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Albertini P, Mainardi P, Bagattini M, Lombardi A, Riccio P, Ragosta M, Pennino F, Bruzzese D, Triassi M. Risk Influence of Some Environmental and Behavioral Factors on Air Contamination in the Operating Room: An Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6592. [PMID: 37623177 PMCID: PMC10454192 DOI: 10.3390/ijerph20166592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
Air contamination in operating rooms (ORs) depends on the conditions of the room and on activities therein performed. Methodologies of air quality assessment in ORs are often inadequately described in the scientific literature, and the time required for a change in status in air quality is never taken into account. The purpose of this study was to determine the influence of the state and the presence of human operators on air quality by implementing a precise measurement protocol that also took into account the time required for changes in the room to affect air pollution. As the main indicators of air pollution, bacterial load and concentration of airborne dust were measured. The results showed that: the use of surgical masks by operators in the OR did not significantly affect bacterial load within a distance of 2 m; keeping OR doors open did not induce a significant increase in bacterial load and of 5 μm particles while 10 μm particles concentration was positively affected; and air pollution measured with open doors was not significantly different from that due to the presence of two staff members, whether or not they were wearing masks. The results clarified the role of some factors on air pollution in ORs.
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Affiliation(s)
- Prospero Albertini
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| | - Pierangela Mainardi
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| | - Maria Bagattini
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| | - Annalisa Lombardi
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| | - Patrizia Riccio
- Department of Molecular Medicine and Medical Biotechnology, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy;
| | - Maria Ragosta
- School of Engineering, University of Basilicata, V.le dell’Ateneo Lucano N° 10, 85100 Potenza, Italy;
| | - Francesca Pennino
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| | - Dario Bruzzese
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| | - Maria Triassi
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
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Merenstein C, Fitzgerald AS, Khatib LA, Graham-Wooten J, Bushman FD, Collman RG. Effects of Mask Reuse on the Oropharyngeal, Skin, and Mask Microbiome. J Infect Dis 2023; 228:479-486. [PMID: 37217829 PMCID: PMC10428194 DOI: 10.1093/infdis/jiad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Face masks have been critical in the coronavirus disease 2019 (COVID-19) pandemic, but supplies were sometimes limited and disposable masks contribute greatly to environmental waste. Studies suggest that filtration capacity is retained with repeated use, and surveys indicate many people reuse surgical masks. However, the impact of mask reuse on the host is understudied. METHODS We applied 16S rRNA gene sequencing to investigate the bacterial microbiome of the facial skin and oropharynx of individuals randomized to wearing fresh surgical masks daily versus masks reused for 1 week. RESULTS Compared to daily fresh masks, reuse was associated with increased richness (number of taxa) of the skin microbiome and trend towards greater diversity, but no difference in the oropharyngeal microbiome. Used masks had either skin-dominant or oropharynx-dominant bacterial sequences, and reused masks had >100-fold higher bacterial content but no change in composition compared to those used for 1 day. CONCLUSIONS One week of mask reuse increased the number of low-abundance taxa on the face but did not impact the upper respiratory microbiome. Thus, face mask reuse has little impact on the host microbiome, although whether minor changes to the skin microbiome might relate to reported skin sequelae of masking (maskne) remains to be determined.
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Affiliation(s)
- Carter Merenstein
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ayannah S Fitzgerald
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Layla A Khatib
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jevon Graham-Wooten
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frederic D Bushman
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ronald G Collman
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Alaidaroos OA, Almuhaydib MN, Alhossan MA, Aldossari AN, Fallatta MO, Alotaibi SM, Alowid FK, Salem AA, Alsaygh KA, Alshammary HS. Unexpected Benefits of Coronavirus Disease 2019: Impact of Coronavirus Disease 2019 Pandemic on Surgical Site Infection: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2023; 24:119-130. [PMID: 36847343 DOI: 10.1089/sur.2022.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Background: We aimed to summarize and synthesize the current evidence regarding the indirect impact of the coronavirus disease 2019 (COVID-19) pandemic and its associated measures on the surgical site infection (SSI) rate compared with the pre-pandemic period. Methods: A computerized search was conducted on MEDLINE via PubMed, Web of Science, and Scopus using the relevant keywords. Two-stage screening and data extraction were done. The National Institutes of Health (NIH) tools were used for the quality assessment. The Review Manager 5.4.1 program was used for the analysis. Results: Sixteen articles (n = 157,426 patients) were included. The COVID-19 pandemic and lockdown were associated with reduced risk of SSIs after surgery (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.56-0.75; p < 0.00001) and (OR, 0.49; 95% CI, 0.29-0.84; p = 0.009), respectively. There was no significant reduction in the SSIs rate after applying the extended use of masks (OR, 0.73; 95% CI, 0.30-1.73; p = 0.47). A reduction in the superficial SSI rate during the COVID-19 pandemic compared with the pre-COVID-19 pandemic period was observed (OR, 0.58; 95% CI, 0.45-0.75; p < 0.0001). Conclusions: The current evidence suggests that the COVID-19 pandemic may have some unexpected benefits, including improved infection control protocols, which resulted in reduced SSI rates, especially superficial SSIs. In contrast to extended mask use, the lockdown was associated with reduced rates of SSIs.
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Affiliation(s)
| | | | - Mashari Ahmed Alhossan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulkarem Naif Aldossari
- College of Medicine, Najran University, Najran, Saudi Arabia.,Emergency Department, King Khalid Hospital, Najran, Saudi Arabia
| | - Mawadda Omar Fallatta
- College of Medicine, Umm Al Qura University, Makkah, Saudi Arabia.,General Surgery Department, Althaghr Hospital, Jeddah, Saudi Arabia
| | | | - Fay Khalid Alowid
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Abreu-Irizarry R, Torres-Lugo NJ, De Virgilio-Salgado L, Echegaray-Casalduc G, Deliz-Jimenez D, Martinez-Ramos J, Estarellas-Cobian S, Ramírez N, Foy-Parilla C. Is the whole-day use of surgical masks during the coronavirus pandemic increasing the contamination of surgeons' masks? Am J Infect Control 2023; 51:349-350. [PMID: 35944743 PMCID: PMC9356566 DOI: 10.1016/j.ajic.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/21/2022]
Abstract
Evaluating the impact of surgical masks' conservation practices during the Coronavirus Disease pandemic in the bioburden of the operating room seems imperative, as they play a critical role against this pandemic. We demonstrate that surgeons' masks tend to be contaminated due to the conservation techniques to maximize protection equipment during the pandemic. Health institutions should highlight the importance of surgical mask exchange to avoid increments in surgical mask contamination.
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Affiliation(s)
| | | | | | | | - David Deliz-Jimenez
- Department of Orthopedic Surgery, University of Puerto Rico, San Juan, Puerto Rico
| | | | | | - Norman Ramírez
- Department of Orthopedic Surgery, Mayagüez Medical Center, Mayagüez, Puerto Rico
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Li J, Yin J, Ramakrishna S, Ji D. Smart Mask as Wearable for Post-Pandemic Personal Healthcare. BIOSENSORS 2023; 13:205. [PMID: 36831971 PMCID: PMC9953568 DOI: 10.3390/bios13020205] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
A mask serves as a simple external barrier that protects humans from infectious particles from poor air conditions in the surrounding environment. As an important personal protective equipment (PPE) to protect our respiratory system, masks are able not only to filter pathogens and dust particles but also to sense, reflect or even respond to environmental conditions. This smartness is of particular interest among academia and industries due to its potential in disease detection, health monitoring and caring aspects. In this review, we provide an overlook of the current air filtration strategies used in masks, from structural designs to integrated functional modules that empower the mask's ability to sense and transfer physiological or environmental information to become smart. Specifically, we discussed recent developments in masks designed to detect macroscopic physiological signals from the wearer and mask-based disease diagnoses, such as COVID-19. Further, we propose the concept of next-generation smart masks and the requirements from material selection and function design perspectives that enable masks to interact and play crucial roles in health-caring wearables.
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Affiliation(s)
- Jingcheng Li
- Centre for Nanotechnology and Sustainability, Department of Mechanical Engineering, National University of Singapore, Singapore 117081, Singapore
| | - Jing Yin
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou 215021, China
| | - Seeram Ramakrishna
- Centre for Nanotechnology and Sustainability, Department of Mechanical Engineering, National University of Singapore, Singapore 117081, Singapore
| | - Dongxiao Ji
- College of Textiles, Donghua University, Shanghai 201620, China
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Ostrowski P, Masiuk H, Kulig P, Skoryk A, Wcisłek A, Jursa-Kulesza J, Sarna A, Sławiński M, Kotowski M, Tejchman K, Kotfis K, Sieńko J. Medical Face Masks Do Not Affect Acid-Base Balance Yet Might Facilitate the Transmission of Staphylococcus aureus in Hospital Settings during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2474. [PMID: 36767840 PMCID: PMC9915457 DOI: 10.3390/ijerph20032474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Due to the SARS-CoV-2 coronavirus pandemic, the wearing of masks has become a common phenomenon. Most of the undesirable effects of using a protective face covering are usually related to the prolonged time of its wearing, and the adverse consequences of face coverings should be considered two-fold. The aim of the study was to evaluate the rate of contamination of the three types of face coverings (surgical, N95, and FFP2 masks) with the microorganism-aerobic bacteria, yeasts, and molds-after the 3 h exposure time. The study aimed to investigate the effects of wearing FFP2 masks (KN95) on respiratory function and the acid-base balance of the human body. RESULTS The presence of S. aureus was confirmed in both nasal carriers and non-carriers which may demonstrate the cross-contamination and spread of this bacterium via hands. S. aureus was found on external and internal surfaces of face masks of each type, and therefore could also be transmitted via hands from external sources. The 3 h exposure time is not sufficient for Gram-negative rods and mold contamination. Moreover, there were no significant differences in most of the parameters studied between the first and second examinations, both in spirometry and capillary blood gas analysis (p > 0.05).
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Affiliation(s)
- Piotr Ostrowski
- Department of General Surgery and Transplantation, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Helena Masiuk
- Independent Laboratory of Medical Microbiology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Piotr Kulig
- Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Anastasiia Skoryk
- Department of General Surgery and Transplantation, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Aleksandra Wcisłek
- Independent Laboratory of Medical Microbiology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Joanna Jursa-Kulesza
- Independent Laboratory of Medical Microbiology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Angela Sarna
- Department of Laboratory Diagnostics, Public Clinical Hospital No. 2, 70-111 Szczecin, Poland
| | - Michał Sławiński
- Department of Laboratory Diagnostics, Public Clinical Hospital No. 2, 70-111 Szczecin, Poland
| | - Maciej Kotowski
- Department of General Surgery and Transplantation, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Karol Tejchman
- Department of General Surgery and Transplantation, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Jerzy Sieńko
- Department of General Surgery and Transplantation, Pomeranian Medical University, 70-111 Szczecin, Poland
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Bacterial contamination on used face masks among nursing home healthcare personnel. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2023; 3:e54. [PMID: 36970428 PMCID: PMC10031582 DOI: 10.1017/ash.2023.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 03/17/2023]
Abstract
Abstract
Objectives:
Since the beginning of the COVID-19 pandemic, face masks have been worn by many in public areas and for prolonged periods by healthcare workers (HCWs). This may facilitate bacterial contamination and transmission to and from patients in nursing homes where clinical care areas with strict precautions and residential and activity areas are interconnected. We assessed and compared bacterial mask colonization in HCWs belonging to different demographic categories and professions (clinical and nonclinical) and among HCWs who had worn the mask for different periods of time.
Design, setting and participants:
We conducted a point-prevalence study of 69 HCW masks at the end of a typical work shift in a 105-bed nursing home serving postacute care and rehabilitation patients. Information collected about the mask user included profession, age, sex, length of time the mask was worn, and known exposure to patients with colonization.
Results:
In total, 123 distinct bacterial isolates were recovered (1–5 isolates per mask), including Staphylococcus aureus from 11 masks (15.9%) and gram-negative bacteria of clinical importance from 22 masks (31.9%). Antibiotic resistance rates were low. There were no significant differences in the number of clinically important bacteria among masks worn more or less than 6 hours, and there were no significant differences among HCWs with different job functions or exposure to colonized patients.
Conclusions:
Bacterial mask contamination was not associated with HCW profession or exposure and did not increase after 6 hours of mask wearing in our nursing home setting. Bacteria contaminating HCW masks may differ from those colonizing patients.
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Checchi V, Montevecchi M, Valeriani L, Checchi L. Bioburden Variation of Filtering Face Piece Respirators over Time: A Preliminary Study. MATERIALS (BASEL, SWITZERLAND) 2022; 15:8790. [PMID: 36556594 PMCID: PMC9785761 DOI: 10.3390/ma15248790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/29/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The microbial contamination of a respirator can be evaluated through a count of the number of bacteria living on a non-sterilized surface (bioburden). This preliminary study investigated the external contamination of two different FFP2s over time by studying the bioburden values in increasing exposure times. METHODS FFP2 respirators of two different brands were used during routine clinical settings and examined through the bioburden test; for each brand, three devices were tested at 8, 16, and 30 h. RESULTS No significant differences were observed between mask brands (p = 0.113). There were only significant CFU differences between each mask and its control (p = 0.027 and p = 0.004). CONCLUSIONS Both brands of respirators were found to be contaminated and this contamination increased with the increase in exposure time. Further studies are needed to investigate the exact amount of contamination that could be considered acceptable before discarding each used mask.
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Affiliation(s)
- Vittorio Checchi
- Unit of Dentistry and Oral-Maxillo-Facial Surgery, Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Marco Montevecchi
- Unit of Dentistry, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40100 Bologna, Italy
| | - Leoluca Valeriani
- Unit of Dentistry, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40100 Bologna, Italy
| | - Luigi Checchi
- Unit of Dentistry, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40100 Bologna, Italy
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Kong K, Chang Y, Yu D, Mao Y, Zeng Y, Yan M, Zhai Z, Li H. Use of a Gigli Saw as a Substitute Osteotomy Tool When Oscillating Saw Malfunctions Occur During Hip Arthroplasty. Orthop Surg 2022; 14:3277-3282. [PMID: 36268676 PMCID: PMC9732580 DOI: 10.1111/os.13555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 09/08/2022] [Accepted: 09/15/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The oscillating saw has some inherent disadvantages, such as notch formation and blood splash. The objective is to introduce the Gigli saw as a substitute osteotomy tool when oscillating saw malfunctions occur during surgery. METHODS During our retrospective study, 120 patients (120 hips) who underwent primary total hip arthroplasty (THA) because of femoral neck fracture, femoral head necrosis, developmental hip dysplasia (Crowe I), or primary osteoarthritis between October 2017 and April 2020 at our institute were included. Sixty patients (26 men and 34 women) with a mean age of 67.3 years (±15.1 years) underwent femoral neck osteotomy using a Gigli saw. The other 60 patients (32 men and 28 women) with a mean age of 64.4 years (±18.8 years) underwent femoral neck osteotomy using an oscillating saw. Intraoperative evaluations, including osteotomy time, osteotomy height, number of notch formations, and blood splash generation, were performed. Routine anteroposterior views of the pelvis and proximal femur were obtained for all patients after surgery. RESULTS The mean osteotomy times were 26.60 ± 14.80 s and 31.80 ± 14.20 s with the oscillating saw and Gigli saw, respectively (t = 1.964, P = 0.0519). The mean osteotomy heights were 1.26 ± 0.22 cm and 1.20 ± 0.14 cm with the oscillating saw and Gigli saw, respectively (t = 1.782, P = 0.0773). The use of a Gigli saw did not result in bone notch formation or blood splash generation when multiple blood splashes were generated in the oscillating saw group. Postoperative radiographs showed no prostheses malposition in the Gigli saw and oscillating saw groups. CONCLUSION The Gigli saw has various advantages and can be a substitute tool for femoral neck osteotomy during THA when oscillating saw malfunctions occur.
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Affiliation(s)
- Keyu Kong
- Present address:
Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yongyun Chang
- Present address:
Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Degang Yu
- Present address:
Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yuanqing Mao
- Present address:
Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yiming Zeng
- Present address:
Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Mengning Yan
- Present address:
Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zanjing Zhai
- Present address:
Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Huiwu Li
- Present address:
Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
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Hafiani EM, Cassier P, Aho S, Albaladejo P, Beloeil H, Boudot E, Carenco P, Lallemant F, Leroy MG, Muret J, Tamames C, Garnier M. Tenue vestimentaire au bloc opératoire 2021. ANESTHÉSIE & RÉANIMATION 2022. [DOI: 10.1016/j.anrea.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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11
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Singh R, Davoudi S, Ness S. Preventive factors, diagnosis, and management of injection-related endophthalmitis: a literature review. Graefes Arch Clin Exp Ophthalmol 2022; 260:2399-2416. [PMID: 35278125 PMCID: PMC8917335 DOI: 10.1007/s00417-022-05607-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Intravitreal medication injections represent the gold standard treatment for a variety of potentially blinding chorioretinal vascular diseases. Despite their excellent safety profile, they are associated with the feared complication of injection-related endophthalmitis (IRE). Though the overall incidence of IRE is low, due to the ever-increasing number of injections being performed, it is a complication that all retina specialists are likely to encounter. This article reviews various factors that could potentially influence the risk of IRE and discusses evidence-based strategies for management. METHOD PubMed was searched for keywords "intravitreal injection" and "endophthalmitis" from the period of 1995-2021. Relevant articles were reviewed and selected articles were analyzed with respect to the incidence, potential preventive factors, clinical presentation, microbial profile, management, and outcomes for IRE. RESULTS There is strong consensus supporting the use of povidone iodine topical antiseptic, eyelid retraction away from the injection site, and avoiding treatment of eyes with active surface or eyelid disease, but there is less agreement on the use of face masks versus "no-talking" policies and optimal anesthetic technique. Current evidence comparing tap and inject or early vitrectomy for treatment of IRE is inadequate to determine an optimal treatment strategy. CONCLUSION Intravitreal injections are sight saving, but even using established prophylactic measures there remains a small but real risk of infectious injection-related complications. Further investigations comparing tap and inject versus vitrectomy may help to establish optimal treatment, although the rarity of IRE makes designing adequately powered prospective trials a difficult task.
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Affiliation(s)
| | - Samaneh Davoudi
- Boston Medical Center, 85 East Concord Street, 8th Floor, Boston, MA, 02118, USA
| | - Steven Ness
- Boston Medical Center, 85 East Concord Street, 8th Floor, Boston, MA, 02118, USA.
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12
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Park AM, Khadka S, Sato F, Omura S, Fujita M, Hashiwaki K, Tsunoda I. Bacterial and fungal isolation from face masks under the COVID-19 pandemic. Sci Rep 2022; 12:11361. [PMID: 35851044 PMCID: PMC9293923 DOI: 10.1038/s41598-022-15409-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/23/2022] [Indexed: 02/08/2023] Open
Abstract
The COVID-19 pandemic has led people to wear face masks daily in public. Although the effectiveness of face masks against viral transmission has been extensively studied, there have been few reports on potential hygiene issues due to bacteria and fungi attached to the face masks. We aimed to (1) quantify and identify the bacteria and fungi attaching to the masks, and (2) investigate whether the mask-attached microbes could be associated with the types and usage of the masks and individual lifestyles. We surveyed 109 volunteers on their mask usage and lifestyles, and cultured bacteria and fungi from either the face-side or outer-side of their masks. The bacterial colony numbers were greater on the face-side than the outer-side; the fungal colony numbers were fewer on the face-side than the outer-side. A longer mask usage significantly increased the fungal colony numbers but not the bacterial colony numbers. Although most identified microbes were non-pathogenic in humans; Staphylococcus epidermidis, Staphylococcus aureus, and Cladosporium, we found several pathogenic microbes; Bacillus cereus, Staphylococcus saprophyticus, Aspergillus, and Microsporum. We also found no associations of mask-attached microbes with the transportation methods or gargling. We propose that immunocompromised people should avoid repeated use of masks to prevent microbial infection.
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Affiliation(s)
- Ah-Mee Park
- Department of Microbiology, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Sundar Khadka
- Department of Microbiology, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Fumitaka Sato
- Department of Microbiology, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Seiichi Omura
- Department of Microbiology, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Mitsugu Fujita
- Department of Microbiology, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Kazuki Hashiwaki
- Department of Microbiology, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Ikuo Tsunoda
- Department of Microbiology, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
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13
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Ebadi M, McCague C, Vallee O, Taylor PK, Lee AHY, Bahrami M. Salt and surfactant coated filters with antiviral properties and low pressure drop for prospective SARS-CoV2 applications. Sci Rep 2022; 12:11546. [PMID: 35798756 PMCID: PMC9262935 DOI: 10.1038/s41598-022-15203-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
Abstract
The COVID-19 pandemic motivated research on antiviral filtration used in personal protective equipment and HVAC systems. In this research, three coating compositions of NaCl, Tween 20 surfactant, and NaCl-Tween 20 were examined on polypropylene spun-bond filters. The pressure drop, coverage, and crystal size of the coating methods and compositions were measured. Also, in vitro plaque assays of the Phi6 Bacteriophage on Pseudomonas syringae as a simulation of an enveloped respiratory virus was performed to investigate the antiviral properties of the coating. NaCl and NaCl-Tween 20 increased the pressure drop in the range of 40-50 Pa for a loading of 5 mg/cm2. Tween 20 has shown an impact on the pressure drop as low as 10 Pa and made the filter surface more hydrophilic which kept the virus droplets on the surface. The NaCl-Tween 20 coated samples could inactivate 108 plaque forming units (PFU) of virus in two hours of incubation. Tween 20 coated filters with loading as low as 0.2 mg/cm2 reduced the activity of 108 PFU of virus from 109 to 102 PFU/mL after 2 h of incubation. NaCl-coated samples with a salt loading of 15 mg/cm2 could not have antiviral properties higher than reducing the viral activity from 109 to 105 PFU/mL in 4 h of incubation.
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Affiliation(s)
- Milad Ebadi
- Laboratory for Alternative Energy Conversion (LAEC), School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, V3T 0A3, Canada
| | - Claire McCague
- Laboratory for Alternative Energy Conversion (LAEC), School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, V3T 0A3, Canada
| | - Ophelia Vallee
- School of Health Science, British Columbia Institute of Technology, SW 3, White Ave, Burnaby, BC, V5G 3H2, Canada
| | - Patrick K Taylor
- Department of Molecular Biology and Biochemistry, Simon Fraser University, 8888 University Drive, Burnaby, B.C, V5A 1S6, Canada
| | - Amy H Y Lee
- Department of Molecular Biology and Biochemistry, Simon Fraser University, 8888 University Drive, Burnaby, B.C, V5A 1S6, Canada
| | - Majid Bahrami
- Laboratory for Alternative Energy Conversion (LAEC), School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, V3T 0A3, Canada.
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14
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Yang S, Fang C, Liu X, Liu Y, Huang S, Wang R, Qi F. Surgical Masks Affect the Peripheral Oxygen Saturation and Respiratory Rate of Anesthesiologists. Front Med (Lausanne) 2022; 9:844710. [PMID: 35492371 PMCID: PMC9047907 DOI: 10.3389/fmed.2022.844710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/15/2022] [Indexed: 01/08/2023] Open
Abstract
BackgroundSurgical masks (SMs) protect medical staff and reduce surgical site infections. Extended SM use may reduce oxygen concentrations in circulation, causing hypoxia, headache, and fatigue. However, no research has examined the effects of wearing SMs on oxygenation and physical discomfort of anesthesiologists.MethodsAn electronic questionnaire was established and administered through WeChat, and a cross-sectional survey was conducted to determine SM use duration and related discomfort of operating room medical staff. Then, operating room anesthesiologists were enrolled in a single-arm study. Peripheral blood oxygen saturation (SpO2), heart rate, and respiratory rate were determined at different times before and after SM use. Shortness of breath, dizziness, and headache were subjectively assessed based on the visual analog scale (VAS) scores.ResultsIn total, 485 operating room medical staff completed the electronic questionnaire; 70.5% of them did not change SMs until after work, and 63.9% wore SMs continuously for more than 4 h. The proportion of anesthesiologists was the highest. After wearing masks for 4 h, the shortness of breath, fatigue, and dizziness/headache rates were 42.1, 34.6, and 30.9%, respectively. Compared with other medical staff, the proportion of subjective discomfort of anesthesiologists increased significantly with prolonged SM use from 1 to 4 h. Thirty-five anesthesiologists completed the study. There was no difference in anesthesiologist SpO2, heart rate, or respiratory rate within 2 h of wearing SMs. After more than 2 h, the variation appears to be statistically rather than clinically significant—SpO2 decreased (98.0 [1.0] vs. 97.0 [1.0], p < 0.05), respiratory rate increased (16.0 [3.0] vs. 17.0 [2.0], p < 0.01), and heart rate remained unchanged. As mask use duration increased, the VAS scores of shortness of breath, dizziness, and headache gradually increased.ConclusionIn healthy anesthesiologists, wearing SMs for more than 2 h can significantly decrease SpO2 and increase respiratory rates without affecting heart rates.
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15
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Martinez E, Crèvecoeur S, Dams L, Rabecki F, Habraken S, Haubruge E, Daube G. Effect of five decontamination methods on face masks and filtering facepiece respirators contaminated with Staphylococcus aureus and Pseudomonas aeruginosa. Access Microbiol 2022; 4:000342. [PMID: 35693470 PMCID: PMC9175975 DOI: 10.1099/acmi.0.000342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/10/2022] [Indexed: 02/02/2023] Open
Abstract
Introduction. In the context of the global pandemic due to SARS-CoV-2, procurement of personal protective equipment during the crisis was problematic. The idea of reusing and decontaminating personal surgical masks in facilities was explored in order to avoid the accumulation of waste and overcome the lack of equipment.
Hypothesis. Our hypothesis is that this work will show the decontamination methods assessed are effective for bacteria, such as
Staphylococcus aureus
and
Pseudomonas aeruginosa
.
Aim. We aim to provide information about the effects of five decontamination procedures (UV treatment, dry heat, vaporized H2O2, ethanol treatment and blue methylene treatment) on
S. aureus
and
P. aeruginosa
. These bacteria are the main secondary bacterial pathogens responsible for lung infections in the hospital environment.
Methodology. The surgical masks and the filtering facepiece respirators were inoculated with two bacterial strains (
S. aureus
ATCC 29213 and
P. aeruginosa
S0599) and submitted to five decontamination treatments: vaporized H2O2 (VHP), UV irradiation, dry heat treatment, ethanol bath treatment and blue methylene treatment. Direct and indirect microbiology assessments were performed on three positive controls, five treated masks and one negative control.
Results. The five decontaminations showed significant (P<0.05) but different degrees of reductions of
S. aureus
and
P. aeruginosa
. VHP, dry heat treatment and ethanol treatment adequately reduced the initial contamination. The 4 min UV treatment allowed only a reduction to five orders of magnitude for face mask respirators. The methylene blue treatment induced a reduction to two orders of magnitude.
Conclusions. The three methods that showed a log10 reduction factor of 6 were the dry heat method, VHP and ethanol bath treatment. These methods are effective and their establishment in the medical field are easy but require economic investment.
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Affiliation(s)
- Elisa Martinez
- Fundamental and Applied Research for Animals & Health (FARAH), Liege, Belgium
- Faculty of Veterinary Medicine, Department of Food Sciences, University of Liege, Liege, Belgium
- *Correspondence: Elisa Martinez,
| | - Sébastien Crèvecoeur
- Fundamental and Applied Research for Animals & Health (FARAH), Liege, Belgium
- Faculty of Veterinary Medicine, Department of Food Sciences, University of Liege, Liege, Belgium
| | - Lorène Dams
- Fundamental and Applied Research for Animals & Health (FARAH), Liege, Belgium
- Faculty of Veterinary Medicine, Department of Infectious and Parasitic Diseases, University of Liege, Liege, Belgium
| | | | - Serge Habraken
- Centre Spatial de Liege, University of Liege, Liege, Belgium
| | - Eric Haubruge
- TERRA Research Centre, Gembloux AgroBiotech, University of Liege, Gembloux, Belgium
| | - Georges Daube
- Fundamental and Applied Research for Animals & Health (FARAH), Liege, Belgium
- Faculty of Veterinary Medicine, Department of Food Sciences, University of Liege, Liege, Belgium
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16
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Fraser JA, Briggs KB, Svetanoff WJ, Rentea RM, Aguayo P, Juang D, Fraser JD, Snyder CL, Hendrickson RJ, St. Peter SD, Oyetunji TA. Behind the mask: extended use of surgical masks is not associated with increased risk of surgical site infection. Pediatr Surg Int 2022; 38:325-330. [PMID: 34665318 PMCID: PMC8524207 DOI: 10.1007/s00383-021-05032-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE COVID-19 has prompted significant policy change, with critical attention to the conservation of personal protective equipment (PPE). An extended surgical mask use policy was implemented at our institution, allowing use of one disposable mask per each individual, per day, for all the cases. We investigate the clinical impact of this policy change and its effect on the rate of 30-day surgical site infection (SSI). METHODS A single-institution retrospective review was performed for all the elective pediatric general surgery cases performed pre-COVID from August 2019 to October 2019 and under the extended mask use policy from August 2020 to October 2020. Procedure type, SSI within 30 days, and postoperative interventions were recorded. RESULTS Four hundred and eighty-eight cases were reviewed: 240 in the pre-COVID-19 cohort and 248 in the extended surgical mask use cohort. Three SSIs were identified in the 2019 cohort, and two in the 2020 cohort. All postoperative infections were superficial and resolved within 1 month of diagnosis with oral antibiotics. There were no deep space infections, readmissions, or infections requiring re-operation. CONCLUSION Extended surgical mask use was not associated with increased SSI in this series of pediatric general surgery cases and may be considered an effective and safe strategy for resource conservation with minimal clinical impact.
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Affiliation(s)
- James A. Fraser
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA
| | - Kayla B. Briggs
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA
| | - Wendy Jo Svetanoff
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA
| | - Rebecca M. Rentea
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA ,University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Pablo Aguayo
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA ,University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - David Juang
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA ,University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Jason D. Fraser
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA ,University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Charles L. Snyder
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA ,University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Richard J. Hendrickson
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA ,University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Shawn D. St. Peter
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA ,University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Tolulope A. Oyetunji
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA ,University of Missouri-Kansas City School of Medicine, Kansas City, MO USA ,Quality Improvement and Surgical Equity Research (QISER) Center, Kansas City, USA
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17
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Babaahmadi V, Amid H, Naeimirad M, Ramakrishna S. Biodegradable and multifunctional surgical face masks: A brief review on demands during COVID-19 pandemic, recent developments, and future perspectives. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 798:149233. [PMID: 34329934 PMCID: PMC8302485 DOI: 10.1016/j.scitotenv.2021.149233] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 05/14/2023]
Abstract
Providing the greater public with the current coronavirus (SARS-CoV-2) vaccines is time-consuming and research-intensive; intermediately, some essential ways to reduce the transmission include social distancing, personal hygiene, testing, contact tracing, and universal masking. The data suggests that universal masking, especially using multilayer surgical face masks, offers a powerful efficacy for indoor places. These layers have different functions including antiviral/antibacterial, fluid barrier, particulate and bacterial filtration, and fit and comfort. However, universal masking poses a serious environmental threat since billions of them are disposed on a daily basis; the current coronavirus disease (COVID-19) has put such demands and consequences in perspective. This review focuses on surgical face mask structures and classifications, their impact on our environment, some of their desirable functionalities, and the recent developments around their biodegradability. The authors believe that this review provides an insight into the fabrication and deployment of effective surgical face masks, and it discusses the utilization of multifunctional structures along with biodegradable materials to deal with future demands in a more eco-friendly fashion.
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Affiliation(s)
- Vahid Babaahmadi
- Department of Materials and Textile Engineering, Faculty of Engineering, Razi University, Kermanshah 6714414971, Iran.
| | - Hooman Amid
- Saint-Gobain Inc., Research and Development Supervisor, Nonwoven Abrasives, McAllen, TX 78503, United States of America
| | - Mohammadreza Naeimirad
- Department of Materials and Textile Engineering, Faculty of Engineering, Razi University, Kermanshah 6714414971, Iran
| | - Seeram Ramakrishna
- Centre for Nanofibers and Nanotechnology, Department of Mechanical Engineering, National University of Singapore, Singapore 117575, Singapore
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18
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Marín-Nieto J, Reino-Perez C, Santillana-Cernuda G, Díaz-Bernal JM, Luque-Aranda R, García-Basterra I. FACE MASK CONTAMINATION DURING COVID-19 PANDEMIA. A STUDY ON PATIENTS RECEIVING INTRAVITREAL INJECTIONS. Retina 2021; 41:2215-2220. [PMID: 33965993 DOI: 10.1097/iae.0000000000003202] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the bacterial growth in the surgical face masks used by patients who received intravitreal injections and study the effect of povidone-iodine on the periocular area (PA) of masks. METHODS Forty patients who attended for intravitreal injections were divided in those with less (<4 hours) and more (>4 hours) than 4 hours of mask use. Each group was divided depending on the application or not of povidone-iodine in the PA of the mask. Bacterial load was studied on PA and mouth area samples. RESULTS The bacterial load in the PA was higher in the >4 hours group compared with the <4 hours group (13.2 vs. 48.75 colony-forming units/μL; P = 0.03). The contamination in the PA significantly decreased after applying povidone-iodine in the >4 hours group (P = 0.01). The use or not of povidone-iodine was strongly correlated to a positive culture (OR = 9.0, P = 0.00. CI 1.63-49.44). CONCLUSION Surgical face masks worn for more than 4 hours present higher contamination in the PA than those with less use. Bacterial load in the PA is reduced with povidone-iodine on masks used for more than 4 hours. This contamination should be considered in the asepsis protocol of intravitreal injections.
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Affiliation(s)
- Juan Marín-Nieto
- Department of Ophthalmology, University Hospital Virgen de la Victoria, Málaga, Spain
- University of Málaga, Málaga, Spain
| | - Carmen Reino-Perez
- Department of Ophthalmology, University Hospital Virgen de la Victoria, Málaga, Spain
| | | | | | - Rafael Luque-Aranda
- Department of Ophthalmology, University Hospital Virgen de la Victoria, Málaga, Spain
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19
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Marson BA, Craxford S, Valdes AM, Ollivere BJ. Are facemasks a priority for all staff in theatre to prevent surgical site infections during shortages of supply? A systematic review and meta-analysis. Surgeon 2021; 19:e132-e139. [PMID: 33039336 PMCID: PMC7539019 DOI: 10.1016/j.surge.2020.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/19/2020] [Accepted: 08/31/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND The provision of facemasks must be prioritised when supplies are interrupted. These include supplies to operating rooms. The aim of this review is to evaluate the available evidence to determine the relative priority for the provision of facemasks in operating rooms to prevent surgical site infection. METHODS A systematic search of OVID Medline, Embase & Cochrane Central was completed. Candidate full-text articles were identified and analysed by two reviewers who also assessed risk of bias. FINDINGS Six studies were identified that described infections with and without facemask usage. The pooled effect of not wearing facemasks was a risk ratio for infection of 0.77 (0.62-0.97) in favour of not wearing masks. Only one case-controlled study evaluated facemask usage in implant surgery and demonstrated an odds ratio for developing infection of 3.34 (95% CI 1.94-5.74) if facemasks were not worn by the operating surgeon. Four studies collected microbiological cultures during periods in surgery with or without facemasks. Two demonstrated an increase in colony forming units in surgery where the wound was directly below the surgeon. One study showed equivocal results when masks were worn, and one was terminated early limiting interpretation. CONCLUSION The use of facemasks by scrubbed staff during implant surgery should be mandatory to prevent infection. We recommend the use of facemasks by all scrubbed staff during other forms of surgery to protect the patient and staff, but the supporting evidence is weak. There is insufficient evidence to show that non-scrubbed staff must wear masks during surgery.
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Affiliation(s)
- Ben A Marson
- University of Nottingham, Queens Medical Centre, Nottingham, NG7 2UH, UK.
| | - Simon Craxford
- University of Nottingham, Queens Medical Centre, Nottingham, NG7 2UH, UK
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20
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Gund MP, Boros G, Hannig M, Thieme-Ruffing S, Gärtner B, Rohrer TR, Simon A, Rupf S. Bacterial contamination of forehead skin and surgical mask in aerosol-producing dental treatment. J Oral Microbiol 2021; 13:1978731. [PMID: 34567438 PMCID: PMC8462870 DOI: 10.1080/20002297.2021.1978731] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Bacterial contamination of dental professionals’ facial skin and protective equipment from treatment-related aerosols and droplets are poorly studied. Methods This prospective study analyzed samples from 67 consecutive aerosol-producing dental treatments. Sterile nylon swabs served to collect samples from dental professionals’ foreheads before and after exposure. Contact samples were obtained from used surgical masks. Samples were incubated on agar under aerobic and anaerobic conditions. Bacteria were classified by MALDI-TOF mass spectrometry. We determined the frequencies of obligate and facultative oral bacteria and scored bacterial growth (0: none; 1: < 100 colonies; 2: >100 colonies; 3: dense). Results Bacteria were detected in 95% of skin-swab and 76% of mask samples. Median bacterial scores were 2 for forehead samples before and after treatment, and 1 for masks. Obligate and facultative oral bacteria were more frequent (6% and 30%) in samples from exposed forehead skin, which also showed increased bacterial scores (28%). 5% of samples contained methicillin-sensitive Staphylococcus aureus; 3% contained obligate anaerobes. Conclusion Exposed forehead skin was significantly less contaminated with obligate oral bacteria than expected based on surgical mask findings. Exposed forehead skin showed increased contamination attributable to aerosol-producing procedures. The forehead’s physiological skin microbiota may offer some protection against bacterial contamination.
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Affiliation(s)
- Madline P Gund
- Clinic Department of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany.,Oral Surgery Clinic, German Armed Forces Central Hospital; Koblenz, Germany
| | - Gabor Boros
- Oral Surgery Clinic, German Armed Forces Central Hospital; Koblenz, Germany
| | - Matthias Hannig
- Clinic Department of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany
| | - Sigrid Thieme-Ruffing
- Institute of Medical Microbiology and Hygiene, Department of Hospital Hygiene, Saarland University, Homburg, Germany
| | - Barbara Gärtner
- Institute of Medical Microbiology and Hygiene, Department of Hospital Hygiene, Saarland University, Homburg, Germany
| | - Tilman R Rohrer
- University Children's Hospital, Saarland University Medical Center, Homburg, Germany
| | - Arne Simon
- University Children's Hospital, Saarland University Medical Center, Homburg, Germany
| | - Stefan Rupf
- Clinic Department of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany.,Chair of Synoptic Dentistry, Saarland University, Homburg, Germany
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21
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Delanghe L, Cauwenberghs E, Spacova I, De Boeck I, Van Beeck W, Pepermans K, Claes I, Vandenheuvel D, Verhoeven V, Lebeer S. Cotton and Surgical Face Masks in Community Settings: Bacterial Contamination and Face Mask Hygiene. Front Med (Lausanne) 2021; 8:732047. [PMID: 34540873 PMCID: PMC8446422 DOI: 10.3389/fmed.2021.732047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
During the current COVID-19 pandemic, the use of face masks has become increasingly recommended and even mandatory in community settings. To evaluate the risk of bacterial cross-contamination, this study analyzed the bacterial bioburden of disposable surgical masks and homemade cotton masks, and surveyed the habits and face mask preferences of the Flemish population. Using culture approaches and 16S rRNA gene amplicon sequencing, we analyzed the microbial community on surgical and/or cotton face masks of 13 healthy volunteers after 4 h of wearing. Cotton and surgical masks contained on average 1.46 × 105 CFU/mask and 1.32 × 104 CFU/mask, respectively. Bacillus, Staphylococcus, and Acinetobacter spp. were mostly cultured from the masks and 43% of these isolates were resistant to ampicillin or erythromycin. Microbial profiling demonstrated a consistent difference between mask types. Cotton masks mainly contained Roseomonas, Paracoccus, and Enhydrobacter taxa and surgical masks Streptococcus and Staphylococcus. After 4 h of mask wearing, the microbiome of the anterior nares and the cheek showed a trend toward an altered beta-diversity. According to dedicated questions in the large-scale Corona survey of the University of Antwerp with almost 25,000 participants, only 21% of responders reported to clean their cotton face mask daily. Laboratory results indicated that the best mask cleaning methods were boiling at 100°C, washing at 60°C with detergent or ironing with a steam iron. Taken together, this study suggests that a considerable number of bacteria, including pathobionts and antibiotic resistant bacteria, accumulate on surgical and even more on cotton face masks after use. Based on our results, face masks should be properly disposed of or sterilized after intensive use. Clear guidelines for the general population are crucial to reduce the bacteria-related biosafety risk of face masks, and measures such as physical distancing and increased ventilation should not be neglected when promoting face mask use.
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Affiliation(s)
- Lize Delanghe
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Eline Cauwenberghs
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Irina Spacova
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Ilke De Boeck
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Wannes Van Beeck
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Koen Pepermans
- Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Ingmar Claes
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Dieter Vandenheuvel
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Veronique Verhoeven
- Department of Primary and Interdisciplinary Care (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Sarah Lebeer
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
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22
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Bennet D, Harris AF, Lacombe J, Brooks C, Bionda N, Strickland AD, Eisenhut T, Zenhausern F. Evaluation of supercritical CO 2 sterilization efficacy for sanitizing personal protective equipment from the coronavirus SARS-CoV-2. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 780:146519. [PMID: 33774282 PMCID: PMC7969838 DOI: 10.1016/j.scitotenv.2021.146519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 05/08/2023]
Abstract
The purpose of this research is to evaluate the supercritical carbon dioxide (scCO2) sterilization-based NovaClean process for decontamination and reprocessing of personal protective equipment (PPE) such as surgical masks, cloth masks, and N95 respirators. Preliminarily, Bacillus atrophaeus were inoculated into different environments (dry, hydrated, and saliva) to imitate coughing and sneezing and serve as a "worst-case" regarding challenged PPE. The inactivation of the microbes by scCO2 sterilization with NovaKill or H2O2 sterilant was investigated as a function of exposure times ranging from 5 to 90 min with a goal of elucidating possible mechanisms. Also, human coronavirus SARS-CoV-2 and HCoV-NL63 were inoculated on the respirator material, and viral activity was determined post-treatment. Moreover, we investigated the reprocessing ability of scCO2-based decontamination using wettability testing and surface mapping. Different inactivation mechanisms have been identified in scCO2 sanitization, such as membrane damage, germination defect, and dipicolinic acid leaks. Moreover, the viral sanitization results showed a complete inactivation of both coronavirus HCoV-NL63 and SARS-CoV-2. We did not observe changes in PPE morphology, topographical structure, or material integrity, and in accordance with the WHO recommendation, maintained wettability post-processing. These experiments establish a foundational understanding of critical elements for the decontamination and reuse of PPE in any setting and provide a direction for future research in the field.
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Affiliation(s)
- Devasier Bennet
- Center for Applied NanoBioscience and Medicine, The University of Arizona, College of Medicine, 475 N Fifth Street, AZ 85004, Phoenix, USA.
| | - Ashlee F Harris
- Center for Applied NanoBioscience and Medicine, The University of Arizona, College of Medicine, 475 N Fifth Street, AZ 85004, Phoenix, USA
| | - Jerome Lacombe
- Center for Applied NanoBioscience and Medicine, The University of Arizona, College of Medicine, 475 N Fifth Street, AZ 85004, Phoenix, USA; Department of Basic Medical Sciences, The University of Arizona, College of Medicine, 475 N 5th St., Phoenix, AZ 85004, USA
| | - Carla Brooks
- Center for Applied NanoBioscience and Medicine, The University of Arizona, College of Medicine, 475 N Fifth Street, AZ 85004, Phoenix, USA
| | | | | | | | - Frederic Zenhausern
- Center for Applied NanoBioscience and Medicine, The University of Arizona, College of Medicine, 475 N Fifth Street, AZ 85004, Phoenix, USA; Department of Basic Medical Sciences, The University of Arizona, College of Medicine, 475 N 5th St., Phoenix, AZ 85004, USA; School of Pharmaceutical Sciences, University of Geneva, 1 rue Michel Servet, 1211, Geneva 4, Switzerland.
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23
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De Maio F, Palmieri V, Babini G, Augello A, Palucci I, Perini G, Salustri A, Spilman P, De Spirito M, Sanguinetti M, Delogu G, Rizzi LG, Cesareo G, Soon-Shiong P, Sali M, Papi M. Graphene nanoplatelet and graphene oxide functionalization of face mask materials inhibits infectivity of trapped SARS-CoV-2. iScience 2021; 24:102788. [PMID: 34222841 PMCID: PMC8233064 DOI: 10.1016/j.isci.2021.102788] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/03/2021] [Accepted: 06/22/2021] [Indexed: 02/06/2023] Open
Abstract
Recent advancements in bidimensional nanoparticles production such as graphene (G) and graphene oxide (GO) have the potential to meet the need for highly functional personal protective equipment (PPE) against SARS-CoV-2 infection. The ability of G and GO to interact with microorganisms provides an opportunity to develop engineered textiles for use in PPE and limit the spread of COVID-19. PPE in current use in high-risk settings for COVID transmission provides only a physical barrier that decreases infection likelihood and does not inactivate the virus. Here, we show that virus pre-incubation with soluble GO inhibits SARS-CoV-2 infection of VERO cells. Furthermore, when G/GO-functionalized polyurethane or cotton was in contact SARS-CoV-2, the infectivity of the fabric was nearly completely inhibited. The findings presented here constitute an important innovative nanomaterial-based strategy to significantly increase PPE efficacy in protection against the SARS-CoV-2 virus that may implement water filtration, air purification, and diagnostics methods.
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Affiliation(s)
- Flavio De Maio
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario “A. Gemelli” IRCSS, Largo A. Gemelli, 8 00168 Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie – Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
| | - Valentina Palmieri
- Istituto dei Sistemi Complessi, CNR, Via dei Taurini 19, 00185 Rome, Italy
| | - Gabriele Babini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario "A. Gemelli", Largo A. Gemelli, 8 00168 Rome, Italy
| | - Alberto Augello
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
- Fondazione Policlinico Universitario “A. Gemelli” IRCSS, Largo A. Gemelli, 8 00168 Rome, Italy
| | - Ivana Palucci
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario “A. Gemelli” IRCSS, Largo A. Gemelli, 8 00168 Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie – Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
| | - Giordano Perini
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
- Fondazione Policlinico Universitario “A. Gemelli” IRCSS, Largo A. Gemelli, 8 00168 Rome, Italy
| | - Alessandro Salustri
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie – Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
| | - Patricia Spilman
- ImmunityBio, LLC, Culver City, 440 Duley Road, El Segundo, California, CA 90245, USA
| | - Marco De Spirito
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
- Fondazione Policlinico Universitario “A. Gemelli” IRCSS, Largo A. Gemelli, 8 00168 Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario “A. Gemelli” IRCSS, Largo A. Gemelli, 8 00168 Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie – Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
| | - Giovanni Delogu
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie – Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
- Mater Olbia Hospital, Strada Statale 125 Orientale Sarda, 07026 Olbia SS, Italy
| | - Laura Giorgia Rizzi
- Directa Plus S.p.A. c/o ComoNExT - Science and Technology Park, 22074 Lomazzo, Como, Italy
| | - Giulio Cesareo
- Directa Plus S.p.A. c/o ComoNExT - Science and Technology Park, 22074 Lomazzo, Como, Italy
| | - Patrick Soon-Shiong
- Nantworks LLC, Culver City, 9920 Jefferson Boulevard, California, CA 90230, USA
| | - Michela Sali
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario “A. Gemelli” IRCSS, Largo A. Gemelli, 8 00168 Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie – Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
| | - Massimiliano Papi
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
- Fondazione Policlinico Universitario “A. Gemelli” IRCSS, Largo A. Gemelli, 8 00168 Rome, Italy
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24
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De Maio F, Palmieri V, Babini G, Augello A, Palucci I, Perini G, Salustri A, Spilman P, De Spirito M, Sanguinetti M, Delogu G, Rizzi LG, Cesareo G, Soon-Shiong P, Sali M, Papi M. Graphene nanoplatelet and graphene oxide functionalization of face mask materials inhibits infectivity of trapped SARS-CoV-2. iScience 2021; 24:102788. [PMID: 34222841 DOI: 10.1101/2020.09.16.20194316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/03/2021] [Accepted: 06/22/2021] [Indexed: 05/19/2023] Open
Abstract
Recent advancements in bidimensional nanoparticles production such as graphene (G) and graphene oxide (GO) have the potential to meet the need for highly functional personal protective equipment (PPE) against SARS-CoV-2 infection. The ability of G and GO to interact with microorganisms provides an opportunity to develop engineered textiles for use in PPE and limit the spread of COVID-19. PPE in current use in high-risk settings for COVID transmission provides only a physical barrier that decreases infection likelihood and does not inactivate the virus. Here, we show that virus pre-incubation with soluble GO inhibits SARS-CoV-2 infection of VERO cells. Furthermore, when G/GO-functionalized polyurethane or cotton was in contact SARS-CoV-2, the infectivity of the fabric was nearly completely inhibited. The findings presented here constitute an important innovative nanomaterial-based strategy to significantly increase PPE efficacy in protection against the SARS-CoV-2 virus that may implement water filtration, air purification, and diagnostics methods.
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Affiliation(s)
- Flavio De Maio
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCSS, Largo A. Gemelli, 8 00168 Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie - Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
| | - Valentina Palmieri
- Istituto dei Sistemi Complessi, CNR, Via dei Taurini 19, 00185 Rome, Italy
| | - Gabriele Babini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario "A. Gemelli", Largo A. Gemelli, 8 00168 Rome, Italy
| | - Alberto Augello
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
- Fondazione Policlinico Universitario "A. Gemelli" IRCSS, Largo A. Gemelli, 8 00168 Rome, Italy
| | - Ivana Palucci
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCSS, Largo A. Gemelli, 8 00168 Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie - Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
| | - Giordano Perini
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
- Fondazione Policlinico Universitario "A. Gemelli" IRCSS, Largo A. Gemelli, 8 00168 Rome, Italy
| | - Alessandro Salustri
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie - Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
| | - Patricia Spilman
- ImmunityBio, LLC, Culver City, 440 Duley Road, El Segundo, California, CA 90245, USA
| | - Marco De Spirito
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
- Fondazione Policlinico Universitario "A. Gemelli" IRCSS, Largo A. Gemelli, 8 00168 Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCSS, Largo A. Gemelli, 8 00168 Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie - Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
| | - Giovanni Delogu
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie - Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
- Mater Olbia Hospital, Strada Statale 125 Orientale Sarda, 07026 Olbia SS, Italy
| | - Laura Giorgia Rizzi
- Directa Plus S.p.A. c/o ComoNExT - Science and Technology Park, 22074 Lomazzo, Como, Italy
| | - Giulio Cesareo
- Directa Plus S.p.A. c/o ComoNExT - Science and Technology Park, 22074 Lomazzo, Como, Italy
| | - Patrick Soon-Shiong
- Nantworks LLC, Culver City, 9920 Jefferson Boulevard, California, CA 90230, USA
| | - Michela Sali
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCSS, Largo A. Gemelli, 8 00168 Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie - Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
| | - Massimiliano Papi
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
- Fondazione Policlinico Universitario "A. Gemelli" IRCSS, Largo A. Gemelli, 8 00168 Rome, Italy
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25
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Kisielinski K, Giboni P, Prescher A, Klosterhalfen B, Graessel D, Funken S, Kempski O, Hirsch O. Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4344. [PMID: 33923935 PMCID: PMC8072811 DOI: 10.3390/ijerph18084344] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/12/2022]
Abstract
Many countries introduced the requirement to wear masks in public spaces for containing SARS-CoV-2 making it commonplace in 2020. Up until now, there has been no comprehensive investigation as to the adverse health effects masks can cause. The aim was to find, test, evaluate and compile scientifically proven related side effects of wearing masks. For a quantitative evaluation, 44 mostly experimental studies were referenced, and for a substantive evaluation, 65 publications were found. The literature revealed relevant adverse effects of masks in numerous disciplines. In this paper, we refer to the psychological and physical deterioration as well as multiple symptoms described because of their consistent, recurrent and uniform presentation from different disciplines as a Mask-Induced Exhaustion Syndrome (MIES). We objectified evaluation evidenced changes in respiratory physiology of mask wearers with significant correlation of O2 drop and fatigue (p < 0.05), a clustered co-occurrence of respiratory impairment and O2 drop (67%), N95 mask and CO2 rise (82%), N95 mask and O2 drop (72%), N95 mask and headache (60%), respiratory impairment and temperature rise (88%), but also temperature rise and moisture (100%) under the masks. Extended mask-wearing by the general population could lead to relevant effects and consequences in many medical fields.
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Affiliation(s)
| | | | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy (MOCA), Wendlingweg 2, 52074 Aachen, Germany;
| | - Bernd Klosterhalfen
- Institute of Pathology, Dueren Hospital, Roonstrasse 30, 52351 Dueren, Germany;
| | - David Graessel
- Institute of Neuroscience and Medicine, Forschungszentrum Jülich, 52425 Jülich, Germany;
| | | | - Oliver Kempski
- Institute of Neurosurgical Pathophysiology, University Medical Centre of the Johannes Gutenberg University of Mainz Langenbeckstr. 1, 55131 Mainz, Germany;
| | - Oliver Hirsch
- Department of Psychology, FOM University of Applied Sciences, 57078 Siegen, Germany
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26
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Patel SN, Hsu J, Sivalingam MD, Chiang A, Kaiser RS, Mehta S, Park CH, Regillo CD, Sivalingam A, Vander JF, Ho AC, Garg SJ. The Impact of Physician Face Mask Use on Endophthalmitis After Intravitreal Anti-Vascular Endothelial Growth Factor Injections. Am J Ophthalmol 2021; 222:194-201. [PMID: 32888902 PMCID: PMC7462768 DOI: 10.1016/j.ajo.2020.08.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the effect of physician face mask use on rates and outcomes of postinjection endophthalmitis. DESIGN Retrospective, comparative cohort study. METHODS Setting: Single-center. StudyPopulation: Eyes receiving intravitreal anti-vascular endothelial growth factor injections from July 1, 2013, to September 1, 2019. INTERVENTION Cases were divided into "Face Mask" group if face masks were worn by the physician during intravitreal injections or "No Talking" group if no face mask was worn but a no-talking policy was observed during intravitreal injections. MainOutcomeMeasures: Rate of endophthalmitis, visual acuity, and microbial spectrum. RESULTS Of 483,622 intravitreal injections administered, 168 out of 453,460 (0.0371%) cases of endophthalmitis occurred in the No Talking group, and 9 out of 30,162 (0.0298%) cases occurred in the Face Mask group (odds ratio, 0.81; 95% confidence interval, 0.41-1.57; P = .527). Sixteen cases of oral flora-associated endophthalmitis were found in the No Talking group (1 in 28,341 injections), compared to none in the Face Mask group (P = .302). Mean logMAR visual acuity at presentation in cases that developed culture-positive endophthalmitis was significantly worse in the No Talking group compared to the Face Mask group (17.1 lines lost from baseline acuity vs 13.4 lines lost; P = .031), though no difference was observed at 6 months after treatment (P = .479). CONCLUSION Physician face mask use did not influence the risk of postinjection endophthalmitis compared to a no-talking policy. However, no cases of oral flora-associated endophthalmitis occurred in the Face Mask group. Future studies are warranted to assess the role of face mask use to reduce endophthalmitis risk, particularly attributable to oral flora.
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Affiliation(s)
- Samir N Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jason Hsu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Meera D Sivalingam
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Allen Chiang
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Richard S Kaiser
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sonia Mehta
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Carl H Park
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Carl D Regillo
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Arunan Sivalingam
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - James F Vander
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Allen C Ho
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sunir J Garg
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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27
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Gund M, Isack J, Hannig M, Thieme-Ruffing S, Gärtner B, Boros G, Rupf S. Contamination of surgical mask during aerosol-producing dental treatments. Clin Oral Investig 2020; 25:3173-3180. [PMID: 33108485 PMCID: PMC7590255 DOI: 10.1007/s00784-020-03645-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022]
Abstract
Objectives Surgical masks are usually contaminated during dental treatment. So far it has not been investigated whether a surgical mask itself can be a source of microbial transmission. The aim of this study was therefore to investigate the microbiological contamination of surgical masks during dental treatment and the transfer of microorganisms from the mask to the hands. Materials and methods Five dental treatment modalities were studied: carious cavity preparation (P-caries, n = 10), tooth substance preparation (P-tooth, n = 10), trepanation and root canal treatment (P-endo, n = 10), supragingival ultrasonic application (US-supra, n = 10), and subgingival periodontal ultrasonic instrumentation (US-sub, n = 10). Bacterial contamination of mask and gloves worn during treatment was tested by imprinting on agar plates. Additionally, before masks were tested, their outer surface was touched with a new sterile glove. This glove was also imprinted on agar. Bacteria were identified by MALDI TOF mass spectrometry. Colony-forming units (CFU) were scored: score 0: 0 CFU, score 1: < 102 CFU, score 2: > 102 CFU, score 3: dense microbial growth. Results All masks and all gloves used during treatment displayed bacterial contamination (sample scores 0/1/2/3: masks 0/46/3/1 and gloves 0/31/10/9). After touching the masks with new sterile gloves, microorganisms were recovered with the following contamination scores: P-caries: 4/6/0/0, P-tooth: 2/8/0/0: P-endo: 7/3/0/0, US-supra: 0/9/1/0, US-sub: 2/8/0/0. No statistically significant differences were detected between the treatment modalities. Streptococci spp. and Staphylococci spp. representing the oral and cutaneous flora dominated. Conclusions Surgical masks are contaminated after aerosol-producing dental treatment procedures. Used masks have a potential to be a source of bacterial contamination of the hands. Clinical relevance Dental staff should avoid touching the outer surface of masks with their hands to prevent transmission of pathogens. It is recommendable to change the mask after each treated patient followed by hand disinfection.
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Affiliation(s)
- Madline Gund
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Saarland University Hospital, Kirrberger Str. 100, Building 73, 66421, Homburg/Saar, Germany
| | - Jonas Isack
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Saarland University Hospital, Kirrberger Str. 100, Building 73, 66421, Homburg/Saar, Germany
| | - Matthias Hannig
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Saarland University Hospital, Kirrberger Str. 100, Building 73, 66421, Homburg/Saar, Germany
| | - Sigrid Thieme-Ruffing
- Institute of Medical Microbiology and Hygiene, Department of Hospital Hygiene, Saarland University, Homburg, Germany
| | - Barbara Gärtner
- Institute of Medical Microbiology and Hygiene, Department of Hospital Hygiene, Saarland University, Homburg, Germany
| | - Gabor Boros
- Department of Oral Surgery, German Armed Forces Central Hospital, Koblenz, Germany
| | - Stefan Rupf
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Saarland University Hospital, Kirrberger Str. 100, Building 73, 66421, Homburg/Saar, Germany.
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28
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Maurer L, Peris D, Kerl J, Guenther F, Koehler D, Dellweg D. Community Masks During the SARS-CoV-2 Pandemic: Filtration Efficacy and Air Resistance. J Aerosol Med Pulm Drug Deliv 2020; 34:11-19. [PMID: 32975460 DOI: 10.1089/jamp.2020.1635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Many countries have introduced a compulsory use of community masks for certain public areas during the SARS-CoV-2 pandemic. Different manufacturers offer reusable community masks in large quantities. The efficacy of these masks, however, is unknown. Method: We tested available community masks of major manufactures and determined the filtration efficacy using radioactive aerosol particles as well as air resistance with a vacuum measurement. Results: Filtration efficacy of the tested reusable community masks ranged from 34.9% ± 1.25% to 88.7% ± 1.18%. Air resistance ranged from 4.3 ± 0.06 to 122.4 ± 0.12 Pa/cm2. There was a good correlation between filtration efficacy and air resistance (Pearson correlation 0.938, p < 0.0001). Conclusions: Filtration efficacy and air resistance differ significantly between the different community masks, but the two measurements correlate well with each other within the entire test series. For optimal protection, one should select a rather airtight mask. When selecting a mask, the highest level of tolerable air resistance can be used as a selection criterion.
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Affiliation(s)
- Lukas Maurer
- Philipps Universität Marburg, Marburg, Deutschland
| | - Davide Peris
- Department of Pulmonary Medicine, Kloster Grafschaft, Schmallenberg, Deutschland
| | - Jens Kerl
- Philipps Universität Marburg, Marburg, Deutschland.,Department of Pulmonary Medicine, Kloster Grafschaft, Schmallenberg, Deutschland
| | - Frank Guenther
- Philipps Universität Marburg, Institution for Microbiology and Hygiene, Marburg, Deutschland
| | - Dieter Koehler
- Department of Pulmonary Medicine, Kloster Grafschaft, Schmallenberg, Deutschland
| | - Dominic Dellweg
- Philipps Universität Marburg, Marburg, Deutschland.,Department of Pulmonary Medicine, Kloster Grafschaft, Schmallenberg, Deutschland
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29
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Jayaweera M, Perera H, Gunawardana B, Manatunge J. Transmission of COVID-19 virus by droplets and aerosols: A critical review on the unresolved dichotomy. ENVIRONMENTAL RESEARCH 2020; 188:109819. [PMID: 32569870 PMCID: PMC7293495 DOI: 10.1016/j.envres.2020.109819] [Citation(s) in RCA: 610] [Impact Index Per Article: 152.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/01/2020] [Accepted: 06/10/2020] [Indexed: 05/07/2023]
Abstract
The practice of social distancing and wearing masks has been popular worldwide in combating the contraction of COVID-19. Undeniably, although such practices help control the COVID-19 pandemic to a greater extent, the complete control of virus-laden droplet and aerosol transmission by such practices is poorly understood. This review paper intends to outline the literature concerning the transmission of virus-laden droplets and aerosols in different environmental settings and demonstrates the behavior of droplets and aerosols resulted from a cough-jet of an infected person in various confined spaces. The case studies that have come out in different countries have, with prima facie evidence, manifested that the airborne transmission plays a profound role in contracting susceptible hosts. The infection propensities in confined spaces (airplane, passenger car, and healthcare center) by the transmission of droplets and aerosols under varying ventilation conditions were discussed. Interestingly, the nosocomial transmission by airborne SARS-CoV-2 virus-laden aerosols in healthcare facilities may be plausible. Hence, clearly defined, science-based administrative, clinical, and physical measures are of paramount importance to eradicate the COVID-19 pandemic from the world.
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Affiliation(s)
- Mahesh Jayaweera
- Department of Civil Engineering, University of Moratuwa, Sri Lanka.
| | - Hasini Perera
- Department of Forestry and Environmental Science, University of Sri Jayewardenepura, Sri Lanka
| | | | - Jagath Manatunge
- Department of Civil Engineering, University of Moratuwa, Sri Lanka
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30
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Li T, Liu Y, Li M, Qian X, Dai SY. Mask or no mask for COVID-19: A public health and market study. PLoS One 2020; 15:e0237691. [PMID: 32797067 PMCID: PMC7428176 DOI: 10.1371/journal.pone.0237691] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/31/2020] [Indexed: 12/18/2022] Open
Abstract
Efficient strategies to contain the coronavirus disease 2019 (COVID-19) pandemic are peremptory to relieve the negatively impacted public health and global economy, with the full scope yet to unfold. In the absence of highly effective drugs, vaccines, and abundant medical resources, many measures are used to manage the infection rate and avoid exhausting limited hospital resources. Wearing masks is among the non-pharmaceutical intervention (NPI) measures that could be effectively implemented at a minimum cost and without dramatically disrupting social practices. The mask-wearing guidelines vary significantly across countries. Regardless of the debates in the medical community and the global mask production shortage, more countries and regions are moving forward with recommendations or mandates to wear masks in public. Our study combines mathematical modeling and existing scientific evidence to evaluate the potential impact of the utilization of normal medical masks in public to combat the COVID-19 pandemic. We consider three key factors that contribute to the effectiveness of wearing a quality mask in reducing the transmission risk, including the mask aerosol reduction rate, mask population coverage, and mask availability. We first simulate the impact of these three factors on the virus reproduction number and infection attack rate in a general population. Using the intervened viral transmission route by wearing a mask, we further model the impact of mask-wearing on the epidemic curve with increasing mask awareness and availability. Our study indicates that wearing a face mask can be effectively combined with social distancing to flatten the epidemic curve. Wearing a mask presents a rational way to implement as an NPI to combat COVID-19. We recognize our study provides a projection based only on currently available data and estimates potential probabilities. As such, our model warrants further validation studies.
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Affiliation(s)
- Tom Li
- Department of Plant Pathology and Microbiology, Texas A&M University, College Station, TX, United States of America
| | - Yan Liu
- Department of Marketing, Texas A&M University, College Station, TX, United States of America
| | - Man Li
- Department of Plant Pathology and Microbiology, Texas A&M University, College Station, TX, United States of America
| | - Xiaoning Qian
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, United States of America
| | - Susie Y. Dai
- Department of Plant Pathology and Microbiology, Texas A&M University, College Station, TX, United States of America
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Long Y, Hu T, Liu L, Chen R, Guo Q, Yang L, Cheng Y, Huang J, Du L. Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis. J Evid Based Med 2020; 13:93-101. [PMID: 32167245 PMCID: PMC7228345 DOI: 10.1111/jebm.12381] [Citation(s) in RCA: 204] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/12/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Previous meta-analyses concluded that there was insufficient evidence to determine the effect of N95 respirators. We aimed to assess the effectiveness of N95 respirators versus surgical masks for prevention of influenza by collecting randomized controlled trials (RCTs). METHODS We searched PubMed, EMbase and The Cochrane Library from the inception to January 27, 2020 to identify relevant systematic reviews. The RCTs included in systematic reviews were identified. Then we searched the latest published RCTs from the above three databases and searched ClinicalTrials.gov for unpublished RCTs. Two reviewers independently extracted the data and assessed risk of bias. Meta-analyses were conducted to calculate pooled estimates by using RevMan 5.3 software. RESULTS A total of six RCTs involving 9 171 participants were included. There were no statistically significant differences in preventing laboratory-confirmed influenza (RR = 1.09, 95% CI 0.92-1.28, P > .05), laboratory-confirmed respiratory viral infections (RR = 0.89, 95% CI 0.70-1.11), laboratory-confirmed respiratory infection (RR = 0.74, 95% CI 0.42-1.29) and influenzalike illness (RR = 0.61, 95% CI 0.33-1.14) using N95 respirators and surgical masks. Meta-analysis indicated a protective effect of N95 respirators against laboratory-confirmed bacterial colonization (RR = 0.58, 95% CI 0.43-0.78). CONCLUSION The use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory-confirmed influenza. It suggests that N95 respirators should not be recommended for general public and nonhigh-risk medical staff those are not in close contact with influenza patients or suspected patients.
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Affiliation(s)
- Youlin Long
- Chinese Evidence‐Based Medicine CenterWest China HospitalSichuan UniversityChengduP.R. China
| | - Tengyue Hu
- West China School of MedicineSichuan UniversityChengduP.R. China
| | - Liqin Liu
- West China School of MedicineSichuan UniversityChengduP.R. China
| | - Rui Chen
- School of Clinical MedicineChengdu University of Traditional Chinese MedicineChengduP.R. China
| | - Qiong Guo
- Chinese Evidence‐Based Medicine CenterWest China HospitalSichuan UniversityChengduP.R. China
| | - Liu Yang
- Chinese Evidence‐Based Medicine CenterWest China HospitalSichuan UniversityChengduP.R. China
| | - Yifan Cheng
- Chinese Evidence‐Based Medicine CenterWest China HospitalSichuan UniversityChengduP.R. China
| | - Jin Huang
- West China HospitalSichuan UniversityChengduP.R. China
| | - Liang Du
- Chinese Evidence‐Based Medicine CenterWest China HospitalSichuan UniversityChengduP.R. China
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Sachdev R, Garg K, Singh G, Mehrotra V. Is safeguard compromised? Surgical mouth mask harboring hazardous microorganisms in dental practice. J Family Med Prim Care 2020; 9:759-763. [PMID: 32318416 PMCID: PMC7113990 DOI: 10.4103/jfmpc.jfmpc_1039_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/27/2019] [Accepted: 01/08/2020] [Indexed: 11/12/2022] Open
Abstract
Context: Dental personals are more prone to acquire infections through saliva and aerosols. Surgical masks (SMs) are used by dental professionals to reduce microorganism shedding from the mouth, nose, and face of the patient. Aims: This aim of the study is to assess the bacterial and fungal presence and their prevalence over the contaminated surgical mask in dental practice. Settings and Design: This study was conducted with sample size 240 used surgical masks collected from 130 dental personnel. Subjects and Methods: A cross-sectional questionnaire survey was conducted with analysis involved inoculation of external and internal surfaces in an enrichment media for isolation of bacteria and fungi. Group of isolated bacteria and fungi were preliminarily identified by morphology and using Gram's stain and lacto-phenol cotton blue mediums. Data were analyzed using paired t-test; the significant level of P < 0.050. Results: Microbiological analysis of samples revealed bacteria Staphylococci 26.35% as a predominant species followed by Pseudomonas 17.82% and Streptococci 15.50%. Aspergillus fungal species was also present in 6.97%. Mean ± SD of bacterial and fungal contamination on inside/outside area of the used masks was 48 ± 26 and 180 ± 110 cfu/ml/piece and 14 ± 6 and 32 ± 13 cfu/ml/piece, respectively, P < 0.001. The used surgical masks from dental department personnel working outpatient dental department had relatively higher bacterial and fungal contamination than the other dental departments. Conclusions: To reduce a load of microorganism contamination in the clinical environment, more awareness campaigns should be implemented in daily routine and air quality of dental departments should be improved with necessary protective measures.
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Affiliation(s)
- Rohan Sachdev
- Department of Public Health, UWA School of Population and Global Health, University of Western Australia, Australia
| | - Kriti Garg
- Department of Oral Medicine and Radiology, Rama Dental College, Kanpur, Uttar Pradesh, India
| | - Garima Singh
- Department of Pedodontics, Rama Dental College, Kanpur, Uttar Pradesh, India
| | - Vishal Mehrotra
- Department of Oral Medicine and Radiology, Rama Dental College, Kanpur, Uttar Pradesh, India
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Patel SN, Gangaputra S, Sternberg P, Kim SJ. Prophylaxis measures for postinjection endophthalmitis. Surv Ophthalmol 2020; 65:408-420. [PMID: 31923477 DOI: 10.1016/j.survophthal.2019.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/24/2019] [Accepted: 12/30/2019] [Indexed: 12/23/2022]
Abstract
Intravitreal injections have become the most commonly performed ophthalmic procedure, transforming modern retina practice. Postinjection endophthalmitis, while rare, remains the most feared potential complication. Prophylaxis measures including topical antisepsis, hand hygiene, gloves, masks, and drapes have all been proposed to help prevent postinjection endophthalmitis; however, there remains significant variation in protocol, given the lack of agreement among retina specialists on which steps are crucial to prevent endophthalmitis. With millions of injections performed annually, collating data have helped us better understand risk factors for endophthalmitis after intravitreal injection. We summarize the consensus guidelines for intravitreal injection technique and comprehensively review the literature on prevention of postinjection endophthalmitis.
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Affiliation(s)
- Shriji N Patel
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - Sapna Gangaputra
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Paul Sternberg
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Stephen J Kim
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Varma S. Masks and respirators, selection criteria for periodontal therapy: Challenges for a periodontist during COVID-19. J Int Oral Health 2020. [DOI: 10.4103/jioh.jioh_218_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Liu Z, Yu D, Ge Y, Wang L, Zhang J, Li H, Liu F, Zhai Z. Understanding the factors involved in determining the bioburdens of surgical masks. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:754. [PMID: 32042770 DOI: 10.21037/atm.2019.11.91] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Surgical site infection (SSI) continues to be one of the most common postoperative complications. In our previous study, surgical mask (SM) bioburden was identified to be a potential source of SSI. In the present study, we investigated the factors involved in SM bioburden. Methods Bioburdens of the disposable SM (A: medical mask; B: medical surgical mask) and newly laundered cloth SM (C) were tested by immediately making an impression of the external surface of the mask on sterile culture media. SM microstructure was observed using a scanning electron microscope (SEM). Filtering efficiency and airflow resistance were evaluated with TSI Automated Filter Tester 8130 (TSI Incorporated) according to GB/19083-2010. Whether speaking during operation and washing the face pre-operatively affect SM bioburdens was also evaluated. Surgical procedures were performed in a dynamic operation room. Fifty cases of mask use were enrolled in this study. Results The bioburden of mask A was the highest. The bioburden of mask B was the lowest. Mask C possessed the lowest filtering efficiency and the highest airflow resistance. SM bioburden was higher in the speaking group. SM bioburden showed no significant difference after washing the face, despite the finding that washing could significantly reduce facial bioburden. Conclusions Multiple factors influence SM bioburdens. Mask B showed the lowest bioburden and best protection effects. Mask C is not recommended to be used, especially considering that surgeons do not wash the cloth masks daily. Unnecessary talking during operation is not recommended, and washing the face before surgery is not strictly necessary.
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Affiliation(s)
- Zhiqing Liu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Degang Yu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yuwei Ge
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Liao Wang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Jingwei Zhang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Huiwu Li
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Fengxiang Liu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Zanjing Zhai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Abstract
The literature for prevention of surgical infection related primarily to foot and ankle surgery is sparse, with most attention on total joint replacement and abdominal surgery. Attention should be paid to preoperative, intraoperative, and postoperative elements, which can have an effect on the development of postoperative infection. Although antibiotic prophylaxis typically is discussed in isolation, inclusion of this step into the process enhances the overall evaluation of surgery with respect to infection. This evolution provides for better patient outcomes and decreases the likelihood of an infection incurred after foot and ankle surgery.
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Affiliation(s)
- John Boyd
- Section of Podiatry, Department of Surgery, St. Vincent Charity Medical Center, 2322 East 22nd Street, Cleveland, OH 44115, USA.
| | - Richard Chmielewski
- Section of Podiatry, Department of Surgery, St. Vincent Charity Medical Center, 2322 East 22nd Street, Cleveland, OH 44115, USA
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