Enhancing compliance rate of hand hygiene before and after Covid-19: An interference analysis in Abu Dhabi, UAE hospitals

Hand hygiene (HH) is a crucial factor for reducing Healthcare Associated Infections (HAIs) in the hospital setting. The current analysis was created to create an intervention methodology to enhance hand hygiene compliance among hospital personnel in a healthcare setting. Covid-19 disease epidemic has additional stressed the need for world-wide development in hand hygiene compliance by the healthcare personnel. Healthcare Associated Infections have been a hot issue for several time periods and Healthcare Associated Infections are the most common adverse results due to the delivery of medical care and treatment. There is unanimity that hand hygiene is the extremely successful way to avoid healthcare associated infections. As healthcare systems fluctuate widely, prevention approaches must be designed appropriately. Hand hygiene, however, remains relevant in all settings, and World Health Organization (WHO) is strongly endorsing alcohol-based hand rubs to interrupt transmission. Nevertheless, very minimal compliance rate amongst the healthcare staff have been reported worldwide. Infected surfaces, especially those that are touched repeatedly by the patient's surroundings, act as reservoirs for pathogens and cause towards pathogen transmission. Therefore, healthcare disinfection requires a thorough approach whereby several strategies may be applied together, risk-based methodologies, to decrease the possibility of HAIs for the patients. In this paper more than 200 articles have been studied from 2016 to 2021 time period and various surveys have been conducted to analyze hand hygiene intervention and studied the various factors involving the patient's situation, medication management behavior of several units, and the type of healthcare employees during and before the Covid-19 pandemic. Based on this study, we evaluated overall hand hygiene compliance rate including the intake of hand wash liquid agent, alcohol-based hand rub (ABHR), the paper wipes, medical waste consumption and personal protective equipment's (gloves, masks etc.) before and after Covid-19 intervention to improve the hand hygiene compliance rate in Abu Dhabi hospitals. © 2023 Author(s).

Practical infection control training for Victoria's aged care workforce at the time of COVID-19 pandemic: a community case study.

The need to improve career development and training for residential aged care workers in Australia to achieve required essential competencies, including infection prevention and control competencies, has been repeatedly highlighted. In Australia long-term care settings for older adults are known as residential aged care facilities (RACFs). The COVID-19 pandemic has brought to light the lack of preparedness of the aged care sector to respond to emergencies, and the urgent need to improve the infection prevention and control training in residential aged care facilities. The government in the Australian State of Victoria allocated funds to support older Australians in RACFs, including funds toward infection prevention and control training of RACF staff. The School of Nursing and Midwifery at Monash University addressed some of these challenges in delivering an education program on effective infection prevention and control practices to the RACF workforce in Victoria, Australia. This was the largest state-funded program delivered to RACF workers to date in the State of Victoria. The aim of this paper is to provide a community case study, where we share our experience of program planning and implementation during early stages of the COVID-19 pandemic and lessons learned.

How COVID-19 impacted CAUTI and CLABSI rates in Alabama.

BACKGROUND: The study objective was to quantify infection rate trends for central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) in 89 Alabama hospitals from 2015 to 2021 to analyze how the COVID-19 pandemic impacted health care delivery. METHODS: Retrospective analysis of CLABSI and CAUTI rates, from 89 Alabama hospitals via data from the Alabama Department of Public Health from 2015 to 2021. RESULTS: Based on our modeling strategies, there was a statistically significant decrease in rates of CAUTIs from 2015 to 2019 at an estimated rate of 7% per year (P = 0.0167) and CLABSIs from 2015 to 2018 at an estimated rate of 13% per year (P < .001) in these hospitals. In 2020, the CAUTI and CLABSI rates began increasing at a modeled rate of 29% per year (P = .001) and 35% per year (P < .001) respectively. DISCUSSION: A review of potential causes for the elevated rate of health care-associated infections illustrated that certain practices may have contributed to increased CAUTI and CLABSI rates. Utilizing staff from noncritical care areas with less experience in health care-associated infection prevention, batching of tasks to conserve personal protective equipment, and a nationwide mental health crisis could have affected infection prevention bundle compliance. CONCLUSIONS: An increase in CAUTIs and CLABSIs was observed during the pandemic, likely due to the large volume of patients requiring advanced medical care and subsequent depleted resources.

Challenges Faced in Treating COVID Patients and Lessons Learnt

Treatment of COVID-19 patients is an immense administrative as well as clinical challenge. The setting up of a dedicated COVID-19 care centre within a short time span, adequate manpower deployment, healthcare worker education and training, provision of facilities for donning and doffing and waste disposal were some of the unique administrative problems. On the other hand, as clinicians we faced enormous hurdles in attempting to treat a disease on which there was no established knowledge and no defined, well-proven treatment protocols and which could strike anyone, anywhere in myriad ways. Coupled with this difficulty in diagnosis and treatment was the challenge of serving COVID-19 patients of every age and clinical requirement, under one roof. Healthcare workers faced a tough time, handling physical discomfort while working for long hours in PPE, along with the fear and apprehension of contracting the infection in the line of duty, and carrying it back home. Mental health issues abounded, both amongst the patients and their caregivers, due to heightened fear, anxiety and loneliness. We share our experience in dealing with the pandemic, the administrative and clinical challenges we faced and some of the ways we overcame them. We further share some of the insights we gleaned from this experience, which may help in better preparation for the future. © The Author(s), under exclusive licence to Springer Nature Singapore Pte Ltd. 2021.

Emergency Medicine

The coronavirus pandemic stretched healthcare resources and infrastructure worldwide. The Emergency Department (ED) is a crucial component in the frontline response to the pandemic. In this chapter, we discuss the logistical and operational challenges faced, the innovative solutions employed, and the lessons learned in our ED as we strived to overcome this unprecedented challenge. Whilst we will share much of what we learned, what we did, and what we believe was responsible for our many successes, at the same time, we are left with a sadness that our healthcare systems (and ‘our' could be applied locally to our community, nationally to our country, and globally to our planet) were simply not designed nor prepared to properly confront a pandemic. The number of patient deaths we witnessed still feels somewhat incomprehensible and scarring. We do, however, hope that our learnings may help inform decisions at other EDs, help prepare us for future crises, and, if nothing else, confers confidence in the ED's ability to overcome this pandemic. © SBH Health System 2022.

Review of the Effect of Continuous Use and Limited Reuse of N95 Respirators on Respirator Fit.

Background: Coronavirus disease 2019 (COVID-19) has led to severe shortages of filtering facepiece respirators (FFRs). As a result, extended use, limited reuse, and FFR decontamination have been utilized to extend the life of single-use FFRs. Although some studies have raised concerns that reuse could affect the FFR's ability to form a seal, no comprehensive literature review of the effect of extended use or limited reuse on FFR seal exists. Objective: The goal of this review was to assess the effect of extended use and reuse on respirator fit, with and without decontamination. Methods: Searches of PubMed and Medrxiv yielded 24 papers that included assessment of fit after extended use or limited reuse on a human. One additional handpicked paper was added. Results: Studies report a wide variation in the number of donnings and doffings before fit failure between different models of respirators. Additionally, while seal checks lack sufficient sensitivity to reliably detect fit failures, individuals who failed fit testing were often able to pass subsequent tests by re-positioning the respirator. Even with failure, respirators often maintained a substantially higher level of fit than a surgical mask, so they may still provide a level of protection in crisis settings. Conclusion: Based on currently available data, this literature review was unable to establish a consensus regarding the amount of time a respirator can be worn or the number of uses before fit failure will occur. Furthermore, variations in reuses before fit failure between different models of N95 respirators limit the ability to offer a comprehensive recommendation of greater than one reuse or a specific amount of wear time.

A Computer Vision System for Street Sweeper Robot

With the spread of Covid-19, more people wear personal protective equipment such as gloves and masks. However, they are littering them all over streets, parking lots and parks. This impacts the environment and damages especially the marine ecosystem. Thus, this waste should not be discarded in the environment. Moreover, it should not be recycled with other plastic materials. Actually, they have to be separated from regular trash collection. Furthermore, littering gloves and masks yields more workload for street cleaners and presents potential harm for them. In this paper, we design a computer vision system for a street sweeper robot that picks up the masks and gloves and disposes them safely in garbage containers. This system relies on Deep Learning techniques for object recognition. In particular, three Deep Learning models will be investigated. They are: You Only Look Once (YOLO) model, Faster Region based Convolutional Neural Network (Faster R-CNN) and DeepLab v3+. The experiment results showed that YOLO is the most suitable approach to design the proposed system. Thus, the performance of the proposed system is 0.94 as F1 measure, 0.79 as IoU, 0.94 as mAP, and 0.41 s as Time to process one image.

COVID-19 personal protective equipment (PPE) contamination in coastal areas of Granada, Spain.

The use of disposable personal protective equipment (PPE) as a control measure to avoid transmission against COVID-19 has generated a challenge to the waste management and enhances plastic pollution in the environment. The research aims to monitor the presence of PPE waste and other plastic debris, in a time interval where the use of face mask at specific places was still mandatory, on the coastal areas of Granada (Spain) which belongs to the Mediterranean Sea. Four beaches called La Rijana, La Charca, La Rábita and Calahonda were examined during different periods. The total amount of sampled waste was 17,558 plastic units. The abundance, characteristics and distribution of PPE and other plastic debris were determined. Results showed that the observed amount of total plastic debris were between 2.531·10-2 and 24.487·10-2 units per square meter, and up to 0.136·10-2 for PPE debris, where face masks represented the 92.22 % of the total PPE debris, being these results comparable to previous studies in other coastal areas in the world. On the other hand, total plastic debris densities were in the range from 2.457·10-2 to 92.219·10-2 g/m2 and densities were up to 0.732·10-2 for PPE debris. PPE debris supposed 0.79 % of the weight of total waste and the 0.51 % of total items. Concerning non-PPE plastic waste: cigarettes filters, food containers and styrofoam were the most abundant items (42.95, 10.19 and 16.37 % of total items, respectively). During vacation periods, total plastic debris amount increased 92.19 % compared to non-vacation periods. Regarding type of beaches, the presence of plastic debris was significantly higher on touristic/recreational than in fishing beaches. Data showed no significant differences between accessible and no-accessible beaches, but between periods with restrictive policy about mask face use and periods with non-restrictive policy data suggest significant differences between densities (g/m2) for PPE litter. The amount of PPEs debris is also correlated with the number of cigarettes filters (Person's r = 0.650), food containers (r = 0.782) and other debris (r = 0.63). Finally, although interesting results were provided in this study, further research is required to better understand the consequences of this type of pollution and to provide viable solutions to this problem.

Data driven flexible supplier network of selfcare essentials during disruptions in supply chain.

During disruptive events, supply chains struggle to meet the demand due to limitations posed by logistics, transportation and supply side failures. In the present study, a flexible supplier network of personal protective equipment (PPEs), such as face masks, hand sanitizers, gloves, and face shields, has been modelled using an extensive risk enabled data driven decision making for addressing disruptions in the supply chain. This paper studies various risks which exists in PPE supply chain and evaluates the total supplier risk based on them. Furthermore, the paper proposes a Multi-objective Mixed Integer Linear Program (MOMILP) to optimally select suppliers and the sustainable allocation of orders under various risks, namely disruption, delay, receivables, inventory, and capacity. The proposed MOMILP model is also extended to promptly revise the orders to other suppliers under a disruption scenario enabling an effective response resulting in minimization of stockouts. The criteria-risk matrix is developed with the help of supply chain experts from industry and academia. Conclusively, the numerical case study and its computational analysis is conducted on the PPE data received from distributors to demonstrate the applicability of the proposed model. The findings suggest that the proposed flexible MOMILP can optimally revise allocations during disruptions to drastically reduce the stockouts and minimize overall cost of procurement in the PPE supply network.

Personalized 3D-printed frames to reduce leak from N95 filtering facepiece respirators: a prospective crossover trial in health care workers.

Correctly fitting N95 filtering facepiece respirators (FFRs) have become increasingly important in health care throughout the COVID-19 pandemic. We evaluated the hypothesis that personalized 3-D-printed frames could improve N95 FFRs quantitative fit test pass rates and test scores in health care workers (HCW). HCW were recruited at a tertiary hospital in Adelaide, Australia (ACTRN 12622000388718). A mobile iPhone camera + app was used to produce 3-D scans of volunteers' faces, which were then imported into a software program to produce personalized virtual scaffolds suited to each user's face and their unique anatomical features. These virtual scaffolds were printed on a commercially available 3-D printer, producing plastic (and then silicone-coated, biocompatible) frames that can be fitted inside existing hospital supply N95 FFR. The primary endpoint was improved pass rates on quantitative fit testing - comparing participants wearing an N95 FFR alone (control 1) with participants wearing the frame + N95 FFR (intervention 1). The secondary endpoint was the fit factor (FF) in these groups, and R-COMFI respirator comfort and tolerability survey scores. N = 66 HCW were recruited. The use of intervention 1 increased overall fit test pass rates to 62/66 (93.8%), compared to 27/66 (40.9%) for controls. (OR for pFF pass 20.89 (95%CI: 6.77, 64.48, P < 0.001). Average FF increased, with the use of intervention 1 to 179.0 (95%CI: 164.3,193.7), compared to 85.2 (95%CI: 70.4,100.0) with control 1. Pass rates and FF were improved with intervention 1 compared to control 1 for all stages of the fit-test: bending, talking, side-to-side, and up-down motion. (P < 0.001 all stages). Tolerability and comfort of the frame was evaluated with the validated R-COMFI respirator comfort score, showing improvement with the frame compared to N95 FFR alone (P = 0.006). Personalized 3-D-printed face frames decrease leakage, improve fit testing pass rates and FF, and provide improved comfort compared to the N95 FFR alone. Personalized 3-D-printed face frames represent a rapidly scalable new technology to decrease FFR leakage in HCW and potentially the wider population.

Design and fabrication of a biodegradable face shield by using cleaner technologies for the protection of direct splash and airborne pathogens during the COVID-19 pandemic.

Due to global supply chain disruptions and high demand for personal protective equipment (PPE), the rapidly expanding COVID-19 crisis left millions of front-line fighters unprotected. The disposal of PPE in the environment caused significant environmental pollution. Hence, indigenous initiatives have been taken to fabricate antiviral and biodegradable face shields with the help of neoteric and cleaner technologies. This paper describes a novel endeavor to design, manufacture, and performance analysis of a face shield made by plastic injection molding and LASER Cutting. Because of the requirement of permanent wear, the face shield's ergonomic design is considered low weight and easy head fixation, alongside high production ability. Here, face shield frames are made with lightweight, biodegradable plastic called Poly Lactic Acid (PLA), whereas an optical grade PLA sheet is used as the visor for better clarity. Visors PLA Sheet is coated with Nano-Silver disinfectant spray to incorporate antiviral properties to the Faceshield. Partially circumferential adjustable elastic straps are used for comfortable head fixation. To evaluate the product, clinical fit tests along with statistical survey were conducted, and the feedback from the end-users on comfort (41% Excellent, 30% Good, 26% Average and 3% Poor), clear view (33% Excellent, 38% Good, 24% Average, and 5% Poor), design features (43% Excellent, 35% Good, and 22% Average), simplicity of installation and disassembly (29% Excellent, 33% Good, and 38% Average), and ease of wearing/removing (45% Excellent, 40% Good, and 15%Average) are encouraging.

COVID-19 lockdown, personal protective equipment, hyper-hygiene and allergy.

SUMMARY: At the beginning of Sars-Cov 2 pandemic, in the absence of "targeted" therapies, the national health authorities have introduced some measures aimed at reducing the spread of infection in the community (lockdown, social distancing, personal protective equipment (PPE), personal hygiene and disinfection of living environments). All the containment measures have led to both positive and negative effects in patients with allergic diseases. We believe that further studies should be undertaken to investigate the possible correlations between SARS-CoV-2 infection and allergy, from a broader perspective. In particular, the risk factors for the development of undesirable effects should be investigated, especially in healthcare professionals forced to use PPE and sanitizing agents for a long time. However, since the COVID-19 pandemic probably will not be short-lived, the use of such protective aids will necessarily be widespread even in the general population. Therefore, further studies on the materials used for the production of PPE and sanitizing agents would be necessary to reduce their sensitizing and, in some cases, toxic potential.

Safety behavior of agricultural workers around face mask-wearing during the COVID-19 pandemic.

BACKGROUND: Agricultural labor-intensive activities have been threatened by COVID-19. Wearing a face mask has been introduced as one of the personal protective equipment (PPE) to reduce COVID-19 risk. OBJECTIVE: The present study aimed to investigate the safety behavior of urban green space workers around wearing a face mask in the time of COVID-19 before vaccination. METHODS: The personal and safety backgrounds of 61 male participants were collected using a designed questionnaire. The nonparametric correlation coefficient of Spearman and logistic regressions were used to investigate the relationships among variables. RESULTS: Above one-third of workers (37.7%) got COVID-19 in the past year. Although all of the participants were aware of wearing a face mask is a protocol against COVID-19, only about half of them (50.8%) completely wear face mask at work. Non-smoking participants were 5.5 times more likely to influence their personal preference on wearing the mask. CONCLUSION: Safety attitude may be a key variable in relation to the factors that influence the wearing face mask. The causes of face mask-wearing during a pandemic such as COVID-19 as well as safety attitudes may be behind the factors studied in this study. Although some significant linkages were found, they were not enough to conclude a comprehensive action program. This concern is still open to discovering factors that influence wearing face mask.

Can disposable masks be worn more than once?

Disposable facemasks are a primary tool to prevent the transmission of SARS-COV-2 during the COVID-19 pandemic. However, plastic waste generated from their disposal represents a significant environmental problem that can be reduced by maximizing the service life of disposable masks. We evaluated the effect of repeated wearing on the fitted filtration efficiency (FFE) of N95, KF94, KN95, and procedure/surgical masks. The FFEs of masks were compared following extended wearing with and without washing. Results reveal that most disposable facemasks can retain a high level of their baseline FFE after extended wearing, even after 40 h of wearing. Laundering disposable masks degraded FFE in some instances. We conclude that the durability of disposable facemask performance is considerably longer than their intended single use indication, suggesting that reusing disposable masks is a safe means of reducing plastic waste in the environment.

Clinical Safety and Performance Evaluation of New Personal Protective Equipment During the COVID-19 Pandemic

As the healthcare response to the COVID-19 pandemic continues, providing enhanced protection to frontline healthcare personnel exposed to aerosolized infectious material is essential. The rapid spread of the COVID-19 virus across the globe in early 2020 generated an overwhelming surge in demand for effective personal protective equipment (PPE), in particular, passive personal respirators (PPR). Global manufacturing of PPR was limited, and research and development of improved respirators were restricted by the availability of accredited laboratories for timely testing at the peak of the pandemic. The authors have described a clinical method of safety and efficacy testing of a new PPR, the TopBioShield, using portable capnography for the measurement of end-tidal pCO2 (ETCO2) and bedside pulse oximetry to measure oxygen saturation (SpO2), respiratory rate (RR), and heart rate (HR) in healthy volunteers to overcome shortages of clinical testing capabilities during the height of the pandemic. Twenty-eight volunteers with a median age of 41 years (range 16–71) representing all 10 subgroups of head/face size were included. Only one participant asked to withdraw due to a feeling of claustrophobia after 30 min. Clinical monitoring while wearing TopBioShield revealed ETCO2, SpO2, respiratory rate, and heart rate measurements were within normal limits in all the subjects throughout the experiment. Bedside clinical monitoring is effective in demonstrating the physiological safety of PPR and is an important alternative to conventional mannequin testing. In this study all measured values over a 90-min experiment period were within normal limits, demonstrating the effectiveness of TopBioShield in preventing CO2 retention. Clinical testing methods must adhere to the highest standards and are essential during times of shortage. © 2023, The Institution of Engineers (India).

Transfer of a critically ill coronavirus disease patient

Coronavirus disease (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Acute respiratory distress syndrome (ARDS) is a feature of SARS-CoV-2, and transferring patients with severe ARDS is challenging owing to their condition and risk of infection during the transfer process. The hemodynamic instability of critically ill patients adds to the challenge of safe transfer, which requires thorough preparation of personnel, medication, equipment, and communication and transport methods, all of which must be organised within the infection control framework. In this case report we discuss a woman, 37 years of age, with suggested COVID-19, intubated due to severe ARDS. Owing to the hospital referral policy in Indonesia, the patient was transferred to a specialist infectious disease hospital by land ambulance, with a special transfer team formed to adhere to infection control protocols and critical patient transfer procedures. Copyright © 2020, Australasian College of Paramedicine. All rights reserved.

Facemask: Protection or threat?

Facemasks were widely used as a protection against SARS-COV-2, which significantly reduced COVID-19 transmission during the pandemic. However, concerns have been raised regarding its adverse impacts on human health due to intense use and mismanagement. Although rampant plastic littering was the norm before the pandemic, the magnitude of the problem is worsening as potentially COVID-19-infected facemasks are thrown along the shoreline. This study assessed the discarded facemasks on the most popular beach destinations in Mati City, Davao Oriental, Philippines. A total of N = 284 discarded facemasks were found in a cumulative area of 22,500 m2, with an average density of 8.4 × 10-4 items/m2. The surgical facemask (82 %; n = 234) was the most abundant type of facemask found in the areas, followed by KF94 (16 %; n = 45) and KN95 (2 %; n = 5). The Analysis of Variance (ANOVA) showed significant differences in the visual counts of facemasks on the three beaches (p < 0.05).

Biophysical and biochemical changes in skin health of healthcare professionals using respirators during COVID-19 pandemic.

BACKGROUND: Personal protective equipment, including respirator devices, has been used to protect healthcare workers (HCWs) during the COVID-19 pandemic. These are fitted to skin sites on the face to prevent airborne transmission but have resulted in reports of discomfort and adverse skin reactions from their continued usage. The present study addresses the objective changes in both the structural integrity and biological response of the skin following prolonged and consecutive use of respirators. MATERIALS AND METHODS: A longitudinal cohort study, involving 17 HCWs who wear respirators daily, was designed. Changes in the barrier properties and biological response of the skin were assessed at three facial anatomical sites, namely, the nasal bridge, left cheek and at a location outside the perimeter of respirator. Assessments were made on three different sessions corresponding to the first, second and third consecutive days of mask usage. Skin parameters included transepidermal water loss (TEWL), stratum corneum (SC) hydration and erythema, as well as cytokine biomarkers sampled from sebum using a commercial tape. RESULTS: The cheek and the site outside the perimeter covered by the respirator presented minimal changes in skin parameters. By contrast, significant increases in both the TEWL (up to 4.8 fold) and SC hydration (up to 2.7 fold) were detected at the nasal bridge on the second consecutive day of respirator-wearing. There was a high degree of variation in the individual expression of pro-and anti-inflammatory cytokines. Increasing trends in nasal bridge TEWL values were associated with the body mass index (p < 0.05). CONCLUSIONS: The most sensitive objective parameter in detecting changes in the skin barrier proved to be the increase in TEWL at the nasal bridge, particularly on the second day of consecutive respirator usage. By contrast, other measures of skin were less able to detect remarkable variations in the barrier integrity. Consideration for protecting skin health is required for frontline workers, who continue to wear respirators for prolonged periods over consecutive days during the pandemic.

Characterisation of superficial corneocytes in skin areas of the face exposed to prolonged usage of respirators by healthcare professionals during COVID-19 pandemic.

INTRODUCTION: During the COVID-19 pandemic healthcare workers (HCWs) have used respiratory protective equipment for prolonged periods, which has been associated with detrimental effects on the underlying skin. The present study aims to evaluate changes in the main cells (corneocytes) of the stratum corneum (SC) following prolonged and consecutive use of respirators. METHODS: 17 HCWs who wore respirators daily during routine hospital practice were recruited to a longitudinal cohort study. Corneocytes were collected via tape stripping from a negative control site (area outside the respirator) and from the cheek which was in contact with the device. Corneocytes were sampled on three occasions and analysed for the level of positive-involucrin cornified envelopes (CEs) and the amount of desmoglein-1 (Dsg1), as indirect measurements of immature CEs and corneodesmosomes (CDs), respectively. These were compared to biophysical measurements (Transepidermal water loss, TEWL, and SC hydration) at the same investigation sites. RESULTS: A large degree of inter-subject variability was observed, with maximum coefficients of variation of 43% and 30% for the level of immature CEs and Dsg1, respectively. Although it was observed that there was not an effect of prolonged respirator usage on the properties of corneocytes, the level of CDs was greater at the cheek than the negative control site (p < 0.05). Furthermore, low levels of immature CEs correlated with greater TEWL values after prolonged respirator application (p < 0.01). It was also noted that a smaller proportion of immature CEs and CDs was associated with a reduced incidence of self-reported skin adverse reactions (p < 0.001). CONCLUSIONS: This is the first study that investigated changes in corneocyte properties in the context of prolonged mechanical loading following respirator application. Although differences were not recorded over time, the levels of CDs and immature CEs were consistently higher in the loaded cheek compared to the negative control site and were positively correlated with a greater number of self-reported skin adverse reactions. Further studies are required to evaluate the role of corneocyte characteristics in the evaluation of both healthy and damaged skin sites.

Use of Electronic Auscultation in Full Personal Protective Equipment to Detect Ventilation Status in Selective Lung Ventilation: A Randomized Controlled Trial.

Chest auscultation is the first procedure performed to detect endotracheal tube malpositioning but conventional stethoscopes do not conform to the personal protective equipment (PPE) protocol during the COVID-19 pandemic. This double-blinded randomized controlled trial evaluated the feasibility of using ear-contactless electronic stethoscope to identify endobronchial blocker established selective lung ventilation, simulating endobronchial intubation during thoracic surgery with full PPE. Conventional and electronic auscultation was performed without and with full PPE, respectively, of 50 patients with selective lung ventilation. The rates of correct ventilation status detection were 86 and 88% in the conventional and electronic auscultation groups (p = 1.00). Electronic auscultation revealed a positive predictive value of 87% (95% CI 77 to 93%), and a negative predictive value of 91% (95% CI 58 to 99%), comparable to the results for conventional auscultation. For detection of the true unilateral lung ventilation, the F1 score and the phi were 0.904 and 0.654, respectively for conventional auscultation; were 0.919 and 0.706, respectively for electronic auscultation. Furthermore, the user experience questionnaire revealed that the majority of participant anesthesiologists (90.5%) rated the audio quality of electronic lung sounds as comparable or superior to that of conventional acoustic lung sounds. In conclusion, electronic auscultation assessments of ventilation status as examined during thoracic surgery in full PPE were comparable in accuracy to corresponding conventional auscultation assessments made without PPE. Users reported satisfactory experience with the electronic stethoscope.