Avoiding SARS-CoV-2 infection in healthcare workers: is behavioral change the answer?

Background

The COVID-19 pandemic has become an important cause of morbimortality, and healthcare workers are at the highest risk of infection. As a result, policies and guidelines have been issued, and behavioral changes have been crucial in hospitals. Among these measures, the implementation of personal protective equipment (PPE) and its appropriate use in the workplace is key to avoiding contagion, as is understanding new measures regarding patient admission, distribution, constant education on virtual platforms, among others, and changing conduct to reduce contagion. However, behavioral change interventions in healthcare workers are challenging as contextual characteristics, attributes of the intervention, and psychological factors are involved.

Study objectives

The issue under investigation is the impact of COVID-19 on frontline healthcare workers in the emergency department of the Fundación Cardioinfantil (FCI). The objective was to describe their behavioral changes by studying and monitoring SARS-CoV-2 infection and their relationship through the tracing process in 2020.

Methods

We conducted a case study to identify and relate the SARS-CoV-2 infection rate within the personnel in the department and the response of healthcare workers to the implementation and adherence to the use of PPE through the analysis of the different variables that contributed to behavioral change. Data were collected by a single author and analyzed by two authors using both the individual-level logic model technique and the triangulation of information, with approval from the institutional review board.

Discussion

Several interventions for behavior change were registered in the data collection process. The data obtained indicated that implementation, embedding, and integration were perceived as collective and individual behavioral processes. This was supported by evidence from healthcare interventions, such as education, incentivization, training, restriction, environmental restructuring, modeling, and enablement.

Conclusion

Behavioral science should be part of public health responses, as the theoretical basis suggests that change may modify the response to avoid the transmission of infectious diseases. Therefore, individuals at the highest risk appear to adopt guidance with targeted behavior adaptation interventions. Efforts to inform, instruct, and motivate healthcare workers must be continuous, and actions at the community level must be strengthened, as it is human behavior that determines the spread and mortality of infectious diseases, where community compliance to preventive behaviors plays a crucial role.

Industrial exoskeletons from bench to field: Human-machine interface and user experience in occupational settings and tasks

Objective

Work-related musculoskeletal disorders (WRMSDs) are considered nowadays the most serious issue in the Occupational Health and Safety field and industrial exoskeletons appear to be a new approach to addressing this medical burden. A systematic review has been carried out to analyze the real-life data of the application of exoskeletons in work settings considering the subjective responses of workers.

Methods

The review was registered on PROSPERO. The literature search and its report have been performed following the PRISMA guidelines. A comprehensive literature search was performed in PubMed, EMBASE, Web of Science, and Scopus.

Results

Twenty-four original studies were included in the literature review; 42% of the papers retrieved included automobilist industry workers, 17% of the studies evaluated the use of exoskeletons in logistic facilities, and 17% of articles involved healthcare. The remaining six papers recruited farmers, plasterers, wasting collectors, construction workers, and other workmen. All the papers selected tested the use of passive exoskeletons, supporting upper arms or back. Usability, perceived comfort, perceived exertion and fatigue, acceptability and intention to use, occupational safety and health, and job performance and productivity were the main topic analyzed.

Conclusion

Exoskeletons are not a fix-all technology, neither for workers nor for job tasks; they tend to show more of their potential in static activities, while in dynamic tasks, they can obstacle regular job performance. Comfort and easiness of use are the key factors influencing the user's experience. More research is needed to determine the most effective and safe ways to implement exoskeleton use in occupational settings.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=275728, identifier CRD42021275728.

Influence of different protection levels of PPE on nurses' physical fatigue during the COVID-19 pandemic

BACKGROUND

The continuous spread of COVID-19 globally has led to busier medical practices and nurses are having to provide medical services to patients while suffering from high levels of fatigue.

OBJECTIVE

This study experimentally investigated the influence of different levels of personal protection equipment (PPE) on nurses' physical fatigue.

METHODS

We collected data from 12 participants by simulating a series of nursing tasks. The participants wore one of three different protection levels of PPE, and data recording their heart rate (HR), oral temperature, task completion time, and subjective fatigue were collected. Following this, relationship models between subjective fatigue and objective fatigue indices was established using multiple linear regression analysis.

RESULTS

By analyzing the variation trends of single indices of HR, oral temperature, task completion time, and subjective fatigue, it was found that the higher the level of protection levels of PPE worn by the participants, the higher the degree of fatigue experienced by them. In addition, taking subjective fatigue variation as the dependent variable and objective fatigue indices as independent variables, relationship models of the three different protection levels of PPE were established.

CONCLUSIONS

The results confirmed the influence of different protection levels of PPE on nurses' physical fatigue levels. They also provide a basis for medical administrators to monitor the degree of fatigue experienced by nurses, attempt to arrange nurses' work content accordingly, and schedule suitably to combat and manage recorded increases in fatigue.

Investigating the Effective Factors of Using Personal Protective Equipment from the Perspective of Nurses Caring for COVID-19 Patients: A Cross-Sectional Study

Considering the importance of appropriate personal protective equipment (PPE) for preventing COVID-19 transmission, the aim of this study was to investigate the factors affecting the use of PPE from the perspective of the nurses caring for COVID-19 patients. This descriptive cross-sectional study surveyed 240 nurses working in the central COVID-19 hospitals of Arak, Iran. Nurses were enrolled in the study by a convenience sampling method. The data collection tool was a validated questionnaire. Data were analyzed by SPSS 16 software using descriptive statistics, analysis of variance (ANOVA), and independent sample t-test. Environmental (4.24 ± 0.45), personal (4.16 ± 0.42), and organizational (4.04 ± 0.50) factors all contribute significantly to nursing attitudes about PPE use (p < 0.05). The average score, combining all identified factors, was 4.15 ± 0.31. The most influential factor contributing to appropriate use of PPE was environmental, while the least impactful parameters were related to rules and regulations. Environmental factors have the greatest impact on the use of PPE from the perspective of the nurses caring for patients with COVID-19. Managers and healthcare organizations should provide appropriate and adequate PPE to nurses, educate them on proper use, and monitor the process to resolve barriers.

Precautionary Measures: Performing ERCP on a Patient With Juxtapapillary Duodenal Diverticula (JPDD)-Related Biliary Stone After COVID-19 Lockdown Restriction Lifted in Wuhan, China

On April 8, 2020, after nearly 3 months of battling against the outbreak of COVID-19, Wuhan, where the pandemic began, began easing lockdown restrictions. However, given that asymptomatic carriers could continue to lead to transmission of COVID-19 during the very early stages, the endoscopists have taken precautions and conduct risk assessments to perform endoscopic intervention in this transition stage. Here, we have reported an urgent ERCP in a patient with acute pancreatitis secondary to JPDD-related biliary stone. Based on our experiences, the objective is to provide practical suggestions for the safe resumption of ERCP procedures in the setting of the COVID-19 pandemic with specific focus on patient risk assessment, personal protection equipment (PPE), and dress code modalities, all of which have been implemented in our hospital to reduce the risk of viral transmission.

Beyond the PPE shortage: Improperly fitting personal protective equipment and COVID-19 transmission among health care professionals

Background: Personal protective equipment (PPE) use is required when caring for COVID-19 patients. Proper mask fitting is essential in prevention of infectious agent transmission at hospital setting.Methods and Results: We describe three cases of health care professionals (HCP) in a COVID-19 designated ward with positive SARS-CoV-2 RT-PCR results, and were found to have improperly fitted masks.Conclusion: These cases of improperly fitting masks in HCP may have contributed to their eventual COVID-19 infection. These cases raise the important issue of PPE fitting. Abbreviations: Personal Protective Equipment (PPE), Health Care Professional (HCP), Real-time PCR (RT-PCR).

Headaches Associated With Personal Protective Equipment - A Cross-Sectional Study Among Frontline Healthcare Workers During COVID-19

BACKGROUND

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease of pandemic proportions. Healthcare workers in Singapore working in high-risk areas were mandated to wear personal protective equipment (PPE) such as N95 face mask and protective eyewear while attending to patients.

OBJECTIVES

We sought to determine the risk factors associated with the development of de novo PPE-associated headaches as well as the perceived impact of these headaches on their personal health and work performance. The impact of COVID-19 on pre-existing headache disorders was also investigated.

METHODS

This is a cross-sectional study among healthcare workers at our tertiary institution who were working in high-risk hospital areas during COVID-19. All respondents completed a self-administered questionnaire.

RESULTS

A total of 158 healthcare workers participated in the study. Majority [126/158 (77.8%)] were aged 21-35 years. Participants included nurses [102/158 (64.6%)], doctors [51/158 (32.3%)], and paramedical staff [5/158 (3.2%)]. Pre-existing primary headache diagnosis was present in about a third [46/158 (29.1%)] of respondents. Those based at the emergency department had higher average daily duration of combined PPE exposure compared to those working in isolation wards [7.0 (SD 2.2) vs 5.2 (SD 2.4) hours, P < .0001] or medical ICU [7.0 (SD 2.2) vs 2.2 (SD 0.41) hours, P < .0001]. Out of 158 respondents, 128 (81.0%) respondents developed de novo PPE-associated headaches. A pre-existing primary headache diagnosis (OR = 4.20, 95% CI 1.48-15.40; P = .030) and combined PPE usage for >4 hours per day (OR 3.91, 95% CI 1.35-11.31; P = .012) were independently associated with de novo PPE-associated headaches. Since COVID-19 outbreak, 42/46 (91.3%) of respondents with pre-existing headache diagnosis either "agreed" or "strongly agreed" that the increased PPE usage had affected the control of their background headaches, which affected their level of work performance.

CONCLUSION

Most healthcare workers develop de novo PPE-associated headaches or exacerbation of their pre-existing headache disorders.