Patient safety with covid-19 in hospital units: a scoping review

Leite, Fernanda de Macedo Coelho; Oliveira, Eloysa dos Santos; Silva, Bruna Vilar Soares da; Melo, Evelin Beatriz Bezerra de; Dantas, Rodrigo Assis Neves; Dantas, Daniele Vieira

doi:10.1590/0034-7167-2022-0557

Fernanda de Macedo Coelho Leite

conception or design of the study/research

analysis and/or interpretation of data

final revision with critical and intellectual participation in the manuscript

Universidade Federal do Rio Grande do Norte. Natal, Rio Grande do Norte, Brazil

https://orcid.org/0000-0002-1079-1227

Eloysa dos Santos Oliveira

conception or design of the study/research

analysis and/or interpretation of data

final revision with critical and intellectual participation in the manuscript

Universidade Federal do Rio Grande do Norte. Natal, Rio Grande do Norte, Brazil

https://orcid.org/0000-0001-9635-3668

Bruna Vilar Soares da Silva

conception or design of the study/research

analysis and/or interpretation of data

final revision with critical and intellectual participation in the manuscript

Universidade Federal do Rio Grande do Norte. Natal, Rio Grande do Norte, Brazil

https://orcid.org/0000-0002-4199-238X

Evelin Beatriz Bezerra de Melo

conception or design of the study/research

analysis and/or interpretation of data

final revision with critical and intellectual participation in the manuscript

Universidade Federal do Rio Grande do Norte. Natal, Rio Grande do Norte, Brazil

https://orcid.org/0000-0003-1822-8022

Rodrigo Assis Neves Dantas

conception or design of the study/research

analysis and/or interpretation of data

final revision with critical and intellectual participation in the manuscript

Universidade Federal do Rio Grande do Norte. Natal, Rio Grande do Norte, Brazil

https://orcid.org/0000-0002-9309-2092

Daniele Vieira Dantas Corresponding author: Daniele Vieira Dantas, E-mail: daniele00@hotmail.com

conception or design of the study/research

analysis and/or interpretation of data

final revision with critical and intellectual participation in the manuscript

Universidade Federal do Rio Grande do Norte. Natal, Rio Grande do Norte, Brazil

https://orcid.org/0000-0003-0307-2424

Corresponding author: Daniele Vieira Dantas, E-mail: daniele00@hotmail.com

EDITOR IN CHIEF: Dulce Barbosa

ASSOCIATE EDITOR: Álvaro Sousa

PCC	MeSH
Population	Coronavirus Infection	OR
AND
Concept	Patient Safety OR Safety Management	OR
AND
Context	Hospital Units OR Health Services	OR

Data sources	Search syntaxes
^* * CINAHL: Cumulative Index of Nursing and Allied Health; † LILACS: Literatura Latino-Americana e do Caribe em Ciências da Saúde; ‡ SciELO: Scientific Electronic Library Online; § Scopus: Elsevier’s Scopus. CINAHL	(Coronavirus Infections) AND (Patient Safety OR Safety Management) AND (Hospital Units OR Health Services)
MEDLINE/PubMed	(“coronavirus infections”[MeSH Terms] OR (“coronavirus”[All Fields] AND “infections”[All Fields]) OR “covid-19”[All Fields]) AND (“patient safety”[MeSH Terms] OR (“patient”[All Fields] AND “safety”[All Fields]) OR “patient safety”[All Fields]) AND “hospital units”[MeSH Terms] OR (“hospital”[All Fields] AND (“units”[All Fields]) OR “hospital units”[All Fields])
^†LILACS	Coronavirus Infections AND Patient Safety OR Safety Management [Palavras] and Hospital Units OR Health Services [Palavras]
Academic Google	(“Coronavirus Infections” OR “covid-19 “) AND (“Patient Safety” AND “Hospital Units”)
^‡SciELO	(^* * CINAHL: Cumulative Index of Nursing and Allied Health; † LILACS: Literatura Latino-Americana e do Caribe em Ciências da Saúde; ‡ SciELO: Scientific Electronic Library Online; § Scopus: Elsevier’s Scopus. Coronavirus Infections) AND (Patient Safety OR Safety Management) AND (Hospital Units OR Health Services)
Science Direct	(SU (Coronavirus Infections)) AND (SU (Patient Safety OR Safety Management)) AND (SU (Hospital Units OR Health Services))
^§Scopus	TITLE-ABS-KEY (coronavirus AND infections) AND TITLE-ABS-KEY (patient AND safety OR Safety AND Management) AND TITLE-ABS-KEY (hospital AND units health AND services)
Web of Science	((TS=(Coronavirus Infections)) AND TS=(Patient Safety OR Safety Management)) AND TS=(Hospital Units OR Health Services)
Gale Academic OneFile	(Coronavirus Infections OR covid-19) AND (Patient Safety) AND (Hospital Units)
Wiley Online Library	“Coronavirus Infections” anywhere and “Patient Safety OR Safety Management” anywhere and “Hospital Units OR Health Services” anywhere

^* * ID = Identification; † LE = Level of evidence; ‡ n/e = No evidence. ID	Study type/ ^†LE/ Country/Year	Occupation area	Actions taken	Outcomes
Alsofyani et al.(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... )	Institutional protocol / N / E / Saudi Arabia / 2020	Operating rooms and ICU	Use of PPE, bed contingency, active search, and monitoring of suspected cases among professionals and patients, admission screening with temperature measurement, health education and continuing education.	The study did not address the results regarding the implementation of the guidelines in the analyzed hospitals.
Cho et al.(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... )	Cohort study/2B/ South Korea / 2020	hemodialysis	HD-positive patients: transferred to a hospital with an isolation room and a portable dialysis machine. Positive healthcare workers: admitted to a hospital with an isolation room, covid-19 care centers or home isolation.	During isolation, nine patients with symptoms tested negative for SARS-CoV-2. Two health professionals were diagnosed in the closure test.
Kawabata et al.(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... )	Cohort study/2B Japan/2020	Gastrointestinal endoscopy	Use of a cube-shaped box on the patient’s head with two windows to allow endoscopy.	Patients suspected of having covid-19 were treated, and there were no complications. Professionals rated the device’s sense of security as 5/5.
Morgan et al.(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... )	Clinical trial/1A/ USA/2020	Critical care unit of a children’s hospital	Among institutions, 91% have implemented changes to their inpatient COVID-19 emergency response systems, 76% have adhered to new protocols for patients with suspected COVID-19, and 74% are using new or adapted technologies.	Most pediatric institutions have adapted their care protocols. The changes were related to PPE, airway management, team members and professional and patient safety.
Rodriguez and Tantillo(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... )	Systematic review/1A/ USA/2020	Mental health	Inpatient care was described using Gunderson’s five functions: containment, support and support, structure, involvement, and validation.	To prevent the spread of covid 19, one must be prepared to manage the potential increase in hospitalizations, with safety for patients and professionals, as well as adequacy of facilities.
Aljohani et al.(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... )	Cohort study/2B/ Saudi Arabia / 2021	Bariatric surgery	Use of preoperative respiratory scoring system screening to select low-risk patients for elective surgery.	None of the patients developed postoperative complications or were admitted to the ICU. Only two patients were tested for covid-19, and both were negative.
Erbas e Dost(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... )	Cohort study/2B/ Turkey / 2021	ICU	Use of aerosol box during percutaneous tracheostomy.	No healthcare professional was infected with SARS-CoV-2 while performing the tracheostomy procedure.
Huddy et al.(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... )	Cohort study/2B/ UK/2021	Colorectal surgery	Creation of a “covid safe” robotic unit for major elective surgeries, minimized employee contact with possible covid patients and isolation of patients, in addition to performing swabs before surgery.	There were no known cases of patients included in the study developing coronavirus throughout the perioperative period.
Jachetti et al.(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... )	Cohort study/2B Italy/2021	Emergency department	Separate screening, isolation for symptomatics, dedicated area for critical and non-critical covid patients, full PPE throughout, pre-isolation area for non-covid patients, decreased swab wait time.	Unfortunately, the changes and contingency plans were not enough and the emergency department remained overcrowded.
Landoas et al.(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... )	Cohort study/2B/France/ 2021	Wards	Use of mask by health professionals and patients, hand hygiene, physical distancing, implementation of screen in double rooms and disinfection of shared equipment.	The safety measures adopted drastically reduced the nosocomial transmission of the virus.
Mihalj et al.(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... )	Narrative review/‡n/e Switzerland /2021	Cardiac surgery	Postponement of non-emergency surgeries, telemedicine for preoperative evaluation, use of masks and PPE, patient swabs during triage, self-isolation before surgery, specific operating room, and nasal decolonization for patients with covid-19.	Operating on COVID‑19 patients may be reasonable in those who remain symptom-free. Nasal decolonization measures were causing more damage by increasing your risk of coughing or sneezing.
Penwill et al.(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... )	Clinical trial/1A/ USA /2021	Children’s Hospital	Regular, transparent, multimodal, and two-way communication was optimized by team members. Physicians increased use of videoconferencing and telehealth.	Changes were identified such as: adoption of new hospital policies, video communication, personnel models, education strategies and support for the mental health of the team.
Pilosof et al.(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... )	Case-control study/3B/ Israel/ 2021	Intensive care unit	The control of nosocomial infections was investigated under the supervision of the team. Reduction of medical errors through the adoption of protocols. Prevention of contamination by covid-19. Stimulation of teamwork and operations management.	Increased virtual visibility of patients and the team, optimization of the unit, facilitation of communication between the team and improvement of care through technological resources.
Martins, Xavier and Cobrado (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... )	Systematic review/ 2A/ Portugal/2022	Sterilization Material Center (CME)	Use of ethanol and isopropanol on porcelain and ceramic surfaces, alcohol, chlorhexidine, PVP-I and soap on biological surfaces, silver, copper, and aluminum oxide combined in air conditioning systems, in addition to UV-C light, heat with different humidity levels for cleaning PPE, ozone.	Alcohols and hand washing are the best options when it comes to choosing a quick and effective action against the virus. After decontamination, treatment with ozone is indicated.
Nahidi et al.(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... )	Clinical trial/1A/ Australia/2022	Critical care unit of a children’s hospital	Of the nurses, 82.3% felt prepared to manage patients with covid-19; 93.4% received specific education, training, or instruction; 55.7% reported that the pandemic has increased their workload.	Most nurses reported being prepared to manage patients with covid-19. Those who had undergone training stood out in the answers.

[1] Corresponding author: Daniele Vieira Dantas, E-mail: daniele00@hotmail.com

Brasil

Brasil

Patient safety with covid-19 in hospital units: a scoping review

Seguridad del paciente con covid-19 en unidades hospitalarias: revisión de ámbito

ABSTRACT

Objective:

Methods:

Results:

Conclusions: