Minimizing contamination in the use of personal protective equipment: Simulation results through tracking contamination and enhanced protocols.

BACKGROUND: Due to variations and the inadequate use of personal protective equipment (PPE), this study aimed to evaluate our enhanced PPE protocols for minimizing doffing contamination. METHODS: Among 3 PPE kits (simple, Level D, and Level C), 30 participants conducted the first simulation in their adapted way and the second following enhanced protocols. After donning, participants performed a 1-minute simulation of direct care on a patient simulator covered with fluorescent powder. For tracking contamination routes between doffing processes, fluorescent powder contamination was examined with ultraviolet lamps in the darkened room. RESULTS: Participants were mostly registered nurses (N = 27, 90%), female (87%), and on average 31.7 years old with 8.5 years of clinical experience. Among 61 total simulations, 32 had at least 1 contamination (52.5%); "Noticeable" level (40%) at the "hands-fingers" and "shirt" body areas were most frequent. For first and second simulations with identical PPE kits, compared to the first with adapted practice, the second with enhanced protocols showed a significant reduction in doffing contamination rates (72.7% vs 22.7%, P = .0009 for both Level C and D; 77.8% vs 27.8%, P = .0027 for Level D). CONCLUSIONS: Our enhanced protocols could significantly reduce contaminations. More studies are necessary to provide safer PPE protocol options.

South Korea's responses to stop the COVID-19 pandemic.

BACKGROUND: South Korea's aggressive responses to the coronavirus disease 2019 (COVID-19) have greatly slowed the epidemic without regional lockdowns. METHODS: The Korean Centers for Disease Control and Prevention's daily briefings were thoroughly reviewed. Information about hospital countermeasures and government coordination was collected via telephone interviews with 4 infection control team leaders, 1 emergency department nurse, and 1 infectious disease physician in Korea. RESULTS: After the 2015 Middle East Respiratory Syndrome outbreak, the government and hospitals prepared for the inevitable outbreak of emerging infectious diseases by reforming the epidemic preparedness system. As a result, COVID-19 diagnostic test kits were quickly developed, enabling extensive early detection of potential cases. Other key steps were tracking cases, finding exposed individuals, coordinating case assignments with health care facilities, and selective clinic screenings for visitors' entering hospitals with mandatory mask wearing. Consequently, after overcoming the initial peak of the outbreak, which was related to a religious group, Korea has been able to maintain daily new cases at around 100 and to less than 50 daily cases in the second week of April. CONCLUSIONS: To counter the COVID-19 pandemic, which may persist, long-term, sustained response strategies must be prepared along with coordination between government and health systems.

Infection Control during Surgery for Patients with Confirmed or Suspected Coronavirus Disease-19

The prevalence of coronavirus disease (COVID-19) has led to an increase in the number of patients being treated at medical institutions, including the number of patients requiring surgical treatments. Although the operating room infection control has focused on preventing surgical site infections in patients, a high interest has been shown in preventing infections in the medical staff because of a high risk of exposure of the medical staff to body fluids and respiratory system secretions during surgery when operating on suggested or confirmed patients with COVID-19. A thorough surgical preparation by the medical institution is warranted to protect both the patient and medical staff from contracting infections. The medical institution should closely examine the operation process to maintain the facilities related to the operation and plan the placement of human resources and patient movement. Further, specific guidelines for commodity, environmental, and waste management should be established in accordance with the agency’s situation, and medical workers should be continuously trained using the related guidelines.

Infection Control of Dialysis Patients for Coronavirus Infectious Disease-19 Response

The effects of coronavirus disease 19 (COVID-19) on patients with chronic kidney disease have not yet been fully studied, but acute kidney damage has been reported in some COVID- 19 patients. Hemodialysis is an essential treatment for patients with chronic kidney disease and they receive treatment for extended periods of time in congested spaces such as artificial kidney rooms. Because suspected or confirmed COVID-19 patients must visit medical institutions regularly for dialysis treatment, it is necessary to take efficient and safe infection control measures to prevent infections from spreading to medical staff or other patients during hemodialysis. Due to artificial kidney rooms receiving a high number of patients for outpatient treatment, it is important to assess the patients before admission. Therefore, a monitoring system is needed to check the epidemiological relevance and possible symptoms of COVID-19. Even if they are not epidemiologically related to COVID-19, patients with fever or respiratory symptoms should receive treatment in isolation rooms, while patients with suspected or confirmed COVID-19 infection should use negative-pressure isolation rooms. The medical staff participating in dialysis treatment for COVID-19 patients should wear appropriate personal protective equipment and provide specific guidelines for equipment, environmental, and waste management according to institutional circumstances.