ABSTRACT
Background: When the world is running away from everyone with possible COVID disease, healthcare staff wade their way towards such patients. Clad in a protective wear they follow all rules hoping not to carry the germs home. Despite taking all precautions during his shift, if a worker fails to doff the protective equipment properly, he carries significant risks of carrying the germs on his person. This study assesses this risk of self-contamination due to improper doffing of PPEs. Methods: An analytical study involving 154 healthcare staff was conducted. Colourless lotion which glows with a greenish fluorescent hue under uv light was applied on the PPEs to simulate germ contamination. Objectives were to note what percentage of workers have contamination on their person after improper doffing. Which portions of the health care worker gets maximally contaminated after doffing, and to assess infestation of which portion of the PPE causes maximum contamination. Results: 27.92% of healthcare workers were carrying germs on them simply because of improper doffing. Almost 15% of these workers had more than one area of contamination. Commonest areas on the body for carrying these germs were the arms (33%), clothing on the abdomen (24%), areas in the lower limb (23%). Germ infestation on the upper parts of a PPE is 2.39 times more likely to cause contamination after doffing, compared to lower suit area infestation. Conclusion: Improper doffing carries a significant risk of contaminating oneself. Risk of carrying germs home is more when the germs are nested in the upper portions of the suit. Proper and regular training regarding doffing, presence of a doffing mate and post doffing showers could reduce this risk.
ABSTRACT
COVID-19 infection has emerged as a pandemic. This infection is new to the world, and the management strategy is evolving daily. As per the current guidelines, the patients of COVID-19 infection requiring mechanical ventilation should be treated on the lines of management of Acute Respiratory Distress Syndrome (ARDS). However, it seems that the management of ventilation in the case of COVID-19 needs to be modified. With growing experience, many hospitals have turned to Non-invasive Ventilation (NIV) to ward-off severe respiratory failure and in keeping with the inadequate resources. The controversy in using NIV is whether the benefits of using such interventions are more than the potential risks of aerosolisation of the virus. There is a hope that helmet-based ventilation may help reduce the risk of nosocomial infection. Autopsy findings demonstrated that besides ARDS, the alveolar capillaries were clearly thickened, with fibrin thrombi within the capillaries and small vessels and surrounding oedema present in COVID-19 affected lungs. This virus attacks the beta chain of haemoglobin, dissociates heme, removing iron converting it to porphyrin. The cause of desaturation is the failure of the blood to carry oxygen leading to multiorgan failure and mortality. The cause of lung damage seen on Computerised Tomography (CT) scans is the release of oxidative iron, which in turn overcomes the natural defenses against pulmonary oxidative stress and causes what is known as the Cytokine Storm. The question is whether mechanical ventilation is harming the patient by traumatising their lungs leading to increased mortality. Prone ventilation is the next preferred step for COVID-19 patients who fail to achieve adequate oxygenation with low tidal volume ventilation. Hyperbaric oxygen therapy can help the leftover functioning haemoglobin to carry more oxygen. Blood transfusion and plasmapheresis provide symptomatic relief. Thrombolytic therapy is also being tried with some benefits. These may be promising in treating patients with COVID-19 infection. Researches are required on the other probability and to test newly emerging treatment modalities.