Selecting Controls for Minimizing SARS-CoV-2 Aerosol Transmission in Workplaces and Conserving Respiratory Protective Equipment Supplies

Abstract With growing evidence of inhalation of small infectious particles as an important mode of transmission for SARS-CoV-2, workplace risk assessments should focus on eliminating or minimizing such exposures by applying the hierarchy of controls. We adapt a control banding model for aerosol-transmissible infectious disease pandemic planning to encourage the use of source and pathway controls before receptor controls (personal protective equipment). Built on the recognition that aerosol-transmissible organisms are likely to exhibit a dose–response function, such that higher exposures result from longer contact times or higher air concentrations, this control banding model offers a systematic method for identifying a set of source and pathway controls that could eliminate or reduce the need for receptor controls. We describe several examples for workers at high risk of exposure in essential or return to work categories. The goal of using control banding for such workers is to develop effective infection and disease prevention programs and conserve personal protective equipment.

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Contagion Management at the Méditerranée Infection University Hospital Institute

Journal of Clinical Medicine ◽

10.3390/jcm10122627 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2627

Author(s):

Pierre-Edouard Fournier ◽

Sophie Edouard ◽

Nathalie Wurtz ◽

Justine Raclot ◽

Marion Bechet ◽

...

Keyword(s):

Infectious Disease ◽

Early Diagnosis ◽

Personal Protective Equipment ◽

Early Stage ◽

Point Of Care ◽

University Hospital ◽

Protective Equipment ◽

Monitoring Point ◽

Epidemiological Monitoring ◽

Wide Range

The Méditerranée Infection University Hospital Institute (IHU) is located in a recent building, which includes experts on a wide range of infectious disease. The IHU strategy is to develop innovative tools, including epidemiological monitoring, point-of-care laboratories, and the ability to mass screen the population. In this study, we review the strategy and guidelines proposed by the IHU and its application to the COVID-19 pandemic and summarise the various challenges it raises. Early diagnosis enables contagious patients to be isolated and treatment to be initiated at an early stage to reduce the microbial load and contagiousness. In the context of the COVID-19 pandemic, we had to deal with a shortage of personal protective equipment and reagents and a massive influx of patients. Between 27 January 2020 and 5 January 2021, 434,925 nasopharyngeal samples were tested for the presence of SARS-CoV-2. Of them, 12,055 patients with COVID-19 were followed up in our out-patient clinic, and 1888 patients were hospitalised in the Institute. By constantly adapting our strategy to the ongoing situation, the IHU has succeeded in expanding and upgrading its equipment and improving circuits and flows to better manage infected patients.

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COVID-19 global pandemic planning: Dry heat incubation and ambient temperature fail to consistently inactivate SARS-CoV-2 on N95 respirators

Experimental Biology and Medicine ◽

10.1177/1535370220977819 ◽

2020 ◽

pp. 153537022097781

Author(s):

Douglas J Perkins ◽

Robert A Nofchissey ◽

Chunyan Ye ◽

Nathan Donart ◽

Alison Kell ◽

...

Keyword(s):

Ambient Temperature ◽

Personal Protective Equipment ◽

Healthcare Personnel ◽

Protective Equipment ◽

Experimental Conditions ◽

Dry Heat ◽

Global Pandemic ◽

Individual Site ◽

Pandemic Planning ◽

N95 Respirators

The ongoing pandemic of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has placed a substantial strain on the supply of personal protective equipment, particularly the availability of N95 respirators for frontline healthcare personnel. These shortages have led to the creation of protocols to disinfect and reuse potentially contaminated personal protective equipment. A simple and inexpensive decontamination procedure that does not rely on the use of consumable supplies is dry heat incubation. Although reprocessing with this method has been shown to maintain the integrity of N95 respirators after multiple decontamination procedures, information on the ability of dry heat incubation to inactivate SARS-CoV-2 is largely unreported. Here, we show that dry heat incubation does not consistently inactivate SARS-CoV-2-contaminated N95 respirators, and that variation in experimental conditions can dramatically affect viability of the virus. Furthermore, we show that SARS-CoV-2 can survive on N95 respirators that remain at room temperature for at least five days. Collectively, our findings demonstrate that dry heat incubation procedures and ambient temperature for five days are not viable methods for inactivating SARS-CoV-2 on N95 respirators for potential reuse. We recommend that decontamination procedures being considered for the reuse of N95 respirators be validated at each individual site and that validation of the process must be thoroughly conducted using a defined protocol.

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478. Psychological Distress among Infectious Disease Physicians during the Response to the COVID-19 Outbreak in the Republic of Korea

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.671 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S305-S305

Author(s):

Se Yoon Park ◽

Bongyoung Kim ◽

Dong Sik Jung ◽

Sook In Jung ◽

Won Sup Oh ◽

...

Keyword(s):

Infectious Disease ◽

Psychological Distress ◽

Infection Control ◽

Personal Protective Equipment ◽

Text Message ◽

Disease Outbreaks ◽

Maslach Burnout Inventory ◽

Republic Of Korea ◽

Protective Equipment ◽

The Republic

Abstract Background This study aimed to investigate psychological distress among infectious disease (ID) physicians during the coronavirus disease (COVID-19) outbreak in the Republic of Korea. Methods Using an online-based survey link sent via text message and email, we conducted a survey from April 21 to 25, 2020, targeting all ID physicians currently working in ID (n = 265). The questionnaire was based on the Maslach Burnout Inventory-Human Services Survey and the Depression, Anxiety, and Stress Scales, and information was collected on factors protecting against psychological distress and difficulties in relation to COVID-19. Results Of 265 ID physicians, 115 (43.3%) responded, showing burnout (97, 90.4%), depression (20, 17.4%), anxiety (23, 20.0%), and stress (5, 4.3%). There were no differences in terms of distress between ID physicians who were directly involved in the care of patients with COVID-19 or not (Table 1). Greater than 50% of physicians valued their work and felt recognized by others, whereas < 10% indicated that sufficient human and financial support and private time had been provided during the outbreak. The most challenging issues concerned a lack of human resources for COVID-19 treatment or infection control, a shortage of personal protective equipment or airborne infection isolation rooms, pressure for research, and lack of guidelines for COVID-19 management (Figure 1). Table 1. Figure 1. Difficulties in response to the COVID-19 outbreak. Abbreviations: COVID-19, coronavirus disease 19; HCWs, healthcare workers; ICPs, infection control practitioners; IRB, Institutional Review Board; PPE, personal protective equipment Conclusion During the COVID-19 outbreak in the ROK, most respondents reported psychological distress. Preparing strategies for infectious disease outbreaks that support ID physicians is essential. Disclosures All Authors: No reported disclosures

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The challenge of infection control in patients' homes

British Journal of Community Nursing ◽

10.12968/bjcn.2021.26.4.168 ◽

2021 ◽

Vol 26 (4) ◽

pp. 168-174

Author(s):

Drew Payne ◽

Martin Peache

Keyword(s):

Infectious Disease ◽

Disease Management ◽

Hand Hygiene ◽

Infection Control ◽

Personal Protective Equipment ◽

Clinical Care ◽

Cross Infection ◽

Protective Equipment ◽

Unique Challenge ◽

Clinical Equipment

Infection control is the responsibility of all nurses, but, traditionally, it has been seen as a priority only in hospitals. Infection control does not stop when a patient is discharged home, but should be practiced wherever clinical care takes place. Community nurses face a unique challenge as they work in patients' homes, and they must manage infection control in that unique environment. This article looks at practical ways to maintain infection control in patients' homes. It covers hand hygiene and personal protective equipment (PPE), including the five moments of hand hygiene, appropriate hand hygiene, the use of all PPE and when gloves are required and when they are not. It also discusses managing clinical equipment, both that taken into the home and that left with a patient, including decontamination, safe storage of sharps and waste management. It touches upon what can be done in a patient's home to reduce the risk of contamination, as well as infectious disease management, including specimens and wound infection management. Lastly, it talks about cross-infection and why staff health is also important.

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Which Personal Protective Equipment Should I Use while Caring for Children Attending the ED? Paediatric Emergency Procedures in the COVID-19 Era and Beyond

10.21203/rs.3.rs-565729/v1 ◽

2021 ◽

Author(s):

Simon Craig ◽

Julia Clark ◽

Mike Starr ◽

Joanne Grindlay ◽

Andrew Tagg ◽

...

Keyword(s):

Infectious Disease ◽

Infectious Diseases ◽

Personal Protective Equipment ◽

Respiratory Illness ◽

Transmission Risk ◽

Protective Equipment ◽

Emergency Physicians ◽

Emergency Procedures ◽

Community Transmission ◽

Infectious Disease Specialists

Abstract ObjectivesTo determine recommendations for the use of personal protective equipment (PPE) based on transmission risk for paediatric procedures in the Emergency Department during the COVID-19 pandemic. MethodsTwo survey rounds were conducted in April-May 2020. The survey presented a number of emergency medicine procedures relevant to the care of children, and asked respondents to provide PPE recommendations according to levels of community transmission, and whether or not the child had symptoms of acute respiratory illness. ResultsParticipants were recruited by approaching relevant professional groups, with 15 from the PREDICT network and 12 from the Australasian Society of Infectious Diseases (ASID) Paediatric Infectious Diseases (ANZPID) Group. Airborne PPE is recommended for resuscitative procedures and various respiratory procedures in most situations There were differences in opinion between emergency and paediatric infectious disease specialists with regards to most appropriate PPE for children without symptoms of COVID-19 in a setting of low community transmission, and for procedures involving the head, neck or airway. In general, emergency physicians were more likely to favour airborne PPE than infectious disease specialists. In the setting of high community transmission, there was a stronger tendency to recommend at least droplet precautions for most procedures – regardless of whether or not the child had symptoms. ConclusionsDifferences in PPE recommendations for various paediatric procedures between infectious disease specialists and emergency physicians were identified. Further research is urgently needed to clarify and quantify risks for many common interventions and determine strategies for multidisciplinary consensus regarding future recommendations.

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ASSESSMENT OF THE AWARENESS AND SAFETY PRACTICES IN MITIGATING HAZARDS OF SILICA DUST EXPOSURE AMONG CONSTRUCTION WORKERS

International Journal of Engineering Applied Sciences and Technology ◽

10.33564/ijeast.2021.v05i10.009 ◽

2021 ◽

Vol 5 (10) ◽

Author(s):

Engr. Jeferd E. Saong ◽

Abigail L. Babaran ◽

Glenn Dale A. Balaho

Keyword(s):

Health Effects ◽

Personal Protective Equipment ◽

Construction Workers ◽

Dust Exposure ◽

Protective Equipment ◽

Construction Site ◽

Construction Sites ◽

Safety Practices ◽

Silica Dust ◽

Mode Of Transmission

Construction sites generate high levels of dust typically from concrete, silica, asbestos, cement, wood, stone, and sand. Workers who are exposed to the said environment are faced with the risk of inhaling particulate materials that might lead to adverse respiratory problems. The lack of publication on the awareness of construction workers on the risk associated with silica dust exposure was the basis of the study. This study assessed the level of awareness of construction workers on the risk associated with silica dust exposure and the safety practices to minimize it. Purposive sampling was used in the selection of 65 respondents from different construction sites located in Baguio City, Philippines. A survey questionnaire containing four point Likert scales were used to determine the level of awareness on the health effects, mode of transmission, and sources of silica dust. The study further assessed the level of safety practices in mitigating the effects of silica dust exposure. The respondents were moderately aware (M=2.52) of the health effects, moderately aware (M=2.69) of the mode of transmission, and moderately aware (M=3.08) of the sources of silica dust. The results further showed that the respondents moderately practiced (M=2.84) activities to mitigate the health effects of silica dust exposure and moderately practiced (M=3.17) the use of personal protective equipment in the construction site. The results suggest that construction workers must be made more aware of the health effects of silica dust exposure and, mitigation activities and utilization of personal protective equipment must be strictly imposed in the construction site.

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Determining the source of transmission of SARS-CoV-2 infection in a healthcare worker

10.1101/2020.04.27.20077016 ◽

2020 ◽

Cited By ~ 2

Author(s):

Nasia Safdar ◽

Gage K. Moreno ◽

Katarina M. Braun ◽

Thomas C. Friedrich ◽

David H. O’Connor

Keyword(s):

Infection Control ◽

Healthcare Worker ◽

Personal Protective Equipment ◽

Healthcare Workers ◽

Total Population ◽

Protective Equipment ◽

Hospital Infection Control ◽

Risk Of Exposure ◽

N95 Respirators ◽

Cumulative Prevalence

BackgroundHealthcare workers (HCWs) are at the frontlines of the COVID-19 pandemic and are at risk of exposure to SARS-CoV-2 infection from their interactions with patients and in the community (1, 2). Limited availability of recommended personal protective equipment (PPE), in particular N95 respirators, has fueled concerns about whether HCWs are adequately protected from exposure while caring for patients. Understanding the source of SARS-CoV-2 infection in a HCW – the community or the healthcare system – is critical for understanding the effectiveness of hospital infection control and PPE practices. In Dane County, Wisconsin, community prevalence of SARS-CoV-2 is relatively low (cumulative prevalence of ~0.06% – positive cases / total population in Dane county as of April 17). Although SARS-CoV-2 infections in HCWs are often presumed to be acquired during the course of patient care, there are few reports unambiguously identifying the source of acquisition.ObjectiveTo determine the source of transmission of SARS-CoV-2 in a healthcare worker.

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Prevention of COVID-19 Infection with Personal Protective Equipment

Journal of Disaster Research ◽

10.20965/jdr.2021.p0061 ◽

2021 ◽

Vol 16 (1) ◽

pp. 61-69

Author(s):

Noriko Shimasaki ◽

Hideaki Morikawa ◽

◽

Keyword(s):

Infectious Disease ◽

Infection Control ◽

Personal Protective Equipment ◽

Control Measures ◽

Protective Equipment ◽

Modes Of Transmission ◽

Infection Control Measures ◽

Urban Disaster ◽

Asymptomatic Individuals ◽

Novel Coronavirus

A new infectious disease caused by a novel coronavirus (COVID-19) has spread rapidly worldwide in 2020. The COVID-19 pandemic in Japan can be viewed as an urban disaster because transmission of this respiratory disease tends to occur in densely populated areas. A scientific understanding of the pathogen itself, the cause of the disaster (infectious disease), as well as infection control measures, are important to implement robust and appropriate countermeasures. This review discribes the features, especially the modes of transmission, of COVID-19 and the principles by which infection control is possible using one of the most effective infection control measures – personal protective equipment (PPE). Because COVID-19 is often transmitted to others by asymptomatic individuals through droplets, even those who are unaware of their infection should wear masks to prevent the spread of droplets that may contain the virus and effectively control the spread of disease. However, given the worldwide competition for masks and the urgent requirement of effective controls, it is necessary to conduct further research to establish a system that can supply adequate numbers of masks to regions where many people are infected in the country, with no shortage of masks, in order to make the country more resilient to disasters caused by infectious diseases in the future.

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Stability of SARS-CoV-2 on Critical Personal Protective Equipment

10.1101/2020.06.11.20128884 ◽

2020 ◽

Cited By ~ 7

Author(s):

Samantha B Kasloff ◽

James E Strong ◽

Duane Funk ◽

Todd Cutts

Keyword(s):

Personal Protective Equipment ◽

Healthcare Workers ◽

Protective Equipment ◽

Potential Utility ◽

Rapid Degradation ◽

Healthcare Settings ◽

Interesting Insight ◽

Mode Of Transmission ◽

Insight Into ◽

Shed Light

AbstractThe spread of COVID-19 in healthcare settings is concerning, with healthcare workers representing a disproportionately high percentage of confirmed cases. Although SARS-CoV-2 virus has been found to persist on surfaces for a number of days, the extent and duration of fomites as a mode of transmission, particularly in healthcare settings, has not been fully characterized. To shed light on this critical matter, the present study provides the first comprehensive assessment of SARS-CoV-2 stability on experimentally contaminated personal protective equipment (PPE) widely used by healthcare workers and the general public. Persistence of viable virus was monitored over 21 days on eight different materials, including nitrile medical examination gloves, reinforced chemical resistant gloves, N-95 and N-100 particulate respirator masks, Tyvek®, plastic, cotton, and stainless steel. Unlike previous reports, viable SARS-CoV-2 in the presence of a soil load persisted for up to 21 days on experimentally inoculated PPE, including materials from filtering facepiece respirators (N-95 and N-100 masks) and a plastic visor. Conversely, when applied to 100% cotton fabric, the virus underwent rapid degradation and became undetectable in less than 24 hours. These findings underline the importance of appropriate handling of contaminated PPE during and following use in high-risk settings and provide interesting insight into the potential utility of cotton, including cotton masks, in limiting COVID-19 transmission.

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The ‘haves’ and ‘have-nots’ of personal protective equipment during the COVID-19 pandemic: the ethics of emerging inequalities amongst healthcare workers

Journal of Medical Ethics ◽

10.1136/medethics-2021-107501 ◽

2021 ◽

pp. medethics-2021-107501

Author(s):

Clifford Shelton ◽

Kariem El-Boghdadly ◽

John B Appleby

Keyword(s):

Personal Protective Equipment ◽

Healthcare Workers ◽

Healthcare Setting ◽

Protective Equipment ◽

Practical Action ◽

Ethical Implications ◽

Healthcare Workforce ◽

Pandemic Planning ◽

Operating Theatres

The COVID-19 pandemic has exacerbated inequalities, including among the healthcare workforce. Based on recent literature and drawing on our experiences of working in operating theatres and critical care in the UK’s National Health Service during the pandemic, we review the role of personal protective equipment and consider the ethical implications of its design, availability and provision at a time of unprecedented demand. Several important inequalities have emerged, driven by factors such as individuals purchasing their own personal protective equipment (either out of choice or to address a lack of provision), inconsistencies between guidelines issued by different agencies and organisations, and the standardised design and procurement of equipment required to protect a diverse healthcare workforce. These, we suggest, have resulted largely because of a lack of appropriate pandemic planning and coordination, as well as insufficient appreciation of the significance of equipment design for the healthcare setting. As with many aspects of the pandemic, personal protective equipment has created and revealed inequalities driven by economics, gender, ethnicity and professional influence, creating a division between the ‘haves’ and ‘have-nots’ of personal protective equipment. As the healthcare workforce continues to cope with ongoing waves of COVID-19, and with the prospect of more pandemics in the future, it is vital that these inequalities are urgently addressed, both through academic analysis and practical action.

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