Insufficient Personal Protective Equipment Research Articles

A Global Survey on the Impact of COVID-19 on Urological Services

BackgroundThe World Health Organization (WHO) declared coronavirus disease-19 (COVID-19) as a pandemic on March 11, 2020. The impact of COVID-19 on urological services in different geographical areas is unknown. ObjectiveTo investigate the global impact of COVID-19 on urological providers and the provision of urological patient care. Design, setting, and participantsA cross-sectional, web-based survey was conducted from March 30, 2020 to April 7, 2020. A 55-item questionnaire was developed to investigate the impact of COVID-19 on various aspects of urological services. Target respondents were practising urologists, urology trainees, and urology nurses/advanced practice providers. Outcome measurements and statistical analysisThe primary outcome was the degree of reduction in urological services, which was further stratified by the geographical location, degree of outbreak, and nature and urgency of urological conditions. The secondary outcome was the duration of delay in urological services. Results and limitationsA total of 1004 participants responded to our survey, and they were mostly based in Asia, Europe, North America, and South America. Worldwide, 41% of the respondents reported that their hospital staff members had been diagnosed with COVID-19 infection, 27% reported personnel shortage, and 26% had to be deployed to take care of COVID-19 patients. Globally, only 33% of the respondents felt that they were given adequate personal protective equipment, and many providers expressed fear of going to work (47%). It was of concerning that 13% of the respondents were advised not to wear a surgical face mask for the fear of scaring their patients, and 21% of the respondents were advised not to discuss COVID-19 issues or concerns on media. COVID-19 had a global impact on the cut-down of urological services, including outpatient clinic appointments, outpatient investigations and procedures, and urological surgeries. The degree of cut-down of urological services increased with the degree of COVID-19 outbreak. On average, 28% of outpatient clinics, 30% of outpatient investigations and procedures, and 31% of urological surgeries had a delay of >8 wk. Urological services for benign conditions were more affected than those for malignant conditions. Finally, 47% of the respondents believed that the accumulated workload could be dealt with in a timely manner after the COVID-19 outbreak, but 50% thought the postponement of urological services would affect the treatment and survival outcomes of their patients. One of the limitations of this study is that Africa, Australia, and New Zealand were under-represented. ConclusionsCOVID-19 had a profound global impact on urological care and urology providers. The degree of cut-down of urological services increased with the degree of COVID-19 outbreak and was greater for benign than for malignant conditions. One-fourth of urological providers were deployed to assist with COVID-19 care. Many providers reported insufficient personal protective equipment and support from hospital administration. Patient summaryCoronavirus disease-19 (COVID-19) has led to significant delay in outpatient care and surgery in urology, particularly in regions with the most COVID-19 cases. A considerable proportion of urology health care professionals have been deployed to assist in COVID-19 care, despite the perception of insufficient training and protective equipment.

Supporting cardiac patients during the COVID-19 pandemic

Supporting cardiac patients during the COVID-19 pandemic

The Challenges Confronting Countries in the Tropics Affected by Covid-19

Compared with other regions of the world, countries in the Tropics appear to have less Covid-19 cases and lower death rates. Warmer temperatures and higher humidity have been proposed as an explanation. An alternative interpretation is that the figures result from a lack of aggressive testing. Regardless of the cause, this paper suggests that the way in which governments respond to the pandemic has a significant impact on containing the pandemic. Additionally, pressing challenges for countries in the Tropics are a lack of water and sanitation, insufficient personal protective equipment, and inadequate training of clinical staff. Suggestions for moving forward are proposed.

Training Directors Strive to Maintain Educational Mission Under Extraordinary Conditions

Back to table of contents Previous article Next article Education & TrainingFull AccessTraining Directors Strive to Maintain Educational Mission Under Extraordinary ConditionsMark MoranMark MoranSearch for more papers by this authorPublished Online:28 Apr 2020https://doi.org/10.1176/appi.pn.2020.5a39AbstractAfter COVID-19, a mental health “tsunami” is sure to follow, and psychiatry will be more essential than ever.Melissa Arbuckle, M.D., Ph.D., president of AADPRT, says that residents “are smart people who are capable of learning new things quickly. I have no doubt that they will save lives.”Joe Henson PhotographyThe hardest challenge for psychiatry training directors around COVID-19 has been managing the redeployment of psychiatry residents to medical settings, according to Melissa Arbuckle, M.D., Ph.D., president of the American Association of Directors of Psychiatric Residency Training (AADPRT).Associated with this challenge are concerns that the residents may not be adequately prepared for the roles they are being asked to do, “whether it is limited skills in critical care—which they were not trained to do—or the possibility of insufficient personal protective equipment.”She added, “We are also critically aware of the psychological toll our residents are facing, as they see firsthand the devastating impact of this disease and its casualties. We are concerned about the risks our residents are taking for themselves and their families.“Our communities desperately need every doctor available. Our residents understand how medical teams work. They understand the language and the culture and have worked in medical settings before. They are smart people who are capable of learning new things quickly. I have no doubt that they will save lives.”She said training directors around the country and across specialties are grappling with these complexities, uncertainties about the future, and whether the new medical school graduates will be able to begin training in June on time. “It’s hard to imagine what everything will be like in June and July.”Certainly, New York City has been uniquely overwhelmed. In areas where COVID-19 has not resulted in a surge of patients, some training directors reported little change outside of the transition from outpatient services and educational activities to telehealth and online technology. In Detroit—among the hottest spots in the country at press time outside New York—Richard Balon, M.D., director of training at Detroit Medical Center (DMC)/Wayne State University School of Medicine, said that psychiatry residents have not yet been deployed to care for COVID-19 patients in medical settings. But a list of residents who had volunteered to serve has been submitted to the Graduate Medical Education Office of the DMC, and some psychiatry residents have voluntarily gone to ICUs to provide emotional support and counseling to ICU residents and to help with contacting and talking with families.Arbuckle noted that training directors are also faced with providing emotional support to a cohort of residents experiencing a wide range of normal reactions, including fear, sadness, and anger. “And it’s not just about work—our residents are also in quarantine, social distancing, homeschooling children, and losing loved ones,” she said.She said that after COVID passes, “a mental health tsunami” is sure to follow. “Psychiatry will be more relevant than ever as our communities struggle with social isolation, the sorrow of lost friends and family members, the financial instability of a crippled economy and vast unemployment, and the trauma faced by essential workers on the front lines of this crisis.”. ■Resources created by AADPRT members for teaching psychiatry online and implementing telepsychiatry, as well as practical tips for addressing the psychological stresses associated with the COVID-19 crisis, are posted on the AADPRT website. ISSUES NewArchived

Risk Communication During COVID-19

During the unprecedented times caused by the novel coronavirus disease 2019, there is rapidly evolving information and guidance. However, a focus must also be on proper and effective risk communication. This is especially the case during pandemics that have high rates of infection, significant morbidity, lack of therapeutic measures, and rapid increases in cases, all of which apply to the current coronavirus disease 2019 pandemic. A consequence of poor risk communication and heightened risk perception is hoarding behavior, which can lead to lack of medications and personal protective equipment. One potential way to ensure appropriate risk communication is using social media channels, and ensuring an ongoing consistent media presence. Another important step is to include all stakeholders including members of the allergy community in broader public health messaging. As we continue to face unprecedented times in the allergy community, an understanding and appreciation of risk communication will be essential as we communicate with, and inform, our patients, and our colleagues, moving forward.

Anxiety and depression and the related factors in nurses of Guilan University of Medical Sciences hospitals during COVID-19: A web-based cross-sectional study

BackgroundThe outbreak of COVID-19 is an unprecedented challenge to the health systems in Iran. We aimed to assess the psychological impact of this outbreak on nurses in the hospitals of Guilan University of Medical Sciences that is one of the top provinces of incidence of COVID-19. MethodsIn a web-based cross-sectional study, 441 nurses working were selected from the hospitals, from 7 to 12 April 2020. Anxiety and depression were measured using the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9, respectively. Simple and multiple logistic regression models were used to identify the factors related to anxiety and depression. ResultsThe majority were in contact with suspected or confirmed COVID-19 cases (93.4%) and their relatives had been infected with COVID-19 (42%). The mean of anxiety-7 and depression total scores were 8.64 ± 5.60 and 8.48 ± 6.19, respectively. Female (OR = 3.27, 95% CI = 1.01–10.64), working in COVID-19 designated hospital (OR = 1.82, 95% CI = 1.13–2.93), being suspected with COVID-19 infection (OR = 2.01, 95% CI = 1.25–3.26), and insufficient personal protective equipment (OR = 2.61, 95% CI = 1.68–4.06) were associated with anxiety. Depression was significantly associated with female sex (OR = 4.62, %95 CI = 1.24–17.16), having chronic disease (OR = 2.12, 95% CI = 1.20–3.74), being suspected or confirmed with COVID-19 infection (OR = 3.44, 95% CI = 2.11–5.59, and OR = 2.21, 95% CI = 1.04–4.70, respectively), and insufficient personal protective equipment (OR = 1.86, 95% CI = 1.19–2.91). ConclusionThe finding declares healthcare workers are at high risk for mental illness. Continuous supervision of the psychological consequences following infectious diseases outbreaks should be a part of the preparedness efforts of health care systems.

Mental health of healthcare professionals in China during the new coronavirus pandemic: an integrative review.

to identify publishing related to the mental health of health professionals working in the front line of the COVID-19 pandemic. an integrative review that included primary articles indexed in the Latin American and Caribbean Literature in Health Sciences, Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, Scopus, Embase, Web of Science, Science Direct databases and US National Library of Medicine databases. The result analysis was performed descriptively, in four analytical categories. The publishing involved aspects related to insufficient personal protective equipment, feelings of fear and stigma, the need for psychological and psychiatric support and the possibility of post-outbreak mental disorders. All mentioned aspects have a direct impact on the mental health of professionals, demanding the creation of strategies that minimize the emotional burnout of workers, considering that each country and culture reacts differently to the disease.

Serious injury and fatality investigations involving pneumatic nail guns, 1985-2012.

This article examines serious and fatal pneumatic nail gun (PNG) injury investigations for workplace, tool design, and human factors relevant to causation and resulting OS&H authorities' responses in terms of citations and penalties. The U.S. Occupational Safety and Health Administration (OSHA) database of Fatality and Catastrophe Investigation Summaries (F&CIS) were reviewed (1985-2012) to identify n = 258 PNG accidents. 79.8% of investigations, and 100% of fatalities, occurred in the construction industry. Between 53-71% of injuries appear to have been preventable had a safer sequential trigger tool been used. Citations and monetary penalties were related to injury severity, body part injured, disabling of safety devices, and insufficient personal protective equipment (PPE). Differences may exist between construction and other industries in investigators interpretations of PNG injury causation and resulting citations/penalties. Violations of PPE standards were penalized most severely, yet the preventive effect of PPE would likely have been less than that of a safer sequential trigger.

Simulated Pediatric Resuscitation Use for Personal Protective Equipment Adherence Measurement and Training During the 2009 Influenza (H1N1) Pandemic

BackgroundPrevious experience with simulated pediatric cardiac arrests (that is, mock codes) suggests frequent deviation from American Heart Association (AHA) basic and advanced life support algorithms. During highly infectious outbreaks, acute resuscitation scenarios may also increase the risk of insufficient personal protective equipment (PPE) use by health care workers (HCWs). Simulation was used as an educational tool to measure adherence with PPE use and pediatric resuscitation guidelines during simulated cardiopulmonary arrests of 2009 influenza A patients.MethodsA retrospective, observational study was performed of 84 HCWs participating in 11 in situ simulations in June 2009. Assessment included (1) PPE adherence, (2) confidence in PPE use, (3) elapsed time to specific resuscitation maneuvers, and (4) deviation from AHA guidelines.ResultsObserved adherence with PPE use was 61% for eye shields, 81% for filtering facepiece respirators or powered air-purifying respirators, and 87% for gown/gloves. Use of a “gatekeeper” to control access and facilitate donning of PPE was associated with 100% adherence with gown and respirator precautions and improved respirator adherence. All simulations showed deviation from pediatric basic life support protocols. The median time to bag-valve-mask ventilation improved from 4.3 to 2.7 minutes with a gatekeeper present. Rapid isolation carts appeared to improve access to necessary PPE. Confidence in PPE use improved from 64% to 85% after the mock code and structured debriefing.ConclusionsLarge gaps exist in the use of PPE and self-protective behaviors, as well as adherence to resuscitation guidelines, during simulated resuscitation events. Intervention opportunities include use of rapid isolation measures, use of gatekeepers, reinforcement of first responder roles, and further simulation training with PPE.

Propofol for Procedural Sedation in a Community Emergency Department

Previous experience with simulated pediatric cardiac arrests (that is, mock codes) suggests frequent deviation from American Heart Association (AHA) basic and advanced life support algorithms. During highly infectious outbreaks, acute resuscitation scenarios may also increase the risk of insufficient personal protective equipment (PPE) use by health care workers (HCWs). Simulation was used as an educational tool to measure adherence with PPE use and pediatric resuscitation guidelines during simulated cardiopulmonary arrests of 2009 influenza A patients.A retrospective, observational study was performed of 84 HCWs participating in 11 in situ simulations in June 2009. Assessment included (1) PPE adherence, (2) confidence in PPE use, (3) elapsed time to specific resuscitation maneuvers, and (4) deviation from AHA guidelines.Observed adherence with PPE use was 61% for eye shields, 81% for filtering facepiece respirators or powered air-purifying respirators, and 87% for gown/gloves. Use of a “gatekeeper” to control access and facilitate donning of PPE was associated with 100% adherence with gown and respirator precautions and improved respirator adherence. All simulations showed deviation from pediatric basic life support protocols. The median time to bag-valve-mask ventilation improved from 4.3 to 2.7 minutes with a gatekeeper present. Rapid isolation carts appeared to improve access to necessary PPE. Confidence in PPE use improved from 64% to 85% after the mock code and structured debriefing.Large gaps exist in the use of PPE and self-protective behaviors, as well as adherence to resuscitation guidelines, during simulated resuscitation events. Intervention opportunities include use of rapid isolation measures, use of gatekeepers, reinforcement of first responder roles, and further simulation training with PPE.

Hospital waste management status in university hospitals of the Fars province, Iran

Hospital waste contains large quantities of hazardous materials. In Iran, as in many developing countries, not much attention has been paid to this matter. Little information is available regarding the generation and disposal of medical waste in Iran, and this fact hinders planning for a better management of the aforementioned waste. This paper describes a survey performed on the collection and disposal of waste in the university hospitals of the Fars province, which are the medical referral centres in the southern half of the country, and the results obtained are fully discussed. The lack of separation between hazardous and non- hazardous waste, an absence of necessary rules and regulations applying to the collection of waste from the hospital wards and the on-site transport to a temporary storage location, a lack of proper waste treatment, disposal of hospital waste along with municipal garbage, insufficient training of personnel, insufficient personal protective equipment and lack of knowledge regarding the proper use of such equipment, were the main findings. For a rapid improvement of existing conditions, performing extensive research for the assessment of present situation in the hospitals of this country, compilation of rules and establishment of standards along with effective training for the personnel is recommended.