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Berryhill BA, Burke KB, Smith AP, Morgan JS, Tarabay J, Mamora J, Varkey JB, Mumma JM, Kraft CS. A bacteriophage-based validation of a personal protective equipment doffing procedure to be used with high-consequence pathogens. Infect Control Hosp Epidemiol 2024:1-7. [PMID: 38706211 DOI: 10.1017/ice.2024.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To determine if the high-level personal protective equipment used in the treatment of high-consequence infectious diseases is effective at stopping the spread of pathogens to healthcare personnel (HCP) while doffing. BACKGROUND Personal protective equipment (PPE) is fundamental to the safety of HCPs. HCPs treating patients with high-consequence infectious diseases use several layers of PPE, forming complex protective ensembles. With high-containment PPE, step-by-step procedures are often used for donning and doffing to minimize contamination risk to the HCP, but these procedures are rarely empirically validated and instead rely on following infection prevention best practices. METHODS A doffing protocol video for a high-containment PPE ensemble was evaluated to determine potential contamination pathways. These potential pathways were tested using fluorescence and genetically marked bacteriophages. RESULTS The experiments revealed existing protocols permit contamination pathways allowing for transmission of bacteriophages to HCPs. Updates to the doffing protocols were generated based on the discovered contamination pathways. This updated doffing protocol eliminated the movement of viable bacteriophages from the outside of the PPE to the skin of the HCP. CONCLUSIONS Our results illustrate the need for quantitative, scientific investigations of infection prevention practices, such as doffing PPE.
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Affiliation(s)
- Brandon A Berryhill
- Department of Biology, Emory University, Atlanta, GA, USA
- Program in Microbiology and Molecular Genetics (MMG), Graduate Division of Biological and Biomedical Sciences (GDBBS), Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Kylie B Burke
- Department of Biology, Emory University, Atlanta, GA, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew P Smith
- Department of Biology, Emory University, Atlanta, GA, USA
| | | | | | | | - Jay B Varkey
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emory Healthcare, Atlanta, GA, USA
| | - Joel M Mumma
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Colleen S Kraft
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emory Healthcare, Atlanta, GA, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Haq ZU, Sher ZF, Khattak FA, Zala, Hakim M, Ullah N, Rahim A, Hussain U, Afaq S. Healthcare workers safety in the COVID-19 era: the impact of pre-pandemic personal protective equipment (PPE) training in Pakistan. BMC Health Serv Res 2023; 23:1256. [PMID: 37968673 PMCID: PMC10647151 DOI: 10.1186/s12913-023-10048-y] [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: 07/10/2023] [Accepted: 09/20/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has revealed vulnerabilities in healthcare systems worldwide, emphasizing the importance of healthcare worker safety through adequate utilization of personal protective equipment (PPE). This study aims to assess the impact of pre-pandemic PPE training on the practices and other associated factors among frontline healthcare workers during the COVID-19 pandemic in Pakistan and provide insights into the implications of such training programs for future initiatives. METHODS A cross-sectional study from May 9th to June 5th, 2020 was conducted among the frontline healthcare workers against COVID-19 in Pakistan, utilizing an online structured questionnaire shared via WhatsApp and Facebook by using purposive sampling. Statistical analyses, including chi-square tests for proportion and logistic regression for the association while multi-logistic regression for potential confounders, were performed using SPSS version 22. RESULTS A total of 453 healthcare staff participated, with 68.9% (n = 312) reporting no prior PPE training and 31.1% (n = 141) having received training. Significant associations were found between prior training and healthcare group distribution (p = 0.006), with doctors exhibiting the highest proportion of training 82 (37.61%), followed by nurses 50 (27.32%) and paramedics 9 (17.31%). Those who didn't receive any prior training in PPEs showed a higher perceived professional risk of 216 (69.23%) compared to those who received prior PPE training 96 (30.77%, p-value 0.005). Similarly, a higher frequency 137 (63.72%) of Perceived Personal risk was observed in those who didn't receive training, labeled as "high risk" compared to those who were trained 78 (36.28%, P value 0.02). Multi-logistic regression analysis identified paramedics as 0.26 times less likely to have received prior PPE training (Adjusted OR 0.26, 95% CI 0.10-0.65, p = 0.01) compared to medical doctors. Healthcare workers in tertiary care hospitals were 0.46 times less likely to undergo PPE training (Adjusted OR 0.46, 95% CI 0.25-0.87,p = 0.01) compared to those working at COVID-19 facilities/hospitals/quarantine centers. Likewise, individuals who doffed disposable gowns [Adjusted OR 3.86, (95% CI, 1.23-12.08, p = 0.02] were 3.86 times more interested in getting prior training in PPE compared to those who don't have skills to wear them. CONCLUSION Our findings highlight that healthcare levels, type of healthcare, and doffing skills are important predictors of whether healthcare workers have taken prior training in PPE. These findings imply developing effective training programs for healthcare workers to ensure safety while providing care during pandemics like COVID-19.
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Affiliation(s)
- Zia Ul Haq
- Khyber Medical University, Peshawar, Pakistan
| | | | | | - Zala
- Khyber Medical University, Peshawar, Pakistan
| | | | | | | | | | - Saima Afaq
- Khyber Medical University, Peshawar, Pakistan.
- Deptt of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, W2 1PG, UK.
- Department of Health Sciences, University of York, York, UK.
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Loibner M, Barach P, Wolfgruber S, Langner C, Stangl V, Rieger J, Föderl-Höbenreich E, Hardt M, Kicker E, Groiss S, Zacharias M, Wurm P, Gorkiewicz G, Regitnig P, Zatloukal K. Resilience and Protection of Health Care and Research Laboratory Workers During the SARS-CoV-2 Pandemic: Analysis and Case Study From an Austrian High Security Laboratory. Front Psychol 2022; 13:901244. [PMID: 35936273 PMCID: PMC9353000 DOI: 10.3389/fpsyg.2022.901244] [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: 03/22/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022] Open
Abstract
The SARS-CoV-2 pandemic has highlighted the interdependency of healthcare systems and research organizations on manufacturers and suppliers of personnel protective equipment (PPE) and the need for well-trained personnel who can react quickly to changing working conditions. Reports on challenges faced by research laboratory workers (RLWs) are rare in contrast to the lived experience of hospital health care workers. We report on experiences gained by RLWs (e.g., molecular scientists, pathologists, autopsy assistants) who significantly contributed to combating the pandemic under particularly challenging conditions due to increased workload, sickness and interrupted PPE supply chains. RLWs perform a broad spectrum of work with SARS-CoV-2 such as autopsies, establishment of virus cultures and infection models, development and verification of diagnostics, performance of virus inactivation assays to investigate various antiviral agents including vaccines and evaluation of decontamination technologies in high containment biological laboratories (HCBL). Performance of autopsies and laboratory work increased substantially during the pandemic and thus led to highly demanding working conditions with working shifts of more than eight hours working in PPE that stressed individual limits and also the ergonomic and safety limits of PPE. We provide detailed insights into the challenges of the stressful daily laboratory routine since the pandemic began, lessons learned, and suggest solutions for better safety based on a case study of a newly established HCBL (i.e., BSL-3 laboratory) designed for autopsies and research laboratory work. Reduced personal risk, increased resilience, and stress resistance can be achieved by improved PPE components, better training, redundant safety measures, inculcating a culture of safety, and excellent teamwork.
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Affiliation(s)
- Martina Loibner
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Paul Barach
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, United States
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Stella Wolfgruber
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Christine Langner
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Verena Stangl
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Julia Rieger
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | | | - Melina Hardt
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Eva Kicker
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Silvia Groiss
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Martin Zacharias
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Philipp Wurm
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Gregor Gorkiewicz
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Peter Regitnig
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Kurt Zatloukal
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
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4
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Bahl P, Doolan C, de Silva C, Chughtai AA, Bourouiba L, MacIntyre CR. Airborne or Droplet Precautions for Health Workers Treating Coronavirus Disease 2019? J Infect Dis 2022. [PMID: 32301491 DOI: 10.1093/infdis/jiaa189/5820886] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
Cases of coronavirus disease 2019 (COVID-19) have been reported in more than 200 countries. Thousands of health workers have been infected, and outbreaks have occurred in hospitals, aged care facilities, and prisons. The World Health Organization (WHO) has issued guidelines for contact and droplet precautions for healthcare workers caring for suspected COVID-19 patients, whereas the US Centers for Disease Control and Prevention (CDC) has initially recommended airborne precautions. The 1- to 2-meter (≈3-6 feet) rule of spatial separation is central to droplet precautions and assumes that large droplets do not travel further than 2 meters (≈6 feet). We aimed to review the evidence for horizontal distance traveled by droplets and the guidelines issued by the WHO, CDC, and European Centre for Disease Prevention and Control on respiratory protection for COVID-19. We found that the evidence base for current guidelines is sparse, and the available data do not support the 1- to 2-meter (≈3-6 feet) rule of spatial separation. Of 10 studies on horizontal droplet distance, 8 showed droplets travel more than 2 meters (≈6 feet), in some cases up to 8 meters (≈26 feet). Several studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) support aerosol transmission, and 1 study documented virus at a distance of 4 meters (≈13 feet) from the patient. Moreover, evidence suggests that infections cannot neatly be separated into the dichotomy of droplet versus airborne transmission routes. Available studies also show that SARS-CoV-2 can be detected in the air, and remain viable 3 hours after aerosolization. The weight of combined evidence supports airborne precautions for the occupational health and safety of health workers treating patients with COVID-19.
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Affiliation(s)
- Prateek Bahl
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, New South Wales, Australia
| | - Con Doolan
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, New South Wales, Australia
| | - Charitha de Silva
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, New South Wales, Australia
| | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, UNSW Sydney, New South Wales, Australia
| | - Lydia Bourouiba
- The Fluid Dynamics of Disease Transmission Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - C Raina MacIntyre
- The Kirby Institute, UNSW Sydney, New South Wales, Australia
- College of Public Service & Community Solutions, and College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
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5
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Park CE. Diagnostic Methods of Respiratory Virus Infections and Infection Control. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2021. [DOI: 10.15324/kjcls.2021.53.1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Chang-Eun Park
- Department of Biomedical Laboratory Science, Molecular Diagnostics Research Institute, Namseoul University, Cheonan, Korea
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6
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The Isolation Communication Management System. A Telemedicine Platform to Care for Patients in a Biocontainment Unit. Ann Am Thorac Soc 2021; 17:673-678. [PMID: 32357069 PMCID: PMC7258411 DOI: 10.1513/annalsats.202003-261ip] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Shaibu S, Kimani RW, Shumba C, Maina R, Ndirangu E, Kambo I. Duty versus distributive justice during the COVID-19 pandemic. Nurs Ethics 2021; 28:1073-1080. [PMID: 33719734 DOI: 10.1177/0969733021996038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The COVID-19 pandemic exposed vulnerabilities in inadequately prioritized healthcare systems in low- and middle-income countries such as Kenya. In this prolonged pandemic, nurses and midwives working at the frontline face multiple ethical problems, including their obligation to care for their patients and the risk for infection with severe acute respiratory syndrome coronavirus 2. Despite the frequency of emergencies in Africa, there is a paucity of literature on ethical issues during epidemics. Furthermore, nursing regulatory bodies in African countries such as Kenya have primarily adopted a Western code of ethics that may not reflect the realities of the healthcare systems and cultural context in which nurses and midwives care for patients. In this article, we discuss the tension between nurses' and midwives' duty of care and resource allocation in the context of the COVID-19 pandemic. There is an urgent need to clarify nurses' and midwives' rights and responsibilities, especially in the current political setting, limited resources, and ambiguous professional codes of ethics that guide their practice.
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Baveja S, Karnik N, Natraj G, Natkar M, Bakshi A, Krishnan A. Rapid volunteer-based SARS-Cov-2 antibody screening among health care workers of a hospital in Mumbai, India. INDIAN JOURNAL OF MEDICAL SCIENCES 2020. [PMCID: PMC8219003 DOI: 10.25259/ijms_234_2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objectives: COVID-19 is highly contagious, and health care workers are at high risk of being infected. We carried out a rapid survey to estimate the proportion of HCWs who are serologically positive for SARS-CoV-2 in the Lokmanya Tilak Municipal General Hospital, Mumbai, India. Material and Methods: After the consent of the hospital authorities, volunteers were asked to report at a special booth set up in the hospital between May 1, 2020, and May 16, 2020. After consent, each worker was administered a questionnaire using a handheld computer which had questions on symptoms in the past 30 days, place of posting (COVID designated area or other), work category (doctor/nurse/others), use of personal protective equipment, smoking, comorbidity, and exposure followed by a test for COVID-19 using the STANDARD Q COVID-19 IgM/ IgG Duo Test of SD Biosensor. We estimated weighted seroprevalence with 95% confidence limits after adjusting for the work category. We calculated the adjusted odds ratio (aOR) using logistic regression with seropositivity as an outcome variable and others as independent variables. Results: The final sample included 501 and 1051 subjects working in the COVID area and non-COVID area, respectively, covering 35% of the total staff of the hospital. Overall, 6.9% (95% CI of 5.7–8.2) of the hospital staff was serologically positive for SARS-Cov-2, similar in the COVID area –5.7 (3.8–8.1) and non-COVID area –7.2 (5.7–9.0). Age more than 50 years (aOR 2.65; 1.45–4.85) and being in others work category 2.84 (1.34–6.02) were identified as significant predictors of being seropositive. Only 10% of the subjects reported COVID-like illness in the past 1 month. Conclusion: The overall modest prevalence of infection among the health care workers, especially non-doctors and nurses, and similarity of prevalence in COVID and non-COVID area staff indicate the possibility of non-hospital source of infection.
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Affiliation(s)
- Sujata Baveja
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and Government Hospital, Mumbai COVID Health Worker Study Group, Mumbai, Maharashtra, India,
| | - Nitin Karnik
- Department of Medicine, Lokmanya Tilak Municipal Medical College and Government Hospital, Mumbai COVID Health Worker Study Group, Mumbai, Maharashtra, India,
| | - Gita Natraj
- Department of Microbiology, Mumbai, Maharashtra, India,
| | - Milind Natkar
- Medicine KEM Hospital and Seth GS Medical College, Mumbai, Maharashtra, India,
| | - Asha Bakshi
- Department of Neurosurgery, Moolchand Hospital, New Delhi, India,
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India,
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9
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Xia W, Fu L, Liao H, Yang C, Guo H, Bian Z. The Physical and Psychological Effects of Personal Protective Equipment on Health Care Workers in Wuhan, China: A Cross-Sectional Survey Study. J Emerg Nurs 2020; 46:791-801.e7. [PMID: 32994038 PMCID: PMC7522005 DOI: 10.1016/j.jen.2020.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The purpose of this study was to rapidly quantify the safety measures regarding donning and doffing personal protective equipment, complaints of discomfort caused by wearing personal protective equipment, and the psychological perceptions of health care workers in hospitals in Wuhan, China, responding to the outbreak. METHODS A cross-sectional online questionnaire design was used Data were collected from March 14, 2020, to March 16, 2020, in Wuhan, China. Descriptive statistics and χ2 analyses testing were used. RESULTS Standard nosocomial infection training could significantly decrease the occurrence of infection (3.6% vs 13.0%, χ2 = 4.47, P < 0.05). Discomfort can be classified into 7 categories. Female sex (66.0% vs 50.5%, χ2 = 6.37), occupation (62.7% vs 30.8%, χ2 = 5.33), working at designated hospitals (44.8% vs 26.7%, χ2 = 5.17) or in intensive care units (70.4% vs 57.9%, χ2 = 3.88), and working in personal protective equipment for > 4 hours (62.2% vs 39.2%, χ2 = 9.17) led to more complaints about physical discomfort or increased occurrence of pressure sores (all P < 0.05). Psychologically, health care workers at designated hospitals (60.0% vs 42.1%, χ2 = 4.97) or intensive care units (55.9% vs 41.5%, χ2 = 4.40) (all P < 0.05) expressed different rates of pride. DISCUSSION Active training on infection and protective equipment could reduce the infection risk. Working for long hours increased the occurrence of discomfort and skin erosion. Reducing the working hours and having adequate protective products and proper psychological interventions may be beneficial to relieve discomfort.
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Wundavalli L, Singh S, Singh AR, Satpathy S. How to rapidly design and operationalise PPE donning and doffing areas for a COVID-19 care facility: quality improvement initiative. BMJ Open Qual 2020; 9:bmjoq-2020-001022. [PMID: 32978176 PMCID: PMC7520810 DOI: 10.1136/bmjoq-2020-001022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/27/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction Effective implementation of standard precautions specific to COVID-19 is a challenge for hospitals within the existing constraints of time and resources. Aim To rapidly design and operationalise personal protective equipment (PPE) donning and doffing areas required for a COVID-19 care facility. Methods Literature review was done to identify all issues pertaining to donning and doffing in terms of Donabedian’s structure, process and outcome. Training on donning and doffing was given to hospital staff. Donning and doffing mock drills were held. 5S was used as a tool to set up donning and doffing areas. Instances of donning and doffing were observed for protocol deviations and errors. Plan–do–study–act cycles were conducted every alternate day for 4 weeks. The initiative was reported using Standards for QUality Improvement Reporting Excellence (SQUIRE) guidelines. Results Best practices in donning and doffing were described. Our study recommends a minimum area of 16 m2 each for donning and doffing rooms. Verbally assisted doffing was found most useful than visual prompts. Discussion Challenges included sustaining the structure and process of donning and doffing, varied supplies of PPE which altered sequencing of donning and/or doffing, and training non-healthcare workers such as plumbers, electricians and drivers who were required during emergencies in the facility. Conclusion Our study used evidence-based literature and quality improvement (QI) tools to design and operationalise donning and doffing areas with focus on people, task and environment. Our QI will enable healthcare facilities to rapidly prototype donning and doffing areas in a systematic way.
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Affiliation(s)
- LaxmiTej Wundavalli
- Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Sheetal Singh
- Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Angel Rajan Singh
- Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Sidhartha Satpathy
- Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
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11
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Jackson D, Anders R, Padula WV, Daly J, Davidson PM. Vulnerability of nurse and physicians with COVID-19: Monitoring and surveillance needed. J Clin Nurs 2020; 29:3584-3587. [PMID: 32428345 PMCID: PMC7276813 DOI: 10.1111/jocn.15347] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Debra Jackson
- School of Nursing, University of Technology Sydney, Sydney, NSW, Australia
| | | | - William V Padula
- Leonard D. Schaeffer Center for Health Policy & Economics & School of Pharmacy University of Southern California, Los Angeles, CA, USA
| | - John Daly
- Western Sydney University and University of Technology Sydney, Sydney, NSW, Australia
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12
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A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. Int J Nurs Stud 2020; 108:103629. [PMID: 32512240 PMCID: PMC7191274 DOI: 10.1016/j.ijnurstu.2020.103629] [Citation(s) in RCA: 175] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 12/15/2022]
Abstract
Background The pandemic of COVID-19 is growing, and a shortage of masks and respirators has been reported globally. Policies of health organizations for healthcare workers are inconsistent, with a change in policy in the US for universal face mask use. The aim of this study was to review the evidence around the efficacy of masks and respirators for healthcare workers, sick patients and the general public. Methods A systematic review of randomized controlled clinical trials on use of respiratory protection by healthcare workers, sick patients and community members was conducted. Articles were searched on Medline and Embase using key search terms. Results A total of 19 randomised controlled trials were included in this study – 8 in community settings, 6 in healthcare settings and 5 as source control. Most of these randomised controlled trials used different interventions and outcome measures. In the community, masks appeared to be effective with and without hand hygiene, and both together are more protective. Randomised controlled trials in health care workers showed that respirators, if worn continually during a shift, were effective but not if worn intermittently. Medical masks were not effective, and cloth masks even less effective. When used by sick patients randomised controlled trials suggested protection of well contacts. Conclusion The study suggests that community mask use by well people could be beneficial, particularly for COVID-19, where transmission may be pre-symptomatic. The studies of masks as source control also suggest a benefit, and may be important during the COVID-19 pandemic in universal community face mask use as well as in health care settings. Trials in healthcare workers support the use of respirators continuously during a shift. This may prevent health worker infections and deaths from COVID-19, as aerosolisation in the hospital setting has been documented.
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13
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Bahl P, Doolan C, de Silva C, Chughtai AA, Bourouiba L, MacIntyre CR. Airborne or droplet precautions for health workers treating COVID-19? J Infect Dis 2020; 225:1561-1568. [PMID: 32301491 PMCID: PMC7184471 DOI: 10.1093/infdis/jiaa189] [Citation(s) in RCA: 282] [Impact Index Per Article: 70.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Indexed: 01/09/2023] Open
Abstract
Cases of coronavirus disease 2019 (COVID-19) have been reported in more than 200 countries. Thousands of health workers have been infected, and outbreaks have occurred in hospitals, aged care facilities, and prisons. The World Health Organization (WHO) has issued guidelines for contact and droplet precautions for healthcare workers caring for suspected COVID-19 patients, whereas the US Centers for Disease Control and Prevention (CDC) has initially recommended airborne precautions. The 1- to 2-meter (≈3–6 feet) rule of spatial separation is central to droplet precautions and assumes that large droplets do not travel further than 2 meters (≈6 feet). We aimed to review the evidence for horizontal distance traveled by droplets and the guidelines issued by the WHO, CDC, and European Centre for Disease Prevention and Control on respiratory protection for COVID-19. We found that the evidence base for current guidelines is sparse, and the available data do not support the 1- to 2-meter (≈3–6 feet) rule of spatial separation. Of 10 studies on horizontal droplet distance, 8 showed droplets travel more than 2 meters (≈6 feet), in some cases up to 8 meters (≈26 feet). Several studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) support aerosol transmission, and 1 study documented virus at a distance of 4 meters (≈13 feet) from the patient. Moreover, evidence suggests that infections cannot neatly be separated into the dichotomy of droplet versus airborne transmission routes. Available studies also show that SARS-CoV-2 can be detected in the air, and remain viable 3 hours after aerosolization. The weight of combined evidence supports airborne precautions for the occupational health and safety of health workers treating patients with COVID-19.
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Affiliation(s)
- Prateek Bahl
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, NSW, Australia
| | - Con Doolan
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, NSW, Australia
| | - Charitha de Silva
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, NSW, Australia
| | | | - Lydia Bourouiba
- The Fluid Dynamics of Disease Transmission Laboratory, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - C Raina MacIntyre
- The Kirby Institute, UNSW Sydney, NSW, Australia.,College of Public Service & Community Solutions, and College of Health Solutions, Arizona State University, Phoenix, AZ, United States
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Lam SK, Kwong EW, Hung MS, Chien WT. Investigating the Strategies Adopted by Emergency Nurses to Address Uncertainty and Change in the Event of Emerging Infectious Diseases: A Grounded Theory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072490. [PMID: 32268470 PMCID: PMC7177466 DOI: 10.3390/ijerph17072490] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/31/2020] [Accepted: 04/04/2020] [Indexed: 11/16/2022]
Abstract
Emergency nurses frequently encounter uncertainty and changes during the management of emerging infectious diseases, which challenge their capability to perform their duties in a well-planned and systematic manner. To date, little is known about the coping strategies adopted by emergency nurses in addressing uncertainty and changes during an epidemic event. The present study explored emergency nurses’ behaviours and strategies in handling uncertainty and practice changes during an epidemic event. A qualitative study based on the Straussian grounded theory approach was established. Semi-structured, face-to-face, individual interviews were conducted with 26 emergency nurses for data collection. Adapting protocol to the evolving context of practice was revealed as the core category. Four interplaying subcategories were identified: (1) Completing a comprehensive assessment, (2) continuing education for emerging infectious disease management, (3) incorporating guideline updates and (4) navigating new duties and competencies. The nurses demonstrated the prudence to orientate themselves to an ambiguous work situation and displayed the ability to adapt and embrace changes in their practice and duties. These findings offer insights into the need for education and training schemes that allow emergency nurses to acquire and develop the necessary decision-making and problem-solving skills to handle a public health emergency.
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Affiliation(s)
- Stanley K.K. Lam
- School of Nursing, Tung Wah College, Kowloon HKG, Hong Kong;
- Correspondence:
| | - Enid W.Y. Kwong
- School of Nursing, The Hong Kong Polytechnic University, Kowloon HKG, Hong Kong;
| | - Maria S.Y. Hung
- School of Nursing, Tung Wah College, Kowloon HKG, Hong Kong;
| | - Wai-tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories HKG, Hong Kong;
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15
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Chughtai AA, Seale H, Islam MS, Owais M, Macintyre CR. Policies on the use of respiratory protection for hospital health workers to protect from coronavirus disease (COVID-19). Int J Nurs Stud 2020; 105:103567. [PMID: 32203757 PMCID: PMC7174826 DOI: 10.1016/j.ijnurstu.2020.103567] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Abrar A Chughtai
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Samuels Building, Kensington 2052, NSW, Australia.
| | - Holly Seale
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Samuels Building, Kensington 2052, NSW, Australia
| | - Md Saiful Islam
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Samuels Building, Kensington 2052, NSW, Australia
| | - Mohammad Owais
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Samuels Building, Kensington 2052, NSW, Australia
| | - C Raina Macintyre
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, Kensington 2052, NSW, Australia AND College of Public Service & Community Solutions, Arizona State University, Phoenix, AZ, USAArizona State University, Tempe, AZ, United States
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16
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Brown CK, Mitchell AH. Realigning the conventional routes of transmission: an improved model for occupational exposure assessment and infection prevention. J Hosp Infect 2020; 105:17-23. [PMID: 32173459 DOI: 10.1016/j.jhin.2020.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/06/2020] [Indexed: 12/14/2022]
Abstract
Current recommendations for standard and transmission-based precautions in place for patients who are suspected or known to be infected or colonized with infectious agents are best suited to prevent the transfer of micro-organisms to other patients - that is, to prevent the acquisition of a healthcare-associated infection, rather than to protect the healthcare worker from self-contamination resulting in a potential occupationally acquired infection. This article reviews current recommended infection prevention and control practices and offers a framework for better protection and controls from an occupational health point of view. We offer a model with two exposure routes - contact and aerosol - resulting from work activities and environments, shifting the focus away from particular pathogenic micro-organisms' typical methods for spreading to patients or to other non-workers in hospital and community settings.
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Affiliation(s)
- C K Brown
- Biodefense Program, Schar School of Policy and Government, George Mason University, Arlington, VA, USA; Directorate of Technical Support and Emergency Management, Occupational Safety and Health Administration, US Department of Labor, Washington, DC, USA.
| | - A H Mitchell
- International Safety Center, League City, TX, USA; Department of Environmental and Occupational Medicine, School of Medicine, University of Maryland, Baltimore, MD, USA
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17
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Chughtai AA, Khan W. Use of personal protective equipment to protect against respiratory infections in Pakistan: A systematic review. J Infect Public Health 2020; 13:385-390. [PMID: 32146139 PMCID: PMC7102706 DOI: 10.1016/j.jiph.2020.02.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/07/2018] [Accepted: 01/21/2019] [Indexed: 11/26/2022] Open
Abstract
Like other low-income countries, limited data are available on the use of personal protective equipment (PPE) in Pakistan. We conducted a systematic review of studies on PPE use for respiratory infections in healthcare settings in Pakistan. MEDLINE, Embase and Goggle Scholar were searched for clinical, epidemiological and laboratory-based studies in English, and 13 studies were included; all were observational/cross-sectional studies. The studies examined PPE use in hospital (n=7), dental (n=4) or laboratory (n=2) settings. Policies and practices on PPE use were inconsistent. Face masks and gloves were the most commonly used PPE to protect from respiratory and other infections. PPE was not available in many facilities and its use was limited to high-risk situations. Compliance with PPE use was low among healthcare workers, and reuse of PPE was reported. Clear policies on the use of PPE and available PPE are needed to avoid inappropriate practices that could result in the spread of infection. Large, multimethod studies are recommended on PPE use to inform national infection-control guidelines.
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Affiliation(s)
- Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
| | - Wasiq Khan
- University of Bath, Bath, United Kingdom
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18
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Bleasdale SC, Sikka MK, Moritz DC, Fritzen-Pedicini C, Stiehl E, Brosseau LM, Jones RM. Experience of Chicagoland acute care hospitals in preparing for Ebola virus disease, 2014-2015. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2019; 16:582-591. [PMID: 31283428 PMCID: PMC7157968 DOI: 10.1080/15459624.2019.1628966] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
During the 2014-2015 Ebola Virus Disease (EVD) outbreak, hospitals in the United States selected personal protective equipment (PPE) and trained healthcare personnel (HCP) in anticipation of receiving EVD patients. To improve future preparations for high-consequence infectious diseases, it was important to understand factors that affected PPE selection and training in the context of the EVD outbreak. Semistructured interviews were conducted with HCP involved with decision-making during EVD preparations at acute care hospitals in the Chicago, IL area to gather information about the PPE selection and training process. HCP who received training were surveyed about elements of training and their perceived impact and overall experience by email invitation. A total of 28 HCP from 15 hospitals were interviewed, and 55 HCP completed the survey. Factors affecting PPE selection included: changing guidance, vendor supply, performance evaluations, and perceived risk and comfort for HCP. Cost did not affect selection. PPE acquisition challenges were mitigated by: sharing within hospital networks, reusing PPE during training, and improvising with existing PPE stock. Selected PPE ensembles were similar across sites. Training included hands-on activities with trained observers, instructional videos, and simulations/drills, which were felt to increase HCP confidence. Many felt refresher training would be helpful. Hands-on training was perceived to be effective, but there is a need to establish the appropriate frequency of refresher training frequency to maintain competence. Lacking confidence in the CDC guidance, interviewed trainers described turning to other sources of information and developing independent PPE evaluation and selection. Response to emerging and/or high consequence infectious diseases would be enhanced by transparent, risk-based guidance for PPE selection and training that addresses protection level, ease of use, ensembles, and availability.
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Affiliation(s)
- Susan C. Bleasdale
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Monica K. Sikka
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Donna C. Moritz
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | | | - Emily Stiehl
- School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Lisa M. Brosseau
- School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Rachael M. Jones
- School of Public Health, University of Illinois at Chicago, Chicago, Illinois
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A Cross-Sectional Study on China's Public Health Emergency Personnel's Field Coping-Capacity: Need, Influencing Factors, and Improvement Options. Disaster Med Public Health Prep 2019; 14:192-200. [PMID: 31327330 DOI: 10.1017/dmp.2019.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to identify the important capacities that were most urgently needed during emergency response and factors associated with the Centers for Disease Control and Prevention (CDC) professionals' field coping-capacity for public health emergency. METHODS Professional workers (N = 1854) from 40 CDC institutions were chosen using the stratified cluster random sampling method in all 13 municipalities of Heilongjiang Province, China. Descriptive analysis and multivariate logistic regression were used. RESULTS Of 10 key capacities, the 3 that were most urgently needed during emergency response fieldwork as identified by respondents were crisis communication capacity, personal protection capacity, and laboratory detection capacity. Overall, 38.1% of respondents self-rated as "poor" on their coping-capacity. The logistic regression found that proficiency in emergency preparedness planning, more practical experiences in emergency response, effectiveness in training and drills, a higher education level, and a higher professional position were significantly associated with the individual's field coping-capacity. CONCLUSION This study identified CDC professionals' most urgent capacity need and the obstructive factors and highlighted the importance of enhancing the capacity in crisis communication, personal protection, and laboratory detection. Intervention should be targeted at sufficient fund, formalized, and effective emergency training and drills, more operational technical guidance, and all-around supervision and evaluation.
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20
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Chughtai AA, Khan W. Use of personal protective equipment to protect against respiratory infections in Pakistan: A systematic review. J Infect Public Health 2019; 12:522-527. [PMID: 30738757 PMCID: PMC7102795 DOI: 10.1016/j.jiph.2019.01.064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/07/2018] [Accepted: 01/21/2019] [Indexed: 11/18/2022] Open
Abstract
Like other low-income countries, limited data are available on the use of personal protective equipment (PPE) in Pakistan. We conducted a systematic review of studies on PPE use for respiratory infections in healthcare settings in Pakistan. MEDLINE, Embase and Goggle Scholar were searched for clinical, epidemiological and laboratory-based studies in English, and 13 studies were included; all were observational/cross-sectional studies. The studies examined PPE use in hospital (n=7), dental (n=4) or laboratory (n=2) settings. Policies and practices on PPE use were inconsistent. Face masks and gloves were the most commonly used PPE to protect from respiratory and other infections. PPE was not available in many facilities and its use was limited to high-risk situations. Compliance with PPE use was low among healthcare workers, and reuse of PPE was reported. Clear policies on the use of PPE and available PPE are needed to avoid inappropriate practices that could result in the spread of infection. Large, multimethod studies are recommended on PPE use to inform national infection-control guidelines.
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Affiliation(s)
- Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
| | - Wasiq Khan
- University of Bath, Bath, United Kingdom
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21
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Health system capacity in Sydney, Australia in the event of a biological attack with smallpox. PLoS One 2019; 14:e0217704. [PMID: 31199825 PMCID: PMC6568391 DOI: 10.1371/journal.pone.0217704] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/16/2019] [Indexed: 11/19/2022] Open
Abstract
Planning for a re-emergent epidemic of smallpox requires surge capacity of space, resources and personnel within health systems. There are many uncertainties in such a scenario, including likelihood and size of an attack, speed of response and health system capacity. We used a model for smallpox transmission to determine requirements for hospital beds, contact tracing and health workers (HCWs) in Sydney, Australia, during a modelled epidemic of smallpox. Sensitivity analysis was done on attack size, speed of response and proportion of case isolation and contact tracing. We estimated 100638 clinical HCWs and 14595 public hospital beds in Sydney. Rapid response, case isolation and contact tracing are influential on epidemic size, with case isolation more influential than contact tracing. With 95% of cases isolated, outbreak control can be achieved within 100 days even with only 50% of contacts traced. However, if case isolation and contact tracing both fall to 50%, epidemic control is lost. With a smaller initial attack and a response commencing 20 days after the attack, health system impacts are modest. The requirement for hospital beds will vary from up to 4% to 100% of all available beds in best and worst case scenarios. If the response is delayed, or if the attack infects 10000 people, all available beds will be exceeded within 40 days, with corresponding surge requirements for clinical health care workers (HCWs). We estimated there are 330 public health workers in Sydney with up to 940,350 contacts to be traced. At least 3 million respirators will be needed for the first 100 days. To ensure adequate health system capacity, rapid response, high rates of case isolation, excellent contact tracing and vaccination, and protection of HCWs should be a priority. Surge capacity must be planned. Failures in any of these could cause health system failure, with inadequate beds, quarantine spaces, personnel, PPE and inability to manage other acute health conditions.
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22
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Popescu S, Leach R. Identifying Gaps in Frontline Healthcare Facility High-Consequence Infectious Disease Preparedness. Health Secur 2019; 17:117-123. [DOI: 10.1089/hs.2018.0098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Saskia Popescu
- Saskia Popescu, MPH, MA, is an Infection Preventionist and Research Assistant, George Mason University, Fairfax, Virginia. Rebecca Leach, MPH, RN, is an Infection Preventionist, Phoenix, Arizona
| | - Rebecca Leach
- Saskia Popescu, MPH, MA, is an Infection Preventionist and Research Assistant, George Mason University, Fairfax, Virginia. Rebecca Leach, MPH, RN, is an Infection Preventionist, Phoenix, Arizona
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23
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Chughtai AA, Chen X, Macintyre CR. Risk of self-contamination during doffing of personal protective equipment. Am J Infect Control 2018; 46:1329-1334. [PMID: 30029796 DOI: 10.1016/j.ajic.2018.06.003] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/02/2018] [Accepted: 06/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim of this study was to describe the risk of self-contamination associated with doffing of personal protective equipment (PPE) and to compare self-contamination with various PPE protocols. METHODS We tested 10 different PPE donning and doffing protocols, recommended by various health organizations for Ebola. Ten participants were recruited for this study and randomly assigned to use 3 different PPE protocols. After donning of PPE, fluorescent lotion and spray were applied on the external surface of the PPE to simulate contamination, and ultraviolet light was used to count fluorescent patches on the skin. RESULTS After testing 30 PPE sequences, large fluorescent patches were recorded after using "WHO coverall and 95" and "North Carolina coverall and N95" sequences, and small patches were recorded after using "CDC coverall and N95" and "Health Canada gown and N95" sequences. Commonly reported problems with PPE use were breathing difficulty, suffocation, heat stress, and fogging-up glasses. Most participants rated PPE high (18/30) or medium (11/30) for ease of donning/doffing and comfort. PPE sequences with powered air-purifying respirators (PAPRs) and assisted doffing were generally associated with fewer problems and were rated the highest. CONCLUSION This study confirmed the risk of self-contamination associated with the doffing of PPE. PAPR-containing protocols and assisted doffing should be preferred whenever possible during the outbreak of highly infectious pathogens.
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Bambi S. Evolution of Intensive Care Unit Nursing. NURSING IN CRITICAL CARE SETTING 2018. [PMCID: PMC7123277 DOI: 10.1007/978-3-319-50559-6_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The specialties of critical care medicine and critical care nursing arose to provide special treatment and care to the most severely ill hospital patients. However, critical care medicine does not seem to have made any major therapeutic progress in the past 30 years. The reduction of mortality in intensive care units (ICUs) is due essentially to improvements in both supportive care and the relevant technologies. In future, increases in the number of ICU beds relative to bed numbers in other hospital wards will probably be contemplated, even in a scenario of decreasing costs; clinical protocols will be computerized and/or nurse-driven; more multicenter and international trials will be performed; and organizational strategies will concentrate ICU personnel in a few large units, to promote the flexible management of these healthcare workers. Moreover, extracorporeal organ support technologies will be improved; technology informatics will cover all the bureaucratic aspects of healthcare work, aiding the staff in workload assessment; and critical care multidisciplinary rounds and follow-up services for post-ICU patients will be implemented. Lastly, a better continuum of care between the pre-hospital phase, the emergency care phase, the ICU phase, and the post-ICU phase should be achieved. Also, policies should be drafted to manage sudden large demands for critical care beds in mega-emergencies. The main lines of discussion in critical care nursing research should include nursing research priorities in critical care patients, holistic approaches to the patient, the humanization of care, special populations of ICU patients, and challenges related to critical care nursing during emerging outbreaks of infectious diseases.
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MacIntyre CR, Chughtai AA, Rahman B, Peng Y, Zhang Y, Seale H, Wang X, Wang Q. The efficacy of medical masks and respirators against respiratory infection in healthcare workers. Influenza Other Respir Viruses 2017; 11:511-517. [PMID: 28799710 PMCID: PMC5705692 DOI: 10.1111/irv.12474] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2017] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE We aimed to examine the efficacy of medical masks and respirators in protecting against respiratory infections using pooled data from two homogenous randomised control clinical trials (RCTs). METHODS The data collected on 3591 subjects in two similar RCTs conducted in Beijing, China, which examined the same infection outcomes, were pooled. Four interventions were compared: (i) continuous N95 respirator use, (ii) targeted N95 respirator use, (iii) medical mask use and (iv) control arm. The outcomes were laboratory-confirmed viral respiratory infection, influenza A or B, laboratory-confirmed bacterial colonisation and pathogens grouped by mode of transmission. RESULTS Rates of all outcomes were consistently lower in the continuous N95 and/or targeted N95 arms. In adjusted analysis, rates of laboratory-confirmed bacterial colonisation (RR 0.33, 95% CI 0.21-0.51), laboratory-confirmed viral infections (RR 0.46, 95% CI 0.23-0.91) and droplet-transmitted infections (RR 0.26, 95% CI 0.16-0.42) were significantly lower in the continuous N95 arm. Laboratory-confirmed influenza was also lowest in the continuous N95 arm (RR 0.34, 95% CI 0.10-1.11), but the difference was not statistically significant. Rates of laboratory-confirmed bacterial colonisation (RR 0.54, 95% CI 0.33-0.87) and droplet-transmitted infections (RR 0.43, 95% CI 0.25-0.72) were also lower in the targeted N95 arm, but not in medical mask arm. CONCLUSION The results suggest that the classification of infections into droplet versus airborne transmission is an oversimplification. Most guidelines recommend masks for infections spread by droplets. N95 respirators, as "airborne precautions," provide superior protection for droplet-transmitted infections. To ensure the occupational health and safety of healthcare worker, the superiority of respirators in preventing respiratory infections should be reflected in infection control guidelines.
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Affiliation(s)
- Chandini Raina MacIntyre
- School of Public Health and Community MedicineUniversity of New South WalesSydneyNSWAustralia
- College of Public Service & Community Solutionsand College of Health SolutionsArizona State UniversityPhoenixAZUSA
| | - Abrar Ahmad Chughtai
- School of Public Health and Community MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Bayzidur Rahman
- School of Public Health and Community MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Yang Peng
- The Beijing Centre for Disease Prevention and ControlBeijingChina
| | - Yi Zhang
- The Beijing Centre for Disease Prevention and ControlBeijingChina
| | - Holly Seale
- School of Public Health and Community MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Xiaoli Wang
- The Beijing Centre for Disease Prevention and ControlBeijingChina
| | - Quanyi Wang
- The Beijing Centre for Disease Prevention and ControlBeijingChina
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Identifying weaknesses in national health emergency response skills and techniques with emergency responders: A cross-sectional study from China. Am J Infect Control 2017; 45:e1-e6. [PMID: 27814923 PMCID: PMC7115265 DOI: 10.1016/j.ajic.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/02/2016] [Accepted: 10/03/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND To identify the weakest skill areas perceived by participants among key skills highly demanded during emergencies and to explore factors influencing the self-rated overall skill proficiency of public health emergency responders. METHODS The participants were selected by a multistage, stratified cluster sampling method in Heilongjiang CDC to complete questionnaires that assessed their perceptions of health emergency response skills and techniques. A final sample of 1,740 staff members was obtained and analyzed. RESULTS The 5 top skill deficiency areas perceived by participants were field epidemiologic investigation, personal protection, effective nuclear and radioactive response as well as psychological interventio (for these two areas gain the equal score), and risk assessment. The logistic regression revealed personal protective skills as the most important factor contributing to the self-rated overall skill proficiency of public health emergency responders, followed by field epidemiologic investigation skills. CONCLUSIONS More attention should be given to emergency response skill training and education programs. Major obstacles hindering the promotion of key skills and techniques among front-line emergency responders should be addressed urgently. Continuous efforts should be made to remove the financial, technical, and resource obstacles to improve public health emergency response capacity.
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Nash TJ. Development, Testing, and Psychometric Qualities of the Nash Duty to Care Scale for Disaster Response. J Nurs Meas 2017; 25:314-331. [DOI: 10.1891/1061-3749.25.2.314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: Although nurses struggle with the decision to report for work during disaster events, there are no instruments to measure nurses’ duty to care for disaster situations. The purpose of this study was to describe the development, testing, and psychometric qualities of the Nash Duty to Care Scale. Methods: A convenience sample of 409 registered nurses were recruited from 3 universities in the United States. Results: Exploratory factor analysis resulted in a 19-item, 4-factor model explaining 67.34% of the variance. Internal consistency reliability was supported by Cronbach’s alpha ranging from .81 to .91 for the 4-factor subscales and .92 for the total scale. Conclusions: The psychometrically sound instrument for measuring nurses’ perceived duty to care for disasters is applicable to contemporary nursing practice, institutional disaster management plans, and patient health outcomes worldwide.
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Xi H, Cao J, Liu J, Li Z, Kong X, Wang Y, Chen J, Ma S, Zhang L. Improving health care workers' protection against infection of Ebola hemorrhagic fever through video surveillance. Am J Infect Control 2016; 44:922-4. [PMID: 27112368 DOI: 10.1016/j.ajic.2016.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 02/14/2016] [Accepted: 02/19/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the importance of supervision through video surveillance in improving the quality of personal protection in preparing health care workers working in Ebola treatment units. METHODS Wardens supervise, remind, and guide health care workers' behavior through onsite voice and video systems when they are in the suspected patient observation ward and in the patient diagnosed ward of the Ebola treatment center. The observation results were recorded, and timely feedback was given to the health care workers. RESULTS After 2 months of supervision, 1,797 cases of incorrect personal protection behaviors were identified and corrected. The error rate continuously declined. The declined rate of the first 2 weeks was statistically different from other time periods. Through reminding and supervising, nonstandard personal protective behaviors can be discovered and corrected, which can help health care workers standardize personal protection. The timely feedback from video surveillance can also offer psychologic support and encouragement promptly to ease psychologic pressure. Finally, this can ensure health care workers stay at a zero infection rate during patient treatment. CONCLUSIONS Personal protective equipment protocol supervised by wardens through a video monitoring process can be used as an effective complement to conventional mutual supervision methods and can help health care workers avoid Ebola infection during treatment.
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Affiliation(s)
- Huijun Xi
- Department of Digestive Endoscopy Center, Changhai Hospital, Shanghai, China
| | - Jie Cao
- Department of Nursing, Changhai Hospital, Shanghai, China
| | - Jingjing Liu
- Nursing School of the Second Military Medical University, Shanghai, China
| | - Zhaoshen Li
- Department of Digestive Endoscopy Center, Changhai Hospital, Shanghai, China.
| | - Xiangyu Kong
- Department of Field Internal Medicine, Changhai Hospital, Shanghai, China
| | - Yonghua Wang
- Department of Nursing, Chengdu Military General Hospital, Chengdu, Sichuan Province, China
| | - Jing Chen
- Department of Nephrology, Changzheng Hospital, Shanghai, China
| | - Su Ma
- Department of Digestive Endoscopy Center, Changhai Hospital, Shanghai, China
| | - Lingjuan Zhang
- Department of Nursing, Changhai Hospital, Shanghai, China.
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McLaws ML, Chughtai AA, Salmon S, MacIntyre CR. A highly precautionary doffing sequence for health care workers after caring for wet Ebola patients to further reduce occupational acquisition of Ebola. Am J Infect Control 2016; 44:740-4. [PMID: 26897694 DOI: 10.1016/j.ajic.2015.12.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/11/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
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30
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Varkey JB, Ribner BS. Preparing for Serious Communicable Diseases in the United States: What the Ebola Virus Epidemic Has Taught Us. Microbiol Spectr 2016; 4:10.1128/microbiolspec.EI10-0011-2016. [PMID: 27337477 PMCID: PMC4922497 DOI: 10.1128/microbiolspec.ei10-0011-2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Indexed: 01/27/2023] Open
Abstract
Ending the West Africa Ebola virus disease (EVD) outbreak required an unprecedented international response. For the United States, participation in the international response to the West Africa EVD outbreak provided an opportunity to learn important lessons in four key domains critical to preparing for future outbreaks of EVD and other serious communicable diseases: (i) safe and effective patient care, (ii) the role of experimental therapeutics and vaccines, (iii) infection control, and (iv) hospital and community preparedness.
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Affiliation(s)
- Jay B Varkey
- Emory University School of Medicine, Atlanta, GA 30307
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31
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CHUGHTAI AA, BARNES M, MACINTYRE CR. Persistence of Ebola virus in various body fluids during convalescence: evidence and implications for disease transmission and control. Epidemiol Infect 2016; 144:1652-60. [PMID: 26808232 PMCID: PMC4855994 DOI: 10.1017/s0950268816000054] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 12/22/2015] [Accepted: 01/06/2016] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to review the current evidence regarding the persistence of Ebola virus (EBOV) in various body fluids during convalescence and discuss its implication on disease transmission and control. We conducted a systematic review and searched articles from Medline and EMBASE using key words. We included studies that examined the persistence of EBOV in various body fluids during the convalescent phase. Twelve studies examined the persistence of EBOV in body fluids, with around 800 specimens tested in total. Available evidence suggests that EBOV can persist in some body fluids after clinical recovery and clearance of virus from the blood. EBOV has been isolated from semen, aqueous humor, urine and breast milk 82, 63, 26 and 15 days after onset of illness, respectively. Viral RNA has been detectable in semen (day 272), aqueous humor (day 63), sweat (day 40), urine (day 30), vaginal secretions (day 33), conjunctival fluid (day 22), faeces (day 19) and breast milk (day 17). Given high case fatality and uncertainties around the transmission characteristics, patients should be considered potentially infectious for a period of time after immediate clinical recovery. Patients and their immediate contacts should be informed about these risks. Convalescent patients may need to abstain from sex for at least 9 months or should use condoms until their semen tests are negative. Breastfeeding should be avoided during the convalescent phase. There is a need for more research on persistence, and a uniform approach to infection control guidelines in convalescence.
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Affiliation(s)
- A. A. CHUGHTAI
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - M. BARNES
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - C. R. MACINTYRE
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
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DeBiasi RL, Song X, Cato K, Floyd T, Talley L, Gorman K, Parra M, Shankar V, Campos J, Chamberlain J, Cora-Bramble D, Sable C, Newman K, Wessel D. Preparedness, Evaluation, and Care of Pediatric Patients Under Investigation for Ebola Virus Disease: Experience from a Pediatric Designated Care Facility. J Pediatric Infect Dis Soc 2016; 5:68-75. [PMID: 26518218 PMCID: PMC4765487 DOI: 10.1093/jpids/piv069] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 09/09/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Roberta L. DeBiasi
- Division of Pediatric Infectious Diseases,Departments of Pediatrics,Tropical Medicine/Microbiology/Immunology
| | - Xiaoyan Song
- Division of Epidemiology and Infection Control,Departments of Pediatrics
| | | | | | - Linda Talley
- Division of Nursing,Division of Chief Nursing Officer
| | | | | | - Venkat Shankar
- Division of Critical Care Medicine,Departments of Pediatrics
| | - Joseph Campos
- Division of Laboratory Medicine,Departments of Pediatrics,Tropical Medicine/Microbiology/Immunology
| | | | | | - Craig Sable
- Departments of Pediatrics,Telemedicine,Cardiology, The George Washington University School of Medicine, Washington, DC
| | - Kurt Newman
- Division of Chief Executive Officer, Children's National Health System,Departments of Pediatrics
| | - David Wessel
- Division of Critical Care Medicine,Division of Chief Medical Officer,Departments of Pediatrics
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33
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Casalino E, Astocondor E, Sanchez JC, Díaz-Santana DE, del Aguila C, Carrillo JP. Personal protective equipment for the Ebola virus disease: A comparison of 2 training programs. Am J Infect Control 2015; 43:1281-7. [PMID: 26277572 DOI: 10.1016/j.ajic.2015.07.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/29/2015] [Accepted: 07/02/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Personal protective equipment (PPE) for preventing Ebola virus disease (EVD) includes basic PPE (B-PPE) and enhanced PPE (E-PPE). Our aim was to compare conventional training programs (CTPs) and reinforced training programs (RTPs) on the use of B-PPE and E-PPE. METHODS Four groups were created, designated CTP-B, CTP-E, RTP-B, and RTP-E. All groups received the same theoretical training, followed by 3 practical training sessions. RESULTS A total of 120 students were included (30 per group). In all 4 groups, the frequency and number of total errors and critical errors decreased significantly over the course of the training sessions (P < .01). The RTP was associated with a greater reduction in the number of total errors and critical errors (P < .0001). During the third training session, we noted an error frequency of 7%-43%, a critical error frequency of 3%-40%, 0.3-1.5 total errors, and 0.1-0.8 critical errors per student. The B-PPE groups had the fewest errors and critical errors (P < .0001). CONCLUSION Our results indicate that both training methods improved the student's proficiency, that B-PPE appears to be easier to use than E-PPE, that the RTP achieved better proficiency for both PPE types, and that a number of students are still potentially at risk for EVD contamination despite the improvements observed during the training.
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Fischer WA, Weber D, Wohl DA. Personal Protective Equipment: Protecting Health Care Providers in an Ebola Outbreak. Clin Ther 2015; 37:2402-2410. [PMID: 26452427 PMCID: PMC4661082 DOI: 10.1016/j.clinthera.2015.07.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/10/2015] [Indexed: 11/29/2022]
Abstract
Purpose The recent Ebola epidemic that devastated West Africa has infected and killed more health care providers than any other outbreak in the history of this virus. An improved understanding of pathogen transmission and the institution of strategies to protect health care providers against infection are needed in infectious disease outbreaks. This review connects what is known about Ebola virus transmission with personal protective equipment (PPE) designed to arrest nosocomial transmission. Methods Articles pertaining to filovirus transmission and PPE in filovirus outbreaks were reviewed and findings are presented. In addition, studies that evaluated PPE and donning and doffing strategies are presented. Findings PPE is one step in a comprehensive infection prevention and control strategy that is required to protect health care providers. Given that the Ebola virus is primarily transmitted through direct contact of mucous membranes and cuts in the skin with infected patients and/or their bodily fluids, it is necessary to cover these potential portals of infection with PPE as part of a structured and instructed donning and doffing procedure. Implications Current recommendations about PPE and the donning and doffing processes are based on anecdotal experience. However, the use of non-human viruses can help provide evidence-based guidelines on both PPE and donning and doffing processes.
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Affiliation(s)
- William A Fischer
- Division of Pulmonary and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David Weber
- Division of Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David A Wohl
- Division of Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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MacIntyre CR. Biopreparedness in the Age of Genetically Engineered Pathogens and Open Access Science: An Urgent Need for a Paradigm Shift. Mil Med 2015; 180:943-9. [PMID: 26327545 PMCID: PMC7107569 DOI: 10.7205/milmed-d-14-00482] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Our systems, thinking, training, legislation, and policies are lagging far behind momentous changes in science, and leaving us vulnerable in biosecurity. Synthetic viruses and genetic engineering of pathogens are a reality, with a rapid acceleration of dual-use science. The public availability of methods for dual-use genetic engineering, coupled with the insider threat, poses an unprecedented risk for biosecurity. Case studies including the 1984 Rajneesh salmonella bioterrorism attack and the controversy over engineered transmissible H5N1 influenza are analyzed. Simple probability analysis shows that the risks of dual-use research are likely to outweigh potential benefits, yet this type of analysis has not been done to date. Many bioterrorism agents may also occur naturally. Distinguishing natural from unnatural epidemics is far more difficult than other types of terrorism. Public health systems do not have mechanisms for routinely considering bioterrorism, and an organizational culture that is reluctant to consider it. A collaborative model for flagging aberrant outbreak patterns and referral from the health to security sectors is proposed. Vulnerabilities in current approaches to biosecurity need to be reviewed and strengthened collaboratively by all stakeholders. New systems, legislation, collaborative operational models, and ways of thinking are required to effectively address the threat to global biosecurity.
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Affiliation(s)
- C Raina MacIntyre
- School of Public Health and Community Medicine, Samuels Building, 325, University of New South Wales, Sydney, NSW 2052, Australia
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36
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MacIntyre CR, Travaglia JF. Heightened vulnerability, reduced oversight, and ethical breaches on the Internet in the West African Ebola epidemic. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2015; 15:65-68. [PMID: 25856609 DOI: 10.1080/15265161.2015.1010017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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