The Impact of Earplugs and Eye Masks on Sleep Quality in Surgical ICU Patients at Risk for Frequent Awakenings.

OBJECTIVES: Sleep disturbances may contribute to the development of delirium, prolonged ICU stay, and increased mortality. There is conflicting data on the effectiveness of earplugs and eye masks for sleep promotion in the ICU. This study evaluates the impact of earplugs and eye masks on sleep quality in postoperative surgical ICU patients at risk for frequent awakenings. DESIGN: Prospective randomized controlled trial. SETTING: Surgical ICU within the University of Texas Southwestern Medical Center. PATIENTS: Adult, female patients admitted to the surgical ICU requiring hourly postoperative assessments following breast free flap surgery between February 2018 and October 2019. INTERVENTIONS: Patients were randomized into an intervention group or a control group. The intervention group received earplugs and eye masks in addition to standard postoperative care, whereas the control group received standard postoperative care. MEASUREMENTS AND MAIN RESULTS: The primary outcome was overall sleep quality assessed via the Richards-Campbell Sleep Questionnaire. Secondary outcomes of patient satisfaction and rates of ICU delirium were assessed with a modified version of the Family Satisfaction in the ICU survey and the Confusion Assessment Method for the ICU. After a planned interim analysis, the study was stopped early because prespecified criteria for significance were attained. Compared with the control group's average Richards-Campbell Sleep Questionnaire total score of 47.3 (95% CI, 40.8-53.8), the intervention group's average Richards-Campbell Sleep Questionnaire total score was significantly higher at 64.5 (95% CI, 58.3-70.7; p = 0.0007). There were no significant between-group differences for Confusion Assessment Method for the ICU scores or modified Family Satisfaction in the ICU survey scores. CONCLUSIONS: These results suggest that earplugs and eye masks are effective in improving sleep quality in ICU patients undergoing frequent assessments. The results strengthen the evidence for nonpharmacologic sleep-promoting adjuncts in the ICU.

Prevention of fogging inside safety goggles for healthcare professionals during COVID-19 pandemic: A low-cost solution in resource-limited settings.

Fogging inside the safety goggles is a common problem experienced by more healthcare professionals during the COVID-19 pandemic than ever. Various anti-fogging remedies are available on the market. We have adopted a low-cost alternative that can be extremely useful in resource-limited settings.

[Comparison of three medical goggle sterilizing approaches].

OBJECTIVE: To compare three sterilizing methods for reusable medical goggles. METHODS: A total of 180 medical goggles of the same brand and same model were randomly divided into three groups. In group A the goggles were first soaked with 2000 mg/L chlorine-containing disinfectant and then cleaned manually; goggles in other two groups were sterilized using pre-programmed automatic spray cleaning and disinfection machine, the disinfection program was set to 90 ℃ for 5 min in group B and 70 ℃ for 30 min in group C. The quality of the sterilization was monitored by visual inspection with luminous magnifying glass and residual protein detection assay. User satisfaction on cleanliness of medical goggles, clarity of mirror surface and suitability of elastic bands was investigated with questionnaire survey. RESULTS: The qualification rates verified by visual inspection were 82.4%, 84.6%and 98.3%in group A, B and C, respectively, the qualification rate in group C was significantly higher than those in group B and group C (all P<0.05). The qualification rates verified by residual protein detection assay were 96.7%, 100.0%and 100.0%in group A, B and C, respectively (P>0.05). A total of 54 questionnaires were submitted for the survey. The satisfaction rates were 100.0%, 90.7%and 94.4% for cleanliness of medical goggles, clarity of mirror surface and suitability of elastic bands, respectively. CONCLUSIONS: Machinery sterilization set 70 ℃ for 30 min has better cleaning and sterilizing effects for reusable medical goggles.

COVID-19: uso de equipamento de proteção individual

Centro de Telessaúde HC-UFMG www.telessaude.hc.ufmg.br

Prevención de la transmisión de agentes infecciosos en entornos sanitário: síntesis rápida de evidencia / Prevention of transmission of infectious agents in healthcare settings: rapid synthesis of evidence

INTRODUCCIÓN: Existe una pandemia actual causada por un Coronavirus similar a previos virus epidémicos como los coronavirus respiratorios del Síndrome Respiratorio Agudo Severo (SARS-CoV) y del Coronavirus del Síndrome Respiratorio del Medio Oriente (MERS-CoV). Esto llevo a que la OMS declarara una emergencia de salud pública internacional y luego a una situación de pandemia. Como parte de la respuesta global a esta pandemia, varias organización como el Centro para el Control y Prevención de enfermedades de los Estados Unidos (CDC) han elaborado guias sobre como controlar esta enfermedad en entornos sanitarios. Para esto se basan en la experiencia adquirida con la epidemia tanto de los coronovarius SARS como de MERS. Los pacientes infectados parecen ser preferentemente mayores de 15 años, habiendo muy pocos infectados en niños en un análisis hecho de pacientes en China (solo 0.9% de los casos). La mayoría fueron hombres (58.1%). La mediana del periodo de incubación fue 7 días (rango intercuartil de 2 a 7). Los síntomas más comunes son fiebre (88,7%), y tos (67.8%). Aproximadamente 5% de los pacientes requieren unidades de cuidados intensivos (UCIs), y 1.4% murieron, siendo esta edad dependiente. Se sabe que el coronavirus SARS-1puede ser transmitido eficientemente en entornos sanitarios si los pacientes con este virus no son reconocidos inmediatamente, y las medidas de control no son aplicadas. Las medidas básicas de control son efectivas en prevenir la transmisión de SARS1 en entornos sanitarios. Dentro de las actividades prioritarias esta reforzar las prácticas de control de infecciones entre el personal de salud, desarrollar planes para tomar las precauciones necesarias en facilidades hospitalarias, y la detección temprana y aislamiento de los pacientes que podrían estar infectados con el coronavirus. En tal sentido, el objetivo de esta revisión rápida es generar evidencia a partir de la guias de control de infecciones publicada que evalúe los mecanismos de la transmisión de agentes infecciosos respiratorios en entornos sanitarios, y las medidas de precaucione neesarias, con énfasis en el aislamiento de los pacientes. MÉTODOS: Se realizó una revisión narrativa de las principales guías de control de infecciones relacionadas al Coronavirus SARS-1 (SARS-Cov-1) y al Coronavirus SARS-2 (SARS-Cov-2). Estas incluyeron principalmente los documentos del Centro para el Control y Prevención de enfermedades de los Estados Unidos (CDC) sobre aislamiento (7,8). Asimismo para la sección de estándares para las salas de aislamiento se revisaron los documentos pertinentes incluyendo la guías para diseño y construcción de hospitales del Facility Guidelines Institute de los Estados Unidos, que es la guía usada por el gobierno federal y gobiernos estatales de los Estados Unidos, asi como el Texto de Control de Infecciones y Epidemiologia de la Asociacion de profesionales en Control de Infecciones. Ademas esta revision esta suplementada con la ultima información sobre las características de trasnmision estudiadas en el nuevo SARS-Cov-2, como la publicada recientemente en el new England Journal of Medicine. RESULTADOS: Las opciones de hospitalización incluyen habitaciones individuales, habitaciones dobles, y habitaciones de camas múltiples. De estas, las habitaciones individuales siempre están indicadas para pacientes en Precauciones de Transmisión aérea, y son las habitaciones preferidas para Precauciones de Gotas aéreas, aunque en caso de falta de camas se pueden colocar a los pacientes en cohortes. Esta es la práctica de agrupar juntos a los pacientes infectados con el mismo organismo, y prevenir su contacto con otros pacientes no infectados. Es preferible no colocar pacientes severamente inmunocomprometidos dentro de las cohortes. Cohortes han sido usadas extensivamente para manejar brotes respiratorios como SARS. Colocar personal de salud en cohortes para cuidar un solo tipo de pacientes infectados, parece limitar la transmisión del agente, aunque es difícil de lograr cuando hay escasez de personal. Dentro de las precauciones generales para pacientes sospechosos o confirmados con agentes infecciosos, el CDC recomienda en general: - Precauciones Estandar que implican a) Higiene de Manos, b) Uso de equipo de protección personal dependiendo de las actividades a realizar, c) Prácticas seguras de Endovenosos, y d) Etiqueta/Higiene Respiratorio. - Limpieza y desinfección de todas las aéreas de pacientes es importante para superficies que se tocan, especialmente aquellas cercanas al paciente (agarraderas, cómodas, manijas, lavatorios, superficies y equipos). Desinfectantes o detergentes aprobados son la mejor manera de mantener la limpieza de las habitaciones. - Textiles sucios, incluido ropa de cama, toallas, y ropa de los pacientes pueden estar contaminas. Aunque la probabilidad de transmisión es baja, deben ser manejadas, transportadas y lavadas de manera segura. Medidas principales incluyen: a) No sacudir o manipular los textiles de manera que aerosolizen los agentes, b) Evitar contacto de los textiles con el cuerpo o la ropa de la persona encargada, c) Colocar los textiles en una bolsa de lavandería o contenedor designado. Mantenerlos cerrados para minimizar la dispersión de aerosoles.

Comparison of three medical goggle sterilizing approaches / 浙江大学学报·医学版

OBJECTIVE@#To compare three sterilizing methods for reusable medical goggles.@*METHODS@#A total of 180 medical goggles of the same brand and same model were randomly divided into three groups. In group A the goggles were first soaked with 2000 mg/L chlorine-containing disinfectant and then cleaned manually; goggles in other two groups were sterilized using pre-programmed automatic spray cleaning and disinfection machine, the disinfection program was set to 90 ℃ for 5 min in group B and 70 ℃ for 30 min in group C. The quality of the sterilization was monitored by visual inspection with luminous magnifying glass and residual protein detection assay. User satisfaction on cleanliness of medical goggles, clarity of mirror surface and suitability of elastic bands was investigated with questionnaire survey.@*RESULTS@#The qualification rates verified by visual inspection were 82.4%, 84.6%and 98.3%in group A, B and C, respectively, the qualification rate in group C was significantly higher than those in group B and group C (all @*CONCLUSIONS@#Machinery sterilization set 70 ℃ for 30 min has better cleaning and sterilizing effects for reusable medical goggles.

OCCUPATIONAL RADIATION EXPOSURE DOSE OF THE EYE IN DEPARTMENT OF CARDIAC ARRHYTHMIA PHYSICIAN.

Interventional radiology (IR) procedures tend to be complex, which delivers high radiation exposure to patient. In the present study, we measured the radiation exposure dose [Hp(3)] in the eye using a direct eye dosemeter placed next to the physician's eye during procedures. Physicians wore a direct eye dosemeter just lateral to eyes and an additional direct eye dosemeter outside the radiation protective eyeglasses close to their eyes. Additionally, a neck glass badge was worn at the neck. Although we found a positive correlation between the left neck glass badge dose [Hp(0.07)] and the left eye lens dose [Hp(3)], the value of R2 of the regression equation were 0.62 and 0.71 (outside and inside). We thought that the exact eye lens dose might not be estimated from the neck glass badge. In conclusion, a correct evaluation of the lens dose [Hp(3)] using the direct eye dosemeter is recommended for tachyarrhythmia physicians.

Sunscreen Application, Safety, and Sun Protection: The Evidence.

Recently in Canada, there has been an effort to create consistent messaging about sun safety as there is a lack of up-to-date evidence-based guidelines regarding sun-protection measures. This review aimed to provide updated, evidence-based recommendations on sunscreen application, safety, and sun protection regarding the following topics for which there is clinical uncertainty: physical barriers, sunscreen properties, sunscreen application, and risk-benefit analysis.

Evaluation of Aircrew Low-Intensity Threat Laser Eye Protection.

Prototype low-intensity threat laser eye protection (LIT-LEP) spectacles were evaluated for US Coast Guard (USCG) cockpits and night vision goggle compatibility. The impetus for interest in aviation LIT-LEP is driven in part by the fact that easily accessible 0.5-2.0 W high-power laser pointers exceed safety standards for direct on-axis viewing. A repeated-measures experimental design was used to assess LIT-LEP performance relative to a no-LEP control for the following tasks: Near- and far contrast acuity, night vision goggle far-contrast acuity, emissive and non-emissive light source color-vision screening, and USCG multifunctional display color symbol discrimination reaction time and accuracy. Near- and far-contrast acuity results demonstrated good LIT-LEP performance for typical in- and out-of-cockpit lighting conditions. Night vision goggle performance suffered marginally at only one contrast level (85%; 20/30 acuity line). Color vision test results showed good color balance in that S-, M-, and L-cone performance did not demonstrate a clinical diagnostic color defect for emissive or non-emissive light sources when wearing LIT-LEP. Color symbol discrimination reaction-time-task results based on inverse efficiency scores revealed that some non-primary flight display colors exhibited a combination of slower speed and decreased accuracy. The findings will contribute to an acquisition decision as well as guide future LEP designs.

Ballistic Eye Protection: Why Are Soldiers Reluctant to Use Them?

INTRODUCTION: The Israel Defense Forces (IDF), as well as many other armies, faces major challenges in balancing the need to protect soldiers from harm while not impeding their ability to fight. Eye protections available in the IDF are underused, for reasons that are as yet unclear. In this study, we aim to gain a better understanding of the influence of eye protection currently in use in the IDF on vision. MATERIALS AND METHODS: In this cross-sectional study, subjects were assessed for best corrected visual acuity, contrast sensitivity, and binocular visual fields (Goldmann) in a crossover design (with and without eye protection). In addition, we established a comprehensive review on the subjective faults of the eye protection, both from personal experiences of soldiers who used them during their military service and from civilian volunteers who used them in a sterile laboratory setting. RESULTS: Visual acuity, contrast sensitivity and visual fields with and without the eye protection were assessed in 25 subjects. Eye protection did not cause any statistically significant change in visual acuity. However, the eye protection caused a statistically significant decrease in visual fields in all quadrants and in both isopters used. CONCLUSIONS: Significant restriction of the visual field can pose a major challenge for soldiers on the battlefield. The use of eye protection with wider lenses or no frame should be considered. Education and instruction should focus on increasing awareness among commanders and soldiers of the benefits of eye protection and fostering trust in the technology's capabilities. In parallel, it is crucial to educate soldiers about its disadvantages, and how such disadvantages can be overcome. We stipulate the findings to the standard IDF goggle and might not apply to other designs.

Short wavelengths filtering properties of sunglasses on the Canadian market: are we protected?

BACKGROUND: Exposure to solar radiation is a risk factor for multiple ocular pathologies. Ultraviolet (UV) radiation is involved in ocular diseases, including pterygium, ocular surface squamous neoplasia, and cataracts. High-energy visible light (HEV) is associated with age-related macular degeneration. Ocular protection against solar radiation seems essential to protect our eyes against the adverse effects of those harmful rays. Australia, New Zealand, Europe, and the United States are the only regions with mandatory standards for UV transmission for sunglasses. Adherence to Canadian standards by sunglasses manufacturers is not mandatory. In this study, we evaluated the UV and visible transmission of sunglasses in the Canadian market to test their compliance with Canadian standards. METHODS: The transmittance of 207 pairs of sunglasses, divided in 3 categories according to their price range, was measured. RESULTS: We show that close to 100% of the sunglasses tested respect the Canadian standards. The average HEV transmittance is around 10%, regardless the price range. CONCLUSIONS: Our study demonstrated that even if following Canadian standards is optional, most sunglasses sold on the Canadian market follow national and international standards. We also found that sunglasses filter around 90% of HEV. With the recent findings on the potential effects of HEV in retinal pathologies, we can ask whether this filtering capacity is sufficient to protect eyes from harmful HEV light. More work needs to be done to determine acceptable HEV light transmission limits to the existing Canadian standards.

Effects of falling weight impact on industrial safety helmets used in conjunction with eye and face protection devices.

Industrial workplaces pose concurrent hazards to the upper part of the head and the eyes. Under the circumstances, workers may use protective helmets in conjunction with protective goggles or spectacles. In order to assess the compatibility of this equipment, a method and a test stand for evaluating the behavior of safety helmets and protective goggles/spectacles upon the impact of a falling weight were designed. The results of tests concerning the displacement and deformation of helmets and spectacles/goggles, the forces acting on the helmets, as well as the forces exerted by the spectacles/goggles on the headform upon falling weight impact are presented. The results revealed the ways in which the tested equipment interacted with each other. The influence of equipment construction on the test results was analyzed and inferences concerning the safety of the studied protective devices were made. Some general construction guidelines were formulated for the compatibility of the equipment.

When is protection from impact needed for the face as well as the eyes in occupational environments?

BACKGROUND: The most commonly identified reason for requiring or using occupational eye and face protection is for protection against flying objects. Standards vary on what risk may require protection of the eyes alone and what requires protection for the whole face. Information on the minimum energy transfer for face damage to occur is not well-established. METHODS: The heads of pigs were used as the common model for human skin. A 6 mm steel ball projected at velocities between 45 and 135 m/s was directed at the face area. Examples of impacts were filmed with a high-speed camera and the resulting damage was rated visually on a scale from 1 (no visible damage) to 5 (penetrated the skin and embedded in the flesh). RESULTS: The results for the cheek area indicate that 85 m/s is the velocity above which damage is more likely to occur unless the skin near the lip is included. For damage to the lip area to be avoided, the velocity needs to be 60 m/s or less. CONCLUSION: The present data support a maximum impact velocity of 85 m/s, provided the thinner and more vulnerable skin of the lids and orbital adnexa is protected. If the coverage area does not extend to the orbital adnexa, then the absolute upper limit for the velocity is 60 m/s. At this stage, eye-only protection, as represented by the lowest level of impact test in the standards in the form of a drop ball test, is not in question.

Photobiology eye safety for horticultural LED lighting: Transmittance performance of eyewear protection using high-irradiant monochromatic LEDs.

Light emitting diodes have slowly gained market share as horticultural lighting systems in greenhouses due to their rapid improvement in color performances and light outputs. These advancements have increased the availability of the full spectrum of visible wavelengths and the corresponding irradiance outputs available to plants. However, light emitting diodes owners have limited information on the proper options for personal eyewear protection as the irradiance levels have increased. The objective of this study was to measure the light transmittance performance of 12 eyewear protection including welding goggles, safety goggles, polarized glasses, and sunglasses across the human visible spectrum (380-740 nm) up to an irradiance level of 1500 W·m-2 from high-irradiant light emitting diodes assemblies. Based on the spectral measurements, certain transmitted spectra exhibited spectrum shifts or an alteration in the bimodal distribution which were different than the light emitting diodes spectra, due to the uneven transmittance efficiencies of the glasses. As for the measured transmittance percentages in two experiments, each type of eyewear protection showed distinct transmittance performances, and the performance of the tested eyewear protection was not impacted by irradiance but was dependent on the wavelength. The mean light transmittance was 1.77% for the welding glasses, 13.12% for the polarized glasses, 15.27% for the safety goggles, and 27.65% for the sunglasses. According to these measured results and the spectral weighting exposure limits from the International Electrotechnical Commission 62471 and EU directive 2006/25, consumers and workers using horticultural lighting can select welding goggles or polarized glasses, to limit the possible ocular impact of the high irradiance of monochromatic light in electrical lighting environment. Sunglasses and safety goggles would not be advised as protection, especially if infrared radiation was used.

Evaluating optical hazards from plasma arc cutting.

The Health Hazard Evaluation Program of the National Institute for Occupational Safety and Health evaluated a steel building materials manufacturer. The employer requested the evaluation because of concerns about optical radiation hazards from a plasma arc cutting system and the need to clarify eye protection requirements for plasma operators, other employees, and visitors. The strength of the ultraviolet radiation, visible radiation (light), and infrared radiation generated by the plasma arc cutter was measured at various distances from the source and at different operating amperages. Investigators also observed employees performing the plasma arc cutting. Optical radiation above safe levels for the unprotected eyes in the ultraviolet-C, ultraviolet-B, and visible light ranges were found during plasma arc cutting. In contrast, infrared and ultraviolet-A radiation levels during plasma arc cutting were similar to background levels. The highest non-ionizing radiation exposures occurred when no welding curtains were used. A plasma arc welding curtain in place did not eliminate optical radiation hazards to the plasma arc operator or to nearby employees. In most instances, the measured intensities for visible light, UV-C, and UV-B resulted in welding shade lens numbers that were lower than those stipulated in the OSHA Filter Lenses for Protection Against Radiant Energy table in 29 CFR 1910.133(a)(5). [1] Investigators recommended using a welding curtain that enclosed the plasma arc, posting optical radiation warning signs in the plasma arc cutter area, installing audible or visual warning cues when the plasma arc cutter was operating, and using welding shades that covered the plasma arc cutter operator's face to protect skin from ultraviolet radiation hazards.

Impact of earplugs and eye mask on sleep in critically ill patients: a prospective randomized study.

BACKGROUND: Poor sleep is common in intensive care unit (ICU) patients, where environmental factors contribute to reduce and fragment sleep. The objective of this study was to evaluate the impact of earplugs and eye mask on sleep architecture in ICU patients. METHODS: A single-center randomized controlled trial of 64 ICU patients was conducted from July 2012 to December 2013. Patients were randomly assigned to sleep with or without earplugs and an eye mask from inclusion until ICU discharge. Polysomnography was performed on the first day and night following inclusion. The primary outcome was the proportion of stage N3 sleep over total sleep time. Secondary outcomes were other descriptors of sleep and major outcome variables. RESULTS: In the intervention group, nine (30%) patients did not wear earplugs all night long. The proportion of N3 sleep was 21 [7-28]% in the intervention group and 11 [3-23]% in the control group (p = 0.09). The duration of N3 sleep was higher among the patients in the intervention group who wore earplugs all night long than in the control group (74 [32-106] vs. 31 [7-76] minutes, p = 0.039). The number of prolonged awakenings was smaller in the intervention group (21 [19-26] vs. 31 [21-47] in the control group, p = 0.02). No significant difference was observed between the two groups in terms of clinical outcome variables. CONCLUSIONS: Earplugs and eye mask reduce long awakenings and increase N3 duration when they are well tolerated. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02292134 . Registered on 21 Nov 2013.

Blast Wave Dynamics at the Cornea as a Function of Eye Protection Form and Fit.

A shock tube and anthropomorphic headforms were used to investigate eye protection form and fit using eyewear on the Authorized Protective Eyewear List in primary ocular blast trauma experiments. Time pressure recordings were obtained from highly linear pressure sensors mounted at the cornea of instrumented headforms of different sizes. A custom shock tube produced highly reliable shock waves and pressure recordings were collected as a function of shock wave orientation and protective eyewear. Eyewear protection coefficients were calculated as a function of a new metric of eyewear fit. In general, better protection was correlated with smaller gaps between the eyewear and face. For oblique angles, most spectacles actually potentiated the blast wave by creating higher peak pressures at the cornea. Installing foam around the perimeter of the spectacle lens to close the gap between the lens and face resulted in significantly lower pressure at the cornea. In conclusion, current eye protection, which was designed to reduce secondary and tertiary blast injuries, provides insufficient protection against primary blast injury.