Human Factor Considerations in Using Personal Protective Equipment in the COVID-19 Pandemic Context: Binational Survey Study

Empathy Unmasked: Patient Perception of Physician Empathy in an Oncologic Emergency Setting. A Randomized Controlled Trial Comparing Personal Protective Equipment Wear versus Unmasked Video Communication

BACKGROUND

Amidst the COVID-19 pandemic, telemedicine emerged as an important option that supports and facilitates clinical practice, however, its usefulness in emergency settings that treat patients with cancer is unclear.

OBJECTIVE

To evaluate patient perception of physician empathy in an emergency oncology setting, comparing video interaction to an in-person with personal protective equipment (PPE) approach.

METHODS

In this single-center, prospective, cross-sectional, survey-based randomized controlled trial, patients were randomized 1:1 for the concluding conversation done in-person which included either interacting with physicians wearing PPE or video interaction with physicians without PPE (virtual). Patients' perceptions of the physicians' relational empathy were assessed and compared for each group by using the Consultation and Relational Empathy (CARE) Measure and the Perception of Physician Compassion measure.

RESULTS

Patients (n = 106) in both the PPE and virtual arms provided favorable responses to all questions. The mean overall CARE scores for the PPE and virtual arms were 45.02 and 44.43, respectively (difference, 0.58 [95% CI: -2.10, 3.30]). Regarding the linear physician compassion scores, patients in the virtual arm appeared to consider physicians to be warmer (difference, -0.42 [95% CI: -0.87, 0.04]) but less pleasant (difference, 0.33 [95% CI: -0.40, 1.10]) than did patients in the PPE arm.

CONCLUSIONS

Cancer patients presenting to the emergency department perceive empathy and compassion equally when approached by physicians virtually without PPE or in person while wearing PPE. Virtual services for specific aspects of clinical practice during emergency department visits in an oncology setting can be implemented to ensure safer interactions between patients and physicians without compromising the physician-patient relationship.

Patients in isolation, their physical, environmental and mental health: An exploratory study

BACKGROUND

Strict patient isolation in hospital is associated with adverse health outcomes. However, there is a lack of high-quality evidence for effective interventions to improve safety and quality of care for these patients.

AIMS

To identify patient reported areas for improvement in the care of patients in hospital isolation and to determine the feasibility of collecting patient reported outcomes using validated tools.

METHODS

Design An exploratory mixed methods study. Setting A major metropolitan teaching hospital in Melbourne, Australia. Participants Patients in hospital isolation for transmissible infections. Data collection Data were collected by (1) phone interviews with patients in isolation and (2) seven validated measurement tools to assess cognition, loneliness, nutritional status, quality of life, anxiety and depression and physical activity. Data were collected between September and December 2021. Data analysis Interviews were transcribed and analysed using thematic analysis. Quantitative data were analysed descriptively including participant characteristics and outcome data.

RESULTS

Participants identified areas for improvement including activities to decrease boredom, more contact with staff to mitigate loneliness and increase comfort care, and formalised communication about clinical treatment and discharge plan. Patients with gastrointestinal symptoms were happier to be alone. There were operational challenges within the health service including delays and miscommunication. Only 70% of the participants completed all questionnaires.

CONCLUSION

This study identified areas for improvement in care of patients in isolation and demonstrated that collecting patient reported outcomes using validated tools was feasible. The results of this research will inform development of an intervention to manage adverse effects.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Patients in hospital isolation require additional consideration to ensure that their needs are met to avoid adverse outcomes. The patient experience and comfort can be negatively affected when fundamental care is lacking.

REPORTING METHOD (EQUATOR)

EQUATOR guidelines for Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR-RHS).

PATIENT OR PUBLIC CONTRIBUTION

Thirteen patients in hospital isolation agreed to participate in this study, sharing their experiences through interviews and assessment.

Burdens of infection control on healthcare workers: a scoping review

INTRODUCTION

Hospital-acquired infections (HAIs) pose a significant risk to patients, and are a major focus of infection prevention and control policies (IPC). One under-recognized reason for the generally poor compliance with IPC is that it is burdensome for healthcare workers (HCWs).

AIM

To identify the burdens of IPC for HCWs.

METHODS

PubMed and CINAHL were searched for studies published in English since 2000 regarding compliance with IPC and the burdens associated with compliance. After screening 1018 initial results, 25 articles were included in the final review.

RESULTS

Evidence was found for burdens including dermatological complications, headaches, sensory symptoms and time pressure. Tools designed to measure compliance with IPC have limitations, and rarely assess the burdens of compliance. A strong safety culture predicted positive compliance, while knowledge of the underlying rationale for IPC had a non-linear relationship with compliance.

CONCLUSION

Future research should clarify IPC-related burdens and how these may be minimized to achieve better compliance.

'Family members screaming for help makes it very difficult to don PPE'. A qualitative study on UK ambulance staff experiences of infection prevention and control practices during the COVID-19 pandemic

Background

During the first wave of the COVID-19 pandemic in the UK, ambulance staff continued to deliver direct patient care whilst simultaneously adapting to a considerable escalation in evolving infection prevention and control (IPC) practices.

Aim

To enable learning to benefit future planning, this qualitative article aims to describe ambulance staff's experiences of this rapid escalation of IPC practices.

Method

Three online surveys were presented during the acceleration, peak, and deceleration phases of the pandemic's first wave in the UK (2020). Overall, 18 questions contributed 14,237 free text responses that were examined using inductive thematic analysis at both descriptive and interpretive levels.

Findings

Many participants lacked confidence in policies related to the use of personal protective equipment (PPE) because of perceived inadequate supporting evidence, confusing communication, and low familiarity with items. Compliance with policy and confidence in PPE use were further influenced by discomfort, urgency, and perceptions of risk. Various suggestions were made to improve IPC practices within the work environment, including reducing unnecessary exposure through public education and remote triage improvements.

Discussion

Some participants' poor experiences of escalating IPC practices were shared with health care workers studied in other environments and in previous epidemics, emphasising the need for lessons to be learnt. PPE should be developed with consideration of ambulance staff's unique working environment and regular familiarisation training could be beneficial. Pragmatic, evidence-based, clearly communicated policies implemented with sufficient resources may protect staff and facilitate them to maintain standards of care delivery during a pandemic.

Effective communication between nursing professionals and patients after the implementation of mask-wearing requirements in the clinical setting: A cross-sectional study

This study aimed to evaluate staff nurses' perspectives on the use of face masks in effective communication and relationship management skills with patients in the hospital setting. The study surveyed registered nurses (RNs) who work with adult patients in different hospital units. An online survey was completed by RNs who were selected by convenience sampling. RNs' communication with patients was perceived as moderately affected by the use of face masks. Statistically significant differences were found when comparing communication with years of professional experience. Participants who had over 10 years of experience reported having greater difficulty in their communication with patients when using face masks. The effect of provider-patient relationship on effective nurse-patient face-mask communication was statistically significant and negative. This study shows that some participants found face masks used in the clinical setting may affect nurse-patient communication, as well as the nurses' ability to manage their relationships with patients. The findings of this study support the need for targeted research into effective communication strategies when face mask use is needed in the healthcare setting.

Literature review of physiological strain of personal protective equipment on personnel in the high-consequence infectious disease isolation environment

BACKGROUND

Heat strain and dehydration can affect an individual's physical and mental performance. The purpose of this review was to examine the literature for the impact of heat strain on health care workers (HCWs) who care for patients with high-consequence infectious diseases (HCIDs) while wearing personal protective equipment (PPE), discuss the risks of impaired safety caused by heat strain and dehydration in HCID environments, identify attempts to combat PPE-related heat strain, recognize limitations, and provide suggestions for further research.

METHODS

A literature search was performed in PubMed or MEDLINE and Google Scholar. Authors screened abstracts for inclusion criteria and reviewed articles if the abstracts were considered to include information relevant to the aim.

RESULTS

The search terms yielded 30 articles that were sorted based on environment setting, physiological impact, and interventions.

DISCUSSION

The safety of the HCWs and patients can be enhanced through the development and usage of cooler, more comfortable PPE materials and ensembles to help slow the rate of dehydration and support the regulation of core body temperature.

CONCLUSIONS

Heat strain caused by wearing PPE is an occupational health concern for HCWs in the high-risk environment, that is, HCID care. Future studies are needed to develop innovative PPE ensembles that can reduce heat strain and improve well-being.

Investigating the short-term effects of using full-body hospital personal protective equipment and changes in physical workload intensity on human physiological and cognitive performance

The present study investigated the short-term effects of using Personal Protective Equipment (PPE) and physical workload intensity on human physiological and cognitive performance among 21 males and 19 females. PPE1 consisted of a medical coverall and surgical mask, while PPE2 consisted of impermeable full-body coverall, shoe covers, latex gloves, N95 mask, and face shield. Objective assessments were heart rate, energy expenditure, core body temperature, clothing microclimate temperature and humidity, and cognitive performance were the continuous performance test and N-Back test. Subjective assessments included thermal sensation, perceived fatigue/skin wetness/clothing moisture. Using PPE2 and increased workload intensity significantly increased the values of all physiological parameters and the subjective ratings of fatigue, thermal sensation, skin wetness, and clothing moisture. Moreover, the participants' cognitive performance was not affected by the type of PPE.Practitioner summary: Healthcare workers are at the highest risk in the fight against pandemics. Therefore, these people are required to use personal protective equipment. Using this equipment may have difficulties. The results show physiological strain and higher subjective ratings associated with using full-body hospital PPE and increased physical workload.

Exploring staff perspectives on caring for isolated hospitalised patients during the COVID-19 pandemic: a qualitative study

BACKGROUND

Strict isolation of COVID-19 patients to prevent cross infection may inadvertently cause serious adverse outcomes including psychological harm, limitations to care, increased incidence of delirium, deconditioning and reduced quality of life. Previous research exploring the staff perspective of the effect of isolation on patients is limited. The aim of this study is to understand staff perceptions and interpretations of their experiences of the care and treatment of isolated patients and the impact of isolation on patients, families, and staff.

METHOD

This qualitative, exploratory study is set in a major metropolitan, quaternary hospital in Melbourne, Australia. Data was collected in focus groups with clinical and non-clinical staff and analysed using content analysis. The hospital ethics committee granted approval. Each participant gave informed verbal consent.

RESULTS

Participants included 58 nursing, medical, allied health, and non-clinical staff. Six main themes were identified: 1) Communication challenges during COVID-19; 2) Impact of isolation on family; 3) Challenges to patients' health and safety; 4) Impact on staff; 5) Challenging standards of care; 6) Contextual influences: policy, decision-makers and the environment.

CONCLUSION

Isolating patients and restricting visitors resulted in good pandemic management, but staff perceived it came at considerable cost to staff and consumers. Innovative communication technology may facilitate improved connection between all parties. Mental health support is needed for patients, families, and staff. Further research using a co-design model with input from patients, families and staff is recommended to determine appropriate interventions to improve care. Preventing the spread of infection is essential for good pandemic management, but the cost to consumers and staff must be mitigated. Preparation for future pandemics must consider workforce preparedness, adapted models of care and workflow.

"There is No Easy Way to Say This…": Communication Challenges in the COVID-19 Intensive Care Unit

How to cite this article: Venkateswaran V, Soni KD, Trikha A. "There is No Easy Way to Say This…": Communication Challenges in the COVID-19 Intensive Care Unit. Indian J Crit Care Med 2023;27(1):79-81.

Physical problems of prolonged use of personal protective equipment during the COVID-19 pandemic: A scoping review

BACKGROUND

It is widely believed that using personal protective equipment (PPE) provides high levels of protection for healthcare workers (HCWs) in the fight against coronavirus disease (COVID-19). However, the long-term use of PPE is inconvenient for HCWs and may cause physical discomfort. These factors could result in poor compliance and disrupt the health and safety of HCWs, which may negatively affect the patient's safety.

OBJECTIVE

This study aimed to investigate the literature for the purpose of collecting convincing evidence of HCWs' physical problems associated with PPE use during the COVID-19 pandemic.

METHODS

This scoping review was conducted using PubMed, Embase, ProQuest, Science Direct, Springer, Biomed Central, and Google Scholar to identify the related literature.

RESULTS

HCWs have experienced various physical disorders including skin, respiratory, musculoskeletal, nervous, urinary, and circulatory system problems that are associated with PPE in various body systems. Among these, skin problems were the most frequent physical problems.

CONCLUSIONS

The literature demonstrated the adverse impacts of using PPE on HCWs. Therefore, healthcare policymakers should take the appropriate measures to improve the work environment during the COVID-19 pandemic, which could consequently prevent and mitigate the adverse effects of using PPE.

Human Factors and Airway Management in COVID-19 Patients: The Perfect Storm?

The SARS-CoV-2 pandemic heavily impacted healthcare workers, increasing their physical and psychological workload. Specifically, COVID-19 patients' airway management is definitely a challenging task regarding both severe and acute respiratory failure and the risk of contagion while performing aerosol-generating procedures. The category of anesthesiologists and intensivists, the main actors of airway management, showed a poor psychological well-being and a high stress and burnout risk. Identifying and better defining the specific main SARS-CoV-2-related stressors can help them deal with and effectively plan a strategy to manage these patients in a more confident and safer way. In this review, we therefore try to analyze the relevance of human factors and non-technical skills when approaching COVID-19 patients. Lessons from the past, such as National Audit Project 4 recommendations, have taught us that safe airway management should be based on preoperative assessment, the planning of an adequate strategy, the optimization of setting and resources and the rigorous evaluation of the scenario. Despite, or thanks to, the critical issues and difficulties, the "take home lesson" that we can translate from SARS-CoV-2 to every airway management is that there can be no more room for improvisation and that creating teamwork must become a priority.

Maternal and neonatal characteristics, operative details and outcomes in COVID-19 positive parturients undergoing cesarean sections: A retrospective observational study

BACKGROUND AND AIMS

There is a marked inclination towards cesarean sections as the preferred mode of delivery in parturients with COVID-19 disease. However, the challenges associated with planning and performing a surgery in the COVID-19 setup are considerable. These factors may lead to widespread changes in obstetric decision-making, operative planning, and perioperative outcomes. Thus, our study aimed to study the clinical and logistical factors involved in cesarean sections in COVID-19 parturients.

MATERIAL AND METHODS

This was a retrospective observational study performed at a dedicated COVID-19 tertiary care center in India. All women undergoing cesarean section in the specially earmarked operating room between 1st May 2020 and 31st December 2020 were included in the study. The clinical characteristics, operative details, and neonatal details, along with maternal and fetal outcomes were noted and analyzed.

RESULTS

A total of 44 women underwent cesarean section during the study period, with elective and emergency surgeries numbering 22 each. No indication, apart from COVID-19 status, was listed in over one-fourth of the women (13/44). The most common preoperative comorbidity was hypothyroidism (12/44). Median surgical duration was 117.5 min (IQR 100-133), with a median of 7.5 (IQR 6-8.25) healthcare personnel in the OT. Over one-fourth (12/44) of the delivered babies had low birth weight, while 4.5% (2/44) tested positive for SARS-CoV-2.

CONCLUSION

COVID-19 status alone continues to be a common indication for cesarean section. Operative time is increased, but the number of healthcare personnel involved can be trimmed with proper planning. Maternal and fetal outcomes are largely positive, with low transmission rates, but a considerable proportion of low-birth-weight neonates.

Personal Protective Equipment for Liver Transplantation in SARS-CoV-2 Polymerase Chain Reaction-Positive Convalescing Recipients

Personal protective equipment (PPE) comes in several variations, and is the principal safety gear during the COVID-19 pandemic. Unfortunately, the user is severely impacted by its serious nonergonomic features. What PPE is appropriate for labor-intensive cases, like liver transplant (LT), remains unknown. We describe our experience with 2 types of PPE used during 2 separate LT performed in COVID-19 positive recipients. We conclude that for the safety of both health care workers and patients, hospitals should designate a few PPE kits for labor-intensive surgical procedures. These kits should include powered air-purifying respirators, or a similar loose-fitting powered air hood.

Impact of SARS-CoV-2 Virus (COVID-19) Preventative Measures on Communication: A Scoping Review

Introduction

Face coverings and distancing as preventative measures against the spread of the Coronavirus disease 2019 may impact communication in several ways that may disproportionately affect people with hearing loss. A scoping review was conducted to examine existing literature on the impact of preventative measures on communication and to characterize the clinical implications.

Method

A systematic search of three electronic databases (Scopus, PubMed, CINAHL) was conducted yielding 2,158 articles. After removing duplicates and screening to determine inclusion eligibility, key data were extracted from the 50 included articles. Findings are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews, including the PRISMA-ScR checklist.

Results

Studies fell into three categories: Studies addressing the impacts of personal protective equipment (PPE) and/or distancing on communication in healthcare contexts (n = 20); studies examining the impact of preventative measures on communication in everyday life (n = 13), and studies measuring the impact of face coverings on speech using acoustic and/or behavioral measures (n = 29). The review revealed that masks disrupt verbal and non-verbal communication, as well as emotional and social wellbeing and they impact people with hearing loss more than those without. These findings are presumably because opaque masks attenuate sound at frequencies above 1 kHz, and conceal the mouth and lips making lipreading impossible, and limit visibility of facial expressions. While surgical masks cause relatively little sound attenuation, transparent masks and face shields are highly attenuating. However, they are preferred by people with hearing loss because they give access to visual cues.

Conclusion

Face coverings and social distancing has detrimental effects that extend well beyond verbal and non-verbal communication, by affecting wellbeing and quality of life. As these measures will likely be part of everyday life for the foreseeable future, we propose that it is necessary to support effective communication, especially in healthcare settings and for people with hearing loss.

The use of personal protection equipment does not negatively affect paramedics' attention and dexterity: a prospective triple-cross over randomized controlled non-inferiority trial

BACKGROUND

The COVID-19 pandemic led to widespread use of personal protection equipment (PPE), including filtering face piece (FFP) masks, throughout the world. PPE. Previous studies indicate that PPE impairs neurocognitive performance in healthcare workers. Concerns for personnel safety have led to special recommendations regarding basic life support (BLS) in patients with a potential SARS-CoV-2 infection, including the use of PPE. Established instruments are available to assess attention and dexterity in BLS settings, respectively. We aimed to evaluate the influence of PPE with different types of FFP masks on these two neuropsychological components of EMS personnel during BLS.

METHODS

This was a randomized controlled non-inferiority triple-crossover study. Teams of paramedics completed three 12-min long BLS scenarios on a manikin after having climbed three flights of stairs with equipment, each in three experimental conditions: (a) without pandemic PPE, (b) with PPE including a FFP2 mask with an expiration valve and (c) with PPE including an FFP2 mask without an expiration valve. The teams and intervention sequences were randomized. We measured the shift in concentration performance using the d2 test and dexterity using the nine-hole peg test (NHPT). We compared results between the three conditions. For the primary outcome, the non-inferiority margin was set at 20 points.

RESULTS

Forty-eight paramedics participated. Concentration performance was significantly better after each scenario, with no differences noted between groups: d2 shift control versus with valve - 8.3 (95% CI - 19.4 to 2.7) points; control versus without valve - 8.5 (- 19.7 to 2.7) points; with valve versus without valve 0.1 (- 11.1 to 11.3) points. Similar results were found for the NHPT: + 0.3 (- 0.7 to 1.4), - 0.4 (- 1.4 to 0.7), 0.7 (- 0.4 to 1.8) s respectively.

CONCLUSION

Attention increases when performing BLS. Attention and dexterity are not inferior when wearing PPE, including FFP2 masks. PPE should be used on a low-threshold basis.

Original Research: Nurses' Experiences of Caring for Patients and Families During the COVID-19 Pandemic: Communication Challenges

OBJECTIVE

The purpose of this study was to gain a better understanding of the perceptions and experiences of nurses caring for patients and families under the COVID-19 pandemic's socially restrictive practices and policies.

BACKGROUND

The COVID-19 global pandemic has affected the delivery of health care to patients and their families, with many aspects altered because of the need for social distancing, social isolation, and visitation restriction policies. These policies have created communication challenges for interdisciplinary health care teams, patients, and families. As frontline caregivers, nurses have felt strongly the impact of these challenges.

METHODS

A qualitative descriptive study was conducted among 17 RNs who were caring for patients during the COVID-19 pandemic and were recruited via social media posts on Facebook, Twitter, and LinkedIn. Watson's theory of human caring served as the conceptual framework for the study.

RESULTS

Several themes emerged regarding nurses' experiences of communication with patients and families. These include communication challenges and barriers, prioritization, integration of group communication, nurse self-reflection, and acceptance of gratitude.

CONCLUSIONS

The study findings underscore the importance of nurses' communication with patients and families under the pandemic's restricted conditions. They demonstrate the value of nurses' ability to innovate in fostering all parties' participation in the plan of care, and highlight the comfort nurses provide to patients who are isolated from loved ones. Strategies that fostered communication were identified, as were areas for further research.

Impact of Masks on Speech Recognition in Adult Patients with and without Hearing Loss

INTRODUCTION

The coronavirus 2019 pandemic has altered how modern healthcare is delivered to patients. Concerns have been raised that masks may hinder effective communication, particularly in patients with hearing loss. The purpose of this study is to determine the effect of masks on speech recognition in adult patients with and without self-reported hearing loss in a clinical setting.

METHODS

Adult patients presenting to an otolaryngology clinic were recruited. A digital recording of 36 spondaic words was presented to each participant in a standard clinical exam room. Each word was recorded in 1 of 3 conditions: no mask, surgical mask, or N95 mask. Participants were instructed to repeat back the word. The word recognition score was determined by the percent correctly repeated.

RESULTS

A total of 45 participants were included in this study. Overall, the mean word recognition score was 87% without a mask, 78% with a surgical mask, and 61% with an N95 mask. Among the 23 subjects (51.1%) with self-reported hearing loss, the average word recognition score was 46% with an N95 mask compared to 79% in patients who reported normal hearing (p < 0.001).

CONCLUSION

Our results suggest that masks significantly decrease word recognition, and this effect is exacerbated with N95 masks, particularly in patients with hearing loss. As masks are essential to allow for safe patient-physician interactions, it is imperative that clinicians are aware they may create a barrier to effective communication.

Workplace Cognitive Failure among Nurses during the COVID-19 Pandemic

Numerous studies provide evidence of the physical and emotional strain experienced by nurses during the COVID-19 pandemic. However, little is known regarding the impact of this occupational strain on nurses’ cognitive function at work. The aim of this study was to identify factors associated with workplace cognitive failure in a sample of U.S. nurses during the COVID-19 pandemic. An online questionnaire was administered in May 2020 to Michigan nurses statewide via three nursing organizations (n = 695 respondents). Path analysis was conducted to test the parallel effects of frequency of contact with COVID patients and personal protective equipment (PPE) supply on workplace cognitive failure scores. Mediation effects of stress, sleep quality, secondary trauma, and work-related exhaustion were examined for each exposure. Results revealed significant indirect effects of all mediators except sleep quality of contact with COVID patients (cumulative indirect effect = 1.30, z = 6.33, p < 0.001) and PPE (cumulative indirect effect = −2.10, z = −5.22, p < 0.001) on cognitive failure. However, 58% of the PPE effect was direct. To reduce the risk of cognitive failure, healthcare organizations need to provide nurses with protective equipment and work environments that allow nurses to strengthen their resilience to extreme working conditions.

Biodegradable Nanofibrous Membranes for Medical and Personal Protection Applications: Manufacturing, Anti-COVID-19 and Anti-Multidrug Resistant Bacteria Evaluation

Biodegradable nanofibrous hybrid membranes of polyvinyl alcohol (PVA) with ZnO and CuO nanoparticles were manufactured and characterized, and their anti-COVID-19 and anti-multidrug resistant bacteria activities were also evaluated. The morphological structures of the prepared PVA composites nanofibers were observed by scanning electron microscope (SEM), which revealed a homogenous pattern of the developed nanofibers, with an average fibrous diameter of 200–250 nm. Moreover, the results of the SEM showed that the fiber size changed with the type and the concentration of the metal oxide. Moreover, the antiviral and antibacterial potential capabilities of the developed nanofibrous membranes were tested in blocking the viral fusion of SARS-COV-2, as a representative activity for COVID-19 deactivation, as well as for their activity against a variety of bacterial strains, including multi-drug resistant bacteria (MDR). The results revealed that ZnO loaded nanofibers were more potent antiviral agents than their CuO analogues. This antiviral action was attributed to the fact that inorganic metallic compounds have the ability to extract hydrogen bonds with viral proteins, causing viral rupture or morphological changes. On the other hand, the anti-multi-drug resistant activity of the prepared nanofibers was also evaluated using two techniques; the standard test method for determining the antimicrobial activity of immobilized antimicrobial agents under dynamic contact conditions and the standard test method for determining the activity of incorporated antimicrobial agents in polymeric or hydrophobic materials. Both techniques proved the superiority of the ZnO loaded nanofibers over the CuO loaded fibers. The results of the antiviral and antibacterial tests showed the effectiveness of such nanofibrous formulas, not only for medical applications, but also for the production of personal protection equipment, such as gowns and textiles.

Best-practices for preventing skin injury beneath personal protective equipment during the COVID-19 pandemic: A position paper from the National Pressure Injury Advisory Panel

COVID-19 has infected millions of patients and impacted healthcare workers worldwide. Personal Protective Equipment (PPE) is a key component of protecting frontline clinicians against infection. The benefits of PPE far outweigh the risks, nonetheless, many clinicians are exhibiting skin injury caused by PPE worn incorrectly. These skin injuries, ranging from lesions to open wounds are concerning because they increase the susceptibility of viral infection and transmission to other individuals. Early into the COVID-19 pandemic (April 2020), the U. S. National Pressure Injury Advisory Panel (NPIAP) developed a series of position statements to improve wear-ability of PPE and protect healthcare professionals and their patients as safe from harm as possible under the circumstances. The NPIAP positions, which were formed by conducting a systematic review of what was known at the time, include: (a) Prepare skin before and after wearing PPE with skin sealants, barrier creams and moisturisers; (b) Frequent PPE offloading to relieve pressure and shear applied to skin; (c) treat visible skin injuries immediately caused by PPE to minimise future infection; (d) non-porous dressings may provide additional skin protection, but lack evidence; (e) health systems should take care to educate clinicians about placement and personal hygiene related to handling PPE. Throughout all of these practices, handwashing remains a top priority to handle PPE. These NPIAP positions provided early guidance to reduce the risk of skin injury caused by PPE based on available research regarding PPE injuries, a cautious application of evidence-based recommendations on prevention of device-related pressure injuries in patients and the expert opinion of the NPIAP Board of Directors. Clinicians who adhere to these recommendations reduce the prospects of skin damage and long-term effects (e.g. scarring). These simple steps to minimise the risk of skin injury and reduce the risk of coronavirus infection from PPE can help.

The impact of personal protective equipment and social distancing on communication and relation between nurses, caregivers and children: a descriptive qualitative study in a maternal and child health hospital

AIMS AND OBJECTIVES

The main objective was to explore the impact of personal protective equipment and social distancing on nurses, caregivers and children's communication and relationship in a maternal and child health hospital.

BACKGROUND

The spread of COVID-19 pandemic made it necessary to apply infection prevention and control measures, including interpersonal distancing and the use of personal protective equipment. These measures may impact communication and relationship between nurses, patients and caregivers especially in a complex environment, such as a paediatric setting.

DESIGN

A qualitative descriptive study design was adopted. Reporting followed the COREQ guidelines.

METHODS

Semi-structured interviews were conducted in two wards of a maternal and child health hospital in north-east Italy. Data were collected between September and November 2020. Transcripts were analysed using inductive content analysis.

RESULTS

Seventeen caregivers and 17 nurses were recruited using convenience sampling. Three themes were identified, namely: "Impact on a trustworthy relationship"; "Impact on common communication resources"; and "Strategies to overcome barriers". Participants agreed Covid-19 infection prevention and control measures impacted key elements of family-centred and compassionate care. Communication strategies and play were critical to overcoming the barriers encountered.

CONCLUSIONS

COVID-19 containment measures impact communication and family-centred care in paediatric hospital settings. There is a need for stakeholders to consider family needs in interventions aimed at controlling pandemics' impact.

CLINICAL RELEVANCE

While COVID-19 pandemic urgency intensified the use of PPE and social distancing, strategies to overcome issues related to family-centred care should be considered in those wards such as oncology or infectious disease paediatric departments where these measures are continuously adopted. Beyond a greater communication awareness, strategies may comprise the implementation of virtual care to guarantee support, continuity of care and information between the child, the healthcare team and the family members that are not admitted to the hospital for safety reasons.

Impact of Face-to-Face Teaching in Addition to Electronic Learning on Personal Protective Equipment Doffing Proficiency in Student Paramedics: Protocol for a Randomized Controlled Trial

Background

The COVID-19 pandemic has brought attention to the importance of correctly using personal protective equipment (PPE). Doffing is a critical phase that increases the risk of contamination of health care workers. Although a gamified electronic learning (e-learning) module has been shown to increase the adequate choice of PPE among prehospital personnel, it failed to enhance knowledge regarding donning and doffing sequences. Adding other training modalities such as face-to-face training to these e-learning tools is therefore necessary to increase prehospital staff proficiency and thus help reduce the risk of contamination.

Objective

The aim of this study is to assess the impact of the Peyton 4-step approach in addition to a gamified e-learning module for teaching the PPE doffing sequence to first-year paramedic students.

Methods

Participants will first follow a gamified e-learning module before being randomized into one of two groups. In the control group, participants will be asked to perform a PPE doffing sequence, which will be video-recorded to allow for subsequent assessment. In the experimental group, participants will first undergo face-to-face training performed by third-year students using the Peyton 4-step approach before performing the doffing sequence themselves, which will also be video-recorded. All participants will then be asked to reconstruct the doffing sequence on an online platform. The recorded sequences will be assessed independently by two investigators: a prehospital emergency medicine expert and an infection prevention and control specialist. The assessors will be blinded to group allocation. Four to eight weeks after this first intervention, all participants will be asked to record the doffing sequence once again for a subsequent skill retention assessment and to reconstruct the sequence on the same online platform to assess knowledge retention. Finally, participants belonging to the control group will follow face-to-face training.

Results

The study protocol has been presented to the regional ethics committee (Req-2020-01340), which issued a declaration of no objection as such projects do not fall within the scope of the Swiss federal law on human research. Study sessions were performed in January and February 2021 in Geneva, and will be performed in April and June 2021 in Bern.

Conclusions

This study should help to determine whether face-to-face training using the Peyton 4-step approach improves the application and knowledge retention of a complex procedure when combined with an e-learning module.

International Registered Report Identifier (IRRID)

PRR1-10.2196/26927

Telemanagement of Home-Isolated COVID-19 Patients Using Oxygen Therapy With Noninvasive Positive Pressure Ventilation and Physical Therapy Techniques: Randomized Clinical Trial

Background

With the growing stress on hospitals caused by the COVID-19 pandemic, the need for home-based solutions has become a necessity to support these overwhelmed hospitals.

Objective

The goal of this study was to compare two nonpharmacological respiratory treatment methods for home-isolated COVID-19 patients using a newly developed telemanagement health care system.

Methods

In this single-blinded randomized clinical trial, 60 patients with stage 1 pneumonia caused by SARS-CoV-2 infection were treated. Group A (n=30) received oxygen therapy with bilevel positive airway pressure (BiPAP) ventilation, and Group B (n=30) received osteopathic manipulative respiratory and physical therapy techniques. Arterial blood gases of PaO₂ and PaCO₂, pH, vital signs (ie, temperature, respiratory rate, oxygen saturation, heart rate, and blood pressure), and chest computed tomography scans were used for follow-up and for assessment of the course and duration of recovery.

Results

Analysis of the results showed a significant difference between the two groups (P<.05), with Group A showing shorter recovery periods than Group B (mean 14.9, SD 1.7 days, and mean 23.9, SD 2.3 days, respectively). Significant differences were also observed between baseline and final readings in all of the outcome measures in both groups (P<.05). Regarding posttreatment satisfaction with our proposed telemanagement health care system, positive responses were given by most of the patients in both groups.

Conclusions

It was found that home-based oxygen therapy with BiPAP can be a more effective prophylactic treatment approach than osteopathic manipulative respiratory and physical therapy techniques, as it can impede exacerbation of early-stage COVID-19 pneumonia. Telemanagement health care systems are promising methods to help in the pandemic-related shortage of hospital beds, as they showed reasonable effectiveness and reliability in the monitoring and management of patients with early-stage COVID-19 pneumonia.

Trial Registration

ClinicalTrials.gov NCT04368923; https://clinicaltrials.gov/ct2/show/NCT04368923

Masked and distanced: a qualitative study of how personal protective equipment and distancing affect teamwork in emergency care

BACKGROUND

Newly intensified use of personal protective equipment (PPE) in emergency departments presents teamwork challenges affecting the quality and safety of care at the frontlines.

OBJECTIVE

We conducted a qualitative study to categorize and describe barriers to teamwork posed by PPE and distancing in the emergency setting.

METHODS

We conducted 55 semi-structured interviews between June 2020 and August 2020 with personnel from two emergency departments serving in a variety of roles. We then performed a thematic analysis to identify and construct patterns of teamwork challenges into themes.

RESULTS

We discovered two types of challenges to teamwork: material barriers related to wearing masks, gowns and powered air-purifying respirators, and spatial barriers implemented to conserve PPE and limit coronavirus exposure. Both material and spatial barriers resulted in disrupted communication, roles and interpersonal relationships, but they did so in unique ways. Material barriers muffled information flow, impeded team member recognition and role/task division, and reduced belonging and cohesion while increasing interpersonal strain. Spatial barriers resulted in mediated communication and added physical and emotional distance between teammates and patients.

CONCLUSION

Our findings identify specific aspects of how intensified PPE use disrupts teamwork and can inform efforts to ensure care quality and safety in emergency settings as PPE use continues during and, potentially beyond, the coronavirus disease-2019 pandemic.

Dispatched nurses' experience of wearing full gear personal protective equipment to care for COVID-19 patients in China-A descriptive qualitative study

Aims and objectives

We explored dispatched nurses’ experiences of wearing full gear personal protective equipment to care for patients with coronavirus disease‐2019 (COVID‐19) in Wuhan, China.

Background

Full gear personal protective equipment is the primary and foremost measure to prevent the contact and transmission of severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV2); however, working in full gear personal protective equipment may hinder nursing care activities and thus negatively affect patients’ and nurses’ health.

Design

This descriptive qualitative inquiry followed the COREQ guidelines.

Methods

Individual semi‐structured telephone interviews were conducted in a purposive sample of 15 frontline nurses who were dispatched to the outbreak epicentre from March to April 2020. Verbatim transcripts were content analysed.

Results

Four themes emerged from the data: inadequate preparedness for working with full gear personal protective equipment, full gear personal protective equipment stimulated stress responses, coping strategies and professional growth. Participants learned a great deal from problem‐focussed and emotion‐focussed strategies to tackle challenges related to the prolonged wearing of full gear personal protective equipment for quality nursing care and reduced risk of exposure. They became more vigilant to the adherence to evolving protocols and appropriate training concerning full gear personal protective equipment use.

Conclusions

Frontline nurses confronted various but diminishing challenges related to the use of full gear personal protective equipment when caring for patients with COVID‐19 across the approximate 40‐day period. Consistent use of coverall personal protective equipment to protect from SARS‐CoV‐2 in high exposure settings would be feasible if nurses were better prepared; therefore, scenario‐based skill training concerning the prolonged use of full gear personal protective equipment should be offered regularly and intensively.

Relevance to clinical practice

This study informs future decisions concerning improved full gear personal protective equipment‐related psychomotor training and promoting ways for nurses to cope with the stress that comes from working in highly contiguous environments.

Human factors engineering for medical devices: European regulation and current issues

A large proportion of the patient injuries or deaths attributable to medical device (MD) misuse can be eliminated and/or mitigated by adopting an effective human factors and ergonomics (HFE) approach. The implementation of a usability engineering process is now mandatory for MD manufacturers seeking to obtain the European Union's CE Mark. Here, we describe the European Union's HFE regulation and highlight the challenges faced by (i) manufacturers implementing this regulation and (ii) regulatory bodies charged with assessing the compliance of usability files. In Europe, 95% of MD manufacturers are small- and medium-sized enterprises; compliance with the CE Mark regulations is a real challenge to their competitiveness. Levels of knowledge about HFE vary greatly from one regulatory organization to another, which can sometimes lead to very different expectations. We also present the specific use-related risk management approach required by the HFE regulation. Lastly, we focus on the limitations of the HFE regulation for MDs and on future HFE challenges in further reducing and/or eliminating MD use errors. The main challenge is the need to go beyond technology design and the premarket assessment and to look at the postproduction stage; the coupling between an MD and a sociotechnical system can lead to consequences that were not predicted during the design process. This implies the need to consider the emerging properties of technologies in use by involving all the stakeholders.

Out-of-Hospital Cardiac Arrest in London during the COVID-19 pandemic

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We compared OHCA presentations in London during March and April 2019 and 2020

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There was an 81% increase in OHCAs during the first peak of the COVID-19 pandemic

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This increase was closely related to SARS-CoV-2 infection rates in London

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We report an increase in the rate of bystander CPR in London during the pandemic

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Outcomes following OHCA were significantly poorer during the COVID-19 pandemic

Aim

There is an emerging potential link between the COVID-19 pandemic and incidence and outcomes from out-of-hospital cardiac arrest (OHCA). We aimed to describe the incidence, characteristics and outcomes from OHCA in London, UK during the first wave of the pandemic.

Methods

We examined data for all OHCA patients attended by the London Ambulance Service from 1st March to 30th April 2020 and compared our findings to the previous year. We also compared OHCA characteristics and short-term outcomes for those suspected or confirmed to have COVID-19 with those who were not. Additionally, we investigated the relationship between daily COVID-19 cases and OHCA incidents.

Results

We observed an 81% increase in OHCAs during the pandemic, and a strong correlation between the daily number of COVID-19 cases and OHCA incidents (r = 0.828, p < 0.001). We report an increase in OHCA occurring in a private location (92.9% vs 85.5%, p < 0.001) and an increased bystander CPR (63.3% vs 52.6%, p < 0.001) during the pandemic, as well as fewer resuscitation attempts (36.4% vs 39.6%, p = 0.03) and longer EMS response times (9.3 vs 7.2 min, p < 0.001). Survival at 30 days post-arrest was poorer during the pandemic (4.4% vs 10.6%, p < 0.001) and amongst patients where COVID-19 was considered likely (1.0% vs 6.3%, p < 0.001).

Conclusions

During the first wave of the COVID-19 pandemic in London, we saw a dramatic rise in the incidence of OHCA, accompanied by a significant reduction in survival. The pattern of increased incidence and mortality closely reflected the rise in confirmed COVID-19 infections in the city.

Difficulties Encountered While Using PPE Kits and How to Overcome Them: An Indian Perspective

Background After a slow start due to an effective lockdown, the coronavirus disease 2019 (COVID-19) pandemic in India has been raging at a rapid pace, posing a formidable challenge to the healthcare system in the country. The personal protective equipment (PPE) undoubtedly provides a shield of protection for the healthcare workers (HCWs) fighting the disease as a valuable asset to the nation. However, there have been various problems associated with the PPE, ranging from its shortage to problems arising from heat, dehydration, etc while wearing them. There is a need to assess these problems faced by HCWs both qualitatively and quantitatively for their timely and effective redressal. Methods An electronic questionnaire survey was conducted among a cohort of HCWs who had performed COVID-19 duties and used PPE kits. The cohort consisted of different categories of doctors, nursing personnel, and other paramedical staff. Results The most common problems associated with using PPE kits was excessive sweating (100%), fogging of goggles, spectacles, or face shields (88%), suffocation (83%), breathlessness (61%), fatigue (75%), headache due to prolonged use (28%), and pressure marks on the skin at one or more areas on repeated use (19%). Occasional problems reported were skin allergy/dermatitis caused by the synthetic material of the PPE kit, face shield impinging onto the neck during intubation, and nasal pain, pain at the root of the pinna, and slipperiness of shoe covers. Various ways and means have been employed by the HCWs to actively address and solve these problems. Conclusion These plausible solutions will definitely help the HCWs to deal with and solve the problems arising out of the PPE use.

Subjective Deterioration of Physical and Psychological Health during the COVID-19 Pandemic in Taiwan: Their Association with the Adoption of Protective Behaviors and Mental Health Problems

This study aimed to determine the proportion of individuals who reported the deterioration of physical and psychological health during the coronavirus disease 2019 (COVID-19) pandemic in Taiwan. Moreover, the related factors of deterioration of physical and psychological health and the association between deterioration of health and adoption of protective behavior against COVID-19 and mental health problems were also examined. We recruited participants via a Facebook advertisement. We determined the subjective physical and psychological health states, cognitive and affective construct of health belief, perceived social support, mental health problems, adoption of protective behavior and demographic characteristics among 1954 respondents (1305 women and 649 men; mean age: 37.9 years with standard deviation 10.8 years). In total, 13.2% and 19.3% of respondents reported deteriorated physical and psychological health during the COVID-19 pandemic, respectively. Participants with higher perceived harm from COVID-19 compared with severe acute respiratory syndrome (SARS) were more likely to report the subjective deterioration of physical and psychological health, whereas respondents who were older and perceived a higher level of social support were less likely to report a deterioration of physical and psychological health. The subjective deterioration of psychological health was significantly associated with avoiding crowded places and wearing a mask. Both subjective deteriorations of physical and psychological health positively related to general anxiety.