Effectiveness of Selected Air Cleaning Devices During Dental Procedures.

INTRODUCTION: The recent COVID-19 pandemic has underscored the necessity of protecting health care providers (HCPs) against the transmission of infectious agents during dental procedures. To this end, the effectiveness of several air cleaning devices (ACDs) in reducing HCPs exposure to aerosols generated during dental procedures was estimated, separately or in combination with each other. These ACDs were a chairside unit capturing aerosols at the source of generation, and four ambient ACDs: a portable ambient ACD; a negative pressure module; a custom made, fan-operated and wall-mounted air filter (WMAF); and a smaller and passive version of the latter. The last three ACDs were intended for mobile dental clinics (MDCs) only. MATERIALS AND METHODS: This assessment was performed in two different environments: in a dental clinic operatory and in a MDC. Two dental personnel, acting in the roles of dentist and dental assistant, performed on simulated patient aerosol-generating and non-aerosol-generating procedures. For each 5-minute scenario, the cumulative exposure to airborne particulate matter 10 µm in size or smaller (PM10) was determined by calculating the sum of all 1 second readings obtained with personal and ambient air monitors. The effectiveness of the ACDs in capturing PM10 was estimated based on the capability of the ACDs to keep PM10 level at or below the initial background level. RESULTS: In all conditions assessed in the dental clinic operatory, when both the chairside and portable ambient ACDs were functioning, an estimated effectiveness of 100% in capturing PM10 was achieved. In the MDC, in all conditions where the chairside ACD was used without the negative pressure module, an estimated effectiveness of 100% was also achieved. The simultaneous operation of the negative pressure module in the MDC, which led to a room negative pressure of -0.25 inch wc, reduced the chairside ACD's effectiveness in capturing aerosols. Conversely, the use of the WMAF in the MDC in combination with the chairside ACD further reduced exposure to PM10 below the initial background level. Nonetheless, in all conditions assessed in both settings (dental clinic operatory and MDC), larger visible aerosols were produced, often landing on the surrounding environment. A fair portion of these aerosols landed on the inside of the chairside ACD flange. CONCLUSIONS: This assessment suggests that the use of the tested chairside ACD, by capturing aerosols at the source of generation, had the greatest impact on reducing exposure of dental personnel to PM10 produced during dental procedures. This study also indicates that such exposure is further reduced with the addition of an ambient ACD. However, creating a negative pressure room as high as -0.25 inch wc can lead to air turbulence reducing the effectiveness of ACDs in capturing aerosols at the source. Furthermore, the presence of uncaptured droplets and spatter on the surrounding environment supports the need to complement the use of engineering controls with proper administrative controls and personal protective equipment, as recommended by governmental agencies and the scientific community for preventing the transmission of infection in health care settings.

What are the barriers to routine clinical use of teleconsultation in oncology? A retrospective study on patient's and their physician's satisfaction with 603 video teleconsultations

Background: Although video teleconsultations (TCs) have shown benefits for clinical follow up in oncology, its development appears very delayed in routine practice. The COVID pandemic has required French physicians to use them, mostly during the first lockdown period. This study aims to identify barriers to TCs development by assessing patient’s and physician’s satisfaction regarding this experience. Methods: Patients who took part in at least one TC during the 7 weeks of strict confinement (from March 7 to May 11, 2020) were asked via email to complete a questionnaire of close-ended questions (5 points Likert scale) with the possibility of additional comments. Their answers were anonymized and gathered via Sphinx, a secured statistical analysis software. A second questionnaire was sent to each physician who conducted these TCs. We then aimed to analyze each patient and physician characteristics and comments, according to their degree of overall satisfaction. Results: 531 patients and 35 physicians (oncologists, surgeons, anesthetists, radiotherapists) used TCs;307 patients (57.8%) and 31(88.5%) physicians completed the survey. Patient’s average age was 59. 140 (46.7%) of them lived in a rural area and 193 (64.3%) lived more than one hour away from their cancer center;66.9% of them were overall satisfied. Unsatisfied patients (12.1%) had the same characteristics as the overall population. Apart from the lack of clinical examination, the main complaints of this group of patients were about altered communication with their physician (44.4% vs 22%), troubles with technical set up (38.9% vs 13.5%) leading to 50% of consultations by phone. Average satisfaction rate among physician was 80.7%. They mainly reported altered relationship with their patient, mostly during tough announcements. Preferred indications were surveillance consultation and treatment monitoring. Conclusions: This study shows high rate of overall satisfaction, from both patients and physicians. TCs seem to provide a suitable alternative to standard in-person consultations, therefore improvements are needed to optimize this technique. Legal entity responsible for the study: Institut Bergonié. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

French Support and Work Assistance Establishments (Esat) In the Face of the COVID 19 Pandemic: The Role of Territory and Proximity in Economic Adaptation to the Crisis

This contribution focuses on the impact of the COVID-19 pandemic on French support and work assistance establishment (ESAT) based on interviews conducted with managers of institutions located in rural and urban areas of the Auvergne-Rhone-Alpes region (France). In order to situate the ESAT in their national context, a first section is devoted to recalling the genesis and functioning of this system, which was set up to promote the social and occupational integration of workers with disabilities, whose originality lies in the articulation of a medico-social logic with an economical logic. We then try to show how the ESAT have organized themselves to provide medico-social support for workers with disabilities despite the obligation of distancing. Then, analyzed through the prism of territorial anchoring and the concept of proximity associated with it, we will focus on the impact of confinement on the economic balance of these establishments to show that the health crisis has less affected the establishments in predominantly agricultural vocation established in rural areas than those, more oriented towards industrial subcontracting, located in urban areas.