Safety Of Healthcare Workers Research Articles

Recommendation for Resuming Elective Surgery during the Normalising Period in COVID-19 Pandemic.

Recommendation for Resuming Elective Surgery during the Normalising Period in COVID-19 Pandemic.

Application of an optimized pharyngeal swab-assisted device in pharyngeal sampling for COVID-19 patients.

BackgroundCoronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has triggered a global pandemic. Healthcare workers are placed at an elevated risk of nosocomial cross-infection from clinical exposure. One diagnostic criterion for COVID-19 is a positive result from a real-time reverse transcriptase-polymerase chain reaction (qRT-PCR) assay of pharyngeal swab specimens, which has been a routine procedure for healthcare workers during the outbreak. In the context of a global shortage of personal protective equipment (PPE), we aimed to lower the probability of clinical cross-infection without impacting the results of pharynx sampling through an optimized pharyngeal swab assisted device (OPAD).MethodsTo evaluate the efficacy and feasibility of an OPAD for the detection of SARS-CoV-2, 22 confirmed COVID-19 cases were enrolled in our self-controlled study. The results of two pharyngeal sampling qRT-PCR tests using the OPAD or the traditional method were recorded each. Clinical data including baseline characteristics, laboratory tests, and computed tomography (CT) results were also collected. The procedure duration and levels of pharynx exposure with the OPAD, and the diagnostic consistency between the OPAD and the traditional method for pharyngeal sampling qRT-PCR, were evaluated individually. Additionally, a questionnaire was designed for healthcare workers who had performed the pharyngeal swab to deepen our understanding of their attitude during their service on the frontline.ResultsIn all 44 samplings (22 samples with each method), the qRT-PCR results of 18 pairs (81.82%) were consistent, while 3 (13.64%) were single positive with the OPAD. The positive rate was slightly higher with the OPAD (54.55%, 12/22) than with the traditional method (45.45%, 10/22). Using the OPAD, the average procedure duration of sampling was 30 s (30±13 s). Pharynx exposure was excellent in 21 subjects (95.45%, 21/22), which meant that the operator could acquire the swabs without difficulty.ConclusionsAs the COVID-19 pandemic escalates, our OPAD has identical efficacy compared to the traditional method for pharyngeal swabs, and it can also contribute to protecting the safety of healthcare workers.

Universal Gloving and Hand Hygiene With Gloves On: Concerns.

To the Editor We read with interest the recent special article by Bowdle et al1 mentioning key recommendations for appropriate infection prevention precautions for routine anesthesia care during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. We wish to add our perspective and concern regarding the use of gloves—an important personal protective equipment (PPE). Universal gloving—a horizontal intervention of contact precautions—was introduced to decrease the exposure of health care workers (HCW) to infectious pathogens while performing patient care. During current pandemic situation like coronavirus disease 2019 (COVID-19) and Ebola virus epidemics, many HCW prefer to wear the same pair of gloves for the extended time while working in contact with patients in operating rooms and intensive care units (ICU). Bowdle et al1 have also recommended wearing double gloves during airway management, with the first pair to be removed immediately after the procedure to prevent surface contamination.1 As per World Health Organization recommendations (2015), when wearing 2 pairs of gloves, change of outer gloves should be practised between patients and before exiting patient care area.2 Also, application of alcohol-based hand rub (ABHR) is often done over gloves, for example, during doffing PPE and routine patient care. We wish to highlight that the impact of this practice on incidence of health care-associated infections (HAI) needs special attention. A meta-analysis of 8 heterogeneous studies concluded that universal gloving may be associated with minimal protection against HAI and may be implemented only in high-risk settings.3 Universal gloving may pose more difficulty for hand hygiene by adding another barrier.4 Also, it remains unclear how more frequent application of AHBRs on worn gloves will affect the incidence of HAI in operating rooms and ICU, both COVID and non-COVID. The other concern is that multiple applications of ABHR on gloves may alter their physical properties. Gao et al5 observed ABHRs affected the tensile strength of the tested nitrile more than latex gloves. In addition, ethanol-containing ABHR led to minimal changes in tensile strength of gloves compared to isopropanol containing ABHR.5 Birnbach et al,6 however, showed that the application of ABHR on widely available nitrile examination gloves does not hamper glove integrity and allows safe performance of anesthesia practices. The possible changes in glove properties with multiple applications of ABHR need to be addressed. This is especially significant in the context of safety of HCW working in COVID areas. In the current COVID-19 scenario, when HCW are advised to perform patient care along with self-care, these concerns need to be explored to understand the impact of universal gloving and application of ABHR over worn gloves on incidence of HAI while maintaining safety of HCW. Neeru Sahni, MDKomal A. Gandhi, MDDepartment of Anesthesia & Intensive CarePost-Graduate Institute of Medical Education and ResearchChandigarh, India[email protected] Manisha Biswal, MDDepartment of Medical MicrobiologyPost-Graduate Institute of Medical Education and ResearchChandigarh, India

Impact of COVID-19 pandemic on functioning of cytopathology laboratory: Experience and perspective from an academic centre in New York.

COVID‐19 has extraordinarily impacted every facet of the health care facilities’ operations. Various strategies and policies were implemented promptly to preserve resources, not only to provide medical care to the expected massive numbers of COVID‐19 patients, but also to mitigate the contagion spread at the workplace to ensure safety of healthcare workers. All routine, non‐essential medical services and procedures were ramped down and workers deemed non‐essential were directed to work remotely from home to reduce the number of people at hospital premises and preserve much needed personal protective equipment that were in short supply at the outset of the pandemic. The laboratories did not remain unscathed and were under immense pressure to maintain workplace safety while being operational and provide best patient care with limited resources. In this paper, we share our experience and challenges that we faced in a cytopathology laboratory at a major academic centre in New York, USA during the peak of infection.

The COVID TIDE Approach: A Protocol for Safe Tracheostomy Practice in COVID Patients.

We all are aware of COVID 19 pandemic. As the numbers are increasing, the critical care demand is also increasing. Tracheostomy is one of the commonest procedures which has been performed on COVID positive ventilated patients. It is important to understand and follow the utmost safe practices for the patient and the health care workers for such aerosol generating procedures. The aim of this study is to identify the lacunae in tracheostomy practices during this COVID times and suggest a systematic approach for the safe practices. An online questionnaire survey-based study was performed in September 2020. The target population was practicing otolaryngologists of India with various years of experience. The aim of the study was to evaluate the lacunae in tracheostomy safe practices and to create a systematic approach for the safety of health care workers. Data compilation and analysis was done by using Microsoft Excel. A systematic COVID TIDE tracheostomy safe practices approach was designed after reviewing various tracheostomy guidelines and recommendations. Total 114 otolaryngologists responded with a complete survey report. 72.2% responders were not up to date with their knowledge of tracheostomy safe practices. 79.8% were not performing this procedure in a negative pressure room. 15.8% were not aware of the personal protective equipment level they are using. Only 56.1% survey responders were holding the ventilation before tracheal incision. Overall, 94.7% responders were keen to know about the safe approach of tracheostomy in COVID positive patients. Tracheostomy is an aerosol generating procedure, lacunae in the knowledge can cause major risk to health care professionals. Finally, in such crises, consideration should be taken for simulation exercises, dedicated airway teams and a systematic COVID TIDE approach to improve the safety of the staff and patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12070-021-02370-w.

Serious Workplace Violence Against Healthcare Providers in China Between 2004 and 2018.

Introduction: Workplace violence (WPV) against healthcare providers has severe consequences and is underreported worldwide. The aim of this study was to present the features, causes, and outcomes of serious WPV against healthcare providers in China.Method: We searched for serious WPV events reported online and analyzed information about time, location, people, methods, motivations, and outcomes related to the incident.Result: Serious WPV reported online in China (n = 379) were mainly physical (97%) and often involved the use of weapons (34.5%). Doctors were victims in most instances (81.1%). Serious WPV mostly happened in cities (90.2%), teaching hospitals (87.4%), and tertiary hospitals (67.9%) and frequently in Emergency Department (ED), Obstetrics and Gynecology Department (OB-GYN), and pediatric departments; it was most prevalent in the months of June, May, and February. Rates of serious WPV increased dramatically in 2014 and decreased after 2015, with death (12.8%), severe injury (6%), and hospitalization (24.2%) being the major outcomes. A law protecting healthcare providers implemented in 2015 may have helped curb the violence.Conclusion: Serious WPV in China may stem from poor patient–doctor relationships, overly stressed health providers in highly demanding hospitals, poorly educated/informed patients, insufficient legal protection, and poor communication. Furthering knowledge about WPV and working toward curtailing its presence in healthcare settings are crucial to increasing the safety and well-being of healthcare workers.

Comparative analysis of N95 respirators fit testing with commercially available and in house reagent

SummaryBackgroundDue to COVID-19, thousands of healthcare workers have been affected and have lost their lives in the line of duty. For the protection of healthcare workers, WHO and CDC have made standard guidelines and requirements for PPE use. N95 masks are amongst the most readily used PPE by healthcare professionals and it is highly recommended by OSHA that every make and model of N95 should go through a fit test at least once in a year.MethodA total of 30 randomly selected healthcare professionals (who were a regular user of N95 respiratory masks) were subjected to assess in-house (saccharin sodium benzoate) reagent for use for standard qualitative fit testing in our hospital. Threshold testing with the in-house reagent at three different concentrations was performed prior to establish participants' sensitivity to the reagent. After successful completion of threshold testing, fit test was performed on participants wearing an N95 mask.ResultsAll the participants included in the study passed the sensitivity testing with three concentrations of the reagents, while it was concluded that the concentration of the in-house reagent that was well suited for the sensitivity testing was a concentration of 1g/dl saccharin with 10g/dl sodium benzoate. For fit testing 12g/dl was found to be more appropriate.DiscussionOur study provided a low cost solution to ensure safety of healthcare workers who are regular users of N95 masks following guidelines implemented by OSHA and CDC.ConclusionThe in-house test solution prepared was found to be equally sensitive to its commercially available counterpart.

Environmental and biological monitoring of formaldehyde inside a hospital setting: a combined approach to manage chemical risk in workplaces.

Background: The safety of healthcare workers exposed to formaldehyde remains a great matter of concern for healthcare management units. This work aimed at describing the results of a combined monitoring approach (environmental and biological) to manage occupational exposure to formaldehyde in a hospital setting.Design and Methods: Environmental monitoring of working spaces and biological monitoring of urinary formaldehyde in 16 exposed healthcare workers of the Anatomic Pathology Unit of a University Hospital in Southern Italy was performed on a fouryear timescale (2016-2019).Results: Values of aero-dispersed formaldehyde identified were on average low; although workers’ urinary formaldehyde levels were also minimal, the statistical analysis highlighted a slight weekly accumulation.Conclusions: Our data confirm that both environmental and biological monitoring are important to identify risk situations, in particular when values of hazardous compounds are below the accepted occupational exposure levels.Significance for public healthHealth workers' regular exposure to formaldehyde may be responsible for long-term health issues; unfortunately, threshold limits of this compound are not harmonized between different government agencies. The combination of environmental and biological monitoring thus becomes an invaluable tool to preserve worker's safety and effectively assess chemical risk in hospital settings.

Medical facemasks are adequate for healthcare worker safety at outdoor coronavirus disease 2019 (COVID-19) drive-through testing centers.

Medical facemasks are adequate for healthcare worker safety at outdoor coronavirus disease 2019 (COVID-19) drive-through testing centers.

Trends in Workplace Violence Involving Health Care Professionals in China from 2000 to 2020: A Review.

The safety of health care workers in China has received an increasing amount of attention owing to numerous incidents of hospital-based violence against medical professionals. When pictures and videos of violent injuries are posted on the internet with real-time data, such as gender or location, researchers can access the information to learn about the incident, its causes, and/or threats to survival. We examined the causes and risk factors for workplace violence by analyzing relevant data retrieved from reports by Chinese internet media for all incidents from 2000 to 2020. We present frequency data on hospital-based violence against medical professionals. A total of 345 incidents occurred in health care settings. The person who committed the violent act was a patient or sick person in the workplace or a co-worker in 95.4% of the incidents; 54 of the incidents resulted in the victim’s murder. We provide the characteristics and risk factors of violent criminals. We describe China’s past and current clinical practices and health care policies, and we discuss the challenges faced by medical professionals who are victims of hospital-based violence from the perspectives of patients, physicians, hospital leaders, and the government. We conclude by making recommendations for preventing violence in hospital settings. It is urgent for the public to understand that the occupational safety of health care workers must be protected, and treatment should be provided to patients in a harmonious and safe environment. This review aims to describe the trends in workplace violence involving health care professionals in China from 2000 to 2020 and to discuss possible strategies for improving working conditions in hospitals and other health care settings.

Short Term Outcomes of Head and Neck Oncology Surgery During Covid-19 Pandemic: Experience from a Tertiary Cancer Care Centre in North India.

With the entire world in the midst of COVID-19 pandemic, several health care facilities have stopped or delayed performing elective surgeries in order to cater to ever increasing number of COVID-19 patients. Moreover, there were initial reports of poor surgical outcomes in patients who underwent surgery and were found to be positive for COVID-19 infection in post-operative period. In this study, we have evaluated the short-term outcomes of head and neck oncology patients operated in our institute following a strict screening protocol and conducting COVID-19 testing by Reverse transcriptase polymerase chain reaction once the test was available. 68 patients operated between 1st April and 30th September, 2020 (COVID-19 era, study group) were compared with 59 patients operated during 1st October, 2019 to 31st March 2020 (Non COVID-19 era, control group). The comparison between the groups was done by measuring 30 days complication rate as defined by Dindo–Clavien classification. 10.3% of patients developed complications in study group as compared to 8.5% of patients in control group which was statistically non-significant (p = 0.7). Importantly, none of the patients developed any sign or symptom suggestive of COVID-19 infection in post-operative period in study group. Head and neck oncology related cancer procedures including complex reconstruction can safely be performed during COVID-19 era by proper screening and pre-operative testing for COVID-19. We also suggest use of N95 masks and face shields as bare minimum in order to ensure the safety of health care workers even after a negative COVID-19 report.

Prioritising intubator safety in a pandemic: the details matter

Our ED-intensive care unit has instituted a new protocol meant to maximise the safety of physicians, nurses and respiratory therapists involved with endotracheal intubation of patients known or suspected of...

Leveraging Innovative Training Technologies for Health Care Workers: Preparing, Privileging and Responding to NovelCorona Virus 19 Pandemic Challenges and Opportunities in Tertiary Care Hospitals in India

Exclusive training of health care workers regarding working instructions for the care of Covid19 patients and Covid -19 ward is essential. With the help of simulation-based training and e-learning platforms via mobile app (Daksh), the training programmes were executed and implemented. All the safety precautions were adhered to. This project aimed to train all the nursing staff about the working instructions for taking care of Covid-19 patients. The main objectives were: to ensuring a smooth work process in Covid-19 wards; safety of health care workers by giving them adequate E-learning and simulation-based training and; clinical privileging of the staff nurses for better delivery of quality patient care in Covid-19 departments, thereby ensuring patient safety and patient satisfaction. The project was implemented via E-learning platform Daksh, which a standard platform by Elsevier Nursing Skills for nurses to learn and grow. Thirty one working instructions with the video material were created and uploaded in portal Daksh. More than 3,500 staff nurses were trained via this portal within a stipulated time. All the e-learning training data can be instantly retrieved from the portal for further analysis.

Safety and Awareness of Healthcare Workers During the COVID-19 Outbreak; A Cross-Sectional Study

Objective: COVID-19 has affected millions of people throughout the world and due to the high rate of its spread, it is very vital to protect the people who are at the frontlines of COVID-19 positive cases. In this study, we have analyzed the level of awareness among the Healthcare Workers (HCWs) and level of preparedness by the Healthcare Authorities (HCA) for the safety of HCWs.
 Study Design: Cross-sectional prospective study.
 Subjects and Methods: Study was conducted online, for 3 months, from July to September 2020, at various Health Care Facilities (HCF) of Sindh, Pakistan. The survey instrument was circulated among the HCWs and a total of 419 filled forms were received and analyzed using SPSS 24.
 Results: Out of 419 participants, 54.4% were male and 45.6% female. Half of the respondents were doctors (50.1%) with majority having 1-5 years (61.6%) of experience. It was found that the major sources of information of HCWs about COVID-19 was social media (80.4%) and only 18.6% of HCWs had trainings to deal with pandemics. HCA couldn’t manage to maintain adequate supply of personal protective equipment (PPE) as goggle/eye shields were available only to 20.5% HCWs, shoe covers to 24.3%, N95 masks to 28.5%.
 Conclusion: We identified serious concern in the source of information but despite that the knowledge and awareness level was quite acceptable among our study respondents. However, greater efforts to be taken for training campaigns for HCWs as well as supply of PPE.

Exploratory Sero Prevalence of SARS-CoV-2 (COVID-19) among Health Care Professionals in Department of Community Medicine & School of Public Health (PGIMER, Chandigarh): An Exploratory Study

The safety of Healthcare Workers (HCWs) against SARS-CoV-2 transmission is an important aspect of managing the COVID-19 pandemic. Depending upon the level of sero prevalence of infection, public health interventions can be implemented for prevention and control of the disease.

Design of powered air purifying respirator used for healthcare workers in isolation room

From December 2019, the COVID-19 outbreak has rapidly spread throughout the whole world and become a devastating infectious diseases, with the risk of cross infection quickly and no drug treatment is available. Some countries have been facing shortage of medical equipment, which leads to millions of deaths and may put healthcare workers at risk of infection when they caring for patients sicked with COVID-19 in isolation room, so need to ensure their occupational health and safety. In order to solve this problem, the paper presents a design of Powered Air Purifying Respirator (PAPR) to prevent cross-contamination COVID-19 infection in isolation room, protect for occupational health and safety of healthcare workers. That is specialized equipment for medical industry using ambient air as energy source to operate, the device removes contaminated air through the filters and UVC germicidal light bulbs, then provides clean air to the user's face through blower. It creates continuous positive pressure, and this positive pressure prevents outside contaminated air to a face, but it must be com ply with the safety standards of NIOSH. Especially, this design can be used in case of an emergency, lack of medical supplies and equipment because it can be connected to commercially available masks through a hose connector and a respiratory hose. In case the device does not work or out of battery, a mask accompanied by a hose connector can be connected to the breathing tubes placed in isolation room, all these breathing tubes use clean air from heating, ventilating, and air conditioning (HVAC) of isolation room. Simulations and experiments are attached below to compare the difference between ideal parameters and actual results. From which to draw conclusions and development directions of the research.

Management of SARS-Cov-2-positive major burns: The tribulations and dilemmas

SARS-CoV-2 (COVID-19) pandemic is still ravaging territories and spreading like wildfire. Infection with this virus is already complicating many clinical and emergency situations by overlapping symptoms, development of newer protocols for disease management, by redefining prognostic indicators, and upscaling the level of protection required for health-care workers. The current report outlines the tribulations and dilemmas of managing an asymptomatic 35% total body surface area burn patient with concomitant SARS-CoV-2 infection, from its diagnosis till full wound healing. Countries with a large population and a high incidence of SARS-CoV-2 infection need to maintain a high index of suspicion for a concomitant SARS-CoV-2 infection because asymptomatic patients can present with burns and they can also be carriers. Further, there is a need to strategize the deployment of resources, workforce, and burn wound management and to adopt effective precautionary measures for better outcomes and safety of health-care workers.

Infection prevention practice and associated factors among health care workers in south Gondar zone, North West Ethiopia, 2020

Background: Infection prevention is universally acknowledged as a vital component of comprehensive approach to patient and healthcare worker safety, quality improvement, and improved health outcomes. Infections acquired during health-care delivery are a significant public health problem around the world. Thus, infection prevention is not only the most cost-effective option, but also the best strategy to prevent the spread of disease within health facilities. Therefore, the objective of this study was to assess infection prevention practices and associated factors among health care workers in governmental health care facilities in South Gondar zone, North West Ethiopia. Methods: Institutional based cross-sectional study design was conducted from 15 February-15 April, 2020 in South Gondar zone among healthcare workers.Multistage was usedas sampling procedures. Data were collected using pre-tested self-administered structured questionnaire. Data were entered and analyzed using Epi-data version 3.1 and SPSS version 23 respectively. The model was fitted using multivariable logistic regression to identify associated factors with infection prevention practices. Odds ration with a 95% confidence interval was used as measure of association. Finally p-value less than 0.05 were used to declare statistical significance. Results: Six hundred two (97%) healthcare workers participated in the study. Three hundred thirty six 60.8%(57.1-64.8%) 95%CI health care workers had good infection prevention practices. Availability of gloves, AOR 3.69(2.015, 6.789)95%CI, Availability Safety box, AOR=1.9(1.2, 3.1)95% CI, Presence of Infection prevention guide line, AOR=0.498(.32, .83) 95% CI, presence of alcohol swab AOR = 0.49(.29, 82)95% CI. Accessibility of hand washing items AOR=2.0(1.2, 3.4) 95% CI were found to be significantly associated. Conclusion: Nearly two-third of the healthcare workers had good infection prevention practices. On infection prevention measures, availability of guide lines, safety box, gloves, alcohol swab, and accessibility of items for hand washings were predictors of good infection prevention practices. To sustain good practices, accessible of hygiene materials should be kept to all units of health facility all times.

The Three “R”s-Rights, Roles and Responsibilities of Healthcare Workers During COVID-19 Outbreak in India

This article addresses the rights, roles and responsibilities of Healthcare Workers (HCW) who are front line warriors in any pandemic outbreak. Coronaviruses 2019 (COVID-19) pandemic has emerged as international public health emergency in March 2020, and exposed the weak/failed health care system preparedness to respond to the pandemic threat and controlling the community spread. In India, huge population, poor economic growth and unacceptable doctor to patient ratio made swift response to emergence of pandemic, safeguarding HCWs, ability to provide care without mental and physical burn out challenging. This review emphasises the need for safety of HCW and patients, infection control, security to the family, psychosocial and mental well-being, proper allocation of medical supplies, medical ethics and communication.

The Utilization of Protective Face Masks among Polish Healthcare Workers during COVID-19 Pandemic: Do We Pass the Exam?

Relevant personal protective measures during the COVID-19 pandemic include face masks, possibly decreasing the risk of infection among the general population and healthcare workers (HCW) if utilized properly. The aim of the study was to assess whether different Polish HCW utilize face masks according to the 2020 World Health Organization guidance (WHO) criteria. This cross-sectional study included 1156 respondents who participated in an internet survey evaluating mask-related behaviors. All the WHO criteria were complied with by 1.4% of participants, regardless of medical profession, specialty or place of employment. HCW mostly adhered to criterion 1 (C1; strict covering of the face and mouth with the mask; 90.8%), C4 (washing/disinfecting the hands after touching/taking off the mask; 49%) and C3 (taking off the mask properly without touching the anterior surface; 43.4%), whereas C2 (avoidance of touching the mask with hands) was complied with least commonly (6.8%). HCW with mask-induced itch (31.6%) complied to C2 less often (odds ratio 0.53; p = 0.01). The study reveals that Polish HCW rarely adhere to all the 2020 WHO guidance criteria on the use of masks, whereas the adherence to particular criteria is variable and may be associated with the presence of skin-related conditions and other factors. Better compliance with the recommendations in the future is necessary to increase personal safety of HCW and prevent the transmission of SARS-CoV-2.