Personal Protective Equipment in the humanitarian governance of Ebola: between individual patient care and global biosecurity

IntroductionAt the early epicentre of the COVID-19 crisis in the USA, our institution saw a surge in the demand for inpatient consultations for areas impacted by COVID-19 (eg, infectious diseases, nephrology, palliative care) and shortages in personal protective equipment (PPE). We aimed to provide timely specialist input for consult requests during the COVID-19 pandemic by implementing an Inpatient eConsult Programme.MethodsWe used the reach, effectiveness, adoption, implementation and maintenance implementation science framework and run chart analysis to evaluate the reach, adoption and maintenance of the Inpatient eConsult Programme compared with traditional in-person consults. We solicited qualitative feedback from frontline physicians and specialists for programme improvements.ResultsDuring the study period, there were 46 available in-person consult orders and 21 new eConsult orders. At the peak of utilisation, 42% of all consult requests were eConsults, and by the end of the study period, utilisation fell to 20%. Qualitative feedback revealed subspecialties best suited for eConsults (infectious diseases, nephrology, haematology, endocrinology) and influenced improvements to the ordering workflow, documentation, billing and education regarding use.DiscussionWhen offered inpatient eConsult requests as an alternative to in-person consults in the context of a surge in patients with COVID-19, frontline physicians used eConsult requests and decreased use of in-person consults. As the demand for consults decreased and PPE shortages were no longer a major concern, eConsult utilisation decreased, revealing a preference for in-person consultations when possible.ConclusionsLessons learnt can be used to develop and implement inpatient eConsults to meet context-specific challenges at other institutions.

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A Statewide Voluntary Movement Addressing the Shortage of Medical Supplies During the COVID-19 Pandemic

American Journal of Public Health ◽

10.2105/ajph.2021.306364 ◽

2021 ◽

Vol 111 (9) ◽

pp. 1595-1599

Author(s):

Martin Krause ◽

Andrew Henderson ◽

Daniel Griner ◽

Olivia S. Rissland ◽

Jeremy Beard ◽

...

Keyword(s):

Health Care ◽

Additive Manufacturing ◽

Patient Care ◽

Health Care Workers ◽

Personal Protective Equipment ◽

Laser Cutting ◽

Voluntary Movement ◽

Protective Equipment ◽

Medical Supplies ◽

Care Workers

During the COVID-19 pandemic, a shortage of personal protective equipment compromised efficient patient care and provider safety. Volunteers from many different backgrounds worked to meet these demands. Additive manufacturing, laser cutting, and alternative supply chains were used to produce, test, and deliver essential equipment for health care workers and first responders. Distributed equipment included ear guards, face shields, and masks. Contingent designs were created for powered air-purifying respirator hoods, filtered air pumps, intubation shields, and N95 masks.

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Compounding sterile products during a personal protective equipment shortage

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab112 ◽

2021 ◽

Author(s):

Amanda Danielle Wollitz ◽

Christine Hong ◽

Fernando Blanco

Keyword(s):

Patient Care ◽

Personal Protective Equipment ◽

Patient Population ◽

Conservation Strategies ◽

Protective Equipment ◽

Pandemic Response

Abstract Purpose To describe our pharmacy department’s plan for conservation of personal protective equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic to ensure continued availability of sterile compounded products. Summary PPE shortages impacted hospitals throughout the nation in the early months of the COVID-19 pandemic response. The PPE requirement for sterile compounding and need to maintain supplies within the pharmacy cleanroom is often overlooked. A sustained supply of PPE is critical to ensure an uninterrupted supply of compounded medications to our patient population. Multiple conservation strategies, including staffing changes, communication, adjustments to training, and even reuse of select PPE, can assist with conservation. Conclusion PPE in pharmacy cleanrooms is critical for the continued provision of sterile compounds with appropriate beyond-use dates and effective patient care. Pharmacy departments must employ multiple conservation strategies to ensure PPE is available for continued compounding of sterile products, and early planning and implementation of conservation strategies are key.

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Effects of personal protective equipment on the physiological parameters of health care workers

Journal of Emergency Management ◽

10.5055/jem.2020.0519 ◽

2020 ◽

Vol 18 (7) ◽

pp. 37-39

Author(s):

Varun Mahajan, MD ◽

Karan Singla, MD ◽

Kamal Kajal, MD ◽

Shiv Soni, MD ◽

Amarjyoti Hazarika, MD ◽

...

Keyword(s):

Health Care ◽

Emergency Management ◽

Patient Care ◽

Health Care Workers ◽

Personal Protective Equipment ◽

Physiological Parameters ◽

Protective Equipment ◽

Physiological Effects ◽

Care Workers

We would like to add to the study, Understanding the physiological effects of wearing enhanced personal protective equipment while providing patient care by Bulson and Shawl from the November/December 2019 issue of Journal of Emergency Management.

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Percepção do enfermeiro acerca do uso de equipamentos de proteção individual em hospital paraibano

Revista Brasileira de Educação e Saúde ◽

10.18378/rebes.v7i1.4858 ◽

2017 ◽

Vol 7 (1) ◽

pp. 01

Author(s):

Allan Dillammary Araújo Barbosa ◽

Allan Martins Ferreira ◽

Edmara da Nóbrega Xavier Martins ◽

Anne Milane Formiga Bezerra ◽

Juliana de Almeida Leandro Bezerra

Keyword(s):

Emergency Department ◽

Patient Care ◽

Work Environment ◽

Personal Protective Equipment ◽

Regional Hospital ◽

Protective Equipment ◽

Personal Protection ◽

Work Activities

Biossegurança ou segurança biológica é um conjunto de ações voltadas à prevenção e proteção do trabalhador. Uma estratégia utilizada como forma de evitar contaminação no ambiente de trabalho se dar a partir do uso de Equipamentos de Proteção Individual (EPIs). Objetivou-se analisar a percepção do enfermeiro sobre o uso e importância do EPI diante da assistência aos pacientes. O trabalho trata-se de um estudo do tipo exploratório-descritivo, com abordagem quantiqualitativa, foi realizado com enfermeiros plantonistas do setor de urgência e emergência de um Hospital Regional paraibano. Conforme os dados observa-se que a maioria dos enfermeiros é do gênero feminino, com faixa etária entre 20 e 30 anos de idade, são especialistas e atuam há dois anos no serviço de emergência. Todos os enfermeiros mostraram conhecimento sobre a importância do uso do EPI, relatando as principais doenças que podem acometê-los caso ocorram episódios de contaminação durante a execução das suas atividades laborais. Alguns dos profissionais afirmaram já se contaminar, sendo o material perfurocortante o que mais causou acidentes. Afirmaram que a instituição oferece a maioria dos EPIs necessários para proteção individual, porém só em algumas circunstâncias fazem uso desses equipamentos. Portanto, pôde-se concluir que tais contaminações poderiam ser evitadas se todos os profissionais fizerem uso dos EPIs em todas as situações que envolvam riscos, pondo em prática o conhecimento relatado, conferindo proteção não só ao profissional como a clientela que procura o serviço.Nurses perception about the use of personal protective equipment in a hospital in parabianAbstract: Biosafety or security biological is a set of actions aimed at the prevention and protection of the worker. One strategy used in order to avoid contamination in the work environment it's given from the use of Personal Protective Equipment (PPE). The work it is a study of exploratory-descriptive, with a quantiqualitative approach, was conducted with nurses in the sector of urgency and emergency in a Regional Hospital Paraiba, aiming analysis on the use and importance of PPE when providing patient care. According to data was realized that most nurses are female, aged between 20 and 30 years old, are experts and acting for two years in the emergency department. All nurses showed knowledge about the importance of using PPE, reporting major diseases that can affect them in case occur contamination episodes during the execution of their work activities. Some professionals said they already been contaminated, being the material pierce cutter which caused more accidents. They stated that the institution offers the majority of PPEs required for personal protection, but only in some circumstances they make use of such equipment. Therefore, it was concluded that such contamination could be avoided if all professionals make use of PPE in all situations involving risk, putting into practice the knowledge reported, providing protection not only to the professional as customers seeking service.

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Personal protective equipment in the COVID-19 pandemic and the use of cooling-wear as alleviator of thermal stress

Wiener klinische Wochenschrift ◽

10.1007/s00508-020-01775-x ◽

2020 ◽

Author(s):

Hanna Luze ◽

Sebastian P. Nischwitz ◽

Petra Kotzbeck ◽

Julia Fink ◽

Judith C. J. Holzer ◽

...

Keyword(s):

Thermal Stress ◽

Patient Care ◽

Personal Protective Equipment ◽

Human Performance ◽

Medical Personnel ◽

Pilot Project ◽

Negative Control ◽

Physiological Parameters ◽

Protective Equipment ◽

Staff Members

Summary Background High temperatures at workplaces lead to health-related risks and premature exhaustion. The coronavirus disease 2019 (COVID-19) pandemic requires many health professionals to perform under unfavorable conditions. Personal protective equipment (PPE) causes thermal stress and negatively affects performance. Patients, materials and methods This pilot project investigated the effects of PPE and additional cooling wear on physiological parameters and concentration of six healthy staff members of the Plastic Surgery Department of the Medical University of Graz, Austria during simulated patient care. In this study two 1‑hour cycles with patient care-related tasks with PPE and PPE + cooling-wear, respectively, were conducted. A third cycle with scrubs exclusively served as baseline/negative control. The assessment occurred immediately pre-cycles and post-cycles. Results Pre-cycle assessments showed no significant differences between the cycles. After PPE cycle, increased physical stress levels and decrements in concentration capacity were observed. Physiological parameters were significantly less affected in the cooling cycle, while concentration capacity slightly increased. Conclusion COVID-19 PPE causes considerable thermal stress, ultimately affecting human performance. As opportunity to withstand thermal stress, and improve patients’ and professionals’ safety, cooling-wear can be considered relevant. Medical personnel performing in exceptional situations may particularly benefit from further development and investigation of cooling strategies.

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Evaluation of Viral Surrogate Markers for Study of Pathogen Dissemination During Simulations of Patient Care

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx128 ◽

2017 ◽

Vol 4 (3) ◽

Cited By ~ 12

Author(s):

Heba Alhmidi ◽

Amrita John ◽

Thriveen C. Mana ◽

Sreelatha Koganti ◽

Jennifer L. Cadnum ◽

...

Keyword(s):

Clostridium Difficile ◽

Patient Care ◽

Mosaic Virus ◽

Personal Protective Equipment ◽

Cauliflower Mosaic Virus ◽

Protective Equipment ◽

Surrogate Markers ◽

Bacteriophage Ms2

Abstract During patient care simulations, cauliflower mosaic virus DNA and bacteriophage MS2 performed similarly as surrogate markers of pathogen dissemination. These markers disseminated to the environment in a manner similar to Clostridium difficile spores but were more frequently detected on skin and clothing of personnel after personal protective equipment removal.

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From natural disaster to pandemic: A health-system pharmacy rises to the challenge

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa180 ◽

2020 ◽

Vol 77 (23) ◽

pp. 1986-1993 ◽

Cited By ~ 2

Author(s):

Autumn D Zuckerman ◽

Pratish C Patel ◽

Mark Sullivan ◽

Amy Potts ◽

Molly Knostman ◽

...

Keyword(s):

Health System ◽

Patient Care ◽

Natural Disaster ◽

Personal Protective Equipment ◽

Care Delivery ◽

Protective Equipment ◽

Staff Members ◽

Quality Patient Care ◽

Pharmacy Department ◽

Virus Exposure

Abstract Purpose This report describes a health-system pharmacy’s response to a natural disaster while staff members simultaneously prepared for the coronavirus disease 2019 (COVID-19) pandemic. By detailing our experience, we hope to help other institutions that are current facing or could encounter similar crises. Summary In early March 2020, a tornado destroyed the health system’s warehouse for storage of most clinical supplies, including personal protective equipment and fluids. The pharmacy purchasing team collaborated with suppliers and manufacturers to recover losses and establish alternative storage areas. Days later, the pharmacy department was forced to address the impending COVID-19 pandemic. Key elements of the COVID-19 response included reducing the potential for virus exposure for patients and staff; overcoming challenges in sourcing of staff, personal protective equipment, and medications; and changing care delivery practices to maintain high-quality patient care while maximizing social distancing. The pharmacy department also created distance learning opportunities for 70 pharmacy students on rotations. After an initial plan, ongoing needs include adjustment in patient care activities if significant staff losses occur, when and how to resume clinical activities, and how to best utilize the resources accumulated. Elements of practice changes implemented to reduce COVID-19 threats to patients and pharmacy personnel have proven beneficial and will be further evaluated for potential continuation. Conclusion The pharmacy department’s efforts to respond to a natural disaster and unprecedented pandemic have proven successful to this point and have illuminated several lessons, including the necessity of cohesive department communication, staff flexibility, prioritization of teamwork, and external collaboration.

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Peculiarities of care for patients with coronavirus infection. Important safety issues for health care workers

Infusion & Chemotherapy ◽

10.32902/2663-0338-2020-3.2-254-256 ◽

2020 ◽

pp. 254-256

Author(s):

A.M. Savych

Keyword(s):

Health Care ◽

Patient Care ◽

Medical Devices ◽

Health Care Workers ◽

Personal Protective Equipment ◽

Surface Cleaning ◽

The Body ◽

Protective Equipment ◽

Care Workers ◽

The Face

Background. In case of coronavirus disease (COVID-19), contact persons include, but are not limited to, health care workers (HCW) and caregivers of COVID-19 patients. Personal protective equipment is required for HCW working with patients or individuals with suspected COVID-19. Correct sequence and the correct technique of putting them on is very important. Objective. To describe the safety measures for HCW in care of patients with COVID-19. Materials and methods. Analysis of literature sources on this topic. Results and discussion. Contaminated environmental surfaces take part in the contact route of transmission. To reduce the role of fomites in the transmission of the new SARS-CoV-2 coronavirus, special recommendations of the Ministry of Health on surface cleaning and disinfection have been developed. After cleaning, disinfectants must be used to reduce the viral load on the surface. These disinfectants are also effective against other pathogens that are important in health care settings. Such agents include ethanol 70-90 %, chlorine-based agents, and hydrogen peroxide >0.5 %. The register of disinfectants of Ukraine contains more than 200 brands. The vast majority of them are represented by alcohol- and chlorine-containing solutions of various concentrations, colors and odors. The use of these solutions is limited to the torso and extremities. These solutions have a number of limitations and caveats in their use. For instance, in case of contact with mucous membranes, they have an irritating effect and require rinsing with plenty of water. Vapors of some of them should not be inhaled, so they should be used in well-ventilated areas or with protective equipment. Alcohol-based products should not be applied to damaged areas of the skin due to protein denaturation. The Food and Drug Administration (FDA) recommends to use the chlorine- and alcohol-based solutions with caution due to the lack of evidence of their safety. The decamethoxine-based solution Yusept (“Yuria-Pharm”) is intended for disinfection of hands and other parts of the body, including the face; for disinfection of HCW gloves and gloves in other places; for disinfection and pre-sterilization cleaning of all medical devices from various materials; for disinfection of hairdresser’s, manicure, pedicure and cosmetic accessories; for disinfection of rooms, furniture, patient care items, hygiene products, utensils, containers, sanitary equipment, rubber carpets; for current, final and preventive disinfection; for use in aerosol disinfection systems such as Yu-box and other disinfection systems. Proper hand washing technique is also an important preventive measure. The effectiveness of prevention of HCW infection during their professional duties depends on how serious the problem is taken by the management of the health care institution and the HCW, who work with infectious patients, themselves. Conclusions. 1. For HCW working with patients or persons with suspected COVID-19, the use of personal protective equipment is mandatory. 2. Contaminated surfaces take part in the implementation of the contact route of infections’ transmission. 3. The vast majority of disinfectant solutions are alcohol- and chlorine-containing ones, which have a number of limitations and precautions in use. 4. Yusept solution is intended for disinfection of hands and other parts of the body, including the face; for disinfection and pre-sterilization cleaning of all medical devices; for disinfection of rooms, furniture, patient care items; for use in aerosol disinfection systems.

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492. Canadian consensus of COVID-19 policy and management aspects

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.685 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S312-S313

Author(s):

Kara Tsang ◽

Dominik Mertz ◽

Zain Chagla ◽

Fiona Smaill ◽

Sarah Khan

Keyword(s):

Infectious Disease ◽

Occupational Health ◽

Infection Control ◽

Patient Care ◽

Personal Protective Equipment ◽

Specific Treatment ◽

Clinical Staff ◽

Conservation Strategies ◽

Protective Equipment ◽

Medical Procedures

Abstract Background As evidence rapidly changes, a need for consensus in hospital policy and management aspects of COVID-19 patient care are needed. This study describes areas where consensus exists and is needed in infection control, and occupational health policy. Methods An online survey was sent to the membership of the Association of Medical Microbiology and Infectious Disease (n~700). The survey included questions about COVID-19 patient and outbreak management, personal protective equipment (PPE), and occupational health considerations. Results Our preliminary results (n=24) were from infectious disease MD/NP or infection control medical directors. All respondents agreed treatment of COVID-19 patients should only occur in the context of a clinical trial. Of 18 centers with neonatal populations, the majority (64.2%) did not have any neonatal specific treatment guidelines. Well-babies born to COVID-19 positive moms, are all being tested (10 of 10 respondents). Variation in practice on when to remove a patient from additional precautions and potential aerosol generating medical procedures (Table 1, 2). Universal masking is in place for all clinical staff (100%), non-clinical staff (70.8%), essential visitors or patient caregivers (70.8%), and universal eye protection is in place for clinical staff (93.3%), but there was a lack of consensus in PPE conservation strategies (Table 3). Most staff do not use neck PPE (68.2%), however there was comments of it being requested by anesthesiologists at 2 sites (Table 2). Healthcare trainees or workers in these groups were restricted from caring for COVID-19 patients; Age >65 years (54.5%) and immunocompromised status (54.5%). COVID-19 positive staff can return to work 14 days after symptom onset (84.2%). Table 1. Areas of COVID-19 management lacking consensus. Not all respondents answered every question. The percentage in brackets was calculated with the number of respondents per question as the denominator. Table 2. Procedures considered as aerosol generating medical procedures (AGMPs). Respondents (n=24) were allowed to select more than one option. Table 3. Personal protective equipment (PPE) conservation strategies (n=24). Not all respondents answered every question. The percentage in brackets was calculated with the number of respondents per question as the denominator. NA corresponds to the question not asked in the survey. Conclusion Across Canada, while there are areas of consensus in outbreak definitions, universal masking of clinical staff. There is significant variation in practice with respect to discontinuing additional precautions or outbreak measures, asymptomatic testing, AGMP definitions, PPE conservation strategies including reprocessing. As evidence evolves, national infection control guidelines will be important to improve standardization of practice and optimize patient care and staff safety. Disclosures All Authors: No reported disclosures

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