The safety, health, and well-being of healthcare workers during COVID-19: A scoping review

Surveillance of SARS-CoV-2 in Healthcare Workers Before and After COVID-19 Vaccination: A Cohort Study in a Primary Care Unit of Brazil

INTRODUCTION

Healthcare workers (HCWs) are at higher risk of SARS-CoV-2 infection. Viral surveillance for early detection of COVID-19 is a critical strategy to understand this population's infection dynamics and prevent transmission. The study examines SARS-CoV-2 infection and reinfection among HCWs vaccinated against COVID-19 working at a primary healthcare unit serving a disenfranchised community in Brazil.

METHODS

The study was conducted in Cidade Estrutural, Federal District, Brazil, between February and October 2021. Participants were interviewed and provided samples. A prospective open cohort study was used to analyze the frequency of SARS-CoV-2 infection and reinfection, and the vaccine-induced seroconversion. Nasopharyngeal swab specimen was collected from workers presenting with flu-like symptoms and subjected to RT-qPCR. Peripheral blood samples were also collected every 30 ± 2 days for eight months, starting from the day participants received their first dose of COVID-19 vaccine, and submitted to serological testing (IgM and IgG chemiluminescence). The frequencies of infection and reinfection (RT-qPCR positive results 90 days after the infection) were calculated along with their respective confidence intervals (95% CI).

RESULTS

Of the 128 workers, 61 (47.65%; CI: 39.19-56.25) reported probable SARS-CoV-2 infection before vaccination and 50 (39.06%; CI: 31.04-47.71) had SARS-CoV-2 infection after vaccination, confirmed by molecular test. Reinfection was identified in seven workers (7/50, 14%; CI: 6.95-26.18) based on the 90-day interval between results. The serological data from the 128 workers during the cohort indicated that 68 (53.12%; CI: 44.5-61.5) had IgG antibodies and 46 had IgM antibodies (35.93%; CI: 28.14-44.54) against SARS-CoV-2. SARS-CoV-2 infection was common in 56% of the community health workers (CHWs), 50% of registered nurses, and licensed vocational nurses (33%). Following the COVID-19 vaccination, the percentage of infections among HCWs decreased from 47.83% to 4.35%.

CONCLUSION

These results demonstrate that (i) approximately 40% of the workers were infected with SARS-CoV-2 in 2021 and (ii) reinfections confirmed by RT-qPCR occurred in 14% of the HCWs after vaccination. The results provide valuable insights into the circulation of SARS-CoV-2 among HCWs in a primary care unit serving a minoritized community.

Digital Contact Tracing Implementation Among Leaders and Health Care Workers in a Pediatric Hospital During the COVID-19 Pandemic: Qualitative Interview Study

BACKGROUND

Health systems had to rapidly implement infection control strategies to sustain their workforces during the COVID-19 pandemic. Various outbreak response tools, such as digital contact tracing (DCT), have been developed to monitor exposures and symptoms of health care workers (HCWs). Limited research evidence exists on the experiences with these technologies and the impacts of DCT innovations from the perspective of stakeholders in health care environments.

OBJECTIVE

This study aims to identify the factors influencing the adoption of DCT, highlight variations in perspectives across 3 key stakeholder groups concerning the impact of DCT, and provide benchmarking evidence for future pandemic preparedness.

METHODS

Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we conducted an exploratory qualitative study to investigate the implementation and impact of DCT at the Children's Hospital of Eastern Ontario between December 2022 and April 2023. We conducted 21 semistructured interviews with key stakeholders, including health care administrators (6/21, 29%), occupational health and safety specialists (8/21, 38%), and HCWs (7/21, 33%). Stakeholders were asked about the factors influencing engagement with the DCT tool, organizational-level uptake, the implementation process, long-term use and sustainability of DCT, and unintended consequences. Verbatim transcripts were subject to thematic analysis using NVivo (QSR International).

RESULTS

The implementation of DCT was viable and well received. End users indicated that their engagement with the DCT tool was facilitated by its perceived ease of use and the ability to gain awareness of probable COVID-19 exposures; however, risk assessment consequences and access concerns were reported as barriers (reach). Participants commonly agreed that the DCT technology had a positive influence on the hospital's capacity to meet the demands of COVID-19 (effectiveness). Implementors and occupational specialists referred to negative staffing impacts and the loss of nuanced information as unintended consequences (effectiveness). Safety-focused communication strategies and having a DCT tool that was human-centered were crucial factors driving staff adoption of the technology. Conversely, adoption was challenged by the misaligned delivery of the DCT tool with HCWs' standard practices, alongside the evolving perceived threat of COVID-19. Stakeholders collectively agreed on the viability of DCT and its applicability to infectious disease practices (maintenance).

CONCLUSIONS

Hospital stakeholders were highly satisfied with DCT technology and it was perceived as feasible, efficient, and having a positive impact on organizational safety. Challenges related to the alignment and delivery of DCT, alongside the evolving perspectives on COVID-19, posed obstacles to continued adoption by HCWs. Our findings contribute to evidence-based practices and present benchmarks that can inform preparedness for future pandemics and infectious disease outbreaks and help other organizations implement similar technologies.

Safeguarding nurses' mental health: The critical role of psychosocial safety climate in mitigating relational stressors and exhaustion

Burnout among nurses is a pervasive concern in healthcare, with profound implications for patient care and nurse well-being. While research has highlighted the detrimental effects of burnout on many aspects of nursing, including patient safety and quality of care, the underlying mechanisms driving burnout warrant further investigation. In this cross-sectional study, we surveyed 196 nurses from diverse Italian hospitals using an online questionnaire via Qualtrics. Our findings revealed significant negative correlations between psychological safety climate and both relational stressors and emotional exhaustion. Conversely, relational stressors positively correlated with emotional exhaustion, and a significant negative indirect effect of psychological safety climate was found for emotional exhaustion through relational stressors, emphasizing the pivotal role of psychological safety climate in mitigating nurse burnout. Our study underscores the potential effectiveness of interventions targeting psychological safety climate and relational stressors in alleviating emotional exhaustion and burnout among nurses. Theoretical implications underscore the importance of deepening the role of psychological safety climate in mitigating emotional exhaustion, while practical implications emphasize the need for fostering a positive psychological safety climate and implementing targeted interventions to support nurses' well-being.

Anxiety, Depression, Social Support, Needs, and Concerns of Frontline Nurses during COVID-19 Peak Infection Period: A Cross-Sectional Multicenter Study

Background

The worldwide pandemic of COVID-19 had put enormous pressure on frontline healthcare workers. In December 2022, China released its "10 new measures," signaling the end of the "dynamic zero COVID-19 strategy." This triggered a period of peak infection, which shocked China's healthcare system and affected the mental health of nurses.

Objective

To explore the anxiety, depression, and social support levels of frontline nurses during the peak period of COVID-19 infection and to identify the main needs and concerns of nurses during this period.

Design

A multicenter cross-sectional study. Settings. 18 hospitals of different grades in three cities in Hunan Province from December 21, 2022, to January 10, 2023, the peak period of COVID-19 infection. Participants. A total of 4,160 nurses completed the survey.

Methods

The questionnaire included general information, symptoms, the preparation for nurses, GAD-7, PHQ-9, PSSS, and two open-ended questions investigating nurses' needs and concerns. General linear models were used to analyze the factors influencing anxiety. Hospital preparation for nurses, nurses' needs, and nurses' concerns were categorized and subjected to frequency counts.

Results

The median (P25, P75) scores for anxiety and depression among nurses were 7.00 (3, 12) and 8 (3, 12), respectively. Type of hospital, professional title, family structure, isolation staff lounge preparation, ibuprofen preparation, health status of parents, fever, chest distress, dyspnea, cough, insufficient protective equipment, number of children, and PSSS others were the influencing factors of GAD grades. The top 3 needs were free drugs and treatments (78.71%), shift breaks and paid leave (77.66%), and understanding and supports from hospitals and families (75.99%). The first three concerns were the fear of spreading the disease to family members (83.89%), the after-effects of infection (65.67%), and cross-infection with colleagues and patients (61.70%).

Conclusions

Nurses' anxiety was more severe during peak infection period. Overloaded work schedules and insufficient sleep became a common situation. Worries about family members became the main concern of nurses. Managers should make contingency plans for public health emergencies and provide frontline nurses with protective equipment, stress-relieving measures, and a rotation system. More importantly, they should pay attention to the needs of nurses' family members and provide medical and care support. The media should also explain how hospitals operate and carry out their duties during these extraordinary times in order for the public to comprehend the condition of frontline epidemic fighters.

Dissecting Loneliness in the Digital Age: An Insight into the Experiences of Medical Students Amid and Beyond the COVID-19 Pandemic

This narrative review explores loneliness among medical students, particularly heightened during the COVID-19 pandemic. This review aims to narratively describe how the digital age, both pre- and post-pandemic, influences loneliness and to assess the psychological effects of the pandemic on medical students. Our literature search, adhering to SANRA guidelines, scrutinized studies published in the last ten years focusing on loneliness among medical students. Our findings reveal that medical students experienced significant loneliness during the pandemic, attributed to virtual learning environments and decreased social interactions. Notably, the transition to online education has mitigated and exacerbated feelings of isolation. The review also highlights the dual role of social media in either alleviating or intensifying loneliness, depending on usage patterns and platform types. Overall, our study underscores the need for targeted interventions and support systems to address the mental well-being of medical students in the digital age and beyond, providing crucial insights for future research and policy-making in educational and psychological support frameworks.

Dissecting Loneliness in the Digital Age: An Insight into the Experiences of Medical Students Amid and Beyond the COVID-19 Pandemic

This narrative review explores loneliness among medical students, particularly heightened during the COVID-19 pandemic. This review aims to narratively describe how the digital age, both pre- and post-pandemic, influences loneliness and to assess the psychological effects of the pandemic on medical students. Our literature search, adhering to SANRA guidelines, scrutinized studies published in the last ten years focusing on loneliness among medical students. Our findings reveal that medical students experienced significant loneliness during the pandemic, attributed to virtual learning environments and decreased social interactions. Notably, the transition to online education has mitigated and exacerbated feelings of isolation. The review also highlights the dual role of social media in either alleviating or intensifying loneliness, depending on usage patterns and platform types. Overall, our study underscores the need for targeted interventions and support systems to address the mental well-being of medical students in the digital age and beyond, providing crucial insights for future research and policy-making in educational and psychological support frameworks.

Correlation between unproven therapies and delayed return-to-work for COVID-19-infected healthcare workers

The objective of this study is to investigate factors influencing the time to return to work (RTW) of HealthCare Workers (HCW) infected with COVID-19 during the initial wave of the pandemic in a southern French university hospital. Data collection of 170 HCW (between March 16 to June 1, 2020) included demographic and professional information, clinical profiles, comorbidities, medical management, therapies and RT-PCR results. The mean time to RTW was 15.6 days. Multivariate analyses revealed that the time to RTW was shorter among laboratory and emergency workers, while it was longer for HCW aged 40 to 49 years, at higher risk of severe illness, with a delayed negative SARS-CoV-2 PCR or those treated with azithromycin and/or hydroxychloroquine. This study highlights diverse factors affecting HCW RTW post-COVID-19 infection, underscoring the importance of exercising caution in administering unproven therapies to HCW during the early stages of a novel infectious pandemic.

What are effective strategies to respond to the psychological impacts of working on the frontlines of a public health emergency?

Background

The COVID-19 pandemic has disrupted the healthcare and public health sectors. The impact of working on the frontlines as a healthcare or public health professional has been well documented. Healthcare organizations must support the psychological and mental health of those responding to future public health emergencies.

Objective

This systematic review aims to identify effective interventions to support healthcare workers' mental health and wellbeing during and following a public health emergency.

Methods

Eight scientific databases were searched from inception to 1 November 2022. Studies that described strategies to address the psychological impacts experienced by those responding to a public health emergency (i.e., a pandemic, epidemic, natural disaster, or mass casualty event) were eligible for inclusion. No limitations were placed based on study design, language, publication status, or publication date. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Joanna Briggs Institute critical appraisal tools. Discrepancies were resolved through discussion and a third reviewer when needed. Results were synthesized narratively due to the heterogeneity of populations and interventions. Outcomes were displayed graphically using harvest plots.

Results

A total of 20,018 records were screened, with 36 unique studies included in the review, 15 randomized controlled trials, and 21 quasi-experimental studies. Results indicate that psychotherapy, psychoeducation, and mind-body interventions may reduce symptoms of anxiety, burnout, depression, and Post Traumatic Stress Disorder, with the lowest risk of bias found among psychotherapy interventions. Psychoeducation appears most promising to increase resilience, with mind-body interventions having the most substantial evidence for increases in quality of life. Few organizational interventions were identified, with highly heterogeneous components.

Conclusion

Promoting healthcare workers' mental health is essential at an individual and health system level. This review identifies several promising practices that could be used to support healthcare workers at risk of adverse mental health outcomes as they respond to future public health emergencies.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=203810, identifier #CRD42020203810 (PROSPERO).