Strategies for maintaining and strengthening the health care workers during epidemics: a scoping review.

INTRODUCTION: During epidemics such as COVID-19, healthcare workers (HCWs) face several challenges, leading to a shortage and weakening of human resources. To address this issue, employing effective strategies is essential in maintaining and strengthening human resources during outbreaks. This study aimed to gather and classify strategies that could retain and strengthen human health resources during epidemics. METHODS: In this scoping review, all studies published about strategies for maintaining and strengthening HCWs in epidemics were collected from 4 international databases, including PubMed, Embase, Scopus, and Web of Science. The English language articles published after 2000 up until June 2022 recommended specific strategies regarding the research question. Then, they were analyzed and classified according to thematic analysis based on Braun and Clarke 6 phases protocols. RESULTS: In total, 9405 records were screened, of which 59 articles were included, and their full texts were reviewed. Fifty factors were identified and classified into five themes: Instruction, Protection, Supporting, Caring, and Communication. Most of the suggestions were conducted in high-income countries and related to the Supporting theme. DISCUSSION: The majority of strategies discussed in the literature addressed only one or two aspects of human resources. This study provides a holistic perspective on these issues by providing a thematic map of different strategies for strengthening and maintaining HCWs during epidemics. Considering the multidimensionality of human nature, it is suggested that policymakers and managers of health systems provide facilities that simultaneously address a wide range of needs.

Coping strategies and emotional responses adopted by health care workers during COVID-19 pandemic-braving the storm.

Background and Aims: Health care workers (HCWs) are caught in the middle of the COVID-19 pandemic storm and are exposed to a large degree of physical and emotional stress. This study was planned to describe the stressors, stress levels, emotional responses, and coping strategies adopted by HCWs amidst this pandemic. Material and Methods: This cross-sectional, web-based survey was conducted after ethics approval, using a structured performa incorporating standardized stress (PSS-10 C), emotional responses (PANAS-10), and coping strategy (Brief COPE) scales. The snowball sampling technique was used to conduct the study and collect data. Data were analyzed using SPSS 26 version (SPSS Inc., Chicago, IL, USA) statistical software. A P value of <0.05 was considered significant. Results: Out of 402 participants (65% doctors and 35% nurses), 87% perceived moderate stress levels, and nearly half of the participants were interns, residents, and medical officers. Infection to self or family members (77.1%), survival of sick patients (75.6%), aggression by patients and relatives (70.3%), and long duty hours (67%) were some of the major stressors as reported by HCWs. The most common positive emotion felt was being alert (19.17 ± 5.57) and negative emotion perceived was being upset (15.6 ± 6.06). Many participants adopted emotion and problem-focused coping strategies such as planning and strategization (68%) and positive reframing (67.6%), whereas dysfunctional coping strategies such as venting and denial were adopted less commonly. Conclusion: Moderate stress levels perceived by HCWs are a cause for concern. Emotional responses of HCWs to stress vary; however, appropriate coping strategies including emotional and problem-focused coping strategies are the need of the hour to tackle pandemic-related stress.

Impact of long duration wearing of N95 masks on cardiorespiratory system and subjective sensations of health-care workers during COVID-19 era.

Background and Aims: N95 mask being an essential element of personal protective equipment to be worn by health-care workers (HCWs) may lead to adverse effects and physiological stress as HCWs have to wear it for prolonged hours. Therefore, we planned to conduct a study in our intensive care unit staff to look for the effects of N95 masks on their health as well as to plan recommendations to ease them. Material and Methods: We conducted this study on our intensive care unit nursing staff and HCWs. We noted their oxygen saturation and heart rate at baseline as well as after 1 h, 2 h, 3 h, and 6 h of duty along with their subjective sensations. Institutional ethical clearance for the same was taken. Collected data were entered in MS Excel database and analyzed using SPSS version 20.0. Fisher's Z test was applied for comparing proportion and analysis of variance for comparing two means. Results: One hundred and nine HCWs participated in this, out of which 93 (85.3%) were females and 16 (14.7%) were males. Eighty-four (77.1%) participants were below 40 years. Twenty-three participants (21.1%) were overweight and 37 (33.9%) were obese. There was no significant drop in saturation and rise in heart rate during these hours. Conclusions: On comparing subjective sensations of HCWs, our study found that feeling of uneasiness was found more in less than 40 years age group as compared to more than 40 years. N95 masks were found to have no impact on cardiovascular system and do not lead to hypoxia while working routinely even for prolonged hours.

Assessment of knowledge gaps and perceptions about COVID-19 among health care workers and general public-national cross-sectional study.

BACKGROUND AND AIMS: COVID-19 has impacted everyone's life and livelihood in one way or the other. Individual response to measures taken to control the rapid spread of this disease depend on their knowledge and perceptions. Hence, we proposed to evaluate responses about COVID-19 among the health care workers (HCWs) as well as general public participants (GPPs). MATERIAL AND METHODS: This was a cross-sectional, observational survey conducted during the peak of the pandemic. The 35-items questionnaire was prepared using Google forms and distributed through e-mails and social media. RESULTS: The 1,026 responses comprised of 558 HCWs (54.4%) and 468 GPPs (45.6%). The most reliable source of information was TV news for 43% GPPs, whereas it was HCWs/Local health authorities for 36.8% HCWs. HCWs had sufficient knowledge regarding COVID-19, while it was relatively low among GPPs (average correct response 65% and 53%, respectively). Intra-group analysis with respect to age, sex, qualification, and socioeconomic status showed that knowledge about mode of transmission by airborne aerosols was significantly low with respect to qualification among GPPs while younger age group (<40 years) HCWs had significantly more knowledge about mode of transmission and asymptomatic carriers. Paranoia of contracting the infection was significantly higher in GPPs with upper and middle socioeconomic status and younger HCWs. CONCLUSION: HCWs had moderate level of knowledge, whereas GPPs had low to moderate knowledge, with large scope of improvement in both groups. Continued education, both at professional and community level will not only be helpful but also necessary to improve knowledge, avert negative attitudes and control the devastating pandemic.

Antibody titres in fully vaccinated healthcare workers with and without breakthrough infection during the Delta and Omicron waves.

Introduction: Assessment of antibody response to vaccination against SARS CoV2 has clinical, public health, and policy implications during the pandemic and in the context of future waves. Method: In this repeated cross-sectional study, we estimated total binding antibody levels to the spike protein of the SARS CoV2 virus post two doses of Covishield vaccine among 133 health care workers (HCWs) (phase 1), followed by antibody levels among a subset (n = 61) of this group at 9 months after the second dose (phase 2). The time period of the first and second blood collection corresponds to Delta and Omicron waves, respectively. Results: We report 100% seroconversion post 28 days of the second dose of the Covishield vaccine among infection naïve HCWs. In this study, 33% had a breakthrough infection in phase 1 and 24% reported a history of infection in phase 2. The antibody titres were higher in the breakthrough infection group compared to the infection naïve group during both Delta and Omicron waves. Conclusion: This shows that there is a good seroconversion with two doses of vaccine, weaning of antibody with time, and a rise of antibody titre if infected with SARS CoV 2 subsequently.

Depression and anxiety among Pakistani healthcare workers amid COVID-19 pandemic: A qualitative study.

Objectives: The sudden COVID-19 crisis required a determined effort on the part of the healthcare workers (HCWs) and excessive workload increased the risk of depressive and anxious symptoms in frontliners. The aim of the study was to assess anxiety and depression levels among HCWs during times of pandemic and its potential aggravating factors. Materials and methods: A web-based survey was conducted to assess the mental health outcomes of healthcare workers and related factors during the COVID-19 pandemic. For assessing depression and anxiety, the Hospital Anxiety and Depression Scale (HADS) comprised of 14 items with seven items for depression and seven for anxiety were used. Results: Of all 436 participants, 158 (36.2%) showed noticeable symptoms of depression and 220 (50.4%) showed substantial anxiety symptoms. The majority of them were females. It has been observed in the study that female gender, young, and unmarried marital status are associated with higher scores. HCWs working in urban regions show more depressive symptoms. Mild depression and anxiety ratio are very common among participants (21.3%). Factors found to be associated with higher anxiety and depression are the increased number of deceased patients with lower family support. Conclusions: Altogether, the present study findings present concerns about the psychological well-being of all HCWs during the acute COVID-19 outbreak. Therefore, steps should be taken to protect them from mental exhaustion, so they may fight with more zeal against the infectious pandemic that has caused significant impacts worldwide.

A Semi-Quantitative Risk Assessment and Management Strategies on COVID-19 Infection to Outpatient Health Care Workers in the Post-Pandemic Period.

BACKGROUND: In the pandemic of COVID-19, due to asymptomatic patients and high personnel fluidity in outpatient clinics, health care workers (HCWs) in outpatients were facing severe threat from infection. There is an urgent need for a risk assessment to recognize and prevent infection risks. PURPOSE: To establish a semi-quantitative risk assessment model on COVID-19 infections for HCWs in outpatient departments, and apply it to practices. Further to provide infection risk management strategies to reduce infection threats in the post-pandemic of COVID-19. METHODS: We used the method of Brainstorm, Literature study and Analytic Hierarchy Process (AHP) for risk factors selection and model construction, we also created corresponding indicators for each risk factors, in order to collect data in assessment practice. RESULTS: Eighteen risk factors were recognized and selected for model construction, by scatter plot, these risk factors had been classified into four parts, spanned the scopes of diagnosis and treatment, environment, personal protection and emergency handling, with specific management suggestions provided. In the practice, outpatient clinics were divided into three risk levels, 5 clinics in high risk level, 9 in medium risk level and 11 in low risk level. CONCLUSION: A proper comprehensive risk assessment model for COVID-19 infections has been successfully established. With the model, the ability to COVID-19 prevention in outpatients can be easily evaluated. The strategies on disinfection, surveillance and personal protection were also valuable references in the post-pandemic of COVID-19.

Occupational stress assessment of health care workers (HCWs) facing COVID-19 patients in Kerman province hospitals in Iran.

BACKGROUND: The health care workers (HCWs) at the frontline of fighting COVID-19 are at higher risk for mental health problems, including stress, anxiety, depression, and insomnia. This study aimed at assess the status of occupational stress in the three occupational groups of nurses, physicians and hospital cleaning crew facing COVID-19 patients in hospitals of Kerman province in Iran. METHODOLOGY: This cross-sectional descriptive analytical study was performed on 290 medical staffs including nurses, physicians and cleaning crew facing COVID-19 patients working in different hospitals in Iran in 2020. Demographic information form and occupational Stress Questionnaire (HSE tool indicator) were used to collect data. The health and safety executive (HSE) questionnaire has 35 questions and 7 areas, which was developed in the 1990s by the UK Health and Safety Institute to measure occupational stress. RESULTS: The mean score of total dimensions among HCWs was 2.93. Communications, Manager support, Changes and Demand factors with scores of 2.76, 2.77, 2.83 and 2.87 had the greatest impact on participants' stress levels, respectively. Also, Colleague support factor with a score of 3.38 had the least effect on stress levels. Also, according to the results, 87% of nurses, 79% of cleaning crew and 67% of physicians had a partial to high levels of stress that, on average, 77.5% of the HCWs participating in this study had at least a small amount of stress. CONCLUSIONS: The mean stress score among the participants of the present study was between high stress level and moderate stress level. Factors such as communications, manager support, change and demand had the greatest impact on employee stress levels. Therefore, by improving the communication between people working in hospitals, increasing managers' support for staff, and reducing workplace demands such as reducing workload and improving workplace environment, the stress level of staff in hospitals during the outbreak of COVID-19 can be reduced.

Risk of prevalence of latent tuberculosis infection in health care workers-an idiographic meta-analysis from a Chinese perspective.

BACKGROUND: China is one of the countries sharing the major burden of tuberculosis (TB) in the world. Health care workers (HCWs) are subject to a high risk of occupational latent tuberculosis infection (LTBI)-an asymptomatic state of TB disease. However, the heterogenic composition of healthcare professionals in terms of nature of their work leads to the inconsistency in predicting the prevalence of LTBI amongst them. Furthermore, the global statistics do not account for the analysis conducted within the Chinese population. Our study reflects a systemic and epidemiological meta-analysis to investigate the risk of contracting LTBI by the HCWs of China. METHODS: A systematic review of the literature was performed to identify studies reporting LTBI prevalence or incidence among HCWs and a control groups in China. Risk of infection, as well as subgroup analysis was calculated by pooled effect estimates. Review Manager 5.0 was used to perform the meta-analyses. RESULTS: Twenty studies containing 9,654 HCWs met the inclusion criteria. The average prevalence of LTBI among HCWs was 51.5%, ranging from 27.9-88.8%. HCWs had a higher risk of prevalence of LTBI than the control groups [odds ratio (OR), 1.78, 95% confidence interval (CI), 1.46-2.16]. In the subgroup analysis, the prevalence of LTBI in HCWs with respect to the control groups was observed to be highest in Eastern China (OR, 2.05; 95% CI, 1.35-3.11). Furthermore, the pooled OR for LTBI was 1.90 and 1.65 separately from the results of the tuberculin skin test (TST) and the interferon-gamma release assay. Lastly, upon comparing the HCWs with the control groups from the community and the nosocomial source, it was observed that the pooled OR favored for the prevalence of LTBI, which was primarily community-sourced (3.12 and 1.54). HCWs had an increased risk of prevalence of LTBI than the control groups, both in general hospitals and TB specific hospitals (pooled OR 2.4 and 1.57). CONCLUSIONS: Risk of LTBI infection among HCWs is relatively high in China, especially in the eastern region, predisposed by the cumulative exposure to Mycobacterium tuberculosis from the community and the general hospitals. Overall, our data reflects an alarming risk posed to our HCWs, and calls for immediate reforms at the policy levels, so as to implement effective screening and treatment of affected HCWs in China.

The Curse of HIV: How Well Prepared is our Paramedical Force?

BACKGROUND: HIV patient-care is determined by the knowledge and attitudes of the health care workers (HCWs) towards the disease and towards HIV-positive individuals. With increasing incidence of HIV, a need was felt to assess the preparedness of the health care providers in the Armed Forces. METHODS: A population based, cross-sectional, questionnaire based analytical study was undertaken among para medical workers in the setting of a medical college and tertiary care service hospital to assess the knowledge and attitudes of HCWs towards HIV. RESULTS: The study indicated that contrary to the expectations and general belief, important knowledge gaps regarding modes of transmission, clinical course, diagnosis and management of HIV infection still exist among the paramedical workers of the Armed Forces. CONCLUSIONS: The present study has highlighted the urgent need to review the training curriculum of our paramedical workers at all levels and undertake intensive on the job training. The study recommends that medical officers should take full responsibility for imparting correct knowledge and ensuring correct attitude among the paramedical workers.