Association between Invitation Method and Response Rate: Results of a Multi-Centered National Survey of Canadian Picu Families

BACKGROUND AND AIM: National surveys soliciting family experiences present challenges and opportunities. We performed a pan-Canadian, multi-centered, online survey of family experiences with restricted family presence in PICU during COVID-19. Sites chose from 6 respondent approach methods. This sub-study explores relationships between invitation methods and response rates. METHOD(S): Information was collected from the 11 participating sites via e-mail-based survey to determine: eligible participant numbers;invitation method;time from PICU admission to survey invitation;contact methods for bereaved and non-bereaved families;participation barriers and facilitators. Responses were quantified using descriptive statistics and Spearman's rank order correlation. Free texts were inductively coded. RESULT(S): Sites invited families of PICU patients admitted during 4-month periods, beginning March 2020 (n=9) and/or November 2020 (n=3). Invitations were sent a mean (SD) of 7.7 (2.8) months post-admission. The overall survey response rate was 270/1005 invited families (27%). The mean institution response rate was 27% (SD=13%, range 4-50%) and was highest for sites using postal invite with telephone follow-up (43%, n=2), followed by telephone approach (26%, n=7), text message paired with social media posts and posters (22%, n=1), and postal invite alone (n=1, 8%). Bereaved families received a personalized telephone call. Time from admission to invitation was inversely correlated with response rate (rs = -0.70, p=0.02). Most common recruitment barriers were lack of funded research personnel (n=4) and REB requiring initial contact by care team rather than researchers (n=3). CONCLUSION(S): Multi-centre surveys with unfunded site participation face challenges. Postal invitation with telephone follow-up may improve response rates.

A novel pilot program to reduce health inequities: A single center's experience with advocacy in pediatric gastroenterology, hepatology and nutrition

Background: Health advocacy that ?promotes social, economic, educational and political changes that ameliorate suffering and threats to human health? is an essential component of comprehensive medical care. The COVID-19 pandemic highlighted existing structural health inequities for vulnerable and marginalized populations, bringing greater visibility and urgency for providers to actively assess social determinants of health and address barriers to improve health outcomes. We aimed to create a multidisciplinary team within our pediatric gastroenterology, hepatology and nutrition division to provide comprehensive and equitable subspecialty care to all children regardless of race or ethnicity, gender identity, sexual orientation, socioeconomic status, disability, illness, language or country of origin. We organized our center's novel integrative approach to pediatric gastroenterology (GI) and hepatology-related advocacy into four action domains: 1) identify and address social disparities and health inequities;2) improve GI and hepatology programming to increase accessibility to and inclusivity for all patients;3) increase community engagement;and 4) amplify subspecialty related advocacy using innovative social media strategies. Methods: The Stanford University Division of Pediatric Gastroenterology, Hepatology and Nutrition Advocacy Group was established in January 2020 and includes 16 voluntary participants including GI trainees, attending physicians, advanced practice providers, dietitians, social workers and staff. The group relies on active cross collaboration and discussion guided by the founder of the GI advocacy group in partnership with the Associate Chair for Policy & Community Engagement as the department level sponsor. The group participates in one-hour monthly meetings with the first 30 minutes focused on ?think tank? discussions about new and ongoing GI and hepatology advocacy projects. The last 30 minutes includes invited speakers related to a current advocacy project, to provide education on community resources for the diverse patients we serve, or to hone a new skill related to pediatric subspecialty advocacy. Our group communicates between meetings through a designated email listserv and our members share a social media platform (Twitter handle @StanfordPedsGI) to promote division-wide advocacy efforts. Results: The Stanford Pediatric GI Advocacy group has worked to take action on systemic inequities and reduce and eliminate barriers to pediatric healthcare. We will share one example from each of the four action domains. To identify and address social disparities we implemented a universal outpatient social determinants of health screening, adapting the Health Leads' screening toolkit in both English and Spanish. To date we have screened approximately 1,000 patients in clinic. Members of our group helped lead a national workshop for addressing racial bias in pediatric liver transplantation (http://bit.ly/SPLITbiasworkshop), which was sponsored by the Society of Pediatric Liver Transplantation (SPLIT) and attended by leaders in transplant surgery and transplant hepatology across two one-hour sessions. To increase accessibility and inclusivity we created a Spanish language ?COVID Townhall? recording for our liver and intestinal transplant recipients (http://bit.ly/COVIDSpanishtownhall) which has been viewed over 200 times. To increase community engagement we participated in six health-related external service projects providing donations and voluntary assistance to bridge gaps and create connections in our local community. Through these efforts we have collected 30+ pounds of food, 500 children's books to establish GI and hepatology clinic libraries, 200 disposable masks, $500 for a local aquatherapy pool and $600 for aid to families in paying utility bills. Finally, to amplify the need to address these issues we established a group website (http://bit.ly/GIAdvocacy) and launched a Twitter media campaign (https://twitter.com/stanfordpedsgi). The Twitter account has produced 24 tweets with over 30,000 otal impressions, and 1,050 total engagements addressing topics related to child health advocacy in pediatric gastroenterology, hepatology, and nutrition. Conclusion: Over the course of one year, our division demonstrated the feasibility of building a team of GI and hepatology advocates, utilizing the strength of a multidisciplinary collaborative team model to successfully implement short and long-term projects. These projects varied across four domains which contributed to the overall health and wellness of our patients. Child health advocacy is a foundational component of clinical subspecialty practice to ensure equitable care for our pediatric gastroenterology and hepatology patients. Combining the clinical expertise of multiple team members of different disciplines has led to a robust effort to support the well-being and care of our patients.

Decontamination interventions for the reuse of surgical mask personal protective equipment: A systematic review

AIMS & OBJECTIVES: Surgical masks are broadly used as personal protective equipment in a pandemic setting, but little is known regarding decontamination interventions to allow for their reuse. This systematic review sought to evaluate and synthesize data from original research evaluating interventions to decontaminate surgical masks. METHODS: The protocol was registered on PROSPERO (CRD42020178290). We searched MEDLINE, Embase, CENTRAL, Global Health, the WHO COVID-19 database, Google Scholar, DisasterLit, and preprint servers from inception to April 8, 2020. Citation screening was conducted independently in duplicate. Outcomes of interest included mask performance (i.e. filtration efficiency, airflow resistance) and germicidal effects following decontamination. RESULTS: Of 1874 unique citations, 33 full-texts were assessed of which 7 studies were included. One study evaluated mask performance with interventions applied after mask use: dry heat (via rice cooker), autoclave, and three chemical agents (70% ethanol, 100% isopropanol, and 0.5% sodium hypochlorite). Six studies evaluated interventions applied prior to mask use to enhance antimicrobial properties and/or mask performance: nanoparticle emulsions, quaternary ammonium agent, N-halamine, salt film, and a fluorochemical repellent. Heterogeneity of interventions evaluated and outcomes assessed precluded quantitative analysis. Mask performance was best preserved with dry heat decontamination. Good germicidal effects were observed in salt-, N-halamine-, and nanoparticle-coated masks. Safety outcomes were infrequently evaluated. CONCLUSIONS: Limited evidence exists on the safety or efficacy of surgical mask decontamination interventions. Studies to date have evaluated interventions and outcomes using heterogenous and non-standardized test conditions, limiting our ability to compare between interventions or draw conclusions on the most efficacious intervention.

Microwave- and heat-based decontamination of N95 filtering facepiece respirators: a systematic review.

BACKGROUND: In pandemics such as COVID-19, shortages of personal protective equipment are common. One solution may be to decontaminate equipment such as facemasks for reuse. AIM: To collect and synthesize existing information on decontamination of N95 filtering facepiece respirators (FFRs) using microwave and heat-based treatments, with special attention to impacts on mask function (aerosol penetration, airflow resistance), fit, and physical traits. METHODS: A systematic review (PROSPERO CRD42020177036) of literature available from Medline, Embase, Global Health, and other sources was conducted. Records were screened independently by two reviewers, and data was extracted from studies that reported on effects of microwave- or heat-based decontamination on N95 FFR performance, fit, physical traits, and/or reductions in microbial load. FINDINGS: Thirteen studies were included that used dry/moist microwave irradiation, heat, or autoclaving. All treatment types reduced pathogen load by a log10 reduction factor of at least three when applied for sufficient duration (>30 s microwave, >60 min dry heat), with most studies assessing viral pathogens. Mask function (aerosol penetration <5% and airflow resistance <25 mmH2O) was preserved after all treatments except autoclaving. Fit was maintained for most N95 models, though all treatment types caused observable physical damage to at least one model. CONCLUSIONS: Microwave irradiation and heat may be safe and effective viral decontamination options for N95 FFR reuse during critical shortages. The evidence does not support autoclaving or high-heat (>90°C) approaches. Physical degradation may be an issue for certain mask models, and more real-world evidence on fit is needed.

Decontaminating N95 and SN95 masks with ultraviolet germicidal irradiation does not impair mask efficacy and safety.

Inadequate supply of filtering facepiece respirators (FFRs) for healthcare workers during a pandemic such as the novel coronavirus outbreak (SARS-CoV-2) is a serious public health issue. The aim of this study was to synthesize existing data on the effectiveness of ultraviolet germicidal irradiation (UVGI) for N95 FFR decontamination. A systematic review (PROSPERO CRD42020176156) was conducted on UVGI in N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined eligibility and extracted predefined variables. Original research reporting on function, decontamination, or mask fit following UVGI were included. Thirteen studies were identified, comprising 54 UVGI intervention arms and 58 N95 models. FFRs consistently maintained certification standards following UVGI. Aerosol penetration averaged 1.19% (0.70-2.48%) and 1.14% (0.57-2.63%) for control and UVGI arms, respectively. Airflow resistance for the control arms averaged 9.79 mm H2O (7.97-11.70 mm H2O) vs 9.85 mm H2O (8.33-11.44 mm H2O) for UVGI arms. UVGI protocols employing a cumulative dose >20,000 J/m2 resulted in a 2-log reduction in viral load. A >3-log reduction was observed in seven UVGI arms using >40,000 J/m2. Impact of UVGI on fit was evaluated in two studies (16,200; 32,400 J/m2) and no evidence of compromise was found. Our findings suggest that further work in this area (or translation to a clinical setting) should use a cumulative UV-C dose of 40,000 J/m2 or greater, and confirm appropriate mask fit following decontamination.

Efficacy and safety of disinfectants for decontamination of N95 and SN95 filtering facepiece respirators: a systematic review.

BACKGROUND: Decontaminating and reusing filtering facepiece respirators (FFRs) for healthcare workers is a potential solution to address inadequate FFR supply during a global pandemic. AIM: The objective of this review was to synthesize existing data on the effectiveness and safety of using chemical disinfectants to decontaminate N95 FFRs. METHODS: A systematic review was conducted on disinfectants to decontaminate N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined study eligibility and extracted predefined data fields. Original research reporting on N95 FFR function, decontamination, safety, or FFR fit following decontamination with a disinfectant was included. FINDINGS AND CONCLUSION: A single cycle of vaporized hydrogen peroxide (H2O2) successfully removes viral pathogens without affecting airflow resistance or fit, and maintains an initial filter penetration of <5%, with little change in FFR appearance. Residual hydrogen peroxide levels following decontamination were within safe limits. More than one decontamination cycle of vaporized H2O2 may be possible but further information is required on how multiple cycles would affect FFR fit in a real-world setting before the upper limit can be established. Although immersion in liquid H2O2 does not appear to adversely affect FFR function, there is no available data on its ability to remove infectious pathogens from FFRs or its impact on FFR fit. Sodium hypochlorite, ethanol, isopropyl alcohol, and ethylene oxide are not recommended due to safety concerns or negative effects on FFR function.

Decontamination interventions for the reuse of surgical mask personal protective equipment: a systematic review.

BACKGROUND: The high demand for personal protective equipment during the novel coronavirus outbreak has prompted the need to develop strategies to conserve supply. Little is known regarding decontamination interventions to allow for surgical mask reuse. AIM: To identify and synthesize data from original research evaluating interventions to decontaminate surgical masks for the purpose of reuse. METHODS: MEDLINE, Embase, CENTRAL, Global Health, the WHO COVID-19 database, Google Scholar, DisasterLit, preprint servers, and prominent journals from inception to April 8th, 2020, were searched for prospective original research on decontamination interventions for surgical masks. Citation screening was conducted independently in duplicate. Study characteristics, interventions, and outcomes were extracted from included studies by two independent reviewers. Outcomes of interest included impact of decontamination interventions on surgical mask performance and germicidal effects. FINDINGS: Seven studies met eligibility criteria: one evaluated the effects of heat and chemical interventions applied after mask use on mask performance, and six evaluated interventions applied prior to mask use to enhance antimicrobial properties and/or mask performance. Mask performance and germicidal effects were evaluated with heterogeneous test conditions. Safety outcomes were infrequently evaluated. Mask performance was best preserved with dry heat decontamination. Good germicidal effects were observed in salt-, N-halamine-, and nanoparticle-coated masks. CONCLUSION: There is limited evidence on the safety or efficacy of surgical mask decontamination. Given the heterogeneous methods used in studies to date, we are unable to draw conclusions on the most efficacious and safe intervention for decontaminating surgical masks.