HEMATOLOGY PATIENT PROTECTION DURING THE COVID-19 PANDEMIC IN ITALY: A NATIONWIDE NURSING SURVEY Hematology patient protection during the COVID-19

Main Article Content

Stefano Botti
Nicola Serra
Fausto Castagnetti
Sabina Chiaretti
Nicola Mordini
Gianpaolo Gargiulo
Laura Orlando

Keywords

COVID-19, SARS-CoV-2, coronavirus, infection spread, hematology, infection control, patient safety, patient protection, nursing, COVID-19; infection spread; Hematology

Abstract

Background: Italy has been one of the first European countries hit by the COVID-19 pandemic, with many patients dying from severe respiratory issues, especially frail subjects. Hematology patients are generally thought to be at high risk of developing severe COVID-19-associated complications. The aim of this work was to describe the infection control measures adopted in Italian hematology settings to protect patients and healthcare professionals.


Materials and Methods: On behalf of the Nursing Campus in Hematology Group, a nationwide nursing survey was conducted. Questionnaire items included general information, infection control measures, patient and healthcare professional protection, information management, and participants opinion on key issues. Data have been analyzed by center location (Northern, Central or Southern Italy) and by patient age (adult vs pediatric).


Results: Forty-four Italian hematology centers participated, representing 52.4% of those invited. Patients underwent nasopharyngeal swabs (93.2%) generally the day before admission (43.2%), though less frequently in southern centers (p = 0.0377). Visitor restrictions were implemented in all centers: 65.9% barred all visitors, while 25.0% allowed visitors only for patients with specific conditions, especially in central Italy. Deficiency of personal protective equipment, including masks (45.5%) and gloves (22.7%), was reported, although the nurses’ opinion was that the emergency was nevertheless well managed in terms of protecting patients and professionals. Almost all healthcare institutions (97.7%) provided recommendations on emergency management. No significant differences were found between adult and pediatric centers in terms of infection prevention and control.


Discussion:. Low variability in patient protection strategies was observed, meaning that national recommendations were effective. However, some critical issues emerged regarding the management of infected healthcare professionals and their contacts.

Downloads

Download data is not yet available.
Abstract 605 | PDF Downloads 187 HTML Downloads 62

References

1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323: 1239-42 .
2. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Published February 16, 2020. https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf. Accessed June 18, 2020.
3. Hewitt J, Carter B, Vilches-Moraga A, Quinn TJ, Braude P, Verduri A, Pearce L, Stechman M, Short R, Price A, Collins JT, Bruce E, Einarsson A, Rickard F, Mitchell E, Holloway M, Hesford J, Barlow-Pay F, Clini E, Myint PK, Moug SJ, McCarthy K; COPE Study Collaborators. The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study. Lancet Public Health. 2020 Aug;5(8):e444-e451. doi: 10.1016/S2468-2667(20)30146-8.
4. Laing AG, Lorenc A, Del Molino Del Barrio I, Das A, Fish M, Monin L, Muñoz-Ruiz M, McKenzie DR, Hayday TS, Francos-Quijorna I, Kamdar S, Joseph M, Davies D, Davis R, Jennings A, Zlatareva I, Vantourout P, Wu Y, Sofra V, Cano F, Greco M, Theodoridis E, Freedman J, Gee S, Chan JNE, Ryan S, Bugallo-Blanco E, Peterson P, Kisand K, Haljasmägi L, Chadli L, Moingeon P, Martinez L, Merrick B, Bisnauthsing K, Brooks K, Ibrahim MAA, Mason J, Lopez Gomez F, Babalola K, Abdul-Jawad S, Cason J, Mant C, Seow J, Graham C, Doores KJ, Di Rosa F, Edgeworth J, Shankar-Hari M, Hayday AC. A dynamic COVID-19 immune signature includes associations with poor prognosis. Nat Med. 2020 Aug 17. doi: 10.1038/s41591-020-1038-6.
5. World Health Organization. Coronavirus disease (COVID-2019) situation reports. Situation report – 34. February 23, 2020. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. Accessed May 17, 2020.
6. Onder G, Rezza, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA. 2020;323(18):1775-1776. doi:10.1001/jama.2020.4683
7. Presidenza del Consiglio dei Ministri, Dipartimento di Protezione Civile e Ministero della Salute. Bollettino COVID-19. 1 Marzo 2020. Available at: http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioVideoNuovoCoronavirus.jsp?lingua=italiano&menu=multimedia&p=video&id=2048 . Accessed May 14, 2020.
8. Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA. Published online March 13, 2020. doi:10.1001/jama.2020.4031
9. Istituto Superiore di Sanità. Epidemiology for Pubblic Health (Epicentro). COVID-19 integrated surveillance: key National data. Available at: https://www.epicentro.iss.it/en/coronavirus/sars-cov-2-integrated-surveillance-data. Accessed May 15, 2020.
10. Presidenza della Repubblica Italiana. Decreto Legge 23 febbraio 2020, n. 6. Misure urgenti in materia di contenimento e gestione dell'emergenza epidemiologica da COVID-19. (20G00020). Gazzetta Ufficiale della Repubblica Italiana. Anno 161° - Numero 45 del 23-2-2020.
11. Presidenza del Consiglio dei Ministri. Decreto del Presidente del Consiglio Dei Ministri, 1 Marzo 2020. Ulteriori disposizioni attuative del decreto-legge 23 febbraio 2020, n. 6, recante misure urgenti in materia di contenimento e gestione dell'emergenza epidemiologica da COVID-19. (20A01381) Gazzetta Ufficiale della Repubblica Italiana. Anno 161° - Numero 52 del 1-3-2020.
12. Presidenza del Consiglio dei Ministri. Decreto del Presidente del Consiglio Dei Ministri, 1 Marzo 2020. Ulteriori disposizioni attuative del decreto-legge 23 febbraio 2020, n. 6, recante misure urgenti in materia di contenimento e gestione dell'emergenza epidemiologica da COVID-19 applicabili sull’intero territorio Nazionale. (20A01475) Gazzetta Ufficiale della Repubblica Italiana. Anno 161° - Numero 55 del 4-3-2020.
13. World Health Organization. Coronavirus disease (COVID-2019) situation reports. Situation report – 48. March 8, 2020. Available at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200308-sitrep-48-covid-19.pdf?sfvrsn=16f7ccef_4. Accessed May 17, 2020.
14. Istituto Superiore di Sanità. Report sulle caratteristiche dei pazienti deceduti positivi a COVID-19 in Italia del 20 Marzo 2020. Available at: https://www.iss.it/documents/20126/0/Report+per+COVID_20_3_2019.pdf/f4d20257-53d5-eb89-087e-285e2cadf44f?t=1584724121898 . Accessed May 8, 2020.
15. Zhou G, Chen S. & Chen Z. Advances in COVID-19: the virus, the pathogenesis, and evidence-based control and therapeutic strategies. Front. Med. 14, 117–125 (2020). https://doi.org/10.1007/s11684-020-0773-x
16. Wang D, Hu B, HU C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-1069. doi:10.1001/jama.2020.1585
17. Guan W, Ni Z, Hu Y. Clinical characteristics of 2019 novel coronavirus infection in China. New England Journal of Medicine doi: 10.1056/NEJMoa2002032
18. Yang K, Sheng Y, Huang C, Jin Y, Xiong N, Jiang K, Lu H, Liu J, Yang J, Dong Y, Pan D, Shu C, Li J, Wei J, Huang Y, Peng L, Wu M, Zhang R, Wu B, Li Y, Cai L, Li G, Zhang T, Wu G. Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study. Lancet Oncol. 2020 Jul;21(7):904-913. doi: 10.1016/S1470-2045(20)30310-7.
19. Russell B, Moss C, Papa S, Irshad S, Ross P, Spicer J, Kordasti S, Crawley D, Wylie H, Cahill F, Haire A, Zaki K, Rahman F, Sita-Lumsden A, Josephs D, Enting D, Lei M, Ghosh S, Harrison C, Swampillai A, Sawyer E, D'Souza A, Gomberg S, Fields P, Wrench D, Raj K, Gleeson M, Bailey K, Dillon R, Streetly M, Rigg A, Sullivan R, Dolly S, Van Hemelrijck M. Factors Affecting COVID-19 Outcomes in Cancer Patients: A First Report From Guy's Cancer Center in London. Front Oncol. 2020 Jul 22;10:1279. doi: 10.3389/fonc.2020.01279.
20. Gosain R, Abdou Y, Singh A, Rana N, Puzanov I, Ernstoff MS. COVID-19 and Cancer: a Comprehensive Review. Curr Oncol Rep. 2020 May 8;22(5):53. doi: 10.1007/s11912-020-00934-7.
21. He W, Chen L, Chen L, Yuan G, Fang Y, Chen W, Wu D, Liang B, Lu X, Ma Y, Li L, Wang H, Chen Z, Li Q, Gale RP. COVID-19 in persons with haematological cancers. Leukemia 2020; 34: 1637–45.
22. Mahmoudjafari Z, Alexander M, Roddy J, Shaw R, Shigle TL, Timlin C, Culos K. American Society for Transplantation and Cellular Therapy Pharmacy Special Interest Group Position Statement on Pharmacy Practice Management and Clinical Management for COVID-19 in Hematopoietic Cell Transplantation and Cellular Therapy Patients in the United States. Biol Blood Marrow Transplant. 2020 Jun;26(6):1043-1049. doi: 10.1016/j.bbmt.2020.04.005. Epub 2020 Apr 17.
23. Zeidan AM, Boddu PC, Patnaik MM, Bewersdorf JP, Stahl M, Rampal RK, Shallis R, Steensma DP, Savona MR, Sekeres MA, Roboz GJ, DeAngelo DJ, Schuh AC, Padron E, Zeidner JF, Walter RB, Onida F, Fathi A, DeZern A, Hobbs G, Stein EM, Vyas P, Wei AH, Bowen DT, Montesinos P, Griffiths EA, Verma AK, Keyzner A, Bar-Natan M, Navada SC, Kremyanskaya M, Goldberg AD, Al-Kali A, Heaney ML, Nazha A, Salman H, Luger S, Pratz KW, Konig H, Komrokji R, Deininger M, Cirici BX, Bhatt VR, Silverman LR, Erba HP, Fenaux P, Platzbecker U, Santini V, Wang ES, Tallman MS, Stone RM, Mascarenhas J. Special considerations in the management of adult patients with acute leukaemias and myeloid neoplasms in the COVID-19 era: recommendations from a panel of international experts. Lancet Haematol. 2020 Jun 18:S2352-3026(20)30205-2. doi: 10.1016/S2352-3026(20)30205-2.
24. Ljungman P, Mikulska M, de la Camara R, Basak GW, Chabannon C, Corbacioglu S, Duarte R, Dolstra H, Lankester AC, Mohty M, Montoto S, Murray J, Peffault de Latour R, Snowden JA, Yakoub-Agha I, Verhoeven B, Kröger N, Styczynski J; European Society for Blood and Marrow Transplantation. The challenge of COVID-19 and hematopoietic cell transplantation; EBMT recommendations for management of hematopoietic cell transplant recipients, their donors, and patients undergoing CAR T-cell therapy. Bone Marrow Transplant. 2020 May 13:1-6. doi: 10.1038/s41409-020-0919-0.
25. Società Italiana di Ematologia (SIE) e Gruppo Italiano Trapianto di Midollo Osseo, Cellule Staminali e Terapia Cellulare (GITMO). Raccomandazione SIE-GITMO circa epidema COVID-19 del 20 Marzo 2020. Published March 23, 2020. Available at: http://www.siematologia.it/files/COVID19-Raccomandazioni-SIE-GITMO.pdf . Accessed April 28, 2020.
26. Istituto Superiore di Sanità, Centro Nazionale Trapianti. Aggiornamento delle misure di prevenzione della trasmissione dell'infezione da nuovo Coronavirus (SARS?CoV?2) in Italia attraverso il trapianto di organi, tessuti e cellule. Nota CNT n° 652 del 30 Marzo 2020. Available at: http://www.trapianti.salute.gov.it/imgs/C_17_cntAvvisi_238_0_file.pdf. Accessed April 26, 2020.
27. Istituto Superiore di Sanità. Centro Nazionale Sangue. Aggiornamento delle misure di prevenzione della trasmissione dell'infezione da nuovo Coronavirus (SARS?CoV?2) mediante la trasfusione di emocomponenti labili. Nota CNS n° 653 del 9 Marzo 2020. Available at: https://www.centronazionalesangue.it/sites/default/files/Prot.%20n.%200653.CNS_.2020_Aggiornamento%20misure%20di%20prevenzione%20nuovo%20Coronavirus%20%28SARS-CoV-2%29.pdf . Accessed March 20, 2020.
28. Istituto Superiore di Sanità. Centro Nazionale Trapianti, Gruppo Italiano Trapianto di Midollo Osseo, Italian Bone Marrow Donor registry. Aggiornamento delle misure di prevenzione della trasmissione dell'infezione da nuovo Coronavirus (SARS-CoV-2) in Italia attraverso CSE. Nota CNT-GITMO-IBMDR del 9 Giugno 2020. Published June 24, 2020. Available at: http://www.trapianti.salute.gov.it/imgs/C_17_cntAvvisi_249_0_file.pdf. Accessed June 26, 2020.
29. Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, Wang, M. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA. 2020; 323(14):1406-1407. doi: 10.1001/jama.2020.2565
30. Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect. 2020;104(3):246-251. doi:10.1016/j.jhin.2020.01.022
31. Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. J Adv Res. 2020 Mar 16;24:91-98. doi: 10.1016/j.jare.2020.03.005.
32. Terpos E, Engelhardt M, Cook G, Gay F, Mateos MV, Ntanasis-Stathopoulos I, van de Donk NWCJ, Avet-Loiseau H, Hajek R, Vangsted AJ, Ludwig H, Zweegman S, Moreau P, Einsele H, Boccadoro M, San Miguel J, Dimopoulos MA, Sonneveld P. Management of patients with multiple myeloma in the era of COVID-19 pandemic: a consensus paper from the European Myeloma Network (EMN). Leukemia. 2020 May 22:1-12. doi: 10.1038/s41375-020-0876-z.
33. European Hematology Association. Covid-19 recommendations. Available at: https://ehaweb.org/covid-19/covid-19-recommendations/recommendations-for-specific-hematologic-malignancies/ . Accessed June 10, 2020.
34. Scarfò L, Chatzikonstantinou T, Rigolin GM, Quaresmini G, Motta M, Vitale C, Garcia-Marco JA, Hernández-Rivas JÁ, Mirás F, Baile M, Marquet J, Niemann CU, Reda G, Munir T, Gimeno E, Marchetti M, Quaglia FM, Varettoni M, Delgado J, Iyengar S, Janssens A, Marasca R, Ferrari A, Cuéllar-García C, Itchaki G, Špa?ek M, De Paoli L, Laurenti L, Levin MD, Lista E, Mauro FR, Šimkovi? M, Van Der Spek E, Vandenberghe E, Trentin L, Wasik-Szczepanek E, Ruchlemer R, Bron D, De Paolis MR, Del Poeta G, Farina L, Foglietta M, Gentile M, Herishanu Y, Herold T, Jaksic O, Kater AP, Kersting S, Malerba L, Orsucci L, Popov VM, Sportoletti P, Yassin M, Pocali B, Barna G, Chiarenza A, Dos Santos G, Nikitin E, Andres M, Dimou M, Doubek M, Enrico A, Hakobyan Y, Kalashnikova O, Ortiz Pareja M, Papaioannou M, Rossi D, Shah N, Shrestha A, Stanca O, Stavroyianni N, Strugov V, Tam C, Zdrenghea M, Coscia M, Stamatopoulos K, Rossi G, Rambaldi A, Montserrat E, Foà R, Cuneo A, Ghia P. COVID-19 severity and mortality in patients with chronic lymphocytic leukemia: a joint study by ERIC, the European Research Initiative on CLL, and CLL Campus. Leukemia. 2020 Sep;34(9):2354-2363. doi: 10.1038/s41375-020-0959-x.
35. Cuneo A, Scarfò L, Reda G, Varettoni M, Quaglia FM, Marchetti M, De Paoli L, Re F, Pietrasanta D, Rigolin GM, Orsucci L, Ibatici A, Gattei V, Mauro FR, Trentin L, Laurenti L, Marasca R, Foà R. Chronic lymphocytic leukemia management in Italy during the COVID-19 pandemic: a Campus CLL report. Blood. 2020 Aug 6;136(6):763-766. doi: 10.1182/blood.2020006854.
36. Breccia M, Abruzzese E, Bocchia M, Bonifacio M, Castagnetti F, Fava C, Galimberti S, Gozzini A, Gugliotta G, Iurlo A, Latagliata R, Luciano L, Pregno P, Rege-Cambrin G, Rosti G, Stagno F, Tiribelli M, Foà R, Saglio G; Campus CML working group. Chronic myeloid leukemia management at the time of the COVID-19 pandemic in Italy. A campus CML survey. Leukemia. 2020 Aug;34(8):2260-2261. doi: 10.1038/s41375-020-0904-z.
37. Foà R, Bonifacio M, Chiaretti S, Curti A, Candoni A, Fava C, Ciccone M, Pizzolo G, Ferrara F. Philadelphia-positive acute lymphoblastic leukaemia (ALL) in Italy during the COVID-19 pandemic: a Campus ALL study. Br J Haematol. 2020 Jul;190(1):e3-e5. doi: 10.1111/bjh.16758.
38. Istituto Superiore di Sanità. Epidemia Covid-19. Aggiornamento Nazionale 16 Giugno 2020. Published June 19, 2020. Available at: http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.html#/b0c68bce2cce478eaac82fe38d4138b1 . Accessed June 26, 2020.
39. Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults. Pediatr Pulmonol. 2020 May;55(5):1169-1174. doi: 10.1002/ppul.24718. Epub 2020 Mar 5.
40. Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020 Jun;109(6):1088-1095. doi: 10.1111/apa.15270. Epub 2020 Apr 14.
41. The Lancet. COVID-19: protecting health-care workers. Lancet. 2020 Mar 21;395(10228):922. doi: 10.1016/S0140-6736(20)30644-9.
42. Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DK, Bleicker T, Brünink S, Schneider J, Schmidt ML, Mulders DG, Haagmans BL, van der Veer B, van den Brink S, Wijsman L, Goderski G, Romette JL, Ellis J, Zambon M, Peiris M, Goossens H, Reusken C, Koopmans MP, Drosten C. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill. 2020 Jan;25(3):2000045. doi: 10.2807/1560-7917.ES.2020.25.3.2000045.
43. Center for Disease Control and Prevention. HEALTH DEPARTMENTS: Interim Guidance on Developing a COVID-19 Case Investigation & Contact Tracing Plan. Updated May 26, 2020. Available at: https://www.cdc.gov/coronavirus/2019-ncov/downloads/case-investigation-contact-tracing.pdf . Accessed June 20, 2020.
44. European Centre for Disease Prevention and Control. Infection prevention and control for COVID-19 in healthcare settings – Second update. 31 March 2020. ECDC: Stockholm; 2020.
45. Ling Y, Xu SB, Lin YX, Tian D, Zhu ZQ, Dai FH, Wu F, Song ZG, Huang W, Chen J, Hu BJ, Wang S, Mao EQ, Zhu L, Zhang WH, Lu HZ. Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients. Version 2. Chin Med J (Engl). 2020 May 5;133(9):1039-1043. doi: 10.1097/CM9.0000000000000774.
46. He X, Lau EHY, Wu P, Deng X, Wang J, Hao X, Lau YC, Wong JY, Guan Y, Tan X, Mo X, Chen Y, Liao B, Chen W, Hu F, Zhang Q, Zhong M, Wu Y, Zhao L, Zhang F, Cowling BJ, Li F, Leung GM. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. 2020 May;26(5):672-675. doi: 10.1038/s41591-020-0869-5. Epub 2020 Apr 15.
47. World Health Organization. Infection prevention and control during health care when coronavirus disease (COVID-19) is suspected or confirmed. Interim guidance. June 29, 2020. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance-publications . Accessed June 30, 2020.

Most read articles by the same author(s)