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1.
Am J Health Syst Pharm ; 79(16): 1355-1368, 2022 08 05.
Article in English | MEDLINE | ID: covidwho-1831001

ABSTRACT

PURPOSE: Although outpatient parenteral antibiotic therapy (OPAT) can be a good approach to treatment of infections, a lack of data regarding antibiotic stability in portable elastomeric infusion devices restricts its safe, appropriate, and effective use. The objective of this work was to complete a systematic peer-reviewed analysis of published articles about antibiotic stability in elastomeric infusion devices that provide evidence supporting their use in OPAT. SUMMARY: A systematic review following PRISMA guidelines was conducted in January 2021 to identify published articles about antibiotic stability in portable elastomeric infusion devices. The databases used were PubMed, Embase, Web of Science, and a Cochrane database. A total of 1,615 original studies and conference communications were found. After title, abstract, and full-text review, 33 articles met the inclusion criteria. The data obtained included information about the stability of 30 different antibiotics. To our knowledge, this is the first review to summarize the available published data on the stability of antibiotics in portable elastomeric infusion devices. The results highlight the poor stability of some antibiotics in solution and the variability of the laboratory conditions in the included studies. CONCLUSION: This systematic review can serve as a useful resource for healthcare professionals involved in providing OPAT using portable elastomeric infusion devices. However, further stability studies should be performed, especially high-quality studies simulating real-life time and temperature conditions.


Subject(s)
Anti-Bacterial Agents , Infusion Pumps , Elastomers , Humans , Infusions, Parenteral , Outpatients
3.
Anesthesiology ; 135(6): 951-962, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1546049

ABSTRACT

Respiratory viruses are transmitted via respiratory particles that are emitted when people breath, speak, cough, or sneeze. These particles span the size spectrum from visible droplets to airborne particles of hundreds of nanometers. Barrier face coverings ("cloth masks") and surgical masks are loose-fitting and provide limited protection from airborne particles since air passes around the edges of the mask as well as through the filtering material. Respirators, which fit tightly to the face, provide more effective respiratory protection. Although healthcare workers have relied primarily on disposable filtering facepiece respirators (such as N95) during the COVID-19 pandemic, reusable elastomeric respirators have significant potential advantages for the COVID-19 and future respiratory virus pandemics. However, currently available elastomeric respirators were not designed primarily for healthcare or pandemic use and require further development to improve their suitability for this application. The authors believe that the development, implementation, and stockpiling of improved elastomeric respirators should be an international public health priority.


Subject(s)
COVID-19/epidemiology , Elastomers/standards , Equipment Design/standards , Health Personnel/standards , Occupational Exposure/standards , Ventilators, Mechanical/standards , COVID-19/prevention & control , COVID-19/transmission , Equipment Design/methods , Equipment Reuse/standards , Humans , Occupational Exposure/prevention & control , Pandemics/prevention & control
4.
Int Orthod ; 19(4): 685-688, 2021 12.
Article in English | MEDLINE | ID: covidwho-1472124

ABSTRACT

OBJECTIVE: In orthodontic patients using any chemical substances in oral environment could change the elastomeric properties of their appliances. Since the beginning of the SARS-CoV-2 pandemic, efforts have been devoted to explore methods of prevention including the use of antiviral mouthwashes. This study aimed to investigate the effects of Povidone Iodine (PVP-I) and two other disinfecting solutions on the mechanical properties of orthodontic elastomeric ligatures. MATERIALS AND METHODS: In this study, 130 elastomeric ligatures in five groups (three test groups and two control groups) were examined in laboratory conditions for a period of 28 days. In the control group, specimens were kept dry in a dark environment while all other ligatures were stored in artificial saliva. Elastomeric ligatures were immersed into PVP-I solution (1%) Chlorhexidine (0.02%), and hydrogen peroxide (5%) for one minute each day in three time intervals of one day, 7 days and 28 days. Next, the maximum tensile strength of elastomeric ligatures was tested by a universal testing machine (CN 1174, Germany). RESULTS: The results showed that the tensile strength of elastomeric ligatures was significantly decreased in all three test groups after 28 days (p-value<0.05). However, the difference between groups was not statistically significant. Between-subject ANOVA test showed that there were significant correlations between the time of exposure and type of disinfecting solutions. CONCLUSIONS: PVP-I has comparable effects on elastomeric ligatures as artificial saliva, chlorhexidine, and hydrogen peroxide.


Subject(s)
Chlorhexidine/pharmacology , Hydrogen Peroxide/pharmacology , Orthodontic Appliances , Povidone-Iodine/pharmacology , Tensile Strength/drug effects , COVID-19 , Elastomers , Humans , Materials Testing , SARS-CoV-2 , Saliva, Artificial
5.
J Am Coll Surg ; 231(3): 333-338, 2020 09.
Article in English | MEDLINE | ID: covidwho-1382486

ABSTRACT

BACKGROUND: The COVD-19 global pandemic has placed a large demand on personal protective equipment for healthcare workers. N-95 respirators, required to perform aerosolizing procedures, are in short supply and have increased significantly in cost. The lack of a clear end to the pandemic requires hospitals to create a long-term, cost effective solution to the N95 shortage. We initially used previously described methods to reuse and resterilize N95 masks; however, we found they did not solve the issues related to just-in-time fit-testing and cost. STUDY DESIGN: We initiated a program with the aim to reduce our dependence on N95 masks by initiating a phased program to acquire industrial style elastomeric P100 masks as a substitute for reuse and resterilization of disposable N95s. We created an allocation strategy based on availability of the masks, as well as an operational plan to fit test, educate, and disinfect the masks. RESULTS: Within 1 month, we were able to reduce the number of N95s needed by our network by 95%. We also found that the cost was, conservatively, 10 times less per month than purchasing disposable N95s, and the cost benefit increases the longer they are needed. CONCLUSIONS: Establishment of an elastomeric mask program is feasible and less expensive than programs focused on reusing and disinfecting disposable N95 masks. A well thought out elastomeric distribution and disinfection program does not pose greater operational challenges than an N95 reuse and resterilization program. In addition, elastomeric masks can be stored for future surges and should be considered an essential part of all healthcare facilities' supply of personal protective equipment. Implementation of the program has eliminated our dependence on disposable N95s to maintain normal operations during the global pandemic.


Subject(s)
COVID-19/prevention & control , Disinfection , Elastomers , Equipment Reuse , Health Personnel , N95 Respirators , Disposable Equipment , Equipment Design , Humans , Sterilization
6.
Am J Emerg Med ; 48: 273-275, 2021 10.
Article in English | MEDLINE | ID: covidwho-1230338

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has forced health care workers to explore alternative personal protective equipment (PPE) strategies due to traditional product shortages in the setting of increased global demand. Some physicians have chosen to use elastomeric face masks (EFMs), traditionally used in non-healthcare industries. METHODS: We performed a prospective cohort study of Emergency Medicine (EM) physicians working at a Level 1 Trauma Center who chose to use self-supplied EFMs for PPE. All subjects used commercial EFMs with disposable filters (N95, P95, or P100). All subjects chose their mask size independently with no input from employee health regarding appropriate fit. Per study protocol, subjects were fit tested periodically during clinical shifts over the course of the 6-week study period. All investigators performing fit testing underwent OSHA qualitative fit testing training. Data collected included mask/filters age, subjective assessment of mask seal quality, and fit test results. The data were analyzed using descriptive statistics. RESULTS: 105 fit tests were performed on physicians wearing EFMs over the course of 49 shifts. Physicians felt their fit was adequate for all tests performed. There were no fit test failures in any subjects. CONCLUSIONS: EFMs have an extremely low failure rate. Physicians are able to assess the adequacy of fit and accurately choose EFM size.


Subject(s)
Air Filters , COVID-19/prevention & control , Emergency Medicine , Masks/standards , Physicians , COVID-19/transmission , Cohort Studies , Cross-Sectional Studies , Elastomers , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , N95 Respirators , Prospective Studies , SARS-CoV-2 , United States , United States Occupational Safety and Health Administration
7.
Anaesthesia ; 75(8): 1022-1027, 2020 08.
Article in English | MEDLINE | ID: covidwho-751832

ABSTRACT

The COVID-19 pandemic has increased the demand for disposable N95 respirators. Re-usable elastomeric respirators may provide a suitable alternative. Proprietary elastomeric respirator filters may become depleted as demand increases. An alternative may be the virus/bacterial filters used in anaesthesia circuits, if they can be adequately fitted onto the elastomeric respirators. In addition, many re-usable elastomeric respirators do not filter exhaled breaths. If used for sterile procedures, this would also require modification. We designed a 3D-printed adaptor that permits elastomeric respirators to interface with anaesthesia circuit filters and created a simple modification to divert exhaled breaths through the filter. We conducted a feasibility study evaluating the performance of our modified elastomeric respirators. A convenience sample of eight volunteers was recruited. Quantitative fit testing, respiratory rate and end-tidal carbon dioxide were recorded during fit testing exercises and after 1 h of wear. All eight volunteers obtained excellent quantitative fit testing throughout the trial. The mean (SD) end-tidal carbon dioxide was 4.5 (0.5) kPa and 4.6 (0.4) kPa at baseline and after 1 h of wear (p = 0.148). The mean (SD) respiratory rate was 17 (4) breaths.min-1 and 17 (3) breaths.min-1 at baseline and after 1 h of wear (p = 0.435). Four out of eight subjects self-reported discomfort; two reported facial pressure, one reported exhalation resistance and one reported transient dizziness on exertion. Re-usable elastomeric respirators to utilise anaesthesia circuit filters through a 3D-printed adaptor may be a potential alternative to disposable N95 respirators during the COVID-19 pandemic.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Filtration/instrumentation , Pneumonia, Viral/therapy , Ventilators, Mechanical , Adult , COVID-19 , Carbon Dioxide/physiology , Coronavirus Infections/epidemiology , Elastomers , Equipment Design , Equipment Reuse , Feasibility Studies , Female , Humans , Male , Materials Testing/methods , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Printing, Three-Dimensional , Respiratory Rate , SARS-CoV-2 , Ventilators, Mechanical/supply & distribution
8.
Br J Community Nurs ; 25(8): 376-380, 2020 Aug 02.
Article in English | MEDLINE | ID: covidwho-708758

ABSTRACT

There has been a surging interest in using elastomeric infusion devices to deliver outpatient parenteral antimicrobial therapy (OPAT), which is more cost-effective than standard antibiotic administration, which requires multiple daily home visits. This has been particularly important since the outbreak of the coronavirus pandemic, because reducing patient contact can also help to minimise transmission of COVID-19 to outpatients who are at a high risk of COVID-19-triggered complications. In this retrospective study, the clinical effectiveness of intravenous (IV) infusion of flucloxacillin using an elastomeric device was explored in a convenience sample of patients. Patients with three primary infective diagnoses-bloodstream infection, non-vertebral osteomyelitis and vertebral osteomyelitis-were included in the analyses. In non-vertebral osteomyelitis patients, Accufuser antibiotic infusion shortened the course of OPAT care relative to standard antibiotic administration (p<.05). In contrast, in vertebral osteomyelitis patients, it prolonged the course of OPAT care relative to standard administration (p<.05). In patients with bloodstream infections, no significant difference was found between the treatment modes (p=.93). Thus, the clinical effectiveness of Accufuser antibiotic infusion varies among patients with different infective diagnoses, and there seems to be a complex relationship between the method of antibiotic delivery and the patient's condition.


Subject(s)
Anti-Bacterial Agents/administration & dosage , Bacteremia/drug therapy , Community Health Nursing/methods , Floxacillin/administration & dosage , Home Infusion Therapy/methods , Infusion Pumps , Osteomyelitis/drug therapy , Spinal Diseases/drug therapy , Betacoronavirus , COVID-19 , Coronavirus Infections/prevention & control , Delivery of Health Care/methods , Elastomers , Humans , Infusions, Intravenous/instrumentation , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Retrospective Studies , SARS-CoV-2
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