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Hackett L, Zhang MM, Casey M, Miller J, Smith J, Low C, Aldridge E, Owen PJ, Buntine P. N-95/P2 respirator compliance with fit testing recommendations and respirator satisfaction amongst hospital staff. Infect Dis Health 2024:S2468-0451(24)00023-3. [PMID: 38702235 DOI: 10.1016/j.idh.2024.04.001] [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: 12/14/2023] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Filtering Facepiece Respirators (FFRs) are an important and readily scalable infection control measure; however their effectiveness is ultimately determined by compliance. We aimed to examine staff compliance and satisfaction with wearing the N95/P2 FFRs assigned to them via the standardised fit testing protocol implemented in a single large healthcare network in Victoria, Australia. METHODS In this cross-sectional survey, employees from five hospital campuses who participated in the health networks N95/P2 FFR fit testing process were invited in person to participate in the study. Data were analysed descriptively, after which chi-squared analysis was performed to determine differences between respirator types, gender, and age groups. RESULTS Amongst the 258 staff members surveyed, 28% had either never or only sometimes worn an FFR to which they had been successfully fit tested, and 11% had experienced facial changes that potentially rendered their most recent fit test invalid. More than half (53%) of those surveyed had experienced side effects, the most common being skin irritation and pressure sores. A majority (87%) of staff felt that wearing an FFR had some impact on their ability to perform their duties. Pooled mean self-reported satisfaction ratings were highest for three-panel flat-fold and duckbill models. CONCLUSION 28% of HCWs surveyed described not wearing N-95/P2 FFRs for which they had successfully been fit tested. Reasons for non-compliance remain unclear, but rates of side effects and interference with duties were high. Further research is required to determine and address potential causative factors and ascertain ongoing optimal organisation-level fit test strategies.
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Affiliation(s)
- Liam Hackett
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia.
| | - Melanie Meilun Zhang
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Department of General Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Matthew Casey
- OHS, Emergency Management and Wellbeing, Eastern Health, Melbourne, Victoria, Australia
| | - Joseph Miller
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
| | - Jesse Smith
- Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
| | - Caitlin Low
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Anaesthesia, Pain and Perioperative Medicine, Eastern Health, Melbourne, Victoria, Australia; Department of Anaesthesia, Austin Health, Melbourne, Victoria, Australia
| | - Emogene Aldridge
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
| | - Patrick J Owen
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
| | - Paul Buntine
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
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Pompeii L, Rios J, Kraft CS, Kasbaum M, Benavides E, Patlovich SJ, Ostrosky-Zeichner L, Hornbeck A, McClain C, Fernando RD, Sietsema M, Lane M. Health Care Workers' Comfort Ratings for Elastomeric Half Mask Respirators Versus N95 ® Filtering Facepiece Respirators During the COVID-19 Pandemic. Workplace Health Saf 2024:21650799241238755. [PMID: 38587354 DOI: 10.1177/21650799241238755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
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.
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Affiliation(s)
- Lisa Pompeii
- Cincinnati Children's Hospital Medical Center
- Baylor College of Medicine
- The University of Texas Health Science Center at Houston
| | - Janelle Rios
- The University of Texas Health Science Center at Houston
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Lane M, Pompeii L, Rios J, Benavides E, Kasbaum M, Patlovich S, Ostrosky-Zeichner L, Hornbeck A, McClain C, Fernando R, Sietsema M, Kraft C. Provider experiences with daily use of elastomeric half-mask respirators in health care. Am J Infect Control 2024:S0196-6553(24)00054-3. [PMID: 38278304 DOI: 10.1016/j.ajic.2024.01.015] [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: 10/19/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND During public health emergencies, demand for N95 filtering facepiece respirators (N95 FFRs) can outpace supply. Elastomeric half-mask respirators (EHMRs) are a potential alternative that are reusable and provide the same or higher levels of protection. This study sought to examine the practical aspects of EHMR use among health care personnel (HCP). METHODS Between September and December 2021, 183 HCPs at 2 tertiary referral centers participated in this 3-month EHMR deployment, wearing the EHMR whenever respiratory protection was required according to hospital protocols (ie, when an N95 FFR would typically be worn) and responding to surveys about their experience. RESULTS Participants wore EHMRs typically 1 to 3 hours per shift, reported disinfecting the respirator after 85% of the removals, and reported high confidence in using the EHMR following the study. EHMRs caused minimal interference with patient care tasks, though they did inhibit communication. DISCUSSION HCP who had not previously worn an EHMR were able to wear it as an alternative to an N95 FFR without much-reported interference with their job tasks and with high disinfection compliance. CONCLUSIONS This study highlights the feasibility of the deployment of EHMRs during a public health emergency when an alternative respirator option is necessary.
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Affiliation(s)
- Morgan Lane
- Department of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA.
| | - Lisa Pompeii
- Department of Epidemiology, Genetics, and Environmental Sciences, University of Texas Health Sciences Center, School of Public Health, Houston, TX; Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Janelle Rios
- Department of Epidemiology, Genetics, and Environmental Sciences, University of Texas Health Sciences Center, School of Public Health, Houston, TX
| | - Elisa Benavides
- Department of Epidemiology, Genetics, and Environmental Sciences, University of Texas Health Sciences Center, School of Public Health, Houston, TX
| | - Marie Kasbaum
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Scott Patlovich
- Department of Epidemiology, Genetics, and Environmental Sciences, University of Texas Health Sciences Center, School of Public Health, Houston, TX
| | - Luis Ostrosky-Zeichner
- Department of Epidemiology, Genetics, and Environmental Sciences, University of Texas Health Sciences Center, School of Public Health, Houston, TX
| | - Adam Hornbeck
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA
| | - Caitlin McClain
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA
| | - Rohan Fernando
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA
| | - Margaret Sietsema
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA
| | - Colleen Kraft
- Department of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA
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Harber P, Beckett WS. Health effects of filtering facepiece respirators: Research and clinical implications of comfort, thermal, skin, psychologic, and workplace effects. Am J Ind Med 2023; 66:1017-1032. [PMID: 37702368 DOI: 10.1002/ajim.23535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023]
Abstract
Filtering facepiece respirators (FFR's) such as N95s have become widely used in appropriate settings for personal respiratory protection and are increasingly used beyond workplace settings. Concerns about possible adverse effects have appeared in many publications, particularly since the COVID-19 pandemic led to much more widespread use. This paper synthesizes known effects based upon review of publications in PubMed since 1995, addressing effects other than pulmonary and cardiovascular (reviewed elsewhere). Findings: (1) Subjective discomfort is very frequently reported; this includes general discomfort or organ-system-specific complaints such as respiratory, headache, dermatologic, and heat. Research methods are widely divergent, and we propose a taxonomy to classify such studies by methodology, study population (subjects, experimental vs. observational methodology, comparator, specificity, and timeframe) to facilitate synthesis. (2) Objective measures of increased heat and humidity within the mask are well documented. (3) Frequency and characteristics of dermatologic effects have been insufficiently evaluated. (4) Physical mask designs are varied, making generalizations challenging. (5) More studies of impact on work performance and communication are needed. (6) Studies of effect of FFR design and accompanying training materials on ease and consistency of use are needed.
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Affiliation(s)
- Philip Harber
- Environmental Health Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - William S Beckett
- Mount Auburn Hospital (Emeritus Status), Cambridge, Massachusetts, USA
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Chew NWS, Wong RCC, Djohan AH, Ngiam JN, Chai P, Yeo TC, Tan HC, Sia CH. Association of face mask use with self-reported cardiovascular symptoms during the COVID-19 pandemic. Singapore Med J 2023; 64:609-615. [PMID: 34600453 PMCID: PMC10645009 DOI: 10.11622/smedj.2021140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/07/2021] [Indexed: 11/18/2022]
Abstract
Introduction Countries are mandating the use of face masks to stem the spread of coronavirus disease 2019 (COVID-19). Face mask use has been associated with discomfort due to its effects on thermoregulation, breathing and oxygenation. We evaluated the prevalence and severity of self-reported cardiovascular symptoms before and during face mask use. Methods This was a cross-sectional study of 1,001 participants residing in Singapore, who participated in a self-administered questionnaire between 25 April 2020 and 4 May 2020. Symptom severity before and during mask use, and health-seeking behaviour information were collected. The study outcome was self-reported worsening of cardiovascular symptoms and its association with the type of mask worn, duration of mask worn per day, and intensity of physical activities during mask use. Results The most common symptom reported during mask use was dyspnoea. Independent predictors for self-reported cardiovascular symptoms during mask use were moderate-high physical activity during mask use (odds ratio [OR] 1.634, 95% confidence interval [CI] 1.176-2.270, P = 0.003), duration of mask use for ≥3 h (OR 1.672, 95% CI 1.189-2.352, P = 0.003) and type of mask used, after adjusting for age, sex, healthcare-based worker status and presence of comorbidities. N95 mask was associated with worse symptoms when compared to surgical mask. Participants with ≥3 worsening symptoms or worsening dyspnoea, palpitations, fatigue and dizziness were more likely to seek medical help. Conclusion Face mask use has been proven to be an effective way in curbing COVID-19 transmission. However, participants in this study had concerns regarding its use and these concerns should be urgently addressed to enable mask use policies to be enacted.
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Affiliation(s)
| | - Raymond Ching Chiew Wong
- Department of Cardiology, National University Heart Centre, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Jinghao Nicholas Ngiam
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore
| | - Ping Chai
- Department of Cardiology, National University Heart Centre, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Huay-Cheem Tan
- Department of Cardiology, National University Heart Centre, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Steinhilber B, Seibt R, Gabriel J, Bär M, Dilek Ü, Brandt A, Martus P, Rieger MA. Influence of Face Masks on Physiological and Subjective Response during 130 Min of Simulated Light and Medium Physical Manual Work-An Explorative Study. Healthcare (Basel) 2023; 11:healthcare11091308. [PMID: 37174850 PMCID: PMC10178085 DOI: 10.3390/healthcare11091308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Undesirable side effects from wearing face masks during the ongoing COVID-19 pandemic continue to be discussed and pose a challenge to occupational health and safety when recommending safe application. Only few studies examined the effects of continuously wearing a face mask for more than one hour. Therefore, the influence of wearing a medical mask (MedMask) and a filtering facepiece class II respirator (FFP2) on the physiological and subjective outcomes in the course of 130 min of manual work was exploratively investigated. Physical work load and cardiorespiratory fitness levels were additionally considered as moderating factors. METHODS Twenty-four healthy subjects (12 females) from three different cardiorespiratory fitness levels each performed 130 min of simulated manual work with light and medium physical workload using either no mask, a MedMask or FFP2. Heart rate, transcutaneous oxygen and carbon dioxide partial pressure (PtcO2, PtcCO2) as well as perceived physical exertion and respiratory effort were assessed continuously at discrete time intervals. Wearing comfort of the masks were additionally rated after the working period. RESULTS There was no difference in time-dependent changes of physiological outcomes when using either a MedMask or a FFP2 compared to not wearing a mask. A stronger increase over time in perceived respiratory effort occurred when the face masks were worn, being more prominent for FFP2. Physical workload level and cardiorespiratory fitness level were no moderating factors and higher wearing comfort was rated for the MedMask. CONCLUSION Our results suggest that using face masks during light and medium physical manual work does not induce detrimental side effects. Prolonged wearing episodes appeared to increase respiratory effort, but without affecting human physiology in a clinically relevant way.
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Affiliation(s)
- Benjamin Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany
| | - Robert Seibt
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany
| | - Julia Gabriel
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany
| | - Mona Bär
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany
| | - Ümütyaz Dilek
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany
| | - Adrian Brandt
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, Medical Faculty, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, 72074 Tuebingen, Germany
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Hadinejad F, Morad H, Jahanshahi M, Zarrabi A, Pazoki-Toroudi H, Mostafavi E. A Novel Vision of Reinforcing Nanofibrous Masks with Metal Nanoparticles: Antiviral Mechanisms Investigation. ADVANCED FIBER MATERIALS 2023; 5:1-45. [PMID: 37361103 PMCID: PMC10088653 DOI: 10.1007/s42765-023-00275-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/13/2023] [Indexed: 06/28/2023]
Abstract
Prevention of spreading viral respiratory disease, especially in case of a pandemic such as coronavirus disease of 2019 (COVID-19), has been proved impossible without considering obligatory face mask-wearing protocols for both healthy and contaminated populations. The widespread application of face masks for long hours and almost everywhere increases the risks of bacterial growth in the warm and humid environment inside the mask. On the other hand, in the absence of antiviral agents on the surface of the mask, the virus may have a chance to stay alive and be carried to different places or even put the wearers at risk of contamination when touching or disposing the masks. In this article, the antiviral activity and mechanism of action of some of the potent metal and metal oxide nanoparticles in the role of promising virucidal agents have been reviewed, and incorporation of them in an electrospun nanofibrous structure has been considered an applicable method for the fabrication of innovative respiratory protecting materials with upgraded safety levels. Graphical Abstract
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Affiliation(s)
- Farinaz Hadinejad
- Nanotechnology Research Institute, Faculty of Chemical Engineering, Babol Noushirvani University of Technology, Babol, 4714873113 Iran
| | - Hamed Morad
- Department of Pharmaceutics and Pharmaceutical Nanotechnology, School of Pharmacy, Iran University of Medical Sciences, Tehran, 1475886973 Iran
- Ramsar Campus, Mazandaran University of Medical Sciences, Ramsar, 4691710001 Iran
| | - Mohsen Jahanshahi
- Nanotechnology Research Institute, Faculty of Chemical Engineering, Babol Noushirvani University of Technology, Babol, 4714873113 Iran
| | - Ali Zarrabi
- Department of Biomedical Engineering, Faculty of Engineering and Natural Sciences, Istinye University, Istanbul, 34396 Turkey
| | - Hamidreza Pazoki-Toroudi
- Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, 1449614535 Iran
- Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, 1449614535 Iran
| | - Ebrahim Mostafavi
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305 USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305 USA
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Sarkar MK, Arun Babu T, Dey S, Upparakadiyala R, Lingaiah P, Venugopal V. Front-Line vs Second-Line Healthcare Workers: Susceptibility Prediction to COVID-19 Infection in a Tertiary Care Teaching Institute. Cureus 2023; 15:e37915. [PMID: 37220464 PMCID: PMC10200018 DOI: 10.7759/cureus.37915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/25/2023] Open
Abstract
Background Since the beginning of the novel coronavirus disease in Wuhan city of China in 2019 and its spreading worldwide and taking the form of a pandemic, many healthcare workers (HCWs) were affected by coronavirus disease 2019 (COVID-19) infection. Though we have used many types of personal protective equipment (PPE) kits while taking care of COVID-19 patients, we have seen COVID-19 susceptibility in different working areas were different. The pattern of infection in different working areas depended on HCWs following COVID-19 appropriate behavior. Therefore, we planned to estimate the susceptibility of front-line HCWs and second-line HCWs to getting COVID-19 infection. Aim To determine the risk of COVID-19 in front-line healthcare workers as compared to second-line healthcare workers. Method and materials We planned a retrospective cross-sectional analysis of COVID-19-positive healthcare workers from our institute within six months. Their nature of duty was analyzed and they were divided into two groups: 1) Front-line HCWs were defined as those who were working or who have worked in screening areas of the outpatient department (OPD) or COVID-19 isolation wards within the prior 14 days and provided direct care to patients with confirmed or suspected COVID-19. 2) Second-line HCWs were those who were working in the general OPD or non-COVID-19 areas of our hospital and did not have contact with COVID-19-positive patients. Results A total of 59 HCWs became COVID-19 positive during the study period, 23 as front-line and 36 as second-line HCWs. The mean (SD) duration of work as a front-line worker was 51 and as a second-line worker was 84.4 hours. Fever, cough, body ache, loss of taste, loose stools, palpitation, throat pain, vertigo, vomiting, lung disease, generalized weakness, breathing difficulty, loss of smell, headache, and running nose were present in 21 (35.6%), 15 (25.4%), 9 (15.3%), 10 (16.9%), 3 (5.1%), 5 (8.5%), 5 (8.5%), 1 (1.7%), 4 (6.8%), 2 (3.4%), 11 (18.6%), 4 (6.8%), 9 (15.3%), 6 (10.2%) and 3 (5.1%), respectively. To predict the risk of getting COVID-19 infection in HCWs, binary logistic regression with COVID-19 diagnosis as the output variable was modeled with hours of working in COVID-19 wards as front-line and second-line workers as independent variables. The results showed that there was a 1.18 times increased risk of acquiring the disease for every one-hour excess of working as a front-line worker, whereas, for second-line workers, it was slightly lower, with a 1.11 times increased risk for developing COVID-19 disease with every one hour increase in duty hours. Both these associations were statistically significant (p=0.001 for front-line and 0.006 for second-line HCWs). Conclusion COVID-19 has taught us the importance of COVID-19 appropriate behavior in preventing the spread of respiratory organisms. Our study has shown that both the front-line and second-line HCWs are at increased risk of getting the infection and proper use of a PPE kit or mask can decrease the spread of such respiratory pathogens.
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Affiliation(s)
- Manuj K Sarkar
- General Medicine, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
| | | | - Subhra Dey
- Dentistry, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
| | - Rakesh Upparakadiyala
- General Medicine, All India Institute of Medical Sciences, Mangalagiri, Mangalagiri, IND
| | - Purushotham Lingaiah
- Orthopaedics, All India Institute of Medical Sciences, Mangalagiri, Mangalagiri, IND
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Metin KM, Semercioğlu CS, Hatipoğlu ÇA, Esmer H, Kayretli H, İnan LE, Kınıklı S, Yoldaş TK. Headache caused by the use of personal protective equipment in healthcare workers during the COVID-19 pandemic period. Heliyon 2023; 9:e14493. [PMID: 36942249 PMCID: PMC10008808 DOI: 10.1016/j.heliyon.2023.e14493] [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: 11/15/2022] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
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.
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Affiliation(s)
- Kübra Mehel Metin
- Ministry of Health Ankara Training and Research Hospital, Neurology Clinic, Ankara, Turkey
| | | | - Çiğdem Ataman Hatipoğlu
- Ministry of Health Ankara Training and Research Hospital, İnfectious Diseases Clinic, Ankara, Turkey
| | - Hüseyin Esmer
- Ministry of Health Ankara Training and Research Hospital, İnfectious Diseases Clinic, Ankara, Turkey
| | - Hatice Kayretli
- Ministry of Health Ankara Training and Research Hospital, İnfectious Diseases Clinic, Ankara, Turkey
| | - Levent Ertuğrul İnan
- Ministry of Health Ankara Training and Research Hospital, Neurology Clinic, Ankara, Turkey
| | - Sami Kınıklı
- Ministry of Health Ankara Training and Research Hospital, İnfectious Diseases Clinic, Ankara, Turkey
| | - Tahir Kurtuluş Yoldaş
- Ministry of Health Ankara Training and Research Hospital, Neurology Clinic, Ankara, Turkey
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10
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HALO CleanSpace PAPR evaluation: Communication, respiratory protection, and usability. Infect Control Hosp Epidemiol 2023; 44:295-301. [PMID: 35361300 PMCID: PMC9929704 DOI: 10.1017/ice.2022.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate a relatively new half-face-piece powered air-purifying respirator (PAPR) device called the HALO (CleanSpace). We assessed its communication performance, its degree of respiratory protection, and its usability and comfort level. DESIGN AND SETTING This simulation study was conducted at the simulation center of the Royal Melbourne Hospital. PARTICIPANTS In total, 8 voluntary healthcare workers participated in the study: 4 women and 4 men comprising 3 nursing staff and 5 medical staff. METHODS We performed the modified rhyme test, outlined by the National Institute for Occupational Safety and Health (NIOSH), for the communication assessment. We conducted quantitative fit test and simulated workplace protection factor studies to assess the degree of respiratory protection for participants at rest, during, and immediately after performing chest compression. We also invited the participants to complete a usability and comfort survey. RESULTS The HALO PAPR met the NIOSH minimum standard for speech intelligibility, which was significantly improved with the addition of wireless communication headsets. The HALO provided consistent and adequate level of respiratory protection at rest, during and after chest compression regardless of the device power mode. It was rated favorably for its usability and comfort. However, participants criticized doffing difficulty and perceived communication interference. CONCLUSIONS The HALO device can be considered as an alternative to a filtering face-piece respirator. Thorough doffing training and mitigation planning to improve the device communication performance are recommended. Further research is required to examine its clinical outcomes and barriers that may potentially affect patient or healthcare worker safety.
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Zhuang E, Chen HH, Kolesnik O, Hines SE. Tolerability, User Acceptance and Preference for a Novel Reusable Respirator Among Healthcare Workers. Am J Infect Control 2022:S0196-6553(22)00673-3. [PMID: 36122632 DOI: 10.1016/j.ajic.2022.09.006] [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: 07/26/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The CleanSpace Technology Halo respirator combines a clear face mask and a powered air supply, without belts or hoses. Although providing higher protection than other respirators used in healthcare, user acceptance of this device has not been assessed with validated tools. METHODS We surveyed healthcare workers (HCWs) within a US medical system using Halo respirators in 2021. Subjects completed three surveys over eight weeks, which included the Respirator Comfort, Wearing Experience, and Function Instrument (R-COMFI), a validated tool to assess respirator tolerability. The survey included additional questions about user acceptability and respirator preference. Responses were evaluated for change over time and for significant predictors. RESULTS Of 113 HCWs who completed the initial survey (29% response rate), mean ± SD R-COMFI score was 9.1± 5.1, (scale 0-47, lower = more tolerable) and did not change over time (p = 0.42). Fewer years in healthcare significantly predicted better R-COMFI score (p=0.01). Many users preferred Halo in both usual care (45-52%) and care of patients with COVID-19 (60-64%). DISCUSSION Halo respirators received favorable tolerability scores by HCWs, who often preferred them, especially during care of patients with COVID-19. CONCLUSIONS Given demand for respirator use in healthcare, the innovative design provides higher protection than other respirators with a favorable user experience.
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Affiliation(s)
- Eileen Zhuang
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca Street #200, Baltimore, MD, 21201, USA
| | - Hegang H Chen
- Department of Epidemiology and Public Health, Division of Biostatistics and Bioinformatics, University of Maryland School of Medicine, Howard Hall, Suite 109, 660 W. Redwood Street, Baltimore, MD, 21201, USA
| | - Olga Kolesnik
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca Street #200, Baltimore, MD, 21201, USA
| | - Stella E Hines
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca Street #200, Baltimore, MD, 21201, USA; Department of Medicine, Division of Occupational and Environmental Medicine, University of Maryland School of Medicine, 11 S. Paca Street #200, Baltimore, MD, 21201, USA.
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12
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Levine M, Levine L, Xun H, Gerber A, Antonietti M, Mathew PJ, Singh D. Face Off: 3D-Printed Masks as a Cost-Effective and Reusable Alternative to N95 Respirators: A Feasibility Study. Am J Med 2022; 135:1109-1115. [PMID: 35580720 DOI: 10.1016/j.amjmed.2022.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND One of the best methods for protection against respiratory diseases is the use of an N95 mask. Supply shortages have demonstrated a significant need for effective alternatives to N95 masks. Benefits of 3D-printed respirators over N95s include reduced cost and ease of production, widespread availability, reusability/sterilizability, and customizability. 3D-printed mask designs have been downloaded thousands of times; however, there is little to no data on the efficacy of these potential alternatives. METHODS Three of the most popular 3D-printed respirator designs were modified to allow for the Occupational Safety and Health Administration (OSHA) quantitative fit testing that disperses saline into the ambient air and determines concentrations within the mask during multiple trials. Five volunteers conducted standardized fit tests of these masks, as well as an N95 and a KN95, and the results were compared. RESULTS One of the 3D-printed respirators, low poly COVID-19 face mask respirator (mask 2), achieved a fit factor greater than 100 in every trial, representing sufficient fit according to OSHA protocols. The N95 mask achieved a sufficient fit in 60% of the trials, and none of the remaining masks provided a suitable fit factor reliably according to the OSHA fit test. Further trials showed no change in fit factor when different 3D-printable plastics are used or when a widely available high efficiency particulate air (HEPA) filter was used. CONCLUSION 3D-printed respirators provide a possible alternative to N95 masks to protect against respiratory pathogens such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Fit testing results demonstrate that certain 3D-printed mask designs may exceed the fit of N95 masks.
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Affiliation(s)
- Marc Levine
- Pennsylvania State University College of Medicine, Hershey, Penn.
| | - Lance Levine
- University of Miami Miller School of Medicine, Miami, Fla
| | - Helen Xun
- Johns Hopkins School of Medicine, Baltimore, Md
| | - Adam Gerber
- Edward Via College of Osteopathic Medicine, Auburn, Ala
| | | | - Prakash J Mathew
- University of Miami Division of Plastic, Aesthetic, and Reconstructive Surgery, Miami, Fla
| | - Devinder Singh
- University of Miami Division of Plastic, Aesthetic, and Reconstructive Surgery, Miami, Fla
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Ng I, Kave B, Begg F, Bodas CR, Segal R, Williams D. N95
respirators: quantitative fit test pass rates and usability and comfort assessment by health care workers. Med J Aust 2022; 217:88-93. [PMID: 35645035 PMCID: PMC9347558 DOI: 10.5694/mja2.51585] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 12/02/2022]
Abstract
Objectives To compare the performance of four N95 respirator types with respect to quantitative fit test pass rate and health care worker‐rated usability and comfort. Design, setting, participants Health care workers who participated in the respiratory protection program at the Royal Melbourne Hospital, 1 October 2020 – 31 May 2021. Participants underwent quantitative N95 respirator fit testing (at least three of four types: semi‐rigid cup, flat‐fold cup, duckbill, and three‐panel flat‐fold types), and were invited to complete an online usability and comfort assessment for respirators for which their fit test results were passes. Main outcome measures Fit test pass rate, and user‐rated overall comfort and assessment ratings (five‐point Likert scales), by N95 respirator type. Results A total of 2161 health care workers underwent quantitative fit testing (women, 1586 [73.4%]; nurses, 1271 [58.8%]). The overall fit test pass rates were 65.0% for the semi‐rigid cup respirators (1029/1583 tests), 32.4% for the flat‐fold respirator (660/2035 tests), 59.2% for the duckbill respirators (2005/3387 tests), and 96.4% for the three‐panel flat‐fold respirator (1876/1946 tests). 378 health care workers completed the comfort and usability survey. Overall comfort and assessment ratings each differed by respirator group (P < 0.001); the median overall comfort (4; IQR, 3–4) and overall assessment values (4; IQR, 3–5) were highest for the three‐panel flat‐fold respirator and lowest for the semi‐rigid cup respirators (comfort: 2 [IQR, 1–3]; assessment: 2 [IQR, 2–3]). Conclusions The three‐panel flat‐fold N95 respirator outperformed the three alternative types with regard to fit test pass rate and user‐rated comfort and usability. To maximise respiratory protection for health care workers, these factors should be considered when making respirator procurement decisions.
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Affiliation(s)
- Irene Ng
- The Royal Melbourne Hospital Melbourne VIC
- The University of Melbourne Melbourne VIC
| | | | - Fiona Begg
- The Royal Melbourne Hospital Melbourne VIC
| | | | - Reny Segal
- The Royal Melbourne Hospital Melbourne VIC
- The University of Melbourne Melbourne VIC
| | - Daryl Williams
- The Royal Melbourne Hospital Melbourne VIC
- The University of Melbourne Melbourne VIC
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Hussain SA, Mahmood NMA, Mahmood TMA, Salih NAM, Abdulrahman ZS. Adverse effects associated with the use of N95 mask among health-care workers at the COVID-19 care units: A cross-sectional study in Sulaimani city, Iraq. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:198. [PMID: 36003243 PMCID: PMC9393953 DOI: 10.4103/jehp.jehp_1001_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/09/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Health-care workers have to use the N95 mask as a part of the protection kit during the COVID-19 pandemic. The adverse effects of such practice are not fully elucidated. The study aims to evaluate negative impacts of N95 face masks on health-care personnel at COVID-19 care units. MATERIALS AND METHODS One hundred and twenty-two health-care workers (aged 20-58 years) from various health-care settings in Sulaimani, Iraq, from January to August 2020, were enrolled in this prospective, cross-sectional study. The physiological variables (blood pressure, heart rate, and oxygen saturation) were recorded before putting on the N95 mask and postremoval of the mask. The incidence of adverse effects such as headache, difficulty breathing, redness, irritation, and dizziness were also reported as a number and percent at the end of the work shift. RESULTS There was a statistically significant difference in the physiological parameters after removal of the mask compared with baseline. Only diastolic pressure was significantly lower in those working >6 h when compared to those working 1-6 h. The changes in physiological markers were poorly and nonsignificantly associated with the duration of wearing the mask. Moreover, 67.2%-70.5% of the participants complain of headaches and breathing difficulties, while 45.9%-51.6% reported signs of itching, redness, and irritation. However, health-care workers who put on the face mask >6 h showed signs of headache, breathing difficulties, and itching at the exposed areas higher than those working for 1-6 h. CONCLUSION N95 mask negatively impacts the physiological variables of health-care providers. The adverse effects may lead to excessive exhaustion after long shifts in the intensive care unit during treatment of COVID-19 patients.
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Affiliation(s)
- Saad Abdulrahman Hussain
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Rafidain University College, Baghdad, Iraq
| | - Naza Mohammed Ali Mahmood
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Sulaimani, Kurdistan Region, Iraq
| | - Trefa Mohammed Ali Mahmood
- Department of Periodontics, Orthodontics and Prevention Dentistry, College of Dentistry, University of Sulaimani, Kurdistan Region, Iraq
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Medical masks' and respirators' pattern of use, adverse effects and errors among Portuguese health care professionals during the COVID-19 pandemic: A cross-sectional study. Am J Infect Control 2022; 50:618-623. [PMID: 34653529 PMCID: PMC8511873 DOI: 10.1016/j.ajic.2021.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 12/21/2022]
Abstract
Background During COVID-19 pandemic, a shortage of surgical masks (Mask) and respirators (Resp) was experienced worldwide. We aimed to assess its pattern of use, adverse effects and user errors by Portuguese health care professionals (HCP). Methods A cross-sectional study was conducted through snowball convenience sample, collected by email/ social media to health care organizations. Participants answered an online anonymous survey in March 2021. Results Mean age of 3052 respondents was 42.1 years old, 83.6% were female and 77.8% provided direct health care to COVID-19 patients. Mean time of use per shift was 6-8 hours in 40.8% of the participants. 28.0% reported never changing it during their shift. Resp use (vs Mask) was more associated with discomfort (58.2% vs 26.8%), affecting task performance (41.5 vs 18.9%) and communication (55.0 vs 40.9%), dyspnea (36.0 vs 14.4%), skin rash (37.5 vs 19.4%) and headache (37.5 vs 19.4%). Frequent user errors included touching the front while in use (70.1% Mask vs 66.3% Resp) and omitting hand hygiene before (61.8% Mask vs 55.0% Resp) or after use (61.3% Mask vs 57.0% Resp). Average number of errors was higher for Mask (4.3), than for Resp (3.2) (all: P < .001). Conclusions Most HCP admitted an extended use of Mask/ Resp. Resp were more prone to adverse effects and Mask more prone to errors. Strategies to reinforce good practices should be considered.
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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: 1] [Impact Index Per Article: 0.5] [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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CEYLAN G, EMİR F. Uzun süreli N95 (FFP2) maske kullanımının kan oksijen satürasyonuna ve diş hekimi konforuna etkisinin değerlendirilmesi. ACTA ODONTOLOGICA TURCICA 2022. [DOI: 10.17214/gaziaot.994450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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18
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Aloweni F, Bouchoucha SL, Hutchinson A, Ang SY, Toh HX, Bte Suhari NA, Bte Sunari RN, Lim SH. Health care workers' experience of personal protective equipment use and associated adverse effects during the COVID-19 pandemic response in Singapore. J Adv Nurs 2022; 78:2383-2396. [PMID: 35170075 PMCID: PMC9111733 DOI: 10.1111/jan.15164] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/28/2021] [Accepted: 11/27/2021] [Indexed: 12/15/2022]
Abstract
Aim One of the greatest challenges in responding to the COVID‐19 pandemic is preventing staff exposure and infection by ensuring consistent and effective use of personal protective equipment (PPE). This study explored health care workers' experience of prolonged PPE use in clinical practice settings and their concerns regarding PPE supply, effectiveness and training needs. Design A descriptive cross‐sectional design was adopted in this study. Methods Health care workers (N = 592) from an acute care hospital completed an online survey from July to September 2020 assessing: (i) usage frequencies, side effects and interference with patient care; and (ii) perceptions of access to PPE, likelihood of exposure to infection and adequacy of PPE training. Results PPE‐related side effects were reported by 319 (53.8%) participants, the majority being nurses (88.4%) and those working in high‐risk areas such as the emergency department (39.5%), respiratory wards (acute 22.3% and non‐acute 23.8%) and COVID‐19 isolation ward (13.8%). The average time wearing PPE per shift was 6.8 h (SD 0.39). The most commonly reported symptoms were from donning N95 masks and included: pressure injuries (45.5%), mask‐induced acne (40.4%) and burning/pain (24.5%). Some 31.3% expressed that PPE‐related side effects had negatively affected their work. The odds of having PPE‐associated side effects was higher in women (OR 2.10, 95% CI [1.29–03.42], p = .003) and those working in high‐risk wards (OR 3.12, 95% CI [2.17–4.60], p < .001]. Most (90.1%) agreed that PPE supplies were readily available, sufficient for all (86.1%) and there was sufficient training in correct PPE use (93.6%). Only 13.7% of participants reported being ‘highly confident’ of overall PPE protection. Conclusions Prevention and management of PPE‐related adverse effects is vital to: preserve the integrity of PPE, improve adherence and minimize viral transmission. Impact The high incidence of PPE‐associated pressure injuries and perception that PPE use can interfere with clinical care should inform future development of PPE products, and strategies to better equip health care workers to prevent and manage PPE‐related side effects.
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Affiliation(s)
- Fazila Aloweni
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | - Stéphane L Bouchoucha
- Associate Head of School (International), Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University Geelong, School of Nursing and Midwifery, Victoria, Australia
| | - Ana Hutchinson
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Epworth Health/Deakin University Partnership, School of Nursing and Midwifery Geelong, Victoria, Australia
| | - Shin Yuh Ang
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | - Hui Xian Toh
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | | | | | - Siew Hoon Lim
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
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Li X, Ding P, Deng F, Mao Y, Zhou L, Ding C, Wang Y, Luo Y, Zhou Y, MacIntyre CR, Tang S, Xu D, Shi X. Wearing time and respiratory volume affect the filtration efficiency of masks against aerosols at different sizes. ENVIRONMENTAL TECHNOLOGY & INNOVATION 2022; 25:102165. [PMID: 34926728 PMCID: PMC8665844 DOI: 10.1016/j.eti.2021.102165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/19/2021] [Accepted: 11/25/2021] [Indexed: 05/09/2023]
Abstract
Face masks are critical in preventing the spread of respiratory infections including coronavirus disease 2019 (COVID-19). Different types of masks have distinct filtration efficiencies (FEs) with differential costs and supplies. Here we reported the impact of breathing volume and wearing time on the inward and outward FEs of four different mask types (N95, surgical, single-use, and cloth masks) against various sizes of aerosols. Specifically, 1) Mask type was an important factor affecting the FEs. The FEs of N95 and surgical mask were better than those of single-use mask and cloth mask; 2) As particle size decreased, the FEs tended to reduce. The trend was significantly observed in FEs of aerosols with particle size < 1 μ m ; 3) After wearing N95 and surgical masks for 0, 2, 4, and 8 h, their FEs (%) maintained from 95.75 ± 0.09 to 100 ± 0 range. While a significant decrease in FEs were noticed for single-use masks worn for 8 h and cloth masks worn >2 h under deep breathing (30 L/min); 4) Both inward and outward FEs of N95 and surgical masks were similar, while the outward FEs of single-use and cloth masks were higher than their inward FEs; 5) The FEs under deep breathing was significantly lower than normal breathing with aerosol particle size <1 μ m. In conclusion, our results revealed that masks have a critical role in preventing the spread of aerosol particles by filtering inhalation, and FEs significantly decreased with the increasing of respiratory volume and wearing time. Deep breathing may cause increasing humidity and hence decrease FEs by increasing the airflow pressure. With the increase of wearing time, the adsorption capacity of the filter material tends to be saturated, which may reduce FEs. Findings may be used to provide information for policies regarding the proper use of masks for general public in current and future pandemics.
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Affiliation(s)
- Xia Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Pei Ding
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Fuchang Deng
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Yixin Mao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Lin Zhou
- Dalian Center for Disease Control and Prevention, Dalian, Liaoning 116021, China
| | - Cheng Ding
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Youbin Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Yueyun Luo
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Yakun Zhou
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - C Raina MacIntyre
- The Kirby Institute, Faculty of Medicine, The University of New South Wales, Sydney, 2052, NSW, Australia
| | - Song Tang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Dongqun Xu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
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Elkington PT, Dickinson AS, Mavrogordato MN, Spencer DC, Gillams RJ, De Grazia A, Rosini S, Garay-Baquero DJ, Diment LE, Mahobia N, Mant A, Baynham T, Morgan H. A Personal Respirator to Improve Protection for Healthcare Workers Treating COVID-19 (PeRSo). FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:664259. [PMID: 35047921 PMCID: PMC8757800 DOI: 10.3389/fmedt.2021.664259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/14/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction: SARS-CoV-2 infection is a global pandemic. Personal Protective Equipment (PPE) to protect healthcare workers has been a recurrent challenge in terms of global stocks, supply logistics and suitability. In some settings, around 20% of healthcare workers treating COVID-19 cases have become infected, which leads to staff absence at peaks of the pandemic, and in some cases mortality. Methods: To address shortcomings in PPE, we developed a simple powered air purifying respirator, made from inexpensive and widely available components. The prototype was designed to minimize manufacturing complexity so that derivative versions could be developed in low resource settings with minor modification. Results: The “Personal Respirator – Southampton” (PeRSo) delivers High-Efficiency Particulate Air (HEPA) filtered air from a battery powered fan-filter assembly into a lightweight hood with a clear visor that can be comfortably worn for several hours. Validation testing demonstrates that the prototype removes microbes, avoids excessive CO2 build-up in normal use, and passes fit test protocols widely used to evaluate standard N95/FFP2 and N99/FFP3 face masks. Feedback from doctors and nurses indicate the PeRSo prototype was preferred to standard FFP2 and FFP3 masks, being more comfortable and reducing the time and risk of recurrently changing PPE. Patients report better communication and reassurance as the entire face is visible. Conclusion: Rapid upscale of production of cheaply produced powered air purifying respirators, designed to achieve regulatory approval in the country of production, could protect healthcare workers from infection and improve healthcare delivery during the COVID-19 pandemic.
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Affiliation(s)
- Paul T Elkington
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Institute for Life Sciences, University of Southampton, Southampton, United Kingdom.,NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Alexander S Dickinson
- Institute for Life Sciences, University of Southampton, Southampton, United Kingdom.,Mechanical Engineering Department, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Mark N Mavrogordato
- Mechanical Engineering Department, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Daniel C Spencer
- School of Electronics & Computer Science, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Richard J Gillams
- Institute for Life Sciences, University of Southampton, Southampton, United Kingdom.,School of Electronics & Computer Science, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Antonio De Grazia
- Mechanical Engineering Department, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Sebastian Rosini
- Mechanical Engineering Department, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Diana J Garay-Baquero
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Laura E Diment
- Mechanical Engineering Department, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Nitin Mahobia
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Alexandra Mant
- Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Tom Baynham
- INDO Lighting Ltd., Southampton, United Kingdom
| | - Hywel Morgan
- Institute for Life Sciences, University of Southampton, Southampton, United Kingdom.,School of Electronics & Computer Science, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
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21
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Tagorti G, Kaya B. Genotoxic effect of microplastics and COVID-19: The hidden threat. CHEMOSPHERE 2022; 286:131898. [PMID: 34411929 DOI: 10.1016/j.chemosphere.2021.131898] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/26/2021] [Accepted: 08/12/2021] [Indexed: 05/10/2023]
Abstract
Microplastics (MPs) are ubiquitous anthropogenic contaminants, and their abundance in the entire ecosystem raises the question of how far is the impact of these MPs on the biota, humans, and the environment. Recent research has overemphasized the occurrence, characterization, and direct toxicity of MPs; however, determining and understanding their genotoxic effect is still limited. Thus, the present review addresses the genotoxic potential of these emerging contaminants in aquatic organisms and in human peripheral lymphocytes and identified the research gaps in this area. Several genotoxic endpoints were implicated, including the frequency of micronuclei (MN), nucleoplasmic bridge (NPB), nuclear buds (NBUD), DNA strand breaks, and the percentage of DNA in the tail (%Tail DNA). In addition, the mechanism of MPs-induced genotoxicity seems to be closely associated with reactive oxygen species (ROS) production, inflammatory responses, and DNA repair interference. However, the gathered information urges the need for more studies that present environmentally relevant conditions. Taken into consideration, the lifestyle changes within the COVID-19 pandemic, we discussed the impact of the pandemic on enhancing the genotoxic potential of MPs whether through increasing human exposure to MPs via inappropriate disposal and overconsumption of plastic-based products or by disrupting the defense system owing to unhealthy food and sleep deprivation as well as stress. Overall, this review provided a reference for the genotoxic effect of MPs, their mechanism of action, as well as the contribution of COVID-19 to increase the genotoxic risk of MPs.
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Affiliation(s)
- Ghada Tagorti
- Akdeniz University, Faculty of Sciences, Department of Biology, 07058-Campus, Antalya, Turkey
| | - Bülent Kaya
- Akdeniz University, Faculty of Sciences, Department of Biology, 07058-Campus, Antalya, Turkey.
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22
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Tuñón-Molina A, Takayama K, Redwan EM, Uversky VN, Andrés J, Serrano-Aroca Á. Protective Face Masks: Current Status and Future Trends. ACS APPLIED MATERIALS & INTERFACES 2021; 13:56725-56751. [PMID: 34797624 DOI: 10.1021/acsami.1c12227] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Management of the COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has relied in part on the use of personal protective equipment (PPE). Face masks, as a representative example of PPE, have made a particularly significant contribution. However, most commonly used face masks are made of materials lacking inactivation properties against either SARS-CoV-2 or multidrug-resistant bacteria. Therefore, symptomatic and asymptomatic individuals wearing masks can still infect others due to viable microbial loads escaping from the masks. Moreover, microbial contact transmission can occur by touching the mask, and the discarded masks are an increasing source of contaminated biological waste and a serious environmental threat. For this reason, during the current pandemic, many researchers have worked to develop face masks made of advanced materials with intrinsic antimicrobial, self-cleaning, reusable, and/or biodegradable properties, thereby providing extra protection against pathogens in a sustainable manner. To overview this segment of the remarkable efforts against COVID-19, this review describes the different types of commercialized face masks, their main fabrication methods and treatments, and the progress achieved in face mask development.
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Affiliation(s)
- Alberto Tuñón-Molina
- Biomaterials and Bioengineering Lab, Centro de Investigación Traslacional San Alberto Magno, Universidad Católica de Valencia San Vicente Mártir, c/Guillem de Castro 94, 46001 Valencia, Valencia, Spain
| | - Kazuo Takayama
- Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto 606-8507, Japan
| | - Elrashdy M Redwan
- Faculty of Science, Department of Biological Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Vladimir N Uversky
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida 33612, United States
| | - Juan Andrés
- Department of Physical and Analytical Chemistry, University Jaume I (UJI), 12071 Castellon, Spain
| | - Ángel Serrano-Aroca
- Biomaterials and Bioengineering Lab, Centro de Investigación Traslacional San Alberto Magno, Universidad Católica de Valencia San Vicente Mártir, c/Guillem de Castro 94, 46001 Valencia, Valencia, Spain
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23
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Jafari E, Togha M, Kazemizadeh H, Haghighi S, Nasergivehchi S, Saatchi M, Ariyanfar S. Evaluation of headache associated with personal protective equipment during COVID-19. Brain Behav 2021; 11:e2435. [PMID: 34775688 PMCID: PMC8646814 DOI: 10.1002/brb3.2435] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/11/2021] [Accepted: 10/28/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has created new conditions for medical staff, forcing them to use personal protective equipment (PPE) for an extended duration of time. Headache is a commonly associated side effect of the use of such equipment among healthcare workers. METHOD In this cross-sectional study, 243 frontline healthcare workers at four referral hospitals for COVID-19 were evaluated for the occurrence of headache following the use of PPE and its relationship with blood gas parameters was assessed. RESULTS The average age of participants was 36 ± 8 years. Of these, 75% were women. The prevalence of headache after the use of masks was 72.4%, with the N95 mask being the most commonly reported cause of headache (41%). Among patients, 25.1% developed external pressure, 22.2% migraine, and 15.2% tension-type headaches. Headache was more common in the female gender. Apart from gender, only increased heart rate was significantly associated with headache due to mask use (p = .03 and .00, respectively). The mean heart rate was 97.7 ± 13.68 in participants with headache compared to 65.8 ± 35.63 in those without headache. No significant relationship was found between headache and venous blood gas parameters, including oxygen and carbon dioxide partial pressure. CONCLUSION Headache due to PPE is common and can decrease the efficiency of hospital staff performance. Hence, it is necessary to consider this issue among health center personnel and provide modalities to reduce the risk of headache.
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Affiliation(s)
- Elham Jafari
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Togha
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Kazemizadeh
- Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Haghighi
- Department of Geriatric Medicine, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Nasergivehchi
- Department of Neurology, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Saatchi
- Research Center in Emergency and Disaster Health, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Shadi Ariyanfar
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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24
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Lynch JB, Davitkov P, Anderson DJ, Bhimraj A, Cheng VCC, Guzman-Cottrill J, Dhindsa J, Duggal A, Jain MK, Lee GM, Liang SY, McGeer A, Varghese J, Lavergne V, Murad MH, Mustafa RA, Sultan S, Falck-Ytter Y, Morgan RL. Infectious Diseases Society of America Guidelines on Infection Prevention for Healthcare Personnel Caring for Patients with Suspected or Known COVID-19. Clin Infect Dis 2021:ciab953. [PMID: 34791102 PMCID: PMC8767890 DOI: 10.1093/cid/ciab953] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Since its emergence in late 2019, SARS-CoV-2 continues to pose a risk to healthcare personnel (HCP) and patients in healthcare settings. Although all clinical interactions likely carry some risk of transmission, human actions like coughing and care activities like aerosol-generating procedures likely have a higher risk of transmission. The rapid emergence and global spread of SARS-CoV-2 continues to create significant challenges in healthcare facilities, particularly with shortages of personal protective equipment (PPE) used by HCP. Evidence-based recommendations for what PPE to use in conventional, contingency, and crisis standards of care continue to be needed. Where evidence is lacking, the development of specific research questions can help direct funders and investigators. OBJECTIVE Develop evidence-based rapid guidelines intended to support HCP in their decisions about infection prevention when caring for patients with suspected or known COVID-19. METHODS IDSA formed a multidisciplinary guideline panel including frontline clinicians, infectious disease specialists, experts in infection control, and guideline methodologists with representation from the disciplines of public health, medical microbiology, pediatrics, critical care medicine and gastroenterology. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. RESULTS The IDSA guideline panel agreed on eight recommendations, including two updated recommendations and one new recommendation added since the first version of the guideline. Narrative summaries of other interventions undergoing evaluations are also included. CONCLUSIONS Using a combination of direct and indirect evidence, the panel was able to provide recommendations for eight specific questions on the use of PPE for HCP providing care for patients with suspected or known COVID-19. Where evidence was lacking, attempts were made to provide potential avenues for investigation. There remain significant gaps in the understanding of the transmission dynamics of SARS-CoV-2 and PPE recommendations may need to be modified in response to new evidence. These recommendations should serve as a minimum for PPE use in healthcare facilities and do not preclude decisions based on local risk assessments or requirements of local health jurisdictions or other regulatory bodies.
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Affiliation(s)
- John B Lynch
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Perica Davitkov
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
| | - Adarsh Bhimraj
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Vincent Chi-Chung Cheng
- Queen Mary Hospital, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Judith Guzman-Cottrill
- Department of Pediatrics, Division of Infectious Diseases, Oregon Health and Science University, Portland, Oregon
| | | | - Abhijit Duggal
- Department of Critical Care, Cleveland Clinic, Cleveland, Ohio
| | - Mamta K Jain
- Department of Internal Medicine, Division of Infectious Diseases, UT Southwestern Medical Center, Dallas, Texas
| | - Grace M Lee
- Department of Pediatrics-Infectious Disease, Stanford University School of Medicine, Stanford, California
| | - Stephen Y Liang
- Division of Infectious Diseases and Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Allison McGeer
- Department of Microbiology, Sinai Health System, University of Toronto, Toronto, Ontario
| | - Jamie Varghese
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - Valery Lavergne
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Yngve Falck-Ytter
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
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25
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A feasible route for the design and manufacture of customised respiratory protection through digital facial capture. Sci Rep 2021; 11:21449. [PMID: 34728650 PMCID: PMC8563770 DOI: 10.1038/s41598-021-00341-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 10/05/2021] [Indexed: 11/12/2022] Open
Abstract
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.
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26
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Galanis P, Vraka I, Fragkou D, Bilali A, Kaitelidou D. Impact of personal protective equipment use on health care workers' physical health during the COVID-19 pandemic: A systematic review and meta-analysis. Am J Infect Control 2021; 49:1305-1315. [PMID: 33965463 PMCID: PMC8102386 DOI: 10.1016/j.ajic.2021.04.084] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, health care workers (HCWs) have been obliged to wear personal protective equipment (PPE). We assessed the impact of PPE use on HCWs' physical health and we examined factors related to a greater risk of adverse events due to PPE use. METHODS We applied the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and the Cochrane criteria. We searched PubMed, Medline, Scopus, ProQuest, CINAHL, and medRxiv from January 1, 2020 to December 27, 2020. RESULTS Our review included 14 studies with 11,746 HCWs. The estimated overall prevalence of adverse events among HCWs was 78% with a range from 42.8% to 95.1% among studies. Among others, the following factors were related to the risk of adverse events among HCWs due to PPE use: obesity, diabetes mellitus, smoking, pre-existing headache, longer duration of shifts wearing PPE, increased consecutive days with PPE, and increased exposure to confirmed or suspected COVID-19 patients. CONCLUSIONS The frequency of adverse events among HCWs due to PPE use is very high. Healthcare facilities should take the necessary precautions and change the working conditions during the COVID-19 pandemic to prevent adverse events associated with PPE use and minimize harm to HCWs.
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Affiliation(s)
- Petros Galanis
- Faculty of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece.
| | - Irene Vraka
- Department of Radiology, P & A Kyriakou Children's Hospital, Athens, Greece
| | - Despoina Fragkou
- Faculty of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece
| | - Angeliki Bilali
- Hospital Waste Management Unit, P & A Kyriakou Children's Hospital, Athens, Greece
| | - Daphne Kaitelidou
- Faculty of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece
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Alarfaj MA, Foula MS, Alshammary S, Nwesar FA, Eldamati AM, Alomar A, Abdulmomen AA, Alarfaj L, Almulhim A, Alarfaj O, Zakaria HM. Impact of wearing personal protective equipment on the performance and decision making of surgeons during the COVID-19 pandemic: An observational cross-sectional study. Medicine (Baltimore) 2021; 100:e27240. [PMID: 34664867 PMCID: PMC8448053 DOI: 10.1097/md.0000000000027240] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/28/2021] [Indexed: 01/10/2023] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, the mandatory use of personal protective equipment (PPE) has resulted in a significant reduction in the infection rate among health care workers (HCWs). However, there are some ongoing concerns about the negative impact of using PPE for prolonged periods.This study examined the impact of wearing PPE on surgeons' performance and decision making during the COVID-19 pandemic.In this cross-sectional study, an anonymous online questionnaire was created and disseminated to surgeons all over the Eastern Province of Saudi Arabia. The questionnaire included the demographic data, the local hospital policies, the non-technical skills (e.g., communication, vision, and comfort) and the technical skills, and the process of decision making.From June 2020 to August 2020, 162 surgeons participated in this questionnaire. Of them, 80.2% were aged from 26 to 45 years, 70.4% have received a special training for PPE, and 59.3% of participants have operated on COVID-19 confirmed cases. A negative impact of wearing PPE was reported on their overall comfort, vision, and communication skills (92.6%, 95.1%, and 82.8%, respectively). The technical skills and decision making were not significantly affected (60.5% and 72.8%, respectively). More preference for conservative approach, damage control procedures, and/or open approach was reported.Despite its benefits, PPE is associated with a significant negative impact on the non-technical skills (including vision, communication, and comfort) as well as a non-significant negative impact on technical skills and decision making of surgeons. Extra efforts should be directed to improve PPE, especially during lengthy pandemics.
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Affiliation(s)
- Mosab A. Alarfaj
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Mohammed S. Foula
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Shadi Alshammary
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Fayrouz A. Nwesar
- Department of Obstetrics and Gynaecology, Alexandria Maternity University Hospital, Alexandria, Egypt
| | - Ahmed M. Eldamati
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Abdullah Alomar
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Abdulrahim A. Abdulmomen
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Leenah Alarfaj
- Department of Surgery, King Fahad Specialist Hospital, Dammam Saudi Arabia
| | - Abdulmohsen Almulhim
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Odai Alarfaj
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hazem M. Zakaria
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
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Deressa W, Worku A, Abebe W, Gizaw M, Amogne W. Availability and use of personal protective equipment and satisfaction of healthcare professionals during COVID-19 pandemic in Addis Ababa, Ethiopia. Arch Public Health 2021; 79:146. [PMID: 34404464 PMCID: PMC8369137 DOI: 10.1186/s13690-021-00668-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/01/2021] [Indexed: 12/01/2022] Open
Abstract
Background Healthcare professionals (HCPs) are at the frontline in the fight against COVID-19 and are at an increased risk of becoming infected with coronavirus. Risk of infection can be minimized by use of proper personal protective equipment (PPE). The aim of this study was to assess the availability and use of PPE, and satisfaction of HCPs with PPE in six public hospitals in Addis Ababa, Ethiopia. Methods A cross-sectional study was conducted among 1134 HCPs in June 2020. A systematic random sampling and consecutive sampling techniques were used to select the study participants. Data were collected using a self-administered questionnaire. Descriptive statistics were used to describe the data and Chi-square test was used to assess the association between the groups. Bivariate and multivariable logistic regression models were used to assess factors associated with satisfaction of healthcare workers. Results The mean (±SD) age of the participants was 30.26 ± 6.43 year and 52.6% were females. Nurses constituted about 40% of the overall sample, followed by physicians (22.2%), interns (10.8%), midwives (10.3%) and others (16.7%). The majority (77%) of the HCPs reported that their hospital did not have adequate PPE. A critical shortage of N95 respirators was particularly reported, it only increased from 13 to 24% before and during COVID-19, respectively. The use of N95 increased from 9 to 21% before and during COVID-19, respectively. Almost 72% of the respondents were dissatisfied with the availability and use of PPE in their hospital. The independent predictors of the respondents’ satisfaction level about PPE were healthcare workers who reported that PPE was adequately available in the hospital (adjusted OR = 7.65, 95% CI:5.09–11.51), and preparedness to provide care to COVID-19 cases (adjusted OR = 2.07, 95% CI:1.42–3.03). Conclusions A critical shortage of appropriate PPE and high level of dissatisfaction with the availability and use of PPE were identified. Therefore, urgent efforts are needed to adequately supply the healthcare facilities with appropriate PPE to alleviate the challenges. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00668-3.
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Affiliation(s)
- Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Alemayehu Worku
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workeabeba Abebe
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Muluken Gizaw
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondwossen Amogne
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Garra GM, Parmentier D, Garra G. Physiologic Effects and Symptoms Associated with Extended-Use Medical Mask and N95 Respirators. Ann Work Expo Health 2021; 65:862-867. [PMID: 33733270 DOI: 10.1093/annweh/wxab010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/15/2021] [Accepted: 01/26/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Compliance and tolerance of facemasks for extended periods are legitimate concerns. The goal of this study was to identify the physiologic and symptomatic effects of extended-use N95 filtering facepiece respirator (N95) compared with medical masks. We hypothesized that hospital personnel wearing medical masks alone would report fewer subjective complaints compared with personnel wearing an N95 with or without overlying medical mask. METHODS This was a nonrandomized cohort study of hospital-based healthcare personnel at a single tertiary center wearing a medical mask alone or N95 with or without overlying medical mask during routine clinical activity. Potential subjects were consented and asked to complete a structured survey, including a 10-point Likert scale for subjective symptoms: headache, lightheadedness, breathlessness, facial bruising, facial irritation, mental fatigue, physical fatigue, and yawning. Study investigators also obtained vital signs on the participants. Results between subjects wearing a medical mask and subjects wearing an N95 were compared. A sample of 144 subjects, 72 in each mask cohort, was needed to detect a 20% difference in a composite outcome of headache, shortness of breath, or lightheadedness between groups with an alpha of 0.05 and power of 0.8. RESULTS We enrolled 72 subjects in each group. There were no differences in baseline demographics. Overall 77% of the cohort reported subjective symptoms while donning a mask. There was no difference in the composite outcome, no difference recorded symptoms except facial bruising, and no difference in physiologic measures between groups. CONCLUSIONS Most medical mask and N95 users reported symptoms during mask use. However, there was no difference in the symptom proportion or severity in either user.
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Affiliation(s)
- Gabrielle M Garra
- Department of Emergency Medicine, South Shore University Hospital at Northwell Health, 301 East Main Street, Bay Shore, NY 11706, USA
| | - Darlene Parmentier
- Department of Emergency Medicine, South Shore University Hospital at Northwell Health, 301 East Main Street, Bay Shore, NY 11706, USA
| | - Gregory Garra
- Department of Emergency Medicine, South Shore University Hospital at Northwell Health, 301 East Main Street, Bay Shore, NY 11706, USA
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30
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Balanay JAG, Oh J. Adsorption Characteristics of Activated Carbon Fibers in Respirator Cartridges for Toluene. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168505. [PMID: 34444254 PMCID: PMC8393755 DOI: 10.3390/ijerph18168505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 11/26/2022]
Abstract
Respirator use has been shown to be associated with overall discomfort. Activated carbon fiber (ACF) has potential as an alternative adsorbent for developing thinner, lightweight, and efficient respirators due to its larger surface area, microporosity, and fabric form. The purpose of this pilot study was to determine the adsorption characteristics of commercially available ACF in respirator cartridges with varying ACF composition for toluene protection. Seven ACF types (one cloth, six felt) with varying properties were tested. Seven ACF cartridge configurations with varying ACF composition were challenged with five toluene concentrations (20–500 ppm) at constant air temperature (23 °C), relative humidity (50%), and air flow (32 LPM). Breakthrough curves were obtained using photoionization detectors. Breakthrough times (10%, 50%, and 5 ppm) and adsorption capacities were compared among ACF cartridge configurations to determine their suitable application in respiratory protection. Results showed that ACF cartridges containing the densest ACF felt types had the longest average breakthrough times (e.g., ~250–270 min to reach 5 ppm breakthrough time) and those containing ACF felt types with the highest specific surface areas had the highest average adsorption capacity (~450–470 mg/g). The ACF cartridges demonstrated breakthrough times of <1 h for 500 ppm toluene and 8–16 h for 20 ppm toluene. The ACF cartridges are more reliable for use at low ambient toluene concentrations but still have potential for use at higher concentrations for short-term protection. ACF felt forms with appropriate properties (density of ~0.07 g/cm3; specific surface area of ~2000 m2/g) have shown promising potential for the development of lighter and thinner respirators for protection against toluene.
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Affiliation(s)
- Jo Anne G. Balanay
- Environmental Health Sciences Program, Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC 27858, USA
- Correspondence:
| | - Jonghwa Oh
- Department of Environmental Health Sciences, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233, USA;
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31
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Olaniyan OT, Dare A, Okoli B, Adetunji CO, Ibitoye BO, Okotie GE, Eweoya O. Increase in SARS-CoV-2 infected biomedical waste among low middle-income countries: environmental sustainability and impact with health implications. J Basic Clin Physiol Pharmacol 2021; 33:27-44. [PMID: 34293833 DOI: 10.1515/jbcpp-2020-0533] [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] [Received: 05/29/2020] [Accepted: 06/28/2021] [Indexed: 12/15/2022]
Abstract
Studies have shown that severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) is a highly infectious disease, with global deaths rising to about 360,438 as of 28 May 2020. Different countries have used various approaches such as lockdown, social distancing, maintenance of personal hygiene, and increased establishment of testing and isolation centers to manage the pandemic. Poor biomedical waste (BMW) management, treatment, and disposal techniques, especially SARS-CoV-2 infected BMW, may threaten the environmental and public health in most developing countries and, by extension, impact the economic status of individuals and the nation at large. This may increase the potential for the transmission of air/blood body fluid-borne pathogens, increase the growth of microorganisms, risk of mutagenesis, and upsurge of more virulent strain. In contrast, uncontrolled substandard burning could increase the potential spread of nosocomial infection and environmental exposure to toxic organic compounds, heavy metals, radioactive, and genotoxic bio-aerosols which might be present in the gaseous, liquid, and solid by-products. The paucity of understanding of pathophysiology and management of the SARS-CoV-2 pandemic has also necessitated the need to put in place appropriate disposal techniques to cater for the sudden increase in the global demand for personal protective equipment (PPE) and pharmaceutical drugs to manage the pandemic and to reduce the risk of preventable infection by the waste. Therefore, there is a need for adequate sensitization, awareness, and environmental monitoring of the impacts of improper handling of SARS-CoV-2 infected BMWs. Hence, this review aimed to address the issues relating to the improper management of increased SARS-CoV-2 infected BMW in low middle-income countries (LMICs).
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Affiliation(s)
- Olugbemi T Olaniyan
- Department of Physiology, Laboratory for Reproductive Biology and Developmental Programming, Edo University Iyamho, Iyamho, Nigeria
| | - Ayobami Dare
- Discipline of Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bamidele Okoli
- Institute of Chemical and Biotechnology, Vaal University of Technology, Southern Gauteng Science and Technology Park, Sebokeng, South Africa
| | - Charles O Adetunji
- Department of Microbiology, Applied Microbiology, Biotechnology and Nanotechnology Laboratory, Edo University Iyamho, Iyamho, Edo State, Nigeria
| | | | - Gloria E Okotie
- Department of Physiology, University of Ibadan, Ibadan, Nigeria
| | - Olugbenga Eweoya
- Department of Anatomical Sciences, School of Medicine and Allied Health Sciences, University of the Gambia, Serekunda, The Gambia
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Khalid A, Romutis S, Ibinson J, Thomas C, Myint A, Dueker J, Johnston E, Kreiss C, Kingsley M, Skef W, Vipperla K, McGrath K, Phillips AE, Das R, Fasanella K, Ibinson J. Acute physiologic effects of N95 respirator use on gastroenterologists performing simulated colonoscopy. Gastrointest Endosc 2021; 94:160-168.e3. [PMID: 33497642 DOI: 10.1016/j.gie.2021.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/18/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS During the severe acute respiratory syndrome coronavirus 2 pandemic, N95 filtering facepiece respirator (FFR) use was required while performing aerosol-generating procedures. We studied the physiologic effects of N95 FFR use in a cohort of gastroenterologists performing simulated colonoscopies. METHODS Data collection and comparisons included (1) symptoms and change in vital signs in 12 gastroenterologists performing simulated colonoscopy for 60 minutes while wearing a surgical mask (SM) and faceshield (FS); N95 FFR, SM, and FS; and powered air-purifying respirator (PAPR) and (2) respiratory belt plethysmography and continuous electrocardiographic frequency-based heart rate (HR) variability indices including very low frequency power (measures intracardiac sympathetic tone) and low frequency to high frequency ratios (intracardiac sympathetic to vagal ratio) in 11 gastroenterologists performing simulated colonoscopy while wearing an SM (15 minutes), N95 FFR and SM (60 minutes), and SM (15 minutes) in rapid sequence. RESULTS Ten of 12 gastroenterologists (83%) reported symptoms with N95 FFR use, most commonly breathing difficulty, frustration, fatigue, and headache. Nine of these gastroenterologists (75%) had associated significant HR elevation. Respiratory peak to trough measurement showed a significant increase (F(2) = 7.543, P = .004) during the N95 FFR stage, which resolved after removal of the N95 FFR. Although not statistically different, all gastroenterologists showed a decrease in sympathetic to vagal ratios and an increase in intracardiac sympathetic effects in the N95 FFR stage. PAPR use was better tolerated but was associated with headache and elevated HR in 4 gastroenterologists (33%). CONCLUSIONS N95 FFR use by gastroenterologists is associated with development of acute physiologic changes and symptoms.
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Affiliation(s)
- Asif Khalid
- VA Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA; University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | - Stephanie Romutis
- University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | | | | | - Alex Myint
- VA Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA; University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | - Jeffrey Dueker
- VA Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA; University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | - Elyse Johnston
- VA Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA; University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | | | - Michael Kingsley
- VA Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA; University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | - Wasseem Skef
- University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | - Kishore Vipperla
- University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | - Kevin McGrath
- University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | | | - Rohit Das
- University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | - Kenneth Fasanella
- University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | - James Ibinson
- VA Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA; University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
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Alghamdi HA. Research and effectiveness of anti-viral drugs against COVID-19; global public intervention to prevent coronavirus and to improve human health. Saudi J Biol Sci 2021; 28:4082-4088. [PMID: 33897263 PMCID: PMC8055498 DOI: 10.1016/j.sjbs.2021.04.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/06/2021] [Accepted: 04/11/2021] [Indexed: 12/23/2022] Open
Abstract
Since the first case report on COVID-19, its transmission took place rapidly across the globe. Currently, it is reported to be spread into a total of 216 countries and territories. The suppression on industrial and gasoline burning activities accompanied after COVID-19 lock down favorably boosted the nature to restore its deteriorated sections such as in air with the improved Air quality index and in water bodies with the natural tone of purity. Increased use of anti-viral drugs along with herbal therapies has been observed at mass scale as global intervention to prevent the disease. The use of personal protective equipment and disinfection strategies for the control of pandemic has dramatically increased the pollution of plastic and medical waste. This article aims to forecast and highlight the evidence-based impact/changes (+ive and -ive) of coronavirus on the environment, global interventions to prevent the disease along with the levels of effectiveness of personal used protective equipment to stop the spread of coronavirus.
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Affiliation(s)
- Huda Ahmed Alghamdi
- Department of Biology, College of Sciences, King Khalid University, Abha, Saudi Arabia
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Hoedl M, Eglseer D, Bauer S. Associations between personal protective equipment and nursing staff stress during the COVID-19 pandemic. J Nurs Manag 2021; 29:2374-2382. [PMID: 34174009 PMCID: PMC8420325 DOI: 10.1111/jonm.13400] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 06/08/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022]
Abstract
Aim This study gives insights into the association between the use of personal protective equipment (PPE), wearing time of masks and stress among frontline nursing staff during the COVID‐19 pandemic. Background PPE can have physical consequences like headache and pain, which could result in increased nurse stress levels. Methods A total of 2600 nurses participated in this online survey. The questionnaire is based on literature and includes the perceived level of stress scale. Results We found no significant association between the use of PPE and stress. Nurses who wore masks for more than 8 h had significant higher stress levels than those who used the masks for a shorter period. Conclusions The duration of wearing masks is associated with nurse's stress level. Our findings can help nurses to argue a higher frequency of breaks and a maximum duration of mask usage in their organisations. Implications for Nursing Management We recommend that nursing managers implement practical strategies such as a mask break task force. This task force could promote awareness for mask breaks and recommend and allocate rooms or locations such as balconies for mask breaks.
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Affiliation(s)
- Manuela Hoedl
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Silvia Bauer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
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Air Pollution Observations in Selected Locations in Poland during the Lockdown Related to COVID-19. ATMOSPHERE 2021. [DOI: 10.3390/atmos12070806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The coronavirus disease (COVID-19) has caused huge changes in people’s daily habits and had a significant impact on the economy. The lockdowns significantly reduced road traffic and meant that many people worked remotely. Therefore, the question arose as to how the reduced road traffic and stays of residents at home affected the degree of pollution and the structure of major air pollutants. To answer this question, the article presents an analysis of changes in typical air pollutants (PM10, PM2.5, NO2) in the five largest Polish cities and one of the voivodships. The data from the Polish State Environmental Monitoring were used for the analysis. The analysis showed that the period of the first lockdown in Poland (April 2020), despite the reduced road traffic, resulted in a significant increase in PM10 emissions (9–91% during working days and an average of 30% on Saturdays and Sundays), a slight increase in PM2.5 emissions (on average from 2% to 11% for all analyzed locations), and a reduction in NO2 emissions (on average from 6% to 11% for all analyzed locations) compared to the period before the lockdown. However, the changes were not homogeneous—in Łódź and Warsaw, in most cases, an increase in all analyzed pollutants was observed, and the greatest decrease in pollution took place in Małopolska voivodship (including Kraków). Comparing the data from April 2020 to the data from April 2019, the overall difference in the PMs concentrations was small, although there are places where there has been a significant decrease (Wrocław, Poznań), and there were also places where the concentration increased (Warsaw, Łódź, Małopolska). In the case of nitrogen dioxide, pollution concentration decreased in most locations. The only exception was the background stations in Warsaw, where the increase was 27%.
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Ong JJY, Chan ACY, Bharatendu C, Teoh HL, Chan YC, Sharma VK. Headache Related to PPE Use during the COVID-19 Pandemic. Curr Pain Headache Rep 2021; 25:53. [PMID: 34129112 PMCID: PMC8203491 DOI: 10.1007/s11916-021-00968-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 01/10/2023]
Abstract
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.
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Affiliation(s)
- Jonathan J Y Ong
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Amanda C Y Chan
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Chandra Bharatendu
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Stead Family Department of Pediatrics, Division of Medical Genetics and Genomics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Hock Luen Teoh
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Yee Cheun Chan
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Vijay K Sharma
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
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Foula MS, Nwesar FA, Oraby EH, Foula A, Alarfaj MA, Foula HS, Mohamed NE. Does wearing personal protective equipment affect the performance and decision of physicians? A cross-sectional study during the COVID-19 pandemic. Ann Med Surg (Lond) 2021; 67:102488. [PMID: 34127939 PMCID: PMC8189734 DOI: 10.1016/j.amsu.2021.102488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 02/06/2023] Open
Abstract
Background The use of personal protective equipment (PPE) decreased the probability of viral transmission during the COVID-19 pandemic. However, some drawbacks have been observed with its extensive use, such as headaches, anxiety, and stress among physicians, which could affect decision-making processes, the performance of physicians, and consequently patients’ safety. Few articles have studied the impact of PPE on physicians from different specialties. This study assessed the effect of wearing PPE on the performance and decision-making of physicians during the COVID-19 pandemic and compared the effects of wearing PPE on physicians from different specialties. Methods A descriptive cross-sectional study was carried out through an anonymous 39-item online questionnaire. The physicians were divided according to the probability and frequency of performing invasive procedures. Group 1 included emergency medicine and critical care physicians, intensivists, and anesthetists, group 2 included physicians from different surgical subspecialties, and group 3 included physicians from different medical fields. Results This study included 272 physicians; group 1 included 54, group 2 included 120, and group 3 included 98 physicians. Approximately, 90.4% of the participants aged between 30 and -40 years, and 72.8% of the participants were specialists. Results indicated that the comfort, vision, and communication were significantly reduced in all groups (81.1%, 88.7%, and 75.5%, respectively). In contrast, the handling of instruments was not significantly affected in the second group only. In addition, the decision-making and the rate of complications were not significantly affected. Conclusion There was a negative impact of wearing PPE on the non-technical skills (vision, communication and overall comfort), and the technical skills of the physicians. The decision-making and patients’ safety were not significantly affected. Recommendations include additional improvement of the PPE design due to its crucial effect on both non-technical and technical skills of physicians. The use of PPE decreases the rate of infection of healthcare providers. The use of PPE affected the physicians' performance (comfort, vision, and communication). The decision-making and patients' safety were not affected. Improvement of PPE design is important for better performance.
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Affiliation(s)
- Mohammed S Foula
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Fayrouz A Nwesar
- Department of Obstetrics and Gynaecology, Alexandria University Maternity Hospital, Egypt
| | - Esraa H Oraby
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Alexandria University, Egypt
| | - Ahmed Foula
- Department of Anaesthesia, Alamerya General Hospital, Ministry of Health, Egypt
| | - Mosab A Alarfaj
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Hassan S Foula
- Department of Nephrology, Abou Qir General Hospital, Ministry of Health, Egypt
| | - Noha E Mohamed
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Alexandria University, Egypt
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Affiliation(s)
- Samuel Gelnick
- Department of Ophthalmology, Northwell Health, Great Neck, NY, USA
| | - Marib Akanda
- Department of Ophthalmology, Northwell Health, Great Neck, NY, USA
| | - Ronni Lieberman
- Department of Ophthalmology, Mt Sinai Medical Center, Ichan School of Medicine, New York, NY, USA
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Rhee MSM, Lindquist CD, Silvestrini MT, Chan AC, Ong JJY, Sharma VK. Carbon dioxide increases with face masks but remains below short-term NIOSH limits. BMC Infect Dis 2021; 21:354. [PMID: 33858372 PMCID: PMC8049746 DOI: 10.1186/s12879-021-06056-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/05/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE COVID-19 pandemic led to wide-spread use of face-masks, respirators and other personal protective equipment (PPE) by healthcare workers. Various symptoms attributed to the use of PPE are believed to be, at least in part, due to elevated carbon-dioxide (CO2) levels. We evaluated concentrations of CO2 under various PPE. METHODS In a prospective observational study on healthy volunteers, CO2 levels were measured during regular breathing while donning 1) no mask, 2) JustAir® powered air purifying respirator (PAPR), 3) KN95 respirator, and 4) valved-respirator. Serial CO2 measurements were taken with a nasal canula at a frequency of 1-Hz for 15-min for each PPE configuration to evaluate whether National Institute for Occupational Safety and Health (NIOSH) limits were breached. RESULTS The study included 11 healthy volunteers, median age 32 years (range 16-54) and 6 (55%) men. Percent mean (SD) changes in CO2 values for no mask, JustAir® PAPR, KN95 respirator and valve respirator were 0.26 (0.12), 0.59 (0.097), 2.6 (0.14) and 2.4 (0.59), respectively. Use of face masks (KN95 and valved-respirator) resulted in significant increases in CO2 concentrations, which exceeded the 8-h NIOSH exposure threshold limit value-weighted average (TLV-TWA). However, the increases in CO2 concentrations did not breach short-term (15-min) limits. Importantly, these levels were considerably lower than the long-term (8-h) NIOSH limits during donning JustAir® PAPR. There was a statistically significant difference between all pairs (p < 0.0001, except KN95 and valved-respirator (p = 0.25). However, whether increase in CO2 levels are clinically significant remains debatable. CONCLUSION Although, significant increase in CO2 concentrations are noted with routinely used face-masks, the levels still remain within the NIOSH limits for short-term use. Therefore, there should not be a concern in their regular day-to-day use for healthcare providers. The clinical implications of elevated CO2 levels with long-term use of face masks needs further studies. Use of PAPR prevents relative hypercapnoea. However, whether PAPR should be advocated for healthcare workers requiring PPE for extended hours needs to evaluated in further studies.
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Affiliation(s)
- Michelle S M Rhee
- Theranova LLC, 101 Mississippi Street, San Francisco, CA, 94107, USA
| | - Carin D Lindquist
- Theranova LLC, 101 Mississippi Street, San Francisco, CA, 94107, USA
| | | | - Amanda C Chan
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS, Tower Block, 1E Kent Ridge Road, 119228, Singapore City, Singapore
| | - Jonathan J Y Ong
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS, Tower Block, 1E Kent Ridge Road, 119228, Singapore City, Singapore
| | - Vijay K Sharma
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS, Tower Block, 1E Kent Ridge Road, 119228, Singapore City, Singapore.
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Nguyen DL, Kay-Rivest E, Tewfik MA, Hier M, Lehmann A. Association of In-Ear Device Use With Communication Quality Among Individuals Wearing Personal Protective Equipment in a Simulated Operating Room. JAMA Netw Open 2021; 4:e216857. [PMID: 33871614 PMCID: PMC8056284 DOI: 10.1001/jamanetworkopen.2021.6857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic has brought forth new challenges for health care workers, such as the daily use of personal protective equipment, including reusable facial respirators. Poor communication while wearing respirators may have fatal complications for patients, and no solution has been proposed to date. OBJECTIVE To examine whether use of an in-ear communication device is associated with improved communication while wearing different personal protective equipment (N95 mask, half-face elastomeric respirator, and powered air-purifying respirator [PAPR]) in the operating room. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study was conducted in June 2020. Surgical residents from the Department of Otolaryngology-Head and Neck Surgery at McGill University in Montreal, Quebec, Canada, were recruited. All participants had normal hearing, were fluent in English, and had access to the operating rooms at the Royal Victoria Hospital. EXPOSURES All participants performed the speech intelligibility tasks with and without an in-ear communication device. MAIN OUTCOMES AND MEASURES Speech intelligibility was measured using a word recognition task (Modified Rhyme Test) and a sentence recognition task (AzBio Sentence Test). A percentage correct score (0% to 100%) was obtained for each speech intelligibility test. Listening effort was assessed using the NASA Task Load Index. An overall workload score, ranging from 0 points (low workload) to 100 points (high workload), was obtained. RESULTS A total of 12 participants were included (mean [SD] age, 31.2 [1.9] years; 8 women [66.7%]). AzBio Sentence Test results revealed that, while wearing the N95 mask, the mean (SD) speech intelligibility was 98.8% (1.8%) without the in-ear device vs 94.3% (7.4%) with the device. While wearing the half-face elastomeric respirator, the mean speech intelligibility was 58.5% (12.4%) without the in-ear device vs 90.8% (8.9%) with the device. While wearing the PAPR, the mean speech intelligibility was 84.6% (9.8%) without the in-ear device vs 94.5% (5.5%) with the device. Use of the in-ear device was associated with a significant improvement in speech intelligibility while wearing the half-face elastomeric respirator (32.3%; 95% CI, 23.8%-40.7%; P < .001) and the PAPR (9.9%; 95% CI, 1.4%-18.3%; P = .01). Furthermore, use of the device was associated with decreased listening effort. The NASA Task Load Index results reveal that, while wearing the N95 mask, the mean (SD) overall workload score was 12.6 (10.6) points without the in-ear device vs 17.6 (9.2) points with the device. While wearing the half-face elastomeric respirator, the mean overall workload score was 67.7 (21.6) points without the in-ear device vs 29.3 (14.4) points with the in-ear device. While wearing the PAPR, the mean overall workload score was 42.2 (18.2) points without the in-ear device vs 23.8 (12.8) points with the in-ear device. Use of the in-ear device was associated with a significant decrease in overall workload score while wearing the half-face elastomeric respirator (38.4; 95% CI, 23.5-53.3; P < .001) and the PAPR (18.4; 95% CI, 0.4-36.4; P = .04). CONCLUSIONS AND RELEVANCE This study found that among participants using facial respirators that impaired communication, a novel in-ear device was associated with improved communication and decreased listening effort. Such a device may be a feasible solution for protecting health care workers in the operating room while allowing them to communicate safely, especially during the COVID-19 pandemic.
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Affiliation(s)
- Don Luong Nguyen
- Laboratory for Brain, Music and Sound Research (BRAMS), Centre for Research on Brain, Language or Music (CRBLM), Royal Victoria Hospital, Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Emily Kay-Rivest
- Royal Victoria Hospital, Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Marc A. Tewfik
- Royal Victoria Hospital, Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Michael Hier
- Jewish General Hospital, Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Alexandre Lehmann
- Laboratory for Brain, Music and Sound Research (BRAMS), Centre for Research on Brain, Language or Music (CRBLM), Royal Victoria Hospital, Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
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Licina A, Silvers A. Use of powered air-purifying respirator(PAPR) as part of protective equipment against SARS-CoV-2-a narrative review and critical appraisal of evidence. Am J Infect Control 2021; 49:492-499. [PMID: 33186678 PMCID: PMC7654369 DOI: 10.1016/j.ajic.2020.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The last 2 decades have seen an increasing frequency of zoonotic origin viral diseases leaping from animal to human hosts including Severe Acute Respiratory Syndrome Coronaviruses (SARS-CoV-2). Respiratory component of the infectious disease program against SARS-CoV-2 incorporates use of protective airborne respiratory equipment. METHODS In this narrative review, we explore the features of Powered Air Purifying Respirators (PAPR) as well as logistical and evidence-based advantages and disadvantages. RESULTS Simulation study findings support increased heat tolerance and wearer comfort with a PAPR, versus decreased communication ability, mobility, and dexterity. Although PAPRs have been recommended for high-risk procedures on suspected or confirmed COVID-19 patients, this recommendation remains controversial due to lack of evidence. Guidelines for appropriate use of PAPR during the current pandemic are sparse. International regulatory bodies do not mandate the use of PAPR for high-risk aerosol generating procedures in patients with SARS-CoV-2. Current reports of the choice of protective respiratory technology during the SARS-CoV-2 pandemic are disparate. Patterns of use appear to be related to geographical locations. DISCUSSION Field observational studies do not indicate a difference in healthcare worker infection utilizing PAPR devices versus other compliant respiratory equipment in healthcare workers performing AGPs in patients with SARS-CoV-2. Whether a higher PAPR filtration factor translates to decreased infection rates of HCWs remains to be elucidated. Utilization of PAPR with high filtration efficiency may represent an example of "precautionary principle" wherein action taken to reduce risk is guided by logistical advantages of PAPR system.
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Affiliation(s)
- Ana Licina
- VMO Anaesthesia, Austin Health, Melbourne, Victoria, Australia.
| | - Andrew Silvers
- VMO Anaesthesia, Monash Medical Centre, Adjunct Senior Lecturer, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
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Thiagarajan S, Shetty P, Gulia A, Prakash G, Pramesh CS, Puri A. A Survey of Personnel Protective equipment's (PPE) Use and Comfort Levels Among Surgeons During Routine Cancer Surgery in the COVID-19 Pandemic. Indian J Surg Oncol 2021; 12:365-373. [PMID: 33785996 PMCID: PMC7995676 DOI: 10.1007/s13193-021-01316-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/21/2021] [Indexed: 12/12/2022] Open
Abstract
Personnel protective equipment (PPE) are recommended during surgery even in COVID-19 negative patients especially in a high-prevalence region due to its higher false-negative rates. However, the use of PPE has not been universal mainly due to the perception of discomfort and associated stress and fatigue. This study was done to understand the pattern of PPE use by cancer surgeons during the pandemic and the associated discomfort, stress, and fatigue with its use. The survey, consisting of 29 questions, was circulated widely across the country by email and chat groups among cancer surgeons. The study was registered with the Clinical Trials Registry of India (CTRI/2020/08/027050). We received a total of 342 evaluable responses that could be included for analysis. All the respondents used appropriate PPE in different combinations. N-95 mask and the face shield were the two components of the PPE that gave rise to a lot of discomforts. Fogging (of face shields) (p < 0.001,OR 3.61), dryness of mouth (p < 0.001,OR 3.35), and breathing difficulty/feeling of suffocation (p = 0.034,OR 1.68) contributed to the stress, whereas headache (p < 0.001,OR 11.34) and breathing difficulty/feeling of suffocation (p < 0.001,OR 4.24) contributed to the fatigue associated with PPE use the most. PPE was routinely used during cancer surgery in COVID-19 negative patients during the pandemic. However, most surgeons experienced different degrees of discomfort, especially with the N-95 masks and eye protection.
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Affiliation(s)
- Shivakumar Thiagarajan
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India
| | - Preethi Shetty
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India
| | - Aashish Gulia
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India
| | - Gagan Prakash
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India
| | - C. S. Pramesh
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India
| | - Ajay Puri
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India
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Bubbico L, Mastrangelo G, Larese-Filon F, Basso P, Rigoli R, Maurelli M, Ferlito S, Capelli M, Gisabella C, Javanbakht M, Bellizzi S, Cegolon L. Community Use of Face Masks against the Spread of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063214. [PMID: 33808861 PMCID: PMC8003592 DOI: 10.3390/ijerph18063214] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 02/04/2023]
Abstract
The role of face masks to prevent and control COVID-19 is critical, especially since asymptomatic or pre-symptomatic infected individuals can shed high loads of SARS-CoV-2 in the surrounding environment. In addition to being a two-way barrier to protect against virions droplets both in terms of "source control" (for the benefits of the community) and "physical protection" (for wearer), face masks also allow maintaining physiological temperatures and humidity of the nasal cavity and mouth, independently from the external environmental conditions. Beyond compromising the viral transmission speed, exposure to cold environments could have a detrimental effect on the host's susceptibility to SARS-CoV-2. The innate human immune system becomes in fact weaker with cooler nose temperatures and thus more vulnerable to viral replication. Furthermore, there is evidence that warm, humid climates are associated with reduced spread of SARS-CoV-2, while cold dry conditions favor its stability and transmissibility. In the early stage of a viral infection, a physiological body temperature in the upper airways supports the innate immune system, endorsing the muco-ciliary clearance, inhibiting, or deactivating any first settlement of viruses. Face masks are therefore strongly recommended also outdoors, especially under cold weather conditions, not only as a physical barrier against the transmission of SARS-CoV-2, but also to prevent the rapid cooling of the nasal mucosa and the inhibition of the human innate defense of the upper airways.
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Affiliation(s)
- Luciano Bubbico
- Sensori-Neural Disabilities Research Unit, INAPP, 00198 Rome, Italy;
| | - Giuseppe Mastrangelo
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, Padua University, 35122 Padua, Italy;
| | - Francesca Larese-Filon
- Occupational Medicine Unit, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy; (F.L.-F.); (P.B.)
| | - Paolo Basso
- Occupational Medicine Unit, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy; (F.L.-F.); (P.B.)
| | - Roberto Rigoli
- Microbiology Unit, Ca’ Foncello Hospital, Local Health Unit N.2 ‘Marca Trevigiana”, 31100 Treviso, Italy;
| | - Martina Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37129 Verona, Italy;
| | - Salvatore Ferlito
- Department of Surgical Medical Sciences and Advanced Technologies, School of Medicine, University of Catania, 95124 Catania, Italy;
| | - Marco Capelli
- Ear Nose and Throat (ENT) Department, CDI—Italian Diagnostic Centre, 20122 Milan, Italy;
| | - Claudio Gisabella
- Public Health Department, Local Health Unit N.2 “Marca Trevigiana”, 31100 Treviso, Italy;
| | - Mohammad Javanbakht
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran 1435916471, Iran;
| | - Saverio Bellizzi
- Partnership for Maternal, Newborn & Child Health, World Health Organization, 1200 Geneva, Switzerland;
| | - Luca Cegolon
- Public Health Department, Local Health Unit N.2 “Marca Trevigiana”, 31100 Treviso, Italy;
- Correspondence: or ; Tel.: +39-0422-323757
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Preparing for an Influenza Pandemic: Hospital Acceptance Study of Filtering Facepiece Respirator Decontamination Using Ultraviolet Germicidal Irradiation. J Patient Saf 2021; 16:117-122. [PMID: 32175970 PMCID: PMC7224602 DOI: 10.1097/pts.0000000000000600] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objectives Predictions estimate supplies of filtering facepiece respirators (FFRs) would be limited in the event of a severe influenza pandemic. Ultraviolet decontamination and reuse (UVDR) is a potential approach to mitigate an FFR shortage. A field study sought to understand healthcare workers’ perspectives and potential logistics issues related to implementation of UVDR methods for FFRs in hospitals. Methods Data were collected at three hospitals using a structured guide to conduct 19 individual interviews, 103 focus group interviews, and 285 individual surveys. Data were then evaluated using thematic analysis to reveal key themes. Results Data revealed noteworthy variation in FFR use across the sample, along with preferences and requirements for the use of UVDR, unit design, and FFR reuse. Based on a scale of 1 (low) to 10 (high), the mean perception of safety in a high mortality pandemic wearing no FFR was 1.25 of 10, wearing an FFR for an extended period without decontamination was 4.20 of 10, and using UVDR was 7.72 of 10. Conclusions In addition to technical design and development, preparation and training will be essential to successful implementation of a UVDR program. Ultraviolet decontamination and reuse program design and implementation must account for actual clinical practice, compliance with regulations, and practical financial considerations to be successfully adopted so that it can mitigate potential FFR shortages in a pandemic.
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Abstract
Respiratory protection in the dental setting has become more important to protect healthcare professionals, their household members and their patients. As dental practices become increasingly independent in managing their respiratory protection requirements, the need for an in-depth understanding of the principles of respiratory protection is warranted. This article aims to enhance the awareness of dental professionals about the principles of respiratory protection and equipment, including designs, classification and levels of protection afforded to wearers. Determining the adequacy and suitability of respiratory protection, along with ensuring safe selection of appropriate equipment for protection of both wearer and patient, is described. Moreover, a detailed review of fit testing principles, procedures and governance are described. This comprehensive review should ensure that dental professionals are ideally placed to understand the implications of respiratory protection and safely apply it in their workplaces. Describes the principles of respiratory protection in the dental workplace. Details the characteristics of different respiratory protective equipment, including the appropriateness of each in dental settings. Explains the fundamental principles of fit testing.
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Bakhit M, Krzyzaniak N, Scott AM, Clark J, Glasziou P, Del Mar C. Downsides of face masks and possible mitigation strategies: a systematic review and meta-analysis. BMJ Open 2021; 11:e044364. [PMID: 33619199 PMCID: PMC7903088 DOI: 10.1136/bmjopen-2020-044364] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To identify, appraise and synthesise studies evaluating the downsides of wearing face masks in any setting. We also discuss potential strategies to mitigate these downsides. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, CENTRAL and EuropePMC were searched (inception-18 May 2020), and clinical registries were searched via CENTRAL. We also did a forward-backward citation search of the included studies. INCLUSION CRITERIA We included randomised controlled trials and observational studies comparing face mask use to any active intervention or to control. DATA EXTRACTION AND ANALYSIS Two author pairs independently screened articles for inclusion, extracted data and assessed the quality of included studies. The primary outcomes were compliance, discomforts, harms and adverse events of wearing face masks. RESULTS We screened 5471 articles, including 37 (40 references); 11 were meta-analysed. For mask wear adherence, 47% (95% CI 25% to 68%, p<0.0001), more people wore face masks in the face mask group compared with control; adherence was significantly higher (26%, 95% CI 8% to 46%, p<0.01) in the surgical/medical mask group than in N95/P2 group. The largest number of studies reported on the discomfort and irritation outcome (20 studies); fewest reported on the misuse of masks, and none reported on mask contamination or risk compensation behaviour. Risk of bias was generally high for blinding of participants and personnel and low for attrition and reporting biases. CONCLUSIONS There are insufficient data to quantify all of the adverse effects that might reduce the acceptability, adherence and effectiveness of face masks. New research on face masks should assess and report the harms and downsides. Urgent research is also needed on methods and designs to mitigate the downsides of face mask wearing, particularly the assessment of possible alternatives. SYSTEMATIC REVIEW REGISTRATION Open Science Framework website https://osf.io/sa6kf/ (timestamp 20-05-2020).
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Affiliation(s)
- Mina Bakhit
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Natalia Krzyzaniak
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Chris Del Mar
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
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de Araújo Andrade T, Nascimento Junior JAC, Santos AM, Borges LP, Quintans-Júnior LJ, Walker CIB, Frank LA, Serafini MR. Technological Scenario for Masks in Patent Database During Covid-19 Pandemic. AAPS PharmSciTech 2021; 22:72. [PMID: 33575845 PMCID: PMC7877530 DOI: 10.1208/s12249-021-01918-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/28/2020] [Indexed: 01/08/2023] Open
Abstract
Since January 2020, the World Health Organization announces COVID-19 outbreak a case of public health emergency of international interest, and declaring it a pandemic on March. Due to the high transmission of this disease, rate precautions have been implemented, such as the use of masks by the population, personal protective equipment (PPE), and safety protocols, mainly to health workers. Thus, we performed a patent review to evaluate the current patents related to the protective mask. The review was carried out in the patent database in the period of May 2019 to May 2020. After the process of screening and eligibility, 563 patents were selected for our analysis according to the aim of the study which used masks such as a PPE against dust particles and pathogens, mostly when it is about airborne transmission, such as viruses and bacteria. Here, an overview of the main materials used in the mask manufacturing and their efficiency was described. The results of the review showed that most of the masks used cotton, nylon, silver fiber fabrics, among others as fabrics to develop the masks. It also makes an analysis of masks composed of nanotechnology which provide high filtration efficiency. Moreover, the review also brought possibilities of masking the population, which already have been done in countries such as China and Korea and ways of sterilization for reuse of PPE during COVID-19 outbreak. Thus, this review can further researchers in the developing of masks to decrease the spread of a pandemic disease. Graphical abstract.
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Round M, Isherwood P. Speech intelligibility in respiratory protective equipment - Implications for verbal communication in critical care. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021; 36:23-29. [PMID: 38620262 PMCID: PMC7428718 DOI: 10.1016/j.tacc.2020.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 11/20/2022]
Abstract
Respiratory protective equipment (RPE) such as filtering facepiece respirators, elastomeric respirators and powered air-purifying respirators are routinely worn in the critical care unit as a component of personal protective equipment (PPE) when caring for patients with coronavirus disease 2019 (COVID-19). It is the authors' anecdotal experience that RPE may, however, inadvertently interfere with verbal communication between critical care staff. The literature pertaining to the effects of RPE wear on verbal communication was therefore reviewed. A literature search returned 98 articles, and 4 records were identified from other sources; after screening for content relevancy, 15 experimental studies were included in the narrative synthesis. Previous studies in both healthcare and other occupational settings suggest a detrimental impact on speech intelligibility, varying according to RPE type and test conditions. The effects of background noise and potential for increased cognitive load through compensatory behaviours are also identified. The clinical significance of these effects remains uncertain though, as evidence measuring clinical outcomes or errors is lacking. Mitigating strategies include increasing speech intelligibility through environmental changes and technology; modifying verbal communication strategies; and decreasing reliance on verbal communication where possible.
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Affiliation(s)
- Matthew Round
- University Hospitals Birmingham NHS Foundation Trust, UK
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Burton C, Coles B, Adisesh A, Smith S, Toomey E, Chan XHS, Ross L, Greenhalgh T. Performance and impact of disposable and reusable respirators for healthcare workers during pandemic respiratory disease: a rapid evidence review. Occup Environ Med 2021; 78:679-690. [PMID: 33504624 DOI: 10.1136/oemed-2020-107058] [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: 09/21/2020] [Revised: 10/29/2020] [Accepted: 11/20/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To synthesise evidence concerning the range of filtering respirators suitable for patient care and guide the selection and use of different respirator types. DESIGN Comparative analysis of international standards for respirators and rapid review of their performance and impact in healthcare. DATA SOURCES Websites of international standards organisations, Medline and Embase, hand-searching of references and citations. STUDY SELECTION Studies of healthcare workers (including students) using disposable or reusable respirators with a range of designs. We examined respirator performance, clinician adherence and performance, comfort and impact, and perceptions of use. RESULTS We included standards from eight authorities across Europe, North and South America, Asia and Australasia and 39 research studies. There were four main findings. First, international standards for respirators apply across workplace settings and are broadly comparable across jurisdictions. Second, effective and safe respirator use depends on proper fitting and fit testing. Third, all respirator types carry a burden to the user of discomfort and interference with communication which may limit their safe use over long periods; studies suggest that they have little impact on specific clinical skills in the short term but there is limited evidence on the impact of prolonged wearing. Finally, some clinical activities, particularly chest compressions, reduce the performance of filtering facepiece respirators. CONCLUSION A wide range of respirator types and models is available for use in patient care during respiratory pandemics. Careful consideration of performance and impact of respirators is needed to maximise protection of healthcare workers and minimise disruption to care.
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Affiliation(s)
- Christopher Burton
- Academic Unit of Primary Medical Care, The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
| | - Briana Coles
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, Leicestershire, UK
| | - Anil Adisesh
- Occupational Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Simon Smith
- Canadian Standards Biological Aerosols Group, Canadian Standards Association, Toronto, Ontario, Canada
| | - Elaine Toomey
- School of Allied Health, University of Limerick Faculty of Education and Health Sciences, Limerick, Ireland
| | - Xin Hui S Chan
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, UK
| | - Lawrence Ross
- Infectious Diseases, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
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Abstract
Objectives/hypothesis To investigate the effect of FFP3 mask usage on venous blood gases (VBG) and some subjective symptoms Methods VBG analyses and subjective symptom questionary were obtained from 15 healthcare proffesionals before and after 4-h FFP3 mask usage. Results Wearing an FFP3 mask for 4 hours did not change any venous blood gas parameters between pre- and post-values, statistically. According to an 8-symptom questionary, only nausea did not show any significance. Headache, lightheadedness, visual difficulties, shortness of breath, palpitation, confusion, and difficult communication showed statistically significant difference between pre and post values. Conclusion Four-hour use of FFP3 mask did not cause any significant VBG change. Although the participants complained about some subjective symptoms, this study indicated that long-term use of FFP3 mask did not cause any significant discomforts, and it was well tolerated.
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