Medical masks' and respirators' pattern of use, adverse effects and errors among Portuguese health care professionals during the COVID-19 pandemic: A cross-sectional study

Risk assessment and the use of personal protective equipment in an emergency department: Differing perspectives of emergency and infection control clinicians. A video-vignette survey

BACKGROUND

The use of personal protective equipment (PPE) in emergency departments (EDs) is an important defense during infectious disease emergencies. However, what counts as appropriate PPE in EDs is contentious and inconsistently implemented in practice.

METHODS

An online scenario-based video survey was distributed through purposive sampling, and completed by 270 ED and infection prevention and control clinicians in Australia. A descriptive content analysis was performed on the data, and differences between groups were tested using Fisher exact test.

RESULTS

Participants agreed that most items were required in both scenarios. Eye protection, mask use, and hand hygiene frequency were more contentious. Physicians were more likely than nurses, and ED clinicians more likely than infection prevention and control clinicians, to regard items or actions as optional rather than essential. Many ED clinicians, particularly physicians, regarded sequences as too time-consuming to be practical in a busy ED.

DISCUSSION

Our findings likely reflect differences in professional roles, competing priorities, and risks, and highlight important contextual characteristics of EDs, such as diagnostic uncertainty, equipment inaccessibility, and resource constraints.

CONCLUSIONS

To be feasible, practicable, and thereby effective, PPE guidance in the ED must be designed collaboratively with frontline ED staff, and reflects the complexities of their practice.

Healthcare Workers' Adherence and Attitudes Toward the Adherence to COVID-19 Precautionary Guidelines Post-Vaccination: A Cross-Sectional Pilot Study

BACKGROUND

Healthcare workers (HCWs) have shown increased adherence to infection control practices during the COVID-19 pandemic. However, there is a need to assess their adherence to and attitude toward COVID-19 guidelines after being vaccinated. The purpose of this pilot study is to assess the adherence to and attitudes toward the adherence to COVID-19 guidelines among HCWs who have been vaccinated.

METHODS

A retrospective cross-sectional design was employed. One hundred and eight participants were recruited via email from a medical center in the Midwest United States. The participants completed online surveys measuring the level of adherence to and attitudes toward the adherence to COVID-19 guidelines. The response rate was 5.4%.

FINDINGS

Most participants were female (73.1%) and white (82.4%). The participants adhered to COVID-19 guidelines 79.7% of the time. The most frequently followed guidelines were performing hand hygiene, wearing a respirator or well-fitting mask in areas where patients may be present, and wearing eye protection when entering the room for a patient with suspected or confirmed COVID-19 infection. The least performed precautions were performing COVID-19 testing after exposure to a suspected or confirmed COVID-19 case and maintaining social distancing. There was a significant decrease in the perceived importance of adherence to COVID-19 precautions post-vaccination (p <.001, 95% CI [-0.78, -0.35]).

CONCLUSIONS

The increased perception of safety after receiving COVID-19 vaccination may negatively influence HCWs' adherence to COVID-19 precautionary guidelines. Continuous education and monitoring of HCWs' safety practices are important to influence HCWs' attitudes to adhere to COVID-19 precautions, particularly after vaccination.

Effect of Face Masking on Transmission of SARS-CoV-2

The efficacy of face masking for the public is not convincing to prevent the transmission of respiratory tract viruses such as SARS-CoV-2 when the criteria of evidence-based medicine are applied. This finding is mainly explained by the results from randomized-controlled trials (RCTs) when a high prevalence of the infection and a high compliance in mask wearing was assured. Throughout these studies no significant protective effect was observed. Observational studies with surgical masks describe a significant protective effect, but are prone to confounders such as physical distance. Respirators do not provide an additional health benefit compared to surgical or medical masks (RCTs). Community masks can even increase the risk of infection (RCTs). Based on the categories of evidence-based medicine, the efficacy results can best be categorized as conflicting evidence. Many relevant adverse events are described when masks are worn for hours such as dyspnea (12.2-52.8%), headache (3.9-73.4%), pruritus (0.0-60.0%), and skin reactions (0.0-85.0%). Their frequency is often higher with respirators. In future pandemics, masks should only be recommended or mandated for settings in which a clinically relevant health benefit can be expected, defined as the prevention of severe, critical or fatal disease, that clearly outweighs the expectable associated adverse reactions.

Prevention and management of health products shortages by the French national agency (ANSM), 10 years of experience

Shortages of drugs and medical devices have tended to increase in France and worldwide, with consequences for patients and healthcare professionals. Preventing shortages of health products has become a priority for regulatory authorities, including the French National Agency for Medicines and Health Products Safety (ANSM). To highlight perspectives for a better prevention, we described and analyzed the management of shortages in the availability of health products in France over the last 10 years. The supply chain was mapped to identify the main causes of shortages and stakeholders involved in managing shortages throughout the supply chain. National and European initiatives and regulatory measures were reviewed. A retrospective nationwide data analysis from the French reporting system of health product shortage reports was conducted over 10 years for drugs (2013-2022) and over an 18-month period for medical devices, from 1st March 2022 to 31st August 2023. An increase in drug shortage reports was observed, rising from 404 in 2013 to 3,761 in 2022 for drugs, with a relatively constant distribution of affected therapeutic classes. In 2022, the main reported causes of drug shortage risk were insufficient production capacity (27.1%), increased sales volume (21.5%), or lack of supply (13.6%). Over half of the reports on medical devices (55.4%) were objectified as indispensable, and their causes were mainly due to a lack of supply (48.2%), discontinuation of marketing (14.9%), increased sales volume (13.2%), and regulatory reasons (9.6%). ANSM and French authorities have engaged a public health policy for prevention and management of health product shortages including financial penalties, minimum safety stocks for Major Therapeutic Interest drugs, and a shortage management plan. Based on 10 years of experience, four priority measures have been identified to anticipate the risk of heath products shortages based: the importance of a national coordination from raw materials to local market, the implementation of new prevention and management actions in the supply chain, strengthening European cooperation and regulation including the establishment of a list of critical drugs, and promoting transparency and information.

Comparison of adaptive thermal comfort with face masks in library building in Guangzhou, China

During the COVID-19 pandemic, wearing masks in public spaces has become a protective strategy. Field tests and questionnaire surveys were carried out at a university library in Guangzhou, China, during June 2021 and January 2022. The indoor environmental parameters were observed, thermal sensation votes of students on various environmental parameters were collected, symptoms of students wearing masks were quantified, and the appropriate amount of time to wear masks was established. To identify acceptable and comfortable temperature ranges, the relationship between thermal sensation and thermal index was investigated. During summer and winter, people wearing masks are symptomatic for a certain duration. The most frequently voted symptom was facial heat (62.7 % and 54.6 % during summer and winter, respectively), followed by dyspnea. During summer, more than 80 % of the participants subjects were uncomfortable and showed some symptoms after wearing masks for more than 2 h (3 h during winter). In the summer air conditioning environment in Guangzhou, the neutral T_op was 26.4 °C, and the comfortable T_op range was 25.1–27.7 °C. Under the natural ventilation environment in winter, the neutral T_op was 20.5 °C, and the comfortable T_op range was 18.5–22.5 °C. This study may provide guidance for indoor office work and learning to wear masks in Guangzhou.

Facial dermatoses induced by face masks: A systematic review and meta-analysis of observational studies

The use of masks for infection control was common in the COVID-19 pandemic. As numerous cross-sectional studies have suggested a link between the use of such masks and various facial dermatoses, a systematic review and meta-analysis of published studies was conducted to evaluate this association, as well as potential risk factors for the development of such facial dermatoses. Observational studies were searched for in MEDLINE, EMBASE and the Cochrane Central Register. Thirty-seven observational studies with a total of 29 557 study participants were identified. This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 checklist and quality was assessed via the Newcastle-Ottawa Quality Assessment Scale., Overall prevalence of facial dermatoses was 55%. Individually, acne, facial dermatitis, itch and pressure injuries were consistently reported as facial dermatoses, with a pooled prevalence of 31%, 24%, 30% and 31%, respectively. Duration of mask-wear was the most significant risk factor for the development of facial dermatoses (95% CI: 1.31-1.54, p < 0.001). Overall, facial dermatoses associated with mask wear are common, and consist of distinct entities. They are related to duration of use. Appropriate and tailored treatment is important to improve the outcomes for these affected patients.

Personal protective equipment-associated headaches in health care workers during COVID-19: A systematic review and meta-analysis

Introduction

Health Care Workers (HCWs) use Personal Protective Equipment (PPE) during the COVID-19 pandemic to protect themselves and prevent the transmission of the disease. The use of PPE, especially respiratory masks, has adverse consequences, including headaches, which have been secondary and unusual. The aim of the present systematic review and meta-analysis study was to investigate the prevalence of PPE-associated headaches in HCWs during COVID-19 pandemic.

Methods

The present review study was performed based on the PRISMA guideline. The protocol of the present study was registered in PROSPERO with the code CRD42022304437. Valid data resources such as Scopus, PubMed, Web of Science, Science Direct, Google Scholar, Embase were used to identify and extract relevant studies. The searches were conducted between the beginning of 2020 and the end of January 2022. A random effects model was used for meta-analysis and I ² index was used to investigate between-study heterogeneity. Data were analyzed using STATA ver. 14.

Results

A total of 539 articles were first identified through initial search and finally 26 final studies were selected to undergo the meta-analysis phase. According to the results of meta-analysis, the prevalence of headache after and before the use of PPE was 48.27% (95% CI: 40.20-56.34, I ² = 99.3%, p = 0 < 001) and 30.47% (95% CI: 20.47-40.47, I ² = 97.3%, p = 0 < 001), respectively.

Conclusion

The results of the present study showed that the prevalence of PPE-associated headache in HCWs was relatively high, so, the use of PPE during COVID-19 pandemic can be considered as one of the causes of headache. Therefore, management strategies such as regular screening of HCWs for headaches and regular rest periods without the use of PPE can be effective in reducing the prevalence of headaches.

The Seroprevalence of SARS-CoV-2 Antibodies among HealthCare Workers in University Hospital in Krakow before the Era of Vaccination

Background: Knowledge of occupational health is crucial to the safety of healthcare workers in the pandemic period. The aim of our study was the rating of SARS-CoV-2 seroprevalence in connection with selected demographic, social, and organizational factors, as well as the identification of key elements determining the safety of HCWs and patients of the University Hospital in Krakow. Methods: This was a non-interventional, uncontrolled, open, single-center, cross-sectional online survey on the preparedness for the COVID-19 epidemic and the seroprevalence of medical and non-medical HCWs and students. Serum specimens from 1221 persons were tested using an immunoassay analyzer based on the ECLIA technique for the anti-SARS-CoV-2 antibodies IgM + IgG. Results: The total seroprevalence was 42.7%. In medical students it was 25.2%, while in physicians it was 43.4% and in nurses/midwives it was 48.1%. Of those who tested positive, 21.5% did not know their serological status. The use of personal protective equipment did not have any significant impact on the result of testing for anti-SARS-CoV-2 antibodies. The risk of developing the disease was not influenced by sex, professional work experience, workplace, or intensity of contact with the patient. Among the studied elements, only care of COVID-19 patients significantly increased the risk. The protective factor was starting work between the waves of the epidemic (June–September 2020). Conclusions: PPE is only one element of infection prevention and control—without other components, such as hand hygiene, it can be dangerous and contribute to self-infection. It is also very important to test healthcare workers. Not being aware of the COVID-19 status of HCWs poses a threat to other staff members, as well as patients and the family and friends of the infected. Thus, extreme caution should be applied when employing respirators with exhalation valves during the COVID-19 pandemic.