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BMJ Case Rep ; 14(2)2021 Feb 17.
Article in English | MEDLINE | ID: covidwho-1088211


Placement of a double-lumen tube to achieve one lung ventilation is an aerosol-generating procedure. Performing it on a patient with COVID-19 will put healthcare workers at high risk of contracting the disease. We herein report a case of its use in a patient with traumatic diaphragmatic rupture, who was also suspected to have COVID-19. This article aims to highlight the issues, it presented and ways to address them as well as the perioperative impact of personal protective equipment.

/prevention & control , Health Personnel/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , One-Lung Ventilation/standards , Personal Protective Equipment/standards , Accidents, Traffic , Adult , /transmission , Diaphragm/injuries , Diaphragm/surgery , Humans , Male , One-Lung Ventilation/instrumentation , Practice Guidelines as Topic , /etiology , Rupture/etiology , Rupture/therapy
Int J Environ Res Public Health ; 18(4)2021 02 08.
Article in English | MEDLINE | ID: covidwho-1079658


BACKGROUND: During the SARS-CoV-2 pandemic, there was shortage of the standard respiratory protective equipment (RPE). The aim of this study was to develop a procedure to test the performance of alternative RPEs used in the care of COVID-19 patients. METHODS: A laboratory-based test was developed to compare RPEs by total inward leakage (TIL). We used a crossflow nebulizer to produce a jet spray of 1-100 µm water droplets with a fluorescent marker. The RPEs were placed on a dummy head and sprayed at distances of 30 and 60 cm. The outcome was determined as the recovery of the fluorescent marker on a membrane filter placed on the mouth of the dummy head. RESULTS: At 30 cm, a type IIR surgical mask gave a 17.7% lower TIL compared with an FFP2 respirator. At 60 cm, this difference was similar, with a 21.7% lower TIL for the surgical mask compared to the respirator. When adding a face shield, the TIL at 30 cm was further reduced by 9.5% for the respirator and 16.6% in the case of the surgical mask. CONCLUSIONS: A safe, fast and very sensitive test method was developed to assess the effectiveness of RPE by comparison under controlled conditions.

/prevention & control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Masks/standards , Personal Protective Equipment/standards , Respiratory Protective Devices/standards , Aerosols/adverse effects , Humans , Occupational Exposure/prevention & control , Ventilators, Mechanical , Water
Br J Nurs ; 30(1): 16-22, 2021 Jan 14.
Article in English | MEDLINE | ID: covidwho-1068040


BACKGROUND: On 11 March 2020, the World Health Organization (WHO) declared a global pandemic in the wake of the coronavirus disease 2019 (COVID-19) outbreak. The unpredictable nature of transmission of COVID-19 requires a meticulous understanding of guidance on personal protective equipment (PPE) as published by WHO and Public Health England (PHE). AIM: To assess perceived confidence and knowledge of PHE guidance relating to PPE by nursing staff. METHODS: A nationwide survey was disseminated between May and June 2020 through social media platforms as well as internal mail via regulatory bodies and individual hospital trusts. RESULTS: Data were collated from 339 nurses. Perceived confidence as measured on a Likert scale was a mode score of 3/5, with the average score for knowledge-based questions being 5/10. Of the respondents, 47% cited insufficient training on PPE guidance, and 84% advocated further training. Conclusions: Unifying published PPE guidance and ensuring consistency in training can improve awareness, confidence, and knowledge among nursing staff.

Attitude of Health Personnel , Health Knowledge, Attitudes, Practice , Nursing , Personal Protective Equipment/standards , Guidelines as Topic , Humans , Self Report
Health Sociol Rev ; 29(2): 158-167, 2020 07.
Article in English | MEDLINE | ID: covidwho-1066140


Shortages of personal protective equipment (PPE) and medical devices needed during the COVID-19 pandemic were widely reported in early 2020. In response, civic DIY volunteers explored how they could produce the required equipment. Members of communities such as hacker- and makerspaces employed their skills and tools to manufacture, for example, face shields and masks. The article discusses these civic innovation practices and their broader social implications by relating them to critical making theory. Methodologically, it is based on a digital ethnography approach, focusing on hacker and maker communities in the UK. Communities' DIY initiatives display characteristics of critical making and 'craftivism', as they assessed and counteracted politicised healthcare supply shortages. It is argued that their manufacturing activities during the COVID pandemic relate to UK austerity politics' effects on healthcare and government failure to ensure medical crisis supplies. Facilitated by open source design, communities' innovation enabled healthcare emergency equipment. At the same time, their DIY manufacturing raises practical as well as ethical issues concerning, among other things, efficacy and safety of use.

/prevention & control , Masks/supply & distribution , Personal Protective Equipment/supply & distribution , Protective Devices , Equipment Design , Humans , Masks/standards , Personal Protective Equipment/standards , Private Sector
AANA J ; 89(1): 71-75, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1049350


The ongoing coronavirus disease 2019 (COVID-19) pandemic has created many changes and difficulties in healthcare, and the anesthesia specialty is no exception. Both the increased need for personal protective equipment (PPE) and the potential for infection and contamination through respiratory droplets have been sources of much concern. Policies and protocols have been adapted worldwide to help neutralize infection risk and exposure. Transmission of the virus to healthcare workers has been a major concern, and the risk of infection is exceptionally high for Certified Registered Nurse Anesthetists (CRNAs) because of their close contact with infected patients. CRNAs are in a unique position to help decrease exposure for themselves and other members of the healthcare team by taking extra precautions during airway manipulation. A great deal of focus has been placed on reducing risks during intubation, but reports describing methods of reducing contamination and exposure to respiratory droplets during emergence and extubation are scarce. The authors have reviewed techniques to reduce coughing, thereby decreasing the potential of virus exposure through contact with large respiratory droplets and aerosolized particles that may remain suspended in air.

/prevention & control , Health Personnel/psychology , Infection Control/methods , Infection Control/standards , Operating Rooms/standards , Pandemics/prevention & control , Personal Protective Equipment/standards , Attitude of Health Personnel , Guidelines as Topic , Humans , Infection Control/statistics & numerical data , Personal Protective Equipment/statistics & numerical data
Front Public Health ; 8: 575029, 2020.
Article in English | MEDLINE | ID: covidwho-1045489


In March 2020, northern Italy became the second country worldwide most affected by Covid-19 and the death toll overtook that in China. Hospital staff soon realized that Covid-19 was far more severe than expected from the few data available at that time. The Covid-19 pandemic forced hospitals to adjust to rapidly changing circumstances. We report our experience in a general teaching hospital in Milan, the capital of Lombardy, the most affected area in Italy. First, we briefly describe Lombardy's regional Covid-19-related health organizational changes as well as general hospital reorganization. We also provide a multidisciplinary report of the main clinical, radiological and pathological Covid-19 findings we observed in our patients.

/epidemiology , Hospitals, University/organization & administration , Organizational Innovation , Patient Care Team/standards , Personal Protective Equipment/standards , /pathology , Humans , Italy , Patient Care Team/organization & administration
Rev. enferm. UERJ ; 28: e51476, jan.-dez. 2020.
Article in English, Portuguese | LILACS (Americas) | ID: covidwho-1016414


Objetivo: desenvolver um modelo de máscara de tecido, com aplicação do elemento filtrante em celulose, para fins de utilização como barreira física segura para aerossóis, como estratégia de resposta emergencial à pandemia provocada pelo SARS-CoV-2. Método: pesquisa laboratorial realizada por meio de protótipos, testagens empíricas e análises e discussões junto a expertises. Resultados: a condução da pesquisa demonstrou que os aerossóis são retidos pela barreira física de celulose introduzida à estrutura das máscaras, o que motivou a segunda fase do estudo em unidade da Rede Brasileira de Laboratórios Analíticos de Saúde sobre a eficácia desses materiais. Conclusão: a confecção de máscaras de tecido é um fenômeno mundial importante e urgente frente à pandemia da COVID-19. Em função da crise de abastecimento e dos parâmetros ressaltados neste estudo, acredita-se que o uso desse equipamento possa ser estendido a setores não críticos de unidades de saúde, além da população em geral.

Objective: to develop a model of fabric mask, with the application of a cellulose filter element, for use as a safe physical barrier for aerosols, as an emergency response strategy for the SARS-CoV-2 pandemic. Method: laboratory research carried out by means of prototypes, empirical tests and analyses, and discussions with experts. Results: the research demonstrated that aerosols are retained by the physical cellulose barrier introduced into the structure of the masks, which motivated the second phase of the study into the effectiveness of these materials at a unit of the Brazilian Analytical Health Laboratories Network. Conclusion: the making of fabric masks is an important and urgent worldwide phenomenon in tackling the COVID-19 pandemic. In view of the supply crisis and the parameters highlighted in this study, it is believed that the use of this equipment can be extended to non-critical sectors of health units, as well as to the general population.

Objetivo: desarrollar un modelo de mascarilla de tela, con la aplicación de un elemento filtrante de celulosa, para su uso como barrera física segura para aerosoles, como estrategia de respuesta de emergencia para la pandemia SARS-CoV-2. Método: investigación de laboratorio realizada mediante prototipos, pruebas y análisis empíricos y discusiones con expertos. Resultados: la investigación demostró que los aerosoles son retenidos por la barrera física de celulosa introducida en la estructura de las máscaras, lo que motivó la segunda fase del estudio sobre la efectividad de estos materiales en una unidad de la Red Brasileña de Laboratorios Analíticos de Salud. Conclusión: la fabricación de máscaras de tela es un fenómeno mundial importante y urgente para hacer frente a la pandemia de COVID-19. Ante la crisis de oferta y los parámetros resaltados en este estudio, se cree que el uso de este equipamiento puede extenderse a sectores no críticos de las unidades de salud, así como a la población en general.

Humans , Coronavirus Infections/prevention & control , Personal Protective Equipment/standards , Betacoronavirus , Masks/standards , Materials Testing , Brazil , Cellulose , Filters , Surge Capacity , Pandemics/prevention & control
Future Microbiol ; 16: 5-11, 2021 01.
Article in English | MEDLINE | ID: covidwho-993128


Aim: Face masks are an important addition to our arsenal in the fight against COVID-19. The aim of this study is to present a novel method of measuring mask performance which can simultaneously assess both fabric penetration and leakage due to poor fit. Materials & methods: A synthetic aerosol is introduced into the lung of a medical dummy. A conical laser sheet surrounds the face of the dummy where it illuminates the aerosol emitted during a simulated breath. The system is demonstrated with five mask types. Conclusions: The curved laser sheet highlights both penetration through the mask fabric and leakage around the edges of the mask. A large variation in both material penetration and leakage was observed.

/prevention & control , Masks/standards , Textiles , Aerosols/analysis , Clothing , Equipment Design , Humans , Materials Testing , Particle Size , Personal Protective Equipment/standards , Sodium Chloride
Int J Dermatol ; 60(3): 327-331, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-977494


BACKGROUND: Coronavirus Disease 2019 (COVID-19) is a viral illness caused by the novel coronavirus SARS-CoV-2 which spreads via droplets from an infected person. There has been an unprecedented rise in the use of personal protective equipment and practice of personal hygiene measures against COVID-19. The extended use of protective measures (PM) can lead to ill effects on the skin. Our aim was to investigate PM-induced dermatoses amongst healthcare workers and the general population during the COVID-19 pandemic. METHODS: A cross-sectional study was conducted over a period of 2 months. The study subjects were patients who presented to dermatology outpatient clinics or sought teleconsultation for skin problems related to the use of PMs against COVID-19. A detailed history was obtained and cutaneous examination was documented for all the patients in a pre-set proforma. Diagnoses of the adverse skin effects were formulated based upon history and clinical examination. RESULTS: A total of 101 cases with cutaneous adverse effects due to the use of PMs against COVID-19 were included in the study. The general population and healthcare workers were affected similarly, comprising of 54.5% and 45.5%, respectively. The mean age of the study participants was 36.71 ± 15.72 years. The most common culprit material was soap and water (56.4%). Contact dermatitis was found to be the most common adverse effect in the majority of our patients (72.3%). The most common symptom reported was pruritus (45.5%). The wearing of personal protective equipment for a longer duration was significantly associated with multiple symptoms (P = 0.026). CONCLUSION: The enhanced use of different PMs against COVID-19 can result in a variety of adverse skin effects. In our study, the use of soap and water was the most common culprit PM, and contact dermatitis was the most common adverse effect noted.

/prevention & control , Dermatitis, Contact/epidemiology , Dermatitis, Occupational/epidemiology , Hand Hygiene/standards , Pandemics/prevention & control , Personal Protective Equipment/adverse effects , Adult , /transmission , Communicable Disease Control/instrumentation , Communicable Disease Control/standards , Cross-Sectional Studies , Dermatitis, Contact/etiology , Dermatitis, Occupational/etiology , Female , Hand Hygiene/methods , Humans , Male , Middle Aged , Personal Protective Equipment/standards , Soaps/adverse effects , Young Adult
J Occup Environ Hyg ; 18(2): 72-83, 2021 02.
Article in English | MEDLINE | ID: covidwho-975161


Simple plastic face shields have numerous practical advantages over regular surgical masks. In light of the spreading COVID-19 pandemic, the potential of face shields as a substitution for surgical masks was investigated. In order to determine the efficacy of the protective equipment we used a cough simulator. The protective equipment considered was placed on a manikin head that simulated human breathing. Concentration and size distribution of small particles that reached the manikin respiration pathways during the few tens of seconds following the cough event were monitored. Additionally, water sensitive papers were taped on the tested protective equipment and the manikin face. In the case of frontal exposure, for droplet diameter larger than 3 µm, the shield efficiency in blocking cough droplets was found to be comparable to that of regular surgical masks, with enhanced protection for portions of the face that the mask does not cover. Additionally, for finer particles, down to 0.3 µm diameter, a shield blocked about 10 times more fine particles than the surgical mask. When exposure from the side was considered, the performance of the shield was found to depend dramatically on its geometry. While a narrow shield allowed more droplets and aerosol to penetrate in comparison to a mask under the same configuration, a slightly wider shield significantly improved the performance. The source control potential of shields was also investigated. A shield, and alternatively, a surgical mask, were placed on the cough simulator, while the breathing simulator, situated 60 cm away in the jet direction, remained totally exposed. In both cases, no droplets or particles were found in the vicinity of the breathing simulator. Conducted experiments were limited to short time periods after expiratory events, and do not include longer time ranges associated with exposure to suspended aerosol. Thus, additional evidence regarding the risk posed by floating aerosol is needed to establish practical conclusions regarding actual transmittance reduction potential of face shields and surgical face masks.

/prevention & control , Inhalation Exposure/analysis , Masks/standards , Personal Protective Equipment/standards , /isolation & purification , Aerosols/analysis , Air Microbiology , Cough/virology , Environmental Monitoring , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Inhalation Exposure/prevention & control , Materials Testing , Occupational Exposure/analysis , Occupational Exposure/prevention & control
J Clin Gastroenterol ; 54(10): 833-840, 2020.
Article in English | MEDLINE | ID: covidwho-963399


Performance of endoscopic procedures is associated with a risk of infection from COVID-19. This risk can be reduced by the use of personal protective equipment (PPE). However, shortage of PPE has emerged as an important issue in managing the pandemic in both traditionally high and low-resource areas. A group of clinicians and researchers from thirteen countries representing low, middle, and high-income areas has developed recommendations for optimal utilization of PPE before, during, and after gastrointestinal endoscopy with particular reference to low-resource situations. We determined that there is limited flexibility with regard to the utilization of PPE between ideal and low-resource settings. Some compromises are possible, especially with regard to PPE use, during endoscopic procedures. We have, therefore, also stressed the need to prevent transmission of COVID-19 by measures other than PPE and to conserve PPE by reduction of patient volume, limiting procedures to urgent or emergent, and reducing the number of staff and trainees involved in procedures. This guidance aims to optimize utilization of PPE and protection of health care providers.

Coronavirus Infections/prevention & control , Endoscopy, Gastrointestinal/economics , Health Resources/economics , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Personal Protective Equipment/standards , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Coronavirus Infections/epidemiology , Endoscopy, Gastrointestinal/statistics & numerical data , Female , Gastroenterology/standards , Global Health , Humans , Infection Control/organization & administration , Internationality , Male , Occupational Health/statistics & numerical data , Pandemics/statistics & numerical data , Personal Protective Equipment/statistics & numerical data , Pneumonia, Viral/epidemiology , Poverty , Societies, Medical
Antimicrob Resist Infect Control ; 9(1): 185, 2020 11 10.
Article in English | MEDLINE | ID: covidwho-917950


BACKGROUND: Prehospital professionals such as emergency physicians or paramedics must be able to choose and adequately don and doff personal protective equipment (PPE) in order to avoid COVID-19 infection. Our aim was to evaluate the impact of a gamified e-learning module on adequacy of PPE in student paramedics. METHODS: This was a web-based, randomized 1:1, parallel-group, triple-blind controlled trial. Student paramedics from three Swiss schools were invited to participate. They were informed they would be presented with both an e-learning module and an abridged version of the current regional prehospital COVID-19 guidelines, albeit not in which order. After a set of 22 questions designed to assess baseline knowledge, the control group was shown the guidelines before answering a set of 14 post-intervention questions. The e-learning group was shown the gamified e-learning module right after the guidelines, and before answering post-intervention questions. The primary outcome was the difference in the percentage of adequate choices of PPE before and after the intervention. RESULTS: The participation rate was of 71% (98/138). A total of 90 answer sets was analyzed. Adequate choice of PPE increased significantly both in the control (50% [33;83] vs 25% [25;50], P = .013) and in the e-learning group (67% [50;83] vs 25% [25;50], P = .001) following the intervention. Though the median of the difference was higher in the e-learning group, there was no statistically significant superiority over the control (33% [0;58] vs 17% [- 17;42], P = .087). The e-learning module was of greatest benefit in the subgroup of student paramedics who were actively working in an ambulance company (42% [8;58] vs 25% [- 17;42], P = 0.021). There was no significant effect in student paramedics who were not actively working in an ambulance service (0% [- 25;33] vs 17% [- 8;50], P = .584). CONCLUSIONS: The use of a gamified e-learning module increases the rate of adequate choice of PPE only among student paramedics actively working in an ambulance service. In this subgroup, combining this teaching modality with other interventions might help spare PPE and efficiently protect against COVID-19 infection.

Betacoronavirus/physiology , Coronavirus Infections/prevention & control , Health Personnel/education , Pandemics/prevention & control , Personal Protective Equipment , Pneumonia, Viral/prevention & control , Adult , Allied Health Personnel/education , Allied Health Personnel/standards , Betacoronavirus/genetics , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Education, Distance/statistics & numerical data , Europe , Female , Health Personnel/standards , Humans , Infectious Disease Transmission, Patient-to-Professional , Internet , Knowledge , Learning , Male , Personal Protective Equipment/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Students/psychology , Young Adult
Rev. cir. (Impr.) ; 72(5): 449-454, oct. 2020. tab, ilus
Article in Spanish | LILACS (Americas) | ID: covidwho-895935


Resumen El nuevo coronavirus (SARS-CoV-2), causante de la enfermedad COVID-19, es una pandemia con alta morbimortalidad mundial. Uno de los factores más importantes es su alta tasa de transmisibilidad por gotitas, aerosoles y fómites. La tendencia actual es el aumento progresivo de pacientes contagiados en nuestro país y, por consiguiente, de mayor cantidad de enfermos en unidades de cuidados intensivos (UCI) con uso de ventilación mecánica invasiva (VMI). La traqueostomía (TQT) se utiliza en pacientes críticos para facilitar la VMI a largo plazo y el destete de la ventilación. Una TQT temprana, definida como la realizada en los primeros 7 días después de la intubación orotraqueal (IOT), se asocia a una reducción en el tiempo de la VMI, mortalidad y permanencia en UCI. La TQT es una técnica quirúrgica con alta generación de aerosoles la cual implica medidas especiales frente a la realización de ésta en pacientes con COVID-19. Para limitar el contagio del SARS-CoV-2 en los trabajadores de salud es necesario el uso de elementos de protección personal (EPP) adecuados según la intervención a realizar. Es por esta razón que en el presente artículo se propone utilizar el acrónimo C-O-RO-NA para no olvidar elementos y pasos fundamentales al momento de realizar esta técnica, minimizando de esta manera el contagio en los trabajadores de salud.

The new coronavirus (SARS-CoV-2), which causes COVID-19 disease, is a high mortality pandemic illness. One of the most important factors is its high rate of transmissibility by respiratory droplets, aerosols and fomites. The reigning trend of this disease is progressively increasing infected patients in our country, therefore, more patients in intensive care units (ICU) with invasive mechanical ventilation (IMV). Tracheostomy (TQT) is used in critical patients to facilitate long-term IMV and ventilation weaning. An early TQT, defined as performed in the first 7 days after orotracheal intubation (IOT) is associated with a reduction IMV duration, mortality rate and length of stay in ICU. TQT is a surgical procedure which generates a huge amount of aerosols that need special measures to perform in COVID-19 patients. It is necessary to use appropriate personal protection elements (PPE) according to the intervention, limiting the spread of SARS-CoV-2 in health workers. It is for this reason that this article proposes to use the acronym C-O-RO-NA to remember fundamental elements and steps when performing this technique in order to minimize health workers infection.

Humans , Pneumonia, Viral/prevention & control , Tracheostomy/methods , Coronavirus Infections/prevention & control , Surgical Procedures, Operative/standards , Clinical Protocols , Pandemics , Personal Protective Equipment/standards , Betacoronavirus
J Otolaryngol Head Neck Surg ; 49(1): 76, 2020 Oct 26.
Article in English | MEDLINE | ID: covidwho-892373


The novel Coronavirus (COVID-19) has created a worldwide deadly pandemic that has become a major public health challenge. All semi-urgent and elective medical care has come to a halt to conserve capacity to care for patients during this pandemic. As the numbers of COVID-19 cases decrease across Canada, our healthcare system also began to reopen various facilities and medical offices. The aim for this document is to compile the current evidence and provide expert consensus on the safe return to clinic practice in Otolaryngology - Head & Neck Surgery. These recommendations will also summarize general precaution principles and practical tips for office across Canada to optimize patient and provider safety. Risk assessment and patient selection are crucial to minimizing exposure to COVID-19. Controversial topics such as COVID-19 mode of transmission, duration of exposure, personal protective equipment, and aerosol-generating procedures will be analyzed and discussed. Practical solutions of pre-visit office preparation, front office and examination room set-up, and check out procedures are explored. Specific considerations for audiology, pediatric population, and high risk AGMPs are also addressed. Given that the literature surrounding COVID-19 is rapidly evolving, these guidelines will serve to start our specialty back into practice over the next weeks to months and they may change as we learn more about this disease.

Betacoronavirus , Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Otolaryngology , Otorhinolaryngologic Surgical Procedures/standards , Personal Protective Equipment/standards , Pneumonia, Viral/epidemiology , Societies, Medical , Canada/epidemiology , Coronavirus Infections/transmission , Humans , Pandemics , Pneumonia, Viral/transmission