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1.
Disaster Med Public Health Prep ; : 1-16, 2021 Apr 30.
Article in English | MEDLINE | ID: covidwho-1700344

ABSTRACT

Objective: Bottlenecks in the personal protective equipment (PPE) supply chain have contributed to shortages of PPE during the COVID-19 pandemic, resulting in fractures in the functionality of healthcare systems. This study was conducted with the aim of determining the effectiveness of retrofitted commercial snorkel masks as an alternative respirator for healthcare workers during infectious disease outbreaks.Methods: A retrospective analysis was performed, analyzing qualitative and quantitative fit test results of the retrofitted Aria Ocean Reef® full-face snorkeling mask on healthcare workers at the McGill University Health Centre between April-June 2020. Historical fit test results, using medical-grade respirators, for healthcare workers were also analyzed.Results: During the study period, 71 participants volunteered for fit testing, 60.6% of which were nurses. The overall fit test passing rate using the snorkel mask was 83.1%. Of the participants who did not previously pass fit testing with medical-grade respirators, 80% achieved a passing fit test with the snorkel respirator.Conclusions: The results suggest that this novel respirator may be an effective and feasible alternative solution to address PPE shortages, while still providing healthcare workers with ample protection. Additional robust testing will be required to ensure that respirator fit is maintained, after numerous rounds of disinfection.

2.
Occup Environ Med ; 78(9): 679-690, 2021 09.
Article in English | MEDLINE | ID: covidwho-1362002

ABSTRACT

OBJECTIVES: To synthesise evidence concerning the range of filtering respirators suitable for patient care and guide the selection and use of different respirator types. DESIGN: Comparative analysis of international standards for respirators and rapid review of their performance and impact in healthcare. DATA SOURCES: Websites of international standards organisations, Medline and Embase, hand-searching of references and citations. STUDY SELECTION: Studies of healthcare workers (including students) using disposable or reusable respirators with a range of designs. We examined respirator performance, clinician adherence and performance, comfort and impact, and perceptions of use. RESULTS: We included standards from eight authorities across Europe, North and South America, Asia and Australasia and 39 research studies. There were four main findings. First, international standards for respirators apply across workplace settings and are broadly comparable across jurisdictions. Second, effective and safe respirator use depends on proper fitting and fit testing. Third, all respirator types carry a burden to the user of discomfort and interference with communication which may limit their safe use over long periods; studies suggest that they have little impact on specific clinical skills in the short term but there is limited evidence on the impact of prolonged wearing. Finally, some clinical activities, particularly chest compressions, reduce the performance of filtering facepiece respirators. CONCLUSION: A wide range of respirator types and models is available for use in patient care during respiratory pandemics. Careful consideration of performance and impact of respirators is needed to maximise protection of healthcare workers and minimise disruption to care.


Subject(s)
COVID-19/epidemiology , Disposable Equipment/statistics & numerical data , Equipment Reuse/statistics & numerical data , Ventilators, Mechanical/statistics & numerical data , Disposable Equipment/standards , Equipment Reuse/standards , Health Personnel/statistics & numerical data , Humans , Pandemics/statistics & numerical data , Ventilators, Mechanical/standards
3.
Int J Occup Med Environ Health ; 34(2): 239-249, 2021 May 27.
Article in English | MEDLINE | ID: covidwho-1181806

ABSTRACT

OBJECTIVES: To evaluate the effectiveness of safety guidelines in the workplace, the authors analyzed the work-related exposure to SARS-CoV-2 and the source of COVID­19 infections among healthcare workers (HCWs), together with the use of personal protective equipment (PPE). MATERIAL AND METHODS: A cross-sectional prospective study was conducted in tertiary hospitals in the Uusimaa region, Finland, with 1072 volunteers being enrolled in the study from among the HCWs at the Helsinki University Hospital. Overall, 866 (80.8%) HCWs (including 588 nurses, 170 doctors, and 108 laboratory and medical imaging nurses) completed the questionnaire by July 15, 2020, with 52% of the participants taking care of COVID­19 patients. The participants answered a structured questionnaire regarding their use of PPE, the ability to follow safety guidelines, exposure to COVID­19, and the source of potential COVID­19 infections. The participants with COVID­19 symptoms were tested with the SARS-CoV-2 realtime polymerase chain reaction method. All infected participants were contacted, and their answers were confirmed regarding COVID­19 exposure. RESULTS: In total, 41 (4.7%) participants tested positive for SARS-CoV-2, with 22 (53.6%) of infections being confirmed or likely occupational, and 12 (29.3%) originating from colleagues. In 14 cases (63.6%), occupational infections occurred while using a surgical mask, and all infections originating from patients occurred while using a surgical mask or no mask at all. No occupational infections were found while using an FFP2/3 respirator and following aerosol precautions. The combined odds ratio for working at an intensive care unit, an emergency department, or a ward was 3.4 (95% CI: 1.2-9.2, p = 0.016). CONCLUSIONS: A high infection rate was found among HCWs despite safety guidelines. Based on these findings, the authors recommend the use of FFP2/3 respirators in all patient contacts with confirmed or suspected COVID­19, along with the use of universal masking, also in personnel rooms. Int J Occup Med Environ Health. 2021;34(2):239-49.


Subject(s)
COVID-19/epidemiology , Disease Transmission, Infectious/prevention & control , Health Personnel , Personal Protective Equipment/standards , SARS-CoV-2 , Adult , COVID-19/transmission , Cross-Sectional Studies , Female , Finland/epidemiology , Humans , Male , Prospective Studies
5.
World Neurosurg ; 150: e182-e202, 2021 06.
Article in English | MEDLINE | ID: covidwho-1169302

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has exerted a significant impact on health care workers. Recent studies have reported the detrimental effects of the pandemic on neurosurgery residents in North America, Asia, and Italy. However, the impact of the pandemic on neurosurgical training in Latin America and Spain has not yet been reported. In the present report, we describe effects of COVID-19 on training and working conditions of neurosurgery residents in these countries. METHODS: An electronic survey with 33 questions was sent to neurosurgery residents between September 7, 2020 and October 7, 2020. Statistical analysis was made in SPSS version 25. RESULTS: A total of 293 neurosurgery residents responded. The median age was 29.47 ± 2.6 years, and 79% (n = 231) were male. Of respondents, 36.5% (n = 107) were residents training from Mexico; 42% surveyed reported COVID symptoms and 2 (0.7%) received intensive care unit care; 61.4% of residents had been tested for COVID and 21.5% had a positive result; 84% of the respondents mentioned persisted with the same workload (≥70 hours per week) during the pandemic. Most residents from Mexico were assigned to management of patients with COVID compared with the rest of the countries (88% vs. 68.3%; P < 0.001), mainly in medical care (65.4% vs. 40.9%; P < 0.001), mechanical ventilators (16.8% vs. 5.9%; P = 0.003), and neurologic surgeries (94% vs. 83%; P = 0.006). CONCLUSIONS: Our results offer a first glimpse of the changes imposed by the COVID-19 pandemic on neurosurgical work and training in Latin America and Spain, where health systems rely strongly on a resident workforce.


Subject(s)
COVID-19/epidemiology , Internship and Residency/trends , Neurosurgery/education , Pandemics , Adult , COVID-19/therapy , COVID-19 Testing , Critical Care , Female , Guidelines as Topic , Humans , Latin America/epidemiology , Male , Neurosurgeons , Spain/epidemiology , Surveys and Questionnaires , Ventilators, Mechanical , Workload , Young Adult
6.
J Family Med Prim Care ; 9(12): 5850-5852, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1122403

ABSTRACT

A general term N95 Mask has been widely used by all including the health care personnel. It has been use incorrectly by all and it should be replaced with the term filtering facepiece respirator. There are two types of respirators being used in the world. One is the industrial type whereas the other one is the medical surgical one. The medical surgical masks are an intermediate product between the industrial and the triple layer medical mask. Many other equivalent products like KN95 masks are also available in the market. There is an urgent need of certification because this is the only way quality face masks can be provided to the public in these difficult times of COVID-19. This is essential because of the entry of many counterfeit and uncertified respirators have entered the market.

7.
Anaesthesia ; 76(5): 617-622, 2021 05.
Article in English | MEDLINE | ID: covidwho-1066603

ABSTRACT

Disposable N95 respirator masks are the current standard for healthcare worker respiratory protection in the COVID-19 pandemic. In addition to shortages, qualitative fit testing can have low sensitivity for detecting poor fit, leading to inconsistent protection. Multiple groups have developed alternative solutions such as modified snorkel masks to overcome these limitations, but validation of these solutions has been lacking. We sought to determine if N95s and snorkel masks with attached high-efficiency filters provide consistent protection levels in healthcare workers and if the addition of positive pressure via an inexpensive powered-air purifying respirator to the snorkel mask would provide enhanced protection. Fifty-one healthcare workers who were qualitatively fitted with N95 masks underwent quantitative mask fit testing according to a simulated workplace exercise protocol. N95, snorkel masks with high-efficiency filters and snorkel masks with powered-air purifying respirators were tested. Respiratory filtration ratios were collected for each step and averaged to obtain an overall workplace protocol fit factor. Failure was defined as either an individual filtration ratio or an overall fit factor below 100. N95s and snorkel masks with high-efficiency filters failed one or more testing steps in 59% and 20% of participants, respectively, and 24% and 12% failed overall fit factors, respectively. The snorkel masks with powered-air purifying respirators had zero individual or overall failures. N95 and snorkel masks with high-efficiency filter respirators were found to provide inconsistent respiratory protection in healthcare workers.


Subject(s)
COVID-19/prevention & control , Cost-Benefit Analysis/standards , Health Personnel/standards , Masks/standards , N95 Respirators/standards , Adult , COVID-19/economics , Cohort Studies , Equipment Design/economics , Equipment Design/standards , Female , Health Personnel/economics , Humans , Male , Masks/economics , Middle Aged , N95 Respirators/economics , Occupational Exposure/economics , Occupational Exposure/prevention & control , Personal Protective Equipment/economics , Personal Protective Equipment/standards , Prospective Studies , Reproducibility of Results
8.
J Long Term Eff Med Implants ; 30(4): 241-246, 2020.
Article in English | MEDLINE | ID: covidwho-1034940

ABSTRACT

Introduction - The coronavirus disease 2019 (COVID-19) is considered to be highly contagious and restriction of transmission requires the utilization of protective equipment like surgical masks from both healthcare workers and public. The aim of this review is to investigate the role of surgical masks during the COVID-19 pandemic. Materials and Methods - A literature research was conducted via PubMed to detect articles featuring the potential protective role of surgical masks when they were worn by healthcare workers or by the general public. Results - Among 114 articles, only 31 met the inclusion criteria. Thirteen additional articles provided useful information according to the aim of this review. Existing literature supports the positive effect of surgical masks on COVID-19 con-lamination. Debate on the efficacy of surgical masks compared with other forms of facial protective devices exists. There seems to be a tendency to favor the use of particulate-filtering facepiece respirators in healthcare professionals who face higher risk of infection. However, surgical masks primarily and cloth masks secondarily seem to be adequate means of protection for the general public and for healthcare workers during procedures where respiratory droplets are not generated. Rational use of surgical masks is imperative; however, reuse after decontamination is not ideal. Conclusions - For optimum protection from COVID-19, the use of surgical masks should be combined with other infection control measures like hand hygiene and social distancing, since the level of their effectiveness is still being investigated. Shortage of surgical masks should be prevented; therefore, rational use plays a crucial role in this direction.


Subject(s)
COVID-19/prevention & control , COVID-19/transmission , Masks , Decontamination , Humans , SARS-CoV-2
9.
Int J Infect Dis ; 100: 224-229, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-959824

ABSTRACT

OBJECTIVES: There are currently no studies that have examined whether one dosage can be uniformly applied to different respirator types to effectively decontaminate SARS-CoV-2 on N95 filtering facepiece respirators (FFRs). Health care workers have been using this disinfection method during the pandemic. Our objective was to determine the effect of UVC on SARS-CoV-2 inoculated N95 respirators and whether this was respirator material/model type dependent. METHODS: Four different locations (facepiece and strap) on five different N95 FFR models (3M 1860, 8210, 8511, 9211; Moldex 1511) were inoculated with a 10 µL drop of SARS-CoV-2 viral stock (8 × 107 TCID50/mL). The outside-facing and wearer-facing surfaces of the respirators were each irradiated with a dose of 1.5 J/cm2 UVC (254 nm). Viable SARS-CoV-2 was quantified by a median tissue culture infectious dose assay (TCID50). RESULTS: UVC delivered using a dose of 1.5 J/cm2, to each side, was an effective method of decontamination for the facepieces of 3M 1860 and Moldex 1511, and for the straps of 3M 8210 and the Moldex 1511. CONCLUSION: This dose is an appropriate decontamination method to facilitate the reuse of respirators for healthcare personnel when applied to specific models/materials. Also, some straps may require additional disinfection to maximize the safety of frontline workers. Implementation of widespread UVC decontamination methods requires careful consideration of model, material type, design, and fit-testing following irradiation.


Subject(s)
Decontamination/methods , Masks/virology , SARS-CoV-2/physiology , SARS-CoV-2/radiation effects , Ultraviolet Rays , Ventilators, Mechanical/virology , Disinfection/methods , Dose-Response Relationship, Radiation , Equipment Reuse , Humans , Pandemics
10.
Dermatol Ther ; 33(6): e14528, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-917742

ABSTRACT

Given the current lack of a therapeutic vaccine for coronavirus disease 2019 (COVID-19), preventive measures including mask wearing are crucial in slowing the transmission of cases. However, prolonged wearing of protective respirators, medical and fabric masks can easily generate excessive sweating, moisture and friction. Closed and warm environments heighten the skin's permeability and sensitivity to physical or chemical irritants, leading to chronic cumulative irritant contact dermatitis or, rarely, even allergic contact dermatitis. Although not representing a life-threatening condition, contact dermatitis can have a significant impact on emergency management, as it is potentially able to reduce work performance and create emotional discomfort due to the involvement of evident body areas. To minimize the skin breakdown, adherence to standards on wearing protective and safe equipments and avoidance of overprotection should be performed. At the same time, some measures of skin care are recommended. Here, we offer some tips on how to prevent and manage contact dermatitis due to masks not only in health care workers, but also in the general population during this COVID-19 outbreak.


Subject(s)
COVID-19/prevention & control , Dermatitis, Contact/prevention & control , Dermatitis, Occupational/prevention & control , Facial Dermatoses/prevention & control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Inhalation Exposure/prevention & control , Masks/adverse effects , N95 Respirators/adverse effects , Skin Care , Administration, Cutaneous , Adrenal Cortex Hormones/administration & dosage , Anti-Allergic Agents/administration & dosage , Anti-Bacterial Agents/administration & dosage , COVID-19/transmission , Dermatitis, Contact/diagnosis , Dermatitis, Contact/etiology , Dermatitis, Occupational/diagnosis , Dermatitis, Occupational/etiology , Facial Dermatoses/diagnosis , Facial Dermatoses/etiology , Humans , Inhalation Exposure/adverse effects , Occupational Health , Protective Factors , Risk Assessment , Risk Factors , Treatment Outcome
11.
BMJ Open ; 10(10): e040321, 2020 10 16.
Article in English | MEDLINE | ID: covidwho-873543

ABSTRACT

OBJECTIVES: In patient-facing healthcare workers delivering secondary care, what is the evidence behind UK Government personal protective equipment (PPE) guidance on surgical masks versus respirators for SARS-CoV-2 protection? DESIGN: Two independent reviewers performed a rapid review. Appraisal was performed using Critical Appraisal Skills Programme checklists and Grading of Recommendations, Assessment, Development and Evaluations methodology. Results were synthesised by comparison of findings and appraisals. DATA SOURCES: MEDLINE, Google Scholar, UK Government COVID-19 website and grey literature. ELIGIBILITY CRITERIA: Studies published on any date containing primary data comparing surgical facemasks and respirators specific to SARS-CoV-2, and studies underpinning UK Government PPE guidance, were included. RESULTS: Of 30 identified, only 3 laboratory studies of 14 different respirators and 12 surgical facemasks were found. In all three, respirators were significantly more effective than facemasks when comparing protection factors, reduction factors, filter penetrations, total inspiratory leakages at differing particle sizes, mean inspiratory flows and breathing rates. Tests included live viruses and inert particles on dummies and humans. In the six clinical studies (6502 participants) included the only statistically significant result found continuous use of respirators more effective in clinical respiratory illness compared with targeted use or surgical facemasks. There was no consistent definition of 'exposure' to determine the efficacy of respiratory protective equipment (RPE). It is difficult to define 'safe'. CONCLUSIONS: There is a paucity of evidence on the comparison of facemasks and respirators specific to SARS-CoV-2, and poor-quality evidence in other contexts. The use of surrogates results in extrapolation of non-SARS-CoV-2 specific data to guide UK Government PPE guidance. The appropriateness of this is unknown given the uncertainty over the transmission of SARS-CoV-2.This means that the evidence base for UK Government PPE guidelines is not based on SARS-CoV-2 and requires generalisation from low-quality evidence of other pathogens/particles. There is a paucity of high-quality evidence regarding the efficacy of RPE specific to SARS-CoV-2. UK Government PPE guidelines are underpinned by the assumption of droplet transmission of SARS-CoV-2.These factors suggest that the triaging of filtering face piece class 3 respirators might increase the risk of COVID-19 faced by some.


Subject(s)
Aerosols/adverse effects , Betacoronavirus , Coronavirus Infections/transmission , Disease Transmission, Infectious/prevention & control , Health Personnel , Infection Control/methods , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/transmission , Triage/methods , COVID-19 , Coronavirus Infections/epidemiology , Humans , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2
12.
J Oral Maxillofac Surg ; 78(12): 2114-2127, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-834554

ABSTRACT

PURPOSE: Coronavirus Disease 2019 (COVID-19) has caused suffering and death around the world. Careful selection of facial protection is paramount for preventing virus spread among healthcare workers and preserving mask and N95 respirator supplies. METHODS: This paper is a comprehensive review of literature written in English and available on Pubmed comparing the risk of viral respiratory infections when wearing masks and N95 respirators. Current international oral and maxillofacial surgery guidelines for mask and N95 respirator use, patient COVID-19 disease status, aerosol producing procedures were also collected and incorporated into a workflow for selecting appropriate facial protection for oral and maxillofacial surgery procedures during the current pandemic. RESULTS: Most studies suggest N95 respirators and masks are equally protective against respiratory viruses. Some evidence favors N95 respirators, which are preferred for high-risk procedures when aerosol production is likely or when the COVID-19 status of a patient is positive or unknown. N95 respirators may also be used for multiple patients or reused depending on the type of procedure and condition of the respirator after each patient encounter. CONCLUSION: N95 respirators are preferred over masks against viral respiratory pathogens, especially during aerosol-generating procedures or when a patient's COVID-19 status is positive or unknown.


Subject(s)
COVID-19 , Respiratory Protective Devices , Humans , Masks , N95 Respirators , Pandemics/prevention & control , SARS-CoV-2
13.
Risk Anal ; 41(5): 731-744, 2021 05.
Article in English | MEDLINE | ID: covidwho-796693

ABSTRACT

Because asymptomatic carriers of COVID-19 produce respiratory droplets that can remain suspended in air for several hours, social distancing may not be a reliable physical barrier to transmission. During the COVID-19 pandemic, however, some governments were reluctant to mandate public mask use out of concern this would worsen shortages of respirators for healthcare workers. Cloth masks with a filtering effectiveness of 70-90% can be made from widely available materials, and are a better option than respirators for the public. Countries could rapidly implement Effective Fiber Mask Programs (EFMPs) to use local resources to mass produce effective and affordable cloth masks, and to engage the public in their correct use. EFMPs could be a cost-effective measure to ease isolation while limiting new infections during pandemics. EFMPs could also protect healthcare workers by increasing the supply of respirators for their use, reducing their risk of acquiring the illness from their communities, and by reducing the number of patients they must treat.


Subject(s)
COVID-19/prevention & control , Masks , Pandemics , Textiles , Aerosols , COVID-19/transmission , COVID-19/virology , Humans , Models, Theoretical , SARS-CoV-2/isolation & purification
14.
Anaesthesia ; 76(1): 91-100, 2021 01.
Article in English | MEDLINE | ID: covidwho-760106

ABSTRACT

For healthcare workers performing aerosol-generating procedures during the COVID-19 pandemic, well fitted filtering facepiece respirators, for example, N95/FFP2 or N99/FFP3 masks, are recommended as part of personal protective equipment. In this review, we evaluate the role of fit checking and fit testing of respirators, in addition to airborne protection provided by respirators. Filtering facepiece respirators are made of material with sufficient high filter capacity to protect against airborne respiratory viruses. Adequate viral protection can only be provided by respirators that properly fit the wearer's facial characteristics. Initial fit pass rates vary between 40% and 90% and are especially low in female and in Asian healthcare workers. Fit testing is recommended to ensure a proper fit of respirators for the individual healthcare worker so that alternative respirators can be selected if required. Although fit testing is required to comply with respirator standards, it is not performed consistently within all healthcare settings. Fit checking (a self-test) is recommended every time a healthcare worker dons a respirator, but is unreliable in detecting proper fit or leak. Additionally, fit testing has a high educational value and as such is best performed as part of a hospital respiratory protection programme. Whether fit checking alone, as opposed to fit tested and fit checked respirators, provides adequate airborne protection against aerosols containing the SARS-CoV-2 virus and other respiratory viruses remains unknown. While fit testing undoubtedly incurs additional costs, it is still recommended, not only to protect healthcare workers but also as it may reduce overall healthcare cost when considering the potential costs of sickness leave and the associated legal costs of compensation.


Subject(s)
COVID-19/prevention & control , Masks/standards , Personal Protective Equipment/standards , Humans , N95 Respirators , Pandemics , Respiratory Protective Devices/standards
15.
Wound Repair Regen ; 29(1): 45-52, 2021 01.
Article in English | MEDLINE | ID: covidwho-751583

ABSTRACT

Numerous healthcare professionals fighting COVID-19 worldwide are suffering from the protective respirators related facial pressure injuries. This study explored the mechanism and prevention of such injuries and devised a novel emergent strategy, which was supported by a multicenter self-controlled study in 1161 frontline healthcare professionals. In this study, according to the anatomy of the face and the characteristics of facial pressure injuries, a respirator liner was designed using a polyurethane foam to redistribute the pressure across the face. A preclinical crossover trial was performed on eight participants to evaluate its efficacy. The strategy was then widely applied among 11 100 healthcare workers in seven frontline hospitals, and 1161 of them were sampled for a questionnaire investigation. The preclinical crossover trial showed that the novel strategy was very effective in preventing facial pressure injuries. The questionnaire investigation showed that pain score, wearing disturbance, and the incidence of pressure injury in the healthcare professionals were significantly correlated with wearing time (all ρ = 0.986). The new strategy significantly reduced the incidence of pressure injury from 84.7% to 11.1%, pain score IQR from 5 (2) to 1 (2), and wearing disturbance rate from 91.6% to 6.3%, and the results analyzed according to individual hospitals or different wearing time showed similar trends (all P < .0005). The protective respirators related facial pressure injuries can be effectively mitigated with this emergent strategy, which has also been applied in some European hospitals and can be popularized to help more healthcare professionals who are combating COVID-19 on the frontlines.


Subject(s)
COVID-19/therapy , Delivery of Health Care/methods , Health Personnel/standards , Pressure Ulcer/prevention & control , Respiration, Artificial/adverse effects , Adolescent , Adult , Aged , COVID-19/epidemiology , Face , Female , Humans , Male , Middle Aged , Pressure Ulcer/etiology , SARS-CoV-2 , Wound Healing , Young Adult
16.
J Hosp Infect ; 106(1): 163-175, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-716812

ABSTRACT

Inadequate supply of filtering facepiece respirators (FFRs) for healthcare workers during a pandemic such as the novel coronavirus outbreak (SARS-CoV-2) is a serious public health issue. The aim of this study was to synthesize existing data on the effectiveness of ultraviolet germicidal irradiation (UVGI) for N95 FFR decontamination. A systematic review (PROSPERO CRD42020176156) was conducted on UVGI in N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined eligibility and extracted predefined variables. Original research reporting on function, decontamination, or mask fit following UVGI were included. Thirteen studies were identified, comprising 54 UVGI intervention arms and 58 N95 models. FFRs consistently maintained certification standards following UVGI. Aerosol penetration averaged 1.19% (0.70-2.48%) and 1.14% (0.57-2.63%) for control and UVGI arms, respectively. Airflow resistance for the control arms averaged 9.79 mm H2O (7.97-11.70 mm H2O) vs 9.85 mm H2O (8.33-11.44 mm H2O) for UVGI arms. UVGI protocols employing a cumulative dose >20,000 J/m2 resulted in a 2-log reduction in viral load. A >3-log reduction was observed in seven UVGI arms using >40,000 J/m2. Impact of UVGI on fit was evaluated in two studies (16,200; 32,400 J/m2) and no evidence of compromise was found. Our findings suggest that further work in this area (or translation to a clinical setting) should use a cumulative UV-C dose of 40,000 J/m2 or greater, and confirm appropriate mask fit following decontamination.


Subject(s)
Coronavirus Infections/prevention & control , Disinfection/standards , Equipment Reuse/standards , Guidelines as Topic , Masks/standards , Occupational Exposure/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Ultraviolet Rays , Betacoronavirus , COVID-19 , Efficiency , Humans , SARS-CoV-2 , Safety/standards
17.
J Hosp Infect ; 106(3): 504-521, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-709227

ABSTRACT

BACKGROUND: Decontaminating and reusing filtering facepiece respirators (FFRs) for healthcare workers is a potential solution to address inadequate FFR supply during a global pandemic. AIM: The objective of this review was to synthesize existing data on the effectiveness and safety of using chemical disinfectants to decontaminate N95 FFRs. METHODS: A systematic review was conducted on disinfectants to decontaminate N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined study eligibility and extracted predefined data fields. Original research reporting on N95 FFR function, decontamination, safety, or FFR fit following decontamination with a disinfectant was included. FINDINGS AND CONCLUSION: A single cycle of vaporized hydrogen peroxide (H2O2) successfully removes viral pathogens without affecting airflow resistance or fit, and maintains an initial filter penetration of <5%, with little change in FFR appearance. Residual hydrogen peroxide levels following decontamination were within safe limits. More than one decontamination cycle of vaporized H2O2 may be possible but further information is required on how multiple cycles would affect FFR fit in a real-world setting before the upper limit can be established. Although immersion in liquid H2O2 does not appear to adversely affect FFR function, there is no available data on its ability to remove infectious pathogens from FFRs or its impact on FFR fit. Sodium hypochlorite, ethanol, isopropyl alcohol, and ethylene oxide are not recommended due to safety concerns or negative effects on FFR function.


Subject(s)
Coronavirus Infections/prevention & control , Decontamination/standards , Disinfectants/administration & dosage , Equipment Reuse/standards , Hydrogen Peroxide/administration & dosage , Respiratory Protective Devices/virology , Sodium Hypochlorite/administration & dosage , Guidelines as Topic , Humans , Ultraviolet Rays
18.
J Healthc Qual Res ; 35(4): 245-252, 2020.
Article in Spanish | MEDLINE | ID: covidwho-680300

ABSTRACT

BACKGROUND AND OBJECTIVE: In the COVID-19 pandemic, the demand of masks has been increased by health professionals and the general population. In this context, it is necessary to summarize the features and indications of the different types of masks. MATERIAL AND METHODS: To consult and to compile the different recommendations disseminated by prestigious institutions such as the World Health Organization, the European Center for Disease Prevention, the Center for Evidence-Based Medicine, or the Ministry of Health of the Government of Spain has been reviewed. RESULTS: The institutions consulted recommend reserving FFP respirators for healthcare workers, especially when carrying out aerosol-generating procedures (AGPs) (minimum FFP2 protection) and consider some reutilization systems during times of scarcity. The use of surgical masks is recommended to professionals who do not perform AGPs and to the symptomatic population but exist variations in its indications intended for the general healthy population. CONCLUSION: In the context of shortage of personal protective equipment due to the COVID-19 pandemic, a prioritization and rationalization of the use of each type of mask should be established according to the user and the activity performed.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Guidelines as Topic , Masks/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Respiratory Protective Devices/standards , COVID-19 , Coronavirus Infections/epidemiology , Equipment Contamination , Equipment Reuse/standards , Filtration/instrumentation , Health Personnel , Humans , Hygiene/standards , Masks/classification , Masks/supply & distribution , Personal Protective Equipment/standards , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Spain/epidemiology
19.
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
20.
mBio ; 11(3)2020 06 25.
Article in English | MEDLINE | ID: covidwho-616491

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused a severe, international shortage of N95 respirators, which are essential to protect health care providers from infection. Given the contemporary limitations of the supply chain, it is imperative to identify effective means of decontaminating, reusing, and thereby conserving N95 respirator stockpiles. To be effective, decontamination must result in sterilization of the N95 respirator without impairment of respirator filtration or user fit. Although numerous methods of N95 decontamination exist, none are universally accessible. In this work, we describe a microwave-generated steam decontamination protocol for N95 respirators for use in health care systems of all sizes, geographies, and means. Using widely available glass containers, mesh from commercial produce bags, a rubber band, and a 1,100-W commercially available microwave, we constructed an effective, standardized, and reproducible means of decontaminating N95 respirators. Employing this methodology against MS2 phage, a highly conservative surrogate for SARS-CoV-2 contamination, we report an average 6-log10 plaque-forming unit (PFU) (99.9999%) and a minimum 5-log10 PFU (99.999%) reduction after a single 3-min microwave treatment. Notably, quantified respirator fit and function were preserved, even after 20 sequential cycles of microwave steam decontamination. This method provides a valuable means of effective decontamination and reuse of N95 respirators by frontline providers facing urgent need.IMPORTANCE Due to the rapid spread of coronavirus disease 2019 (COVID-19), there is an increasing shortage of protective gear necessary to keep health care providers safe from infection. As of 9 April 2020, the CDC reported 9,282 cumulative cases of COVID-19 among U.S. health care workers (CDC COVID-19 Response Team, MMWR Morb Mortal Wkly Rep 69:477-481, 2020, https://doi.org/10.15585/mmwr.mm6915e6). N95 respirators are recommended by the CDC as the ideal method of protection from COVID-19. Although N95 respirators are traditionally single use, the shortages have necessitated the need for reuse. Effective methods of N95 decontamination that do not affect the fit or filtration ability of N95 respirators are essential. Numerous methods of N95 decontamination exist; however, none are universally accessible. In this study, we describe an effective, standardized, and reproducible means of decontaminating N95 respirators using widely available materials. The N95 decontamination method described in this work will provide a valuable resource for hospitals, health care centers, and outpatient practices that are experiencing increasing shortages of N95 respirators due to the COVID-19 pandemic.


Subject(s)
Betacoronavirus/radiation effects , Coronavirus Infections/prevention & control , Decontamination/instrumentation , Decontamination/methods , Masks , Steam , Betacoronavirus/physiology , COVID-19 , Coronavirus Infections/transmission , Coronavirus Infections/virology , Decontamination/standards , Disease Transmission, Infectious/prevention & control , Disinfection/instrumentation , Disinfection/methods , Equipment Reuse/standards , Filtration , Humans , Microwaves , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Reproducibility of Results , SARS-CoV-2 , Sterilization , United States
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