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

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.

scholarly journals Stress and Associated Factors among Frontline Healthcare Workers in the COVID-19 Epicenter of Da Nang City, Vietnam

2021 ◽  
Vol 18 (14) ◽  
pp. 7378
Author(s):  
Nhan Phuc Thanh Nguyen ◽  
Duong Dinh Le ◽  
Robert Colebunders ◽  
Joseph Nelson Siewe Fodjo ◽  
Trung Dinh Tran ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Stress Component ◽  
Multivariable Analysis ◽  
Working Hours ◽  
Health Facilities ◽  
Protective Equipment ◽  
Laboratory Workers ◽  
Frontline Healthcare Workers ◽  
Second Wave

Frontline healthcare workers (HCWs) involved in the COVID-19 response have a higher risk of experiencing psychosocial distress amidst the pandemic. Between July and September 2020, a second wave of the COVID-19 pandemic appeared in Vietnam with Da Nang city being the epicenter. During the outbreak, HCWs were quarantined within the health facilities in a bid to limit the spread of COVID-19 to their respective communities. Using the stress component of the 21-item Depression, Anxiety and Stress Scale (DASS-21), we assessed the level of stress among HCWs in Da Nang city. Between 30 August and 15 September 2020, 746 frontline HCWs were recruited to fill in an online structured questionnaire. Overall, 44.6% of participants experienced increased stress and 18.9% severe or extremely severe stress. In multivariable analysis, increased stress was associated with longer working hours (OR = 1.012; 95% CI: 1.004–1.019), working in health facilities providing COVID-19 treatment (OR = 1.58, 95% CI: 1.04–2.39), having direct contact with patients or their bio-samples (physicians, nurses and laboratory workers; OR = 1.42, 95% CI: 1.02–1.99), low confidence in the available personal protective equipment (OR = 0.846; 95% CI: 0.744–0.962) and low knowledge on COVID-19 prevention and treatment (OR = 0.853; 95% CI: 0.739–0.986). In conclusion, many frontline HCWs experienced increased stress during the COVID-19 outbreak in Da Nang city. Reducing working time, providing essential personal protective equipment and enhancing the knowledge on COVID-19 will help to reduce this stress. Moreover, extra support is needed for HCWs who are directly exposed to COVID-19 patients.

scholarly journals Evaluating the contributions of strategies to prevent SARS-CoV-2 transmission in the healthcare setting: a modelling study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044644
Author(s):  
Xueting Qiu ◽  
Joel C Miller ◽  
Derek R MacFadden ◽  
William P Hanage
Keyword(s):  
Healthcare Workers ◽  
Healthcare Setting ◽  
Stochastic Simulations ◽  
Limited Resources ◽  
Base Case ◽  
Protective Equipment ◽  
Random Testing ◽  
Weekly Basis ◽  
Force Of Infection ◽  
Effective Use

IntroductionSince its onset, the COVID-19 pandemic has caused significant morbidity and mortality worldwide, with particularly severe outcomes in healthcare institutions and congregate settings. To mitigate spread, healthcare systems have been cohorting patients to limit contacts between uninfected patients and potentially infected patients or healthcare workers (HCWs). A major challenge in managing the pandemic is the presence of currently asymptomatic/presymptomatic individuals capable of transmitting the virus, who could introduce COVID-19 into uninfected cohorts. The optimal combination of personal protective equipment (PPE), testing and other approaches to prevent these events is unclear, especially in light of ongoing limited resources.MethodsUsing stochastic simulations with a susceptible-exposed-infected-recovered dynamic model, we quantified and compared the impacts of PPE use, patient and HCWs surveillance testing and subcohorting strategies.ResultsIn the base case without testing or PPE, the healthcare system was rapidly overwhelmed, and became a net contributor to the force of infection. We found that effective use of PPE by both HCWs and patients could prevent this scenario, while random testing of apparently asymptomatic/presymptomatic individuals on a weekly basis was less effective. We also found that even imperfect use of PPE could provide substantial protection by decreasing the force of infection. Importantly, we found that creating smaller patient/HCW-interaction subcohorts can provide additional resilience to outbreak development with limited resources.ConclusionThese findings reinforce the importance of ensuring adequate PPE supplies even in the absence of testing and provide support for strict subcohorting regimens to reduce outbreak potential in healthcare institutions.

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

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.

scholarly journals To Volunteer or Not? Perspectives towards Pre-Registered Nursing Students Volunteering Frontline during COVID-19 Pandemic to Ease Healthcare Workforce: A Qualitative Study

2021 ◽  
Vol 18 (12) ◽  
pp. 6668
Author(s):  
Betsy Seah ◽  
Ben Ho ◽  
Sok Ying Liaw ◽  
Emily Neo Kim Ang ◽  
Siew Tiang Lau
Keyword(s):  
Nursing Students ◽  
Qualitative Study ◽  
Professional Identity ◽  
Healthcare Workers ◽  
Healthcare Services ◽  
Strategic Partnerships ◽  
Healthcare Workforce ◽  
Student Volunteer ◽  
Operational Processes

COVID-19 has caused a shortage of healthcare workers and has strained healthcare systems globally. Pre-registered healthcare students with training have a duty of care and can support the healthcare workforce. This study explored factors influencing the willingness of final-year nursing students to volunteer during the COVID-19 pandemic, the role of professional identity in volunteering as healthcare workers, and strategies to improve future volunteering uptakes and processes. A qualitative study using focus-group discussions was conducted. Final-year nursing students who volunteered, students who did not volunteer, and lecturers who supervised student volunteers were recruited. Interviews were conducted online, video-recorded, and transcribed verbatim. A thematic analysis was used. The themes were “wavering thoughts on volunteering”, “bringing out ‘the nurse’ in students through volunteering” and “gearing up to volunteer”. Findings suggested the need to look beyond the simplicity of altruism to the role of professional identity, operational, and motivational factors to explain nursing students’ decision to volunteer and their volunteer behavior. Providing accommodation, monetary and academic-related incentives, supporting the transitionary phase from students to “professional volunteers”, promoting cohesive and positive staff–student volunteer relationships, and establishing a volunteer management team are strategies identified to improve volunteering uptake and operational processes. Our findings advocate strategic partnerships between hospitals/communities and academic institutions in providing various healthcare services during pandemics.

scholarly journals Fit Testing Retrofitted Full-Face Snorkel Masks as a Form of Novel Personal Protective Equipment During the COVID-19 Pandemic

2021 ◽  
pp. 1-16
Author(s):  
Stephanie Toigo ◽  
Michel Jacques ◽  
Tarek Razek ◽  
Ewa Rajda ◽  
Sidney Omelon ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Health Centre ◽  
Disease Outbreaks ◽  
Protective Equipment ◽  
Test Results ◽  
Passing Rate ◽  
Fit Testing ◽  
Full Face ◽  
Medical Grade

ABSTRACT Objective: Bottlenecks in the personal protective equipment (PPE) supply chain have contributed to shortages of PPE during the COVID-19 pandemic, resulting in fractures in the functionality of healthcare systems. This study was conducted with the aim of determining the effectiveness of retrofitted commercial snorkel masks as an alternative respirator for healthcare workers during infectious disease outbreaks. Methods: A retrospective analysis was performed, analyzing qualitative and quantitative fit test results of the retrofitted Aria Ocean Reef® full-face snorkeling mask on healthcare workers at the McGill University Health Centre between April-June 2020. Historical fit test results, using medical-grade respirators, for healthcare workers were also analyzed. Results: During the study period, 71 participants volunteered for fit testing, 60.6% of which were nurses. The overall fit test passing rate using the snorkel mask was 83.1%. Of the participants who did not previously pass fit testing with medical-grade respirators, 80% achieved a passing fit test with the snorkel respirator. Conclusions: The results suggest that this novel respirator may be an effective and feasible alternative solution to address PPE shortages, while still providing healthcare workers with ample protection. Additional robust testing will be required to ensure that respirator fit is maintained, after numerous rounds of disinfection.

scholarly journals Acoustic voice characteristics with and without wearing a facemask

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Duy Duong Nguyen ◽  
Patricia McCabe ◽  
Donna Thomas ◽  
Alison Purcell ◽  
Maree Doble ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Protective Equipment ◽  
Mask Condition ◽  
Connected Speech ◽  
Significant Attenuation ◽  
Cepstral Peak Prominence ◽  
Vocal Intensity ◽  
Significant Change ◽  
The Voice

AbstractFacemasks are essential for healthcare workers but characteristics of the voice whilst wearing this personal protective equipment are not well understood. In the present study, we compared acoustic voice measures in recordings of sixteen adults producing standardised vocal tasks with and without wearing either a surgical mask or a KN95 mask. Data were analysed for mean spectral levels at 0–1 kHz and 1–8 kHz regions, an energy ratio between 0–1 and 1–8 kHz (LH1000), harmonics-to-noise ratio (HNR), smoothed cepstral peak prominence (CPPS), and vocal intensity. In connected speech there was significant attenuation of mean spectral level at 1–8 kHz region and there was no significant change in this measure at 0–1 kHz. Mean spectral levels of vowel did not change significantly in mask-wearing conditions. LH1000 for connected speech significantly increased whilst wearing either a surgical mask or KN95 mask but no significant change in this measure was found for vowel. HNR was higher in the mask-wearing conditions than the no-mask condition. CPPS and vocal intensity did not change in mask-wearing conditions. These findings implied an attenuation effects of wearing these types of masks on the voice spectra with surgical mask showing less impact than the KN95.

scholarly journals Adherence to personal protective equipment use among healthcare workers caring for confirmed COVID-19 and alleged non-COVID-19 patients

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Meike M. Neuwirth ◽  
Frauke Mattner ◽  
Robin Otchwemah
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
University Hospital ◽  
Protective Equipment ◽  
Care Workers

AbstractAdherence observations of health care workers (HCW) revealed deficiencies in the use of recommended personal protective equipment (PPE) among HCW caring in COVID-19 and non-COVID-19 wards during the first period of the SARS-CoV-2 pandemic in a university hospital in Germany. The adherence to wearing surgical face or FFP2-masks and disinfecting hands prior to donning and after doffing the PPE was significantly higher in COVID-19 wards However, there was no total adherence of 100% in COVID-19 wards.

scholarly journals Use of Personal Protective Equipment and Operating Room Behaviors in Four Surgical Subspecialties: Personal Protective Equipment and Behaviors in Surgery

1999 ◽  
Vol 20 (02) ◽  
pp. 110-114 ◽  
Author(s):  
Deniz Akduman ◽  
Lynn E. Kim ◽  
Rodney L. Parks ◽  
Paul B. L'Ecuyer ◽  
Sunita Mutha ◽  
...  
Keyword(s):  
Operating Room ◽  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Tertiary Care ◽  
Hand Surgery ◽  
Occupational Exposures ◽  
Protective Equipment ◽  
Care Hospital ◽  
Exposure Rate ◽  
Total Exposure

AbstractObjective:To evaluate Universal Precautions (UP) compliance in the operating room (OR).Design:Prospective observational cohort. Trained observers recorded information about (1) personal protective equipment used by OR staff; (2) eyewear, glove, or gown breaks; (3) the nature of sharps transfers; (4) risk-taking behaviors of the OR staff; and (5) needlestick injuries and other blood and body-fluid exposures.Setting:Barnes-Jewish Hospital, a 1,000-bed, tertiary-care hospital affiliated with Washington University School of Medicine, St Louis, Missouri.Participants:OR personnel in four surgical specialties (gynecologic, orthopedic, cardiothoracic, and general). Procedures eligible for the study were selected randomly. Hand surgery and procedures requiring no or a very small incision (eg, arthroscopy, laparoscopy) were excluded.Results:A total of 597 healthcare workers' procedures were observed in 76 surgical cases (200 hours). Of the 597 healthcare workers, 32% wore regular glasses, and 24% used no eye protection. Scrub nurses and medical students were more likely than other healthcare workers to wear goggles. Only 28% of healthcare workers double gloved, with orthopedic surgery personnel being the most compliant. Sharps passages were not announced in 91% of the surgical procedures. In 65 cases (86%), sharps were adjusted manually. Three percutaneous and 14 cutaneous exposures occurred, for a total exposure rate of 22%.Conclusion:OR personnel had poor compliance with UP. Although there was significant variation in use of personal protective equipment between groups, the total exposure rate was high (22%), indicating the need for further training and reinforcement of UP to reduce occupational exposures.

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