An International Outbreak of Pneumonia - Research Paper Example

 Table of Contents Introduction 2 Objective of the Study 2 Significance of the Study 2 Environmental Decontamination 4 Literature Review 5 Effectiveness of Interventions in Protecting Healthcare Workers 6 Methodology 7 Findings 9 Conclusion 9 References 10 Introduction The world Health organization noted that there was an international outbreak of pneumonia in 2003 that was referred to as SARS. The virus spread globally, especially along travelling routes. It caused several nosocomial outbreaks in China, Vietnam, Singapore, and Hong Kong. The airborne protections that were adopted by infected hospitals were incomplete. The outbreak in Canada resulted in 438 cases and 51 % of these cases were health care workers. Three healthcare workers died because of Severe Acute Respiratory Syndrome. Objective of the Study The objective of this proposal is to find ways on how to protect faces of the health workers and the effectiveness of the facial protective equipment and procedures for control that can be used. This will include reviewing of the literature of environmental, organizational, and individual factors that improves on the effectiveness of health workers. It will also include identification of the framework that will carry on the final research. The major goal of this proposal is to identify Severe Acute Respiratory Syndrome and nosocomial; infections of the respiratory tract in relation to the safety of workers and specific areas where further research should focus on. The target audience of this research proposal is the healthcare workers. Significance of the Study The significance of this study is to make workers more effective at their workplaces if they are provided with facial preventive measures. The current events in relation to SARS in healthcare workers of Canada have attracted much attention on how to prevent this epidemic. Facial protection involved the use of a mask and protective eyewear. Following the outbreaks, there is need to ensure that the healthcare workers are protected to prevent future outbreaks and not only in severe acute respiratory syndrome but also other respiratory infections. Following these observations there is needed to carry out a review on facial protection that would deal with healthcare workers concerns. This influenced me to write a proposal on SARS. Severe Acute Respiratory Syndrome is a disease that is spread through respiratory droplets. According to research carried out, SARS is less contagious compared to other respiratory infections. It is important to note that persistent use of infection control measures reduces occurrence of such outbreaks in China, Vietnam, and Singapore. Much attention focused on why the implementation of appropriate precautions failed and the need to promote these precautions in future. It is also evident that sneezing and coughing do not generate highly infectious aerosols compared to mechanical procedures in hospitals. This disease can be spread through the following ways: Symptomatic patients could transmit the disease to other patients. Healthcare workers transmitted the disease to each other through working closely. The disease was also highly transmitted in the hospital environment because some patients wore masks others did not. Workers who underwent the generating procedures of aerosols were also exposed to higher chances of infections. The current events with regard to SARS and the rate of mortality in the healthcare workers of Canada focused on the effectiveness of facial protection to prevent transmission infections for instance droplet spread and airborne. During the outbreak of severe acute respiratory syndrome, various individuals had different opinions on the emergence of facial protection; they were of the view that the masks used by agents were inappropriate because it resulted in infections. There was need to examine the effectiveness of facial protection to see to it that the healthcare workers are prevented not only from SARS but also from other infections. The evidence related to protect faces of healthcare workers emerges from studies carried out in relation to other infectious diseases that affect healthcare workers. Studies have indicated that organizational factors are very significant in limiting the transmission of the disease. The spread of nosocomial can be reduced through isolation, cohorting of patients or screening of patients who have been admitted. Some of the organizational factors were found to be significant in preventing infections and lowering the transmission rates of nosocomial disease: there should be a physician who has an interest in preventing the infection of the disease, developing control policies for nosocomial diseases. The general infection control procedures aim at controlling both the public and the patients. This infection can be controlled through using the following strategies: Preventing health workers from SARS if they wear a surgical mask. Filters also can be installed on the exhaust port of the masks and use of pulmonary function machine, manual ventilation units, and ventilators with filters. However, there is need for further study of the effectiveness of these measures. It was noted that in Hong Kong SARS was spread through improper hospital ventilation. There is need for more research to identify if isolation and ventilation in hospitals can be used to reduce SARS infection. Environmental Decontamination It is known that SARS can last for some days on the surface, and stay for a long period from patients with diarrhea. However, SARS is grounded on hand washing and surface decontamination. Personal protective equipment wearing gowns, gloves, and goggles are very protective with health workers. Studies indicate that continual use of masks by health workers is very protective. N95 masks are very effective in reducing airborne particles compared to surgical masks. In univariate analysis wearing gowns, gloves, and goggles are very protective with health workers. Research carried out on Thai healthcare workers indicated that In case of an outbreak in Taiwan, Hong Kong, and Toronto several interventions have been applied on varied physical space. For instance, allocating workers in different waiting rooms for emergency wards, separating the already infected patients in different rooms in the emergency departments, intensive care units. Varia (2003) stated that there should be some implications resulting from the separation of SARS patients from other patients. Literature Review Brosseau (1997) examined the use of several respirators and surgical masks by the healthcare workers. Brosseau (1997) made sure that the bacterial aerosol passed through drying process to make sure that most of the particles were personal bacterium and not water droplet. They found organisms to be nonviable when retrieved from masks. Coffey et al (2002) identified the role of fit testing and performance of a respirator under certain conditions. These articles stated the sequential developments of a model to evaluate methods of quantitative fit testing. They also carried out various aerosol tests to assess the accuracy of fit testing. .Investigators used the workplace environment to carry out their studies. The results of this study were simulated testing had better protection by screening that was poorly fit. Huff et al (1994) clearly explained why it is important to wear a tested and fit face piece respirator in relation to the use of isolation techniques. Evaluation carried out by personnel indicated that there was contamination on hair, clothing, and nose swabs. The second part indicated that cover gowns, surgical masks, and head covering were contaminated. In part three, personnel were provided with fume respirators whose major function was to protect them from radionuclide, head coverings, and gowns and were trained in procedures for infection control. They used face piece type respirator was used to create a good facial seal. Kouri and Ernest (1993) who examined that there was contamination of facial shield during caesarean and vaginal delivery provided the importance of facial protection in healthcare. His studies indicate that 32% of vaginal deliveries and 50% of caesarean deliveries resulted in face shield surface contamination. Similarly, a study carried out indicated that dumping of the manual medical wastes resulted in face shields and goggles contamination. His studies showed that 2% of the goggles and face shield sample were contaminated. This was a report of his study of contamination of body fluids on macroscopic, conjunctiva of orthopedic surgeons. A study carried out on 72 workers of a certain hospital who had SARS in Hong Kong. He discovered that higher risks of SARS were associated with lack of adequate training on infection control. Almost 50% of workers who had SARS had not received any training on infection control (Huff et al., 1994). analyzed the results of patients being exposed to SARS unexpectedly led to 16 intensive care staff being infected. Out of these 16 health care workers, 7 were infected. This included workers who wore goggles, gloves, and N95 respirator. Studies that have been carried out to determine the effectiveness of eye protection have different results. Effectiveness of Interventions in Protecting Healthcare Workers For control guidelines to be effective in preventing healthcare workers and patients from SARS, it is important to understand the most effective procedures like personal protective equipment. The factors that determine the ability for one to comply with these procedures are: workers characteristics, environmental, and organizational factors. Green (1980) developed a health promotion model that modified by Dejoy (1995) to be used in determining the protective behavior of workers. Personal characteristics for instance values, attitudes, and believes are known for facilitating personal self-protective behavior. Organizational factors like performance feedback, training, communication, and approval and disapproval from coworkers are also referred to as reinforcing factors. There is an increase in the number of studies carried out on the health and safeties of workers for instance the demand for workers, their characteristics, and organizational and environmental factors. All of these factors have to coordinate to achieve desired results. Methodology This section will look at the efficiency of facial protective equipment in preventing the spread of respiratory infections in healthcare workers. It will describe methods that will be applicable in this research. The research team will develop a list of important words to be used in retrieving information from articles published in the last 15 years. The articles were related to occupational; health and safety issues, infection control practices, behavior of the organization and other important measures that can be used in protecting health workers from respiratory infections literature searches will be carried out using Web of science and OSHROM, and cumulated index of nursing and allied health literature. These citations will be categorized into two groups for instance the first group will determine various types of protective equipment that can be applicable in preventing infections of respiratory infections. The environmental, organizational, and individual will determine procedures that will be used in determining effective control measures. These searches will be expected to produce 462 and 379 citations respectively. This research proposal will have to provide forms that will be used to collect data from each article. I will also develop group focus in to come up with an effective safety, occupational health, and policies that will be used by health care workers to control the infection. Group focus will determine the individual, organizational, and environmental factors useful in determining effective infection control procedures, especially in healthcare workers. This focus will be carried out in two cities, Vancouver, Toronto and will involve seven various categories of health workers: physicians, infection control practitioners, clinical nursing staff, occupational health staff, allied health professionals, support staff, and hospital managers. An extra mixed group of infection control and health professionals will be contacted in Ottawa. Participants for the 11 focus groups will be recruited in three ways. I will write letters to the chief executive officer of 13 hospitals 11 in Toronto and 2 in Ottawa admits patients with severe acute respiratory syndrome. We will be in a position to determine the major goal o0f the study and will request the participants to identify appropriate facilities. I will also writer letters to the Greater Toronto area, Canadian College of Health services executives, registered nurses of Ontario, Ontario medical association, and occupational health, safety workers. I will also send e-mails to infection control physicians to help me forward the messages to other physicians. All my invitations will appeal participants to have direct experience with severe acute Respiratory syndrome. Eight seven people will come from varied 21 health care institutions, professional organizations, and institutions to take part in 11 Ontario focus groups. In Toronto, I will conduct two focus groups one from occupational health staff and the other one from hospital administrators. I will also conduct two groups of combined workers from two dissimilar facilities. I will give 90 minutes to each focus group. Participants of each focus group will discuss three questions in relation to individual, organizational, and occupational factors and the significance of these factors in controlling the infection and occupational safety and health facilities. Findings We expect that 8 out of 16 participants from Toronto will not have appropriate information. 80% of the participants should come from Ontario, and 19% should come from BC. A minimum of 85% should come from healthcare facilities where severe acute respiratory syndrome where patients should be admitted. $4% of the participants should have been in contact with patients for at least once in their lifetime. 37% should be vaccinated either at home or at workplace during the outbreak. Clinical managers should have the largest percentage followed by infection control managers. Only four participants should be recruited. The average age of the participant’s is estimated to be 43.1 years. Conclusion The analysis of the 15 focus groups indicates that healthcare workers put much emphasis on organizational factors in preventing facial infection. Healthcare workers do not see these factors to be very important and therefore there is need for researchers to put much emphasis on these factors if they want health workers to support them. References Brosseau, L.M., McCullough, N. V. & Vesley, D. (1997). Mycobacterial aerosol collection efficiency of respirator and surgical mask filters under varying conditions of flow. North-Holland: Elsevier Science Publishers. p. 907-917 Coffey, C., Campbell, D. & Zhuang, Z. (2002). Simulated workplace performance of N95 respirators. American Industrial Hygiene Association Journal, 60(5), 618-624. DeJoy, D.(1986). A Behavioral-Diagnostic Model for Fostering Self-Protective Behavior in the Workplace. In Trends in Ergonomics/Human Factors III, W. Karwowski. North-Holland: Elsevier Science Publishers B.V. p. 907-917. Green L.W. & Kreuter,M. & S.e.a (1980). Deeds, Health Education Planning: Diagnostic approach. Palo Alto, CA: Mayfield. Huff, R. D., Horwitz, P. & Klash, S. (1994). Personnel protection during aerosol ventilation humidity. Applied Occupational & Environmental Hygiene journal, 12(6), 435-445, Kouri, D. L. & Ernest, J. M. (1993). Incidence of perceived and actual face shield contamination studies using radioactive technetium (Tc99m). American Industrial Hygiene Association during vaginal and cesarean delivery. American Journal of Obstetrics & Gynecology, 169(2), 1-5. Varia, M., et al (2003). Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada. Canadian Medical Association Journal, 169(4), 285-292 Read More