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Cui Y, Wu H, Zhang S, Zhang Z, Cheng G, Sun R, Shi Y, Hu Y. Nanoscale hyperthermia mesostructures for sustainable antimicrobial design. CELL REPORTS. PHYSICAL SCIENCE 2024; 5:102081. [PMID: 39092206 PMCID: PMC11293369 DOI: 10.1016/j.xcrp.2024.102081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Sustainability is critical in addressing global challenges posed by prolonged pandemics that impact health, economies, and the environment. Here, we introduce a molecular engineering approach for thermoregulated antimicrobial management inspired by firewalking rituals. The study uses in situ spectroscopy and multi-scale modeling to validate a hierarchical design. Efficient light-to-thermal energy conversion is achieved by engineering the molecular band structure. Rapid nanoscale hyperthermia is facilitated through thermal engineering. This approach significantly reduces the half-life of pathogens such as Escherichia coli, influenza A, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to 1.4 min while maintaining a low perceived temperature on human skin. Standard disease infection and epidemic models show this technology's potential to flatten outbreak curves and delay peak infection rates, which is crucial during the early stages of pandemics when developing vaccines and antiviral drugs takes time. The scalable manufacturing and broad antimicrobial applicability hold great promise for controlling emerging infectious diseases and diverse bioprotective applications.
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Affiliation(s)
- Ying Cui
- Department of Mechanical and Aerospace Engineering, School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Huan Wu
- Department of Mechanical and Aerospace Engineering, School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Shilei Zhang
- Department of Microbiology, Immunology and Molecular Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Zhihan Zhang
- Department of Mechanical and Aerospace Engineering, School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Genhong Cheng
- Department of Microbiology, Immunology and Molecular Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Ren Sun
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Yuan Shi
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Yongjie Hu
- Department of Mechanical and Aerospace Engineering, School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Lead contact
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Chen XE, Zhao C, Luo Y, Tang T, Chen W. Contamination of SARS-CoV-2 RNA on personal protective equipment and environmental surfaces in nonpatient entry area of a Fangcang shelter hospital. Am J Ind Med 2023; 66:805-812. [PMID: 37394558 DOI: 10.1002/ajim.23513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVES To determine the extent of contamination of personal protective equipment (PPE) and surfaces by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the nonpatient entry area of a Fangcang shelter hospital, the medical staff accommodation area, and the staff transport bus. METHODS We collected 816 samples from the nonpatient entry area and floors in a Fangcang shelter hospital, medical staff accommodation area, and scheduled bus, and the five major types of PPE used from April 13 to May 18, 2022. SARS-CoV-2 ribonucleic acid (RNA) was detected by reverse transcription-polymerase chain reaction. RESULTS Overall, 22.2% of PPE samples were positive for SARS-CoV-2 RNA. Boot covers and gowns were the most contaminated types of PPE. The positive PPE contamination rate of staff collecting respiratory specimens was significantly higher than that of the general-treatment staff group (35.8% vs. 12.2%) and cleaner group (35.8% vs. 26.4%), p < 0.01. In total, 27 of 265 (10.2%) environmental surface samples were positive for SARS-CoV-2 RNA. The contamination-positive rates were 26.8% (22/82), 5.4% (4/74), and 0.9% (1/109) for contaminated, potentially contaminated, and clean zones, respectively. SARS-CoV-2 RNA was frequently detected on objects such as mobile phones, tables, computer keyboards and mice, and door handles. CONCLUSIONS SARS-CoV-2 RNA was widely distributed on high-touch surfaces and on PPE in the contaminated zone of the Fangcang shelter hospital, implying a potentially high infection risk for healthcare workers. Our findings emphasize the need to ensure adequate environmental cleaning, improve hand hygiene, and reduce the risk of infection. Additionally, prevention of self-contamination during PPE donning and doffing is complex and needs more research.
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Affiliation(s)
- Xue-E Chen
- Department of Nosocomial Infection Control, The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - ChenHao Zhao
- Department of Neurology, The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - YeTao Luo
- Department of Nosocomial Infection Control, The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Tang Tang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Wei Chen
- Department of Nosocomial Infection Control, The Second Affiliated Hospital, Army Medical University, Chongqing, China
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Srinidhi S, Stephen S, Mohankumar K, D’Cruz TM, Subbiah K, Subbiah GK, Nagappan N, Mani B. Assessment of Role of PPE in Preventing the Spread of Infection among the Dental Surgeons: A Prospective Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S362-S366. [PMID: 37654383 PMCID: PMC10466661 DOI: 10.4103/jpbs.jpbs_546_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/04/2022] [Accepted: 12/22/2022] [Indexed: 09/02/2023] Open
Abstract
Although there is easy accessibility of infection control measures and recommendation regarding the PPE, most of the dentists failed to practice appropriate infection control measures. The aim of the current survey was conducted to assess the knowledge, perception, and attitude regarding the role of PPE among the dental care professionals in COVID-19. This is cross-sectional web-based questionnaire survey conducted among dental care professionals in Tamil Nadu. The self-administered questions related to the PPE infection control measures were collected from 500 subjects. The statistical analysis was done using Statistical Package for Social Sciences SPSS (V 22.0). The frequency distribution was computed. This survey revealed that all the 500 (100%) respondents had awareness about the role of PPE in COVID-19 pandemic. Among the 500 study subjects, 93.2% had well-known knowledge about PPE, 60.4% of dentist strictly adheres to the use of PPE in routine dental practice, 80.2% of dentist mentioned PPE is safe and effective against spread of infection, and 93.4% of dentist had awareness about donning and doffing. Conclusion From the beginning of this COVID-19, information provided by the health organization like CDC and WHO regarding the role of PPE had positive impact among the dental care professionals.
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Affiliation(s)
- S. Srinidhi
- Department of Public Health Dentistry, Karpaga Vinayaga Institute of Dental Sciences, Chengalpet District, Tamil Nadu, India
| | - Sujithraj Stephen
- Department of Dentistry, Panimalar Medical College Hospital and Research Institute, Varadharajapuram, Chennai, Tamil Nadu, India
| | | | - Thomson M. D’Cruz
- Department of Oral and Maxillofacial Surgery, Dr. G. D. Pol Foundation’s Y. M. T. Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Krithika Subbiah
- Department of Public Health, University of Waterloo, Ontario, Canada
| | | | - Nagappan Nagappan
- Department of Public Health Dentistry, Chettinad Dental College and Research Institute, Kelambakkam, Tamil Nadu, India
| | - Bhuvaneswari Mani
- Department of Orthodontics and Dentofacial Orthopedics, KarpagaVinayaga Institute of Dental Sciences, Chengalpet District, Tamil Nadu, India
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Bhatia R, Aggarwal R, Ravichandrane B, Rajendrakumar K, Ahmed A, Sahoo D, Soni KD, Khanna P, Trikha A. Early Doffing among Frontline Healthcare Workers Working in the COVID Areas in Resource-Limited Settings: Lessons Learned and Interventions Taken. Indian J Occup Environ Med 2023; 27:209-213. [PMID: 38047167 PMCID: PMC10691514 DOI: 10.4103/ijoem.ijoem_46_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 08/22/2022] [Accepted: 09/02/2022] [Indexed: 12/05/2023] Open
Abstract
Background In the fight against the pandemic, personal protective equipment (PPE) has played a vital role. However, working with PPE has its own difficulties and problems. The aim of this study was to find out the reasons of early doffing, that is, in doffing in emergency situations before the shift among healthcare workers (HCWs) working in PPE in the COVID areas in resource-limited settings. Methods This cross-sectional, survey-based study was carried out on healthcare workers involved in direct care of patients with COVID-19 in tertiary care COVID center, India. The questionnaire was sent as a Google form through email and social media platforms like WhatsApp and Facebook. The data was reported as the mean ± SD for continuous variables and as the percentage for categorical variables. Findings Among 252 healthcare workers who participated in the survey, 145 (57.5%) participants doffed early on 300 occasions. Out of these 145, 50% doffed early only once and rest doffed early multiple times. The most common reason of early doffing was found to be breach in PPE (15.33%) followed by fogging (14%) and headache (12%), and most commonly, breach was in mask or coverall/gown (32.6% each). Conclusion Although PPE decreases the risk of infection, it is challenging for HCWs to work in PPE leading to instances of early doffing. The most common reason for early doffing in our study was the breach in PPE and the most common component of breach was found to be mask and coverall/gown. Therefore, we suggest that the proper sizes of the PPE should be made available and proper training in donning should be imparted to HCWs working in PPE.
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Affiliation(s)
- Ridhima Bhatia
- Department of Anaesthesiology, Critical Care and Pain Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Aggarwal
- Critical and Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Banupriya Ravichandrane
- Department of Anaesthesiology, Critical Care and Pain Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Karthiga Rajendrakumar
- Department of Anaesthesiology, Critical Care and Pain Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Aasim Ahmed
- Department of Anaesthesiology, Critical Care and Pain Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Debasis Sahoo
- Department of Anaesthesiology, Critical Care and Pain Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Critical and Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Puneet Khanna
- Department of Anaesthesiology, Critical Care and Pain Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, Critical Care and Pain Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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Staying proper with your personal protective equipment: How to don and doff. J Clin Anesth 2023; 86:111057. [PMID: 36696834 PMCID: PMC9869806 DOI: 10.1016/j.jclinane.2023.111057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/09/2023] [Accepted: 01/15/2023] [Indexed: 01/24/2023]
Abstract
INTRODUCTION The global COVID-19 pandemic highlighted the importance of protecting frontline healthcare workers from novel respiratory infections while also exposing the limited instruction that medical students receive on proper donning of personal protective equipment (PPE) and more importantly the safe doffing of contaminated PPE to minimize their risk of nosocomial infection. The best methods of providing this kind of instruction have not yet been determined. METHODS Anesthesiology interns and CA-1 residents were trained on proper PPE donning and doffing for AGPs using a methodology based on Miller's pyramid and following a "knows-knows how-shows-does" progression. Participants donned PPE without instruction and were sprayed with Glo Germ® to identify areas of contamination, after which they received both video and in-person instruction on best practices for donning and doffing PPE for AGPs. Following instruction, they again donned PPE and were sprayed with Glo Germ® to identify areas of contamination. RESULTS 54 participants completed the study. Before training, overall donning compliance was 60% and overall doffing compliance was 48%. Overall, 70% were contaminated after PPE doffing, with 46% having multiple sites of contamination. After training, donning compliance increased by nearly 30% (P < 0.001), doffing compliance increased by over 20% (P < 0.001), and overall contamination decreased by nearly 30% (P = 0.029), with multiple-site contamination decreasing to only 6% (P = 0.013). DISCUSSION While best methods for providing instruction regarding topics such as PPE donning and doffing have not yet been determined, we have demonstrated that the underlying knowledge base from medical school regarding proper donning and doffing for respiratory isolation is insufficient for preventing self-contamination, and that Miller's pyramid-based training using both video and in-person instruction combined with task execution by learners can improve compliance with PPE donning and doffing protocols and more importantly decrease skin contamination among a group of early training anesthesiology residents.
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Color-variable dual-dyed photodynamic antimicrobial polyethylene terephthalate (PET)/cotton blended fabrics. Photochem Photobiol Sci 2023:10.1007/s43630-023-00398-1. [PMID: 36894800 PMCID: PMC9998264 DOI: 10.1007/s43630-023-00398-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023]
Abstract
The urgent demand for scalable, potent, color variable, and comfortable antimicrobial textiles as personal protection equipment (PPE) to help reduce infection transmission in hospitals and healthcare facilities has significantly increased since the start of the COVID-19 pandemic. Here, we explored photodynamic antimicrobial polyethylene terephthalate/cotton (TC) blended fabrics comprised of photosensitizer-conjugated cotton fibers and polyethylene terephthalate (PET) fibers dyed with disperse dyes. A small library of TC blended fabrics was constructed wherein the PET fibers were embedded with traditional disperse dyes dominating the fabric color, thereby enabling variable color expression, while the cotton fibers were covalently coupled with the photosensitizer thionine acetate as the microbicidal agent. Physical (SEM, CLSM, TGA, XPS and mechanical strength) and colorimetric (K/S and CIELab values) characterization methods were employed to investigate the resultant fabrics, and photooxidation studies with DPBF demonstrated the ability of these materials to generate reactive oxygen species (i.e., singlet oxygen) upon visible light illumination. The best results demonstrated a photodynamic inactivation of 99.985% (~ 3.82 log unit reduction, P = 0.0021) against Gram-positive S. aureus, and detection limit inactivation (99.99%, 4 log unit reduction, P ≤ 0.0001) against Gram-negative E. coli upon illumination with visible light (60 min; ~ 300 mW/cm2; λ ≥ 420 nm). Enveloped human coronavirus 229E showed a photodynamic susceptibility of ~ 99.99% inactivation after 60 min illumination (400-700 nm, 65 ± 5 mW/cm2). The presence of the disperse dyes on the fabrics showed no significant effects on the aPDI results, and furthermore, appeared to provide the photosensitizer with some measure of protection from photobleaching, thus improving the photostability of the dual-dyed fabrics. Taken together, these results suggest the feasibility of low cost, scalable and color variable thionine-conjugated TC blended fabrics as potent self-disinfecting textiles.
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Greaves SW, Alter SM, Ahmed RA, Hughes KE, Doos D, Clayton LM, Solano JJ, Echeverri S, Shih RD, Hughes PG. A Simulation-based PPE orientation training curriculum for novice physicians. Infect Prev Pract 2023; 5:100265. [PMID: 36536774 PMCID: PMC9753485 DOI: 10.1016/j.infpip.2022.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/24/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Background Personal protective equipment (PPE) is effective in preventing coronavirus disease (COVID-19) infection. Resident knowledge of proper use and effective training methods is unknown. We hypothesise that contamination decreases and knowledge increases after a formalised PPE educational session. Methods Participants included first year interns during their residency orientation in June 2020. Before training, participants took a knowledge test, donned PPE, performed a simulated resuscitation, and doffed. A standardised simulation-based PPE training of the donning and doffing protocol was conducted, and the process repeated. Topical non-toxic highlighter tracing fluid was applied to manikins prior to each simulation. After doffing, areas of contamination, defined as discrete fluorescent areas on participants' body, was evaluated by ultraviolet light. Donning and doffing were video recorded and asynchronously rated by two emergency medicine (EM) physicians using a modified Centers for Disease Control and Prevention (CDC) protocol. The primary outcome was PPE training effectiveness defined by contamination and adherence to CDC sequence. Results Forty-eight residents participated: 24 internal medicine, 12 general surgery, 6 EM, 3 neurology, and 3 psychiatry. Before training, 81% of residents were contaminated after doffing; 17% were contaminated after training (P<0.001). The most common contamination area was the wrist (50% pre-training vs. 10% post-training, P<0.001). Donning sequence adherence improved (52% vs. 98%, P<0.001), as did doffing (46% vs. 85%, P<0.001). Participant knowledge improved (62%-87%, P <0.001). Participant confidence (P<0.001) and preparedness (P<0.001) regarding using PPE increased with training. Conclusion A simulation-based training improved resident knowledge and performance using PPE.
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Affiliation(s)
- Spencer W. Greaves
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, USA
| | - Scott M. Alter
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, USA
| | - Rami A. Ahmed
- Department of Emergency Medicine, Division of Simulation, Indiana University School of Medicine, USA
| | - Kate E. Hughes
- Department of Emergency Medicine, University of Arizona, USA
| | - Devin Doos
- Department of Emergency Medicine, Division of Simulation, Indiana University School of Medicine, USA
| | - Lisa M. Clayton
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, USA
| | - Joshua J. Solano
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, USA
| | - Sindiana Echeverri
- Clinical Skills Simulation Center, Florida Atlantic University Charles E. Schmidt College of Medicine, USA
| | - Richard D. Shih
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, USA
| | - Patrick G. Hughes
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, USA,Corresponding author. Florida Atlantic University at Bethesda Health, Department of Emergency Medicine, GME Suite, Lower Level, 2815 South Seacrest Blvd, Boynton Beach, FL 33435, USA. Tel.: +(561) 733 5933; fax: +(866) 617 8268
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Zeng C, Liu H, Jiang Y, Fu Y, Liu Y, Chang W, Li T, Huang X, Li C. How to reduce the exposure risk of medical staff from SARS-CoV-2 by reducing environmental contamination: Experience from designated hospitals in China. Front Public Health 2022; 10:963999. [PMID: 36523588 PMCID: PMC9745115 DOI: 10.3389/fpubh.2022.963999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background Using daily monitoring of environmental surfaces and personal protective equipment (PPE), we found an increase in environmental contamination since August 18, 2021, in a designated hospital for COVID-19 patients in China, which may lead to an increased risk of exposure to medical staff. Methods To investigate the cause of increased environmental contamination and effect of our intervention, we obtained environmental samples at pre-intervention (August 18-21, 2021) and post-intervention (August 22-28, 2021) from six infection isolation rooms with windows for ventilation and other auxiliary areas at 105 and 129 sites before routine daily cleaning, respectively. In addition, we obtained PPE samples from 98 medical staff exiting the patient rooms/contaminated areas at 482 sites. Between August 22 and 24, 2021, we took measures to reduce environmental contamination based on sampling and inspection results. Findings At pre-intervention, the positivity rates for contamination of environmental surfaces and PPE samples were significantly higher for critical patients (37.21 and 27.86%, respectively) than severely ill patients (25.00 and 12.50%, respectively) and moderately ill patients (0.00 and 0.00%, respectively) (Pearson's Chi-square: χ2 = 15.560, p = 0.000; Fisher's exact test: χ2 = 9.358, p = 0.007). Therefore, we inferred that the source of contamination of environmental surfaces and PPE was mainly the room of critically ill patients, likely through the hands of medical staff to the potentially contaminated areas. A critically ill patient had emergency tracheal intubation and rescue on August 18, 2021, due to worsened patient condition. The ventilator tube used for first aid did not match the ventilator, and the ventilator tube fell off multiple times on August 18-21, 2021, which may explain the increased contamination of environmental surfaces and PPE from critically ill patients, as well as lead to indirect contamination of potentially contaminated areas. The contamination positivity rates of environmental surfaces and PPE were reduced by replacing the appropriate ventilator catheter, limiting the number of people entering the isolation room simultaneously, increasing the frequency of environmental disinfection, standardizing the undressing process, setting up undressing monitoring posts to supervise the undressing process, and preventing the spread of virus infections in the hospital during an epidemic. Conclusions Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was spread on object surfaces in isolation rooms mainly by touch, and the contamination of environmental surfaces and PPE was greater in rooms of patients with greater disease severity and higher surface touch frequency. Therefore, strict protective measures for medical staff, frequent environmental cleaning for isolation rooms, and compliance with mask wearing by patients when conditions permit should be advised to prevent SARS-CoV-2 spread in hospitals.
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Affiliation(s)
- Cui Zeng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China,Department of Infection Control, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,Xiangya Center for Evidence-Based Nursing Practice and Healthcare Innovation: A Joanna Briggs Institute (JBI) Affiliated Group, Xiangya Hospital, Central South University, Changsha, China
| | - Hengzhuo Liu
- Department of Infection Control, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuling Jiang
- Department of Infection Control, Hunan Provincial People's Hospital, Changsha, China
| | - Yuanyu Fu
- Department of Infection Control, The First People's Hospital of Huaihua City, Huaihua, China
| | - Yuan Liu
- Department of Infection Control, The First Affiliated Hospital of Shaoyang University, Shaoyang, China
| | - Wei Chang
- Department of Infection Control, People's Hospital of Zhangjiajie, Zhangjiajie, China
| | - Tingting Li
- Department of Infection Control, The First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Changsha, China
| | - Xun Huang
- Department of Infection Control, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Chunhui Li
- Department of Infection Control, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Chunhui Li
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Xue X, Coleman CM, Duncan JD, Hook AL, Ball JK, Alexander C, Alexander MR. Evaluation of the relative potential for contact and doffing transmission of SARS-CoV-2 by a range of personal protective equipment materials. Sci Rep 2022; 12:16654. [PMID: 36198720 PMCID: PMC9533983 DOI: 10.1038/s41598-022-20952-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/21/2022] [Indexed: 11/09/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-the causative agent of coronavirus disease 2019 (COVID-19)-has caused a global public health emergency. Personal protective equipment (PPE) is the primary defence against viral exposure in healthcare and community settings. However, the surfaces of PPE materials may trap virus for contact transmission or through laden aerosols generated during removal of PPE, through cleaning or during movement. In this study, the relative efficacy of current PPE materials in terms of virion adsorption to materials and their antiviral potency, has been evaluated on a wide range of PPE for the first time, including four polymer glove types, two types of scrubs, apron material, a mask, visor and a selection of other commercial polymers and products. Although differences in virion adsorption to the test materials were observed, none of the existing polymer-based PPE resulted in more than tenfold reduction in the SARS-CoV-2 titre within either 10 min or 30 min contact period. The wettability and surface chemistry of the test materials were analysed to investigate any correlations with their surface physicochemical properties. While no correlation was found between wettability and viral retention under air flow challenge, one secondary ion of m/z 101.03 (+) and three secondary ions of m/z 31.98 (-), 196.93 (-) and 394.33 (+) in ToF-SIMS data of the test materials showed positive and negative correlations with the viral retention, respectively, which was identified by PLS regression model, suggesting that the surface chemistry plays a role in determining the extent of virion adsorption. Our findings outline the material aspects that influence the efficacy of current PPE against SARS-CoV-2 transmission and give suggestions on the development of novel simple polymer-based PPE for better infection protection.
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Affiliation(s)
- Xuan Xue
- Division of Advanced Materials and Healthcare Technologies, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Christopher M Coleman
- School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
- Wolfson Centre for Research on Global Virus Infections, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Joshua D Duncan
- School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Andrew L Hook
- Division of Advanced Materials and Healthcare Technologies, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Jonathan K Ball
- School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
- Wolfson Centre for Research on Global Virus Infections, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
- Nottingham Biomedical Research Centre, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Cameron Alexander
- Division of Molecular Therapeutics and Formulation, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Morgan R Alexander
- Division of Advanced Materials and Healthcare Technologies, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK.
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Obuhoro O, Jones RM. Assessing Patterns of Body Contamination after Personal Protective Equipment Removal among Healthcare Workers: A Scoping Review. Am J Infect Control 2022:S0196-6553(22)00674-5. [PMID: 36116680 DOI: 10.1016/j.ajic.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is now widely recognized that healthcare personnel (HCP) are at risk of contamination with pathogens during personal protective equipment (PPE) doffing. Studies of this phenonemona, have utilized a variety of PPE ensembles, doffing methods and experimental methods. METHODS A scoping review was performed, consistent with PRISMA guidance. The PubMed and sciVerse Scopus databases were searched using an a priori search strategy. Data were extracted for analysis using the matrix method, and then a narrative analysis performed. Articles were classified based on PPE ensemble. RESULTS Only 19 of 151 articles were included in the final anlaysis. All included studies reported some post-doffing contamination, and this contamination was most frequently observed on the hands, wrist, face and neck. Reviewed studies used a variety of tracer contaminants, PPE ensembles, doffing protocols, tracer assessment locations and methods, making it difficult to identify patterns across studies. DISCUSSION&CONCLUISONS Additional research is needed to improve study methodology related to the selection and placement of tracers to ensure sensitive detection of post-doffing contamination, compare how specific doffing procedures or pieces of PPE influence post-doffing contamination, and to understand what post-doffing contamination means for patient and HCP infection risk.
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Affiliation(s)
- Olosengbuan Obuhoro
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT
| | - Rachael M Jones
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT; Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA.
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11
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Merettig N, Bockmühl DP. Virucidal Efficacy of Laundering. Pathogens 2022; 11:993. [PMID: 36145425 PMCID: PMC9503802 DOI: 10.3390/pathogens11090993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 11/23/2022] Open
Abstract
Viruses contribute significantly to the burden of infectious diseases worldwide. Although there are multiple infection routes associated with viruses, it is important to break the chain of infection and thus consider all possible transmission routes. Consequently, laundering can be a means to eliminate viruses from textiles, in clinical settings well as for domestic laundry procedures. Several factors influence the survival and inactivation of microorganisms, including viruses on hard surfaces and textiles. Therefore, textiles should be regarded as potential fomites. While in clinical and industrial settings laundry hygiene is ensured by standardized processes, temperatures of at least 60 °C and the use of oxidizing agents, domestic laundry is not well defined. Thus, the parameters affecting viral mitigation must be understood and prudently applied, especially in domestic laundering. Laundering can serve as a means to break the chain of infection for viral diseases by means of temperature, time, chemistry and mechanical action.
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Affiliation(s)
| | - Dirk P. Bockmühl
- Faculty of Life Sciences, Rhine-Waal University of Applied Sciences, 47533 Kleve, Germany
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12
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MacIsaac SA, Mullin TJ, Munoz S, Ontiveros CC, Gagnon GA. Immersive ultraviolet disinfection of E. coli and MS2 phage on woven cotton textiles. Sci Rep 2022; 12:13260. [PMID: 35918389 PMCID: PMC9345007 DOI: 10.1038/s41598-022-17663-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/28/2022] [Indexed: 12/01/2022] Open
Abstract
Immersive ultraviolet disinfection provides a chemical-free technology for safer textiles, surfaces, and public spaces by inactivating communicable pathogens. This study examined immersive UV disinfection, using a disinfection cabinet, of E. coli and MS2 that was inoculated on white cotton T-shirts. The impact that porous materials have on UV disinfection is poorly understood with the majority of previous surface disinfection research focusing on hard, smooth surfaces. Several approaches were used in this study to characterize the light dynamics within the disinfection cabinet including colorimetric dosimetry coupons, biodosimetry, and spectroradiometry. Micro and macro geometry of porous surfaces are important factors to consider when using immersive UV technologies. The geometry of the cabinet impacted the distribution of emitted UV light within the disinfection cabinet and the physical properties of a porous material, such as the woven pattern of cotton, both contribute to UV disinfection efficiency. This work identified that light distribution is crucial for immersive UV technologies as the delivered fluence was highly variable within the disinfection cabinet and resulted in a difference of several logs of reduction for adjacent areas of T-shirt samples. Other inoculated areas achieved upwards of 1-log reductions values for MS2 and upwards of 2-log reductions for E. coli.
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Affiliation(s)
- Sean A MacIsaac
- Centre for Water Resources Studies, Department of Civil and Resource Engineering, Dalhousie University, 1360 Barrington St., Halifax, NS, B3H 4R2, Canada
| | - Toni J Mullin
- Centre for Water Resources Studies, Department of Civil and Resource Engineering, Dalhousie University, 1360 Barrington St., Halifax, NS, B3H 4R2, Canada
| | - Sebastian Munoz
- Centre for Water Resources Studies, Department of Civil and Resource Engineering, Dalhousie University, 1360 Barrington St., Halifax, NS, B3H 4R2, Canada
| | - C Carolina Ontiveros
- Centre for Water Resources Studies, Department of Civil and Resource Engineering, Dalhousie University, 1360 Barrington St., Halifax, NS, B3H 4R2, Canada
| | - Graham A Gagnon
- Centre for Water Resources Studies, Department of Civil and Resource Engineering, Dalhousie University, 1360 Barrington St., Halifax, NS, B3H 4R2, Canada.
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13
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Fanaselle W, Pouillot R, Papafragkou E, Liggins G, Williams L, Doren JMVAN. Evaluation of the Impact of Compliance with Mitigation Strategies and Frequency of Restaurant Surface Cleaning and Sanitizing on Control of Norovirus Transmission from Ill Food Employees Using an Existing Quantitative Risk Assessment Model. J Food Prot 2022; 85:1177-1191. [PMID: 35358310 DOI: 10.4315/jfp-21-423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/29/2022] [Indexed: 11/11/2022]
Abstract
ABSTRACT Reduction of foodborne illness caused by norovirus (NoV) continues to be a focus for the food safety community. Using a previously published quantitative risk assessment model, we evaluated more than 60 scenarios examining the impact of implementation of and compliance with risk management strategies identified in the U.S. Food and Drug Administration Food Code for (a) surface cleaning and sanitizing, (b) hand hygiene, (c) exclusion, or (d) restriction of ill employees. Implementation of and compliance with hand hygiene and ill food employee exclusion strategies had the largest impact on the predicted number of highly contaminated food servings and associated consumer illnesses. In scenarios in which gloves were always worn and hand washing compliance was 90%, the model estimated reductions in the number of highly contaminated food servings and ill consumers to 39 and 43% of baseline estimates (i.e., typical practice), respectively. Reductions were smaller when gloves were never worn. Hand washing compliance after using the restroom strongly impacted predicted numbers of highly contaminated servings and consumer illnesses. Ten percent compliance with removing or excluding ill food employees was predicted to increase the number of highly contaminated food servings and ill consumers to 221 and 213% of baseline estimates, respectively. Ninety-four percent compliance with exclusion of ill food employees was predicted to decrease these numbers to 69 and 71% of baseline estimates, respectively. Surface cleaning in food establishments had a relatively small impact on these measures. Restriction of food employees (removed from contact with food and food contact equipment and utensils) was not effective for reducing NoV illness unless this restriction included additional provisions. The results from this study can help risk managers prioritize mitigation strategies and their implementation for controlling the transmission of NoV and subsequent consumer foodborne illness. HIGHLIGHTS
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Affiliation(s)
- Wendy Fanaselle
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 5001 Campus Drive, College Park, Maryland 20740, USA
| | - Régis Pouillot
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 5001 Campus Drive, College Park, Maryland 20740, USA
| | - Efstathia Papafragkou
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 5001 Campus Drive, College Park, Maryland 20740, USA
| | - Girvin Liggins
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 5001 Campus Drive, College Park, Maryland 20740, USA
| | - Laurie Williams
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 5001 Campus Drive, College Park, Maryland 20740, USA
| | - Jane M VAN Doren
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 5001 Campus Drive, College Park, Maryland 20740, USA
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14
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Ito T, Okachi S, Sato K, Yasui H, Fukatsu N, Ando M, Chen-Yoshikawa TF, Saka H. Prevention of droplet dispersal with 'e-mask': A new daily use endoscopic mask during bronchoscopy. Respirology 2022; 27:863-873. [PMID: 35781913 DOI: 10.1111/resp.14321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/07/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Bronchoscopy is an airborne particle-generating procedure. However, few methods for safe bronchoscopy have been developed. To reduce airborne particles during bronchoscopy, we created an 'e-mask', which is a simple, disposable mask for patients. Our objective was to evaluate the e-mask's protective ability against airborne particles and to assess respiratory adverse events and complications. METHODS Patients with stage 2-4 chronic obstructive pulmonary disease were excluded. We performed visualization and quantifying experiments on airborne particles with and without the e-mask. We prospectively evaluated whether wearing the e-mask during bronchoscopy was associated with the incidence of patients requiring >5 L/min oxygen to maintain >90% oxygen saturation, and patients with >45 mm Hg end-tidal carbon dioxide (EtCO2 ) elevation, in addition to complications, compared to historical controls. RESULTS In the visualization experiment, more than ten thousand times of airborne particles were generated without the e-mask than with the e-mask. The volume of airborne particles was significantly reduced with the e-mask, compared to that without the e-mask (p = 0.011). Multivariate logistic regression analysis revealed that wearing the e-mask had no significant effect on the incidence of patients requiring >5 L/min oxygen to maintain >90% oxygen saturation, (p = 0.959); however, wearing the e-mask was a significant factor in >45 mm Hg EtCO2 elevation (p = 0.026). No significant differences in complications were observed between the e-mask and control groups (5.8% vs. 2.5%, p = 0.395). CONCLUSION Wearing the e-mask during bronchoscopy significantly reduced the generation of airborne particles during bronchoscopy without increasing complications.
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Affiliation(s)
- Takayasu Ito
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shotaro Okachi
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhide Sato
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Advanced Analytical and Diagnostic Imaging Center (AADIC)/Medical Engineering Unit (MEU), B3 Unit, Nagoya University Institute for Advanced Research, Nagoya, Japan
- FOREST-Souhatsu, CREST, JST, Nagoya, Japan
| | - Hirotoshi Yasui
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Noriaki Fukatsu
- Advanced Analytical and Diagnostic Imaging Center (AADIC)/Medical Engineering Unit (MEU), B3 Unit, Nagoya University Institute for Advanced Research, Nagoya, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | | | - Hideo Saka
- Department of Respiratory Medicine, Matsunami General Hospital, Hashima-gun, Japan
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15
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Montalbano L, Gallo L, Ferrante G, Malizia V, Cilluffo G, Fasola S, Alesi M, La Grutta S. Serious Games: A new Approach to Foster Information and Practices About Covid-19? Front Robot AI 2022; 9:830950. [PMID: 35677083 PMCID: PMC9168068 DOI: 10.3389/frobt.2022.830950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
The current Covid-19 pandemic poses an unprecedented global challenge in the field of education and training. As we have seen, the lack of proper information about the virus and its transmission has forced the general population and healthcare workers to rapidly acquire knowledge and learn new practices. Clearly, a well-informed population is more likely to adopt the correct precautionary measures, thus reducing the transmission of the infection; likewise, properly educated healthcare workers are better equipped to manage the emergency. However, the need to maintain physical distancing has made it impossible to provide in-presence information and training. In this regard, new technologies have proved to be an invaluable resource by facilitating distance learning. Indeed, e-learning offers significant advantages because it does not require the physical presence of learners and teachers. This innovative method applied to serious games has been considered potentially effective in enabling rapid and large-scale dissemination of information and learning through content interactivity. We will review studies that have observed the development and use of serious games to foster information and practices about Covid-19 aimed at promoting behavioral changes in the population and the healthcare personnel involved on the front line.
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Affiliation(s)
- L. Montalbano
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, Palermo, Italy
- *Correspondence: L. Montalbano,
| | - L. Gallo
- Institute for High Performance Computing and Networking (ICAR), National Research Council of Italy, Napoli, Italy
| | - G. Ferrante
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - V. Malizia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, Palermo, Italy
| | - G. Cilluffo
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, Palermo, Italy
| | - S. Fasola
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, Palermo, Italy
| | - M. Alesi
- Department of Psychology, Educational Science and Human Movement (SPPEFF), University of Palermo, Palermo, Italy
| | - S. La Grutta
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, Palermo, Italy
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16
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Mahalingam K, Surbhi, Balaji A, Ganesh R, Daniel RA, Aggarwal R, Soni KD, Singh AK, Khanna P, Gupta V, Trikha A. 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. J Family Med Prim Care 2022; 11:1935-1942. [PMID: 35800524 PMCID: PMC9254845 DOI: 10.4103/jfmpc.jfmpc_1937_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/07/2021] [Accepted: 12/11/2021] [Indexed: 01/25/2023] Open
Abstract
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.
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Affiliation(s)
- Karthikeyan Mahalingam
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Surbhi
- Department of Anaethesia and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Akshaya Balaji
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ragul Ganesh
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Roy Arokiam Daniel
- Department of Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Richa Aggarwal
- Department of Anaethesia and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kapil Dev Soni
- Department of Anaethesia and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Akhil Kant Singh
- Department of Anaethesia and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Puneet Khanna
- Department of Anaethesia and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Viney Gupta
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anjan Trikha
- Department of Anaethesia and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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17
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Impact of Face-to-Face Teaching in Addition to Electronic Learning on Personal Protective Equipment Doffing Proficiency in Student Paramedics: Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053077. [PMID: 35270768 PMCID: PMC8910255 DOI: 10.3390/ijerph19053077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 01/04/2023]
Abstract
Personal protective equipment doffing is a complex procedure that needs to be adequately performed to prevent health care worker contamination. During the COVID-19 pandemic, junior health care workers and students of different health care professions who had not been trained to carry out such procedures were often called upon to take care of infected patients. To limit direct contact, distance teaching interventions were used, but different trials found that their impact was rather limited. We therefore designed and carried out a randomized controlled trial assessing the impact of adding a face-to-face intervention using Peyton's four-step approach to a gamified e-learning module. Sixty-five student paramedics participated in this study. The proportion of doffing sequences correctly performed was higher in the blended learning group (33.3% (95%CI 18.0 to 51.8) versus 9.7% (95%CI 2.0 to 25.8), p = 0.03). Moreover, knowledge and skill retention four to eight weeks after the teaching intervention were also higher in this group. Even though this study supports the use of a blended learning approach to teach doffing sequences, the low number of student paramedics able to adequately perform this procedure supports the need for iterative training sessions. Further studies should determine how often such sessions should be carried out.
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18
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Bui TKN, Mawatari K, Emoto T, Fukushima S, Shimohata T, Uebanso T, Akutagawa M, Kinouchi Y, Takahashi A. UV-LED irradiation reduces the infectivity of herpes simplex virus type 1 by targeting different viral components depending on the peak wavelength. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2022; 228:112410. [PMID: 35193038 DOI: 10.1016/j.jphotobiol.2022.112410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/11/2022] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
Herpes simplex virus type 1 (HSV-1) is an enveloped virus that mainly infects humans. Given its high global prevalence, disinfection is critical for reducing the risk of infection. Ultraviolet-light-emitting diodes (UV-LEDs) are eco-friendly irradiating modules with different peak wavelengths, but the molecules degraded by UV-LED irradiation have not been clarified. To identify the target viral molecules of UV-LEDs, we exposed HSV-1 suspensions to UV-LED irradiation at wavelengths of 260-, 280-, 310-, and 365-nm and measured viral DNA, protein, and lipid damage and infectivity in host cells. All UV-LEDs substantially reduced by inhibiting host cell transcription, but 260- and 280-nm UV-LEDs had significantly stronger virucidal efficiency than 310- and 365-nm UV-LEDs. Meanwhile, 260- and 280-nm UV-LEDs induced the formation of viral DNA photoproducts and the degradation of viral proteins and some phosphoglycerolipid species. Unlike 260- and 280-nm UV-LEDs, 310- and 365-nm UV-LEDs decreased the viral protein levels, but they did not drastically change the levels of viral DNA photoproducts and lipophilic metabolites. These results suggest that UV-LEDs reduce the infectivity of HSV-1 by targeting different viral molecules based on the peak wavelength. These findings could facilitate the optimization of UV-LED irradiation for viral inactivation.
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Affiliation(s)
- Thi Kim Ngan Bui
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuramoto-cho 3-18-15, Tokushima City, Tokushima 770-8503, Japan
| | - Kazuaki Mawatari
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuramoto-cho 3-18-15, Tokushima City, Tokushima 770-8503, Japan.
| | - Takahiro Emoto
- Graduate School of Science and Technology, Tokushima University, Minamijyousanjima-cho 2-1, Tokushima City, Tokushima 770-8506, Japan
| | - Shiho Fukushima
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuramoto-cho 3-18-15, Tokushima City, Tokushima 770-8503, Japan
| | - Takaaki Shimohata
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuramoto-cho 3-18-15, Tokushima City, Tokushima 770-8503, Japan; Department of Marine Science and Technology, Fukui Prefectural University, 1-1 Gakuen-cho, Obama, Fukui 917-0003, Japan
| | - Takashi Uebanso
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuramoto-cho 3-18-15, Tokushima City, Tokushima 770-8503, Japan
| | - Masatake Akutagawa
- Graduate School of Science and Technology, Tokushima University, Minamijyousanjima-cho 2-1, Tokushima City, Tokushima 770-8506, Japan
| | - Yohsuke Kinouchi
- Graduate School of Science and Technology, Tokushima University, Minamijyousanjima-cho 2-1, Tokushima City, Tokushima 770-8506, Japan
| | - Akira Takahashi
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuramoto-cho 3-18-15, Tokushima City, Tokushima 770-8503, Japan
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19
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Investigating Viral Inoculation and Recovery from Medical Masks. Adv Virol 2022; 2022:3173883. [PMID: 35237326 PMCID: PMC8885274 DOI: 10.1155/2022/3173883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/05/2022] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Abstract
The SARS-CoV-2 pandemic from 2019 onwards has significantly increased the usage of surgical style medical masks, both in healthcare and public settings. It is important to study the contamination of and viral transfer from such masks. However, accepted standard test methods such as ISO 18184 have prescribed inoculation methods which may not be fully representative of the type of viral insult experienced in the clinic or community. In addition to studying a conventional mask, the performance of a mask featuring an antimicrobial photosensitiser was also studied.
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20
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Sisco E, Robinson EL, Mead R, Miller CR. Measuring changes in drug particulate on evidence packaging due to routine case analysis. Forensic Chem 2021. [DOI: 10.1016/j.forc.2021.100372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Self-contamination following removal of two personal protective equipment suits: a randomized, controlled, crossover simulation trial. J Hosp Infect 2021; 119:155-162. [PMID: 34606932 DOI: 10.1016/j.jhin.2021.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Healthcare personnel are often at high risk of contamination when participating in airway management and other aerosol-generating procedures. AIM To explore the differences in self-contamination after removal of gown and coverall personal protective equipment (PPE) using an ultraviolet-fluorescent solution. METHODS This prospective, randomized, controlled crossover trial was set in a third-level university health centre in Buenos Aires, Argentina between August and October 2020. The study included 60 anaesthesia personnel volunteers, and no participants were excluded from the study. A two-period/two-intervention design was chosen; each intervention comprised audio-guided placement of PPE, full-body spraying of fluorescent solution, audio-guided removal of PPE, and self-contamination assessment through ultraviolet light scanning. The primary outcome was the mean within-participant difference (any traces) between PPE suits. Statistical significance was tested using t-tests for paired data. The allocation ratio was 25/35 (gown followed by coverall/coverall followed by gown). FINDINGS Self-contamination after removal of coveralls was greater than that after removal of gowns, with a mean within-participant difference of 11.45 traces (95% confidence interval 8.26-14.635; P<0.001). Significant differences were found for the number of self-contaminated body zones, small fluorescent traces and large fluorescent traces. Removal of a gown was associated with a markedly lower risk of self-contamination. CONCLUSIONS Quick one-step removal of a gown and gloves may reduce self-contamination in the arm/hand area. Fluorescent solutions can help to identify self-contamination and compare outcomes between available PPE suits. Repeated training sessions and enhanced knowledge on self-contamination following removal of PPE are paramount. CLINICAL TRIAL REGISTRATION NUMBER NCT04763304 (on ClinicalTrials.gov).
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22
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Paul D, Mondal SK, Mandal SM. Biologia Futura: use of biocides during COVID-19-global reshuffling of the microbiota. Biol Futur 2021; 72:273-280. [PMID: 34554548 PMCID: PMC7848239 DOI: 10.1007/s42977-021-00069-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 01/12/2021] [Indexed: 11/02/2022]
Abstract
Aim The article reviews the current usage of biocides during this lockdown period for sanitizing our living areas due to the pandemic and discusses the pros and cons. Subject COVID-19 spread like wildfire to over 200 countries of the world across all continents. The causative agent, novel coronavirus (SARS-CoV-2) is being counter attacked by a thorough application of disinfectants and sterilants. However, the virus mutated over 30 times during this global pandemic, creating panic and leading to enhanced pathogenicity and consequently to more stringent sanitation measures for controlling it. However, excessive use of different types of biocides for disinfecting surfaces is highly alarming in several cases. Extensive application of biocides affects the microbial flora, leading to an abrupt decrease in the number and diversity of beneficial microbes that may directly affect the functioning of nutrient cycles. Results The increased concentration of biocides in agricultural land via surface water or pond water indirectly affect the soil and water ecosystem, soil aggregation and fertility. This will also lead to the flourishing of resistant strains due to loss of competition from the other species, which fail to persist after prolonged use of biocides. Conclusion It is necessary to realize the environmental impacts of biocides and sterilants. It is the right time to stop their entry into the agricultural ecosystem by following adequate management strategies and complete neutralization.
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Affiliation(s)
- Debarati Paul
- Amity Institute of Biotechnology, Amity University, Sector 125, Noida, UP, 201313, India.
| | - Suresh K Mondal
- Central Research Facility, Indian Institute of Technology Kharagpur, Kharagpur, 721302, India
| | - Santi M Mandal
- Central Research Facility, Indian Institute of Technology Kharagpur, Kharagpur, 721302, India.
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23
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Allison AL, Ambrose-Dempster E, Bawn M, Arredondo MC, Chau C, Chandler K, Dobrijevic D, Aparasi TD, Hailes HC, Lettieri P, Liu C, Medda F, Michie S, Miodownik M, Munro B, Purkiss D, Ward JM. The impact and effectiveness of the general public wearing masks to reduce the spread of pandemics in the UK: a multidisciplinary comparison of single-use masks versus reusable face masks. UCL OPEN. ENVIRONMENT 2021; 3:e022. [PMID: 37228803 PMCID: PMC10208332 DOI: 10.14324/111.444/ucloe.000022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/05/2021] [Indexed: 05/27/2023]
Abstract
During the coronavirus (COVID-19) pandemic, the UK government mandated the use of face masks in various public settings and recommended the use of reusable masks to combat shortages of medically graded single-use masks in healthcare. To assist decision-making on the choice of masks for future pandemics, where shortages may not be a contributing factor, the University College London (UCL) Plastic Waste Innovation Hub has carried out a multidisciplinary comparison between single-use and reusable masks based on their anatomy, standalone effectiveness, behavioural considerations, environmental impact and costs. Although current single-use masks have a higher standalone effectiveness against bacteria and viruses, studies show that reusable masks have adequate performance in slowing infection rates of respiratory viruses. Material flow analysis (MFA), life cycle assessment (LCA) and cost comparison show that reusable masks have a lower environmental and economic impact than single-use masks. If every person in the UK uses one single-use mask each day for a year, it will create a total of 124,000 tonnes of waste, 66,000 tonnes of which would be unrecyclable contaminated plastic waste (the masks), with the rest being the recyclable packaging typically used for transportation and distribution of masks. Using reusable masks creates >85% less waste, generates 3.5 times lower impact on climate change and incurs 3.7 times lower costs. Further behavioural research is necessary to understand the extent and current practices of mask use; and how these practices affect mask effectiveness in reducing infection rates. Wearing single-use masks may be preferred over reusable masks due to perceptions of increased hygiene and convenience. Understanding behaviour towards the regular machine-washing of reusable masks for their effective reuse is key to maximise their public health benefits and minimise environmental and economic costs.
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Affiliation(s)
- Ayşe Lisa Allison
- UCL Plastic Waste Innovation Hub, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - Esther Ambrose-Dempster
- UCL Plastic Waste Innovation Hub, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - Maria Bawn
- UCL Plastic Waste Innovation Hub, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - Miguel Casas Arredondo
- UCL Plastic Waste Innovation Hub, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - Charnett Chau
- UCL Plastic Waste Innovation Hub, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - Kimberley Chandler
- UCL Plastic Waste Innovation Hub, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - Dragana Dobrijevic
- UCL Plastic Waste Innovation Hub, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - Teresa Domenech Aparasi
- UCL Plastic Waste Innovation Hub, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - Helen C. Hailes
- UCL Plastic Waste Innovation Hub, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - Paola Lettieri
- UCL Plastic Waste Innovation Hub, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - Chao Liu
- UCL Plastic Waste Innovation Hub, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - Francesca Medda
- UCL Plastic Waste Innovation Hub, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - Susan Michie
- UCL Plastic Waste Innovation Hub, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - Mark Miodownik
- UCL Plastic Waste Innovation Hub, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - Beth Munro
- UCL Plastic Waste Innovation Hub, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - Danielle Purkiss
- UCL Plastic Waste Innovation Hub, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - John M. Ward
- UCL Plastic Waste Innovation Hub, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
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Sisco E, Staymates ME, Watt LM. Net Weights: Visualizing and Quantifying their Contribution to Drug Background Levels in Forensic Laboratories. Forensic Chem 2021; 20. [PMID: 34151050 DOI: 10.1016/j.forc.2020.100259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
While the drug background in forensic laboratories has been quantified, the processes that most contribute to the background have not been extensively researched. This work presents both qualitative visualization and quantitative analysis of the spread of simulant drug particulate during the process of taking net weights. The process was modeled using three masses of powder (0.2 g, 2 g, and 100 g). The net weight process, in which the mixture was poured onto weighing paper, was mimicked and the resulting aerosolized particulate was allowed to settle. Wetted cotton swabs were then used to sample 6.45 cm2 (1 in2) squares extending up to 61 cm (24 in) away from the weigh paper. The swabs were then extracted and quantified using LC-MS/MS and two-dimensional color plots were created to visualize the magnitude of particulate spread. Qualitative flow visualization of the process, accomplished using laser light sheet videography, was also completed to support the quantitative extraction experiments and provide a visual representation of the mechanism of particulate spread. Surface concentrations were found to be highest in the area immediately surrounding the weigh paper, though transport as far as 61 cm (24 in) was observed with all mass loadings. The amount of the material aerosolized and transported on the bench surrounding the weigh paper was dependent upon the mass of material being poured. These results highlight that weighing activities encountered in forensic labs may be a primary contributor to drug background and may be a potential source of inhalation exposure for chemists.
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25
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Kang J, Kim EJ, Choi JH, Hong HK, Han SH, Choi IS, Kim J, Kim JY, Park ES, Choe PG. Minimizing contamination in the use of personal protective equipment: Simulation results through tracking contamination and enhanced protocols. Am J Infect Control 2021; 49:713-720. [PMID: 33159995 PMCID: PMC7832077 DOI: 10.1016/j.ajic.2020.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 12/26/2022]
Abstract
Our enhanced protocols presented a significant reduction in doffing contaminations. Long-sleeve apron as the broad outer layer perfectly protected major contaminations. Tracking contamination showed every touch with outer surfaces brought contamination. Wipes certainly decreased contamination amounts from contaminated glove surfaces. But wipes did not fully clean glove contaminations between fingers and fingertips.
Background Due to variations and the inadequate use of personal protective equipment (PPE), this study aimed to evaluate our enhanced PPE protocols for minimizing doffing contamination. Methods Among 3 PPE kits (simple, Level D, and Level C), 30 participants conducted the first simulation in their adapted way and the second following enhanced protocols. After donning, participants performed a 1-minute simulation of direct care on a patient simulator covered with fluorescent powder. For tracking contamination routes between doffing processes, fluorescent powder contamination was examined with ultraviolet lamps in the darkened room. Results Participants were mostly registered nurses (N = 27, 90%), female (87%), and on average 31.7 years old with 8.5 years of clinical experience. Among 61 total simulations, 32 had at least 1 contamination (52.5%); “Noticeable” level (40%) at the “hands-fingers” and “shirt” body areas were most frequent. For first and second simulations with identical PPE kits, compared to the first with adapted practice, the second with enhanced protocols showed a significant reduction in doffing contamination rates (72.7% vs 22.7%, P = .0009 for both Level C and D; 77.8% vs 27.8%, P = .0027 for Level D). Conclusions Our enhanced protocols could significantly reduce contaminations. More studies are necessary to provide safer PPE protocol options.
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Affiliation(s)
- JaHyun Kang
- College of Nursing, Seoul National University, Seoul, Korea; Research Institute of Nursing Science, Seoul National University, Seoul, Korea.
| | - Eun Jin Kim
- College of Nursing, Seoul National University, Seoul, Korea; Center for Infection Prevention and Control, Seoul National University Hospital, Seoul, Korea
| | - Jeong Hwa Choi
- Infection Control Team, Konkuk University Medical Center, Seoul, Korea
| | - Hae Kyung Hong
- Infection Control Team, Soonchunhyang University Bucheon Hospital, Bucheon-si, Gyeonggi-do, Korea
| | - Si-Hyeon Han
- Infection Control Team, Dankook University Hospital, Cheonan-si, Chungcheongnam-do, Korea
| | - In Soon Choi
- Infection Control Team, Chung-Ang University Hospital, Seoul, Korea
| | - Jinhwa Kim
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jae Yeun Kim
- Infection Control Team, Konyang University Hospital, Daejeon-si, Korea
| | - Eun Suk Park
- Department of Infection Control, Yonsei University Severance Hospital, Seoul, Korea
| | - Pyoeng Gyun Choe
- Center for Infection Prevention and Control, Seoul National University Hospital, Seoul, Korea; Division of Infectious Diseases, Department of Internal Medicine, Seoul National University School of Medicine, Seoul, Korea
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26
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Peddinti BST, Downs SN, Yan J, Smith SD, Ghiladi RA, Mhetar V, Tocchetto R, Griffiths A, Scholle F, Spontak RJ. Rapid and Repetitive Inactivation of SARS-CoV-2 and Human Coronavirus on Self-Disinfecting Anionic Polymers. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:e2003503. [PMID: 34105286 PMCID: PMC7994973 DOI: 10.1002/advs.202003503] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/06/2021] [Indexed: 05/20/2023]
Abstract
While the ongoing COVID-19 pandemic affirms an urgent global need for effective vaccines as second and third infection waves are spreading worldwide and generating new mutant virus strains, it has also revealed the importance of mitigating the transmission of SARS-CoV-2 through the introduction of restrictive social practices. Here, it is demonstrated that an architecturally- and chemically-diverse family of nanostructured anionic polymers yield a rapid and continuous disinfecting alternative to inactivate coronaviruses and prevent their transmission from contact with contaminated surfaces. Operating on a dramatic pH-drop mechanism along the polymer/pathogen interface, polymers of this archetype inactivate the SARS-CoV-2 virus, as well as a human coronavirus surrogate (HCoV-229E), to the minimum detection limit within minutes. Application of these anionic polymers to frequently touched surfaces in medical, educational, and public-transportation facilities, or personal protection equipment, can provide rapid and repetitive protection without detrimental health or environmental complications.
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Affiliation(s)
| | - Sierra N. Downs
- National Emerging Infectious Diseases LaboratoriesBoston University School of MedicineBostonMA02118USA
| | - Jiaqi Yan
- Department of Chemical & Biomolecular EngineeringNorth Carolina State UniversityRaleighNC27695USA
| | - Steven D. Smith
- Corporate Research & DevelopmentThe Procter & Gamble CompanyCincinnatiOH45224USA
| | - Reza A. Ghiladi
- Department of ChemistryNorth Carolina State UniversityRaleighNC27695USA
- Center for Advanced Virus ExperimentationNorth Carolina State UniversityRaleighNC27695USA
| | - Vijay Mhetar
- Kraton Innovation CenterKraton CorporationHoustonTX77084USA
| | | | - Anthony Griffiths
- National Emerging Infectious Diseases LaboratoriesBoston University School of MedicineBostonMA02118USA
| | - Frank Scholle
- Center for Advanced Virus ExperimentationNorth Carolina State UniversityRaleighNC27695USA
- Department of Biological SciencesNorth Carolina State UniversityRaleighNC27695USA
| | - Richard J. Spontak
- Department of Chemical & Biomolecular EngineeringNorth Carolina State UniversityRaleighNC27695USA
- Center for Advanced Virus ExperimentationNorth Carolina State UniversityRaleighNC27695USA
- Department of Materials Science & EngineeringNorth Carolina State UniversityRaleighNC27695USA
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27
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Carrillo-Diaz M, Lacomba-Trejo L, del Valle-González A, Romero-Maroto M, González-Olmo MJ. Anxiety and facial self-contacts: possible impact on COVID-19 transmission in dental practice. BMC Oral Health 2021; 21:200. [PMID: 33879144 PMCID: PMC8056369 DOI: 10.1186/s12903-021-01564-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/12/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose was to analyse the associations between dental and trait anxiety, fear of COVID-19 and the duration and frequency of spontaneous hand-to-face contact (self-contact). METHODS A cross-sectional design was carried out with 128 adult patients from four dental clinics in Madrid, during the confinement, from March 15 to May 15. The patients' movements in the waiting room were monitored with Microsoft Kinect Software, also completed the Trait anxiety subscale of the STAI, the COVID-19 Fear and the S-DAI questionnaire. RESULTS Associations were observed between the duration and frequency of facial, mask and eye contact with trait anxiety and dental fear was determined only by the frequency of this self-contact. Trait anxiety is associated with dental anxiety and with fear of COVID-19. Although facial self-contact is higher in women, it also rises in men as dental fear increases. Moreover, dental anxiety is a good predictor of trait anxiety and the incidence of facial self-contact. CONCLUSIONS Understanding the possible associations between biopsychosocial factors, such as trait anxiety, dental anxiety and self-contact is important. It may help to prevent the spread of COVID-19 in the population as well as enabling the formulation of effective interventions to improve oral health care through the implementation of dental care programmes.
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Affiliation(s)
- María Carrillo-Diaz
- Orthodontic and Pediatric Dentistry Department, Rey Juan Carlos University, Avda de Atenas s/n 28922, Alcorcón, Madrid, Spain
| | - Laura Lacomba-Trejo
- Faculty of Psychology, Department of Personality, Assessment and Psychological Treatments, University of Valencia, Av. Blasco Ibáñez, 21, 46010 Valencia, Spain
| | - Antonio del Valle-González
- Orthodontic and Pediatric Dentistry Department, Rey Juan Carlos University, Avda de Atenas s/n 28922, Alcorcón, Madrid, Spain
| | - Martín Romero-Maroto
- Orthodontic and Pediatric Dentistry Department, Rey Juan Carlos University, Avda de Atenas s/n 28922, Alcorcón, Madrid, Spain
| | - María José González-Olmo
- Orthodontic and Pediatric Dentistry Department, Rey Juan Carlos University, Avda de Atenas s/n 28922, Alcorcón, Madrid, Spain
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28
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Pertile D, Gipponi M, Aprile A, Batistotti P, Ferrari CM, Massobrio A, Soriero D, Epis L, Scabini S. Colorectal Cancer Surgery During the COVID-19 Pandemic: A Single Center Experience. In Vivo 2021; 35:1299-1305. [PMID: 33622934 DOI: 10.21873/invivo.12382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/03/2020] [Accepted: 12/11/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND/AIM A notable re-allocation of healthcare resources and specific clinical and organizational measures have been required to prevent COVID-19 infection among hospitalized patients and healthcare workers. PATIENTS AND METHODS From March 9th to May 9th 2020 we performed colorectal cancer elective surgery on 25 patients: a pre-hospital screening was carried out in order to avoid hospitalization of patients suspected of COVID-19 infection. RESULTS All patients (median age=76 years; range=37-88 years) were considered suitable for admission after telephone triage; the median interval between primary diagnosis and hospital admission was 23.1 days (range=1-55 days). The median hospitalization was 7.8 days (range=4-18 days). One COVID-19-associated death was reported. CONCLUSION Our experience demonstrates that safe colorectal cancer elective surgery can be performed during the pandemic COVID-19. Further consensus and guidelines to prevent diffusion of pandemic diseases among hospitalized patients and healthcare workers still need to be implemented.
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Affiliation(s)
- Davide Pertile
- General and Oncologic Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy;
| | - Marco Gipponi
- Breast Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Aprile
- General and Oncologic Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paola Batistotti
- General and Oncologic Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Carol Marzia Ferrari
- General and Oncologic Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Massobrio
- General and Oncologic Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Domenico Soriero
- General and Oncologic Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lorenzo Epis
- General and Oncologic Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefano Scabini
- General and Oncologic Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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29
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Kasloff SB, Leung A, Strong JE, Funk D, Cutts T. Stability of SARS-CoV-2 on critical personal protective equipment. Sci Rep 2021; 11:984. [PMID: 33441775 DOI: 10.1101/2020.06.11.20128884] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/10/2020] [Indexed: 05/17/2023] Open
Abstract
The spread of COVID-19 in healthcare settings is concerning, with healthcare workers representing a disproportionately high percentage of confirmed cases. Although SARS-CoV-2 virus has been found to persist on surfaces for a number of days, the extent and duration of fomites as a mode of transmission, particularly in healthcare settings, has not been fully characterized. To shed light on this critical matter, the present study provides the first comprehensive assessment of SARS-CoV-2 stability on experimentally contaminated personal protective equipment (PPE) widely used by healthcare workers and the general public. Persistence of viable virus was monitored over 21 days on eight different materials, including nitrile medical examination gloves, reinforced chemical resistant gloves, N-95 and N-100 particulate respirator masks, Tyvek, plastic, cotton, and stainless steel. Unlike previous reports, viable SARS-CoV-2 in the presence of a soil load persisted for up to 21 days on experimentally inoculated PPE, including materials from filtering facepiece respirators (N-95 and N-100 masks) and a plastic visor. Conversely, when applied to 100% cotton fabric, the virus underwent rapid degradation and became undetectable by TCID50 assay within 24 h. These findings underline the importance of appropriate handling of contaminated PPE during and following use in high-risk settings and provide interesting insight into the potential utility of cotton in limiting COVID-19 transmission.
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Affiliation(s)
- Samantha B Kasloff
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, MB, R3E 3R2, Canada
| | - Anders Leung
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, MB, R3E 3R2, Canada
| | - James E Strong
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, MB, R3E 3R2, Canada
- Department of Pediatrics and Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Infectious Diseases and Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Duane Funk
- Department of Anaesthesia and Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Todd Cutts
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, MB, R3E 3R2, Canada.
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30
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Lindsley WG, Blachere FM, Law BF, Beezhold DH, Noti JD. Efficacy of face masks, neck gaiters and face shields for reducing the expulsion of simulated cough-generated aerosols. AEROSOL SCIENCE AND TECHNOLOGY : THE JOURNAL OF THE AMERICAN ASSOCIATION FOR AEROSOL RESEARCH 2021; 55:449-457. [PMID: 35924077 PMCID: PMC9345365 DOI: 10.1080/02786826.2020.1862409] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 05/18/2023]
Abstract
Face masks are recommended to reduce community transmission of SARS-CoV-2. One of the primary benefits of face masks and other coverings is as source control devices to reduce the expulsion of respiratory aerosols during coughing, breathing, and speaking. Face shields and neck gaiters have been proposed as an alternative to face masks, but information about face shields and neck gaiters as source control devices is limited. We used a cough aerosol simulator with a pliable skin headform to propel small aerosol particles (0 to 7 μm) into different face coverings. An N95 respirator blocked 99% (standard deviation (SD) 0.3%) of the cough aerosol, a medical grade procedure mask blocked 59% (SD 6.9%), a 3-ply cotton cloth face mask blocked 51% (SD 7.7%), and a polyester neck gaiter blocked 47% (SD 7.5%) as a single layer and 60% (SD 7.2%) when folded into a double layer. In contrast, the face shield blocked 2% (SD 15.3%) of the cough aerosol. Our results suggest that face masks and neck gaiters are preferable to face shields as source control devices for cough aerosols.
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Affiliation(s)
- William G. Lindsley
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Francoise M. Blachere
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Brandon F. Law
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Donald H. Beezhold
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - John D. Noti
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
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31
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Lindsley WG, Blachere FM, Law BF, Beezhold DH, Noti JD. Efficacy of face masks, neck gaiters and face shields for reducing the expulsion of simulated cough-generated aerosols. AEROSOL SCIENCE AND TECHNOLOGY : THE JOURNAL OF THE AMERICAN ASSOCIATION FOR AEROSOL RESEARCH 2021; 55:449-457. [PMID: 35924077 DOI: 10.1101/2020.10.05.20207241] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Face masks are recommended to reduce community transmission of SARS-CoV-2. One of the primary benefits of face masks and other coverings is as source control devices to reduce the expulsion of respiratory aerosols during coughing, breathing, and speaking. Face shields and neck gaiters have been proposed as an alternative to face masks, but information about face shields and neck gaiters as source control devices is limited. We used a cough aerosol simulator with a pliable skin headform to propel small aerosol particles (0 to 7 μm) into different face coverings. An N95 respirator blocked 99% (standard deviation (SD) 0.3%) of the cough aerosol, a medical grade procedure mask blocked 59% (SD 6.9%), a 3-ply cotton cloth face mask blocked 51% (SD 7.7%), and a polyester neck gaiter blocked 47% (SD 7.5%) as a single layer and 60% (SD 7.2%) when folded into a double layer. In contrast, the face shield blocked 2% (SD 15.3%) of the cough aerosol. Our results suggest that face masks and neck gaiters are preferable to face shields as source control devices for cough aerosols.
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Affiliation(s)
- William G Lindsley
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Francoise M Blachere
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Brandon F Law
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Donald H Beezhold
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - John D Noti
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
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32
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Strauch AL, Brady TM, Niezgoda G, Almaguer CM, Shaffer RE, Fisher EM. Evaluación de la eficacia de las lengüetas en las tiras de la mascarilla autofiltrante para mejorar las técnicas de retirada adecuadas al mismo tiempo que se reduce la transmisión por contacto de los patógenos. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:S35-S43. [PMID: 33822693 DOI: 10.1080/15459624.2021.1877058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
RESUMENLas mascarillas respiratorias autofiltrantes (filtering facepiece respirators, FFR) N95 certificadas por el Instituto Nacional de Seguridad y Salud Laborales (National Institute for Occupational Safety and Health, NIOSH) se utilizan en los centros de atención sanatoria como medida de control para mitigar las exposiciones a partículas atmosféricas infecciosas. Cuando la superficie externa de una FFR se contamina, supone un riesgo de transmisión para el usuario. La guía de los Centros para el Control y Prevención de Enfermedades (Centers for Disease Control and Prevention, CDC) recomienda que el personal sanitario retire las FFR agarrando las tiras en la parte posterior de la cabeza para evitar el contacto con la superficie posiblemente contaminada. Al parecer, la adherencia a la técnica de retirada adecuada es baja, debido a numerosos factores que incluyen la dificultad para ubicar y agarrar las tiras. En este estudio se compara el impacto de lengüetas ubicadas en las tiras de la FFR con el de mascarillas comparativas (sin lengüetas) sobre la retirada adecuada, la facilidad de uso, la comodidad y la reducción de la transmisión de la contaminación al usuario. El uso de un agente fluorescente como rastreador de contactos para explorar la contaminación de las FFR en manos y áreas de la cabeza de 20 sujetos humanos demostró que no hubo diferencia entre las tiras de la FFR con lengüetas y las mascarillas comparativas en el sentido de estimular la retirada adecuada de las mismas (p = 0.48), pero la hizo más fácil (p = 0.04), según indican siete de ocho sujetos que usaron las lengüetas. Siete de 20 sujetos opinaron que las FFR con lengüetas son más fáciles de retirar, mientras que solo dos de 20 sujetos indicaron que las FFR sin lengüetas son más fáciles de retirar. La incomodidad no fue un factor relevante para ninguno de los tipos de tiras de las FFR. Al retirar una FFR con las manos contaminadas, el uso de lengüetas redujo de forma importante la cantidad del rastreador de contactos transferida en comparación con las tiras sin lengüetas (p = 0.012). Las FFR con lengüetas en las tiras están asociadas con la facilidad de la retirada y una transferencia notablemente menor del rastreador de contactos fluorescente.
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Affiliation(s)
- Amanda L Strauch
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
| | - Tyler M Brady
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
| | - George Niezgoda
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
| | - Claudia M Almaguer
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
| | - Ronald E Shaffer
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
| | - Edward M Fisher
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
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Phan LT, Maita D, Mortiz DC, Weber R, Fritzen-Pedicini C, Bleasdale SC, Jones RM. Prácticas de retiro del equipo de protección personal para personal sanitario. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:S53-S60. [PMID: 33822695 DOI: 10.1080/15459624.2021.1877056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
RESUMENCuando se retira el equipo de protección personal (EPP), los patógenos pueden transferirse desde el EPP al cuerpo de los trabajadores de la salud, poniendo en riesgo de exposición e infección tanto a ellos mismos como a sus pacientes. Entre marzo de 2017 y abril de 2018 se observaron las prácticas de retirada del EPP del personal sanitario que atendía pacientes con infecciones respiratorias virales en un hospital de atención de enfermedades agudas. Un observador capacitado registró el desempeño del personal sanitario cuando retiraba el EPP dentro de las habitaciones de los pacientes, utilizando una lista de verificación predefinida basada en las directrices de los Centros para el Control y Prevención de Enfermedades (Centers for Disease Control and Prevention, CDC). Se observaron 162 prácticas de retirada durante el cuidado de 52 pacientes infectados con patógenos virales respiratorios. De estos 52 pacientes, 30 estaban en aislamiento por gota y contacto, 21 en aislamiento por gota y uno en aislamiento de contacto. En general, en 90% de los casos la retirada del EPP observada se realizó de manera incorrecta, ya sea en cuanto a la secuencia de retirada, la técnica de retirada o el uso del EPP apropiado. Los errores más comunes consistieron en quitarse la bata por adelante, retirar la pantalla facial de la mascarilla y tocar superficies y EPP potencialmente contaminados durante el proceso. Las desviaciones del protocolo recomendado para retirar el EPP son comunes y pueden aumentar el potencial de contaminación de la ropa o la piel del personal sanitario después de proporcionar atención. Existe una clara necesidad de cambiar el enfoque utilizado para capacitar al personal en las prácticas de retirada del EPP.
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Affiliation(s)
- Linh T Phan
- Escuela de Salud Pública, Universidad de Illinois en Chicago, Chicago, Illinois
| | - Dayana Maita
- Colegio de Medicina, Universidad de Illinois en Chicago, Chicago, Illinois
| | - Donna C Mortiz
- Colegio de Medicina, Universidad de Illinois en Chicago, Chicago, Illinois
| | - Rachel Weber
- Escuela de Salud Pública, Universidad de Illinois en Chicago, Chicago, Illinois
| | | | - Susan C Bleasdale
- Colegio de Medicina, Universidad de Illinois en Chicago, Chicago, Illinois
| | - Rachael M Jones
- Escuela de Salud Pública, Universidad de Illinois en Chicago, Chicago, Illinois
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Tekalegn Y, Sahiledengle B, Bekele K, Tesemma A, Aseffa T, Teferu Engida Z, Girma A, Tasew A, Zenbaba D, Aman R, Seyoum K, Woldeyohannes D, Legese B. Correct Use of Facemask Among Health Professionals in the Context of Coronavirus Disease (COVID-19). Risk Manag Healthc Policy 2020; 13:3013-3019. [PMID: 33376425 PMCID: PMC7755342 DOI: 10.2147/rmhp.s286217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/17/2020] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Coronavirus disease (COVID-19) mainly spreads through respiratory droplets and close contacts. Wearing a facemask and other personal protective equipment (PPE) is essential in preventing the spread of COVID-19. However, the use of PPE alone does not provide a sufficient level of protection, and correct use and disposal are required. Hence, this study aimed to assess health professionals' practice regarding proper use of facemask in the perspectives of COVID-19 prevention. METHODS A web-based online survey was conducted from June 3, 2020, to August 11, 2020, to assess health professionals' practice regarding correct use of facemask. The survey tool was prepared in Google form and distributed to the health professionals through their emails and social media pages. Data were analyzed using STATA version 14. A descriptive result was reported using frequency tables and bar charts. Factors associated with correct use of facemask were assessed using binary logistic regression model. RESULTS A total of 368 health professionals have participated in this study. All of the participants' work involves direct contact with patients and 98 (26.6%) of them work in direct contact with COVID-19 patients daily. The level of overall correct use of facemask was 10.1% (95% CI: 7.4-13.6). Two hundred fifty-five (69.3%) do not perform hand hygiene before wearing a facemask and 238 (64.7%) do not perform hand hygiene after removing the facemask. Three hundred twenty-three (87.8%) of the study participants reuse disposable facemasks. The odds of practicing correct use of facemask were more than two times higher among health professionals who received training related to personal protective equipment utilization (AOR= 2.2, 95% CI: 1.1-4.5) compared to their counterparts. CONCLUSION This study revealed that health professionals' practice regarding the correct use of facemask in the context of COVID-19 prevention is very low. Receiving training related to proper utilization of personal protective equipment was found to favor the correct use of facemask. In this regard, health authorities should provide training to enable the rational and correct use of facemask among healthcare workers.
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Affiliation(s)
- Yohannes Tekalegn
- Department of Public Health, Madda Walabu University, Goba Referral Hospital, School of Health Sciences, Bale-Goba, Ethiopia
| | - Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University, Goba Referral Hospital, School of Health Sciences, Bale-Goba, Ethiopia
| | - Kebebe Bekele
- Department of Surgery, Madda Walabu University, Goba Referral Hospital, School of Medicine, Bale-Goba, Ethiopia
| | - Abdi Tesemma
- Department of Surgery, Madda Walabu University, Goba Referral Hospital, School of Medicine, Bale-Goba, Ethiopia
| | - Tesfaye Aseffa
- Department of Nursing, Madda Walabu University, Goba Referral Hospital, School of Health Sciences, Bale-Goba, Ethiopia
| | - Zinash Teferu Engida
- Department of Public Health, Madda Walabu University, Goba Referral Hospital, School of Health Sciences, Bale-Goba, Ethiopia
| | - Alemu Girma
- Department of Surgery, Madda Walabu University, Goba Referral Hospital, School of Medicine, Bale-Goba, Ethiopia
| | - Alelign Tasew
- Department of Public Health, Madda Walabu University, Goba Referral Hospital, School of Health Sciences, Bale-Goba, Ethiopia
| | - Demisu Zenbaba
- Department of Public Health, Madda Walabu University, Goba Referral Hospital, School of Health Sciences, Bale-Goba, Ethiopia
| | - Rameto Aman
- Department of Public Health, Madda Walabu University, Goba Referral Hospital, School of Health Sciences, Bale-Goba, Ethiopia
| | - Kenbon Seyoum
- Department of Midwifery, Madda Walabu University, Goba Referral Hospital, School of Health Sciences, Bale-Goba, Ethiopia
| | - Demelash Woldeyohannes
- Department of Public Health, Wachemo University, School of Medicine and Health Sciences, Hossana, Ethiopia
| | - Birhan Legese
- Department of Public Health, Ambo University, School of Medicine and Health Sciences, Ambo, Ethiopia
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35
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Suppan M, Catho G, Robalo Nunes T, Sauvan V, Perez M, Graf C, Pittet D, Harbarth S, Abbas M, Suppan L. A Serious Game Designed to Promote Safe Behaviors Among Health Care Workers During the COVID-19 Pandemic: Development of "Escape COVID-19". JMIR Serious Games 2020; 8:e24986. [PMID: 33242312 PMCID: PMC7717924 DOI: 10.2196/24986] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/12/2020] [Accepted: 11/26/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND As many countries fear and even experience the emergence of a second wave of COVID-19, reminding health care workers (HCWs) and other hospital employees of the critical role they play in preventing SARS-CoV-2 transmission is more important than ever. Building and strengthening the intrinsic motivation of HCWs to apply infection prevention and control (IPC) guidelines to avoid contaminating their colleagues, patients, friends, and relatives is a goal that must be energetically pursued. A high rate of nosocomial infections during the first COVID-19 wave was detected by IPC specialists and further cemented their belief in the need for an engaging intervention that could improve compliance with COVID-19 safe behaviors. OBJECTIVE Our aim was to develop a serious game that would promote IPC practices with a specific focus on COVID-19 among HCWs and other hospital employees. METHODS The first 3 stages of the SERES framework were used to develop this serious game. A brainswarming session between developers and IPC specialists was used to identify the target audience and acquisition objectives. Nicholson's RECIPE mnemonic (reflection, engagement, choice, information, play, exposition) for meaningful gamification was used to guide the general design. A common and simple terminology was used to suit the broad target audience. The game was tested on various platforms (smartphones, tablets, laptops, desktop computers) by different users during each development loop and before its final release. RESULTS The game was designed to target all hospital staff who could be in direct contact with patients within the Geneva University Hospitals. In total, 10 acquisition objectives were defined by IPC specialists and implemented into the game according to the principles of meaningful gamification. A simple storyboard was first created using Microsoft PowerPoint and was progressively refined through multiple iteration loops. Articulate Storyline was then used to create two successive versions of the actual game. In the final version, a unique graphic atmosphere was created with help from a professional graphic designer. Feedback mechanisms were used extensively throughout the game to strengthen key IPC messages. CONCLUSIONS The SERES framework was successfully used to create "Escape COVID-19," a serious game designed to promote safe IPC practices among HCWs and other hospital employees during the COVID-19 pandemic. This game can be obtained free of charge for research and educational purposes. A SCORM (shareable content object reference model) package is available to facilitate results and completion tracking on most current learning management systems.
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Affiliation(s)
- Mélanie Suppan
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Gaud Catho
- Infection Control Program, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Tomás Robalo Nunes
- Infection Control Program, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
- Infectious Diseases Department, Hospital Garcia de Orta, EPE, Almada, Portugal
| | - Valérie Sauvan
- Infection Control Program, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Monique Perez
- Infection Control Program, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Christophe Graf
- Department of Rehabilitation and Geriatrics, Geneva University Hospital, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Program, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Program, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Mohamed Abbas
- Infection Control Program, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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36
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Zhang Z, El-Moghazy AY, Wisuthiphaet N, Nitin N, Castillo D, Murphy BG, Sun G. Daylight-Induced Antibacterial and Antiviral Nanofibrous Membranes Containing Vitamin K Derivatives for Personal Protective Equipment. ACS APPLIED MATERIALS & INTERFACES 2020; 12:49416-49430. [PMID: 33089989 DOI: 10.1021/acsami.0c14883] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
During the development of antibacterial and antiviral materials for personal protective equipment (PPE), daylight active functional polymeric materials containing vitamin K compounds (VKs) and impacts of polymer structures to the functions were investigated. As examples, hydrophobic polyacrylonitrile (PAN) and hydrophilic poly(vinyl alcohol-co-ethylene) (PVA-co-PE) polymers were directly blended with three VK compounds and electrospun into VK-containing nanofibrous membranes (VNFMs). The prepared VNFMs exhibited robust photoactivity in generating reactive oxygen species (ROS) under both daylight (D65, 300-800 nm) and ultraviolet A (UVA, 365 nm) irradiation, resulting in high antimicrobial and antiviral efficiency (>99.9%) within a short exposure time (<90 min). Interestingly, the PVA-co-PE/VK3 VNFM showed higher ROS production rates and better biocidal functions than those of the PAN/VK3 VNFM under the same photoirradiation conditions, indicating that PVA-co-PE is a better matrix polymer material for these functions. Moreover, the prepared PVA-co-PE/VK3 VNFM maintains its powerful microbicidal function even after five times of repeated exposures to bacteria and viruses, showing the stability and reusability of the antimicrobial materials. The fabrication of photoinduced antimicrobial VNFMs may provide new insights into the development of non-toxic and reusable photoinduced antimicrobial materials that could be applied in personal protective equipment with improved biological protections.
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Affiliation(s)
- Zheng Zhang
- Department of Biological and Agricultural Engineering, University of California, Davis, California 95616, United States
| | - Ahmed Y El-Moghazy
- Department of Food Science and Technology, University of California, Davis, California 95616, United States
| | - Nicharee Wisuthiphaet
- Department of Food Science and Technology, University of California, Davis, California 95616, United States
| | - Nitin Nitin
- Department of Biological and Agricultural Engineering, University of California, Davis, California 95616, United States
- Department of Food Science and Technology, University of California, Davis, California 95616, United States
| | - Diego Castillo
- Department of Pathology, Microbiology, and Immunology, University of California, Davis, California 95616, United States
| | - Brian G Murphy
- Department of Pathology, Microbiology, and Immunology, University of California, Davis, California 95616, United States
| | - Gang Sun
- Department of Biological and Agricultural Engineering, University of California, Davis, California 95616, United States
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Xue X, Ball JK, Alexander C, Alexander MR. All Surfaces Are Not Equal in Contact Transmission of SARS-CoV-2. MATTER 2020; 3:1433-1441. [PMID: 33043292 PMCID: PMC7538118 DOI: 10.1016/j.matt.2020.10.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The world faces a severe and acute public health emergency due to the ongoing coronavirus disease 2019 (COVID-19) global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Healthcare workers are in the front line of the COVID-19 outbreak response and are exposed to the risk of SARS-CoV-2 infection daily. Personal protective equipment (PPE) is their main defense against viral contamination; gloves, visors, face masks, and gown materials are designed to eliminate viral transfer from infected patients. Here, we review research investigating the stability of SARS-CoV-2 and similar viruses on surfaces and highlight opportunities for materials that can actively reduce SARS-CoV-2 surface contamination and associated transmission and improve PPE.
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Affiliation(s)
- Xuan Xue
- Division of Advanced Materials and Healthcare Technologies, School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK
| | - Jonathan K Ball
- School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
- Nottingham Biomedical Research Centre, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
- Centre for Research on Global Virus Infections, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Cameron Alexander
- Division of Molecular Therapeutics and Formulation, School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK
| | - Morgan R Alexander
- Division of Advanced Materials and Healthcare Technologies, School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK
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38
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Wundavalli L, Singh S, Singh AR, Satpathy S. How to rapidly design and operationalise PPE donning and doffing areas for a COVID-19 care facility: quality improvement initiative. BMJ Open Qual 2020; 9:bmjoq-2020-001022. [PMID: 32978176 PMCID: PMC7520810 DOI: 10.1136/bmjoq-2020-001022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/27/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction Effective implementation of standard precautions specific to COVID-19 is a challenge for hospitals within the existing constraints of time and resources. Aim To rapidly design and operationalise personal protective equipment (PPE) donning and doffing areas required for a COVID-19 care facility. Methods Literature review was done to identify all issues pertaining to donning and doffing in terms of Donabedian’s structure, process and outcome. Training on donning and doffing was given to hospital staff. Donning and doffing mock drills were held. 5S was used as a tool to set up donning and doffing areas. Instances of donning and doffing were observed for protocol deviations and errors. Plan–do–study–act cycles were conducted every alternate day for 4 weeks. The initiative was reported using Standards for QUality Improvement Reporting Excellence (SQUIRE) guidelines. Results Best practices in donning and doffing were described. Our study recommends a minimum area of 16 m2 each for donning and doffing rooms. Verbally assisted doffing was found most useful than visual prompts. Discussion Challenges included sustaining the structure and process of donning and doffing, varied supplies of PPE which altered sequencing of donning and/or doffing, and training non-healthcare workers such as plumbers, electricians and drivers who were required during emergencies in the facility. Conclusion Our study used evidence-based literature and quality improvement (QI) tools to design and operationalise donning and doffing areas with focus on people, task and environment. Our QI will enable healthcare facilities to rapidly prototype donning and doffing areas in a systematic way.
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Affiliation(s)
- LaxmiTej Wundavalli
- Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Sheetal Singh
- Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Angel Rajan Singh
- Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Sidhartha Satpathy
- Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
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Bergman M, Fisher EM, Heimbuch BK. A Review of Decontamination Methods for Filtering Facepiece Respirators. JOURNAL OF THE INTERNATIONAL SOCIETY FOR RESPIRATORY PROTECTION 2020; 37:71-86. [PMID: 33268915 PMCID: PMC7707143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
During the current COVID-19 infectious disease pandemic, the demand for NIOSH-approved filtering facepiece respirators (FFR) has exceeded supplies and decontamination and reuse of FFRs has been implemented by various user groups. FFR decontamination and reuse is only intended to be implemented as a crisis capacity strategy. This paper provides a review of decontamination procedures in the published literature and calls attention to their benefits and limitations. In most cases, the data are limited to a few FFR models and a limited number of decontamination cycles. Institutions planning to implement a decontamination method must understand its limitations in terms of the degree of inactivation of the intended microorganisms and the treatment's effects on the fit and filtration of the device.
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Affiliation(s)
- Mike Bergman
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, 626 Cochrans Mill Road, Pittsburgh, PA 15236
| | - Edward M. Fisher
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, 626 Cochrans Mill Road, Pittsburgh, PA 15236
| | - Brian K. Heimbuch
- Applied Research Associates, 430 W 5th St, Suite 700, Panama City, FL 32401
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40
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Kpadeh-Rogers Z, Robinson GL, Alserehi H, Morgan DJ, Harris AD, Herrera NB, Rose LJ, Noble-Wang J, Johnson JK, Leekha S. Effect of Glove Decontamination on Bacterial Contamination of Healthcare Personnel Hands. Clin Infect Dis 2020; 69:S224-S227. [PMID: 31517972 PMCID: PMC6761364 DOI: 10.1093/cid/ciz615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We examined the effect of glove decontamination prior to removal on bacterial contamination of healthcare personnel hands in a laboratory simulation study. Glove decontamination reduced bacterial contamination of hands following removal. However, hand contamination still occurred with all decontamination methods, reinforcing the need for hand hygiene following glove removal.
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Affiliation(s)
| | - Gwen L Robinson
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Haleema Alserehi
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Natalia Blanco Herrera
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Laura J Rose
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Judith Noble-Wang
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - J Kristie Johnson
- Department of Pathology, Baltimore.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Surbhi Leekha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
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41
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Drews FA, Mulvey D, Stratford K, Samore MH, Mayer J. Evaluation of a Redesigned Personal Protective Equipment Gown. Clin Infect Dis 2020; 69:S199-S205. [PMID: 31517973 PMCID: PMC6761366 DOI: 10.1093/cid/ciz520] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background In healthcare, the goal of personal protective equipment (PPE) is to protect healthcare personnel (HCP) and patients from body fluids and infectious organisms via contact, droplet, or airborne transmission. The critical importance of using PPE properly is highlighted by 2 potentially fatal viral infections, severe acute respiratory syndrome–associated coronavirus and Ebola virus, where HCP became infected while caring for patients due to errors in the use of PPE. However, PPE in dealing with less dangerous, but highly infectious organisms is important as well. This work proposes a framework to test and evaluate PPE with a focus on gown design. Methods An observational study identified issues with potential for contamination related to gown use. After redesigning the existing gown, a high-fidelity patient simulator study with 40 HCP as participants evaluated the gown redesign using 2 commonly performed tasks. Variables of interest were nonadherence to procedural standards, use problems with the gown during task performance, and usability and cognitive task load ratings of the standard and redesigned gowns. Results While no differences were found in terms of nonadherence and use problems between the current and the redesigned gown, differences in usability and task load ratings suggested that the redesigned gown is perceived more favorably by HCP. Conclusions This work proposes a framework to guide the evaluation of PPE. The results suggest that the current design of the PPE gown can be improved in usability and user satisfaction. Although our data did not find an increase in adherence to protocol when using the redesigned gown, it is likely that higher usability and lower task load could result in higher adherence over longer periods of use.
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Affiliation(s)
- Frank A Drews
- Department of Psychology, Department of Internal Medicine, University of Utah, Salt Lake City.,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City
| | - Diane Mulvey
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City
| | - Kristina Stratford
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City
| | - Matthew H Samore
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City
| | - Jeanmarie Mayer
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City
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42
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Wong MF, Matić Z, Campiglia GC, Zimring CM, Mumma JM, Kraft CS, Casanova LM, Durso FT, Walsh VL, Shah PY, Shane AL, Jacob JT, Dubose JR. Design Strategies for Biocontainment Units to Reduce Risk During Doffing of High-level Personal Protective Equipment. Clin Infect Dis 2020; 69:S241-S247. [PMID: 31517982 PMCID: PMC6743504 DOI: 10.1093/cid/ciz617] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Few data exist to guide the physical design of biocontainment units, particularly the doffing area. This can impact the contamination risk of healthcare workers (HCWs) during doffing of personal protective equipment (PPE). Methods In phase I of our study, we analyzed simulations of a standard patient care task with 56 trained HCWs focusing on doffing of high-level PPE. In phase II, using a rapid cycle improvement approach, we tested different balance aids and redesigned doffing area layouts with 38 students. In phase III, we tested 1 redesigned layout with an additional 10 trained HCWs. We assessed the effectiveness of design changes on improving the HCW performance (measured by occurrence and number of risky behaviors) and reducing the physical and cognitive load by comparing the results from phase I and phase III. Results The physical load was highest when participants were removing their shoe covers without any balance aid; the use of a chair required the lowest physical effort, followed by horizontal and vertical grab bars. In the revised design (phase III), the overall performance of participants improved. There was a significant decrease in the number of HCW risky behaviors (P = .004); 5 risky behaviors were eliminated and 2 others increased. There was a significant decrease in physical load when removing disposable shoe covers (P = .04), and participants reported a similar workload in the redesigned doffing layout (P = .43). Conclusions Through optimizing the design and layout of the doffing space, we reduced risky behaviors of HCWs during doffing of high-level PPE.
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Affiliation(s)
- Maria F Wong
- SimTigrate Design Lab, Georgia State University, and College of Design
| | - Zorana Matić
- SimTigrate Design Lab, Georgia State University, and College of Design
| | | | - Craig M Zimring
- SimTigrate Design Lab, Georgia State University, and College of Design
| | - Joel M Mumma
- School of Psychology, Georgia State University, and Georgia Institute of Technology
| | - Colleen S Kraft
- Division of Infectious Diseases, Georgia State University, and Department of Medicine.,Department of Pathology and Laboratory Medicine, Georgia State University, and Emory University School of Medicine
| | | | - Francis T Durso
- School of Psychology, Georgia State University, and Georgia Institute of Technology
| | - Victoria L Walsh
- Division of Infectious Diseases, Georgia State University, and Department of Medicine
| | - Puja Y Shah
- Division of Infectious Diseases, Georgia State University, and Department of Medicine
| | - Andi L Shane
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, and Children's Healthcare of Atlanta, Georgia
| | - Jesse T Jacob
- Division of Infectious Diseases, Georgia State University, and Department of Medicine
| | - Jennifer R Dubose
- SimTigrate Design Lab, Georgia State University, and College of Design
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43
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Barycka K, Torlinski T, Filipiak KJ, Jaguszewski M, Nadolny K, Szarpak L. Risk of self-contamination among healthcare workers in the COVID-19 pandemic. Am J Emerg Med 2020; 46:751-752. [PMID: 33008700 PMCID: PMC7521207 DOI: 10.1016/j.ajem.2020.09.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/24/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Katarzyna Barycka
- Department of Veterinary Hygiene, Kielce Regional Veterinary Inspectorate, Kielce, Poland; Polish Society of Disaster Medicine, Warsaw, Poland
| | - Tomasz Torlinski
- Department of Anaesthetics and Intensive Care Medicine, University Hospitals Birmingham NHS FT, Birmingham, United Kingdom
| | | | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Klaudiusz Nadolny
- Department of Emergency Medical Service, Higher School of Strategic Planning in Dabrowa Gornicza, Dabrowa Gornicza, Poland
| | - Lukasz Szarpak
- Polish Society of Disaster Medicine, Warsaw, Poland; Maria Sklodowska-Curie Medical Academy, Warsaw, Poland.
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Owen L, Laird K. The role of textiles as fomites in the healthcare environment: a review of the infection control risk. PeerJ 2020; 8:e9790. [PMID: 32904371 PMCID: PMC7453921 DOI: 10.7717/peerj.9790] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Infectious diseases are a significant threat in both healthcare and community settings. Healthcare associated infections (HCAIs) in particular are a leading cause of complications during hospitalisation. Contamination of the healthcare environment is recognised as a source of infectious disease yet the significance of porous surfaces including healthcare textiles as fomites is not well understood. It is currently assumed there is little infection risk from textiles due to a lack of direct epidemiological evidence. Decontamination of healthcare textiles is achieved with heat and/or detergents by commercial or in-house laundering with the exception of healthcare worker uniforms which are laundered domestically in some countries. The emergence of the COVID-19 pandemic has increased the need for rigorous infection control including effective decontamination of potential fomites in the healthcare environment. This article aims to review the evidence for the role of textiles in the transmission of infection, outline current procedures for laundering healthcare textiles and review studies evaluating the decontamination efficacy of domestic and industrial laundering. METHODOLOGY Pubmed, Google Scholar and Web of Science were searched for publications pertaining to the survival and transmission of microorganisms on textiles with a particular focus on the healthcare environment. RESULTS A number of studies indicate that microorganisms survive on textiles for extended periods of time and can transfer on to skin and other surfaces suggesting it is biologically plausible that HCAIs and other infectious diseases can be transmitted directly through contact with contaminated textiles. Accordingly, there are a number of case studies that link small outbreaks with inadequate laundering or infection control processes surrounding healthcare laundry. Studies have also demonstrated the survival of potential pathogens during laundering of healthcare textiles, which may increase the risk of infection supporting the data published on specific outbreak case studies. CONCLUSIONS There are no large-scale epidemiological studies demonstrating a direct link between HCAIs and contaminated textiles yet evidence of outbreaks from published case studies should not be disregarded. Adequate microbial decontamination of linen and infection control procedures during laundering are required to minimise the risk of infection from healthcare textiles. Domestic laundering of healthcare worker uniforms is a particular concern due to the lack of control and monitoring of decontamination, offering a route for potential pathogens to enter the clinical environment. Industrial laundering of healthcare worker uniforms provides greater assurances of adequate decontamination compared to domestic laundering, due to the ability to monitor laundering parameters; this is of particular importance during the COVID-19 pandemic to minimise any risk of SARS-CoV-2 transmission.
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Affiliation(s)
- Lucy Owen
- Infectious Disease Research Group, The Leicester School of Pharmacy, De Montfort University, Leicester, United Kingdom
| | - Katie Laird
- Infectious Disease Research Group, The Leicester School of Pharmacy, De Montfort University, Leicester, United Kingdom
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Hung KC, Chen IW, Sun CK. A safe-distance technique for orotracheal intubation using trachway intubating stylet in the airborne isolation room. Anaesth Crit Care Pain Med 2020; 39:736-737. [PMID: 32798730 PMCID: PMC7426212 DOI: 10.1016/j.accpm.2020.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Kuo-Chuan Hung
- Department of Anaesthesiology, Chi Mei Medical Centre, Tainan, Taiwan
| | - I-Wen Chen
- Department of Anaesthesiology, Chi Mei Medical Centre, Tainan, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung 82445, Taiwan; School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
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46
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Whitworth C, Mu Y, Houston H, Martinez-Smith M, Noble-Wang J, Coulliette-Salmond A, Rose L. Persistence of Bacteriophage Phi 6 on Porous and Nonporous Surfaces and the Potential for Its Use as an Ebola Virus or Coronavirus Surrogate. Appl Environ Microbiol 2020; 86:e01482-20. [PMID: 32591388 PMCID: PMC7440805 DOI: 10.1128/aem.01482-20] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 12/03/2022] Open
Abstract
The infection of health care workers during the 2013 to 2016 Ebola outbreak raised concerns about fomite transmission. In the wake of the coronavirus disease 2019 (COVID-19) pandemic, investigations are ongoing to determine the role of fomites in coronavirus transmission as well. The bacteriophage phi 6 has a phospholipid envelope and is commonly used in environmental studies as a surrogate for human enveloped viruses. The persistence of phi 6 was evaluated as a surrogate for Ebola virus (EBOV) and coronaviruses on porous and nonporous hospital surfaces. Phi 6 was suspended in a body fluid simulant and inoculated onto 1-cm2 coupons of steel, plastic, and two fabric curtain types. The coupons were placed at two controlled absolute humidity (AH) levels: a low AH of 3.0 g/m3 and a high AH of 14.4 g/m3 Phi 6 declined at a lower rate on all materials under low-AH conditions, with a decay rate of 0.06-log10 PFU/day to 0.11-log10 PFU/day, than under the higher AH conditions, with a decay rate of 0.65-log10 PFU/h to 1.42-log10 PFU/day. There was a significant difference in decay rates between porous and nonporous surfaces at both low AH (P < 0.0001) and high AH (P < 0.0001). Under these laboratory-simulated conditions, phi 6 was found to be a conservative surrogate for EBOV under low-AH conditions in that it persisted longer than Ebola virus in similar AH conditions. Additionally, some coronaviruses persist longer than phi 6 under similar conditions; therefore, phi 6 may not be a suitable surrogate for coronaviruses.IMPORTANCE Understanding the persistence of enveloped viruses helps inform infection control practices and procedures in health care facilities and community settings. These data convey to public health investigators that enveloped viruses can persist and remain infective on surfaces, thus demonstrating a potential risk for transmission. Under these laboratory-simulated Western indoor hospital conditions, we assessed the suitability of phi 6 as a surrogate for environmental persistence research related to enveloped viruses, including EBOV and coronaviruses.
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Affiliation(s)
- Carrie Whitworth
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yi Mu
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hollis Houston
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marla Martinez-Smith
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Judith Noble-Wang
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Angela Coulliette-Salmond
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura Rose
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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48
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Abraham JP, Plourde BD, Cheng L. Using heat to kill SARS-CoV-2. Rev Med Virol 2020; 30:e2115. [PMID: 32614102 PMCID: PMC7361064 DOI: 10.1002/rmv.2115] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 11/12/2022]
Abstract
The current coronavirus pandemic has reached global proportions and requires unparalleled collective and individual efforts to slow its spread. One critically important issue is the proper sterilization of physical objects that have been contaminated by the virus. Here, we review the currently existing literature on thermal inactivation of coronavirus (SARS‐CoV‐2) and present preliminary guideless on temperatures and exposure durations required to sterilize. We also compare these temperatures/exposure durations with potential household appliances that may be thought capable of performing sterilization.
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Affiliation(s)
- John P Abraham
- School of Engineering, University of St. Thomas, St. Paul, Minnesota, USA
| | - Brian D Plourde
- School of Engineering, University of St. Thomas, St. Paul, Minnesota, USA
| | - Lijing Cheng
- International Center for Climate and Environment Sciences, Institute of Atmospheric Physics, Chinese Academy of Sciences, Beijing, China
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49
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Fregatti P, Gipponi M, Giacchino M, Sparavigna M, Murelli F, Toni ML, Calabrò MT, Orsino L, Friedman D. Breast Cancer Surgery During the COVID-19 Pandemic: An Observational Clinical Study of the Breast Surgery Clinic at Ospedale Policlinico San Martino - Genoa, Italy. In Vivo 2020; 34:1667-1673. [PMID: 32503827 DOI: 10.21873/invivo.11959] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND COVID-19 pandemic required a marked re-allocation of healthcare resources, including at Breast Units. A patient-tailored program was developed to assess its efficacy regarding prevention of COVID-19 infection among patients with breast cancer undergoing surgery and healthcare workers (HCWs). PATIENTS AND METHODS From March 9th to April 9th 2020, 91 patients were selected for elective surgery by means of: i) Pre-hospital screening aimed at avoiding hospitalization of symptomatic or suspicious COVID-19 patients, and ii) prioritisation of surgical procedure according to specific disease features. RESULTS Eighty-five patients (93.4%) were fit for surgery, while five patients (5.5%) were temporarily excluded through 'telephone triage'; another two patients were excluded at in-hospital triage. A total of 71 out of 85 patients (83.5%) were diagnosed with invasive cancer, most of whom were undergoing breast-conserving surgery (61 out of 85 patients, 71.8%). The mean in-hospital stay was 2.2 days (SD=0.7 days). After hospital discharge, no patient needed re-admission due to post-operative complications; moreover, no COVID-19 infection among patients or HCWs was detected. CONCLUSION Safe breast cancer surgery was accomplished for both patients and HCWs by means of a careful preoperative selection of patients and in-hospital preventative measures. This screening program can be transferred to high-volume Breast Units and it may be useful in implementing European Community recommendations for prevention of COVID-19 infection.
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Affiliation(s)
- Piero Fregatti
- Department Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, Genoa, Italy.,Breast Surgery Clinic, Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Gipponi
- Breast Surgery Clinic, Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Giacchino
- Department Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, Genoa, Italy
| | - Marco Sparavigna
- Department Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, Genoa, Italy
| | - Federica Murelli
- Department Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, Genoa, Italy.,Breast Surgery Clinic, Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Luisa Toni
- Direction Health Professions (DAPS), Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Teresa Calabrò
- Direction Health Professions (DAPS), Ospedale Policlinico San Martino, Genoa, Italy
| | - Lina Orsino
- Direction Health Professions (DAPS), Ospedale Policlinico San Martino, Genoa, Italy
| | - Daniele Friedman
- Department Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, Genoa, Italy.,Breast Surgery Clinic, Ospedale Policlinico San Martino, Genoa, Italy
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Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, Tikka C, Ruotsalainen JH, Kilinc Balci FS. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2020; 5:CD011621. [PMID: 32412096 PMCID: PMC8785899 DOI: 10.1002/14651858.cd011621.pub5] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND In epidemics of highly infectious diseases, such as Ebola, severe acute respiratory syndrome (SARS), or coronavirus (COVID-19), healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Personal protective equipment (PPE) can reduce the risk by covering exposed body parts. It is unclear which type of PPE protects best, what is the best way to put PPE on (i.e. donning) or to remove PPE (i.e. doffing), and how to train HCWs to use PPE as instructed. OBJECTIVES To evaluate which type of full-body PPE and which method of donning or doffing PPE have the least risk of contamination or infection for HCW, and which training methods increase compliance with PPE protocols. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL to 20 March 2020. SELECTION CRITERIA We included all controlled studies that evaluated the effect of full-body PPE used by HCW exposed to highly infectious diseases, on the risk of infection, contamination, or noncompliance with protocols. We also included studies that compared the effect of various ways of donning or doffing PPE, and the effects of training on the same outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed the risk of bias in included trials. We conducted random-effects meta-analyses were appropriate. MAIN RESULTS Earlier versions of this review were published in 2016 and 2019. In this update, we included 24 studies with 2278 participants, of which 14 were randomised controlled trials (RCT), one was a quasi-RCT and nine had a non-randomised design. Eight studies compared types of PPE. Six studies evaluated adapted PPE. Eight studies compared donning and doffing processes and three studies evaluated types of training. Eighteen studies used simulated exposure with fluorescent markers or harmless microbes. In simulation studies, median contamination rates were 25% for the intervention and 67% for the control groups. Evidence for all outcomes is of very low certainty unless otherwise stated because it is based on one or two studies, the indirectness of the evidence in simulation studies and because of risk of bias. Types of PPE The use of a powered, air-purifying respirator with coverall may protect against the risk of contamination better than a N95 mask and gown (risk ratio (RR) 0.27, 95% confidence interval (CI) 0.17 to 0.43) but was more difficult to don (non-compliance: RR 7.5, 95% CI 1.81 to 31.1). In one RCT (59 participants) coveralls were more difficult to doff than isolation gowns (very low-certainty evidence). Gowns may protect better against contamination than aprons (small patches: mean difference (MD) -10.28, 95% CI -14.77 to -5.79). PPE made of more breathable material may lead to a similar number of spots on the trunk (MD 1.60, 95% CI -0.15 to 3.35) compared to more water-repellent material but may have greater user satisfaction (MD -0.46, 95% CI -0.84 to -0.08, scale of 1 to 5). According to three studies that tested more recently introduced full-body PPE ensembles, there may be no difference in contamination. Modified PPE versus standard PPE The following modifications to PPE design may lead to less contamination compared to standard PPE: sealed gown and glove combination (RR 0.27, 95% CI 0.09 to 0.78), a better fitting gown around the neck, wrists and hands (RR 0.08, 95% CI 0.01 to 0.55), a better cover of the gown-wrist interface (RR 0.45, 95% CI 0.26 to 0.78, low-certainty evidence), added tabs to grab to facilitate doffing of masks (RR 0.33, 95% CI 0.14 to 0.80) or gloves (RR 0.22, 95% CI 0.15 to 0.31). Donning and doffing Using Centers for Disease Control and Prevention (CDC) recommendations for doffing may lead to less contamination compared to no guidance (small patches: MD -5.44, 95% CI -7.43 to -3.45). One-step removal of gloves and gown may lead to less bacterial contamination (RR 0.20, 95% CI 0.05 to 0.77) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28) than separate removal. Double-gloving may lead to less viral or bacterial contamination compared to single gloving (RR 0.34, 95% CI 0.17 to 0.66) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28). Additional spoken instruction may lead to fewer errors in doffing (MD -0.9, 95% CI -1.4 to -0.4) and to fewer contamination spots (MD -5, 95% CI -8.08 to -1.92). Extra sanitation of gloves before doffing with quaternary ammonium or bleach may decrease contamination, but not alcohol-based hand rub. Training The use of additional computer simulation may lead to fewer errors in doffing (MD -1.2, 95% CI -1.6 to -0.7). A video lecture on donning PPE may lead to better skills scores (MD 30.70, 95% CI 20.14 to 41.26) than a traditional lecture. Face-to-face instruction may reduce noncompliance with doffing guidance more (odds ratio 0.45, 95% CI 0.21 to 0.98) than providing folders or videos only. AUTHORS' CONCLUSIONS We found low- to very low-certainty evidence that covering more parts of the body leads to better protection but usually comes at the cost of more difficult donning or doffing and less user comfort. More breathable types of PPE may lead to similar contamination but may have greater user satisfaction. Modifications to PPE design, such as tabs to grab, may decrease the risk of contamination. For donning and doffing procedures, following CDC doffing guidance, a one-step glove and gown removal, double-gloving, spoken instructions during doffing, and using glove disinfection may reduce contamination and increase compliance. Face-to-face training in PPE use may reduce errors more than folder-based training. We still need RCTs of training with long-term follow-up. We need simulation studies with more participants to find out which combinations of PPE and which doffing procedure protects best. Consensus on simulation of exposure and assessment of outcome is urgently needed. We also need more real-life evidence. Therefore, the use of PPE of HCW exposed to highly infectious diseases should be registered and the HCW should be prospectively followed for their risk of infection.
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Affiliation(s)
- Jos H Verbeek
- Cochrane Work Review Group, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Blair Rajamaki
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Sharea Ijaz
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Bronagh Blackwood
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Christina Tikka
- Finnish Institute of Occupational Health, TYÖTERVEYSLAITOS, Finland
| | | | - F Selcen Kilinc Balci
- National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Pittsburgh, PA, USA
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