Effectiveness of personal protective equipment in preventing severe acute respiratory syndrome coronavirus 2 infection among healthcare workers

Introduction: As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads across the globe, physicians face the challenges of a contagious pandemic including which patients to isolate, how to conserve personal protective equipment, and who to test. The current protocol at our hospital is to place anyone with new cough, dyspnea, or fever into airborne and contact precautions and consider them for testing. Unfortunately, the symptomatic presentations of coronavirus disease 2019 (COVID-19) are proving more variable than previously thought. Case Report: Our case of COVID-19 presented with headache and then progressed to a meningitis-like illness with co-existing shingles rash. Conclusion: COVID-19 can have a variety of initial presentations that are not the classic respiratory symptoms and fever. These presenting symptoms of COVID-19 can include a meningitis-like illness, as our case report indicates. The wide variety of presentations of COVID-19 may warrant widespread testing to identify cases, protect healthcare workers, and prevent the spread of this pandemic.

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Viral Genomics to Inform Infection-control Response in Occupational Coronavirus Disease 2019 (COVID-19) Transmission

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1385 ◽

2020 ◽

Author(s):

Naomi C A Whyler ◽

Norelle L Sherry ◽

Courtney R Lane ◽

Torsten Seemann ◽

Patiyan Andersson ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Infection Control ◽

Personal Protective Equipment ◽

Healthcare Workers ◽

Genomic Sequencing ◽

Protective Equipment ◽

Viral Genomics ◽

Subsequent Response ◽

Increased Risk ◽

Control Response

Abstract Healthcare workers are at increased risk of occupational transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report 2 instances of healthcare workers contracting SARS-CoV-2 despite no known breach of personal protective equipment. Additional specific equipment cleaning was initiated. Viral genomic sequencing supported this transmission hypothesis and our subsequent response.

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Cluster of Cases of Severe Acute Respiratory Syndrome Among Toronto Healthcare Workers After Implementation of Infection Control Precautions: A Case Series

Infection Control and Hospital Epidemiology ◽

10.1086/504363 ◽

2006 ◽

Vol 27 (5) ◽

pp. 473-478 ◽

Cited By ~ 42

Author(s):

Marianna Ofner-Agostini ◽

Denise Gravel ◽

L. Clifford McDonald ◽

Marcus Lem ◽

Shelley Sarwal ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Infection Control ◽

Personal Protective Equipment ◽

Healthcare Workers ◽

High Risk Patient ◽

Case Series ◽

Case Definition ◽

Protective Equipment ◽

Proper Order ◽

Cleaning Equipment

Objective.To review the severe acute respiratory syndrome (SARS) infection control practices, the types of exposure to patients with SARS, and the activities associated with treatment of such patients among healthcare workers (HCWs) who developed SARS in Toronto, Canada, after SARS-specific infection control precautions had been implemented.Methods.A retrospective review of work logs and patient assignments, detailed review of medical records of patients with SARS, and comprehensive telephone-based interviews of HCWs who met the case definition for SARS after implementation of infection control precautions.Results.Seventeen HCWs from 6 hospitals developed disease that met the case definition for SARS after implementation of infection control precautions. These HCWs had a mean age ( ± SD) of 39 ± 2.3 years. Two HCWs were not interviewed because of illness. Of the remaining 15, only 9 (60%) reported that they had received formal infection control training. Thirteen HCWs (87%) were unsure of proper order in which personal protective equipment should be donned and doffed. Six HCWs (40%) reused items (eg, stethoscopes, goggles, and cleaning equipment) elsewhere on the ward after initial use in a room in which a patient with SARS was staying. Use of masks, gowns, gloves, and eyewear was inconsistent among HCWs. Eight (54%) reported that they were aware of a breach in infection control precautions. HCWs reported fatigue due to an increase number and length of shifts; participants worked a median of 10 shifts during the 10 days before onset of symptoms. Seven HCWs were involved in the intubation of a patient with SARS. One HCW died, and the remaining 16 recovered.Conclusion.Multiple factors were likely responsible for SARS in these HCWs, including the performance of high-risk patient care procedures, inconsistent use of personal protective equipment, fatigue, and lack of adequate infection control training.

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Skin problems related to personal protective equipment among healthcare workers during the COVID-19 pandemic (online research)

Cutaneous and Ocular Toxicology ◽

10.1080/15569527.2021.1902340 ◽

2021 ◽

pp. 1-17

Author(s):

Fatma Etgu ◽

Sevda Onder

Keyword(s):

Personal Protective Equipment ◽

Healthcare Workers ◽

Protective Equipment ◽

Online Research

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Stress and Associated Factors among Frontline Healthcare Workers in the COVID-19 Epicenter of Da Nang City, Vietnam

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147378 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7378

Author(s):

Nhan Phuc Thanh Nguyen ◽

Duong Dinh Le ◽

Robert Colebunders ◽

Joseph Nelson Siewe Fodjo ◽

Trung Dinh Tran ◽

...

Keyword(s):

Personal Protective Equipment ◽

Healthcare Workers ◽

Stress Component ◽

Multivariable Analysis ◽

Working Hours ◽

Health Facilities ◽

Protective Equipment ◽

Laboratory Workers ◽

Frontline Healthcare Workers ◽

Second Wave

Frontline healthcare workers (HCWs) involved in the COVID-19 response have a higher risk of experiencing psychosocial distress amidst the pandemic. Between July and September 2020, a second wave of the COVID-19 pandemic appeared in Vietnam with Da Nang city being the epicenter. During the outbreak, HCWs were quarantined within the health facilities in a bid to limit the spread of COVID-19 to their respective communities. Using the stress component of the 21-item Depression, Anxiety and Stress Scale (DASS-21), we assessed the level of stress among HCWs in Da Nang city. Between 30 August and 15 September 2020, 746 frontline HCWs were recruited to fill in an online structured questionnaire. Overall, 44.6% of participants experienced increased stress and 18.9% severe or extremely severe stress. In multivariable analysis, increased stress was associated with longer working hours (OR = 1.012; 95% CI: 1.004–1.019), working in health facilities providing COVID-19 treatment (OR = 1.58, 95% CI: 1.04–2.39), having direct contact with patients or their bio-samples (physicians, nurses and laboratory workers; OR = 1.42, 95% CI: 1.02–1.99), low confidence in the available personal protective equipment (OR = 0.846; 95% CI: 0.744–0.962) and low knowledge on COVID-19 prevention and treatment (OR = 0.853; 95% CI: 0.739–0.986). In conclusion, many frontline HCWs experienced increased stress during the COVID-19 outbreak in Da Nang city. Reducing working time, providing essential personal protective equipment and enhancing the knowledge on COVID-19 will help to reduce this stress. Moreover, extra support is needed for HCWs who are directly exposed to COVID-19 patients.

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Safe On-Boat Resuscitation by Lifeguards in COVID-19 Era: A Pilot Study Comparing Three Sets of Personal Protective Equipment

Prehospital and Disaster Medicine ◽

10.1017/s1049023x2100011x ◽

2021 ◽

pp. 1-7

Author(s):

Roberto Barcala-Furelos ◽

Cristian Abelairas-Gómez ◽

Alejandra Alonso-Calvete ◽

Francisco Cano-Noguera ◽

Aida Carballo-Fazanes ◽

...

Keyword(s):

Pilot Study ◽

Cardiopulmonary Resuscitation ◽

Severe Acute Respiratory Syndrome ◽

Personal Protective Equipment ◽

High Efficiency ◽

Prehospital Care ◽

Protective Equipment ◽

Preparation Time

Abstract Introduction: On-boat resuscitation can be applied by lifeguards in an inflatable rescue boat (IRB). Due to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2) and recommendations for the use of personal protective equipment (PPE), prehospital care procedures need to be re-evaluated. The objective of this study was to determine how the use of PPE influences the amount of preparation time needed before beginning actual resuscitation and the quality of cardiopulmonary resuscitation (CPR; QCPR) on an IRB. Methods: Three CPR tests were performed by 14 lifeguards, in teams of two, wearing different PPE: (1) Basic PPE (B-PPE): gloves, a mask, and protective glasses; (2) Full PPE (F-PPE): B-PPE + a waterproof apron; and (3) Basic PPE + plastic blanket (B+PPE). On-boat resuscitation using a bag-valve-mask (BVM) and high efficiency particulate air (HEPA) filter was performed sailing at 20km/hour. Results: Using B-PPE takes less time and is significantly faster than F-PPE (B-PPE 17 [SD = 2] seconds versus F-PPE 69 [SD = 17] seconds; P = .001), and the use of B+PPE is slightly higher (B-PPE 17 [SD = 2] seconds versus B+PPE 34 [SD = 6] seconds; P = .002). The QCPR remained similar in all three scenarios (P >.05), reaching values over 79%. Conclusion: The use of PPE during on-board resuscitation is feasible and does not interfere with quality when performed by trained lifeguards. The use of a plastic blanket could be a quick and easy alternative to offer extra protection to lifeguards during CPR on an IRB.

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Fit Testing Retrofitted Full-Face Snorkel Masks as a Form of Novel Personal Protective Equipment During the COVID-19 Pandemic

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2021.133 ◽

2021 ◽

pp. 1-16

Author(s):

Stephanie Toigo ◽

Michel Jacques ◽

Tarek Razek ◽

Ewa Rajda ◽

Sidney Omelon ◽

...

Keyword(s):

Personal Protective Equipment ◽

Healthcare Workers ◽

Health Centre ◽

Disease Outbreaks ◽

Protective Equipment ◽

Test Results ◽

Passing Rate ◽

Fit Testing ◽

Full Face ◽

Medical Grade

ABSTRACT Objective: Bottlenecks in the personal protective equipment (PPE) supply chain have contributed to shortages of PPE during the COVID-19 pandemic, resulting in fractures in the functionality of healthcare systems. This study was conducted with the aim of determining the effectiveness of retrofitted commercial snorkel masks as an alternative respirator for healthcare workers during infectious disease outbreaks. Methods: A retrospective analysis was performed, analyzing qualitative and quantitative fit test results of the retrofitted Aria Ocean Reef® full-face snorkeling mask on healthcare workers at the McGill University Health Centre between April-June 2020. Historical fit test results, using medical-grade respirators, for healthcare workers were also analyzed. Results: During the study period, 71 participants volunteered for fit testing, 60.6% of which were nurses. The overall fit test passing rate using the snorkel mask was 83.1%. Of the participants who did not previously pass fit testing with medical-grade respirators, 80% achieved a passing fit test with the snorkel respirator. Conclusions: The results suggest that this novel respirator may be an effective and feasible alternative solution to address PPE shortages, while still providing healthcare workers with ample protection. Additional robust testing will be required to ensure that respirator fit is maintained, after numerous rounds of disinfection.

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Acoustic voice characteristics with and without wearing a facemask

Scientific Reports ◽

10.1038/s41598-021-85130-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Duy Duong Nguyen ◽

Patricia McCabe ◽

Donna Thomas ◽

Alison Purcell ◽

Maree Doble ◽

...

Keyword(s):

Personal Protective Equipment ◽

Healthcare Workers ◽

Protective Equipment ◽

Mask Condition ◽

Connected Speech ◽

Significant Attenuation ◽

Cepstral Peak Prominence ◽

Vocal Intensity ◽

Significant Change ◽

The Voice

AbstractFacemasks are essential for healthcare workers but characteristics of the voice whilst wearing this personal protective equipment are not well understood. In the present study, we compared acoustic voice measures in recordings of sixteen adults producing standardised vocal tasks with and without wearing either a surgical mask or a KN95 mask. Data were analysed for mean spectral levels at 0–1 kHz and 1–8 kHz regions, an energy ratio between 0–1 and 1–8 kHz (LH1000), harmonics-to-noise ratio (HNR), smoothed cepstral peak prominence (CPPS), and vocal intensity. In connected speech there was significant attenuation of mean spectral level at 1–8 kHz region and there was no significant change in this measure at 0–1 kHz. Mean spectral levels of vowel did not change significantly in mask-wearing conditions. LH1000 for connected speech significantly increased whilst wearing either a surgical mask or KN95 mask but no significant change in this measure was found for vowel. HNR was higher in the mask-wearing conditions than the no-mask condition. CPPS and vocal intensity did not change in mask-wearing conditions. These findings implied an attenuation effects of wearing these types of masks on the voice spectra with surgical mask showing less impact than the KN95.

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Adherence to personal protective equipment use among healthcare workers caring for confirmed COVID-19 and alleged non-COVID-19 patients

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-020-00864-w ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Meike M. Neuwirth ◽

Frauke Mattner ◽

Robin Otchwemah

Keyword(s):

Health Care ◽

Health Care Workers ◽

Personal Protective Equipment ◽

Healthcare Workers ◽

University Hospital ◽

Protective Equipment ◽

Care Workers

AbstractAdherence observations of health care workers (HCW) revealed deficiencies in the use of recommended personal protective equipment (PPE) among HCW caring in COVID-19 and non-COVID-19 wards during the first period of the SARS-CoV-2 pandemic in a university hospital in Germany. The adherence to wearing surgical face or FFP2-masks and disinfecting hands prior to donning and after doffing the PPE was significantly higher in COVID-19 wards However, there was no total adherence of 100% in COVID-19 wards.

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Use of Personal Protective Equipment and Operating Room Behaviors in Four Surgical Subspecialties: Personal Protective Equipment and Behaviors in Surgery

Infection Control and Hospital Epidemiology ◽

10.1086/501601 ◽

1999 ◽

Vol 20 (02) ◽

pp. 110-114 ◽

Cited By ~ 45

Author(s):

Deniz Akduman ◽

Lynn E. Kim ◽

Rodney L. Parks ◽

Paul B. L'Ecuyer ◽

Sunita Mutha ◽

...

Keyword(s):

Operating Room ◽

Personal Protective Equipment ◽

Healthcare Workers ◽

Tertiary Care ◽

Hand Surgery ◽

Occupational Exposures ◽

Protective Equipment ◽

Care Hospital ◽

Exposure Rate ◽

Total Exposure

AbstractObjective:To evaluate Universal Precautions (UP) compliance in the operating room (OR).Design:Prospective observational cohort. Trained observers recorded information about (1) personal protective equipment used by OR staff; (2) eyewear, glove, or gown breaks; (3) the nature of sharps transfers; (4) risk-taking behaviors of the OR staff; and (5) needlestick injuries and other blood and body-fluid exposures.Setting:Barnes-Jewish Hospital, a 1,000-bed, tertiary-care hospital affiliated with Washington University School of Medicine, St Louis, Missouri.Participants:OR personnel in four surgical specialties (gynecologic, orthopedic, cardiothoracic, and general). Procedures eligible for the study were selected randomly. Hand surgery and procedures requiring no or a very small incision (eg, arthroscopy, laparoscopy) were excluded.Results:A total of 597 healthcare workers' procedures were observed in 76 surgical cases (200 hours). Of the 597 healthcare workers, 32% wore regular glasses, and 24% used no eye protection. Scrub nurses and medical students were more likely than other healthcare workers to wear goggles. Only 28% of healthcare workers double gloved, with orthopedic surgery personnel being the most compliant. Sharps passages were not announced in 91% of the surgical procedures. In 65 cases (86%), sharps were adjusted manually. Three percutaneous and 14 cutaneous exposures occurred, for a total exposure rate of 22%.Conclusion:OR personnel had poor compliance with UP. Although there was significant variation in use of personal protective equipment between groups, the total exposure rate was high (22%), indicating the need for further training and reinforcement of UP to reduce occupational exposures.

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