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Broom J, Williams Veazey L, Broom A, Hor S, Degeling C, Burns P, Wyer M, Gilbert GL. Experiences of the SARS-CoV-2 pandemic amongst Australian healthcare workers: from stressors to protective factors. J Hosp Infect 2022; 121:75-81. [PMID: 34902500 PMCID: PMC8662954 DOI: 10.1016/j.jhin.2021.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The SARS-CoV-2 pandemic has critically challenged healthcare systems globally. Examining the experiences of healthcare workers (HCWs) is important for optimizing ongoing and future pandemic responses. OBJECTIVES In-depth exploration of Australian HCWs' experiences of the SARS-CoV-2 pandemic, with a focus on reported stressors vis-à-vis protective factors. METHODS Individual interviews were performed with 63 HCWs in Australia. A range of professional streams and operational staff were included. Thematic analysis was performed. RESULTS Thematic analysis identified stressors centred on paucity of, or changing, evidence, leading to absence of, or mistrust in, guidelines; unprecedented alterations to the autonomy and sense of control of clinicians; and deficiencies in communication and support. Key protective factors included: the development of clear guidance from respected clinical leaders or recognized clinical bodies, interpersonal support, and strong teamwork, leadership, and a sense of organizational preparedness. CONCLUSIONS This study provides insights into the key organizational sources of emotional stress for HCWs within pandemic responses and describes experiences of protective factors. HCWs experiencing unprecedented uncertainty, fear, and rapid change, rely on clear communication, strong leadership, guidelines endorsed by recognized expert groups or individuals, and have increased reliance on interpersonal support. Structured strategies for leadership and communication at team, service group and organizational levels, provision of psychological support, and consideration of the potential negative effects of centralizing control, would assist in ameliorating the extreme pressures of working within a pandemic environment.
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Affiliation(s)
- J Broom
- Sunshine Coast Health Institute, Birtinya, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
| | - L Williams Veazey
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, University of Sydney, New South Wales, Australia
| | - A Broom
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, University of Sydney, New South Wales, Australia
| | - S Hor
- Centre for Health Services Management, Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - C Degeling
- Centre for Health Engagement, Evidence and Values, University of Wollongong, New South Wales, Australia
| | - P Burns
- ANU Medical School, Hospital Road, Garran ACT, 2605, Australia; School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - M Wyer
- The Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, New South Wales, Australia; Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - G L Gilbert
- The Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, New South Wales, Australia; Westmead Institute for Medical Research, Westmead, New South Wales, Australia
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Young BC, Earle SG, Soeng S, Sar P, Kumar V, Hor S, Sar V, Bousfield R, Sanderson ND, Barker L, Stoesser N, Emary KR, Parry CM, Nickerson EK, Turner P, Bowden R, Crook DW, Wyllie DH, Day NP, Wilson DJ, Moore CE. Panton-Valentine leucocidin is the key determinant of Staphylococcus aureus pyomyositis in a bacterial GWAS. eLife 2019; 8:42486. [PMID: 30794157 PMCID: PMC6457891 DOI: 10.7554/elife.42486] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/21/2019] [Indexed: 02/07/2023] Open
Abstract
Pyomyositis is a severe bacterial infection of skeletal muscle, commonly affecting children in tropical regions, predominantly caused by Staphylococcus aureus. To understand the contribution of bacterial genomic factors to pyomyositis, we conducted a genome-wide association study of S. aureus cultured from 101 children with pyomyositis and 417 children with asymptomatic nasal carriage attending the Angkor Hospital for Children, Cambodia. We found a strong relationship between bacterial genetic variation and pyomyositis, with estimated heritability 63.8% (95% CI 49.2–78.4%). The presence of the Panton–Valentine leucocidin (PVL) locus increased the odds of pyomyositis 130-fold (p=10-17.9). The signal of association mapped both to the PVL-coding sequence and to the sequence immediately upstream. Together these regions explained over 99.9% of heritability (95% CI 93.5–100%). Our results establish staphylococcal pyomyositis, like tetanus and diphtheria, as critically dependent on a single toxin and demonstrate the potential for association studies to identify specific bacterial genes promoting severe human disease. Certain bacteria that normally live on the skin or in the nose without causing problems can sometimes lead to diseases elsewhere in the body. For example, the bacterium Staphylococcus aureus can cause blood infections or a severe and painful infection of the muscle called pyomyositis, which is very common in children who live in the tropics. Scientists believe that pyomyositis happens when S. aureus bacteria in the blood stream infect the muscles. Some strains of this bacteria are more likely to cause such infections, but why is unclear. One potential cause is a toxin produced by some S. aureus bacteria called Panton-Valentine leucocidin (PVL). So far, studies looking at whether PVL-producing bacteria are more likely to cause pyomyositis have had conflicting results. Now, Young et al. show that the gene for PVL is always present in S. aureus strains that cause pyomyosistis in Cambodian children, but is rarely found in S. aureus taken from the noses of their healthy counterparts. In the experiments, bacteria were collected from 101 children with pyomyositis and from the noses of 417 healthy children at the Angkor Hospital for Children in Cambodia over a 5-year period. The DNA in these bacteria were compared using very sensitive genetic techniques. The comparisons showed having the gene for PVL increased the odds of having pyomyositis 130-fold, showing that this one toxin likely accounts for much of the risk of developing this disease. If more studies confirm the link between PVL and pyomyositis, developing vaccines that block the gene for PVL might be one way to protect children in the tropics from developing this infection. Treating children with pyomyositis with antibiotics that reduce the production of the PVL toxin may also be helpful.
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Affiliation(s)
- Bernadette C Young
- Nuffield Department of Medicine, Experimental Medicine Division, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.,NIHR Oxford Biomedical Research Centre, Infection Theme, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Sarah G Earle
- Nuffield Department of Medicine, Experimental Medicine Division, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Sona Soeng
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Poda Sar
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Varun Kumar
- Department of Pediatrics, East Tennessee State University Quillen College of Medicine, Johnson City, United States
| | - Songly Hor
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Vuthy Sar
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Rachel Bousfield
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Nicholas D Sanderson
- Nuffield Department of Medicine, Experimental Medicine Division, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Leanne Barker
- Nuffield Department of Medicine, Experimental Medicine Division, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Nicole Stoesser
- Nuffield Department of Medicine, Experimental Medicine Division, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.,Public Health England Academic Collaborating Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Katherine Rw Emary
- NIHR Oxford Biomedical Research Centre, Infection Theme, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Christopher M Parry
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Emma K Nickerson
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Paul Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rory Bowden
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Derrick W Crook
- Nuffield Department of Medicine, Experimental Medicine Division, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.,NIHR Oxford Biomedical Research Centre, Infection Theme, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.,Public Health England Academic Collaborating Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - David H Wyllie
- Nuffield Department of Medicine, Experimental Medicine Division, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.,Public Health England Academic Collaborating Centre, John Radcliffe Hospital, Oxford, United Kingdom.,The Jenner Institute Laboratories, University of Oxford, Oxford, United Kingdom
| | - Nicholas Pj Day
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Daniel J Wilson
- Nuffield Department of Medicine, Experimental Medicine Division, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.,Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom.,Institute for Emerging Infections, Oxford Martin School, University of Oxford, Oxford, United Kingdom
| | - Catrin E Moore
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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