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Memarian B, Brooks SB, Le JC. Pre-task planning for construction worker safety and health: Implementation and assessment. Am J Ind Med 2024. [PMID: 39127892 DOI: 10.1002/ajim.23647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/19/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Compared to other industry sectors, construction workers experience a disproportionately high rate of occupational injuries and fatalities. As research findings suggest, most of these incidents could be prevented if hazards were proactively recognized and properly addressed. In the construction industry, pre-task planning (PTP) is a preventive process intended to describe each step of work, identify associated safety and health hazards, and recommend controls to eliminate or mitigate the hazards before work begins. Despite its importance, the construction industry lacks comprehensive guidelines to design and implement PTP in a consistent and effective manner. To fill this gap, this study pursued two objectives: (1) identify shortcomings in current PTP practices and explore recommended solutions from practitioners' perspectives and (2) translate research findings into an applied tool to help practitioners assess and improve the quality of their PTP process. METHODS To fill the gap, 28 construction safety and health professionals and 104 workers were interviewed, and seven onsite PTP sessions were directly observed. RESULTS Shortcomings of current PTP practices as well as recommended solutions were categorized as (1) planning and implementation, (2) all-trades coordination, (3) engagement and buy-in, (4) training and logistics, (5) workforce diversity and the language barrier, and (6) PTP content accessibility. DISCUSSION/CONCLUSIONS An effective PTP process should be based on workers' direct involvement and input on task requirements and hazards. It needs to be regularly updated to reflect the changing work conditions. In addition to task-related information, to increase workers' awareness, PTP should paint a holistic view of the project and other trades' scopes.
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Affiliation(s)
- Babak Memarian
- CPWR-The Center for Construction Research and Training, Silver Spring, Maryland, USA
| | - Sara B Brooks
- CPWR-The Center for Construction Research and Training, Silver Spring, Maryland, USA
| | - Jean Christophe Le
- CPWR-The Center for Construction Research and Training, Silver Spring, Maryland, USA
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2
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Mehrotra P, Desai A. Resource sustainability and challenges in the supply chain: implications for infection prevention. Curr Opin Infect Dis 2024; 37:277-281. [PMID: 38843441 DOI: 10.1097/qco.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW Infection prevention and control practices remain the bedrock of healthcare associated infection prevention and outbreak and epidemic control efforts. However, issues in supply chain management can hinder these efforts, as exemplified by various public health emergencies. This review explores the key role of supply chains in infection prevention and explores specific challenges. RECENT FINDINGS In all of the critical components of infection prevention and control - hand hygiene, personal protective equipment, sterile supplies, environmental disinfection, and waste management - disruptions in supply chains have led to limited availability and dissemination. SUMMARY Strategies to mitigate these resource constraints in the inter-epidemic period will also be highlighted. The infection prevention workforce is well poised to inform supply chain dynamics. Without robust and adequate supply chains, infection prevention and control efforts suffer which perpetuates healthcare-associated infections, clusters, and epidemics.
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Affiliation(s)
- Preeti Mehrotra
- Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Boston, Massachusetts
| | - Angel Desai
- University of California, Davis, Division of Infectious Diseases, Sacramento, California, USA
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3
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Plachouras D, Kacelnik O, Rodríguez-Baño J, Birgand G, Borg MA, Kristensen B, Kubele J, Lyytikäinen O, Presterl E, Reilly J, Voss A, Zingg W, Suetens C, Monnet DL. Revisiting the personal protective equipment components of transmission-based precautions for the prevention of COVID-19 and other respiratory virus infections in healthcare. Euro Surveill 2023; 28:2200718. [PMID: 37561052 PMCID: PMC10416576 DOI: 10.2807/1560-7917.es.2023.28.32.2200718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 05/10/2023] [Indexed: 08/11/2023] Open
Abstract
The COVID-19 pandemic highlighted some potential limitations of transmission-based precautions. The distinction between transmission through large droplets vs aerosols, which have been fundamental concepts guiding infection control measures, has been questioned, leading to considerable variation in expert recommendations on transmission-based precautions for COVID-19. Furthermore, the application of elements of contact precautions, such as the use of gloves and gowns, is based on low-quality and inconclusive evidence and may have unintended consequences, such as increased incidence of healthcare-associated infections and spread of multidrug-resistant organisms. These observations indicate a need for high-quality studies to address the knowledge gaps and a need to revisit the theoretical background regarding various modes of transmission and the definitions of terms related to transmission. Further, we should examine the implications these definitions have on the following components of transmission-based precautions: (i) respiratory protection, (ii) use of gloves and gowns for the prevention of respiratory virus infections, (iii) aerosol-generating procedures and (iv) universal masking in healthcare settings as a control measure especially during seasonal epidemics. Such a review would ensure that transmission-based precautions are consistent and rationally based on available evidence, which would facilitate decision-making, guidance development and training, as well as their application in practice.
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Affiliation(s)
| | | | - Jesús Rodríguez-Baño
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases and Microbiology division, Hospital Universitario Virgen Macarena and Department of Medicine, University of Seville/CSIC, Biomedicine Institute of Seville, Seville, Spain
| | - Gabriel Birgand
- Health Protection Research Unit, Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, United Kingdom
- Regional Centre for Infection Prevention and Control, Region of Pays de la Loire, Nantes, France
| | - Michael A Borg
- Infection Control Department, Mater Dei Hospital, Msida, Malta
| | | | - Jan Kubele
- Clinical Microbiology and ATB centre, Na Homolce Hospital, Prague, Czechia
| | | | - Elisabeth Presterl
- Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria
| | - Jacqui Reilly
- Research Centre for Health, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Andreas Voss
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, Groningen, the Netherlands
| | - Walter Zingg
- Charité Universitätsmedizin, Berlin, Germany
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Carl Suetens
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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4
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Cubas ALV, Moecke EHS, Provin AP, Dutra ARA, Machado MM, Gouveia IC. The Impacts of Plastic Waste from Personal Protective Equipment Used during the COVID-19 Pandemic. Polymers (Basel) 2023; 15:3151. [PMID: 37571045 PMCID: PMC10421242 DOI: 10.3390/polym15153151] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/13/2023] [Accepted: 07/14/2023] [Indexed: 08/13/2023] Open
Abstract
The period from 2019 to 2022 has been defined by the COVID-19 pandemic, resulting in an unprecedented demand for and use of Personal Protective Equipment (PPE). However, the disposal of PPE without considering its environmental impact and proper waste management practices has become a growing concern. The increased demand for PPE during the pandemic and associated waste management practices have been analyzed. Additionally, the discussion around treating these residues and exploring more environmentally friendly alternatives, such as biodegradable or reusable PPE, is crucial. The extensive use of predominantly non-degradable plastics in PPE has led to their accumulation in landfills, with potential consequences for marine environments through the formation of microplastics. Therefore, this article seeks to establish a connection between these issues and the Sustainable Development Goals, emphasizing the importance of efficient management aligned with sustainable development objectives to address these emerging challenges and ensure a more sustainable future.
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Affiliation(s)
- Anelise Leal Vieira Cubas
- Environmental Science Master’s Program, University of Southern Santa Catarina (Unisul), Avenida Pedra Branca, 25, Palhoça 88137-270, Brazil; (E.H.S.M.); (A.P.P.); (A.R.A.D.)
| | - Elisa Helena Siegel Moecke
- Environmental Science Master’s Program, University of Southern Santa Catarina (Unisul), Avenida Pedra Branca, 25, Palhoça 88137-270, Brazil; (E.H.S.M.); (A.P.P.); (A.R.A.D.)
| | - Ana Paula Provin
- Environmental Science Master’s Program, University of Southern Santa Catarina (Unisul), Avenida Pedra Branca, 25, Palhoça 88137-270, Brazil; (E.H.S.M.); (A.P.P.); (A.R.A.D.)
| | - Ana Regina Aguiar Dutra
- Environmental Science Master’s Program, University of Southern Santa Catarina (Unisul), Avenida Pedra Branca, 25, Palhoça 88137-270, Brazil; (E.H.S.M.); (A.P.P.); (A.R.A.D.)
| | - Marina Medeiros Machado
- Environmental Engineering, Federal University of Ouro Preto (UFOP), Ouro Preto 35402-163, Brazil;
| | - Isabel C. Gouveia
- FibEnTech R&D—Fiber Materials and Environmental Technologies, University of Beira Interior, Rua Marquês d’Ávila e Bolama, 6201-001 Covilhã, Portugal;
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5
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GHASEMI F, DOOSTI-IRANI A, AGHAEI H. Applications, shortcomings, and new advances of Job Safety Analysis (JSA): findings from a systematic review. Saf Health Work 2023. [DOI: 10.1016/j.shaw.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023] Open
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6
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Brosseau LM, Jones RM, Gardner K, Williams SC, Henry KP, Sanders D. Health and Safety Regulations for COVID-19: A Policy Analysis. Ann Work Expo Health 2023; 67:21-35. [PMID: 36511485 DOI: 10.1093/annweh/wxac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic spurred some regulators in the USA to require occupational health and safety programs to prevent COVID-19 transmission in workplaces. The objective of this study was to describe such state and federal regulations enacted between January 2020 and January 2022. Regulations, including emergency temporary standards (ETS) and permanent standards, were identified through a search of Nexis Uni and Bloomberg Law and review of US OSHA websites and the Federal Register. Full texts were reviewed for regulatory scope, hazard and exposure definitions, determination of exposure or risk levels, and control strategies. Four state (California, Michigan, Virginia, and Oregon) and two federal regulations were identified. All regulations described respiratory aerosols as the primary source of SARS-CoV-2 and recognized person-to-person transmission by droplet, airborne, and contact routes. Only the US OSHA ETS for healthcare explicitly stated that inhalation of respiratory particles was the most likely method of COVID-19 transmission. The Virginia, Michigan, and Oregon regulations described different categories of risk defined by exposure frequency and duration or specific workplace activities. California described exposure as places and times when employees come into contact or congregate with other people. The US OSHA ETS for healthcare described exposure as involving close contact with suspected or confirmed COVID-19 patients. While all of the state regulations required strategies from across the hierarchy, only the Virginia regulations specifically incorporated the hierarchy of controls. Only the California and Virginia regulations explicitly linked control strategies to the transmission route, while Virginia demarcated control strategies by risk level. Oregon linked risk level to occupancy levels and physical distancing requirements and referred to the use of a layered approach for transmission control. The US OSHA ETS for healthcare defined droplet and airborne precautions but made no mention of the hierarchy of controls or risk levels. Respirators were discussed in most of the regulations. The first Michigan regulation explicitly required respirators appropriate to exposure risk. The California regulations noted that respirators protect the wearer while face coverings protect people around the wearer. These regulations offer insights for a permanent US OSHA infectious disease regulation, such as the need to consider a range of transmission modes including near- and far-range aerosol inhalation, endemic and novel pathogens, workplaces beyond healthcare settings, factors that contribute to exposure and risk, the hierarchy of controls, the role of vaccination, and the importance of written exposure assessment and infection prevention plans.
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Affiliation(s)
- Lisa M Brosseau
- Center for Infectious Disease Research and Policy, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA
| | - Rachael M Jones
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, 50 Charles E Young Dr S, Los Angeles, CA 90095, USA.,Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, 375 Chipeta Way Suite A, Salt Lake City, UT 84108, USA
| | - Kate Gardner
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, 375 Chipeta Way Suite A, Salt Lake City, UT 84108, USA
| | - Spencer C Williams
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, 375 Chipeta Way Suite A, Salt Lake City, UT 84108, USA
| | | | - Denali Sanders
- Department of Environmental Health and Radiological Health Sciences, Colorado State University, 122A Environmental Health Building, Fort Collins, CO 80523, USA
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7
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Song Y, Zhang L, Wang W. An Analysis of the Effect of Personal Protective Equipment (PPE) Training Based on the Information-Motivation-Behavior Skills Model in the Practice of COVID-19 PPE Application. Infect Drug Resist 2022; 15:4829-4835. [PMID: 36045872 PMCID: PMC9420738 DOI: 10.2147/idr.s366049] [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: 03/16/2022] [Accepted: 07/20/2022] [Indexed: 12/15/2022] Open
Abstract
Objective The aim of this study is to improve the effectiveness of training in putting on and removing personal protective equipment (PPE) during COVID-19. Methods An information–motivation–behavioral skills (IMB) model intervention team was established with the adoption of the IMB model to intervene in putting on and removing PPE by medical staff during COVID-19. Specifically, the information intervention was strengthened through the formulation of the hospital manual for PPE application. In the present study’s five-stage motivational interview, the personal motivation and social motivation of medical staff were deeply understood, helping the medical staff to improve their belief in the importance of correct PPE application and to establish the correct attitude toward PPE application. In terms of behavioral skills, there are numerous issues that could interfere with the establishment of proper PPE application, including material supply, double duty, simultaneous supervision of entering and leaving, continuous supervision, video supervision, and nosocomial infection inspection. The scores relating to PPE application knowledge and self-efficacy as well as the PPE usage qualification rate were calculated in the control group and the IMB intervention group and subsequently compared. Results For the control group and the IMB intervention group, the scores for PPE application knowledge were 87.78 ± 10.46 and 95.56 ± 9.06 points, respectively. For self-efficacy, the scores were 25.19 ± 0.97 and 33.79 ± 2.05 points, and the PPE usage qualification rates were 64.8% and 90.0%, respectively. The differences in all the scores were statistically significant between the two groups. Conclusion The application of the IMB model could improve the relevant knowledge relating to PPE application, strengthen the belief in the importance of and motivation for correct PPE application, improve the qualification rate for PPE application, and provide a theoretical and practical basis for reducing the occurrence of nosocomial infection.
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Affiliation(s)
- Yan Song
- Department of Nursing, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210000, People's Republic of China
| | - Lijun Zhang
- Department of Nursing, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210000, People's Republic of China
| | - Wenhui Wang
- Department of Nursing, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210000, People's Republic of China
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8
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Liu X, Cao J, Ji Y, Li T, Zhu Z, Huang T, Lu H. An innovative two-wing model for balancing the demands of inpatients with COVID-19 and general medical service in a designated hospital for COVID-19 in Shenzhen, China. Biosci Trends 2022; 16:163-166. [PMID: 35296579 DOI: 10.5582/bst.2022.01106] [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: 01/08/2023]
Abstract
Since COVID-19 was first reported in 2019, the pandemic has posed a great threat to human health. Due to its multiple transmission pathways and virus mutation, this epidemic may be protracted further, and it has already placed a heavy burden on healthcare systems. A strategy needs to be devised to address both needs for COVID-19 treatment and demands for general medical service. A two-wing model of hospital operation, which provides a safe treatment environment for patients, an On duty/On Standby work approach for medical staff, and a reliable surveillance system for hospital operation, is an effective management template to help achieve a balance between multiple demands for medical service in this new era of a long-term war against COVID-19.
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Affiliation(s)
- Xiaoning Liu
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, Guangdong, China.,National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Jing Cao
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, Guangdong, China
| | - Yiling Ji
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, Guangdong, China
| | - Ting Li
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, Guangdong, China
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China.,Fudan University Centre for Evidence-based Nursing, Shanghai, China
| | - Ting Huang
- Department of Healthcare-associated Infection Management, National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, Guangdong, China
| | - Hongzhou Lu
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, Guangdong, China
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9
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Chaurasia RK, Yadav U, Bhat NN, Sapra BK. A Quick Laboratory Method for Assessment of Blood Penetration and Splash Resistance of PPE Fabrics During the COVID-19 Pandemic Situation. TRANSACTIONS OF THE INDIAN NATIONAL ACADEMY OF ENGINEERING 2022; 7:339-347. [PMID: 35837007 PMCID: PMC8800417 DOI: 10.1007/s41403-021-00318-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/30/2021] [Indexed: 12/02/2022]
Abstract
In the current outbreak of COVID-19, healthcare facilities are hit by a shortage of supply of Personal Protective Equipments (PPE) owing to extensive local and global demands and restrictions on their import or export. To circumvent this, trials with several indigenous materials suitable to qualify for PPEs and sterilization techniques for their reuse are being carried out. Prior to their commercialisation, it is imperative to evaluate the resistance of the PPE fabrics against penetration of synthetic blood under applied pressure, 40–300 mmHg as per test standards. Generally, two types of tests are recommended, Penetration Test and Splash Resistance Test, the former being more stringent. While the final certification of PPEs is carried out by authorised agencies, a first impression quick estimate of the choice of fabric can be made using a simple laboratory set-up. This study describes setups developed in the laboratory to carry out these tests. Evaluation of the fabrics, post-gamma irradiation, was also carried out. Microscopic examinations were performed to investigate radiation-induced structural changes in fabrics showing degraded performance. This set-up is useful for selection of fabrics and to assess the feasibility of reuse of PPEs, which is the need of the hour in this pandemic situation.
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Affiliation(s)
- R. K. Chaurasia
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - U. Yadav
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - N. N. Bhat
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - B. K. Sapra
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
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10
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Elkington PT, Dickinson AS, Mavrogordato MN, Spencer DC, Gillams RJ, De Grazia A, Rosini S, Garay-Baquero DJ, Diment LE, Mahobia N, Mant A, Baynham T, Morgan H. A Personal Respirator to Improve Protection for Healthcare Workers Treating COVID-19 (PeRSo). FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:664259. [PMID: 35047921 PMCID: PMC8757800 DOI: 10.3389/fmedt.2021.664259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/14/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction: SARS-CoV-2 infection is a global pandemic. Personal Protective Equipment (PPE) to protect healthcare workers has been a recurrent challenge in terms of global stocks, supply logistics and suitability. In some settings, around 20% of healthcare workers treating COVID-19 cases have become infected, which leads to staff absence at peaks of the pandemic, and in some cases mortality. Methods: To address shortcomings in PPE, we developed a simple powered air purifying respirator, made from inexpensive and widely available components. The prototype was designed to minimize manufacturing complexity so that derivative versions could be developed in low resource settings with minor modification. Results: The “Personal Respirator – Southampton” (PeRSo) delivers High-Efficiency Particulate Air (HEPA) filtered air from a battery powered fan-filter assembly into a lightweight hood with a clear visor that can be comfortably worn for several hours. Validation testing demonstrates that the prototype removes microbes, avoids excessive CO2 build-up in normal use, and passes fit test protocols widely used to evaluate standard N95/FFP2 and N99/FFP3 face masks. Feedback from doctors and nurses indicate the PeRSo prototype was preferred to standard FFP2 and FFP3 masks, being more comfortable and reducing the time and risk of recurrently changing PPE. Patients report better communication and reassurance as the entire face is visible. Conclusion: Rapid upscale of production of cheaply produced powered air purifying respirators, designed to achieve regulatory approval in the country of production, could protect healthcare workers from infection and improve healthcare delivery during the COVID-19 pandemic.
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Affiliation(s)
- Paul T Elkington
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Institute for Life Sciences, University of Southampton, Southampton, United Kingdom.,NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Alexander S Dickinson
- Institute for Life Sciences, University of Southampton, Southampton, United Kingdom.,Mechanical Engineering Department, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Mark N Mavrogordato
- Mechanical Engineering Department, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Daniel C Spencer
- School of Electronics & Computer Science, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Richard J Gillams
- Institute for Life Sciences, University of Southampton, Southampton, United Kingdom.,School of Electronics & Computer Science, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Antonio De Grazia
- Mechanical Engineering Department, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Sebastian Rosini
- Mechanical Engineering Department, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Diana J Garay-Baquero
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Laura E Diment
- Mechanical Engineering Department, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Nitin Mahobia
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Alexandra Mant
- Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Tom Baynham
- INDO Lighting Ltd., Southampton, United Kingdom
| | - Hywel Morgan
- Institute for Life Sciences, University of Southampton, Southampton, United Kingdom.,School of Electronics & Computer Science, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
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11
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Ayabaca C, Vila C, Reina S, Medina A, Cesén M, Carrión M. Collaborative manufacturing of ergonomic personal protective equipment (PPE) accessories to prevent infectious disease. ACTA ACUST UNITED AC 2021; 49:1-7. [PMID: 34395195 PMCID: PMC8353840 DOI: 10.1016/j.matpr.2021.07.429] [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: 11/11/2022]
Abstract
Throughout history there have been epidemics and pandemics of all kinds, however the most recent ones have been respiratory diseases that have had a significant effect on the society and that have caused high mortality rates. The preventive measures to minimize the risk of contagion by contact with infected surfaces include ergonomic accessories including personal protective equipment (PPE) to prevent hands to be in contact with surfaces that could be infected by viruses, bacteria, fungi, etc., thus avoiding infection by the usual entry routes (mouth, nose, and eyes) to the human body of highly contagious diseases such as COVID-19. The collaborative manufacture of these safety accessories at the site of consumption is a current option that minimizes infectious diseases and reduces costs. Accessories such as the so-called “ear saver” and “anti-contact keys” can be produced by 3D printing with a general CAD/CAM and allow users in hospitals, and schools, such as medical and teaching staff and society in general to extend the life of N95 respirator fasteners (protective masks) and avoid contagion. These devices can be used to open doors and windows and control elevators, etc. The accessories can be optimized ergonomically for individual use by providing a custom design. The collaborative manufacture of these elements allows the product design stages to be carried out autonomously. In the manufacturing stage, 3D printers can be used to produce the devices at the point of use, thus saving on transport and distribution costs. This paper describes a comparative analysis of their design, manufacture and use in hospitals, schools, universities, and commercial areas with the aim of improving the current design.
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Affiliation(s)
- César Ayabaca
- Department of Mechanical Engineering, Escuela Politécnica Nacional, E11-253, Quito 170525, Ecuador.,DIMEB Research Group, Escuela Politécnica Nacional, E11-253, Quito 170525, Ecuador
| | - Carlos Vila
- Department of Mechanical Engineering and Materials, Universitat Politècnica de València, Valencia 46022, Spain
| | - Salvatore Reina
- Department of Mechanical Engineering, Escuela Politécnica Nacional, E11-253, Quito 170525, Ecuador.,DIMEB Research Group, Escuela Politécnica Nacional, E11-253, Quito 170525, Ecuador
| | - Ana Medina
- Consultant in Occupational Safety and Health, Quito 170511, Ecuador
| | - Mario Cesén
- Department of Mechanical Engineering, Escuela Politécnica Nacional, E11-253, Quito 170525, Ecuador.,DIMEB Research Group, Escuela Politécnica Nacional, E11-253, Quito 170525, Ecuador
| | - Marco Carrión
- Department of Mechanical Engineering, Escuela Politécnica Nacional, E11-253, Quito 170525, Ecuador
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12
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Rees PA, Watson S, Corcoran J, Slade DAJ, Pathmanaban O, Bibi A, Carlson GL. Powered air-purifying respirators: a solution to shortage of FFP3 filtering facepiece respirators in the operating theatre. Br J Surg 2021; 108:e160-e161. [PMID: 33778849 DOI: 10.1093/bjs/znab008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 11/27/2020] [Accepted: 12/27/2020] [Indexed: 11/12/2022]
Affiliation(s)
- P A Rees
- Salford Royal NHS Foundation Trust, UK
| | - S Watson
- Salford Royal NHS Foundation Trust, UK
| | | | - D A J Slade
- National Intestinal Failure Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - A Bibi
- Salford Royal NHS Foundation Trust, UK
| | - G L Carlson
- Department of Surgery, Salford Royal NHS Foundation Trust, Salford, UK
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Developing a sampling method and preliminary taxonomy for classifying COVID-19 public health guidance for healthcare organizations and the general public. J Biomed Inform 2021; 120:103852. [PMID: 34192573 PMCID: PMC8236411 DOI: 10.1016/j.jbi.2021.103852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 05/09/2021] [Accepted: 06/24/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Development and dissemination of public health (PH) guidance to healthcare organizations and the general public (e.g., businesses, schools, individuals) during emergencies like the COVID-19 pandemic is vital for policy, clinical, and public decision-making. Yet, the rapidly evolving nature of these events poses significant challenges for guidance development and dissemination strategies predicated on well-understood concepts and clearly defined access and distribution pathways. Taxonomies are an important but underutilized tool for guidance authoring, dissemination and updating in such dynamic scenarios. OBJECTIVE To design a rapid, semi-automated method for sampling and developing a PH guidance taxonomy using widely available Web crawling tools and streamlined manual content analysis. METHODS Iterative samples of guidance documents were taken from four state PH agency websites, the US Center for Disease Control and Prevention, and the World Health Organization. Documents were used to derive and refine a preliminary taxonomy of COVID-19 PH guidance via content analysis. RESULTS Eight iterations of guidance document sampling and taxonomy revisions were performed, with a final corpus of 226 documents. The preliminary taxonomy contains 110 branches distributed between three major domains: stakeholders (24 branches), settings (25 branches) and topics (61 branches). Thematic saturation measures indicated rapid saturation (≤5% change) for the domains of "stakeholders" and "settings", and "topic"-related branches for clinical decision-making. Branches related to business reopening and economic consequences remained dynamic throughout sampling iterations. CONCLUSION The PH guidance taxonomy can support public health agencies by aligning guidance development with curation and indexing strategies; supporting targeted dissemination; increasing the speed of updates; and enhancing public-facing guidance repositories and information retrieval tools. Taxonomies are essential to support knowledge management activities during rapidly evolving scenarios such as disease outbreaks and natural disasters.
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Brêda Mascarenhas LA, Machado BAS, Rodrigues LDAP, Saraiva Hodel KV, Bandeira Santos AÁ, Freitas Neves PR, da Silva Andrade LPC, Soares MB, de Andrade JB, Badaró R. Potential application of novel technology developed for instant decontamination of personal protective equipment before the doffing step. PLoS One 2021; 16:e0250854. [PMID: 34086691 PMCID: PMC8177472 DOI: 10.1371/journal.pone.0250854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 02/02/2021] [Indexed: 12/14/2022] Open
Abstract
The use of personal protective equipment (PPE) has been considered the most effective way to avoid the contamination of healthcare workers by different microorganisms, including SARS-CoV-2. A spray disinfection technology (chamber) was developed, and its efficacy in instant decontamination of previously contaminated surfaces was evaluated in two exposure times. Seven test microorganisms were prepared and inoculated on the surface of seven types of PPE (respirator mask, face shield, shoe, glove, cap, safety glasses and lab coat). The tests were performed on previously contaminated PPE using a manikin with a motion device for exposure to the chamber with biocidal agent (sodium hypochlorite) for 10 and 30s. In 96.93% of the experimental conditions analyzed, the percentage reduction was >99% (the number of viable cells found on the surface ranged from 4.3x106 to <10 CFU/mL). The samples of E. faecalis collected from the glove showed the lowest percentages reduction, with 86.000 and 86.500% for exposure times of 10 and 30 s, respectively. The log10 reduction values varied between 0.85 log10 (E. faecalis at 30 s in glove surface) and 9.69 log10 (E. coli at 10 and 30 s in lab coat surface). In general, E. coli, S. aureus, C. freundii, P. mirabilis, C. albicans and C. parapsilosis showed susceptibility to the biocidal agent under the tested conditions, with >99% reduction after 10 and 30s, while E. faecalis and P. aeruginosa showed a lower susceptibility. The 30s exposure time was more effective for the inactivation of the tested microorganisms. The results show that the spray disinfection technology has the potential for instant decontamination of PPE, which can contribute to an additional barrier for infection control of healthcare workers in the hospital environment.
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Affiliation(s)
- Luís Alberto Brêda Mascarenhas
- SENAI CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
| | - Bruna Aparecida Souza Machado
- SENAI CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
- SENAI CIMATEC, National Service of Industrial Learning–SENAI, Computational Modeling and Industrial Technology, University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
| | - Leticia de Alencar Pereira Rodrigues
- SENAI CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
| | - Katharine Valéria Saraiva Hodel
- SENAI CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
| | - Alex Álisson Bandeira Santos
- SENAI CIMATEC, National Service of Industrial Learning–SENAI, Computational Modeling and Industrial Technology, University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
| | - Paulo Roberto Freitas Neves
- SENAI CIMATEC, National Service of Industrial Learning–SENAI, Computational Modeling and Industrial Technology, University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
| | - Leone Peter Correia da Silva Andrade
- SENAI CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
| | - Milena Botelho Soares
- SENAI CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (IGM-FIOCRUZ/BA), Salvador, Bahia, Brazil
| | - Jailson Bittencourt de Andrade
- SENAI CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
| | - Roberto Badaró
- SENAI CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
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15
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Cuschieri J, Robinson B, Lynch J, Mitchell S, Arbabi S, Bryson C, Sayre M, Maier RV, Bulger E. The Covid-19 Pandemic: Lessons Learned for Sustained Trauma Preparedness and Responses. Ann Surg 2021; 273:1051-1059. [PMID: 33378302 DOI: 10.1097/sla.0000000000004695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The emergence of coronavirus disease 2019 (COVID-19) that is caused by the SARS-CoV-2 virus has led to an overwhelming strain on healthcare delivery. This pandemic has created a sustained stress on the modern healthcare system, with unforeseen and potential drastic effects. Although the initial focus during this pandemic has been preparedness and response directed to the pandemic itself, traumatic injury has continued to remain a common problem that requires immediate evaluation and care to provide optimal outcomes. The State of Washington had the first reported case and death related to COVID-19 in the United States. Harborview Medical Center, which serves as the sole Level-1 adult and pediatric trauma center for the state, was rapidly affected by COVID-19, but still needed to maintain preparedness and responses to injured patients for the region. Although initially the focus was on the emerging pandemic on institutional factors, it became obvious that sustained efforts for regional trauma care required a more global focus. Because of these factors, Harborview Medical Center was quickly entrusted to serve as the coordinating center for the regions COVID-19 response, while also continuing to provide optimal care for injured patients during the pandemic. This response allowed the care of injured patients to be maintained within designated trauma centers during this pandemic. This present report summarizes the evolution of trauma care delivery during the first phase of this pandemic and provides informative recommendations for sustained responses to the care of injured patients during the pandemic based on lessons learned during the initial response.
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Affiliation(s)
- Joseph Cuschieri
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Bryce Robinson
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - John Lynch
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Steve Mitchell
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Saman Arbabi
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Chloe Bryson
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Michael Sayre
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Ronald V Maier
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
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16
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Garcia GPA, Fracarolli IFL, Santos HECD, Souza VRDS, Cenzi CM, Marziale MHP. Use of personal protective equipment to care for patients with COVID-19: scoping review. ACTA ACUST UNITED AC 2021; 42:e20200150. [PMID: 34037178 DOI: 10.1590/1983-1447.2021.20200150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/09/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To summarize the knowledge about recommendations for the use of personal protective equipment necessary for the provision of care by health professionals to patients suspected or infected by the new coronavirus. METHOD Scoping review with search for primary studies, reviews and preprints articles in English, Portuguese and Spanish, in the last 20 years on the bases WOS/ISI, SCOPUS, MEDLINE/PuBMed, CINAHL, LILACS and SciELO. Unpublished studies in journals were surveyed on bioRxiv and SciELO preprints. RESULTS 23 studies were eligible. Experiences with coronavirus prior to SARS-CoV-2 revealed that the equipment was an essential barrier in preventing transmission and followed the recommendations for standard precautions, contact, droplet and aerosol. In 13 (57%) studies, this equipment complied international recommendations and in 10 (45%) local recommendations. CONCLUSION The personal protective equipment used does not follow global standardization according to type, quality and adequate provision, exposing these professionals to the risk of contamination.
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Affiliation(s)
- Gracielle Pereira Aires Garcia
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Programa de Pós-graduação em Enfermagem Fundamental. Ribeirão Preto, São Paulo, Brasil
| | - Isabela Fernanda Larios Fracarolli
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Programa de Pós-graduação em Enfermagem Fundamental. Ribeirão Preto, São Paulo, Brasil
| | - Heloisa Ehmke Cardoso Dos Santos
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Programa de Pós-graduação em Enfermagem Fundamental. Ribeirão Preto, São Paulo, Brasil
| | | | - Camila Maria Cenzi
- Universidade Federal de Mato Grosso (UFMT), Faculdade de Enfermagem. Cuiabá, Mato Grosso, Brasil
| | - Maria Helena Palucci Marziale
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Programa de Pós-graduação em Enfermagem Fundamental. Ribeirão Preto, São Paulo, Brasil
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17
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Shammi M, Behal A, Tareq SM. The Escalating Biomedical Waste Management To Control the Environmental Transmission of COVID-19 Pandemic: A Perspective from Two South Asian Countries. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:4087-4093. [PMID: 33434001 PMCID: PMC7839416 DOI: 10.1021/acs.est.0c05117] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Indexed: 05/22/2023]
Abstract
The global pandemic COVID-19 culminated in escalating biomedical waste (BMW) worldwide, and the management authorities are struggling with waste treatment. Bangladesh and India are two densely populated South Asian developing countries with limited resources. Both countries face mass community transmission of the disease, with India facing severe infections and deaths. Predictably, a large population might sum up to a large amount of COVID-19-related BMW. There is also the question of capacity, whether the existing BMW policies and regulations of the regions can manage the BMW strategically driven by the pressure of the pandemic. Here, we have shown a framework leading to further environmental and community transmission of the COVID-19 pandemic if the BMW generated at healthcare facilities and homes is not appropriately managed. The BMW, such as safety suits or personal protective equipment (PPE), masks, gloves, and shields, would likely damage the environment in the long run by creating microplastic pollution. Modification and modernization of the existing policies, plans, and guidelines on the proper management of the hospital and household infectious waste is suggested. Moreover, occupational health and safety assessments for waste management workers at the hospitals are recommended. Installing suitable capacity incinerators and related infrastructures are recommended for appropriate waste management. In the absence of incinerators, the existing industrial furnaces, cement kilns, and mobile incinerators can be used with a rapid impact assessment adhering to the appropriate implementations of the policies and guidelines.
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Affiliation(s)
- Mashura Shammi
- Hydrobiogeochemistry and Pollution Control Laboratory,
Department of Environmental Sciences, Jahangirnagar University,
Dhaka 1342, Bangladesh
| | - Arvind Behal
- Department of Biotechnology, GGDSD
College, Sector 32-C, Chandigarh 160030, India
| | - Shafi M Tareq
- Hydrobiogeochemistry and Pollution Control Laboratory,
Department of Environmental Sciences, Jahangirnagar University,
Dhaka 1342, Bangladesh
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18
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Allen AR, Ford T, Skuce RA. Does Mycobacterium tuberculosis var. bovis Survival in the Environment Confound Bovine Tuberculosis Control and Eradication? A Literature Review. Vet Med Int 2021; 2021:8812898. [PMID: 33628412 PMCID: PMC7880718 DOI: 10.1155/2021/8812898] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/12/2021] [Accepted: 01/25/2021] [Indexed: 12/13/2022] Open
Abstract
Bovine tuberculosis (bTB) is one of the globe's most common, multihost zoonoses and results in substantial socioeconomic costs for governments, farming industries, and tax payers. Despite decades of surveillance and research, surprisingly, little is known about the exact mechanisms of transmission. In particular, as a facultative intracellular pathogen, to what extent does survival of the causative agent, Mycobacterium tuberculosis var. bovis (M. bovis), in the environment constitute an epidemiological risk for livestock and wildlife? Due largely to the classical pathology of cattle cases, the received wisdom was that bTB was spread by direct inhalation and exchange of bioaerosols containing droplets laden with bacteria. Other members of the Mycobacterium tuberculosis complex (MTBC) exhibit differing host ranges, an apparent capacity to persist in environmental fomites, and they favour a range of different transmission routes. It is possible, therefore, that infection from environmental sources of M. bovis could be a disease transmission risk. Recent evidence from GPS-collared cattle and badgers in Britain and Ireland suggests that direct transmission by infectious droplets or aerosols may not be the main mechanism for interspecies transmission, raising the possibility of indirect transmission involving a contaminated, shared environment. The possibility that classical pulmonary TB can be simulated and recapitulated in laboratory animal models by ingestion of contaminated feed is a further intriguing indication of potential environmental risk. Livestock and wildlife are known to shed M. bovis onto pasture, soil, feedstuffs, water, and other fomites; field and laboratory studies have indicated that persistence is possible, but variable, under differing environmental conditions. Given the potential infection risk, it is timely to review the available evidence, experimental approaches, and methodologies that could be deployed to address this potential blind spot and control point. Although we focus on evidence from Western Europe, the concepts are widely applicable to other multihost bTB episystems.
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Affiliation(s)
- Adrian R. Allen
- Agri-Food and Biosciences Institute, Veterinary Sciences Division, Bacteriology Branch, Stoney Road Stormont, Belfast BT4 3SD, Northern Ireland, UK
| | - Tom Ford
- Agri-Food and Biosciences Institute, Veterinary Sciences Division, Bacteriology Branch, Stoney Road Stormont, Belfast BT4 3SD, Northern Ireland, UK
| | - Robin A. Skuce
- Agri-Food and Biosciences Institute, Veterinary Sciences Division, Bacteriology Branch, Stoney Road Stormont, Belfast BT4 3SD, Northern Ireland, UK
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19
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Lawrence RJ, O'Donoghue G, Kitterick P, O'Donoghue K, Hague R, Mitchell L, Lycett-Ranson Z, Hartley DEH. Recommended Personal Protective Equipment for Cochlear Implant and Other Mastoid Surgery During the COVID-19 Era. Laryngoscope 2020; 130:2693-2699. [PMID: 32720316 DOI: 10.1002/lary.29014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/10/2020] [Accepted: 07/21/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES/HYPOTHESIS The overall aim of this study was to evaluate personal protective equipment (PPE) that may facilitate the safe recommencement of cochlear implantation in the COVID-19 era, with the broader goal of minimizing the period of auditory deprivation in prelingually deaf children and reducing the risk of cochlear ossification in individuals following meningitis. METHODS The study design comprised 1) an objective assessment of mastoid drilling-induced droplet spread conducted during simulated cochlear implant (CI) surgery and its mitigation via the use of a protective drape tent and 2) an evaluation of three PPE configurations by otologists while performing mastoid drilling on ex vivo temporal bones. The various PPE solutions were assessed in terms of their impact on communication, vital physiological parameters, visual acuity and fields, and acceptability to surgeons using a systematic risk-based approach. RESULTS Droplet spread during simulated CI surgery extended over 2 m, a distance greater than previously reported. A drape tent significantly reduced droplet spread. The ensemble of a half-face mask and safety spoggles (foam lined safety goggles) had consistently superior performance across all aspects of clinical usability. All other PPE options were found to substantially restrict the visual field, making them unsafe for microsurgery. CONCLUSIONS The results of this preclinical study indicate that the most viable solution to enable the safe conduct of CI and other mastoid surgery is a combination of a filtering facepiece (FFP3) mask or half-face respirator with safety spoggles as PPE. Prescription spoggles are an option for surgeons who need to wear corrective glasses to operate. A drape tent reduces droplet spread. A multicenter clinical trial to evaluate the effectiveness of PPE should be the next step toward safely performing CI surgery during the COVID-19 era. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2693-2699, 2020.
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Affiliation(s)
- Rachael J Lawrence
- National Institute for Health Research Nottingham Biomedical Research Centre, Ropewalk House, Nottingham, United Kingdom.,Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
| | - Gerard O'Donoghue
- National Institute for Health Research Nottingham Biomedical Research Centre, Ropewalk House, Nottingham, United Kingdom.,Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
| | - Pádraig Kitterick
- National Institute for Health Research Nottingham Biomedical Research Centre, Ropewalk House, Nottingham, United Kingdom.,Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
| | - Kevin O'Donoghue
- Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
| | - Richard Hague
- Centre for Additive Manufacturing, University of Nottingham, Nottingham, United Kingdom
| | - Laura Mitchell
- Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
| | - Zoe Lycett-Ranson
- Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
| | - Douglas E H Hartley
- National Institute for Health Research Nottingham Biomedical Research Centre, Ropewalk House, Nottingham, United Kingdom.,Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
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20
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Bielicki JA, Duval X, Gobat N, Goossens H, Koopmans M, Tacconelli E, van der Werf S. Monitoring approaches for health-care workers during the COVID-19 pandemic. THE LANCET. INFECTIOUS DISEASES 2020; 20:e261-e267. [PMID: 32711692 PMCID: PMC7377794 DOI: 10.1016/s1473-3099(20)30458-8] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/22/2020] [Accepted: 06/02/2020] [Indexed: 12/15/2022]
Abstract
Health-care workers are crucial to any health-care system. During the ongoing COVID-19 pandemic, health-care workers are at a substantially increased risk of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and could come to considerable harm as a result. Depending on the phase of the pandemic, patients with COVID-19 might not be the main source of SARS-CoV-2 infection and health-care workers could be exposed to atypical patients, infected family members, contacts, and colleagues, or live in communities of active transmission. Clear strategies to support and appropriately manage exposed and infected health-care workers are essential to ensure effective staff management and to engender trust in the workplace. These management strategies should focus on risk stratification, suitable clinical monitoring, low-threshold access to diagnostics, and decision making about removal from and return to work. Policy makers need to support health-care facilities in interpreting guidance during a pandemic that will probably be characterised by fluctuating local incidence of SARS-CoV-2 to mitigate the impact of this pandemic on their workforce.
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Affiliation(s)
- Julia A Bielicki
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, UK; Paediatric Infectious Diseases and Infection Prevention and Control, University of Basel Children's Hospital, Basel, Switzerland.
| | - Xavier Duval
- Center for Clinical Investigation, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France; INSERM, Infections Antimicrobials Modelling Evolution, University of Paris, Paris, France
| | - Nina Gobat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | | | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Sylvie van der Werf
- Department of Virology, University of Paris, Paris, France; National Reference Center for Respiratory Viruses, Institut Pasteur, Paris, France
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21
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Yeon JH, Shin YS. Effects of Education on the Use of Personal Protective Equipment for Reduction of Contamination: A Randomized Trial. SAGE Open Nurs 2020; 6:2377960820940621. [PMID: 33415295 PMCID: PMC7774400 DOI: 10.1177/2377960820940621] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 06/14/2020] [Indexed: 01/16/2023] Open
Abstract
Introduction Accurate doffing personal protective equipment (PPE) is one of the key practices of infection control because of increased risk of infection transmission caused by medical garments or environmental contamination. Objectives The study aimed to develop a reality-based education program and identify its effects on nurses’ knowledge, attitudes, and contamination after PPE doffing. Methods Randomized control group pretest–posttest design. A total of 56 nurses were randomly assigned to experimental (n = 28) and control (n = 28) groups. The experimental group underwent a new reality-based education program to improve PPE use. Subsequently, participants were assessed on knowledge of and attitude toward PPE use, as well as number and area of contaminated sites after removing PPE and mask fitting test. Results There were no significant differences in knowledge and attitude to PPE use. The experimental group had significantly fewer contaminated sites than the control group (42 vs. 89), and a significantly lower mean contaminated site area (16.63 ± 24.27 vs. 95.41 ± 117.51 cm2). The tuberculosis mask fitting test success rates were 68% and 50% in the experimental and control groups, respectively, but the difference was not significant. Conclusion The reality-based education on use of PPE helps to reduce contamination and improve performance related to the use of PPE for infection control.
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Affiliation(s)
- Jeong Hwa Yeon
- Infection Control Unit, National Health Insurance Service, Ilsan Hospital, Goyang, Republic of Korea.,Graduate School, Hanyang University, Seoul, Republic of Korea
| | - Yong Soon Shin
- School of Nursing, Hanyang University, Seoul, Republic of Korea
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22
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Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, Tikka C, Ruotsalainen JH, Kilinc Balci FS. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2020; 5:CD011621. [PMID: 32412096 PMCID: PMC8785899 DOI: 10.1002/14651858.cd011621.pub5] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND In epidemics of highly infectious diseases, such as Ebola, severe acute respiratory syndrome (SARS), or coronavirus (COVID-19), healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Personal protective equipment (PPE) can reduce the risk by covering exposed body parts. It is unclear which type of PPE protects best, what is the best way to put PPE on (i.e. donning) or to remove PPE (i.e. doffing), and how to train HCWs to use PPE as instructed. OBJECTIVES To evaluate which type of full-body PPE and which method of donning or doffing PPE have the least risk of contamination or infection for HCW, and which training methods increase compliance with PPE protocols. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL to 20 March 2020. SELECTION CRITERIA We included all controlled studies that evaluated the effect of full-body PPE used by HCW exposed to highly infectious diseases, on the risk of infection, contamination, or noncompliance with protocols. We also included studies that compared the effect of various ways of donning or doffing PPE, and the effects of training on the same outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed the risk of bias in included trials. We conducted random-effects meta-analyses were appropriate. MAIN RESULTS Earlier versions of this review were published in 2016 and 2019. In this update, we included 24 studies with 2278 participants, of which 14 were randomised controlled trials (RCT), one was a quasi-RCT and nine had a non-randomised design. Eight studies compared types of PPE. Six studies evaluated adapted PPE. Eight studies compared donning and doffing processes and three studies evaluated types of training. Eighteen studies used simulated exposure with fluorescent markers or harmless microbes. In simulation studies, median contamination rates were 25% for the intervention and 67% for the control groups. Evidence for all outcomes is of very low certainty unless otherwise stated because it is based on one or two studies, the indirectness of the evidence in simulation studies and because of risk of bias. Types of PPE The use of a powered, air-purifying respirator with coverall may protect against the risk of contamination better than a N95 mask and gown (risk ratio (RR) 0.27, 95% confidence interval (CI) 0.17 to 0.43) but was more difficult to don (non-compliance: RR 7.5, 95% CI 1.81 to 31.1). In one RCT (59 participants) coveralls were more difficult to doff than isolation gowns (very low-certainty evidence). Gowns may protect better against contamination than aprons (small patches: mean difference (MD) -10.28, 95% CI -14.77 to -5.79). PPE made of more breathable material may lead to a similar number of spots on the trunk (MD 1.60, 95% CI -0.15 to 3.35) compared to more water-repellent material but may have greater user satisfaction (MD -0.46, 95% CI -0.84 to -0.08, scale of 1 to 5). According to three studies that tested more recently introduced full-body PPE ensembles, there may be no difference in contamination. Modified PPE versus standard PPE The following modifications to PPE design may lead to less contamination compared to standard PPE: sealed gown and glove combination (RR 0.27, 95% CI 0.09 to 0.78), a better fitting gown around the neck, wrists and hands (RR 0.08, 95% CI 0.01 to 0.55), a better cover of the gown-wrist interface (RR 0.45, 95% CI 0.26 to 0.78, low-certainty evidence), added tabs to grab to facilitate doffing of masks (RR 0.33, 95% CI 0.14 to 0.80) or gloves (RR 0.22, 95% CI 0.15 to 0.31). Donning and doffing Using Centers for Disease Control and Prevention (CDC) recommendations for doffing may lead to less contamination compared to no guidance (small patches: MD -5.44, 95% CI -7.43 to -3.45). One-step removal of gloves and gown may lead to less bacterial contamination (RR 0.20, 95% CI 0.05 to 0.77) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28) than separate removal. Double-gloving may lead to less viral or bacterial contamination compared to single gloving (RR 0.34, 95% CI 0.17 to 0.66) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28). Additional spoken instruction may lead to fewer errors in doffing (MD -0.9, 95% CI -1.4 to -0.4) and to fewer contamination spots (MD -5, 95% CI -8.08 to -1.92). Extra sanitation of gloves before doffing with quaternary ammonium or bleach may decrease contamination, but not alcohol-based hand rub. Training The use of additional computer simulation may lead to fewer errors in doffing (MD -1.2, 95% CI -1.6 to -0.7). A video lecture on donning PPE may lead to better skills scores (MD 30.70, 95% CI 20.14 to 41.26) than a traditional lecture. Face-to-face instruction may reduce noncompliance with doffing guidance more (odds ratio 0.45, 95% CI 0.21 to 0.98) than providing folders or videos only. AUTHORS' CONCLUSIONS We found low- to very low-certainty evidence that covering more parts of the body leads to better protection but usually comes at the cost of more difficult donning or doffing and less user comfort. More breathable types of PPE may lead to similar contamination but may have greater user satisfaction. Modifications to PPE design, such as tabs to grab, may decrease the risk of contamination. For donning and doffing procedures, following CDC doffing guidance, a one-step glove and gown removal, double-gloving, spoken instructions during doffing, and using glove disinfection may reduce contamination and increase compliance. Face-to-face training in PPE use may reduce errors more than folder-based training. We still need RCTs of training with long-term follow-up. We need simulation studies with more participants to find out which combinations of PPE and which doffing procedure protects best. Consensus on simulation of exposure and assessment of outcome is urgently needed. We also need more real-life evidence. Therefore, the use of PPE of HCW exposed to highly infectious diseases should be registered and the HCW should be prospectively followed for their risk of infection.
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Affiliation(s)
- Jos H Verbeek
- Cochrane Work Review Group, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Blair Rajamaki
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Sharea Ijaz
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Bronagh Blackwood
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Christina Tikka
- Finnish Institute of Occupational Health, TYÖTERVEYSLAITOS, Finland
| | | | - F Selcen Kilinc Balci
- National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Pittsburgh, PA, USA
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Wesemann C, Pieralli S, Fretwurst T, Nold J, Nelson K, Schmelzeisen R, Hellwig E, Spies BC. 3-D Printed Protective Equipment during COVID-19 Pandemic. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E1997. [PMID: 32344688 PMCID: PMC7215430 DOI: 10.3390/ma13081997] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 12/16/2022]
Abstract
While the number of coronavirus cases from 2019 continues to grow, hospitals are reporting shortages of personal protective equipment (PPE) for frontline healthcare workers. Furthermore, PPE for the eyes and mouth, such as face shields, allow for additional protection when working with aerosols. 3-D printing enables the easy and rapid production of lightweight plastic frameworks based on open-source data. The practicality and clinical suitability of four face shields printed using a fused deposition modeling printer were examined. The weight, printing time, and required tools for assembly were evaluated. To assess the clinical suitability, each face shield was worn for one hour by 10 clinicians and rated using a visual analogue scale. The filament weight (21-42 g) and printing time (1:40-3:17 h) differed significantly between the four frames. Likewise, the fit, wearing comfort, space for additional PPE, and protection varied between the designs. For clinical suitability, a chosen design should allow sufficient space for goggles and N95 respirators as well as maximum coverage of the facial area. Consequently, two datasets are recommended. For the final selection of the ideal dataset to be used for printing, scalability and economic efficiency need to be carefully balanced with an acceptable degree of protection.
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Affiliation(s)
- Christian Wesemann
- Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4–6, 14197 Berlin, Germany
| | - Stefano Pieralli
- Department of Prosthetic Dentistry, Medical Center—University of Freiburg, Center for Dental Medicine, Hugstetter Str. 55, 79106 Freiburg, Germany; (S.P.); (J.N.); (B.C.S.)
- Department of Oral and Maxillofacial Surgery, Medical Center—University of Freiburg, Center for Dental Medicine, Hugstetter Str. 55, 79106 Freiburg, Germany; (T.F.); (K.N.); (R.S.)
| | - Tobias Fretwurst
- Department of Oral and Maxillofacial Surgery, Medical Center—University of Freiburg, Center for Dental Medicine, Hugstetter Str. 55, 79106 Freiburg, Germany; (T.F.); (K.N.); (R.S.)
| | - Julian Nold
- Department of Prosthetic Dentistry, Medical Center—University of Freiburg, Center for Dental Medicine, Hugstetter Str. 55, 79106 Freiburg, Germany; (S.P.); (J.N.); (B.C.S.)
| | - Katja Nelson
- Department of Oral and Maxillofacial Surgery, Medical Center—University of Freiburg, Center for Dental Medicine, Hugstetter Str. 55, 79106 Freiburg, Germany; (T.F.); (K.N.); (R.S.)
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, Medical Center—University of Freiburg, Center for Dental Medicine, Hugstetter Str. 55, 79106 Freiburg, Germany; (T.F.); (K.N.); (R.S.)
| | - Elmar Hellwig
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany;
| | - Benedikt Christopher Spies
- Department of Prosthetic Dentistry, Medical Center—University of Freiburg, Center for Dental Medicine, Hugstetter Str. 55, 79106 Freiburg, Germany; (S.P.); (J.N.); (B.C.S.)
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24
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Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, Tikka C, Ruotsalainen JH, Kilinc Balci FS. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2020; 4:CD011621. [PMID: 32293717 PMCID: PMC7158881 DOI: 10.1002/14651858.cd011621.pub4] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND In epidemics of highly infectious diseases, such as Ebola, severe acute respiratory syndrome (SARS), or coronavirus (COVID-19), healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Personal protective equipment (PPE) can reduce the risk by covering exposed body parts. It is unclear which type of PPE protects best, what is the best way to put PPE on (i.e. donning) or to remove PPE (i.e. doffing), and how to train HCWs to use PPE as instructed. OBJECTIVES To evaluate which type of full-body PPE and which method of donning or doffing PPE have the least risk of contamination or infection for HCW, and which training methods increase compliance with PPE protocols. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL to 20 March 2020. SELECTION CRITERIA We included all controlled studies that evaluated the effect of full-body PPE used by HCW exposed to highly infectious diseases, on the risk of infection, contamination, or noncompliance with protocols. We also included studies that compared the effect of various ways of donning or doffing PPE, and the effects of training on the same outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed the risk of bias in included trials. We conducted random-effects meta-analyses were appropriate. MAIN RESULTS Earlier versions of this review were published in 2016 and 2019. In this update, we included 24 studies with 2278 participants, of which 14 were randomised controlled trials (RCT), one was a quasi-RCT and nine had a non-randomised design. Eight studies compared types of PPE. Six studies evaluated adapted PPE. Eight studies compared donning and doffing processes and three studies evaluated types of training. Eighteen studies used simulated exposure with fluorescent markers or harmless microbes. In simulation studies, median contamination rates were 25% for the intervention and 67% for the control groups. Evidence for all outcomes is of very low certainty unless otherwise stated because it is based on one or two studies, the indirectness of the evidence in simulation studies and because of risk of bias. Types of PPE The use of a powered, air-purifying respirator with coverall may protect against the risk of contamination better than a N95 mask and gown (risk ratio (RR) 0.27, 95% confidence interval (CI) 0.17 to 0.43) but was more difficult to don (non-compliance: RR 7.5, 95% CI 1.81 to 31.1). In one RCT (59 participants), people with a long gown had less contamination than those with a coverall, and coveralls were more difficult to doff (low-certainty evidence). Gowns may protect better against contamination than aprons (small patches: mean difference (MD) -10.28, 95% CI -14.77 to -5.79). PPE made of more breathable material may lead to a similar number of spots on the trunk (MD 1.60, 95% CI -0.15 to 3.35) compared to more water-repellent material but may have greater user satisfaction (MD -0.46, 95% CI -0.84 to -0.08, scale of 1 to 5). Modified PPE versus standard PPE The following modifications to PPE design may lead to less contamination compared to standard PPE: sealed gown and glove combination (RR 0.27, 95% CI 0.09 to 0.78), a better fitting gown around the neck, wrists and hands (RR 0.08, 95% CI 0.01 to 0.55), a better cover of the gown-wrist interface (RR 0.45, 95% CI 0.26 to 0.78, low-certainty evidence), added tabs to grab to facilitate doffing of masks (RR 0.33, 95% CI 0.14 to 0.80) or gloves (RR 0.22, 95% CI 0.15 to 0.31). Donning and doffing Using Centers for Disease Control and Prevention (CDC) recommendations for doffing may lead to less contamination compared to no guidance (small patches: MD -5.44, 95% CI -7.43 to -3.45). One-step removal of gloves and gown may lead to less bacterial contamination (RR 0.20, 95% CI 0.05 to 0.77) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28) than separate removal. Double-gloving may lead to less viral or bacterial contamination compared to single gloving (RR 0.34, 95% CI 0.17 to 0.66) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28). Additional spoken instruction may lead to fewer errors in doffing (MD -0.9, 95% CI -1.4 to -0.4) and to fewer contamination spots (MD -5, 95% CI -8.08 to -1.92). Extra sanitation of gloves before doffing with quaternary ammonium or bleach may decrease contamination, but not alcohol-based hand rub. Training The use of additional computer simulation may lead to fewer errors in doffing (MD -1.2, 95% CI -1.6 to -0.7). A video lecture on donning PPE may lead to better skills scores (MD 30.70, 95% CI 20.14 to 41.26) than a traditional lecture. Face-to-face instruction may reduce noncompliance with doffing guidance more (odds ratio 0.45, 95% CI 0.21 to 0.98) than providing folders or videos only. AUTHORS' CONCLUSIONS We found low- to very low-certainty evidence that covering more parts of the body leads to better protection but usually comes at the cost of more difficult donning or doffing and less user comfort, and may therefore even lead to more contamination. More breathable types of PPE may lead to similar contamination but may have greater user satisfaction. Modifications to PPE design, such as tabs to grab, may decrease the risk of contamination. For donning and doffing procedures, following CDC doffing guidance, a one-step glove and gown removal, double-gloving, spoken instructions during doffing, and using glove disinfection may reduce contamination and increase compliance. Face-to-face training in PPE use may reduce errors more than folder-based training. We still need RCTs of training with long-term follow-up. We need simulation studies with more participants to find out which combinations of PPE and which doffing procedure protects best. Consensus on simulation of exposure and assessment of outcome is urgently needed. We also need more real-life evidence. Therefore, the use of PPE of HCW exposed to highly infectious diseases should be registered and the HCW should be prospectively followed for their risk of infection.
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Affiliation(s)
- Jos H Verbeek
- Academic Medical Center, University of Amsterdam, Cochrane Work Review Group, Amsterdam, Netherlands, 1105AZ
| | - Blair Rajamaki
- University of Eastern Finland, School of Pharmacy, Kuopio, Finland
| | - Sharea Ijaz
- University of Bristol, Population Health Sciences, Bristol Medical School, Bristol, UK, BS1 2NT
| | | | | | - Bronagh Blackwood
- Queen's University Belfast, Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Wellcome-Wolfson Building, 97 Lisburn Road, Belfast, Northern Ireland, UK, BT9 7LB
| | - Christina Tikka
- Finnish Institute of Occupational Health, TYÖTERVEYSLAITOS, Finland, FI-70032
| | - Jani H Ruotsalainen
- Finnish Medicines Agency, Assessment of Pharmacotherapies, Microkatu 1, Kuopio, Finland, FI-70210
| | - F Selcen Kilinc Balci
- Centers for Disease Control and Prevention (CDC), National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH), 626 Cochrans Mill Road, Pittsburgh, PA, USA, 15236
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Ribeiro AP, Oliveira GL, Silva LS, Souza ERD. Saúde e segurança de profissionais de saúde no atendimento a pacientes no contexto da pandemia de Covid-19: revisão de literatura. REVISTA BRASILEIRA DE SAÚDE OCUPACIONAL 2020. [DOI: 10.1590/2317-6369000013920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Resumo Objetivo: analisar a produção científica sobre a saúde dos trabalhadores da Saúde que atendem pacientes no contexto da pandemia de COVID-19. Métodos: realizou-se revisão de literatura que incluiu artigos publicados em 2020, indexados nas bases PubMed, Web of Science e na Biblioteca Virtual em Saúde (Medline e Lilacs). Resultados: foram analisados 52 artigos, segundo grupo profissional estudado, país onde a pesquisa foi realizada, tipo de estudo e tema abordado. Os conhecimentos e questões mais atuais e relevantes e as lacunas existentes sobre o tema foram evidenciados e discutidos do ponto de vista da Saúde Coletiva, particularmente da Saúde do Trabalhador. Mais da metade dos documentos foi produzida na China (55,7%) e focalizou as diferentes categorias profissionais de saúde em conjunto (57,7%). Estudos do tipo ensaio/opinião (46,1%) e estudos transversais (30,8%) foram os mais frequentes. Os temas destacados foram o conhecimento dos profissionais sobre a doença, os casos de COVID-19 entre os profissionais, a saúde mental dos trabalhadores da saúde e a segurança no trabalho. Conclusão: os estudos publicados no início da pandemia destacam a insuficiência de conhecimentos atualizados e falhas na proteção da saúde dos trabalhadores e recomendam o gerenciamento dos processos e locais de trabalho, dos casos de COVID-19, das políticas públicas e dos direitos dos trabalhadores.
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Nascimento JCP, Rocha RRA, Dantas JKDS, Oliveira EDS, Dantas DV, Dantas RAN. MANAGEMENT OF PATIENTS DIAGNOSED OR SUSPECTED WITH COVID-19 IN CARDIORESPIRATORY ARREST: A SCOPING REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2020. [DOI: 10.1590/1980-265x-tce-2020-0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to map the production of knowledge about the recommendations that can be applied in managing patients diagnosed or suspected with COVID-19 in cardiorespiratory arrest. Method: a scoping review, according to the Joanna Briggs Institute (2020) guidelines. Search was performed in ten data sources, and two electronic search engines were used; from 2001 to 2020. Results: of the 547 studies found, 14 met the inclusion and exclusion criteria. Most studies were published in 2020 (35.7%), and most studies were conducted in Canada (21.4%). It is observed the use of a systematized care to identify the possible means of care that should be provided to patients who suffer a cardiorespiratory arrest in hospitals, such as the monitoring of suspected cases by assessing the victim’s breathing and pulse and identifying arrhythmias and shockable rhythms quickly. Personal protective equipment must be used to protect against droplets and aerosols and respiratory etiquette. Conclusion: managing patients in cardiorespiratory arrest suspected or diagnosis with COVID-19 requiring cardiopulmonary resuscitation should be performed in isolation areas and with the use of adequate protective equipment. There are gaps in scientific productions so that they address more clearly and instructively management when performing cardiopulmonary resuscitation in patients suspected or diagnosed with COVID-19.
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