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Background: Signage is important in any public place. It involves information about nomenclature, wayfinding, service timing, emergency preparedness, and regulatory compliance. It plays an important role in helping the patient reach their desired destination with minimum difficulty, thereby enhancing the patient experience. The hospital under study is a vast facility encompassing 130 acres. Outpatient services have a monthly footfall of nearly 1 lakh patients, and there are about 1,800 admissions per month. Patients and visitors are usually unaware of the facility and face difficulties in wayfinding amidst the large number of patients. Due to difficulty in wayfinding, the patients often seek the help of hospital staff to reach the desired locations. Trilingual signage (English, Hindi, and regional language - Odia) was installed in a 960-bed tertiary care public hospital in Eastern India as a Quality Improvement initiative towards the goal of a patient-friendly hospital. OBJECTIVE: The study aims to evaluate the multi-lingual signage system in the hospital and recommend suggestions. METHODOLOGY: Wayfinding or the signage work was undertaken as a Total Quality Management (TQM) Project in the study setting, conducted over 36 months. The effectiveness of the signage system was evaluated using a questionnaire-based survey among the patients, attendants, and other visitors. RESULTS: Color-coded multilingual signage installed in the hospital block and its surrounding areas included the naming of various areas, way-finding, and safety signage. The most difficult areas to find were ICUs (35.6%), OT (31.1%), and laboratories (31.1%). Additionally, 98% of the participants could reach their desired destination but had to double-check with the staff. CONCLUSION: It was evident from the study that hospital signage plays a crucial role in hospitals by improving wayfinding, enhancing the patient experience, and promoting safety and emergency preparedness. Signage also indirectly contributes to better patient care. In large teaching hospitals, human assistance is also necessary for wayfinding.

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CONTEXT:  The generation of biomedical waste (BMW) in hospitals presents a significant hazard to both healthcare workers (HCWs) and the environment. The management of BMW is a challenge regarding inappropriate behavior among HCWs, leading to improper segregation of the BMW, which deserves attention. The indiscriminate BMW management issue in India has attracted the attention of the highest judicial bodies. The rise in the incidence of needle stick injuries is a severe threat to waste handlers and is mainly due to improper segregation practices. AIM: This study aimed to identify the challenges in BMW management in the institute and develop a strategy to improve the knowledge and practices of healthcare professionals (HCPs) in BMW management. METHODOLOGY:  A process-based intervention was developed and implemented that involved facility inspection rounds, focused group discussions with HCWs, preparation of information, education, and communication (IEC) materials, signage, staff training, and improved infrastructure and supplies for waste collection. A questionnaire-based evaluation of the staff's knowledge of BMW management was conducted, and the impact of the intervention was assessed from the hospital infection control audit reports. RESULTS:  Multiple reasons for poor compliance with BMW segregation practices were identified, and it improved from 57% to 91% with interventions. A significant difference was noted in the knowledge level of staff before and after the interventions. Post-intervention score was highest among the nurses (98.5%), followed by sanitation staff (92.7%), doctors (89.25%), and paramedics (81.7%). CONCLUSIONS:  Incorrect segregation practices of BMW and incidents of occupational exposure to blood and body fluids are reduced with interventions in the study. Robust supply chain management with regular training of staff is vital to ensure compliance in BMW management.

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With the introduction of the novel coronavirus in late 2019, the healthcare system of every country in the world experienced many challenges. In India, every healthcare organization has prepared itself to fight against these global challenges. This study aims to describe the challenges faced during the COVID-19 pandemic and how we dealt with the pandemic successfully. This narrative analysis study was made in a 960-bedded teaching hospital during the pandemic. The challenges were identified from the minutes of meetings, circulars issued, and various strategic decisions made to combat the pandemic. The challenges faced by the institute were categorized into nine different categories: infrastructural, human resource, hospital operations, and others. Lack of knowledge during the initial days of the pandemic, need for round-theclock situational management, and day-to-day operation needed aggressive training and adherence to the guidelines. Gaps identified in areas like inventory, infection control, logistics, etc., were quickly addressed, and processes were created as per the nation's changing guidelines. This study revealed strategies to manage the pandemic by optimally utilizing available resources with good teamwork and situational leadership.

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BACKGROUND: Although checklists can improve safety in the operating room (OR), compliance with their use is variable. Use of a forcing function, a principle of human factors engineering, has not been reported earlier as a method of increasing checklist use. The authors conducted this study to determine the feasibility and effects of introducing a forcing function on OR surgical safety checklist implementation and adherence. METHODS: The authors developed and introduced the use of an electronic version of the surgical safety checklist on an Android application, provided on a personal device available in the OR. This application was linked by Bluetooth to electrocautery equipment, which could not be started before the electronic checklist was completed on the screen of the personal device. In the same OR, retrospective data from use of the traditional (paper-based) checklist were compared with data from the new electronic checklist for frequency of use, and completeness (percentage of all checklist items completed) at three stages of the surgical process-sign-in, time-out, and sign-out. RESULTS: The frequency of use was 100.0% for the electronic checklist, compared with 97.9% for the traditional checklist. The frequency of completeness was 27.1% for the traditional vs. 100.0% for the electronic (p < 0.001).The manual checklist's sign-out component was completed only 37.0% of the time. CONCLUSION: Although checklist use in some form was already high with the traditional checklist, completion rate was low and significantly increased with the use of the electronic checklist with a forcing function.

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In this retrospective observational study, we have performed a comparative analysis of the demographic, clinical and epidemiological characteristics of the HCWs affected with SARS-CoV-2 infection during first two waves in India. The overall prevalence of SARS-CoV-2 infection among HCWs was found to be 15.24% (14.20-16.33) and 23.38% (22.14-25.65) during first and second waves respectively. The second wave showed an adjusted odds ratio of 0.04(0.02-0.07) and 2.09(1.49-2.93) for hospitalization and being symptomatic, respectively. We detected significantly higher level of C-reactive protein (CRP) among admitted HCWs during the second wave (5.10 -14.60 mg/dl) as compared to the first wave (2.00 - 2.80 mg/dl). Our study found the relative risk of SARS-CoV-2 reinfection among HCWs during the second wave to be 0.68 [0.57-0.82, p < 0.001)]. Although, the prevalence of SARS CoV-2 infection and risk of being symptomatic was higher during second wave, the risk of hospitalization was less when compared with the first wave.

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The whole world was shaken with the pandemic of Coronavirus Disease (COVID-19) in end of the year 2019. Due to its novel origin, it was required to follow all precautions possible. Dealing with the massive amount of infectious healthcare waste became an enormous challenge. This review identifies the impacts of the pandemic on biomedical waste management. This systematic review was made by using keywords "biomedical waste" and "COVID 19" in open access databases like PubMed, Science Direct, Scopus, Google Scholers etc. 2124 articles downloaded and 765 found duplicate and 634 not related to the topic. after scrutiny with inclusion criteria 102 articles were considered to analyze the practices related to biomedical waste management during pandemic using PRISMA guideline.. The COVID-19 waste segregation, collection, storage, transportation, and disposal are a big challenge with all stakeholders. In order to control the virus spread, strict monitoring of the complete waste management cycle is required. Adoption of appropriate guidelines is paramount to worker safety and containment of infection. Sustainable recycling methods are needed to deal with the ever-increasing plastic waste resulting from mandatory personal protective equipment (PPE) usage. The situation also demands a rethinking of the healthcare system. Overall, there was an increase in BMW generation, and municipal waste had increased globally. Pandemic preparedness requires a global public health strategy and long-term investments. This will be vital for making a robust community capable enough to fight against any public health pressures in the future, as well as the pandemic tremors. Systematized efforts from all stakeholders, at all levels, not only refines epidemic preparation but also helps to attain a sustainable development of health for a healthier future.

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STATEMENT OF THE PROBLEM: Healthcare workers (HCW) are the most vulnerable group for contracting SARS-CoV-2. Assessment of seroprevalence of SARS-CoV-2 antibodies among HCW, thus can provide important data on pathogen exposure, infectivity, and adherence to personal protective equipment (PPE). The present study aimed at assessing SARS-CoV-2 seroprevalence among HCW and exploring associations with demographics, category of exposure to COVID-19 patients, preventive measures taken and relation with COVID-19 symptoms. METHOD OF STUDY: HCWs with a minimum gap 2 weeks from last duty were eligible to participate in the study. The enrolled HCW were categorized into high-risk and low-risk category based on work in COVID-19 areas. HCWs SARS-CoV-2 specific IgG and IgM antibodies were detected using rapid immunochromatography test. RESULTS: Out of 821 randomly selected HCWs, either IgM or IgG antibody was detected in 32 HCWs (32/821, 3.9%). Only IgM antibodies were detected in 14 (1.7%), only IgG was detected in 9 (1.0%), and both IgM and IgG antibodies were present in 9 HCWs. Seropositivity was significantly higher in high-risk category (5.7% vs. 2.2.%), HCWs who ever had COVID-19 related symptoms in last 3 months (5.6% vs. 2.8%), and those who had earlier tested positive for SARS-CoV-2 with real-time reverse transcriptase PCR (36.6% vs. 3.5%). Seroprevalence was highest (6.9%) among housekeeping and sanitation staff. CONCLUSIONS: Overall, low seroprevalence of SARS-CoV-2 antibodies in our HCWs is an indicator of effective infection control practice. HCW posted in dedicated COVID ward need more stringent implementation of infection prevention measures.