COVID-19 Yoğun Bakım Hekim ve Hemşirelerinin SARS-CoV-2 ile Enfekte Olma Oranlarının ve Bulaştırıcılık Durumlarının İncelenmesi

Year 2024, , 10 - 19, 29.01.2024

Ecem Özdemir , Necla Dereli , Öznur Kavaklı

https://doi.org/10.53493/avrasyasbd.1290746

Abstract

Amaç: Bu çalışmada, Mayıs 2020-Ocak 2021 tarihleri arasındaki 8 aylık süre boyunca, hastanemizdeki COVID-19 yoğun bakım hekim ve hemşirelerinin SARS-CoV-2 ile enfekte olma oranları ve bulaştırıcılık durumlarının incelemesi ve bu doğrultuda önerilerde bulunulması hedeflenmiştir.
Materyal ve Metod: Retroprospektif tipte tanımlayıcı bir araştırma olan bu çalışma Mayıs 2020 ile Ocak 2021 tarihleri arasında tek ve tersiyer bir merkez olan, SBÜ Ankara Keçiören Eğitim ve Araştırma Hastanesi Anestezi Yoğun Bakım Ünitesi’nde (COVID-19 YBÜ) görev yapan hekim ve hemşirelerle gerçekleştirilmiştir. Çalışmada katılımcılardan sosyo-demografik verilerini ve literatürle paralel olarak hazırlanan SARS-CoV-2 ile enfekte olma oranlarını ve başkalarına bulaştırma verilerini içeren anket formunu doldurmaları istenmiştir. Örneklem grubu; gönüllü olarak çalışmaya katılmayı kabul eden 74 hemşire ve 16 doktor olmak üzere toplam 90 kişiden oluşmaktadır.
Bulgular: Araştırmaya katılanların %74,4'ünün kadın, %58,9'unun evli, %82,2'sinin hemşire, %17,8’inin hekim olduğu belirlendi. Katılımcıların%66,7'sinin SARS-CoV-2 ile enfekte olduğu, enfekte olanların %66,6'sının 14 gün içinde yakınlarında COVID-19 semptomlarının görüldüğü, bunların %72,5'inde en az 4-6 kişide semptom olduğu tespit edildi. Katılımcıların %64,4’ünün endotrakeal entübasyon, non-invaziv mekanik ventilasyon uygulamaları gibi acil durumlarda kişisel koruyucu ekipmanlarını uygun kullanmaksızın hastalara müdahale ettikleri (1,5 m’den az mesafede yaklaştıkları) tespit edilmiştir. Kişisel koruyucu ekipmanları uygun olmayan şekilde kullanarak hastalara müdahale eden sağlık çalışanlarında SARS-CoV-2 enfekte olma oranları istatistiksel olarak anlamlı olarak yüksek bulunmuştur (p<0,05). SARS-CoV-2 ile enfekte olan sağlık profesyonellerinin yakınlarında da 14 gün içinde COVID-19 semptomlarının görülmesi istatistiksel olarak anlamlı yüksek tespit edilmiştir (p<0,05).
Sonuç: Bu anket çalışması, pandemi döneminde COVID-19 YBÜ’de çalışan sağlık profesyonellerinin SARS-CoV-2 ile enfekte olma oranlarını ve yakınlarına bu virüsü bulaştırma durumlarının anlık bir görüntüsünü bize sunmaktadır. Ankete katılanlar, özellikle pandeminin erken dönemlerinde kişisel koruyucu ekipmanlara ulaşım zorluğu yaşandıklarını ve acil durumlarda bu ekipmanları uygun şekilde kullanamadıklarını bildirmiştir. Kişisel koruyucu ekipmanlara ulaşım zorluğunun yaşanması, yoğun bakım ünitelerinde çalışan sağlık personelinin hastanenin diğer bölümlerinde çalışan personellerine göre daha fazla çalışması ve hastalara daha yakın mesafeden müdahale edilmesi, pandeminin erken dönemlerinde COVID-19 YBÜ hemşire ve doktorlarının SARS-CoV-2 ile enfekte olma oranını arttırmıştır. Sağlık profesyonellerinin virüs ile enfekte olmalarının önlenmesi için kişisel koruyucu ekipmanlara ulaşımları kolaylaştırılmalı, personelin bu ekipmanları dikkatli ve özenli kullanmaları, sürekli eğitimlerle sağlık profesyonellerinde ve toplumda farkındalık düzeylerinin arttırılması için çalışmalar yapılmalıdır. Sağlık profesyonellerine yalnızca pandemi döneminde değil her büyük toplumsal felaket sırasında ihtiyaç duyulacağı akıldan çıkarılmamalıdır.

Keywords

COVID-19, Yoğun Bakım Ünitesi, Hekim, Enfekte Hasta Bakımı, Hemşire

Investigation of SARS-CoV-2 Infection Rates and Contagion Status of Physicians and Nurses Working in the COVID-19 Intensive Care Unit

Abstract

AIM: This study aimed to examine the rates of SARS-CoV-2 infection and contagiousness of physicians and nurses working in the COVID-19 intensive care unit.
METHOD: This retrospective and cross-sectional study was conducted on a total of 90 healthcare professionals. The study included healthcare professionals who were infected between May 2020-January 2021. Research data were collected through the "Survey Form" created by the researchers by examining the literature.
RESULTS: 74.4 % of the participants were female, 82.2 % were nurses, 17.8 % were doctors. 66.7% of the participants were infected with SARS-CoV-2, 66.6% of those infected had symptoms of COVID-19 in their relatives within 14 days. SARS-CoV-2 infection rates were found to be statistically significantly higher among healthcare professionals who intervened with patients by using personal protective equipment inappropriately.
CONCLUSION: It has been determined that the health personnel working in the intensive care units work more than the health personnel working in other parts of the hospital, intervene with the patients from a closer distance, have difficulties in accessing personal protective equipment in the early stages of the pandemic, nurses and doctors are the factors that increase the rate of SARS-CoV-2 infection.

Keywords

COVID-19, critical care unit, doctor, infection patient care, nurse.

References

• Auwaerter PG. (2023). (Updated: October 8, 2023). Coronavirus COVID-19 (SARS-CoV-2) Johns Hopkins ABX Guide. https:// www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ ABX_Guide/540747/all/ (accessed November 13, 2023).
• Bartoszko JJ, Farooqi MAM, Alhazzani W, Loeb M. (2020). Medical masks vs N95 respirators for preventing COVID-19 in healthcare workers: A systematic review and meta-analysis of randomized trials. Influenza Other Respir Viruses, 14(4): 365–373. doi: 10.1111/irv.12745
• COVIDSurg Collaborative. (2020). Global guidance for surgical care during the COVID-19 pandemic. Br J Surg, 107(9): 1097- 1103. doi: 10.1002/bjs.11646
• Centers for Disease Control and Prevention. (Updated: 2007). Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. https://www.cdc.gov/infectioncontrol/guidelines/ isolation/index.html (accessed September 16, 2023.)
• Center for Disease Control and Prevention (2023). (Updated: May 8, 2023) Interim infection prevention and control recommendations for patients with suspected of confirmed coronavirus disease 2019 (COVID-19) in health care settings. https://www.cdc.gov/coronavirus/2019- ncov/hcp/infection-control-recommendations.html (accessed September 23, 2023.)
• Chen Q, Liang M, Li Y, Guo J, Dongxue F, Wang L, He L, Sheng C, Cai Y, Li X, Wang J, Zhang Z. (2020). Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiatry, 7(4): 15-16. doi: 10.1016/S2215-0366(20)30078-X
• Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Higgs A. (2020). Consensus guidelines for managing the airway in patients with COVID-19. Anaesthesia, 75: 785–99. doi: 10.1111/anae.15054
• Constantino C. Cannizzaro E, Verso MG, Tramuto F, Maida CM, Lacca G, Alba D, Cimino L, Conforto A, Cirrincione L, Graziano G, Palmeri S, Pizzo S, Restivo V, Casuccio A, Vitale F, Mazzucco W. (2021). SARS-CoV-2 infection in healthcare professionals and general population during “first wave” of COVID-19 Pandemic: A cross-sectional study conducted in Sicily, Italy. Front Public Health, 9: 644008. doi: 10.3389/ fpubh.2021.644008
• El Zowalaty ME, Järhult JD. (2020). From SARS to COVID-19: A previously unknown SARS-CoV-2 virus of pandemic potential infecting humans–call for a one health approach. One Health, 9: 100124. doi: 10.1016/j.onehlt.2020.100124
• England PH. (Updated: April 24, 2020). Guidance: COVID-19 personal protective equipment (PPE). h t t p s : / / a s s e t s . p u b l i s h i n g . s e r v i c e . g o v . u k / media/5ea81dd3d3bf7f6533efe3d9/COVID-19_personal_ protective_equipment__PPE__-_GOV.UK.pdf (accessed September 25, 2023).
• Ferioli M, Cisternino C, Leo V, Pisani L, Palange P, Nava S. (2020). Protecting healthcare workers from SARS-CoV-2 infection: practical indications. European Respiratory Review, 29(155):200068. doi: 10.1183/16000617.0068-2020
• Fischer R, Morris DH, van Doremalen N, Sarchette S, Matson MJ, Bushmaker T, Yinda CK, Seifert SN, Gamble A, Williamson BN, Judson SD, de Wit E, Lloyd-Smith JO, Munster VJ. (2020). Assessment of N95 respirator decontamination and reuse for SARS-CoV-2. Emerg Infect Dis, 26(9):2253- 2255 doi: 10.3201/eid2609.201524
• Forrester JD, Nassar AK, Maggio PM, Hawn MT. (2020). Precautions for operating room team members during the COVID-19 pandemic. J Am Coll Surg, 230(6): 1098-1101. doi: 10.1016/j.jamcollsurg.2020.03.030
• Global Health Workforce Alliance, World Health Organization. (2013). A universal truth: no health without a workforce. https://www.who.int/publications/m/item/hrh_universal_ truth (accessed September 25, 2023).
• Greenberg N, Docherty M, Gnanapragasam S, Wessely S. (2020). Managing mental health challenges faced by healthcare workers during COVID-19 pandemic. BMJ, 368: 1211. doi: 10.1136/bmj.m1211
• Iannone P, Castellini G, Coclite D, Napoletano A, Fauci A J, Iacorossi L, D’Angelo D, Toree GL, Mastroianni CA, Gianola S. (2020). The need of health policy perspective to protecthealthcare workers during COVID-19 pandemic. A GRADE rapid review on the N95 respirators effectiveness. Plos One, 15(6): e0234025. doi: 10.1371/journal.pone.0234025
• Jayaweera M, Perera H, Gunawardana B, Manatunge J. (2020). Transmission of COVID-19 virus by droplets and aerosols: A critical review on the unresolved dichotomy. Environmental Research, V: 188, 109819. doi: 10.1016/j.envres.2020.109819
• Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, Wu J, Du H, Chen T, Li R, Tan H, Kang L, Yao L, Huang M, Wang H, Wang G, Liu Z, Hu S. (2020). Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open, 3(3): e203976. doi: 10.1001/ jamanetworkopen.2020.3976
• Liu JX, Goryakin Y, Maeda A, Bruckner T, Scheffler R. (2017). Global health workforce labor market projections for 2030. Hum Resour Health, 3; 15(1). doi: 10.1186/s12960-017-0187-2
• Livingston E, Desai A, Berkwits M. (2020). Sourcing personal protective equipment during the COVID-19 Pandemic. JAMA, 323(19): 1912-1914. doi: 10.1001/jama.2020.5317
• Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, Wang PW, Song H, Huang B, Zhu N, Bi Y, Ma PX, Zhan F, Wang L, Hu T, Zhou H, Hu Z, Zhou W, Zhao L, Chen J, Meng Y, Wang J, Lin Y, Yuan J, Xie Z, Ma J, Liu WJ, Wang D, Xu W, Holmes EC, Gao GF, Wu G, Chen W, Shi W, Tan W. (2020). Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. The Lancet, 395(10224): 565–574. doi: 10.1016/S0140-6736(20)30251-8
• Ministry of Health (MoH) of the Republic of Turkey, (2023, January 11). COVID-19 Information Platform. https:// COVID19.saglik.gov.tr/ (accessed January 30, 2023).
• Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo CG, Ma W, Mehta RS, Warner ET, Sikavi DR, Lo CH, Kwon S, Song M, Mucci LA, Stampfer MJ, Willett WC, Eliassen AH, Hart JE, Chavarro JE, Rich-Edwards JW, Davies R, Capdevila J, Lee KA, Lochlainn MN, Varsavsky T, Sudre CH, Cardosa MJ, Wolf J, SpectorTD, Ourselin S, Steves CJ, Chan AT. (2020). Risk of COVID-19 among frontline healthcare workers and the general community: a prospective cohort study. Version 6. MedRxiv, 5(9):e475-e483. doi: 10.1101/2020.04.29.20084111.
• Pan A, Liu L, Wang C, Guo H, Hao X, Wang Q, Huang J, He N, Yu H, Lin X, Wei S, Wu T. (2020). Association of public health interventions with the epidemiology of the COVID-19 outbreak in Wuhan, China. JAMA, 323(19): 1915–23. doi: 10.1001/jama.2020.6130.
• Pascarella G, Strumia A, Piliego C, Bruno F, Buono RD, Costa F, Scarlata S, Agro FE. (2020). COVID-19 diagnosis and management: a comprehensive review. J Intern Med, 288(2): 192-206. doi: 10.1111/joim.13091
• Razai MS, Doerholt K, Ladhani S, Oakeshott P. (2020). Coronavirus disease 2019 (Covid-19): a guide for UK GPs. BMJ, 368: 800. doi: 10.1136/bmj.m800
• Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, Navalesi P, Antonelli M, Brozek J, Conti G, Ferrer M, Guntupalli K, Jaber S, Keenan S, Mancebo J, Mehta S, Suhail Raoof Members Of The Task Force. (2017). Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J, 50: 1602426. doi: 10.1183/13993003.02426-2016
• Schwartz A, Stiegel M, Greeson N, Vogel A, Thomann W, Brown M, Sempowski GD, Alderman TS, Condreay JS, Burch J, Wolfe C, Smith B, Lewis S. (2020). Decontamination and reuse of N95 respirators with hydrogen peroxide vapor to address worldwide personal protective equipment shortages during the SARS-CoV-2 (COVID-19) Pandemic. Applied Biosafety, 25(2): 67-70. doi: 10.1177/1535676020919932
• Sidibé M, Campbell J. (2015). Reversing a global health workforce crisis. Bull World Health Organ, 93: 3. doi: 10.2471/BLT.14.151209
• Su A. (Updated: February 25, 2020). Doctors and nurses fighting coronavirus in China die of both infection and fatigue. https://www.latimes.com/world-nation/ story/2020-02-25/doctors-fighting-coronavirus-in-china-die-of-both-infection-and-fatigue (accessed January 30, 2023).
• Uzman S, Ayazoğlu T. (2021). SARS-CoV-2 infection in intensive care unit healthcare workers in Turkey: a tertiary center cohort study. Med Bull Haseki, 59: 103-107. doi: 10.4274/ haseki.galenos.2021.6764
• Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, Tikka C, Ruotsalainen JH, Kilinc Balci FS. (2020). Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev, 4(4): CD011621. doi: 10.1002/14651858.CD011621.pub4
• World Health Organization. (Updated: 2020, April 11). Coronavirus disease 2019 (COVID-19) Situation Report–82. https://www.who.int/docs/default-source/coronaviruse/ situation-reports/20200411-sitrep-82-covid-19.pdf (accessed September 19, 2023).
• World Health Organization. Global strategy on human resources for health: workforce, 2030. https://www. who.int/publications/i/item/9789241511131 (accessed September 19, 2023).
• Worldometers. https://www.covidvisualizer.com/ (accessed November 13, 2023).