Intensive Care Unit Healthcare Research Articles

Mental health outcomes of ICU and non-ICU healthcare workers during the COVID-19 outbreak: a cross-sectional study

BackgroundIntensive care workers are known for their stressful work environment and for a high prevalence of mental health outcomes. The aim of this study was to evaluate the mental health, well-being and changes in lifestyle among intensive care unit (ICU) healthcare workers (HCW) during the first wave of the COVID-19 pandemic and to compare these results with those of HCW in other hospital units. Another objective was to understand which associated factors aggravate their mental health during the COVID-19 outbreak.MethodsThis cross-sectional survey collected socio-demographic data, lifestyle changes and mental health evaluations as assessed by the Generalized Anxiety Disorder 7 items (GAD-7), the Patient Health Questionnaire 9 items (PHQ-9), the Peritraumatic Distress Inventory (PDI) and the World Health Organization Well-Being Index (WHO-5) from the 28th May to 7th July 2020. The study was carried out at Geneva University Hospitals, a group of eight public hospitals in Switzerland. ICU HCW were analyzed for mental health outcomes and lifestyles changes and then compared to non-ICU HCW. A series of linear regression analyses were performed to assess factors associated with mental health scores.ResultsA total of 3461 HCW were included in the study, with 352 ICU HCW. Among ICU HCW, 145 (41%) showed low well-being, 162 (46%) symptoms of anxiety, 163 (46%) symptoms of depression and 76 (22%) had peritraumatic distress. The mean scores of GAD-7, PHQ-9 and WHO-5 were worse in ICU HCW than in non-ICU HCW (p < 0.01). Working in the ICU rather than in other departments resulted in a change of eating habits, sleeping patterns and alcohol consumption (p < 0.01). Being a woman, the fear of catching and transmitting COVID-19, anxiety of working with COVID-19 patients, work overload, eating and sleeping disorders as well as increased alcohol consumption were associated with worse mental health outcomes.ConclusionThis study confirms the suspicion of a high prevalence of anxiety, depression, peritraumatic distress and low well-being during the first COVID-19 wave among HCW, especially among ICU HCW. This allows for the identification of associated risk factors. Long-term psychological follow-up should be considered for HCW.

Feasibility of a virtual reality intervention in the intensive care unit

BackgroundDelirium prevention requires optimal management of pain and anxiety. Given the limitations of current pharmacologic interventions, evaluation of novel non-pharmacological interventions is required. Virtual reality (VR) stimulation may be a promising intervention because of its capability to reduce psychophysiological stress, pain, and anxiety and to restore cognitive and attentional capacities. ObjectiveTo ascertain patients’ and providers’ perceptions of acceptability and safety of VR intervention in the intensive care unit (ICU). MethodsWe enrolled a cohort of 15 ICU patients and 21 health care providers to administer a 15-minute session showing a relaxing beach scene with VR headsets and nature sound effects. Participants were then asked to rate their experiences on a Likert scale survey. ResultsThe majority of patients (86%, 12 of 14) rated the headsets as moderately to very comfortable. All had moderate or greater sense of presence in the virtual environment, and 79% (11 of 14) rated their overall experience at 3 or greater (5 indicating that they enjoyed it very much). Seventy-one percent (10 of 14) of the patients felt that their anxiety was better with VR, and 57% (8 of 14) did not notice a change in their pain or discomfort. All health care providers found the headset to be at least moderately comfortable and felt a moderate or greater sense of presence. All providers concluded that VR therapy should be available for their patients. Both groups experienced minimal side effects. ConclusionIn this prospective study of perceptions of VR therapy for ICU patients and health care providers, there was a high level of acceptance, with minimal side effects, for both groups despite their low levels of prior experience with virtual reality and video gaming.

The global mental health burden of COVID-19 on critical care staff.

Although the mental health burden in healthcare workers caused by COVID-19 has gained increasing attention both within the profession and through public opinion, there has been a lack of data describing their experience; specifically, the mental wellbeing of healthcare workers in the intensive care unit (ICU), including those redeployed. The authors aimed to compare the mental health status of ICU healthcare workers (physicians, nurses and allied health professionals) affected by various factors during the COVID-19 pandemic; and highlight to policymakers areas of staff vulnerabilities in order to improve wellbeing strategies within healthcare systems. An online survey using three validated scales was conducted in France, the UK, Italy, Mainland China, Taiwan, Egypt and Belgium. The proportion of respondents who screened positive on the three scales across the countries was 16-49% for depression, 60-86% for insomnia and 17-35% for post-traumatic stress disorder. The authors also identified an increase in the scores with longer time spent in personal protective equipment, female gender, advancing age and redeployed status. The high prevalence of mental disorders among ICU staff during the COVID-19 crisis should inform local and national wellbeing policies.

Mental health and stress among ICU healthcare professionals in France according to intensity of the COVID-19 epidemic

BackgroundWe investigated the impact of the COVID-19 crisis on mental health of professionals working in the intensive care unit (ICU) according to the intensity of the epidemic in France.MethodsThis cross-sectional survey was conducted in 77 French hospitals from April 22 to May 13 2020. All ICU frontline healthcare workers were eligible. The primary endpoint was the mental health, assessed using the 12-item General Health Questionnaire. Sources of stress during the crisis were assessed using the Perceived Stressors in Intensive Care Units (PS-ICU) scale. Epidemic intensity was defined as high or low for each region based on publicly available data from Santé Publique France. Effects were assessed using linear mixed models, moderation and mediation analyses.ResultsIn total, 2643 health professionals participated; 64.36% in high-intensity zones. Professionals in areas with greater epidemic intensity were at higher risk of mental health issues (p < 0.001), and higher levels of overall perceived stress (p < 0.001), compared to low-intensity zones. Factors associated with higher overall perceived stress were female sex (B = 0.13; 95% confidence interval [CI] = 0.08–0.17), having a relative at risk of COVID-19 (B = 0.14; 95%-CI = 0.09–0.18) and working in high-intensity zones (B = 0.11; 95%-CI = 0.02–0.20). Perceived stress mediated the impact of the crisis context on mental health (B = 0.23, 95%-CI = 0.05, 0.41) and the impact of stress on mental health was moderated by positive thinking, b = − 0.32, 95% CI = − 0.54, − 0.11.ConclusionCOVID-19 negatively impacted the mental health of ICU professionals. Professionals working in zones where the epidemic was of high intensity were significantly more affected, with higher levels of perceived stress. This study is supported by a grant from the French Ministry of Health (PHRC-COVID 2020).

Intrapleural Steroid Instillation for Critically Ill Patients With Covid-19 Severe Adult Respiratory Distress Syndrome.

Within a very short period, outbreaks of a novel coronavirus disease (COVID-19) have affected 183 countries worldwide. COVID-19 resolves acutely, but it has resulted in thousands of deaths, with an overall fatality rate of 2% to 5% (1). Among the fatal cases, over 50% of patients died from respiratory failure with massive alveolar damage due to virus-activated “cytokine storm syndrome” (2). Of these patients, 67% developed adult respiratory distress syndrome (ARDS), 29% developed acute kidney injury, 23% developed cardiac injury, and 29% experienced liver dysfunction (3). The intensive care unit (ICU) mortality rate among those who required invasive mechanical ventilation was 86% (4), and the mortality of patients who received extracorporeal membrane oxygenation was also extremely high (5). Until now, there have been no proven effective specific treatment strategies and so methylprednisolone may be the best option for COVID-19 patients who develop ARDS (6). Although interferon alfa-2b, antiviral therapy, antibiotics for the prevention of secondary infection, and methylprednisolone were all administered to attenuate lung inflammation, histological examination still revealed bilateral diffuse alveolar damage with hyaline membrane formation in an autopsy of a patient (7). According to the imaging changes and pathological findings associated with ARDS, a tubular and enlarged appearance of the pulmonary vessels with a sudden caliber reduction seen within ground glass opacity lesions showing partial consolidation and fibrosis should be expected in severe cases of COVID-19 (8, 9). Fortunately, corticosteroids have a greater anti-inflammatory effect when administered intrapleurally, rather than via the intravenous route, because the permeability of the damaged visceral pleural membrane increases during pulmonary edema and steroid treatment, with the characteristic of fat-solubility, further permits infiltration into the lung parenchyma. Glucocorticoids can easily pass through the visceral pleura and bind to steroid hormone receptors, thereby allowing them to reach the injured areas and avoiding the problems of a ventilation–perfusion mismatch and the need for a shunt via intratracheal instillation or intravenous instillation. Glucocorticoids can normalize the ion pump (Na-K pump) and increase the synthesis of Na+/K+-ATPase, thus contributing to reductions in lung edema and optimization of oxygenation because alveolar fluid clearance is impaired in the majority of patients with ARDS (10). In COVID-19 severe refractory ARDS, more aggressive management is required to reduce the inflammatory reaction and consequent lung injury. The results of our study provide more evidence supporting the efficacy of intrapleural steroid instillation (IPSI) in the treatment of ARDS with multiple organ failure (11). This alternative treatment resulted in significant improvement in oxygenation and survival benefits after 5 days of treatment. The dosing schedule of intrapleural methylprednisolone was initially 40 mg q6 h in both pleural cavities, but the dose was reduced on the basis of chest radiography appearance, inspired oxygen concentration demand, and positive end-expiratory pressure of the ventilator. Thoracic catheterization was easily performed because COVID-19 patients usually had significant pleural effusion. Although managing COVID-19 pneumonia is currently a major issue for ICU healthcare providers around the world, IPSI will greatly improve the ability to respond effectively to current needs. Our recommendation in this severe case of COVID-19 might help physicians implement suitable therapeutic strategies for similar severe patients and reduce mortality.

An international tool to measure perceived stressors in intensive care units: the PS-ICU scale

BackgroundThe intensive care unit is increasingly recognized as a stressful environment for healthcare professionals. This context has an impact on the health of these professionals but also on the quality of their personal and professional life. However, there is currently no validated scale to measure specific stressors perceived by healthcare professionals in intensive care. The aim of this study was to construct and validate in three languages a perceived stressors scale more specific to intensive care units (ICU).ResultsWe conducted a three-phase study between 2016 and 2019: (1) identification of stressors based on the verbatim of 165 nurses and physicians from 4 countries (Canada, France, Italy, and Spain). We identified 99 stressors, including those common to most healthcare professions (called generic), as well as stressors more specific to ICU professionals (called specific); (2) item elaboration and selection by a panel of interdisciplinary experts to build a provisional 99-item version of the scale. This version was pre-tested with 70 professionals in the 4 countries and enabled us to select 50 relevant items; (3) test of the validity of the scale in 497 ICU healthcare professionals. Factor analyses identified six dimensions: lack of fit with families and organizational functioning; patient- and family-related emotional load; complex/at risk situations and skill-related issues; workload and human resource management issues; difficulties related to team working; and suboptimal care situations. Correlations of the PS-ICU scale with a generic stressors measure (i.e., the Job Content Questionnaire) tested its convergent validity, while its correlations with the Maslach Burnout Inventory-HSS examined its concurrent validity. We also assessed the test–retest reliability of PS-ICU with intraclass correlation coefficients.ConclusionsThe perceived stressors in intensive care units (PS-ICU) scale have good psychometric properties in all countries. It includes six broad dimensions covering generic or specific stressors to ICU, and thus, enables the identification of work situations that are likely to generate high levels of stress at the individual and unit levels. For future studies, this tool will enable the implementation of targeted corrective actions on which intervention research can be based. It also enables national and international comparisons of stressors’ impact.

Clinicians' experiences and reflections from a health system cyberattack

AbstractUniversal Health Services experienced a cyberattack in September 2020 that impacted all hospitals in their system. Nearly all computer systems that store and communicate patient care information were shut down to prevent malware propagation. The impact of this attack was magnified by the ongoing coronavirus disease 2019 (COVID‐19) pandemic. The objective of this paper is to describe the response of our intensive care unit (ICU) rounding team to the loss of all electronic health record (EHR) systems within our institution and to share lessons learned through the experience. Guidance is available on prevention of cyberattacks but does not effectively address the need to establish and train providers for alternative care mechanisms at the local level. Many providers and trainees have limited or no experience with manual patient care systems and had difficulty in transitioning to paper records, notes, and order writing. The transition also highlighted a number of unintended consequences that have occurred secondary to implementation and adaptation of EHRs over time. Institutional memory played a major role in addressing the crisis as providers who had utilized paper charting systems were more adaptive. Critical care pharmacists practicing as members of an integrated ICU health care team were an essential resource during the crisis, maintaining patient safety, assisting with order writing, troubleshooting medication issues, and providing education. The cyberattack provided an opportunity to re‐evaluate processes and procedures that have developed over time through the use of EHRs. The crisis magnified the importance of team‐based care and the integral role of the acute care clinical pharmacist.

SARS-CoV-2 Infection in Intensive Care Unit Healthcare Workers in Turkey: A Tertiary Center Cohort Study

Aim: Intensive care unit (ICU) workers have a greater risk of being infected due to procedures requiring intensive contact with the coronavirus disease-2019 (COVID-19 ) patient We aimed to explain how we applied the protection of healthcare workers against the contagion of COVID-19 infection in the ICU of a university hospital Methods: The study was performed in ICUs of the Goztepe Training Research Hospital with 650 beds which was affiliated to Medeniyet University in Istanbul, Turkey We recorded the number of COVID-19 patients We also recorded ICU workers (doctor, nurse, and others), and their working layouts The frequency of the contagion of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) to ICU workers was investigated We also evaluated precautions for the prevention and evaluated the arrangement of ICUs for COVID-19 patients Results: Between March 17th 2020 and May 26th 2020 totaly, a total of 120 hospitalized COVID-19 patients were treated in ICUs Laboratory confirmed COVID-19 was detected in only one health-care worker in ICUs Conclusion: Our experience showed that the correct and proper use of personal protective equipment according to the protocols are effective in protecting ICU workers against the contagion of SARS-CoV-2

Depressive and Anxiety Symptoms of Healthcare Workers in Intensive Care Unit Under the COVID-19 Epidemic: An Online Cross-Sectional Study in China.

Background: Since the coronavirus disease-2019 (COVID-19) outbreak, intensive care unit (ICU) healthcare workers were responsible for the critical infected patients. However, few studies focused on the mental health of ICU healthcare workers. This study aimed to investigate the psychological impact of COVID-19 on ICU healthcare workers in China.Methods: We distributed the nine-item Patient Health Questionnaire (PHQ-9) and seven-item General Anxiety Disorder questionnaire (GAD-7) online to ICU healthcare workers in China. Respondents were divided into frontline and second-line according to whether they have contact with COVID-19 patients. Depressive and anxiety symptoms of all respondents were evaluated based on their questionnaire scores.Results: There were 731 ICU healthcare workers finally enrolled in our study, including 303 (41.5%) male, 383 (52.4%) doctors, and 617 (84.4%) aged 26–45 years. All in all, 482 (65.9%) ICU healthcare workers reported symptoms of depression, while 429 (58.7%) reported anxiety. There was no significant difference between frontline (n = 325) and second-line (n = 406) respondents in depression (P = 0.15) and anxiety severity (P = 0.56). Logistic regression analysis showed that being female, ICU work time >5 years, and night duty number ≥10 were risk factors of developing depressive and anxiety symptoms. Income reduction was separately identified as risk of anxiety. Additionally, ICU work time >5 years was also identified as risk of developing moderate–severe depressive and anxiety symptoms.Conclusions: Frontline ICU work was not associated with higher risk of depressive and anxiety symptoms during COVID-19 pandemic remission period in China. Actions like controlling night duty number, ensuring vacation, and increasing income should be taken to relieve mental health problem. Furthermore, we should pay close attention to those who had worked long years in ICU.

Bacterial Colonization of Intensive Care Unit Environment and Healthcare Workers in A Tertiary Care Hospital in Kolar Region, India

Direct shedding of microbes by patients and health care workers results in contamination of Intensive care unit environment. Intensive care unit acquired infections due to microbial contamination is a major concern because the patient’s immunity is already compromised. To determine the rate of bacterial contamination on environmental surfaces of Intensive care unit and health care workers and to determine the antibiogram of the isolates. Air samples and swabs from healthcare workers, their accessories, surrounding environmental surfaces were collected randomly over a period of 2 months in Adult Intensive care units. Bacterial isolates were identified by standard microbiological techniques. Antibiotic sensitivity testing was performed by Kirby Bauer disc diffusion method and data analyzed by Statistical Product and Service Solutions 22 version software. A total of 208 samples were randomly collected over 2 months, of which 56 samples yielded positive bacterial growth. Of 56 growth, 12 isolates were detected from air sampling method and 44 isolates from swabs. Among 44 isolates identified from swabs, 10 were isolated from healthcare workers, 4 from health care worker’s accessories and 30 from environmental surfaces. Six different bacterial isolates were identified, Coagulase Negative Staphylococcus (24) and Micrococcus (15) were the major isolates followed by Non fermenters (6), Staphylococcus aureus(4), Bacillus species(4) and diphtheroids (3) The antimicrobial sensitivity pattern of these bacterial isolates were sensitive to commonly used antibacterial agents. Study results showed Intensive care unit staff and environmental surfaces as probable sources of bacterial contamination. Study highlights the importance of cleaning and disinfection process and educate the health care workers about the possible sources of infections within Intensive care unit.

Efficacy of a Protective Hand Cream versus a Conventional Cream to Improve Skin Barrier Function among Pediatric Intensive Care Unit Healthcare Workers: A Pilot Study

Background: Hand hygiene is one of the most effective procedures for preventing health care-associated infection. Barrier creams are used to prevent the irritant effect caused by occupational exposure. Objective: To compare an aluminum chlorohydrate-containing hand cream and a conventional cream in health-care workers (HCWs) by using clinical assessment score and quantitative measurement of transepidermal water loss (TEWL). Materials and Methods: A double-blinded, randomized, placebo-controlled trial was performed in pediatric intensive care unit HCWs. The subjects were assigned to regularly use the given cream (one fingertip unit per time, equal to 0.5 gram) after washing their hands with either 4% chlorhexidine gluconate or alcohol hand rub, which is 70% alcohol, glycerin, D-panthenol. The clinical assessment score, ranging from 0 to 3 points per item, were performed by the investigator evaluating for erythema, dryness, scaling, vesicles, fissuring and lichenification, and by the subject evaluating the redness, itching, tightness, dryness and sweating, together with TEWL assessment in a controlled environmental condition at day 0, 7, and 14. Results: Sixty HCWs were equally divided for each product. Barrier cream and conventional cream, amount used were 32.20 g and 26.43 g, respectively. At day 14, the clinical assessment score by the investigator and by the subject were reduced by 40.02% and 43.38% in the barrier cream group, and 35.5% and 47.83% in the conventional cream group (p&lt;0.001. However, the TEWL in both groups was not significantly different from the baseline. Both products were well tolerated. Conclusion: The amount of cream applied by HCWs was lower than assigned. Both barrier cream and conventional cream can clinically improve the clinical score. Frequent and regular use of hand creams should be encouraged to decrease or prevent skin irritation and hand dermatitis. Keywords: Protective hand cream, Transepidermal water loss, Healthcare workers, Hand hygiene practices, Pediatric intensive care unit

Point-of-Care Echocardiography and Hemodynamic Monitoring in Cirrhosis and Acute-on-Chronic Liver Failure in the COVID-19 Era.

Point-of-Care (POC) transthoracic echocardiography (TTE) is transforming the management of patients with cirrhosis presenting with septic shock, acute kidney injury, hepatorenal syndrome and acute-on-chronic liver failure (ACLF) by correctly assessing the hemodynamic and volume status at the bedside using combined echocardiography and POC ultrasound (POCUS). When POC TTE is performed by the hepatologist or intensivist in the intensive care unit (ICU), and interpreted remotely by a cardiologist, it can rule out cardiovascular conditions that may be contributing to undifferentiated shock, such as diastolic dysfunction, myocardial infarction, myocarditis, regional wall motion abnormalities and pulmonary embolism. The COVID-19 pandemic has led to a delay in seeking medical treatment, reduced invasive interventions and deferment in referrals leading to "collateral damage" in critically ill patients with liver disease. Thus, the use of telemedicine in the ICU (Tele-ICU) has integrated cardiology, intensive care, and hepatology practices across the spectrum of ICU, operating room, and transplant healthcare. Telecardiology tools have improved bedside diagnosis when introduced as part of COVID-19 care by remote supervision and interpretation of POCUS and echocardiographic data. In this review, we present the contemporary approach of using POC echocardiography and offer a practical guide for primary care hepatologists and gastroenterologists for cardiac assessment in critically ill patients with cirrhosis and ACLF. Evidenced based use of Tele-ICU can prevent delay in cardiac diagnosis, optimize safe use of expert resources and ensure timely care in the setting of critically ill cirrhosis, ACLF and liver transplantation in the COVID-19 era.

Vicarious spiritual distress in intensive care unit healthcare providers: A qualitative study

ObjectivesTo explore the impact of caring for family members experiencing spiritual distress on Intensive Care Unit healthcare providers. DesignA qualitative study involving interviews and focus groups between May 2016 and April 2017. ParticipantsIntensive care healthcare providers from nine teaching and three non-teaching units across Alberta, Canada. MeasurementsTranscribed data were analysed using interpretive description. FindingsForty-two participants variably described experiences of vicarious spiritual distress, along with coping strategies and outcomes related to these experiences. Vicarious spiritual distress was experienced as sorrow/distress, helplessness and preoccupation/rumination. Coping strategies were both adaptive (self-awareness/reflection, reframing/resiliency, team support/debriefing, self-care, accepting limitations) and maladaptive (compartmentalising/distancing, substance use). Lastly, the emotional burden of these experiences resulted in both favourable (satisfaction, appreciation) and unfavourable (moral distress, burnout, hopelessness) outcomes. ConclusionOur findings describe the novel concept of vicarious spiritual distress as experienced by intensive care healthcare providers and highlight the importance of identifying effective ways to support these professionals throughout their careers to prevent unfavorable outcomes and the perpetuation of maladaptive coping strategies. The adaptive coping strategies described in this study may help inform wellness initiatives and resiliency training tailored to intensive care healthcare providers.

A Multisite Survey of NICU Healthcare Professionals' Perceptions About Family-Centered Care.

Family-centered care contributes to improved outcomes for preterm and ill infants. Little is known about the perceptions of neonatal intensive care unit (NICU) healthcare professionals regarding the degree to which their NICU practices or values family-centered care. The aims of this study were to describe attitudes and beliefs of NICU healthcare professionals about family-centered care and to explore professional characteristics that might influence those views. Data were derived from the baseline phase of a multicenter quasi-experimental study comparing usual family-centered NICU care with mobile-enhanced family-integrated care. Neonatal intensive care unit healthcare professionals completed the Family-Centered Care Questionnaire-Revised (FCCQ-R), a 45-item measure of 9 core dimensions of Current Practice and Necessary Practice for family-centered care. A total of 382 (43%) NICU healthcare professionals from 6 NICUs completed 1 or more of the FCCQ-R subscales, 83% were registered nurses. Total and subscale scores on the Necessary Practice scale were consistently higher than those on the Current Practice scale for all dimensions of family-centered care (mean: 4.40 [0.46] vs 3.61 [0.53], P < .001). Only years of hospital experience and NICU site were significantly associated with Current Practice and Necessary Practice total scores. Ongoing assessment of the perceptions of NICU healthcare professionals regarding their current practice and beliefs about what is necessary for the delivery of high-quality family-centered care can inform NICU education, quality improvement, and maintenance of family-centered care during the COVID-19 pandemic. Further research is needed to identify additional factors that predict family-centered care perceptions and behaviors.

The Psychological impact of COVID-19 on Healthcare Workers in Saudi Arabia

Background: Healthcare workers are burdened by the clinical diagnosis and treatment of COVID-19 and public prevention. Many occupational factors such as high expectations, shortage of time, lack of skills, and social support can lead to stress. The objective of this study is to investigate the psychological impact of COVID- 19 on health workers in Saudi Arabia. Methods: A cross-sectional study with a self-administered online questionnaire was used to measure the psychological well-being of emergency room and critical care unit health professionals in Saudi Arabia. Results: The study included 120 individuals; multiple linear regressions indicated that the demographic variables sex and department had a significant influence on healthcare personnel&amp;apos;s psychological well-being. This emphasizes the development of more effective treatment options for healthcare professionals, particularly those at risk for psychological distress. Conclusion: Psychological disorders were prevalent among Intensive Care Unit (ICU) and Emergency (ER) healthcare workers. The independent risk factors for these psychological disorders among ICU and ER healthcare workers were the male gender, being in the

Impact of Covid-19 infection in high-risk coronary patients

BackgroundCoronary artery disease (CAD) has been recognized as a major determinant of Covid-19 vulnerability and severity. We sought to compare demographic characteristics, clinical presentation, and outcomes for Covid-19 in a large cohort of chronic CAD patients living in Strasbourg's cluster region (Fig. 1).MethodsFollow-up was conducted by telephone interviews performed by cardiologists one month after the start of the French lockdown. The primary outcome was the composite of death or hospitalization related to Covid-19 infection. Secondary endpoints included Covid-19 related death, Covid-19 related hospitalization, intensive care unit (ICU) admission, allcause mortality, cardiovascular (CV) mortality and healthcare compliance.ResultsOut of 891 patients included, twenty CAD patients (2.2%) had RT-PCR confirmed Covid-19 infection. Confirmed or suspect cases were evidenced in 48 patients (5.4%). Covid-19 patients showed lower left ventricular ejection fraction, were more frequently obese, less likely to smoke or follow lipid lowering therapy. The composite of death or hospitalization related to Covid-19 was 90%. Mortality rate was 30% among confirmed Covid-19 patients. Drugs’ discontinuation rate was low (1.1%) during the confinement. Reticence to consult a healthcare professional occurred in 6.4%. Postponement or cancellation of non-essential medical visits occurred in 15,7% (Table 1).ConclusionsCoronary patients from a large French cluster of COVID-19 showed a high risk of Covid-19 infection and worse in-hospital outcomes.

Moral distress among health care workers in the intensive care unit; a systematic review and meta-analysis

Background: The effect of moral distress among healthcare providers is significant on disease morbidity, especially within the intensive care unit (ICU). In this systematic review and meta-analysis, we aimed to gather all evidence regarding moral distress frequency and severity/intensity among ICU health care providers. Methods: We conducted a systematic search to gather all relevant studies from six databases, followed by a manual search of references. Fourteen studies consisting of 5905 participants were included in the final moral distress scale analyses. Results: Overall, there was moderate moral distress severity/intensity among all participants (Mean = 27.79; 95% confidence interval (CI) = 7.40–64.18). On further stratification of the results according to countries, Canada (Mean = 91.99; 95% CI = 80.10–105.65) and USA (Mean = 52.54; 95% CI = 44.78–61.64) showed the highest distress scores, followed by Iran (Mean = 21.20; 95% CI = 7.21–62.30) and Italy (Mean = 3.42; 95% CI = 3.15–3.72). Studies conducted in high income-earning countries reported more severity/intensity (Mean = 22.65; 95% CI = 6.58–78.02) compared to those in the upper-middle income-earning ones (Mean = 18.89; 95% CI = 2.80–127.34). There was significant heterogeneity among the included studies, which could not be explained by the difference in scales, country of the participants, or the female proportion. Moreover, there was a moderate frequency of moral distress (Mean = 46.83; 95% CI = 8.34–262.87), which was found to be much higher (Mean = 87.94; 95% CI = 83.55–92.57), in performing analysis. Conclusion: Moral distress is a major problem in the ICU setting, in terms of both severity/intensity and frequency. Future large-scale studies are required, through a unified framework, to develop appropriate interventions to address ICU-related moral distress.

Adverse Effects of Personal Protective Equipment Among Intensive Care Unit Healthcare Professionals During the COVID-19 Pandemic: A Scoping Review.

IntroductionTo avoid exposure to SARS-COV-2, healthcare professionals use personal protective equipment (PPE) while treating COVID-19 patients. Prior studies have revealed the adverse effects (AEs) of PPE on healthcare workers (HCWs); however, no review has focused on the AEs of PPE on HCWs in intensive care units (ICUs). This review aimed to identify the AEs of PPE on HCWs working in ICUs during the COVID-19 pandemic.MethodsA scoping review was conducted. MEDLINE, CINAHL, the World Health Organization (WHO) global literature on COVID-19, and Igaku-chuo-zasshi (a Japanese medical database), Google Scholar, medRxiv, and Health Research Board (HRB) open research were searched from January 25–28, 2021. The extracted data included author(s) name, year of publication, country, language, article title, journal name, publication type, study methodology, population, outcome, and key findings.ResultsThe initial search identified 691 articles and abstracts. Twenty-five articles were included in the analysis. The analysis comprised four key topics: studies focusing on PPE-related headache, voice disorders, skin manifestations, and miscellaneous AEs of PPE. The majority of AEs for HCWs in ICUs were induced by prolonged use of masks.ConclusionThe AEs of PPE among HCWs in ICUs included heat, headaches, skin injuries, chest discomfort, and dyspnea. Studies with a focus on specific diseases were on skin injuries. Moreover, many AEs were induced by prolonged use of masks.

Prevalence of Nasal carriage of coagulase negative staphylococci and its antimicrobial susceptibility among ICU health care workers at a tertiary care hospital of Barabanki, UP

Introduction: Health care workers (HCW) including medical as well as paramedical workers are a potential source of carrier of infection for the patients admitted in different intensive care units (ICU). The anterior nares are the main reservoir of Staphylococcus although other body sites are frequently colonised with it, such as hands, skin, axillae, and intestinal tract. The body parts of health care workers as well as the equipments and accessories used by them are likely to transmit infections. Materials and Methods: A prospective study was conducted to evaluate the infections in different ICUs. A total of 288 parallel nasal and hands swabs were collected. These samples were cultured as per standard protocols and antibiotic sentivity was also carried out. For antibiotic sensitivity Kirby disc diffusion method on Mueller Hinton agar plate was used. Coagulase negative Staphylococcus was the bacteria isolated and subjected to sensitivity towards different antibiotics. Results: Of the 288 samples 90 samples (31.3%) were positive while 198 (68.7%) were negative. The distribution of the positive samples from Medical ICUs – 47 cases, Paediatric ICUs – 21 and, Surgical ICUs – 22 cases. Conclusion: Coagulase negative Staphylococci were predominantly isolated from culture and increasing antibiotic resistance is also observed. The most effective antibiotics were Tobramycin, Teicoplanin and Linezolid while Penicillin, Gentamycin and Erythromycin showed highest resistance. HCW themselves as well as the accessories used by them are an important potential source of infection for the admitted patients. Regular disinfection of these accessories should be strictly followed in each and every ICU. Keywords: Nosocomial, Cons, Healthcare workers, Nasal carrier, ICU.

The Psychological Impact of COVID-19 Disease is more Severe on Intensive Care Unit Healthcare Providers: A Cross-sectional Study.

ObjectiveFear, anxiety, depression and sleep deprivation are common mental health disorders in COVID-19 disease. We aimed to analyse the risk for healthcare providers during COVID-19 pandemic in a university hospital.MethodsAnesthesiologists, nurses and nurse anesthetists were invited to fill out the survey. The survey was consist of questions from ‘’The Fear of COVID-19 Scale’’, ‘’Patient Health Questionnaire’’ and ‘’Pittsburgh Sleep Quality Index’’ (PSQI). Each question was worth a point.ResultsThe data of 208 participants were analyzed. Mean age was 29 ± 7.748 years, 72.1% were male, 67.3% were nurses, 62% were working in intensive care units, 38% were in hospital wards, 62% of all participants were living alone. Moderate depression was the most frequently detected outcome (n = 90, 43.3%). Mean The Fear of COVID-19 Scale for all participants was 18.56 ± 7.731. The mean PSQI of patients was 6.18 ± 4.356 with a 45.7% rate of poor sleep quality. PSQI was found significantly higher in nurses (7.1 ± 4.7, p = 0.000). Nurses were the group with the highest deterioration in sleep quality (53.6%, p = 0.003). The rate of moderate-to-severe depressive symptoms was significantly higher in intensive care unit nurses and physicians (p = 0.018). PSQI score was found significantly higher in intensive care unit nurses and physicians than hospital ward co-workers (7.02 ± 4.59 vs. 4.81 ± 3.57 respectively, p = 0.001). A significant positive correlation was observed between PSQI and The Fear of COVID-19 Scale total score in all patients (p < 0.005).ConclusionDepression, anxiety, fear and sleep disorders may occur in healthcare workers during COVID-19 outbreak. Intensive care unit nurses were at highest risk.