Limiting factors for wearing personal protective equipment (PPE) in a health care environment evaluated in a randomised study

Improving Safety and Comfort of Healthcare Workers Caring for Patients With High-Consequence Infectious Diseases in a High-Level Isolation Unit Using Innovative Approaches

Patients with high-consequence infectious diseases (HCIDs) require high-quality care by specially trained staff in a high-level isolation unit (HLIU) that follows strict infection prevention and control (IPC) measures. Caring for patients with (suspected) HCID is challenging, mainly because of the strict personal protective equipment (PPE) and IPC protocols healthcare workers (HCW) must adhere to for protection. The Radboud University Medical Center, located in Nijmegen, the Netherlands, has been a dedicated HLIU facility since 2008. A newly built HLIU opened in May 2022, and encouraged us to review the existing PPE selection, IPC protocols, and HCID training program to improve safety and comfort for HCWs working in the HLIU. Based on a systematic search through (inter)national HCID PPE guidelines and semistructured interviews with end users, we selected an improved, more comfortable set of PPE. Additionally, we developed a more concise and easier-to-use patient care process flow and implemented a new teaching strategy. The new way of working was tested in October 2022 when the first 2 patients with suspected HCID were admitted to our unit. We used surveys to evaluate the experiences of HCWs involved in this care to further improve the workflow of the unit. When optimizing safety and comfort for HCWs, it is important to consider (inter)national guidelines as well as user preferences. By systematically evaluating recent experiences of patient admission to the HLIU and then adjusting protocols and training, we can ensure that the quality of provided healthcare and the safety of HCWs working in the HLIU remains high.

Using a telemedicine-assisted airway model to improve the communication and teamwork of tracheal intubation during the coronavirus disease 2019 pandemic

INTRODUCTION

Isolated spaces impair communication and teamwork during tracheal intubation (TI) in suspected coronavirus disease 2019 patients. We thus aimed to evaluate the telemedicine-assisted airway model (TAM) to improve communication and teamwork during the pandemic.

METHODS

This two-stage prospective study included adult patients intubated in the emergency department of the National Taiwan University Hospital between 1 August 2020 and 31 July 2021. First, we randomised patients receiving TI in the standard setting into the conventional group (Con-G) and the isolation area into the isolation group (Iso-G). We evaluated the obstacles to communication and teamwork in an isolation scenario. Second, we developed the TAM to facilitate communication and teamwork between staff in separate spaces during TI and assigned patients to the TAM group (TAM-G). Communication and teamwork were evaluated using the Team Emergency Assessment Measure (TEAM). Subjective evaluations were conducted using a questionnaire administered to medical staff.

RESULTS

Eighty-nine patients were enrolled: 17, 34, and 38 in the Con-G, Iso-G, and TAM-G, respectively. The communication frequency (CF) of the Con-G and Iso-G was the highest and lowest, respectively. The CF of the TAM-G increased and approached that of the Con-G. The overall TEAM score was the highest in the Con-G and the lowest in the Iso-G, while the overall score in the TAM-G was comparable to that of the Con-G.

DISCUSSION

The TAM may improve communication and teamwork for TIs without compromising efficacy during the pandemic. This study was registered at ClinicalTrials.gov; registration numbers: NCT04479332 and NCT04591873.

Australian emergency nurses' experiences of working with personal protective equipment during the COVID-19 pandemic. A qualitative study

INTRODUCTION

The COVID-19 pandemic has exposed a need to understand the challenges associated with wearing Personal protective Equipment (PPE). The aim in this study was to explore emergency nurses' experiences early in the COVID-19 pandemic in Australia and the impact of PPE use on their practice.

METHODS

An explorative descriptive qualitative study was conducted between January 2022 and April 2022. Eighteen emergency nurses and six leaders participated. Semi-structured interviews (n = 21) and one focus group were conducted. Interview transcripts were analysed using Braun and Clarke's framework.

RESULTS

Two major themes were identified. The first theme was: (1) The shifting ground of the COVID-19 pandemic response. Associated sub-themes were: i) What's the go with PPE today? ii) In the beginning we were scrambling for masks; iii) Emergency is the true frontline. The second theme was: (2) Physical and emotional impacts of emergency nursing work. Sub-themes were: (i) Facing the fear of exposure; (ii) By the end of the shift I am just absolutely spent; iii) Discomfort of wearing PPE impacts on compliance.

CONCLUSIONS

Healthcare leaders need to secure PPE supply chains and evaluate the effectiveness and side-effects of different PPE designs to minimise occupational harms associated with prolonged PPE use.

Robotic system for nasopharyngeal swab sampling based on remote center of motion mechanism

PURPOSE

In this study, a robotic system is proposed for nasopharyngeal (NP) swab sampling with high safety and efficiency. Most existing swab-sampling robots have more than six degrees of freedom (DOFs). However, not all six DOFs are necessarily required for NP swab sampling. A high number of DOFs can cause safety problems, such as collisions between the robot and patient.

METHOD

We developed a new type of robot with four DOFs for NP swab sampling that consists of a two DOFs remote center of motion (RCM) mechanism, a two DOFs insertion mechanism, and a nostril support unit. With the nostril support unit, the robot no longer needs to adjust the insertion position of the swab. The proposed robot enables the insertion orientation and depth to be adjusted according to different postures or facial shapes of the subject. For intuitive and precise remote control of the robot, a dedicated master device for the RCM and a visual feedback system were developed.

RESULT

The effectiveness of the robotic system was demonstrated by repeatability, RCM accuracy, tracking accuracy, and in vitro phantom experiments. The average tracking error between the master device and the robot was less than 2 mm. The contact force exerted on the swab prior to reaching the nasopharynx was less than 0.04 N, irrespective of the phantom's pose.

CONCLUSION

This study confirmed that the RCM-based robotic system is effective and safe for NP swab sampling while using minimal DOFs.

Effects of Presenteeism on Burnout among Rehabilitation Medical Workers in Korea: Multiple Mediating Effects of Organization and Supervisor Supports

PURPOSES

This study aimed to examine the discriminatory impacts of two major impairment factors-job presenteeism and attention presenteeism (JP and AP)-in presenteeism on burnout and to verify the multiple mediating effects of organizational and supervisory support in their causal relationship to provide theoretical and practical implications for alleviating burnout among rehabilitation medical workers (RMWs).

METHODS

Participants were convenience sampled from 23 hospitals and rehabilitation medical institutions in Korea, and 494 datasets were analyzed using the R packages R-studio, Jamovi, and JASP.

RESULTS

The significant effects of JP and AP on burnout were investigated; AP (0.609) had a much higher effect than JP (0.170) on burnout among RMWs. Moreover, the multiple mediating effects of organizational support and supervisory support were verified in the JP-AP relationship and burnout among RMWs. Additionally, the absolute effect on burnout was more from AP than JP, and organizational support had a far more significant effect than supervisory support in the process of affecting burnout.

CONCLUSIONS

The present study contributes to the literature on burnout by examining the relationships between presenteeism and burnout and by extending the current understanding of burnout and presenteeism to RMWs. And it is practically important to understand that the effect of AP was greater than that of JP between the two key sub-factors of presenteeism affecting burnout among RMWs, and Korean RMWs are more affected by support from the organization system than by personal support from their boss. Related theoretical and practical implications are further elaborated.

The Impact of Personal Protective Equipment on Cognitive and Emotional Aspects of Health Care Work

OBJECTIVE

Personal protective equipment (PPE) is critical to the safety of health professionals and vital to clinical practice. However, there is little known about the cognitive and emotional impact of PPE on health professionals' performance, comfort, and well-being.

METHODS

A mixed-method, cross-sectional, observational study was adopted. An online survey consisting of 5-point Likert scale questions and free-text comments canvassed the opinions of patient-facing health professionals.

RESULTS

An overall negative impact of PPE on health professionals' ability to carry out work was found from 185 responses from medicine, nursing, and allied health disciplines, including increased fatigue, poor communication, and feeling uncomfortable.

CONCLUSIONS

There are significant negative impacts of PPE on health professionals' ability to carry out work, impairing communication, task efficiency, and comfort. Personal protective equipment is an essential infection control practice requiring further research, design, and testing to overcome challenges.

Real-world comparison between mechanical and manual cardiopulmonary resuscitation during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has posed significant challenges to healthcare systems worldwide, including an increase in out-of-hospital cardiac arrests (OHCA). Healthcare providers are now required to use personal protective equipment (PPE) during cardiopulmonary resuscitation (CPR). Additionally, mechanical CPR devices have been introduced to reduce the number of personnel required for resuscitation. This study aimed to compare the outcomes of CPR performed with a mechanical device and the outcomes of manual CPR performed by personnel wearing PPE.

METHODS

This multicenter observational study utilized data from the Korean Cardiac Arrest Research Consortium registry. The study population consisted of OHCA patients who underwent CPR in emergency departments (EDs) between March 2020 and June 2021. Patients were divided into two equal propensity score matched groups: mechanical CPR group (n = 421) and PPE-equipped manual CPR group (n = 421). Primary outcomes included survival rates and favorable neurological outcomes at discharge. Total CPR duration in the ED was also assessed.

RESULTS

There were no significant between-group differences with respect to survival rate at discharge (mechanical CPR: 7.4% vs PPE-equipped manual CPR: 8.3%) or favorable neurological outcomes (3.3% vs. 3.8%, respectively). However, the mechanical CPR group had a longer duration of CPR in the ED compared to the manual CPR group.

CONCLUSION

This study found no significant differences in survival rates and neurological outcomes between mechanical CPR and PPE-equipped manual CPR in the ED setting. However, a longer total CPR duration was observed in the mechanical CPR group. Further research is required to explore the impact of PPE on healthcare providers' performance and fatigue during CPR in the context of the pandemic and beyond.

Mental Health Among Healthcare Workers During the COVID-19 Pandemic in Vietnam

OBJECTIVES

The objective of this study was to characterize mental health issues among Vietnamese healthcare workers (HCWs) and to identify related factors.

METHODS

A cross-sectional study was conducted with 990 HCWs in 2021. Their mental health status was measured using the Depression, Anxiety, and Stress Scale.

RESULTS

In total, 49.9%, 52.3%, and 29.8% of respondents were found to have depression, anxiety, and stress, respectively. The multivariable linear regression model revealed that factors associated with increased anxiety scores included depression scores (β, 0.45; 95% confidence interval [CI], 0.39 to 0.51) and stress scores (β, 0.46; 95% CI, 0.41 to 0.52). Factors associated with increased depression scores included being frontline HCWs (β, 0.57; 95% CI, 0.10 to 1.10), stress scores (β, 0.50; 95% CI, 0.45 to 0.56), and anxiety scores (β, 0.41; 95% CI, 0.36 to 0.47), while working experience was associated with reduced depression scores (β, -0.08; 95% CI, -0.16 to -0.01). Factors associated with increased stress scores included working experience (β, 0.08; 95% CI, 0.00 to 0.16), personal protective equipment interference with daily activities (β, 0.55; 95% CI, 0.07 to 1.00), depression scores (β, 0.54; 95% CI, 0.48 to 0.59), and anxiety scores (β, 0.45; 95% CI, 0.39 to 0.50), while age was associated with reduced stress scores (β, -0.12; 95% CI, -0.20 to -0.05).

CONCLUSIONS

Specific interventions are necessary to enhance and promote the mental health of HCWs so they can successfully cope with the circumstances of the pandemic.

'You learn to smile with your eyes', exploring the impact of enhanced personal protective equipment on primary care dental practitioners in the UK: An interpretative phenomenological study

OBJECTIVE

The aim of the study was to explore how dental practitioners in primary care settings perceive the impact of enhanced personal protective equipment (PPE) upon patient communication and wider clinical practice.

METHODS

This study utilized a qualitative approach, rooted in critical realism. An interpretative phenomenological analysis (IPA) methodology was adopted as the study method. In accordance with IPA, in-depth semi-structured interviews were conducted. Eight dental practitioners were recruited, with data analysis conducted according to the principles of IPA.

RESULTS

Three themes were synthesized (related to communication and clinical practice): (1) Impaired communication and relationship building; (2) Physical impacts and required adjustments when wearing enhanced-PPE; and (3) Psychological stress of implementing enhanced-PPE. Theme one reflects changes to the dynamic of communication between patients and colleagues brought about by enhanced-PPE. Theme two describes the physical and psychological strains of providing care in enhanced-PPE and the ways through which practitioners tried to overcome these challenges. Theme three explores how the roll-out and guidance related to the use of enhanced-PPE affected clinical practice.

CONCLUSIONS

Dental Practitioners described several barriers to communication as well as physical and mental stressors caused by enhanced-PPE, all of which were perceived to impact upon the quality of care provided to patients. Further research is required to develop effective interventions to mitigate the impact of enhanced-PPE upon clinical practice and to explore the long-term impact of enhanced-PPE on clinical practice, post-COVID.

Refocusing on work-based hazards for the anaesthesiologist in a post-pandemic era

The coronavirus pandemic has raised public awareness of one of the many hazards that healthcare workers face daily: exposure to harmful pathogens. The anaesthesia workplace encompasses the operating room, interventional radiology suite, and other sites that contain many other potential occupational and environmental hazards. This review article highlights the work-based hazards that anaesthesiologists and other clinicians may encounter in the anaesthesia workplace: ergonomic design, physical, chemical, fire, biological, or psychological hazards. As the anaesthesia work environment enters a post-COVID-19 pandemic phase, anaesthesiologists will do well to review and consider these hazards. The current review includes proposed solutions to some hazards and identifies opportunities for future research.

Literature review of physiological strain of personal protective equipment on personnel in the high-consequence infectious disease isolation environment

BACKGROUND

Heat strain and dehydration can affect an individual's physical and mental performance. The purpose of this review was to examine the literature for the impact of heat strain on health care workers (HCWs) who care for patients with high-consequence infectious diseases (HCIDs) while wearing personal protective equipment (PPE), discuss the risks of impaired safety caused by heat strain and dehydration in HCID environments, identify attempts to combat PPE-related heat strain, recognize limitations, and provide suggestions for further research.

METHODS

A literature search was performed in PubMed or MEDLINE and Google Scholar. Authors screened abstracts for inclusion criteria and reviewed articles if the abstracts were considered to include information relevant to the aim.

RESULTS

The search terms yielded 30 articles that were sorted based on environment setting, physiological impact, and interventions.

DISCUSSION

The safety of the HCWs and patients can be enhanced through the development and usage of cooler, more comfortable PPE materials and ensembles to help slow the rate of dehydration and support the regulation of core body temperature.

CONCLUSIONS

Heat strain caused by wearing PPE is an occupational health concern for HCWs in the high-risk environment, that is, HCID care. Future studies are needed to develop innovative PPE ensembles that can reduce heat strain and improve well-being.

Impact of COVID-19 on occupational injuries and illnesses among nursing care facility workers: Analysis of California workers' compensation data, 2019-2021

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic greatly affected healthcare workers, both physically and psychologically, by increasing their workload and stress. This may also have increased their risk of occupational injuries. This study analyzed workers' compensation (WC) claims among California nursing care facility workers during 2019-2021, to assess the impact of the pandemic on occupational injury risk.

METHODS

This study used data from the California Workers' Compensation Information System. WC claims in prepandemic and pandemic periods were described and compared between nursing care facilities and other settings. Nursing facility cases were described by demographic, job, and injury characteristics.

RESULTS

In 2019-2021, we identified 41,134 claims as nursing facility cases in California. Annual claims increased by 64.6% from 2019 to 2020 and then decreased in 2021, returning to levels similar to pre-COVID. In contrast, non-healthcare settings had decreases in claims during the pandemic. COVID-related claims accounted for 50.5% of claims in nursing facilities in 2020-2021; this proportion was much higher compared with other healthcare (35.7%) or nonhealthcare settings (14.3%). Non-COVID claims decreased during the pandemic but mental disorder or stress claims increased in nursing facilities, particularly in 2020 (+42.5%).

CONCLUSIONS

Our findings show that nursing care facilities were more severely affected by the pandemic than other settings. We did not find evidence of an increased risk of occupational injuries during the pandemic, except for increased claims for stress or mental disorders. Our findings indicate a clear need to address psychological stress and mental health among nursing facility workers during a pandemic.

Investigating the short-term effects of using full-body hospital personal protective equipment and changes in physical workload intensity on human physiological and cognitive performance

The present study investigated the short-term effects of using Personal Protective Equipment (PPE) and physical workload intensity on human physiological and cognitive performance among 21 males and 19 females. PPE1 consisted of a medical coverall and surgical mask, while PPE2 consisted of impermeable full-body coverall, shoe covers, latex gloves, N95 mask, and face shield. Objective assessments were heart rate, energy expenditure, core body temperature, clothing microclimate temperature and humidity, and cognitive performance were the continuous performance test and N-Back test. Subjective assessments included thermal sensation, perceived fatigue/skin wetness/clothing moisture. Using PPE2 and increased workload intensity significantly increased the values of all physiological parameters and the subjective ratings of fatigue, thermal sensation, skin wetness, and clothing moisture. Moreover, the participants' cognitive performance was not affected by the type of PPE.Practitioner summary: Healthcare workers are at the highest risk in the fight against pandemics. Therefore, these people are required to use personal protective equipment. Using this equipment may have difficulties. The results show physiological strain and higher subjective ratings associated with using full-body hospital PPE and increased physical workload.

Impact of personal protective equipment on patient safety and health care workers

Background

The study aims to assess the effect of personal protective equipment (PPE) on the physical and psychological well-being of health care workers (HCWs) and its impact on patient safety.

Methods

After ethical approval, a 14-point questionnaire was circulated offline and online among the HCWs of ours institute, who were involved in performing invasive procedures while wearing a PPE. The responses were analysed using the SPSS software version 26.

Results

Of 198 responses, the mean duration of PPE use was 4.6 ± 1.52 h. Seventy percent of respondents suggested <4 h of continuous use of PPE. Seventy-seven percent found difficulties during the procedures while wearing PPE and agreed to errors while performing a procedure. Poor visibility (95.5%), fogging (84.9%), communication difficulty (75.3%), sweating (74.2%), posture-related discomfort (56.1%) and poor concentration (51%) were major causes. Anxiety (39.9%) and fear of spreading an infection to the family (42.9%) were major psychological effects. Eighty percent of HCWs raised concern over the quality of PPE, N95 mask and eye protector. The HCWs felt the need to improve the quality of PPEs, use extra padding around the ears, sealing the N95 mask with adhesive tape, besides using sign language for communication for more safety. Fifty percent graded the procedure-related difficulty level >6 on a Likert scale of 1-10.

Conclusion

PPE-related discomfort is common among the HCWs and could contribute to errors during an invasive procedure. Efforts to alleviate the physical and psychological well-being of the HCWs will be essential for reducing procedural error while wearing a PPE.

The Impact of Personal Protective Equipment on Healthcare Workers on COVID-19 Duty in a Tertiary Care Hospital in South India

Context The proper usage of personal protective equipment (PPE) must be prioritised for health care workers (HCWs), where shortages and prolonged use of personal protective equipment can threaten safety in essential health services. Aims To evaluate the effect of personal protective equipment on the health and well-being of HCWs, physicians, nurses, and technicians on duty for COVID-19 rotational postings. Settings and design This cross-sectional study was done by simple random sampling. Methods and materials This study was conducted at a tertiary care centre in South India to assess the utilisation of personal protective equipment (PPE) during the second wave of COVID-19. A physical questionnaire was distributed to a total of 266 healthcare workers, aged 20 to 50, who had worked for a minimum of three consecutive days between May and August 2021. The objective of the study was to evaluate the effectiveness of PPE use among healthcare workers during the second wave of the COVID-19 pandemic. Statistical analysis The data analysis in this study was conducted using IBM Statistical Package for Social Sciences (SPSS) version 19 (IBM Corp., Armonk, New York). The mean and standard deviation, or median, were used to present continuous variables, while frequency and percentage were used to present categorical variables. Furthermore, the minimum sample size required for this study was calculated to be 246 participants. Results The survey included 266 healthcare workers. The mean+/-SD of age was 28.18+/-5.64 and consisted of females (54.51%) and males (45.48%). The postings were in emergency (13.15%), intensive care unit (30.82%), and ward (56.01%), respectively. The HCWs who used PPE for four to seven days reported more symptoms than those who used it for one to three days. Discomforts experienced while wearing PPE were chest suffocation (49.62%), difficulty in performing intubation (36.09%), difficulty in seeing clearly (68.79%), dizziness (49.62%), excessive sweating (75.56%), micturition desire (52.63%), nausea (42.48%), retro-auricular pain (56.76%), stomach burns (27.44%), and thirst or dry throat (78.57%). The symptoms suffered after doffing were tiredness (69.17%), dry mouth (67.29%), dizziness (43.60%), headache (55.63%), chest suffocation (36.46%), dry skin (57.14%), reduced ability to concentrate (48.12%), dark-coloured urine (55.63%), reduced alertness (42.48%), and stomach burns (28.94%). The first thoughts after doffing were to drink water (68.42%), eat something (36.09%), clean yourself (61.27%), urinate (33.08%), and have some rest (29.32%), respectively. 81 (30.45%). The HCWs suffered skin injuries while wearing gloves. The time for restoring after a shift was 12 hours (37.59%), 24 hours (34.21%), 36 hours (11.65%), and 48 hours (16.59%). Pressure sores were reported on the forehead by 53 (19.92%) participants, the nose by 54 (20.30%), the cheek by 31 (11.65%), and behind the ear by 77 (65.71%) participants. The optimal size of PPE was experienced only by 76 (28.57%) participants, while 73 (27.44%) of them felt tight and 117 (43.98%) felt loose. Conclusions To minimise discomfort while managing infectious diseases, HCWs can adopt several practices like taking regular breaks, ensuring humane working hours, utilising high-quality PPE, and wearing properly fitting gear. By implementing these measures, HCWs can enhance their ability to handle infectious diseases effectively while prioritising their comfort and well-being.

The Effectiveness of Healthcare System Resilience during the COVID-19 Pandemic: A Case Study

Introduction: The outbreak of the COVID-19 pandemic was a period of uncertainty and stress for healthcare managers due to the lack of knowledge (about the transmission of the virus, etc.) and also due to the lack of uniform organisational and treatment procedures. It was a period where the ability to prepare for a crisis, to adapt to the existing conditions, and to draw conclusions from the situation were of critical importance to keep ICUs (intensive care units) operating. The aim of this project is to compare the pandemic response to COVID-19 in Poland during the first and second waves of the pandemic. This comparison will be used to identify the strengths and weaknesses of the response, including challenges presented to health professionals and health systems and ICUs with COVID-19 patients according to the European Union Resilience Model (2014) and the WHO Resilience Model (2020). The WHO Resilience model was suitable to the COVID-19 situation because it was developed based on this experience. Methods: A matrix of 6 elements and 13 standards assigned to them was created using the EC and WHO resilience guidelines. Results: Good governance in resilient systems ensures access to all resources without constraints, free and transparent flow of information, and a sufficient number of well-motivated human resources. Conclusions: Appropriate preparation, adaptation to the existing situation, and effective management of crisis situations are important elements of ensuring the resilience of ICUs.

Human thermal physiological response of wearing personal protective equipment: An educational building semi-open space experimental investigation

With the outbreak and spread of the COVID-19 epidemic, HCWs are frequently required to wear personal protective equipment (PPE) for nucleic acid sample collection in semi-open transition spaces. Wearing PPE causes significant psychological and physical stress in HCWs. In this study, operative temperature (T_op) and wet-bulb globe temperature (WBGT) were used to assess thermal conditions through field experiments, while multiple physiological parameters were measured in the subjects. The results indicated that the subjects showed statistically significant differences in thermal perception and physiological parameters with and without PPE. Using observed increases in heart rate (HR), auditory canal temperature (T_ac), mean skin temperature (MST), and end-tidal CO₂ pressure, subjects were shown to have an increased metabolic rate and heat storage while wearing PPE. Additionally, a decrease in oxygen concentration was also observed, and this decrease may be linked to fatigue and cognitive impairment. Moreover, HR, MST, and T_ac showed a significant linear relationship, which increased with temperature and operative temperature, and the HR response was stronger with PPE than without PPE. The neutral, preferred, and acceptable temperatures were significantly lower with PPE than without PPE, and the deviations for neutral T_op/WBGT were 9.5/7.1 °C and preferred T_op/WBGT was 2.2/4.0 °C, respectively. Moreover, the upper limits of acceptable WBGT, 29.4 °C with PPE and 20.4 °C without PPE, differed significantly between the two phases. Furthermore, the recorded physiological parameter responses and thermal perception responses of the subjects while wearing PPE indicated that they were at risk of thermal stress. Overall, these results suggest that people who wear PPE should focus on their health and thermal stress. This study provides a reference for the development of strategies to counteract heat stress and improve thermal comfort.

Impact of personal protective equipment attached powered air-purifying respirator on nursing-skill performance and psychosocial stress of intensive care unit COVID-19 nurses: A cross-sectional study

AIM

To investigate how personal protective equipment with an attached powered air-purifying respirator worn by intensive care unit nurses caring for COVID-19 patients in Korea impacts nursing-skill performance and psychosocial stress.

DESIGN

A cross-sectional descriptive study was designed using purposive sampling.

REVIEW METHODS

Online data collection was conducted from 3 March 2021-20 March 2021on 181 nurses who had worked for more than 1 month in COVID-19 critical care settings wearing personal protective equipment with a powered air-purifying respirator. A structured questionnaire was used to gather data on sociodemographic characteristics, attitude toward personal protective equipment, nursing-skill performance wearing personal protective equipment and psychosocial stress.

DATA SOURCES

Data was sourced from structured questionnaire responses.

RESULTS

Nursing skill performance decreased to 63.4%, compared with normal performance. Subjects' perceptions and attitudes related to PPE scored 3.56 out of 5; 44.7% of subjects reported severe psychosocial stress, which was significantly affected by attitude toward personal protective equipment usage, nursing performance, experience caring for COVID-19 patients and length of personal protective equipment usage per shift.

CONCLUSION

Greater negative attitude toward usage of personal protective equipment with a powered air-purifying respirator, results in lower nursing-skill performance and higher the psychosocial stress of nurses responding to COVID-19 outbreaks.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

High negative attitude toward PPE and low nursing-skill performance due to PPE with an attached PAPR results in significant and debilitating psychosocial stress in ICU nurses responding to COVID-19 outbreaks. To respond effectively to future infectious disease outbreaks and improve nursing performance, minimising the inconvenience and restrictions experienced by nurses wearing personal protective equipment is critical.

REPORTING METHOD

We adhered to relevant EQUATOR guidelines to report.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Psychosocial Challenges of the Coronavirus Disease-2019 Pandemic Among Frontline Health Care Providers and Their Coping Mechanisms at Mbarara Regional Referral Hospital, Southwestern Uganda

Background

As a novel global health pandemic, Coronavirus Disease-2019 (COVID-2019) has posed various challenges to frontline healthcare providers (FHCPs). This study explored the social and psychological challenges of COVID-19 to the FHCPs at Mbarara Regional Referral Hospital, southwestern Uganda.

Methods

This was a cross-sectional study with a qualitative approach. Participants were purposively selected, consented, and interviewed. Interviews were audio-recorded and transcribed. Data were entered into NVivo 10 software and analyzed using a thematic analysis approach.

Results

Fourteen FHCPs with diverse roles, including 8 men, were interviewed. Participants' median age was 38 years (range: 26-51 years) and eleven of them were married. The subjects' experiences were explored in relation to perceived social and psychological challenges of working during the COVID-19 pandemic, and coping mechanisms in the COVID-19 pandemic situation. The social challenges identified were burnout, domestic violence, and a financially constrained environment. A further, psychological challenge was anxiety, as well as fear and distress. FHCPs responded with a variety of coping mechanisms, including situational acceptance, religious coping, coping through emotional support of others, and bulk purchase of supply-constrained basic necessities.

Conclusion

FHCPs experienced numerous social and psychological challenges, which negatively affected their quality of life amidst a wavering pandemic. As the pandemic rages on, creative and low-cost psychosocial interventions for FHCPs are needed, possibly including more formal peer support, and an improved flow of information about ongoing infectious disease control interventions, so FHCPs feel more knowledgeable about what is ahead.

The Impact of Mental Well-Being, Stress, and Coping Strategies on Resilience among Staff Nurses during COVID-19 in Saudi Arabia: A Structural Equational Model

Previous studies have revealed various factors related to nurses' resilience and predictors of resilience. However, there are no studies analysing the association of three variables-mental well-being, coping strategies, and stress-with resilience. This study aims to assess the impact of mental well-being, levels of stress, and coping strategies on resilience using path analysis. This study used a cross-sectional approach that involved 763 nurses from 16 major hospitals in the eastern and northern regions of Saudi Arabia during the COVID-19 pandemic. The data gathering was conducted from August to November 2022. The staff nurses possessed positive mental wellness (3.75 ± 1.08), moderate stress levels (3.06 ± 1.21), adequate coping skills (3.33 ± 1.23), and a low level of resilience (2.90 ± 1.040). Age had a small effect on resilience (β = 0.040; p < 0.001) but work experience (β = -0.019; p > 0.139) and marital status (β = 0.019; p > 0.072) were not significant. Conversely, mental well-being (β = 0.043; p < 0.001) and stress (β = -0.089; p < 0.001) had a small effect on resilience, but coping strategies (β = 0.561; p < 0.001) had a large effect on resilience. Therefore, coping strategies must be reinforced at all times to assist nurses and other healthcare professionals in identifying contributing elements that maintain these workers' resilience in the face of unforeseen and protracted pandemics and other life events.

Field investigation of the heat stress in outdoor of healthcare workers wearing personal protective equipment in South China

Since the advent of coronavirus disease 2019 (COVID-19), healthcare workers (HCWs) wearing personal protective equipment (PPE) has become a common phenomenon. COVID-19 outbreaks overlap with heat waves, and healthcare workers must unfortunately wear PPE during hot weather and experience excessive heat stress. Healthcare workers are at risk of developing heat-related health problems during hot periods in South China. The investigation of thermal response to heat stress among HCWs when they do not wear PPE and when they finish work wearing PPE, and the impact of PPE use on HCWs' physical health were conducted. The field survey were conducted in Guangzhou, including 11 districts. In this survey, HCWs were invited to answer a questionnaire about their heat perception in the thermal environment around them. Most HCWs experienced discomfort in their back, head, face, etc., and nearly 80% of HCWs experienced "profuse sweating." Up to 96.81% of HCWs felt "hot" or "very hot." The air temperature had a significant impact on thermal comfort. Healthcare workers' whole thermal sensation and local thermal sensation were increased significantly by wearing PPE and their thermal sensation vote (TSV) tended towards "very hot." The adaptive ability of the healthcare workers would decreased while wearing PPE. In addition, the accept range of the air temperature (T _a) were determined in this investigation. Graphical Abstract.

Thermophysiological and Perceptual Responses of Amateur Healthcare Workers: Impacts of Ambient Condition, Inner-Garment Insulation and Personal Cooling Strategy

While personal protective equipment (PPE) protects healthcare workers from viruses, it also increases the risk of heat stress. In this study, the effects of environmental heat stress, the insulation of the PPE inner-garment layer, and the personal cooling strategy on the physiological and perceptual responses of PPE-clad young college students were evaluated. Three levels of wet bulb globe temperatures (WBGT = 15 °C, 28 °C, and 32 °C) and two types of inner garments (0.37 clo and 0.75 clo) were chosen for this study. In an uncompensable heat stress environment (WBGT = 32 °C), the effects of two commercially available personal cooling systems, including a ventilation cooling system (VCS) and an ice pack cooling system (ICS) on the heat strain mitigation of PPE-clad participants were also assessed. At WBGT = 15 °C with 0.75 clo inner garments, mean skin temperatures were stabilized at 31.2 °C, H_skin was 60-65%, and HR was about 75.5 bpm, indicating that the working scenario was on the cooler side. At WBGT = 28 °C, T_skin plateaued at approximately 34.7 °C, and the participants reported "hot" thermal sensations. The insulation reduction in inner garments from 0.75 clo to 0.37 clo did not significantly improve the physiological thermal comfort of the participants. At WBGT = 32 °C, T_skin was maintained at 35.2-35.7 °C, H_skin was nearly 90% RH, T_core exceeded 37.1 °C, and the mean HR was 91.9 bpm. These conditions indicated that such a working scenario was uncompensable, and personal cooling to mitigate heat stress was required. Relative to that in NCS (no cooling), the mean skin temperatures in ICS and VCS were reduced by 0.61 °C and 0.22 °C, respectively, and the heart rates were decreased by 10.7 and 8.5 bpm, respectively. Perceptual responses in ICS and VCS improved significantly throughout the entire field trials, with VCS outperforming ICS in the individual cooling effect.

Adaptive IR- and Water-Gating Textiles Based on Shape Memory Fibers

Thermoregulation is an essential function of the human body for adapting to the surrounding temperature. Stimuli-responsive smart textiles can provide effective protection of the human skin temperature from a continuously changing environment. Herein, we develop a smart textile based on shape memory polymer (SMP) fibers for adaptive regulation of IR and water transmission on human skin. An SMP textile is fabricated with hierarchical micro/nanoporous structures to enhance thermal insulation performance, and silver nanowires are coated on one side to provide asymmetric IR reflectivity and hydrophilicity. The porous SMP textile shows great tunability of thermal insulation and asymmetric wettability by deformation and recovery of the shape and structure in response to stimuli. The degree of thermal insulation is controlled by 65.7% of the original value, and the surface temperature of the SMP textile on a hot plate is successfully controlled in the IR images due to adaptive IR reflectivity. Additionally, the directional transportation of water droplets can be switched on/off according to the shape of the SMP textiles, which can be employed for sweat removal from the human skin. This IR- and water-gating smart textile can provide a feasible strategy for protecting the human skin from external environmental changes.

Combining multiple human physiological signals using fuzzy logic to determine stress caused by battle dress uniforms

Abstract

This study presents a novel stress index for clothing using physiological signals to estimate stress induced by battle dress uniforms (BDU) during physical activity. The approach uses a fuzzy logic-based nonlinear mapping to compute the stress from physiological signals. Ten healthy men performed a battery of physical activities in a controlled environment. Heart rate (HR), respiration rate (RR), skin temperature (ST), and galvanic skin response (GSR) were measured continuously for the participants during activity wearing three kinds of clothing (two BDUs and a control garment). The individual physiological responses were combined using a fuzzy-logic system to derive a stress measure called Clothed Activity Stress Index (CASI). Repeated measures ANOVA showed that the garments significantly (α = .05) affected the HR (p < .001) and RR (p < .001). In addition, interactions between the activity and garment were significant for HR, RR, and ST (p < .001, p < .001, p < .036). The physiological measures differed significantly between rest and activity for the two uniforms. The stress indices (ranging between 0 and 1) during rest and activity were 0.24 and 0.35 for control, 0.27 and 0.43 for BDU-1, and 0.33 and 0.44 for BDU-2. It is shown here that clothing systems impact human stress levels to a measurable level. This computational approach is applicable to measure stress caused by protective wear under different operational conditions and can be suitable for sports and combat gears.

Article Highlights

Improvement of the psychosocial support for frontline nurses in public hospitals during COVID-19 pandemic

AIM

The aim of this study was to explore and describe the psychosocial support for frontline nurses during the COVID-19 pandemic in the Tshwane district, Gauteng Province, South Africa.

BACKGROUND

The COVID-19 pandemic has brought a lot of psychosocial distress for frontline nurses taking care of COVID-19 patients. The frontline nurses were scared of being infected with COVID-19, or exposing their families and loved ones to the risk of infection. A high number of nurses were infected with COVID-19, and some died due to the virus.

EVALUATION

This study followed a qualitative, explorative, and descriptive research design. Data were collected using semi-structured interviews and individual interviews were conducted. Seventeen participants, who consisted of all categories of nurses taking care of COVID-19 patients, were interviewed until data saturation was reached. Non-probability sampling method was used as a technique to select the participants. Data were analysed using Tesch's method of open coding.

KEY ISSUES

The following five themes are identified: (1) acknowledgement, appreciation, and recognition of frontline nurses, (2) conducive managerial practices, (3) debriefing and training of frontline nurses, (4) human resources support, and (5) psychological and social support for frontline nurses and their families.

CONCLUSION

The implementation of the psychosocial support for frontline nurses taking care of COVID-19 patients is critical in improving patient care.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings of this study should alert nurse managers to plan the best way to support frontline nurses caring for COVID-19 patients.

Sustainable management of plastic wastes in COVID-19 pandemic: The biochar solution

To prevent the COVID-19 transmission, personal protective equipment (PPE) and packaging materials have been extensively used but often managed inappropriately, generating huge amount of plastic waste. In this review, we comprehensively discussed the plastic products utilized and the types and amounts of plastic waste generated since the outbreak of COVID-19, and reviewed the potential treatments for these plastic wastes. Upcycling of plastic waste into biochar was addressed from the perspectives of both environmental protection and practical applications, which can be verified as promising materials for environmental protections and energy storages. Moreover, novel upcycling of plastic waste into biochar is beneficial to mitigate the ubiquitous plastic pollution, avoiding harmful impacts on human and ecosystem through direct and indirect micro-/nano-plastic transmission routes, and achieving the sustainable plastic waste management for value-added products, simultaneously. This suggests that the plastic waste could be treated as a valuable resource in an advanced and green manner.

Experimental investigation of the effects of personal protective equipment on thermal comfort in hot environments

Since the outbreak of COVID-19, wearing personal protective equipment (PPE) has become increasingly common, especially for healthcare workers performing nucleic acid sample collection. A field experiment and questionnaire survey were conducted in a semi-open transition space of a university building in Guangzhou, southern China. Thirty-two subjects wore PPE to simulate nucleic acid sample collection, during which thermal parameters were recorded and subjective questionnaires were completed. The relationship between thermal sensation and thermal index was analyzed to determine the neutral temperature and comfort temperature zones. Subjects had higher requirements for thermal environment parameters when wearing PPE than when not wearing PPE, and were found to have statistically significant differences in thermal perception when wearing and not wearing PPE. Wearing PPE significantly raised the subjects' thermal and humidity sensations and restricted their airflow. Wearing PPE resulted in thermal discomfort for the subjects and a high unacceptability rate for environmental thermal parameters. The subjects wore PPE for an acceptable duration of approximately 1.5 h. The neutral operative temperatures were significantly lower when wearing PPE than when not wearing PPE, and the deviation from the neutral temperature was 9.7 °C. The neutral operative temperature was 19.5 °C and the comfort temperature zone was 17.4-21.5 °C when subjects wore PPE, demonstrating that subjects who wore PPE preferred lower temperatures. These results suggest that people who wear PPE for work, especially outdoors, should receive more attention to ensure thermal comfort and safety.

A Cross-Sectional Study to Ascertain the Effect of COVID-19 Pandemic on Regional Anaesthesia Practices Amongst Anaesthesiologists of India

Background and aims Regional anaesthesia has been advocated as a preferred modality during the coronavirus disease 2019 (COVID‑19) pandemic, but pursuing regional anaesthesia during COVID-19 is challenging. Our cross-sectional survey aimed to analyze the challenges in conducting regional anaesthesia and the alterations in practices imposed by the COVID‑19 pandemic across the nation. Material and methods The questionnaire was validated by seven experts. Following ethical approval and trial registration, this Google Forms-based survey was circulated to anaesthesiologists across the country via emails over 3 months (April 2021 to June 2021). Weekly reminders were sent to the non-responders till the desired sample size was attained, after which the survey was closed and responses were analyzed. Results Five hundred and thirty-two of 1100 anaesthesiologists completed the survey (48.3% response rate). Among the 532 respondents, 65.8% reported an increase in the use of regional anaesthesia due to the pandemic, with 77.4% reporting a change in practice. Almost 90% of the respondents used a dedicated operation theatre for all infected patients. Most respondents (75%) used disposable plastic drapes (75%) and full personal protective equipment (PPE) for COVID-19-positive patients during the procedure. However, using PPE resulted in poor vision due to fogging and multiple attempts and increased performance duration. Most respondents (74.4%) used gloves to maintain ultrasound probe sterility, while many other respondents (65.7%) used a sterile camera cover for the same. Many respondents ordered inflammatory markers during preoperative evaluation. Conclusion The present survey revealed that there was increased utilization of regional anaesthesia with increased utilization of PPE, sterility routines, and ordering of investigations. The use of PPE led to many challenges while performing regional anaesthesia. However, many deviations were identified from the accepted recommendations, and one needs to be aware of proper practices to achieve optimal patient outcomes and provider safety.

Resilience and Protection of Health Care and Research Laboratory Workers During the SARS-CoV-2 Pandemic: Analysis and Case Study From an Austrian High Security Laboratory

The SARS-CoV-2 pandemic has highlighted the interdependency of healthcare systems and research organizations on manufacturers and suppliers of personnel protective equipment (PPE) and the need for well-trained personnel who can react quickly to changing working conditions. Reports on challenges faced by research laboratory workers (RLWs) are rare in contrast to the lived experience of hospital health care workers. We report on experiences gained by RLWs (e.g., molecular scientists, pathologists, autopsy assistants) who significantly contributed to combating the pandemic under particularly challenging conditions due to increased workload, sickness and interrupted PPE supply chains. RLWs perform a broad spectrum of work with SARS-CoV-2 such as autopsies, establishment of virus cultures and infection models, development and verification of diagnostics, performance of virus inactivation assays to investigate various antiviral agents including vaccines and evaluation of decontamination technologies in high containment biological laboratories (HCBL). Performance of autopsies and laboratory work increased substantially during the pandemic and thus led to highly demanding working conditions with working shifts of more than eight hours working in PPE that stressed individual limits and also the ergonomic and safety limits of PPE. We provide detailed insights into the challenges of the stressful daily laboratory routine since the pandemic began, lessons learned, and suggest solutions for better safety based on a case study of a newly established HCBL (i.e., BSL-3 laboratory) designed for autopsies and research laboratory work. Reduced personal risk, increased resilience, and stress resistance can be achieved by improved PPE components, better training, redundant safety measures, inculcating a culture of safety, and excellent teamwork.

Design considerations for protective mask development: A remote mask usability evaluation

The design of N95 filtering facepiece respirators (FFRs) continues to pose usability concerns for healthcare workers, which have been exacerbated by the COVID-19 pandemic. The aim of this study was to develop a holistic model to guide mask design improvement. Dental students (n = 38) with experience wearing N95 FFRs participated in a randomized wear trial of three alternative protective masks. A mixed methods survey was used to examine usability of individual mask design components, the relationship of facial/head area to mask features, and overall mask design. Survey results indicated MNmask v1 demonstrated higher usability in seal confidence (M = 3.46), while MNmask v2 performed higher in satisfactory fit (M = 3.50). Design components of nose wire and head/neck bands were the most problematic, while conditions of skin irritation and tight/loose fit created an unfavorable wear experience. To consider healthcare workers' needs in improving the usability of protective masks, a model is presented to consider characteristics of fit, comfort, material, and design.

Maternal and neonatal characteristics, operative details and outcomes in COVID-19 positive parturients undergoing cesarean sections: A retrospective observational study

Background and Aims

There is a marked inclination towards cesarean sections as the preferred mode of delivery in parturients with COVID-19 disease. However, the challenges associated with planning and performing a surgery in the COVID-19 setup are considerable. These factors may lead to widespread changes in obstetric decision-making, operative planning, and perioperative outcomes. Thus, our study aimed to study the clinical and logistical factors involved in cesarean sections in COVID-19 parturients.

Material and Methods

This was a retrospective observational study performed at a dedicated COVID-19 tertiary care center in India. All women undergoing cesarean section in the specially earmarked operating room between 1st May 2020 and 31st December 2020 were included in the study. The clinical characteristics, operative details, and neonatal details, along with maternal and fetal outcomes were noted and analyzed.

Results

A total of 44 women underwent cesarean section during the study period, with elective and emergency surgeries numbering 22 each. No indication, apart from COVID-19 status, was listed in over one-fourth of the women (13/44). The most common preoperative comorbidity was hypothyroidism (12/44). Median surgical duration was 117.5 min (IQR 100-133), with a median of 7.5 (IQR 6-8.25) healthcare personnel in the OT. Over one-fourth (12/44) of the delivered babies had low birth weight, while 4.5% (2/44) tested positive for SARS-CoV-2.

Conclusion

COVID-19 status alone continues to be a common indication for cesarean section. Operative time is increased, but the number of healthcare personnel involved can be trimmed with proper planning. Maternal and fetal outcomes are largely positive, with low transmission rates, but a considerable proportion of low-birth-weight neonates.

Emergency nurses' attitudes, perceptions about personal protective equipment and willingness to care for COVID-19 patients: A descriptive, cross-sectional study

Aims

This study investigated emergency nurses' attitudes and perceptions about personal protective equipment and their association with the willingness to care for COVID‐19 patients.

Background

Emergency nurses are at increased risk for COVID‐19 infection as frontline workers and must wear personal protective equipment while attending suspected and confirmed COVID‐19 patients.

Methods

In September 2021, 188 nurses in four emergency departments completed online questionnaires.

Results

Multivariable logistic regression demonstrated that as perceptions of COVID‐19 infection risk increased by 1 point, 26% of nurses were willing to care of COVID‐19 patients. The willingness to care for COVID‐19 patients increased in their attitudes by 1.16 point and perceptions by 1.08 points about PPE.

Conclusions

Perceptions of the risk of infection exposure and confidence in safety of personal protective equipment are associated with nurses' willingness to care for COVID‐19 patients.

Implications for Nursing Management

Nurse managers need to assess nurses' needs for safety and provide a supportive climate to mitigate their concerns regarding infection risk and encourage nurses' willingness to care for patients. Nurse managers should provide precise guidelines on correct personal protective equipment use. Repetitive training on personal protective equipment should be provided to encourage nurses' adaptation to its use.

Personal Protective Equipment for Liver Transplantation in SARS-CoV-2 Polymerase Chain Reaction-Positive Convalescing Recipients

Personal protective equipment (PPE) comes in several variations, and is the principal safety gear during the COVID-19 pandemic. Unfortunately, the user is severely impacted by its serious nonergonomic features. What PPE is appropriate for labor-intensive cases, like liver transplant (LT), remains unknown. We describe our experience with 2 types of PPE used during 2 separate LT performed in COVID-19 positive recipients. We conclude that for the safety of both health care workers and patients, hospitals should designate a few PPE kits for labor-intensive surgical procedures. These kits should include powered air-purifying respirators, or a similar loose-fitting powered air hood.

Thermal Perception and Physiological Responses under Different Protection States in Indoor Crowded Spaces during the COVID-19 Pandemic in Summer

Currently, people in crowded indoor spaces are required to wear a variety of personal protective equipment to curb the spread of COVID-19. This study aimed to investigate the effects of wearing four types of personal protective equipment (unprotected, wearing masks, wearing face shield and wearing medical protective clothing) on human thermal perception and physiological responses in indoor crowded spaces in summer. The experiment was conducted in a climate chamber designed to simulate the indoor crowded spaces. Environmental parameters of climate chamber (air temperature, relative humidity and wind speed), physiological parameters of subjects (wrist skin temperature and pulse rate), and subjective perceptions (thermal sensation and thermal comfort) were collected during the experiment. The experimental results showed that medical protective clothing has the most obvious blocking effect on heat exchange between human and environment. Thermal sensation in state 4 (wearing medical protective clothing) was significantly (p < 0.05) higher than that in other states. The study of physiological parameters showed that the wrist skin temperature and pulse rate under different protection states increased with the increase of room temperature. Through regression analysis, the thermal sensation estimation model of protective personnel in indoor crowded spaces based on wrist skin temperature and pulse rate was established. The adjusted R2 and RMSE of all models were above 82% and less than 1, indicating that the established thermal sensation model had a good prediction effect.

Is it a challenging task to work with personal protective equipment in a COVID-19 ICU: Findings from a hospital-based cross-sectional study from north India

Introduction

Amidst the coronavirus disease 2019 (COVID-19) pandemic, the use of personal protective equipment (PPE) is mandatory for healthcare workers to remain protected against infection. The present study was undertaken to evaluate challenges faced by the healthcare workers while using level 3 PPE.

Methods

This hospital-based study was conducted among resident doctors selected by convenience sampling method using a pretested, semi-structured, self-administered questionnaire after getting informed consent from the participants to collect data on the somatic, psychological, and technical problems faced while working in PPE. Bivariate and multivariable logistic regression was done between outcome variables and other independent variables to check for the association.

Results

Of the total, 252 resident doctors completed the survey, their age ranged from 22 to 36 years with 140 (55.6%) males and 112 (44.4%) females. One-twenty-nine (51.2%) residents were trained to work in ICU, 73 (29%) participants used PPE ≤10 times and the rest 179 (71%) used PPE more than 10 times. The difficulties faced were as follows: visual impairment (n = 244, 96.8%), headache (n = 226, 89.6%), breathing difficulty (n = 216, 85.7%), hearing impairment (n = 201, 79.8%), sweating (n = 242, 96%), and fear of being infected (n = 156,61.9%). Two-thirty-six (93.6%) participants felt that overall work quality reduced due to PPE. Headache, hunger, urge to micturate, anxiety, sleep disturbances, and need to change the timing of medication or diet were higher with increased duration of work with PPE.

Conclusion

A longer duration of work is associated with headache, hunger, anxiety, and sleep disturbances. More research has to be done to improve the PPE to reduce problems like visual impairment, skin irritation, sweating, and breathing difficulty.

Barriers faced by health-care workers in use of personal protective equipment during COVID pandemic at tertiary care hospital Uttarakhand, India: A qualitative study

BACKGROUND

To reduce the likelihood of transmission of infection to health-care workers (HCWs), personal protective equipment is used. However, wearing personal protective equipment (PPE) increases the risk of heat stress and loss of dexterity, leads to poor compliance to PPE. To address the issues of poor compliance to PPE, it was necessary to gain a deeper understanding about the factors that influence compliance. Thus this qualitative study was planned to explore barriers faced by HCWs while using PPE during a pandemic situation in a tertiary care hospital, Uttarakhand, India.

MATERIALS AND METHODS

A exploratory qualitative study was undertaken among health care workers involved in the care of COVID patients. FGDs were done and an unstructured interview guide with open-ended questions was used which helped to explore the factors which can be potential barriers to the HCWs while working wearing PPE.

RESULTS

Organizational and individual factors acting as barriers such as unavailability of essential personal protective equipment, a disharmonious work environment, lack of comfort, inadequate size, and quality of PPE were identified as the major barriers in the present study.

CONCLUSION

Future efforts to optimize PPE use should focus on to adequate supplies both in quality and quantity can help in avoidance of such barriers. Resources should be prioritized with the needs of the HCWs in the times of pandemic. Regular training and feedbacks are necessary for the satisfaction of HCWs and improving PPE compliance.

Health care workers' experience of personal protective equipment use and associated adverse effects during the COVID-19 pandemic response in Singapore

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.

Impact of full personal protective equipment on alertness of healthcare workers: a prospective study

The COVID-19 pandemic has resulted in healthcare workers (HCWs) having to wear full personal protective equipment (FPPE) even for routine patient care. When worn for prolonged periods, FPPE has the potential to adversely affect the ability of HCW to carry out their tasks. This study aimed to assess the impact of FPPE on the alertness levels of HCWs in the intensive care unit.

Fifty HCWs were tested using psychomotor vigilance test (PVT) and serial sevens test (SST) on two occasions during their shift—once without FPPE and once after they had been in FPPE for at least 2 hours. The median time in FPPE was 2.5 hours. FPPE induced a significant increase in the average reaction time and the number of false responses in PVT. Subjects took longer to complete SST in FPPE compared with without it.

This study demonstrates that being in FPPE for as little as 2.5 hours can adversely affect HCW alertness. The findings of this study are relevant in terms of workforce environment considerations as the use of FPPE in certain settings is likely to become a regular feature.

The use of personal protection equipment does not negatively affect paramedics' attention and dexterity: a prospective triple-cross over randomized controlled non-inferiority trial

BACKGROUND

The COVID-19 pandemic led to widespread use of personal protection equipment (PPE), including filtering face piece (FFP) masks, throughout the world. PPE. Previous studies indicate that PPE impairs neurocognitive performance in healthcare workers. Concerns for personnel safety have led to special recommendations regarding basic life support (BLS) in patients with a potential SARS-CoV-2 infection, including the use of PPE. Established instruments are available to assess attention and dexterity in BLS settings, respectively. We aimed to evaluate the influence of PPE with different types of FFP masks on these two neuropsychological components of EMS personnel during BLS.

METHODS

This was a randomized controlled non-inferiority triple-crossover study. Teams of paramedics completed three 12-min long BLS scenarios on a manikin after having climbed three flights of stairs with equipment, each in three experimental conditions: (a) without pandemic PPE, (b) with PPE including a FFP2 mask with an expiration valve and (c) with PPE including an FFP2 mask without an expiration valve. The teams and intervention sequences were randomized. We measured the shift in concentration performance using the d2 test and dexterity using the nine-hole peg test (NHPT). We compared results between the three conditions. For the primary outcome, the non-inferiority margin was set at 20 points.

RESULTS

Forty-eight paramedics participated. Concentration performance was significantly better after each scenario, with no differences noted between groups: d2 shift control versus with valve - 8.3 (95% CI - 19.4 to 2.7) points; control versus without valve - 8.5 (- 19.7 to 2.7) points; with valve versus without valve 0.1 (- 11.1 to 11.3) points. Similar results were found for the NHPT: + 0.3 (- 0.7 to 1.4), - 0.4 (- 1.4 to 0.7), 0.7 (- 0.4 to 1.8) s respectively.

CONCLUSION

Attention increases when performing BLS. Attention and dexterity are not inferior when wearing PPE, including FFP2 masks. PPE should be used on a low-threshold basis.

Skin-related problems associated with the use of personal protective equipment among health care workers during the COVID-19 pandemic: A online survey study

Aim

The aim of this study was to determine the skin-related problems caused by personal protective equipment (PPE) use in health care workers (HCWs) and to identify the factors contributing to their occurrence.

Materials and Methods

This descriptive and cross-sectional online survey study was carried out with 297 HCWs working in a university hospital in Turkey between March 20, 2021, and May 20, 2021. The study data was collected using an online questionnaire consisting of 3 parts. Descriptive statistics, Pearson's Chi-square, and Fisher's Exact Chi-square tests were used to analyze the data.

Results

Among the HCWs, 95.6% reported that skin-related problems associated with at least one PPE use. Skin-related problems that develop due to PPE use were mostly associated with the use of Surgical/N95 masks (97.1%) and gloves (96.8%). The most commonly reported problems were ''dryness'' (%74.0) and ''itching'' (%72.1) when wearing gloves, ''perspiration and moisture'' (73.6%), ''formation of equipment traces'' (53.9%), and ''skin lesions'' (52.8%) when wearing a surgical/N95 mask, ''perspiration and moisture'' (89.7%) when wearing protective overalls/gowns. Wearing PPE for more than 4h (p=0.001), taking additional precautions to increase the sense of protection (p=0.026), and not applying preventive measures while using PPE (p=0.003) significantly increase the risk of skin-related problems.

Conclusion

The results suggest that skin-related problems due to the use of PPE are common among HCWs.

Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial

A safe way of securing the airway with an endotracheal tube is one of the priorities of an advanced cardiovascular life support algorithm for suspected or confirmed COVID-19 patients. The aim of this study was to compare intubation success rates (ISR) and intubation time (IT) of different laryngoscopes for simulated COVID-19 patients under cardiopulmonary resuscitation. The study was designed as a prospective, randomized, crossover trial. Fifty four active paramedics performed endotracheal intubation with a Macintosh direct laryngoscope (MAC) and McGrath videolaryngoscope (McGrath) with and without personal protective equipment (PPE). Without PPE, ISRs were 87% and 98% for MAC and McGrath, respectively (p = 0.32). ITs were 22.5 s (IQR: 19–26) and 19.5 s (IQR: 17–21) for MAC and McGrath, respectively (p = 0.005). With PPE, first-pass ISR were 30% and 89% with MAC and McGrath, respectively (p < 0.001). The overall success rates were 83% vs. 100% (p = 0.002). Median ITs were 34.0 s (IQR: 29.5–38.5) and 24.8 s (IQR: 21–29) for MAC and McGrath, respectively (p < 0.001). In conclusion, the McGrath videolaryngoscope appears to possess significant advantages over the Macintosh direct laryngoscope when used by paramedics in suspected or confirmed COVID-19 intubation scenarios.

Limiting factors of face shield use for health professionals during the COVID-19 pandemic

BACKGROUND

Coronavirus disease (COVID-19) is caused by SARS-COV2, a highly transmissible and pathogenic viral infection, and was identified in December 2019 in Wuhan, China. Three months later, it became a severe pandemic.

OBJECTIVE

To identify scientific evidence on the use of face shields by health professionals during the COVID-19 pandemic period.

METHOD

An integrative literature review of articles obtained from PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science databases was undertaken. For the search, controlled, non-controlled descriptors and specific keywords: "face shield," "fluid resistance procedure," "respiratory infections," "healthcare workers," "COVID-19," "aerosols," and "personal protection infection" were used.

RESULTS

The sample comprised seven studies. The available evidence has shown that face shields do not have a defined standard for their production-their effectiveness depends on the quality of the visor, structure, and fixation system. They must be used as adjuvants to other personal protective equipment (PPE), and their isolated use is not recommended due to the fragilities of peripheral face sealing, especially during the COVID-19 pandemic period.

CONCLUSION

Due to the shortage of this equipment, domestic face shields can be indicated if they meet production requirements, based on scientific evidence for their efficient use.

Shortage of Personal Protective Equipment and Nurse Safety in the Coronavirus Disease-19 Pandemic: A Cross-sectional Study in Indonesia

BACKGROUND: There has been a substantial scarcity of personal protective equipment (PPE) in several countries during the ongoing pandemic of Coronavirus disease-19 (COVID-19). Nurses in Indonesia also experience a shortage of PPE as the number of COVID-19 patients in Indonesia continues to increase. There is no accurate data yet regarding the exact number of PPE scarcity for nurses. AIM: This study aimed to describe the availability of PPE and adverse consequences long-term used off the PPE and examine the relationship between shortage PPE and nurse behavior response in Indonesia. METHODS: An online-based survey was used to collect data on the nurse, regardless of their discipline, training background, or degree of experience, who are directly involved in managing COVID-19 patients. In this study, a total of 211 questionnaires were gathered. The survey was conducted using the Google form. This study employs univariate and bivariate analysis. RESULTS: Most of the mask N95 provision reaches up to 80%. The second is the hazmat (71%) and the lowest in the gloves (30%). Around 71% of respondents generally resist removing their PPE until the shift is complete. Then, 62% of the respondents are ready to propose to the leaders of the PPE, and 51% show that they are modifying the PPE. Nasal blisters are the most prevalent type of injury sustained by nurses while wearing PPE (86%), followed by headaches and dehydration. This study found that most respondents (60.7%) with insufficient PPE had a positive behavior reaction, whereas just 18% had a poor behavior reaction. CONCLUSION: Most nurses have difficulties accessing N95 and experience some adverse effects of prolonging PPE use. Policymakers should take urgent action to tackle these concerns.

Key ingredients and recycling strategy of personal protective equipment (PPE): Towards sustainable solution for the COVID-19 like pandemics

The COVID-19 pandemic has intensified the complications of plastic trash management and disposal. The current situation of living in fear of transmission of the COVID-19 virus has further transformed our behavioural models, such as regularly using personal protective equipment (PPE) kits and single-use applications for day to day needs etc. It has been estimated that with the passage of the coronavirus epidemic every month, there is expected use of 200 billion pieces of single-use facemasks and gloves. PPE are well established now as life-saving items for medicinal specialists to stay safe through the COVID-19 pandemic. Different processes such as glycolysis, hydrogenation, aminolysis, hydrolysis, pyrolysis, and gasification are now working on finding advanced technologies to transfer waste PPE into value-added products. Here, in this article, we have discussed the recycling strategies of PPE, important components (such as medical gloves, gowns, masks & respirators and other face and eye protection) and the raw materials used in PPE kits. Further, the value addition methods to recycling the PPE kits, chemical & apparatus used in recycling and recycling components into value-added products. Finally, the biorenewable materials in PPE for textiles components have been discussed along with concluded remarks.

Gender and Race on the Frontline: Experiences of Health Workers in Brazil during the COVID-19 Pandemic

Studies on the differential effects of health emergencies have largely overlooked women health workers. Whilst the literature has shown the impact of Coronavirus disease-19 (COVID-19) on women and on healthcare workers, little research has considered the gendered effects of the health workforce. This article analyses the impact of COVID-19 on healthcare workers and working conditions in Brazil's public healthcare system, through consideration of gendered and racialized understandings of care and work. Data were taken from an online survey of 1,263 health workers, undertaken between September and October 2020, disaggregated by sex and by race in order to understand health workers' experiences of the pandemic in one of the countries most significantly affected by the crisis.

Impact of Personal Cooling on Performance, Comfort and Heat Strain of Healthcare Workers in PPE, a Study From West Africa

Background: Personal protective equipment (PPE) is an essential component of safely treating suspected or confirmed SARS-CoV-2 patients. PPE acts as a barrier to heat loss, therefore increasing the risk of thermal strain which may impact on cognitive function. Healthcare workers (HCWs) need to be able to prioritize and execute complex tasks effectively to ensure patient safety. This study evaluated pre-cooling and per-cooling methods on thermal strain, thermal comfort and cognitive function during simulated emergency management of an acutely unwell patient. Methods: This randomized controlled crossover trial was run at the Clinical Services Department of the Medical Research Unit The Gambia. Each participant attended two sessions (Cool and Control) in standard PPE. Cool involved pre-cooling with an ice slurry ingestion and per-cooling by wearing an ice-vest external to PPE. Results: Twelve participants completed both sessions. There was a significant increase in tympanic temperature in Control sessions at both 1 and 2 h in PPE (p = 0.01). No significant increase was seen during Cool. Effect estimate of Cool was -0.2°C (95% CI -0.43; 0.01, p = 0.06) post 1 h and -0.28°C (95% CI -0.57; 0.02, p = 0.06) post 2 h on tympanic temperature. Cool improved thermal comfort (p < 0.001), thermal sensation (p < 0.001), and thirst (p = 0.04). No difference on cognitive function was demonstrated using multilevel modeling. Discussion: Thermal strain in HCWs wearing PPE can be safely reduced using pre- and per-cooling methods external to PPE.

Assessing personal protective equipment needs for healthcare workers

BACKGROUND

Personal protective equipment (PPE) is critical for healthcare workers (HCWs) since it acts as a barrier to infection transmission; however, current PPE is not ideally suited to their needs due to limitations in protection and comfort. Thus, the purpose of this study was to identify major issues of current PPE for body protection and assess its needs within health care.

METHODS

An online survey was conducted with a convenience sample of 200 U.S. healthcare professionals who interact with patients. The survey was designed to identify the types of PPE that HCWs currently use, assess current PPE design features for body protection, examine the effect of PPE design features for body protection, and HCWs' years of work experiences on overall PPE acceptability, and explore current PPE maintenance practices. Both quantitative and qualitative data were used for analyses.

RESULTS

This study showed the need for current PPE improvement in terms of fit, comfort, mobility, and donning and doffing for HCWs' safety and health. Donning and doffing plays an important role in HCWs' overall acceptance of PPE for body protection. This study revealed that most HCWs dispose of their PPE in a trashcan in a healthcare unit and non-disposed PPE is laundered at home, which may expose their family members to a health risk if a proper precaution is not followed.

CONCLUSION

This study provides critical insights for the needs of (a) novel PPE design research and (b) proper donning and doffing training and its strict regulatory effort to ensure HCWs' safety and health.

Has the time to reinstate elective orthopedic procedures come?

BACKGROUND

The coronavirus pandemic changed how we manage and operate patients in orthopaedic practice. Although elective orthopaedic procedures were halted to prevent spread of the disease as well as sustain supplies of essential protective equipment and healthcare workers, trauma services were continued. We studied the orthopaedic trauma cases operated over 6 months of the pandemic, and discuss the protocols used to minimize disease spread.

METHODS

Data was collected for all orthopaedic emergency cases operated at our centre from 1 st March - 10 th August 2020. During this time specific protocols were used for first aid, pre-operative care, inside the operation theatre, post-operative stay as well as for follow ups.

RESULTS

A total of 851 patients were operated. A sharp decline in surgeries was seen during the lockdown. Average stay in the hospital was 4 days. Only 44% of the patients came for follow-up visits. None of the contacted patients or their relatives developed symptoms or tested positive for COVID after discharge.

CONCLUSION

Multiple waves and various mutant strains of COVID-19 have made this pandemic longer than expected. Elective orthopaedic cases cannot be ignored for forever, as it leads to poor quality of life and an increasing burden of such patients. We suggest, that using the protocols used at our centre, we have successfully operated on cases without risking spread of the virus. Thus, we believe it's time to reinstate elective orthopaedic procedures, in a phased manner.

Experiences of nurses working with COVID-19 patients: A qualitative study

BACKGROUND

The global COVID-19 pandemic has led to massive disruptions in daily life, business, education, lifestyle and economies worldwide. Nurses are a professional group who care directly for COVID-19 patients and thus face direct exposure to the virus. The nurses who work on the front lines during this period put their own well-being at risk to care for these patients.

PURPOSE/AIM

The aim of this study was to identify the experiences and challenges faced by nurses working in pandemic clinics in Turkey during the COVID-19 pandemic.

METHODS

This qualitative study was based on semi-structured in-depth interviews conducted through the mobile application Whatsapp with 19 nurses who were actively working in pandemic clinics. Due to the pandemic, the snowball sampling method was used to reach the sample group. Interviews were continued until data saturation was achieved. All interviews were audio recorded and later transcribed. The study data were interpreted according to themes identified using thematic analysis. Throughout the study, the authors followed the COREQ checklist.

RESULTS

The experiences of nurses caring for COVID-19 patients were summarised into five major themes: psychosocial adaptation, protection, difficulty in care and treatment, access to information and working conditions.

CONCLUSION

Nurses caring for COVID-19 patients in Turkey have been affected psychologically, socially and physiologically. They experienced stigmatisation, exhaustion and burnout. One of the biggest challenges for the nurses was difficulty providing physical care and treatment due to the use of personal protective equipment. Nurses want improved compensation in addition to applause from the public. Interventions to help bolster nurses' psychological and physiological strength are recommended.

RELEVANCE TO CLINICAL PRACTICE

This study emphasised nurses' psychologically, socially and physiologically affected. Therefore, improvements in financial and moral support would provide psychological reinforcement for nurses during the epidemic. Informing the public is necessary to reduce the stigmatisation of nurses working in pandemic clinics.

The Association between Using Personal Protective Equipment and Headache among Healthcare Workers in Saudi Arabia Hospitals during the COVID-19 Pandemic

It is mandatory that healthcare workers wear personal protective equipment (PPE) while caring for COVID-19 patients. Studies have shown that wearing PPE for a prolonged time may lead to symptoms of physical discomfort including headache. The aim of this study is to assess the prevalence and association between prolonged use of PPE and headaches. This was a cross-sectional study. A convenience sample of healthcare workers who worked with COVID-19 patients in clinical settings was recruited. The data were collected through an electronic survey shared as a link through social media. This study included 1060 participants, 753 (71%) female and 307 (29%) male. Participants were divided into two groups. Group A had 628 (60%) participants who did not have chronic headache before the COVID-19 pandemic, while Group B contained 432 (40%) participants who had a previous chronic headache. Headaches differed significantly between Groups A and B in frequency, type, location, and quality during the COVID-19 period. The analysis found a significant relationship between duration of PPE use and headache occurrence. The significant relationship between the duration of PPE usage and headache occurrence among healthcare workers should be considered when refining policies and procedures regarding prolonged PPE use.