Multilevel approach to individual and organisational predictors of stress and fatigue among healthcare workers of a university hospital: a longitudinal study.

OBJECTIVE: Healthcare workers (HCWs) are at high risk of experiencing stress and fatigue due to the demands of their work within hospitals. Improving their physical and mental health and, in turn, the quality and safety of care requires considering factors at both individual and organisational/ward levels. Using a multicentre prospective cohort, this study aims to identify the individual and organisational predictors of stress and fatigue of HCWs in several wards from university hospitals. METHODS: Our cohort consists of 695 HCWs from 32 hospital wards drawn at random within four volunteer hospital centres in Paris-area. Three-level longitudinal analyses, accounting for repeated measures (level 1) across participants (level 2) nested within wards (level 3) and adjusted for relevant fixed and time-varying confounders, were performed. RESULTS: At baseline, the sample was composed by 384 registered nurses, 300 auxiliary nurses and 11 midwives. According to the three-level longitudinal models, some predictors were found in common for both stress and fatigue (low social support from supervisors, work overcommitment, sickness presenteeism and number of beds per ward). However, specific predictors for high level of stress (negative life events, low social support from colleagues and breaks frequently cancelled due to work overload) and fatigue (longer commuting duration, frequent use of interim staff in the ward) were also found. CONCLUSION: Our results may help identify at-risk HCWs and wards, where interventions to reduce stress and fatigue should be focused. These interventions could include manager training to favour better staff support and overall safety culture of HCWs.

Identifying individual and organizational predictors of accidental exposure to blood (AEB) among hospital healthcare workers: A longitudinal study.

BACKGROUND: Accidental exposure to blood (AEB) poses a risk of bloodborne infections for healthcare workers (HCWs) during hospital activities. In this study, we identified individual behavioral and organizational predictors of AEB among HCWs. METHODS: The study was a prospective, 1-year follow-up cohort study conducted in university hospitals in Paris, France. Data were collected from the Stress at Work and Infectious Risk in Patients and Caregivers (STRIPPS) study. Eligible participants included nurses, nursing assistants, midwives, and physicians from 32 randomly selected wards in 4 hospitals. AEB occurrences were reported at baseline, 4 months, 8 months, and 12 months, and descriptive statistical and multilevel risk-factor analyses were performed. RESULTS: The study included 730 HCWs from 32 wards, predominantly nurses (52.6%), nursing assistants (41.1%), physicians (4.8%), and midwives (1.5%). The incidence rate of AEB remained stable across the 4 visits. The multilevel longitudinal analysis identified several significant predictors of AEB occurrence. Individual-level predictors included younger age, occupation as nurses or midwives, irregular work schedule, rotating shifts, and lack of support from supervisors. The use of external nurses was the most significant ward-level predictor associated with AEB occurrence. CONCLUSIONS: AEBs among HCWs are strongly associated with organizational predictors, highlighting the importance of complementing infection control policies with improved staff management and targeted training. This approach can help reduce AEB occurrences and enhance workplace safety for HCWs.

Environmental contamination related to SARS-CoV-2 in ICU patients.

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak is a primary global concern, and data are lacking concerning risk of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) environmental contamination. OBJECTIVE: To identify risk factors for SARS-CoV-2 environmental contamination in COVID-19 patients admitted to the intensive care unit (ICU). METHODS: A prospective single centre 1-day study was carried out in an ICU. Four surfaces (the ventilator control screen, the control buttons of the syringe pump, the bed rails and the computer table located >1 m away from the patient) were systematically swabbed at least 8 h after any cleaning process. We analysed clinical, microbiological and radiological data to identify risk factors for SARS-CoV-2 environmental contamination. RESULTS: 40% of ICU patients were found to contaminate their environment. No particular trend emerged regarding the type of surface contaminated. Modality of oxygen support (high-flow nasal cannula oxygenation, invasive mechanical ventilation, standard oxygen mask) was not associated with the risk of environmental contamination. Univariate analysis showed that lymphopenia <0.7×109·L-1 was associated with environmental contamination. CONCLUSION: Despite small sample size, our study generated surprising results. Modality of oxygen support is not associated with risk of environmental contamination. Further studies are needed.

Extensively-drug-resistant bacteria carriers among overseas travellers: one-third had not been hospitalized previously.

BACKGROUND: Extensively-drug-resistant bacteria (XDRB) have emerged as a major source of resistance. Hospitalization abroad seems to be the major risk factor associated with carriage, and numerous reports have warned about the risk of in-hospital transmission. However, little is known regarding possible community transmission. METHODS: A retrospective matched case-control study was conducted in a Parisian teaching hospital, which included patients admitted to hospital with a history of travel abroad over the preceding 12 months. Each XDRB carrier at admission (case) was matched with two non-carriers (controls) hospitalized in the same ward and admitted during the same month. AIM: To describe and identify risk factors associated with XDRB carriage at admission. FINDINGS: Forty-six cases and 92 controls were enrolled. The results of univariate and multi-variate analyses showed that health repatriation was the only factor associated with a higher risk of carrying XDRB (odds ratio 3.22, 95% confidence interval 1.23-7.84; P=0.01). Surprisingly, one-third of the study population had not been hospitalized abroad within the preceding 12 months. The most frequently identified XDRB species were Escherichia coli (36%), Enterococcus spp. (17%) and Klebsiella pneumoniae (9%), and the most frequently identified enzyme was OXA-48 (36%). CONCLUSION: In this retrospective study, health repatriation was the only risk factor for XDRB carriage identified at admission. Furthermore, the data suggest community-onset transmission. Therefore, there is an urgent need to conduct studies in high-risk countries to identify the risk factors associated with community carriage.