A Randomized Trial of Instructor-Led Training Versus Video Lesson in Training Health Care Providers in Proper Donning and Doffing of Personal Protective Equipment

Relationships between effective safety training, safety knowledge and personal protective equipment related behaviors among firefighters

INTRODUCTION

Firefighter injuries and fatalities have been attributed to improper or ineffective use of personal protective equipment (PPE). Although studies have examined predictors of PPE to include situational, leadership, stressors and other psychosocial factors, research has not thoroughly examined the relationships between effective safety training administration, knowledge creation, and the influence of those factors on PPE use among firefighters.

METHOD

This study aimed to assess those relationships by using structural equation modeling analysis.

RESULTS

The model fit was good, and findings confirmed the hypothesized model and relationships, which included a positive, significant relationship between effective safety training and safety knowledge and positive, significant relationships between safety knowledge and PPE-related safety behavior outcomes, including the effective use of PASS devices, the correct use of SCBA and PPE during overhaul operations, and the correct use and inspection of PPE among firefighters in general.

PRACTICAL APPLICATIONS

Findings support the importance of safety training in the fire service to bolster knowledge and correct PPE use.

A individually randomized controlled trial comparing Healer-led vs. clinician- led training to improve personal protective equipment use among traditional healers in South Africa

Like allopathic healthcare workers, healers are also exposed to patients' blood and body fluids. A widespread practice is the traditional "injection," in which the healer performs subcutaneous incisions to rub herbs directly into the bloodied skin, resulting in 1,500 blood exposures over their lifetime. We tested the impact of healer-led PPE training, staffed by trained traditional healers who reported using PPE during each risky clinical encounter vs. healthcare worker (HCW)-led PPE training sessions. We randomized 136 healers into one of the two study arms (67 in the healer-led group, 69 in the HCW-led group) and assessed the impact of trainer on PPE skills and use over a six-month period. All healers received one in-person day of didactic and practical training followed by three sessions at the healers' home. Participants were largely female (80%), averaged 51 years old, and practiced as a healer for an average of 17 years. Almost 44% either disclosed themselves as HIV+ or received a positive HIV test result at study initiation. Healers in the HCW arm showed equivalent PPE scores as those trained by traditional healers at baseline and at seven months. Healers in both arms self-reported high levels of glove use during"injections," with no statistical difference of use by study arm. When we assessed actual gloves and razor blades disposed of each month, a similar trend emerged. No one seroconverted during the study period. The need for PPE support among traditional healers cannot be ignored. Traditional healers can be trained to effectively disseminate PPE knowledge and skills to other traditional healers. With an estimated 200,000 traditional healers in South Africa, it is imperative that all of them have access to PPE training and supplies to prevent HIV, HCV, or HBV infections. Trial registration: ClinicalTrials.gov, NCT04440813. Registered 17 June 2020, https://clinicaltrials.gov/ct2/show/NCT04440813.

Personal protective equipment and medical students in times of COVID-19: experiences and perspectives from the final clerkship year

BACKGROUND

The availability and correct use of personal protective equipment (PPE) to prevent and control infections plays a critical role in the safety of medical students in clinical placements. This study explored their experiences and perspectives in their final clerkship year with PPE during the COVID-19 pandemic.

METHODS

This qualitative study was based on social constructivism and was conducted in 2021 at the Charité - Universitätsmedizin Berlin. In three online focus group discussions, 15 medical students in their final clerkship year reported their experiences with PPE training and use during the COVID-19 pandemic. Data were recorded, transcribed and analysed based on Kuckartz's approach to content analysis. We drew upon the a priori dimensions of the capability, opportunity, motivation - behaviour (COM-B) model as main categories as well as emergent issues raised by the study participants (subcategories).

RESULTS

In addition to the three main categories of the COM-B model, eleven subcategories were identified through inductive analysis. The study participants reported several factors that hindered the correct use of PPE. In the area of capabilities, these factors were related to learning experience with PPE in terms of both theoretical and practical learning together with later supervision in practice. In the area of opportunities, these factors included the limited availability of some PPE components, a lack of time for PPE instruction and supervision and inappropriate role modelling due to the inconsistent use of PPE by physicians and nursing staff. The area of motivation to use PPE was characterized by an ambivalent fear of infection by the SARS-CoV-2 virus and the prioritization of patient safety, i.e., the need to prevent the transmission of the virus to patients.

CONCLUSIONS

Our study revealed several limitations pertaining to the enabling factors associated with the trainable behaviour "correct use of PPE". The concept of shared responsibility for student safety was used to derive recommendations for future improvement specifically for the medical school as an organization, the teachers and supervisors, and students themselves. This study may guide and stimulate other medical schools and faculties to explore and analyse components of student safety in clinical settings in times of infectious pandemics.

[Practical Application of Body Mechanics Principles in the Process of Health Workers Doffing Personal Protective Equipment]

Objective

To examine the application effect of body mechanics principles in the process of health workers doffing personal protective equipment (PPE).

Methods

A total of 360 health workers from a Fangcang shelter hospital, also known as alternate care site, in Shanghai were involved in a centralized 1-day training concerning essential skills for taking off PPE. The training was focused on integrating body mechanics principles, including expanding the support surface, lowering the center of gravity, reducing the shift in the the center of gravity, using the principle of leverage, and creating the appropriate operating space, in the PPE doffing process. Through remote video monitoring and recording, observations were made of the physical stability, pollution risks, and operational smoothness of the health workers when they applied body mechanics principles in their actions.

Results

The results of binary logistic regression showed that, compared with the actions taken without applying body mechanics principles, performing the operation of the body leaning forward and then slightly leaning backward was positively correlated with stability in the doffing process (odds ratio [O R]=3.291, 95% confidence interval [ CI]: 1.627-6.656), negatively correlated with pollution risks ( OR=0.203, 95% CI: 0.100-0.412), and positively correlated with operational smoothness ( OR=20.847, 95% CI: 8.061-53.916); performing the operation of taking off the boot sleeve in a horse-riding stance, with one foot standing ahead of the other, was positively correlated with stability ( OR=5.299, 95% CI: 1.041-26.957), negatively correlated with pollution risks ( OR=0.079, 95% CI: 0.009-0.692), and positive correlated with operational smoothness ( OR=16.729, 95% CI: 1.238-226.077); performing the operation of taking off the boot sleeve by lifting the heel and then the toes was positively correlated with stability ( OR=19.361, 95% CI: 8.391-44.671), negatively correlated with pollution risks ( OR=0.181, 95% CI: 0.084-0.393), and positively correlated with operational smoothness ( OR=10.977, 95% CI: 3.764-32.008); performing the operation of the leaning forward and keeping the face looking forward when taking off the mask was positively correlated with stability ( OR=2.935, 95% CI: 1.412-6.101), negatively correlated with pollution risks ( OR=0.123, 95% CI: 0.059-0.258), and positively correlated with operational smoothness ( OR=18.126, 95% CI: 6.665-49.297).

Conclusion

In the process of medical staffs doffing PPE, correct and proper mechanical postures and actions can effectively assist medical staffs to maintain balance and stability and reduce the risks of infection, which has major significance and should be widely incorporated in personal protection skills training and applied in clinical practice.

Assessing efficacy of instructor based orientation to donning doffing protocols and modifications to doffing area infrastructure in reducing SARS-CoV-2 infection among Doctors assigned to COVID-19 patient care

Background

We assess the efficacy of orientation programmes for doctors of proper donning, doffing techniques for personal protective equipment (PPE) and safe practices inside the COVID-19 hospital in reducing the COVID-19 infection rate among doctors.

Methods

A total of 767 resident doctors and 197 faculty visits on weekly rotation were recorded over a six month period. Doctors were guided through orientation sessions before their entry into the COVID-19 hospital from 1 August 2020.The infection rate among doctors was used to study the efficacy of the programme. McNemars Chi-square test was used to compare the infection rate in the two groups before and after orientation sessions were commenced.

Discussion

A statistically significant reduction in SARS-CoV-2 infection was seen among resident doctors after orientation programmes and infrastructure modification (3% vs 7.4%, p=0.03). Twenty-eight of 32 (87.5%) doctors who tested positive developed asymptomatic to mild infection. The infection rate was 3.65% and 2.1% among residents and faculty respectively. There was no mortality recorded.

Conclusion

Orientation programme for healthcare workers for PPE donning and doffing protocols with practical demonstration and trial of PPE usage can significantly reduce COVID-19infection. Such sessions should be mandatory for all workers on deputation in designated area for Infectious Diseases and in pandemic situations.

Challenges and opportunities for educating health professionals after the COVID-19 pandemic

The education of health professionals substantially changed before, during, and after the COVID-19 pandemic. A 2010 Lancet Commission examined the 100-year history of health-professional education, beginning with the 1910 Flexner report. Since the publication of the Lancet Commission, several transformative developments have happened, including in competency-based education, interprofessional education, and the large-scale application of information technology to education. Although the COVID-19 pandemic did not initiate these developments, it increased their implementation, and they are likely to have a long-term effect on health-professional education. They converge with other societal changes, such as globalisation of health care and increasing concerns of health disparities across the world, that were exacerbated by the pandemic. In this Health Policy, we list institutional and instructional reforms to assess what has happened to health-professional education since the publication of the Lancet Commission and how the COVID-19 pandemic altered the education process.

How Can Personal Protective Equipment Be Best Used and Reused: A Closer Look at Donning and Doffing Procedures

OBJECTIVE

The aim of this study was to examine safety-related contamination threats and risks to health-care workers (HCWs) due to the reuse of personal protective equipment (PPE) among emergency department (ED) personnel.

METHODS

We used a Participatory Design (PD) approach to conduct task analysis (TA) of PPE use and reuse. TA identified the steps, risks, and protective behaviors involved in PPE reuse. We used the Centers for Disease Control and Prevention (CDC) guidance for PPE donning and doffing specifying the recommended task order. Then, we convened subject matter experts (SMEs) with relevant backgrounds in Patient Safety, Human Factors and Emergency Medicine to iteratively identify and map the tasks, risks, and protective behaviors involved in the PPE use and reuse.

RESULTS

Two emerging threats were associated with behaviors in donning, doffing, and re-using PPE: (i) direct exposure to contaminant, and (ii) transmission/spread of contaminant. Protective behaviors included: hand hygiene, not touching the patient-facing surface of PPE, and ensuring a proper fit and closure of all PPE ties and materials.

CONCLUSIONS

TA was helpful revealed that the procedure for donning and doffing of re-used PPE does not protect ED personnel from contaminant spread and risk of exposure, even with protective behaviors present (e.g., hand hygiene, respirator use, etc.). Future work should make more apparent the underlying risks associated with PPE use and reuse.

The lived experiences of family members who visit their relatives in Covid-19 intensive care unit for the first time: A phenomenological study

BACKGROUND

COVID-19 patient experiences in the intensive care unit (ICU) are marked by family separation. Families understand the importance of isolation and hospital visiting policies, but they consider it necessary to visit their loved ones and use personal protective equipment.

OBJECTIVE

To describe the lived experiences of family members in their first contact with a relative in a COVID-ICU.

METHODS

A phenomenological study was conducted using Cohen's method. The subjects were interviewed using an open-question format to allow them full freedom of expression. Twelve family members were recruited between February and March 2021.

RESULTS

Analysis of the qualitative data resulted in five major themes: (1) fear of contagion related to donning/doffing procedures, (2) positive emotions related to first contact with the hospitalized relative, (3) concern for the emotional state of the hospitalized relative, (4) impact of the COVID-ICU and comparisons between imagination and reality regarding the severity of the disease, and (5) recognition of and gratitude toward healthcare professionals.

CONCLUSIONS

It has been confirmed that visits to the ICU reduce anxiety among family members. Our findings constitute an internationally relevant contribution to understanding of the needs of relatives who meet loved ones for the first time while wearing personal protective equipment.

The Well-Being of Healthcare Workers During the COVID-19 Pandemic: A Narrative Review

The coronavirus disease 2019 (COVID-19) pandemic has turned into a global healthcare challenge, causing significant morbidity and mortality.Healthcare workers (HCWs) who are on the frontline of the COVID-19 outbreak response face an increased risk of contracting the disease. Some common challenges encountered by HCWs include exposure to the pathogen, psychological distress, and long working hours. In addition, HCWs may be more prone to develop mental health issues such as anxiety, depression, suicidal thoughts, post-traumatic stress disorder (PTSD), sleep disorders, and drug addictions compared to the general population. These issues arise from increased job stress, fear of spreading the disease to loved ones, and potential discrimination or stigma associated with the disease. This study aims to review the current literature to explore the effects of COVID-19 on healthcare providers' physical and mental well-being and suggest interventional strategies to combat these issues. To that end, we performed a literature search on Google Scholar and PubMed databases using combinations of the following keywords and synonyms: "SARS-CoV-2", "Healthcare-worker", "COVID-19", "Well-being", "Wellness", "Depression", "Anxiety", and "PTSD."

The Comparative Effectiveness of Virtual Reality Versus E-Module on the Training of Donning and Doffing Personal Protective Equipment: A Randomized, Simulation-Based Educational Study

Introduction Preventing errors in donning and doffing of personal protective equipment (PPE) is critical for limiting the spread of infectious diseases. Virtual reality (VR) has demonstrated itself as an effective tool for asynchronous learning, but its use in PPE training has not been tested. The objective of this study was to compare donning and doffing performance between VR and e-module PPE training. Methods A prospective randomized open-blinded controlled trial was conducted to determine differences in donning and doffing performance after VR and e-module PPE training among medical staff and medical students at a single institution. The primary outcome was donning and doffing performance with real PPE, assessed using a 64-point checklist. The secondary outcome was participant preparedness and confidence level after training.  Results Fifty-four participants were randomized, mostly consisting of medical students (n=24 {44%}) or emergency medicine and otolaryngology residents (n=19 {35%}). The VR group (n=27 {50%}) performed better than the control in the overall PPE scores but this was not statistically significant (mean {SD}, VR: 55.4 {4.4} vs e-module: 53.3 {8.1}; p = 0.40). VR participants also reported higher levels of preparedness and confidence after training. Residents as a subgroup achieved the highest increases after VR training compared to their counterparts in the control training group (mean {SD}, VR: 55.6 {4.9} vs e-module 48.4 {5.5}, p = 0.009).  Conclusion In this randomized trial, VR training was found to be non-inferior to e-module for asynchronous PPE training. Our results suggest that in particular residents may benefit most from VR PPE training. Additionally, VR participants felt more confident and prepared to don and doff PPE after training compared to e-module participants. These findings are particularly relevant given the ongoing coronavirus disease 2019 (COVID-19) pandemic. Future studies need to focus on VR integration into residency curriculum and monitoring for long-term skill retention.

Health care workers' experience of personal protective equipment use and associated adverse effects during the COVID-19 pandemic response in Singapore

Aim

One of the greatest challenges in responding to the COVID‐19 pandemic is preventing staff exposure and infection by ensuring consistent and effective use of personal protective equipment (PPE). This study explored health care workers' experience of prolonged PPE use in clinical practice settings and their concerns regarding PPE supply, effectiveness and training needs.

Design

A descriptive cross‐sectional design was adopted in this study.

Methods

Health care workers (N = 592) from an acute care hospital completed an online survey from July to September 2020 assessing: (i) usage frequencies, side effects and interference with patient care; and (ii) perceptions of access to PPE, likelihood of exposure to infection and adequacy of PPE training.

Results

PPE‐related side effects were reported by 319 (53.8%) participants, the majority being nurses (88.4%) and those working in high‐risk areas such as the emergency department (39.5%), respiratory wards (acute 22.3% and non‐acute 23.8%) and COVID‐19 isolation ward (13.8%). The average time wearing PPE per shift was 6.8 h (SD 0.39). The most commonly reported symptoms were from donning N95 masks and included: pressure injuries (45.5%), mask‐induced acne (40.4%) and burning/pain (24.5%). Some 31.3% expressed that PPE‐related side effects had negatively affected their work. The odds of having PPE‐associated side effects was higher in women (OR 2.10, 95% CI [1.29–03.42], p = .003) and those working in high‐risk wards (OR 3.12, 95% CI [2.17–4.60], p < .001]. Most (90.1%) agreed that PPE supplies were readily available, sufficient for all (86.1%) and there was sufficient training in correct PPE use (93.6%). Only 13.7% of participants reported being ‘highly confident’ of overall PPE protection.

Conclusions

Prevention and management of PPE‐related adverse effects is vital to: preserve the integrity of PPE, improve adherence and minimize viral transmission.

Impact

The high incidence of PPE‐associated pressure injuries and perception that PPE use can interfere with clinical care should inform future development of PPE products, and strategies to better equip health care workers to prevent and manage PPE‐related side effects.

Work-based concerns of Australian frontline healthcare workers during the first wave of the COVID-19 pandemic

OBJECTIVE

This research sought to gauge the extent to which doctors, nurses and paramedics in Australia were concerned about contracting SARS-CoV-2 during the country's first wave of the virus in April 2020.

METHODS

Australian registered doctors, nurses and paramedics (n=580) completed an online questionnaire during April 16-30, 2020 (period immediately following the highest four-week period (first wave) of SARS-CoV-2 confirmed cases in Australia).

RESULTS

During April 2020, two-thirds of participants felt it was likely they would contract SARS-CoV-2 at work. Half the participants suggested Personal Protective Equipment (PPE) supplies were inadequate for them to safely perform their job, with two-thirds suggesting management advised them to alter normal PPE use. One-third of participants suggested they were dissatisfied with their employer's communication of COVID-19 related information. Conclusions and implications for public health: After reports of PPE shortages during Australia's first SARS-CoV-2 wave, and suggestions access to PPE was still limited during Australia's second wave five months later, we must forecast for this and future pandemics ensuring adequate access to PPE for frontline healthcare workers. Further, ensuring consistent and standardised pathways for communication to staff (acknowledging the reality that information may rapidly change) will help alleviate frustration and anxiety.

Ethical commitments, principles, and practices guiding intracranial neuroscientific research in humans

Leveraging firsthand experience, BRAIN-funded investigators conducting intracranial human neuroscience research propose two fundamental ethical commitments: (1) maintaining the integrity of clinical care and (2) ensuring voluntariness. Principles, practices, and uncertainties related to these commitments are offered for future investigation.

Learning From a Massive Open Online COVID-19 Vaccination Training Experience: Survey Study

Background

To prepare key stakeholders for the global COVID-19 vaccination rollout, the World Health Organization and partners developed online vaccination training packages. The online course was launched in December 2020 on the OpenWHO learning platform. This paper presents the findings of an evaluation of this course.

Objective

The aim of this evaluation was to provide insights into user experiences and challenges, measure the impact of the course in terms of knowledge gained, and anticipate potential interest in future online vaccination courses.

Methods

The primary source of data was the anonymized information on course participants, enrollment, completion, and scores from the OpenWHO platform’s statistical data and metric reporting system. Data from the OpenWHO platform were analyzed from the opening of the courses in mid-December 2020 to mid-April 2021. In addition, a learner feedback survey was sent by email to all course participants to complete within a 3-week period (March 19 to April 9, 2021). The survey was designed to determine the perceived strengths and weaknesses of the training packages and to understand barriers to access.

Results

During the study period, 53,593 learners enrolled in the course. Of them, 30,034 (56.0%) completed the course, which is substantially higher than the industry benchmark of 5%-10% for a massive open online course (MOOC). Overall, learners averaged 76.5% on the prequiz compared to 85% on the postquiz, resulting in an increase in average score of 9%. A total of 2019 learners from the course participated in the survey. Nearly 98% (n=1647 fully agree, n=308 somewhat agree; N=1986 survey respondents excluding missing values) of respondents fully or somewhat agreed that they had more confidence in their ability to support COVID-19 vaccination following completion of this course.

Conclusions

The online vaccine training was well received by the target audience, with a measurable impact on knowledge gained. The key benefits of online training were the convenience, self-paced nature, access to downloadable material, and ability to replay material, as well as an increased ability to concentrate. Online training was identified as a timely, cost-effective way of delivering essential training to a large number of people to prepare for the COVID-19 vaccination rollout.

Sufficient personal protective equipment training can reduce COVID-19 related symptoms in healthcare workers: A prospective cohort study

BACKGROUND

The association between inadequate personal protective equipment during the COVID-19 pandemic and an increased risk of SARS-CoV-2 infection in frontline healthcare workers has been proven. However, frontline healthcare workers with an adequate supply of personal protective equipment still showed an increased risk of contracting COVID-19. Research on the use of personal protective equipment could provide insight into handling present and future pandemics.

OBJECTIVES

This study aims to investigate the impact of the availability, training and correct selection of personal protective equipment on the incidence of SARS-CoV-2 infection or positive suspect cases in healthcare workers during the COVID-19 pandemic in Belgium.

DESIGN

This was a prospective cohort study involving Belgian healthcare workers: nurses, nursing aides, and midwives working in hospitals, home care services, and residential care services.

METHODS

Respondents were invited from May to July 2020 (period 1) followed by a second time in October 2020 (period 2) to complete a digital survey on personal protective equipment availability, training, personal protective equipment selection, screening ability, COVID-19 testing and status, and symptoms corresponding with the COVID-19 suspect case definition. The main outcome was a composite of COVID-19 status change (from negative to positive) during the study or a positive suspect case definition in period 2.

RESULTS

Full data were available for 617 participants. The majority of respondents were nurses (93%) employed in a hospital (83%). In total, 379 respondents provided frontline care for COVID-19 patients (61%) and were questioned on personal protective equipment availability and personal protective equipment selection. Nurses were more likely to select the correct personal protective equipment compared with nursing aides and midwives. Respondents working in residential care settings were least likely to choose personal protective equipment correctly. Of all healthcare workers, 10% tested positive for COVID-19 during the course of the study and a composite outcome was reached in 54% of all respondents. Working experience and sufficient personal protective equipment training showed an inverse relation with the composite outcome. The relationship between personal protective equipment availability and the composite outcome was fully mediated by personal protective equipment training (-0.105 [95% confidence interval -0.211 - -0.020]).

CONCLUSIONS

Proper training in personal protective equipment usage is critical to reduce the risk of COVID infection in healthcare workers. During a pandemic, rapid dissemination of video guidelines could improve personal protective equipment knowledge in practitioners. Tweetable abstract: Proper training in personal protective equipment usage is critical to reduce the risk of COVID infection in healthcare workers.

Challenges of students and residents of human medicine in the first four months of the fight against the Covid-19 pandemic - Implications for future waves and scenarios

INTRODUCTION

In the fight against the Covid-19 pandemic, medical students and residents are expected to adapt and contribute in a healthcare environment characterized by ever-changing measures and policies. The aim of this narrative review is to provide a summary of the literature that addresses the challenges of students and residents of human medicine in the first 4 months of the fight against the Covid-19 pandemic in order to identify gaps and find implications for improvement within the current situation and for potential future scenarios.

METHODS

We performed a systematic literature search and content analysis (CA) of articles available in English language that address the challenges of students and residents of human medicine in the first 4 months of the fight against the Covid-19 pandemic.

RESULTS

We retrieved 82 articles from a wide range of journals, professional backgrounds and countries. CA identified five recurring subgroup topics: "faculty preparation", «uncertainties and mental health», «clinical knowledge», «rights and obligations» and «(self-) support and supply». Within these subgroups the main concerns of (re-)deployment, interruption of training and career, safety issues, transmission of disease, and restricted social interaction were identified as potential stressors that hold a risk for fatigue, loss of morale and burnout.

DISCUSSION

Students and residents are willing and able to participate in the fight against Covid-19 when provided with appropriate deployment, legal guidance, safety measures, clinical knowledge, thorough supervision, social integration and mental health support. Preceding interviews to decide on reasonable voluntary deployment, the use of new technology and frequent feedback communication with faculties, educators and policymakers can further help with a successful and sustainable integration of students and residents in the fight against the pandemic.

CONCLUSION

It is critical that faculties, educators and policymakers have a thorough understanding of the needs and concerns of medical trainees during pandemic times. Leaders should facilitate close communication with students and residents, value their intrinsic creativeness and regularly evaluate their needs in regards to deployment, knowledge aspects, safety measures, legal concerns and overall well-being.

Dissemination interventions to improve healthcare workers' adherence with infection prevention and control guidelines: a systematic review and meta-analysis

Background

The COVID-19 pandemic has challenged health systems worldwide since 2020. At the frontline of the pandemic, healthcare workers are at high risk of exposure. Compliance with infection prevention and control (IPC) should be encouraged at the frontline. This systematic review aimed to assess the effects of dissemination interventions to improve healthcare workers’ adherence with IPC guidelines for respiratory infectious diseases in the workplace.

Methods

We searched CENTRAL, MEDLINE, Embase, and the Cochrane COVID-19 Study Register. We included randomized controlled trials (RCTs) and cluster RCTs that assessed the effect of any dissemination strategy in any healthcare settings. Certainty of evidence was assessed using the GRADE approach. We synthesized data using random-effects model meta-analysis in Stata 14.2.

Results

We identified 14 RCTs conducted from 2004 to 2020 with over 65,370 healthcare workers. Adherence to IPC guidelines was assessed by influenza vaccination uptake, hand hygiene compliance, and knowledge on IPC. The most assessed intervention was educational material in combined strategies (plus educational meetings, local opinion leaders, audit and feedback, reminders, tailored interventions, monitoring the performance of the delivery of health care, educational games, and/or patient-mediated interventions). Combined dissemination strategies compared to usual routine improve vaccination uptake (risk ratio [RR] 1.59, 95% confidence interval [CI] 1.54 to 1.81, moderate-certainty evidence), and may improve hand hygiene compliance (RR 1.70; 95% CI 1.03 to 2.83, moderate-certainty). When compared to single strategies, combined dissemination strategies probably had no effect on vaccination uptake (RR 1.01, 95% CI 0.95 to 1.07, low-certainty), and hand hygiene compliance (RR 1.16, 95% CI 0.99 to 1.36, low-certainty). Knowledge of healthcare workers on IPC improved when combined dissemination strategies were compared with usual activities, and the effect was uncertain in comparison to single strategy (very low-certainty evidence).

Conclusions

Combined dissemination strategies increased workers’ vaccination uptake, hand hygiene compliance, and knowledge on IPC in comparison to usual activities. The effect was negligible when compared to single dissemination strategies. The adoption of dissemination strategies in a planned and targeted way for healthcare workers may increase adherence to IPC guidelines and thus prevent dissemination of infectious disease in the workplace.

Trial registration

Protocol available at http://osf.io/aqxnp.

Effect of virtual reality simulation training on the response capability of public health emergency reserve nurses in China: a quasiexperimental study

OBJECTIVE

To develop a virtual reality simulation training programme, and further verify the effect of the programme on improving the response capacity of emergency reserve nurses confronting public health emergencies.

DESIGN

A prospective quasiexperimental design with a control group.

PARTICIPANTS

A total of 120 nurses were recruited and randomly divided into the control group and the intervention group.

INTERVENTION

Participants underwent a 3-month training. The control group received the conventional training of emergency response (eg, theoretical lectures, technical skills and psychological training), while the intervention group underwent the virtual reality simulation training in combination with skills training. The COVID-19 cases were incorporated into the intervention group training, and the psychological training was identical to both groups. At the end of the training, each group conducted emergency drills twice. Before and after the intervention, the two groups were assessed for the knowledge and technical skills regarding responses to fulminate respiratory infectious diseases, as well as the capacity of emergency care. Furthermore, their pandemic preparedness was assessed with a disaster preparedness questionnaire.

RESULTS

After the intervention, the scores of the relevant knowledge, the capacity of emergency care and disaster preparedness in the intervention group significantly increased (p<0.01). The score of technical skills in the control group increased more significantly than that of the intervention group (p<0.01). No significant difference was identified in the scores of postdisaster management in two groups (p>0.05).

CONCLUSION

The virtual reality simulation training in combination with technical skills training can improve the response capacity of emergency reserve nurses as compared with the conventional training. The findings of the study provide some evidence for the emergency training of reserve nurses in better response to public health emergencies and suggest this methodology is worthy of further research and popularisation.

Biosafety measures to prevent COVID-19 in healthcare professionals: an integrative review

OBJECTIVE

to identify the main biosafety measures for preventing COVID-19 in healthcare professionals.

METHODS

this is an integrative literature review, with studies published between January and July 2020, on the MEDLINE/PubMed, Scopus, Embase, Web of Science, LILACS, SciELo, Wiley Online Library, Cochrane CINAHL databases. The selection of studies followed the PRISMA recommendations.

RESULTS

among the 2,208 publications identified, 12 studies comprised the sample, which enabled the analysis in four thematic categories: The importance of using recommendations about the use of personal protective equipment; The restructuring of new operational and clinical routines and flows in the practice of services; Monitoring professionals, especially testing; Conducting training.

CONCLUSIONS

the phenomena involved are innumerable, covering operational management and the training of teams to deal with highly infectious pathogens and disease outbreaks.

Training and education of healthcare workers during viral epidemics: a systematic review

BACKGROUND

It is necessary to train a large number of healthcare workers (HCW) within a limited time to ensure adequate human resources during an epidemic. There remains an urgent need for best practices on development and implementation of training programmes.

OBJECTIVE

To explore published literature in relation to training and education for viral epidemics as well as the effect of these interventions to inform training of HCW.

DATA SOURCES

Systematic searches in five databases performed between 1 January 2000 and 24 April 2020 for studies reporting on educational interventions in response to major viral epidemics.

STUDY ELIGIBILITY CRITERIA

All studies on educational interventions developed, implemented and evaluated in response to major global viral outbreaks from 2000 to 2020.

PARTICIPANTS

Healthcare workers.

INTERVENTIONS

Educational or training interventions.

STUDY APPRAISAL AND SYNTHESIS METHODS

Descriptive information were extracted and synthesised according to content, competency category, educational methodology, educational effects and level of educational outcome. Quality appraisal was performed using a criterion-based checklist.

RESULTS

A total of 15 676 records were identified and 46 studies were included. Most studies were motivated by the Ebola virus outbreak with doctors and nurses as primary learners. Traditional didactic methods were commonly used to teach theoretical knowledge. Simulation-based training was used mainly for training of technical skills, such as donning and doffing of personal protective equipment. Evaluation of the interventions consisted mostly of surveys on learner satisfaction and confidence or tests of knowledge and skills. Only three studies investigated transfer to the clinical setting or effect on patient outcomes.

CONCLUSIONS AND IMPLICATIONS OF FINDINGS

The included studies describe important educational experiences from past epidemics with a variety of educational content, design and modes of delivery. High-level educational evidence is limited. Evidence-based and standardised training programmes that are easily adapted locally are recommended in preparation for future outbreaks.

How COVID-19 has fundamentally changed clinical research in global health

COVID-19 has had negative repercussions on the entire global population. Despite there being a common goal that should have unified resources and efforts, there have been an overwhelmingly large number of clinical trials that have been registered that are of questionable methodological quality. As the final paper of this Series, we discuss how the medical research community has responded to COVID-19. We recognise the incredible pressure that this pandemic has put on researchers, regulators, and policy makers, all of whom were doing their best to move quickly but safely in a time of tremendous uncertainty. However, the research community's response to the COVID-19 pandemic has prominently highlighted many fundamental issues that exist in clinical trial research under the current system and its incentive structures. The COVID-19 pandemic has not only re-emphasised the importance of well designed randomised clinical trials but also highlighted the need for large-scale clinical trials structured according to a master protocol in a coordinated and collaborative manner. There is also a need for structures and incentives to enable faster data sharing of anonymised datasets, and a need to provide similar opportunities to those in high-income countries for clinical trial research in low-resource regions where clinical trial research receives considerably less research funding.

Training non-intensivist doctors to work with COVID-19 patients in intensive care units

Background

Due to an expected surge of COVID‐19 patients in need of mechanical ventilation, the intensive care capacity was doubled at Rigshospitalet, Copenhagen, in March 2020. This resulted in an urgent need for doctors with competence in working with critically ill COVID‐19 patients. A training course and a theoretical test for non‐intensivist doctors were developed. The aims of this study were to gather validity evidence for the theoretical test and explore the effects of the course.

Methods

The 1‐day course was comprised of theoretical sessions and hands‐on training in ventilator use, hemodynamic monitoring, vascular access, and use of personal protective equipment. Validity evidence was gathered for the test by comparing answers from novices and experts in intensive care. Doctors who participated in the course completed the test before (pretest), after (posttest), and again within 8 weeks following the course (retention test).

Results

Fifty‐four non‐intensivist doctors from 15 different specialties with a wide range in clinical experience level completed the course. The test consisted of 23 questions and demonstrated a credible pass–fail standard at 16 points. Mean pretest score was 11.9 (SD 3.0), mean posttest score 20.6 (1.8), and mean retention test score 17.4 (2.2). All doctors passed the posttest.

Conclusion

Non‐intensivist doctors, irrespective of experience level, can acquire relevant knowledge for working in the ICU through a focused 1‐day evidence‐based course. This knowledge was largely retained as shown by a multiple‐choice test supported by validity evidence. The test is available in appendix and online.

Educational needs in the COVID-19 pandemic: a Delphi study among doctors and nurses in Wuhan, China

OBJECTIVE

To identify theoretical and technical aspects regarding treatment, prevention of spread and protection of staff to inform the development of a comprehensive training curriculum on COVID-19 management.

DESIGN

Cross-sectional study.

SETTING

Nine hospitals caring for patients with COVID-19 in Wuhan, China.

PARTICIPANTS

134 Chinese healthcare professionals (74 doctors and 60 nurses) who were deployed to Wuhan, China during the COVID-19 epidemic were included. A two-round Delphi process was initiated between March and May 2020. In the first round, the participants identified knowledge, technical and behavioural (ie, non-technical) skills that are needed to treat patients, prevent spread of the virus and protect healthcare workers. In round 2, the participants rated each item according to its importance to be included in a training curriculum on COVID-19. Consensus for inclusion in the final list was set at 80%.

PRIMARY OUTCOME MEASURES

Knowledge, technical and behavioural (ie, non-technical) skills that could form the basis of a training curriculum for COVID-19 management.

RESULTS

In the first round 1398 items were suggested by the doctors and reduced to 67 items after content analysis (treatment of patients: n=47; infection prevention and control: n=20). The nurses suggested 1193 items that were reduced to 70 items (treatment of patients: n=49; infection prevention and control: n=21). In round 2, the response rates were 82% in doctors and 93% in nurses. Fifty-eight items of knowledge, technical and behavioural skills were agreed on by the doctors to include in the final list. For the nurses, 58 items were agreed on.

CONCLUSIONS

This needs assessment process resulted in a comprehensive list of knowledge, technical and behavioural skills for COVID-19 management. Educators can use these to guide decisions regarding content of training curricula not only for COVID-19 management but also in preparation for future viral pandemic outbreaks.

Personal protective equipment for reducing the risk of COVID-19 infection among health care workers involved in emergency trauma surgery during the pandemic: An umbrella review

BACKGROUND

Health care facilities in low- and middle-income countries are inadequately resourced to adhere to current COVID-19 prevention recommendations. Recommendations for surgical emergency trauma care measures need to be adequately informed by available evidence and adapt to particular settings. To inform future recommendations, we set to summarize the effects of different personal protective equipment (PPE) on the risk of COVID-19 infection in health personnel caring for trauma surgery patients.

METHODS

We conducted an umbrella review using Living Overview of Evidence platform for COVID-19, which performs regular automated searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and more than 30 other sources. Systematic reviews of experimental and observational studies assessing the efficacy of PPE were included. Indirect evidence from other health care settings was also considered. Risk of bias was assessed with the AMSTAR II tool (Assessing the Methodological Quality of Systematic Reviews, Ottawa, ON, Canada), and the Grading of Recommendations, Assessment, Development, and Evaluation approach for grading the certainty of the evidence is reported (registered in International Prospective Register of Systematic Reviews, CRD42020198267).

RESULTS

Eighteen studies that fulfilled the selection criteria were included. There is high certainty that the use of N95 respirators and surgical masks is associated with a reduced risk of COVID-19 when compared with no mask use. In moderate- to high-risk environments, N95 respirators are associated with a further reduction in risk of COVID-19 infection compared with surgical masks. Eye protection also reduces the risk of contagion in this setting. Decontamination of masks and respirators with ultraviolet germicidal irradiation, vaporous hydrogen peroxide, or dry heat is effective and does not affect PPE performance or fit.

CONCLUSION

The use of PPE drastically reduces the risk of COVID-19 compared with no mask use in health care workers. N95 and equivalent respirators provide more protection than surgical masks. Decontamination and reuse appear feasible to overcome PPE shortages and enhance the allocation of limited resources. These effects are applicable to emergency trauma care and should inform future recommendations.

LEVEL OF EVIDENCE

Review, level II.

Willingness to volunteer and readiness to practice of undergraduate medical students during the COVID-19 pandemic: a cross-sectional survey in Indonesia

BACKGROUND

The question to involve or restrict medical students' involvement in the coronavirus disease 2019 (COVID-19) pandemic response remains contentious. As their state of preparation and perceptions in volunteering during this pandemic have yet to be investigated, this study aims to evaluate Indonesian medical students' willingness to volunteer and readiness to practice during the COVID-19 pandemic.

METHODS

A web-based survey was conducted among undergraduate medical students throughout Indonesia. Socio-demographic and social interaction information, in addition to willingness to volunteer and readiness to practice, were obtained using a self-reported questionnaire. The significance level was set at 5%.

RESULTS

Among 4870 participants, 2374 (48.7%) expressed their willingness to volunteer, while only 906 (18.6%) had adequate readiness to practice. Male students, students with prior volunteering experience in health or non-health sectors, and students from public universities or living in Central Indonesia (vs Java) had higher scores of willingness and readiness to volunteer. Students from Sumatra also had better preparedness (odds ratio [OR] 1.56, 95% confidence interval [CI] 1.15-2.12, p = 0.004), while the opposite occurred for students from Eastern Indonesia (OR 0.63, 95% CI: 0.44-0.89, p = 0.002)-when compared to students from Java. In addition, compared to students with high family income, students from lower-middle income families were less willing to volunteer (OR 0.76, 95% CI: 0.59-0.98, p = 0.034), though those with low family income had better readiness (OR 1.51, 95% CI: 1.10-2.08, p = 0.011). Shortage of medical personnel, sense of duty, and solicitation by stakeholders were the main reasons increasing the students' willingness to volunteer; whereas contrarily fear for own's health, absence of a cure, and fear of harming patients were the primary factors diminishing their willingness to volunteer.

CONCLUSION

Our findings indicated that many Indonesian medical students are willing to volunteer, yet only few of them were ready to practice, indicating that further preparations are required to maximize their potentials and minimize their exposure to hazards. We suggest that their potentials as a firm support system during the pandemic should not be overlooked, and that the integration of relevant courses to the medical curricula are imperative to prepare for future public health emergencies.

Healer-led vs. clinician-led training to improve personal protective equipment use among traditional healers in South Africa: a randomized controlled trial protocol

There are estimated two million traditional healers in sub-Saharan Africa (SSA), with more than 10% (200,000) working in South Africa. Traditional healers in SSA are frequently exposed to bloodborne pathogens through the widespread practice of traditional 'injections', in which the healers perform dozens of subcutaneous incisions to rub herbs directly into the bloodied tissue with their hands. Healers who report exposure to patient blood have a 2.2-fold higher risk of being HIV-positive than those who do not report exposure. We propose a randomized controlled trial (61 healers in the intervention group and 61 healers in the control group) in Mpumalanga Province. Healers will receive personal protective equipment (PPE) education and training, general HIV prevention education, and three educational outreach visits at the healer's place of practice to provide advice and support for PPE use and disposal. Healers in the control arm will be trained by health care providers, while participants in the intervention arm will receive training and outreach from a team of healers who were early adopters of PPE. We will evaluate intervention implementation using data from surveys, observation, and educational assessments. Implementation outcomes of interest include acceptability and feasibility of PPE use during clinical encounters and fidelity of PPE use during treatments that involve blood exposure. We will test our two intervention strategies to identify an optimal strategy for PPE education in a region with high HIV prevalence.

Reporting and design of randomized controlled trials for COVID-19: A systematic review

Background

The novel coronavirus 2019 (COVID-19) pandemic has mobilized global research at an unprecedented scale. While challenges associated with the COVID-19 trial landscape have been discussed previously, no comprehensive reviews have been conducted to assess the reporting, design, and data sharing practices of randomized controlled trials (RCTs).

Purpose

The purpose of this review was to gain insight into the current landscape of reporting, methodological design, and data sharing practices for COVID-19 RCTs.

Data sources

We conducted three searches to identify registered clinical trials, peer-reviewed publications, and pre-print publications.

Study selection

After screening eight major trial registries and 7844 records, we identified 178 registered trials and 38 publications describing 35 trials, including 25 peer-reviewed publications and 13 pre-prints.

Data extraction

Trial ID, registry, location, population, intervention, control, study design, recruitment target, actual recruitment, outcomes, data sharing statement, and time of data sharing were extracted.

Data synthesis

Of 178 registered trials, 112 (62.92%) were in hospital settings, median planned recruitment was 100 participants (IQR: 60, 168), and the majority (n = 166, 93.26%) did not report results in their respective registries. Of 35 published trials, 31 (88.57%) were in hospital settings, median actual recruitment was 86 participants (IQR: 55.5, 218), 10 (28.57%) did not reach recruitment targets, and 27 trials (77.14%) reported plans to share data.

Conclusions

The findings of our study highlight limitations in the design and reporting practices of COVID-19 RCTs and provide guidance towards more efficient reporting of trial results, greater diversity in patient settings, and more robust data sharing.

Developments in medical education in response to the COVID-19 pandemic: A rapid BEME systematic review: BEME Guide No. 63

BACKGROUND

The novel coronavirus disease (COVID-19) was declared a pandemic in March 2020. This rapid systematic review synthesised published reports of medical educational developments in response to the pandemic, considering descriptions of interventions, evaluation data and lessons learned.

METHODS

The authors systematically searched four online databases and hand searched MedEdPublish up to 24 May 2020. Two authors independently screened titles, abstracts and full texts, performed data extraction and assessed risk of bias for included articles. Discrepancies were resolved by a third author. A descriptive synthesis and outcomes were reported.

RESULTS

Forty-nine articles were included. The majority were from North America, Asia and Europe. Sixteen studies described Kirkpatrick's outcomes, with one study describing levels 1-3. A few papers were of exceptional quality, though the risk of bias framework generally revealed capricious reporting of underpinning theory, resources, setting, educational methods, and content. Key developments were pivoting educational delivery from classroom-based learning to virtual spaces, replacing clinical placement based learning with alternate approaches, and supporting direct patient contact with mitigated risk. Training for treating patients with COVID-19, service reconfiguration, assessment, well-being, faculty development, and admissions were all addressed, with the latter categories receiving the least attention.

CONCLUSIONS

This review highlights several areas of educational response in the immediate aftermath of the COVID-19 pandemic and identifies a few articles of exceptional quality that can serve as models for future developments and educational reporting. There was often a lack of practical detail to support the educational community in enactment of novel interventions, as well as limited evaluation data. However, the range of options deployed offers much guidance for the medical education community moving forward and there was an indication that outcome data and greater detail will be reported in the future.

Disaster Ergonomics: Human Factors in COVID-19 Pandemic Emergency Management

OBJECTIVE

We aimed to identify opportunities for application of human factors knowledge base to mitigate disaster management (DM) challenges associated with the unique characteristics of the COVID-19 pandemic.

BACKGROUND

The role of DM is to minimize and prevent further spread of the contagion over an extended period of time. This requires addressing large-scale logistics, coordination, and specialized training needs. However, DM-related challenges during the pandemic response and recovery are significantly different than with other kinds of disasters.

METHOD

An expert review was conducted to document issues relevant to human factors and ergonomics (HFE) in DM.

RESULTS

The response to the COVID-19 crisis has presented complex and unique challenges to DM and public health practitioners. Compared to other disasters and previous pandemics, the COVID-19 outbreak has had an unprecedented scale, magnitude, and propagation rate. The high technical complexity of response and DM coupled with lack of mental model and expertise to respond to such a unique disaster has seriously challenged the response work systems. Recent research has investigated the role of HFE in modeling DM systems' characteristics to improve resilience, accelerating emergency management expertise, developing agile training methods to facilitate dynamically changing response, improving communication and coordination among system elements, mitigating occupational hazards including guidelines for the design of personal protective equipment, and improving procedures to enhance efficiency and effectiveness of response efforts.

CONCLUSION

This short review highlights the potential for the field's contribution to proactive and resilient DM for the ongoing and future pandemics.

Comparison of Repeated Video Display vs Combined Video Display and Live Demonstration as Training Methods to Healthcare Providers for Donning and Doffing Personal Protective Equipment: A Randomized Controlled Trial

Purpose

The lack of training in personal protective equipment (PPE) donning and doffing is hindering the current fight against the COVID-19 worldwide. In order to enable medical staff to learn how to don and doff PPE faster and more effectively, we compared two training methods of PPE donning and doffing.

Methods

Participants in this study were 48 health care workers randomly divided into two groups. Group A watched a 10-minute demonstration (demo) video four times, while Group B watched the same 10-minute demo video twice and then watched a 10-minute live demo twice. The 40-minute learning time was the same for both groups. A 29-step examination was held after the training was completed. The examination scores of Groups A and B were recorded according to a checklist containing PPE donning and doffing steps . The time spent by the participants on PPE donning and doffing, their satisfaction with the training, and their confidence in donning and doffing PPE accurately were analyzed.

Results

The average score of Group B was higher than that Group A, with a mean (SD) of 94.92 (1.72) vs 86.63 (6.34), respectively (P<0.001). The average time spent by Group B was shorter than that spent by Group A, with a mean (SD) of 17.67 (1.01) vs 21.75 (1.82), respectively (P<0.001). The satisfaction and confidence of Group B were higher than those of Group A (P<0.001).

Conclusion

Compared with repeated video display, combined video display and live demonstration are more suitable training methods for donning and doffing PPE.

Factors associated with access and use of PPE during COVID-19: A cross-sectional study of Italian physicians

Objectives

During the course of the Novel Coronavirus (SARS-CoV-2) pandemic, Italy has reported one of the highest number of infections. Nearly ten percent of reported coronavirus infections in Italy occurred in healthcare workers. This study aimed to understand physicians’ access to personal protective equipment (PPE) and to information about their use, risk perception and strategies adopted to prevent contracting the infection.

Methods

We undertook a cross-sectional, online self-reported survey implemented between March 31 and April 5 2020 of Italian physicians.

Results

Responses were received from 516 physicians, only 13% of which reported to have access to PPE every time they need them. Approximately half of the physicians reported that the information received about the use of PPE was either clear (47%) or complete (54%). Risk perception about contracting the infection was influenced by receiving adequate information on the use of PPE. Access to adequate information on the use of PPE was associated with better ability to perform donning and doffing procedures [OR = 2.2 95% C.I. 1.7–2.8] and reduced perception of risk [OR = 0.5, 95% C.I. 0.4–0.6].

Conclusions

Results from this rapid survey indicate that while ramping up supplies on PPE for healthcare workers is certainly of mandatory importance, adequate training and clear instructions are just as important.

Response of an Obstetric Unit during the Coronavirus Disease of 2019 (COVID-19) Pandemic: Experiences from a Tertiary Care Center

Objective  To describe our experiences in preparing our obstetric unit in Westchester County, New York, during the COVID-19 (coronavirus disease of 2019) pandemic. We focus on describing our timeline, continuously evolving actions, observations, and challenges. Methods  With guidance from the New York State Department of Health (NYSDOH), our institutional epidemiologist, and key multidisciplinary faculty members, we evaluated emerging national data as well as expert opinions to identify issues and challenges to create action plans. Results  We created and modified policies for our patients presenting for obstetrical care on the labor and delivery unit to accommodate their unique needs during this pandemic. Conclusion  The COVID-19 pandemic has posed many unique challenges. Balancing communication, risks of infection to providers, patient autonomy and rights, and resources for testing and personal protective equipment were among the valuable lessons learnt. We have shared our experiences and described our observations and challenges in Westchester County, New York.

Hospital preparedness for mass critical care during SARS-CoV-2 pandemic

Mass critical care caused by the severe acute respiratory syndrome corona virus 2 pandemic poses an extreme challenge to hospitals. The primary goal of hospital disaster preparedness and response is to maintain conventional or contingency care for as long as possible. Crisis care must be delayed as long as possible by appropriate measures. Increasing the intensive care unit (ICU) capacities is essential. In order to adjust surge capacity, the reduction of planned, elective patient care is an adequate response. However, this involves numerous problems that must be solved with a sense of proportion. This paper summarises preparedness and response measures recommended to acute care hospitals.