Physiological Effects of Wearing N95 Respirator on Medical Staff During Prolong Work Hours in Covid-19 Departments

Abstract BackgroundSince the emergence of coronavirus disease, health care professionals in high-risk environments are mandated to wear N95 respirators for prolonged periods. The effect of this prolonged use on cardio-respiratory variables and gas-exchange is poorly defined. The objective of the current study was to determine gas exchange abnormalities and physiological changes among healthcare workers during a 4-hour emergency department (ED) shift while wearing the N95 respirator.MethodsThis was a single-center prospective observational study that consisted of medical staff working at the Sheba Medical Center ED. Physiological effects and gas exchange variables were obtained under normal breathing conditions and after 4-hour shifts while continuously wearing an N95 respirator. Comparisons of paired measurements were performed using a non-parametric Wilcoxon matched-pairs signed-rank test.ResultsForty-one subjects were included in the study. Prolonged N95 respirator use was associated with a significant decline in plasma pH [7.35mmHg vs. 7.34mmHg, P=0.02], PvO2 [23.2 mmHg vs. 18.6 mmHg, P<0.001] and a concurrent increase in EtCO2 [32.5mmHg vs. 38.5mmHg, p<0.0001]. PvCO2 and bicarbonate levels did not differ. No significant change was observed for heart rate or oxygen saturation. ConclusionUsing an N95 respirator for prolonged periods by healthcare professionals may provoke changes in gas exchange. The clinical significance of these changes in terms of symptoms or longer-term health status is unknown and remains to be determined.

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Physiological Effects of Wearing N95 Respirator on Medical Staff During Prolong Work Hours in Covid-19 Departments

10.21203/rs.3.rs-491901/v1 ◽

2021 ◽

Author(s):

liran shechtman ◽

Gal Ben-Haim ◽

Ilan Ben-Zvi ◽

Laurence steel ◽

Avinoah Ironi ◽

...

Keyword(s):

Gas Exchange ◽

Health Care Professionals ◽

Medical Staff ◽

Medical Center ◽

Rank Test ◽

Physiological Effects ◽

Risk Environments ◽

Signed Rank ◽

Signed Rank Test ◽

N95 Respirators

Abstract Background Since the emergence of coronavirus disease, health care professionals in high-risk environments are mandated to wear N95 respirators for prolonged periods. The effect of this prolonged use on cardio-respiratory variables and gas-exchange is poorly defined. The objective of the current study was to determine gas exchange abnormalities and physiological changes among healthcare workers during a 4-hour emergency department (ED) shift while wearing the N95 respirator. Methods This was a single-center prospective observational study that consisted of medical staff working at the Sheba Medical Center ED. Physiological effects and gas exchange variables were obtained under normal breathing conditions and after 4-hour shifts while continuously wearing an N95 respirator. Comparisons of paired measurements were performed using a non-parametric Wilcoxon matched-pairs signed-rank test. Results Forty-one subjects were included in the study. Prolonged N95 respirator use was associated with a significant decline in plasma pH [7.35mmHg vs. 7.34mmHg, P = 0.02], PvO2 [23.2 mmHg vs. 18.6 mmHg, P < 0.001] and a concurrent increase in EtCO2 [32.5mmHg vs. 38.5mmHg, p < 0.0001]. PvCO2 and bicarbonate levels did not differ. No significant change was observed for heart rate or oxygen saturation. Conclusion Using an N95 respirator for prolonged periods by healthcare professionals may provoke changes in gas exchange. The clinical significance of these changes in terms of symptoms or longer-term health status is unknown and remains to be determined.

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Bone marrow donation perceptions among healthcare workers: A follow-up study at University of Cincinnati Medical Center.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18032 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18032-e18032

Author(s):

Logan Roof ◽

Rekha T. Chaudhary

Keyword(s):

Health Care ◽

Bone Marrow ◽

Medical Students ◽

Health Care Professionals ◽

Healthcare Workers ◽

Medical Center ◽

Donation Process ◽

Bone Marrow Donation ◽

Attending Physicians ◽

Surrounding Bone

e18032 Background: It has been well-documented that there is a severe lack of participants enrolled in the National Bone Marrow Donor registry. Even those who are registered often decline to donate at a critical juncture in the donation process due to a wide variety of misconceptions. Health care professionals should be among the most educated about the bone marrow donation process as they will often be giving advice to potential donors. Methods: We conducted an anonymous online survey of medical students, residents, fellows, and attending physicians at the University of Cincinnati Medical Center to determine the common misconceptions surrounding bone marrow donation. Results: There were a total of 187 participants (73% medical students, 23% residents/fellows, 4% attending physicians). Fifty-one percent were already bone marrow donors, while 49% were not. Forty percent of respondents believe bone marrow biopsy is necessary for donation and 10% believe CT scans are done prior to donation. Twenty-eight percent responded that bone marrow is extracted under general anesthesia, 43% responded that it is extracted not under general anesthesia, 5% responded that it is extracted via central intravenous line, and 24% responded that it is extracted via peripheral intravenous line. Thirty percent responded that they are not bone marrow donors because bone marrow donation is painful, 12% because it involves surgery, 2% because it weakens the donor, 13% because it involves a lengthy recovery process, 3% because donors have to pay for donation, 1% because of ethnic/religious/cultural beliefs, while 39% have not had the opportunity to donate but would or are planning on it. Conclusions: The majority of allogeneic transplants are performed with peripherally collected bone marrow stem cells, however, most potential donors including health care professionals do not know this. We conclude that a great deal of education surrounding bone marrow donation is still needed among healthcare workers today. Educating health care workers is of the utmost importance as they will impart this knowledge to those considering donation. Future aims of this project are to develop an educational curriculum to address the most common misconceptions, particularly in medical students, as they are in the age group most targeted in bone marrow donation and they will be the future generation of physicians to educate patients on the process.

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Personal protective equipment for reducing the risk of COVID-19 infection among healthcare workers involved in emergency trauma surgery during the pandemic: an umbrella review

10.1101/2020.09.24.20201293 ◽

2020 ◽

Author(s):

Dylan Paul Griswold ◽

Andres Gempeler ◽

Angelos Kolias ◽

Peter Hutchinson ◽

Andres Rubiano

Keyword(s):

Systematic Reviews ◽

Healthcare Workers ◽

Randomised Controlled Trials ◽

Trauma Surgery ◽

Controlled Trials ◽

Protective Equipment ◽

Risk Environments ◽

Surgical Masks ◽

Randomised Controlled ◽

N95 Respirators

Objective: The objective of this review was to summarise the effects of different personal protective equipment (PPE) for reducing the risk of COVID-19 infection in health personnel caring for patients undergoing trauma surgery. The purpose of the review was to inform recommendations for rational use of PPE for emergency surgery staff, particularly in low resources environments where PPE shortages and high costs are expected to hamper the safety of healthcare workers (HCWs) and affect the care of trauma patients. Introduction: Many healthcare facilities in low-and middle-income countries are inadequately resourced. COVID-19 has the potential to decimate these already strained surgical healthcare services unless health systems take stringent measures to protect healthcare workers from viral exposure. Inclusion criteria: This review included systematic reviews, experimental and observational studies evaluating the effect of different PPE on the risk of COVID-19 infection in HCWs involved in emergency trauma surgery. Indirect evidence from other healthcare settings was considered, as well as evidence from other viral outbreaks summarised and discussed for the COVID-19 pandemic. Methods: We conducted searches in the LOVE (Living OVerview of Evidence) platform for COVID-19, a system that performs automated regular searches in PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and over thirty other sources. The risk of bias assessment of the included studies was planned with the AMSTAR II tool for systematic reviews, the RoBII tool for randomised controlled trials, and the ROBINS-I tool for non-randomised studies. Data were extracted using a standardised data extraction tool and summarised narratively. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach for grading the certainty of the evidence was followed. Results: We identified 17 systematic reviews that fulfilled our selection criteria and were included for synthesis. We did not identify randomised controlled trials during COVID-19 or studies additional to those included in the reviews that discussed other similar viral respiratory illnesses. Conclusions: The use of PPE drastically reduces the risk of COVID-19 compared with no mask use in HCWs in the hospital setting. N95 and N95 equivalent respirators provided more protection and were found to halve the risk of COVID-19 contagion in HCWs from moderate and high-risk environments. Eye protection also offers additional security and is associated with reduced incidence of contagion. These effects apply to emergency trauma care. Decontamination and reuse appear as feasible, cost-effective measures that would likely help overcome PPE shortages and enhance the allocation of limited resources. SUMMARY OF FINDINGS There is high certainty that the use of N95 respirators and surgical masks are associated with a reduced risk of coronaviruses respiratory illness when compared with no mask use. In moderate to high-risk environments, especially in aerosol-generating procedures, N95 respirators are associated with a more significant reduction in risk of COVID-19 infection compared with surgical masks. Eye protection also reduces the risk of contagion. Decontamination of masks and respirators with ultraviolet germicidal irradiation, vaporous hydrogen peroxide, or dry heat is effective and does not affect PPE performance or fit.

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Compliance With Routine Use of Gowns by Healthcare Workers (HCWs) and Non-HCW Visitors on Entry Into the Rooms of Patients Under Contact Precautions

Infection Control and Hospital Epidemiology ◽

10.1086/510811 ◽

2007 ◽

Vol 28 (3) ◽

pp. 337-340 ◽

Cited By ~ 44

Author(s):

Farrin A. Manian ◽

John J. Ponzillo

Keyword(s):

Healthcare Workers ◽

Prospective Observational Study ◽

Community Hospital ◽

Medical Center ◽

Tertiary Care ◽

Contact Precautions ◽

Teaching Community ◽

Direct Exposure ◽

General Wards ◽

The Relationship

Background.Modified contact precautions (MCP), defined as routine donning of isolation gowns (along with routine gloving) on entry into the rooms of patients under contact precautions, regardless of the likelihood of direct exposure to the patient or their immediate environment, were instituted at our medical center to reduce nosocomial transmission of common hospital pathogens.Objectives.To study compliance with MCP policy regarding routine gowning in intensive care units (ICUs) and general wards and to determine the relationship between gown and glove use in the care of patients under MCP in ICUs.Design.Prospective observational study from February 20, 2004, through January 8, 2005, involving 2,110 persons (1,504 healthcare workers [HCWs] and 606 non-HCW visitors).Setting.A 900-bed tertiary care teaching community hospital.Results.Overall compliance with routine gown use was observed for 1,542 persons (73%), including 1,150 HCWs (76%) and 392 visitors (65%) (odds ratio [OR], 1.8 [95% confidence interval {CI}, 1.4-2.2]; P < .001). Visitors in the ICUs (186 [91%] of 204) were more likely than visitors in the general wards (202 [51%] of 398) to comply with gown use (OR, 10 [95% CI, 6.0-17.0]; P < .001). In logistic regression analysis, independent predictors of gown compliance among HCWs were female sex (OR, 2.3 [95% CI, 1.8-3.0]; P < .001) and ICU setting (OR, 2.2 [95% CI, 1.7-2.9]; P < .001). In the ICUs, gown use was highly predictive of glove use among HCWs (positive predictive value, 95%).Conclusion.Improvement in compliance with gown use at our medical center will require more-intensive educational efforts targeted at male HCWs and at HCWs and visitors on general wards. In the care of ICU patients under MCP, HCW compliance with gown use may be used as a proxy for their compliance with glove use.

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Rationale and process for N95 respirator sanitation and re-use in the COVID-19 pandemic

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.37 ◽

2021 ◽

pp. 1-20

Author(s):

Gregory J. Golladay ◽

Kevin A. Leslie ◽

Wilhelm A. Zuelzer ◽

Anthony D. Cassano ◽

Joshua J. Plauny ◽

...

Keyword(s):

Healthcare Workers ◽

Structural Integrity ◽

Process Development ◽

Uv Light ◽

Medical Center ◽

Academic Medical Center ◽

Throughput Capacity ◽

Environmental Testing ◽

Level I ◽

N95 Respirators

Abstract Objective: The novel SARS-CoV-2 virus was first reported in Wuhan, China in December 2019 and is notable for being highly contagious and potentially lethal and is mainly spread by droplet transmission. The US healthcare system’s response to the COVID-19 pandemic has been challenged by a shortage of personal protective equipment (PPE), especially N95 respirators. Restricted use, re-use, and sanitation of PPE have been widely adopted to provide protection for frontline healthcare workers caring for often critically ill and highly contagious patients. This objective of this manuscript is to describe our validated process for N95 respirator sanitation. Design: Process development, validation, and implementation Setting: Level-I urban academic medical center Methods: A multidisciplinary team developed a novel evidence-based process for N95 respirator re-processing and sanitation using ultraviolet (UV) light. Dose measurement, structural integrity, moisture content, particle filtration, fit testing, and environmental testing were performed for both quality control and validation of the process. Results: The process achieved UV light dosing for sanitation while maintaining the functional and structural integrity of the N95 respirators, with a daily potential throughput capacity of ˜12,000 masks. This process has supported our health system to provide respiratory PPE to all frontline team members. Conclusions: This novel method of N95 respirator sanitation can safely enable re-use of the N95 respirator essential for healthcare workers caring for patients with COVID-19. Our high-throughput process can extend local supplies of this critical PPE until the national supply is replenished.

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Analysis of SteraMist ionized hydrogen peroxide technology in the sterilization of N95 respirators and other PPE

Scientific Reports ◽

10.1038/s41598-021-81365-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Avilash K. Cramer ◽

Deborah Plana ◽

Helen Yang ◽

Mary M. Carmack ◽

Enze Tian ◽

...

Keyword(s):

Hydrogen Peroxide ◽

Healthcare Workers ◽

Occupational Safety ◽

Medical Center ◽

Biological Indicator ◽

Bacterial Spores ◽

Safety And Health ◽

Single Use ◽

Environment Chamber ◽

N95 Respirators

AbstractThe COVID-19 pandemic has led to widespread shortages of personal protective equipment (PPE) for healthcare workers, including of N95 masks (filtering facepiece respirators; FFRs). These masks are intended for single use but their sterilization and subsequent reuse has the potential to substantially mitigate shortages. Here we investigate PPE sterilization using ionized hydrogen peroxide (iHP), generated by SteraMist equipment (TOMI; Frederick, MD), in a sealed environment chamber. The efficacy of sterilization by iHP was assessed using bacterial spores in biological indicator assemblies. After one or more iHP treatments, five models of N95 masks from three manufacturers were assessed for retention of function based on their ability to form an airtight seal (measured using a quantitative fit test) and filter aerosolized particles. Filtration testing was performed at a university lab and at a National Institute for Occupational Safety and Health (NIOSH) pre-certification laboratory. The data demonstrate that N95 masks sterilized using SteraMist iHP technology retain filtration efficiency up to ten cycles, the maximum number tested to date. A typical iHP environment chamber with a volume of ~ 80 m3 can treat ~ 7000 masks and other items (e.g. other PPE, iPADs), making this an effective approach for a busy medical center.

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Assessment of indicators of nervous and emotional stress in medical center personnel depending on the characteristics of their professional activity

Russian Journal of Occupational Health and Industrial Ecology ◽

10.31089/1026-9428-2020-60-10-650-657 ◽

2020 ◽

Vol 60 (10) ◽

pp. 650-657

Author(s):

Irina V. Fedotova ◽

Tatyana N. Vasilyeva ◽

Tatyana V. Blinova ◽

Irina A. Umnyagina ◽

Yuliya V. Lyapina ◽

...

Keyword(s):

Oxidative Stress ◽

Emotional Stress ◽

Functional State ◽

Working Conditions ◽

Medical Staff ◽

Medical Center ◽

The Body ◽

Office Workers ◽

Glutathione System ◽

Medical Centers

Introduction. Digital technologies are actively used in the work of specialists of medical centers of various profiles, which causes the impact on employees of a number of professional factors that determine the characteristics of their work. The aim of the study is to evaluate the influence of professional factors on the functional state of the employees' body and the glutathione system as an objective indicator of stress based on the analysis of the subjective perception of the medical center employees of the specifics of working with personal computers and psychophysiological testing. Materials and methods. The study involved 109 specialists of medical centers (25 ophthalmologists, 31 representatives of the secondary medical staff - nurses and paramedics, 53 office employees). The anonymous survey concerned the assessment of working conditions and their impact on the functional state of the body of the respondents. Performance and stress tolerance indicators were evaluated using three standard questionnaires. The study of 66 subjects' levels of glutathione in the blood: total, reduced, oxidized and the ratio of reduced and oxidized - was used to analyze the relationship of the neuro-emotional nature of labor with the reaction of oxidative stress. Statistical processing of the obtained data was carried out using traditional methods of variation statistics and calculating the value of the odds ratio (OR) with a 95% confidence interval (CI). Results. The survey revealed a significant proportion of people in all groups of respondents who constantly use computer technology in their work. Describing the quality of the processed information, doctors more than representatives of other groups note its complexity, importance, negative emotional color, a high degree of responsibility and tension. Doctors more often than average medical staff and office workers associate the manifestation of fatigue with an uncomfortable state of the visual organ, nervous system, and musculoskeletal system. The subjects showed reduced performance and stress tolerance with the most pronounced negative trends in the group of doctors. Changes in the glutathione system were detected, indicating the presence of oxidative stress in 40% of ophthalmologists and office workers, and in half of nurses. Conclusions. The work of specialists of medical centers of various profiles in accordance with their assessment is characterized by high nervous and emotional stress, due to the need to process a significant amount of complex and important professionally significant information. Subjectively noted by respondents the influence of working conditions on the functional state of the body is confirmed by indicators of the glutathione system, which can be used as indicators of nervous and emotional stress.

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Hand Hygiene Compliance Study at a Large Central Hospital in Vietnam

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16040607 ◽

2019 ◽

Vol 16 (4) ◽

pp. 607 ◽

Cited By ~ 6

Author(s):

Cam Le ◽

Erik Lehman ◽

Thanh Nguyen ◽

Timothy Craig

Keyword(s):

Quality Assurance ◽

Hand Hygiene ◽

Healthcare Workers ◽

Medical Center ◽

Compliance Rate ◽

World Health ◽

Limiting Factors ◽

Cultural Attitudes ◽

Knowledge And Attitude ◽

Hygiene Compliance

Lack of proper hand hygiene among healthcare workers has been identified as a core facilitator of hospital-acquired infections. Although the concept of hand hygiene quality assurance was introduced to Vietnam relatively recently, it has now become a national focus in an effort to improve the quality of care. Nonetheless, barriers such as resources, lack of education, and cultural norms may be limiting factors for this concept to be properly practiced. Our study aimed to assess the knowledge and attitude of healthcare workers toward hand hygiene and to identify barriers to compliance, as per the World Health Organization’s guidelines, through surveys at a large medical center in Vietnam. In addition, we aimed to evaluate the compliance rate across different hospital departments and the roles of healthcare workers through direct observation. Results showed that, in general, healthcare workers had good knowledge of hand hygiene guidelines, but not all believed in receiving reminders from patients. The barriers to compliance were identified as: limited resources, patient overcrowding, shortage of staff, allergic reactions to hand sanitizers, and lack of awareness. The overall compliance was 31%; physicians had the lowest rate of compliance at 15%, while nurses had the highest rate at 39%; internal medicine had the lowest rate at 16%, while the intensive care unit had the highest rate at 40%. In summary, it appears that addressing cultural attitudes in addition to enforcing repetitive quality assurance and assessment programs are needed to ensure adherence to safe hand washing.

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