scholarly journals Personal protective equipment does not sufficiently protect against virus aerosol unless combined with advanced air purification or ventilation techniques

2021 ◽  
Author(s):  
Shane A Landry ◽  
Dinesh Subedi ◽  
Jeremy J Barr ◽  
Martin I MacDonald ◽  
Samantha Dix ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Hospital Capacity ◽  
Degree Of Protection ◽  
Aerosol Exposure ◽  
Skin Contamination ◽  
The Face ◽  
Close Range ◽  
Virus Exposure ◽  
High Virus

ABSTRACTBackgroundHealthcare workers (HCWs) are at risk from nosocomial transmission of SARS-CoV-2 from virus laden aerosols. This study aimed to: 1) quantify the degree of protection from virus aerosol provided by different types of mask (surgical, N95, fit-tested N95) and personal protective equipment (PPE); 2) determine if the use of a portable HEPA filter can enhance the effectiveness of PPE; 3) determine the effectiveness of a decontamination shower to remove virus aerosol contamination of a HCW.MethodsVirus aerosol exposure experiments were conducted using bacteriophage PhiX174 (108copies/mL). A HCW wearing PPE (mask, gloves, gown, faceshield) was exposed to nebulised viruses for 40mins in a sealed clinical room. After exiting, the HCW doffed PPE. Virus exposure was quantified via skin swabs applied to the face and nostrils, forearms, neck, and forehead. Experiments were performed with and without the presence of a portable HEPA filter (set to 470m3/hr).FindingsSwabs quantified significant virus exposure under the surgical and N95 mask. Only the fit-tested N95 resulted in lower virus counts compared to no mask control (p=0.027). Nasal swabs demonstrated very high virus exposure, which was not mitigated by the surgical or N95 masks, although there was a trend for the fit-tested N95 mask to reduce virus counts (p=0.058). The addition of HEPA filtration substantially reduced virus counts from all swab sites, and to near zero levels when combined with a fit-tested N95 mask, gloves, gown and faces shield. Virus counts were substantially reduced to near zero levels following a shower.InterpretationThese data demonstrate that quantitatively fit tested N95 masks combined with a HEPA filter can offer protection against high virus aerosol loads at close range and for prolonged periods of time. Skin contamination from virus aerosol can be effectively by removed by showering.FundingEpworth Hospital Capacity Building Research Grant ID: EH2020-654

scholarly journals The COVID-19 Pandemic and nursing challenges: A review of the early literature

Work ◽  
2021 ◽  
pp. 1-14
Author(s):  
Mojtaba K. Danesh ◽  
Ehsan Garosi ◽  
Hamedeh Golmohamadpour
Keyword(s):  
Health Systems ◽  
Personal Protective Equipment ◽  
Qualitative Studies ◽  
Systematic Search ◽  
Current Paper ◽  
Protective Equipment ◽  
Early Literature ◽  
The Face ◽  
Physical Distress ◽  
The Impact

BACKGROUND: The COVID-19 pandemic has put health systems under unprecedented pressure, challenging their workforce, especially nurses. OBJECTIVE: The current paper presented a review of the early literature concerning emerging nursing challenges during the early stages of the COVID-19 pandemic. METHODS: A systematic search of the published literature between January and May 2020 was carried out in Medline, Science Direct, and Google Scholar to identify relevant quantitative and qualitative studies. RESULTS: Twenty-two original articles were retrieved, the majority of which were survey studies from China. Synthesis of the evidence resulted in four overarching themes including “being physically and mentally drained in the face of fear and uncertainty,” “shortage of personal protective equipment and usability issues,” “psychosomatic disturbances among nurses,” and “moderators to mitigate nurses’ challenges.” CONCLUSIONS: Providing care for demanding COVID-19 patients, nurses experienced a gruelling situation, during which a significant amount of psychological and physical distress was inflicted to them. However, receiving proper support from their organization and society could improve the condition substantially. Further research is required to explore the impact of the COVID-19 pandemic on nurses, especially from Western countries.

scholarly journals Development and Comparison of Complementary Methods to Study Potential Skin and Inhalational Exposure to Pathogens During Personal Protective Equipment Doffing

2019 ◽  
Vol 69 (Supplement_3) ◽  
pp. S231-S240 ◽  
Author(s):  
Jennifer Therkorn ◽  
David Drewry ◽  
Jennifer Andonian ◽  
Lauren Benishek ◽  
Carrie Billman ◽  
...  
Keyword(s):  
Pilot Study ◽  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Recovery Efficiency ◽  
Breathing Zone ◽  
Tracer Method ◽  
Fluorescent Tracer ◽  
Air Sampler ◽  
Airborne Contamination ◽  
Skin Contamination

Abstract Background Fluorescent tracers are often used with ultraviolet lights to visibly identify healthcare worker self-contamination after doffing of personal protective equipment (PPE). This method has drawbacks, as it cannot detect pathogen-sized contaminants nor airborne contamination in subjects’ breathing zones. Methods A contamination detection/quantification method was developed using 2-µm polystyrene latex spheres (PSLs) to investigate skin contamination (via swabbing) and potential inhalational exposure (via breathing zone air sampler). Porcine skin coupons were used to estimate the PSL swabbing recovery efficiency and limit of detection (LOD). A pilot study with 5 participants compared skin contamination levels detected via the PSL vs fluorescent tracer methods, while the air sampler quantified potential inhalational exposure to PSLs during doffing. Results Average PSL skin swab recovery efficiency was 40% ± 29% (LOD = 1 PSL/4 cm2 of skin). In the pilot study, all subjects had PSL and fluorescent tracer skin contamination. Two subjects had simultaneously located contamination of both types on a wrist and hand. However, for all other subjects, the PSL method enabled detection of skin contamination that was not detectable by the fluorescent tracer method. Hands/wrists were more commonly contaminated than areas of the head/face (57% vs 23% of swabs with PSL detection, respectively). One subject had PSLs detected by the breathing zone air sampler. Conclusions This study provides a well-characterized method that can be used to quantitate levels of skin and inhalational contact with simulant pathogen particles. The PSL method serves as a complement to the fluorescent tracer method to study PPE doffing self-contamination.

scholarly journals Contamination of personal protective equipment during COVID-19 autopsies

2022 ◽  
Author(s):  
Johanna M. Brandner ◽  
Peter Boor ◽  
Lukas Borcherding ◽  
Carolin Edler ◽  
Sven Gerber ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Infectious Virus ◽  
Viral Rna ◽  
Medical Community ◽  
Protective Equipment ◽  
Risk Of Infection ◽  
Safe Work ◽  
Hygiene Measures ◽  
The Face ◽  
Positive Controls

AbstractConfronted with an emerging infectious disease at the beginning of the COVID-19 pandemic, the medical community faced concerns regarding the safety of autopsies on those who died of the disease. This attitude has changed, and autopsies are now recognized as indispensable tools for understanding COVID-19, but the true risk of infection to autopsy staff is nevertheless still debated. To clarify the rate of SARS-CoV-2 contamination in personal protective equipment (PPE), swabs were taken at nine points in the PPE of one physician and one assistant after each of 11 full autopsies performed at four centers. Swabs were also obtained from three minimally invasive autopsies (MIAs) conducted at a fifth center. Lung/bronchus swabs of the deceased served as positive controls, and SARS-CoV-2 RNA was detected by real-time RT-PCR. In 9 of 11 full autopsies, PPE samples tested RNA positive through PCR, accounting for 41 of the 198 PPE samples taken (21%). The main contaminated items of the PPE were gloves (64% positive), aprons (50% positive), and the tops of shoes (36% positive) while the fronts of safety goggles, for example, were positive in only 4.5% of the samples, and all the face masks were negative. In MIAs, viral RNA was observed in one sample from a glove but not in other swabs. Infectious virus isolation in cell culture was performed on RNA-positive swabs from the full autopsies. Of all the RNA-positive PPE samples, 21% of the glove samples, taken in 3 of 11 full autopsies, tested positive for infectious virus. In conclusion, PPE was contaminated with viral RNA in 82% of autopsies. In 27% of autopsies, PPE was found to be contaminated even with infectious virus, representing a potential risk of infection to autopsy staff. Adequate PPE and hygiene measures, including appropriate waste deposition, are therefore essential to ensure a safe work environment.

scholarly journals Effective design of barrier enclosure to contain aerosol emissions from COVID-19 patients

2020 ◽  
Author(s):  
Dan Daniel ◽  
Marcus Lin ◽  
Irvan Luhung ◽  
Tony Lui ◽  
Anton Sadovoy ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Laser Sheet ◽  
High Flow ◽  
Protective Equipment ◽  
Flow Rates ◽  
Physiological Conditions ◽  
Aerosol Exposure ◽  
Aerosol Emissions ◽  
Effective Design

AbstractFacing shortages of personal protective equipment, some clinicians have advocated the use of barrier enclosures (typically mounted over the head, with and without suction) to contain aerosol emissions from coronavirus disease 2019 (COVID-19) patients. There is however little evidence for its usefulness. To test the effectiveness of such a device, we built a manikin that can expire micron-sized aerosols at flow rates close to physiological conditions. We then placed the manikin inside the enclosure and used a laser sheet to visualize the aerosol leaking out. We show that with sufficient suction, it is possible to effectively contain aerosol from the manikin even at high flow rates (up to 60 L min−1) of oxygen, reducing aerosol exposure outside the enclosure by 99%. In contrast, a passive barrier without suction only reduces aerosol exposure by 60%.

Environmental and Personal Protective Equipment Contamination during Simulated Healthcare Activities

2019 ◽  
Vol 63 (7) ◽  
pp. 784-796 ◽  
Author(s):  
Rachel T Weber ◽  
Linh T Phan ◽  
Charissa Fritzen-Pedicini ◽  
Rachael M Jones
Keyword(s):  
Personal Protective Equipment ◽  
Central Venous Access ◽  
Vital Signs ◽  
Venous Access ◽  
Protective Equipment ◽  
Bodily Fluids ◽  
Environmental Surfaces ◽  
The Face ◽  
Definition Of ◽  
Experimental Trials

Abstract Providing care to patients with an infectious disease can result in the exposure of healthcare workers (HCWs) to pathogen-containing bodily fluids. We performed a series of experiments to characterize the magnitude of environmental contamination—in air, on surfaces and on participants—associated with seven common healthcare activities. The seven activities studied were bathing, central venous access, intravenous access, intubation, physical examination, suctioning and vital signs assessment. HCWs with experience in one or more activities were recruited to participate and performed one to two activities in the laboratory using task trainers that contained or were contaminated with fluorescein-containing simulated bodily fluid. Fluorescein was quantitatively measured in the air and on seven environmental surfaces. Fluorescein was quantitatively and qualitatively measured on the personal protective equipment (PPE) worn by participants. A total of 39 participants performed 74 experiments, involving 10–12 experimental trials for each healthcare activity. Healthcare activities resulted in diverse patterns and levels of contamination in the environment and on PPE that are consistent with the nature of the activity. Glove and gown contamination were ubiquitous, affirming the value of wearing these pieces of PPE to protect HCW’s clothing and skin. Though intubation and suctioning are considered aerosol-generating procedures, fluorescein was detected less frequently in air and at lower levels on face shields and facemasks than other activities, which suggests that the definition of aerosol-generating procedure may need to be revised. Face shields may protect the face and facemask from splashes and sprays of bodily fluids and should be used for more healthcare activities.

scholarly journals Aerosolization During Common Ventilation Scenarios

2020 ◽  
Vol 163 (4) ◽  
pp. 702-704 ◽  
Author(s):  
Roy Xiao ◽  
Alan D. Workman ◽  
Elefteria Puka ◽  
Jeremy Juang ◽  
Matthew R. Naunheim ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Aerosol Generation ◽  
Aerosol Exposure ◽  
Increased Risk ◽  
Particle Sizer ◽  
Second Period

Otolaryngologists are at increased risk for exposure to suspected aerosol-generating procedures during the ongoing coronavirus disease 2019 (COVID-19) pandemic. In the present study, we sought to quantify differences in aerosol generation during common ventilation scenarios. We performed a series of 30-second ventilation experiments on porcine larynx-trachea-lung specimens. We used an optical particle sizer to quantify the number of 1- to 10-µm particles observed per 30-second period (PP30). No significant aerosols were observed with ventilation of intubated specimens (10.8 ± 2.4 PP30 vs background 9.5 ± 2.1, P = 1.0000). Simulated coughing through a tracheostomy produced 53.5 ± 25.2 PP30, significantly more than background ( P = .0121) and ventilation of an intubated specimen ( P = .0401). These data suggest that undisturbed ventilation and thus intubation without stimulation or coughing may be safer than believed. Coughing increases aerosol production, particularly via tracheostomy. Otolaryngologists who frequently manage patient airways and perform tracheostomy are at increased risk for aerosol exposure and require appropriate personal protective equipment, especially during the ongoing COVID-19 pandemic.

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

2020 ◽  
Vol 77 (23) ◽  
pp. 1986-1993 ◽  
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.

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

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.

scholarly journals Biosafety and action in front of COVID-19

2021 ◽  
Vol 9 (4) ◽  
pp. 129-141
Author(s):  
Anna Clara Cachoni ◽  
Micael Borges Cadari ◽  
Augusto Alberto Foggiato ◽  
Juliana Zorzi Coléte ◽  
João Lopes Toledo Neto ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Health Professionals ◽  
High Rate ◽  
Personal Hygiene ◽  
Protective Equipment ◽  
Hygiene Measures ◽  
The Face ◽  
Individual Protection ◽  
Entire World

The COVID-19 disease that affected the entire world in 2020 is caused by a virus (SARS-CoV-2) with a high rate of pathogenicity and transmission that caused several deaths in its trajectory. To combat this disease several personal hygiene measures and the use of personal protective equipment were necessary. In view of this, the study aims to clarify some doubts regarding the vaccine and its effectiveness, individual protection and the performance of health professionals in the face of this situation.

scholarly journals Medical Interns and COVID-19: results of national research

2020 ◽  
Vol 66 (6) ◽  
pp. 812-817 ◽  
Author(s):  
Maria M. C. Carrascosa ◽  
Tercio de Campos ◽  
Jéssica E. Sampaio ◽  
Rafaella R. F. Souza ◽  
Vitória L. Ribeiro ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Demographic Data ◽  
Protective Equipment ◽  
Online Questionnaire ◽  
Chi Square ◽  
Cross Sectional ◽  
Public And Private ◽  
The Face ◽  
Ease Of Access ◽  
The Impact

SUMMARY OBJECTIVE Assess the impact of COVID-19 on medical students’ internships in public and private institutions in Brasil, in addition to estimating the quality of the measures taken by their respective Universities in the face of the problem and the availability of personal protective equipment (PPE). METHODS A descriptive cross-sectional quantitative analysis study carried out with 317 students undergoing medical internship from March 31, 2020, to April 12, 2020. The survey was conducted through an online questionnaire using the SurveyMonkey tool with 20 questions. Interns from the fourth to the sixth year of medical schools in the country were randomly included in the study through a survey sent by Whatsapp application. Statistical analysis was performed using the Chi-Square, considering p <0.05 as significant. RESULTS Four main topics were identified in the research: student demographic data; how classes and courses are being taught; the use and ease of access to personal protective equipment and the students’ fears and perspectives for the future. CONCLUSION The study clarified that although half of the students still have some degree of content and, in their majority, they are satisfied, there is still a lot of difficulty in obtaining personal protective equipment, which prevents students from returning safely to their internships.

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