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Keegan D, Heffernan E, Clarke B, Deasy C, O'Donnell C, Crowley P, Hughes A, Murphy AW, Masterson S. Tools and methods for evaluating the change to health service delivery due to pandemics or other similar emergencies: A rapid evidence review. EVALUATION AND PROGRAM PLANNING 2024; 102:102378. [PMID: 37856938 DOI: 10.1016/j.evalprogplan.2023.102378] [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: 10/11/2021] [Revised: 08/21/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023]
Abstract
The novel coronavirus, SARS-CoV-2 and its associated disease COVID-19, were declared a pandemic in March 2020. Countries developed rapid response activities within their health services to prevent spread of the virus and protect their populations. Evaluating health service delivery change is vital to assess how adapted practices worked, particularly during times of crisis. This review examined tools and methods that are used to evaluate health service delivery change during pandemics and similar emergencies. Five databases were searched, including PubMed, CENTRAL, Embase, CINAHL, and PsycINFO. The SPIDER tool informed the inclusion criteria for the articles. Articles in English and published from 2002 to 2020 were included. Risk of bias was assessed using the Mixed-Methods Appraisal Tool (MMAT). A narrative synthesis approach was used to analyse the studies. Eleven articles met the inclusion criteria. Many evaluation tools, methods, and frameworks were identified in the literature. Only one established tool was specific to a particular disease outbreak. Others, including rapid-cycle improvement and PDSA cycles were implemented across various disease outbreaks. Novel evaluation strategies were common across the literature and included checklists, QI frameworks, questionnaires, and surveys. Adherence practices, experience with telehealth, patient/healthcare staff safety, and clinical competencies were some areas evaluated by the tools and methods. Several domains, including patient/practitioner safety and patient/practitioner experience with telemedicine were also identified in the studies.
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Affiliation(s)
- Dylan Keegan
- UCD Clinical Research Centre, School of Medicine, University College Dublin, Dublin, Ireland; Discipline of General Practice, Clinical Science Institute, School of Medicine, University of Galway, Galway, Ireland.
| | - Eithne Heffernan
- Discipline of General Practice, Clinical Science Institute, School of Medicine, University of Galway, Galway, Ireland; National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK; Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, UK.
| | - Bridget Clarke
- National Ambulance Service, Health Service Executive, Dublin, Ireland.
| | - Conor Deasy
- National Ambulance Service, Health Service Executive, Dublin, Ireland; Emergency Department, Cork University Hospital, Cork, Ireland; University College Cork, Cork, County Cork, Ireland.
| | - Cathal O'Donnell
- National Ambulance Service, Health Service Executive, Dublin, Ireland.
| | - Philip Crowley
- National Quality Improvement Team, Health Service Executive, Dublin, Ireland.
| | - Angela Hughes
- National Quality Improvement Team, Health Service Executive, Dublin, Ireland.
| | - Andrew W Murphy
- Discipline of General Practice, Clinical Science Institute, School of Medicine, University of Galway, Galway, Ireland; HRB Primary Care Clinical Trials Network Ireland, University of Galway, Galway, Ireland.
| | - Siobhán Masterson
- Discipline of General Practice, Clinical Science Institute, School of Medicine, University of Galway, Galway, Ireland; National Ambulance Service, Health Service Executive, Dublin, Ireland.
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Tomasi SE, Fechter-Leggett ED, Materna BL, Meiman JG, Nett RJ, Cummings KJ. Impact of Epidemic Intelligence Service Training in Occupational Respiratory Epidemiology. ATS Sch 2023; 4:441-463. [PMID: 38196681 PMCID: PMC10773279 DOI: 10.34197/ats-scholar.2023-0062ps] [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: 06/05/2023] [Accepted: 08/03/2023] [Indexed: 01/11/2024] Open
Abstract
The Centers for Disease Control and Prevention's Epidemic Intelligence Service (EIS) is a fellowship in applied epidemiology for physicians, veterinarians, nurses, scientists, and other health professionals. Each EIS fellow is assigned to a position at a federal, state, or local site for 2 years of on-the-job training in outbreak investigation, epidemiologic research, surveillance system evaluation, and scientific communication. Although the original focus of the program on the control of infectious diseases remains salient, positions are available for training in other areas of public health, including occupational respiratory disease. In this Perspective, we describe the EIS program, highlight three positions (one federal and two state-based) that provide training in occupational respiratory epidemiology, and summarize trainees' experiences in these positions over a 30-year period. For early-career health professionals interested in understanding and preventing occupational respiratory hazards and diseases, EIS offers a unique career development opportunity.
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Affiliation(s)
- Suzanne E. Tomasi
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Ethan D. Fechter-Leggett
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Barbara L. Materna
- Center for Healthy Communities, California Department of Public Health, Richmond, California
| | | | - Randall J. Nett
- Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Kristin J. Cummings
- Center for Healthy Communities, California Department of Public Health, Richmond, California
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Thiel CL, Sreedhar P, Silva GS, Greene HC, Seetharaman M, Durr M, Roberts T, Vedanthan R, Lee PH, Andrade G, El-Shahawy O, Hochman SE. Conservation Practices for Personal Protective Equipment: A Systematic Review with Focus on Lower-Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2575. [PMID: 36767940 PMCID: PMC9915410 DOI: 10.3390/ijerph20032575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 06/18/2023]
Abstract
During the start of the COVID-19 pandemic, shortages of personal protective equipment (PPE) necessitated unprecedented and non-validated approaches to conserve PPE at healthcare facilities, especially in high income countries where single-use disposable PPE was ubiquitous. Our team conducted a systematic literature review to evaluate historic approaches for conserving single-use PPE, expecting that lower-income countries or developing contexts may already be uniquely conserving PPE. However, of the 50 included studies, only 3 originated from middle-income countries and none originated from low-income countries. Data from the included studies suggest PPE remained effective with extended use and with multiple or repeated use in clinical settings, as long as donning and doffing were performed in a standard manner. Multiple decontamination techniques were effective in disinfecting single use PPE for repeated use. These findings can inform healthcare facilities and providers in establishing protocols for safe conservation of PPE supplies and updating existing protocols to improve sustainability and overall resilience. Future studies should evaluate conservation practices in low-resource settings during non-pandemic times to develop strategies for more sustainable and resilient healthcare worldwide.
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Affiliation(s)
- Cassandra L. Thiel
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | | | - Genevieve S. Silva
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hannah C. Greene
- Social Science Division, New York University Abu Dhabi, Abu Dhabi P.O. Box 129188, United Arab Emirates
| | - Meenakshi Seetharaman
- College of Literature, Science, and Arts, University of Michigan, Ann Arbor, MI 48109, USA
| | - Meghan Durr
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Timothy Roberts
- Health Sciences Library, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Paul H. Lee
- Department of Oral and Maxillofacial Surgery, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Gizely Andrade
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Omar El-Shahawy
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Sarah E. Hochman
- Department of Medicine, Division of Infectious Diseases and Immunology, NYU Grossman School of Medicine, New York, NY 10016, USA
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Huang M, Hasan MK, Pillai SD, Pharr M, Staack D. Electron beam technology for Re-processing of personal protective equipment. Radiat Phys Chem Oxf Engl 1993 2022; 202:110557. [PMID: 36189446 PMCID: PMC9516357 DOI: 10.1016/j.radphyschem.2022.110557] [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: 03/30/2022] [Revised: 09/01/2022] [Accepted: 09/18/2022] [Indexed: 11/26/2022]
Abstract
Beginning with the outbreak of COVID-19 at the dawn of 2020, the continuing spread of the pandemic has challenged the healthcare market and the supply chain of Personal Protective Equipment (PPE) around the world. Moreover, the emergence of the variants of COVID-19 occurring in waves threatens the sufficient supply of PPE. Among the various types of PPE, N95 Respirators, surgical masks, and medical gowns are the most consumed and thus have a high potential for a serious shortage during such emergencies. Considering the unanticipated demand for PPE during a pandemic, re-processing of used PPE is one approach to continue to protect the health of first responders and healthcare personnel. This paper evaluates the viability and efficacy of using FDA-approved electron beam (eBeam) sterilization technology (ISO 11137) to re-process used PPE. PPEs including 3M N95 Respirators, Proxima Sirus gowns, and face shields were eBeam irradiated in different media (air, argon) over a dose range of 0-200 kGy. Several tests were then performed to examine surface properties, mechanical properties, functionality performance, discoloration phenomenon, and liquid barrier performance. The results show a reduction of filtration efficiency to about 63.6% in the N95 Respirator; however, charge regeneration may improve the re-processed efficiency. Additionally, mechanical degradation was observed in Proxima Sirus gown with increasing dose up to 100 kGy. However, no mechanical degradation was observed in the face shields after 10 times donning and doffing. Apart from the face shield, N95 Respirators and Proxima Sirus gown both show significant mechanical degradation with ebeam dose over sterilization doses (>25 kGy), indicating that eBeam technology is not appropriate for the re-processing these PPEs.
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Affiliation(s)
- Min Huang
- Department of Mechanical Engineering, Texas A&M University, 3123 Spence St, College Station, TX, 77840, USA
| | - Md Kamrul Hasan
- Department of Mechanical Engineering, Texas A&M University, 3123 Spence St, College Station, TX, 77840, USA
| | - Suresh D Pillai
- National Center for Electron Beam Research, Texas A&M University, College Station, TX, 77840, USA
| | - Matt Pharr
- Department of Mechanical Engineering, Texas A&M University, 3123 Spence St, College Station, TX, 77840, USA
| | - David Staack
- Department of Mechanical Engineering, Texas A&M University, 3123 Spence St, College Station, TX, 77840, USA
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How Can Personal Protective Equipment Be Best Used and Reused: A Closer Look at Donning and Doffing Procedures. Disaster Med Public Health Prep 2022; 17:e272. [PMID: 36155649 DOI: 10.1017/dmp.2022.209] [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: 11/05/2022]
Abstract
OBJECTIVE The aim of this study was to examine safety-related contamination threats and risks to health-care workers (HCWs) due to the reuse of personal protective equipment (PPE) among emergency department (ED) personnel. METHODS We used a Participatory Design (PD) approach to conduct task analysis (TA) of PPE use and reuse. TA identified the steps, risks, and protective behaviors involved in PPE reuse. We used the Centers for Disease Control and Prevention (CDC) guidance for PPE donning and doffing specifying the recommended task order. Then, we convened subject matter experts (SMEs) with relevant backgrounds in Patient Safety, Human Factors and Emergency Medicine to iteratively identify and map the tasks, risks, and protective behaviors involved in the PPE use and reuse. RESULTS Two emerging threats were associated with behaviors in donning, doffing, and re-using PPE: (i) direct exposure to contaminant, and (ii) transmission/spread of contaminant. Protective behaviors included: hand hygiene, not touching the patient-facing surface of PPE, and ensuring a proper fit and closure of all PPE ties and materials. CONCLUSIONS TA was helpful revealed that the procedure for donning and doffing of re-used PPE does not protect ED personnel from contaminant spread and risk of exposure, even with protective behaviors present (e.g., hand hygiene, respirator use, etc.). Future work should make more apparent the underlying risks associated with PPE use and reuse.
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Thurman P, Zhuang E, Chen HH, McClain C, Sietsema M, Fernando R, McDiarmid MA, Hines SE. Characteristics Associated With Health Care Worker Knowledge and Confidence in Elastomeric Half-Mask Respirator Use. J Occup Environ Med 2022; 64:802-807. [PMID: 35704776 PMCID: PMC9426319 DOI: 10.1097/jom.0000000000002611] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study evaluated health care workers' (HCWs') knowledge and confidence in using elastomeric half-mask respirator (EHMR) attributes known to influence usage. METHODS Health care workers were surveyed regarding their EHMR donning and doffing experience. Respondents were categorized into competency categories based on their scores. Category differences were analyzed using χ 2 and multiple logistic regression. RESULTS Seventy-two percent showed high levels of EHMR donning and doffing knowledge and confidence (mastery); however, 21% had greater confidence than knowledge (misinformed). Respiratory therapists had greater odds of mastery than other HCWs ( P < 0.05), whereas those working in medical/surgical and pediatric units had greater odds of doubt than other HCWs ( P < 0.01). CONCLUSIONS Although most HCWs show high knowledge and confidence with EHMR use, strategies to confirm respirator use competency may ensure greater HCWs protection.
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Cloet A, Griffin L, Yu M, Durfee W. Design considerations for protective mask development: A remote mask usability evaluation. APPLIED ERGONOMICS 2022; 102:103751. [PMID: 35339761 PMCID: PMC8943342 DOI: 10.1016/j.apergo.2022.103751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/07/2022] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
The design of N95 filtering facepiece respirators (FFRs) continues to pose usability concerns for healthcare workers, which have been exacerbated by the COVID-19 pandemic. The aim of this study was to develop a holistic model to guide mask design improvement. Dental students (n = 38) with experience wearing N95 FFRs participated in a randomized wear trial of three alternative protective masks. A mixed methods survey was used to examine usability of individual mask design components, the relationship of facial/head area to mask features, and overall mask design. Survey results indicated MNmask v1 demonstrated higher usability in seal confidence (M = 3.46), while MNmask v2 performed higher in satisfactory fit (M = 3.50). Design components of nose wire and head/neck bands were the most problematic, while conditions of skin irritation and tight/loose fit created an unfavorable wear experience. To consider healthcare workers' needs in improving the usability of protective masks, a model is presented to consider characteristics of fit, comfort, material, and design.
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Affiliation(s)
- Alison Cloet
- College of Design, University of Minnesota, 1985 Buford Ave, 240 McNeal Hall, St. Paul, MN, 55108, USA
| | - Linsey Griffin
- College of Design, University of Minnesota, 1985 Buford Ave, 240 McNeal Hall, St. Paul, MN, 55108, USA.
| | - Minji Yu
- College of Design, University of Minnesota, 1985 Buford Ave, 240 McNeal Hall, St. Paul, MN, 55108, USA
| | - William Durfee
- Department of Mechanical Engineering, University of Minnesota, 111 Church Street SE, Minneapolis, MN, 55455, USA
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Yoon N, Ari M, Yorio P, Iskander J, D'Alessandro M. Applying the CDC Science Impact Framework to the results of the National Institute for Occupational Safety and Health and the Bureau of Labor Statistics 2001 survey of respirator use and practices. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2022; 19:394-407. [PMID: 35404773 DOI: 10.1080/15459624.2022.2063875] [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
During 2001-2002, the National Institute for Occupational Safety and Health (NIOSH), at the United States Centers for Disease Control and Prevention, collaborated with the Bureau of Labor Statistics (BLS) at the United States Department of Labor to conduct a voluntary survey of U.S. employers regarding the use of respiratory protective devices. In 2003, the survey results were jointly published by NIOSH and BLS. This study highlights and evaluates the scientific impact of the 2001-2002 survey by using the Science Impact Framework which provides a historical tracking method with five domains of influence. The authors conducted interviews with original project management as well as a thorough document review and qualitative content analysis of published papers, books, presentations, and other relevant print media. A semi-structured and cross-vetted coding was applied across the five domains: Disseminating Science, Creating Awareness, Catalyzing Action, Effecting Change, and Shaping the Future. The 2001-2002 survey findings greatly enhanced understanding and awareness of respirator use in occupational settings within the United States. It also led to similar surveys in other countries, regulatory initiatives by the Occupational Safety and Health Administration and Mine Safety and Health Administration, and ultimately to a renewed partnership between NIOSH and BLS to collect contemporary estimates of respirator use in the workplace within the United States.
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Affiliation(s)
- Nami Yoon
- CDC/NIOSH/NPPTL, Pittsburg, Pennsylvania
| | - Mary Ari
- CDC-Office of Science, Atlanta, Georgia
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Hines SE, Gaitens J, Mueller NM, Molina Ochoa D, Fernandes E, McDiarmid MA. Respiratory Protection Perceptions among Malian Health Workers: Insights from the Health Belief Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053028. [PMID: 35270723 PMCID: PMC8909975 DOI: 10.3390/ijerph19053028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/10/2022] [Accepted: 02/25/2022] [Indexed: 12/10/2022]
Abstract
Reusable respiratory protective devices called elastomeric respirators have demonstrated their effectiveness and acceptability in well-resourced healthcare settings. Using standard qualitative research methods, we explored the feasibility of elastomeric respirator use in low- and middle-income countries (LMIC). We conducted interviews and focus groups with a convenience sample of health workers at one clinical center in Mali. Participants were users of elastomeric and/or traditional N95 respirators, their supervisors, and program leaders. Interview transcripts of participants were analyzed using a priori constructs from the Health Belief Model (HBM) and a previous study about healthcare respirator use. In addition to HBM constructs, the team identified two additional constructs impacting uptake of respirator use (system-level factors and cultural factors). Together, these framed the perceptions of Malian health workers and highlighted both facilitators of and barriers to respirator use uptake. As needs for respiratory protection from airborne infectious hazards become more commonly recognized, elastomeric respirators may be a sustainable and economic solution for health worker protection in LMIC.
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Affiliation(s)
- Stella E. Hines
- Division of Occupation and Environmental Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (J.G.); (M.A.M.)
- Correspondence:
| | - Joanna Gaitens
- Division of Occupation and Environmental Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (J.G.); (M.A.M.)
| | - Nora M. Mueller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MD 02115, USA;
| | | | - Eseosa Fernandes
- Department of Preventative Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Melissa A. McDiarmid
- Division of Occupation and Environmental Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (J.G.); (M.A.M.)
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Obrová K, Vaňková E, Sláma M, Hodek J, Khun J, Ulrychová L, Nogueira F, Laos T, Sponseiler I, Kašparová P, Machková A, Weber J, Scholtz V, Lion T. Decontamination of High-Efficiency Mask Filters From Respiratory Pathogens Including SARS-CoV-2 by Non-thermal Plasma. Front Bioeng Biotechnol 2022; 10:815393. [PMID: 35237577 PMCID: PMC8883054 DOI: 10.3389/fbioe.2022.815393] [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: 11/16/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
The current pandemic resulted in a rapidly increasing demand for personal protective equipment (PPE) initially leading to severe shortages of these items. Hence, during an unexpected and fast virus spread, the possibility of reusing highly efficient protective equipment could provide a viable solution for keeping both healthcare professionals and the general public equipped and protected. This requires an efficient decontamination technique that preserves functionality of the sensitive materials used for PPE production. Non-thermal plasma (NTP) is a decontamination technique with documented efficiency against select bacterial and fungal pathogens combined with low damage to exposed materials. We have investigated NTP for decontamination of high-efficiency P3 R filters from viral respiratory pathogens in comparison to other commonly used techniques. We show that NTP treatment completely inactivates SARS-CoV-2 and three other common human respiratory viruses including Influenza A, Rhinovirus and Adenovirus, revealing an efficiency comparable to 90°C dry heat or UVC light. Unlike some of the tested techniques (e.g., autoclaving), NTP neither influenced the filtering efficiency nor the microstructure of the filter. We demonstrate that NTP is a powerful and economic technology for efficient decontamination of protective filters and other sensitive materials from different respiratory pathogens.
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Affiliation(s)
- Klára Obrová
- St. Anna Children’s Cancer Research Institute (CCRI), Division Molecular Microbiology, Vienna, Austria
- *Correspondence: Klára Obrová, ; Thomas Lion,
| | - Eva Vaňková
- Department of Physics and Measurements, University of Chemistry and Technology, Prague, Czech Republic
| | - Michal Sláma
- Faculty of Science, University of Hradec Kralove, Hradec Králové, Czech Republic
| | - Jan Hodek
- Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Prague, Czech Republic
| | - Josef Khun
- Department of Physics and Measurements, University of Chemistry and Technology, Prague, Czech Republic
| | - Lucie Ulrychová
- Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Prague, Czech Republic
- Department of Genetics and Microbiology, Charles University, Faculty of Sciences, Prague, Czech Republic
| | - Filomena Nogueira
- St. Anna Children’s Cancer Research Institute (CCRI), Division Molecular Microbiology, Vienna, Austria
| | - Triin Laos
- St. Anna Children’s Cancer Research Institute (CCRI), Division Molecular Microbiology, Vienna, Austria
| | - Isabella Sponseiler
- St. Anna Children’s Cancer Research Institute (CCRI), Division Molecular Microbiology, Vienna, Austria
| | - Petra Kašparová
- Department of Physics and Measurements, University of Chemistry and Technology, Prague, Czech Republic
| | - Anna Machková
- Department of Physics and Measurements, University of Chemistry and Technology, Prague, Czech Republic
| | - Jan Weber
- Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Prague, Czech Republic
| | - Vladimír Scholtz
- Department of Physics and Measurements, University of Chemistry and Technology, Prague, Czech Republic
| | - Thomas Lion
- St. Anna Children’s Cancer Research Institute (CCRI), Division Molecular Microbiology, Vienna, Austria
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
- *Correspondence: Klára Obrová, ; Thomas Lion,
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11
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Lynch JB, Davitkov P, Anderson DJ, Bhimraj A, Cheng VCC, Guzman-Cottrill J, Dhindsa J, Duggal A, Jain MK, Lee GM, Liang SY, McGeer A, Varghese J, Lavergne V, Murad MH, Mustafa RA, Sultan S, Falck-Ytter Y, Morgan RL. Infectious Diseases Society of America Guidelines on Infection Prevention for Healthcare Personnel Caring for Patients with Suspected or Known COVID-19. Clin Infect Dis 2021:ciab953. [PMID: 34791102 PMCID: PMC8767890 DOI: 10.1093/cid/ciab953] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Since its emergence in late 2019, SARS-CoV-2 continues to pose a risk to healthcare personnel (HCP) and patients in healthcare settings. Although all clinical interactions likely carry some risk of transmission, human actions like coughing and care activities like aerosol-generating procedures likely have a higher risk of transmission. The rapid emergence and global spread of SARS-CoV-2 continues to create significant challenges in healthcare facilities, particularly with shortages of personal protective equipment (PPE) used by HCP. Evidence-based recommendations for what PPE to use in conventional, contingency, and crisis standards of care continue to be needed. Where evidence is lacking, the development of specific research questions can help direct funders and investigators. OBJECTIVE Develop evidence-based rapid guidelines intended to support HCP in their decisions about infection prevention when caring for patients with suspected or known COVID-19. METHODS IDSA formed a multidisciplinary guideline panel including frontline clinicians, infectious disease specialists, experts in infection control, and guideline methodologists with representation from the disciplines of public health, medical microbiology, pediatrics, critical care medicine and gastroenterology. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. RESULTS The IDSA guideline panel agreed on eight recommendations, including two updated recommendations and one new recommendation added since the first version of the guideline. Narrative summaries of other interventions undergoing evaluations are also included. CONCLUSIONS Using a combination of direct and indirect evidence, the panel was able to provide recommendations for eight specific questions on the use of PPE for HCP providing care for patients with suspected or known COVID-19. Where evidence was lacking, attempts were made to provide potential avenues for investigation. There remain significant gaps in the understanding of the transmission dynamics of SARS-CoV-2 and PPE recommendations may need to be modified in response to new evidence. These recommendations should serve as a minimum for PPE use in healthcare facilities and do not preclude decisions based on local risk assessments or requirements of local health jurisdictions or other regulatory bodies.
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Affiliation(s)
- John B Lynch
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Perica Davitkov
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
| | - Adarsh Bhimraj
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Vincent Chi-Chung Cheng
- Queen Mary Hospital, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Judith Guzman-Cottrill
- Department of Pediatrics, Division of Infectious Diseases, Oregon Health and Science University, Portland, Oregon
| | | | - Abhijit Duggal
- Department of Critical Care, Cleveland Clinic, Cleveland, Ohio
| | - Mamta K Jain
- Department of Internal Medicine, Division of Infectious Diseases, UT Southwestern Medical Center, Dallas, Texas
| | - Grace M Lee
- Department of Pediatrics-Infectious Disease, Stanford University School of Medicine, Stanford, California
| | - Stephen Y Liang
- Division of Infectious Diseases and Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Allison McGeer
- Department of Microbiology, Sinai Health System, University of Toronto, Toronto, Ontario
| | - Jamie Varghese
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - Valery Lavergne
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Yngve Falck-Ytter
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
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De Vito D, Fusco A, Benincasa C, Laghi L, Ceruso FM. Healthcare Management During a Pandemic: The Other Side of the Coin for the Treatment of Covid-19 Infection. Endocr Metab Immune Disord Drug Targets 2021; 22:383-394. [PMID: 34635046 DOI: 10.2174/1871530321666211011102038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/07/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND World Health Organization (WHO) has increasingly improved the guidelines to tackle the spread of Coronavirus Disease 2019 (COVID-19) among the worldwide population. In this context, each country has introduced specific social, healthcare, political and macroeconomic measures to face COVID pandemic locally. OBJECTIVE The general aim of this comparative overview is to highlight the most significant effects of COVID-19 pandemic on the main healthcare systems. Also, we critically analyzed the macroeconomic variables and the most promising solutions to improve both healthcare system and its related risk management, taking into specific consideration the most industrialized countries. METHOD The main strategy has been built on a renewed concept of the hospital, rebuilding the old concepts of "triage" and "intensive care". Recently, COVID-19 hospitals have allowed to cater the patients affected by COVID-19. Moreover, the reshaping of several healthcare policies and requirements has led to several positive effects, such as the recruitment of a huge number of human resources in the healthcare systems. Nevertheless, several negative effects have also impacted the communities mostly subjected to infections. CONCLUSION Undoubtedly, the national healthcare systems have somehow addressed the people's needs, trying not to neglect the social, healthcare, economic and political aspects. In our overview, we have reported how the different actions taken in the last months, have resulted in different outcomes.
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Affiliation(s)
- Danila De Vito
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro". Italy
| | | | - Caterina Benincasa
- Marrelli Health - Tecnologica Research Institute, Biomedical Section, Street E. Fermi 1, Crotone. Italy
| | - Luca Laghi
- Queen Elisabeth hospital, Birmingham . United Kingdom
| | - Francesco M Ceruso
- Department of Dentistry "Fra G.B. Orsenigo - Ospedale San Pietro F.B.F.", Rome. Italy
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13
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McAvoy M, Bui ATN, Hansen C, Plana D, Said JT, Yu Z, Yang H, Freake J, Van C, Krikorian D, Cramer A, Smith L, Jiang L, Lee KJ, Li SJ, Beller B, Huggins K, Short MP, Yu SH, Mostaghimi A, Sorger PK, LeBoeuf NR. 3D Printed frames to enable reuse and improve the fit of N95 and KN95 respirators. BMC Biomed Eng 2021; 3:10. [PMID: 34099062 PMCID: PMC8182357 DOI: 10.1186/s42490-021-00055-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 05/09/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In response to supply shortages caused by the COVID-19 pandemic, N95 filtering facepiece respirators (FFRs or "masks"), which are typically single-use devices in healthcare settings, are routinely being used for prolonged periods and in some cases decontaminated under "reuse" and "extended use" policies. However, the reusability of N95 masks is limited by degradation of fit. Possible substitutes, such as KN95 masks meeting Chinese standards, frequently fail fit testing even when new. The purpose of this study was to develop an inexpensive frame for damaged and poorly fitting masks using readily available materials and 3D printing. RESULTS An iterative design process yielded a mask frame consisting of two 3D printed side pieces, malleable wire links that users press against their face, and cut lengths of elastic material that go around the head to hold the frame and mask in place. Volunteers (n = 45; average BMI = 25.4), underwent qualitative fit testing with and without mask frames wearing one or more of four different brands of FFRs conforming to US N95 or Chinese KN95 standards. Masks passed qualitative fit testing in the absence of a frame at rates varying from 48 to 94 % (depending on mask model). For individuals who underwent testing using respirators with broken or defective straps, 80-100 % (average 85 %) passed fit testing with mask frames. Among individuals who failed fit testing with a KN95, ~ 50 % passed testing by using a frame. CONCLUSIONS Our study suggests that mask frames can prolong the lifespan of N95 and KN95 masks by serving as a substitute for broken or defective bands without adversely affecting fit. Use of frames made it possible for ~ 73 % of the test population to achieve a good fit based on qualitative and quantitative testing criteria, approaching the 85-90 % success rate observed for intact N95 masks. Frames therefore represent a simple and inexpensive way of expanding access to PPE and extending their useful life. For clinicians and institutions interested in mask frames, designs and specifications are provided without restriction for use or modification. To ensure adequate performance in clinical settings, fit testing with user-specific masks and PanFab frames is required.
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Affiliation(s)
- Malia McAvoy
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Department of Neurosurgery, University of Washington, Seattle, WA USA
| | - Ai-Tram N. Bui
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Christopher Hansen
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Harvard Graduate School of Design, Cambridge, MA USA
| | - Deborah Plana
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA USA
- Department of Systems Biology, Harvard Ludwig Cancer Research Center, Harvard Medical School, Boston, MA USA
| | - Jordan T. Said
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Zizi Yu
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Helen Yang
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
| | - Jacob Freake
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Fikst Product Development, Woburn, MA USA
| | - Christopher Van
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Borobot, Middleborough, MA USA
| | - David Krikorian
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Dana-Farber Cancer Institute, MA Boston, USA
| | - Avilash Cramer
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA USA
| | - Leanne Smith
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Borobot, Middleborough, MA USA
| | - Liwei Jiang
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA USA
| | - Karen J. Lee
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA USA
| | - Sara J. Li
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA USA
| | - Brandon Beller
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Engineering Science at Norwalk Community College, Norwalk, CT USA
| | | | - Michael P. Short
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Department of Nuclear Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
| | - Sherry H. Yu
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Department of Dermatology, Yale University School of Medicine, New Haven, CT USA
| | - Arash Mostaghimi
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA USA
| | - Peter K. Sorger
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Department of Systems Biology, Harvard Ludwig Cancer Research Center, Harvard Medical School, Boston, MA USA
- Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA USA
| | - Nicole R. LeBoeuf
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Dana-Farber Cancer Institute, MA Boston, USA
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA USA
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Cetisli-Korkmaz N, Bilek F, Can-Akman T, Baskan E, Keser I, Dogru-Huzmeli E, Duray M, Aras B, Kilinc B. Rehabilitation strategies and neurological consequences in patients with COVID-19: part II. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1907939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Furkan Bilek
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Firat University, Elazig, Turkey
| | - Tuba Can-Akman
- School of Physiotherapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Emre Baskan
- School of Physiotherapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Ilke Keser
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gazi University, Ankara, Turkey
| | - Esra Dogru-Huzmeli
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Mehmet Duray
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Suleyman Demirel University, Isparta, Turkey
| | - Bahar Aras
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kutahya Health Sciences University, Kutahya, Turkey
| | - Buse Kilinc
- School of Health Sciences, Department of Physiotherapy and Rehabilitation, KTO Karatay University, Konya, Turkey
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Licina A, Silvers A. Use of powered air-purifying respirator(PAPR) as part of protective equipment against SARS-CoV-2-a narrative review and critical appraisal of evidence. Am J Infect Control 2021; 49:492-499. [PMID: 33186678 PMCID: PMC7654369 DOI: 10.1016/j.ajic.2020.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The last 2 decades have seen an increasing frequency of zoonotic origin viral diseases leaping from animal to human hosts including Severe Acute Respiratory Syndrome Coronaviruses (SARS-CoV-2). Respiratory component of the infectious disease program against SARS-CoV-2 incorporates use of protective airborne respiratory equipment. METHODS In this narrative review, we explore the features of Powered Air Purifying Respirators (PAPR) as well as logistical and evidence-based advantages and disadvantages. RESULTS Simulation study findings support increased heat tolerance and wearer comfort with a PAPR, versus decreased communication ability, mobility, and dexterity. Although PAPRs have been recommended for high-risk procedures on suspected or confirmed COVID-19 patients, this recommendation remains controversial due to lack of evidence. Guidelines for appropriate use of PAPR during the current pandemic are sparse. International regulatory bodies do not mandate the use of PAPR for high-risk aerosol generating procedures in patients with SARS-CoV-2. Current reports of the choice of protective respiratory technology during the SARS-CoV-2 pandemic are disparate. Patterns of use appear to be related to geographical locations. DISCUSSION Field observational studies do not indicate a difference in healthcare worker infection utilizing PAPR devices versus other compliant respiratory equipment in healthcare workers performing AGPs in patients with SARS-CoV-2. Whether a higher PAPR filtration factor translates to decreased infection rates of HCWs remains to be elucidated. Utilization of PAPR with high filtration efficiency may represent an example of "precautionary principle" wherein action taken to reduce risk is guided by logistical advantages of PAPR system.
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Affiliation(s)
- Ana Licina
- VMO Anaesthesia, Austin Health, Melbourne, Victoria, Australia.
| | - Andrew Silvers
- VMO Anaesthesia, Monash Medical Centre, Adjunct Senior Lecturer, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
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16
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Preparing for an Influenza Pandemic: Hospital Acceptance Study of Filtering Facepiece Respirator Decontamination Using Ultraviolet Germicidal Irradiation. J Patient Saf 2021; 16:117-122. [PMID: 32175970 PMCID: PMC7224602 DOI: 10.1097/pts.0000000000000600] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objectives Predictions estimate supplies of filtering facepiece respirators (FFRs) would be limited in the event of a severe influenza pandemic. Ultraviolet decontamination and reuse (UVDR) is a potential approach to mitigate an FFR shortage. A field study sought to understand healthcare workers’ perspectives and potential logistics issues related to implementation of UVDR methods for FFRs in hospitals. Methods Data were collected at three hospitals using a structured guide to conduct 19 individual interviews, 103 focus group interviews, and 285 individual surveys. Data were then evaluated using thematic analysis to reveal key themes. Results Data revealed noteworthy variation in FFR use across the sample, along with preferences and requirements for the use of UVDR, unit design, and FFR reuse. Based on a scale of 1 (low) to 10 (high), the mean perception of safety in a high mortality pandemic wearing no FFR was 1.25 of 10, wearing an FFR for an extended period without decontamination was 4.20 of 10, and using UVDR was 7.72 of 10. Conclusions In addition to technical design and development, preparation and training will be essential to successful implementation of a UVDR program. Ultraviolet decontamination and reuse program design and implementation must account for actual clinical practice, compliance with regulations, and practical financial considerations to be successfully adopted so that it can mitigate potential FFR shortages in a pandemic.
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Greenawald LA, Moore SM, Wizner K, Yorio PL. Developing a methodology to collect empirical data that informs policy and practices for stockpiling personal protective equipment. Am J Infect Control 2021; 49:166-173. [PMID: 32659415 DOI: 10.1016/j.ajic.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Personal protective equipment (PPE) are stockpiled across the nation to offset supply depletion during public health emergencies. Stockpiled PPE inventories vary across the United States by type, model, quantity, and the conditions in which they are stored. Over the past decade, federal, state, and local stockpile managers have had concerns for the viability of aging PPE. METHODS To understand factors that may affect stockpiled PPE, we explored the breadth of stockpile storage conditions and respirator and surgical gown inventories through collaboration with the national PPE community, qualitative observations collected at 10 different US stockpiles, and by compiling stockpile PPE inventories and climate data from a convenience sample of US stockpiles. RESULTS The aggregated inventory from 20 stockpiles is reported, accounting for approximately 53 million respirators. Most respirators (69% or 35.8 million) have been stored between 5 and 10 years. Upon visiting 10 stockpile facilities, we report on the storage conditions observed and summarize the storage environment data collected. CONCLUSIONS This is the first study to identify common PPE types, inventories, and storage conditions across federal, state, and local government stockpile facilities as well as health care organization-managed caches. These findings will be leveraged to guide the development of sampling protocols for air-purifying respirators and surgical gowns in US stockpiles to understand the performance viability after long-term storage.
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18
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Strauch AL, Brady TM, Niezgoda G, Almaguer CM, Shaffer RE, Fisher EM. Evaluación de la eficacia de las lengüetas en las tiras de la mascarilla autofiltrante para mejorar las técnicas de retirada adecuadas al mismo tiempo que se reduce la transmisión por contacto de los patógenos. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:S35-S43. [PMID: 33822693 DOI: 10.1080/15459624.2021.1877058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
RESUMENLas mascarillas respiratorias autofiltrantes (filtering facepiece respirators, FFR) N95 certificadas por el Instituto Nacional de Seguridad y Salud Laborales (National Institute for Occupational Safety and Health, NIOSH) se utilizan en los centros de atención sanatoria como medida de control para mitigar las exposiciones a partículas atmosféricas infecciosas. Cuando la superficie externa de una FFR se contamina, supone un riesgo de transmisión para el usuario. La guía de los Centros para el Control y Prevención de Enfermedades (Centers for Disease Control and Prevention, CDC) recomienda que el personal sanitario retire las FFR agarrando las tiras en la parte posterior de la cabeza para evitar el contacto con la superficie posiblemente contaminada. Al parecer, la adherencia a la técnica de retirada adecuada es baja, debido a numerosos factores que incluyen la dificultad para ubicar y agarrar las tiras. En este estudio se compara el impacto de lengüetas ubicadas en las tiras de la FFR con el de mascarillas comparativas (sin lengüetas) sobre la retirada adecuada, la facilidad de uso, la comodidad y la reducción de la transmisión de la contaminación al usuario. El uso de un agente fluorescente como rastreador de contactos para explorar la contaminación de las FFR en manos y áreas de la cabeza de 20 sujetos humanos demostró que no hubo diferencia entre las tiras de la FFR con lengüetas y las mascarillas comparativas en el sentido de estimular la retirada adecuada de las mismas (p = 0.48), pero la hizo más fácil (p = 0.04), según indican siete de ocho sujetos que usaron las lengüetas. Siete de 20 sujetos opinaron que las FFR con lengüetas son más fáciles de retirar, mientras que solo dos de 20 sujetos indicaron que las FFR sin lengüetas son más fáciles de retirar. La incomodidad no fue un factor relevante para ninguno de los tipos de tiras de las FFR. Al retirar una FFR con las manos contaminadas, el uso de lengüetas redujo de forma importante la cantidad del rastreador de contactos transferida en comparación con las tiras sin lengüetas (p = 0.012). Las FFR con lengüetas en las tiras están asociadas con la facilidad de la retirada y una transferencia notablemente menor del rastreador de contactos fluorescente.
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Affiliation(s)
- Amanda L Strauch
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
| | - Tyler M Brady
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
| | - George Niezgoda
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
| | - Claudia M Almaguer
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
| | - Ronald E Shaffer
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
| | - Edward M Fisher
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
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19
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Filtration efficiency of surgical sterilization fabric for respiratory protection during COVID-19 pandemic. Am J Infect Control 2021; 49:1-7. [PMID: 33166599 PMCID: PMC7647410 DOI: 10.1016/j.ajic.2020.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/21/2022]
Abstract
Background Due to COVID-19 and high demand for respirators, some healthcare professionals have been using the Halyard H600 fabric as an alternative to N95 respirators without testing the filtration efficiency of the fabric with established scientific methods. The purpose of this study was to assess the efficiency of the Halyard H600 as a respirator filtering material as compared to the NIOSH-certified N95 and P100 filters, and determine if H600 is a good alternative for respiratory protection for healthcare professionals during the COVID-19 pandemic. Methods Three filter types (Halyard H600, N95, and P100) were challenged with salt particles inside an exposure chamber at a flow rate of 43 LPM and relative humidity of 40 ± 2%. N95 and P100 respirator filters were tested initially to establish the validity of the chamber, followed by the Halyard H600 fabric. Particle penetration was measured using an aerosol spectrometer. The filtration efficiency was calculated for different particle sizes by measuring the particle number concentration upstream and downstream of the filter. The pressure drop across the filter materials was measured using a manometer. Results The efficiency of the P100 for particles ≥250 nm was 100%. The N95 efficiency was 97 ± 1% at 275 nm, 99 ± 0% at 324 nm, and 100% for larger particles. The Halyard H600 fabric had a variable efficiency with an average of 62 ± 28% at 275 nm, 89 ± 8% at 324 nm, and 100% efficiency for particles >450 nm. The pressure drop values for P100 and N95 were 32 and 8 mmH2O, respectively. The Halyard H600 fabric resistance increased dramatically from 30 mmH2O at the start of the exposure to 65 mmH2O after 16-minutes of exposure. Conclusion The high variability in filter efficiency for particles ≤324 nm and the increased fabric breathing resistance demonstrate that the Halyard H600 has an inferior performance and is not a good substitute for N95 and P100. Thus, the use of the Halyard H600 fabric for respiratory protection is not recommended.
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Lacombe A, Quintela I, Liao YT, Wu VCH. Food safety lessons learned from the COVID-19 pandemic. J Food Saf 2020; 41:e12878. [PMID: 33612893 PMCID: PMC7883256 DOI: 10.1111/jfs.12878] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/19/2020] [Accepted: 11/26/2020] [Indexed: 12/26/2022]
Abstract
The COVID‐19 pandemic has ushered in a new era of food safety. To date, there is no evidence to suggest that consuming food is associated with COVID‐19. Nevertheless, COVID‐19's impact on food safety and security has been grave. The world is currently experiencing several supply chain issues as a direct result of extensive lockdowns and impacts on essential workers' safety. However, disruption in the food supply, while catastrophic in nature, has created opportunities for the advancement of medical science, data processing, security monitoring, foodborne pathogen detection, and food safety technology. This article will discuss the key components for food safety during the COVID‐19 pandemic. The discussion will draw from lessons learned early in the outbreak and will analyze the etiology of the disease through a food safety perspective. From there, we will discuss personal protective equipment, detection of SARS‐CoV‐2, useful surrogates to study SARS‐CoV‐2, and the expanding field of data science, from the food safety point of view. In the future, scientists can apply the knowledge to the containment of COVID‐19 and eventually to future pandemics.
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Affiliation(s)
- Alison Lacombe
- Produce Safety and Microbiology Research Unit, United States Department Agricultural Agricultural Research Service Albany California USA
| | - Irwin Quintela
- Produce Safety and Microbiology Research Unit, United States Department Agricultural Agricultural Research Service Albany California USA
| | - Yen-Te Liao
- Produce Safety and Microbiology Research Unit, United States Department Agricultural Agricultural Research Service Albany California USA
| | - Vivian C H Wu
- Produce Safety and Microbiology Research Unit, United States Department Agricultural Agricultural Research Service Albany California USA
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21
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Sun Y, Otomaru H, Quaye SED, Somani J, Bagdasarian N, Beh DLL, Fisher DA, Cook AR, Dickens BL. Scenarios to Manage the Demand for N95 Respirators for Healthcare Workers During the COVID-19 Pandemic. Risk Manag Healthc Policy 2020; 13:2489-2496. [PMID: 33177904 PMCID: PMC7652237 DOI: 10.2147/rmhp.s275496] [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: 08/04/2020] [Accepted: 09/24/2020] [Indexed: 01/08/2023] Open
Abstract
Background By estimating N95 respirator demand based on simulated epidemics, we aim to assist planning efforts requiring estimations of respirator demand for the healthcare system to continue operating safely in the coming months. Methods We assess respiratory needs over the course of mild, moderate and severe epidemic scenarios within Singapore as a case study using a transmission dynamic model. The number of respirators required within the respiratory isolation wards and intensive care units was estimated over the course of the epidemic. We also considered single-use, extended-use and prolonged-use strategies for N95 respirators for use by healthcare workers treating suspected but negative (misclassified) or confirmed COVID-19 patients. Results Depending on the confirmed to misclassified case ratio, from 1:0 to 1:10, a range of 117.1 million to 1.1 billion masks are required for single-use. This decreases to 71.6–784.4 million for extended-use and 12.8–148.2 million for prolonged-use, representing a 31.8–38.9% and 86.5–89.1% reduction, respectively. Conclusion An extended-use policy should be considered when short-term supply chains are strained but planning measures are in place to ensure long-term availability. With severe shortage expectations from a severe epidemic, as some European countries have experienced, prolonged use is necessary to prolong supply.
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Affiliation(s)
- Yinxiaohe Sun
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Hirono Otomaru
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Sharon Esi Duoduwa Quaye
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Jyoti Somani
- Division of Infectious Diseases, National University Hospital, Singapore
| | | | - Darius L L Beh
- Division of Infectious Diseases, National University Hospital, Singapore
| | - Dale A Fisher
- Division of Infectious Diseases, National University Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Borame L Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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22
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Clarke B, Haze N, Sly J, Thomas A, Ponte PR, Jurgens CY. Just-in-time safety training for N95 respirators: A virtual approach. Nurs Manag (Harrow) 2020; 51:17-22. [PMID: 33116046 DOI: 10.1097/01.numa.0000719392.56384.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Beth Clarke
- At Boston College William F. Connell School of Nursing in Chestnut Hill, Mass., Beth Clarke is a clinical instructor, Nanci Haze is a clinical assistant professor, Jacqueline Sly is a clinical instructor, Allan Thomas is a clinical instructor, Patricia Reid Ponte is an associate clinical professor, and Corrine Y. Jurgens is an associate professor
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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 2020; 16:619-626. [PMID: 33040770 PMCID: PMC7737120 DOI: 10.1017/dmp.2020.380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [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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Bergman M, Fisher EM, Heimbuch BK. A Review of Decontamination Methods for Filtering Facepiece Respirators. JOURNAL OF THE INTERNATIONAL SOCIETY FOR RESPIRATORY PROTECTION 2020; 37:71-86. [PMID: 33268915 PMCID: PMC7707143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
During the current COVID-19 infectious disease pandemic, the demand for NIOSH-approved filtering facepiece respirators (FFR) has exceeded supplies and decontamination and reuse of FFRs has been implemented by various user groups. FFR decontamination and reuse is only intended to be implemented as a crisis capacity strategy. This paper provides a review of decontamination procedures in the published literature and calls attention to their benefits and limitations. In most cases, the data are limited to a few FFR models and a limited number of decontamination cycles. Institutions planning to implement a decontamination method must understand its limitations in terms of the degree of inactivation of the intended microorganisms and the treatment's effects on the fit and filtration of the device.
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Affiliation(s)
- Mike Bergman
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, 626 Cochrans Mill Road, Pittsburgh, PA 15236
| | - Edward M. Fisher
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, 626 Cochrans Mill Road, Pittsburgh, PA 15236
| | - Brian K. Heimbuch
- Applied Research Associates, 430 W 5th St, Suite 700, Panama City, FL 32401
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25
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Jessop ZM, Dobbs TD, Ali SR, Combellack E, Clancy R, Ibrahim N, Jovic TH, Kaur AJ, Nijran A, O'Neill TB, Whitaker IS. Personal protective equipment for surgeons during COVID-19 pandemic: systematic review of availability, usage and rationing. Br J Surg 2020; 107:1262-1280. [PMID: 32395837 PMCID: PMC7273092 DOI: 10.1002/bjs.11750] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Surgeons need guidance regarding appropriate personal protective equipment (PPE) during the COVID-19 pandemic based on scientific evidence rather than availability. The aim of this article is to inform surgeons of appropriate PPE requirements, and to discuss usage, availability, rationing and future solutions. METHODS A systematic review was undertaken in accordance with PRISMA guidelines using MEDLINE, Embase and WHO COVID-19 databases. Newspaper and internet article sources were identified using Nexis. The search was complemented by bibliographic secondary linkage. The findings were analysed alongside guidelines from the WHO, Public Health England, the Royal College of Surgeons and specialty associations. RESULTS Of a total 1329 articles identified, 95 studies met the inclusion criteria. Recommendations made by the WHO regarding the use of PPE in the COVID-19 pandemic have evolved alongside emerging evidence. Medical resources including PPE have been rapidly overwhelmed. There has been a global effort to overcome this by combining the most effective use of existing PPE with innovative strategies to produce more. Practical advice on all aspects of PPE is detailed in this systematic review. CONCLUSION Although there is a need to balance limited supplies with staff and patient safety, this should not leave surgeons treating patients with inadequate PPE.
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Affiliation(s)
- Z M Jessop
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - T D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - S R Ali
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - E Combellack
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - R Clancy
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - N Ibrahim
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - T H Jovic
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - A J Kaur
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - A Nijran
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - T B O'Neill
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - I S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
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Singh R, Azim A, Singh N. Should We or Should We Not Reuse Filtering Face Piece Masks? A Review. Indian J Crit Care Med 2020; 24:857-862. [PMID: 33132573 PMCID: PMC7584827 DOI: 10.5005/jp-journals-10071-23565] [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] [Indexed: 11/23/2022] Open
Abstract
Disposable filtering face piece respirators (FFRs) are usually not approved for routine practice of decontamination and reuse. However, such practice of decontamination and reuse may be needed only as a crisis capacity strategy to ensure continued availability. The current severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic would help us enlighten about more effective and efficient ways of decontamination and reuse. Based on the limited research available, ultraviolet irradiation, vapors of hydrogen peroxide, and moist heat showed the most promising potential methods to decontaminate FFRs. This article summarizes available research about decontamination of FFRs before reuse. How to cite this article: Singh R, Azim A, Singh N. Should We or Should We Not Reuse Filtering Face Piece Masks? A Review. Indian J Crit Care Med 2020;24(9):857-862.
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Affiliation(s)
- Ritu Singh
- Department of Anesthesia and Critical Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Afzal Azim
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nidhi Singh
- Department of Anesthesia, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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27
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Yang H, Hu J, Li P, Zhang C. Ultraviolet germicidal irradiation for filtering facepiece respirators disinfection to facilitate reuse during COVID-19 pandemic: A review. Photodiagnosis Photodyn Ther 2020; 31:101943. [PMID: 32763473 PMCID: PMC7402378 DOI: 10.1016/j.pdpdt.2020.101943] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 01/14/2023]
Abstract
UVGI is one possible method for respiratory disinfection to facilitate the reuse of dwindling supplies. Appropriate dose UVGI exposition could provide enough energy to effectively decontaminate respiratory viral agent and maintenance respirator's integrity for reuse. Further evidence concerning UVGI as a decontamination technique for SARS-COV-2 is needed.
Background To review the effect of ultraviolet germicidal irradiation (UVGI) as a disinfection method for filtering facepiece respirators (FFRs) to facilitate reuse during COVID-19 pandemic. Methods Systematic review of the research concerning UVGI for FFRs disinfection to facilitate reuse (also termed limited reuse) during respiratory infectious diseases where aerosol transmission is considered possible. Results UVGI is one possible method for respiratory disinfection to facilitate the reuse of dwindling supplies. Appropriate dose UVGI exposition could provide enough energy to effectively decontaminate respiratory viral agents and maintain respirator's integrity for reuse. There was not currently sufficient research evidence on the effect of UVGI to inactivate coronaviruses SARS-CoV-2, and the practical application of UVGI is still unclear. . Conclusion Appropriate dose UVGI exposition could provide enough energy to effectively decontaminate respiratory viral agents and maintain respirator's integrity for reuse. Further evidence concerning UVGI as a decontamination technique specifically for SARS-CoV-2 isneeded.
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Affiliation(s)
- Hua Yang
- Department of Thoracic Internal Medicine, Hunan Cancer Hospital, Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China
| | - Jiajia Hu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Ping Li
- Department of Obstetrics, Xiangya Hospital, Central South University Changsha, China; Hunan Engineering Research Center of Early Life Development and Disease Prevention, Changsha,China
| | - Chengliang Zhang
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, China.
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Polkinghorne A, Branley J. Evidence for decontamination of single-use filtering facepiece respirators. J Hosp Infect 2020; 105:663-669. [PMID: 32473179 PMCID: PMC7251398 DOI: 10.1016/j.jhin.2020.05.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/20/2020] [Indexed: 12/13/2022]
Abstract
Single-use filtering face respirators (FFRs) are critical pieces of personal protective equipment for healthcare workers treating patients with suspected upper respiratory tract pathogens. Experiences during pandemics in the 2000s, as well as the ongoing COVID-19 pandemic caused by the SARS-2-CoV-2, have highlighted concerns over the pressures that sustained respiratory virus pandemics may have on supplies of FFRs globally. Decontamination of FFRs has been posited as one solution to support the re-use of FFRs with a growing body of literature over the last 10+ years beginning to examine both the efficacy of disinfection of contaminated FFRs but also the impact of the decontamination process on the FFR's performance. Physical and chemical methods of decontamination have been tested for treatment of FFRs with ultraviolet germicidal irradiation, sterilization by steam, ethylene oxide and vaporous hydrogen peroxide, demonstrating the most promising results thus far. Many of these methods utilize existing equipment that may already be available in hospitals and could be re-purposed for FFR decontamination. Importantly, some methods may also be replicated on household equipment, broadening the utility of FFR decontamination across a range of healthcare settings. Utilizing techniques to experimentally contaminate FFRs with a range of microorganisms, most decontamination methods appear to reduce the risk of the mask as a source of infection to the wearer and others to negligible levels. The performance of the filter, especially the efficiency of particle penetration following treatment, varied greatly depending on the processing method as well as the model of the filter itself, however. Urgent regulatory body-supported research is required to endorse the routine decontamination of FFRs. In emergency settings, these methods should nevertheless be carefully considered as one strategy to address potential shortfalls in supplies of FFRs for healthcare workers.
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Affiliation(s)
- A Polkinghorne
- Department of Microbiology and Infectious Diseases, New South Wales Health Pathology, Nepean Blue Mountains Pathology Service, PO Box 63, Penrith, New South Wales, 2751, Australia; Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, 62 Derby St, Kingswood, New South Wales, 2747, Australia
| | - J Branley
- Department of Microbiology and Infectious Diseases, New South Wales Health Pathology, Nepean Blue Mountains Pathology Service, PO Box 63, Penrith, New South Wales, 2751, Australia; Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, 62 Derby St, Kingswood, New South Wales, 2747, Australia.
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29
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Lynch JB, Davitkov P, Anderson DJ, Bhimraj A, Cheng VCC, Guzman-Cottrill J, Dhindsa J, Duggal A, Jain MK, Lee GM, Liang SY, McGeer A, Lavergne V, Murad MH, Mustafa RA, Morgan RL, Falck-Ytter Y, Sultan S. Infectious Diseases Society of America Guidelines on Infection Prevention for Health Care Personnel Caring for Patients with Suspected or Known COVID-19. Clin Infect Dis 2020:ciaa1063. [PMID: 32716496 PMCID: PMC7454357 DOI: 10.1093/cid/ciaa1063] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND SARS-CoV-2 is a highly transmissible virus that can infect health care personnel and patients in health care settings. Specific care activities, in particular aerosol-generating procedures, may have a higher risk of transmission. The rapid emergence and global spread of SARS-CoV-2 has created significant challenges in health care facilities, particularly with severe shortages of personal protective equipment (PPE) used to protect health care personnel (HCP). Evidence-based recommendations for what PPE to use in conventional, contingency, and crisis standards of care are needed. Where evidence is lacking, the development of specific research questions can help direct funders and investigators. OBJECTIVE Develop evidence-based rapid guidelines intended to support HCP in their decisions about infection prevention when caring for patients with suspected or known COVID-19. METHODS IDSA formed a multidisciplinary guideline panel including front-line clinicians, infectious disease specialists, experts in infection control and guideline methodologists with representation from the disciplines of preventive care, public health, medical microbiology, pediatrics, critical care medicine and gastroenterology. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. RESULTS The IDSA guideline panel agreed on eight recommendations and provided narrative summaries of other interventions undergoing evaluations. CONCLUSIONS Using a combination of direct and indirect evidence, the panel was able to provide recommendations for eight specific questions on the use of PPE for HCP providing care for patients with suspected or known COVID-19. Where evidence was lacking, attempts were made to provide potential avenues for investigation. There remain significant gaps in the understanding of the transmission dynamics of SARS-CoV-2 and PPE recommendations may need to be modified in response to new evidence.
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Affiliation(s)
- John B Lynch
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Perica Davitkov
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
| | - Adarsh Bhimraj
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Vincent Chi-Chung Cheng
- Queen Mary Hospital, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Judith Guzman-Cottrill
- Department of Pediatrics, Division of Infectious Diseases, Oregon Health and Science University, Portland, Oregon
| | | | - Abhijit Duggal
- Department of Critical Care, Cleveland Clinic, Cleveland, Ohio
| | - Mamta K Jain
- Department of Internal Medicine, Division of Infectious Diseases, UT Southwestern Medical Center, Dallas, Texas
| | - Grace M Lee
- Department of Pediatrics-Infectious Disease, Stanford University School of Medicine, Stanford, California
| | - Stephen Y Liang
- Divisions of Infectious Diseases and Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Allison McGeer
- Department of Microbiology, Sinai Health System, University of Toronto, Toronto, Ontario
| | - Valery Lavergne
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - Yngve Falck-Ytter
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Health care System, Minneapolis, Minnesota
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30
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McAvoy M, Bui ATN, Hansen C, Plana D, Said JT, Yu Z, Yang H, Freake J, Van C, Krikorian D, Cramer A, Smith L, Jiang L, Lee KJ, Li SJ, Beller B, Short M, Yu SH, Mostaghimi A, Sorger PK, LeBoeuf NR. 3D Printed frames to enable reuse and improve the fit of N95 and KN95 respirators. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.07.20.20151019. [PMID: 32743606 PMCID: PMC7386530 DOI: 10.1101/2020.07.20.20151019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In response to supply shortages during the COVID-19 pandemic, N95 filtering facepiece respirators (FFRs or "masks"), which are typically single-use devices in healthcare settings, are routinely being used for prolonged periods and in some cases decontaminated under "reuse" and "extended use" policies. However, the reusability of N95 masks is often limited by degradation or breakage of elastic head bands and issues with mask fit after repeated use. The purpose of this study was to develop a frame for N95 masks, using readily available materials and 3D printing, which could replace defective or broken bands and improve fit. RESULTS An iterative design process yielded a mask frame consisting of two 3D-printed side pieces, malleable wire links that users press against their face, and cut lengths of elastic material that go around the head to hold the frame and mask in place. Volunteers (n= 41; average BMI= 25.5), of whom 31 were women, underwent qualitative fit with and without mask frames and one or more of four different brands of FFRs conforming to US N95 or Chinese KN95 standards. Masks passed qualitative fit testing in the absence of a frame at rates varying from 48 - 92% (depending on mask model and tester). For individuals for whom a mask passed testing, 75-100% (average = 86%) also passed testing with a frame holding the mask in place. Among users for whom a mask failed in initial fit testing, 41% passed using a frame. Success varied with mask model and across individuals. CONCLUSIONS The use of mask frames can prolong the lifespan of N95 and KN95 masks by serving as a substitute for broken or defective bands without adversely affecting fit. Frames also have the potential to improve fit for some individuals who cannot fit existing masks. Frames therefore represent a simple and inexpensive way of extending the life and utility of PPE in short supply. For clinicians and institutions interested in mask frames, designs and specifications are provided without restriction for use or modification. To ensure adequate performance in clinical settings, qualitative fit testing with user-specific masks and frames is required.
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Affiliation(s)
- Malia McAvoy
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, USA
| | - Ai-Tram N. Bui
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christopher Hansen
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard Graduate School of Design, Cambridge, MA, USA
| | - Deborah Plana
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, USA
- Harvard Ludwig Cancer Research Center and Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Jordan T. Said
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Zizi Yu
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Helen Yang
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
| | - Jacob Freake
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Fikst Product Development, Woburn, MA, USA
| | - Christopher Van
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Borobot, Middleborough, MA, USA
| | - David Krikorian
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA
| | - Avilash Cramer
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, USA
| | - Leanne Smith
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Borobot, Middleborough, MA, USA
| | - Liwei Jiang
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Karen J. Lee
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Sara J. Li
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Brandon Beller
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Engineering Science at Norwalk Community College Norwalk, CT, USA
| | - Michael Short
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Department of Nuclear Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Sherry H. Yu
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Department of Dermatology, Yale University School of Medicine, New Haven, CT USA
| | - Arash Mostaghimi
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Peter K. Sorger
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard Ludwig Cancer Research Center and Department of Systems Biology, Harvard Medical School, Boston, MA, USA
- Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA, USA
| | - Nicole R. LeBoeuf
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, USA
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31
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Chughtai AA, Seale H, Macintyre CR. Effectiveness of Cloth Masks for Protection Against Severe Acute Respiratory Syndrome Coronavirus 2. Emerg Infect Dis 2020; 26. [PMID: 32639930 PMCID: PMC7510705 DOI: 10.3201/eid2610.200948] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Cloth masks have been used in healthcare and community settings to protect the wearer from respiratory infections. The use of cloth masks during the coronavirus disease (COVID-19) pandemic is under debate. The filtration effectiveness of cloth masks is generally lower than that of medical masks and respirators; however, cloth masks may provide some protection if well designed and used correctly. Multilayer cloth masks, designed to fit around the face and made of water-resistant fabric with a high number of threads and finer weave, may provide reasonable protection. Until a cloth mask design is proven to be equally effective as a medical or N95 mask, wearing cloth masks should not be mandated for healthcare workers. In community settings, however, cloth masks may be used to prevent community spread of infections by sick or asymptomatically infected persons, and the public should be educated about their correct use.
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32
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Hegde S. Which type of personal protective equipment (PPE) and which method of donning or doffing PPE carries the least risk of infection for healthcare workers? Evid Based Dent 2020; 21:74-76. [PMID: 32591668 PMCID: PMC7317256 DOI: 10.1038/s41432-020-0097-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Data sources CENTRAL, MEDLINE, Embase and CINAHL. Study selection Controlled studies (randomised or non-randomised) that evaluated the effect of full-body PPE on healthcare workers (HCW) exposed to highly infectious diseases, assessed which method of donning and doffing PPE was associated with reduced risk of contamination or infection for HCW, and which training methods increased compliance with PPE protocols. Data extraction and synthesis Two reviewers independently screened the titles and abstracts for inclusion of studies. Full text articles were subsequently assessed for eligibility and disagreements were resolved through consensus. Using criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions, pairs of review authors independently assessed risk of bias for each randomised study and rated each potential source of bias as high, low, or unclear. ROBINS-I tool was used for the assessment of risk of bias in non-randomised intervention studies. Where appropriate, random effects meta-analyses were conducted. Results A total of 24 studies (randomised controlled trials [RCT] [n = 14]; Quasi-RCT [n = 1] and non-randomised design [n=9]) with 2278 participants were included. Included studies compared types of PPE (n = 8), evaluated modified PPE (n = 6), procedures for donning and doffing PPE (n = 8), and types of training (n = 3). Twenty-two studies were simulation studies, of which 18 simulated exposure of HCW to contaminated body fluids using fluorescent markers or harmless microbes and measured contamination outcomes, and four studies provided modified PPE or procedures and measured compliance with donning and doffing procedures. Types of PPE Powered, air-purifying respirator with coverall may protect against the risk of contamination better than a N95 mask and gown (risk ratio [RR] 0.27, 95% confidence interval [CI] 0.17 to 0.43) but was more difficult to don (non-compliance: RR 7.5, 95% CI 1.81 to 31.1). Gowns compared to aprons may protect better against contamination (MD) -10.28, 95% CI -14.77 to -5.79). Breathable types of PPE are more comfortable and may increase user satisfaction, however with little impact on contamination. Modified PPE versus standard PPE Appropriate modifications to PPE design may lead to less contamination compared to standard PPE. For example, contamination can be reduced using a sealed gown and glove combination so that they can be removed together and cover the wrist area (RR 0.27, 95% CI 0.09 to 0.78), tight fitting gown around the neck, wrist area and hands (RR 0.08, 95% CI 0.01 to 0.55) and added tabs to facilitate doffing of masks (RR 0.33, 95%nCI 0.14 to 0.80) or gloves (RR 0.22, 95% CI 0.15 to 0.31). Guidance on PPE use: following the guidance and recommendations from the Centres for Disease Control and Prevention for doffing PPE compared to no guidance may reduce self-contamination (MD −5.44, 95% CI −7.43 to −3.45). One-step removal of gloves and gown compared to separate removal (RR 0.20, 95% CI 0.05 to 0.77), double gloving compared to single gloving (RR 0.34, 95% CI 0.17 to 0.66) and sanitising gloves before doffing with quaternary ammonium or bleach (but not alcohol-based hand rub) may decrease contamination. Additional verbal instructions may lead to fewer errors in doffing (MD −0.9, 95% CI −1.4 to −0.4). User training To a vast extent, face-to-face training may reduce non-compliance with doffing guidance (odds ratio 0.45, 95% CI 0.21 to 0.98) compared to solely providing folders or videos. In addition, computer simulation may lead to fewer errors in doffing (MD −1.2, 95% CI −1.6 to −0.7) and video lecture on donning PPE may lead to better skills scores (MD 30.70, 95% CI 20.14 to 41.26) compared to traditional lectures. Conclusions The more body parts are covered with PPE the better protection it offers. However, this is also associated and increased difficulty in donning and doffing PPE, and the PPE is less comfortable. Coveralls are the most difficult PPE to remove but may offer the best protection, followed by long gowns, gowns and aprons. The included studies had a high or unclear risk of bias, indirectness of evidence in simulation studies and small participant numbers. This increases the uncertainty about the estimates of effects, and it is likely that the true effects may be substantially different from the ones reported in this review.
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Affiliation(s)
- Shalika Hegde
- Academic, Deakin University, Manager, Centre for Value Based Health Care, Research and Evaluation, Dental Health Services Victoria, Australia
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Branley JM, Polkinghorne A, Gilbert GL. Reusing N95 (or P2) masks: current evidence and urgent research questions. Med J Aust 2020; 213:140-140.e1. [PMID: 32623732 PMCID: PMC7361397 DOI: 10.5694/mja2.50694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- James M Branley
- Nepean Hospital, Sydney, NSW.,University of Sydney, Sydney, NSW
| | | | - Gwendolyn L Gilbert
- University of Sydney, Sydney, NSW.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW
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Mahlke L, Flohé S, Matthes G, Paffrath T, Wagner F, Wölfl C. [Surgery during the SARS-CoV-2 pandemic : Recommendations on operative procedures]. Unfallchirurg 2020; 123:571-578. [PMID: 32488319 PMCID: PMC7265879 DOI: 10.1007/s00113-020-00830-6] [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: 11/11/2022]
Abstract
BACKGROUND In February 2020 Germany was also hit by the SARS-CoV‑2 pandemic. Even patients infected by SARS-CoV‑2 or COVID-19 may need operative procedures. Currently, no uniform recommendations exist on precautions to be taken when operating on these patients. Furthermore, they may differ from one hospital to another. METHODS The task force COVID-19 of the emergency, intensive and severely injured section of the German Trauma Society (DGU e. V.) has developed consensus-based recommendations on surgical treatment of patients with SARS-CoV‑2 infections. Great importance is placed on the implementation in hospitals at all levels of care. RESULTS The indications for surgical interventions in patients with COVID-19 infections require an extremely critical evaluation. When indicated these surgical intervention should ideally be performed in a separate operating theater. All personnel involved should wear personal protective equipment with FFP2 masks, face shields and double gloves. The emergency team in the resuscitation bay should generally wear the same personal protective equipment. Special training is mandatory and the exposure of team members should be minimized. CONCLUSION The recommendations are principally used for all kinds of surgery and comply with the currently available knowledge. Nevertheless, all recommendations represent a compromise between maximum safety of all medical staff and practicability in the routine hospital workflow.
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Affiliation(s)
- Lutz Mahlke
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, St. Vincenz-Krankenhaus GmbH, Am Busdorf 2, 33098, Paderborn, Deutschland.
| | - Sascha Flohé
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Städtisches Klinikum Solingen GmbH, Solingen, Deutschland
| | - Gerrit Matthes
- Klinik für Unfall- und Wiederherstellungschirurgie, Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - Thomas Paffrath
- Sektion Unfallchirurgie, Klinik für Allgemein‑, Viszeral‑, Thorax- und Unfallchirurgie, Krankenhaus der Augustinerinnen gGmbH, Köln, Deutschland
| | - Frithjof Wagner
- Abteilung für septische und rekonstruktive Chirurgie, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
| | - Christoph Wölfl
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Marienhausklinikum Hetzelstift, Neustadt an der Weinstraße, Deutschland
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Strategies for Optimizing the Supply of N95 Filtering Facepiece Respirators During the Coronavirus Disease 2019 (COVID-19) Pandemic. Disaster Med Public Health Prep 2020; 14:658-669. [PMID: 32423515 PMCID: PMC7303467 DOI: 10.1017/dmp.2020.160] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
N95 respirators are personal protective equipment most often used to control exposures to infections transmitted via the airborne route. Supplies of N95 respirators can become depleted during pandemics or when otherwise in high demand. In this paper, we offer strategies for optimizing supplies of N95 respirators in health care settings while maximizing the level of protection offered to health care personnel when there is limited supply in the United States during the 2019 coronavirus disease pandemic. The strategies are intended for use by professionals who manage respiratory protection programs, occupational health services, and infection prevention programs in health care facilities to protect health care personnel from job-related risks of exposure to infectious respiratory illnesses. Consultation with federal, state, and local public health officials is also important. We use the framework of surge capacity and the occupational health and safety hierarchy of controls approach to discuss specific engineering control, administrative control, and personal protective equipment measures that may help in optimizing N95 respirator supplies.
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Lam UN, Md Mydin Siddik NSF, Mohd Yussof SJ, Ibrahim S. N95 respirator associated pressure ulcer amongst COVID-19 health care workers. Int Wound J 2020; 17:1525-1527. [PMID: 32397010 PMCID: PMC7272882 DOI: 10.1111/iwj.13398] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- U-Nee Lam
- Plastic and Reconstructive Surgery Department, Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - Nur Shazwani Farah Md Mydin Siddik
- Plastic and Reconstructive Surgery Department, Hospital Sungai Buloh, Sungai Buloh, Malaysia.,Plastic, Reconstructive and Aesthetic Surgery Unit, Faculty of Medicine, Universiti Teknologi MARA, Cawangan Selangor, Kampus Sungai Buloh, Jalan Hospital, 47000 Sungai Buloh, Selangor, Malaysia
| | - Shah Jumaat Mohd Yussof
- Plastic and Reconstructive Surgery Department, Hospital Sungai Buloh, Sungai Buloh, Malaysia.,Plastic, Reconstructive and Aesthetic Surgery Unit, Faculty of Medicine, Universiti Teknologi MARA, Cawangan Selangor, Kampus Sungai Buloh, Jalan Hospital, 47000 Sungai Buloh, Selangor, Malaysia
| | - Salina Ibrahim
- Plastic and Reconstructive Surgery Department, Hospital Sungai Buloh, Sungai Buloh, Malaysia
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Hines SE, Brown C, Oliver M, Gucer P, Frisch M, Hogan R, Roth T, Chang J, McDiarmid M. Storage and Availability of Elastomeric Respirators in Health Care. Health Secur 2020; 17:384-392. [PMID: 31593514 DOI: 10.1089/hs.2019.0039] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Use of reusable respirators, such as elastomeric half-face respirators (EHFRs), may serve as one solution to combating the problem of N95 respirator shortages experienced during infectious disease emergencies. To clarify whether logistical issues like respirator storage and availability are barriers to implementation of healthcare respiratory protection strategies that include EHFRs, this study aimed to evaluate the availability, storage, and respirator and filter replacement practices of EHFRs used in healthcare settings under routine use. Healthcare workers using EHFRs were surveyed about their use practices. To explore whether issues related to storage and availability of EHFRs affected compliance with assigned respirator use, responses were compared between concordant users and EHFR users who were assigned to use EHFRs but currently use different respirators ("discordant users"). Most concordant EHFR users reported that their respirator was always available when needed (63.8%). Almost two-thirds of concordant but only half of discordant users reported storing their EHFRs conveniently in the patient care area (p = <0.001). Among mobile workers, discordant users had higher odds (aOR = 3.2, 95% CI [1.4,7.5]) of reporting that their respirator was not stored in the patient care area, suggesting that storage location has a significant impact on compliance with expected practice, particularly in this group. Storage and access are barriers to optimal elastomeric respirator use in healthcare. Strategies to assure ready availability and storage of respirators will permit EHFR inclusion in pandemic and routine respiratory protection programs.
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Affiliation(s)
- Stella E Hines
- Stella E. Hines, MD, MSPH, is Assistant Professor; Marc Oliver, RN, MPH, MBA, is a Research Nurse; Patricia Gucer, PhD, is Assistant Professor; Tracy Roth, RN, is a Research Nurse; and Melissa McDiarmid, MD, MPH, DABT, is Director; all in the Division of Occupational and Environmental Medicine, Department of Medicine, School of Medicine, University of Maryland-Baltimore, Baltimore, MD
| | - Clayton Brown
- Clayton Brown, PhD, is Professor, Department of Epidemiology and Public Health, Division of Biostatistics and Bioinformatics, School of Medicine, University of Maryland-Baltimore
| | - Marc Oliver
- Stella E. Hines, MD, MSPH, is Assistant Professor; Marc Oliver, RN, MPH, MBA, is a Research Nurse; Patricia Gucer, PhD, is Assistant Professor; Tracy Roth, RN, is a Research Nurse; and Melissa McDiarmid, MD, MPH, DABT, is Director; all in the Division of Occupational and Environmental Medicine, Department of Medicine, School of Medicine, University of Maryland-Baltimore, Baltimore, MD
| | - Patricia Gucer
- Stella E. Hines, MD, MSPH, is Assistant Professor; Marc Oliver, RN, MPH, MBA, is a Research Nurse; Patricia Gucer, PhD, is Assistant Professor; Tracy Roth, RN, is a Research Nurse; and Melissa McDiarmid, MD, MPH, DABT, is Director; all in the Division of Occupational and Environmental Medicine, Department of Medicine, School of Medicine, University of Maryland-Baltimore, Baltimore, MD
| | - Melissa Frisch
- Melissa Frisch, MD, MPH, is an Occupational and Environmental Medicine physician; Regina Hogan, RN, MS, is Manager, Employee Health Services; and James Chang, CIH, is Safety Officer; all at the University of Maryland Medical Center, Baltimore, MD
| | - Regina Hogan
- Melissa Frisch, MD, MPH, is an Occupational and Environmental Medicine physician; Regina Hogan, RN, MS, is Manager, Employee Health Services; and James Chang, CIH, is Safety Officer; all at the University of Maryland Medical Center, Baltimore, MD
| | - Tracy Roth
- Stella E. Hines, MD, MSPH, is Assistant Professor; Marc Oliver, RN, MPH, MBA, is a Research Nurse; Patricia Gucer, PhD, is Assistant Professor; Tracy Roth, RN, is a Research Nurse; and Melissa McDiarmid, MD, MPH, DABT, is Director; all in the Division of Occupational and Environmental Medicine, Department of Medicine, School of Medicine, University of Maryland-Baltimore, Baltimore, MD
| | - James Chang
- Melissa Frisch, MD, MPH, is an Occupational and Environmental Medicine physician; Regina Hogan, RN, MS, is Manager, Employee Health Services; and James Chang, CIH, is Safety Officer; all at the University of Maryland Medical Center, Baltimore, MD
| | - Melissa McDiarmid
- Stella E. Hines, MD, MSPH, is Assistant Professor; Marc Oliver, RN, MPH, MBA, is a Research Nurse; Patricia Gucer, PhD, is Assistant Professor; Tracy Roth, RN, is a Research Nurse; and Melissa McDiarmid, MD, MPH, DABT, is Director; all in the Division of Occupational and Environmental Medicine, Department of Medicine, School of Medicine, University of Maryland-Baltimore, Baltimore, MD
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Chughtai AA, Seale H, Islam MS, Owais M, Macintyre CR. Policies on the use of respiratory protection for hospital health workers to protect from coronavirus disease (COVID-19). Int J Nurs Stud 2020; 105:103567. [PMID: 32203757 PMCID: PMC7174826 DOI: 10.1016/j.ijnurstu.2020.103567] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Abrar A Chughtai
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Samuels Building, Kensington 2052, NSW, Australia.
| | - Holly Seale
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Samuels Building, Kensington 2052, NSW, Australia
| | - Md Saiful Islam
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Samuels Building, Kensington 2052, NSW, Australia
| | - Mohammad Owais
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Samuels Building, Kensington 2052, NSW, Australia
| | - C Raina Macintyre
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, Kensington 2052, NSW, Australia AND College of Public Service & Community Solutions, Arizona State University, Phoenix, AZ, USAArizona State University, Tempe, AZ, United States
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Chughtai AA, Seale H, Rawlinson WD, Kunasekaran M, Macintyre CR. Selection and Use of Respiratory Protection by Healthcare Workers to Protect from Infectious Diseases in Hospital Settings. Ann Work Expo Health 2020; 64:368-377. [DOI: 10.1093/annweh/wxaa020] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 02/03/2020] [Accepted: 02/13/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Infection control policies and guidelines recommend using facemasks and respirators to protect healthcare workers (HCWs) from respiratory infections. Common types of respirators used in healthcare settings are filtering facepiece respirators (FFRs) and powered air-purifying respirators (PAPRs). Aims of this study were to examine the current attitudes and practices of HCWs regarding the selection and use of respiratory protection and determine the acceptability of a novel PAPR.
Methods
In-depth interviews were undertaken with 20 HCWs from a large tertiary hospital in Sydney, Australia. Participants were fit tested with a lightweight tight-fitting half-facepiece PAPR (CleanSpace2™ Power Unit, PAF-0034, by CleanSpace Technology®) using the TSI™ Portacount quantitative fit test method.
Results
Interview results showed that HCWs had a limited role in the selection and use of facemasks and respirators and had been using the devices provided by the hospital. The majority of subjects had no knowledge of hospital policy for the use of facemasks and respirators, had not been trained on the use of respirators, and had not been fit tested previously. Compliance with the use of facemasks and respirators was perceived as being low and facemasks and respirators were typically used only for short periods of time.
All 20 participants were successfully fit tested to the CleanSpace2™ PAPR (overall geometric mean fit factor—6768). According to the exit surveys, CleanSpace2™ PAPRs were easy to don (14/20) and doff (15/20) and comfortable to wear (14/20). Most participants believed that PAPRs provide higher protection, comfort and reusability over N95 FFR and can be used during pandemics and other high-risk situations.
Conclusions
HCWs should be aware of infection control policies and training should be provided on the correct use of respiratory protective devices. PAPRs can be used in hospital settings to protect HCWs from certain highly infectious and emerging pathogens, however, HCWs require adequate training on storage, use, and cleaning of PAPRs.
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Affiliation(s)
- Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, The University of New South Wales, , Sydney, NSW, Australia
| | - Holly Seale
- School of Public Health and Community Medicine, The University of New South Wales, , Sydney, NSW, Australia
| | - William D Rawlinson
- Virology Research Laboratory, Serology and Virology Division (SAViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - C Raina Macintyre
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
- College of Public Service & Community Solutions, Arizona State University, Phoenix, AZ, USA
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Yorio PL, Fisher EM, Kilinc-Balci FS, Rottach D, Harney J, Seaton M, Dahm MM, Niemeier T. Planning for Epidemics and Pandemics: Assessing the Potential Impact of Extended Use and Reuse Strategies on Respirator Usage Rates to Support Supply-and-Demand Planning Efforts. JOURNAL OF THE INTERNATIONAL SOCIETY FOR RESPIRATORY PROTECTION 2020; 37:52-60. [PMID: 32508390 PMCID: PMC7274506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
During epidemics and pandemics healthcare personnel (HCP) are on the front line of disease containment and mitigation. Personal protective equipment (PPE), such as NIOSH-approved N95 filtering facepiece respirators (FFRs), serve an important role in minimizing HCP risks and are in high demand during public health emergencies. Because PPE demand can exceed supply, various public health strategies have been developed to reduce the rate of PPE consumption as supply dwindles. Extended use and limited reuse of N95 FFRs are strategies advocated by many governmental agencies used to increase the number of times a device can be used. Increased use of respirators designed for reuse-such as powered air-purifying respirators (PAPRs) and elastomeric half-mask and full facepiece air-purifying respirators- is another option designed to reduce the continuous need for new devices as the daily need for respirator use increases. Together, these strategies are designed to reduce the number of PPE units that must be discarded daily and, therefore, extend the longevity of available supply. The purpose of this paper is to theoretically estimate the impact of extended use and limited reuse strategies for N95 FFRs and the increased use of reusable respirator options on PPE consumed. The results suggest that a considerable reduction in PPE consumption would result from extended use and limited reuse of N95 FFRs and the increased use of respirators designed for reuse; however, the practical benefits must be balanced with the risks and economic costs. In addition, extended use and reuse strategies must be accompanied by proper procedures to reduce risk. The study is designed to support epidemic and pandemic PPE supply and demand planning efforts.
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Affiliation(s)
- Patrick L. Yorio
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA USA
| | - Edward M. Fisher
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA USA
| | - F Selcen Kilinc-Balci
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA USA
| | - Dana Rottach
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA USA
| | - Joshua Harney
- National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH USA
| | - Melissa Seaton
- National Institute for Occupational Safety and Health, Division of Science Integration, Cincinnati, OH USA
| | - Matthew M. Dahm
- National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH USA
| | - Todd Niemeier
- National Institute for Occupational Safety and Health, Division of Science Integration, Cincinnati, OH USA
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Barratt R, Gilbert GL, Shaban RZ, Wyer M, Hor SY. Enablers of, and barriers to, optimal glove and mask use for routine care in the emergency department: an ethnographic study of Australian clinicians. Australas Emerg Care 2019; 23:105-113. [PMID: 31810897 PMCID: PMC7104090 DOI: 10.1016/j.auec.2019.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 12/27/2022]
Abstract
Background The risk of healthcare-acquired infection increases during outbreaks of novel infectious diseases. Emergency department (ED) clinicians are at high risk of exposure to both these and common communicable diseases. Personal protective equipment (PPE) is recommended to protect clinicians from acquiring, or becoming vectors of, infection, yet compliance is typically sub-optimal. Little is known about factors that influence use of PPE—specifically gloves and masks—during routine care in the ED. Methods This was an ethnographic study, incorporating documentation review, field observations and interviews. The theoretical domains framework (TDF) was used to aid thematic analysis and identify relevant enablers of and barriers to optimal PPE use. Results Thirty-one behavioural themes were identified that influenced participants’ use of masks and gloves. There were significant differences, namely: more reported enablers of glove use vs more barriers to mask use. Reasons included more positive unit culture towards glove use, and lower perception of risk via facial contamination. Conclusion Emerging infectious diseases, spread (among other routes) by respiratory droplets, have caused global outbreaks. Emergency clinicians should ensure that, as with gloves, the use of masks is incorporated into routine cares where appropriate. Further research which examines items of PPE independently is warranted.
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Affiliation(s)
- Ruth Barratt
- University of Sydney, Faculty of Medicine and Health, Westmead Hospital, Cnr Hawkesbury Road and, Darcy Rd, Westmead, NSW 2145, Australia.
| | - Gwendolyn L Gilbert
- University of Sydney, Faculty of Medicine and Health, Westmead Hospital, Cnr Hawkesbury Road and, Darcy Rd, Westmead, NSW 2145, Australia; University of Sydney, Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, 176 Hawkesbury Road, Westmead, NSW 2145, Australia; University of Sydney, Sydney Health Ethics, 92/94 Parramatta Rd, Camperdown, NSW, Australia
| | - Ramon Z Shaban
- University of Sydney, Faculty of Medicine and Health, Westmead Hospital, Cnr Hawkesbury Road and, Darcy Rd, Westmead, NSW 2145, Australia; University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Australia; University of Sydney, Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, 176 Hawkesbury Road, Westmead, NSW 2145, Australia; Nursing, Midwifery and Clinical Governance Directorate, Western Sydney Local Health District, Westmead Hospital, Cnr Hawkesbury Road and, Darcy Rd, Westmead, NSW 2145, Australia
| | - Mary Wyer
- University of Sydney, Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, 176 Hawkesbury Road, Westmead, NSW 2145, Australia; Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, 176 Hawkesbury Road, Westmead, NSW 2145, Australia; University of Sydney, Sydney Health Ethics, 92/94 Parramatta Rd, Camperdown, NSW, Australia
| | - Su-Yin Hor
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, 176 Hawkesbury Road, Westmead, NSW 2145, Australia; University of Sydney, Sydney Health Ethics, 92/94 Parramatta Rd, Camperdown, NSW, Australia; Centre for Health Services Management, Faculty of Health, University of Technology, Sydney, Australia
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Hines SE, Brown C, Oliver M, Gucer P, Frisch M, Hogan R, Roth T, Chang J, McDiarmid M. User acceptance of reusable respirators in health care. Am J Infect Control 2019; 47:648-655. [PMID: 30638674 PMCID: PMC7115316 DOI: 10.1016/j.ajic.2018.11.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Inclusion of reusable respirators, such as elastomeric half-face respirators (EHFRs) and powered air-purifying respirators (PAPRs), in hospital respiratory protection inventories may represent 1 solution to the problem of N95 respirator shortages experienced during pandemics. User acceptance of these devices is 1 potential barrier to implementing such a strategy in respiratory protection programs. METHODS To assess user attitudes toward various respirators, health care workers enrolled in respiratory protection programs in a medical system using EHFRs, N95s, and PAPRs and completed an online questionnaire that addressed attitudes, beliefs, and respirator preferences under different risk scenarios. Responses were compared between user groups. RESULTS Of 1,152 participants, 53% currently used N95s, 24% used EHFRs, and 23% used PAPRs. N95 users rated their respirators more favorably compared with EHFR and PAPR users (P < .001) regarding comfort and communication, however, EHFR users rated their respirators much more highly regarding sense of protection (P < .001). For all user groups, reusable respirators were significantly more likely (odds ratios 2.3-7.7) to be preferred over N95 filtering facepiece respirators in higher risk scenarios compared to "usual circumstance" scenarios. CONCLUSIONS Despite somewhat less favorable ratings on comfort and communication, experienced EHFR and PAPR users still prefer reusable respirators over N95s in certain higher risk scenarios. This suggests that reusable respirators are an acceptable alternative to N95 respirators in health care and offer 1 viable solution to prevent pandemic-generated respirator shortages.
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Affiliation(s)
- Stella E Hines
- Department of Medicine, Division of Occupational and Environmental Medicine, The University of Maryland-Baltimore, School of Medicine, Baltimore, MD.
| | - Clayton Brown
- Department of Medicine, Division of Occupational and Environmental Medicine, The University of Maryland-Baltimore, School of Medicine, Baltimore, MD
| | - Marc Oliver
- Department of Medicine, Division of Occupational and Environmental Medicine, The University of Maryland-Baltimore, School of Medicine, Baltimore, MD
| | - Patricia Gucer
- Department of Medicine, Division of Occupational and Environmental Medicine, The University of Maryland-Baltimore, School of Medicine, Baltimore, MD
| | - Melissa Frisch
- Department of Medicine, Division of Occupational and Environmental Medicine, The University of Maryland-Baltimore, School of Medicine, Baltimore, MD
| | - Regina Hogan
- Department of Medicine, Division of Occupational and Environmental Medicine, The University of Maryland-Baltimore, School of Medicine, Baltimore, MD
| | - Tracy Roth
- Department of Medicine, Division of Occupational and Environmental Medicine, The University of Maryland-Baltimore, School of Medicine, Baltimore, MD
| | - James Chang
- Department of Medicine, Division of Occupational and Environmental Medicine, The University of Maryland-Baltimore, School of Medicine, Baltimore, MD
| | - Melissa McDiarmid
- Department of Medicine, Division of Occupational and Environmental Medicine, The University of Maryland-Baltimore, School of Medicine, Baltimore, MD
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Sietsema M, Radonovich L, Hearl FJ, Fisher EM, Brosseau LM, Shaffer RE, Koonin LM. A Control Banding Framework for Protecting the US Workforce from Aerosol Transmissible Infectious Disease Outbreaks with High Public Health Consequences. Health Secur 2019; 17:124-132. [PMID: 30942621 PMCID: PMC10500541 DOI: 10.1089/hs.2018.0103] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Recent high-profile infectious disease outbreaks illustrate the importance of selecting appropriate control measures to protect a wider range of employees, other than those in healthcare settings. In such settings, where routine exposure risks are often high, control measures may be more available, routinely implemented, and studied for effectiveness. In the absence of evidence-based guidelines or established best practices for selecting appropriate control measures, employers may unduly rely on personal protective equipment (PPE) because of its wide availability and pervasiveness as a control measure, circumventing other effective options for protection. Control banding is one approach that may be used to assign job tasks into risk categories and prioritize the application of controls. This article proposes an initial control banding framework for workers at all levels of risk and incorporates a range of control options, including PPE. Using the National Institutes of Health (NIH) risk groups as a surrogate for toxicity and combining the exposure duration with the exposure likelihood, we can generate the risk of a job task to the worker.
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Affiliation(s)
- Margaret Sietsema
- Margaret Sietsema, PhD, is Research Assistant Professor, and Lisa M. Brosseau, ScD, CIH, is Professor, both in Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago. Lew Radonovich, MD, is Chief of Research; Edward M. Fisher, MS, is Associate Service Fellow; and Ronald E. Shaffer, PhD, is former Branch Chief; all at the National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, PA. Frank J. Hearl, MS, PE, is Chief of Staff, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC. Lisa M. Koonin, DrPH, MN, MPH, is former Deputy Director, Influenza Coordination Unit, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lew Radonovich
- Margaret Sietsema, PhD, is Research Assistant Professor, and Lisa M. Brosseau, ScD, CIH, is Professor, both in Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago. Lew Radonovich, MD, is Chief of Research; Edward M. Fisher, MS, is Associate Service Fellow; and Ronald E. Shaffer, PhD, is former Branch Chief; all at the National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, PA. Frank J. Hearl, MS, PE, is Chief of Staff, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC. Lisa M. Koonin, DrPH, MN, MPH, is former Deputy Director, Influenza Coordination Unit, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Frank J Hearl
- Margaret Sietsema, PhD, is Research Assistant Professor, and Lisa M. Brosseau, ScD, CIH, is Professor, both in Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago. Lew Radonovich, MD, is Chief of Research; Edward M. Fisher, MS, is Associate Service Fellow; and Ronald E. Shaffer, PhD, is former Branch Chief; all at the National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, PA. Frank J. Hearl, MS, PE, is Chief of Staff, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC. Lisa M. Koonin, DrPH, MN, MPH, is former Deputy Director, Influenza Coordination Unit, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Edward M Fisher
- Margaret Sietsema, PhD, is Research Assistant Professor, and Lisa M. Brosseau, ScD, CIH, is Professor, both in Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago. Lew Radonovich, MD, is Chief of Research; Edward M. Fisher, MS, is Associate Service Fellow; and Ronald E. Shaffer, PhD, is former Branch Chief; all at the National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, PA. Frank J. Hearl, MS, PE, is Chief of Staff, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC. Lisa M. Koonin, DrPH, MN, MPH, is former Deputy Director, Influenza Coordination Unit, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lisa M Brosseau
- Margaret Sietsema, PhD, is Research Assistant Professor, and Lisa M. Brosseau, ScD, CIH, is Professor, both in Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago. Lew Radonovich, MD, is Chief of Research; Edward M. Fisher, MS, is Associate Service Fellow; and Ronald E. Shaffer, PhD, is former Branch Chief; all at the National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, PA. Frank J. Hearl, MS, PE, is Chief of Staff, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC. Lisa M. Koonin, DrPH, MN, MPH, is former Deputy Director, Influenza Coordination Unit, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ronald E Shaffer
- Margaret Sietsema, PhD, is Research Assistant Professor, and Lisa M. Brosseau, ScD, CIH, is Professor, both in Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago. Lew Radonovich, MD, is Chief of Research; Edward M. Fisher, MS, is Associate Service Fellow; and Ronald E. Shaffer, PhD, is former Branch Chief; all at the National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, PA. Frank J. Hearl, MS, PE, is Chief of Staff, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC. Lisa M. Koonin, DrPH, MN, MPH, is former Deputy Director, Influenza Coordination Unit, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lisa M Koonin
- Margaret Sietsema, PhD, is Research Assistant Professor, and Lisa M. Brosseau, ScD, CIH, is Professor, both in Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago. Lew Radonovich, MD, is Chief of Research; Edward M. Fisher, MS, is Associate Service Fellow; and Ronald E. Shaffer, PhD, is former Branch Chief; all at the National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, PA. Frank J. Hearl, MS, PE, is Chief of Staff, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC. Lisa M. Koonin, DrPH, MN, MPH, is former Deputy Director, Influenza Coordination Unit, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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Barratt R, Shaban RZ, Gilbert GL. Clinician perceptions of respiratory infection risk; a rationale for research into mask use in routine practice. Infect Dis Health 2019; 24:169-176. [PMID: 30799181 PMCID: PMC7129171 DOI: 10.1016/j.idh.2019.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 11/18/2022]
Abstract
Outbreaks of emerging and re-emerging infectious diseases are global threats to society. Planning for, and responses to, such events must include healthcare and other measures based on current evidence. An important area of infection prevention and control (IPC) is the optimal use of personal protective equipment (PPE) by healthcare workers (HCWs), including masks for protection against respiratory pathogens. Appropriate mask use during routine care is a forerunner to best practice in the event of an outbreak. However, little is known about the influences on decisions and behaviours of HCWs with respect to protective mask use when providing routine care. In this paper we argue that there is a need for more research to provide a better understanding of the decision-making and risk-taking behaviours of HCWs in respect of their use of masks for infectious disease prevention. Our argument is based on the ongoing threat of emerging infectious diseases; a need to strengthen workforce capability, capacity and education; the financial costs of healthcare and outbreaks; and the importance of social responsibility and supportive legislation in planning for global security. Future research should examine HCWs' practices and constructs of risk to provide new information to inform policy and pandemic planning. Emerging and remerging infectious diseases continue to pose a threat to human health and global security. Outbreaks of respiratory infection result in human and economic costs including staff illness and wider societal disruption. Clinicians' use of personal protective equipment is critical to reducing the risk of transmission of infectious disease. Training in the use of PPE should take account of clinicians' and patients' perceptions of risk. Individual and societal responsibility towards infection prevention may influence clinicians' use of protective masks.
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Affiliation(s)
- Ruth Barratt
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW 2050, Australia; The Westmead Clinical School, University of Sydney, NSW 2145, Australia.
| | - Ramon Z Shaban
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW 2050, Australia; Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, NSW 2050, Australia; Directorate of Nursing, Midwifery and Clinical Governance, Western Sydney Local Health District, Westmead, NSW 2145, Australia.
| | - Gwendoline L Gilbert
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW 2050, Australia.
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Mills D, Harnish DA, Lawrence C, Sandoval-Powers M, Heimbuch BK. Ultraviolet germicidal irradiation of influenza-contaminated N95 filtering facepiece respirators. Am J Infect Control 2018; 46:e49-e55. [PMID: 29678452 PMCID: PMC7115285 DOI: 10.1016/j.ajic.2018.02.018] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 02/16/2018] [Accepted: 02/17/2018] [Indexed: 12/17/2022]
Abstract
Ultraviolet light can significantly reduce viable influenza on N95 respirators. Ultraviolet decontamination of N95 respirators can vary between models. Straps of N95 respirators are challenging to decontaminate using ultraviolet light.
Background Safe and effective decontamination and reuse of N95 filtering facepiece respirators (FFRs) has the potential to significantly extend FFR holdings, mitigating a potential shortage due to an influenza pandemic or other pandemic events. Ultraviolet germicidal irradiation (UVGI) has been shown to be effective for decontaminating influenza-contaminated FFRs. This study aims to build on past research by evaluating the UVGI decontamination efficiency of influenza-contaminated FFRs in the presence of soiling agents using an optimized UVGI dose. Methods Twelve samples each of 15 N95 FFR models were contaminated with H1N1 influenza (facepiece and strap), then covered with a soiling agent—artificial saliva or artificial skin oil. For each soiling agent, 3 contaminated FFRs were treated with 1 J/cm2 UVGI for approximately 1 minute, whereas 3 other contaminated FFRs remained untreated. All contaminated surfaces were cut out and virus extracted. Viable influenza was quantified using a median tissue culture infectious dose assay. Results Significant reductions (≥3 log) in influenza viability for both soiling conditions were observed on facepieces from 12 of 15 FFR models and straps from 7 of 15 FFR models. Conclusions These data suggest that FFR decontamination and reuse using UVGI can be effective. Implementation of a UVGI method will require careful consideration of FFR model, material type, and design.
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Evaluation of 9 health care organizations' respiratory protection programs and respiratory protective device practices: Implications for adoption of elastomerics. Am J Infect Control 2018; 46:350-352. [PMID: 29079137 DOI: 10.1016/j.ajic.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 11/21/2022]
Abstract
Interview, observational, and discussion group data at 9 health care organizations (HCOs) were collected to better understand elastomeric half-facepiece respirators' (EHFRs) use. We found that HCOs do not routinely use EHFRs as a respiratory protection device (RPD) for health care workers; compliance with other respirator types was less than expected. This finding has important training implications for proper use of all RPDs and EHFRs as an alternative RPD stockpiled for use during a respiratory infectious outbreak.
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47
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Rengasamy S, Niezgoda G, Shaffer R. Flammability of Respirators and other Head and Facial Personal Protective Equipment. JOURNAL OF THE INTERNATIONAL SOCIETY FOR RESPIRATORY PROTECTION 2018; 35:1-13. [PMID: 30364752 PMCID: PMC6198820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Personal protective equipment (PPE) is worn by workers in surgical settings to protect them and patients. Food and Drug Administration (FDA) clears some PPE (e.g., surgical masks (SM)) as class II medical devices, and regulates some (e.g. surgical head cover) as class I exempt devices. For respiratory protection, National Institute for Occupational Safety and Health (NIOSH)-approved N95 filtering facepiece respirators (FFRs), and powered air-purifying respirators (PAPRs) are used. One type of PPE, "surgical N95 respirators", is a NIOSH-approved FFR that is also cleared by the FDA for use in medical settings. The surgical environment poses unique risks such as the potential for surgical fires. As part of its substantial equivalence determination process, FDA requests testing of flammability and other parameters for SM and surgical N95 respirators. A lack of data regarding flammability of PPE used in healthcare exists. We hypothesize that commonly used PPE, regardless of whether regulated and/or cleared by FDA or not, will pass an industry standard such as the 16 CFR 1610 flammability test. METHODS Eleven N95 FFR models, eight surgical N95 respirator models, seven SM models, five surgical head cover models, and five PAPR hood models were evaluated for flammability with a 45 degree flammability tester using the 16 CFR 1610 method. Three common fabrics were included for comparison. RESULTS All of the PPE samples regulated/and or cleared by FDA or not, passed the flammability test at class 1 (normal flammability), meaning they are less likely to burn. Only one of the three common fabrics, a cotton fabric at the lowest basis weight, was class 3 (high flammability). CONCLUSIONS The results obtained in the study suggest that NIOSH-approved N95 FFRs would likely pass the 16 CFR 1610 flammability standard. Moreover, results suggest that NIOSH is capable of undertaking flammability testing using the 16 CFR 1610 standard as the flammability results NIOSH obtained for N95 FFRs were comparable to the results obtained by a third party independent laboratory.
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Lawrence C, Harnish DA, Sandoval-Powers M, Mills D, Bergman M, Heimbuch BK. Assessment of half-mask elastomeric respirator and powered air-purifying respirator reprocessing for an influenza pandemic. Am J Infect Control 2017; 45:1324-1330. [PMID: 28844381 DOI: 10.1016/j.ajic.2017.06.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Health care facilities are considering the use of reusable respiratory protective devices (RPDs) to mitigate a potential N95 filtering facepiece respirator shortage caused by an influenza pandemic. US regulators are also considering stockpiling reusable RPDs for pandemic preparedness, but limited data exist on the effectiveness of cleaning and disinfection of these devices. This study defines reprocessing protocols and evaluates their effectiveness against a pandemic influenza strain in a laboratory setting. METHODS Five half-mask elastomeric respirator models and 3 powered air-purifying respirator models were contaminated with influenza virus and artificial skin oil on multiple surfaces. RPDs were then manually treated with 1 of 2 methods: cleaned or cleaned and disinfected. Presence of viable influenza was determined via swab sampling and a median tissue culture infectious dose assay. RESULTS Across 41 RPD surfaces, a mean log reduction in viable influenza of 4.54 ± 0.97 log10 median tissue culture infectious dose was achieved for all treated surfaces, which included both cleaned and cleaned and disinfected surfaces. CONCLUSIONS The methods defined as part of this study are effective for eliminating viable influenza in the presence of artificial skin oil on most of the RPD surfaces tested. Material type and RPD design should be considered when implementing RPD reprocessing protocols.
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Brady TM, Strauch AL, Almaguer CM, Niezgoda G, Shaffer RE, Yorio PL, Fisher EM. Transfer of bacteriophage MS2 and fluorescein from N95 filtering facepiece respirators to hands: Measuring fomite potential. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2017; 14:898-906. [PMID: 28650715 PMCID: PMC5705010 DOI: 10.1080/15459624.2017.1346799] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Contact transmission of pathogens from personal protective equipment is a concern within the healthcare industry. During public health emergency outbreaks, resources become constrained and the reuse of personal protective equipment, such as N95 filtering facepiece respirators, may be needed. This study was designed to characterize the transfer of bacteriophage MS2 and fluorescein between filtering facepiece respirators and the wearer's hands during three simulated use scenarios. Filtering facepiece respirators were contaminated with MS2 and fluorescein in droplets or droplet nuclei. Thirteen test subjects performed filtering facepiece respirator use scenarios including improper doffing, proper doffing and reuse, and improper doffing and reuse. Fluorescein and MS2 contamination transfer were quantified. The average MS2 transfer from filtering facepiece respirators to the subjects' hands ranged from 7.6-15.4% and 2.2-2.7% for droplet and droplet nuclei derived contamination, respectively. Handling filtering facepiece respirators contaminated with droplets resulted in higher levels of MS2 transfer compared to droplet nuclei for all use scenarios (p = 0.007). MS2 transfer from droplet contaminated filtering facepiece respirators during improper doffing and reuse was greater than transfer during improper doffing (p = 0.008) and proper doffing and reuse (p = 0.042). Droplet contamination resulted in higher levels of fluorescein transfer compared to droplet nuclei contaminated filtering facepiece respirators for all use scenarios (p = 0.009). Fluorescein transfer was greater for improper doffing and reuse (p = 0.007) from droplet contaminated masks compared to droplet nuclei contaminated filtering facepiece respirators and for improper doffing and reuse when compared improper doffing (p = 0.017) and proper doffing and reuse (p = 0.018) for droplet contaminated filtering facepiece respirators. For droplet nuclei contaminated filtering facepiece respirators, the difference in MS2 and fluorescein transfer did not reach statistical significance when comparing any of the use scenarios. The findings suggest that the results of fluorescein and MS2 transfer were consistent and highly correlated across the conditions of study. The data supports CDC recommendations for using proper doffing techniques and discarding filtering facepiece respirators that are directly contaminated with secretions from a cough or sneeze.
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Affiliation(s)
- Tyler M Brady
- a National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory , Pittsburgh , Pennsylvania
| | - Amanda L Strauch
- a National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory , Pittsburgh , Pennsylvania
| | - Claudia M Almaguer
- a National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory , Pittsburgh , Pennsylvania
| | - George Niezgoda
- a National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory , Pittsburgh , Pennsylvania
| | - Ronald E Shaffer
- a National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory , Pittsburgh , Pennsylvania
| | - Patrick L Yorio
- a National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory , Pittsburgh , Pennsylvania
| | - Edward M Fisher
- a National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory , Pittsburgh , Pennsylvania
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Respiratory Protection Program Compliance in Iranian Hospitals: Application of Fuzzy Analytical Hierarchy Process. Workplace Health Saf 2017; 66:173-182. [DOI: 10.1177/2165079917703410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In hospitals, health care workers (HCWs) are exposed to a wide range of respiratory hazards, which requires using respiratory protective equipment and implementing Respiratory Protection Programs (RPPs). The aim of this cross-sectional study was to investigate RPP implementation in 36 teaching hospitals located in the Fars province of Iran. A researcher-developed checklist, including nine components of the RPP standard, was completed by industrial hygienists in the study hospitals. The Fuzzy Analytical Hierarchy Process (FAHP) was used to determine the weight coefficient of RPP components. Finally, a Respiratory Protection Program Index (RPPI) was developed to calculate hospital compliance with RPP. The results showed that RPP were not fully implemented in the studied hospitals, and the highest and lowest RPPI scores were related to training and fit testing, respectively. To promote the implementation of RPP, significant efforts are required for all components, especially fit testing and worker evaluation.
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