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2.
Medicine (Baltimore) ; 100(37): e27240, 2021 Sep 17.
Article in English | MEDLINE | ID: covidwho-1434546

ABSTRACT

ABSTRACT: During the coronavirus disease 2019 (COVID-19) pandemic, the mandatory use of personal protective equipment (PPE) has resulted in a significant reduction in the infection rate among health care workers (HCWs). However, there are some ongoing concerns about the negative impact of using PPE for prolonged periods.This study examined the impact of wearing PPE on surgeons' performance and decision making during the COVID-19 pandemic.In this cross-sectional study, an anonymous online questionnaire was created and disseminated to surgeons all over the Eastern Province of Saudi Arabia. The questionnaire included the demographic data, the local hospital policies, the non-technical skills (e.g., communication, vision, and comfort) and the technical skills, and the process of decision making.From June 2020 to August 2020, 162 surgeons participated in this questionnaire. Of them, 80.2% were aged from 26 to 45 years, 70.4% have received a special training for PPE, and 59.3% of participants have operated on COVID-19 confirmed cases. A negative impact of wearing PPE was reported on their overall comfort, vision, and communication skills (92.6%, 95.1%, and 82.8%, respectively). The technical skills and decision making were not significantly affected (60.5% and 72.8%, respectively). More preference for conservative approach, damage control procedures, and/or open approach was reported.Despite its benefits, PPE is associated with a significant negative impact on the non-technical skills (including vision, communication, and comfort) as well as a non-significant negative impact on technical skills and decision making of surgeons. Extra efforts should be directed to improve PPE, especially during lengthy pandemics.


Subject(s)
COVID-19/prevention & control , Decision Making , Personal Protective Equipment/standards , Surgeons/psychology , Adult , COVID-19/psychology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Personal Protective Equipment/statistics & numerical data , Saudi Arabia , Surgeons/statistics & numerical data , Surveys and Questionnaires
4.
Anesth Analg ; 133(4): 876-890, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1412364

ABSTRACT

The coronavirus disease 2019 (COVID-19) disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), often results in severe hypoxemia requiring airway management. Because SARS-CoV-2 virus is spread via respiratory droplets, bag-mask ventilation, intubation, and extubation may place health care workers (HCW) at risk. While existing recommendations address airway management in patients with COVID-19, no guidance exists specifically for difficult airway management. Some strategies normally recommended for difficult airway management may not be ideal in the setting of COVID-19 infection. To address this issue, the Society for Airway Management (SAM) created a task force to review existing literature and current practice guidelines for difficult airway management by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. The SAM task force created recommendations for the management of known or suspected difficult airway in the setting of known or suspected COVID-19 infection. The goal of the task force was to optimize successful airway management while minimizing exposure risk. Each member conducted a literature review on specific clinical practice section utilizing standard search engines (PubMed, Ovid, Google Scholar). Existing recommendations and evidence for difficult airway management in the COVID-19 context were developed. Each specific recommendation was discussed among task force members and modified until unanimously approved by all task force members. Elements of Appraisal of Guidelines Research and Evaluation (AGREE) Reporting Checklist for dissemination of clinical practice guidelines were utilized to develop this statement. Airway management in the COVID-19 patient increases HCW exposure risk. Difficult airway management often takes longer and may involve multiple procedures with aerosolization potential, and strict adherence to personal protective equipment (PPE) protocols is mandatory to reduce risk to providers. When a patient's airway risk assessment suggests that awake tracheal intubation is an appropriate choice of technique, and procedures that may cause increased aerosolization of secretions should be avoided. Optimal preoxygenation before induction with a tight seal facemask may be performed to reduce the risk of hypoxemia. Unless the patient is experiencing oxygen desaturation, positive pressure bag-mask ventilation after induction may be avoided to reduce aerosolization. For optimal intubating conditions, patients should be anesthetized with full muscle relaxation. Videolaryngoscopy is recommended as a first-line strategy for airway management. If emergent invasive airway access is indicated, then we recommend a surgical technique such as scalpel-bougie-tube, rather than an aerosolizing generating procedure, such as transtracheal jet ventilation. This statement represents recommendations by the SAM task force for the difficult airway management of adults with COVID-19 with the goal to optimize successful airway management while minimizing the risk of clinician exposure.


Subject(s)
Airway Management/standards , COVID-19/prevention & control , Health Personnel/standards , Infection Control/standards , Personal Protective Equipment/standards , Societies, Medical/standards , Adult , Advisory Committees/standards , Airway Extubation/methods , Airway Extubation/standards , Airway Management/methods , COVID-19/epidemiology , Humans , Infection Control/methods , Intubation, Intratracheal/methods , Intubation, Intratracheal/standards , Practice Guidelines as Topic/standards
5.
West J Emerg Med ; 22(5): 1045-1050, 2021 Aug 17.
Article in English | MEDLINE | ID: covidwho-1405508

ABSTRACT

INTRODUCTION: The coronavirus 2019 (COVID-19) pandemic has reinforced the importance of facial protection against droplet transmission of diseases. Healthcare workers wear personal protection equipment (PPE), including face shields and masks. Plastic face shields may have advantages over regular medical masks. Although many designs of face shields exist, there is a paucity of evidence regarding the efficacy of shield designs against droplet transmissions. There is even less published evidence comparing various face shields. Due to the urgency of the pandemic and the health and safety of healthcare workers, we aimed to study the efficacy of various face shields against droplet transmission. METHODS: We simulated droplet transmission via coughing using a heavy-duty chemical spray bottle filled with fluorescein. A standard-adult sized mannequin head was used. The mannequin head wore various face shields and was positioned to face the spray bottle at either a 0°, 45°, or 90° angle. The spray bottle was positioned at and sprayed from 30 centimeters (cm), 60 cm, or 90 cm away from the head. These steps were repeated for all face shields used. Control was a mannequin that wore no PPE. A basic mask was also tested. We collected data for particle count, total area of particle distribution, average particle size, and percentage area covered by particles. We analyzed percent covered by particles using a repeated measures mixed-model regression with Tukey-Kramer pairwise comparison. RESULTS: We used least square means to estimate the percentage area covered by particles. Wearing PPE regardless of the design reduced particle transmission to the mannequin compared to the control. The LCG mask had the lowest square means of 0.06 of all face-shield designs analyzed. Tukey-Kramer pairwise comparison showed that all PPEs had a decrease in particle contamination compared to the control. LCG shield was found to have the least contamination compared to all other masks (P < 0.05). CONCLUSION: Results suggest the importance of wearing a protective covering against droplet transmission. The LCG shield was found to decrease facial contamination by droplets the most of any tested protective equipment.


Subject(s)
Aerosols/analysis , COVID-19/prevention & control , Infection Control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Inhalation Exposure/prevention & control , Masks/statistics & numerical data , Personal Protective Equipment/statistics & numerical data , COVID-19/epidemiology , Cough , Delivery of Health Care , Humans , Manikins , Masks/standards , Particle Size , Personal Protective Equipment/standards , SARS-CoV-2
6.
PLoS One ; 16(9): e0257064, 2021.
Article in English | MEDLINE | ID: covidwho-1394555

ABSTRACT

The pandemic of Coronavirus disease 2019 (COVID-19) has brought significant pressure on nurses globally as they are the frontline of care. This study aimed to explore the experiences and challenges of nurses who worked with hospitalised patients with COVID-19. In this qualitative study, a purposive sample of 14 nurses participated in in-depth telephone interviews. Data were analysed using Colaizzi's phenomenological method. Five key themes emerged: (1) physical and psychological distress of nurses, (2) willingness to work, (3) the essential role of support mechanisms, (4) educational and informational needs of nurses and (5) the role of modern technology in COVID-19 care. Although the provision of care led to physical and psychological distress among nurses, with their commitment and professional obligation, it is a new experience that leads to personal satisfaction. Guilty feeling related to inefficiency of care, witnessing the suffering of patients, discomfort associated with wearing personal protective equipment (PPE), work-related issues (e.g., long hour shifts), negative impact to the family and rejection by others are the leading distress factors. Religious beliefs, including keeping trust in good and bad merits, have become a strong coping mechanism. Addressing distress among nurses is essential. The reported learning needs of nurses included skills related to donning and doffing PPE, skills in performing nursing procedures and breaking bad news. Nurse managers need to pay special attention to expanding training opportunities as well as support mechanisms, for example, welfare, appreciations and counselling services for nurses. Modern technology, particularly robots and telecommunication, can perform an essential role in COVID-19 care. The establishment of timely policies and strategies to protect health workers during a national disaster like COVID-19 is needed.


Subject(s)
COVID-19/psychology , Nurses/psychology , Nursing Staff, Hospital/psychology , Pandemics , Adaptation, Psychological , Anxiety/epidemiology , Anxiety/psychology , COVID-19/epidemiology , COVID-19/virology , Fear/psychology , Female , Health Personnel/psychology , Humans , Interviews as Topic , Male , Personal Protective Equipment/standards , Psychological Distress , Psychology, Clinical , Robotics/standards , SARS-CoV-2/pathogenicity , Telecommunications
9.
PLoS One ; 15(10): e0240499, 2020.
Article in English | MEDLINE | ID: covidwho-1388890

ABSTRACT

During the current SARS-CoV-2 pandemic there is unprecedented demand for personal protective equipment (PPE), especially N95 respirators and surgical masks. The ability of SARS-CoV-2 to be transmitted via respiratory droplets from asymptomatic individuals has necessitated increased usage of both N95 respirators in the healthcare setting and masks (both surgical and homemade) in public spaces. These precautions rely on two fundamental principles of transmission prevention: particle filtration and droplet containment. The former is the focus of NIOSH N95 testing guidelines, and the latter is an FDA guideline for respirators and surgical masks. While studies have investigated droplet containment to provide guidance for homemade mask production, limited work has been done to characterize the filtration efficiency (FE) of materials used in home mask making. In this work, we demonstrate the low-cost (<$300) conversion of standard equipment used to fit-test respirators in hospital and industrial settings into a setup that measures quantitative FEs of materials based on NIOSH N95 guidelines, and subsequently measure FEs of materials found in healthcare and consumer spaces. These materials demonstrate significant variability in filtration characteristics, even for visually similar materials. We demonstrate a FE of 96.49% and pressure drop of 25.4 mmH20 for a double-layer of sterilization wrap used in surgical suites and a FE of 90.37% for a combination of consumer-grade materials. The excellent filtration characteristics of the former demonstrate potential utility for emergent situations when N95 respirators are not available, while those of the latter demonstrate that a high FE can be achieved using publicly available materials.


Subject(s)
Air Filters/standards , Betacoronavirus , Coronavirus Infections/prevention & control , Equipment Safety/methods , Masks/standards , Materials Testing/methods , Pandemics/prevention & control , Personal Protective Equipment/standards , Pneumonia, Viral/prevention & control , Respiratory Protective Devices/standards , Aerosols , COVID-19 , Coronavirus Infections/virology , Equipment Safety/instrumentation , Health Personnel , Humans , Materials Testing/instrumentation , Occupational Exposure/prevention & control , Pneumonia, Viral/virology , SARS-CoV-2
11.
ACS Nano ; 14(7): 9188-9200, 2020 07 28.
Article in English | MEDLINE | ID: covidwho-1387153

ABSTRACT

Filtration efficiency (FE), differential pressure (ΔP), quality factor (QF), and construction parameters were measured for 32 cloth materials (14 cotton, 1 wool, 9 synthetic, 4 synthetic blends, and 4 synthetic/cotton blends) used in cloth masks intended for protection from the SARS-CoV-2 virus (diameter 100 ± 10 nm). Seven polypropylene-based fiber filter materials were also measured including surgical masks and N95 respirators. Additional measurements were performed on both multilayered and mixed-material samples of natural, synthetic, or natural-synthetic blends to mimic cloth mask construction methods. Materials were microimaged and tested against size selected NaCl aerosol with particle mobility diameters between 50 and 825 nm. Three of the top five best performing samples were woven 100% cotton with high to moderate yarn counts, and the other two were woven synthetics of moderate yarn counts. In contrast to recently published studies, samples utilizing mixed materials did not exhibit a significant difference in the measured FE when compared to the product of the individual FE for the components. The FE and ΔP increased monotonically with the number of cloth layers for a lightweight flannel, suggesting that multilayered cloth masks may offer increased protection from nanometer-sized aerosol with a maximum FE dictated by breathability (i.e., ΔP).


Subject(s)
Coronavirus Infections/prevention & control , Masks/standards , Pandemics/prevention & control , Personal Protective Equipment/standards , Pneumonia, Viral/prevention & control , Respiratory Protective Devices/standards , Textiles/standards , Aerosols/chemistry , Betacoronavirus/pathogenicity , COVID-19 , Filtration , Humans , Masks/virology , Nanoparticles/chemistry , Nanoparticles/virology , Personal Protective Equipment/virology , Respiratory Protective Devices/virology , SARS-CoV-2 , Textiles/adverse effects , Textiles/virology
17.
Natl Med J India ; 33(6): 349-357, 2020.
Article in English | MEDLINE | ID: covidwho-1332193

ABSTRACT

Covid-19 infection has placed health systems under unprecedented strain and foresight for preparedness is the key factor to avert disaster. Every facility that provides obstetric service needs a certain level of preparedness to be able to handle at least Covid-suspect pregnant women awaiting test reports, who need to be managed as Covid-positive patients till reports are available. Thus, these facilities need to have triage areas and Covid-suspect labour rooms. Healthcare facilities can have designated areas for Covid-positive patients or have referral linkages with designated Covid-positive hospitals. Preparation includes structural reorganization with setting up a Covid-suspect and Covid-positive facility in adequate space, as well as extensive training of staff about infection control practices and rational use of personal protective equipment (PPE). A systematic approach involving five essential steps of making standard operating procedures, infrastructural reorganization for a triage area and a Covid-suspect labour ward, procurement of PPE, managing the personnel and instituting appropriate infection control practices can ensure uninterrupted services to patients without compromising the safety of healthcare providers.


Subject(s)
COVID-19/prevention & control , Infection Control/organization & administration , Obstetrics and Gynecology Department, Hospital/organization & administration , Pregnancy Complications, Infectious/prevention & control , Triage/organization & administration , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , COVID-19 Testing/standards , Disinfection/organization & administration , Disinfection/standards , Female , Health Personnel/education , Health Personnel/psychology , Health Personnel/standards , Humans , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Obstetrics and Gynecology Department, Hospital/standards , Occupational Stress/prevention & control , Occupational Stress/psychology , Pandemics/prevention & control , Personal Protective Equipment/standards , Postnatal Care/organization & administration , Postnatal Care/standards , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/virology , SARS-CoV-2/isolation & purification , Triage/standards
19.
Anaesthesia ; 76(12): 1577-1584, 2021 12.
Article in English | MEDLINE | ID: covidwho-1318625

ABSTRACT

Many guidelines consider supraglottic airway use to be an aerosol-generating procedure. This status requires increased levels of personal protective equipment, fallow time between cases and results in reduced operating theatre efficiency. Aerosol generation has never been quantitated during supraglottic airway use. To address this evidence gap, we conducted real-time aerosol monitoring (0.3-10-µm diameter) in ultraclean operating theatres during supraglottic airway insertion and removal. This showed very low background particle concentrations (median (IQR [range]) 1.6 (0-3.1 [0-4.0]) particles.l-1 ) against which the patient's tidal breathing produced a higher concentration of aerosol (4.0 (1.3-11.0 [0-44]) particles.l-1 , p = 0.048). The average aerosol concentration detected during supraglottic airway insertion (1.3 (1.0-4.2 [0-6.2]) particles.l-1 , n = 11), and removal (2.1 (0-17.5 [0-26.2]) particles.l-1 , n = 12) was no different to tidal breathing (p = 0.31 and p = 0.84, respectively). Comparison of supraglottic airway insertion and removal with a volitional cough (104 (66-169 [33-326]), n = 27), demonstrated that supraglottic airway insertion/removal sequences produced <4% of the aerosol compared with a single cough (p < 0.001). A transient aerosol increase was recorded during one complicated supraglottic airway insertion (which initially failed to provide a patent airway). Detailed analysis of this event showed an atypical particle size distribution and we subsequently identified multiple sources of non-respiratory aerosols that may be produced during airway management and can be considered as artefacts. These findings demonstrate supraglottic airway insertion/removal generates no more bio-aerosol than breathing and far less than a cough. This should inform the design of infection prevention strategies for anaesthetists and operating theatre staff caring for patients managed with supraglottic airways.


Subject(s)
Airway Extubation/standards , Environmental Monitoring/standards , Intubation, Intratracheal/standards , Operating Rooms/standards , Particle Size , Supraglottitis/therapy , Airway Extubation/methods , Airway Management/methods , Airway Management/standards , Cough/therapy , Environmental Monitoring/methods , Humans , Intubation, Intratracheal/methods , Operating Rooms/methods , Personal Protective Equipment/standards , Prospective Studies
20.
Isr J Health Policy Res ; 10(1): 41, 2021 07 19.
Article in English | MEDLINE | ID: covidwho-1317128

ABSTRACT

OBJECTIVES: Coronavirus Disease 2019 (COVID-19) is a highly infectious viral pandemic that has claimed the lives of millions. Personal protective equipment (PPE) may reduce the risk of transmission for health care workers (HCWs), especially in the emergency setting. This study aimed to compare the adherence to PPE donning and doffing protocols in the Emergency Department (ED) vs designated COVID-19 wards and score adherence according to the steps in our protocol. DESIGN: Prior to managing COVID-19 patients, mandatory PPE training was undertaken for all HCWs. HCWs were observed donning or doffing COVID-19 restricted areas. SETTING: Donning and doffing was observed in COVID-19 designated Emergency department and compared to COVID-19 positive wards. PARTICIPANTS: All HCWs working in the aforementioned wards during the time of observation. RESULTS: We observed 107 donning and doffing procedures (30 were observed in the ED). 50% HCWs observed donned PPE correctly and 37% doffed correctly. The ED had a significantly lower mean donning score (ED: 78%, Internal: 95% ICU: 96%, p < 0.001); and a significantly lower mean doffing score (ED: 72%, Internal: 85% ICU: 91%, p = 0.02). CONCLUSIONS: As hypothesized, HCWs assigned to the designated ED wing made more protocol deviations compared with HCWs positive COVID-19 wards. Time management, acuity, lack of personnel, stress and known COVID-19 status may explain the lesser adherence to donning and doffing protocols. Further studies to assess the correlation between protocol deviations in use of PPE and morbidity as well as improvement implementations are required. Resources should be invested to ensure PPE is properly used.


Subject(s)
COVID-19/prevention & control , Emergency Service, Hospital/standards , Health Personnel/statistics & numerical data , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Personal Protective Equipment/statistics & numerical data , Guideline Adherence/statistics & numerical data , Humans , Infection Control/methods , Infection Control/standards , Israel , Personal Protective Equipment/standards , Personnel, Hospital/standards , Personnel, Hospital/statistics & numerical data
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