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Br J Radiol ; 95(1129): 20210835, 2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-1575206


OBJECTIVE: To evaluate the efficacy of a barrier shield in reducing droplet transmission and its effect on image quality and radiation dose in an interventional suite. METHODS: A human cough droplet visualisation model in a supine position was developed to assess efficacy of barrier shield in reducing environmental contamination. Its effect on image quality (resolution and contrast) was evaluated via image quality test phantom. Changes in the radiation dose to patient post-shield utilisation was measured. RESULTS: Use of the shield prevented escape of visible fluorescent cough droplets from the containment area. No subjective change in line-pair resolution was observed. No significant difference in contrast-to-noise ratio was measured. Radiation dosage to patient was increased; this is predominantly attributed to the increased air gap and not the physical properties of the shield. CONCLUSION: Use of the barrier shield provided an effective added layer of personal protection in the interventional radiology theatre for aerosol generating procedures. ADVANCES IN KNOWLEDGE: This is the first time a human supine cough droplet visualisation has been developed. While multiple types of barrier shields have been described, this is the first systematic practical evaluation of a barrier shield designed for use in the interventional radiology theatre.

Infectious Disease Transmission, Patient-to-Professional/prevention & control , Protective Devices , Radiology, Interventional/instrumentation , Adult , COVID-19/transmission , Cough , Equipment Design , Fluorescence , Humans , Male , Phantoms, Imaging , Radiation Dosage , Signal-To-Noise Ratio , Supine Position
Curr Opin Ophthalmol ; 31(5): 374-379, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1511065


PURPOSE OF REVIEW: The use of slit lamp shields has been recommended by the American Academy of Ophthalmology as an infection control measure during the coronavirus disease 2019 pandemic. However, there is limited evidence regarding its efficacy to reduce viral transmission risks. We aim to provide an evidence-based approach to optimize the use of slit lamp shields during clinical examination. RECENT FINDINGS: Respiratory droplets from coughing and sneezing can travel up to 50 m/s and over a distance of 2 m, with a potential area of spread of 616 cm. Slit lamp shields confer added protection against large droplets but are limited against smaller particles. A larger shield curved toward the ophthalmologist and positioned closer to the patient increases protection against large droplets. A potential improvement to the design of such shields is the use of hydrophilic materials with antiviral properties which may help to minimize splashing of infectious droplets, reducing transmission risks. These include gold or silver nanoparticles and graphene oxide. SUMMARY: Slit lamp shields serve as a barrier for large droplets, but its protection against smaller droplets is undetermined. It should be large, positioned close to the patient, and used in tandem with routine basic disinfection practices.

Betacoronavirus , Coronavirus Infections/transmission , Infection Control/instrumentation , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pneumonia, Viral/transmission , Protective Devices , Slit Lamp , COVID-19 , Humans , Infection Control/methods , Pandemics , SARS-CoV-2
PLoS One ; 16(3): e0249098, 2021.
Article in English | MEDLINE | ID: covidwho-1477519


BACKGROUND: Nursing homes (NH) for the elderly have been particularly affected by the Covid-19 pandemic mainly due to their hosted vulnerable populations and poor outbreak preparedness. In Belgium, the medical humanitarian organization Médecins Sans Frontières (MSF) implemented a support project for NH including training on infection prevention and control (IPC), (re)-organization of care, and psychosocial support for NH staff. As psychosocial and mental health needs of NH residents in times of Covid-19 are poorly understood and addressed, this study aimed to better understand these needs and how staff could respond accordingly. METHODS: A qualitative study adopting thematic content analysis. Eight focus group discussions with direct caring staff and 56 in-depth interviews with residents were conducted in eight purposively and conveniently selected NHs in Brussels, Belgium, June 2020. RESULTS: NH residents experienced losses of freedom, social life, autonomy, and recreational activities that deprived them of their basic psychological needs. This had a massive impact on their mental well-being expressed in feeling depressed, anxious, and frustrated as well as decreased meaning and quality of life. Staff felt unprepared for the challenges posed by the pandemic; lacking guidelines, personal protective equipment and clarity around organization of care. They were confronted with professional and ethical dilemmas, feeling 'trapped' between IPC and the residents' wellbeing. They witnessed the detrimental effects of the measures imposed on their residents. CONCLUSION: This study revealed the insights of residents' and NH staff at the height of the early Covid-19 pandemic. Clearer outbreak plans, including psychosocial support, could have prevented the aggravated mental health conditions of both residents and staff. A holistic approach is needed in NHs in which tailor-made essential restrictive IPC measures are combined with psychosocial support measures to reduce the impact on residents' mental health impact and to enhance their quality of life.

COVID-19/pathology , Nursing Staff/psychology , Quality of Life , Vulnerable Populations/psychology , Aged , Aged, 80 and over , Anxiety/etiology , COVID-19/virology , Depression/etiology , Female , Focus Groups , Humans , Interviews as Topic , Male , Middle Aged , Nursing Homes , Personal Autonomy , Protective Devices/supply & distribution , Quarantine , SARS-CoV-2
Texto & contexto enferm ; 30: e20200561, 2021. tab, graf
Article in English | LILACS (Americas) | ID: covidwho-1341550


ABSTRACT Objective: to describe the process for the elaboration and validation of a digital educational booklet intended for health professionals on the correct use of Personal Protective Equipment in the context of COVID-19. Method: a methodological study conducted between June and September 2020, operationalized in three stages: 1ststage: bibliographic survey; 2ndstage: elaboration of the booklet with the graphic designer to help in the development process of the technology; 3rdstage: content validation of the booklet by specialists through the Delphi technique. The validation was performed by 35 health and biology professionals and the local for selection of these was the Lattes Platform, using the Delphi technique in two rounds. The Content Validation Index was considered an acceptance criterion, with an agreement ≥ 0.78 among the judges being considered a good level. Results: the first version of the booklet obtained a global Content Validation Index of 0.79. There were suggestions for improvement that were accepted and, after the Delphi 2 phase, there was the resubmission of the booklet; it presented a global Content Validation Index of 0.99. Conclusion: the booklet was validated regarding its content and is compatible with its intended purpose, being important for the promotion of knowledge about the correct procedure to put on this equipment so that prevention measures are effective and shared.

RESUMEN Objetivo: describir el proceso de elaboración y validación de una cartilla educativa digital sobre el uso correcto de Equipamos de Protección Personal en el contexto de COVID-19, destinada a los profesionales de la salud. Método: estudio metodológico realizado entre junio y septiembre de 2020, efectivizado en tres etapas: 1ª etapa: levantamiento bibliográfico; 2ª etapa: elaboración de la cartilla junto al diseñador gráfico para asistir en el proceso de desarrollo de la tecnología; 3ª etapa: validación del contenido de la cartilla a cargo de especialistas, a través de la técnica Delphi. La validación fue realizada por 35 profesionales de la salud y de biología, con Plataforma Lattes como lugar elegido para su selección, utilizando la técnica Delphi en dos rondas. Se consideró el Índice de Validez de Contenido como criterio de aceptación, con un grado de acuerdo ≥ 0,78 entre los jueces, considerándose un buen nivel. Resultados: la primera versión de la cartilla obtuve un Índice de Validez de Contenido global de 0,79. Se presentaron sugerencia de mejora que fueron aceptadas y, después de la fase Delphi 2, en la cual se volvió a presentar la cartilla para su evaluación, la misma presentó un Índice de Validez de Contenido global de 0,99. Conclusión: la cartilla fue validada en relación a su contenido y es compatible con el fin para el cual fue prevista, siendo importante la promoción del conocimiento sobre el manejo correcto de estos equipos para que las medidas de prevención sean efectivas y compartidas.

RESUMO Objetivo: descrever o processo de construção e validação de uma cartilha educativa digital destinada aos profissionais de saúde sobre o uso correto de Equipamentos de Proteção Individual no contexto da COVID-19. Método: estudo metodológico, realizado entre junho e setembro 2020, operacionalizado em três etapas: 1ª etapa: levantamento bibliográfico; a 2ª etapa: elaboração da cartilha junto ao designer gráfico para auxiliar no processo de desenvolvimento da tecnologia; 3ª etapa: validação de conteúdo da cartilha por especialistas, através da técnica Delphi. A validação foi realizada por 35 profissionais da saúde e da biologia, tendo como local para seleção destes a Plataforma Lattes, utilizando a técnica de Delphi em duas rodadas. Considerou-se o Índice de Validade de Conteúdo como critério de aceitação, com a concordância ≥ 0,78 entre os juízes, sendo um nível considerado bom. Resultados: a primeira versão da cartilha obteve Índice de Validade de Conteúdo global de 0,79. Houve sugestões de melhoria que foram acatadas e, após a fase Delphi 2, onde ocorreu a ressubmissão da cartilha, ela apresentou Índice de Validade de Conteúdo global de 0,99. Conclusão: a cartilha foi validada quanto ao seu conteúdo e é compatível com o fim a que se propõe, sendo importante a promoção do conhecimento sobre a paramentação correta destes equipamentos para que as medidas de prevenção sejam efetivas e compartilhadas.

Humans , Adult , Middle Aged , Protective Devices , Nursing Methodology Research , Health Education , Coronavirus Infections , Validation Study
Prim Care Companion CNS Disord ; 23(4)2021 07 08.
Article in English | MEDLINE | ID: covidwho-1302621


Objective: To investigate the impact of masks and plastic partitions on patient-doctor communication and subjective anxiety for infection in patients with psychiatric disorders.Methods: Subjects were patients who visited a psychiatric clinic in Japan from April 27 to August 31, 2020. Anxiety of being infected and the psychological barrier to communication were evaluated on a 5-point scale.Results: The final analysis included 425 patients. Most participants answered that there was no change with regard to communication when the doctor was wearing a mask (n = 353, 91.0%) or using a plastic partition (n = 318, 82.8%). Most participants responded that anxiety for being infected was very mild, a little mild, or not changed by the doctor wearing a mask and using a plastic partition. Most participants felt significantly less anxiety with the doctor wearing a mask/using a plastic partition before than after the state of emergency declaration (P = .005 for mask and P < .001 for plastic partition). Participants in the older age range felt significantly higher anxiety compared to those in the younger and middle age range groups from doctors wearing masks (P < .001) and compared to those in the middle age range group from plastic partitions (P = .001).Conclusions: Use of masks and plastic partitions in psychiatric practice is recommended, as it may result in reduction of anxiety for infection without affecting patient-doctor communication in patients with psychiatric disorders. The generalizability of the results of the present study should be tested.

Anxiety/psychology , Attitude to Health , COVID-19/prevention & control , Communicable Disease Control , Masks , Mentally Ill Persons/psychology , Physician-Patient Relations , Protective Devices , Adolescent , Adult , Aged , Female , Hospitals, Psychiatric , Humans , Male , Middle Aged , Outpatient Clinics, Hospital , Young Adult
Dermatitis ; 32(1): 5-9, 2021.
Article in English | MEDLINE | ID: covidwho-1272982


Acetophenone azine (CAS 729-43-1) was recently discovered as a potent allergen in shin pads and footwear containing the foam elastomer ethyl vinyl acetate. The compound is probably not intentionally added to ethyl vinyl acetate but is likely the result of reactions between other additives that take place during the manufacturing process. A patch testing concentration of 0.1% in acetone or petrolatum is recommended. Acetophenone azine should be part of patch testing shoe series, as well as plastics and glues series. The compound is not currently available from patch testing materials suppliers, a situation that hopefully will be corrected.

Allergens , Dermatitis, Allergic Contact/etiology , Hydrazines/adverse effects , Imines/adverse effects , Protective Devices , Shoes , Sports Equipment , Humans , Vinyl Compounds
JNMA J Nepal Med Assoc ; 59(236): 361-364, 2021 Apr 30.
Article in English | MEDLINE | ID: covidwho-1257584


INTRODUCTION: Healthcare workers are always at the risk of exposure to different diseases like respiratory illness including COVID-19. Using appropriate face mask or respiratory protective equipment correctly can prevent transmission of diseases from and to healthcare workers while caring for patients. The study aimed to find out the practice regarding use of face masks during the COVID-19 pandemic in a tertiary care center. METHODS: A descriptive cross-sectional study was conducted at a tertiary care hospital during June-July 2020 after receiving ethical approval from the review committee regarding practice of use of face masks. Convenience sampling method was used and a sample size of 162 was taken. Descriptive statistical analysis was done. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Among 162 participants, 123 (75.9%) knew the correct way of using the masks (72.5-79.3 at 95% Confidence Interval). CONCLUSIONS: In this study regarding practice of use of face masks, most of the healthcare workers knew the correct way of using masks and practised hygiene before and after using masks.

COVID-19 , Pandemics , Cross-Sectional Studies , Health Personnel , Humans , Protective Devices , SARS-CoV-2 , Tertiary Care Centers
BMJ Open Qual ; 10(2)2021 05.
Article in English | MEDLINE | ID: covidwho-1243717


Ophthalmologists were concerned about the risk of SARS-COV-2 transmission via droplets given the close proximity to the patient during slit lamp examination. There is a need to design a simple, low-cost, waterproof breath shield to minimise risk of infection.Dimensions of the Haag-Streit slit lamp (model BM 900) were recorded to guide accurate design of the breath shield. A questionnaire was circulated among slit lamp users on their perceived risk and concern about SARS-CoV-2 transmission and their perception of how effective different designs of breath shields would be at protecting them from an infection. A number of breath shield prototypes were designed and trialled. Plan, Do, Study, Act (PDSA) cycles were used to improve the design. Materials used to create the breath shields included transparent A3 laminating pouches and laminator, two sheets of A4 paper, scissors, hole punch and a ruler. The breath shield was designed to fit over the objective lens on the slit lamp after temporarily removing the standard, manufacturer-provided breath shield, before replacing it. The breath shields were cleaned after every patient with alcohol wipes and removed for deep cleaning with hand soap and water after each session. We used a proof of concept experiment using fluorescein instilled spray to test the effectiveness of each breath shield at preventing droplet transmission to the slit lamp user.Following four PDSA cycles, a breath shield that is user-friendly, easy to clean was produced. The percentage of confidence that the final design would be effective at preventing droplet transmission increased from 5.6% to 80%.Implementation of a low cost, simple to make, transparent, waterproof breath shield together with other forms of person protective equipment (PPE) creates a safe working environment for clinicians and patients. This intervention can be readily replicated and modified for other slit lamp models.

COVID-19/prevention & control , COVID-19/transmission , Disease Transmission, Infectious/prevention & control , Equipment Design , Protective Devices , Slit Lamp Microscopy/instrumentation , Slit Lamp , Humans , SARS-CoV-2
BMJ Open ; 11(5): e047716, 2021 05 20.
Article in English | MEDLINE | ID: covidwho-1238535


OBJECTIVE: To describe success rates of respiratory protective equipment (RPE) fit testing and factors associated with achieving suitable fit. DESIGN: Prospective observational study of RPE fit testing according to health and safety, and occupational health requirements. SETTING: A large tertiary referral UK healthcare facility. POPULATION: 1443 healthcare workers undergoing quantitative fit testing. MAIN OUTCOME MEASURES: Quantitative fit test success (pass/fail) and the count of tests each participant required before successful fit. RESULTS: Healthcare workers were fit tested a median (IQR) 2 (1-3) times before successful fit was obtained. Males were tested a median 1 (1-2) times, while females were tested a median 2 (1-2) times before a successful fit was found. This difference was statistically significant (p<0.001). Modelling each fit test as its own independent trial (n=2359) using multivariable logistic regression, male healthcare workers were significantly more likely to find a well-fitting respirator and achieve a successful fit on first attempt in comparison to females, after adjusting for other factors (adjusted OR=2.07, 95% CI): 1.66 to 2.60, p<0.001). Staff who described their ethnicity as White were also more likely to achieve a successful fit compared with staff who described their ethnicity as Asian (OR=0.47, 95% CI: 0.38 to 0.58, p<0.001), Black (OR=0.54, 95% CI: 0.41 to 0.71, p<0.001), mixed (OR=0.50 95% CI: 0.31 to 0.80, p=0.004) or other (OR=0.53, 95% CI: 0.29 to 0.99, p=0.043). CONCLUSIONS: Male and White ethnicity healthcare workers are more likely to achieve RPE fit test success. This has broad operational implications to healthcare services with a large female and Black, Asian and minority ethnic group population. Fit testing is imperative in ensuring RPE effectiveness in protecting healthcare workers during the COVID-19 pandemic and beyond.

COVID-19 , Pandemics , Bias , Female , Health Personnel , Humans , Male , Protective Devices , SARS-CoV-2
Br J Dermatol ; 185(1): 7-8, 2021 07.
Article in English | MEDLINE | ID: covidwho-1216733
Front Public Health ; 9: 622155, 2021.
Article in English | MEDLINE | ID: covidwho-1156165


The COVID-19 pandemic of 2020 in Italy had its first epidemic manifestations on January 31, 2020. The socio-sanitary rules imposed by the government concerned the social distance and management of intimate relationships, the sense of individual responsibility toward public health. Physical distancing and housing isolation have produced new representations of intrafamily, generational, neighborhood, community responsibility, bringing out a new "medicalized dimension" of society. In light of this contextual framework, the research aims are to analyze how: the perception of individual responsibility for public and familial health and physical distancing has redrawn the relation between subjects-family-community; the State's technical-health intervention has reformulated the idea of social closeness, but also how the pandemic fear and social confinement has re-evaluated a desire for community, neighborhood, proximity; during the lockdown families, friends, neighbors have reconstructed feelings of closeness and forms of belonging. The methodology used is quanti-qualitative and involved 300 women through an online questionnaire. The data collected highlight how the house during the lockdown is perceived as a safe place and how women implement both the recommendations and the behaviors aimed at preventing contagion, but also ways that allow coping with the situation from a perspective of well-being. Furthermore, the data show how the dimension of distancing has loosened the relational dimension outside the family unit, with a greater distancing compared to pre-pandemic data. However, the majority of women report that they have joined solidarity initiatives, demonstrating that they want to maintain ties and participate actively in community life.

Adaptation, Psychological , COVID-19/psychology , Communicable Disease Control/methods , Fear/psychology , Pandemics/prevention & control , Physical Distancing , Social Isolation/psychology , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Humans , Italy/epidemiology , Middle Aged , Protective Devices/statistics & numerical data , SARS-CoV-2 , Surveys and Questionnaires
Int J Environ Res Public Health ; 17(13)2020 Jun 27.
Article in English | MEDLINE | ID: covidwho-625844


The SARS-CoV-2 (COVID-19) pandemic has provided a unique set of global supply chain limitations with an exponentially growing surge of patients requiring care. The needs for Personal Protective Equipment (PPE) for hospital staff and doctors have been overwhelming, even just to rule out patients not infected. High demand for traditionally manufactured devices, challenged by global demand and limited production, has resulted in a call for additive manufactured (3D printed) equipment to fill the gap between traditional manufacturing cycles. This method has the unique ability to pivot in real time, while traditional manufacturing may take months to change production runs. 3D printing has been used to produce a variety of equipment for hospitals including face shields, masks, and even ventilator components to handle the surge. This type of rapid, crowd sourced, design and production resulted in new challenges for regulation, liability, and distribution. This manuscript reviews these challenges and successes of additive manufacturing and provides a forward plan for hospitals to consider for future surge events. Recommendations: To accommodate future surges, hospitals and municipalities should develop capacity for short-run custom production, enabling them to validate new designs. This will rapidly increase access to vetted equipment and critical network sharing with community distributed manufacturers and partners. Clear guidance and reviewed design repositories by regulatory authorities will streamline efforts to combat future pandemic waives or other surge events.

Coronavirus Infections , Pandemics , Personal Protective Equipment , Pneumonia, Viral , Printing, Three-Dimensional , Betacoronavirus , COVID-19 , Hospitals , Humans , Masks , Protective Devices , SARS-CoV-2