A qualitative study

INTRODUCTION

The COVID-19 pandemic has exposed a need to understand the challenges associated with wearing Personal protective Equipment (PPE). The aim in this study was to explore emergency nurses' experiences early in the COVID-19 pandemic in Australia and the impact of PPE use on their practice.

METHODS

An explorative descriptive qualitative study was conducted between January 2022 and April 2022. Eighteen emergency nurses and six leaders participated. Semi-structured interviews (n = 21) and one focus group were conducted. Interview transcripts were analysed using Braun and Clarke's framework.

RESULTS

Two major themes were identified. The first theme was: (1) The shifting ground of the COVID-19 pandemic response. Associated sub-themes were: i) What's the go with PPE today? ii) In the beginning we were scrambling for masks; iii) Emergency is the true frontline. The second theme was: (2) Physical and emotional impacts of emergency nursing work. Sub-themes were: (i) Facing the fear of exposure; (ii) By the end of the shift I am just absolutely spent; iii) Discomfort of wearing PPE impacts on compliance.

CONCLUSIONS

Healthcare leaders need to secure PPE supply chains and evaluate the effectiveness and side-effects of different PPE designs to minimise occupational harms associated with prolonged PPE use.

Radiographer experiences of personal protective equipment during COVID-19 in Gauteng, South Africa

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.

COVID-19 Infection Prevention and PPE Use: A Cross-Sectional Survey of Maternity Health Care Workers' Perspectives and Practices in a Tertiary Hospital, Nigeria

BACKGROUND

Maternity healthcare workers play an important role in curbing maternal and perinatal morbidity and mortality rates. They must be supported to protect themselves from the adverse impact of Covid 19 infection. This study assessed the knowledge, attitude and practice of maternity health care workers towards personal protective equipment (PPE) in preventing coronavirus infection.

METHODOLOGY

This was a prospective cross-sectional survey of consecutively consenting 380 maternity healthcare workers in a tertiary health institution in southwestern Nigeria between September 2021 and December 2021. A self-administered questionnaire was used to capture socio-demographic data and assess the survey participant's knowledge, attitude and practice as regards Covid-19 infection and transmission prevention and PPE use.

RESULTS

Only 22.1% (n = 84) of the respondents considered the pandemic a high health risk; 46.1% (n = 175) considered it a low health risk whilst 31.8% (n =121) of the MHWs considered its risk as moderate. The knowledge of the complete PPE inventory varied significantly with education status (p< 0.0001), 90.1% of the MHWs with knowledge of full inventory had tertiary education, proximity to patients during work (p<0.0001, 80% proximity), and work stations (p < 0.0005, 68.4% clinics). When utilizing PPEs 88.2% (n = 335) reported varying forms of discomfort and only 10.8% (n = 41) reported nil discomfort associated with its use. The commonly reported complaints were increased body heat, skin rashes, excessive sweat, and breathing difficulties.

CONCLUSION

There is a need to continually educate, train and retrain medical health workers on the need for the provision and proper use of personal protective equipment.

Headache Associated with PPE During COVID-19 Pandemic in Health Care Workers

PURPOSE

In the pandemic coronavirus disease 2019 (COVID-19), health care workers (HCWs) are at very high risk. Personal protective equipment (PPE) and masks are not only difficult to wear while working but also causes various complications. The present self-administered questionnaire- based study aimed to explore the headache and complications in HCWs on wearing PPE during the COVID-19 pandemic.

METHODS

The present study was performed by obtaining a self-administered questionnaire from HCWs, which provides evidence of various complications due to the use of a PPE and mask.

RESULTS

Out of a total of 329 respondents, 189(57.45%), 67(20.36%), 238(72.34%), 213(64.74%), 177(53.80%), and 34(10.33%) reported headache, breathlessness, suffocation, nose pain, ear pain, and leg pain respectively. Out of 329 respondents, 47(14.29%) had pre-existing headaches. Headache was significantly high for those who wore PPE for 4-6h (121/133; 87.05%) than that of those who wore up to 4h (18/26; 69.23%). Of the 34(24.46%) required medication who reported headaches wearing PPE. Acetaminophen is quite helpful in most health care workers to decrease headaches. Nose-related complications occur frequently in health care workers after regular shifts for more than 6 days. Gelatinous adhesives patch was a wonderful prophylactic remedy as it was helpful to prevent nose- related complications in 24 HCWs out of 25(96%).

CONCLUSIONS

More than half of the HCWs reported headache, suffocation, nose pain, and ear pain. Duration of PPE use of more than 4h is significantly associated with headache. Short duration PPE use prevent HCWs from headache and various ill effects.

Effect of Wearing Personal Protective Equipment (PPE) for COVID-19 Treatment on Blood Culture Contamination: Implication for Optimal PPE Strategies

The personal protective equipment (PPE) used to minimize exposure to hazards can hinder healthcare workers from performing sophisticated procedures. We retrospectively reviewed 77,535 blood cultures (202,012 pairs) performed in 28,502 patients from January 2020 to April 2022. The contamination rate of all blood cultures was significantly elevated in the coronavirus disease 2019 ward at 4.68%, compared to intensive care units at 2.56%, emergency rooms at 1.13%, hematology wards at 1.08%, and general wards at 1.07% (All of P < 0.001). This finding implies that wearing PPE might interfere with adherence to the aseptic technique. Therefore, a new PPE policy is needed that considers the balance between protecting healthcare workers and medical practices.

PPE non-compliance among construction workers: An assessment of contributing factors utilizing fuzzy theory

INTRODUCTION

Construction practitioners are at a disproportionately higher risk of fatal and nonfatal injuries compared to practitioners from other industries. The absence of and inappropriate use of personal protective equipment (PPE), hereinafter referred to as PPE non-compliance, are major causes of fatal and nonfatal injuries at construction workplaces.

METHOD

Accordingly, a robust 4-step research methodology was employed to investigate and assess factors that contribute to PPE non-compliance. As a result, 16 factors were identified utilizing literature review and ranked utilizing fuzzy set theory and K-means clustering. Top among them: inadequate safety supervision, poor risk perception, lack of climate adaptation, lack of safety training, and lack of management support.

RESULTS

Managing construction safety in a proactive manner is vital to eliminate or minimize construction hazards and improve overall site safety. Thus, proactive measures to address these 16 factors were identified utilizing a focus group methodology. The validation of the statistical findings with that of the focus groups of industry professionals provides validation of the findings as both practical and actionable.

PRACTICAL APPLICATIONS

This study significantly contributes to construction safety knowledge and practice which, in turn, aids academic researchers and construction practitioners in their continuous efforts to reduce fatal and nonfatal injuries among construction workers.

Cooling vest improves surgeons' thermal comfort without affecting cognitive performance: a randomised cross-over trial

OBJECTIVES

Surgeons become uncomfortable while performing surgery because heat transfer and evaporative cooling are restricted by insulating surgical gowns. Consequently, perceptions of thermal discomfort during surgery may impair cognitive performance. We, therefore, aimed to evaluate surgeons' thermal comfort, cognitive performance, core and mean skin temperatures, perceptions of sweat-soaked clothing, fatigue and exertion with and without a CoolSource cooling vest (Cardinal Health, Dublin, Ohio, USA).

METHODS

Thirty orthopaedic surgeons participated in a randomised cross-over trial, each performing four total-joint arthroplasties with randomisation to one of four treatment sequences. The effects of cooling versus no cooling were measured using a repeated-measures linear model accounting for within-subject correlations.

RESULTS

The cooling vest improved thermal comfort by a mean (95% CI) of -2.1 (-2.7 to -1.6) points on a 0-10 scale, p<0.001, with no evidence of treatment-by-period interaction (p=0.94). In contrast, cooling had no perceptible effect on cognition, with an estimated mean difference (95% CI) in Cleveland Clinic Cognitive Battery (C3B) Processing Speed Test score of 0.03 (95% CI -2.44 to 2.51), p=0.98, or in C3B Visual Memory Test score with difference of 0.88 (95% CI -2.25 to 4.01), p=0.57. Core temperature was not lower with the cooling vest, with mean difference (95% CI) of -0.13 (-0.33°C to 0.07°C), p=0.19, while mean skin temperature was lower, with mean difference of -0.23 (95% CI -0.40°C to -0.06°C) lower, p=0.011. The cooling vest significantly reduced surgeons' perceptions of sweat-soaked clothing, fatigue and exertion.

CONCLUSIONS

A cooling vest worn during surgery lowered core and skin temperatures, improved thermal comfort, and decreased perceptions of sweating and fatigue, but did not improve cognition. Thermal discomfort during major orthopaedic surgery is thus largely preventable, but cooling does not affect cognition.

TRIAL REGISTRATION NUMBER

NCT04511208.

Impact of DHCWs' Safety Perception on Vaccine Acceptance and Adoption of Risk Mitigation Strategies

OBJECTIVES

To estimate the association between safety perception on vaccine acceptance and adoptions of risk mitigation strategies among dental health care workers (DHCWs).

METHODS

A survey was emailed to DHCWs in the New Jersey area from December 2020 to January 2021. Perceived safety from regular SARS-CoV-2 testing of self, coworkers, and patients and its association with vaccine hesitancy and risk mitigation were ascertained. Risk Mitigation Strategy (RiMS) scores were computed from groupings of office measures: 1) physical distancing (reduced occupancy, traffic flow, donning of masks, minimal room crowding), 2) personal protective equipment (fitted for N95; donning N95 masks; use of face shields; coverings for head, body, and feet), and 3) environmental disinfection (suction, air filtration, ultraviolet, surface wiping).

RESULTS

SARS-CoV-2 testing of dental professionals, coworkers, and patients were perceived to provide safety at 49%, 55%, and 68%, respectively. While dentists were least likely to feel safe with regular self-testing for SARS-CoV-2 (P < 0.001) as compared with hygienists and assistants, they were more willing than hygienists (P = 0.004; odds ratio, 1.79 [95% CI, 1.21 to 2.66]) and assistants (P < 0.001; odds ratio, 3.32 [95% CI, 1.93 to 5.71]) to receive the vaccine. RiMS scores ranged from 0 to 19 for 467 participants (mean [SD], 10.9 [2.9]). RiMS scores did not significantly differ among groups of DHCWs; however, mean RiMS scores were higher among those who received or planned to receive the COVID-19 vaccine than those with who did not (P = 0.004). DHCWs who felt safer with regular testing had greater RiMS scores than those who did not (11.0 vs. 10.3, P = 0.01).

CONCLUSIONS

Understanding DHCWs' perception of risk and safety is crucial, as it likely influences attitudes toward testing and implementation of office risk mitigation policies. Clinical studies that correlate risk perception and RiMS with SARS-CoV-2 testing are needed to demonstrate the effectiveness of RiMS in dental care settings.

KNOWLEDGE TRANSFER STATEMENT

Educators, clinicians, and policy makers can use the results of this study when improving attitudes toward testing and implementation of risk mitigation policies within dental offices, for current and future pandemics.

Environmental footprints of disposable and reusable personal protective equipment ‒ a product life cycle approach for body coveralls

Body coveralls, often made of single-use plastics, are essential Personal Protective Equipment (PPE) and, along with masks, are widely used in healthcare facilities and public spaces in the wake of the recent COVID-19 pandemic. The widespread use of these body coveralls poses a significant threat to terrestrial and aquatic ecosystems, given their polluting nature and disposal frequency. Therefore, it is necessary to promote the adoption of alternatives that increase the safe reusability of PPE clothing and reduce environmental and health hazards. This study presents a comparative Cradle-to-Grave Life Cycle Assessment (LCA) of disposable and reusable PPE body coveralls from a product life cycle perspective. A comprehensive life cycle inventory and LCA framework specific to Indian conditions have been developed through this study. The LCA is performed as per standard protocols using SimaPro software under recipe 2016 (H) impact assessment method. Six midpoint impact categories viz. Global Warming Potential, Terrestrial Acidification, Freshwater Eutrophication, Terrestrial Ecotoxicity, Human Carcinogenic Toxicity, and Water Consumption are assessed, along with Cumulative Energy Demand. Results suggest that reusable PPE improves environmental and human health performance in all the impact categories except water consumption. Sensitivity analysis reveals that replacing conventional electricity with solar energy for PPE manufacturing and disposal will provide additional environmental benefits. The findings can help the medical textile industries, healthcare workers, and policymakers to make environmentally informed choices.

Laryngeal injury in a coronavirus disease 2019 caregiver following voluntary cough-holding within an inappropriately sized personal protective equipment suit

OBJECTIVE

To document laryngeal framework rupture following voluntary cough-holding as an airway complication of donning a personal protective equipment suit that was too small in size.

METHODS

Clinical record and literature review, with proposition of plausible aerodynamics of the airway injury.

RESULTS

Whilst carrying out his duty in the coronavirus disease ward, a resident attempted to stifle a paroxysm of cough when wearing a personal protective equipment suit that was too small with his neck flexed and restricted. There was a sudden release of pressure, intense pain and swelling in the neck with crepitus. Imaging revealed a non-displaced fracture in the lower end of the partially ossified right thyroid lamina, a cricothyroid membrane tear and subcutaneous emphysema. The symptoms resolved gradually on conservative management.

CONCLUSION

This report underlines the importance of donning appropriately sized personal protective equipment and encouraging its proper use amongst coronavirus disease 2019 caregivers. Non-traumatic laryngeal injury, itself a rare event, has never been reported as a posture-related complication of wearing personal protective equipment.

Structural and Managerial Risk Factors for COVID-19 Occurrence in French Nursing Homes

BACKGROUND

Nursing home (NH) residents accounted for half of the deaths during the 2020 spring wave of the coronavirus disease 2019 (COVID-19) epidemic in France. Our objective was to identify structural and managerial factors associated with COVID-19 outbreaks in NHs.

METHODS

We conducted in July 2020 a retrospective study by questionnaire addressed to NH directors in the Brittany region of France. The questions related to structural characteristics of the establishment, human resources, and crisis management decisions. The primary endpoint was the occurrence of at least one confirmed case of COVID-19 among residents between March 1, 2020 and May 31, 2020. The secondary endpoint was total mortality during this period. We used multivariate regressions to identify factors associated with these outcomes.

RESULTS

Responses were collected from 231 NHs hosting 20,881 residents, representing a participation rate of 47%. In 24 (10%) NHs, at least one resident presented confirmed COVID-19. NHs often implemented stringent protective measures, with 65% of them choosing to confine residents to their rooms. In multivariate analysis, factors associated with a reduced risk of case occurrence were in-room meal service, early ban of family visits, and daily access to an outdoor space. No association was found between mortality and the factors studied. Our results show an early and strict implementation of lockdown measures, with good epidemiological results in a context of shortage of personal protective equipment (PPE) and non-vaccination. Nevertheless, it raises ethical questions concerning respect of residents' wellbeing and rights.

CONCLUSION

Cessation of communal dining seems to be the main measure likely to be effective in preventive terms. It does not seem that room lockdown and cessation of group activities should be recommended, particularly if mask wearing is possible.

[Security protocols adapted to COVID-19 in elective surgery thru 2021]

BACKGROUND

Medical personnel are among the populations with the most infections and morbidity and mortality during the COVID-19 pandemic worldwide.

OBJECTIVE

To evaluate patient and health personnel safety in anesthetic procedures of elective surgeries during COVID-19 pandemic in a 3rd level care Hospital in Puebla, Mexico.

MATERIAL AND METHODS

Descriptive, prospective, analytical study in a 3rd level care unit of the Mexican Social Security Institute in Puebla, Mexico. Elective surgeries from all shifts and any specialty, whose staff signed informed consent, were included. The modified surgical safety checklist for COVID 19, from the World Federation of Societies of Anesthesiologists, was applied.

RESULTS

170 surgeries were evaluated, the predominant specialties were oncosurgery (39.41%), urology (25.29%) and general surgery (14.71%). The most used anesthetic technique was general anesthesia (47.05%); 10.12% accomplished safe intubation/extubation protocols, presence of essential personnel in 6.34%. The use of personal protective equipment decreased during the stages of the pandemic, the use of face masks by medical personnel/patients is the most frequent (100%).

CONCLUSIONS

Security measures have decreased. Adequate security protocols must be continued to avoid new infections. Basic protection measures, the use of personal protective equipment and other protection strategies must persist.

Exploring healthcare workers' perspectives of video feedback for training in the use of powered air purifying respirators (PAPR) at the onset of the COVID-19 pandemic

BACKGROUND

With the advent of COVID-19, many healthcare workers (HWs) in Australia requested access to powered air purifying respirators (PAPR) for improved respiratory protection, comfort and visibility. The urgency of the response at our hospital required rapid deployment of innovative training to ensure the safe use of PAPRs, in particular, a video-feedback training option to prepare HWs for PAPR competency.

AIM

To explore the feasibility, acceptability, and utility of video-feedback in PAPR training and competency assessment.

METHODS

Semi-structured interviews were conducted with 12 HWs, including clinicians from Intensive Care, Anaesthetics and Respiratory Medicine, at a large teaching hospital in Australia.

FINDINGS

Participants believed that the use of video-feedback in PAPR training was feasible, acceptable and useful. They described a variety of benefits to learning and retention, from a variety of ways in which they engaged with the personal video-feedback. Participants also described the impact of reviewing personalised practice footage, compared to generic footage of an ideal performance.

CONCLUSION

By conceptualising video-feedback using a pedagogical approach, this study contributes to knowledge around optimising methods for training HWs in PPE use, particularly when introducing a new and complex PPE device during an infectious disease outbreak.

Personal protective equipment training & lived experience for healthcare staff during COVID-19

Objectives

To describe the lived experience of healthcare staff during the Coronavirus Disease 2019 (COVID-19) pandemic relating to the use of personal protective equipment (PPE) and investigate risks associated with PPE use, error mitigation and acceptability of mindfulness incorporation into PPE practice.

Methods

A qualitative human factors' study at two Irish hospitals occurred in late 2020. Data was collected by semi-structured interview and included role description, pre-COVID-19 PPE experience, the impact of COVID-19 on lived experience, risks associated with PPE use, contributory factors to errors, error mitigation strategies and acceptability of incorporating mindfulness into PPE practice.

Results

Of 45 participants, 23 of whom were nursing staff (51%), 34 (76%) had previously worn PPE and 25 (56%) used a buddy system. COVID-19 lived experience impacted most on social life/home-work interface (n=36, 80%). Nineteen staff (42%) described mental health impacts. The most cited risk concerned 'knowledge of procedures' (n=18, 40%). Contributory factors to PPE errors included time (n=15, 43%) and staffing pressures (n=10, 29%). Mitigation interventions included training/education (n=12, 40%). The majority (n=35, 78%) supported mindfulness integration into PPE practice.

Conclusions

PPE training should address healthcare staff lived experiences and consider incorporation of mindfulness and key organisational factors contributing to safety.

[Body image adaptation in health personnel during COVID-19]

BACKGROUND

Everything that has contact with the body is also integrated as part of the individual's body image; Personal Protective Equipment (PPE) could be integrated into body image.

OBJECTIVE

To describe the characteristics of the drawing of the human figure as a projective tool of body image in health personnel.

MATERIAL AND METHODS

A retrospective longitudinal descriptive study was carried out, which consisted of the compilation and analysis of the drawing tests of the human figure performed on health personnel in the contingency of COVID-19. A descriptive analysis of the qualitative variables and an inferential analysis with McNemar's test were carried out to compare proportions between groups.

RESULTS

147 drawings in the previous context and their respective drawings in context during the contingency were included. When comparing both groups, in the pandemic context an increase in distortions or omissions was observed (p = 0.013), mainly located in the hands and arms (p < 0.001). Also, traces suggestive of isolation (p = 0.039), drawings with poor definition of the eyes (p = 0.69), inclusion of PPE (p < 0.001), and omission of the nose (p = 0.011) and mouth (p < 0.001) were observed).

CONCLUSIONS

The increase in distortions or omissions may be related to reconstructing the social part. Six months after the start of the contingency, 40% of the health personnel had already incorporated the PPE into their projective drawing of body image.

Work-based concerns of Australian frontline healthcare workers during the first wave of the COVID-19 pandemic

OBJECTIVE

This research sought to gauge the extent to which doctors, nurses and paramedics in Australia were concerned about contracting SARS-CoV-2 during the country's first wave of the virus in April 2020.

METHODS

Australian registered doctors, nurses and paramedics (n=580) completed an online questionnaire during April 16-30, 2020 (period immediately following the highest four-week period (first wave) of SARS-CoV-2 confirmed cases in Australia).

RESULTS

During April 2020, two-thirds of participants felt it was likely they would contract SARS-CoV-2 at work. Half the participants suggested Personal Protective Equipment (PPE) supplies were inadequate for them to safely perform their job, with two-thirds suggesting management advised them to alter normal PPE use. One-third of participants suggested they were dissatisfied with their employer's communication of COVID-19 related information. Conclusions and implications for public health: After reports of PPE shortages during Australia's first SARS-CoV-2 wave, and suggestions access to PPE was still limited during Australia's second wave five months later, we must forecast for this and future pandemics ensuring adequate access to PPE for frontline healthcare workers. Further, ensuring consistent and standardised pathways for communication to staff (acknowledging the reality that information may rapidly change) will help alleviate frustration and anxiety.

Implementing COVID-19 Simulation Training for Anesthesiology Residents

INTRODUCTION

During the COVID-19 pandemic, anesthesiology residents faced increased risk of exposure to SARS-CoV-2 while performing aerosolizing procedures. We developed an airway simulation on the out-of-operating-room management of COVID-19 patients.

METHODS

A 90-minute simulation focused on caring for a 45-year-old COVID-19 patient provided training in donning and doffing personal protective equipment, intubation, management of postinduction hypotension, management of ICU ventilators, treatment strategies for acute respiratory distress syndrome (ARDS), interpersonal communication, and resource management. Presimulation, postsimulation, and 3-months postsimulation questionnaires measured changes in confidence, knowledge, and clinical practice. Statistical analysis was completed using related-samples Wilcoxon signed rank tests.

RESULTS

Twenty-four residents participated in the simulation. Questionnaire response rates were 100% presimulation and postsimulation and 88% 3-months postsimulation. Confidence scores (1 = not at all, 5 = extremely) improved with donning and doffing personal protective equipment (from 3.0 to 4.1, p < .001), ARDS management (from 3.1 to 4.0, p < .001), and COVID-19 airway management (from 2.8 to 4.0, p < .001). Correct answers on 10 knowledge questions increased significantly between presimulation and postsimulation (from 5.1 to 9.0, p < .001) but not between presimulation and 3-months postsimulation (from 5.1 to 5.8, p = .27). All participants who cared for COVID-19 patients at 3 months agreed or strongly agreed that their current management of COVID-19 patients was directly influenced by the simulation session (M = 4.4).

DISCUSSION

This simulation is a safe, effective method of providing the experiential training necessary to care for actual COVID-19 patients during an active pandemic.

COVID-19 Pneumonia and Status Asthmaticus With Respiratory Failure in a Pediatric Patient: A Simulation for Emergency Medicine Providers

INTRODUCTION

During COVID-19 surges, medical trainees may perform patient care outside typical clinical responsibilities. While respiratory failure in pediatric patients secondary to COVID-19 is rare, it is critical that providers can effectively care for these children while protecting the health care team. Simulation is an important tool for giving learners a safe environment in which to learn and practice these new skills.

METHODS

In this simulation, learners provided care to a 13-year-old male with obesity, COVID-19 pneumonia, status asthmaticus, and respiratory failure. Target learners were pediatric emergency medicine fellows and emergency medicine residents. Providers were expected to identify the signs and symptoms of status asthmaticus, pneumonia, and respiratory failure and demonstrate appropriate evaluation and management while minimizing COVID-19 exposure. Participants completed a postsimulation survey on their satisfaction and confidence in performing the objectives.

RESULTS

Twenty-eight PGY 1-PGY 6 learners participated in this simulation. The postsimulation survey showed that most learners felt the simulation was effective in teaching the evaluation and management of respiratory failure due to COVID-19 (M = 5.0; 95% CI, 4.9-5.0) and was relevant to their work (M = 5.0; 95% CI, 5.0-5.0).

DISCUSSION

Learners felt that the case was effective in teaching the skills needed to care for a child with COVID-19 pneumonia, status asthmaticus, and respiratory failure. Future directions include updating the case with new COVID-19 knowledge and personal protective equipment practices gained over time, using hybrid telesimulation to increase learners' exposure to the case, and adapting the case for other health care providers.

[An Evaluation of the Validity and Reliability of the Face Mask Use Scale's Korean Version among Community-Dwelling Adults]

PURPOSE

This study evaluated the validity and reliability of the Korean version of the Face Mask Use Scale (K-FMUS) among community-dwelling adults.

METHODS

The participants of the study were community-dwelling adults in Korea using face masks during the COVID-19 pandemic. The English FMUS was translated into Korean using forward and backward translation procedures. The construct validity and reliability of the K-FMUS were evaluated using the exploratory and confirmatory factor analyses and the internal consistency reliability test.

RESULTS

The K-FMUS comprised 6 items divided into 2 factors. The variance of the factors was approximately 79.1%, which suggested that the scale indicated the effectiveness of face mask usage. The two factors were labeled as face mask use in society (4 items) and face mask use at home (2 items). Cronbach's α value for the overall scale was .88.

CONCLUSION

The K-FMUS is a valid and reliable scale that can be used to measure face mask usage among community-dwelling adults in Korea during the COVID-19 pandemic.

The UK national registry of ENT surgeons with coronavirus disease 2019: one year on

OBJECTIVES

To report the one-year findings of the UK national registry of ENT surgeons with suspected or confirmed coronavirus disease 2019, and the results of a survey on the coronavirus disease 2019 experience of UK ENT trainees.

METHOD

An online registry was created in April 2020. A separate survey was circulated electronically to all members of the Association of Otolaryngologists in Training.

RESULTS

The registry recorded 98 clinicians with confirmed or suspected coronavirus disease 2019. The majority of infections were reported in the first wave of spring 2020. Two ENT surgeons were hospitalised and one died. The majority suspected workplace exposure, with a significant proportion attributing this to a lack of personal protective equipment at a time before formal guidance had been introduced. Of the ENT trainees surveyed, almost one-third believed that they had contracted coronavirus disease 2019.

CONCLUSION

This highlights the importance of ongoing risk-reduction measures, including optimal personal protective equipment and vaccination.

The effects of chlorination, thickness, and moisture on glove donning efficiency

Changing gloves more frequently is encouraged, more now than ever given the COVID-19 pandemic. When the donning process has moisture introduced, however, complications can arise, which consumes vital time. Most commonly, gloves undergo a chlorination treatment to reduce glove tack, allowing easier donning. To assess the effects of different chlorination strengths and glove thicknesses on donning, acrylonitrile butadiene gloves were manufactured at two different thicknesses (0.05 and 0.10 mm) with 4 different chlorination treatments: 0, 500, 1000 and 2000 ppm. Six participants were used to assess the time taken to don each of the glove sets with dry and wet hands (16 tests in total). Overall, the thicker gloves took longer to don, due to differences in the material stiffness hindering the donning process. The quickest performance from the chlorinated gloves was noted in the 1000 and 2000 ppm concentrations. Wet conditions also showed significant increases in the donning time.Practitioners Summary: The study was conducted based on the gaps identified in previous literature reviews which revealed the requirement for a greater understanding of glove donning process. It was found a stronger chlorination was detrimental when the hands were wet, but better when dry. Thicker gloves were also found to be detrimental. Abbreviations: PPE: personal protective equipment; NBR: acrylonitrile butadiene rubber; NRL: natural rubber latex; EN: European standards; s: seconds; Ts: tensile strength; Fb: force at break; T: thickness; Eb: elongation at break; HSD: honest significant difference; FTIR: Fourier transform infrared; covid-19: coronavirus disease 2019.

[Dermatological reactions secondary to the use of personal protective equipment]

BACKGROUND

During the COVID-19 pandemic, healthcare professionals use personal protective equipment (PPE) on a constant basis and for extended periods, leading to adverse dermatological reactions, a situation little known and studied despite its relevance.

OBJECTIVE

To determine the risk factors associated with the development of adverse dermatological reactions in health workers using PPE during the COVID-19 pandemic.

MATERIAL AND METHODS

An observational, cross-sectional, analytical study conducted through an online survey that evaluated the association between dermatological reactions and the use of PPE through a descriptive and inferential statistical analysis.

RESULTS

There was a sample of 171 healthcare professionals. It was reported a high prevalence of adverse reactions (59%) and the most affected sites were the facial region and hands. The use of PPE > 6 hours, a history of dermatological disease, female gender, use of plastic overalls and the use of a respirator were documented as risk factors.

CONCLUSIONS

Being an infectious disease, COVID-19 forces healthcare professionals to use accessories as a form of personal protection, implying potential health risks; for this, effective preventive strategies and treatment are required.

"Concerns and Psychological Wellbeing of Health Care Workers During the COVID-19 Pandemic in a Tertiary Care Hospital in NSW"

Background

In early 2020, the impending COVID‐19 pandemic placed a once‐in‐a‐generation professional and personal challenge on healthcare workers. Publications on direct physical disease abound. The authors wanted to focus on doctors' psychological well‐being.

Aims

To assess the impact of the COVID‐19 pandemic on doctors' well‐being and evaluate their concerns as the pandemic progressed.

Methods

A mixed‐methods, hospital‐based survey was sent to doctors at the 650‐bed tertiary referral hospital in NSW at two different periods (late‐March and early May 2020). A validated mental well‐being tool (Short Warwick Edinburgh Mental Well‐being Scale (SWEMWBS)) was combined with COVID‐19‐specific questions.

Results

Two hundred and thirty‐five responses were obtained from 450 doctors, with a response rate of 32% in the first survey and 20% in the second. The majority (35%) of respondents were doctors‐in‐training, followed by staff‐specialists (23%). The highest response was from frontline workers in both surveys, including the intensive care unit (27%), anaesthesia (21%) and emergency department (13%). ‘Extreme concern’ regarding personal protective equipment (PPE) shortage dropped from 22.6% to 2.2% and ‘extreme concern’ of contracting COVID‐19 fell from 22.6% to 3.4% in the second survey. The proportion of respondents with a ‘low’ psychological well‐being score improved from 38% to 27% between the two surveys. The resulting mean improvement in the SWEMWBS was 3.49 (95% confidence interval = 3.06–3.91, P < 0.001).

Conclusion

Both COVID‐19 specific concerns and psychological well‐being improved greatly in the second survey. Possible explanations are the fall in COVID‐19 cases in the district, improvements in PPE supply and supportive measures communicated to doctors during this period.

Lessons from Cadaver Dissection during the COVID-19 Pandemic

The rapid increase of the coronavirus disease 2019 pandemic from mid-February 2020 has led the anatomy department of the Korea University College of Medicine to cease the dissection laboratory. However, the hands-on anatomy laboratory experience is paramount to maximizing learning outcomes. In this paper, we share the experiences and lessons learned through the face-to-face cadaveric dissection experience during this disruptive situation. To minimize infection risks, the following strategies were applied: first, students' on-campus attendance was reduced; second, body temperatures and symptoms were checked before entering the laboratory, and personal protective equipment was provided to all participants; and third, a negative pressure air circulation system was used in the dissection room. We suggest that conducting face-to-face cadaveric anatomy dissection is feasible when the daily count of newly infected cases stabilizes, and there is ample provision of safety measures to facilitate hands-on education.

The Effects of Firefighter Equipment and Gear on the Static and Dynamic Postural Stability of Fire Cadets

BACKGROUND

Slips, trips, falls, and jumps were the second leading cause of injuries at the fireground.

RESEARCH QUESTION

The purpose of this study was to explore the effects of firefighter equipment and gear (EQG) on postural stability and determine if load per kg of body mass (L/BM) is associated with postural stability.

METHODS

26 male fire cadets (26.15 ± 4.16 yr., 178.92 ± 6.92 cm, 86.61 ± 9.09 kg) were included in the analyses. Participants performed 3 single-leg landings (SLL) with and without EQG. The first 3 seconds of ground reaction forces following initial ground contact were used to calculate dynamic postural stability index (DPSI). Participants completed 2 static balance tasks (normal stability and limits of stability (LoS)) with and without EQG. Main outcome measures were overall LoS score (LoSS), direction-specific LoSS, and LoS distance (cm) of COP excursion (LoSD) in the anterior, posterior, right, and left directions. Separate paired-samples t-tests were run to determine the differences between load conditions for DPSI, overall LoSS, direction-specific LoSS, and LoSD in all directions. Bivariate correlations were conducted to determine the relationship of L/BM to DPSI, overall LoSS, and LoSS and LoSD in the anterior, posterior, right and left directions.

RESULTS

Due to the use of multiple statistical tests, a Bonferroni correction was used, and the alpha level of .05 was adjusted to .005. DPSI was significantly higher loaded than unloaded, t(25) = -13.965, p < .001, d = 7.032, 95% CI, -0.133 to -0.099. No other comparisons were significant. A significant strong positive correlation (r(24) = .665, p < .001) was observed between L/BM and DPSI. No other correlations were significant.

SIGNIFICANCE

This study demonstrates that firefighter EQG may significantly impact a cadet's ability to maintain postural stability while performing their duties.

Feasibility study of the Vitom 3D exoscope in ENT surgery using an animal model: relevance to coronavirus disease 2019

Objective

The application of a 4K display resolution three-dimensional exoscope system (Vitom 3D) was evaluated to determine the feasibility of adopting the system in ENT surgery in the coronavirus disease 2019 era and beyond.

Methods

Eighteen ENT surgeons performed structured otological tasks on fresh-frozen sheep heads using the Vitom 3D. Structured feedback of the participants’ experience was analysed.

Results

Seventy-four per cent and 94 per cent of participants reported that the Vitom 3D was ergonomic and comfortable to use respectively. Whilst colour fidelity and image quality were very good, 50 per cent of participants reported image distortion and pixilation at the highest magnification. All participants agreed that there was an increased educational value to exoscope technology. Half the participants preferred the microscope over the Vitom 3D for fine otological work, which may reflect the learning curve.

Conclusion

The Vitom 3D exoscope is a promising and viable alternative for performing otological surgery when using full personal protective equipment in the coronavirus disease 2019 era.

Awareness Of Occupational Hazards, Use of Personal Protective Equipment and Workplace Risk Assessment Among Welders in Mechanic Village, Abakaliki, South-East Nigeria

Background

Occupational diseases can result in sickness absence, economic loss, disability, or death of workers. Several studies have revealed that occupational health and safety practice is still low in some occupational groups despite their knowledge and the occupational health legislation. This study assessed the level of knowledge, Background: Occupational health service delivery, includes the creation of a safe and healthy work environment. The protection and promotion of workers' health; is at its infantile stages in the informal sector such as the welding industry in Nigeria. We determined the level and determinants of awareness of occupational hazards, determinants of use of personal protective equipment (PPE) and carried out a workplace risk assessment among the welders at the mechanic village in Abakaliki, Ebonyi State.

Methodology

We conducted a cross-sectional study among welders who work in the mechanic village, Abakaliki. A structured, pretested interviewer-administered questionnaire was used to extract information on awareness of occupational hazards, frequency of use of PPE, health-related complaints amongst others. Chi-square test and logistic regression analysis were conducted at a 5% level of significance.

Result

All the respondents were male with a mean age of 27.6± 10.1 years. We found a good awareness of occupational hazards in 60% of the respondents and though this was associated with being older than 30years (p=0.03), being an expert compared to apprentice (p=0.003), duration of work more than 5years (p=0.004), none of these factors, when modelled in logistic regression, were predictors of good awareness. Regular use of PPE was reported in 49.79% of respondents. Cuts, sparks, foreign bodies in the eye were the most common hazards they were aware of. Cuts were the most reported health complaint. Good awareness of hazards was associated with higher odds of sustaining cuts (adjusted odds ratio [AOR]: 3.1, 95% CI:1.46 - 6.69) and a predictor of regular use of PPE (AOR:2.6, 95%CI:1.12 - 5.88). The workplace risk assessment revealed a work environment not conducive to occupational safety and health.

Conclusion

A good awareness of occupational hazards was moderately high, a predictor of regular use of PPE and not protective of sustaining cuts in the suboptimal work environment.

Prediction of personal protective equipment use in hospitals during COVID-19

Demand for Personal Protective Equipment (PPE) such as surgical masks, gloves, and gowns has increased significantly since the onset of the COVID-19 pandemic. In hospital settings, both medical staff and patients are required to wear PPE. As these facilities resume regular operations, staff will be required to wear PPE at all times while additional PPE will be mandated during medical procedures. This will put increased pressure on hospitals which have had problems predicting PPE usage and sourcing its supply. To meet this challenge, we propose an approach to predict demand for PPE. Specifically, we model the admission of patients to a medical department using multiple independent [Formula: see text] queues. Each queue represents a class of patients with similar treatment plans and hospital length-of-stay. By estimating the total workload of each class, we derive closed-form estimates for the expected amount of PPE required over a specified time horizon using current PPE guidelines. We apply our approach to a data set of 22,039 patients admitted to the general internal medicine department at St. Michael's hospital in Toronto, Canada from April 2010 to November 2019. We find that gloves and surgical masks represent approximately 90% of predicted PPE usage. We also find that while demand for gloves is driven entirely by patient-practitioner interactions, 86% of the predicted demand for surgical masks can be attributed to the requirement that medical practitioners will need to wear them when not interacting with patients.

Safety footwear: A survey of end-users

This paper presents the results of an extensive survey concerning the experience of safety footwear end-users. Safety footwear has been in widespread use across many industries worldwide since the 1970s, and has become an essential part of industrial Personal Protective Equipment. The number of women entering predominantly male industrial environments, and requiring safety footwear is rising, and this is accompanied by anecdotal reports of ill-fitting and uncomfortable footwear. This research proactively compares the opinions of women and men regarding their experience of safety footwear. A systematically designed survey aims to substantiate previously anecdotal knowledge around safety footwear, including key drivers for end-user purchases, wear habits and comfort issues (establishing any differences between women and men). Chi-squared testing was used to assess statistical significance and ensure robustness of findings. The responses and resulting analysis confirmed that comfort and fit were key drivers for all end users; women and men have different wear habits (women wear their safety footwear less frequently and for shorter periods of time than men - likely due to the reported comfort issues); a significant proportion of women (60%) found their safety footwear less comfortable than their regular footwear, however, 45% of men also reported the same, which has not been reported anecdotally. In general, the users of safety footwear accepted a level of discomfort in at least one area of the foot before deeming footwear 'uncomfortable'. The significant analysis performed on the captured data has, to the authors knowledge, never before been undertaken for this breadth of industry, age and gender with 632 responses received. This makes it the largest study of this field to date.

Headache related to mask use of healthcare workers in COVID-19 pandemic

Background

It has been reported that a new type of headache may develop as a result of face mask use during the COVID-19 pandemic. The aim of this study is to investigate the clinical features of face mask-related headache during the COVID-19 pandemic.

Methods

This is a cross-sectional study carried out on healthcare workers at the Afyonkarahisar Health Sciences University. The number of workers at our university was established. Sample size was calculated using the G*Power program. A questionnaire consisting of questions relating to pre-existing headache, an aggravation in headache, and de-novo headache was filled out by 3 neurologists with all participants.

Results

Data was collected from a total of 375 participants, after the exclusion of 5 individuals who refused to participate. Out of all participants, 26 (6.9%) used a filtering mask, 274 (73.1%) used a surgical mask, 75 (20.0%) participants used a combination of both masks. The number of participants with preexisting headache was 114 (30.4%) had pre-existing headache. Of those with pre-existing headache, 77 (67.5%) healthcare workers had reported an aggravation in their headache after mask use. De-novo headache was observed in 116 (30.9%) of participants. De-novo headache characteristics included throbbing in 17 (14.7%) participants and pressing in 99 (85.3%) participants. In addition, symptoms such as tachypnea, sleep disturbance, and fatigue were found to be significantly higher.

Conclusions

This study indicates that healthcare workers develop headaches due to use of masks during the COVID-19 outbreak.

Site of Care for COVID-19-Like Respiratory Illnesses

COVID-19 is primarily a respiratory illness. Historically, upper and lower respiratory illness has been cared for at home or in the ambulatory primary care setting. It is likely that patients experiencing COVID-19-like symptoms may first contact their primary care provider. The Medical Expenditure Panel Survey (MEPS) is a representative sample of patients from the United States that regularly assesses their use of medical care services. We analyzed 2017 MEPS data to determine the number and proportion of patients who were seen in primary care or family medicine ambulatory settings or hospitalized for upper or lower respiratory illness or pneumonia. In a given year, 19.5 million patients are seen by primary care for an upper respiratory illness, 10.7 million patients for bronchitis, and 9 million for pneumonia. In contrast, 890,000 patients are hospitalized with pneumonia. Given that a primary etiology for respiratory illness in early 2020 was SARS CoV-2 (COVID-19), primary care practices likely were the site of first contact for most patients with COVID-19 illness. Unfortunately, there has been inadequate support for in-person and telehealth visits. Primary care clinicians reported serious shortages of personal protective equipment (PPE) and testing capacity. Inadequate reimbursement for telehealth visits coupled with decreased in-person visits put primary care practices at risk of layoffs and closure. Policies related to primary care payment, federal relief efforts, PPE access, testing and follow-up capacity, and telehealth technical support are essential so primary care can provide first contact and continuity for their patients and communities throughout the COVID-19 pandemic response and recovery.

Conducting a conventional multi-casualty incident in COVID-19 personal protective equipment - a semi-structured interview

Background

The risk of COVID-19 transmission to healthcare professionals is likely to continue for the foreseeable future. The wearing of personal protective equipment (PPE) presents a number of potential challenges to responders that may impact upon the management of patients in a multi-casualty incident.

This report describes a multi-agency multi-casualty incident. It identifies learning points specifically related to the challenges of conducting a conventional multi-casualty incident in COVID-19 PPE.

Case

The multi casualty incident in Reading, UK on the 20 June 2020 involved six stab injury victims and was attended by four pre-hospital critical care teams. This was the first conventional multi-casualty incident that pre-hospital critical care teams had attended during the COVID-19 era and it was conducted in COVID-19 PPE (1). The scene was an urban park where three patients were confirmed to be in Traumatic Cardiac Arrest (TCA) from stab wounds and another three patients had also suffered stab injuries. By the time the incident had concluded three patients were pronounced dead at the scene. Two patients were transported to the local trauma unit and one patient was transported to the regional Major Trauma Centre depending on the severity of their injuries.

Conclusions

We conducted a semi structured telephone interview with the critical care clinicians who were involved in the incident. The interviews focused specifically on the challenges of responding whilst wearing COVID-19 PPE, rather than the wider challenges of responding to such an incident. The key learning points identified were:

Improving the identifiability of clinicians in level 3 PPE

wearing identification tabards

using visible labelling on PPE suits

Improving communication by radio

using a belt to carry the radio

using an earpiece and push to talk system.

Training in conducting multi casualty incidents in level 3 PPE.

Nursing and health policy perspectives 2020 - a year to remember or one to forget?

2020 has certainly been a year of challenges for nurses and healthcare workers around the world with the relentless spread of COVID-19. These challenges are many, including countries and health systems not being prepared for a pandemic, shortages of personal protective equipment and acute shortages of nurses, poor communication from governments and the lack of accurate data regarding COVID-19 morbidity and mortality among nurses and health workers. Nurses are suffering from psychological distress and are exhausted and burntout as the pandemic's second wave moves around the world. Many have been subjected to violence and aggression from people in their communities. Against this backdrop, nurses' contributions have been vital in saving lives and the profession has learnt many powerful lessons that will resonate in nursing practice for the future. But governments must do more, including ensuring nurses receive vaccinations early to protect them when a successful vaccine becomes available.

[Lack of Personal Protective Equipment in Brazil]

N/a.

Personal protective equipment in the siege of respiratory viral pandemics: strides made and next steps

Introduction: In December 2019, SARS-CoV-2 originated from China, and spread rapidly to several countries, bringing a frightening scarcity of personal protective equipment (PPE). The CDC recommends N95 or higher-level particulate filtering respirators as part of the PPE while caring for patients with COVID-19, with facemasks as an alternative; and cloth face-coverings in public where social distancing of at least 6 ft. is not feasible. With new evidence about the efficacy of facemasks, knowledge gaps remain.Areas covered: This reviews the history of respiratory viral pandemics and PPE use, exploring the influenza pandemics of the 20^th and 21^st century, and prior coronavirus pandemics. A literature search of PubMed and google was done between March 22^nd to May 2^nd, and on September 28, 2020. The evidence for PPE is described, to delineate their efficacy and 'best safe' practices. Solutions to ameliorate pandemic preparedness to meet surge-capacity to efficiently combat future pandemics, should they arise, are discussed.Expert opinion: PPE, when used appropriately in addition to other infection control measures, is effective protection during respiratory viral pandemics. The current evidence suggests that wearing facemasks in the community is protective, especially if used consistently and correctly with other infection control measures such as hand hygiene.

The US COVID-19 crises: facts, science and solidarity

The United States leads the world in COVID-19 cases and deaths. The government's poorly coordinated response has lacked national mandates, failed to deploy adequate personal protective equipment, supplies and testing and devalued advice of science experts. COVID-19 exposed racial disparities in health care and as protests against racial injustice erupted, nurses have responded to the call to confront racism as a public health crisis. Nurses also suffer from lack of personal protective equipment, burnout, extreme workloads, overwhelming deaths and fear of contracting COVID-19. While facing danger, nurses have implemented practice changes and fostered new roles and teamwork to provide safer care. Advancing policy to provide personal protective equipment as well as financial and mental health support for nurses is a priority nationally and globally.

Infectious Diseases Simulation for Medical Students: Experiential Instruction on Personal Protective Equipment

INTRODUCTION

The emergence of COVID-19 highlighted the critical importance of appropriate use of personal protective equipment (PPE) for the safety of patients and health care personnel. However, previously published survey data indicated that formal instruction on the correct utilization of PPE is uncommon in medical school curricula, and there is no published guidance about optimal instruction methods. The infectious disease (ID) simulation lab at Oregon Health & Science University filled this need.

METHODS

Second- through fourth-year medical students participated in the infection intersession, a 2-week didactic session that students were required to enroll in once during their clinical rotations. As part of the course, students completed the ID simulation lab, during which they were presented with common ID syndromes (suspected tuberculosis, C. difficile colitis, and neutropenic fever) and asked to select the proper PPE prior to interacting with standardized patients. ID physicians acted as the patients and then conducted feedback sessions, which focused on PPE choice, donning and doffing techniques, and ID diagnosis and management principles.

RESULTS

More than 500 medical students participated between 2016 and 2020, demonstrating the feasibility of the experience. The average exam scores were above 80%, and the average student evaluation score of the session was 8.9 out of 10, demonstrating acceptability.

DISCUSSION

The ID simulation lab allowed students to reinforce didactic teaching about PPE, dispel common misconceptions, and receive real-time feedback from ID clinicians. Availability of the lab and facilitators were limiting factors. Future work will focus on better understanding the efficacy of the sessions.

Coronavirus antibody positive tests and continued use of personal protective equipment throughout the pandemic

The COVID-19 pandemic has thrust not only a novel virus onto the world, but new challenges resulting in novel approaches. Governments have reduced regulation in order to facilitate timely advances to combat the disease. Antibody testing has rapidly been deployed but it is creating challenges for staff and patients. Mask use has come to the forefront and human factor (HF) strategies must be examined to reduce risk associated with lack of engagement from both healthcare staff and patients. In this we explore these issues and suggest some solutions.

Pressure Optimized PowEred Respirator (PROPER): A miniaturized wearable cleanroom and biosafety system for aerially transmitted viral infections such as COVID-19

The supply of Personal Protective Equipment (PPE) in hospitals to keep the Health Care Professionals (HCP) safe taking care of patients may be limited, especially during the outbreak of a new disease. In particular, the face and body protective equipment is critical to prevent the wearer from exposure to pathogenic biological airborne particulates. This situation has been now observed worldwide during the onset of the COVID-19 pandemic. As concern over shortages of PPE at hospitals grows, we share with the public and makers' community the Pressure Optimized PowEred Respirator (PROPER) equipment, made out of COTS components. It is functionally equivalent to a Powered Air Purifying Respirator (PAPR). PROPER, a hood-based system which uses open source and easily accessible components is low-cost, relatively passive in terms of energy consumption and mechanisms, and easy and fast to 3D print, build and assemble. We have adapted our experience on building clean room environments and qualifying the bioburden of space instruments to this solution, which is in essence a miniaturized, personal, wearable cleanroom. PROPER would be able to offer better protection than an N95 respirator mask, mainly because it is insensitive to seal fit and it shields the eyes as well. The PROPER SMS fabric is designed for single-use and not intended for reuse, as they may start to tear and fail but the rest of the parts can be disinfected and reused. We provide a set of guidelines to build a low-cost 3D printed solution for an effective PAPR system and describe the procedures to validate it to comply with the biosafety level 3 requirements. We have validated the prototype of PROPER unit for air flow, ISO class cleanliness level, oxygen and carbon-dioxide gas concentrations during exhalation, and present here these results for illustration. We demonstrate that the area inside the hood is more than 200 times cleaner than the external ambient without the operator and more than 175 times with the operator and in an aerosol exposed environment. We also include the procedure to clean and disinfect the equipment for reuse. PROPER may be a useful addition to provide protection to HCPs against the SARS-CoV-2 virus or other potential future viral diseases that are transmitted aerially.

The effects of N95 mask and face shield on speech perception among healthcare workers in the coronavirus disease 2019 pandemic scenario

OBJECTIVE

The current circumstances of the coronavirus disease 2019 pandemic necessitate the use of personal protective equipment in hospitals. N95 masks and face shields are being used as personal protective equipment to protect from aerosol-related spread of infection. Personal protective equipment, however, hampers communication. This study aimed to assess the effect of using an N95 mask and face shield on speech perception among healthcare workers with normal hearing.

METHODS

Twenty healthcare workers were recruited for the study. Pure tone audiometry was conducted to ensure normal hearing. Speech reception threshold and speech discrimination score were obtained, first without using personal protective equipment and then repeated with the audiologist wearing an N95 mask and face shield.

RESULTS

A statistically significant increase in speech reception threshold (mean of 12.4 dB) and decrease in speech discrimination score (mean of 7 per cent) was found while using the personal protective equipment.

CONCLUSION

Use of personal protective equipment significantly impairs speech perception. Alternate communication strategies should be developed for effective communication.

Plans to Reactivate Gastroenterology Practices Following the COVID-19 Pandemic: A Survey of North American Centers

BACKGROUND & AIMS

Practices dramatically reduced endoscopy services due to the COVID-19 pandemic. Because practices now are considering reintroduction of elective endoscopy, we conducted a survey of North American practices to identify reactivation barriers and strategies.

METHODS

We designed and electronically distributed a web-based survey to North American gastroenterologists consisting of 7 domains: institutional demographics, impact of COVID-19 on endoscopy practice, elective endoscopy resumption plans, anesthesia modifications, personal protective equipment policies, fellowship training, and telemedicine use. Responses were stratified by practice type: ambulatory surgery center (ASC) or hospital-based.

RESULTS

In total, 123 practices (55% ASC-based and 45% hospital-based) responded. At the pandemic's peak (as reported by the respondents), practices saw a 90% decrease in endoscopy volume, with most centers planning to resume elective endoscopy a median of 55 days after initial restrictions. Declining community prevalence of COVID-19, personal protective equipment availability, and preprocedure severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing availability were ranked as the 3 primary factors influencing reactivation timing. ASC-based practices were more likely to identify preprocedure testing availability as a major factor limiting elective endoscopy resumption (P = .001). Preprocedure SARS-CoV-2 testing was planned by only 49.2% of practices overall; when testing is performed and negative, 52.9% of practices will continue to use N95 masks.

CONCLUSIONS

This survey highlights barriers and variable strategies for reactivation of elective endoscopy services after the COVID-19 pandemic. Our results suggest that more widespread access to preprocedure SARS-CoV-2 tests with superior performance characteristics is needed to increase provider and patient comfort in proceeding with elective endoscopy.

[Respiratory and Facial Protection: Current Perspectives in the Context of the COVID-19 Pandemic]

The new SARS-CoV-2 pandemic is an example of an international public health emergency, which is associated with considerable social and economic challenges. At the healthcare level there is the risk that nosocomial outbreaks can be local amplifiers. Adequate infection control practices are of critical importance, which include proper use of personal protective equipment. This equipment must be appropriate to the pathogen transmission route that, in the case of SARS-CoV-2, occurs through droplet and contact routes. The infected individual, when talking, coughing or sneezing, spreads droplets containing the virus, directly contaminating other individuals within one to two meters of distance, as well as the surrounding environment. Airborne transmission may occur when aerosol-generating procedures are performed. Concerning respiratory protection, there is currently weak evidence that the use of respirators provides better protection than surgical masks for SARS-CoV-2 or other viruses (with the exception of aerosol-generating procedures, in which case the use of a respirator is recommended). Eye protection should be guaranteed whenever there is a risk of splashes, droplets or aerosols. The use of different, or higher than necessary, level of personal protective equipment, for the transmission route of the agent, is a form of misuse and can affect its supply for situations when it is clearly indicated. The adequate provision of protective equipment, as well as training of healthcare professionals in its correct use, is highly recommended to ensure safety of care.

Ophthalmic Workplace Modifications for the Post-COVID Era

The COVID-19 pandemic necessitates implementation of exposure control measures in all facets of the healthcare sector. Healthcare professionals who work in busy ophthalmology clinics and theaters are amidst the highest at-risk of contracting COVID-19. The authors review the up-to-date scientific evidence of SARS-CoV-2 transmission to demystify and explain the exposure control options available for ophthalmic workplace and offer insights from an industrial hygiene standpoint. As the we enter the post-COVID world, these measures will be critical to enhance workplace safety, and thus protect patients and staff alike.

[Occupational safety in the treatment of COVID-19 patients : Relevant laws and regulations for the treating personnel]

Die intensivmedizinische Versorgung von COVID-19-Patienten stellt das eingesetzte Personal vor – bisher unbekannte – Herausforderungen. So kommen beispielsweise nun großflächig Schutzausrüstungen zum Einsatz, die ansonsten nur in ausgewählten Situationen verwendet wurden. Die Arbeit in einem solchen Umfeld ist unter dem Aspekt des Arbeitsschutzes anders zu bewerten als die sonstige Patientenversorgung. Auch in einer Pandemie bleiben die gesetzlichen Vorgaben gültig. Ziel dieser Arbeit ist es, einen Überblick über die aktuell relevanten Vorschriften und Regelungen darzulegen.

Role of 3D printing for the protection of surgical and critical care professionals in the COVID-19 pandemic

Antecedentes y objetivo

Durante la pandemia de COVID-19 se produce una reducción del material para la protección de los profesionales. La impresión 3D ofrece la posibilidad de compensar la escasez de algunos de los suministros. El objetivo es describir el papel de la impresión 3D en un servicio de salud durante la pandemia de COVID-19, con énfasis en proceso para desarrollar un producto final listo para ser implementado en el entorno clínico.

Materiales y métodos

Se formó un grupo de trabajo entre la administración sanitaria, clínicos y otras instituciones público-privadas de Cantabria coordinado en el Hospital virtual Valdecilla. El proceso incluyó la recepción de las propuestas de impresión, el conocimiento de los recursos de impresión en la región, la selección de los dispositivos, la creación de un equipo para cada proyecto, diseño de prototipos, evaluación y rediseño, fabricación montaje y distribución.

Resultados

Se producen 1) dispositivos que ayudan a prevenir el contagio de los profesionales: pantallas de protección facial (2.400 unidades), accesorios personalizados para fotóforos (20 unidades) y horquillas salvaorejas para mascarillas (1.200 unidades); 2) productos relacionados con la ventilación de pacientes infectados: conectores de sistemas de ventilación no invasiva entre tubuladura y mascarilla; y 3) hisopos oro y nasofaríngeos (7.500 unidades) para la identificación de portadoras del coronavirus con el objetivo de diseñar protocolos de actuación en las área clínicas.

Conclusiones

La impresión 3D es un recurso válido para la producción de material de protección de los profesionales cuyo suministro está reducido durante una pandemia.

Roles of nurses and National Nurses Associations in combating COVID-19: Taiwan experience

As the COVID‐19 pandemic continues to expand worldwide, Taiwan has effectively contained the spread domestically and protected its citizens after registering its first case relatively early on 21 January 2020. Proactive preparedness and deployment by the national government, timely evidence and experience‐based judgements and decision‐making, information transparency, rapid response, and effective communication and measures have all been critical to combating COVID‐19 in Taiwan. Nurses play a pivotal role in providing direct health care as well as providing contact tracing and care for the quarantined clients and community care services. The Taiwan Nurses Association and other nurses’ associations serve a vital leadership role in advocating for nurses, raising public awareness, enhancing nursing’s professional profile, and sharing experiences via national and international platforms. The implications for nursing and health policy are that we need to well prepare for any unpredicted emerging pandemic in the future. Providing adequate personal protective equipment and safe staffing should be the highest priority for the governments and policymakers around the world to combat pandemic successfully.

The UK national registry of ENT surgeons with coronavirus disease 2019

BACKGROUND

ENT surgeons are likely to be at high risk of coronavirus disease 2019 exposure.

METHODS

A national registry of UK ENT surgeons with suspected or confirmed coronavirus disease 2019 was created with the support of ENT UK. Voluntary entry was made by either the affected individual or a colleague, using a web-based platform.

RESULTS

A four-month data collection period is reported, comprising 73 individuals. Coronavirus disease 2019 was test-confirmed in 35 respondents (47.9 per cent). There was a need for hospitalisation in two cases (2.7 per cent) and tragically one individual died. Symptom onset peaked in March. The majority suspected their exposure to have been in the workplace, with a significant proportion attributing their disease to a lack of personal protective equipment at a time before formal guidance had been introduced.

CONCLUSION

The registry suggests that a significant number of ENT clinicians in the UK have contracted coronavirus disease 2019, and supports the need for tailored personal protective equipment guidance and service planning.

Tracheostomy in the coronavirus disease 2019 patient: evaluating feasibility, challenges and early outcomes of the 14-day guidance

OBJECTIVES

To report feasibility, early outcomes and challenges of implementing a 14-day threshold for undertaking surgical tracheostomy in the critically ill coronavirus disease 2019 patient.

METHODS

Twenty-eight coronavirus disease 2019 patients underwent tracheostomy. Demographics, risk factors, ventilatory assistance, organ support and logistics were assessed.

RESULTS

The mean time from intubation to tracheostomy formation was 17.0 days (standard deviation = 4.4, range 8-26 days). Mean time to decannulation was 15.8 days (standard deviation = 9.4) and mean time to intensive care unit stepdown to a ward was 19.2 days (standard deviation = 6.8). The time from intubation to tracheostomy was strongly positively correlated with: duration of mechanical ventilation (r(23) = 0.66; p < 0.001), time from intubation to decannulation (r(23) = 0.66; p < 0.001) and time from intubation to intensive care unit discharge (r(23) = 0.71; p < 0.001).

CONCLUSION

Performing a tracheostomy in coronavirus disease 2019 positive patients at 8-14 days following intubation is compatible with favourable outcomes. Multidisciplinary team input is crucial to patient selection.