"We could have used a lot more of this before…": A qualitative study understanding barriers and facilitators to implementing a provincial PPE safety coach program during the COVID-19 pandemic

BACKGROUND

A Provincial PPE Safety Coach Program was introduced to support appropriate use of personal protective equipment by health care workers. The objective was to understand barriers and facilitators to implementation.

METHODS

A qualitative study was conducted mid-2021. Participants were recruited using a purposive sampling strategy. Interviews were conducted using a guide informed by the Theoretical Domains Framework and Consolidated Framework for Implementation Research. Analysis was conducted using the Theoretical Domains Framework.

RESULTS

Prominent domains identified by staff were "social influences and skills", "environmental context and resources", "social/professional role and identity", "emotion", and "belief of consequences". Prominent domains identified by safety coaches were "knowledge", "social/professional role and identity", "environmental context and resources", and "memory". Only "environmental context and resources" and "social/professional role and identity" were similar. The main facilitators were fear of COVID-19 and leadership commitment, while the main barriers were lack of clarity and balancing the role.

DISCUSSION

Understanding the local context of a health care environment influenced the success of safety coaches. The role allowed individuals to develop leadership skills and help staff improve their perceived competence in using personal protective equipment.

CONCLUSIONS

Safety coaches were well received. Influencing factors provide a basis for strategies to embed this approach throughout a health care system.

Personal protective equipment impacts firefighters' anaerobic fitness

BACKGROUND

Personal protective equipment (PPE) is vital for firefighters' safety and effectiveness during daily operations. However, concerns have emerged about its potential impact on firefighters' anaerobic fitness (AF), which is crucial for their operational readiness. The Physical Ability Test (PAT) is used to assess readiness, but there is inconsistency among fire departments regarding whether PAT is conducted with full PPE or regular exercise clothing. This variation in testing conditions may exacerbate the stress on firefighters' AF.

AIMS

To analyse differences in firefighters' AF performance while wearing full PPE compared to regular exercise clothing.

METHODS

We studied two cohorts totalling 62 firefighters from specific fire departments in South Florida. We conducted occupation-specific AF tests, including handgrip dynamometry (HG), vertical jump (VJ), Margaria-Kalamen (MK), and a 300-yard shuttle run (300YD), both with full PPE (WPPE) and without PPE (NPPE). We adjusted AF variables for body weight (e.g. NPPE) and occupational weight (e.g. WPPE) and used a repeated-measures design in Jamovi (P < 0.05).

RESULTS

Wearing WPPE significantly reduced relative HG strength by 59%, VJ peak power by 11%, and MK mean power by 49%, while increased 300YD completion time by 18%.

CONCLUSIONS

The study reveals that PPE substantially impairs firefighters' anaerobic performance during occupation-specific tests. This emphasizes the need for tailored AF training programs to support the anaerobic system and related performance while wearing PPE, acknowledging the significance of occupational specificity in assessing firefighters' fitness components.

Personal Protective Equipment Use and Surface Contamination With Antineoplastic Drugs: The Impact of the COVID-19 Pandemic

BACKGROUND

Surface contamination with antineoplastic drugs (ADs) is persistent. The use of personal protective equipment (PPE) is recommended to reduce exposure to ADs.

OBJECTIVES

This study explored the impact of the COVID-19 pandemic on nurses' PPE use and surface contamination with ADs.

METHODS

Demographic characteristics, PPE use, and associated factors were assessed on two inpatient oncology units where etoposide and cyclophosphamide were administered before (N = 26) and during the COVID-19 pandemic (N = 31).

FINDINGS

PPE use when handling contaminated excreta was significantly higher during the pandemic. Perceived risk of chemotherapy exposure was significantly associated with greater PPE use when handling AD-contaminated excreta, and conflict of interest was related to less PPE use during AD administration and handling of AD-contaminated excreta. During the pandemic, surface contamination with etoposide increased in shared areas and decreased in patient rooms.

Adherence to standard precautions in university hospitals during the COVID-19 pandemic: a mixed study

OBJECTIVE

To analyze adherence to standard precautions by healthcare professionals and associated factors during the COVID-19 pandemic in Brazilian university hospitals.

METHOD

Multicenter study, with a mixed approach, with a concomitant incorporated strategy and a sample of 559 health professionals and 53 managers from five university hospitals in Southern Brazil. Data collected online from September 2020 to October 2021 with the Instrument of Variables Related to Standard Precautions and sociodemographic and pandemic-related variables. Descriptive and inferential statistical analysis (Mann-Whitney and Kruskal-Wallis test) and content analysis were performed.

RESULTS

High level of adherence to standard precautions, with a significant association with having children (p = 0.014); COVID area (p < 0.001), biosafety training (p = 0.018), and social distancing (p < 0.001). The testimonies demonstrated a high risk perception and search for the use of protective equipment and biosafety knowledge.

CONCLUSION

High adherence to standard precautions, associated with having children, working in COVID-19 care units, receiving biosafety guidance/training at the institution and practicing social distancing.

A mixed-methods analysis of moral injury among healthcare workers during the COVID-19 pandemic

During the COVID-19 pandemic, healthcare workers faced grave responsibilities amidst rapidly changing policies and material and staffing shortages. Moral injury, psychological distress following events where actions transgress moral beliefs/ expectations, increased among healthcare workers. We used a sequential mixed methods approach to examine workplace and contextual factors related to moral injury early in the pandemic. Using a Total Worker Health® framework, we 1) examined factors associated with moral injury among active healthcare professionals (N = 14,145) surveyed between May-August 2020 and 2) qualitatively analyzed open-ended responses from 95 randomly selected participants who endorsed moral injury on the survey. Compared to inpatient hospital, outpatient (OR = 0.74 [0.65, 0.85]) or school clinic settings (OR = 0.37 [0.18, 0.75]) were associated with lower odds of moral injury; while group care settings increased odds (OR = 1.36 [1.07, 1.74]). Working with COVID+ patients (confirmed+ OR = 1.27 [1.03, 1.55]), PPE inadequacy (OR = 1.54 [1.27, 1.87]), and greater role conflict (OR = 1.57 [1.53, 1.62]) were associated with greater odds of moral injury. Qualitative findings illustrate how outside factors as well as organizational policies and working conditions influenced moral injury. Moral injury experiences affected staff turnover and patient care, potentially producing additional morally injurious effects. Worker- and patient-centered organizational policies are needed to prevent moral injury among healthcare workers. The generalizability of these findings may be limited by our predominantly white and female sample. Further research is indicated to replicate these findings in minoritized samples.

Behavior Analysis of the Use of Personal Protective Equipment (PPE) for Workers at PT. Maruki International Indonesia

Personal protective equipment (PPE) is a set of tools used by workers to protect all or part of their body against the potential danger of work accidents in the work area. The use of personal protective equipment is often considered unimportant by workers, especially those working in dangerous and risky areas. The discipline of workers in using personal protective equipment is still low, so the risk of work accidents that can endanger workers is quite large. The purpose of this study was to determine the relationship between perception, motivation, knowledge and supervision of the behavior of using PPE at PT. Maruki International Indonesia, Tamalanrea District, Makassar City, South Sulawesi Province. This type of research is analytical research with a cross-sectional study approach with a total sample of 41 people. The results showed that there was a relationship between perceptions and the behavior of using PPE (p = .004), there was a relationship between motivation and behavior in using PPE (p = .002), there was no relationship between knowledge and behavior in using PPE (p = .814), there was a relationship between supervision and usage behavior. PPE (p = .008). It is recommended that workers be obedient and disciplined to use PPE (personal protective equipment) according to the regulations and make it a work norm, provide IEC PPE in all work locations, and increase supervision of the use of PPE through improved management.

Prevalence of Anxiety Symptoms Among Health Care Workers in Colombia During the COVID-19 Pandemic

OBJECTIVE

This study aimed to determine the prevalence of anxiety symptoms in a Colombian HCW sample during the COVID-19 pandemic.

METHODS

A cross-sectional study was carried out by means of an online survey (May-June 2020). Respondents were HCWs in Colombia reached by a nonprobability sample. Zung's self-rating anxiety scale allowed the estimation of prevalence and classification of anxiety symptoms.

RESULTS

A total of 568 HCWs answered the questionnaire, 66.0% were women, the mean age was 38.6±11.4 years. 28.9% presented with anxiety symptoms, of whom 9.2% were moderate-severe. Characteristics such as living with relatives at higher risk of mortality from COVID-19 infection (OR: 1.90; 95% CI: 1.308-2.762), female sex (OR: 2.16; 95% CI: 1.422-3.277), and personal history of psychiatric illness (OR: 3.41; 95% CI: 2.08-5.57) were associated with higher levels of anxiety. Access to sufficient personal protective equipment (OR: 0.45; 95% CI: 0.318-0.903) and age >40 years (OR: 0.53; 95% CI: 0.358-0.789) were associated with lower anxiety levels.

CONCLUSIONS

Anxious symptoms are common in the population of HCWs faced with patient care during the COVID-19 pandemic. Different strategies are required to intervene with subgroups at risk of developing higher levels of anxiety during the pandemic.

Factors influencing nurses' compliance related to the use of personal protective equipment during the COVID-19 pandemic: A descriptive cross-sectional study

AIM

To determine how nurses' experiences with the coronavirus disease (COVID-19) pandemic affected their knowledge, awareness, and compliance related to the use of personal protective equipment (PPE) during the COVID-19 pandemic in South Korea.

DESIGN

A descriptive cross-sectional study.

METHODS

A total of 247 nurses in South Korea participated in this study between May 10 and 19, 2023. An online self-report questionnaire was used to collect data on demographic and occupational characteristics, COVID-19 experience, knowledge, awareness, and compliance related to the use of PPE. Factors affecting compliance were analysed using hierarchical multiple linear regression.

RESULTS

Mean age of the nurses was 31.92, and 94.3% were women. Most had a bachelor's degree or higher and the mean clinical experience as a nurse was 6.45 years. Knowledge of the use of PPE was 8.45 out of 10, awareness was 3.52 out of 5, and compliance was 4.28 out of 5. Knowledge and awareness were correlated with compliance related to PPE use. Awareness (β = 0.234, p < 0.001), knowledge (β = 0.218, p < 0.001), experience caring for COVID-19 patients (β = 0.234, p = 0.004), optional fourth dose vaccine (β = 0.150, p = 0.017), clinical experience (β = 0.140, p = 0.022), and COVID-19 infection control education (β = 0.115, p = 0.037) were found to have a significant impact on compliance.

CONCLUSION

During the COVID-19 pandemic, nurses' knowledge and awareness of PPE use was a crucial factor in compliance. factors such as clinical experience, experience in caring for COVID-19 patients, optional vaccination, and completion of COVID-19 education also influenced compliance. We hope that these factors can provide a basis for developing training programs for nurses to respond to future emerging infectious diseases.

A scoping review to evaluate occupational controls and their effectiveness when handling engineered nanomaterials in workplaces

Research has shown that controlling worker exposure to engineered nanomaterials (ENMs) helps to reduce the exposure risk to employees in workplaces. This study aimed to identify the available evidence on the effectiveness of various control methods used in the workplace to reduce worker exposure to ENMs. The search was conducted in databases-Medline, OVID, Scopus, Science Direct, Web of Science, and Cochrane and the gray literature published from January 2010 to December 2022. The search keywords included ENM controls and their efficiency in workplace environments. Of the 152 studies retrieved, 22 were included in the review. The control measures in the review included (1) substitution controls; (2) engineering measures (i.e., isolation, direct source extraction, and wetting technologies); (3) personal protective equipment; and (4) administrative and work practices. The study results indicate that the above-mentioned control measures were effective in reducing ENM exposures. This information can be used to help employers choose the most effective controls for their workplaces.

The role of operative protocols for the prevention of occupational infectious risk on the crime scene

Background

Crime scenes are possible scenario of accidents for operators, despite those risks the are no operative protocols in literature. However, COVID-19 pandemic has affected in a positive manner the management of infectious risk, encouraging use of Personal protective equipment (PPE). The aim of the study is to deepen and examine the occupational risk of all health professionals involved in the analysis of the crime scene and biological material collection to develop an operational protocol that explains in detail all the strategies applicable to reduce it.

Materials and Methods

We conducted a review of the literature researching among the main databases, such as: PUBMED, EMBASE, COCHRANE introducing as keywords: crime scene, medico-legal investigations, occupational risk, infections. Subsequently, we developed an operational protocol that is currently applied during the activity of the Institute of Forensic Medicine "Magna Graecia" of Catanzaro.

Conclusion

The crime scene can show numerous dangers for operators, due to the presence of syringes, contaminated biological material or sharps or access to areas with poor hygienic and sanitary conditions. This paper shows various strategies that may be implemented to reduce the risk. The aim of this work is to focus on the occupational risk for operators by proposing an operative protocol showing in detail how to manage a crime scene by reducing the infectious risk for operators until the transfer of the body and the collected evidence to the morgue and to the laboratory.

Prevalence of Covid-19 infection among healthcare workers in Central Hospitals of Covid-19 vs non-Covid-19 hospitals in Khuzestan Province, Iran

BACKGROUND

Healthcare workers (HCWs) are at high risk of contracting Covid-19 due to their frontline roles and close interactions with infected patients. Understanding the prevalence of Covid-19 infection among HCWs and the factors contributing to it is crucial for informing mitigation strategies. However, the available data on Covid-19 infection rates among Iranian HCWs is limited.

OBJECTIVE

The primary objective of this study was to compare the prevalence of Covid-19 infection among HCWs working in hospitals dedicated to Covid-19 care versus HCWs in other non-Covid-19 hospitals in Khuzestan province, Iran. Additionally, the study aimed to identify potential risk factors associated with Covid-19 transmission and symptom severity in this population.

METHODS

This cohort study recruited 3,012 HCWs from 35 hospitals in Khuzestan province. Covid-19 diagnosis was made using RT-PCR testing, chest CT scans, and clinical examination.

RESULTS

Overall, 96% (n=2,918) of the 3,012 HCWs were infected with Covid-19. The prevalence was significantly higher among HCWs from Covid-19 hospitals (59.83%, n=1,746) compared to those from non-Covid-19 hospitals (5.75%, n=168). The capital city of Ahvaz had the highest proportion of Covid-19 cases at 28%.

CONCLUSIONS

HCWs, especially those working in hospitals dedicated to Covid-19 care, face a substantial risk of contracting the virus. The high infection rates observed may be attributed to factors like weakened immune systems, non-compliance with precautions, and delayed diagnosis. These findings underscore the critical need to strengthen infection control measures, improve access to personal protective equipment, and enhance surveillance of Covid-19 among frontline HCWs in Iran.

Challenges faced by older people with dementia during the COVID-19 pandemic as perceived by professionals: a qualitative study with interviews

BACKGROUND

Previous studies have highlighted a decline in the mental health of older adults over the course of the coronavirus disease 2019 (COVID-19) pandemic. Few studies have determined the possible causes of behavioural and psychological symptoms of dementia during COVID-19 in a comprehensive manner. We aimed to identify the challenges faced by older adults with dementia during the COVID-19 pandemic.

METHODS

This study adopted a qualitative approach to understanding the perceptions of healthcare professionals, such as regarding the negative effects of COVID-19 on the mental health of people with dementia. Between January and March 2022, the authors conducted individual in-depth interviews on how COVID-19 affected the stress levels, care, and self-determination of people with dementia. Qualitative data from the individual interviews were data cleansed to ensure the clarity and readability of the transcripts. The qualitative data were then analyzed by inductive manual coding using a qualitative content analysis approach. The grouping process involved reading and comparing individual labels to cluster similar labels into categories and inductively formulate themes.

RESULTS

Qualitative analysis extracted 61 different semantic units that were duplicated. Seven categories were inductively extracted using a grouping process. These were further integrated to extract the following four themes: fear of personal protective equipment (PPE), loneliness, dissatisfaction with behavioural restrictions and limitations of video calls, and family interference with service use.

DISCUSSION

People with dementia often faced mental distress during the pandemic owing to preventive measures against COVID-19, and a lack of awareness and understanding of such preventive measures worsened their distress. They experienced a severe sense of social isolation and loneliness. Findings also indicated that families tended to ignore the needs of people with dementia and their decisions and opinions regarding healthcare service use.

Cyclophosphamide exposure factors in family caregivers for pediatric cancer patients

The exposure of family caregivers to anticancer drugs for pediatric patients with malignancy is a potential health risk that needs to be minimized. We monitored the amount of cyclophosphamide (CPM) that had adhered to the undershirts of patients and the personal protective equipment (PPE) of family caregivers as well as the caregivers' urine levels of CPM within the first three days after the first and second courses of high-dose CPM therapy. Liquid chromatography/mass spectrometry (LC/MS/MS) detected >0.03 ng/ml of CPM in 26% (23/88) of urine samples from 8 of 11 (72.7%) patients' family caregivers, with a peak of 0.7 ng/ml from 24 to 48 h after administration. Since urine CPM concentrations in family caregivers varied after the first and second courses, the exposure risk factors were analyzed by scoring the PPE-wearing time index (caring minutes × PPE points from wearing masks, gloves, and/or gowns) and CPM adhesion of PPE items with the caring patterns of diaper change, washing body care, oral care, eating assistance, emotional support, and co-sleeping. The closest association was observed for CPM adhesion between oral care gloves and undershirts (correlation coefficient 0.67, p = 0.001). The mixed-effect model analysis indicated only a significant correlation between the PPE-wearing time index and emotional care (playing, cuddling, and physical contact) (p = 0.016). These results suggest that prolonged emotional support results in poor PPE protection, which increases the risk of exposure in family caregivers. Strict PPE care within 48 h after high-dose CPM controls the exposure to high-risk anticancer drugs in caregivers of pediatric patients.

Midwives' experiences with PPE during the COVID-19 pandemic: The Birth in the Time of COVID (BITTOC) study

BACKGROUND

The COVID-19 pandemic resulted in rapid changes aimed at reducing disease transmission in maternity services in Australia. An increase in personal protective equipment (PPE) in the clinical and community setting was a key strategy. There was variation in the type of PPE and when it was to be worn in clincial practice.

AIM

This paper reports on Australian midwives' experiences of PPE during the pandemic.

METHODS

This sequential mixed methods study was part of the Birth in the Time of COVID-19 (BITTOC 2020) study. Data were obtained from in-depth semi-structured interviews with midwives in 2020 followed by a national survey undertaken at two time points (2020 and 2021). Qualitative open-text survey responses and interview data were analysed using content analysis.

FINDINGS

16 midwives were interviewed and 687 midwives provided survey responses (2020 n = 477, 2021 n = 210). Whilst midwives largley understood the need for increased PPE, and were mainly happy with this, as it was protective, they reported a number of concerns. These included: inconsistency with PPE type, use, availability, quality, fit and policy; the impact of PPE on the physical and psychological comfort of midwives; and the barriers PPE use placed on communication and woman centred care. This at times resulted in midwives working outside of policy.

CONCLUSION

These findings highlight the need for future comprehensive pandemic preparedness that ensures policy and procedure recommendations are consistent and PPE is available, of approriate quality, and individually fitted in order to ensure that Australian maternity services are well placed to manage future pandemics.

Evaluation of inhalation risk during quarantine work with quaternary ammonium compounds-based disinfectant

Quarantine work is widely recognized as an indispensable endeavor in curbing the propagation of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Furthermore, the heavy workload places workers at a heightened risk of chemical exposure and respiratory damage. Consequently, it is paramount to systematically perform health risk assessments and meticulously oversee the work by wearing personal protective equipment to minimize these risks. To assess the inhalation exposure, this study examined data on disinfectant exposure from quarantine professional users who utilized disinfectants containing quaternary ammonium compounds. Through a survey of 6,199 cases conducted by 300 quarantine professional users who actively engaged in quarantine work, we assembled a database of exposure factors derived from their utilization of spray-type disinfectants for quarantine purposes. Based on these data, we formulated an inhalation exposure algorithm, which considers the time-weighted average (TWA) air concentrations. The test results demonstrated that the industrial-grade respirator mask could prevent a minimum of 68.3 % of particles, reducing respiratory exposure. Consequently, the hazard quotient (HQ) due to disinfectant exposure also decreased. This research is essential in safeguarding the safety and health of professional users engaged in quarantine-related tasks. By implementing strict measures like health risk assessments and personal protective equipment, individuals with quarantine experience can safely carry out their quarantine work. The results of this study are expected to serve as a framework for improving policies and regulations concerning quarantine work and safeguarding the health of professional users.

Quality of life and associated factors for community health workers in the context of the COVID-19 pandemic in northeastern Brazil

In this study, we evaluated the quality of life (QoL) and associated factors of community health workers (CHWs) in different urban settings as a contributor to the preparedness of Brazilian primary care for future sanitary emergencies. The sample included 1935 CHWs from 4 state capitals and 4 inland municipalities in northeastern Brazil. Information was collected on QoL (WHOQOL-BREF), work routines, sociodemographics, direct and indirect exposure to violence, general self-efficacy, social support (MSPSS), mental health (SRQ-20) and coronavirus anxiety. The data were subjected to multiple linear regression analysis (α = 5%). In the state capitals, the factors associated with loss of QoL were poor mental health, lack of training, uncertainty about occupational biosafety, and lack of adaptation of services to tend to patients diagnosed with COVID-19. Among the inland municipalities, the main factors were coronavirus anxiety, poor mental health, lack of adaptation of services, lack of training, and lack of personal protective equipment (PPE). A high MSPSS (family and friends) score and self-efficacy had positive impacts on QoL in both urban settings. Our results highlight the need for investment in permanent education, PPE, social support, and mental health care for CHWs.

Removal of Contaminated Personal Protective Equipment With and Without Supervision. A Randomized Crossover Simulation-Based Study

INTRODUCTION

Personal protective equipment (PPE) reduces the risk of pathogens reaching the skin and clothing of health care personnel. We hypothesize that doffing PPE following verbal instructions by a supervisor is more effective in reducing contamination compared with doffing without verbal instructions. Our primary aim was to determine contamination rates with and without supervised doffing. The secondary aim was to determine the number and localization of contaminated body sites and PPE removal times in both groups.

METHODS

Staff members of Bnai Zion Medical Center participated in this single-center, randomized simulation study (NCT05008627). Using a crossover design, all participants donned and doffed the PPE twice, once under guidance from a trained supervisor and then independently without supervision (group A), or vice versa (group B). Participants were randomized to either group A or B using a computer-generated random allocation sequence. The PPE was "contaminated" with Glo Germ on the thorax, shoulders, arms, hands, legs, and face shield. After doffing the PPE, the participant was examined under ultraviolet light to detect traces of contamination. The following variables were collected: contamination rates, the number and localization of contaminated body sites, and PPE doffing time.

RESULTS

Forty-nine staff members were included. In group A, the contamination rate was significantly lower (8% vs. 47%; χ 2 = 17.19; p < 0.001). The sites most frequently contaminated were the neck and hands. Mean PPE doffing time under verbal instructions was significantly longer [mean (SD): 183.98 (3.63) vs. 68.43 (12.75) seconds, P < 0.001] compared with unsupervised doffing.

CONCLUSIONS

In a simulated setting, PPE doffing following step-by-step verbal instructions from a trained supervisor reduces the rate of contamination but prolongs doffing time. These findings could have important implications for clinical practice and could further protect health care workers against contamination from emerging and high-consequence pathogens.

Exposure control measures proposed by different organizations: the curious case of nanomaterial-involved activities

Objectives. The unique properties of nanomaterials have turned them into an emerging threat for humans and the environment. This study therefore aimed to review exposure control measures proposed for nanomaterial-involved activities. Methods. This study is based on the published guidelines of different organizations on safe handling of nanomaterials. The search for documents was provided using the keywords 'Exposure controls', 'Good practices', 'Working safely', 'Safe practices', 'Handling safely', 'Safety guide' and 'Safety and health', combined with 'Nanomaterials', 'Nanotechnology' and 'Nanoparticles' on different databases and websites. Results. Thirty-one guidelines from 27 organizations were included. Most of the guidelines recommended engineering controls, administrative controls and personal protective equipment (PPE). Changing the physical form of nanomaterials or the process, using prevention through design (PtD) and using green chemistry principals were other suggestions to reduce exposure to nanomaterials. Conclusions. Considering the difficulty of implementation and case specificity of the solutions of the first two priorities of the hierarchy of controls (elimination and substitution), the emphasis of the guidelines on the next three priorities for controlling exposure to nanomaterials is understood. The type and method of using PPE and engineering controls should be resolved by referring to cutting-edge articles.

The cardinal rules: Principles of personal protective equipment for high-consequence infectious disease events

In recognition of an increasing number of high-consequence infectious disease events, a group of subject-matter experts identified core safety principles that can be applied across all donning and doffing protocols for personal protective equipment.

Protective face mask: an effective weapon against SARS-CoV-2 with controlled environmental pollution

Masks are face coverings that give protection from infectious agents, airborne pathogens, bacteria, viruses, surgical fog, dust, and other chemical hazards by acting as a barrier between the wearer and the environment. In the COVID-19 pandemic, this major personal protective equipment's became essential part of our daily life. The aim of this review is to analyze and discuss the different types of masks with their pros and cons, manufacturing procedures, evaluation criteria, and application with some of the sterilization process for reuse and smart mask. The review used a thorough examination of the literature to analyze the preventive effects of surgical, N95, smart mask, and potential environmental damage from those masks. Several studies and evidence were also examined to understand the efficiency of different mask on different environment. N95 respirators are capable of filtering out non-oil-based 95% air-born particles, and surgical masks act as a protective barrier between the wearer and the environment. The application of spoon bond and melt blown techniques in the fabrication process of those masks improves their protective nature and makes them lightweight and comfortable. But the high demand and low supply forced users to reuse and extend their use after sterilizations, even though those masks are recommended to be used once. Universal masking in the SARS-COV-2 pandemic increased the chance of environmental pollution, so the application of smart masks became essential because of their high protection power and self-sterilizing and reusing capabilities.

Evaluating the impact of different hard hats on the peripheral vision of construction workers

Construction safety is always an issue for construction workers. Hence, personal protective equipment plays a critical role in avoiding potential hazards on construction sites. Among these, hard hats protect against head contact with falling objects on construction sites. This study aims to examine the effects of hard hats with different peak lengths on the field of view at different angles in the upward part and to examine the effects of possible field of view losses caused by the hard hat on the reaction times of the workers. A questionnaire was designed and administered to the construction workers. Experiments were then conducted with a group of subjects to assess their peripheral vision level as well as reaction times. The study found that peripheral vision is affected by the peak size of hard hats. The study further revealed that there is a significant relationship between reaction times and hard hat peak size.

Quantitative microbial risk assessment (QMRA) of the work of manual pit emptiers, commonly known as bayakous

In Haiti, manual pit emptiers, known as bayakous, face significant health risks. They work by descending naked into latrine pits, exposing themselves to pathogens and contributing to environmental contamination. This study employs the quantitative microbial risk assessment (QMRA) method to evaluate the microbial risks associated with this practice, considering nine prevalent pathogens in Haiti. Three ingestion scenarios were developed: hand-to-mouth contact, ingestion while immersed in excreta, and a combination of both. A sensitivity analysis assessed the impact of input data on study outcomes. The results indicate a high probability of infection and illness during pit emptying operations annually for all scenarios and pathogens. Recommendations include adopting personal protective equipment (PPE) and using a manual Gulper waste pump to eliminate the need to descend directly into the pits, thereby reducing the risk of injury from sharp objects. The study proposes the establishment of intermediate disposal points approximately 5 km from collection sites to deter illegal dumping. National regulations and professionalization of the bayakou profession are suggested, along with awareness campaigns to promote PPE and Gulper pump usage. Addressing these issues is crucial for safeguarding the health of bayakou and public health in Haiti.

Under Armour - Use of personal protective equipment for simulated CPR of COVID-19 patients: an observational study

BACKGROUND

Personal protective equipment (PPE) protects healthcare workers and patients. Data on guideline compliance on how to dress (donning) or remove (doffing) PPE and the assistance among multiple participants (buddying) are limited. This study assesses the quality of donning, doffing, and buddying of PPE in a simulated medical emergency.

METHOD

Physicians handling a simulated cardiac arrest of a COVID-19 patient. Adjacent to the victim, PPE was available. The appropriateness of PPE choice was assessed by using video recordings, with each individual participant being analyzed from the beginning of the simulation scenario from two perspectives regarding the selection of items during donning and doffing, hygiene aspects, time, and team support (buddying). The primary outcome was the number of participants being appropriately protected, defined as both wearing (a) all PPE items provided, and (b) all PPE items correctly at the time of first patient contact (FPC). Secondary outcomes included the timing of participants being appropriately protected. Statistical analysis was performed using SPSS (version 28). Mann-Whitney test, chi-square test, and linear regression analysis were performed as appropriate.

RESULTS

At first patient contact 21% (91/437) were correctly protected. One or more incorrect PPE items were found in 4% (19/437), whereas 61% (265/437) wore one or more PPE items incorrectly. In 14% (62/437), one or more PPE items were missing. The time interval between donning start and FPC was 66 (55-78) sec. Time to FPC was longer in correctly than in incorrectly protected participants 77 (66-87) vs. 64 (54-75) sec; p < 0.001) and decreased by 7 ± 2 s per PPE item omitted (P = 0.002). Correct doffing was observed in 192/345 (56%), while buddying occurred in 120 participants (27%), indicating that they either assisted other participants in some manner (verbally or physically) or received assistance themselves.

CONCLUSIONS

Our findings imply a need for education in correct and timely PPE donning and doffing. Donning PPE as intended delayed FPC. This and the influence of buddying needs further investigation (German study register number DRKS00023184).

Association between characteristics of employing healthcare facilities and healthcare worker infection rates and psychosocial experiences during the COVID-19 pandemic

BACKGROUND

Healthcare facility characteristics, such as ownership, size, and location, have been associated with patient outcomes. However, it is not known whether the outcomes of healthcare workers are associated with the characteristics of their employing healthcare facilities, particularly during the COVID-19 pandemic.

METHODS

This was an analysis of a nationwide registry of healthcare workers (the Healthcare Worker Exposure Response and Outcomes (HERO) registry). Participants were surveyed on their personal, employment, and medical characteristics, as well as our primary study outcomes of COVID-19 infection, access to personal protective equipment, and burnout. Participants from healthcare sites with at least ten respondents were included, and these sites were linked to American Hospital Association data to extract information about sites, including number of beds, teaching status, urban/rural location, and for-profit status. Generalized estimating equations were used to estimate linear regression models for the unadjusted and adjusted associations between healthcare facility characteristics and outcomes.

RESULTS

A total of 8,941 healthcare workers from 97 clinical sites were included in the study. After adjustment for participant demographics, healthcare role, and medical comorbidities, facility for-profit status was associated with greater odds of COVID-19 diagnosis (aOR 1.76, 95% CI 1.02-3.03, p = .042). Micropolitan location was associated with decreased odds of COVID-19 infection after adjustment (aOR = 0.42, 95% CI 0.24, 0.71, p = .002. For-profit facility status was associated with decreased odds of burnout after adjustment (aOR = 0.53, 95% CI 0.29-0.98), p = .044).

CONCLUSIONS

For-profit status of employing healthcare facilities was associated with greater odds of COVID-19 diagnosis but decreased odds of burnout after adjustment for demographics, healthcare role, and medical comorbidities. Future research to understand the relationship between facility ownership status and healthcare outcomes is needed to promote wellbeing in the healthcare workforce.

TRIAL REGISTRATION

The registry was prospectively registered: ClinicalTrials.gov Identifier (trial registration number) NCT04342806, submitted April 8, 2020.

Controlling COVID-19 outbreaks in the correctional setting: A mathematical modelling study

Correctional centres (termed here 'prisons') are at high risk of COVID-19 and have featured major outbreaks worldwide. Inevitable close contacts, frequent inmate movements, and a disproportionate burden of co-morbidities mean these environments need to be prioritised in any public health response to respiratory pathogens such as COVID-19. We developed an individual-based SARS-CoV-2 transmission model for the prison system in New South Wales, Australia - incorporating all 33 correctional centres, 13,458 inmates, 578 healthcare and 6,909 custodial staff. Potential COVID-19 disease outbreaks were assessed under various mitigation strategies, including quarantine on entry, isolation of cases, rapid antigen testing of staff, as well as immunisation.Without control measures, the model projected a peak of 472 new infections daily by day 35 across the prison system, with all inmates infected by day 120. The most effective individual mitigation strategies were high immunisation coverage and prompt lockdown of centres with infected inmates which reduced outbreak size by 62-73%. Other than immunisation, the combination of quarantine of inmates at entry, isolation of proven or suspected cases, and widespread use of personal protective equipment by staff and inmates was the most effective strategy. High immunisation coverage mitigates the spread of COVID-19 within and between correctional settings but is insufficient alone. Maintaining quarantine and isolation, along with high immunisation levels, will allow correctional systems to function with a low risk of outbreaks. These results have informed public health policy for respiratory pathogens in Australian correctional systems.