• COVID-19
• Fit-testing
• Hospital protection program
• N95-mask
• P2-mask
• Personal protective equipment
• Training

• Humans
• New Zealand/epidemiology
• COVID-19/prevention & control
• COVID-19/epidemiology
• Australia/epidemiology
• Cross-Sectional Studies
• Intensive Care Units
• Personal Protective Equipment/supply & distribution
• Pandemics/prevention & control
• SARS-CoV-2
• Coronavirus Infections/prevention & control
• Coronavirus Infections/epidemiology
• Surveys and Questionnaires
• Pneumonia, Viral/prevention & control
• Pneumonia, Viral/epidemiology

• COVID-19 pandemic
• Healthcare workers
• Turnover intention

• COVID-19/epidemiology
• Health Personnel/psychology
• Humans
• Intention
• Pandemics
• Personnel Turnover

• Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore

• Implementation
• Infection prevention
• Masks
• Personal protective equipment
• Respiratory protective device
• Training

• Delivery of Health Care
• Health Facilities
• Health Personnel/psychology
• Humans
• Personal Protective Equipment

We developed a composite index–hospital preparedness index (HOSPI)–to gauge preparedness of hospitals in India to deal with COVID-19 pandemic.

We developed and validated a comprehensive survey questionnaire containing 63 questions, out of which 16 critical items were identified and classified under 5 domains: staff preparedness, effects of COVID-19, protective gears, infrastructure, and future planning. Hospitals empaneled under Ayushman Bharat Yojana (ABY) were invited to the survey. The responses were analyzed using weighted negative log likelihood scores for the options. The preparedness of hospitals was ranked after averaging the scores state-wise and district-wise in select states. HOSPI scores for states were classified using K-means clustering.

Out of 20,202 hospitals empaneled in ABY included in the study, a total of 954 hospitals responded to the questionnaire by July 2020. Domains 1, 2, and 4 contributed the most to the index. The overall preparedness was identified as the best in Goa, and 12 states/ UTs had scores above the national average score. Among the states which experienced high COVID-19 cases during the first pandemic wave, we identified a cluster of states with high HOSPI scores indicating better preparedness (Maharashtra, Tamil Nadu, Karnataka, Uttar Pradesh and Andhra Pradesh), and a cluster with low HOSPI scores indicating poor preparedness (Chhattisgarh, Delhi, Uttarakhand).

Using this index, it is possible to identify areas for targeted improvement of hospital and staff preparedness to deal with the COVID-19 crisis.

Patients with terminal illnesses hospitalized with acute deteriorations often suffer from unnecessary/inappropriate therapies at the end of their lives. Appropriate advance care planning (ACP) practices aligned to patients’ goals of care may mitigate this.

To explore the rationale for clinical decision-making in hospitalized patients with terminal illnesses and formulate a practice pathway to streamline care. Between May and December 2018, a questionnaire survey with three case vignettes derived from intensive care unit (ICU) patients was emailed to ICU, respiratory and renal doctors, and nurses in two Sydney hospitals. Respondents chose various management options ranging from all active therapies to palliation. The primary outcome was the proportion of responses for each management option. With these and a thematic analysis of responses to identify barriers to ACP practice, a practice pathway was formulated.

Of the 310 invited clinicians, 178 responded (57.4%). About 89.2% of respondents reported caring for dying patients frequently. Sixty percent saw patients suffering from prolonged therapies. Most respondents deemed patients in the case vignettes to be terminally ill, warranting ACP discussions. However, many still wanted to treat the acute deterioration with active ICU-level interventions. Most respondents reported being comfortable in having ACP discussions.

The survey showed discordance between the stated opinions and the choice of management options for terminally ill patients with acute deteriorations; possibly due to the lack of a considered approach in choosing management options that align with medical consensus and the patient's/family's wishes, a practice pathway is suggested to improve management.

Sarangi RK, Rajamani A, Lakshmanan R, Srinivasan S, Arvind H. A Survey of Clinicians Regarding Goals of Care for Patients with Severe Comorbid Illnesses Hospitalized for an Acute Deterioration. Indian J Crit Care Med 2022;26(4):457–463.

• COVID-19
• accident & emergency medicine
• infection control
• public health

• COVID-19
• Cross-Sectional Studies
• Emergency Service, Hospital
• Humans
• Infection Control/methods
• New Zealand/epidemiology
• Personal Protective Equipment
• SARS-CoV-2

• Anxiety
• COVID-19 outbreak
• Emotional stress
• Healthcare workers
• Infection control policies
• Personal protective equipment
• Physical exhaustion
• Risk perception
• SARS-CoV-2

• COVID-19
• Cross-Sectional Studies
• Female
• Health Personnel
• Humans
• Pandemics
• Perception
• Prospective Studies
• SARS-CoV-2
• Victoria

• Associated factors
• COVID-19
• SARS-CoV-2
• health care worker
• personal protective equipment
• psychological preparedness

• COVID-19
• Singapore
• pandemic
• public health
• research

• COVID-19
• Humans
• Pandemics
• Public Health
• SARS-CoV-2
• Singapore

• NMRC/CG/C019/2017 National Medical Research Council

The exact risk association of coronavirus disease 2019 (COVID-19) for surgeons is not quantified which may be affected by their risk of exposure and individual factors. The objective of this review is to quantify the risk of COVID-19 among surgeons, and explore whether facemask can minimise the risk of COVID-19 among surgeons. A systematised review was carried out by searching MEDLINE to locate items on severe acute respiratory syndrome coronavirus 2 or COVID-19 in relation to health care workers (HCWs) especially those work in surgical specialities including surgical nurses and intensivists. Additionally, systematic reviews that assessed the effectiveness of facemask against viral respiratory infections, including COVID-19, among HCWs were identified. Data from identified articles were abstracted, synthesised and summarised. Fourteen primary studies that provided data on severe acute respiratory syndrome coronavirus 2 infection or experience among surgeons and 11 systematic reviews that provided evidence of the effectiveness of facemask (and other personal protective equipment) were summarised. Although the risk of COVID-19 could not be quantified precisely among surgeons, about 14% of HCWs including surgeons had COVID-19, there could be variations depending on settings. Facemask was found to be somewhat protective against COVID-19, but the HCWs’ compliance was highly variable ranging from zero to 100%. Echoing surgical societies’ guidelines we continue to recommend facemask use among surgeons to prevent COVID-19.

• COVID-19
• Health care worker
• Personal protective equipment
• SARS-CoV-2
• Surgeon
• Surgical mask

Personal-protective equipment (PPE)-preparedness, defined as adherence to guidelines, healthcare worker (HCW) training, procuring PPE stocks and responding appropriately to suspected cases, is crucial to prevent HCW-infections.

To perform a follow-up survey to assess changes in PPE-preparedness across six Asia-Pacific countries during the COVID-19 pandemic.

A prospective follow-up cross-sectional, web-based survey was conducted between 10/08/2020 to 01/09/ 2020, five months after the initial Phase 1 survey. The survey was sent to the same 231 intensivists across the six Asia-Pacific countries (Australia, Hong Kong, India, New Zealand, Philippines, and Singapore) that participated in Phase 1. The main outcome measure was to identify any changes in PPE-preparedness between Phases 1 and 2.

Phase 2 had responses from 132 ICUs (57%). Compared to Phase 1 respondents reported increased use of PPE-based practices such as powered air-purifying respirator (40.2% vs. 6.1%), N95-masks at all times (86.4% vs. 53.7%) and double-gloving (87.9% vs. 42.9%). The reported awareness of PPE stocks (85.6% vs. 51.9%), mandatory showering policies following PPE-breach (31.1% vs. 6.9%) and safety perception amongst HCWs (60.6% vs. 28.4%) improved significantly during Phase 2. Despite reported statistically similar adoption rate of the buddy system in both phases (42.4% vs. 37.2%), there was a reported reduction in donning/doffing training in Phase 2 (44.3% vs. 60.2%). There were no reported differences HCW training in other areas, such as tracheal intubation, intra-hospital transport and safe waste disposal, between the 2 phases.

Overall reported PPE-preparedness improved between the two survey periods, particularly in PPE use, PPE inventory and HCW perceptions of safety. However, the uptake of HCW training and implementation of low-cost safety measures continued to be low and the awareness of PPE breach management policies were suboptimal. Therefore, the key areas for improvement should focus on regular HCW training, implementing low-cost buddy-system and increasing awareness of PPE-breach management protocols.

• Coronavirus
• ICU
• Personal protective equipment preparedness training
• Quality assurance

• COVID-19
• Ethical conflict
• critical care nursing
• decision-making
• ethics responsibilities
• pandemic Nursing ethics; Nurses

• COVID-19
• Conservative oxygen therapy
• High-flow nasal cannula oxygen therapy
• Hypoxemia
• Indian intensive care unit
• Low-flow nasal oxygen
• NIV: Noninvasive mechanical ventilation
• SARS-COV-2