The coronavirus disease 2019 (COVID-19) pandemic has caused tragic events by disrupting people’s lives, social welfare and the global economy.1,2 The burden of COVID-19 is critical and devastating in healthcare institutions, and carries a significant risk of disease transmission to the healthcare team and cross-contamination to patients.3–9
In general, the pandemic has overwhelmed health systems and presented unprecedented challenges to medical staff globally. Surgical departments are the cornerstone of every health system, contributing to public health in both elective and emergency situations. They are very vulnerable to the spread of the disease and the main source of viral transmission to individuals, both surgical staff and patients, and likely to their attendants, and of contamination of the community at large.10–12
The nature of COVID-19 transmission creates significant risks in surgical departments, including obstetric care, owing to the close contact of medical staff with patients, the limited physical environment of the operating theatre and recovery room, and the possibility of shared surgical equipment, especially aerosol-generating equipment/procedures such as surgical sets, airway devices and electrosurgery equipment. The pandemic also presents challenges to the practices in the surgical department, especially to ENT surgery, maxillofacial surgery and anesthesia care providers, as they share a high viral load.13–17
Epidemic statistics from Wuhan, China, and Italy revealed that the disease infected about 3.8–20% of health workers, with an overall mortality rate of 0.6%.18–20
Globally, studies have reported that the effects of the pandemic on surgical departments have been profound, potentially long-lasting and extensive, and have had a collateral health effect on the delivery of surgical care to millions of patients as a result of the near-universal disruption and cancellation of surgical services.21–28
To manage these effects, different local guidelines and recommendations have been developed to control the disease, which may create differences in the local conditions relating to the extent of COVID-19 infections within the type of practice/hospital system, the availability of effective personal protective equipment (PPE) and other supplies, the physical configuration of workspaces, practice economics, local rules and regulations, and other constraints (eg, economic).
Thus, harmonized and effective national/international guidelines for specific surgical streams during perioperative periods are pertinent to curtail the infection, and will inevitably need to be adapted for consistent and sustainable implementation by all medical staff. The ultimate goal of the adapted guidelines and recommendations is to provide the right and optimal decisions, to maximize the benefits to both medical staff and patients, as well as to improve patient outcomes and minimize the burden of the disease on the healthcare systems through the wise use of resources, routine screening for the disease prior to surgical intervention, and focusing on emergency treatment while postponing non-priority treatments, especially in resource-constrained countries.
The standard guidelines and recommendations for perioperative surgical patient care during a pandemic equivocally enable and alert medical staff and health institutions to prepare for a pandemic and familiarize themselves with standard guidelines to manage the surgical space/environment, staff and supplies, so that optimum care is provided to patients through the domains of infection prevention measures, equipment handling, use of PPE and patient preparation, which can be implemented to reduce disease transmission in the hospital and in the community at large. The extent of surgical patient care during the COVID-19 pandemic at Jimma Medical Center (JMC) has not been explored yet. Therefore, the present study aimed to describe the extent of perioperative surgical patient care, equipment handling and operating room (OR) management during the COVID-19 pandemic at JMC, compared with standard guidelines, and to suggest adaptations for implemention.
Materials and Methods
An institution-based cross-sectional study was conducted at JMC, located in Jimma zone, Oromia region, southwest Ethiopia, at a distance of 350 km from the capital of the country, Addis Ababa. The hospital provides health services to millions of people living in the catchment area.
The pattern of current hospital practice in perioperative (preoperative, intraoperative and postoperative) surgical patient care was assessed using five-point Likert scales (0, not at all; 1, rarely; 2, sometimes; 3, most of the time; 4, frequently) in terms of seven domains (A, infection prevention and PPE;29 B, patient preparation/preoperative phase;30,31 C, intraoperative phase;32 D, equipment handling process and status of CSR;33 E, operating room management;34 F, anesthesia care;35 and G, recovery room/ICU care in the postoperative phase36) at JMC in seven surgical departments (A, ophthalmology; B, ENT/maxillofacial surgery; C, orthopedics; D, general surgery; E, gynecology/obstetrics; F, pediatrics; and G, neurosurgery). A total of 90 respondents [35 patients (five patients from each of the seven surgical departments) and 55 healthcare providers (six professionals from each of the nine units, including the center of sterility room and anesthesia)] who were available during the study period, selected by a convenience sampling technique with multistage clustering, participated in the study. Data were collected using a structured questionnaire (Supplementary Annex 1) via direct observation and a face-to-face interview approach (with patients undergoing surgery, healthcare providers and hospital administrators), against the developed checklists for the standard surgical patient care guidelines/recommendations set by different organizations.11,37–48
A letter of ethical clearance was obtained from the research ethical committee/institutional review board of Jimma University (IHRPGR/152/2021). Letters of support were also collected from JMC. Oral and written consent was obtained from all participants and their information was handled confidentially (Supplementary Annex 2). All protocols for COVID-19-preventive measures were maintained during data collection. The participants were informed about the purpose of the study, in accordance with the Declaration of Helsinki. The collected data were manually checked for missing values and outliers, cleared, entered into EpiData version 4.3.1 and finally exported to SPSS version 22 for further analysis. The findings of the study were reported using tables and narration. The mean score of surgical care practice was compared among different disciplines by applying the unpaired t-test. A p-value of less than 0.05 was declared as statistically significant.
Results
Extent of Surgical Care Practice in the Domain of Infection Prevention and Personal Protective Equipment Use Status During COVID-19 Pandemic in JMC
The implementation of COVID-19-preventive measures was higher among surgical staff compared to patients undergoing surgery, as detailed in Table 1 for different surgical departments.
Table 1 Extent of Surgical Care Practice in the Domain of Infection Prevention and Personal Protective Equipment Use (Implementation Level of COVID-19 Preventive Measures) During COVID-19 Pandemic in JMC
Status of Surgical Care Practice in the Patient Preparation/Preoperative Phase During COVID-19 Pandemic in JMC
Even though the extent of preoperative patient care differed before and during the COVID-19 pandemic, there was variation among surgical disciplines. The preoperative care implemented during the pandemic included the application of telemedicine to reduce physical contacts, screening for COVID-19 by different methods, isolation of high-risk patients in the ward and the use of PPE according to the patient status during preoperative evaluations. The practice of following preoperative guidelines (especially isolation of risky patients on the ward and screening for COVID-19) was satisfactory in the general surgery and gynecology/obstetrics departments, with mean scores of 3.6 for each (where they performed most of the time), as seen in Table 2.
Table 2 Status of Surgical Care Practice During the Patient Preparation/Preoperative Phase in JMC
Level of Surgical Care Practice in the Intraoperative Phase During COVID-19 Pandemic in JMC
Different preoperative patient care guidelines/recommendations were implemented during the COVID-19 pandemic. For instance, patients wore a face mask when they were transferred to the OR, and differences were observed in the techniques of donning/doffing, scrubbing, disinfecting, cautery usage and PPE use, according to patient status, etc (Table 3).
Table 3 Level of Surgical Care Practice During the Intraoperative Phase in JMC
Status of Equipment Handling in the Center of Sterility Room During COVID-19 Pandemic in JMC
The extent of implementation of equipment handling guidelines/recommendations was very low (not at all practiced or rarely practiced) in the center of sterility room of JMC, as the staff working in the area raised multiple barriers (especially claiming that there was no up-to-date information/training on the guidelines), as detailed in Table 4.
Table 4 Status of Equipment Handling in the Center of Sterility Room During COVID-19 Pandemic in JMC
Status of Operating Room Management Practice During COVID-19 Pandemic in JMC
Different OR management guidelines/recommendations were implemented during the COVID-19 pandemic, for instance, limiting the number of OR attendees and differences in OR cleaning patterns after the patient had been transferred. The level of implementation of the guideline that recommends having separate OR entry and exit showed statistically significant differences among surgical departments, and was lacking in the ophthalmology OR (Table 5).
Table 5 Status of Operating Room Management Practice During COVID-19 Pandemic in JMC
Status of Anesthesia Care Practice During COVID-19 Pandemic in JMC
Different anesthesia care practice guidelines/recommendations were implemented during the COVID-19 pandemic at different levels of practice, as shown in Table 6.
Table 6 Status of Anesthesia Care Practice During COVID-19 Pandemic in JMC
Extent of Postoperative Care Practice in the Recovery Room During COVID-19 Pandemic in JMC
Different postoperative safe practice guidelines/recommendations were implemented during the COVID-19 pandemic, for instance, limiting the number of OR attendees and differences in the OR cleaning patterns after the patient had been transferred (Table 7).
Table 7 Extent of Postoperative Care Practice in the Recovery Room During COVID-19 Pandemic in JMC
Discussion
The COVID-19 pandemic has led to an unprecedented number of infections and deaths in recent years and continues to present a colossal challenge to healthcare systems. The situation is especially bad in surgical departments, where there is a higher risk of transmission owing to the close contact with patients and the use of procedures that generate aerosols.22,49,50
Therefore, it is important to triage patients effectively, using preferred practices and recommendations set by expert panels, so that genuine emergencies can be tackled effectively and efficiently without facilitating disease transmission.32,34
The current study revealed that the majority of surgical staff were implementing preventive measures against COVID-19 most of the time, while they were less well practiced among patients. The guidelines for surgical practice during the preoperative phase were well applied, especially screening patients by different methods and the application of telemedicine to reduce physical contacts. But, against the guidelines, elective patients were planned and underwent surgery, especially in the general surgery department.
The implementation of recommended guidelines in the center of sterility room in handling surgical equipment was not very different before and during the pandemic. The extent of practice for anesthesia care, operating room management and postoperative care in the recovery room had changed, and the guidelines were sometimes applied.
Limitation of the Study
The study lacks a comparison of the extent of perioperative surgical care practice during the pandemic among healthcare professionals. It simply describes the extent of perioperative surgical care practice among different surgical departments by taking a convenience sample of patients and professionals. The provided responses thus relate to the pattern of practice in the specific surgical departments, not that of the individual respondents.
Conclusion and Recommendations
Despite the differences in perioperative surgical care practice before and during the pandemic, the standard guidelines/recommendations were inconsistently implemented among the surgical departments. The safe surgical guidelines were not strictly developed and implemented in the hospital and the level of the practice varied for different domains among the surgical departments. The implementation of the recommended guidelines in the center of sterility room in handling surgical equipment was not very different before and during the pandemic.
Therefore, the authors developed safe surgical care guidelines throughout different domains (infection prevention and PPE use; preoperative care, intraoperative care, operating room management, anesthesia care, equipment handling process and postoperative care) for all disciplines and shared them with all staff. Thus, we recommend that all surgical staff should access these guidelines/recommendations and strictly adhere to them during surgical service.
It is also recommended that awareness of the disease and its preventive measures should be raised in patients, and that such information should be communicated frequently.
Data Sharing Statement
The authors confirm that the data used for the study are available within the article, and any other required data and materials will be provided by the corresponding author of the study.
Ethics Approval and Consent to Participate
A letter of ethical clearance was obtained from the research ethical committee/institutional review board of Jimma University (IHRPGR/152/2021). The participants were informed about the purpose of the study, in accordance with the Declaration of Helsinki. Letters of support were also collected from JMC. Oral and written consent was obtained from all participants and their information was handled confidentially. All protocols of COVID-19 preventive measures were maintained during data collection. The procedures in this study were conducted in accordance with the ethical standards of the committee responsible for human experimentation in accordance with the Declaration of Helsinki.
Acknowledgment
The authors would like to thank Jimma University for providing funding, and all data collectors and study participants.
Funding
Jimma University provided funding for data collectors through the postgraduate mega research program in 2021 (IHRPGR/152/2021).
Disclosure
The authors report no conflicts of interest in relation to this work.
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MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.
There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.
The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.
Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.
Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.
Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.
“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.
Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.
But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.
That includes his own teenage daughter.
“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.
It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.
“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”
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AP data journalist Kasturi Pananjady contributed to this report.
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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
How a sperm and egg fuse together has long been a mystery.
New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.
“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.
The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.
Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.
It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.
Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.
Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.
The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.
The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
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