Human-machine collaboration using artificial intelligence to enhance the safety of donning and doffing personal protective equipment (PPE).

OBJECTIVES: To compare the accuracy of monitoring personal protective equipment (PPE) donning and doffing process between an artificial intelligent (AI) machine collaborated with remote human buddy support system and an onsite buddy, and to determine the degree of AI autonomy at the current development stage. DESIGN AND SETTING: We conducted a pilot simulation study with 30 procedural scenarios (15 donning and 15 doffing, performed by one individual) incorporating random errors in 55 steps. In total, 195 steps were assessed. METHODS: The human-AI machine system and the onsite buddy assessed the procedures independently. The human-AI machine system performed the assessment via a tablet device, which was positioned to allow full-body visualization of the donning and doffing person. RESULTS: The overall accuracy of PPE monitoring using the human-AI machine system was 100% and the overall accuracy of the onsite buddy was 99%. There was a very good agreement between the 2 methods (κ coefficient, 0.97). The current version of the AI technology was able to perform autonomously, without the remote human buddy's rectification in 173 (89%) of 195 steps. It identified 67.3% of all the errors independently. CONCLUSIONS: This study provides preliminary evidence suggesting that a human-AI machine system may be able to serve as a substitute or enhancement to an onsite buddy performing the PPE monitoring task. It provides practical assistance using a combination of a computer mirror, visual prompts, and verbal commands. However, further studies are required to examine its clinical efficacy with a diverse range of individuals performing the donning and doffing procedures.

Impact on quantitative fit-test results after application of prophylactic hydrocolloid dressing under N95 respirators.

OBJECTIVE: Discomfort and device-related pressure injury (DRPI) caused by N95 filtering facepiece respirators (FFRs) are common. The use of prophylactic hydrocolloid dressings is one of the strategies that may improve comfort and reduce DRPI. In this study, we investigated the impact of these dressings on N95 respirator fit. METHODS: We performed a repeat quantitative fit testing through the Respiratory Protection Program on 134 healthcare workers (HCWs), who applied hydrocolloid dressings on the bridge of their nose under the N95 FFRs that they passed the initial fit test with, but reported discomfort with the FFR. RESULTS: With the hydrocolloid dressings in place, the fit-test pass rate for the semirigid cup style (3M 1860) was 94% (108 of 115); for the the vertical flat-fold style (BYD), the pass rate was 85% (44 of 52); for the duckbill style (BSN medical ProShield and Halyard Fluidshield), the pass rate was 81% (87 of 108); and for the 3-panel flat-fold style (3M Aura) N95 FFRs, the pass rate was 100% (3 of 3). There was a statistically significant reduction in the overall fit factors for both the vertical flat-fold and duckbill type N95 respirators after the application of hydrocolloid dressings. CONCLUSIONS: Hydrocolloid dressings are likely to disturb the mask seal for nonrigid-style N95 FFRs, particularly the vertical flat-fold style and the duckbill style N95 FFRs. Given the risk of mask seal disturbance of N95 respirators as shown in this study, we advocate that any HCW requiring the use of prophylactic dressings should undergo repeat quantitative fit testing with the dressing in place prior to using the dressing and mask in combination.

The psychological impact on perioperative healthcare workers during Victoria's second COVID-19 wave: A prospective longitudinal thematic analysis.

The COVID-19 pandemic has had a profound psychological impact on our frontline healthcare workers. Throughout the entire second COVID-19 wave at one major tertiary hospital in Melbourne Australia, longitudinal qualitative data between perioperative staff members, and analyses of intrapersonal changes were reported. Inductive analysis of three open-ended questions generated four major themes: Organisational Response to the Pandemic, Psychological Impact, Changes in Feelings of Support Over Time and Suggestions for Changes. Understanding the challenges, perception and suggestions from this longitudinal study allows us to provide a range of support services and interventions to minimise the long-term negative psychological impact and be better prepared should another similar situation arises again.

Quantitative fit-test concordance of a pair of similar-fit 3M Aura respirator models, 3M 9320A+ and 3M 1870+: A randomized crossover study.

OBJECTIVE: Some manufacturers provide information on similar-fit model pairings of filtering facepiece respirators (FFRs), suggesting that fit-test outcome of one model helps predict the other. This guidance may be useful during crisis capacity when FFR supplies and/or fit tests are constrained. The purpose of this study was to compare quantitative fit-test (QNFT) results and concordance between a pair of similar-fit 3M Aura FFRs: the 3M 9320A+ and 3M 1870+. METHODS: All participants completed online training and a QNFT with both respirators. The order of the respirator being examined first was randomly allocated. The outcomes included QNFT pass rate, concordance between the 2 models, overall and individual fit factors, and percentage of male and female participants who passed or failed the QNFT. RESULTS: We recruited 1,000 participants (668 females and 332 males). The QNFT pass rate, overall fit factors, and individual fit factors were significantly higher for the 3M 9320A+ than the 3M 1870+ FFR. The concordance between the models was "fair" (κ coefficient, 0.38). Male participants who passed a QNFT with either of the FFRs had 96% chance of passing the QNFT for the alternate model. Female participants who passed the 3M 1870+ had 97% chance of passing the QNFT for the 3M 9320A+ model. However, ∼1 in 12 females who passed the QNFT for the 3M 9320A+ failed the QNFT for the 3M 1870+ FFR. CONCLUSIONS: Similar-fit paired FFR models may provide a consequentially different level of respiratory protection, especially for women. Our findings are important for FFR stockpiling and fit-testing strategies, especially during crisis capacity.

Protocol of a prospective comprehensive evaluation of an elastic band beard cover for filtering facepiece respirators in healthcare.

Individuals who are unable to be clean shaven for religious, medical or cultural reasons are unable to wear a filtering facepiece respirator (FFR), as the respirator cannot provide adequate protection against aerosol-transmissible diseases. There is currently a paucity of validated techniques to ensure the safe inclusion of bearded healthcare workers in the pandemic workforce. We propose to undertake a healthcare-based multi-modal evaluation study on the elastic band beard cover for FFR technique, examining the quantitative fit test (QNFT) results, usability and skill level of participants with repeated assessments over time. This is a prospective study conducted through the Respiratory Protection Program at the Royal Melbourne Hospital. Healthcare workers are invited to participate if they require respiratory protection and cannot shave for religious, cultural or medical reasons. An online education package on the use of respiratory protective equipment and the elastic band beard cover for FFR technique is provided. This is followed by a face-to-face session, where the participant will receive: one-on-one training; undergo a skill assessment on their donning, doffing and user seal check techniques; complete QNFTs and a usability survey. Participants will be invited to repeat the assessment within 3 months of the first session and at 12 months. This study involves multimodal and repeated assessments of an elastic band beard cover for FFRs. The findings of this study will provide information on: whether this simple technique can provide safe, consistent and effective respiratory protection; whether it will interfere with occupational activities; and whether it is comfortable and tolerable for the duration of wear. This is of significant importance to the health workforce around the world, who cannot shave but require access to respiratory protective equipment during the COVID-19 pandemic.

Mental health symptoms in Australian general practitioners during the COVID-19 pandemic.

BACKGROUND: General practitioners (GPs) play a central role during the COVID-19 pandemic, and yet awareness of their mental health is limited. METHODS: A nationwide online survey of self-identified frontline healthcare workers was conducted between 27 August and 23 October 2020. Participants were recruited through health and professional organisations, colleges, universities, government contacts, and media. A subset of the findings on GPs and hospital medical staff (HMS) was used for this study. RESULTS: Of 9518 responses, there were 389 (4%) GPs and 1966 (21%) HMS. Compared with HMS, GPs received significantly less training on personal protective equipment usage or care for COVID-19 patients, and less support or communication within their workplace. GPs were significantly more concerned about household income, disease transmission to family and being blamed by colleagues if they became infected, all of which were associated with worse psychological outcomes. Significantly more GPs reported burnout, and experienced moderate-to-severe emotional exhaustion than HMS. Both groups used similar coping strategies, except fewer GPs than HMS used digital health applications or increased alcohol consumption. Less than 25% of either group sought professional help. CONCLUSIONS: GPs are vital in our healthcare systems, yet face unique workplace challenges and mental health stressors during the pandemic. Targeted workplace and psychological support is essential to protect wellbeing among the primary care workforce.

Respiratory protection preparedness in critical care healthcare workers: An observational audit of facial hair at a major tertiary hospital in Australia.

BACKGROUND: Facial hair under a tight fitting P2/N95 respirator diminishes respiratory protection. There is limited guidance with respect to the threshold to be clean shaven in readiness to wear N95 respirators. METHODS: We performed a cross sectional audit in late August 2021 to observe whether staff had facial hair that could decrease respiratory protection of tight fitting respirators. The audit was conducted in three critical care areas at a major tertiary public hospital in Australia during a period of moderate-to-high community prevalence of COVID-19. All staff observed had previously successfully completed quantitative fit testing with a clean shaven face in the preceding 12 months. RESULTS: 110 consecutive male critical care staff were observed including thirty staff who were required to wear a N95/P2 respirator at the time. Forty - five percent of male staff observed were not clean shaven in the face seal zone of their respirators. CONCLUSIONS: The readiness to wear a tight-fitting respirator and hence the need to be clean shaven, should be guided by both state and local COVID-19 risk ratings, as well as the specific respiratory biohazard risks present in the clinical area at that time. During periods of significant community transmission of COVID-19, critical care clinical staff should be clean shaven, so they are fit-for-purpose and ready to wear a tight fitting respirator at short notice. Respiratory protection preparedness in critical care healthcare workers: An observational audit of facial hair at a major tertiary hospital in Australia.

Separate Lives, Uncertain Futures: Does Covid-19 Align or Differentiate the Lives of Low- and Higher-Wage Young Workers?

With labour markets already polarised in industrialised economies, if Covid-19 worsens this polarity, young people could be more severely affected. This is because their entry into a post-pandemic economy has ramifications for their divergent or convergent career trajectories far into the future. Therefore, on the premise that work life is central to quality of life, this article assesses the effects of low wage and Covid-19 on the psychological outlook of young people in Singapore. We found that Covid-19 did worsen polarisation. On average, higher wage workers telecommuted more and had more work, but low wage young workers bore the brunt of earnings loss and job disruption. Low wage respondents also experienced poorer psychological well-being, even after adverse child experiences, highest educational qualification and occupation type were controlled for. However, higher wage workers might be more psychologically affected by the Covid-19 impacts. This might be because low earning workers are more accustomed to employment instability. These findings suggest the urgency of policy attention to help low wage young workers recover from Covid-19.

Making universal digital access universal: lessons from COVID-19 in Singapore.

Digital resources-which include devices, internet connection and digital literacy-have become basic needs. Thus with the global COVID-19 pandemic having accelerated digitalization, the urgency for universal digital inclusion has hastened. Otherwise, digital inequality will lead to social inequality and impede social mobility. Using Singapore as a case study, this article applies the insights learned from a participatory action research to recommend a policy framework for universal digital access, with practical humanistic steps towards full digital inclusion. Singapore is a digitally advanced nation with almost universal digital availability, yet when COVID-19 forced rapid digital adoption, gaps in access by vulnerable groups such as low-income households, elderly and migrant workers were found. From the learning points on gaps and measures taken by community groups, volunteers and policy-makers in our research, we recommend making access to all three digital resources automatic and affordable, with an undergirding principle to implement technology among the most digitally excluded first before national roll out. A public-community-corporate funding and partnership model is also proposed to sustain universal provision.

A longitudinal study of the psychological impact of the COVID-19 pandemic on frontline perioperative healthcare staff in an Australian tertiary public hospital.

OBJECTIVE: This longitudinal study examined changes in psychological outcomes of perioperative frontline healthcare workers at one of Australia's most COVID-19 affected hospitals, following the surge and decline of a pandemic wave. METHOD: A single-centred longitudinal online survey was conducted between 26 May and 17 November 2020. Recruitment was via poster advertisement and email invitation. The survey was sent out every 4 weeks, resulting in seven time-points. RESULTS: In total, 385 survey results were analysed from 193 staff (about 64% response rate), 72 (37%) of whom completed the survey more than once. The prevalence of moderate-to-severe anxiety and depressive symptoms peaked at 27% and 25%, respectively, during the pandemic surge. Up to 35% displayed post-traumatic stress disorder (PTSD) symptoms. Although not statistically significant, the trend of depressive and PTSD symptoms worsened over time, especially among females and anaesthetic/surgical trainees, despite subsidence of the pandemic curve. Technicians and anaesthetic/scrub nurses were the at-risk groups with worst psychological outcomes. CONCLUSION: We found persistent mental health impacts on frontline perioperative HCWs despite subsidence of the pandemic wave. Further research is needed to determine the extent and trajectory of such impacts with larger sample sizes to determine generalisability to frontline HCWs in general.

Variations in COVID-19 airway management and preparedness among Victorian hospitals

The COVID-19 pandemic presents significant concerns surrounding the risk of transmission to health care workers involved in airway management of patients with suspected or known infection. Limited evidence has been available to guide the preparation of staff, intubation environments, team structure and personal protective equipment. Our study invited Victorian hospitals to complete a survey on their airway management practices and protocols, in order to assess the degree of variability in practice and preparedness. Twenty hospitals responded in September 2020, during Victoria's second wave of COVID-19. Forty percent had dedicated COVID-19 intubation teams, aLL including consultant anaesthetists. Seventy-five percent had negatively pressured dedicated intubation rooms. ALL provided airborne precautions including N95 masks for airway and cardiac arrest management of suspected or confirmed COVID-19 positive patients, with 35 per cent providing N95 mask fit testing and 15 per cent providing powered air purifying respirators or elastomeric respirators. Thirty-five percent provided airborne precautions for cardiac arrest management of patients not suspected to be COVID-19 positive. Significant inter-hospitaL variations were reported in airway management practices, such as preoxygenation, bag-mask ventilation, medications and techniques to minimise aerosoLisation. Although some of this variation was Likely due to individual hospital infrastructure and resource Limitations, it would be ideaL to achieve a more consistent, standardised approach across Victorian hospitals. This study may highlight areas for improvement for some hospitals. These areas for improvement may include consideration of the establishment of COVID-19 intubation teams in at Least major metropolitan hospitals, N95 mask fit testing and the use of airborne precautions for cardiac arrest management during times of increased community prevalence of COVID-19.

The Psychological Experience of Frontline Perioperative Health Care Staff in Responding to COVID-19: Qualitative Study.

BACKGROUND: The rapid spread of the novel coronavirus (COVID-19) has presented immeasurable challenges to health care workers who remain at the frontline of the pandemic. A rapidly evolving body of literature has quantitatively demonstrated significant psychological impacts of the pandemic on health care workers. However, little is known about the lived experience of the pandemic for frontline medical staff. OBJECTIVE: This study aimed to explore the qualitative experience of perioperative staff from a large trauma hospital in Melbourne, Australia. METHODS: Inductive thematic analysis using a critical realist approach was used to analyze data from 9 semistructured interviews. RESULTS: Four key themes were identified. Hospital preparedness related to the perceived readiness of the hospital to respond to the pandemic and encompassed key subthemes around communication of policy changes, team leadership, and resource availability. Perceptions of readiness contributed to the perceived psychological impacts of the pandemic, which were highly varied and ranged from anger to anxiety. A number of coping strategies were identified in response to psychological impacts which incorporated both internal and external coping mechanisms. Finally, adaptation with time reflected change and growth over time, and encompassed all other themes. CONCLUSIONS: While frontline staff and hospitals have rapidly marshalled a response to managing the virus, relatively less consideration was seen regarding staff mental health in our study. Findings highlight the vulnerability of health care workers in response to the pandemic and reinforce the need for a coordinated approach to managing mental health.

Post-operative use of HME filter‑protected open tracheostomy circuit during the COVID-19 pandemic

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. 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. 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. 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.

High levels of psychosocial distress among Australian frontline healthcare workers during the COVID-19 pandemic: a cross-sectional survey.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had a profound and prolonged impact on healthcare services and healthcare workers. AIMS: The Australian COVID-19 Frontline Healthcare Workers Study aimed to investigate the severity and prevalence of mental health issues, as well as the social, workplace and financial disruptions experienced by Australian healthcare workers during the COVID-19 pandemic. METHODS: A nationwide, voluntary, anonymous, single timepoint, online survey was conducted between 27 August and 23 October 2020. Individuals self-identifying as frontline healthcare workers in secondary or primary care were invited to participate. Participants were recruited through health organisations, professional associations or colleges, universities, government contacts and national media. Demographics, home and work situation, health and psychological well-being data were collected. RESULTS: A total of 9518 survey responses were received; of the 9518 participants, 7846 (82.4%) participants reported complete data. With regard to age, 4110 (52.4%) participants were younger than 40 years; 6344 (80.9%) participants were women. Participants were nurses (n=3088, 39.4%), doctors (n=2436, 31.1%), allied health staff (n=1314, 16.7%) or in other roles (n=523, 6.7%). In addition, 1250 (15.9%) participants worked in primary care. Objectively measured mental health symptoms were common: mild to severe anxiety (n=4694, 59.8%), moderate to severe burnout (n=5458, 70.9%) and mild to severe depression (n=4495, 57.3%). Participants were highly resilient (mean (SD)=3.2 (0.66)). Predictors for worse outcomes on all scales included female gender; younger age; pre-existing psychiatric condition; experiencing relationship problems; nursing, allied health or other roles; frontline area; being worried about being blamed by colleagues and working with patients with COVID-19. CONCLUSIONS: The COVID-19 pandemic is associated with significant mental health symptoms in frontline healthcare workers. Crisis preparedness together with policies and practices addressing psychological well-being are needed.

Coping strategies adopted by Australian frontline health workers to address psychological distress during the COVID-19 pandemic.

OBJECTIVES: The Australian COVID-19 Frontline Healthcare Workers Study investigated coping strategies and help-seeking behaviours, and their relationship to mental health symptoms experienced by Australian healthcare workers (HCWs) during the COVID-19 pandemic. METHODS: Australian HCWs were invited to participate a nationwide, voluntary, anonymous, single time-point, online survey between 27th August and 23rd October 2020. Complete responses on demographics, home and work situation, and measures of health and psychological wellbeing were received from 7846 participants. RESULTS: The most commonly reported adaptive coping strategies were maintaining exercise (44.9%) and social connections (31.7%). Over a quarter of HCWs (26.3%) reported increased alcohol use which was associated with a history of poor mental health and worse personal relationships. Few used psychological wellbeing apps or sought professional help; those who did were more likely to be suffering from moderate to severe symptoms of mental illness. People living in Victoria, in regional areas, and those with children at home were significantly less likely to report adaptive coping strategies. CONCLUSIONS: Personal, social, and workplace predictors of coping strategies and help-seeking behaviour during the pandemic were identified. Use of maladaptive coping strategies and low rates of professional help-seeking indicate an urgent need to understand the effectiveness of, and the barriers and enablers of accessing, different coping strategies.

A randomised crossover study to compare the user seal check and quantitative fit test between two types of duckbill N95 particulate respirator masks: The Halyard Fluidshield® N95 and the BSN Medical ProShield® N-95 particulate respirator masks.

N95 particulate respirator masks are currently recommended for all healthcare workers who care for patients with suspected or confirmed coronavirus disease (COVID-19) when performing aerosol-generating procedures. The protection provided by N95 particulate respirator masks is dependent on the filter's efficiency and seal quality. In this prospective randomised crossover study, we conducted the user seal check and the quantitative fit test on two readily available duckbill models of N95 masks, the Halyard Fluidshield® N95 (Halyard, Alpharetta, GA, USA) and the BSN Medical ProShield® N-95 (BSN Medical, Mount Waverley, Victoria) particulate respirator masks. We recruited a total of 96 anaesthetic staff, of whom 26% were of South-East Asian ethnicity. We found that both types of masks provided reasonably high fit test pass rates among our participants and there was no significant difference between the two brands (77% for the Fluidshield and 65% for the ProShield, P = 0.916). Ninety-two percent of the participants could find at least one well-fitted mask among these two types of masks. We also demonstrated that the user seal check had low accuracy and low concordance (kappa coefficient of 0.16 for the Fluidshield and 0.08 for the ProShield) when compared to the quantitative fit test, and hence was not a reliable method to test seal quality.