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Williams DL, Kave B, Bodas C, Begg F, Roberts M, Ng I. Prospective comprehensive evaluation of an elastic-band beard cover for filtering facepiece respirators in healthcare workers. Infect Control Hosp Epidemiol 2024; 45:89-95. [PMID: 37435792 PMCID: PMC10782203 DOI: 10.1017/ice.2023.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/21/2023] [Accepted: 05/23/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To undertake a healthcare-based multimodal evaluation of the combination of filtering facepiece respirator (FFR) with the elastic-band beard cover technique, including quantitative fit test (QNFT) results, skills assessment, and usability assessment. DESIGN AND SETTING We conducted a prospective study through the Respiratory Protection Program at the Royal Melbourne Hospital from May 2022 to January 2023. PARTICIPANTS Healthcare workers who required respiratory protection and could not shave for religious, cultural, or medical reasons. INTERVENTION Online education and personal face-to-face training on the use of FFR with the elastic-band beard cover technique. RESULTS Among 87 participants (median beard length 38 mm; interquartile range [IQR], 20-80), 86 (99%) passed 3 QNFTs consecutively with the elastic-band beard cover under a Trident P2 respirator and 68 (78%) passed 3 QNFTs consecutively with a 3M 1870+ Aura respirator. The first QNFT pass rate and the overall fit factors were significantly higher when using the technique than without the elastic-band beard cover. Most participants displayed a high skill level in their donning, doffing, and user seal-check techniques. Of 87 participants, 83 (95%) completed the usability assessment. The overall ease of use, comfort, and overall assessment were rated highly. CONCLUSIONS The elastic-band beard cover technique can provide safe and effective respiratory protection for bearded healthcare workers. The technique was easily taught, comfortable, well tolerated and accepted by healthcare workers, potentially allowing them full participation in the workforce during pandemics with airborne transmission. We recommend further research and evaluation of this technique in a broader health workforce.
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Affiliation(s)
- Daryl Lindsay Williams
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | - Benjamin Kave
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Charles Bodas
- Respiratory Protection Program, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Fiona Begg
- Respiratory Protection Program, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Megan Roberts
- Respiratory Protection Program, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Irene Ng
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Williams DL, Kave B, Bodas C, Begg F, Roberts M, Ng I. Protocol of a prospective comprehensive evaluation of an elastic band beard cover for filtering facepiece respirators in healthcare. PLoS One 2023; 18:e0281152. [PMID: 36719896 PMCID: PMC9888701 DOI: 10.1371/journal.pone.0281152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/08/2022] [Indexed: 02/01/2023] Open
Abstract
Individuals who are unable to be clean shaven for religious, medical or cultural reasons are unable to wear a filtering facepiece respirator (FFR), as the respirator cannot provide adequate protection against aerosol-transmissible diseases. There is currently a paucity of validated techniques to ensure the safe inclusion of bearded healthcare workers in the pandemic workforce. We propose to undertake a healthcare-based multi-modal evaluation study on the elastic band beard cover for FFR technique, examining the quantitative fit test (QNFT) results, usability and skill level of participants with repeated assessments over time. This is a prospective study conducted through the Respiratory Protection Program at the Royal Melbourne Hospital. Healthcare workers are invited to participate if they require respiratory protection and cannot shave for religious, cultural or medical reasons. An online education package on the use of respiratory protective equipment and the elastic band beard cover for FFR technique is provided. This is followed by a face-to-face session, where the participant will receive: one-on-one training; undergo a skill assessment on their donning, doffing and user seal check techniques; complete QNFTs and a usability survey. Participants will be invited to repeat the assessment within 3 months of the first session and at 12 months. This study involves multimodal and repeated assessments of an elastic band beard cover for FFRs. The findings of this study will provide information on: whether this simple technique can provide safe, consistent and effective respiratory protection; whether it will interfere with occupational activities; and whether it is comfortable and tolerable for the duration of wear. This is of significant importance to the health workforce around the world, who cannot shave but require access to respiratory protective equipment during the COVID-19 pandemic.
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Affiliation(s)
- Daryl Lindsay Williams
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Benjamin Kave
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia
| | - Charles Bodas
- Respiratory Protection Program, Royal Melbourne Hospital, Parkville, Australia
| | - Fiona Begg
- Respiratory Protection Program, Royal Melbourne Hospital, Parkville, Australia
| | - Megan Roberts
- Respiratory Protection Program, Royal Melbourne Hospital, Parkville, Australia
| | - Irene Ng
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
- * E-mail:
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Lederman Z, Halberthal M. A Close Shave: Balancing Religious Tolerance and Patient Care in the Age of COVID-19. J Bioeth Inq 2022; 19:625-633. [PMID: 35852780 DOI: 10.1007/s11673-022-10201-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/30/2022] [Indexed: 06/15/2023]
Abstract
In this essay we discuss an ethical dilemma that recently arose in our institution, involving healthcare workers who lamented the requirement to shave their facial hair as a condition to care for COVID-19 patients. The essay represents a genuine attempt to grapple with the dilemma sensibly and vigorously. We first provide a brief introduction, focusing on the tension between religious tolerance and the institutional obligation to optimize patient care and public health in the age of COVID-19. We then discuss the complex relationship between facial hair and cultural as well as religious factors throughout history. Next, we make a case, based on several principles in Islam jurisprudence, that Muslim healthcare professionals in our institution should be expected to shave their facial hair so they could care for COVID patients. We end with considering two alternative solutions that were offered in the literature.
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Affiliation(s)
- Zohar Lederman
- Rambam Medical Campus, Ha'alyia Hashnia 8, Haifa, Israel.
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Bhatia DD, Bhatia KS, Saluja T, Saluja AP, Thind A, Bamra A, Singh G, Singh N, Clezy K, Dempsey K, Hudson B, Jain S. Under-mask beard covers achieve an adequate seal with tight-fitting disposable respirators using quantitative fit testing. J Hosp Infect 2022; 128:8-12. [PMID: 35662553 DOI: 10.1016/j.jhin.2022.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tight-fitting respirators are a critical component of respiratory protection against airborne diseases for health workers. However, they are not recommended for health workers with facial hair. Some health workers are unable to shave for religious or medical reasons. Under-mask beard covers have been proposed as a solution to allow health workers with facial hair to wear tight-fitting respirators. However, studies to date have been limited by their predominant reliance on qualitative rather than quantitative fit testing techniques. AIM To assess the efficacy of under-mask beard covers in achieving an adequate seal with tight-fitting disposable P2/N95 respirators using quantitative fit testing. METHODS Bearded adult males underwent quantitative fit testing with an under-mask beard cover using either a TSI PortaCount Respirator Fit Tester 8038™ or AccuFit 9000 PRO™ fit testing device on up to five disposable P2/N95 respirators (3M 1860, 3M 1870+, BYD N95 Helathcare Particulate Respirator, BSN Medical ProShield N-95 Medium and Trident RTCFFP2). The primary outcome was the proportion of subjects that passed or failed quantitative fit testing with an under-mask beard cover. FINDINGS Thirty subjects were assessed, 24 (80%) passed quantitative fit testing with at least one tight-fitting P2/N95 disposable respirator. Among these subjects the median (IQR) best achieved fit factor was 200 (178-200). No subject had an adverse reaction to the under-mask beard cover. CONCLUSION The under-mask beard cover technique may be used to achieve a satisfactory seal with tight-fitting P2/N95 respirators in health workers with facial hair that cannot shave.
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Williams DL, Begg F, Bodas C, Ng I. Respiratory protection preparedness in critical care healthcare workers: An observational audit of facial hair at a major tertiary hospital in Australia. Infect Dis Health 2022; 27:159-162. [PMID: 35153190 DOI: 10.1016/j.idh.2022.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/29/2021] [Accepted: 01/16/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Facial hair under a tight fitting P2/N95 respirator diminishes respiratory protection. There is limited guidance with respect to the threshold to be clean shaven in readiness to wear N95 respirators. METHODS We performed a cross sectional audit in late August 2021 to observe whether staff had facial hair that could decrease respiratory protection of tight fitting respirators. The audit was conducted in three critical care areas at a major tertiary public hospital in Australia during a period of moderate-to-high community prevalence of COVID-19. All staff observed had previously successfully completed quantitative fit testing with a clean shaven face in the preceding 12 months. RESULTS 110 consecutive male critical care staff were observed including thirty staff who were required to wear a N95/P2 respirator at the time. Forty - five percent of male staff observed were not clean shaven in the face seal zone of their respirators. CONCLUSIONS The readiness to wear a tight-fitting respirator and hence the need to be clean shaven, should be guided by both state and local COVID-19 risk ratings, as well as the specific respiratory biohazard risks present in the clinical area at that time. During periods of significant community transmission of COVID-19, critical care clinical staff should be clean shaven, so they are fit-for-purpose and ready to wear a tight fitting respirator at short notice. Respiratory protection preparedness in critical care healthcare workers: An observational audit of facial hair at a major tertiary hospital in Australia.
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Affiliation(s)
- Daryl L Williams
- Respiratory Protection Program, The Royal Melbourne Hospital, Parkville, 3050, Australia; Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Parkville, 3050, Australia; Department of Critical Care Medicine, The University of Melbourne, Parkville, 3050, Australia.
| | - Fiona Begg
- Respiratory Protection Program, The Royal Melbourne Hospital, Parkville, 3050, Australia
| | - Charles Bodas
- Respiratory Protection Program, The Royal Melbourne Hospital, Parkville, 3050, Australia
| | - Irene Ng
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Parkville, 3050, Australia; Department of Critical Care Medicine, The University of Melbourne, Parkville, 3050, Australia
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Rekha V, Manoharan JS, Hemalatha R, Saravanan D. Deep Learning Models for Multiple Face Mask Detection under a Complex Big Data Environment. Procedia Comput Sci 2022; 215:706-12. [PMID: 36618030 DOI: 10.1016/j.procs.2022.12.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The Covid-19 (coronavirus) pandemic creates a worldwide health crisis. According to the WHO, the effective protection system is wearing a face mask in public places. Many studies proved that carrying a face mask is also one of the precautions to decrease the possibility of viral transmission. Strict monitoring of face mask being worn by people is now enforced in many countries. Manual observation and monitoring is quite tedious. Hence, automated systems have been researched using well-kwown face mask detection methods. However, this research paper, deals with some deep learning models which can be effectively used to detect multiple face masks in a crowded environment when the amount of incoming data from sensors is huge or in otherwise stated to a Big data problem. Hence, standalone face detection models are not quite suited. Deep learning models are required in such Big data scenario which forms the essence of this study.
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Prince SE, Chen H, Tong H, Berntsen J, Masood S, Zeman KL, Clapp PW, Bennett WD, Samet JM. Assessing the effect of beard hair lengths on face masks used as personal protective equipment during the COVID-19 pandemic. J Expo Sci Environ Epidemiol 2021; 31:953-960. [PMID: 34006963 PMCID: PMC8130778 DOI: 10.1038/s41370-021-00337-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 05/09/2023]
Abstract
BACKGROUND Globally, a large percentage of men keep a beard at least occasionally. Workplace regulations prohibit beards with N95 respirators, but there is little information on the effect of beards with face masks worn by the public for protection against SARS-CoV-2. METHODS AND FINDINGS We examined the fitted filtration efficiency (FFE) of five commonly worn protective face masks as a function of beard length following the US Occupational Safety and Health Administration Quantitative Fit Test: N95 (respirator), KF94 and KN95, surgical/procedure, and cloth masks. A comparison using N95 respirators was carried out in shaven and bearded men. A detailed examination was conducted for beard lengths between 0 and 10 mm (0.5 mm increments). The effect of an exercise band covering the beard on FFE was also tested. Although N95 respirators showed considerable variability among bearded men, they had the highest FFE for beard lengths up to 10 mm. KF94 and KN95 masks lost up to 40% of their FFE. Procedure and cotton masks had poor performance even on bare skin (10-30% FFE) that did not change appreciably with beard length. Marked performance improvements were observed with an exercise band worn over the beard. CONCLUSIONS Though variable, N95 respirators offer the best respiratory protection for bearded men. While KF94 and KN95 FFE is compromised considerably by increasing beard length, they proved better options than procedure and cotton face masks. A simple exercise band improves FFE for face masks commonly used by bearded men during the COVID-19 pandemic.
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Affiliation(s)
- Steven E Prince
- Public Health and Environmental Systems Division, Center for Public Health and Environmental Assessment, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC, USA.
| | - Hao Chen
- Oak Ridge Institute for Science Education, Oak Ridge, TN, USA
| | - Haiyan Tong
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC, USA
| | | | - Syed Masood
- Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kirby L Zeman
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Phillip W Clapp
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - William D Bennett
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James M Samet
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC, USA
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Sahota R. COVID-19, beards and BAME: how ethnic minorities with religious beards are being let down. J Occup Environ Hyg 2021; 18:477-480. [PMID: 34410218 DOI: 10.1080/15459624.2021.1963446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Calum HP, Sode LP, Pedersen M. Status: nosocomial transmission and prevention of SARS-CoV-2 in a Danish context. APMIS 2021; 129:340-351. [PMID: 34050990 PMCID: PMC8239927 DOI: 10.1111/apm.13160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/18/2021] [Indexed: 11/30/2022]
Abstract
The unexpected pandemic with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has challenged the healthcare sector as regards preventing and controlling the virus from spreading between patients and hospital personnel. The massive spread of the pandemic has led state authorities to introduce restrictions on society and public behavior unprecedented in modern times. First, we describe the Danish effort regarding standard precautions, personal protective equipment, and disinfection in the healthcare setting with Denmark as an example. As regards, the number of coronavirus disease 2019 (COVID‐19)‐related hospital submissions, deaths, and infected healthcare workers in Denmark is not the hardest hit country compared with others. This cannot be explained by the hardness of the restrictions alone. Several aspects concerning the person‐to‐person spread of SARS‐CoV‐2 are not fully understood and require more experimental studies. The dogma is that virus transmission happens through either respiratory droplets or contact routes. However, it is likely not the whole truth, as we describe scenarios where droplets and/or direct contact cannot alone explain how all patients were infected. Aspects of the physiology of airborne transmission are considered, as several parameters are in play beyond particle size and respiratory rate. These are ozone concentration, ambient temperature, and humidity. In a hospital environment, these factors are not necessarily all controllable, making infection prevention and control a challenge.
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Affiliation(s)
- Henrik Pierre Calum
- Department of Clinical Microbiology, Hvidovre Hospital, Copenhagen University, Copenhagen, Denmark
| | - Louise Palasin Sode
- Department of Orthopedic, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Michael Pedersen
- Department of Clinical Microbiology, Hvidovre Hospital, Copenhagen University, Copenhagen, Denmark
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Singh R, Grewal B. Your Hair or Your Service: An Issue of Faith for Sikh Healthcare Professionals During the COVID-19 Pandemic. Ann Work Expo Health 2021; 65:613-616. [PMID: 33616162 PMCID: PMC7929463 DOI: 10.1093/annweh/wxab009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 11/30/2022] Open
Abstract
Sikh healthcare professionals make up a small but significant proportion of the workforce in the United Kingdom. The COVID-19 pandemic has presented healthcare staff across the country with challenges relating to safe clinical practice whilst wearing personal protective equipment (PPE). Practising Sikhs are mandated to keep their hair unshorn and have been negatively impacted by some standard PPE requirements. This article aims to raise awareness of this issue and provide suggestions on how this conflict can be resolved.
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Affiliation(s)
- Rajinder Singh
- Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Bhajneek Grewal
- Palliative Medicine, Leeds Teaching Hospitals NHS Trust, Leeds UK
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