Surface Contamination of Reusable Respirators and Face Shields During Care of Critically Ill COVID-19 Patients.

BACKGROUND: With the emergence of SARS-CoV-2, healthcare workers (HCW) have relied on reusable personal protective equipment (PPE), including respirators and face shields (FSs). The effectiveness of decontamination procedures outside experimental settings is unclear. We examined the prevalence of surface contamination on reusable PPE used by HCWs at a hospital incorporating daily centralized decontamination and post-use wiping by sampling for common pathogens. METHOD: Samples were collected from HCWs' CleanSpace Halo respirator face masks (FMs) and FSs at the start of shift, immediately after use, and after cleaning with disinfecting wipes. Samples were analyzed for pathogens using the Applied Biosystems™ TaqPath™ COVID-19 Combo Kit and ThermoFisher TaqMan Array Card. Patient charts were reviewed for clinical correlation. FINDINGS: Of the 89 samples, 51 from FMs and 38 from FSs, none tested positive for SARS-CoV-2, despite 58 being obtained from PPE used in the care of patients with COVID-19, many with recent aerosol-generating procedures. Four samples tested positive (4.5%) for Staphylococcus aureus, two each from FMs and FSs. FMs that tested positive were not worn concurrently with FSs that tested positive. The FM and FS samples testing positive were worn in the care of patients without diagnosed S. aureus infection. No FMs tested positive following wipe-based disinfection, but both positive FS samples were found after disinfection wiping. CONCLUSION/APPLICATION TO PRACTICE: Contamination of reusable PPE appears uncommon, especially with SARS-CoV-2, when regular decontamination programs are in place. The rare presence of S. aureus highlights the importance of doffing procedures and hand hygiene by HCW to prevent surface contamination.

Tolerability, user acceptance and preference for a novel reusable respirator among health care workers.

BACKGROUND: The CleanSpace Technology Halo respirator combines a clear face mask and a powered air supply, without belts or hoses. Although providing higher protection than other respirators used in health care, user acceptance of this device has not been assessed with validated tools. METHODS: We surveyed healthcare workers (HCWs) within a US medical system using Halo respirators in 2021. Subjects completed 3 surveys over 8 weeks, which included the Respirator Comfort, Wearing Experience, and Function Instrument (R-COMFI), a validated tool to assess respirator tolerability. The survey included additional questions about user acceptability and respirator preference. Responses were evaluated for change over time and for significant predictors. RESULTS: Of 113 HCWs who completed the initial survey (29% response rate), mean ± SD R-COMFI score was 9.1± 5.1, (scale 0-47, lower = more tolerable) and did not change over time (P = .42). Fewer years in healthcare significantly predicted better R-COMFI score (P = .01). Many users preferred Halo in both usual care (45%-52%) and care of patients with COVID-19 (60%-64%). DISCUSSION: Halo respirators received favorable tolerability scores by HCWs, who often preferred them, especially during care of patients with COVID-19. CONCLUSIONS: Given demand for respirator use in health care, the innovative design provides higher protection than other respirators with a favorable user experience.

Characteristics Associated With Health Care Worker Knowledge and Confidence in Elastomeric Half-Mask Respirator Use.

OBJECTIVE: This study evaluated health care workers' (HCWs') knowledge and confidence in using elastomeric half-mask respirator (EHMR) attributes known to influence usage. METHODS: Health care workers were surveyed regarding their EHMR donning and doffing experience. Respondents were categorized into competency categories based on their scores. Category differences were analyzed using χ 2 and multiple logistic regression. RESULTS: Seventy-two percent showed high levels of EHMR donning and doffing knowledge and confidence (mastery); however, 21% had greater confidence than knowledge (misinformed). Respiratory therapists had greater odds of mastery than other HCWs ( P < 0.05), whereas those working in medical/surgical and pediatric units had greater odds of doubt than other HCWs ( P < 0.01). CONCLUSIONS: Although most HCWs show high knowledge and confidence with EHMR use, strategies to confirm respirator use competency may ensure greater HCWs protection.

Physiological Impacts of Surgical Mask Coverage of Elastomeric Half-mask Respirator Exhalation Valves in Healthcare Workers.

OBJECTIVES: Elastomeric half-mask respirator (EHMR) use in healthcare increased significantly during the COVID-19 pandemic. Concern for potential release of infectious aerosols from EHMR exhalation valves prompted recommendations to cover them with surgical masks (SMs), thereby improving source control. The physiological and subjective effects of wearing a SM over the exhalation valve of an EHMR, however, are unknown. METHODS: Twelve healthy healthcare worker volunteers completed a 30-min series of simulated healthcare-related tasks, including resting, talking, walking, and bending, proning and supinating a weighted manikin, and performing cardiopulmonary resuscitation. This series recurred three times with different mask configurations-SM only, EHMR only, or EHMR with SM covering the exhalation valve. A transcutaneous sensor continuously measured carbon dioxide (tcPCO2), oxygen saturation (SpO2), and heart rate (HR) from each subject. Subjects scored their rates of perceived exertion (RPE) and levels of discomfort after each round. Physiological parameters and subjective scores were analyzed using mixed linear models with a fixed effect for mask type, activity, age, body mass index (BMI), and gender. Analysis also tested for interaction between mask type and activity. RESULTS: Physiological parameters remained within normal ranges for all mask configurations but varied by task. Statistically significant but small decreases in mean tcPCO2 (37.17 versus 37.88 mmHg, P < 0.001) and SpO2 (97.74 versus 97.94%, P < 0.001) were associated with wearing EHMR with SM over the exhalation valve compared with EHMR alone. Mean HR did not differ between these mask configurations. Wearing SM only was associated with lower RPE and level of discomfort compared with EHMR, but these subjective scores did not differ when comparing EHMR with SM to EHMR only. Age, BMI, and gender had no significant effect on any outcomes. CONCLUSIONS: Wearing a SM over an EHMR did not produce clinically significant changes in tcPCO2, SpO2, or HR compared with uncovered EHMR during healthcare-related tasks. Covered EHMR use also did not affect perceived exertion or discomfort compared with uncovered EHMR use. Covering the exhalation valve of an EHMR with a SM for source control purposes can be done safely.

Can extraoral suction units minimize droplet spatter during a simulated dental procedure?

BACKGROUND: Aerosol and droplet production is inherent to dentistry. Potential for COVID-19 spread through aerosols and droplets characterizes dentistry as having a high risk of experiencing viral transmission, with necessity for aerosol and droplet mitigation. METHODS: Simulations of restorative treatment were completed on a dental manikin with a high-speed handpiece and high-volume evacuation suction. Variable experimental conditions with use of an extraoral vacuum suction at different distances from the simulated patient's mouth and different vacuum settings were tested to evaluate extraoral suction ability for droplet reduction. RESULTS: Using the extraoral suction unit during dental procedure simulations reduced droplet spatter at the dentist's eye level, as well as the level of the simulated patient's mouth. When the extraoral suction unit was used at level 10 and 4 inches from the simulated patient's mouth, less spatter was detected. CONCLUSIONS: Extraoral suction units are an effective method of reducing droplet spatter during operative dental procedures and can be useful in helping reduce risk of experiencing COVID-19 spread during dental procedures. PRACTICAL IMPLICATIONS: During the pandemic, dentistry and its aerosol-generating procedures were placed on hold. The process to getting back to patient care is multifactorial, including personal protective equipment, patient screening, and mitigating aerosol spread.

Trends in Moral Injury, Distress, and Resilience Factors among Healthcare Workers at the Beginning of the COVID-19 Pandemic.

The coronavirus severe acute respiratory syndrome (COVID-19) pandemic has placed increased stress on healthcare workers (HCWs). While anxiety and post-traumatic stress have been evaluated in HCWs during previous pandemics, moral injury, a construct historically evaluated in military populations, has not. We hypothesized that the experience of moral injury and psychiatric distress among HCWs would increase over time during the pandemic and vary with resiliency factors. From a convenience sample, we performed an email-based, longitudinal survey of HCWs at a tertiary care hospital between March and July 2020. Surveys measured occupational and resilience factors and psychiatric distress and moral injury, assessed by the Impact of Events Scale-Revised and the Moral Injury Events Scale, respectively. Responses were assessed at baseline, 1-month, and 3-month time points. Moral injury remained stable over three months, while distress declined. A supportive workplace environment was related to lower moral injury whereas a stressful, less supportive environment was associated with increased moral injury. Distress was not affected by any baseline occupational or resiliency factors, though poor sleep at baseline predicted more distress. Overall, our data suggest that attention to improving workplace support and lowering workplace stress may protect HCWs from adverse emotional outcomes.

Self-reported impact of respirator use on health care worker ability to perform patient care.

In a study of 1,152 health care workers surveyed prior to the COVID-19 pandemic, most disagreed that respiratory protective equipment use interferes with patient care but reported that it would affect respirator use compliance if it did. A patient's fear reaction variably influenced self-reported health care worker compliance with respirator use. Strategies to improve protective equipment design may remove potential barriers to respirator use and allow better health care worker-patient relationships.