Randomized crossover study comparing quantitative fit tests between Trident™ and 3M™ Aura™ N95/P2 respirators.

BACKGROUND: Various styles of N95/P2 filtering facepiece respirators (FFRs) have been used by Australian healthcare workers (HCWs) during the COVID-19 pandemic. This is usually driven by the national stockpile availability. Many studies demonstrate three-panel flat-fold N95/P2 FFRs have higher quantitative fit test (QNFT) pass rates than other FFR styles. This prospective randomized crossover study utilized QNFT to evaluate the performance of the new three-panel flat-fold FFR, the Trident™ P2 respirator compared to the previously most effective model, the 3M™ Aura™ 9320A + N95 respirator. METHODS: We recruited 500 participants who completed online training and QNFT on both respirators. The order of the respirator being examined first was randomly allocated. The primary outcome was the QNFT pass rate. Secondary outcomes included the overall fit factor, the individual fit factor for each exercise, and the first-attempt QNFT pass rate. RESULTS: We found that both the overall and first-attempt QNFT pass rates of the Trident P2 respirator were significantly higher than the 3M Aura (99.2% vs 92.6%, p < 0.001; and 92.6% vs 76.4%, p < 0.001 respectively). The overall fit factor and the individual fit factor were also significantly higher for the Trident FFR than the 3M Aura. CONCLUSIONS: This study is the first to report hospital-based QNFT results of the Trident FFR, demonstrating very high first-time and overall pass rates. Our findings are consistent with previous research showing very high QNFT pass rates with three-panel flat-fold FFRs. These findings are important for pandemic preparedness with respect to the stockpiling and safe utilization of N95/P2 respirators.

Post-operative use of hme filter-protected open tracheostomy circuit during the covid-19 pandemic

Introduction In the era of the COVID-19 pandemic, the avoidance of aerosol generating procedures (AGPs) is paramount to reduce the risk of viral transmission to staff and other patients. Perioperative management of a new tracheostomy is challenging as routine care, such as suctioning, frequently involves AGPs. Method We developed and implemented an apparatus called the heat and moisture exchanger (HME) filter-protected open circuit. This enabled closed suctioning to be performed and allowed spontaneously breathing patients to be managed with an open circuit in a shared environment while reducing the risk of viral aerosolisation. We performed a prospective observational study of 20 cases, recording the incidence of desaturation (<90%), apparatus disconnection, apparatus dislodgement and apparatus replacement. The ease of use of the apparatus for recovery nursing staff and patient comfort were measured on a Likert scale. Results There were no incidents of desaturation. There were two circuit disconnections. Apparatus replacement with an alternate circuit was not required for any patient. Most recovery nursing staff agreed or strongly agreed that the apparatus was easy to use and that the apparatus bulk or weight did not interfere with patient care activities. Ninety-five per cent of patients reported that their breathing was comfortable prior to discharge from the Post Anaesthesia Care Unit. Conclusion In conclusion, the HME filter-protected open circuit is a relatively safe, acceptable and practical device to use for spontaneously breathing patients with newly created tracheostomies in the perioperative environment. This work is licensed under a Creative Commons Attribution 4.0 License.

Learning during the pandemic: Perspectives of medical students in Singapore

The COVID-19 pandemic has significantly disrupted medical education, particularly affecting clinical-year students. Educational institutions often had to halt, shorten or impose significant restrictions on their hospital rotations due to strict infection control and social-distancing guidelines implemented in tertiary healthcare institutions, as well as manpower and logistical constraints amid the pandemic. Thus, distance-based learning platforms such as online lectures and case-based teaching were increasingly adopted in place of bedside and face-to-face tutorials. While interactive virtual case-based discussions are generally useful in imparting clinical reasoning skills to medical students, they are unfortunately not able to fully replicate the experience of clerking, examining and managing real patients in the wards, which is a quintessential process towards building clinical acumen and attaining core clinical competencies. Therefore, for final year medical students who are preparing for their Bachelor of Medicine and Bachelor of Surgery (MBBS) examinations, many are naturally concerned by how learning in this "new normal" may affect their ability to make the transition to become competent junior doctors. As such, we seek to share our learning experiences as the first batch of medical students to have completed our entire final year of clinical education amid the COVID-19 pandemic, and offer 4 practical suggestions to future batches of students on how to adapt and optimise clinical learning under these circumstances: actively engaging in virtual learning, making the most of every clinical encounter, learning how to construct peer teaching/practice sessions, and maintaining physical and psychological well-being.

Impacts on staff after implementation of a respiratory protection program in a Victorian public hospital.

BACKGROUND: In October 2020, the Royal Melbourne Hospital implemented a Respiratory Protection Program (RPP), which was initiated by the Victorian Government. This study was to evaluate the effectiveness of the program. METHODS: A cohort of 158 employees, who were identified as high risk to respiratory biohazard exposure, were invited to participate in the RPP. We provided a bundle of interventions, which included an online training package, and mandatory quantitative fit testing. The main outcomes included the participants' knowledge and attitude toward respiratory protection equipment (RPE), which were assessed via an online survey. Their donning and doffing skills, and user seal check techniques on four different types of N95 respirators were also assessed by an observer using a pre-determined marking sheet. We compared these outcomes before and after participation in the program. RESULTS: There was a total of 125 participants, all of whom completed the knowledge and attitude assessment, and 69 completed the skill assessment before and after the program. There was a statistically significant improvement in their knowledge scores, donning and doffing skills, and user seal check techniques after participation in the RPP. Participants also reported significant increased level of confidence in their RPE knowledge, training and skills; and workplace safety. CONCLUSION: This initial report of the implementation of a novel RPP in a Victorian major tertiary hospital provides guidance on the benefits to respiratory protection, staff knowledge, skills, confidence and morale that can be acquired from a scalable online training package combined with mandatory quantitative fit testing.