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Evidence Check - System capacity and evaluation

Infrastructure, hospital capacity, human resources, supplies, monitoring, surveillance, prediction, evaluation, post-pandemic

Mental health of healthcare workers evidence check

Added: 15 Apr 2020

What evidence is available about the psychological impact of COVID-19 on healthcare workers?
What organisational responses can be implemented to reduce the risk of physiological distress and mental health issues for healthcare workers responding to COVID-19?
  • Healthcare workers are at increased risk of mental health issues when faced with the challenges associated with the COVID-19 pandemic.
  • Early findings from China and Singapore showed healthcare workers experienced symptoms of depression, anxiety, insomnia and distress.
  • A survey conducted by TKW Research (a research data collection and recruitment organisation) with 433 health care workers found 49% had experienced anxiety and tiredness since the outbreak of COVID-19.
  • Previous pandemics, such as SARS, resulted in high levels of psychological distress and mental health issues among healthcare workers.
  • Some studies show that frontline healthcare workers experience higher anxiety than the general community about contacting the virus during a pandemic.
  • There is limited guidance on how best to respond and mitigate risks to healthcare workers. Current recommendations include, the provision of clear, accurate and updated information about COVID-19, establishing and encouraging support systems and supporting health care workers to take breaks.There is limited guidance on how best to respond and mitigate risks to healthcare workers. Current recommendations include, the provision of clear, accurate and updated information about COVID-19, establishing and encouraging support systems and supporting health care workers to take breaks.

Tools to support communication between patients and families evidence check

Added: 13 Apr 2020

What emerging tools are being used to support communication between patients and their loved ones during the COVID-19 pandemic?
  • Strict visitor restrictions are in place across hospitals.
  • While data are scarce, there is significant activity on Twitter, suggesting hospitals around the world are using bespoke solutions to connect patients and their families during the COVID-19 pandemic.
  • Hospitals are using virtual visiting solutions, apps and smart devices. This includes hospitals from Australia, the UK, USA and Canada.
  • The NHS in the UK and the Department of Health and Human Services in the USA have issued advice that Skype, WhatsApp and Facetime can be used to support individual care. Providers are required to notify patients that these third-party applications could introduce privacy risks and recommend enabling all privacy and encryption settings. These applications all use end-to-end encryption. However, the human component of these applications affects compliance levels and software exists that can record the calls.
  • The ways in which communication tools are being deployed and implemented are rapidly evolving: from devices being used in plastic covers, tripods for mounting smart devices and bespoke virtual visiting solution for families of critical care patients.
  • Wollongong Hospital is working with a company called Taleka and the University of Wollongong to install software in the intensive care unit so that patients have access to iPads.
  • A number of studies have documented the bacterial contamination and recommendations for infection control.

Dedicated or temporary COVID-19 healthcare facilities evidence check

Added: 12 Apr 2020

What is the evidence regarding the use of dedicated hospitals and wards exclusively for the use of COVID-19 patients?
What temporary hospital facilities, including new and re-purposed buildings, have been set up during COVID-19?
  • Dedicated wards - The World Health Organisation advises there will be need for multiple COVID-19 treatment areas during the community transmission phase of the outbreak. Many jurisdictions have described ways in which they have transformed existing hospitals/wards into dedicated COVID-19 wards. Published guidance describes elements of design such as space, infection control, waste disposal, safety of healthcare workers, which can be adapted to the context of either a new construction or makeshift construction on top of an existing structure.
  • Temporary hospitals - Existing buildings that have been converted into temporary hospitals include hotels, sports stadiums, convention centres, closed hospitals, fields and grounds such as parking lots. Two new buildings were built in Wuhan, China to be used as hospitals. There is significant variation in the capacity of the temporary facilities. Most temporary hospitals are dedicated to COVID-19 patients, for quarantine and isolation, screening/triage, staff support and backfill capacity. Mostly existing staff and military are utilised for the temporary hospitals, with some sites reporting the use of volunteers

Personal protective equipment and intrapartum care for low risk women evidence check

Added: 4 Apr 2020

What evidence is available regarding appropriate PPE for healthcare workers providing routine intrapartum care during the COVID-19 outbreak and other respiratory pandemics?
What evidence is available about nosocomial infections or aerosol generating procedures in the provision of intrapartum care?
  • The Royal Australian and New Zealand College of Obstetricians and Gynaecologists recently released advice that when providing intrapartum care for any patient – including low-risk, screen-negative, non-COVID-19 patients, medical personnel should wear protective apparel, fluid-repellent surgical mask and eye protection during the pushing phase. It advises full PPE e.g. N95 masks - are not required for those caring for low-risk women (1).
  • Experts in the US advise that a N95 mask should be worn in addition to droplet precaution PPE for any patients with suspected or confirmed COVID, and for any patient, regardless of respiratory symptoms, during indispensable aerosolising procedures, including second stage of labour (2)
  • Aerosol-generating procedures (AGPs) are recognised as important sources for nosocomial transmission of emerging viruses. A systematic review of aerosol generating procedures in the SARS outbreak found no evidence of nosocomial infection associated with providing intrapartum care (3)
  • Case reports and advice from maternal services in Italy and China report no vertical transmission of COVID-19 nor any nosocomial infections of healthcare workers (4, 5)
  • The CDC notes that in times of PPE shortages, alternatives to N95s should be considered, and respirators reserved for situations where respiratory protection is most important, such as performance of aerosol-generating procedures on suspected or confirmed COVID-19 patients or provision of care to patients with other infections for which respiratory protection is strongly indicated (e.g., tuberculosis, measles, varicella (6) (and potentially Figure on p7).

Models for redeploying staff evidence check

Added: 29 Mar 2020

What are the existing models for redeploying (reassigning) staff during COVID-19 (or pandemics)?
  • The Australian and New Zealand Intensive Care Society released guidelines recommending to identify and potentially redeploy nursing, medical, allied health and other staff. This can be done by identifying staff with former critical care experience or similar experience and re-deploying nurses without specific critical care experience to assist with routine nursing care
  • In Ireland, a redeployment policy for the Health Service Executive outlines that organisations need to identify all essential and non-essential services, redeploy the additional staff once non-essential services have been cancelled to areas with increased capacity. They may engage retired staff of those with clinical background not working on frontline. Payroll and refusal are also described.
  • In the UK, advice states trainees should be considered individually, they should not be ‘pooled’, rather utilised in a phased (Consolidate, Mobilise, Repurpose & Redeploy) and stratified manner, recognising different skill sets, experience and utility for the NHS
  • Australia’s Health Practitioner Regulation Agency’s website states there is potential to fast-track registration, depending on the applicant’s situation for practitioners with non-practising registration and for recently retired practitioners, and the opportunity to redeploy International Medical Graduates
  • When re-deployed, there should be a rapid orientation program, training should be provided and staff should be supervised
  • Welfare and wellness issues must be anticipated, planned for and mitigated where possible.

Daily Evidence Digest

Rapid evidence checks are based on a simplified review method and may not be entirely exhaustive, but aim to provide a balanced assessment of what is already known about a specific problem or issue. This brief has not been peer-reviewed and should not be a substitute for individual clinical judgement, nor is it an endorsed position of NSW Health.

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