Hydroxychloroquine in Treatment of Asymptomatic and Mildly Symptomatic COVID-19: A Multi-Centre Cohort Study.

BACKGROUND: Although hydroxychloroquine (HCQ) lacks benefit in patients with moderate-to-severe COVID-19, its role in asymptomatic and mildly symptomatic disease needs better elucidation. METHODS: This multi-centre cohort study included asymptomatic and mildly symptomatic, RT-PCR confirmed COVID-19 cases between 30 March and 20 May, 2020. Patients were categorized into two groups (HCQ-treated and untreated) based on exposure to HCQ. Dose of HCQ used was 400 mg twice daily (day one) followed by once daily for seven days. HCQ-untreated patients were managed supportively without any active antiviral or immunomodulatory therapy. Nasopharyngeal SARS-CoV-2 clearance by RT-PCR (primary outcome) was compared between HCQ-treated and untreated patients using Kaplan-Meier analysis and Cox proportional-hazards regression. Clinical efficacy and safety profile of HCQ were assessed (secondary outcomes). RESULTS: 162 patients [84 (51·9%) males; mean age 38·2 (15·2) years] were included. Forty-four (27·2%) patients had mild disease, rest 118 (72·8%) were asymptomatic. Seventy-five (46·3%) patients received HCQ. Median time to virological negativity was lesser in HCQ-treated (13 days) versus untreated patients (15 days) (logrank<0·001) in both asymptomatic and mildly symptomatic patients. Treatment with HCQ was the only independent predictor of virological negativity (hazardratio=2·24; adjusted p-value<0·001). Two (5·4%) mildly symptomatic patients progressed to severe disease within 24 hours (two doses) of HCQ initiation, compared to none in the HCQ-untreated group. Five HCQ-treated patients developed minor gastrointestinal side effects, not requiring drug discontinuation. CONCLUSION: HCQ reduced the time to virologic negativity (by 2 days) in asymptomatic and mildly symptomatic COVID-19, without any serious adverse events. However, no obvious clinical benefit was noted.

Demographic & clinical profile of patients with COVID-19 at a tertiary care hospital in north India.

BACKGROUND & OBJECTIVES: The COVID-19 pandemic emerged as a major public health emergency affecting the healthcare services all over the world. It is essential to analyze the epidemiological and clinical characteristics of patients with COVID-19 in different parts of our country. This study highlights clinical experience in managing patients with COVID-19 at a tertiary care centre in northern India. METHODS: Clinical characteristics and outcomes of consecutive adults patients admitted to a tertiary care hospital at Chandigarh, India, from April 1 to May 25, 2020 were studied. The diagnosis of SARS-CoV-2 infection was confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) on throat and/or nasopharyngeal swabs. All patients were managed according to the institute's consensus protocol and in accordance with Indian Council of Medical Research guidelines. RESULTS: During the study period, 114 patients with SARS-CoV-2 infection were admitted. The history of contact with COVID-19-affected individuals was available in 75 (65.8%) patients. The median age of the patients was 33.5 yr (13-79 yr), and there were 66 (58%) males. Of the total enrolled patients, 48 (42%) were symptomatic. The common presenting complaints were fever (37, 77%), cough (26, 54%) and shortness of breath (10, 20.8%). Nineteen (17%) patients had hypoxia (SpO2<94%) at presentation and 36 (31%) had tachypnoea (RR >24). Thirty four (29.8%) patients had an accompanying comorbid illness. Age more than 60 yr and presence of diabetes and hypertension were significantly associated with severe COVID-19 disease. Admission to the intensive care unit (ICU) was needed in 18 patients (52%), with three (2.6%) patients requiring assisted ventilation. Mortality of 2.6 per cent (3 patients) was observed. INTERPRETATION & CONCLUSIONS: Majority of the patients with COVID-19 infection presenting to our hospital were young and asymptomatic. Fever was noted only in three-fourth of the patients and respiratory symptoms in half of them. Patients with comorbidities were more vulnerable to complications. Triaged classification of patients and protocol-based treatment resulted in good outcomes and low case fatality.

Bacterial coinfections and secondary infections in COVID-19 patients from a tertiary care hospital of northern India: Time to adhere to culture-based practices.

OBJECTIVE: Bacterial co-pathogens are common in various viral respiratory tract infections, leading to increased disease severity and mortality. Still, they are understudied during large outbreaks and pandemics. This study was conducted to highlight the overall burden of these infections in COVID-19 patients admitted to our tertiary care hospital, along with their antibiotic susceptibility patterns. MATERIAL AND METHODS: During the six-month study period, clinical samples (blood samples, respiratory samples, and sterile body fluids, including cerebrospinal fluid [CSF]) of COVID-19 patients with suspected bacterial coinfections (at presentation) or secondary infections (after 48 hours of hospitalization) were received and processed for the same. RESULTS: Clinical samples of 814 COVID-19 patients were received for bacterial culture and susceptibility. Out of the total patient sample, 75% had already received empirical antibiotics before the samples were sent for analysis. Overall, 17.9% of cultures were positive for bacterial infections. Out of the total patients with bacterial infection, 74% (108/146) of patients had secondary bacterial infections (after 48 hours of hospitalization) and 26% (38/146) had bacterial coinfections (at the time of admission). Out of the 143 total isolates obtained, the majority (86%) were gram-negative organisms, of which Acinetobacter species was the commonest organism (35.6%), followed by Klebsiella pneumoniae (18.1%). The majority (50.7%) of the pathogenic organisms reported were multidrug resistant. CONCLUSION: The overall rate of secondary bacterial infections (SBIs) in our study was lower (7.9%) than reported by other studies. A rational approach would be to adhere to the practice of initiating culture-based guidance for antibiotics and to restrict unnecessary empirical antimicrobial therapy.

Assessment of motivation levels and associated factors among the nursing staff of tertiary-level government hospitals.

The present study assessed the motivation level of nurses working in 3 highly decorated tertiary-level government hospitals of India and also underpins the factors attributing to motivation levels. A sequential mixed-method design was used in this study wherein 400 nurses working in 5 units of nursing care in the hospitals were enrolled based upon proportionate random stratified sampling techniques. A self-administered questionnaire with Likert scale was developed based upon scale used by Mbindyo et al. The attributes of motivation were then categorized into external and internal attributes. For the qualitative component, participants with varied responses in quantitative data were selected and interviewed. Overall mean motivation score of the nursing staff was found 3.57 ± 0.93, which was higher for extrinsic motivational attributes (3.67 ± 0.88) as compared with intrinsic attributes (3.47 ± 0.98). The intrinsic motivational attribute of organizational commitment was rated highest followed by general motivation, conscientiousness, and self-efficacy. Personal issues, timeliness, and burnout were prime discouraging attributes among study participants. Sociodemographic characteristics and work profile characteristics showed significant relationship with the attributes of motivation. This study underscores the significance of different attributes of motivation which needs to be considered while framing administrative strategies and policy guidelines by authorities.

Ventilator-associated pneumonia - What price does the public health system pay?

BACKGROUND: Ventilator-associated pneumonia (VAP) is the commonest healthcare-associated infection (HAI) in intensive care units (ICU), especially in trauma patients. VAP imposes a significant cost burden on the healthcare ecosystem. However, there are few data from the developing world. METHODOLOGY: We conducted this study in the trauma ICU (TICU) of PGIMER, Chandigarh, from October 2021 to December 2022. The incidence, incidence density, and average length of stay (ALOS) of both VAP and non-VAP patients were established. The health system cost was assessed using a mixed (top-down and bottom-up) micro-costing approach. We collected data for all the resources (direct and indirect costs) utilized during service delivery and estimated the health system cost per bed per day. RESULTS: In this study, 494 patients were admitted to TICU, of which 484 received Mechanical Ventilation (MV) and 47 developed VAP. We included 41 and 44 patients with and without VAP. The VAP incidence rate was 9.7% and the VAP incidence density was 10.79/1000 MV days. The ALOS for VAP patients was 21 days, and for non- VAP patients was 8.2 days. Our study estimated a total health system cost of INR 25,927 per bed per day. The health system cost of treating a VAP patient was INR 544,467 compared to INR 207,416 for a non-VAP patient. CONCLUSION: Treatment of VAP poses substantial costs for the health system and patients. There is a need to focus on preventing VAP, which would eventually reduce the length of stay and the resultant financial impact on the health system and the patient.

Utility of the Comprehensive Health and Stringency Indexes in Evaluating Government Responses for Containing the Spread of COVID-19 in India: Ecological Time-Series Study.

BACKGROUND: Many nations swiftly designed and executed government policies to contain the rapid rise in COVID-19 cases. Government actions can be broadly segmented as movement and mass gathering restrictions (such as travel restrictions and lockdown), public awareness (such as face covering and hand washing), emergency health care investment, and social welfare provisions (such as poor welfare schemes to distribute food and shelter). The Blavatnik School of Government, University of Oxford, tracked various policy initiatives by governments across the globe and released them as composite indices. We assessed the overall government response using the Oxford Comprehensive Health Index (CHI) and Stringency Index (SI) to combat the COVID-19 pandemic. OBJECTIVE: This study aims to demonstrate the utility of CHI and SI to gauge and evaluate the government responses for containing the spread of COVID-19. We expect a significant inverse relationship between policy indices (CHI and SI) and COVID-19 severity indices (morbidity and mortality). METHODS: In this ecological study, we analyzed data from 2 publicly available data sources released between March 2020 and October 2021: the Oxford Covid-19 Government Response Tracker and the World Health Organization. We used autoregressive integrated moving average (ARIMA) and seasonal ARIMA to model the data. The performance of different models was assessed using a combination of evaluation criteria: adjusted R2, root mean square error, and Bayesian information criteria. RESULTS: implementation of policies by the government to contain the COVID-19 crises resulted in higher CHI and SI in the beginning. Although the value of CHI and SI gradually fell, they were consistently higher at values of >80% points. During the initial investigation, we found that cases per million (CPM) and deaths per million (DPM) followed the same trend. However, the final CPM and DPM models were seasonal ARIMA (3,2,1)(1,0,1) and ARIMA (1,1,1), respectively. This study does not support the hypothesis that COVID-19 severity (CPM and DPM) is associated with stringent policy measures (CHI and SI). CONCLUSIONS: Our study concludes that the policy measures (CHI and SI) do not explain the change in epidemiological indicators (CPM and DPM). The study reiterates our understanding that strict policies do not necessarily lead to better compliance but may overwhelm the overstretched physical health systems. Twenty-first-century problems thus demand 21st-century solutions. The digital ecosystem was instrumental in the timely collection, curation, cloud storage, and data communication. Thus, digital epidemiology can and should be successfully integrated into existing surveillance systems for better disease monitoring, management, and evaluation.

Injury pattern of road traffic accident cases attending trauma centre of tertiary care hospital of North India.

Introduction: Injury is a significant global health burden and can result in mortality if not attended to on time. Trauma system refers to a collection of services provided by various super-specialties. According to the WHO-World Bank Report, RTA will rise from ninth place to the third biggest cause of mortality. Materials and Methods: The study was done at Advanced Trauma Centre (ATC) at PGIMER, a teaching hospital of north India. Study included area from most of the patient come for treatment (rural/urban) and injury patterns seen in these patients, which included mode of injury, type of injury, type of road accidents and location of injury. Results and Observations: In maximum cases, 60.2% (245) of the mode of injury was RTA. It was seen that the maximum number of patients, 44.4%, (115) had motorbike/scooter collisions with vehicles. In most patients, the type of injury seen was 35.9% (147) head, neck and back injuries, and in maximum cases, the location of the accident site was road/street 63.2%. Discussion: In our country, where the trauma delivery system is poorly developed, teaching hospitals have to bear the burden of treating many patients. No concept of emergency medicine or trauma care is in use, even in urban areas. As a result, teaching hospitals' emergency departments receive many referrals for emergency conditions.

Doffing Corridor: Establishing Expedited High-Volume Doffing With Exposure Reduction to Contaminated Personal Protective Equipment (PPE) in a COVID-19 Hospital in India.

Background Considering the virulent nature of the COVID-19, the safety of healthcare workers (HCW) became a challenge for hospital administrators. Wearing a personal protective equipment (PPE) kit, called donning, which can be easily done by the help of another staff. But correctly removing the infectious PPE kit (doffing) was a challenge. The increased number of HCWs for COVID-19 patient care raised the opportunity to develop an innovative method for the smooth doffing of PPEs. Objective We aimed to design and establish an innovative PPE doffing corridor in a tertiary care COVID-19 hospital during the pandemic in India with a heavy doffing rate and minimize the COVID-19 virus spread among healthcare workers. Methodology A prospective, observational cohort study at the COVID-19 hospital, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, was conducted from July 19, 2020, to March 30, 2021. The time taken for PPE doffing process of HCWs was observed and compared between the doffing room and doffing corridor. The data was collected by a public health nursing officer using Epicollect5 mobile software and Google forms. The following parameters, like grade of satisfaction, time and volume of doffing, the errors in the steps of doffing, rate of infection, were compared between the doffing corridor and the doffing room. The statistical analysis was done by the use of SPSS software. Result 'Doffing corridor' decreased the overall doffing time by 50% compared to the initial doffing room. The doffing corridor solved the purpose of accommodating more HCWs for PPE doffing and an overall saving of 50% time. Fifty-one percent of HCWs rated the satisfaction rate as Good in the grading scale. The errors in the steps of doffing that occurred in the doffing process were comparatively lesser in the doffing corridor. The HCWs who doffed in the doffing corridor were three times less likely to get self-infection than the conventional doffing room. Conclusion Since COVID-19 was a new pandemic, the healthcare organizations focused on innovations to combat the spread of virus. One of these was an innovative doffing corridor to expedite the doffing process and decrease the exposure time to the contaminated items. The doffing corridor process can be considered at a high-interest rate to any hospital dealing with infectious disease, with high working satisfaction, less exposure to the contagion, and less risk of infection.

A descriptive study on child sexual abuse act in India.

Background: Child sexual abuse (CSA) is a significant public health problem. Health care professionals can play an important role in the identification and reporting of such cases. This study was conducted to assess the awareness level among doctors working in a medical Institute about CSA. Materials and Methods: This is a cross-sectional descriptive study. Data was collected using a closed-ended structured questionnaire. Descriptive analysis was done to compute percentages and frequencies. Respondents' educational qualification, as well as the relationship between their level of education and their awareness of child abuse, was also assessed. Results: Nearly 70% of respondents came across child abuse cases, wherein sexual abuse was found to be the commonest (58%), followed by physical abuse (28%). Nearly 40% of child abuse cases were reported in the hospital where they worked, while 15% of child abuse cases occurred in other hospital areas. The study also revealed that 81% of respondents had knowledge about child sexual abuse. However, only 34% were aware of the repercussions of non-reporting of a child abuse case. Nearly 64% of respondents had an idea about an online complaint system for child abuse, and 70% were aware of the availability of a one-stop centre at a respondent's hospital. The majority (68%) were aware of the POCSO (Protection of Children from Sexual Offences) Act on sexual abuse. On seeking information regarding evidence of anal sexual abuse among children and adolescents, 36% were completely aware, and 13% were partly aware of it. Conclusion: There is a need for continued education and advancement of all health care professionals to improve the diagnosis and reporting of CSA.

Ensconcing a biostatistics clinic in tertiary care research institute of India: A descriptive study.

Context: Data collection and statistical analysis are integral components of research. The beauty of statistics lies in its ability to evaluate evidence in the face of uncertainty. However, lack of dedicated biostatistical consultation units, rote academic teaching and training lead to poor statistical analysis. Thus, we aim to explore and understand the challenges of establishing a Biostatistics Clinic (BC) in a tertiary care research institute. A secondary aim is to identify the stage of research at which participants approach biostatisticians. Material and Methods: The data for the current study came from a consultancy unit named as "Biostatistics Clinic" in the department of biostatistics from Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. The residents and students who approached the department of biostatistics for consultancy regarding study design, sample size, statistical analysis and other analytical work were the sampling units. Results: A total of 208 residents and students made 404 visits to biostatistics clinic. The male and female visits were 118 (56.7%) and 90 (43.5%), respectively. Majority of visitors approached for data analysis (171; 75%) followed by study design and sample size calculation for protocol preparation (43; 18.9%). Leading reference to approach the biostatistics clinic was through a faculty (91; 43.8%) followed by self (54; 26%). Conclusion: Despite the thrust and apparent advantages of contacting statistician at the beginning of the study, majority approached only at the data analysis stage. Therefore, repeated and improved efforts are required to spread the message of approaching statistician early.

Comparison of Imaging Severity Between Vaccinated and Unvaccinated COVID-19 Patients: Perspective of an Indian District.

BACKGROUND: Extensive vaccination drives undertaken globally helped in the fight against the coronavirus disease 2019 (COVID-19) pandemic, but different nations adopted different vaccination policies to tackle the disease. The vaccination drive in India began with the administration of two different vaccines: Covishield and Covaxin. We assessed the effect of vaccination status on imaging severity in patients with positive COVID-19 reverse transcription-polymerase chain reaction (RT-PCR)/antigen tests. METHOD: This was a single-center retrospective observation analysis carried out over three months between March 1, 2021, to May 31, 2021. Data access was provided by the District Hospital Review Board (DHRB) and the Department of Health (DOH), District Ambala, Haryana. Appropriate statistical tools were used to analyze the data. Statistical Package for Social Sciences (SPSS) 26.0 and Python 3.9 were used for statistical analysis and visualization, and a p-value of less than 0.05 was considered statistically significant. RESULTS: The total sample size of the study was 1,316, out of which 371 (28.2%) were vaccinated and 945 (71.8%) were not vaccinated. The mean age of the study participants was 49.6 ± 15.7 years. Seven hundred ninety-seven (60.6%) participants were male, while 519 (39.4%) participants were female. A statistically significant reduction was observed in the computed tomography severity score (CTSS) of the vaccinated population compared to the non-vaccinated group (χ2 = 74.3, p < 0.001). Vaccination led to a statistically significant decrease in mean CTSS across all lung lobes. CONCLUSION: Emerging COVID-19 variants challenge the effect of available vaccines, with different nations adopting different vaccination strategies to deal with the ongoing health problem. CTSS was employed as an objective marker to study the disease severity and effect of vaccination. Vaccination resulted in a significant reduction in CTSS seen on high-resolution computed tomography (HRCT) chest scans. There was a significant decrease in the incidence of severe COVID-19 pneumonia among vaccinated individuals. We need more observational data to corroborate the efficacy of vaccines presented in the randomized trials. Sharing such data between different nations can help us adopt a unifying vaccination strategy and decrease the impact of COVID-19 in subsequent disease waves.

A Fire Incident Case at a Radiodiagnostic Center of a Tertiary Care Hospital: Methods for Reduction in Fatality by Smoke Evacuation.

For the general public, healthcare facilities are always a safe and secure place for treatment. Generally, healthcare institutions are equipped to deal with exterior interruptions, but circumstances brought on by internal risks are more serious and frequently require an emergency evacuation of the facility. An incident happened at the radiodiagnostic setup of a tertiary care institute in North India. This fire incident created panic among staff and patients. At the place of casualty, there were around 150 persons, including staff, patients, and their attendants. Immediately after the confirmation of the fire incident, the fire department and security department took action in the form of fire control and smoke evacuation. Though six fire handling staff required minor emergency services for asphyxia due to smoke inhalation and were cured by oxygen support only, none of the patients was affected due to timely smoke evacuation. Most often, smoke management techniques implemented are compartmentation, pressurization, dilution, ventilation, buoyancy, and airflow. So, we concluded that the step of timely smoke evacuation and preventing the spread of smoke by various methods help to reduce fatality due to smoke. The training programs and mock drills give stakeholders the needed knowledge, skills, and practice they need to safeguard patients and employees.

Surface contamination by SARS-CoV2 RNA in dedicated COVID care area of a tertiary care hospital in North India.

Environmental surfaces are potential source of SARS-CoV2 transmission. The study assessed the efficacy of hospital disinfection policy and contamination of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) RNA in COVID management Hospital. Inanimate surfaces from both patient areas (n = 70) and non-patient areas (n = 39) were sampled through surface swabbing and subjected to Reverse transcriptase PCR. Out of the 70 samples collected from the COVID hospital, SARS-CoV2 RNA positivity of 17.5% (7/40) and 6.7% (2/30) was seen in high risk and moderate risk area respectively. Samples from Non COVID related patient area such as CD ward and administrative block were assessed and the SARS CoV-2 RNA positivity was 0% and 10% respectively. Among the total 8 environmental surface samples positive for SARS-CoV2 RNA detected from the area surrounding the SARS-CoV2 infected patients, maximum positivity of 31.8% (7/22) was found among the environmental samples collected around the patients with < 20 Ct value in nasopharyngeal swab samples followed by 3.3% positivity (1/30) around patients with Ct value ranging from 20 to 25 whereas no SARS-CoV2 RNA (0/5) was detected around the patient with > 25 Ct value. Nearly 50% (2/4) of the surface samples came positive from the resident PPE and mobile of the treating doctors which largely elaborates the need for stringent doffing measurement and hand hygiene policy post doffing. The study emphasizes the necessity of frequent and aggressive disinfection policy to prevent nosocomial infection in such high risk areas within close vicinity of the patients.

Exploring the Utility of Google Mobility Data During the COVID-19 Pandemic in India: Digital Epidemiological Analysis.

BACKGROUND: Association between human mobility and disease transmission has been established for COVID-19, but quantifying the levels of mobility over large geographical areas is difficult. Google has released Community Mobility Reports (CMRs) containing data about the movement of people, collated from mobile devices. OBJECTIVE: The aim of this study is to explore the use of CMRs to assess the role of mobility in spreading COVID-19 infection in India. METHODS: In this ecological study, we analyzed CMRs to determine human mobility between March and October 2020. The data were compared for the phases before the lockdown (between March 14 and 25, 2020), during lockdown (March 25-June 7, 2020), and after the lockdown (June 8-October 15, 2020) with the reference periods (ie, January 3-February 6, 2020). Another data set depicting the burden of COVID-19 as per various disease severity indicators was derived from a crowdsourced API. The relationship between the two data sets was investigated using the Kendall tau correlation to depict the correlation between mobility and disease severity. RESULTS: At the national level, mobility decreased from -38% to -77% for all areas but residential (which showed an increase of 24.6%) during the lockdown compared to the reference period. At the beginning of the unlock phase, the state of Sikkim (minimum cases: 7) with a -60% reduction in mobility depicted more mobility compared to -82% in Maharashtra (maximum cases: 1.59 million). Residential mobility was negatively correlated (-0.05 to -0.91) with all other measures of mobility. The magnitude of the correlations for intramobility indicators was comparatively low for the lockdown phase (correlation ≥0.5 for 12 indicators) compared to the other phases (correlation ≥0.5 for 45 and 18 indicators in the prelockdown and unlock phases, respectively). A high correlation coefficient between epidemiological and mobility indicators was observed for the lockdown and unlock phases compared to the prelockdown phase. CONCLUSIONS: Mobile-based open-source mobility data can be used to assess the effectiveness of social distancing in mitigating disease spread. CMR data depicted an association between mobility and disease severity, and we suggest using this technique to supplement future COVID-19 surveillance.

Multidimensional dynamic healthcare personnel (HCP)-centric model from a low-income and middle-income country to support and protect COVID-19 warriors: a large prospective cohort study.

OBJECTIVES: Healthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty. SETTING: Our tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless. PARTICIPANTS: We recruited willing low-risk HCP, aged <50 years, with no comorbidities to work in COVID-19 zones. Social distancing, hand hygiene and universal masking were advocated in the low-risk zone. RESULTS: Between 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (<1%), ensured satisfaction with training (92%), PPE (90.8%), medical and psychosocial support (79%) and improved acceptance of COVID-19 duty with 54.7% volunteering for re-deployment. CONCLUSION: A multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.

Response to a Fire Incident in the Operation Room: A Cautionary Tale.

Health care facilities are always seen as places of haven and protection for managing external incidents, but situations become difficult and challenging when such facilities themselves are affected by internal hazards. Such incidents are arguably more disruptive than external incidents, because patients are dependent on supportive measures and are neither in position to respond to such crisis situation nor do they know how to respond. Operating room fires are rare but potentially catastrophic, involving loss of costly resources and possibly lives. This case report details a true operating room fire incident in an emergency operating room and details the real-life challenges encountered by operating room staff in preserving both life and property. As a result of this work, precautionary measures may be implemented to mitigate such incidents. Careful coordination, continuous training, and fire drill exercises can improve the overall outcomes and minimize the possibility of these potentially fatal problems, thereby making a safer health care environment for every worker and patient.