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Soegiarto G, Purnomosari D, Wulandari L, Mahdi BA, Fahmita KD, Hadmoko ST, Gautama HI, Prasetyo ME, Prasetyaningtyas D, Negoro PP, Arafah N, Sigit Prakoeswa CR, Endaryanto A, Agung Suprabawati DG, Tinduh D, Rachmad EB, Triyono EA, Wahyuhadi J, Keswardiono CB, Wardani FE, Mayorita F, Kristiani N, Baskoro A, Fetarayani D, Nurani WK, Oceandy D. Incidence of SARS-CoV-2 infection in hospital workers before and after vaccination programme in East Java, Indonesia-A retrospective cohort study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 10:100130. [PMID: 36531927 PMCID: PMC9742226 DOI: 10.1016/j.lansea.2022.100130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/11/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
Background The incidence of the Coronavirus Disease 2019 (COVID-19) among healthcare workers (HCWs) is widespread. It is important to understand COVID-19 characteristics among HCWs before and after vaccination. We evaluated the incidence of COVID-19 among HCWs in East Java, Indonesia comparing the characteristics of the disease between the pre- vs post-vaccination periods. Methods A retrospective observational study was conducted among HCWs in two major hospitals in East Java, Indonesia, between April 01, 2020, and Oct 31, 2021. All HCWs were offered vaccination with inactivated viral vaccine (CoronaVac) from Jan 15, 2021. Therefore, we divided the time of the study into the pre-vaccination period (between April 01, 2020, and Jan 14, 2021) and post-vaccination period (between Jan 15 and Oct 31, 2021). We then compared the pattern of COVID-19 infections, and hospitalisations between these periods. Findings A total of 434 (15.1%) and 649 (22.6%) SARS-CoV-2 infections were reported among study participants (n = 2878) during the pre-vaccination and post-vaccination periods, respectively. The vaccine effectiveness was 73.3% during the first 3-4 months after vaccination but this decreased to 17.6% at 6-7 months after vaccination, which coincided with the emergence of the delta variant. The overall hospitalisation rate was reduced from 23.5% in the pre-vaccination period to 14.3% in the post-vaccination period. Hypertension appeared to be the strongest risk factor affecting hospitalisation in the pre-vaccination period. However, the risk due to hypertension was reduced in the post-vaccination period. Interpretation The risk to contract COVID-19 remains high among HCWs in East Java, Indonesia. Vaccination is important to reduce infection and hospitalisation. It is essentially important to evaluate the characteristics of COVID-19 infection, hospitalisation, the impact of co-morbidities and vaccine effectiveness in order to improve the measures applied in protecting HCWs during the pandemic. Funding Mandate Research Grant No:1043/UN3.15/PT/2021, Universitas Airlangga, Indonesia.
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Affiliation(s)
- Gatot Soegiarto
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia,Corresponding author. Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga and Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, Jl. Mayjen. Prof. Dr. Moestopo no. 6-8, Surabaya, 60286, East Java, Indonesia
| | - Dewajani Purnomosari
- Department of Histology and Cell Biology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Laksmi Wulandari
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Bagus Aulia Mahdi
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Karin Dhia Fahmita
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Satrio Tri Hadmoko
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Hendra Ikhwan Gautama
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Muhammad Edwin Prasetyo
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Dewi Prasetyaningtyas
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Pujo Prawiro Negoro
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Nur Arafah
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Cita Rosita Sigit Prakoeswa
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Anang Endaryanto
- Department of Child Health, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Desak Gede Agung Suprabawati
- Division of Oncology, Department of Surgery, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Damayanti Tinduh
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Eka Basuki Rachmad
- Medical Service Bureau, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Erwin Astha Triyono
- Division of Tropical Disease and Infection, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Joni Wahyuhadi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | | | | | - Fitriyah Mayorita
- Syarifah Ambami Rato Ebu Hospital, Bangkalan, Madura, East Java, Indonesia
| | - Nunuk Kristiani
- Syarifah Ambami Rato Ebu Hospital, Bangkalan, Madura, East Java, Indonesia
| | - Ari Baskoro
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Deasy Fetarayani
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Wita Kartika Nurani
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Delvac Oceandy
- Division of Cardiovascular Sciences Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom,Department of Biomedical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia,Corresponding author. Division of Cardiovascular Sciences Faculty of Biology Medicine and Health, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
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Jefferson T, Dooley L, Ferroni E, Al-Ansary LA, van Driel ML, Bawazeer GA, Jones MA, Hoffmann TC, Clark J, Beller EM, Glasziou PP, Conly JM. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev 2023; 1:CD006207. [PMID: 36715243 PMCID: PMC9885521 DOI: 10.1002/14651858.cd006207.pub6] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Viral epidemics or pandemics of acute respiratory infections (ARIs) pose a global threat. Examples are influenza (H1N1) caused by the H1N1pdm09 virus in 2009, severe acute respiratory syndrome (SARS) in 2003, and coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 in 2019. Antiviral drugs and vaccines may be insufficient to prevent their spread. This is an update of a Cochrane Review last published in 2020. We include results from studies from the current COVID-19 pandemic. OBJECTIVES To assess the effectiveness of physical interventions to interrupt or reduce the spread of acute respiratory viruses. SEARCH METHODS We searched CENTRAL, PubMed, Embase, CINAHL, and two trials registers in October 2022, with backwards and forwards citation analysis on the new studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs investigating physical interventions (screening at entry ports, isolation, quarantine, physical distancing, personal protection, hand hygiene, face masks, glasses, and gargling) to prevent respiratory virus transmission. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. MAIN RESULTS We included 11 new RCTs and cluster-RCTs (610,872 participants) in this update, bringing the total number of RCTs to 78. Six of the new trials were conducted during the COVID-19 pandemic; two from Mexico, and one each from Denmark, Bangladesh, England, and Norway. We identified four ongoing studies, of which one is completed, but unreported, evaluating masks concurrent with the COVID-19 pandemic. Many studies were conducted during non-epidemic influenza periods. Several were conducted during the 2009 H1N1 influenza pandemic, and others in epidemic influenza seasons up to 2016. Therefore, many studies were conducted in the context of lower respiratory viral circulation and transmission compared to COVID-19. The included studies were conducted in heterogeneous settings, ranging from suburban schools to hospital wards in high-income countries; crowded inner city settings in low-income countries; and an immigrant neighbourhood in a high-income country. Adherence with interventions was low in many studies. The risk of bias for the RCTs and cluster-RCTs was mostly high or unclear. Medical/surgical masks compared to no masks We included 12 trials (10 cluster-RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness (two trials with healthcare workers and 10 in the community). Wearing masks in the community probably makes little or no difference to the outcome of influenza-like illness (ILI)/COVID-19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants; moderate-certainty evidence. Wearing masks in the community probably makes little or no difference to the outcome of laboratory-confirmed influenza/SARS-CoV-2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate-certainty evidence). Harms were rarely measured and poorly reported (very low-certainty evidence). N95/P2 respirators compared to medical/surgical masks We pooled trials comparing N95/P2 respirators with medical/surgical masks (four in healthcare settings and one in a household setting). We are very uncertain on the effects of N95/P2 respirators compared with medical/surgical masks on the outcome of clinical respiratory illness (RR 0.70, 95% CI 0.45 to 1.10; 3 trials, 7779 participants; very low-certainty evidence). N95/P2 respirators compared with medical/surgical masks may be effective for ILI (RR 0.82, 95% CI 0.66 to 1.03; 5 trials, 8407 participants; low-certainty evidence). Evidence is limited by imprecision and heterogeneity for these subjective outcomes. The use of a N95/P2 respirators compared to medical/surgical masks probably makes little or no difference for the objective and more precise outcome of laboratory-confirmed influenza infection (RR 1.10, 95% CI 0.90 to 1.34; 5 trials, 8407 participants; moderate-certainty evidence). Restricting pooling to healthcare workers made no difference to the overall findings. Harms were poorly measured and reported, but discomfort wearing medical/surgical masks or N95/P2 respirators was mentioned in several studies (very low-certainty evidence). One previously reported ongoing RCT has now been published and observed that medical/surgical masks were non-inferior to N95 respirators in a large study of 1009 healthcare workers in four countries providing direct care to COVID-19 patients. Hand hygiene compared to control Nineteen trials compared hand hygiene interventions with controls with sufficient data to include in meta-analyses. Settings included schools, childcare centres and homes. Comparing hand hygiene interventions with controls (i.e. no intervention), there was a 14% relative reduction in the number of people with ARIs in the hand hygiene group (RR 0.86, 95% CI 0.81 to 0.90; 9 trials, 52,105 participants; moderate-certainty evidence), suggesting a probable benefit. In absolute terms this benefit would result in a reduction from 380 events per 1000 people to 327 per 1000 people (95% CI 308 to 342). When considering the more strictly defined outcomes of ILI and laboratory-confirmed influenza, the estimates of effect for ILI (RR 0.94, 95% CI 0.81 to 1.09; 11 trials, 34,503 participants; low-certainty evidence), and laboratory-confirmed influenza (RR 0.91, 95% CI 0.63 to 1.30; 8 trials, 8332 participants; low-certainty evidence), suggest the intervention made little or no difference. We pooled 19 trials (71, 210 participants) for the composite outcome of ARI or ILI or influenza, with each study only contributing once and the most comprehensive outcome reported. Pooled data showed that hand hygiene may be beneficial with an 11% relative reduction of respiratory illness (RR 0.89, 95% CI 0.83 to 0.94; low-certainty evidence), but with high heterogeneity. In absolute terms this benefit would result in a reduction from 200 events per 1000 people to 178 per 1000 people (95% CI 166 to 188). Few trials measured and reported harms (very low-certainty evidence). We found no RCTs on gowns and gloves, face shields, or screening at entry ports. AUTHORS' CONCLUSIONS The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions. There were additional RCTs during the pandemic related to physical interventions but a relative paucity given the importance of the question of masking and its relative effectiveness and the concomitant measures of mask adherence which would be highly relevant to the measurement of effectiveness, especially in the elderly and in young children. There is uncertainty about the effects of face masks. The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of RCTs did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness, and although this effect was also present when ILI and laboratory-confirmed influenza were analysed separately, it was not found to be a significant difference for the latter two outcomes. Harms associated with physical interventions were under-investigated. There is a need for large, well-designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, as well as the impact of adherence on effectiveness, especially in those most at risk of ARIs.
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Affiliation(s)
- Tom Jefferson
- Department for Continuing Education, University of Oxford, Oxford OX1 2JA, UK
| | - Liz Dooley
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Eliana Ferroni
- Epidemiological System of the Veneto Region, Regional Center for Epidemiology, Veneto Region, Padova, Italy
| | - Lubna A Al-Ansary
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mieke L van Driel
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Ghada A Bawazeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mark A Jones
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Elaine M Beller
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Paul P Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - John M Conly
- Cumming School of Medicine, University of Calgary, Room AGW5, SSB, Foothills Medical Centre, Calgary, Canada
- O'Brien Institute for Public Health and Synder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Zone, Alberta Health Services, Calgary, Canada
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Ismael ST, Manoharan G, George A, Al-Kaisi K, Abas S, Al-Musabi M, Prasad Rao S, Singh R, Kiely N. UK CoPACK Study: knowledge and confidence of healthcare workers in using personal protective equipment and related anxiety levels during the COVID-19 pandemic. Clin Med (Lond) 2023; 23:24-30. [PMID: 36697010 PMCID: PMC11046536 DOI: 10.7861/clinmed.2021-0642] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Healthcare workers (HCWs) are at increased risk of coronavirus 2019 (COVID-19) infection. Personal protective equipment (PPE) and infection control guidelines help limit transmission. However, poor confidence leads to higher levels of anxiety rates and infection. We assessed knowledge and confidence in PPE among HCWs and associated anxiety. METHODS A cross-sectional, multi-centre survey using a validated questionnaire assessing actual and self-perceived knowledge on PPE was distributed among HCWs across the UK. Confidence in PPE and levels of anxiety were assessed using the General Anxiety Disorder-7 (GAD-7) tool. RESULTS In total, 1,055 responses were received; 99% had familiarity with PPE guidance; however, only 15% correctly answered questions on PPE guidance; 86% and 80% had received mask-fitting and donning-doffing training, respectively; 33% indicated poor/very poor hospital communication. Confidence and anxiety were related to: profession; comorbidities; self-perceived knowledge; and PPE training and communication. CONCLUSION Confidence in PPE was poor and anxiety was related to inadequate information and training. Thus, improved communication is required for effective response to subsequent COVID-19 waves and similar pandemics.
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Affiliation(s)
- Salam T Ismael
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | | | | | | | | | | | | | - Rohit Singh
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Oswestry, UK
| | - Nigel Kiely
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Oswestry, UK
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Abed Alah MTT, Abdeen S, Selim N, Tayar E, Bougmiza I. Occupational Prevention of COVID-19 Among Healthcare Workers in Primary Healthcare Settings: Compliance and Perceived Effectiveness of Personal Protective Equipment. J Patient Saf 2022; 18:747-755. [PMID: 36458999 PMCID: PMC9696679 DOI: 10.1097/pts.0000000000001004] [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] [Indexed: 12/14/2022]
Abstract
OBJECTIVES It is crucial for healthcare workers (HCWs) to comply with infection prevention and control precautions such as the appropriate use of personal protective equipment (PPE) for their safety and the safety of patients. In this study, we aimed to assess HCWs' compliance with the appropriate use of PPE in primary healthcare settings in Qatar along with its associated factors and explore their perceived effectiveness of different PPE items in protecting against COVID-19 infection. METHODS A Web-based survey was conducted between November 2020 and January 2021 targeting all clinical HCWs under the umbrella of Primary Health Care Corporation. RESULTS A total of 757 HCWs completed the survey, and most were between 30 and 39 years of age (50.2%), females (62.7%), and nurses (35.3%). Eighty eight percent of participants believed that PPE could provide high or very high protection against COVID-19. About one-half (53%) were found to be fully compliant with PPE use during patient interactions with suspected or confirmed COVID-19 cases, whereas three-quarters (76.3%) were fully compliant while performing aerosol-generating procedures. Healthcare workers' age, nationality, health center region, area of work, clinical experience, frequency of interaction with suspected or confirmed COVID-19 cases, and the perceived effectiveness of PPE were significant predictors of full compliance with PPE. Shortage of PPE was the commonest reported barrier to appropriate use. CONCLUSIONS Despite HCWs' high perceived effectiveness for PPE in protecting against COVID-19 infection, their full compliance rate with using PPE was moderate and needs further improvement.
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Affiliation(s)
| | - Sami Abdeen
- From the Community Medicine Department, Hamad Medical Corporation (HMC)
| | - Nagah Selim
- Department of Family and Community Medicine, Primary Health Care Corporation, Doha, Qatar
- Public Health and Preventive Medicine, Cairo University, Cairo, Egypt
| | - Elias Tayar
- From the Community Medicine Department, Hamad Medical Corporation (HMC)
| | - Iheb Bougmiza
- Community Medicine Department, Primary Health Care Corporation (PHCC), Doha, Qatar
- Community Medicine Department, College of Medicine, Sousse University, Sousse, Tunisia
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The Effect of Face Mask, Air Temperature, and Humidity on COVID-19 Transmission: A Systematic Review and Meta-analysis. HEALTH SCOPE 2022. [DOI: 10.5812/jhealthscope-129121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Context: At the beginning of the COVID-19 pandemic, the effects of personal protective equipment (PPE) such as face masks, as well as environmental conditions, including temperature and humidity changes, were discussed due to the lack of effective medicine. Methods: The preferred reporting items for systematic reviews and meta-analysis (PRISMA) were implemented to conduct the present systematic review. The articles were selected from papers published by May 2020 in PubMed, Web of Science, Science Direct, Scopus, and Google Scholar databases. This meta-analysis estimated relative risk (RR) and pooled mean depicted as effect size (ES) using the random or fixed effects methods. Results: Ten studies met inclusion criteria, four of which addressed the effect of face masks and six of which dealt with temperature and humidity changes. This eta-analysis study showed that wearing face masks against the COVID-19 virus had a remarkable safety impact with RR (%95 CI) 8.56 (2.10 - 34.90), (I2 = %0.0 P = 0.999), and the pooled mean changes in temperature and humidity were estimated to be with ES (%95 CI) 9.03 (4.32 - 13.74), (I2 = %99.7, P = 0.0001) and with ES (%95 CI) 56.82 (46.12 - 67.51), ( I2 = %99.3, P = 0.0001) during the outbreak of the COVID-19. Conclusions: The findings of this systematic review and meta-analysis illustrate the effectiveness of face masks, in general, in preventing the transmission of the COVID-19 virus. According to the findings, temperature and humidity changes do not increase the outbreak of the COVID-19 virus.
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Abed Alah M, Abdeen S, Selim N, Hamdani D, Radwan E, Sharaf N, Al-katheeri H, Bougmiza I. Knowledge and Perceived Effectiveness of Infection Prevention and Control Measures Among Health Care Workers During the COVID-19 Pandemic: A National Survey. J Nurs Care Qual 2022; 37:E23-E30. [PMID: 34935733 PMCID: PMC8860130 DOI: 10.1097/ncq.0000000000000615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Being the first line of defense against COVID-19 infection, health care workers (HCWs) are at an increased risk of getting infected. Infection prevention and control (IPC) measures were deemed to be instrumental in protecting them and their patients against infection. PURPOSE To assess HCWs' knowledge of IPC measures and their perceived effectiveness in protecting against COVID-19. METHODS A national web-based survey was conducted in different health care sectors in Qatar. RESULTS A total of 1757 HCWs completed the survey. HCWs believed in applying stricter IPC precautions while dealing with confirmed COVID-19 cases than with suspected cases. Males and physicians were more likely to have high perceived effectiveness of IPC measures than females, nurses, and pharmacists. Higher proportions of HCWs believed in the effectiveness of hand hygiene than most types of personal protective equipment. CONCLUSION Further research is recommended to assess the impact of HCWs' knowledge and perceived effectiveness of IPC measures on their compliance.
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Affiliation(s)
- Muna Abed Alah
- Community Medicine Department, Hamad Medical Corporation (HMC), Doha, Qatar (Drs Abed Alah and Abdeen); Public Health and Preventive Medicine, Cairo University, Egypt (Dr Selim); Department of Family and Community Medicine (Dr Selim) and Community Medicine Department (Dr Bougmiza), Primary Health Care Corporation (PHCC), Doha, Qatar; Health Care Quality Management and Patient Safety Department (Ms Hamdani and Drs Radwan and Sharaf) and Strategic Planning and Performance Department (Ms Al-katheeri), Ministry of Public Health (MOPH), Doha, Qatar; and Community Medicine Department, College of Medicine, Sousse University, Tunisia (Dr Bougmiza)
| | - Sami Abdeen
- Community Medicine Department, Hamad Medical Corporation (HMC), Doha, Qatar (Drs Abed Alah and Abdeen); Public Health and Preventive Medicine, Cairo University, Egypt (Dr Selim); Department of Family and Community Medicine (Dr Selim) and Community Medicine Department (Dr Bougmiza), Primary Health Care Corporation (PHCC), Doha, Qatar; Health Care Quality Management and Patient Safety Department (Ms Hamdani and Drs Radwan and Sharaf) and Strategic Planning and Performance Department (Ms Al-katheeri), Ministry of Public Health (MOPH), Doha, Qatar; and Community Medicine Department, College of Medicine, Sousse University, Tunisia (Dr Bougmiza)
| | - Nagah Selim
- Community Medicine Department, Hamad Medical Corporation (HMC), Doha, Qatar (Drs Abed Alah and Abdeen); Public Health and Preventive Medicine, Cairo University, Egypt (Dr Selim); Department of Family and Community Medicine (Dr Selim) and Community Medicine Department (Dr Bougmiza), Primary Health Care Corporation (PHCC), Doha, Qatar; Health Care Quality Management and Patient Safety Department (Ms Hamdani and Drs Radwan and Sharaf) and Strategic Planning and Performance Department (Ms Al-katheeri), Ministry of Public Health (MOPH), Doha, Qatar; and Community Medicine Department, College of Medicine, Sousse University, Tunisia (Dr Bougmiza)
| | - Dhouha Hamdani
- Community Medicine Department, Hamad Medical Corporation (HMC), Doha, Qatar (Drs Abed Alah and Abdeen); Public Health and Preventive Medicine, Cairo University, Egypt (Dr Selim); Department of Family and Community Medicine (Dr Selim) and Community Medicine Department (Dr Bougmiza), Primary Health Care Corporation (PHCC), Doha, Qatar; Health Care Quality Management and Patient Safety Department (Ms Hamdani and Drs Radwan and Sharaf) and Strategic Planning and Performance Department (Ms Al-katheeri), Ministry of Public Health (MOPH), Doha, Qatar; and Community Medicine Department, College of Medicine, Sousse University, Tunisia (Dr Bougmiza)
| | - Eman Radwan
- Community Medicine Department, Hamad Medical Corporation (HMC), Doha, Qatar (Drs Abed Alah and Abdeen); Public Health and Preventive Medicine, Cairo University, Egypt (Dr Selim); Department of Family and Community Medicine (Dr Selim) and Community Medicine Department (Dr Bougmiza), Primary Health Care Corporation (PHCC), Doha, Qatar; Health Care Quality Management and Patient Safety Department (Ms Hamdani and Drs Radwan and Sharaf) and Strategic Planning and Performance Department (Ms Al-katheeri), Ministry of Public Health (MOPH), Doha, Qatar; and Community Medicine Department, College of Medicine, Sousse University, Tunisia (Dr Bougmiza)
| | - Nahla Sharaf
- Community Medicine Department, Hamad Medical Corporation (HMC), Doha, Qatar (Drs Abed Alah and Abdeen); Public Health and Preventive Medicine, Cairo University, Egypt (Dr Selim); Department of Family and Community Medicine (Dr Selim) and Community Medicine Department (Dr Bougmiza), Primary Health Care Corporation (PHCC), Doha, Qatar; Health Care Quality Management and Patient Safety Department (Ms Hamdani and Drs Radwan and Sharaf) and Strategic Planning and Performance Department (Ms Al-katheeri), Ministry of Public Health (MOPH), Doha, Qatar; and Community Medicine Department, College of Medicine, Sousse University, Tunisia (Dr Bougmiza)
| | - Huda Al-katheeri
- Community Medicine Department, Hamad Medical Corporation (HMC), Doha, Qatar (Drs Abed Alah and Abdeen); Public Health and Preventive Medicine, Cairo University, Egypt (Dr Selim); Department of Family and Community Medicine (Dr Selim) and Community Medicine Department (Dr Bougmiza), Primary Health Care Corporation (PHCC), Doha, Qatar; Health Care Quality Management and Patient Safety Department (Ms Hamdani and Drs Radwan and Sharaf) and Strategic Planning and Performance Department (Ms Al-katheeri), Ministry of Public Health (MOPH), Doha, Qatar; and Community Medicine Department, College of Medicine, Sousse University, Tunisia (Dr Bougmiza)
| | - Iheb Bougmiza
- Community Medicine Department, Hamad Medical Corporation (HMC), Doha, Qatar (Drs Abed Alah and Abdeen); Public Health and Preventive Medicine, Cairo University, Egypt (Dr Selim); Department of Family and Community Medicine (Dr Selim) and Community Medicine Department (Dr Bougmiza), Primary Health Care Corporation (PHCC), Doha, Qatar; Health Care Quality Management and Patient Safety Department (Ms Hamdani and Drs Radwan and Sharaf) and Strategic Planning and Performance Department (Ms Al-katheeri), Ministry of Public Health (MOPH), Doha, Qatar; and Community Medicine Department, College of Medicine, Sousse University, Tunisia (Dr Bougmiza)
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Malmgren Fänge A, Christensen J, Backhouse T, Kenkmann A, Killett A, Fisher O, Chiatti C, Lethin C. Care Home and Home Care Staff’s Learning during the COVID-19 Pandemic and Beliefs about Subsequent Changes in the Future: A Survey Study in Sweden, Italy, Germany and the United Kingdom. Healthcare (Basel) 2022; 10:healthcare10020306. [PMID: 35206920 PMCID: PMC8872186 DOI: 10.3390/healthcare10020306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023] Open
Abstract
The aim of this study was to compare perceptions of learning from the COVID-19 pandemic and beliefs in subsequent changes for the future, among care home and home care staff, in four European countries. A 29-item on-line questionnaire was designed in English and later translated into Swedish, Italian, and German on the impact of the pandemic on stress and anxiety. Anonymous data from care staff respondents was collected in four countries between 7 October 2020 and 17 December 2010: Sweden (n = 212), Italy (n = 103), Germany (n = 120), and the United Kingdom (n = 167). While care staff in all countries reported learning in multiple areas of care practice, Italy reported the highest levels of learning and the most agreement that changes will occur in the future due to the pandemic. Conversely, care staff in Germany reported low levels of learning and reported the least agreement for change in the future. While the pandemic has strained care home and home care staff practices, our study indicates that much learning of new skills and knowledge has taken place within the workforce. Our study has demonstrated the potential of cross-border collaborations and experiences for enhancing knowledge acquisition in relation to societal challenges and needs. The results could be built upon to improve future health care and care service practices.
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Affiliation(s)
- Agneta Malmgren Fänge
- Department of Health Sciences, Lund University, 221 00 Lund, Sweden; (A.M.F.); (C.L.)
| | - Jonas Christensen
- Department of Social Work, Faculty of Health and Society, Malmö University, 205 06 Malmö, Sweden
- Correspondence:
| | - Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (T.B.); (A.K.)
| | - Andrea Kenkmann
- Center for Aging, Catholic University of Applied Sciences Munich, 836 71 Benediktbeuern, Germany;
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (T.B.); (A.K.)
| | - Oliver Fisher
- Department of Economics and Social Sciences, Università Politecnica delle Marche, 60121 Ancona, Italy;
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA—National Institute of Health and Science on Ageing, 60124 Ancona, Italy
| | | | - Connie Lethin
- Department of Health Sciences, Lund University, 221 00 Lund, Sweden; (A.M.F.); (C.L.)
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Burger R, Christian C, English R, Maughan-Brown B, Rossouw L. Predictors of mask-wearing during the advent of the COVID-19 pandemic: Evidence from South Africa. Transl Behav Med 2021; 12:6448738. [PMID: 34865174 PMCID: PMC8690224 DOI: 10.1093/tbm/ibab132] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background In the absence of a vaccine, the global spread of COVID-19 during 2020 has necessitated non-pharmaceutical interventions to curb the rise of cases. Purpose The article uses the health belief model and a novel rapid mobile survey to examine correlates of reported mask-wearing as a non-pharmaceutical intervention in South Africa between May and August 2020. Methods Two-way tabulations and multivariable analysis via logistic regression modeling describe correlations between reported mask-wearing and factors of interest among a sample of 7074 adults in a two-period national longitudinal survey, the National Income Dynamics Study-Coronavirus Rapid Mobile Survey (NIDS-CRAM). Results In line with the health belief model, results showed that self-efficacy, the prevalence of others’ mask-wearing in the same district, and affluence were positively associated with reported mask-wearing. Those who reported staying at home were significantly less likely to report wearing a mask. There was little evidence that the expected severity of the disease if contracted, affects these decisions. Hypertension, obesity, or being overweight (measured three years earlier) did not have a significant association with mask-wearing. The prevalence of mask-wearing increased significantly from May to August 2020 as COVID-19 cases increased and lockdown restrictions were eased. Contrary to the health belief model, we found that despite having a higher mortality risk, the elderly had significantly lower odds of mask-wearing. Conclusion In South Africa, the mask-wearing adherence has increased rapidly. It is concerning that the elderly had lower odds of mask-wearing. This should be examined further in future research.
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Affiliation(s)
- Ronelle Burger
- Economics Department, Stellenbosch University, Stellenbosch, South Africa
| | - Carmen Christian
- Economics Department, University of the Western Cape, Cape Town, South Africa
| | - Rene English
- Division of Health Systems and Public Health, Global Health Department, Stellenbosch University, Tygerberg campus, Cape Town, South Africa
| | - Brendan Maughan-Brown
- The Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town, South Africa
| | - Laura Rossouw
- School of Economics and Finance, University of the Witwatersrand, Johannesburg, South Africa
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Badran EF, Jarrah S, Masadeh R, Al Hammad A, Al Shimi R, Salhout S, Al Wahabi N, Al Jaberi M, Rayyan A, Madi T, Hassan S. Assessment of Perceived Compliance and Barriers to Personal Protective Equipment Use Among Healthcare Workers During the COVID-19 Pandemic's Second Wave Surge: "Walk to Talk" Cross-Sectional Correlational Study. Disaster Med Public Health Prep 2021; 17:e45. [PMID: 34496993 PMCID: PMC8545841 DOI: 10.1017/dmp.2021.289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study aimed at investigating HCWs' perceptions of PPE compliance and barriers, as well as influencing factors, in order to develop methods to combat the rise in their infection rates. METHODS During the 'second wave' surge, a cross-sectional correlational analysis was conducted over a 1-month period. It consists of HCWs from various hospital sectors that admit COVID-19 patients using an online self-administered predesigned tool. RESULTS Out of the 285 recruited participants, 36.1% had previously been diagnosed with COVID-19. Around 71% received training on PPE use. The perceived compliance was good for (PPE) usage (mean 2.60 ± 1.10). A significant higher compliance level was correlated with previous diagnosis with COVID-19, working with patients diagnosed with COVID-19, and having a direct contact with a family member older than 45 years old (P < 0.01). The main perceived barriers to the use of PPEs were unavailability of full PPEs (35%), interference with their ability to provide patient care (29%), not enough time to comply with the rigors of PPEs (23.2%) and working in emergency situations (22.5%). With regards to perceived barriers, those working with patients diagnosed with COVID-19 and those who reported having a direct contact with a family member older than 45 years old showed significantly higher level of barriers. CONCLUSION A series of measures, including prioritization of PPE acquisition, training, and monitoring to guarantee appropriate resources for IPC, are necessary to reduce transmission.
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Affiliation(s)
- Eman F Badran
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan
| | - Samiha Jarrah
- Department of Nursing, School of Nursing, Applied Science Private University, Amman, Jordan
| | - Rami Masadeh
- Department of Community Health, School of Nursing, Applied Science Private University, Amman, Jordan
| | | | - Rana Al Shimi
- School of Medicine, University of Jordan, Amman, Jordan
| | - Samar Salhout
- School of Medicine, University of Jordan, Amman, Jordan
| | | | | | | | - Thaira Madi
- Department of Accreditation, Healthcare Accreditation Council, Amman, Jordan
| | - Samar Hassan
- Department of Accreditation, Healthcare Accreditation Council, Amman, Jordan
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Brooks SK, Greenberg N, Wessely S, Rubin GJ. Factors affecting healthcare workers' compliance with social and behavioural infection control measures during emerging infectious disease outbreaks: rapid evidence review. BMJ Open 2021; 11:e049857. [PMID: 34400459 PMCID: PMC8370838 DOI: 10.1136/bmjopen-2021-049857] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The 2019-2020 outbreak of novel coronavirus has raised concerns about nosocomial transmission. This review's aim was to explore the existing literature on emerging infectious disease outbreaks to identify factors associated with compliance with infection control measures among healthcare staff. METHODS A rapid evidence review for primary studies relevant to healthcare workers' compliance with infection control measures. RESULTS Fifty-six papers were reviewed. Staff working in emergency or intensive care settings or with contact with confirmed cases appeared more likely to comply with recommendations. There was some evidence that anxiety and concern about the risk of infection were more associated with compliance, and that monitoring from superiors could improve compliance. Observed non-compliance of colleagues could hinder compliance. Staff identified many barriers to compliance related to personal protective equipment, including availability, perceived difficulty and effectiveness, inconvenience, discomfort and a negative impact on patient care. There were many issues regarding the communication and ease of understanding of infection control guidance. CONCLUSION We recommend provision of training and education tailored for different occupational roles within the healthcare setting, managerial staff 'leading by example', ensuring adequate resources for infection control and timely provision of practical evidence-based infection control guidelines.
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Affiliation(s)
- Samantha K Brooks
- Department of Psychological Medicine, King's College London, London, UK
| | - N Greenberg
- Department of Psychological Medicine, King's College London, London, UK
| | - Simon Wessely
- Department of Psychological Medicine, King's College London, London, UK
| | - G J Rubin
- Department of Psychological Medicine, King's College London, London, UK
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Abed Alah M, Abdeen S, Selim N, Hamdani D, Radwan E, Sharaf N, Al-Katheeri H, Bougmiza I. Compliance and barriers to the use of infection prevention and control measures among health care workers during COVID-19 pandemic in Qatar: A national survey. J Nurs Manag 2021; 29:2401-2411. [PMID: 34351012 PMCID: PMC8420516 DOI: 10.1111/jonm.13440] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/12/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
AIM To assess health care workers' compliance with infection prevention and control measures in different health care sectors in Qatar during COVID-19 pandemic. BACKGROUND Being the first line of defense against COVID-19 infection, health care workers are particularly at increased risk of getting infected. Compliance with infection prevention and control measures is essential for their safety and the safety of patients. METHODS A web-based national survey was conducted between November 2020 and January 2021 targeting all health care workers in governmental, semi-governmental, and private health care sectors. RESULTS Of 1757 health care workers, 49.9% were between 30-39 years of age, majority (47.5%) were nurses. Participants reported a significant increase in the median self-rated compliance scores during the pandemic compared to before it (p<0.001). During the pandemic, 49.7% of health care workers were fully compliant with personal protective equipment (PPE) use, 83.1% were fully compliant with hand hygiene. Overall, 44.1% were fully compliant with infection prevention and control measures (PPE and hand hygiene). Nationality, health sector, profession, and frequency of interactions with suspected or confirmed COVID-19 cases were significantly associated with compliance with overall infection prevention and control measures. The most reported barriers were work overload, and shortages of PPE and handwashing agents. CONCLUSIONS Compliance of health care workers with infection prevention and control measures needs further improvement. IMPLICATIONS FOR NURSING MANAGEMENT Frequent quality checks, provision of adequate supplies, and behavior change interventions are recommended strategies for hospital and nursing administrators to improve health care workers' compliance.
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Affiliation(s)
- Muna Abed Alah
- Community Medicine Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Sami Abdeen
- Community Medicine Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Nagah Selim
- Department of Family and Community Medicine, Primary Health Care Corporation, Doha, Qatar
| | - Dhouha Hamdani
- Health care Quality Management and Patient Safety Department, Ministry of Public Health (MOPH), Doha, Qatar
| | - Eman Radwan
- Health care Quality Management and Patient Safety Department, Ministry of Public Health (MOPH), Doha, Qatar
| | - Nahla Sharaf
- Health care Quality Management and Patient Safety Department, Ministry of Public Health (MOPH), Doha, Qatar
| | - Huda Al-Katheeri
- Department of Strategic Planning and Performance, Ministry of Public Health (MOPH), Doha, Qatar
| | - Iheb Bougmiza
- Community Medicine Department, Primary Health Care Corporation (PHCC), Doha, Qatar.,Community Medicine Department, College of Medicine, Sousse University, Tunisia
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12
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Garcia GPA, Fracarolli IFL, Santos HECD, Souza VRDS, Cenzi CM, Marziale MHP. Use of personal protective equipment to care for patients with COVID-19: scoping review. ACTA ACUST UNITED AC 2021; 42:e20200150. [PMID: 34037178 DOI: 10.1590/1983-1447.2021.20200150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/09/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To summarize the knowledge about recommendations for the use of personal protective equipment necessary for the provision of care by health professionals to patients suspected or infected by the new coronavirus. METHOD Scoping review with search for primary studies, reviews and preprints articles in English, Portuguese and Spanish, in the last 20 years on the bases WOS/ISI, SCOPUS, MEDLINE/PuBMed, CINAHL, LILACS and SciELO. Unpublished studies in journals were surveyed on bioRxiv and SciELO preprints. RESULTS 23 studies were eligible. Experiences with coronavirus prior to SARS-CoV-2 revealed that the equipment was an essential barrier in preventing transmission and followed the recommendations for standard precautions, contact, droplet and aerosol. In 13 (57%) studies, this equipment complied international recommendations and in 10 (45%) local recommendations. CONCLUSION The personal protective equipment used does not follow global standardization according to type, quality and adequate provision, exposing these professionals to the risk of contamination.
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Affiliation(s)
- Gracielle Pereira Aires Garcia
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Programa de Pós-graduação em Enfermagem Fundamental. Ribeirão Preto, São Paulo, Brasil
| | - Isabela Fernanda Larios Fracarolli
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Programa de Pós-graduação em Enfermagem Fundamental. Ribeirão Preto, São Paulo, Brasil
| | - Heloisa Ehmke Cardoso Dos Santos
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Programa de Pós-graduação em Enfermagem Fundamental. Ribeirão Preto, São Paulo, Brasil
| | | | - Camila Maria Cenzi
- Universidade Federal de Mato Grosso (UFMT), Faculdade de Enfermagem. Cuiabá, Mato Grosso, Brasil
| | - Maria Helena Palucci Marziale
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Programa de Pós-graduação em Enfermagem Fundamental. Ribeirão Preto, São Paulo, Brasil
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Sharma P, Goel N, Dogar K, Bhalla M, Thami GP, Punia K. Adverse skin reactions related to PPE among healthcare workers managing COVID-19. J Eur Acad Dermatol Venereol 2021; 35:e481-e483. [PMID: 33866611 PMCID: PMC8251062 DOI: 10.1111/jdv.17290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- P Sharma
- Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
| | - N Goel
- Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
| | - K Dogar
- Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
| | - M Bhalla
- Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
| | - G P Thami
- Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
| | - K Punia
- Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
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Janah RMM, Martiana T. The Correlation between Perceptions and Compliance in the Use of Personal Protective Equipment of Nurses at RSU Haji Surabaya. THE INDONESIAN JOURNAL OF OCCUPATIONAL SAFETY AND HEALTH 2021. [DOI: 10.20473/ijosh.v10i1.2021.88-96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: According to previous studies, the level of compliance with the use of personal protective equipment of the nurses at RSU Haji Surabaya was still quite low. Only 17.8% of the nurses were compliant in using masks, whereas 82.2% of the nurses were not. Moreover, 57.8% nurses were compliant in using medical gloves, whereas 42.2% were not. The purpose of this study is to analyze the relationship between perception and compliance with the use of personal protective equipment of the nurses at at RSU Haji Surabaya. Methods: This study was an observational and cross-sectional study. The population used in this study was the nurses who served in the operating and lung room of at RSU Haji Surabaya. Total sampling technique was used to 33 samples. Moreover, the data were taken by questionnaires and observations. Data analysis was performed by coefficient contingency test by looking at the value of C. Results: The results show that 85.7% of nurses in the operating room are non-compliant and 33.3% nurses in the lung room are non- compliant with the use of PPE. The results also showthat the perception variable that has the strongest relationship with compliance is perception of severity (C = 0.312). Conclusion: The closest relationship between the two variables are the relationship of compliance of PPE usage with the gender of nurses, and the determination of nurses' perceptions is based on the Health Belief Model approach.Keywords: compliance, nurse, perception, personal protective equipment
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Hetzmann MS, Mojtahedzadeh N, Nienhaus A, Harth V, Mache S. Occupational Health and Safety Measures in German Outpatient Care Services during the COVID-19 Pandemic: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062987. [PMID: 33799465 PMCID: PMC8001336 DOI: 10.3390/ijerph18062987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/04/2021] [Accepted: 03/11/2021] [Indexed: 12/18/2022]
Abstract
Due to the coronavirus disease 2019 (COVID-19) pandemic, outpatient caregivers are exposed to new serious health threats at work. To protect their health, effective occupational health and safety measures (OHSM) are necessary. Outpatient caregivers (n = 15) participated in semi-structured telephone interviews in May/June 2020 (1) to examine the pandemic-related OHSM that have been implemented in their outpatient care services, as well as (2) to identify their corresponding unmet needs. Interviews were recorded, transcribed and analysed by using qualitative content analysis in accordance with Mayring. Available OHSM in outpatient care services described by outpatient caregivers mainly included personal protective equipment (PPE) and surface disinfection means after an initial shortage in the first peak of the pandemic. Further OHSM implied social distancing, increased hygiene regulations and the provision of pandemic-related information by the employer, as well as the possibility to consult a company doctor. Our study revealed that OHSM were largely adapted to the health threats posed by COVID-19, however an optimum has not yet been achieved. There is still a need for improvement in the qualitative and quantitative supply of PPE, as well as on the organisational level, e.g., with regard to the development of pandemic plans or in work organisation.
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Affiliation(s)
- Mara Shirin Hetzmann
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Centre Hamburg-Eppendorf (UKE), Seewartenstr. 10, 20459 Hamburg, Germany; (M.S.H.); (N.M.); (V.H.)
| | - Natascha Mojtahedzadeh
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Centre Hamburg-Eppendorf (UKE), Seewartenstr. 10, 20459 Hamburg, Germany; (M.S.H.); (N.M.); (V.H.)
| | - Albert Nienhaus
- Department of Occupational Medicine, Hazardous Substances and Public Health, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Pappelallee 33/35/37, 22089 Hamburg, Germany;
- Institute for Health Service Research in Dermatology and Nursing (IVDP), Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Centre Hamburg-Eppendorf (UKE), Seewartenstr. 10, 20459 Hamburg, Germany; (M.S.H.); (N.M.); (V.H.)
| | - Stefanie Mache
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Centre Hamburg-Eppendorf (UKE), Seewartenstr. 10, 20459 Hamburg, Germany; (M.S.H.); (N.M.); (V.H.)
- Correspondence: ; Tel.: +49-40-428-37-4313
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Foley LJ, Urdaneta F, Berkow L, Aziz MF, Baker PA, Jagannathan N, Rosenblatt W, Straker TM, Wong DT, Hagberg CA. Difficult Airway Management in Adult COVID-19 Patients: Statement by the Society of Airway Management. Anesth Analg 2021; 133:876-890. [PMID: 33711004 DOI: 10.1213/ane.0000000000005554] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The COVID-19 disease, caused by Coronavirus SARS-CoV-2, often results in severe hypoxemia requiring airway management. Because SARS CoV-2 virus is spread via respiratory droplets, bag-mask ventilation, intubation, and extubation may place health care workers (HCW) at risk. While existing recommendations address airway management in patients with COVID-19, no guidance exists specifically for difficult airway management. Some strategies normally recommended for difficult airway management may not be ideal in the setting of COVID-19 infection. To address this issue the Society for Airway Management (SAM) created a task force to review existing literature and current Practice Guidelines for management of the difficult airway by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. SAM task force created recommendations for management of known or suspected difficult airway in the setting of known or suspected COVID-19 infection. The goal of the task force was to optimize successful airway management while minimizing exposure risk. Each member conducted a literature review on specific clinical practice section utilizing standard search engines (PubMed, Ovid, Google Scholar). Existing recommendations and evidence for difficult airway management in COVID-19 context were developed. Each specific recommendation was discussed among task force members and modified until unanimously approved by all task force members. Elements of AGREE Reporting Checklist for dissemination of clinical practice guidelines were utilized to develop this statement. Airway management in the COVID-19 patient increases HCW exposure risk. and difficult airway management often takes longer, may involve multiple procedures with aerosolization potential, strict adherence to personal protective equipment (PPE) protocols is mandatory to reduce risk to providers. When patient's airway risk assessment suggests awake tracheal intubation is an appropriate choice of technique, procedures that may cause increased aerosolization of secretions should be avoided. Optimal preoxygenation before induction with tight seal facemask may be performed to reduce risk of hypoxemia. Unless the patient is experiencing oxygen desaturation, positive pressure bag-mask ventilation after induction may be avoided to reduce aerosolization. For optimal intubating conditions, patients should be anesthetized with full muscle relaxation. Videolaryngoscopy is recommended as first-line strategy for airway management. If emergent invasive airway access is indicated, we recommend a surgical technique such as scalpel-bougie-tube, rather than an aerosolizing generating procedure, such as transtracheal jet ventilation. This statement represents recommendations by SAM task force for the difficult airway management of adults with COVID-19 with the goal to optimize successful airway management while minimizing the risk of clinician exposure.
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Affiliation(s)
- Lorraine J Foley
- Department of Anesthesiology, Winchester Hospital of Beth Israel Lahey Health, Tufts School of Medicine, Boston, MA, USA
| | - Felipe Urdaneta
- Department of Anesthesiology, University of Florida NFSGVHS, Gainesville FL, USA
| | - Lauren Berkow
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Michael F Aziz
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Paul A Baker
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Narasimhan Jagannathan
- Department of Anesthesiology Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine Chicago, IL
| | - William Rosenblatt
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Tracey M Straker
- Department of Anesthesiology, Montefiore Hospital, Albert Einstein College of Medicine New York, NY, USA
| | - David T Wong
- Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Carin A Hagberg
- Department of Anesthesiology & Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, van Driel ML, Jones MA, Thorning S, Beller EM, Clark J, Hoffmann TC, Glasziou PP, Conly JM. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev 2020; 11:CD006207. [PMID: 33215698 PMCID: PMC8094623 DOI: 10.1002/14651858.cd006207.pub5] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Viral epidemics or pandemics of acute respiratory infections (ARIs) pose a global threat. Examples are influenza (H1N1) caused by the H1N1pdm09 virus in 2009, severe acute respiratory syndrome (SARS) in 2003, and coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 in 2019. Antiviral drugs and vaccines may be insufficient to prevent their spread. This is an update of a Cochrane Review published in 2007, 2009, 2010, and 2011. The evidence summarised in this review does not include results from studies from the current COVID-19 pandemic. OBJECTIVES To assess the effectiveness of physical interventions to interrupt or reduce the spread of acute respiratory viruses. SEARCH METHODS We searched CENTRAL, PubMed, Embase, CINAHL on 1 April 2020. We searched ClinicalTrials.gov, and the WHO ICTRP on 16 March 2020. We conducted a backwards and forwards citation analysis on the newly included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs of trials investigating physical interventions (screening at entry ports, isolation, quarantine, physical distancing, personal protection, hand hygiene, face masks, and gargling) to prevent respiratory virus transmission. In previous versions of this review we also included observational studies. However, for this update, there were sufficient RCTs to address our study aims. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence. Three pairs of review authors independently extracted data using a standard template applied in previous versions of this review, but which was revised to reflect our focus on RCTs and cluster-RCTs for this update. We did not contact trialists for missing data due to the urgency in completing the review. We extracted data on adverse events (harms) associated with the interventions. MAIN RESULTS We included 44 new RCTs and cluster-RCTs in this update, bringing the total number of randomised trials to 67. There were no included studies conducted during the COVID-19 pandemic. Six ongoing studies were identified, of which three evaluating masks are being conducted concurrent with the COVID pandemic, and one is completed. Many studies were conducted during non-epidemic influenza periods, but several studies were conducted during the global H1N1 influenza pandemic in 2009, and others in epidemic influenza seasons up to 2016. Thus, studies were conducted in the context of lower respiratory viral circulation and transmission compared to COVID-19. The included studies were conducted in heterogeneous settings, ranging from suburban schools to hospital wards in high-income countries; crowded inner city settings in low-income countries; and an immigrant neighbourhood in a high-income country. Compliance with interventions was low in many studies. The risk of bias for the RCTs and cluster-RCTs was mostly high or unclear. Medical/surgical masks compared to no masks We included nine trials (of which eight were cluster-RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness (two trials with healthcare workers and seven in the community). There is low certainty evidence from nine trials (3507 participants) that wearing a mask may make little or no difference to the outcome of influenza-like illness (ILI) compared to not wearing a mask (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.82 to 1.18. There is moderate certainty evidence that wearing a mask probably makes little or no difference to the outcome of laboratory-confirmed influenza compared to not wearing a mask (RR 0.91, 95% CI 0.66 to 1.26; 6 trials; 3005 participants). Harms were rarely measured and poorly reported. Two studies during COVID-19 plan to recruit a total of 72,000 people. One evaluates medical/surgical masks (N = 6000) (published Annals of Internal Medicine, 18 Nov 2020), and one evaluates cloth masks (N = 66,000). N95/P2 respirators compared to medical/surgical masks We pooled trials comparing N95/P2 respirators with medical/surgical masks (four in healthcare settings and one in a household setting). There is uncertainty over the effects of N95/P2 respirators when compared with medical/surgical masks on the outcomes of clinical respiratory illness (RR 0.70, 95% CI 0.45 to 1.10; very low-certainty evidence; 3 trials; 7779 participants) and ILI (RR 0.82, 95% CI 0.66 to 1.03; low-certainty evidence; 5 trials; 8407 participants). The evidence is limited by imprecision and heterogeneity for these subjective outcomes. The use of a N95/P2 respirator compared to a medical/surgical mask probably makes little or no difference for the objective and more precise outcome of laboratory-confirmed influenza infection (RR 1.10, 95% CI 0.90 to 1.34; moderate-certainty evidence; 5 trials; 8407 participants). Restricting the pooling to healthcare workers made no difference to the overall findings. Harms were poorly measured and reported, but discomfort wearing medical/surgical masks or N95/P2 respirators was mentioned in several studies. One ongoing study recruiting 576 people compares N95/P2 respirators with medical surgical masks for healthcare workers during COVID-19. Hand hygiene compared to control Settings included schools, childcare centres, homes, and offices. In a comparison of hand hygiene interventions with control (no intervention), there was a 16% relative reduction in the number of people with ARIs in the hand hygiene group (RR 0.84, 95% CI 0.82 to 0.86; 7 trials; 44,129 participants; moderate-certainty evidence), suggesting a probable benefit. When considering the more strictly defined outcomes of ILI and laboratory-confirmed influenza, the estimates of effect for ILI (RR 0.98, 95% CI 0.85 to 1.13; 10 trials; 32,641 participants; low-certainty evidence) and laboratory-confirmed influenza (RR 0.91, 95% CI 0.63 to 1.30; 8 trials; 8332 participants; low-certainty evidence) suggest the intervention made little or no difference. We pooled all 16 trials (61,372 participants) for the composite outcome of ARI or ILI or influenza, with each study only contributing once and the most comprehensive outcome reported. The pooled data showed that hand hygiene may offer a benefit with an 11% relative reduction of respiratory illness (RR 0.89, 95% CI 0.84 to 0.95; low-certainty evidence), but with high heterogeneity. Few trials measured and reported harms. There are two ongoing studies of handwashing interventions in 395 children outside of COVID-19. We identified one RCT on quarantine/physical distancing. Company employees in Japan were asked to stay at home if household members had ILI symptoms. Overall fewer people in the intervention group contracted influenza compared with workers in the control group (2.75% versus 3.18%; hazard ratio 0.80, 95% CI 0.66 to 0.97). However, those who stayed at home with their infected family members were 2.17 times more likely to be infected. We found no RCTs on eye protection, gowns and gloves, or screening at entry ports. AUTHORS' CONCLUSIONS The high risk of bias in the trials, variation in outcome measurement, and relatively low compliance with the interventions during the studies hamper drawing firm conclusions and generalising the findings to the current COVID-19 pandemic. There is uncertainty about the effects of face masks. The low-moderate certainty of the evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of randomised trials did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks during seasonal influenza. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness. Harms associated with physical interventions were under-investigated. There is a need for large, well-designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, especially in those most at risk of ARIs.
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Affiliation(s)
- Tom Jefferson
- Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
| | - Chris B Del Mar
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Liz Dooley
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Eliana Ferroni
- Epidemiological System of the Veneto Region, Regional Center for Epidemiology, Veneto Region, Padova, Italy
| | - Lubna A Al-Ansary
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ghada A Bawazeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Mark A Jones
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Sarah Thorning
- GCUH Library, Gold Coast Hospital and Health Service, Southport, Australia
| | - Elaine M Beller
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Paul P Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - John M Conly
- Cumming School of Medicine, University of Calgary, Room AGW5, SSB, Foothills Medical Centre, Calgary, Canada
- O'Brien Institute for Public Health and Synder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Zone, Alberta Health Services, Calgary, Canada
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Availability, Use, and Satisfaction of Personal Protective Equipment Among Healthcare Workers: A Cross-Sectional Assessment of Low- and Middle-Income Countries. J Occup Environ Med 2020; 62:e657-e664. [PMID: 32956236 DOI: 10.1097/jom.0000000000002028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the discrepancy among and within low- and middle-income countries (LMICs) regarding PPE availability, use, and satisfaction. METHODS The study population consisted of healthcare workers from LMICs who partook in the questionnaire survey from March 1, 2020, until April 15, 2020. RESULTS In the bivariate analysis, gender (P = 0.05), HCWs (P < 0.01), and level of care (P < 0.01) were associated with the public or private sector (P < 0.05). Using multivariate analysis, PPE factors were associated with the health sector (p < 0.05). The multivariate logistic regression model determined a Pearson's χ value of 706.736 (df = 726, P = -0.689) and a c-statistic of 0.592, indicating a good model. CONCLUSION In LMICs, huge discrepancies are present in PPE provision to HCWs, especially among the public healthcare sectors. Efforts at national and international levels ought to be addressed to protect frontline HCWs at higher risk of contracting COVID-19.
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Assessment of Health Workers’ Knowledge, Beliefs, Attitudes, and Use of Personal Protective Equipment for Prevention of COVID-19 Infection in Low-Resource Settings. ADVANCES IN PUBLIC HEALTH 2020. [DOI: 10.1155/2020/4619214] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious disease with a potential for healthcare workers (HCWs) getting infected due to inadequate protection while attending to patients. Effective use of personal protective equipment (PPE) is key to mitigating the spread of SARS-CoV-2 infection in healthcare settings. Hence, there is a need to understand HCWs’ use of PPE in resource-limited settings and how closely the currently recommended guidelines for PPE are followed. This study assessed the HCWs’ knowledge about, attitudes towards, beliefs on, and use of PPE to prevent SARS-CoV-2 infection in a resource-limited setting. Methods. This cross-sectional study was conducted in April 2020 in Southwest and Northwest Nigeria. The selection of participants was performed via the snowball sampling technique using a 33-item, web-based, self-administered questionnaire via a social media network. We obtained relevant sociodemographic data and information on participants’ occupations and knowledge about, attitudes towards, beliefs on, and use of PPE. We analysed the data using SPSS version 23.0 for Windows (IBM, Armonk, New York, USA). A p values <0.05 were considered statistically significant. Results. A total of 290 subjects responded to the questionnaire, and 18 (6.2%) were excluded because of incomplete data. The mean age of the respondents was 32.3 ± 9.9 years. There were 116 males (42.6%). The majority of the respondents were medical doctors (114, 41.9%), followed by nurses and clinical students. Of the 272 respondents in this survey, only 70 (25.7%) had adequate knowledge about PPE. Of the respondents who presumed they had adequate knowledge about donning and doffing PPE, 94 (56%) were incorrect. The predictors of good knowledge were ages younger than 45 years (p=0.046) and practice location (p=0.009). Conclusion. This study showed that HCWs’ knowledge about, attitudes towards, and beliefs on PPE and their PPE skill in practice in Nigeria were remarkably poor. There is an urgent need for nationwide practical training on PPE use to curtail the spread of SARS-CoV-2 infection among HCWs.
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Matuschek C, Moll F, Fangerau H, Fischer JC, Zänker K, van Griensven M, Schneider M, Kindgen-Milles D, Knoefel WT, Lichtenberg A, Tamaskovics B, Djiepmo-Njanang FJ, Budach W, Corradini S, Häussinger D, Feldt T, Jensen B, Pelka R, Orth K, Peiper M, Grebe O, Maas K, Gerber PA, Pedoto A, Bölke E, Haussmann J. Face masks: benefits and risks during the COVID-19 crisis. Eur J Med Res 2020; 25:32. [PMID: 32787926 PMCID: PMC7422455 DOI: 10.1186/s40001-020-00430-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/21/2020] [Indexed: 12/22/2022] Open
Abstract
Background The German government has made it mandatory to wear respiratory masks covering mouth and nose (MNC) as an effective strategy to fight SARS-CoV-2 infections. In many countries, this directive has been extended on shopping malls or public transportation. The aim of this paper is to critically analyze the statutory regulation to wear protective masks during the COVID-19 crisis from a medical standpoint. Methods We performed an extensive query of the most recent publications addressing the prevention of viral infections including the use of face masks in the community as a method to prevent the spread of the infection. We addressed the issues of practicability, professional use, and acceptability based on the community and the environment where the user resided. Results Upon our critical review of the available literature, we found only weak evidence for wearing a face mask as an efficient hygienic tool to prevent the spread of a viral infection. However, the use of MNC seems to be linked to relevant protection during close contact scenarios by limiting pathogen-containing aerosol and liquid droplet dissemination. Importantly, we found evidence for significant respiratory compromise in patients with severe obstructive pulmonary disease, secondary to the development of hypercapnia. This could also happen in patients with lung infections, with or without SARS-CoV-2. Conclusion Epidemiologists currently emphasize that wearing MNC will effectively interrupt airborne infections in the community. The government and the politicians have followed these recommendations and used them to both advise and, in some cases, mandate the general population to wear MNC in public locations. Overall, the results seem to suggest that there are some clinically relevant scenarios where the use of MNC necessitates more defined recommendations. Our critical evaluation of the literature both highlights the protective effects of certain types of face masks in defined risk groups, and emphasizes their potential risks.
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Affiliation(s)
- Christiane Matuschek
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Friedrich Moll
- Department of the History, Philosophy and Ethics of Medicine, Heinrich Heine University, Medical Faculty, Dusseldorf, Germany
| | - Heiner Fangerau
- Department of the History, Philosophy and Ethics of Medicine, Heinrich Heine University, Medical Faculty, Dusseldorf, Germany
| | - Johannes C Fischer
- Institute for Transplant Diagnostics and Cell Therapeutics, Heinrich Heine University, Dusseldorf, Germany
| | - Kurt Zänker
- Center for Biomedical Education and Research (ZBAF), University Witten/Herdecke, Witten, Germany
| | - Martijn van Griensven
- Department cBITE, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, The Netherlands
| | - Marion Schneider
- Department of Experimental Anesthesiology, University of Ulm, Ulm, Germany
| | - Detlef Kindgen-Milles
- Department of Anesthesiology and Intensive Care Medicine, Heinrich Heine University, Dusseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department for General Visceral and Pediatric Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Artur Lichtenberg
- Department for Cardiac Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | | | - Wilfried Budach
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Dusseldorf, Germany
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Dusseldorf, Germany
| | - Björn Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Dusseldorf, Germany
| | - Rainer Pelka
- Institute for Applied Statistics, Munich, Germany
| | - Klaus Orth
- University of Hannover, Hannover, Germany
| | | | - Olaf Grebe
- Department for Cardiology, Rhythmology and Intensive Care Medicine, Evangelic Hospital, Dusseldorf, Germany
| | - Kitti Maas
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | | | - Alessia Pedoto
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edwin Bölke
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany.
| | - Jan Haussmann
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
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Hu K, Fan J, Li X, Gou X, Li X, Zhou X. The adverse skin reactions of health care workers using personal protective equipment for COVID-19. Medicine (Baltimore) 2020; 99:e20603. [PMID: 32541493 PMCID: PMC7302613 DOI: 10.1097/md.0000000000020603] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/28/2020] [Accepted: 05/07/2020] [Indexed: 11/25/2022] Open
Abstract
In December 2019, a new coronavirus was found in Wuhan, Hubei Province, China, and spread rapidly throughout the country, attracting global attention. On February 11, the World Health Organization (WHO) officially named the disease caused by 2019-nCoV coronavirus disease 2019 (COVID-19). With the increasing number of cases, health care workers (HCWs) from all over China volunteered to work in Hubei Province. Because of the strong infectivity of COVID-19, HCWs need to wear personal protective equipment (PPE), such as N95 masks, latex gloves, and protective clothing. Due to the long-term use of PPE, many adverse skin reactions may occur. Therefore, the purpose of this study is to explore the adverse skin reactions among HCWs using PPE.Questionnaires were used for the research; a quantitative study was carried out to determine the incidence of adverse skin reactions among HCWs using PPE.A total of 61 valid questionnaires were collected. The most common adverse skin reactions among HCWs wearing N95 masks were nasal bridge scarring (68.9%) and facial itching (27.9%). The most common adverse skin reactions among HCWs wearing latex gloves were dry skin (55.7%), itching (31.2%), and rash (23.0%). The most common adverse skin reactions among HCWs wearing protective clothing were dry skin (36.1%) and itching (34.4%).When most HCWs wear PPE for a long period of time, they will experience adverse skin reactions. The incidence of adverse skin reactions to the N95 mask was 95.1%, that to latex gloves was 88.5%, and that to protective clothing was 60.7%.
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Affiliation(s)
- Kaihui Hu
- Department of Urology, the First Affiliated Hospital, Chongqing Medical University
| | - Jing Fan
- Department of Urology, the First Affiliated Hospital, Chongqing Medical University
| | - Xueqin Li
- Department of Urology, the First Affiliated Hospital, Chongqing Medical University
| | - Xin Gou
- Department of Urology, the First Affiliated Hospital, Chongqing Medical University
| | - Xinyuan Li
- Department of Urology, the First Affiliated Hospital, Chongqing Medical University
- Chongqing Key Laboratory of Molecular Oncology and Epigenetics, Chongqing, China
| | - Xiang Zhou
- Department of Urology, the First Affiliated Hospital, Chongqing Medical University
- Chongqing Key Laboratory of Molecular Oncology and Epigenetics, Chongqing, China
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Salehi H, Pennathur PR, Da Silva JP, Herwaldt LA. Examining health care personal protective equipment use through a human factors engineering and product design lens. Am J Infect Control 2019; 47:595-598. [PMID: 30522839 DOI: 10.1016/j.ajic.2018.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/11/2018] [Accepted: 10/11/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Hugh Salehi
- Department of Industrial and Systems Engineering, Seamans Center for the Engineering Arts and Sciences, University of Iowa, Iowa City, IA
| | - Priyadarshini R Pennathur
- Department of Industrial and Systems Engineering, Seamans Center for the Engineering Arts and Sciences, University of Iowa, Iowa City, IA; Carver College of Medicine, University of Iowa School of Medicine, Iowa City, IA.
| | - Jaqueline Pereira Da Silva
- Department of Industrial and Systems Engineering, Seamans Center for the Engineering Arts and Sciences, University of Iowa, Iowa City, IA
| | - Loreen A Herwaldt
- Carver College of Medicine, University of Iowa School of Medicine, Iowa City, IA; College of Public Health, University of Iowa, Iowa City, IA
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Mukerji S, MacIntyre CR, Newall AT. Review of economic evaluations of mask and respirator use for protection against respiratory infection transmission. BMC Infect Dis 2015; 15:413. [PMID: 26462473 PMCID: PMC4605092 DOI: 10.1186/s12879-015-1167-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 09/30/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There has been increasing debate surrounding mask and respirator interventions to control respiratory infection transmission in both healthcare and community settings. As decision makers are considering the recommendations they should evaluate how to provide the most efficient protection strategies with minimum costs. The aim of this review is to identify and evaluate the existing economic evaluation literature in this area and to offer advice on how future evaluations on this topic should be conducted. METHODS We searched the Scopus database for all literature on economic evaluation of mask or respirator use to control respiratory infection transmission. Reference lists from the identified studies were also manually searched. Seven studies met our inclusion criteria from the initial 806 studies identified by the search strategy and our manual search. RESULTS Five studies considered interventions for seasonal and/or pandemic influenza, with one also considering SARS (Severe Acute Respiratory Syndrome). The other two studies focussed on tuberculosis transmission control interventions. The settings and methodologies of the studies varied greatly. No low-middle income settings were identified. Only one of the reviewed studies cited clinical evidence to inform their mask/respirator intervention effectiveness parameters. Mask and respirator interventions were generally reported by the study authors to be cost saving or cost-effective when compared to no intervention or other control measures, however the evaluations had important limitations. CONCLUSIONS Given the large cost differential between masks and respirators, there is a need for more comprehensive economic evaluations to compare the relative costs and benefits of these interventions in situations and settings where alternative options are potentially applicable. There are at present insufficient well conducted cost-effectiveness studies to inform decision-makers on the value for money of alternative mask/respirator options.
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Affiliation(s)
- Shohini Mukerji
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Anthony T Newall
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
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Sim SW, Moey KSP, Tan NC. The use of facemasks to prevent respiratory infection: a literature review in the context of the Health Belief Model. Singapore Med J 2015; 55:160-7. [PMID: 24664384 DOI: 10.11622/smedj.2014037] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Acute respiratory infections are prevalent and pose a constant threat to society. While the use of facemasks has proven to be an effective barrier to curb the aerosol spread of such diseases, its use in the local community is uncommon, resulting in doubts being cast on its effectiveness in preventing airborne infections during epidemics. We thus aimed to conduct a literature review to determine the factors that influence the use of facemasks as a primary preventive health measure in the community. METHODS A search for publications relating to facemask usage was performed on Medline, PubMed, Google, World Health Organization and Singapore government agencies' websites, using search terms such as 'facemask', 'mask', 'influenza', 'respiratory infection', 'personal protective equipment', 'disease prevention', 'compliance' and 'adherence'. Findings were framed under five components of the Health Belief Model: perceived susceptibility, perceived benefits, perceived severity, perceived barriers and cues to action. RESULTS We found that individuals are more likely to wear facemasks due to the perceived susceptibility and perceived severity of being afflicted with life-threatening diseases. Although perceived susceptibility appeared to be the most significant factor determining compliance, perceived benefits of mask-wearing was found to have significant effects on mask-wearing compliance as well. Perceived barriers include experience or perception of personal discomfort and sense of embarrassment. Media blitz and public health promotion activities supported by government agencies provide cues to increase the public's usage of facemasks. CONCLUSION Complex interventions that use multipronged approaches targeting the five components of the Health Belief Model, especially perceived susceptibility, are needed to increase the use of facemasks in the community. Further studies are required to evaluate the effectiveness of implemented interventions.
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Affiliation(s)
- Shin Wei Sim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore 119228.
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Kim SA, Oh HS, Suh YO, Seo WS. An integrative model of workplace self-protective behavior for Korean nurses. Asian Nurs Res (Korean Soc Nurs Sci) 2014; 8:91-8. [PMID: 25030640 DOI: 10.1016/j.anr.2014.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 11/22/2013] [Accepted: 02/19/2014] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study was conducted to develop and test a hypothetical stage model of workplace self-protective behaviors with respect to blood transmitted infections and musculoskeletal injuries for Korean nurses. METHODS A nonexperimental, cross-sectional study design was adopted. The study participants were 320 nurses at two Korean university hospitals. Perceived sensitivity, severity, barriers, benefits, self-efficacy, social support, and safety climate were assessed. RESULTS Overall, fit indicators showed a good fit for the hypothetical model of self-protective behaviors against blood transmitted infections and musculoskeletal injuries. The significant factors of self-protective behaviors against blood transmitted infections were perceived barriers and social support. The significant factors of self-protective behaviors against musculoskeletal injuries were perceived benefits, barriers, and self-efficacy. CONCLUSION Our findings suggest that the significant psychosocial constructs of stages of self-protective behavior are dependent on health problem type. Accordingly, we advise that characteristics of behavior and types of disease and health problem should be given priority when developing intervention programs for particular self-protective health behaviors.
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Affiliation(s)
- Seol Ah Kim
- Inha University Hospital, Incheon, South Korea
| | - Hyun Soo Oh
- Department of Nursing, Inha University, Incheon, South Korea
| | - Yeon Ok Suh
- Department of Nursing, Soonchunhyang University, Asan, South Korea
| | - Wha Sook Seo
- Department of Nursing, Inha University, Incheon, South Korea.
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Health Care Workers' Knowledge and Confidence in Personal Protective Equipment During the H1N1 Pandemic in Israel. Disaster Med Public Health Prep 2014; 8:150-157. [PMID: 24725982 DOI: 10.1017/dmp.2014.25] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Healthcare workers (HCW) are at increased risk of infection during pandemics. HCW personal protective equipment (PPE) use has been shown to lower infection rates among HCW and patients. However, low compliance and misuse are frequent. Since future outbreaks are unavoidable, this issue needs to be addressed. METHODS A validated questionnaire was distributed to 617 HCWs (nurses and physicians) in 21 hospitals and 40 primary care clinics in Israel at the peak of the A/H1N1 pandemic. RESULTS PPE confidence was higher among HCWs with higher tested and self-perceived knowledge. Confidence was also higher among nurses compared with physicians and among employees in hospitals compared with those in primary care clinics. Experience treating A/H1N1 patients was related to higher self-perceived knowledge and PPE confidence. CONCLUSIONS High levels of PPE knowledge were significantly correlated to HCWs' confidence in PPE and may help increase PPE usage and reduce absenteeism. (Diaster Med Public Health Preparedness. 2014;0:1-8).
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Naghavi SHR, Shabestari O, Roudsari AV, Harrison J. Design and validation of a questionnaire to measure the attitudes of hospital staff concerning pandemic influenza. J Infect Public Health 2012; 5:89-101. [PMID: 22341848 PMCID: PMC7102719 DOI: 10.1016/j.jiph.2011.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 11/02/2011] [Accepted: 11/03/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVE When pandemics lead to a higher workload in the healthcare sector, the attitude of healthcare staff and, more importantly, the ability to predict the rate of absence due to sickness are crucial factors in emergency preparedness and resource allocation. The aim of this study was to design and validate a questionnaire to measure the attitude of hospital staff toward work attendance during an influenza pandemic. METHOD An online questionnaire was designed and electronically distributed to the staff of a teaching medical institution in the United Kingdom. The questionnaire was designed de novo following discussions with colleagues at Imperial College and with reference to the literature on the severe acute respiratory syndrome (SARS) epidemic. The questionnaire included 15 independent fact variables and 33 dependent measure variables. A total of 367 responses were received in this survey. RESULTS The data from the measurement variables were not normally distributed. Three different methods (standardized residuals, Mahalanobis distance and Cook's distance) were used to identify the outliers. In all, 19 respondents (5.17%) were identified as outliers and were excluded. The responses to this questionnaire had a wide range of missing data, from 1 to 74 cases in the measured variables. To improve the quality of the data, missing value analysis, using Expectation Maximization Algorithm (EMA) with a non-normal distribution model, was applied to the responses. The collected data were checked for homoscedasticity and multicollinearity of the variables. These tests suggested that some of the questions should be merged. In the last step, the reliability of the questionnaire was evaluated. This process showed that three questions reduced the reliability of the questionnaire. Removing those questions helped to achieve the desired level of reliability. CONCLUSION With the changes proposed in this article, the questionnaire for measuring staff attitudes concerning pandemic influenza can be converted to a standardized and validated questionnaire to properly measure the expectations and attendance of healthcare staff in the event of pandemic flu.
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Affiliation(s)
- Seyed Hamid Reza Naghavi
- Department of Occupational Health - Barking, Havering and Redbridge University Hospitals NHS Trust, Essex, UK.
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Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al‐Ansary LA, Bawazeer GA, van Driel ML, Nair NS, Jones MA, Thorning S, Conly JM. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev 2011; 2011:CD006207. [PMID: 21735402 PMCID: PMC6993921 DOI: 10.1002/14651858.cd006207.pub4] [Citation(s) in RCA: 242] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Viral epidemics or pandemics of acute respiratory infections like influenza or severe acute respiratory syndrome pose a global threat. Antiviral drugs and vaccinations may be insufficient to prevent their spread. OBJECTIVES To review the effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses. SEARCH STRATEGY We searched The Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL 2010, Issue 3), which includes the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to October 2010), OLDMEDLINE (1950 to 1965), EMBASE (1990 to October 2010), CINAHL (1982 to October 2010), LILACS (2008 to October 2010), Indian MEDLARS (2008 to October 2010) and IMSEAR (2008 to October 2010). SELECTION CRITERIA In this update, two review authors independently applied the inclusion criteria to all identified and retrieved articles and extracted data. We scanned 3775 titles, excluded 3560 and retrieved full papers of 215 studies, to include 66 papers of 67 studies. We included physical interventions (screening at entry ports, isolation, quarantine, social distancing, barriers, personal protection, hand hygiene) to prevent respiratory virus transmission. We included randomised controlled trials (RCTs), cohorts, case-controls, before-after and time series studies. DATA COLLECTION AND ANALYSIS We used a standardised form to assess trial eligibility. We assessed RCTs by randomisation method, allocation generation, concealment, blinding and follow up. We assessed non-RCTs for potential confounders and classified them as low, medium and high risk of bias. MAIN RESULTS We included 67 studies including randomised controlled trials and observational studies with a mixed risk of bias. A total number of participants is not included as the total would be made up of a heterogenous set of observations (participant people, observations on participants and countries (object of some studies)). The risk of bias for five RCTs and most cluster-RCTs was high. Observational studies were of mixed quality. Only case-control data were sufficiently homogeneous to allow meta-analysis. The highest quality cluster-RCTs suggest respiratory virus spread can be prevented by hygienic measures, such as handwashing, especially around younger children. Benefit from reduced transmission from children to household members is broadly supported also in other study designs where the potential for confounding is greater. Nine case-control studies suggested implementing transmission barriers, isolation and hygienic measures are effective at containing respiratory virus epidemics. Surgical masks or N95 respirators were the most consistent and comprehensive supportive measures. N95 respirators were non-inferior to simple surgical masks but more expensive, uncomfortable and irritating to skin. Adding virucidals or antiseptics to normal handwashing to decrease respiratory disease transmission remains uncertain. Global measures, such as screening at entry ports, led to a non-significant marginal delay in spread. There was limited evidence that social distancing was effective, especially if related to the risk of exposure. AUTHORS' CONCLUSIONS Simple and low-cost interventions would be useful for reducing transmission of epidemic respiratory viruses. Routine long-term implementation of some measures assessed might be difficult without the threat of an epidemic.
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Affiliation(s)
- Tom Jefferson
- University of OxfordCentre for Evidence Based MedicineOxfordUKOX2 6GG
| | - Chris B Del Mar
- Bond UniversityCentre for Research in Evidence‐Based Practice (CREBP)University DriveGold CoastQueenslandAustralia4229
| | - Liz Dooley
- Bond UniversityFaculty of Health Sciences and MedicineGold CoastQueenslandAustralia4229
| | - Eliana Ferroni
- Regional Center for Epidemiology, Veneto RegionEpidemiological System of the Veneto RegionPassaggio Gaudenzio 1PadovaItaly35131
| | - Lubna A Al‐Ansary
- World Health OrganizationDepartment of Health Metrics and MeasurementGenevaSwitzerland
| | - Ghada A Bawazeer
- King Saud UniversityDepartment of Clinical Pharmacy, College of PharmacyP.O. Box 22452RiyadhSaudi Arabia11495
| | - Mieke L van Driel
- The University of QueenslandPrimary Care Clinical Unit, Faculty of MedicineBrisbaneQueenslandAustralia4029
- Ghent UniversityDepartment of Public Health and Primary CareCampus UZ 6K3, Corneel Heymanslaan 10GhentBelgium9000
| | - N Sreekumaran Nair
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) (Institution of National Importance Under Ministry of Health and Family Welfare, Government of India)Department of Medical Biometrics & Informatics (Biostatistics)4th Floor, Administrative BlockDhanvantri NagarPuducherryIndia605006
| | - Mark A Jones
- Bond UniversityInstitute for Evidence‐Based Healthcare11 University DriveRobinaGold CoastQueenslandAustralia4226
| | - Sarah Thorning
- Gold Coast Hospital and Health ServiceGCUH LibraryLevel 1, Block E, GCUHSouthportQueenslandAustralia4215
| | - John M Conly
- Foothills Medical Centre, Room 930, North Tower1403‐29th St NWCalgaryABCanadaT2N 2T9
- WHO. Infection Prevention and Control in Health CareDepartment of Global Alert and Response ‐ Health Security and EnvironmentOffice L420, 20, Avenue AppiaGenevaSwitzerlandCH‐1211
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May L, Katz R, Johnston L, Sanza M, Petinaux B. Assessing physicians' in training attitudes and behaviors during the 2009 H1N1 influenza season: a cross-sectional survey of medical students and residents in an urban academic setting. Influenza Other Respir Viruses 2010; 4:267-75. [PMID: 20795309 PMCID: PMC4634655 DOI: 10.1111/j.1750-2659.2010.00151.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Please cite this paper as: May et al. (2010) Assessing physicians’ in training attitudes and behaviors during the 2010 H1N1 influenza season: a cross‐sectional survey of medical students and residents in an urban academic setting. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2010.00151.x. Background Despite concern for hospital‐based transmission of influenza, little research has been carried out on perceptions and behaviors of physicians in training with regard to influenza‐like illness (ILI), especially in light of the recent H1N1 pandemic. Objectives We aimed to evaluate self‐reported episodes of ILI among medical students and residents to determine the impact of ILI on school and clinical performance, absenteeism, and patterns of preventive measures used by this population both in and out of the healthcare setting. Methods We anonymously surveyed medical students and residents at an urban institution between November 3 and December 11, 2009. Data were analyzed separately for medical students and residents for frequency of close‐ended responses. Open‐ended answers were analyzed thematically. Our Institutional Review Board exempted this study from review. Results Forty‐five percent of medical students and 53% of resident respondents perceived the risk of acquiring H1N1 at school or work as high, and although 43% of medical students and 66% of resident respondents had received the influenza vaccination and most reported increasing non‐pharmaceutical preventive measures, 9% of medical students and 61% of residents with one or more episodes of ILI chose to continue to attend class or work when ill. Conclusions Although students and residents report high risk of infection because of work‐ or school‐related activities, many involved in patient care activities do not comply with recommended infection control precautions. Educational campaigns should be developed and infection control guidelines should be included in routine medical student and resident curricular activities.
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Affiliation(s)
- Larissa May
- Department of Emergency Medicine, The George Washington University, Washington, DC 20037, USA.
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Yen MY, Lu YC, Huang PH, Chen CM, Chen YC, Lin YE. Quantitative evaluation of infection control models in the prevention of nosocomial transmission of SARS virus to healthcare workers: implication to nosocomial viral infection control for healthcare workers. ACTA ACUST UNITED AC 2010; 42:510-5. [PMID: 20148749 DOI: 10.3109/00365540903582400] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Healthcare workers (HCWs) are at high risk of acquiring emerging infections while caring for patients, as has been shown in the recent SARS and swine flu epidemics. Using SARS as an example, we determined the effectiveness of infection control measures (ICMs) by logistic regression and structural equation modelling (SEM), a quantitative methodology that can test a hypothetical model and validates causal relationships among ICMs. Logistic regression showed that installing hand wash stations in the emergency room (p = 0.012, odds ratio = 1.07) was the only ICM significantly associated with the protection of HCWs from acquiring the SARS virus. The structural equation modelling results showed that the most important contributing factor (highest proportion of effectiveness) was installation of a fever screening station outside the emergency department (51%). Other measures included traffic control in the emergency department (19%), availability of an outbreak standard operation protocol (12%), mandatory temperature screening (9%), establishing a hand washing setup at each hospital checkpoint (3%), adding simplified isolation rooms (3%), and a standardized patient transfer protocol (3%). Installation of fever screening stations outside of the hospital and implementing traffic control in the emergency department contributed to 70% of the effectiveness in the prevention of SARS transmission. Our approach can be applied to the evaluation of control measures for other epidemic infectious diseases, including swine flu and avian flu.
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Jefferson T, Del Mar C, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, van Driel ML, Nair S, Foxlee R, Rivetti A. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev 2010:CD006207. [PMID: 20091588 DOI: 10.1002/14651858.cd006207.pub3] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Viral epidemics or pandemics of acute respiratory infections like influenza or severe acute respiratory syndrome pose a world-wide threat. Antiviral drugs and vaccinations may be insufficient to prevent catastrophe. OBJECTIVES To systematically review the effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 2); MEDLINE (1966 to May 2009); OLDMEDLINE (1950 to 1965); EMBASE (1990 to May 2009); and CINAHL (1982 to May 2009). SELECTION CRITERIA We scanned 2958 titles, excluded 2790 and retrieved the full papers of 168 trials, to include 59 papers of 60 studies. We included any physical interventions (isolation, quarantine, social distancing, barriers, personal protection and hygiene) to prevent transmission of respiratory viruses. We included the following study designs: randomised controlled trials (RCTs), cohorts, case controls, cross-over, before-after, and time series studies. DATA COLLECTION AND ANALYSIS We used a standardised form to assess trial eligibility. RCTs were assessed by: randomisation method; allocation generation; concealment; blinding; and follow up. Non-RCTs were assessed for the presence of potential confounders, and classified into low, medium, and high risks of bias. MAIN RESULTS The risk of bias for the four RCTs, and most cluster RCTs, was high. The observational studies were of mixed quality. Only case-control data were sufficiently homogeneous to allow meta-analysis.The highest quality cluster RCTs suggest respiratory virus spread can be prevented by hygienic measures, such as handwashing, especially around younger children. Additional benefit from reduced transmission from children to other household members is broadly supported in results of other study designs, where the potential for confounding is greater. Six case-control studies suggested that implementing barriers to transmission, isolation, and hygienic measures are effective at containing respiratory virus epidemics. We found limited evidence that N95 respirators were superior to simple surgical masks, but were more expensive, uncomfortable, and caused skin irritation. The incremental effect of adding virucidals or antiseptics to normal handwashing to decrease respiratory disease remains uncertain. Global measures, such as screening at entry ports, were not properly evaluated. There was limited evidence that social distancing was effective especially if related to the risk of exposure. AUTHORS' CONCLUSIONS Many simple and probably low-cost interventions would be useful for reducing the transmission of epidemic respiratory viruses. Routine long-term implementation of some of the measures assessed might be difficult without the threat of a looming epidemic.
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Affiliation(s)
- Tom Jefferson
- Vaccines Field, The Cochrane Collaboration, Via Adige 28a, Anguillara Sabazia, Roma, Italy, 00061
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Singapore's response to the severe acute respiratory syndrome outbreak: what do Singapore physicians think? Int J Public Health 2009; 55:139-43. [PMID: 19960223 DOI: 10.1007/s00038-009-0099-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 11/02/2009] [Accepted: 11/15/2009] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To gauge Singapore physicians' perceptions of the national response to the severe acute respiratory syndrome (SARS) outbreak using a questionnaire survey. METHODS Random sampling was applied to draw the survey population. Descriptive analysis and logistic regressions were used. RESULTS The majority of physicians agreed that home quarantine of contacts of patients with probable SARS was warranted (95%), government's public education effort was effective (83%), and the overall Singapore's response was commendable (82%). Only 38%, however, agreed that health care workers were supplied with timely and adequate personal protective equipment. CONCLUSIONS Most Singapore physicians have positive comments about the national response to the SARS crisis. However, systematic weaknesses are identified and recommendations are presented.
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Balinska M, Rizzo C. Behavioural responses to influenza pandemics: what do we know? PLOS CURRENTS 2009; 1:RRN1037. [PMID: 20025201 PMCID: PMC2762764 DOI: 10.1371/currents.rrn1037] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/09/2009] [Indexed: 11/18/2022]
Abstract
The emergence of the novel A/H1N1 virus has made pandemic preparedness a crucial issue for public health worldwide. Although the epidemiological aspects of the three 20th century influenza pandemics have been widely investigated, little is known about population behaviour in a pandemic situation. Such knowledge is however critical, notably for predicting population compliance with non pharmaceutical interventions. This paper reviews the relevant scientific literature for the 1918-1920, 1957-1958, 1969-1969 influenza epidemics and the 2003 SARS outbreak. Although the evidence base of most non pharmaceutical interventions (NPIs) and personal protection measures is debated, it appears on the basis of past experience that NPIs implemented the most systematically, the earliest, and for the longest time could reduce overall mortality rates and spread out epidemic peaks. Adequate, transparent, and targeted communication on the part of public health authorities would be also of crucial importance in the event of a serious influenza pandemic.
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Jefferson T, Foxlee R, Del Mar C, Dooley L, Ferroni E, Hewak B, Prabhala A, Nair S, Rivetti A. Cochrane Review: Interventions for the interruption or reduction of the spread of respiratory viruses. ACTA ACUST UNITED AC 2008; 3:951-1013. [PMID: 32313518 PMCID: PMC7163512 DOI: 10.1002/ebch.291] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Viral epidemics or pandemics such as of influenza or severe acute respiratory syndrome (SARS) pose a significant threat. Antiviral drugs and vaccination may not be adequate to prevent catastrophe in such an event. Objectives To systematically review the evidence of effectiveness of interventions to interrupt or reduce the spread of respiratory viruses (excluding vaccines and antiviral drugs, which have been previously reviewed). Search strategy We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, issue 4); MEDLINE (1966 to November 2006); OLDMEDLINE (1950 to 1965); EMBASE (1990 to November 2006); and CINAHL (1982 to November 2006). Selection criteria We scanned 2300 titles, excluded 2162 and retrieved the full papers of 138 trials, including 49 papers of 51 studies. The quality of three randomised controlled trials (RCTs) was poor; as were most cluster RCTs. The observational studies were of mixed quality. We were only able to meta‐analyse case‐control data. We searched for any interventions to prevent viral transmission of respiratory viruses (isolation, quarantine, social distancing, barriers, personal protection and hygiene). Study design included RCTs, cohort studies, case‐control studies, cross‐over studies, before‐after, and time series studies. Data collection and analysis We scanned the titles, abstracts and full text articles using a standardised form to assess eligibility. RCTs were assessed according to randomisation method, allocation generation, concealment, blinding, and follow up. Non‐RCTs were assessed for the presence of potential confounders and classified as low, medium, and high risk of bias. Main results The highest quality cluster RCTs suggest respiratory virus spread can be prevented by hygienic measures around younger children. Additional benefit from reduced transmission from children to other household members is broadly supported in results of other study designs, where the potential for confounding is greater. The six case‐control studies suggested that implementing barriers to transmission, isolation, and hygienic measures are effective at containing respiratory virus epidemics. We found limited evidence that the more uncomfortable and expensive N95 masks were superior to simple surgical masks. The incremental effect of adding virucidals or antiseptics to normal handwashing to decrease respiratory disease remains uncertain. The lack of proper evaluation of global measures such as screening at entry ports and social distancing prevent firm conclusions about these measures. Authors' conclusions Many simple and probably low‐cost interventions would be useful for reducing the transmission of epidemic respiratory viruses. Routine long‐term implementation of some of the measures assessed might be difficult without the threat of a looming epidemic. Plain language summary Interventions to interrupt or reduce the spread of respiratory viruses Although respiratory viruses usually only cause minor disease, they can cause epidemics. Approximately 10% to 15% of people worldwide contract influenza annually, with attack rates as high as 50% during major epidemics. Global pandemic viral infections have been devastating because of their wide spread. In 2003 the severe acute respiratory syndrome (SARS) epidemic affected ˜8,000 people, killed 780, and caused an enormous social and economic crisis. A new avian influenza pandemic caused by the H5N1 strain might be more catastrophic. Single measures (particularly the use of vaccines or antiviral drugs) may be insufficient to interrupt the spread. We found 51 studies including randomised controlled trials (RCTs) and observational studies with a mixed risk of bias. Respiratory virus spread might be prevented by hygienic measures around younger children. These might also reduce transmission from children to other household members. Implementing barriers to transmission, isolation, and hygienic measures may be effective at containing respiratory virus epidemics. There was limited evidence that (more uncomfortable and expensive) N95 masks were superior to simple ones. Adding virucidals or antiseptics to normal handwashing is of uncertain benefit. There is insufficient evaluation of global measures such as screening at entry ports and social distancing.
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Affiliation(s)
- Tom Jefferson
- Vaccines Field, The Cochrane Collaboration, Roma, Italy
| | - Ruth Foxlee
- Cochrane Wounds Group, Health Sciences, University of York, York, UK
| | - Chris Del Mar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Liz Dooley
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Eliana Ferroni
- Institute of Hygiene, Catholic University of The Sacred Heart, Rome, Italy
| | | | - Adi Prabhala
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Sreekumaran Nair
- Department of Statistics, Manipal Academy of Higher Education, Manipal, India
| | - Alessandro Rivetti
- Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI - Cochrane Vaccines Field, Azienda Sanitaria Locale ASL AL, Alessandria, Italy
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Lau JTF, Kim JH, Tsui HY, Griffiths S. Perceptions related to bird-to-human avian influenza, influenza vaccination, and use of face mask. Infection 2008; 36:434-43. [PMID: 18795229 PMCID: PMC7099207 DOI: 10.1007/s15010-008-7277-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Accepted: 01/29/2008] [Indexed: 11/26/2022]
Abstract
Background: H5N1 avian influenza may become pandemic in humans in the near future. According to the severe acute respiratory syndrome (SARS) experience, anticipation of the pandemic may have impact on behaviors related to influenza vaccination (IV) and relevant public health behaviors such as wearing a face mask when having influenza-like-illnesses (ILI), which would play an important role in the control of human avian influenza outbreaks. This paper investigated the prevalence and factors related to IV uptake and use of face mask in public venues when having ILI symptoms. Methods: An anonymous cross-sectional population-based random telephone survey of 302 Hong Kong Chinese adults aged 18–60, using a structured questionnaire, was conducted in November 2005. Results: In the last 3 months, 17.9% of the respondents received IV; 36.6% of those presenting ILI symptoms often used face mask in public venues. Anticipation of a bird-to-human H5N1 outbreak, perceptions that such an outbreak would be worse than SARS, that IV was efficacious in preventing bird-to-human avian influenza transmission were associated with the studied IV behavior (OR=2.64–3.97, p < 0.05). Exposure to live birds, perceived similar symptoms between influenza and bird-to-human H5N1 avian influenza, that bird-to-human avian influenza was more lethal than SARS were predictive use of face mask when having ILI symptoms (OR = 4.25–8.34, p < 0.05). Conclusion: The prevalence of IV and use of face mask in the study population may be increasing, which may be related to concerns of avian influenza. Perceptions related to human avian influenza were associated with IV and mask use behaviors. This can potentially be turned into opportunities of promoting desirable public health behaviors.
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Affiliation(s)
- J T F Lau
- Centre for Epidemiology and Biostatistics, Faculty of Medicine, School of Public Health, The Chinese University of Hong Kong, 5/F, School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong.
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Nichol K, Bigelow P, O'Brien-Pallas L, McGeer A, Manno M, Holness DL. The individual, environmental, and organizational factors that influence nurses' use of facial protection to prevent occupational transmission of communicable respiratory illness in acute care hospitals. Am J Infect Control 2008; 36:481-7. [PMID: 18786451 PMCID: PMC7132646 DOI: 10.1016/j.ajic.2007.12.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 12/05/2007] [Accepted: 12/10/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND Communicable respiratory illness is an important cause of morbidity among nurses. One of the key reasons for occupational transmission of this illness is the failure to implement appropriate barrier precautions, particularly facial protection. The objectives of this study were to describe the factors that influence nurses' decisions to use facial protection and to determine their relative importance in predicting compliance. METHODS This cross-sectional survey was conducted in 9 units of 2 urban hospitals in which nursing staff regularly use facial protection. RESULTS A total of 400 self-administered questionnaires were provided to nurses, and 177 were returned (44% response rate). Less than half of respondents reported compliance with the recommended use of facial protection (eye/face protection, respirators, and surgical masks) to prevent occupational transmission of communicable respiratory disease. Multivariate analysis showed 5 factors to be key predictors of nurses' compliance with the recommended use of facial protection. These factors include full-time work status, greater than 5 years tenure as a nurse, at least monthly use of facial protection, a belief that media coverage of infectious diseases impacts risk perception and work practices, and organizational support for health and safety. CONCLUSION Strategies and interventions based on these findings should result in enhanced compliance with facial protection and, ultimately, a reduction in occupational transmission of communicable respiratory illness.
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Affiliation(s)
- Kathryn Nichol
- Centre for Research Expertise in Occupational Disease, University of Toronto and St. Michael's Hospital, Toronto, Canada.
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Hall RC, Hall RC, Chapman MJ. The 1995 Kikwit Ebola outbreak: lessons hospitals and physicians can apply to future viral epidemics. Gen Hosp Psychiatry 2008; 30:446-52. [PMID: 18774428 PMCID: PMC7132410 DOI: 10.1016/j.genhosppsych.2008.05.003] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 05/09/2008] [Accepted: 05/14/2008] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This article looks at lessons learned from the 1995 Kikwit Ebola outbreak and suggests how modern hospitals should apply these lessons to the next lethal viral epidemic that occurs. METHOD The 1995 Kikwit Ebola outbreak in the Democratic Republic of the Congo (formally Zaire) is one of the most well studied epidemics to have occurred to date. Many of the lessons learned from identifying, containing and treating that epidemic are applicable to future viral outbreaks, natural disasters and bioterrorist attacks. This is due to Ebola's highly contagious nature and high mortality rate. RESULTS When an outbreak occurs, it often produces fear in the community and causes the basic practice of medicine to be altered. Changes seen at Kikwit included limited physical examinations, hesitance to give intravenous medications and closure of supporting hospital facilities. The Kikwit Ebola outbreak also provided beneficial psychological insight into how patients, staff and the general community respond to a biological crisis and how this will affect physicians working in an epidemic. CONCLUSIONS General lessons from the outbreak include the importance of having simple, well-defined triage procedures; staff who are flexible and able to adapt to situations with unknowns; and the need to protect staff physically and emotionally to ensure a sustained effort to provide care.
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Affiliation(s)
- Ryan C.W. Hall
- Case Western Reserve University, Cleveland, OH 44106, USA,Corresponding author. Tel.: +1 407 322 8199; fax: +1 407 322 8169
| | - Richard C.W. Hall
- Department of Psychiatry, University of South Florida, Lake Mary, FL 32746, USA
| | - Marcia J. Chapman
- Research Assistant, Richard C.W. Hall, M.D., P.A., Lake Mary, FL, USA
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Jefferson T, Foxlee R, Del Mar C, Dooley L, Ferroni E, Hewak B, Prabhala A, Nair S, Rivetti A. Interventions for the interruption or reduction of the spread of respiratory viruses. Cochrane Database Syst Rev 2007:CD006207. [PMID: 17943895 DOI: 10.1002/14651858.cd006207.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Viral epidemics or pandemics such as of influenza or severe acute respiratory syndrome (SARS) pose a significant threat. Antiviral drugs and vaccination may not be adequate to prevent catastrophe in such an event. OBJECTIVES To systematically review the evidence of effectiveness of interventions to interrupt or reduce the spread of respiratory viruses (excluding vaccines and antiviral drugs, which have been previously reviewed). SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 4); MEDLINE (1966 to November 2006); OLDMEDLINE (1950 to 1965); EMBASE (1990 to November 2006); and CINAHL (1982 to November 2006). SELECTION CRITERIA We scanned 2300 titles, excluded 2162 and retrieved the full papers of 138 trials, including 49 papers of 51 studies. The quality of three randomised controlled trials (RCTs) was poor; as were most cluster RCTs. The observational studies were of mixed quality. We were only able to meta-analyse case-control data. We searched for any interventions to prevent viral transmission of respiratory viruses (isolation, quarantine, social distancing, barriers, personal protection and hygiene). Study design included RCTs, cohort studies, case-control studies, cross-over studies, before-after, and time series studies. DATA COLLECTION AND ANALYSIS We scanned the titles, abstracts and full text articles using a standardised form to assess eligibility. RCTs were assessed according to randomisation method, allocation generation, concealment, blinding, and follow up. Non-RCTs were assessed for the presence of potential confounders and classified as low, medium, and high risk of bias. MAIN RESULTS The highest quality cluster RCTs suggest respiratory virus spread can be prevented by hygienic measures around younger children. Additional benefit from reduced transmission from children to other household members is broadly supported in results of other study designs, where the potential for confounding is greater. The six case-control studies suggested that implementing barriers to transmission, isolation, and hygienic measures are effective at containing respiratory virus epidemics. We found limited evidence that the more uncomfortable and expensive N95 masks were superior to simple surgical masks. The incremental effect of adding virucidals or antiseptics to normal handwashing to decrease respiratory disease remains uncertain. The lack of proper evaluation of global measures such as screening at entry ports and social distancing prevent firm conclusions about these measures. AUTHORS' CONCLUSIONS Many simple and probably low-cost interventions would be useful for reducing the transmission of epidemic respiratory viruses. Routine long-term implementation of some of the measures assessed might be difficult without the threat of a looming epidemic.
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Pratt RJ, Pellowe CM, Wilson JA, Loveday HP, Harper PJ, Jones SRLJ, McDougall C, Wilcox MH. epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2007; 65 Suppl 1:S1-64. [PMID: 17307562 PMCID: PMC7134414 DOI: 10.1016/s0195-6701(07)60002-4] [Citation(s) in RCA: 407] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were commissioned by the Department of Health (DH) and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were published in January 2001. These guidelines describe the precautions healthcare workers should take in three areas: standard principles for preventing HCAI, which include hospital environmental hygiene, hand hygiene, the use of personal protective equipment, and the safe use and disposal of sharps; preventing infections associated with the use of short-term indwelling urethral catheters; and preventing infections associated with central venous catheters. The evidence for these guidelines was identified by multiple systematic reviews of experimental and non-experimental research and expert opinion as reflected in systematically identified professional, national and international guidelines, which were formally assessed by a validated appraisal process. In 2003, we developed complementary national guidelines for preventing HCAI in primary and community care on behalf of the National Collaborating Centre for Nursing and Supportive Care (National Institute for Healthand Clinical Excellence). A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective in preventing HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. Consequently, the DH commissioned a review of new evidence published following the last systematic reviews. We have now updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the original epic guidelines published in 2001 remain robust, relevant and appropriate but that adjustments need to be made to some guideline recommendations following a synopsis of the evidence underpinning the guidelines. These updated national guidelines (epic2) provide comprehensive recommendations for preventing HCAI in hospitals and other acute care settings based on the best currently available evidence. Because this is not always the best possible evidence, we have included a suggested agenda for further research in each section of the guidelines. National evidence-based guidelines are broad principles of best practice which need to be integrated into local practice guidelines. To monitor implementation, we have suggested key audit criteria for each section of recommendations. Clinically effective infection prevention and control practice is an essential feature of protecting patients. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiring an infection during episodes of healthcare in NHS hospitals in England can be minimised.
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Affiliation(s)
- R J Pratt
- Richard Wells Research Centre, Faculty of Health and Human Sciences, Thames Valley University, London.
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Abstract
This review examines the literature, including literature in Chinese, on the effectiveness of handwashing as an intervention against severe acute respiratory syndrome (SARS) transmission. Nine of 10 epidemiological studies reviewed showed that handwashing was protective against SARS when comparing infected cases and non‐infected controls in univariate analysis, but only in three studies was this result statistically significant in multivariate analysis. There is reason to believe that this is because most of the studies were too small. The evidence for the effectiveness of handwashing as a measure against SARS transmission in health care and community settings is suggestive, but not conclusive.
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Gomersall CD, Tai DYH, Loo S, Derrick JL, Goh MS, Buckley TA, Chua C, Ho KM, Raghavan GP, Ho OM, Lee LB, Joynt GM. Expanding ICU facilities in an epidemic: recommendations based on experience from the SARS epidemic in Hong Kong and Singapore. Intensive Care Med 2006; 32:1004-13. [PMID: 16570146 DOI: 10.1007/s00134-006-0134-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2005] [Accepted: 02/22/2006] [Indexed: 11/24/2022]
Abstract
Epidemics have the potential to severely strain intensive care resources and may require an increase in intensive care capability. Few intensivists have direct experience of rapidly expanding intensive care services in response to an epidemic. This contribution presents the recommendations of an expert group from Hong Kong and Singapore who had direct experience of expanding intensive care services in response to the epidemic of severe acute respiratory syndrome. These recommendations cover training, infection control, staffing, communication and ethical issues. The issue of what equipment to purchase is not addressed. Early preparations should include fit testing of negative pressure respirators, training of reserve staff, sourcing of material for physical modifications to the ICU, development of infection control policies and training programmes, and discussion of triage and quarantine issues.
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Affiliation(s)
- Charles D Gomersall
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong, China.
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Gomersall CD, Joynt GM, Ho OM, Ip M, Yap F, Derrick JL, Leung P. Transmission of SARS to healthcare workers. The experience of a Hong Kong ICU. Intensive Care Med 2006; 32:564-9. [PMID: 16505989 PMCID: PMC7079890 DOI: 10.1007/s00134-006-0081-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Accepted: 01/18/2006] [Indexed: 02/04/2023]
Abstract
Objective To describe the extent and temporal pattern of transmission of severe acute respiratory syndrome (SARS) to intensive care unit staff. Design Retrospective observational cohort study. Setting University hospital intensive care unit, caring solely for patients with SARS or suspected to have SARS. Participants Thirty-five doctors and 152 nurses and healthcare assistants who worked in the ICU during the SARS epidemic. Interventions: Infection control measures designed to prevent transmission of disease to staff were implemented. Measurements and results Sixty-seven patients with SARS were admitted to the intensive care unit. Four nurses and one healthcare assistant contracted SARS, with three of these developing symptoms within 10 days of admission of the first patient with SARS. Doctors were exposed to patients with SARS for a median (IQR) of 284 (97–376) h, while nurses and healthcare assistants were exposed for a median (IQR) of 119 (57–166) h. The ICU did not meet international standards for physical space or ventilation. Conclusions In an ICU in which infection control procedures are rigorously applied, the risk to staff of contracting SARS from patients is low, despite long staff exposure times and a sub-standard physical environment. Electronic supplementary material The electronic reference of this article is http://dx.doi.org/10.1007/s00134-006-0081-1 The online full-text version of this article includes electronic supplementary material. This material is available to authorised users and can be accessed by means of the ESM button beneath the abstract or in the structured full-text article. To cite or link to this article you can use the above reference.
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Affiliation(s)
- Charles D Gomersall
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
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