scholarly journals A77 A REUSABLE POLYCARBONATE BOX TO DECREASE DROPLET CONTAMINATION DURING UPPER ENDOSCOPY: A SIMULATION-BASED STUDY FOR THE COVID-19 PANDEMIC

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 43-45
Author(s):  
N Gimpaya ◽  
R Khan ◽  
Z R Gallinger ◽  
M A Scaffidi ◽  
A K Al Abdulqader ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Upper Body ◽  
Protective Equipment ◽  
Funding Agencies ◽  
Simulation Based ◽  
Upper Gi Endoscopy ◽  
Lateral Decubitus ◽  
Contamination Levels ◽  
Upper Gastrointestinal ◽  
Risk Categories

Abstract Background Upper gastrointestinal (GI) endoscopic procedures are aerosol-generating, increasing the risk of healthcare workers (HCW) contracting Coronavirus disease 2019 (COVID-19). Aims To present a polycarbonate box (EndoBox) designed for use in upper GI endoscopy and evaluate its impact on the contamination of endoscopy staff during simulated procedures. Methods Simulated gastroscopies were performed using an upper body simulator placed in left lateral decubitus (LLD) and supine positions. The endoscopist and assistant wore personal protective equipment. Droplet exposure was measured using fluorescent abiotic surrogate particles. Two blinded observers independently viewed images from each scenario to qualitatively evaluate contamination levels. The primary outcome was the level of HCW contamination by droplets generated from a simulated cough with and without the EndoBox on the upper body simulator. The endoscopist’s ergonomic behaviour was also assessed using the Rapid Upper Limb Assessment (RULA) tool. Results Without the EndoBox, there was a higher level of contamination on the endoscopist when the upper body simulator is in the LLD position. A higher level of contamination was observed on the assistant when the simulator is in supine position. With the EndoBox, the contamination levels on the endoscopy staff were lower in both LLD and supine scenarios. The endoscopist’s ergonomics were rated 2 to 3 on the RULA tool when using the EndoBox. Conclusions The EndoBox reduces macroscopic droplet contamination during simulated gastroscopy. The endoscopist’s risk of musculoskeletal injury remained in the low risk categories as assessed by the RULA tool. Another advantage of the EndoBox design is the arch extending from the bottom that allows for removal of the box without withdrawing the endoscope. This enables rapid access to the patient’s airway if they experience respiratory distress. This study was limited by an inability to assess microscopic contamination and contamination at the level of the port or buttons when suction is applied. Within these limitations, the EndoBox may be a useful adjunct to traditional personal protective equipment. Funding Agencies SMHA AFP COVID-Related Innovation Funds

scholarly journals Does my personal protective equipment really work? A simulation‐based approach

2020 ◽  
Vol 54 (8) ◽  
pp. 759-760 ◽  
Author(s):  
Patrick G. Hughes ◽  
Kate E. Hughes ◽  
Rami A. Ahmed
Keyword(s):  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Simulation Based

scholarly journals Human Factors Considerations in Using Personal Protective Equipment in the COVID-19 Pandemic Context: A Multinational Survey Study (Preprint)

2020 ◽  
Author(s):  
Avi Parush ◽  
Oren Wacht ◽  
Ricardo Gomes ◽  
Amit Frenkel
Keyword(s):  
Factor Analysis ◽  
Human Factors ◽  
Personal Protective Equipment ◽  
Situational Awareness ◽  
Survey Study ◽  
Protective Equipment ◽  
Research Approach ◽  
Level 1 ◽  
Contamination Levels ◽  
Effective Use

BACKGROUND Full personal protective equipment (level 1 PPE) is used in various domains and contexts. Prior research has shown positive influences of such equipment on performance, comfort, and contamination levels. The COVID-19 pandemic forced a pervasive requirement of PPE, with little preparation, rushed deployment, inadequate time for training, and massive use by personnel who are inexperienced or not qualified in its effective use. OBJECTIVE This study aimed to examine the key human factors: physical and ergonomic, perceptual and cognitive, that influence the use of level 1 PPE when attending to suspected or confirmed COVID-19 patients. METHODS The research approach consisted of a short survey disseminated to healthcare professionals in two countries, Israel and Portugal, with similar demographics and healthcare systems. The survey included 10 items with a 5-point Likert Scale, regarding the key human factors involved in level 1 PPE, as identified in prior research. RESULTS A total of 722 respondents from Israel and 301 respondents from Portugal were included in the analysis. All the respondents reported using level 1 PPE with COVID-19 patients in the range of several hours daily to several hours weekly. Cronbach’s alpha was .73 for Israel, and .75 for Portugal. Responses showed high levels of difficulty, with medians of 4 for items related to discomfort, hearing and seeing, and doffing. A factor analysis conducted with the Kaiser-Meyer-Olkin test result for sampling adequacy yielded 0.75 for the Israeli sample and .77 for the Portuguese sample. This indicates suitability of the data for factor analysis. The analysis showed a strong primary factor including difficulties in hearing, understanding speech, and understanding the surroundings, all with factor loadings higher than .6. A subsequent mediation analysis showed an association of PPE discomfort with situational awareness (P<.01), but this association was mediated by difficulties in hearing and understanding speech, which reflect difficulties in communication. CONCLUSIONS In 2020, the Covid-19 pandemic is paving the way for updating PPE design. The use of already deployed technology affords ample opportunities to improve, adapt, and overcome caveats. The findings here suggest that the use of level 1 PPE with COVID-19 patients has perceptual and cognitive effects, in addition to physical and ergonomic influences. Efforts should be taken to mitigate harmful effects of such influences, both regarding the performance of medical actions and the risk of contamination to healthcare workers. Such efforts involve the design of PPE, training staff in using the equipment, and effective communication and teamwork protocols.

scholarly journals Influence of Personal Protective Equipment on the Quality of Chest Compressions: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 8 ◽  
Author(s):  
Ying Cui ◽  
Siyi Jiang
Keyword(s):  
Personal Protective Equipment ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Protective Equipment ◽  
Chest Compressions ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Simulation Based ◽  
Reduced Rate

Background: Randomized controlled trials (RCTs) evaluating the influence of personal protective equipment (PPE) on quality of chest compressions during cardiopulmonary resuscitation (CPR) showed inconsistent results. Accordingly, a meta-analysis was performed to provide an overview.Methods: Relevant studies were obtained by search of Medline, Embase, and Cochrane's Library databases. A random-effect model incorporating the potential heterogeneity was used to pool the results.Results: Six simulation-based RCTs were included. Overall, pooled results showed that there was no statistically significant difference between the rate [mean difference (MD): −1.70 time/min, 95% confidence interval (CI): −5.77 to 2.36, P = 0.41, I2 = 80%] or the depth [MD: −1.84 mm, 95% CI: −3.93 to 0.24, P = 0.11, I2 = 73%] of chest compressions performed by medical personnel with and without PPE. Subgroup analyses showed that use of PPE was associated with reduced rate of chest compressions in studies before COVID-19 (MD: −7.02 time/min, 95% CI: −10.46 to −3.57, P &lt; 0.001), but not in studies after COVID-19 (MD: 0.14 time/min, 95% CI: −5.77 to 2.36, P = 0.95). In addition, PPE was not associated with significantly reduced depth of chest compressions in studies before (MD: −3.34 mm, 95% CI: −10.29 to −3.62, P = 0.35) or after (MD: −0.97 mm, 95% CI: −2.62 to 0.68, P = 0.25) COVID-19. No significant difference was found between parallel-group and crossover RCTs (P for subgroup difference both &gt; 0.05).Conclusions: Evidence from simulation-based RCTs showed that use of PPE was not associated with reduced rate or depth of chest compressions in CPR.

scholarly journals Surface contamination of the outer and blister packages of oral anticancer drugs: A multicenter study

2019 ◽  
Vol 26 (1) ◽  
pp. 141-145
Author(s):  
Hisanaga Nomura ◽  
Noriaki Katakura ◽  
Tomoko Morita ◽  
Yoshiyuki Sano ◽  
Hiroaki Usui ◽  
...  
Keyword(s):  
Detection Limit ◽  
Anticancer Drugs ◽  
Personal Protective Equipment ◽  
Surface Contamination ◽  
Contamination Level ◽  
Protective Equipment ◽  
Degree Of Contamination ◽  
The Press ◽  
Contamination Levels ◽  
Wipe Tests

Introduction All guidelines necessitate wearing personal protective equipment during dispensing of oral anticancer drugs. This study aims to measure the degree of contamination on the press-through-package strips of oral anticancer drugs in Japan. Method Surface contamination of the external packaging of anticancer drugs was examined by performing wipe tests at four hospitals and two community pharmacies. The following commercially available drugs were examined: Xeloda®, TS-1®, and methotrexate tablets and SA-1® and Rheumatrex® capsules. Results The wipe tests’ results revealed that the contamination levels of Xeloda® and TS-1® tablets and SA-1® capsules were within their detection limits. In some facilities, the contamination levels on the press-through-package strips of Rheumatrex® capsules were 3.27 × 10−1, which is close to its detection limit. However, across all facilities, the contamination level of methotrexate tablets was above its detection limit. Conclusion The results of this study suggested that adherence to oral anticancer drugs may not occur during manufacture or transportation. However, it may be due to the presence of pollutants in the facilities. Prevention of pollution in facilities might eliminate the need to wear personal protective equipment during dispensing of oral anticancer drugs.

scholarly journals How Risky are Elective Endoscopic Procedures during the COVID-19 Normalization Process?

2020 ◽  
Vol 11 (04) ◽  
pp. 275-278
Author(s):  
Mehmet Bayram ◽  
Ozgur Yildirim
Keyword(s):  
Protective Equipment ◽  
Shortness Of Breath ◽  
Test Results ◽  
Endoscopic Procedures ◽  
Upper Gi ◽  
Endoscopic Gastrostomy ◽  
Upper Gi Endoscopy ◽  
Training And Research ◽  
Normalization Process ◽  
Upper Gastrointestinal

Abstract Objective In this study, we aimed to investigate the incidence of COVID-19 after endoscopic procedures were performed with elective indications during the normalization process of the COVID-19 pandemic. We also aimed to investigate safety of these procedures. Materials and Methods The study included 351 patients who underwent an endoscopic procedure for elective indications in the endoscopy unit of the gastroenterology department of the İstanbul Kanuni Sultan Süleyman Training and Research Hospital and whose risk assessment for COVID-19 was low before the procedure. All patients were followed-up within 14 days after the procedure in terms of getting a COVID-19 PCR test and its results and also assessing development of any symptoms such as fever, cough, and shortness of breath associated with COVID-19. Results A total of 351 patients were included in the study. A total of 445 procedures were performed: upper gastrointestinal (GI) system endoscopy in 180 patients, colonoscopy in 74 patients, double procedure (upper GI endoscopy + colonoscopy) in 94 patients, and percutaneous endoscopic gastrostomy (PEG) in three patients. It was found that at least one of the symptoms including cough, shortness of breath, and fever developed in 33 (9.4%) of these 351 patients within 14 days. It was observed that 20(5.6‰)of these 33 patients were tested for COVID-19 and the test results were reported as positive in two(5.6‰)patients. Conclusion In the normalization process of COVID-19, elective endoscopic procedures can be performed in patients, who are shown to be low risk, by paying attention to the consummate use of the personal protective equipment (PPE).

Impact of COVID-19 on Nuclear Medicine in Germany, Austria and Switzerland: An International Survey in April 2020

2020 ◽  
Vol 59 (04) ◽  
pp. 294-299 ◽  
Author(s):  
Lutz S. Freudenberg ◽  
Ulf Dittmer ◽  
Ken Herrmann
Keyword(s):  
Nuclear Medicine ◽  
Health Systems ◽  
Personal Protective Equipment ◽  
Large Scale ◽  
Diagnostic Procedures ◽  
Protective Equipment ◽  
Current Crisis ◽  
Web Based ◽  
Public Versus Private ◽  
The Impact

Abstract Introduction Preparations of health systems to accommodate large number of severely ill COVID-19 patients in March/April 2020 has a significant impact on nuclear medicine departments. Materials and Methods A web-based questionnaire was designed to differentiate the impact of the pandemic on inpatient and outpatient nuclear medicine operations and on public versus private health systems, respectively. Questions were addressing the following issues: impact on nuclear medicine diagnostics and therapy, use of recommendations, personal protective equipment, and organizational adaptations. The survey was available for 6 days and closed on April 20, 2020. Results 113 complete responses were recorded. Nearly all participants (97 %) report a decline of nuclear medicine diagnostic procedures. The mean reduction in the last three weeks for PET/CT, scintigraphies of bone, myocardium, lung thyroid, sentinel lymph-node are –14.4 %, –47.2 %, –47.5 %, –40.7 %, –58.4 %, and –25.2 % respectively. Furthermore, 76 % of the participants report a reduction in therapies especially for benign thyroid disease (-41.8 %) and radiosynoviorthesis (–53.8 %) while tumor therapies remained mainly stable. 48 % of the participants report a shortage of personal protective equipment. Conclusions Nuclear medicine services are notably reduced 3 weeks after the SARS-CoV-2 pandemic reached Germany, Austria and Switzerland on a large scale. We must be aware that the current crisis will also have a significant economic impact on the healthcare system. As the survey cannot adapt to daily dynamic changes in priorities, it serves as a first snapshot requiring follow-up studies and comparisons with other countries and regions.

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