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Qi X, Zhang K, Wang Y, Wan G, Sun J, Sun J, Zhao W. Incidence and characteristics of otitis media with effusion in adults before, during, and after the COVID-19 pandemic. Eur Arch Otorhinolaryngol 2024; 281:2275-2280. [PMID: 38085307 DOI: 10.1007/s00405-023-08338-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/06/2023] [Indexed: 04/18/2024]
Abstract
OBJECTIVES To investigate the incidence and characteristics of adult otitis media with effusion (OME) before, during, and after the COVID-19 pandemic. METHODS A retrospective descriptive study was conducted. The incidence, age, sex, affected ear side, time of OME onset according to COVID-19 and days of improvement after conservative treatment were determined to assess the clinical features of adult OME in different periods of the COVID-19 pandemic. RESULTS The incidence of adult OME during these periods was 3.17%, 2.30%, 6.18%, and 3.68%, respectively. Unilateral ear involvement and male sex were more common. The onset of adult OME occurred 7.80 ± 3.97 days after COVID-19 diagnosis, and improvement was observed after 12.24 ± 5.08 days of conservative treatment. Patients in the post-pandemic period were older than those in the non-pandemic period. CONCLUSION The incidence of adult OME in China showed a tendency to decrease, recover, and decrease again following the COVID-19 outbreak. Pandemic prevention and control measures have had a certain impact on reducing the incidence, but the elderly are more prone to this disease.
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Affiliation(s)
- Xiaoyu Qi
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 443 Huangshan Road, Hefei, 230026, People's Republic of China
| | - Ke Zhang
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 443 Huangshan Road, Hefei, 230026, People's Republic of China
| | - Yinfeng Wang
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 443 Huangshan Road, Hefei, 230026, People's Republic of China
| | - Guanglun Wan
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 443 Huangshan Road, Hefei, 230026, People's Republic of China
| | - Jiaqiang Sun
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 443 Huangshan Road, Hefei, 230026, People's Republic of China
| | - Jingwu Sun
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 443 Huangshan Road, Hefei, 230026, People's Republic of China.
| | - Wan Zhao
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 443 Huangshan Road, Hefei, 230026, People's Republic of China.
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Mrvič T, Stevanoska S, Beović B, Logar M, Gregorčič S, Žnidaršič B, Seme K, Velimirović I, Švent Kučina N, Maver Vodičar P, Križan Hergouth V, Džeroski S, Pirs M. The Impact of COVID-19 on Multidrug-Resistant Bacteria at a Slovenian Tertiary Medical Center. Antibiotics (Basel) 2024; 13:214. [PMID: 38534649 DOI: 10.3390/antibiotics13030214] [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: 12/31/2023] [Revised: 02/02/2024] [Accepted: 02/18/2024] [Indexed: 03/28/2024] Open
Abstract
The COVID-19 pandemic has strained healthcare systems globally. Shortages of hospital beds, reassignment of healthcare workers to COVID-19-dedicated wards, an increased workload, and evolving infection prevention and control measures have potentially contributed to the spread of multidrug-resistant bacteria (MDRB). To determine the impact of the COVID-19 pandemic at the University Medical Center Ljubljana, a tertiary teaching hospital, we analyzed the monthly incidence of select bacterial species per patient from 2018 to 2022. The analysis was performed for all isolates and for MDRB isolates. The data were analyzed separately for isolates from all clinical samples, from blood culture only, and from clinical and surveillance samples. Our findings revealed an increased incidence density of patients with Enterococcus faecium, Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa isolates from clinical samples during the COVID-19 period in the studied hospital. Notably, the incidence density of MDRB isolates-vancomycin-resistant E. faecium, extended-spectrum betalactamase-producing K. pneumoniae, and betalactam-resistant P. aeruginosa-from clinical samples increased during the COVID-19 period. There were no statistically significant differences in the incidence density of patients with blood culture MDRB isolates. We observed an increase in the overall MDRB burden (patients with MDRB isolates from both clinical and surveillance samples per 1000 patient days) in the COVID-19 period in the studied hospital for vancomycin-resistant E. faecium, carbapenem-resistant K. pneumoniae, and betalactam-resistant P. aeruginosa and a decrease in the methicillin-resistant S. aureus burden.
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Affiliation(s)
- Tatjana Mrvič
- Infection Prevention and Control Unit, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | | | - Bojana Beović
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Infectious Diseases, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Mateja Logar
- Infection Prevention and Control Unit, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Infectious Diseases, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Sergeja Gregorčič
- Infection Prevention and Control Unit, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Benica Žnidaršič
- Infection Prevention and Control Unit, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Katja Seme
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Ivana Velimirović
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Nataša Švent Kučina
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Polona Maver Vodičar
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Veronika Križan Hergouth
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | | | - Mateja Pirs
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Ercalik NY, Turkseven Kumral E, Mangan MS, Alpogan O, Imamoglu S, Ozcelik Kose A, Tekcan H. Changes in pupil size, ocular wavefront aberrations, and accommodation in healthcare workers using FFP3 masks. Int Ophthalmol 2023; 43:4991-4996. [PMID: 37843764 DOI: 10.1007/s10792-023-02902-z] [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: 09/10/2022] [Accepted: 09/27/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE To evaluate changes in pupil size, ocular wavefront aberrations (WA), and accommodation in healthcare workers after 4-h usage of Filtering Facepiece class 3 (FFP3) masks. MATERIAL AND METHODS This prospective study included 22 healthy healthcare workers. Pupil size, ocular WA, and accommodation changes before and after FFP3 mask usage were evaluated using a Hartmann Schack aberrometer. Accommodative responses to stimulus ranging from 0 to 5 diopters (D) in increments of 0.5 D were assessed. Ocular high-order aberrations (HOAs) were recorded at baseline and at every accommodative stimulus. Oxygen saturation (SpO2) was measured by pulse oximetry before and after the mask usage. RESULTS The mean age was 36.6 ± 8.5 years. The SpO2 significantly decreased from 98.95 to 97.95% after usage of the FFP3 mask (p < 0.001). The mean pupil size did not significantly differ before (6.22 ± 0.75 mm) and after (6.38 ± 0.83 mm) the 4-h mask usage (p = 0.093). The mean total RMS of the total HOAs was 0.36 ± 0.17 before and 0.39 ± 0.15 after the mask usage (p = 0.071). Post-mask accommodation showed a significant decrease at the 2 D (p = 0.041), 2.5D (p = 0.022), and 3 D (p = 0.025) stimuli. CONCLUSION The present study shows that after 4 h-usage of FFP3 mask, both SpO2 and accommodative response to increasing stimuli might be significantly decreased.
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Affiliation(s)
- Nimet Yesim Ercalik
- University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Tibbiye Cad. No:23, Uskudar, Istanbul, 34668, Turkey.
| | - Esra Turkseven Kumral
- University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Tibbiye Cad. No:23, Uskudar, Istanbul, 34668, Turkey
| | - Mehmet Serhat Mangan
- University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Tibbiye Cad. No:23, Uskudar, Istanbul, 34668, Turkey
| | - Oksan Alpogan
- University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Tibbiye Cad. No:23, Uskudar, Istanbul, 34668, Turkey
| | - Serhat Imamoglu
- University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Tibbiye Cad. No:23, Uskudar, Istanbul, 34668, Turkey
| | - Alev Ozcelik Kose
- University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Tibbiye Cad. No:23, Uskudar, Istanbul, 34668, Turkey
| | - Hatice Tekcan
- University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Tibbiye Cad. No:23, Uskudar, Istanbul, 34668, Turkey
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Realmuto J, Kleinman MT, Sanger T, Lawler MJ, Smith JN. Design and testing of a sew-free origami mask for improvised respiratory protection. NANOTECHNOLOGY 2023; 35:045101. [PMID: 37625393 DOI: 10.1088/1361-6528/acf3f3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/25/2023] [Indexed: 08/27/2023]
Abstract
Respiratory aerosols with diameters smaller than 100μm have been confirmed as important vectors for the spread of diseases such as SARS-CoV-2. While disposable and cloth masks afford some protection, they are typically inefficient at filtering these aerosols and require specialized fabrication devices to produce. We describe a fabrication technique that makes use of a folding procedure (origami) to transform any filtration material into a mask. These origami masks can be fabricated by non-experts at minimal cost and effort, provide adequate filtration efficiencies, and are easily scaled to different facial sizes. Using a mannequin fit test simulator, we demonstrate that these masks can provide filtration efficiencies of over 90% while simultaneously providing greater comfort as demonstrated by pressure drops of <20 Pa. We also quantify mask leakage by measuring the variations in filtration efficiency and pressure drop when masks are sealed to the mannequin face compared to when the mask is unsealed but positioned to achieve the best fit. While leakage generally trended with pressure drop, some of the best performing mask media achieved <10% reduction in filtration efficiency due to leakage. Because this mask can provide high filtration efficiencies at low pressure drop compared to commercial alternatives, it is likely to promote greater mask wearing tolerance and acceptance.
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Affiliation(s)
- Jonathan Realmuto
- Department of Mechanical Engineering, University of California, Riverside, United States of America
| | - Michael T Kleinman
- Department of Community and Environmental Medicine, University of California, Irvine, United States of America
- School of Medicine, University of California, Irvine, United States of America
| | - Terence Sanger
- School of Medicine, University of California, Irvine, United States of America
- Department of Electrical Engineering and Computer Science, University of California, Irvine, United States of America
| | - Michael J Lawler
- Cooperative Institute for Research in Environmental Sciences, University of Colorado, Boulder, United States of America
- Department of Chemistry, University of California, Irvine, United States of America
| | - James N Smith
- Department of Chemistry, University of California, Irvine, United States of America
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Rashid AB, Showva NN. Design and fabrication of a biodegradable face shield by using cleaner technologies for the protection of direct splash and airborne pathogens during the COVID-19 pandemic. CLEANER ENGINEERING AND TECHNOLOGY 2023; 13:100615. [PMID: 36911790 PMCID: PMC9984231 DOI: 10.1016/j.clet.2023.100615] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
Due to global supply chain disruptions and high demand for personal protective equipment (PPE), the rapidly expanding COVID-19 crisis left millions of front-line fighters unprotected. The disposal of PPE in the environment caused significant environmental pollution. Hence, indigenous initiatives have been taken to fabricate antiviral and biodegradable face shields with the help of neoteric and cleaner technologies. This paper describes a novel endeavor to design, manufacture, and performance analysis of a face shield made by plastic injection molding and LASER Cutting. Because of the requirement of permanent wear, the face shield's ergonomic design is considered low weight and easy head fixation, alongside high production ability. Here, face shield frames are made with lightweight, biodegradable plastic called Poly Lactic Acid (PLA), whereas an optical grade PLA sheet is used as the visor for better clarity. Visors PLA Sheet is coated with Nano-Silver disinfectant spray to incorporate antiviral properties to the Faceshield. Partially circumferential adjustable elastic straps are used for comfortable head fixation. To evaluate the product, clinical fit tests along with statistical survey were conducted, and the feedback from the end-users on comfort (41% Excellent, 30% Good, 26% Average and 3% Poor), clear view (33% Excellent, 38% Good, 24% Average, and 5% Poor), design features (43% Excellent, 35% Good, and 22% Average), simplicity of installation and disassembly (29% Excellent, 33% Good, and 38% Average), and ease of wearing/removing (45% Excellent, 40% Good, and 15%Average) are encouraging.
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Affiliation(s)
- Adib Bin Rashid
- Industrial and Production Engineering Department, Military Institute of Science and Technology (MIST), Bangladesh
| | - Nazmir-Nur Showva
- Biomedical Engineering Department, Military Institute of Science and Technology (MIST), Bangladesh
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Elgendy MO, El-Gendy AO, Elgendy SO, Abdelaty LN, Abdelrahim MEA, Abdelrahman MA. Perceptions, Knowledge, and Experiences of Using Face Masks among Egyptian Healthcare Workers during the COVID-19 Pandemic: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11060838. [PMID: 36981495 PMCID: PMC10048152 DOI: 10.3390/healthcare11060838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
Using face masks appropriately is important for preventing the community spread of respiratory infections. A cross-sectional study was conducted to evaluate the knowledge level and experience of using face masks between healthcare teams to protect them and limit the spread of COVID-19 infection. A structured questionnaire was distributed to 228 healthcare members in July–December 2021. It was divided into two sections and consisted of 29 questions for a total possible score of 0 to 29. The first section was related to perceptions and knowledge about face masks (13 items); the second was related to the experience of using face masks (16 items). The average score of this questionnaire was 23.21/29 with respect to the knowledge about face masks and their proper use techniques. The healthcare team studied had satisfactory knowledge about face mask use techniques, and the study shed light on their unsatisfactory practices. Following instructions is very vital to protecting the person wearing the mask and preventing the spread of infection during health care by blocking droplets produced by speaking or coughing. Providing the healthcare teams with knowledge and experience about how to use face masks during the pandemic is critical to increase their awareness and practice in using face masks and prevent the infection from spreading.
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Affiliation(s)
- Marwa O. Elgendy
- Department of Clinical Pharmacy, Beni-Suef University Hospitals, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt
- Department of Clinical Pharmacy, Faculty of Pharmacy, Nahda University (NUB), Beni-Suef 62513, Egypt
- Correspondence:
| | - Ahmed O. El-Gendy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62521, Egypt
| | - Sara O. Elgendy
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt
| | - Lamiaa N. Abdelaty
- Department of Clinical Pharmacy, Faculty of Pharmacy, October 6 University, Giza 12525, Egypt
| | | | - Mona A. Abdelrahman
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62521, Egypt
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Abreu-Irizarry R, Torres-Lugo NJ, De Virgilio-Salgado L, Echegaray-Casalduc G, Deliz-Jimenez D, Martinez-Ramos J, Estarellas-Cobian S, Ramírez N, Foy-Parilla C. Is the whole-day use of surgical masks during the coronavirus pandemic increasing the contamination of surgeons' masks? Am J Infect Control 2023; 51:349-350. [PMID: 35944743 PMCID: PMC9356566 DOI: 10.1016/j.ajic.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/21/2022]
Abstract
Evaluating the impact of surgical masks' conservation practices during the Coronavirus Disease pandemic in the bioburden of the operating room seems imperative, as they play a critical role against this pandemic. We demonstrate that surgeons' masks tend to be contaminated due to the conservation techniques to maximize protection equipment during the pandemic. Health institutions should highlight the importance of surgical mask exchange to avoid increments in surgical mask contamination.
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Affiliation(s)
| | | | | | | | - David Deliz-Jimenez
- Department of Orthopedic Surgery, University of Puerto Rico, San Juan, Puerto Rico
| | | | | | - Norman Ramírez
- Department of Orthopedic Surgery, Mayagüez Medical Center, Mayagüez, Puerto Rico
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Real-Time Facemask Detection for Preventing COVID-19 Spread Using Transfer Learning Based Deep Neural Network. ELECTRONICS 2022. [DOI: 10.3390/electronics11142250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The COVID-19 pandemic disrupted people’s livelihoods and hindered global trade and transportation. During the COVID-19 pandemic, the World Health Organization mandated that masks be worn to protect against this deadly virus. Protecting one’s face with a mask has become the standard. Many public service providers will encourage clients to wear masks properly in the foreseeable future. On the other hand, monitoring the individuals while standing alone in one location is exhausting. This paper offers a solution based on deep learning for identifying masks worn over faces in public places to minimize the coronavirus community transmission. The main contribution of the proposed work is the development of a real-time system for determining whether the person on a webcam is wearing a mask or not. The ensemble method makes it easier to achieve high accuracy and makes considerable strides toward enhancing detection speed. In addition, the implementation of transfer learning on pretrained models and stringent testing on an objective dataset led to the development of a highly dependable and inexpensive solution. The findings provide validity to the application’s potential for use in real-world settings, contributing to the reduction in pandemic transmission. Compared to the existing methodologies, the proposed method delivers improved accuracy, specificity, precision, recall, and F-measure performance in three-class outputs. These metrics include accuracy, specificity, precision, and recall. An appropriate balance is kept between the number of necessary parameters and the time needed to conclude the various models.
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Chizmar L, Lewis S. A questionnaire for physical findings of malnutrition when physical exams are not possible. Nutr Clin Pract 2022; 37:1307-1315. [PMID: 35819371 DOI: 10.1002/ncp.10894] [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: 02/08/2022] [Revised: 05/10/2022] [Accepted: 06/09/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND When nutrition assessments must be performed virtually, such as during the coronavirus pandemic, it is difficult to fully assess patients for malnutrition without the ability to perform a nutrition-focused physical exam. Practitioners may ask patients about their physical appearance, but there is currently no validated set of questions whose answers correlate with nutrition-focused physical findings for the diagnosis of malnutrition in such situations. The aim of this study was to evaluate correlations between patients' responses to verbalized questions and physical signs of malnutrition. METHODS Questions related to the physical findings of malnutrition were developed and evaluated for content validity. Thirty patients receiving nutrition assessments at an acute care veterans' hospital were asked the questions prior to a nutrition-focused physical exam. Patients' responses were compared with a diagnosis of malnutrition and physical findings of muscle, fat, fluid accumulation, and handgrip strength. RESULTS Four questions significantly correlated with malnutrition: "Does the area around your eyes appear sunken in?" (P = 0.03), "Are you able to see your ribs?" (P = 0.05), "Do you feel you are unusually skinny for you?" (P = 0.001), and "Do you find yourself eating less due to swelling in your belly?" (P = 0.008). CONCLUSION There are relationships between patients' responses to certain verbalized questions and their physical status. Such questions can be used to identify physical signs of malnutrition when nutrition-focused physical exams cannot be performed. Further research is needed to validate these questions in other populations.
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Affiliation(s)
- Lora Chizmar
- Nutrition and Food Service, James A. Haley VA Hospital and Clinics, Tampa, Florida, USA
| | - Sherri Lewis
- Nutrition and Food Service, James A. Haley VA Hospital and Clinics, Tampa, Florida, USA
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Zhang Y, Wang SK, Zheng B. Force application of laparoscopic surgeons under the impact of heavy personal protective equipment. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2022; 5:106-110. [PMID: 35578593 PMCID: PMC9096646 DOI: 10.1016/j.lers.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 04/30/2022] [Accepted: 05/04/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Surgeons are required to wear heavy personal protective equipment while delivering care to patients during the COVID-19 pandemic. We examined the impact of wearing double gloves on surgeons’ performance in laparoscopic surgery. Methods Eleven surgeons-in-training at the Surgical Simulation Research Lab of the University of Alberta were recruited to perform laparoscopic cutting tasks in simulation while wearing none, one pair, and two pairs of surgical gloves. Forces applied to laparoscopic instruments were measured. Results Wearing gloves prolonged task times (one pair of gloves: 301.6 ± 61.7 s; two pairs of gloves: 295.8 ± 65.3 s) compared with no gloves (241.7 ± 46.9 s; p = 0.043). Wearing double gloves increased cutting errors (20.4 ± 5.1 mm2) compared with wearing one pair of gloves (16.9 ± 5.5 mm2) and no gloves (14.4 ± 4.6 mm2; p = 0.030). Wearing gloves reduced the peak force (one pair of gloves: 2.4 ± 0.7 N; two pairs of gloves: 2.7 ± 0.6 N; no gloves: 3.4 ± 1.4 N; p = 0.049), and the total force (one pair of gloves: 10.1 ± 2.8 N; two pairs of gloves: 10.3 ± 2.6 N; no glove: 12.6 ± 1.9 N; p = 0.048) delivered onto laparoscopic scissors compared with wearing no glove. Conclusion The combined effects of wearing heavy gloves and using tools reduced the touching sensation, which limited the surgeons’ confidence in performing surgical tasks. Increasing practice in simulation is suggested to allow surgeons to overcome difficulties brought by personal protective equipment.
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Affiliation(s)
- Yao Zhang
- Surgical Simulation Research Lab, University of Alberta, Edmonton, Alberta, Canada
| | - Shuyi Kiana Wang
- Surgical Simulation Research Lab, University of Alberta, Edmonton, Alberta, Canada
| | - Bin Zheng
- Surgical Simulation Research Lab, University of Alberta, Edmonton, Alberta, Canada
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Defi IR, Iskandar S, Charismawati S, Turnip A, Novita D. Healthcare Workers’ Point of View on Medical Robotics During COVID-19 Pandemic – A Scoping Review. Int J Gen Med 2022; 15:3767-3777. [PMID: 35418776 PMCID: PMC8995177 DOI: 10.2147/ijgm.s355734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/25/2022] [Indexed: 11/26/2022] Open
Abstract
COVID-19 affected how healthcare workers interact with patients. Medical technology and robotics are developed in hospital settings to limit human contact. The aim of this review is to elucidate what kind of medical robotics is required for healthcare workers during COVID-19 pandemic. This review was obtained from electronic databases such as Google Scholar, PubMed, EBSCO, and Cochrane reviews were searched for articles using keywords such as “healthcare professional” OR “health worker” AND “COVID-19” AND “robot application” OR “robotics” OR “health technology” AND “needs assessment” OR “expectation” OR “perception” published during 2020 to 2021. Inclusion criteria were full-text articles related to assessment of healthcare workers’ need for medical robotics during COVID-19 pandemics. Exclusion criteria included abstracts, duplicate articles, blogs, news articles, promotional brochures, and conference proceedings. A total of 13,692 articles were identified through the search engines (PubMed 179, Cochrane Library 1300, EBSCO 13, Google Scholar 12,200). Five full-text articles fulfilled the inclusion criteria. Determining robotic functions is important to healthcare workers who will be user of such medical technology. This review divided robotic functions into medical, operational, movement, and social functions. Healthcare workers’ demands for robotics were also influenced by the types of robots, such as examination robots, robot-based sample test and medicine production, surgery and rehabilitation robots, disinfection and cleaning robots, delivery and logistic robot, telemedicine, and telepresence robots. Medical robotics is required for healthcare workers during the COVID-19 pandemic. The highest demands for medical robotics functions include cardiac measurements and oxygen saturation monitoring (medical functions); examination record delivery, video and image play, and medical information delivery (operational functions); and the ability to recognize and avoid obstacles (movement functions). Disinfection and cleaning robots were the type of robots with the highest demand among healthcare workers.
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Affiliation(s)
- Irma Ruslina Defi
- Department of Physical Medicine and Rehabilitation, Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Bandung, Jawa Barat, Indonesia
- Correspondence: Irma Ruslina Defi, Department of Physical Medicine and Rehabilitation, Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Jl. Pasteur No. 38, Bandung, Jawa Barat, 40161, Indonesia, Tel +62 (22) 203 4989, Email
| | - Shelly Iskandar
- Department of Psychiatry, Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Bandung, Jawa Barat, Indonesia
| | - Septiana Charismawati
- Department of Physical Medicine and Rehabilitation, Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Bandung, Jawa Barat, Indonesia
| | - Arjon Turnip
- Department of Electrical Engineering, Faculty of Mathematics and Natural Sciences, Universitas Padjadjaran, Sumedang, Jawa Barat, Indonesia
| | - Dessy Novita
- Department of Electrical Engineering, Faculty of Mathematics and Natural Sciences, Universitas Padjadjaran, Sumedang, Jawa Barat, Indonesia
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Roberge RJ, Roberge MR. Cloth Face Coverings for Use as Facemasks During the Coronavirus (SARS-CoV-2) Pandemic: What Science and Experience Have Taught Us. Disaster Med Public Health Prep 2022; 16:726-733. [PMID: 32921329 PMCID: PMC7711344 DOI: 10.1017/dmp.2020.354] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 12/15/2022]
Abstract
The current coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) pandemic has resulted in severe shortages of personal protective equipment, including respiratory protective equipment, such as N95 respirators. This has led some government agencies to suggest the use of cloth face coverings (CFCs) by health-care providers and the general public as a last resort when standard respiratory protective equipment is unavailable. Although such coverings have been in use for over a century and have found widespread use during some previous pandemics, research data are relatively scant for the protective value of this measure. This article, a literature review, explores the development of CFCs and reviews available scientific research regarding the efficacy of this intervention as a preventive measure in the spread of airborne infectious diseases.
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Affiliation(s)
| | - Marc R. Roberge
- Attending physician, University of Pittsburgh Medical Center East, Monroeville, Pennsylvania
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13
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Sharma N, Gupta A, Killedar M, Bindra A, Patil A, Gupta S, Gopathoti P, Kumar P. One for Everyone: A Study of User Satisfaction Among Health-Care Providers Regarding Extended Use of N95 Masks During the COVID-19 Pandemic. Disaster Med Public Health Prep 2022; 16:619-626. [PMID: 33040770 PMCID: PMC7737120 DOI: 10.1017/dmp.2020.380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study was conducted to assess the feasibility of extended use of N95 masks in our hospital during the coronavirus disease 2019 (COVID-19) pandemic. We also studied the use pattern, user satisfaction, and issues faced during extended use of the mask. METHODS This cross-sectional study was conducted among health-care providers in a large tertiary care teaching hospital in northern India from April 1 to May 31, 2020. A list was prepared from the institute's register, and participants were chosen by random sampling. The data collected from the physical forms were transferred to excel sheets. RESULTS A total of 1121 responses were received. The most common problem stated with reuse of N95 masks was loss of fit followed by damage to the slings, highlighted by 44.6% and 44.4% of the participants, respectively. A total of 476 (42.5%) participants responded that they would prefer "cup-shaped N95 mask with respirator". The median scores regarding the satisfaction with the quality of masks and their fit was also 4 each. CONCLUSIONS It was concluded that the extended use of N95 masks was acceptable, with more than 96% of the participants using these masks.
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Affiliation(s)
- Nishant Sharma
- Department of Hospital Administration, AIIMS, New Delhi, India
| | - Anant Gupta
- Department of Hospital Administration, AIIMS, New Delhi, India
| | | | - Ashish Bindra
- Department of Neuroanaesthesiology and Critical Care, AIIMS, New Delhi, India
| | - Asmita Patil
- Department of Physiology, AIIMS, New Delhi, India
| | - Surabhi Gupta
- Department of Reproductive Biology, AIIMS, New Delhi, India
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14
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We Can Dance If We Want To (with Safety Measures). mBio 2022; 13:e0029522. [PMID: 35225682 PMCID: PMC9040796 DOI: 10.1128/mbio.00295-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This work considers the spread of SARS-CoV-2 during a multiday intensive dance camp occurring from 26 December 2021 to 1 January 2022 in Asheville, North Carolina. Approximately 370 dancers and performers were in attendance, and the data presented are the result of an anonymous survey distributed 10 days following the event. While some transmission occurred during the time span of the event, it appears that the majority of transmission occurred either through the result of individual interactions or activities outside the formal dance event rather than due to a buildup of airborne viral particles in the event space.
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15
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Uthman OA, Adetokunboh OO, Wiysonge CS, Al-Awlaqi S, Hanefeld J, El Bcheraoui C. Classification Schemes of COVID-19 High Risk Areas and Resulting Policies: A Rapid Review. Front Public Health 2022; 10:769174. [PMID: 35284361 PMCID: PMC8916531 DOI: 10.3389/fpubh.2022.769174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has posed a significant global health threat since January 2020. Policies to reduce human mobility have been recognized to effectively control the spread of COVID-19; although the relationship between mobility, policy implementation, and virus spread remains contentious, with no clear pattern for how countries classify each other, and determine the destinations to- and from which to restrict travel. In this rapid review, we identified country classification schemes for high-risk COVID-19 areas and associated policies which mirrored the dynamic situation in 2020, with the aim of identifying any patterns that could indicate the effectiveness of such policies. We searched academic databases, including PubMed, Scopus, medRxiv, Google Scholar, and EMBASE. We also consulted web pages of the relevant government institutions in all countries. This rapid review's searches were conducted between October 2020 and December 2021. Web scraping of policy documents yielded additional 43 country reports on high-risk area classification schemes. In 43 countries from which relevant reports were identified, six issued domestic classification schemes. International classification schemes were issued by the remaining 38 countries, and these mainly used case incidence per 100,000 inhabitants as key indicator. The case incidence cut-off also varied across the countries, ranging from 20 cases per 100,000 inhabitants in the past 7 days to more than 100 cases per 100,000 inhabitants in the past 28 days. The criteria used for defining high-risk areas varied across countries, including case count, positivity rate, composite risk scores, community transmission and satisfactory laboratory testing. Countries either used case incidence in the past 7, 14 or 28 days. The resulting policies included restrictions on internal movement and international travel. The quarantine policies can be summarized into three categories: (1) 14 days self-isolation, (2) 10 days self-isolation and (3) 14 days compulsory isolation.
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Affiliation(s)
- Olalekan A. Uthman
- Warwick Centre for Global Health Research, The University of Warwick, Coventry, United Kingdom
| | - Olatunji O. Adetokunboh
- South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, South Africa
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Sameh Al-Awlaqi
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Johanna Hanefeld
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Charbel El Bcheraoui
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
- *Correspondence: Charbel El Bcheraoui
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16
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Obrová K, Vaňková E, Sláma M, Hodek J, Khun J, Ulrychová L, Nogueira F, Laos T, Sponseiler I, Kašparová P, Machková A, Weber J, Scholtz V, Lion T. Decontamination of High-Efficiency Mask Filters From Respiratory Pathogens Including SARS-CoV-2 by Non-thermal Plasma. Front Bioeng Biotechnol 2022; 10:815393. [PMID: 35237577 PMCID: PMC8883054 DOI: 10.3389/fbioe.2022.815393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
The current pandemic resulted in a rapidly increasing demand for personal protective equipment (PPE) initially leading to severe shortages of these items. Hence, during an unexpected and fast virus spread, the possibility of reusing highly efficient protective equipment could provide a viable solution for keeping both healthcare professionals and the general public equipped and protected. This requires an efficient decontamination technique that preserves functionality of the sensitive materials used for PPE production. Non-thermal plasma (NTP) is a decontamination technique with documented efficiency against select bacterial and fungal pathogens combined with low damage to exposed materials. We have investigated NTP for decontamination of high-efficiency P3 R filters from viral respiratory pathogens in comparison to other commonly used techniques. We show that NTP treatment completely inactivates SARS-CoV-2 and three other common human respiratory viruses including Influenza A, Rhinovirus and Adenovirus, revealing an efficiency comparable to 90°C dry heat or UVC light. Unlike some of the tested techniques (e.g., autoclaving), NTP neither influenced the filtering efficiency nor the microstructure of the filter. We demonstrate that NTP is a powerful and economic technology for efficient decontamination of protective filters and other sensitive materials from different respiratory pathogens.
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Affiliation(s)
- Klára Obrová
- St. Anna Children’s Cancer Research Institute (CCRI), Division Molecular Microbiology, Vienna, Austria
- *Correspondence: Klára Obrová, ; Thomas Lion,
| | - Eva Vaňková
- Department of Physics and Measurements, University of Chemistry and Technology, Prague, Czech Republic
| | - Michal Sláma
- Faculty of Science, University of Hradec Kralove, Hradec Králové, Czech Republic
| | - Jan Hodek
- Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Prague, Czech Republic
| | - Josef Khun
- Department of Physics and Measurements, University of Chemistry and Technology, Prague, Czech Republic
| | - Lucie Ulrychová
- Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Prague, Czech Republic
- Department of Genetics and Microbiology, Charles University, Faculty of Sciences, Prague, Czech Republic
| | - Filomena Nogueira
- St. Anna Children’s Cancer Research Institute (CCRI), Division Molecular Microbiology, Vienna, Austria
| | - Triin Laos
- St. Anna Children’s Cancer Research Institute (CCRI), Division Molecular Microbiology, Vienna, Austria
| | - Isabella Sponseiler
- St. Anna Children’s Cancer Research Institute (CCRI), Division Molecular Microbiology, Vienna, Austria
| | - Petra Kašparová
- Department of Physics and Measurements, University of Chemistry and Technology, Prague, Czech Republic
| | - Anna Machková
- Department of Physics and Measurements, University of Chemistry and Technology, Prague, Czech Republic
| | - Jan Weber
- Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Prague, Czech Republic
| | - Vladimír Scholtz
- Department of Physics and Measurements, University of Chemistry and Technology, Prague, Czech Republic
| | - Thomas Lion
- St. Anna Children’s Cancer Research Institute (CCRI), Division Molecular Microbiology, Vienna, Austria
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
- *Correspondence: Klára Obrová, ; Thomas Lion,
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17
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Hijdra R, Rutten W, Gubbels J. Experiences of Dutch Midwives Regarding the Quality of Care during the COVID-19 Pandemic. Healthcare (Basel) 2022; 10:healthcare10020304. [PMID: 35206918 PMCID: PMC8871661 DOI: 10.3390/healthcare10020304] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
This study assessed how the quality of care during the COVID-19 pandemic has been experienced by Dutch midwives. At the beginning of May 2020, 15 Dutch midwives were interviewed during the first wave of the pandemic. The interviews included questions based on the value-based healthcare framework by Porter. The interviews were transcribed verbatim, coded, and analyzed according to recurrent themes using the directed content analysis approach. Key themes identified included high quality midwifery care, information provision, costs, under/over treatment, interprofessional collaboration, and shared decision making. The quality of midwifery care during the COVID-19 pandemic was experienced to be sufficient, given the challenging circumstances. The midwives experienced the lack of face-to-face check-ups to be problematic. Unclear information and lack of personal protective equipment caused stress and confusion, and they worked an additional 2–4 h per working day. Some pregnant women were hesitant to call or visit them when they thought something was wrong. The midwives perceived some advantages in using video or telephone calls. Considerations for future pandemics include an additional face-to-face check-up between 16 and 27 weeks of pregnancy and one postpartum visit. For post-pandemic care, providing a check-up through telephone or video call could be offered in certain cases.
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Affiliation(s)
- Roos Hijdra
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Correspondence:
| | - Wim Rutten
- Zorggroep Verloskunde ZuidOost Brabant, Zandberglaan 29, 4818 GH Breda, The Netherlands; (W.R.); (J.G.)
| | - Jessica Gubbels
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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18
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Ataei M, Shirazi FM, Nakhaee S, Abdollahi M, Mehrpour O. Assessment of cloth masks ability to limit Covid-19 particles spread: a systematic review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:1645-1676. [PMID: 34689269 PMCID: PMC8541808 DOI: 10.1007/s11356-021-16847-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/28/2021] [Indexed: 05/10/2023]
Abstract
After the spread of Covid 19 worldwide, the use of cloth masks increased significantly due to a shortage of medical masks. Meanwhile, there were different opinions about the effectiveness of these masks and, so far, no study has been done to find the best fabric masks. This study reviews and summarizes all studies related to fabric masks' effectiveness and various fabrics against coronavirus. This systematic review is based on PRISMA rules. Two researchers separately examined three databases: PubMed, Scopus, and Web of Science. Laboratory and clinical studies were included. After extracting the articles, their quality was assessed with the Joanna Briggs Institute (JBI) tool. In addition to efficacy, other factors, including the penetration of masks, pressure drop, and quality factor, were examined to select the best fabrics. Of the 42 studies selected, 39 were laboratory studies, and 3 were clinical studies. Among the various fabrics examined, cotton quilt 120 thread per inch (TPI), copy paper (bonded), hybrid of cotton with chiffon/ silk, and flannel filtration were found to have over 90% effectiveness in the particle size range of Covid-19. The results and comparison of different factors (pressure drop, filtration efficacy, penetration, filtration quality, and fit factor have been evaluated) showed that among different fabrics, hybrid masks, 2-layered cotton quilt, 2-layered 100% cotton, cotton flannel, and hairy tea towel + fleece sweater had the best performance. Clinical studies have not explicitly examined cloth masks' effectiveness in Covid-19, so the effectiveness of these types of masks for Covid 19 is questionable, and more studies are needed.
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Affiliation(s)
- Mahshid Ataei
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), and Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Farshad M Shirazi
- Arizona Poison & Drug Information Center, University of Arizona, College of Pharmacy and University of Arizona College of Medicine, Tucson, AZ, USA
| | - Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran
| | - Mohammad Abdollahi
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), and Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran.
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
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19
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Duvall J, Grindle GG, Kaplan J, Marks D, Sylvers L, Patel J, Lain M, Bagay A, Chung C, Cooper RA. VA TECHNOLOGY TRANSFER PROGRAM RESPONDS TO COVID-19 PANDEMIC. TECHNOLOGY AND INNOVATION 2021; 22:173-179. [PMID: 35096277 PMCID: PMC8793323 DOI: 10.21300/22.2.2021.6] [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] [Indexed: 11/06/2022]
Abstract
The COVID-19 pandemic stressed healthcare systems all over the world. Two primary challenges that healthcare systems faced were a shortage of personal protective equipment and the need for new technologies to handle infection prevention for staff and patients. The Department of Veteran's Affairs (VA) Technology Transfer Program responded by prioritizing the development of innovations in the Technology Transfer Assistance Project which addressed the pandemic. This paper describes several innovations that addressed the needs of the VA healthcare system during the pandemic and how they were rapidly developed.
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Affiliation(s)
- Jonathan Duvall
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Garrett G. Grindle
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - John Kaplan
- Office of Research and Development Technology Transfer Program, Department of Veterans Affairs, Washington D.C., USA
| | - David Marks
- Office of Research and Development Technology Transfer Program, Department of Veterans Affairs, Washington D.C., USA
| | - Lee Sylvers
- Office of Research and Development Technology Transfer Program, Department of Veterans Affairs, Washington D.C., USA
| | - Jenish Patel
- Office of Research and Development Technology Transfer Program, Department of Veterans Affairs, Washington D.C., USA
| | - Michael Lain
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Andrea Bagay
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - C.S. Chung
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rory A Cooper
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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20
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Zhou J, Otter JA, Price JR, Cimpeanu C, Garcia DM, Kinross J, Boshier PR, Mason S, Bolt F, Holmes AH, Barclay WS. Investigating Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Surface and Air Contamination in an Acute Healthcare Setting During the Peak of the Coronavirus Disease 2019 (COVID-19) Pandemic in London. Clin Infect Dis 2021; 73:e1870-e1877. [PMID: 32634826 PMCID: PMC7454437 DOI: 10.1093/cid/ciaa905] [Citation(s) in RCA: 172] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We evaluated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) surface and air contamination during the coronavirus disease 2019 (COVID-19) pandemic in London. METHODS Prospective, cross-sectional, observational study in a multisite London hospital. Air and surface samples were collected from 7 clinical areas occupied by patients with COVID-19 and a public area of the hospital. Three or four 1.0-m3 air samples were collected in each area using an active air sampler. Surface samples were collected by swabbing items in the immediate vicinity of each air sample. SARS-CoV-2 was detected using reverse-transcription quantitative polymerase chain reaction (PCR) and viral culture; the limit of detection for culturing SARS-CoV-2 from surfaces was determined. RESULTS Viral RNA was detected on 114 of 218 (52.3%) surfaces and in 14 of 31 (38.7%) air samples, but no virus was cultured. Viral RNA was more likely to be found in areas immediately occupied by COVID-19 patients than in other areas (67 of 105 [63.8%] vs 29 of 64 [45.3%]; odds ratio, 0.5; 95% confidence interval, 0.2-0.9; P = .025, χ2 test). The high PCR cycle threshold value for all samples (>30) indicated that the virus would not be culturable. CONCLUSIONS Our findings of extensive viral RNA contamination of surfaces and air across a range of acute healthcare settings in the absence of cultured virus underlines the potential risk from environmental contamination in managing COVID-19 and the need for effective use of personal protective equipment, physical distancing, and hand/surface hygiene.
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Affiliation(s)
- Jie Zhou
- Department of Infectious Disease, Imperial College London, London, UK
| | - Jonathan A Otter
- National Institute for Healthcare Research Health Protection Research Unit (NIHR HPRU) in HCAI and AMR, Imperial College London & Public Health England, Hammersmith Hospital
- Imperial College Healthcare NHS Trust, St. Mary’s Hospital, London, UK
| | - James R Price
- National Institute for Healthcare Research Health Protection Research Unit (NIHR HPRU) in HCAI and AMR, Imperial College London & Public Health England, Hammersmith Hospital
- Imperial College Healthcare NHS Trust, St. Mary’s Hospital, London, UK
| | - Cristina Cimpeanu
- Imperial College Healthcare NHS Trust, St. Mary’s Hospital, London, UK
| | - Danel Meno Garcia
- Imperial College Healthcare NHS Trust, St. Mary’s Hospital, London, UK
| | - James Kinross
- Imperial College Healthcare NHS Trust, St. Mary’s Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Piers R Boshier
- Imperial College Healthcare NHS Trust, St. Mary’s Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sam Mason
- Imperial College Healthcare NHS Trust, St. Mary’s Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Frances Bolt
- National Institute for Healthcare Research Health Protection Research Unit (NIHR HPRU) in HCAI and AMR, Imperial College London & Public Health England, Hammersmith Hospital
- Imperial College Healthcare NHS Trust, St. Mary’s Hospital, London, UK
| | - Alison H Holmes
- National Institute for Healthcare Research Health Protection Research Unit (NIHR HPRU) in HCAI and AMR, Imperial College London & Public Health England, Hammersmith Hospital
- Imperial College Healthcare NHS Trust, St. Mary’s Hospital, London, UK
| | - Wendy S Barclay
- Department of Infectious Disease, Imperial College London, London, UK
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21
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Nambiema A, Fouquet J, Guilloteau J, Descatha A. La revue systématique et autres types de revue de la littérature : qu’est-ce que c’est, quand, comment, pourquoi ? ARCH MAL PROF ENVIRO 2021. [DOI: 10.1016/j.admp.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Rodriguez-Lopez M, Parra B, Vergara E, Rey L, Salcedo M, Arturo G, Alarcon L, Holguin J, Osorio L. A case-control study of factors associated with SARS-CoV-2 infection among healthcare workers in Colombia. BMC Infect Dis 2021; 21:878. [PMID: 34452600 PMCID: PMC8391859 DOI: 10.1186/s12879-021-06581-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/17/2021] [Indexed: 02/14/2023] Open
Abstract
Background Healthcare Workers (HCW) are repeatedly exposed to SARS-CoV-2 infection. The aim of this study was to identify factors associated with SARS-CoV-2 infection among HCW in one of the largest cities in Colombia. Methods We conducted a case–control study, where cases had a positive reverse transcription-polymerase chain reaction and controls had a negative result. Participants were randomly selected and interviewed by phone. Analyses were performed using logistic regression models. Results A total of 110 cases and 113 controls were included. Men (AdjOR 4.13 95% CI 1.70–10.05), Nurses (AdjOR 11.24 95% CI 1.05–119.63), not using a high-performance filtering mask (AdjOR 2.27 95% CI 1.02–5.05) and inadequate use of personal protective equipment (AdjOR 4.82 95% CI 1.18–19.65) were identified as risk factors. Conversely, graduate (AdjOR 0.06 95% CI 0.01–0.53) and postgraduate (AdjOR 0.05 95% CI 0.005–0.7) education, feeling scared or nervous (AdjOR 0.45 95% CI 0.22–0.91), not always wearing any gloves, caps and goggles/face shields (AdjOR 0.10 95% CI 0.02–0.41), and the use of high-performance filtering or a combination of fabric plus surgical mask (AdjOR 0.27 95% CI 0.09–0.80) outside the workplace were protective factors. Conclusion This study highlights the protection provided by high-performance filtering masks or double masking among HCW. Modifiable and non-modifiable factors and the difficulty of wearing other protective equipment needs to be considered in designing, implementing and monitoring COVID-19 biosafety protocols for HCW.
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Affiliation(s)
- Merida Rodriguez-Lopez
- Pontificia Universidad Javeriana Seccional Cali, Calle 18 No.118 - 250 Edificio Raúl Posada S.J. Tercer Piso, Cali, Colombia.
| | | | - Enrique Vergara
- Pontificia Universidad Javeriana Seccional Cali, Calle 18 No.118 - 250 Edificio Raúl Posada S.J. Tercer Piso, Cali, Colombia
| | - Laura Rey
- Pontificia Universidad Javeriana Seccional Cali, Calle 18 No.118 - 250 Edificio Raúl Posada S.J. Tercer Piso, Cali, Colombia
| | | | - Gabriela Arturo
- Secretaria de Salud Pública Municipal de Cali, Cali, Colombia
| | - Liliana Alarcon
- Secretaria de Salud Pública Municipal de Cali, Cali, Colombia
| | - Jorge Holguin
- Pontificia Universidad Javeriana Seccional Cali, Calle 18 No.118 - 250 Edificio Raúl Posada S.J. Tercer Piso, Cali, Colombia.,Secretaria de Salud Pública Municipal de Cali, Cali, Colombia
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Riutord-Sbert P, Pereira TC, de Pedro-Gómez JE, González-Carrasco D, López-Gónzalez AA, Barkvoll P. Study of the use of a personalized peripheral sealing device on surgical face masks in high-risk situations against COVID-19. PLoS One 2021; 16:e0253382. [PMID: 34358250 PMCID: PMC8345852 DOI: 10.1371/journal.pone.0253382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/04/2021] [Indexed: 12/28/2022] Open
Abstract
A significant number of health care professionals subjected to high-risk situations have been infected by Covid-19 due to the lack of adequate protection equipment or the deficient safety margins that these present. The aim of this study was to investigate whether the use of a personal peripheral sealing device (PSD) on surgical face masks (SM) allows them to achieve double mask properties, by providing two-way protection to professionals or users. The proposed device is a thermoplastic resin ring composed of a reusable and biodegradable polylactic acid (PLA) designed to be used in a healthcare setting. Since it is a thermoplastic device, it can be molded and adapted to each individual, becoming personalized and ensuring a correct adjustment to the user's face. First, a qualitative fit test was performed using a saccharin solution (SS) to evaluate respiratory protective equipment in recruited professionals exposed to high-risk situations of infection by Covid-19. Individuals were divided into an intervention group, who used SM with the PSD, and a control group, who used SM without the PSD. In addition, a quantitative inward air leakage fit test was performed using a 2% sodium chloride (NaCl) aerosol in a sealed cabinet with probes sensitive to this substance, in order to validate the SM with the PSD as a Face Filtering Mask (FFP). Only 5% of the individuals who performed the qualitative fit test with the PSD perceived the sweet taste of the SS, while 100% of the individuals who performed the test without the PSD sensed it (p = 0.0001). In the quantitative fit test, the percentage of air leakage of 2% NaCl aerosol into the SM with the PSD was 6.5%, achieving the same range of air leakage as a FFP mask. Thus, the use of a personalized PLA thermoplastic PSD, together with an inexpensive and widely available SM, could have a significant impact in terms of preventive safety by providing bi-directional protection to its user.
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Affiliation(s)
- Pere Riutord-Sbert
- ADEMA School of Dentistry, University of the Balearic Islands, Palma, Balearic Islands, Spain
| | - Thais Cristina Pereira
- ADEMA School of Dentistry, University of the Balearic Islands, Palma, Balearic Islands, Spain
| | - Joan Ernest de Pedro-Gómez
- ADEMA School of Dentistry, University of the Balearic Islands, Palma, Balearic Islands, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Balearic Islands, Spain
| | - Diego González-Carrasco
- ADEMA School of Dentistry, University of the Balearic Islands, Palma, Balearic Islands, Spain
| | - Angel Arturo López-Gónzalez
- ADEMA School of Dentistry, University of the Balearic Islands, Palma, Balearic Islands, Spain
- Occupational Risk Prevention Service, Balearic Islands Health Service, Palma, Balearic Islands, Spain
| | - Pål Barkvoll
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
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Sethi S, Kathuria M, Kaushik T. Face mask detection using deep learning: An approach to reduce risk of Coronavirus spread. J Biomed Inform 2021; 120:103848. [PMID: 34171485 PMCID: PMC8223067 DOI: 10.1016/j.jbi.2021.103848] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 06/10/2021] [Accepted: 06/20/2021] [Indexed: 11/30/2022]
Abstract
Effective strategies to restrain COVID-19 pandemic need high attention to mitigate negatively impacted communal health and global economy, with the brim-full horizon yet to unfold. In the absence of effective antiviral and limited medical resources, many measures are recommended by WHO to control the infection rate and avoid exhausting the limited medical resources. Wearing a mask is among the non-pharmaceutical intervention measures that can be used to cut the primary source of SARS-CoV2 droplets expelled by an infected individual. Regardless of discourse on medical resources and diversities in masks, all countries are mandating coverings over the nose and mouth in public. To contribute towards communal health, this paper aims to devise a highly accurate and real-time technique that can efficiently detect non-mask faces in public and thus, enforcing to wear mask. The proposed technique is ensemble of one-stage and two-stage detectors to achieve low inference time and high accuracy. We start with ResNet50 as a baseline and applied the concept of transfer learning to fuse high-level semantic information in multiple feature maps. In addition, we also propose a bounding box transformation to improve localization performance during mask detection. The experiment is conducted with three popular baseline models viz. ResNet50, AlexNet and MobileNet. We explored the possibility of these models to plug-in with the proposed model so that highly accurate results can be achieved in less inference time. It is observed that the proposed technique achieves high accuracy (98.2%) when implemented with ResNet50. Besides, the proposed model generates 11.07% and 6.44% higher precision and recall in mask detection when compared to the recent public baseline model published as RetinaFaceMask detector. The outstanding performance of the proposed model is highly suitable for video surveillance devices.
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Affiliation(s)
- Shilpa Sethi
- Department of Computer Applications, J.C. Bose University of Science and Technology, Faridabad, India
| | - Mamta Kathuria
- Department of Computer Applications, J.C. Bose University of Science and Technology, Faridabad, India.
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25
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El-Sokkary RH, Khater WS, El-Kholy A, Mohy Eldin S, Gad DM, Bahgat S, Negm EEM, El Kholy JA, Mowafy S, Mahmoud E, Mortada EM. Compliance of healthcare workers to the proper use of personal protective equipment during the first wave of COVID-19 pandemic. J Infect Public Health 2021; 14:1404-1410. [PMID: 34344624 PMCID: PMC8317453 DOI: 10.1016/j.jiph.2021.07.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 12/20/2022] Open
Abstract
Background In limited resource settings, compliance to proper personal protective equipment (PPE) use is challenging. This study aims to characterize the pattern of PPE use among healthcare workers (HCWs) during the first wave of coronavirus diseases-2019 (COVID-19) in Egypt and to determine the factors associated with compliance to the proper use of PPE. Methods A cross-sectional study was conducted among Egyptian HCWs using an online self-administered questionnaire. Participants were classified as “Compliant” or “Non-compliant” according to their score. Results A total of 404 responses were analyzed, with a mean age of 36.6 ± 8.4 years, and 56.4% were females. Non-compliant HCWs represented 53.2% of participants. The majority reported shortage in N95 respirators (91.3%) and practiced extended PPE use (88.1%). Better compliance to proper PPE use was reported: females (51.3%, p = 0.05), Physicians (54.2 %, p = 0.005), medical specialities (34.7 %, p < 0.001), <10 years’ work experience (42.9%, p = 0.05) and working > eight hours/day (71.3%, p < 0.001). The significant predictors for compliance were; receiving prior training on the proper use of PPE (OR: 4.59, CI: 2.22–9.47, p ≤ 0.001), exposure to COVID-19 patients (OR: 2.75, CI: 1.19–6.35, p = 0.02) and performing procedures that pose HCWs at a high risk of exposure to Severe Acute Respiratory Syndrome Coronavirus 2 (OR: 2.21, CI: 1.04–4.71, p = 0.04). The high percentage of non-compliant HCWs turns on a warning signal. Increase the availability of PPE, prioritize their use, provide more focus on training of HCWs and monitor their compliance is highly recommended.
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Affiliation(s)
- Rehab H El-Sokkary
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Walaa S Khater
- Medical Microbiology and Immunology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amani El-Kholy
- Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Doaa M Gad
- Chest Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Shereen Bahgat
- Family Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Essam E M Negm
- Anesthesia & Surgical Intensive Care Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Jehan A El Kholy
- Anesthesia & Surgical Intensive Care Department, Faculty of Medicine, Cairo University, Cairo, Egypt; Infection Prevention and Control Department, Dar Al Fouad Hospital, Nasr City, Cairo, Egypt
| | - Sherif Mowafy
- Anesthesia & Surgical Intensive Care Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Eman Mahmoud
- Microbiology and Immunology Department, National Liver Institute, Menoufeya University, Shibin el Kom, Egypt
| | - Eman M Mortada
- Community, Occupational and Environmental Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt; Health Sciences Department, Health Sciences & Rehabilitation College, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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26
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Escandón K, Rasmussen AL, Bogoch II, Murray EJ, Escandón K, Popescu SV, Kindrachuk J. COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection. BMC Infect Dis 2021; 21:710. [PMID: 34315427 PMCID: PMC8314268 DOI: 10.1186/s12879-021-06357-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
Scientists across disciplines, policymakers, and journalists have voiced frustration at the unprecedented polarization and misinformation around coronavirus disease 2019 (COVID-19) pandemic. Several false dichotomies have been used to polarize debates while oversimplifying complex issues. In this comprehensive narrative review, we deconstruct six common COVID-19 false dichotomies, address the evidence on these topics, identify insights relevant to effective pandemic responses, and highlight knowledge gaps and uncertainties. The topics of this review are: 1) Health and lives vs. economy and livelihoods, 2) Indefinite lockdown vs. unlimited reopening, 3) Symptomatic vs. asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 4) Droplet vs. aerosol transmission of SARS-CoV-2, 5) Masks for all vs. no masking, and 6) SARS-CoV-2 reinfection vs. no reinfection. We discuss the importance of multidisciplinary integration (health, social, and physical sciences), multilayered approaches to reducing risk ("Emmentaler cheese model"), harm reduction, smart masking, relaxation of interventions, and context-sensitive policymaking for COVID-19 response plans. We also address the challenges in understanding the broad clinical presentation of COVID-19, SARS-CoV-2 transmission, and SARS-CoV-2 reinfection. These key issues of science and public health policy have been presented as false dichotomies during the pandemic. However, they are hardly binary, simple, or uniform, and therefore should not be framed as polar extremes. We urge a nuanced understanding of the science and caution against black-or-white messaging, all-or-nothing guidance, and one-size-fits-all approaches. There is a need for meaningful public health communication and science-informed policies that recognize shades of gray, uncertainties, local context, and social determinants of health.
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Affiliation(s)
- Kevin Escandón
- School of Medicine, Universidad del Valle, Cali, Colombia.
| | - Angela L Rasmussen
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
- Georgetown Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
| | - Isaac I Bogoch
- Division of Infectious Diseases, University of Toronto, Toronto General Hospital, Toronto, Canada
| | - Eleanor J Murray
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Karina Escandón
- Department of Anthropology, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Saskia V Popescu
- Georgetown Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
- Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Jason Kindrachuk
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
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27
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Chu J, Ghenand O, Collins J, Byrne J, Wentworth A, Chai PR, Dadabhoy F, Hur C, Traverso G. Thinking green: modelling respirator reuse strategies to reduce cost and waste. BMJ Open 2021; 11:e048687. [PMID: 34275864 PMCID: PMC8290946 DOI: 10.1136/bmjopen-2021-048687] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To compare the impact of respirator extended use and reuse strategies with regard to cost and sustainability during the COVID-19 pandemic. DESIGN Cost analysis. SETTING USA. PARTICIPANTS All healthcare workers within the USA. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A model was developed to estimate usage, costs and waste incurred by several respirator usage strategies over the first 6 months of the pandemic in the USA. This model assumed universal masking of all healthcare workers. Estimates were taken from the literature, government databases and commercially available data from approved vendors. RESULTS A new N95 respirator per patient encounter would require 7.41 billion respirators, cost $6.38 billion and generate 84.0 million kg of waste in the USA over 6 months. One respirator per day per healthcare worker would require 3.29 billion respirators, cost $2.83 billion and generate 37.22 million kg of waste. Decontamination by ultraviolet germicidal irradiation would require 1.64 billion respirators, cost $1.41 billion and accumulate 18.61 million kg of waste. H2O2 vapour decontamination would require 1.15 billion respirators, cost $1.65 billion and produce 13.03 million kg of waste. One reusable respirator with daily disposable filters would require 18 million respirators, cost $1.24 billion and generate 15.73 million kg of waste. Pairing a reusable respirator with H2O2 vapour-decontaminated filters would reduce cost to $831 million and generate 1.58 million kg of waste. The use of one surgical mask per healthcare worker per day would require 3.29 billion masks, cost $460 million and generate 27.92 million kg of waste. CONCLUSIONS Decontamination and reusable respirator-based strategies decreased the number of respirators used, costs and waste generated compared with single-use or daily extended-use of disposable respirators. Future development of low-cost,simple technologies to enable respirator and/or filter decontamination is needed to further minimise the economic and environmental costs of masks.
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Affiliation(s)
- Jacqueline Chu
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Omkar Ghenand
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Joy Collins
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - James Byrne
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Radiation Oncology Program, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Adam Wentworth
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Peter R Chai
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Farah Dadabhoy
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Chin Hur
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
- Department of Epidemiology, Columbia University Medical Center, New York, New York, USA
| | - Giovanni Traverso
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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28
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Damiani G, Gironi LC, Pacifico A, Cristaudo A, Malagoli P, Allocco F, Bragazzi NL, Linder DM, Santus P, Buja A, Savoia P, Pigatto PD. Masks use and facial dermatitis during COVID-19 outbreak: is there a difference between CE and non-CE approved masks? Multi-center, real-life data from a large Italian cohort. Ital J Dermatol Venerol 2021; 156:220-225. [PMID: 33960753 DOI: 10.23736/s2784-8671.21.06895-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND During the recent COVID-19 outbreak, masks became mandatory and shortages frequent, therefore the prevalence of non-CE (European Conformity Mark) approved masks increased in the general population. We aimed to quantify the prevalence of mask-related cutaneous side effects and the differences between CE and non-CE approved masks. METHODS In this multicenter prospective observational study conducted from March 20, 2020 to May 12, 2020(during and after quarantine), patients attending emergency departments for a dermatological consult were clinically assessed and their masks were inspected to detect CE marks and UNI (Italian National Unification Entity) norms. Patients with history of facial dermatoses or under current treatment for facial dermatoses were excluded. RESULTS We enrolled 412 patients (318 during quarantine and 94 after quarantine). CE-approved masks were observed 52.8% vs. 24.5%, whilst subsets of non-CE approved masks were 9.7% vs. 14.9% (Personal protective equipment (PPE)-masks), 16.4% vs. 12.8% (surgical masks [SM]), and 21.1% vs. 47.9%(non-PPE) and (non-SM masks), respectively during and after quarantine. Remarkably, non-CE-approved masks resulted in patients displaying a statistically significant higher incidence of facial dermatoses and irritant contact dermatitis compared to CE-approved masks, and these differences were mainly driven by non-PPE non-SM masks. Comparing quarantine and after quarantine periods, no statistically significant differences were found for CE-approved masks, whilst differences were detected in non-CE-approved masks regarding incidence of facial dermatoses (P<0.0001)and irritant contact dermatitis (P=0.0041). CONCLUSIONS Masks are essential to prevent COVID-19 but at the same time higher awareness regarding mask specifications should be promoted in the general population. Non-PPE and non-SM masks should undergo more rigorous testing to prevent the occurrence of cutaneous side effects and future patients' lawsuit damages.
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Affiliation(s)
- Giovanni Damiani
- Department of Clinical Dermatology, IRCCS Galeazzi Orthopedic Institute, Milan, Italy - .,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy -
| | - Laura C Gironi
- Maggiore della Carità University Hospital, Novara, Italy
| | - Alessia Pacifico
- Department of Clinical Dermatology, IRCCS S. Gallicano Dermatological Institute, Rome, Italy
| | - Antonio Cristaudo
- Department of Clinical Dermatology, IRCCS S. Gallicano Dermatological Institute, Rome, Italy
| | - Piergiorgio Malagoli
- Unit of Dermatology, Hospital of San Donato Milanese, San Donato Milanese, Milan, Italy
| | | | - Nicola L Bragazzi
- Department of Mathematics and Statistics, Laboratory for Industrial and Applied Mathematics (LIAM), York University, Toronto, ON, Canada
| | - Dennis M Linder
- Department of Dermatology, University Hospital, Padua, Italy
| | - Pierachille Santus
- Respiratory Unit, Department of Biomedical And Clinical Sciences (DIBIC), University of Milan, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Alessandra Buja
- Department of Cardiological, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Paola Savoia
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Paolo Dm Pigatto
- Department of Clinical Dermatology, IRCCS Galeazzi Orthopedic Institute, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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Reutman SR, Reponen T, Yermakov M, A Grinshpun S. Homemade facemasks: particle filtration, breathability, fit, and other performance characteristics. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:334-344. [PMID: 34080950 DOI: 10.1080/15459624.2021.1925124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Homemade cloth masks and other improvised face coverings have become widespread during the COVID-19 pandemic driven by severe shortages of personal protective equipment. In this study, various alternative (mostly common household) materials, which have not traditionally been used in respiratory protective devices, were tested for particle filtration performance and breathability. Most of these materials were found of some-but rather limited-utility in facemasks. At a breathing flow rate of 30 L min-1, 17 out of 19 tested materials demonstrated collection efficiency below 50%; at 85 L min-1, only one material featured particle collection efficiency above 50%. Pressure drop values were mostly below 4 mm w.g. (observed in 89% of cases for the two flow rates), which provides comfortable breathing. Only for one fabric material (silk) tested at 85 L min-1 did the pressure drop reach 11 mm w.g. Based on these results, a three-layer facemask prototype was designed and fabricated comprised of the best performing materials. Additional tests were conducted to examine possible particle detachment/shedding from the materials used in the newly developed facemask, but no such phenomenon was observed. The prototype was evaluated on 10 human subjects using the standard OSHA-approved quantitative fit testing protocol. The mask protection level, determined as an adopted fit factor, was found to lie between that of the two commercial surgical/medical masks tested for comparison. A 10-cycle washing of the mask prototype lowered its collection efficiency across the particle size range; however, washing did not substantially affect mask breathability. The study revealed that although homemade masks offer a certain level of protection to a wearer, one should not expect them to provide the same respiratory protection as high-end commercial surgical/medical masks or-by any means-NIOSH-certified N95 filtering facepieces.
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Affiliation(s)
- Susan R Reutman
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tiina Reponen
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michel Yermakov
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sergey A Grinshpun
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio
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30
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Jones RM, Rempel D. Standards for Surgical Respirators and Masks: Relevance for Protecting Healthcare Workers and the Public During Pandemics. Ann Work Expo Health 2021; 65:495-504. [PMID: 33942848 PMCID: PMC8135753 DOI: 10.1093/annweh/wxab008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/02/2020] [Accepted: 01/20/2021] [Indexed: 12/30/2022] Open
Abstract
National standards for surgical respirators and masks are written and enforced to protect healthcare workers from particles and microorganisms such as Severe Acute Respriatory Syndrome Coronavirus 2 (SARS-CoV-2). In addition to the ability to filter particles (e.g. filtration efficiency, FE), the standards address breathability (e.g. differential pressure), how well the mask seals to a worker’s face (e.g. fit test), the level of protection from a fluid splash, and other factors. Standards used in the USA, European Union (EU), and China were compared with respect to testing methods and certification criteria. Although there are substantial similarities in standards for respirators, such as surgical N95, FFP2, and KN95 filtering facepiece respirators (FFRs), there are differences with respect to who performs that testing and fit-testing requirements that influence certification. There is greater variation in test methods between countries for surgical (USA) or medical (EU and China) masks than for FFRs. Surgical/medical masks can be certified to different levels of protection. The impact of the similarities and differences in testing methods and certification criteria on FFR and mask performance for protecting healthcare workers from SARS-CoV-2 are discussed, as well as the value of a new standard in the EU for testing fabrics for masks used by the public. Health and safety personnel in healthcare settings must understand the differences between standards so that they can select respirators and masks that provide appropriate protection for healthcare workers.
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Affiliation(s)
- Rachael M Jones
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA.,Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake, UT, USA
| | - David Rempel
- Division of Occupational and Environmental Medicine, University of California, San Francisco, USA
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31
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Sharma R, Bindra A, Soni KD. Personal Protective Equipment-Related Nasal Bridge Folliculitis in a Corona Warrior. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0041-1722834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractNasal bridge is a common site suffering personal protective equipment-induced skin damages over face among first-line health care workers in this coronavirus disease 2019 pandemic. We hereby report folliculitis as a complication following regular use of N95 respirator and goggles, unreported in literature till now.
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Affiliation(s)
- Rajeev Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Bindra
- Department of Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
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32
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Brêda Mascarenhas LA, Machado BAS, Rodrigues LDAP, Saraiva Hodel KV, Bandeira Santos AÁ, Freitas Neves PR, da Silva Andrade LPC, Soares MB, de Andrade JB, Badaró R. Potential application of novel technology developed for instant decontamination of personal protective equipment before the doffing step. PLoS One 2021; 16:e0250854. [PMID: 34086691 PMCID: PMC8177472 DOI: 10.1371/journal.pone.0250854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 02/02/2021] [Indexed: 12/14/2022] Open
Abstract
The use of personal protective equipment (PPE) has been considered the most effective way to avoid the contamination of healthcare workers by different microorganisms, including SARS-CoV-2. A spray disinfection technology (chamber) was developed, and its efficacy in instant decontamination of previously contaminated surfaces was evaluated in two exposure times. Seven test microorganisms were prepared and inoculated on the surface of seven types of PPE (respirator mask, face shield, shoe, glove, cap, safety glasses and lab coat). The tests were performed on previously contaminated PPE using a manikin with a motion device for exposure to the chamber with biocidal agent (sodium hypochlorite) for 10 and 30s. In 96.93% of the experimental conditions analyzed, the percentage reduction was >99% (the number of viable cells found on the surface ranged from 4.3x106 to <10 CFU/mL). The samples of E. faecalis collected from the glove showed the lowest percentages reduction, with 86.000 and 86.500% for exposure times of 10 and 30 s, respectively. The log10 reduction values varied between 0.85 log10 (E. faecalis at 30 s in glove surface) and 9.69 log10 (E. coli at 10 and 30 s in lab coat surface). In general, E. coli, S. aureus, C. freundii, P. mirabilis, C. albicans and C. parapsilosis showed susceptibility to the biocidal agent under the tested conditions, with >99% reduction after 10 and 30s, while E. faecalis and P. aeruginosa showed a lower susceptibility. The 30s exposure time was more effective for the inactivation of the tested microorganisms. The results show that the spray disinfection technology has the potential for instant decontamination of PPE, which can contribute to an additional barrier for infection control of healthcare workers in the hospital environment.
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Affiliation(s)
- Luís Alberto Brêda Mascarenhas
- SENAI CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
| | - Bruna Aparecida Souza Machado
- SENAI CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
- SENAI CIMATEC, National Service of Industrial Learning–SENAI, Computational Modeling and Industrial Technology, University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
| | - Leticia de Alencar Pereira Rodrigues
- SENAI CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
| | - Katharine Valéria Saraiva Hodel
- SENAI CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
| | - Alex Álisson Bandeira Santos
- SENAI CIMATEC, National Service of Industrial Learning–SENAI, Computational Modeling and Industrial Technology, University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
| | - Paulo Roberto Freitas Neves
- SENAI CIMATEC, National Service of Industrial Learning–SENAI, Computational Modeling and Industrial Technology, University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
| | - Leone Peter Correia da Silva Andrade
- SENAI CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
| | - Milena Botelho Soares
- SENAI CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (IGM-FIOCRUZ/BA), Salvador, Bahia, Brazil
| | - Jailson Bittencourt de Andrade
- SENAI CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
| | - Roberto Badaró
- SENAI CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador, Bahia, Brazil
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Sahota S, Gill S, Ridenton J, Hegarty H, Pope K, Gentile G. Hair today, gone tomorrow: How personal protective equipment guidance changed doctor's facial hair during the COVID-19 pandemic. Health Sci Rep 2021; 4:e278. [PMID: 33977160 PMCID: PMC8103089 DOI: 10.1002/hsr2.278] [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: 12/02/2020] [Revised: 03/14/2021] [Accepted: 03/25/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To investigate how personal protective equipment (PPE) guidance altered the facial hair of hospital doctors and explore the wider impact and implications of these changes. METHODS A single site uncontrolled before-after survey study examining change in facial hairstyles, and wider implications on doctor's cultural, religious, and personal wellbeing. Outcome measures included change in facial hair between January and April 2020 and whether these changes adhered to guidance set by Public Health England. Participants were also asked about the wider impact of these changes which were thematically analyzed using an inductive approach. RESULTS Of those who completed the survey, 257 participants met the inclusion criteria. 68% (n = 67) of doctors who could grow facial hair changed their facial hairstyle during the COVID-19 pandemic and 96% (n = 64) reported that the change was in response to PPE guidance. The odds of having a facial hairstyle that complied with PPE guidance before the pandemic was 0.32, which rose to 2.77 after guidance was released, giving an odds ratio of 8.54 (95% CI 4.49-16.23, P < .001). When compared to those who sported a shaven face prepandemic, the odds ratio of a change in style for those with prepandemic full beards was 37.92 (95% CI 7.45-192.8, P < .001), for goatees was 7.22 (95% CI 1.076-48.47, P = .04), for moustaches was 4.33 (95% CI 0.207-90.85, P = .345), and for stubble was 9.06 (95% CI 2.133-38.49, P = .003). Qualitative analysis revealed multiple themes, including skin irritation, loss of identity, and a significant impact on participants required to maintain a beard due to religious or cultural reasons. CONCLUSIONS Facial hairstyles have changed significantly at our hospital during the COVID-19 pandemic. Facial hair can impact upon doctors' cultural, religious, and personal wellbeing and these factors need to be considered with policy and provision of PPE.
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Affiliation(s)
- Sanjeev Sahota
- Brighton and Sussex University Hospitals NHS Trust, AnaestheticsBrighton and HoveUK
| | - Simon Gill
- Royal Cornwall Hospitals NHS Trust, AnaestheticsTruroUK
| | | | - Helen Hegarty
- Sussex Partnership Trust, Department of PsychiatryEastbourne General HospitalEastbourneUK
| | | | - Giorgio Gentile
- Royal Cornwall Hospitals NHS TrustNephrologyTruroUK
- University of Exeter, Medicine, The Knowledge SpaExeterDevonUK
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34
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Joo JY, Liu MF. Nurses' barriers to caring for patients with COVID-19: a qualitative systematic review. Int Nurs Rev 2021; 68:202-213. [PMID: 33420749 PMCID: PMC8013562 DOI: 10.1111/inr.12648] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/15/2020] [Accepted: 12/07/2020] [Indexed: 12/23/2022]
Abstract
AIM The aim of this qualitative systematic review is to identify and synthesize qualitative studies of frontline nurses' experiences and challenges when caring for patients with COVID-19 in hospitals. BACKGROUND This review is the first qualitative systematic review of nurses' experiences since the beginning of the COVID-19 pandemic in 2020. Understanding nurses' experiences with COVID-19 is important because nurses are among the most vital of healthcare workers. METHODS This study used a qualitative systematic review methodology with thematic synthesis to analyse the included studies. Five databases (CINAHL, PubMed, Ovid, Web of Science, and PsycINFO) were searched from January to mid-August 2020, and 25 abstracts were screened. Based on inclusion criteria, this qualitative systematic review included nine studies. RESULTS Five themes were identified as barriers to COVID-19 care by 133 hospital-based nurses: limited information about COVID-19, unpredictable tasks and challenging practices, insufficient support, concerns about family, and emotional and psychological stress. CONCLUSIONS The five barriers identified in this review should be overcome to improve nurses' experiences and, in turn, the quality of care patients with COVID-19 receive. IMPLICATIONS FOR NURSING AND HEALTH POLICY The findings from this review can be used to reform current healthcare and hospital-support systems for populations with COVID-19. They can also be used to point towards areas of research interested in improving frontline nursing. Finally, nursing leaders, healthcare policymakers and governments should use these findings to better support the nursing workforce in the current or a future pandemic.
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Affiliation(s)
| | - Megan F. Liu
- School of Gerontology Health ManagementCollege of NursingTaipei Medical UniversityTaipeiTaiwan
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35
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Radhakrishnan N, Sudarsan SS, Deepak Raj K, Krishnamoorthy S. Clinical Audit on Symptomatology of Covid-19 Healthcare Workers and Impact on Quality-of-Life (QOL) Due to Continuous Facemask Usage: A Prospective Study. Indian J Otolaryngol Head Neck Surg 2021; 73:486-493. [PMID: 33842302 PMCID: PMC8019073 DOI: 10.1007/s12070-021-02530-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/22/2021] [Indexed: 01/08/2023] Open
Abstract
Covid-19 due to Sars-Cov-2 infection has reached pandemic proportion. Many healthcare workers are involved in managing both COVID-suspected and confirmed cases. It is mandatory for healthcare workers to have droplet and contact precautions by means of Personal protective equipment (PPE), facemask, face shield or eye protection. Prolonged usage of medical mask results in various adverse effects. This study is an attempt to know the common effects of prolonged face mask in healthcare workers and its resultant quality-of-life (QOL). To study the common effects of prolonged face mask and its impact on QOL of healthcare workers during the COVID 19 crisis. This was a prospective cross-sectional study conducted over 6 months among 2750 healthcare workers. A questionnaire requesting demographic details and most common side effects after prolonged usage of face mask was circulated. We also attached a short form-12 (sf-12) questionnaire to assess its impact on QOL. Out of 2750 personnel, 299 were excluded. Male preponderance was noted. Study was conducted on candidates using 3ply mask or above. Age range was between 18 and 65 years with mean age being 37.61 ± 15.23 in mask users < 5 h per day, 32.2 ± 10.02 in 5–10 h group and 30.19 ± 8.15 in 10 h group. 8.48% (n = 174) had comorbidities. QOL impacted. The complaints with face mask use definitely are troublesome with increase in severity with duration of mask usage. This definitely has a proportional impact on the healthcare workers’ QOL.
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Affiliation(s)
- Nandhini Radhakrishnan
- Department of ENT-HNS, Saveetha Medical College and Hospital, No. 1, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105 India
| | - Shyam Sudhakar Sudarsan
- Department of ENT-HNS, Saveetha Medical College and Hospital, No. 1, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105 India
| | - K Deepak Raj
- Department of ENT-HNS, Saveetha Medical College and Hospital, No. 1, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105 India
| | - Srinivasan Krishnamoorthy
- Department of ENT-HNS, Saveetha Medical College and Hospital, No. 1, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105 India
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Griswold DP, Gempeler A, Kolias A, Hutchinson PJ, Rubiano AM. Personal protective equipment for reducing the risk of COVID-19 infection among health care workers involved in emergency trauma surgery during the pandemic: An umbrella review. J Trauma Acute Care Surg 2021; 90:e72-e80. [PMID: 33433175 PMCID: PMC7996059 DOI: 10.1097/ta.0000000000003073] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/30/2020] [Accepted: 12/26/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Health care facilities in low- and middle-income countries are inadequately resourced to adhere to current COVID-19 prevention recommendations. Recommendations for surgical emergency trauma care measures need to be adequately informed by available evidence and adapt to particular settings. To inform future recommendations, we set to summarize the effects of different personal protective equipment (PPE) on the risk of COVID-19 infection in health personnel caring for trauma surgery patients. METHODS We conducted an umbrella review using Living Overview of Evidence platform for COVID-19, which performs regular automated searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and more than 30 other sources. Systematic reviews of experimental and observational studies assessing the efficacy of PPE were included. Indirect evidence from other health care settings was also considered. Risk of bias was assessed with the AMSTAR II tool (Assessing the Methodological Quality of Systematic Reviews, Ottawa, ON, Canada), and the Grading of Recommendations, Assessment, Development, and Evaluation approach for grading the certainty of the evidence is reported (registered in International Prospective Register of Systematic Reviews, CRD42020198267). RESULTS Eighteen studies that fulfilled the selection criteria were included. There is high certainty that the use of N95 respirators and surgical masks is associated with a reduced risk of COVID-19 when compared with no mask use. In moderate- to high-risk environments, N95 respirators are associated with a further reduction in risk of COVID-19 infection compared with surgical masks. Eye protection also reduces the risk of contagion in this setting. Decontamination of masks and respirators with ultraviolet germicidal irradiation, vaporous hydrogen peroxide, or dry heat is effective and does not affect PPE performance or fit. CONCLUSION The use of PPE drastically reduces the risk of COVID-19 compared with no mask use in health care workers. N95 and equivalent respirators provide more protection than surgical masks. Decontamination and reuse appear feasible to overcome PPE shortages and enhance the allocation of limited resources. These effects are applicable to emergency trauma care and should inform future recommendations. LEVEL OF EVIDENCE Review, level II.
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37
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Farmer N, Connor M. Reducing the risk of infection to patients and staff during gynaecological outpatient and ambulatory appointments. Best Pract Res Clin Obstet Gynaecol 2021; 73:22-39. [PMID: 33903030 PMCID: PMC7970421 DOI: 10.1016/j.bpobgyn.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/09/2021] [Indexed: 12/24/2022]
Abstract
This chapter explores ways to reduce the risk of severe acute respiratory syndrome coronavirus-2 transmission to women and staff within gynaecology outpatient clinics. The likely routes of transmission are discussed, namely through droplets, aerosols and fomites. Using the 'hierarchy of control' categories, elimination, substitution, engineering, administration and personal protective equipment, practical strategies for modifying virus exposure are presented. The management of specific clinical conditions are reviewed based on advice prepared by the specialist societies in conjunction with each other and the Royal College of Obstetricians and Gynaecologists. The need to maintain at least a minimal level of gynaecological services is recognised and that this should provide safe, equitable and effective care. Ways to reduce clinic attendance are discussed with the substitution of face-to-face with remote consultations and when this is relevant. Current recommendations for ambulatory procedures, which include colposcopy and hysteroscopy, are considered so that best use is made of reduced resources.
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Affiliation(s)
- Natalie Farmer
- Yorkshire and Humberside Deanery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2SF, UK.
| | - Mary Connor
- Department of Obstetrics and Gynaecology, Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2SF, UK.
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Boffetta P, Violante F, Durando P, De Palma G, Pira E, Vimercati L, Cristaudo A, Icardi G, Sala E, Coggiola M, Tafuri S, Gattini V, Apostoli P, Spatari G. Determinants of SARS-CoV-2 infection in Italian healthcare workers: a multicenter study. Sci Rep 2021; 11:5788. [PMID: 33707646 PMCID: PMC7970984 DOI: 10.1038/s41598-021-85215-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 01/27/2021] [Indexed: 12/23/2022] Open
Abstract
Healthcare workers (HCWs) are at increased risk of being infected with SARS-CoV-2, yet limited information is available on risk factors of infection. We pooled data on occupational surveillance of 10,654 HCW who were tested for SARS-CoV-2 infection in six Italian centers. Information was available on demographics, job title, department of employment, source of exposure, use of personal protective equipment (PPEs), and COVID-19-related symptoms. We fitted multivariable logistic regression models to calculate odds ratios and 95% confidence intervals of infection. The prevalence of infection ranged from 3.0 to 22.0%, and was correlated with that of the respective areas. Women were at lower risk of infection compared to men. Fever, cough, dyspnea and malaise were the symptoms most strongly associated with infection, together with anosmia and ageusia. No differences in the risk of infection were detected according to job title, or working in a COVID-19 designated department. Reported contact with a patient inside or outside the workplace was a risk factor. Use of a mask was strongly protective against risk of infection as was use of gloves. The use of a mask by the source of exposure (patient or colleague) had an independent effect in reducing infection risk.
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Affiliation(s)
- Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA. .,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Francesco Violante
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giuseppe De Palma
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Enrico Pira
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Luigi Vimercati
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Alfonso Cristaudo
- University Hospital Pisana, Pisa, Italy.,University of Pisa, Pisa, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Emma Sala
- University Hospital Spedali Civili di Brescia, Brescia, Italy
| | - Maurizio Coggiola
- University Hospital City of Health and Science of Turin, Turin, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Vittorio Gattini
- University Hospital Pisana, Pisa, Italy.,University of Pisa, Pisa, Italy
| | - Pietro Apostoli
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,Italian Society of Occupational Medicine, Bologna, Italy
| | - Giovanna Spatari
- Department of Biomedical and Dentistry Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
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Talarico V, Pinto L, Marseglia GL, Centonze A, Cristofaro C, Reina R, Nocerino A, Lubrano R, Zampogna S. Impact of novel coronavirus Disease-19 (COVID-19) pandemic in Italian pediatric emergency departments: a national survey. Ital J Pediatr 2021; 47:47. [PMID: 33658068 PMCID: PMC7927765 DOI: 10.1186/s13052-021-00996-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronavirus Disease-19 (COVID-19) has rapidly become a pandemic emergency, distressing health systems in each affected country. Preparation strategies for managing this pandemic have been keys to face the COVID-19 surge all over the world and all levels of care. MATERIALS AND METHODS During the epidemic, the Italian society of pediatric emergency-urgency (SIMEUP) promoted a national survey aiming to evaluate preparedness and response of pediatric emergency departments (PED) critical in ensuring optimal management of COVID-19 cases. RESULTS Our results suggest that Italian PED have promptly set a proactive approach to the present emergency. 98.9% of the hospitals have defined special pathways and assistive protocols concerning the management of pediatric COVID-19 cases. The highest percentage of application of the measures for preventive and protective for COVID-19 concerned the use of personal protective equipments. CONCLUSIONS Results show that the following measures for pediatric patients, admitted in PED, have been promptly implemented throughout the whole country: eg. use of protective devices, pre-triage of patients accessing the hospital. Despite COVID-19 being a new threat, we have shown that by developing an easy-to-follow decision algorithm and clear plans for the interventional platform teams, we can ensure optimal health care workers and patients' safety.
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Affiliation(s)
- Valentina Talarico
- Department of Pediatric, "Pugliese-Ciaccio" Hospital, Viale Pio X, 88100, Catanzaro, Italy.
| | - Luciano Pinto
- Italian Society of Pediatric Emergency Medicine, Naples, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico "San Matteo" University of Pavia, Pavia, Italy
| | - Antonella Centonze
- Department of Pediatric Surgery, "Pugliese-Ciaccio" Hospital, Viale Pio X, Catanzaro, Italy
| | - Concetta Cristofaro
- Department of Law, History Economics and Social Science, Magna Graecia University, Catanzaro, Italy
| | - Rocco Reina
- Department of Law, History Economics and Social Science, Magna Graecia University, Catanzaro, Italy
| | - Agostino Nocerino
- Department of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Riccardo Lubrano
- Department of Pediatrics, "La Sapienza" University of Roma -Hospital of Latina, Roma, Italy
| | - Stefania Zampogna
- Department of Pediatric, "Pugliese-Ciaccio" Hospital, Viale Pio X, 88100, Catanzaro, Italy
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40
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Chai PR, Dadabhoy FZ, Huang HW, Chu JN, Feng A, Le HM, Collins J, da Silva M, Raibert M, Hur C, Boyer EW, Traverso G. Assessment of the Acceptability and Feasibility of Using Mobile Robotic Systems for Patient Evaluation. JAMA Netw Open 2021; 4:e210667. [PMID: 33662134 PMCID: PMC8058534 DOI: 10.1001/jamanetworkopen.2021.0667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Before the widespread implementation of robotic systems to provide patient care during the COVID-19 pandemic occurs, it is important to understand the acceptability of these systems among patients and the economic consequences associated with the adoption of robotics in health care settings. OBJECTIVE To assess the acceptability and feasibility of using a mobile robotic system to facilitate health care tasks. DESIGN, SETTING, AND PARTICIPANTS This study included 2 components: a national survey to examine the acceptability of using robotic systems to perform health care tasks in a hospital setting and a single-site cohort study of patient experiences and satisfaction with the use of a mobile robotic system to facilitate triage and telehealth tasks in the emergency department (ED). The national survey comprised individuals living in the US who participated in a sampling-based survey via an online analytic platform. Participants completed the national survey between August 18 and August 21, 2020. The single-site cohort study included patients living in the US who presented to the ED of a large urban academic hospital providing quaternary care in Boston, Massachusetts between April and August 2020. All data were analyzed from August to October 2020. EXPOSURES Participants in the national survey completed an online survey to measure the acceptability of using a mobile robotic system to perform health care tasks (facilitating telehealth interviews, acquiring vital signs, obtaining nasal or oral swabs, placing an intravenous catheter, performing phlebotomy, and turning a patient in bed) in a hospital setting in the contexts of general interaction and interaction during the COVID-19 pandemic. Patients in the cohort study were exposed to a mobile robotic system, which was controlled by an ED clinician and used to facilitate a triage interview. After exposure, patients completed an assessment to measure their satisfaction with the robotic system. MAIN OUTCOMES AND MEASURES Acceptability of the use of a mobile robotic system to facilitate health care tasks in a hospital setting (national survey) and feasibility and patient satisfaction regarding the use of a mobile robotic system in the ED (cohort study). RESULTS For the national survey, 1154 participants completed all acceptability questions, representing a participation rate of 35%. After sample matching, a nationally representative sample of 1000 participants (mean [SD] age, 48.7 [17.0] years; 535 women [53.5%]) was included in the analysis. With regard to the usefulness of a robotic system to perform specific health care tasks, the response of "somewhat useful" was selected by 373 participants (37.3%) for facilitating telehealth interviews, 350 participants (35.0%) for acquiring vital signs, 307 participants (30.7%) for obtaining nasal or oral swabs, 228 participants (22.8%) for placing an intravenous catheter, 249 participants (24.9%) for performing phlebotomy, and 371 participants (37.1%) for turning a patient in bed. The response of "extremely useful" was selected by 287 participants (28.7%) for facilitating telehealth interviews, 413 participants (41.3%) for acquiring vital signs, 192 participants (19.2%) for obtaining nasal or oral swabs, 159 participants (15.9%) for placing an intravenous catheter, 167 participants (16.7%) for performing phlebotomy, and 371 participants (37.1%) for turning a patient in bed. In the context of the COVID-19 pandemic, the median number of individuals who perceived the application of robotic systems to be acceptable for completing telehealth interviews, obtaining nasal and oral swabs, placing an intravenous catheter, and performing phlebotomy increased. For the ED cohort study, 51 individuals were invited to participate, and 41 participants (80.4%) enrolled. One participant was unable to complete the study procedures because of a signaling malfunction in the robotic system. Forty patients (mean [SD] age, 45.8 [2.7] years; 29 women [72.5%]) completed the mobile robotic system-facilitated triage interview, and 37 patients (92.5%) reported that the interaction was satisfactory. A total of 33 participants (82.5%) reported that their experience of receiving an interview facilitated by a mobile robotic system was as satisfactory as receiving an in-person interview from a clinician. CONCLUSIONS AND RELEVANCE In this study, a mobile robotic system was perceived to be acceptable for use in a broad set of health care tasks among survey respondents across the US. The use of a mobile robotic system enabled the facilitation of contactless triage interviews of patients in the ED and was considered acceptable among participants. Most patients in the ED rated the quality of mobile robotic system-facilitated interaction to be equivalent to in-person interaction with a clinician.
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Affiliation(s)
- Peter R Chai
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts
- The Fenway Institute, Boston, Massachusetts
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge
| | - Farah Z Dadabhoy
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Hen-Wei Huang
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jacqueline N Chu
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston
| | - Annie Feng
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge
| | - Hien M Le
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge
| | - Joy Collins
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Chin Hur
- Division of Gastroenterology, Department of Medicine, Columbia University, New York, New York
| | - Edward W Boyer
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- The Fenway Institute, Boston, Massachusetts
| | - Giovanni Traverso
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge
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41
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Kamar A, Maalouf N, Hitti E, El Eid G, Isma'eel H, Elhajj IH. Challenge of forecasting demand of medical resources and supplies during a pandemic: A comparative evaluation of three surge calculators for COVID-19. Epidemiol Infect 2021; 149:e51. [PMID: 33531094 PMCID: PMC7925989 DOI: 10.1017/s095026882100025x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/28/2020] [Accepted: 01/29/2021] [Indexed: 12/15/2022] Open
Abstract
Ever since the World Health Organization (WHO) declared the new coronavirus disease 2019 (COVID-19) as a pandemic, there has been a public health debate concerning medical resources and supplies including hospital beds, intensive care units (ICU), ventilators and protective personal equipment (PPE). Forecasting COVID-19 dissemination has played a key role in informing healthcare professionals and governments on how to manage overburdened healthcare systems. However, forecasting during the pandemic remained challenging and sometimes highly controversial. Here, we highlight this challenge by performing a comparative evaluation for the estimations obtained from three COVID-19 surge calculators under different social distancing approaches, taking Lebanon as a case study. Despite discrepancies in estimations, the three surge calculators used herein agree that there will be a relative shortage in the capacity of medical resources and a significant surge in PPE demand if the social distancing policy is removed. Our results underscore the importance of implementing containment interventions including social distancing in alleviating the demand for medical care during the COVID-19 pandemic in the absence of any medication or vaccine. The paper also highlights the value of employing several models in surge planning.
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Affiliation(s)
- A. Kamar
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
| | - N. Maalouf
- Maroun Semaan Faculty of Engineering and Architecture, Department of Electrical and Computer Engineering, American University of Beirut, Beirut, Lebanon
| | - E. Hitti
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - G. El Eid
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - H. Isma'eel
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - I. H. Elhajj
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
- Maroun Semaan Faculty of Engineering and Architecture, Department of Electrical and Computer Engineering, American University of Beirut, Beirut, Lebanon
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Carrington Y, Orlino J, Romero A, Gustin J, Rezaei M, Greene E, Rose S, Aiyer RA, Nasarabadi S. COVID-19 Diagnostic Testing For All - Using Non-Dilutive Saliva Sample Collection, Stabilization and Ambient Transport Devices. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33532800 DOI: 10.1101/2021.01.20.20243782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
COVID-19 testing is not accessible for millions during this pandemic despite our best efforts. Without greatly expanded testing of asymptomatic individuals, contact tracing and subsequent isolation of spreaders remains as a means for control. In an effort to increase RT-PCR assay testing for the presence of the novel beta-coronavirus SARS-CoV-2 as well as improve sample collection safety, GenTegra LLC has introduced two products for saliva collection and viral RNA stabilization: GTR-STM™ (GenTegra Saliva Transport Medium) and GTR-STMdk™ (GenTegra Saliva Transport Medium Direct to PCR). Both products contain a proprietary formulation based on GenTegra's novel "Active Chemical Protection™" (ACP) technology that gives non-dilutive, error-free saliva sample collection using RNA stabilization chemicals already dried in the collection tube. GTR-STM can be used for safer saliva-based sample collection at home (or at a test site). Following saliva collection, the sample-containing GTR-STM can be kept at ambient temperature during shipment to an authorized CLIA lab for analysis. SARS-CoV-2 viral RNA in GTR-STM is stable for over a month at ambient temperature, easily surviving the longest transit times from home to lab. GTR-STM enhances patient comfort, convenience, compliance and reduces infectious virus exposure to essential medical and lab professionals. Alternatively, the GTR-STMdk direct-into-PCR product can be used to improve lab throughput and reduce reagent costs for saliva sample collection and testing at any lab site with access to refrigeration. GTR-STMdk reduces lab process time by 25% and reagent costs by 30% compared to other approaches. Since GTR-STMdk retains SARS-CoV-2 viral RNA stability for three days at ambient temperature, it is optimized for lab test site rather than at home saliva collection. SARS-COV-2 viral RNA levels as low as 0.4 genome equivalents/uL are detected in saliva samples using GTR-STMdk. The increased sensitivity of SARS-CoV-2 detection can expand COVID-19 testing to include asymptomatic individuals using pooled saliva. One Sentence Summary GTR-STM and Direct-into-PCR GTR-STMdk offer substantive improvements in SARS-CoV-2 viral RNA stability, safety, and RT-PCR process efficiency for COVID-19 testing by using a non-dilutive saliva sample collection system for individuals at home or onsite respectively.
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Galicia JC, Mungia R, Taverna MV, Mendoza MJ, Estrela C, Gaudin A, Zhang C, Vaughn BA, Khan AA. Response by Endodontists to the SARS-CoV-2 (COVID−19) Pandemic: An International Survey. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2020.617440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
As SARS-CoV-2 continues to wreak havoc, health care workers are on the front lines to protect our communities. Dentists, particularly endodontists who manage dental emergencies, are engaged in high risk procedures that necessitate the modification of their treatment strategies in order to protect themselves, their staff and their patients from exposure to SARS-CoV-2. This study gathered international data from 448 endodontists to describe their awareness, their clinical care modifications, their strategies for re-opening and their reflection on the effects of the pandemic on their lives. Most endodontic practitioners (78%, n = 350) provided but limited their treatments to emergency care during the government-mandated shutdowns. They agreed with their local government's actions more than that of the national government, screened their patients for symptoms prior to treatment and changed their clinical care protocol to mitigate the spread of the virus. The pandemic has impacted their income, their ability to retain staff, and their financial and personal outlook in life.
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Sarkis-Onofre R, Borges RDC, Demarco G, Dotto L, Schwendicke F, Demarco FF. Decontamination of N95 respirators against SARS-CoV-2: A scoping review. J Dent 2021; 104:103534. [PMID: 33197526 PMCID: PMC7664347 DOI: 10.1016/j.jdent.2020.103534] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES This scoping review aimed to map and compile the available evidence regarding the effectiveness of decontaminating N95 respirators against the novel coronavirus (SARS-CoV-2). DATA We selected studies written in English assessing or discussing the decontamination strategies of N95 respirators against SARS-CoV-2. Two independent researchers performed the search and study screening. A descriptive analysis was carried out considering the study design of the included studies. SOURCES PubMed, SCOPUS, and Preprint platforms (bioRxiv and medRxiv). STUDY SELECTION We included 55 reports from PubMed and SCOPUS. Nine articles were letters to the editors, 21 were in vitro studies, 16 were literature reviews, and 9 were classified as other study designs. We included 37 preprints. Two articles were letters to the editors, 24 were in vitro studies, 3 were literature reviews, and 8 were classified as other study designs. In general, vaporized hydrogen peroxide and ultraviolet irradiation were the strategies most cited and most promising. However, there is a lack of evidence and consensus related to the best method of N95 respirator decontamination. CONCLUSION The evidence regarding decontamination strategies of N95 respirators against SARS-CoV-2 remains scarce. Vaporized hydrogen peroxide and ultraviolet irradiation seem to be the current standard for N95 respirator decontamination. CLINICAL SIGNIFICANCE Vaporized hydrogen peroxide and ultraviolet irradiation appear to be the most promising methods for N95 respirator decontamination.
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Affiliation(s)
| | | | - Giulia Demarco
- Post-Graduate Program in Dentistry - Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lara Dotto
- Graduate Program in Dentistry - Meriodional Faculty/IMED, Passo Fundo, Brazil
| | - Falk Schwendicke
- Department for Operative and Preventive Dentistry, Charité, Berlin, Germany
| | - Flávio Fernando Demarco
- Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil; Graduate Program in Dentistry - Federal University of Pelotas, Pelotas, RS, Brazil.
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45
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Ramirez-Moreno JM, Ceberino D, Gonzalez Plata A, Rebollo B, Macias Sedas P, Hariramani R, Roa AM, Constantino AB. Mask-associated 'de novo' headache in healthcare workers during the COVID-19 pandemic. Occup Environ Med 2020; 78:oemed-2020-106956. [PMID: 33380516 PMCID: PMC7780429 DOI: 10.1136/oemed-2020-106956] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/14/2020] [Accepted: 12/07/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The pandemic caused by the new coronavirus (COVID-19) has changed care activities of health professionals. We analysed the possible association between the appearance of 'de novo' headache according to the type of mask used, the related factors and the impact of the cephalalgia on health professionals. METHODS Cross-sectional study in a tertiary hospital in Extremadura, Spain. We provided an online questionnaire to healthcare workers during the period of maximum incidence of COVID-19 in our setting. RESULTS The subjects are n=306, 244 women (79.7%), with an average age of 43 years (range 23-65). Of the total, 129 (42.2%) were physicians, 112 (36.6%) nurses and 65 (21.2%) other health workers. 208 (79.7%) used surgical masks and 53 (20.3%) used filter masks. Of all those surveyed, 158 (51.6%) presented 'de novo' headache. The occurrence of a headache was independently associated with the use of a filter mask, OR 2.14 (95% CI 1.07 to 4.32); being a nurse, OR 2.09 (95% CI 1.18 to 3.72) or another health worker, OR 6.94 (95% CI 3.01 to 16.04); or having a history of asthma, OR 0.29 (95% CI 0.09 to 0.89). According to the type of mask used, there were differences in headache intensity, and the impact of a headache in the subjects who used a filter mask was worse in all the aspects evaluated. CONCLUSION The appearance of 'de novo' headache is associated with the use of filter masks and is more frequent in certain healthcare workers, causing a greater occupational, family, personal and social impact.
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Affiliation(s)
- José María Ramirez-Moreno
- Biomedical Sciences, University of Extremadura, Faculty of Medicine, Badajoz, Spain
- Neurology, Badajoz University Hospital, Badajoz, Spain
| | | | | | - Belen Rebollo
- Neurology, Badajoz University Hospital, Badajoz, Spain
| | | | | | - Ana M Roa
- Neurology, Badajoz University Hospital, Badajoz, Spain
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Inglis R, Barros L, Checkley W, Cizmeci EA, Lelei-Mailu F, Pattnaik R, Papali A, Schultz MJ, Ferreira JC. Pragmatic Recommendations for Safety while Caring for Hospitalized Patients with COVID-19 in Low- and Middle-Income Countries. Am J Trop Med Hyg 2020; 104:12-24. [PMID: 33355072 PMCID: PMC7957241 DOI: 10.4269/ajtmh.20-1128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/06/2020] [Indexed: 11/07/2022] Open
Abstract
Infection prevention and control measures to control the spread of COVID-19 are challenging to implement in many low- and middle-income countries (LMICs). This is compounded by the fact that most recommendations are based on evidence that mainly originates in high-income countries. There are often availability, affordability, and feasibility barriers to applying such recommendations in LMICs, and therefore, there is a need for developing recommendations that are achievable in LMICs. We used a modified version of the GRADE method to select important questions, searched the literature for relevant evidence, and formulated pragmatic recommendations for safety while caring for patients with COVID-19 in LMICs. We selected five questions related to safety, covering minimal requirements for personal protective equipment (PPE), recommendations for extended use and reuse of PPE, restriction on the number of times healthcare workers enter patients' rooms, hand hygiene, and environmental ventilation. We formulated 21 recommendations that are feasible and affordable in LMICs.
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Affiliation(s)
- Rebecca Inglis
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Lia Barros
- Division of Cardiology, University of Washington, Seattle, Washington
| | - William Checkley
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Elif A. Cizmeci
- Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Faith Lelei-Mailu
- Department of Quality Health and Safety, AIC Kijabe Hospital, Kijabe, Kenya
| | | | - Alfred Papali
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Juliana C. Ferreira
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - for the COVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU)
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Division of Cardiology, University of Washington, Seattle, Washington
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
- Department of Quality Health and Safety, AIC Kijabe Hospital, Kijabe, Kenya
- Division of Critical Care Medicine, Ispat General Hospital, Rourkela, India
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Zhang XS, Duchaine C. SARS-CoV-2 and Health Care Worker Protection in Low-Risk Settings: a Review of Modes of Transmission and a Novel Airborne Model Involving Inhalable Particles. Clin Microbiol Rev 2020; 34:e00184-20. [PMID: 33115724 PMCID: PMC7605309 DOI: 10.1128/cmr.00184-20] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Since the beginning of the COVID-19 pandemic, there has been intense debate over SARS-CoV-2's mode of transmission and appropriate personal protective equipment for health care workers in low-risk settings. The objective of this review is to identify and appraise the available evidence (clinical trials and laboratory studies on masks and respirators, epidemiological studies, and air sampling studies), clarify key concepts and necessary conditions for airborne transmission, and shed light on knowledge gaps in the field. We find that, except for aerosol-generating procedures, the overall data in support of airborne transmission-taken in its traditional definition (long-distance and respirable aerosols)-are weak, based predominantly on indirect and experimental rather than clinical or epidemiological evidence. Consequently, we propose a revised and broader definition of "airborne," going beyond the current droplet and aerosol dichotomy and involving short-range inhalable particles, supported by data targeting the nose as the main viral receptor site. This new model better explains clinical observations, especially in the context of close and prolonged contacts between health care workers and patients, and reconciles seemingly contradictory data in the SARS-CoV-2 literature. The model also carries important implications for personal protective equipment and environmental controls, such as ventilation, in health care settings. However, further studies, especially clinical trials, are needed to complete the picture.
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Affiliation(s)
- X Sophie Zhang
- Department of General Medicine, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- CHSLD Bruchési and CHSLD Jean De La Lande, Montreal, Canada
- GMF-U Faubourgs, Montreal, Canada
- Centre de Recherche et d'Aide aux Narcomanes, Montreal, Canada
| | - Caroline Duchaine
- Department of Biochemistry, Microbiology, and Bioinformatics, Université Laval, Quebec City, Canada
- Quebec Heart and Lung Institute-Université Laval (CRIUCPQ), Quebec City, Canada
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48
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Otieno BO, Kihara EN, Mua BN. Infection Control Practices Among Private Practicing Dentists in Nairobi During the Pre-coronavirus Disease 2019 Period. FRONTIERS IN ORAL HEALTH 2020; 1:587603. [PMID: 35047984 PMCID: PMC8757696 DOI: 10.3389/froh.2020.587603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/16/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Cross-infection control is a dynamic field that requires frequent updates due to emerging diseases, advancement in technology, and scientific knowledge. Despite wide publication of guidelines, a laxity in compliance to the standard precautions for infection control by dental health-care personnel (DHCP) has been reported globally. Therefore, there is need to review previous shortcomings in order to adequately secure dental practices during the coronavirus disease 2019 (COVID-19) pandemic. The aim of the study was to determine knowledge and infection control practices by dentists in private practices. The study was done a few months before the first COVID-19 case was confirmed in Kenya. Materials and Methods: The study design was a descriptive cross-sectional study that was carried out in selected private dental clinics located in Nairobi. Data were collected using an interviewer-administered questionnaire. Convenience sampling method was utilized, while data were analyzed using SPSS 20.0.0.0. Results: A total of 71 private dentists participated in the study. Their mean age was 38 years with an age range of 27-55 years. Almost all (70, 98.6%) the dentists were able to define cross infection correctly. Majority (62, 87.3%) correctly differentiated between sterilization and disinfection, while 9 (12.7%) had difficulties. Most (68, 95.8%) of the respondents were aware of the standard precautions for cross-infection control. All participants used face masks and gloves. About half of them (38, 54%) practiced hand washing after removal of gloves and 31 (43.7%) before and after wearing of gloves, while 2 (2.8%) washed hands only before wearing gloves. Only 31 (42.3%) and 26 (36.6%) participants reported use of rubber dam isolation and impervious barrier, respectively. All the dentists reported disposal of sharps into especially labeled containers, while about half reported use of disposable suction traps and amalgam separators. Conclusion: The dentists had a good knowledge on various aspects of infection control measures that were studied. Use of basic personal protective equipment was widely practiced. There were irregularities in hand hygiene, use of rubber dam, surface barriers, and waste management. The work highlights that many dentists were unprepared to manage infectious risk during the COVID-19 outbreak, which justified the closure of the dental facilities. Development of strategies to promote adequate and safe practice is highly recommended.
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Affiliation(s)
- Benedict Odhiambo Otieno
- Department of Periodontology/Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, Nairobi, Kenya
| | - Eunice Njeri Kihara
- Department of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, School of Dental Sciences, University of Nairobi, Nairobi, Kenya
| | - Bernard Nzioka Mua
- Department of Periodontology/Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, Nairobi, Kenya
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49
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Wilkason C, Lee C, Sauer LM, Nuzzo J, McClelland A. Assessing and Reducing Risk to Healthcare Workers in Outbreaks. Health Secur 2020; 18:205-211. [PMID: 32559156 DOI: 10.1089/hs.2019.0131] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The 2014-2016 West African Ebola epidemic was devastating in many respects, not least of which was the impact on healthcare systems and their health workforce. Healthcare workers-including physicians, clinical officers, nurses, midwives, and community health workers-serve on the front lines of efforts to detect, control, and stop the spread of disease. Risk mitigation strategies, including infection prevention and control (IPC) practices, are meant to keep healthcare workers safe from occupational exposure to disease and to protect patients from healthcare-associated infections. Despite ongoing IPC efforts, steady rates of both healthcare-associated and healthcare worker infections signal that these mitigation measures have been inadequate at all levels and present a potential critical point of failure in efforts to limit and control the spread of outbreaks. The fact that healthcare workers continue to be infected or are a source of infection during public health emergencies reveals a weakness in global preparedness efforts. Identification of key points of failure-both within the health system and during emergencies-is the first step to mitigating risk of exposure. A 2-pronged solution is proposed to address long-term gaps in the health system that impact infection control and emergency response: prioritization of IPC for epidemic preparedness at a global level and development and use of rapid risk assessments to prioritize risk mitigation strategies for IPC. Without global support, evidence, and systems in place to support the lives of healthcare workers, the lives of their patients and the health system in general are also at risk.
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Affiliation(s)
- Colby Wilkason
- Colby Wilkason, MPH, is Technical Advisor for Prevent Epidemics
| | - Christopher Lee
- Christopher T. Lee, MD, is Senior Technical Advisor for Prevent Epidemics
| | - Lauren M Sauer
- Lauren M. Sauer, MS, is Director of Operations and an Assistant Professor, Department of Emergency Medicine, Johns Hopkins Office of Critical Event Preparedness and Response, Johns Hopkins University School of Medicine
| | - Jennifer Nuzzo
- Jennifer Nuzzo, DrPH, SM, is a Senior Scholar, Johns Hopkins Center for Health Security, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amanda McClelland
- Amanda McClelland, MPHTM, is Senior Vice President; all are at Resolve to Save Lives, New York, New York
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50
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Zhang PC, Ahmed Y, Hussein IM, Afenu E, Feasson M, Daud A. Optimization of community-led 3D printing for the production of protective face shields. 3D Print Med 2020; 6:35. [PMID: 33230665 PMCID: PMC7682762 DOI: 10.1186/s41205-020-00089-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023] Open
Abstract
Background As the healthcare system faced an acute shortage of personal protective equipment (PPE) during the COVID-19 pandemic, the use of 3D printing technologies became an innovative method of increasing production capacity to meet this acute need. Due to the emergence of a large number of 3D printed face shield designs and community-led PPE printing initiatives, this case study examines the methods and design best optimized for community printers who may not have the resources or experience to conduct such a thorough analysis. Case presentation We present the optimization of the production of 3D printed face shields by community 3D printers, as part of an initiative aimed at producing PPE for healthcare workers. The face shield frames were manufactured using the 3DVerkstan design and were coupled with an acetate sheet to assemble a complete face shield. Rigorous quality assurance and decontamination protocols ensured community-printed PPE was satisfactory for healthcare use. Conclusion Additive manufacturing is a promising method of producing adequate face shields for frontline health workers because of its versatility and quick up-start time. The optimization of stacking and sanitization protocols allowed 3D printing to feasibly supplement formal public health responses in the face of a global pandemic.
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Affiliation(s)
- Peter Chengming Zhang
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Rotman School of Management, University of Toronto, Toronto, Ontario, Canada
| | - Yousuf Ahmed
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Isra M Hussein
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Edem Afenu
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Manon Feasson
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anser Daud
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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