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Boitet LM, Meese KA, Colón-López A, Sweeney KL, Rogers DA. Feeling safe versus being safe: Perceptions of safety versus actual disease exposure across the entire health care team. J Healthc Risk Manag 2023; 43:10-18. [PMID: 37208959 DOI: 10.1002/jhrm.21542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/14/2023] [Indexed: 05/21/2023]
Abstract
As supply chains experienced disruptions early in the COVID-19 pandemic, personal protective equipment (PPE) quickly became scarce. The purpose of this study was to examine the impact of perceptions of inadequate PPE, fear of COVID-19 infection, and self-reported direct COVID-19 exposure on health care workers. Data to assess distress, resilience, social-ecological factors, and work and nonwork-related stressors were collected from June to July 2020 at a large medical center. Stressors were analyzed by role using descriptive statistics and multivariate regression analysis. Our data indicate that job role influenced fear of infection and perceptions of inadequate PPE in the early phase of the COVID-19 pandemic. Perceived organizational support was also related to perceptions of inadequate PPE supply. Interestingly, work location, rather than job role, was predictive of direct COVID-19 exposure. Our data highlight a disconnect between the perception of safety in the health care setting with real risk of exposure to infectious disease. This study suggests that leaders in health care should focus on cultivating supportive organizational cultures, assessing both perceived and actual safety, and provide adequate training in safety practices may improve preparedness and organizational trust during times of both certainty and crisis particularly for clinical workers with less education and training.
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Affiliation(s)
- Laurence M Boitet
- Department of Health Services Administration, UAB Medicine Office of Wellness, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Department of Health Services Administration and Director of Wellness Research, University of Alabama at Birmingham (UAB), UAB Medicine Office of Wellness, UAB, Birmingham, Alabama, USA
| | - Katherine A Meese
- Department of Health Services Administration, UAB Medicine Office of Wellness, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Department of Health Services Administration and Director of Wellness Research, University of Alabama at Birmingham (UAB), UAB Medicine Office of Wellness, UAB, Birmingham, Alabama, USA
| | - Alejandra Colón-López
- Department of Medical Education, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Katherine L Sweeney
- Department of Health Services Administration and Director of Wellness Research, University of Alabama at Birmingham (UAB), UAB Medicine Office of Wellness, UAB, Birmingham, Alabama, USA
- Department of Sociology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - David A Rogers
- Department of Health Services Administration and Director of Wellness Research, University of Alabama at Birmingham (UAB), UAB Medicine Office of Wellness, UAB, Birmingham, Alabama, USA
- Department of Surgery and Chief Wellness Officer, UAB Medicine Office of Wellness, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
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Sato S, Iijima S. Evaluation of a Web-based learning system for skills in removing personal protective equipment for highly infectious diseases-A randomized controlled trial. Infect Control Hosp Epidemiol 2023; 44:1131-1136. [PMID: 38013414 DOI: 10.1017/ice.2022.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Which educational method is best for 3-month retention of proper skills in removing personal protective equipment (PPE) in the setting of highly infectious diseases is unclear. We evaluated the effectiveness of a Web-based learning system after 3 months of use. SETTING One general hospital in Japan. INTERVENTION We conducted a randomized, nonblinded, parallel-group trial with 35 nurses using the substitution block method. At baseline, both groups received face-to-face training in putting on and removing PPE. The intervention group was given access to the Web-based learning system we developed using Modular Object-Oriented Dynamic Learning Environment (Moodle). After 3 months, we assessed both groups regarding knowledge and skills in removing PPE using a 34-point test, fluorescent markers, and video recordings. RESULTS Overall, 34 participants completed the trial: 16 in the intervention group and 18 in the control group. Postintervention knowledge test scores (1.3 vs -0.8; P = .013; effect size r = .42) and deviations from the required procedure (-5.4 vs 1.9; P = .001; effect size r = .55) were significantly better in the intervention group than in the control group. The number of contaminated sites (-0.5 vs 0.4; P = .128; effect size r = .26) and contaminated participants (-18.7% vs 11.1% decreased in the intervention group, and increased in the control group, although this was not significant (P = .242; effect size ϕ = .47). CONCLUSIONS This learning system was an effective educational method in maintaining and improving knowledge of proper PPE removal skills. The number of deviations from the required procedure decreased, and this reduction continued after 3 months. CLINICAL TRIALS IDENTIFIER Evaluation of the Web materials for learning PPE removal skills in the setting of highly infectious diseases. University Hospital Medical Information Network, UMIN000042725: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000048767.
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Affiliation(s)
- Shota Sato
- Graduate School of Health Care and Nursing, Juntendo University, Urayasu, Japan
- National Defense Medical College, Saitama, Japan
| | - Sachiko Iijima
- Graduate School of Health Care and Nursing, Juntendo University, Urayasu, Japan
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Mahalingam K, Surbhi, Balaji A, Ganesh R, Daniel RA, Aggarwal R, Soni KD, Singh AK, Khanna P, Gupta V, Trikha A. Is it a challenging task to work with personal protective equipment in a COVID-19 ICU: Findings from a hospital-based cross-sectional study from north India. J Family Med Prim Care 2022; 11:1935-1942. [PMID: 35800524 PMCID: PMC9254845 DOI: 10.4103/jfmpc.jfmpc_1937_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/07/2021] [Accepted: 12/11/2021] [Indexed: 01/25/2023] Open
Abstract
Introduction Amidst the coronavirus disease 2019 (COVID-19) pandemic, the use of personal protective equipment (PPE) is mandatory for healthcare workers to remain protected against infection. The present study was undertaken to evaluate challenges faced by the healthcare workers while using level 3 PPE. Methods This hospital-based study was conducted among resident doctors selected by convenience sampling method using a pretested, semi-structured, self-administered questionnaire after getting informed consent from the participants to collect data on the somatic, psychological, and technical problems faced while working in PPE. Bivariate and multivariable logistic regression was done between outcome variables and other independent variables to check for the association. Results Of the total, 252 resident doctors completed the survey, their age ranged from 22 to 36 years with 140 (55.6%) males and 112 (44.4%) females. One-twenty-nine (51.2%) residents were trained to work in ICU, 73 (29%) participants used PPE ≤10 times and the rest 179 (71%) used PPE more than 10 times. The difficulties faced were as follows: visual impairment (n = 244, 96.8%), headache (n = 226, 89.6%), breathing difficulty (n = 216, 85.7%), hearing impairment (n = 201, 79.8%), sweating (n = 242, 96%), and fear of being infected (n = 156,61.9%). Two-thirty-six (93.6%) participants felt that overall work quality reduced due to PPE. Headache, hunger, urge to micturate, anxiety, sleep disturbances, and need to change the timing of medication or diet were higher with increased duration of work with PPE. Conclusion A longer duration of work is associated with headache, hunger, anxiety, and sleep disturbances. More research has to be done to improve the PPE to reduce problems like visual impairment, skin irritation, sweating, and breathing difficulty.
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Affiliation(s)
- Karthikeyan Mahalingam
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Surbhi
- Department of Anaethesia and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Akshaya Balaji
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ragul Ganesh
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Roy Arokiam Daniel
- Department of Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Richa Aggarwal
- Department of Anaethesia and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kapil Dev Soni
- Department of Anaethesia and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Akhil Kant Singh
- Department of Anaethesia and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Puneet Khanna
- Department of Anaethesia and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Viney Gupta
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anjan Trikha
- Department of Anaethesia and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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de Araujo CM, Guariza-Filho O, Gonçalves FM, Basso IB, Schroder AGD, Cavalcante-Leão BL, Ravazzi GC, Zeigelboim BS, Stechman-Neto J, Santos RS. Front lines of the COVID-19 pandemic: what is the effectiveness of using personal protective equipment in health service environments?-a systematic review. Int Arch Occup Environ Health 2022; 95:7-24. [PMID: 34674034 PMCID: PMC8528650 DOI: 10.1007/s00420-021-01775-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/08/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE This systematic review aimed to evaluate the effectiveness of the use of personal protective equipment (PPE) in closed environments, similar to waiting or exam rooms of healthcare facilities, in the face of exposure to a bioaerosol. METHODS Combinations of words were selected for six electronic databases and for the gray literature. To consider the eligibility of the studies to be included/excluded, the acronym "PECOS" was used: humans and/or experimental models that simulate aerosol (Population); aerosol exposure and the use of masks/respirators (exposition/intervention); controlled or not controlled (comparison); effectiveness of PPE and the receiver exposure (outcomes); and randomized clinical studies or not, observational or laboratory simulation studies (Studies design). RESULTS A total of 4820 references were retrieved by the search strategy. Thirty-five articles were selected for complete reading, of which 13 articles were included for qualitative synthesis. A surgical mask or N95 respirator reduced the risk of transmission, even over short distances. The use of masks, even those with less filtering power, when used by all individuals in the same environment is more effective in reducing risk than the use of respirators with high filtering power for only some of the individuals present. CONCLUSION The use of mask in closed environments is effective in reducing the risk of transmission and contagion of a contaminated bioaerosol, with greater effectiveness when these devices are used by the source and receiver, regardless of the equipment's filtering power. (PROSPERO 2020 CRD 42020183759).
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Affiliation(s)
| | - Odilon Guariza-Filho
- Department of Orthodontics, School of Health and Bioscience, Pontifícia Universidade Católica do Paraná, Street Imaculada Conceição, 1155, Prado Velho, Curitiba, Paraná 80215-901 Brazil
| | - Flavio Magno Gonçalves
- Postgraduate Program in Communication Disorders, Tuiuti University of Paraná, Curitiba, Brazil
| | - Isabela Bittencourt Basso
- Postgraduate Program in Dentistry, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná Brazil
| | | | | | - Glória Cortz Ravazzi
- Postgraduate Program in Communication Disorders, Tuiuti University of Paraná, Curitiba, Brazil
| | | | - José Stechman-Neto
- Postgraduate Program in Communication Disorders, Tuiuti University of Paraná, Curitiba, Brazil
| | - Rosane Sampaio Santos
- Postgraduate Program in Communication Disorders, Tuiuti University of Paraná, Curitiba, Brazil
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5
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Hirschwald LT, Herrmann S, Felder D, Kalde AM, Stockmeier F, Wypysek D, Alders M, Tepper M, Rubner J, Brand P, Kraus T, Wessling M, Linkhorst J. Discrepancy of particle passage in 101 mask batches during the first year of the Covid-19 pandemic in Germany. Sci Rep 2021; 11:24490. [PMID: 34966168 PMCID: PMC8716525 DOI: 10.1038/s41598-021-03862-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/19/2021] [Indexed: 11/09/2022] Open
Abstract
During the first wave of Covid-19 infections in Germany in April 2020, clinics reported a shortage of filtering face masks with aerosol retention> 94% (FFP2 & 3, KN95, N95). Companies all over the world increased their production capacities, but quality control of once-certified materials and masks came up short. To help identify falsely labeled masks and ensure safe protection equipment, we tested 101 different batches of masks in 993 measurements with a self-made setup based on DIN standards. An aerosol generator provided a NaCl test aerosol which was applied to the mask. A laser aerosol spectrometer measured the aerosol concentration in a range from 90 to 500 nm to quantify the masks' retention. Of 101 tested mask batches, only 31 batches kept what their label promised. Especially in the initial phase of the pandemic in Germany, we observed fluctuating mask qualities. Many batches show very high variability in aerosol retention. In addition, by measuring with a laser aerosol spectrometer, we were able to show that not all masks filter small and large particles equally well. In this study we demonstrate how important internal and independent quality controls are, especially in times of need and shortage of personal protection equipment.
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Affiliation(s)
- Lukas T Hirschwald
- AVT.CVT - Chair of Chemical Process Engineering, RWTH Aachen University, Forckenbeckstraße. 51, 52074, Aachen, Germany
| | - Stefan Herrmann
- AVT.CVT - Chair of Chemical Process Engineering, RWTH Aachen University, Forckenbeckstraße. 51, 52074, Aachen, Germany
| | - Daniel Felder
- AVT.CVT - Chair of Chemical Process Engineering, RWTH Aachen University, Forckenbeckstraße. 51, 52074, Aachen, Germany.,DWI - Leibniz Institute for Interactive Materials, Forckenbeckstr. 50, 52074, Aachen, Germany
| | - Anna M Kalde
- AVT.CVT - Chair of Chemical Process Engineering, RWTH Aachen University, Forckenbeckstraße. 51, 52074, Aachen, Germany.,DWI - Leibniz Institute for Interactive Materials, Forckenbeckstr. 50, 52074, Aachen, Germany
| | - Felix Stockmeier
- AVT.CVT - Chair of Chemical Process Engineering, RWTH Aachen University, Forckenbeckstraße. 51, 52074, Aachen, Germany.,DWI - Leibniz Institute for Interactive Materials, Forckenbeckstr. 50, 52074, Aachen, Germany
| | - Denis Wypysek
- AVT.CVT - Chair of Chemical Process Engineering, RWTH Aachen University, Forckenbeckstraße. 51, 52074, Aachen, Germany.,DWI - Leibniz Institute for Interactive Materials, Forckenbeckstr. 50, 52074, Aachen, Germany
| | - Michael Alders
- AVT.CVT - Chair of Chemical Process Engineering, RWTH Aachen University, Forckenbeckstraße. 51, 52074, Aachen, Germany
| | - Maik Tepper
- AVT.CVT - Chair of Chemical Process Engineering, RWTH Aachen University, Forckenbeckstraße. 51, 52074, Aachen, Germany.,DWI - Leibniz Institute for Interactive Materials, Forckenbeckstr. 50, 52074, Aachen, Germany
| | - Jens Rubner
- AVT.CVT - Chair of Chemical Process Engineering, RWTH Aachen University, Forckenbeckstraße. 51, 52074, Aachen, Germany
| | - Peter Brand
- Institute for Occupational, Social and Environmental Medicine, RWTH Aachen University Hospital, Pauwelstr. 30, 52074, Aachen, Germany
| | - Thomas Kraus
- Institute for Occupational, Social and Environmental Medicine, RWTH Aachen University Hospital, Pauwelstr. 30, 52074, Aachen, Germany
| | - Matthias Wessling
- AVT.CVT - Chair of Chemical Process Engineering, RWTH Aachen University, Forckenbeckstraße. 51, 52074, Aachen, Germany.,DWI - Leibniz Institute for Interactive Materials, Forckenbeckstr. 50, 52074, Aachen, Germany
| | - John Linkhorst
- AVT.CVT - Chair of Chemical Process Engineering, RWTH Aachen University, Forckenbeckstraße. 51, 52074, Aachen, Germany.
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Persad E, Engela-Volker JS, Noertjojo K, Pizarro AB, Mbeye N, Jørgensen KJ, Martin C, Sampson O, Bruschettini M. Elimination, substitution, engineering, and administrative interventions to reduce the risk of SARS-CoV-2 infection in healthcare workers. Hippokratia 2021. [DOI: 10.1002/14651858.cd015113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Emma Persad
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation; Danube University Krems; Krems Austria
- Karl Landsteiner University of Health Sciences; Krems Austria
| | | | | | | | - Nyanyiwe Mbeye
- School of Public Health and Family Medicine, College of Medicine; University of Malawi; Blantyre Malawi
| | | | | | | | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics; Lund University, Skåne University Hospital; Lund Sweden
- Cochrane Sweden; Lund University, Skåne University Hospital; Lund Sweden
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7
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Keleb A, Ademas A, Lingerew M, Sisay T, Berihun G, Adane M. Prevention Practice of COVID-19 Using Personal Protective Equipment and Hand Hygiene Among Healthcare Workers in Public Hospitals of South Wollo Zone, Ethiopia. Front Public Health 2021; 9:782705. [PMID: 34926394 PMCID: PMC8674420 DOI: 10.3389/fpubh.2021.782705] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/02/2021] [Indexed: 01/06/2023] Open
Abstract
Objective: The use of personal protective equipment and hand hygiene are often the most recommended line of defense against coronavirus disease-19 (COVID-19). The purpose of this study is to determine the magnitude of compliance and associated factors of personal protective equipment (PPE) utilization and hand hygiene practice among healthcare workers in public hospitals of South Wollo Zone, Northeastern Ethiopia. Methods: A hospital-based cross-sectional study was conducted among 489 healthcare workers in public hospitals of South Wollo Zone, Northeastern Ethiopia from June 15 to July 30, 2021. Proportional sample size allocation to each selected hospital followed by simple random sampling techniques were used to select the study participants using human resource records from each hospital. A pre-tested and structured self-administered questionnaire with WHO's standardized hand hygiene and PPE utilization observational checklist were used to collect data. Bivariate and multivariable analyses with 95% CI and p-value < 0.05 were employed to identify the associated factors of personal protective equipment utilization. Results: About 32 and 22.3% of healthcare workers were compliant with personal protective equipment utilization and hand hygiene practice, respectively. Feedback for safety (AOR = 2.05; 95% CI: 1.26-3.35), training on COVID-19 prevention (AOR = 3.43; 95% CI: 2.01-5.86), and perception to infection risk (AOR = 1.98; 95% CI: 1.18-3.33) were significant factors of good compliance with personal protective equipment utilization. Conclusion: The magnitude of good compliance with personal protective equipment utilization and hand hygiene was low. Interventions to promote personal protective equipment utilization and hand hygiene should focus on feedback for safety, training on COVID-19 prevention, and perception of infection risk.
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Affiliation(s)
- Awoke Keleb
- Department of Environmental Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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8
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Bansal S, Wiegelmann J, Matava C, Bereznicki C, Alam F. Cutting corners: donning under duress-a VR teaching tool. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:129-131. [PMID: 35003448 PMCID: PMC8740249 DOI: 10.36834/cmej.72143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Shikha Bansal
- Department of Anesthesia, Northern Ontario School of Medicine and Thunder Bay Regional Health Sciences Centre, Ontario, Canada
| | - Julian Wiegelmann
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Clyde Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Ontario, Canada
| | | | - Fahad Alam
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Ontario, Canada
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Holt A, Hornsey E, Seale AC, Rohan H, Bausch DG, Ihekweazu C, Okwor T. A mixed-methods analysis of personal protective equipment used in Lassa fever treatment centres in Nigeria. Infect Prev Pract 2021; 3:100168. [PMID: 34430843 PMCID: PMC8367797 DOI: 10.1016/j.infpip.2021.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/28/2021] [Indexed: 11/09/2022] Open
Abstract
Background Lassa fever (LF) is a viral haemorrhagic fever endemic in West Africa. Lassa virus is maintained in and spread to humans from rodents, with occasional secondary human-to-human transmission. Present recommendations for personal protective equipment (PPE) for care of patients with LF generally follow those for filovirus diseases. However, the need for such high-level PPE for LF, which is thought to be considerably less transmissible between humans than filoviruses, is unclear. Aim In Nigerian Lassa Treatment Centres (LTCs) we aimed to describe current PPE practices, identify barriers and facilitators to implementation of existing guidance, and assess healthcare workers' understanding. This would inform the development of future PPE guidelines for LF. Methods We performed a mixed-methods study, including short cross-sectional surveys of PPE used in LTCs, observations of practice, and in-depth interviews with key informants. We described the quantitative data and we conducted a thematic analysis of qualitative data. Findings Our survey of 74 HCWs found that approximately half reported problems with recommended PPE. In three LTCs PPE was used highly variably. Full PPE, as recommended in Nigeria CDC guidelines, was used in less than a quarter (21%) of interactions. In-depth interviews suggested this was based on availability and HCWs' own risk assessments. Conclusion Without specific guidance on Lassa, the current approach is both resource and labour-intensive, where these are both limited. This has led to low adherence by health care workers, whose own experience indicates lower risk. The evidence-base to inform PPE required for LF must be improved to inform a more tailored approach.
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Affiliation(s)
- Andrew Holt
- London School of Hygiene & Tropical Medicine, London, UK
| | - Emilio Hornsey
- UK Public Health Rapid Support Team, London, UK.,Public Health England, UK
| | - Anna C Seale
- London School of Hygiene & Tropical Medicine, London, UK.,UK Public Health Rapid Support Team, London, UK
| | - Hana Rohan
- London School of Hygiene & Tropical Medicine, London, UK.,UK Public Health Rapid Support Team, London, UK
| | - Daniel G Bausch
- London School of Hygiene & Tropical Medicine, London, UK.,UK Public Health Rapid Support Team, London, UK.,Public Health England, UK
| | | | - Tochi Okwor
- Nigeria Center for Disease Control, Abuja, Nigeria
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Rivera-Lozada O, Galvez CA, Castro-Alzate E, Bonilla-Asalde CA. Factors associated with knowledge, attitudes and preventive practices towards COVID-19 in health care professionals in Lima, Peru. F1000Res 2021; 10:582. [PMID: 34804498 PMCID: PMC8567687 DOI: 10.12688/f1000research.53689.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Nowadays, we are facing a disease caused by SARS-CoV- 2, known globally as COVID-19, which is considered a threat to global health due to its high contagiousness and rapid spread. Methods: Analytical cross-sectional study in 302 health professionals. An online questionnaire consisting of questions about knowledge, attitudes and practices (KAP) towards COVID-19 was applied. Socio- demographic, occupational and comorbidities factors were explored. Simple and multiple logistic regression models were used to identify factors associated with KAP. Results: Of the total, 25.2%, 31.5% and 37.4% had high levels of knowledge, preventive practices and risk perception attitudes respectively. Being married aOR=6.75 CI(1.46-31.2) p=0.014, having a master's degree aOR=0.4, CI(0.21-0.80) p=0.009, having a working day with less than ten hours ORa=0.49 CI(0.25-0.95) p=0.036 and obesity aOR=0.38 CI (0.15-0.95) p=0.039 were associated with a low level of knowledge of COVID-19. The variables associated with preventive practices were being over the age of 50 aOR=0.52 CI(0.27-0.98) p=0.007, working in the hospitalization area aOR=1.86 CI(1.08-3.18) p= 0.018 and having comorbidities such as arterial hypertension aOR=0.28 CI(0.081-0.99) p=0.02 and obesity aOR=0.35 CI(0.14-0.83) p=0.019. In relation to negative attitudes towards COVID-19, it was found that physical contact with patients with a confirmed diagnosis aOR=1.84 CI (1.14-2.97) p=0.006 and having asthma aOR=2.13 CI(1.081-4.22) p=0.029 were associated with these attitudes. Conclusion: Our study revealed that health professionals have an insufficient level of knowledge of COVID-19. This is why we recommend implementing strategies such as health literacy programs among health care workers. Thus, they can help develop positive.
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Affiliation(s)
- Oriana Rivera-Lozada
- Unidad de Posgrado de Salud Pública, Universidad Peruana Unión, Lima, Lima, Lima 15, Peru
- Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima, Lima, Lima 32, Peru
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, Lima, Peru
| | - Cesar Augusto Galvez
- Unidad de Posgrado de Salud Pública, Universidad Peruana Unión, Lima, Lima, Lima 15, Peru
| | - Elvis Castro-Alzate
- Escuela de Rehabilitaciòn Humana, Universidad del Valle, Cali, Valle Del Cauca, Colombia
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11
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Rivera-Lozada O, Galvez CA, Castro-Alzate E, Bonilla-Asalde CA. Factors associated with knowledge, attitudes and preventive practices towards COVID-19 in health care professionals in Lima, Peru. F1000Res 2021; 10:582. [PMID: 34804498 PMCID: PMC8567687 DOI: 10.12688/f1000research.53689.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 04/05/2024] Open
Abstract
Background: Nowadays, we are facing a disease caused by SARS-CoV-2, known globally as COVID-19, which is considered a threat to global health due to its high contagiousness and rapid spread. Methods: Analytical cross-sectional study in 302 health professionals. An online questionnaire consisting of questions about knowledge, attitudes and practices (KAP) towards COVID-19 was applied. Socio-demographic, occupational and comorbidities factors were explored. Simple and multiple logistic regression models were used to identify factors associated with KAP. Results: Of the total, 25.2%, 31.5% and 37.4% had high levels of knowledge, preventive practices and risk perception attitudes respectively. Being married (aOR=6.75), having a master's degree (aOR= 0.41), having a working day with less than ten hours (ORa=0.49) and obesity (aOR=0.38) were associated with a low level of knowledge of COVID-19. The variables associated with preventive practices were being over the age of 50 (aOR=0.52), working in the hospitalization area (aOR=1.86) and having comorbidities such as arterial hypertension (aOR=0.28) and obesity (aOR=0.35). In relation to negative attitudes towards COVID 19, it was found that physical contact with patients with a confirmed diagnosis (aOR=1.84) and having asthma (aOR=2.13) were associated with these attitudes. Conclusion: Being married, having a master's degree, working less than ten hours were associated with having a low level of knowledge of COVID-19. Being older than 50, working in the hospitalization area were associated with preventive practices. Physical contact with COVID-19 patients was associated with negative attitudes.
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Affiliation(s)
- Oriana Rivera-Lozada
- Unidad de Posgrado de Salud Pública, Universidad Peruana Unión, Lima, Lima, Lima 15, Peru
- Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima, Lima, Lima 32, Peru
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, Lima, Peru
| | - Cesar Augusto Galvez
- Unidad de Posgrado de Salud Pública, Universidad Peruana Unión, Lima, Lima, Lima 15, Peru
| | - Elvis Castro-Alzate
- Escuela de Rehabilitaciòn Humana, Universidad del Valle, Cali, Valle Del Cauca, Colombia
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Rivera-Lozada O, Galvez CA, Castro-Alzate E, Bonilla-Asalde CA. Factors associated with knowledge, attitudes and preventive practices towards COVID-19 in health care professionals in Lima, Peru. F1000Res 2021; 10:582. [PMID: 34804498 PMCID: PMC8567687 DOI: 10.12688/f1000research.53689.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 04/05/2024] Open
Abstract
Background: Nowadays, we are facing a disease caused by SARS-CoV-2, known globally as COVID-19, which is considered a threat to global health due to its high contagiousness and rapid spread. Methods: Analytical cross-sectional study in 302 health professionals. An online questionnaire consisting of questions about knowledge, attitudes and practices (KAP) towards COVID-19 was applied. Socio-demographic, occupational and comorbidities factors were explored. Simple and multiple logistic regression models were used to identify factors associated with KAP. Results: Of the total, 25.2%, 31.5% and 37.4% had high levels of knowledge, preventive practices and risk perception attitudes respectively. Being married aOR=6.75 IC(1.46-31.2) p=0.014, having a master's degree aOR=0.4, IC(0.21-0.80) p=0.009, having a working day with less than ten hours ORa=0.49 IC(0.25-0.95) p=0.036 and obesity aOR=0.38 IC (0.15-0.95) p=0.039 were associated with a low level of knowledge of COVID-19. The variables associated with preventive practices were being over the age of 50 aOR=0.52 IC(0.27-0.98) p=0.007, working in the hospitalization area aOR=1.86 IC(1.08-3.18) p= 0.018 and having comorbidities such as arterial hypertension aOR=0.28 IC(0.081-0.99) p=0.02 and obesity aOR=0.35 IC(0.14-0.83) p=0.019. In relation to negative attitudes towards COVID-19, it was found that physical contact with patients with a confirmed diagnosis aOR=1.84 IC (1.14-2.97) p=0.006 and having asthma aOR=2.13 IC(1.081-4.22) p=0.029 were associated with these attitudes. Conclusion: Our study revealed that health professionals have an insufficient level of knowledge of COVID-19. This is why we recommend implementing strategies such as health literacy programs among health care workers. Thus, they can help develop positive attitudes towards the acquisition of self-care habits at work that, in turn, improve their confidence so that health care workers can provide adequate care for their patients and protect themselves.
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Affiliation(s)
- Oriana Rivera-Lozada
- Unidad de Posgrado de Salud Pública, Universidad Peruana Unión, Lima, Lima, Lima 15, Peru
- Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima, Lima, Lima 32, Peru
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, Lima, Peru
| | - Cesar Augusto Galvez
- Unidad de Posgrado de Salud Pública, Universidad Peruana Unión, Lima, Lima, Lima 15, Peru
| | - Elvis Castro-Alzate
- Escuela de Rehabilitaciòn Humana, Universidad del Valle, Cali, Valle Del Cauca, Colombia
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Madziatera D, Msofi KS, Phiri TV, Mkandawire SD, Comber A. Availability, Accessibility and Proper Use of Personal Protective Equipment in Wards at Queen Elizabeth Central Hospital (QECH) Blantyre, Malawi: An Observational Study. Malawi Med J 2021; 32:124-131. [PMID: 33488983 PMCID: PMC7812152 DOI: 10.4314/mmj.v32i3.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background The purpose of this study was to evaluate the availability, accessibility and proper use of personal protective equipment (PPE) in the wards at Queen Elizabeth Central Hospital (QECH). Methods We conducted an observational study with a cross-section design. Convenience sampling method was used for selection of healthcare workers (HCWs) in wards. HCWs filled a checklist on accessibility of PPEs and they were observed on proper use of PPE while conducting clinical procedures. Nurse ward in-charge was asked to fill out a checklist on availability of PPE in their ward. Results PPE was available in 75.8% of wards, not available in 12.5%. Goggles were absent in 70.8% of wards. PPEs were 71.4% accessible and 28.6% inaccessible to healthcare workers in the wards. The most inaccessible PPEs were goggles (83.2%) and footwear (73.7%) while facemasks, sterile and non-sterile gloves and aprons were readily accessible. Non sterile gloves were 100% available and accessible. Only 13.5% of the HCWs had good compliance with PPE standard procedures. The average PPE compliance score of those who had been trained was 6 % greater than those who were not trained. Conclusion This study identified areas of improvement in healthcare system delivery regarding standard precautions with emphasis on PPE. Improvements in training during professional college education and in-service refresher training could improve compliance with appropriate use of PPE for relatively low cost. Management support could improve availability and accessibility of PPE in the wards at QECH, with active supervision to improve adherence levels to personal protective equipment usage. The study can also help in the development of policies and guidelines regarding PPE usage by showing that most HCWs need to be trained in proper PPE usage.
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Jose S, Cyriac MC, Dhandapani M. Health Problems and Skin Damages Caused by Personal Protective Equipment: Experience of Frontline Nurses Caring for Critical COVID-19 Patients in Intensive Care Units. Indian J Crit Care Med 2021; 25:134-139. [PMID: 33707889 PMCID: PMC7922454 DOI: 10.5005/jp-journals-10071-23713] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In the event of coronavirus disease-2019 (COVID-19) spread worldwide, frontline healthcare workers play a key role in the containment of this devastating pandemic, and to prevent the cross-transmission and gain confidence in battle with the pandemic, they are wearing personal protective equipment (PPE). AIM AND OBJECTIVE To explore the adverse health problems and skin reactions caused by the use of PPEs among the frontline nurses in the ICUs of COVID hospital. MATERIALS AND METHODS A cross-sectional study was conducted using an online-based questionnaire assessing the physical problems, and adverse skin reactions of PPEs were sent among the 150 frontline nurses in ICUs of COVID hospital. The collected data were analyzed using descriptive statistics. RESULTS We got 137 valid responses from frontline nurses, and the most common adverse health effects expressed by them were headache (73.4%), extreme sweating (59.6%), and difficulty in breathing (36.7%); 91.7% complained about the fogging of the goggle. Majority of frontline nurses expressed nasal bridge scarring (76.64%) and indentation and pain on the back of the ears (66.42%) as the adverse skin reactions after wearing N95 masks. The common skin problems identified due to double gloving of latex gloves were excessive skin soakage with sweat (70.07%) and skin chapping (19%). The protective clothing caused minimal adverse reactions, and excessive sweating (71.53%) was the most reported. CONCLUSION The healthcare workers wearing PPE for a prolonged period show significant adverse effects, so appropriate strategies should be taken to prevent the adverse effects by designing effective PPEs and education of preventive measures among healthcare workers. HOW TO CITE THIS ARTICLE Jose S, Cyriac MC, Dhandapani M. Health Problems and Skin Damages Caused by Personal Protective Equipment: Experience of Frontline Nurses Caring for Critical COVID-19 Patients in Intensive Care Units. Health Problems and Skin Damages Caused by Personal Protective Equipment: Experience of Frontline Nurses Caring for Critical COVID-19 Patients in Intensive Care Units. Indian J Crit Care Med 2021;25(2):134-139.
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Affiliation(s)
- Sinu Jose
- Department of Nursing, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Maneesha C Cyriac
- Department of Nursing, Bel-Air College of Nursing, Panchgani, Maharashtra, India
| | - Manju Dhandapani
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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García-Salido A, Antón J, Martínez-Pajares JD, Giralt Garcia G, Gómez Cortés B, Tagarro A, Belda Hofheinz S, Calvo Penadés I, de Carlos Vicente JC, Grasa Lozano CD, Hernández Bou S, Pino Ramírez RM, Núñez Cuadros E, Pérez-Lescure Picarzo J, Saavedra Lozano J, Salas-Mera D, Villalobos Pinto E. [Spanish consensus document on diagnosis, stabilisation and treatment of pediatric multisystem inflammatory syndrome related to SARS-CoV-2 (SIM-PedS)]. An Pediatr (Barc) 2021; 94:116.e1-116.e11. [PMID: 33132066 PMCID: PMC7604157 DOI: 10.1016/j.anpedi.2020.09.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 12/24/2022] Open
Abstract
A new paediatric multisystem inflammatory syndrome, linked to SARS-CoV-2, has been described. The clinical picture is variable and is associated with an active or recent infection due to SARS-CoV-2. A review of the existing literature by a multidisciplinary group of paediatric specialists is presented in this document. Later, they make recommendations on the stabilisation, diagnosis, and treatment of this syndrome.
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Affiliation(s)
- Alberto García-Salido
- Sociedad Española de Cuidados Intensivos Pediátricos (SECIP); Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, , Madrid, España.
| | - Jordi Antón
- Sociedad Española de Reumatología pediátrica (SERPE); Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, España
| | - José David Martínez-Pajares
- Sociedad Española de Pediatría Hospitalaria (SEPHO); Unidad de Pediatría, Hospital de Antequera, Área Sanitaria Norte de Málaga, Málaga, España
| | - Gemma Giralt Garcia
- Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (SECPCC); Hospital Universitario Hospital Vall d'Hebron, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Borja Gómez Cortés
- Sociedad Española de Urgencias de Pediatría (SEUP); Servicio de Urgencias de Pediatría. Hospital Universitario Cruces, Barakaldo
| | - Alfredo Tagarro
- Sociedad Española de Infectología Pediátrica (SEIP); Servicio de Pediatría, Hospital Universitario Infanta Sofía, Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, España
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Burton C, Coles B, Adisesh A, Smith S, Toomey E, Chan XHS, Ross L, Greenhalgh T. Performance and impact of disposable and reusable respirators for healthcare workers during pandemic respiratory disease: a rapid evidence review. Occup Environ Med 2021; 78:679-690. [PMID: 33504624 DOI: 10.1136/oemed-2020-107058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/29/2020] [Accepted: 11/20/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To synthesise evidence concerning the range of filtering respirators suitable for patient care and guide the selection and use of different respirator types. DESIGN Comparative analysis of international standards for respirators and rapid review of their performance and impact in healthcare. DATA SOURCES Websites of international standards organisations, Medline and Embase, hand-searching of references and citations. STUDY SELECTION Studies of healthcare workers (including students) using disposable or reusable respirators with a range of designs. We examined respirator performance, clinician adherence and performance, comfort and impact, and perceptions of use. RESULTS We included standards from eight authorities across Europe, North and South America, Asia and Australasia and 39 research studies. There were four main findings. First, international standards for respirators apply across workplace settings and are broadly comparable across jurisdictions. Second, effective and safe respirator use depends on proper fitting and fit testing. Third, all respirator types carry a burden to the user of discomfort and interference with communication which may limit their safe use over long periods; studies suggest that they have little impact on specific clinical skills in the short term but there is limited evidence on the impact of prolonged wearing. Finally, some clinical activities, particularly chest compressions, reduce the performance of filtering facepiece respirators. CONCLUSION A wide range of respirator types and models is available for use in patient care during respiratory pandemics. Careful consideration of performance and impact of respirators is needed to maximise protection of healthcare workers and minimise disruption to care.
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Affiliation(s)
- Christopher Burton
- Academic Unit of Primary Medical Care, The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
| | - Briana Coles
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, Leicestershire, UK
| | - Anil Adisesh
- Occupational Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Simon Smith
- Canadian Standards Biological Aerosols Group, Canadian Standards Association, Toronto, Ontario, Canada
| | - Elaine Toomey
- School of Allied Health, University of Limerick Faculty of Education and Health Sciences, Limerick, Ireland
| | - Xin Hui S Chan
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, UK
| | - Lawrence Ross
- Infectious Diseases, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
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Bains VK, Bains R, Gupta V, Salaria SK. Knowledge of COVID-19 and its implications in dental treatment, and practices of personal protective equipment among dentists: A survey-based assessment. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:79. [PMID: 34084826 PMCID: PMC8057157 DOI: 10.4103/jehp.jehp_763_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/02/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND Oral health-care providers are always at a risk of transmitting or acquiring airborne, saliva-borne, or blood-borne infections due to their proximity to the patient's mouth, contact with saliva, and handling of sharp instruments. the aim this study was to evaluate the knowledge of the dentists regarding COVID-19, methods to prevent its transmission, and implications of COVID-19 in dental treatment. MATERIALS AND METHODS It was a cross-sectional online survey. There were 35 questions in total, divided into sections of knowledge of COVID-19, practices of personal protective equipment (PPE), and knowledge of implications of COVID-19 in dental treatment. Both convenience sampling and snowball sampling were used, so that maximal participation could be ensured. The results were analyzed using descriptive statistics and making comparisons among various groups. The data were summarized as proportions and percentages (%). All the associations were tested using the Chi-square test, ANOVA, and Pearson's correlation coefficient. Statistical analyses were performed using SPSS version 19.0. RESULTS 26.8% of respondents had a high knowledge, 61.5% had good knowledge, 10.1% had low knowledge, and 6 (1.5%) had nil knowledge about COVID-19. No significant association was found between qualification and knowledge level among the respondents (P = 0.053). Both graduates and postgraduates had low knowledge regarding effective PPE components (P = 0.053), donning (P = 0.888), and doffing (P = 0.745). Only 52.9% of postgraduates and 43.7% graduates answered correctly about the sequence of donning, and 47.9% of postgraduates and 46.1% of graduates had knowledge regarding correct doffing sequence of PPE. Furthermore, knowledge was low regarding the implications of COVID-19 in dental treatment. CONCLUSION Although the dentists were found to have high/good knowledge scores regarding COVID-19, there was a lack of knowledge regarding hand hygiene, proper use of PPE, and implications of COVID-19 in dental treatment. Thus, they need to be trained and sensitized regarding the same.
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Affiliation(s)
- Vivek Kumar Bains
- Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
- Address for correspondence: Dr. Vivek Kumar Bains, 233, Tiwari Ganj, Faizabad Road, Chinhat, Saraswati Dental College, Lucknow - 226 028, Uttar Pradesh, India. E-mail:
| | - Rhythm Bains
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vivek Gupta
- Department of Periodontology, Dental Institute, Rajendra Institute of Medical Sciences (RIMS),Ranchi, Jharkhand, India
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Roychoudhury S, Das A, Sengupta P, Dutta S, Roychoudhury S, Choudhury AP, Ahmed ABF, Bhattacharjee S, Slama P. Viral Pandemics of the Last Four Decades: Pathophysiology, Health Impacts and Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9411. [PMID: 33333995 PMCID: PMC7765415 DOI: 10.3390/ijerph17249411] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 01/08/2023]
Abstract
The twenty-first century has witnessed some of the deadliest viral pandemics with far-reaching consequences. These include the Human Immunodeficiency Virus (HIV) (1981), Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) (2002), Influenza A virus subtype H1N1 (A/H1N1) (2009), Middle East Respiratory Syndrome Coronavirus (MERS-CoV) (2012) and Ebola virus (2013) and the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) (2019-present). Age- and gender-based characterizations suggest that SARS-CoV-2 resembles SARS-CoV and MERS-CoV with regard tohigher fatality rates in males, and in the older population with comorbidities. The invasion-mechanism of SARS-CoV-2 and SARS-CoV, involves binding of its spike protein with angiotensin-converting enzyme 2 (ACE2) receptors; MERS-CoV utilizes dipeptidyl peptidase 4 (DPP4), whereas H1N1 influenza is equipped with hemagglutinin protein. The viral infections-mediated immunomodulation, and progressive inflammatory state may affect the functions of several other organs. Although no effective commercial vaccine is available for any of the viruses, those against SARS-CoV-2 are being developed at an unprecedented speed. Until now, only Pfizer/BioNTech's vaccine has received temporary authorization from the UK Medicines and Healthcare products Regulatory Agency. Given the frequent emergence of viral pandemics in the 21st century, proper understanding of their characteristics and modes of action are essential to address the immediate and long-term health consequences.
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Affiliation(s)
| | - Anandan Das
- Department of Life Science and Bioinformatics, Assam University, Silchar 788011, India;
| | - Pallav Sengupta
- Department of Physiology, Faculty of Medicine and Biomedical Sciences, MAHSA University, SP2, Bandar Saujana Putra, Jenjarom, Selangor 42610, Malaysia;
| | - Sulagna Dutta
- Department of Oral Biology and Biomedical Sciences, Faculty of Dentistry, MAHSA University, SP2, Bandar Saujana Putra, Jenjarom, Selangor 42610, Malaysia;
| | - Shatabhisha Roychoudhury
- Department of Microbiology, R. G. Kar Medical College and Hospital, Kolkata 700004, India;
- Health Centre, Assam University, Silchar 788011, India
| | - Arun Paul Choudhury
- Department of Obstetrics and Gynecology, Silchar Medical College and Hospital, Silchar 788014, India; (A.P.C.); (A.B.F.A.)
| | - A. B. Fuzayel Ahmed
- Department of Obstetrics and Gynecology, Silchar Medical College and Hospital, Silchar 788014, India; (A.P.C.); (A.B.F.A.)
| | | | - Petr Slama
- Department of Animal Morphology, Physiology and Genetics, Faculty of AgriSciences, Mendel University in Brno, Zemedelska 1, 613 00 Brno, Czech Republic;
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Vargas SC, de Oliveira CF, Renner JDP, Krug SBF, Possuelo L. Prevalence of occupational infectious diseases among primary oral health care teams and prevention measures. Rev Bras Med Trab 2020; 18:149-157. [PMID: 33324456 PMCID: PMC7732045 DOI: 10.47626/1679-4435-2020-546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The dental surgeon and dental health assistant experience risk situations and must be prepared for the prevention of diseases and accidents at work. Objective Evaluating the prevalence of occupational infectious diseases and prevention measures used by the DS and dental health assistants. Methods Cross-sectional study carried out with professionals working at the Northwestern region of Rio Grande do Sul. We carried out an interview using a structured questionnaire containing variables related to sociodemographic factors and prevention of infectious diseases. Subjects were submitted to blood collection for serological test for infectious diseases. Results The use of goggles and cap was higher among the dental health assistant. The dental surgeon reported frequent use of mask: 45.5% replaced the used mask at each new patient. All participants reported using gloves and changing them for each new patient. 78.3% of workers have attended patients with infectious diseases. Among professionals evaluated, dental surgeons reported the highest number of accidents with needle stick instruments (59.1%). Post-exposure prophylaxis procedures are known by 68.2% of dental surgeon and 62.5% of dental health assistant. We did not find positive results for hepatitis B, hepatitis C and human immunodeficiency virus (HIV). Conclusions We did not found cases of occupational infectious disease. Dental professionals adopt some preventive actions, but a few professionals, even knowing about the risks they will be exposed during work, do not use some protective equipment.
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Affiliation(s)
- Sheila Cristina Vargas
- Pós-Graduação em Promoção da Saúde, Universidade de Santa Cruz do Sul - Santa Cruz do Sul (RS), Brazil
| | - Caio Fernando de Oliveira
- Pós-Graduação em Promoção da Saúde, Universidade de Santa Cruz do Sul - Santa Cruz do Sul (RS), Brazil
| | - Jane Dagmar Pollo Renner
- Pós-Graduação em Promoção da Saúde, Universidade de Santa Cruz do Sul - Santa Cruz do Sul (RS), Brazil
| | | | - Lia Possuelo
- Pós-Graduação em Promoção da Saúde, Universidade de Santa Cruz do Sul - Santa Cruz do Sul (RS), Brazil
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Ramzy M, Montrief T, Gottlieb M, Brady WJ, Singh M, Long B. COVID-19 cardiac arrest management: A review for emergency clinicians. Am J Emerg Med 2020; 38:2693-2702. [PMID: 33041141 PMCID: PMC7430285 DOI: 10.1016/j.ajem.2020.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/19/2020] [Accepted: 08/01/2020] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION A great deal of literature has recently discussed the evaluation and management of the coronavirus disease of 2019 (COVID-19) patient in the emergency department (ED) setting, but there remains a dearth of literature providing guidance on cardiac arrest management in this population. OBJECTIVE This narrative review outlines the underlying pathophysiology of patients with COVID-19 and discusses approaches to cardiac arrest management in the ED based on the current literature as well as extrapolations from experience with other pathogens. DISCUSSION Patients with COVID-19 may experience cardiovascular manifestations that place them at risk for acute myocardial injury, arrhythmias, and cardiac arrest. The mortality for these critically ill patients is high and increases with age and comorbidities. While providing resuscitative interventions and performing procedures on these patients, healthcare providers must adhere to strict infection control measures and prioritize their own safety through the appropriate use of personal protective equipment. A novel approach must be implemented in combination with national guidelines. The changes in these guidelines emphasize early placement of an advanced airway to limit nosocomial viral transmission and encourage healthcare providers to determine the effectiveness of their efforts prior to placing staff at risk for exposure. CONCLUSIONS While treatment priorities and goals are identical to pre-pandemic approaches, the management of COVID-19 patients in cardiac arrest has distinct differences from cardiac arrest patients without COVID-19. We provide a review of the current literature on the changes in cardiac arrest management as well as details outlining team composition.
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Affiliation(s)
- Mark Ramzy
- Department of Emergency Medicine, Maimonides Medical Center, United States
| | - Tim Montrief
- Department of Emergency Medicine, Jackson Memorial Health System, United States
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States
| | - William J Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States.
| | - Manpreet Singh
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Brit Long
- Research, SAUSHEC, Emergency Medicine, Brooke Army Medical Center, United States.
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Anderson-Shaw LK, Zar FA. COVID-19, Moral Conflict, Distress, and Dying Alone. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:777-782. [PMID: 33169271 PMCID: PMC7652046 DOI: 10.1007/s11673-020-10040-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/26/2020] [Indexed: 05/16/2023]
Abstract
COVID-19 has truly affected most of the world over the past many months, perhaps more than any other event in recent history. In the wake of this pandemic are patients, family members, and various types of care providers, all of whom share different levels of moral distress. Moral conflict occurs in disputes when individuals or groups have differences over, or are unable to translate to each other, deeply held beliefs, knowledge, and values. Such conflicts can seriously affect healthcare providers and cause distress during disastrous situations such as pandemics when medical and human resources are stretched to the point of exhaustion. In the current pandemic, most hospitals and healthcare institutions in the United States have not allowed visitors to come to the hospitals to see their family or loved ones, even when the patient is dying. The moral conflict and moral distress (being constrained from doing what you think is right) among care providers when they see their patients dying alone can be unbearable and lead to ongoing grief and sadness. This paper will explore the concepts of moral distress and conflict among hospital staff and how a system-wide provider wellness programme can make a difference in healing and health.
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Affiliation(s)
- Lisa K. Anderson-Shaw
- Department of Medical Education, University of Illinois College of Medicine, 1853 Polk Street (m/c 785), Chicago, IL 60612 USA
| | - Fred A. Zar
- University of Illinois College of Medicine, 840 South Wood Street #440, Chicago, IL 60612 USA
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22
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Xia W, Fu L, Liao H, Yang C, Guo H, Bian Z. The Physical and Psychological Effects of Personal Protective Equipment on Health Care Workers in Wuhan, China: A Cross-Sectional Survey Study. J Emerg Nurs 2020; 46:791-801.e7. [PMID: 32994038 PMCID: PMC7522005 DOI: 10.1016/j.jen.2020.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The purpose of this study was to rapidly quantify the safety measures regarding donning and doffing personal protective equipment, complaints of discomfort caused by wearing personal protective equipment, and the psychological perceptions of health care workers in hospitals in Wuhan, China, responding to the outbreak. METHODS A cross-sectional online questionnaire design was used Data were collected from March 14, 2020, to March 16, 2020, in Wuhan, China. Descriptive statistics and χ2 analyses testing were used. RESULTS Standard nosocomial infection training could significantly decrease the occurrence of infection (3.6% vs 13.0%, χ2 = 4.47, P < 0.05). Discomfort can be classified into 7 categories. Female sex (66.0% vs 50.5%, χ2 = 6.37), occupation (62.7% vs 30.8%, χ2 = 5.33), working at designated hospitals (44.8% vs 26.7%, χ2 = 5.17) or in intensive care units (70.4% vs 57.9%, χ2 = 3.88), and working in personal protective equipment for > 4 hours (62.2% vs 39.2%, χ2 = 9.17) led to more complaints about physical discomfort or increased occurrence of pressure sores (all P < 0.05). Psychologically, health care workers at designated hospitals (60.0% vs 42.1%, χ2 = 4.97) or intensive care units (55.9% vs 41.5%, χ2 = 4.40) (all P < 0.05) expressed different rates of pride. DISCUSSION Active training on infection and protective equipment could reduce the infection risk. Working for long hours increased the occurrence of discomfort and skin erosion. Reducing the working hours and having adequate protective products and proper psychological interventions may be beneficial to relieve discomfort.
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23
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Bradford Smith P, Agostini G, Mitchell JC. A scoping review of surgical masks and N95 filtering facepiece respirators: Learning from the past to guide the future of dentistry. SAFETY SCIENCE 2020; 131:104920. [PMID: 32834515 PMCID: PMC7406415 DOI: 10.1016/j.ssci.2020.104920] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 05/03/2023]
Abstract
With the 2019 emergence of coronavirus disease 19 (colloquially called COVID-19) came renewed public concern about airborne and aerosolized virus transmission. Accompanying this concern were many conflicting dialogues about which forms of personal protective equipment best protect dental health care practitioners and their patients from viral exposure. In this comprehensive review we provide a thorough and critical assessment of face masks and face shields, some of the most frequently recommended personal safeguards against viral infection. We begin by describing the function and practicality of the most common mask types used in dentistry: procedural masks, surgical masks, and filtering respirator facemasks (also called N95s). This is followed by a critical assessment of mask use based on a review of published evidence in three key domains: the degree to which each mask type is shown to protect against airborne and aerosolized disease, the reported likelihood for non-compliance among mask users, and risk factors associated with both proper and improper mask use. We use this information to conclude our review with several practical, evidence-based recommendations for mask use in dental and dental educational clinics.
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Key Words
- ADA, American Dental Association
- ARI, Acute Respiratory Infections
- ASTM, American Society of Testing Materials
- CDC, Center for Disease Control
- COVID-19, Coronavirus Disease, first detected in 2019
- CRI, Confirmed respiratory infection
- DHCP, Dental Health Care Practitioner
- ER, Emergency Room
- Evidence-based review
- FDA, Food and Drug Administration
- FFR, Filtering Facepiece Respirators
- H1N1, H1N1 Subtype of Influenza-A
- HCW, Healthcare Workers
- HVE, High-Volume Evacuation
- ICP, Infection Control Protocol
- ILI, Influenza-like Illness
- Infectious disease transmission
- LCI, Laboratory-confirmed Influenza
- MERS, Middle East Respiratory Syndrome (a coronavirus formally identified in 2012)
- N95 respirator
- N95, Non-oil-resistant, filtering facepiece respirator filtering 95% of airborne particles
- NASIOM, National Academy of Sciences’ Institute of Medicine
- NIOSH, National Institute for Occupational Safety and Health
- OSHA, Occupational Safety and Health Administration
- PPE, Personal protective equipment
- RCT, Randomized Controlled Trial
- SARS, Severe Acute Respiratory Syndrome (a coronavirus formally identified in 2003
- Surgical facemask
- WHO, World Health Organization
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Affiliation(s)
- P Bradford Smith
- Midwestern University College of Dental Medicine, AZ, United States
| | - Gina Agostini
- Midwestern University College of Dental Medicine, AZ, United States
| | - John C Mitchell
- Midwestern University College of Dental Medicine, AZ, United States
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24
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Kpadeh-Rogers Z, Robinson GL, Alserehi H, Morgan DJ, Harris AD, Herrera NB, Rose LJ, Noble-Wang J, Johnson JK, Leekha S. Effect of Glove Decontamination on Bacterial Contamination of Healthcare Personnel Hands. Clin Infect Dis 2020; 69:S224-S227. [PMID: 31517972 PMCID: PMC6761364 DOI: 10.1093/cid/ciz615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We examined the effect of glove decontamination prior to removal on bacterial contamination of healthcare personnel hands in a laboratory simulation study. Glove decontamination reduced bacterial contamination of hands following removal. However, hand contamination still occurred with all decontamination methods, reinforcing the need for hand hygiene following glove removal.
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Affiliation(s)
| | - Gwen L Robinson
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Haleema Alserehi
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Natalia Blanco Herrera
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Laura J Rose
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Judith Noble-Wang
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - J Kristie Johnson
- Department of Pathology, Baltimore.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Surbhi Leekha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
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25
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Segal D, Rotschield J, Ankory R, Kutikov S, Moaddi B, Verhovsky G, Benov A, Twig G, Glassberg E, Fink N, Bader T, Karp E. Measures to Limit COVID-19 Outbreak Effects Among Military Personnel: Preliminary Data. Mil Med 2020; 185:e1624-e1631. [PMID: 32484225 PMCID: PMC7313862 DOI: 10.1093/milmed/usaa112] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/04/2020] [Accepted: 04/21/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The COVID-19 outbreak posed a threat to the readiness of military forces as well as their ability to fulfill missions. Seeing that military forces have been encountering similar challenges, we found it eminent to share the Israeli Defense Force (IDF) Northern Command's (NC) preliminary experience. MATERIALS AND METHODS We retrospectively summarized the actions that were taken by our team, focusing on 18 battalions at the Israeli NC. These actions included promoting a series of organizational changes in terms of social distancing and medical regulations as well as working to strengthen medical leadership through designated video meetings with medical commanders across our organization. Meetings included relevant clinical education, updates, and leadership building. These actions and others were aimed to increase our influence on the decision-making processes. While we conducted real-time reverse transcriptase polymerase chain reaction SARS-CoV-2 laboratory tests for soldiers who were suspected to have COVID-19 (those presenting with compatible signs and symptoms after having been exposed to a confirmed COVID-19 patient), we were not able to screen healthy populations, nor did we have serum antibody serologic tests available during the study period. We reviewed the COVID-19 outbreak national data, obtained from Ministry of Health publishings and the IDF databases. Data were included from February 26th, 2020 (day 0, first COVID-19 patient in Israel) to April 19th, 2020 (day 53, about 1 month after most of the COVID-19 regulation were issued in the NC). RESULTS The mean age of the battalion soldiers was 21.29 ± 4.06 (range 18-50), 81.34% male. Most restrictions were issued on day 18. On day 53, 98.85% of the personnel in the battalions were kept active and asymptomatic in their units. CONCLUSIONS Despite the limited availability of laboratory testing for COVID-19 our actions enabled us to lead a strict risk-management policy while maintaining most of the available workforce.
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Affiliation(s)
- David Segal
- The Israeli Defense Forces Medical Corps, The Hebrew University of Jerusalem, Aharon Katzir Blvd 1, 52656 Jerusalem, Israel
| | - Jacob Rotschield
- The Israeli Defense Forces Medical Corps, The Hebrew University of Jerusalem, Aharon Katzir Blvd 1, 52656 Jerusalem, Israel
| | - Ran Ankory
- The Israeli Defense Forces Medical Corps, The Hebrew University of Jerusalem, Aharon Katzir Blvd 1, 52656 Jerusalem, Israel
| | - Sergey Kutikov
- The Israeli Defense Forces Medical Corps, The Hebrew University of Jerusalem, Aharon Katzir Blvd 1, 52656 Jerusalem, Israel
| | - Bian Moaddi
- The Israeli Defense Forces Medical Corps, The Hebrew University of Jerusalem, Aharon Katzir Blvd 1, 52656 Jerusalem, Israel
| | - Guy Verhovsky
- The Israeli Defense Forces Medical Corps, The Hebrew University of Jerusalem, Aharon Katzir Blvd 1, 52656 Jerusalem, Israel
| | - Avi Benov
- The Israeli Defense Forces Medical Corps, The Hebrew University of Jerusalem, Aharon Katzir Blvd 1, 52656 Jerusalem, Israel
| | - Gilad Twig
- The Israeli Defense Forces Medical Corps, The Hebrew University of Jerusalem, Aharon Katzir Blvd 1, 52656 Jerusalem, Israel
| | - Elon Glassberg
- The Israeli Defense Forces Medical Corps, The Hebrew University of Jerusalem, Aharon Katzir Blvd 1, 52656 Jerusalem, Israel
| | - Noam Fink
- The Israeli Defense Forces Medical Corps, The Hebrew University of Jerusalem, Aharon Katzir Blvd 1, 52656 Jerusalem, Israel
| | - Tarif Bader
- The Israeli Defense Forces Medical Corps, The Hebrew University of Jerusalem, Aharon Katzir Blvd 1, 52656 Jerusalem, Israel
| | - Erez Karp
- The Israeli Defense Forces Medical Corps, The Hebrew University of Jerusalem, Aharon Katzir Blvd 1, 52656 Jerusalem, Israel
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26
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Yánez Benítez C, Güemes A, Aranda J, Ribeiro M, Ottolino P, Di Saverio S, Alexandrino H, Ponchietti L, Blas JL, Ramos JP, Rangelova E, Muñoz M, Yánez C. Impact of Personal Protective Equipment on Surgical Performance During the COVID-19 Pandemic. World J Surg 2020; 44:2842-2847. [PMID: 32564140 PMCID: PMC7305697 DOI: 10.1007/s00268-020-05648-2] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The Severe Acute Respiratory Syndrome Coronavirus 2 pandemic has exposed surgeons to hazardous working conditions, imposing the need for personal protective equipment (PPE) use during surgery. The use of such equipment may affect their non-technical skills, augment fatigue, and affect performance. This study aimed to assess the surgeons’ perceptions of the impact of wearing PPE during emergency surgery throughout the pandemic. Methods An international cooperation group conducted an anonymous online survey among surgeons from over 30 countries, to assess perceptions about the impact of PPE use on non-technical skills, overall comfort, decision making, and surgical performance during emergency surgery on COVID-19 patients. Results Responses to the survey (134) were received from surgeons based on 26 countries. The vast majority (72%) were males. More than half of the respondents (54%) felt that their surgical performance was hampered with PPE. Visual impairment was reported by 63%, whereas 54% had communication impediments. Less than half (48%) felt protected with the use of PPE, and the same proportion perceived that the use of such equipment influenced their decision making. Decreased overall comfort was cited by 66%, and 82% experienced increased surgical fatigue. Conclusions Surgeons perceived impediment for both visibility and communication, and other non-technical skills while using PPE on emergency surgery in COVID-19 patients. Their perceived lack of protection and comfort and increased fatigue may have inhibited their optimal surgical performance. More attention should be placed in the design of more user-friendly equipment, given the possibility of a second wave of the pandemic.
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Affiliation(s)
- Carlos Yánez Benítez
- Department of General Surgery, Royo Villanova Hospital, SALUD, Ave. de San Gregorio s/n., 50015, Zaragoza, Spain.
| | - Antonio Güemes
- Department of General Surgery, Lozano Blesa University Hospital, Av. San Juan Bosco, 15, 50009, Zaragoza, Spain
| | - José Aranda
- Department of General Surgery, Regional University Hospital of Malaga, Av. Carlos Haya, 29010, Málaga, Spain
| | - Marcelo Ribeiro
- Department of General Surgery & Trauma Surgery, Hospital Moriah, Avenida Victor Civita, 235, Sao Paulo, Brazil
| | - Pablo Ottolino
- Department of General Surgery, Sótero del Río Healthcare Complex, Santiago, Chile
| | - Salomone Di Saverio
- Department of General Surgery, Varese University Hospital, University of Insubria, ASST Sette Laghi, Regione Lombardia, Varese, Italy
| | - Henrique Alexandrino
- Department of General Surgery, Faculty of Medicine, Coimbra University Hospital Center, University of Coimbra, Praceta Mota Pinto, 3000-045, Coimbra, Portugal
| | - Luca Ponchietti
- Department of General Surgery, San Jorge Hospital, University of Zaragoza, Av. Martínez de Velazco, 36, 22004, Huesca, Spain
| | - Juan L Blas
- Department of General Surgery, Royo Villanova Hospital, Ave. de San Gregorio s/n., 50015, Zaragoza, Spain
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27
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Ashokka B, Chakraborty A, Subramanian BJ, Karmakar MK, Chan V. Reconfiguring the scope and practice of regional anesthesia in a pandemic: the COVID-19 perspective. Reg Anesth Pain Med 2020; 45:536-543. [PMID: 32471930 PMCID: PMC7362872 DOI: 10.1136/rapm-2020-101541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023]
Abstract
The COVID-19 outbreak is on the world. While many countries have imposed general lockdown, emergency services are continuing. Healthcare professionals have been infected with the virulent severe acute respiratory syndrome coronavirus-2 (SARS), which spreads by close contact and aerosols. The anesthesiologist is particularly vulnerable to aerosols while performing intubation and other airway related procedures. Regional anesthesia (RA) minimizes the need for airway manipulation and the risks of cross infection to other patients, and the healthcare personnel. In this context, for prioritizing RA over general anesthesia, wherever possible, a structured algorithmic approach is outlined. The role of percentage saturation of hemoglobin with oxygen (oxygen saturation), blood pressure and early use of point-of-care ultrasound in differential diagnosis and specific management is detailed. The perioperative anesthetic implications of multisystem manifestations of COVID-19, anesthetic management options, the scope of RA and considerations for its safe conduct in operating rooms is described. An outline for safe and rapid training of healthcare personnel, with an Entrustable Professional Activity framework for ascertaining the practice readiness among trained residents for RA in COVID-19, is suggested. These are the authors' experiences gained from the current pandemic and similar SARS, Middle East Respiratory Syndrome and influenza outbreaks in recent past faced by our authors in Singapore, India, Hong Kong and Canada.
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Affiliation(s)
- Balakrishnan Ashokka
- Anaesthesia, National University Health System, Singapore
- Centre for Medical Education, National University Singapore Yong Loo Lin School of Medicine, Singapore
| | | | | | - Manoj Kumar Karmakar
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vincent Chan
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, Ontario, Canada
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28
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Yuan N, Yang WX, Lu JL, Lv ZH. Investigation of adverse reactions in healthcare personnel working in Level 3 barrier protection PPE to treat COVID-19. Postgrad Med J 2020; 97:351-354. [PMID: 32554543 PMCID: PMC7301344 DOI: 10.1136/postgradmedj-2020-137854] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/21/2020] [Accepted: 06/06/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE OF THE STUDY The aim of our study was to investigate potential adverse reactions in healthcare professionals working in Level 3 barrier protection personal protective equipment (L3PPE) to treat patients with COVID-19. STUDY DESIGN By using a convenience sampling approach, 129 out of 205 randomly selected healthcare professionals from the First Affiliated Hospital of Zhejiang University School of Medicine were invited to take part in a WeChat messaging app survey, Questionnaire Star, via a survey link. Healthcare personnel details were collected, including profession, years of professional experience and adverse reactions while wearing L3PPE. Survey results were divided by profession and years of professional experience; differences in adverse reactions were compared. RESULTS Among the 129 healthcare professionals surveyed, 21 (16.28%) were doctors and 108 (83.72%) were nurses. A total of 122 (94.57%) healthcare professionals experienced discomfort while wearing L3PPE to treat patients with COVID-19. The main reasons for adverse reactions and discomfort include varying degrees of adverse skin reactions, respiratory difficulties, heat stress, dizziness and nausea. Doctors had a lower incidence of rashes (χ2=4.519, p=0.034) and dizziness (χ2=4.123, p=0.042) when compared with nurses. Junior (8.5 years of experience or fewer) healthcare personnel also experienced a higher rate of heat stress when compared with senior personnel (more than 8.5 years greater) (χ2=5.228, p=0.022). CONCLUSION More attention should be offered to healthcare personnel wearing L3PPE to treat patients with COVID-19 because they are susceptible to developing adverse reactions.
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Affiliation(s)
- Niu Yuan
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wei-Xia Yang
- Department of Respiratory and Gastroenterology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jian-Li Lu
- Deparment of Orthopedics, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhang-Hong Lv
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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29
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Moradian N, Ochs HD, Sedikies C, Hamblin MR, Camargo CA, Martinez JA, Biamonte JD, Abdollahi M, Torres PJ, Nieto JJ, Ogino S, Seymour JF, Abraham A, Cauda V, Gupta S, Ramakrishna S, Sellke FW, Sorooshian A, Wallace Hayes A, Martinez-Urbistondo M, Gupta M, Azadbakht L, Esmaillzadeh A, Kelishadi R, Esteghamati A, Emam-Djomeh Z, Majdzadeh R, Palit P, Badali H, Rao I, Saboury AA, Jagan Mohan Rao L, Ahmadieh H, Montazeri A, Fadini GP, Pauly D, Thomas S, Moosavi-Movahed AA, Aghamohammadi A, Behmanesh M, Rahimi-Movaghar V, Ghavami S, Mehran R, Uddin LQ, Von Herrath M, Mobasher B, Rezaei N. The urgent need for integrated science to fight COVID-19 pandemic and beyond. J Transl Med 2020; 18:205. [PMID: 32430070 PMCID: PMC7236639 DOI: 10.1186/s12967-020-02364-2] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/04/2020] [Indexed: 12/17/2022] Open
Abstract
The COVID-19 pandemic has become the leading societal concern. The pandemic has shown that the public health concern is not only a medical problem, but also affects society as a whole; so, it has also become the leading scientific concern. We discuss in this treatise the importance of bringing the world's scientists together to find effective solutions for controlling the pandemic. By applying novel research frameworks, interdisciplinary collaboration promises to manage the pandemic's consequences and prevent recurrences of similar pandemics.
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Affiliation(s)
- Negar Moradian
- Universal Scientific Education and Research Network (USERN),.,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 14194, Iran
| | - Hans D Ochs
- Universal Scientific Education and Research Network (USERN),.,Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle, WA, USA
| | - Constantine Sedikies
- Universal Scientific Education and Research Network (USERN),.,Centre for Research on Self Identity, Department of Psychology, School of Psychology, University of Southampton, Southampton, UK
| | - Michael R Hamblin
- Universal Scientific Education and Research Network (USERN),.,Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.,Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, 2028, South Africa
| | - Carlos A Camargo
- Universal Scientific Education and Research Network (USERN),.,Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Alfredo Martinez
- Universal Scientific Education and Research Network (USERN),.,University of Navarra, CIBERobn and IMDEA food, International Union of Nutritional Sciences (IUNS), Navarra, Spain.,International Union of Nutritional Sciences (IUNS), London, UK
| | - Jacob D Biamonte
- Universal Scientific Education and Research Network (USERN),.,Skolkovo Institute of Science and Technology, Moscow, Russia
| | - Mohammad Abdollahi
- Universal Scientific Education and Research Network (USERN),.,Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), and School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Pedro J Torres
- Universal Scientific Education and Research Network (USERN),.,Departamento de Matemática Aplicada, Universidad de Granada, 18071, Granada, Spain
| | - Juan J Nieto
- Universal Scientific Education and Research Network (USERN),.,Instituto de Matemáticas, Universidade de Santiago de Compostela, Santiago De Compostela, Spain
| | - Shuji Ogino
- Universal Scientific Education and Research Network (USERN),.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - John F Seymour
- Universal Scientific Education and Research Network (USERN),.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Ajith Abraham
- Universal Scientific Education and Research Network (USERN),.,Machine Intelligence Research Labs, Auburn, WA, USA
| | - Valentina Cauda
- Universal Scientific Education and Research Network (USERN),.,Department of Applied Science and Technology, Politecnico di Torino Corso, Duca degli Abruzzi 24, 10129, Turin, Italy
| | - Sudhir Gupta
- Universal Scientific Education and Research Network (USERN),.,Division of Basic and Clinical Immunology, University of California Irvine, California, USA
| | - Seeram Ramakrishna
- Universal Scientific Education and Research Network (USERN),.,National University of Singapore, Singapore, Singapore
| | - Frank W Sellke
- Universal Scientific Education and Research Network (USERN),.,Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Armin Sorooshian
- Universal Scientific Education and Research Network (USERN),.,Department of Chemical and Environmental Engineering, University of Arizona, Tucson, AZ, USA.,Department of Hydrology and Atmospheric Sciences, University of Arizona, Tucson, AZ, USA
| | - A Wallace Hayes
- Universal Scientific Education and Research Network (USERN),.,A. Wallace Hayes, University of South, Florida College of Public Health and Institute for Integrative Toxicology, Michigan State University, East Lansing, USA
| | | | - Manoj Gupta
- Universal Scientific Education and Research Network (USERN),.,Department of Mechanical Engineering, National University of Singapore, Singapore, Singapore
| | - Leila Azadbakht
- Universal Scientific Education and Research Network (USERN),.,Department of Mechanical Engineering, National University of Singapore, Singapore, Singapore
| | - Ahmad Esmaillzadeh
- Universal Scientific Education and Research Network (USERN),.,Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Kelishadi
- Universal Scientific Education and Research Network (USERN),.,Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Esteghamati
- Universal Scientific Education and Research Network (USERN),.,Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Zahra Emam-Djomeh
- Universal Scientific Education and Research Network (USERN),.,Department of Food Science, Engineering and Technology, College of Agriculture & Natural Resources, University of Tehran, Karaj Campus, Karaj, Iran; Transfer Phenomena Laboratory (TPL), Controlled Release Center, University of Tehran, Karaj Campus, Karaj, Iran
| | - Reza Majdzadeh
- Universal Scientific Education and Research Network (USERN),.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Partha Palit
- Universal Scientific Education and Research Network (USERN),.,Department of Pharmaceutical Sciences, Drug Discovery Research Laboratorty, Assam University, Silchar, Assam, India
| | - Hamid Badali
- Universal Scientific Education and Research Network (USERN),.,Invasive Fungi Research Center and Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Idupulapati Rao
- Universal Scientific Education and Research Network (USERN),.,Centro Internacional de Agricultura Tropical (CIAT), Cali, Colombia
| | - Ali Akbar Saboury
- Universal Scientific Education and Research Network (USERN),.,Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - L Jagan Mohan Rao
- Universal Scientific Education and Research Network (USERN),.,Spice and Flavour Science Department, CSIR-Central Food Technological Research Institute, Mysore, India
| | - Hamid Ahmadieh
- Universal Scientific Education and Research Network (USERN),.,Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Montazeri
- Universal Scientific Education and Research Network (USERN),.,Population Health Research Group, Health Metrics Research Center, Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Gian Paolo Fadini
- Universal Scientific Education and Research Network (USERN),.,Department of Medicine, Division of Metabolic Diseases and, Padova Hospital, University of Padova, Padua, Italy
| | - Daniel Pauly
- Universal Scientific Education and Research Network (USERN),.,Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, BC, Canada
| | - Sabu Thomas
- Universal Scientific Education and Research Network (USERN),.,School of Chemical Sciences, Mahatma Gandhi University, Kerala, 686 560, India
| | - Ali A Moosavi-Movahed
- Universal Scientific Education and Research Network (USERN),.,Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - Asghar Aghamohammadi
- Universal Scientific Education and Research Network (USERN),.,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 14194, Iran
| | - Mehrdad Behmanesh
- Universal Scientific Education and Research Network (USERN),.,Department of Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Vafa Rahimi-Movaghar
- Universal Scientific Education and Research Network (USERN),.,Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Ghavami
- Universal Scientific Education and Research Network (USERN),.,Department of Human Anatomy and Cell Science, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 3P4, Canada.,Faculty of Medicine, Katowice School of Technology, 40-555, Katowice, Poland
| | - Roxana Mehran
- Universal Scientific Education and Research Network (USERN),.,Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai and Cardiovascular Research Foundation, New York, NY, USA
| | - Lucina Q Uddin
- Universal Scientific Education and Research Network (USERN),.,Department of Psychology, University of Miami, Miami, USA
| | - Matthias Von Herrath
- Universal Scientific Education and Research Network (USERN),.,Center for Type 1, Diabetes Research, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Bahram Mobasher
- Universal Scientific Education and Research Network (USERN),.,Department of Physics and Astronomy, University of California Riverside, Riverside, CA, 92521, USA
| | - Nima Rezaei
- Universal Scientific Education and Research Network (USERN), , . .,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 14194, Iran.
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Malysz M, Dabrowski M, Böttiger BW, Smereka J, Kulak K, Szarpak A, Jaguszewski M, Filipiak KJ, Ladny JR, Ruetzler K, Szarpak L. Resuscitation of the patient with suspected/confirmed COVID-19 when wearing personal protective equipment: A randomized multicenter crossover simulation trial. Cardiol J 2020; 27:497-506. [PMID: 32419128 DOI: 10.5603/cj.a2020.0068] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/07/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate various methods of chest compressions in patients with suspected/confirmed SARS-CoV-2 infection conducted by medical students wearing full personal protective equipment (PPE) for aerosol generating procedures (AGP). METHODS This was prospective, randomized, multicenter, single-blinded, crossover simulation trial. Thirty-five medical students after an advanced cardiovascular life support course, which included performing 2-min continuous chest compression scenarios using three methods: (A) manual chest compression (CC), (B) compression with CPRMeter, (C) compression with LifeLine ARM device. During resuscitation they are wearing full personal protective equipment for aerosol generating procedures. RESULTS The median chest compression depth using manual CC, CPRMeter and LifeLine ARM varied and amounted to 40 (38-45) vs. 45 (40-50) vs. 51 (50-52) mm, respectively (p = 0.002). The median chest compression rate was 109 (IQR; 102-131) compressions per minute (CPM) for manual CC, 107 (105-127) CPM for CPRMeter, and 102 (101-102) CPM for LifeLine ARM (p = 0.027). The percentage of correct chest recoil was the highest for LifeLine ARM - 100% (95-100), 80% (60-90) in CPRMeter group, and the lowest for manual CC - 29% (26-48). CONCLUSIONS According to the results of this simulation trial, automated chest compression devices (ACCD) should be used for chest compression of patients with suspected/confirmed COVID-19. In the absence of ACCD, it seems reasonable to change the cardiopulmonary resuscitation algorithm (in the context of patients with suspected/confirmed COVID-19) by reducing the duration of the cardiopulmonary resuscitation cycle from the current 2-min to 1-min cycles due to a statistically significant reduction in the quality of chest compressions among rescuers wearing PPE AGP.
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Affiliation(s)
- Marek Malysz
- Polish Society of Disaster Medicine, Warsaw, Poland
| | - Marek Dabrowski
- Chair and Department of Medical Education, Poznan University of Medical Sciences, Poznan, Poland
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Köln, Germany
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.,Polish Society of Disaster Medicine, Warsaw, Poland
| | | | | | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof J Filipiak
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Jerzy R Ladny
- Clinic of Emergency Medicine, Medical University of Bialystok, Bialystok, Poland.,Polish Society of Disaster Medicine, Warsaw, Poland
| | - Kurt Ruetzler
- Departments of General Anesthesiology and Outcomes Research, Cleveland Clinic, Anesthesiology Institute, Cleveland, OH, USA
| | - Lukasz Szarpak
- Lazarski University, Warsaw, Poland. .,Polish Society of Disaster Medicine, Warsaw, Poland.
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31
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Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, Tikka C, Ruotsalainen JH, Kilinc Balci FS. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2020; 5:CD011621. [PMID: 32412096 PMCID: PMC8785899 DOI: 10.1002/14651858.cd011621.pub5] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND In epidemics of highly infectious diseases, such as Ebola, severe acute respiratory syndrome (SARS), or coronavirus (COVID-19), healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Personal protective equipment (PPE) can reduce the risk by covering exposed body parts. It is unclear which type of PPE protects best, what is the best way to put PPE on (i.e. donning) or to remove PPE (i.e. doffing), and how to train HCWs to use PPE as instructed. OBJECTIVES To evaluate which type of full-body PPE and which method of donning or doffing PPE have the least risk of contamination or infection for HCW, and which training methods increase compliance with PPE protocols. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL to 20 March 2020. SELECTION CRITERIA We included all controlled studies that evaluated the effect of full-body PPE used by HCW exposed to highly infectious diseases, on the risk of infection, contamination, or noncompliance with protocols. We also included studies that compared the effect of various ways of donning or doffing PPE, and the effects of training on the same outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed the risk of bias in included trials. We conducted random-effects meta-analyses were appropriate. MAIN RESULTS Earlier versions of this review were published in 2016 and 2019. In this update, we included 24 studies with 2278 participants, of which 14 were randomised controlled trials (RCT), one was a quasi-RCT and nine had a non-randomised design. Eight studies compared types of PPE. Six studies evaluated adapted PPE. Eight studies compared donning and doffing processes and three studies evaluated types of training. Eighteen studies used simulated exposure with fluorescent markers or harmless microbes. In simulation studies, median contamination rates were 25% for the intervention and 67% for the control groups. Evidence for all outcomes is of very low certainty unless otherwise stated because it is based on one or two studies, the indirectness of the evidence in simulation studies and because of risk of bias. Types of PPE The use of a powered, air-purifying respirator with coverall may protect against the risk of contamination better than a N95 mask and gown (risk ratio (RR) 0.27, 95% confidence interval (CI) 0.17 to 0.43) but was more difficult to don (non-compliance: RR 7.5, 95% CI 1.81 to 31.1). In one RCT (59 participants) coveralls were more difficult to doff than isolation gowns (very low-certainty evidence). Gowns may protect better against contamination than aprons (small patches: mean difference (MD) -10.28, 95% CI -14.77 to -5.79). PPE made of more breathable material may lead to a similar number of spots on the trunk (MD 1.60, 95% CI -0.15 to 3.35) compared to more water-repellent material but may have greater user satisfaction (MD -0.46, 95% CI -0.84 to -0.08, scale of 1 to 5). According to three studies that tested more recently introduced full-body PPE ensembles, there may be no difference in contamination. Modified PPE versus standard PPE The following modifications to PPE design may lead to less contamination compared to standard PPE: sealed gown and glove combination (RR 0.27, 95% CI 0.09 to 0.78), a better fitting gown around the neck, wrists and hands (RR 0.08, 95% CI 0.01 to 0.55), a better cover of the gown-wrist interface (RR 0.45, 95% CI 0.26 to 0.78, low-certainty evidence), added tabs to grab to facilitate doffing of masks (RR 0.33, 95% CI 0.14 to 0.80) or gloves (RR 0.22, 95% CI 0.15 to 0.31). Donning and doffing Using Centers for Disease Control and Prevention (CDC) recommendations for doffing may lead to less contamination compared to no guidance (small patches: MD -5.44, 95% CI -7.43 to -3.45). One-step removal of gloves and gown may lead to less bacterial contamination (RR 0.20, 95% CI 0.05 to 0.77) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28) than separate removal. Double-gloving may lead to less viral or bacterial contamination compared to single gloving (RR 0.34, 95% CI 0.17 to 0.66) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28). Additional spoken instruction may lead to fewer errors in doffing (MD -0.9, 95% CI -1.4 to -0.4) and to fewer contamination spots (MD -5, 95% CI -8.08 to -1.92). Extra sanitation of gloves before doffing with quaternary ammonium or bleach may decrease contamination, but not alcohol-based hand rub. Training The use of additional computer simulation may lead to fewer errors in doffing (MD -1.2, 95% CI -1.6 to -0.7). A video lecture on donning PPE may lead to better skills scores (MD 30.70, 95% CI 20.14 to 41.26) than a traditional lecture. Face-to-face instruction may reduce noncompliance with doffing guidance more (odds ratio 0.45, 95% CI 0.21 to 0.98) than providing folders or videos only. AUTHORS' CONCLUSIONS We found low- to very low-certainty evidence that covering more parts of the body leads to better protection but usually comes at the cost of more difficult donning or doffing and less user comfort. More breathable types of PPE may lead to similar contamination but may have greater user satisfaction. Modifications to PPE design, such as tabs to grab, may decrease the risk of contamination. For donning and doffing procedures, following CDC doffing guidance, a one-step glove and gown removal, double-gloving, spoken instructions during doffing, and using glove disinfection may reduce contamination and increase compliance. Face-to-face training in PPE use may reduce errors more than folder-based training. We still need RCTs of training with long-term follow-up. We need simulation studies with more participants to find out which combinations of PPE and which doffing procedure protects best. Consensus on simulation of exposure and assessment of outcome is urgently needed. We also need more real-life evidence. Therefore, the use of PPE of HCW exposed to highly infectious diseases should be registered and the HCW should be prospectively followed for their risk of infection.
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Affiliation(s)
- Jos H Verbeek
- Cochrane Work Review Group, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Blair Rajamaki
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Sharea Ijaz
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Bronagh Blackwood
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Christina Tikka
- Finnish Institute of Occupational Health, TYÖTERVEYSLAITOS, Finland
| | | | - F Selcen Kilinc Balci
- National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Pittsburgh, PA, USA
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32
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Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S. Healthcare workers & SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19. Indian J Med Res 2020; 151:459-467. [PMID: 32611916 PMCID: PMC7530442 DOI: 10.4103/ijmr.ijmr_2234_20] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND & OBJECTIVES Healthcare workers (HCWs) are at an elevated risk of contracting COVID-19. While intense occupational exposure associated with aerosol-generating procedures underlines the necessity of using personal protective equipment (PPE) by HCWs, high-transmission efficiency of the causative agent [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] could also lead to infections beyond such settings. Hydroxychloroquine (HCQ), a repurposed antimalarial drug, was empirically recommended as prophylaxis by the National COVID-19 Task Force in India to cover such added risk. Against this background, the current investigation was carried out to identify the factors associated with SARS-CoV-2 infection among HCWs in the country. METHODS A case-control design was adopted and participants were randomly drawn from the countrywide COVID-19 testing data portal maintained by the ICMR. The test results and contact details of HCWs, diagnosed as positive (cases) or negative (controls) for SARS-CoV-2 using real-time reverse transcription-polymerase chain reaction (qRT-PCR), were available from this database. A 20-item brief-questionnaire elicited information on place of work, procedures conducted and use of PPE. RESULTS Compared to controls, cases were slightly older (34.7 vs. 33.5 yr) and had more males (58 vs. 50%). In multivariate analyses, HCWs performing endotracheal intubation had higher odds of being SARS-CoV-2 infected [adjusted odds ratio (AOR): 4.33, 95% confidence interval (CI): 1.16-16.07]. Consumption of four or more maintenance doses of HCQ was associated with a significant decline in the odds of getting infected (AOR: 0.44; 95% CI: 0.22-0.88); a dose-response relationship existed between frequency of exposure to HCQ and such reductions (χ[2] for trend=48.88; P <0.001). In addition, the use of PPE was independently associated with the reduction in odds of getting infected with SARS-CoV-2. INTERPRETATIONS & CONCLUSIONS Until results of clinical trials for HCQ prophylaxis become available, this study provides actionable information for policymakers to protect HCWs at the forefront of COVID-19 response. The public health message of sustained intake of HCQ prophylaxis as well as appropriate PPE use need to be considered in conjunction with risk homoeostasis operating at individual levels.
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Affiliation(s)
| | - Tanu Anand
- Multidisciplinary Research Unit/Model Rural Health Research Unit, New Delhi, India
| | | | - Reeta Rasaily
- Division of Reproductive Biology, Maternal Health & Child Health, New Delhi, India
| | - Ravinder Singh
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Santasabuj Das
- Division of Clinical Medicine, ICMR-National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Harpreet Singh
- Informatics, Systems & Research Management Cell, Indian Council of Medical Research, New Delhi, India
| | - Ira Praharaj
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Raman R. Gangakhedkar
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Balram Bhargava
- Department of Health Research, Ministry of Health & Family Welfare, Indian Council of Medical Research, New Delhi, India
| | - Samiran Panda
- ICMR-National AIDS Research Institute, Pune, Maharashtra, India
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33
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Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, Tikka C, Ruotsalainen JH, Kilinc Balci FS. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2020; 4:CD011621. [PMID: 32293717 PMCID: PMC7158881 DOI: 10.1002/14651858.cd011621.pub4] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND In epidemics of highly infectious diseases, such as Ebola, severe acute respiratory syndrome (SARS), or coronavirus (COVID-19), healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Personal protective equipment (PPE) can reduce the risk by covering exposed body parts. It is unclear which type of PPE protects best, what is the best way to put PPE on (i.e. donning) or to remove PPE (i.e. doffing), and how to train HCWs to use PPE as instructed. OBJECTIVES To evaluate which type of full-body PPE and which method of donning or doffing PPE have the least risk of contamination or infection for HCW, and which training methods increase compliance with PPE protocols. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL to 20 March 2020. SELECTION CRITERIA We included all controlled studies that evaluated the effect of full-body PPE used by HCW exposed to highly infectious diseases, on the risk of infection, contamination, or noncompliance with protocols. We also included studies that compared the effect of various ways of donning or doffing PPE, and the effects of training on the same outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed the risk of bias in included trials. We conducted random-effects meta-analyses were appropriate. MAIN RESULTS Earlier versions of this review were published in 2016 and 2019. In this update, we included 24 studies with 2278 participants, of which 14 were randomised controlled trials (RCT), one was a quasi-RCT and nine had a non-randomised design. Eight studies compared types of PPE. Six studies evaluated adapted PPE. Eight studies compared donning and doffing processes and three studies evaluated types of training. Eighteen studies used simulated exposure with fluorescent markers or harmless microbes. In simulation studies, median contamination rates were 25% for the intervention and 67% for the control groups. Evidence for all outcomes is of very low certainty unless otherwise stated because it is based on one or two studies, the indirectness of the evidence in simulation studies and because of risk of bias. Types of PPE The use of a powered, air-purifying respirator with coverall may protect against the risk of contamination better than a N95 mask and gown (risk ratio (RR) 0.27, 95% confidence interval (CI) 0.17 to 0.43) but was more difficult to don (non-compliance: RR 7.5, 95% CI 1.81 to 31.1). In one RCT (59 participants), people with a long gown had less contamination than those with a coverall, and coveralls were more difficult to doff (low-certainty evidence). Gowns may protect better against contamination than aprons (small patches: mean difference (MD) -10.28, 95% CI -14.77 to -5.79). PPE made of more breathable material may lead to a similar number of spots on the trunk (MD 1.60, 95% CI -0.15 to 3.35) compared to more water-repellent material but may have greater user satisfaction (MD -0.46, 95% CI -0.84 to -0.08, scale of 1 to 5). Modified PPE versus standard PPE The following modifications to PPE design may lead to less contamination compared to standard PPE: sealed gown and glove combination (RR 0.27, 95% CI 0.09 to 0.78), a better fitting gown around the neck, wrists and hands (RR 0.08, 95% CI 0.01 to 0.55), a better cover of the gown-wrist interface (RR 0.45, 95% CI 0.26 to 0.78, low-certainty evidence), added tabs to grab to facilitate doffing of masks (RR 0.33, 95% CI 0.14 to 0.80) or gloves (RR 0.22, 95% CI 0.15 to 0.31). Donning and doffing Using Centers for Disease Control and Prevention (CDC) recommendations for doffing may lead to less contamination compared to no guidance (small patches: MD -5.44, 95% CI -7.43 to -3.45). One-step removal of gloves and gown may lead to less bacterial contamination (RR 0.20, 95% CI 0.05 to 0.77) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28) than separate removal. Double-gloving may lead to less viral or bacterial contamination compared to single gloving (RR 0.34, 95% CI 0.17 to 0.66) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28). Additional spoken instruction may lead to fewer errors in doffing (MD -0.9, 95% CI -1.4 to -0.4) and to fewer contamination spots (MD -5, 95% CI -8.08 to -1.92). Extra sanitation of gloves before doffing with quaternary ammonium or bleach may decrease contamination, but not alcohol-based hand rub. Training The use of additional computer simulation may lead to fewer errors in doffing (MD -1.2, 95% CI -1.6 to -0.7). A video lecture on donning PPE may lead to better skills scores (MD 30.70, 95% CI 20.14 to 41.26) than a traditional lecture. Face-to-face instruction may reduce noncompliance with doffing guidance more (odds ratio 0.45, 95% CI 0.21 to 0.98) than providing folders or videos only. AUTHORS' CONCLUSIONS We found low- to very low-certainty evidence that covering more parts of the body leads to better protection but usually comes at the cost of more difficult donning or doffing and less user comfort, and may therefore even lead to more contamination. More breathable types of PPE may lead to similar contamination but may have greater user satisfaction. Modifications to PPE design, such as tabs to grab, may decrease the risk of contamination. For donning and doffing procedures, following CDC doffing guidance, a one-step glove and gown removal, double-gloving, spoken instructions during doffing, and using glove disinfection may reduce contamination and increase compliance. Face-to-face training in PPE use may reduce errors more than folder-based training. We still need RCTs of training with long-term follow-up. We need simulation studies with more participants to find out which combinations of PPE and which doffing procedure protects best. Consensus on simulation of exposure and assessment of outcome is urgently needed. We also need more real-life evidence. Therefore, the use of PPE of HCW exposed to highly infectious diseases should be registered and the HCW should be prospectively followed for their risk of infection.
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Affiliation(s)
- Jos H Verbeek
- Academic Medical Center, University of Amsterdam, Cochrane Work Review Group, Amsterdam, Netherlands, 1105AZ
| | - Blair Rajamaki
- University of Eastern Finland, School of Pharmacy, Kuopio, Finland
| | - Sharea Ijaz
- University of Bristol, Population Health Sciences, Bristol Medical School, Bristol, UK, BS1 2NT
| | | | | | - Bronagh Blackwood
- Queen's University Belfast, Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Wellcome-Wolfson Building, 97 Lisburn Road, Belfast, Northern Ireland, UK, BT9 7LB
| | - Christina Tikka
- Finnish Institute of Occupational Health, TYÖTERVEYSLAITOS, Finland, FI-70032
| | - Jani H Ruotsalainen
- Finnish Medicines Agency, Assessment of Pharmacotherapies, Microkatu 1, Kuopio, Finland, FI-70210
| | - F Selcen Kilinc Balci
- Centers for Disease Control and Prevention (CDC), National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH), 626 Cochrans Mill Road, Pittsburgh, PA, USA, 15236
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Kumar GP, Kulkarni AP, Govil D, Dixit SB, Chaudhry D, Samavedam S, Zirpe KG, Gopal PB, Kar A. Airway Management and Related Procedures in Critically Ill COVID-19 Patients: Position Statement of the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2020; 24:630-642. [PMID: 33024367 PMCID: PMC7519615 DOI: 10.5005/jp-journals-10071-23471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic has affected nearly all nations globally. The highly contagious nature of the disease puts the healthcare workers at high risk of acquiring infection, especially while handling airway and performing aerosol-generating procedures. The Indian Society of Critical Care Medicine, through this position paper, aims to provide guidance for safe airway management to all healthcare workers dealing with airway in COVID-19 patients.
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Affiliation(s)
- G Praveen Kumar
- Institute of Critical Care and Anesthesia, Medanta-the Medicity, Gurugram, Haryana, India
| | - Atul P Kulkarni
- Division of Critical Care Medicine, Department of Anesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Deepak Govil
- Institute of Critical Care and Anesthesia, Medanta-the Medicity, Gurugram, Haryana, India
| | - Subhal B Dixit
- Department of Critical Care, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences, Rohtak, Haryana, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
| | - Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Palepu Bn Gopal
- Division of Critical Care, CARE Hospitals, Hyderabad, Telangana, India
| | - Arindam Kar
- Institute of Critical Care, Calcutta Medical Research Institute, Kolkata, West Bengal, India
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Teufer B, Ebenberger A, Affengruber L, Kien C, Klerings I, Szelag M, Grillich L, Griebler U. Evidence-based occupational health and safety interventions: a comprehensive overview of reviews. BMJ Open 2019; 9:e032528. [PMID: 31831544 PMCID: PMC6924871 DOI: 10.1136/bmjopen-2019-032528] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Occupational injuries and diseases are a huge public health problem and cause extensive suffering and loss of productivity. Nevertheless, many occupational health and safety (OHS) guidelines are still not based on the best available evidence. In the last decade, numerous systematic reviews on behavioural, relational and mixed interventions to reduce occupational injuries and diseases have been carried out, but a comprehensive synopsis is yet missing. The aim of this overview of reviews is to provide a comprehensive basis to inform evidence-based decision-making about interventions in the field of OHS. METHODS We conducted an overview of reviews. We searched MEDLINE (Ovid), the Cochrane Library (Wiley), epistemonikos.org and Scopus (Elsevier) for relevant systematic reviews published between January 2008 and June 2018. Two authors independently screened abstracts and full-text publications and determined the risk of bias of the included systematic reviews with the ROBIS (Risk of Bias in Systematic Reviews) tool. RESULTS We screened 2287 abstracts and 200 full-texts for eligibility. Finally, we included 25 systematic reviews with a low risk of bias for data synthesis and analysis. We identified systematic reviews on the prevention of occupational injuries, musculoskeletal, skin and lung diseases, occupational hearing impairment and interventions without specific target diseases. Several interventions led to consistently positive results on individual diseases; other interventions did not show any effects, or the studies are contradictory. We provide detailed results on all included interventions. DISCUSSION To our knowledge, this is the first comprehensive overview of behavioural, relational and mixed interventions and their effectiveness in preventing occupational injuries and diseases. It provides policymakers with an important basis for making evidence-based decisions on interventions in this field. PROSPERO REGISTRATION NUMBER CRD42018100341.
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Affiliation(s)
- Birgit Teufer
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Agnes Ebenberger
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Lisa Affengruber
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Christina Kien
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Irma Klerings
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Monika Szelag
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Ludwig Grillich
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Ursula Griebler
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
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36
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Hunger I, Becker S, Frank C, Grunow R, Herzog C, Kurth A, Monazahian M, Nitsche A, Sasse J, Schulz-Weidhaas C, Wollin KM, Schaade L. [Four years after the Ebola crisis : Challenges, experiences, and implications in the German public health context]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1041-1051. [PMID: 31428830 DOI: 10.1007/s00103-019-02995-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Ebola virus disease outbreak in West Africa in 2014/2015 was by far the biggest, most prolonged, and geographically most widespread outbreak of this disease since the discovery of the Ebola virus in 1976. Although no cases of Ebola virus disease were confirmed in Germany, a number of crisis management activities were initiated.Based on a combination of local, national, and international lessons learned, literature research, and a large number of discussions among German colleagues as well as German and foreign colleagues, the experiences of selected German public health actors as well as implications for health protection activities in Germany are presented.On the one hand, preparedness for managing unusual high consequence health events-caused by rare, highly pathogenic biological agents-including the provision of adequate material and personnel resources remains important in Germany. On the other hand, more German engagement in global health is necessary, because the dividing line between global health and local health is increasingly disappearing.
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Affiliation(s)
- Iris Hunger
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland.
| | - Stephan Becker
- Institut für Virologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Christina Frank
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Roland Grunow
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Christian Herzog
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Andreas Kurth
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Masyar Monazahian
- Zentrum für Gesundheits- und Infektionsschutz, Niedersächsisches Landesgesundheitsamt, Hannover, Deutschland
| | - Andreas Nitsche
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Julia Sasse
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Claudia Schulz-Weidhaas
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Klaus-Michael Wollin
- Zentrum für Gesundheits- und Infektionsschutz, Niedersächsisches Landesgesundheitsamt, Hannover, Deutschland
| | - Lars Schaade
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
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Su CP, de Perio MA, Cummings KJ, McCague AB, Luckhaupt SE, Sweeney MH. Case Investigations of Infectious Diseases Occurring in Workplaces, United States, 2006-2015. Emerg Infect Dis 2019; 25:397-405. [PMID: 30789129 PMCID: PMC6390751 DOI: 10.3201/eid2503.180708] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Workers in specific settings and activities are at increased risk for certain infectious diseases. When an infectious disease case occurs in a worker, investigators need to understand the mechanisms of disease propagation in the workplace. Few publications have explored these factors in the United States; a literature search yielded 66 investigations of infectious disease occurring in US workplaces during 2006–2015. Reported cases appear to be concentrated in specific industries and occupations, especially the healthcare industry, laboratory workers, animal workers, and public service workers. A hierarchy-of-controls approach can help determine how to implement effective preventive measures in workplaces. Consideration of occupational risk factors and control of occupational exposures will help prevent disease transmission in the workplace and protect workers’ health.
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Bleasdale SC, Sikka MK, Moritz DC, Fritzen-Pedicini C, Stiehl E, Brosseau LM, Jones RM. Experience of Chicagoland acute care hospitals in preparing for Ebola virus disease, 2014-2015. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2019; 16:582-591. [PMID: 31283428 PMCID: PMC7157968 DOI: 10.1080/15459624.2019.1628966] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
During the 2014-2015 Ebola Virus Disease (EVD) outbreak, hospitals in the United States selected personal protective equipment (PPE) and trained healthcare personnel (HCP) in anticipation of receiving EVD patients. To improve future preparations for high-consequence infectious diseases, it was important to understand factors that affected PPE selection and training in the context of the EVD outbreak. Semistructured interviews were conducted with HCP involved with decision-making during EVD preparations at acute care hospitals in the Chicago, IL area to gather information about the PPE selection and training process. HCP who received training were surveyed about elements of training and their perceived impact and overall experience by email invitation. A total of 28 HCP from 15 hospitals were interviewed, and 55 HCP completed the survey. Factors affecting PPE selection included: changing guidance, vendor supply, performance evaluations, and perceived risk and comfort for HCP. Cost did not affect selection. PPE acquisition challenges were mitigated by: sharing within hospital networks, reusing PPE during training, and improvising with existing PPE stock. Selected PPE ensembles were similar across sites. Training included hands-on activities with trained observers, instructional videos, and simulations/drills, which were felt to increase HCP confidence. Many felt refresher training would be helpful. Hands-on training was perceived to be effective, but there is a need to establish the appropriate frequency of refresher training frequency to maintain competence. Lacking confidence in the CDC guidance, interviewed trainers described turning to other sources of information and developing independent PPE evaluation and selection. Response to emerging and/or high consequence infectious diseases would be enhanced by transparent, risk-based guidance for PPE selection and training that addresses protection level, ease of use, ensembles, and availability.
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Affiliation(s)
- Susan C. Bleasdale
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Monica K. Sikka
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Donna C. Moritz
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | | | - Emily Stiehl
- School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Lisa M. Brosseau
- School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Rachael M. Jones
- School of Public Health, University of Illinois at Chicago, Chicago, Illinois
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Verbeek JH, Rajamaki B, Ijaz S, Tikka C, Ruotsalainen JH, Edmond MB, Sauni R, Kilinc Balci FS. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2019; 7:CD011621. [PMID: 31259389 PMCID: PMC6601138 DOI: 10.1002/14651858.cd011621.pub3] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In epidemics of highly infectious diseases, such as Ebola Virus Disease (EVD) or Severe Acute Respiratory Syndrome (SARS), healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Contact precautions by means of personal protective equipment (PPE) can reduce the risk. It is unclear which type of PPE protects best, what is the best way to remove PPE, and how to make sure HCW use PPE as instructed. OBJECTIVES To evaluate which type of full body PPE and which method of donning or doffing PPE have the least risk of self-contamination or infection for HCW, and which training methods increase compliance with PPE protocols. SEARCH METHODS We searched MEDLINE (PubMed up to 15 July 2018), Cochrane Central Register of Trials (CENTRAL up to 18 June 2019), Scopus (Scopus 18 June 2019), CINAHL (EBSCOhost 31 July 2018), and OSH-Update (up to 31 December 2018). We also screened reference lists of included trials and relevant reviews, and contacted NGOs and manufacturers of PPE. SELECTION CRITERIA We included all controlled studies that compared the effects of PPE used by HCW exposed to highly infectious diseases with serious consequences, such as Ebola or SARS, on the risk of infection, contamination, or noncompliance with protocols. This included studies that used simulated contamination with fluorescent markers or a non-pathogenic virus.We also included studies that compared the effect of various ways of donning or doffing PPE, and the effects of training in PPE use on the same outcomes. DATA COLLECTION AND ANALYSIS Two authors independently selected studies, extracted data and assessed risk of bias in included trials. We planned to perform meta-analyses but did not find sufficiently similar studies to combine their results. MAIN RESULTS We included 17 studies with 1950 participants evaluating 21 interventions. Ten studies are Randomised Controlled Trials (RCTs), one is a quasi RCT and six have a non-randomised controlled design. Two studies are awaiting assessment.Ten studies compared types of PPE but only six of these reported sufficient data. Six studies compared different types of donning and doffing and three studies evaluated different types of training. Fifteen studies used simulated exposure with fluorescent markers or harmless viruses. In simulation studies, contamination rates varied from 10% to 100% of participants for all types of PPE. In one study HCW were exposed to Ebola and in another to SARS.Evidence for all outcomes is based on single studies and is very low quality.Different types of PPEPPE made of more breathable material may not lead to more contamination spots on the trunk (Mean Difference (MD) 1.60 (95% Confidence Interval (CI) -0.15 to 3.35) than more water repellent material but may have greater user satisfaction (MD -0.46; 95% CI -0.84 to -0.08, scale of 1 to 5).Gowns may protect better against contamination than aprons (MD large patches -1.36 95% CI -1.78 to -0.94).The use of a powered air-purifying respirator may protect better than a simple ensemble of PPE without such respirator (Relative Risk (RR) 0.27; 95% CI 0.17 to 0.43).Five different PPE ensembles (such as gown vs. coverall, boots with or without covers, hood vs. cap, length and number of gloves) were evaluated in one study, but there were no event data available for compared groups.Alterations to PPE design may lead to less contamination such as added tabs to grab masks (RR 0.33; 95% CI 0.14 to 0.80) or gloves (RR 0.22 95% CI 0.15 to 0.31), a sealed gown and glove combination (RR 0.27; 95% CI 0.09 to 0.78), or a better fitting gown around the neck, wrists and hands (RR 0.08; 95% CI 0.01 to 0.55) compared to standard PPE.Different methods of donning and doffing proceduresDouble gloving may lead to less contamination compared to single gloving (RR 0.36; 95% CI 0.16 to 0.78).Following CDC recommendations for doffing may lead to less contamination compared to no guidance (MD small patches -5.44; 95% CI -7.43 to -3.45).Alcohol-based hand rub used during the doffing process may not lead to less contamination than the use of a hypochlorite based solution (MD 4.00; 95% CI 0.47 to 34.24).Additional spoken instruction may lead to fewer errors in doffing (MD -0.9, 95% CI -1.4 to -0.4).Different types of trainingThe use of additional computer simulation may lead to fewer errors in doffing (MD -1.2, 95% CI -1.6 to -0.7).A video lecture on donning PPE may lead to better skills scores (MD 30.70; 95% CI 20.14,41.26) than a traditional lecture.Face to face instruction may reduce noncompliance with doffing guidance more (OR 0.45; 95% CI 0.21 to 0.98) than providing folders or videos only.There were no studies on effects of training in the long term or on resource use.The quality of the evidence is very low for all comparisons because of high risk of bias in all studies, indirectness of evidence, and small numbers of participants. AUTHORS' CONCLUSIONS We found very low quality evidence that more breathable types of PPE may not lead to more contamination, but may have greater user satisfaction. Alterations to PPE, such as tabs to grab may decrease contamination. Double gloving, following CDC doffing guidance, and spoken instructions during doffing may reduce contamination and increase compliance. Face-to-face training in PPE use may reduce errors more than video or folder based training. Because data come from single small studies with high risk of bias, we are uncertain about the estimates of effects.We still need randomised controlled trials to find out which training works best in the long term. We need better simulation studies conducted with several dozen participants to find out which PPE protects best, and what is the safest way to remove PPE. Consensus on the best way to conduct simulation of exposure and assessment of outcome is urgently needed. HCW exposed to highly infectious diseases should have their use of PPE registered and should be prospectively followed for their risk of infection in the field.
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Affiliation(s)
- Jos H Verbeek
- University of Eastern FinlandCochrane Work Review GroupKuopioFinland70201
| | - Blair Rajamaki
- University of Eastern FinlandInstitute of Public Health and Clinical Nutrition, Occupational Health UnitKuopioFinland
| | - Sharea Ijaz
- University of BristolPopulation Health Sciences, Bristol Medical SchoolBristolUKBS1 2NT
| | - Christina Tikka
- Finnish Institute of Occupational HealthCochrane Work Review GroupTYÖTERVEYSLAITOSFinlandFI‐70032
| | - Jani H Ruotsalainen
- Coronel Institute of Occupational HealthCochrane Work Review GroupAcademic Medical Center, University of AmsterdamPO Box 22700AmsterdamNetherlands1100 DE
| | - Michael B Edmond
- University of Iowa Hospitals and ClinicsC512 GH, 200 Hawkins DriveIowa CityIAUSA52241
| | - Riitta Sauni
- Finnish Institute of Occupational HealthP.O.Box 486TampereFinlandFI‐33101
| | - F Selcen Kilinc Balci
- Centers for Disease Control and Prevention (CDC)National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH)626 Cochrans Mill RoadPittsburghPAUSA15236
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Martín-Rodríguez F. Metabolic fatigue in resuscitators using personal protection equipment against biological hazard. INVESTIGACION Y EDUCACION EN ENFERMERIA 2019; 37:e04. [PMID: 31487441 PMCID: PMC7871487 DOI: 10.17533/udea.iee.v37n2e04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 06/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To describe the effects of wearing individual protection equipment against biological hazard when performing a simulated resuscitation. METHODS Uncontrolled quasi-experimental study involving 47 volunteers chosen by random sampling stratified by sex and professional category. We determined vital signs, anthropometric parameters and baseline lactate levels; subsequently, the volunteers put on level D individual protection equipment against biological hazard and performed a simulated resuscitation for 20 minutes. After undressing and 10 minutes of rest, blood was extracted again to determine lactate levels. Metabolic fatigue was defined as a level of lactic acid above 4 mmol/L at the end of the intervention. RESULTS 25.5% of the participants finished the simulation with an unfavorable metabolic tolerance pattern. The variables that predict metabolic fatigue were the level of physical activity and bone mass -in a protective form- and muscle mass. People with a low level of physical activity had ten times the probability of metabolic fatigue compared to those with higher levels of activity (44% versus 4.5%, respectively). CONCLUSIONS Professionals who present a medium or high level of physical activity tolerate resuscitation tasks better with a level D individual biological protection suit in a simulated resuscitation.
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Sterilisation in Dentistry: A Review of the Literature. Int J Dent 2019; 2019:6507286. [PMID: 30774663 PMCID: PMC6350571 DOI: 10.1155/2019/6507286] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/03/2018] [Accepted: 12/25/2018] [Indexed: 11/18/2022] Open
Abstract
In a small and medium-sized dental facility, the correct management of the sterilisation and presterilisation phases plays a fundamental role in good management of instruments and personnel, in order to ensure conditions that are more efficient with less down time. Nowadays, instrument sterilizers are increasingly efficient in achieving results, both in terms of time and size, and ensure that materials are sterile and ready to be stocked in a reasonable time. A literature search for articles related to revision work was performed using electronic databases such as PubMed, Scopus, and Google Scholar. The following keywords have been entered in the previously mentioned databases: sterilisation instruments; dental autoclave; precleaning; instruments disinfectants. The records obtained were screened by three reviewers, and only relevant articles were read full text. In addition, the timings of dental and sterilisation procedures were measured, and from these, suggestions are made in order to improve the efficiency of instrumentation management (facility used as study subject: University Dental Clinic, University of Foggia) as a function of the health-care interventions. We arrived at the conclusion that without doubt, sterilisation of instruments and products plays a fundamental role, but the efficiency of the sterilisation and presterilisation procedures cannot be separated from managing the personnel in charge by giving them specific and precise tasks.
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Making the invisible visible: Why does design matter for safe doffing of personal protection equipment? Infect Control Hosp Epidemiol 2018; 39:1375-1377. [PMID: 30277187 DOI: 10.1017/ice.2018.206] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Poller B, Hall S, Bailey C, Gregory S, Clark R, Roberts P, Tunbridge A, Poran V, Crook B, Evans C. 'VIOLET': a fluorescence-based simulation exercise for training healthcare workers in the use of personal protective equipment. J Hosp Infect 2018; 99:229-235. [PMID: 29421340 PMCID: PMC7133760 DOI: 10.1016/j.jhin.2018.01.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/30/2018] [Indexed: 01/06/2023]
Abstract
Background Healthcare workers caring for patients with high-consequence infectious diseases (HCIDs) require protection from pathogen exposure, for example by wearing personal protective equipment (PPE). Protection is acquired through the inherent safety of the PPE components, but also their safe and correct use, supported by adequate training and user familiarity. However, the evidence base for HCID PPE ensembles and any associated training is lacking, with subsequent variation between healthcare providers. Aim To develop an evidence-based assessment and training tool for evaluating PPE ensembles and doffing protocols, in the assessment of patients with suspected HCIDs. Methods VIOLET (Visualising Infection with Optimised Light for Education and Training) comprises a healthcare mannequin adapted to deliver simulated bodily fluids containing UV-fluorescent tracers. On demand and remotely operated, the mannequin projectile vomits (blue), coughs (red), has diarrhoea (yellow) and is covered in sweat (orange). Wearing PPE, healthcare staff participate in an HCID risk assessment and examination of the ‘patient’, thereby becoming exposed to these bodily fluids. Contamination of PPE is visualized and body-mapped under UV light before and after removal. Observational findings and participant feedback, around its use as a training exercise, is also recorded. Findings Significant contamination from different exposure events was seen, enabling evaluation of PPE and doffing procedures used. Observational data and participant feedback demonstrated its strengths and success as a training technique. Conclusion Simulation exercises using VIOLET provide evidence-based assessment of PPE ensembles, and are a valuable resource for training of healthcare staff in wearing and safe doffing of PPE.
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Affiliation(s)
- B Poller
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | - S Hall
- Health and Safety Executive, Buxton, UK
| | - C Bailey
- Health and Safety Executive, Buxton, UK
| | - S Gregory
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - R Clark
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - P Roberts
- Health and Safety Executive, Buxton, UK
| | - A Tunbridge
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - V Poran
- Health and Safety Executive, Leeds, UK
| | - B Crook
- Health and Safety Executive, Buxton, UK
| | - C Evans
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Den Boon S, Vallenas C, Ferri M, Norris SL. Incorporating health workers' perspectives into a WHO guideline on personal protective equipment developed during an Ebola virus disease outbreak. F1000Res 2018; 7:45. [PMID: 29527297 PMCID: PMC5820616 DOI: 10.12688/f1000research.12922.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2018] [Indexed: 11/25/2022] Open
Abstract
Background: Ebola virus disease (EVD) health facility transmission can result in infection and death of health workers. The World Health Organization (WHO) supports countries in preparing for and responding to public health emergencies, which often require developing new guidance in short timelines with scarce evidence. The objective of this study was to understand frontline physicians’ and nurses’ perspectives about personal protective equipment (PPE) use during the 2014-2016 EVD outbreak in West Africa and to incorporate these findings into the development process of a WHO rapid advice guideline. Methods
: We surveyed frontline physicians and nurses deployed to West Africa between March and September of 2014. Results: We developed the protocol, obtained ethics approval, delivered the survey, analysed the data and presented the findings as part of the evidence-to-decision tables at the expert panel meeting where the recommendations were formulated within eight weeks. Forty-four physicians and nurses responded to the survey. They generally felt at low or extremely low risk of virus transmission with all types of PPE used. Eye protection reduced the ability to provide care, mainly due to impaired visibility because of fogging. Heat and dehydration were a major issue for 76% of the participants using goggles and for 64% using a hood. Both gowns and coveralls were associated with significant heat stress and dehydration. Most participants (59%) were very confident that they were using PPE correctly. Conclusion
: Our study demonstrated that it was possible to incorporate primary data on end-users’ preferences into a rapid advice guideline for a public health emergency in difficult field conditions. Health workers perceived a balance between transmission protection and ability to care for patients effectively while wearing PPE. These findings were used by the guideline development expert panel to formulate WHO recommendations on PPE for frontline providers caring for EVD patients in outbreak conditions.
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Kwon JH, Burnham CAD, Reske KA, Liang SY, Hink T, Wallace MA, Shupe A, Seiler S, Cass C, Fraser VJ, Dubberke ER. Assessment of Healthcare Worker Protocol Deviations and Self-Contamination During Personal Protective Equipment Donning and Doffing. Infect Control Hosp Epidemiol 2017; 38:1077-1083. [PMID: 28606192 PMCID: PMC6263164 DOI: 10.1017/ice.2017.121] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate healthcare worker (HCW) risk of self-contamination when donning and doffing personal protective equipment (PPE) using fluorescence and MS2 bacteriophage. DESIGN Prospective pilot study. SETTING Tertiary-care hospital. PARTICIPANTS A total of 36 HCWs were included in this study: 18 donned/doffed contact precaution (CP) PPE and 18 donned/doffed Ebola virus disease (EVD) PPE. INTERVENTIONS HCWs donned PPE according to standard protocols. Fluorescent liquid and MS2 bacteriophage were applied to HCWs. HCWs then doffed their PPE. After doffing, HCWs were scanned for fluorescence and swabbed for MS2. MS2 detection was performed using reverse transcriptase PCR. The donning and doffing processes were videotaped, and protocol deviations were recorded. RESULTS Overall, 27% of EVD PPE HCWs and 50% of CP PPE HCWs made ≥1 protocol deviation while donning, and 100% of EVD PPE HCWs and 67% of CP PPE HCWs made ≥1 protocol deviation while doffing (P=.02). The median number of doffing protocol deviations among EVD PPE HCWs was 4, versus 1 among CP PPE HCWs. Also, 15 EVD PPE protocol deviations were committed by doffing assistants and/or trained observers. Fluorescence was detected on 8 EVD PPE HCWs (44%) and 5 CP PPE HCWs (28%), most commonly on hands. MS2 was recovered from 2 EVD PPE HCWs (11%) and 3 CP PPE HCWs (17%). CONCLUSIONS Protocol deviations were common during both EVD and CP PPE doffing, and some deviations during EVD PPE doffing were committed by the HCW doffing assistant and/or the trained observer. Self-contamination was common. PPE donning/doffing are complex and deserve additional study. Infect Control Hosp Epidemiol 2017;38:1077-1083.
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Affiliation(s)
- Jennie H. Kwon
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carey-Ann D. Burnham
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kimberly A. Reske
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephen Y. Liang
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tiffany Hink
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Meghan A. Wallace
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Angela Shupe
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sondra Seiler
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Candice Cass
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Victoria J. Fraser
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Erik R. Dubberke
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
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Abstract
The recent Ebola virus disease outbreak highlighted the need to build national and worldwide capacity to provide care for patients with highly infectious diseases. Specialized biocontainment units were successful in treating several critically ill patients with Ebola virus disease both in the United States and Europe. Several key principles underlie the care of critically ill patients in a high-containment environment. Environmental factors, staffing, equipment, training, laboratory testing, procedures, and waste management each present unique challenges. A multidisciplinary approach is key to developing effective systems and protocols to maintain the safety of patients, staff, and communities.
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Affiliation(s)
- Brian T Garibaldi
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, 1830 East Monument Street, 5th Floor, Baltimore, MD 21205, USA
| | - Daniel S Chertow
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, 10 Center Drive, Room 2C-145, Bethesda, MD 20892-1662, USA.
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Villano JS, Follo JM, Chappell MG, Collins MT. Personal Protective Equipment in Animal Research. Comp Med 2017; 67:203-214. [PMID: 28662749 PMCID: PMC5482512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 11/28/2016] [Accepted: 02/17/2017] [Indexed: 06/07/2023]
Abstract
The occupational health and safety program is an integral component of a comprehensive animal care and use program. It is important to mitigate the risk of exposures of animal care and research personnel to allergens and physical, chemical, radiologic, and biologic hazards during the conduct of various tasks. This need is especially true in infectious disease and biocontainment research. One aspect of the program is the provision of personal protective equipment (PPE). Commercially available PPE should be carefully evaluated based on their material composition and performance according to manufacturer data. To help institutions and end users by providing them guidance on choosing appropriate PPE, we here discuss the regulatory framework, device standards, and materials engineering for various PPE, including gloves, shoe covers, head caps, gowns, aprons, masks, hearing and eye protection devices, and respirators. Ultimately, the choice of appropriate PPE is based on the risk assessment, which should include consideration for personnel comfort, correct device fitting, and the containment level for the hazard used.
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Affiliation(s)
- Jason S Villano
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan;,
| | - Janet M Follo
- Department of Environment, Health and Safety, University of Michigan, Ann Arbor, Michigan
| | - Mark G Chappell
- United States Army Medical Research Institute of Infectious Diseases, United States Army, Fort Detrick, Maryland
| | - Morris T Collins
- INDA - The Association of the Nonwoven and Engineered Fabrics Industry, Cary, North Carolina
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Pennathur PR, Herwaldt LA. Role of Human Factors Engineering in Infection Prevention: Gaps and Opportunities. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2017; 9:230-249. [PMID: 32226329 PMCID: PMC7100866 DOI: 10.1007/s40506-017-0123-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Human factors engineering (HFE), with its focus on studying how humans interact with systems, including their physical and organizational environment, the tools and technologies they use, and the tasks they perform, provides principles, tools, and techniques for systematically identifying important factors, for analyzing and evaluating how these factors interact to increase or decrease the risk of Healthcare-associated infections (HAI), and for identifying and implementing effective preventive measures. We reviewed the literature on HFE and infection prevention and control and identified major themes to document how researchers and infection prevention staff have used HFE methods to prevent HAIs and to identify gaps in our knowledge about the role of HFE in HAI prevention and control. Our literature review found that most studies in the healthcare domain explicitly applying (HFE) principles and methods addressed patient safety issues not infection prevention and control issues. In addition, most investigators who applied human factors principles and methods to infection prevention issues assessed only one human factors element such as training, technology evaluations, or physical environment design. The most significant gap pertains to the limited use and application of formal HFE tools and methods. Every infection prevention study need not assess all components in a system, but investigators must assess the interaction of critical system components if they want to address latent and deep-rooted human factors problems.
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Affiliation(s)
- Priyadarshini R. Pennathur
- Department of Mechanical and Industrial Engineering, 2132 Seamans Center for the Engineering Arts and Sciences, University of Iowa, Iowa City, IA USA
| | - Loreen A. Herwaldt
- Department of Medicine, University of Iowa School of Medicine, Iowa City, IA USA
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Identifying weaknesses in national health emergency response skills and techniques with emergency responders: A cross-sectional study from China. Am J Infect Control 2017; 45:e1-e6. [PMID: 27814923 PMCID: PMC7115265 DOI: 10.1016/j.ajic.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/02/2016] [Accepted: 10/03/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND To identify the weakest skill areas perceived by participants among key skills highly demanded during emergencies and to explore factors influencing the self-rated overall skill proficiency of public health emergency responders. METHODS The participants were selected by a multistage, stratified cluster sampling method in Heilongjiang CDC to complete questionnaires that assessed their perceptions of health emergency response skills and techniques. A final sample of 1,740 staff members was obtained and analyzed. RESULTS The 5 top skill deficiency areas perceived by participants were field epidemiologic investigation, personal protection, effective nuclear and radioactive response as well as psychological interventio (for these two areas gain the equal score), and risk assessment. The logistic regression revealed personal protective skills as the most important factor contributing to the self-rated overall skill proficiency of public health emergency responders, followed by field epidemiologic investigation skills. CONCLUSIONS More attention should be given to emergency response skill training and education programs. Major obstacles hindering the promotion of key skills and techniques among front-line emergency responders should be addressed urgently. Continuous efforts should be made to remove the financial, technical, and resource obstacles to improve public health emergency response capacity.
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Kang J, O'Donnell JM, Colaianne B, Bircher N, Ren D, Smith KJ. Use of personal protective equipment among health care personnel: Results of clinical observations and simulations. Am J Infect Control 2017; 45:17-23. [PMID: 28065328 DOI: 10.1016/j.ajic.2016.08.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Very little is known about how health care personnel (HCP) actually use personal protective equipment (PPE). METHODS The clinical PPE practices of 50 HCP from selected units at the University of Pittsburgh Medical Center (UPMC) Presbyterian Hospital were videotaped with HCP consent. For 2 PPE simulation sessions (simple and full-body sets), 82 HCP were recruited throughout the UPMC system. Simulation practices were videotaped and examined using fluorescent powder with ultraviolet lighting. All participants completed an electronic survey. For a follow-up evaluation simulation, 12 HCP were recruited among simulation participants. RESULTS Among 130 total sessions from 65 participants, contamination occurred in 79.2% of simulations during the doffing process with various PPE items: simple set (92.3%) and full-body set (66.2%). Among 11 follow-up evaluation participants, contaminations still occurred in 82% after receiving individual feedback, but the overall contamination level was reduced. Using the contamination information gained during the simulation analysis, 66% of potential contamination was estimated for the clinical observation. Concerns and barriers in PPE use from HCP survey responses were as follows: time-consuming, cumbersomeness, and PPE effectiveness. CONCLUSIONS Although HCP knew they were being videotaped, contamination occurred in 79.2% of the PPE simulations. Devising better standardized PPE protocols and implementing innovative PPE education are necessary to ensure HCP safety.
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