Preventive measures and customs in families not infected by COVID-19 during confinement

Despite the exuberant figures of those infected and deceased by COVID-19, there are families that were not infected. Objective: To describe the preventive measures and customs in families not infected by COVID-19 during confinement. Method: Descriptive qualitative research, 13 mothers from Ferrenafe with no member affected by COVID-19 participated. The data was collected through the semi-structured interview through telephone calls and processed manually, with thematic content analysis. Results: Four categories were obtained: a) Preventive measures when leaving the home: use of a mask, alcohol and social distancing, b) Preventive measures at home: handwashing, disinfection of the home and what enters, c) Restriction of family gatherings and use of social networks, d) Change of eating habits and use of home remedies. Conclusions: The families changed some customs or practices, complied with the confinement, social distancing, restricted family gatherings, used cloth masks, medicinal alcohol, and bleach. In addition, they increased the frequency of hand washing, home hygiene, healthy eating, the use of social networks, together with the use of home remedies commonly used to prevent or treat respiratory diseases.

Risk assessment for aerosol infection by SARS-CoV-2 and protection by respirators and surgical masks

SARS-CoV-2 is dispersed from patients by talking, coughing, and sneezing. The generated microdroplets aerosols can travel up to 8m, stay suspended for long periods, and preserve viral infectivity for median of 2.7h. An unprotected person exposed to this cloud might inhale a considerable amount of infectious viral doses, which will attach to the ACE two receptors at the respiratory system epithelial, resulting in infection. N95 respirators and surgical masks block 95% and 50%-60%, respectively, of inhalable particles and protect the wearer from infection. Surgical masks and N95 without exhalation valve protect both the wearer and the environment from carriers and sick people. The highest risk of infection is in closed and unventilated spaces. Any kind of respiratory protection will mitigate risk of infection, including cloth masks, but none will protect if there is no good seal around the face. Medical staff and laboratory workers will benefit most by wearing NIOSH approved N95 respirators, while adhering to guidelines and instructions for keeping the seal around the face. N95 with exhale valve protects the wearer but not others. Face shields with combination of masks or respirators provide additional protection from infection, by reducing ocular exposure or contamination of masks or hands, as well as by diverting movement of air around the face. © 2023 Elsevier Inc. All rights reserved.

3D printed devices to avoid hand contact with commonly shared surfaces

In the context of the COVID-19 pandemic, public spaces had to be quickly adapted to the new circumstances especially under the uncertainty of the pandemic development. Door handles are some of the most touched surfaces and so, this point of contagion was chosen to be tackled and two solutions were developed that would prevent direct touch with the handle: a portable and a fixed device. The portable device (HYHOOK + HYTIP) is a hook-like device holding a finger cover, which permits to open doors and push buttons safely. The fixed device (HANDGENIC) is meant to be assembled in door handles to equip buildings, such as universities or schools. With the fixed device, the user can open the door using their forearm which makes them less likely to transfer any particles to eyes, nose or mouth. The 3D printing Fused Filament Fabrication (FFF) process was selected as manufacturing technique, which allows the fast production of prototypes. This work portrays the development process and design iterations taking into consideration the concerns about the functioning of the devices and possible failures or alternative uses. To assure structural integrity of the parts, finite element (FE) analysis was used to verify its mechanical response. As conclusion, it was found that FE analysis indicate that the devices are structurally sound to be used in public spaces and that 3D printing is a useful way to rapidly develop devices while testing several design possibilities.

Agent-based Modeling of COVID-19 Infection Rate vis-à-vis the Philippine Government Community Quarantine and Face Covering Measures

The COVID-19 pandemic has uprooted the normal lives and routines of Filipinos. Dubbed as the 'new normal,' the wearing of face masks and face shields and adherence to social distancing and the community quarantines have been enforced by the Philippine government to all its citizens. The primary concern is to slow down the spread of SARS-CoV-2 virus absent of widespread and available pharmaceutical interventions such as vaccines and therapies, in the hopes of keeping the overall healthcare system functional. In this study, the researchers use NetLogo, an agent-based modeling software to emulate such government measures on a closed population of agents and observe the effects on the spread of COVID-19. Running different simulation scenarios, the researchers find that the NetLogo model is able to predict long- term trends imposed by these government restrictions. The results show that through increasing the number of people using face coverings and restricting interactions through enforcement of community quarantines, the rise of infections can be decreased substantially. The results of our model are consistent with the Philippine government's collated pandemic data on the effect of the enforcement of restrictions to the ongoing outbreak during certain time periods in the year 2020. © 2021 IEEE.

3D Printing Solutions in the Fight Against Covid-19 Pandemic

The global pandemic, caused by COVID-19, brought the whole world to its knees in 2020. Medical systems worldwide succumbed due to the disease outbreaks while healthcare workers have been fighting at the forefront. Medical supplies were running out in many countries and countless lives were lost because of it. Engineers, inventors, and creators from around the world have teamed up to help this cause through 3D printing solutions. It is additive manufacturing that became a leading light in the fight against the COVID-19 as a go-to method in case of medical supply shortages. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Efficacy of personal protective equipment against coronavirus transmission via dental handpieces.

BACKGROUND: This laboratory study was done to evaluate the efficacy of personal protective equipment (PPE) and high-volume evacuation (HVE) against the spread of human coronavirus type 229E (HCoV-229E) during a standard dental procedure. METHODS: Patient and operator manikins were used to recreate a dental setting inside a custom-built class III cabinet-like chamber. The mouth of the patient manikin was inoculated with an HCoV-229E suspension, the viral load of which was similar to that of asymptomatic people infected with severe acute respiratory syndrome coronavirus 2. The dental procedure was performed with an air turbine handpiece and HVE for 10 seconds. The efficacy of surgical masks, N95 (filtering facepiece class 2) and filtering facepiece class 3 respirators, and face shields was tested via quantitative real-time polymerase chain reaction. RESULTS: The wide surface on which the inoculum was spread caused low contamination. Over the external surfaces of masks and respirators, when a face shield was not worn, viral loads ranged from 1.2 through 1.4 log10 mean gene copies per cm2. When the shield was worn, viral loads dropped below the detection limit (< 0.317 log10 gene copies/cm2) for all PPE. On the operator's forehead, viral loads were 0.6 through 0.8 log10 gene copies/cm2. Inside the operator manikin's mouth, viral loads were under the detection limit when using any PPE, with or without the shield. HVE did not significantly change viral loads. CONCLUSIONS: All PPE combinations significantly reduced viral loads in the operator manikin's mouth to below the detection limit, but HVE did not decrease viral contamination. PRACTICAL IMPLICATIONS: Although caution is suggested when removing and disposing of PPE to avoid self-contamination, the combination of PPE and face shields drastically decreases the risk of transmitting human coronavirus during aerosol-generating dental procedures.

Challenges of personal protective equipment use among ophthalmologists during the COVID-19 pandemic: A multicenter international study.

PURPOSE: To explore the possible challenges and difficulties of using Personal Protective Equipment (PPE) in ophthalmic practice during the Coronavirus disease 2019 (COVID-19) pandemic. METHODS: This is a multicenter, international survey among practicing ophthalmologists across different countries. The survey was conducted from September 9th to October 24th, 2020. It included a total of 23 questions that navigated through the currently adopted recommendations in different clinical situations. The survey also assessed the convenience of using various PPE in ophthalmic practice and addressed the clarity of the examination field while using various PPE during clinical or surgical procedures. RESULTS: One hundred and seventy-two ophthalmologists completed the survey (101 from Egypt, 50 from the USA, and 21 from four other countries). The analysis of the responses showed that most ophthalmologists use face masks without significant problems during their examinations, while face shields followed by protective goggles were the most inconvenient PPE in the current ophthalmic practice. Moreover, most of the participants (133, 77.3%) noticed an increase in their examination time when using PPE. Furthermore, a considerable percentage of the respondents (70, 40.7%) stopped using one or more of the PPE due to inconvenience or discomfort. CONCLUSIONS: Due to the unique nature of the ophthalmic examination, certain PPE are not ophthalmologist-friendly. Innovative PPE should be tailored for prompt, more convenient, and clearer ophthalmological practice.

COVID-19: risk of ocular transmission in health care professionals.

INTRODUCTION: The current pandemic of severe acute respiratory symptom coronavirus 2 (SARS-CoV-2) has had a major impact on individuals' lives. Social isolation and the use of personal protective equipment - the latter being especially important for health care workers - emerged as two of the main methods of preventing the spread of the disease. The eye can represent a source of transmission through contaminated tears, as well as a source of infection for respiratory droplets or aerosol particles, which may come into contact with the ocular surface and migrate to the lungs and other parts of the body. OBJECTIVES: To investigate the risk of ocular transmission through a literature review and identify ways of preventing it. METHODS: A search of the scientific literature was conducted in the PubMed and Cochrane databases, using a combination of the following keywords: "COVID-19," "eye," "personal protective equipment," "SARS-CoV-2," "protective goggles," "face shields," and "workers' health." RESULTS: The mechanisms of ocular transmission have not been fully elucidated, but studies have demonstrated the presence of viral RNA in the conjunctival sac and aerosolized secretions of contaminated patients; these droplets may come into contact with the eyes of uninfected bystanders, entering the respiratory system through the nose and gaining access to the lungs. CONCLUSIONS: Studies show that the virus can be effectively transmitted through the eyes, underscoring the importance of protective goggles for health care workers or potential transmitters of the virus, in addition to the need for additional education measures to encourage hand hygiene and discourage touching of the eyes.

Application of 3D printing and distributed manufacturing during the first-wave of COVID-19 pandemic. Our experience at a third-level university hospital.

BACKGROUND: 3D printing and distributed manufacturing represent a paradigm shift in the health system that is becoming critical during the COVID-19 pandemic. University hospitals are also taking on the role of manufacturers of custom-made solutions thanks to 3D printing technology. CASE PRESENTATION: We present a monocentric observational case study regarding the distributed manufacturing of three groups of products during the period of the COVID-19 pandemic from 14 March to 10 May 2020: personal protective equipment, ventilatory support, and diagnostic and consumable products. Networking during this period has enabled the delivery of a total of 17,276 units of products manufactured using 3D printing technology. The most manufactured product was the face shields and ear savers, while the one that achieved the greatest clinical impact was the mechanical ventilation adapters and swabs. The products were manufactured by individuals in 57.3% of the cases, and our hospital acted as the main delivery node in a hub with 10 other hospitals. The main advantage of this production model is the fast response to stock needs, being able to adapt almost in real time. CONCLUSIONS: The role of 3D printing in the hospital environment allows the reconciliation of in-house and distributed manufacturing with traditional production, providing custom-made adaptation of the specifications, as well as maximum efficiency in the working and availability of resources, which is of special importance at critical times for health systems such as the current COVID-19 pandemic.

Experimental Efficacy of the Face Shield and the Mask against Emitted and Potentially Received Particles.

There is currently not sufficient evidence to support the effectiveness of face shields for source control. In order to evaluate the comparative barrier performance effect of face masks and face shields, we used an aerosol generator and a particle counter to evaluate the performance of the various devices in comparable situations. We tested different configurations in an experimental setup with manikin heads wearing masks (surgical type I), face shields (22.5 cm high with overhang under the chin of 7 cm and circumference of 35 cm) on an emitter or a receiver manikin head, or both. The manikins were face to face, 25 cm apart, with an intense particle emission (52.5 L/min) for 30 s. The particle counter calculated the total cumulative particles aspirated on a volume of 1.416 L In our experimental conditions, when the receiver alone wore a protection, the face shield was more effective (reduction factor = 54.8%), while reduction was lower with a mask (reduction factor = 21.8%) (p = 0.002). The wearing of a protective device by the emitter alone reduced the level of received particles by 96.8% for both the mask and face shield (p = NS). When both the emitter and receiver manikin heads wore a face shield, the protection allowed for better results in our experimental conditions: 98% reduction for the face shields versus 97.3% for the masks (p = 0.01). Face shields offered an even better barrier effect than the mask against small inhaled particles (<0.3 µm-0.3 to 0.5 µm-0.5 to 1 µm) in all configurations. Therefore, it would be interesting to include face shields as used in our experimental study as part of strategies to reduce transmission within the community setting.

A Cross University-Led COVID-19 Rapid-Response Effort: Design, Build, and Distribute Drexel AJFlex Face Shields.

The purpose of this article is to demonstrate how a new cross-community leadership team came together, collaborated, coordinated across academic units with external community partners, and executed a joint mission to address the unmet clinical need for medical face shields during these unprecedented times. Key aspects of this success include the ability to forge and leverage new opportunities, overcome challenges, adapt to changing constraints, and serve the significant need across the Philadelphia region and healthcare systems. We teamed to design-build durable face shields (AJFlex Shields). This was accomplished by high-volume manufacturing via injection molding and by 3-D printing the key headband component that supports the protective shield. Partnering with industry collaborators and civic-minded community allies proved to be essential to bolster production and deliver approximately 33,000 face shields to more than 100 organizations in the region. Our interdisciplinary team of engineers, clinicians, product designers, manufacturers, distributors, and dedicated volunteers is committed to continuing the design-build effort and providing Drexel AJFlex Shields to our communities.

Association between universal face shield in a quaternary care center and reduction of SARS-COV2 infections among healthcare personnel and hospitalized patients.

We implemented universal face shield use for all healthcare personnel upon entry to facility in order to counter an increase in SARS-COV2 cases among healthcare personnel and hospitalized patients. There was a marked reduction of infections in both healthcare personnel and hospitalized patients between pre and post intervention. Our results support universal face shield use as part of a multifaceted approach in areas of high SARS-COV2 community transmission.

Efficacy of face masks, neck gaiters and face shields for reducing the expulsion of simulated cough-generated aerosols.

Face masks are recommended to reduce community transmission of SARS-CoV-2. One of the primary benefits of face masks and other coverings is as source control devices to reduce the expulsion of respiratory aerosols during coughing, breathing, and speaking. Face shields and neck gaiters have been proposed as an alternative to face masks, but information about face shields and neck gaiters as source control devices is limited. We used a cough aerosol simulator with a pliable skin headform to propel small aerosol particles (0 to 7 µm) into different face coverings. An N95 respirator blocked 99% (standard deviation (SD) 0.3%) of the cough aerosol, a medical grade procedure mask blocked 59% (SD 6.9%), a 3-ply cotton cloth face mask blocked 51% (SD 7.7%), and a polyester neck gaiter blocked 47% (SD 7.5%) as a single layer and 60% (SD 7.2%) when folded into a double layer. In contrast, the face shield blocked 2% (SD 15.3%) of the cough aerosol. Our results suggest that face masks and neck gaiters are preferable to face shields as source control devices for cough aerosols.

Remote Learning for Children with Auditory Access Needs: What We Have Learned during COVID-19.

COVID-19 has challenged most everyone in every facet of life. In the beginning of the pandemic shutdown, schools had to make decisions quickly often with limited planning. For students who were deaf or hard of hearing, communication access during instruction was the urgent focus of teachers of the deaf/hard of hearing and educational audiologists. The move from the classroom to home resulted in both predictable and unpredictable challenges as well as some unexpected benefits. Based on numerous conversations with these professionals as well as parents, the challenges encountered with online learning and solutions that were implemented to support students are reported.

The Inadequacy of Regulatory Frameworks in Time of Crisis and in Low-Resource Settings: Personal Protective Equipment and COVID-19.

COVID-19 pandemic is plaguing the world and representing the most significant stress test for many national healthcare systems and services, since their foundation. The supply-chain disruption and the unprecedented request for intensive care unit (ICU) beds have created in Europe conditions typical of low-resources settings. This generated a remarkable race to find solutions for the prevention, treatment and management of this disease which is involving a large amount of people. Every day, new Do-It-Yourself (DIY) solutions regarding personal protective equipment and medical devices populate social media feeds. Many companies (e.g., automotive or textile) are converting their traditional production to manufacture the most needed equipment (e.g., respirators, face shields, ventilators etc.). In this chaotic scenario, policy makers, international and national standards bodies, along with the World Health Organization (WHO) and scientific societies are making a joint effort to increase global awareness and knowledge about the importance of respecting the relevant requirements to guarantee appropriate quality and safety for patients and healthcare workers. Nonetheless, ordinary procedures for testing and certification are currently questioned and empowered with fast-track pathways in order to speed-up the deployment of new solutions for COVID-19. This paper shares critical reflections on the current regulatory framework for the certification of personal protective equipment. We hope that these reflections may help readers in navigating the framework of regulations, norms and international standards relevant for key personal protective equipment, sharing a subset of tests that should be deemed essential even in a period of crisis.

Exploration of alternative supply chains and distributed manufacturing in response to COVID-19; a case study of medical face shields.

Quarantine conditions arising as a result of the coronavirus (COVID-19) have had a significant impact on global production-rates and supply chains. This has coincided with increased demands for medical and personal protective equipment such as face shields. Shortages have been particularly prevalent in western countries which typically rely upon global supply chains to obtain these types of device from low-cost economies. National calls for the repurposing of domestic mass-production facilities have the potential to meet medical requirements in coming weeks, however the immediate demand associated with the virus has led to the mobilisation of a diverse distributed workforce. Selection of appropriate manufacturing processes and underused supply chains is paramount to the success of these operations. A simplified medical face shield design is presented which repurposes an assortment of existing alternative supply chains. The device is easy to produce with minimal equipment and training. It is hoped that the methodology and approach presented is of use to the wider community at this critical time.