ABSTRACT
Objective:
Map, in the scientific literature, the actions taken to promote the safety of patients with covid-19 in the hospital context.
Methods:
This is a scoping review according to the Joanna Briggs Institute, using the Checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. In April 2022, searches were performed on nine data sources. The results were summarized in a table and analyzed descriptively.
Results:
Fifteen studies were selected to compose the final sample. Most articles refer to cohort studies, followed by clinical trials. As for the areas of activity, there was a predominance of surgical centers, followed by adult and pediatric Intensive Care Units.
Conclusions:
With this review, it was possible to map measures such as contingency plans and reorganization of beds, rooms, and operating rooms, in addition to the isolation and distancing practiced by patients and professionals.
Descriptors:
Health Services; Patient Safety; Hospital Units; Coronavirus Infections; Covid-19
RESUMEN
Objetivo:
Mapear, en la literatura científica, las acciones adoptadas para promover la seguridad del paciente con covid-19 en el contexto hospitalario.
Métodos:
Se trata de una revisión de ámbito de acuerdo con el Instituto Joanna Briggs, utilizando el Checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. En abril de 2022, fueron realizadas búsquedas en nueve fuentes de datos. Los resultados fueron sintetizados en un cuadro y analizados de manera descriptiva.
Resultados:
Fueron seleccionados 15 estudios para componer la muestra final. La mayoría de los artículos se refieren a estudios de cohorte, seguidos de ensayos clínicos. Cuanto las áreas de actuación, notado predominancia de los centros quirúrgicos, seguidos por Unidades de Cuidados Intensivos adulto y pediátrica.
Conclusiones:
Con esta revisión, fue posible mapear medidas como planes de contingencia y reorganización de lechos, cuartos y salas quirúrgicas, además del aislamiento y distanciamiento practicados por pacientes y profesionales.
Descriptores:
Servicios de Salud; Seguridad del Paciente; Unidades Hospitalarias; Infecciones por Coronavirus; Covid-19
RESUMO
Objetivo:
Mapear, na literatura científica, as ações adotadas para promover a segurança do paciente com covid-19 no contexto hospitalar.
Métodos:
Trata-se de uma revisão de escopo de acordo com o Instituto Joanna Briggs, utilizando o Checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Em abril de 2022, foram realizadas buscas em nove fontes de dados. Os resultados foram sintetizados em um quadro e analisados de forma descritiva.
Resultados:
Foram selecionados 15 estudos para compor a amostra final. A maioria dos artigos se refere a estudos de coorte, seguidos de ensaios clínicos. Quanto às áreas de atuação, notou-se predominância dos centros cirúrgicos, seguidos por Unidades de Terapia Intensiva adulto e pediátrica.
Conclusões:
Com esta revisão, foi possível mapear medidas como planos de contingência e reorganização de leitos, quartos e salas de cirurgias, além do isolamento e distanciamento praticados pelos pacientes e profissionais.
Descritores:
Serviços de Saúde; Segurança do Paciente; Unidades Hospitalares; Infecções por Coronavírus; Covid-19.
INTRODUCTION
In December 2019, in the city of Wuhan, China, severe cases of pneumonia associated with a new coronavirus, identified as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV 2), were detected. Due to the high transmissibility of the virus and the exponential number of infected people worldwide, in 2020 the World Health Organization (WHO) declared a pandemic resulting from the disease called CORONA VIRUS DISEASE-19 (covid-19), caused by the new coronavirus. Since then, the first measures aimed at controlling the course of the disease began to be publicized, such as the closure of borders(11 Marques SC, Silveira AJT, Pimenta DN. A pandemia de COVID-19: interseções e desafios para a história da saúde e do tempo presente [Internet]. Coleção história do tempo presente: volume III. 2020 [cited 2022 May 5]. Available from: https://portal.fiocruz.br/sites/portal.fiocruz.br/files/documentos/a-pandemia-de-covid-19_intersecoes-e-desafios-para-a-historia-da-saude-e-do-tempo-presente.pdf
https://portal.fiocruz.br/sites/portal.f...
2 Organização Panamericana de Saúde (OPAS). Folha informativa sobre COVID-19 [Internet]. 2022 [cited 2022 May 5]. Available from: https://www.paho.org/pt/covid19
https://www.paho.org/pt/covid19...
-33 Wang C, Horby PW, Hayden FG, George FG. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470-73https://doi.org/10.1016/S0140-6736(20)30185-9
https://doi.org/10.1016/S0140-6736(20)30...
).
Despite being a worldwide phenomenon, it is worth noting that the covid-19 pandemic can develop very differently depending on the peculiarity of each place, such as the availability of infrastructure, professionals, environments and practices; that is: the impacts of the pandemic are not homogeneous, so a more critical view of this process is necessary(11 Marques SC, Silveira AJT, Pimenta DN. A pandemia de COVID-19: interseções e desafios para a história da saúde e do tempo presente [Internet]. Coleção história do tempo presente: volume III. 2020 [cited 2022 May 5]. Available from: https://portal.fiocruz.br/sites/portal.fiocruz.br/files/documentos/a-pandemia-de-covid-19_intersecoes-e-desafios-para-a-historia-da-saude-e-do-tempo-presente.pdf
https://portal.fiocruz.br/sites/portal.f...
,44 Prado PR, Ventura CAA, Rigotti AR, Reis RK, Zamarioli CM, Souza FB, et al. Linking worker safety to patient safety: recommendations and bioethical issues for the care of patients in the covid-19 pandemic. Texto Contexto Enferm. 2021;30(e20200535):1-11. https://doi.org/10.1590/1980-265X-TCE-2020-0535
https://doi.org/10.1590/1980-265X-TCE-20...
).
In this sense, one can evaluate the Brazilian State, which, unlike developed countries, has hospital networks with fragile structures, lacking reinforcements and constant adaptations. This could be seen in the pandemic, in which infirmary beds had to be transformed into beds in the Intensive Care Unit (ICU) for the care of critical patients with covid-19. Such emergency changes may also compromise patient safety(11 Marques SC, Silveira AJT, Pimenta DN. A pandemia de COVID-19: interseções e desafios para a história da saúde e do tempo presente [Internet]. Coleção história do tempo presente: volume III. 2020 [cited 2022 May 5]. Available from: https://portal.fiocruz.br/sites/portal.fiocruz.br/files/documentos/a-pandemia-de-covid-19_intersecoes-e-desafios-para-a-historia-da-saude-e-do-tempo-presente.pdf
https://portal.fiocruz.br/sites/portal.f...
,44 Prado PR, Ventura CAA, Rigotti AR, Reis RK, Zamarioli CM, Souza FB, et al. Linking worker safety to patient safety: recommendations and bioethical issues for the care of patients in the covid-19 pandemic. Texto Contexto Enferm. 2021;30(e20200535):1-11. https://doi.org/10.1590/1980-265X-TCE-2020-0535
https://doi.org/10.1590/1980-265X-TCE-20...
).
It should be noted that the escalation of the disease was unprecedented and the increase in cases was accompanied by the unimaginable growth in the number of deaths, as well as the overcrowding of beds, scenes of saturation of health services, isolation of patients, death without goodbyes. and collective burials(11 Marques SC, Silveira AJT, Pimenta DN. A pandemia de COVID-19: interseções e desafios para a história da saúde e do tempo presente [Internet]. Coleção história do tempo presente: volume III. 2020 [cited 2022 May 5]. Available from: https://portal.fiocruz.br/sites/portal.fiocruz.br/files/documentos/a-pandemia-de-covid-19_intersecoes-e-desafios-para-a-historia-da-saude-e-do-tempo-presente.pdf
https://portal.fiocruz.br/sites/portal.f...
,55 Croda JHR, Garcia LP. Immediate Health Surveillance Response to COVID-19. Epidemiol Serv Saúde. 2020;29(1):1-3. https://doi.org/10.5123/S1679-49742020000100021
https://doi.org/10.5123/S1679-4974202000...
). Since then, until the first half of 2022, covid-19 has had more than 500 million cases and 6 million deaths worldwide(66 World Health Organization (WHO). WHO Coronavirus (COVID-19) Dashboard) [Internet]. 2022[cited 2022 May 5]. Available from: https://covid19.who.int/
https://covid19.who.int/...
).
At the same time, it is known that Patient Safety, according to the National Patient Safety Program (PNSP), proposes measures to prevent and reduce incidents in health services, promoting, for example, training processes in patient safety for managers or professionals acting directly or indirectly in health care that results in unnecessary harm to the user(77 Ministério da Saúde (BR). Programa Nacional de Segurança do Paciente (PNSP) [Internet]. Brasília: Ministério da Saúde. 2020[cited 2022 May 5]. Available from: https://www.gov.br/saude/pt-br/acesso-a-informacao/acoes-e-programas/pnsp
https://www.gov.br/saude/pt-br/acesso-a-...
-88 Ministério da Saúde (BR). Orientações para preenchimento da avaliação das práticas de segurança do paciente[Internet]. Agência Nacional de Vigilância Sanitária. Brasília. 2022[cited 2022 May 5]. Available from: https://www.gov.br/anvisa/pt-br/assuntos/servicosdesaude/seguranca-do-paciente
https://www.gov.br/anvisa/pt-br/assuntos...
).
In this context, due to the high transmissibility of covid-19 by contact and droplets, the pandemic brought new challenges to health institutions. As a result, the performance of the PNSP was essential in view of this reality, since it required, for example, a quick redefinition of service flows and the creation of new protocols, to offer safe assistance(99 Organização Mundial da Saúde (OMS). Atualização epidemiológica semanal COVID-19 - 20 de julho de 2021[Internet]. 2021 [cited 2022 May 5]. Available from: https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---20-july-2021
https://www.who.int/publications/m/item/...
). However, several countries, including Brazil, experienced the reality of a shortage of qualified professionals to provide care to users in critical condition due to covid-19, directly compromising patient safety(44 Prado PR, Ventura CAA, Rigotti AR, Reis RK, Zamarioli CM, Souza FB, et al. Linking worker safety to patient safety: recommendations and bioethical issues for the care of patients in the covid-19 pandemic. Texto Contexto Enferm. 2021;30(e20200535):1-11. https://doi.org/10.1590/1980-265X-TCE-2020-0535
https://doi.org/10.1590/1980-265X-TCE-20...
).
Added to this, Prado et al. (2021)(44 Prado PR, Ventura CAA, Rigotti AR, Reis RK, Zamarioli CM, Souza FB, et al. Linking worker safety to patient safety: recommendations and bioethical issues for the care of patients in the covid-19 pandemic. Texto Contexto Enferm. 2021;30(e20200535):1-11. https://doi.org/10.1590/1980-265X-TCE-2020-0535
https://doi.org/10.1590/1980-265X-TCE-20...
) emphasize the existence of other factors that need to be considered in order to provide safe care. Examples of these factors are the production and proper distribution of ventilators and personal protective equipment (PPE) and access to essential equipment for care, highlighting the need to use them safely. The scarcity of these resources, therefore, was a present reality that threatened the safety of professionals and patients.
In addition, the safety culture and the set of skills developed within the scope of patient safety, according to the PNSP, are essential for adapting to a constantly changing environment. In this way, covid-19 requires the work of responsible teams as essential tools for the success of a program of change and support for patients, professionals and organizations(1010 Ferreira CIGM, Diniz ACAM, Bordalo IMSVL, Leitão MJLS, Ramos SMSV. [Can we talk about patient safety during a pandemia? a portuguese experience]. Cad Ibero-amer Dir Sanit. 2021;10(1):129-48. http://doi.org/10.17566/ciads.v10i1.682. Portuguese.
http://doi.org/10.17566/ciads.v10i1.682...
).
In view of the above, it is clear that the pandemic scenario has led to an urgent need to reorganize care practices, especially with regard to patient safety and covid-19. Therefore, this study is justified by its relevance in bringing contributions to the scientific, academic and health professionals’ community regarding the presentation of data from the scientific literature on patient safety in the context of the covid-19 pandemic in the hospital environment. The purpose was to promote a technical-scientific basis on the subject, in addition to identifying gaps, enabling the development of new studies on the subject.
OBJECTIVE
Map, in the scientific literature, the actions taken to promote the safety of patients with covid-19 in the hospital context.
METHODS
This is a scope review, which aims to identify gaps in knowledge when exploring concepts in a given area, providing the synthesis and dissemination of the results obtained. The development of the study and the elaboration of the protocol and flowchart followed the recommendations of the JBI(1111 Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H, et al. Scoping Reviews. In: Aromataris E, Munn Z (Editors). Joanna Briggs Institute Reviewer´s Manual. JBI. 2020[cited 2022 May 5]. https://doi.org/10.46658/JBIMES-20-12
https://doi.org/10.46658/JBIMES-20-12...
), using the Checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR)(1212 Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:n160. https://doi.org/10.1136/bmj.n160
https://doi.org/10.1136/bmj.n160...
). Furthermore, the article was registered on the Open Science Framework (OSF) platform. (osf.io/b3m9t/).
Furthermore, for the elaboration of the study, five steps were followed: 1) construction of the research question; 2) identification of records relevant to the study; 3) selection and inclusion of studies; 4) data summarization; 5) summary of results(1313 Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1). https://doi.org/10.1080/1364557032000119616
https://doi.org/10.1080/1364557032000119...
).
For the formulation of the research question, the mnemonic Population, Concept and Context (PCC) was used, being P - patients with covid-19; C - promotion of safe care; C - hospital units(1212 Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:n160. https://doi.org/10.1136/bmj.n160
https://doi.org/10.1136/bmj.n160...
). In this way, the following research question was defined: “What actions are taken in hospital units to promote the safe care of patients with covid-19?”
In order to identify the similarity of studies with the present review, a search was carried out in the Open Science Fromework (OSF) data sources; JBI Clinical Online Network of Evidence for Care and Therapeutics (COnNECT+), Database of Abstracts of Reviews of Effects (DARE), The Cochrane Library, as well as the International Prospective Register of Ongoing Systematic Reviews (PROSPERO), in which no similar results were found.
The descriptors were selected according to the Descriptors in Health Sciences (DeCS) e Medical Subject Headings (MeSH), to follow the standard terminology of concepts in Portuguese and English Coronavirus/Coronavirus Infections; Segurança do Paciente/Patient Safety; Gestão da Segurança/Safety Management; Unidades Hospitalares/Hospital Units; Serviços de Saúde/Health Services. Keywords were not used. It is also important to emphasize that limitations found regarding the controlled descriptors and keywords are justified by a certain scarcity of these terms in scientific articles, since they started to be published after the beginning of the pandemic.
In the elaboration of the search syntaxes, the Boolean operators “AND” and “OR” were used, being adapted according to the particularity of each data source, conserving the combinations between the descriptors. The crossings performed, in order to align the Boolean operators with the PCC, are described in Chart 1.
In April 2022, searches were performed in nine data sources: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane library, Latin American and Caribbean Literature in Health Sciences (LILACS), National Library of Medicine and National Institutes of Health (PUBMED), Scientific Electronic Library Online (SciELO), Science Direct, Elsevier’s Scopus, Web of Science and Wiley Online Library. The search syntaxes used in each data source are listed in Chart 2.
The search process took place through the Journal Portal of the Coordination for the Improvement of Higher Education Personnel (CAPES) and through the Federated Academic Community (CAFe), a tool provided by the Federal University of Rio Grande do Norte (UFRN).
Ministerial ordinances, theses, dissertations, guidelines, and scientific articles were included, without time frame or language restriction. However, abstracts, opinion articles, letters to the editor and records that did not meet the proposed theme or duplicates were excluded - these having been considered only once.
The search and selection of studies was carried out simultaneously and on different devices by two independent and duly trained evaluators. In cases of divergence between the selected articles, a third evaluator was consulted to, after discussions, decide between the inclusion or exclusion of the study in the sample. To summarize the results, a table was prepared according to the study identification variables (type of study, level of evidence, country, year of publication, area of activity, safety measures/protocols adopted in the studies and outcome), analyzed descriptively.
Regarding the level of evidence and degree of recommendation, the established by the Oxford Center for Evidence-based Medicine(1414 Oxford Centre for Evidence-Based Medicine: levels of evidence [Internet]. 2009 [cited 2022 Jun 16]. Available from: https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/.
https://www.cebm.net/2009/06/oxford-cent...
) was considered, when determining that the lowest number corresponds to a better level of evidence and the classification in “A” means higher recommendation, representing greater relevance for the scientific community.
RESULTS
Through searches in data sources, 12,264 scientific articles were found, with 15 studies selected to compose the final sample, as shown by the steps in Figure 1.
Search flowchart adapted from Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA ScR), 2022
As for the types of studies, seven (46.6%) of the records refer to cohort studies, with three (20%) clinical trials, two (13.3%) systematic reviews, one (6.6%) narrative review, a case-control study, and an institutional protocol.
Regarding the level of evidence of the studies, seven (46.6%) articles have level 2B; four (26.6%), level 1A; two (13.3%) have no evidence; one (6.6%) is level 1B; and one (6.6%) at level 3B. Furthermore, the countries with the highest number of publications were the United States of America (USA), with three (20%) studies, and Saudi Arabia, with two (13.3%). However, at a continental level, the present review identified a highlight in Europe, with six (40%) publications.
Concerning the areas of action in the health services where the studies were carried out, there was a predominance of surgical centers (26%), followed by adult and pediatric ICUs (20%). The other studies had a ward, a mental health hospital, a hemodialysis room, a sterilization material center (CME), an emergency department as a scenario, and another study was developed during a gastrointestinal endoscopy procedure.
Chart 3 displays the summary of studies referring to the final sample, according to the identification of the studies, type of study, level of evidence, country, year of publication, area of expertise, safety measures/protocols adopted in the studies and outcome.
Summary of the studies regarding their identification, type of study, level of evidence, country, year of publication, area of expertise, safety measures/protocols adopted in the studies and outcome, 2022
About the safety measures and protocols adopted in the hospital context, it is demonstrated that the most recurrent practices were those of contingency and reorganization of beds, rooms and operating rooms, as well as the isolation and distancing practiced by patients and professionals(1515 Alsofyani MA, Malaekah HM, Bashawyah A, Bawazeer M, Akkour K, Alsalmi S, et al. Safety measures for COVID-19: a review of surgical preparedness at four major medical centres in Saudi Arabia. Patient Saf Surg. 2020;(14):1-14. https://doi.org/10.1186/s13037-020-00259-1
https://doi.org/10.1186/s13037-020-00259...
-1616 Cho JH, Kang SH, Park HC, Kim DK, Lee SH, Do JY, et al. Hemodialysis with Cohort Isolation to Prevent Secondary Transmission during a COVID-19 Outbreak in Korea. J Am Soc Nephrol. 2020;31(7):1398-408. https://doi.org/10.1681/ASN.2020040461
https://doi.org/10.1681/ASN.2020040461...
,2222 Huddy JR, Crockett M, Nizar AS, Smith R, Malki M, Barber N, et al. Experiences of a “COVID protected” robotic surgical centre for colorectal and urological cancer in the COVID-19 pandemic. J Robotic Surg. 2021;2022(16):59-64. https://doi.org/10.1007/s11701-021-01199-3
https://doi.org/10.1007/s11701-021-01199...
23 Jachetti A, Colombo G, Ottolini-Brignolo B, Franchi J, Solbiati M, Meli MP, et al. Emergency department reorganisation to cope with COVID-19 outbreak in Milan university hospital: a time-sensitive challenge. BMC Emerg Med. 2021;21(74):1-8. https://doi.org/10.1186/s12873-021-00464-w
https://doi.org/10.1186/s12873-021-00464...
24 Landoas A, Cazzorl F, Gallouche M, Larrat S, Nemoz B, Giner C, et al. SARS-CoV-2 nosocomial infection acquired in a French university hospital during the 1st wave of the Covid-19 pandemic, a prospective study. Antimicrob Resist Infect Control. 2021;10(114):1-8. https://doi.org/10.1186/s13756-021-00984-x
https://doi.org/10.1186/s13756-021-00984...
-2525 Mihalj M, Mosbahi S, Schmidli J, Heinisch PP, Reineke D, Schoenhoff F, et al. Providing safe perioperative care in cardiac surgery during the COVID-19 pandemic. Best Pract Res Clin Anaesthesiol. 2021;10(2021):321-32. https://doi.org/10.1016/j.bpa.2021.01.002
https://doi.org/10.1016/j.bpa.2021.01.00...
).
It is worth mentioning that important security measures were rarely present, such as the active search and monitoring of suspected cases in professionals/patients and continuing education(1515 Alsofyani MA, Malaekah HM, Bashawyah A, Bawazeer M, Akkour K, Alsalmi S, et al. Safety measures for COVID-19: a review of surgical preparedness at four major medical centres in Saudi Arabia. Patient Saf Surg. 2020;(14):1-14. https://doi.org/10.1186/s13037-020-00259-1
https://doi.org/10.1186/s13037-020-00259...
), adaptation of the support staff to patients with covid-19(2323 Jachetti A, Colombo G, Ottolini-Brignolo B, Franchi J, Solbiati M, Meli MP, et al. Emergency department reorganisation to cope with COVID-19 outbreak in Milan university hospital: a time-sensitive challenge. BMC Emerg Med. 2021;21(74):1-8. https://doi.org/10.1186/s12873-021-00464-w
https://doi.org/10.1186/s12873-021-00464...
), changes in protocols, plans, technologies and policies in care(1818 Morgan RW, Kienzle M, Sen AI, Kilbaugh TJ, Dewan M, Raymond TT, et al. Pediatric Resuscitation Practices During the Coronavirus Disease 2019 Pandemic. Pediatr Crit Care Med. 2020;21(9):e652. https://doi.org/10.1097/PCC.0000000000002512
https://doi.org/10.1097/PCC.000000000000...
), in addition to care based on Gunderson’s five functions (restraint, support and support, structure, involvement and validation)(1919 Rodriguez NQ, Tantillo L. Preventing COVID-19 Infection in Mental Health Units: recommendations for Best Practices. Ment Health Nurs. 2020;41(11):969-75. https://doi.org/10.1080/01612840.2020.1820646
https://doi.org/10.1080/01612840.2020.18...
).
The repercussions of the adopted measures were almost totally positive, being evident the situations in which the patients did not have commitments or complications in the procedures; there was also promotion of greater safety in surgical procedures(2222 Huddy JR, Crockett M, Nizar AS, Smith R, Malki M, Barber N, et al. Experiences of a “COVID protected” robotic surgical centre for colorectal and urological cancer in the COVID-19 pandemic. J Robotic Surg. 2021;2022(16):59-64. https://doi.org/10.1007/s11701-021-01199-3
https://doi.org/10.1007/s11701-021-01199...
,2525 Mihalj M, Mosbahi S, Schmidli J, Heinisch PP, Reineke D, Schoenhoff F, et al. Providing safe perioperative care in cardiac surgery during the COVID-19 pandemic. Best Pract Res Clin Anaesthesiol. 2021;10(2021):321-32. https://doi.org/10.1016/j.bpa.2021.01.002
https://doi.org/10.1016/j.bpa.2021.01.00...
) and implementation of effective communication based on new hospital practices to provide more qualified assistance(1717 Kawabata H, Okazaki Y, Watanabe K, Inoue T, Yamaguchie K, Ueda Y, et al. A box-shaped shielding device for reducing the risk of COVID-19 droplet infection during gastrointestinal endoscopic procedures. J Clin Transl Res. 2020;6(6):236-40. https://doi.org/10.18053/jctres.06.202006.001
https://doi.org/10.18053/jctres.06.20200...
,2020 Aljohani EA, Almadi FA, Basardah RA, Banjar MS, Almufawez KA, Tamimi HA. Safety of Bariatric Surgery During the COVID-19 Pandemic: is there a need to screen low-risk patients? Int Surg. 2021;105(1-3):521-27. https://doi.org/10.9738/INTSURG-D-20-00021.1
https://doi.org/10.9738/INTSURG-D-20-000...
,2626 Penwill NY, Angulo NR, Pathak PR, Ja C, Elster MJ, Hochreiter D, et al. Changes in pediatric hospital care during the COVID-19 pandemic: a national qualitative study. BMC Health Serv Res. 2021;2021(21):1-10. https://doi.org/10.1186/s12913-021-06947-7
https://doi.org/10.1186/s12913-021-06947...
-2727 Pilosof NP, Barrett M, Oborn E, Barkai G, Passach IM, Zimlichman E. Inpatient Telemedicine and New Models of Care during COVID-19: Hospital Design Strategies to Enhance Patient and Staff Safety. Int J Environ Res Public Health. 2021;18(8391):1-15. https://doi.org/10.3390/ijerph18168391
https://doi.org/10.3390/ijerph18168391...
). Other examples of optimistic outcomes were shown in studies whose results showed a reduction in virus transmission(2424 Landoas A, Cazzorl F, Gallouche M, Larrat S, Nemoz B, Giner C, et al. SARS-CoV-2 nosocomial infection acquired in a French university hospital during the 1st wave of the Covid-19 pandemic, a prospective study. Antimicrob Resist Infect Control. 2021;10(114):1-8. https://doi.org/10.1186/s13756-021-00984-x
https://doi.org/10.1186/s13756-021-00984...
), including studies that showed professionals and patients with no record of infection during the study(2121 Erbas M, Dost B. Efficacy and Safety of an Aerosol Box for Percutaneous Tracheostomy in Patients with COVID-19 in an Intensive Care Unit. J Coll Physicians Surg Pak. 2021;31(1):79-82. http://doi.org/10.29271/jcpsp.2021.Supp3.S79
http://doi.org/10.29271/jcpsp.2021.Supp3...
-2222 Huddy JR, Crockett M, Nizar AS, Smith R, Malki M, Barber N, et al. Experiences of a “COVID protected” robotic surgical centre for colorectal and urological cancer in the COVID-19 pandemic. J Robotic Surg. 2021;2022(16):59-64. https://doi.org/10.1007/s11701-021-01199-3
https://doi.org/10.1007/s11701-021-01199...
).
Furthermore, one of the articles pointed out that health education provides health professionals with confidence to manage patients with covid-19(2929 Nahidi S, Sotomayor-Castillo C, Li C, Currey J, Elliott R, Shaban, RZ. Australian critical care nurses’ knowledge, preparedness, and experiences of managing SARS-COV-2 and COVID-19 pandemic. Aust Crit Care. 2022;35(2022):22-27. https://doi.org/10.1016/j.aucc.2021.04.008
https://doi.org/10.1016/j.aucc.2021.04.0...
). Another included concepts for future projects, with increased virtual visibility of patients and the team through technological resources, helping to optimize the hospital unit(2727 Pilosof NP, Barrett M, Oborn E, Barkai G, Passach IM, Zimlichman E. Inpatient Telemedicine and New Models of Care during COVID-19: Hospital Design Strategies to Enhance Patient and Staff Safety. Int J Environ Res Public Health. 2021;18(8391):1-15. https://doi.org/10.3390/ijerph18168391
https://doi.org/10.3390/ijerph18168391...
). A systematic review also listed detailed disinfection methods for surfaces, biological materials, air and PPE that are more efficient for eliminating the virus(2828 Martins CPV, Xavier CSF, Cobrado L. Disinfection methods against SARS-CoV-2: a systematic review. J Hosp Infect. 2022;119(2022):85-117. https://doi.org/10.1016/j.jhin.2021.07.014
https://doi.org/10.1016/j.jhin.2021.07.0...
). Finally, the last positive scenario showed preparation to manage the potential increase in hospitalizations, demonstrating that the facilities need to be adequate and equipped(1919 Rodriguez NQ, Tantillo L. Preventing COVID-19 Infection in Mental Health Units: recommendations for Best Practices. Ment Health Nurs. 2020;41(11):969-75. https://doi.org/10.1080/01612840.2020.1820646
https://doi.org/10.1080/01612840.2020.18...
).
In contrast, few studies had negative outcomes. One of them, carried out in the Emergency Department of a hospital, reported that contingency measures and change of plans were insufficient to manage hospital demand(2323 Jachetti A, Colombo G, Ottolini-Brignolo B, Franchi J, Solbiati M, Meli MP, et al. Emergency department reorganisation to cope with COVID-19 outbreak in Milan university hospital: a time-sensitive challenge. BMC Emerg Med. 2021;21(74):1-8. https://doi.org/10.1186/s12873-021-00464-w
https://doi.org/10.1186/s12873-021-00464...
). Another presented a more specific measure adopted in a cardiac surgery unit, which was nasal decolonization, which resulted in an increased risk of coughing and sneezing(2525 Mihalj M, Mosbahi S, Schmidli J, Heinisch PP, Reineke D, Schoenhoff F, et al. Providing safe perioperative care in cardiac surgery during the COVID-19 pandemic. Best Pract Res Clin Anaesthesiol. 2021;10(2021):321-32. https://doi.org/10.1016/j.bpa.2021.01.002
https://doi.org/10.1016/j.bpa.2021.01.00...
). A study did not bring clear resolutions, results or outcomes(1515 Alsofyani MA, Malaekah HM, Bashawyah A, Bawazeer M, Akkour K, Alsalmi S, et al. Safety measures for COVID-19: a review of surgical preparedness at four major medical centres in Saudi Arabia. Patient Saf Surg. 2020;(14):1-14. https://doi.org/10.1186/s13037-020-00259-1
https://doi.org/10.1186/s13037-020-00259...
).
DISCUSSION
The global health crisis caused by covid-19 has had negative impacts on various sectors, such as education, the economy and health. In the health systems of less developed countries, the repercussions were even more severe. For example, in Bangladesh, it was identified that the high demand for care made it difficult to access care in the public health system, making it necessary to transfer users to the private sector, which treated 77% of patients with SARS-CoV- 2(3030 Nasrin M. The Socio-Economic Impact and Implications of Covid-19 in Bangladesh: a sociological study according to sociological theories and social determinants. OALib. 2021;8(10):e7906. https://doi.org/10.4236/oalib.1107906
https://doi.org/10.4236/oalib.1107906...
). Still in this sense, based on the results, a large number of studies carried out on the European continent can be observed, which is related to the fact that Europe was one of the epicenters of the virus at the beginning of the pandemic(3131 Erquicia J, Valls L, Barja A, Gil S, Miquel J, Leal-Blanquet J, et al. Emotional impact of the Covid-19 pandemic on healthcare workers in one of the most important infection outbreaks in Europe. Med Clín. 2020;155(issue10):434-40. https://doi.org/10.1016/j.medcli.2020.07.006
https://doi.org/10.1016/j.medcli.2020.07...
).
According to the results of the present study, many health services have undergone changes in their care protocols in order to adapt to the new pandemic scenario to adequately promote patient safety. According to Rodriguez and Tantillo (2020)(1919 Rodriguez NQ, Tantillo L. Preventing COVID-19 Infection in Mental Health Units: recommendations for Best Practices. Ment Health Nurs. 2020;41(11):969-75. https://doi.org/10.1080/01612840.2020.1820646
https://doi.org/10.1080/01612840.2020.18...
), one of the major concerns of professionals is the organization of the flow of care, with regard to the follow-up of cases with suspected or confirmed covid-19.
In addition, it was identified that some institutions used specific environments that were isolated from other facilities to provide screening services. This is in line with the recommendation of the Ministry of Health (MS) that the flow of care should follow the priority of each patient, determined by the severity of the signs and symptoms presented(3232 Brasil. Ministério da Saúde. 2ª Etapa Fluxogramas COVID-19 SAES Z [Internet]. Brasília; 2020[cited 2022 May 6]. Available from: https://www.saude.gov.br/images/pd
https://www.saude.gov.br/images/pd...
). In this sense, actions needed to be incorporated into health systems to promote patient safety in order to reduce adverse events. For this, there was the development of new policies and care protocols in the hospital sector(3333 Cardoso LSP, Silva AA, Jardim MJA. [The role of patient safety service in the fight against covid-19 in a hospital]. Enferm Foco [Internet]. 2020 [cited 2022 May 6];11(1):217-21. Available from: http://revista.cofen.gov.br/index.php/enfermagem/article/view/3782/831 Portuguese.
http://revista.cofen.gov.br/index.php/en...
).
Faced with changes in care plans to achieve full patient safety during their care, more specific actions were needed, aimed at mitigating the adversities of the pandemic period in the hospital environment. Among the most frequently adopted security measures in the analyzed studies are contingency and reorganization of beds, rooms, and operating rooms; isolation and distancing practiced by patients and professionals; strict and adequate use of PPE; patient risk classification and postponement of elective surgeries; sorting reorganization; health education and training of professionals; swab in patients; disinfection of equipment and environments; and use of telehealth(1515 Alsofyani MA, Malaekah HM, Bashawyah A, Bawazeer M, Akkour K, Alsalmi S, et al. Safety measures for COVID-19: a review of surgical preparedness at four major medical centres in Saudi Arabia. Patient Saf Surg. 2020;(14):1-14. https://doi.org/10.1186/s13037-020-00259-1
https://doi.org/10.1186/s13037-020-00259...
1616 Cho JH, Kang SH, Park HC, Kim DK, Lee SH, Do JY, et al. Hemodialysis with Cohort Isolation to Prevent Secondary Transmission during a COVID-19 Outbreak in Korea. J Am Soc Nephrol. 2020;31(7):1398-408. https://doi.org/10.1681/ASN.2020040461
https://doi.org/10.1681/ASN.2020040461...
,2222 Huddy JR, Crockett M, Nizar AS, Smith R, Malki M, Barber N, et al. Experiences of a “COVID protected” robotic surgical centre for colorectal and urological cancer in the COVID-19 pandemic. J Robotic Surg. 2021;2022(16):59-64. https://doi.org/10.1007/s11701-021-01199-3
https://doi.org/10.1007/s11701-021-01199...
2525 Mihalj M, Mosbahi S, Schmidli J, Heinisch PP, Reineke D, Schoenhoff F, et al. Providing safe perioperative care in cardiac surgery during the COVID-19 pandemic. Best Pract Res Clin Anaesthesiol. 2021;10(2021):321-32. https://doi.org/10.1016/j.bpa.2021.01.002
https://doi.org/10.1016/j.bpa.2021.01.00...
,2828 Martins CPV, Xavier CSF, Cobrado L. Disinfection methods against SARS-CoV-2: a systematic review. J Hosp Infect. 2022;119(2022):85-117. https://doi.org/10.1016/j.jhin.2021.07.014
https://doi.org/10.1016/j.jhin.2021.07.0...
).
Despite the adoption of all these measures and the mostly positive outcomes presented, a cross-sectional study(3434 Brborovic O, Brborovic H, Hrain L. The COVID-19 Pandemic Crisis and Patient Safety Culture: a mixed-method study. Int J Environ Res Public Health. 2022;19(4):1-14. https://doi.org/10.3390/ijerph19042237
https://doi.org/10.3390/ijerph19042237...
) in Croatia, carried out with doctors and nurses from a hospital on the front line of the pandemic, demonstrated that the areas with the lowest patient safety index were in the departments involved in the care of patients with covid-19. This suggested that a high workload was associated with a lower patient safety culture, with problems related to failures in team communication, shortage of professionals, as well as non-punitive response to errors and underreporting of events.
A qualitative study(2727 Pilosof NP, Barrett M, Oborn E, Barkai G, Passach IM, Zimlichman E. Inpatient Telemedicine and New Models of Care during COVID-19: Hospital Design Strategies to Enhance Patient and Staff Safety. Int J Environ Res Public Health. 2021;18(8391):1-15. https://doi.org/10.3390/ijerph18168391
https://doi.org/10.3390/ijerph18168391...
) carried out in Australia found that, with effective communication and support to staff, it is possible to provide effective care to patients, despite the challenges posed by a pandemic. In addition, the creative use of technology to structure the workforce, disseminate information, keep staff up-to-date on guidelines, and promote engagement with patients’ families through videoconferencing was seen as facilitating care delivery(3535 Sundararajan K, Bi P, Milazzo A, Poole A, Reddi B, Mahmood MA. Preparedness and response to COVID-19 in a quaternary intensive care unit in Australia: perspectives and insights from frontline critical care clinicians. BMJ Open. 2022;12:e051982. https://doi.org/10.1136/bmjopen-2021-051982
https://doi.org/10.1136/bmjopen-2021-051...
).
Regarding the health procedures affected by the pandemic period, it is undeniable that the challenges faced required an immediate creation of conditions to meet the various emerging needs of the population(3636 Ribeiro OMPL, Trindade LL, Novo AFMP, Rocha CG, Sousa CN, Teles PJFC, et al. The COVID-19 pandemic and professional nursing practice in the context of hospitals. Healthcare. 2022;10(2):1-15. https://doi.org/10.3390/healthcare10020326
https://doi.org/10.3390/healthcare100203...
). In the evaluated articles, it was observed that elective surgeries had to be postponed; and, when performed, prior isolation and swabs were required for all patients, in order to reduce the transmission of the virus and other opportunistic infections; in addition, outpatient consultations and screening began to be carried out through telemedicine and not in person(2525 Mihalj M, Mosbahi S, Schmidli J, Heinisch PP, Reineke D, Schoenhoff F, et al. Providing safe perioperative care in cardiac surgery during the COVID-19 pandemic. Best Pract Res Clin Anaesthesiol. 2021;10(2021):321-32. https://doi.org/10.1016/j.bpa.2021.01.002
https://doi.org/10.1016/j.bpa.2021.01.00...
).
It is clear, therefore, that isolation is very effective in controlling the transmission of covid-19, although it can cause psychosocial deficits capable of lasting for a long period(2323 Jachetti A, Colombo G, Ottolini-Brignolo B, Franchi J, Solbiati M, Meli MP, et al. Emergency department reorganisation to cope with COVID-19 outbreak in Milan university hospital: a time-sensitive challenge. BMC Emerg Med. 2021;21(74):1-8. https://doi.org/10.1186/s12873-021-00464-w
https://doi.org/10.1186/s12873-021-00464...
,2626 Penwill NY, Angulo NR, Pathak PR, Ja C, Elster MJ, Hochreiter D, et al. Changes in pediatric hospital care during the COVID-19 pandemic: a national qualitative study. BMC Health Serv Res. 2021;2021(21):1-10. https://doi.org/10.1186/s12913-021-06947-7
https://doi.org/10.1186/s12913-021-06947...
). In hemodynamic facilities evaluated by one of the studies, it was found that, among the forms of containment of transmission, are continuous monitoring of isolation and early detection with rapid rRT-PCR test(1616 Cho JH, Kang SH, Park HC, Kim DK, Lee SH, Do JY, et al. Hemodialysis with Cohort Isolation to Prevent Secondary Transmission during a COVID-19 Outbreak in Korea. J Am Soc Nephrol. 2020;31(7):1398-408. https://doi.org/10.1681/ASN.2020040461
https://doi.org/10.1681/ASN.2020040461...
). It is also noteworthy that isolation measures and establishment of exclusive areas became little used as studies demonstrated the main transmission routes and after the advent of vaccination(1616 Cho JH, Kang SH, Park HC, Kim DK, Lee SH, Do JY, et al. Hemodialysis with Cohort Isolation to Prevent Secondary Transmission during a COVID-19 Outbreak in Korea. J Am Soc Nephrol. 2020;31(7):1398-408. https://doi.org/10.1681/ASN.2020040461
https://doi.org/10.1681/ASN.2020040461...
).
Accordingly, Landoas et al. (2021)(2424 Landoas A, Cazzorl F, Gallouche M, Larrat S, Nemoz B, Giner C, et al. SARS-CoV-2 nosocomial infection acquired in a French university hospital during the 1st wave of the Covid-19 pandemic, a prospective study. Antimicrob Resist Infect Control. 2021;10(114):1-8. https://doi.org/10.1186/s13756-021-00984-x
https://doi.org/10.1186/s13756-021-00984...
) argued in favor of monitoring nosocomial cases of covid-19 during the first wave, in order to determine the limit of protection of patients with the use of hygiene measures (such as hand asepsis, use of masks and measures contact blocking), which drastically reduced the transmission of the virus(2828 Martins CPV, Xavier CSF, Cobrado L. Disinfection methods against SARS-CoV-2: a systematic review. J Hosp Infect. 2022;119(2022):85-117. https://doi.org/10.1016/j.jhin.2021.07.014
https://doi.org/10.1016/j.jhin.2021.07.0...
).
From this perspective, before considering patients for elective surgery, it is necessary that they undergo a screening process. A limited number of surgeries are performed, giving preference to patients with a low risk of respiratory disease. Therefore, it is up to the multidisciplinary team to carefully assess which treatments can be postponed and which should be performed immediately, in addition to frequently reassessing the progression of the possible primary disease(2020 Aljohani EA, Almadi FA, Basardah RA, Banjar MS, Almufawez KA, Tamimi HA. Safety of Bariatric Surgery During the COVID-19 Pandemic: is there a need to screen low-risk patients? Int Surg. 2021;105(1-3):521-27. https://doi.org/10.9738/INTSURG-D-20-00021.1
https://doi.org/10.9738/INTSURG-D-20-000...
,2525 Mihalj M, Mosbahi S, Schmidli J, Heinisch PP, Reineke D, Schoenhoff F, et al. Providing safe perioperative care in cardiac surgery during the COVID-19 pandemic. Best Pract Res Clin Anaesthesiol. 2021;10(2021):321-32. https://doi.org/10.1016/j.bpa.2021.01.002
https://doi.org/10.1016/j.bpa.2021.01.00...
).
In addition, part of the analyzed studies discussed technologies developed during the pandemic, in order to protect users and health professionals during procedures that required physical contact. For example, the study by Huddy et al. (2021)(2222 Huddy JR, Crockett M, Nizar AS, Smith R, Malki M, Barber N, et al. Experiences of a “COVID protected” robotic surgical centre for colorectal and urological cancer in the COVID-19 pandemic. J Robotic Surg. 2021;2022(16):59-64. https://doi.org/10.1007/s11701-021-01199-3
https://doi.org/10.1007/s11701-021-01199...
) presents the results of a facility designed to provide emergency robotic surgery, in the safest possible way, in the early recovery period after the first peak of COVID-19 infection. Among the results of the study, the first ones suggest that one of the benefits of this installation may be shorter dwell times.
The application of technologies during the pandemic period was also part of care in the pediatric hospitalization area, including video technologies and measures to promote physical distancing and limit exposure. Furthermore, Penwill et al. (2021(2626 Penwill NY, Angulo NR, Pathak PR, Ja C, Elster MJ, Hochreiter D, et al. Changes in pediatric hospital care during the COVID-19 pandemic: a national qualitative study. BMC Health Serv Res. 2021;2021(21):1-10. https://doi.org/10.1186/s12913-021-06947-7
https://doi.org/10.1186/s12913-021-06947...
) bring lessons that could be used to guide hospital leaders in possible future crises, such as the development of communication between the multidisciplinary team.
Still in this context, pediatric hospital resuscitation systems quickly adapted to the covid-19 pandemic, as shown by Morgan et al. (2020)(1818 Morgan RW, Kienzle M, Sen AI, Kilbaugh TJ, Dewan M, Raymond TT, et al. Pediatric Resuscitation Practices During the Coronavirus Disease 2019 Pandemic. Pediatr Crit Care Med. 2020;21(9):e652. https://doi.org/10.1097/PCC.0000000000002512
https://doi.org/10.1097/PCC.000000000000...
). Although institutions seek to create or adapt policies associated with team members, the use of PPE or airway management, in many situations the implemented changes needed to be modified in order to provide individualized care to each user.
Study limitations
Despite the importance of the proposed theme, it was identified, as a limitation of the study, that the measures and protocols adopted are still not sufficient to promote patient safety in its entirety, especially in situations of lack of control, such as pandemics. In addition, it was found that the number of studies in the area is still scarce and that there is a need for work with more complex methods, such as randomized clinical trials, capable of showing in detail the actions to promote patient safety and their outcomes. Even so, it is possible that the methodological aspects have led to a limitation regarding the interpretation of the findings.
Furthermore, although the focus of the review is patient safety in the context of hospital units, the lack of strategies in other contexts, such as Primary Health Care, home care services, among others, can be identified as a limitation.
Contributions to the Area
By exposing the main procedures adopted to promote patient safety, in addition to presenting the technology being developed in favor of health to mitigate the risk of contamination, this review brings together scientific evidence capable of assisting in the clinical management of patients hospitalized for covid-19. In this way, it seeks to contribute to the development of skills and abilities inherent to the work of nurses and other components of the multidisciplinary team; and serve as a basis for further research aimed at deepening some of the management highlighted.
Also, this study proposes proven effective ways to deal with infectious diseases in the hospital environment and even at home. Therefore, this work can be used as a subsidy for learning the techniques necessary in situations of outbreaks, epidemics or pandemics, in order to contribute directly to the improvement of quality of life.
CONCLUSIONS
Reducing damage and commitment to the patient, the following actions mapped in this study proved to be very present and positive: contingency and reorganization of beds, rooms and operating rooms; isolation and distancing practiced by patients and professionals; use of PPE; patient risk classification; postponement of medical procedures; sorting reorganization; health education and training of professionals; performing swabs on patients; disinfection of equipment and environments; and use of telehealth.
REFERENCES
-
1Marques SC, Silveira AJT, Pimenta DN. A pandemia de COVID-19: interseções e desafios para a história da saúde e do tempo presente [Internet]. Coleção história do tempo presente: volume III. 2020 [cited 2022 May 5]. Available from: https://portal.fiocruz.br/sites/portal.fiocruz.br/files/documentos/a-pandemia-de-covid-19_intersecoes-e-desafios-para-a-historia-da-saude-e-do-tempo-presente.pdf
» https://portal.fiocruz.br/sites/portal.fiocruz.br/files/documentos/a-pandemia-de-covid-19_intersecoes-e-desafios-para-a-historia-da-saude-e-do-tempo-presente.pdf -
2Organização Panamericana de Saúde (OPAS). Folha informativa sobre COVID-19 [Internet]. 2022 [cited 2022 May 5]. Available from: https://www.paho.org/pt/covid19
» https://www.paho.org/pt/covid19 -
3Wang C, Horby PW, Hayden FG, George FG. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470-73https://doi.org/10.1016/S0140-6736(20)30185-9
» https://doi.org/10.1016/S0140-6736(20)30185-9 -
4Prado PR, Ventura CAA, Rigotti AR, Reis RK, Zamarioli CM, Souza FB, et al. Linking worker safety to patient safety: recommendations and bioethical issues for the care of patients in the covid-19 pandemic. Texto Contexto Enferm. 2021;30(e20200535):1-11. https://doi.org/10.1590/1980-265X-TCE-2020-0535
» https://doi.org/10.1590/1980-265X-TCE-2020-0535 -
5Croda JHR, Garcia LP. Immediate Health Surveillance Response to COVID-19. Epidemiol Serv Saúde. 2020;29(1):1-3. https://doi.org/10.5123/S1679-49742020000100021
» https://doi.org/10.5123/S1679-49742020000100021 -
6World Health Organization (WHO). WHO Coronavirus (COVID-19) Dashboard) [Internet]. 2022[cited 2022 May 5]. Available from: https://covid19.who.int/
» https://covid19.who.int/ -
7Ministério da Saúde (BR). Programa Nacional de Segurança do Paciente (PNSP) [Internet]. Brasília: Ministério da Saúde. 2020[cited 2022 May 5]. Available from: https://www.gov.br/saude/pt-br/acesso-a-informacao/acoes-e-programas/pnsp
» https://www.gov.br/saude/pt-br/acesso-a-informacao/acoes-e-programas/pnsp -
8Ministério da Saúde (BR). Orientações para preenchimento da avaliação das práticas de segurança do paciente[Internet]. Agência Nacional de Vigilância Sanitária. Brasília. 2022[cited 2022 May 5]. Available from: https://www.gov.br/anvisa/pt-br/assuntos/servicosdesaude/seguranca-do-paciente
» https://www.gov.br/anvisa/pt-br/assuntos/servicosdesaude/seguranca-do-paciente -
9Organização Mundial da Saúde (OMS). Atualização epidemiológica semanal COVID-19 - 20 de julho de 2021[Internet]. 2021 [cited 2022 May 5]. Available from: https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---20-july-2021
» https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---20-july-2021 -
10Ferreira CIGM, Diniz ACAM, Bordalo IMSVL, Leitão MJLS, Ramos SMSV. [Can we talk about patient safety during a pandemia? a portuguese experience]. Cad Ibero-amer Dir Sanit. 2021;10(1):129-48. http://doi.org/10.17566/ciads.v10i1.682 Portuguese.
» http://doi.org/10.17566/ciads.v10i1.682 -
11Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H, et al. Scoping Reviews. In: Aromataris E, Munn Z (Editors). Joanna Briggs Institute Reviewer´s Manual. JBI. 2020[cited 2022 May 5]. https://doi.org/10.46658/JBIMES-20-12
» https://doi.org/10.46658/JBIMES-20-12 -
12Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:n160. https://doi.org/10.1136/bmj.n160
» https://doi.org/10.1136/bmj.n160 -
13Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1). https://doi.org/10.1080/1364557032000119616
» https://doi.org/10.1080/1364557032000119616 -
14Oxford Centre for Evidence-Based Medicine: levels of evidence [Internet]. 2009 [cited 2022 Jun 16]. Available from: https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/
» https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/ -
15Alsofyani MA, Malaekah HM, Bashawyah A, Bawazeer M, Akkour K, Alsalmi S, et al. Safety measures for COVID-19: a review of surgical preparedness at four major medical centres in Saudi Arabia. Patient Saf Surg. 2020;(14):1-14. https://doi.org/10.1186/s13037-020-00259-1
» https://doi.org/10.1186/s13037-020-00259-1 -
16Cho JH, Kang SH, Park HC, Kim DK, Lee SH, Do JY, et al. Hemodialysis with Cohort Isolation to Prevent Secondary Transmission during a COVID-19 Outbreak in Korea. J Am Soc Nephrol. 2020;31(7):1398-408. https://doi.org/10.1681/ASN.2020040461
» https://doi.org/10.1681/ASN.2020040461 -
17Kawabata H, Okazaki Y, Watanabe K, Inoue T, Yamaguchie K, Ueda Y, et al. A box-shaped shielding device for reducing the risk of COVID-19 droplet infection during gastrointestinal endoscopic procedures. J Clin Transl Res. 2020;6(6):236-40. https://doi.org/10.18053/jctres.06.202006.001
» https://doi.org/10.18053/jctres.06.202006.001 -
18Morgan RW, Kienzle M, Sen AI, Kilbaugh TJ, Dewan M, Raymond TT, et al. Pediatric Resuscitation Practices During the Coronavirus Disease 2019 Pandemic. Pediatr Crit Care Med. 2020;21(9):e652. https://doi.org/10.1097/PCC.0000000000002512
» https://doi.org/10.1097/PCC.0000000000002512 -
19Rodriguez NQ, Tantillo L. Preventing COVID-19 Infection in Mental Health Units: recommendations for Best Practices. Ment Health Nurs. 2020;41(11):969-75. https://doi.org/10.1080/01612840.2020.1820646
» https://doi.org/10.1080/01612840.2020.1820646 -
20Aljohani EA, Almadi FA, Basardah RA, Banjar MS, Almufawez KA, Tamimi HA. Safety of Bariatric Surgery During the COVID-19 Pandemic: is there a need to screen low-risk patients? Int Surg. 2021;105(1-3):521-27. https://doi.org/10.9738/INTSURG-D-20-00021.1
» https://doi.org/10.9738/INTSURG-D-20-00021.1 -
21Erbas M, Dost B. Efficacy and Safety of an Aerosol Box for Percutaneous Tracheostomy in Patients with COVID-19 in an Intensive Care Unit. J Coll Physicians Surg Pak. 2021;31(1):79-82. http://doi.org/10.29271/jcpsp.2021.Supp3.S79
» http://doi.org/10.29271/jcpsp.2021.Supp3.S79 -
22Huddy JR, Crockett M, Nizar AS, Smith R, Malki M, Barber N, et al. Experiences of a “COVID protected” robotic surgical centre for colorectal and urological cancer in the COVID-19 pandemic. J Robotic Surg. 2021;2022(16):59-64. https://doi.org/10.1007/s11701-021-01199-3
» https://doi.org/10.1007/s11701-021-01199-3 -
23Jachetti A, Colombo G, Ottolini-Brignolo B, Franchi J, Solbiati M, Meli MP, et al. Emergency department reorganisation to cope with COVID-19 outbreak in Milan university hospital: a time-sensitive challenge. BMC Emerg Med. 2021;21(74):1-8. https://doi.org/10.1186/s12873-021-00464-w
» https://doi.org/10.1186/s12873-021-00464-w -
24Landoas A, Cazzorl F, Gallouche M, Larrat S, Nemoz B, Giner C, et al. SARS-CoV-2 nosocomial infection acquired in a French university hospital during the 1st wave of the Covid-19 pandemic, a prospective study. Antimicrob Resist Infect Control. 2021;10(114):1-8. https://doi.org/10.1186/s13756-021-00984-x
» https://doi.org/10.1186/s13756-021-00984-x -
25Mihalj M, Mosbahi S, Schmidli J, Heinisch PP, Reineke D, Schoenhoff F, et al. Providing safe perioperative care in cardiac surgery during the COVID-19 pandemic. Best Pract Res Clin Anaesthesiol. 2021;10(2021):321-32. https://doi.org/10.1016/j.bpa.2021.01.002
» https://doi.org/10.1016/j.bpa.2021.01.002 -
26Penwill NY, Angulo NR, Pathak PR, Ja C, Elster MJ, Hochreiter D, et al. Changes in pediatric hospital care during the COVID-19 pandemic: a national qualitative study. BMC Health Serv Res. 2021;2021(21):1-10. https://doi.org/10.1186/s12913-021-06947-7
» https://doi.org/10.1186/s12913-021-06947-7 -
27Pilosof NP, Barrett M, Oborn E, Barkai G, Passach IM, Zimlichman E. Inpatient Telemedicine and New Models of Care during COVID-19: Hospital Design Strategies to Enhance Patient and Staff Safety. Int J Environ Res Public Health. 2021;18(8391):1-15. https://doi.org/10.3390/ijerph18168391
» https://doi.org/10.3390/ijerph18168391 -
28Martins CPV, Xavier CSF, Cobrado L. Disinfection methods against SARS-CoV-2: a systematic review. J Hosp Infect. 2022;119(2022):85-117. https://doi.org/10.1016/j.jhin.2021.07.014
» https://doi.org/10.1016/j.jhin.2021.07.014 -
29Nahidi S, Sotomayor-Castillo C, Li C, Currey J, Elliott R, Shaban, RZ. Australian critical care nurses’ knowledge, preparedness, and experiences of managing SARS-COV-2 and COVID-19 pandemic. Aust Crit Care. 2022;35(2022):22-27. https://doi.org/10.1016/j.aucc.2021.04.008
» https://doi.org/10.1016/j.aucc.2021.04.008 -
30Nasrin M. The Socio-Economic Impact and Implications of Covid-19 in Bangladesh: a sociological study according to sociological theories and social determinants. OALib. 2021;8(10):e7906. https://doi.org/10.4236/oalib.1107906
» https://doi.org/10.4236/oalib.1107906 -
31Erquicia J, Valls L, Barja A, Gil S, Miquel J, Leal-Blanquet J, et al. Emotional impact of the Covid-19 pandemic on healthcare workers in one of the most important infection outbreaks in Europe. Med Clín. 2020;155(issue10):434-40. https://doi.org/10.1016/j.medcli.2020.07.006
» https://doi.org/10.1016/j.medcli.2020.07.006 -
32Brasil. Ministério da Saúde. 2ª Etapa Fluxogramas COVID-19 SAES Z [Internet]. Brasília; 2020[cited 2022 May 6]. Available from: https://www.saude.gov.br/images/pd
» https://www.saude.gov.br/images/pd -
33Cardoso LSP, Silva AA, Jardim MJA. [The role of patient safety service in the fight against covid-19 in a hospital]. Enferm Foco [Internet]. 2020 [cited 2022 May 6];11(1):217-21. Available from: http://revista.cofen.gov.br/index.php/enfermagem/article/view/3782/831 Portuguese.
» http://revista.cofen.gov.br/index.php/enfermagem/article/view/3782/831 -
34Brborovic O, Brborovic H, Hrain L. The COVID-19 Pandemic Crisis and Patient Safety Culture: a mixed-method study. Int J Environ Res Public Health. 2022;19(4):1-14. https://doi.org/10.3390/ijerph19042237
» https://doi.org/10.3390/ijerph19042237 -
35Sundararajan K, Bi P, Milazzo A, Poole A, Reddi B, Mahmood MA. Preparedness and response to COVID-19 in a quaternary intensive care unit in Australia: perspectives and insights from frontline critical care clinicians. BMJ Open. 2022;12:e051982. https://doi.org/10.1136/bmjopen-2021-051982
» https://doi.org/10.1136/bmjopen-2021-051982 -
36Ribeiro OMPL, Trindade LL, Novo AFMP, Rocha CG, Sousa CN, Teles PJFC, et al. The COVID-19 pandemic and professional nursing practice in the context of hospitals. Healthcare. 2022;10(2):1-15. https://doi.org/10.3390/healthcare10020326
» https://doi.org/10.3390/healthcare10020326
Edited by
Publication Dates
-
Publication in this collection
09 Oct 2023 -
Date of issue
2023
History
-
Received
10 Mar 2022 -
Accepted
29 Mar 2023