Hospitals’ Collaborations Strengthen Pandemic Preparedness: Lessons Learnt from COVID-19
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Population
2.2. Ethical Considerations
2.3. USAID-AUB Initiative
2.3.1. Pre-Assessment Visits
2.3.2. Training Visits
2.3.3. PPE and Equipment Delivery
2.3.4. Post-Assessment Visits
2.4. Study Participants
2.5. Data Collection
2.5.1. Quantitative Data Collection
Knowledge and Evaluation Questionnaires
Hospital Preparedness Checklist (HPC)
2.5.2. Qualitative Data Collection
2.6. Data Analysis
2.6.1. Statistical Analysis
2.6.2. Thematic Analysis
2.7. Data Synthesis
3. Results
3.1. Partner Hospitals’ Characteristics
3.2. Theme One: Measures Taken in Response to the Pandemic Prior to the USAID-AUB Project
3.2.1. Re-Structuring Measures
“In the ICU, we created a new unit specific for COVID patients with negative pressure”.(IC-5)
“Because the architecture of the hospital isn’t much helpful and we have an open floor, we had to close with wood to separate this unit from other units”.(HD-1)
“We prepared a new COVID-19 department that is separate from the hospital, even the access from the department to the old building is separate, and the radiology department is separate from the flow of other patients”.(HD-9)
“We also opened a flu clinic”.(QL-3)
“Now, from April first till April 6, we still did not host any COVID-19 patients, but we opened a unit for PCR testing”.(QL-10)
3.2.2. Operational Measures
“We did a meeting, and we launched the plan with the medical director, and we decided that we must cooperate with all staff to put the plan and work on it”.NS-6
“The circulation of all waste and the personnel who evacuate the infected waste were changed and transformed specifically for COVID”.HD-5
“Food and everything related to COVID-19 patients had a new policy in place”.HD-1
“All the patients and visitors were obliged to put on masks; this wasn’t found before. Even inside the hospital, we were making sure that each patient has only one person with him, and of course with a mask. At the entrance, we were asking them some questions after taking their temperature.”IC-5
“We used telephone to manage patients with mild cases”.IC-10
“We also did awareness for the community around us either through the hospital pamphlets or videos that we prepared with the infection control and posted on Facebook, and I can say that we were up to the challenge.”HD-1
“We were exporting the learning to other hospitals. Other hospitals were also coming to learn. We had multiple positive networking with other hospitals”.HD-8
“We are fully prepared, doctors, physicians, and nurses have been trained well and undergo continuous training. We are fully prepared”QL-3
“New employees were selected from university graduates. Old and new employees were trained to care for COVID patients”IC-6
3.2.3. Informational Source
“The Lebanese Society of Infectious Disease was mainly used to extract COVID-19 Info”IC-4
3.3. Theme Two: Challenges Faced by the Hospitals before the USAID-AUB Project
3.3.1. Challenges in Finances and Hospital Resources
“The tube for the scanner alone costs 150,000$ at the black-market rate and this is an amount that you can never secure”.HD-9
“Very huge costs that are not paid from the corona patients”.HD-9
“We did not even have a lab for the results we used to send them to another laboratory and wait for the results”.QL-10
“The problem of medications that we suffered to find”.HD-5
3.3.2. Challenges in Workflow
“We weren’t able to apply all the protocols comfortably because of this crisis.”IC-3
3.3.3. Challenges in Human Resources
Shortage in HCWs
“International organizations came and paid them in US dollars, so they left us”NS-6
Psychological Burden on HCWs
“It was a hard phase emotionally, psychologically, financially and everything”NS-3
3.4. Theme Three: Impact of the TTT on HCWs
3.4.1. Feedback on the Training Sessions
“We all attended the trainings, and it was really helpful. Then we repeated the training to all the staff based on what we were trained by [Name of institution]”.NS-4
3.4.2. COVID-19 Pre/Post-Training Results
3.4.3. COVID-19 Training Evaluation
3.5. Theme Four: Impact of the USAID-AUB Intervention on Hospitals’ Preparedness
3.5.1. Key Personnel’s Feedback
“Of course, this initiative came exactly when we needed it. Many of the supplies we needed were not found in the market at the time.”IC-7
“To be honest and we were expecting more help from the USAID than just the regular PPEs that we are using on a daily basis.”HD-9
3.5.2. HPC Results: Pre- and Post-Intervention
3.6. Theme Five: Additional Support Needed
3.6.1. Financial Support
“We mainly need financial support of course or anything that can be provided today will help us”HD-10
3.6.2. Material and Technical Support
“We had to coordinate with other hospitals to send them our patients when we have no more room or equipment.”(IC_10)
3.6.3. Human Resources Support
“Training for the new staff (intensive training) are needed”.(NS-2)
“Psychological support is much needed. All Teams are tired (medical, nursing and admin)”IC-6
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
AUB | American University of Beirut |
CDC | Centers for Disease Control and Prevention |
HCWs | Health Care Workers |
HPC | Hospital Preparedness Checklist |
ICU | Intensive Care Unit |
IRB | Institutional Review Board |
KSA | Kingdom of Saudi Arabia |
MCQs | Multiple Choice Questions |
PPE | Personal Protective Equipment |
SD | Standard Deviation |
SPSS | Statistical Package for the Social Sciences |
TTT | Train the Trainer |
UCSDHSP | UC San Diego Health System |
USAID | United States Agency for International Development |
USA | United States of America |
WHO | World Health Organization |
References
- Peiffer-Smadja, N.; Lucet, J.C.; Bendjelloul, G.; Bouadma, L.; Gerard, S.; Choquet, C.; Jacques, S.; Khalil, A.; Maisani, P.; Casalino, E.; et al. Challenges and issues about organizing a hospital to respond to the COVID-19 outbreak: Experience from a French reference centre. Clin. Microbiol. Infect. Off. Publ. Eur. Soc. Clin. Microbiol. Infect. Dis. 2020, 26, 669–672. [Google Scholar] [CrossRef] [PubMed]
- Grimm, C.A. Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23–27, 2020; US Department of Health and Human Services Office of Inspector General: Washington, DC, USA, 2020; Volume 41. [Google Scholar]
- Organisation for Economic Co-Operation and Development. Developing Countries and Development Co-Operation: What Is at Stake? Available online: https://www.oecd.org/coronavirus/policy-responses/developing-countries-and-development-co-operation-what-is-at-stake-50e97915/#snotes-d4e116 (accessed on 7 July 2022).
- United Nations. UN/DESA Policy Brief #66: COVID-19 and the Least Developed Countries. Available online: https://www.un.org/development/desa/dpad/publication/un-desa-policy-brief-66-covid-19-and-the-least-developed-countries/ (accessed on 7 July 2022).
- International Federation of Gynecology and Obstetrics. COVID-19 in Low-Middle-Income Countries. Available online: https://www.figo.org/covid-19-low-middle-income-countries (accessed on 7 July 2022).
- Mallay, R.; Mallay, R. When the Pandemic Hits the Most Vulnerable: Developing Countries Are Hurtling toward Coronavirus Catastrophe. Available online: https://www.foreignaffairs.com/articles/africa/2020-03-31/when-pandemic-hits-most-vulnerable (accessed on 11 July 2022).
- Maclean, R.; Marks, S. 10 African Countries Have No Ventilators. Available online: https://www.nytimes.com/2020/04/18/world/africa/africa-coronavirus-ventilators.html (accessed on 11 July 2022).
- Gage, A.; Bauhoff, S. Health Systems in Low-Income Countries Will Struggle to Protect Health Workers from COVID-19; Center for Global Development: Washington, DC, USA, 2020; Volume 2024. [Google Scholar]
- Melvin, S.C.; Wiggins, C.; Burse, N.; Thompson, E.; Monger, M. The Role of Public Health in COVID-19 Emergency Response Efforts From a Rural Health Perspective. Prev. Chronic Dis. 2020, 17, E70. [Google Scholar] [CrossRef] [PubMed]
- Kumar, A.; Rajasekharan Nayar, K.; Koya, S.F. COVID-19: Challenges and its consequences for rural health care in India. Public Health Pract. 2020, 1, 100009. [Google Scholar] [CrossRef] [PubMed]
- The World Bank. Lebanon Sinking into One of the Most Severe Global Crises Episodes, Amidst Deliberate Inaction. Available online: https://www.worldbank.org/en/news/press-release/2021/05/01/lebanon-sinking-into-one-of-the-most-severe-global-crises-episodes (accessed on 12 July 2022).
- El-Jardali, F.; Fadlallah, R.; Abou Samra, C.; Hilal, N.; Daher, N.; BouKarroum, L.; Ataya, N. K2P Rapid Response: Informing Lebanon’s Response to the COVID-19 Pandemic, Knowledge to Policy (K2P) Center. Available online: https://www.aub.edu.lb/k2p/Documents/Final-K2P%20Corona%20Rapid%20Response%20March%2017%202020%20%281%29.pdf (accessed on 7 July 2022).
- Zahreddine, N.K.; Haddad, S.F.; Kerbage, A.; Kanj, S.S. Challenges of coronavirus disease 2019 (COVID-19) in Lebanon in the midst of the economic collapse. Antimicrob. Steward. Healthc. Epidemiol. 2022, 2, e67. [Google Scholar] [CrossRef] [PubMed]
- Abou Hassan, F.F.; Bou Hamdan, M.; Ali, F.; Melhem, N.M. Response to COVID-19 in Lebanon: Update, challenges and lessons learned. Epidemiol Infect 2023, 151, e23. [Google Scholar] [CrossRef] [PubMed]
- Human Rights Watch. Lebanon: COVID-19 Worsens Medical Supply Crisis; Human Rights Watch: New York, NY, USA, 2020. [Google Scholar]
- UN Office for the Coordination of Humanitarian Affairs. COVID-19 Response—Lebanon bi-Monthly Situation Report (11 December 2020). Available online: https://reliefweb.int/report/lebanon/covid-19-response-lebanon-bi-monthly-situation-report-11-december-2020 (accessed on 1 January 2023).
- Koweyes, J.; Salloum, T.; Haidar, S.; Merhi, G.; Tokajian, S. COVID-19 Pandemic in Lebanon: One Year Later, What Have We Learnt? mSystems 2021, 6, 2. [Google Scholar] [CrossRef] [PubMed]
- Schoonenboom, J.; Johnson, R.B. How to Construct a Mixed Methods Research Design. Koln. Z Soziol. Sozpsychol. 2017, 69, 107–131. [Google Scholar] [CrossRef]
- European Center for Disease Prevention and Control. Checklist for Hospitals Preparing for the Reception and Care of Coronavirus 2019 (COVID-19) Patients; European Center for Disease Prevention and Control: Solna, Sweden, 2020; Available online: https://www.ecdc.europa.eu/en/publications-data/checklist-hospitals-preparing-reception-and-care-coronavirus-2019-covid-19 (accessed on 1 January 2023).
- Centers for Disease Control and Prevention. Comprehensive Hospital Preparedness Checklist for Coronavirus Disease 2019. Available online: https://www.cdc.gov/coronavirus/2019-ncov/hcp/hcp-hospital-checklist.html (accessed on 10 January 2023).
- World Health Organization. Hospital Readiness Checklist for COVID-19. Available online: http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/novel-coronavirus-2019-ncov-technical-guidance/coronavirus-disease-covid-19-outbreak-technical-guidance-europe/hospital-readiness-checklist-for-covid-19 (accessed on 10 January 2023).
- O’Cathain, A.; Murphy, E.; Nicholl, J. The quality of mixed methods studies in health services research. J. Health Serv. Res. Policy 2008, 13, 92–98. [Google Scholar] [CrossRef]
- Singh, S.; Govindagoudar, M.B.; Chaudhry, D.; Singh, P.K.; Vashist, A.; Vashist, M.G. Assessment of pandemic (COVID-19) preparedness in a teaching hospital in Northern India using available (CDC-Atlanta) checklist. J. Fam. Med. Prim. Care 2021, 10, 2619. [Google Scholar] [CrossRef]
- Braun, V.; Clarke, V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006, 3, 77–101. [Google Scholar] [CrossRef]
- Fetters, M.D.; Curry, L.A.; Creswell, J.W. Achieving integration in mixed methods designs-principles and practices. Health Serv. Res. 2013, 48, 2134–2156. [Google Scholar] [CrossRef]
- Ranney, M.L.; Griffeth, V.; Jha, A.K. Critical Supply Shortages—The Need for Ventilators and Personal Protective Equipment during the COVID-19 Pandemic. N. Engl. J. Med. 2020, 382, e41. [Google Scholar] [CrossRef] [PubMed]
- Kim, Y.J.; Jeong, Y.J.; Kim, S.H.; Kim, Y.J.; Lee, S.Y.; Kim, T.Y.; Choi, M.S.; Ahn, J.H. Preparedness for COVID-19 infection prevention in Korea: A single-centre experience. J. Hosp. Infect. 2020, 105, 370–372. [Google Scholar] [CrossRef] [PubMed]
- Kandel, N.; Chungong, S.; Omaar, A.; Xing, J. Health security capacities in the context of COVID-19 outbreak: An analysis of International Health Regulations annual report data from 182 countries. Lancet 2020, 395, 1047–1053. [Google Scholar] [CrossRef] [PubMed]
- Ministry of Public Health. Monitoring of COVID-19 Infection in Lebanon. Available online: https://www.moph.gov.lb/userfiles/files/Prevention/nCoV-%202019/Monitoring%20of%20COVID-19%20Infection%20In%20Lebanon/31-10-2020.pdf (accessed on 1 February 2023).
- UNICEF. Synthesis of the Crisis Impact on Lebanon. Available online: https://www.unicef.org/lebanon/reports/synthesis-crisis-impact-lebanon (accessed on 2 February 2023).
- Singh, M.; Lath, D.; Reddy, J.; Balakrishna, N. Knowledge and attitude regarding the COVID-19 pandemic among healthcare workers at a medical college and hospital in South India. Natl. J. Physiol. Pharm. Pharmacol. 2020, 10, 1–7. [Google Scholar] [CrossRef]
- Jalal, S.M.; Akhter, F.; Abdelhafez, A.I.; Alrajeh, A.M. Assessment of Knowledge, Practice and Attitude about Biomedical Waste Management among Healthcare Professionals during COVID-19 Crises in Al-Ahsa. Healthcare 2021, 9, 747. [Google Scholar] [CrossRef]
- Aleanizy, F.S.; Alqahtani, F.Y. Awareness and knowledge of COVID-19 infection control precautions and waste management among healthcare workers: Saudi cross-sectional study. Medicine 2021, 100, e26102. [Google Scholar] [CrossRef]
- Basiony Darwish, E.H.; Ramadan, A.M.; Abdelsalam, W.N.; Ibrahim, A.G.; Tawfiq Foda, N.M. Assessment and development of hospital emergency preparedness plan in response to COVID-19 pandemic in Alexandria University Hospitals. Alex. J. Med. 2022, 58, 69–77. [Google Scholar] [CrossRef]
- Fernandes, S.F.; Trigueiro, J.G.; Barreto, M.A.F.; Carvalho, R.E.F.L.d.; Silva, M.R.F.d.; Moreira, T.M.M.; Costa, M.V.d.; Freitas, R.J.M.d. Interprofessional work in health in the context of the COVID-19 pandemic: A scoping review. Rev. Esc. Enferm. USP 2021, 55, e20210207. [Google Scholar] [CrossRef]
- World Bank. Lebanon: Normalization of Crisis Is No Road to Stabilization. Available online: https://www.worldbank.org/en/news/press-release/2023/05/16/lebanon-normalization-of-crisis-is-no-road-to-stabilization#:~:text=BEIRUT%2C%20May%2016%2C%202023%20%E2%80%93,Lebanon%20Economic%20Monitor%20released%20today (accessed on 2 March 2023).
- World Bank. Lebanon Economic Monitor. Available online: https://www.worldbank.org/en/country/lebanon/publication/lebanon-economic-monitor (accessed on 2 March 2023).
- Dadouch, S.; Durgham, N. Lebanon Was Famed for Its Medical Care. Now, Doctors and Nurses Are Fleeing in Droves. The Washigton Post, 14 November 2021; p. H1. [Google Scholar]
- World Health Organization. Lebanon Press Briefing Statement. Available online: https://www.emro.who.int/media/news/lebanon-press-briefing-statement.html (accessed on 2 March 2023).
- Youssef, D.; Abboud, E.; Abou-Abbas, L.; Hassan, H.; Youssef, J. Prevalence and correlates of burnout among Lebanese health care workers during the COVID-19 pandemic: A national cross-sectional survey. J. Pharm. Policy Pract. 2022, 15, 102. [Google Scholar] [CrossRef]
- Wu, J.T.; Leung, K.; Leung, G.M. Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: A modelling study. Lancet 2020, 395, 689–697. [Google Scholar] [CrossRef] [PubMed]
- Peterson, W.J.; Munzer, B.W.; Tucker, R.V.; Losman, E.D.; Harvey, C.; Hatton, C.; Sefa, N.; Bassin, B.S.; Hsu, C.H. Rapid Dissemination of a COVID-19 Airway Management Simulation Using a Train-the-Trainers Curriculum. Acad. Med. 2021, 96, 1414–1418. [Google Scholar] [CrossRef] [PubMed]
- Haigh, K.A.; Liuzzi, F.; Irvine, S.; Thompson, A.; Hepworth, E.; Hoyle, M.C.; Cruise, J.; Hine, P.; Walker, N.F. A ‘train the trainers’ approach to infection prevention and control training in pandemic conditions. Clin. Infect. Pr. 2023, 19, 100228. [Google Scholar] [CrossRef] [PubMed]
- Shehu, N.; Okwor, T.; Dooga, J.; Wele, A.; Cihambanya, L.; Okonkon, I.; Gadanya, M.; Sebastine, J.; Okoro, B.; Okafor, O. Train-the-trainers intervention for national capacity building in infection prevention and control for COVID-19 in Nigeria. Heliyon 2023, 9, e21978. [Google Scholar] [CrossRef] [PubMed]
- Gazewood, J.D.; Rollins, L.K.; Galazka, S.S. Beyond the horizon: The role of academic health centers in improving the health of rural communities. Acad. Med. 2006, 81, 793–797. [Google Scholar] [CrossRef]
- Michener, L.; Cook, J.; Ahmed, S.M.; Yonas, M.A.; Coyne-Beasley, T.; Aguilar-Gaxiola, S. Aligning the goals of community-engaged research: Why and how academic health centers can successfully engage with communities to improve health. Acad. Med. 2012, 87, 285–291. [Google Scholar] [CrossRef]
- Villarroel, L.; Christ, C.M.; Smith, L.; Larsen, C.; Staab, R.N.; White, M.D.; Frey, K.A.; Brown, J.; Wilson, D.; Chapital, A. Collaboration on the Arizona surge line: How COVID-19 became the impetus for public, private, and federal hospitals to function as one system. NEJM Catal. Innov. Care Deliv. 2021, 2, 1–12. [Google Scholar] [CrossRef]
- Ramnath, V.R.; Hill, L.; Schultz, J.; Mandel, J.; Smith, A.; Morris, T.; Holberg, S.; Horton, L.E.; Malhotra, A.; Friedman, L.S. An in-person and telemedicine “hybrid” system to improve cross-border critical care in COVID-19. Ann. Glob. Health 2021, 87, 1. [Google Scholar] [CrossRef]
- Schaye, V.E.; Reich, J.A.; Bosworth, B.P.; Stern, D.T.; Volpicelli, F.; Shapiro, N.M.; Hauck, K.D.; Fagan, I.M.; Villagomez, S.M.; Uppal, A.; et al. Collaborating Across Private, Public, Community, and Federal Hospital Systems: Lessons Learned from the COVID-19 Pandemic Response in NYC. NEJM Catal. 2020, 1, 6. [Google Scholar] [CrossRef]
- Waitzberg, R.; Hernández-Quevedo, C.; Bernal-Delgado, E.; Estupiñán-Romero, F.; Angulo-Pueyo, E.; Theodorou, M.; Kantaris, M.; Charalambous, C.; Gabriel, E.; Economou, C.; et al. Early health system responses to the COVID-19 pandemic in Mediterranean countries: A tale of successes and challenges. Health Policy 2022, 126, 465–475. [Google Scholar] [CrossRef]
- Creswell, J.W. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches, 3rd ed.; Sage Publications, Inc.: Thousand Oaks, CA, USA, 2009. [Google Scholar]
Partner Hospitals | Number of Beds | ICU Beds | Number of Invasive Mechanical Ventilators | Number of Non-Invasive Ventilators | Presence of Microbiology Laboratory |
---|---|---|---|---|---|
Hospital 1 | 130 | 7 | 13 | 5 | Yes |
Hospital 2 | 199 | 7 | 41 | 4 | Yes |
Hospital 3 | 125 | 29 | 20 | 7 | Yes |
Hospital 4 | 100 | 8 | 12 | 2 | Yes |
Hospital 5 | 100 | 21 | 14 | 12 | Yes |
Hospital 6 | 220 | 16 | 46 | 11 | Yes |
Hospital 7 | 75 | 7 | 18 | 18 | Yes |
Hospital 8 | 106 | 9 | 14 | 3 | Yes |
Hospital 9 | 135 | 28 | 11 | 11 | Yes |
Hospital 10 | 80 | 13 | 10 | 10 | Yes |
Training Session | Sample Size (N) | Pre-Training Test Mean (±SD #) | Post-Training Test Mean (±SD) | Mean Difference | p-Value |
---|---|---|---|---|---|
Infection control 1 | 112 | 4.08 (±0.98) | 4.37 (±0.86) | 0.29 | <0.001 * |
Nursing 2 | 110 | 7.89 (±1.64) | 8.61 (±1.75) | 0.72 | <0.001 * |
PCR sampling 3 | 84 | 3.56 (±0.73) | 3.75 (±0.46) | 0.19 | 0.006 * |
Housekeeping 4,5 | 20 | 4.95 (±0.99) | 4.90 (±1.02) | −0.05 | 0.783 |
Maximum Score | Pre-Mean Score (±SD) | Post Mean Score (±SD) | Mean Difference | 95% CI | p-Value | ||
---|---|---|---|---|---|---|---|
Lower Bound | Upper Bound | ||||||
Total preparedness assessment score | 372 | 296.00 (±39.43) | 339.90 (±24.50) | 43.90 | 19.09 | 68.71 | 0.005 * |
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Sakr, C.J.; Assaf, S.A.; Fakih, L.; Dakroub, S.; Rahme, D.; Musharrafieh, U.; Khater, B.; Naous, J.; Romani, M.; Tannous, J.; et al. Hospitals’ Collaborations Strengthen Pandemic Preparedness: Lessons Learnt from COVID-19. Healthcare 2024, 12, 321. https://doi.org/10.3390/healthcare12030321
Sakr CJ, Assaf SA, Fakih L, Dakroub S, Rahme D, Musharrafieh U, Khater B, Naous J, Romani M, Tannous J, et al. Hospitals’ Collaborations Strengthen Pandemic Preparedness: Lessons Learnt from COVID-19. Healthcare. 2024; 12(3):321. https://doi.org/10.3390/healthcare12030321
Chicago/Turabian StyleSakr, Carine J., Sara A. Assaf, Lina Fakih, Saada Dakroub, Diana Rahme, Umayya Musharrafieh, Beatrice Khater, Jihane Naous, Maya Romani, Joseph Tannous, and et al. 2024. "Hospitals’ Collaborations Strengthen Pandemic Preparedness: Lessons Learnt from COVID-19" Healthcare 12, no. 3: 321. https://doi.org/10.3390/healthcare12030321