The Experience of ER Nurses in Lebanese Hospitals, During the COVID-19 Outbreak: A Qualitative Study.

OBJECTIVE: The increasing number of COVID-19 cases, as well as the overwhelming workload, constitutes a serious occupational health threat to Emergency Room (ER) nurses working on the frontlines. In Lebanon, where unstable socio-economic conditions reign, the Covid-19 outbreak was added to the plethora of daily challenges faced by healthcare workers. The study's objective is to explore how Lebanese ER nurses perceived their duty on the frontlines amid the Covid-19 pandemic. METHODS: This study employed a descriptive exploratory qualitative design. 15 Lebanese ER nurses working directly with Covid-19 patients were recruited from 3 university hospitals in Beirut. Interviews were held for data collection until data saturation. Subsequent analysis was done via coding of the transcribed verbatim. RESULTS: The findings showed significant gaps related to preparedness, support, and governmental action. Similarly, the frontliners faced serious challenges that increased their stress levels both physically and mentally. Furthermore, some participants were subject to stigma and had to face irresponsible behaviors during triage. Participants emphasized the need to guarantee a safe environment at work, to provide Covid-19 patients with the needed care. CONCLUSIONS: ER nurses struggled during this pandemic while working on the frontlines. They described their experience as not satisfying, with high levels of stress, danger, and challenges.

Comparison of steam sterilization conditions efficiency in the treatment of Infectious Health Care Waste.

Many studies show that the treatment of Infectious Health Care Waste (IHCW) in steam sterilization devices at usual operating standards does not allow for proper treatment of Infectious Health Care Waste (IHCW). Including a grinding component before sterilization allows better waste sterilization, but any hard metal object in the waste can damage the shredder. The first objective of the study is to verify that efficient IHCW treatment can occur at standard operating parameters defined by the contact time-temperature couple in steam treatment systems without a pre-mixing/fragmenting or pre-shredding step. The second objective is to establish scientifically whether the standard operation conditions for a steam treatment system including a step of pre-mixing/fragmenting were sufficient to destroy the bacterial spores in IHCW known to be the most difficult to treat. Results show that for efficient sterilization of dialysis cartridges in a pilot 60L steam treatment system, the process would require more than 20 min at 144°C without a pre-mixing/fragmenting step. In a 720L steam treatment system including pre-mixing/fragmenting paddles, only 10 min at 144°C are required to sterilize IHCW proved to be sterilization challenges such as dialysis cartridges and diapers in normal conditions of rolling.

Health Care Waste generation rates and patterns: The case of Lebanon.

The objective of this study is to analyze Infectious Health Care Waste generation rates and patterns in Lebanon. Therefore, the quantities generated during five years by 57 hospitals from a total of 163 in the country have been analyzed. The seasonal evolution of Infectious Health Care Waste production and the evolution of the evaluation of the trends over years have been studied. Besides, the generation per capita have been estimated and compared to other countries. The variance between categories and the correlation between number of beds and Infectious Health Care Waste generation have been analyzed. The obtained results showed that the large private hospitals (over 200 beds) are characterized by their high generation rate: an average of 2.45kg per occupied bed(-1)day(-1), whereas the average generation rate for other categories is 0.94kg per occupied bed(-1)day(-1). The weighted mean is 1.14 per occupied kgbed(-1)day(-1). Small public hospitals (i.e. less than 100 beds) have the smallest standard deviation: 0.13, whereas large private hospitals (i.e. over than 200 beds) have the highest standard deviation: 0.40. Infectious Health Care Waste generation has been estimated to 1.42kg/capita/year. The correlation between the numbers of hospitals beds in hospitals and the generation rate per bed is weak. The correlation between Infectious Health Care Waste generation per day and beds number is stronger. The total quantity produced by hospitals has increased over the five past years. These results suggest that the quantities of medical waste are not well controlled, and that hospitals have a defective monitoring management system of their waste. Annual peaks are observed in June, July, and December. Thus, this study, for the first time in Lebanon, has provided information on the infectious waste generation, allowing benchmarking between hospitals and between countries.