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

Death by accidental intravenous administration of gasoline

Herein, we present the case of accidental intravenous injection of gasoline in a 62-year-old male who was admitted to a dialysis center for his regular hemodialysis. Due to previous contact with another SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) positive patient, the hemodialysis was conducted in an isolated room. At the end of the procedure, the nurse, wearing all necessary personal protective equipment (PPE), in the intent to clean the dialysis catheter, applied medical gasoline, instead of 0.9% sodium chloride, intravenously to the patient. Soon afterwards, the patient's clinical condition deteriorated, and cardiopulmonary resuscitation was started. Despite the immediate reaction of the medical staff, after two successful cardiopulmonary reanimation and necessary intensive care measures, the patient suffered respiratory, metabolic, and lactic acidosis, hypotension, and tachyarrhythmia and ultimately died 7 h after the incident. The autopsy was conducted under the order of the district attorney. Main autopsy findings were marked congestion; right pleural and pericardial effusion; brain and lung edema; enlarged heart with left ventricle thickening and mild perivascular fibrosis; nephrosclerosis; tubular thyroidization; and interstitial fibrosis with inflammation. Gasoline presence was indisputably proven by conducted toxicology analysis in lung, bile, and brain samples. Traces of gasoline could be noted in the patient's blood sample in comparison to the blood that did not contain gasoline, but it was not possible to confidently claim that gasoline was present in the blood. Based on relevant findings, we concluded that the death of the patient was violent and that the cause of death was acute intoxication by gasoline.

Virological and cytological changes in tears and conjunctiva of patients with COVID-19

Purpose

To analyze the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in tears/conjunctival epithelium and assess the cytomorphological changes in the conjunctival epithelium of coronavirus disease 2019 (COVID-19) patients.

Methods

In this pilot study, patients with moderate to severe COVID-19 were recruited from the COVID ward/intensive care unit of the institute. Tears and conjunctival swabs were collected from COVID-19 patients and sent to the virology laboratory for reverse transcription polymerase chain reaction (RT-PCR) testing. Conjunctival swabs were used to prepare smears, which underwent cytological evaluation and immunocytochemistry for SARS-CoV-2 nucleocapsid protein.

Results

Forty-two patients were included. The mean age of participants was 48.61 (range: 5-75) years. Seven (16.6%) patients tested positive for SARS-CoV-2 ribonucleic acid in tears samples, four (9.5%) of which were positive on conjunctival swab by RT-PCR in the first test. Cytomorphological changes were observed significantly more in smears from patients with positive RT-PCR on tear samples, including bi-/multi-nucleation (p = 0.01), chromatin clearing (p = 0.02), and intra-nuclear inclusions (p < 0.001). One case (3.2%) showed immunopositivity for SARS-CoV-2; this patient had severe disease and the lowest Ct values for tear and conjunctival samples among all positive cases.

Conclusion

Conjunctival smears from patients with COVID-19 revealed cytomorphological alterations, even in the absence of clinically significant ocular infection. However, viral proteins were demonstrated within epithelial cells only rarely, suggesting that although the conjunctival epithelium may serve as a portal for entry, viral replication is possibly rare or short-lived.

Analysis of the Flammability and the Mechanical and Electrostatic Discharge Properties of Selected Personal Protective Equipment Used in Oxygen-Enriched Atmosphere in a State of Epidemic Emergency

Numerous fires occurring in hospitals during the COVID-19 pandemic highlighted the dangers of the existence of an oxygen-enriched atmosphere. At oxygen concentrations higher than 21%, fires spread faster and more vigorously; thus, the safety of healthcare workers and patients is significantly reduced. Personal protective equipment (PPE) made mainly from plastics is combustible and directly affects their safety. The aim of this study was to assess its fire safety in an oxygen-enriched atmosphere. The thermodynamic properties, fire, and burning behavior of the selected PPE were studied, as well as its mechanical and electrostatic discharge properties. Cotton and disposable aprons were classified as combustible according to their LOI values of 17.17% and 17.39%, respectively. Conall Health A (23.37%) and B/C (23.51%) aprons and the Prion Guard suit (24.51%) were classified as self-extinguishing. The cone calorimeter test revealed that the cotton apron ignites the fastest (at 10 s), while for the polypropylene PPE, flaming combustion starts between 42 and 60 s. The highest peak heat release rates were observed for the disposable apron (62.70 kW/m²), Prion Guard suit (61.57 kW/m²), and the cotton apron (62.81 kW/m²). The mean CO yields were the lowest for these PPEs. Although the Conall Health A and B/C aprons exhibited lower pHRR values, their toxic CO yield values were the highest. The most durable fabrics of the highest maximum tensile strength were the cotton apron (592.1 N) and the Prion Guard suit (274.5 N), which also exhibited the lowest electrification capability. Both fabrics showed the best abrasion resistance of 40,000 and 38,000 cycles, respectively. The abrasion values of other fabrics were significantly lower. The research revealed that the usage of PPE made from polypropylene in an oxygen-enriched atmosphere may pose a fire risk.