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Van Belle TA, King EC, Roy M, Michener M, Hung V, Zagrodney KAP, McKay SM, Holness DL, Nichol KA. Factors influencing nursing professionals' adherence to facial protective equipment usage: A comprehensive review. Am J Infect Control 2024; 52:964-973. [PMID: 38657906 DOI: 10.1016/j.ajic.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Facial protective equipment (FPE) adherence is necessary for the health and safety of nursing professionals. This review was conducted to synthesize predisposing, enabling, and reinforcing factors that influence FPE adherence, and thus inform efforts to promote adherence. METHODS Articles were collected using Cumulated Index to Nursing and Allied Health Literature and MEDLINE and screened for inclusion. Included articles were original studies focused on FPE adherence by nurses to prevent respiratory infection which contained occupation-specific data from at least 10 individuals and were published in English between January 2005 and February 2022. RESULTS Thirty articles were included, 21 of which reported adherence rates. Adherence ranged from 33% to 100% for respiratory protection and 22% to 100% for eye protection. Predisposing demographic factors influencing adherence included tenure and occupation, while modifiable predisposing factors included knowledge and perception of FPE, infection transmission, and risk. Enabling factors included geography, care settings, and FPE availability. Reinforcing factors included organizational support for health and safety, clear policies, and training. CONCLUSIONS The identified demographic factors suggest populations that may benefit from targeted interventions, while modifiable factors suggest opportunities to enhance education as well as operational processes and supports. Interventions that target these areas have the potential to promote adherence and thereby improve the occupational safety of nurses.
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Affiliation(s)
| | - Emily C King
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Meghla Roy
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada
| | - Mel Michener
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada
| | - Vivian Hung
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada
| | - Katherine A P Zagrodney
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Canadian Health Workforce Network, University of Ottawa, Ottawa, Ontario, Canada
| | - Sandra M McKay
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Ted Rogers School of Management, Toronto Metropolitan University, Toronto, Ontario, Canada; The Institute for Education Research (TIER), University Health Network, Toronto, Ontario, Canada; Michener Institute of Education, University Health Network, Toronto, Ontario, Canada; Micheal Garron Hospital, Toronto East Health Network, East York, Ontario, Canada
| | - D Linn Holness
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and MAP Centre for Urban Health Solutions, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Centre for Research Expertise in Occupational Disease, Toronto, Ontario Canada
| | - Kathryn A Nichol
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Centre for Research Expertise in Occupational Disease, Toronto, Ontario Canada
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Altan E, Barmak E, Tatar EÇ, Saylam G, Korkmaz MH. Which Mask, N95 or Surgical Mask, Causes Hoarseness in Healthcare Workers? J Voice 2024:S0892-1997(24)00154-1. [PMID: 38902143 DOI: 10.1016/j.jvoice.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVES This study aimed to determine the impact of different types of masks on the voices of healthcare professionals who had to wear masks for an extended amount of time during the pandemic period and had a healthy voice. METHODS Our research included 41 healthcare workers. The participants were separated into two groups: surgical (n = 21) and N95 mask users (n = 20). Healthcare workers evaluated masks before and after wearing them for at least 8 hours throughout the workday. All subjects had a videolaryngoscopic examination; the Voice Handicap Index-10 (VHI-10), GRBAS, acoustic voice analysis (F0, jitter%, shimmer%, noise/harmonic ratio, relative average perturbation [RAP]), aerodynamic measures (maximum phonation time, MPT), and blood oxygen saturation were evaluated. RESULTS Although both groups' VHI-10 scores increased after using the mask, this rise was not statistically significant in our research. According to the GRBAS classification, voice quality deterioration was identified in 9.6% (mild-moderate) of the group using surgical masks and 15% (mild) of the group wearing N95. Only the jitter and RAP values of individuals wearing both surgical and N95 masks were determined to be statistically significant. There was no significant change in MPT following mask wear in either group. Both the surgical and N95 mask-using groups showed a substantial drop in blood oxygen saturation before and after mask usage. CONCLUSION There was no change in voice quality between healthcare workers wearing surgical and N95 masks. It has been noticed that voice perception and quality are affected by the mask's barrier effect rather than the kind of mask.
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Affiliation(s)
- Esma Altan
- Department of Otorhinolaryngology and Head and Neck Surgery, Ankara Etlik City Hospital, Ankara, Turkey.
| | - Elife Barmak
- Ankara Yıldırım Beyazıt University Department of Speech and Language Therapy, Ankara, Turkey
| | - Emel Çadallı Tatar
- Department of Otorhinolaryngology and Head and Neck Surgery, Ankara Private Practice Dr, Etlik City Hospital, Ankara, Turkey
| | - Guleser Saylam
- Department of Otorhinolaryngology and Head and Neck Surgery, Ankara Lokman Hekim Hospital, Ankara, Turkiye
| | - Mehmet Hakan Korkmaz
- Department of Otorhinolaryngology and Head and Neck Surgery, Ankara Private Practice Dr, Etlik City Hospital, Ankara, Turkey
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Wang G, Luo C, Cui C, Huang J. Study on the relationship between the fitness of three types of N95 respirators and facial dimensions. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2024; 21:319-325. [PMID: 38416473 DOI: 10.1080/15459624.2024.2311295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
N95 respirators are the core equipment used by healthcare workers to prevent the spread of respiratory diseases. The protective effect of N95 against infection spread depends on the fit of the N95 to the wearer, which is related to the wearer's facial dimensions. The purpose of this cross-sectional study was to assess the relationship between the fit of three types of N95 and facial dimensions. A total of 305 healthcare workers from ten hospitals in Beijing were recruited for this study. Facial dimensions of workers were measured using Intel RealSense Depth Camera D435. Fit testing was conducted on three types of N95 using the TSI-8038 Porta Count Pro + Respirator Fit Tester. Possible associations between the fit test results and facial dimension data were examined. A Porta Count reading of 100 was used as the criterion for an acceptable fit. The fit of the folding respirators was positively correlated with nose length (r = 0.13, p = 0.02), nose height (r = 0.14, p = 0.02), and face width (r = 0.12, p = 0.03), whereas that of flat respirators was correlated with nose width (r = 0.16, p < 0.01), chin length (r = 0.18, p < 0.01), and pro-face width (r = 0.13, p = 0.02), and that of arched respirators was correlated with the nose length (r = 0.13, p = 0.03). The fit of N95 for wearers depends on their facial features. The results of this study can provide advice for medical workers to choose the appropriate N95. Medical staff should fully consider their facial dimensions when choosing an appropriate N95 to improve the protective efficacy of respirators and to reduce the risk of infection by respiratory diseases.
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Affiliation(s)
- Guifang Wang
- Department of Infection Management and Disease Control and Prevention, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Changwei Luo
- Department of Electronic Engineering, Tsinghua University, Beijing, China
- Academy of Military Sciences, Beijing, China
| | - Can Cui
- Department of Infection Management and Disease Control and Prevention, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Jing Huang
- Department of Infection Control, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Aram SA, Wang H. Prevalence and associations between occupational diseases, emotional exhaustion, and dust mask anxiety among coal miners in Northern China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:122066-122086. [PMID: 37966655 DOI: 10.1007/s11356-023-30737-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
This study examined the prevalence and associations between occupational-related diseases, emotional exhaustion, and dust mask anxiety among coal miners in Northern China. The study sampled 506 miners from two coal mines in Northern China. Descriptive (frequency, percentages, and chi-square tests) and inferential (complementary log-log logistic regression) analyses were carried out to assess prevalence and associations. The prevalence of coal mining-related pulmonary diseases was 94%, with 40% and 37% reporting pneumoconiosis and bronchitis respectively. Emphysema and tuberculosis were less prevalent with a total prevalence of 5% while 12% of the miners reported two, three, or four of these diseases. For cardiovascular diseases, 66% of the miners reported 3H (hypertension, hyperlipemia, and hyperglycemia) while heart disease and cerebral infarction were reported by 6% and 2% of the miners respectively. Also, 5% and 2% of the miners reported two or all three of 3H, heart condition, and cerebral infarction. The overall prevalence of cardiovascular diseases was 81% while 82% and 63% of the miners reported experiencing some frequency of emotional exhaustion and dust mask anxiety respectively. The study also identified associations between mining-related diseases, emotional exhaustion, dust mask anxiety, and other demographic, personal habits and work-related factors. Miners with pulmonary diseases were more likely to experience emotional exhaustion and dust mask anxiety. Contrariwise, miners with cardiovascular diseases were less likely to experience dust mask anxiety. Factors such as age, engaging in physical exercises, rhinitis, source of pressure and shift system were also associated with emotional exhaustion and dust mask anxiety. These findings highlight the prevalence of occupational diseases, emotional exhaustion, and dust mask anxiety among coal miners in China. The study emphasizes the need for interventions to address health risks, improve work conditions, and support miners' well-being in the coal mining industry.
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Affiliation(s)
- Simon Appah Aram
- College of Safety and Emergency Management Engineering, Taiyuan University of Technology, Taiyuan, People's Republic of China.
- Center of Shanxi Engineering Research for Coal Mine Intelligent Equipment, Taiyuan University of Technology, Taiyuan, 030024, People's Republic of China.
| | - Hongwei Wang
- Center of Shanxi Engineering Research for Coal Mine Intelligent Equipment, Taiyuan University of Technology, Taiyuan, 030024, People's Republic of China
- College of Mechanical and Vehicle Engineering, Taiyuan University of Technology, Taiyuan, 030024, People's Republic of China
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Robertson I, Kortum P. The Usability of Face Coverings Used to Prevent the Spread of COVID-19. HUMAN FACTORS 2023; 65:1702-1717. [PMID: 34905433 DOI: 10.1177/00187208211051131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe the perceived usability and usability problems associated with face coverings used to prevent the spread of COVID-19. BACKGROUND Since public health experts have now identified the appropriate use of facemasks as one of the critical elements in an effective COVID mitigation strategy, understanding how people use and care for them has become important. METHOD Data were collected via a survey that was shared on social media to which 2148 people responded. Participants were asked to identify the category class of the face covering they most often wear, rate its usability, answer demographic information, and questions about their mask use and hygiene, and identify issues they may suffer in relation to face cover use. RESULTS Overall, users appear to perceive their face coverings favorably from a usability and satisfaction standpoint, even though almost two-thirds of users indicated that they experienced discomfort and problems with glasses fogging with the most popular mask types. When considering demographic information, users' political party affiliation appears related to how they perceive the usability of their face covering. CONCLUSION Designers should work to improve the fit and comfort properties of protective masks; evidence suggests the System Usability Scale may be a useful tool in those efforts. APPLICATION Understanding mask design and behavioral issues related to their use can help in the development of masks and will maximize their acceptance and effectiveness in the field.
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Affiliation(s)
- Ian Robertson
- Department of Psychological Sciences, Rice University, Houston, TX, USA
| | - Philip Kortum
- Department of Psychological Sciences, Rice University, Houston, TX, USA
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Harber P, Beckett WS. Health effects of filtering facepiece respirators: Research and clinical implications of comfort, thermal, skin, psychologic, and workplace effects. Am J Ind Med 2023; 66:1017-1032. [PMID: 37702368 DOI: 10.1002/ajim.23535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023]
Abstract
Filtering facepiece respirators (FFR's) such as N95s have become widely used in appropriate settings for personal respiratory protection and are increasingly used beyond workplace settings. Concerns about possible adverse effects have appeared in many publications, particularly since the COVID-19 pandemic led to much more widespread use. This paper synthesizes known effects based upon review of publications in PubMed since 1995, addressing effects other than pulmonary and cardiovascular (reviewed elsewhere). Findings: (1) Subjective discomfort is very frequently reported; this includes general discomfort or organ-system-specific complaints such as respiratory, headache, dermatologic, and heat. Research methods are widely divergent, and we propose a taxonomy to classify such studies by methodology, study population (subjects, experimental vs. observational methodology, comparator, specificity, and timeframe) to facilitate synthesis. (2) Objective measures of increased heat and humidity within the mask are well documented. (3) Frequency and characteristics of dermatologic effects have been insufficiently evaluated. (4) Physical mask designs are varied, making generalizations challenging. (5) More studies of impact on work performance and communication are needed. (6) Studies of effect of FFR design and accompanying training materials on ease and consistency of use are needed.
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Affiliation(s)
- Philip Harber
- Environmental Health Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - William S Beckett
- Mount Auburn Hospital (Emeritus Status), Cambridge, Massachusetts, USA
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Realmuto J, Kleinman MT, Sanger T, Lawler MJ, Smith JN. Design and testing of a sew-free origami mask for improvised respiratory protection. NANOTECHNOLOGY 2023; 35:045101. [PMID: 37625393 DOI: 10.1088/1361-6528/acf3f3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/25/2023] [Indexed: 08/27/2023]
Abstract
Respiratory aerosols with diameters smaller than 100μm have been confirmed as important vectors for the spread of diseases such as SARS-CoV-2. While disposable and cloth masks afford some protection, they are typically inefficient at filtering these aerosols and require specialized fabrication devices to produce. We describe a fabrication technique that makes use of a folding procedure (origami) to transform any filtration material into a mask. These origami masks can be fabricated by non-experts at minimal cost and effort, provide adequate filtration efficiencies, and are easily scaled to different facial sizes. Using a mannequin fit test simulator, we demonstrate that these masks can provide filtration efficiencies of over 90% while simultaneously providing greater comfort as demonstrated by pressure drops of <20 Pa. We also quantify mask leakage by measuring the variations in filtration efficiency and pressure drop when masks are sealed to the mannequin face compared to when the mask is unsealed but positioned to achieve the best fit. While leakage generally trended with pressure drop, some of the best performing mask media achieved <10% reduction in filtration efficiency due to leakage. Because this mask can provide high filtration efficiencies at low pressure drop compared to commercial alternatives, it is likely to promote greater mask wearing tolerance and acceptance.
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Affiliation(s)
- Jonathan Realmuto
- Department of Mechanical Engineering, University of California, Riverside, United States of America
| | - Michael T Kleinman
- Department of Community and Environmental Medicine, University of California, Irvine, United States of America
- School of Medicine, University of California, Irvine, United States of America
| | - Terence Sanger
- School of Medicine, University of California, Irvine, United States of America
- Department of Electrical Engineering and Computer Science, University of California, Irvine, United States of America
| | - Michael J Lawler
- Cooperative Institute for Research in Environmental Sciences, University of Colorado, Boulder, United States of America
- Department of Chemistry, University of California, Irvine, United States of America
| | - James N Smith
- Department of Chemistry, University of California, Irvine, United States of America
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Balate D, Afai G, Sallé F, Simone T, Baltazar CS, Zulliger R, Rossetto ÉV. Mask use in public places in Maputo City, Mozambique: Cross-sectional survey. PLoS One 2023; 18:e0288957. [PMID: 37531372 PMCID: PMC10395954 DOI: 10.1371/journal.pone.0288957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/10/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION The use of face masks is one of the preventive measures that Mozambique adopted in order to limit the spread of COVID-19. A study carried out from May 25 to June 6, 2020 found that although many wore masks, incorrect use was observed in 27.5% of the population observed. This data collection aimed to measure the degree of mask use compliance during a more protracted, higher second wave of transmission. METHODOLOGY A cross-sectional study was conducted in the City of Maputo from 19 to 28 October 2020 through direct observation of mask use of all individuals present in markets, supermarkets and bus terminals. The data were collected using mobile phones with the Open Data Kit Collect (ODK) data collection program. Sociodemographic characteristics, mask use, and type of mask used were documented. Factors associated with incorrect mask use were evaluated considering sex, age, observation period and location. RESULTS A total of 49,404 individuals were observed, of whom 24,977(50.6%) were male, 46,484 (94.1%) were adults and 17,549 (35.5%) were observed in the markets. An observed 41,786 (84.6%) wore a mask, of whom 33,851 (81.0%) used it correctly. Not covering the mouth and nose was common; observed in 4,649 (58.5%) of those using incorrectly. Of different types of masks, fabric masks were most often used incorrectly 7,225 (21.4%). The factors associated with incorrect mask use were female gender (OR = 1.2 [1.1-1.3], p <0.001), observation in peri-urban versus urban areas (OR = 1.9 [1.8-2.1], p <0.001) and observation during the afternoon (OR = 1.5 [1.5-1.6], p <0. 001). CONCLUSION A high proportion of observed individuals wore a mask in the context of prevention of COVID-19, however some non-use and incorrect use persists. Intensified public awareness of the correct use of the mask is recommended, especially in peri-urban areas and at the end of the day.
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Affiliation(s)
- Dionísia Balate
- Field Epidemiology Training Program, National Institute of Health, Maputo, Mozambique
| | - Gerson Afai
- Field Epidemiology Training Program, National Institute of Health, Maputo, Mozambique
| | - Faiza Sallé
- Survey and Surveillance Department, National Institute of Health, Maputo, Mozambique
| | - Timóteo Simone
- US Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Cynthia Semá Baltazar
- Survey and Surveillance Department, National Institute of Health, Maputo, Mozambique
| | - Rose Zulliger
- U.S. President's Malaria Initiative, US Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Érika Valeska Rossetto
- MassGenics assigned to US Centers for Disease Control and Prevention, Maputo, Mozambique
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Powell JB, Quinn T, Walbert G, Simons J. Evaluation of Surgical N95 Respirators Covered With Combinations of Masks and Face Shield. J Occup Environ Med 2023; 65:610-614. [PMID: 37043393 PMCID: PMC10330396 DOI: 10.1097/jom.0000000000002862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate the metabolic demands and internal breathing environments when covering an N95 with a surgical mask, cloth mask, and/or FS. METHODS Three N95 models approved by the National Institute for Occupational Safety and Health were evaluated under six covering conditions using the National Institute for Occupational Safety and Health Automated Breathing and Metabolic Simulator. All conditions used one trial with each N95 for six incremental 5-minute work rates. Inhaled oxygen and carbon dioxide concentrations, peak inhaled and exhaled pressures, and inhaled wet-bulb and dry-bulb temperatures were measured continuously and averaged across all work rates and covering conditions. CONCLUSIONS Results suggest that metabolic demands and internal breathing environments are significantly impacted by all combinations of coverings tested when compared to N95 only.
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Brooks JP, Layman J, Willis J. Physiologic effects of surgical masking in children versus adults. PeerJ 2023; 11:e15474. [PMID: 37342359 PMCID: PMC10278594 DOI: 10.7717/peerj.15474] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/07/2023] [Indexed: 06/22/2023] Open
Abstract
Background Surgical masks remain a focal part of the CDC guidelines to decrease COVID-19 transmission. Evidence refuting significant effects of masking on ventilation is mostly limited to small studies, with a paucity of studies on children, and none comparing children to adults. Methods A total of 119 subjects were enrolled (71 adults, 49 children) in a prospective interventional study with each subject serving as their own mask-free control. End tidal CO2 (ETCO2), inspired CO2 (ICO2), and respiratory rate were measured by nasal cannula attached to an anesthesia machine D-fend module. Pulse oximetry and heart rate were also followed. After the mask-free period, an ASTM Level 3 disposable surgical mask was donned and 15 min of mask-worn data were collected. Results A steady state was confirmed for ETCO2 and ICO2 over the masked period, and mean ICO2 levels rose significantly (p < 0.001) after masking in all age groups. The increase in ICO2 for the 2- to 7-year-old group of 4.11 mmHg (3.23-4.99), was significantly higher (p < 0.001) than the final ΔICO2 levels for both the 7- to 14-year-old group, 2.45 mmHg (1.79-3.12), and adults, 1.47 mmHg (1.18-1.76). For the pediatric group there was a negative, significant correlation between age and ΔICO2, r = -0.49, p < 0.001. Masking resulted in a statistically significant (p < 0.01) rise in ETCO2 levels of 1.30 mmHg in adults and 1.36 mmHg in children. The final respective ETCO2 levels, 34.35 (33.55-35.15) and 35.07 (34.13-36.01), remained within normal limits. Pulse oximetry, heart rate, and respiratory rate were not significantly affected. Discussion The physiology of mechanical dead space is discussed, including the inverse relationship of subject age vs ICO2. The methodology and results are compared to previously published studies which detracted from the physiologic safety of surgical masking. Conclusions The wearing of a surgical mask results in a statistically significant rise in ICO2 and a smaller rise in ETCO2. Because ETCO2 and other variables remain well within normal limits, these changes are clinically insignificant.
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Affiliation(s)
- J Patrick Brooks
- School of Anesthesia, Missouri State University, Springfield, Missouri, United States
- Department of Biomedical Sciences, Missouri State University, Springfield, Missouri, United States
| | - Jill Layman
- School of Anesthesia, Missouri State University, Springfield, Missouri, United States
| | - Jessica Willis
- RStats Institute, Missouri State University, Springfield, Missouri, USA
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Kumar P, Nath K, Prasad A, Tiwari LK, Chowdhry BK, Sinha AK, Chaudhary N. Effects of the Use of N95 Masks on the Vital Signs of Healthy Healthcare Workers During the COVID-19 Pandemic: A Hospital-Based Cross-Sectional Study. Cureus 2023; 15:e40622. [PMID: 37476108 PMCID: PMC10355089 DOI: 10.7759/cureus.40622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND AND AIMS The N95 filtering facepiece respirator (FR) is the most commonly recommended respiratory protection used in healthcare settings. However, concerns have been raised about its use because it can increase respiratory resistance and dead space. The primary objective of this study was to determine the effect of wearing N95 masks on the vital signs, i.e., oxygen saturation, pulse rate, and respiratory rate, of the participant health workers. Our secondary objective was to assess the subjective feeling of discomfort when wearing N95 masks. METHODS The study participants were healthy healthcare workers taking care of coronavirus disease 2019 (COVID-19)-infected pediatric cases who did at least six hours of continuous shift duty in the pediatric COVID-19 ward at a tertiary care hospital in the eastern part of India. They were evaluated for vital signs at various time intervals while wearing N95 masks. Subjective discomfort at any point in time was also noted. RESULTS We found a significant variation in the mean oxygen saturation (SpO2) and heart rate (HR) reduction across the four different points. The pair-wise comparison showed a small but significant decrease in the mean SpO2 of 98.3% (1.1) at six hours as compared with a mean SpO2 of 98.7% (0.9) at three hours. Similarly, a significant increase was noted for a mean HR of 84.7 bpm (11.2) at six hours compared with a baseline of 82.3 bpm (9.2) and 83.2 bpm (8.8) at three hours. CONCLUSION The continuous use of an N95 mask leads to a mild increase in respiratory rate. However, heart rate and oxygen saturation vary significantly at different points in time after N95 mask use.
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Affiliation(s)
- Pradeep Kumar
- Pediatrics, All India Institute of Medical Sciences, Patna, IND
| | - Kunal Nath
- Pediatrics, All India Institute of Medical Sciences, Patna, IND
| | - Arun Prasad
- Pediatrics, All India Institute of Medical Sciences, Patna, IND
| | - Lokesh K Tiwari
- Pediatrics, All India Institute of Medical Sciences, Rishikesh, IND
| | | | - Amit K Sinha
- Pediatric Surgery, All India Institute of Medical Sciences, Patna, IND
| | - Neha Chaudhary
- Community and Family Medicine, All India Institute of Medical Sciences, Patna, IND
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Steinhilber B, Seibt R, Gabriel J, Bär M, Dilek Ü, Brandt A, Martus P, Rieger MA. Influence of Face Masks on Physiological and Subjective Response during 130 Min of Simulated Light and Medium Physical Manual Work-An Explorative Study. Healthcare (Basel) 2023; 11:1308. [PMID: 37174850 PMCID: PMC10178085 DOI: 10.3390/healthcare11091308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Undesirable side effects from wearing face masks during the ongoing COVID-19 pandemic continue to be discussed and pose a challenge to occupational health and safety when recommending safe application. Only few studies examined the effects of continuously wearing a face mask for more than one hour. Therefore, the influence of wearing a medical mask (MedMask) and a filtering facepiece class II respirator (FFP2) on the physiological and subjective outcomes in the course of 130 min of manual work was exploratively investigated. Physical work load and cardiorespiratory fitness levels were additionally considered as moderating factors. METHODS Twenty-four healthy subjects (12 females) from three different cardiorespiratory fitness levels each performed 130 min of simulated manual work with light and medium physical workload using either no mask, a MedMask or FFP2. Heart rate, transcutaneous oxygen and carbon dioxide partial pressure (PtcO2, PtcCO2) as well as perceived physical exertion and respiratory effort were assessed continuously at discrete time intervals. Wearing comfort of the masks were additionally rated after the working period. RESULTS There was no difference in time-dependent changes of physiological outcomes when using either a MedMask or a FFP2 compared to not wearing a mask. A stronger increase over time in perceived respiratory effort occurred when the face masks were worn, being more prominent for FFP2. Physical workload level and cardiorespiratory fitness level were no moderating factors and higher wearing comfort was rated for the MedMask. CONCLUSION Our results suggest that using face masks during light and medium physical manual work does not induce detrimental side effects. Prolonged wearing episodes appeared to increase respiratory effort, but without affecting human physiology in a clinically relevant way.
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Affiliation(s)
- Benjamin Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (M.B.); (Ü.D.); (A.B.); (M.A.R.)
| | - Robert Seibt
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (M.B.); (Ü.D.); (A.B.); (M.A.R.)
| | - Julia Gabriel
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (M.B.); (Ü.D.); (A.B.); (M.A.R.)
| | - Mona Bär
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (M.B.); (Ü.D.); (A.B.); (M.A.R.)
| | - Ümütyaz Dilek
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (M.B.); (Ü.D.); (A.B.); (M.A.R.)
| | - Adrian Brandt
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (M.B.); (Ü.D.); (A.B.); (M.A.R.)
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, Medical Faculty, University Hospital Tuebingen, 72076 Tuebingen, Germany;
| | - Monika A. Rieger
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany; (R.S.); (J.G.); (M.B.); (Ü.D.); (A.B.); (M.A.R.)
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Kisielinski K, Hirsch O, Wagner S, Wojtasik B, Funken S, Klosterhalfen B, Kanti Manna S, Prescher A, Sukul P, Sönnichsen A. Physio-metabolic and clinical consequences of wearing face masks-Systematic review with meta-analysis and comprehensive evaluation. Front Public Health 2023; 11:1125150. [PMID: 37089476 PMCID: PMC10116418 DOI: 10.3389/fpubh.2023.1125150] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/17/2023] [Indexed: 04/08/2023] Open
Abstract
Background As face masks became mandatory in most countries during the COVID-19 pandemic, adverse effects require substantiated investigation. Methods A systematic review of 2,168 studies on adverse medical mask effects yielded 54 publications for synthesis and 37 studies for meta-analysis (on n = 8,641, m = 2,482, f = 6,159, age = 34.8 ± 12.5). The median trial duration was only 18 min (IQR = 50) for our comprehensive evaluation of mask induced physio-metabolic and clinical outcomes. Results We found significant effects in both medical surgical and N95 masks, with a greater impact of the second. These effects included decreased SpO2 (overall Standard Mean Difference, SMD = -0.24, 95% CI = -0.38 to -0.11, p < 0.001) and minute ventilation (SMD = -0.72, 95% CI = -0.99 to -0.46, p < 0.001), simultaneous increased in blood-CO2 (SMD = +0.64, 95% CI = 0.31-0.96, p < 0.001), heart rate (N95: SMD = +0.22, 95% CI = 0.03-0.41, p = 0.02), systolic blood pressure (surgical: SMD = +0.21, 95% CI = 0.03-0.39, p = 0.02), skin temperature (overall SMD = +0.80 95% CI = 0.23-1.38, p = 0.006) and humidity (SMD +2.24, 95% CI = 1.32-3.17, p < 0.001). Effects on exertion (overall SMD = +0.9, surgical = +0.63, N95 = +1.19), discomfort (SMD = +1.16), dyspnoea (SMD = +1.46), heat (SMD = +0.70), and humidity (SMD = +0.9) were significant in n = 373 with a robust relationship to mask wearing (p < 0.006 to p < 0.001). Pooled symptom prevalence (n = 8,128) was significant for: headache (62%, p < 0.001), acne (38%, p < 0.001), skin irritation (36%, p < 0.001), dyspnoea (33%, p < 0.001), heat (26%, p < 0.001), itching (26%, p < 0.001), voice disorder (23%, p < 0.03), and dizziness (5%, p = 0.01). Discussion Masks interfered with O2-uptake and CO2-release and compromised respiratory compensation. Though evaluated wearing durations are shorter than daily/prolonged use, outcomes independently validate mask-induced exhaustion-syndrome (MIES) and down-stream physio-metabolic disfunctions. MIES can have long-term clinical consequences, especially for vulnerable groups. So far, several mask related symptoms may have been misinterpreted as long COVID-19 symptoms. In any case, the possible MIES contrasts with the WHO definition of health. Conclusion Face mask side-effects must be assessed (risk-benefit) against the available evidence of their effectiveness against viral transmissions. In the absence of strong empirical evidence of effectiveness, mask wearing should not be mandated let alone enforced by law. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256694, identifier: PROSPERO 2021 CRD42021256694.
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Affiliation(s)
- Kai Kisielinski
- Orthopaedic and Trauma Surgery, Clinical Medicine, Private Practice, Düsseldorf, Germany
| | - Oliver Hirsch
- Department of Psychology, Fachhochschule für Oekonomie und Management (FOM) University of Applied Sciences, Siegen, Germany
| | - Susanne Wagner
- Veterinary Medicine, Wagner Medical Science Liason (MSL) Management, Blankenfelde-Mahlow, Germany
| | - Barbara Wojtasik
- Department of Genetics and Biosystematics, Faculty of Biology, University of Gdańsk, Gdansk, Poland
| | - Stefan Funken
- Internal Medicine, Clinical Medicine, Private Practice, Moers, Germany
| | | | - Soumen Kanti Manna
- Biophysics and Structural Genomics Division, Saha Institute of Nuclear Physics, Kolkata, India
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy (MOCA), Rhine-Westphalia Technical University of Aachen, Aachen, Germany
| | - Pritam Sukul
- Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Department of Anesthesiology and Intensive Care, University Medicine Rostock, Rostock, Germany
| | - Andreas Sönnichsen
- Internal Medicine, Clinical Medicine, Private Practice, Gesundheit für Österreich e.V. (Health for Austria), Vienna, Austria
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14
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Kisielinski K, Wagner S, Hirsch O, Klosterhalfen B, Prescher A. Possible toxicity of chronic carbon dioxide exposure associated with face mask use, particularly in pregnant women, children and adolescents - A scoping review. Heliyon 2023; 9:e14117. [PMID: 37057051 PMCID: PMC9981272 DOI: 10.1016/j.heliyon.2023.e14117] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction During the SARS-CoV-2-pandemic, face masks have become one of the most important ubiquitous factors affecting human breathing. It increases the resistance and dead space volume leading to a re-breathing of CO2. So far, this phenomenon and possible implications on early life has not been evaluated in depth. Method As part of a scoping review, literature was systematically reviewed regarding CO2 exposure and facemask use. Results Fresh air has around 0.04% CO2, while wearing masks more than 5 min bears a possible chronic exposure to carbon dioxide of 1.41% to 3.2% of the inhaled air. Although the buildup is usually within the short-term exposure limits, long-term exceedances and consequences must be considered due to experimental data. US Navy toxicity experts set the exposure limits for submarines carrying a female crew to 0.8% CO2 based on animal studies which indicated an increased risk for stillbirths. Additionally, mammals who were chronically exposed to 0.3% CO2 the experimental data demonstrate a teratogenicity with irreversible neuron damage in the offspring, reduced spatial learning caused by brainstem neuron apoptosis and reduced circulating levels of the insulin-like growth factor-1. With significant impact on three readout parameters (morphological, functional, marker) this chronic 0.3% CO2 exposure has to be defined as being toxic. Additional data exists on the exposure of chronic 0.3% CO2 in adolescent mammals causing neuron destruction, which includes less activity, increased anxiety and impaired learning and memory. There is also data indicating testicular toxicity in adolescents at CO2 inhalation concentrations above 0.5%. Discussion There is a possible negative impact risk by imposing extended mask mandates especially for vulnerable subgroups. Circumstantial evidence exists that extended mask use may be related to current observations of stillbirths and to reduced verbal motor and overall cognitive performance in children born during the pandemic. A need exists to reconsider mask mandates.
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Affiliation(s)
- Kai Kisielinski
- Independent Researcher, Surgeon, Private Practice, 40212 Düsseldorf, Germany
| | - Susanne Wagner
- Non Clinical Expert, Veterinarian, Wagner MSL Management, 15831 Mahlow, Germany
| | - Oliver Hirsch
- Department of Psychology, FOM University of Applied Sciences, 57078 Siegen, Germany
| | | | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy (MOCA), 52074 Aachen, Germany
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15
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Fang Z, Mao Y, Zhu Y, Lu J, Zheng Z, Chen X. Human thermal physiological response of wearing personal protective equipment: An educational building semi-open space experimental investigation. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 877:162779. [PMID: 36924973 PMCID: PMC10014506 DOI: 10.1016/j.scitotenv.2023.162779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 05/03/2023]
Abstract
With the outbreak and spread of the COVID-19 epidemic, HCWs are frequently required to wear personal protective equipment (PPE) for nucleic acid sample collection in semi-open transition spaces. Wearing PPE causes significant psychological and physical stress in HCWs. In this study, operative temperature (Top) and wet-bulb globe temperature (WBGT) were used to assess thermal conditions through field experiments, while multiple physiological parameters were measured in the subjects. The results indicated that the subjects showed statistically significant differences in thermal perception and physiological parameters with and without PPE. Using observed increases in heart rate (HR), auditory canal temperature (Tac), mean skin temperature (MST), and end-tidal CO2 pressure, subjects were shown to have an increased metabolic rate and heat storage while wearing PPE. Additionally, a decrease in oxygen concentration was also observed, and this decrease may be linked to fatigue and cognitive impairment. Moreover, HR, MST, and Tac showed a significant linear relationship, which increased with temperature and operative temperature, and the HR response was stronger with PPE than without PPE. The neutral, preferred, and acceptable temperatures were significantly lower with PPE than without PPE, and the deviations for neutral Top/WBGT were 9.5/7.1 °C and preferred Top/WBGT was 2.2/4.0 °C, respectively. Moreover, the upper limits of acceptable WBGT, 29.4 °C with PPE and 20.4 °C without PPE, differed significantly between the two phases. Furthermore, the recorded physiological parameter responses and thermal perception responses of the subjects while wearing PPE indicated that they were at risk of thermal stress. Overall, these results suggest that people who wear PPE should focus on their health and thermal stress. This study provides a reference for the development of strategies to counteract heat stress and improve thermal comfort.
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Affiliation(s)
- Zhaosong Fang
- School of Civil Engineering, Guangzhou University, Guangzhou, China
| | - Yudong Mao
- School of Civil Engineering, Guangzhou University, Guangzhou, China
| | - Yongcheng Zhu
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiaxin Lu
- School of Civil Engineering, Guangzhou University, Guangzhou, China
| | - Zhimin Zheng
- School of Civil Engineering, Guangzhou University, Guangzhou, China.
| | - Xiaohui Chen
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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16
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Metin KM, Semercioğlu CS, Hatipoğlu ÇA, Esmer H, Kayretli H, İnan LE, Kınıklı S, Yoldaş TK. Headache caused by the use of personal protective equipment in healthcare workers during the COVID-19 pandemic period. Heliyon 2023; 9:e14493. [PMID: 36942249 PMCID: PMC10008808 DOI: 10.1016/j.heliyon.2023.e14493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
Objective Coronavirus 2019 disease (COVID-19), the cause of the ongoing pandemic, is an acute respiratory tract infection, which has made it necessary for healthcare personnel to use protective equipment such as N95 masks, protective goggles and visors. External compression headaches caused by the compression of the pericranial soft tissues by wearing hats, helmets, or goggles (worn during swimming or diving) have been previously described. In our study, we aimed to evaluate the presence and characteristics of personal protective equipment-associated headaches in healthcare workers during the COVID-19 pandemic period and to determine the effects of such headaches. Materials and methods A face-to-face questionnaire was delivered to 300 male and female healthcare personnel between the ages of 18-56 working in healthcare units where COVID-19 patients were evaluated and treated. The data from 296 completed questionnaires was evaluated. Results We included 296 participants (166 females and 130 males) in our study; the mean age was 33.98 ± 8.52 years (range 18-56). One hundred ninety-six (66.22%) participants indicated that they had new onset personal protective equipment-associated headaches. Percentages of those with newly emergent headaches because of protective equipment were higher in the following participant groups: females (p = 0.045), those with COVID-19 disease history (p < 0.001), and those diagnosed with headaches before the pandemic (p = 0.001). Conclusion Our study showed the presence of new-onset headaches associated with personal protective equipment in healthcare workers during the COVID-19 pandemic. Personal protective equipment-related headaches were associated with the following factors: female sex, a history of COVID-19 disease, and the presence of primary headaches diagnosed before the pandemic.
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Affiliation(s)
- Kübra Mehel Metin
- Ministry of Health Ankara Training and Research Hospital, Neurology Clinic, Ankara, Turkey
| | | | - Çiğdem Ataman Hatipoğlu
- Ministry of Health Ankara Training and Research Hospital, İnfectious Diseases Clinic, Ankara, Turkey
| | - Hüseyin Esmer
- Ministry of Health Ankara Training and Research Hospital, İnfectious Diseases Clinic, Ankara, Turkey
| | - Hatice Kayretli
- Ministry of Health Ankara Training and Research Hospital, İnfectious Diseases Clinic, Ankara, Turkey
| | - Levent Ertuğrul İnan
- Ministry of Health Ankara Training and Research Hospital, Neurology Clinic, Ankara, Turkey
| | - Sami Kınıklı
- Ministry of Health Ankara Training and Research Hospital, İnfectious Diseases Clinic, Ankara, Turkey
| | - Tahir Kurtuluş Yoldaş
- Ministry of Health Ankara Training and Research Hospital, Neurology Clinic, Ankara, Turkey
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17
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Harber P, Beckett WS. Health effects of filtering facepiece respirators: Systematic review of pulmonary and cardiovascular effects. Am J Ind Med 2023; 66:181-198. [PMID: 36464991 PMCID: PMC9878161 DOI: 10.1002/ajim.23450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/11/2022]
Abstract
Filtering facepiece respirators (FFRs) were introduced to protect the wearer by removing small particles from inspired air. FFRs are now also used to reduce the spread of transmissible agents from the wearer and are worn outside traditional healthcare and other workplaces. The COVID-19 pandemic increased concerns about potential adverse effects on wearers. A PUBMED query retrieved articles through June 2022. Abstracts and selected full-text articles were systematically reviewed by the authors. This article focuses upon cardiopulmonary physiologic effects (e.g., ventilation, CO2 elimination, oxygen uptake, and respiratory control) with emphasis upon current and potential research methods as well as summarizing results. 1985 records were identified, of which only 26% were published before 2020. FFR effects on CO2 elimination appear more likely to be significant than effects on oxygenation or cardiovascular function. While FFRs appear well tolerated by healthy persons, more research is needed for those with pulmonary or cardiac disorders, and for children. Many traditional pulmonary exercise study methods require special care when applied to filtering facepiece respirators. Studying additional parameters may explain the paradox of many subjective discomfort reports despite very limited physiologic effects.
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Affiliation(s)
- Philip Harber
- University of Arizona‐Mel and Enid Zuckerman College of Public HealthTucsonArizonaUSA
| | - William S. Beckett
- Harvard Medical School and Mount Auburn HospitalCambridgeMassachusettsUSA
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18
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Zhu Y, Mao Y, Li Y, Tang T, Jiang H, Qiao S, Lin S, Zheng Z, Fang Z, Chen X. Field investigation of the heat stress in outdoor of healthcare workers wearing personal protective equipment in South China. Front Public Health 2023; 11:1166056. [PMID: 37143989 PMCID: PMC10151780 DOI: 10.3389/fpubh.2023.1166056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/20/2023] [Indexed: 05/06/2023] Open
Abstract
Since the advent of coronavirus disease 2019 (COVID-19), healthcare workers (HCWs) wearing personal protective equipment (PPE) has become a common phenomenon. COVID-19 outbreaks overlap with heat waves, and healthcare workers must unfortunately wear PPE during hot weather and experience excessive heat stress. Healthcare workers are at risk of developing heat-related health problems during hot periods in South China. The investigation of thermal response to heat stress among HCWs when they do not wear PPE and when they finish work wearing PPE, and the impact of PPE use on HCWs' physical health were conducted. The field survey were conducted in Guangzhou, including 11 districts. In this survey, HCWs were invited to answer a questionnaire about their heat perception in the thermal environment around them. Most HCWs experienced discomfort in their back, head, face, etc., and nearly 80% of HCWs experienced "profuse sweating." Up to 96.81% of HCWs felt "hot" or "very hot." The air temperature had a significant impact on thermal comfort. Healthcare workers' whole thermal sensation and local thermal sensation were increased significantly by wearing PPE and their thermal sensation vote (TSV) tended towards "very hot." The adaptive ability of the healthcare workers would decreased while wearing PPE. In addition, the accept range of the air temperature (T a) were determined in this investigation. Graphical Abstract.
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Affiliation(s)
- Yongcheng Zhu
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yudong Mao
- School of Civil Engineering, Guangzhou University, Guangzhou, China
| | - Yanling Li
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tianwei Tang
- School of Civil Engineering, Guangzhou University, Guangzhou, China
| | - Huilin Jiang
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Sicheng Qiao
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shaopeng Lin
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhimin Zheng
- School of Civil Engineering, Guangzhou University, Guangzhou, China
| | - Zhaosong Fang
- School of Civil Engineering, Guangzhou University, Guangzhou, China
- Zhaosong Fang,
| | - Xiaohui Chen
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- *Correspondence: Xiaohui Chen,
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Grafeneder J, Fuhrmann V, Tscherny K, Niederer M, Schreiber W, Herkner H, Roth D, Kienbacher CL. COVID-19: Masks do not influence neurocognitive performance during a shift at the emergency department. World J Emerg Med 2023; 14:317-321. [PMID: 37425077 PMCID: PMC10323511 DOI: 10.5847/wjem.j.1920-8642.2023.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/27/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- Jürgen Grafeneder
- Department of Emergency Medicine, Medical University of Vienna, Wien 1090, Austria
| | - Verena Fuhrmann
- Department of Emergency Medicine, Medical University of Vienna, Wien 1090, Austria
| | - Katharina Tscherny
- Department of Emergency Medicine, Medical University of Vienna, Wien 1090, Austria
- Department of Anaesthesiology and Intensive Care, Hospital Scheibbs, Scheibbs 3270, Austria
| | - Maximilian Niederer
- Department of Emergency Medicine, Medical University of Vienna, Wien 1090, Austria
- Department of Anaesthesiology and Intensive Care, Hospital Scheibbs, Scheibbs 3270, Austria
| | - Wolfgang Schreiber
- Department of Emergency Medicine, Medical University of Vienna, Wien 1090, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Wien 1090, Austria
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, Wien 1090, Austria
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Jain VM, Parihar SRS, Acharya S, Acharya S. Effects of wearing personal protective equipment (PPE) and its role in affecting the work efficiency of dentists during the COVID-19 pandemic. Work 2023; 76:3-10. [PMID: 36872823 DOI: 10.3233/wor-220083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The risk of exposure to COVID-19 infection through droplets/aerosol in dental clinics has renewed focus on the utility and possible adverse effects of using personal protective equipment (PPE) on dentists. OBJECTIVE To obtain information from a cross-section of dentists regarding their PPE usage and to evaluate the possible risk factors that can influence their work efficiency. METHODS A 31-item cross-sectional survey with a structured multiple-choice questionnaire was designed. Social media and emails were used to circulate the questionnaire among dental professionals worldwide. A total of 317 respondents returned the completed forms. RESULTS A total of 184 (55%) participants reported getting soaking wet while wearing PPE at the end of the working hours (approximately eight hours of working). Many respondents (n = 286, 90%) reported that the use of PPE resulted in reduced visibility of the operating field. The majority of respondents (84%) felt that their overall work efficiency had reduced after using PPE. Binary logistic regression had shown that two significant factors that were associated with reduced work efficiency included, pre-existing systemic illness and getting soaking wet from wearing a PPE. CONCLUSION Definite protocols should be introduced that mandate the doffing of PPE for every patient, in a separate well-ventilated area where the skin can recuperate from the heat and pressure points caused by the PPE. Dentists should take greater care in choosing the appropriate PPE to prevent exacerbation of pre-existing illnesses, which may reduce their work efficiency.
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Affiliation(s)
- Vedushi M Jain
- Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | | | - Shruthi Acharya
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Shashidhar Acharya
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, India
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21
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Lima GLDS, Rocha TC, Silva Júnior GPDLD, Martins MT. The influence of N95 and FFP2 masks on cardiorespiratory variables in healthy individuals during aerobic exercise: a systematic review and meta-analysis. J Bras Pneumol 2023; 49:e20220143. [PMID: 36946844 PMCID: PMC10171276 DOI: 10.36416/1806-3756/e20220143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 01/12/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE In view of the current COVID-19 pandemic, the objective of this study was to determine, through a systematic review and meta-analysis, whether the use of N95/FFP2 masks during aerobic exercise has a significant impact on HR, RR, SpO2, and blood pressure (BP) in healthy individuals. METHODS We searched the MEDLINE database for studies published in English between 2005 and 2021. To reduce bias and increase reliability, only randomized controlled trials and randomized crossover clinical trials were considered for inclusion. The selected outcomes included HR, RR, SpO2, and BP, with perceived exertion being evaluated by means of the Borg scale. RESULTS Eight controlled trials were included in the meta-analysis. Seven evaluated HR (p > 0.05), five evaluated RR (p > 0.05), five evaluated SpO2 and BP (p > 0.05 for both), and six evaluated perceived exertion, presenting controversial results such as risk ratios that were grouped for each variable. CONCLUSIONS This study suggests that N95 and FFP2 masks do not have significant effects on HR, RR, SpO2, and BP during aerobic exercise in healthy individuals.
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Affiliation(s)
- Gustavo Lucas da Silva Lima
- . Faculdade de Ciências Médicas e da Saúde de Juiz de Fora - SUPREMA - Juiz de Fora (MG) Brasil
- . Hospital Maternidade Therezinha de Jesus, Juiz de Fora (MG) Brasil
| | - Thiago Casali Rocha
- . Faculdade de Ciências Médicas e da Saúde de Juiz de Fora - SUPREMA - Juiz de Fora (MG) Brasil
- . Hospital Maternidade Therezinha de Jesus, Juiz de Fora (MG) Brasil
| | | | - Marcelo Tarcísio Martins
- . Faculdade de Ciências Médicas e da Saúde de Juiz de Fora - SUPREMA - Juiz de Fora (MG) Brasil
- . Hospital Maternidade Therezinha de Jesus, Juiz de Fora (MG) Brasil
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22
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Farag S, ElSadek A, Salah-Eldin W, Georgy SS, Fathy M. Characteristics, causes and impact of headache among a sample of physicians working during COVID-19 pandemic. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:86. [PMID: 35855737 PMCID: PMC9281347 DOI: 10.1186/s41983-022-00520-7] [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: 03/15/2022] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Headache is considered a common health problem affecting physicians during Coronavirus disease-19 (COVID-19) pandemic and has direct impact on their productivity. Wearing personal protective equipment (PPE), stress and lack of sleep are common factors affecting their headache.
Results
Out of 165 participants, 38(23%) experienced new onset headache. Participants using Combined Face and eye PPE usage were at higher risk of developing headache compared to single PPE users, Participants wearing face shield were at higher risk of developing headache compared to eyewear non users.
Conclusion
COVID-19 hospital’s physicians may experience new-onset headache or change in their previously existing headache, mostly disposed by PPE eyewear and combined face and eye PPE.
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23
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Ginszt M, Zieliński G, Szkutnik J, Wójcicki M, Baszczowski M, Litko-Rola M, Zielińska D, Różyło-Kalinowska I. The Difference in Electromyographic Activity While Wearing a Medical Mask in Women with and without Temporomandibular Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315559. [PMID: 36497634 PMCID: PMC9737111 DOI: 10.3390/ijerph192315559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 05/27/2023]
Abstract
Wearing a medical mask influences resting activity of the temporalis anterior and masseter muscles in healthy young women. However, no studies link medical mask-wearing with masticatory muscle activity in patients with temporomandibular disorders (TMDs). Therefore, this study aims to compare electromyographic patterns while wearing a medical mask between women with and without temporomandibular disorders. Based on the Research Diagnostic Criteria for Temporomandibular Disorders, 115 adult women qualified for the study. Participants were divided into the following two groups: diagnosed TMDs (n = 55; mean age: 23.5 ± 2.3 years) and healthy women (n = 60; mean age: 23.7 ± 2.6 years). Examinations of the resting and functional electromyographic activity of the temporalis anterior (TA), superficial masseter (MM), anterior bellies of the digastric muscle (DA), and the middle part of the sternocleidomastoid muscle (SCM) were carried out using the BioEMG III™. Both groups showed statistically significant decreases in resting masticatory muscle activity during medical mask examination compared to no mask measurement. The significant differences in no mask measurement between both groups were noted regarding resting masticatory activity, clenching in the intercuspal position, and clenching on dental cotton rollers. During medical mask examination, women with TMDs showed differences in resting masticatory activity and clenching on dental cotton rollers compared to the healthy group. In all analyzed variables, both groups showed similar electromyographic patterns in the maximum mouth opening measurement during medical mask and no mask examination. A medical mask influences the resting bioelectric activity of the masticatory muscles in women with temporomandibular disorders and healthy women. We observed differences and some similarities in resting and functional electromyographic patterns within masticatory and neck muscles in both groups during medical mask and no mask examination.
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Affiliation(s)
- Michał Ginszt
- Department of Rehabilitation and Physiotherapy, Medical University of Lublin, 20-093 Lublin, Poland
| | - Grzegorz Zieliński
- Department of Sports Medicine, Medical University of Lublin, 20-093 Lublin, Poland
| | - Jacek Szkutnik
- Independent Unit of Functional Masticatory Disorders, Medical University of Lublin, 20-093 Lublin, Poland
| | - Marcin Wójcicki
- Independent Unit of Functional Masticatory Disorders, Medical University of Lublin, 20-093 Lublin, Poland
| | - Michał Baszczowski
- Interdisciplinary Scientific Group of Sports Medicine, Department of Sports Medicine, Medical University of Lublin, 20-093 Lublin, Poland
| | - Monika Litko-Rola
- Independent Unit of Functional Masticatory Disorders, Medical University of Lublin, 20-093 Lublin, Poland
| | - Diana Zielińska
- Independent Unit of Functional Masticatory Disorders, Medical University of Lublin, 20-093 Lublin, Poland
| | - Ingrid Różyło-Kalinowska
- Department of Dental and Maxillofacial Radiodiagnostics, Medical University of Lublin, 20-093 Lublin, Poland
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Guan X, Lin J, Han J, Gao X, Zhang Y, Hu B, Guidoin R, Wang L. Prolonged Use of Surgical Masks and Respirators Affects the Protection and Comfort for Healthcare Workers. MATERIALS (BASEL, SWITZERLAND) 2022; 15:ma15227918. [PMID: 36431403 PMCID: PMC9696921 DOI: 10.3390/ma15227918] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 05/24/2023]
Abstract
This study explored the ideal period for wearing masks to prevent the physiological and psychological problems associated with long-term face mask use during respiratory infections by healthcare workers. Breathing simulators, surgical masks (SM) and medical respirators (PM) were prepared for two to eight hours. Changes in the comfort of masks (facial skin temperature, breathing resistance, and moisture permeability) and protection (filtration efficiency, resistance to blood penetration, and colony count) were assessed. The results demonstrated that the masks offered efficient liquid-particle filtering even after eight hours of use. However, the number of bacterial colonies using PM and SM grew significantly after two and four hours, respectively. Concerning comfort, the inspiratory resistance of masks rose dramatically after two hours, whereas the moisture permeability declined considerably after four hours. In addition, skin temperature had a significant increase within two hours, which may result in facial discomfort. When conditions permitted, the hospital staff was instructed to replace their masks every two hours.
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Affiliation(s)
- Xiaoning Guan
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Jing Lin
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Jiaxiang Han
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Xiaodong Gao
- Department of Hospital Infection Management, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ying Zhang
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Bijie Hu
- Department of Hospital Infection Management, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Robert Guidoin
- LOEX, Division of Regenerative Medicine, Centre de Recherche du CHU, Université Laval, Quebec City, QU G1V 0A6, Canada
- Department of Surgery, Faculty of Medicine, Université Laval, Quebec City, QU G1V 0A6, Canada
| | - Lu Wang
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
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Novák M, Gloor C, Wicki E, Herb D, Schibli A, Richner G. Assessment of a novel, easy-to-implement, aerosolized H 2O 2 decontamination method for single-use filtering facepiece respirators in case of shortage. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2022; 19:663-675. [PMID: 36107018 DOI: 10.1080/15459624.2022.2125519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has affected the world and caused a supply shortage of personal protection equipment, especially filtering facepiece respirators (FFP). This has increased the risk of many healthcare workers contracting SARS-CoV-2. Various strategies have been assessed to tackle these supply issues. In critical shortage scenarios, reusing single-use-designed respirators may be required. Thus, an easily applicable and reliable FFP2 (or alike) respirator decontamination method, allowing safe re-use of FFP2 respirators by healthcare personnel, has been developed and is presented in this study. A potent and gentle aerosolized hydrogen peroxide (12% wt) method was applied over 4 hr to decontaminate various brands of FFP2 respirators within a small common room, followed by adequate aeration and storage overnight. The microbial efficacy was tested on unused respirator pieces using spores of Geobacillus stearothermophilus. Further, decontamination effectiveness was tested on used respirators after one 12-hr shift by swabbing before and after the decontamination. The effects of up to ten decontamination cycles on the respirators' functionality were evaluated using material properties, the structural integrity of the respirators, and fit tests with subjects. The suggested H2O2 decontamination procedure was proven to be (a) sufficiently potent (no microbial recovery, total inactivation of biological indicators as well as spore inoculum on critical respirator surfaces), (b) gentle as no significant damage to the respirator structural integrity and acceptable fit factors were observed, and (c) safe as no H2O2 residue were detected after the defined aeration and storage. Thus, this easy-to-implement and scalable method could overcome another severe respirator shortage, providing enough flexibility to draft safe, effective, and logistically simple crisis plans. However, as highlighted in this study, due to the wealth of design and material used in different models and brands of respirators, the decontamination process should be validated for each FFP respirator model before its field implementation.
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Affiliation(s)
- Martin Novák
- Research and Strategic Business Development, SKAN AG, Allschwil, Switzerland
| | - Christian Gloor
- Federal Office for Civil Protection, Spiez Laboratory, Spiez, Switzerland
| | - Esther Wicki
- Division of Infectious Diseases and Hospital Epidemiology, Zurich City Hospital, Zurich, Switzerland
| | - Dorothea Herb
- Division of Infectious Diseases and Hospital Epidemiology, Zurich City Hospital, Zurich, Switzerland
| | - Adrian Schibli
- Division of Infectious Diseases and Hospital Epidemiology, Zurich City Hospital, Zurich, Switzerland
| | - Gilles Richner
- Federal Office for Civil Protection, Spiez Laboratory, Spiez, Switzerland
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Muacevic A, Adler JR. A Systematic Review of Whether the Use of N95 Respirator Masks Decreases the Incidence of Cardiovascular Disease in the General Population. Cureus 2022; 14:e29823. [PMID: 36199761 PMCID: PMC9526995 DOI: 10.7759/cureus.29823] [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] [Accepted: 10/01/2022] [Indexed: 12/02/2022] Open
Abstract
The usage of masks such as the N95 has increased exponentially worldwide. With the ever-increasing global rates of cardiovascular disease, it is vital that preventative measures are adopted to help tackle this crisis. N95 masks have been promoted as health prevention odysseys in the battle against viruses such as COVID-19. A systematic review was conducted on whether the N95 masks could help improve our cardiovascular health. Our data sources included PubMed, Medline and Scopus. Eleven studies met the eligibility criteria to be included in the review. N95 mask usage led to increased reports of dyspnoea, however, no significant effect was seen on blood pressure. N95 masks also showed improvement in aortic parameters. While encouraging results were yielded, further focussed studies on the use of N95 masks and the effect on various cardiovascular parameters would help strengthen the association.
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Slimani M, Paravlic A, Abazovic E, Znazen H, Bragazzi NL. Effect of facemask use on cognitive function during a maximal running aerobic fitness test. Front Physiol 2022; 13:912740. [PMID: 36246122 PMCID: PMC9557100 DOI: 10.3389/fphys.2022.912740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The aim of the present randomized, crossover study was to determine the physiological and cognitive function responses while wearing a facemask during a maximal running aerobic fitness test. Methods: Fourteen healthy, nonsmoking physical education students (age = 17.5 years, height = 1.72 m, body mass = 70.4 kg) volunteered to participate in this study. They carried out a 20 m multistage fitness test (MSFT) while wearing or not a cloth facemask on two separate occasions performed in random order. The “Rating of Perceived Exertion” (RPE) and the d2 test for visual attention were administered and assessed before and immediately after the MSFT for both conditions (with or without a facemask). Results: When wearing the facemask, the participants exhibited lower maximal aerobic speed (p = 0.039), VO2max (p = 0.039), distance covered during the MSFT (p = 0.057), and concentration performance (p < 0.001), when compared with the control situation (without facemask). Moreover, they made more errors compared with the control condition (p = 0.021). The use of a cloth facemask during maximal endurance running tests (such as the MSFT) reduced VO2max, and measures of cognitive performance as assessed by the test of focused visual attention (the d2 test). This data suggests avoiding using a cloth facemask during maximal aerobic fitness tests, and before any tasks that require a high level of visual attention.
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Affiliation(s)
- Maamer Slimani
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), Genoa University, Genoa, Italy
- Higher Institute of Sport and Physical Education of Ksar Said, University of Manouba, Tunisia, North Africa
- *Correspondence: Maamer Slimani,
| | - Armin Paravlic
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
- Faculty of Sports Studies, Masaryk University, Brno, Czechia
| | - Ensar Abazovic
- Faculty of Sports and Physical Education, Sarajevo, Bosnia and Herzegovina
| | - Hela Znazen
- Department of Physical Education and Sport, College of Education, Taif University, Taif, Saudi Arabia
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
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Hijazi H, Baniissa W, Al Abdi R, Al-Yateem N, Almarzouqi A, Rahman S, Alshammari R, Alameddine M. Experiences of Work-Related Stress Among Female Healthcare Workers During the COVID-19 Public Health Emergency: A Qualitative Study in the United Arab of Emirates. Psychol Res Behav Manag 2022; 15:2701-2715. [PMID: 36172543 PMCID: PMC9512021 DOI: 10.2147/prbm.s381177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/07/2022] [Indexed: 02/05/2023] Open
Abstract
Objective Frontline healthcare workers experienced high levels of psychological distress and emotional turmoil due to the changes necessitated by the COVID-19 public health emergency. Given that workplace stress can negatively influence both quality of work, and job performance, this study sought to explore the lived experiences of work-related stress among female healthcare workers in United Arab of Emirates during the COVID-19 pandemic. Methods A qualitative phenomenological investigation was performed using a purposive sampling approach. A total of 26 semi-structured interviews were conducted with female healthcare workers who worked directly with COVID-19 patients. Using Giorgi's descriptive method, the data were analyzed to identify the main themes. Results Three main themes emerged from the data analysis, with nine categories under these themes. The first theme was "sources of work-related stress." The participants reported a high workload, fear of being infected and transmitting the virus to others, and uncertainty and lack of knowledge regarding COVID-19 to be the main sources of their work-related stress. The second theme was "challenges of working during the pandemic." The participants related being challenged by changes in the organization of care, the need to use personal protective equipment, a work-life imbalance, and witnessing patients' suffering. The third theme was "coping strategies." The participants perceived having sources of social support and using self-adjustment skills to be helpful strategies in terms of coping with the stressful situations they experienced. Conclusion The findings suggest a number of strategies and interventions that could be used at the individual and institutional levels to promote the preparedness and efficacy of healthcare workers during future crises and public health emergencies.
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Affiliation(s)
- Heba Hijazi
- Department of Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Wegdan Baniissa
- Nursing Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Rabah Al Abdi
- Department of Biomedical Engineering, Faculty of Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Nabeel Al-Yateem
- Nursing Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Amina Almarzouqi
- Department of Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Syed Rahman
- Department of Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Rayya Alshammari
- Department of Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohamad Alameddine
- Department of Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Mahmud R, Joy KMNI, Rassel MA, Monayem FB, Datta PK, Hossain MS, Hoque MM, Habib SMHR, Munna NH, Ahmed M, Sayeed SKJB, Rahman M, Chowdhury AH, Hossain MZ, Ahmed KGU, Miah MT, Rahman MM. Health hazards related to using masks and/or personal protective equipment among physicians working in public hospitals in Dhaka: A cross-sectional study. PLoS One 2022; 17:e0274169. [PMID: 36107841 PMCID: PMC9477277 DOI: 10.1371/journal.pone.0274169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Wearing masks or personal protective equipment (PPE) has become an integral part of the occupational life of physicians due to the coronavirus disease 2019 (COVID-19) pandemic. Most physicians have been developing various health hazards related to the use of different protective gears. This study aimed to determine the burden and spectrum of various health hazards associated with using masks or PPE and their associated risk factors.
Methods
This cross-sectional survey was conducted in Dhaka Medical College from March 01–May 30, 2021, among physicians from different public hospitals in Dhaka, Bangladesh. We analyzed the responses of 506 physicians who completed case record forms through Google forms or hard copies.
Findings
The mean (SD) age of the respondents was 35.4 [7.7], and 69.4% were men. Approximately 40% were using full PPE, and 55% were using N-95 masks. A total of 489 (96.6%) patients experienced at least one health hazard. The reported severe health hazards were syncope, severe dyspnea, severe chest pain, and anaphylaxis. Headache, dizziness, mood irritation, chest pain, excessive sweating, panic attack, and permanent facial disfigurement were the minor health hazards reported. Extended periods of work in the COVID-19-unit, reuse of masks, diabetes, obesity, and mental stress were risk factors for dyspnea. The risk factors for headaches were female sex, diabetes, and previous primary headaches. Furthermore, female sex and reusing masks for an extended period (> 6 h) were risk factors for facial disfigurement. The risk factors for excessive sweating were female sex and additional evening office practice for an extended period.
Conclusions
Healthcare workers experienced several occupational hazards after using masks and PPE. Therefore, an appropriate policy is required to reduce such risks.
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Affiliation(s)
- Reaz Mahmud
- Department of Neurology, Dhaka Medical College, Dhaka, Bangladesh
- * E-mail: ,
| | | | - Mohammad Aftab Rassel
- Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | | | | | | | | | | | - Nazmul Hoque Munna
- Assistant professor, Department of Neurology, Mugda Medical College, Dhaka, Bangladesh
| | - Mohiuddin Ahmed
- Department of Neurology, Dhaka Medical College, Dhaka, Bangladesh
| | | | - Motlabur Rahman
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | | | | | | | - Md. Titu Miah
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - Md. Mujibur Rahman
- Department of Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka. Bangladesh
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Kogel A, Hepp P, Stegmann T, Tünnemann-Tarr A, Falz R, Fischer P, Mahfoud F, Laufs U, Fikenzer S. Effects of surgical and FFP2 masks on cardiopulmonary exercise capacity in patients with heart failure. PLoS One 2022; 17:e0269470. [PMID: 35998172 PMCID: PMC9397906 DOI: 10.1371/journal.pone.0269470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 05/22/2022] [Indexed: 11/25/2022] Open
Abstract
Aims Surgical and FFP2 masks are recommended to reduce transmission of SARS-CoV-2. The cardiopulmonary effects of facemasks in patients with chronic heart failure are unknown. This prospective, cross-over study quantified the effects of wearing no mask (nm), surgical mask (sm), and FFP2 mask (ffpm) in patients with stable heart failure. Methods 12 patients with clinically stable chronic heart failure (HF) (age 63.8±12 years, left ventricular ejection fraction (LVEF) 43.8±11%, NTProBNP 573±567 pg/ml) underwent spiroergometry with and without masks in a randomized sequence. Comfort/discomfort was assessed using a standardized questionnaire. Results Maximum power was reduced with both types of masks (nm: 108.3 W vs. sm: 101.2 W vs. ffpm: 95.6 W, p<0.01). Maximum respiratory oxygen uptake (1499ml/min vs. 1481 ml/min vs. 1300 ml/min, p = 0.95 and <0.01), peak ventilation (62.1 l/min vs. 56.4 l/min vs. 50.3 l/min, p = 0.15 and p<0.05) and O2-pulse (11.6 ml/beat vs. 11.8 ml/beat vs. 10.6 ml/beat, p = 0.87 and p<0.01) were significantly changed with ffpm but not sm. Discomfort was moderately but significantly increased (nm: 1.6 vs. sm: 3.4 vs. ffpm: 4.4, p<0.05). Conclusion Both surgical and FFP masks reduce exercise capacity in heart failure patients, while FFP2 masks reduce oxygen uptake and peak ventilation. This reduction in cardiopulmonary performance should be considered in heart failure patients whose daily life activities are often just as challenging as exercise is for healthy adults.
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Affiliation(s)
- Alexander Kogel
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
- * E-mail:
| | - Pierre Hepp
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Tina Stegmann
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | | | - Roberto Falz
- Institute of Sport Medicine and Prevention, University of Leipzig, Leipzig, Germany
| | - Patrick Fischer
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg (Saar), Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg (Saar), Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Sven Fikenzer
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
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Mao Y, Zhu Y, Guo Z, Zheng Z, Fang Z, Chen X. Experimental investigation of the effects of personal protective equipment on thermal comfort in hot environments. BUILDING AND ENVIRONMENT 2022; 222:109352. [PMID: 35782230 PMCID: PMC9239730 DOI: 10.1016/j.buildenv.2022.109352] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/21/2022] [Accepted: 06/26/2022] [Indexed: 05/16/2023]
Abstract
Since the outbreak of COVID-19, wearing personal protective equipment (PPE) has become increasingly common, especially for healthcare workers performing nucleic acid sample collection. A field experiment and questionnaire survey were conducted in a semi-open transition space of a university building in Guangzhou, southern China. Thirty-two subjects wore PPE to simulate nucleic acid sample collection, during which thermal parameters were recorded and subjective questionnaires were completed. The relationship between thermal sensation and thermal index was analyzed to determine the neutral temperature and comfort temperature zones. Subjects had higher requirements for thermal environment parameters when wearing PPE than when not wearing PPE, and were found to have statistically significant differences in thermal perception when wearing and not wearing PPE. Wearing PPE significantly raised the subjects' thermal and humidity sensations and restricted their airflow. Wearing PPE resulted in thermal discomfort for the subjects and a high unacceptability rate for environmental thermal parameters. The subjects wore PPE for an acceptable duration of approximately 1.5 h. The neutral operative temperatures were significantly lower when wearing PPE than when not wearing PPE, and the deviation from the neutral temperature was 9.7 °C. The neutral operative temperature was 19.5 °C and the comfort temperature zone was 17.4-21.5 °C when subjects wore PPE, demonstrating that subjects who wore PPE preferred lower temperatures. These results suggest that people who wear PPE for work, especially outdoors, should receive more attention to ensure thermal comfort and safety.
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Affiliation(s)
- Yudong Mao
- School of Civil Engineering, Guangzhou University, Guangzhou, China
| | - Yongcheng Zhu
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhisheng Guo
- School of Civil Engineering, Guangzhou University, Guangzhou, China
| | - Zhimin Zheng
- School of Civil Engineering, Guangzhou University, Guangzhou, China
| | - Zhaosong Fang
- School of Civil Engineering, Guangzhou University, Guangzhou, China
| | - Xiaohui Chen
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Jokubaitis M, Timofejavaitė R, Braschinsky M, Zvaune L, Leheste AR, Gribuste L, Mattila P, Strautmane S, Dapkutė A, Ryliškienė K. Risk factors for development of personal protective equipment induced headache: e-survey of medical staff in Baltic states. BMC Health Serv Res 2022; 22:1016. [PMID: 35948960 PMCID: PMC9363870 DOI: 10.1186/s12913-022-08412-5] [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: 04/11/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background The COVID-19 pandemic led to an unprecedented increase in the use of personal protective equipment (PPE) among medical personnel. The goal of this study was to determine the risk factors and frequency of PPE-induced headache during the COVID-19 pandemic. Methods From January 25 to March 1, 2021, an anonymous online survey was undertaken in the Baltic states. Results In total, 2132 individuals participated. 52.3% experienced a PPE-induced headache. Usual onset time was between 2–3 h, lasting up to 1 h after PPE removal. The most common localization was in temporal and frontal regions. Headache usually occurred 2 to 3 days per week with an average pain score of 5.04 ± 1.80 points. Higher risk was associated with discomfort/pressure OR = 11.55, heat stress OR = 2.228, skin conditions OR = 1.784, long PPE use (duration 10-12 h) OR = 2,18, headache history prior PPE use OR = 1.207. Out of 52.3% respondents with PPE-induced headache, 45.5% developed de novo headache, whereas 54.5% had headache history. Statistically significant differences of PPE-induced headache between respective groups included severity (4.73 vs 5.29), duration (≥ 6 h 6.7% vs 8.2%), accompanying symptoms (nausea (19.3% vs 25.7%), photophobia (19.1% vs 25.7%), phonophobia (15.8% vs 23.5%), osmophobia (5.3% vs 12.0%)) and painkiller use (43.0% vs 61.7%). Conclusions Over half of the medical personnel reported headache while using PPE. The risk was higher in individuals with headache history, increased duration of PPE use and discomfort while using PPE. Predisposed individuals reported PPE-induced headache which persisted longer, was more intense and debilitating than in the respondents with de novo headache. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08412-5.
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Affiliation(s)
| | | | - Mark Braschinsky
- Neurology Clinic, Tartu University Hospital, Tartu, Estonia.,Department of Neurology and Neurosurgery, University of Tartu, Tartu, Tartu, Estonia
| | - Linda Zvaune
- Department of Neurology and Neurosurgery, Riga East Clinical University Hospital, Riga, Latvia
| | | | - Laura Gribuste
- Department of Neurology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Paula Mattila
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Sintija Strautmane
- Department of Neurology, Pauls Stradins Clinical University Hospital, Riga, Latvia.,Faculty of Residency, Riga Stradins University, Riga, Latvia
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Hussain SA, Mahmood NMA, Mahmood TMA, Salih NAM, Abdulrahman ZS. Adverse effects associated with the use of N95 mask among health-care workers at the COVID-19 care units: A cross-sectional study in Sulaimani city, Iraq. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:198. [PMID: 36003243 PMCID: PMC9393953 DOI: 10.4103/jehp.jehp_1001_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/09/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Health-care workers have to use the N95 mask as a part of the protection kit during the COVID-19 pandemic. The adverse effects of such practice are not fully elucidated. The study aims to evaluate negative impacts of N95 face masks on health-care personnel at COVID-19 care units. MATERIALS AND METHODS One hundred and twenty-two health-care workers (aged 20-58 years) from various health-care settings in Sulaimani, Iraq, from January to August 2020, were enrolled in this prospective, cross-sectional study. The physiological variables (blood pressure, heart rate, and oxygen saturation) were recorded before putting on the N95 mask and postremoval of the mask. The incidence of adverse effects such as headache, difficulty breathing, redness, irritation, and dizziness were also reported as a number and percent at the end of the work shift. RESULTS There was a statistically significant difference in the physiological parameters after removal of the mask compared with baseline. Only diastolic pressure was significantly lower in those working >6 h when compared to those working 1-6 h. The changes in physiological markers were poorly and nonsignificantly associated with the duration of wearing the mask. Moreover, 67.2%-70.5% of the participants complain of headaches and breathing difficulties, while 45.9%-51.6% reported signs of itching, redness, and irritation. However, health-care workers who put on the face mask >6 h showed signs of headache, breathing difficulties, and itching at the exposed areas higher than those working for 1-6 h. CONCLUSION N95 mask negatively impacts the physiological variables of health-care providers. The adverse effects may lead to excessive exhaustion after long shifts in the intensive care unit during treatment of COVID-19 patients.
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Affiliation(s)
- Saad Abdulrahman Hussain
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Rafidain University College, Baghdad, Iraq
| | - Naza Mohammed Ali Mahmood
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Sulaimani, Kurdistan Region, Iraq
| | - Trefa Mohammed Ali Mahmood
- Department of Periodontics, Orthodontics and Prevention Dentistry, College of Dentistry, University of Sulaimani, Kurdistan Region, Iraq
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Zhao M, Zhao J, Yan J, Gao X. The Evaluation of Physiological Index Changes and Safety Work of Female Medical Staff With Different Medical Protection Standards in the Ward of COVID-19. Front Med (Lausanne) 2022; 9:906140. [PMID: 35814785 PMCID: PMC9256920 DOI: 10.3389/fmed.2022.906140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Effective personal protective equipment (PPE) contribute to the prevention of COVID-19 infection. However, it is necessary to evaluate the potential risk of different medical protections in the isolation ward of COVID-19. Objectives We aimed to explore the dynamics in physiological indexes of medical staff under primary and secondary PPE in the isolation ward of COVID-19 and provide the scientific basis for determining the safe work strategy. Materials and Methods In this study, 30 female nurses were selected to simulate medical work under the primary or secondary PPE, respectively. The oral temperature, axillary temperature, heart rate, respiratory rate, blood oxygen saturation, and blood pressure were measured and recorded every 20 min. The subjective adverse symptoms were recorded every 30 min. The blood glucose and weight of the individuals were measured and recorded before and after the trial. Results The results indicated that the median trial persistence time in the participants with moderate-intensity work wearing the secondary PPE (70.0 min) was much lower than that with moderate-intensity work wearing the primary PPE (180 min) and with light-intensity work wearing the primary PPE (110 min; p < 0.05). Importantly, the heart rate, oral/axillary temperature, and respiratory rate of physiological indexes of the participants under moderate-intensity work wearing the secondary PPE increased significantly faster than the primary PPE (p < 0.001), while blood oxygen saturation decreased significantly faster than the primary PPE (p < 0.001). In addition, the proportions of subjective adverse symptoms (such as dry mouth, dizziness, palpitations, and anhelation) were much higher than primary PPE (p < 0.001). The average sweat volume and blood glucose consumption of participants under moderate-intensity work wearing primary PPE were higher than secondary PPE (p < 0.001). Conclusion The combination of an exacerbated workload and secondary PPE worn by COVID-19 healthcare workers increases the change in physiological indicators, and in some cases the adverse symptoms, which can affect and even suspend their medical work. For any medical institution, there is room for improvement in terms of bioethics of a "Job Well Done" to reduce the risks of medical activities under secondary PPE.
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Affiliation(s)
- Min Zhao
- Department of Internal Medicine, Fuzhou Pulmonary Hospital of Fujian, Fuzhou, China
| | - Jianhui Zhao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Junbing Yan
- Department of Internal Medicine, Fuzhou Pulmonary Hospital of Fujian, Fuzhou, China
| | - Xiaoye Gao
- Department of Internal Medicine, Fuzhou Pulmonary Hospital of Fujian, Fuzhou, China
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Dominguez-Moreno R, Venegas-Gómez VA, Zepeda-Gutiérrez LA, De La Rosa-Cuevas JJ, Hernández-Félix JH, Martos-Armendariz EO, Chiquete E, Vega-Boada F, Flores-Silva F, Cantú-Brito C. Headache related to personal protective equipment in healthcare workers during COVID-19 pandemic in Mexico: baseline and 6-month follow-up. Int Arch Occup Environ Health 2022; 95:1945-1954. [PMID: 35716173 PMCID: PMC9206092 DOI: 10.1007/s00420-022-01895-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/26/2022] [Indexed: 11/30/2022]
Abstract
Background and aim Headaches related to the use of personal protective equipment (PPE) could affect performance at work in healthcare personnel. Our aim was to describe the prevalence and risk factors for headaches related to PPE, in the personnel of a specialized coronavirus disease 2019 (COVID-19) tertiary hospital. Methods In this cross-sectional survey study, we invited healthcare workers from COVID-19 referral center in Mexico (May 22–June 19, 2020) to answer a standardized structure questionnaire on characteristics of new-onset PPE-related headache or exacerbation of primary headache disorder. Participants were invited regardless of whether they had a current headache to avoid selection bias. This is the primary analysis of these data. Results Two hundred and sixty-eight subjects were analyzed, 181/268 (67.5%) women, 177/268 (66%) nurses, mean age 28 years. The prevalence of PPE-related headache was 210/268 (78.4%). Independent risk factors were occupation other than physician (OR 1.59, 95% CI 1.20–2.10), age > 30 years (OR 2.54, 95% CI 1.25–5.14), and female sex (OR 3.58, 95% CI 1.86–6.87). In the 6-month follow-up, 13.1% of subjects evolve to chronic headache, with stress as predictive risk factor. Conclusion The frequency of PPE-associated headache is high, and a subgroup could evolve to chronic headache. More studies are necessary to improve the knowledge about this condition.
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Affiliation(s)
- Rogelio Dominguez-Moreno
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México.
| | - Venny A Venegas-Gómez
- Department of Internal Medicine, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México
| | - Luis Asdruval Zepeda-Gutiérrez
- Department of Internal Medicine, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México
| | - Juan José De La Rosa-Cuevas
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México
| | - Jorge Humberto Hernández-Félix
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México
| | - Edgar Omar Martos-Armendariz
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México
| | - Erwin Chiquete
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México
| | - Felipe Vega-Boada
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México
| | - Fernando Flores-Silva
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México
| | - Carlos Cantú-Brito
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México
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Ahmadian M, Ghasemi M, Nasrollahi Borujeni N, Afshan S, Fallah M, Ayaseh H, Pahlavan M, Nabavi Chashmi SM, Haeri T, Imani F, Zahedmanesh F, Akbari A, Nasiri K, Dabidi Roshan V. Does wearing a mask while exercising amid COVID-19 pandemic affect hemodynamic and hematologic function among healthy individuals? Implications of mask modality, sex, and exercise intensity. PHYSICIAN SPORTSMED 2022; 50:257-268. [PMID: 33902400 DOI: 10.1080/00913847.2021.1922947] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We investigated how wearing a mask - and its modality (surgical vs. N95) - affect hemodynamic and hematologic function in males and females across two exercise intensities (submaximal (SUB) and maximal (MAX)). METHODS 144 individuals participated in the present study and were randomly allocated to three mask groups of 48 (N95, SURGICAL, and NO MASK) with two exercise subgroups for each mask group (MAX, n = 24; SUB, n = 24) for both sexes. Participants in each experimental group (N95SUB, N95MAX; SURSUB, SURMAX; SUB, MAX) were assessed for their hemodynamic and hematologic function at baseline and during recovery after exercise. RESULTS No significant differences were noted for either hemodynamic or hematologic function at post-exercise as compared to baseline with regard to mask modality (P > 0.05). Heart rate (HR) for maximal intensity were significantly greater at 1 min post-exercise in N95 as compared to SURGICAL (P < 0.05). No differences were noted for hemodynamic and hematologic function with N95 and SURGICAL compared to NOMASK for either intensity (P > 0.05). Females showed significantly greater HR values at 1 min post-exercise in N95 as compared to NO MASK, but no significant differences were noted for hematological function between sexes (P > 0.05). CONCLUSION Our findings show that wearing a face mask (N95/surgical) while exercising has no detrimental effects on hemodynamic/hematologic function in both males and females, and suggest that wearing a mask, particularly a surgical mask, while exercising during the ongoing pandemic is safe and poses no risk to individual's health. Future studies examining physiological responses to chronic exercise with masks are warranted.
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Affiliation(s)
- Mehdi Ahmadian
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Mohammad Ghasemi
- Department of Exercise Physiology, Faculty of Sport Science, University of Mazandaran, Babolsar, Iran
| | | | - Samaneh Afshan
- Department of Exercise Physiology, Faculty of Sport Science, University of Mazandaran, Babolsar, Iran
| | - Masoumeh Fallah
- Department of Exercise Physiology, Faculty of Sport Science, University of Mazandaran, Babolsar, Iran
| | - Hamed Ayaseh
- Department of Exercise Physiology, Faculty of Sport Science, University of Mazandaran, Babolsar, Iran
| | - Mohammad Pahlavan
- Department of Exercise Physiology, Faculty of Sport Science, University of Mazandaran, Babolsar, Iran
| | | | - Tahereh Haeri
- Department of Exercise Physiology, Faculty of Sport Science, University of Mazandaran, Babolsar, Iran
| | - Fattaneh Imani
- Department of Exercise Physiology, Faculty of Sport Science, University of Mazandaran, Babolsar, Iran
| | - Foruzan Zahedmanesh
- Department of Exercise Physiology, Faculty of Sport Science, University of Mazandaran, Babolsar, Iran
| | - Abolfazl Akbari
- Department of Physiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Khadijeh Nasiri
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Valiollah Dabidi Roshan
- Department of Exercise Physiology, Faculty of Sport Science, University of Mazandaran, Babolsar, Iran.,Athletic Performance and Health Research Center, Department of Exercise Physiology, Faculty of Sport Science, University of Mazandaran, Babolsar, Iran
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Medical masks' and respirators' pattern of use, adverse effects and errors among Portuguese health care professionals during the COVID-19 pandemic: A cross-sectional study. Am J Infect Control 2022; 50:618-623. [PMID: 34653529 PMCID: PMC8511873 DOI: 10.1016/j.ajic.2021.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 12/21/2022]
Abstract
Background During COVID-19 pandemic, a shortage of surgical masks (Mask) and respirators (Resp) was experienced worldwide. We aimed to assess its pattern of use, adverse effects and user errors by Portuguese health care professionals (HCP). Methods A cross-sectional study was conducted through snowball convenience sample, collected by email/ social media to health care organizations. Participants answered an online anonymous survey in March 2021. Results Mean age of 3052 respondents was 42.1 years old, 83.6% were female and 77.8% provided direct health care to COVID-19 patients. Mean time of use per shift was 6-8 hours in 40.8% of the participants. 28.0% reported never changing it during their shift. Resp use (vs Mask) was more associated with discomfort (58.2% vs 26.8%), affecting task performance (41.5 vs 18.9%) and communication (55.0 vs 40.9%), dyspnea (36.0 vs 14.4%), skin rash (37.5 vs 19.4%) and headache (37.5 vs 19.4%). Frequent user errors included touching the front while in use (70.1% Mask vs 66.3% Resp) and omitting hand hygiene before (61.8% Mask vs 55.0% Resp) or after use (61.3% Mask vs 57.0% Resp). Average number of errors was higher for Mask (4.3), than for Resp (3.2) (all: P < .001). Conclusions Most HCP admitted an extended use of Mask/ Resp. Resp were more prone to adverse effects and Mask more prone to errors. Strategies to reinforce good practices should be considered.
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Shechtman L, Ben-Haim G, Ben-Zvi I, Steel L, Ironi A, Huszti E, Chatterji S, Levy L. Physiological Effects of Wearing N95 Respirator on Medical Staff During Prolong Work Hours in Covid-19 Departments. J Occup Environ Med 2022; 64:e378-e380. [PMID: 35543650 PMCID: PMC9275795 DOI: 10.1097/jom.0000000000002542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of the current study was to determine gas exchange abnormalities and physiological changes among healthcare workers during a 4-hour emergency department (ED) shift while wearing the N95 respirator. METHODS Single-center prospective observational study. Comparisons of paired measurements were performed using a non-parametric Wilcoxon matched-pairs signed-rank test. Results: Forty-one subjects were included. Prolonged N95 respirator use was associated with a significant decline in plasma pH (7.35 mmHg vs 7.34 mmHg, P = 0.02), PvO 2 (23.2 mmHg vs 18.6 mmHg, P < 0.001) and a concurrent increase in EtCO 2 (32.5 mmHg vs 38.5 mmHg, P < 0.0001). PvCO 2 and bicarbonate levels did not differ. No significant change was observed for heart rate or oxygen saturation. CONCLUSION Using an N95 respirator for prolonged periods by healthcare professionals may provoke changes in gas exchange. The clinical significance of these changes remains to be determined.
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Affiliation(s)
- Liran Shechtman
- From the Internal Medicine Department, Sheba Medical Center, Tel Hashomer, Israel (Dr Shechtman and Dr Ben-Zvi); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr Shechtman, Dr ben-Haim, Dr Ben-Zvi, Dr Steel, Dr Ironi, Dr Chatterji, and Dr Levy); Department of Emergency Medicine, Sheba Medical Center, Tel Hashomer, Israel (Dr Ben-Haim, Dr Steel, and Dr Ironi); Biostatistics Research Unit, University Health Network, University of Toronto, Toronto, ON, Canada (Dr Huszti); Institute of Pulmonary Medicine, Sheba Medical Center, Tel-Hashomer, Israel (Dr Chatterji and Dr Levy)
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Manookian A, Dehghan Nayeri N, Shahmari M. Physical problems of prolonged use of personal protective equipment during the COVID-19 pandemic: A scoping review. Nurs Forum 2022; 57:874-884. [PMID: 35575417 PMCID: PMC9347983 DOI: 10.1111/nuf.12735] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Abstract
Background It is widely believed that using personal protective equipment (PPE) provides high levels of protection for healthcare workers (HCWs) in the fight against coronavirus disease (COVID‐19). However, the long‐term use of PPE is inconvenient for HCWs and may cause physical discomfort. These factors could result in poor compliance and disrupt the health and safety of HCWs, which may negatively affect the patient's safety. Objective This study aimed to investigate the literature for the purpose of collecting convincing evidence of HCWs' physical problems associated with PPE use during the COVID‐19 pandemic. Methods This scoping review was conducted using PubMed, Embase, ProQuest, Science Direct, Springer, Biomed Central, and Google Scholar to identify the related literature. Results HCWs have experienced various physical disorders including skin, respiratory, musculoskeletal, nervous, urinary, and circulatory system problems that are associated with PPE in various body systems. Among these, skin problems were the most frequent physical problems. Conclusions The literature demonstrated the adverse impacts of using PPE on HCWs. Therefore, healthcare policymakers should take the appropriate measures to improve the work environment during the COVID‐19 pandemic, which could consequently prevent and mitigate the adverse effects of using PPE.
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Affiliation(s)
- Arpi Manookian
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.,USERN Care (TUMS) Office, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Dehghan Nayeri
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehraban Shahmari
- Department of Medical-Surgical, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Doğan A, Karasu F, Yilmaz L. The effects of nurses' use of personal protective equipment on their vital signs during the COVID-19 pandemic. Work 2022; 71:843-850. [PMID: 35253717 DOI: 10.3233/wor-211232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In order for nurses to provide the desired/expected care during the COVID-19 pandemic, the personal protective equipment (PPE) they use should not cause additional damage. OBJECTIVE The current study examined the effect of nurses' use of PPE on their vital signs during the COVID-19 pandemic. METHODS The present study was executed in a public hospital located in Turkey between October 2020 and December 2020 with a total of 112 nurses, 54 of them were serving in COVID-19 clinics, and 58 of them were working in other clinics. The data of the study was collected by using the introductory information form, the vital signs measurement, and the Visual Analogue Scale. The numbers, percentages, means, standard deviation, Chi-square, ANOVA, Mann-Whitney U and Wilcoxon tests were used to analyze the data. RESULTS The mean scores of SpO2, respiratory rate, body temperature, heart rate and blood pressure measurements of the nurses in the experimental group were compared before and after putting on the PPE. It was found that the difference between the two averages was statistically significant (p < 0.05). CONCLUSION It was found that the use of PPE for a long time causes a decrease in SpO2, increase in respiratory rate, pulse and blood pressure, as well as the aches in face, ear, nose and head.
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Affiliation(s)
- Aysel Doğan
- Department of Nursing, Faculty of Health Sciences, Toros University, Mersin, Turkey
| | - Fatma Karasu
- Department of Nursing, Faculty of Health Sciences, Kilis 7 Aralık University, Kilis, Turkey
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CEYLAN G, EMİR F. Uzun süreli N95 (FFP2) maske kullanımının kan oksijen satürasyonuna ve diş hekimi konforuna etkisinin değerlendirilmesi. ACTA ODONTOLOGICA TURCICA 2022. [DOI: 10.17214/gaziaot.994450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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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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Ünver S, Yildirim M, Cansu Yeni̇ğün S. Personal protective equipment related skin changes among nurses working in pandemic intensive care unit: A qualitative study. J Tissue Viability 2022; 31:221-230. [PMID: 35094886 PMCID: PMC8785367 DOI: 10.1016/j.jtv.2022.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/25/2021] [Accepted: 01/20/2022] [Indexed: 01/17/2023]
Abstract
AIM The respiratory tract is the main transmission way of the SARS-CoV-2 virus and nurses who care for COVID-19 patients in intensive care units (ICUs) are required to constantly use personal protective equipment (PPE) during their daily work. This study aimed to examine the PPE-related skin changes experienced by the nurses working in pandemic ICU during the COVID-19 pandemic. METHODS Using a descriptive phenomenological approach, semi-structured interviews were conducted between November 1st and December 25th, 2020, in the pandemic ICU of a training and research hospital in Usak, Turkey. The nurses who worked in the pandemic ICU for at least one week and experienced skin changes due to PPE use were included. Individual interviews were carried out online through video conferencing. Colaizzi's method was used in data analysis by using the ATLAS.ti 8.0. RESULTS The main themes were main causes of PPE-related skin changes, its location along with secondary adverse effects, symptomatology, prevention, and therapeutic interventions used for curing PPE-related skin changes. Nurses mostly reported PPE-related skin changes behind their ears, over their nose, cheeks and jaw due to wearing N95 masks and on the forehead due to wearing face shields. Wearing PPE at least 2 h, the type/quality of PPE, and being dehydrated were identified as the common causes. CONCLUSION This study provides a deeper understanding into the PPE-related skin change experiences of pandemic ICU nurses and the importance of the quality of the PPE used. It is recommended to enable shortened working shifts and ergonomic PPE materials for ICU nurses.
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Affiliation(s)
- Seher Ünver
- Trakya University, Faculty of Health Sciences, Department of Surgical Nursing, Edirne, Turkey,Corresponding author. Trakya University, Balkan Campus, Faculty of Health Sciences, Department of Surgical Nursing, 22020, Edirne, Turkey
| | - Meltem Yildirim
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Seda Cansu Yeni̇ğün
- Akdeniz University, Kumluca Faculty of Health Sciences, Department of Surgical Nursing, Antalya, Turkey
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Leung R, Cook MM, Capra MF, Johnstone KR. The contribution of respiratory and hearing protection use to psychological distress in the workplace: a scoping review. Int Arch Occup Environ Health 2022; 95:1647-1659. [PMID: 35474491 PMCID: PMC9041289 DOI: 10.1007/s00420-022-01863-7] [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: 12/23/2021] [Accepted: 04/01/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Workers from various industries use personal protective equipment (PPE) including masks, respirators, and hearing protection to reduce their exposures to workplace hazards. Many studies have evaluated the physiological impacts of PPE use, but few have assessed the psychological impacts. The aim of the present study was to carry out a scoping review to compile existing evidence and determine the extent of knowledge on workplace mask, respirator or hearing protection use as a psychosocial hazard (stressor) that could result in a stress response and potentially lead to psychological injury. METHODS The scoping review followed recognized methods and was conducted using Ovid Emcare, PubMed, Sage Journals, ScienceDirect, Scopus, SpringerLink, Google Scholar and preprint databases (OSF Preprints and medRxiv). Articles on the stressors associated with the use of masks, respirators, and hearing protection were included. The extracted data included author(s) name, year of publication, title of article, study design, population data, stressors assessed, and key findings. RESULTS We retrieved 650 articles after removal of duplicates, of which 26 were deemed eligible for inclusion for review. Identified factors associated with PPE use that could potentially create a stress response were identified: communication impacts, physical impacts, psychological illness symptoms, cognitive impacts, and perceived PPE-related impacts. Evidence for respirators suggest that there may be psychological injury associated with their use. However, hearing protection appears to have a protective effect in reducing psychological symptoms such as anxiety, depression, and aggression. CONCLUSIONS Mask or respirator use may lead to an increase in work-related stress. Whereas hearing protection may have protective effects against psychological symptoms and improves speech intelligibility. More research is needed to better understand potential psychosocial impacts of mask, respirator and/or hearing protection use.
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Affiliation(s)
- Richard Leung
- School of Earth and Environmental Sciences, The University of Queensland, Brisbane, Australia.
| | - Margaret M Cook
- School of Earth and Environmental Sciences, The University of Queensland, Brisbane, Australia
| | - Mike F Capra
- School of Earth and Environmental Sciences, The University of Queensland, Brisbane, Australia
| | - Kelly R Johnstone
- School of Earth and Environmental Sciences, The University of Queensland, Brisbane, Australia
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Karsli E, Yilmaz A, Kemancı A, Canacik O, Ozen M, Seyit M, Şahin L, Oskay A, Sabirli R, Turkcuer I. The effect of N95 respirators on vital parameters, PETCO 2, among healthcare providers at the pandemic clinics. Ir J Med Sci 2022; 192:853-860. [PMID: 35415774 PMCID: PMC9005163 DOI: 10.1007/s11845-022-03013-x] [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: 03/08/2022] [Accepted: 04/08/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Wearing face shields and masks, which used to have very limited public use before the COVID-19 outbreak, has been highly recommended by organizations, such as CDC and WHO, during this pandemic period. AIMS The aim of this prospective study is to scrutinize the dynamic changes in vital parameters, change in end tidal CO2 (PETCO2) levels, the relationship of these changes with taking a break, and the subjective complaints caused by respiratory protection, while healthcare providers are performing their duties with the N95 mask. METHODS The prospective cohort included 54 healthcare workers (doctors, nurses, paramedics) who worked in the respiratory unit of the emergency department (ED) and performed their duties by wearing valved N95 masks and face shields. The vital parameters and PETCO2 levels were measured at 0-4th-5th and 9th hours of the work-shift. RESULTS Only the decrease in diastolic BP between 0 and 9 h was statistically significant (p = 0.038). Besides, mean arterial pressure (MAP) values indicated a significant decrease between 0-9 h and 5-9 h (p = 0.024 and p = 0.049, respectively). In terms of the vital parameters of the subjects working with and without breaks, only PETCO2 levels of those working uninterruptedly increased significantly at the 4th hour in comparison to the beginning-of-shift baseline levels (p = 0.003). CONCLUSION Although the decrease in systolic blood pressure (SBP) and MAP values is assumed to be caused by increased fatigue due to workload and work pace as well as increase in muscle activity, the increase in PETCO2 levels in the ED healthcare staff working with no breaks between 0 and 4 h should be noted in terms of PPE-induced hypoventilation.
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Affiliation(s)
- Emre Karsli
- Department of Emergency Medicine, Faculty of Medicine, Tınaztepe University, Izmir, Turkey
| | - Atakan Yilmaz
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Aykut Kemancı
- Department of Emergency Medicine, Tavsanli Doc Dr. Mustafa Kalemli State Hospital, Kutahya, Turkey
| | - Omer Canacik
- Department of Emergency Medicine, Memorial Sisli Hospital, Istanbul, Turkey
| | - Mert Ozen
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Murat Seyit
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Levent Şahin
- Department of Emergency Medicine, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Alten Oskay
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ramazan Sabirli
- Department of Emergency Medicine, Bakircay University Faculty of Medicine Cigli Training and Research Hospital, 35620, Izmir, Turkey.
| | - Ibrahim Turkcuer
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Litwinowicz K, Choroszy M, Ornat M, Wróbel A, Waszczuk E. Bayesian network meta-analysis of face masks' impact on human physiology. Sci Rep 2022; 12:5823. [PMID: 35388100 PMCID: PMC8985742 DOI: 10.1038/s41598-022-09747-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 02/28/2022] [Indexed: 12/21/2022] Open
Abstract
Several concerns regarding the safety of face masks use have been propounded in public opinion. The objective of this review is to examine if these concerns find support in the literature by providing a comprehensive overview of physiological responses to the use of face masks. We have performed a systematic review, pairwise and network meta-analyses to investigate physiological responses to the use of face masks. The study has been registered with PROSPERO (C RD42020224791). Obtained results were screened using our exclusion and inclusion criteria. Meta-analyses were performed using the GeMTC and meta R packages. We have identified 26 studies meeting our inclusion and exclusion criteria, encompassing 751 participants. The use of face masks was not associated with significant changes in pulsoxymetrically measured oxygen saturation, even during maximal-effort exercises. The only significant physiological responses to the use of face masks during low-intensity activities were a slight increase in heart rate, mildly elevated partial pressure of carbon dioxide (not meeting criteria for hypercarbia), increased temperature of facial skin covered by the mask, and subsequent increase of the score in the rating of heat perception, with N95 filtering facepiece respirators having a greater effect than surgical masks. In high-intensity conditions, the use of face masks was associated with decreased oxygen uptake, ventilation, and RR. Face masks are safe to use and do not cause significant alterations in human physiology. The increase in heart rate stems most likely from increased respiratory work required to overcome breathing resistance. The increase in carbon dioxide is too small to be clinically relevant. An increased rating of heat perception when using face masks results from higher temperature of facial skin covered by the mask.
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Affiliation(s)
- Kamil Litwinowicz
- Department of Biochemistry and Immunochemistry, Wroclaw Medical University, Wrocław, Poland.
| | - Marcin Choroszy
- Department of Microbiology, Wroclaw Medical University, Wrocław, Poland
| | - Maciej Ornat
- Department of Human Morphology and Embryology, Wroclaw Medical University, Wrocław, Poland
| | - Anna Wróbel
- Department of Psychotherapy and Psychosomatic Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Ewa Waszczuk
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wrocław, Poland
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Sharma N, Gupta A, Killedar M, Bindra A, Patil A, Gupta S, Gopathoti P, Kumar P. One for Everyone: A Study of User Satisfaction Among Health-Care Providers Regarding Extended Use of N95 Masks During the COVID-19 Pandemic. Disaster Med Public Health Prep 2022; 16:619-626. [PMID: 33040770 PMCID: PMC7737120 DOI: 10.1017/dmp.2020.380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study was conducted to assess the feasibility of extended use of N95 masks in our hospital during the coronavirus disease 2019 (COVID-19) pandemic. We also studied the use pattern, user satisfaction, and issues faced during extended use of the mask. METHODS This cross-sectional study was conducted among health-care providers in a large tertiary care teaching hospital in northern India from April 1 to May 31, 2020. A list was prepared from the institute's register, and participants were chosen by random sampling. The data collected from the physical forms were transferred to excel sheets. RESULTS A total of 1121 responses were received. The most common problem stated with reuse of N95 masks was loss of fit followed by damage to the slings, highlighted by 44.6% and 44.4% of the participants, respectively. A total of 476 (42.5%) participants responded that they would prefer "cup-shaped N95 mask with respirator". The median scores regarding the satisfaction with the quality of masks and their fit was also 4 each. CONCLUSIONS It was concluded that the extended use of N95 masks was acceptable, with more than 96% of the participants using these masks.
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Affiliation(s)
- Nishant Sharma
- Department of Hospital Administration, AIIMS, New Delhi, India
| | - Anant Gupta
- Department of Hospital Administration, AIIMS, New Delhi, India
| | | | - Ashish Bindra
- Department of Neuroanaesthesiology and Critical Care, AIIMS, New Delhi, India
| | - Asmita Patil
- Department of Physiology, AIIMS, New Delhi, India
| | - Surabhi Gupta
- Department of Reproductive Biology, AIIMS, New Delhi, India
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Zhuang E, Thurman P, Chen HH, McDiarmid MA, Hines SE. Physiological Impacts of Surgical Mask Coverage of Elastomeric Half-mask Respirator Exhalation Valves in Healthcare Workers. Ann Work Expo Health 2022; 66:233-245. [PMID: 34585722 PMCID: PMC8500049 DOI: 10.1093/annweh/wxab069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/23/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Elastomeric half-mask respirator (EHMR) use in healthcare increased significantly during the COVID-19 pandemic. Concern for potential release of infectious aerosols from EHMR exhalation valves prompted recommendations to cover them with surgical masks (SMs), thereby improving source control. The physiological and subjective effects of wearing a SM over the exhalation valve of an EHMR, however, are unknown. METHODS Twelve healthy healthcare worker volunteers completed a 30-min series of simulated healthcare-related tasks, including resting, talking, walking, and bending, proning and supinating a weighted manikin, and performing cardiopulmonary resuscitation. This series recurred three times with different mask configurations-SM only, EHMR only, or EHMR with SM covering the exhalation valve. A transcutaneous sensor continuously measured carbon dioxide (tcPCO2), oxygen saturation (SpO2), and heart rate (HR) from each subject. Subjects scored their rates of perceived exertion (RPE) and levels of discomfort after each round. Physiological parameters and subjective scores were analyzed using mixed linear models with a fixed effect for mask type, activity, age, body mass index (BMI), and gender. Analysis also tested for interaction between mask type and activity. RESULTS Physiological parameters remained within normal ranges for all mask configurations but varied by task. Statistically significant but small decreases in mean tcPCO2 (37.17 versus 37.88 mmHg, P < 0.001) and SpO2 (97.74 versus 97.94%, P < 0.001) were associated with wearing EHMR with SM over the exhalation valve compared with EHMR alone. Mean HR did not differ between these mask configurations. Wearing SM only was associated with lower RPE and level of discomfort compared with EHMR, but these subjective scores did not differ when comparing EHMR with SM to EHMR only. Age, BMI, and gender had no significant effect on any outcomes. CONCLUSIONS Wearing a SM over an EHMR did not produce clinically significant changes in tcPCO2, SpO2, or HR compared with uncovered EHMR during healthcare-related tasks. Covered EHMR use also did not affect perceived exertion or discomfort compared with uncovered EHMR use. Covering the exhalation valve of an EHMR with a SM for source control purposes can be done safely.
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Affiliation(s)
- Eileen Zhuang
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Paul Thurman
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Hegang H Chen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melissa A McDiarmid
- Department of Medicine, Division of Occupational and Environmental Medicine, University of Maryland School of Medicine, Suite 200, Baltimore, MD, USA
| | - Stella E Hines
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, Division of Occupational and Environmental Medicine, University of Maryland School of Medicine, Suite 200, Baltimore, MD, USA
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Aloweni F, Bouchoucha SL, Hutchinson A, Ang SY, Toh HX, Bte Suhari NA, Bte Sunari RN, Lim SH. Health care workers' experience of personal protective equipment use and associated adverse effects during the COVID-19 pandemic response in Singapore. J Adv Nurs 2022; 78:2383-2396. [PMID: 35170075 PMCID: PMC9111733 DOI: 10.1111/jan.15164] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/28/2021] [Accepted: 11/27/2021] [Indexed: 12/15/2022]
Abstract
Aim One of the greatest challenges in responding to the COVID‐19 pandemic is preventing staff exposure and infection by ensuring consistent and effective use of personal protective equipment (PPE). This study explored health care workers' experience of prolonged PPE use in clinical practice settings and their concerns regarding PPE supply, effectiveness and training needs. Design A descriptive cross‐sectional design was adopted in this study. Methods Health care workers (N = 592) from an acute care hospital completed an online survey from July to September 2020 assessing: (i) usage frequencies, side effects and interference with patient care; and (ii) perceptions of access to PPE, likelihood of exposure to infection and adequacy of PPE training. Results PPE‐related side effects were reported by 319 (53.8%) participants, the majority being nurses (88.4%) and those working in high‐risk areas such as the emergency department (39.5%), respiratory wards (acute 22.3% and non‐acute 23.8%) and COVID‐19 isolation ward (13.8%). The average time wearing PPE per shift was 6.8 h (SD 0.39). The most commonly reported symptoms were from donning N95 masks and included: pressure injuries (45.5%), mask‐induced acne (40.4%) and burning/pain (24.5%). Some 31.3% expressed that PPE‐related side effects had negatively affected their work. The odds of having PPE‐associated side effects was higher in women (OR 2.10, 95% CI [1.29–03.42], p = .003) and those working in high‐risk wards (OR 3.12, 95% CI [2.17–4.60], p < .001]. Most (90.1%) agreed that PPE supplies were readily available, sufficient for all (86.1%) and there was sufficient training in correct PPE use (93.6%). Only 13.7% of participants reported being ‘highly confident’ of overall PPE protection. Conclusions Prevention and management of PPE‐related adverse effects is vital to: preserve the integrity of PPE, improve adherence and minimize viral transmission. Impact The high incidence of PPE‐associated pressure injuries and perception that PPE use can interfere with clinical care should inform future development of PPE products, and strategies to better equip health care workers to prevent and manage PPE‐related side effects.
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Affiliation(s)
- Fazila Aloweni
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | - Stéphane L Bouchoucha
- Associate Head of School (International), Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University Geelong, School of Nursing and Midwifery, Victoria, Australia
| | - Ana Hutchinson
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Epworth Health/Deakin University Partnership, School of Nursing and Midwifery Geelong, Victoria, Australia
| | - Shin Yuh Ang
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | - Hui Xian Toh
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | | | | | - Siew Hoon Lim
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
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Li X, Ding P, Deng F, Mao Y, Zhou L, Ding C, Wang Y, Luo Y, Zhou Y, MacIntyre CR, Tang S, Xu D, Shi X. Wearing time and respiratory volume affect the filtration efficiency of masks against aerosols at different sizes. ENVIRONMENTAL TECHNOLOGY & INNOVATION 2022; 25:102165. [PMID: 34926728 PMCID: PMC8665844 DOI: 10.1016/j.eti.2021.102165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/19/2021] [Accepted: 11/25/2021] [Indexed: 05/09/2023]
Abstract
Face masks are critical in preventing the spread of respiratory infections including coronavirus disease 2019 (COVID-19). Different types of masks have distinct filtration efficiencies (FEs) with differential costs and supplies. Here we reported the impact of breathing volume and wearing time on the inward and outward FEs of four different mask types (N95, surgical, single-use, and cloth masks) against various sizes of aerosols. Specifically, 1) Mask type was an important factor affecting the FEs. The FEs of N95 and surgical mask were better than those of single-use mask and cloth mask; 2) As particle size decreased, the FEs tended to reduce. The trend was significantly observed in FEs of aerosols with particle size < 1 μ m ; 3) After wearing N95 and surgical masks for 0, 2, 4, and 8 h, their FEs (%) maintained from 95.75 ± 0.09 to 100 ± 0 range. While a significant decrease in FEs were noticed for single-use masks worn for 8 h and cloth masks worn >2 h under deep breathing (30 L/min); 4) Both inward and outward FEs of N95 and surgical masks were similar, while the outward FEs of single-use and cloth masks were higher than their inward FEs; 5) The FEs under deep breathing was significantly lower than normal breathing with aerosol particle size <1 μ m. In conclusion, our results revealed that masks have a critical role in preventing the spread of aerosol particles by filtering inhalation, and FEs significantly decreased with the increasing of respiratory volume and wearing time. Deep breathing may cause increasing humidity and hence decrease FEs by increasing the airflow pressure. With the increase of wearing time, the adsorption capacity of the filter material tends to be saturated, which may reduce FEs. Findings may be used to provide information for policies regarding the proper use of masks for general public in current and future pandemics.
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Affiliation(s)
- Xia Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Pei Ding
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Fuchang Deng
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Yixin Mao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Lin Zhou
- Dalian Center for Disease Control and Prevention, Dalian, Liaoning 116021, China
| | - Cheng Ding
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Youbin Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Yueyun Luo
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Yakun Zhou
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - C Raina MacIntyre
- The Kirby Institute, Faculty of Medicine, The University of New South Wales, Sydney, 2052, NSW, Australia
| | - Song Tang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Dongqun Xu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
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