Healthcare professional perspectives following implementation of an infection management care pathway for pediatric patients with cancer: a qualitative study.

PURPOSE: The Pediatric Oncology Group of Ontario (POGO) supported an effort to implement infection management care pathways based on clinical practice guidelines, to improve the consistency of infection management in pediatric cancer patients. The objective of this qualitative study was to describe the perspective of healthcare professionals (HCPs) following implementation. METHODS: Four tertiary pediatric oncology centers in Ontario, Canada, implemented the pathways. We randomly identified three HCPs per group (clinical pharmacists; nurse case managers, educators or practitioners and physician assistants; pediatric oncology fellows; or pediatric oncology staff physicians) per site and invited them to participate in a qualitative interview. One-on-one interviews were conducted remotely, followed by thematic analysis of interview transcripts. RESULTS: A total of 66 invitations were extended and 42 HCPs participated. Identified themes were: (1) implementation approach, (2) access and navigation, (3) engagement, (4) concerns, (5) workplace benefits, (6) reception, and (7) provincial harmonization. HCPs preferred in-person implementation strategies over e-mail communication. They identified teaching/educational utility and benefits to non-oncology departments and non-tertiary centers participating in shared care of patients. Other positive aspects related to evidence-based practice, safety, supporting oncology HCPs, and benefits to patients and families. Concerns included need to ensure users applied clinical judgement and loss of autonomy. Provincial harmonization of practice was viewed positively, although potential logistical and institutional cultural barriers were raised. CONCLUSIONS: Following infection management care pathway implementation, HCPs described educational utility and benefits to non-oncology departments, oncology HCPs, patients, and families. Our findings may facilitate future infection management care pathway provincial harmonization.

Impact of COVID-19-related restricted family presence policies on Canadian pediatric intensive care unit clinicians: a qualitative study.

PURPOSE: Pediatric intensive care units (PICUs) worldwide restricted family presence in response to the COVID-19 pandemic. We aimed to explore the experiences and impact of restricted family presence policies on Canadian PICU clinicians. METHODS: We conducted a qualitative study that followed an interpretive phenomenological design. Participants were PICU clinicians providing direct patient care in Canada during periods of COVID-19-related restricted family presence. We purposively sampled for maximum variation among survey participants who consented to be contacted for further research on the same topic. In-depth interviews were conducted remotely via telephone or video-call, audio-recorded, and transcribed. Interviews were inductively coded and underwent thematic analysis. Proposed themes were member-checked by interviewees. RESULTS: Sixteen PICU clinicians completed interviews. Interviewees practiced across Canada, represented a range of disciplines (eight nurses, two physicians, two respiratory therapists, two child life specialists, two social workers) and years in profession (0-34 years). We identified four themes representing the most meaningful aspects of restricted family presence for participants: 1) balancing infection control and family presence; 2) feeling disempowered by hospital and policy-making hierarchies; 3) empathizing with family trauma; and 4) navigating threats to the therapeutic relationship. CONCLUSION: Pediatric intensive care unit clinicians were impacted by restricted family presence policies during the COVID-19 pandemic. These policies contributed to feelings of disempowerment and challenged clinicians' perceived ability to provide the best family-centred care possible. Frontline expertise should be incorporated into the design and implementation of policies to best support family-centred care in any context and minimize risks of moral distress for PICU clinicians.

RéSUMé: OBJECTIF: Les unités de soins intensifs pédiatriques (USIP) du monde entier ont restreint la présence des familles en réponse à la la pandémie de COVID-19. Notre objectif était d'explorer les expériences et l'impact des politiques de restriction de la présence familiale sur les clinicien·nes des USIP canadiennes. MéTHODE: Nous avons mené une étude qualitative qui a suivi un plan phénoménologique interprétatif. Les participant·es étaient des clinicien·nes des USIP qui dispensaient des soins directs aux patient·es au Canada pendant les périodes de présence restreinte des familles en raison de la COVID-19. Nous avons délibérément échantillonné pour obtenir une variation maximale parmi les participant·es à l'enquête qui ont accepté d'être contacté·es pour d'autres recherches sur le même sujet. Des entretiens approfondis ont été menés à distance par téléphone ou par appel vidéo, enregistrés et transcrits. Les entretiens ont été codés de manière inductive et ont fait l'objet d'une analyse thématique. Les thèmes proposés ont été contrôlés par membre par les personnes interrogées. RéSULTATS: Seize cliniciennes et cliniciens des USIP ont passé des entrevues. Les personnes interrogées exerçaient partout au Canada, représentaient un éventail de disciplines (huit infirmiers et infirmières, deux médecins, deux inhalothérapeutes, deux spécialistes du milieu de l'enfant, deux travailleuses et travailleurs sociaux) et d'années d'expérience professionnelle (de 0 à 34 ans). Nous avons identifié quatre thèmes représentant les aspects les plus significatifs de la présence restreinte de la famille pour les participant·es : 1) l'équilibre entre la prévention des infections et la présence de la famille; 2) le sentiment d'être dépossédé·e par les hiérarchies de l'hôpital et de ne pas pouvoir participer à l'élaboration des politiques; 3) le sentiment d'empathie à l'égard des traumatismes familiaux; et 4) la réponse aux menaces qui ont pesé sur la relation thérapeutique. CONCLUSION: Les cliniciens et cliniciennes des unités de soins intensifs pédiatriques ont été touché·es par les politiques de restriction de la présence familiale pendant la pandémie de COVID-19. Ces politiques ont contribué à un sentiment d'impuissance et ont remis en question la capacité perçue des équipes à fournir les meilleurs soins possibles axés sur la famille. L'expertise de première ligne devrait être intégrée à la conception et à la mise en œuvre des politiques afin de mieux soutenir les soins axés sur la famille dans n'importe quel contexte et de minimiser les risques de détresse morale pour les cliniciennes et cliniciens des USIP.

Factors influencing long-term care facility performance during the COVID-19 pandemic: a scoping review.

BACKGROUND: The COVID-19 pandemic wreaked havoc on long-term care facilities (LTCFs). Some LTCFs performed better than others at slowing COVID-19 transmission. Emerging literature has mostly described infection prevention and control strategies implemented by LTCFs during the pandemic. However, there is a need for a comprehensive review of factors that influenced the performance of LTCFs in containing COVID-19 spread to inform public health policy. OBJECTIVE: To build on the existing literature, we conducted a scoping review of factors that influenced LTCF performance during the COVID-19 pandemic using a multidimensional conceptual framework of performance. METHODS: We followed the Joanna Briggs Institute's methodology for scoping reviews. We queried CINAHL, MEDLINE (Ovid), CAIRN, Science Direct, Scopus, and Web of Science for peer-reviewed literature in English or French published between January 1st, 2020 and December 31st, 2021. Retrieved records were screened for context (COVID-19 pandemic), population (LTCFs), interest (internal and external factors that influenced LTCF performance), and outcomes (dimensions of performance: equity, accessibility, reactivity, safety, continuity, efficacy, viability, efficiency). Descriptive characteristics of included articles were summarized. Dimensions of performance as well as internal (e.g., facility characteristics) and external (e.g., visitors) factors identified to have influenced LTCF performance were presented. RESULTS: We retained 140 articles of which 68% were classified as research articles, 47% originated in North America, and most covered a period between March and July 2020. The most frequent dimensions of performance were "efficacy" (75.7%) and "safety" (75.7%). The most common internal factors were "organizational context" (72.9%) and "human resources" (62.1%), and the most common external factors were "visitors" (27.1%) and "public health guidelines" (25.7%). CONCLUSIONS: Our review contributes to a global interest in understanding the impact of the COVID-19 pandemic on vulnerable populations residing and working in LTCFs. Though a myriad of factors were reported, a lack of randomized controlled trials makes it impossible to establish causality between the identified factors and LTCF performance. The use of a multidimensional framework can be recommended to evaluate healthcare system performance not merely in terms of efficacy and safety, but alongside other critical dimensions such as efficiency and equity. TRIAL REGISTRATION: Research Registry ID: researchregistry7026.

Did the organization of primary care practices during the COVID-19 pandemic influence quality and safety? - an international survey.

BACKGROUND: Changes in demographics with an older population, the illness panorama with increasing prevalence of non-communicable diseases, and the shift from hospital care to home-based care place demand on primary health care, which requires multiprofessional collaboration and team-based organization of work. The COVID-19 pandemic affected health care in various ways, such as heightened infection control measures, changing work practices, and increased workload. OBJECTIVES: This study aimed to investigate the association between primary care practices' organization, and quality and safety changes during the COVID-19 pandemic. DESIGN: Data were collected from 38 countries in a large online survey, the PRICOV-19 study. For this paper, the participating practices were categorized as "Only GPs", comprising practices with solely general practitioners (GPs) and/or GP trainees, without any other health care professionals (n = 1,544), and "Multiprofessional," comprising practices with at least one GP or GP trainee and one or more other health professionals (n = 3,936). RESULTS: Both categories of practices improved in infection control routines when compared before and during the COVID-19 pandemic. A larger proportion of the multiprofessional practices changed their routines to protect vulnerable patients. Telephone triage was used in more "Multiprofessional" practices, whereas "Only GPs" were more likely to perform video consultations as an alternative to physical visits. Both types of practices reported that the time to review new guidelines and scientific literature decreased during the pandemic. However, both had more meetings to discuss directives than before the pandemic. CONCLUSIONS: Multiprofessional teams were keener to introduce changes to the care organization to protect vulnerable patients. However, practices with only GPs were found to be more aligned with video consultations, perhaps reflecting the close patient-doctor relationship. In contrast, telephone triage was used more in multiprofessional teams.

Implementation of COVID-19 infection control best practices in nursing homes amid the pandemic.

BACKGROUND: The COVID-19 pandemic has claimed around 170,000 lives among nursing home residents and staff in the United States through April 2023. In a cluster randomized controlled trial (RCT) with 136 nursing homes, we delivered training to improve COVID-19 infection control best practices. We sought to assess the implementation of infection control practices in participating nursing homes. METHODS: Concurrent with the delivery of the RCT (January-November 2021), we surveyed nursing home administrators (NHAs, n = 38) at baseline and 6-month follow-up. Using validated items from the Centers for Disease Control and Prevention (CDC), the surveys inquired about 80 infection control best-practice activities (yes/no). The survey also asked seven scales corresponding to inner setting factors that may have impacted implementation. We assessed changes in infection control practices and inner setting factors between baseline and 6-month follow-up. RESULTS: Overall, the implementation of 11 best practices changed over time. NHAs reported an increase in the availability of informational materials for residents and families (84% vs. 100%, p = 0.031), the use of alcohol-based hand sanitizer over soap (76% vs. 97%, p = 0.008), and the development of contingency plans for increased postmortem care (53% vs. 82%, p = 0.013). The implementation of four best-practice visitation policies and three communal restrictions decreased between baseline and 6-month follow-up (all p < 0.05). Regarding inner setting factors, only culture stress (perceived strain, stress, and role overload) increased between surveys (mean scores: 3.14 vs. 3.58, p = 0.004). CONCLUSION: This study was among the first to report changes in implementing COVID-19 infection control best practices in nursing homes amid the pandemic. Culture stress was an important inner setting factor that may have impacted implementation activities. TRIAL REGISTRATION: NCT04499391 DATE OF REGISTRATION: August 3rd, 2020.

How Did We Deal with the Pandemic? - Experience from a Tertiary Health Institute in Eastern India.

With the introduction of the novel coronavirus in late 2019, the healthcare system of every country in the world experienced many challenges. In India, every healthcare organization has prepared itself to fight against these global challenges. This study aims to describe the challenges faced during the COVID-19 pandemic and how we dealt with the pandemic successfully. This narrative analysis study was made in a 960-bedded teaching hospital during the pandemic. The challenges were identified from the minutes of meetings, circulars issued, and various strategic decisions made to combat the pandemic. The challenges faced by the institute were categorized into nine different categories: infrastructural, human resource, hospital operations, and others. Lack of knowledge during the initial days of the pandemic, need for round-theclock situational management, and day-to-day operation needed aggressive training and adherence to the guidelines. Gaps identified in areas like inventory, infection control, logistics, etc., were quickly addressed, and processes were created as per the nation's changing guidelines. This study revealed strategies to manage the pandemic by optimally utilizing available resources with good teamwork and situational leadership.

Need for Infection Prevention and Control Curriculum for Nursing in Developing Countries.

How to cite this article: Siddiqui AH, Umair R, Ahmad J. Need for Infection Prevention and Control Curriculum for Nursing in Developing Countries. J Assoc Physicians India 2023;https://doi.org/10.59556/japi.71.0329.

Evaluation of infection prevention and control programmes according to the European Centre for Disease Prevention and Control and the World Health Organization in Spain 2012-2022: indicators of core component 1.

BACKGROUND: Key and core components of effective infection prevention and control programmes (IPCPs) issued by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) have been described. WHO core component 1 relates to the structure, organization and management of IPCPs. AIM: The objective of this study was to assess the status and the time trends of some indicators of core component 1 of IPCPs in acute hospitals in Spain throughout the period 2012-2022. METHODS: Hospital-level data from the Spanish point prevalence survey for years 2012-2022 were analysed. Core component 1 indicators were calculated and tested for association to healthcare-associated infections (HAIs). In addition, trends were also examined. RESULTS: Overall, 67.0% and 57.2% of Spanish hospitals reported having an annual infection prevention and control (IPC) plan and an annual IPC report that was approved by the hospital managing director, respectively. The global median number of full-time equivalent (FTE) IPC nurses per 250 beds for the period was 0.87 and the global median number of FTE IPC doctors was 0.70. The rates of blood cultures and stool tests for Clostridioides difficile were 39.9 and 6.1 per 1000 patient-days, respectively. No significant correlation was found between core component 1 indicators and HAI prevalence. CONCLUSION: Spain is currently at a basic level on the structure, organization and management of IPCPs. Profound differences were found between hospitals depending on size and type.

Healthcare-associated infection management in 62 ICUs for patients with congenital heart disease in China: a survey study.

OBJECTIVES: All patients with congenital heart disease (CHD) receive postoperative management in ICUs. Infection prevention and control (IPC) has a significant impact on prognosis. This study provides a preliminary understanding of the fundamental aspects of IPC in ICUs following CHD surgery in China. METHODS: From September to October 2023, we initiated a survey on healthcare-associated infection (HAI) management in hospitals that perform CHD surgeries independently. The questionnaires were jointly completed by the ICU physicians and IPC personnel. Duplicate or unqualified questionnaires were excluded from the study. The contents of our questionnaires covered hospital and ICU capacity, performance of the infection control department, HAI surveillance, implementation of IPC measures, and antimicrobial stewardship (AMS). Qualified questionnaires were compared according to the volume of annual CHD surgeries performed in different ICUs. Group 1 was defined as volume more than 300 cases and group 2 was defined as volume less than or equal to 300 cases. RESULTS: Sixty-two of the 118 questionnaires were completed, with a response rate of 53%. The CHD surgical volume in 2022 of the 62 hospitals was 36342, accounting for 52% of the annual CHD surgical volume (69 672) across the country. The postoperative infection rates obtained from the 15 ICUs varied from 1.3 to 15%, with a median rate of 4.5%. A total of 16 ICUs provided data on drug-resistant bacteria, Klebsiella pneumoniae exhibiting the highest frequency. More than 95% of ICUs have established complete HAI management systems. Information-based HAI surveillance was conducted in 89% of ICUs. Approximately 67% of ICUs stopped prophylactic antibiotics within 48 hours after surgery. In complex cases, carbapenems were administered empirically in 89% of ICUs. Group 1 had an advantage over group 2 in preventing multi-drug-resistant organisms (all instruments should be used alone 100% vs. 86%, P =0.047; cleaning and disinfection of environmental surfaces, 100% vs. 81%, P =0.035; antibiotic consumption control 85% vs. 61%, P =0.044) and in preventing surgical site infections (perioperative blood glucose monitoring, 88% vs. 67%, P =0.048). However, Group 1 did not perform well in preventing catheter-related bloodstream infection (delayed catheter removal due to convenience of laboratory tests, 31% vs. 6%, P =0.021) and catheter-associated urinary tract infection (delayed catheter removal due to muscle relaxant administration, 88% vs. 58%, P =0.022). CONCLUSIONS: A relatively complete HAI management system has been established throughout the country in ICUs for CHD patients. Information-based surveillance of HAI needs to be promoted, and actions should be taken to facilitate the implementation of IPC measures and AMS bundles. Training and feedback are critical for implementing IPC measures.

Viewpoint: The impending pandemic of resistant organisms - a paradigm shift towards source control is needed.

The United States needs a paradigm shift in its approach to control infectious diseases. Current recommendations are often made in a siloed feedback loop. This may be the driver for such actions as the abandonment of contact precautions in some settings, the allowance of nursing home residents who are carriers of known pathogens to mingle with others in their facility, and the determination of an intervention's feasibility based upon budgetary rather than health considerations for patients and staff. Data from both the U.S. Veterans Health Administration and the U.K.'s National Health Service support the importance of carrier identification and source control. Both organizations observed marked decreases in methicillin-resistant Staphylococcus aureus (MRSA), but not methicillin-susceptible Staphylococcus aureus infections with the implementation of MRSA admission screening measures. Facilities are becoming over-reliant on horizontal prevention strategies, such as hand hygiene and chlorhexidine bathing. Hand hygiene is an essential practice, but the goal should be to minimize the risk of workers' hands becoming contaminated with defined pathogens, and there are conflicting data on the efficacy of chlorhexidine bathing in non-ICU settings. Preemptive identification of dedicated pathogens and effective source control are needed. We propose that the Centers for Disease Control and Prevention should gather and publicly report the community incidence of dedicated pathogens. This will enable proactive rather than reactive strategies. In the future, determination of a patient's microbiome may become standard, but until then we propose that we should have knowledge of the main pathogens that they are carrying.

Infection prevention and control in Dutch general practices before and during the COVID-19 pandemic and its implications for pandemic preparedness and seasonal respiratory epidemics: a qualitative study on lessons learned.

BACKGROUND: The COVID-19 pandemic has prompted a re-evaluation of infection prevention and control (IPC) in general practices, highlighting the need for comprehensive IPC implementation. This study aimed to evaluate healthcare workers' (HCWs) experiences and perspectives regarding IPC in general practices before and during the COVID-19 pandemic, and its implications for post-pandemic IPC implementation. METHODS: This qualitative study involved semi-structured, in-depth interviews during two time periods: (1) prior to the COVID-19 pandemic (July 2019-February 2020), involving 14 general practitioners (GPs) and medical assistants; and (2) during the COVID-19 pandemic (July 2022-February 2023), including 22 GPs and medical assistants. Data analysis included thematic analysis that addressed multiple system levels. RESULTS: Findings indicated a shift towards comprehensive IPC implementation and organisation during the pandemic compared to the pre-pandemic period. Since the Omicron variant, some general practices maintained a broad set of IPC measures, while others released most measures. HCWs' future expectations on post-pandemic IPC implementation varied: some anticipated reduced implementation due to the desire to return to the pre-pandemic standard, while others expected IPC to be structurally scaled up during seasonal respiratory epidemics. Main contextual challenges included patient cooperation, staff shortages (due to infection), shortages of IPC materials/equipment, and frequently changing and ambiguous guidelines. Key lessons learned were enhanced preparedness (e.g., personal protective equipment supply), and a new perspective on care organisation (e.g., digital care). Main recommendations reported by HCWs were to strengthen regional collaboration within primary care, and between primary care, public health, and secondary care. CONCLUSION: HCWs' experiences, perspectives and recommendations provide insights to enhance preparedness for future epidemics and pandemics, and sustain IPC in general practices. For IPC improvement strategies, adopting an integrated system-based approach that encompasses actions across multiple levels and engages multiple stakeholders is recommended.

Four Years And More Than 200,000 Deaths Later: Lessons Learned From The COVID-19 Pandemic In US Nursing Homes.

Nursing home residents and staff were disproportionately affected by the COVID-19 pandemic, drawing attention to long-standing challenges of poor infection control, understaffing, and substandard quality of care in many facilities. Evolving practices and policies during the pandemic often focused on these challenges, with little effect. Despite the emergence of best practices to mitigate transmission of the virus, even the highest-quality facilities experienced outbreaks, indicating a larger systemic problem, rather than a quality problem at the facility level. Here we present a narrative review and discussion of the evolution of policies and practices and their effectiveness, drawing on evidence from the United States that was published during 2020-23. The lessons learned from this experience point to the need for more fundamental and nuanced changes to avoid similar outcomes from a future pandemic: greater integration of long-term care into public health planning, and ultimately a shift in the physical structure of nursing homes. More incremental measures such as vaccination mandates, higher staffing, and balancing infection control with resident quality of life will avoid some adverse outcomes, but without more systemic change, nursing home residents and staff will remain at substantial risk for repetition of the poor outcomes from the COVID-19 pandemic.

Infection Control Measure Performance in Long-Term Care Hospitals and Their Relationship to Joint Commission Accreditation.

BACKGROUND: This study evaluated the relationship between Joint Commission accreditation and health care-associated infections (HAIs) in long-term care hospitals (LTCHs). METHODS: This observational study used Centers for Medicare & Medicaid Services (CMS) LTCH data for the period 2017 to June 2021. The standardized infection ratio (SIR) of three measures used by the Centers for Disease Control and Prevention's National Healthcare Safety Network were used as dependent variables in a random coefficient Poisson regression model (adjusting for CMS region, owner type, and bed size quartile): catheter-associated urinary tract infections (CAUTIs), Clostridioides difficile infections (CDIs), and central line-associated bloodstream infections (CLABSIs) for the periods 2017 to 2019 and July 1, 2020, to June 30, 2021. Data from January 1 to June 30, 2020, were excluded due to the COVID-19 pandemic. RESULTS: The data set included 244 (73.3%) Joint Commission-accredited and 89 (26.7%) non-Joint Commission-accredited LTCHs. Compared to non-Joint Commission-accredited LTCHs, accredited LTCHs had significantly better (lower) SIRs for CLABSI and CAUTI measures, although no differences were observed for CDI SIRs. There were no significant differences in year trends for any of the HAI measures. For each year of the study period, a greater proportion of Joint Commission-accredited LTCHs performed significantly better than the national benchmark for all three measures (p = 0.04 for CAUTI, p = 0.02 for CDI, p = 0.01 for CLABSI). CONCLUSION: Although this study was not designed to establish causality, positive associations were observed between Joint Commission accreditation and CLABSI and CAUTI measures, and Joint Commission-accredited LTCHs attained more consistent high performance over the four-year study period for all three measures. Influencing factors may include the focus of Joint Commission standards on infection control and prevention (ICP), including the hierarchical approach to selecting ICP-related standards as inputs into LTCH policy.

One response: Global Outbreak Alert and Response Network supporting the COVID-19 response, Kiribati.

Problem: In January 2022, Kiribati experienced widespread community transmission of COVID-19, leading to high rates of infection among health-care workers (HCWs), which reduced essential HCWs during a period of increased hospital admissions. Context: Kiribati, a Pacific island country made up of a remote group of 33 low-lying atolls in the Pacific Ocean, experienced its first surge of COVID-19 cases beginning on 24 January 2022. Action: Reports of increasing numbers of COVID-19 cases in South Tarawa prompted the Kiribati Ministry of Health and Medical Services to request assistance from the international community, including the World Health Organization's Global Outbreak Alert and Response Network (GOARN), to support national COVID-19 response operations. Specialists in infection prevention and control (IPC) were deployed to Kiribati in February 2022 to assist the Ministry's National COVID-19 Taskforce in collaboration with national partners. These specialists helped review and strengthen IPC capacities to accommodate a potential patient surge and consequent demands for medical consumables in health-care facilities in South Tarawa. Outcome: Strengthened knowledge about and processes for IPC among HCWs prevented health care-associated infections and reduced community disease transmission during the first surge of COVID-19 cases in Kiribati. Discussion: GOARN has the capacity and ability to rapidly deploy experts to support requests for assistance. Outbreak response activities can be enhanced and sustained by using GOARN's resources and collaborating with all partners, as necessary.

Rethinking Infection Control: Nursing Home Administrator Experiences during the COVID-19 Pandemic.

OBJECTIVE: To examine nursing home administrator perspectives of infection control practices in nursing homes at the height of the COVID-19 pandemic and characterize lessons learned. DESIGN: Descriptive qualitative study. SETTING AND PARTICIPANTS: Administrators from 40 nursing homes across 8 diverse health care markets in the United States. METHODS: Semistructured interviews were conducted via telephone or Zoom with nursing home administrators. Interviews were repeated at 3-month intervals, for a total of 4 interviews per participant between July 2020 and December 2021 (n = 156). Qualitative analysis of interview transcripts used modified grounded theory and thematic analysis to identify overarching themes. RESULTS: Three major themes emerged reflecting administrator experiences managing infection control practices and nursing home operations at the height of the COVID-19 pandemic. First, administrators reported that the more stringent infection control protocols implemented to manage and mitigate COVID-19 at their facilities increased awareness and understanding of the importance of infection control; second, administrators reported incorporating higher standards of infection control practices into facility-level policies, emergency preparedness plans, and staff training; and third, administrators said they and their executive leadership were reevaluating and upgrading their facilities' physical structures and operational processes for better infection control infrastructure in preparation for future pandemics or other public health crises. CONCLUSIONS AND IMPLICATIONS: Insights from this study's findings suggest important next steps for restructuring and improving nursing home infection control protocols and practices in preparation for future pandemics and public health emergencies. Nursing homes need comprehensive, standardized infection control training and upgrading of physical structures to improve ventilation and facilitate isolation practices when needed. Furthermore, nursing home emergency preparedness plans need better integration with local, state, and federal agencies to ensure effective communication, proper resource tracking and allocation, and coordinated, rapid response during future public health crises.

Papel dos trabalhadores de enfermagem no centro de material e esterilização: revisão integrativa / Papel de los trabajadores de enfermería en la central de esterilización: revisión integrativa / The role of central sterile supply department nursing team members: an integrative review

RESUMO Objetivo Analisar o papel dos trabalhadores de Enfermagem em Centros de Material e Esterilização. Método Realizou-se uma revisão integrativa. Buscas compreensivas foram realizadas nas seguintes bases de dados: CINAHL via EBSCOhost, IBECS, LILACS, MEDLINE via PubMed, e Scopus. O método de comparação constante foi aplicado para analisar os achados dos estudos. A classificação inicial de subgrupos baseou-se no conceito de papel do Sistema Conceitual de King. Resultados Vinte e nove artigos de pesquisa foram selecionados, e três categorias identificadas: Percepções dos trabalhadores de Enfermagem do Centro de Material e Esterilização (CME) sobre seu papel; Percepções dos trabalhadores de unidades consumidoras sobre o papel de trabalhadores de Enfermagem no CME; e Funções dos trabalhadores de Enfermagem no CME. Conclusão e implicações para a prática As funções dos trabalhadores de Enfermagem do CME foram conceitualizadas como atividades de cuidado indireto. A visibilidade limitada da atribuição do CME conduz à percepção de status inferior na organização hospitalar e nos conflitos de papel.

RESUMEN Objetivo Analizar el papel de los miembros del equipo de Enfermería en Centrales de Esterilización. Métodos Se realizó una revisión integradora. Se realizaron búsquedas exhaustivas en CINAHL via EBSCOhost, IBECS, LILACS, MEDLINE via PubMed y Scopus. Se aplicó el método de comparación constante para analizar los resultados de las investigaciones. La clasificación inicial de subgrupos se basó en el concepto de rol del Sistema Conceptual de King. Resultados Se seleccionaron veintinueve artículos de investigación. Se identificaron tres categorías: las percepciones de los miembros del equipo de Enfermería del Central de Esterilización (CE) sobre su función; percepciones de los trabajadores del departamento de consumidores sobre el papel de los miembros del equipo de enfermería de CE; y las funciones de los miembros del equipo de enfermería CE. Conclusión e implicaciones para la práctica Las funciones de los miembros del equipo de enfermería de CE se conceptualizaron como actividades de cuidado indirecto. La visibilidad limitada del trabajo de este departamento lleva a una percepción de un estado inferior en la organización del hospital y conflictos de roles.

ABSTRACT Objective to analyze the role of nursing team members in Central Sterile Supply Departments. Methods an integrative review was conducted. Comprehensive searches were conducted in CINAHL via EBSCOhost, IBECS, LILACS, MEDLINE via PubMed, and Scopus. Constant comparison method was applied to analyze the study findings. The initial subgroup classification was based on the King's Conceptual System's concept of role. Results twenty-nine research articles were selected. Three categories emerged: Central Sterile Supply Department (CSSD) nursing team members' perceptions of their role; Consumer department workers' perceptions of the role of CSSD nursing team members; and CSSD nursing team members' functions. Conclusion and implications for practice the CSSD nursing team members' functions were conceptualized as indirect care activities. The limited visibility of this department's work leads to a perception of lower status in the hospital organization and role conflicts.

La farmacia hospitalaria en el equipo multidisciplinar de las unidades COVID de hospitalización / Hospital Pharmacy in the multidisciplinary team of COVID inpatient units

La colaboración entre los especialistas en farmacia hospitalaria y enfermedades infecciosas está implantada en la mayoría de los hospitales españoles desde 2012, a raíz de los Programas de Optimización de Antibióticos. Los objetivos principales de esta colaboración son el abordaje integral de los pacientes con enfermedades infecciosas y el uso adecuado de los antimicrobianos en el hospital. Las actividades estructuradas y organizadas que los farmacéuticos tenían dentro de los grupos se vieron truncadas por la pandemia por SARS‑CoV-2, que requirió una alta dedicación. El intercambio de información en tiempo real entre las especialidades ha sido una vía efectiva para generar y mantener protocolos de tratamiento adaptados a cada centro, con continuas modificaciones basadas en las publicaciones que iban apareciendo. Los servicios de farmacia se tuvieron que reorganizar para dar respuesta, por un lado, a los pacientes que ingresaban por esta infección, y por otro, para continuar con las actividades anteriores, con las dificultades añadidas que exigían las normativas para la protección del personal sanitario. Hubo que reinventarse para establecer otros sistemas de comunicación y de colaboración, protocolizando el tratamiento farmacológico de estos pacientes, con modificaciones continuas, gestión de medicamentos a través de medicamentos especiales, diseño de circuitos para tratar a pacientes en su domicilio y en centros sociosanitarios y modificación de circuitos internos para minimizar los desplazamientos de los profesionales en el hospital, así como del personal que atendía a pacientes con SARS-CoV-2. A día de hoy, se desconoce el mejor fármaco antiviral y el mejor tratamiento antiinflamatorio, pero la colaboración del farmacéutico hospitalario es fundamental, pues dispone del conocimiento de los mecanismos de acción de fármacos tan diferentes y de las interacciones que pueden ocasionar. La urgente necesidad de utilizar fármacos experimentales, preferiblemente dentro de ensayos clínicos, coloca al farmacéutico en un papel clave dentro del equipo interdisciplinario imprescindible para conseguir los mejores resultados

Since the implementation of the Antimicrobial Therapy Optimization Programme, hospital pharmacy specialists have collaborated with infectious disease specialists on a regular basis in most hospitals in Spain. Cooperation between these professionals ensures the integrated management of patients with infectious diseases and the appropriate use of antimicrobials in hospitals. The COVID-19 pandemic forced hospital pharmacists to abruptly suspend all their structured activities and concentrate on the health crisis. Realtime information sharing between different medicine specialties is an effective strategy to generate and maintain treatment protocols adapted to each center, with continuous evidence-based modifications as new publications appear. Hospital pharmacies had to reorganize their activities to respond to the pandemic. On the one side were patients with COVID-19, and on the other were routine hospital pharmacy tasks, with the added difficulty of adapting to individual protection measures. New communication and collaboration strategies were adopted. Protocols were established for the management of COVID-19 patients, with continuous changes; special medications had to be prepared and distributed; circuits were designed for the home- or institution- based care of patients; internal circuits were created to minimize the movements of hospital staff and professionals caring for COVID-19 patients. The most effective antiviral drug and anti inflammatory therapy remains elusive. In this scenario, hospital pharmacists emerge as a key player, as they have a deep understanding of the mechanisms of action of drugs and potential interactions. In a setting where experimental drugs preferably tested in clinical trials are being used, the role of hospital pharmacists in interdisciplinary teams has become essential for the optimization of clinical outcomes

La investigación clínica de la farmacia hospitalaria en la lucha contra la COVID-19 / Clinical research in hospital pharmacy during the fight against COVID-19

La presente crisis sanitaria derivada de la rápida expansión del virus SARS-CoV-2 a nivel mundial, así como la falta de evidencia de los tratamientos empleados actualmente, ha provocado la aparición de un gran número de ensayos clínicos y estudios observacionales. Del mismo modo, ha ocasionado la puesta en marcha de importantes medidas en el entorno sanitario e investigador con el fin de conseguir detener la evolución de la pandemia lo antes posible. El objetivo del actual trabajo es recopilar aspectos fundamentales relacionados con la investigación clínica desarrollada por los servicios de farmacia hospitalaria durante la crisis provocada por la COVID-19. La iniciativa de la Sociedad Española de Farmacia Hospitalaria de actuar como promotor de ensayos clínicos ha posibilitado que el 13% de estos servicios de farmacia hospitalaria haya podido liderar uno. En este sentido, la Agencia Española de Medicamentos y Productos Sanitarios, junto con los Comités de Ética de Investigación, ha acelerado los procedimientos de autorización de nuevos ensayos clínicos destinados a tratar o prevenir la COVID-19. Asimismo, han sido numerosas las convocatorias públicas y priva-das destinadas a la financiación de proyectos de diversa índole con el fin de contribuir a la lucha contra este virus. A pesar de la irrupción de la pandemia, también han surgido acciones destinadas a mantener las actividades de los ensayos clínicos y estudios puestos previamente en marcha, garantizando la seguridad y bienestar del paciente. Concretamente, la Agencia Española de Medicamentos y Productos Sanitarios y la Agencia Europea de Medicamentos han publicado guías que incluyen cambios en los protocolos de los ensayos clínicos que deben mantenerse mientras dure la pandemia. La emergencia sanitaria actual ha obligado a la comunidad científica a la generación de evidencia a contrarreloj. Por ello, en este momento en el que se requiere del mayor rigor posible, el farmacéutico de hospital debe alzarse como una figura clave en la investigación en salud, contribuyendo a que las decisiones sanitarias sean racionales, eficientes y seguras

The health crisis resulting from the rapid spread of SARS-CoV-2 worlwide, added to the low evidence of currently used treatments has led to the development of a large number of clinical trials (CT) and observational studies. Likewise, important measures have been adopted in healthcare and research centers aimed at halting the pandemic as soon as possible. The objective of this study is to gather the main aspects of the clinical research studies undertaken by the Departments of Hospital Pharmacy (DHP) of Spain during the COVID-19 crisis. The decision of the Spanish Society of Hospital Pharmacy (SEFH) to sponsor CTs made it possible that 13% of DHP had been led at least one CT. The Spanish Agency for Medicines and Medical Devices (AEMPS), in coordination with Institutional Review Boards, has adopted a fast-track review procedure to accelerate authorizations for CTs related to the treatment or prevention of COVID-19. There have also been numerous public and private calls for financing research projects aimed at contributing to the fight against this virus. Despite the pandemic, actions have been taken to continue ongoing CTs and studies while the safety and well-being of patients are guaranteed. More specifically, the AEMPS and the European Medicines Agency (EMA) have issued guidelines that incorporate changes to CT protocols that will have to be applied until the pandemic is over. In this health emergency, the scientific community has found itself in a race against time to generate evidence. It is at this moment that hospital pharmacists emerge as key players in clinical research and are contributing to a rational, effective and safe healthcare decision-making

Restablecimiento de la actividad en los servicios de Digestivo. Recomendaciones de la SEPD, AEEH, GETECCU y AEG / Resumption of activity in gastroenterology departments. Recommendations by SEPD, AEEH, GETECCU and AEG

El artículo recoge el conjunto de medidas propuestas por la SEPD, la AEEH, el GETECCU y la AEG que pretenden servir de ayuda a los servicios en su reincorporación a la actividad habitual. Hemos confeccionado una serie de recomendaciones prácticas respecto al manejo y a la reintroducción progresiva de la actividad asistencial. Estas recomendaciones están guiadas por la escasa y cambiante evidencia disponible y serán objeto de futuras actualizaciones en base a las necesidades diarias y a la disponibilidad del material fungible para adecuarse a ellas, y se podrán implementar en cada servicio en función de la incidencia acumulada de SARS-CoV-2 en cada región y de la carga que la epidemia ha ocasionado en cada uno de los hospitales. Los objetivos generales de estas recomendaciones son: a) Proteger a nuestros pacientes de los riesgos de la infección por SARS-CoV-2 y prestarles una atención de calidad. b) Proteger a todos los profesionales sanitarios de los riesgos de la infección por SARS-CoV-2. c)Recuperar el normal funcionamiento de nuestros servicios en un entorno de riesgo continuado de infección por SARS-CoV-2

The set of measures proposed by SEPD, AEEH, GETECCU and AEG are aimed to help departments in their resumption of usual activity. We have prepared a number of practical recommendations regarding patient management and the stepwise resumption of healthcare activity. These recommendations are based on the sparse, changing evidence available, and will be updated in the future according to daily needs and the availability of expendable materials to suit them; in each department they will be implemented depending upon the cumulative incidence of SARS-CoV-2 infection in each region, and the burden the pandemic has represented for each hospital. The general objectives of these recommendations include: (a) To protect our patients against the risks of infection with SARS-CoV-2 and to provide them with high-quality care. (b) To protect all healthcare professionals against the risks of infection with SARS-CoV-2. (c)To resume normal functioning of our departments in a setting of ongoing risk for infection with SARS-CoV-2

Childbirth, puerperium and abortion care protocol during the Covid-19 pandemic / Protocolo de cuidados no parto, no puerpério e no abortamento durante a pandemia de Covid-19

Abstract The new coronavirus (severe acute respiratory syndrome-related coronavirus 2, SARSCoV- 2) is a virus that causes a potentially serious respiratory disease that has spread in several countries, reaching humans in all age groups, including pregnant women. The purpose of this protocol is to provide technical and scientific support to Brazilian obstetricians regarding childbirth, postpartum and abortion care during the pandemic.

Resumo O novo coronavírus (severe acute respiratory syndrome-related coronavirus 2, SARS-CoV- 2) é umvírus que causa uma doença respiratória potencialmente grave que se espalhou por vários países, acometendo seres humanos de todas as faixas etárias, incluindo gestantes. O propósito deste protocolo é fornecer apoio técnico e científico aos obstetras brasileiros com relação aos cuidados no parto, pós-parto e aborto durante a pandemia.