Health care workers' reported discomfort while wearing filtering face-piece respirators

Health Care Workers' Comfort Ratings for Elastomeric Half-Mask Respirators Versus N95® Filtering Facepiece Respirators During the COVID-19 Pandemic

BACKGROUND

Reusable elastomeric half-mask respirators (EHMR) are an alternative to address shortages of disposable respirators. While respirator discomfort has been noted as a barrier to adherence to wearing an N95 filtering facepiece respirator (FFR) among health care personnel (HCP), few have examined EHMR comfort while providing patient care, which was the purpose of this study.

METHOD

Among a cohort of 183 HCP, we prospectively examined how HCP rated EHMR tolerability using the Respirator Comfort, Wearing Experience, and Function Instrument (R-COMFI) questionnaire at Study Week 2 and Week 10. At the completion of the study (Week-12), HCP compared EHMR comfort with their prior N95 FFR use. Overall R-COMFI scores and three subscales (comfort, wear experience, and function) were examined as well as individual item scores.

FINDINGS

The HCP reported an improved overall R-COMFI score (lower score more favorable, 30.0 vs. 28.7/47, respectively) from Week 2 to Week 10. Many individual item scores improved or remained low over this period, except difficulty communicating with patients and coworkers. The overall R-COMFI scores for the EHMR were more favorable than for the N95 FFR (33.7 vs. 37.4, respectively), with a large proportion of workers indicating their perception that EHMR fit better, provided better protection, and they preferred to wear it in pandemic conditions compared with the N95 FFR.

CONCLUSION/APPLICATION TO PRACTICE

Findings suggest that the EHMR is a feasible respiratory protection device with respect to tolerance. EHMRs can be considered as a possible alternative to the N95 FFR in the health care setting. Future work is needed in the EHMR design to improve communication.

Headache caused by the use of personal protective equipment in healthcare workers during the COVID-19 pandemic period

Objective

Coronavirus 2019 disease (COVID-19), the cause of the ongoing pandemic, is an acute respiratory tract infection, which has made it necessary for healthcare personnel to use protective equipment such as N95 masks, protective goggles and visors. External compression headaches caused by the compression of the pericranial soft tissues by wearing hats, helmets, or goggles (worn during swimming or diving) have been previously described. In our study, we aimed to evaluate the presence and characteristics of personal protective equipment-associated headaches in healthcare workers during the COVID-19 pandemic period and to determine the effects of such headaches.

Materials and methods

A face-to-face questionnaire was delivered to 300 male and female healthcare personnel between the ages of 18-56 working in healthcare units where COVID-19 patients were evaluated and treated. The data from 296 completed questionnaires was evaluated.

Results

We included 296 participants (166 females and 130 males) in our study; the mean age was 33.98 ± 8.52 years (range 18-56). One hundred ninety-six (66.22%) participants indicated that they had new onset personal protective equipment-associated headaches. Percentages of those with newly emergent headaches because of protective equipment were higher in the following participant groups: females (p = 0.045), those with COVID-19 disease history (p < 0.001), and those diagnosed with headaches before the pandemic (p = 0.001).

Conclusion

Our study showed the presence of new-onset headaches associated with personal protective equipment in healthcare workers during the COVID-19 pandemic. Personal protective equipment-related headaches were associated with the following factors: female sex, a history of COVID-19 disease, and the presence of primary headaches diagnosed before the pandemic.

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

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

Evaluating Filtering Facepiece Respirator Wearing-Comfort of Lebanese Red Cross Healthcare Providers

Introduction

The COVID-19 pandemic significantly increased the usage of various types of face masks. In addition, it triggered the rapid manufacture of new production lines of masks to cope with the unprecedented demand to overcome worldwide shortages. Such masks, which were previously used mostly by the health care personnel, became a daily necessity to the greater mainstream population. This rapid and sudden increase in their usage and the fact that new masks' innovations are progressively emerging to meet the growing global shortage requires an ongoing analysis on the factors associated with the fit and comfort while using these masks.

Methods

This paper presents the first translation and validation of the R-COMFI questionnaire to evaluate the comfort of a newly developed filtering face-piece respirator by the research team at the University of Antwerp. The questionnaire, which consists of 3 sections: Discomfort, General wearing experience, and Function, was translated from English to Arabic and involved 43 participants in the Lebanese Red Cross healthcare field based in Lebanon.

Results

The results showed discomfort factors that are mostly related to breathability and sweating caused by mask usage. Additionally, the results revealed that female respondents found the mask significantly less comfortable than male respondents (p-value with the two-tailed test is 0.0319), which confirmed that future validations should consider the concerns of both genders, and validated the R-COMFI translation exercise detailed in this paper.

Discussion

The contribution of this paper can be pinned down into three findings. The first finding is related to the discomfort issues. The second finding highlighted a significant difference in comfort experience between females and males. The last finding is the translation validation of the R-COMFI instrument, which confirmed that the questionnaire can be applied among wider geographical locations.

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

Introduction

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

Methods

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

Results

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

Conclusion

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

Personal protective equipment related skin changes among nurses working in pandemic intensive care unit: A qualitative study

AIM

The respiratory tract is the main transmission way of the SARS-CoV-2 virus and nurses who care for COVID-19 patients in intensive care units (ICUs) are required to constantly use personal protective equipment (PPE) during their daily work. This study aimed to examine the PPE-related skin changes experienced by the nurses working in pandemic ICU during the COVID-19 pandemic.

METHODS

Using a descriptive phenomenological approach, semi-structured interviews were conducted between November 1st and December 25th, 2020, in the pandemic ICU of a training and research hospital in Usak, Turkey. The nurses who worked in the pandemic ICU for at least one week and experienced skin changes due to PPE use were included. Individual interviews were carried out online through video conferencing. Colaizzi's method was used in data analysis by using the ATLAS.ti 8.0.

RESULTS

The main themes were main causes of PPE-related skin changes, its location along with secondary adverse effects, symptomatology, prevention, and therapeutic interventions used for curing PPE-related skin changes. Nurses mostly reported PPE-related skin changes behind their ears, over their nose, cheeks and jaw due to wearing N95 masks and on the forehead due to wearing face shields. Wearing PPE at least 2 h, the type/quality of PPE, and being dehydrated were identified as the common causes.

CONCLUSION

This study provides a deeper understanding into the PPE-related skin change experiences of pandemic ICU nurses and the importance of the quality of the PPE used. It is recommended to enable shortened working shifts and ergonomic PPE materials for ICU nurses.

Physiological Hazard Assessment While Wielding Personal Protective Equipment (PPE) Among Health Care Workers

Introduction

Accurate use of personal protective equipment (PPE) is an essential part of infection prevention and control measures to protect health care workers and patients from various hazardous conditions. Health care workers caring for patients with potentially infectious health conditions are using PPE for long periods of time. However, long-term use of PPE can cause many physiological health hazards among health care workers. So, the current study was carried out to assess the general health problems and dermatological problems experienced by health care workers with PPE use.

Materials and methods

A descriptive cross-sectional survey has been carried out in two selected tertiary care hospitals in central India by recruiting 301 health care workers. Non-probability convenient sampling technique was used to select participants for the study. Sociodemographic Performa and structured questionnaires were used to collect data on demographic characteristics of the participants and various health problems experienced by health care workers with PPE use. Collected data were analyzed using appropriate descriptive and inferential statistics.

Results

The current study reported excessive sweating (86.4%), difficulty in reading (85%), dry mouth (80.7%), and breathing difficulty (74.1%) as the most common problem associated with PPE use. In addition to this, adverse reactions like headache, restlessness, and dizziness were reported by 70.1%, 64.5%, and 50.8%. Indentation and pain on the back of the ears (76.1%), skin soaking (67.1%), and excessive sweating (76.1%) were identified as the most common problems related to N-95 masks, gloves, and coverall use. 

Conclusion

The current study revealed a higher incidence of various health problems with PPE use among health care workers. The findings of the study highlight the importance of developing various guidelines to reduce the negative impact of PPE use and implementing preventive measures to decrease health problems associated with PPE use.

PPE fit of healthcare workers during the COVID-19 pandemic

Historically, PPE (Personal Protective Equipment) has generally been designed around the size and shape of an average European or US white man's face and body. There is little academic evidence to support anecdotal reports that women are at a greater disadvantage than men from ill-fitting PPE. This is especially relevant in healthcare settings where women make up at least 75% of frontline workers. The COVID-19 pandemic has exacerbated problems associated with the fit of PPE that until now have been mainly anecdotal. This research presents results and analysis of a quantitative and qualitative survey concerning the fit of PPE worn by 248 healthcare workers, in a variety of healthcare roles and settings, during the COVID-19 pandemic. The analysis of the survey results showed that women were less likely than men to feel safe carrying out their roles, with only 30.5% of women and 53.3% of men stating that they felt safe all of the time. A statistically significant link is made between women suffering more with poor fit than men with certain categories of PPE (gowns, masks, visors, goggles). Over four times as many women (54.8%) as men (13.3%) reported their surgical gowns being large to some degree and women were nearly twice as likely (53.5%) to experience oversized surgical masks than men (28.6%). However, it was recognized that PPE fit problems are not exclusive to women as many men also do not conform to the underlying shape and size of PPE designs. Survey results indicated that both sexes felt equally hampered due to the fit of their PPE and around a third of both women and men had modified their PPE to address fit issues. Oversized and modified PPE presents its own set of unintended consequences. Following strict processes for doffing and removing PPE is key to virus control but doffing modified PPE can fall outside of these processes, risking cross infection. In addition, wearers of critical items of PPE (such as respirators) currently undergo a "fit test"; however, fit does not reconcile with comfort and over-tightened PPE can cause headaches, discomfort and distraction when worn for long periods. Requirements and fit tests are also not setting-specific; qualitative responses from the survey give an indication that this must be a future consideration.

A feasible route for the design and manufacture of customised respiratory protection through digital facial capture

The World Health Organisation has called for a 40% increase in personal protective equipment manufacturing worldwide, recognising that frontline workers need effective protection during the COVID-19 pandemic. Current devices suffer from high fit-failure rates leaving significant proportions of users exposed to risk of viral infection. Driven by non-contact, portable, and widely available 3D scanning technologies, a workflow is presented whereby a user’s face is rapidly categorised using relevant facial parameters. Device design is then directed down either a semi-customised or fully-customised route. Semi-customised designs use the extracted eye-to-chin distance to categorise users in to pre-determined size brackets established via a cohort of 200 participants encompassing 87.5% of the cohort. The user’s nasal profile is approximated to a Gaussian curve to further refine the selection in to one of three subsets. Flexible silicone provides the facial interface accommodating minor mismatches between true nasal profile and the approximation, maintaining a good seal in this challenging region. Critically, users with outlying facial parameters are flagged for the fully-customised route whereby the silicone interface is mapped to 3D scan data. These two approaches allow for large scale manufacture of a limited number of design variations, currently nine through the semi-customised approach, whilst ensuring effective device fit. Furthermore, labour-intensive fully-customised designs are targeted as those users who will most greatly benefit. By encompassing both approaches, the presented workflow balances manufacturing scale-up feasibility with the diverse range of users to provide well-fitting devices as widely as possible. Novel flow visualisation on a model face is presented alongside qualitative fit-testing of prototype devices to support the workflow methodology.

Oxygen saturation and perceived discomfort with face mask types, in the era of COVID-19: a hospital-based cross-sectional study

Introduction

the COVID-19 pandemic has necessitated the prolonged use of facemasks by healthcare workers. Facemask non-compliance has been largely blamed on discomfort associated with the mask, and apprehension regarding potential health hazards such as asphyxia from mask usage. We sought to evaluate the impact of different respiratory mask types on the comfort of healthcare workers and their arterial oxygen saturation during periods of active clinical duty.

Methods

we conducted a cross-sectional study on healthcare workers donning different types of facemasks in the normal course of duty. Objective non-invasive determination of arterial oxygen saturation of each participant was done using a portable pulse oximeter. Subjective self-assessment of global discomfort was scored by means of a 11-point numerical scale from 0 (no discomfort) to 10 (worst discomfort imaginable). The user's perceived elements of the discomfort were also evaluated. A statistical significance was accepted when P <0.05.

Results

seventy-six healthcare workers completed the study, and wore the masks for periods ranging from 68-480 minutes. The discomfort experienced with the use of the N95 mask; 4.3 (2.0) was greater than the surgical mask; 2.7 (1.8); P=0.001. No significant change in arterial oxygen saturation was observed with the use of either of the mask types. The tight strapping of the N95 mask was perceived as a contributor to the discomfort experienced with mask usage; P=0.009.

Conclusion

the N95 masks imposed greater discomfort than the surgical masks, but neither of the masks impacted on the arterial oxygen saturation of the healthcare workers.

Headache Related to PPE Use during the COVID-19 Pandemic

PURPOSE OF REVIEW

Personal protection equipment (PPE)-associated headache is an unusual secondary headache disorder that predominantly occurs in healthcare workers as a consequence of the donning of protective respirators, face masks and/or eyewear. The appreciation of this entity is important given the significant ramifications upon the occupational health of healthcare workers and could additionally have an impact on persons living with pre-existing headache disorder(s).

RECENT FINDINGS

There has been a renewed interest and recognition of PPE-associated headaches amongst healthcare professionals, largely brought about by the ongoing COVID-19 pandemic which has besieged healthcare systems worldwide. De novo PPE-associated headaches may present with migrainous or tension-type features and can be viewed as a subtype of external compression headache. The prognosis of the disorder is generally favourable, given that most headaches are short-lived without long-term sequalae. Several aetiologies have been postulated to account for the development of these headaches. Notably, these headaches can affect the occupational health and work performance of healthcare workers. In this review, we discuss the epidemiology, clinical characteristics, probable etiopathogenesis, management and prognosis of PPE-associated headaches in the context of the COVID-19 pandemic. Future directions for research and PPE development are proposed.

SARS-CoV-2 and its new variants: a comprehensive review on nanotechnological application insights into potential approaches

SARS-CoV-2 (COVID-19) spreads and develops quickly worldwide as a new global crisis which has left deep socio-economic damage and massive human mortality. This virus accounts for the ongoing outbreak and forces an urgent need to improve antiviral therapeutics and targeted diagnosing tools. Researchers have been working to find a new drug to combat the virus since the outbreak started in late 2019, but there are currently no successful drugs to control the SARS-CoV-2, which makes the situation riskier. Very recently, new variant of SARS-CoV-2 is identified in many countries which make the situation very critical. No successful treatment has yet been shown although enormous international commitment to combat this pandemic and the start of different clinical trials. Nanomedicine has outstanding potential to solve several specific health issues, like viruses, which are regarded a significant medical issue. In this review, we presented an up-to-date drug design strategy against SARS-CoV-2, including the development of novel drugs and repurposed product potentials were useful, and successful drugs discovery is a constant requirement. The use of nanomaterials in treatment against SARS-CoV-2 and their use as carriers for the transport of the most frequently used antiviral therapeutics are discussed systematically here. We also addressed the possibilities of practical applications of nanoparticles to give the status of COVID-19 antiviral systems.

Safety on demand: A case study for the design and manufacturing-on-demand of personal protective equipment for healthcare workers during the COVID-19 pandemic

The COVID-19 pandemic has highlighted the difficulties of countries and healthcare systems in preparing for major emergency situations. In the first month of the pandemic there was a global shortage of personal protective equipment (PPE), thereby causing a rise in infection cases and deaths among healthcare workers (HCWs) in some countries. Moreover, the PPE used in hospitals today is not designed for prolonged use, and causes problems such as headaches and vision difficulties. To address these problems, a case study of an active PPE system for HCWs that is based on 3D printing and the use of ready-made parts is presented here. This case study demonstrates a new approach toward the design and manufacturing of PPE in emergency situations that relies on rapid development and domestic manufacturing of products through 3D printing technologies. The system was developed during the first months of the pandemic under restrictive quarantine conditions, and was fabricated and then tested by HCWs at several hospitals. Apart from sterilization difficulties, the system received positive feedback in user testing.

Assessment of hypoxia and physiological stress evinced by usage of n95 masks among frontline dental healthcare workers in a humid western coastal region of India-A repeated measure observational study

Aim:

To assess the oxygen saturation in DHCWs using N95 and 3 ply surgical masks and determine the presence of any other subjective discomfort in them.

Settings and Design:

A repeated measure observational study conducted at the Tertiary Care Dental Institute situated in Goa, a western coastal region of India recording humid conditions year around.

Methods and Material:

Participants constituted 60 frontline DHCWs wearing N95 masks and 60 DHCWs working in non-clinical setting wearing surgical masks. After completion of a self-administered questionnaire their oxygen saturation and pulse rate were monitored at baseline, 60mins and 120mins using pulse oximetry. Statistical Analysis: Mann Whitney u test compared oxygen saturation between the two groups. Friedmann and Wilcoxon signed rank test with Bonferroni correction computed differences within group at various time intervals. Binary logistic and linear regression was used to compare the study variables with outcome measure. p value was set at < 0.05.

Results and Conclusion:

Oxygen saturation reported a significant drop post one hour of wearing N95 masks which increased in the second hour. Prolonged use of N95 mask in humid environment adds to the body's physiological burden or perceptions of discomfort and exertion. Efforts need to be taken to address this for better compliance to the use of these protective gears.

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

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.

Association of Personal Protective Equipment with De Novo Headaches in Frontline Healthcare Workers during COVID-19 Pandemic: A Cross-Sectional Study

OBJECTIVES

 This study aimed to determine the association of personal protective equipment (PPE) usage with new-onset headaches and exacerbation of pre-existing headache disorders among healthcare workers at the frontlines during coronavirus disease 2019 (COVID-19) pandemic.

MATERIALS AND METHODS

 A descriptive cross-sectional survey was conducted across Pakistan in June-July 2020. The study was approved by Ethical Committee, Armed Forces Institute of Dentistry, Rawalpindi (IRB form no.905/Trg-ABP 1K2). A qualitative questionnaire was developed and was shared via different social networks. The questionnaire was closed when 241 responses were received.

STATISTICAL ANALYSIS

 Descriptive analysis was performed on demographic data. Chi-squared analysis was performed between demographic data and PPE-usage patterns among participants with or without de novo headaches. Univariable and multivariable logistic regression models were used to compare variables with the development of new-onset headaches. Chi-squared test was also performed between demographic data and other factors that may be causing new-onset headaches. A p-value < 0.05 was considered significant.

RESULTS

 A total of 241 healthcare workers participated, of which 68 participants (28.2%) reported de novo headaches since the start of the pandemic. Incidence of pre-existing headaches (odds ratio [OR] = 1.91; 95% confidence interval [CI]: 0.99-0.37; p = 0.049) was associated with new-onset headaches. Post hoc multivariable logistic regression analysis stated that incidence of pre-existing headaches (OR = 1.88; 95% CI: 0.94-3.78; p = 0.75) and age (OR = 2.21; 95% CI: 0.47-10.33; p = 0.36) was independently associated with new-onset PPE-induced headaches but was not statistically significant. Chi-squared analysis showed a statistically significant relationship between other factors (sleep deprivation, emotional stress, etc.) and department of activity, gender, and occupation (p < 0.05).

CONCLUSION

 Healthcare workers with previous history of pre-existing headaches were found to be more susceptible to PPE-induced headaches during COVID-19 pandemic. However, age and the department where the healthcare workers performed may also be risk factors.

Self-reported impact of respirator use on health care worker ability to perform patient care

In a study of 1,152 health care workers surveyed prior to the COVID-19 pandemic, most disagreed that respiratory protective equipment use interferes with patient care but reported that it would affect respirator use compliance if it did. A patient's fear reaction variably influenced self-reported health care worker compliance with respirator use. Strategies to improve protective equipment design may remove potential barriers to respirator use and allow better health care worker-patient relationships.

Personal Protective Equipment: A Pandora's Box

Countries all over the world writhing under the wrath of coronavirus face not only the challenge of protecting their population but the tougher challenge of protecting their healthcare workers (HCWs) dealing with the patient population. This pandemic has put unprecedented pressure on global healthcare systems, with personal protective equipment (PPE) being the most notable one. Apart from the challenge of procurement of PPE, the major challenge is rationalizing the use of PPE in this war against corona virus disease 19 (COVID19). Using PPE comes with its own set of problems such as extreme exhaustion, rashes, inability to consume food, or use washroom which can result in clouding of judgment and breach of infection barrier. Making PPE user-friendly and limiting the interaction of HCW with COVID19 patients coupled with the use of robotics, telemedicine, and other innovations is the need of the hour.

COVID-19: A Call for Physical Scientists and Engineers

The COVID-19 pandemic is one of those global challenges that transcends territorial, political, ideological, religious, cultural, and certainly academic boundaries. Public health and healthcare workers are at the frontline, working to contain and to mitigate the spread of this disease. Although intervening biological and immunological responses against viral infection may seem far from the physical sciences and engineering that typically work with inanimate objects, there actually is much that can-and should-be done to help in this global crisis. In this Perspective, we convert the basics of infectious respiratory diseases and viruses into physical sciences and engineering intuitions, and through this exercise, we present examples of questions, hypotheses, and research needs identified based on clinicians' experiences. We hope researchers in the physical sciences and engineering will proactively study these challenges, develop new hypotheses, define new research areas, and work with biological researchers, healthcare, and public health professionals to create user-centered solutions and to inform the general public, so that we can better address the many challenges associated with the transmission and spread of infectious respiratory diseases.

Headaches Associated With Personal Protective Equipment - A Cross-Sectional Study Among Frontline Healthcare Workers During COVID-19

BACKGROUND

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease of pandemic proportions. Healthcare workers in Singapore working in high-risk areas were mandated to wear personal protective equipment (PPE) such as N95 face mask and protective eyewear while attending to patients.

OBJECTIVES

We sought to determine the risk factors associated with the development of de novo PPE-associated headaches as well as the perceived impact of these headaches on their personal health and work performance. The impact of COVID-19 on pre-existing headache disorders was also investigated.

METHODS

This is a cross-sectional study among healthcare workers at our tertiary institution who were working in high-risk hospital areas during COVID-19. All respondents completed a self-administered questionnaire.

RESULTS

A total of 158 healthcare workers participated in the study. Majority [126/158 (77.8%)] were aged 21-35 years. Participants included nurses [102/158 (64.6%)], doctors [51/158 (32.3%)], and paramedical staff [5/158 (3.2%)]. Pre-existing primary headache diagnosis was present in about a third [46/158 (29.1%)] of respondents. Those based at the emergency department had higher average daily duration of combined PPE exposure compared to those working in isolation wards [7.0 (SD 2.2) vs 5.2 (SD 2.4) hours, P < .0001] or medical ICU [7.0 (SD 2.2) vs 2.2 (SD 0.41) hours, P < .0001]. Out of 158 respondents, 128 (81.0%) respondents developed de novo PPE-associated headaches. A pre-existing primary headache diagnosis (OR = 4.20, 95% CI 1.48-15.40; P = .030) and combined PPE usage for >4 hours per day (OR 3.91, 95% CI 1.35-11.31; P = .012) were independently associated with de novo PPE-associated headaches. Since COVID-19 outbreak, 42/46 (91.3%) of respondents with pre-existing headache diagnosis either "agreed" or "strongly agreed" that the increased PPE usage had affected the control of their background headaches, which affected their level of work performance.

CONCLUSION

Most healthcare workers develop de novo PPE-associated headaches or exacerbation of their pre-existing headache disorders.

A randomised clinical trial to evaluate the safety, fit, comfort of a novel N95 mask in children

Children are more vulnerable to the risks of air pollution, including susceptibility to acquiring chronic diseases in their developing lungs. Despite these, there are no specific masks designed for and tested in children that are available to protect our young from the common particulate air pollutants today. We evaluated safety, fit and comfort of a specially designed paediatric N95 mask with an optional micro ventilator (micro fan, MF) in healthy children aged 7-14 years, in a randomized, two-period crossover design. The subjects' cardiorespiratory physiological measurements were assessed in different states of physical activity under different interventions (mask without and with MF). A total of 106 subjects were recruited between July-August 2016. The use of the mask without MF increased the End-Tidal CO2 (ETCO2) and Fractional concentration of Inspired CO2 (FICO2) at rest and on mild exertion, as expected. The use of the mask with MF brought FICO2 levels comparably closer to baseline levels without the mask for both activities. The mask, with or without the MF, was found to be well fitting, comfortable and safe for use in children at rest and on mild exertion. The N95 mask tested offers a promising start for more studies in the paediatric population.

Design of Web-to-Web Spacing for the Reduced Pressure Drop and Effective Depth Filtration

The study aims at lowering the pressure drop and extending the service life at a given set of filter materials implementing a space between the filter layers. As design factors, the web-to-web space was implemented by inserting either a bulk air gap or porous spacer web between the filter webs. The effect of spacing, either by the air gap or by the spacer web, on the pressure drop reduction was apparent for 4-layer constructions, and the effect was greater at the higher face velocity. The use of spacer web was more effective than the air gap in reducing the pressure drop, because the porous, fluffy spacer web acted as an effective air flow channel between the compact filter layers. The loading capacity was also increased with the spacer web implementation, effectively delaying the clogging point and extending the service life. Employing both experimental investigation and numerical simulation, this study intended to provide a practical design solution to the important problem in the field of air filtration. The results of this study can be used as a practical design guide to reduce pressure drop via depth filtration.

Health care workers' perceptions and reported use of respiratory protective equipment: A qualitative analysis

BACKGROUND

Little is known about health care workers' (HCW) perceptions of, or experiences using, respiratory protective equipment (RPE). We sought to characterize their perceptions and identify reasons underlying inappropriate use.

METHODS

We conducted 12 focus groups with nurses and nursing assistants at 4 medical centers. We analyzed the thematic content of 73 discrete "stories" told by focus group participants.

RESULTS

We identified 5 story types surrounding RPE use: 1) policies are known and seen during work routines; 2) during protocol lapses, use is reinforced through social norms; 3) clinical experiences sometimes supersede protocol adherence; 4) when risk perception is high, we found concern regarding accessing RPE; and 5) HCWs in emergency departments were viewed as not following protocol because risk was ever-present.

DISCUSSION

HCWs were aware of the importance of RPE and protocols for using it, and these supported use when protocol lapses occurred. However, protocol adherence was undermined by clinical experience, perceived risk, and the distinct context of the emergency department where patients continually arrive with incomplete or delayed diagnoses.

CONCLUSIONS

Protocols, visual cues, and social norms contribute to a culture of safety. This culture can be undermined when HCWs experience diagnostic uncertainty or they mistrust the protocol and instead rely on their clinical experiences.

A tolerability assessment of new respiratory protective devices developed for health care personnel: A randomized simulated clinical study

BACKGROUND

U.S. health care personnel (HCP) have reported that some respiratory protective devices (RPD) commonly used in health care have suboptimal tolerability. Between 2012 and 2016, the U.S. National Institute for Occupational Safety and Health, and the Veterans Health Administration collaborated with two respirator manufacturers, Company A and B, to bring new RPD with improved tolerability to the U.S. health care marketplace. The purpose of this study was to compare the tolerability of four new prototype RPD to two models commonly used in U.S. health care delivery.

METHODS

A randomized, simulated workplace study was conducted to compare self-reported tolerability of four new prototype RPD (A1, A2, B1, and B2) worn by HCP and two N95 control respirators commonly used in U.S. health care delivery, the 1870 and 1860, manufactured by 3M Corporation. A new survey tool, the Respirator Comfort, Wearing Experience, and Function Instrument (R-COMFI), developed previously in part for the current study, was used as the primary outcome metric. With a maximum total score of 47, lower R-COMFI scores reflected better self-reported tolerability. Poisson regression analyses were used to estimate prototype relative risks compared to controls.

RESULTS

Conducted between 2014 and 2015 in two inpatient care rooms at the North Florida/South Georgia Veterans Health System, among 383 participants who enrolled, 335 (87.5%) completed the study. Mean total R-COMFI scores for the 3M 1870, 3M 1860, and prototypes A1, A2, B1, and B2 were 8.26, 9.36, 5.79, 7.70, 6.09, and 5.71, respectively. Compared to the 3M 1870, total R-COMFI unadjusted relative risks (RR) and 95 percent confidence intervals (CI) were A1 (RR 0.70, CI 0.60, 0.82), A2 (RR 0.93, CI 0.82, 1.06), B1 (RR 0.74, CI 0.64, 0.85), and B2 (RR 0.69, CI 0.60, 0.80). Compared to the 3M 1860, prototype total R-COMFI unadjusted RR and 95 percent CI were A1 (RR 0.62, CI 0.53, 0.72), A2 (RR 0.82, CI 0.73, 0.93), B1 (RR 0.65, CI 0.57, 0.74), and B2 (RR 0.61, CI 0.53, 0.70). Similarly, models adjusted for demographic characteristics showed that prototypes A1, B1, and B2 significantly improved tolerability scores compared to both controls, while prototype A2 was significantly improved compared to the 3M 1860.

CONCLUSIONS

Compared to the 3M 1870 and 3M 1860, two RPDs commonly used in U.S. health care delivery, tolerability improved for three of four newly developed prototypes in this simulated workplace study. The R-COMFI tool, used in this study to assess tolerability, should be useful for future comparative studies of RPD.

Evaluation of 9 health care organizations' respiratory protection programs and respiratory protective device practices: Implications for adoption of elastomerics

Interview, observational, and discussion group data at 9 health care organizations (HCOs) were collected to better understand elastomeric half-facepiece respirators' (EHFRs) use. We found that HCOs do not routinely use EHFRs as a respiratory protection device (RPD) for health care workers; compliance with other respirator types was less than expected. This finding has important training implications for proper use of all RPDs and EHFRs as an alternative RPD stockpiled for use during a respiratory infectious outbreak.

Development and initial validation of the Respirator Comfort, Wearing Experience, and Function Instrument [R-COMFI]

Filtering face-piece respirators (FFRs) are worn to protect health care personnel from airborne particles; however, clinical studies have demonstrated that FFR adherence is relatively low in some settings, in part, due to discomfort and intolerance. The objective of this study was to develop and initially evaluate the psychometric properties of an instrument designed to measure the comfort and tolerability of FFRs. Instrument items were developed through literature reviews, focus groups, and several iterations of ranking and refining by experts. Psychometric evaluation of the instrument was conducted using Rasch partial credit model (PCM) analysis. Pivot anchoring was used to specify the threshold defining item difficulty; in our analyses, this was the point that participants moved from possessing none of the trait to some of the trait. The final instrument was completed by 165 health care personnel from 3 Veterans Health Administration facilities, and data were analyzed using Rasch PCM. Seven items were removed because they: (1) violated the assumption of independence; (2) were mis-fitting; and/or (3) were deemed not relevant. Category function analysis demonstrated that all categories progressed monotonically. Principal components analysis demonstrated the existence of three subscales (Discomfort, General Wearing Experience, and Function). Final reliability analyses showed that the scale had moderate to high person reliability and high item reliability. The final instrument contained 21 items. Until now, to our knowledge no instrument with evidence supporting its reliability and validity to assess discomfort and tolerance of FFRs among health care personnel has been published. A 21-item psychometrically sound measure of comfort and tolerability of FFRs, Respirator Comfort, Wearing Experience, and Function Instrument (R-COMFI), was developed. The significance of developing such an instrument is that it will help identify respirators that are likely to have better adherence in practice settings. The R-COMFI may be used within and beyond the VA healthcare system as a psychometrically sound instrument to evaluate the comfort and tolerability of respirators, including developmental prototypes.

Assessing the efficacy of tabs on filtering facepiece respirator straps to increase proper doffing techniques while reducing contact transmission of pathogens

NIOSH-certified N95 filtering facepiece respirators (FFRs) are used in healthcare settings as a control measure to mitigate exposures to airborne infectious particles. When the outer surface of an FFR becomes contaminated, it presents a contact transmission risk to the wearer. The Centers for Disease Control and Prevention (CDC) guidance recommends that healthcare workers (HCWs) doff FFRs by grasping the straps at the back of the head to avoid contact with the potentially contaminated surface. Adherence to proper doffing technique is reportedly low due to numerous factors including difficulty in locating and grasping the straps. This study compares the impact of tabs placed on FFR straps to controls (without tabs) on proper doffing, ease of use and comfort, and reduction of transfer of contamination to the wearer. Utilizing a fluorescent agent as a tracer to track contamination from FFRs to hand and head areas of 20 human subjects demonstrated that there was no difference in tabbed FFR straps and controls with respect to promoting proper doffing (p = 0.48), but did make doffing easier (p = 0.04) as indicated by 7 of 8 subjects that used the tabs. Seven of the 20 subjects felt that FFRs with tabs were easier to remove, while only 2 of 20 indicated that FFRs without tabs were easier to remove. Discomfort was not a factor for either FFR strap type. When removing an FFR with contaminated hands, the use of the tabs significantly reduced the amount of tracer transfer compared to straps without tabs (p = 0.012). FFRs with tabs on the straps are associated with ease of doffing and significantly less transfer of the fluorescent tracer.