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Holt RIG, Cockram CS, Ma RCW, Luk AOY. Diabetes and infection: review of the epidemiology, mechanisms and principles of treatment. Diabetologia 2024; 67:1168-1180. [PMID: 38374451 PMCID: PMC11153295 DOI: 10.1007/s00125-024-06102-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/04/2023] [Indexed: 02/21/2024]
Abstract
An association between diabetes and infection has been recognised for many years, with infection being an important cause of death and morbidity in people with diabetes. The COVID-19 pandemic has re-kindled an interest in the complex relationship between diabetes and infection. Some infections occur almost exclusively in people with diabetes, often with high mortality rates without early diagnosis and treatment. However, more commonly, diabetes is a complicating factor in many infections. A reciprocal relationship occurs whereby certain infections and their treatments may also increase the risk of diabetes. People with diabetes have a 1.5- to 4-fold increased risk of infection. The risks are the most pronounced for kidney infection, osteomyelitis and foot infection, but are also increased for pneumonia, influenza, tuberculosis, skin infection and general sepsis. Outcomes from infection are worse in people with diabetes, with the most notable example being a twofold higher rate of death from COVID-19. Hyperglycaemia has deleterious effects on the immune response. Vascular insufficiency and neuropathy, together with altered skin, mucosal and gut microbial colonisation, contribute to the increased risk of infection. Vaccination is important in people with diabetes although the efficacy of certain immunisations may be compromised, particularly in the presence of hyperglycaemia. The principles of treatment largely follow those of the general population with certain notable exceptions.
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Affiliation(s)
- Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Clive S Cockram
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
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2
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Booth A, Sommer I, Noyes J, Houghton C, Campbell F. Rapid reviews methods series: guidance on rapid qualitative evidence synthesis. BMJ Evid Based Med 2024; 29:194-200. [PMID: 38355285 PMCID: PMC11137447 DOI: 10.1136/bmjebm-2023-112620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 02/16/2024]
Abstract
This paper forms part of a series of methodological guidance from the Cochrane Rapid Reviews Methods Group and addresses rapid qualitative evidence syntheses (QESs), which use modified systematic, transparent and reproducible methodsu to accelerate the synthesis of qualitative evidence when faced with resource constraints. This guidance covers the review process as it relates to synthesis of qualitative research. 'Rapid' or 'resource-constrained' QES require use of templates and targeted knowledge user involvement. Clear definition of perspectives and decisions on indirect evidence, sampling and use of existing QES help in targeting eligibility criteria. Involvement of an information specialist, especially in prioritising databases, targeting grey literature and planning supplemental searches, can prove invaluable. Use of templates and frameworks in study selection and data extraction can be accompanied by quality assurance procedures targeting areas of likely weakness. Current Cochrane guidance informs selection of tools for quality assessment and of synthesis method. Thematic and framework synthesis facilitate efficient synthesis of large numbers of studies or plentiful data. Finally, judicious use of Grading of Recommendations Assessment, Development and Evaluation approach for assessing the Confidence of Evidence from Reviews of Qualitative research assessments and of software as appropriate help to achieve a timely and useful review product.
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Affiliation(s)
- Andrew Booth
- EnSyGN Sheffield Evidence Synthesis Group, University of Sheffield, Sheffield, UK
- Cochrane Qualitative and Implementation Methods Group (CQIMG), London, UK
| | - Isolde Sommer
- Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
- Cochrane Rapid Reviews Group & Cochrane Austria, Krems, Austria
| | - Jane Noyes
- Cochrane Qualitative and Implementation Methods Group (CQIMG), London, UK
- Bangor University, Bangor, UK
| | - Catherine Houghton
- Cochrane Qualitative and Implementation Methods Group (CQIMG), London, UK
- University of Galway, Galway, Ireland
| | - Fiona Campbell
- EnSyGN Sheffield Evidence Synthesis Group, University of Sheffield, Sheffield, UK
- University of Newcastle upon Tyne, Newcastle upon Tyne, UK
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Niekrens V, Kunz B, Werner M, Valenza G, Seggewies C, Bogdan C, Esse J. Analysis of the effectiveness of hygiene measures and COVID-19 vaccination at a tertiary-care university hospital during the first two years of the SARS-CoV-2 pandemic. Heliyon 2024; 10:e30311. [PMID: 38726181 PMCID: PMC11079082 DOI: 10.1016/j.heliyon.2024.e30311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
Objective Assessment of the effectiveness of protective measures at a tertiary-care hospital during the SARS-CoV-2 infection waves to provide advice for future pandemics. Design Retrospective cohort study among hospital staff using in-house surveillance data. Setting University Hospital Erlangen (UKER), a tertiary-care provider in Bavaria, Germany. Methods We outline the preventive measures introduced at UKER and retrospectively assess their effectiveness using anonymized monitoring data that were collected during the SARS-CoV-2 pandemic from February 2020 to the end of January 2022. Analysed data includes the incidence of SARS-CoV-2 infections among employees, the frequency of high-risk contacts with infected patients or staff members and breakthrough infections considering the context of exposure. Results The cumulative incidence of SARS-CoV-2 infections among UKER employees was higher before, but lower after the vaccination campaign when compared to the general population. Healthcare workers (HCW), notably physicians and nurses, were especially at risk of infection compared to other UKER employees with less direct patient contact (OR 1.36 [95% CI 1.18-1.57 p < 0.001]). Breakthrough infections mostly occurred after exposure during private life, i.e. in situations without protective equipment. The frequency of high-risk contacts during direct patient care remained stable after SARS-CoV-2 vaccination. Prior to vaccination, 5.2% of HCW with direct patient care tested positive for SARS-CoV-2 within 14 days. After vaccination until the onset of the Omicron wave, conversion rate dropped to 0%. Conclusions This study provides real-world data on the effectiveness of vaccination, contact tracing, personal protective equipment and general hygiene measures during the SARS-CoV-2 pandemic. Based on our findings, we recommend a protective approach combining all these preventive measures.
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Affiliation(s)
- Valentin Niekrens
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Wasserturmstraße 3/5, D-91054, Erlangen, Germany
| | - Bernd Kunz
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Wasserturmstraße 3/5, D-91054, Erlangen, Germany
| | - Markus Werner
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Wasserturmstraße 3/5, D-91054, Erlangen, Germany
| | - Giuseppe Valenza
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Wasserturmstraße 3/5, D-91054, Erlangen, Germany
| | - Christof Seggewies
- Medical Informatics and Communication Center, Universitätsklinikum Erlangen, Glückstraße 11, D-91054, Erlangen, Germany
| | - Christian Bogdan
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Wasserturmstraße 3/5, D-91054, Erlangen, Germany
- FAU Profile Center Immunomedicine, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Schlossplatz 1, D-91054, Erlangen, Germany
| | - Jan Esse
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Wasserturmstraße 3/5, D-91054, Erlangen, Germany
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Meyer C, Crayton E, Wright A, Spyer M, Vora N, Houlihan C, Walker NF, Nastouli E, Michie S, Lorencatto F. Factors influencing uptake of protective behaviours by healthcare workers in England during the COVID-19 pandemic: A theory-based mixed-methods study. PLoS One 2024; 19:e0299823. [PMID: 38722954 PMCID: PMC11081271 DOI: 10.1371/journal.pone.0299823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/15/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Hospital infection control policies protect patients and healthcare workers (HCWs) and limit the spread of pathogens, but adherence to COVID-19 guidance varies. We examined hospital HCWs' enactment of social distancing and use of personal protective equipment (PPE) during the COVID-19 pandemic, factors influencing these behaviours, and acceptability and feasibility of strategies to increase social distancing. METHODS An online, cross-sectional survey (n = 86) and semi-structured interviews (n = 22) with HCWs in two English hospitals during the first wave of the COVID-19 pandemic (May-December 2020). The Capability, Opportunity, Motivation (COM-B) model of behaviour change underpinned survey and topic guide questions. Spearman Rho correlations examined associations between COM-B domains and behaviours. Interviews were analysed using inductive and deductive thematic analysis. Potential strategies to improve social distancing were selected using the Behaviour Change Wheel and discussed in a stakeholder workshop (n = 8 participants). RESULTS Social distancing enactment was low, with 85% of participants reporting very frequently or always being in close contact with others in communal areas. PPE use was high (88% very frequently or always using PPE in typical working day). Social distancing was associated with Physical Opportunity (e.g., size of physical space), Psychological Capability (e.g., clarity of guidance), and Social Opportunity (e.g., support from managers). Use of PPE was associated with Psychological Capability (e.g., training), Physical Opportunity (e.g., availability), Social Opportunity (e.g., impact on interactions with patients), and Reflective Motivation (e.g., beliefs that PPE is effective). Local champions and team competition were viewed as feasible strategies to improve social distancing. CONCLUSIONS It is valuable to understand and compare the drivers of individual protective behaviours; when faced with the same level of perceived threat, PPE use was high whereas social distancing was rarely enacted. Identified influences represent targets for intervention strategies in response to future infectious disease outbreaks.
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Affiliation(s)
- Carly Meyer
- Centre for Behaviour Change, University College London, London, United Kingdom
- NIHR Policy Research Unit in Behavioural Science, University College London, London, United Kingdom
| | - Elise Crayton
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Abigail Wright
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Moira Spyer
- Department of Infection, Immunity and Inflammation, UCL GOS Institute of Child Health, London, United Kingdom
| | - Nina Vora
- UCL Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, United Kingdom
| | - Catherine Houlihan
- Department of Clinical Virology, University College London Hospitals NHS Trust, London, United Kingdom
| | - Naomi F. Walker
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Eleni Nastouli
- Department of Infection, Immunity and Inflammation, UCL GOS Institute of Child Health, London, United Kingdom
- Department of Clinical Virology, University College London Hospitals NHS Trust, London, United Kingdom
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, United Kingdom
- NIHR Policy Research Unit in Behavioural Science, University College London, London, United Kingdom
| | - Fabiana Lorencatto
- Centre for Behaviour Change, University College London, London, United Kingdom
- NIHR Policy Research Unit in Behavioural Science, University College London, London, United Kingdom
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Ehsan A, Ehsan F, Hanif H. Infection control practices in public sector hospitals of Punjab: a critical analysis. BMJ Open Qual 2024; 13:e002380. [PMID: 38719521 PMCID: PMC11086194 DOI: 10.1136/bmjoq-2023-002380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/29/2023] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Infection prevention and control (IPC) is imperative towards patient safety and health. The Infection Prevention and Control Assessment Framework (IPCAF) developed by WHO provides a baseline assessment at the acute healthcare facility level. This study aimed to assess the existing IPC level of selected public sector hospital facilities in Punjab to explore their strengths and deficits. METHODS Between October and April 2023, 11 public sector hospitals (including tertiary, secondary and primary level care) were selected. Data were collected using the IPCAF assessment tool comprising eight sections, which were then categorised into four distinct IPC levels- inadequate, basic, intermediate and advanced. Key performance metrics were summarised within and between hospitals. RESULTS The overall median IPCAF score for the public sector hospitals was 532.5 (IQR: 292.5-690) out of 800. Four hospitals each scored 'advanced' as well as 'basic' IPC level and three hospitals fell into 'intermediate level'. Most hospitals had IPC guidelines as well as IPC programme, environments, materials and equipments. Although 90% of secondary care hospitals had IPC education and training, only 2 out of 5 (40%) tertiary care and 2 out of 3 (67%) primary care hospitals have IPC or additional experts for training. Only 1 out of 5 tertiary care hospitals (20%) were recorded in an agreed ratio of healthcare workers to patients while 2 out of 5 (40%) of these hospitals lack staffing need assessment. CONCLUSION Overall the sampled public sector (tertiary, secondary and primary) hospitals demonstrated satisfactory IPC level. Challenging areas are the healthcare-associated infection surveillance, monitoring/audit and staffing, bed occupancy overall in all the three categories of hospitals. Periodic training and assessment can facilitate improvement in public sector systems.
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Affiliation(s)
| | - Fatima Ehsan
- Physiology, Riphah International University, Islamabad, Pakistan
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Han SJ, Hong HJ, Shin BS. Korean Hospital Nurses' Experiences with COVID-19: A Meta-Synthesis of Qualitative Findings. Healthcare (Basel) 2024; 12:903. [PMID: 38727460 PMCID: PMC11083708 DOI: 10.3390/healthcare12090903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
This study aims to provide a meta-synthesis of qualitative studies examining the perceptions and experiences of nurses who cared for patients in dedicated COVID-19 hospitals in South Korea. We searched key health databases (RISS, KISS, KMbase, NDSL, KoreaMed, DBpia, PubMed, CINAHL, and Cochrane) from September to November 2023. We reviewed and analyzed articles using a thematic synthesis approach. The quality of the studies was ascertained using the Critical Appraisal Skills Program checklist for qualitative research. Ultimately, 13 studies involving 219 nurses were included in the final review. Six major themes and thirteen subthemes emerged. During the unexpected COVID-19 pandemic, nurses were able to overcome difficult situations through their interactions with patients, sense of a professional mission, and commitment to nursing. Most importantly, they persevered through their collaboration and closeness with fellow nurses, despite confusion about their professional identity, the ethical dilemmas they faced in patient care, and the conflicting attitudes of their social support system. To prepare for future infectious disease outbreaks, a multifaceted support system should be established to enable nurses to have positive interactions with their families, colleagues, and patients, which have become central to their resilience.
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Affiliation(s)
- Suk-Jung Han
- College of Nursing, Sahmyook University, Seoul 01795, Republic of Korea;
| | - Hee-Jung Hong
- Department of Nursing, Severance Hospital, Seoul 03722, Republic of Korea
| | - Bok-Soon Shin
- College of Nursing, Inha University, Incheon 22212, Republic of Korea;
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Ruan Y, Hong Q, Feng L, Chien CW, Sun K, Chuang YC, Tang F. Identification of key potential risk areas and key potential failure modes in hemodialysis rooms by the FMEA method following routine prevention and control of the COVID-19 pandemic. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2024. [PMID: 38616513 DOI: 10.1111/risa.14304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 04/16/2024]
Abstract
Hemodialysis is an important part of nosocomial infection prevention and control (IPC). This study aimed to identify the key potential risk areas and failure modes in hemodialysis rooms in hospitals and put forward a series of improvement measures to prevent and control the spread of the coronavirus disease 2019 (COVID-19). Hemodialysis patients are highly susceptible to COVID-19 and usually have a high incidence of severe illness and mortality after infection with COVID-19. Therefore, IPC in hemodialysis patients is of crucial strategic significance. Based on 30 domain experts' interviews and careful analysis of prevention and control documents, we constructed a comprehensive failure system for a model that identifies the potential risks for nosocomial COVID-19 infection in the hemodialysis room. Subsequently, a thorough risk assessment of the potential failure factors identified in our model was conducted. The failure key factors corresponding to the human element in medical waste (garbage) disposal (C2) are verified to be the highest risk factors. They are as follows: The cleaning staff did not dispose of different types of medical waste (garbage) (C21), did not wear masks according to the regulations (C22), and lacked knowledge and norms of nosocomial IPC (C23). This study provides valuable insights for hospital decision-makers on the potential failure factors related to COVID-19 infections in hemodialysis rooms. By working with hospital infection specialists, the suggested improvement measures can help reduce the risk of virus exposure among hospital medical staff, patients, and cleaning staff.
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Affiliation(s)
- Yingying Ruan
- Hemodialysis Room, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Qijun Hong
- Hemodialysis Room, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Lili Feng
- Nursing Department, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, China
| | - Kai Sun
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yen-Ching Chuang
- Institute of Public Health and Emergency Management, Taizhou University, Taizhou, Zhejiang, China
- Business College, Taizhou University, Taizhou, Zhejiang, China
- Key Laboratory of evidence-based Radiology of Taizhou, Linhai, Zhejiang, China
| | - Fuqin Tang
- Nursing Department, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
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Constantin AM, Noertjojo K, Sommer I, Pizarro AB, Persad E, Durao S, Nussbaumer-Streit B, McElvenny DM, Rhodes S, Martin C, Sampson O, Jørgensen KJ, Bruschettini M. Workplace interventions to reduce the risk of SARS-CoV-2 infection outside of healthcare settings. Cochrane Database Syst Rev 2024; 4:CD015112. [PMID: 38597249 PMCID: PMC11005086 DOI: 10.1002/14651858.cd015112.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Although many people infected with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) experience no or mild symptoms, some individuals can develop severe illness and may die, particularly older people and those with underlying medical problems. Providing evidence-based interventions to prevent SARS-CoV-2 infection has become more urgent with the potential psychological toll imposed by the coronavirus disease 2019 (COVID-19) pandemic. Controlling exposures to occupational hazards is the fundamental method of protecting workers. When it comes to the transmission of viruses, workplaces should first consider control measures that can potentially have the most significant impact. According to the hierarchy of controls, one should first consider elimination (and substitution), then engineering controls, administrative controls, and lastly, personal protective equipment. This is the first update of a Cochrane review published 6 May 2022, with one new study added. OBJECTIVES To assess the benefits and harms of interventions in non-healthcare-related workplaces aimed at reducing the risk of SARS-CoV-2 infection compared to other interventions or no intervention. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science Core Collections, Cochrane COVID-19 Study Register, World Health Organization (WHO) COVID-19 Global literature on coronavirus disease, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, and medRxiv to 13 April 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) and non-randomised studies of interventions. We included adult workers, both those who come into close contact with clients or customers (e.g. public-facing employees, such as cashiers or taxi drivers), and those who do not, but who could be infected by coworkers. We excluded studies involving healthcare workers. We included any intervention to prevent or reduce workers' exposure to SARS-CoV-2 in the workplace, defining categories of intervention according to the hierarchy of hazard controls (i.e. elimination; engineering controls; administrative controls; personal protective equipment). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were incidence rate of SARS-CoV-2 infection (or other respiratory viruses), SARS-CoV-2-related mortality, adverse events, and absenteeism from work. Our secondary outcomes were all-cause mortality, quality of life, hospitalisation, and uptake, acceptability, or adherence to strategies. We used the Cochrane RoB 2 tool to assess risk of bias, and GRADE methods to evaluate the certainty of evidence for each outcome. MAIN RESULTS We identified 2 studies including a total of 16,014 participants. Elimination-of-exposure interventions We included one study examining an intervention that focused on elimination of hazards, which was an open-label, cluster-randomised, non-inferiority trial, conducted in England in 2021. The study compared standard 10-day self-isolation after contact with an infected person to a new strategy of daily rapid antigen testing and staying at work if the test is negative (test-based attendance). The trialists hypothesised that this would lead to a similar rate of infections, but lower COVID-related absence. Staff (N = 11,798) working at 76 schools were assigned to standard isolation, and staff (N = 12,229) working at 86 schools were assigned to the test-based attendance strategy. The results between test-based attendance and standard 10-day self-isolation were inconclusive for the rate of symptomatic polymerase chain reaction (PCR)-positive SARS-CoV-2 infection (rate ratio (RR) 1.28, 95% confidence interval (CI) 0.74 to 2.21; 1 study; very low-certainty evidence). The results between test-based attendance and standard 10-day self-isolation were inconclusive for the rate of any PCR-positive SARS-CoV-2 infection (RR 1.35, 95% CI 0.82 to 2.21; 1 study; very low-certainty evidence). COVID-related absenteeism rates were 3704 absence days in 566,502 days-at-risk (6.5 per 1000 working days) in the control group and 2932 per 539,805 days-at-risk (5.4 per 1000 working days) in the intervention group (RR 0.83, 95% CI 0.55 to 1.25). We downgraded the certainty of the evidence to low due to imprecision. Uptake of the intervention was 71% in the intervention group, but not reported for the control intervention. The trial did not measure our other outcomes of SARS-CoV-2-related mortality, adverse events, all-cause mortality, quality of life, or hospitalisation. We found seven ongoing studies using elimination-of-hazard strategies, six RCTs and one non-randomised trial. Administrative control interventions We found one ongoing RCT that aims to evaluate the efficacy of the Bacillus Calmette-Guérin (BCG) vaccine in preventing COVID-19 infection and reducing disease severity. Combinations of eligible interventions We included one non-randomised study examining a combination of elimination of hazards, administrative controls, and personal protective equipment. The study was conducted in two large retail companies in Italy in 2020. The study compared a safety operating protocol, measurement of body temperature and oxygen saturation upon entry, and a SARS-CoV-2 test strategy with a minimum activity protocol. Both groups received protective equipment. All employees working at the companies during the study period were included: 1987 in the intervention company and 1798 in the control company. The study did not report an outcome of interest for this systematic review. Other intervention categories We did not find any studies in this category. AUTHORS' CONCLUSIONS We are uncertain whether a test-based attendance policy affects rates of PCR-positive SARS-CoV-2 infection (any infection; symptomatic infection) compared to standard 10-day self-isolation amongst school and college staff. A test-based attendance policy may result in little to no difference in absenteeism rates compared to standard 10-day self-isolation. The non-randomised study included in our updated search did not report any outcome of interest for this Cochrane review. As a large part of the population is exposed in the case of a pandemic, an apparently small relative effect that would not be worthwhile from the individual perspective may still affect many people, and thus become an important absolute effect from the enterprise or societal perspective. The included RCT did not report on any of our other primary outcomes (i.e. SARS-CoV-2-related mortality and adverse events). We identified no completed studies on any other interventions specified in this review; however, eight eligible studies are ongoing. More controlled studies are needed on testing and isolation strategies, and working from home, as these have important implications for work organisations.
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Affiliation(s)
- Alexandru Marian Constantin
- Department of Internal Medicine Clinical Hospital Colentina, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | | | - Isolde Sommer
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
| | | | - Emma Persad
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
- Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Solange Durao
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Barbara Nussbaumer-Streit
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
| | - Damien M McElvenny
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
- Institute of Occupational Medicine, Edinburgh, UK
| | - Sarah Rhodes
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | | | | | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Matteo Bruschettini
- Cochrane Sweden, Department of Research and Education, Lund University, Skåne University Hospital, Lund, Sweden
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Cholewa J, Ponsar C, de Rouffignac S, Pétré B, Van Poel E, Willems S, De Jonghe M. General practitioners' well-being in Belgium: results from the cross-sectional PRICOV-19 study. BMC PRIMARY CARE 2024; 24:284. [PMID: 38594628 PMCID: PMC11005122 DOI: 10.1186/s12875-024-02341-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The mental health and well-being of GPs is a critical issue as they play a vital role in providing healthcare services to individuals and communities. Research has shown that GPs often face high levels of stress, burnout, and mental health problems due to their demanding work environment. During the COVID-19 pandemic, GPs faced additional challenges which further impacted their mental health and well-being. This study aims to investigate the impact of systemic work-related stressors on the level of well-being of GPs in Belgium during the pandemic, with a particular emphasis on identifying regional variations between Flanders, Wallonia, and Brussels-Capital. METHODS Data were collected with a self-reported online questionnaire from 479 GPs Belgian practices between December 2020 and August 2021 as part of the international PRICOV-19 study that explored the organization of general practices during COVID-19 in 38 countries to guarantee safe, effective, patient-centered, and equitable care. Well-being was evaluated by the Mayo Clinic's expanded 9-item well-being index. RESULTS The findings of this study reveal notable regional discrepancies in the degree of well-being experienced by Belgian GPs, with the Walloon region displaying the lowest level of well-being (37%) in a population highly susceptible to professional distress (57%). Among the key stressors contributing to such distress, financial difficulties among patients (p < 0.011), the fee-for-service payment system (p = 0.013), a lack of work-related purpose (p = 0.047), and inadequate work-life balance (p < 0.001) were identified as significant factors. When examining the influence of regional disparities, it was found that the sole significant interaction between work-related stressors and region regarding the probability of experiencing distress was related to the possibility of workload sharing among practice personnel. CONCLUSION The findings from this study underscore the imperative for more comprehensive research aimed at scrutinizing the differences in well-being across the three regions in Belgium and identifying the systemic factors that influence the practice environment, as opposed to exclusively concentrating on enhancing individual resilience.
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Affiliation(s)
- Joanna Cholewa
- Academic Center of General Medicine, Faculty of Medicine and Dentistry, UCLouvain, Brussels, Belgium
| | - Cecile Ponsar
- Academic Center of General Medicine, Faculty of Medicine and Dentistry, UCLouvain, Brussels, Belgium.
| | - Ségolène de Rouffignac
- Academic Center of General Medicine, Faculty of Medicine and Dentistry, UCLouvain, Brussels, Belgium
| | - Benoit Pétré
- Department of Public Health Sciences, Liège University, Liège, Belgium
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Michel De Jonghe
- Academic Center of General Medicine, Faculty of Medicine and Dentistry, UCLouvain, Brussels, Belgium
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Meng M, Hu J, Liu X, Tian M, Lei W, Liu E, Han Z, Li Q, Chen Y. Barriers and facilitators to guideline for the management of pediatric off-label use of drugs in China: a qualitative descriptive study. BMC Health Serv Res 2024; 24:435. [PMID: 38580958 PMCID: PMC10998389 DOI: 10.1186/s12913-024-10860-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 03/12/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Despite being a global public health concern, there is a research gap in analyzing implementation strategies for managing off-label drug use in children. This study aims to understand professional health managers' perspectives on implementing the Guideline in hospitals and determine the Guideline's implementation facilitators and barriers. METHODS Pediatric directors, pharmacy directors, and medical department directors from secondary and tertiary hospitals across the country were recruited for online interviews. The interviews were performed between June 27 and August 25, 2022. The Consolidated Framework for Implementation Research (CFIR) was adopted for data collection, data analysis, and findings interpretation to implement interventions across healthcare settings. RESULTS Individual interviews were conducted with 28 healthcare professionals from all over the Chinese mainland. Key stakeholders in implementing the Guideline for the Management of Pediatric Off-Label Use of Drugs in China (2021) were interviewed to identify 57 influencing factors, including 27 facilitators, 29 barriers, and one neutral factor, based on the CFIR framework. The study revealed the complexity of the factors influencing managing children's off-label medication use. A lack of policy incentives was the key obstacle in external settings. The communication barrier between pharmacists and physicians was the most critical internal barrier. CONCLUSION To our knowledge, this study significantly reduces the implementation gap in managing children's off-label drug use. We provided a reference for the standardized management of children's off-label use of drugs.
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Affiliation(s)
- Min Meng
- Chevidence Lab of Child & Adolescent Health, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Jiale Hu
- Department of Nurse Anesthesia, Virginia Commonwealth University, Richmond, USA
| | - Xiao Liu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Min Tian
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Wenjuan Lei
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Enmei Liu
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhu Han
- College of Pharmacy, Gansu University of Chinese Medicine, Lanzhou, China
| | - Qiu Li
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
- Chongqing Key Laboratory of Pediatrics, Chongqing, China.
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Chongqing, China.
| | - Yaolong Chen
- Chevidence Lab of Child & Adolescent Health, Children's Hospital of Chongqing Medical University, Chongqing, China.
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
- Chongqing Key Laboratory of Pediatrics, Chongqing, China.
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences(2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China.
- Lanzhou University GRADE Center, Lanzhou, China.
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Houben F, den Heijer CD, Dukers-Muijrers NH, Smeets-Peels C, Hoebe CJ. Perceived barriers and facilitators to infection prevention and control in Dutch residential care facilities for people with intellectual and developmental disabilities: a cross-sectional study. BMC Public Health 2024; 24:704. [PMID: 38443810 PMCID: PMC10916042 DOI: 10.1186/s12889-024-18159-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Adequate implementation of infection prevention and control (IPC) in residential care facilities (RCFs) for people with intellectual and developmental disabilities (IDDs) is crucial to safeguarding this vulnerable population. Studies in this field are scarce. This study aimed to identify perceived barriers to and facilitators of IPC among professionals working in these settings, along with recommendations to improve IPC, to inform the development of targeted interventions. METHODS We administered an online questionnaire to 319 professionals from 16 Dutch RCFs for people with IDDs (March 2021-March 2022). Perceived multilevel barriers and facilitators (guideline, client, interpersonal, organisational, care sector, and policy level) were measured on a 5-point Likert scale (totally disagree-totally agree). Recommendations were assessed using a 5-point Likert scale (not at all helpful-extremely helpful), supplemented by an open-ended question. Barriers, facilitators, and recommendations were analysed by descriptive statistics. Open answers to recommendations were analysed through thematic coding. RESULTS Barriers to IPC implementation included the client group (e.g., lack of hygiene awareness) (63%), competing values between IPC and the home-like environment (42%), high work pressure (39%), and the overwhelming quantity of IPC guidelines/protocols (33%). Facilitators included perceived social support on IPC between professionals and from supervisors (90% and 80%, respectively), procedural clarity of IPC guidelines/protocols (83%), and the sense of urgency for IPC in the organisation (74%). Main recommendations included the implementation of clear IPC policies and regulations (86%), the development of a practical IPC guideline (84%), and the introduction of structural IPC education and training programmes (for new staff members) (85%). Professionals also emphasised the need for IPC improvement efforts to be tailored to the local care context, and to involve clients and their relatives. CONCLUSIONS To improve IPC in disability care settings, multifaceted strategies should be adopted. Initial efforts should involve clients (and relatives), develop a practical and context-specific IPC guideline, encourage social support among colleagues through interprofessional coaching, reduce workload, and foster an IPC culture including shared responsibility within the organisation.
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Affiliation(s)
- Famke Houben
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD, Maastricht, P.O. box 616, The Netherlands.
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health Mosa, South Limburg Public Health Service, 6400 AA, Heerlen, P.O. box 33, The Netherlands.
| | - Casper Dj den Heijer
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD, Maastricht, P.O. box 616, The Netherlands
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health Mosa, South Limburg Public Health Service, 6400 AA, Heerlen, P.O. box 33, The Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), 6202 AZ, Maastricht, P.O. box 5800, The Netherlands
| | - Nicole Htm Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health Mosa, South Limburg Public Health Service, 6400 AA, Heerlen, P.O. box 33, The Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD, Maastricht, P.O. box 616, The Netherlands
| | | | - Christian Jpa Hoebe
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD, Maastricht, P.O. box 616, The Netherlands
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health Mosa, South Limburg Public Health Service, 6400 AA, Heerlen, P.O. box 33, The Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), 6202 AZ, Maastricht, P.O. box 5800, The Netherlands
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Videl H, Levin C, Azulay Chertok I. Perceived Health Risks, Health Behaviors, and BMI Among Diverse Adults in Israel. J Transcult Nurs 2024; 35:151-160. [PMID: 38158789 DOI: 10.1177/10436596231217681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Obesity is associated with an increased relative risk of COVID-19-related mortality. The interplay of culture and religion in the overweight/obesity context has been minimally examined. The purpose of this study was to examine the association between preventive health behaviors, sociodemographic factors, and obesity among religiously diverse adults in Israel. METHODS Using a quantitative cross-sectional design, an online survey was distributed to diverse adults in Israel during the pandemic using social media, email, and snowball methods. RESULTS Participants included 635 adults: 69.1% Jewish, 26.5% Muslim, and 4.4% "other." Jewish adults scored lower than others on perceived personal risk (p < .001), infection spread risk (p < .001), and preventive behaviors engagement (p < .005). Higher body mass index (BMI) predicted higher personal risk and higher likelihood of preventive behaviors engagement (p < .001). DISCUSSION Results demonstrate the association between religion, health risk perceptions, and COVID-19-related health behaviors. Nurses should consider the influence of culture and religion on health practices and recommend relevant lifestyle modifications to reduce COVID-19 risks.
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Affiliation(s)
- Hila Videl
- The Jerusalem College of Technology-Lev Academic Center, Israel
- Herzliya Medical Center, Israel
| | - Chedva Levin
- The Jerusalem College of Technology-Lev Academic Center, Israel
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Shihora J, Damor NC, Parmar A, Pankaj N, Murugan Y. Knowledge, Attitudes, and Preventive Practices Regarding Tuberculosis Among Healthcare Workers and Patients in India: A Mixed-Method Study. Cureus 2024; 16:e56368. [PMID: 38633958 PMCID: PMC11022008 DOI: 10.7759/cureus.56368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a major public health challenge in India. Healthcare workers (HCWs) and TB patients are critical to disease transmission and prevention. This study evaluated and compared knowledge, attitudes, and practices related to TB infection control. MATERIALS AND METHODS This was a mixed-method study that included a cross-sectional survey conducted among 167 HCWs and 346 patients with TB at tertiary hospitals in western Gujarat using a validated questionnaire. Additionally, 20 HCWs and 20 patients were interviewed to gain qualitative insights. Between-group analyses were performed, and multivariate regressions identified predictors of knowledge and compliance, while thematic analysis explored qualitative insights. RESULTS A total of 142/167 (85.0%) HCWs had good knowledge, whereas 208/346 (60.1%) patients had good knowledge. A total of 151/167 (90.4%) HCWs had positive attitudes, whereas 242/346 (69.9%) patients had positive attitudes. A total of 159/167 (95.2%) HCWs practiced good preventive behaviors, whereas 225/346 (65.0%) patients did. HCWs demonstrated significantly higher mean knowledge scores (9.2 vs. 7.1, p<0.001) and higher median attitude scores (ranging from 5 with IQR 4-5 to 5 with IQR 5-5) compared to patients (ranging from 4 with IQR 3-5 to 5 with IQR 4-5) across all attitude statements assessed using the Likert scale (p<0.001). Being an HCW was associated with good knowledge (adjusted odds ratio (AOR) 2.5, 95% CI 1.5-4.1), positive attitudes (AOR 2.2, 95% CI 1.4-3.6), and good practices (AOR 3.1, 95% CI 1.8-5.2). The qualitative themes highlighted the need for accessible education, clear communication, adequate resourcing, and personal responsibility. CONCLUSION This study identified gaps in TB prevention knowledge and practices among patients compared to those among HCWs in India. Tailored educational initiatives, optimized health communication, improved infrastructure, and accessible messaging can help individuals assimilate appropriate infection control behaviors among healthcare system actors and communities toward ending TB.
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Affiliation(s)
- Jeel Shihora
- Preventive Medicine, Shri M. P. Shah Medical College, Jamnagar, IND
| | - Naresh C Damor
- Community Medicine, Shri M. P. Shah Medical College, Jamnagar, IND
| | - Alpesh Parmar
- Public Health, Shri M. P. Shah Medical College, Jamnagar, IND
| | - Nikhil Pankaj
- Pulmonary Medicine, Shri M. P. Shah Medical College, Jamnagar, IND
| | - Yogesh Murugan
- Family Medicine, Guru Gobind Singh Government Hospital, Jamnagar, IND
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Cohen R, Gesser-Edelsburg A. Advanced theoretical-applied model based on the PD approach in the light of healthcare-associated infections: what have we achieved so far? Front Public Health 2024; 12:1291551. [PMID: 38410666 PMCID: PMC10894930 DOI: 10.3389/fpubh.2024.1291551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/02/2024] [Indexed: 02/28/2024] Open
Abstract
Healthcare-associated infections remain a persistent concern despite decades of research and intervention efforts. Adherence to infection prevention and control guidelines by health professionals remains a challenge, necessitating innovative strategies. The Positive Deviance (PD) approach, rooted in harnessing localized solutions, holds promise but lacks comprehensive frameworks and empirical validation to bolster its theoretical underpinnings. This perspective article serves a dual purpose: first, to examine the unique challenges of applying the PD approach in the context of HAIs; and second, to introduce a robust theoretical-applied model developed in response to these challenges. This article addresses these gaps through a multi-faceted model developed in a mixed-methods study across three Israeli governmental hospitals and comprises four essential components that address the identified gaps in existing research. This article enriches the dialog on PD's applicability in HAIs by providing a robust model that not only offers solutions but reshapes the approach to healthcare hygiene and safety. It responds to critical gaps highlighted in the literature, offering tailored interventions by practical, context-specific solutions to improve adherence to IPC guidelines in the long term. Methodological clarity is also a key focus, offering a toolkit for practical implementation. This bottom-up approach empowers HPs to drive change, fostering a culture of innovation and improvement in healthcare settings.
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Affiliation(s)
- Ricky Cohen
- Cheryl Spencer Department of Nursing and the Health and Risk Communication Research Lab, University of Haifa, Haifa, Israel
| | - Anat Gesser-Edelsburg
- Head of the Health Promotion Program and Head of the Health and Risk Communication Lab, School of Public Health, University of Haifa, Haifa, Israel
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Rumintang Marito D, Widianto S. Link of Infection Prevention Climate to Patient-Centered Care: Role of Workplace Safety and Risk Mitigation. Risk Manag Healthc Policy 2024; 17:329-340. [PMID: 38352960 PMCID: PMC10863469 DOI: 10.2147/rmhp.s439907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
Background Healthcare-associated infections pose a substantial threat to the quality of healthcare services. Consequently, it is imperative for hospital organizations to actively support an infection prevention climate, fostering workplace safety and risk mitigation, thereby promoting patient-centered care. Purpose This study aims to explore the interconnectedness between the infection prevention climate, workplace safety, risk mitigation, and patient-centered care. Methods A cross-sectional study design was employed, utilizing a questionnaire administered to 235 healthcare professionals in intensive care and inpatient units at Bandung Kiwari Regional General Hospital. Data analysis was conducted using partial least squares structural equation modeling (PLS-SEM) with SmartPLS 4 and SPSS 25. Results The study revealed several significant relationships, including (1) between infection prevention climate and patient-centered care; (2) infection prevention climate and workplace safety; (3) workplace safety and patient-centered care; (4) infection prevention climate and patient-centered care mediated by workplace safety; (5) infection prevention climate and risk mitigation; (6) risk mitigation and patient-centered care; (7) and the relationship between infection prevention climate and patient-centered care mediated by risk mitigation. Conclusion Infection prevention climate emerges as a crucial intangible value that hospital organizations can cultivate to shape workplace safety. This, in turn, encourages healthcare workers' compliance in implementing infection prevention controls as a form of risk mitigation, ultimately contributing to the provision of patient-centered care.
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Affiliation(s)
| | - Sunu Widianto
- Department of Management and Business, Universitas Padjadjaran, Bandung, Indonesia
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Valim MD, Rossetto JR, Bortolini J, Herwaldt L. Hand hygiene compliance in a Brazilian COVID-19 unit: the impact of moments and contact precautions. Antimicrob Resist Infect Control 2024; 13:7. [PMID: 38254156 PMCID: PMC10801978 DOI: 10.1186/s13756-023-01356-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Healthcare-associated infections are among the most common complications during hospitalization. These infections increase morbidity and mortality and they increase length of hospital stay and the cost of healthcare. The aims of our study were to monitor hand hygiene (HH) compliance, HH technique quality and factors related to HH practice among health professionals in a COVID-19 Intensive Care Unit (ICU). METHODS An observational, prospective study. Between September and December 2021, we observed 69 healthcare professionals in an eight-bed ICU for patients with COVID-19 in midwestern Brazil. We used the WHO observation form to collect data. The dependent variable was HH compliance and independent variables were professional category, sex, HH quality (3-step technique for at least 15 s), number of HH opportunities observed, observation shift and inappropriate glove use. RESULTS We observed 1185 HH opportunities. The overall compliance rate was 26.4%, but only 6.5% were performed with the correct 3-step technique for the minimum time. HH compliance was considerably lower for moments "before" tasks (6.7%; 95% CI 4.8%, 9.2%) compared with moments "after" tasks (43.8%; 95% CI 39.9%, 47.8%). The logistic model found that inappropriate glove use, night shift and physicians (p < 0.001) were associated with low HH compliance. The infrastructure analysis found that the unit had an insufficient number of alcohol-based handrub (ABHR) dispensers at the point of care and that the mechanism for activating them was poorly designed. CONCLUSIONS HH compliance was very low. Inappropriate glove use was associated with low compliance and the unit's infrastructure did not support good HH practice. The fact that healthcare professionals were more likely to do HH after tasks, suggests that they use HH to protect themselves rather than the patients. Adequate infrastructure and ongoing health education with a focus on HH while caring for patients in contact precautions are essential for improving HH compliance and patient safety.
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Affiliation(s)
- Marília Duarte Valim
- Nursing Department, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.
| | | | - Juliano Bortolini
- Statistics Department, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Loreen Herwaldt
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Boroumand S, Majidi RF, Gheibi A, Majidi RF. Selenium nanoparticles incorporated in nanofibers media eliminate H1N1 activity: a novel approach for virucidal antiviral and antibacterial respiratory mask. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:2360-2376. [PMID: 38063966 DOI: 10.1007/s11356-023-31202-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/20/2023] [Indexed: 01/18/2024]
Abstract
The consecutive viral infectious outbreaks impose severe complications on public health besides the economic burden which led to great interest in antiviral personal protective equipment (PPE). Nanofiber-based respiratory mask has been introduced as a significant barrier to eliminate the airborne transmission from aerosols toward reduction the viral infection spreading. Herein, selenium nanoparticles incorporated in polyamide 6 nanofibers coated on spunbond nonwoven were synthesized via electrospinning technique (PA6@SeNPs), with an average diameter of 180 ± 2 nm. The nanofiber-coated media were tested for 0.3 μm particulate filtration efficiency based on Standard NIOSH (42 CFR 84). PA6@SeNPs had a pressure drop of 45 ± 2 Pa and particulate filtration efficiency of more than 97.33 which is comparable to the N95 respiratory mask. The bacterial killing efficiency of these nanofibers was 91.25% and 16.67% against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli), respectively. Furthermore, the virucidal antiviral test for H1N1 infected Madin-Darby Canine Kidney cells (MDCK) exhibited TCID50 of 108.13, 105.88, and 105.5 for 2, 10, and 120 min of exposure times in comparison with 108.5, 107.5, and 106.5 in PA6 nanofibers as control sample. MTT assay indicated excellent biocompatibility of electrospun PA6@SeNP nanofibers on L292 cells. These results propose the PA6@SeNP nanofibers have a high potential to be used as an efficient layer in respiratory masks for protection against respiratory pathogens.
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Affiliation(s)
| | | | - Ali Gheibi
- Fanavaran Nano-Meghyas (Fnm Co. Ltd.), Tehran, Iran
| | - Reza Faridi Majidi
- Fanavaran Nano-Meghyas (Fnm Co. Ltd.), Tehran, Iran.
- Department of Medical Nanotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Daba C, Atamo A, Gebretsadik Weldehanna D, Oli A, Debela SA, Luke AO, Gebrehiwot M. Infection prevention and control compliance of healthcare workers towards COVID-19 in conflict-affected public hospitals of Ethiopia. BMJ Open 2023; 13:e074492. [PMID: 38159945 PMCID: PMC10759124 DOI: 10.1136/bmjopen-2023-074492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE Non-compliance with COVID-19 infection prevention and control (IPC) is one of the global public health problems particularly among those frontline healthcare workers. However, there are no detailed investigations on COVID-19 IPC compliance among healthcare workers in conflict-affected settings. The objective of this research was to assess compliance with COVID-19 IPC measures and determine the factors associated with it among healthcare providers in Ethiopian governmental hospitals affected by conflict. DESIGN A cross-sectional study was carried out within institutional settings. STUDY SETTING AND PERIOD The study was conducted in three public hospitals located in northeastern Ethiopia during the period of March to April 2022. PARTICIPANTS Simple random sampling technique was used to select 325 healthcare workers after proportional allocation was made to each public hospital. PRIMARY OUTCOME MEASURES The primary outcome was non-compliance with COVID-19 IPC. A multivariable logistic regression analysis was employed to identify factors associated with the lack of adherence to the COVID-19 IPC protocol. RESULTS Nearly half (150, 46.2%) of the healthcare workers had non-compliance with COVID-19 IPC protocol. Absence of hand washing soap (adjusted OR (AOR)=2.99; 95% CI 2.46 to 5.76), workload (AOR=2.25; 95% CI 1.33 to 3.84), disruption in the supply of piped water (AOR=1.82; 95% CI 1.11 to 2.99), did not undergo training in COVID-19 IPC (AOR=2.85; 95% CI 1.85 to 4.84), absence of COVID-19 IPC guidelines (AOR=2.14; 95% CI 1.11 to 4.13) and chewing khat (AOR=2.3; 95% CI 1.32 to 3.72) were determinant factors for non-compliance. CONCLUSIONS The magnitude of non-compliance with COVID-19 IPC was high. Hospital managers and federal ministry of health should provide regular training on COVID-19 IPC, continuous piped water and personal protective facilities for healthcare workers. Ultimately, improving the security situation in the area would help improve COVID-19 IPC compliance among healthcare workers in these and other similar conflict-affected settings.
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Affiliation(s)
- Chala Daba
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Amanuel Atamo
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Daniel Gebretsadik Weldehanna
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abdi Oli
- Department of Mathemathics, College of Natural and Computational Sciences, Wollo University, Dessie, Ethiopia
| | - Sisay Abebe Debela
- Department of Public Health, College of Medicine and Health Sciences, Salale University, Fitche, Ethiopia
| | - Amana Ogeto Luke
- Department of Public Health, Lancha Campus, Rift Valley University, Addis Ababa, Ethiopia
| | - Mesfin Gebrehiwot
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Lv Y, Xiang Q, Jiang X, Zhang B, Wu J, Cao H. Effectiveness of inspector mechanism for the emergency infection prevention and control in the SARS-CoV-2 epidemic period: a self-control real-word study. BMC Infect Dis 2023; 23:858. [PMID: 38057717 DOI: 10.1186/s12879-023-08682-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/07/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND To ensure emergency infection prevention and control (IPC) can be fully supervised and monitored in coronavirus disease (COVID-19) epidemic period, a three-level inspector mechanism called "Internal self-check, Departmental cross-check, and Verification of outstanding key and difficult issues" was established in southwest China. The present study aimed to explore the effectiveness of inspector mechanism for the emergency IPC. METHODS A self-control real-world study was conducted during COVID-19 epidemic period from 2020 to 2022. An innovative designed mobile phone application was used to realize paperless information transmission and data management. Data were compared between inspection levels using SPSS 19.0 software. RESULTS A total of 2,800,132 supervision records were collected, including 149,137 comprehensive epidemic IPC projects, 1,410,093 personal protective equipment (PPE) use, 1,223,595 wearing and removing process of PPE and 17,307 ultraviolet light-detectable fluorescent (UV/F) surface marker. During the study period, the inspectors and subjects explored many optimized IPC measures. The compliance rate of check items has exceeded 98%, and internal self-check has a statistically significant higher rate than departmental cross-check (99.95% versus 98.74%, χ2 = 26111.479, P < 0.001). Compare with the failure rate in internal self check, the failure rate of PPE usage and wearing/removing process was statistically higher in departmental cross-check (χ2 = 1957.987, P < 0.001, χ2 = 465.610, P < 0.001, respectively). The overall clearance rate of UV/F surface markers is 87.88%, but there is no statistically significant difference over the three years of the present study (F = 2.902, P = 0.071). CONCLUSIONS Inspector mechanism for the emergency IPC completed an incredible inspection workload and offered creative assistance to combat the COVID-19 outbreak. These methods and accumulated experiences should be helpful for us to strengthen IPC for future epidemic.
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Affiliation(s)
- Yu Lv
- Healthcare-Associated Infection Control Center, Sichuan Provincial People's Hospital, school of medicine, University of Electronic Science and Technology of China, Chengdu, 610072, Sichuan, P. R. China
| | - Qian Xiang
- Healthcare-Associated Infection Control Center, Sichuan Provincial People's Hospital, school of medicine, University of Electronic Science and Technology of China, Chengdu, 610072, Sichuan, P. R. China
| | - Xiaoyan Jiang
- Healthcare-Associated Infection Control Center, Sichuan Provincial People's Hospital, school of medicine, University of Electronic Science and Technology of China, Chengdu, 610072, Sichuan, P. R. China
| | - Bo Zhang
- Development Department, Chengdu Yiou Technology Co. LTD, Chengdu, 610000, Sichuan, P. R. China
| | - Jiayu Wu
- Healthcare-Associated Infection Control Center, Sichuan Provincial People's Hospital, school of medicine, University of Electronic Science and Technology of China, Chengdu, 610072, Sichuan, P. R. China.
| | - Hongrong Cao
- Healthcare-Associated Infection Control Center, Sichuan Provincial People's Hospital, school of medicine, University of Electronic Science and Technology of China, Chengdu, 610072, Sichuan, P. R. China.
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Sunkwa-Mills G, Senah K, Breinholdt M, Aberese-Ako M, Tersbøl BP. A qualitative study of infection prevention and control practices in the maternal units of two Ghanaian hospitals. Antimicrob Resist Infect Control 2023; 12:125. [PMID: 37953285 PMCID: PMC10641978 DOI: 10.1186/s13756-023-01330-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023] Open
Abstract
INTRODUCTION Healthcare-associated infections (HAIs) remain a common challenge in healthcare delivery, with a significant burden in low- and middle-income countries. Preventing HAIs has gained enormous attention from policy makers and healthcare managers and providers, especially in resource-limited settings. Despite policies to enforce infection prevention and control (IPC) measures to prevent HAIs, IPC compliance remains a challenge in hospital settings. In this study, we explore the experiences of healthcare providers and women in the post-natal phase and investigate factors influencing IPC practices in two hospitals in Ghana. METHODS The study used a qualitative approach involving semi-structured interviews, focus group discussions, and observations among healthcare providers and women in the postnatal phase in two maternity units from January 2019 to June 2019. Interviews were recorded and transcribed verbatim for thematic analysis. The data sets were uploaded into the qualitative software NVivo 12 to facilitate coding and analysis. FINDINGS Healthcare providers were driven by the responsibility to provide medical care for their patients and at the same time, protect themselves from infections. IPC facilitators include leadership commitment and support, IPC training and education. Women were informed about IPC in educational talks during antenatal care visits, and their practices were also shaped by their background and their communities. IPC barriers include the poor documentation or 'invisibility' of HAIs, low prioritization of IPC tasks, lack of clear IPC goals and resources, discretionary use of guidelines, and communication-related challenges. The findings demonstrate the need for relevant power holders to position themselves as key drivers of IPC and develop clear goals for IPC. Hospital managers need to take up the responsibility of providing the needed resources and leadership support to facilitate IPC. Patient engagement should be more strategic both within the hospital and at the community level.
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Affiliation(s)
- Gifty Sunkwa-Mills
- Ghana Health Service, Awutu Senya East Municipal, Kasoa, Central Region, Ghana.
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Kodjo Senah
- Department of Sociology, University of Ghana, Legon, Accra, Ghana
| | | | - Matilda Aberese-Ako
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Britt Pinkowski Tersbøl
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Daw MA, Mahamat MH, Wareg SE, El-Bouzedi AH, Ahmed MO. Epidemiological manifestations and impact of healthcare-associated infections in Libyan national hospitals. Antimicrob Resist Infect Control 2023; 12:122. [PMID: 37932815 PMCID: PMC10629173 DOI: 10.1186/s13756-023-01328-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 10/29/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Healthcare-associated infection is a serious global problem, particularly in developing countries. In North African countries, comprehensive research on the incidence and effects of such infections is rare. This study evaluated the epidemiology and determined the impact of healthcare-associated infections in Libyan national teaching hospitals. METHODS A prospective longitudinal study was carried out in Libya's four largest teaching and referral hospitals (Tripoli Medical Center, Tripoli-Central Hospital, Benghazi Medical Center, and Sabha Medical Center) from November 1, 2021, to October 31, 2022. The epidemiological events and the parameters incorporated in this study were based on the data published by the Libyan Centers for Disease Control. The surveillance was carried out on all patients admitted to the wards of medicine, surgery, intensive care, gynecology & obstetrics, and pediatrics in all four hospitals. Trained staff reviewed the medical records and compared the percentages of patients with healthcare-associated infections. Bio-statistical and multivariable logistic regression analyses were carried out to test the variables associated with healthcare-associated infections and the resulting deaths. RESULTS A total of 22,170 hospitalized patients in four hospitals were included in the study. Hospital-acquired infection was reported in 3037 patients (13.7%; 95% CI: 12.9-14.4%). The highest incidence was in Benghazi Medical Center (17.9%; 95% CI: 16.9-18.7%), followed by Sabha Medical Center (14.8%; 95% CI:14.9-16.51%). Surgical site infection was the most prevalent (31.3%), followed by ventilator-associated pneumonia (29.3%), urinary tract infection (26.8%), and bloodstream infection (12.6%). Patients with healthcare-associated infections experienced severe morbidity requiring intervention. New antimicrobial regimens were needed for 1836 patients (93%), and 752 patients (34%) required admission to intensive care. Surgical intervention, respiratory support, and inotropes were also needed as a consequence of HAI events. CONCLUSIONS The high incidence of healthcare-associated infections in Libyan hospitals should be considered a major problem and a serious burden. This should alert healthcare authorities at the national and hospital levels to the urgent need for preventive and control strategies to combat hospital-acquired infections.
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Affiliation(s)
- Mohamed Ali Daw
- Department of Medical Microbiology & Immunology, Faculty of Medicine, University of Tripoli, Tripoli, 82668, CC, Libya.
- Clinical Microbiology & Epidemiology, Acting Physician of Internal Medicine, Scientific Coordinator of Libyan Society of Hospital Infection, Tripoli, Libya.
| | | | | | - Abdallah H El-Bouzedi
- Department of Statistics, Faculty of Science, Tripoli University, Tripoli, 82668, CC, Libya
| | - Mohamed Omar Ahmed
- Department of Microbiology & Parasitology, Faculty of Veterinary Medicine, University of Tripoli, Tripoli, 82668, CC, Libya
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Mathews M, Liu T, Ryan D, Hedden L, Lukewich J, Marshall EG, Buote R, Meredith L, Moritz LR, Spencer S, Asghari S, Brown JB, Freeman TR, Gill PS, Sibbald S. Practice- and System-Based Interventions to Reduce COVID-19 Transmission in Primary Care Settings: A Qualitative Study. Healthc Policy 2023; 19:63-78. [PMID: 38105668 PMCID: PMC10751755 DOI: 10.12927/hcpol.2023.27232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Using qualitative interviews with 68 family physicians (FPs) in Canada, we describe practice- and system-based approaches that were used to mitigate COVID-19 exposure in primary care settings across Canada to ensure the continuation of primary care delivery. Participants described how they applied infection prevention and control procedures (risk assessment, hand hygiene, control of environment, administrative control, personal protective equipment) and relied on centralized services that directed patients with COVID-19 to settings outside of primary care, such as testing centres. The multi-layered approach mitigated the risk of COVID-19 exposure while also conserving resources, preserving capacity and supporting supply chains.
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Affiliation(s)
- Maria Mathews
- Professor, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Tiffany Liu
- Research Assistant, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Dana Ryan
- Research Assistant, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Lindsay Hedden
- Assistant Professor, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | - Julia Lukewich
- Associate Professor, Faculty of Nursing, Memorial University, St. John's, NL
| | - Emily Gard Marshall
- Professor, Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, NS
| | - Richard Buote
- Research Assistant, Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, NS
| | - Leslie Meredith
- Research Manager, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Lauren R. Moritz
- Research Associate, Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, NS
| | - Sarah Spencer
- Research Coordinator, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | - Shabnam Asghari
- Professor, Discipline of Family Medicine, Memorial University, St. John's, NL
| | - Judith B. Brown
- Professor, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Thomas R. Freeman
- Professor Emeritus, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Paul S. Gill
- Professor, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Lecturer, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Shannon Sibbald
- Associate Professor, School of Health Studies, Faculty of Health Sciences, Western University, Associate Professor, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
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AMALI OWOICHOOKO, VAN WYK RENAYHELOUISE. Infection prevention knowledge and practices among healthcare workers at a health facility in Makurdi, Benue State, Nigeria. J Public Health Afr 2023; 14:2497. [PMID: 38020267 PMCID: PMC10662215 DOI: 10.4081/jphia.2023.2599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/27/2023] [Indexed: 12/01/2023] Open
Abstract
The ongoing COVID-19 pandemic has highlighted the critical importance of infection prevention practices among healthcare workers. Prioritizing this crucial aspect of healthcare can mitigate the spread of infectious diseases and ensure the well-being of our healthcare heroes and their communities. The purpose of the research was to investigate the knowledge and practice of infection prevention and control. The study was a cross-sectional study that used self-administered paper-based questionnaires. The study sample of 316 eligible healthcare workers was selected using stratified sampling. Data was entered into EPI Info version 7.2 and exported to SPSS version 27 for analysis. The ethics committees of the university and the hospital approved the study. The majority of participants 116 (36.7%) were nurses. The mean age was 34.79 years ± 8.37, 118 (37.30%) were male while 198 (62.7%) were female. Only 169 (53.9%) knew the recommended duration for hand washing. 132 (41.8%) of healthcare workers believed needles should be recapped following use. Healthcare workers were twice as likely to wash their hands before contact and five times more likely to wash their hands after contact with a patient, their bedding, or after a procedure (AOR 1.82, 95% CI 1.04-3.20), (AOR 4.51, 95% CI 1.76-11.54) respectively. Personal protective equipment (PPEs) were twice as likely to be unavailable (AOR 2.39, 95% CI 1.31-4.37). The findings revealed suboptimal knowledge and practice of hand hygiene indicating the need for healthcare workers to be trained on Infection Prevention and Control. PPE(s) must be provided for healthcare workers to improve compliance with IPC practices.
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Affiliation(s)
| | - RENAY HELOUISE VAN WYK
- Faculty of Health Sciences, Department of Environmental Health, University of Johannesburg, South Africa
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24
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Sami R, Salehi K, Hashemi M, Haghighat S, Atashi V. Barriers to adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease in Iran: a descriptive qualitative study. BMJ Open 2023; 13:e073972. [PMID: 37802628 PMCID: PMC10565240 DOI: 10.1136/bmjopen-2023-073972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/01/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES Chronic obstructive pulmonary disease is a chronic disease with numerous complications. Therefore, its effective management depends on home-based pulmonary rehabilitation. The effectiveness of home-based pulmonary rehabilitation programmes in turn depends on patient adherence to them. The aim of this study was to explore the barriers to adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease. DESIGN Qualitative descriptive design. SETTING The lung care wards of Al-Zahra and Khorshid teaching hospitals and the comprehensive lung care clinic of Khorshid hospital, Isfahan, Iran. PARTICIPANTS Participants patients with chronic obstructive pulmonary disease (n=20), their family caregivers (n=15) and healthcare providers (n=14) recruited via purposive sampling. RESULTS The five main categories of the barriers to adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease were patient-related barriers, caregivers' caregiving burden, limited support for patients, healthcare providers' limited professional competence and ineffective home-based pulmonary rehabilitation planning. CONCLUSION Different and complex factors related to patients, families and healthcare providers can affect adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease. Healthcare authorities can use the findings of this study to develop strategies to support patients with chronic obstructive pulmonary disease and their family caregivers and thereby reduce the physical and mental complications of Chronic obstructive pulmonary disease.
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Affiliation(s)
- Ramin Sami
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Kobra Salehi
- Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan, Iran
| | - Marzieh Hashemi
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Shila Haghighat
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vajihe Atashi
- Nursing and Midwifery Care Research Center, Adult Health Nursing Department, School of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran
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Mahdavi A, Atlasi R, Ebrahimi M, Azimian E, Naemi R. Human resource management (HRM) strategies of medical staff during the COVID-19 pandemic. Heliyon 2023; 9:e20355. [PMID: 37771528 PMCID: PMC10522956 DOI: 10.1016/j.heliyon.2023.e20355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
Healthcare workers are at the forefront of fight against COVID-19 and the managers of medical centers should develop coping strategies for the challenges caused by COVID-19, especially for health human resources in order to improve the performance of healthcare organizations. Hence, the purpose of this study is to investigate the human resource management strategies of medical staff during the COVID-19 to help them cope with the new strains of COVID-19 or epidemics of viral diseases that may occur in the future. In this study, a search was performed in the international Web of Science electronic database, using keywords such as human resource management and COVID-19. As a result, a total of 1884 articles published between January 1st, 2020 and October 22nd, 2021 were extracted. After screening the articles based on inclusion and exclusion criteria, 24 articles were selected to enter the study. Then, a scientometric analysis was performed on the content of selected articles and the results were presented in the form of tables and conceptual models. In total, 9 strategies were extracted from the selected articles including development of organizational culture, staff screening, policy-making, infection control training and monitoring the implementation of learned materials, patient management, human resource management, psychological and motivational support, communication and coordination, and digital health services. Employing comprehensive strategies to maintain the health of healthcare workers during the COVID-19 can play an effective role in reducing burnout, improving productivity and employee satisfaction, and in increasing the resilience of healthcare workers. It also has a positive effect on the patient's safety. Revision and reengineering of human resource management strategies in health and treatment organizations according to different cultures and contexts require research and investment in creative and innovative strategies.
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Affiliation(s)
- Abdullah Mahdavi
- Department of Health Information Management, School of Paramedical Sciences, Ardabil University of Medical Sciences, Iran
| | - Rasha Atlasi
- Information and Scientometrics Center at Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Iran
| | - Maryam Ebrahimi
- Department of Health Information Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Ehsanollah Azimian
- Department of Linguistics and Foreign Languages, Payame Noor University, Tehran, Iran
| | - Roya Naemi
- Department of Health Information Management, School of Paramedical Sciences, Ardabil University of Medical Sciences, Iran
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McKenna K, Bouchoucha S, Redley B, Hutchinson A. "Building the plane while flying it" Reflections on pandemic preparedness and response; an organisational case study. BMC Health Serv Res 2023; 23:940. [PMID: 37658384 PMCID: PMC10472588 DOI: 10.1186/s12913-023-09874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/04/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic provided a unique opportunity to learn about acute health organisations experiences implementing a pandemic response plan in real-time. This study was conducted to explore organisational leader's perspectives and experience activating a COVID-19 pandemic response plan in their health service and the impact of this on service provision, clinicians, and consumers. METHODS This study was conducted at a large metropolitan health service in Australia that provides acute, subacute, and residential aged care services. Semi-structured interviews were conducted with 12 key participants from the COVID-19 leadership team between November-January 2021/2022. A semi-structured interview guide was developed to explore how the health service developed a clinical governance structure, policy and procedures and experience when operationalising each element within the Hierarchy of Controls Framework. Thematic analysis was used to code data and identify themes. A cross-sectional survey of frontline healthcare workers on the impacts and perceptions of infection control practices during the COVID-19 pandemic, was also completed in 2021 with 559 responses. RESULTS Twelve organisational leaders completed the semi-structured interviews. Key themes that emerged were: (1) Building the plane while flying it, (2) A unified communications strategy, (3) Clinicians fear 'my job is going to kill me', (4) Personal Protective Equipment (PPE) supply and demand, and (5) Maintaining a workforce. When surveyed, front-line healthcare workers responded positively overall about the health services pandemic response, in terms of communication, access to PPE, education, training, and availability of resources to provide a safe environment. CONCLUSION Health service organisations were required to respond rapidly to meet service needs, including implementing a pandemic plan, developing a command structure and strategies to communicate and address the workforce needs. This study provides important insights for consideration when health service leaders are responding to future pandemics. Future pandemic plans should include detailed guidance for acute and long-term care providers in relation to organisational responsibilities, supply chain logistics and workforce preparation.
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Affiliation(s)
- Karen McKenna
- Health Services Manager Infection Prevention, Mercy Health, Victoria, Australia.
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, School of Nursing and Midwifery, Deakin University Geelong, Victoria, Australia.
| | - Stéphane Bouchoucha
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, School of Nursing and Midwifery, Deakin University Geelong, Victoria, Australia
- Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Deakin University, Geelong, VIC, Australia
| | - Bernice Redley
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, School of Nursing and Midwifery, Deakin University Geelong, Victoria, Australia
| | - Anastasia Hutchinson
- Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, School of Nursing and Midwifery Geelong, Epworth Health/Deakin University Partnership, Victoria, Australia
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Yılmaz S, Koyuncu Aydın S. Why is Turkey losing its doctors? A cross-sectional study on the primary complaints of Turkish doctors. Heliyon 2023; 9:e19882. [PMID: 37809803 PMCID: PMC10559269 DOI: 10.1016/j.heliyon.2023.e19882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
In 2022, Turkey encountered the formidable task of addressing an unprecedented loss of medical doctors and seeking remedies for potential issues within the healthcare system. This study set out to explore the inclination of 402 actively practicing Turkish doctors to depart from Turkey, assess the socio-demographic and socio-economic factors influencing this trend, and establish the hierarchy of raised concerns among doctors. Employing a cross-sectional and analytical approach, the study drew comparisons between doctors' demographic characteristics and the significance of their grievances, while also examining the correlation between the importance of complaints and the desire to remain in Turkey. The doctors' primary complaints encompassed financial challenges, instances of violence in the healthcare sector, and insufficient examination durations. The migration of doctors poses a substantial risk to healthcare accessibility, public health, and the sustainability of Turkey's healthcare delivery capacity. To mitigate this risk and curb doctor migration, corrective measures must be implemented to improve working conditions. Additionally, there is a need for further scientific research focusing on doctors' concerns, particularly in developing countries like Turkey, to expand the current body of literature on this subject.
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Affiliation(s)
- Salim Yılmaz
- Istanbul Arel University, Faculty of Health Sciences, Assistant Professor at Health Management Department, Istanbul, Turkiye
| | - Seher Koyuncu Aydın
- Sancaktepe Sehit Prof.Dr. Ilhan Varank Training and Research Hospital, Research Assistant at Gynecology and Obstetrics, Istanbul, Turkiye
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28
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Tangeraas Hansen MJ, Storm M, Syre H, Dalen I, Husebø AML. Attitudes and self-efficacy towards infection prevention and control and antibiotic stewardship among nurses: A mixed-methods study. J Clin Nurs 2023; 32:6268-6286. [PMID: 36841961 DOI: 10.1111/jocn.16657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/06/2023] [Indexed: 02/27/2023]
Abstract
AIMS To gain a comprehensive understanding of nurses' infection control practices, antibiotics stewardship attitudes and self-efficacy when caring for patients with multidrug-resistant bacterial infections in a hospital setting. BACKGROUND Multidrug-resistant bacteria cause a substantial health burden by complicating infections and prolonging hospital stays. Attitudes and self-efficacy can inform professional behaviour. Nurses' attitudes and self-efficacy concerning multidrug-resistant bacteria, infection prevention and control and antibiotic stewardship are vital in keeping patients safe. DESIGN A descriptive and convergent mixed-methods design involving quantitative and qualitative approaches was used. METHODS Two hundred and seventeen nurses working in clinical practice at seven different hospital wards (i.e., general medicine, surgical, haematological and oncology) at a Norwegian university hospital were invited to participate. Data were collected in February and March 2020 via two questionnaires: the Multidrug-Resistant Bacteria Attitude Questionnaire and the General Perceived Self-Efficacy Scale (n = 131) and four focus group interviews (n = 22). The data were analysed using descriptive statistics and systematic text condensation. RESULTS Most nurses showed moderate knowledge, adequate behavioural intentions towards infection prevention and antibiotic stewardship, and high self-efficacy. However, they reported negative emotions towards their knowledge level and negative emotions towards nursing care. The nurses appeared uncertain about their professional influence and role in antibiotic stewardship practices. Organisational and relational challenges and ambivalent perceptions of nurses' role were potential explanations. CONCLUSION Nurses report moderate attitudes and high self-efficacy when caring for patients with multidrug-resistant bacterial infections. This study suggests that nurses experience organisational and relational factors in their work environment that challenge their attitudes towards infection prevention and control and antibiotic stewardship practices. Measures that strengthen their knowledge and emotional response underpin correct infection prevention and control behaviour. A role clarification is needed for antibiotic stewardship. No Patient or Public Contribution. RELEVANCE TO CLINICAL PRACTICE Measures to increase attitudes towards infection prevention and control, antibiotic stewardship and multidrug resistance is recommended. Measures should be taken to overcome organisational challenges. A clarification of the nurses' role in antibiotic stewardship is needed.
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Affiliation(s)
| | - Marianne Storm
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Heidi Syre
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Ingvild Dalen
- Section of Biostatistics, Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Anne Marie Lunde Husebø
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Jahangiri H, Zamanian Z, Daneshmandi H, Seif M, Jamshidi H. Investigating the short-term effects of using full-body hospital personal protective equipment and changes in physical workload intensity on human physiological and cognitive performance. ERGONOMICS 2023; 66:1295-1309. [PMID: 36343173 DOI: 10.1080/00140139.2022.2145375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
The present study investigated the short-term effects of using Personal Protective Equipment (PPE) and physical workload intensity on human physiological and cognitive performance among 21 males and 19 females. PPE1 consisted of a medical coverall and surgical mask, while PPE2 consisted of impermeable full-body coverall, shoe covers, latex gloves, N95 mask, and face shield. Objective assessments were heart rate, energy expenditure, core body temperature, clothing microclimate temperature and humidity, and cognitive performance were the continuous performance test and N-Back test. Subjective assessments included thermal sensation, perceived fatigue/skin wetness/clothing moisture. Using PPE2 and increased workload intensity significantly increased the values of all physiological parameters and the subjective ratings of fatigue, thermal sensation, skin wetness, and clothing moisture. Moreover, the participants' cognitive performance was not affected by the type of PPE.Practitioner summary: Healthcare workers are at the highest risk in the fight against pandemics. Therefore, these people are required to use personal protective equipment. Using this equipment may have difficulties. The results show physiological strain and higher subjective ratings associated with using full-body hospital PPE and increased physical workload.
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Affiliation(s)
- Hamid Jahangiri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Zamanian
- Department of Ergonomics, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hadi Daneshmandi
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Seif
- Non-Communicable Diseases Research Center, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Jamshidi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Kalkan N, Sözeri Öztürk E, Arpaci T. Celebrating Nursing Week during the COVID-19 pandemic: The example of Twitter in Turkey for 2020-2021. Int Nurs Rev 2023; 70:307-314. [PMID: 37585812 DOI: 10.1111/inr.12843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/24/2023] [Indexed: 08/18/2023]
Abstract
AIM To explore how the nursing profession reflected on Twitter in Turkey about the Nursing Week celebration during the COVID-19 pandemic. BACKGROUND The COVID-19 pandemic affected the whole world, made every aspect of life extremely difficult, and required excessive involvement by healthcare professionals-especially nurses. Nurses have played a key role in meeting the care needs of people during this time. METHODS A qualitative research design was used for this study. Turkish social media data were analysed via a data crawler on Twitter. Tweets regarding the COVID-19 pandemic during 12-18 May 2020 and 12-18 May 2021-dates celebrated as Nursing Week in Turkey-and tweets containing at least one of the following relevant hashtags: #nurse, #nursesday, #nursesweek, #nursingweek, #12May, or #12Maynursesday, were considered. RESULTS The hashtag #12May was used the most in both years, and the most tweets were posted with the hashtag #12May (n = 2996) in 2020. Three categories, 'Being a nurse in the pandemic', 'Nursing Week with celebrations', and 'Nursing Week with definitions', were identified through a thematic analysis. The categories included the importance of nursing, respectability, difficult working conditions, insufficiency in the number of nurses, difficulties in social life, etc. DISCUSSION: Turkish society posted tweets to celebrate Nursing Week. In addition to the celebration, there were many statements revealing the positive aspects of nurses and the nursing profession, as well as the difficulties nurses faced during the COVID-19 pandemic. CONCLUSION Our findings revealed that in the celebrations of Nursing Week in Turkey, the important role of nursing in the health system, difficulties experienced during the COVID-19 pandemic, and definitions describing the roles of nursing were reflected on Twitter. IMPLICATION FOR NURSING AND HEALTH POLICIES This presents a source for perspective on the opinions reflected on social media about nurses and the nursing profession via Nursing Week celebrations during the pandemic. The findings can guide the development of policies on the rights and social privileges of the nursing profession that need to be improved in exceptional situations like a pandemic.
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Affiliation(s)
- Nevra Kalkan
- Faculty of Nursing, Gazi University, Ankara, Turkey
| | | | - Tuba Arpaci
- Department of Nursing, Faculty of Health Sciences, Karamanoglu Mehmetbey University, Karaman, Turkey
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Srigley JA, Cheng B, Collet JC, Donovan Towell T, Han G, Keen D, Leung KW, Mori J, Ali RA. Barriers to infection prevention and control in long-term care/assisted living settings in British Columbia during the COVID-19 pandemic: a cross-sectional survey. Antimicrob Resist Infect Control 2023; 12:84. [PMID: 37649046 PMCID: PMC10469816 DOI: 10.1186/s13756-023-01292-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic disproportionately impacted long-term care and assisted living (LTC/AL) facilities in Canada, where infection prevention and control (IPAC) programs had been suboptimal. We aimed to identify barriers affecting healthcare workers' (HCW) adherence to IPAC practices during the pandemic in British Columbia in LTC/AL compared to acute care settings. METHODS We conducted a web-based survey of direct care providers and IPAC professionals across BC from August to September 2021, focused on knowledge and attitudes toward IPAC within the context of the COVID-19 pandemic, and barriers that affected respondents' abilities to follow IPAC practices throughout the pandemic. RESULTS The final analysis included 896 acute care respondents and 441 from LTC/AL. More LTC/AL respondents reported experiencing the following barriers: following IPAC guidance was of lower priority compared to other tasks (29.1% vs. 14.7%, FDR = 0.001) and not their responsibility (28.0% vs. 11.2%, FDR = 0.001); limited supplies for personal protective equipment (PPE) (49.0% vs. 33.6%, FDR = 0.001), hand hygiene products (42.2% vs. 28.8%, FDR = 0.001), and cleaning/disinfection products (44.1% vs. 30.3%, FDR = 0.001); deficits in IPAC leadership support (46.2% vs. 38.9%, FDR = 0.012), IPAC education and training (46.9% vs. 32.0%, FDR = 0.001), and patient care knowledge for managing COVID-19 infections (46.6% vs. 36.0%, FDR = 0.001). CONCLUSIONS This survey found that barriers to HCWs' adherence to IPAC practices during the COVID-19 pandemic were different in LTC/AL settings compared to acute care. Improvement efforts should focus on strengthening IPAC programs in LTC/AL, particularly enhanced IPAC staffing/leadership, increased training and education, and improving access to PPE, hand hygiene, and cleaning products.
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Affiliation(s)
- Jocelyn A Srigley
- Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
- Department of Pathology and Laboratory Medicine, BC Children's Hospital and BC Women's Hospital and Health Centre, 4500 Oak St, Room 2J3, Vancouver, BC, V6H 3N1, Canada.
| | - Brooke Cheng
- Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jun Chen Collet
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC, V6H 4C1, Canada
| | - Tara Donovan Towell
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC, V6H 4C1, Canada
| | - Guanghong Han
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC, V6H 4C1, Canada
| | - Dave Keen
- Fraser Health Authority, Suite 400, Central City Tower 13450 - 102nd Avenue, Surrey, BC, V3T 0H1, Canada
| | - Ka Wai Leung
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC, V6H 4C1, Canada
| | - Julie Mori
- Interior Health Authority, 505 Doyle Ave, Kelowna, BC, V1Y 0C5, Canada
| | - R Ayesha Ali
- Department of Mathematics and Statistics, University of Guelph, 50 Stone Road East, Room 437 MacNaughton Building, Guelph, ON, N1G 2W1, Canada
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Ezema A, Caputo M, Semaan A, Benova L, Liang ST, Hirschhorn LR. Stress and safety of maternal and newborn healthcare workers early in the COVID-19 pandemic: a repeat cross-sectional analysis from a global online survey from March 2020 to March 2021. BMJ Open 2023; 13:e072155. [PMID: 37640461 PMCID: PMC10462945 DOI: 10.1136/bmjopen-2023-072155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES This study aims to characterise the physical and psychological well-being of maternal and newborn healthcare workers (MNHCWs) during the COVID-19 pandemic. DESIGN Observational repeated cross-sectional study. SETTING An online questionnaire was distributed to MNHCWs around the globe in three separate rounds from March 2020 to March 2021. PARTICIPANTS Total samples of N=1357 (round 1) and N=420 (round 3) primarily consisted of doctors, midwives and nurses in maternal and newborn specialties. Samples represented all WHO regions, with 33% (round 1) and 42% (round 3) from low- or middle-income countries (LMICs). PRIMARY AND SECONDARY OUTCOME MEASURES Responses from rounds 1 (March-June 2020) and 3 (December 2020-March 2021) were analysed to measure self-reported levels of relative stress and workplace protection from COVID-19, while associated factors were determined through multivariable ordinal logistic regression. RESULTS In round 1, 90% of MNHCWs reported increased stress levels and 45% reported insufficient personal protective equipment (PPE) access. Nurses and physicians were less likely to report increased stress than midwives at the pandemic onset. Factors associated with increased stress included being female, being from an LMIC and insufficient PPE. In round 3, 75% reported similar or increased stress while 10% reported insufficient PPE. In both rounds, over 50% of MNHCWs felt relatively or completely unprotected from COVID-19 in the workplace. Those from LMICs were more likely to report feeling unprotected, while receiving organisational information that valued safety was associated with better feelings of protection in the workplace. CONCLUSIONS Among our international sample of MNHCWs, we observed high rates of self-reported stress increase at the start of the pandemic with persistence or increase up to a year later. High rates of feeling unprotected persisted even as PPE became more available. These results may inform interventions needed to support and protect MNHCWs during this and future pandemics.
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Affiliation(s)
- Ashley Ezema
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Matthew Caputo
- Robert J Havey, MD Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Shu-Ting Liang
- Robert J Havey, MD Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lisa R Hirschhorn
- Robert J Havey, MD Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Tahmasebi A, Masoudi Asl I, Aryankhesal A, Vatankhah S, Masoumi G. Best Practices of Hospitals in Management of Epidemic Conditions: A Scoping Review. Galen Med J 2023; 12:1-14. [PMID: 38774843 PMCID: PMC11108671 DOI: 10.31661/gmj.v12i.2824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Many hospitals globally have valuable experiences in preparing for management and responding to infectious epidemics. Identifying and analyzing these experiences can provide comprehensive and practical data for decision-making and effective performance. This study aimed to conduct a scoping review and content analysis of the best practices of hospital (private or public) management in epidemic conditions. MATERIALS AND METHODS This research is a scoping review and content analysis, conducted in 2021. Data was collected by searching different databases, including Pubmed, Scopus, Web of Sciences, ProQuest, websites, search engines, and public reports without time limits. Content analysis was performed for data analysis. RESULTS We retrieved 8842 records from databases and other sources. Finally, 24 studies from 12 countries were selected for analysis. Most studies belonged to the United States (9 cases), and most subjects were on Coronavirus disease 2019 (Covid-19) (19 studies). We classified the results into two major categories of in-hospital executive readiness and logistic readiness. Executive readiness included 11 main categories (physical structure, resource management, exposure reduction, patients and caregivers' management, corpse management, disinfection, staff support, patient admission, instructions and guidelines, tele- communication, and education) and 26 sub-categories. Logistic readiness consisted of three major categories (leadership/team making, communication, and using capabilities) and five sub-categories. CONCLUSION Healthcare managers can use the identified categories and dimensions of managerial readiness and responsiveness as an action plan during an infectious disease epidemic.
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Affiliation(s)
- Ali Tahmasebi
- Department of Health Services Management, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Iravan Masoudi Asl
- Department of Health Services Management, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aidin Aryankhesal
- Department of Health Services Management, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Soudabeh Vatankhah
- Department of Health Services Management, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Masoumi
- Department of Health in Disaster and Emergencies, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Rátiva Hernández NK, Carrero-Barragán TY, Ardila AF, Rodríguez-Salazar JD, Lozada-Martinez ID, Velez-Jaramillo E, Ortega Delgado DA, Fiorillo Moreno O, Navarro Quiroz E. Factors associated with suicide in physicians: a silent stigma and public health problem that has not been studied in depth. Front Psychiatry 2023; 14:1222972. [PMID: 37645639 PMCID: PMC10461439 DOI: 10.3389/fpsyt.2023.1222972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
Suicide is a complex and multifaceted public health issue that affects individuals from all walks of life, including healthcare professionals such as physicians. According to research, physicians have a higher risk of suicide compared to the general population, with an estimated suicide rate that is two to three times greater than that of the general population. Suicide in physicians can have devastating consequences, not only for the individual but also for their patients and colleagues. The factors contributing to suicide in physicians are numerous and often interrelated. Physicians are exposed to numerous stressors in their daily lives, including long work hours, high workload, burnout, and exposure to traumatic events. These stressors can lead to mental health problems such as depression, anxiety, and substance use disorders, which in turn can increase the risk of suicide. In addition to work-related stressors, personal factors such as relationship problems, financial stress, and a history of mental health problems can also contribute to suicide risk in physicians. Stigma and shame around seeking help for mental health issues may also prevent physicians from seeking treatment, exacerbating the problem. Understanding the complex factors that contribute to suicide in physicians is crucial for developing effective prevention strategies. For this reason, it is necessary to know the behavior of this phenomenon and the factors associated with a higher risk of suicide in this population. However, taking into account that different regions of the world vary in socioeconomic, cultural, professional, occupational, and health attributes, it is to be expected that the behavior of these risk factors will also be heterogeneous. At present, it is presumed that there is a significant gap in the evidence, due to a predominance of evidence on this topic from high-income countries. Considering the importance of having a comprehensive understanding of the risk factors for suicide in the medical population and possible strategies to mitigate this condition, the aim of this review is to analyze the most recent evidence on these factors, and to assess the quality of the evidence and gaps that need to be studied further.
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Affiliation(s)
| | | | | | | | - Ivan David Lozada-Martinez
- Epidemiology Program, Department of Graduate Studies in Health Sciences, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
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Tsandila-Kalakou F, Wiig S, Aase K. Factors contributing to healthcare professionals' adaptive capacity with hospital standardization: a scoping review. BMC Health Serv Res 2023; 23:799. [PMID: 37496014 PMCID: PMC10369840 DOI: 10.1186/s12913-023-09698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 06/13/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Certain factors contribute to healthcare professionals' adaptive capacities towards risks, challenges, and changes such as attitudes, stress, motivation, cognitive capacity, group norms, and teamwork. However, there is limited evidence as to factors that contribute to healthcare professionals' adaptive capacity towards hospital standardization. This scoping review aimed to identify and map the factors contributing to healthcare professionals' adaptive capacity with hospital standardization. METHODS Scoping review methodology was used. We searched six academic databases to September 2021 for peer-reviewed articles in English. We also reviewed grey literature sources and the reference lists of included studies. Quantitative and qualitative studies were included if they focused on factors influencing how healthcare professionals adapted towards hospital standardization such as guidelines, procedures, and strategies linked to clinical practice. Two researchers conducted a three-stage screening process and extracted data on study characteristics, hospital standardization practices and factors contributing to healthcare professionals' adaptive capacity. Study quality was not assessed. RESULTS A total of 57 studies were included. Factors contributing to healthcare professionals' adaptive capacity were identified in numerous standardization practices ranging from hand hygiene and personal protective equipment to clinical guidelines or protocols on for example asthma, pneumonia, antimicrobial prophylaxis, or cancer. The factors were grouped in eight categories: (1) psychological and emotional, (2) cognitive, (3) motivational, (4) knowledge and experience, (5) professional role, (6) risk management, (7) patient and family, and (8) work relationships. This combination of individual and group/social factors decided whether healthcare professionals complied with or adapted hospital standardization efforts. Contextual factors were identified related to guideline system, cultural norms, leadership support, physical environment, time, and workload. CONCLUSION The literature on healthcare professionals' adaptive capacity towards hospital standardization is varied and reflect different reasons for compliance or non-compliance to rules, guidelines, and protocols. The knowledge of individual and group/social factors and the role of contextual factors should be used by hospitals to improve standardization practices through educational efforts, individualised training and motivational support. The influence of patient and family factors on healthcare professionals' adaptive capacity should be investigated. TRIAL REGISTRATION Open Science Framework ( https://osf.io/ev7az ) https://doi.org/10.17605/OSF.IO/EV7AZ .
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Affiliation(s)
- Foteini Tsandila-Kalakou
- Centre for Resilience in Healthcare SHARE, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway.
| | - Siri Wiig
- Centre for Resilience in Healthcare SHARE, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Karina Aase
- Centre for Resilience in Healthcare SHARE, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
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Zhang X, Yang Z, Chen J, Zhang C, Zhang J. Implementation of the Admission Process of Patients Under the Public Crisis Situation of COVID-19 Pandemic: A Real-World Case Study. J Multidiscip Healthc 2023; 16:1905-1914. [PMID: 37465015 PMCID: PMC10351921 DOI: 10.2147/jmdh.s415678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
Purpose To clarify the implementation of the admission process under the public crisis of COVID-19 pandemic. Methods A real-world study was conducted to collect data on the normal and public crisis situations at a tertiary hospital in China and understand the views of 18 head nurses on the necessity of the admission process in public crisis situations. Independent t-test and chi-square test were used to analyze the work data in two situations; Spearman correlation analysis was performed to determine the correlation of work data with two situations of process implementation, and differences between the head nurses' views of necessity of the admission process and actual implementation under public crisis situations were analyzed. Results Significant differences were observed in the working data between the normal and public crisis situations (P < 0.05), and the implementation of the admission process was not in place. The number of nurses on duty was positively correlated with each item of admission process (P < 0.05), the rest of work data were negatively correlated with each item in the admission process (P < 0.05), and there was a significant difference between the necessity of each item in the admission process and the actual implementation results (P < 0.05). Conclusion Public crisis leads to the lack of implementation of admission process, and the original admission process and quality control standards are not applicable during the public crisis situation.
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Affiliation(s)
- Xiaohong Zhang
- Nursing Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Ziyan Yang
- College of Nursing, Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Jiaqi Chen
- Nursing Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Cuiling Zhang
- Department of Digestive Oncology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Junyan Zhang
- Department of Clinical Epidemiology and Evidence-based Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
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Abu Awwad D, Hill S, Lewis S, Jimenez Y. Knowledge, attitudes and practice of infection prevention and control in the CT suite. BMC Health Serv Res 2023; 23:741. [PMID: 37422620 DOI: 10.1186/s12913-023-09779-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Infection, prevention, and control (IPC) practices are essential to protect patients and staff within healthcare facilities. Radiology departments cater to both inpatients and outpatients, and breaches of IPC practice have led to outbreaks of disease within healthcare facilities. This study aims to examine the knowledge, attitudes and practice (KAP) of computed tomography (CT) radiographers and nurses in their infection, prevention, and control (IPC) practice. The KAP components focuses on the CT environment, contrast injector use, and workplace factors that impact IPC practice. METHODS A cross-sectional KAP survey was distributed online to Australian CT radiographers and radiology nurses across different institutions. The survey covered demographics, each KAP component, and workplace culture. Spearman's correlation was used to compare KAP scores. Kruskal-Wallis test was used to compare the KAP scores between demographic categories, and Chi Square was used to compare demographic data with workplace culture. RESULTS There were 147 respondents, 127 of which were radiographers and 20 were nurses. There was a moderate positive correlation between knowledge and attitude for radiographers (rho = 0.394, p < 0.001). Radiographers also had a moderate positive relationship between attitudes and practice (rho = 0.466, p < 0.001). Both radiographers and nurses scored high in the knowledge section of the survey, but nurses had statistically significant higher practice scores than radiographers (p = 0.014). CT radiographers who had an IPC team in their workplace or worked in public hospitals, had statistically significant higher attitudes and practice scores. Age, education, and years of experience did not impact on KAP scores. CONCLUSION The study found that radiographers and nurses had a good baseline knowledge of standard precautions. IPC teams and continued training is important to positively influence knowledge and attitudes of health professionals towards IPC practice. The KAP survey was a useful tool to assess the knowledge, attitudes, and practice on IPC of CT radiographers and nurses and identified areas for education, interventions, and leadership.
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Affiliation(s)
- Dania Abu Awwad
- Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.
| | - Suzanne Hill
- Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Sarah Lewis
- Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Yobelli Jimenez
- Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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Minaya-Freire A, Subirana-Casacuberta M, Pou-Pujol G, Ramon-Aribau A. Nursing Practice Variations in Pain Management in Older Adults With Dementia Admitted to an Acute Geriatrics Unit During the COVID-19 Pandemic. Res Gerontol Nurs 2023; 16:173-182. [PMID: 37040309 DOI: 10.3928/19404921-20230405-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
The current retrospective descriptive study evaluated nursing practice variations on pain management in older adults with dementia admitted to an acute geriatrics unit (AGU) before (2018) and during (2021) the coronavirus disease 2019 (COVID-19) pandemic. Data were gathered from electronic health records. Pain intensity was evaluated a median of 1.9 times per day of stay in the pre-COVID-19 sample, whereas in the COVID-19 sample, the median was 0.7 times per day of stay. Median number of analgesic administrations per day of stay and mean percentage of clinical care records that mentioned pain were higher in patients admitted during the pandemic. Variations in nursing care organization in the AGU due to the COVID-19 pandemic had an impact on the patterns of pain management nursing practice in older adults with dementia. [Research in Gerontological Nursing, 16(4), 173-182.].
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Kim SJ. Relationship between nurses' knowledge of COVID-19, professional quality of life, and practice during the COVID-19 pandemic: A descriptive correlational study. PLoS One 2023; 18:e0287457. [PMID: 37347781 PMCID: PMC10286984 DOI: 10.1371/journal.pone.0287457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 06/06/2023] [Indexed: 06/24/2023] Open
Abstract
The purpose of this study was to examine knowledge, professional quality of life, and practices among nurses during the coronavirus disease 2019 (COVID-19) pandemic and explore factors associated with nurses' practice. A total of 167 nurses were recruited from 4 general hospitals for this cross-sectional study, which was conducted from June to July 2021. Using SPSS/WIN 22, the collected data were analyzed using descriptive statistics, t-tests, analysis of variance, Pearson's correlation coefficients, and hierarchical multiple regression analysis. The mean age of the participants was 31.43, and the sample comprised 144 women (86.2%) and 23 men (13.8%). The results indicated that practice was negatively correlated with burnout (r = -.18, p = .017). The regression model explained 24.1% of the variance. For general characteristics in Model 1, education on COVID-19 management (β = .18, p = .014) was the factor most associated with nurses' practice. In Model 2, with professional quality of life added, burnout (β = -.21, p = .003) was the only influential factor. These results highlight the need to establish an effective prevention system for infectious diseases such as COVID-19, including education programs pertinent to the prevention and management of infection that improve the modifiable predictors of nurses' practice-education and burnout.
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Affiliation(s)
- Sun Ju Kim
- Chungnam National University Se-Jong Hospital, Sejong-si, Republic of Korea
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Pourvakhshoori N, Karami K, Sigaroudi AE, Adib M, Salari A, Bazyar J, Hosseini SA. Experiences and challenges of nursing education in response to the COVID-19 pandemic: A qualitative study in Iran. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:163. [PMID: 37404921 PMCID: PMC10317258 DOI: 10.4103/jehp.jehp_970_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/09/2022] [Indexed: 07/06/2023]
Abstract
BACKGROUND The preparedness of nurses in the COVID-19 pandemic, will be of great importance when it comes to the unknown future of the pandemic and other similar ones. Identifying their problems can lead to better planning, preparation, and management. This study aims to explore Iranian nurses' experience of their preparedness challenges to give an effective response to the pandemic. MATERIALS AND METHODS A qualitative content analysis approach using semi-structured interviews was employed to explore nurses' preparedness experiences. 28 nurses were interviewed, after transcription of the interviews, a content analysis using constant comparison was performed for data analysis based on Graneheim and Lundman approach. RESULTS The results of the study can be summarized in 6 main categories and 14 subcategories, such as the necessity of continuing educational workshops, the necessity of holding exercises in the same environment, the importance of familiarity with the pandemic, the importance of educating all those involved in providing services in the pandemic, the need for providing immersive education for the pandemic and the need for planning and practice concerning the pandemic. CONCLUSION When nurses receive more support, they can have their best performance. up-to-date training can prepare nurses more effectively, which will, in turn, make prepared nurses available, maximize their efficiency, and minimize their adverse mental consequences. Nurse managers may support nurses and increase hospital resilience in such emergencies. Nurses indicated some issues including managers' support, workplace culture, education, physical space, access to PPE, and willingness to provide the best care. These findings can be helpful in the management of the pandemic and preparing nurses as a large group of healthcare workers. Necessary training, along with the provision of adequate resources, should be programmed to support this effective group of health providers.
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Affiliation(s)
- Negar Pourvakhshoori
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran, Medical Education Research Center, Education Development Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Kimia Karami
- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Abdolhossein Emami Sigaroudi
- Department of Cardiology, Cardiovascular Diseases Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Masoomeh Adib
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran, Medical Education Research Center, Education Development Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Arsalan Salari
- Department of Cardiology, Cardiovascular Diseases Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Jafar Bazyar
- School of Public Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Seyed Ali Hosseini
- Department of Occupational Therapy, Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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McGrath BA, Shelton CL, Gardner A, Coleman R, Lynch J, Alexander PG, Cooper G. Bubble-PAPR: a phase 1 clinical evaluation of the comfort and perception of a prototype powered air-purifying respirator for use by healthcare workers in an acute hospital setting. BMJ Open 2023; 13:e066524. [PMID: 37156585 PMCID: PMC10174029 DOI: 10.1136/bmjopen-2022-066524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES We aimed to design and produce a low-cost, ergonomic, hood-integrated powered air-purifying respirator (Bubble-PAPR) for pandemic healthcare use, offering optimal and equitable protection to all staff. We hypothesised that participants would rate Bubble-PAPR more highly than current filtering face piece (FFP3) face mask respiratory protective equipment (RPE) in the domains of comfort, perceived safety and communication. DESIGN Rapid design and evaluation cycles occurred based on the identified user needs. We conducted diary card and focus group exercises to identify relevant tasks requiring RPE. Lab-based safety standards established against British Standard BS-EN-12941 and EU2016/425 covering materials; inward particulate leakage; breathing resistance; clean air filtration and supply; carbon dioxide elimination; exhalation means and electrical safety. Questionnaire-based usability data from participating front-line healthcare staff before (usual RPE) and after using Bubble-PAPR. SETTING Overseen by a trial safety committee, evaluation progressed sequentially through laboratory, simulated, low-risk, then high-risk clinical environments of a single tertiary National Health Service hospital. PARTICIPANTS 15 staff completed diary cards and focus groups. 91 staff from a range of clinical and non-clinical roles completed the study, wearing Bubble-PAPR for a median of 45 min (IQR 30-80 (15-120)). Participants self-reported a range of heights (mean 1.7 m (SD 0.1, range 1.5-2.0)), weights (72.4 kg (16.0, 47-127)) and body mass indices (25.3 (4.7, 16.7-42.9)). OUTCOME MEASURES Preuse particulometer 'fit testing' and evaluation against standards by an independent biomedical engineer.Primary:Perceived comfort (Likert scale).Secondary: Perceived safety, communication. RESULTS Mean fit factor 16 961 (10 participants). Bubble-PAPR mean comfort score 5.64 (SD 1.55) vs usual FFP3 2.96 (1.44) (mean difference 2.68 (95% CI 2.23 to 3.14, p<0.001). Secondary outcomes, Bubble-PAPR mean (SD) versus FFP3 mean (SD), (mean difference (95% CI)) were: how safe do you feel? 6.2 (0.9) vs 5.4 (1.0), (0.73 (0.45 to 0.99)); speaking to other staff 7.5 (2.4) vs 5.1 (2.4), (2.38 (1.66 to 3.11)); heard by other staff 7.1 (2.3) vs 4.9 (2.3), (2.16 (1.45 to 2.88)); speaking to patients 7.8 (2.1) vs 4.8 (2.4), (2.99 (2.36 to 3.62)); heard by patients 7.4 (2.4) vs 4.7 (2.5), (2.7 (1.97 to 3.43)); all p<0.01. CONCLUSIONS Bubble-PAPR achieved its primary purpose of keeping staff safe from airborne particulate material while improving comfort and the user experience when compared with usual FFP3 masks. The design and development of Bubble-PAPR were conducted using a careful evaluation strategy addressing key regulatory and safety steps. TRIAL REGISTRATION NUMBER NCT04681365.
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Affiliation(s)
- Brendan A McGrath
- Acute Intensive Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Science Centre, Manchester, UK
| | - Clifford L Shelton
- Department of Anaesthesia, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Angela Gardner
- Acute Intensive Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ruth Coleman
- Acute Intensive Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - James Lynch
- Acute Intensive Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter G Alexander
- Acute Intensive Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Science Centre, Manchester, UK
| | - Glen Cooper
- The University of Manchester School of Mechanical Aerospace and Civil Engineering, Manchester, UK
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Turon H, Wolfenden L, Finch M, McCrabb S, Naughton S, O'Connor SR, Renda A, Webb E, Doherty E, Howse E, Harrison CL, Love P, Smith N, Sutherland R, Yoong SL. Dissemination of public health research to prevent non-communicable diseases: a scoping review. BMC Public Health 2023; 23:757. [PMID: 37095484 PMCID: PMC10123991 DOI: 10.1186/s12889-023-15622-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/06/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Dissemination is a critical element of the knowledge translation pathway, and a necessary step to ensure research evidence is adopted and implemented by key end users in order to improve health outcomes. However, evidence-based guidance to inform dissemination activities in research is limited. This scoping review aimed to identify and describe the scientific literature examining strategies to disseminate public health evidence related to the prevention of non-communicable diseases. METHODS Medline, PsycInfo and EBSCO Search Ultimate were searched in May 2021 for studies published between January 2000 and the search date that reported on the dissemination of evidence to end users of public health evidence, within the context of the prevention of non-communicable diseases. Studies were synthesised according to the four components of Brownson and colleagues' Model for Dissemination of Research (source, message, channel and audience), as well as by study design. RESULTS Of the 107 included studies, only 14% (n = 15) directly tested dissemination strategies using experimental designs. The remainder primarily reported on dissemination preferences of different populations, or outcomes such as awareness, knowledge and intentions to adopt following evidence dissemination. Evidence related to diet, physical activity and/or obesity prevention was the most disseminated topic. Researchers were the source of disseminated evidence in over half the studies, and study findings/knowledge summaries were more frequently disseminated as the message compared to guidelines or an evidence-based program/intervention. A broad range of dissemination channels were utilised, although peer-reviewed publications/conferences and presentations/workshops predominated. Practitioners were the most commonly reported target audience. CONCLUSIONS There is a significant gap in the peer reviewed literature, with few experimental studies published that analyse and evaluate the effect of different sources, messages and target audiences on the determinants of uptake of public health evidence for prevention. Such studies are important as they can help inform and improve the effectiveness of current and future dissemination practices in public health contexts.
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Affiliation(s)
- Heidi Turon
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Luke Wolfenden
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
| | - Meghan Finch
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Shaan Naughton
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, 3220, Australia
| | - Sean R O'Connor
- School of Psychology, Queen's University Belfast, Malone Road, Belfast, BT9 5BN, Northern Ireland
| | - Ana Renda
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Population Health, Sydney Local Health District, Camperdown, NSW, 2050, Australia
| | - Emily Webb
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Emma Doherty
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
| | - Eloise Howse
- The Australian Prevention Partnership Centre, Sax Institute, Glebe, NSW, 2037, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, 3168, Australia
| | - Penelope Love
- Faculty of Health, School of Exercise and Nutrition Sciences (SENS), Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Natasha Smith
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, 3220, Australia
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Marme G, Kuzma J, Zimmerman PA, Harris N, Rutherford S. Tuberculosis infection prevention and control in rural Papua New Guinea: an evaluation using the infection prevention and control assessment framework. Antimicrob Resist Infect Control 2023; 12:31. [PMID: 37046339 PMCID: PMC10092912 DOI: 10.1186/s13756-023-01237-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/30/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Papua New Guinea (PNG) is one of the 14 countries categorised as having a triple burden of tuberculosis (TB), multidrug-resistant TB (MDR TB), and TB-human immunodeficiency virus (HIV) co-infections. TB infection prevention and control (TB-IPC) guidelines were introduced in 2011 by the National Health Department of PNG. This study assesses the implementation of this policy in a sample of district hospitals in two regions of PNG. METHODS The implementation of TB-IPC policy was assessed using a survey method based on the World Health Organization (WHO) IPC assessment framework (IPCAF) to implement the WHO's IPC core components. The study included facility assessment at ten district hospitals and validation observations of TB-IPC practices. RESULTS Overall, implementation of IPC and TB-IPC guidelines was inadequate in participating facilities. Though 80% of facilities had an IPC program, many needed more clearly defined IPC objectives, budget allocation, and yearly work plans. In addition, they did not include senior facility managers in the IPC committee. 80% (n = 8 of 10) of hospitals had no IPC training and education; 90% had no IPC committee to support the IPC team; 70% had no surveillance protocols to monitor infections, and only 20% used multimodal strategies for IPC activities. Similarly, 70% of facilities had a TB-IPC program without a proper budget and did not include facility managers in the TB-IPC team; 80% indicated that patient flow poses a risk of TB transmission; 70% had poor ventilation systems; 90% had inadequate isolation rooms; and though 80% have personal protective equipment available, frequent shortages were reported. CONCLUSIONS The WHO-recommended TB-IPC policy is not effectively implemented in most of the participating district hospitals. Improvements in implementing and disseminating TB-IPC guidelines, monitoring TB-IPC practices, and systematic healthcare worker training are essential to improve TB-IPC guidelines' operationalisation in health settings to reduce TB prevalence in PNG.
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Affiliation(s)
- Gigil Marme
- Faculty of Medicine and Health Sciences, Department of Public Health and Leadership, Divine Word University, P O Box 483, Madang Province, Papua New Guinea.
| | - Jerzy Kuzma
- Faculty of Medicine and Health Sciences, Department of Medicine, Divine Word University, P O Box 483, Madang Province, Papua New Guinea
| | - Peta-Anne Zimmerman
- School of Nursing and Midwifery, Graduate Infection Prevention and Control Program, Griffith University, Parklands Drive, Southport, QLD, 4215, Australia
| | - Neil Harris
- School of Medicine & Dentistry (Public Health), Griffith University, Gold Coast, QLD, 4215, Australia
| | - Shannon Rutherford
- School of Medicine & Dentistry (Public Health), Griffith University, Gold Coast, QLD, 4215, Australia
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Aulanko I, Sanmark E, Oksanen L, Oksanen S, Lahdentausta L, Kivimäki A, Paju S, Pietiäinen M, Pussinen P, Geneid A. Working conditions during the COVID-19 pandemic in primary and tertiary healthcare: a comparative cross-sectional study. Int J Occup Med Environ Health 2023; 36:139-150. [PMID: 36786712 PMCID: PMC10464802 DOI: 10.13075/ijomeh.1896.01944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/30/2022] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic has globally affected healthcare workers' (HCWs) health and wellbeing. Most studies on COVID-19 have focused on tertiary healthcare. The aim of this study was to increase the knowledge on the effects of the pandemic on working conditions in tertiary and primary healthcare. MATERIAL AND METHODS The comparative cross-sectional study consisted of an online questionnaire sent to HCWs of the City of Helsinki (primary healthcare) and Helsinki University Hospital (tertiary healthcare). Altogether 1580 HCWs with direct patient contact participated in the study: 895 from tertiary and 685 from primary healthcare. Statistical analysis used SPSS 25 from IBM. The tests used were the χ2 test, Fisher's exact test, and binary logistic regression analysis. RESULTS Primary HCWs were less likely to treat COVID-19 patients (OR = 0.45, 95% CI: 0.37-0.56). However, both groups reported a similar number of COVID-19 infections, primary HCWs 4.9% and tertiary HCWs 5.0%, and workrelated quarantine was significantly more prevalent (OR = 1.96, 95% CI: 1.38-2.79) among primary HCWs. In addition, work-related wellbeing was poorer among primary HCWs than tertiary HCWs in terms of feeling more stressed at work (OR = 3.20, 95% CI: 2.55-4.02), not recovering from work (OR = 0.49, 95% CI: 0.39-0.62), reported mental wellbeing below normal levels (OR: 1.59, 95% CI: 1.26-2.00), and increased working hours (OR = 1.63, 95% CI: 1.25-2.12). CONCLUSIONS The study demonstrates how the pandemic has affected the wellbeing and working conditions of not only tertiary but also less studied primary HCWs. The authors' findings suggest that the challenges identified during the COVID-19 pandemic in the health and wellbeing of healthcare workers are even greater in primary care than in tertiary care. Int J Occup Med Environ Health. 2023;36(1):139-50.
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Affiliation(s)
- Ida Aulanko
- Helsinki University Hospital, Helsinki, Finland (COVID19VATEHY Research Group, Head and Neck Center)
- University of Helsinki, Helsinki, Finland (Doctoral Programme in Clinical Research)
- Joint Municipal Authority for Social and Healthcare in Central Uusimaa (Keusote), Hyvinkää, Finland
| | - Enni Sanmark
- Helsinki University Hospital, Helsinki, Finland (COVID19VATEHY Research Group, Head and Neck Center)
- Helsinki University Hospital and University of Helsinki, Finland (Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery)
| | - Lotta Oksanen
- Helsinki University Hospital, Helsinki, Finland (COVID19VATEHY Research Group, Head and Neck Center)
- University of Helsinki, Helsinki, Finland (Doctoral Programme in Clinical Research)
- Helsinki University Hospital and University of Helsinki, Finland (Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery)
| | - Sampo Oksanen
- Aalto University, Helsinki, Finland (School of Business)
| | - Laura Lahdentausta
- Helsinki University Hospital, Helsinki, Finland (COVID19VATEHY Research Group, Head and Neck Center)
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland (Department of Oral and Maxillofacial Diseases)
| | - Anne Kivimäki
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland (Department of Oral and Maxillofacial Diseases)
| | - Susanna Paju
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland (Department of Oral and Maxillofacial Diseases)
| | - Milla Pietiäinen
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland (Department of Oral and Maxillofacial Diseases)
| | - Pirkko Pussinen
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland (Department of Oral and Maxillofacial Diseases)
| | - Ahmed Geneid
- Helsinki University Hospital, Helsinki, Finland (COVID19VATEHY Research Group, Head and Neck Center)
- Helsinki University Hospital and University of Helsinki, Finland (Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery)
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Drysdale HRE, Watters DA, Leang Y, N J Thomson B, Brown WA, Wilson A. Victoria's surgical response to the COVID-19 pandemic: the first two years. ANZ J Surg 2023; 93:476-486. [PMID: 36757821 DOI: 10.1111/ans.18311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Abstract
Victoria suffered three major waves during the first two years of the COVID-19 pandemic. Melbourne became the longest locked down city in the world at 267 days. This narrative review documents the chronological waves of COVID-19 in Victoria and key themes influencing the State-wide surgical response. In 2020, Victoria needed to secure supplies of personal protective equipment (PPE) and later, recognizing the importance of aerosol transmission, introduced a respiratory protection program to protect health care workers (HCWs) with fit-tested N-95 masks. It established routine preoperative PCR testing for periods when community prevalence was high and developed strategies to restrict elective surgery when hospital capacity was limited. In 2021, three short-term outbreaks were contained and eliminated whilst vaccination of HCWs and the vulnerable was taking place. A third major wave (Delta) occurred July to November 2021, succeeded by another involving the Omicron variant from December 2021. Planned surgery waiting list numbers, and waiting times for surgery, doubled between March 2020 and March 2022. In early 2022, almost 300 patients underwent surgery when infected with Omicron, with a low mortality (2.6%), though mortality was significantly higher in the unvaccinated (7.3% versus 1.4%). In conclusion, the Victorian response to COVID-19 involved tight state-wide social restrictions, contact tracing, furlough, escalating PPE guidance and respiratory protection. HCW infections were greatly reduced in 2021 compared with 2020. Pre-operative PCR testing gave confidence for emergency and urgent elective surgery to proceed during pandemic waves. Other elective cases were performed as health system capacity allowed, without compromising outcomes.
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Affiliation(s)
- Henry Richard Edward Drysdale
- Departmentof Surgery, Barwon Health, Geelong, Victoria, Australia
- School of Medicine and Health Sciences, Deakin University, Geelong, Victoria, Australia
| | - David Allan Watters
- Departmentof Surgery, Barwon Health, Geelong, Victoria, Australia
- School of Medicine and Health Sciences, Deakin University, Geelong, Victoria, Australia
| | - Yit Leang
- Departmentof Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Benjamin N J Thomson
- Specialist General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Wendy Ann Brown
- Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia
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Mathews M, Ryan D, Hedden L, Lukewich J, Marshall EG, Asghari S, Terry AL, Buote R, Meredith L, Moritz L, Spencer S, Brown JB, Christian E, Freeman TR, Gill PS, Sibbald SL, Wong E. Family physicians' responses to personal protective equipment shortages in four regions in Canada: a qualitative study. BMC PRIMARY CARE 2023; 24:56. [PMID: 36849904 PMCID: PMC9969942 DOI: 10.1186/s12875-022-01958-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/23/2022] [Indexed: 03/01/2023]
Abstract
BACKGROUND Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians' (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning. METHODS As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in Canada. During the interviews, FPs were asked to describe the pandemic-related roles they performed over different stages of the pandemic, facilitators and barriers they experienced in performing these roles, and potential roles they could have filled. Interviews were transcribed and a thematic analysis approach was employed to identify recurring themes. For the current study, we examined themes related to PPE. RESULTS A total of 68 FPs were interviewed across the four regions. Four overarching themes were identified: 1) factors associated with good PPE access, 2) managing PPE shortages, 3) impact of PPE shortages on practice and providers, and 4) symbolism of PPE in primary care. There was a wide discrepancy in access to PPE both within and across regions, and integration with hospital or regional health authorities often resulted in better access than community-based practices. When PPE was limited, FPs described rationing and reusing these resources in an effort to conserve, which often resulted in anxiety and personal safety concerns. Many FPs expressed that PPE shortages had come to symbolize neglect and a lack of concern for the primary care sector in the pandemic response. CONCLUSIONS During the COVID-19 pandemic response, hospital-centric plans and a lack of prioritization for primary care led to shortages of PPE for family physicians. This study highlights the need to consider primary care in PPE conservation and allocation strategies and to examine the influence of the underlying organization of primary care on PPE distribution during the pandemic.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada.
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Emily Gard Marshall
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Shabnam Asghari
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Amanda Lee Terry
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Richard Buote
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Lauren Moritz
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Judith B Brown
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Erin Christian
- Nova Scotia Health, 78 Lovett Lake Ct, Halifax, NS, B3S 1B8, Canada
| | - Thomas R Freeman
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Paul S Gill
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Shannon L Sibbald
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada.,Faculty of Health Sciences, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada.,Thames Valley Family Health Team, 1385 North Routledge Park, Unit 6, London, ON, N6H 5N5, Canada.,St. Joseph's Health Care London, Family Medical Centre, PO Box 5777, Stn B, London, ON, N6A 4V2, Canada
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Tropea J, Peters S, Francis JJ, Bennett N, Fetherstonhaugh D, Buising K, Lim LL, Marshall C, Flynn M, Murray M, Yates P, Aboltins C, Johnson D, Kwong J, Long K, McCahon J, Lim WK. IMpleMenting Effective infection prevention and control in ReSidential aged carE (IMMERSE): protocol for a multi-level mixed methods implementation study. BMC Geriatr 2023; 23:109. [PMID: 36823588 PMCID: PMC9948775 DOI: 10.1186/s12877-023-03766-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/19/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Older people living in residential aged care facilities are at high risk of acquiring infections such as influenza, gastroenteritis, and more recently COVID-19. These infections are a major cause of morbidity and mortality among this cohort. Quality infection prevention and control practice in residential aged care is therefore imperative. Although appointment of a dedicated infection prevention and control (IPC) lead in every Australian residential aged care facility is now mandated, all people working in this setting have a role to play in IPC. The COVID-19 pandemic revealed inadequacies in IPC in this sector and highlighted the need for interventions to improve implementation of best practice. METHODS Using mixed methods, this four-phase implementation study will use theory-informed approaches to: (1) assess residential aged care facilities' readiness for IPC practice change, (2) explore current practice using scenario-based assessments, (3) investigate barriers to best practice IPC, and (4) determine and evaluate feasible and locally tailored solutions to overcome the identified barriers. IPC leads will be upskilled and supported to operationalise the selected solutions. Staff working in residential aged care facilities, residents and their families will be recruited for participation in surveys and semi-structured interviews. Data will be analysed and triangulated at each phase, with findings informing the subsequent phases. Stakeholder groups at each facility and the IMMERSE project's Reference Group will contribute to the interpretation of findings at each phase of the project. DISCUSSION This multi-site study will comprehensively explore infection prevention and control practices in residential aged care. It will inform and support locally appropriate evidence-based strategies for enhancing infection prevention and control practice.
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Affiliation(s)
- Joanne Tropea
- Department of Aged Care, Royal Melbourne Hospital, Level 8 CRM, 300 Grattan Street, Parkville, VIC, 3050, Australia. .,Department of Medicine - Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Sanne Peters
- grid.1008.90000 0001 2179 088XSchool of Health Sciences, University of Melbourne, Parkville, VIC 3010 Australia ,grid.5596.f0000 0001 0668 7884Department of Public Health and Primary Care, University of Leuven, KU Leuven, Louvain, Belgium
| | - Jill J. Francis
- grid.1008.90000 0001 2179 088XSchool of Health Sciences, University of Melbourne, Parkville, VIC 3010 Australia ,grid.1055.10000000403978434Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XDepartment of Oncology, Sir Peter MacCallum, University of Melbourne, Parkville, VIC 3010 Australia ,grid.412687.e0000 0000 9606 5108Ottawa Hospital Research Institute – General Campus, Centre for Implementation Research, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Noleen Bennett
- grid.1008.90000 0001 2179 088XVictorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre and Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia ,grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, National Centre for Antimicrobial Stewardship, University of Melbourne, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XDepartment of Nursing, School of Health Sciences, University of Melbourne, Parkville, VIC 3010 Australia
| | - Deirdre Fetherstonhaugh
- grid.1018.80000 0001 2342 0938Australian Centre for Evidence Based Aged Care (ACEBAC), La Trobe University, Bundoora, VIC 3086 Australia
| | - Kirsty Buising
- grid.416153.40000 0004 0624 1200Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC 3050 Australia ,grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia
| | - Lyn-li Lim
- grid.1008.90000 0001 2179 088XVictorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre and Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia
| | - Caroline Marshall
- grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia ,grid.416153.40000 0004 0624 1200Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Parkville, VIC 3050 Australia
| | - Madelaine Flynn
- Director of Infection Prevention, Northern Health, Epping, VIC 3076 Australia ,Victorian Aged Care Response Centre, Australian Department of Health, Melbourne VIC 3000, Australia
| | - Michael Murray
- grid.1018.80000 0001 2342 0938Australian Centre for Evidence Based Aged Care (ACEBAC), La Trobe University, Bundoora, VIC 3086 Australia ,grid.410678.c0000 0000 9374 3516Department of Geriatric Medicine, Austin Health, Heidelberg, VIC 3084 Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine – Austin Health, University of Melbourne, Heidelberg, VIC 3084 Australia
| | - Paul Yates
- grid.410678.c0000 0000 9374 3516Department of Geriatric Medicine, Austin Health, Heidelberg, VIC 3084 Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine – Austin Health, University of Melbourne, Heidelberg, VIC 3084 Australia
| | - Craig Aboltins
- grid.410684.f0000 0004 0456 4276Department of Infectious Diseases, Northern Health, Epping, Vic 3076 Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine, Northern Clinical School, University of Melbourne, Epping VIC 3076, Australia
| | - Douglas Johnson
- grid.1008.90000 0001 2179 088XDepartment of Medicine – Royal Melbourne Hospital, University of Melbourne, Parkville, VIC 3010 Australia ,grid.416153.40000 0004 0624 1200Departments of General Medicine and Infectious Diseases, Royal Melbourne Hospital, Parkville VIC 3050, Australia
| | - Jason Kwong
- grid.1008.90000 0001 2179 088XDepartment of Medicine – Austin Health, University of Melbourne, Heidelberg, VIC 3084 Australia ,grid.410678.c0000 0000 9374 3516Department of Infectious Diseases, Austin Health, Heidelberg VIC 3084, Australia ,grid.1008.90000 0001 2179 088XDepartment of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne VIC 3000, Australia
| | - Karrie Long
- grid.416153.40000 0004 0624 1200Director Nursing Research Hub, Royal Melbourne Hospital, Parkville VIC 3050, Australia
| | - Judy McCahon
- Consumer Representative of the IMMERSE Research Team, and Melbourne Academic Centre for Health, Parkville VIC 3050, Australia
| | - Wen K. Lim
- grid.416153.40000 0004 0624 1200Department of Aged Care, Royal Melbourne Hospital, Level 8 CRM, 300 Grattan Street, Parkville, VIC 3050 Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine – Royal Melbourne Hospital, University of Melbourne, Parkville, VIC 3010 Australia
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Bojaj G, Tahirbegolli B, Beqiri P, Alloqi Tahirbegolli I, Van Poel E, Willems S, Rizanaj N, Hoxha I. Health Service Management and Patient Safety in Primary Care during the COVID-19 Pandemic in Kosovo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3768. [PMID: 36834461 PMCID: PMC9965489 DOI: 10.3390/ijerph20043768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Several changes must be made to the services to ensure patient safety and enable delivering services in environments where the danger of infection of healthcare personnel and patients in primary care (PC) institutions is elevated, i.e., during the COVID-19 pandemic. OBJECTIVE This study aimed to examine patient safety and healthcare service management in PHC practices in Kosovo during the COVID-19 pandemic. METHODS In this cross-sectional study, data were collected using a self-reported questionnaire among 77 PHC practices. RESULTS Our main finding reveals a safer organization of PC practices and services since the COVID-19 pandemic compared to the previous period before the pandemic. The study also shows a collaboration between PC practices in the close neighborhood and more proper human resource management due to COVID-19 suspicion or infection. Over 80% of the participating PC practices felt the need to introduce changes to the structure of their practice. Regarding infection protection measures (IPC), our study found that health professionals' practices of wearing a ring or bracelet and wearing nail polish improved during the COVID-19 pandemic compared to the pre-pandemic period. During the COVID-19 pandemic, PC practice health professionals had less time to routinely review guidelines or medical literature. Despite this, implementing triage protocols over the phone has yet to be applied at the intended level by PC practices in Kosovo. CONCLUSIONS Primary care practices in Kosovo responded to the COVID-19 pandemic crisis by modifying how they organize their work, implementing procedures for infection control, and enhancing patient safety.
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Affiliation(s)
- Gazmend Bojaj
- Department of Health Institutions and Services Management, Heimerer College, 10000 Prishtina, Kosovo
- Principal Family Medicine Center, 32000 Kline, Kosovo
| | - Bernard Tahirbegolli
- Department of Health Institutions and Services Management, Heimerer College, 10000 Prishtina, Kosovo
- National Sports Medicine Centre, 10000 Prishtina, Kosovo
| | - Petrit Beqiri
- Department of Health Institutions and Services Management, Heimerer College, 10000 Prishtina, Kosovo
| | - Iliriana Alloqi Tahirbegolli
- Laboratory Technician Department, Heimerer College, 10000 Prishtina, Kosovo
- Hematology Clinic, University Clinical Center of Kosovo, 10000 Prishtina, Kosovo
| | - Esther Van Poel
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Nderim Rizanaj
- Nursing Department, Heimerer College, 10000 Prishtina, Kosovo
| | - Ilir Hoxha
- Department of Health Institutions and Services Management, Heimerer College, 10000 Prishtina, Kosovo
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH 03766, USA
- Evidence Synthesis Group, 10000 Prishtina, Kosovo
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49
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Bozzani FM, McCreesh N, Diaconu K, Govender I, White RG, Kielmann K, Grant AD, Vassall A. Cost-effectiveness of tuberculosis infection prevention and control interventions in South African clinics: a model-based economic evaluation informed by complexity science methods. BMJ Glob Health 2023; 8:e010306. [PMID: 36792227 PMCID: PMC9933667 DOI: 10.1136/bmjgh-2022-010306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/16/2022] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Nosocomial Mycobacterium tuberculosis (Mtb) transmission substantially impacts health workers, patients and communities. Guidelines for tuberculosis infection prevention and control (TB IPC) exist but implementation in many settings remains suboptimal. Evidence is needed on cost-effective investments to prevent Mtb transmission that are feasible in routine clinic environments. METHODS A set of TB IPC interventions was codesigned with local stakeholders using system dynamics modelling techniques that addressed both core activities and enabling actions to support implementation. An economic evaluation of these interventions was conducted at two clinics in KwaZulu-Natal, employing agent-based models of Mtb transmission within the clinics and in their catchment populations. Intervention costs included the costs of the enablers (eg, strengthened supervision, community sensitisation) identified by stakeholders to ensure uptake and adherence. RESULTS All intervention scenarios modelled, inclusive of the relevant enablers, cost less than US$200 per disability-adjusted life-year (DALY) averted and were very cost-effective in comparison to South Africa's opportunity cost-based threshold (US$3200 per DALY averted). Two interventions, building modifications to improve ventilation and maximising use of the existing Central Chronic Medicines Dispensing and Distribution system to reduce the number of clinic attendees, were found to be cost saving over the 10-year model time horizon. Incremental cost-effectiveness ratios were sensitive to assumptions on baseline clinic ventilation rates, the prevalence of infectious TB in clinic attendees and future HIV incidence but remained highly cost-effective under all uncertainty analysis scenarios. CONCLUSION TB IPC interventions in clinics, including the enabling actions to ensure their feasibility, afford very good value for money and should be prioritised for implementation within the South African health system.
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Affiliation(s)
- Fiammetta Maria Bozzani
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Nicky McCreesh
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Karin Diaconu
- Institute of Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
| | - Indira Govender
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- Africa Health Research Institute, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, Kwa-Zulu Natal, South Africa
| | - Richard G White
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Karina Kielmann
- Institute of Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Alison D Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- Africa Health Research Institute, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, Kwa-Zulu Natal, South Africa
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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50
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Kelly S, Kaehny M, Powell MC. Learning from Nursing Home Infection Prevention and Control Citations During the COVID-19 Pandemic. J Gerontol Nurs 2023; 49:36-42. [PMID: 36719658 DOI: 10.3928/00989134-20230106-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The devastating effects of coronavirus disease 2019 (COVID-19) highlight the critical need for effective infection prevention and control (IPC) practices in nursing homes. Nursing management and infection preventionists should be cognizant of the most common reasons underlying federal IPC citations during the pandemic. Analysis of IPC citation data from the first 7 months of the public health emergency identified that adherence to personal protective equipment (PPE) and mask use, appropriate transmission-based precautions, and hand hygiene were the most common reasons for COVID-19-related F880 citations, including those that placed a person at immediate risk for serious injury or death. More specific staff practices and other factors leading to a citation are also highlighted. Although nursing homes may have limited control over factors such as PPE supply and staffing resources, nursing management and infection preventionists can use these results to help ensure that operational mechanisms, staff training, and adherence monitoring efforts effectively address the areas most associated with COVID-19 IPC noncompliance. [Journal of Gerontological Nursing, 49(2), 36-42.].
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