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Jain S, Dempsey K, Clezy K, Bradd P. Evaluation of health worker acceptance and tolerance of respirators in clinical practice-An Australian perspective. Am J Infect Control 2024; 52:46-53. [PMID: 37454930 DOI: 10.1016/j.ajic.2023.07.003] [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: 04/20/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND One of the main infection prevention and control measures introduced during the COVID-19 pandemic was the focused application of respiratory protection to ensure health worker safety and the effective use of personal protective equipment. However, user acceptance of these strategies is paramount in sustainable compliance. This study explores various aspects of respirator use and provides recommendations to improve and maximize health worker safety. The aim of this study was to understand the relationship between respirator (P2/N95) comfort and user experience toward respiratory protection. The aim of this study was to understand the relationship between respirator (P2/N95) comfort and user experience toward respiratory protection. METHODS The nonexperimental cross-sectional design study was conducted in New South Wales, Australia between November and December 2022 using an anonymous self-administered online questionnaire in Microsoft Forms. RESULTS Of 2,514 respondents, 65% reported to have used a respirator every working day with only a few using a respirator once weekly or less (9%). Almost all respondents had completed at least one quantitative fit test (96%) prior to the survey. Fifty-nine percent reported to have experienced discomfort from wearing a respirator and the most reported adverse effect was difficulty communicating (64%), followed by skin irritation or acne (62%) and headache (56%). CONCLUSIONS Despite somewhat less favorable ratings on comfort and communication, health workers are in favor of respiratory protection. However, a focus on tolerance of respirators and strategies to address adverse effects from prolonged respirator use must be considered when implementing policies and procedures. Moreover, resources must be allocated to improve the design, breathability, and sustainability of a respirator along with education and training on how to use respiratory protection safely and effectively.
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Affiliation(s)
- Susan Jain
- Healthcare Associated Infection Program, Clinical Excellence Commission, Sydney, New South Wales, Australia.
| | - Kathy Dempsey
- Healthcare Associated Infection Program, Clinical Excellence Commission, Sydney, New South Wales, Australia
| | - Kate Clezy
- Healthcare Associated Infection Program, Clinical Excellence Commission, Sydney, New South Wales, Australia
| | - Patricia Bradd
- Healthcare Associated Infection Program, Clinical Excellence Commission, Sydney, New South Wales, Australia
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Lu Y, Okpani AI, McLeod CB, Grant JM, Yassi A. Masking strategy to protect healthcare workers from COVID-19: An umbrella meta-analysis. Infect Dis Health 2023; 28:226-238. [PMID: 36863978 PMCID: PMC9932689 DOI: 10.1016/j.idh.2023.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The burden of severe disease and death due to SARS-CoV-2 (COVID-19) pandemic among healthcare workers (HCWs) worldwide has been substantial. Masking is a critical control measure to effectively protect HCWs from respiratory infectious diseases, yet for COVID-19, masking policies have varied considerably across jurisdictions. As Omicron variants began to be predominant, the value of switching from a permissive approach based on a point of care risk assessment (PCRA) to a rigid masking policy needed to be assessed. METHODS A literature search was conducted in MEDLINE (Ovid platform), Cochrane Library, Web of Science (Ovid platform), and PubMed to June 2022. An umbrella review of meta-analyses investigating protective effects of N95 or equivalent respirators and medical masks was then conducted. Data extraction, evidence synthesis and appraisal were duplicated. RESULTS While the results of Forest plots slightly favoured N95 or equivalent respirators over medical masks, eight of the ten meta-analyses included in the umbrella review were appraised as having very low certainty and the other two as having low certainty. CONCLUSION The literature appraisal, in conjunction with risk assessment of the Omicron variant, side-effects and acceptability to HCWs, along with the precautionary principle, supported maintaining the current policy guided by PCRA rather than adopting a more rigid approach. Well-designed prospective multi-centre trials, with systematic attention to the diversity of healthcare settings, risk levels and equity concerns are needed to support future masking policies.
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Affiliation(s)
- Yijun Lu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia (BC), V6T 1Z3, Canada; Workplace Health & Safety, Interior Health, Kelowna, BC, V1Y OC5, Canada.
| | - Arnold Ikedichi Okpani
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia (BC), V6T 1Z3, Canada
| | - Christopher B McLeod
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia (BC), V6T 1Z3, Canada
| | - Jennifer M Grant
- Divisons of Infectious Diseases and Medical Microbiology University of British Columbia, Vancouver, BC, V6T 1Z3, Canada; Divisions of Medical Microbiology and Infectious Diseases Vancouver Coastal Health, BC, Canada
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia (BC), V6T 1Z3, Canada; Medical Practitioners Occupational Safety and Health, Vancouver Coastal Health, BC, Canada
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Gutierrez-Camacho JR, Avila-Carrasco L, Martinez-Vazquez MC, Garza-Veloz I, Zorrilla-Alfaro SM, Gutierrez-Camacho V, Martinez-Fierro ML. Oral Lesions Associated with COVID-19 and the Participation of the Buccal Cavity as a Key Player for Establishment of Immunity against SARS-CoV-2. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11383. [PMID: 36141654 PMCID: PMC9517300 DOI: 10.3390/ijerph191811383] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Some oral lesions have been described in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); the possibility has been raised that the buccal lesions observed in patients with the coronavirus disease 2019 (COVID-19) are due to this virus and the patient's systemic condition. The aim of this review was to integrate the knowledge related to the oral lesions associated with COVID-19 and the participation of the buccal cavity in the establishment of immunity against SARS-CoV-2. METHODS A literature search on the manifestations of buccal lesions from the beginning of the pandemic until October 2021 was carried out by using the PubMed database. A total of 157 scientific articles were selected from the library, which included case reports and reports of lesions appearing in patients with COVID-19. RESULTS Oral lesions included erosions, ulcers, vesicles, pustules, plaques, depapillated tongue, and pigmentations, among others. The oral cavity is a conducive environment for the interaction of SARS-CoV-2 with the mucosal immune system and target cells; direct effects of the virus in this cavity worsen the antiviral inflammatory response of underlying oral disorders, immunodeficiencies, and autoimmunity primarily. CONCLUSIONS The oral cavity is an accessible and privileged environment for the interaction of SARS-CoV-2 with the mucosal immune system and target cells; the direct effects of the virus in this cavity worsen the antiviral inflammatory response of underlying oral disorders, in particular those related to immunodeficiencies and autoimmunity.
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Scheepers PTJ, Wertheim HFL, van Dael M, Anzion R, Holterman HJ, Teerenstra S, de Groot M, Voss A, Hopman J. Reply to Viner, A.; Ayrey, S. Comment on “Scheepers et al. Comparative Performance Testing of Respirator versus Surgical Mask Using a Water Droplet Spray Model. Int. J. Environ. Res. Public Health 2021, 18, 1599”. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106296. [PMID: 35627832 PMCID: PMC9141231 DOI: 10.3390/ijerph19106296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Paul T. J. Scheepers
- Department for Health Evidence, Research Laboratory Molecular Epidemiology, Radboudumc, 6500 HB Nijmegen, The Netherlands; (M.v.D.); (R.A.)
- Correspondence: ; Tel.: +31-24-361-687
| | - Heiman F. L. Wertheim
- Department of Medical Microbiology, Radboudumc, 6500 HB Nijmegen, The Netherlands; (H.F.L.W.); (A.V.); (J.H.)
- Radboudumc Centre for Infectious Diseases, Radboudumc, 6500 HB Nijmegen, The Netherlands
| | - Maurice van Dael
- Department for Health Evidence, Research Laboratory Molecular Epidemiology, Radboudumc, 6500 HB Nijmegen, The Netherlands; (M.v.D.); (R.A.)
| | - Rob Anzion
- Department for Health Evidence, Research Laboratory Molecular Epidemiology, Radboudumc, 6500 HB Nijmegen, The Netherlands; (M.v.D.); (R.A.)
| | - Henk Jan Holterman
- Wageningen Plant Research, Wageningen University and Research, 6700 AA Wageningen, The Netherlands;
| | - Steven Teerenstra
- Department for Health Evidence, Section Biostatistics, Radboudumc, 6500 HB Nijmegen, The Netherlands;
| | - Martijn de Groot
- Radboudumc REshape Center, Radboudumc, 6500 HB Nijmegen, The Netherlands;
| | - Andreas Voss
- Department of Medical Microbiology, Radboudumc, 6500 HB Nijmegen, The Netherlands; (H.F.L.W.); (A.V.); (J.H.)
- Radboudumc Centre for Infectious Diseases, Radboudumc, 6500 HB Nijmegen, The Netherlands
- Department of Medical Microbiology and Infectious Disease, Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
| | - Joost Hopman
- Department of Medical Microbiology, Radboudumc, 6500 HB Nijmegen, The Netherlands; (H.F.L.W.); (A.V.); (J.H.)
- Radboudumc Centre for Infectious Diseases, Radboudumc, 6500 HB Nijmegen, The Netherlands
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Schwab R, Droste A, Stewen K, Brenner W, Schmidt M, Hasenburg A. Patients' expectations of preventive measures of medical institutions during the SARS-CoV-2 pandemic in Germany in women with an increased risk of breast and ovarian cancer: a cross-sectional, web-based survey. BMJ Open 2022; 12:e060038. [PMID: 35545389 PMCID: PMC9096054 DOI: 10.1136/bmjopen-2021-060038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To identify patient-approved contingency measures for protection of patients and healthcare workers (HCWs) from COVID-19 infection and to use these findings to improve staff's preparedness to cope with the course of this pandemic or similar situations. METHODS DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS We conducted a cross-sectional, web-based survey of women with an increased risk of breast or ovarian cancer, regardless of whether they had experienced an active malignant disease during the pandemic. A self-reported questionnaire, developed for this study, was used to assess expectations and opinions about preventive measures within medical institutions. RESULTS Sixty-four (71.9%) of the 89 potential participants responded to at least one question regarding contingency measures within medical institutions. Approximately 37% of the respondents preferred having information about their facility's hygiene protocols before appointment; 57.8% of the respondents endorsed regular SARS-CoV-2 testing of patients prior to medical appointments and 95.3% endorsed regular testing of HCWs. Additionally, 84.4% of the respondents supported HCWs' use of surgical masks and 68.8% supported HCWs' use of masks with greater protection. Notably, 75.0% of the respondents advocated for the presence of a significant other during medical consultations; 71.9% approved the use of telemedicine and 93.8% endorsed changes in appointment practices to enable social distancing. No significant associations were found between respondents' sociodemographic, disease-specific or pandemic-specific factors and their opinions on hygiene precautions. CONCLUSIONS Patients at high risk of infection or severe course of COVID-19 approve strict contingency measures designed to lower the transmission of COVID-19 in medical facilities. Moreover, vulnerable groups may profit from contingency plans in healthcare facilities in order to follow preventive measures, avoid diagnostic delay or avoid worsening of pre-existing conditions. However, they also value the presence of a significant other during medical consultations and procedures.
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Affiliation(s)
- Roxana Schwab
- Department of Obstetrics and Gynecology, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Annika Droste
- Department of Obstetrics and Gynecology, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Kathrin Stewen
- Department of Obstetrics and Gynecology, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Walburgis Brenner
- Department of Obstetrics and Gynecology, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Marcus Schmidt
- Department of Obstetrics and Gynecology, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Annette Hasenburg
- Department of Obstetrics and Gynecology, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
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Kunstler B, Newton S, Hill H, Ferguson J, Hore P, Mitchell BG, Dempsey K, Stewardson AJ, Friedman D, Cole K, Sim MR, Ferguson B, Burns P, King N, McGloughlin S, Dicks M, McCarthy S, Tam B, Hazelton B, McGurgan C, McDonald S, Turner T. P2/N95 respirators & surgical masks to prevent SARS-CoV-2 infection: Effectiveness & adverse effects. Infect Dis Health 2022; 27:81-95. [PMID: 35151628 PMCID: PMC8769935 DOI: 10.1016/j.idh.2022.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Millions of people have acquired and died from SARS-CoV-2 infection during the COVID-19 pandemic. Healthcare workers (HCWs) are required to wear personal protective equipment (PPE), including surgical masks and P2/N95 respirators, to prevent infection while treating patients. However, the comparative effectiveness of respirators and masks in preventing SARS-CoV-2 infection and the likelihood of experiencing adverse events (AEs) with wear are unclear. METHODS Searches were carried out in PubMed, Europe PMC and the Cochrane COVID-19 Study Register to 14 June 2021. A systematic review of comparative epidemiological studies examining SARS-CoV-2 infection or AE incidence in HCWs wearing P2/N95 (or equivalent) respirators and surgical masks was performed. Article screening, risk of bias assessment and data extraction were duplicated. Meta-analysis of extracted data was carried out in RevMan. RESULTS Twenty-one studies were included, with most having high risk of bias. There was no statistically significant difference in respirator or surgical mask effectiveness in preventing SARS-CoV-2 infection (OR 0.85, [95%CI 0.72, 1.01]). Healthcare workers experienced significantly more headaches (OR 2.62, [95%CI 1.18, 5.81]), respiratory distress (OR 4.21, [95%CI 1.46, 12.13]), facial irritation (OR 1.80, [95%CI 1.03, 3.14]) and pressure-related injuries (OR 4.39, [95%CI 2.37, 8.15]) when wearing respirators compared to surgical masks. CONCLUSION The existing epidemiological evidence does not enable definitive assessment of the effectiveness of respirators compared to surgical masks in preventing infection. Healthcare workers wearing respirators may be more likely to experience AEs. Effective mitigation strategies are important to ensure the uptake and correct use of respirators by HCWs.
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Affiliation(s)
- Breanne Kunstler
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton, Melbourne, VIC, 3800, Australia.
| | - Skye Newton
- Adelaide Health Technology Assessment (AHTA), School of Public Health, University of Adelaide, Australia
| | - Hayley Hill
- Adelaide Health Technology Assessment (AHTA), School of Public Health, University of Adelaide, Australia
| | - John Ferguson
- Division of Medicine, John Hunter Hospital, Newcastle Regional Mail Centre, NSW, 2310, Australia
| | - Phillipa Hore
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Brett G. Mitchell
- The University of Newcastle, School of Nursing and Midwifery, Level 9, 77a Holden St, Gosford Hospital, Gosford, NSW, Australia, 2250
| | - Kathy Dempsey
- The Clinical Excellence Commission, 1 Reserve Road, St Leonards, NSW, Australia, 2065
| | - Andrew J. Stewardson
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, 85 Commercial Rd, Melbourne, VIC, Australia, 3004
| | - Deborah Friedman
- Deputy Chief Health Officer, Victorian Department of Health Melbourne, VIC, Australia, 3004
| | - Kate Cole
- Cole Health Pty Ltd, Balmain, NSW, Australia, 2041
| | - Malcolm R. Sim
- Monash Centre for Occupational & Environmental Health (MonCOEH), School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Rd, Melbourne, VIC, Australia, 3004
| | - Bridget Ferguson
- Central Queensland University, School of Nursing, Midwifery and Social Sciences; 554-700 Yaamba Rd, Norman Gardens, QLD, 4701, Australia
| | - Penelope Burns
- Academic Unit of General Practice, ANU Medical School, The Australian National University, Building 4, Hospital Road, Garran, ACT, 2605, Australia
| | - Nicole King
- North Shore Private Hospital, 3 Westbourne St, St Leonard's, 2065, Australia
| | - Steven McGloughlin
- Alfred Health and School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, Australia, 3004
| | - Melanie Dicks
- Ernst & Young, 121 Marcus Clarke Street, Canberra, ACT, Australia, 2601
| | - Sally McCarthy
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Barry Tam
- Health Infrastructure NSW, 60 Day Road, Cheltenham, NSW, 2119, Australia
| | - Briony Hazelton
- PathWest Laboratory Medicine, QEII Medical Centre, Hospital Avenue, Nedlands, WA, Australia, 6009
| | - Cherylynn McGurgan
- Royal Melbourne Hospital Emergency Department, 300 Grattan Street, Parkville, VIC, Australia, 3050
| | - Steve McDonald
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Tari Turner
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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