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2.
Sci Rep ; 12(1): 19944, 2022 Nov 19.
Article in English | MEDLINE | ID: covidwho-2133605

ABSTRACT

Due to the shortage of personal protective equipment (PPE) during the COVID-19 pandemic, the interest and demand for sterilization devices to reuse PPE has increased. For reuse of face masks, they must be effectively decontaminated of potential infectious agents without compromising its filtration ability during sterilization. In this study, we utilized an atmospheric pressure pulsed dielectric barrier discharge (DBD), combined with nebulized liquid microdroplets to generate plasma-activated mist (PAM). MS2 and T4 bacteriophages were used to conduct the decontamination tests on two types of N95 respirators. Results showed at least a 2-log reduction of MS2 and T4 on N95 respirators treated in one cycle with 7.8% hydrogen peroxide PAM and at least a 3-log reduction treated in 10% hydrogen peroxide PAM. In addition, it was found that there was no significant degradation in filtration efficiency of N95 respirators (3M 1860 and 1804) treated in 10% hydrogen peroxide PAM found after 20 cycles. In terms of re-useability of masks after treatment as determined, it was shown that the elastic straps of 3M 1804 were fragmented after 20 treatment cycles rendering them unusable, while the straps of 3M 1860 were not negatively affected even after 20 disinfection cycles.


Subject(s)
COVID-19 , Respiratory Protective Devices , Viruses , Humans , N95 Respirators , Disinfection/methods , Water , Bacteriophage T4 , Hydrogen Peroxide , Pandemics
3.
PLoS One ; 17(11): e0277570, 2022.
Article in English | MEDLINE | ID: covidwho-2116520

ABSTRACT

N95/FFP3 respirators have been critical to protect healthcare workers and their patients from the transmission of COVID-19. However, these respirators are characterised by a limited range of size and geometry, which are often associated with fitting issues in particular sub-groups of gender and ethnicities. This study describes a novel methodology which combines magnetic resonance imaging (MRI) of a cohort of individuals (n = 8), with and without a respirator in-situ, and 3D registration algorithm which predicted the goodness of fit of the respirator. Sensitivity analysis was used to optimise a deformation value for the respirator-face interactions and corroborate with the soft tissue displacements estimated from the MRI images. An association between predicted respirator fitting and facial anthropometrics was then assessed for the cohort.


Subject(s)
COVID-19 , Respiratory Protective Devices , Humans , COVID-19/prevention & control , N95 Respirators , Ventilators, Mechanical , Health Personnel
7.
Infect Control Hosp Epidemiol ; 42(11): 1313-1317, 2021 11.
Article in English | MEDLINE | ID: covidwho-2093408

ABSTRACT

OBJECTIVE: We quantitatively assessed the fit failure rate of N95 respirators according to the number of donning/doffing and hours worn. DESIGN: Experimental study. SETTING: A tertiary-care referral center in South Korea. PARTICIPANTS: In total, 10 infection control practitioners participated in the fit test. METHODS: The first experiment comprised 4 consecutive 1-hour donnings and fit tests between each donning. The second experiment comprised 2 consecutive 3-hour donnings and fit tests between each donning. The final experiment comprised fit tests after an 1-hour donning or a 2-hour donning. RESULTS: For 1-hour donnings, 60%, 70%, and 90% of the participants had fit failures after 2, 3, and 4 consecutive donnings, respectively. For 3-hour donnings, 50% had fit failure after the first donning and 70% had failures after 2 consecutive donnings. All participants passed the fit test after refitting whenever fit failure occurred. The final experiment showed that 50% had fit failure after a single use of 1 hour, and 30% had fit failure after a single use of 2 hours. CONCLUSIONS: High fit-failure rates were recorded after repeated donning and extended use of N95 respirators. Caution is needed for reuse (≥1 time) and extended use (≥1 hour) of N95 respirators in high-risk settings such as those involving aerosol-generating procedures. Although adequate refitting may recover the fit factor, the use of clean gloves and strict hand hygiene afterward should be ensured when touching the outer surfaces of N95 respirators for refitting.


Subject(s)
Occupational Exposure , Respiratory Protective Devices , Humans , N95 Respirators , Republic of Korea
8.
BMC Med Educ ; 22(1): 688, 2022 Sep 23.
Article in English | MEDLINE | ID: covidwho-2043125

ABSTRACT

BACKGROUND: With the advent of COVID-19, many healthcare workers (HWs) in Australia requested access to powered air purifying respirators (PAPR) for improved respiratory protection, comfort and visibility. The urgency of the response at our hospital required rapid deployment of innovative training to ensure the safe use of PAPRs, in particular, a video-feedback training option to prepare HWs for PAPR competency. AIM: To explore the feasibility, acceptability, and utility of video-feedback in PAPR training and competency assessment. METHODS: Semi-structured interviews were conducted with 12 HWs, including clinicians from Intensive Care, Anaesthetics and Respiratory Medicine, at a large teaching hospital in Australia. FINDINGS: Participants believed that the use of video-feedback in PAPR training was feasible, acceptable and useful. They described a variety of benefits to learning and retention, from a variety of ways in which they engaged with the personal video-feedback. Participants also described the impact of reviewing personalised practice footage, compared to generic footage of an ideal performance. CONCLUSION: By conceptualising video-feedback using a pedagogical approach, this study contributes to knowledge around optimising methods for training HWs in PPE use, particularly when introducing a new and complex PPE device during an infectious disease outbreak.


Subject(s)
COVID-19 , Respiratory Protective Devices , COVID-19/prevention & control , Feedback , Health Personnel/education , Humans , Pandemics/prevention & control
9.
J Occup Environ Med ; 64(9): 802-807, 2022 09 01.
Article in English | MEDLINE | ID: covidwho-2018287

ABSTRACT

OBJECTIVE: This study evaluated health care workers' (HCWs') knowledge and confidence in using elastomeric half-mask respirator (EHMR) attributes known to influence usage. METHODS: Health care workers were surveyed regarding their EHMR donning and doffing experience. Respondents were categorized into competency categories based on their scores. Category differences were analyzed using χ 2 and multiple logistic regression. RESULTS: Seventy-two percent showed high levels of EHMR donning and doffing knowledge and confidence (mastery); however, 21% had greater confidence than knowledge (misinformed). Respiratory therapists had greater odds of mastery than other HCWs ( P < 0.05), whereas those working in medical/surgical and pediatric units had greater odds of doubt than other HCWs ( P < 0.01). CONCLUSIONS: Although most HCWs show high knowledge and confidence with EHMR use, strategies to confirm respirator use competency may ensure greater HCWs protection.


Subject(s)
Respiratory Protective Devices , Child , Health Personnel , Humans , Ventilators, Mechanical
10.
PLoS One ; 17(8): e0272834, 2022.
Article in English | MEDLINE | ID: covidwho-2002312

ABSTRACT

BACKGROUND: The COVID-19 pandemic has infected hundreds of millions of people resulting in millions of deaths worldwide. While N95 respirators remain the gold standard as personal protective equipment, they are resource-intensive to produce and obtain. Surgical masks, easier to produce and obtain, filter ≥95% submicron particles but are less protective due to a lack of seal around a user's face. This study tested the ability of a simple surgical mask modification using rubber bands to create a seal against particle exposure that would pass N95 standards. METHODS AND FINDINGS: Forty healthcare workers underwent TSI PortaCount mask fit testing using an ASTM Level 1 surgical mask modified with rubber bands. Fit Factor was determined after testing four standard OSHA N95 fit testing scenarios. Performance of the properly-modified surgical mask was compared to that of a poorly-modified surgical mask, an unmodified standard surgical mask, and an N95 respirator. Thirty-one of forty (78%) healthcare workers passed Fit Factor testing using a properly-modified mask. The Fit Factor success rate significantly improved by subsequent test date (p = 0.043), but was not associated with any other participant characteristics. The average Fit Factor score for the properly-modified mask was 151 (SD 65.2), a significantly better fit than the unmodified mask score of 3.8 (SD 3.1, p<0.001) and the poorly-modified mask score of 24.6 (SD 48.4, p<0.001) but significantly lower than a properly fitted N95 score of 199 (SD 4.5, p<0.001).do. CONCLUSIONS: Rubber bands, a low-cost and easily-accessible modification, can improve the seal and protective ability of a standard surgical mask to the level of an N95 respirator. This could mitigate N95 respirator shortages worldwide and provide individuals in under-resourced regions a practical means for increased personal respiratory protection.


Subject(s)
COVID-19 , Occupational Exposure , Respiratory Protective Devices , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Masks , N95 Respirators , Occupational Exposure/prevention & control , Pandemics/prevention & control
11.
J Occup Environ Hyg ; 19(10-11): 615-628, 2022.
Article in English | MEDLINE | ID: covidwho-1991950

ABSTRACT

The use of filtering facepiece respirators (FFRs) of various types increased dramatically by both workers and the public during the ongoing COVID-19 pandemic. This increased use has, likewise, instigated a proliferation of research on the qualities of FFRs. An aspect of FFR development and optimization involves the use of mathematical models that predict filter efficiency based on various filter characteristics while also considering a number of particle capture forces. An evaluation of current literature failed to identify a publication that provides a comprehensive assessment of the models developed to predict filter efficiency. The purpose of this review was, therefore, to describe models developed to include the forces associated with diffusion, interception, impaction, and electrostatic attraction as they contribute to the efficiency of an entire filter. The literature review was augmented with figures created with the use of many of the models discussed to compare different models of the same force as well as to illustrate the influence of electrostatic forces on overall filter efficiency.


Subject(s)
Air Pollutants, Occupational , COVID-19 , Respiratory Protective Devices , United States , Humans , Air Pollutants, Occupational/analysis , National Institute for Occupational Safety and Health, U.S. , Particle Size , Pandemics/prevention & control , Filtration , Materials Testing/methods , COVID-19/prevention & control , Respiratory Aerosols and Droplets , Ventilators, Mechanical
12.
Br J Nurs ; 31(15): S30-S36, 2022 Aug 11.
Article in English | MEDLINE | ID: covidwho-1990304

ABSTRACT

AIM: To explore the impact that prolonged use of personal protective equipment (PPE) has on the skin integrity of Canadian health professionals. METHOD: A descriptive, pan-Canadian, cross-sectional, online survey was carried out to explore the type and prevalence of PPE-related skin injury among Canadian health professionals. Convenience sampling was used to disseminate the online survey link to health professionals. RESULTS: There were responses from 757 health professionals. Masks worn included surgical masks (90%), a combination of surgical or N95/KN95 masks (7.7%) and an N95/KN95 mask alone (2.7%). Responses showed 84.6% of providers always wear a mask while at work with 38.5% wearing the same mask all shift; 90% of participants wore protective eye wear. Complications included soreness or pressure injuries behind the ears (70%), new or worsening acne (52%), a runny nose or sneezing (45%), itching (39%), and dry skin (37%). Hand issues included dry skin (53%), red skin (30%), itching (26%), broken skin (20%), rash (16%), and dermatitis (11%) - 51% of respondents did not moisturise their hands. Complications related to gown use included itching (6%), moisture-associated skin damage (5.5%), feeling claustrophobic (4.5%), and new or worsening acne (3%). Increased perspiration due to PPE was experienced in 87.5% of respondents. Some 43% of respondents noted their mental health became worse due to wearing PPE for prolonged periods. CONCLUSION: These findings should be used in the development of guidelines to prevent and manage PPE-related skin injuries among health professionals. Education for professionals should focus on skin protection, prevention of PPE-related skin complications and support for mental health issues.


Subject(s)
Acne Vulgaris , COVID-19 , Respiratory Protective Devices , Canada , Cross-Sectional Studies , Health Personnel , Humans , Personal Protective Equipment , Pruritus , SARS-CoV-2
14.
PLoS One ; 17(6): e0268542, 2022.
Article in English | MEDLINE | ID: covidwho-1987130

ABSTRACT

Proper respiratory tract protection is the key factor to limiting the rate of COVID-19 spread and providing a safe environment for health care workers. Traditional N95 (FFP2) respirators are not easy to regenerate and thus create certain financial and ecological burdens; moreover, their quality may vary significantly. A solution that would overcome these disadvantages is desirable. In this study a commercially available knit polyester fleece fabric was selected as the filter material, and a total of 25 filters of different areas and thicknesses were prepared. Then, the size-resolved filtration efficiency (40-400 nm) and pressure drop were evaluated at a volumetric flow rate of 95 L/min. We showed the excellent synergistic effect of expanding the filtration area and increasing the number of filtering layers on the filtration efficiency; a filter cartridge with 8 layers of knit polyester fabric with a surface area of 900 cm2 and sized 25 × 14 × 8 cm achieved filtration efficiencies of 98% at 95 L/min and 99.5% at 30 L/min. The assembled filter kit consists of a filter cartridge (14 Pa) carried in a small backpack connected to a half mask with a total pressure drop of 84 Pa at 95 L/min. In addition, it is reusable, and the filter material can be regenerated at least ten times by simple methods, such as boiling. We have demonstrated a novel approach for creating high-quality and easy-to-breathe-through respiratory protective equipment that reduces operating costs and is a green solution because it is easy to regenerate.


Subject(s)
COVID-19 , Respiratory Protective Devices , Aerosols , COVID-19/prevention & control , Equipment Design , Filtration/methods , Humans , Masks , Materials Testing/methods , Polyesters
15.
Am J Infect Control ; 49(11): 1369-1375, 2021 11.
Article in English | MEDLINE | ID: covidwho-1283217

ABSTRACT

BACKGROUND: Healthcare personnel (HCP) knowledge and attitudes toward infection control measures are important determinants of practices that can protect them from transmission of infectious diseases. METHODS: Healthcare personnel were recruited from Emergency Departments and outpatient clinics at seven sites. They completed knowledge surveys at the beginning and attitude surveys at the beginning and end of each season of participation. Attitudes toward infection prevention and control measures, especially medical masks and N95 respirators, were compared. The proportion of participants who correctly identified all components of an infection control bundle for seven clinical scenarios was calculated. RESULTS: The proportion of participants in the medical mask group who reported at least one reason to avoid using medical masks fell from 88.5% on the pre-season survey to 39.6% on the post-season survey (odds ratio [OR] for preseason vs. postseason 0.11, 95% CI 0.10-0.14). Among those wearing N95 respirators, the proportion fell from 87.9% to 53.6% (OR 0.24, 95% CI 0.21-0.28). Participants correctly identified all components of the infection control bundle for 4.9% to 38.5% of scenarios. CONCLUSIONS: Attitudes toward medical masks and N95 respirators improved significantly between the beginning and end of each season. The proportion of HCP who correctly identified the infection control precautions needed for clinical scenarios was low, but it improved over successive years of participation in the study.


Subject(s)
Respiratory Protective Devices , Respiratory Tract Infections , Attitude , Delivery of Health Care , Health Personnel , Humans , Masks , Outpatients , Respiratory Tract Infections/prevention & control
16.
J Hazard Mater ; 422: 126783, 2022 01 15.
Article in English | MEDLINE | ID: covidwho-1347177

ABSTRACT

We designed a novel experimental set-up to pseudo-simultaneously measure size-segregated filtration efficiency (ηF), breathing resistance (ηP) and potential usage time (tB) for 11 types of face protective equipment (FPE; four respirators; three medical; and four handmade) in the submicron range. As expected, the highest ηF was exhibited by respirators (97 ± 3%), followed by medical (81 ± 7%) and handmade (47 ± 13%). Similarly, the breathing resistance was highest for respirators, followed by medical and handmade FPE. Combined analysis of efficiency and breathing resistance highlighted trade-offs, i.e. respirators showing the best overall performance across these two indicators, followed by medical and handmade FPE. This hierarchy was also confirmed by quality factor, which is a performance indicator of filters. Detailed assessment of size-segregated aerosols, combined with the scanning electron microscope imaging, revealed material characteristics such as pore density, fiber thickness, filter material and number of layers influence their performance. ηF and ηP showed an inverse exponential decay with time. Using their cross-over point, in combination with acceptable breathability, allowed to estimate tB as 3.2-9.5 h (respirators), 2.6-7.3 h (medical masks) and 4.0-8.8 h (handmade). While relatively longer tB of handmade FPE indicate breathing comfort, they are far less efficient in filtering virus-laden submicron aerosols compared with respirators.


Subject(s)
Masks , Respiratory Protective Devices , Aerosols , Filtration , Particle Size
17.
Infect Dis Health ; 27(3): 159-162, 2022 08.
Article in English | MEDLINE | ID: covidwho-1977338

ABSTRACT

BACKGROUND: Facial hair under a tight fitting P2/N95 respirator diminishes respiratory protection. There is limited guidance with respect to the threshold to be clean shaven in readiness to wear N95 respirators. METHODS: We performed a cross sectional audit in late August 2021 to observe whether staff had facial hair that could decrease respiratory protection of tight fitting respirators. The audit was conducted in three critical care areas at a major tertiary public hospital in Australia during a period of moderate-to-high community prevalence of COVID-19. All staff observed had previously successfully completed quantitative fit testing with a clean shaven face in the preceding 12 months. RESULTS: 110 consecutive male critical care staff were observed including thirty staff who were required to wear a N95/P2 respirator at the time. Forty - five percent of male staff observed were not clean shaven in the face seal zone of their respirators. CONCLUSIONS: The readiness to wear a tight-fitting respirator and hence the need to be clean shaven, should be guided by both state and local COVID-19 risk ratings, as well as the specific respiratory biohazard risks present in the clinical area at that time. During periods of significant community transmission of COVID-19, critical care clinical staff should be clean shaven, so they are fit-for-purpose and ready to wear a tight fitting respirator at short notice. Respiratory protection preparedness in critical care healthcare workers: An observational audit of facial hair at a major tertiary hospital in Australia.


Subject(s)
COVID-19 , Respiratory Protective Devices , COVID-19/prevention & control , Critical Care , Cross-Sectional Studies , Hair , Health Personnel , Humans , Male , Tertiary Care Centers
19.
Am J Infect Control ; 50(9): 1067-1069, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1944006

ABSTRACT

The use of fit tested respirators in the workplace is required to protect health workers against airborne pathogens. The COVID-19 pandemic required rapid upscaling of fit testing which was achieved using the framework of a respiratory protection program. Implementing and sustaining such a program in the midst of a pandemic was challenging and required clear direction from a lead agency combined with stakeholder engagement.


Subject(s)
COVID-19 , Respiratory Protective Devices , COVID-19/prevention & control , Delivery of Health Care , Health Personnel , Humans , Pandemics/prevention & control
20.
Int J Environ Res Public Health ; 19(14)2022 07 15.
Article in English | MEDLINE | ID: covidwho-1938800

ABSTRACT

During the COVID-19 pandemic, N95 respirators were commonly used in many situations. Respiratory problems from prolonged use of respirators were discussed in many studies, which show varied results. From the inconclusive results, the current systematic review and meta-analysis discerned the effects of the N95 respirator by assessing the oxygen and carbon dioxide changes in both high- and low-to-moderate-intensity physical activities in a healthy population. Thirteen studies were identified for inclusion in the study. In high-intensity physical activities, our meta-analysis showed borderline lower oxygen saturation and higher carbon dioxide partial pressure, but oxygen saturation did not change in low-to-moderate physical activity. The use of N95 respirators could statistically affect the physiologic changes of carbon dioxide and oxygen in high-intensity physical activity among healthy participants, but this may not be clinically significant. Some users who have certain health conditions, such as respiratory problems, should be informed of the clinical symptoms related to hypercarbia and hypoxia for the early detection of adverse effects of N95 respirators.


Subject(s)
COVID-19 , Respiratory Protective Devices , COVID-19/prevention & control , Carbon Dioxide , Humans , N95 Respirators , Oxygen , Pandemics/prevention & control
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