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Oblea PN, Nguyen-Wu ED, Siaki LA, Cho S, Romito KJ, Chan W. Impact of Hydrocolloid Dressing and Moisturizing Cream as Facial Skin Protectants Among Health Care Workers. Mil Med 2024:usae202. [PMID: 38771104 DOI: 10.1093/milmed/usae202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/09/2024] [Accepted: 04/04/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION During the novel coronavirus disease 2019 pandemic, health care workers experienced facial problems from prolonged use of N95 masks, including skin irritation, pigmentation changes, and contact dermatitis. We assessed the use of hydrocolloid dressing versus dimethicone cream to prevent skin breakdown among military health care workers while wearing an N95. MATERIALS AND METHODS Participants were recruited using convenience and snowball sampling in this nonblinded, randomized, cross-over study with 2 active treatments, hydrocolloid dressing and dimethicone cream, across 3 time points. The skin was assessed using photographs and subepidermal moisture scanner (SEM). N95 seal integrity was assessed using qualitative fit test. Institutional review board approval was obtained from the Madigan Army Medical Center Institutional Review Board. RESULTS Among the 73 participants, wearing an N95 alone versus with dimethicone cream or hydrocolloid dressing caused more adverse skin reactions. There were no significant differences in qualitative fit test failure rate between groups. Participants experienced minimal to no dizziness, loss of energy/tiredness/fatigue, claustrophobia, shortness of breath, difficulty breathing, and dry or itchy eyes. For all interventions, wearing an N95 did not interfere with participants' concentration, verbal communication, hearing, vision, and, importantly, delivery of care. CONCLUSIONS Using a skin protectant with an N95 may prevent adverse skin reactions while preserving health care workers' ability to safely and competently care for patients in routine and pandemic conditions.
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Affiliation(s)
- Pedro N Oblea
- Department of Clinical Inpatient Services, Center for Nursing Science & Clinical Inquiry, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | | | - Leilani A Siaki
- Department of Clinical Inpatient Services, Center for Nursing Science & Clinical Inquiry, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Sunghun Cho
- School of Medicine, Dermatology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Kenneth J Romito
- Graduate School of Nursing, Adult Gerontology Clinical Nurse Specialist Program, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Wenyaw Chan
- Biostatistics and Data Science, University of Texas Health Sciences Center, Houston, TX 77030, USA
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Göransson M, Lundberg-Rasmussen J, Sengpiel V, Linden K. "If I blink twice everything is OK" - A qualitative study of Swedish midwives' strategies for supporting birthing women while working in full personal protective equipment. Women Birth 2024; 37:436-442. [PMID: 38220550 DOI: 10.1016/j.wombi.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 01/16/2024]
Abstract
PROBLEM Midwives all over the world have had to adapt to the use of personal protective equipment (PPE) during the COVID-19 pandemic. The issue of how they managed to support birthing women, despite the use of PPE, has been insufficiently studied. BACKGROUND Midwives support birthing women in one of their most life-changing situations. Having COVID-19 at the time of childbirth makes birthing women even more vulnerable. PPE has been shown to impact the ability of providing support to birthing women. AIM To describe midwives' strategies for supporting birthing women while working in full PPE METHODS: A qualitative study based on focus group discussons with Swedish midwives. Data were analysed by inductive content analysis. FINDINGS To support birthing women while in full PPE, the midwives adapted existing working methods, increased collaboration with colleagues, unveiled, adapted to the requirements for contagion prevention, addressed women's concern for the midwife and maintained focus on the birth while remaining mindful of the risk of contagion. DISCUSSION Midwives adopted strategies in order to uphold provision of support to the birthing women, as well as to address contextual factors related to PPE that hinder provision of support. CONCLUSION The respective effects of different PPE types and models on the birth experience should be explored. Explicit strategies for supporting birthing women while working in full PPE must be created and discussed among midwives.
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Affiliation(s)
- Malin Göransson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jonna Lundberg-Rasmussen
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Brandão EDS, Lanzillotti RS, Granja PD, Silva LF, Mandelbaum MHS, Tonole R. Association between skin injuries and the importance atributed to prevention by health professionals during the pandemic. Rev Gaucha Enferm 2024; 45:e20230114. [PMID: 38324882 DOI: 10.1590/1983-1447.2024.20230114.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/28/2023] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE To verify the association between the occurrence of skin lesions due to the use of products and/or personal protective equipment and the importance attributed to preventive care among health professionals working on the front lines of the struggle against the COVID-19 pandemic. METHOD Cross-sectional, analytical study, carried out between May and June 2020, with a convenience sample (n=398) of health workers from 10 professional categories. To verify the existence of an association between the occurrence of skin lesions and exposure variables, a Contingency Table was used to obtain the Prevalence Ratio and respective Confidence Intervals. RESULTS 260 (65.3%) participants self-declared the development of skin lesions, predominantly nurses (53.8%), women (54.0%), from public institutions (52.8%), characterized by pressure injuries (37.3%), contact/allergic dermatitis (25.8%), or both lesions simultaneously (16.5%). More than half of professionals (53.5%) used preventive products, mainly moisturizers (51.0%). CONCLUSION There was probability of an association between professionals who attributed less importance to the predictor "Protocol for proper product PPE and products" and the risk of skin injuries.
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Affiliation(s)
- Euzeli da Silva Brandão
- Universidade Federal Fluminense (UFF). Escola de Enfermagem Aurora de Afonso Costa. Departamento de Fundamentos de Enfermagem e Administração. Niterói, Rio de Janeiro, Brasil
| | - Regina Serrão Lanzillotti
- Universidade do Estado do Rio de Janeiro (UERJ). Instituto de Matemática e Estatística. Niterói, Rio de Janeiro, Brasil
| | - Paula Dadalti Granja
- Universidade Federal Fluminense (UFF). Faculdade de Medicina, Departamento de Medicina Clínica. Niterói, Rio de Janeiro, Brasil
| | - Liliane Faria Silva
- Universidade Federal Fluminense (UFF). Escola de Enfermagem Aurora de Afonso Costa. Departamento de Enfermagem Materno-Infantil e Psiquiátrica. Niterói, Rio de Janeiro, Brasil
| | | | - Renato Tonole
- Instituto Nacional de Câncer (INCa). Hospital do Câncer I. Niterói, Rio de Janeiro, Brasil
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Kua A, Richmond S, Farnell DJ. Initial evidence that skin health deteriorates for younger age groups and with increased daily use of face masks for healthcare professionals at a dental hospital in the United Kingdom. J Dent 2024; 141:104799. [PMID: 38056758 DOI: 10.1016/j.jdent.2023.104799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/16/2023] [Accepted: 12/03/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE To determine the incidence and site of any adverse effects of wearing face masks via an online questionnaire. METHODS Healthcare workers in a dental hospital who wear Respiratory Protective Equipment (RPE) were invited to participate. An online questionnaire was used to identify adverse effects as a result of wearing face masks and possible remedies. RESULTS Red marks (72.1 %) and indentations (66.7 %) were the most frequently reported issues with increased use of the RPE. The bridge of the nose and cheeks were the most frequently reported sites of facial skin problems, such as blanching (54.1 % and 42.2 %, respectively) and pressure damage (42.3 % and 24.3 %, respectively). Overall perceived facial skin health deteriorated strongly and significantly (P < 0.001) following the use of RPE, where the mean skin health score (0 = best possible skin health and 10 = worst possible skin health) increased from 2.68 to 4.76. Broadly, there was increased discomfort with increased hours of use of RPE per day (P = 0.049). 71 % of participants said that they generally felt safe or very safe using RPE. CONCLUSION The facial skin health of respondents deteriorated strongly after the use of RPE. Guidelines for using RPE should be made clearer. A greater range of face mask sizes or bespoke masks should be made available to improve the fit and wearability, as well as to reduce the frequency and incidence of surface skin problems. CLINICAL SIGNIFICANCE This study has identified the factors influencing adverse skin reactions from face mask use, which can be used to inform face mask designers and manufacturers to improve the fit and wearability of face masks.
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Affiliation(s)
- Aaron Kua
- School of Dentistry, Cardiff University, Cardiff CF14 4XY, Wales, United Kingdom
| | - Stephen Richmond
- School of Dentistry, Cardiff University, Cardiff CF14 4XY, Wales, United Kingdom
| | - Damian Jj Farnell
- School of Dentistry, Cardiff University, Cardiff CF14 4XY, Wales, United Kingdom.
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Giaume L, Le Roy B, Daniel Y, Lauga Cami H, Jost D, Travers S, Trousselard M. Psychological, cognitive, and physiological impact of hazards casualties' trainings on first responders: the example of a chemical and radiological training. An exploratory study. Front Psychol 2024; 15:1336701. [PMID: 38352026 PMCID: PMC10861781 DOI: 10.3389/fpsyg.2024.1336701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Background First responders are among the first to respond to hazards casualties. They might operate in volatile, uncertain, complex, and ambiguous (VUCA) environments. While they have underlined the need to improve their knowledge and training to face these environments, there are few data regarding the stress induced by these trainings. Chemical, biological, radiological, and nuclear (CBRN) hazards casualties' trainings seem to be a good model of "in vivo" stress. First responders must operate in a hostile and encountered environment with a CBRN protective equipment that places demand on their psychological, cognitive, and physiological capacities. Current research recognizes that the activity of the parasympathetic system (PSS) can be used as an objective marker of stress adaptation, measured as heart rate variability (HRV). Objectives To compare between baseline and simulation the evolution of the parasympathetic activity (primary outcome), anxiety, emotions, cognitive load, and body posture awareness (secondary outcomes). Methods A total of 28 first responders attended to three simulated scenarios requiring CBRN management of casualties. One day before simulation, we collected HRV data (baseline). The simulations' day (pre-, post-simulation) we collected anxiety score (STAI-Y B), emotions (SPANE), cognitive load (NASA TLX), body posture awareness (PAS) and HRV. The morning after we collected the PAS score (recovery). We compare data' evolution between different times of the simulation. Results (i) A high level of anxiety at baseline [Median 51 (46; 56)] which decreased between pre- and post-simulation (p = 0.04; F = 2.93); (ii) a post-simulation decrease in negative feelings (p = 0.03); (iii) a decrease in body awareness after simulation which returned to the initial level at recovery (p = 0.03; F = 3.48); (iv) a decrease in mean RR between baseline, pre- and post-simulation (p = 0.009; F = 5.11). There were no significant difference between times on others analysis of HRV. Conclusion Prior to simulation, participants experienced anticipatory anxiety. Simulations training practiced regularly could be one way to combat anticipatory anxiety.
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Affiliation(s)
- Louise Giaume
- Emergency Medical Department, Paris Fire Brigade, Paris, France
- French Military Biomedical Research, Brétigny-sur-Orge, France
| | | | - Yann Daniel
- Emergency Medical Department, Paris Fire Brigade, Paris, France
| | | | - Daniel Jost
- Emergency Medical Department, Paris Fire Brigade, Paris, France
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Ampos LF, Olino L, Magalhães AMMD, Tavares JP, Magnago TSBDS, Dal Pai D. Atuação da enfermagem em unidades dedicadas e não dedicadas à COVID-19: implicações na saúde ocupacional. Rev Lat Am Enfermagem 2023. [DOI: 10.1590/1518-8345.6215.3742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Resumo Objetivo: analisar as implicações da pandemia sobre a saúde ocupacional da equipe de enfermagem conforme a atuação em unidades dedicadas e não dedicadas à COVID-19. Método: estudo multicêntrico, de método misto, estratégia explanatória sequencial. Participaram 845 profissionais na primeira etapa, respondendo a um formulário eletrônico contendo variáveis sociodemográficas, laborais, sobre a pandemia e sua saúde e o Self-Reporting Questionnaire. Na segunda etapa, 19 profissionais foram entrevistados. Os dados quantitativos foram submetidos à estatística analítica e os qualitativos à análise temática de conteúdo, sendo integrados por conexão. Resultados: os impactos da pandemia sobre a saúde dos profissionais ocorreram tanto nas áreas dedicadas como nas não dedicadas à COVID-19. Contudo, a composição das equipes apresentou características distintas entre as áreas, bem como as percepções de risco e das exigências no trabalho. Conclusão: os profissionais que atuam em áreas dedicadas e não dedicadas à COVID-19 estão igualmente adoecidos, mas com exposição laboral distinta quanto às exigências no trabalho nas unidades dedicadas e o medo da contaminação nas unidades não dedicadas.
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Affiliation(s)
- Larissa Fonseca Ampos
- Universidade Federal do Rio Grande do Sul, Brazil; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brazil
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Ampos LF, Olino L, Magalhães AMMD, Tavares JP, Magnago TSBDS, Dal Pai D. Trabajo de enfermería en unidades dedicadas y no dedicadas al COVID-19: consecuencias para la salud ocupacional. Rev Lat Am Enfermagem 2023. [DOI: 10.1590/1518-8345.6215.3740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Resumen Objetivo: analizar las consecuencias que tuvo la pandemia en la salud ocupacional de los enfermeros según si se desempeñaban en unidades dedicadas y no dedicadas al COVID-19. Método: estudio multicéntrico, método mixto, estrategia explicativa secuencial. En la primera etapa participaron en total 845 profesionales que respondieron un formulario electrónico que contenía variables sociodemográficas, ocupacionales, sobre la pandemia y la salud y el Self-Reporting Questionnaire. En la segunda etapa, fueron entrevistados 19 profesionales. Los datos cuantitativos fueron sometidos a estadística analítica y los datos cualitativos al análisis de contenido temático, posteriormente, ambos fueron integrados por conexión. Resultados: los impactos de la pandemia en la salud de los profesionales se produjeron tanto en las áreas dedicadas como en las no dedicadas al COVID-19. Sin embargo, la composición de los equipos presentó distintas características entre las áreas, así como también diferentes percepciones de riesgo y exigencias en el trabajo. Conclusión: los profesionales que trabajan en áreas dedicadas y no dedicadas al COVID-19 se enfermaron por igual, pero tuvieron diferente exposición ocupacional debido a las exigencias que presentaba el trabajo en las unidades dedicadas y al miedo al contagio en las unidades no dedicadas.
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Affiliation(s)
- Larissa Fonseca Ampos
- Universidade Federal do Rio Grande do Sul, Brazil; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brazil
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Çakar V, Karadağ A, Bugan B, Kılıç H, Demir AS. Personal Protective Equipment-Related Problems Experienced by Healthcare Workers, Solutions, and Recommendations: A Qualitative Study. Adv Skin Wound Care 2023; 36:1-9. [PMID: 37861670 DOI: 10.1097/asw.0000000000000059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To understand the problems experienced by healthcare workers (HCWs) who used personal protective equipment (PPE) on their face during the COVID-19 pandemic, their interventions to prevent these problems, and their recommendations for improving the quality of PPE. METHODS This descriptive and qualitative study included HCWs (N = 29) from health institutions at different levels in Turkey. Researchers collected data using a semistructured data collection form (13 items) and in-depth individual interviews. Data were analyzed with descriptive statistics and qualitative inductive content analysis. RESULTS Of the 29 participants, 15 (51.7%) were women, and 18 (62.1%) were nurses. Participants' answers regarding problems related to PPE use were grouped into four main categories, answers regarding the prevention of these problems were grouped into three main categories, and answers regarding improving the quality of PPE were grouped into three main categories. Skin concerns were the most commonly reported problems related to PPE, and interventions to prevent these problems primarily related to skin protection and care. Recommendations to improve the quality of PPE focused on using materials for masks and face shields that reduce pressure and friction; participants also suggested that face shields be produced in sterile and disposable packages. CONCLUSIONS This research indicates that HCWs need support and they are able to create individual solutions for the problems with PPE that they experience. Skin-friendly PPE that ensures the safety and comfort of HCWs should be produced, and hospitals should develop policies for institutional use to prevent PPE injury.
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Affiliation(s)
- Vildan Çakar
- Vildan Çakar, PhD, is Assistant Professor, Department of Nursing, School of Health Sciences, Istanbul Medipol University, Istanbul, Turkey. Ayişe Karadağ, PhD, ET/WOCN, is Professor, School of Nursing, Koç University, Istanbul, Turkey. Berna Bugan, BSN, is Staff Nurse, Koç University Hospital. Havanur Kılıç, BSN, and Ayşe Sılanur Demir, BSN, are Research Assistants and PhD Students, Graduate School of Health Sciences, Koç University. Acknowledgment : The authors thank the voluntary participants of the study. The authors have disclosed no financial relationships related to this article. Submitted March 23, 2022; accepted in revised form August 18, 2022
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Antalová N, Riad A, LeBlanc K, Woo K, Pokorná A. Prevalence of personal protective equipment (PPE)-related injuries among Czech and Slovak healthcare professionals. J Tissue Viability 2023; 32:499-507. [PMID: 37932190 DOI: 10.1016/j.jtv.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023]
Affiliation(s)
- Natália Antalová
- Department of Health Sciences, Faculty of Medicine, Masaryk University, Czech Republic; Department of Public Health, Faculty of Medicine, Masaryk University, Czech Republic
| | - Abanoub Riad
- Department of Public Health, Faculty of Medicine, Masaryk University, Czech Republic
| | - Kimberley LeBlanc
- Wound, Ostomy and Continence Institute, Ottawa, Ontario, Canada; KDS Professional Consulting, Ottawa, Canada
| | - Kevin Woo
- Nurse Specialized in Wound, Ostomy and Continence, Queen's University, Kingston, Ontario, Canada
| | - Andrea Pokorná
- Department of Health Sciences, Faculty of Medicine, Masaryk University, Czech Republic; Department of Public Health, Faculty of Medicine, Masaryk University, Czech Republic.
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Zhu F, Su H, Kong Y, Xu B, Lv Q, Lin J, Yi L, Xie J. Evaluation of dressings preventing facial medical device-related pressure injury in medical staff during the COVID-19 pandemic: A systematic review and network meta-analysis. J Clin Nurs 2023; 32:5988-5999. [PMID: 37082837 DOI: 10.1111/jocn.16721] [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: 11/18/2022] [Revised: 02/06/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
AIM This study systematically compared the efficacy of various dressings that may prevent facial medical device-related pressure injury (MRDPI) in medical staff during the COVID-19 pandemic. BACKGROUND During the COVID-19 pandemic, medical staff who are required to wear masks, goggles and other personal protective equipment (PPE) are susceptible to facial MRDPI, which exacerbates working conditions. Dressings can effectively prevent or alleviate MRDPI, but it is unclear which dressings are most effective. DESIGN A systematic review and network meta-analysis, in accordance with PRISMA. METHODS A comprehensive literature search was conducted in four English and four Chinese databases to identify relevant studies published up to 8 September 2022. The selected studies were randomised controlled trials, with populations comprising medical staff who wore PPE during the COVID-19 pandemic and included an observation and control group. RESULTS The network meta-analysis of the 12 selected articles showed that foam dressing, hydrocolloid dressing and petrolatum gauze were better than conventional protection for preventing MRDPI. The surface under the cumulative ranking curve indicated that foam dressing was the best preventative. CONCLUSION Foam dressing is more effective than other dressings in preventing facial MRDPI in medical staff. When PPE must be worn for many hours, such as during the COVID-19 pandemic, medical staff can use foam dressings to prevent MRDPI. RELEVANCE TO CLINICAL PRACTICE The results support the use of dressings, especially foam dressings, to prevent MRDPI in healthcare workers. The appropriate dressings are recommended to prevent MRDPI associated with wearing PPE.
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Affiliation(s)
- Fangfang Zhu
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Honghong Su
- Nursing College, Fuzhou Institute of Technology, Fuzhou, China
| | - Yue Kong
- Teaching and Research Department, Fuzong Clinical Medical College of Fujian Medical University (The 900th Hospital of Joint Logistic Support Force, PLA), Fuzhou, China
| | - Baoling Xu
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Qian Lv
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jiamin Lin
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Luanxing Yi
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jieling Xie
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Caggiari S, Bader D, Packman Z, Robinson J, Tranka S, Böhning D, Worsley P. Retrospective evaluation of factors affecting successful fit testing of respiratory protective equipment during the early phase of COVID-19. BMJ Open 2023; 13:e065068. [PMID: 37230519 DOI: 10.1136/bmjopen-2022-065068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES Respiratory protective equipment is critical to protect healthcare workers from COVID-19 infection, which includes filtering facepiece respirators (FFP3). There are reports of fitting issues within healthcare workers, although the factors affecting fitting outcomes are largely unknown. This study aimed to evaluate factors affecting respirator fitting outcomes. DESIGN This is a retrospective evaluation study. We conducted a secondary analysis of a national database of fit testing outcomes in England between July and August 2020. SETTINGS The study involves National Health Service (NHS) hospitals in England. PARTICIPANTS A total of 9592 observations regarding fit test outcomes from 5604 healthcare workers were included in the analysis. INTERVENTION Fit testing of FFP3 on a cohort of healthcare workers in England, working in the NHS. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measure was the fit testing result, that is, pass or fail with a specific respirator. Key demographics, including age, gender, ethnicity and face measurements of 5604 healthcare workers, were used to compare fitting outcomes. RESULTS A total of 9592 observations from 5604 healthcare workers were included in the analysis. A mixed-effects logistic regression model was used to determine the factors which affected fit testing outcome. Results showed that males experienced a significantly (p<0.05) higher fit test success than females (OR 1.51; 95% CI 1.27 to 1.81). Those with non-white ethnicities demonstrated significantly lower odds of successful respirator fitting; black (OR 0.65; 95% CI 0.51 to 0.83), Asian (OR 0.62; 95% CI 0.52 to 0.74) and mixed (OR 0.60; 95% CI 0.45 to 0.79. CONCLUSION During the early phase of COVID-19, females and non-white ethnicities were less likely to have a successful respirator fitting. Further research is needed to design new respirators which provide equal opportunity for comfortable, effective fitting of these devices.
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Affiliation(s)
- Silvia Caggiari
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Dan Bader
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | | | | | - Dankmar Böhning
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Peter Worsley
- School of Health Sciences, University of Southampton, Southampton, UK
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12
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Laxmidhar R, Desai C, Patel P, Laxmidhar F. Adverse Effects Faced by Healthcare Workers While Using Personal Protective Equipment During the COVID-19 Pandemic in Civil Hospital, Ahmedabad. Cureus 2023; 15:e38485. [PMID: 37273298 PMCID: PMC10237251 DOI: 10.7759/cureus.38485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Background Healthcare workers (HCWs) were compelled to use personal protective equipment (PPE) during the COVID-19 pandemic to prevent cross-transmission. One of the most significant challenges in responding to the COVID-19 pandemic is the consistent and effective use of PPE to avoid staff exposure and infection. This study aimed to detect and evaluate the adverse effects of PPE and determine the associated risk factors. Methodology This cross-sectional study included 186 randomly selected HCWs at Civil Hospital, Ahmedabad, from May 2022 to July 2022. An anonymous self-administered questionnaire was used for data collection, and data analysis was done using descriptive statistics. Results PPE-related adverse effects were noted among 147 HCWs, with a prevalence of 79.03%. Data analysis showed that factors significantly associated with PPE adverse effects in HCWs were age group 20-40 years (chi-squared (χ2) = 4.119, p = 0.04) and female gender (χ2 = 7.153, p = 0.007). Overall, 30.8% of participants had tested positive while on duty during the pandemic. Similarly, adverse effects were associated with PPE use of more than four hours per day and more than three days per week (χ2 = 5.477, p = 0.02 and χ2 = 6.488, p = 0.01, respectively). The majority of HCWs expressed indentation and pain on the back of the ear (52.7%) and pressure-related injury (39.8%) as adverse effects after wearing masks; skin soaking in sweat (54.83%) due to gloves; profuse sweating due to gown (64.28%); fogging (65.26%) due to googles and face-shield; and discomfort (61.29%). Conclusions The prevalence of adverse effects related to wearing PPE was alarmingly high among HCWs. The major risk factors were age, female sex, and duration of use. Although the majority of healthcare personnel have received vaccinations, the use of PPE has not altered, and severe skin reactions continue to be a global issue with no known solution. To further understand the problem, national data for the impacted healthcare professionals could be helpful. Furthermore, workplace prevention programs are necessary.
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Affiliation(s)
- Rosy Laxmidhar
- Infectious Diseases, Byramjee Jeejeebhoy (BJ) Medical College, Civil Hospital Asarwa, Ahmedabad, IND
| | - Chetna Desai
- Pharmacology, Byramjee Jeejeebhoy (BJ) Medical College, Civil Hospital Asarwa, Ahmedabad, IND
| | - Prakruti Patel
- Pharmacology, Byramjee Jeejeebhoy (BJ) Medical College, Civil Hospital Asarwa, Ahmedabad, IND
| | - Fehmida Laxmidhar
- Infectious Diseases, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
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13
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Hyun C, Jensen MM, Yang K, Weaver JC, Wang X, Kudo Y, Gordon SJ, Samir AE, Karp JM. The Ultra fit community mask-Toward maximal respiratory protection via personalized face fit. PLoS One 2023; 18:e0281050. [PMID: 36920944 PMCID: PMC10016631 DOI: 10.1371/journal.pone.0281050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/16/2023] [Indexed: 03/16/2023] Open
Abstract
Effective masking policies to prevent the spread of airborne infections depend on public access to masks with high filtration efficacy. However, poor face-fit is almost universally present in pleated multilayer disposable face masks, severely limiting both individual and community respiratory protection. We developed a set of simple mask modifications to mass-manufactured disposable masks, the most common type of mask used by the public, that dramatically improves both their personalized fit and performance in a low-cost and scalable manner. These modifications comprise a user-moldable full mask periphery wire, integrated earloop tension adjusters, and an inner flange to trap respiratory droplets. We demonstrate that these simple design changes improve quantitative fit factor by 320%, triples the level of protection against aerosolized droplets, and approaches the model efficacy of N95 respirators in preventing the community spread of COVID-19, for an estimated additional cost of less than 5 cents per mask with automated production.
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Affiliation(s)
- Chulho Hyun
- Katharos Labs LLC., Boston, Massachusetts, United States of America
| | - Mark M. Jensen
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Perioperative and Pain Medicine, Center for Nanomedicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Kisuk Yang
- Department of Anesthesiology, Perioperative and Pain Medicine, Center for Nanomedicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard–MIT Division of Health Sciences and Technology, Cambridge, Massachusetts, United States of America
- Proteomics Platform, Broad Institute, Cambridge, Massachusetts, United States of America
- Division of Bioengineering, Incheon National University, Incheon, Republic of Korea
- Research Center for Bio Materials & Process Development, Incheon National University, Incheon, Republic of Korea
| | - James C. Weaver
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, United States of America
| | - Xiaohong Wang
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Radiology, Center for Ultrasound Research & Translation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Yoshimasa Kudo
- Department of Anesthesiology, Perioperative and Pain Medicine, Center for Nanomedicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Steven J. Gordon
- Katharos Labs LLC., Boston, Massachusetts, United States of America
| | - Anthony E. Samir
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Radiology, Center for Ultrasound Research & Translation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jeffrey M. Karp
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Perioperative and Pain Medicine, Center for Nanomedicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard–MIT Division of Health Sciences and Technology, Cambridge, Massachusetts, United States of America
- Proteomics Platform, Broad Institute, Cambridge, Massachusetts, United States of America
- Harvard Stem Cell Institute, Cambridge, Massachusetts, United States of America
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Demirer E, Karadağ A, Aktan DÇ, Çakar V. Development and psychometric property testing of a Medical Device-related Pressure Injuries Knowledge and Practice Assessment Tool. Int J Nurs Pract 2023:e13145. [PMID: 36890656 DOI: 10.1111/ijn.13145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/29/2023] [Accepted: 02/19/2023] [Indexed: 03/10/2023]
Abstract
AIMS We aimed to develop and test the psychometric properties of a Medical Device-related Pressure Injuries Knowledge and Practice Assessment Tool. BACKGROUND Assessment of nurses' knowledge and practices is critical in the prevention of Medical Device-related Pressure Injuries. DESIGN This was an instrument development and testing study. METHODS The sample of the study consisted of nurses (n = 189). The study was conducted in three phases between January and February 2021. In the first phase, multiple-choice items contained within Aetiology/Risk Factors, Prevention Interventions, and Staging domains were created. In the second phase, content validity and criterion validity were evaluated, and the tool was pre-tested. The third phase examined item difficulty, discrimination index and distractor quality. The test-retest method was used for reliability. RESULTS The Content Validity Index was found to be 0.75, 0.86 and 0.96 for the domains of Aetiology/Risk Factors, Prevention and Staging, respectively. The item difficulty values of the items were between 0.18 and 0.96. A positive, strong and significant relationship was found between the results and a positive, moderate and significant relationship between the tools administered for the proof of scale validity. The Cronbach's alpha reliability coefficient was found to be 0.54. CONCLUSIONS The tool is a suitable measurement instrument for use in nursing education, research and clinical settings.
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Affiliation(s)
- Erdinç Demirer
- Graduate School of Health Sciences, Koç University, Istanbul, Turkey
| | - Ayişe Karadağ
- Department of Fundamentals of Nursing, School of Nursing, Koç University, Istanbul, Turkey
| | - Derya Çobanoğlu Aktan
- Department of Educational Sciences, Educational Assessment and Evaluation, Faculty of Education, Hacettepe University, Ankara, Turkey
| | - Vildan Çakar
- Department of Nursing, School of Health Sciences, Medipol University, Istanbul, Turkey
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15
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Arici Parlak E, Ayhan H, Iyigun E. Comparison of operating room nurses' satisfaction and preferences in using personal protective equipment for eye protection in the COVID-19 pandemic. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2023; 29:224-229. [PMID: 35109783 DOI: 10.1080/10803548.2022.2035988] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives. This study aimed to compare the problems, satisfaction and preferences of operating room nurses about the use of personal protective equipment (PPE) for eye protection during operations in the COVID-19 pandemic. Methods. This prospective quasi-experimental study was conducted in April 2021 in the operating room of a hospital in Turkey. The sample of this study consisted of 35 nurses who met the inclusion criteria. The evaluation of three types of eye protection equipment (goggles, goggle-type face shield and face shield) was repeated in the same group on consecutive days. Results. The comparison of the problems related to the use of PPE indicated that the highest rate of fogging (91.4%) was observed in goggles (p < 0.001), and skin injuries (28.6%) were experienced in goggles and face shields (p = 0.002). It was observed that operating room nurses were most satisfied (7.2 ± 1.4) with goggle-type face shields and ranked them in first place (80%) (p < 0.001). Conclusion. According to the results of this research, it was found that the PPE for eye protection that was the least problematic, provided the most satisfaction and was ranked in first place during the pandemic was the goggle-type face shield.
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Affiliation(s)
- Emine Arici Parlak
- Department of Operating Room, Gulhane Training and Research Hospital, Turkey
| | - Hatice Ayhan
- Gülhane Faculty of Nursing, University of Health Sciences, Turkey
| | - Emine Iyigun
- Gülhane Faculty of Nursing, University of Health Sciences, Turkey
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16
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Feng L, Hu C, Li J, Ying Y, Chen L, Wei H, Liang H, Hu H. The Chinese version of the skin tear knowledge assessment instrument (OASES): Cultural adaptation and validation. J Tissue Viability 2023; 32:107-113. [PMID: 36543636 DOI: 10.1016/j.jtv.2022.12.004] [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: 06/14/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Skin tear knowledge is an important predictor of the decreased incidence and management of skin tears, and the knowledge level among Chinese nurses is unknown so far. A validated instrument for measuring skin tear knowledge is urgent. OBJECTIVE To culturally adapt the skin tear knowledge assessment instrument (OASES) into Chinese and verify its validity and reliability in the Chinese context. METHODS The cultural adaptation process for OASES into Chinese was established on Beaton's translation model. Content validity was determined by the 8-expert group in wound care. A nationwide psychometric validation study was performed on a convenience sample of 3333 nurses from 113 tertiary hospitals, of whom 98 nurses finished the test-retest procedure for reliability analysis. Item validity (item difficulty and discriminating index) and construct validity (known-groups technique) were tested. RESULTS The content validity index was 0.88-1.00. The item validity was as follows: Item difficulty ranged from 0.16 to 0.86, with an average value of 0.52; the discriminating index varied between 0.05 and 0.61. The known-group technique demonstrated excellent construct validity with a significant difference between predefined groups with theoretically expected higher knowledge scores and theoretically expected lower knowledge scores (P < 0.001). For the test-retest reliability, the Intraclass correction coefficient (ICC) during a 14-day interval for the overall tool was 0.79 (95% CI = 0.71-0.86), and Cohen's kappa value for each item varied from 0.17 to 0.62. CONCLUSIONS The Chinese version of OASES was validated to be suitable for skin tear knowledge assessment with acceptable psychometric properties, through which the knowledge and training priorities of skin tear among Chinese nurses can be quantified.
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Affiliation(s)
- Liuqun Feng
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chen Hu
- Nursing Department, School of Medicine, Zhejiang University, Hangzhou, China
| | - Juyun Li
- Department of Nursing, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Yuai Ying
- Nursing Department, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lanpeng Chen
- Kangda College of Nanjing Medical University, Lianyungang, China
| | - Huiyan Wei
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongyan Liang
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongyang Hu
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Arora G, Khandpur S, Bansal A, Shetty B, Aggarwal S, Saha S, Sachdeva S, Gupta M, Sharma A, Monalisa K, Bhandari M, Bagrodia A. Current understanding of frictional dermatoses: A review. Indian J Dermatol Venereol Leprol 2023; 89:170-188. [PMID: 36461803 DOI: 10.25259/ijdvl_519_2021] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 10/01/2021] [Indexed: 11/11/2022]
Abstract
Human skin is continually exposed to internal and external forces, dynamic as well as static. The skin is normally flexible and can resist mechanical trauma due to friction, pressure, vibration, suction and laceration to a considerable degree. However, an excess of these forces can abnormally affect the structure and function of the skin, setting the stage for the development of a skin disorder. Repetitive trauma can cause lichenification, hyperpigmentation, erythema, scaling, fissuring, blisters, ulceration and chronic alterations. Frictional dermatoses is an under-recognised entity with no clear-cut definition and encompasses a variety of terms such as frictional dermatitis, frictional melanosis, frictional pigmentary dermatoses and certain other named entities, many of which are confusing. The authors propose to define frictional dermatoses as 'a group of disorders caused by repetitive trauma to the skin as a result of friction of varied aetiology which can have a wide range of cutaneous manifestations depending on the type of insult.' The exact prevalence of frictional dermatoses as a separate entity is unknown. Authors who conducted this review include a group of dermatologists and post graduate students from various institutions. Literature was reviewed through PubMed, Medscape, Medline, ResearchGate and Google Scholar using the terms 'frictional dermatitis,' 'friction and skin,' 'dermatoses and culture,' 'clothing dermatitis,' 'friction melanosis,' 'PPE induced dermatoses in COVID-19 era,' etc. A total of 122 articles were reviewed and 100 articles among them were shortlisted and included in the study, after removing duplications. The review was followed up with further deliberation which resulted in the formulation of a new definition and classification of frictional dermatoses taking into account the morphology, histopathological characteristics, anatomical region affected and the major predisposing factors. The rising incidence of mechanical dermatoses in the COVID-19 era was also emphasised.
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Affiliation(s)
- Gulhima Arora
- Mehektagul Dermaclinic, All India Institute of Medical Sciences, New Delhi, India
| | - Sujay Khandpur
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Anuva Bansal
- Department of Dermatology and Venereology, Maulana Azad Medical College, New Delhi, India
| | - Bhavishya Shetty
- Department of Dermatology and Venereology, Maulana Azad Medical College, New Delhi, India
| | - Sonia Aggarwal
- Department of Dermatology and Venereology, University College of Medical Sciences, New Delhi, India
| | - Sushobhan Saha
- Department of Dermatology and Venereology, University College of Medical Sciences, New Delhi, India
| | - Soumya Sachdeva
- Department of Dermatology and Venereology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi, India
| | - Meghna Gupta
- Department of Dermatology and Venereology, Maulana Azad Medical College, New Delhi, India
| | - Ananya Sharma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Kumari Monalisa
- Department of Dermatology and Venereology, Maulana Azad Medical College, New Delhi, India
| | - Molisha Bhandari
- Department of Dermatology and Venereology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Anjali Bagrodia
- Department of Dermatology and Venereology, Maulana Azad Medical College, New Delhi, India
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Ampos LF, Olino L, de Magalhães AMM, Tavares JP, Magnago TSBDS, Dal Pai D. Nursing performance in COVID-19 and non-COVID-19 units: Implications for occupational health. Rev Lat Am Enfermagem 2023; 31:e3741. [PMID: 36722632 PMCID: PMC9886079 DOI: 10.1590/1518-8345.6215.3741] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/15/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE to analyze the implications of the pandemic on the Nursing team's occupational health according to its performance in COVID-19 and non-COVID-19 units. METHOD a multicenter and mixed-methods study, with a sequential explanatory strategy. A total of 845 professionals took part in the first stage, answering an electronic form which contained sociodemographic and work-related variables, as well as about the pandemic and their health, in addition to the Self-Reporting Questionnaire. 19 professionals were interviewed in the second stage. The quantitative data were submitted to statistical analysis and the qualitative ones to thematic content analysis, with integration by connection. RESULTS the pandemic exerted impacts on the professionals' health, both in the COVID-19 and non-COVID-19 areas. However, composition of the teams presented different characteristics between the areas, as well as the risk perceptions and the work demands. CONCLUSION the professionals working in areas COVID-19 and non-COVID-19 areas are equally affected, although with different work exposure regarding the requirements at work in the COVID-19 units and the fear of contamination in non-COVID-19 units.
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Affiliation(s)
- Larissa Fonseca Ampos
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil, Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil, Larissa Fonseca Ampos E-mail:
| | - Luciana Olino
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Juliana Petri Tavares
- Universidade Federal do Rio Grande do Sul, Departamento de Enfermagem Médico-Cirúrgica, Porto Alegre, RS, Brazil
| | | | - Daiane Dal Pai
- Universidade Federal do Rio Grande do Sul, Departamento de Enfermagem Médico-Cirúrgica, Porto Alegre, RS, Brazil
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19
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Abiakam N, Jayabal H, Mitchell K, Bader D, Worsley P. Biophysical and biochemical changes in skin health of healthcare professionals using respirators during COVID-19 pandemic. Skin Res Technol 2023; 29:e13239. [PMID: 36382670 PMCID: PMC9838774 DOI: 10.1111/srt.13239] [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: 06/07/2022] [Accepted: 10/29/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Personal protective equipment, including respirator devices, has been used to protect healthcare workers (HCWs) during the COVID-19 pandemic. These are fitted to skin sites on the face to prevent airborne transmission but have resulted in reports of discomfort and adverse skin reactions from their continued usage. The present study addresses the objective changes in both the structural integrity and biological response of the skin following prolonged and consecutive use of respirators. MATERIALS AND METHODS A longitudinal cohort study, involving 17 HCWs who wear respirators daily, was designed. Changes in the barrier properties and biological response of the skin were assessed at three facial anatomical sites, namely, the nasal bridge, left cheek and at a location outside the perimeter of respirator. Assessments were made on three different sessions corresponding to the first, second and third consecutive days of mask usage. Skin parameters included transepidermal water loss (TEWL), stratum corneum (SC) hydration and erythema, as well as cytokine biomarkers sampled from sebum using a commercial tape. RESULTS The cheek and the site outside the perimeter covered by the respirator presented minimal changes in skin parameters. By contrast, significant increases in both the TEWL (up to 4.8 fold) and SC hydration (up to 2.7 fold) were detected at the nasal bridge on the second consecutive day of respirator-wearing. There was a high degree of variation in the individual expression of pro-and anti-inflammatory cytokines. Increasing trends in nasal bridge TEWL values were associated with the body mass index (p < 0.05). CONCLUSIONS The most sensitive objective parameter in detecting changes in the skin barrier proved to be the increase in TEWL at the nasal bridge, particularly on the second day of consecutive respirator usage. By contrast, other measures of skin were less able to detect remarkable variations in the barrier integrity. Consideration for protecting skin health is required for frontline workers, who continue to wear respirators for prolonged periods over consecutive days during the pandemic.
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Affiliation(s)
- Nkemjika Abiakam
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Hemalatha Jayabal
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Kay Mitchell
- Critical Care Team, University Hospital Southampton Foundation Trust, Southampton, UK
| | - Dan Bader
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Peter Worsley
- School of Health Sciences, University of Southampton, Southampton, UK
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20
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Hunt A, Ting J, Schweitzer D, Laakso E, Stewart I. Personal protective equipment for COVID-19 among healthcare workers in an emergency department: An exploratory survey of workload, thermal discomfort and symptoms of heat strain. Emerg Med Australas 2022; 35:483-488. [PMID: 36478390 PMCID: PMC9877975 DOI: 10.1111/1742-6723.14152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/30/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To examine workload, thermal discomfort and heat-related symptoms among healthcare workers (HCWs) in an Australian ED during the COVID-19 pandemic. METHODS A cross-sectional study design was employed among HCWs in an ED at a metropolitan hospital in Brisbane, Australia. Respondents provided demographic information including their self-reported age, sex, height, weight, role (e.g. doctor, nurse), and whether they wore personal protective equipment (PPE) during their shift, rated as either Full PPE, Partial PPE, or usual uniform or scrubs. The workload of HCWs was assessed with the National Aeronautics and Space Administration's task load index (NASA-TLX). Thermal discomfort was evaluated using scales from the International Organisation for Standardisation. Responders rated their subjective heat illness using the Environmental Symptoms Questionnaire. RESULTS Fifty-nine HCWs completed the survey (27 male, 31 female, one prefer not to answer). Overall workload from the NASA-TLX was 64.6 (interquartile range [IQR] 56.5-73.3) for doctors, 72.5 (IQR 63.3-83.3) for nurses and 66.7 (IQR 58.3-74.17) for other staff, representing moderate to high ratings. Eighty-one percent reported thermal sensation to be slightly warm, warm, or hot, and 88% reported being uncomfortable, ranging from slightly to extremely. Ninety-seven percent reported at least one heat-strain symptom. More than 50% reported light-headedness or headache and approximately 30% reported feeling dizzy, faint, or weak. CONCLUSIONS ED HCWs experience thermal discomfort when wearing PPE. Combined with their workloads, HCWs experienced symptoms related to heat strain. Therefore, careful consideration should be given to managing heat strain among HCWs when wearing PPE in an ED.
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Affiliation(s)
- Andrew Hunt
- School of Biomedical Sciences, Faculty of HealthQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Joseph Ting
- School of Public Health and Social Work, Faculty of HealthQueensland University of TechnologyBrisbaneQueenslandAustralia,Department of Emergency MedicineMater HospitalBrisbaneQueenslandAustralia
| | - Daniel Schweitzer
- Centre for NeurosciencesMater HospitalBrisbaneQueenslandAustralia,Wesley HospitalBrisbaneQueenslandAustralia,School of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - E‐Liisa Laakso
- Mater Research InstituteThe University of QueenslandBrisbaneQueenslandAustralia,Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
| | - Ian Stewart
- School of Exercise and Nutrition Sciences, Faculty of HealthQueensland University of TechnologyBrisbaneQueenslandAustralia
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Su H, Lv Q, Kong Y, Zeng H, Zhou W, Zhu F, Xu B, Zhou Q. Evaluation of evidence of prevention and management of facial pressure injuries in medical staff. Nurs Open 2022; 10:2746-2756. [PMID: 36502522 PMCID: PMC10077380 DOI: 10.1002/nop2.1543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/17/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022] Open
Abstract
AIM This systematic review evaluated the quality of evidence for the prevention and management of facial pressure injuries in medical staff. DESIGN This review was presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS We retrieved the relevant studies from 19 databases. Using the literature evaluation standards and evidence grading system of the Australian Joanna Briggs Institute Evidence-Based Health Care Center, we evaluated the quality of the literature encompassing different types of research and assessed their levels of evidence. RESULTS A total of 13 studies were included, including seven expert consensuses, two recommended practices, one clinical decision, one best practice information booklet, one systematic review and one randomized controlled trial. In the end, 31 best evidence were summarized, including skin cleaning and care, PPE placement and movement, reasonable use of dressings, treatment measures and education and training.
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Affiliation(s)
- Honghong Su
- Nursing College Fujian University of Traditional Chinese Medicine Fuzhou China
| | - Qian Lv
- Nursing College Fujian University of Traditional Chinese Medicine Fuzhou China
| | - Yue Kong
- Teaching and Research Department Fuzong Clinical Medical College of Fujian Medical University (The 900th Hospital of Joint Logistic Support Force, PLA) Fuzhou China
| | - Huiling Zeng
- Nursing College Fujian University of Traditional Chinese Medicine Fuzhou China
| | - Wenguang Zhou
- Department of Equipment Chenggong Hospital of Xiamen University (the 73th Group Military Hospital of People's Liberation Army) Xiamen China
| | - Fangfang Zhu
- Nursing College Fujian University of Traditional Chinese Medicine Fuzhou China
| | - Baoling Xu
- Nursing College Fujian University of Traditional Chinese Medicine Fuzhou China
| | - Qijun Zhou
- Medical College Qiqihar Medical University Qiqihar China
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22
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da Silva Brandao E, Sant'Ana Mandelbaum MH, Lanzillotti RS, Granja PD, da Silva LF, Tonole R. Skin lesions resulting from use of personal protective equipment in the context of COVID-19: a cross-sectional study. J Wound Care 2022; 31:S22-S28. [PMID: 36475845 DOI: 10.12968/jowc.2022.31.sup12.s22] [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: 12/13/2022]
Abstract
OBJECTIVE During the SARS-CoV-2 (COVID-19) pandemic, to prevent the transmission of the virus, the use of personal protection products and equipment were recommended by international and national organisations. The need to use it more frequently and for a long time can damage the skin of health professionals. The aim of this study was to estimate the prevalence and factors associated with skin lesions in health professionals resulting from the use of personal protective equipment (PPE). METHOD This was a cross-sectional exploratory study through an online questionnaire. The first part of the questionnaire collected socio-labour characterisation data and the second part related to exposure factors. The variables were analysed according to the prevalence and the odds ratio (OR), within a 95% confidence interval (CI). RESULTS Of the 398 participants who met the inclusion criteria, 65.3% were self-diagnosed with skin lesions: 37.3% with pressure injury, 25.8% with contact/allergic dermatitis and 2.7% with acne. Regarding the use of PPE, of the 240 professionals who reported using an N95 mask, 80.4% developed injuries, 70.4% of which related to a work regime of >6 hours per day (OR: 2.08, 95% CI: 1.79-2.42). CONCLUSION The results of this study showed a significant prevalence of skin lesions in health professionals. Among exposure factors, the N95 mask and goggles stand out. Longer or more frequent exposure time to personal protective products and equipment proved to be important factors to be considered.
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23
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The prevalence of facial pressure injuries among nurses during COVID-19 pandemic and its relationship to COVID-19 infection. J Tissue Viability 2022; 31:699-706. [PMID: 36195528 PMCID: PMC9526514 DOI: 10.1016/j.jtv.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/12/2022] [Accepted: 09/25/2022] [Indexed: 02/04/2023]
Abstract
AIM The aim of this study was to investigate the prevalence of facial pressure injuries related to personal protective equipment use in nurses and the relationship with getting COVID-19 infection. DESIGN The study used descriptive and correlational online survey design. METHODS Nurses in Turkey were recruited via an electronic link sent to their social media platforms (e.g., Facebook, Instagram, Twitter), WhatsApp, and e-mail during the study: March-April 2021. Of them, 603 participants completed the survey form from all over Turkey. RESULTS/FINDINGS Facial pressure injuries develop in nurses due to use of personal protective equipment. The rates of facial pressure injuries were higher in the nurses who were younger (p=0.002) and those who had less experience years (p=0.005) than the other nurses. The statistically significant variables were determined as age, status of using face shield, status of wearing overalls and status of wearing shoe covers (p<0.05). We determined that facial pressure injuries were not significantly associated with getting COVID-19 infection (p>0,05). CONCLUSIONS This study showed that facial pressure injuries associated with personal protective equipment use among nurses, who work on the frontlines in the COVID-19 pandemic period, is highly prevalent. Experiencing facial pressure injuries did not have a significant effect on the participants' statuses of getting infected with COVID-19. Providing training in health institutions may present an effective strategy in lowering problems.
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Bharatha A, Krishnamurthy K, Cohall D, Rahman S, Forde CA, Corbin-Harte R, Ojeh N, Kabir R, Parsa AD, Rabbi AMF, Majumder MAA. Personal protective equipment (PPE) related adverse skin reactions among healthcare workers at the main COVID-19 isolation center in Barbados. Front Public Health 2022; 10:978590. [PMID: 36304246 PMCID: PMC9592812 DOI: 10.3389/fpubh.2022.978590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
Background The use of personal protective equipment (PPE) reduces the risk of transmission of infectious agents significantly among healthcare workers (HCWs). The study aimed to investigate the prevalence and characteristics of PPE-related adverse skin reactions among HCWs working at the main COVID-19 isolation center in Barbados. Methods A cross-sectional web-based online survey was conducted during April to June 2021 which recorded demographic information, details of PPE use and adverse skin reactions including severity and duration of onset of symptoms. Results Most of the respondents used PPE for consecutive days (77.9%), 1-6 h/day (59.2%), and more than a year (62.5%). Fewer than half of the participants (45.6%) experienced adverse skin reactions from the use of PPE. The reactions were mostly observed in the cheeks (40.4%) and nose bridges (35.6%). Females had more reactions than their male counterparts (p = 0.003). The use of N95 masks and a combination of surgical and N95 masks produced adverse effects predominantly in the ears (60%) and cheeks (56.4%). Binary logistic regression showed that female HCWs (OR = 5.720 95% CI: 1.631, 20.063), doctors (OR = 5.215 95% CI: 0.877, 31.002), and longer duration of PPE use (>1 year) (OR = 2.902 95% CI: 0.958, 8.787) caused a significantly higher prevalence of adverse skin reactions. Conclusion The PPE-related skin reactions were common among HCWs which mainly occurred due to prolonged use. Preventive measures inclusive of appropriate training of HCWs on the use of PPE are recommended to minimize these adverse events.
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Affiliation(s)
- Ambadasu Bharatha
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Kandamaran Krishnamurthy
- PICU Consultant, Queen Elizabeth Hospital, Bridgetown, Barbados,*Correspondence: Kandamaran Krishnamurthy
| | - Damian Cohall
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Sayeeda Rahman
- American University of Integrative Sciences, School of Medicine, Bridgetown, Barbados
| | - Corey A. Forde
- Infection Prevention and Control/Infectious Diseases Programs, The Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Rhea Corbin-Harte
- Isolation Facilities Client Relations and Activities, Bridgetown, Barbados
| | - Nkemcho Ojeh
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Russell Kabir
- Faculty of Health Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Ali Davod Parsa
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, United Kingdom
| | | | - Md Anwarul Azim Majumder
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
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Valk B, Ivanov NN, Nahhas A, Corwin K, Hansen K, Globerson J, LaCasse A, Corser W, Sikorski L. Mask-related skin changes among healthcare workers in a community-based hospital. J Osteopath Med 2022; 122:609-615. [PMID: 36028224 DOI: 10.1515/jom-2022-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/04/2022] [Indexed: 11/15/2022]
Abstract
CONTEXT During the COVID-19 pandemic, dermatologists within the Beaumont Farmington Hills' Dermatology program noticed an increase in conditions associated with mask wearing, such as "maskne" (acne in a mask distribution, thought to be caused by mask wearing), as well as worsening of previously diagnosed dermatologic conditions. OBJECTIVES The goal of our study was to explore various factors that impacted mask-related skin changes and how these skin changes affected quality of life. METHODS A cross-sectional study was performed. The primary 10-item survey instrument administered was the Dermatology Life Quality Index (DLQI). Respondents were asked a series of 10 additional questions concerning the degree to which abnormal mask-related skin conditions affect their skin symptoms, possible embarrassment/self-consciousness, and perceived impact of mask-related skin changes. A series of descriptive statistics, cross-tabulation charts, and graphical examinations of data was utilized to evaluate sample subgroup and outcome distributional patterns. Pearson r bivariate correlation coefficients between possible collinear predictive measures on the primary study outcome were calculated. A series of simple inferential chi-squared (Χ2) tests of independence were also conducted. RESULTS A total of 370 out of 430 (86.0%) Beaumont Health employees noticed some degree of skin changes since the work-hours face mask requirement was instituted, while 378 out of 430 (87.9%) felt that their skin was better when not wearing a mask. The majority of respondents, 283 (65.8%), reported having at least a little symptomatic skin (i.e., itchy, painful, sore, stinging) during the prior week. Furthermore, 72.3% reported that they were at least a little embarrassed or self-conscious of their skin. Chi-squared analysis of composite DLQI score categories by the number of types of masks utilized (Pearson X2=19.0, df=8, p=0.015), and some degree of symptomatic skin (Pearson X2=156.4, df=4, p<0.001) were found to be statistically significant. CONCLUSIONS A large number of healthcare workers are affected by mask-related skin changes. Further research should be directed at better understanding how skin changes associated with mask wearing impact one's quality of life and mental health.
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Affiliation(s)
- Brittany Valk
- Beaumont Health Systems - Department of Dermatology, Farmington Hills Campus, Farmington Hills, MI, USA
| | - Nedyalko N Ivanov
- Beaumont Health Systems - Department of Dermatology, Farmington Hills Campus, Farmington Hills, MI, USA
| | - Amanda Nahhas
- Beaumont Health Systems - Department of Dermatology, Farmington Hills Campus, Farmington Hills, MI, USA
| | - Katie Corwin
- Beaumont Health Systems - Department of Dermatology, Farmington Hills Campus, Farmington Hills, MI, USA
| | - Katrina Hansen
- Beaumont Health Systems - Department of Dermatology, Farmington Hills Campus, Farmington Hills, MI, USA
| | - Jeff Globerson
- Beaumont Health Systems - Department of Dermatology, Farmington Hills Campus, Farmington Hills, MI, USA
| | - Annette LaCasse
- Beaumont Health Systems - Department of Dermatology, Farmington Hills Campus, Farmington Hills, MI, USA
| | - William Corser
- Michigan State University Statewide Campus System, East Lansing, MI, USA
| | - Lynn Sikorski
- Beaumont Health Systems - Department of Dermatology, Farmington Hills Campus, Farmington Hills, MI, USA
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Kaur M, Kumar A, Kaur S, Nagar PK, Nagi M, Thakur V, Khan R. Adverse Effects of Personal Protective Equipment and Their Self-Practiced Preventive Strategies among the Covid-19 Frontline Health Care Workers. Hosp Top 2022:1-12. [PMID: 35983853 DOI: 10.1080/00185868.2022.2112523] [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: 10/15/2022]
Abstract
BACKGROUND Owing to the highly contagious nature of SARS-CoV-2, the use of personal protective equipment (PPE) among the healthcare workers (HCWs) is mandatory. However, PPE associated adverse effects are also there. OBJECTIVE To study the adverse effects associated with PPE and their preventive measures amongst the HCWs. MATERIAL AND METHODS A descriptive study was conducted among 200 HCWs working in a Covid center of a tertiary care center. The participants were sent the questionnaires online. Some of them not having smart phones were interviewed telephonically. Their information profile, the various adverse effects associated with PPE, and the preventive measures being practiced by them were noted. Data was analyzed using descriptive and inferential statistics. RESULTS Total 97% HCWs reported adverse effects with hazmat suit; 96% with N 95 mask; 92% with goggle and 78% with gloves. The adverse effects associated with the prolonged use of the mask were erythema; erosions and scar at the nasal bridge; ear pain; difficulty in breathing; and headache. Sixty-seven percent of the participants had sweating with the use of gloves, which led to cutaneous exfoliation such as dry hands (55%) and skin itching (43%). Moisturizers and natural oils were used to prevent the dryness of hands. For the pressure related injury over the nasal bridge due to N95 mask, participants used to apply Band-Aid (adhesive bandage) and cotton dressing. CONCLUSION Adverse skin reactions related to PPE are common among HCWs. Comprehensive assessment of the skin condition and awareness on adverse skin reactions should be advocated.
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Affiliation(s)
| | - Ashok Kumar
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Sukhpal Kaur
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | | | - Manisha Nagi
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Vishal Thakur
- Department of Dermatology, Venereology & Leprology, Himalayan Institute of Medical Sciences, Uttarakhand, India
| | - Reshma Khan
- Nursing Department, PGIMER, Chandigarh, India
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Prevalence and associated factors of dry skin among older inpatients in hospitals and nursing homes: A multicentre cross-sectional study. Int J Nurs Stud 2022; 135:104358. [DOI: 10.1016/j.ijnurstu.2022.104358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022]
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Holder H, Aningalan AM, Walker S, Cato K, Gannon B“R. Feasibility of nasal bridge pressure injury prevention using a protective dressing and the Halyard Fluidshield® N95 mask in a COVID-positive environment. Int Wound J 2022; 20:278-284. [PMID: 35851746 PMCID: PMC9349906 DOI: 10.1111/iwj.13871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/31/2022] [Accepted: 06/04/2022] [Indexed: 02/03/2023] Open
Abstract
The purpose of this study was to prevent nasal bridge pressure injury among fit-tested employees, secondary to long-term wear of the N95 mask during working hours. A prospective, single-blinded, experimental cohort design. Participants were enrolled using the convenience sampling methods and randomisation was utilised for group assignment. Eligibility was determined by a COVID Anxiety Scale score and non-COVID clinical assignment. Participants with a history of previous skin injury or related condition were excluded. The experimental group was assigned Mepilex Lite® and the control group used Band- Aid®. Formal skin evaluations were done by Nurse Specialists who are certified in wound and ostomy care by the Wound, Ostomy, Continence, Nursing Certification Board (WOCNCB®). Fit test logs were provided to participants to measure subjective user feedback regarding mask fit and level of comfort. The results of this feasibility trial are promising in supporting the use of a thin polyurethane foam dressing as a safe and effective dressing to apply beneath the N95 mask. Additional research is needed to validate results due to limited data on efficacy and safety of the various barrier dressings as a potential intervention to prevent skin breakdown to the nasal bridge.
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Affiliation(s)
- Hazel Holder
- NewYork‐Presbyterian HospitalNew YorkNew YorkUSA
| | | | | | - Kenrick Cato
- School of NursingColumbia UniversityNew YorkNew YorkUSA,Department of Emergency MedicineColumbia University Irving School of MedicineNew YorkNew YorkUSA
| | - Brittany “Ray” Gannon
- NewYork‐Presbyterian HospitalNew YorkNew YorkUSA,School of NursingColumbia UniversityNew YorkNew YorkUSA
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29
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Pretto CR, Morais KCPD, Mendes VC, Paiva AL, Silva RMD, Beck CLC. The Impact of COVID-19 on the Physical Well-being of Nursing and Medical Personnel: An Integrative Review. AQUICHAN 2022. [DOI: 10.5294/aqui.2022.22.2.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective: To highlight the impact of responding to COVID-19 on the physical well-being of nursing and medical personnel. Method: This integrative literature review includes Spanish, English, and Portuguese articles. From July 10 to 16, 2020, the search was carried out in the Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, Web of Science, SciVerse Scopus, and National Library of Medicine databases. Twenty-five studies were analyzed, and the results are presented descriptively and in tables. Results: Of the total number of articles, 52 % addressed coronavirus infection and related factors as an impact on nursing and medical personnel’s physical well-being resulting from responding to COVID-19, 28 % addressed sleep quality and predictors, and 20 % addressed damage stemming from the use of personal protective equipment or other preventive measures. Conclusions: Responding to COVID-19 has been conducive to coronavirus infection among personnel due to the work process and prevention measures, poor sleep quality due to mental disorders and lack of social support, and physical harm, such as headaches and skin injuries, due to the use of protective equipment and hand disinfection.
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30
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Liu N, Ye M, Zhu Q, Chen D, Xu M, He J, Li Q, Li J. Adverse Reactions to Facemasks in Health-Care Workers: A Cross-Sectional Survey. Clin Cosmet Investig Dermatol 2022; 15:947-954. [PMID: 35642175 PMCID: PMC9148581 DOI: 10.2147/ccid.s365390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) has developed into a worldwide pandemic, which presents several challenges for frontline health-care workers (HCWs). HCWs are highly prone to various skin diseases due to prolonged use of personal protective equipment (PPE). The most frequently used type of PPE is facemasks. To effectively control adverse skin reactions, there is an urgent need for a range of preventive practices. Methods This cross-sectional study was conducted at 12 hospitals in Zhejiang province, China. HCWs were invited to participate in the web survey. Data were extracted by two independent reviewers using a predesigned data collection form and analyzed with SPSS 20.0. Results A total of 1147 questionnaires were collected, and of these, 1090 (95.03%) were valid and returned. The incidence of chest tightness and shortness of breath and face eczema was significantly higher in HCWs wearing N95 facemasks (41.91%; 31.62%) than in the HCWs wearing medical facemasks (38.05%, P = 0.010; 21.91%, P = 0.012). The incidence of ear pain and indentation was significantly higher in HCWs wearing hang-facemasks (83.81%) than in HCWs wearing strains-facemasks (61.19%, P < 0.001). The incidence of ear pain and indentation was significantly higher in HCWs wearing undiscriminating size code facemasks (79.88%) than in the HCWs wearing discriminating size code facemasks (67.86%, P = 0.031). There was a significant reduction (P < 0.001) in the incidence of HCWs without adverse reactions (ADRs) with increasing time wearing facemasks. Conclusion Incidence of ADRs does not significantly increase with the durations of mask wear where wearing mask time exceeded 4 hours per day. The medical staff generally wore masks for more than 4 hours per day; therefore, we recommend taking 15 min of rest after 2 hours of mask-wearing. Results in this study support the conclusion that the type of strain-facemasks and discriminating size code facemasks has a lower incidence of ADRs than other type of medical facemasks.
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Affiliation(s)
- Ning Liu
- Outpatient Department, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang Province, 314000, People's Republic of China
| | - Min Ye
- Nursing Department, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang Province, 314000, People's Republic of China
| | - Qinya Zhu
- Nursing Department, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang Province, 314000, People's Republic of China
| | - Dingchao Chen
- Medical Department, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang Province, 314000, People's Republic of China
| | - Mingmin Xu
- Ultrasonic Department, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang Province, 314000, People's Republic of China
| | - Jia He
- Department of Urology, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang Province, 314000, People's Republic of China
| | - Qian Li
- Ultrasonic Department, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang Province, 314000, People's Republic of China
| | - Jie Li
- The Health Administration Center, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang Province, 314000, People's Republic of China
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Nyberg A, Rajaleid K, Demmelmaier I. The Work Environment during Coronavirus Epidemics and Pandemics: A Systematic Review of Studies Using Quantitative, Qualitative, and Mixed-Methods Designs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116783. [PMID: 35682365 PMCID: PMC9180570 DOI: 10.3390/ijerph19116783] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 02/05/2023]
Abstract
We aimed to provide an overview of how work environment and occupational health are affected, and describe interventions designed to improve the work environment during epidemics and pandemics. The guidelines on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) were followed. The databases Cinahl, Medline, PsycInfo, and Web of Science were searched for population: working population; exposure: coronavirus epidemic or pandemic; and outcome: work environment, in articles published until October 2020. Quality assessment was based on a modified version of the Mixed Methods Appraisal Tool (MMAT). After deduplication 3711 articles remained, of which 530 were selected for full-text screening and 119 for quality assessment. After the exclusion of studies that were low quality, 95 remained, of which 85 focused on healthcare personnel and 10 on employees in other industries; 73 used quantitative methods and 22 used qualitative or mixed methods; the majority were based on cross-sectional data. Healthcare staff experienced increased job demands, poor leadership, and lack of resources (personal protective equipment, personnel, and competence). High demands and work with infected patients were associated with negative mental health outcomes. There was a lack of studies assessing interventions, studies from industries other than healthcare, and studies of high quality.
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Affiliation(s)
- Anna Nyberg
- Department of Public Health and Caring Sciences, Uppsala University, P.O. Box 564, SE-751 22 Uppsala, Sweden;
- Correspondence: ; Tel.: +46-8-708-234318
| | - Kristiina Rajaleid
- Stress Research Institute, Department of Psychology, Stockholm University, SE-106 91 Stockholm, Sweden;
| | - Ingrid Demmelmaier
- Department of Public Health and Caring Sciences, Uppsala University, P.O. Box 564, SE-751 22 Uppsala, Sweden;
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Temmesfeld MJ, Gorzkowska-Sobas AA, Hedlund K, Øyen MØ, Kanten L, Grant P, Jakobsen RB. Surgical helmets can be converted into efficient disinfectable powered air-purifying respirators. Am J Infect Control 2022; 50:624-630. [PMID: 34958857 DOI: 10.1016/j.ajic.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Filtering facepiece respirators often fail to provide sufficient protection due to a poor fit. Powered air-purifying respirators (PAPRs) are not designed for healthcare personnel, and are challenging to disinfect. Surgical helmets (SH) are available in many United States hospitals but do not provide respiratory protection. Several modifications to SH have been suggested, but none are sufficiently compliant with safety and efficiency standards. The purpose of this investigation was the development of a filter adaptor, which converts SHs into efficient, safe, and disinfectable PAPRs. METHODS Four critical features were investigated close to regulatory requirements: total inward leakage of particles, CO2 concentrations, intra-helmet differential pressure, and automated disinfection. RESULTS The average total inward leakage in the 2 independent tests were 0.005% and 0.01%. CO2 concentrations were lower than in the original SH. The modification generates a positive differential pressure. The filter's performance was not compromised after 50 cycles in a sterilization machine. DISCUSSION The modified SH provides several hundred times better protection than FFP-3 masks. CONCLUSIONS Surgical helmets can be modified into safe, efficient, and disinfectable PAPRs, suitable for HCP and the operating room in particular. They can play a role in the preparedness for upcoming events requiring efficient respiratory protection.
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Affiliation(s)
- Max Joachim Temmesfeld
- Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Orthopedics, Akershus University Hospital, Lørenskog, Norway.
| | | | | | | | - Lars Kanten
- Department of Sterile Supplies, Akershus University Hospital, Lørenskog, Norway
| | - Peter Grant
- Department of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gotehnburg, Sweden; Lovisenberg Diaconal Hospital, Nydalen, Oslo, Norway
| | - Rune B Jakobsen
- Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Orthopedics, Akershus University Hospital, Lørenskog, Norway
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Thermal discomfort caused by personal protective equipment in healthcare workers during the delta COVID-19 pandemic in Guangzhou, China: A case study. CASE STUDIES IN THERMAL ENGINEERING 2022; 34:101971. [PMCID: PMC8983079 DOI: 10.1016/j.csite.2022.101971] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/10/2022] [Accepted: 03/23/2022] [Indexed: 06/17/2023]
Abstract
Background In contrast to the previous COVID-19 pandemic, most frontline healthcare workers (HCWs) worked on residents’ nucleic acid tests in outdoor environments, instead of taking care of COVID-19 patients in hospitals during the hot summer of 2021. Therefore, it is necessary to investigate the prevalence and characteristics of thermal discomfort caused by personal protective equipment (PPE). Methods A cross-sectional survey was conducted online at hospitals from 11 administrative regions of Guangzhou for the assessment of thermal discomfort among HCWs from June 12–16, 2021. Univariate and logistic regression analyses were used to explore the risk factors associated with thermal discomfort. Results A total of 3658 valid responses were collected. The thermal discomfort and humid discomfort levels increased from 2.91 ± 1.19 to 3.61 ± 0.72 and from 0.98 ± 1.36 to 3.06 ± 1.1 after wearing PPE, respectively (p < 0.01). Feelings of being “very hot” and “uncomfortably humid” were the most influenced by wearing PPE, increasing from 31% to 69.1% and from 9.1% to 45.7%, respectively. There were significant increases in the thermal discomfort level (3.75 ± 0.57 vs. 3.33 ± 0.89, p < 0.01) and the humid discomfort level (3.33 ± 0.95 vs. 2.54 ± 1.19, p < 0.01) between the comfortable group and uncomfortable group, accompanied by similar patterns in the feelings of being “very hot” and “uncomfortably humid.” For general thermal-related symptoms, the most common new-onset symptom was profuse sweating (80%) followed by labored breathing (55.2%) and excessive dehydration (46.8%), while facial swelling (74%) was associated with local thermal-related symptoms, followed by hand maceration erosion (56.7%) and visual impairment (49.3%). In the multivariate analysis, the apparent temperature of the environment (≥35 °C), working in negative-pressure ambulances and outdoors, continuing to wear PPE for 1–3 days during this period, being aged >40 years, and previous experiences fighting the pandemic were independently associated with thermal discomfort (p < 0.01). Immediately after PPE removal, 32.3% of respondents considered drinking ice water/another drink, followed by 25% shortening the duration of wearing PPE and 19.1% going to the toilet. A large proportion of the participants looked forward to modifications to the material of the suit (72.9%) and mask (53.4%) for heat dissipation and dehumidification, as well as anti-fogging goggles (60.2%), adding hydration equipment to PPE (53.4%), and using soft materials to reduce pressure (40%). Conclusions Thermal discomfort is common and degrades health physiology related to PPE in summer environments. This suggests that modifications to the current working practices are urgently required to improve the resilience of HCWs and enhance their services during pandemics.
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Stiger I. Protecting yourself from PPE skin injuries. Nursing 2022; 52:45-47. [PMID: 35452041 DOI: 10.1097/01.nurse.0000827144.89703.c9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
ABSTRACT Nurses are wearing personal protective equipment (PPE) for extended periods while providing patient care during the ongoing COVID-19 pandemic. This article identifies dermatologic issues of extended PPE use, explores the risks of injury, and offers prevention strategies.
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Affiliation(s)
- Ivan Stiger
- Ivan Stiger is a doctoral student at Loma Linda University - School of Nursing in Loma Linda, Calif
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Protective equipment-related pressure ulcers in healthcare workers during COVID-19 pandemic: A systematic review. J Tissue Viability 2022; 31:213-220. [PMID: 35210162 PMCID: PMC8856964 DOI: 10.1016/j.jtv.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 01/29/2022] [Accepted: 02/14/2022] [Indexed: 01/17/2023]
Abstract
AIM This systematic review was carried out to examine pressure ulcers in healthcare staff due to the use of protective equipment during COVID-19 pandemic and the precautions taken to prevent these injuries. METHOD Relevant studies were retrospectively searched. Seven English keywords identified from MESH were used while searching. The search was carried out in five international databases by trying various combinations of these words during February 15-25, 2021. This systematic review was updated by rescanning databases on December 20, 2021 and a total of 611 studies were attained. RESULTS 17 studies which met the study inclusion criteria, which were conducted mostly through online survey method in different study designs and which included a total of 24,889 healthcare professionals were examined. The incidence of PPE-related pressure ulcers was found to be between 30% and 92.8%. Grade I pressure ulcers were the most common (44.1%-82%). The incidence of skin problems except PPE-related pressure ulcers such as itching, redness and dry skin was found to be between 42.8-88.1%. Risk factors that frequently played a role in the development of PPE-related pressure ulcers and other skin problems were longer use of PPE and sweating. PPE-related pressure ulcers and other skin problems were more frequent over the nose (nasal bone/nasal bridge), ears, forehead and cheeks. PPE-related itching, redness and dry skin mostly occurred. Several dressing applications were found to be effective in the prevention of PPE-related pressure ulcers and other skin problems that might develop especially on the facial region. CONCLUSION PPE-related pressure ulcers and other skin problems were found to be higher among healthcare professionals. Data regarding the sealing of dressing applications against viral transmission in the prevention of PPE-related pressure ulcers and other skin problems are limited. It is estimated that future studies will be performed to prevent device-related pressure ulcers in healthcare workers. It is suggested that there is a need to conduct studies with larger samples where expert researchers make observations for pressure ulcers in order to determine the prevalence and incidence of PPE-related pressure ulcers.
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Ünver S, Yildirim M, Cansu Yeni̇ğün S. Personal protective equipment related skin changes among nurses working in pandemic intensive care unit: A qualitative study. J Tissue Viability 2022; 31:221-230. [PMID: 35094886 PMCID: PMC8785367 DOI: 10.1016/j.jtv.2022.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/25/2021] [Accepted: 01/20/2022] [Indexed: 01/17/2023]
Abstract
AIM The respiratory tract is the main transmission way of the SARS-CoV-2 virus and nurses who care for COVID-19 patients in intensive care units (ICUs) are required to constantly use personal protective equipment (PPE) during their daily work. This study aimed to examine the PPE-related skin changes experienced by the nurses working in pandemic ICU during the COVID-19 pandemic. METHODS Using a descriptive phenomenological approach, semi-structured interviews were conducted between November 1st and December 25th, 2020, in the pandemic ICU of a training and research hospital in Usak, Turkey. The nurses who worked in the pandemic ICU for at least one week and experienced skin changes due to PPE use were included. Individual interviews were carried out online through video conferencing. Colaizzi's method was used in data analysis by using the ATLAS.ti 8.0. RESULTS The main themes were main causes of PPE-related skin changes, its location along with secondary adverse effects, symptomatology, prevention, and therapeutic interventions used for curing PPE-related skin changes. Nurses mostly reported PPE-related skin changes behind their ears, over their nose, cheeks and jaw due to wearing N95 masks and on the forehead due to wearing face shields. Wearing PPE at least 2 h, the type/quality of PPE, and being dehydrated were identified as the common causes. CONCLUSION This study provides a deeper understanding into the PPE-related skin change experiences of pandemic ICU nurses and the importance of the quality of the PPE used. It is recommended to enable shortened working shifts and ergonomic PPE materials for ICU nurses.
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Affiliation(s)
- Seher Ünver
- Trakya University, Faculty of Health Sciences, Department of Surgical Nursing, Edirne, Turkey,Corresponding author. Trakya University, Balkan Campus, Faculty of Health Sciences, Department of Surgical Nursing, 22020, Edirne, Turkey
| | - Meltem Yildirim
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Seda Cansu Yeni̇ğün
- Akdeniz University, Kumluca Faculty of Health Sciences, Department of Surgical Nursing, Antalya, Turkey
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Yang R, Ke Q, Chan SW, Liu Y, Lin H, Li W, Zhu J. The relationship between frontline nurses’ skin lesions and their anxiety and depression during the COVID‐19 pandemic: exploring the mediating role of fear and resilience. J Nurs Manag 2022; 30:1903-1912. [PMID: 35434883 PMCID: PMC9115287 DOI: 10.1111/jonm.13638] [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: 11/18/2021] [Revised: 03/25/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
Abstract
Aim Background Methods Results Conclusion Implications for nursing management
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Affiliation(s)
- Rumei Yang
- School of Nursing, Nanjing Medical University Nanjing city Jiangsu Province P. R. China
| | - Qiaohong Ke
- Department of Gynaecology, Women and Children's Hospital, School of Medicine Xiamen University Xiamen Fujian Province P. R. China
| | | | - Yang Liu
- School of Medicine Xiamen University Xiamen Fujian Province P.R. China
| | - Huicong Lin
- School of Medicine Xiamen University Xiamen Fujian Province P.R. China
| | - Wengang Li
- School of Medicine Xiamen University Xiamen Fujian Province P.R. China
| | - Jiemin Zhu
- School of Medicine Xiamen University Xiamen Fujian Province P.R. China
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George J, Verma R, Shafqat N. Physiological Hazard Assessment While Wielding Personal Protective Equipment (PPE) Among Health Care Workers. Cureus 2022; 14:e23510. [PMID: 35494999 PMCID: PMC9037050 DOI: 10.7759/cureus.23510] [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] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Accurate use of personal protective equipment (PPE) is an essential part of infection prevention and control measures to protect health care workers and patients from various hazardous conditions. Health care workers caring for patients with potentially infectious health conditions are using PPE for long periods of time. However, long-term use of PPE can cause many physiological health hazards among health care workers. So, the current study was carried out to assess the general health problems and dermatological problems experienced by health care workers with PPE use. Materials and methods A descriptive cross-sectional survey has been carried out in two selected tertiary care hospitals in central India by recruiting 301 health care workers. Non-probability convenient sampling technique was used to select participants for the study. Sociodemographic Performa and structured questionnaires were used to collect data on demographic characteristics of the participants and various health problems experienced by health care workers with PPE use. Collected data were analyzed using appropriate descriptive and inferential statistics. Results The current study reported excessive sweating (86.4%), difficulty in reading (85%), dry mouth (80.7%), and breathing difficulty (74.1%) as the most common problem associated with PPE use. In addition to this, adverse reactions like headache, restlessness, and dizziness were reported by 70.1%, 64.5%, and 50.8%. Indentation and pain on the back of the ears (76.1%), skin soaking (67.1%), and excessive sweating (76.1%) were identified as the most common problems related to N-95 masks, gloves, and coverall use. Conclusion The current study revealed a higher incidence of various health problems with PPE use among health care workers. The findings of the study highlight the importance of developing various guidelines to reduce the negative impact of PPE use and implementing preventive measures to decrease health problems associated with PPE use.
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Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. Second edition. J Wound Care 2022; 31:S1-S72. [PMID: 35616340 DOI: 10.12968/jowc.2022.31.sup3a.s1] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator, Wounds Research Laboratory, Catholic University of Portugal, Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Lisbon, Portugal
| | - Guido Ciprandi
- Chief Wound Care, Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing (joint appointment), Intensive Care Services, Royal Brisbane and Women's Hospital, School of Nursing, Queensland University of Technology, Brisbane, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Nicola Waters
- Senior Research Associate, Health, The Conference Board of Canada; Adjunct Professor, School of Nursing, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Peter Worsley
- Associate Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor, College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Clinical Lead and Skin Integrity Lead, HAC Pressure Injury Coordinator, Sydney Local Health District; Adj Associate Professor, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor, Skin Integrity Research Group (SKINT), Ghent University, Belgium; Professor and Vice-Head, School for Research and Internationalisation, Örebro University, Sweden
| | | | | | - Nils A Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, Grenoble Alpes University, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner, Paediatric Skin and Wound Management, Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children's Hospital, Zurich, Switzerland
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Aloweni F, Bouchoucha SL, Hutchinson A, Ang SY, Toh HX, Bte Suhari NA, Bte Sunari RN, Lim SH. Health care workers' experience of personal protective equipment use and associated adverse effects during the COVID-19 pandemic response in Singapore. J Adv Nurs 2022; 78:2383-2396. [PMID: 35170075 PMCID: PMC9111733 DOI: 10.1111/jan.15164] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/28/2021] [Accepted: 11/27/2021] [Indexed: 12/15/2022]
Abstract
Aim One of the greatest challenges in responding to the COVID‐19 pandemic is preventing staff exposure and infection by ensuring consistent and effective use of personal protective equipment (PPE). This study explored health care workers' experience of prolonged PPE use in clinical practice settings and their concerns regarding PPE supply, effectiveness and training needs. Design A descriptive cross‐sectional design was adopted in this study. Methods Health care workers (N = 592) from an acute care hospital completed an online survey from July to September 2020 assessing: (i) usage frequencies, side effects and interference with patient care; and (ii) perceptions of access to PPE, likelihood of exposure to infection and adequacy of PPE training. Results PPE‐related side effects were reported by 319 (53.8%) participants, the majority being nurses (88.4%) and those working in high‐risk areas such as the emergency department (39.5%), respiratory wards (acute 22.3% and non‐acute 23.8%) and COVID‐19 isolation ward (13.8%). The average time wearing PPE per shift was 6.8 h (SD 0.39). The most commonly reported symptoms were from donning N95 masks and included: pressure injuries (45.5%), mask‐induced acne (40.4%) and burning/pain (24.5%). Some 31.3% expressed that PPE‐related side effects had negatively affected their work. The odds of having PPE‐associated side effects was higher in women (OR 2.10, 95% CI [1.29–03.42], p = .003) and those working in high‐risk wards (OR 3.12, 95% CI [2.17–4.60], p < .001]. Most (90.1%) agreed that PPE supplies were readily available, sufficient for all (86.1%) and there was sufficient training in correct PPE use (93.6%). Only 13.7% of participants reported being ‘highly confident’ of overall PPE protection. Conclusions Prevention and management of PPE‐related adverse effects is vital to: preserve the integrity of PPE, improve adherence and minimize viral transmission. Impact The high incidence of PPE‐associated pressure injuries and perception that PPE use can interfere with clinical care should inform future development of PPE products, and strategies to better equip health care workers to prevent and manage PPE‐related side effects.
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Affiliation(s)
- Fazila Aloweni
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | - Stéphane L Bouchoucha
- Associate Head of School (International), Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University Geelong, School of Nursing and Midwifery, Victoria, Australia
| | - Ana Hutchinson
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Epworth Health/Deakin University Partnership, School of Nursing and Midwifery Geelong, Victoria, Australia
| | - Shin Yuh Ang
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | - Hui Xian Toh
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | | | | | - Siew Hoon Lim
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
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Moore Z, Moore D, McEvoy NL, Avsar P, O'Connor T, Budri A, Curley G, Walsh S, Burke F, Porter‐Armstrong A, Chaboyer W, Rice J, Patton D. Preventing facial pressure injuries among health care staff working in diverse COVID-19 care environments. Int Wound J 2022; 19:1677-1685. [PMID: 35146927 PMCID: PMC9111615 DOI: 10.1111/iwj.13768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 02/03/2023] Open
Abstract
The aim of this study was to determine the impact of a specially designed care bundle on the development of facial pressure injuries among frontline health care workers wearing personal protective equipment (PPE) during the COVID-19 pandemic. This was a mixed methods study. First, a pre-posttest observational design was employed to evaluate the impact of the pre-piloted intervention, a care bundle including skin cleansing and hydration, protective material use, facemask selection and skin inspection, developed in line with international best practice guidelines. Data were collected using survey methodology. Frontline COVID-19 staff working in acute, community and ambulance services were invited to participate. Then, judgemental and volunteer sampling was used to select participants to undertake semi-structured interviews to elicit feedback on their perceptions of the care bundle. The sample included 120 acute hospital staff, 60 Ambulance staff, 24 Community Hub staff and 20 COVID-19 testing centre staff. A survey response rate of 61% was realised (n = 135/224). Of the participants, 32% (n = 43) had a facial pressure ulcer (FPI) pre-intervention and 13% (n = 18) developed an FPI while using the care bundle. The odds ratio (OR) was 0.33 (95% CI: 0.18 to 0.61; P = .0004), indicating a 77% reduction in the odds of FPI development with use of the care bundle. Analysis of the qualitative data from 22 interviews identified three key themes, the context for the care bundle, the ease of use of the care bundle and the care bundle as a solution to FPI development. The care bundle reduced the incidence of FPI among the participants and was found to be easy to use. Implementation of skin protection for frontline staff continues to be important given the persistently high incidence of COVID-19 and the ongoing need to wear PPE for protracted durations.
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Affiliation(s)
- Zena Moore
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland,Fakeeh College of Health SciencesJeddahSaudi Arabia,School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia,Faculty of Medicine, Nursing and Health SciencesMonash UniversityMonashAustralia,Department of Public HealthFaculty of Medicine and Health Sciences, Ghent UniversityGhentBelgium,Lida InstituteShanghaiChina,University of WalesCardiffUK,National Health and Medical Research Council Centre of Research Excellence in Wiser Wound CareMenzies Health Institute QueenslandQueenslandAustralia
| | | | - Natalie L. McEvoy
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland,Beaumont HospitalDublinIreland
| | - Pinar Avsar
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | - Tom O'Connor
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland,Fakeeh College of Health SciencesJeddahSaudi Arabia,School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia,Lida InstituteShanghaiChina
| | - Aglecia Budri
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | - Gerard Curley
- Beaumont HospitalDublinIreland,RCSI University of Medicine and Health SciencesDublinIreland
| | - Simone Walsh
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | - Frank Burke
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | | | - Wendy Chaboyer
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia,National Health and Medical Research Council Centre of Research Excellence in Wiser Wound CareMenzies Health Institute QueenslandQueenslandAustralia
| | | | - Declan Patton
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland,Fakeeh College of Health SciencesJeddahSaudi Arabia,School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia,Faculty of Science, Medicine and HealthUniversity of WollongongAustralia
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Gupta V, Jaisinghani A, Chauhan A. Skin damage due to personal protective equipment among nursing staff in a dedicated coronavirus disease-2019 hospital of tribal India. JOURNAL OF INTEGRATIVE NURSING 2022. [DOI: 10.4103/jin.jin_42_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gupta V, Jaisinghani A, Gour N, Sharma M. Skin damage due to personal protective equipment among health-care professionals in a dedicated COVID-19 hospital of tribal India. BLDE UNIVERSITY JOURNAL OF HEALTH SCIENCES 2022. [DOI: 10.4103/bjhs.bjhs_123_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Subramaniam A, Tiruvoipati R, Zuberav A, Wengritzky R, Bowden C, Wang WC, Wadhwa V. Risk perception and emotional wellbeing in healthcare workers involved in rapid response calls during the COVID-19 pandemic: A substudy of a cross-sectional survey. Aust Crit Care 2022; 35:34-39. [PMID: 34654611 PMCID: PMC8437811 DOI: 10.1016/j.aucc.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/12/2021] [Accepted: 08/22/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Coronavirus disease-2019 (COVID-19) has effected major changes to healthcare delivery within acute care settings. Rapid response calls (RRCs) in healthcare organisations have been effective at identifying and urgently managing acute clinical deterioration. Code-95 RRC were introduced to prewarn healthcare workers (HCWs) attending to patients suspected or confirmed with COVID-19 infection. AIMS The primary aim of the study was to identify the personal impact of the COVID-19 pandemic on HCWs involved in attending Code-95 RRC. We sought to evaluate their perception of risks and effects on wellbeing and identify potential opportunities for improvement at organisational levels. METHODS We undertook a detailed survey on HCWs attending Code-95 RRCs, including questions that sought to understand the impact of the pandemic as well as their perception of infection risk and emotional wellbeing. This was a substudy of the prospective cross-sectional single-centre survey of HCWs that was conducted over a 3-week period at Frankston Hospital, Victoria, Australia. We adopted a quantitative content analysis approach for free-text responses in this secondary analysis. RESULTS Four hundred two free-text comments were received from 297 respondents and were analysed. More than two-thirds (68%, 223/297) were female. Of all comments, 39% (155/402) were related to organisational issues including communication, confusion due to constantly changing infection control policies, and insufficient training. Thirty-three percent of comments (133/402) raised issues regarding the adequacy of personal protective equipment. Anxiety was reported in 25% of comments (101/402) with concerns predominantly relating to emotional stress and fatigue, risks of virus exposure and transmitting the infection to others, and COVID-19 precautions impairing care delivery. CONCLUSION(S) Our study raises important issues that have relevance for all healthcare organisations in the management of patients with COVID-19. These include the importance of improving communication, especially when infection control policies are revised, optimising training, maintaining adequate personal protective equipment, and HCW support. Early recognition and management of these issues are crucial to maintain optimal healthcare delivery.
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Affiliation(s)
- Ashwin Subramaniam
- Frankston Hospital, Peninsula Health, Australia; Peninsula Clinical School, Monash University, Australia; School of Public Health and Preventive Medicine, Monash UNiversity, Australia; The Bays Hospital, Mornington, Australia.
| | - Ravindranath Tiruvoipati
- Frankston Hospital, Peninsula Health, Australia; Peninsula Clinical School, Monash University, Australia; Peninsula Private Hospital, Australia.
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Gupta V, Phulsunga R, Kumar S, Surana A. Eustachian tube dysfunctions due to mask among quarantined health-care professionals during COVID-19 pandemic. ADVANCES IN HUMAN BIOLOGY 2022. [DOI: 10.4103/aihb.aihb_56_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Yip KH, Yip YC. Use of thin silicone dressings for prolonged use of filtering facepiece respirators: Lessons from the universal community testing programme during the COVID-19. Int Wound J 2021; 19:1188-1196. [PMID: 34729933 PMCID: PMC8652981 DOI: 10.1111/iwj.13714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 12/17/2022] Open
Abstract
A universal community testing programme (UCTP) was initiated by the government of the Hong Kong Special Administrative Region of the People's Republic of China, as part of a territory‐wide initiative to enhance the control of the coronavirus disease (COVID‐19) pandemic, to facilitate the early identification of asymptomatic patients in the community‐transmission chain. The authors (who were also engaged in this programme) observed that, at the end of their 6‐hour shift, most of the HCPs sustained medical device‐related pressure injuries (MDRPI), frequently on their faces, over the bridge of their nose, the upper cheeks, above the ears, lower jaws, and chin that caused pain and erythema. In this study, our team examined whether two different types of dressing (light silicone foam dressing and soft silicone perforated tape dressing) applied on the anatomical locations (including the bridge of the nose, upper cheek, above the ears, and lower jaw) would enable the wearer to pass the quantitative respirator fit testing that was conducted using a PortaCount Pro+ Respirator Fit Tester 8038. We also investigated if any skin reactions occurred after the participants worn the respirator with our applied dressing materials for 240 minutes in a safe laboratory setting. Lastly, we collected the qualitative feedback concerning how the participants felt about the performance of our dressing materials in preventing MDRPI associated with the prolonged use of tight‐fitting FFRs. A small convenience sample of HCPs (n = 24) who participated in the UCTP was recruited. We randomly selected 12 participants for one type of dressing, and the rest for the second type of dressing. Quantitative fit testing showed an adequate seal of the respirators with the use of both types of thin dressings that were available in the clinical settings. All of the participants except one tolerated the dressings for prolonged use without any report of adverse skin reactions. Our findings may move a step forward in assisting the process of developing feasible pre‐emptive skincare practice guidelines to reduce MDRPI during the prolonged use of nanofiber bacterial surgical respirators.
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Affiliation(s)
- Ka-Huen Yip
- School of Health Sciences, Caritas Institute of Higher Education, Tseung Kwan O, Hong Kong, China
| | - Yuk-Chiu Yip
- School of Health Sciences, Caritas Institute of Higher Education, Tseung Kwan O, Hong Kong, China
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Chopra J, Abiakam N, Kim H, Metcalf C, Worsley P, Cheong Y. The influence of gender and ethnicity on facemasks and respiratory protective equipment fit: a systematic review and meta-analysis. BMJ Glob Health 2021; 6:e005537. [PMID: 34764145 PMCID: PMC8587533 DOI: 10.1136/bmjgh-2021-005537] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 09/12/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Black, Asian and minority ethnic (BAME) people are disproportionately affected by COVID-19. Respiratory protective equipment (RPE) has conventionally been developed for a predominantly white male population that does not represent the healthcare workforce. The literature was reviewed to determine the protection offered to female and BAME users. METHODS Five databases were searched. Eligible studies related to respirator fit in the context of anthropometrics, gender and ethnicity. Meta-analysis was performed for gender-based anthropometric differences. A priori protocol registration was not performed. RESULTS 32 studies were included and anthropometric data was extracted from 15 studies. Meta-analysis revealed 14 anthropometric measurements were significantly smaller for females. Mean differences ranged from 0.37 mm to 22.05 mm. Gender-based anthropometric differences did not always translate to lower fit factor scores, with 12 studies reporting worse performance and fit for females and 10 reporting no gender effect. No studies provided disaggregate anthropometric data by ethnic group. Pass rates (PR) were low or moderate in 12 BAME or mixed-ethnicity cohorts. 14 studies reported associations between facial dimensions (FD) and respirator fit. Three comparative studies showed lower PR among selective BAME people. 18 studies reported RPE performance differed with model and design. Most studies did not prespecify inclusion/exclusion criteria. Small sample size and lack of justification or power calculations was a concern. Significant heterogeneity in study designs limited comparisons, particularly relating to respirator selection or availability and defining study outcomes relating to RPE performance. CONCLUSION The literature reports on largely Caucasian or single ethnic populations, and BAME people remain under-represented, limiting comparisons between ethnic groups. Facial anthropometrics vary between gender and likely between ethnicity, which may contribute to lower PR among females and ethnic minorities, particularly Asians. There is a need for studies including a broader spectrum of ethnicities and for consideration of female and BAME users during RPE development.
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Affiliation(s)
- Jagrati Chopra
- Scool of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nkemjika Abiakam
- School of Health Sciences, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, UK
| | - Hansung Kim
- School of Electronics and Computer Science, University of Southampton, Southampton, UK
| | - Cheryl Metcalf
- School of Health Sciences, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, UK
| | - Peter Worsley
- School of Health Sciences, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, UK
| | - Ying Cheong
- Scool of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- Complete Fertility Southampton, Princess Anne Hospital, Southampton, UK
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Mohseni Afshar Z, Babazadeh A, Hasanpour A, Barary M, Sayad B, Janbakhsh A, Aryanian Z, Ebrahimpour S. Dermatological manifestations associated with COVID-19: A comprehensive review of the current knowledge. J Med Virol 2021; 93:5756-5767. [PMID: 34241899 PMCID: PMC8427109 DOI: 10.1002/jmv.27187] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has become a significant health problem globally. The virus has spread widely and become a global pandemic. The pathophysiology for SARS-CoV-2 has not been explained clearly. It has been associated with several multiorgan symptoms, among which its dermatological manifestations are of great interest. Primarily, there has been no report of skin features among COVID-19 patients. Nevertheless, recently there have been several reports regarding COVID-19 patients who presented with cutaneous manifestations. In the current review, we focus on the various cutaneous manifestations of COVID-19 infection.
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Affiliation(s)
- Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
| | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research InstituteBabol University of Medical SciencesBabolIran
| | | | - Mohammad Barary
- Student Research CommitteeBabol University of Medical SciencesBabolIran
| | - Babak Sayad
- Clinical Research Development Center, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
| | - Alireza Janbakhsh
- Clinical Research Development Center, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
| | - Zeinab Aryanian
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
- Department of Dermatology, School of MedicineBabol University of Medical SciencesBabolIran
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research InstituteBabol University of Medical SciencesBabolIran
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49
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Erize-Herrera JA, García-Mireles V, Uh-Sánchez I, Felix-Téllez F, Encarnación-Martínez M, Estrada-Aguilar L. Manifestaciones dermatológicas en los profesionales de la salud asociadas al uso de equipo de protección personal para la atención de los pacientes con infección por COVID-19 en los hospitales del área metropolitana de la ciudad de México. PIEL 2021. [PMCID: PMC7705331 DOI: 10.1016/j.piel.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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50
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Galanis P, Vraka I, Fragkou D, Bilali A, Kaitelidou D. Impact of personal protective equipment use on health care workers' physical health during the COVID-19 pandemic: A systematic review and meta-analysis. Am J Infect Control 2021; 49:1305-1315. [PMID: 33965463 PMCID: PMC8102386 DOI: 10.1016/j.ajic.2021.04.084] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, health care workers (HCWs) have been obliged to wear personal protective equipment (PPE). We assessed the impact of PPE use on HCWs' physical health and we examined factors related to a greater risk of adverse events due to PPE use. METHODS We applied the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and the Cochrane criteria. We searched PubMed, Medline, Scopus, ProQuest, CINAHL, and medRxiv from January 1, 2020 to December 27, 2020. RESULTS Our review included 14 studies with 11,746 HCWs. The estimated overall prevalence of adverse events among HCWs was 78% with a range from 42.8% to 95.1% among studies. Among others, the following factors were related to the risk of adverse events among HCWs due to PPE use: obesity, diabetes mellitus, smoking, pre-existing headache, longer duration of shifts wearing PPE, increased consecutive days with PPE, and increased exposure to confirmed or suspected COVID-19 patients. CONCLUSIONS The frequency of adverse events among HCWs due to PPE use is very high. Healthcare facilities should take the necessary precautions and change the working conditions during the COVID-19 pandemic to prevent adverse events associated with PPE use and minimize harm to HCWs.
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Affiliation(s)
- Petros Galanis
- Faculty of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece.
| | - Irene Vraka
- Department of Radiology, P & A Kyriakou Children's Hospital, Athens, Greece
| | - Despoina Fragkou
- Faculty of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece
| | - Angeliki Bilali
- Hospital Waste Management Unit, P & A Kyriakou Children's Hospital, Athens, Greece
| | - Daphne Kaitelidou
- Faculty of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece
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