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Takougang I, Lekeumo Cheuyem FZ, Ze BRS, Tsamoh FF, Moneboulou HM. Awareness of standard precautions, circumstances of occurrence and management of occupational exposures to body fluids among healthcare workers in a regional level referral hospital (Bertoua, Cameroon). BMC Health Serv Res 2024; 24:424. [PMID: 38570843 PMCID: PMC10993453 DOI: 10.1186/s12913-024-10855-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Healthcare workers (HCW) are exposed to infectious agents within biological materials including blood, tissues, other body fluids and on medical supplies, contaminated surfaces within the care delivery environment. Trends in occupational injuries are influenced by the level of awareness and observance of standard precautions (SP) among HCWs. This study aimed to assess the level of awareness of SP, exposure to body fluids, reporting pattern and management among HCWs in a Referral Hospital. METHODS The present hospital-based cross-sectional study was carried out from 1st November 2020 to 31st May 2021. The exhaustive sampling method was used and a total of 120 consenting HCWs were invited to participate. A self-administered questionnaire addressed questions related to knowledge, experience, circumstances of exposure, reporting, management of occupational exposure to body fluids, hepatitis B vaccination status. Data were analyzed using R Statistic version 4.3.1. A p-value < 0.05 was considered significant. RESULTS Out of the 120 participating HCWs, 104 (86.7%) reported at least one accidental exposure to body fluids over the last year. Men (aOR = 4.19; p = 0.277) and HCWs aged 35 and over (aOR = 4.11; p = 0.114) were more at risk for AEB even though the difference was not statistically significant. Nurses/midwives (aOR = 65.9; p-value = 0.0005) and cleaners (aOR = 14.7; p-value = 0.0438) faced the highest risk of exposure. Lack of knowledge (79%) and patient agitation (49%) were the most reported reasons for exposure. Half of the participants (53%) reported that they used a personal protective equipment during care. Face mask (59.2%) and gowns (30.8%) were the most commonly used PPE. Most HCWs (62%) did not report AEB. Half of the affected HCWs (50.8%) received a course of post-exposure antiretroviral therapy. Few HCWs (4.2%) were fully immunized against Hepatitis B. CONCLUSIONS Most HCWs reported an accidental exposure to body fluids over the last year. Midwives and nurses were disproportionally affected socio-professional groups. Two-thirds of the AEB were undeclared. Only half of the participants reported using PPE systematically. Hepatitis B vaccination coverage was low. There is need to strengthen the observance of standard precautions, including preventive vaccination and the systematic reporting and management of AEB.
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Affiliation(s)
- Innocent Takougang
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon.
| | - Fabrice Zobel Lekeumo Cheuyem
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
| | - Billy Ralph Sanding Ze
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
| | - Forlemu Fabiola Tsamoh
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
| | - Hortense Mengong Moneboulou
- Department of Odonto-Stomatology & Maxillofacial Surgery, Faculty of Medicine & Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
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Gund MP, Naim J, Rupf S, Gärtner B, Hannig M. Bacterial contamination potential of personal protective equipment itself in dental aerosol-producing treatments. Odontology 2024; 112:309-316. [PMID: 37702832 PMCID: PMC10925564 DOI: 10.1007/s10266-023-00848-3] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023]
Abstract
Personal protective equipment (PPE) has long been a high priority in dental aerosol-producing treatments. Since COVID-19 pandemic, its importance has increased yet again. While importance of PPE in preventing transmission and thus possible infection of pathogens is well known, contamination potential of PPE after treatment itself is less investigated. This review aims to give an overview of the current literature and contamination potential (viral, blood, bacterial) of components of protective equipment itself. The literature search was performed using the Medline database; furthermore, a hand search was conducted. Last search took place on 23 November 2022. Two categories of hygiene-related keywords were formed (category A: mask, face shield, goggles, eyewear, personal protective equipment; category B: contamination, aerosol). Each keyword from one category was combined with all keywords from the other one. In addition, the keyword "dental" was always added. First, a title and abstract screening was performed. Afterward, a full-text analysis was followed for the included studies. A total of 648 search hits were found in the Medline database. 47 were included after title and abstract screening. 22 studies were excluded after full-text analysis, 25 studies were included. The hand search resulted in 4 studies that were included. Bacterial contamination of PPE after treatment has been adequately studied, contamination with blood less. Microorganisms mainly originate from the oral and cutaneous flora; however, a transmission of potential pathogens like Staphylococcus aureus or Escherichia coli was also described. Studies showing transmission pathways starting from PPE and its various components are lacking. No measures have yet been described that fully protect the protective equipment from contamination. There is growing awareness that PPE itself can be a source of pathogen transmission, and thus possible infection. Therefore, not only wearing of protective clothing, but also conscious handling of it is crucial for transmission and possible infection prevention. However, studies showing transmission pathways starting from PPE and its various components are lacking. Several studies have investigated what measures can be taken to protect the protective equipment itself. So far, none of the methods evaluated can prevent contamination of PPE.
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Affiliation(s)
- Madline Priska Gund
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Clinic of Operative Dentistry, Saarland University Hospital, Saarland University, Kirrberger Str. 100, Building 73, 66421, Homburg, Saar, Germany.
| | - Jusef Naim
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Clinic of Operative Dentistry, Saarland University Hospital, Saarland University, Kirrberger Str. 100, Building 73, 66421, Homburg, Saar, Germany
| | - Stefan Rupf
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Clinic of Operative Dentistry, Saarland University Hospital, Saarland University, Kirrberger Str. 100, Building 73, 66421, Homburg, Saar, Germany
- Chair of Synoptic Dentistry, Homburg, Germany
| | - Barbara Gärtner
- Institute of Medical Microbiology and Hygiene, Department of Hospital Hygiene, Saarland University, Homburg, Germany
| | - Matthias Hannig
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Clinic of Operative Dentistry, Saarland University Hospital, Saarland University, Kirrberger Str. 100, Building 73, 66421, Homburg, Saar, Germany
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Lee DU, Jeong SB, Lee BJ, Park SK, Kim HM, Shin JH, Lee SY, Kim G, Park J, Kim GM, Jung JH, Choi DY. Antimicrobial and Antifouling Effects of Petal-Like Nanostructure by Evaporation-Induced Self-Assembly for Personal Protective Equipment. Small 2024; 20:e2306324. [PMID: 37990401 DOI: 10.1002/smll.202306324] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/19/2023] [Indexed: 11/23/2023]
Abstract
Although the personal protective equipment (PPE) used by healthcare workers (HCWs) effectively blocks hazardous substances and pathogens, it does not fully rule out the possibility of infection, as pathogens surviving on the fabric surface pose a substantial risk of cross-infection through unintended means. Therefore, PPE materials that exhibit effective biocidal activity while minimizing contamination by viscous body fluids (e.g., blood and saliva) and pathogen-laden droplets are highly sought. In this study, petal-like nanostructures (PNSs) are synthesized through the vertical rearrangement of colloidal lamellar bilayers via evaporation-induced self-assembly of octadecylamine, silica-alumina sol, and diverse photosensitizer. The developed method is compatible with various fabrics and imparts visible-light-activated antimicrobial and superhydrophobic-based antifouling activities. PNS-coated fabrics could provide a high level of protection and effectively block pathogen transmission as exemplified by their ability to roll off viscous body fluids reducing bacterial droplet adhesion and to inactivate various microorganisms. The combination of antifouling and photobiocidal activities results in the complete inactivation of sprayed pathogen-laden droplets within 30 min. Thus, this study paves the way for effective contagious disease management and the protection of HCWs in general medical environments, inspiring further research on the fabrication of materials that integrate multiple useful functionalities.
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Affiliation(s)
- Dong Uk Lee
- Biomedical Manufacturing Technology Center, Korea Institute of Industrial Technology, Yeongcheon, 38822, Republic of Korea
| | - Sang Bin Jeong
- Indoor Environment Center, Korea Testing Laboratory, Seoul, 08389, Republic of Korea
- Department of Mechanical Engineering, Sejong University, Seoul, 05006, Republic of Korea
| | - Byeong Jin Lee
- Biomedical Manufacturing Technology Center, Korea Institute of Industrial Technology, Yeongcheon, 38822, Republic of Korea
- School of Mechanical Engineering, Kyungpook National University, Daegu, 41566, Republic of Korea
| | - Se Kye Park
- Biomedical Manufacturing Technology Center, Korea Institute of Industrial Technology, Yeongcheon, 38822, Republic of Korea
| | - Hyoung-Mi Kim
- Biomedical Manufacturing Technology Center, Korea Institute of Industrial Technology, Yeongcheon, 38822, Republic of Korea
| | - Jae Hak Shin
- Department of Mechanical Engineering, Sejong University, Seoul, 05006, Republic of Korea
| | - Seung Yeon Lee
- Department of Mechanical Engineering, Sejong University, Seoul, 05006, Republic of Korea
| | - Gunwoo Kim
- Biomedical Manufacturing Technology Center, Korea Institute of Industrial Technology, Yeongcheon, 38822, Republic of Korea
| | - Junghun Park
- Biomedical Manufacturing Technology Center, Korea Institute of Industrial Technology, Yeongcheon, 38822, Republic of Korea
| | - Gyu Man Kim
- School of Mechanical Engineering, Kyungpook National University, Daegu, 41566, Republic of Korea
| | - Jae Hee Jung
- Department of Mechanical Engineering, Sejong University, Seoul, 05006, Republic of Korea
| | - Dong Yun Choi
- Biomedical Manufacturing Technology Center, Korea Institute of Industrial Technology, Yeongcheon, 38822, Republic of Korea
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Haas EJ, Kelly-Reif K, Edirisooriya M, Reynolds L, Beatty Parker CN, Zhu D, Weber DJ, Sickbert-Bennett E, Boyce RM, Ciccone EJ, Aiello AE. Infection precaution adherence varies by potential exposure risks to SARS-CoV-2 and job role: Findings from a US medical center. Am J Infect Control 2024; 52:381-386. [PMID: 38069921 DOI: 10.1016/j.ajic.2023.10.010] [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: 06/02/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND Infection precautions (IP) facilitate standardized and safe patient care. Research has demonstrated several barriers to IP adherence among health care personnel (HCP) but potential exposure risk to SARS-CoV-2 and job role has not been considered. METHODS Researchers used self-reported baseline surveys with 191 HCPs at a university medical center to examine factors that may have affected IP adherence (eg, personal protective equipment [PPE] and hand hygiene errors) over the 2 weeks prior to the survey. Chi-square tests were used to determine if differences existed first, among job role and IP adherence, and second, the potential risk of exposure to SARS-CoV-2 and IP adherence. A binary logistic regression estimated if PPE nonadherence was associated with COVID-19 stress, job role, and potential exposure risk to SARS-CoV-2. RESULTS PPE nonadherence varied by job role. Those in the Other group (ie, nonphysician/non-nursing HCP) reported significantly fewer errors (9.6%) compared to Physicians (26.5%) and Registered Nurses (33.3%). Hand/glove hygiene errors between COVID-19 patient rooms varied by job role. Respondents who had higher risks of exposure to SARS-CoV-2 were 5.74 times more likely to experience errors. CONCLUSIONS The results provide implications for adopting systems-level approaches to support worker knowledge and engagement across job roles to improve IP adherence.
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Affiliation(s)
- Emily J Haas
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Pittsburgh, PA.
| | - Kaitlin Kelly-Reif
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Mihili Edirisooriya
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Pittsburgh, PA
| | - Laura Reynolds
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV
| | - Cherese N Beatty Parker
- Department of Epidemiology and Robert N. Butler Columbia Aging Center, Columbia University, New York, NY
| | - Deanna Zhu
- Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
| | - David J Weber
- Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Emily Sickbert-Bennett
- Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Ross M Boyce
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Emily J Ciccone
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Allison E Aiello
- Department of Epidemiology and Robert N. Butler Columbia Aging Center, Columbia University, New York, NY
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Hazell LJ, Stork LA. Radiographer experiences of personal protective equipment during COVID-19 in Gauteng, South Africa. J Med Imaging Radiat Sci 2024; 55:61-66. [PMID: 38172010 DOI: 10.1016/j.jmir.2023.12.002] [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: 10/22/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Amidst the COVID-19 pandemic, healthcare workers (HCWs) were found to be at a greater risk of becoming infected with severe acute respiratory syndrome (SARS-CoV-2). This disease is highly contagious and is for the most part preventative if correct Personal Protective Equipment (PPE) is used while attending to patients. Subsequently, a lack of PPE in South Africa was putting the lives of health care workers at risk impacting on the functioning of the healthcare system. METHODS This exploratory, descriptive, qualitative study used purposeful sampling to obtain data saturation. The study comprised twelve individual interviews with radiographers from both private and government hospitals in Gauteng, South Africa who worked in x-ray departments during the COVID-19 pandemic. Online video interviews were conducted. The transcripts of the interviews were further coded into themes and categorised using thematic analysis and verified by an independent coder. RESULTS The radiographers' experiences of PPE during COVID-19 in Gauteng, South Africa generated 3 themes: radiographers' experiences with PPE supplied during COVID-19, workplace practices and procedures for PPE during COVID-19 and emotional challenges faced during PPE shortage. DISCUSSION While there was an understandable fear of contracting the COVID-19 virus during the height of the pandemic. The researcher also believes that radiographers would benefit greatly by receiving training on how to use PPE correctly for infection control in highly stressful situations. Education is required for use of PPE when supply is scarce and the number of infected patients outweighs the quantities of PPE available. This study further found that there needs to be more support given to healthcare workers (HCW's) to assess their mental health and emotional stress experienced when facing a pandemic. CONCLUSION While COVID-19 has started to settle, the lessons learnt should inform recommendations on PPE use, regarding procurement and preservation. In addition, mental health assessments can be considered for radiographers during future pandemic.
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Affiliation(s)
| | - Laura Amy Stork
- University of Johannesburg Doornfontein, Johannesburg, Gauteng, South Africa
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Pratt AA, Brown GD, Perencevich EN, Diekema DJ, Nonnenmann MW. Comparison of virus aerosol concentrations across a face shield worn on a healthcare personnel during a simulated patient cough. Infect Control Hosp Epidemiol 2024; 45:221-226. [PMID: 37609833 DOI: 10.1017/ice.2023.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Patients diagnosed with coronavirus disease 2019 (COVID-19) aerosolize severe acute respiratory coronavirus virus 2 (SARS-CoV-2) via respiratory efforts, expose, and possibly infect healthcare personnel (HCP). To prevent transmission of SARS-CoV-2 HCP have been required to wear personal protective equipment (PPE) during patient care. Early in the COVID-19 pandemic, face shields were used as an approach to control HCP exposure to SARS-CoV-2, including eye protection. METHODS An MS2 bacteriophage was used as a surrogate for SARS-CoV-2 and was aerosolized using a coughing machine. A simulated HCP wearing a disposable plastic face shield was placed 0.41 m (16 inches) away from the coughing machine. The aerosolized virus was sampled using SKC biosamplers on the inside (near the mouth of the simulated HCP) and the outside of the face shield. The aerosolized virus collected by the SKC Biosampler was analyzed using a viability assay. Optical particle counters (OPCs) were placed next to the biosamplers to measure the particle concentration. RESULTS There was a statistically significant reduction (P < .0006) in viable virus concentration on the inside of the face shield compared to the outside of the face shield. The particle concentration was significantly lower on the inside of the face shield compared to the outside of the face shield for 12 of the 16 particle sizes measured (P < .05). CONCLUSIONS Reductions in virus and particle concentrations were observed on the inside of the face shield; however, viable virus was measured on the inside of the face shield, in the breathing zone of the HCP. Therefore, other exposure control methods need to be used to prevent transmission from virus aerosol.
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Affiliation(s)
- Alessandra A Pratt
- University of Iowa, Department of Occupational and Environmental Health, Iowa City, Iowa
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
| | - Grant D Brown
- Department of Biostatistics, University of Iowa, Iowa City, Iowa
| | - Eli N Perencevich
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Daniel J Diekema
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Department of Medicine, Maine Medical Center, PortlandMaine
| | - Matthew W Nonnenmann
- Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, Nebraska
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Buratti CR, Veillette M, Bridier A, Aubin CE, Lebrun M, Ammaiyappan AK, Vanoli E, Crawford C, Duchaine C, Jouvet P. Effectiveness of SplashGuard Caregiver prototype in reducing the risk of aerosol transmission in intensive care unit rooms of SARS-CoV-2 patients: a prospective and simulation study. J Hosp Infect 2024; 144:75-84. [PMID: 38040038 DOI: 10.1016/j.jhin.2023.11.007] [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: 09/06/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND The contagiousness of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is known to be linked to the emission of bioaerosols. Thus, aerosol-generating procedures (AGPs) could increase the risk of infection among healthcare workers (HCWs). AIM To investigate the impact of an aerosol protection box, the SplashGuard Caregiver (SGGC) with suction system, by direct analysis of the presence of viral particles after an AGP, and by using the computational fluid dynamics (CFD) simulation method. METHODS This prospective observational study investigated HCWs caring for patients with SARS-CoV-2 admitted to an intensive care unit (ICU). Rooms were categorized as: SGCG present and SGCG absent. Virus detection was performed through direct analysis, and using a CFD model to simulate the movement dynamics of airborne particles produced by a patient's respiratory activities. FINDINGS Of the 67 analyses performed, three samples tested positive on quantitative polymerase chain reaction: one of 33 analyses in the SCCG group (3%) and two of 34 analyses in the non-SGCG group (5.9%). CFD simulations showed that: (1) reduction of the gaps of an SGCG could decrease the number of emitted particles remaining airborne within the room by up to 70%; and (2) positioning HCWs facing the opposite direction to the main air flow would reduce their exposure. CONCLUSIONS This study documented the presence of SARS-CoV-2 among HCWs in a negative pressure ICU room of an infected patient with or without the use of an SGCG. The simulation will help to improve the design of the SGCG and the positioning of HCWs in the room.
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Affiliation(s)
- C R Buratti
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital da Criança Santo Antônio, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - M Veillette
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada
| | - A Bridier
- Paediatric Intensive Care, Department of Paediatrics, Purpan Hospital, University of Toulouse, Toulouse, France
| | - C E Aubin
- Polytechnique Montreal, University Hospital Centre Sainte-Justine, Montréal, Québec, Canada
| | - M Lebrun
- Dassault Systèmes Simulia Corporation, Vélizy-Villacoublay, France
| | | | - E Vanoli
- Dassault Systèmes Simulia Corporation, Vélizy-Villacoublay, France
| | - C Crawford
- Dassault Systèmes Simulia Corporation, Vélizy-Villacoublay, France
| | - C Duchaine
- Université Laval, Québec, Québec, Canada
| | - P Jouvet
- Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital Centre Sainte-Justine, Montréal, Québec, Canada.
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Çakar V, Karadağ A, Bugan B, Kılıç H, Demir AS. Personal Protective Equipment-Related Problems Experienced by Healthcare Workers, Solutions, and Recommendations: A Qualitative Study. Adv Skin Wound Care 2023; 36:1-9. [PMID: 37861670 DOI: 10.1097/asw.0000000000000059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To understand the problems experienced by healthcare workers (HCWs) who used personal protective equipment (PPE) on their face during the COVID-19 pandemic, their interventions to prevent these problems, and their recommendations for improving the quality of PPE. METHODS This descriptive and qualitative study included HCWs (N = 29) from health institutions at different levels in Turkey. Researchers collected data using a semistructured data collection form (13 items) and in-depth individual interviews. Data were analyzed with descriptive statistics and qualitative inductive content analysis. RESULTS Of the 29 participants, 15 (51.7%) were women, and 18 (62.1%) were nurses. Participants' answers regarding problems related to PPE use were grouped into four main categories, answers regarding the prevention of these problems were grouped into three main categories, and answers regarding improving the quality of PPE were grouped into three main categories. Skin concerns were the most commonly reported problems related to PPE, and interventions to prevent these problems primarily related to skin protection and care. Recommendations to improve the quality of PPE focused on using materials for masks and face shields that reduce pressure and friction; participants also suggested that face shields be produced in sterile and disposable packages. CONCLUSIONS This research indicates that HCWs need support and they are able to create individual solutions for the problems with PPE that they experience. Skin-friendly PPE that ensures the safety and comfort of HCWs should be produced, and hospitals should develop policies for institutional use to prevent PPE injury.
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Affiliation(s)
- Vildan Çakar
- Vildan Çakar, PhD, is Assistant Professor, Department of Nursing, School of Health Sciences, Istanbul Medipol University, Istanbul, Turkey. Ayişe Karadağ, PhD, ET/WOCN, is Professor, School of Nursing, Koç University, Istanbul, Turkey. Berna Bugan, BSN, is Staff Nurse, Koç University Hospital. Havanur Kılıç, BSN, and Ayşe Sılanur Demir, BSN, are Research Assistants and PhD Students, Graduate School of Health Sciences, Koç University. Acknowledgment : The authors thank the voluntary participants of the study. The authors have disclosed no financial relationships related to this article. Submitted March 23, 2022; accepted in revised form August 18, 2022
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Affiliation(s)
- Laura A Graham
- Stanford University, School of Medicine, Stanford, California
- VA Palo Alto Healthcare System, Palo Alto, California
| | - Yvonne A Maldonado
- Stanford University, School of Medicine, Stanford, California
- Stanford Health Care and Lucile Packard Children's Hospital, Stanford, California
| | - Lucy S Tompkins
- Stanford University, School of Medicine, Stanford, California
| | - Samuel H Wald
- Stanford University, School of Medicine, Stanford, California
| | - Amanda Chawla
- Stanford Health Care and Lucile Packard Children's Hospital, Stanford, California
| | - Mary T Hawn
- Stanford University, School of Medicine, Stanford, California
- VA Palo Alto Healthcare System, Palo Alto, California
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Fortin G, Saucier A, Munoz-Bertrand M, Yuan M, Ante Z, Narasiah L, Zinszer K. Portrait of Montréal healthcare workers infected with SARS-CoV-2 during the first wave of the pandemic: a cross-sectional study. Can J Public Health 2023; 114:534-546. [PMID: 37410364 PMCID: PMC10351277 DOI: 10.17269/s41997-023-00789-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 05/23/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES During the first wave of COVID-19 in Québec, healthcare workers (HCWs) represented 25% of the cases in Montréal. A study was conducted to describe SARS-CoV-2-infected HCWs in Montréal, and certain workplace and household characteristics. Secondary objectives included estimating the associations between having had access to personal protective equipment (PPE) and training, and following self-isolation recommendations, and certain sociodemographic and workplace characteristics. METHODS A cross-sectional study was conducted, based on a stratified random sample, among Montréal HCWs who tested positive for SARS-CoV-2 between March and July 2020. A total of 370 participants answered a telephone-administered questionnaire. Descriptive statistics were conducted, followed by log binomial regressions to estimate the associations. RESULTS Study participants were mostly female (74%), born outside of Canada (65%), and identified as Black, Indigenous, and People of Colour (BIPOC; 63%). In terms of healthcare positions, most were orderlies (40%) or registered nurses (20%). Half (52%) of the participants reported having had insufficient access to PPE and 30% reported having received no training related to SARS-CoV-2 infection prevention, with large proportions being BIPOC women. Working evening or night shifts decreased chances of having had sufficient access to PPE (OR 0.50; 0.30-0.83). CONCLUSION This study describes the profile of the HCWs who were infected during the first wave of the pandemic in Montréal. Recommendations include collecting comprehensive sociodemographic data on SARS-CoV-2 infections and ensuring equitable access to infection prevention and control training and PPE during health crises, particularly those at highest risk of exposure.
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Affiliation(s)
- Geneviève Fortin
- École de Santé Publique, Université de Montréal, Montréal, QC, Canada.
- Centre de Recherche en Santé Publique (CReSP), Montréal, QC, Canada.
| | - Adrien Saucier
- École de Santé Publique, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, QC, Canada
| | - Marie Munoz-Bertrand
- Direction Régionale de Santé Publique de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Mengru Yuan
- École de Santé Publique, Université de Montréal, Montréal, QC, Canada
| | | | - Lavanya Narasiah
- Direction Régionale de Santé Publique de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Kate Zinszer
- École de Santé Publique, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, QC, Canada
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11
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Plachouras D, Kacelnik O, Rodríguez-Baño J, Birgand G, Borg MA, Kristensen B, Kubele J, Lyytikäinen O, Presterl E, Reilly J, Voss A, Zingg W, Suetens C, Monnet DL. Revisiting the personal protective equipment components of transmission-based precautions for the prevention of COVID-19 and other respiratory virus infections in healthcare. Euro Surveill 2023; 28:2200718. [PMID: 37561052 PMCID: PMC10416576 DOI: 10.2807/1560-7917.es.2023.28.32.2200718] [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: 08/30/2022] [Accepted: 05/10/2023] [Indexed: 08/11/2023] Open
Abstract
The COVID-19 pandemic highlighted some potential limitations of transmission-based precautions. The distinction between transmission through large droplets vs aerosols, which have been fundamental concepts guiding infection control measures, has been questioned, leading to considerable variation in expert recommendations on transmission-based precautions for COVID-19. Furthermore, the application of elements of contact precautions, such as the use of gloves and gowns, is based on low-quality and inconclusive evidence and may have unintended consequences, such as increased incidence of healthcare-associated infections and spread of multidrug-resistant organisms. These observations indicate a need for high-quality studies to address the knowledge gaps and a need to revisit the theoretical background regarding various modes of transmission and the definitions of terms related to transmission. Further, we should examine the implications these definitions have on the following components of transmission-based precautions: (i) respiratory protection, (ii) use of gloves and gowns for the prevention of respiratory virus infections, (iii) aerosol-generating procedures and (iv) universal masking in healthcare settings as a control measure especially during seasonal epidemics. Such a review would ensure that transmission-based precautions are consistent and rationally based on available evidence, which would facilitate decision-making, guidance development and training, as well as their application in practice.
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Affiliation(s)
| | | | - Jesús Rodríguez-Baño
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases and Microbiology division, Hospital Universitario Virgen Macarena and Department of Medicine, University of Seville/CSIC, Biomedicine Institute of Seville, Seville, Spain
| | - Gabriel Birgand
- Health Protection Research Unit, Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, United Kingdom
- Regional Centre for Infection Prevention and Control, Region of Pays de la Loire, Nantes, France
| | - Michael A Borg
- Infection Control Department, Mater Dei Hospital, Msida, Malta
| | | | - Jan Kubele
- Clinical Microbiology and ATB centre, Na Homolce Hospital, Prague, Czechia
| | | | - Elisabeth Presterl
- Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria
| | - Jacqui Reilly
- Research Centre for Health, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Andreas Voss
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, Groningen, the Netherlands
| | - Walter Zingg
- Charité Universitätsmedizin, Berlin, Germany
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Carl Suetens
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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12
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张 慧, 康 豪, 罗 红, 朱 京, 游 建. [Practical Application of Body Mechanics Principles in the Process of Health Workers Doffing Personal Protective Equipment]. Sichuan Da Xue Xue Bao Yi Xue Ban 2023; 54:798-803. [PMID: 37545077 PMCID: PMC10442625 DOI: 10.12182/20230760102] [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] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Indexed: 08/08/2023]
Abstract
Objective To examine the application effect of body mechanics principles in the process of health workers doffing personal protective equipment (PPE). Methods A total of 360 health workers from a Fangcang shelter hospital, also known as alternate care site, in Shanghai were involved in a centralized 1-day training concerning essential skills for taking off PPE. The training was focused on integrating body mechanics principles, including expanding the support surface, lowering the center of gravity, reducing the shift in the the center of gravity, using the principle of leverage, and creating the appropriate operating space, in the PPE doffing process. Through remote video monitoring and recording, observations were made of the physical stability, pollution risks, and operational smoothness of the health workers when they applied body mechanics principles in their actions. Results The results of binary logistic regression showed that, compared with the actions taken without applying body mechanics principles, performing the operation of the body leaning forward and then slightly leaning backward was positively correlated with stability in the doffing process (odds ratio [O R]=3.291, 95% confidence interval [ CI]: 1.627-6.656), negatively correlated with pollution risks ( OR=0.203, 95% CI: 0.100-0.412), and positively correlated with operational smoothness ( OR=20.847, 95% CI: 8.061-53.916); performing the operation of taking off the boot sleeve in a horse-riding stance, with one foot standing ahead of the other, was positively correlated with stability ( OR=5.299, 95% CI: 1.041-26.957), negatively correlated with pollution risks ( OR=0.079, 95% CI: 0.009-0.692), and positive correlated with operational smoothness ( OR=16.729, 95% CI: 1.238-226.077); performing the operation of taking off the boot sleeve by lifting the heel and then the toes was positively correlated with stability ( OR=19.361, 95% CI: 8.391-44.671), negatively correlated with pollution risks ( OR=0.181, 95% CI: 0.084-0.393), and positively correlated with operational smoothness ( OR=10.977, 95% CI: 3.764-32.008); performing the operation of the leaning forward and keeping the face looking forward when taking off the mask was positively correlated with stability ( OR=2.935, 95% CI: 1.412-6.101), negatively correlated with pollution risks ( OR=0.123, 95% CI: 0.059-0.258), and positively correlated with operational smoothness ( OR=18.126, 95% CI: 6.665-49.297). Conclusion In the process of medical staffs doffing PPE, correct and proper mechanical postures and actions can effectively assist medical staffs to maintain balance and stability and reduce the risks of infection, which has major significance and should be widely incorporated in personal protection skills training and applied in clinical practice.
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Affiliation(s)
- 慧兰 张
- 陆军军医大学第一附属医院 感染病科 (重庆 400038)Department of Infectious Diseases, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - 豪 康
- 陆军军医大学第一附属医院 感染病科 (重庆 400038)Department of Infectious Diseases, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - 红霞 罗
- 陆军军医大学第一附属医院 感染病科 (重庆 400038)Department of Infectious Diseases, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - 京慈 朱
- 陆军军医大学第一附属医院 感染病科 (重庆 400038)Department of Infectious Diseases, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - 建平 游
- 陆军军医大学第一附属医院 感染病科 (重庆 400038)Department of Infectious Diseases, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
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13
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Alghader MRM, Valvi D, de la Hoz RE. Transmission and Risk Factors of COVID-19 among Health Care Workers. Semin Respir Crit Care Med 2023; 44:340-348. [PMID: 37015285 DOI: 10.1055/s-0043-1766118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) poses a significant occupational risk factor to health care workers (HCWs). As in previous events, this occupational risk amplifies and compounds the adverse impact of the pandemic. We conducted a narrative review summarizing risk factors associated with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) transmission in HCWs. We searched for original observational studies (including case-control, cross-sectional, prospective and retrospective cohorts) using PubMed, Scopus, and Google Scholar. A total of 22 articles were reviewed, including eligible English articles published between April 2020 and May 2022. Job category, work environment, personal protective equipment (PPE) noncompliance, lack of PPE awareness and training, unvaccinated status, and competing community and household exposures were identified as risk factors for SARS-CoV-2 transmission among HCWs. Effective measures to protect HCWs from SARS-CoV-2 need to account for the identified occupational risk factors. Identifying and understanding COVID-19 risk factors among HCWs must be considered a public health priority for policy makers to mitigate occupational and community transmission in current and future epidemics.
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Affiliation(s)
- Majdi R M Alghader
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Damaskini Valvi
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rafael E de la Hoz
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
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14
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Galván-Ramírez MDLL, Preciado-Serrano MDL, Gallegos-Bonifaz M. The Impact of Biosecurity on Biological and Psychosocial Risks for Health Workers of COVID Hospitals in Guadalajara, Jalisco, Mexico. Int J Environ Res Public Health 2023; 20:858. [PMID: 36613180 PMCID: PMC9819450 DOI: 10.3390/ijerph20010858] [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] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Some data support that health care workers (HCWs) must have sufficient and good quality personal protective equipment (PPE) and the necessary training to manage COVID patients to avoid contagion that can lead to death. The objective of this study was to determine the relationship between biosafety on the biological risks of SARS-CoV-2 and risks of fatigue, anxiety, or depression in health workers who care for patients in COVID hospitals, from September 2020 to August 2021. MATERIAL AND METHODS The questionnaire used in this study (Q6S64I) consisted of 6 spheres: Sociodemographic aspects, working conditions; Personal Protection Equipment; safety and health; training and knowledge about COVID-19, the form of transport, and personal health conditions. The answers were online. The Goldberg questionnaire (EADG) measures anxiety and depression, and the questionnaire measures fatigue (Barrientos-Gutiérrez et al.) (PSSF). RESULTS In total, 76.5% of the HCWs were doctors, 25.2% worked in the emergency services, 79.3% received PPE from their institution, 82.9% cared for COVID-19 patients, and 27.9% tested positive for COVID-19. The PPE provided by the employer was 80%, but the quality was deficient, insufficient, and associated with a relative risk of 4.6. A total of 99% acquired better PPE on their own. The exposure to COVID-19 and the surgical mask provided by the institution had an associated relative risk of 2.8 for the HCWs. A total of 39% of the HCWs reported being calm. CONCLUSIONS PPE, risk exposure, and safety at work were significantly associated with drowsiness and heaviness, difficulty concentrating, anxiety, and depression.
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Affiliation(s)
- María de la Luz Galván-Ramírez
- Department of Microbiology Pathology, Centro Universitario de Ciencias de la Salud Universidad de Guadalajara, Sierra Mojada 950 Colonia Independencia, Guadalajara 44340, Mexico
| | - María de Lourdes Preciado-Serrano
- Department of Public Health, Centro Universitario de Ciencias de la Salud Universidad de Guadalajara, Sierra Mojada 950 Colonia Independencia, Guadalajara 44340, Mexico
| | - Mildred Gallegos-Bonifaz
- Department of Public Health, Centro Universitario de Ciencias de la Salud Universidad de Guadalajara, Sierra Mojada 950 Colonia Independencia, Guadalajara 44340, Mexico
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15
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Waring MS, Lo LJ, Kohanski MA, Kahle E, Marcus IM, Smith H, Spiller KL, Walker SL. Design and quantitative evaluation of 'Aerosol Bio-Containment Device (ABCD)' for reducing aerosol exposure during infectious aerosol-generating events. PLoS One 2023; 18:e0272716. [PMID: 36608021 PMCID: PMC9821519 DOI: 10.1371/journal.pone.0272716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/25/2022] [Indexed: 01/07/2023] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic renewed interest in infectious aerosols and reducing risk of airborne respiratory pathogen transmission, prompting development of devices to protect healthcare workers during airway procedures. However, there are no standard methods for assessing the efficacy of particle containment with these protective devices. We designed and built an aerosol bio-containment device (ABCD) to contain and remove aerosol via an external suction system and tested the aerosol containment of the device in an environmental chamber using a novel, quantitative assessment method. The ABCD exhibited a strong ability to control aerosol exposure in experimental and computational fluid dynamic (CFD) simulated scenarios with appropriate suction use and maintenance of device seals. Using a log-risk-reduction framework, we assessed device containment efficacy and showed that, when combined with other protective equipment, the ABCD can significantly reduce airborne clinical exposure. We propose this type of quantitative analysis serves as a basis for rating efficacy of aerosol protective enclosures.
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Affiliation(s)
- Michael S. Waring
- Department of Civil, Architectural and Environmental Engineering, Drexel University, Philadelphia, PA, United States of America
- * E-mail:
| | - L. James Lo
- Department of Civil, Architectural and Environmental Engineering, Drexel University, Philadelphia, PA, United States of America
| | - Michael A. Kohanski
- Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Elizabeth Kahle
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, United States of America
| | - Ian M. Marcus
- Department of Civil, Architectural and Environmental Engineering, Drexel University, Philadelphia, PA, United States of America
| | - Heather Smith
- Life Sciences Department, Riverside City College, Riverside, CA, United States of America
| | - Kara L. Spiller
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, United States of America
| | - Sharon L. Walker
- Department of Civil, Architectural and Environmental Engineering, Drexel University, Philadelphia, PA, United States of America
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16
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Knobloch JK, Popp W, Exner M, Walger P, Kampf G. An FFP2 respirator mandate for healthcare workers to prevent transmission of SARS-CoV-2 lacks proportionality. J Hosp Infect 2022; 130:146-147. [PMID: 36150562 PMCID: PMC9487173 DOI: 10.1016/j.jhin.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022]
Affiliation(s)
- J K Knobloch
- Institute for Medical Microbiology, Virology and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - W Popp
- HyKoMed GmbH, Dortmund, Germany
| | - M Exner
- German Society of Hospital Hygiene, Berlin, Germany
| | - P Walger
- German Society of Hospital Hygiene, Berlin, Germany
| | - G Kampf
- University Medicine Greifswald, Greifswald, Germany.
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17
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Abstract
Two and a half years after the emergence of the COVID-19 pandemic, Loeb and colleagues reported the first randomized trial of N95 respirators versus medical masks in health care workers. The editorialist discusses the findings and highlights remaining areas of uncertainty about optimal mask type.
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Affiliation(s)
- Roger Chou
- Oregon Health & Science University, Portland, Oregon
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18
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Mac Giolla Eain M, Cahill R, MacLoughlin R, Nolan K. Aerosol release, distribution, and prevention during aerosol therapy: a simulated model for infection control. Drug Deliv 2022; 29:10-17. [PMID: 34962221 PMCID: PMC8725970 DOI: 10.1080/10717544.2021.2015482] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 10/24/2022] Open
Abstract
Aerosol therapy is used to deliver medical therapeutics directly to the airways to treat respiratory conditions. A potential consequence of this form of treatment is the release of fugitive aerosols, both patient derived and medical, into the environment and the subsequent exposure of caregivers and bystanders to potential viral infections. This study examined the release of these fugitive aerosols during a standard aerosol therapy to a simulated adult patient. An aerosol holding chamber and mouthpiece were connected to a representative head model and breathing simulator. A combination of laser and Schlieren imaging was used to non-invasively visualize the release and dispersion of fugitive aerosol particles. Time-varying aerosol particle number concentrations and size distributions were measured with optical particle sizers at clinically relevant positions to the simulated patient. The influence of breathing pattern, normal and distressed, supplemental air flow, at 0.2 and 6 LPM, and the addition of a bacterial filter to the exhalation port of the mouthpiece were assessed. Images showed large quantities of fugitive aerosols emitted from the unfiltered mouthpiece. The images and particle counter data show that the addition of a bacterial filter limited the release of these fugitive aerosols, with the peak fugitive aerosol concentrations decreasing by 47.3-83.3%, depending on distance from the simulated patient. The addition of a bacterial filter to the mouthpiece significantly reduces the levels of fugitive aerosols emitted during a simulated aerosol therapy, p≤ .05, and would greatly aid in reducing healthcare worker and bystander exposure to potentially harmful fugitive aerosols.
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Affiliation(s)
| | - Ronan Cahill
- School of Medicine, UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Ronan MacLoughlin
- Aerogen Ltd, IDA Business Park, Galway, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons, Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Kevin Nolan
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
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19
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Moy N, Dulleck U, Shah A, Messmann H, Thrift AP, Talley NJ, Holtmann GJ. Risk-based decision-making related to preprocedural coronavirus disease 2019 testing in the setting of GI endoscopy: management of risks, evidence, and behavioral health economics. Gastrointest Endosc 2022; 96:735-742.e3. [PMID: 35690149 PMCID: PMC9174097 DOI: 10.1016/j.gie.2022.05.023] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/06/2022] [Accepted: 05/28/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Controversies exist regarding the benefits and most appropriate approach for preprocedural coronavirus disease 2019 (COVID-19) testing (eg, rapid antigen test, polymerase chain reaction, or real-time polymerase chain reaction) for outpatients undergoing diagnostic and therapeutic procedures, such as GI endoscopy, to prevent COVID-19 infections among staff. Guidelines for protecting healthcare workers (HCWs) from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from outpatient procedures varies across medical professional organizations. This study provides an evidence-based decision support tool for key decision-makers (eg, clinicians) to respond to COVID-19 transmission risks and reduce the effect of personal biases. METHODS A scoping review was used to identify relevant factors influencing COVID-19 transmission risk relevant for GI endoscopy. From 12 relevant publications, 8 factors were applicable: test sensitivity, prevalence of SARS-CoV-2 in the population, age-adjusted SARS-CoV-2 prevalence in the patient cohort, proportion of asymptomatic patients, risk of transmission from asymptomatic carriers, risk reduction by personal protective equipment (PPE), vaccination rates of HCWs, and risk reduction of SAE by vaccination. The probability of a serious adverse event (SAE), such as workplace-acquired infection resulting in HCW death, under various scenarios with preprocedural testing was determined to inform decision-makers of expected costs of reductions in SAEs. RESULTS In a setting of high community transmission, without testing and PPE, 117.5 SAEs per million procedures were estimated to occur, and this was reduced to between .079 and 2.35 SAEs per million procedures with the use of PPE and preprocedural testing. When these variables are used and a range of scenarios are tested, the probability of an SAE was low even without testing but was reduced by preprocedural testing. CONCLUSIONS Under all scenarios tested, preprocedural testing reduced the SAE risk for HCWs regardless of the SARS-CoV-2 variant. Benefits of preprocedural testing are marginal when community transmission is low (eg, below 10 infections a day per 100,000 population). The proposed decision support tool can assist in developing rational preprocedural testing policies.
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Affiliation(s)
- Naomi Moy
- School of Economics and Finance, Faculty of Business and Law, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Behavioural Economics, Society and Technology, Queensland University Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Uwe Dulleck
- School of Economics and Finance, Faculty of Business and Law, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Behavioural Economics, Society and Technology, Queensland University Australia; Crawford School of Public Policy, Australian National University, Canberra, Australian Capital Territory, Australia; CESifo, LMU Munich, Munich, Germany
| | - Ayesha Shah
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Aaron P Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Nicholas J Talley
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Gerald J Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; University of Queensland Diamantina Institute, University of Queensland, Woolloongabba, Queensland, Australia; Australian Gastrointestinal Rearch Alliance, Newcastle, New South Wales, Australia; NHMRC Centre for Research Excellence in Digestive Health, Brisbane, Queensland, Australia
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20
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Zhou G, Burnett GW, Shah RS, Lai CY, Katz D, Fried EA. Development of an Easily Reproducible Cough Simulator With Droplets and Aerosols for Rapidly Testing Novel Personal Protective Equipment. Simul Healthc 2022; 17:336-342. [PMID: 35238849 DOI: 10.1097/sih.0000000000000644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The current COVID-19 pandemic has produced numerous innovations in personal protective equipment, barrier devices, and infection mitigation strategies, which have not been validated. During high-risk procedures such as airway manipulation, coughs are common and discrete events that may expose healthcare workers to large amounts of viral particles. A simulated cough under controlled circumstances can rapidly test novel devices and protocols and thus aid in their evaluation and the development of implementation guidelines. Physiologic cough simulators exist but require significant expertise and specialized equipment not available to most clinicians. METHODS Using components commonly found in healthcare settings, a cough simulator was designed for clinicians to easily assemble and use. Both droplet and aerosol particle generators were incorporated into a bimodal experimental system. High-speed flash photography was used for data collection. RESULTS Using a gas flow analyzer, video recordings, and high-speed digital photography, the cough and particle simulators were quantitatively and qualitatively compared with known physiologic cough parameters and in vivo Schlieren imaging of human coughs. CONCLUSIONS Based on our validation studies, this cough and particle simulator model approximates a physiologic, human cough in the context of testing personal protective equipment, barrier devices, and infection prevention measures.
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Affiliation(s)
- George Zhou
- From the Department of Anesthesiology, Perioperative and Pain Medicine (G.Z.), Stanford University Hospital, Stanford, CA; Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.B., C.Y.L., D.K., E.A.F.); and Department of Anesthesiology and Critical Care Medicine (R.S.S.), Memorial Sloan Kettering Cancer Center, New York, NY
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21
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Marshall KE, Barton M, Nichols J, de Perio MA, Kuhar DT, Spence-Davizon E, Barnes M, Herlihy RK, Czaja CA. Health Care Personnel Exposures to Subsequently Laboratory-Confirmed Monkeypox Patients — Colorado, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1216-1219. [PMID: 36136939 PMCID: PMC9531564 DOI: 10.15585/mmwr.mm7138e2] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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22
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Monroe LW, Johnson JS, Gutstein HB, Lawrence JP, Lejeune K, Sullivan RC, Jen CN. Preventing spread of aerosolized infectious particles during medical procedures: A lab-based analysis of an inexpensive plastic enclosure. PLoS One 2022; 17:e0273194. [PMID: 36137079 PMCID: PMC9499281 DOI: 10.1371/journal.pone.0273194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022] Open
Abstract
Severe viral respiratory diseases, such as SARS-CoV-2, are transmitted through aerosol particles produced by coughing, talking, and breathing. Medical procedures including tracheal intubation, extubation, dental work, and any procedure involving close contact with a patient’s airways can increase exposure to infectious aerosol particles. This presents a significant risk for viral exposure of nearby healthcare workers during and following patient care. Previous studies have examined the effectiveness of plastic enclosures for trapping aerosol particles and protecting health-care workers. However, many of these enclosures are expensive or are burdensome for healthcare workers to work with. In this study, a low-cost plastic enclosure was designed to reduce aerosol spread and viral transmission during medical procedures, while also alleviating issues found in the design and use of other medical enclosures to contain aerosols. This enclosure is fabricated from clear polycarbonate for maximum visibility. A large single-side cutout provides health care providers with ease of access to the patient with a separate cutout for equipment access. A survey of medical providers in a local hospital network demonstrated their approval of the enclosure’s ease of use and design. The enclosure with appropriate plastic covers reduced total escaped particle number concentrations (diameter > 0.01 μm) by over 93% at 8 cm away from all openings. Concentration decay experiments indicated that the enclosure without active suction should be left on the patient for 15–20 minutes following a tracheal manipulation to allow sufficient time for >90% of aerosol particles to settle upon interior surfaces. This decreases to 5 minutes when 30 LPM suction is applied. This enclosure is an inexpensive, easily implemented additional layer of protection that can be used to help contain infectious or otherwise potentially hazardous aerosol particles while providing access into the enclosure.
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Affiliation(s)
- Luke W. Monroe
- Center for Atmospheric Particle Studies, Carnegie Mellon University, Pittsburgh, PA, United States of America
| | - Jack S. Johnson
- Center for Atmospheric Particle Studies, Carnegie Mellon University, Pittsburgh, PA, United States of America
| | - Howard B. Gutstein
- Anesthesiology Institute, Allegheny Health Network, Pittsburgh, PA, United States of America
| | - John P. Lawrence
- Anesthesiology Institute, Allegheny Health Network, Pittsburgh, PA, United States of America
| | - Keith Lejeune
- Anesthesiology Institute, Allegheny Health Network, Pittsburgh, PA, United States of America
| | - Ryan C. Sullivan
- Center for Atmospheric Particle Studies, Carnegie Mellon University, Pittsburgh, PA, United States of America
- * E-mail:
| | - Coty N. Jen
- Center for Atmospheric Particle Studies, Carnegie Mellon University, Pittsburgh, PA, United States of America
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Ludewick H, Hahn R, Italiano C, Pereira L, Fatovich D, Saxton J, Hunt R, Ho KM, Boan P, Pavey W. COVID-19 Serosurvey of Frontline Healthcare Workers in Western Australia. J Epidemiol Glob Health 2022; 12:472-477. [PMID: 36131202 PMCID: PMC9491653 DOI: 10.1007/s44197-022-00065-1] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 09/10/2022] [Indexed: 11/25/2022] Open
Abstract
We aimed to study COVID-19 infection in healthcare workers (HCWs) during the first wave in a setting of low community incidence prior to HCW vaccination. We performed a cross-sectional study of frontline HCWs in two tertiary hospitals in Western Australia with questionnaire and testing for SARS-CoV-2 IgG antibodies, using a screening assay followed by confirmatory assays for initial reactive results. 799 Frontline HCWs were enrolled in the study, working in the emergency department (n = 194, 24.2%), ICU (n = 176, 22.0%), respiratory ward (n = 20, 2.5%), COVID clinic (n = 37, 4.6%), and theatre (n = 222, 28%). 189 (23.6%) were doctors, 327 (41.0%) nurses, and 283 (35.4%) other. Contact with a known COVID-19-positive patient occurred at work for 337 (42.1%), and outside work for 10 (1.2%). Four were diagnosed with COVID-19 by PCR, acquired overseas in two cases and related to healthcare work in two cases (one acquired from a colleague and one possibly acquired from patient contact in the healthcare setting). Nine HCWs had reactive screening serology, and three had confirmed positive IgG (these three were PCR-positive cases). Infection control procedures in the setting of low community incidence were effective at preventing HCW acquisition of COVID-19 infection.
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Affiliation(s)
- Herbert Ludewick
- Heart and Lung Research Institute of Western Australia Inc, Harry Perkins Institute of Medical Research, 5 Robin Warren Drive, Perth, WA, Australia
| | - Rebecca Hahn
- Heart and Lung Research Institute of Western Australia Inc, Harry Perkins Institute of Medical Research, 5 Robin Warren Drive, Perth, WA, Australia
| | - Claire Italiano
- Department of Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia
| | - Lynette Pereira
- Department of Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia
| | - Daniel Fatovich
- Department of Emergency Medicine, Royal Perth Hospital, University of Western Australia, Perth, WA, Australia
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, WA, Australia
| | - Jemma Saxton
- Heart and Lung Research Institute of Western Australia Inc, Harry Perkins Institute of Medical Research, 5 Robin Warren Drive, Perth, WA, Australia
| | - Richard Hunt
- Department of Anaesthesia, Fiona Stanley Hospital, Perth, WA, Australia
| | - Kwok M Ho
- Department of Intensive Care, Royal Perth Hospital, Perth, WA, Australia
| | - Peter Boan
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, WA, Australia.
- Department of Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Perth, 11 Robin Warren Dve, Murdoch, WA, 6150, Australia.
| | - Warren Pavey
- Heart and Lung Research Institute of Western Australia Inc, Harry Perkins Institute of Medical Research, 5 Robin Warren Drive, Perth, WA, Australia
- Department of Anaesthesia, Fiona Stanley Hospital, Perth, WA, Australia
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Dörr T, Haller S, Müller MF, Friedl A, Vuichard D, Kahlert CR, Kohler P. Risk of SARS-CoV-2 Acquisition in Health Care Workers According to Cumulative Patient Exposure and Preferred Mask Type. JAMA Netw Open 2022; 5:e2226816. [PMID: 35969403 PMCID: PMC9379739 DOI: 10.1001/jamanetworkopen.2022.26816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This cohort study compares the risk of infection with SARS-CoV-2 among health care workers by mask preference and level of patient exposure.
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Affiliation(s)
- Tamara Dörr
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Sabine Haller
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | - Andrée Friedl
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital Baden, Baden, Switzerland
| | - Danielle Vuichard
- Division of Infectious Diseases and Hospital Epidemiology, Thurgau Hospital Group, Muensterlingen, Switzerland
- Swiss National Centre for Infection Prevention (Swissnoso), Berne, Switzerland
| | - Christian R. Kahlert
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, Children’s Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
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25
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Simpson LA, Macdonald K, Searle EF, Shearer JA, Dimitrov D, Foley D, Morales E, Shenoy ES. Development and deployment of tools for rapid response notification of Monkeypox exposure, exposure risk assessment and stratification, and symptom monitoring. Infect Control Hosp Epidemiol 2022; 43:963-967. [PMID: 35815416 DOI: 10.1017/ice.2022.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Public health authorities recommend symptom monitoring of healthcare personnel (HCP) after defined exposures to monkeypox. We report on the rapid development and implementation of mobile responsive survey solutions for notification of possible exposure, exposure risk assessment and stratification, and symptom monitoring. SETTING An academic health center in Boston, Massachusetts, after admission of first diagnosed case of monkeypox in the United States during the current global outbreak. PARTICIPANTS Research Electronic Data Capture (REDCap) design and programmers, infection control, occupational health, and emergency preparedness specialists, and HCP with possible exposure to monkeypox. INTERVENTIONS Design and deployment of REDCap tools to identify HCP with possible exposure to monkeypox, to perform exposure risk assessment and stratification for postexposure prophylaxis (PEP), and to conduct symptom monitoring during the exposure window. Project enhancements included dashboards for HCP tracking and short message service (SMS text) reminders for symptom monitoring. RESULTS Tools to support the contact tracing and exposure investigation were deployed within 24 hours of identification of a patient with suspected monkeypox, with the full suite in production within 4 days of confirmation of the monkeypox diagnosis. Clinical follow-up of HCP was integrated into the design, and real-time versioning allowed for improvements in HCP symptom monitoring compliance and enhanced tracking. CONCLUSIONS During the current monkeypox outbreak, timely and comprehensive evaluation of potential HCP exposures is necessary but presents logistical challenges. Rapid development of monkeypox-specific solutions using REDCap facilitated flexibility in design and approach, and integration of targeted clinical support enhanced functionality.
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Affiliation(s)
- Lynn A Simpson
- Harvard Catalyst, The Harvard Clinical and Translational Science Center, Boston, Massachusetts
- Mass General Brigham Research Information Science & Computing, Boston, Massachusetts
| | - Kaitlin Macdonald
- Mass General Brigham Occupational Health Services, Boston, Massachusetts
| | - Eileen F Searle
- Center for Disaster Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Regional Emerging Special Pathogens Treatment Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer A Shearer
- Center for Disaster Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Emergency Preparedness and Business Continuity, Mass General Brigham, Boston, Massachusetts
| | - Dimitar Dimitrov
- Mass General Brigham Research Information Science & Computing, Boston, Massachusetts
| | - Daniel Foley
- Mass General Brigham Research Information Science & Computing, Boston, Massachusetts
| | - Eduardo Morales
- Mass General Brigham Research Information Science & Computing, Boston, Massachusetts
| | - Erica S Shenoy
- Regional Emerging Special Pathogens Treatment Center, Massachusetts General Hospital, Boston, Massachusetts
- Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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26
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Abstract
During the early phase of the COVID-19 pandemic, many respiratory therapies were classified as aerosol-generating procedures. This categorization resulted in a broad range of clinical concerns and a shortage of essential medical resources for some patients. In the past 2 years, many studies have assessed the transmission risk posed by various respiratory care procedures. These studies are discussed in this narrative review, with recommendations for mitigating transmission risk based on the current evidence.
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Affiliation(s)
- Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, Illinois
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27
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Khashaba E, El-Gilany AH, Shalaby H, El-Kurdy R. Personal protective equipment used by obstetricians and obstetric nurses during the COVID-19 pandemic in Mansoura, Egypt. F1000Res 2022; 11:413. [PMID: 35903420 PMCID: PMC9274016 DOI: 10.12688/f1000research.110835.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/20/2022] Open
Abstract
Background: This study was done to describe the pattern of personal protective equipment (PPE) use, associated factors, and adverse events among obstetricians and obstetric nurses in obstetrics & gynecology departments. Methods: A cross sectional study was conducted in Obstetrics & Gynecology departments in three hospitals (physician & nurses n=252) using an online Google form including demographic and occupational health data, type of available personal protective equipment during usual care, CS and emergency labor, infection control measures and hazards of full PPE use. Results Full PPE use was 37.7% during CS and 34.9% during emergency labor. The significant predictors of wearing full PPE during CS were daily work hours > 8 hours and receiving formal training about PPE use. During CS & emergency labor most of HCws used sterile gloves and sterile fluid resistant gowns and surgical mask.to less extent used face shields or tight fitting googles and one tenth (11.8%) only used N95. The most common health effects of full PPE use was sense of heat (79.5%)
. Conclusion: During the COVID-19 pandemic more vigorous respiratory (N95 mask) and eye protection is required during aerosol-generating procedures. Formal training is an evident predictor for full PPE use.
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Affiliation(s)
- Eman Khashaba
- Assistant professor of Occupational Health and Industrial Medicine,Public health & Community medicine, Faculty of Medicine,Mansoura University, Mansoura, 35516, Egypt
| | - Abdel-Hady El-Gilany
- Professor of Public Health & Preventive Medicine,, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
| | - Hend Shalaby
- Professor of Obstetrics & Gynecology, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
| | - Rania El-Kurdy
- Lecturer of Woman’s Health & Midwifery Nursing, Faculty of Nursing,Mansoura University, Mansoura, 35516, Egypt
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28
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Jin X, Gao F, Qin M, Yu Y, Zhao Y, Shao T, Chen C, Zhang W, Xie B, Xiong Y, Yang L, Wu Y. How to Make Personal Protective Equipment Spontaneously and Continuously Antimicrobial (Incorporating Oxidase-like Catalysts). ACS Nano 2022; 16:7755-7771. [PMID: 35491982 DOI: 10.1021/acsnano.1c11647] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 06/14/2023]
Abstract
The inability of commercial personal protective equipment (PPE) to inactivate microbes in the droplets/aerosols they intercept makes used PPE a potential source of cross-contamination. To make PPE spontaneously and continuously antimicrobial, we incorporate PPE with oxidase-like catalysts, which efficiently convert O2 into reactive oxygen species (ROS) without requiring any externally applied stimulus. Using a single-atom catalyst (SAC) nanoparticle containing atomically dispersed copper atoms as the reactive centers (Cu-SAC) and a silver-palladium bimetallic alloy nanoparticle (AgPd0.38) as models for oxidase-like catalysts, we show that the incorporation of oxidase-like catalysts enables PPE to inactivate bacteria in the droplets/aerosols they intercept without requiring any externally applied stimulus. Notably, this approach works both for PPE that are fibrous and woven such as a commercial KN95 facial respirator and for those made of solid plastics such as an apron. This work suggests a feasible and global approach for preventing PPE from spreading infectious diseases.
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Affiliation(s)
- Xinyang Jin
- Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
- CAS Key Laboratory of Soft Matter Chemistry, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
- School of Chemistry and Materials Science, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
| | - Feng Gao
- Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
- CAS Key Laboratory of Soft Matter Chemistry, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
- School of Chemistry and Materials Science, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
| | - Mingxin Qin
- School of Chemistry and Materials Science, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
| | - Yunpeng Yu
- Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
- CAS Key Laboratory of Soft Matter Chemistry, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
- School of Chemistry and Materials Science, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
| | - Yue Zhao
- School of Chemistry and Materials Science, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
| | - Tianyi Shao
- School of Chemistry and Materials Science, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
| | - Cai Chen
- School of Chemistry and Materials Science, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
- College of Chemistry and Chemical Engineering, Southwest Petroleum University, Chengdu 610500, China
| | - Wenhua Zhang
- Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
- School of Chemistry and Materials Science, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
| | - Bin Xie
- Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
| | - Yujie Xiong
- Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
- School of Chemistry and Materials Science, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
| | - Lihua Yang
- Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
- CAS Key Laboratory of Soft Matter Chemistry, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
- School of Chemistry and Materials Science, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
| | - Yuen Wu
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
- Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
- School of Chemistry and Materials Science, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026, China
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29
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Kumar A, Kaur M, Kaur S, Nagi M, Agnihotri M, Nagar PK, Kumar P, Das K. Attitude and Perception of Nursing Personnel Involved in Real Time Remote Audio-Visual Aided (RT-RAVA) Monitoring of Doffing for the Prevention of Covid-19 Infection among the Health Care Workers. Hosp Top 2022; 102:1-8. [PMID: 35535975 DOI: 10.1080/00185868.2022.2073303] [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] [Indexed: 10/18/2022]
Abstract
The study was carried out to explore the attitude and perception of observers involved in monitoring of doffing through Real Time Remote Audio-Visual aided (RT-RAVA), the first well-sophisticated surveillance system. A 21-item online-survey proforma was used to collect the data amongst 150 nursing personnel. 3/4th of the participants strongly agreed that they helped in reducing the doffing errors through RT-RAVA doffing. 97.3% perceived that the system is highly effective in reducing the infection during doffing. There was significant correlation between attitude and perception of the observers. The system was perceived as highly effective and was recommended for doffing.
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Affiliation(s)
- Ashok Kumar
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Maninderdeep Kaur
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sukhpal Kaur
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Nagi
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Meenakshi Agnihotri
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pramod Kumar Nagar
- Department of Nursing, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pramod Kumar
- Department of Nursing, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karobi Das
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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30
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Kaya AG, Öz M, Orhun İK, Erol S, Çiledağ A, Karnak D, Kaya A. A new device for bronchoscopy for better protection. Turk J Med Sci 2022; 52:361-369. [PMID: 36161605 PMCID: PMC10381228 DOI: 10.3906/sag-2109-258] [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: 09/25/2021] [Accepted: 12/04/2021] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the risk of transmission of SARS-CoV-2 has not been precisely known in bronchoscopy procedures. We have designed a cabinet device called Ankara University Bronchoscopy Cabinet (Aubrocab®) to protect healthcare. We aimed to evaluate preventing effect of Aubrocab® on aerosol spreading by measuring the particles in the bronchoscopy suite. METHODS The patients were categorized into two groups as those who underwent bronchoscopy with and without Aubrocab®. We measured PM 0.5 levels before and after bronchoscopy in the bronchoscopy suite. RESULTS A total of 82 patients, 62 of whom underwent bronchoscopy with Aubrocab®, were enrolled in the study. The PM 0.5 level measured before bronchoscopy was similar in both groups, whereas the PM 0.5 level measured after bronchoscopy was lower in the Aubrocab® group (42,603 ± 8,632 vs. 50,377 ± 10,487, p = 0.001). The percent of particle change (50.76 ± 19.91 vs 67.15 ± 24.24, p = 0.003) and the difference of the particle numbers between pre and postprocedure (13,638 ± 4,292 and 19,501 ± 5,891, p < 0.001) were lower in the Aubrocab® group. DISCUSSION Our institution developed a barrier device named Aubrocab® which was shown to prevent excessive aerosol release in addition to routine precautions during bronchoscopy procedures.
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Affiliation(s)
- Aslıhan Gürün Kaya
- Department of Chest Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Miraç Öz
- Department of Chest Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Serhat Erol
- Department of Chest Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Aydın Çiledağ
- Department of Chest Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Demet Karnak
- Department of Chest Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Akın Kaya
- Department of Chest Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
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31
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Chirico F, Nucera G, Sacco A, Taino G, Szarpak L, Imbriani M. Protecting hospitals from SARS-CoV-2 infection: A review-based comprehensive strategy for COVID-19 prevention and control. G Ital Med Lav Ergon 2022; 44:32-40. [PMID: 36346297] [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] [Subscribe] [Scholar Register] [Accepted: 01/01/2022] [Indexed: 05/18/2023]
Abstract
SUMMARY SARS-CoV-2-related infection can determine hospital-acquired infections among patients and healthcare workers. Aim of this paper was to review the literature for developing a strategy for protecting healthcare workers, patients, and visitors by COVID-19 hospital infection. A critical and rapid revision of the literature and international standards and Regulations on this topic allowed us to propose an evidencebased strategy in the framework of the workplace risk assessment for preventing nosocomial COVID-19 outbreaks. The virus' high transmissibility, the high prevalence of asymptomatic carriers and false-negative Covid-19 rates on naso- and oropharingeal swabs, put hospitals at high-risk of COVID-19 outbreaks. A comprehensive strategy based on standard precautions, administrative, environmental, and engineering controls, a screening protocol for patients on their admission to hospital, and a testing-based strategy for HCWs within health surveillance programs may prevent the onset of hospital outbreaks, which are a threat to community, patients and HCWs, compromising the sustainability of healthcare facilities.
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Affiliation(s)
- Francesco Chirico
- Post-graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Sanitario Polifunzionale di Milano, Health Service Department, Italian State Police, Ministry of the Interior, Italy
| | - Gabriella Nucera
- Faculty of Medicine and Surgery, Nursing Science, University of Milan, Italy
- ASST Fatebenefratelli e Sacco, FatebeneFratelli Hospital, Department of Emergency, Milan, Italy
| | - Angelo Sacco
- Post-graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
- ASL Rome 2, Rome, Italy
| | - Giuseppe Taino
- IRCCS S. Maugeri Foundation, Hospital Unit of Occupational Medicine (UOOML), Pavia, Italy
| | - Lukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland and Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
| | - Marcello Imbriani
- IRCCS S. Maugeri Foundation, Hospital Unit of Occupational Medicine (UOOML), Pavia, Italy
- Department of Public Health, Experimental Medicine and Forensic, University of Pavia, Pavia, Italy
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32
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Roche E, Lim C, Sayma M, Navaratnam A, Davis PJ, Ramnarayan P, Fraser J, Kenny S. Learning lessons from the paediatric critical care response to the SARS-CoV-2 pandemic in England and Wales: a qualitative study. Arch Dis Child 2022; 107:e6. [PMID: 34417188 PMCID: PMC8384492 DOI: 10.1136/archdischild-2020-320662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 08/03/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To explore the experiences of clinical leads in paediatric critical care units (PCCUs) in England and Wales during the reorganisation of services in the initial surge of the SARS-CoV-2 pandemic and to learn lessons for future surges and service planning. METHODS A qualitative study design using semistructured interviews via virtual conferencing was conducted with consultant clinical leads and lead nurses covering 21 PCCUs. Interviews were conducted over a period of 2 weeks, 2 months after the initial SARS-CoV-2 surge. Interview notes underwent thematic analysis. RESULTS Thematic analysis revealed six themes: leadership, management and planning; communication; workforce development and training; innovation; workforce experience; and infection prevention and control. Leadership was facilitated through clinician-led local autonomy for decision-making and services were better delivered when the workforce was empowered to be flexible in their response. Communication was preferred through collaborative management structures. Further lessons include recognising workforce competencies in surge preparations, the use of virtual technology in facilitating training and meetings, the importance of supporting the well-being of the workforce and the secondary consequences of personal protective equipment use. CONCLUSIONS During the 2020 SARS-CoV-2 pandemic, an agile response to a rapidly changing situation was enabled through effective clinical leadership and an adaptive workforce. Open systems of communication across senior clinical and management teams facilitated service planning. Support for all members of the workforce through implementation of appropriate and innovative education and well-being solutions was vital in sustaining resilience. This learning supports planning for future surge capacity across paediatric critical care locally and nationally.
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Affiliation(s)
- Emma Roche
- Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Chun Lim
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Peter J Davis
- Bristol Royal Hospital for Children, Paediatric Intensive Care Unit, Bristol, UK
- NHS England & NHS Improvement, London, UK
| | - Padmanabhan Ramnarayan
- Children's Acute Transport Service, London, UK
- Paediatric Critical Care Society, London, UK
| | - James Fraser
- Bristol Royal Hospital for Children, Paediatric Intensive Care Unit, Bristol, UK
- Paediatric Critical Care Society, London, UK
| | - Simon Kenny
- Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- Medical Director for Children and Young People, NHS England & NHS Improvement, London, UK
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33
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Nasa P, Azoulay E, Chakrabarti A, Divatia JV, Jain R, Rodrigues C, Rosenthal VD, Alhazzani W, Arabi YM, Bakker J, Bassetti M, De Waele J, Dimopoulos G, Du B, Einav S, Evans L, Finfer S, Guérin C, Hammond NE, Jaber S, Kleinpell RM, Koh Y, Kollef M, Levy MM, Machado FR, Mancebo J, Martin-Loeches I, Mer M, Niederman MS, Pelosi P, Perner A, Peter JV, Phua J, Piquilloud L, Pletz MW, Rhodes A, Schultz MJ, Singer M, Timsit JF, Venkatesh B, Vincent JL, Welte T, Myatra SN. Infection control in the intensive care unit: expert consensus statements for SARS-CoV-2 using a Delphi method. Lancet Infect Dis 2022; 22:e74-e87. [PMID: 34774188 PMCID: PMC8580499 DOI: 10.1016/s1473-3099(21)00626-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 02/07/2023]
Abstract
During the current COVID-19 pandemic, health-care workers and uninfected patients in intensive care units (ICUs) are at risk of being infected with SARS-CoV-2 as a result of transmission from infected patients and health-care workers. In the absence of high-quality evidence on the transmission of SARS-CoV-2, clinical practice of infection control and prevention in ICUs varies widely. Using a Delphi process, international experts in intensive care, infectious diseases, and infection control developed consensus statements on infection control for SARS-CoV-2 in an ICU. Consensus was achieved for 31 (94%) of 33 statements, from which 25 clinical practice statements were issued. These statements include guidance on ICU design and engineering, health-care worker safety, visiting policy, personal protective equipment, patients and procedures, disinfection, and sterilisation. Consensus was not reached on optimal return to work criteria for health-care workers who were infected with SARS-CoV-2 or the acceptable disinfection strategy for heat-sensitive instruments used for airway management of patients with SARS-CoV-2 infection. Well designed studies are needed to assess the effects of these practice statements and address the remaining uncertainties.
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Affiliation(s)
- Prashant Nasa
- NMC Speciality Hospital, Dubai, United Arab Emirates
| | - Elie Azoulay
- Saint-Louis Teaching Hospital, APHP, University of Paris, Paris, France
| | | | | | - Ravi Jain
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Camilla Rodrigues
- PD Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | | | | | - Yaseen M Arabi
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Jan Bakker
- New York University Grossman School of Medicine, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Erasmus University Medical Center, Rotterdam, Netherlands; Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Matteo Bassetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - George Dimopoulos
- Attikon University Hospital, Athens, Greece; National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Bin Du
- State Key Laboratory of Rare, Complex and Critical Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Sharon Einav
- Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | | | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Imperial College London, London, UK
| | - Claude Guérin
- University de Lyon, Lyon, France; Institut Mondor de Recherches Biomédicales, Créteil, France
| | - Naomi E Hammond
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Newton, Adelaide, SA, Australia
| | - Samir Jaber
- Hôpital Saint-Éloi, Montpellier University Hospital, Montpellier, France
| | - Ruth M Kleinpell
- Vanderbilt University School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Younsuck Koh
- College of Medicine, University of Ulsan College of Medicine, University of Ulsan, Seoul, South Korea
| | - Marin Kollef
- Washington University School of Medicine, Washington University, St Louis, MO, USA
| | - Mitchell M Levy
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Flavia R Machado
- Hospital Sao Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Mervyn Mer
- Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | | | - Paolo Pelosi
- IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Genoa, Italy; University of Genoa, Genoa, Italy
| | - Anders Perner
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Jason Phua
- Alexandra Hospital, National University Health System, Singapore; National University Hospital, National University Health System, Singapore
| | - Lise Piquilloud
- University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mathias W Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Andrew Rhodes
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Marcus J Schultz
- Amsterdam University Medical Centers, Locatie AMC, Amsterdam, Netherlands; Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | | | | | - Tobias Welte
- German Center of Lung Research, Hannover, Germany
| | - Sheila N Myatra
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
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Banu B, Akter N, Chowdhury SH, Islam KR, Islam MT, Hossain SM. Infection and vaccination status of COVID-19 among healthcare professionals in academic platform: Prevision vs. reality of Bangladesh context. PLoS One 2022; 17:e0263078. [PMID: 35180216 PMCID: PMC8856526 DOI: 10.1371/journal.pone.0263078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/11/2022] [Indexed: 11/26/2022] Open
Abstract
COVID-19 posed the healthcare professionals at enormous risk during this pandemic era while vaccination was recommended as one of the effective preventive approaches. It was visualized that almost all health workforces would be under vaccination on a priority basis as they are the frontline fighters during this pandemic. This study was designed to explore the reality regarding infection and vaccination status of COVID-19 among healthcare professionals of Bangladesh. It was a web-based cross-sectional survey and conducted among 300 healthcare professionals available in the academic platform of Bangladesh. A multivariate logistic regression model was used for the analytical exploration. Adjusted and Unadjusted Odds Ratio (OR) with 95% confidence intervals (95% CI) were calculated for the specified setting indicators. A Chi-square test was used to observe the association. Ethical issues were maintained according to the guidance of the declaration of Helsinki. Study revealed that 41% of all respondents identified as COVID-19 positive whereas a significant number (18.3%) found as non-vaccinated due to registration issues as 52.70%, misconception regarding vaccination as 29.10%, and health-related issues as 18.20%. Respondents of more than 50 years of age found more significant on having positive infection rather than the younger age groups. Predictors for the non-vaccination guided that male respondents (COR/p = 3.49/0.01), allied health professionals, and respondents from the public organizations (p = 0.01) who were ≤29 (AOR/p = 4.45/0.01) years of age significantly identified as non-vaccinated. As the older female groups were found more infected and a significant number of health care professionals found as non-vaccinated, implementation of specific strategies and policies are needed to ensure the safety precautions and vaccination among such COVID-19 frontiers.
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Affiliation(s)
- Bilkis Banu
- Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh
| | - Nasrin Akter
- Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh
- * E-mail:
| | | | - Kazi Rakibul Islam
- Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh
| | - Md. Tanzeerul Islam
- Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh
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Naidoo K, Spijkerman S, Wyngaard J, De Menezes-Williams H, Janse van Rensburg C. A cross-sectional observational study of endotracheal intubation and extubation practices among doctors treating adult COVID-19 and suspected COVID-19 patients in South Africa. S Afr Med J 2022; 112:13517. [PMID: 35140003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Patients with severe COVID-19 may require endotracheal intubation. Unique adjustments to endotracheal intubation and extubation practices are necessary to decrease the risk of SARS-CoV-2 transmission to healthcare workers (HCWs) while avoiding complications of airway management. OBJECTIVES To investigate the practice of endotracheal intubation and extubation, resources available and complications encountered by clinicians performing endotracheal intubation and extubation of COVID-19 and suspected COVID-19 patients in South Africa (SA). METHOD A cross-sectional observational study was conducted during the initial surge of COVID-19 cases in SA. Data were collected by means of a self-administered questionnaire completed by clinicians in the private and public healthcare sectors after performing an endotracheal intubation and/or extubation of a patient with confirmed or suspected COVID-19. RESULTS Data from 135 endotracheal intubations and 45 extubations were collected. Anaesthetists accounted for 87.0% (n=120) of the study participants, specialist clinicians in their respective fields for 59.4% (n=82), and public HCWs for 71.0% (n=98). Cases from Gauteng Province made up 76.8% (n=106) of the database. Haemoglobin desaturation was the most frequent complication encountered during endotracheal intubation (40.0%; n=54). Endotracheal intubations performed at private healthcare institutions were associated with a significantly lower complication rate of 17.5% (n=7) compared with 52.6% (n=50) in the public healthcare sector (p<0.001). Endotracheal intubations performed in theatre had the lowest complication rate of 10.4% (n=5; p<0.001). Propofol was used in 90 endotracheal intubations (66.7%), and its use was associated with fewer complications relative to other induction agents. Minimising the number of intubation attempts (p=0.009) and the use of checklists (p=0.013) significantly reduced the frequency of complications encountered during endotracheal intubation. Intravenous induction technique, neuromuscular blocking agent used, intubating device used and time at which intubation was performed did not affect the incidence of complications. The majority of endotracheal extubations were uncomplicated (88.9%). CONCLUSIONS The study provides valuable insight into the resources used by clinicians and complications encountered when endotracheal intubations and/or extubations were performed. Data from this study may be used to guide future clinical practice and research, especially in resource-limited settings.
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Affiliation(s)
- K Naidoo
- Department of Anaesthesiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa.
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Abstract
IMPORTANCE Resuscitation is a niche example of how the COVID-19 pandemic has affected society in the long term. Those trained in cardiopulmonary resuscitation (CPR) face the dilemma that attempting to save a life may result in their own harm. This is most of all a problem for drowning, where hypoxia is the cause of cardiac arrest and ventilation is the essential first step in reversing the situation. OBJECTIVE To develop recommendations for water rescue organizations in providing their rescuers with safe drowning resuscitation procedures during the COVID-19 pandemic. EVIDENCE REVIEW Two consecutive modified Delphi procedures involving 56 participants from 17 countries with expertise in drowning prevention research, resuscitation, and programming were performed from March 28, 2020, to March 29, 2021. In parallel, PubMed and Google Scholar were searched to identify new emerging evidence relevant to each core element, acknowledge previous studies relevant in the new context, and identify knowledge gaps. FINDINGS Seven core elements, each with their own specific recommendations, were identified in the initial consensus procedure and were grouped into 4 categories: (1) prevention and mitigation of the risks of becoming infected, (2) resuscitation of drowned persons during the COVID-19 pandemic, (3) organizational responsibilities, and (4) organizations unable to meet the recommended guidelines. The common measures of infection risk mitigation, personal protective equipment, and vaccination are the base of the recommendations. Measures to increase drowning prevention efforts reduce the root cause of the dilemma. Additional infection risk mitigation measures include screening all people entering aquatic facilities, defining criteria for futile resuscitation, and avoiding contact with drowned persons by rescuers with a high-risk profile. Ventilation techniques must balance required skill level, oxygen delivery, infection risk, and costs of equipment and training. Bag-mask ventilation with a high-efficiency particulate air filter by 2 trained rescuers is advised. Major implications for the methods, facilities, and environment of CPR training have been identified, including nonpractical skills to avoid being infected or to infect others. Most of all, the organization is responsible for informing their members about the impact of the COVID-19 pandemic and taking measures that maximize rescuer safety. Research is urgently needed to better understand, develop, and implement strategies to reduce infection transmission during drowning resuscitation. CONCLUSIONS AND RELEVANCE This consensus document provides an overview of recommendations for water rescue organizations to improve the safety of their rescuers during the COVID-19 pandemic and balances the competing interests between a potentially lifesaving intervention and risk to the rescuer. The consensus-based recommendations can also serve as an example for other volunteer organizations and altruistic laypeople who may provide resuscitation.
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Affiliation(s)
- Ana Catarina Queiroga
- EPIUnit (Unidade de Investigação em Epidemiologia), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- ITR (Laboratory for Integrative and Translational Research in Population Health), Porto, Portugal
- International Life Saving Federation, Leuven, Belgium
- International Drowning Researchers' Alliance, Kuna, Idaho
| | - Cody Dunne
- International Life Saving Federation, Leuven, Belgium
- International Drowning Researchers' Alliance, Kuna, Idaho
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Leonardo Andres Manino
- International Life Saving Federation, Leuven, Belgium
- International Drowning Researchers' Alliance, Kuna, Idaho
- Costanera Rosario, Civil Defense Rosario Municipality, Rosario, Argentina
- Equipo Professional de Salvamento Acuático, Buenos Aires, Argentina
| | | | - Tom Mecrow
- International Drowning Researchers' Alliance, Kuna, Idaho
- International Maritime Rescue Federation, Enfield, United Kingdom
- Royal National Lifeboat Institution, Poole, United Kingdom
| | - Joost Bierens
- International Life Saving Federation, Leuven, Belgium
- International Drowning Researchers' Alliance, Kuna, Idaho
- Royal Dutch Lifeboat Institution, IJmuiden, the Netherlands
- Research Group Emergency and Disaster Medicine, Vrije Universiteit Brussels, Brussels, Belgium
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Goga AE, Bekker LG, Garrett N, Takuva S, Sanne I, Odhiambo J, Mayat F, Fairall L, Brey Z, Bamford L, Tanna G, Grey G. Sisonke phase 3B open-label study: Lessons learnt for national and global vaccination scale-up during epidemics. S Afr Med J 2021; 112:13486. [PMID: 35140006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023] Open
Abstract
Sisonke is a multicentre, open-label, single-arm phase 3B vaccine implementation study of healthcare workers (HCWs) in South Africa, with prospective surveillance for 2 years. The primary endpoint is the rate of severe COVID‑19, including hospitalisations and deaths. The Sisonke study enrolled and vaccinated participants nationally at potential vaccination roll-out sites between 17 February and 26 May 2021. After May 2021, additional HCWs were vaccinated as part of a sub-study at selected clinical research sites. We discuss 10 lessons learnt to strengthen national and global vaccination strategies:(i) consistently advocate for vaccination to reduce public hesitancy; (ii) an electronic vaccination data system (EVDS) is critical; (iii) facilitate access to a choice of vaccination sites, such as religious and community centres, schools, shopping malls and drive-through centres; (iv) let digitally literate people help elderly and marginalised people to register for vaccination; (v) develop clear 'how to' guides for vaccine storage, pharmacy staff and vaccinators; (vi) leverage instant messaging platforms, such as WhatsApp, for quick communication among staff at vaccination centres; (vii) safety is paramount - rapid health assessments are needed at vaccination centres to identify people at high risk of serious adverse events, including anaphylaxis or thrombosis with thrombocytopenia syndrome. Be transparent about adverse events and contextualise vaccination benefits, while acknowledging the small risks; (viii) provide real-time, responsive support to vaccinees post vaccination and implement an accessible national vaccine adverse events surveillance system; (ix) develop efficient systems to monitor and investigate COVID‑19 breakthrough infections; and (x) flexibility and teamwork are essential in vaccination centres across national, provincial and district levels and between public and private sectors.
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Affiliation(s)
- A E Goga
- South African Medical Research Council, South Africa; Department of Paediatrics and Child Health, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa.
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Sanghani S, Loewenstein K, Andrus J, Allan S, Mangubat L, Bashkirov I, Glick M, Linder H, Petrides G. Electroconvulsive Therapy in the Epicenter of COVID-19: Experiences and Reflections. J ECT 2021; 37:225-229. [PMID: 34519682 DOI: 10.1097/yct.0000000000000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | - Liezl Mangubat
- From the Zucker Hillside Hospital, Northwell Health, Glen Oaks
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Alsaffan A. Photodynamic therapy procedures in coronavirus (COVID-19) outbreak: perception of health risks among clinical dental faculty and dental students. Eur Rev Med Pharmacol Sci 2021; 25:8004-8011. [PMID: 34982464 DOI: 10.26355/eurrev_202112_27651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim of the study was to investigate clinical faculty members and final year dentistry students' perceptions regarding their health concerns and risks of performing photodynamic therapy (PDT) procedure in dental clinics amidst the COVID-19 pandemic. SUBJECTS AND METHODS A 21-item questionnaire comprising open and closed questions was sent to dental faculty members (n=43) and final year dentistry students (n=99) of Riyadh Elm University during mid-January 2021 that ended only after two weeks. The survey included health risks perception of performing PDT procedures, the impact of the COVID-19 outbreak on PDT performance and stress levels, perceived efficacy of the preventive steps, perception of the effect of the probable suspension of PDT procedure in dental clinics, and influence of alternative teaching methods of PDT procedure on clinical competence were reported. RESULTS A response rate of 82% for faculty members (n=35) and 75% for students (n=74) was recorded. 91% of faculty members and 95% of students felt that their health was not at risk during performing PDT procedure in dental clinics amidst the COVID-19. 82% of faculty and 83% of students expressed that the PPE and universal preventive steps to perform PDT procedure were enough for preventing the cross-infection with the virus. 89% of faculty members and 91% of students thought that a provisional suspension of PDT procedures in dental clinics would assist in containment of the virus and reduce the infection risk from the contact and not the PDT procedure. CONCLUSIONS Students and faculty members reported that their health is not at risk while performing PDT procedure in dental clinics amidst the COVID-19 outbreak.
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Affiliation(s)
- A Alsaffan
- Preventive Department, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia.
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Ashoor M, Alshammari S, Alzahrani F, Almulhem N, Almubarak Z, Alhayek A, Alrahim A, Alardhi A. Knowledge and practice of Protective Personal Equipment (PPE) among healthcare providers in Saudi Arabia during the early stages of COVID-19 pandemic in 2020. J Prev Med Hyg 2021; 62:E830-E840. [PMID: 35603244 PMCID: PMC9104681 DOI: 10.15167/2421-4248/jpmh2021.62.4.2177] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
Introduction Healthcare providers are at high risk of becoming infected when taking care of patients who have COVID-19, especially while attending aerosol generating procedures. Protective personal equipment must be used in the correct manner to prevent transmission of the disease. Published protocols on protective personal equipment (PPE) donning and doffing have been issued by disease control agencies. Methods A questionnaire-based cross-sectional study was designed. An online anonymous questionnaire, which was validated and tested for reliability, focused on PPE related knowledge, donning and doffing practices of healthcare providers across the eastern region of Saudi Arabia. Results A total of 312 healthcare providers across the eastern region of Saudi Arabia participated in the study, 208 physicians (66.7%) and 104 non-physicians (33.3%). Results indicate poor practice regarding PPE donning (13.8% reported the correct sequence) and PPE doffing (3.5% reported the correct sequence) among participants. In addition, practice and confidence scores regarding other issues with PPE were analyzed. Based on questionnaire responses, being male (T = 2.825; p = 0.008), being a non-physician (T = -2.120; p = 0.014) and being an allied medical professional (F = 5.379; p = 0.003) were significantly associated with higher confidence levels. Also, being a consultant was significantly associated with higher practice scores (F = 4.774; p = 0.008). Conclusion The study demonstrates deficiencies among healthcare providers in following the recommended practices for correctly using PPE during the pandemic. Poor practice in PPE donning and doffing necessitates additional educational and training programs focused on infection control practices.
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Affiliation(s)
- Mona Ashoor
- Department of Otolaryngology Head and Neck Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Saad Alshammari
- Department of Otolaryngology Head and Neck Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fahad Alzahrani
- Department of Otolaryngology Head and Neck Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Noorah Almulhem
- Department of Otolaryngology Head and Neck Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Zaid Almubarak
- Department of Otolaryngology Head and Neck Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ali Alhayek
- Department of Otolaryngology Head and Neck Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmed Alrahim
- Department of Otolaryngology Head and Neck Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah Alardhi
- Department of Otolaryngology Head and Neck Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Ecker H, Kolvenbach S, Herff H, Wetsch WA. Intubation using VieScope vs. Video laryngoscopy in full personal protective equipment - a randomized, controlled simulation trial. BMC Anesthesiol 2021; 21:288. [PMID: 34809581 PMCID: PMC8606276 DOI: 10.1186/s12871-021-01502-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/01/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND VieScope is a new type of laryngoscope, with a straight, transparent and illuminated blade, allowing for direct line of sight towards the larynx. In addition, VieScope is disposed of after single patient use, which can avoid cross-contaminations of contagious material. This has gained importance especially when treating patients with highly contagious infectious diseases, such as during the SARS-CoV2 pandemic. In this context, VieScope has not been evaluated yet in a clinical study. MATERIAL AND METHODS This study compared intubation with VieScope to video-laryngoscopy (GlideScope) in normal and difficult airway in a standardized airway manikin in a randomized controlled simulation trial. Thirty-five medical specialists were asked to perform endotracheal intubation in full personal protective equipment (PPE). Primary endpoint was correct tube position. First-pass rate (i.e., success rate at the first attempt), time until intubation and time until first correct ventilation were registered as secondary endpoints. RESULTS For correct tracheal tube placement, there was no significant difference between VieScope and GlideScope in normal and difficult airway conditions. VieScope had over 91% fist-pass success rate in normal airway setting. VieScope had a comparable success rate to GlideScope in difficult airway, but had a significantly longer time until intubation and time until ventilation. CONCLUSION VieScope and GlideScope had high success rates in normal as well as in difficult airway. There was no unrecognized esophageal intubation in either group. Overall time for intubation was longer in the VieScope group, though in an acceptable range given in literature. Results from this simulation study suggest that VieScope may be an acceptable alternative for tracheal intubation in full PPE. TRIAL REGISTRATION The study was registered at the German Clinical Trials Register www.drks.de (Registration date: 09/11/2020; TrialID: DRKS00023406 ).
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Affiliation(s)
- Hannes Ecker
- Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Simone Kolvenbach
- Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Holger Herff
- Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Wolfgang A Wetsch
- Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
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Lim WY, Ng B, Lee CK, Shen J, Koh C, Lee P. Strategy for Safe Bronchoscopy during COVID pandemic. Ann Thorac Surg 2021; 114:e29-e32. [PMID: 34678292 PMCID: PMC8526119 DOI: 10.1016/j.athoracsur.2021.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022]
Abstract
Aerosol generating procedures are avoided for COVID-19 patients to lower the risk of transmission to healthcare providers. However, when bronchoscopy is indicated, it remains unclear if the procedure performed under general anesthesia leads to contamination of the surroundings and if standard endoscopy reprocessing methods are effective in eradicating SARS-CoV-2. We share our experience of bronchoscopic retrieval of airway foreign body under general anesthesia in a patient tested positive for novel 2019 coronavirus disease (COVID 19). We focus on anesthesia techniques to minimise aerosolization.
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Affiliation(s)
- Wei-Yang Lim
- Division of Respiratory and Critical Care Medicine, National University Hospital, Singapore.
| | - Bryan Ng
- Department of Anesthesia, National University Hospital, Singapore
| | - Chun-Kiat Lee
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Jiayi Shen
- Department of Anesthesia, National University Hospital, Singapore
| | - Calvin Koh
- Division of Gastroenterology, National University Hospital, Singapore
| | - Pyng Lee
- Division of Respiratory and Critical Care Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Jones H, Gendre A, Walshe P, Walsh M, Glynn F, Lacy P, Gaffney R, McConn Walsh R, Mamdouh S, O'Rourke J, Morgan R, O'Brien ME, Shine N, Curley GF, O'Neill JP. The Royal College of surgeons multidisciplinary guidelines on elective tracheostomy insertion in COVID-19 ventilated patients. Surgeon 2021; 19:e265-e269. [PMID: 33423925 PMCID: PMC7833599 DOI: 10.1016/j.surge.2020.12.002] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/28/2020] [Accepted: 12/11/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The current COVID-19 pandemic has placed enormous strain on healthcare systems worldwide. Understanding of COVID-19 is rapidly evolving. Pneumonia associated with COVID-19 may lead to respiratory failure requiring mechanical ventilation. The rise in patients requiring mechanical ventilation may lead to an increase in tracheostomies being performed in patients with COVID-19. Performing tracheostomy in patients with active SARS-CoV-2 infection poses a number of challenges. METHODS These guidelines were written following multidisciplinary agreement between Otolaryngology, Head and Neck Surgery, Respiratory Medicine and the Department of Anaesthetics and Critical Care Medicine in the Royal College of Surgeons in Ireland. A literature review was performed and a guideline for elective tracheostomy insertion in patients with COVID-19 proposed. CONCLUSION The decision to perform tracheostomy in patients with COVID-19 should be undertaken by senior members of the multidisciplinary team. Steps should be taken to minimise risks to healthcare workers.
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Affiliation(s)
- Holly Jones
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland.
| | - Adrien Gendre
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
| | - Peter Walshe
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
| | - Michael Walsh
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
| | - Fergal Glynn
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
| | - Peter Lacy
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
| | - Robert Gaffney
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
| | - Rory McConn Walsh
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
| | - Sherif Mamdouh
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
| | - James O'Rourke
- Department of Anaesthesia and Critical Care Medicine, The Royal College of Surgeons, Ireland
| | - Ross Morgan
- Department of Respiratory Medicine, The Royal College of Surgeons, Ireland
| | | | - Neville Shine
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
| | - Gerard F Curley
- Department of Anaesthesia and Critical Care Medicine, The Royal College of Surgeons, Ireland
| | - James Paul O'Neill
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
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Montauban P, Balakumar C, Rait J, Zarsadias P, Iqbal S, Aravind B, Shrestha A, Fernandes R, Shah A. The important role of in-situ simulation in preparing surgeons for the COVID-19 pandemic. Surgeon 2021; 19:279-286. [PMID: 33039335 PMCID: PMC7508547 DOI: 10.1016/j.surge.2020.08.013] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/23/2020] [Accepted: 08/31/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Effective training is vital when facing viral outbreaks such as the SARS Coronavirus 2 (SARS-CoV-2) outbreak of 2019. The objective of this study was to measure the impact of in-situ simulation on the confidence of the surgical teams of two hospitals in assessing and managing acutely unwell surgical patients who are high-risk or confirmed to have COVID-19. METHODS This was a quasi-experimental study with a pretest-posttest design. The surgical teams at each hospital participated in multi-disciplinary simulation sessions to explore the assessment and management of a patient requiring emergency surgery who is high risk for COVID-19. The participants were surveyed before and after receiving simulation training to determine their level of confidence on a Visual Analog Scale (VAS) for the premise stated in each of the nine questions in the survey, which represented multiple aspects of the care of these patients. RESULTS 27 participants responded the pre-simulation survey and 24 the one post-simulation. The level of confidence (VAS score) were statistically significantly higher for all nine questions after the simulation. Specific themes were identified for further training and changes in policy. CONCLUSION In-situ simulation is an effective training method. Its versatility allows it to be set up quickly as rapid-response training in the face of an imminent threat. In this study, it improved the preparedness of two surgical teams for the challenges of the COVID-19 pandemic.
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Affiliation(s)
- Pierre Montauban
- General Surgery Department, William Harvey Hospital, Kennington Rd, Ashford, Kent, TN24 0LZ, United Kingdom.
| | - Charannya Balakumar
- General Surgery Department, William Harvey Hospital, Kennington Rd, Ashford, Kent, TN24 0LZ, United Kingdom.
| | - Jaideep Rait
- General Surgery Department, William Harvey Hospital, Kennington Rd, Ashford, Kent, TN24 0LZ, United Kingdom.
| | - Prizzi Zarsadias
- General Surgery Department, William Harvey Hospital, Kennington Rd, Ashford, Kent, TN24 0LZ, United Kingdom.
| | - Sara Iqbal
- General Surgery Department, William Harvey Hospital, Kennington Rd, Ashford, Kent, TN24 0LZ, United Kingdom.
| | - Biju Aravind
- General Surgery Department, William Harvey Hospital, Kennington Rd, Ashford, Kent, TN24 0LZ, United Kingdom.
| | - Ashish Shrestha
- General Surgery Department, William Harvey Hospital, Kennington Rd, Ashford, Kent, TN24 0LZ, United Kingdom.
| | - Roland Fernandes
- General Surgery Department, William Harvey Hospital, Kennington Rd, Ashford, Kent, TN24 0LZ, United Kingdom.
| | - Ankur Shah
- General Surgery Department, William Harvey Hospital, Kennington Rd, Ashford, Kent, TN24 0LZ, United Kingdom.
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Dix R, Straiton D, Metherall P, Laidlaw J, McLean L, Hayward A, Ginger G, Forrester L, O’Rourke P, Jefferies R. COVID-19: A systematic evaluation of personal protective equipment (PPE) performance during restraint. Med Sci Law 2021; 61:275-285. [PMID: 33715558 PMCID: PMC8490659 DOI: 10.1177/00258024211000805] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Restraint is widely practised within inpatient mental health services and is considered a higher-risk procedure for patients and staff. There is a sparsity of evidence in respect of the efficacy of personal protective equipment (PPE) used during restraint for reducing risk of infection. METHODS A series of choreographed restraint episodes were used to simulate contact contamination in research participants playing the roles of staff members and a patient. For comparison, one episode of simulated recording of physical observations was taken. Ultraviolet (UV) fluorescent material was used to track the simulated contact contamination, with analysis undertaken using established image registration techniques of UV photographs. This was repeated for three separate sets of PPE. RESULTS All three PPE sets showed similar performance in protecting against contamination transfer. For teams not utilising coveralls, this was dependent upon effective cleansing as part of doffing. There were similar patterns of contamination for restraint team members assigned to specific roles, with hands and upper torso appearing to be higher-risk areas. The restraint-related contamination was 23 times higher than that observed for physical observations. DISCUSSION A second layer of clothing that can be removed showed efficacy in reducing contact contamination. PPE fit to individual is important. Post-restraint cleansing procedures are currently inadequate, with new procedures for face and neck cleansing required. These findings leave scope for staff to potentially improve their appearance when donning PPE and engaging with distressed patients.
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Affiliation(s)
- Roland Dix
- Gloucestershire Health and Care NHS Foundation Trust, Montpellier Unit, Wotton Lawn Hospital, UK
| | - David Straiton
- Gloucestershire Health and Care NHS Foundation Trust, Montpellier Unit, Wotton Lawn Hospital, UK
| | - Peter Metherall
- Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, UK
| | - James Laidlaw
- Gloucestershire Health and Care NHS Foundation Trust, Montpellier Unit, Wotton Lawn Hospital, UK
| | - Lisa McLean
- Gloucestershire Health and Care NHS Foundation Trust, Montpellier Unit, Wotton Lawn Hospital, UK
| | - Andy Hayward
- Gloucestershire Health and Care NHS Foundation Trust, Montpellier Unit, Wotton Lawn Hospital, UK
| | - Gary Ginger
- Gloucestershire Health and Care NHS Foundation Trust, Montpellier Unit, Wotton Lawn Hospital, UK
| | - Louise Forrester
- Gloucestershire Health and Care NHS Foundation Trust, Montpellier Unit, Wotton Lawn Hospital, UK
| | - Paul O’Rourke
- Gloucestershire Health and Care NHS Foundation Trust, Montpellier Unit, Wotton Lawn Hospital, UK
| | - Rob Jefferies
- Avon and Wiltshire Mental Health Partnership NHS Trust, UK
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Hardy N, Dalli J, Khan MF, Nolan K, Cahill RA. Aerosols, airflow, and airspace contamination during laparoscopy. Br J Surg 2021; 108:1022-1025. [PMID: 33829231 PMCID: PMC8083507 DOI: 10.1093/bjs/znab114] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/15/2021] [Accepted: 03/01/2021] [Indexed: 11/12/2022]
Abstract
Laparoscopic surgery has been undermined throughout the COVID-19 pandemic by concerns that it may generate an infectious risk to the operating team through aerosolization of peritoneal particles. There is anyway a need for increased awareness and understanding of the occupational hazard for surgical teams regarding unfiltered escape of pollutants generated by surgical smoke and other microbials. Here, the aerosol-generating nature of this access modality was confirmed through repeatable real-time methodology both qualitatively and quantitively to inform best practice and additional engineering solutions to optimize the operating room environment.
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Affiliation(s)
- N Hardy
- UCD Centre of Precision Surgery, School of Medicine, University College Dublin, Dublin, Ireland
| | - J Dalli
- UCD Centre of Precision Surgery, School of Medicine, University College Dublin, Dublin, Ireland
| | - M F Khan
- UCD Centre of Precision Surgery, School of Medicine, University College Dublin, Dublin, Ireland
| | - K Nolan
- School of Mechanical and Material Engineering, University College Dublin, Dublin, Ireland
| | - R A Cahill
- UCD Centre of Precision Surgery, School of Medicine, University College Dublin, Dublin, Ireland
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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Bennardo L, Del Duca E, Dattola A, Cannarozzo G, Nistico SP. Management of laser treatments during the coronavirus disease 2019 pandemic: The Italian experience. Clin Dermatol 2021; 39:521-522. [PMID: 34518014 PMCID: PMC7884231 DOI: 10.1016/j.clindermatol.2021.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Luigi Bennardo
- Dermatological Unit of "Magna Graecia" University, Catanzaro, Italy
| | - Ester Del Duca
- Dermatological Unit of "Magna Graecia" University, Catanzaro, Italy
| | - Annunziata Dattola
- Department of Dermatology, University of Rome "Tor Vergata," Rome, Italy
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La Torre G, Marte M, Previte CM, Barone LC, Picchioni F, Chiappetta M, Faticoni A, Marotta D, Mazzalai E, Barletta VI, Kibi S, Cammalleri V, Dorelli B, Giffi M, Pocino RN, Massetti AP, Fimiani C, Turriziani O, Romano F, Antonelli G, Deales A, Mastroianni CM, Vasaturo F. The Synergistic Effect of Time of Exposure, Distance and No Use of Personal Protective Equipment in the Determination of SARS-CoV-2 Infection: Results of a Contact Tracing Follow-Up Study in Healthcare Workers. Int J Environ Res Public Health 2021; 18:ijerph18189456. [PMID: 34574381 PMCID: PMC8467491 DOI: 10.3390/ijerph18189456] [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] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 01/16/2023]
Abstract
The aim of this study is to assess the effect of contact time, contact distance and the use of personal protective equipment on the determination of SARS-CoV-2 infection in healthcare workers (HCWs). This study consists of an analysis of data gathered for safety reasons at the Sapienza Teaching Hospital Policlinico Umberto I in Rome through the surveillance system that was put into place after the worsening of the COVID-19 pandemic. The studied subjects consist of HCWs who were put under health surveillance, i.e., all employees who were in contact with subjects who were confirmed to have tested positive for SARS-CoV-2. The HCWs under surveillance were monitored for a period encompassing ten days after the date of contact, during which they undertook nasopharyngeal swab tests analysed through RT-PCR (RealStar® SARS-CoV-2 Altona Diagnostic–Germany). Descriptive and univariate analyses have been undertaken, considering the following as risk factors: (a) no personal protective equipment use (PPE); (b) Distance < 1 m between the positive and contact persons; (c) contact time > 15′. Finally, a Cox regression and an analysis of the level of synergism between factors, as specified by Rothman, were carried out. We analysed data from 1273 HCWs. Of these HCWs, 799 (62.8%) were females, with a sample average age of 47.8 years. Thirty-nine (3.1%) tested positive during surveillance. The overall incidence rate was 0.4 per 100 person-days. Time elapsed from the last exposure and a positive RT-PCR result ranged from 2 to 17 days (mean = 7, median = 6 days). In the univariate analysis, a distance <1 m and a contact time > 15′ proved to be risk factors for the SARS-CoV-2 infection, with a hazard ratio (HR) of 2.62 (95% CI: 1.11–6.19) and 3.59 (95% IC: 1.57–8.21), respectively. The synergism analysis found the highest synergism between the “no PPE use” x “Contact time”. The synergy index S remains strongly positive also in the analysis of the factors “no PPE use” x “Distance” and “Time of contact” x “Distance”. This study confirms the absolute need to implement safety protocols during the pandemic and to use the correct PPE within health facilities in order to prevent SARS-CoV-2 infection. The analysis shows that among the factors considered (contact time and distance, no use of PPE), there is a strong synergistic effect.
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Affiliation(s)
- Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
- Unit of Occupational Medicine, Teaching Hospital Policlinico Umberto I, 00161 Roma, Italy
- Correspondence:
| | - Mattia Marte
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
| | - Carlo Maria Previte
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
| | - Lavinia Camilla Barone
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
| | - Filippo Picchioni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
| | - Marta Chiappetta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
| | - Augusto Faticoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
| | - Daniela Marotta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
| | - Elena Mazzalai
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
| | - Vanessa India Barletta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
| | - Shizuka Kibi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
| | - Vittoria Cammalleri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
| | - Barbara Dorelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
| | - Monica Giffi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
| | - Roberta Noemi Pocino
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
| | - Anna Paola Massetti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
| | - Caterina Fimiani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
| | - Ombretta Turriziani
- Laboratory of Virology, Department of Molecular Medicine, Sapienza University of Rome, 00185 Roma, Italy; (O.T.); (G.A.)
| | - Ferdinando Romano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
| | - Guido Antonelli
- Laboratory of Virology, Department of Molecular Medicine, Sapienza University of Rome, 00185 Roma, Italy; (O.T.); (G.A.)
| | - Alberto Deales
- Health Direction, Teaching Hospital Policlinico Umberto I, 00161 Roma, Italy;
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy; (M.M.); (C.M.P.); (L.C.B.); (F.P.); (M.C.); (A.F.); (D.M.); (E.M.); (V.I.B.); (S.K.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.P.M.); (C.F.); (F.R.); (C.M.M.)
| | - Fortunata Vasaturo
- Clinica Medica Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, 00185 Roma, Italy;
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50
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Slomski A. Covering Tracheostomies Reduces Viral Spread to Health Care Staff. JAMA 2021; 326:800. [PMID: 34547093 DOI: 10.1001/jama.2021.13454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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