Comparison of Effects of N95 Respirators and Surgical Masks to Physiological and Psychological Health among Healthcare Workers: A Randomized Controlled Trial

Since the onset of the coronavirus disease 2019 pandemic, wearing facemasks has become more important for healthcare workers. This study aimed to investigate and compare the influence of wearing N95 respirators and surgical masks for 8 h on physiological and psychological health. Sixty-eight healthcare workers were randomly assigned to the N95 respirator or surgical mask groups. Physiological parameters of participants were measured by Tensor Tip MTX at baseline and at the 2nd, 4th, 6th and 8th h of wearing the facemasks. The symptoms after wearing facemasks were also determined via the questionnaire. There were no significant changes in physiological parameters at most time checkpoints in both groups. Significant differences were observed in terms of heart rate at the 8th h, time trends (adjusted difference of least squares means were −8.53 and −2.01), and interaction of time and mask type between the two groups (p-value for interaction was 0.0146). The values of these physiological parameters were within normal ranges. The N95 respirator group had significantly higher incidences of shortness of breath, headache, dizziness, difficulty talking and fatigue that spontaneously resolved. In conclusion, healthcare workers who wore either N95 respirators or surgical masks during an 8 h shift had no obvious harmful effects on physiological and psychological health. Additionally, the N95 respirator group did not show a higher risk than the surgical mask group.

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Vaporized H2O2 decontamination against surrogate viruses for the reuse of N95 respirators in the COVID-19 emergency

10.1101/2020.06.25.20140269 ◽

2020 ◽

Cited By ~ 1

Author(s):

Ebru Oral ◽

Keith K. Wannomae ◽

Rachel L. Connolly ◽

Joseph A. Gardecki ◽

Hui Min Leung ◽

...

Keyword(s):

Healthcare Workers ◽

Hospital Environment ◽

Bacterial Spores ◽

Virus Concentration ◽

Log10 Reduction ◽

Mycobacterium Species ◽

Enveloped Viruses ◽

Surgical Masks ◽

Wide Range ◽

N95 Respirators

Decontamination of N95 respirators has become critical to alleviate PPE shortages for healthcare workers in the current COVID-19 emergency. The factors that are considered for the effective reuse of these masks are the fit, filter efficiency and decontamination/disinfection level both for SARS-CoV-2, which is the causative virus for COVID-19, and for other organisms of concern in the hospital environment such as Staphylococcus aureus or Clostridium difficile.In its guidance entitled ‘Recommendations for Sponsors Requesting EUAs for Decontamination and Bioburden Reduction Systems for Surgical Masks and Respirators During the Coronavirus Disease 2019 (COVID19) Public Health Emergency’ (May 2020)[1], the FDA recommends a 6-log10 reduction in either the most resistant bacterial spores for the system or in a mycobacterium species to authorize the use of a decontamination method of N95 respirators for single or multiple users. While the goal is primarily inactivation against SARS-CoV-2, testing of decontamination methods against the virus may not always be available. For decontamination methods considered for only single users, the recommendation is a 6-log10 reduction in the infective virus concentration of 3 non-enveloped viruses or in the concentration of two Gram (+) and two Gram (-) bacteria. Based on these recommendations, we explored the efficacy of vaporized H2O2 (VHP) treatment of N95 respirators against surrogate viruses covering a wide range of disinfection resistance for emergency decontamination and reuse to alleviate PPE shortages for healthcare workers in the COVID-19 emergency.

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Physical interventions to interrupt or reduce the spread of respiratory viruses. Part 1 - Face masks, eye protection and person distancing: systematic review and meta-analysis

10.1101/2020.03.30.20047217 ◽

2020 ◽

Cited By ~ 11

Author(s):

T Jefferson ◽

MA Jones ◽

L Al-Ansary ◽

GA Bawazeer ◽

EM Beller ◽

...

Keyword(s):

Risk Ratio ◽

Healthcare Workers ◽

Meta Analysis ◽

Cochrane Review ◽

Respiratory Viruses ◽

Randomised Trials ◽

Insufficient Evidence ◽

Eye Protection ◽

Surgical Masks ◽

N95 Respirators

AbstractOBJECTIVETo examine the effectiveness of eye protection, face masks, or person distancing on interrupting or reducing the spread of respiratory viruses.DESIGNUpdate of a Cochrane review that included a meta-analysis of observational studies during the SARS outbreak of 2003.DATA SOURCESEligible trials from the previous review; search of Cochrane Central Register of Controlled Trials, PubMed, Embase and CINAHL from October 2010 up to 1 April 2020; and forwardand backward citation analysis.DATA SELECTIONRandomised and cluster-randomised trials of people of any age, testing the use ofeye protection, face masks, or person distancing against standard practice, or a similar physical barrier. Outcomes included any acute respiratory illness and its related consequences.DATA EXTRACTION AND ANALYSISSix authors independently assessed risk of bias using the Cochrane tool and extracted data. We used a generalised inverse variance method for pooling using a random-effects model and reported results with risk ratios and 95% Confidence Intervals (CI).RESULTSWe included 15 randomised trials investigating the effect of masks (14 trials) in healthcare workers and the general population and of quarantine (1 trial). We found no trials testing eye protection. Compared to no masks there was no reduction of influenza-like illness (ILI) cases (Risk Ratio 0.93, 95%CI 0.83 to 1.05) or influenza (Risk Ratio 0.84, 95%CI 0.61-1.17) for masks in the general population, nor in healthcare workers (Risk Ratio 0.37, 95%CI 0.05 to 2.50). There was no difference between surgical masks and N95 respirators: for ILI (Risk Ratio 0.83, 95%CI 0.63 to 1.08), for influenza (Risk Ratio 1.02, 95%CI 0.73 to 1.43). Harms were poorly reported and limited to discomfort with lower compliance. The only trial testing quarantining workers with household ILI contacts found a reduction in ILI cases, but increased risk of quarantined workers contracting influenza. All trials were conducted during seasonal ILI activity.CONCLUSIONSMost included trials had poor design, reporting and sparse events. There was insufficient evidence to provide a recommendation on the use of facial barriers without other measures. We found insufficient evidence for a difference between surgical masks and N95 respirators and limited evidence to support effectiveness of quarantine. Based on observational evidence from the previous SARS epidemic included in the previous version of our Cochrane review we recommend the use of masks combined with other measures.

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Facial protection for healthcare workers during pandemics: a scoping review

BMJ Global Health ◽

10.1136/bmjgh-2020-002553 ◽

2020 ◽

Vol 5 (5) ◽

pp. e002553 ◽

Cited By ~ 32

Author(s):

Laura R Garcia Godoy ◽

Amy E Jones ◽

Taylor N Anderson ◽

Cameron L Fisher ◽

Kylie M L Seeley ◽

...

Keyword(s):

Scoping Review ◽

Healthcare Workers ◽

English Language ◽

Grey Literature ◽

Conservation Strategies ◽

Surgical Masks ◽

Inpatient Settings ◽

N95 Respirators ◽

The Impact ◽

Medical Grade

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has led to personal protective equipment (PPE) shortages, requiring mask reuse or improvisation. We provide a review of medical-grade facial protection (surgical masks, N95 respirators and face shields) for healthcare workers, the safety and efficacy of decontamination methods, and the utility of alternative strategies in emergency shortages or resource-scarce settings.MethodsWe conducted a scoping review of PubMed and grey literature related to facial protection and potential adaptation strategies in the setting of PPE shortages (January 2000 to March 2020). Limitations included few COVID-19-specific studies and exclusion of non-English language articles. We conducted a narrative synthesis of the evidence based on relevant healthcare settings to increase practical utility in decision-making.ResultsWe retrieved 5462 peer-reviewed articles and 41 grey literature records. In total, we included 67 records which met inclusion criteria. Compared with surgical masks, N95 respirators perform better in laboratory testing, may provide superior protection in inpatient settings and perform equivalently in outpatient settings. Surgical mask and N95 respirator conservation strategies include extended use, reuse or decontamination, but these strategies may result in inferior protection. Limited evidence suggests that reused and improvised masks should be used when medical-grade protection is unavailable.ConclusionThe COVID-19 pandemic has led to critical shortages of medical-grade PPE. Alternative forms of facial protection offer inferior protection. More robust evidence is required on different types of medical-grade facial protection. As research on COVID-19 advances, investigators should continue to examine the impact on alternatives of medical-grade facial protection.

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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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N95 Respirators or Surgical Masks to Protect Healthcare Workers against Respiratory Infections: Are We There Yet?

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/rccm.201303-0581ed ◽

2013 ◽

Vol 187 (9) ◽

pp. 904-905 ◽

Cited By ~ 6

Author(s):

Mary T. Bessesen ◽

Connie Savor-Price ◽

Michael Simberkoff ◽

Nicholas G. Reich ◽

Andrew T. Pavia ◽

...

Keyword(s):

Healthcare Workers ◽

Respiratory Infections ◽

Surgical Masks ◽

N95 Respirators

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Protecting Healthcare Workers From Acute Respiratory Infections: Surgical Masks or N95 Respirators?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv133.202 ◽

2015 ◽

Vol 2 (suppl_1) ◽

Author(s):

Jeffrey Smith ◽

Colin Macdougall ◽

Jennie Johnstone ◽

Ray Copes ◽

Brian Schwartz ◽

...

Keyword(s):

Healthcare Workers ◽

Respiratory Infections ◽

Acute Respiratory Infections ◽

Surgical Masks ◽

N95 Respirators

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A pilot randomized controlled trial of a tailored smoking cessation program for people living with HIV in the Washington, D.C. metropolitan area

BMC Research Notes ◽

10.1186/s13104-020-05417-3 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Elexis C. Kierstead ◽

Emily Harvey ◽

Denisse Sanchez ◽

Kimberly Horn ◽

Lorien C. Abroms ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Smoking Cessation ◽

Self Efficacy ◽

Text Messaging ◽

Controlled Trial ◽

P Value ◽

People Living With Hiv ◽

Randomized Controlled ◽

Living With Hiv ◽

Pilot Randomized Controlled Trial

Abstract Objective Morbidity and mortality from smoking-related diseases among people living with HIV (PLWH) in the U.S. surpasses that due to HIV itself. Conventional smoking cessation treatments have not demonstrated strong efficacy among PLWH. We conducted a pilot randomized controlled trial (RCT) to evaluate a tailored smoking cessation intervention based on the minority stress model. We compared standard of care counseling (SOC) to a tailored intervention (TI) including one face-to-face counseling session incorporating cognitive behavioral therapy to build resilience, and 30 days of 2-way text messaging. Results The primary outcome was smoking cessation. Secondary outcomes included cigarettes per day (CPD), exhaled carbon monoxide (CO), and cessation self-efficacy. A total of 25 participants were enrolled (TI:11, SOC:14), and 2 were lost to follow-up. There were no significant differences in quit rates between study groups. However, there was a significantly greater decrease in CPD in the TI versus SOC (13.5 vs. 0.0, p-value:0.036). Additionally, self-efficacy increased in both groups (TI p-value:0.012, SOC p-value:0.049) and CO decreased in both groups (TI p-value: < 0.001, SOC p-value:0.049). This intervention shows promise to support smoking cessation among PLWH. A larger study is needed to fully evaluate the efficacy of this approach. Clinical trial: Trial Registration: Retrospectively registered (10/20/2020) NCT04594109.

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The Influence of Connectedness to Nature on Psychological Well-Being: Evidence from the Randomized Controlled Trial Play&Grow

Challenges ◽

10.3390/challe12010012 ◽

2021 ◽

Vol 12 (1) ◽

pp. 12

Author(s):

Tanja Sobko ◽

Gavin T. L. Brown

Keyword(s):

Randomized Controlled Trial ◽

Young Children ◽

Psychological Health ◽

Mental Health Problems ◽

Controlled Trial ◽

Well Being ◽

Path Model ◽

Psychological Well Being ◽

Connectedness To Nature ◽

Randomized Controlled

Urbanized children today have fewer opportunities to interact with nature which may lead to a greater risk of mental health problems. The objective of this randomized controlled trial was to investigate which particular changes in connectedness to nature (CN) would improve psychological well-being (PW) in young children. Six hundred and thirty-nine preschoolers (52.0% boys, age 34.9 ± 9.5 months) participated in Play&Grow, an early environmental education intervention. Children’s CN and PW were evaluated by parents before and after the program with validated measures; the CNI-PPC (four factors) and the SDQ, Strength and Difficulties questionnaire (five factors), respectively. The effectiveness of the intervention on the primary outcomes (CN, PW) as well as the relationship between them was analyzed in a repeated measures path model with intervention status as a causal predictor. Specific CN factors consistently increased ProSocial behavior and reduced Hyperactivity and Emotional problems. In summary, this study showed that the previously reported impact shifted from the total CN score to the specific CN factors. The Play&Grow intervention positively increased children’s CN and improved some aspects of psychological well-being in children which is a preliminary evidence of developmental benefits of connecting young children with nature. Our results indicate promising direction of action for the improvement of families’ psychological health.

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Effects of cycling workstation to get tertiary employee moving on their overall health: study protocol for a REMOVE trial

Trials ◽

10.1186/s13063-021-05317-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Terry Guirado ◽

Lore Metz ◽

Bruno Pereira ◽

Audrey Bergouignan ◽

David Thivel ◽

...

Keyword(s):

Physical Activity ◽

Psychological Health ◽

Controlled Trial ◽

Office Workers ◽

Health Study ◽

Full Time ◽

Eating Behaviours ◽

Potential Health ◽

Link Type ◽

Working Day

Abstract Background Sedentary behaviour (SB) and low levels of physical activity (PA) are predictors of morbidity and mortality. Tertiary employees spend a considerable amount of their daily time seated and new efficient strategies to both reduce sedentary time and increase physical activity are needed. In that context, the REMOVE study aims at evaluating the health effects of a 24-week cycling desk intervention among office workers. Methods A prospective, open-label, multicentre, two-arm parallel, randomized controlled trial (RCT) will be conducted in office-sitting desk workers. Office workers (N = 80) who have 0.8 full time equivalent hours (FTE) and 75% of this time in a sitting position will be recruited from tertiary worksites in Clermont-Ferrand, France. Subjects will be randomly assigned to one of the two following interventions: (i) PPM6: performance of two 30 min of cycling desk (using portable pedal exercise machine—PPM) per working day for 6 months or (ii) CTL_PPM3: 3 months with no intervention (control) followed by 3 months during which workers will be asked to complete two 30 min of PPM per working day. At baseline (T0), at 3 months (T1) and at 6 months (T2) after the start of the interventions, primary outcomes; 7-day PA and SB (3D-accelerometers), secondary outcomes; body composition (bioelectrical impedance), physical fitness (aerobic fitness, upper and lower limb strength), metabolic outcomes (fasting blood samples), self-perceived stress, anxiety, quality of life at work and job strain (questionnaires), tertiary outcomes; resting metabolic rate and cycling energy expenditure (indirect calorimetry) and eating behaviours (questionnaires) will be measured. An ergonomic approach based on observations and individual interviews will be used to identify parameters that could determine adherence. Discussion The REMOVE study will be the first RCT to assess the effects of cycling workstations on objectively measured PA and SB during working and non-working hours and on key physiological and psychological health outcomes. This study will provide important information regarding the implementation of such cycling workstations in office workers and on the associated potential health benefits. Trial registration ClinicalTrials.govNCT04153214. Registered on November 2019, version 1

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COVID-19 Vaccination Perception and Attitude among Healthcare Workers in Egypt

Journal of Primary Care & Community Health ◽

10.1177/21501327211013303 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110133

Author(s):

Samar Fares ◽

Merihan M. Elmnyer ◽

Shimaa Sabry Mohamed ◽

Radwa Elsayed

Keyword(s):

Healthcare Workers ◽

Study Groups ◽

World Health ◽

Vaccine Hesitancy ◽

Accurate Information ◽

P Value ◽

Major Barrier ◽

Vaccination Programs ◽

The World ◽

Health Organization

Introduction COVID-19 pandemic has affected the whole world, especially the frontline worriers. To get shielded through this war, the world is racing to reach and manufacture COVID-19 vaccines. Vaccination hesitancy is one of the significant obstacles to global health. Objectives This study aimed to assess the perception and attitude of healthcare workers in Egypt toward COVID-19 vaccines, acknowledge the determinants of their attitude, and the factors that could increase the acceptance of the vaccine. Methods an observational web-based anonymous survey was conducted on 385 Egyptian healthcare workers in different governorates. The questionnaire-based on Vaccine Hesitancy Survey Questions of the World Health Organization was available in Arabic and English languages and was tested for reliability. Results Regarding vaccination decision, 51% of the participants were undecided, 28% refused, and 21% accepted vaccination. Reasons for vaccine acceptance mainly were risks of COVID-19 (93%), safety (57.5%), and effectiveness (56.25%) of the vaccine. Simultaneously, the reasons for vaccine hesitancy were the absence of enough clinical trials (92.4%) and fear of side effects of the vaccine (91.4%). The leading factor that could increase vaccination acceptance among the participants was to get sufficient and accurate information about the available vaccines. The participants revealed a high mean level of concern for COVID-19 vaccines’ safety (3.8 of 5) that differs significantly among the different study groups ( P-value .002). Conclusion Despite the COVID-19 pandemic, only approximately 21% of Egyptian healthcare workers in our study accepted the COVID-19 vaccination. Vaccine hesitancy represents a major barrier to implementing vaccination programs.

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