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1.
J Occup Environ Hyg ; 18(7): 334-344, 2021 07.
Article in English | MEDLINE | ID: covidwho-1254232

ABSTRACT

Homemade cloth masks and other improvised face coverings have become widespread during the COVID-19 pandemic driven by severe shortages of personal protective equipment. In this study, various alternative (mostly common household) materials, which have not traditionally been used in respiratory protective devices, were tested for particle filtration performance and breathability. Most of these materials were found of some-but rather limited-utility in facemasks. At a breathing flow rate of 30 L min-1, 17 out of 19 tested materials demonstrated collection efficiency below 50%; at 85 L min-1, only one material featured particle collection efficiency above 50%. Pressure drop values were mostly below 4 mm w.g. (observed in 89% of cases for the two flow rates), which provides comfortable breathing. Only for one fabric material (silk) tested at 85 L min-1 did the pressure drop reach 11 mm w.g. Based on these results, a three-layer facemask prototype was designed and fabricated comprised of the best performing materials. Additional tests were conducted to examine possible particle detachment/shedding from the materials used in the newly developed facemask, but no such phenomenon was observed. The prototype was evaluated on 10 human subjects using the standard OSHA-approved quantitative fit testing protocol. The mask protection level, determined as an adopted fit factor, was found to lie between that of the two commercial surgical/medical masks tested for comparison. A 10-cycle washing of the mask prototype lowered its collection efficiency across the particle size range; however, washing did not substantially affect mask breathability. The study revealed that although homemade masks offer a certain level of protection to a wearer, one should not expect them to provide the same respiratory protection as high-end commercial surgical/medical masks or-by any means-NIOSH-certified N95 filtering facepieces.


Subject(s)
COVID-19/prevention & control , Equipment Design , Filtration/instrumentation , Masks/standards , Materials Testing , Humans , Masks/supply & distribution , Occupational Exposure/prevention & control , Particle Size , Personal Protective Equipment/standards , Personal Protective Equipment/supply & distribution , Respiration , Respiratory Protective Devices/standards , Respiratory Protective Devices/supply & distribution , SARS-CoV-2 , Textiles
2.
Can J Psychiatry ; 66(1): 17-24, 2021 01.
Article in English | MEDLINE | ID: covidwho-1072892

ABSTRACT

OBJECTIVES: To examine the relationship between perceived adequacy of personal protective equipment (PPE) and workplace-based infection control procedures (ICP) and mental health symptoms among a sample of health-care workers in Canada within the context of the current COVID-19 pandemic. METHODS: A convenience-based internet survey of health-care workers in Canada was facilitated through various labor organizations between April 7 and May 13, 2020. A total of 7,298 respondents started the survey, of which 5,988 reported information on the main exposures and outcomes. Anxiety symptoms were assessed using the Generalized Anxiety Disorder (GAD-2) screener, and depression symptoms using the Patient Health Questionnaire (PHQ-2) screener. We assessed the perceived need and adequacy of 8 types of PPE and 10 different ICP. Regression analyses examined the proportion of GAD-2 and PHQ-2 scores of 3 and higher across levels of PPE and ICP, adjusted for a range of demographic, occupation, workplace, and COVID-19-specific measures. RESULTS: A total of 54.8% (95% confidence interval [CI], 53.5% to 56.1%) of the sample had GAD-2 scores of 3 and higher, and 42.3% (95% CI, 41.0% to 43.6%) of the sample had PHQ-2 scores of 3 and higher. Absolute differences of 18% (95% CI, 12% to 23%) and 17% (95% CI, 12% to 22%) were observed in the prevalence of GAD-2 scores of 3 and higher between workers whose perceived PPE needs and ICP needs were met compared to those who needs were not met. Differences of between 11% (95% CI, 6% to 17%) and 19% (95% CI, 14% to 24%) were observed in PHQ-2 scores of 3 and higher across these same PPE and ICP categories. CONCLUSIONS: Our results suggest strengthening employer-based infection control strategies likely has important implications for the mental health symptoms among health-care workers in Canada.


Subject(s)
Anxiety/psychology , COVID-19/prevention & control , Depression/psychology , Health Personnel/psychology , Infection Control/standards , Occupational Health , Personal Protective Equipment/supply & distribution , Age Factors , Anxiety/epidemiology , Attitude of Health Personnel , Canada/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Eye Protective Devices/supply & distribution , Female , Health Personnel/statistics & numerical data , Humans , Male , Masks/supply & distribution , N95 Respirators/supply & distribution , Patient Health Questionnaire , Perception , Respiratory Protective Devices/supply & distribution , SARS-CoV-2 , Sex Factors , Surgical Attire/supply & distribution , Surveys and Questionnaires
3.
Ann Work Expo Health ; 64(8): 775-777, 2020 10 08.
Article in English | MEDLINE | ID: covidwho-1060033

ABSTRACT

Many academics and researchers have responded to the COVID-19 pandemic by forming on-line national and international collaborative groups to rapidly investigate issues of prevention and treatment. This commentary describes the spontaneous formation of an international team of 115 researchers who summarized the literature on safe methods for decontaminating N95 filtering facepiece respirators in response to the supply crisis. The summary reports and fact sheets on the (www.n95decon.org) website have had more than 200 000 unique visits and the organization's webinars have reached health care professionals from more than 50 countries. The team is extending its mission to cover other personal protective equipment. The success of these collaborations may alter how scientific questions are tackled in the future.


Subject(s)
Coronavirus Infections/prevention & control , Decontamination/methods , International Cooperation , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Respiratory Protective Devices , Betacoronavirus , COVID-19 , Equipment Contamination , Equipment Reuse , Humans , Occupational Exposure/prevention & control , Respiratory Protective Devices/supply & distribution , Respiratory Protective Devices/virology , SARS-CoV-2
4.
Swiss Med Wkly ; 151: w20459, 2021 01 18.
Article in English | MEDLINE | ID: covidwho-1055197

ABSTRACT

BACKGROUND: SARS-CoV-2 is a respiratory virus. Transmission occurs by droplets, contact and aerosols. In medical settings, filtering facepiece (FFP) respirators are recommended for use by personnel exposed to aerosol-generating procedures. During the COVID-19 pandemic, the demand for FFP respirators exceeded their supply worldwide and low-quality products appeared on the market, potentially putting healthcare workers at risk. AIMS: To raise awareness about variations in quality of imported FFP respirators in Switzerland during the COVID-19 pandemic, to draw attention to the current directives regulating the market launch of FFP respirators in Switzerland, to provide practical support in identifying suspicious products or documents and, finally, to offer strategies aimed at reducing the distribution of low-quality FFP respirators in the future. METHODS: Three Swiss laboratories, Spiez Laboratory and Unisanté in partnership with TOXpro SA individually set up testing procedures to evaluate aerosol penetration and fit testing of FFP respirators imported into Switzerland during COVID-19 pandemic. Additionally, Spiez Laboratory visually inspected the products, examined the certification documents and crosschecked the product information with international databases. RESULTS: Between 31 March and 15 June 2020, 151 FFP respirators were analysed. The initial assessment performed before testing allowed a reduction of up to 35% in the number of FFP respirators sent to Spiez Laboratory for evaluation, for which product information found to be faulty. After filtration efficiency evaluation and fit testing, 52% and 60% of all products tested by Spiez Laboratory and Unisanté-TOXpro SA, respectively, did not meet the minimum performance requirements established independently by the three Swiss laboratories. CONCLUSION: The demand for FFP respirators exceeded the supply capacity from established suppliers of the Swiss market. New production and import channels emerged, as did the number of poor-quality FFP respirators. FFP respirators remaining in stocks should be checked for conformity before being used, or eliminated and replaced if quality does not meet standards.


Subject(s)
COVID-19/prevention & control , N95 Respirators/standards , COVID-19/transmission , Humans , In Vitro Techniques , N95 Respirators/supply & distribution , Product Labeling , Respiratory Protective Devices/standards , Respiratory Protective Devices/supply & distribution , SARS-CoV-2 , Switzerland
5.
Chest ; 159(2): 619-633, 2021 02.
Article in English | MEDLINE | ID: covidwho-1049757

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has severely affected ICUs and critical care health-care providers (HCPs) worldwide. RESEARCH QUESTION: How do regional differences and perceived lack of ICU resources affect critical care resource use and the well-being of HCPs? STUDY DESIGN AND METHODS: Between April 23 and May 7, 2020, we electronically administered a 41-question survey to interdisciplinary HCPs caring for patients critically ill with COVID-19. The survey was distributed via critical care societies, research networks, personal contacts, and social media portals. Responses were tabulated according to World Bank region. We performed multivariate log-binomial regression to assess factors associated with three main outcomes: limiting mechanical ventilation (MV), changes in CPR practices, and emotional distress and burnout. RESULTS: We included 2,700 respondents from 77 countries, including physicians (41%), nurses (40%), respiratory therapists (11%), and advanced practice providers (8%). The reported lack of ICU nurses was higher than that of intensivists (32% vs 15%). Limiting MV for patients with COVID-19 was reported by 16% of respondents, was lowest in North America (10%), and was associated with reduced ventilator availability (absolute risk reduction [ARR], 2.10; 95% CI, 1.61-2.74). Overall, 66% of respondents reported changes in CPR practices. Emotional distress or burnout was high across regions (52%, highest in North America) and associated with being female (mechanical ventilation, 1.16; 95% CI, 1.01-1.33), being a nurse (ARR, 1.31; 95% CI, 1.13-1.53), reporting a shortage of ICU nurses (ARR, 1.18; 95% CI, 1.05-1.33), reporting a shortage of powered air-purifying respirators (ARR, 1.30; 95% CI, 1.09-1.55), and experiencing poor communication from supervisors (ARR, 1.30; 95% CI, 1.16-1.46). INTERPRETATION: Our findings demonstrate variability in ICU resource availability and use worldwide. The high prevalence of provider burnout and its association with reported insufficient resources and poor communication from supervisors suggest a need for targeted interventions to support HCPs on the front lines.


Subject(s)
COVID-19/therapy , Critical Care , Health Personnel/psychology , Health Resources , Health Workforce , Personal Protective Equipment/supply & distribution , Burnout, Professional/psychology , Critical Care Nursing , Female , Financial Stress/psychology , Health Care Rationing , Hospital Bed Capacity , Humans , Male , N95 Respirators/supply & distribution , Nurses/psychology , Nurses/supply & distribution , Physicians/psychology , Physicians/supply & distribution , Psychological Distress , Respiratory Protective Devices/supply & distribution , Resuscitation Orders , SARS-CoV-2 , Surveys and Questionnaires , Ventilators, Mechanical/supply & distribution
7.
J Hosp Infect ; 108: 113-119, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1014625

ABSTRACT

BACKGROUND: The coronavirus disease 2019 pandemic has caused problems with respirator supplies. Re-use may minimize the impact of the shortage, but requires the availability of an efficient and safe decontamination method. AIM: To determine whether low-temperature-steam-2%-formaldehyde (LTSF) sterilization is effective, preserves the properties of filtering facepiece (FFP) respirators and allows safe re-use. METHODS: Fourteen unused FFP2, FFP3 and N95 respirator models were subjected to two cycles of decontamination cycles. After the second cycle, each model was inspected visually and accumulated residual formaldehyde levels were analysed according to EN 14180. After one and two decontamination cycles, the fit factor (FF) of each model was tested, and penetration tests with sodium chloride aerosols were performed on five models. FINDINGS: Decontamination physically altered three of the 14 models. All of the residual formaldehyde values were below the permissible threshold. Irregular decreases and increases in FF were observed after each decontamination cycle. In the sodium chloride aerosol penetration test, three models obtained equivalent or superior results to those of the FFP classification with which they were marketed, both at baseline and after one and two cycles of decontamination, and two models had lower filtering capacity. CONCLUSION: One and two decontamination cycles using LTSF did not alter the structure of most (11/14) respirators tested, and did not degrade the fit or filtration capacity of any of the analysed respirators. The residual formaldehyde levels complied with EN 14180. This reprocessing method could be used in times of shortage of personal protective equipment.


Subject(s)
Decontamination/methods , Formaldehyde/pharmacology , Respiratory Protective Devices/virology , Sterilization/methods , Adult , Aerosols/adverse effects , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/virology , Equipment Reuse , Formaldehyde/analysis , Humans , Male , Masks/trends , Masks/virology , Personal Protective Equipment/supply & distribution , Respiratory Protective Devices/supply & distribution , SARS-CoV-2/genetics , Sodium Chloride/analysis , Steam/adverse effects , Ventilators, Mechanical/supply & distribution , Ventilators, Mechanical/virology
8.
A A Pract ; 14(9): e01280, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-992615

ABSTRACT

N95 respirator masks are used by medical providers for respiratory protection from airborne pathogens of transmissible diseases. In extreme situations or pandemics, when N95 masks may be in short supply, the American Society of Anesthesiologists (ASA) reported that some groups created their own N95 mask utilizing an anesthesia circuit mask plus a filter for use in short but high-risk procedures. The makeshift option for personal protective equipment was tested with a qualitative respirator mask fit test.


Subject(s)
Coronavirus Infections/prevention & control , Equipment Design , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Respiratory Protective Devices/supply & distribution , Adult , Betacoronavirus , COVID-19 , Coronavirus Infections/transmission , Female , Humans , Male , Masks , Middle Aged , Personal Protective Equipment , Pneumonia, Viral/transmission , SARS-CoV-2
9.
Chest ; 159(2): 619-633, 2021 02.
Article in English | MEDLINE | ID: covidwho-938825

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has severely affected ICUs and critical care health-care providers (HCPs) worldwide. RESEARCH QUESTION: How do regional differences and perceived lack of ICU resources affect critical care resource use and the well-being of HCPs? STUDY DESIGN AND METHODS: Between April 23 and May 7, 2020, we electronically administered a 41-question survey to interdisciplinary HCPs caring for patients critically ill with COVID-19. The survey was distributed via critical care societies, research networks, personal contacts, and social media portals. Responses were tabulated according to World Bank region. We performed multivariate log-binomial regression to assess factors associated with three main outcomes: limiting mechanical ventilation (MV), changes in CPR practices, and emotional distress and burnout. RESULTS: We included 2,700 respondents from 77 countries, including physicians (41%), nurses (40%), respiratory therapists (11%), and advanced practice providers (8%). The reported lack of ICU nurses was higher than that of intensivists (32% vs 15%). Limiting MV for patients with COVID-19 was reported by 16% of respondents, was lowest in North America (10%), and was associated with reduced ventilator availability (absolute risk reduction [ARR], 2.10; 95% CI, 1.61-2.74). Overall, 66% of respondents reported changes in CPR practices. Emotional distress or burnout was high across regions (52%, highest in North America) and associated with being female (mechanical ventilation, 1.16; 95% CI, 1.01-1.33), being a nurse (ARR, 1.31; 95% CI, 1.13-1.53), reporting a shortage of ICU nurses (ARR, 1.18; 95% CI, 1.05-1.33), reporting a shortage of powered air-purifying respirators (ARR, 1.30; 95% CI, 1.09-1.55), and experiencing poor communication from supervisors (ARR, 1.30; 95% CI, 1.16-1.46). INTERPRETATION: Our findings demonstrate variability in ICU resource availability and use worldwide. The high prevalence of provider burnout and its association with reported insufficient resources and poor communication from supervisors suggest a need for targeted interventions to support HCPs on the front lines.


Subject(s)
COVID-19/therapy , Critical Care , Health Personnel/psychology , Health Resources , Health Workforce , Personal Protective Equipment/supply & distribution , Burnout, Professional/psychology , Critical Care Nursing , Female , Financial Stress/psychology , Health Care Rationing , Hospital Bed Capacity , Humans , Male , N95 Respirators/supply & distribution , Nurses/psychology , Nurses/supply & distribution , Physicians/psychology , Physicians/supply & distribution , Psychological Distress , Respiratory Protective Devices/supply & distribution , Resuscitation Orders , SARS-CoV-2 , Surveys and Questionnaires , Ventilators, Mechanical/supply & distribution
10.
BMJ Open ; 10(9): e039424, 2020 09 22.
Article in English | MEDLINE | ID: covidwho-788150

ABSTRACT

OBJECTIVE: We examined the ability of fabrics which might be used to create home-made face masks to filter out ultrafine (0.02-0.1 µm) particles at the velocity of adult human coughing. METHODS: Twenty commonly available fabrics and materials were evaluated for their ability to reduce air concentrations of ultrafine particles at coughing face velocities. Further assessment was made on the filtration ability of selected fabrics while damp and of fabric combinations which might be used to construct home-made masks. RESULTS: Single fabric layers blocked a range of ultrafine particles. When fabrics were layered, a higher percentage of ultrafine particles were filtered. The average filtration efficiency of single layer fabrics and of layered combination was found to be 35% and 45%, respectively. Non-woven fusible interfacing, when combined with other fabrics, could add up to 11% additional filtration efficiency. However, fabric and fabric combinations were more difficult to breathe through than N95 masks. CONCLUSIONS: The current coronavirus pandemic has left many communities without access to N95 face masks. Our findings suggest that face masks made from layered common fabric can help filter ultrafine particles and provide some protection for the wearer when commercial face masks are unavailable.


Subject(s)
Coronavirus Infections/transmission , Cough , Masks/supply & distribution , Materials Testing , Particulate Matter , Pneumonia, Viral/transmission , Textiles , Air Filters , Betacoronavirus , COVID-19 , Cellulose , Coronavirus Infections/prevention & control , Cotton Fiber , Humans , Nylons , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Polyesters , Polyurethanes , Respiratory Protective Devices/supply & distribution , SARS-CoV-2 , Wool Fiber
11.
Am J Infect Control ; 48(12): 1543-1545, 2020 12.
Article in English | MEDLINE | ID: covidwho-653329

ABSTRACT

Many healthcare systems have been forced to outsource simple mask production due to international shortages caused by the COVID-19 pandemic. Providence created simple masks using surgical wrap and submitted samples to an environmental lab for bacterial filtration efficiency testing. Bacterial filtration efficiency rates ranged from 83.0% to 98.1% depending on specific material and ply, and particular filtration efficiency rates ranged from 92.3% to 97.7%. Based on mask configuration, specific surgical wrap selected, and ply, the recommended filtration efficiency for isolation and surgical masks of 95% and 98%, respectively can be achieved. These alternative masks can allow for similar coverage and safety when hospital-grade isolation masks are in short supply.


Subject(s)
COVID-19/prevention & control , Equipment Safety/statistics & numerical data , Filtration/instrumentation , Masks/microbiology , Respiratory Protective Devices/microbiology , SARS-CoV-2 , Air Microbiology , Bacteria/isolation & purification , Equipment Design , Humans , Masks/supply & distribution , Materials Testing , Particulate Matter/isolation & purification , Respiratory Protective Devices/supply & distribution
14.
Influenza Other Respir Viruses ; 14(4): 365-373, 2020 07.
Article in English | MEDLINE | ID: covidwho-637288

ABSTRACT

BACKGROUND: Respiratory protective devices are critical in protecting against infection in healthcare workers at high risk of novel 2019 coronavirus disease (COVID-19); however, recommendations are conflicting and epidemiological data on their relative effectiveness against COVID-19 are limited. PURPOSE: To compare medical masks to N95 respirators in preventing laboratory-confirmed viral infection and respiratory illness including coronavirus specifically in healthcare workers. DATA SOURCES: MEDLINE, Embase, and CENTRAL from January 1, 2014, to March 9, 2020. Update of published search conducted from January 1, 1990, to December 9, 2014. STUDY SELECTION: Randomized controlled trials (RCTs) comparing the protective effect of medical masks to N95 respirators in healthcare workers. DATA EXTRACTION: Reviewer pair independently screened, extracted data, and assessed risk of bias and the certainty of the evidence. DATA SYNTHESIS: Four RCTs were meta-analyzed adjusting for clustering. Compared with N95 respirators; the use of medical masks did not increase laboratory-confirmed viral (including coronaviruses) respiratory infection (OR 1.06; 95% CI 0.90-1.25; I2  = 0%; low certainty in the evidence) or clinical respiratory illness (OR 1.49; 95% CI: 0.98-2.28; I2  = 78%; very low certainty in the evidence). Only one trial evaluated coronaviruses separately and found no difference between the two groups (P = .49). LIMITATIONS: Indirectness and imprecision of available evidence. CONCLUSIONS: Low certainty evidence suggests that medical masks and N95 respirators offer similar protection against viral respiratory infection including coronavirus in healthcare workers during non-aerosol-generating care. Preservation of N95 respirators for high-risk, aerosol-generating procedures in this pandemic should be considered when in short supply.


Subject(s)
Coronavirus Infections/prevention & control , Masks/standards , Occupational Exposure/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Respiratory Tract Infections/prevention & control , Ventilators, Mechanical/standards , COVID-19 , Health Personnel , Humans , Infection Control/methods , Randomized Controlled Trials as Topic , Respiratory Protective Devices/standards , Respiratory Protective Devices/supply & distribution , Respiratory Tract Infections/virology
16.
J Crit Care ; 59: 70-75, 2020 10.
Article in English | MEDLINE | ID: covidwho-597194

ABSTRACT

PURPOSE: To survey healthcare workers (HCW) on availability and use of personal protective equipment (PPE) caring for COVID-19 patients in the intensive care unit (ICU). MATERIALS AND METHOD: A web-based survey distributed worldwide in April 2020. RESULTS: We received 2711 responses from 1797 (67%) physicians, 744 (27%) nurses, and 170 (6%) Allied HCW. For routine care, most (1557, 58%) reportedly used FFP2/N95 masks, waterproof long sleeve gowns (1623; 67%), and face shields/visors (1574; 62%). Powered Air-Purifying Respirators were used routinely and for intubation only by 184 (7%) and 254 (13%) respondents, respectively. Surgical masks were used for routine care by 289 (15%) and 47 (2%) for intubations. At least one piece of standard PPE was unavailable for 1402 (52%), and 817 (30%) reported reusing single-use PPE. PPE was worn for a median of 4 h (IQR 2, 5). Adverse effects of PPE were associated with longer shift durations and included heat (1266, 51%), thirst (1174, 47%), pressure areas (1088, 44%), headaches (696, 28%), Inability to use the bathroom (661, 27%) and extreme exhaustion (492, 20%). CONCLUSIONS: HCWs reported widespread shortages, frequent reuse of, and adverse effects related to PPE. Urgent action by healthcare administrators, policymakers, governments and industry is warranted.


Subject(s)
Coronavirus Infections/transmission , Health Personnel , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Occupational Health , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/transmission , Adult , Africa , Allied Health Personnel , Asia , Betacoronavirus , COVID-19 , Europe , Eye Protective Devices , Female , Gloves, Protective , Headache/etiology , Hot Temperature , Humans , Intensive Care Units , Male , Masks/adverse effects , Masks/supply & distribution , Middle Aged , North America , Nurses , Oceania , Pandemics , Personal Protective Equipment/adverse effects , Personnel Staffing and Scheduling , Physicians , Respiratory Protective Devices/adverse effects , Respiratory Protective Devices/supply & distribution , SARS-CoV-2 , South America , Surgical Attire , Surveys and Questionnaires , Thirst
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