Implementation of a Warm Zone Model During the COVID-19 Pandemic.

ABSTRACT: In March 2020, in response to the coronavirus disease 2019 (COVID-19) pandemic, the executive leadership of an academic medical center in Atlanta tasked an interprofessional quality improvement (QI) team with identifying ways to improve staff and patient safety while caring for patients with suspected or confirmed COVID-19 infection. Additional goals of the initiative were to improve workflow efficiency by reducing the amount of time spent donning and doffing personal protective equipment (PPE) and to conserve PPE, which could be in short supply in a prolonged pandemic. The QI team developed a "warm zone model" that allowed staff members to wear the same mask, eye protection, and gown while moving between the rooms of patients who had tested positive for COVID-19. The risk of self-contamination while doffing PPE is well documented. Staff members were trained to conserve PPE and to properly change gloves and perform hand hygiene between exiting and entering patients' rooms. The warm zone model allowed multidisciplinary team members to reduce the times they donned and doffed PPE per shift while maintaining or increasing the times they entered and exited patients' rooms. Staff members believed that the model improved workflow and teamwork while maintaining staff members' personal safety. Daily gown use decreased on the acute care unit where the model was employed, helping to preserve PPE supplies. Once the model was proven successful in acute care, it was modified and instituted on several critical care COVID-19 cohort units.

PPE during a pandemic: The experience of obtaining PPE and lessons learned from a department of obstetrics and gynecology in New York city.

The COVID-19 Pandemic is an ongoing crisis that has strained hospitals and health systems around the globe. The provision of personal protective equipment (PPE) for frontline healthcare workers is of utmost importance in sustaining an effective response to this crisis. New York City has experienced one of the most devastating outbreaks of the SARS-CoV-2 virus. In this article we report the experience of the Department of Obstetrics and Gynecology at Columbia University in New York City in managing the supply of PPE for providers and staff during the height of the outbreak. We describe the types of equipment used and aspects of PPE regulation and certification. We also describe our practices in extended use and reuse of PPE in light of the current understanding of the virus characteristics and modes of transmission.

COVID-19-associated shortage of alcohol-based hand rubs, face masks, medical gloves, and gowns: proposal for a risk-adapted approach to ensure patient and healthcare worker safety.

The coronavirus disease 2019 (COVID-19) pandemic has caused a huge demand for alcohol-based hand rubs, medical gloves, face masks, and gowns in healthcare and from the public. More and more hospitals face a serious shortage of these articles. We propose a risk-adapted approach to ensure adequate patient and healthcare worker safety for as long as possible.

Availability, Accessibility and Proper Use of Personal Protective Equipment in Wards at Queen Elizabeth Central Hospital (QECH) Blantyre, Malawi: An Observational Study.

Background: The purpose of this study was to evaluate the availability, accessibility and proper use of personal protective equipment (PPE) in the wards at Queen Elizabeth Central Hospital (QECH). Methods: We conducted an observational study with a cross-section design. Convenience sampling method was used for selection of healthcare workers (HCWs) in wards. HCWs filled a checklist on accessibility of PPEs and they were observed on proper use of PPE while conducting clinical procedures. Nurse ward in-charge was asked to fill out a checklist on availability of PPE in their ward. Results: PPE was available in 75.8% of wards, not available in 12.5%. Goggles were absent in 70.8% of wards. PPEs were 71.4% accessible and 28.6% inaccessible to healthcare workers in the wards. The most inaccessible PPEs were goggles (83.2%) and footwear (73.7%) while facemasks, sterile and non-sterile gloves and aprons were readily accessible. Non sterile gloves were 100% available and accessible. Only 13.5% of the HCWs had good compliance with PPE standard procedures. The average PPE compliance score of those who had been trained was 6 % greater than those who were not trained. Conclusion: This study identified areas of improvement in healthcare system delivery regarding standard precautions with emphasis on PPE. Improvements in training during professional college education and in-service refresher training could improve compliance with appropriate use of PPE for relatively low cost. Management support could improve availability and accessibility of PPE in the wards at QECH, with active supervision to improve adherence levels to personal protective equipment usage. The study can also help in the development of policies and guidelines regarding PPE usage by showing that most HCWs need to be trained in proper PPE usage.

Challenges encountered in providing integrated HIV, antenatal and postnatal care services: a case study of Katakwi and Mubende districts in Uganda.

BACKGROUND: Integration of sexual and reproductive health (SRH), HIV/AIDS and maternal health (MH) services is a critical strategy to confront the HIV/AIDS epidemic, high maternal mortality and the unmet need for contraception. In 2011 the AIDS Information Centre (AIC) in partnership with the Ministry of Health implemented SRH, HIV/AIDS and MH integration services in the districts of Katakwi and Mubende in Uganda. This paper documents challenges encountered in providing these integrated services in the two districts. METHODS: This was a cross-sectional qualitative study conducted in Mubende and Katakwi districts in Uganda. Data were collected using 10 focus group discussions with 89 women attending ANC and postnatal care and 21 key informant interviews with district managers and health workers who were involved in the integrated service delivery. Content thematic approach was used for data analysis. RESULTS: The study findings indicate that various challenges were encountered in integrating HIV, ANC and PNC services. Major challenges included inadequate staff, gaps in knowledge of service providers especially with regard to provision of long-term family planning, limited space, shortage of critical supplies such as HIV test kits, drugs and gloves. CONCLUSION: These findings indicate that the delivery of integrated HIV, SRH and MH services is hampered greatly by health system challenges and depict the need for additional staffing in health facilities, capacity building of health workers and health managers as well as ensuring sufficient supplies to health facilities for smooth implementation of integrated SRH, HIV and MH services.

Are aloe-coated gloves effective in healthcare?

The moisturising properties of aloe vera have long been known. Examination gloves with aloe coatings are now available on the UK market for use in healthcare settings. This article examines the evidence surrounding the use of these gloves in the workplace to prevent dry, sore hands.

Principles of appropriate use of disposable gloves.

Shila Patel explains the principles of glove use, highlighting the procedures for which they are indicated and advising on appropriate storage.

Intervention development in occupational research: an example from the printing industry.

BACKGROUND: Intervention development research is an essential prerequisite of any study that attempts to determine whether specific interventions work to prevent work related injury and illness. METHODS: Focus groups (n = 5) and direct observational studies (n = 21) of printers were used to elicit key issues that would aid the development of subsequent interventions. Transcripts from these were analysed by standard qualitative methods to identify common and related themes. RESULTS: The views of managers differed significantly from those of print workers in a number of areas, and working practices did not always follow policy. The majority of printers did not perceive dermatitis to be a major problem, although many complained of dry hands. Other key results included: the lack of skin care policy in most companies; poor understanding of the nature, causes, and treatment of dermatitis; low priority of dermatitis within health and safety concerns; little or no provision of occupational health services, particularly skin checks; variability in provision of and access to appropriate skin protection; and lack of accessible washing facilities. CONCLUSIONS: As a result it was decided to evaluate the implementation of four INTERVENTIONS: provision of (1) skin checks and treatment advice; (2) gloves of the correct type and size, and use of an after-work cream; (3) information on dermatitis within the printing industry; and (4) development of best practice skin care policy.

Choosing the right glove for the right purpose.

With the increase in the number of health-care workers developing allergies to natural rubber latex, knowing what alternative gloves can be used is becoming increasingly important. This article provides a guide to the various types of gloves available and their specific uses in health care.

Chemotherapy-handling practices of outpatient and office-based oncology nurses.

PURPOSE/OBJECTIVES: To determine the current patterns of use of personal protective equipment among oncology nurses while handling antineoplastic chemotherapeutic agents in outpatient and office-based settings. DESIGN: Descriptive-correlational, mailed survey. SETTING: National survey of oncology nurses. SAMPLE: 500 randomly selected members of the Oncology Nursing Society who identified their work settings as office, clinic, or outpatient private practice; 263 responded for an overall response rate of 53%. METHODS: Mailed, self-report survey based on the current Occupational Safety and Health Administration's (OSHA's) guidelines for the handling of hazardous drugs. MAIN RESEARCH VARIABLE: Chemotherapy-handling practices. FINDINGS: More than 94% of participants reported usually wearing gloves during chemotherapy handling; 55% reported using laboratory coats as protective garments. Usual use of face and respiratory protection was less than 6%. Chemotherapy was reported to be prepared in laminar air flow hoods in 99% of work settings. Only 46% of sites reportedly provided any type of medical monitoring. CONCLUSION: Use and availability of personal protective equipment when handling chemotherapy have increased, but medical monitoring of exposed employees still is neither widely practiced nor consistent with OSHA guidelines. IMPLICATIONS FOR NURSING: Safety concerns and potential adverse health effects associated with the occupational handling of chemotherapeutic agents have been reported. Historically, nurses' adherence to chemotherapy-handling guidelines has been poor. Results suggest that adherence is increasing; however, research is lacking regarding nurses' level of knowledge of and specific barriers to safe handling of chemotherapy.

Factors that impact on the infection control capability of gloves.

The use of gloves can reduce the risk of cross-infection for patients and health-care professionals. This is dependent, however, on the correct type of glove being selected for the appropriate job. Care must be taken to ensure that gloves are stored and worn correctly, to reduce the chance of exposing them to factors that may damage their integrity.

Latex protein allergy and your choice of gloves: a balanced consideration.

Natural rubber gloves have been acknowledged as the best protective devices available for protecting health care personnel and their patients against viral transmission and infectious fluids. Yet, with the adoption of standard safety precautions and the increase in the use of gloves, an increasing number of people are being affected with latex allergy. Negative publicity related to latex allergy has resulted in health care personnel deciding against using the highly protective natural rubber gloves. The relationship between natural rubber gloves and latex protein allergy needs to be better understood in order for health care professionals to make an informed choice in their selection of gloves.

Dock closings worried glove suppliers.

Hospitals, suppliers and group purchasing organizations evaluated how they could be vulnerable to shortages if the closure of 29 West Coast ports had continued much beyond a few weeks.

Community infection control: what is the evidence?

Evidence-based practice is the conscientious use of current best evidence in decision-making about care or the delivery of health services (National Institute for Public Health, 1996). Evidence-based health care is one aspect of the quality improvement activities of clinical governance as a main component of the programme of quality in the NHS (Hek, 2000). Practitioners working in clinical areas are therefore being required to deliver care that has been shown to be effective. (Playle, 2000).