scholarly journals EP.FRI.221Safe delivery of emergency laparotomy using Personal Protective Equipment (PPE) during the first peak of the COVID-19 pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Adam O'Connor ◽  
Jayne Bennett ◽  
Imran Alam
Keyword(s):  
Personal Protective Equipment ◽  
Cerebrovascular Accident ◽  
Emergency Laparotomy ◽  
Protective Equipment ◽  
Acute Cerebrovascular Accident ◽  
Risk Of Mortality ◽  
Co Morbidity ◽  
Timely Access ◽  
The Mean ◽  
Operating Surgeon

Abstract Aims To evaluate emergency laparotomies and examine operating surgeon use of PPE as per guidelines in the first COVID-19 peak. Methods The NELA database for our hospital was interrogated to examine for emergency laparotomy cases between March to September 2020. Data was recorded on age, pathology, NELA mortality score, post-operative destination, mortality COVID-19 swab status as an inpatient and use of PPE. Results 55 laparotomies were undertaken. The median age was 67 years. 48% had a Clinical Frailty Score >4. 53% of patients were 'high-risk' in their NELA mortality score (>5%). 56% were ASA >3. 44% went to intensive care post-operatively. 18% and 36% had significant cardiac and respiratory co-morbidities. The mean NELA mortality score was 10% pre-operatively. Mean post-operative risk of mortality score was 67%. Only 1 patient contracted COVID-19 whilst an inpatient and subsequently died of acute cerebrovascular accident unrelated to her COVID-19. PPE was available and used as per guidelines in all cases. Conclusions Our department remained busy throughout the first peak however there was a reduction in cases compared with 2019. Our population is generally heavily co-morbid based on ASA scores and cardiorespiratory co-morbidity. Nevertheless only 1 patient contracted COVID whilst an inpatient in this cohort. Access to adequate amounts of personal protective equipment is paramount to ensure safe and timely access to emergency laparotomy for patients and surgeons alike.

scholarly journals The Cupola: An Additional Layer of Protection for Providers Working in the Oropharyngeal Region

2021 ◽  
Author(s):  
Alessandro Villa ◽  
Marlene Grenon
Keyword(s):  
Pilot Study ◽  
Personal Protective Equipment ◽  
Airborne Particles ◽  
Protective Equipment ◽  
Additional Layer ◽  
Dental Procedures ◽  
The Mean ◽  
Mechanical Barrier

Abstract ObjectivesTo reduce the spread of the infection, especially during aerosol generating procedures, we invented “The Cupola”, a shield that creates a mechanical barrier around the patient’s head and body. With this pilot study we aimed to assess the effectiveness of an additional layer of protection (The Cupola) developed for providers working in the oropharyngeal region.ResultsThe mean number of 0.3 μm particles with no Cupola was 3777 (SD: ±556), with The Cupola was 2068 (SD: ±1468) and with the Cupola and Drape was 2031 (SD: ±1108) (p<0.015). The mean number of 0.5 μm airborne particles with no Cupola was 65 (SD: ±7), with The Cupola was 29 (SD: ±28) and with the Cupola and Drape was 28 (SD: ±23) (p<0.05). Results showed a significant reduction of aerosols generated during simulated dental procedures when the Cupola was used. The Cupola offers an extra layer of protection in addition to the recommended personal protective equipment.

scholarly journals Systematic review and meta-analysis comparing ventilatory support in chemical, biological and radiological emergencies

2020 ◽  
Vol 28 ◽  
Author(s):  
Israel Baptista de Souza Borges ◽  
Magali Rezende de Carvalho ◽  
Marcel de Souza Quintana ◽  
Alexandre Barbosa de Oliveira
Keyword(s):  
Personal Protective Equipment ◽  
Health Professionals ◽  
Meta Analysis ◽  
Ventilatory Support ◽  
Orotracheal Intubation ◽  
Protective Equipment ◽  
Laryngeal Masks ◽  
Orotracheal Tube ◽  
The Mean ◽  
Meta Analyses

Objective: to compare the mean development time of the techniques of direct laryngoscopy and insertion of supraglottic devices; and to evaluate the success rate in the first attempt of these techniques, considering health professionals wearing specific personal protective equipment (waterproof overalls; gloves; boots; eye protection; mask). Method: meta-analysis with studies from LILACS, MEDLINE, CINAHL, Cochrane, Scopus and Web of Science. The keywords were the following: personal protective equipment; airway management; intubation; laryngeal masks. Results: in the “reduction of the time of the procedures” outcome, the general analysis of the supraglottic devices in comparison with the orotracheal tube initially presented high heterogeneity of the data (I2= 97%). Subgroup analysis had an impact on reducing heterogeneity among the data. The “laryngeal mask as a guide for orotracheal intubation” subgroup showed moderate heterogeneity (I2= 74%). The “2ndgeneration supraglottic devices” subgroup showed homogeneity (I2= 0%). All the meta-analyses favored supraglottic devices. In the “success in the first attempt” outcome, moderate homogeneity was found (I2= 52%), showing a higher proportion of correct answers for supraglottic devices. Conclusion: in the context of chemical, biological or radiological disaster, the insertion of the supraglottic device proved to be faster and more likely to be successful by health professionals. PROSPERO record (CRD42019136139).

scholarly journals Forecast predictions for the COVID-19 pandemic in Brazil by statistical modeling using the Weibull distribution for daily new cases and deaths

2020 ◽  
Author(s):  
Vitor Hugo Moreau
Keyword(s):  
Decision Making ◽  
Weibull Distribution ◽  
Statistical Modeling ◽  
Personal Protective Equipment ◽  
Educational Level ◽  
Protective Equipment ◽  
Preventive Strategies ◽  
Health Authorities ◽  
Total Death ◽  
The Mean

Abstract COVID-19 has killed more than 330.000 people worldwide and more than 21,000 Brazilians. Since there are no specific drugs or vaccines, the available tools against COVID-19 are preventive, such as the use of personal protective equipment, social distancing, lockdowns and mass testing. Such measures are hindered in Brazil due to a restrict budget, low educational level of the population and misleading attitudes from the federal authorities. Predictions for COVID-19 are of pivotal importance to subsidize and mobilize health authorities’ efforts in applying the necessary preventive strategies. The Weibull distribution was used to model the forecast prediction of COVID-19, in four scenarios, based on the curve of daily new deaths as a function of time. The date in which the number of daily new deaths will fall below the rate of 3 deaths per million, the mean level considered by some countries to relax stay-at-home measures, was estimated. If the daily new deaths curve was bended today (i. e. about 1,250 deaths per day), the predicted date would be on June 18th. Analysis of the lethality rate allowed the estimation of daily new cases and total death toll at the end of the outbreak. Our results suggest that each additional day that lasts to bend the daily new deaths curve can correspond to additional 3,718 deaths at the end of COVID-19 outbreak in Brazil (R2 = 0.9938). Predictions of the outbreak can be used to guide Brazilian health authorities in the decision making to properly fight COVID-19 pandemic.

scholarly journals The Cupola: an additional layer of protection for providers working in the oropharyngeal region

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Alessandro Villa ◽  
Marlene Grenon
Keyword(s):  
Pilot Study ◽  
Personal Protective Equipment ◽  
Airborne Particles ◽  
Protective Equipment ◽  
Additional Layer ◽  
Dental Procedures ◽  
The Mean ◽  
Mechanical Barrier

Abstract Objectives To reduce the spread of the infection, especially during aerosol generating procedures, we invented “The Cupola”, a shield that creates a mechanical barrier around the patient’s head and body. With this pilot study we aimed to assess the effectiveness of an additional layer of protection (The Cupola) developed for providers working in the oropharyngeal region. Results The mean number of 0.3 μm particles with no Cupola was 3777 (SD: ± 556), with The Cupola was 2068 (SD: ± 1468) and with the Cupola and Drape was 2031 (SD: ± 1108) (p < 0.015). The mean number of 0.5 μm airborne particles with no Cupola was 65 (SD: ± 7), with The Cupola was 29 (SD: ± 28) and with the Cupola and Drape was 28 (SD: ± 23) (p < 0.05). Results showed a significant reduction of aerosols generated during simulated dental procedures when the Cupola was used. The Cupola offers an extra layer of protection in addition to the recommended personal protective equipment.

scholarly journals Application of an objective structured clinical examination to evaluate and monitor interns’ proficiency in hand hygiene and personal protective equipment use in the United States

2019 ◽  
Vol 16 ◽  
pp. 31 ◽  
Author(s):  
Ying Nagoshi ◽  
Lou Ann Cooper ◽  
Lynne Meyer ◽  
Kartik Cherabuddi ◽  
Julia Close ◽  
...  
Keyword(s):  
United States ◽  
Hand Hygiene ◽  
Clinical Examination ◽  
Personal Protective Equipment ◽  
The United States ◽  
Objective Structured Clinical Examination ◽  
Protective Equipment ◽  
Contact Precaution ◽  
Percent Correct ◽  
The Mean

Purpose: This study was conducted to determine whether an objective structured clinical examination (OSCE) could be used to evaluate and monitor hand hygiene and personal protective equipment (PPE) proficiency among medical interns in the United States.Methods: Interns in July 2015 (N=123, cohort 1) with no experience of OSCE-based contact precaution evaluation and teaching were evaluated in early 2016 using an OSCE for hand hygiene and PPE proficiency. They performed poorly. Therefore, the new interns entering in July 2016 (N=151, cohort 2) were immediately tested at the same OSCE stations as cohort 1, and were provided with feedback and teaching. Cohort 2 was then retested at the OSCE station in early 2017. The Mann-Whitney U-test was used to compare the performance of cohort 1 and cohort 2 on checklist items. In cohort 2, performance differences between the beginning and end of the intern year were compared using the McNemar chi-square test for paired nominal data.Results: Checklist items were scored, summed, and reported as percent correct. In cohort 2, the mean percent correct was higher on the posttest than on the pretest (92% vs. 77%, P<0.0001), and the passing rate (100% correct) was also significantly higher on the posttest (55% vs. 16%). At the end of intern year, the mean percent correct was higher in cohort 2 than in cohort 1 (95% vs. 90%, P<0.0001), and 55% of cohort 2 passed (a perfect score) compared to 24% in cohort 1 (P<0.0001).Conclusion: An OSCE can be utilized to evaluate and monitor hand hygiene and PPE proficiency among interns in the United States.

scholarly journals Tracheotomy in a High-Volume Center During the COVID-19 Pandemic: Evaluating the Surgeon’s Risk

2020 ◽  
pp. 019459982095517 ◽  
Author(s):  
Arielle G Thal ◽  
Bradley A. Schiff ◽  
Yasmina Ahmed ◽  
Angela Cao ◽  
Allen Mo ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Transmission Rate ◽  
High Volume ◽  
Protective Equipment ◽  
Minimal Risk ◽  
Surgical Team ◽  
Positive Antibody ◽  
Control And Prevention ◽  
The Mean ◽  
Mean Time

Objective Performing tracheotomy in patients with COVID-19 carries a risk of transmission to the surgical team due to potential viral particle aerosolization. Few studies have reported transmission rates to tracheotomy surgeons. We describe our safety practices and the transmission rate to our surgical team after performing tracheotomy on patients with COVID-19 during the peak of the pandemic at a US epicenter. Study Design Retrospective cohort study. Setting Tertiary academic hospital. Methods Tracheotomy procedures for patients with COVID-19 that were performed April 15 to May 28, 2020, were reviewed, with a focus on the surgical providers involved. Methods of provider protection were recorded. Provider health status was the main outcome measure. Results Thirty-six open tracheotomies were performed, amounting to 65 surgical provider exposures, and 30 (83.3%) procedures were performed at bedside. The mean time to tracheotomy from hospital admission for SARS-CoV-2 symptoms was 31 days, and the mean time to intubation was 24 days. Standard personal protective equipment, according to Centers for Disease Control and Prevention, was worn for each case. Powered air-purifying respirators were not used. None of the surgical providers involved in tracheotomy for patients with COVID-19 demonstrated positive antibody seroconversion or developed SARS-CoV-2–related symptoms to date. Conclusion Tracheotomy for patients with COVID-19 can be done with minimal risk to the surgical providers when standard personal protective equipment is used (surgical gown, gloves, eye protection, hair cap, and N95 mask). Whether timing of tracheotomy following onset of symptoms affects the risk of transmission needs further study.

Hygienic Assessment of Risks of Thermal Balance Disruption in Medical Laboratory Workers Using Personal Protective Equipment for Biohazards

2021 ◽  
pp. 31-36
Author(s):  
VV Shkarin ◽  
NI Latyshevskaya ◽  
DV Orlov ◽  
BN Filatov ◽  
TV Zhukova ◽  
...  
Keyword(s):  
Skin Temperature ◽  
Personal Protective Equipment ◽  
Thermal State ◽  
Thermal Balance ◽  
Medical Laboratory ◽  
Protective Equipment ◽  
Heat Sensation ◽  
Laboratory Workers ◽  
The Mean ◽  
Thermoregulatory Reactions

Introduction: Specifics of activities of medical personnel in different types of laboratories can potentially create working conditions that violate occupational safety and health regulations. Objective: The study aimed to assess health risks of thermal balance disruption in PCR laboratory staff wearing personal protective equipment for biohazards in the context of the COVID-19 pandemic. Materials and methods: The study was conducted in winter 2020–2021 in PCR laboratories of the Volgograd Region. It included measurements of laboratory microclimate parameters, such as relative humidity, air temperature and velocity, used to estimate the heat load index. An observation cohort of 31 female medical laboratory workers aged 32.48 ± 1.45 years with a three to nine months experience of work in the PCR laboratory was formed to monitor the thermal state at the start and end of the work shift by measuring skin temperature at five points, sublingual temperature, and heat sensation. The results of measurements were used to estimate the mean skin temperature and heart rate while the dynamics of work ability was assessed by the results of contact tremorometry. Results: We established a significant increase in all measured values. The mean skin temperature at the end of the shift reached 33.85 ± 0.24 °C, thus exceeding the upper limit of the permissible value. The heart rate and heat sensation parameters approached the upper values of the maximum permissible thermal state of a person. Contact tremorometry results indicated a decrease in the performance by the end of the work shift. The findings gave evidence of tension of thermoregulatory reactions and the risk of thermal balance disruption posed by the use of a specific type of personal protective equipment in the PCR laboratory. Conclusion: The research results provide strong support for the conclusion that the use of PPE for biohazards poses a risk of thermal balance disruption in medical laboratory personnel. The severity of stress of thermoregulatory reactions depends on technical and design characteristics of the PPE used. The necessity of a physiological and hygienic substantiation of acceptable duration of work of medical workers wearing various types of PPE for biohazards in PCR laboratories justifies the importance of further studies.

scholarly journals The Response of Pakistani Social Workers amid the COVID-19 Pandemic: A Qualitative Analysis of the Main Challenges

2020 ◽  
Author(s):  
Kiran Abbas ◽  
Muhammad Inam Ul Haq ◽  
Wareesha Afaq Zaidi ◽  
Ahmed Kaleem ◽  
Hamza Sohail ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Qualitative Analysis ◽  
Social Workers ◽  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Non Profit ◽  
The Social ◽  
The Family ◽  
The Mean

AbstractThe study aimed to highlight the main challenges faced by the social workers amid the pandemic. A qualitative study was conducted between March 2020 to May 2020 in Karachi, Pakistan. All participants who belonged to a non-profit organization were eligible to participate. Open-ended questions were asked by the participants. The mean age of the participants was 24.8 ± 5.9 years. The main challenges faced by the social workers were: i) resistance from the family and friends, ii) lack of personal protective equipment, iii) mistrust from public, iv) uncooperative government/authorities.

scholarly journals A Randomized Trial of Instructor-Led Training Versus Video Lesson in Training Health Care Providers in Proper Donning and Doffing of Personal Protective Equipment

2020 ◽  
Vol 14 (4) ◽  
pp. 514-520 ◽  
Author(s):  
Liva Christensen ◽  
Charlotte Schang Rasmussen ◽  
Thomas Benfield ◽  
Jeffrey Michael Franc
Keyword(s):  
Effect Size ◽  
Personal Protective Equipment ◽  
Training Session ◽  
Control Group ◽  
Protective Equipment ◽  
Junior Doctors ◽  
Care Providers ◽  
Significant Difference ◽  
The Mean ◽  
Video Group

ABSTRACTObjective:This study compared live instructor-led training with video-based instruction in personal protective equipment (PPE) donning and doffing. It assessed the difference in performance between (1) attending 1 instructor-led training session in donning and doffing PPE at 1 month prior to assessment, and (2) watching training videos for 1 month.Methods:This randomized controlled trial pilot study divided 21 medical students and junior doctors into 2 groups. Control group participants attended 1 instructor-led training session. Video group participants watched training videos demonstrating the same procedures, which they could freely watch again at home. After 1 month, a doctor performed a blind evaluation of performance using checklists.Results:Nineteen participants were assessed after 1 month. The mean donning score was 84.8/100 for the instructor-led group and 88/100 for the video group; mean effect size was 3.2 (95% CI: -7.5 to 9.5). The mean doffing score was 79.1/100 for the instructor-led group and 73.9/100 for the video group; mean effect size was 5.2 (95% CI: -7.6 to 18).Conclusion:Our study found no significant difference in donning and doffing scores between instructor-led and video lessons. Video training could be a fast and resource-efficient method of training in PPE donning and doffing in responding to the COVID-19 pandemic.

scholarly journals Endotracheal intubation of COVID-19 patients by paramedics using a box barrier: A randomized crossover manikin study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248383
Author(s):  
Oren Feldman ◽  
Nir Samuel ◽  
Noa Kvatinsky ◽  
Ravit Idelman ◽  
Raz Diamand ◽  
...  
Keyword(s):  
Endotracheal Intubation ◽  
Personal Protective Equipment ◽  
Primary Outcome ◽  
Protective Equipment ◽  
Intubation Time ◽  
Success Rates ◽  
Clinical Environment ◽  
Aerosol Delivery ◽  
The Mean ◽  
Study Participants

Background In the prehospital setting, endotracheal intubation (ETI) may be required to secure the coronavirus disease 2019 (COVID-19) patient airway. It has been suggested that the use of a protective barrier can reduce possible aerosol delivery from patients to clinicians during ETI. We sought to assess the performance of ETI by paramedics wearing personal protective equipment with and without the use of a box barrier. Methods A randomized, crossover simulation study was performed in a simulation laboratory. Study participants were 18 paramedics actively working in the clinical environment. Participants’ performance of ETI via direct laryngoscopy (DL) with and without the use of a box barrier was assessed. The sequence of intubation was randomized to either BoxDL-first or DL-first. The primary outcome was the success rate of ETI on first-attempt. The secondary and tertiary outcomes were ETI success rates on three attempts and total intubation time, respectively. Results There were no differences between the DL group and the BoxDL group in one-attempt success rates (14/18 vs 12/18; P = 0.754), and in overall success rates (16/18 vs 14/18; P = 0.682). The mean (standard deviation) of the total intubation times for the DL group and the BoxDL group were 27.3 (19.7) seconds and 36.8 (26.2) seconds, respectively (P < 0.015). Conclusions The findings of this pilot study suggest that paramedics wearing personal protective equipment can successfully perform ETI using a barrier box, but the intubation time may be prolonged. The applicability of these findings to the care of COVID-19 patients remain to be investigated.

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