1
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Bray C, Vanberkel PT. A framework for comparing N95 and elastomeric facepiece respirators on cost and function for healthcare use during a pandemic- A literature review. Health Policy 2023; 134:104857. [PMID: 37336164 DOI: 10.1016/j.healthpol.2023.104857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 05/16/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
SARS-CoV-2 has posed implications for personal protective equipment supply. In this literature review we examine if elastomeric facepiece respirators (EFRs) are effective substitutes for N95 respirators through comparing their functionality and cost. We reviewed 30 articles which researched the advantages and disadvantages of each respirator. We compiled the reported results and found, among other things, that users favour N95 respirators for comfort but prefer EFRs for protection. EFRs are more cost effective when N95s are used as designed (single use) but mixed strategies minimize costs when N95s are reused (as practiced during shortages). Future research is needed on multicriteria analyses and to incorporate SARS-CoV-2 specific data to support future pandemic planning.
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Affiliation(s)
- Ceilidh Bray
- Dalhousie University, Industrial Engineering, PO BOX 15000, Halifax, NS B3H 4R2, Canada
| | - Peter T Vanberkel
- Dalhousie University, Industrial Engineering, PO BOX 15000, Halifax, NS B3H 4R2, Canada.
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2
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Youcharoen K, Taosiri P, Muangthong P, Poenateetai A, Sombuntham N, Dhanesuan N. Utilization of a mask fitter or micropore tape to improve the fit of a surgical mask. J Oral Sci 2022; 64:271-273. [PMID: 36070924 DOI: 10.2334/josnusd.22-0162] [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: 11/01/2022]
Abstract
PURPOSE This study aimed to test the face seal of a surgical mask modified using a custom-made mask fitter or by sealing all borders with micropore tape, in comparison to the N95 mask as a gold standard. METHODS Fifteen participants were assigned to wear an N95 mask, a surgical mask sealed with a mask fitter, and a surgical mask sealed with micropore tape. A quantitative fit test was performed using a Portacount respirator fit tester in 4 different actions: bending over, talking, moving the head from side to side, and moving the head up and down. RESULTS The N95 showed the highest overall fit factor score (134.67 ± 66.62), passing Occupational Safety and Health Administration (OSHA) standards. The surgical mask alone had the lowest overall fit factor score of 4.73 ± 3.30. Modification of the surgical mask using a mask fitter or micropore tape significantly increased the overall fit factor to 35.33 ± 14.58 and 29.33 ± 9.73, respectively. This pattern was similar for all exercises. CONCLUSION The N95 was the only mask type that passed the OSHA standard for protection. Use of a mask fitter or micropore tape significantly increased the face seal of a surgical mask. This could offer useful levels of protection during a non-aerosol dental procedure.
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Affiliation(s)
- Kwanchanok Youcharoen
- Department of Pedodontics and Preventive Dentistry, Faculty of Dentistry, Srinakharinwirot University
| | - Patchara Taosiri
- Department of Stomatology, Faculty of Dentistry, Srinakharinwirot University
| | | | - Atiya Poenateetai
- Department of Stomatology, Faculty of Dentistry, Srinakharinwirot University
| | - Nonglak Sombuntham
- Department of Pedodontics and Preventive Dentistry, Faculty of Dentistry, Srinakharinwirot University
| | - Nirada Dhanesuan
- Department of Stomatology, Faculty of Dentistry, Srinakharinwirot University
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3
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Thurman P, Zhuang E, Chen HH, McClain C, Sietsema M, Fernando R, McDiarmid MA, Hines SE. Characteristics Associated With Health Care Worker Knowledge and Confidence in Elastomeric Half-Mask Respirator Use. J Occup Environ Med 2022; 64:802-807. [PMID: 35704776 PMCID: PMC9426319 DOI: 10.1097/jom.0000000000002611] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study evaluated health care workers' (HCWs') knowledge and confidence in using elastomeric half-mask respirator (EHMR) attributes known to influence usage. METHODS Health care workers were surveyed regarding their EHMR donning and doffing experience. Respondents were categorized into competency categories based on their scores. Category differences were analyzed using χ 2 and multiple logistic regression. RESULTS Seventy-two percent showed high levels of EHMR donning and doffing knowledge and confidence (mastery); however, 21% had greater confidence than knowledge (misinformed). Respiratory therapists had greater odds of mastery than other HCWs ( P < 0.05), whereas those working in medical/surgical and pediatric units had greater odds of doubt than other HCWs ( P < 0.01). CONCLUSIONS Although most HCWs show high knowledge and confidence with EHMR use, strategies to confirm respirator use competency may ensure greater HCWs protection.
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Liu J, Ma J, Ahmed IIK, Varma DK. Effectiveness of a 3D-printed mask fitter in an Ophthalmology setting during COVID-19. CANADIAN JOURNAL OF OPHTHALMOLOGY 2022; 57:161-166. [PMID: 33838139 PMCID: PMC7972674 DOI: 10.1016/j.jcjo.2021.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/19/2021] [Accepted: 03/10/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To assess the effectiveness of a 3D-printed custom mask fitter in lieu of N95 respirators among ophthalmologists and other eye care professionals who may not be prioritized to receive N95 respirators amidst the coronavirus disease 2019 pandemic. METHODS This was a proof-of-concept study from a tertiary eye care center in Oakville, Canada. All participants underwent the N95 Qualitative Fit Test with a custom mask fitter secured over an American Society for Testing and Materials Level 3 face mask. Participants answered a 10-point Likert scale questionnaire on comfort, ease of use, and feasibility of the custom mask fitter, as well as comfort of a regular face mask. RESULTS Twenty participants were recruited. Of the 20 recruited, 18 (90%) successfully passed the fit test. The median scores for comfort, ease of use, and everyday feasibility for the custom mask fitter were 3.5, 4.5, and 3, respectively, whereas the median score for comfort of a regular face mask was 8.5. CONCLUSION A reusable, low-cost, 3D-printed custom mask fitter is a potential effective alternative to an N95 respirator among eye care professionals but may require improvement in its design and comfort. This is especially relevant in the context of a limited supply of N95 respirators amidst a global pandemic.
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Affiliation(s)
| | | | | | - Devesh K. Varma
- Correspondence to Devesh Varma, 2201 Bristol Circle, Suite 100, Oakville, ON, L6H 0J8, Canada
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5
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Rashid TU, Sharmeen S, Biswas S. Effectiveness of N95 Masks against SARS-CoV-2: Performance Efficiency, Concerns, and Future Directions. ACS CHEMICAL HEALTH & SAFETY 2022; 29:135-164. [PMID: 37556270 PMCID: PMC8768005 DOI: 10.1021/acs.chas.1c00016] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Indexed: 12/24/2022]
Abstract
The coronavirus disease 2019 (COVID-19) epidemic, which is caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has continued to spread around the world since December 2019. Healthcare workers and other medical first responders in particular need personal protective equipment to protect their respiratory system from airborne particulates, in addition to liquid splashes to the face. N95 respirator have become a critical component for reducing SARS-CoV-2 transmission and controlling the scale of the COVID-19 pandemic. However, a major dispute concerning the protective performance of N95 respirators has erupted, with a myriad of healthcare workers affected despite wearing N95 masks. This article reviews the most recent updates about the performance of N95 respirators in protecting against the SARS-CoV-2 virus in the present pandemic situation. A brief overview of the manufacturing methods, air filtration mechanisms, stability, and reusability of the mask is provided. A detailed performance evaluation of the mask is studied from an engineering point of view. This Review also reports on a comparative study about the protective performance of all commercially available surgical and respiratory masks used to combat the spread of COVID-19. With the aim of protecting healthcare providers more efficiently, we suggest some potential directions for the development of this respiratory mask that improve the performance efficiency of the mask.
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Affiliation(s)
- Taslim Ur Rashid
- Fiber and Polymer Science, Department of Textile
Engineering, Chemistry and Science, Wilson College of Textiles, North
Carolina State University, 1020 Main Campus Drive, Raleigh, North Carolina
27695, United States
- Department of Applied Chemistry and Chemical
Engineering, Faculty of Engineering and Technology, University of
Dhaka, Dhaka 1000, Bangladesh
| | - Sadia Sharmeen
- Department of Applied Chemistry and Chemical
Engineering, Faculty of Engineering and Technology, University of
Dhaka, Dhaka 1000, Bangladesh
- Chemistry Department, University of
Nebraska−Lincoln, Lincoln, Nebraska 68588, United
States
| | - Shanta Biswas
- Department of Applied Chemistry and Chemical
Engineering, Faculty of Engineering and Technology, University of
Dhaka, Dhaka 1000, Bangladesh
- Department of Chemistry, Louisiana State
University, Baton Rouge, Louisiana 70803, United
States
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6
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Martelly E, Li C, Shimada K. Moldable Mask: A Reusable, Hot Water Moldable, Additively Manufactured Mask to Be Used as an N95 Alternative. MATERIALS (BASEL, SWITZERLAND) 2021; 14:7082. [PMID: 34832483 PMCID: PMC8624460 DOI: 10.3390/ma14227082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/01/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022]
Abstract
There has been high demand for personal protective equipment (PPE) during the COVID-19 pandemic, especially N95 respirators. Unfortunately, at the early stage of the pandemic, the supply could not meet the demand for N95 respirators, leading to a shortage and unsafe reuse of this form of PPE. We developed the Moldable Mask to ease the demand for N95 respirators by creating a 3D-printed mask that uses a piece of N95 material as a filter. A sheet of N95 material could be used or one N95 respirator to be turned into two masks. The main feature of the mask is the ability to easily mold it in hot water to create a custom fit for each user. It can also be easily assembled at home with affordable materials. The final mask design was qualitatively fit tested on 13 subjects, with all subjects showing an improvement in fit with the hot water molding technique and 10 (77%) subjects passing the fit test. This shows that the Moldable Mask is a viable option for a safe, affordable N95 alternative when N95 mask supply is strained.
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Affiliation(s)
- Erica Martelly
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA; (C.L.); (K.S.)
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7
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Park JJ, Seo YB, Lee J. Fit Test for N95 Filtering Facepiece Respirators and KF94 Masks for Healthcare Workers: a Prospective Single-center Simulation Study. J Korean Med Sci 2021; 36:e140. [PMID: 34060256 PMCID: PMC8167410 DOI: 10.3346/jkms.2021.36.e140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/18/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND For protection against coronavirus disease 2019 (COVID-19), the Korean government recommended the KF94 mask or that a mask at the same level as the KF94 should be worn when contacting a patient with COVID-19. Furthermore, adequately fitted N95 respirators and KF94 masks are essential. We investigated the fit tests to determine whether healthcare workers had adequate protection with N95 respirators and KF94 masks. METHODS In this prospective single-center simulation study, five N95 respirators (two made in the USA by 3M and three made in Korea) and six KF94 masks, the Korean standard medical masks, were tested. The fit factor (FF) and leakage rate were evaluated using a two-fit test device. Adequate protection (defined as FF ≥ 100 or leakage rate ≤ 5) rates were compared between N95 respirators and KF94 masks, and between made in Korea and the 3M N95 respirators. For KF94 masks, adequate protection rates were compared before and after ear strap fixation. RESULTS Overall, 30 participants were enrolled, and 330 fit tests were performed for FF and leakage rate. Adequate protection rates of all tested N95 respirators and KF94 masks were 22.7% (n = 75) by FF and 20.6% (n = 68) by leakage rate. N95 respirators showed a significantly higher adequate protection rate than KF94 masks for FF (48.7% vs. 1.1%, P < 0.001) and leakage rate (42.0% vs. 2.8%, P < 0.001). Adequate protection rate of 3M-made N95 respirators was significantly higher than that of those made in Korea (83.3% vs. 25.6% in FF, P < 0.001; 73.3% vs. 21.1% in leakage rate, P < 0.001). In KF94 masks, after fixation of ear strap with a hook, adequate protection rate improved significantly (1.1% vs. 12.8% in FF, P < 0.001; 2.8% vs. 11.1%, P < 0.001). CONCLUSION Although adequate protection rate of N95 respirators was higher than that of KF94 masks, N95 respirator protection rate was not optimum. Thus, it is necessary to minimize exposure to risk by selecting an appropriate mask or respirator that adequately fits each person, and by wearing respirators or masks appropriately, before contacting the patients. With their superior protection rate, wearing N95 respirators is recommended instead of KF94 masks, especially when performing aerosol-generating procedures.
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Affiliation(s)
- Jin Ju Park
- Division of Infectious Diseases, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yu Bin Seo
- Division of Infectious Diseases, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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8
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Measuria HD, Verma YV, Kerstein R, Tucker S. Modified full-face snorkel mask: answer to the PPE crisis? BMJ INNOVATIONS 2021; 7:308-310. [PMID: 37556243 PMCID: PMC7789198 DOI: 10.1136/bmjinnov-2020-000468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/29/2020] [Accepted: 12/06/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Harshul D Measuria
- Department of Plastic
Surgery, Oxford University Hospitals NHS Foundation
Trust, Oxford, Oxfordshire, UK
| | - Yash V Verma
- Department of Plastic
Surgery, Oxford University Hospitals NHS Foundation
Trust, Oxford, Oxfordshire, UK
| | - Ryan Kerstein
- Department of Plastic
Surgery, Oxford University Hospitals NHS Foundation
Trust, Oxford, Oxfordshire, UK
| | - Sarah Tucker
- Department of Plastic
Surgery, Oxford University Hospitals NHS Foundation
Trust, Oxford, Oxfordshire, UK
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9
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Burton C, Coles B, Adisesh A, Smith S, Toomey E, Chan XHS, Ross L, Greenhalgh T. Performance and impact of disposable and reusable respirators for healthcare workers during pandemic respiratory disease: a rapid evidence review. Occup Environ Med 2021; 78:679-690. [PMID: 33504624 DOI: 10.1136/oemed-2020-107058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/29/2020] [Accepted: 11/20/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To synthesise evidence concerning the range of filtering respirators suitable for patient care and guide the selection and use of different respirator types. DESIGN Comparative analysis of international standards for respirators and rapid review of their performance and impact in healthcare. DATA SOURCES Websites of international standards organisations, Medline and Embase, hand-searching of references and citations. STUDY SELECTION Studies of healthcare workers (including students) using disposable or reusable respirators with a range of designs. We examined respirator performance, clinician adherence and performance, comfort and impact, and perceptions of use. RESULTS We included standards from eight authorities across Europe, North and South America, Asia and Australasia and 39 research studies. There were four main findings. First, international standards for respirators apply across workplace settings and are broadly comparable across jurisdictions. Second, effective and safe respirator use depends on proper fitting and fit testing. Third, all respirator types carry a burden to the user of discomfort and interference with communication which may limit their safe use over long periods; studies suggest that they have little impact on specific clinical skills in the short term but there is limited evidence on the impact of prolonged wearing. Finally, some clinical activities, particularly chest compressions, reduce the performance of filtering facepiece respirators. CONCLUSION A wide range of respirator types and models is available for use in patient care during respiratory pandemics. Careful consideration of performance and impact of respirators is needed to maximise protection of healthcare workers and minimise disruption to care.
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Affiliation(s)
- Christopher Burton
- Academic Unit of Primary Medical Care, The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
| | - Briana Coles
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, Leicestershire, UK
| | - Anil Adisesh
- Occupational Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Simon Smith
- Canadian Standards Biological Aerosols Group, Canadian Standards Association, Toronto, Ontario, Canada
| | - Elaine Toomey
- School of Allied Health, University of Limerick Faculty of Education and Health Sciences, Limerick, Ireland
| | - Xin Hui S Chan
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, UK
| | - Lawrence Ross
- Infectious Diseases, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
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10
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Wentworth AJ, Byrne JD, Orguc S, Sands J, Maji S, Tov C, Babaee S, Huang HW, Boyce H, Chai PR, Min S, Li C, Chu JN, Som A, Becker SL, Gala M, Chandrakasan A, Traverso G. Prospective Evaluation of the Transparent, Elastomeric, Adaptable, Long-Lasting (TEAL) Respirator. ACS Pharmacol Transl Sci 2020; 3:1076-1082. [PMID: 33330837 PMCID: PMC7671102 DOI: 10.1021/acsptsci.0c00157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Indexed: 11/28/2022]
Abstract
N95 filtering facepiece respirators (FFR) and surgical masks are essential in reducing airborne disease transmission, particularly during the COVID-19 pandemic. However, currently available FFR's and masks have major limitations, including masking facial features, waste, and integrity after decontamination. In a multi-institutional trial, we evaluated a transparent, elastomeric, adaptable, long-lasting (TEAL) respirator to evaluate success of qualitative fit test with user experience and biometric evaluation of temperature, respiratory rate, and fit of respirator using a novel sensor. There was a 100% successful fit test among participants, with feedback demonstrating excellent or good fit (90% of participants), breathability (77.5%), and filter exchange (95%). Biometric testing demonstrated significant differences between exhalation and inhalation pressures among a poorly fitting respirator, well-fitting respirator, and the occlusion of one filter of the respirator. We have designed and evaluated a transparent elastomeric respirator and a novel biometric feedback system that could be implemented in the hospital setting.
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Affiliation(s)
- Adam J. Wentworth
- Division
of Gastroenterology, Brigham and Women’s
Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Department
of Mechanical Engineering, Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States
- David
H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, United States
| | - James D. Byrne
- Division
of Gastroenterology, Brigham and Women’s
Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Department
of Mechanical Engineering, Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States
- David
H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, United States
- Harvard
Radiation Oncology Program, Brigham and
Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Sirma Orguc
- Microsystems
Technology Laboratories, Massachusetts Institute
of Technology, Cambridge, Massachusetts 02139, United States
| | - Joanna Sands
- Microsystems
Technology Laboratories, Massachusetts Institute
of Technology, Cambridge, Massachusetts 02139, United States
| | - Saurav Maji
- Microsystems
Technology Laboratories, Massachusetts Institute
of Technology, Cambridge, Massachusetts 02139, United States
| | - Caitlynn Tov
- Division
of Gastroenterology, Brigham and Women’s
Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Sahab Babaee
- Department
of Mechanical Engineering, Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States
- David
H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, United States
| | - Hen-Wei Huang
- Division
of Gastroenterology, Brigham and Women’s
Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Department
of Mechanical Engineering, Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States
- David
H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, United States
| | - Hannah Boyce
- Division
of Gastroenterology, Brigham and Women’s
Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Peter R. Chai
- David
H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, United States
- Division
of Medical Toxicology, Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical
School, Boston, Massachusetts 02115, United States
- The
Fenway Institute, Boston, Massachusetts 02215, United States
- Department
of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston Massachusetts 02215, United States
| | - Seokkee Min
- Department
of Mechanical Engineering, Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Canchen Li
- David
H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, United States
| | - Jacqueline N. Chu
- Division
of Gastroenterology, Massachusetts General
Hospital, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Avik Som
- Department
of Radiology, Massachusetts General Hospital,
Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Sarah L. Becker
- Division
of Gastroenterology, Brigham and Women’s
Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Manish Gala
- Division
of Gastroenterology, Massachusetts General
Hospital, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Anantha Chandrakasan
- Microsystems
Technology Laboratories, Massachusetts Institute
of Technology, Cambridge, Massachusetts 02139, United States
| | - Giovanni Traverso
- Division
of Gastroenterology, Brigham and Women’s
Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Department
of Mechanical Engineering, Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States
- David
H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, United States
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11
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Fakherpour A, Jahangiri M, Seif M. Qualitative fitting characteristics of filtering face-piece respirators on Iranian people. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2020; 18:587-597. [PMID: 33312585 PMCID: PMC7721967 DOI: 10.1007/s40201-020-00484-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/05/2020] [Indexed: 05/18/2023]
Abstract
To evaluate the qualitative fitting characteristics of FFRs on Iranian people. 62 participants were fit tested qualitatively by four brands of FFRs, including three imported (A, B, and C) and one domestic (D). The respirators were assigned to the participants randomly based on the Latin Square design (LSD) using the Moldex® Bitrex® Fit Test Kit. R 3.2.5.0 software was used to analyze the data. Among the respirators, A and C respirators had the lowest and highest fit test passing rates with 1.60% and 43.50%, respectively. The majority of the participants had medium face sizes (45.20%) and small and long/narrow shapes (32.20% and 32.30%). There was a significant difference between the passing rate of domestic (D) and imported (C) respirators (p value<0.001). Factors including respirator brand, style, and gender had significant effects on respirator fit (p value<0.01). There was a low fit test passing rate of the studied respirators among participants. Furthermore, 19.40% of the participants fell out of the NIOSH fit test panel. Therefore, it is required to develop a unique bivariate fit test panel and design the respirators based on the Iranian facial dimensions. Meantime, manufacturers need to provide various sizes and styles of the respirators to provide adequate respiratory protection for the users.
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Affiliation(s)
- Anahita Fakherpour
- Department of Occupational Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Jahangiri
- Department of Occupational Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Seif
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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12
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Samaranayake LP, Fakhruddin KS, Ngo HC, Chang JWW, Panduwawala C. The effectiveness and efficacy of respiratory protective equipment (RPE) in dentistry and other health care settings: a systematic review. Acta Odontol Scand 2020; 78:626-639. [PMID: 32881590 DOI: 10.1080/00016357.2020.1810769] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The global pandemic of coronavirus disease-19, caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is the latest hazard facing healthcare workers (HCW) including dental care workers (DCW). It is clear that the major mode of SARS-CoV-2 transmission is the airborne route, through inhalation of virus-infested aerosols and droplets. Several respiratory protection equipment (RPE), including masks, face shields/visors, and respirators, are available to obviate facial and conjunctival contamination by microbes. However, as their barrier value against microbial inhalation has not been evaluated, we systematically reviewed the data on the effectiveness and efficacy of facemasks and respirators, including protective eyewear, with particular emphasis on dental healthcare. MATERIAL AND METHODS PubMed, MEDLINE, the Cochrane Library, and Embase databases were searched between 01January 1990 and 15 May 2020. RESULTS Of 310 identified English language records, 21 were included as per eligibility criteria. In clinical terms, wearing layered, face-fitting masks/respirators and protective-eyewear can limit the spread of infection among HCWs. Specifically, combined interventions such as a face mask and a face shield, better resist bioaerosol inhalation than either alone. The prolonged and over-extended use of surgical masks compromise their effectiveness. CONCLUSIONS In general, RPE is effective as a barrier protection against aerosolized microbes in healthcare settings. But their filtration efficacy is compromised by the (i) inhalant particle size, (ii) airflow dynamics, (iii) mask-fit factor, (iv) period of wear, (v) 'wetness' of the masks, and (vi) their fabrication quality. The macro-data presented here should inform policy formulation on RPE wear amongst HCWs.
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Affiliation(s)
| | | | - Hien Chi Ngo
- School of Dentistry, University of Western Australia, Perth, Australia
| | - Jeffrey Wen Wei Chang
- Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Chamila Panduwawala
- Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, UAE
- Department Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, UAE
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Wahidi MM, Shojaee S, Lamb CR, Ost D, Maldonado F, Eapen G, Caroff DA, Stevens MP, Ouellette DR, Lilly C, Gardner DD, Glisinski K, Pennington K, Alalawi R. The Use of Bronchoscopy During the Coronavirus Disease 2019 Pandemic: CHEST/AABIP Guideline and Expert Panel Report. Chest 2020; 158:1268-1281. [PMID: 32361152 PMCID: PMC7252059 DOI: 10.1016/j.chest.2020.04.036] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/19/2020] [Accepted: 04/29/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) has swept the globe and is causing significant morbidity and mortality. Given that the virus is transmitted via droplets, open airway procedures such as bronchoscopy pose a significant risk to health-care workers (HCWs). The goal of this guideline was to examine the current evidence on the role of bronchoscopy during the COVID-19 pandemic and the optimal protection of patients and HCWs. STUDY DESIGN AND METHODS A group of approved panelists developed key clinical questions by using the Population, Intervention, Comparator, and Outcome (PICO) format that addressed specific topics on bronchoscopy related to COVID-19 infection and transmission. MEDLINE (via PubMed) was systematically searched for relevant literature and references were screened for inclusion. Validated evaluation tools were used to assess the quality of studies and to grade the level of evidence to support each recommendation. When evidence did not exist, suggestions were developed based on consensus using the modified Delphi process. RESULTS The systematic review and critical analysis of the literature based on six PICO questions resulted in six statements: one evidence-based graded recommendation and 5 ungraded consensus-based statements. INTERPRETATION The evidence on the role of bronchoscopy during the COVID-19 pandemic is sparse. To maximize protection of patients and HCWs, bronchoscopy should be used sparingly in the evaluation and management of patients with suspected or confirmed COVID-19 infections. In an area where community transmission of COVID-19 infection is present, bronchoscopy should be deferred for nonurgent indications, and if necessary to perform, HCWs should wear personal protective equipment while performing the procedure even on asymptomatic patients.
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Affiliation(s)
- Momen M Wahidi
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, NC.
| | - Samira Shojaee
- Department of Medicine, Divisions of Pulmonary and Critical Care and Infectious Disease, Virginia Commonwealth University, Richmond, VA
| | - Carla R Lamb
- Department of Medicine, Divisions of Pulmonary and Critical Care and Infectious Disease, Lahey Hospital and Medical Center, Burlington, MA
| | - David Ost
- Department of Medicine, Division of Pulmonary and Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Fabien Maldonado
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, Vanderbilt University, Nashville, TN
| | - George Eapen
- Department of Medicine, Division of Pulmonary and Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel A Caroff
- Department of Medicine, Divisions of Pulmonary and Critical Care and Infectious Disease, Lahey Hospital and Medical Center, Burlington, MA
| | - Michael P Stevens
- Department of Medicine, Divisions of Pulmonary and Critical Care and Infectious Disease, Virginia Commonwealth University, Richmond, VA
| | - Daniel R Ouellette
- Department of Medicine, Division of Pulmonary and Critical Care, Henry Ford Health System, Detroit, MI
| | - Craig Lilly
- Department of Medicine, Division of Pulmonary and Critical Care, University of Massachusetts, Worcester, MA
| | - Donna D Gardner
- Department of Respiratory Care, Texas State University, Round Rock, TX
| | - Kristen Glisinski
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, NC
| | - Kelly Pennington
- Department of Medicine, Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN
| | - Raed Alalawi
- Department of Medicine, Division of Pulmonary and Critical Care, University of Arizona, Phoenix, AZ
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Elastomeric respirators are safer and more sustainable alternatives to disposable N95 masks during the coronavirus outbreak. Int J Emerg Med 2020; 13:39. [PMID: 32689926 PMCID: PMC7369563 DOI: 10.1186/s12245-020-00296-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/23/2020] [Indexed: 12/26/2022] Open
Abstract
Background In this paper, the authors review the safety and practicality of elastomeric respirators for protecting themselves and others from the novel coronavirus or COVID-19. They also describe the safe donning and doffing procedures for this protective gear. Main text Due to the shortage of personal protective equipment (PPE), the CDC has recommended ways to conserve disposable N95 masks, including re-use and extended use, and reserving N95 masks for aerosol-generating procedures. However, these were never made to be re-used. Although the modes of transmission of COVID-19 are not fully understood, based on what we know about severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), droplets and aerosolized droplets contribute to the spread of this virus. More evidence from Wuhan, China, has demonstrated that COVID-19 viral particles are aerosolized and found in higher concentrations in rooms where PPE is being removed. Thus, it is best for all healthcare providers to have full aerosol protection. Conclusion Given the shortage of PPE for aerosols, it is logical to utilize reusable elastomeric respirators with filter efficiency of 95% or higher. A single elastomeric respirator may replace hundreds to thousands of new disposable N95 masks.
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Byrne JD, Wentworth AJ, Chai PR, Huang HW, Babaee S, Li C, Becker SL, Tov C, Min S, Traverso G. Injection Molded Autoclavable, Scalable, Conformable (iMASC) system for aerosol-based protection: a prospective single-arm feasibility study. BMJ Open 2020; 10:e039120. [PMID: 32641368 PMCID: PMC7342850 DOI: 10.1136/bmjopen-2020-039120] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To develop and test a new reusable, sterilisable N95 filtering facepiece respirator (FFR)-comparable face mask, known as the Injection Molded Autoclavable, Scalable, Conformable (iMASC) system, given the dire need for personal protective equipment within healthcare settings during the COVID-19 pandemic. DESIGN Single-arm feasibility study. SETTING Emergency department and outpatient oncology clinic. PARTICIPANTS Healthcare workers who have previously undergone N95 fit testing. INTERVENTIONS Fit testing of new iMASC system. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome is success of fit testing using an Occupational Safety and Health Administration (OSHA)-approved testing method, and secondary outcomes are user experience with fit, breathability and filter replacement. RESULTS Twenty-four subjects were recruited to undergo fit testing, and the average age of subjects was 41 years (range of 21-65 years) with an average body mass index of 26.5 kg/m2. The breakdown of participants by profession was 46% nurses (n=11), 21% attending physicians (n=5), 21% resident physicians (n=5) and 12% technicians (n=3). Of these participants, four did not perform the fit testing due to the inability to detect saccharin solution on premask placement sensitivity test, lack of time and inability to place mask over hair. All participants (n=20) who performed the fit test were successfully fitted for the iMASC system using an OSHA-approved testing method. User experience with the iMASC system, as evaluated using a Likert scale with a score of 1 indicating excellent and a score of 5 indicating very poor, demonstrated an average fit score of 1.75, breathability of 1.6, and ease of replacing the filter on the mask was scored on average as 2.05. CONCLUSIONS The iMASC system was shown to successfully fit multiple different face sizes and shapes using an OSHA-approved testing method. These data support further certification testing needed for use in the healthcare setting.
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Affiliation(s)
- James D Byrne
- Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Adam J Wentworth
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Peter R Chai
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hen-Wei Huang
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sahab Babaee
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Canchen Li
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Sarah L Becker
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Caitlynn Tov
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Seokkee Min
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Giovanni Traverso
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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16
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Byrne JD, Wentworth AJ, Chai PR, Huang HW, Babaee S, Li C, Becker SL, Tov C, Min S, Traverso G. Injection Molded Autoclavable, Scalable, Conformable (iMASC) system for aerosol-based protection: a prospective single-arm feasibility study. BMJ Open 2020. [PMID: 32641368 DOI: 10.1101/2020.04.03.20052688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
OBJECTIVE To develop and test a new reusable, sterilisable N95 filtering facepiece respirator (FFR)-comparable face mask, known as the Injection Molded Autoclavable, Scalable, Conformable (iMASC) system, given the dire need for personal protective equipment within healthcare settings during the COVID-19 pandemic. DESIGN Single-arm feasibility study. SETTING Emergency department and outpatient oncology clinic. PARTICIPANTS Healthcare workers who have previously undergone N95 fit testing. INTERVENTIONS Fit testing of new iMASC system. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome is success of fit testing using an Occupational Safety and Health Administration (OSHA)-approved testing method, and secondary outcomes are user experience with fit, breathability and filter replacement. RESULTS Twenty-four subjects were recruited to undergo fit testing, and the average age of subjects was 41 years (range of 21-65 years) with an average body mass index of 26.5 kg/m2. The breakdown of participants by profession was 46% nurses (n=11), 21% attending physicians (n=5), 21% resident physicians (n=5) and 12% technicians (n=3). Of these participants, four did not perform the fit testing due to the inability to detect saccharin solution on premask placement sensitivity test, lack of time and inability to place mask over hair. All participants (n=20) who performed the fit test were successfully fitted for the iMASC system using an OSHA-approved testing method. User experience with the iMASC system, as evaluated using a Likert scale with a score of 1 indicating excellent and a score of 5 indicating very poor, demonstrated an average fit score of 1.75, breathability of 1.6, and ease of replacing the filter on the mask was scored on average as 2.05. CONCLUSIONS The iMASC system was shown to successfully fit multiple different face sizes and shapes using an OSHA-approved testing method. These data support further certification testing needed for use in the healthcare setting.
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Affiliation(s)
- James D Byrne
- Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, Massachusetts, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Adam J Wentworth
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Peter R Chai
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hen-Wei Huang
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sahab Babaee
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Canchen Li
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Sarah L Becker
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Caitlynn Tov
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Seokkee Min
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Giovanni Traverso
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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Park SH. Personal Protective Equipment for Healthcare Workers during the COVID-19 Pandemic. Infect Chemother 2020; 52:165-182. [PMID: 32618146 PMCID: PMC7335655 DOI: 10.3947/ic.2020.52.2.165] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease (COVID-19) pandemic has posed a challenge for healthcare systems, and healthcare workers (HCWs) are at high risk of exposure. Protecting HCWs is of paramount importance to maintain continuous patient care and keep healthcare systems functioning. Used alongside administrative and engineering control measures, personal protective equipment (PPE) is the last line of defense and the core component of protection. Current data suggest that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is mainly transmitted through respiratory droplets and close contact. Airborne transmission may occur during aerosol-generating procedures. However, the modes of transmission still remain uncertain, especially regarding the possibility of airborne transmission when aerosol-generating procedures are not performed. Thus, there are some inconsistencies in the respiratory protective equipment recommended by international and national organizations. In Korea, there have been several modifications to PPE recommendations offering options in choosing PPE for respiratory and body protection, which confuses HCWs; they are often unsure what to wear and when to wear it. The choice of PPE is based on the risk of exposure and possible modes of transmission. The level of protection provided by PPE differs based on standards and test methods. Thus, understanding them is the key in selecting the proper PPE. This article reviews evidence on the mode of SARS-CoV-2 transmission, compares the current PPE recommendations of the World Health Organization with those in Korea, and discusses standard requirements and the proper selection of PPE.
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Affiliation(s)
- Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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18
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Suen LKP, Guo YP, Ho SSK, Au-Yeung CH, Lam SC. Comparing mask fit and usability of traditional and nanofibre N95 filtering facepiece respirators before and after nursing procedures. J Hosp Infect 2019; 104:336-343. [PMID: 31545991 DOI: 10.1016/j.jhin.2019.09.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/08/2019] [Accepted: 09/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The reliability of N95 filtering facepiece respirators (FFRs) depends on correct fitting. The perceived usability of FFRs is equally important because discomfort during usage may affect compliance. Body movements during nursing procedures may also increase the risk of face seal leakage. AIM To evaluate the mask fit and usability of the best-fitting 3M N95 FFR and the nanofibre N95 FFR before and after nursing procedures. The physical properties of these FFRs were also examined. METHODS This experimental study had a one-group multiple comparison design. In total, 104 nursing students participated, and performed nursing procedures for 10 min when wearing the best-fitting 3M FFR and the nanofibre FFR. Mask fit and perceived usability of the FFRs were evaluated. FINDINGS More participants failed to obtain a fit factor ≥100 when using the best-fitting 3M FFR than when wearing the nanofibre FFR (33.7% vs 21.2%) after the procedures (P=0.417). The nanofibre FFR also demonstrated higher usability than the 3M FFRs in terms of facial heat, breathability, facial pressure, speech intelligibility, itchiness, difficulty of maintaining the mask in place, and comfort level (P<0.001). The nanofibre FFR was also lighter, thinner and had slightly higher bacterial filtration efficiency than the 3M FFRs. CONCLUSION The nanofibre FFR demonstrated significantly better usability than the 3M FFRs. None of the respirators were able to provide consistent protection for the wearer, as detected by face seal leakage after performing nursing procedures. Further improvement in the prototype design is needed to increase compliance and ensure the respiratory protection of users.
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Affiliation(s)
- L K P Suen
- Squina International Centre for Infection Control, School of Nursing, The Hong Kong Polytechnic University, HungHom, Hong Kong.
| | - Y P Guo
- Squina International Centre for Infection Control, School of Nursing, The Hong Kong Polytechnic University, HungHom, Hong Kong
| | - S S K Ho
- Squina International Centre for Infection Control, School of Nursing, The Hong Kong Polytechnic University, HungHom, Hong Kong
| | - C H Au-Yeung
- Squina International Centre for Infection Control, School of Nursing, The Hong Kong Polytechnic University, HungHom, Hong Kong
| | - S C Lam
- Squina International Centre for Infection Control, School of Nursing, The Hong Kong Polytechnic University, HungHom, Hong Kong
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Suen LK, Yang L, Ho SS, Fung KH, Boost MV, Wu CS, Au-Yeung CH, O'Donoghue M. Reliability of N95 respirators for respiratory protection before, during, and after nursing procedures. Am J Infect Control 2017; 45:974-978. [PMID: 28526306 DOI: 10.1016/j.ajic.2017.03.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The adequate fit of an N95 respirator is important for health care workers to reduce the transmission of airborne infectious diseases in the clinical setting. This study aimed to evaluate whether adequately sealed N95 respirators may provide consistent protection for the wearer while performing nursing procedures. METHODS Participants were a group of nursing students (N = 120). The best fitting respirator for these participants was identified from the 3 common models, 1860, 1860S, and 1870+ (3M), using the quantitative fit test (QNFT) method. Participants performed nursing procedures for 10-minute periods while wearing a backpack containing the portable aerosol spectrometers throughout the assessment to detect air particles inside the respirator. RESULTS The average fit factor of the best fitting respirator worn by the participants dropped significantly after nursing procedures (184.85 vs 134.71) as detected by the QNFT. In addition, significant differences in particle concentration of different sizes (>0.3, >0.4, >1.0, and >4.0 µm) inside the respirator were detected by the portable aerosol spectrometers before, during, and after nursing procedures. CONCLUSIONS Body movements during nursing procedures may increase the risk of face seal leakage. Further research, including the development of prototype devices for better respirator fit, is necessary to improve respiratory protection of users.
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Hon CY, Danyluk Q, Bryce E, Janssen B, Neudorf M, Yassi A, Shen H, Astrakianakis G. Comparison of qualitative and quantitative fit-testing results for three commonly used respirators in the healthcare sector. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2017; 14:175-179. [PMID: 27717300 DOI: 10.1080/15459624.2016.1237030] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
N95 filtering facepiece respirators are used by healthcare workers when there is a risk of exposure to airborne hazards during aerosol-generating procedures. Respirator fit-testing is required prior to use to ensure that the selected respirator provides an adequate face seal. Two common fit-test methods can be employed: qualitative fit-test (QLFT) or quantitative fit-test (QNFT). Respiratory protection standards deem both fit-tests to be acceptable. However, previous studies have indicated that fit-test results may differ between QLFT and QNFT and that the outcomes may also be influenced by the type of respirator model. The aim of this study was to determine if there is a difference in fit-test outcomes with our suite of respirators, 3M - 1860S, 1860, AND 1870, and whether the model impacts the fit-test results. Subjects were recruited from residential care facilities. Each participant was assigned a respirator and underwent sequential QLFT and QNFT fit-tests and the results (either pass or fail) were recorded. To ascertain the degree of agreement between the two fit-tests, a Kappa (Κ) statistic was conducted as per the American National Standards Institute (ANSI) respiratory protection standard. The pass-fail rates were stratified by respirator model and a Kappa statistic was calculated for each to determine effect of model on fit-test outcomes. We had 619 participants and the aggregate Κ statistic for all respirators was 0.63 which is below the suggested ANSI threshold of 0.70. There was no statistically significant difference in results when stratified by respirator model. QNFT and QLFT produced different fit-test outcomes for the three respirator models examined. The disagreement in outcomes between the two fit-test methods with our suite of N95 filtering facepiece respirators was approximately 12%. Our findings may benefit other healthcare organizations that use these three respirators.
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Affiliation(s)
- Chun-Yip Hon
- a Worksafe and Wellness, Vancouver Coastal Health , Vancouver , British Columbia , Canada
- b School of Occupational and Public Health, Ryerson University , Toronto , Ontario , Canada
| | - Quinn Danyluk
- c Workplace Health, Fraser Health , Surrey , British Columbia , Canada
| | - Elizabeth Bryce
- d Medical Microbiology and Infection Control, Vancouver Coastal Health , Vancouver , British Columbia , Canada
| | - Bob Janssen
- e Policy, Regulation & Research Division, WorkSafeBC , Richmond , British Columbia , Canada
| | - Mike Neudorf
- c Workplace Health, Fraser Health , Surrey , British Columbia , Canada
| | - Annalee Yassi
- f School of Population and Public Health, University of British Columbia , Vancouver , British Columbia , Canada
| | - Hui Shen
- f School of Population and Public Health, University of British Columbia , Vancouver , British Columbia , Canada
| | - George Astrakianakis
- f School of Population and Public Health, University of British Columbia , Vancouver , British Columbia , Canada
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21
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Wound Infection Surveillance of War Wounds in British Forces Personnel. Prehosp Disaster Med 2017. [DOI: 10.1017/s1049023x00024109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Mitchell BG, Wells A, McGregor A, McKenzie D. Can homemade fit testing solutions be as effective as commercial products? ACTA ACUST UNITED AC 2016; 17:111-114. [PMID: 32288839 PMCID: PMC7129124 DOI: 10.1071/hi12019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 08/14/2012] [Indexed: 11/25/2022]
Abstract
Background Fit testing is used to determine whether a N95 mask will provide respiratory protection for the wearer by preventing inhalation of airborne transmitted microorganisms. National guidelines recommend that healthcare workers (HCW) who use N95 masks require fit testing. Quantitative fit testing requires the purchasing and use of fit testing solutions and associated equipment. In high volume, these solutions are expensive and may not be readily available, as was seen in the 2009 H1N1 influenza pandemic. The aim of this study was to determine how a homemade solution compared against a commercially available product and a placebo. Methods Afit test was performed on the same person, on three separate occasions, using three different solutions – commercial (45% sodium saccharin), homemade (to be disclosed) and placebo (water). The solution was double blinded and solutions were chosen and administered in a random order. Results Atotal of 48 people participated in this study.At the threshold testing stage, 8.3% did not taste any solution, 16.7% of people could taste the placebo, 89.6% could taste the commercial solution and 91.7% could taste the homemade solution. All persons who could taste the commercial solution could taste homemade solution. Conclusion The findings of our study suggest that fit testing solutions could be made locally with a similar effect to that of commercial products, that quantitative fit testing is unreliable and that serious consideration should be given to the role of quantitative fit testing in future guidelines and standards. We recommend that this study be conducted on a larger scale to support our findings.
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Affiliation(s)
- Brett G Mitchell
- Tasmanian Infection Prevention and Control Unit, PO Box 125, Hobart, Tas. 7001, Australia.,Australian Catholic University, School of Nursing Midwifery and Paramedicine, PO Box 256, Dickson, ACT 2602, Australia.,University of Tasmania, School of Nursing and Midwifery, Private Bag 135, Hobart, Tas. 7000, Australia
| | - Anne Wells
- Tasmanian Infection Prevention and Control Unit, PO Box 125, Hobart, Tas. 7001, Australia
| | - Alistair McGregor
- Tasmanian Infection Prevention and Control Unit, PO Box 125, Hobart, Tas. 7001, Australia.,Department of Infectious Diseases, Royal Hobart Hospital, PO Box 1061, Hobart, Tas. 7001, Australia
| | - Duncan McKenzie
- Department of Pharmacy, Royal Hobart Hospital, PO Box 1061, Hobart, Tas. 7001, Australia
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Abstract
OVERVIEW In 2014, the authors published the results of a study investigating nurses' use of personal protective equipment (PPE) in the care of a live simulated patient requiring contact and airborne precautions. The 24 participants were video-recorded as they donned and doffed PPE. Variations in practices that had the potential to cause contamination were noted. In this article, the authors comment on those variations, analyzing each element of proper PPE protocols and examining why the behaviors are a safety concern for the nurse and a potential risk for disease transmission in the hospital or other clinical area. The authors note that making use of reflective practice for complicated care situations such as infection control may help nurses improve decision making in isolation care.
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Shaffer RE, Janssen LL. Selecting models for a respiratory protection program: what can we learn from the scientific literature? Am J Infect Control 2015; 43:127-32. [PMID: 25499425 DOI: 10.1016/j.ajic.2014.10.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 10/23/2014] [Accepted: 10/23/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND An unbiased source of comparable respirator performance data would be helpful in setting up a hospital respiratory protection program. METHODS The scientific literature was examined to assess the extent to which performance data (respirator fit, comfort and usability) from N95 filtering facepiece respirator (FFR) models are available to assist with FFR model selection and procurement decisions. RESULTS Ten studies were identified that met the search criteria for fit, whereas 5 studies met the criteria for comfort and usability. CONCLUSION Analysis of these studies indicated that it is difficult to directly use the scientific literature to inform the FFR selection process because of differences in study populations, methodologies, and other factors. Although there does not appear to be a single best fitting FFR, studies demonstrate that fit testing programs can be designed to successfully fit nearly all workers with existing products. Comfort and usability are difficult to quantify. Among the studies found, no significant differences were noted.
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Iaco GD, Puro V, Fusco FM, Schilling S, Maltezou HC, Brouqui P, Gottschalk R, Bannister B, Brodt HR, Siikamaki H, Perronne C, Brantsæter AB, Fjellet AL, Ippolito G. Personal Protective Equipment Management and Policies: European Network for Highly Infectious Diseases Data from 48 Isolation Facilities in 16 European Countries. Infect Control Hosp Epidemiol 2015; 33:1008-16. [DOI: 10.1086/667729] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective.To collect data about personal protective equipment (PPE) management and to provide indications for improving PPE policies in Europe.Design.Descriptive, cross-sectional survey.Setting and Participants.Data were collected in 48 isolation facilities in 16 European countries nominated by National Health Authorities for the management of highly infectious diseases (HIDs).Methods.Data were collected through standardized checklists at on-site visits during February-November 2009. Indications for adequate PPE policies were developed on the basis of a literature review, partners' expert opinions, and the collected data.Results.All facilities have procedures for the selection of PPE in case of HID, and 44 have procedures for the removal of PPE. In 40 facilities, different levels of PPE are used according to a risk assessment process, and in 8 facilities, high-level PPE (eg, positive-pressure complete suits or Trexler units) is always used. A fit test is performed at 25 of the 40 facilities at which it is applicable, a seal check is recommended at 25, and both procedures are used at 17. Strategies for promoting and monitoring the correct use of PPE are available at 42 facilities. In case of a sudden increase in demand, 44 facilities have procedures for rapid supply of PPE, whereas 14 facilities have procedures for decontamination and reuse of some PPE.Conclusions.Most isolation facilities devote an acceptable level of attention to PPE selection and removal, strategies for the promotion of the correct use of PPE, and ensuring adequate supplies of PPE. Fit test and seal check procedures are still not widely practiced. Moreover, policies vary widely between and within European countries, and the development of common practice procedures is advisable.Infect Control Hosp Epidemiol 2012;33(10):1008-1016
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Harber P, Su J, Hu CC. Persistence of respirator use learning. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2014; 11:826-832. [PMID: 24847912 DOI: 10.1080/15459624.2014.925115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Although retraining and repeat fit-testing are needed for respirator users, the optimal frequency is uncertain. The persistence of proper respirator donning/doffing techniques and changes in quantitative fit factor over 6 months after initial training were measured in this study. Initial training was designed for rapid rollout situations in which direct contact with well-trained occupational health professionals may be infeasible. Subjects (n = 175) were assigned randomly to use either a filtering facepiece N95 (FFR) or dual cartridge half facemask (HFM) respirator. Each was assigned randomly to one of three training methods-printed brochure, video, or computer-based training. Soon after initial training, quantitative fit and measures of proper technique were determined. These measurements were repeated 6 months later. In the six-month followup, subjects were randomized to receive either a brief reminder card or a placebo card. Total performance score, major errors, and quantitative fit all became significantly worse at 6 months. An individual's result soon after training was the most important predictor of performance 6 months later. There was a marginal not statistically significant tendency for those initially trained by video to have better protection 6 months later. The study suggests that persons who use respirators intermittently should be thoroughly retrained and reevaluated periodically. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: Additional statistical analyses.
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Affiliation(s)
- Philip Harber
- a Community, Environment, and Policy Division, Mel and Enid Zuckerman College of Public Health , University of Arizona , Tucson , Arizona
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Roberge RJ, Palmiero AJ, Liu Y, Kim JH, Zhuang Z. Effect of upper strap downward displacement on n95 filtering facepiece respirator fit factors: a pilot study. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2014; 11:338-341. [PMID: 24274974 PMCID: PMC4466548 DOI: 10.1080/15459624.2013.866716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Fifteen subjects underwent three replicates of quantitative respirator fit-testing with N95 filtering facepiece respirators that were donned with the upper strap high on the occiput, as per the manufacturers' donning instructions. Each fit-test was immediately followed by repeat fit-testing with the upper strap downwardly displaced to the level of the ear sulcus to determine any change in fit factors that might occur with upper strap downward slippage. A total of 35/45 (78%) initial fit-tests had a passing score (fit factor ≥ 100) with the top strap high on the occiput and 33/35 (94%) of these passed subsequent fit-testing after the top strap was displaced downward to the ear sulcus. Geometric mean fit factors for the initial passed fit-tests, and following downward strap displacement, were 217 ± 1.6 and 207 ± 1.9, respectively (p = 0.64). Downward displacement of the top strap did not significantly impact fit factors of N95 FFRs that had previously passed fit-testing.
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Affiliation(s)
- Raymond J Roberge
- a National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Pittsburgh , Pennsylvania
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Ciotti C, Pellissier G, Rabaud C, Lucet JC, Abiteboul D, Bouvet E. Effectiveness of respirator masks for healthcare workers, in France. Med Mal Infect 2012; 42:264-9. [PMID: 22683102 DOI: 10.1016/j.medmal.2012.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 02/09/2012] [Accepted: 05/01/2012] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The authors had for objective to evaluate the air-tightness of FFP2 respirator masks used by healthcare workers, with a quantitative fit-test protocol. MATERIALS AND METHODS This test measures the number of ambient particles inside and outside the respirator mask. The ratio between both is called fit-factor. The fit-test is successful for an FFP2 respirator mask when the fit-factor is equal or superior to 100. The tests were performed in three hospitals. Nine types of FFP2 respirator masks were fit-tested, classified in three groups: hard shell, duckbill, and flat-fold respirator masks. RESULTS One hundred and eighty fit-tests were performed. Less than a third of the fit-tests were successful (35/130). The rate of successful tests was higher with flat-fold (57.5%, 23/40) than with duckbill (18.3%, 11/60), or hard shell respirator masks (3.3%, 1/30), (P<0.05). Zero to 60% of healthcare workers had a successful fit-test with the respirator masks used in each hospital. This percentage increased with the number of tested respirator masks. No 100% success rate was ever reached in any hospital with the three tested respirator masks. CONCLUSION Duckbill, and flat-fold respirator masks seem to be better adapted for healthcare workers than hard shell respirator masks. It seems necessary to implement new recommendations for respiratory protection in France. At least two types of respirator masks with various sizes and shape should be available and fitting controls should be performed with respirator masks that are worn by healthcare workers exposed to infectious risks.
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Affiliation(s)
- C Ciotti
- Groupe d'Étude sur le Risque d'Exposition des Soignants aux Agents Infectieux-GERES, Faculté de Médecine Xavier-Bichat, 16 Rue Henri-Huchard, 75018 Paris, France.
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Watson CM, Duval-Arnould JM, McCrory MC, Froz S, Connors C, Perl TM, Hunt EA. Simulated pediatric resuscitation use for personal protective equipment adherence measurement and training during the 2009 influenza (H1N1) pandemic. Jt Comm J Qual Patient Saf 2012; 37:515-23. [PMID: 22132664 PMCID: PMC7185510 DOI: 10.1016/s1553-7250(11)37066-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Previous experience with simulated pediatric cardiac arrests (that is, mock codes) suggests frequent deviation from American Heart Association (AHA) basic and advanced life support algorithms. During highly infectious outbreaks, acute resuscitation scenarios may also increase the risk of insufficient personal protective equipment (PPE) use by health care workers (HCWs). Simulation was used as an educational tool to measure adherence with PPE use and pediatric resuscitation guidelines during simulated cardiopulmonary arrests of 2009 influenza A patients. Methods A retrospective, observational study was performed of 84 HCWs participating in 11 in situ simulations in June 2009. Assessment included (1) PPE adherence, (2) confidence in PPE use, (3) elapsed time to specific resuscitation maneuvers, and (4) deviation from AHA guidelines. Results Observed adherence with PPE use was 61% for eye shields, 81% for filtering facepiece respirators or powered air-purifying respirators, and 87% for gown/gloves. Use of a “gatekeeper” to control access and facilitate donning of PPE was associated with 100% adherence with gown and respirator precautions and improved respirator adherence. All simulations showed deviation from pediatric basic life support protocols. The median time to bag-valve-mask ventilation improved from 4.3 to 2.7 minutes with a gatekeeper present. Rapid isolation carts appeared to improve access to necessary PPE. Confidence in PPE use improved from 64% to 85% after the mock code and structured debriefing. Conclusions Large gaps exist in the use of PPE and self-protective behaviors, as well as adherence to resuscitation guidelines, during simulated resuscitation events. Intervention opportunities include use of rapid isolation measures, use of gatekeepers, reinforcement of first responder roles, and further simulation training with PPE.
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Affiliation(s)
- Christopher M Watson
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
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Moore D. Pandemic influenza (H1N1) 2009 and infection control controversies: Working with ongoing change. Paediatr Child Health 2010; 14:623-7. [PMID: 21037840 PMCID: PMC2806086 DOI: 10.1093/pch/14.9.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Dl Moore
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee
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Tompkins BM, Kerchberger JP. Special article: personal protective equipment for care of pandemic influenza patients: a training workshop for the powered air purifying respirator. Anesth Analg 2010; 111:933-45. [PMID: 20810676 DOI: 10.1213/ane.0b013e3181e780f8] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Virulent respiratory infectious diseases may present a life-threatening risk for health care professionals during aerosol-generating procedures, including endotracheal intubation. The 2009 Pandemic Influenza A (H1N1) brings this concern to the immediate forefront. The Centers for Disease Control and Prevention have stated that, when performing or participating in aerosol-generating procedures on patients with virulent contagious respiratory diseases, health care professionals must wear a minimum of the N95 respirator, and they may wish to consider using the powered air purifying respirator (PAPR). For influenza and other diseases transmitted by both respiratory and contact modes, protective respirators must be combined with contact precautions. The PAPR provides 2.5 to 100 times greater protection than the N95, when used within the context of an Occupational Safety and Health Administration-compliant respiratory protection program. The relative protective capability of a respirator is quantified using the assigned protection factor. The level of protection designated by the APF can only be achieved with appropriate training and correct use of the respirator. Face seal leakage limits the protective capability of the N95 respirator, and fit testing does not assure the ability to maintain a tight face seal. The protective capability of the PAPR will be defeated by improper handling of contaminated equipment, incorrect assembly and maintenance, and improper don (put on) and doff (take off) procedures. Stress, discomfort, and physical encumbrance may impair performance. Acclimatization through training will mitigate these effects. Training in the use of PAPRs in advance of their need is strongly advised. "Just in time" training is unlikely to provide adequate preparation for groups of practitioners requiring specialized personal protective equipment during a pandemic. Employee health departments in hospitals may not presently have a PAPR training program in place. Anesthesia and critical care providers would be well advised to take the lead in working with their hospitals' employee health departments to establish a PAPR training program where none exists. User instructions state that the PAPR should not be used during surgery because it generates positive outward airflow, and may increase the risk of wound infection. Clarification of this prohibition and acceptable solutions are currently lacking and need to be addressed. The surgical hood system is not an acceptable alternative. We provide on line a PAPR training workshop. Supporting information is presented here. Anesthesia and critical care providers may use this workshop to supplement, but not substitute for, the manufacturers' detailed use and maintenance instructions.
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Affiliation(s)
- Bonnie M Tompkins
- Department of Anesthesiology, University of Wisconsin Hospitals, Madison, WI 53792-0001, USA.
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Evaluation of a pandemic preparedness training intervention of emergency medical services personnel. Prehosp Disaster Med 2010; 24:508-11. [PMID: 20301068 DOI: 10.1017/s1049023x00007421] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Emergency medical services (EMS) personnel play an integral role during the national response to a pandemic event. To help ensure their health and safety, especially during the early stages of an outbreak, knowledge and adherence with personal protective equipment (PPE) and infection control strategies will be essential. OBJECTIVES The objective of this study was to assess the effectiveness of a multi-method, pandemic preparedness training intervention using a pre-/post-test design. METHODS A convenience sample of 129 EMS personnel participated in a training program on pandemic preparedness. Training consisted of an educational intervention with a focus on the routes of transmission of the influenza virus, proper use of respiratory PPE, agency policies regarding infection control practices, and seasonal influenza vaccination. This was followed by a skill-based drill on respirator fit-checking and proper respirator donning and doffing procedures. RESULTS Pre-/post-test results indicate a significant increase in knowledge and behavioral intentions with respect to respirator use, vaccination with seasonal influenza vaccine, and willingness to report to duty during a pandemic. CONCLUSIONS This method was effective in increasing knowledge and compliance intentions in EMS healthcare personnel. Further research should focus on whether training results in behavior modification.
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Moore DL. La grippe pandémique H1N1 2009 et les controverses entourant le contrôle de l’infection : Travailler dans un contexte de changements continus. Paediatr Child Health 2009; 14:625-627. [PMID: 32288510 PMCID: PMC2806087 DOI: 10.1093/pch/14.9.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Affiliation(s)
- D L Moore
- Société canadienne de pédiatrie, comité des maladies infectieuses et d'immunisation
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