Hygienic Assessment of Personal Protective Equipment against Biological Hazards

Introduction: The professional use of personal protective equipment (PPE) eliminates occupational exposure of personnel to pathogens that cause infectious diseases, including COVID-19. Apart from the risk of exposure to biological hazards, healthcare workers are at risk of impaired work performance and work-related diseases posed by adverse health effects of PPE itself. Objective: To make a physiological and hygienic assessment of personal protective equipment against biological hazards used by healthcare professionals. Materials and methods: We evaluated the thermal state of the body in 13 volunteers under simulated conditions of the Tabai temperature and humidity chamber (Japan). The study design included a physiological and hygienic assessment of four variants of protective suits, all compliant with recommendations of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor) for use when working with microorganisms of risk groups I and II. We studied the physiological response of the thermoregulatory system to heat exposures in terms of indicators characterizing the temperature of the "core”, the temperature of the "shell”, and their integral indicators (weighted mean skin and body temperatures). Changes in the fluid and electrolyte metabolism and the functional state of the cardiorespiratory system were assessed based on objective (sweat and heart rates) and subjective (heat sensation) indicators. Results: At the air temperatures of 25 and 30 °C, the maximum thermal exposure was registered in the volunteers wearing coveralls made of nonwoven material of the Tyvek type (China). A suit made of polyester fabric with a polyurethane mem-brane coating (Russia) had a less pronounced effect on the thermal state of the body. The minimum core and shell temperatures were noted for the suits made of polymer-viscose dustproof, water-repellent twill weave fabric (Russia) and Barrier 2X fabric (Russia). Conclusion: The excess of established values of the thermal state of the body during medium work was observed for all types of the studied suits both in permissible (25 °C) and harmful (30 °C) microclimate conditions. To prevent ill-being of medical personnel, it is necessary to schedule work taking into account the type of PPE used, the intensity of physical activity, and indoor microclimate parameters. © 2022, Federal Center for Hygiene and Epidemiology. All rights reserved.

Blood transfusion in COVID-19 hospital

Background: The novel coronavirus disease 2019 (COVID-19) has caused a sudden and unexpected rise in hospitalizations and deaths around the world. Many hospitals have changed their daily work and become infectious. A reduction in blood collection of 10 to 50% has been reported. In Russia, in 2020, compared to 2019, blood collection decreased by 4%. Data on the use of blood products by patients with COVID-19 is very limited and highly variable. According to various sources, from 3.3 to 13.4% of patients with COVID-19 need a blood transfusion. In different hospitals transferred to the COVID-19 mode, blood transfusion changes in different ways: somewhere it increases, and somewhere it decreases. Aims: To identify the features of transfusion therapy in the COVID- 19 hospital of the Pirogov Center. Methods: We studied the structure of recipients and blood transfusions in the COVID-19 hospital and other departments of the Pirogov Center in 2020. We transfused leucodepleted red blood cells in PAGGS-M, leucodepleted amotosalen/UVA pathogen inactivated platelets in SSP+ and methylene blue/white light pathogen inactivated male plasma. No COVID-19 convalescent plasma has been transfused. Results: Among the 1141 patients of the COVID-19 hospital, 61 patients (5.3%) and among 37,136 patients in other departments, 710 (1.9%) patients received transfusions of blood components. During the operation of the COVID-19 hospital, the Pirogov Center's need for donor blood components was fully met. In the COVID-19 hospital compared to other departments: • the part of recipients of all blood components, red blood cells and plasma was higher (p < 0.01);• 4 units and 4-6 units of red blood cells were transfused more often (p < 0.01), more than 11 units of red blood cells were not transfused;• among recipients of red blood cells, the part of people over 60 years old is 42.4% higher than the same part among other patients (p < 0.01);• among plasma recipients, the part of persons under 45 years of age is significantly reduced (p < 0.05). Red blood cells transfusion helped to save most of the most severe patients: • over 70 years old, • anaemia on admission, • the period of D-dimer concentration over 1.5 mg/l-more than 20 days, • concomitant oncological diseases-in 20% of patients. Among patients with new coronavirus infection and no indication for red blood cell transfusion, haemoglobin concentration negatively correlates with age and D-dimer level. The absence of such connections in red blood cells recipients indicates the importance of other factors (oncological process, bleeding) in the development of anaemia that requires transfusion correction. Summary/Conclusions: The data on the needs of patients in the COVID-19 hospital for transfusion therapy can be used as a benchmark for the related work planning.

Assessment of the working conditions of medical personnel in military medical organizations during the pandemic of new coronavirus infection

Relevance. During the pandemic of new coronavirus infection, healthcare professionals have increased occupational risks of exposure to the pathogen SARS-CoV-2, as well as physical and psychological stress, especially when treating Covid patients in “red zones”. Such a change in working conditions wasn't reflected in the results of a special assessment, which requires the development of an individual scientifically based approach to its organization in conditions equated to emergency situations. Intention. Evaluate the results of a special assessment of working conditions and their compliance with actual working conditions, taking into account the health risks for healthcare professionals taking care of Covid patients. Methodology. We retrospectively conducted a comparative analysis of 295 cards for a special assessment of the working conditions of medical personnel of military medical organizations of therapeutic and infectious profile over 2015-2019, and 266 cards from the same organizations for 2020. Results and Discussion. Study of cards for special assessment of working conditions of medical personnel of military medical organizations for 2015-2020 showed the leading role of biological factors for all categories of medical personnel. Working in the “Red zone” should be assessed as 3.3 (Degree III harmful) based on biological hazard or 4 (dangerous) due to risks of acute occupational diseases and death. This should be reflected in the results of special assessment of working conditions and compensated via reduction of working hours. However, in the context of the pandemic, actual working hours of healthcare professionals exceeded the established 39 hours per week (Article 350 of the Labor Code of the Russian Federation), and the medical personnel were allowed to work with the pathogen of Group II pathogenicity without preliminary medical examinations. Conclusion. Analysis of the results of special assessment of the working conditions of medical personnel showed that they do not reflect the actual harmful (dangerous) working conditions of employees involved in providing care to patients with new coronavirus infection in these medical and preventive institutions. © 2021 Medico-Biological and Socio-Psychological Issues of Safety in Emergency Situations. All rights reserved.