Helmet Modification to PPE With 3D Printing During the COVID-19 Pandemic at Duke University Medical Center: A Novel Technique

Metal and Polymer Based Composites Manufactured Using Additive Manufacturing-A Brief Review

This review examines the mechanical performance of metal- and polymer-based composites fabricated using additive manufacturing (AM) techniques. Composite materials have significantly influenced various industries due to their exceptional reliability and effectiveness. As technology advances, new types of composite reinforcements, such as novel chemical-based and bio-based, and new fabrication techniques are utilized to develop high-performance composite materials. AM, a widely popular concept poised to shape the development of Industry 4.0, is also being utilized in the production of composite materials. Comparing AM-based manufacturing processes to traditional methods reveals significant variations in the performance of the resulting composites. The primary objective of this review is to offer a comprehensive understanding of metal- and polymer-based composites and their applications in diverse fields. Further on this review delves into the intricate details of metal- and polymer-based composites, shedding light on their mechanical performance and exploring the various industries and sectors where they find utility.

Volatile Compound Emissions from Stereolithography Three-Dimensional Printed Cured Resin Models for Biomedical Applications

Stereolithography three-dimensional printing is used increasingly in biomedical applications to create components for use in healthcare and therapy. The exposure of patients to volatile organic compounds (VOCs) emitted from cured resins represents an element of concern in such applications. Here, we investigate the biocompatibility in relation to inhalation exposure of volatile emissions of three different cured commercial resins for use in printing a mouthpiece adapter for sampling exhaled breath. VOC emission rates were estimated based on direct analysis using a microchamber/thermal extractor coupled to a proton transfer reaction-mass spectrometer. Complementary analyses using comprehensive gas chromatography-mass spectrometry aided compound identification. Major VOCs emitted from the cured resins were associated with polymerization agents, additives, and postprocessing procedures and included alcohols, aldehydes, ketones, hydrocarbons, esters, and terpenes. Total VOC emissions from cubes printed using the general-purpose resin were approximately an order of magnitude higher than those of the cubes printed using resins dedicated to biomedical applications at the respective test temperatures (40 and 25 °C). Daily inhalation exposures were estimated and compared with daily tolerable intake levels or standard thresholds of toxicological concerns. The two resins intended for biomedical applications were deemed suitable for fabricating an adapter mouthpiece for use in breath research. The general-purpose resin was unsuitable, with daily inhalation exposures for breath sampling applications at 40 °C estimated at 310 μg day^-1 for propylene glycol (tolerable intake (TI) limit of 190 μg day^-1) and 1254 μg day^-1 for methyl acrylate (TI of 43 μg day^-1).

Mohan D, Karganroudi SS. The Unprecedented Role of 3D Printing Technology in Fighting the COVID-19 Pandemic: A Comprehensive Review

The coronavirus disease 2019 (COVID-19) rapidly spread to over 180 countries and abruptly disrupted production rates and supply chains worldwide. Since then, 3D printing, also recognized as additive manufacturing (AM) and known to be a novel technique that uses layer-by-layer deposition of material to produce intricate 3D geometry, has been engaged in reducing the distress caused by the outbreak. During the early stages of this pandemic, shortages of personal protective equipment (PPE), including facemasks, shields, respirators, and other medical gear, were significantly answered by remotely 3D printing them. Amidst the growing testing requirements, 3D printing emerged as a potential and fast solution as a manufacturing process to meet production needs due to its flexibility, reliability, and rapid response capabilities. In the recent past, some other medical applications that have gained prominence in the scientific community include 3D-printed ventilator splitters, device components, and patient-specific products. Regarding non-medical applications, researchers have successfully developed contact-free devices to address the sanitary crisis in public places. This work aims to systematically review the applications of 3D printing or AM techniques that have been involved in producing various critical products essential to limit this deadly pandemic's progression.

Smart face shield for the monitoring of COVID-19 physiological parameters: Personal protective equipment (PPE) for health-care workers (HCW’s) and COVID-19 patients

The COVID-19 pandemic has triggered instabilities in various aspects of daily life. This includes economic, social, financial, and health crisis. In addition, the COVID-19 pandemic with the evolution of different virus strains such as delta and omicron has led to frequent global lockdowns. These lockdowns have caused disruption of trade activities that in turn have led to the shortage of medical supplies, especially personal protective equipment’s (PPE’s). Health-care workers (HCW’s) have been at the forefront of the fight against this pandemic and are responsible for saving millions of lives worldwide. However, the PPE’s available to HCW’s in the form of face shields and face masks only provide face and eye protection without encapsulating the ability to continuously monitor vital COVID-19 parameters including body temperature, heart rate, and SpO2. Hence, in this study, we propose the design and utilization of a PPE in the form of smart face shield. The device has been integrated with the MAX30102 sensor for measuring the heart rate and oxygen saturation (SpO2) and the DS18B20 body temperature measuring sensor. The readings of these sensors are analyzed by a NodeMCU ESP8266 and measurements are displayed on a laptop screen. Also, the Wi-Fi module of NodeMCU ESP8266 enables compatibility with the ThingSpeak mobile application and permits HCW’s and patients recovering from COVID-19 to keep a track of their physiological parameters. Overall, this PPE has been observed to provide reliable readings and the results indicate that the designed prototype can be used for monitoring COVID-19 essential parameters.

3D-printed mouthpiece adapter for sampling exhaled breath in medical applications

The growing use of 3D printing in the biomedical sciences demonstrates its utility for a wide range of research and healthcare applications, including its potential implementation in the discipline of breath analysis to overcome current limitations and substantial costs of commercial breath sampling interfaces. This technical note reports on the design and construction of a 3D-printed mouthpiece adapter for sampling exhaled breath using the commercial respiration collector for in-vitro analysis (ReCIVA) device. The paper presents the design and digital workflow transition of the adapter and its fabrication from three commercial resins (Surgical Guide, Tough v5, and BioMed Clear) using a Formlabs Form 3B stereolithography (SLA) printer. The use of the mouthpiece adapter in conjunction with a pulmonary function filter is appraised in comparison to the conventional commercial silicon facemask sampling interface. Besides its lower cost - investment cost of the printing equipment notwithstanding - the 3D-printed adapter has several benefits, including ensuring breath sampling via the mouth, reducing the likelihood of direct contact of the patient with the breath sampling tubes, and being autoclaveable to enable the repeated use of a single adapter, thereby reducing waste and associated environmental burden compared to current one-way disposable facemasks. The novel adapter for breath sampling presented in this technical note represents an additional field of application for 3D printing that further demonstrates its widespread applicability in biomedicine.

Scientometric Review for Research Patterns on Additive Manufacturing of Lattice Structures

Over the past 15 years, interest in additive manufacturing (AM) on lattice structures has significantly increased in producing 3D/4D objects. The purpose of this study is to gain a thorough grasp of the research pattern and the condition of the field's research today as well as identify obstacles towards future research. To accomplish the purpose, this work undertakes a scientometric analysis of the international research conducted on additive manufacturing for lattice structure materials published from 2002 to 2022. A total of 1290 journal articles from the Web of Science (WoS) database and 1766 journal articles from the Scopus database were found using a search system. This paper applied scientometric science, which is based on bibliometric analysis. The data were subjected to a scientometric study, which looked at the number of publications, authorship, regions by countries, keyword co-occurrence, literature coupling, and scientometric mapping. VOSviewer was used to establish research patterns, visualize maps, and identify transcendental issues. Thus, the quantitative determination of the primary research framework, papers, and themes of this research field was possible. In order to shed light on current developments in additive manufacturing for lattice structures, an extensive systematic study is provided. The scientometric analysis revealed a strong bias towards researching AM on lattice structures but little concentration on technologies that emerge from it. It also outlined its unmet research needs, which can benefit both the industry and academia. This review makes a prediction for the future, with contributions by educating researchers, manufacturers, and other experts on the current state of AM for lattice structures.

Design of a Low Respiratory Resistance Mask for COVID-19

Observational evidence suggests that mask-wearing mitigates transmission of COVID-19; at the same time high respiratory resistance leads to an unwillingness to wear masks. This paper proposed a respiratory drive structure to reduce the air resistance of a mask. This structure provides different shapes during expiration and inspiration while focusing on filtering dust, bacteria, or viruses. Meanwhile, the assembled system on the mask can be disassembled and replaced. Then porous media simulation is used to verify the model effect. Experimental results of a new mask show that the ventilation resistance is reduced by 20%, and the bacterial filtration efficiency meets the requirements of YY 0469–2011.

Personal Protective Equipment for Liver Transplantation in SARS-CoV-2 Polymerase Chain Reaction-Positive Convalescing Recipients

Personal protective equipment (PPE) comes in several variations, and is the principal safety gear during the COVID-19 pandemic. Unfortunately, the user is severely impacted by its serious nonergonomic features. What PPE is appropriate for labor-intensive cases, like liver transplant (LT), remains unknown. We describe our experience with 2 types of PPE used during 2 separate LT performed in COVID-19 positive recipients. We conclude that for the safety of both health care workers and patients, hospitals should designate a few PPE kits for labor-intensive surgical procedures. These kits should include powered air-purifying respirators, or a similar loose-fitting powered air hood.

Surgical helmets can be converted into efficient disinfectable powered air-purifying respirators

BACKGROUND

Filtering facepiece respirators often fail to provide sufficient protection due to a poor fit. Powered air-purifying respirators (PAPRs) are not designed for healthcare personnel, and are challenging to disinfect. Surgical helmets (SH) are available in many United States hospitals but do not provide respiratory protection. Several modifications to SH have been suggested, but none are sufficiently compliant with safety and efficiency standards. The purpose of this investigation was the development of a filter adaptor, which converts SHs into efficient, safe, and disinfectable PAPRs.

METHODS

Four critical features were investigated close to regulatory requirements: total inward leakage of particles, CO₂ concentrations, intra-helmet differential pressure, and automated disinfection.

RESULTS

The average total inward leakage in the 2 independent tests were 0.005% and 0.01%. CO₂ concentrations were lower than in the original SH. The modification generates a positive differential pressure. The filter's performance was not compromised after 50 cycles in a sterilization machine.

DISCUSSION

The modified SH provides several hundred times better protection than FFP-3 masks.

CONCLUSIONS

Surgical helmets can be modified into safe, efficient, and disinfectable PAPRs, suitable for HCP and the operating room in particular. They can play a role in the preparedness for upcoming events requiring efficient respiratory protection.

The future of 3D food printing: Opportunities for space applications

Over the past decade or so, there have been major advances in the development of 3D printing technology to create innovative food products, including for printing foods in homes, restaurants, schools, hospitals, and even space flight missions. 3D food printing has the potential to customize foods for individuals based on their personal preferences for specific visual, textural, mouthfeel, flavor, or nutritional attributes. Material extrusion is the most common process currently used to 3D print foods, which is based on forcing a fluid or semi-solid food "ink" through a nozzle and then solidifying it. This type of 3D printing application for space missions is particularly promising because a wide range of foods can be produced from a limited number of food inks in a confined area. This is especially important for extended space missions because astronauts desire and require a variety of foods, but space and resources are minimal. This review highlights the potential applications of 3D printing for creating custom-made foods in space and the challenges that need to be addressed.

The use of a surgical helmet system with a high-efficiency particulate air filter as possible protection equipment during the coronavirus disease 2019 pandemic: a double-blinded randomized control study

PURPOSE

The rapid spread of coronavirus disease 2019 (COVID-19) has increased the use of personal protective equipment. The purpose of this study was to investigate whether a commercially available sterile surgical helmet system (SSHS) can be considered protective against COVID-19 and therefore safe for use.

METHODS

A double-blinded randomized controlled study was performed to investigate the efficacy of the ViVi® SSHS with a high-efficiency particulate air filter called HFD Hood (THI, Total Healthcare Innovation GmbH, Feistritz im Rosental, Austria) to protect against respiratory droplets. Forty recruited participants were divided into two different groups. The SSHS was tested using a validated qualitative test for respirator masks through saccharin or placebo solutions based on random allocation into two cohorts. Saccharin droplets are a validated surrogated marker for any elements of viral size, such as coronaviruses. A positive report of sweet taste after saccharin exposure was suggestive of ViVi® SSHS inefficacy in protection against droplets.

RESULTS

One participant out of 21 (4.8%) reported positive for taste within the placebo cohort, while five out of 19 (26.3%) reported positive for taste within the saccharin cohort upon testing. Two out of 21 (9.5%) participants reported positive for taste within the placebo cohort, and two out of 19 (10.5%) reported positive for taste within the saccharin cohort upon retesting. There were no statistically significant differences between the saccharin and placebo groups in either the test or retest measurements (p = 0.085 and p = 1.000, respectively).

CONCLUSIONS

This study demonstrates that the ViVi® SSHS equipped with HFD Hood protects against respiratory droplets, increasing protection against several microorganisms, including the virus that causes COVID-19, allowing surgeons to carry out procedures on COVID-positive patients in a more comfortable and safer way.

Get Us PPE: A Self-Organizing Platform Ecosystem for Supply Chain Optimization during COVID-19

The COVID-19 pandemic caused a global health emergency that triggered an acute shortage of Personal Protective Equipment (PPE), putting essential healthcare workers at risk. Starting March 2020, given the skyrocketing prices of PPE in the open market, healthcare institutions were confronted with the dire need to reshape their PPE procurement strategy. One avenue that financially constrained healthcare institutions pursued were donation platforms that offered access to donated PPE by individuals and organizations. We document a real-life case study of one of the most prominent donor platforms that emerged during this period: Get Us PPE. From 20 March 2020 to 2 July 2021, Get Us PPE received 23,001 total individual requests for PPE from every US state and some US territories. In response to these 23,001 requests, Get Us PPE delivered 17,540,571 units of PPE. The number of PPE units delivered was still less than 25% of the total units of PPE requested, indicating the enormity of the PPE shortage. Using this case study, we identify key supply chain issues that manifest during emergencies and highlight the formation of a platform ecosystem to resolve these issues. We also observed a robust supply chain network design that addresses key supply chain sustainability metrics such as minimizing material waste and transportation miles, while balancing other stakeholder factors such as donor and recipient characteristics as well as shipment complexity. We argue that the roadmap followed by Get Us PPE could serve as a template for organizations that emerge in the context of future humanitarian crises.

Digital technologies, healthcare and Covid-19: insights from developing and emerging nations

COVID-19 pandemic created a global health crisis affecting every nation. The essential smart medical devices/accessories, quarantine facilities, surveillance systems, and related digital technologies are in huge demand. Healthcare, manufacturing industries, and educational institutions need technologies that allow working from a safe location. Digital technologies and Industry 4.0 tools have the potential to fulfil these customized requirements during and post COVID-19 crisis. The purpose of this research is to provide understanding to healthcare professionals, government policymakers, researchers, industry professionals, academics, and students/learners of the paradigm of different Digital technologies, Industry 4.0 tools, and their applications during the COVID-19 pandemic. Digital technologies, Industry 4.0 tools and their current and potential applications have been reviewed. The use of different Digital technologies and Industry 4.0 tools is identified. Digital technologies and Industry 4.0 tools (3D Printing, Artificial Intelligence, Cloud Computing, Autonomous Robot, Biosensor, Telemedicine service, Internet of Things (IoT), Virtual reality, and holography) offer opportunities for effective delivery of healthcare service(s), online education, and Work from Home (WFH) environment. The article emphasises the usefulness, most recent development, and implementation of Digital technologies, Industry 4.0 techniques, and tools in fighting the COVID-19 pandemic worldwide.

3D-Printed Microfluidics Potential in Combating Future and Current Pandemics (COVID-19)

Coronavirus disease (COVID-19) emerged in China in December 2019. In March 2020, the WHO declared it a pandemic leading to worldwide lockdowns and travel restrictions. By May, it infected 4,789,205 and killed 318,789 people. This led to severe shortages in the medical sector besides devastating socio-economic effects. Many technologies such as artificial intelligence (AI), virtual reality (VR), microfluidics, 3D printing, and 3D scanning can step into contain the virus and hinder its extensive spread. This article aims to explore the potentials of 3D printing and microfluidic in accelerating the diagnosis and monitoring of the disease and fulfilling the shortages of personal protective equipment (PPE) and medical equipment. It highlights the main applications of 3D printers and microfluidics in providing PPE (masks, respirators, face shields, goggles, and isolation chambers/hoods), supportive care (respiratory equipment) and diagnostic supplies (sampling swabs & lab-on-chip) to ease the COVID-19 pressures. Also, the cost of such technology and regulation considerations are addressed. We conclude that 3D printing provided reusable and low-cost solutions to mitigate the shortages. However, safety, sterility, and compatibility with environmental protection standards need to be guaranteed through standardization and assessment by regulatory bodies. Finally, lessons learned from this pandemic can also help the world prepare for upcoming outbreaks.

Additive manufacturing against the Covid-19 pandemic: a technological model for the adaptability and networking

This investigation analyzes the main contributions that additive manufacturing (AM) technology provides to the world in fighting against the pandemic COVID-19 from a materials and applications perspective. With this aim, different sources, which include academic reports, initiatives, and industrial companies, have been systematically analyzed. The AM technology applications include protective masks, mechanical ventilator parts, social distancing signage, and parts for detection and disinfection equipment (Ju, 2020). There is a substantially increased number of contributions from AM technology to this global issue, which is expected to continuously increase until a sound solution is found. The materials and manufacturing technologies in addition to the current challenges and opportunities were analyzed as well. These contributions came from a lot of countries, which can be used as a future model to work in massive collaboration, technology networking, and adaptability, all lined up to provide potential solutions for some of the biggest challenges the human society might face in the future.

3D Printing in Eye Care

Three-dimensional printing enables precise modeling of anatomical structures and has been employed in a broad range of applications across medicine. Its earliest use in eye care included orbital models for training and surgical planning, which have subsequently enabled the design of custom-fit prostheses in oculoplastic surgery. It has evolved to include the production of surgical instruments, diagnostic tools, spectacles, and devices for delivery of drug and radiation therapy. During the COVID-19 pandemic, increased demand for personal protective equipment and supply chain shortages inspired many institutions to 3D-print their own eye protection. Cataract surgery, the most common procedure performed worldwide, may someday make use of custom-printed intraocular lenses. Perhaps its most alluring potential resides in the possibility of printing tissues at a cellular level to address unmet needs in the world of corneal and retinal diseases. Early models toward this end have shown promise for engineering tissues which, while not quite ready for transplantation, can serve as a useful model for in vitro disease and therapeutic research. As more institutions incorporate in-house or outsourced 3D printing for research models and clinical care, ethical and regulatory concerns will become a greater consideration. This report highlights the uses of 3D printing in eye care by subspecialty and clinical modality, with an aim to provide a useful entry point for anyone seeking to engage with the technology in their area of interest.

Orthopedic Surgical Helmet Systems Significantly Impair Speech Intelligibility

Surgical suits provide protection to orthopedic surgeons, but the suits and fan noise may interfere with communication between operative team members. The goal of this study was to quantify the fan sound and effect of the suit, fan, and N95 mask. Sound levels were measured using a specialized manikin and evaluated using preferred speech interference levels (PSILs), noise criterion (NC) ratings, and comparison with speech sound levels from the literature. Additionally, sound blocking due to the surgical suit was measured and combined effects of the fan and suit were described using a signal to noise ratio (SNR). The noise with the fan at medium and high speed was louder than average speech and the PSILs at these speeds were significantly higher than with the fan off. The fan NC rating of 50 to 60 exceeded the recommended range of 25 to 30 for operating rooms. The N95 mask, space suit, and distance between speaker and receiver all reduced the sound signal at the receiver's ear, with the worst case being full personal protective equipment on both and speaker distanced from receiver. The estimated SNR for the suit and fan system was negative for many frequency bands used in speech, indicating more noise than signal. Multiple measures indicated that the fan noises were at levels associated with speech interference. This noise combined with sound blocking provided by the suit produced SNRs commonly associated with noisy to very noisy environments. This study suggests the combined effects of the suit, fan, and distance may negatively impact operating room communication. [Orthopedics. 2021;44(4):208-214.].

Shortage of Personal Protective Equipment and Nurse Safety in the Coronavirus Disease-19 Pandemic: A Cross-sectional Study in Indonesia

BACKGROUND: There has been a substantial scarcity of personal protective equipment (PPE) in several countries during the ongoing pandemic of Coronavirus disease-19 (COVID-19). Nurses in Indonesia also experience a shortage of PPE as the number of COVID-19 patients in Indonesia continues to increase. There is no accurate data yet regarding the exact number of PPE scarcity for nurses. AIM: This study aimed to describe the availability of PPE and adverse consequences long-term used off the PPE and examine the relationship between shortage PPE and nurse behavior response in Indonesia. METHODS: An online-based survey was used to collect data on the nurse, regardless of their discipline, training background, or degree of experience, who are directly involved in managing COVID-19 patients. In this study, a total of 211 questionnaires were gathered. The survey was conducted using the Google form. This study employs univariate and bivariate analysis. RESULTS: Most of the mask N95 provision reaches up to 80%. The second is the hazmat (71%) and the lowest in the gloves (30%). Around 71% of respondents generally resist removing their PPE until the shift is complete. Then, 62% of the respondents are ready to propose to the leaders of the PPE, and 51% show that they are modifying the PPE. Nasal blisters are the most prevalent type of injury sustained by nurses while wearing PPE (86%), followed by headaches and dehydration. This study found that most respondents (60.7%) with insufficient PPE had a positive behavior reaction, whereas just 18% had a poor behavior reaction. CONCLUSION: Most nurses have difficulties accessing N95 and experience some adverse effects of prolonging PPE use. Policymakers should take urgent action to tackle these concerns.

Use of Industrial Filters by Health Care Workers During Shortages of N95 Respirators in Pandemic Times

The coronavirus disease 2019 (COVID-19) pandemic has led to a significant shortage of personal protective equipment in multiple health care facilities around the world, with the highest impact on N95 respirator masks. The N95 respirator is a mask that blocks at least 95% of very small (0.3 μm) particles and is considered a standard for enhanced respiratory precautions. The N95 mask shortage has created a need for other options for nasal and oral respiratory protection with similar filtration efficiency and "medical-grade" clearance, which can be used in health care settings. However, the literature around various filter types, their filtration capabilities, and the organizations certifying their use is dense, confusing, and not easily accessible to the public. Here, we synthesize relevant literature to analyze and disseminate information on (1) alternative viable filter options to N95s, (2) the National Institute for Occupational Safety and Health certification process, (3) the relationship of National Institute for Occupational Safety and Health certification to Food and Drug Administration certification of filtration devices and surgical masks, and (4) how this relationship may affect future filtration usage in the medical community during a pandemic. Analysis of these standards is meant to inform regarding evidence of respirator efficacy but does not imply any official endorsement of these alternatives. With this article, we illuminate viable alternative respirator options during the COVID-19 pandemic to help alleviate the dependency on N95 face masks.

Novel 3D printable powered air purifying respirator for emergency use during PPE shortage of the COVID-19 pandemic: a study protocol and device safety analysis

OBJECTIVES

To design a low-cost 3D printable powered air-purifying respirator (PAPR) that meets National Institute for Occupational Safety and Health (NIOSH) standard for flow rate and Occupational Safety and Health Administration (OSHA) standard for particle filtration for loose-fitting PAPRs and that can be made with a 3D printer and widely available materials.

DESIGN

Detailed description of components, assembly instructions and testing of a novel PAPR design in an academic laboratory following respective protocols. The assembled PAPR must meet NIOSH standards of flow rate, 170 L/min; OSHA fit factor for particle filtration, ≥250 and maintain positive pressure during regular and deep breathing.

MAIN OUTCOME MEASURES

The PAPR design was run through a series of tests: air flow (L/min), particle filtration (quantitative and qualitative) and positive pressure measured inside the helmet (mm Hg).

RESULTS

Flow rate was 443.32 L/min (NIOSH standard: minimum 170 L/min) and overall fit factor for particle filtration was 1362 (OSHA pass level: ≥500), n=1. The device passed qualitative particle filtration, n=2, and measured peak pressure of 6mm Hg (>0 mm Hg indicates positive pressure) in the helmet, n=1.

CONCLUSIONS

The Hygieia PAPR is a low-cost, easily accessible, just-in-time 3D printable PAPR design that meets minimum NIOSH and OSHA standards for flow-rate and particle filtration for loose-fitting PAPR devices to be made and used when industry-made designs are unavailable.

3D Printing for Medical Applications: Current State of the Art and Perspectives during the COVID-19 Crisis

The coronavirus SARS-CoV-2 pandemic has affected over one hundred million people worldwide and has resulted in over two million deaths. In addition to the toll that coronavirus takes on the health of humans infected with the virus and the potential long term effects of infection, the repercussions of the pandemic on the economy as well as on the healthcare system have been enormous. The global supply of equipment necessary for dealing with the pandemic experienced extreme stress as healthcare systems around the world attempted to acquire personal protective equipment for their workers and medical devices for treating COVID-19. This review describes how 3D printing is currently being used in life saving surgeries such as heart and lung surgery and how 3D printing can address some of the worldwide shortage of personal protective equipment, by examining recent trends of the use of 3D printing and how these technologies can be applied during and after the pandemic. We review the use of 3D printed models for treating the long term effects of COVID-19. We then focus on methods for generating face shields and different types of respirators. We conclude with areas for future investigation and application of 3D printing technology.

Chronicling the effect of COVID-19 on orthopedic literature

Background

The novel coronavirus disease (COVID-19) has had a significant impact on orthopedic surgery practice, but there has been little investigation of the effects of COVID-19 on the orthopedic surgery literature. Additionally, because orthopedic research plays a vital role in physician education, changes to the characteristics and content of published literature can have lasting impacts on future teaching and learning. This paper represents the first known analysis of the COVID-19 pandemic's impact on peer-reviewed articles published in orthopedic surgery journals.

Methods

The 20 orthopedic journals with the highest impact factors in 2019, according to the Journal Citation Reports, were included in this study. Using PubMed and COVID-19 related keywords as well as manual screening, a final count of 199 articles were assessed for this study and subsequently sorted by country of origin, orthopedic subspecialty, article type, and general theme. Kruskal Wallis and Pearson's Chi-squared tests were used to analyze continuous and categorical variables, respectively.

Results

Fourteen journals published articles relating to COVID-19, representing 26 countries with the United States (37%) and United Kingdom (13%) publishing the greatest proportion of all COVID-19 articles. Sixty percent of publications discussed COVID-19's impact on the overall field of orthopedic surgery, with the remainder focusing on specific subspecialties. Forty-seven percent of publications were original research articles while 46% were editorials or commentaries. The median time to publication for all COVID-19 related articles was 24.5 days, compared to the 129 days reported for orthopedic journals prior to the COVID-19 pandemic (p < 0.001). In the first 100 articles published, 49% (n = 49) originated exclusively from United States institutions, whereas only 25% (n = 25) of the next ninety-nine articles had US-only institutions (p < 0.001).

Conclusions

The COVID-19 pandemic has significantly impacted the characteristics, content, and time to publication of the orthopedic surgery literature. The data and ideas presented in this paper should help streamline future, formal analysis on the lasting implications of COVID-19 on orthopedic surgery practice, teaching, and learning.

Effect of N95 filtering facepiece respirators on dental health professionals with an emphasis on pulmonary function and heart rate: An intrasubject comparison

Despite the ubiquitous use of N95 filtering facepiece respirators (N95 FFR), published literature on the topic remains scarce, especially in relation to dental professionals. This study assesses the impact of N95 FFRs on blood oxygen saturation and heart rate of dental health professionals while performing procedures requiring varying degrees of physical exertion in an aerosol-rich environment. A total of 51 participants, consisting of 43 men and eight women aged between 23 and 31 years were recruited into the study. All subjects were well-versed in wearing personal protective equipment (PPE). A clinical grade pulse oximeter was used with a clamp placed around the fingertip or the earlobe of the participant. The selection of N95 FFR was based on fit and leakage. All data were collected once from the same participants using a surgical mask as a control. Data were collected again from the same subjects after 1, 2, and 3 hours of use. There were significant differences in both oxygen saturation (SpO₂) and heart rate between the two groups after 1, 2, and 3 hours of wearing the respective masks. In healthy young individuals, wearing an N95 FFR for an extended period of time during clinical dental procedures reduced the SpO₂level and increased the heart rate compared with a standard surgical mask. However, SpO₂ levels remained within a healthy range of more than 95%, and heart rate was within acceptable limits.

The rise of 3D Printing entangled with smart computer aided design during COVID-19 era

During the current Pandemic, seven and a half million flights worldwide were canceled which disrupted the supply chain of all types of goods such as, personal protective gears, medical health devices, raw materials, food, and other essential equipments. The demand for health and medical related goods increased during this period globally, while the production using classical manufacturing techniques were effected because of the lockdowns and disruption in the transporation system. This created the need of geo scattered, small, and rapid manufacturing units along with a smart computer aided design (CAD) facility. The availability of 3D printing technologies and open source CAD design made it possible to overcome this need. In this article, we present an extensive review on the utilization of 3D printing technology in the days of pandamic. We observe that 3D printing together with smart CAD design show promise to overcome the disruption caused by the lockdown of classical manufacturing units specially for medical and testing equipment, and protective gears. We observe that there are several short communications, commentaries, correspondences, editorials and mini reviews compiled and published; however, a systematic state-of-the-art review is required to identify the significance of 3D printing, design for additive manufacturing (AM), and digital supply chain for handling emergency situations and in the post-COVID era. We present a review of various benefits of 3DP particularly in emergency situations such as a pandemic. Furthermore, some relevant iterative design and 3DP case studies are discussed systematically. Finally, this article highlights the areas that can help to control the emergency situation such as a pandemic, and critically discusses the research gaps that need further research in order to exploit the full potential of 3DP in pandemic and post-pandemic future era.

Applications of additive manufacturing (AM) in sustainable energy generation and battle against COVID-19 pandemic: The knowledge evolution of 3D printing

Sustainable and cleaner manufacturing systems have found broad applications in industrial processes, especially aerospace, automotive and power generation. Conventional manufacturing methods are highly unsustainable regarding carbon emissions, energy consumption, material wastage, costly shipment and complex supply management. Besides, during global COVID-19 pandemic, advanced fabrication and management strategies were extremely required to fulfill the shortfall of basic and medical emergency supplies. Three-dimensional printing (3DP) reduces global energy consumption and CO2 emissions related to industrial manufacturing. Various renewable energy harvesting mechanisms utilizing solar, wind, tidal and human potential have been fabricated through additive manufacturing. 3D printing aided the manufacturing companies in combating the deficiencies of medical healthcare devices for patients and professionals globally. In this regard, 3D printed medical face shields, respiratory masks, personal protective equipment, PLA-based recyclable air filtration masks, additively manufactured ideal tissue models and new information technology (IT) based rapid manufacturing are some significant contributions of 3DP. Furthermore, a bibliometric study of 3D printing research was conducted in CiteSpace. The most influential keywords and latest research frontiers were found and the 3DP knowledge was categorized into 10 diverse research themes. The potential challenges incurred by AM industry during the pandemic were categorized in terms of design, safety, manufacturing, certification and legal issues. Significantly, this study highlights the versatile role of 3DP in battle against COVID-19 pandemic and provides up-to-date research frontiers, leading the readers to focus on the current hurdles encountered by AM industry, henceforth conduct further investigations to enhance 3DP technology.

Additive manufacturing and the COVID-19 challenges: An in-depth study

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapidly achieved global pandemic status. The pandemic created huge demand for relevant medical and personal protective equipment (PPE) and put unprecedented pressure on the healthcare system within a very short span of time. Moreover, the supply chain system faced extreme disruption as a result of the frequent and severe lockdowns across the globe. In such a situation, additive manufacturing (AM) becomes a supplementary manufacturing process to meet the explosive demands and to ease the health disaster worldwide. Providing the extensive design customization, a rapid manufacturing route, eliminating lengthy assembly lines and ensuring low manufacturing lead times, the AM route could plug the immediate supply chain gap, whilst mass production routes restarted again. The AM community joined the fight against COVID-19 by producing components for medical equipment such as ventilators, nasopharyngeal swabs and PPE such as face masks and face shields. The aim of this article is to systematically summarize and to critically analyze all major efforts put forward by the AM industry, academics, researchers, users, and individuals. A step-by-step account is given summarizing all major additively manufactured products that were designed, invented, used, and produced during the pandemic in addition to highlighting some of the potential challenges. Such a review will become a historical document for the future as well as a stimulus for the next generation AM community.

Innovation in a Time of Crisis: A Systematic Review of Three-Dimensional Printing in the COVID-19 Pandemic

The coronavirus (COVID-19) global pandemic resulted in the breakdown of traditional supply chains responsible for providing essential equipment to hospitals and personal protective equipment (PPE) for health and social care workers. The three-dimensional (3D) printing community has responded to emerging need by recognizing shortages across health care systems and providing innovative solutions in real time, circumventing short-term global supply issues. A systematic review was undertaken to investigate the role of 3D printing in the COVID-19 pandemic in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the MEDLINE, EMBASE, and World Health Organization (WHO) COVID-19 databases. Newspaper and internet article sources were identified using the NEXIS media database. All studies and articles on the application of 3D printed solutions during the peak of the COVID-19 pandemic were included. The literature search identified 26 related articles, and 13 studies met inclusion criteria and were suitable for full-text review. One thousand two hundred and one unique digital media articles were identified; after removal of duplicates and screening of headlines for the inclusion and exclusion criteria, 460 articles were suitable for full-text review. The cross-collaboration between the 3D printing community and health care systems has aided in the provision of innovative solutions to combat the COVID-19 crisis. The applications for 3D printing ranged from oxygenation equipment to noninvasive and invasive ventilatory parts and innovative solutions for infection control and quarantine hubs. This review has identified that 3D printing technology has made the biggest contribution to the production of PPE in particular face shields, mirroring the areas of greatest shortage and need. Additive manufacturing has played a pivotal role in aligning disciplines in engineering, science, and medicine for the greater good. We have witnessed the rapid reconfiguration of traditional supply chains to circumvent global shortages, while making advancements in effort to limit the impact of this and future pandemics.

Printing in a Pandemic: 3D printing solutions for healthcare during COVID-19. A Protocol for a PRISMA systematic review

Introduction

The COVID-19 pandemic had an unprecedented global socioeconomic impact. Responses to pandemics include strategies to accumulate vast stockpiles of vital medical equipment. In such times of desperation, 3D-printing could be a life-saving alternative.

Methods

We undertook a PRISMA systematic review of 3D printing solutions in response to COVID-19 utilising the PICO methodology. The objectives were to identify the uses of 3D printing during the COVID-19 pandemic, determine the extent of preclinical testing, comparison to commercial alternatives, presence of regulatory approvals and replicability regarding the description of the printing parameters and the availability of the print file.

Results

Literature searches of MEDLINE (OVID interface)/ PubMed identified 601 studies. Of these, 10 studies fulfilled the inclusion and exclusion criteria. Reported uses of 3D printing included personal protective equipment (PPE), nasopharyngeal swabs and adjunctive anaesthetic equipment. Few studies undertook formal safety and efficacy testing before clinical use with only one study comparing to the commercial equivalent. Six articles made their model print files available for wider use.

Conclusion

We describe a protocol for a systematic review of 3D-printed healthcare solutions in response to COVID-19. This remains a viable method of producing vital healthcare equipment when supply chains are exhausted. We hope that this will serve as a summary of innovative 3D-printed solutions during the peak of the pandemic and also highlight concerns and omissions regarding safety and efficacy testing that should be addressed urgently in preparation for a subsequent resurgences and future pandemics.

Polymer 3D Printing Review: Materials, Process, and Design Strategies for Medical Applications

Polymer 3D printing is an emerging technology with recent research translating towards increased use in industry, particularly in medical fields. Polymer printing is advantageous because it enables printing low-cost functional parts with diverse properties and capabilities. Here, we provide a review of recent research advances for polymer 3D printing by investigating research related to materials, processes, and design strategies for medical applications. Research in materials has led to the development of polymers with advantageous characteristics for mechanics and biocompatibility, with tuning of mechanical properties achieved by altering printing process parameters. Suitable polymer printing processes include extrusion, resin, and powder 3D printing, which enable directed material deposition for the design of advantageous and customized architectures. Design strategies, such as hierarchical distribution of materials, enable balancing of conflicting properties, such as mechanical and biological needs for tissue scaffolds. Further medical applications reviewed include safety equipment, dental implants, and drug delivery systems, with findings suggesting a need for improved design methods to navigate the complex decision space enabled by 3D printing. Further research across these areas will lead to continued improvement of 3D-printed design performance that is essential for advancing frontiers across engineering and medicine.

Total Joint Arthroplasty During the COVID-19 Pandemic: A Scoping Review with Implications for Future Practice

BACKGROUND

Recent studies have examined the impact of the COVID-19 pandemic on the practice of total joint arthroplasty. A scoping review of the literature with compiled recommendations is a useful tool for arthroplasty surgeons as they resume their orthopedic practices during the pandemic.

METHODS

In June 2020, PubMed, Embase (Ovid), Cochrane Library (Wiley), Scopus, LitCovid, CINAHL, medRxiv, and bioRxiv were queried for articles using controlled vocabulary and keywords pertaining to COVID-19 and total joint arthroplasty. Studies were characterized by their region of origin, design, and Center of Evidence Based Medicine level of evidence. The identified relevant studies were grouped into 6 categories: changes to future clinical workflow, education, impact on patients, impact on surgeons, technology, and surgical volume.

RESULTS

The COVID-19 pandemic has had a significant impact on arthroplasty practice, including the disruption of the clinical teaching environment, personal and financial consequences for patients and physicians, and the drastic reduction in surgical volume. New pathways for clinical workflow have emerged, along with novel technologies with applications for both patients and trainees.

CONCLUSIONS

The COVID-19 pandemic emphasizes the recent trend in arthroplasty toward risk stratification and outpatient surgery, which may result in improved clinical outcomes and significant cost-savings. Furthermore, virtual technologies are a promising area of future focus that may ultimately improve upon previous existing inefficiencies in the education and clinical environments.

Development of a Low-Resource Operating Room and a Wide-Awake Orthopedic Surgery Program During the COVID-19 Pandemic

Introduction. The COVID-19 pandemic resulted in significant medication, supply and equipment, and provider shortages, limiting the resources available for provision of surgical care. In response to mandates restricting surgery to high-acuity procedures during this period, our institution developed a multidisciplinary Low-Resource Operating Room (LROR) Taskforce in April 2020. This study describes our institutional experience developing an LROR to maintain access to urgent surgical procedures during the peak of the COVID-19 pandemic. Methods. A delineation of available resources and resource replacement strategies was conducted, and a final institution-wide plan for operationalizing the LROR was formed. Specialty-specific subgroups then convened to determine best practices and opportunities for LROR utilization. Orthopedic surgery performed in the LROR using wide-awake local anesthesia no tourniquet (WALANT) is presented as a use case. Results. Overall, 19 limited resources were identified, spanning across the domains of physical space, drugs, devices and equipment, and personnel. Based on the assessment, the decision to proceed with creation of an LROR was made. Sixteen urgent orthopedic surgeries were successfully performed using WALANT without conversion to general anesthesia. Conclusion. In response to the COVID-19 pandemic, a LROR was successfully designed and operationalized. The process for development of a LROR and recommended strategies for operating in a resource-constrained environment may serve as a model for other institutions and facilitate rapid implementation of this care model should the need arise in future pandemic or disaster situations.

3D-printed shields for slit lamps produced during the COVID-19 pandemic

Additive manufacturing has been extensively used during the COVID-19 pandemic to design and produce protection equipment. During clinical examinations using slit lamps, ophthalmologists are at risk of being contaminated by the SARS-CoV-2 virus, and the device itself is exposed to viral contamination. Several solutions have already been proposed for fixing transparent shields on the physician side. Here we propose a 3D-printed device fixed on the chin rest on the patient side, aiming at limiting viral spread both on the lamp itself and towards the physician.

Supporting the Quadruple Aim Using Simulation and Human Factors During COVID-19 Care

The health care sector has made radical changes to hospital operations and care delivery in response to the coronavirus disease (COVID-19) pandemic. This article examines pragmatic applications of simulation and human factors to support the Quadruple Aim of health system performance during the COVID-19 era. First, patient safety is enhanced through development and testing of new technologies, equipment, and protocols using laboratory-based and in situ simulation. Second, population health is strengthened through virtual platforms that deliver telehealth and remote simulation that ensure readiness for personnel to deploy to new clinical units. Third, prevention of lost revenue occurs through usability testing of equipment and computer-based simulations to predict system performance and resilience. Finally, simulation supports health worker wellness and satisfaction by identifying optimal work conditions that maximize productivity while protecting staff through preparedness training. Leveraging simulation and human factors will support a resilient and sustainable response to the pandemic in a transformed health care landscape.

The role of three-dimensional printing in coronavirus disease-19 medical management: A French nationwide survey

Objectives

Coronavirus disease-19 (COVID-19) has spread worldwide and poses various challenges to healthcare services. The limited supply of medical and personal-protective equipment has affected the ability of many countries to respond to the crisis. Three-dimensional printing (3DP) is well suited to addressing these shortages. We assessed the medical role of 3DP during the COVID-19 outbreak in hospitals in France.

Design

Retrospective survey.

Setting and intervention

We included and questioned all French level-1 and -2 COVID-certified centers.

Participants

One hundred and thirty-eight COVID-certified centers were contacted across France: 38 (27.5 %) level 1 and 100 (72.5 %) level 2 centers. The analysis focused on 133 centers (96.37 %), among which 98 (73.68 %) used 3DP.

Main outcome measures

The primary endpoint was the number of pieces printed in 3D. The secondary endpoints were the mode, type, and benefits of 3DP.

Results

The total number of pieces printed in 3D nationwide was 84,886: 76,000 pieces of individual protective equipment (IPE) (89.53 %), 6335 pieces of biomedical equipment (7.47 %), and 2551 prototypes (3.01 %). In 91 cases (92.85 %), 3DP was performed using external printers. The pieces 3D-printed by the various centers helped around 6109 patients and protected around 41,091 caregivers.

Conclusions

3DP produced more than 84,000 pieces at 98 centers, helped more than 6000 patients, and protected more than 41,000 caregivers. Therefore, 3DP played a major role in medical aid during the COVID-19 outbreak in France.

3D printing in the battle against COVID-19

Coronavirus disease 2019 (COVID-19) that is SARS-CoV-2, previously called 2019-nCoV, is a kind of human infectious disease caused by severe acute respiratory syndrome coronavirus. Based on the prompt increase of human infection rate, COVID-19 outbreak was distinguished as a pandemic by the World Health Organization (WHO). By 2020, COVID-19 becomes a major health problem all around the world. Due to the battle against COVID-19, there are some adversities that are encountered with. The most significant difficulty is the lack of equipment for the COVID-19 battle. Lately, there is not sufficient personal protective equipment (PPE) for hospital workers on the front lines in this terrifying time. All around the world, hospitals are overwhelmed by the volume of patients and the lack of personal protective equipment including face masks, gloves, eye protection and clothing. In addition, the lack of nasal swabs, which are necessary components, that are used for testing is another issue that is being faced. There are a small number of respirators, which are emergency devices that help patients breathe for a short period of time. To overcome the limited number of equipment available, the foremost solution can be 3D printing that allows three-dimensional renderings to be realized as physical objects with the use of a printer and that revolutionized prototyping. Low-cost desktop 3D printers allow economical 3D models and guides but have less quality approvals. 3D printing is already well integrated into the process of COVID-19 battle by manufacturing the equipment that are convenient. The goals of this review are to explore the techniques of 3D printing for the equipment that are used for COVID-19 battle and evaluate the materials that are used for manufacturing and the manufactured equipment. Lastly, the advantages and disadvantages of 3D printing are figured out.

3D Printing in Development of Nanomedicines

Three-dimensional (3D) printing is gaining numerous advances in manufacturing approaches both at macro- and nanoscales. Three-dimensional printing is being explored for various biomedical applications and fabrication of nanomedicines using additive manufacturing techniques, and shows promising potential in fulfilling the need for patient-centric personalized treatment. Initial reports attributed this to availability of novel natural biomaterials and precisely engineered polymeric materials, which could be fabricated into exclusive 3D printed nanomaterials for various biomedical applications as nanomedicines. Nanomedicine is defined as the application of nanotechnology in designing nanomaterials for different medicinal applications, including diagnosis, treatment, monitoring, prevention, and control of diseases. Nanomedicine is also showing great impact in the design and development of precision medicine. In contrast to the "one-size-fits-all" criterion of the conventional medicine system, personalized or precision medicines consider the differences in various traits, including pharmacokinetics and genetics of different patients, which have shown improved results over conventional treatment. In the last few years, much literature has been published on the application of 3D printing for the fabrication of nanomedicine. This article deals with progress made in the development and design of tailor-made nanomedicine using 3D printing technology.

Algorithmic matching of personal protective equipment donations with healthcare facilities during the COVID-19 pandemic

GetUsPPE.org has built a centralized platform to facilitate matches for PPE donations, with an active role in matching donors with the appropriate recipients. A manual match process was limited by volunteer hours, thus we developed an open-access matching algorithm using a linear programming-based transportation model. From April 14, 2020 to April 27, 2020, the algorithm was used to match 83,136 items of PPE to 135 healthcare facilities in need across the United States with a median of 214.3 miles traveled, 100% of available donations matched, met the full quantity of requested PPE for 67% of recipients matched, and with 46% matches under 30 miles traveled. Compared with the period April 1, 2020 to April 13, 2020, when PPE matching was manual, the algorithm resulted in a 280% increase in matches/day. This publicly available automated algorithm could be deployed in future situations when the healthcare supply chain is insufficient.

Review on 3D printing: Fight against COVID-19

The outbreak of coronavirus disease in 2019 (COVID-19) caused by the SARS-CoV-2 virus and its pandemic effects have created a demand for essential medical equipment. To date, there are no specific, clinically significant licensed drugs and vaccines available for COVID-19. Hence, mapping out COVID-19 problems and preventing the spread with relevant technology are very urgent. This study is a review of the work done till October, 2020 on solving COVID-19 with 3D printing. Many patients who need to be hospitalized because of COVID-19 can only survive on bio-macromolecules antiviral respiratory assistance and other medical devices. A bio-cellular face shield with relative comfortability made of bio-macromolecules polymerized polyvinyl chloride (BPVC) and other biomaterials are produced with 3D printers. Summarily, it was evident from this review study that additive manufacturing (AM) is a proffered technology for efficient production of an improved bio-macromolecules capable of significant COVID-19 test and personal protective equipment (PPE) to reduce the effect of COVID-19 on the world economy. Innovative AM applications can play an essential role to combat invisible killers (COVID-19) and its hydra-headed pandemic effects on humans, economics and society.

Comparing cost and print time estimates for six commercially-available 3D printers obtained through slicing software for clinically relevant anatomical models

Background

3D printed patient-specific anatomical models have been applied clinically to orthopaedic care for surgical planning and patient education. The estimated cost and print time per model for 3D printers have not yet been compared with clinically representative models across multiple printing technologies. This study investigates six commercially-available 3D printers: Prusa i3 MK3S, Formlabs Form 2, Formlabs Form 3, LulzBot TAZ 6, Stratasys F370, and Stratasys J750 Digital Anatomy.

Methods

Seven representative orthopaedic standard tessellation models derived from CT scans were imported into the respective slicing software for each 3D printer. For each printer and corresponding print setting, the slicing software provides a print time and material use estimate. Material quantity was used to calculate estimated model cost. Print settings investigated were infill percentage, layer height, and model orientation on the print bed. The slicing software investigated are Cura LulzBot Edition 3.6.20, GrabCAD Print 1.43, PreForm 3.4.6, and PrusaSlicer 2.2.0.

Results

The effect of changing infill between 15% and 20% on estimated print time and material use was negligible. Orientation of the model has considerable impact on time and cost with worst-case differences being as much as 39.30% added print time and 34.56% added costs. Averaged across all investigated settings, horizontal model orientation on the print bed minimizes estimated print time for all 3D printers, while vertical model orientation minimizes cost with the exception of Stratasys J750 Digital Anatomy, in which horizontal orientation also minimized cost. Decreasing layer height for all investigated printers increased estimated print time and decreased estimated cost with the exception of Stratasys F370, in which cost increased. The difference in material cost was two orders of magnitude between the least and most-expensive printers. The difference in build rate (cm³/min) was one order of magnitude between the fastest and slowest printers.

Conclusions

All investigated 3D printers in this study have the potential for clinical utility. Print time and print cost are dependent on orientation of anatomy and the printers and settings selected. Cost-effective clinical 3D printing of anatomic models should consider an appropriate printer for the complexity of the anatomy and the experience of the printer technicians.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41205-020-00091-4.

Improvising the surgical helmet system for aerosol-generating procedures in the OR: Surgeon designed 3D printed mould for augmented filtration system

1 BACKGROUND

The aim of this paper is to describe the process of designing and developing a mould for filter placement via 3D printing on top of the surgical helmet. This mould was designed to affix a filter material on top of the helmet system for use during the COVID - 19 pandemic.

2 METHOD

The authors performed 3D scanning of the Stryker Surgical helmet (Stryker T5, REF 400-610, US patents 6,973,677:7,753,682) and created a negative template of the top of the helmet. A mould for filter placement was printed and fitted onto the top of the surgical helmet. This construct was tested to evaluate the surgeon's comfort, aerosol filtration efficiency etc.

3 RESULT

The helmet provided adequate comfort, showed no evidence of staining on spill test and the filter passed the industry filtration efficiency standards.

4 CONCLUSION

The 3D printed mould is an inexpensive, efficient, and comfortable design to augment personal protection ability of the Stryker helmet system. This process can be extrapolated to 3D print templates for other surgical helmets.

Maintaining Access to Orthopaedic Surgery During Periods of Operating Room Resource Constraint: Expanded Use of Wide-Awake Surgery During the COVID-19 Pandemic

INTRODUCTION

Wide-awake local anesthesia no tourniquet (WALANT) presents a nonstandard anesthetic approach initially described for use in hand surgery that has gained interest and utilization across a variety of orthopaedic procedures. In response to operating room resource constraints imposed by the COVID-19 pandemic, our orthopaedic service rapidly adopted and expanded its use of WALANT.

METHODS

A retrospective review of 16 consecutive cases performed by 7 surgeons was conducted. Patient demographics, surgical details, and perioperative outcomes were assessed. The primary end point was WALANT failure, defined as intraoperative conversion to general anesthesia.

RESULTS

No instances of WALANT failure requiring conversion to general anesthesia occurred. In recovery, one patient (6%) required narcotics for pain control, and the average postoperative pain numeric rating scale was 0.6. The maximum pain score experienced was 4 in the patient requiring postoperative narcotics. The average time in recovery was 42 minutes and ranged from 8 to 118 minutes.

CONCLUSION

The WALANT technique was safely and effectively used in 16 cases across multiple orthopaedic subspecialties, including three procedures not previously described in the literature. WALANT techniques hold promise for use in future disaster scenarios and should be evaluated for potential incorporation into routine orthopaedic surgical care.

The role of 3D printing during COVID-19 pandemic: a review

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has spread through more than 180 countries, leading to diverse health systems overload around the world. Because of the high number of patients and the supply chain disruption, it generated a shortage of medical devices and personal protective equipment. In this context, initiatives from the additive manufacturing community emerged to fight the lack of devices. Diverse designs were produced and are currently being used in hospitals by patients and health workers. However, as some devices must follow strict standards, these products may not fulfill these standards. Therefore, to ensure the user's health, there is a need for understanding each device, their usage, and standards. This study reviews the use of additive manufacturing during COVID-19 pandemic. It gathers the source of several 3D printed devices such as face shields, face masks, valves, nasopharyngeal swabs, and others, discussing their use and regulatory issues. In this regard, the major drawbacks of the technology, addressed for the next pandemic scenario, are highlighted. Finally, some insights of the future of additive manufacturing during emergency are given and discussed.

Integrated 3D printing solution to mitigate shortages of airway consumables and personal protective equipment during the COVID-19 pandemic

BACKGROUND

To cope with shortages of equipment during the COVID-19 pandemic, we established a nonprofit end-to-end system to identify, validate, regulate, manufacture, and distribute 3D-printed medical equipment. Here we describe the local and global impact of this system.

METHODS

Together with critical care experts, we identified potentially lacking medical equipment and proposed solutions based on 3D printing. Validation was based on the ISO 13485 quality standard for the manufacturing of customized medical devices. We posted the design files for each device on our website together with their technical and printing specifications and created a supply chain so that hospitals from our region could request them. We analyzed the number/type of items, petitioners, manufacturers, and catalogue views.

RESULTS

Among 33 devices analyzed, 26 (78·8%) were validated. Of these, 23 (88·5%) were airway consumables and 3 (11·5%) were personal protective equipment. Orders came from 19 (76%) hospitals and 6 (24%) other healthcare institutions. Peak production was reached 10 days after the catalogue was published. A total of 22,135 items were manufactured by 59 companies in 18 sectors; 19,212 items were distributed to requesting sites during the busiest days of the pandemic. Our online catalogue was also viewed by 27,861 individuals from 113 countries.

CONCLUSIONS

3D printing helped mitigate shortages of medical devices due to problems in the global supply chain.

Modification of Stryker T5TM and Stryker Flyte® Personal Protection Surgical Helmets to Function as Powered Air-Purifying Respirators

Since the SARS-CoV-2 (COVID-19) outbreak, health-care workers (HCWs) have had to create personal protective equipment (PPE) due to the worldwide demand and thus ensuing shortage. To address the dearth of available PPE, HCWs have quickly explored options to repurpose in-hospital equipment to provide alternative PPE to caregivers. We report the modification of a Stryker T5TM and Stryker Flyte® personal protection surgical helmets as a powered air-purifying respirator.

Custom solution for personal protective equipment (PPE) in the orthopaedic setting: retrofitting Stryker Flyte T5 PPE system

The coronavirus disease 2019 pandemic has meant that there is growing pressure on hospital resources, not least the availability of appropriate personal protective equipment (PPE), particularly face masks and respirator masks. Within the field of orthopaedic surgery, it is a common sight to see surgeons wearing ‘space suits’ (SSs) which comprise a helmet, hood and surgical gown.

In this study, the authors made modifications to two different SS systems to incorporate a high-efficiency particulate air (HEPA) filter into the fan inlet to assess their potential as re-usable PPE systems for surgeons with regard to protection from a virus spread via respiratory droplets. The testing was carried out using particle counters upstream and downstream on a mannequin wearing two different SS systems with and without modifications to the fan inlet.

The results show that using a layer of HEPA filter, cut to size and sealed to the fan inlet in the helmet, will reduce downstream particulates at the user's mouth by >99.5%; this is equivalent to a respirator mask. HEPA filter material is relatively cheap and can be used repeatedly, making this a viable alternative to disposable, and even resterilized, respirator masks in the setting of a respiratory-droplet-spread viral pandemic.

Open source high-temperature RepRap for 3-D printing heat-sterilizable PPE and other applications

Thermal sterilization is generally avoided for 3-D printed components because of the relatively low deformation temperatures for common thermoplastics used for material extrusion-based additive manufacturing. 3-D printing materials required for high-temperature heat sterilizable components for COVID-19 and other applications demands 3-D printers with heated beds, hot ends that can reach higher temperatures than polytetrafluoroethylene (PTFE) hot ends and heated chambers to avoid part warping and delamination. There are several high temperature printers on the market, but their high costs make them inaccessible for full home-based distributed manufacturing required during pandemic lockdowns. To allow for all these requirements to be met for under $1000, the Cerberus - an open source three-headed self-replicating rapid prototyper (RepRap) was designed and tested with the following capabilities: i) 200 °C-capable heated bed, ii) 500 °C-capable hot end, iii) isolated heated chamber with 1 kW space heater core and iv) mains voltage chamber and bed heating for rapid start. The Cereberus successfully prints polyetherketoneketone (PEKK) and polyetherimide (PEI, ULTEM) with tensile strengths of 77.5 and 80.5 MPa, respectively. As a case study, open source face masks were 3-D printed in PEKK and shown not to warp upon widely home-accessible oven-based sterilization.

The Impact of COVID-19 on the Treatment of Craniomaxillofacial Trauma and Head and Neck Infections

There is no shortage of news, information, and guidelines with regards to novel coronavirus (COVID-19). However, there is none yet that is specific to the treatment of patients who have sustained trauma or active head and neck infections-frequently encountered from oropharyngeal sources such as peritonsillar abscess or odontogenic infections. The COVID outbreak has not diminished the incidence of these conditions, and in fact has exacerbated access to care by the closing of urgent care treatment centers as well as private dental offices. The purpose of this article is to outline a protocol to protect health care providers in the provision of this care for at-risk patient populations.

Open source high-temperature RepRap for 3-D printing heat-sterilizable PPE and other applications

Thermal sterilization is generally avoided for 3-D printed components because of the relatively low deformation temperatures for common thermoplastics used for material extrusion-based additive manufacturing. 3-D printing materials required for high-temperature heat sterilizable components for COVID-19 and other applications demands 3-D printers with heated beds, hot ends that can reach higher temperatures than polytetrafluoroethylene (PTFE) hot ends and heated chambers to avoid part warping and delamination. There are several high temperature printers on the market, but their high costs make them inaccessible for full home-based distributed manufacturing required during pandemic lockdowns. To allow for all these requirements to be met for under $1000, the Cerberus - an open source three-headed self-replicating rapid prototyper (RepRap) was designed and tested with the following capabilities: i) 200 °C-capable heated bed, ii) 500 °C-capable hot end, iii) isolated heated chamber with 1 kW space heater core and iv) mains voltage chamber and bed heating for rapid start. The Cereberus successfully prints polyetherketoneketone (PEKK) and polyetherimide (PEI, ULTEM) with tensile strengths of 77.5 and 80.5 MPa, respectively. As a case study, open source face masks were 3-D printed in PEKK and shown not to warp upon widely home-accessible oven-based sterilization.

The nose lid for the endoscopic endonasal procedures during COVID-19 era: technical note

Background

COVID-19 pandemic has disrupted the global health systems worldwide. According to the tremendous rate of interhuman transmission via aerosols and respiratory droplets, severe measures have been required to contain contagion spread. Accordingly, medical and surgical maneuvers involving the respiratory mucosa and, among them, transnasal transsphenoidal surgery have been charged of maximum risk of spread and contagion, above all for healthcare professionals.

Method

Our department, according to the actual COVID-19 protocol national guidelines, has suspended elective procedures and, in the last month, only three patients underwent to endoscopic endonasal procedures, due to urgent conditions (a pituitary apoplexy, a chondrosarcoma causing cavernous sinus syndrome, and a pituitary macroadenoma determining chiasm compression). We describe peculiar surgical technique modifications and the use of an endonasal face mask, i.e., the nose lid, to be applied to the patient during transnasal procedures for skull base pathologies as a further possible COVID-19 mitigation strategy.

Results

The nose lid is cheap, promptly available, and can be easily assembled with the use of few tools available in the OR; this mask allows to both operating surgeon and his assistant to perform wider surgical maneuvers throughout the slits, without ripping it, while limiting the nostril airflow.

Conclusions

Transnasal surgery, transgressing respiratory mucosa, can definitely increase the risk of virus transmission: we find that adopting further precautions, above all limiting high-speed drill can help preventing or at least reducing aerosol/droplets. The creation of a non-rigid face mask, i.e., the nose lid, allows the comfortable introduction of instruments through one or both nostrils and, at the same time, minimizes the release of droplets from the patient’s nasal cavity.