Resource Utilization in a Post-pandemic World

Extracorporeal Membrane Oxygenation is a resource intensive therapy;heavily reliant upon specialized equipment, unique disposables, and skilled staff. The Covid-19 pandemic and following events exposed flaws in multiple phases of the care delivery system. The combination of high patient census, acuity, manufacturing delays, and supply chain disruptions led to our center's reassessment of the way in which limited resources are utilized. As a combined pediatric and adult center, we possess the ability to share resources amongst all patient populations. Currently, the majority of our equipment and disposables support a heavier use of Centrimag. We adjusted our general weight guidelines in order to best serve the most patients. (<8kg Sorin Rollerhead, 8-20kg Sorin Revolution, >20kg Centrimag.) Presently, a major challenge is the cessation of production of the -inch Better Bladder. The ECMO Coordinator team collaborated with key physician stakeholders. It was decided that the fluid reservoir and air trap benefits of a bladder outweighed the risks of running without one on our Sorin Rollerhead circuit. We designed a circuit with a 3/8 Bigger Better Bladder. Recognizing the increased risk of clotting with the 3/8 segment, we added a post-oxygenator shunt. This allows for adequate blood flow to maintain circuit integrity, while limiting the amount of flow to the patient. The nationwide nursing shortage is well-known. Though our multidisciplinary ECMO Specialist Team supports nursing and respiratory therapy, the nursing shortage still impacts our staffing models, resulting in the inability to safely staff bedside nurses and ECMO specialists. At times of high census, ECMO patients are cohorted into one geographical location. This allows for a temporary 2:1 staffing model for Centrimag patients. Our goal remains to staff pediatric cases as a 1:1 ECMO Specialist assignment. The ability to obtain this is assessed shift to shift;factoring patient stability, experience of the ECMO specialist, and unit staffing. The collaboration with ICU Nurse Managers, Hospital Supervisors and Central Staffing Office is imperative to the success of staffing model alterations. Our ECMO department has increased its FTEs, implementing a core team to be preassigned to two ECMO beds. The objective is to alleviate the burden on ICU staffing, limiting the number of nurses pulled from staffing grids. In uncertain times, flexibility is vital. It is important to remain vigilant and proactive. Our ECMO program feels that continuous assessment of supplies, equipment, and open communication has been the key to successfully serving our patients.

Allergic contact dermatitis to the elastic bands of an N95 mask

Case report Introduction: In the wake of the COVID-19 pandemic, occupational contact dermatitis related to the use of personal protective equipment (PPE) has become increasingly prevalent. While most cases are irritant in nature, allergic contact dermatitis (ACD) remains an important cause of occupational dermatitis. We report a case of ACD to rubber accelerators in the elastic bands of an N95 mask. Informed consent was obtained from the patient for this report. Case Report: A 27-year-old healthcare worker presented with a progressive pruritic eruption over her face and neck, 1 week after she began wearing N95 masks at work. She had only worn disposable surgical masks. She had no medical history apart from hand dermatitis, which was well controlled with topical medications. Examination revealed linear eczematous plaques along her lateral cheeks and posterior neck, corresponding to contact areas between the mask bands and her skin. Patch tests revealed a positive reaction to several rubber accelerators, including Thimerosal, 2-Mercaptobenzothiazole (MBT), and Methylisothiazolinone. We performed another patch test to several N95 mask straps, to which the patient developed an eczematous reaction to the elastic bands of 2 N95 mask types with elastic bands. Clarification with the manufacturer confirmed the use of rubber accelerators similar in properties to MBT in the production of these masks. A diagnosis of allergic contact dermatitis to rubber accelerator was made. The patient's dermatitis resolved with topical corticosteroids and the avoidance of N95 masks with elastic bands. Discussion and Conclusion(s): The use of facial PPE such as masks is a recognised cause of occupational dermatitis among healthcare workers. A variety of dermatoses are associated with the use of facial PPE, with contact dermatitis being the most common. However, while the majority of contact dermatitis are irritant in nature, ACD remains an important and preventable cause of occupational dermatitis. Commonly implicated allergens associated with mask use include preservatives and adhesives used in their production, as well as metals in the nose clip. Although less common, mask elastic bands have also been reported to be a potential source of ACD, with rubber accelerators being identified as potential allergens. However, there is often a lack of declaration of such chemicals used in the production of PPE. Given the need for continued use in the occupational setting, early identification and avoidance of allergens are key. Failure to do so may result in the progression of skin lesions, ultimately affecting the patients' quality of life and work performance. With the ubiquitous use of masks in the current climate, we wish to highlight the need for greater awareness of rubber accelerators as potential allergens, and their presence in the elastic bands of frequently used PPE.

CPAP therapy and the COVID pandemic

Introduction: Continuous positive airway pressure (CPAP) is an aerosol-generating procedure with increased potential to transmit COVID-19 during use. Our health service was located at the epicentre of the COVID-19 outbreak in Melbourne, Australia, placing our patients and staff at high risk of nosocomial COVID-19 infection. We describe our experience with a modified CPAP circuit utilising non vented masks and high efficiency microbial filters to reduce viral transmission in patients potentially infected with COVID-19. Method(s): Retrospective analysis of medical records and polysomnography (PSG) reports of 82 inpatients who used CPAP during admission, and 72 patients who underwent CPAP in-lab PSG with our modified circuit. This consisted of a non vented mask, 2 high efficiency microbial filters, an oxygen port (placed distal to a filter) for expiration, and ancillary equipment such as disposable tubing. Result(s): The mean age amongst inpatients (45 males/37 females) was 65.9 +/- 11.6 years. Equipment issues occurred in 28/82 patients. 9 patients (10.9%) chose not to use PAP therapy, 10 patients (12.2%) experienced excessive mask leak and 6 patients (7.3%) experienced discomfort. 7 patients (8.5%) were discharged before the circuit could be unmodified. The majority of issues occurred on non-respiratory wards. The mean age of in-lab PSG patients (48 males/24 females) was 51.3 +/- 13.6 years. 24 CPAP implementation, 31 CPAP treatment review and 17 split-night studies were included. Circuit modification did not impact the study conclusion in the majority (97.2%). Mask leak (13.9%) and patient discomfort (8.3%) were common. Conclusion(s): Our modified circuit was safe and well tolerated in the majority and did not significantly affect the outcome of in-lab CPAP studies.

Compliance with World Health Organization's COVID-19 guidelines among Iraqi health workers

During the COVID-19 pandemic, the World Health Organization (WHO) introduced guidelines with respect to hygiene practices, quarantine policies, and medical practices for health institutions to follow. Most studies examining compliance with WHO guidelines have been conducted at individual level but not at institutional level. This study investigates the availability of resources of health institutions in Iraq and their compliance with WHO COVID-19 guidelines. A total of 234 health workers, including physicians, nurses and medical technicians, were recruited in Babylon, Iraq. Self-reported number of health workers available in the health centre and the levels of compliance with the WHO's guidelines were assessed. Implementation of preventive measures for infected persons, fogging procedures, and having a crisis management team in the health centre were the top three common practices as recommended by WHO. There was a weak but significant positive relationship between the number of health workers in the healthcare centre and the levels of compliance with the WHO's COVID-19 guidelines (rho = 0.243, p < 0.05), indicating that manpower may determine the implementation of these guidelines. There is a correlation between the quantity of health workers and the levels of compliance with the WHO's COVID-19 guidelines, showing that it is important to ensure sufficient human resources available in the health centre to implement the standard practices. In addition, more financial resources are needed to provide sufficient protective equipment and disposable supplies to health workers in Iraq.Copyright © 2023 The Authors. World Medical & Health Policy published by Wiley Periodicals LLC on behalf of Policy Studies Organization.

Pharmacists' Roles and Practices in Pharmaceutical Services During Covid-19 Pandemic: A Qualitative Study

The World Health Organization (WHO) declared COVID-19 a global pandemic on March 11, 2020. Pharmacists as health workers also play an important role in this pandemic. This study aims to dig deeper into how pharmacists perceive their role and pharmaceutical services during this pandemic through a qualitative study with Focus Group Discussions (FGDs). Fifteen pharmacists from The Riau Islands Province were involved in the study based on a purposive sampling technique. They were purposively selected to include a wide range of pharmacists from the community pharmacies, hospitals, and community health centers. The FGDs were conducted via recorded Zoom meetings. The collected data were then transcribed and analyzed with inductive content analysis. This study found five themes with 18 sub-themes. The five themes were the roles and efforts of pharmacists in managing medicines, medical devices, and disposable medical materials (personal protective equipment);the roles of pharmacists in providing pharmaceutical care;community behaviors during the pandemic;development of pharmacists' roles and capacity during the pandemic;and external factors influencing the roles and practice of pharmacists during the pandemic. During the pandemic, pharmacists continued to work according to their previous roles and adjusted their roles and practice in pharmaceutical services to follow changes in community behaviors. This condition also encouraged pharmacists to develop their roles and capacities. The healthcare management team, the government, and the professional organizations influenced their roles, both positively and negatively. The results of this study provide a deeper understanding of pharmacist roles and practices during the pandemic. This understanding will be useful for the pharmacist in developing their potential and capability to be involved as healthcare professionals, specifically during the pandemic situation and generally in disaster management.Copyright © 2022 by Indonesian Journal of Pharmacy (IJP).

SARS-CoV-2 RNA in exhaled air of hospitalized COVID-19 patients

Knowledge about contagiousness is key to accurate management of hospitalized COVID-19 patients. Epidemiological studies suggest that in addition to transmission through droplets, aerogenic SARS-CoV-2 transmission contributes to the spread of infection. However, the presence of virus in exhaled air has not yet been sufficiently demonstrated. In pandemic situations low-tech disposable and user-friendly bedside devices are required, while commercially available samplers are unsuitable for application in patients with respiratory distress. We included 49 hospitalized COVID-19 patients and used a disposable modular breath sampler to measure SARS-CoV-2 RNA load in exhaled air samples and compared these SARS-CoV-2 RNA load of combined nasopharyngeal throat swabs and saliva. Exhaled air sampling using the modular breath sampler has proven to be feasible in a clinical COVID-19 setting and demonstrated viral detection in 25% of the patients (Figure 1).

Protective Role of Wearing a Mask in a Preschool

Undoubtedly, children in preschool are at high risk for COVID-19 as they have not been vaccinated, do not wear masks properly, and do not provide good hand hygiene. This study presents a girl who was not infected with SARS-CoV-2 as she wore a mask properly during the COVID-19 outbreak in her school. In January 2022, a child whose mother was reported to be positive for COVID-19 was found to have a positive SARS-CoV-2 test. It was reported that the positive child had been going to school for the last three days and did not wear a mask during this time. He did not have any symptoms. Due to close contact with the infected case, SARS-CoV-2 RT-qPCR (BioSpeedy SARS-CoV-2 kit, Bioeksen Inc., Ístanbul, Türkiye) test was performed on all children. The school was immediately closed. All children and teachers working at the school were isolated at home for seven days. On the second and third days of the quarantine, 50% of the kindergarten (eight students and one teacher) tested positive for SARS-CoV-2 RT-qPCR. It was noted that the teacher had three doses with Comirnaty (formerly BioNTech, Pfizer) (BNT 162b2) (BioNTech, Fosun Pharma, Pfizer, NY, USA) and did not wear a mask in those days. In the five-year-old class, only the SARS-CoV-2 RT-qPCR tests of a girl who wore the mask appropriately and a boy who had a previous COVID-19 were negative. The tests of these children did not turn out to be positive until the end of the quarantine. In the COVID-19 outbreak that started in a kindergarten classroom, a five-year-old unvaccinated girl wearing her disposable mask properly was protected against COVID-19 and prevented the virus from spreading to her family.

An investigation into the aging of disposable face masks in landfill leachate

Due to the excessive use of disposable face masks during the COVID-19 pandemic, their accumulation has posed a great threat to the environment. In this study, we explored the fate of masks after being disposed in landfill. We simulated the possible process that masks would experience, including the exposure to sunlight before being covered and the contact with landfill leachate. After exposure to UV radiation, all three mask layers exhibited abrasions and fractures on the surface and became unstable with the increased UV radiation duration showed aging process. The alterations in chemical groups of masks as well as the lower mechanical strength of masks after UV weathering were detected to prove the happened aging process. Then it was found that the aging of masks in landfill leachate was further accelerated compared to these processes occurring in deionized water. Furthermore, the carbonyl index and isotacticity of the mask samples after aging for 30 days in leachate were higher than those of pristine materials, especially for those endured longer UV radiation. Similarly, the weight and tensile strength of the aged masks were also found lower than the original samples. Masks were likely to release more microparticles and high concentration of metal elements into leachate than deionized water after UV radiation and aging. After being exposed to UV radiation for 48 h, the concentration of released particles in leachate was 39.45 muL/L after 1 day and then grew to 309.45 muL/L after 30 days of aging. Seven elements (Al, Cr, Cu, Zn, Cd, Sb and Pb) were detected in leachate and the concentration of this metal elements increased with the longer aging time. The findings of this study can advance our understanding of the fate of disposable masks in the landfill and develop the strategy to address this challenge in waste management. Copyright © 2023 Elsevier B.V.

Using rain ponchos against viruses-Specialised outpatient palliative care (SAPV) during the Covid-19 pandemic

Introduction: On 27.01.2020 the first case of Covid-19 infection in Germany was described, on 11.3.2020 the worldwide spread of Covid-19 was declared a pandemic. The risk group includes people with comorbidities and weakened immune systems, which means that palliative patients belong to this risk group. Approximately 10% of this patient group is cared for by an SAPV in addition to their primary care. Especially at the beginning of the coronary crisis, the care of palliative patients by family doctors and nursing services was ofen massively complicated or reduced due to overwork, tightened isolation measures or an occurred Covid-19 infection. In addition, the current legal situation made access to nursing homes more difcult. SAPV had to ensure the protection not only of patients but also of its employees, since COVID-19 infections within the SAPV team would have led to considerable gaps in care. At the beginning of the pandemic, protective equipment was patchily available. The example of an SAPV is used to illustrate the restructuring and measures taken to maintain palliative care: Methods: Separation of persons: SAPV trips are carried out alone (doctor/nurse), no personal contact with the coordinators or among the team members, instead more telephone contact and video conferences Contact with hospices/nursing homes/patients mainly through video consultation Protective measures: initially all SAPV visits with surgical face masks, in case of suspected corona FFP-2 mask, in the course of the pandemic: all visits with FFP-2 mask. In case of suspected corona: at the beginning of the pandemic, disposable rain ponchos, later again available protective gowns/glasses Telephone corona screening by coordinator upon patient admission Directly before visiting the patient: renewed telephone corona screening by doctor/nurse on the basis of a given list of questions At each visit: reduce contact with relatives, keep distance rule as far as possible, reduce visiting time, shif detailed discussions to video consultation Providing a room within the SAPV ofces for video conferences 8.Equipping the SAPV cars with protective clothing, disinfectant Results: So far no Covid-19 infection among the team members, full maintenance of SAPV care. Conclusion(s): Even in times of crisis, rapid and sometimes innovative structural changes can maintain continuous outpatient care for palliative patients.

The efficacy of hemoadsorption for severe Multisystem Inflammatory Syndrome in children (MIS-C): a case series

Background: In the COVID-19 pandemic, children with COVID-19 infection have mild symptoms. However, some children may develop a hyperinflammatory response called multisystem inflammatory syndrome in children (MIS-C) after the COVID-19 infection. The main pathophysiology of this syndrome is mainly dysregulated inflammatory response lead to multi-organ dysfunction especially cardiovascular system. Despite early treatment with IVIG and corticosteroid, some children with MIS-C are still refractory disease and progressive symptoms. Additional from biologic agent, we try to find the treatment options as adjunctive treatment for rapid removing the inflammatory mediators. Blood purification by hemoadsorption may be a good choice for improve this clinical symptoms. Method(s): Five critically ill children with severe MIS-C who received initiated treatment with IVIG and corticosteroid, all children were received an extracorporeal blood purification by using HA330 disposable hemoperfusion cartridge (HA330;Jafron, Zhuhai City, China) combined with a continuous renal replacement therapy (CRRT) machine. Hemoadsorption (HA) will be performed for a maximum of 4 hours, and the second session will be started approximately 12-24 hours after the end of the first session. We observed the reduction of the PELOD-2 and PRISM-3 score compared between baseline and 72 hours after HA treatment. The reduction of VIS and inflammatory markers such as IL-6, procalcitonin (PCT), high sensitivity C-reactive protein (hs-CRP), lactate levels at 72 hours will be recorded. Result(s): This small case series, a total of 5 children who diagnosed with MIS-C were compared the severity score before and after HA treatment. The average PELOD-2 score decreased significantly from 9.0 (IQR;7.0-10.0) at baseline to 2.0 (IQR;0-7.0) at 72 hours (p = 0.04). The median PRISM-3 score also decreased significantly from 15.0 (IQR;15.0-18.0) at baseline to 2.0 (IQR;0-8.0) at 72 hours (p = 0.04). The median VIS decreased from 20.0 (IQR;20.0-52.0) at baseline to 7.0 (IQR;3.0-7.0) at 72 hours but no statistically significant in reduction. Similar to VIS, there were no statistically difference in other inflammatory markers such as IL-6, PCT, hs- CRP and lactate levels at 72 hours. Conclusion(s): MIS-C is rare and may have a serious complications especially cardiovascular dysfunction. Early initiated treatment with IVIG and corticosteroid may have a favorable outcome. In the severe MIS-C and refractory disease, using HA330 may be a good option and safe for adjunctive treatment with IVIG and corticosteroid for rapid improvement in organ dysfunction and mortality score in context of rapid reduction of the inflammatory cytokines.

Implementation of Hydrogen Peroxide Vapor (HPV) Decontamination of N95 Respirators for Reuse During COVID-19 Pandemic

Background. To ensure an adequate supply of N95 respirators in response to the global shortages caused by the COVID-19 pandemic, we evaluated and implemented hydrogen peroxide vapor (HPV) to reprocess disposable N95 respirators. Previous work performed by our team showed that HPV was effective in eradicating viable viruses from experimentally contaminated N95 respirators and that they retained their breathability and filtering efficiency for 3 cycles of HPV disinfection. Methods. A multidisciplinary team worked by performing experiments and PDSA cycles to develop the ultimate process. Key processes and stakeholders were identified and engaged in operations decisions. Results. The respirator reprocessing program was successfully implemented. One of the critical components for its success was the implementation of a Personal Protective Equipment (PPE) liaison program which was developed to create a process and local, unit-level champion for the collection of used N95s and to educate the staff on the program and provide guidance per the hospitals' PPE policy. A courier system was implemented for the collection, transport and delivery of bulk containers of respirators between facilities. Facility Services designed and constructed a centralized respirator reprocessing center to include a receiving location, a negative pressure decontamination area to sort and stage the respirators on racks, two HPV reprocessing rooms and a clean room to receive the reprocessed N95s and to repackage and label for distribution. Standard operating procedures, staff training and competencies, and logs for documentation were created. Within 18 weeks (March 13, 2020 through July 2020), nearly 32,000 N95 respirators were reprocessed and packaged for redistribution utilizing the 2 HPV disinfection rooms and 5 full time employees. As built, there was capacity to reprocess 5,000 respirators per day and evaluated by the U. S. Food and Drug Administration (FDA) led to the issue of an Emergency Use Authorization. Conclusion. This scalable program enabled YNHHS to ensure an adequate supply of respirators for the safety of staff during the COVID-19 pandemic and global shortages of PPE. A multidisciplinary team and leadership commitment to provide resources for space and personnel were critical for program success.

Breath Sample Collection from Individuals Infected with SARS-CoV-2: Biosafety Methodology

Background. Breath samples collected from patients infected with respiratory viruses are necessary for viral detection using breath analyzer devices. Given the highly transmissible nature of many of these illnesses, sample collection requires a multilayered approach to ensure the safety of the research staff responsible for obtaining and transporting these samples. Our team established a protocol to minimize exposure to and transmission of COVID-19 when collecting breath samples. Methods. We collected breath samples from 64 participants, of which 31 (48.4%) were positive for SARS-CoV-2 at the time of their visit. Before we started sample collection, biosafety inspection was conducted. We used a five-pronged approach to enhance safety and minimize transmission. First, we collected specimens in an outdoor space while the patients were seated in their vehicles. Second, we used a disposable mouthpiece and a one-way valve tofill a 1L TEDLAR bag. Third, patients were instructed to close the valve tightly before returning it to the staff. Fourth, we placed the bag in secondary containers which were placed in tertiary containers to minimize any contact with aerosols in the TEDLAR bag. In the last step, we placed a portable HEPAfilter near the indoor sample processing unit to minimize exposure and air contamination with the samples. Study staff donned all forms of necessary personal protective equipment, including gloves, gowns, N95 respirators, and protective eyewear, during sample collection and transportation. Results. A total of 64 breath samples were collected from 64 adult participants from February to March 2022. A total of 30 participants (46.9%) were within 7 days of their initial diagnosis. All participants were able to successfully collect samples without additional resources or attempts. All samples were able to be transported successfully into the lab. No staff contracted COVID-19 during the study period. Conclusion. Layered safety measures, including protective equipment, physical barriers, and well-ventilated environments mitigated the risks associated with breath sample collections from infected participants.

Drug Delivery Device Trends for 2022

In this article, Tom Oakley, Director of Drug Delivery Device Development, Springboard, looks at some of the current trends in the drug delivery industry and projects some of the key factors that will influence drug delivery decision making in 2022. Copyright © 2022, Frederick Furness Publishing. All rights reserved.

Evaluating the Feasibility and Usability of the Disposable Intubation Drape (I-Drape)

In response to the COVID-19 pandemic, several protective barrier enclosures were developed to protect healthcare providers during airway manipulation. A certified registered nurse anesthetist (CRNA) created a barrier, the disposable intubation drape (I-Drape), that addressed limitations in range of motion. A nonrandomized, quasi-experimental design with repeated measures was used to evaluate I-Drape usability. CRNAs implemented I-Drape up to three times. Multilevel modeling was used to analyze the primary outcome: time (in seconds) to successful intubation. An online survey was used to evaluate secondary outcomes of interest: users' perceptions of features such as usability, visibility, and durability. We recruited 23 CRNAs as participants for 59 trials. Overall successful intubation and first-pass success rates were 96.6% and 93.2%, respectively. Time to successful intubation did not significantly decrease (β = -9.6, P = 0.323) or differ significantly among types of laryngoscopy device and years of experience was not a significant factor. Overall, users favorably rated I-Drape with respect to usability, visibility, durability, and feature utility. This study demonstrated the functionality, success rate, and acceptability of I-Drape. I-Drape can be used safely and efficiently with any type of laryngoscopy device by providers with various experience levels.

Evaluation Of The Results Of The Study Of Dental Indices In Patients With Covid-19 And Healthy Individuals Who Have Not Undergone Covid-19

The so-called coronavirus disease 2019 (COVID-19) has a higher severity and mortality in the elderly, in patients with comorbidities such as hypertension and diabetes, and in people with reduced immune activity [1, 2, 3, 4, 5]. In addition to being a serious threat to public health, the pandemic has also affected social life and the global economy. Research aimed to study clinical assessments of the results of the KPU, GI, and RMA indices in patients with COVID-19 and healthy individuals who did not undergo COVID-19. To achieve the goals and objectives of the study, 118 patients were examined, 22 of whom were healthy individuals who did not have COVID-19 from the city of Tashkent and were examined at the Institute of Allergology and Human Immunology of the Academy of the Republic of Uzbekistan. 96 patients from the Tashkent region were examined at the specialized Zangiota Hospital No. 2, intended for the treatment of patients with COVID-19. The examined patients were divided into 3 groups depending on the severity of COVID-19: group 1 (moderate COVID-19), n = 53;group 2 (severe COVID-19), n = 43;and group 3 (control), n = 22 healthy individuals. The examination was carried out with disposable kits for each patient. As can be seen from Table 1, the KPU index was the highest in group 2 of patients aged 61-70 years (24+/-0.41) with severe COVID-19. In the control group and in group 1 with a moderate degree of COVID-19 at the age of 61-70 years, this indicator was the same (20+/-1.93) and (20+/-0.00). Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Worn Face Mask Testing to Diagnose SARS-CoV-2 Infection in Hemodialysis Patients

Background: Hemodialysis (HD) patients are at increased risk for COVID-19 infection, hospitalization, and mortality. Early COVID-19 diagnosis is thus critical to mitigate SARS-CoV-2 spread and improving patients' health outcomes. Generally, nasopharyngeal (NP) specimens are considered the most sensitive biological samples to diagnose SARS-CoV-2 infections. However, NP swabbing is considered uncomfortable by most patients, and it requires health professionals, thus impacting its cost-effectiveness. In a previous proof-of-principle study, we demonstrated that face masks worn by in-center HD patients can harbor SARS-CoV-2. In this Kidney-X funded study, we determined efficiency of face mask testing by comparing results to saliva specimen collected from same individuals. Method(s): Disposable 3-layer masks were provided to each subject at the time of entering the dialysis center. Masks were collected 4 hours after worn. Saliva was collected using Salivette kit at the time of mask collection. RT-PCR based testing were performed using Thermo Fisher COVID-19 Combo Kit (A47814). Result(s): We collected 179 pairs of saliva/masks, 114 from 42 dialysis staff and patients without recent COVID-19 infection (control group), and 65 from 30 HD patients with COVID-19, diagnosed by NP RT-PCR (COVID-19 group). Patients provided 1 to 7 sample pairs on average 11+/-8 days (0 to 36) after COVID-19 diagnosis. Thirty-one of the 65 sample pairs were SARS-CoV-2 positive either in the saliva or the mask samples (26 positive saliva;20 positive masks). Saliva and mask testing sensitivities were 84% and 65% with a mean cycle threshold (CT) of 31.8 and 32.2, respectively. Fifteen pairs tested positive for both worn masks and saliva. Mask and saliva CT values did not differ significantly. Of note, in 5 sample pairs saliva tested negative while masks tested positive. In the control group, all 114 saliva samples tested negative;one mask tested weakly positive, resulting in saliva and mask testing specificities of 100% and 99%, respectively. S gene dropout was observed in all positive samples, indicating Omicron BA.1 infection. Conclusion(s): While the sensitivity of mask testing is less compared to saliva testing, its operational ease, lack of patient discomfort, seamless repeatability, and lower costs make it a viable option for SARS-CoV-2 screening.

Single-Use Disposable Flexible Cystoscopes: Implementation in a Mobile Bedside Portable Cystoscopy Service

Introduction &Objective: Single-use disposable cystoscopes have recently been introduced, with portable smaller screens and good quality images. Within our institution, emergency cystoscopy was mainly done in the emergency operating theatre with reusable cystoscopes. We report our experience in developing a mobile bedside portable cystoscopy service with use of single-use disposable cystoscopes. Method(s): With the increase in COVID-19 admissions and unwell patients in isolation, to decrease patient transfers, exposure risks, reduce inpatient admissions and bed occupancy, we introduced the single use portable bedside cystoscopy service in our department. The Ambu aScopeTM 4 Cysto single-use disposable flexible cystoscope paired with a small portable viewing screen was used. From 24th September 2021 to 22nd Feb 2022, we deployed 17 cystoscopes, with 16 in the emergency setting. With the scope, we had a portable accessory kit, with an inventory of adjunct equipment including guidewires and urethral dilators. We also developed a standardised workflow to activate the service. We retrospectively review our series. Result(s): A total of 17 cystoscopes were deployed in this 5-month period. Location wise, 7 (41%) were in the emergency department, 3 (18%) in COVID-19 isolation ward and intensive care unit, 1 (6%) in high dependency, 5 (29%) in general ward, and 1 (6%) in the angiography suite. 6 patients (35%) had challenges for transfer out of the ward due to infectious isolation or clinical status. Indications included difficult urethral catheter insertion (n = 14, 82%), urethral evaluation in trauma (n = 1, 6%), urethral catheter malfunction (n = 1, 6%) and ureteric catheterisation before renal tumour ablation (n = 1, 6%). Adjunctive procedures performed with cystoscopy included: indwelling urethral catheter insertion (n = 10, 59%), urethral dilatation with indwelling catheter insertion (n = 5, 29%), suprapubic catheter insertion (n = 1, 6%) and ureteric catheterisation (n = 1, 6%). No immediate complications were noted. 3 emergency department patients were discharged from the emergency department directly after cystoscopy, saving an inpatient bed and inpatient stay costs. Conclusion(s): The advent of single-use disposable flexible cystoscopes and its utilisation in a portable cystoscopy service has allowed us to bring cystoscopy in a compact mobile manner to the bedside of patients including those who emergently need cystoscopy, reducing need for patient transfer, inpatient stay, operating theatre usage and operating theatre nurse manpower, avoiding arrangements for emergency operating theatre.

Trends in Cosmetic Facial Plastic Surgery: Post-COVID-19 Pandemic

Introduction: With the relaxation of pandemic-related operative restrictions, there has been an increase in elective facial plastic surgical cases in comparison with 2018, prior to the COVID-19 pandemic. The objective of this study is to compare the surgical volume of pre-COVID-19 pandemic cosmetic facial plastic surgery (FPS) in 2018 with the postpandemic volume in 2021, in both a tertiary care academic practice and community practice. Method(s): This is a retrospective chart review of adult patients undergoing cosmetic FPS at an academic tertiary care center and community practice: Louisiana State University Health Shreveport (LSU) and Kenneth Sanders Facial Plastic Surgery in Louisiana, respectively. Information assessed included demographics, surgical date, and surgical procedure performed during the first 6 months of 2018 and 2021. Categorical variables were compared using 2-proportion z test and Pearson chi2 test. Odds ratio (OR) was used to calculate the likelihood of procedural year predicting subsequent FPS. Result(s): One hundred thirty-nine patients were identified: 58 (41.7%) patients in 2018 and 81 (58.3%) patients in 2021. The number of patients having FPS in the <30-year-old age group increased by 13.6% from 2018 to 2021 (P=.02). The number of septorhinoplasties increased by 20.5% from 2018 to 2021 (P=.01). Furthermore, the odds of one having a septorhinoplasty in 2021 increased 144% compared with 2018 (OR: 2.44 [95% CI, 1.19, 5.11]). The only cosmetic surgery to significantly decrease in volume during the postpandemic time period was rhytidectomy (OR: 0.33 [95% CI, 0.12, 0.82]). Conclusion(s): The COVID-19 pandemic has seen a significant rise in FPS in patients younger than 30 years and those electing to have septorhinoplasty. The etiology of this increase is not clear;however, possible explanations include the following: increased disposable income, "Zoom dysmorphia," and the ability for conspicuous recovery behind a mask.

ADJUNCTIVE USE OF DISPOSABLE 1.1-MM CRYOPROBE WITH ROBOTIC-ASSISTED BRONCHOSCOPY

SESSION TITLE: Tales in Bronchoscopy SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Peripheral pulmonary nodule biopsy can be challenging based on its location and size. Robotic bronchoscopy is augmenting peripheral navigation, allowing for approximation of peripheral nodules. The diagnostic yield is variable and is primarily dependent upon operator experience, selection of biopsy equipment and nodule texture. Hard pulmonary nodules are difficult to biopsy with a needle, brush and forceps. We report a case of utilizing combined disposable 1.1 mm cryoprobe and robotic bronchoscopy to diagnose a right lower lobe nodule. CASE PRESENTATION: A 83-year-old woman with a remote history of non-Hodgkin's lymphoma presented with dyspnea and fatigue. 18F-FDG PET/CT revealed a 2.7 cm hypermetabolic nodule with central photopenia in the right lower lobe (RLL) along with patchy bilateral ground-glass opacities related to COVID-19 infection. After a few weeks, robotic navigation was used for approximation of the RLL superior segment nodule. Under fluoroscopic and radial guidance with circumferential signal, 6 forcep biopsies and 5 fine needle aspirations with 21-gauge needle yielded a non-diagnostic sample. A decision was made to utilize a 1.1 mm disposable cryoprobe, which was inserted through the opening made by the forceps into the target lesion. Six cryo biopsies were obtained with 4-6 seconds freeze time. Minimal bleeding was encountered and no pneumothorax occurred. Histopathological examination revealed necrotizing granulomatous inflammation. DISCUSSION: To the best of our knowledge, this is the first reported case of combination 1.1 mm disposable cryoprobe biopsy with robotic bronchoscopy. Interventional pulmonologists are primarily using cryo probe for mechanical tumor debulking and peripheral lung biopsy for diagnosis of interstitial lung disease. The use of a 1.1 mm cryoprobe under robotic guidance allows for well-preserved tissue samples and possibly boosting diagnostic yield. The advantage of the 1.1 mm cryoprobe lies with its size and excellent flexibility. The robotic platform also corrects for any unwanted deflection. One limitation of using a flexible cryoprobe is its blunt tip, requiring an additional step in gaining access to nodules located outside the airway with either the biopsy needle or forceps. Future improvements in cryoprobe design with a sharp tip may address this limitation. CONCLUSIONS: Combining 1.1 mm disposable cryoprobe with robotic bronchoscopy is safe and can be considered as an adjunct to conventional biopsy, allowing for well-preserved tissue. Further prospective studies to evaluate its performance and safety is warranted. Reference #1: Kho SS, Chai CS, Nyanti LE, et al. Combination of 1.1 mm flexible cryoprobe with conventional guide sheath and therapeutic bronchoscope in biopsy of apical upper lobe solitary pulmonary nodule. BMC Pulm Med. 2020. 158(20). doi.org/10.1186/s12890-020-01199-3 Reference #2: Chen AC, Pastis NJ Jr, Mahajan AK, et al. Robotic Bronchoscopy for Peripheral Pulmonary Lesions: A Multicenter Pilot and Feasibility Study (BENEFIT). Chest. 2021;159(2):845-852. doi:10.1016/j.chest.2020.08.2047 Reference #3: Sahajal Dhooria, Inderpaul Singh Sehgal, Ashutosh NA Digambar Behera, Ritesh Agarwal. Diagnostic Yield and Safety of Cryoprobe Transbronchial Lung Biopsy in Diffuse Parenchymal Lung Diseases: Systematic Review and Meta-Analysis. Respiratory Care. 2016. 61(5):700-712. doi.org/10.4187/respcare.04488 DISCLOSURES: No relevant relationships by Sailendra Chundu No relevant relationships by Moiz Javed No relevant relationships by Abid Khokar No relevant relationships by Ali Saeed No relevant relationships by Andrew Talon No relevant relationships by Melinda Wang