Corona Virus Infection among Healthcare Workers in a COVID Dedicated Tertiary Care Hospital in Dhaka, Bangladesh

Background: Health care workers (HCWs) are at high risk of acquiring infections during this ongoing COVID-19 outbreak. This study was aimed at determining the prevalence of SARS-CoV-2 infection, the socio demographic and clinical profile and the possible risk factors for infection among the HCWs at Mugda Medical College Hospital (MuMCH). Method: This retrospective observational study was done among the HCWs of MuMCH from 19 April, 2020 to 15 May, 2020. The SARS-CoV-2 positive 37 HCWs were interviewed over telephone by a structured questionnaire and the obtained data were analyzed by using descriptive statistics. Result: Out of total 343 HCWs, total 37(10.79%) cases were detected COVID-19 positive. Out of them, 13(35.14%) were male and 24 (64.86%) were female. The median age was 36 years. Among the infected HCWs, 26 (70.27%) did not have any pre-existing comorbidities. Bronchial asthma (13.51%) and HTN (13.51%) were the most prevalent comorbidities. Around 43.24% (16) had no definite symptoms for COVID- 19. Among the 21(56.76%) symptomatic cases, 15(40.54%) had mild and 6(16.22%) had moderate symptoms. The most common symptoms were cough (16, 43.24%), fever (11, 29.73%), sore throat (7, 18.92%) and fatigue/malaise (7, 18.92%). All had completely recovered uneventfully although 22(59.46%) got admitted to hospital. Only 12(32.43%) were involved in aerosol generating procedure. Total 26 cases (70.27%) used appropriate PPE during their duty. Although only 4(10.81%) got adequate training on PPE use, 33(89.19%) of them had adequate knowledge on that. About 15(40.54%) were reusing PPEs. Most of them (33, 89.20%) were not taking any chemoprophylaxis; all were following traditional preventive measures. Among the HCWs, 26(70.27%) were not satisfied with the infection prevention and control (IPC) measures taken by the hospital authority. All of them presumed that, their occupational exposure was the possible source of COVID-19 infection. Conclusion: More than 1 in 10 HCWs at MuMCH was infected with SARS-CoV-2 while working at the hospital. They represented the younger age group, had fewer comorbidities. Nurses were the most affected category. All experienced uneventful recovery and most of them were not satisfied with the IPC measures taken by the hospital authority. Further studies are required to identify the level of risk of infection, possible risk factors and outcomes and to improve the IPC measures of the hospital. J Bangladesh Coll Phys Surg 2020; 38(0): 43-49

Improvement of Safety in Operating Theatres by Training and Teamwork

Medical incidents in public hospitals in Hong Kong have persisted for years. The operating theatres are one of the places where medical accidents occur, especially affecting service quality. The surgical team is a substantial cause of medical incidents, possibly because of human mistakes, environmental, equipment, and system failures. Not all surgery departments will implement uniform working styles. The Hospital Authority may set a management plan to unify practice and to identity the problems faced. Therefore, the government and Hospital Authority should focus on human resources, especially in terms of professional training and retention of staff. After all, surgery is a task of teamwork.

Crisis responses in public hospitals: case studies in Hong Kong

Purpose The purpose of this paper is to investigate the medical incident responses from two public hospitals in Hong Kong, namely, Kowloon Hospital and Caritas Medical Centre, in order to improve the strategic preparation for crisis management in hospitals. Design/methodology/approach The paper analyses two medical incidents using Situational Crisis Communication Theory by Coombs (2007). The two case studies presented herein demonstrate the importance of consistency in terms of crisis responses. Findings For the first case, the crisis responses from different parties after the incident, including Hospital Authority, the doctor and the nurses from Kowloon Hospital, are contradicting to each other. First, Hospital Authority confirmed that the incident is solely an accident which is a denial response. Second, the doctor passed the responsibility to the nurses which is a scapegoating response. Third, the nurses tend to reduce the responsibility for the death of patient by excusing strategy. As a whole, their responses are inconsistent to each other. For the second case, Caritas had initially denied the responsibilities, but finally had given partial apology under public pressure. That makes people think that Caritas does not really regret. Originality/value Rebuilding posture should be used instead of denial and diminishment posture. However, public organization and civil servants are reluctant to use a full apology due to possible legal consequences. The apology ordinance would ease the pressure to express regret and sympathy.

Ten-year risk prediction models of complications and mortality of Chinese patients with diabetes mellitus in primary care in Hong Kong: a study protocol

IntroductionDiabetes mellitus (DM) is a major disease burden worldwide because it is associated with disabling and lethal complications. DM complication risk assessment and stratification is key to cost-effective management and tertiary prevention for patients with diabetes in primary care. Existing risk prediction functions were found to be inaccurate in Chinese patients with diabetes in primary care. This study aims to develop 10-year risk prediction models for total cardiovascular diseases (CVD) and all-cause mortality among Chinese patients with DM in primary care.Methods and analysisA 10-year cohort study on a population-based primary care cohort of Chinese patients with diabetes, who were receiving care in the Hospital Authority General Outpatient Clinic on or before 1 January 2008, were identified from the clinical management system database of the Hospital Authority. All patients with complete baseline risk factors will be included and followed from 1 January 2008 to 31 December 2017 for the development and validation of prediction models. The analyses will be carried out separately for men and women. Two-thirds of subjects will be randomly selected as the training sample for model development. Cox regressions will be used to develop 10-year risk prediction models of total CVD and all-cause mortality. The validity of models will be tested on the remaining one-third of subjects by Harrell’s C-statistics and calibration plot. Risk prediction models for diabetic complications specific to Chinese patients in primary care will enable accurate risk stratification, prioritisation of resources and more cost-effective interventions for patients with DM in primary care.Ethics and disseminationThe study was approved by the Institutional Review Board of the University of Hong Kong—the Hospital Authority Hong Kong West Cluster (reference number: UW 15–258).Trial registration numberNCT03299010; Pre-results.

Changes in Rehabilitation Outcomes by new Guidelines of Hong Kong Hospital Authority in Implant Choice for Femoral Neck Fractures—Austin Moore versus Cemented Exeter Hemiarthroplasty

Background In 2013, Hospital Authority of Hong Kong replaced Austin Moore Arthroplasty (AMA) with cemented Exeter hemiarthroplasty for displaced femoral neck fractures. This study evaluated whether this new guidelines resulted in better mortality, hospital service reattendances and rehabilitation outcomes. Methods Patients aged 65–84 years with hemiarthroplasty done in a tertiary hospital during 2012–2014 were reviewed retrospectively. AMA group included AMAs carried out during years 2012–2013, and Exeter group included cemented modular Exeter hemiarthroplasties carried out during years 2013–2014. All patients were followed-up for 2 years. Results The Exeter group performed significantly better in rehabilitation outcomes than AMA group in terms of mobility score, independent and outdoor walking and community dwelling. They also had less hospital service reattendances due to falls, refractures and implant-related causes. There was a trend towards lower mortality in the Exeter group with increasing duration from operation. Conclusion The new guidelines in replacing AMA with cemented Exeter hemiarthroplasty resulted in better patient outcomes.