Research roundup: COVID ICU practice guidelines, tools for coping with patient deaths, history of respiratory disease

Here are three research papers that caught our eye this week: Seeking COVID consensus A paper from The Lancet notes the wide variation in clinical practice of infection control and prevention in ICUs when it comes to COVID-19. “Using a Delphi process, international experts in intensive care, infectious diseases, and infection control developed consensus statements on infection control for SARS-CoV-2 in an ICU.” Read: N.L. medical officer of health's says her experience highlights need for a national physician's licence in Canada The process achieved consensus for 31 of 33 statements and subsequently issues 25 clinical practice statements on “guidance on ICU design and engineering, healthcare worker safety, visiting policy, personal protective equipment, patients and procedures, disinfection, and sterilisation.” Notably, consensus could not be reached on the ideal return-to-work criteria for COVID-19 infected healthcare workers or on the best disinfection strategy for heat-sensitive instruments used for patient airway management. Read the full paper here: Infection control in the intensive care unit: expert consensus statements for SARS-CoV-2 using a Delphi method Taking a moment A paper published in JBI Evidence Implementation studied the benefits of a reflective exercise immediately post death of an ICU patient. Read: POLL: Does Canada need a national licence for doctors? The project focused on nurses and how they might use a standardized exercise as a coping method for handling this type of ICU event. “After standardizing the reflective exercise procedure, teaching methods were employed to support implementation. One follow-up audit measured compliance with completing a reflective exercise for all deaths occurring in the three ICUs. Contextual data were collected for completed exercises including type of death and words to describe nurses’ emotions.” The study examined the use of the tool in two ICUs where such exercises were new and one where the tool was being reintroduced. Researchers found remarkably little uptake by nurses in the ICUs where the tool was newly introduced. “Further exploration of barriers, such as type of death, and re-education are essential strategies to bolster and sustain practice and to provide support for our nursing staff to prevent emotional distress,” the study concluded. Read the full paper here: Nurse-facilitated reflective exercise post patient death in the ICU: a best practice implementation project Respiratory refresher A paper published in The Royal Society examines what the historic scientific literature on the subject of respiratory diseases does and doesn’t tell us about their transmission. COVID-19, the paper asserts, has shone a light on the gaps in knowledge surrounding transmission, noting that public policies have been based on several factors. “In particular,current recommendations have been based on four tenets: (i) respiratory disease transmission routes can be viewed mostly in a binary manner of ‘droplets’ versus ‘aerosols’; (ii) this dichotomy depends on droplet size alone; (iii) the cut-off size between these routes of transmission is 5 µm; and (iv) there is a dichotomy in the distance at which transmission by each route is relevant,” the abstract reads. “Yet, a relationship between these assertions is not supported by current scientific knowledge.” The paper examines the history of the scientific research that let to these assertions, proposing that this, “journey into the past highlights potential solutions for better collaboration and integration of scientific results into practice for building a more resilient society with more sound, far-sighted and effective public health policies.” Read the full paper here: How did we get here: what are droplets and aerosols and how far do they go? A historical perspective on the transmission of respiratory infectious disease

Research roundup: COVID ICU practice guidelines, tools for coping with patient deaths, history of respiratory disease

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