scholarly journals Critical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global, Multidisciplinary Approach

2020 ◽  
Vol 29 (6) ◽  
pp. e116-e127
Author(s):  
Vinciya Pandian ◽  
Linda L. Morris ◽  
Martin B. Brodsky ◽  
James Lynch ◽  
Brian Walsh ◽  
...  

Purpose Critical care nurses caring for patients with a tracheostomy are at high risk because of the predilection of SARS-CoV-2 for respiratory and mucosal surfaces. This review identifies patient-centered practices that ensure safety and reduce risk of infection transmission to health care workers during the coronavirus disease 2019 (COVID-19) pandemic. Methods Consensus statements, guidelines, institutional recommendations, and scientific literature on COVID-19 and previous outbreaks were reviewed. A global interdisciplinary team analyzed and prioritized findings via electronic communications and video conferences to develop consensus recommendations. Results Aerosol-generating procedures are commonly performed by nurses and other health care workers, most notably during suctioning, tracheostomy tube changes, and stoma care. Patient repositioning, readjusting circuits, administering nebulized medications, and patient transport also present risks. Standard personal protective equipment includes an N95/FFP3 mask with or without surgical masks, gloves, goggles, and gown when performing aerosol-generating procedures for patients with known or suspected COVID-19. Viral testing of bronchial aspirate via tracheostomy may inform care providers when determining the protective equipment required. The need for protocols to reduce risk of transmission of infection to nurses and other health care workers is evident. Conclusion Critical care nurses and multidisciplinary teams often care for patients with a tracheostomy who are known or suspected to have COVID-19. Appropriate care of these patients relies on safeguarding the health care team. The practices described in this review may greatly reduce risk of infectious transmission.

Author(s):  
Subhash Chand ◽  
Neeraj Sharma ◽  
Sanjay Kumar

Background: To know adverse effects of prolonged use of (PPE) personal protective equipment among various categories of health care providers while taking care of COVID-19 patients.Methods: This study include health care workers involved in care of covid-19 positive patients admitted in COVID dedicated hospital. A preformed questionnaire based performa was distributed among health care providers. Questions were framed about various possible adverse effects of use of PPE. Duration of study was six month from first July 2020 to 31 December 2020. The data was obtained from questionnaire and thereafter analysed to determine the adverse effects of different parts of PPE among various categories of HCPs depending on their age, sex and duration of exposure.Results: A total of 150 health care workers of various categories were surveyed. Maximum numbers of health care workers were in the age group of 31-40 years. Most common side effects were itching, rash, suffocation and impaired cognition. N-95 masks, gloves and face shield when used caused maximum discomfort.Conclusions: COVID-19 is ongoing pandemic with uncertinity about its end. Health care workers are continuously exposed to COVID-19 positive patients and almost all the healthcare providers experienced discomfort while using PPE causing reduced work efficiency.


2020 ◽  
Vol 29 (3) ◽  
pp. 1320-1334 ◽  
Author(s):  
Charissa J. Zaga ◽  
Vinciya Pandian ◽  
Martin B. Brodsky ◽  
Sarah Wallace ◽  
Tanis S. Cameron ◽  
...  

Purpose As the COVID-19 pandemic has unfolded, there has been growing recognition of risks to frontline health care workers. When caring for patients with tracheostomy, speech-language pathologists have significant exposure to mucosal surfaces, secretions, and aerosols that may harbor the SARS-CoV-2 virus. This tutorial provides guidance on practices for safely performing patient evaluation and procedures, thereby reducing risk of infection. Method Data were collated through review of literature, guidelines, and consensus statements relating to COVID-19 and similar high-consequent infections, with a focus on mitigating risk of transmission to health care workers. Particular emphasis was placed on speech-language pathologists, nurses, and other allied health professionals. A multinational interdisciplinary team then analyzed findings, arriving at recommendations through consensus via electronic communications and video conference. Results Reports of transmission of infection to health care workers in the current COVID-19 pandemic and previous outbreaks substantiate the need for safe practices. Many procedures routinely performed by speech-language pathologists have a significant risk of infection due to aerosol generation. COVID-19 testing can inform level of protective equipment, and meticulous hygiene can stem spread of nosocomial infection. Modifications to standard clinical practice in tracheostomy are often required. Personal protective equipment, including either powered air-purifying respirator or N95 mask, gloves, goggles, and gown, are needed when performing aerosol-generating procedures in patients with known or suspected COVID-19 infection. Conclusions Speech-language pathologists are often called on to assist in the care of patients with tracheostomy and known or suspected COVID-19 infection. Appropriate care of these patients is predicated on maintaining the health and safety of the health care team. Careful adherence to best practices can significantly reduce risk of infectious transmission.


2020 ◽  
Vol 35 (4) ◽  
pp. 434-437
Author(s):  
Li-Chien Chien ◽  
Christian K. Beÿ ◽  
Kristi L. Koenig

AbstractThe COVID-19 pandemic has strained health care system resources and reduced the availability of life-sustaining and medical-grade personal protective equipment (PPE) though the combination of increased demand and disrupted manufacturing supply chains. As a result of these shortages, many health care providers have temporarily used largely untested, improvised PPE (iPPE). Lack of quality control for makeshift PPE and frequent repurposing of used items to conserve supplies increase both the risk of provider infection and nosocomial spread to uninfected patients. One strategy to reduce risk of infection and preserve existing equipment is the implementation of secondary barrier devices placed directly over patients or providers. The authors describe an inexpensive, disposable, positive-pressure head isolation unit that can be rapidly constructed from materials readily available in nearly all health care settings for under five US dollars. The unit was successfully deployed in Taiwan during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, and again during the COVID-19 pandemic. The iPPE worn directly by the health care workers (HCWs) can be donned prior to patient contact in the presence of an air source. This strategy may be more protective than a covering placed over the patient in an aerosol-generating environment, which requires the HCW to be in close contact with the patient prior to securing the protective device.


2020 ◽  
Author(s):  
Yongxing Li ◽  
Yong Wang ◽  
Yuhui Li ◽  
Ming Zhong ◽  
Huihui Liu ◽  
...  

Abstract Background During the COVID-19 pandemic, not only was there a lack of personal protective equipment (PPE) for health care workers but a dearth in training in respect of its donning and doffing. This study compared two training methods for donning and doffing PPE in order to teach health care workers how to do so more effectively and quickly. Method A total of 48 health care workers were recruited and randomly divided into two groups. Group A watched a 10-minute demonstration (demo) video repeated four times, while Group B watched the same demo video twice followed by a 10-minute live demo twice. The learning time of both groups was the same, and an examination was performed immediately after the completion of training. The examination scores of Group A and Group B were recorded according to the checklist (Appendix 1). The time taken for the participants to don and doff PPE, their satisfaction with the training, and the confidence to don and doff PPE were analyzed. Results The average score of Group B was better than that of Group A, with a mean (SD) of 94.92 (1.72) vs. 86.63 (6.34), respectively (P < 0.001). The average time spent by Group B to do the examination was shorter than that of Group A, with a mean (SD) of 17.67 (1.01) vs. 21.75 (1.82), respectively (P < 0.001). The satisfaction and confidence of Group B were higher than those of group A (P < 0.001). Conclusions Compared with repeated video-watching learning, the video-watching plus a live demonstration teaching method is more suitable for health care workers to learn how to put on and remove personal protective equipment.


2020 ◽  
Vol 11 (SPL1) ◽  
pp. 628-631
Author(s):  
Devangi Agrawal ◽  
Namisha Khara ◽  
Bhushan Mundada ◽  
Nitin Bhola ◽  
Rajiv Borle

In the wake of the current outbreak of novel Covid-19, which is now declared as a 'pandemic' by the WHO, people around the globe have been dealing with a lot of difficulties. This virus had come into light in December 2019 and since then has only grown exponentially. Amongst the most affected are the ones who have been working extremely hard to eradicate it, which includes the hospitals, dental fraternity and the health-care workers. These people are financially burdened due to limited practise. In the case of dentistry, to avoid the spread of the virus, only emergency treatments are being approved, and the rest of the standard procedures have been put on hold. In some cases, as the number of covid cases is rising, many countries are even trying to eliminate the emergency dental procedures to divert the finances towards the treatment of covid suffering patients. What we need to realise is that this is probably not the last time that we are facing such a situation. Instead of going down, we should set up guidelines with appropriate precautionary measures together with the use of standardised PPEs. The government should also establish specific policies to support dental practices and other health-care providers. Together, we can fight this pandemic and come out stronger.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dereje Tsegaye ◽  
Muluneh Shuremu ◽  
Dereje Oljira ◽  
Sileshi Dubale ◽  
Getachew Befekadu ◽  
...  

Abstract Background Novel-coronavirus 2019 (COVID-19) disease is currently a worldwide health risk and public health emergency concern. The virus is transmitted from an infected person to another person through close contact and droplets. Frontline health care workers are the most at risk of infection, and so a WHO interim guidance document was issued by the World Health Organization (WHO) which underscores the importance of proper sanitation and waste management practices for COVID- 19 in health-care settings. This study aimed at assessing knowledge and preventive practices towards Covid-19 among health care providers in selected health facilities of Illu Aba Bor and Buno Bedele zones, Southwest Ethiopia. Methods An institution-based cross-sectional study was conducted from April to May 2020 among 330 health workers in selected health facilities of Illu Aba Bor and Buno-Bedelle Zones, Southwest Ethiopia. Data were collected using a self-administered structured questionnaire. The collected data were entered into Epidata version 3.1 and exported to SPSS version 23 for analysis. Bivariate and multivariable logistic regression analysis was used to identify independent predictors of preventive practices towards Covid-19. Statistical significance was declared at a p-value of < 0.05. Result The majority of respondents (93.3%) demonstrated good knowledge of COVID-19, and the mean (SD) knowledge score was 9.04 ± 1.06. Nearly two-thirds (64.2%) of the study participants had good infection prevention practices. Being male (AOR = 3.65, 95% CI: (1.96, 6.80)), education level (AOR = 1.82, 95% CI (1.02, 3.22)), profession (AOR = 3.17, 95% CI (1.08, 9.33)), service year (5–10 years) (AOR = 2.00 (1.02, 3.92)) and more than 10 years (AOR = 3.14 (1.51, 6.52)), availability of personal protective equipment (AOR = 1.96 (1.06, 3.61)) and Knowledge level (AOR = 2.61 (1.48, 4.62)) were independent predictors of COVID-19 preventive practices. Conclusion The overall level of knowledge of HCWs was good. However, the practice was relatively low. Gender, educational status, profession, year of service, knowledge towards COVID-19, and availability of personal protective equipment were independent predictors of good infection prevention practices. Optimizing the infection prevention and control loop of the health facilities is recommended.


Author(s):  
Meike M. Neuwirth ◽  
Frauke Mattner ◽  
Robin Otchwemah

AbstractAdherence observations of health care workers (HCW) revealed deficiencies in the use of recommended personal protective equipment (PPE) among HCW caring in COVID-19 and non-COVID-19 wards during the first period of the SARS-CoV-2 pandemic in a university hospital in Germany. The adherence to wearing surgical face or FFP2-masks and disinfecting hands prior to donning and after doffing the PPE was significantly higher in COVID-19 wards However, there was no total adherence of 100% in COVID-19 wards.


2021 ◽  
Vol 9 ◽  
Author(s):  
Manisha Naithani ◽  
Meenakshi Khapre ◽  
Rajesh Kathrotia ◽  
Puneet Kumar Gupta ◽  
Vandana Kumar Dhingra ◽  
...  

Background: Occupational health hazard pertaining to health care providers is one of the neglected areas that need serious attention. Any compromise in their safety would result in reduction in workforce, which may affect patient care, keeping in mind the wide gap between the required number and actual health care workers (HCWs) available in the world over.Aim: This study was undertaken to evaluate the change in knowledge through a sensitization training program on occupational health hazards and vaccination for HCWs.Materials and Methods: Participants of the study included nursing and allied HCWs of a tertiary care health institute in Uttarakhand, India. Multiple training sessions, each of around 180 min, were held periodically in small groups with 20–40 participants over 2 years. Participants were assessed with pretest and posttest questionnaires, and feedback was taken. Questionnaires comprised three categories: general safety and ergonomics, biological hazards, and chemical and radiation hazards. Data of incident reporting for needlestick injury from 2017 to 2019 were retrieved. All data were compiled in Excel sheet and analyzed.Results: A total of 352 participants were included in the study. Mean ± SD for pretest and posttest scores were 5.3 ± 2.13 and 11.22 ± 2.15, respectively. There was considerable improvement in knowledge, which was found to be statistically significant with p-value of 0.001 for all categories. Participants in their feedback suggested for inclusion of psychosocial aspect in further training programs.Conclusion: Low baseline knowledge prior to attending the course highlights a need for an intervention through such structured sensitization program to create awareness and educate HCWs on common occupational health hazards and vaccination. Statistically significant improvement in posttest knowledge highlights effectiveness of the training program. A drastic rise in incident reporting for needlestick injury reflects fairly good impact of training program. Regular and appropriate form of training can reduce injuries resulting from occupational hazards and ensure healthy workforce contributing toward a positive impact on national economy.


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