency Management of Frontline Health Workers in Selected African Countries

Health workers are often exposed to health risks and danger in the discharge of their duties. This is especially distressing during the COVID-19 pandemic. This study employs a multiple case study design to investigate the COVID-19 emergency management of frontline workers in South Africa, Kenya, Ghana, and Nigeria. The findings from the study reveal that governments in the selected countries prioritize the response phase of the emergency management theory over the mitigation and preparedness phases. The response phase was meted with inevitable consequences. Health workers feared risking their lives, and the majority threatened to abandon their jobs due to insufficient personal protective equipment (PPE) and welfare support. The study concludes that the government should prioritize all the phases of emergency management instead of focusing on the response phase, which involves the use of both human and financial resources on an overwhelming pandemic. They should have prepared the frontline workers adequately and equipped their health systems in preparation for any impending epidemic.

Role of cleaners in establishing and maintaining essential environmental conditions in healthcare facilities in Malawi

Abstract Healthcare facility (HCF) cleaners play an important role in preventing healthcare-acquired infections and promoting a safe and clean healthcare environment. There is little evidence describing cleaner roles in HCFs in low-income countries and factors facilitating and constraining their roles and responsibilities. We analyzed qualitative and quantitative data from 57 in-depth interviews with cleaners in 44 government-run HCFs in Malawi. Cleaner constraints included inadequate training on infection prevention and control (IPC), personal protective equipment (PPE), hand hygiene, and waste management; insufficient PPE and hand hygiene resources; assignment of tasks that are unrelated to core responsibilities and their job description; risk of work-related injuries; and disrespect and stigma from medical staff, patients, and guardians. Facilitators included the positive collaboration and communication with medical staff, high job satisfaction, and a positive working attitude. We recommend the provision of more robust IPC, PPE, hand hygiene, and waste management training (including orientation and refresher). PPE resources must be made available to ensure HCF cleanliness and to keep cleaners, staff, patients, and guardians safe. Clearly defined job descriptions for cleaners will clarify their roles, describe bounds of their work, and ensure cleaners are viewed as essential frontline workers who ensure the safety of staff and patients.

Depression, Anxiety and Stress among health care workers during the COVID-19 pandemic in Jazan city, Kingdom of Saudi Arabia

Background: The mental health impact of a disease outbreak is usually neglected by pandemic management with costly consequences. Early evidence shows that health workers directly involved in the diagnosis, treatment, and care of patients with COVID-19 are at risk of developing mental health symptoms. Similar adverse psychological reactions were reported among healthcare workers in previous studies during the 2003 severe acute respiratory syndrome outbreak. Objectives: to assess the prevalence and determinants of depression, anxiety, and stress among healthcare workers at Prince Mohammed bin Nasser Tertiary Hospital in Jazan City during the COVID-19 pandemic. Methods: This was a cross-sectional study conducted among healthcare worker at Prince Mohammed bin Nasser Hospital. A total of 352 health workers were included in the study. Data was collected through a self-administered questionnaire pertaining to socio-demographic characteristics and the depression anxiety stress scale 21-item questionnaire. Descriptive statistics were calculated for study variables, including frequency and percentage for qualitative variables and the mean and standard deviation for quantitative variables. A chi-square test was used to compare categorical data. P 0.05 was used as an indicator of statistically significant differences. Results: A high proportion of mild depression and anxiety was observed among those who had chronic illness (25.7%) and for those who had insufficient personal protective equipment (16.9%). Those differences were statistically significant, with a high proportion of mild stress observed among 3.4% of those who experienced the death of a relative by COVID-19. Conclusion: There was a considerable prevalence of depression, anxiety, and stress among healthcare workers during the COVID-19 pandemic, especially among those who experienced the death of a relative from COVID-19 and those who had a chronic disease. Keywords: depression, anxiety, stress, healthcare worker, COVID-19, Jizan, Saudi Arabia

Primary Care Practices in Western North Carolina: Adaptation to the COVID-19 Pandemic and Ongoing Challenges.

The COVID-19 pandemic has created unique challenges for primary care practices while also highlighting their importance in the pandemic response. To understand primary care practice needs, a survey was conducted of practices in Western North Carolina. Phase 2 of a primary care needs assessment was administered to 63 practices in Western North Carolina over the course of six weeks, from July 23 to August 31, 2021. Most practices were operating with normal hours, though some still operated with reduced hours. Many practices reported insufficient personal protective equipment (PPE) supplies. While most practices provided at least some care via telehealth, practices cited different barriers to providing telehealth, with patient technology challenges being the most frequently cited. Practices have adapted to the restrictions of the pandemic, but many are still vulnerable, and the patients they serve may face reduced access to care due to practice limitations or barriers to telehealth. Practices play a critical role in providing care to patients throughout the pandemic and continue to assist in pandemic response by providing COVID-19 testing and other services. Primary care practices in Western North Carolina continue to provide care to patients and support the overall pandemic response. The pandemic has highlighted the need to include primary care in emergency response efforts. Ongoing work will allow North Carolina to reach practices more effectively in future crises via the newly created NC Responds system, which allows primary care practices to be contacted in the event of a public health emergency.

National hospital readiness for COVID-19 in Lesotho: evidence for oxygen ecosystem strengthening.

Sub-Saharan African country, Lesotho, during the SARS-CoV-2 COVID-19 pandemic. To evaluate COVID-19 hospital capacity in Lesotho. We conducted a pragmatic assessment of all public hospitals in Lesotho using a WHO COVID-19 hospital assessment tool during July 2020 (baseline), with targeted follow-up in December 2020. We adapted the WHO tool into a questionnaire with a focus on hospital services and included oxygen ecosystem elements (pulse oximeters, oxygen, and advanced respiratory care). We converted qualitative questionnaire answers into quantitative ordinal variables and used standard statistics for analysis. At baseline, we found all 12 questionnaire domains demonstrate both hospital preparedness and weakness in infection prevention and control. Key baseline gaps were lack of a dedicated team, and insufficient personal protective equipment and space for donning and doffing. Substantial limitations were noted in hypoxemia diagnosis and treatment; information management and care coordination pathways were also suboptimal. Targeted follow-up after 5 months revealed improvement in the availability of pulse oximetry, oxygen capacity, and heated high-flow nasal cannula devices. Our baseline findings may reflect uneven early pandemic care quality; targeted follow-up suggests strengthening of the oxygen ecosystem.

Infection prevention strategies are highly protective in COVID-19 units while main risks to healthcare professionals come from coworkers and the community

BackgroundEarly evaluations of healthcare professional (HCP) COVID-19 risk occurred during insufficient personal protective equipment and disproportionate testing, contributing to perceptions of high patient-care related HCP risk. We evaluated HCP COVID-19 seropositivity after accounting for community factors and coworker outbreaks.MethodsPrior to universal masking, we conducted a single-center retrospective cohort plus cross-sectional study. All HCP (1) seen by Occupational Health for COVID-like symptoms (regardless of test result) or assigned to (2) dedicated COVID-19 units, (3) units with a COVID-19 HCP outbreak, or (4) control units from 01/01/2020 to 04/15/2020 were offered serologic testing by an FDA-authorized assay plus a research assay against 67 respiratory viruses, including 11 SARS-CoV-2 antigens. Multivariable models assessed the association of demographics, job role, comorbidities, care of a COVID-19 patient, and geocoded socioeconomic status with positive serology.ResultsOf 654 participants, 87 (13.3%) were seropositive; among these 60.8% (N = 52) had never cared for a COVID-19 patient. Being male (OR 1.79, CI 1.05–3.04, p = 0.03), working in a unit with a HCP-outbreak unit (OR 2.21, CI 1.28–3.81, p < 0.01), living in a community with low owner-occupied housing (OR = 1.63, CI = 1.00–2.64, p = 0.05), and ethnically Latino (OR 2.10, CI 1.12–3.96, p = 0.02) were positively-associated with COVID-19 seropositivity, while working in dedicated COVID-19 units was negatively-associated (OR 0.53, CI = 0.30–0.94, p = 0.03). The research assay identified 25 additional seropositive individuals (78 [12%] vs. 53 [8%], p < 0.01).ConclusionsPrior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission.Article summaryPrior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission.

‘Stressed, uncomfortable, vulnerable, neglected’: a qualitative study of the psychological and social impact of the COVID-19 pandemic on UK frontline keyworkers

ObjectivesNon-healthcare keyworkers face distinct occupational vulnerabilities that have received little consideration within broader debates about ‘essential’ work and psychological distress during the COVID-19 pandemic. The aim of this study was...

Shortage of Personal Protective Equipment and Nurse Safety in the Coronavirus Disease-19 Pandemic: A Cross-sectional Study in Indonesia

BACKGROUND: There has been a substantial scarcity of personal protective equipment (PPE) in several countries during the ongoing pandemic of Coronavirus disease-19 (COVID-19). Nurses in Indonesia also experience a shortage of PPE as the number of COVID-19 patients in Indonesia continues to increase. There is no accurate data yet regarding the exact number of PPE scarcity for nurses. AIM: This study aimed to describe the availability of PPE and adverse consequences long-term used off the PPE and examine the relationship between shortage PPE and nurse behavior response in Indonesia. METHODS: An online-based survey was used to collect data on the nurse, regardless of their discipline, training background, or degree of experience, who are directly involved in managing COVID-19 patients. In this study, a total of 211 questionnaires were gathered. The survey was conducted using the Google form. This study employs univariate and bivariate analysis. RESULTS: Most of the mask N95 provision reaches up to 80%. The second is the hazmat (71%) and the lowest in the gloves (30%). Around 71% of respondents generally resist removing their PPE until the shift is complete. Then, 62% of the respondents are ready to propose to the leaders of the PPE, and 51% show that they are modifying the PPE. Nasal blisters are the most prevalent type of injury sustained by nurses while wearing PPE (86%), followed by headaches and dehydration. This study found that most respondents (60.7%) with insufficient PPE had a positive behavior reaction, whereas just 18% had a poor behavior reaction. CONCLUSION: Most nurses have difficulties accessing N95 and experience some adverse effects of prolonging PPE use. Policymakers should take urgent action to tackle these concerns.

Infection preventionists’ experiences during the first nine months of the COVID-19 pandemic: Findings from focus groups conducted with Association of Professionals in Infection Control & Epidemiology (APIC) members

IntroductionA novel human Coronavirus (SARS CoV-2) was identified in January, 2020 and developed into a pandemic by March, 2020. This rapid, enormous, and unanticipated event had major implications for healthcare. Infection preventionists (IP) have a critical role in worker and patient safety. IPs’ lessons learned can guide future pandemic response.MethodsSeven focus groups were conducted with APIC members in September and October, 2020 via Zoom to elicit IPs’ experiences during the COVID-19 pandemic. Sessions were recorded then transcribed verbatim. Major themes were identified through content analysis.ResultsIn total, 73 IPs participated (average of 10 IPs per focus group) and represented all geographical areas and work settings. Participating IPs described multiple challenges they have faced during the COVID-19 pandemic, including rapidly changing and conflicting guidance, a lack of infection prevention recommendations for nonacute care settings, insufficient personal protective equipment, healthcare personnel complacency with personal protective equipment and infection prevention protocols, and increases in healthcare associated infections and workload.ConclusionsThe identified gaps in pandemic response need to be addressed in order to minimize healthcare associated infections and occupational illness. In addition, the educational topics identified by the participating IPs should be developed into new educational programs and resources.

Original Research: Well-Being and Resilience Among Health Care Workers During the COVID-19 Pandemic: A Cross-Sectional Study.

Poor well-being among health care workers, often observed as professional burnout, is a well-documented phenomenon. The coronavirus disease 2019 (COVID-19) pandemic has further stressed the health care workforce, but its specific effects on this workforce remain unknown. This study examined well-being and resilience among health care workers during the COVID-19 pandemic. The study used a cross-sectional survey design. Data collection took place through anonymous surveys of nurses (LPNs and RNs), advanced practice providers (NPs, physician assistants, and certified nurse midwives), certified registered nurse anesthetists, respiratory therapists, health care technicians, and therapy service professionals (physical, occupational, and speech therapists). Of the 6,120 health care workers recruited to participate in the study, data from 2,459 participants were analyzed using logistic regression and linear regression. The study found that several factors significantly increased the likelihood of at-risk well-being. These included having a lower level of resilience, using support resources, feeling the organization lacked understanding of the emotional support needs of health care workers during the pandemic, believing the workload had increased, believing there was insufficient personal protective equipment, believing there was inadequate staffing to safely care for patients, and having a lower degree of psychological safety. After controlling for health care workers' role and employment location, several factors were found to be significantly associated with higher levels of resilience. These included having positive perceptions about the organization's understanding of the emotional support needs of health care workers during the pandemic, believing sufficient educational resources were available regarding the care of COVID-19 patients, having positive perceptions of leadership support from direct managers, having positive perceptions of the redeployment policy, and having a higher degree of psychological safety. This study identified several work environment factors that have significantly affected health care workers' well-being and resilience during the COVID-19 pandemic. This knowledge has practical relevance for health care leaders who aim to better understand and address the well-being and resilience of the health care workforce during this pandemic and beyond.

OCCUPATIONAL HEALTH AND SAFETY OF HEALTH CARE WORKERS IN COVID 19: A RISING CONCERN IN INDIA

The COVID-19 pandemic has put a strain on healthcare services all over the world. With the rising range of healthcare providers diagnosed with COVID globally and with the second wave in India, the crisis has gained global attention and assistance. The healthcare system in India is under strain, putting frontline healthcare staff on edge. Long and exhausting work hours, quickly depleting supplies of personal protective equipment, day-to-night news reports of COVID-19 statistics, inadequate availability of particular drugs, and insufficient societal assistance may all lead to the additional emotional strain of these HCWs. Depression, anxiety, insomnia, and stress are very prevalent among HCWs. Employed in the high-risk division like infectious disorder and pulmonology, and to see a family member that has been diagnosed, deficient or inadequate hand hygiene before and after interaction with patients, insufficient PPE, direct patient interaction (12 times a day), long daily contact hours (15 hrs), and uncontrolled exposure were all linked to COVID-19 risk among Health Care Workers. Working with COVID-19 has demonstrated the interdependence of various components of the work system, such as personal protective equipment (PPE), ventilators, monitoring equipment, staffing, work setting, and so on. Healthcare workers should also implement a detailed ‘infectious disease preparedness and recovery strategy' to train and protect staff before and after a pandemic. Workers must be closely watched, supported, and, when possible, supplied with evidence-based practice after the crisis has passed.

Associations between the working experiences at frontline of COVID-19 pandemic and mental health of Korean public health doctors

BackgroundDemographic, work environmental, and psychosocial features are associated with mental health of healthcare professionals at pandemic frontline. The current study aimed to find predictors of mental health for public health doctors from working experiences at frontline of COVID-19 pandemic.MethodsWith first-come and first-served manner, 350 public health doctors with experiences of work at COVID-19 frontline participated online survey on August 2020. Mental health was defined using the total scores of the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Perceived Stress Scale, and the Stanford Presenteeism Scale-6. Multivariate logistic regression models of mental health with lowest Akaike Information Criterion were determined among all combinations of working environments, perceived threats and satisfaction at frontline, and demographics that were significant (P < 0.05) in the univariate logistic regression.ResultsPerceived distress, lowered self-efficacy at work, anxiety, and depressive mood were reported by 45.7, 34.6, 11.4, and 15.1% of respondents, respectively. Predictors of poor mental health found in the multivariate logistic regression analyses were environmental (insufficient personal protective equipment, workplace of screening center, prolonged workhours) and psychosocial (fear of infection and death, social stigma and rejection) aspects of working experiences at frontline. Satisfaction of monetary compensation and proactive coping (acceptance and willingness to volunteer at frontline) were predictive of better mental health.ConclusionsSufficient supply of personal protective equipment and training on infection prevention at frontline, proper workhours and satisfactory monetary compensation, and psychological supports are required for better mental health of public health doctors at frontline of COVID-19 pandemic.

Assessment of the willingness of doctors to work at coronavirus disease-19 treatment center

Objectives: The Coronavirus disease 2019 (COVID-19) pandemic is currently ravaging the entire world. Doctors as well as other healthcare workers as front-liners in tackling this disease are at a higher risk of exposure to the virus and its potential consequences. The objectives of this study were to assess the knowledge of doctors on the mode of transmission of the virus, to assess their willingness and readiness to work at the COVID-19 treatment center, to identify factors that affect their willingness to work at the treatment center, and to assess their knowledge on infection prevention and control (IPC) practices. Materials and Methods: All medical doctors who attended the COVID-19 sensitization and preparedness meeting with the management of Federal Medical Centre, Owo, Ondo State Nigeria, were recruited into the study after an informed consent was obtained. Study period spanned from the beginning of April 2020 to middle of June 2020. A structured, pre-tested questionnaire was administered to collect relevant information. Results: A total of 112 doctors that were in attendance had the questionnaires administered to them; however, 106 (94.64%) questionnaires were returned. Out of these, 64.2% had correct knowledge of the mode of transmission of COVID-19. We observed that only 34.9% of doctors were willing to work in the treatment center while 1.9% were indifferent. The perceived lack of adequate training and insufficient personal protective equipment (PPE) for staff were major reasons why some doctors were not willing to work in these centers. Fifty percent of the participants got the correct meaning of donning and doffing and three quarters of them had good knowledge of IPC practice. Conclusion: We found in our study that a substantial number of doctors were unwilling to work in COVID-19 treatment areas due to a number of factors including perceived inadequate PPE and inadequate knowledge. The factors that would influence their willingness to work in COVID-19 treatment center were more training, provision of inducement or extra allowances and life insurance schemes. We recommend that in addition to putting emphasis on training, re-training, and providing appropriate equipment, special inducement allowance, and life insurance for healthcare workers might be helpful to encourage them to work in COVID-19 treatment centers.

POS0051 THE IMPACT OF COVID-19 ON RHEUMATOLOGY TRAINING: RESULTS FROM THE COVID-19 GLOBAL RHEUMATOLOGY ALLIANCE TRAINEE SURVEY

Background:The COVID-19 pandemic has disrupted healthcare delivery and education of physicians, including rheumatology trainees.Objectives:To assess the impact of the COVID-19 pandemic on the clinical experiences, research opportunities, and well-being of rheumatology trainees.Methods:A voluntary, anonymous, web-based survey was administered in English, Spanish, or French from 19/08/2020 to 05/10/2020. Adult and paediatric rheumatology trainees worldwide in training in 2020 were invited to participate via social media and email. Using multiple choice questions, Likert scales, and free text answers, we assessed trainee patient care activities, redeployment, research, and well-being.Results:The 302 respondents were from 33 countries, with most (83%, 252/302) in adult rheumatology training. Many trainees (45%, 135/300) reported an increase in non-rheumatology clinical work (e.g. care of COVID-19 patients), with 52% of these (70/135) also continuing rheumatology clinical work. COVID-19 redeployment was not optional for 68% (91/134).Trainees reported a negative impact of the pandemic in their growth in rheumatology (Figure 1). They also reported a substantial impact on several training areas: outpatient clinics (79%, 238/302), inpatient consultations (59%, 177/302), formal teaching (55%, 167/302), procedures (53%, 147/302), teaching opportunities (52%, 157/302), and ultrasonography (36%, 110/302), with 87-96% perceiving a negative impact on these areas. Only 54% (159/294) reported feeling comfortable with their level of clinical supervision during the pandemic (Figure 1).Many trainees (46%, 128/280) reported changes in research experiences during the pandemic; 39% (110/285) reported that COVID-19 negatively affected their ability to continue their pre-pandemic research and 50% (142/285) reported difficulty maintaining research goals (Figure 1).Some rheumatology trainees reported having health condition(s) putting them at high risk for COVID-19 (10%, 30/302) and 14% of trainees (41/302) reported having had COVID-19 (Table 1). Only 53% (160/302) reported feeling physically safe in the workplace while 25% (76/302) reported not feeling physically safe; reasons included lack of training about COVID-19, lack of comfort in the clinical setting, insufficient personal protective equipment, immunocompromised state, and pregnancy. Half (151/302) reported burnout and 68% (204/302) an increase in stress from work during the pandemic (Figure 1), whilst 25% (75/302) reported that changes to their training programme negatively impacted their physical health.Conclusion:The COVID-19 pandemic has negatively impacted the experience of rheumatology training as well as the well-being of trainees globally. Our data highlight concerns for rheumatology trainees including research opportunities and clinical care which should be a focus for curriculum planning.Figure 1.Rheumatology trainee perceptions of pandemic impact and changes in training programme.Table 1.Estimated hazard ratios, adjusted for age and gender, for individuals with rheumatoid arthritisEuropen = 89ROWn = 213Combinedn = 302Disability1 (1)9 (4)10 (3)High risk7 (8)23 (11)30 (10)Pregnant4 (5)15 (7)19 (6)Shielding/Quarantining12 (13)70 (33)82 (27)Acquired COVID-1920 (22)21 (10)41 (14)Disclosure of Interests:Kristen Young: None declared, Su-Ann Yeoh: None declared, Michael Putman: None declared, Elizabeth Graef: None declared, Francis Berenbaum: None declared, Richard Conway: None declared, Rebecca Grainger Speakers bureau: Speaker fees from Abbvie, Janssen, Novartis, Pfizer, Cornerstones, all not related to this work, Consultant of: Consultancy fees from Abbvie, Janssen, Novartis, Pfizer, Cornerstones, all not related to this work, Grant/research support from: Travel assistance from Pfizer, not related to this work, Adam Kilian: None declared, Maximilian Konig: None declared, Jean Liew Grant/research support from: Research grant from Pfizer unrelated to this manuscript, Pedro M Machado Speakers bureau: Speaker fees from Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript, Consultant of: Consulting fees from Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript, Sebastian E. Sattui: None declared, Jeffrey Sparks Consultant of: Consultancy for Bristol-Myers Squibb, Gilead, Inova Diagnostics, Optum, and Pfizer unrelated to this manuscript, Grant/research support from: Research support from Bristol-Myers Squibb unrelated to this manuscript, Paul Sufka: None declared, Manuel Ugarte-Gil Grant/research support from: Research grants from Janssen and Pfizer unrelated to this manuscript, Laura Upton: None declared, Zachary Wallace: None declared, Jinoos Yazdany Consultant of: Consultancy for Astra Zeneca, Eli Lilly, and Pfizer, not related to this work, Grant/research support from: Research grants from Gilead and Pfizer, not related to this work, Arundathi Jayatilleke: None declared.

Impact of the COVID-19 pandemic on the mental health and well-being of UK healthcare workers.

The coronavirus disease 2019 (COVID-19) pandemic has had a significant psychological impact on healthcare workers (HCWs). There is an urgent need to understand the risk and protective factors associated with poor mental well-being of UK HCWs working during the COVID-19 pandemic. Shortly after the April 2020 UK COVID-19 peak 2773 HCWs completed a survey containing measures of anxiety, depression, post-traumatic stress disorder and stress, as well as questions around potential predictors such as roles, COVID-19 risk perception and workplace-related factors. Respondents were classified as high or low symptomatic on each scale and logistic regression revealed factors associated with severe psychiatric symptoms. Change in well-being from pre- to during COVID-19 was also quantified. Nearlya third of HCWs reported moderate to severe levels of anxiety and depression, and the number reporting very high symptoms was more than quadruple that pre-COVID-19. Several controllable factors were associated with the most severe level of psychiatric symptoms: insufficient personal protective equipment availability, workplace preparation, training and communication, and higher workload. Being female, 'front line', previous psychiatric diagnoses, traumatic events, and being an allied HCW or manager were also significantly associated with severe psychiatric symptoms. Sharing stress, resilience and ethical support for treatment decisions were significantly associated with low psychiatric symptoms. Front-line workers showed greater worsening of mental health compared with non-front-line HCWs. Poor mental well-being was prevalent during the COVID-19 response, however, controllable factors associated with severe psychiatric symptoms are available to be targeted to reduce the detrimental impact of COVID-19 and other pandemics on HCW mental health.

P127 The global impact of the first Coronavirus Disease 2019 (COVID-19) pandemic wave on vascular services

BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic is having an unprecedented impact on healthcare delivery. This international qualitative study captured the global impact on vascular patient care during the first pandemic ‘wave’.MethodsAn online structured survey was used to collect regular unit-level data regarding the modification to a wide range of vascular services and treatment pathways on a global scale.ResultsThe survey commenced on 23rd March 2020 worldwide. Over six weeks, 249 vascular units took part in 53 countries (465 individual responses). Overall, 65% of units stopped carotid surgery for anyone except patients with crescendo symptoms or offered surgery on a case-by-case basis, 25% only intervened for symptomatic aortic aneurysms cancelling all ‘elective’ repairs. For patients with symptomatic peripheral arterial disease 60% of units moved to an endovascular-first strategy. For patients who had previously undergone endovascular aortic aneurysm repair, 31.8% of units stopped all postoperative surveillance. Of those units regularly engaging in multidisciplinary team meetings, 59.5% of units stopped regular meetings and 39.1% had not replaced them. Further, 20% of units did not have formal personal protective equipment (PPE) guidelines in place and 25% reported insufficient PPE availability.ConclusionsThe COVID-19 pandemic has had a major impact on vascular services worldwide. There will be a significant vascular disease burden awaiting screening and intervention after the pandemic.

Relationship Between Personal Protective Equipment Use and Contact Dermatitis in Palm Oil Pesticide Workers

Contact dermatitis is the most common occupation-related dermatological disease. Skin contact with chemicals that are irritants or allergens continuously cause vulnerability in workers. Among the chemicals that can cause contact dermatitis are pesticides, which are often used in the community, particularly by palm oil plantation companies. The use of personal protective equipment (PPE) is one risk control for contact dermatitis. This study aimed to determine the relationship between PPE usage and contact dermatitis among palm oil plantation workers who dispense pesticides. Using a cross-sectional research design and a total sampling technique, the study analysed data on contact dermatitis obtained from workers’ medical records and PPE usage through random observations for three days. The results showed that 62.2% of pesticide workers had experienced contact dermatitis within the past three months, and there was a significant relationship between insufficient PPE usage and contact dermatitis (p-value &lt; 0.001). Therefore, the occurrence of contact dermatitis can be reduced by increasing PPE usage.&#x0D; Keywords: contact dermatitis, pesticide, personal protective equipment, palm oil

Influence of anxiety and resilience on depression among hospital nurses: A comparison of nurses working with confirmed and suspected patients in the COVID-19 and non-COVID-19 units.

Aims and objectivesThis study aimed to compare anxiety, resilience, and depression between COVID‐19 unit (confirmed patients and suspected patients) and non‐COVID‐19 unit nurses and assess their effects on depression.BackgroundNurses working during the global pandemic are known to be physically and psychologically exhausted, and experience severe anxiety and depression. However, there is a lack of studies comparing anxiety and depression between COVID‐19 and non‐COVID‐19 unit nurses.DesignDescriptive research study.MethodsThis study was conducted on 64 nurses who directly worked for more than a month in a COVID‐19 unit of a general hospital with nationally designated negative‐pressure isolation beds and 64 nurses working in a non‐COVID‐19 unit. Data were collected through questionnaires and were analysed using SPSS 25.0. Reporting of this research adheres to the STROBE guidelines.ResultsAnxiety and depression were significantly higher in nurses working with patients suspected to have COVID‐19 rather than nurses working with confirmed COVID‐19 patients and non‐COVID‐19 patients. Resilience was significantly lower in suspected patient unit nurses than in COVID‐19 unit nurses. Anxiety was the major factor predicting depression in both COVID‐19 unit (confirmed patients and suspected patients) and non‐COVID‐19 unit nurses with 76.6%, 80.7%, and 63.6% explanatory power, respectively.ConclusionsAmong nurses working in COVID‐19 units, suspected patients unit nurses had higher depression than confirmed patients unit nurses due to an unsafe facility environment, insufficient personal protective equipment, and unknown conditions of the patients. Thus, interventions which have a high impact on depression need to be provided to relieve anxiety.Relevance to clinical practiceThe nursing organisation must provide comprehensive support including coordinated shifts, internal motivation, incentives, up‐to‐date information, and clear infection prevention guidelines to relieve anxiety caused by exhaustive workload, uncertainty of infectious diseases, and lack of human and material resources.

Pushed to the Margins and Stretched to the Limit: Experiences of Freelance Eldercare Workers During the Covid-19 Pandemic in the Netherlands

Eldercare professionals engaged in precarious work in the Netherlands faced shortages in personal protective equipment (PPE), testing, and staffing during the COVID-19 pandemic. This qualitative study of the health, financial situations, and paid and unpaid caring responsibilities of freelance eldercare workers illustrates how labor market inequalities have been (re)produced and exacerbated during the pandemic. Freelancers were pushed toward the margins of the labor market, working risky shifts and compromising their own interests, while unprotected by organizations, social security, or political efforts. Consequently, these workers were stretched to limits where they could no longer attend to their own health or to their paid and unpaid care responsibilities. The study places these empirical findings within Nancy Fraser and Rahel Jaeggi’s theoretical work on capitalism, illustrating how eldercare workers found themselves at the center of boundary struggles during the pandemic. HIGHLIGHTS In the Netherlands, paid eldercare workers increasingly opt for freelance care work. During the pandemic freelance eldercare workers were seen as a health risk for clients. Some lost assignments; others were asked to work with insufficient PPE. As a result, many struggled with moral and financial dilemmas. Unions and other players in the Netherlands hold conflicting views on freelancers in eldercare. These views stand in the way of building an alliance to enhance the situations of all working in the sector.

Knowledge and experience of healthcare workers during the COVID-19 pandemic: a cross-sectional study in Tema, Ghana

Background: Coronavirus Disease 2019 is a pandemic caused by a novel human coronavirus previously known as 2019-nCov. Healthcare workers are essential in the response to and management of such infectious diseases. Methods: A hospital-based cross-sectional study was conducted at Tema General Hospital, Ghana. Data was collected from healthcare workers using a structured questionnaire. Descriptive statistics was done for all socio-demographic characteristics of respondents. Level of knowledge about coronavirus disease and factors influencing participants’ willingness to work were summarized as frequencies, percentages and charts. Chi-square test was used to test for association between level of knowledge and all independent variables. Results: A total of 157 healthcare workers participated in this study. The news media (135, 85.99%) was the commonest source of information for participants. Almost half of participants (47.8%) had been tested for coronavirus disease, and 91.08% had sufficient knowledge about the disease. Occupation (p=0.047) was significantly associated with participants’ level of knowledge. A total of 46.49% disagreed with adequacy of personal protective equipment provided, with 70.06% admitting they have had to use their own personal protective equipment at work. A sense of duty (20, 31.8%) and motivation (14, 22.2%) positively influenced participants’ ability to work while challenges faced included fear of contracting and transmitting the virus (98.7%) and stigmatization (70.7%). Conclusions: The healthcare workers had sufficient knowledge about coronavirus disease. Insufficient personal protective equipment was evident during the pandemic. Measures must be established to ensure that barriers to work are eliminated while factors that enhance work output are encouraged.