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Goldsworthy A, Olsen M, Koh A, Demaneuf T, Singh G, Almheiri R, Chapman B, Almazrouei S, Ghemrawi R, Senok A, McKirdy S, Alghafri R, Tajouri L. Extended Reality Head-Mounted Displays Are Likely to Pose a Significant Risk in Medical Settings While Current Classification Remains as Non-Critical. Microorganisms 2024; 12:815. [PMID: 38674759 PMCID: PMC11052361 DOI: 10.3390/microorganisms12040815] [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: 03/15/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Extended reality (XR) devices, including virtual and augmented reality head-mounted displays (HMDs), are increasingly utilised within healthcare to provide clinical interventions and education. Currently, XR devices are utilised to assist in reducing pain and improving psychological outcomes for immunocompromised patients in intensive care units, palliative care environments and surgical theatres. However, there is a paucity of research on the risks of infection from such devices in healthcare settings. Identify existing literature providing insights into the infection control risk XR HMDs pose within healthcare facilities and the efficacy of current infection control and cleaning procedures. Three databases (PubMed, Embase and CINAHL) in addition to Google Scholar were systematically searched. A total of seven studies were identified for this review. Microorganisms, including pathogenic bacteria (e.g., Staphylococcus aureus and Pseudomonas aeruginosa), were found to be present on XR HMDs. Published cleaning and infection control protocols designed to disinfect XR HMDs and protect users were heterogeneous in nature. Current cleaning protocols displayed varying levels of efficacy with microbial load affected by multiple factors, including time in use, number of users and XR HMD design features. In healthcare settings, fitting XR HMDs harbouring microorganisms near biological and mucosal entry points presents an infection control risk. An urgent revision of the Spaulding classification is required to ensure flexibility that allows for these devices to be reclassified from 'Non-critical' to 'Semi-Critical' depending on the healthcare setting and patient population (surgery, immunocompromised, burns, etc.). This review identified evidence supporting the presence of microorganisms on XR HMDs. Due to the potential for HMDs to contact mucosal entry points, devices must be re-considered within the Spaulding classification as 'Semi-critical'. The existence of microbial contaminated XR HMDs in high-risk medical settings such as operating wards, intensive care units, emergency departments, labour and delivery wards and clinical areas with immunosuppressed patients requires urgent attention. Public health authorities have a duty of care to develop revised guidelines or new recommendations to ensure efficient sanitation of such devices.
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Affiliation(s)
- Adrian Goldsworthy
- Harry Butler Institute, Murdoch University, Perth, WA 6150, Australia; (A.G.); (B.C.); (S.M.); (R.A.)
- Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, QLD 4226, Australia; (M.O.); (G.S.)
| | - Matthew Olsen
- Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, QLD 4226, Australia; (M.O.); (G.S.)
| | - Andy Koh
- Department of Forensic Medicine, Kindai University, Osaka 589-8511, Japan;
| | | | - Gobinddeep Singh
- Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, QLD 4226, Australia; (M.O.); (G.S.)
| | - Reem Almheiri
- Dubai Police Scientists Council, Dubai Police, Dubai, United Arab Emirates;
| | - Brendan Chapman
- Harry Butler Institute, Murdoch University, Perth, WA 6150, Australia; (A.G.); (B.C.); (S.M.); (R.A.)
| | - Shaima Almazrouei
- International Centre for Forensic Sciences, Dubai Police, Dubai, United Arab Emirates;
| | - Rose Ghemrawi
- Health and Biomedical Research Center, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates;
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Abiola Senok
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates;
- School of Dentistry, Cardiff University, Cardiff CF10 3AT, UK
| | - Simon McKirdy
- Harry Butler Institute, Murdoch University, Perth, WA 6150, Australia; (A.G.); (B.C.); (S.M.); (R.A.)
| | - Rashed Alghafri
- Harry Butler Institute, Murdoch University, Perth, WA 6150, Australia; (A.G.); (B.C.); (S.M.); (R.A.)
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Lotti Tajouri
- Harry Butler Institute, Murdoch University, Perth, WA 6150, Australia; (A.G.); (B.C.); (S.M.); (R.A.)
- Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, QLD 4226, Australia; (M.O.); (G.S.)
- Dubai Police Scientists Council, Dubai Police, Dubai, United Arab Emirates;
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Roberts SC, Havill NL, Flores RM, Hendrix Ii CA, Williams MJ, Feinn RS, Choi SJ, Martinello RA, Marks AM, Murray TS. Disinfection of Virtual Reality Devices in Health Care Settings: In Vitro Assessment and Survey Study. J Med Internet Res 2022; 24:e42332. [PMID: 36269222 PMCID: PMC9756115 DOI: 10.2196/42332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Virtual reality (VR) devices are increasingly used in health care settings. The use among patients has the potential to unintentionally transmit pathogens between patients and hospital staff. No standard operating procedure for disinfection exists to ensure safe use between patients. OBJECTIVE This study aims to determine the efficacy of disinfectants on VR devices in order to ensure safe use in health care settings. METHODS Three types of bacteria were inoculated onto porous and nonporous surfaces of 2 VR devices: the Meta Oculus Quest and Meta Oculus Quest 2. Disinfection was performed using either isopropyl alcohol or alcohol-free quaternary ammonium wipes. A quantitative culture was used to assess the adequacy of disinfection. A survey was separately sent out to VR device technicians at other pediatric health care institutes to compare the methods of disinfection and how they were established. RESULTS Both products achieved adequate disinfection of the treated surfaces; however, a greater log-kill was achieved on nonporous surfaces than on the porous surfaces. Alcohol performed better than quaternary ammonium on porous surfaces. The survey respondents reported a wide variability in disinfection processes with only 1 person reporting an established standard operating procedure. CONCLUSIONS Disinfection can be achieved through the use of either isopropyl alcohol or quaternary ammonium products. Porous surfaces showed lesser log-kill rates than the nonporous surfaces, indicating that the use of an added barrier may be of benefit and should be a point of future research. Given the variability in the disinfection process across health care systems, a standard operating procedure is proposed.
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Affiliation(s)
- Scott C Roberts
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
- Department of Infection Prevention, Yale New Haven Hospital, New Haven, CT, United States
| | - Nancy L Havill
- Department of Infection Prevention, Yale New Haven Hospital, New Haven, CT, United States
| | - Rosa M Flores
- Department of Infection Prevention, Yale New Haven Hospital, New Haven, CT, United States
| | - Curtis Anthony Hendrix Ii
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | | | - Richard S Feinn
- Department of Medical Sciences, Frank H Netter MD School of Medicine, Quinnipiac University, North Haven, CT, United States
| | - Steven J Choi
- Department of Infection Prevention, Yale New Haven Hospital, New Haven, CT, United States
| | - Richard A Martinello
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
- Department of Infection Prevention, Yale New Haven Hospital, New Haven, CT, United States
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
| | - Asher M Marks
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
| | - Thomas S Murray
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
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Advani SD, Sickbert-Bennett E, Moehring R, Cromer A, Lokhnygina Y, Dodds-Ashley E, Kalu IC, DiBiase L, Weber DJ, Anderson DJ. The Disproportionate Impact of Coronavirus Disease 2019 (COVID-19) Pandemic on Healthcare-Associated Infections in Community Hospitals: Need for Expanding the Infectious Disease Workforce. Clin Infect Dis 2022; 76:e34-e41. [PMID: 35997795 PMCID: PMC9452131 DOI: 10.1093/cid/ciac684] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/26/2022] [Accepted: 08/19/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic had a considerable impact on US healthcare systems, straining hospital resources, staff, and operations. However, a comprehensive assessment of the impact on healthcare-associated infections (HAIs) across different hospitals with varying level of infectious disease (ID) physician expertise, resources, and infrastructure is lacking. METHODS This retrospective longitudinal multicenter cohort study included central-line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), Clostridioides difficile infections (CDIs), and ventilator-associated events (VAEs) from 53 hospitals (academic and community) in Southeastern United States from 1 January 2018 to 31 March 2021. Segmented negative binomial regression generalized estimating equations models estimated changes in monthly incidence rates in the baseline (01/2018-02/2020) compared to the pandemic period (03/2020-03/2021, further divided into three pandemic phases). RESULTS CLABSIs and VAEs increased by 24% and 34%, respectively, during the pandemic period. VAEs increased in all phases of the pandemic, while CLABSIs increased in later phases of the pandemic. CDI trend increased by 4.2% per month in the pandemic period. On stratifying the analysis by hospital characteristics, the impact of the pandemic on healthcare-associated infections was more significant in smaller sized and community hospitals. CAUTIs did not change significantly during the pandemic across all hospital types. CONCLUSIONS CLABSIs, VAEs, and CDIs increased significantly during the pandemic, especially in smaller community hospitals, most of which lack ID physician expertise. Future efforts should focus on better understanding challenges faced by community hospitals, strengthening the infection prevention infrastructure, and expanding the ID workforce, particularly to community hospitals.
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Affiliation(s)
- Sonali D Advani
- Corresponding Author: Sonali D. Advani MBBS, MPH, Assistant Professor of Medicine, Division of Infectious Diseases, Duke University School of Medicine, 315 Trent Drive, Hanes House, Room 154, Durham, NC, 27710, United States,
| | - Emily Sickbert-Bennett
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, US
| | - Rebekah Moehring
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, US,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US
| | - Andrea Cromer
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US
| | - Yuliya Lokhnygina
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, US
| | - Elizabeth Dodds-Ashley
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, US,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US
| | - Ibukunoluwa C Kalu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, NC, US
| | - Lauren DiBiase
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, US
| | - David J Weber
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, US
| | - Deverick J Anderson
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, US,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US
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Interactive Exploration of Virtual Heritage by Means of Natural Gestures. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094452] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper is situated at the intersection of using Virtual Reality as a tool for cultural heritage preservation and using gesture interaction-based technology in order to achieve touchless, distant interaction of users with reconstructed artifacts. Various studies emphasize the positive effect on the cultural experience brought on by the use of Virtual Reality in a museum context. We build our approach on this idea, by modeling and reconstructing museum exhibits, both small artifacts and large architectural edifices. We propose and design navigation and interaction scenarios, at the same time taking into account present day limitations regarding social interaction, imposed during the COVID-19 pandemic. By considering the user in the center of the experience and focusing on enabling him/her to adjust the perspective on the visualized artifacts and to freely interact with them through natural gestures, we allow the user to immerse in the virtual environment and interact with the reconstructed artifacts by means of simple hand gestures, with no touch. Finally, we assess the usability and utility of the Virtual Reality system in a questionnaire-based study with 137 participants over a period of 6 months, whose results we discuss in the paper.
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