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Ammendolia J, Saturno J, Brooks AL, Jacobs S, Jambeck JR. An emerging source of plastic pollution: Environmental presence of plastic personal protective equipment (PPE) debris related to COVID-19 in a metropolitan city. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 269:116160. [PMID: 33316501 PMCID: PMC7833877 DOI: 10.1016/j.envpol.2020.116160] [Citation(s) in RCA: 157] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/07/2020] [Accepted: 11/24/2020] [Indexed: 05/19/2023]
Abstract
The COVID-19 pandemic has resulted in an unprecedented surge of production, consumption, and disposal of personal protective equipment (PPE) including face masks, disposable gloves, and disinfectant wipes, which are often made of single use plastic. Widespread public use of these items has imposed pressure on municipalities to properly collect and dispose of potentially infectious PPE. There has been a lack of structured monitoring efforts to quantify the emerging trend of improperly disposed of PPE debris. In this study, we present a baseline monitoring survey to describe the spatial distribution of PPE debris during the COVID-19 pandemic from the metropolitan city of Toronto, Canada. Our objectives were to: (1) quantify PPE debris types among surveyed areas and; (2) identify PPE debris densities and accumulation of surveyed areas. A total of 1306 PPE debris items were documented, with the majority being disposable gloves (44%), followed by face masks (31%), and disinfecting wipes (25%). Of the face masks, 97% were designed for single use while only 3% were reusable. Of the surveyed locations, the highest daily average densities of PPE debris were recorded in the large and medium-sized grocery store parking lots and the hospital district (0.00475 items/m2, 0.00160 items/m2, and 0.00133 items/m2 respectively). The two surveyed residential areas had the following highest PPE densities (0.00029 items/m2 and 0.00027 items/m2), while the recreational trail had the lowest densities (0.00020 items/m2). Assuming a business-as-usual accumulation, an estimated 14,298 PPE items will be leaked as debris in just the surveyed areas annually. To facilitate proper disposal of PPE debris by the public we recommend development of municipal efforts to improve PPE collection methods that are informed by the described PPE waste pathways.
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Affiliation(s)
- Justine Ammendolia
- Canadian Ocean Literacy Coalition, Canadian Museum of Nature, 1740 Pink Road Natural Heritage Campus, Gatineau, Quebec, J9J 3N7, Canada.
| | - Jacquelyn Saturno
- School of Fisheries, Fisheries and Marine Institute of Memorial University, 155 Ridge Road, St. John's, Newfoundland and Labrador, A1C 5R3, Canada
| | - Amy L Brooks
- College of Engineering, New Materials Institute, Center for Circular Materials Management, University of Georgia, Riverbend Research Lab South, 220 Riverbend Road, Athens, GA, 30602, United States
| | - Shoshanah Jacobs
- Department of Integrative Biology, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada
| | - Jenna R Jambeck
- College of Engineering, New Materials Institute, Center for Circular Materials Management, University of Georgia, Riverbend Research Lab South, 220 Riverbend Road, Athens, GA, 30602, United States
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Andrews AS, Powers JR, Cichowicz JK, Coffey CC, Fries ML, Yorio PL, D'Alessandro MM. Respiratory Protection in a Time of Crisis: NIOSH Testing of International Respiratory Protective Devices for Emergency Use. Health Secur 2021; 19:379-385. [PMID: 33434096 PMCID: PMC8906491 DOI: 10.1089/hs.2020.0173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
National Institute for Occupational Safety and Health (NIOSH)-approved
respirators are required by the Occupational Safety and Health Administration
(OSHA) when personal respiratory protection is used in US occupational settings.
During the COVID-19 pandemic, the demand for NIOSH-approved N95 filtering
facepiece respirators overwhelmed the available supply. To supplement the
national inventory of N95 respirators, contingency and crisis capacity
strategies were implemented and incorporated a component that endorsed the use
of non-NIOSH-approved respiratory protective devices that conformed to select
international standards. The development and execution of this strategy required
the collaborative effort of numerous agencies. The Food and Drug Administration
temporarily authorized non-NIOSH-approved international respiratory protective
devices through an emergency use authorization, OSHA relaxed their enforcement
guidance concerning their use in US workplaces, and NIOSH initiated a
supplemental performance assessment process to verify the quality of
international devices. NIOSH testing revealed that many of the
non-NIOSH-approved respiratory protective devices had filtration efficiencies
below 95% and substantial inconsistencies in filtration performance. This
article reports the results of the NIOSH testing to date and discusses how it
has contributed to continuous improvement of the crisis strategy of temporarily
permitting the use of non-NIOSH-approved respirators in US occupational settings
during the COVID-19 pandemic.
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Affiliation(s)
- Angela S Andrews
- Angela S. Andrews, MS, is a Physical Scientist; John R. Powers, Jr. is a Supervisory General Engineer; and Christopher C. Coffey, PhD, is the former Associate Director for Science (retired); all at the National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV. Jaclyn K. Cichowicz, MA, and Marisa L. Fries are Health Communications Specialists; Patrick L. Yorio, PhD, is a Health Statistician; and Maryann M. D'Alessandro, PhD, is Director; all at the NPPTL, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of NIOSH or CDC. Product and company names are provided for identification purposes only and do not imply endorsement by the CDC
| | - John R Powers
- Angela S. Andrews, MS, is a Physical Scientist; John R. Powers, Jr. is a Supervisory General Engineer; and Christopher C. Coffey, PhD, is the former Associate Director for Science (retired); all at the National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV. Jaclyn K. Cichowicz, MA, and Marisa L. Fries are Health Communications Specialists; Patrick L. Yorio, PhD, is a Health Statistician; and Maryann M. D'Alessandro, PhD, is Director; all at the NPPTL, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of NIOSH or CDC. Product and company names are provided for identification purposes only and do not imply endorsement by the CDC
| | - Jaclyn K Cichowicz
- Angela S. Andrews, MS, is a Physical Scientist; John R. Powers, Jr. is a Supervisory General Engineer; and Christopher C. Coffey, PhD, is the former Associate Director for Science (retired); all at the National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV. Jaclyn K. Cichowicz, MA, and Marisa L. Fries are Health Communications Specialists; Patrick L. Yorio, PhD, is a Health Statistician; and Maryann M. D'Alessandro, PhD, is Director; all at the NPPTL, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of NIOSH or CDC. Product and company names are provided for identification purposes only and do not imply endorsement by the CDC
| | - Christopher C Coffey
- Angela S. Andrews, MS, is a Physical Scientist; John R. Powers, Jr. is a Supervisory General Engineer; and Christopher C. Coffey, PhD, is the former Associate Director for Science (retired); all at the National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV. Jaclyn K. Cichowicz, MA, and Marisa L. Fries are Health Communications Specialists; Patrick L. Yorio, PhD, is a Health Statistician; and Maryann M. D'Alessandro, PhD, is Director; all at the NPPTL, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of NIOSH or CDC. Product and company names are provided for identification purposes only and do not imply endorsement by the CDC
| | - Marisa L Fries
- Angela S. Andrews, MS, is a Physical Scientist; John R. Powers, Jr. is a Supervisory General Engineer; and Christopher C. Coffey, PhD, is the former Associate Director for Science (retired); all at the National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV. Jaclyn K. Cichowicz, MA, and Marisa L. Fries are Health Communications Specialists; Patrick L. Yorio, PhD, is a Health Statistician; and Maryann M. D'Alessandro, PhD, is Director; all at the NPPTL, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of NIOSH or CDC. Product and company names are provided for identification purposes only and do not imply endorsement by the CDC
| | - Patrick L Yorio
- Angela S. Andrews, MS, is a Physical Scientist; John R. Powers, Jr. is a Supervisory General Engineer; and Christopher C. Coffey, PhD, is the former Associate Director for Science (retired); all at the National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV. Jaclyn K. Cichowicz, MA, and Marisa L. Fries are Health Communications Specialists; Patrick L. Yorio, PhD, is a Health Statistician; and Maryann M. D'Alessandro, PhD, is Director; all at the NPPTL, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of NIOSH or CDC. Product and company names are provided for identification purposes only and do not imply endorsement by the CDC
| | - Maryann M D'Alessandro
- Angela S. Andrews, MS, is a Physical Scientist; John R. Powers, Jr. is a Supervisory General Engineer; and Christopher C. Coffey, PhD, is the former Associate Director for Science (retired); all at the National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV. Jaclyn K. Cichowicz, MA, and Marisa L. Fries are Health Communications Specialists; Patrick L. Yorio, PhD, is a Health Statistician; and Maryann M. D'Alessandro, PhD, is Director; all at the NPPTL, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of NIOSH or CDC. Product and company names are provided for identification purposes only and do not imply endorsement by the CDC
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Galán MI, Velasco M, Casas ML, Goyanes MJ, Rodríguez-Caravaca G, Losa-García JE, Noguera C, Castilla V. Hospital-Wide SARS-CoV-2 seroprevalence in health care workers in a Spanish teaching hospital. Enferm Infecc Microbiol Clin 2020; 40:S0213-005X(20)30418-3. [PMID: 33485676 PMCID: PMC7833995 DOI: 10.1016/j.eimc.2020.11.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Hospital-wide SARS-CoV-2 seroprevalence is rarely explored and can identify areas of unexpected risk. We determined the seroprevalence against SARS-CoV-2 in all health care workers (HCW) at a hospital. METHODS Cross-sectional study (14-27/04/2020). We determined SARS-CoV-2 IgG by ELISA in all HCW including external workers of a teaching hospital in Madrid. They were classified by professional category, working area, and risk for SARS-CoV-2 exposure. RESULTS Among 2919 HCW, 2590 (88,7%) were evaluated. The mean age was 43.8 years (SD 11.1), and 73.9% were females. Globally, 818 (31.6%) workers were IgG positive with no differences for age, sex or previous diseases. Of these, 48.5% did not report previous symptoms. Seropositivity was more frequent in high- (33.1%) and medium- (33.8%) than in low-risk areas (25.8%, p=0.007), but not for hospitalization areas attending COVID-19 and non-COVID-19 patients (35.5 vs 38.3% p>0.05). HWC with a previous SARS-CoV2 PCR-positive test were IgG seropositive in 90.8%. By multivariate logistic regression analysis seropositivity was significantly associated with being physicians (OR 2.37, CI95% 1.61-3.49), nurses (OR 1.67, CI95% 1.14-2.46), nurse assistants (OR 1.84, CI95% 1.24-2.73), HCW working at COVID-19 hospitalization areas (OR 1.71, CI95% 1.22-2.40), non-COVID-19 hospitalization areas (OR 1.88, CI95% 1.30-2.73), and at the Emergency Room (OR 1.51, CI95% 1.01-2.27). CONCLUSIONS Seroprevalence uncovered a high rate of infection previously unnoticed among HCW. Patients not suspected of having COVID-19 as well as asymptomatic HCW may be a relevant source for nosocomial SARS-CoV-2 transmission.
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Affiliation(s)
- Mª Isabel Galán
- Occupational Health Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - María Velasco
- Infectious Diseases and Research Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
| | - Mª Luisa Casas
- Laboratory Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Mª José Goyanes
- Microbiology Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Juan E Losa-García
- Preventive Medicine Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Carmen Noguera
- Nurse Subdirector, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Virgilio Castilla
- Medical Director, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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Abulebda K, Ahmed RA, Auerbach MA, Bona AM, Falvo LE, Hughes PG, Gross IT, Sarmiento EJ, Barach PR. National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic. World J Crit Care Med 2020; 9:74-87. [PMID: 33384950 PMCID: PMC7754533 DOI: 10.5492/wjccm.v9.i5.74] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/04/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease pandemic caught many pediatric hospitals unprepared and has forced pediatric healthcare systems to scramble as they examine and plan for the optimal allocation of medical resources for the highest priority patients. There is limited data describing pediatric intensive care unit (PICU) preparedness and their health worker protections.
AIM To describe the current coronavirus disease 2019 (COVID-19) preparedness efforts among a set of PICUs within a simulation-based network nationwide.
METHODS A cross-sectional multi-center national survey of PICU medical director(s) from children’s hospitals across the United States. The questionnaire was developed and reviewed by physicians with expertise in pediatric critical care, disaster readiness, human factors, and survey development. Thirty-five children’s hospitals were identified for recruitment through a long-established national research network. The questions focused on six themes: (1) PICU and medical director demographics; (2) Pediatric patient flow during the pandemic; (3) Changes to the staffing models related to the pandemic; (4) Use of personal protective equipment (PPE); (5) Changes in clinical practice and innovations; and (6) Current modalities of training including simulation.
RESULTS We report on survey responses from 22 of 35 PICUs (63%). The majority of PICUs were located within children’s hospitals (87%). All PICUs cared for pediatric patients with COVID-19 at the time of the survey. The majority of PICUs (83.4%) witnessed decreases in non-COVID-19 patients, 43% had COVID-19 dedicated units, and 74.6% pivoted to accept adult COVID-19 patients. All PICUs implemented changes to their staffing models with the most common changes being changes in COVID-19 patient room assignment in 50% of surveyed PICUs and introducing remote patient monitoring in 36% of the PICU units. Ninety-five percent of PICUs conducted training for donning and doffing of enhanced PPE. Even 6 months into the pandemic, one-third of PICUs across the United States reported shortages in PPE. The most common training formats for PPE were hands-on training (73%) and video-based content (82%). The most common concerns related to COVID-19 practice were changes in clinical protocols and guidelines (50%). The majority of PICUs implemented significant changes in their airway management (82%) and cardiac arrest management protocols in COVID-19 patients (68%). Simulation-based training was the most commonly utilized training modality (82%), whereas team training (73%) and team dynamics (77%) were the most common training objectives.
CONCLUSIONS A substantial proportion of surveyed PICUs reported on large changes in their preparedness and training efforts before and during the pandemic. PICUs implemented broad strategies including modifications to staffing, PPE usage, workflow, and clinical practice, while using simulation as the preferred training modality. Further research is needed to advance the level of preparedness, support staff assuredness, and support deep learning about which preparedness actions were effective and what lessons are needed to improve PICU care and staff protection for the next COVID-19 patient waves.
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Affiliation(s)
- Kamal Abulebda
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, United States
| | - Rami A Ahmed
- Department of Emergency Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, United States
| | - Marc A Auerbach
- Department of Pediatrics, Division of Pediatrics Emergency Medicine, Yale University School of Medicine, New Haven, CT 06504, United States
| | - Anna M Bona
- Department of Emergency Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, United States
| | - Lauren E Falvo
- Department of Emergency Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, United States
| | - Patrick G Hughes
- Department of Integrated Medical Science, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Isabel T Gross
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT 06504, United States
| | - Elisa J Sarmiento
- Department of Emergency Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, United States
| | - Paul R Barach
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48202, Jefferson College of Population Health, Philadelphia, PA, 19107, United States
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Cohen J, Rodgers YVDM. Contributing factors to personal protective equipment shortages during the COVID-19 pandemic. Prev Med 2020; 141:106263. [PMID: 33017601 PMCID: PMC7531934 DOI: 10.1016/j.ypmed.2020.106263] [Citation(s) in RCA: 240] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 01/01/2023]
Abstract
This study investigates the forces that contributed to severe shortages in personal protective equipment in the US during the COVID-19 crisis. Problems from a dysfunctional costing model in hospital operating systems were magnified by a very large demand shock triggered by acute need in healthcare and panicked marketplace behavior that depleted domestic PPE inventories. The lack of effective action on the part of the federal government to maintain and distribute domestic inventories, as well as severe disruptions to the PPE global supply chain, amplified the problem. Analysis of trade data shows that the US is the world's largest importer of face masks, eye protection, and medical gloves, making it highly vulnerable to disruptions in exports of medical supplies. We conclude that market prices are not appropriate mechanisms for rationing inputs to health because health is a public good. Removing the profit motive for purchasing PPE in hospital costing models, strengthening government capacity to maintain and distribute stockpiles, developing and enforcing regulations, and pursuing strategic industrial policy to reduce US dependence on imported PPE will help to better protect healthcare workers with adequate supplies of PPE.
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Affiliation(s)
- Jennifer Cohen
- Department of Global and Intercultural Studies, Miami University, 501 E. High St. Oxford, OH 45056, USA; Ezintsha, Wits Reproductive Health and HIV Institute, Department of Medicine, Faculty of Health Sciences, 32 Princess of Wales Terr., Sunnyside Office Park, Block D, Floor 5, University of the Witwatersrand, Johannesburg 2193, South Africa.
| | - Yana van der Meulen Rodgers
- Department of Labor Studies & Employment Relations, and Department of Women's, Gender, & Sexuality Studies, Rutgers University, 94 Rockafeller Road, Piscataway, NJ 08854, USA
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O'Hearn K, Gertsman S, Webster R, Tsampalieros A, Ng R, Gibson J, Sampson M, Sikora L, McNally JD. Efficacy and safety of disinfectants for decontamination of N95 and SN95 filtering facepiece respirators: a systematic review. J Hosp Infect 2020; 106:504-521. [PMID: 32800824 PMCID: PMC7423630 DOI: 10.1016/j.jhin.2020.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/06/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Decontaminating and reusing filtering facepiece respirators (FFRs) for healthcare workers is a potential solution to address inadequate FFR supply during a global pandemic. AIM The objective of this review was to synthesize existing data on the effectiveness and safety of using chemical disinfectants to decontaminate N95 FFRs. METHODS A systematic review was conducted on disinfectants to decontaminate N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined study eligibility and extracted predefined data fields. Original research reporting on N95 FFR function, decontamination, safety, or FFR fit following decontamination with a disinfectant was included. FINDINGS AND CONCLUSION A single cycle of vaporized hydrogen peroxide (H2O2) successfully removes viral pathogens without affecting airflow resistance or fit, and maintains an initial filter penetration of <5%, with little change in FFR appearance. Residual hydrogen peroxide levels following decontamination were within safe limits. More than one decontamination cycle of vaporized H2O2 may be possible but further information is required on how multiple cycles would affect FFR fit in a real-world setting before the upper limit can be established. Although immersion in liquid H2O2 does not appear to adversely affect FFR function, there is no available data on its ability to remove infectious pathogens from FFRs or its impact on FFR fit. Sodium hypochlorite, ethanol, isopropyl alcohol, and ethylene oxide are not recommended due to safety concerns or negative effects on FFR function.
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Affiliation(s)
- K O'Hearn
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
| | - S Gertsman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - R Webster
- Clinical Research Unit, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - A Tsampalieros
- Clinical Research Unit, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - R Ng
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - J Gibson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - M Sampson
- Library Services, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - L Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - J D McNally
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
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57
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Microwave- and heat-based decontamination of N95 filtering facepiece respirators: a systematic review. J Hosp Infect 2020; 106:536-553. [PMID: 32841704 PMCID: PMC7443086 DOI: 10.1016/j.jhin.2020.08.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND In pandemics such as COVID-19, shortages of personal protective equipment are common. One solution may be to decontaminate equipment such as facemasks for reuse. AIM To collect and synthesize existing information on decontamination of N95 filtering facepiece respirators (FFRs) using microwave and heat-based treatments, with special attention to impacts on mask function (aerosol penetration, airflow resistance), fit, and physical traits. METHODS A systematic review (PROSPERO CRD42020177036) of literature available from Medline, Embase, Global Health, and other sources was conducted. Records were screened independently by two reviewers, and data was extracted from studies that reported on effects of microwave- or heat-based decontamination on N95 FFR performance, fit, physical traits, and/or reductions in microbial load. FINDINGS Thirteen studies were included that used dry/moist microwave irradiation, heat, or autoclaving. All treatment types reduced pathogen load by a log10 reduction factor of at least three when applied for sufficient duration (>30 s microwave, >60 min dry heat), with most studies assessing viral pathogens. Mask function (aerosol penetration <5% and airflow resistance <25 mmH2O) was preserved after all treatments except autoclaving. Fit was maintained for most N95 models, though all treatment types caused observable physical damage to at least one model. CONCLUSIONS Microwave irradiation and heat may be safe and effective viral decontamination options for N95 FFR reuse during critical shortages. The evidence does not support autoclaving or high-heat (>90°C) approaches. Physical degradation may be an issue for certain mask models, and more real-world evidence on fit is needed.
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Dalla S, Shinde R, Ayres J, Waller S, Nachtigal J. 3D-printed snorkel mask adapter for failed N95 fit tests and personal protective equipment shortages. JOURNAL OF 3D PRINTING IN MEDICINE 2020. [PMCID: PMC7885525 DOI: 10.2217/3dp-2020-0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Personal protective equipment (PPE) shortages persist amidst increasing COVID-19 caseloads. These shortages encouraged some to pursue 3D printing to produce stopgap N95 alternatives. The design presented is an adapter for a commercially available snorkel mask to serve as a full-face respirator, used in dire PPE shortages or in individuals who failed fit testing. Masks were fit tested at The University of Kansas Health System in Kansas City, KS. The mask was fit tested on 22 individuals who previously failed fit testing, and all passed qualitative fit testing with the snorkel mask, adapter and viral filter apparatus. The authors endorse this design as a stopgap measure, proven to be effective in situations of dire PPE shortage or for individuals who have failed fit testing with conventional PPE.
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Affiliation(s)
- Shiv Dalla
- University of Kansas School of Medicine, Kansas City, KS 66160, USA
| | | | - Jack Ayres
- University of Kansas School of Medicine, Kansas City, KS 66160, USA
| | - Stephen Waller
- University of Kansas School of Medicine, Kansas City, KS 66160, USA
| | - Jay Nachtigal
- University of Kansas School of Medicine, Kansas City, KS 66160, USA
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Availability, Use, and Satisfaction of Personal Protective Equipment Among Healthcare Workers: A Cross-Sectional Assessment of Low- and Middle-Income Countries. J Occup Environ Med 2020; 62:e657-e664. [PMID: 32956236 DOI: 10.1097/jom.0000000000002028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the discrepancy among and within low- and middle-income countries (LMICs) regarding PPE availability, use, and satisfaction. METHODS The study population consisted of healthcare workers from LMICs who partook in the questionnaire survey from March 1, 2020, until April 15, 2020. RESULTS In the bivariate analysis, gender (P = 0.05), HCWs (P < 0.01), and level of care (P < 0.01) were associated with the public or private sector (P < 0.05). Using multivariate analysis, PPE factors were associated with the health sector (p < 0.05). The multivariate logistic regression model determined a Pearson's χ value of 706.736 (df = 726, P = -0.689) and a c-statistic of 0.592, indicating a good model. CONCLUSION In LMICs, huge discrepancies are present in PPE provision to HCWs, especially among the public healthcare sectors. Efforts at national and international levels ought to be addressed to protect frontline HCWs at higher risk of contracting COVID-19.
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60
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Zorko D, Gertsman S, O'Hearn K, Timmerman N, Ambu-Ali N, Dinh T, Sampson M, Sikora L, McNally J, Choong K. Decontamination interventions for the reuse of surgical mask personal protective equipment: a systematic review. J Hosp Infect 2020; 106:283-294. [PMID: 32653432 PMCID: PMC7347478 DOI: 10.1016/j.jhin.2020.07.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/06/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND The high demand for personal protective equipment during the novel coronavirus outbreak has prompted the need to develop strategies to conserve supply. Little is known regarding decontamination interventions to allow for surgical mask reuse. AIM To identify and synthesize data from original research evaluating interventions to decontaminate surgical masks for the purpose of reuse. METHODS MEDLINE, Embase, CENTRAL, Global Health, the WHO COVID-19 database, Google Scholar, DisasterLit, preprint servers, and prominent journals from inception to April 8th, 2020, were searched for prospective original research on decontamination interventions for surgical masks. Citation screening was conducted independently in duplicate. Study characteristics, interventions, and outcomes were extracted from included studies by two independent reviewers. Outcomes of interest included impact of decontamination interventions on surgical mask performance and germicidal effects. FINDINGS Seven studies met eligibility criteria: one evaluated the effects of heat and chemical interventions applied after mask use on mask performance, and six evaluated interventions applied prior to mask use to enhance antimicrobial properties and/or mask performance. Mask performance and germicidal effects were evaluated with heterogeneous test conditions. Safety outcomes were infrequently evaluated. Mask performance was best preserved with dry heat decontamination. Good germicidal effects were observed in salt-, N-halamine-, and nanoparticle-coated masks. CONCLUSION There is limited evidence on the safety or efficacy of surgical mask decontamination. Given the heterogeneous methods used in studies to date, we are unable to draw conclusions on the most efficacious and safe intervention for decontaminating surgical masks.
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Affiliation(s)
- D.J. Zorko
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - S. Gertsman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - K. O'Hearn
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - N. Timmerman
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - N. Ambu-Ali
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - T. Dinh
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - M. Sampson
- Library Services, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - L. Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - J.D. McNally
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada,Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - K. Choong
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada,Department of Critical Care, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Corresponding author. Address: Department of Pediatric Critical Care, McMaster University, Room 3E20, 1280 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada. Tel.: +1 905 521 2100x76651
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Huang D, Shu W, Li M, Ma J, Li Z, Gong J, Khattab NM, Vermund SH, Hu Y. Social Media Survey and Web Posting Assessment of the COVID-19 Response in China: Health Worker Attitudes Toward Preparedness and Personal Protective Equipment Shortages. Open Forum Infect Dis 2020; 7:ofaa400. [PMID: 33088845 PMCID: PMC7499695 DOI: 10.1093/ofid/ofaa400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/26/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Understanding health worker awareness, attitudes, and self-confidence in the workplace can inform local and global responses toward emerging infectious threats, like the coronavirus disease 2019 (COVID-19) pandemic. Availability of accessible personal protective equipment (PPE) is vital to effective care and prevention. METHODS We conducted a cross-sectional survey from February 24 to 28, 2020, to assess COVID-19 preparedness among health workers. In addition, we assessed trends from search engine web crawling and text-mining data trending over the Sina Weibo platform from January 1 to March 3, 2020. Data were abstracted on Chinese outbreak preparedness. RESULTS In the survey, we engaged 6350 persons, of whom 1065 agreed to participate, and after an eligibility logic check, 1052 participated (16.6%). We accessed 412 internet posts as to PPE availability. Health workers who were satisfied with current preparedness to address COVID-19 were more likely to be female, to obtain knowledge about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak from government organizations, and to consider their hospital prepared for outbreak management. Health workers with more confidence in their abilities to respond were those with more faith in their institution's response capacities. Elements of readiness included having airborne infection isolation rooms, visitor control procedures, and training in precautions and PPE use. Both survey and web post assessments suggested that health workers in need were unable to reliably obtain PPE. CONCLUSIONS Health workers' self-confidence depends on perceived institutional readiness. Failure to maintain available PPE inventory for emerging infectious diseases preparedness suggests a failure to learn key lessons from the 2003-2004 SARS outbreak in China.
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Affiliation(s)
- Dayong Huang
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wen Shu
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China
| | - Menglong Li
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China
| | - Juntao Ma
- Yisheng Yishi Medical (Beijing) Technology Co., Ltd, Beijing, China
| | - Ziang Li
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China
| | - JiaJian Gong
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China
| | - Nourhan M Khattab
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China
| | - Sten H Vermund
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Yifei Hu
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China
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Zorko DJ, Gertsman S, O'Hearn K, Timmerman N, Ambu-Ali N, Dinh T, Sampson M, Sikora L, McNally JD, Choong K. Decontamination interventions for the reuse of surgical mask personal protective equipment: a systematic review. J Hosp Infect 2020; 106:283-294. [PMID: 32653432 DOI: 10.31219/osf.io/z7exu] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/06/2020] [Indexed: 05/29/2023]
Abstract
BACKGROUND The high demand for personal protective equipment during the novel coronavirus outbreak has prompted the need to develop strategies to conserve supply. Little is known regarding decontamination interventions to allow for surgical mask reuse. AIM To identify and synthesize data from original research evaluating interventions to decontaminate surgical masks for the purpose of reuse. METHODS MEDLINE, Embase, CENTRAL, Global Health, the WHO COVID-19 database, Google Scholar, DisasterLit, preprint servers, and prominent journals from inception to April 8th, 2020, were searched for prospective original research on decontamination interventions for surgical masks. Citation screening was conducted independently in duplicate. Study characteristics, interventions, and outcomes were extracted from included studies by two independent reviewers. Outcomes of interest included impact of decontamination interventions on surgical mask performance and germicidal effects. FINDINGS Seven studies met eligibility criteria: one evaluated the effects of heat and chemical interventions applied after mask use on mask performance, and six evaluated interventions applied prior to mask use to enhance antimicrobial properties and/or mask performance. Mask performance and germicidal effects were evaluated with heterogeneous test conditions. Safety outcomes were infrequently evaluated. Mask performance was best preserved with dry heat decontamination. Good germicidal effects were observed in salt-, N-halamine-, and nanoparticle-coated masks. CONCLUSION There is limited evidence on the safety or efficacy of surgical mask decontamination. Given the heterogeneous methods used in studies to date, we are unable to draw conclusions on the most efficacious and safe intervention for decontaminating surgical masks.
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Affiliation(s)
- D J Zorko
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - S Gertsman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - K O'Hearn
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - N Timmerman
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - N Ambu-Ali
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - T Dinh
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - M Sampson
- Library Services, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - L Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - J D McNally
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - K Choong
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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A Qualitative Study of Barriers to Personal Protective Equipment Use among Laundry Workers in Government Hospitals, Hawassa, Ethiopia. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2020; 2020:5146786. [PMID: 33029156 PMCID: PMC7528124 DOI: 10.1155/2020/5146786] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/29/2020] [Accepted: 09/11/2020] [Indexed: 11/23/2022]
Abstract
Background The need to reduce the transmission of infectious diseases makes the use of personal protective equipment and safety medical devices compulsory among hospital laundry staff. The practice, however, remains to be low among hospital laundry staff members. Globally, not many studies seem to have been carried out to sufficiently tell us about the barriers to personal protective equipment use among hospital laundry workers. Related studies in Ethiopia are even fewer. This study assessed the barriers to personal protective equipment use among laundry staff of government hospitals in Hawassa City, Southern Ethiopia, 2019. Methods Two qualitative data-gathering methods—focus group discussions and key informant interviews—were used to collect data for this study. Eight focus group discussions were conducted with hospital laundry workers. Similarly, six key informant interviews were held with Infection Prevention and Patient Safety Officers. Thematic analysis was performed using Open Code 4.02. Result Organizational- and individual-level barriers such as unavailability of essential personal protective equipment, a disharmonious work environment, low perception of susceptibility, and belief about personal protective equipment interference with work performance were identified as the major barriers to personal protective equipment use in the present study. Conclusion Organizational- and individual-level barriers have been identified as causes for the low level of personal protective equipment use among hospital laundry workers. Therefore, improving institutional supplies in quantity and quality may have a positive implication for the improvement of infection prevention practices in the study area. Also, designing sustainable strategies and raising laundry workers' awareness of a safe work environment may lead to the improvement of infection prevention practices.
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O'Hearn K, Gertsman S, Sampson M, Webster R, Tsampalieros A, Ng R, Gibson J, Lobos AT, Acharya N, Agarwal A, Boggs S, Chamberlain G, Staykov E, Sikora L, McNally JD. Decontaminating N95 and SN95 masks with ultraviolet germicidal irradiation does not impair mask efficacy and safety. J Hosp Infect 2020; 106:163-175. [PMID: 32687870 PMCID: PMC7367810 DOI: 10.1016/j.jhin.2020.07.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/13/2020] [Indexed: 10/27/2022]
Abstract
Inadequate supply of filtering facepiece respirators (FFRs) for healthcare workers during a pandemic such as the novel coronavirus outbreak (SARS-CoV-2) is a serious public health issue. The aim of this study was to synthesize existing data on the effectiveness of ultraviolet germicidal irradiation (UVGI) for N95 FFR decontamination. A systematic review (PROSPERO CRD42020176156) was conducted on UVGI in N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined eligibility and extracted predefined variables. Original research reporting on function, decontamination, or mask fit following UVGI were included. Thirteen studies were identified, comprising 54 UVGI intervention arms and 58 N95 models. FFRs consistently maintained certification standards following UVGI. Aerosol penetration averaged 1.19% (0.70-2.48%) and 1.14% (0.57-2.63%) for control and UVGI arms, respectively. Airflow resistance for the control arms averaged 9.79 mm H2O (7.97-11.70 mm H2O) vs 9.85 mm H2O (8.33-11.44 mm H2O) for UVGI arms. UVGI protocols employing a cumulative dose >20,000 J/m2 resulted in a 2-log reduction in viral load. A >3-log reduction was observed in seven UVGI arms using >40,000 J/m2. Impact of UVGI on fit was evaluated in two studies (16,200; 32,400 J/m2) and no evidence of compromise was found. Our findings suggest that further work in this area (or translation to a clinical setting) should use a cumulative UV-C dose of 40,000 J/m2 or greater, and confirm appropriate mask fit following decontamination.
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Affiliation(s)
- K O'Hearn
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - S Gertsman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - M Sampson
- Library Services, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - R Webster
- Clinical Research Unit, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - A Tsampalieros
- Clinical Research Unit, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - R Ng
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - J Gibson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - A T Lobos
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada; Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - N Acharya
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - A Agarwal
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - S Boggs
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - G Chamberlain
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - E Staykov
- Department of Biology, University of Ottawa, Ottawa, ON, Canada
| | - L Sikora
- Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | - J D McNally
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada; Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
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Webb SR, Twyman RM, Moloney M. Agtech infrastructure for pandemic preparedness. Nat Biotechnol 2020; 38:1025-1027. [DOI: 10.1038/s41587-020-0654-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Petsonk EL, Harber P. Respiratory protection for health care workers: A 2020 COVID-19 perspective. Am J Ind Med 2020; 63:655-658. [PMID: 32496602 PMCID: PMC7300982 DOI: 10.1002/ajim.23144] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/31/2022]
Abstract
As the US health care system began to respond to the coronavirus disease‐2019 pandemic, demand for respiratory personal protective equipment (PPE) increased precipitously, as did the number of users. This commentary discusses ensuing deviations from accepted respiratory PPE program practices, which potentially increased risk to health care workers. Such lapses included omitting user training and fit testing, provision of unapproved devices, and application of devices in settings and ways for which they were not intended. The temporary compromise of professionally accepted standards due to exigencies must not become the new normal. Rather, the current attention to PPE should be leveraged to enhance practice, motivate vital research, and strengthen professional, governmental, and institutional capabilities to control health care worker exposures to infectious hazards.
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Affiliation(s)
- Edward L. Petsonk
- Department of MedicineSchool of Medicine, West Virginia University Morgantown West Virginia
| | - Philip Harber
- Community, Environment & Policy DepartmentCollege of Medicine, University of Arizona Tucson Arizona
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Laing S, Westervelt E. Canada's National Emergency Stockpile System: time for a new long-term strategy. CMAJ 2020; 192:E810-E811. [PMID: 32586836 DOI: 10.1503/cmaj.200946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Scott Laing
- Department of Family Medicine (Laing), University of Ottawa; Procurement (Westervelt), Queensway Carleton Hospital, Ottawa, Ont.
| | - Ellen Westervelt
- Department of Family Medicine (Laing), University of Ottawa; Procurement (Westervelt), Queensway Carleton Hospital, Ottawa, Ont
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Ng-Kamstra J, Stelfox HT, Fiest K, Conly J, Leigh JP. Perspectives on personal protective equipment in acute care facilities during the COVID-19 pandemic. CMAJ 2020; 192:E805-E809. [PMID: 32586837 PMCID: PMC7828870 DOI: 10.1503/cmaj.200575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Josh Ng-Kamstra
- Department of Critical Care Medicine (Ng-Kamstra, Stelfox, Fiest), Cumming School of Medicine, University of Calgary and Alberta Health Services; Departments of Community Health Sciences and O'Brien Institute for Public Health (Stelfox, Fiest), Psychiatry and Hotchkiss Brain Institute (Fiest), Medicine (Conly), Pathology and Laboratory Medicine (Conly) and Microbiology, Immunology, and Infectious Diseases, and Snyder Institute for Chronic Diseases (Conly), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Health ( Parsons Leigh), School of Health Administration, and Department of Critical Care Medicine, Faculty of Medicine (Parsons Leigh), Dalhousie University, Halifax, NS
| | - Henry T Stelfox
- Department of Critical Care Medicine (Ng-Kamstra, Stelfox, Fiest), Cumming School of Medicine, University of Calgary and Alberta Health Services; Departments of Community Health Sciences and O'Brien Institute for Public Health (Stelfox, Fiest), Psychiatry and Hotchkiss Brain Institute (Fiest), Medicine (Conly), Pathology and Laboratory Medicine (Conly) and Microbiology, Immunology, and Infectious Diseases, and Snyder Institute for Chronic Diseases (Conly), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Health ( Parsons Leigh), School of Health Administration, and Department of Critical Care Medicine, Faculty of Medicine (Parsons Leigh), Dalhousie University, Halifax, NS
| | - Kirsten Fiest
- Department of Critical Care Medicine (Ng-Kamstra, Stelfox, Fiest), Cumming School of Medicine, University of Calgary and Alberta Health Services; Departments of Community Health Sciences and O'Brien Institute for Public Health (Stelfox, Fiest), Psychiatry and Hotchkiss Brain Institute (Fiest), Medicine (Conly), Pathology and Laboratory Medicine (Conly) and Microbiology, Immunology, and Infectious Diseases, and Snyder Institute for Chronic Diseases (Conly), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Health ( Parsons Leigh), School of Health Administration, and Department of Critical Care Medicine, Faculty of Medicine (Parsons Leigh), Dalhousie University, Halifax, NS
| | - John Conly
- Department of Critical Care Medicine (Ng-Kamstra, Stelfox, Fiest), Cumming School of Medicine, University of Calgary and Alberta Health Services; Departments of Community Health Sciences and O'Brien Institute for Public Health (Stelfox, Fiest), Psychiatry and Hotchkiss Brain Institute (Fiest), Medicine (Conly), Pathology and Laboratory Medicine (Conly) and Microbiology, Immunology, and Infectious Diseases, and Snyder Institute for Chronic Diseases (Conly), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Health ( Parsons Leigh), School of Health Administration, and Department of Critical Care Medicine, Faculty of Medicine (Parsons Leigh), Dalhousie University, Halifax, NS
| | - Jeanna Parsons Leigh
- Department of Critical Care Medicine (Ng-Kamstra, Stelfox, Fiest), Cumming School of Medicine, University of Calgary and Alberta Health Services; Departments of Community Health Sciences and O'Brien Institute for Public Health (Stelfox, Fiest), Psychiatry and Hotchkiss Brain Institute (Fiest), Medicine (Conly), Pathology and Laboratory Medicine (Conly) and Microbiology, Immunology, and Infectious Diseases, and Snyder Institute for Chronic Diseases (Conly), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Health ( Parsons Leigh), School of Health Administration, and Department of Critical Care Medicine, Faculty of Medicine (Parsons Leigh), Dalhousie University, Halifax, NS
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Affiliation(s)
- Umesh N. Khot
- Cleveland Clinic Heart, Vascular and Thoracic Institute Center for Healthcare Delivery Innovation, Cleveland, OH
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Jamieson DJ, Steinberg JP, Martinello RA, Perl TM, Rasmussen SA. Obstetricians on the Coronavirus Disease 2019 (COVID-19) Front Lines and the Confusing World of Personal Protective Equipment. Obstet Gynecol 2020; 135:1257-1263. [PMID: 32304512 PMCID: PMC7188024 DOI: 10.1097/aog.0000000000003919] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 12/14/2022]
Abstract
As health care systems struggle to maintain adequate supplies of personal protective equipment, there is confusion and anxiety among obstetricians and others about how to best protect themselves, their coworkers, and their patients. Although use of personal protective equipment is a critical strategy to protect health care personnel from coronavirus disease 2019 (COVID-19), other strategies also need to be implemented on labor and delivery units to reduce the risk of health care-associated transmission, including screening of all pregnant women who present for care (case identification), placing a mask on and rapidly isolating ill pregnant women, and minimizing the number of personnel who enter the room of an ill patient (physical distancing). Although the mechanism of transmission of COVID-19 is not known with certainty, current evidence suggests that COVID-19 is transmitted primarily through respiratory droplets. Therefore, strict adherence to hand hygiene and consistent use of recommended personal protective equipment are cornerstones for reducing transmission. In addition, it is critical that health care professionals receive training on and practice correct donning (putting on) and doffing (removing) of personal protective equipment and avoid touching their faces as well as their facial protection to minimize self-contamination.
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Affiliation(s)
- Denise J Jamieson
- Departments of Gynecology and Obstetrics and Medicine, Emory University School of Medicine, Atlanta, Georgia; the Departments of Medicine and Pediatrics, Yale School of Medicine, and the Department of Infection Prevention, Yale New Haven Health, New Haven, Connecticut; the University of Texas Southwestern Medical Center, Dallas, Texas; and the Departments of Pediatrics and Epidemiology, University of Florida College of Medicine & College of Public Health and Health Professions, Gainesville, Florida
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Golan MS, Jernegan LH, Linkov I. Trends and applications of resilience analytics in supply chain modeling: systematic literature review in the context of the COVID-19 pandemic. ACTA ACUST UNITED AC 2020; 40:222-243. [PMID: 32837820 PMCID: PMC7261049 DOI: 10.1007/s10669-020-09777-w] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The increasingly global context in which businesses operate supports innovation, but also increases uncertainty around supply chain disruptions. The COVID-19 pandemic clearly shows the lack of resilience in supply chains and the impact that disruptions may have on a global network scale as individual supply chain connections and nodes fail. This cascading failure underscores the need for the network analysis and advanced resilience analytics we find lacking in the existing supply chain literature. This paper reviews supply chain resilience literature that focuses on resilience modeling and quantification and connects the supply chain to other networks, including transportation and command and control. We observe a fast increase in the number of relevant papers (only 47 relevant papers were published in 2007–2016, while 94 were found in 2017–2019). We observe that specific disruption scenarios are used to develop and test supply chain resilience models, while uncertainty associated with threats including consideration of “unknown unknowns” remains rare. Publications that utilize more advanced models often focus just on supply chain networks and exclude associated system components such as transportation and command and control (C2) networks, which creates a gap in the research that needs to be bridged. The common goal of supply chain modeling is to optimize efficiency and reduce costs, but trade-offs of efficiency and leanness with flexibility and resilience may not be fully addressed. We conclude that a comprehensive approach to network resilience quantification encompassing the supply chain in the context of other social and physical networks is needed to address the emerging challenges in the field. The connection to systemic threats, such as disease pandemics, is specifically discussed.
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Affiliation(s)
- Maureen S Golan
- Contractor US Army Corps of Engineers, Air Tight Consulting, LLC., Pittsburgh, PA USA
| | - Laura H Jernegan
- Contractor US Army Corps of Engineers, Air Tight Consulting, LLC., Pittsburgh, PA USA
| | - Igor Linkov
- Risk and Decision Science Lead, US Army Engineer Research and Development Center, US Army Corps of Engineers, 696 Virginia Rd., Concord, MA 01742 USA
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Pompeii LA, Kraft CS, Brownsword EA, Lane MA, Benavides E, Rios J, Radonovich LJ. Training and Fit Testing of Health Care Personnel for Reusable Elastomeric Half-Mask Respirators Compared With Disposable N95 Respirators. JAMA 2020; 323:1849-1852. [PMID: 32211889 PMCID: PMC7097838 DOI: 10.1001/jama.2020.4806] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study examines the feasibility of rapidly training and fit testing health care workers to use elastomeric half-mask respirators (EHMRs), widely used in construction and manufacturing, as an alternative to N95 respirators during periods of shortage.
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Affiliation(s)
- Lisa A. Pompeii
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Colleen S. Kraft
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | | | - Morgan A. Lane
- Division of Infectious Diseases, Emory University, Atlanta, Georgia
| | - Elisa Benavides
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Janelle Rios
- Department of Epidemiology, Genetics and Environmental Sciences, University of Texas Health Science Center at Houston, Houston
| | - Lewis J. Radonovich
- National Institute for Occupational Safety and Health Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania
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73
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Mehrotra P, Malani P, Yadav P. Personal Protective Equipment Shortages During COVID-19—Supply Chain–Related Causes and Mitigation Strategies. JAMA HEALTH FORUM 2020; 1:e200553. [DOI: 10.1001/jamahealthforum.2020.0553] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Preeti Mehrotra
- Infection Control/Hospital Epidemiology, Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Prashant Yadav
- Center for Global Development, Washington, DC
- INSEAD, Fontainebleau, France
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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Cao Y, Li Q, Chen J, Guo X, Miao C, Yang H, Chen Z, Li C, Li L. Hospital Emergency Management Plan During the COVID-19 Epidemic. Acad Emerg Med 2020; 27:309-311. [PMID: 32124506 PMCID: PMC7159322 DOI: 10.1111/acem.13951] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Yubin Cao
- Department of Head and Neck OncologyWest China College of StomatologySichuan UniversityChengduChina
- State Key Laboratory of Oral DiseasesWest China College of StomatologySichuan UniversityChengduChina
| | - Qin Li
- Emergency DepartmentWest China HospitalSichuan UniversityChengduChina
- Institute of Disaster MedicineSichuan UniversityChengduChina
- West China School of NursingSichuan UniversityChengduChina
| | - Jing Chen
- State Key Laboratory of Oral DiseasesWest China College of StomatologySichuan UniversityChengduChina
- West China School of NursingSichuan UniversityChengduChina
- Operation RoomSichuan UniversityChengduChina
| | - Xia Guo
- College of Foreign Languages and CulturesSichuan UniversityChengduChina
| | - Cheng Miao
- Department of Head and Neck OncologyWest China College of StomatologySichuan UniversityChengduChina
- State Key Laboratory of Oral DiseasesWest China College of StomatologySichuan UniversityChengduChina
| | - Hui Yang
- State Key Laboratory of Oral DiseasesWest China College of StomatologySichuan UniversityChengduChina
- West China School of NursingSichuan UniversityChengduChina
- Operation RoomSichuan UniversityChengduChina
| | - Zihang Chen
- Department of PathologyWest China HospitalSichuan UniversityChengduChina
| | - Chunjie Li
- Department of Head and Neck OncologyWest China College of StomatologySichuan UniversityChengduChina
- State Key Laboratory of Oral DiseasesWest China College of StomatologySichuan UniversityChengduChina
- Medical Administration DepartmentWest China Hospital of StomatologySichuan UniversityChengduChina
| | - Longjiang Li
- Department of Head and Neck OncologyWest China College of StomatologySichuan UniversityChengduChina
- State Key Laboratory of Oral DiseasesWest China College of StomatologySichuan UniversityChengduChina
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75
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Pergert P, Sullivan CE, Adde M, Afungchwi GM, Downing J, Hollis R, Ilbawi A, Morrissey L, Punjwani R, Challinor J. An ethical imperative: Safety and specialization as nursing priorities of WHO Global Initiative for Childhood Cancer. Pediatr Blood Cancer 2020; 67:e28143. [PMID: 31886610 DOI: 10.1002/pbc.28143] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/05/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Pernilla Pergert
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Melissa Adde
- International Network for Cancer Treatment and Research (INCTR), Brussels, Belgium
| | | | - Julia Downing
- International Children's Palliative Care Network, Durban, South Africa
- Makerere University, Kampala, Uganda
| | - Rachel Hollis
- The Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | | | - Julia Challinor
- University of California San Francisco, San Francisco, California, USA
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76
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Zhao Z, Zhang Z, Lanzarini-Lopes M, Sinha S, Rho H, Herckes P, Westerhoff P. Germicidal Ultraviolet Light Does Not Damage or Impede Performance of N95 Masks Upon Multiple Uses. ENVIRONMENTAL SCIENCE & TECHNOLOGY LETTERS 2020; 7:600-605. [PMID: 37566376 PMCID: PMC7323059 DOI: 10.1021/acs.estlett.0c00416] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 05/24/2023]
Abstract
The COVID-19 pandemic is increasing the need for personal protective equipment (PPE) worldwide, including the demand for facial masks used by healthcare workers. Disinfecting and reusing these masks may offer benefits in the short term to meet urgent demand. Germicidal ultraviolet light provides a nonchemical, easily deployable technology capable of achieving inactivation of H1N1 virus on masks. Working with N95-rated masks and nonrated surgical masks, we demonstrated that neither 254 nor 265 nm UV-C irradiation at 1 and 10 J/cm2 had adverse effects on the masks' ability to remove aerosolized virus-sized particles. Additional testing showed no change in polymer structure, morphology, or surface hydrophobicity for multiple layers in the masks and no change in pressure drop or tensile strength of the mask materials. Results were similar when applying 254 nm low-pressure UV lamps and 265 nm light-emitting diodes. On the basis of the input from healthcare workers and our findings, a treatment system and operational manual were prepared to enable treatment and reuse of N95 facial masks. Knowledge gained during this study can inform techno-economic analyses for treating and reusing masks or lifecycle assessments of options to reduce the enormous waste production of single-use PPE used in the healthcare system, especially during pandemics.
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Affiliation(s)
- Zhe Zhao
- NSF Nanosystems Engineering Research
Center for Nanotechnology-Enabled Water Treatment, School of
Sustainable Engineering and the Built Environment, Ira A. Fulton
Schools of Engineering, Arizona State
University, Tempe, Arizona 85287-3005,
United States
| | - Zhaobo Zhang
- School of Molecular Sciences,
Arizona State University, Tempe,
Arizona 85297-1604, United States
| | - Mariana Lanzarini-Lopes
- NSF Nanosystems Engineering Research
Center for Nanotechnology-Enabled Water Treatment, School of
Sustainable Engineering and the Built Environment, Ira A. Fulton
Schools of Engineering, Arizona State
University, Tempe, Arizona 85287-3005,
United States
| | - Shahnawaz Sinha
- NSF Nanosystems Engineering Research
Center for Nanotechnology-Enabled Water Treatment, School of
Sustainable Engineering and the Built Environment, Ira A. Fulton
Schools of Engineering, Arizona State
University, Tempe, Arizona 85287-3005,
United States
| | - Hojung Rho
- NSF Nanosystems Engineering Research
Center for Nanotechnology-Enabled Water Treatment, School of
Sustainable Engineering and the Built Environment, Ira A. Fulton
Schools of Engineering, Arizona State
University, Tempe, Arizona 85287-3005,
United States
| | - Pierre Herckes
- School of Molecular Sciences,
Arizona State University, Tempe,
Arizona 85297-1604, United States
| | - Paul Westerhoff
- NSF Nanosystems Engineering Research
Center for Nanotechnology-Enabled Water Treatment, School of
Sustainable Engineering and the Built Environment, Ira A. Fulton
Schools of Engineering, Arizona State
University, Tempe, Arizona 85287-3005,
United States
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77
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Golan MS, Jernegan LH, Linkov I. Trends and applications of resilience analytics in supply chain modeling: systematic literature review in the context of the COVID-19 pandemic. ENVIRONMENT SYSTEMS & DECISIONS 2020. [PMID: 32837820 DOI: 10.1007/s10669-020-09777-] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The increasingly global context in which businesses operate supports innovation, but also increases uncertainty around supply chain disruptions. The COVID-19 pandemic clearly shows the lack of resilience in supply chains and the impact that disruptions may have on a global network scale as individual supply chain connections and nodes fail. This cascading failure underscores the need for the network analysis and advanced resilience analytics we find lacking in the existing supply chain literature. This paper reviews supply chain resilience literature that focuses on resilience modeling and quantification and connects the supply chain to other networks, including transportation and command and control. We observe a fast increase in the number of relevant papers (only 47 relevant papers were published in 2007-2016, while 94 were found in 2017-2019). We observe that specific disruption scenarios are used to develop and test supply chain resilience models, while uncertainty associated with threats including consideration of "unknown unknowns" remains rare. Publications that utilize more advanced models often focus just on supply chain networks and exclude associated system components such as transportation and command and control (C2) networks, which creates a gap in the research that needs to be bridged. The common goal of supply chain modeling is to optimize efficiency and reduce costs, but trade-offs of efficiency and leanness with flexibility and resilience may not be fully addressed. We conclude that a comprehensive approach to network resilience quantification encompassing the supply chain in the context of other social and physical networks is needed to address the emerging challenges in the field. The connection to systemic threats, such as disease pandemics, is specifically discussed.
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Affiliation(s)
- Maureen S Golan
- Contractor US Army Corps of Engineers, Air Tight Consulting, LLC., Pittsburgh, PA USA
| | - Laura H Jernegan
- Contractor US Army Corps of Engineers, Air Tight Consulting, LLC., Pittsburgh, PA USA
| | - Igor Linkov
- Risk and Decision Science Lead, US Army Engineer Research and Development Center, US Army Corps of Engineers, 696 Virginia Rd., Concord, MA 01742 USA
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78
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Armani AM, Hurt DE, Hwang D, McCarthy MC, Scholtz A. Low-tech solutions for the COVID-19 supply chain crisis. NATURE REVIEWS. MATERIALS 2020; 5:403-406. [PMID: 32395258 PMCID: PMC7212509 DOI: 10.1038/s41578-020-0205-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
A global effort is ongoing in the scientific community and in the maker movement, which focuses on creating devices and tinkering with them, to reverse-engineer commercial medical equipment and get it to healthcare workers. For these 'low-tech' solutions to have a real impact, it is important for them to coalesce around approved designs.
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Affiliation(s)
- Andrea M. Armani
- Department of Chemical Engineering and Materials Science, University of Southern California, Los Angeles, CA USA
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA USA
| | - Darrell E. Hurt
- Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA
| | - Darryl Hwang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA USA
- Department of Radiology, University of Southern California, Los Angeles, CA USA
| | - Meghan C. McCarthy
- Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA
| | - Alexis Scholtz
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA USA
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79
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Patel A, Lee L, Pillai SK, Valderrama AL, Delaney LJ, Radonovich L. Approach to Prioritizing Respiratory Protection When Demand Exceeds Supplies During an Influenza Pandemic: A Call to Action. Health Secur 2019; 17:152-155. [PMID: 31009256 DOI: 10.1089/hs.2019.0027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Anita Patel
- Anita Patel, PharmD, MS, is Senior Advisor, Medical Care and Countermeasures Lead, Influenza Coordination Unit; and Leslie Lee, MPH, is a Public Health Advisor, General Dynamics Information Technology, contracted to the Influenza Coordination Unit; both in the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Satish K. Pillai, MD, MPH, is Deputy Director, Division of Preparedness and Emerging Infectious Disease; and Amy L. Valderrama, PhD, RN, is a Nurse Epidemiologist, Division of Healthcare Quality Promotion; both in the National Center for Emerging and Zoonotic Infections Diseases, CDC, Atlanta, GA. Lisa J. Delaney, MS, is Associate Director for Emergency Preparedness and Response, National Institute for Occupational Safety and Health (NIOSH), CDC, Atlanta, GA. Lewis Radonovich, MD, is Chief of Research, National Personal Protective Technology Laboratory, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
| | - Leslie Lee
- Anita Patel, PharmD, MS, is Senior Advisor, Medical Care and Countermeasures Lead, Influenza Coordination Unit; and Leslie Lee, MPH, is a Public Health Advisor, General Dynamics Information Technology, contracted to the Influenza Coordination Unit; both in the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Satish K. Pillai, MD, MPH, is Deputy Director, Division of Preparedness and Emerging Infectious Disease; and Amy L. Valderrama, PhD, RN, is a Nurse Epidemiologist, Division of Healthcare Quality Promotion; both in the National Center for Emerging and Zoonotic Infections Diseases, CDC, Atlanta, GA. Lisa J. Delaney, MS, is Associate Director for Emergency Preparedness and Response, National Institute for Occupational Safety and Health (NIOSH), CDC, Atlanta, GA. Lewis Radonovich, MD, is Chief of Research, National Personal Protective Technology Laboratory, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
| | - Satish K Pillai
- Anita Patel, PharmD, MS, is Senior Advisor, Medical Care and Countermeasures Lead, Influenza Coordination Unit; and Leslie Lee, MPH, is a Public Health Advisor, General Dynamics Information Technology, contracted to the Influenza Coordination Unit; both in the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Satish K. Pillai, MD, MPH, is Deputy Director, Division of Preparedness and Emerging Infectious Disease; and Amy L. Valderrama, PhD, RN, is a Nurse Epidemiologist, Division of Healthcare Quality Promotion; both in the National Center for Emerging and Zoonotic Infections Diseases, CDC, Atlanta, GA. Lisa J. Delaney, MS, is Associate Director for Emergency Preparedness and Response, National Institute for Occupational Safety and Health (NIOSH), CDC, Atlanta, GA. Lewis Radonovich, MD, is Chief of Research, National Personal Protective Technology Laboratory, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
| | - Amy L Valderrama
- Anita Patel, PharmD, MS, is Senior Advisor, Medical Care and Countermeasures Lead, Influenza Coordination Unit; and Leslie Lee, MPH, is a Public Health Advisor, General Dynamics Information Technology, contracted to the Influenza Coordination Unit; both in the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Satish K. Pillai, MD, MPH, is Deputy Director, Division of Preparedness and Emerging Infectious Disease; and Amy L. Valderrama, PhD, RN, is a Nurse Epidemiologist, Division of Healthcare Quality Promotion; both in the National Center for Emerging and Zoonotic Infections Diseases, CDC, Atlanta, GA. Lisa J. Delaney, MS, is Associate Director for Emergency Preparedness and Response, National Institute for Occupational Safety and Health (NIOSH), CDC, Atlanta, GA. Lewis Radonovich, MD, is Chief of Research, National Personal Protective Technology Laboratory, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
| | - Lisa J Delaney
- Anita Patel, PharmD, MS, is Senior Advisor, Medical Care and Countermeasures Lead, Influenza Coordination Unit; and Leslie Lee, MPH, is a Public Health Advisor, General Dynamics Information Technology, contracted to the Influenza Coordination Unit; both in the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Satish K. Pillai, MD, MPH, is Deputy Director, Division of Preparedness and Emerging Infectious Disease; and Amy L. Valderrama, PhD, RN, is a Nurse Epidemiologist, Division of Healthcare Quality Promotion; both in the National Center for Emerging and Zoonotic Infections Diseases, CDC, Atlanta, GA. Lisa J. Delaney, MS, is Associate Director for Emergency Preparedness and Response, National Institute for Occupational Safety and Health (NIOSH), CDC, Atlanta, GA. Lewis Radonovich, MD, is Chief of Research, National Personal Protective Technology Laboratory, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
| | - Lewis Radonovich
- Anita Patel, PharmD, MS, is Senior Advisor, Medical Care and Countermeasures Lead, Influenza Coordination Unit; and Leslie Lee, MPH, is a Public Health Advisor, General Dynamics Information Technology, contracted to the Influenza Coordination Unit; both in the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Satish K. Pillai, MD, MPH, is Deputy Director, Division of Preparedness and Emerging Infectious Disease; and Amy L. Valderrama, PhD, RN, is a Nurse Epidemiologist, Division of Healthcare Quality Promotion; both in the National Center for Emerging and Zoonotic Infections Diseases, CDC, Atlanta, GA. Lisa J. Delaney, MS, is Associate Director for Emergency Preparedness and Response, National Institute for Occupational Safety and Health (NIOSH), CDC, Atlanta, GA. Lewis Radonovich, MD, is Chief of Research, National Personal Protective Technology Laboratory, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
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