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Zhou Z, Wang D, Pan Z, You T, Xu G, Liang Y, Tang M. Bioinspired Structures Made of Silicone Nanofilaments for Upcycling Waste Masks to Reusable N95 Respirators. Nano Lett 2024; 24:4415-4422. [PMID: 38577835 DOI: 10.1021/acs.nanolett.4c00079] [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] [Indexed: 04/06/2024]
Abstract
The increasing demand for personal protective equipment such as single-use masks has led to large amounts of nondegradable plastic waste, aggravating economic and environmental burdens. This study reports a simple and scalable approach for upcycling waste masks via a chemical vapor deposition technique, realizing a trichome-like biomimetic (TLB) N95 respirator with superhydrophobicity (water contact angle ≥150°), N95-level protection, and reusability. The TLB N95 respirator comprising templated silicone nanofilaments with an average diameter of ∼150 nm offers N95-level protection and breathability comparable to those of commercial N95 respirators. The TLB N95 respirator can still maintain its N95-level protection against particulate matter and viruses after 10 disinfection treatment cycles (i.e., ultraviolet irradiation, microwave irradiation, dry heating, and autoclaving), demonstrating durable reusability. The proposed strategy provides new insight into upcycle waste masks, breaking the existing design and preparation concept of reusable masks.
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Affiliation(s)
- Zhiqiang Zhou
- School of Light Industry and Engineering, South China University of Technology, Guangzhou, 510641, China
| | - Di Wang
- School of Light Industry and Engineering, South China University of Technology, Guangzhou, 510641, China
| | - Zhengyuan Pan
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Tianle You
- School of Light Industry and Engineering, South China University of Technology, Guangzhou, 510641, China
| | - Guilong Xu
- School of Light Industry and Engineering, South China University of Technology, Guangzhou, 510641, China
| | - Yun Liang
- School of Light Industry and Engineering, South China University of Technology, Guangzhou, 510641, China
| | - Min Tang
- School of Light Industry and Engineering, South China University of Technology, Guangzhou, 510641, China
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Ayub A, Cheong YK, Castro JC, Cumberlege O, Chrysanthou A. Use of Hydrogen Peroxide Vapour for Microbiological Disinfection in Hospital Environments: A Review. Bioengineering (Basel) 2024; 11:205. [PMID: 38534479 DOI: 10.3390/bioengineering11030205] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/28/2024] Open
Abstract
Disinfection of nosocomial pathogens in hospitals is crucial to combat healthcare-acquired infections, which can be acquired by patients, visitors and healthcare workers. However, the presence of a wide range of pathogens and biofilms, combined with the indiscriminate use of antibiotics, presents infection control teams in healthcare facilities with ongoing challenges in the selection of biocides and application methods. This necessitates the development of biocides and innovative disinfection methods that overcome the shortcomings of conventional methods. This comprehensive review finds the use of hydrogen peroxide vapour to be a superior alternative to conventional methods. Motivated by observations in previous studies, herein, we provide a comprehensive overview on the utilisation of hydrogen peroxide vapour as a superior high-level disinfection alternative in hospital settings. This review finds hydrogen peroxide vapour to be very close to an ideal disinfectant due to its proven efficacy against a wide range of microorganisms, safety to use, lack of toxicity concerns and good material compatibility. The superiority of hydrogen peroxide vapour was recently demonstrated in the case of decontamination of N95/FFP2 masks for reuse to address the critical shortage caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the COVID-19 pandemic. Despite the significant number of studies demonstrating antimicrobial activity, there remains a need to critically understand the mechanism of action by performing studies that simultaneously measure damage to all bacterial cell components and assess the correlation of this damage with a reduction in viable cell count. This can lead to improvement in antimicrobial efficacy and foster the development of superior approaches.
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Affiliation(s)
- Aaqib Ayub
- School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Yuen Ki Cheong
- School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Jesus Calvo Castro
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
| | | | - Andreas Chrysanthou
- School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK
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S S Schneider D, de Magalhães AMM, de Oliveira JLC, Costanzi AP, Nora CRD, Trevilato DD. Integrity and filtration efficiency of decontaminated N95/PFF2 masks to protect health care professionals against COVID-19: A systematic literature review and meta-analysis. Am J Infect Control 2024:S0196-6553(24)00059-2. [PMID: 38342344 DOI: 10.1016/j.ajic.2024.01.020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 01/27/2024] [Accepted: 01/31/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND To evaluate the evidence related to maintaining the integrity and filtration efficiency of N95 and/or PFF2 respirators after decontamination in health care professionals' protection against COVID-19. METHODS Systematic review, developed based on the guidelines from Joanna Briggs Institute for syntheses focusing on effectiveness evidence. The protocol was registered on the International Prospective Register of Ongoing Systematic Reviews platform, under the number CRD42022354256. This study report was developed in accordance with the guidelines recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Publications between January 2020 and August 2022 were selected of Embase, Medline, CINAHL, Web of Science, Cochrane, SciELO and Virtual Health Library databases. Joanna Briggs critical appraisal tool for nonrandomized experimental tests was used to evaluate the evidence quality. RESULTS Seven articles were included in the data extraction and critical evaluation, and 3 in the meta-analysis. Four studies evaluated the integrity by visual inspection and 2 by electron microscopy. There was no association between the number of cycles increase and the reduction in filtration in up to 10 cycles. None study was considered of high methodological quality. CONCLUSIONS There is some evidence that integrity and filtration capacity were maintained after decontamination of N95/PFF2 respirators to prevent COVID-19.
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Affiliation(s)
- Daniela S S Schneider
- PhD in Nursing at the Federal University of Rio Grande do Sul (UFRGS), Master in Genetics and Toxicology, Specialist in Operations Management for Health, Nursing Manager of the Central sterile services department (CSSD) of the Hospital de Clínicas de Porto Alegre (HCPA), Member of the Center for Nursing Management Studies (NEGE), Porto Alegre, Rio Grande do Sul, Brazil; PhD student in Nursing at the Federal University of Rio Grande do Sul (UFRGS), Master in Health Teaching, Nurse Assistant of the Surgical Center department of the Hospital Moinhos de Vento (RS), Assistant Professor of the Undergraduate Nursing Course of the Moinhos de Vento Health Sciences College, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Ana M M de Magalhães
- Director of the School of Nursing of the Federal University of Rio Grande do Sul (UFRGS), Associate Professor of the Department of Assistance and Professional Orientation, DAOP, Permanent Professor of the Postgraduate Program in Nursing (PPGENF-UFRGS), Coordinator of the Center for Nursing Management Studies (NEGE), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Joao L C de Oliveira
- Adjunct Professor, Department of Assistance and Professional Guidance, DAOP of the School of Nursing, Federal University of Rio Grande do Sul (UFRGS), Assistant Professor of the Service of Clinical Nursing of the Nursing Department of the Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | | | - Carlise R D Nora
- Adjunct Professor, Department of Assistance and Professional Guidance, DAOP, School of Nursing, Federal University of Rio Grande do Sul (UFRGS), Advisory Professor at the Nursing Service in Surgical Center (SECC) of the Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Denilse D Trevilato
- PhD student in Nursing at the Federal University of Rio Grande do Sul (UFRGS), Master in Health Teaching, Nurse Assistant of the Surgical Center department of the Hospital Moinhos de Vento (RS), Assistant Professor of the Undergraduate Nursing Course of the Moinhos de Vento Health Sciences College, Porto Alegre, Rio Grande do Sul, Brazil.
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Brook RD, Rajagopalan S, Al‐Kindi S. N95 Respirators for Cardiovascular Protection During Wildfire Smoke Events. J Am Heart Assoc 2024; 13:e032422. [PMID: 38193297 PMCID: PMC10926833 DOI: 10.1161/jaha.123.032422] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/14/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Robert D. Brook
- Division of Cardiovascular Diseases, Department of Internal MedicineWayne State UniversityDetroitMI
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University HospitalsClevelandOH
| | - Sadeer Al‐Kindi
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
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Yüksel Aslıer NG, Karataş M. Eustachian tube dysfunction after using different types of masks during the coronavirus disease 2019 pandemic. J Laryngol Otol 2024:1-5. [PMID: 38224045 DOI: 10.1017/s0022215124000124] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
OBJECTIVE This study aimed to investigate the relationship between the use of different types of masks (N95/filtering facepiece type 2, surgical) and Eustachian tube dysfunction in healthcare workers. METHODS The study included 37 healthcare workers using N95/filtering facepiece type 2 masks and 35 using surgical masks for at least 6 hours per day, and 42 volunteers who are not healthcare workers using surgical masks for less than 6 hours per day. Participants' demographic features, clinical data and Eustachian Tube Dysfunction Questionnaire scores were compared. RESULTS The frequencies of autophony and aural fullness were significantly higher in the healthcare workers using N95/filtering facepiece type 2 masks. Autophony and aural fullness were significantly greater in the post-mask period than the pre-mask period. Middle-ear peak pressures and Eustachian Tube Dysfunction Questionnaire scores were higher in healthcare workers who used N95/filtering facepiece type 2 masks. CONCLUSION Healthcare workers who used N95/filtering facepiece type 2 masks had worsened middle-ear pressures and Eustachian Tube Dysfunction Questionnaire scores. Use of N95/filtering facepiece type 2 masks was associated with higher rates of autophony, aural fullness and higher Eustachian Tube Dysfunction Questionnaire scores in the post-mask period.
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Affiliation(s)
- Nesibe Gül Yüksel Aslıer
- Department of Otorhinolaryngology, Health Science University, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Mesut Karataş
- Department of Otorhinolaryngology, Health Science University, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Zhu J, Jiang Q, Ye Y, He X, Shao J, Li X, Zhao X, Xu H, Hu Q. Water-blocking Asphyxia of N95 Medical Respirator During Hot Environment Work Tasks With Whole-body Enclosed Anti-bioaerosol Suit. Saf Health Work 2023; 14:457-466. [PMID: 38187212 PMCID: PMC10770281 DOI: 10.1016/j.shaw.2023.10.009] [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: 07/27/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 01/09/2024] Open
Abstract
Background During hot environment work tasks with whole-body enclosed anti-bioaerosol suit, the combined effect of heavy sweating and exhaled hot humid air may cause the N95 medical respirator to saturate with water/sweat (i.e., water-blocking). Methods 32 young male subjects with different body mass indexes (BMI) in whole-body protection (N95 medical respirator + one-piece protective suit + head covering + protective face screen + gloves + shoe covers) were asked to simulate waste collecting from each isolated room in a seven-story building at 27-28°C, and the weight, inhalation resistance (Rf), and aerosol penetration of the respirator before worn and after water-blocking were analyzed. Results All subjects reported water-blocking asphyxia of the N95 respirators within 36-67 min of the task. When water-blocking occurred, the Rf and 10-200 nm total aerosol penetration (Pt) of the respirators reached up to 1270-1810 Pa and 17.3-23.3%, respectively, which were 10 and 8 times of that before wearing. The most penetration particle size of the respirators increased from 49-65 nm before worn to 115-154 nm under water-blocking condition, and the corresponding maximum size-dependent aerosol penetration increased from 2.5-3.5% to 20-27%. With the increase of BMI, the water-blocking occurrence time firstly increased then reduced, while the Rf, Pt, and absorbed water all increased significantly. Conclusions This study reveals respirator water-blocking and its serious negative impacts on respiratory protection. When performing moderate-to-high-load tasks with whole-body protection in a hot environment, it is recommended that respirator be replaced with a new one at least every hour to avoid water-blocking asphyxia.
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Affiliation(s)
- Jintuo Zhu
- Key Laboratory of Gas and Fire Control for Coal Mines (China University of Mining and Technology), Ministry of Education, Xuzhou, Jiangsu, China
- National Professional Laboratory for Fundamental Research of Mine Gas and Dust Control Technology, School of Safety Engineering, China University of Mining and Technology, Xuzhou, Jiangsu, China
- School of Safety Engineering, China University of Mining and Technology, Xuzhou, Jiangsu, China
| | - Qijun Jiang
- Key Laboratory of Gas and Fire Control for Coal Mines (China University of Mining and Technology), Ministry of Education, Xuzhou, Jiangsu, China
- National Professional Laboratory for Fundamental Research of Mine Gas and Dust Control Technology, School of Safety Engineering, China University of Mining and Technology, Xuzhou, Jiangsu, China
- School of Safety Engineering, China University of Mining and Technology, Xuzhou, Jiangsu, China
| | - Yuxuan Ye
- Key Laboratory of Gas and Fire Control for Coal Mines (China University of Mining and Technology), Ministry of Education, Xuzhou, Jiangsu, China
- National Professional Laboratory for Fundamental Research of Mine Gas and Dust Control Technology, School of Safety Engineering, China University of Mining and Technology, Xuzhou, Jiangsu, China
- School of Safety Engineering, China University of Mining and Technology, Xuzhou, Jiangsu, China
| | - Xinjian He
- Key Laboratory of Gas and Fire Control for Coal Mines (China University of Mining and Technology), Ministry of Education, Xuzhou, Jiangsu, China
- National Professional Laboratory for Fundamental Research of Mine Gas and Dust Control Technology, School of Safety Engineering, China University of Mining and Technology, Xuzhou, Jiangsu, China
- School of Safety Engineering, China University of Mining and Technology, Xuzhou, Jiangsu, China
| | - Jiang Shao
- School of Architecture & Design, China University of Mining and Technology, Xuzhou, Jiangsu, China
| | - Xinyu Li
- Key Laboratory of Gas and Fire Control for Coal Mines (China University of Mining and Technology), Ministry of Education, Xuzhou, Jiangsu, China
- National Professional Laboratory for Fundamental Research of Mine Gas and Dust Control Technology, School of Safety Engineering, China University of Mining and Technology, Xuzhou, Jiangsu, China
- School of Safety Engineering, China University of Mining and Technology, Xuzhou, Jiangsu, China
| | - Xijie Zhao
- School of Architecture & Design, China University of Mining and Technology, Xuzhou, Jiangsu, China
| | - Huan Xu
- School of Materials Science and Physics, China University of Mining and Technology, Xuzhou, Jiangsu, China
| | - Qi Hu
- Key Laboratory of Gas and Fire Control for Coal Mines (China University of Mining and Technology), Ministry of Education, Xuzhou, Jiangsu, China
- National Professional Laboratory for Fundamental Research of Mine Gas and Dust Control Technology, School of Safety Engineering, China University of Mining and Technology, Xuzhou, Jiangsu, China
- School of Safety Engineering, China University of Mining and Technology, Xuzhou, Jiangsu, China
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Wu G, Ji Q, Shi Y. A systematic review and meta-analysis of the efficacy of N95 respirators and surgical masks for protection against COVID-19. Prev Med Rep 2023; 36:102414. [PMID: 37736310 PMCID: PMC10509348 DOI: 10.1016/j.pmedr.2023.102414] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/15/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023] Open
Abstract
Former meta-analyses concluded that there was not sufficient evidence to determine the effect of surgical masks and N95 respirators. We collected randomized controlled trials (RCTs) and conducted a systematic review and meta-analysis to evaluate the efficacy of N95 respirators and surgical masks for protection against COVID-19. We retrieved relevant RCTs published between January 2019 and January 2023 by searching the PubMed, EMBASE, and Cochrane CENTRAL. Study quality was evaluated using the Cochrane Risk of Bias tool with the RevMan 5.4 software. Meta-analyses were conducted to calculate pooled estimates using the RevMan 5.4 software. A total of six RCTs were finally included. The findings revealed that wearing a mark made little difference in preventing COVID-19 [odds ratio (OR) = 0.10; 95% confidence interval (CI): 0.01-0.93; P = 0.04]. Subgroup analysis showed that the heterogeneity of data was I2 = 64% (OR = 0.32; 95% CI: 0.06-1.77; P = 0.19) for surgical mask use and I2 = 0% (OR = 0.03; 95 %CI: 0.01-0.15; P < 0.01) for N95 respirator use. The heterogeneity of data for medical staff was I2 = 0% (OR = 0.03; 95 %CI: 0.01-0.12; P < 0.01). Meta-analysis indicated a protective effect of N95 respirators against COVID-19, particularly for medical staff. The use of surgical masks is not associated with a lower risk of COVID-19. However, the subgroup using N95 respirators, particularly medical staff, showed a significant protective. These findings suggest that N95 respirators should be reserved for high-risk medical staff in the absence of sufficient resources during an epidemic. But the number of included studies was small, more studies in future analyses is required to reduce the risk of distribution bias.
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Affiliation(s)
- Gaohong Wu
- Department of Neonatology, Zhuhai Center for Maternal and Child Health Care, Zhuhai, China
- Department of Neonatology Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China Chongqing, China
| | - Qingyang Ji
- Department of Breast Surgery, Zhuhai Center for Maternal and Child Health Care, Zhuhai, China
| | - Yuan Shi
- Department of Neonatology Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China Chongqing, China
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Lam SC, Odetayo A, Yu ITS, So SNY, Cheung K, Lee PH, Suen LKP. Evaluation of N95 respirators on fit rate, real-time leakage, and usability among Chinese healthcare workers: study protocol of a randomized crossover trial. Front Public Health 2023; 11:1266607. [PMID: 38045983 PMCID: PMC10691761 DOI: 10.3389/fpubh.2023.1266607] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023] Open
Abstract
Background N95 respirators are used to limit the transmission of respiratory viruses in clinical settings. There are two to three major types of N95 available for all healthcare workers in Hong Kong. However, after the coronavirus outbreak and the consequent shortage of many commonly used respirators, several new N95 respirators were adopted temporarily in clinical settings without evaluation. Prior literature indicates that traditional N95 respirators used in hospitals in Hong Kong are not fit for Chinese people and have fit rates ranging from 50 to 60%. This study aims to investigate and compare the fit rate, real-time leakage, and mask usability of traditional and new N95 respirators among Chinese healthcare workers. Methods This study will employ two sequential phases. Phase 1 has a cross-sectional exploratory design used to investigate the fit rate and mask usability of three types of respirators. Phase 2 will examine the effectiveness of respiratory protection by comparing traditional and new N95 respirators by a randomized crossover trial. Eligible participants will be randomly allocated through a controlled crossover experiment to either a traditional or new respirator group (n = 100 in each arm) for performing standard clinical procedures. The primary outcome (real-time leakage) will be recorded at 30 s intervals during nasopharyngeal suctioning and cardiopulmonary resuscitation. The secondary outcomes are the fit rate and mask usability. After a 2 min suctioning (15 s twice) and 4 min one-person CPR, the fit rate (assessed by standard N95 fit testing) and mask usability (measured by self-reported mask usability scale) will be recorded as data of post-procedure. After 10 min rest, measurement of real-time leakage (i.e., crossover), fit test, and usability will be repeated. Discussion The result of real-time leakage will be a vital indicator of the respiratory protection of Chinese healthcare workers while performing prevalent clinical procedures, such as resuscitation. The fit rate and usability result will serve as an essential reference for consumable purchase policy in clinical settings.Trial registration: ISRCTN registry: ISRCTN40115047. Retrospectively registered on May 9, 2023. https://www.isrctn.com/ISRCTN40115047.
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Affiliation(s)
- Simon Ching Lam
- School of Nursing, Tung Wah College, Kowloon, Hong Kong SAR, China
| | - Aderonke Odetayo
- School of Nursing, Tung Wah College, Kowloon, Hong Kong SAR, China
| | - Ignatius Tak Sun Yu
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | | | - Kin Cheung
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Paul Hong Lee
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
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Cass HG, Hanlon GC, McKenzie DP, Harley NS, Kelly DN, Barrett JA. The adequacy of user seal checking for N95 respirators compared to formal fit testing: A multicentred observational study. Aust Crit Care 2023; 36:787-792. [PMID: 36244917 DOI: 10.1016/j.aucc.2022.08.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 08/14/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the adequacy of the user seal check (USC) in predicting N95 respirator fit. DESIGN This was a prospective, observational study conducted from May to September 2020. SETTING The study setting included three private intensive care units (ICUs) in Victoria, Australia. PARTICIPANTS ICU staff members in three private ICUs in Melbourne and regional Victoria participated in this study. MAIN OUTCOME MEASURES The main outcome measure is the proportion of participants who passed a USC and subsequently failed fit testing of an N95 respirator. INTERVENTION Three different respirators were available: two N95 respirator brands and CleanSpace HALO® powered air-purifying respirator. Participants were sequentially tested on N95 respirators followed by powered air-purifying respirators until either successful fit testing or failure of all three respirators. The first N95 tested was based on the availability on the day of testing. The primary outcome was failure rate of fit testing on the first N95 respirator type passing a USC. RESULTS Of 189 participants, 22 failed USC on both respirators, leaving 167 available for the primary outcome. Fifty-one of 167 (30.5%, 95% confidence interval = 23.7-38.1) failed fit testing on the first respirator type used that had passed a USC. CONCLUSION USC alone was inadequate in assessing N95 respirator fit and failed to detect inadequate fit in 30% of participants. Mandatory fit testing is essential to ensure adequate respiratory protection against COVID-19 and other airborne pathogens. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12620001193965.
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Affiliation(s)
- Helen G Cass
- Intensive Care Department, Epworth HealthCare, Epworth Richmond, Victoria, 3121, Australia
| | - Gabrielle C Hanlon
- Intensive Care Department, Epworth HealthCare, Epworth Richmond, Victoria, 3121, Australia
| | - Dean P McKenzie
- Research Development and Governance, Epworth HealthCare, Richmond, Victoria, 3121, Australia; Department of Health Sciences and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, 3122, Australia
| | - Nerina S Harley
- Intensive Care Department, Epworth HealthCare, Epworth Freemasons, East Melbourne, Victoria, 3002, Australia; Intensive Care Department, Epworth HealthCare, Epworth Geelong, Geelong, Victoria, 3216, Australia
| | - Diane N Kelly
- Intensive Care Department, Epworth HealthCare, Epworth Richmond, Victoria, 3121, Australia
| | - Jonathan A Barrett
- Intensive Care Department, Epworth HealthCare, Epworth Richmond, Victoria, 3121, Australia.
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Yang SC, Lee CW. Physiological effects of N95 respirators on rescuers during cardiopulmonary resuscitation. Heliyon 2023; 9:e18970. [PMID: 37600379 PMCID: PMC10432712 DOI: 10.1016/j.heliyon.2023.e18970] [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: 11/09/2022] [Revised: 07/14/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives There is a lack of evidence in the medical literature reporting the physiological stress imposed by the wearing of N95 respirators during cardiopulmonary resuscitation (CPR) in healthcare providers. The aim of this study is to monitor the changes in hemodynamics and blood gas profiles in rescuers during the performance of CPR while wearing N95 respirators. Methods Thirty-two healthy healthcare workers performed standard CPR on manikins, each participant conducted 2 min of chest compression followed by 2 min of rest for 3 cycles. A non-invasive blood gas measuring device via a fingertip detector was used to collect arterial blood gas and hemodynamic data. Student t-test was used for comparison of various physiologic parameters before and after each session of chest compression. Results There were no significant differences in arterial blood gas profiles including partial pressure of arterial carbon dioxide and partial pressure of arterial oxygen before and after each session of chest compression (p > 0.05 for all). Heart rate and cardiac output were significantly higher after CPR (p < 0.05 for all), but no significant changes were found on blood pressure. Conclusions Our data suggest that healthcare providers wearing N95 respirators during provision of CPR in a short period of time does not cause any significant abnormalities in blood gas profiles and blood pressure. This may provide evidence to reassure the safe use of N95 respirator during performance of CPR.
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Affiliation(s)
- Shih-Chia Yang
- Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Wei Lee
- Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan
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Nampoolsuksan C, Akaraviputh T, Methasate A, Swangsri J, Trakarnsanga A, Phalanusitthepha C, Parakonthun T, Taweerutchana V, Srisuworanan N, Suwatthanarak T, Tawantanakorn T, Lohsiriwat V, Chinswangwatanakul V. Aerosol protection using modified N95 respirator during upper gastrointestinal endoscopy: a randomized controlled trial. Clin Endosc 2023:ce.2023.018. [PMID: 37430403 DOI: 10.5946/ce.2023.018] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/22/2023] [Indexed: 07/12/2023] Open
Abstract
Background/Aims The coronavirus disease 2019 pandemic has affected the worldwide practice of upper gastrointestinal endoscopy. Here we designed a modified N95 respirator with a channel for endoscope insertion and evaluated its efficacy in upper gastrointestinal endoscopy. Methods Thirty patients scheduled for upper gastrointestinal endoscopy were randomized into the modified N95 (n=15) or control (n=15) group. The mask was placed on the patient after anesthesia administration and particles were counted every minute before (baseline) and during the procedure by a TSI AeroTrak particle counter (9306-04; TSI Inc.) and categorized by size (0.3, 0.5, 1, 3, 5, and 10 µm). Differences in particle counts between time points were recorded. Results During the procedure, the modified N95 group displayed significantly smaller overall particle sizes than the control group (median [interquartile range], 231 [54-385] vs. 579 [213-1,379]×103/m3; p=0.056). However, the intervention group had a significant decrease in 0.3-µm particles (68 [-25-185] vs. 242 [72-588]×103/m3; p=0.045). No adverse events occurred in either group. The device did not cause any inconvenience to the endoscopists or patients. Conclusions This modified N95 respirator reduced the number of particles, especially 0.3-µm particles, generated during upper gastrointestinal endoscopy.
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Affiliation(s)
- Chawisa Nampoolsuksan
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thawatchai Akaraviputh
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Asada Methasate
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jirawat Swangsri
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Atthaphorn Trakarnsanga
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Thammawat Parakonthun
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Voraboot Taweerutchana
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nicha Srisuworanan
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tharathorn Suwatthanarak
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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12
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Bray C, Vanberkel PT. A framework for comparing N95 and elastomeric facepiece respirators on cost and function for healthcare use during a pandemic- A literature review. Health Policy 2023; 134:104857. [PMID: 37336164 DOI: 10.1016/j.healthpol.2023.104857] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 05/16/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
SARS-CoV-2 has posed implications for personal protective equipment supply. In this literature review we examine if elastomeric facepiece respirators (EFRs) are effective substitutes for N95 respirators through comparing their functionality and cost. We reviewed 30 articles which researched the advantages and disadvantages of each respirator. We compiled the reported results and found, among other things, that users favour N95 respirators for comfort but prefer EFRs for protection. EFRs are more cost effective when N95s are used as designed (single use) but mixed strategies minimize costs when N95s are reused (as practiced during shortages). Future research is needed on multicriteria analyses and to incorporate SARS-CoV-2 specific data to support future pandemic planning.
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Affiliation(s)
- Ceilidh Bray
- Dalhousie University, Industrial Engineering, PO BOX 15000, Halifax, NS B3H 4R2, Canada
| | - Peter T Vanberkel
- Dalhousie University, Industrial Engineering, PO BOX 15000, Halifax, NS B3H 4R2, Canada.
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13
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Kamal M, Bhatti M, Stewart WC, Johns M, Collins D, Shehabi Y, Thambiraj SR, Arora S. Safety Goggles with Elastic Headband to Improve N95 Fit Following Failed Quantitative Fit Test. Indian J Crit Care Med 2023; 27:386-391. [PMID: 37378367 PMCID: PMC10291674 DOI: 10.5005/jp-journals-10071-24473] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/08/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction N95 respirators, together with eye protection, form vital elements of personal protective equipment (PPE) for healthcare workers (HCW) caring for patients with respiratory infections, such as COVID-19. Duckbill N95 respirators are widely used but have a high failure rate when Fit Tested. The commonest site for inward leaks is the region between the nose and maxilla. Safety goggles with an elastic headband may press the upper rim of the respirator against the face, thereby reducing inward leaks. We hypothesized that the use of safety goggles with an elastic headband will improve the overall fit-factor of a duckbill N95 respirator and increase the proportion of users who pass a quantitative Fit Test. Methods About 60 volunteer HCWs, who had previously failed quantitative Fit Testing with a duckbill N95 respirator, participated in this before-and-after intervention study. A PortaCount® 8048 was used for quantitative Fit Testing. The test was first performed with a duckbill N95 respirator only. It was then repeated after participants donned a pair of safety goggles (3M Fahrenheit, ID 70071531621). Results Before the intervention, i.e., with the respirator only, 8 (13.3%) participants passed their Fit Test. This increased to 49 (81.7%) after the application of safety goggles (OR 42, 95% CI 7.14-1697.9, p < 0.0001). The adjusted mean overall fit factor, using Tobit regression analysis, increased from 40.3 to 193.0 (t = 12.32, p < 0.001). Conclusion The use of safety goggles with an elastic headband significantly increases the proportion of users who pass a quantitative Fit Test and improves the fit-factor of a duckbill N95 respirator. How to cite this article Kamal M, Bhatti M, Stewart WC, Johns M, Collins D, Shehabi Y, et al. Safety Goggles with Elastic Headband to Improve N95 Fit Following Failed Quantitative Fit Test. Indian J Crit Care Med 2023;27(6):386-391.
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Affiliation(s)
- Mohamed Kamal
- Department of Intensive Care Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Mominah Bhatti
- Department of Intensive Care Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | | | - Moira Johns
- Department of Intensive Care Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - David Collins
- Department of Intensive Care Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Yahya Shehabi
- Department of Intensive Care Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Solomon Rajesh Thambiraj
- Department of Intensive Care Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Sumesh Arora
- Department of Intensive Care Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
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Ajith Kumar AK, Nikhil N. Innovations with Validation: An Ingenious Way Forward? Indian J Crit Care Med 2023; 27:377-378. [PMID: 37378363 PMCID: PMC10291659 DOI: 10.5005/jp-journals-10071-24478] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
How to cite this article: Ajith Kumar AK, Nikhil N. Innovations with Validation: An Ingenious Way Forward? Indian J Crit Care Med 2023;27(6):377-378.
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Affiliation(s)
- AK Ajith Kumar
- Department of Critical Care Medicine, Aster Whitefield Hospital, Bengaluru, Karnataka, India
| | - N Nikhil
- Department of Critical Care Medicine, Aster Whitefield Hospital, Bengaluru, Karnataka, India
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15
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Wardhan R, Patel V, Neff AB, Cook RB, White JD, Vasilopoulos T. Qualitative fit test outcomes for N95 filtering facepiece respirators in health care workers. Am J Infect Control 2023; 51:194-198. [PMID: 35659562 DOI: 10.1016/j.ajic.2022.05.022] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND We analyzed the qualitative fit test results of the filtering facepiece respirators (FFRs) used at our institution to determine their performance and utility. METHODS We retrospectively analyzed 12,582 qualitative fit testing results for several FFR models among 8,809 health care workers (HCWs). RESULTS The overall failure rate for HCWs was 15.2%. Nearly one-third (2933/8809, 33.3%) had multiple FFRs fit tested. HCW sex was a statistically significant indicator of fit testing failure (χ2 = 29.9, df = 1, P < .001), with women having a 44% higher likelihood (OR, 1.4; 95% CI: 1.27-1.65) than men. There were statistically significant differences in the failure rate across FFRs (Fig 4, F[5, 12475] = 8.4, P < .001). Fluidshield 46867S had a significantly higher failure rate (49%) than the 3M 1860 (P = .012), 3M 1860S (P < .001), 3M 8210 (P < .001), and Safelife (P < .001) FFRs. CONCLUSIONS There was a large degree of variation in fit testing results for the FFRs tested. Although we were unable to find an FFR that fit more than 95% of the HCWs successfully, we identified poorly functioning FFRs that can help our institution with decision-making and budgeting for acquisition and stocking appropriate FFRs.
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Affiliation(s)
- Richa Wardhan
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL.
| | | | - Andrew B Neff
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL
| | - R B Cook
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL
| | - Jeffrey D White
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL
| | - Terrie Vasilopoulos
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL; Department of Orthopaedic Surgery and Sports Medicine, University of Florida College of Medicine, Gainesville, FL
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Bani M, Raggi E, Russo S, Riccelli M, Ardenghi S, Rampoldi G, Strepparava MG. The impact of facemasks on blood donation process: The professionals' perspective. Nurs Health Sci 2022; 24:845-852. [PMID: 36097961 PMCID: PMC10092482 DOI: 10.1111/nhs.12985] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 01/28/2023]
Abstract
Facemasks represent an essential measure of prevention against the spread of COVID-19; however, they lessen the ability to convey and understand emotions through facial expressions. In blood donation settings, facemasks may interfere with professionals' tasks. This qualitative study aims to describe healthcare staff's experiences, beliefs, and attitudes toward facemask wearing and strategies used to overcome communication and relational barriers along the blood donation process. Semistructured qualitative interviews were conducted with 25 healthcare professionals (14 physicians and 11 nurses) working in Italian blood donation centers. The framework analysis method was used to organize the data and identify emerging themes. More than 70% of participants reported discomfort and a negative impact on communicating effectively with donors and building empathic relationships. The difficulty to detect early signs of adverse reactions was reported by almost all nurses, and physicians were concerned that facemasks limited the identification of donors and the detection of deferral criteria. Facemasks have changed the blood donation process, reducing the healthcare professionals' ability to build empathic relationships and communicate with donors effectively. New strategies should be developed to overcome these limitations.
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Affiliation(s)
- Marco Bani
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | - Erika Raggi
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | - Selena Russo
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | - Mattia Riccelli
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | - Stefano Ardenghi
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | - Giulia Rampoldi
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | - Maria Grazia Strepparava
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy.,Department of Mental Health, Clinical Psychology Unit, San Gerardo Hospital, ASST-Monza, Monza, Italy
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Derr TH, James MA, Kuny CV, Patel DR, Kandel PP, Field C, Beckman MD, Hockett KL, Bates MA, Sutton TC, Szpara ML. Aerosolized Hydrogen Peroxide Decontamination of N95 Respirators, with Fit-Testing and Viral Inactivation, Demonstrates Feasibility for Reuse during the COVID-19 Pandemic. mSphere 2022;:e0030322. [PMID: 36040048 DOI: 10.1128/msphere.00303-22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
In response to the demand for N95 respirators by health care workers during the COVID-19 pandemic, we evaluated decontamination of N95 respirators using an aerosolized hydrogen peroxide (aHP) system. This system is designed to dispense a consistent atomized spray of aerosolized, 7% hydrogen peroxide (H2O2) solution over a treatment cycle. Multiple N95 respirator models were subjected to 10 or more cycles of respirator decontamination, with a select number periodically assessed for qualitative and quantitative fit testing. In parallel, we assessed the ability of aHP treatment to inactivate multiple viruses absorbed onto respirators, including phi6 bacteriophage, herpes simplex virus 1 (HSV-1), coxsackievirus B3 (CVB3), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For pathogens transmitted via respiratory droplets and aerosols, it is critical to address respirator safety for reuse. This study provided experimental validation of an aHP treatment process that decontaminates the respirators while maintaining N95 function. External National Institute for Occupational Safety & Health (NIOSH) certification verified respirator structural integrity and filtration efficiency after 10 rounds of aHP treatment. Virus inactivation by aHP was comparable to the decontamination of commercial spore-based biological indicators. These data demonstrate that the aHP process is effective, with successful fit-testing of respirators after multiple aHP cycles, effective decontamination of multiple virus species, including SARS-CoV-2, successful decontamination of bacterial spores, and filtration efficiency maintained at or greater than 95%. While this study did not include extended or clinical use of N95 respirators between aHP cycles, these data provide proof of concept for aHP decontamination of N95 respirators before reuse in a crisis-capacity scenario. IMPORTANCE The COVID-19 pandemic led to unprecedented pressure on health care and research facilities to provide personal protective equipment. The respiratory nature of the SARS-CoV2 pathogen makes respirator facepieces a critical protective measure to limit inhalation of this virus. While respirator facepieces were designed for single use and disposal, the pandemic increased overall demand for N95 respirators, and corresponding manufacturing and supply chain limitations necessitated the safe reuse of respirators when necessary. In this study, we repurposed an aerosolized hydrogen peroxide (aHP) system that is regularly utilized to decontaminate materials in a biosafety level 3 (BSL3) facility, to develop a method for decontamination of N95 respirators. Results from viral inactivation, biological indicators, respirator fit testing, and filtration efficiency testing all indicated that the process was effective at rendering N95 respirators safe for reuse. This proof-of-concept study establishes baseline data for future testing of aHP in crisis-capacity respirator-reuse scenarios.
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Abstract
Objectives Many individuals have difficulty adapting to face mask use and report symptoms while using masks. Our primary objective was to determine whether continuous mask-wearing causes elevated levels of carbon dioxide (CO2) behind the facemasks. Methods CO2 concentrations were measured behind 3 different types of face masks and were compared to CO2 concentrations at the mask front in 261 subjects who continuously wore masks for at least 5 minutes. These CO2 concentrations were also measured in several randomly selected subjects after a 5-minute walk. Results There were significantly higher CO2 concentrations behind the mask (3176 ppm) compared to the front (843 ppm) with an average of 49 minutes of continuous mask use. Of all the subjects, 76.6% had a behind-the-mask CO2 concentration of more than 2000 ppm (the threshold for clinical symptoms), and 12.2% had a CO2 concentration of at least 5000 ppm (occupational health exposure limit). The CO2 level behind the N-95 masks was highest (especially after exertion) and was lowest behind cloth masks. The combination of warm ambient temperature, an N-95 mask, exercise, and young age appeared to induce exceedingly high CO2 levels that should be avoided. Discussion Although masks might be necessary for healthcare workers or to lessen the spread of airborne disease, we found that elevated CO2 concentrations were present while wearing them. Elevated CO2 concentrations have historically caused symptoms of CO2 toxicity. Periodic mask breaks in designated areas may be needed to avoid adverse effects. Conclusion The use of masks increased the CO2 concentration in the air behind them to levels historically associated with toxicity.
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19
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Gündoğan M, Akkaya S, Bayram N. Assessment of the impact of N95 respirators or surgical masks use on the retinal microvasculature. Eur J Ophthalmol 2022; 32:2306-2311. [PMID: 35410534 DOI: 10.1177/11206721221093199] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the possible impact of wearing N95 respirator or surgical masks on retinal vessel diameters and choroidal thickness in healthy healthcare workers. METHODS Diameters of peripapillary retinal arteries and veins and choroidal thickness values at the foveal center and at 1000 μm distances from the foveal center in both nasal and temporal directions were measured before mask wearing using a spectral-domain optical coherence tomography. After four hours (h) of N95 or surgical mask wearing vessel diameter and choroidal thickness measurements were repeated. RESULTS A total of 52 eyes from 52 participants (28 F [53.8%]; 24 M [46.2%]) were enrolled in this study. The mean age of patients was 34.58 ± 5.24 years (25-44 years). The diameters of all measured arteries [inferior temporal artery (p = 0.003), superior temporal artery (p < 0.001), inferior nasal artery (p = 0.003), and superior nasal artery (p = 0.004)] and veins,with the exception of superior nasal vein, (inferior temporal vein (p = 0.031), superior temporal vein (p = 0.027), inferior nasal vein (p < 0.001), and superior nasal vein (p = 0.063)] increased significantly after four hour use of N95 respirators and surgical maskswhen compared to baseline. There was also a significant diameter increase of the superior temporal (p < 0.001), inferior nasal veins (p < 0.001), and superior temporal artery (p = 0.037) for N95 respirators and surgical masks use, respectively. The differences in central subfoveal, temporal, and nasal choroidal thickness between baseline and after 4 h use of N95 respirators were statistically significant (From 366.73 ± 70.81 μm to 381.23 ± 69.29μm,p < 0.001 for the subfoveal; from 324.00 ± 64.13μm to 335.40 ± 61.35 μm, p = 0.007 for the temporal; from 297.40 ± 68.18 μm to 308.23 ± 74.51μm, p = 0.002 for the nasal thicknesses). Choroidal thickness values were also increased with surgical mask use. But only the increase in central subfoveal thickness was statistically significant (From 366.78 ± 71.00 μm to 372.58 ± 76.56 μm, p = 0.031 for the central subfoveal; from 297.42 ± 68.35 μmto 302.79 ± 73.05 μm, p = 0.068 for the nasal; from 324.01 ± 64.21μm to 330.33 ± 65.84, p = 0.117 for the temporal thicknesses). CONCLUSION With four hours use of N95 respirators or surgical face masks, retinal vessel diameters and choroidal thicknesses showed an increase in comparison to baseline measurements. Hemodynamic changes seen secondary to hypercapnia due to prolonged use of N95 respirators or surgical masks may also be observed in the retinal and choroidal circulation. Furthermore, the use of face masks should be taken into account while assessing the retinal microvasculature.
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Affiliation(s)
- Medine Gündoğan
- Department of Ophthalmology, 567955Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Serkan Akkaya
- Department of Ophthalmology, 64082Ankara Training and Research Hospital, Ankara, Turkey
| | - Nurettin Bayram
- Department of Ophthalmology, 567955Kayseri City Training and Research Hospital, Kayseri, Turkey
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20
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Karsli E, Yilmaz A, Kemancı A, Canacik O, Ozen M, Seyit M, Şahin L, Oskay A, Sabirli R, Turkcuer I. The effect of N95 respirators on vital parameters, PETCO 2, among healthcare providers at the pandemic clinics. Ir J Med Sci 2022; 192:853-860. [PMID: 35415774 PMCID: PMC9005163 DOI: 10.1007/s11845-022-03013-x] [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: 03/08/2022] [Accepted: 04/08/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Wearing face shields and masks, which used to have very limited public use before the COVID-19 outbreak, has been highly recommended by organizations, such as CDC and WHO, during this pandemic period. AIMS The aim of this prospective study is to scrutinize the dynamic changes in vital parameters, change in end tidal CO2 (PETCO2) levels, the relationship of these changes with taking a break, and the subjective complaints caused by respiratory protection, while healthcare providers are performing their duties with the N95 mask. METHODS The prospective cohort included 54 healthcare workers (doctors, nurses, paramedics) who worked in the respiratory unit of the emergency department (ED) and performed their duties by wearing valved N95 masks and face shields. The vital parameters and PETCO2 levels were measured at 0-4th-5th and 9th hours of the work-shift. RESULTS Only the decrease in diastolic BP between 0 and 9 h was statistically significant (p = 0.038). Besides, mean arterial pressure (MAP) values indicated a significant decrease between 0-9 h and 5-9 h (p = 0.024 and p = 0.049, respectively). In terms of the vital parameters of the subjects working with and without breaks, only PETCO2 levels of those working uninterruptedly increased significantly at the 4th hour in comparison to the beginning-of-shift baseline levels (p = 0.003). CONCLUSION Although the decrease in systolic blood pressure (SBP) and MAP values is assumed to be caused by increased fatigue due to workload and work pace as well as increase in muscle activity, the increase in PETCO2 levels in the ED healthcare staff working with no breaks between 0 and 4 h should be noted in terms of PPE-induced hypoventilation.
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Affiliation(s)
- Emre Karsli
- Department of Emergency Medicine, Faculty of Medicine, Tınaztepe University, Izmir, Turkey
| | - Atakan Yilmaz
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Aykut Kemancı
- Department of Emergency Medicine, Tavsanli Doc Dr. Mustafa Kalemli State Hospital, Kutahya, Turkey
| | - Omer Canacik
- Department of Emergency Medicine, Memorial Sisli Hospital, Istanbul, Turkey
| | - Mert Ozen
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Murat Seyit
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Levent Şahin
- Department of Emergency Medicine, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Alten Oskay
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ramazan Sabirli
- Department of Emergency Medicine, Bakircay University Faculty of Medicine Cigli Training and Research Hospital, 35620, Izmir, Turkey.
| | - Ibrahim Turkcuer
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Raju SP, Sachdev M, Khunger N, Madnani N. Mask Acne in Skin of Color: A Significant Dermatological Condition Amidst the COVID-19 Pandemic. J Clin Aesthet Dermatol 2022; 15:44-48. [PMID: 35465038 PMCID: PMC9017666] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemic has given rise to the need to use personal protective equipment such as masks, among healthcare professionals and the general public. Numerous facial dermatoses linked to the use of masks have been described, from which the term maskne or mask acne has emerged. Although prolonged mask usage has been necessary, and a vast majority of people develop various skin conditions, there is a lack of research on the effects of masks on skin. In this article, we review alterations in biochemical properties of skin associated with mask use in individuals with skin of color and the factors predisposing them to developing acne. Because masks are crucial in preventing the spread of COVID-19, we also elucidate some fundamental strategies such as gentle skin care measures, decreasing the duration of mask wear, and following appropriate protocols for mask re-use, which may prevent mask acne and its long-term effects.
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Affiliation(s)
- Sahana P Raju
- Dr. Raju is with the Department of Dermatology, Bangalore Medical College and Research Institute, India
- Dr. Sachdev is with the Department of Dermatology at Manipal Hospital in Bangalore, India
- Dr. Khunger is with the Department of Dermatology at VMMC & Safdarjung Hospital in New Delhi, India
- Dr. Madnani is with the Department of Dermatology at PD Hinduja National Hospital and Sir HN Reliance Foundation Hospital in Mumbai, India
| | - Mukta Sachdev
- Dr. Raju is with the Department of Dermatology, Bangalore Medical College and Research Institute, India
- Dr. Sachdev is with the Department of Dermatology at Manipal Hospital in Bangalore, India
- Dr. Khunger is with the Department of Dermatology at VMMC & Safdarjung Hospital in New Delhi, India
- Dr. Madnani is with the Department of Dermatology at PD Hinduja National Hospital and Sir HN Reliance Foundation Hospital in Mumbai, India
| | - Niti Khunger
- Dr. Raju is with the Department of Dermatology, Bangalore Medical College and Research Institute, India
- Dr. Sachdev is with the Department of Dermatology at Manipal Hospital in Bangalore, India
- Dr. Khunger is with the Department of Dermatology at VMMC & Safdarjung Hospital in New Delhi, India
- Dr. Madnani is with the Department of Dermatology at PD Hinduja National Hospital and Sir HN Reliance Foundation Hospital in Mumbai, India
| | - Nina Madnani
- Dr. Raju is with the Department of Dermatology, Bangalore Medical College and Research Institute, India
- Dr. Sachdev is with the Department of Dermatology at Manipal Hospital in Bangalore, India
- Dr. Khunger is with the Department of Dermatology at VMMC & Safdarjung Hospital in New Delhi, India
- Dr. Madnani is with the Department of Dermatology at PD Hinduja National Hospital and Sir HN Reliance Foundation Hospital in Mumbai, India
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Klompas M, Rhee C, Baker MA. Universal Use of N95 Respirators in Healthcare Settings When Community Coronavirus Disease 2019 Rates Are High. Clin Infect Dis 2022; 74:529-531. [PMID: 34113977 PMCID: PMC8384408 DOI: 10.1093/cid/ciab539] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Indexed: 12/23/2022] Open
Abstract
The Centers for Disease Control and Prevention recommends N95 respirators for all providers who see patients with possible or confirmed coronavirus disease 2019 (COVID-19). We suggest that N95 respirators may be just as important for the care of patients without suspected COVID-19 when community incidence rates are high. This is because severe acute respiratory syndrome coronavirus 2 is most contagious before symptom onset. Ironically, by the time patients are sick enough to be admitted to the hospital with COVID-19, they tend to be less contagious. The greatest threat of transmission in healthcare facilities may therefore be patients and healthcare workers with early occult infection. N95 respirators' superior fit and filtration provide superior exposure protection for healthcare providers seeing patients with early undiagnosed infection and superior source control to protect patients from healthcare workers with early undiagnosed infection. The probability of occult infection in patients and healthcare workers is greatest when community incidence rates are high. Universal use of N95 respirators may help decrease nosocomial transmission at such times.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School
and Harvard Pilgrim Health Care Institute, Boston,
Massachusetts, USA
- Department of Medicine, Brigham and Women’s
Hospital, Boston, Massachusetts, USA
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School
and Harvard Pilgrim Health Care Institute, Boston,
Massachusetts, USA
- Department of Medicine, Brigham and Women’s
Hospital, Boston, Massachusetts, USA
| | - Meghan A Baker
- Department of Population Medicine, Harvard Medical School
and Harvard Pilgrim Health Care Institute, Boston,
Massachusetts, USA
- Department of Medicine, Brigham and Women’s
Hospital, Boston, Massachusetts, USA
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23
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Johns M, Kyaw S, Lim R, Stewart WC, Thambiraj SR, Shehabi Y, Collins DW, Whyte CM, Arora S. Fit Factor Change on Quantitative Fit Testing of Duckbill N95 Respirators with the Use of Safety Goggles. Indian J Crit Care Med 2021; 25:981-986. [PMID: 34963714 PMCID: PMC8664035 DOI: 10.5005/jp-journals-10071-23972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 01/17/2023] Open
Abstract
N95 respirators and safety goggles are important components of personal protective equipment to reduce the spread of airborne infections, such as COVID-19, among healthcare workers. Poor N95 respirator seal may reduce its protective effect, thereby increasing transmission. Quantitative fit testing is an established way of assessing the N95 respirator fit, which provides a quantitative measure for seal, called the fit factor. Duckbill N95 respirators frequently fail the fit test. We hypothesized that using safety goggles with a wraparound elastic headband will increase their fit-factor by reinforcing the seal between the face and the upper margin of the respirator. We studied the effect of safety goggles with a wraparound elastic headband (3M™ Chemical Splash Resistant Goggles, ID 70006982741) on the fit factor of two types of Duckbill N95 respirators (Halyard FLUIDSHIELD*3, Model 99SA070M, and ProShield® N95 Model TN01-11) in 63 healthy volunteers in a nonrandomized, before-and-after intervention study design. The mean fit factor increased from 69.4 to 169.1 increased from 17/63 (27%) to 46/63 (73%) after the intervention (p <0.0001, OR 3 [95% CI = 4.9–1223]). This is the first study to explore the impact of safety goggles on N95 respirator fit. We conclude that the use of safety goggles with a wraparound elastic headband increases the fit factor of the tested Duckbill N95 respirators.
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Affiliation(s)
- Moira Johns
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Sandy Kyaw
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Rimen Lim
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Warren C Stewart
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Solomon R Thambiraj
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Yahya Shehabi
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - David W Collins
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Claudia M Whyte
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Sumesh Arora
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
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24
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Kyaw S, Johns M, Lim R, Stewart WC, Rojas N, Thambiraj SR, Shehabi Y, Arora S. Prediction of N95 Respirator Fit from Fogging of Eyeglasses: A Pilot Study. Indian J Crit Care Med 2021; 25:976-980. [PMID: 34963713 PMCID: PMC8664036 DOI: 10.5005/jp-journals-10071-23947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/23/2022] Open
Abstract
Aim and objective Fogging of eyeglasses while wearing N95 respirators is common. It is commonly held that the N95 respirator has a poor fit if there is fogging of eyeglasses. We conducted this prospective, pilot study to determine if fogging of eyeglasses predicts poor fit of N95 respirator. Materials and methods Seventy volunteer healthcare workers from a tertiary intensive care unit in Sydney, Australia participated. The participants donned one of the following N95 respirators: three-panel flat-fold respirator (3M 1870), cup-shaped respirator (3M 1860), or a duckbill respirator. After a satisfactory "user seal check" as recommended by the manufacturer, the participants donned eyeglasses and checked for fogging. A quantitative fit test (QnFT) of the respirator was then performed (using PortaCount Respirator Fit Tester 8048, TSI Inc., Minnesota, USA). A fit factor of <100 on quantitative fit testing indicates poor fit. The sensitivity and specificity for fogging of eyeglasses (index test) to predict the poor fit of N95 respirator was determined, compared to QnFT (gold standard test). Results Fogging of eyeglasses as a predictor of poor respirator fit (i.e., fit factor <100 on QnFT) had sensitivity of 71% (95% CI, 54-85%) and specificity 46% (95% CI, 29-63%). The odds ratio of fogging as a predictor for poor fit was 2.10 (95% CI, 0.78-5.67), with a two-tailed p-value of 0.22 (not significant). The receiver operating characteristic curve for fogging of eyeglasses as a diagnostic test had the area under the curve of 0.59. Conclusion Fogging of eyeglasses is neither a sensitive nor a specific predictor for poor fit of N95 respirators. How to cite this article Kyaw S, Johns M, Lim R, Stewart WC, Rojas N, Thambiraj SR, et al. Prediction of N95 Respirator Fit from Fogging of Eyeglasses: A Pilot Study. Indian J Crit Care Med 2021;25(9):976-980.
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Affiliation(s)
- Sandy Kyaw
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Moira Johns
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Rimen Lim
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Warren C Stewart
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Natalia Rojas
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Solomon R Thambiraj
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Yahya Shehabi
- Clinical School of Medicine, University of New South Wales
| | - Sumesh Arora
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
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25
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Cabanillas-Barea S, Rodríguez-Sanz J, Carrasco-Uribarren A, López-de-Celis C, González-Rueda V, Zegarra-Chávez D, Cedeño-Bermúdez S, Pérez-Bellmunt A. Effects of Using the Surgical Mask and FFP2 during the 6-Min Walking Test. A Randomized Controlled Trial. Int J Environ Res Public Health 2021; 18:12420. [PMID: 34886145 DOI: 10.3390/ijerph182312420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/13/2021] [Accepted: 11/23/2021] [Indexed: 12/27/2022]
Abstract
During the COVID-19 pandemic, the use of masks has been recommended as a containment measure. The mask is a hindrance to normal breathing that causes discomfort. This could put more work on the respiratory accessory muscles, and, consequently, these muscles could see their tone increase. For this reason, during this clinical trial (registered in clincaltrials.gov, number: NCT04789603), it was observed whether the use of the mask produced changes in the distance traveled, in the heart rate, in the oxygenometry, in the self-perceived dyspnea and in the tone of accessory respiratory muscles during a 6-min walk test (6MWT). Fifty healthy volunteers were recruited and carried out the 6MWT on three occasions. They carried out the 6MWT in various situations: using an FFP2/N95 mask, using a surgical mask, and without using a mask. The distance walked, the heart rate, the oxygen therapy, the tone of the accessory respiratory muscles, and the self-perceived dyspnea were recorded in each situation. Significant differences were found between the three situations in terms of self-perceived dyspnea FFP2/N95 > surgical mask > no mask. However, there are no differences between the experimental situations during the 6MWT in terms of distance travelled, heart rate, oxygenometry or respiratory muscle tone.
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26
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Saran S. CPR in COVID-19: Should We Use the PAPR to Keep the Savior Safe? Indian J Crit Care Med 2021; 25:950. [PMID: 34733042 PMCID: PMC8559752 DOI: 10.5005/jp-journals-10071-23925] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Saran S. CPR in COVID-19: Should We Use the PAPR to Keep the Savior Safe? Indian J Crit Care Med 2021;25(8):950.
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Affiliation(s)
- Sai Saran
- Department of Critical Care Medicine, King George Medical University, Lucknow, Uttar Pradesh, India
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27
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Schilling K, Gentner DR, Wilen L, Medina A, Buehler C, Perez-Lorenzo LJ, Pollitt KJG, Bergemann R, Bernardo N, Peccia J, Wilczynski V, Lattanza L. An accessible method for screening aerosol filtration identifies poor-performing commercial masks and respirators. J Expo Sci Environ Epidemiol 2021; 31:943-952. [PMID: 32764709 PMCID: PMC7406964 DOI: 10.1038/s41370-020-0258-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/10/2020] [Accepted: 07/27/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic has presented an acute shortage of regulation-tested masks. Many of the alternatives available to hospitals have not been certified, leaving uncertainty about their ability to properly protect healthcare workers from SARS-CoV-2 transmission. OBJECTIVE For situations where regulatory methods are not accessible, we present experimental methods to evaluate mask filtration and breathability quickly via cost-effective approaches (e.g., ~$2000 USD) that could be replicated in communities of need without extensive infrastructure. We demonstrate the need for screening by evaluating an existing diverse inventory of masks/respirators from a local hospital. METHODS Two experimental approaches are presented to examine both aerosol filtration and flow impedance (i.e., breathability). For one of the approaches ("quick assessment"), screening for appropriate filtration could be performed under 10 min per mask, on average. Mask fit tests were conducted in tandem but are not the focus of this study. RESULTS Tests conducted of 47 nonregulation masks reveal variable performance. A number of commercially available masks in hospital inventories perform similarly to N95 masks for aerosol filtration of 0.2 μm and above, but there is a range of masks with relatively lower filtration efficiencies (e.g., <90%) and a subset with poorer filtration (e.g., <70%). All masks functioned acceptably for breathability, and impedance was not correlated with filtration efficiency. SIGNIFICANCE With simplified tests, organizations with mask/respirator shortages and uncertain inventories can make informed decisions about use and procurement.
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Affiliation(s)
- Katherine Schilling
- Department of Chemical and Environmental Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, 06511, USA
| | - Drew R Gentner
- Department of Chemical and Environmental Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, 06511, USA
- SEARCH (Solutions for Energy, Air, Climate and Health) Center, Yale University, New Haven, CT, USA
| | - Lawrence Wilen
- School of Engineering and Applied Science, Yale University, New Haven, CT, 06511, USA
| | - Antonio Medina
- School of Engineering and Applied Science, Yale University, New Haven, CT, 06511, USA
| | - Colby Buehler
- Department of Chemical and Environmental Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, 06511, USA
- SEARCH (Solutions for Energy, Air, Climate and Health) Center, Yale University, New Haven, CT, USA
| | - Luis J Perez-Lorenzo
- Department of Mechanical Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, 06511, USA
| | - Krystal J Godri Pollitt
- Department of Chemical and Environmental Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, 06511, USA
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT, 06510, USA
| | - Reza Bergemann
- School of Engineering and Applied Science, Yale University, New Haven, CT, 06511, USA
| | - Nick Bernardo
- School of Engineering and Applied Science, Yale University, New Haven, CT, 06511, USA
| | - Jordan Peccia
- Department of Chemical and Environmental Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, 06511, USA
| | - Vincent Wilczynski
- School of Engineering and Applied Science, Yale University, New Haven, CT, 06511, USA
| | - Lisa Lattanza
- Department of Orthopaedics and Rehabilitation, School of Medicine, Yale University, New Haven, CT, 06511, USA.
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28
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Shaterian N, Abdi F, Atarodi Kashani Z, Shaterian N, Darvishmotevalli M. Facemask and Respirator in Reducing the Spread of Respiratory Viruses; a Systematic Review. Arch Acad Emerg Med 2021; 9:e56. [PMID: 34580654 PMCID: PMC8464015 DOI: 10.22037/aaem.v9i1.1286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Respiratory viruses spread fast, and some manners have been recommended for reducing the spread of these viruses, including the use of a facemask or respirator, maintaining hand hygiene, and perfoming social distancing. This systematic review aimed to assess the impact of facemasks and respirators on reducing the spread of respiratory viruses. Methods We conducted a systematic review using MeSH terms, and reported findings according to PRISMA. PubMed, Embase, Cochrane Library, Scopus, ProQuest, Web of Science(WoS), and Google Scholar were searched for articles published between 2009 and 2020. Two independent reviewers determined whether the studies met inclusion criteria. The risk of bias of studies was assessed using Newcastle-Ottawa (NOS) and Consolidated Standards of Reporting Trials (CONSORT). Results A total of 1505 articles were initially retrieved and 10 were finally included in our analysis (sample size: 3065). 96.8% of non-infected participants used facemask or respirator in contact with people infected with a respiratory virus, facemask and respirator have a significant effect on reducing the spread of respiratory viruses. Conclusion Evidence support that using a facemask or respirator can reduce the spread of all types of respiratory viruses; therefore, this result can be generalized to the present pandemic of a respiratory virus (SARS-COV-2) and it is recommended to use a facemask or respirator for reducing the spread of this respiratory virus.
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Affiliation(s)
- Negin Shaterian
- Student Research Committee, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Abdi
- School of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran.,Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Negar Shaterian
- Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Mohammad Darvishmotevalli
- Research Center for Health, Safety and Environment , Alborz University of Medical Sciences, Karaj, Iran
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29
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Jiang ZY, Huang Z, Schmale I, Brown EL, Lorenz MC, Patlovich SJ, Goswami K, Wilson HB, Ahmad J, Alexander R, Bryan W, Burke L, Citardi MJ, Elias J, Ho T, Jacob J, Low G, Miramón P, Patki AU, Yao WC, Luong AU. N95 respirator reuse, decontamination methods, and microbial burden: A randomized controlled trial. Am J Otolaryngol 2021; 42:103017. [PMID: 33857782 DOI: 10.1016/j.amjoto.2021.103017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the effectiveness and ease of N95 respirator decontamination methods in a clinic setting and to identify the extent of microbial colonization on respirators associated with reuse. METHODS In a prospective fashion, N95 respirators (n = 15) were randomized to a decontamination process (time, dry heat, or ultraviolet C light [UVC]) in outpatient clinics. Each respirator was re-used up to 5 separate clinic sessions. Swabs on each respirator for SARS-CoV-2, bacteria, and fungi were obtained before clinic, after clinic and post-treatment. Mask integrity was checked after each treatment (n = 68). Statistical analyses were performed to determine factors for positive samples. RESULTS All three decontamination processes reduced bacteria counts similarly. On multivariate mixed model analysis, there were an additional 8.1 colonies of bacteria (95% CI 5.7 to 10.5; p < 0.01) on the inside compared to the outside surface of the respirators. Treatment resulted in a decrease of bacterial load by 8.6 colonies (95% CI -11.6 to -5.5; p < 0.01). Although no decontamination treatment affected the respirator filtration efficiency, heat treatments were associated with the breakdown of thermoplastic elastomer straps. Contamination with fungal and SARS-CoV-2 viral particles were minimal to non-existent. CONCLUSIONS Time, heat and UVC all reduced bacterial load on reused N95 respirators. Fungal contamination was minimal. Heat could permanently damage some elastic straps making the respirators nonfunctional. Given its effectiveness against microbes, lack of damage to re-treated respirators and logistical ease, UVC represents an optimal decontamination method for individual N95 respirators when reuse is necessary.
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30
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McAvoy M, Bui ATN, Hansen C, Plana D, Said JT, Yu Z, Yang H, Freake J, Van C, Krikorian D, Cramer A, Smith L, Jiang L, Lee KJ, Li SJ, Beller B, Huggins K, Short MP, Yu SH, Mostaghimi A, Sorger PK, LeBoeuf NR. 3D Printed frames to enable reuse and improve the fit of N95 and K N95 respirators. BMC Biomed Eng 2021; 3:10. [PMID: 34099062 PMCID: PMC8182357 DOI: 10.1186/s42490-021-00055-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 05/09/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In response to supply shortages caused by the COVID-19 pandemic, N95 filtering facepiece respirators (FFRs or "masks"), which are typically single-use devices in healthcare settings, are routinely being used for prolonged periods and in some cases decontaminated under "reuse" and "extended use" policies. However, the reusability of N95 masks is limited by degradation of fit. Possible substitutes, such as KN95 masks meeting Chinese standards, frequently fail fit testing even when new. The purpose of this study was to develop an inexpensive frame for damaged and poorly fitting masks using readily available materials and 3D printing. RESULTS An iterative design process yielded a mask frame consisting of two 3D printed side pieces, malleable wire links that users press against their face, and cut lengths of elastic material that go around the head to hold the frame and mask in place. Volunteers (n = 45; average BMI = 25.4), underwent qualitative fit testing with and without mask frames wearing one or more of four different brands of FFRs conforming to US N95 or Chinese KN95 standards. Masks passed qualitative fit testing in the absence of a frame at rates varying from 48 to 94 % (depending on mask model). For individuals who underwent testing using respirators with broken or defective straps, 80-100 % (average 85 %) passed fit testing with mask frames. Among individuals who failed fit testing with a KN95, ~ 50 % passed testing by using a frame. CONCLUSIONS Our study suggests that mask frames can prolong the lifespan of N95 and KN95 masks by serving as a substitute for broken or defective bands without adversely affecting fit. Use of frames made it possible for ~ 73 % of the test population to achieve a good fit based on qualitative and quantitative testing criteria, approaching the 85-90 % success rate observed for intact N95 masks. Frames therefore represent a simple and inexpensive way of expanding access to PPE and extending their useful life. For clinicians and institutions interested in mask frames, designs and specifications are provided without restriction for use or modification. To ensure adequate performance in clinical settings, fit testing with user-specific masks and PanFab frames is required.
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Affiliation(s)
- Malia McAvoy
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Department of Neurosurgery, University of Washington, Seattle, WA USA
| | - Ai-Tram N. Bui
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Christopher Hansen
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Harvard Graduate School of Design, Cambridge, MA USA
| | - Deborah Plana
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA USA
- Department of Systems Biology, Harvard Ludwig Cancer Research Center, Harvard Medical School, Boston, MA USA
| | - Jordan T. Said
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Zizi Yu
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Helen Yang
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
| | - Jacob Freake
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Fikst Product Development, Woburn, MA USA
| | - Christopher Van
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Borobot, Middleborough, MA USA
| | - David Krikorian
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Dana-Farber Cancer Institute, MA Boston, USA
| | - Avilash Cramer
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA USA
| | - Leanne Smith
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Borobot, Middleborough, MA USA
| | - Liwei Jiang
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA USA
| | - Karen J. Lee
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA USA
| | - Sara J. Li
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA USA
| | - Brandon Beller
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Engineering Science at Norwalk Community College, Norwalk, CT USA
| | | | - Michael P. Short
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Department of Nuclear Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
| | - Sherry H. Yu
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Department of Dermatology, Yale University School of Medicine, New Haven, CT USA
| | - Arash Mostaghimi
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA USA
| | - Peter K. Sorger
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Department of Systems Biology, Harvard Ludwig Cancer Research Center, Harvard Medical School, Boston, MA USA
- Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA USA
| | - Nicole R. LeBoeuf
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Dana-Farber Cancer Institute, MA Boston, USA
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA USA
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31
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Chang CT, Rajan P, Hoe VCW. Filtering Facepiece Respirators for Healthcare Workers Protection in the Time of COVID-19 Pandemic. Malays J Med Sci 2021; 28:151-154. [PMID: 34285653 PMCID: PMC8260073 DOI: 10.21315/mjms2021.28.3.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/12/2021] [Indexed: 01/09/2023] Open
Abstract
Protecting healthcare workers (HCWs) who are in the frontline during the time of the COVID-19 pandemic is paramount. The filtering facepiece respirators (FFRs) or N95 respirator is one of the personal protective equipment (PPE) used to protect HCWs exposed to airborne pathogens in clinical practice or when performing aerosol generating procedures. The FFRs should be able to serve the intended purpose without causing additional health and safety hazards for the HCWs. The following commentary will provide some basic information on selecting correct FFRs and conducting fitness test.
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Affiliation(s)
- Chee Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Victor Chee Wai Hoe
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia,Occupational Safety Health and Environmental Unit, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia
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Ramírez A, Ochoa D, Llanque G, Trelles B, Watanabe R, Alvitez-Temoche D, Mayta-Tovalino F. Historical Evolution and Filtering Characteristics of Masks and Respirators in Dentistry in the Context of COVID-19: A Literature Review. J Int Soc Prev Community Dent 2021; 11:248-255. [PMID: 34268186 PMCID: PMC8257016 DOI: 10.4103/jispcd.jispcd_22_21] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/03/2021] [Accepted: 03/19/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES At present, it is very important to identify the available literature regarding the use of masks and respirators by analyzing their historical evolution in the medical field. In addition, consideration should be given to the major filtering characteristics of those most used due to the current SARS-CoV-2 pandemic. Therefore, the purpose of this literature review is to describe the qualitative evolution that facemasks and respirators have undergone along with their different characteristics. MATERIALS AND METHODS This literature review was conducted between September and December 2020. Articles were identified from PubMed Central, Scopus, and Web of Science. The following keywords were used: "COVID-19," "dentistry," and "masks." These MeSH terms were combined with the Boolean operators "AND" and "OR." RESULTS We found 36 articles in PubMed Central, 21 in Scopus, and 17 in Web of Science, which included reviews, clinical, descriptive, and experimental trials. CONCLUSION The emergence of new pathogens leads to continuous improvement in masks and respirators. It was determined that for the dental field, respirators with filtration characteristics greater than 95%, such as FFP3, N100, N95, and KN95, are indicated in addition to their decontamination and reuse processes.
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Affiliation(s)
- Angela Ramírez
- Academic Department, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Dagny Ochoa
- Academic Department, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Ginna Llanque
- Academic Department, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Briggitte Trelles
- Academic Department, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Romel Watanabe
- Department of Rehabilitative Stomatology, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Daniel Alvitez-Temoche
- Academic Department, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Frank Mayta-Tovalino
- Postgraduate Department, CHANGE Research Working Group, Faculty of Health Sciences, Universidad Científica del Sur, Lima, Perú
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Oksanen LMAH, Sanmark E, Oksanen SA, Anttila VJ, Paterno JJ, Lappalainen M, Lehtonen L, Geneid A. Sources of healthcare workers' COVID‑19 infections and related safety guidelines. Int J Occup Med Environ Health 2021; 34:239-249. [PMID: 33847307 DOI: 10.13075/ijomeh.1896.01741] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of safety guidelines in the workplace, the authors analyzed the work-related exposure to SARS-CoV-2 and the source of COVID‑19 infections among healthcare workers (HCWs), together with the use of personal protective equipment (PPE). MATERIAL AND METHODS A cross-sectional prospective study was conducted in tertiary hospitals in the Uusimaa region, Finland, with 1072 volunteers being enrolled in the study from among the HCWs at the Helsinki University Hospital. Overall, 866 (80.8%) HCWs (including 588 nurses, 170 doctors, and 108 laboratory and medical imaging nurses) completed the questionnaire by July 15, 2020, with 52% of the participants taking care of COVID‑19 patients. The participants answered a structured questionnaire regarding their use of PPE, the ability to follow safety guidelines, exposure to COVID‑19, and the source of potential COVID‑19 infections. The participants with COVID‑19 symptoms were tested with the SARS-CoV-2 realtime polymerase chain reaction method. All infected participants were contacted, and their answers were confirmed regarding COVID‑19 exposure. RESULTS In total, 41 (4.7%) participants tested positive for SARS-CoV-2, with 22 (53.6%) of infections being confirmed or likely occupational, and 12 (29.3%) originating from colleagues. In 14 cases (63.6%), occupational infections occurred while using a surgical mask, and all infections originating from patients occurred while using a surgical mask or no mask at all. No occupational infections were found while using an FFP2/3 respirator and following aerosol precautions. The combined odds ratio for working at an intensive care unit, an emergency department, or a ward was 3.4 (95% CI: 1.2-9.2, p = 0.016). CONCLUSIONS A high infection rate was found among HCWs despite safety guidelines. Based on these findings, the authors recommend the use of FFP2/3 respirators in all patient contacts with confirmed or suspected COVID‑19, along with the use of universal masking, also in personnel rooms. Int J Occup Med Environ Health. 2021;34(2):239-49.
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Affiliation(s)
| | - Enni Sanmark
- University of Helsinki, Helsinki, Finland (Faculty of Medicine)
| | | | | | - Jussi J Paterno
- Kuopio University Hospital, Kuopio, Finland (Department of Ophthalmology)
| | | | - Lasse Lehtonen
- University of Helsinki, Helsinki, Finland (Faculty of Medicine)
| | - Ahmed Geneid
- University of Helsinki, Helsinki, Finland (Faculty of Medicine)
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Russo R, Levine C, Grady C, Peixoto B, McCormick-Ell J, Block T, Gresko A, Delmas G, Chitale P, Frees A, Ruiz A, Alland D. Decontaminating N95 respirators during the COVID-19 pandemic: simple and practical approaches to increase decontamination capacity, speed, safety and ease of use. J Hosp Infect 2020; 109:52-57. [PMID: 33347939 PMCID: PMC7748974 DOI: 10.1016/j.jhin.2020.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 08/21/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 12/14/2022]
Abstract
Background The COVID-19 pandemic has caused a severe shortage of personal protective equipment (PPE), especially N95 respirators. Efficient, effective and economically feasible methods for large-scale PPE decontamination are urgently needed. Aims (1) to develop protocols for effectively decontaminating PPE using vaporized hydrogen peroxide (VHP); (2) to develop novel approaches that decrease set-up and take-down time while also increasing decontamination capacity; (3) to test decontamination efficiency for N95 respirators heavily contaminated by make-up or moisturizers. Methods We converted a decommissioned Biosafety Level 3 laboratory into a facility that could be used to decontaminate N95 respirators. N95 respirators were hung on metal racks, stacked in piles, placed in paper bags or covered with make-up or moisturizer. A VHP® VICTORY™ unit from STERIS was used to inject VHP into the facility. Biological and chemical indicators were used to validate the decontamination process. Findings: N95 respirators individually hung on metal racks were successfully decontaminated using VHP. N95 respirators were also successfully decontaminated when placed in closed paper bags or if stacked in piles of up to six. Stacking reduced the time needed to arrange N95 respirators for decontamination by approximately two-thirds while almost tripling facility capacity. Make-up and moisturizer creams did not interfere with the decontamination process. Conclusions Respirator stacking can reduce the hands-on time and increase decontamination capacity. When personalization is needed, respirators can be decontaminated in labelled paper bags. Make up or moisturizers do not appear to interfere with VHP decontamination.
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Affiliation(s)
- R Russo
- Center for Emerging Pathogens, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - C Levine
- Center for Emerging Pathogens, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - C Grady
- Center for Emerging Pathogens, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - B Peixoto
- Center for Emerging Pathogens, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - J McCormick-Ell
- Rutgers Environmental Health and Safety, Rutgers University, Newark, NJ, USA
| | - T Block
- Rutgers Environmental Health and Safety, Rutgers University, Newark, NJ, USA
| | - A Gresko
- Rutgers Environmental Health and Safety, Rutgers University, Newark, NJ, USA
| | - G Delmas
- Rutgers Environmental Health and Safety, Rutgers University, Newark, NJ, USA
| | - P Chitale
- Center for Emerging Pathogens, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - A Frees
- Rutgers Environmental Health and Safety, Rutgers University, Newark, NJ, USA
| | - A Ruiz
- Rutgers Environmental Health and Safety, Rutgers University, Newark, NJ, USA
| | - D Alland
- Center for Emerging Pathogens, New Jersey Medical School, Rutgers University, Newark, NJ, USA.
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Aljabo A, Mueller E, Abdul-Azeez D, Hoare T, Jain A. Gravity steam reprocessing in healthcare facilities for the reuse of N95 respirators. J Hosp Infect 2020; 106:698-708. [PMID: 33017616 PMCID: PMC7530561 DOI: 10.1016/j.jhin.2020.09.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/17/2020] [Accepted: 09/27/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has significantly impacted the health of millions of people around the world. The shortage of personal protective equipment, including N95 respirators, in hospital facilities has put frontline healthcare professionals at high risk for contracting this virus. AIM To develop a reproducible and safe N95 respirator reprocessing method that satisfies all presented regulatory standards and that can be directly implemented by hospitals using existing available equipment. METHODS A non-toxic gravity steam reprocessing method has been developed for the reuse of N95 respirators consisting of 30 min of steam treatment at 121°C followed by 30 min of heat drying. Samples of model number 1860, 1860s, 1870+, and 9105 N95 respirators were either collected from hospitals (for microbiology testing) or purchased new (for functionality testing), with all functionality tests (i.e. filter efficiency, fit evaluation, and strap integrity) performed at the Centers for Disease Control and Prevention using standard procedures established by the National Institute for Occupational Safety and Health. FINDINGS All tested models passed the minimum filter efficiency of 95% after three cycles of gravity steam reprocessing. The 1870+ N95 respirator model is the most promising model for reprocessing based on its efficient bacterial inactivation coupled with the maintenance of all other key functional respirator properties after multiple reprocessing steps. CONCLUSIONS The gravity steam method can effectively reprocess N95 respirators over at least three reprocessing cycles without negatively impacting the functionality requirements set out by regulators. Enabling the reuse of N95 respirators is a crucial tool for managing both the current pandemic and future healthcare crises.
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Affiliation(s)
- A Aljabo
- SteriPro Canada, Inc., Mississauga, Ontario, Canada.
| | - E Mueller
- Department of Chemical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - D Abdul-Azeez
- Department of Chemical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - T Hoare
- Department of Chemical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - A Jain
- SteriPro Canada, Inc., Mississauga, Ontario, Canada
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Sun Y, Otomaru H, Quaye SED, Somani J, Bagdasarian N, Beh DLL, Fisher DA, Cook AR, Dickens BL. Scenarios to Manage the Demand for N95 Respirators for Healthcare Workers During the COVID-19 Pandemic. Risk Manag Healthc Policy 2020; 13:2489-2496. [PMID: 33177904 PMCID: PMC7652237 DOI: 10.2147/rmhp.s275496] [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: 08/04/2020] [Accepted: 09/24/2020] [Indexed: 01/08/2023] Open
Abstract
Background By estimating N95 respirator demand based on simulated epidemics, we aim to assist planning efforts requiring estimations of respirator demand for the healthcare system to continue operating safely in the coming months. Methods We assess respiratory needs over the course of mild, moderate and severe epidemic scenarios within Singapore as a case study using a transmission dynamic model. The number of respirators required within the respiratory isolation wards and intensive care units was estimated over the course of the epidemic. We also considered single-use, extended-use and prolonged-use strategies for N95 respirators for use by healthcare workers treating suspected but negative (misclassified) or confirmed COVID-19 patients. Results Depending on the confirmed to misclassified case ratio, from 1:0 to 1:10, a range of 117.1 million to 1.1 billion masks are required for single-use. This decreases to 71.6–784.4 million for extended-use and 12.8–148.2 million for prolonged-use, representing a 31.8–38.9% and 86.5–89.1% reduction, respectively. Conclusion An extended-use policy should be considered when short-term supply chains are strained but planning measures are in place to ensure long-term availability. With severe shortage expectations from a severe epidemic, as some European countries have experienced, prolonged use is necessary to prolong supply.
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Affiliation(s)
- Yinxiaohe Sun
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Hirono Otomaru
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Sharon Esi Duoduwa Quaye
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Jyoti Somani
- Division of Infectious Diseases, National University Hospital, Singapore
| | | | - Darius L L Beh
- Division of Infectious Diseases, National University Hospital, Singapore
| | - Dale A Fisher
- Division of Infectious Diseases, National University Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Borame L Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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Niño MC, De La Hoz J, Montoya MC, Madrid G. Guidelines: Anaesthesia in the context of COVID-19 pandemic. Anaesth Crit Care Pain Med 2020; 39:742. [PMID: 33002667 DOI: 10.1016/j.accpm.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/21/2020] [Indexed: 12/20/2022]
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Purushothaman PK, Priyangha E, Vaidhyswaran R. Effects of Prolonged Use of Facemask on Healthcare Workers in Tertiary Care Hospital During COVID-19 Pandemic. Indian J Otolaryngol Head Neck Surg 2020;:1-7. [PMID: 32953633 DOI: 10.1007/s12070-020-02124-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/31/2020] [Indexed: 10/27/2022] Open
Abstract
The fundamental aim of this study is to determine the effects of prolonged usage of N95 respirators and surgical facemasks amid health care workers in our institution. Cross-sectional study. SRM medical college hospital, Kattankulathur. A self-constructed questionnaire containing 20 queries regarding the effects of prolonged use of face masks, after being analysed by the experts of our institution were handed over to 250 participants.. All participants wore either surgical masks or N95 respirators for a minimum of 4 h per day. People aged between 20 and 48 years were selected for this study. Study period was from 20/07/2020 to 26/07/2020. Completed questionnaires were sent for statistical analysis. A total of 250 healthcare workers participated in the study, out of which 179 were females. The acquired results were excessive sweating around the mouth accounting to 67.6%, difficulty in breathing on exertion 58.2%, acne 56.0% and itchy nose 52.0%. This study suggests that prolonged use of facemasks induces difficulty in breathing on exertion and excessive sweating around the mouth to the healthcare workers which results in poorer adherence and increased risk of susceptibility to infection.
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Abstract
The novel coronavirus causing the COVID-19 pandemic is spread by respiratory transmission through droplets and contact. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommend the use of personal protective equipment (PPE) including a gown, gloves, and a surgical mask or N95 respirator plus a face shield and/or goggles for health-care workers who are in direct contact with COVID-19 patients. A study in China by Wang found that health-care workers on the front line of disease treatment had inadequate training in the use of PPE, particularly for respiratory infectious diseases. Instruction in the proper use of N95 respirators, with an emphasis on performing user seal checks, as well as donning and doffing, is recommended for everyone caring for COVID-19 patients.
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Affiliation(s)
- Tooba Hoseini Azizi
- Department of Critical Care Nursing and Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeideh Varasteh
- Department of medical- surgical Nursing and Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Esmaeili
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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Zhang S, Guo M, Wu F, Xiong N, Ma Y, Wang Z, Duan L, Chen L, Ouyang H, Jin Y. Factors associated with asymptomatic infection in health-care workers with severe acute respiratory syndrome coronavirus 2 infection in Wuhan, China: a multicentre retrospective cohort study. Clin Microbiol Infect 2020; 26:1670-1675. [PMID: 32911080 PMCID: PMC7476563 DOI: 10.1016/j.cmi.2020.08.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/21/2020] [Accepted: 08/30/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To describe the fraction of asymptomatic health-care workers (HCWs) in two designated hospitals for coronavirus disease 2019 (COVID-19) treatment in Wuhan and explore the factors associated with asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS All HCWs in Wuhan Union Hospital and Wuhan Red Cross Hospital with either positive SARS-CoV-2 nucleic acid or positive antibody test before 18 April 2020 were included. Exposure, epidemiological and demographic information were retrospectively collected by a structured questionnaire. Medical records were also reviewed for clinical characteristics and CT images of HCWs. RESULTS As of 18 April 2020, a total of 424 HCWs were identified. Among them, 276 (65.1%) were symptomatic and 148 (34.9%) were asymptomatic. Fifty-five (19.9%) families of the symptomatic HCWs and 16 (10.8%) families of the asymptomatic HCWs were infected with SARS-CoV-2. HCWs with infected family members tended to be symptomatic (OR 2.053, 95% CI 1.130-3.730; p 0.018). Multivariable logistic regression analysis exhibited that performing tracheal intubation or extubation (OR 4.057, 95% CI 1.183-13.909; p 0.026) was associated with an increased likelihood of symptomatic SARS-CoV-2 infection, whereas consistent use of N95 respirators (OR 0.369, 95% CI 0.201-0.680; p 0.001) and eye protection (OR 0.217, 95% CI 0.116-0.404; p < 0.001) were associated with an increased likelihood of asymptomatic SARS-CoV-2 infection. CONCLUSIONS Asymptomatic SARS-CoV-2 infection in HCWs comprised a considerable proportion of HCW infections during the pandemic of COVID-19. Those who performed tracheal intubation or extubation were most likely to develop related symptoms, whereas those taking aggressive measures, including consistent use of N95 masks and eye protection, tended to be asymptomatic cases.
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Affiliation(s)
- Shuai Zhang
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mengfei Guo
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Feng Wu
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Nian Xiong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Yanling Ma
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhihui Wang
- Department of Scientific Research, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Limin Duan
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lan Chen
- Hospital Infection-Control Department, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Haixia Ouyang
- Department of Human Resources, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Yang Jin
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Brun D, Curti C, Mekideche T, Benech A, Hounliasso I, Lamy E, Castera C, Rathelot P, Vanelle P. Stockpiled N95 respirator/surgical mask release beyond manufacturer-designated shelf-life: a French experience. J Hosp Infect 2020; 106:258-263. [PMID: 32745593 PMCID: PMC7395218 DOI: 10.1016/j.jhin.2020.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/24/2020] [Accepted: 07/27/2020] [Indexed: 11/08/2022]
Abstract
Background To reduce the shortage of N95 respirators and surgical masks during the COVID-19 pandemic, stockpiled equipment beyond its expiry date could be released. Aim: Centralized testing of batches of expired surgical masks and N95 for safe distribution to hospital departments saving users time. Methods Tests of compliance with health authority directives were developed and carried out on 175 batches of N95 masks and 31 batches of surgical masks from 12th March 2020 to 16 April 2020. Five quality-control tests were performed on batch samples to check: packaging integrity, mask appearance, breaking strength of elastic ties and strength of nose clip test, and face-fit. Findings Forty-nine per cent of FFP2 mask batches were compliant with directives, 32% of batches were compliant but with some concerns and 19% of batches were non-compliant. For surgical masks, 58% of batches were compliant, 39% of batches compliant but with concerns and 3% of batches were non-compliant. Conclusion The main areas of non-compliance were the breaking strength of the elastic ties and the nose clip but these alone were not considered to make the masks unacceptable. Only mask appearance and face-fit results were decisive non-compliance criteria.
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Affiliation(s)
- D Brun
- Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Pharmacy Department, AP-HM, Marseille, France; Aix-Marseille Université, CNRS, Institut de Chimie Radicalaire ICR, UMR 7273, Equipe de Pharmaco-Chimie Radicalaire, Marseille, France
| | - C Curti
- Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Pharmacy Department, AP-HM, Marseille, France; Aix-Marseille Université, CNRS, Institut de Chimie Radicalaire ICR, UMR 7273, Equipe de Pharmaco-Chimie Radicalaire, Marseille, France.
| | - T Mekideche
- Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Pharmacy Department, AP-HM, Marseille, France
| | - A Benech
- Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Pharmacy Department, AP-HM, Marseille, France
| | - I Hounliasso
- Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Pharmacy Department, AP-HM, Marseille, France
| | - E Lamy
- Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Pharmacy Department, AP-HM, Marseille, France; Aix-Marseille Université, UMR 7287 CNRS, Institut des Sciences du Mouvement ISM, Faculté des Sciences du Sport, Marseille, France
| | - C Castera
- Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Pharmacy Department, AP-HM, Marseille, France; Aix-Marseille Université, CNRS, Institut de Chimie Radicalaire ICR, UMR 7273, Equipe de Pharmaco-Chimie Radicalaire, Marseille, France
| | - P Rathelot
- Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Pharmacy Department, AP-HM, Marseille, France; Aix-Marseille Université, CNRS, Institut de Chimie Radicalaire ICR, UMR 7273, Equipe de Pharmaco-Chimie Radicalaire, Marseille, France
| | - P Vanelle
- Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Pharmacy Department, AP-HM, Marseille, France; Aix-Marseille Université, CNRS, Institut de Chimie Radicalaire ICR, UMR 7273, Equipe de Pharmaco-Chimie Radicalaire, Marseille, France
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McAvoy M, Bui ATN, Hansen C, Plana D, Said JT, Yu Z, Yang H, Freake J, Van C, Krikorian D, Cramer A, Smith L, Jiang L, Lee KJ, Li SJ, Beller B, Short M, Yu SH, Mostaghimi A, Sorger PK, LeBoeuf NR. 3D Printed frames to enable reuse and improve the fit of N95 and K N95 respirators. medRxiv 2020:2020.07.20.20151019. [PMID: 32743606 PMCID: PMC7386530 DOI: 10.1101/2020.07.20.20151019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In response to supply shortages during the COVID-19 pandemic, N95 filtering facepiece respirators (FFRs or "masks"), which are typically single-use devices in healthcare settings, are routinely being used for prolonged periods and in some cases decontaminated under "reuse" and "extended use" policies. However, the reusability of N95 masks is often limited by degradation or breakage of elastic head bands and issues with mask fit after repeated use. The purpose of this study was to develop a frame for N95 masks, using readily available materials and 3D printing, which could replace defective or broken bands and improve fit. RESULTS An iterative design process yielded a mask frame consisting of two 3D-printed side pieces, malleable wire links that users press against their face, and cut lengths of elastic material that go around the head to hold the frame and mask in place. Volunteers (n= 41; average BMI= 25.5), of whom 31 were women, underwent qualitative fit with and without mask frames and one or more of four different brands of FFRs conforming to US N95 or Chinese KN95 standards. Masks passed qualitative fit testing in the absence of a frame at rates varying from 48 - 92% (depending on mask model and tester). For individuals for whom a mask passed testing, 75-100% (average = 86%) also passed testing with a frame holding the mask in place. Among users for whom a mask failed in initial fit testing, 41% passed using a frame. Success varied with mask model and across individuals. CONCLUSIONS The use of mask frames can prolong the lifespan of N95 and KN95 masks by serving as a substitute for broken or defective bands without adversely affecting fit. Frames also have the potential to improve fit for some individuals who cannot fit existing masks. Frames therefore represent a simple and inexpensive way of extending the life and utility of PPE in short supply. For clinicians and institutions interested in mask frames, designs and specifications are provided without restriction for use or modification. To ensure adequate performance in clinical settings, qualitative fit testing with user-specific masks and frames is required.
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Affiliation(s)
- Malia McAvoy
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, USA
| | - Ai-Tram N. Bui
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christopher Hansen
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard Graduate School of Design, Cambridge, MA, USA
| | - Deborah Plana
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, USA
- Harvard Ludwig Cancer Research Center and Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Jordan T. Said
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Zizi Yu
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Helen Yang
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
| | - Jacob Freake
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Fikst Product Development, Woburn, MA, USA
| | - Christopher Van
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Borobot, Middleborough, MA, USA
| | - David Krikorian
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA
| | - Avilash Cramer
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, USA
| | - Leanne Smith
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Borobot, Middleborough, MA, USA
| | - Liwei Jiang
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Karen J. Lee
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Sara J. Li
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Brandon Beller
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Engineering Science at Norwalk Community College Norwalk, CT, USA
| | - Michael Short
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Department of Nuclear Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Sherry H. Yu
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Department of Dermatology, Yale University School of Medicine, New Haven, CT USA
| | - Arash Mostaghimi
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Peter K. Sorger
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard Ludwig Cancer Research Center and Department of Systems Biology, Harvard Medical School, Boston, MA, USA
- Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA, USA
| | - Nicole R. LeBoeuf
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, USA
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Bartoszko JJ, Farooqi MAM, Alhazzani W, Loeb M. Medical masks vs N95 respirators for preventing COVID-19 in healthcare workers: A systematic review and meta-analysis of randomized trials. Influenza Other Respir Viruses 2020; 14:365-373. [PMID: 32246890 PMCID: PMC7298295 DOI: 10.1111/irv.12745] [Citation(s) in RCA: 297] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Respiratory protective devices are critical in protecting against infection in healthcare workers at high risk of novel 2019 coronavirus disease (COVID-19); however, recommendations are conflicting and epidemiological data on their relative effectiveness against COVID-19 are limited. PURPOSE To compare medical masks to N95 respirators in preventing laboratory-confirmed viral infection and respiratory illness including coronavirus specifically in healthcare workers. DATA SOURCES MEDLINE, Embase, and CENTRAL from January 1, 2014, to March 9, 2020. Update of published search conducted from January 1, 1990, to December 9, 2014. STUDY SELECTION Randomized controlled trials (RCTs) comparing the protective effect of medical masks to N95 respirators in healthcare workers. DATA EXTRACTION Reviewer pair independently screened, extracted data, and assessed risk of bias and the certainty of the evidence. DATA SYNTHESIS Four RCTs were meta-analyzed adjusting for clustering. Compared with N95 respirators; the use of medical masks did not increase laboratory-confirmed viral (including coronaviruses) respiratory infection (OR 1.06; 95% CI 0.90-1.25; I2 = 0%; low certainty in the evidence) or clinical respiratory illness (OR 1.49; 95% CI: 0.98-2.28; I2 = 78%; very low certainty in the evidence). Only one trial evaluated coronaviruses separately and found no difference between the two groups (P = .49). LIMITATIONS Indirectness and imprecision of available evidence. CONCLUSIONS Low certainty evidence suggests that medical masks and N95 respirators offer similar protection against viral respiratory infection including coronavirus in healthcare workers during non-aerosol-generating care. Preservation of N95 respirators for high-risk, aerosol-generating procedures in this pandemic should be considered when in short supply.
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Affiliation(s)
- Jessica J. Bartoszko
- Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonONCanada
| | | | - Waleed Alhazzani
- Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonONCanada
- Department of MedicineDivision of Critical CareMcMaster UniversityHamiltonONCanada
| | - Mark Loeb
- Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonONCanada
- Department of Pathology and Molecular MedicineMcMaster UniversityHamiltonONCanada
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Bartoszko JJ, Farooqi MAM, Alhazzani W, Loeb M. Medical masks vs N95 respirators for preventing COVID-19 in healthcare workers: A systematic review and meta-analysis of randomized trials. Influenza Other Respir Viruses 2020. [PMID: 32246890 DOI: 10.1111/irv.v14.410.1111/irv.12745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Respiratory protective devices are critical in protecting against infection in healthcare workers at high risk of novel 2019 coronavirus disease (COVID-19); however, recommendations are conflicting and epidemiological data on their relative effectiveness against COVID-19 are limited. PURPOSE To compare medical masks to N95 respirators in preventing laboratory-confirmed viral infection and respiratory illness including coronavirus specifically in healthcare workers. DATA SOURCES MEDLINE, Embase, and CENTRAL from January 1, 2014, to March 9, 2020. Update of published search conducted from January 1, 1990, to December 9, 2014. STUDY SELECTION Randomized controlled trials (RCTs) comparing the protective effect of medical masks to N95 respirators in healthcare workers. DATA EXTRACTION Reviewer pair independently screened, extracted data, and assessed risk of bias and the certainty of the evidence. DATA SYNTHESIS Four RCTs were meta-analyzed adjusting for clustering. Compared with N95 respirators; the use of medical masks did not increase laboratory-confirmed viral (including coronaviruses) respiratory infection (OR 1.06; 95% CI 0.90-1.25; I2 = 0%; low certainty in the evidence) or clinical respiratory illness (OR 1.49; 95% CI: 0.98-2.28; I2 = 78%; very low certainty in the evidence). Only one trial evaluated coronaviruses separately and found no difference between the two groups (P = .49). LIMITATIONS Indirectness and imprecision of available evidence. CONCLUSIONS Low certainty evidence suggests that medical masks and N95 respirators offer similar protection against viral respiratory infection including coronavirus in healthcare workers during non-aerosol-generating care. Preservation of N95 respirators for high-risk, aerosol-generating procedures in this pandemic should be considered when in short supply.
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Affiliation(s)
- Jessica J Bartoszko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Waleed Alhazzani
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Mark Loeb
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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Scarano A, Inchingolo F, Lorusso F. Facial Skin Temperature and Discomfort When Wearing Protective Face Masks: Thermal Infrared Imaging Evaluation and Hands Moving the Mask. Int J Environ Res Public Health 2020; 17:E4624. [PMID: 32605056 DOI: 10.3390/ijerph17134624] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 12/16/2022]
Abstract
Individual respiratory protective devices and face masks represent critical tools in protecting health care workers in hospitals and clinics, and play a central role in decreasing the spread of the high-risk pandemic infection of 2019, coronavirus disease (COVID-19). The aim of the present study was to compare the facial skin temperature and the heat flow when wearing medical surgical masks to the same factors when wearing N95 respirators. A total of 20 subjects were recruited and during the evaluation, each subject was invited to wear a surgical mask or respirator for 1 h. The next day in the morning at the same hour, the same subject wore a N95 mask for 1 h with the same protocol. Infrared thermal evaluation was performed to measure the facial temperature of the perioral region and the perception ratings related to the humidity, heat, breathing difficulty, and discomfort were recorded. A significant difference in heat flow and perioral region temperature was recorded between the surgical mask and the N95 respirator (p < 0.05). A statistically significant difference in humidity, heat, breathing difficulty, and discomfort was present between the groups. The study results suggest that N95 respirators are able to induce an increased facial skin temperature, greater discomfort and lower wearing adherence when compared to the medical surgical masks.
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Kumar P, Chaudhry D, Parmar A, Tyagi D, Manjunath BG, Singh PK. Ultraviolet Box: An Innovative In-house Use of Ultraviolet Irradiation for Conservation of Respirators in COVID-19 Pandemic. Indian J Crit Care Med 2020; 24:713-715. [PMID: 33024381 PMCID: PMC7519598 DOI: 10.5005/jp-journals-10071-23534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/23/2022] Open
Abstract
Aim To use ultraviolet (UV) radiations in an indigenous method for sterilization of respirators for reuse during COVID-19 outbreak. Background COVID-19 outbreak has infected more than 200 countries. In India, till now, more than 100,000 cases have been reported. Healthcare workers are at high risk of developing infections being in the frontline of taking care of COVDI-19 cases. The demands of personal protective equipment (PPE) are increasing, but the same is not matched with supply due to various reasons. In such scenarios, reusing respirators and face shields is an alternative. UV radiations have quick action and are able to preserve the quality of respirators. We have developed a UV box for surface sterilization of respirators with an intention to reuse. Technique A thermocol box was taken from the central drug store and was fitted with two UV tubes of 254 nm wavelength procured from local service center of water purifiers. The position of the two tubes was such that one was near the base while other was fixed at the top. An aluminum mesh frame was placed in the middle of the box to act as a platform. The roof of the box was converted into a lid. The effectiveness of assembly was tested using culture of Escherichia coli and Staphylococcus aureus. In addition, a biological indicator tube containing test strip with spores of Bacillus atrophaeus was also exposed to UV light for a predefined duration, which did not show any color change after incubation for 48 hours. Conclusion Our prototype assembly with supported efficacy from microbiological tests is an option for use of UV light within available resources for disinfection and reuse of scarce supplies of personal protective equipment. Clinical significance UV box can help in meeting the demand supply deficit for respirators, face shields, and goggles that are paramount for the protection of HCW. How to cite this article Kumar P, Chaudhry D, Parmar A, Tyagi D, BG Manjunath, Singh PK. Ultraviolet Box: An Innovative In-house Use of Ultraviolet Irradiation for Conservation of Respirators in COVID-19 Pandemic. Indian J Crit Care Med 2020;24(8):713-715.
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Affiliation(s)
- Prashant Kumar
- Department of Anaesthesiology and Critical Care, Pt Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, Pt Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Aparna Parmar
- Department of Microbiology, Pt Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Diksha Tyagi
- Department of Pulmonary and Critical Care Medicine, Pt Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - B G Manjunath
- Department of Pulmonary and Critical Care Medicine, Pt Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Pawan Kumar Singh
- Department of Pulmonary and Critical Care Medicine, Pt Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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Choudhury A, Singh M, Khurana DK, Mustafi SM, Ganapathy U, Kumar A, Sharma S. Physiological Effects of N95 FFP and PPE in Healthcare Workers in COVID Intensive Care Unit: A Prospective Cohort Study. Indian J Crit Care Med 2020; 24:1169-1173. [PMID: 33446967 PMCID: PMC7775948 DOI: 10.5005/jp-journals-10071-23671] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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] [Indexed: 01/08/2023] Open
Abstract
Background Healthcare workers (HCWs) are at increased risk of exposure to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Personal protective equipment (PPE) is mandated for HCWs. However, the physiological effects on the HCWs while working in the protective gear remains unexplored. This study aimed to assess the physiological effects of the prolonged use of PPE on HCWs. Materials and methods Seventy-five HCWs, aged 18–50 years were enrolled in this prospective, observational, cohort study. The physiological variables [heart rate, oxygen saturation, and perfusion index (PI)] were recorded at the start of duty, 4 hours after wearing N95 filtering facepiece respirator (FFR), pre-donning, and post-doffing. The rating of perceived exertion (RPE) score and modified Borg scale for dyspnea was evaluated. The physiological variables were represented as the mean ± standard deviation. Wilcoxon signed-rank test was used to show any difference in RPE and modified Borg scale for dyspnea. A p value of <0.05 was considered significant. Results There is a statistically significant difference in the physiological parameters post-doffing compared with baseline: Heart rate (p < 0.001); oxygen saturation (p < 0.001); PI (p < 0.001). RPE score showed increased discomfort with continuous use of N95 FFR. However, exertion increased only marginally. The major adverse effects noted with PPE use were fogging, headache, tiredness, difficulty in breathing, and mask soakage, with a resultant mean duration of donning to be 3.1 hours. Conclusion The use of PPE can result in considerable changes in the physiological variables of healthy HCWs. The side effects may lead to excessive exhaustion and increased tiredness after prolonged shifts in the intensive care unit (ICU) while wearing PPE. How to cite this article Choudhury A, Singh M, Khurana DK, Mustafi SM, Ganapathy U, Kumar A, et al. Physiological Effects of N95 FFP and PPE in Healthcare Workers in COVID Intensive Care Unit: A Prospective Cohort Study. Indian J Crit Care Med 2020;24(12):1169–1173.
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Affiliation(s)
- Arin Choudhury
- Department of Anesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Meena Singh
- Department of Anaesthesiology, BPS Medical College for Women, Sonepat, Haryana, India
| | - Deepa Kerketta Khurana
- Department of Anesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Saurav Mitra Mustafi
- Department of Anesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Usha Ganapathy
- Department of Anesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ajay Kumar
- Department of Anesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Saumya Sharma
- Department of Ophthalmology, Sharp Sight Group of Eye Hospitals, New Delhi, India
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Jazani RK, Seyedmehdi SM, Kavousi A, Javazm ST. A Novel Questionnaire to Ergonomically Assess Respirators among Health Care Staff: Development and Validation. Tanaffos 2018; 17:257-263. [PMID: 31143216 PMCID: PMC6534796] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Health care workers are at a high risk of exposure to infectious diseases spread by airborne transmission. N95 respirators are the most common respirators used in the health care system and negligence in using them may cause health problems. Hence, more emphasis should be on ergonomic aspects of this mask. This study aimed to develop a tool for ergonomic evaluation of these respirators. MATERIALS AND METHODS After reviewing previous studies and employees' problems in the use of the N95 respirators, 50 questionnaires were designed and their validity was assessed. Then, the questionnaire was completed by 290 staff members of Masih Daneshvari Hospital and its internal consistency and reproducibility were investigated using Cronbach's alpha coefficient and test-retest method, respectively. Confirmatory factor analysis was used to assess its consistency and internal consistency (construct validity). RESULTS With the confirmation of the face and content validities, internal consistency (0.89) calculated by the Cronbach's alpha coefficient and reproducibility of the questionnaire (0.997; p<0.001) assessed by using the ICC Index, were approved. Following examining internal consistency and stability, the questionnaire convergent construct validity was also confirmed using confirmatory factor analysis. CONCLUSION The questionnaire contained 42 items and it is beneficial to use it in the health care system to evaluate the ergonomic problems of the respirators and to have optimal choice in this respect. Also, it can be used in the promotion of the staffs' behavior in wearing these respirators when necessary.
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Affiliation(s)
- Reza Khani Jazani
- School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Seyedmehdi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Kavousi
- School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somaye Tahernezhad Javazm
- School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Correspondence to: Tahernezhad Javazm S Address: School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email address:
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49
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Offeddu V, Yung CF, Low MSF, Tam CC. Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis. Clin Infect Dis 2018; 65:1934-1942. [PMID: 29140516 PMCID: PMC7108111 DOI: 10.1093/cid/cix681] [Citation(s) in RCA: 205] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/29/2017] [Indexed: 01/01/2023] Open
Abstract
This systematic review and meta-analysis quantified the protective effect of facemasks and respirators against respiratory infections among healthcare workers. Relevant articles were retrieved from Pubmed, EMBASE, and Web of Science. Meta-analyses were conducted to calculate pooled estimates. Meta-analysis of randomized controlled trials (RCTs) indicated a protective effect of masks and respirators against clinical respiratory illness (CRI) (risk ratio [RR] = 0.59; 95% confidence interval [CI]:0.46-0.77) and influenza-like illness (ILI) (RR = 0.34; 95% CI:0.14-0.82). Compared to masks, N95 respirators conferred superior protection against CRI (RR = 0.47; 95% CI: 0.36-0.62) and laboratory-confirmed bacterial (RR = 0.46; 95% CI: 0.34-0.62), but not viral infections or ILI. Meta-analysis of observational studies provided evidence of a protective effect of masks (OR = 0.13; 95% CI: 0.03-0.62) and respirators (OR = 0.12; 95% CI: 0.06-0.26) against severe acute respiratory syndrome (SARS). This systematic review and meta-analysis supports the use of respiratory protection. However, the existing evidence is sparse and findings are inconsistent within and across studies. Multicentre RCTs with standardized protocols conducted outside epidemic periods would help to clarify the circumstances under which the use of masks or respirators is most warranted.
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Affiliation(s)
- Vittoria Offeddu
- Saw Swee Hock School of Public Health, National University of Singapore
| | - Chee Fu Yung
- Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | | | - Clarence C Tam
- Saw Swee Hock School of Public Health, National University of Singapore.,London School of Hygiene & Tropical Medicine, London, United Kingdom
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50
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Tong PSY, Kale AS, Ng K, Loke AP, Choolani MA, Lim CL, Chan YH, Chong YS, Tambyah PA, Yong EL. Respiratory consequences of N95-type Mask usage in pregnant healthcare workers-a controlled clinical study. Antimicrob Resist Infect Control 2015; 4:48. [PMID: 26579222 PMCID: PMC4647822 DOI: 10.1186/s13756-015-0086-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 07/15/2015] [Accepted: 10/22/2015] [Indexed: 01/06/2023] Open
Abstract
Background Outbreaks of emerging infectious diseases have led to guidelines recommending the routine use of N95 respirators for healthcare workers, many of whom are women of childbearing age. The respiratory effects of prolonged respirator use on pregnant women are unclear although there has been no definite evidence of harm from past use. Methods We conducted a two-phase controlled clinical study on healthy pregnant women between 27 to 32 weeks gestation. In phase I, energy expenditure corresponding to the workload of routine nursing tasks was determined. In phase II, pulmonary function of 20 subjects was measured whilst at rest and exercising to the predetermined workload while breathing ambient air first, then breathing through N95-mask materials. Results Exercising at 3 MET while breathing through N95-mask materials reduced mean tidal volume (TV) by 23.0 % (95 % CI −33.5 % to −10.5 %, p < 0.001) and lowered minute ventilation (VE) by 25.8 % (95 % CI −34.2 % to −15.8 %, p < 0.001), with no significant change in breathing frequency compared to breathing ambient air. Volumes of oxygen consumption (VO2) and carbon dioxide expired (VCO2) were also significantly reduced; VO2 by 13.8 % (95 % CI −24.2 % to −3 %, p = 0.013) and VCO2 by 17.7 %, (95 % CI −28.1 % to −8.6 %, p = 0.001). Although no changes in the inspired oxygen and carbon dioxide concentrations were demonstrated, breathing through N95-mask materials during low intensity work (3 MET) reduced expired oxygen concentration by 3.2 % (95 % CI: −4.1 % to −2.2 %, p < 0.001), and increased expired carbon dioxide by 8.9 % (95 % CI: 6.9 % to 13.1 %; p <0.001) suggesting an increase in metabolism. There were however no changes in the maternal and fetal heart rates, finger-tip capillary lactate levels and oxygen saturation and rating of perceived exertion at the work intensity investigated. Conclusions Breathing through N95 mask materials have been shown to impede gaseous exchange and impose an additional workload on the metabolic system of pregnant healthcare workers, and this needs to be taken into consideration in guidelines for respirator use. The benefits of using N95 mask to prevent serious emerging infectious diseases should be weighed against potential respiratory consequences associated with extended N95 respirator usage. Trial Registration The study was registered at clinicaltrials.gov, identifier NCT00265926.
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Affiliation(s)
- Pearl Shuang Ye Tong
- Department of Obstetrics and Gynecology, National University Hospital, 11 Mandalay Road, Singapore, 308232 Singapore
| | - Anita Sugam Kale
- Department of Obstetrics and Gynecology, National University Hospital, 11 Mandalay Road, Singapore, 308232 Singapore
| | - Kailyn Ng
- Department of Obstetrics and Gynecology, National University Hospital, 11 Mandalay Road, Singapore, 308232 Singapore
| | - Amelia Peiwen Loke
- Department of Obstetrics and Gynecology, National University Hospital, 11 Mandalay Road, Singapore, 308232 Singapore
| | - Mahesh Arjandas Choolani
- Department of Obstetrics and Gynecology, National University Hospital, 11 Mandalay Road, Singapore, 308232 Singapore
| | - Chin Leong Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 11 Mandalay Road, Singapore, 308232 Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, National University of Singapore, Singapore, Republic of Singapore
| | - Yap Seng Chong
- Department of Obstetrics and Gynecology, National University Hospital, 11 Mandalay Road, Singapore, 308232 Singapore
| | - Paul Anantharajah Tambyah
- Medicine, National University of Singapore, 1E Kent Ridge Road, Level 12, Singapore, 119228 Singapore
| | - Eu-Leong Yong
- Medicine, National University of Singapore, 1E Kent Ridge Road, Level 12, Singapore, 119228 Singapore
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