An observational study to identify types of personal protective equipment breaches on inpatient wards

Avo, Cameron; Cawthorne, Katie-Rose; Walters, J; Healy, Brendan

doi:10.1016/j.jhin.2020.06.024

Cited by 11 publications

(16 citation statements)

References 6 publications

(6 reference statements)

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“…In moderate risk settings, where patients may have only suspected, or even unsuspected, covid-19, the use of more resource intensive and burdensome personal protective equipment of the kind deployed in high risk settings is very challenging. 24 25 One proposed alternative, or additional, measure to improve safety is therefore to redeploy healthcare workers from patient facing to non-patient facing roles if they or their households are more susceptible to severe disease. Our findings suggest that this may be a feasible policy for two reasons.…”

Section: Discussionmentioning

confidence: 99%

Risk of hospital admission with coronavirus disease 2019 in healthcare workers and their households: nationwide linkage cohort study

Shah

Wood

Gribben

et al. 2020

BMJ

299

282

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ObjectiveTo assess the risk of hospital admission for coronavirus disease 2019 (covid-19) among patient facing and non-patient facing healthcare workers and their household members.DesignNationwide linkage cohort study.SettingScotland, UK, 1 March to 6 June 2020.ParticipantsHealthcare workers aged 18-65 years, their households, and other members of the general population.Main outcome measureAdmission to hospital with covid-19.ResultsThe cohort comprised 158 445 healthcare workers, most of them (90 733; 57.3%) being patient facing, and 229 905 household members. Of all hospital admissions for covid-19 in the working age population (18-65 year olds), 17.2% (360/2097) were in healthcare workers or their households. After adjustment for age, sex, ethnicity, socioeconomic deprivation, and comorbidity, the risk of admission due to covid-19 in non-patient facing healthcare workers and their households was similar to the risk in the general population (hazard ratio 0.81 (95% confidence interval 0.52 to 1.26) and 0.86 (0.49 to 1.51), respectively). In models adjusting for the same covariates, however, patient facing healthcare workers, compared with non-patient facing healthcare workers, were at higher risk (hazard ratio 3.30, 2.13 to 5.13), as were household members of patient facing healthcare workers (1.79, 1.10 to 2.91). After sub-division of patient facing healthcare workers into those who worked in “front door,” intensive care, and non-intensive care aerosol generating settings and other, those in front door roles were at higher risk (hazard ratio 2.09, 1.49 to 2.94). For most patient facing healthcare workers and their households, the estimated absolute risk of hospital admission with covid-19 was less than 0.5%, but it was 1% and above in older men with comorbidity.ConclusionsHealthcare workers and their households contributed a sixth of covid-19 cases admitted to hospital. Although the absolute risk of admission was low overall, patient facing healthcare workers and their household members had threefold and twofold increased risks of admission with covid-19.

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Section: Discussionmentioning

confidence: 99%

Risk of hospital admission with coronavirus disease 2019 in healthcare workers and their households: nationwide linkage cohort study

Shah

Wood

Gribben

et al. 2020

BMJ

299

282

View full text Add to dashboard Cite

show abstract

“…Of the three studies investigating behaviour during COVID-19, all three studied healthcare workers (one in Germany, one in the US and one in Thailand) and one also studied the general public (In Thailand). 26, 52, 53 . All three looked at hand hygiene adherence; one also looked at face covering use.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of observational methods used to quantify personal protective behaviours among members of the public during the COVID-19 pandemic, and the concordance between observational and self-report measures in infectious disease health protection

Davies

Mowbray

Martin

et al. 2021

Preprint

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Objectives: To assess the quantity and quality of studies using an observational measure of behaviour during the COVID-19 pandemic, and to narratively describe the association between self-report and observational data for behaviours relevant to controlling an infectious disease outbreak. Design: Systematic review and narrative synthesis of observational studies. Data sources: We searched Medline, Embase, PsychInfo, Publons, Scopus and the Public Health England behavioural science LitRep database from inception to 17th September 2021 for relevant studies. Study selection: We included studies which collected observational data of at least one of three health protective behaviours (hand hygiene, face covering use and maintaining physical distance from others (social distancing) during the COVID-19 pandemic. Studies where observational data were compared to self-report data in relation to any infectious disease were also included. Data extraction and synthesis: We evaluated the quality of studies using the NIH quality assessment scale for observational studies, extracted data on sample size, setting and adherence to health protective behaviours, and synthesized results narratively. Results: Of 27,279 published papers on COVID-19 relevant health protective behaviours that included one or more terms relating to hand hygiene, face covering and social distancing, we identified 48 studies that included an objective observational measure. Of these, 35 assessed face covering use, 17 assessed hand hygiene behaviour and seven assessed physical distancing. The general quality of these studies was good. When expanding the search to all infectious diseases, we included 21 studies that compared observational versus self-report data. These almost exclusively studied hand hygiene. The difference in outcomes was striking, with self-report over-estimating observed adherence by up to a factor of five in some settings. In only four papers did self-report match observational data in any domains. Conclusions: Despite their importance in controlling the pandemic, we found remarkably few studies assessing protective behaviours by observation, rather than self-report, though these studies tended to be of reasonably good quality. Observed adherence tends to be substantially lower than estimates obtained via self-report. Accurate assessment of levels of personal protective behaviour, and evaluation of interventions to increase this, would benefit from the use of observational methods.

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“…Greater than half the NZ emergency consultant workforce surveyed are not aware of official breach of PPE policy in their hospital ED or breach criteria. (27) Although they report access to showers, approximately 75% of NZ ED SMOs report no policy for showering after breach, after shifts, or at home.…”

Section: Resultsmentioning

confidence: 99%

New Zealand Emergency Department COVID-19 Preparedness Survey

Howard

Chambers

Mohr

2021

Preprint

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Objective This research sought to assess the level of COVID-19 preparedness of Emergency Departments (EDs) in Aotearoa New Zealand (NZ) through the views of Emergency Medicine specialists working in District Health Boards around the country. Given the limited experience NZ hospitals have had with SARS-CoV-2, a comparison of current local practice with recent literature from other countries identifying known weaknesses may help prevent future healthcare worker infections in NZ. Methods A cross-sectional survey by convenience sample of New Zealand Emergency Specialists in November 2020 to evaluate preparedness of engineering, administrative policy, and PPE use. Results A total of 137 surveys were completed (32% response rate), revealing heterogeneity in NZ ED clinical work environments in November 2020. More than 10% of emergency specialists surveyed reported no access to negative pressure rooms. N95 fit testing was not done on 15 (11%). Most specialists (86%) work in EDs that cohort patients, about one-third (34%) do not use spotters during PPE doffing, few have policy regarding breaches in PPE, and most do not have required space for physical distancing in non-clinical areas. Initial PPE training, simulations and segregating patients were widespread but appear to be waning with persistent low SARS-CoV-2 prevalence. PPE shortages were not identified in NZ EDs, yet 13% of consultants did not indicate they would use respirators during aerosol generating procedures on COVID-19 patients. Treatment interventions including non-invasive ventilation and high flow nasal cannula were common. Many respondents reported high levels of stress attributable to predicted inadequate staffing and the state of overall preparedness in event of a second wave. Conclusions New Zealand emergency specialists identified significant gaps in COVID-19 preparedness, and they have a unique opportunity to translate lessons from other locations into local action. Proactive identification of weaknesses in hospital engineering, policy, and PPE practice in advance of future SARS-CoV-2 endemic transmission would be prudent.

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An observational study to identify types of personal protective equipment breaches on inpatient wards

Cited by 11 publications

References 6 publications

Risk of hospital admission with coronavirus disease 2019 in healthcare workers and their households: nationwide linkage cohort study

Risk of hospital admission with coronavirus disease 2019 in healthcare workers and their households: nationwide linkage cohort study

A systematic review of observational methods used to quantify personal protective behaviours among members of the public during the COVID-19 pandemic, and the concordance between observational and self-report measures in infectious disease health protection

New Zealand Emergency Department COVID-19 Preparedness Survey

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