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# bib

id: cord-002246-er9kqdjw
title: Contamination during doffing of personal protective equipment by healthcare providers
author: Lim, Seong Mi
date: 2015-09-30
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url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052842/
doi: 10.15441/ceem.15.019
summary:
  OBJECTIVE: In this study, we aimed to describe the processes of both the donning and the doffing of personal protective equipment for Ebola and evaluate contamination during the doffing process. Participants were asked to carry out doffing and donning procedures with a helper after a 50-minute brief training and demonstration based on the 2014 Centers for Disease Control and Prevention protocol. For the donning process, the average interval until the end was 234.2 seconds (standard deviation [SD], 65.7), and the most frequent errors occurred when putting on the outer gloves (27.5%), respirator (20.6%), and hood (20.6%). CONCLUSION: A significant number of contaminations occur during the doffing process of personal protective equipment. 8, 9 Cases of contamination while treating Ebola patients rose rapidly during the current outbreak, and the Centers for Disease Control and Prevention (CDC) announced the new personal protective equipment (PPE) guidelines for healthcare providers treating Ebola patients.

abstract:
  OBJECTIVE: In this study, we aimed to describe the processes of both the donning and the doffing of personal protective equipment for Ebola and evaluate contamination during the doffing process. METHODS: We recruited study participants among physicians and nurses of the emergency department of Samsung Medical Center in Seoul, Korea. Participants were asked to carry out doffing and donning procedures with a helper after a 50-minute brief training and demonstration based on the 2014 Centers for Disease Control and Prevention protocol. Two separate cameras with high-density capability were set up, and the donning and doffing processes were video-taped. A trained examiner inspected all video recordings and coded for intervals, errors, and contaminations defined as the outside of the equipment touching the clinician’s body surface. RESULTS: Overall, 29 participants were enrolled. Twenty (68.9%) were female, and the mean age was 29.2 years. For the donning process, the average interval until the end was 234.2 seconds (standard deviation [SD], 65.7), and the most frequent errors occurred when putting on the outer gloves (27.5%), respirator (20.6%), and hood (20.6%). For the doffing process, the average interval until the end was 183.7 seconds (SD, 38.4), and the most frequent errors occurred during disinfecting the feet (37.9%), discarding the scrubs (17.2%), and putting on gloves (13.7%), respectively. During the doffing process, 65 incidences of contamination occurred (2.2 incidents/person). The most vulnerable processes were removing respirators (79.2%), removing the shoe covers (65.5%), and removal of the hood (41.3%). CONCLUSION: A significant number of contaminations occur during the doffing process of personal protective equipment.


id: cord-002885-dhdyxnr3
author: Den Boon, Saskia
date: 2018-03-09
txt: ./txt/cord-002885-dhdyxnr3.txt
cache: ./cache/cord-002885-dhdyxnr3.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5820616/
doi: 10.12688/f1000research.12922.2
summary:
  The objective of this study was to understand frontline physicians'' and nurses'' perspectives about personal protective equipment (PPE) use during the 2014-2016 EVD outbreak in West Africa and to incorporate these findings into the development process of a WHO rapid advice guideline. The specific objectives were to understand and describe frontline physician and nurses'' perspectives about PPE use, while providing direct care for EVD patients in the unprecedented conditions of the 2014-2016 EVD outbreak in West Africa and to incorporate these findings into the rapid advice guideline development process. The findings of the survey were presented at the guideline development meeting and incorporated into evidence-to-decision tables (Supplementary File 2) to inform the formulation of recommendations for PPE components in the context of an EVD outbreak. We developed the study protocol, obtained WHO ethics approval, contacted the participants, delivered the survey, analysed the data, and presented the findings as part of the evidence-to-decision tables at the expert panel meeting where the recommendations were formulated in a period of 8 weeks.

title:
  Incorporating health workers’ perspectives into a WHO guideline on personal protective equipment developed during an Ebola virus disease outbreak

abstract:
  Background: Ebola virus disease (EVD) health facility transmission can result in infection and death of health workers. The World Health Organization (WHO) supports countries in preparing for and responding to public health emergencies, which often require developing new guidance in short timelines with scarce evidence. The objective of this study was to understand frontline physicians’ and nurses’ perspectives about personal protective equipment (PPE) use during the 2014-2016 EVD outbreak in West Africa and to incorporate these findings into the development process of a WHO rapid advice guideline. Methods : We surveyed frontline physicians and nurses deployed to West Africa between March and September of 2014. Results: We developed the protocol, obtained ethics approval, delivered the survey, analysed the data and presented the findings as part of the evidence-to-decision tables at the expert panel meeting where the recommendations were formulated within eight weeks. Forty-four physicians and nurses responded to the survey. They generally felt at low or extremely low risk of virus transmission with all types of PPE used. Eye protection reduced the ability to provide care, mainly due to impaired visibility because of fogging. Heat and dehydration were a major issue for 76% of the participants using goggles and for 64% using a hood. Both gowns and coveralls were associated with significant heat stress and dehydration. Most participants (59%) were very confident that they were using PPE correctly. Conclusion : Our study demonstrated that it was possible to incorporate primary data on end-users’ preferences into a rapid advice guideline for a public health emergency in difficult field conditions. Health workers perceived a balance between transmission protection and ability to care for patients effectively while wearing PPE. These findings were used by the guideline development expert panel to formulate WHO recommendations on PPE for frontline providers caring for EVD patients in outbreak conditions.


id: cord-007571-xzm36og6
title: Are You Covered? Safe Practices for the use of Personal Protective Equipment
author: Valdez, Anna Maria
date: 2015-01-19
txt: ./txt/cord-007571-xzm36og6.txt
cache: ./cache/cord-007571-xzm36og6.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7119349/
doi: 10.1016/j.jen.2014.11.011
abstract: nan
summary:
  To prevent the spread of infection and injury, emergency nurses must be well prepared to appropriately select and use personal protective equipment (PPE). 5 Recently the CDC issued revised standards for EVD precautions, which include detailed guidance on the types of PPE required during patient care and strategies for ensuring safe practice. 6 Because of the complex and detailed nature of the guidance on caring for a patient with known or suspected EVD, emergency nurses should seek information about precautions and PPE standards directly from the CDC Web page at http://www.cdc.gov/vhf/ebola/hcp/index.html. Examples of strategies that can be used to prevent injury include strict adherence to infection control precautions, hands-on and in situ training, and staffing that supports safe care. 7 The CDC recommends that health care providers receive repeated training and demonstrate competency in performing all Ebola-related infection control practices and procedures, including donning and doffing proper PPE before engaging in patient care activities.


id: cord-009432-0ahamczt
author: Ip, Vivian
date: 2020-04-14
txt: ./txt/cord-009432-0ahamczt.txt
cache: ./cache/cord-009432-0ahamczt.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7155761/
doi: 10.1007/s12630-020-01653-0
abstract: nan
summary:
  title: VID-19 pandemic: the 3R''s (reduce, refine, and replace) of personal protective equipment (PPE) sustainability The 3R-mantra of sustainability (reduce, refine, and replace) not only applies to ''''green anesthesia'''' practice, 2 but is also well-suited to PPE preservation. The World Health Organization continues to recommend droplet and contact precautions for general care but airborne precautions for HCPs performing aerosol-generating medical procedures (AGMP) in COVID-19 patients. A On the other hand, US Centers for Disease Control and Prevention (CDC) now recommends the use of respirator masks as part of the first line of protection of HCP caring for suspected COVID-19 patients. The need to refine the current culture of using disposable PPE to sustainable PPE solutions is essential for demand to meet supply-ideally, before a pandemic. Simulation as a tool for assessing and evolving your current personal protective equipment: lessons learned during the coronavirus disease (COVID-19) pandemic

title:
  VID-19 pandemic: the 3R’s (reduce, refine, and replace) of personal protective equipment (PPE) sustainability


id: cord-011413-yv4x8viu
author: Shekar, Kiran
date: 2020-05-12
txt: ./txt/cord-011413-yv4x8viu.txt
cache: ./cache/cord-011413-yv4x8viu.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228451/
doi: 10.1097/mat.0000000000001193
summary:
  The Extracorporeal Life Support Organization (ELSO) Coronavirus Disease 2019 (COVID-19) Guidelines have been developed to assist existing extracorporeal membrane oxygenation (ECMO) centers to prepare and plan provision of ECMO during the ongoing pandemic. 11 The interim recommendations presented here balance the need to provide high-quality ECMO care to those who may benefit most while being cognizant of available resources and maintaining an environment of patient and staff safety (Figure 1) . In addition, the Extracorporeal Life Support Organization (ELSO) COVID-19 Working Group Members completed a survey on patient selection criteria for ECMO to build consensus. We recommend the following contraindications for ECMO in patients with cardiopulmonary failure due to COVID-19 (Table 1) in centers functioning under significant resource constraints, for example, Contingency Capacity ≥ Tier 1. International ECMO Network (ECMONet): Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients

title:
  Extracorporeal Life Support Organization Coronavirus Disease 2019 Interim Guidelines: A Consensus Document from an International Group of Interdisciplinary Extracorporeal Membrane Oxygenation Providers

abstract:
  The Extracorporeal Life Support Organization (ELSO) Coronavirus Disease 2019 (COVID-19) Guidelines have been developed to assist existing extracorporeal membrane oxygenation (ECMO) centers to prepare and plan provision of ECMO during the ongoing pandemic. The recommendations have been put together by a team of interdisciplinary ECMO providers from around the world. Recommendations are based on available evidence, existing best practice guidelines, ethical principles, and expert opinion. This is a living document and will be regularly updated when new information becomes available. ELSO is not liable for the accuracy or completeness of the information in this document. These guidelines are not meant to replace sound clinical judgment or specialist consultation but rather to strengthen provision and clinical management of ECMO specifically, in the context of the COVID-19 pandemic.


id: cord-016223-nk8xwa0t
title: Strict Isolation
author: Andersen, Bjørg Marit
date: 2018-09-25
txt: ./txt/cord-016223-nk8xwa0t.txt
cache: ./cache/cord-016223-nk8xwa0t.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120447/
doi: 10.1007/978-3-319-99921-0_19
summary:
  The unit should be located in a separate ward, preferably in a separate building with direct access via an external sluice and internal access through a negative air pressure sluice with sufficient areal for donning and doffing and for a safe treatment of infectious equipment and waste. Technical staff, handling medical equipment, including collection tanks and autoclaves, shall be specially trained in infection control and must be able to use a sluice function with the use of PPE, when entering these disinfection areas. • Out sluicing needs plenty of space for washbasin and suitable hand disinfectant, for doffing (undressing) and for the use of at least three waste bags (disposal, textiles and reusable equipment). Option if not autoclave/decontaminator in the isolation unit: Infectious waste bag is treated exterior with 5% chloramine and double packed in new yellow thick plastic bag in the sluice.

abstract:
  Strict isolation: suspected highly infectious and transmissible virulent and pathogenic microbes, highly resistant bacterial strains and agents that are not accepted in any form of distribution in the society or in the environment. Examples are completely resistant Mycobacterium tuberculosis, viral haemorrhagic fevers like Ebola and Lassa, pandemic severe influenza and coronavirus like SARS, MERS, etc. In most countries, strict isolation is a rarely used isolation regime but should be a part of the national preparedness plan. For instance, in Norway, strict isolation has not been used for the last 50–60 years, except for one case of imported Ebola infection in 2014. Patients in need of strict isolation should be placed in a separate isolation ward or building. Infection spread by contact, droplet and airborne infection, aerosols, re-aerosols, airborne microbe-carrying particles, skin cells, dust, droplets and droplet nuclei. At the same time, it is always contact transmission (contaminated environment, equipment, textiles and waste). The source of infection is usually a patient but may also be a symptomless carrier or a zoonotic disease.


id: cord-017569-fv88n70v
title: Viral Hemorrhagic Fever Preparedness
author: Hewlett, Angela
date: 2017-09-10
txt: ./txt/cord-017569-fv88n70v.txt
cache: ./cache/cord-017569-fv88n70v.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7122159/
doi: 10.1007/978-3-319-60980-5_21
summary:
  Although each facility may wish to tailor the composition of the HICS team to their own particular needs, and each situation may require adjustment, key team members would typically include logisticians to plan to replenish PPE supply levels and address waste management issues, a public information officer (PIO), medical technical specialists to include infectious disease physicians and nurse leaders to manage the clinical care of the patient and staffing within the patient care unit, a laboratorian to address testing logistics and specimen transport challenges, a clinical research expert to facilitate the use of experimental therapies when necessary, a nurse concierge or other dedicated individual to support family needs, and a behavioral health expert to address staff well-being as well as the psychological and emotional needs of patients and families. The HLCC facilities in the United States that admitted patients infected with Ebola virus disease (EVD) have well developed teams of nurses who are able to provide skilled and effective patient care within their isolation units.

abstract:
  The 2014–2016 outbreak of Ebola virus disease (EVD) in West Africa marked the 25th such occurrence but was noteworthy in its massive scope, causing more human morbidity and mortality than the previous 24 recorded outbreaks combined. As of April 2016, there were 28,652 cases resulting in at least 11,325 deaths, nearly all in the three nations of Guinea, Liberia, and Sierra Leone (Centers for Disease Control and Prevention. http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/index.html. Accessed 2 June 2016). Moreover, the 2014–2016 outbreak was the first in which patients, albeit few in number, were afforded sophisticated intensive care in the United States and in Europe. This “high-level containment care” (HLCC) was provided in specially designed purpose-built biocontainment units (BCUs). In this chapter, we explore the history and evolution of biocontainment, discuss its unique engineering and infection control modalities, and offer recommendations for the clinical and operational management of Ebola and other viral hemorrhagic fevers (VHFs).


id: cord-021907-omruua6n
title: Personal Protective Equipment
author: Hick, John L.
date: 2009-05-15
txt: ./txt/cord-021907-omruua6n.txt
cache: ./cache/cord-021907-omruua6n.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152191/
doi: 10.1016/b978-0-323-03253-7.50043-1
abstract: nan
summary:
  • Use of respirators made it difficult for workers to communicate with each other, often resulting in users breaking the face seal to talk • Turnout gear (the common protective garments used by firefighters) increased heat stress and physical fatigue • At the WTC, the rubble pile was so hot in places that it melted the soles of workers'' boots; providing wash stations to cool the boots resulted in wet feet and serious blisters for many workers; some 440 WTC disaster response workers sought treatment for blisters • Steel-reinforced boots (soles and toes) protected against punctures by sharp objects but conducted and retained heat, which contributed to blisters and burns • Structural firefighting gloves worked well until they got wet and hardened, reducing their dexterity • WTC disaster response workers did not consistently protect their hands against potential hazards such as human remains and bodily fluids • Safety glasses were readily available but often were open at the sides and did not offer adequate protection against airborne particles • Goggles were uncomfortable, hindered peripheral vision, tended to fog, and did not fit well in conjunction with half-face respirators • Many disaster response workers at the WTC (especially law enforcement officers) did not consistently use hearing protection, even around heavy machinery, because they needed to hear their radios and voices and listen for tapping when they were searching for survivors • Most volunteers at the WTC, Pentagon, and Oklahoma City did not receive pre-event training on PPE and hazardous materials • Although firefighters generally received detailed pre-event training, this was less true for law enforcement officers • Accurate "real-time" hazard information was not readily available, especially during the anthrax incidents • Protection from falls was available at some sites (in the form of ropes and harnesses) but was inconsistently used


id: cord-025623-1v9614f8
title: Surface Treatments to Enhance the Functionality of PPEs
author: Mahapatra, Pallab Sinha
date: 2020-05-29
txt: ./txt/cord-025623-1v9614f8.txt
cache: ./cache/cord-025623-1v9614f8.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7257351/
doi: 10.1007/s41403-020-00110-0
summary:
  This paper focuses on improving PPE functionality in a scalable manner by surface treatment and coating with appropriate materials and other functional enhancements, such as exposure to UV rays or other sterilizing agents (e.g., hydrogen peroxide). Surface treatments to enhance resistance against diseasecausing microbes, i.e., antimicrobial coatings, have the potential to improve PPE functionalities dramatically. Hydrophobic coatings make it difficult for droplets/particles to adhere on surfaces and are known to provide antimicrobial characteristics, which are retained after multiple washes; antibacterial and antifungal properties were demonstrated by Mukherjee et al. Klibanov''s group at MIT has shown extended functionality of hydrophobic coating characteristics against influenza viruses, which get transmitted through respiratory droplets, like SARS-CoV-2; Halder et al. Scalable surface treatment strategies that combine antiviral action with liquid-repelling properties are one of many possible approaches to enhance the functionality of PPEs, thereby serving to satisfy their high demand in the healthcare industry and other fronts where the COVID-19 pandemic is being fought.

abstract:
  The outbreak of unknown viral pneumonia in Wuhan China in December 2019 led to a new coronavirus (SARS-CoV-2), which attracted worldwide attention, with the related COVID-19 disease quickly becoming a global pandemic. In about 5 months, this disease has led to ~ 4 million cases and claimed more than 200 k deaths as a result of its highly contagious nature. The present understanding is that SARS-CoV-2 is a type of influenza virus that can be transmitted through respiratory droplets and aerosols; Lewis (Nature 580:175, 2020). The primary methodology to prevent the spreading of this disease has been “social distancing” and usage of personal protective equipment (PPE) at the front lines of healthcare and other critical operations. The scale of the disease has led to unprecedented demand for PPEs and increased functionality of the same. This paper focuses on improving PPE functionality in a scalable manner by surface treatment and coating with appropriate materials and other functional enhancements, such as exposure to UV rays or other sterilizing agents (e.g., hydrogen peroxide).


id: cord-026765-cw4rh1on
title: Altered exodontia techniques
author: Dingle, M.
date: 2020-06-12
txt: ./txt/cord-026765-cw4rh1on.txt
cache: ./cache/cord-026765-cw4rh1on.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294210/
doi: 10.1038/s41415-020-1726-0
abstract: nan
summary:
  authors: Dingle, M.; Irshad, H.; McKernon, S.; Taylor, K. dosing protocols as accurately as possible (to standardise the dosing), and we anticipate the that the product will be available mid-May, initially in a 5L presentation, primarily for dentists, while a nasal and throat spray will follow in late May primarily for pre-procedural use in the hospital setting. Sir, we write to inform your readers about techniques for non-surgical exodontia we have adapted to at Liverpool University Dental Hospital during the COVID-19 pandemic. As cases in our population grew the dental clinic went on an emergency only protocol and to date we have provided dental care to almost 500 patients and performed approximately over 100 dental emergency procedures. Sir, I would like to share my thoughts and experiences on how COVID-19 has affected me as a year 13 student, applying to university to study dentistry this September.


id: cord-027880-1apexs6o
author: Hankenson, F. Claire
date: 2020-06-24
txt: ./txt/cord-027880-1apexs6o.txt
cache: ./cache/cord-027880-1apexs6o.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315381/
doi: 10.1177/1535676020936381
summary:
  To contribute to the decontamination effort for PPE needed in health sites in proximity to our institution, we repurposed a vacant animal research housing facility to establish a center for application of vaporized hydrogen peroxide (VHP) to disinfect critical medical materials for their return into service. 22 Building on our decontamination efforts to date, the VHP process for human medical equipment was assessed internally with the intent to return disinfected N95 respirators to their original owners at our hospital partner sites and assist safety groups (police and fire departments) with equipment disinfection across the state of Michigan. Institutions with AAALAC-accredited animal research areas, all of which comply with regulated environmental controls, will be able to use our protocols, specific VHP cycle times, and BI exposure and collection instructions to deliver VHP decontamination of used medical materials for their regions as well.

title:
  Vaporized Hydrogen Peroxide Decontamination of N95 Respirators in a Dedicated Animal Research Facility for Reuse During a Novel Coronavirus Pandemic

abstract:
  INTRODUCTION: During the COVID-19 pandemic, health care systems and safety providers have faced an unprecedented challenge of limited access to personal protective equipment (PPE) to conduct patient and public care. In federal emergencies, reuse of PPE after disinfection can occur by processes, like vaporized hydrogen peroxide (VHP), recommended by the Centers for Disease and Control and Prevention. We identified a vacant animal holding facility at our institution to repurpose into a regional VHP decontamination center. METHODS: The facility is a multiroom, 20 000 ft(2) building with control of HVAC to adjust to VHP conditional requirements. H(2)O(2) was delivered to rooms using robotic HaloFoggers, dispersing H(2)O(2) vapor and increasingly concentrated microdroplets as a fog for a timed period based on cubic footage of rooms. RESULTS: Fogging cycles eliminated 6-log Geobacillus stearothermophilus up to 7 days postcycle. Functional efficacy of treated N95s was confirmed by fit tests of institutional personnel. Signage, process flow mapping, and training materials facilitated ease of workflow and adherence to safety expectations within the building. DISCUSSION AND CONCLUSION: Our study determined that a variety of N95 respirator types and sizes were able to be cleared of potential bacterial and viral agents using VHP in a controlled fog/dwell/exhaust cycle. This repurposed animal facility has the capacity to decontaminate up to 6700 respirators daily, which will address the predicted surge of COVID-19 cases in the state, and ultimately allow each respirator to be reused multiple times. There is no other public site in the region with our capacity to offset the continued supply chain issues for PPE needs.


id: cord-028595-p7cn71t5
title: A good fit with indemnity
author: Croser, David
date: 2020-07-06
txt: ./txt/cord-028595-p7cn71t5.txt
cache: ./cache/cord-028595-p7cn71t5.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336104/
doi: 10.1038/s41404-020-0444-2
abstract: nan
summary:
  Although it is recommended that AGPs should currently be avoided where possible, there will be occasions when such treatments are in the patient''s best interests and the dental team will need to prevent aerosol transmission, using a disposable, fluidrepellent surgical gown (or waterproof long-sleeved protective apron), gloves, eye protection and suitable respiratory protective equipment (RPE) such as an FFP3 respirator (or FFP2 when these are not available). The SOP guidance advises contractors to inform their employers liability (EL) insurer that all staff undertaking aerosol generating procedures are required to be fit tested for appropriate PPE, to ensure their EL insurance cover is sufficient. In addition, dentists should check with their indemnity provider if they are performing the fit testing for their own staff or that of other local dental contractors, again to ensure they have adequate cover. 2 BDA indemnity cover allows policyholders to fit-test respiratory protective equipment (RPE) for dental staff in their own and other practices.


id: cord-028605-ehercdou
title: COVID-19 pandemic preparedness: A practical guide from an operational pharmacy perspective
author: Merchan, Cristian
date: 2020-06-16
txt: ./txt/cord-028605-ehercdou.txt
cache: ./cache/cord-028605-ehercdou.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337640/
doi: 10.1093/ajhp/zxaa212
summary:
  PURPOSE: To describe our medical center''s pharmacy services preparedness process and offer guidance to assist other institutions in preparing for surges of critically ill patients such as those experienced during the coronavirus disease 2019 (COVID-19) pandemic. It was essential to create guidance documents outlining workflow, provide comprehensive staff education, and repurpose non–intensive care unit (ICU)-trained clinical pharmacotherapy specialists to work in ICUs. Teamwork was crucial to ensure staff safety, develop complete scheduling, maintain adequate drug inventory and sterile compounding, optimize the electronic health record and automated dispensing cabinets to help ensure appropriate prescribing and effective management of medication supplies, and streamline the pharmacy workflow to ensure that all patients received pharmacotherapeutic regimens in a timely fashion. Our pharmacy residents'' training was redesigned to enable them to assist with both clinical and operational needs, including rounding in newly established units designated as "COVID-ICUs," participating in medical code responses, and assisting with operational needs such as sterile compounding, hand deliveries, and other tasks.

abstract:
  PURPOSE: To describe our medical center’s pharmacy services preparedness process and offer guidance to assist other institutions in preparing for surges of critically ill patients such as those experienced during the coronavirus disease 2019 (COVID-19) pandemic. SUMMARY: The leadership of a department of pharmacy at an urban medical center in the US epicenter of the COVID-19 pandemic proactively created a pharmacy action plan in anticipation of a surge in admissions of critically ill patients with COVID-19. It was essential to create guidance documents outlining workflow, provide comprehensive staff education, and repurpose non–intensive care unit (ICU)-trained clinical pharmacotherapy specialists to work in ICUs. Teamwork was crucial to ensure staff safety, develop complete scheduling, maintain adequate drug inventory and sterile compounding, optimize the electronic health record and automated dispensing cabinets to help ensure appropriate prescribing and effective management of medication supplies, and streamline the pharmacy workflow to ensure that all patients received pharmacotherapeutic regimens in a timely fashion. CONCLUSION: Each hospital should view the COVID-19 crisis as an opportunity to internally review and enhance workflow processes, initiatives that can continue even after the resolution of the COVID-19 pandemic.


id: cord-029722-85h5060v
title: Decoding the English standard operating procedures for dentists and the dental industry
author: Proffitt, Edmund
date: 2020-07-24
txt: ./txt/cord-029722-85h5060v.txt
cache: ./cache/cord-029722-85h5060v.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380156/
doi: 10.1038/s41415-020-1853-7
summary:
  It could be seen as a vehicle to herald what the CDO England has described as a ''COVID-19 legacy hallmarked by a determined revision of the current activitydriven clinical approach, optimising time with patients and delivered as an integrated oral health team.'' 3 Beyond the scope of the SOP document, there also appears to be an appetite for contract reform to support this ''revision'' going forwards. Seemingly, the raison d''être of the new standard operating procedures is not just to outline the detailed procedures for kick-starting dentistry, but also to support practices through transition and the shift towards a preventative and minimally invasive clinical approach that meets the current clinical challenges, and possibly then goes beyond. Seemingly, the raison d''être of the new standard operating procedures is not just to outline the detailed procedures for kick-starting dentistry, but also to support practices through transition and the shift towards a preventative and minimally invasive clinical approach that meets the current clinical challenges, and possibly then goes beyond.

abstract:
  The recently published Standard operating procedure: transition to recovery for the resumption of dental treatment in England may prove to be not only the blueprint for the resumption of face-to-face treatments, but also a possible catalyst for change. Seemingly, the raison d'être of the new standard operating procedures is not just to outline the detailed procedures for kick-starting dentistry, but also to support practices through transition and the shift towards a preventative and minimally invasive clinical approach that meets the current clinical challenges, and possibly then goes beyond. Detailed guidance is also provided throughout the document, including the provision and type of required personal protective equipment and clinical guidelines.


id: cord-031378-iy67xnec
author: Atif, Iqra
date: 2020-09-03
txt: ./txt/cord-031378-iy67xnec.txt
cache: ./cache/cord-031378-iy67xnec.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7471498/
doi: 10.1007/s41403-020-00164-0
summary:
  Potential digital technologies that could be applied to tackle various problems related to COVID-19 pandemic are artificial intelligence (AI), data analytics, Internet of medical things (IoMT), smart biosensors and sanitizing equipment. Smart bio-sensor-based face shields can also be used in the mining industry, not only for protection purposes, but also as display screens to highlight any critical information related to the miner''s health and safety. Smart boots is another digital technology that can be useful to prevent infectious viruses like COVID-19 by providing the worker contact tracing and ensure social distancing (Fig. 8) . The National Academies of Sciences, Engineering and Medicine reported that ultraviolet (UV) light-based walkthrough gates possibly could eradicate the coronavirus that contains the deadly Fig. 9 IoT-Q-Band system for real-time monitoring of the health condition of individual and ensure social distancing to prevent the spread of COVID-19 virus, source: Singh et al.

title:
  The Role of Digital Technologies that Could Be Applied for Prescreening in the Mining Industry During the COVID-19 Pandemic

abstract:
  The novel COVID-19 (coronavirus disease of 2019) pandemic has caused global havoc and impacted almost every aspect of human life and the global economy. The mining industry is not immune to such impacts. The pandemic has accelerated the need for digital transformation in the mining industry and in the era of the fourth Industrial Revolution (4IR), there is further application of digital technologies in the early detection and prescreening of emerging infectious and viral diseases to keep mining areas and communities safer and less vulnerable. This paper aims to explore the application of smart digital technologies that could be applied for detection, prescreening and prevention of COVID-19 in the mining industry. The study will contribute, firstly, to demonstrate the utility and applications of digital technologies in the mining industry and, secondly, the development of a body of knowledge that can be consulted to prevent the spread of the disease in the mining industry.


id: cord-032498-5ugoi1tu
author: Smith, Peter M.
date: 2020-09-21
txt: ./txt/cord-032498-5ugoi1tu.txt
cache: ./cache/cord-032498-5ugoi1tu.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509238/
doi: 10.1177/0706743720961729
summary:
  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. 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. 5, 8, 9 The objective of this study is to examine the relationship between perceived adequacy of PPE and workplace-based ICP and anxiety and depression symptoms among a large sample of health-care workers in Canada, within the context of the current COVID-19 pandemic. 5 In this sample of almost 6,000 health-care workers in Canada, we observed a graded relationship between the perceived adequacy of PPE provision and ICP implementation with symptoms of anxiety and depression, with lower symptoms among respondents whose PPE and ICP needs were being met.

title:
  The Association between the Perceived Adequacy of Workplace Infection Control Procedures and Personal Protective Equipment with Mental Health Symptoms: A Cross-sectional Survey of Canadian Health-care Workers during the COVID-19 Pandemic: L’association entre le caractère adéquat perçu des procédures de contrôle des infections au travail et de l’équipement de protection personnel pour les symptômes de santé mentale. Un sondage transversal des travailleurs de la santé canadiens durant la pandémie COVID-19

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.


id: cord-035137-uxtaw02u
author: Chowdhury, Anis Z.
date: 2020-11-10
txt: ./txt/cord-035137-uxtaw02u.txt
cache: ./cache/cord-035137-uxtaw02u.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7653449/
doi: 10.1057/s41301-020-00256-y
summary:
  But most national authorities outside of East Asia did not take adequate early precautionary measures speedily enough to contain the spread of the outbreak, typically by promoting safe ''physical distancing'', obligatory use of masks in public areas, and other measures to reduce the spread and likelihood of infection. Government capacity to respond depends crucially on system capacity and capabilities-e.g., authorities'' ability to speedily trace, isolate and treat the infected-and available fiscal resources-e.g., to quickly enhance testing capacity and secure personal protective equipment (PPE). Finally, it draws some implications of different policy responses in East Asia, Southeast Asia-especially Vietnam, and India''s Kerala state-Argentina, Brazil and Peru, that are relevant for other countries. And where communities or clusters had significant infection rates, urgent, targeted measures could have helped ''turn the tide'' on COVID-19 with decisive early actions, as in China, Korea and Vietnam, without imposing nationwide ''stay in shelter'' or ''shelter in place'' lockdowns, 16 or restrictions on movements of people within its borders.

title:
  Responding to the COVID-19 Pandemic in Developing Countries: Lessons from Selected Countries of the Global South

abstract:
  Reviewing selected policy responses in Asia and South America, this paper draws pragmatic lessons for developing countries to better address the COVID-19 pandemic. It argues that not acting quickly and adequately incurs much higher costs. So-called ‘best practices’, while useful, may be inappropriate, especially if not complemented by effective and suitable socio-economic measures. Public understanding, support and cooperation, not harsh and selective enforcement of draconian measures, are critical for successful implementation of containment strategies. This requires inclusive and transparent policy-making, and well-coordinated and accountable government actions that build and maintain trust between citizens and government. In short, addressing the pandemic crisis needs ‘all of government’ and ‘whole of society’ approaches under credible leadership.


id: cord-102456-6jt4ksha
title: How I Do It: Restarting Respiratory Clinical Research in the Era of the COVID19 Pandemic
author: Taylor-Cousar, Jennifer L.
date: 2020-11-13
txt: ./txt/cord-102456-6jt4ksha.txt
cache: ./cache/cord-102456-6jt4ksha.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0012369220351400
doi: 10.1016/j.chest.2020.11.001
summary:
  However, now that we have navigated the initial surge of SARS-CoV-2 cases, many are considering how to reintroduce non-COVID-19 clinical research conduct while protecting participants, staff and ensuring data integrity. Here we review key considerations and suggest a step-wise approach for resuming clinical research including observational research, registry trials, and interventional trials, as well as potential data confounding related to COVID-19 infections that are important to consider as research studies restart and data are analyzed. In the spirit of "Do No Harm", it is critical that institutional policies and processes are in place to ensure that there is no significant additional risk of contracting viral respiratory or other infections in the normal course of participation in research studies; now during the COVID-19 pandemic, these principles are even more critical. Throughout the subject''s participation in clinical research during the pandemic, she expressed her appreciation for the opportunity to continue in the study from which she believed she was benefiting, with minimal risk of exposure to infection from SARS-CoV-2.

abstract:
  The clinical research we do to improve our understanding of disease and development of new therapies has temporarily been paused or delayed as the global healthcare enterprise has focused its attention on those impacted by COVID-19. While rates of SARS-CoV-2 infection are decreasing in many areas, many locations continue to have a high prevalence of infection. Nonetheless, research must continue and institutions are considering approaches to re-starting non-COVID related clinical investigation. Those restarting respiratory research must navigate the added planning challenges that take into account outcome measures that require aerosol generating procedures. Such procedures potentially increase risk of transmission of SARS-CoV-2 to research staff, utilize limited personal protective equipment, and require conduct in negative pressure rooms. One must also be prepared to address the potential for COVID-19 resurgence. With research subject and staff safety and maintenance of clinical trial data integrity as the guiding principles, here we review key considerations and suggest a step-wise approach for resuming respiratory clinical research.


id: cord-131678-rvg1ayp2
author: Ponce, Marcelo
date: 2020-09-02
txt: ./txt/cord-131678-rvg1ayp2.txt
cache: ./cache/cord-131678-rvg1ayp2.txt
extension: .txt
mime: text/plain
url: https://arxiv.org/pdf/2009.01091v1.pdf
doi: nan
summary:
  This paper is organized as follow: in Sec. 2 we describe the covid19.analytics , in Sec. 3 we present some examples of data analysis and visualization, in Sec. 4 we describe in detail how to deploy a web dashboard employing the capabilities of the covid19.analytics package providing full details on the implementation so that this procedure can be repeated and followed by interested users in developing their own dashboards. As the amount of data available for the recorded cases of CoViD19 can be overwhelming, and in order to get a quick insight on the main statistical indicators, the covid19.analytics package includes the report.summary function, which will generate an overall report summarizing the main statistical estimators for the different datasets. The covid19.analytics package provides three different functions to visualize the trends in daily changes of reported cases from time series data.

title:
  covid19.analytics: An R Package to Obtain, Analyze and Visualize Data from the Corona Virus Disease Pandemic

abstract:
  With the emergence of a new pandemic worldwide, a novel strategy to approach it has emerged. Several initiatives under the umbrella of"open science"are contributing to tackle this unprecedented situation. In particular, the"R Language and Environment for Statistical Computing"offers an excellent tool and ecosystem for approaches focusing on open science and reproducible results. Hence it is not surprising that with the onset of the pandemic, a large number of R packages and resources were made available for researches working in the pandemic. In this paper, we present an R package that allows users to access and analyze worldwide data from resources publicly available. We will introduce the covid19.analytics package, focusing in its capabilities and presenting a particular study case where we describe how to deploy the"COVID19.ANALYTICS Dashboard Explorer".


id: cord-205941-npp6566r
title: Low-tech solutions for the COVID19 supply chain crisis
author: Armani, Andrea M
date: 2020-04-27
txt: ./txt/cord-205941-npp6566r.txt
cache: ./cache/cord-205941-npp6566r.txt
extension: .txt
mime: text/plain
url: https://arxiv.org/pdf/2004.13192v1.pdf
doi: nan
summary:
  A global effort is ongoing in the scientific community and in the Maker Movement, which focuses on creating devices and tinkering with them, to reverse engineer commercial medical equipment and get it to healthcare workers. [H1] The manufacturing ecosystem Innovative Makers and hobbyists are stepping in to fill the gaps in the PPE supply chain resulting from the COVID-19 public health emergency, and the U.S. Food and Drug Administration (FDA) has issued emergency use authorizations (https://www.fda.gov/medicaldevices/emergency-situations-medical-devices/emergency-use-authorizations#covid19ppe) to waive requirements for labeling and good manufacturing practices. Although the emergency use authorizations issued by the FDA for face shields (https://www.fda.gov/media/136842/download) and for systems developed by industry, such as the Battelle Decontamination System (https://www.fda.gov/media/136529/download), which can disinfect thousands of masks at a time using a vapor-phase hydrogen peroxide, are only effective for the duration of the COVID-19 crisis, this does not diminish the important role of the community as a stopgap in this time of need.

abstract:
  A global effort is ongoing in the scientific community and in the Maker Movement, which focuses on creating devices and tinkering with them, to reverse engineer commercial medical equipment and get it to healthcare workers. For these low-tech solutions to have a real impact, it is important for them to coalesce around approved designs.


id: cord-253135-0tun7fjk
title: Zoonotic disease risk perceptions in the British veterinary profession
author: Robin, Charlotte
date: 2017-01-01
url: https://www.sciencedirect.com/science/article/pii/S0167587716306109
doi: 10.1016/j.prevetmed.2016.11.015
abstract:
  In human and veterinary medicine, reducing the risk of occupationally-acquired infections relies on effective infection prevention and control practices (IPCs). In veterinary medicine, zoonoses present a risk to practitioners, yet little is known about how these risks are understood and how this translates into health protective behaviour. This study aimed to explore risk perceptions within the British veterinary profession and identify motivators and barriers to compliance with IPCs. A cross-sectional study was conducted using veterinary practices registered with the Royal College of Veterinary Surgeons. Here we demonstrate that compliance with IPCs is influenced by more than just knowledge and experience, and understanding of risk is complex and multifactorial. Out of 252 respondents, the majority were not concerned about the risk of zoonoses (57.5%); however, a considerable proportion (34.9%) was. Overall, 44.0% of respondents reported contracting a confirmed or suspected zoonoses, most frequently dermatophytosis (58.6%). In veterinary professionals who had previous experience of managing zoonotic cases, time or financial constraints and a concern for adverse animal reactions were not perceived as barriers to use of personal protective equipment (PPE). For those working in large animal practice, the most significant motivator for using PPE was concerns over liability. When assessing responses to a range of different “infection control attitudes”, veterinary nurses tended to have a more positive perspective, compared with veterinary surgeons. Our results demonstrate that IPCs are not always adhered to, and factors influencing motivators and barriers to compliance are not simply based on knowledge and experience. Educating veterinary professionals may help improve compliance to a certain extent, however increased knowledge does not necessarily equate to an increase in risk-mitigating behaviour. This highlights that the construction of risk is complex and circumstance-specific and to get a real grasp on compliance with IPCs, this construction needs to be explored in more depth.


id: cord-253933-29tedkf8
title: Tracheostomy guidelines developed at a large academic medical center during the COVID‐19 pandemic
author: David, Abel P.
date: 2020-04-27
txt: ./txt/cord-253933-29tedkf8.txt
cache: ./cache/cord-253933-29tedkf8.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1002/hed.26191
doi: 10.1002/hed.26191
summary:
  1 As an aerosol-generating procedure (AGP), tracheostomy is associated with high droplet and particle generation, placing health care providers at increased risk for transmission of respiratory viral infections. Factors relevant to our review included optimal timing of tracheostomy, duration of viral shedding in patients with COVID-19, risk to procedural teams from aerosol generation during tracheostomy, ICU capacity, and availability of PPE. In the context of the current pandemic, Tay et al conducted a literature review of tracheostomies performed during the SARS epidemic and concluded the following: (a) proper PPE (N95 mask, surgical cap, gown, goggles, and gloves) is of utmost importance; (b) surgical tracheostomy is preferably performed in a negative pressure ICU room by experienced providers with meticulous planning and seamless communication; (c) aerosol generation should be minimized through patient paralysis, ventilation hold during creation of tracheal window, and utilization of HEPA-filtered suction systems.

abstract:
  BACKGROUND: During the SARS‐CoV‐2 pandemic, tracheostomy may be required for COVID‐19 patients requiring long‐term ventilation in addition to other conditions such as airway compromise from head and neck cancer. As an aerosol‐generating procedure, tracheostomy increases the exposure of health care workers to COVID‐19 infection. Performing surgical tracheostomy and tracheostomy care requires a strategy that mitigates these risks and maintains the quality of patient care. METHODS: This study is a multidisciplinary review of institutional tracheostomy guidelines and clinical pathways. Modifications to support clinical decision making in the context of COVID‐19 were derived by consensus and available evidence. RESULTS: Modified guidelines for all phases of tracheostomy care at an academic tertiary care center in the setting of COVID‐19 are presented. DISCUSSION: During the various phases of the COVID‐19 pandemic, clinicians must carefully consider the indications, procedural precautions, and postoperative care for tracheostomies. We present guidelines to mitigate risk to health care workers while preserving the quality of care.


id: cord-255264-2kj961en
author: Hasan, Syed Shahzad
date: 2020-05-01
txt: ./txt/cord-255264-2kj961en.txt
cache: ./cache/cord-255264-2kj961en.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32387229/
doi: 10.1016/j.sapharm.2020.04.033
summary:
  While the United States adopted a universal mask approach and Turkey recommended the use of masks and protective goggles for their pharmacy personnel, almost all of the countries recommended against routine use of face mask and other PPE (gloves or aprons/gowns), except when dealing with suspected COVID-19 patients or performing activities requiring close contact (unable to maintain recommended social distance) with the patients. Though the observation from such case study cannot be regarded as conclusive, the assumption, for now, should be that airborne transmission of SARS-CoV-2 is possible unless being discredited in the future, and therefore we opine that the wearing of appropriate PPE is of utmost importance for healthcare workers, including community pharmacy personnel dealing with individuals may or may not be infected on a day-to-day basis, regardless if they manage to observe social distancing in their workplace or if they perform close contact activities.

title:
  Social distancing and the use of PPE by community pharmacy personnel: Does evidence support these measures?

abstract:
  Community pharmacists are one of the most accessible healthcare professionals and are often served as the first point of contact when it comes to minor ailments and health advice. As such, community pharmacists can play a vital role in a country's response to various preventative and public health measures amid the COVID-19 pandemic. Given the essential nature of community pharmacy as a health service, community pharmacies are unlikely to shut down in any foreseeable lockdown scenario. It is therefore important to assess the preventative measure directives for community pharmacies that are in place to safeguard community pharmacy personnel from SARS-CoV-2 in the various parts of the world. Upon reviewing the recommendations of 15 selected countries across five continents (Asia, Europe, Oceania, North America, and Africa) on social distancing and the use of personal protective equipment (PPE) in community pharmacies, we found inconsistencies in the recommended social distance to be practiced within the community pharmacies. There were also varying recommendations on the use of PPE by the pharmacy personnel. Despite the differences in the recommendations, maintaining recommended social distance and the wearing of appropriate PPE is of utmost importance for healthcare workers, including community pharmacy personnel dealing with day-to-day patient care activities, though full PPE should be worn when dealing with suspected COVID-19 patients.


id: cord-256112-zg63v8hh
author: Rowan, Neil J.
date: 2020-07-10
txt: ./txt/cord-256112-zg63v8hh.txt
cache: ./cache/cord-256112-zg63v8hh.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0048969720320453
doi: 10.1016/j.scitotenv.2020.138532
summary:
  title: Challenges and solutions for addressing critical shortage of supply chain for personal and protective equipment (PPE) arising from Coronavirus disease (COVID19) pandemic – Case study from the Republic of Ireland This REA_PPE team comprises experts representative of anaesthesia and intensive care, medical device technology, infection control, hospital disinfection and sterilization, minimal processing; microbiology, toxicology, virology, material science, software engineering, and social marketing Priority initially focused on delineating effective communication channels in order to inform stocks within healthcare from several routes that include use of dedicated webpage [https: //covidmedsupply.org/] established by researchers from NUI Galway and University of Limerick (Ireland) that collects donations of PPE from regional industries and academic institutions. Original equipment manufacturers (OEMs) of one-time-use PPE have recently provided new information on possible methods for reprocessing these items given the universal need to consider contingency plans arising from shortages during this pandemic (such as 3M Science of Life, 2020).

title:
  Challenges and solutions for addressing critical shortage of supply chain for personal and protective equipment (PPE) arising from Coronavirus disease (COVID19) pandemic – Case study from the Republic of Ireland

abstract:
  Coronavirus (COVID-19) is highly infectious agent that causes fatal respiratory illnesses, which is of great global public health concern. Currently, there is no effective vaccine for tackling this COVID19 pandemic where disease countermeasures rely upon preventing or slowing person-to-person transmission. Specifically, there is increasing efforts to prevent or reduce transmission to front-line healthcare workers (HCW). However, there is growing international concern regarding the shortage in supply chain of critical one-time-use personal and protective equipment (PPE). PPE are heat sensitive and are not, by their manufacturer's design, intended for reprocessing. Most conventional sterilization technologies used in hospitals, or in terminal medical device sterilization providers, cannot effectively reprocess PPE due to the nature and severity of sterilization modalities. Contingency planning for PPE stock shortage is important. Solutions in the Republic of Ireland include use of smart communication channels to improve supply chain, bespoke production of PPE to meets gaps, along with least preferred option, use of sterilization or high-level disinfection for PPE reprocessing. Reprocessing PPE must consider material composition, functionality post treatment, along with appropriate disinfection. Following original manufacturer of PPE and regulatory guidance is important. Technologies deployed in the US, and for deployment in the Republic of Ireland, are eco-friendly, namely vaporised hydrogen peroxide (VH2O2), such as for filtering facepiece respirators and UV irradiation and High-level liquid disinfection (Actichlor+) is also been pursed in Ireland. Safeguarding supply chain of PPE will sustain vital healthcare provision and will help reduce mortality.


id: cord-258498-0mvxwo3w
title: COVID-19 and paediatric dentistry- traversing the challenges. A narrative review
author: Shah, Saleha
date: 2020-08-21
txt: ./txt/cord-258498-0mvxwo3w.txt
cache: ./cache/cord-258498-0mvxwo3w.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S2049080120302557?v=s5
doi: 10.1016/j.amsu.2020.08.007
summary:
  This review article informs about measures which reduce facility risk, manage symptomatic patients and protect personal health care and management with reference to paediatric dentistry. 5, 6, 7 The risk of SARS-CoV-2 transmission via aerosols generated during dental procedures cannot be eliminated when practicing in the absence of Airborne Precautions (airborne infection isolation rooms or single-patient rooms, respiratory protection program, N95 respirators). 47 Primary prevention encompasses prenatal health care, avoidance of night time bottle feed with sugary drinks or milk, restricting sugar intake and frequency for children younger than 24 months, avoiding frequent/nocturnal breast or bottle feeding after 1 year, exposure to dietary fluoridate (water, milk, salt), use of an age appropriate amount of fluoride toothpaste containing at least 1000ppm fluoride for brushing at least twice a day, dental visit in the first year of life and regular applications of 5% fluoride.

abstract:
  The coronavirus disease (COVID-19) pandemic has become a major global public health emergency with a focus on preventing the spread of this virus for controlling this crisis. A dental setting is at a high risk of cross infection amid patients and dental practitioner's owing to the spread of infection via droplets suspended in the air by infected symptomatic or asymptomatic subjects. This review article informs about measures which reduce facility risk, manage symptomatic patients and protect personal health care and management with reference to paediatric dentistry.


id: cord-258504-pnd46ipd
title: Experience of Chicagoland acute care hospitals in preparing for Ebola virus disease, 2014–2015
author: Bleasdale, Susan C.
date: 2019-07-08
txt: ./txt/cord-258504-pnd46ipd.txt
cache: ./cache/cord-258504-pnd46ipd.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1080/15459624.2019.1628966
doi: 10.1080/15459624.2019.1628966
summary:
  During the 2014–2015 Ebola Virus Disease (EVD) outbreak, hospitals in the United States selected personal protective equipment (PPE) and trained healthcare personnel (HCP) in anticipation of receiving EVD patients. Semistructured interviews were conducted with HCP involved with decision-making during EVD preparations at acute care hospitals in the Chicago, IL area to gather information about the PPE selection and training process. For example, an interviewed trainer from a hospital where HCP "wanted to be encased [in PPE] like a mummy" noted that preferences "started to change after like the 4th or 5th simulation where people were like, ''[M]an, [I] can''t work like this.''" When asked to identify the three training modalities that had the greatest positive impact on their confidence to care for an Ebola patient, surveyed trainees most frequently identified: hands-on activities in group (n ¼ 39) or individual settings (n ¼ 28), trained observers (n ¼ 21), instructional videos (n ¼ 11), training in a simulated care area with (n ¼ 10) or without task trainers (n ¼ 8), and using markers for evaluation of self-contamination during PPE doffing (n ¼ 8) ( Table 2 ).

abstract:
  During the 2014–2015 Ebola Virus Disease (EVD) outbreak, hospitals in the United States selected personal protective equipment (PPE) and trained healthcare personnel (HCP) in anticipation of receiving EVD patients. To improve future preparations for high-consequence infectious diseases, it was important to understand factors that affected PPE selection and training in the context of the EVD outbreak. Semistructured interviews were conducted with HCP involved with decision-making during EVD preparations at acute care hospitals in the Chicago, IL area to gather information about the PPE selection and training process. HCP who received training were surveyed about elements of training and their perceived impact and overall experience by email invitation. A total of 28 HCP from 15 hospitals were interviewed, and 55 HCP completed the survey. Factors affecting PPE selection included: changing guidance, vendor supply, performance evaluations, and perceived risk and comfort for HCP. Cost did not affect selection. PPE acquisition challenges were mitigated by: sharing within hospital networks, reusing PPE during training, and improvising with existing PPE stock. Selected PPE ensembles were similar across sites. Training included hands-on activities with trained observers, instructional videos, and simulations/drills, which were felt to increase HCP confidence. Many felt refresher training would be helpful. Hands-on training was perceived to be effective, but there is a need to establish the appropriate frequency of refresher training frequency to maintain competence. Lacking confidence in the CDC guidance, interviewed trainers described turning to other sources of information and developing independent PPE evaluation and selection. Response to emerging and/or high consequence infectious diseases would be enhanced by transparent, risk-based guidance for PPE selection and training that addresses protection level, ease of use, ensembles, and availability.


id: cord-258965-g47n531n
author: Ekpenyong, Bernadine
date: 2020-07-16
txt: ./txt/cord-258965-g47n531n.txt
cache: ./cache/cord-258965-g47n531n.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3390/ijerph17145141
doi: 10.3390/ijerph17145141
summary:
  The aim of this study was to explore knowledge, practice of risk and guidelines of the novel corona virus disease (COVID-19) infection among the eye care practitioners and the potential associated factors. ECPs in Nigeria displayed good knowledge about COVID-19 and provided eye care services during the COVID-19 lockdown in Nigeria, despite the majority not receiving any training on the use of PPEs with concerns over attending to patients. The aim of this study was to assess knowledge and practice of COVID-19 exposure risk among ECPs as well as understand their confidence in current Federal Ministry of Health (FMoH) guidelines for identifying possible COVID-19 cases, knowledge of Personal Protective Equipment (PPE) recommendations and training in its usage when managing such cases. The impact of COVID-19 pandemic on practitioners, their family members and practices, including questions on their confidence in the current FMoH guidelines for identifying possible COVID-19 cases, their knowledge of Personal Protective Equipment (PPE) recommendations, and training in its usage during consultation were assessed.

title:
  Assessment of Knowledge, Practice and Guidelines towards the Novel COVID-19 among Eye Care Practitioners in Nigeria–A Survey-Based Study

abstract:
  The aim of this study was to explore knowledge, practice of risk and guidelines of the novel corona virus disease (COVID-19) infection among the eye care practitioners and the potential associated factors. A cross-sectional self-administered online survey was distributed via emails and social media networks between 2nd and 18th May 2020 corresponding to the week of the lockdown in Nigeria to eye care practitioners (ECPs). Data for 823 respondents were analyzed. Knowledge and risk practice were categorized as binary outcome and univariate and multivariate linear regression were used to examine the associated factors. The mean score for COVID-19-related knowledge of public health guidelines was high and varied across the ECPs. Ophthalmic Nurses, Ophthalmologists and Optometrists showed higher COVID-19-related knowledge than other ECPs (p < 0.001), particularly those working in the private sector. More than 50% of ECPs stated they provided essential services during the COVID-19 lockdown via physical consultation, particularly the Ophthalmologists. Most respondents reported that the guidelines provided by their Association were useful but expressed their lack of confidence in attending to patients during and after the COVID-19 lockdown. Compared to other ECPs in Nigeria, more Ophthalmic Nurses received training in the use of Personal Protective Equipment (PPE). This survey is the first to assess knowledge, attitudes and practice in response to the COVID-19 pandemic in Nigeria. ECPs in Nigeria displayed good knowledge about COVID-19 and provided eye care services during the COVID-19 lockdown in Nigeria, despite the majority not receiving any training on the use of PPEs with concerns over attending to patients. There is need for the government to strengthen health systems by improving and extending training on standard infection prevention and control measures to ECPs for effective control of the pandemic and in the future as essential health workers.


id: cord-259984-csdf1a69
author: Raffiq, Azman
date: 2020-10-27
url: https://www.ncbi.nlm.nih.gov/pubmed/33154710/
doi: 10.21315/mjms2020.27.5.14
title:
  COVID-19 Pandemic and Its Impact on Neurosurgery Practice in Malaysia: Academic Insights, Clinical Experience and Protocols from March till August 2020

abstract:
  The newly discovered coronavirus disease 2019 (COVID-19) is an infectious disease introduced to humans for the first time. Following the pandemic of COVID-19, there is a major shift of practices among surgical departments in response to an unprecedented surge in reducing the transmission of disease. With pooling and outsourcing of more health care workers to emergency rooms, public health care services and medical services, further in-hospital resources are prioritised to those in need. It is imperative to balance the requirements of caring for COVID-19 patients with imminent risk of delay to others who need care. As Malaysia now approaches the recovery phase following the pandemic, the crisis impacted significantly on neurosurgical services throughout the country. Various emergency measures taken at the height of the crisis may remain as the new normal in the provision of neurosurgical services and practices in Malaysia. The crisis has certainly put a strain on the effective delivery of services and as we approach the recovery era, what may have been a strain may prove to be a silver lining in neurosurgical services in Malaysia. The following details are various measures put in place as the new operational protocols for neurosurgical services in Malaysia.


id: cord-264479-s20oacr9
title: COVID-19 Highlights the Need for Trained Social Workers in Nursing Homes
author: Bern-Klug, Mercedes
date: 2020-05-25
txt: ./txt/cord-264479-s20oacr9.txt
cache: ./cache/cord-264479-s20oacr9.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32561232/
doi: 10.1016/j.jamda.2020.05.049
abstract: nan
summary:
  This editorial provides examples of how nursing home social workers are adapting the way they connect with residents and families during the pandemic and concludes with suggestions. In nursing homes experiencing PPE shortages, the lack of equipment means activities and social services staff cannot safely enter resident rooms. While a core function of the social work role has always been to anticipate, assess and address resident psychosocial needs, social workers have also been key liaisons between the family and the facility. In nursing homes with multiple COVID deaths, social workers leave work with a pit in their stomach from the phone conversations with family members to discuss what to do with the decedent''s body and their belongings. Including degreed and licensed social workers as part of the core team is a basic way to provide psychosocial care in nursing homes and enhance resident quality of life.


id: cord-264614-2x7cdul3
title: COVID-19: Biosafety in the Intensive Care Unit
author: Díaz-Guio, Diego Andrés
date: 2020-08-27
txt: ./txt/cord-264614-2x7cdul3.txt
cache: ./cache/cord-264614-2x7cdul3.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s40475-020-00208-z
doi: 10.1007/s40475-020-00208-z
summary:
  PURPOSE OF REVIEW: COVID-19 is a new, highly transmissible disease to which healthcare workers (HCWs) are exposed, especially in the intensive care unit (ICU). This article aims to show the different strategies to prevent the widespread of the disease to critical care healthcare workers based on the review of the recent literature and the author''s experience with the personal protective equipment (PPE) in the care of patients with COVID-19 and work on human factors in crisis management. Nonetheless, to date, there is no robust evidence that medical masks are inferior to N95/FFP2 respirators for protecting healthcare workers against laboratory-confirmed COVID-19 during patients care and non-AGPs [31] . While personal protective equipment is an essential part of safety to prevent SARS-CoV-2 transmission, it must be employed appropriately, together with frequent hand hygiene, and mastering specific techniques and non-technical skills like awareness, closed-loop communication, leadership, team working, appropriate resource management, and cognitive aids [14, 34] .

abstract:
  PURPOSE OF REVIEW: COVID-19 is a new, highly transmissible disease to which healthcare workers (HCWs) are exposed, especially in the intensive care unit (ICU). Information related to protection mechanisms is heterogeneous, and the infected HCWs’ number is increasing. This review intends to summarize the current knowledge and practices to protect ICU personnel during the patient management process in the context of the current pandemic. RECENT FINDINGS: The transmission mechanisms of SARS-CoV-2 are mainly respiratory droplets, aerosols, and contact. The virus can last for a few hours suspended in the air and be viable on surfaces for several days. Some procedures carried out in the ICU can generate aerosols. The shortage of respirators, such as the N95, has generated an increase in the demand for other protective equipment in critical care settings. SUMMARY: The probability of transmission depends on the characteristics of the pathogen, the availability of quality personal protective equipment, and the human factors associated with the performance of health workers. It is necessary to have knowledge of the virus and availability of the best possible personal protection equipment, develop skills for handling equipment, and develop non-technical skills during all intensive care process; this can be achieved through structured training.


id: cord-266173-gmz6oxf6
title: COVID-19 and the role of 3D printing in medicine
author: Tino, Rance
date: 2020-04-27
txt: ./txt/cord-266173-gmz6oxf6.txt
cache: ./cache/cord-266173-gmz6oxf6.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32337613/
doi: 10.1186/s41205-020-00064-7
abstract: nan
summary:
  Access to such models is still limited for many local 3D printing community members and will require close collaboration between companies and hospitals to ensure adequate manufacturing approaches and appropriate clinical use. The reverse-engineered 3D printable model of the Isinnova valve is not widely available at the time of writing, with the authors maintaining the position that such resources should be adequately evaluated and used only when such equipment is not available from the original manufacturers. Members of the global 3D printing community have designed a plethora of reusable personal protective equipment devices with insertable filters, primarily manufactured using low-cost desktop filament extrusion printers. To ensure the best fit, personalizing these masks may be achieved by printing in several sizes, experimenting with flexible materials, or surface scanning intended users'' faces and carrying out additional CAD to virtually fit these masks on an individual basis [9] .


id: cord-266905-j9ljwqv0
title: Laboring Alone?: Brief Thoughts on Ethics and Practical Answers During the COVID-19 Pandemic
author: Ecker, Jeffrey L.
date: 2020-05-15
txt: ./txt/cord-266905-j9ljwqv0.txt
cache: ./cache/cord-266905-j9ljwqv0.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.ajogmf.2020.100141
doi: 10.1016/j.ajogmf.2020.100141
abstract: nan
summary:
  Condensation: To minimize risk of exposure to health care workers, some have proposed eliminating 4 spouses, partners and other visitors to support women during their labor and delivery. In most institutions, however, labor and delivery units have been rare exceptions to the "no-visitor" 23 rules, for visitors there are felt to have, in the words of the New York Department of Health, an 24 "essential" role in process of care, and not having a partner present for the birth of a child seems 25 unimaginable,unkind and, for some, even traumatic. As 100 noted above, the process of labor and delivery requires close quarters, but it is difficult to estimate the 101 true incremental risk that comes with accompanying and supporting a patient, especially if members of 102 the health care team are symptom free and wearing appropriate PPE.


id: cord-267791-v10eh408
author: Chughtai, Abrar Ahmad
date: 2019-02-07
url: https://api.elsevier.com/content/article/pii/S1876034119300668
doi: 10.1016/j.jiph.2019.01.064
title:
  Use of personal protective equipment to protect against respiratory infections in Pakistan: A systematic review

abstract:
  Like other low-income countries, limited data are available on the use of personal protective equipment (PPE) in Pakistan. We conducted a systematic review of studies on PPE use for respiratory infections in healthcare settings in Pakistan. MEDLINE, Embase and Goggle Scholar were searched for clinical, epidemiological and laboratory-based studies in English, and 13 studies were included; all were observational/cross-sectional studies. The studies examined PPE use in hospital (n = 7), dental (n = 4) or laboratory (n = 2) settings. Policies and practices on PPE use were inconsistent. Face masks and gloves were the most commonly used PPE to protect from respiratory and other infections. PPE was not available in many facilities and its use was limited to high-risk situations. Compliance with PPE use was low among healthcare workers, and reuse of PPE was reported. Clear policies on the use of PPE and available PPE are needed to avoid inappropriate practices that could result in the spread of infection. Large, multimethod studies are recommended on PPE use to inform national infection-control guidelines.


id: cord-267996-5l9shks8
author: Tysiąc-Miśta, Monika
date: 2020-06-30
txt: ./txt/cord-267996-5l9shks8.txt
cache: ./cache/cord-267996-5l9shks8.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3390/ijerph17134703
doi: 10.3390/ijerph17134703
summary:
  variables, such as a lack of access to adequate, enhanced PPE; individuals'' COVID-19 contraction risk assessments; self-reported feelings of anxiety regarding the disease; gender; the acknowledgement of national guidance on how to treat patients during the recent health care crisis; and other factors such as age, years of clinical experience, marital status, having children, place of residence, risk group for coronavirus infection due to comorbidities and, finally, dentists'' acknowledgement of the professional recommendations launched by the PDA and PMH. We also investigated factors such as age, years of clinical practice (Table 5) , marital status, having children, place of residence, belonging to the risk group for coronavirus infection due to comorbidities, and dentists'' opinions on the lasting impact of COVID-19 on dental procedures (Table 6 ) in relation to the decision to continue dental practice or not.

title:
  The Attitudes and Professional Approaches of Dental Practitioners during the COVID-19 Outbreak in Poland: A Cross-Sectional Survey

abstract:
  The coronavirus infectious disease 2019 (COVID-19) pandemic has put enormous pressure on health care systems around the world. Dentistry has had to adjust to the new epidemic situation to not only bring relief to suffering patients but also to avoid becoming a source of SARS-CoV-2 transmission. Methods: A comprehensive, cross-sectional survey was conducted between April 6 and 16, 2020 among 875 Polish dental practitioners. The aim of the research was to assess dentists’ attitudes and professional approaches resulting from the COVID-19 pandemic. Results: 71.2% of dentists who responded to the questionnaire decided to suspend their clinical practice during that particular time. The main factors for this fact were the shortage of personal protective equipment (PPE), the respondents’ subjective perceptions of the risk of COVID-19 contraction and a general feeling of anxiety and uncertainty regarding the COVID-19 situation. The authors observed a significant decrease in the number of patients admitted weekly in April 2020 (12.06; SD, 11.55) in comparison to that in the time before the state of pandemic was declared on March 11, 2020 (49.21; SD, 24.97). Conclusions: Due to the unpreparedness of the dental sector, both in national health and private settings, most of the Polish dentists decided to voluntarily suspend their clinical practice in order to mitigate the spread of the disease. The COVID-19 outbreak has revealed numerous shortcomings in the dental care system, especially regarding the insufficient coordination of health services related to the pandemic and lack of advanced PPE. This has led to an overwhelming feeling of fear, confusion and anxiety among dental professionals in Poland and a sudden decrease in the number of performed dental procedures. Hopefully enriched with the recent experience and due to the implementation of proper strategic and long-term measures, dental practitioners will be better prepared and adapted to global health care disruptions in the future.


id: cord-268874-ldja6aa4
title: Personal Protective Equipment for Healthcare Workers during the COVID-19 Pandemic
author: Park, Sun Hee
date: 2020-06-24
txt: ./txt/cord-268874-ldja6aa4.txt
cache: ./cache/cord-268874-ldja6aa4.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3947/ic.2020.52.2.165
doi: 10.3947/ic.2020.52.2.165
summary:
  Although no study has conclusively linked SARS-CoV-2 transmission to contaminated environmental surfaces, indirect contact with fomites is considered a possible route based on the evidence of heavy environmental contamination in healthcare settings, objects used by COVID-19 patients [26, 27] , and the finding that the virus remains viable on plastic surfaces for as long as 3 days [28] . Initially, the Korea Center for Disease Control and Prevention (KCDC) guidelines recommended coveralls with shoe covers for contact precautions, goggles/face shields for eye protection, N95 or equivalent respirators for respiratory protection, and powered airpurifying respirators (PAPRs) when AGPs are performed [46] . PPE for droplet and contact precautions, such as surgical masks with eye protection, gowns, and gloves, are recommended for HCWs in contact with suspected or confirmed COVID-19 patients, and N95 or equivalent respirators should to be worn by HCWs whenever AGPs are performed.

abstract:
  The coronavirus disease (COVID-19) pandemic has posed a challenge for healthcare systems, and healthcare workers (HCWs) are at high risk of exposure. Protecting HCWs is of paramount importance to maintain continuous patient care and keep healthcare systems functioning. Used alongside administrative and engineering control measures, personal protective equipment (PPE) is the last line of defense and the core component of protection. Current data suggest that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is mainly transmitted through respiratory droplets and close contact. Airborne transmission may occur during aerosol-generating procedures. However, the modes of transmission still remain uncertain, especially regarding the possibility of airborne transmission when aerosol-generating procedures are not performed. Thus, there are some inconsistencies in the respiratory protective equipment recommended by international and national organizations. In Korea, there have been several modifications to PPE recommendations offering options in choosing PPE for respiratory and body protection, which confuses HCWs; they are often unsure what to wear and when to wear it. The choice of PPE is based on the risk of exposure and possible modes of transmission. The level of protection provided by PPE differs based on standards and test methods. Thus, understanding them is the key in selecting the proper PPE. This article reviews evidence on the mode of SARS-CoV-2 transmission, compares the current PPE recommendations of the World Health Organization with those in Korea, and discusses standard requirements and the proper selection of PPE.


id: cord-269826-l44xbgok
author: Wills, Timothy T.
date: 2020-06-02
txt: ./txt/cord-269826-l44xbgok.txt
cache: ./cache/cord-269826-l44xbgok.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1177/2151459320930554
doi: 10.1177/2151459320930554
summary:
  title: Utilization of an Orthopedic Hood as Personal Protective Equipment for Intubation of Coronavirus Patients: a Brief Technical Report Personal protective equipment (PPE) has been tailored accordingly, but as of April 2020, close to 10 000 health care workers in the United States have contracted COVID-19 despite wearing recommended PPE. In this brief technical report, we describe the integration of an orthopedic hood cover as an item for full barrier protection against COVID-19 transmission. CONCLUSION: Modification of existing PPE may provide protection for health care workers during high-risk aerosolizing procedures such as endotracheal intubation. We describe in a brief technical report the integration of an orthopedic hood cover as an item for full barrier protection against COVID-19 transmission during endotracheal intubation. The addition of an orthopedic hood covering to standard PPE may provide protection for health care workers during highrisk aerosolizing procedures such as endotracheal intubation.

title:
  Utilization of an Orthopedic Hood as Personal Protective Equipment for Intubation of Coronavirus Patients: a Brief Technical Report

abstract:
  BACKGROUND: The novel coronavirus disease (COVID-19) has afflicted millions of people worldwide since its first case was reported in December 2019. Personal protective equipment (PPE) has been tailored accordingly, but as of April 2020, close to 10 000 health care workers in the United States have contracted COVID-19 despite wearing recommended PPE. As such, standard guidelines for PPE may be inadequate for the health care worker performing high-risk aerosolizing procedures such as endotracheal intubation. In this brief technical report, we describe the integration of an orthopedic hood cover as an item for full barrier protection against COVID-19 transmission. TECHNICAL DESCRIPTION: The Coronavirus Airway Task Force at Virginia Commonwealth University Medical Center approved this initiative and went live with the full barrier suit during the last week of March 2020. The PPE described in this report includes a Stryker T4 Hood, normally used in conjunction with the Stryker Steri-Shield T4 Helmet. Instead of the helmet, the hood is secured to the head via a baseball cap and binder clip. This head covering apparatus is to be used as an accessory to other PPE items that include an N95 mask, waterproof gown, and disposable gloves. The motor ventilation system is not used in order to prevent airborne viral entry into the hood. DISCUSSION: An advantage of the full barrier suit is an additional layer of droplet protection during intubation. The most notable disadvantage is the absence of a ventilation system within the hood covering. CONCLUSION: Modification of existing PPE may provide protection for health care workers during high-risk aerosolizing procedures such as endotracheal intubation. Although the integration of this medical equipment meets the immediate needs of an escalating crisis, further innovation is on the horizon. More research is needed to confirm the safety of modified PPE.


id: cord-269900-7mzyib4r
title: How to Handle a COVID-19 Patient in the Angiographic Suite
author: Ierardi, Anna Maria
date: 2020-04-10
txt: ./txt/cord-269900-7mzyib4r.txt
cache: ./cache/cord-269900-7mzyib4r.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32277272/
doi: 10.1007/s00270-020-02476-8
summary:
  All the staff of the angiographic suite must use personal protective equipment (PPE), according to accepted infectious disease and epidemiology guidelines. Geographic isolation of COVID-19 positive patients should occur in designated suites only, in order to minimize different room exposures and familiarize cleaning staff with the same rooms. When carrying out these procedures on Covid-19 patients, the WHO recommends N95 or FFP2 standard masks or equivalent, and gowns, gloves, eye protection, aprons and shoe covers [4, 6] . According to the internal guidelines of our hospital, all staff members and every person operating in the same room as a positive or suspected COVID-19 patient have to wear N95 or FFP2 masks. To minimize the in and out movement from the potentially contaminated room, the staff must remain close to the angiographic table with PPE and sterile equipment. Strict attention to probe cover removal is required post-procedure (with full PPE and eye protection) to avoid contamination.

abstract:
  This is a single-center report on coordination of staff and handling of patients during the outbreak of the COVID-19 (coronavirus disease 2019) in a region with high incidence and prevalence of disease. The selection of procedures for interventional radiology (IR), preparation of staff and interventional suite before the arrival of patients, the facility ventilation systems and intra- and post-procedural workflow optimization are described. The control measures described may increase the cost of the equipment, prolong procedural times and increase technical difficulties. However, these precautions may help control the spread of COVID-19 within the healthcare facility.


id: cord-270156-qrzjgzyk
author: Cafferkey, J. J.
date: 2020-05-26
txt: ./txt/cord-270156-qrzjgzyk.txt
cache: ./cache/cord-270156-qrzjgzyk.txt
extension: .txt
mime: text/plain
url: http://medrxiv.org/cgi/content/short/2020.05.24.20107193v1?rss=1
doi: 10.1101/2020.05.24.20107193
summary:
  OBJECTIVES: In a tertiary centre in London we aim to implement HoloLens technology, allowing other medical staff to remotely join the consulting clinician when in a high-risk patient area delivering oxygen therapy. MAIN RESULTS: Mean self-reported time in the high-risk zone was less when using HoloLens (2.69 hours) compared to usual practice (3.96 hours) although this difference was not statistically significant (p = 0.3657). In the CPAP unit of a UK teaching hospital we implemented HoloLens2™ as a pragmatic technology-led improvement project to facilitate remote care during the COVID-19 pandemic in a "Red zone" where NIV/CPAP/HFNO is delivered. . https://doi.org/10.1101/2020.05.24.20107193 doi: medRxiv preprint deployment practice was two or more staff donning personal protective equipment (PPE) for ward rounds and to review deteriorating patients. Evaluation of the intervention saw ward staff (doctors, nurses and allied health professionals) completing self-report questionnaires comparing pre-and post-HoloLens2™ deployment. . https://doi.org/10.1101/2020.05.24.20107193 doi: medRxiv preprint usual practice and 240 hours of HoloLens2™ use.

title:
  Using HoloLensâ¢ to reduce staff exposure to aerosol generating procedures during a global pandemic

abstract:
  RATIONALE: COVID-19 poses a unique challenge; caring for patients with a novel, infectious disease whilst protecting staff. Some interventions used to give oxygen therapy are aerosol generating procedures. Staff delivering such interventions require PPE and are exposed to a significant viral load resulting in sick days and even death. We aim to reduce this risk using an augmented-reality communication device: The HoloLens by Microsoft. OBJECTIVES: In a tertiary centre in London we aim to implement HoloLens technology, allowing other medical staff to remotely join the consulting clinician when in a high-risk patient area delivering oxygen therapy. The study primary outcome was to reduce the exposure to staff and demonstrate non-inferiority staff satisfaction when compared to not using the device. Our secondary outcome was to reduce extrapolated PPE costs when using the device. METHODS: Our study was conducted in March and April 2020, within a respiratory unit delivering aerosolising oxygen therapies (High flow nasal oxygen, Continuous positive airway pressure and non-invasive ventilation) to patients with suspected or confirmed COVID-19 infection. MEASUREMENTS: Self-reported questionnaires to assess satisfaction in key areas of patient care. An infrared people counting device was also used to assess staff in and out of the unit. MAIN RESULTS: Mean self-reported time in the high-risk zone was less when using HoloLens (2.69 hours) compared to usual practice (3.96 hours) although this difference was not statistically significant (p = 0.3657). HoloLens showed non-inferiority when compared to usual practice in staff satisfaction score for all domains. Furthermore, mean staff satisfaction score encouragingly improved when using HoloLens. Self-reported PPE counts from this study showed 12 staff members changing PPE 25.8 times per shift, almost double the 13.5 times in the HoloLens count. CONCLUSIONS: We have demonstrated HoloLens can reduce the number of staff exposed to aerosol generating areas in a novel infectious disease. Our results show it did not impair communication, medical staff availability or end of life care. HoloLens technology may also reduce the use of PPE, which has equipment availability and cost benefits. This study provides grounding for further use of the HoloLens device by bringing a bedside experience to experts remote to the situation.


id: cord-270348-5804ffwx
author: Angelino, Andrew F.
date: 2020-07-02
txt: ./txt/cord-270348-5804ffwx.txt
cache: ./cache/cord-270348-5804ffwx.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0033318220302048
doi: 10.1016/j.psym.2020.06.018
summary:
  To prevent COVID-19 outbreaks in our units, we next decided to require universal nasal swab testing for SARS-CoV-2 for all medically asymptomatic patients being admitted to psychiatric units 3 . Second, we realized that we needed to decide where to care for SARS-CoV-2 positive, medically asymptomatic patients with mental illnesses who required hospitalization-those without symptoms of COVID-19. In light of the above, we concluded it would best serve our patients if we developed an inpatient psychiatric unit capable of accepting SARS-CoV-2 infected patients without COVID-19 symptoms, or with mild enough symptoms that they would not require medical hospitalization. Further, it is highly beneficial for continuity of care if the patient requires transfer to a medical COVID-19 unit that the psychiatrist be able to follow them there and maintain the psychiatric treatments as indicated.

title:
  Design and implementation of a regional inpatient psychiatry unit for asymptomatic SARS-CoV-2 positive patients.

abstract:
  Patients with psychiatric illnesses are particularly vulnerable to highly contagious, droplet spread organisms like SARS-CoV-2. Patients with mental illnesses may not be able to consistently follow behavioral prescriptions to avoid contagion, and they are frequently found in settings with close contact and inadequate infection control, such as group homes, homeless shelters, residential rehabilitation centers, and correctional facilities. Further, inpatient psychiatry settings are generally designed as communal spaces, with heavy emphasis on group and milieu therapies. As such, inpatient psychiatry services are vulnerable to rampant spread of contagion. With this in mind, the authors outline the decision process and ultimate design and implementation of a regional inpatient psychiatry unit for asymptomatic SARS-CoV-2 infected patients, and share key points for consideration in implementing future units elsewhere. A major take-away point of the analysis is the particular expertise of trained experts in psychosomatic medicine for treating SARS-CoV-2 infected patients.


id: cord-270781-f9nra823
title: Sarcoma Care Practice in India During COVID Pandemic: A Nationwide Survey
author: Gulia, Ashish
date: 2020-07-31
txt: ./txt/cord-270781-f9nra823.txt
cache: ./cache/cord-270781-f9nra823.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32836364/
doi: 10.1007/s43465-020-00206-3
summary:
  We conducted a survey amongst oncologists across India who are involved in the management of bone and soft tissue sarcomas, to analyse the patterns of screening, prioritising, and managing these patients within the constraints of resources and policies available with them. The purpose of this survey was to determine the consistency, or the lack of it, in the patterns of care offered to sarcoma patients between centres and the policies followed. This survey covered three main domains (a) participants speciality and working environment (b) Institutes'' policies related general COVID-19 prevention and management (c) practices related to musculoskeletal tumor management in COVID-19 pandemic. Surgical management of sarcomas was as per usual only in 15.5% of respondents, with the rest adapting, including 42% who were avoiding procedures requiring long duration and blood loss, 27% were operating only emergency cases, while in 15.5% surgery was done only in high grade sarcomas with curative intent (Fig. 5) .

abstract:
  BACKGROUND: Amidst the COVID-19 pandemic, management of cancer has been one of the most intensely debated topics across the globe. We conducted an online survey to determine the consistency/or the lack of it, in the management of sarcoma patients between centres and the changes in policies. METHODS: A twenty-five question online survey was conducted among practicing physicians over a period of 10 days using online portal (surveymonkey.com). It was followed by a critical analysis based on responses to each question. RESULTS: Of 194 medical professionals who participated, 80% were surgeons and 53% were working in government institutes. Most respondents (81%) continued their practice with some modifications. In OP majority (67%) relied only on symptom, contact enquiry and temperature recording for screening. COVID-19 testing was done more (43%) in IP patients. Most of institutes (83%) followed rotational policy to reduce the number of staff at risk while 57% offered an alternate accommodation. 52.3% continued chemotherapy for all patients while radiotherapy for all was offered by 45%. In metastatic cases, majority preferred either no treatment or non-surgical intervention (71%).84.5% believed in adapting changes (42%—avoid supra major surgeries, 27%—Operating only emergency cases and 15.5%—High grade sarcomas with curative intent) in surgical management of sarcomas. For benign bone tumors, majority (71%) agreed on adapting changes while 25% agreed on deferring all cases. 69% preferred teleconsultations for follow-up. Complete PPE were being used for all aerosol generating procedures by 44%. Only two thirds agreed with their institutes policy of PPE usage and COVID-19 testing. CONCLUSION: This survey has highlighted disparity on COVID-19 screening and management in various institutes across the country. This will act as a reference point for tracking future trends in bone and soft tissue tumor management guidelines, as the COVID-19 scenario unfolds globally and particularly in India.


id: cord-271048-tq1sk01g
title: Operating during the COVID-19 pandemic: How to reduce medical error
author: Ellis, R.
date: 2020-04-13
txt: ./txt/cord-271048-tq1sk01g.txt
cache: ./cache/cord-271048-tq1sk01g.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32312584/
doi: 10.1016/j.bjoms.2020.04.002
summary:
  Many surgical colleagues are being trained in managing unwell patients suffering with coronavirus on the wards, others have been supporting emergency departments and intensive care units. Despite covering an increasing number of patients admitted with COVID-19, surgeons will still be dealing with emergency surgical admissions and will continue to operate on emergency cases. In light of these new and unfamiliar challenges, there are resources available to help surgeons revise their knowledge of acute medicine and receive updates on COVID-19 via webinars 5, 6 ; critical care websites with up to date guidelines and handbooks (such as the intensive care society: www.ics.ac.uk/ICS/handbooks.aspx); Systemic Training in Acute Illness Recognition and Treatment for Surgery (START) course, that includes a human factors presentation, on the RCS website; Non-Technical Skills for Surgeons course (NOTSS) presentations are available on the RCS Edinburgh website (www.rcsed.ac.uk) to both members and non-members.

abstract:
  Our professional and private lives changed on March 11 2020 when the coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO. By March 16, surgical training was suspended, MRCS and FRCS examinations cancelled and all courses postponed. In theory, essential cancer surgery, emergency and trauma operating will continue. All elective, non-essential cases are currently cancelled. While we adapt to our new ways of working, we remind ourselves that surgeons are flexible, resilient and, ultimately, we are doctors in the first instance. We present a short article on operating during the COVID-19 pandemic.


id: cord-271603-zy4l9vtf
author: Skali, Hicham
date: 2020-10-17
txt: ./txt/cord-271603-zy4l9vtf.txt
cache: ./cache/cord-271603-zy4l9vtf.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32709732/
doi: 10.2967/jnumed.120.251355
abstract: nan
summary:
  title: Guidance and Best Practices for Reestablishment of Non-Emergent Care in Nuclear Cardiology Laboratories During the Coronavirus Disease 2019 (COVID-19) Pandemic: An Information Statement from ASNC, IAEA, and SNMMI • For SPECT myocardial perfusion imaging studies in inpatients who are not eligible for stress only testing, consider performing the rest injection in the patient''s inpatient room, to avoid completely or minimize waiting time in the laboratory. The nuclear cardiology laboratory''s protocols and patient scheduling templates will need to be closely monitored and refined multiple times over the coming months as the COVID-19 pandemic slowly recedes, with potential for local or widespread waves of new COVID-19 infections. • Providers and institutions should monitor local data and follow national, state, and department of public health recommendations for possible second COVID-19 waves that may require decreasing nuclear cardiology laboratory activities and enhanced protective measures.

title:
  Guidance and Best Practices for Reestablishment of Non-Emergent Care in Nuclear Cardiology Laboratories During the Coronavirus Disease 2019 (COVID-19) Pandemic: An Information Statement from ASNC, IAEA, and SNMMI


id: cord-271925-85bixn27
title: Droplet nuclei aerosol and Covid 19 - a risk to healthcare staff
author: Rao US, V.
date: 2020-05-03
txt: ./txt/cord-271925-85bixn27.txt
cache: ./cache/cord-271925-85bixn27.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S026643562030190X
doi: 10.1016/j.bjoms.2020.04.036
abstract: nan
summary:
  title: Droplet nuclei aerosol and Covid 19 a risk to healthcare staff The authors need to be complimented for a well-timed paper that addresses the current issue of exposure of health care workers to COVID 19. Authors mentioned that Flügge droplets travel up to 4.5 m, representing a risk to healthcare staff that is not directly involved in patient care. Health care workers and employers who are not directly involved in patient care are also at risk of virus transmission due to this and need to take adequate precautions. As rightly mentioned by the authors, the health care staff and the employee must receive adequate training to use personal protective equipment. Adequate training and education about droplet nuclei aerosol is very important for the safety of health care professionals and reducing risk of virus exposure. Personal protective equipment and COVID 19-a risk to healthcare staff?


id: cord-272182-5lunidrs
title: Resuscitation during the COVID-19 pandemic: Lessons learnt from high-fidelity simulation
author: Lim, Wan Yen
date: 2020-05-22
txt: ./txt/cord-272182-5lunidrs.txt
cache: ./cache/cord-272182-5lunidrs.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32446791/
doi: 10.1016/j.resuscitation.2020.05.024
abstract: nan
summary:
  High-fidelity simulation sessions were conducted in our institution to identify latent threats in existing workflows, and to formulate modified life support protocols focusing on: protection of healthcare workers (HCW) and patients, minimizing aerosolization and reducing delays in resuscitation. Suspected or confirmed COVID-19 patients are managed in negative pressure, single-bedded rooms in the acute care hospital. Due to geographical reasons, the mean (SD) code blue response time to the acute and community care wards were 3.28 (1.76) and 6.67 (2.06) minutes, respectively. In simulations, we adhered to hospital and COVID-19 guidelines of full PPE (including N95 mask or powered air-purifying respirator (PAPR), gown, gloves, goggles and face shield or visor) 2 . Frequent training and simulation sessions including PPE familiarization minimizes delays in resuscitation, reduces risk of viral transmission, enhances communication, teamwork and coordination, and allows latent threats identification and workflow refinement.


id: cord-272585-346ef6qy
author: Lombardi, JM
date: 2020-05-31
txt: ./txt/cord-272585-346ef6qy.txt
cache: ./cache/cord-272585-346ef6qy.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1529943020307609
doi: 10.1016/j.spinee.2020.05.539
summary:
  title: Addressing a National Crisis: The Spine Hospital and Department''s Response to the COVID-19 Pandemic in New York City As peak infections spread across the United States, we hope this article will serve as a resource for other spine departments on how to manage patient care and healthcare worker deployment during the COVID-19 crisis. Our institution has been on the forefront of the COVID-19 pandemic, as we treated "patient zero" in New York City, who presented to our Emergency Department (ED) on February 28 th . Published data by healthcare providers in Asia and Europe demonstrated that the most substantial threat to COVID-19 patient morbidity and mortality was the lack of adequate critical care resources including intensive care unit (ICU) beds and respiratory support [8] [9] . It is vital to note that although redeployment was an important initiative to our department during this time of crisis, our primary concern was to maintain an adequate workforce to meet all orthopaedic surgical demands at our institution.

title:
  Addressing a National Crisis: The Spine Hospital and Department''s Response to the COVID-19 Pandemic in New York City

abstract:
  In a very brief period, the COVID-19 pandemic has swept across the planet leaving governments, societies and healthcare systems unprepared and under-resourced. New York City now represents the global viral epicenter with roughly one third of all mortalities in the United States. To date, our hospital has treated thousands of COVID-19 positive patients and sits at the forefront of the United States response to this pandemic. The goal of this paper is to share the lessons learned by our spine division during a crisis when hospital resources and personnel are stretched thin. Such experiences include management of elective and emergent cases, outpatient clinics, physician redeployment and general health and wellness. As peak infections spread across the United States, we hope this article will serve as a resource for other spine departments on how to manage patient care and healthcare worker deployment during the COVID-19 crisis.


id: cord-272726-ljjirt4g
title: Redesigning a Department of Surgery during the COVID-19 Pandemic
author: Brethauer, Stacy A.
date: 2020-04-28
txt: ./txt/cord-272726-ljjirt4g.txt
cache: ./cache/cord-272726-ljjirt4g.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32347453/
doi: 10.1007/s11605-020-04608-4
summary:
  The department of surgery played a leading role in establishing clinical protocols, guidelines, and policies in preparation for a surge of COVID-19 patients. Within the department of surgery, these challenges required leadership to form new workgroups and reporting structures, establish clear communication strategies, redefine clinical activities for the faculty, and modify the workloads of trainees. For services still performing some essential operations (e.g., advanced cancer, emergent cardiac, trauma, or acute care surgery), every effort was made to minimize the number of faculty coming to work with coverage provided by those who were coming in for operative cases or on call. This "second surge" of elective cases will present its own set of logistic challenges and requires early planning to facilitate care of surgical patients once the COVID-19 surge has passed.

abstract:
  BACKGROUND: COVID-19 has created an urgent need for reorganization and surge planning among departments of surgery across the USA. METHODS: Review of the COVID-19 planning process and work products in preparation for a patient surge. Organizational and process changes, workflow redesign, and communication plans are presented. RESULTS: The planning process included widespread collaboration among leadership from many disciplines. The department of surgery played a leading role in establishing clinical protocols, guidelines, and policies in preparation for a surge of COVID-19 patients. A multidisciplinary approach with input from clinical and nonclinical stakeholders is critical to successful crisis planning. A clear communication plan should be implemented early and input from trainees, staff, and faculty should be solicited. CONCLUSION: Major departmental and health system reorganization is required to adapt academic surgical practices to a widespread crisis. Surgical leadership, innovation, and flexibility are critical to successful planning and implementation.


id: cord-273303-g86w0xt5
title: Early Vascular Surgery Response to the COVID-19 Pandemic: Results of a Nationwide Survey
author: Latz, Christopher A.
date: 2020-05-23
txt: ./txt/cord-273303-g86w0xt5.txt
cache: ./cache/cord-273303-g86w0xt5.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.jvs.2020.05.032
doi: 10.1016/j.jvs.2020.05.032
summary:
  This survey study sought to identify practice changes, understand current personal protection equipment (PPE) use, and determine how caring for patients with COVID-19 differs for vascular surgeons practicing in states with high COVID-19 case numbers versus low case numbers. The majority of vascular surgeons are reusing PPE The majority of 5 respondents worked in an academic setting (81.5%) and were performing only urgent and 6 emergent cases (80.5%) during preparation for the surge. The majority of vascular surgeons are reusing PPE The majority of 5 respondents worked in an academic setting (81.5%) and were performing only urgent and 6 emergent cases (80.5%) during preparation for the surge. The majority of vascular surgeon respondents were also being asked to 22 reuse PPE, a common practice throughout the United States during the pandemic. In our initial response (early March 2020), vascular trainees were not involved in 7 COVID-19 cases and attendings saw these patients alone (both to protect our trainees and to 8 limit use of PPE).

abstract:
  OBJECTIVES: The COVID-19 pandemic has had major implications for the United States healthcare system. This survey study sought to identify practice changes, understand current personal protection equipment (PPE) use, and determine how caring for patients with COVID-19 differs for vascular surgeons practicing in states with high COVID-19 case numbers versus low case numbers. METHODS: A fourteen-question online survey regarding the effect of the COVID-19 pandemic on vascular surgeons’ current practice was sent to 365 vascular surgeons across the country via REDCap from 4/14/2020 to 4/21/2020 with responses closed on 4/23/2020. The survey response was analyzed with descriptive statistics. Further analyses were performed to evaluate whether responses from states with the highest number of COVID-19 cases (New York, New Jersey, Massachusetts, Pennsylvania and California) differed from those with lower case numbers (all other states). RESULTS: A total of 121 vascular surgeon responded (30.6%) to the survey. All high-volume states were represented. The majority of vascular surgeons are reusing PPE The majority of respondents worked in an academic setting (81.5%) and were performing only urgent and emergent cases (80.5%) during preparation for the surge. This did not differ between high case and low COVID case states (p=0.285). High case states were less likely to perform a lower extremity intervention for critical limb ischemia (60.8% vs. 77.5%, p=0.046), but otherwise case types did not differ. Most attendings work with residents (90.8%) and limited their exposure to procedures on suspected/confirmed COVID-19 cases (56.0%). Thirty-eight percent of attendings have been redeployed within the hospital to a vascular access service, and/or other service outside of vascular surgery. This was more frequent in high case volume states compared to low case volume states (p=0.039). The majority of vascular surgeons are reusing PPE (71.4%) and N95 masks (86.4%), and 21% of vascular surgeons feel that they do not have adequate PPE to perform clinical their duties. CONCLUSION: The initial response to the COVID-19 pandemic has resulted in reduced elective cases with primarily only urgent and emergent cases being performed. A minority of vascular surgeons have been redeployed outside of their specialty, however, this is more common among states with high case numbers. Adequate PPE remains an issue for almost a quarter of vascular surgeons who responded to this survey.


id: cord-273748-xy4f5kon
author: Armijo, Priscila R.
date: 2020-08-04
txt: ./txt/cord-273748-xy4f5kon.txt
cache: ./cache/cord-273748-xy4f5kon.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0196655320307628?v=s5
doi: 10.1016/j.ajic.2020.07.037
summary:
  To overcome this challenge, stringent policies and appropriate use of PPE, such as face shields, safety glasses, and N95 masks, are indicated for providers performing aerosol-generating procedures [7] . In response to the COVID-19 Pandemic, The University of Nebraska Medical Center (UNMC), Department of Anesthesiology, mandated that anesthesia providers use face shields during patient care to extend the life of N95 masks and adequately protect providers from infection with SARS-CoV-2. Given this information, we developed a decontamination protocol that utilized a dilute bleach solution that would allow penetration into any of the pores that are generated in the 3D printing process and permit the reuse of the face shields. After careful consideration, we chose to use a Prusa i3 MK3S model printer for our 3D face shield printing needs. As a positive control, organism suspensions were inoculated to each face shield part, allowed to dry, and swabbed without decontamination.

title:
  3D Printing of Face Shields to Meet the Immediate Need for PPE in an Anesthesiology Department during the COVID-19 Pandemic

abstract:
  Anesthesia providers are at risk for contracting COVID-19 due close patient contact. Proper personal protective equipment (PPE) use is critical to providing a safe environment and to minimize the risk of contagion. During the COVID-19 Pandemic, a series of supply chain issues, constant changes in PPE use policy, and higher demand for PPE led to shortages in PPE, specifically N95 masks and face shields. Implementation of decontamination protocols successfully allowed N95 mask reuse but, required masks to be unsoiled. Face shields not only act as a barrier against the soiling of N95 face masks, they also serve as more effective eye protection from respiratory droplets over standard eye shields. The University of Nebraska Medical Center produced face shields using a combination of 3D printing and assembly with commonly available products. Approximately 112 face shields were constructed and made available for use in 72 hours. Importantly, we created and implemented a simple but effective decontamination protocol, which allowed reuse of the face shields. These methods were successfully implemented for in-house production of face shields used at Tripler Army Medical Center (Tripler AMC, Hawaii). The effectiveness of the decontamination protocol was evaluated using the average log(10) reduction in colony counts for Escherichia coli ATCC 8937 and Staphylococcus aureus ATCC 25923 from the American Type Culture Collection (ATCC, Manassas, VA). In this manuscript, we present our detailed protocol and supplies needed for printing 3D face shields to enable the rapid production of this product by individuals with little to no 3D printing experience, in times of urgent need.


id: cord-274477-jkjyh4cs
title: Protecting healthcare personnel from 2019-nCoV infection risks: lessons and suggestions
author: Zhang, Zhiruo
date: 2020-03-23
txt: ./txt/cord-274477-jkjyh4cs.txt
cache: ./cache/cord-274477-jkjyh4cs.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s11684-020-0765-x
doi: 10.1007/s11684-020-0765-x
summary:
  The outbreak of a novel Coronavirus disease (COVID-19, caused by the 2019-nCoV infection) in December 2019 is one of the most severe public health emergencies since the founding of People''s Republic of China in 1949. Healthcare personnel (HCP) nationwide are facing heavy workloads and high risk of infection, especially those who care for patients at the epicenter of the outbreak, Hubei Province. Based on literature search and interviews with some HCP working at Wuhan, capital city of Hubei, we have summarized some of the effective measures taken to reduce infection among HCP, and also made suggestions for improving occupational safety during an infectious disease outbreak. The local outbreak of novel coronavirus epidemic (COVID-19, caused by the 2019-nCoV infection) in Wuhan, Hubei Province of China, last December has rapidly spread nationwide with a cumulative number of 80 026 laboratory-confirmed cases and 2912 deaths as of March 1, 2020 [1] .

abstract:
  The outbreak of a novel Coronavirus disease (COVID-19, caused by the 2019-nCoV infection) in December 2019 is one of the most severe public health emergencies since the founding of People’s Republic of China in 1949. Healthcare personnel (HCP) nationwide are facing heavy workloads and high risk of infection, especially those who care for patients at the epicenter of the outbreak, Hubei Province. Sadly, as of February 20, 2020, over two thousand COVID-19 cases are confirmed among HCP from 476 hospitals nationwide, with nearly 90% of them from Hubei Province. Based on literature search and interviews with some HCP working at Wuhan, capital city of Hubei, we have summarized some of the effective measures taken to reduce infection among HCP, and also made suggestions for improving occupational safety during an infectious disease outbreak. The experience and lessons learned should be a valuable asset for international health community to contain the ongoing COVID-19 epidemic around the world.


id: cord-276265-gjqqfudb
author: Chiang, James
date: 2020-07-20
txt: ./txt/cord-276265-gjqqfudb.txt
cache: ./cache/cord-276265-gjqqfudb.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s12245-020-00296-8
doi: 10.1186/s12245-020-00296-8
summary:
  Since the coronavirus (2019-nCoV) or coronavirus disease (COVID-19) outbreak, shortage of personal protective equipment (PPE) has become a significant issue in numerous countries worldwide [1] , with an estimate of 89 million masks required monthly due to increased demand within and outside healthcare settings [2] . Some of these recommendations include using N95 masks for extended durations, using one mask for several different patients, reserving disposable N95 masks for aerosol generating procedures, and using reusable elastomeric respirators with appropriate filters [3] . Given the persistent shortage of disposable N95 masks, the authors review the safety and practicality of elastomeric respirators as an alternative for protection against the coronavirus COVID-19. Currently, the CDC recommends that health care providers that will be within 3 ft of a suspected or confirmed COVID-19 patient without a mask, or if providers are in the room for an aerosolizing procedure, the provider may voluntarily utilize higher level of protection than N95 masks, such as elastomeric respirators or PAPR.

title:
  Elastomeric respirators are safer and more sustainable alternatives to disposable N95 masks during the coronavirus outbreak

abstract:
  BACKGROUND: In this paper, the authors review the safety and practicality of elastomeric respirators for protecting themselves and others from the novel coronavirus or COVID-19. They also describe the safe donning and doffing procedures for this protective gear. MAIN TEXT: Due to the shortage of personal protective equipment (PPE), the CDC has recommended ways to conserve disposable N95 masks, including re-use and extended use, and reserving N95 masks for aerosol-generating procedures. However, these were never made to be re-used. Although the modes of transmission of COVID-19 are not fully understood, based on what we know about severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), droplets and aerosolized droplets contribute to the spread of this virus. More evidence from Wuhan, China, has demonstrated that COVID-19 viral particles are aerosolized and found in higher concentrations in rooms where PPE is being removed. Thus, it is best for all healthcare providers to have full aerosol protection. CONCLUSION: Given the shortage of PPE for aerosols, it is logical to utilize reusable elastomeric respirators with filter efficiency of 95% or higher. A single elastomeric respirator may replace hundreds to thousands of new disposable N95 masks.


id: cord-276758-k2imddzr
author: Siegel, Jane D.
date: 2007-12-07
txt: ./txt/cord-276758-k2imddzr.txt
cache: ./cache/cord-276758-k2imddzr.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/18068815/
doi: 10.1016/j.ajic.2007.10.007
abstract: nan
summary:
  Activities currently assigned to ICPs in response to emerging challenges include (1) surveillance and infection prevention at facilities other than acute care hospitals (eg, ambulatory clinics, day surgery centers, LTCFs, rehabilitation centers, home care); (2) oversight of employee health services related to infection prevention (eg, assessment of risk and administration of recommended treatment after exposure to infectious agents, tuberculosis screening, influenza vaccination, respiratory protection fit testing, and administration of other vaccines as indicated, such as smallpox vaccine in 2003); (3) preparedness planning for annual influenza outbreaks, pandemic influenza, SARS, and bioweapons attacks; (4) adherence monitoring for selected infection control practices; (5) oversight of risk assessment and implementation of prevention measures associated with construction and renovation; (6) prevention of transmission of MDROs; (7) evaluation of new medical products that could be associated with increased infection risk (eg, intravenous infusion materials); (8) communication with the public, facility staff, and state and local health departments concerning infection control-related issues; and (9) participation in local and multicenter research projects.

title:
  2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings


id: cord-276945-gly0stxm
title: The impact of the Coronavirus (COVID-19) pandemic on maternity care in Europe
author: Coxon, Kirstie
date: 2020-06-10
txt: ./txt/cord-276945-gly0stxm.txt
cache: ./cache/cord-276945-gly0stxm.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.midw.2020.102779
doi: 10.1016/j.midw.2020.102779
abstract: nan
summary:
  This observation, also seen in other countries which gather and report case ethnicity (Khunti et al., 2020) , has shocked many; the reasons are not fully understood, but it is clear that people with BAME ethnicity, whether they are pregnant women, members of the public, essential workers or health care providers, need to be pro-actively protected from contracting COVID-19. Yet women and midwives remain very much affected; care during pregnancy, birth and the postnatal weeks has changed radically and fast, and basic elements of the midwife-woman relationship such as meeting in person and providing a comforting touch have been upended in an attempt to maintain distance and reduce cross-infection. Commonalities include concerns around supply of PPE, high numbers of healthcare staff affected by the virus, and steps taken to reduce pregnant women''s exposure to health settings by switching to online and telephone consultations where possible.


id: cord-277167-qdi6hu82
title: Adjustment for international surgical outreach missions due to COVID-19
author: Fuzaylov, Gennadiy
date: 2020-07-30
txt: ./txt/cord-277167-qdi6hu82.txt
cache: ./cache/cord-277167-qdi6hu82.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32830001/
doi: 10.1016/j.burns.2020.07.016
abstract: nan
summary:
  Doctors Collaborating to help Children is one such non-profit organization which started a global health campaign to improve burn care in Ukraine [4] . The incidence of burn injury, and other surgically treated diseases is unlikely to acutely change in the setting of the COVID-19 pandemic, undoubtably creating an increase in patients seeking care [5] . However, discontinuing international surgical missions is critical in preventing regional viral spread, preserving PPE, and protecting ourselves and our patients. In line with CDC recommendations to increase telemedicine care, we encourage providers involved in surgical outreach to do the same. Limitations in testing and ventilators, PPE requirements, and a call for reducing global spread necessitate a stop in international travel for providers involved in surgical outreach missions. We continuing to work with doctors and health care ministers abroad remotely through increasing telemedicine efforts.


id: cord-277350-zwu254n6
author: Bianco, F.
date: 2020-05-24
txt: ./txt/cord-277350-zwu254n6.txt
cache: ./cache/cord-277350-zwu254n6.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32449034/
doi: 10.1007/s13304-020-00818-2
summary:
  title: Preventing transmission among operating room staff during COVID-19 pandemic: the role of the Aerosol Box and other personal protective equipment During aerosol-generating medical procedures (AGMP; e.g. intubating and extubating patients or any surgical procedures), the production of both airborne particles and droplets may increase the risk of infection. During aerosol-generating medical procedures (AGMP), the production of both airborne particles and droplets may increase the risk of infection. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) defined a list of AGMP, during which the use of personal protective equipment (PPE) should be recommended for all involved theater staff [4, 5] . We report a retrospective case series of six COVID-19 positive male patients undergoing emergent surgical treatment for gastrointestinal complications. Considering the high risk of disease transmission during AGMP, we support the use of both PPE and AB to protect surgical staff during the current COVID-19 outbreak.

title:
  Preventing transmission among operating room staff during COVID-19 pandemic: the role of the Aerosol Box and other personal protective equipment

abstract:
  The COVID-19 pandemic is highly challenging for the operating room staff and healthcare workers in emergency departments. SARS-CoV-2 is a positive-sense single-stranded RNA beta-coronavirus that primarily targets the human respiratory system, with fever, cough, myalgia, and pneumonia as the most common manifestations. However, since SARS-CoV-2 RNA was detected in stool specimens much more attention has been paid to gastrointestinal symptoms such as loss of appetite, nausea, and diarrhea. Furthermore, the expression of ACE-2 receptors in absorptive enterocytes from ileum and colon suggests that these organs should also be considered as a potential high risk for SARS-CoV-2 infection. During aerosol-generating medical procedures (AGMP; e.g. intubating and extubating patients or any surgical procedures), the production of both airborne particles and droplets may increase the risk of infection. In this situation, the surgical staff is strongly recommended to wear personal protective equipment (PPE). A transparent plastic cube, the so-called “Aerosol Box” (AB), has been recently designed to lend further protection against droplets and aerosol exposure during the AGMP.


id: cord-279396-qmixem8i
title: COVID-19 Disease: a critical care perspective
author: Carter, Chris
date: 2020-06-01
txt: ./txt/cord-279396-qmixem8i.txt
cache: ./cache/cord-279396-qmixem8i.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S2666869620300038?v=s5
doi: 10.1016/j.intcar.2020.100003
summary:
  In addition to the relatively high numbers of COVID-19 patients developing severe respiratory failure resulting in acute respiratory distress syndrome (ARDS) and requiring intubation and ventilatory support, the current data suggests an average length of stay for COVID patients in intensive care of eight days. The critical care nurse needs to recognise that patients who develop severe COVID-19 can rapidly develop Type 1 Respiratory Failure, ARDS and therefore require ventilatory support. 18 In non COVID-19 patients with increasing respiratory failure the use of High Flow Nasal Oxygen (HFNO) or Non-Invasive Ventilation (NIV) such as Continuous Positive Airway Pressure (CPAP) may be used as a treatment strategy. 40 There is also a suggestion that an increased number of healthcare professionals is needed when providing care, particularly in critical care for procedures requiring two nurses to one patient (2:1) when PPE is worn.

abstract:
  Abstract COVID-19 is a new highly infectious disease with an incompletely described clinical course, which has caused a pandemic, with Europe being identified as the third epicentre. COVID-19 has placed unprecedented pressure on critical care services which is likely to stretch resources beyond capacity. The situation is exacerbated by increased staff absence from self-isolation and illness, increased referral of patients with suspected or confirmed COVID-19 who develop respiratory failure, and limited availability of Extra Corporeal Membrane Oxygenation (ECMO) services. In addition, there is the ongoing challenge of patients being transferred between departments and hospitals for ongoing care. In consequence, as current needs continue to rise, innovative approaches are needed to redress shortages and support the continuance of services. This article provides an overview of severe COVID-19 infection, outlining treatment strategies and nursing processes that will need to develop and extend in response to this evolving situation.


id: cord-280419-odqo3o4w
title: Custom solution for PPE in the orthopaedic setting: retrofitting Stryker Flyte T5® PPE system
author: Gibbons, John P.
date: 2020-10-26
txt: ./txt/cord-280419-odqo3o4w.txt
cache: ./cache/cord-280419-odqo3o4w.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0195670120304977?v=s5
doi: 10.1016/j.jhin.2020.10.016
summary:
  In this study the authors made modifications to two different SS systems to incorporate high-efficiency particulate air (HEPA) filters to the inlets to the fan to assess their potential as a method of providing a reusable system for PPE for the surgeon with regard to protection from a respiratory droplet spread virus. The results show that using a layer of HEPA filter cut to size, and sealed to the inlet for the fan in the helmet will reduce the downstream particulate at the user''s mouth by over 99.5% which is equivalent to that of a respirator mask. With the modification of the HEPA filter to the inlet of the T5 helmet as described, the downstream penetration was reduced to 0.46% (σ = 0.24%) which is significantly better than all other test configurations and offers a particulate filtration similar to FFP3 and N99 or other equivalent respirator mask.

abstract:
  The COVID-19 pandemic has meant that there is growing pressure on hospital resources not least the availability of appropriate personal protective equipment (PPE), specifically, facemasks and respirator masks. Within the field of orthopaedic surgery, it is a common sight to see orthopaedic surgery carried out in “space suits” (SS) which comprise of a helmet, hood and surgical gown. In this study the authors made modifications to two different SS systems to incorporate high-efficiency particulate air (HEPA) filters to the inlets to the fan to assess their potential as a method of providing a reusable system for PPE for the surgeon with regard to protection from a respiratory droplet spread virus. The testing was carried out using particle counter upstream and downstream on a manikin wearing two different SS systems with and without modifications to the inlet. The results show that using a layer of HEPA filter cut to size, and sealed to the inlet for the fan in the helmet will reduce the downstream particulate at the user’s mouth by over 99.5% which is equivalent to that of a respirator mask. HEPA filter material is relatively cheap and can be used repeatedly making this a viable alternative to disposable, and even re-sterilized, respirator masks in the setting of a respiratory droplet spread viral pandemic.


id: cord-281099-l2i7r1bp
title: A perspective on dental activity during COVID‐19: the Italian survey.
author: Izzetti, Rossana
date: 2020-08-13
txt: ./txt/cord-281099-l2i7r1bp.txt
cache: ./cache/cord-281099-l2i7r1bp.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32791564/
doi: 10.1111/odi.13606
summary:
  MATERIALS AND METHODS: An online anonymous questionnaire was administered to retrieve data on the dental procedures performed, the preventive measures adopted, and the predictions on the future changes in dentistry following the pandemic. Standard procedures appear insufficient in protecting from SARS-CoV-2, and thus specific measures to prevent virus transmission should be adopted to safeguard the health of both patients and oral care providers (Izzetti et al. -Post-dental treatment management of the dental office (Phase IV) A focus on highly epidemic areas, registering the higher number of cases, was also performed in order to evaluate the potential presence of differences between the regions in Northern Italy and the rest of the country. The set-up of the waiting room (non-clinical area) was adapted to the new situation by almost the totality of the sample, by providing a hydro-alcoholic solution for hand disinfection, removing objects at risk of contamination, and reorganizing the schedule in order to guarantee social distancing.

abstract:
  OBJECTIVES: During the months of March and April 2020, Italy saw an exponential outbreak of COVID‐19 epidemic. Dental practitioners were particularly limited in their routine activity, and the sole performance of urgent treatments was strongly encouraged during the peak of the epidemic. A survey among dental professionals was performed between 6(th)‐13(th) of April, in order to evaluate the status of dental practice during COVID‐19 in Italy. MATERIALS AND METHODS: An online anonymous questionnaire was administered to retrieve data on the dental procedures performed, the preventive measures adopted, and the predictions on the future changes in dentistry following the pandemic. RESULTS: The survey was completed by 3,254 respondents and, according to the results obtained, dental activity was reduced by the 95% and limited to urgent treatments. The majority of the surveyed dentists employed additional personal protective equipment compared to normal routine, although in a non‐negligible number of cases difficulty in retrieving the necessary equipment was reported. CONCLUSIONS: The survey provided a snapshot of dental activity during the SARS‐CoV‐2 outbreak. Overall, following the peak of the epidemic, it is probable that dental activities will undergo some relevant changes prior to fully restart.


id: cord-281403-yl7jdarm
title: U.S. Medical Examiner/Coroner capability to handle highly infectious decedents
author: Le, Aurora B.
date: 2018-11-06
url: https://www.ncbi.nlm.nih.gov/pubmed/30402743/
doi: 10.1007/s12024-018-0043-2
abstract:
  In the United States of America, Medical Examiners and Coroners (ME/Cs) investigate approximately 20% of all deaths. Unexpected deaths, such as those occurring due to a deceased person under investigation for a highly infectious disease, are likely to fall under ME/C jurisdiction, thereby placing the ME/C and other morgue personnel at increased risk of contracting an occupationally acquired infection. This survey of U.S. ME/Cs′ capabilities to address highly infectious decedents aimed to determine opportunities for improvement at ME/C facilities serving a state or metropolitan area. Data for this study was gathered via an electronic survey. Of the 177 electronic surveys that were distributed, the overall response rate was N = 108 (61%), with 99 of those 108 respondents completing all the questions within the survey. At least one ME/C responded from 47 of 50 states, and the District of Columbia. Select results were: less than half of respondents (44%) stated that their office had been involved in handling a suspected or confirmed highly infectious remains case and responses indicated medical examiners. Additionally, ME/C altered their personal protective equipment based on suspected versus confirmed highly infectious remains rather than taking an all-hazards approach. Standard operating procedures or guidelines should be updated to take an all-hazards approach, best-practices on handling highly infectious remains could be integrated into a standardized education, and evidence-based information on appropriate personal protective equipment selection could be incorporated into a widely disseminated learning module for addressing suspected or confirmed highly infectious remains, as those areas were revealed to be currently lacking.


id: cord-281627-8cq18gja
author: Hon, Chun-Yip
date: 2008-12-31
txt: ./txt/cord-281627-8cq18gja.txt
cache: ./cache/cord-281627-8cq18gja.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/19084161/
doi: 10.1016/j.ajic.2008.07.007
summary:
  title: Personal protective equipment in health care: Can online infection control courses transfer knowledge and improve proper selection and use? We used observational evaluation to assess the ability of an online learning course to effectively transfer knowledge on personal protective equipment (PPE) selection and removal. The present study evaluated PPE selection and use by HCWs through observational analysis, both before and after the HCWs took an online infection control course. 14-17 From March to June 2007, nurses, care aides, and allied health staff attending the orientation program were invited to participate in a structured observation of PPE use before and after taking the infection control course. [18] [19] [20] 22 For the PPE sequence evaluation, the participant was given a ''''1 point, 1 task'''' score based on the observed structured clinical examination method, with a total maximum score based on the number of donning and doffing and hand hygiene tasks performed.

title:
  Personal protective equipment in health care: Can online infection control courses transfer knowledge and improve proper selection and use?

abstract:
  We used observational evaluation to assess the ability of an online learning course to effectively transfer knowledge on personal protective equipment (PPE) selection and removal. During orientations for new hospital staff, 117 participants applied either airborne, droplet, or contact precautions in mock scenarios. Postcourse, all 3 scenarios demonstrated improvement in PPE sequence scores (P = .001); moreover, hand hygiene also was more frequent during both donning and doffing of PPE (P < .001).


id: cord-281762-qwlfikfl
title: Personal protective equipment during the COVID-19 pandemic (Letter #1)
author: Shorten, George D.
date: 2020-08-07
txt: ./txt/cord-281762-qwlfikfl.txt
cache: ./cache/cord-281762-qwlfikfl.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s12630-020-01784-4
doi: 10.1007/s12630-020-01784-4
abstract: nan
summary:
  During the coronavirus disease pandemic, the circumstances under which donning and doffing of PPE is being learned, trained, and subsequently performed may be suboptimal. Although no overview exists of the training practices for donning and doffing PPE, it is likely that it is less than ideal. Ideally, in designing a training program for a new procedure, one would: 1) share a description of the procedure with ''''trainees'''' that contains unambiguous definitions of each step, and common and critical errors; 2) apply a pre-training preparation standard; 3) provide real-world materials (e.g., PPE) for repeated deliberate practice; 4) provide multiple training sessions based on performance; and 5) undertake an ''''exit'''' assessment. 4 Proficiencybased progression and other forms of metrics-based training decrease the incidence of errors amongst novice practitioners and the evidence of its consistent efficacy is particularly strong for procedural skills. Personal protective equipment (PPE) for both anesthesiologists and other airway managers: principles and practice during the COVID-19 pandemic


id: cord-283900-4pa93xqi
author: Khan, M. Ali
date: 2020-05-22
txt: ./txt/cord-283900-4pa93xqi.txt
cache: ./cache/cord-283900-4pa93xqi.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S2468653020302037?v=s5
doi: 10.1016/j.oret.2020.05.011
summary:
  Abstract Purpose To assess perceptions of occupational risk and changes to clinical practice of ophthalmology trainees in the United States during the COVID-19 pandemic. Main outcome measures Survey questions assessed policies guiding COVID-19 response, known or suspected exposure to SARS-CoV-2, changes in clinical duties and volume, and methods to reduce occupational risk including availability of personal protective equipment. Survey questions assessed training program environment, policies guiding 106 COVID-19 response, changes in fellow duties and clinical volume, and methods to reduce 107 occupational risk including availability of PPE. Discussion of data regarding differential reduction of SARS-CoV-2 or other coronavirus 307 transmission with surgical or N95 respirator masks is outside the scope of this study assessing ophthalmology trainee perceptions of occupational risk. This study reports 323 occupational risk perceptions, currently utilized risk mitigation strategies, and surgical volume 324 training concerns for second year US vitreoretinal surgery fellows mid-pandemic escalation.

title:
  Perceptions of Occupational Risk and Changes in Clinical Practice of U.S. Vitreoretinal Surgery Fellows during the COVID-19 Pandemic

abstract:
  Abstract Purpose To assess perceptions of occupational risk and changes to clinical practice of ophthalmology trainees in the United States during the COVID-19 pandemic. Design An anonymous, non-validated, cross-sectional survey was conducted online. Data was collected from April 7-16, 2020. Participants 2019-2020 second year U.S. vitreoretinal surgery fellows in two-year vitreoretinal surgery training programs were invited to participate. Intervention Online survey. Main outcome measures Survey questions assessed policies guiding COVID-19 response, known or suspected exposure to SARS-CoV-2, changes in clinical duties and volume, and methods to reduce occupational risk including availability of personal protective equipment. Results Completed responses were obtained from 62 of 87 eligible recipients (71.2% response rate). Training settings included academic (58.1%), hybrid academic/private practice (35.5%), and private practice only settings (6.5%). Overall, 19.4% of respondents reported an exposure to a COVID-19 positive patient, 14.5% reported self-quarantining due to possible exposure, and 11.3% reported being tested for COVID-19. In regards to PPE, N95 masks were available in the emergency room (n=40, 64.5%), office (n=35, 56.5%), and operating room settings (n=35, 56.5%). Perceived comfort level with PPE recommendations was significantly associated with availability of an N95 respirator mask in the clinic (p<0.001), emergency room (p<0.001) or operating room (p=0.002) settings. Additional risk mitigation methods outside of PPE were: reduction in patient volume (n=62, 100%), limiting patient companions (n=59, 95.2%), use of a screening process (n=59, 95.2%), use of a slit lamp face shield (n=57, 91.9%), temperature screening of all persons entering clinical space (n=34, 54.84%), and placement of face mask on patients (n=33, 53.2%). Overall, 16.1% reported additional clinical duties within the scope of ophthalmology, and 3.2% reported being re-deployed to non-ophthalmology services. 98.4% of respondents expected a reduction in surgical case volume. No respondents reported loss of employment or reduction in pay or benefits due to COVID-19. Conclusion and Relevance: Suspected or confirmed clinical exposure to COVID-19 positive patients occurred in approximately one-fifth of trainee respondents. Perceived comfort level with PPE standards was significantly associated with N95 respirator mask availability. As surgical training programs grapple with the COVID-19 pandemic, analysis of trainees’ concerns may inform development of mitigation strategies.


id: cord-284274-9uu7yflt
author: Russi, Christopher S.
date: 2020-08-13
url: https://doi.org/10.1016/j.mayocp.2020.07.025
doi: 10.1016/j.mayocp.2020.07.025
abstract: nan
title:
  Emergency Medicine Telehealth for COVID-19: Minimize Front-Line Provider Exposure and Conserve Personal Protective Equipment (PPE)


id: cord-284374-sqxlnk9e
author: Park, Jiyeon
date: 2020-01-15
txt: ./txt/cord-284374-sqxlnk9e.txt
cache: ./cache/cord-284374-sqxlnk9e.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1038/s41598-019-57216-x
doi: 10.1038/s41598-019-57216-x
summary:
  title: Infection Prevention Measures for Surgical Procedures during a Middle East Respiratory Syndrome Outbreak in a Tertiary Care Hospital in South Korea Our experience with setting up a temporary negative-pressure operation room and our conservative approach for managing MERS-related patients can be referred in cases of future unexpected MERS outbreaks in non-endemic countries. Anesthesiologists were recommended to apply enhanced PPE (including PAPR from the middle of the outbreak) when managing all MERS-related patients because they were most directly exposed to the aerosol-producing high-risk procedures, such as endotracheal intubation and extubation. Almost all hospitals generally have positive-pressure operating rooms and they may experience an outbreak without facilities that are prepared for perioperative management of MERS patients, as our hospital did in 2015. First, although the previous guidelines recommended that asymptomatic MERS-exposed patients be managed as general patients undergoing surgery, we applied standard PPE to HCWs and we performed MERS-CoV PCR screening twice.

title:
  Infection Prevention Measures for Surgical Procedures during a Middle East Respiratory Syndrome Outbreak in a Tertiary Care Hospital in South Korea

abstract:
  In 2015, we experienced the largest in-hospital Middle East respiratory syndrome (MERS) outbreak outside the Arabian Peninsula. We share the infection prevention measures for surgical procedures during the unexpected outbreak at our hospital. We reviewed all forms of related documents and collected information through interviews with healthcare workers of our hospital. After the onset of outbreak, a multidisciplinary team devised institutional MERS-control guidelines. Two standard operating rooms were converted to temporary negative-pressure rooms by physically decreasing the inflow air volume (−4.7 Pa in the main room and −1.2 Pa in the anteroom). Healthcare workers were equipped with standard or enhanced personal protective equipment according to the MERS-related patient’s profile and symptoms. Six MERS-related patients underwent emergency surgery, including four MERS-exposed and two MERS-confirmed patients. Negative conversion of MERS-CoV polymerase chain reaction tests was noticed for MERS-confirmed patients before surgery. MERS-exposed patients were also tested twice preoperatively, all of which were negative. All operative procedures in MERS-related patients were performed without specific adverse events or perioperative MERS transmission. Our experience with setting up a temporary negative-pressure operation room and our conservative approach for managing MERS-related patients can be referred in cases of future unexpected MERS outbreaks in non-endemic countries.


id: cord-284484-oak1lfmi
author: Barratt, Ruth
date: 2019-12-04
url: https://www.sciencedirect.com/science/article/pii/S2588994X19300806
doi: 10.1016/j.auec.2019.10.002
title:
  Enablers of, and barriers to, optimal glove and mask use for routine care in the emergency department: an ethnographic study of Australian clinicians

abstract:
  BACKGROUND: The risk of healthcare-acquired infection increases during outbreaks of novel infectious diseases. Emergency department (ED) clinicians are at high risk of exposure to both these and common communicable diseases. Personal protective equipment (PPE) is recommended to protect clinicians from acquiring, or becoming vectors of, infection, yet compliance is typically sub-optimal. Little is known about factors that influence use of PPE—specifically gloves and masks—during routine care in the ED. METHODS: This was an ethnographic study, incorporating documentation review, field observations and interviews. The theoretical domains framework (TDF) was used to aid thematic analysis and identify relevant enablers of and barriers to optimal PPE use. RESULTS: Thirty-one behavioural themes were identified that influenced participants’ use of masks and gloves. There were significant differences, namely: more reported enablers of glove use vs more barriers to mask use. Reasons included more positive unit culture towards glove use, and lower perception of risk via facial contamination. CONCLUSION: Emerging infectious diseases, spread (among other routes) by respiratory droplets, have caused global outbreaks. Emergency clinicians should ensure that, as with gloves, the use of masks is incorporated into routine cares where appropriate. Further research which examines items of PPE independently is warranted.


id: cord-284640-tl9nmvog
author: Tabah, Alexis
date: 2020-06-13
txt: ./txt/cord-284640-tl9nmvog.txt
cache: ./cache/cord-284640-tl9nmvog.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32570052/
doi: 10.1016/j.jcrc.2020.06.005
summary:
  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). While pain, heat stress and fluid loss with using Powered Air-Purifying Respirators (PAPR) were predicted by experimental data (14) , there are no real-life reports of this issue when using PPE that is available to HCWs. The objective of this study was to describe the current reported practices, availability, training, confidence in the use and adverse effects due to extended use of PPE by HCWs from around the world caring for COVID-19 patients who require ICU management. This survey provides a snapshot of the reported availability, perceived adequacy of training and provided protection, adverse effects and usage of PPE among HCW managing COVID-19 patients in critical care environments from across the globe.

title:
  Personal protective equipment and intensive care unit healthcare worker safety in the COVID-19 era (PPE-SAFE): An international survey

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.


id: cord-285804-lyj9tua8
title: Stockpile Model of Personal Protective Equipment in Taiwan
author: Chen, Yu-Ju
date: 2017-04-01
txt: ./txt/cord-285804-lyj9tua8.txt
cache: ./cache/cord-285804-lyj9tua8.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/28418743/
doi: 10.1089/hs.2016.0103
summary:
  In addition, a joint electronic procurement platform has been established for merchandising the replaced PPE to local health authorities and medical and other institutions for their routine or epidemic use. Based on the act, the central government, local health authorities, and medical institutions are required to maintain a minimum stockpile of PPE (including surgical masks, N95 respirators, and coveralls) to ensure a sufficient supply for epidemic prevention and frontline healthcare personnel during the early phase of an epidemic. After the SARS epidemic, the Taiwan CDC proposed ''''A Strategy Plan for PPE Minimum Stockpile'''' and established the 3-tier stockpiling framework-a central health authority (managed by the Taiwan CDC), local health authorities, and medical institutions-to effectively respond to emergent demands and spread the risk of stockpiling. In addition, to ensure the surge capacity during epidemic periods, the contractors must guarantee to provide 5 million surgical masks, 100,000 N95 respirators, and 15,000 coveralls within 14 days in response to an emergency request from the Taiwan CDC.

abstract:
  The Taiwan Centers for Disease Control (Taiwan CDC) has established a 3-tier personal protective equipment (PPE) stockpiling framework that could maintain a minimum stockpile for the surge demand of PPE in the early stage of a pandemic. However, PPE stockpiling efforts must contend with increasing storage fees and expiration problems. In 2011, the Taiwan CDC initiated a stockpile replacement model in order to optimize the PPE stockpiling efficiency, ensure a minimum stockpile, use the government's limited funds more effectively, and achieve the goal of sustainable management. This stockpile replacement model employs a first-in-first-out principle in which the oldest stock in the central government stockpile is regularly replaced and replenished with the same amount of new and qualified products, ensuring the availability and maintenance of the minimum stockpiles. In addition, a joint electronic procurement platform has been established for merchandising the replaced PPE to local health authorities and medical and other institutions for their routine or epidemic use. In this article, we describe the PPE stockpile model in Taiwan, including the 3-tier stockpiling framework, the operational model, the components of the replacement system, implementation outcomes, epidemic supports, and the challenges and prospects of this model.


id: cord-285960-1zuhilmu
author: Conly, John
date: 2020-08-06
txt: ./txt/cord-285960-1zuhilmu.txt
cache: ./cache/cord-285960-1zuhilmu.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32762735/
doi: 10.1186/s13756-020-00779-6
summary:
  The report by the World Health Organization (WHO) Joint Mission on Coronavirus Disease 2019 (COVID-19) in China supports person-to-person droplet and fomite transmission during close unprotected contact with the vast majority of the investigated infection clusters occurring within families, with a household secondary attack rate varying between 3 and 10%, a finding that is not consistent with airborne transmission. Based on the scientific evidence accumulated to date, our view is that SARS-CoV-2 is not spread by the airborne route to any significant extent and the use of particulate respirators offers no advantage over medical masks as a component of personal protective equipment for the routine care of patients with COVID-19 in the health care setting. The findings from multiple systematic reviews and meta analyses over the last decade have not demonstrated any significant difference in the clinical effectiveness of particulate respirators compared to the use of medical masks when used by HCWs in multiple health care settings for the prevention of respiratory virus infections, including influenza [57] [58] [59] .

title:
  Use of medical face masks versus particulate respirators as a component of personal protective equipment for health care workers in the context of the COVID-19 pandemic

abstract:
  Currently available evidence supports that the predominant route of human-to-human transmission of the SARS-CoV-2 is through respiratory droplets and/or contact routes. The report by the World Health Organization (WHO) Joint Mission on Coronavirus Disease 2019 (COVID-19) in China supports person-to-person droplet and fomite transmission during close unprotected contact with the vast majority of the investigated infection clusters occurring within families, with a household secondary attack rate varying between 3 and 10%, a finding that is not consistent with airborne transmission. The reproduction number (R(0)) for the SARS-CoV-2 is estimated to be between 2.2–2.7, compatible with other respiratory viruses associated with a droplet/contact mode of transmission and very different than an airborne virus like measles with a R(0) widely cited to be between 12 and 18. Based on the scientific evidence accumulated to date, our view is that SARS-CoV-2 is not spread by the airborne route to any significant extent and the use of particulate respirators offers no advantage over medical masks as a component of personal protective equipment for the routine care of patients with COVID-19 in the health care setting. Moreover, prolonged use of particulate respirators may result in unintended harms. In conjunction with appropriate hand hygiene, personal protective equipment (PPE) used by health care workers caring for patients with COVID-19 must be used with attention to detail and precision of execution to prevent lapses in adherence and active failures in the donning and doffing of the PPE.


id: cord-286977-330p60oh
author: Barcala-Furelos, Roberto
date: 2020-09-16
txt: ./txt/cord-286977-330p60oh.txt
cache: ./cache/cord-286977-330p60oh.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0735675720307695
doi: 10.1016/j.ajem.2020.08.101
summary:
  title: Plastic blanket drowning kit: A protection barrier to immediate resuscitation at the beach in the Covid-19 era. OBJECTIVE: Introducing a new, simple and inexpensive portable equipment for lifeguards, consisting of a pre-assembled full-size plastic blanket with a mask and HEPA filter, which could offer significant time-saving advantages to reduce COVID-19 risk transmission in the first few minutes of CPR after water rescue, avoiding the negative impact of delayed ventilation. METHOD: A pilot study was carried out to determine the feasibility of the pre-assembled kit of face-mask and HEPA filter adapted on a pre-set plastic-blanket. The PPE kit consists of a pre-assembled full-size transparent plastic blanket with an adaptation to a ventilation face mask with a High Efficiency Particulate Air (HEPA) filter. Plastic blanket drowning kit: a protection barrier to immediate resuscitation at the beach in the Covid-19 era.

title:
  Plastic blanket drowning kit: A protection barrier to immediate resuscitation at the beach in the Covid-19 era. A pilot study.

abstract:
  OBJECTIVE: Introducing a new, simple and inexpensive portable equipment for lifeguards, consisting of a pre-assembled full-size plastic blanket with a mask and HEPA filter, which could offer significant time-saving advantages to reduce COVID-19 risk transmission in the first few minutes of CPR after water rescue, avoiding the negative impact of delayed ventilation. METHOD: A pilot study was carried out to determine the feasibility of the pre-assembled kit of face-mask and HEPA filter adapted on a pre-set plastic-blanket. The first step consisted of washing hands, putting on safety glasses and gloves as the first personal protection equipment (PPE) and then covering the victim with an assembled plastic blanket. The second step consisted of 10 min of cardiopulmonary resuscitation (CPR) with PPE and plastic blanket, following the technical recommendations for ventilation during COVID-19. RESULTS: Ten rescuers took part in the pilot study. The average time to wear PPE and place the pre-assembly kit on the victim was 82 s [IC 58–105]. After 10 min the quality of the resuscitation (QCPR) was 91% [87–94]. Quality chest compressions (CC) were 22% better than ventilations (V). Most of the rescuers (60%) thought that placing the plastic blanket on the victim on the beach was somewhat simple or very simple. CONCLUSIONS: Resuscitation techniques in COVID-19 era at the beach have added complexities for the correct use of PPE. Plastic blanket plus basic ventilations equipment resource could be a new alternative to be considered for lifeguards to keep ventilation on use while reducing risk transmission.


id: cord-287303-b7vg439c
author: Piché-Renaud, Pierre-Philippe
date: 2020-08-12
txt: ./txt/cord-287303-b7vg439c.txt
cache: ./cache/cord-287303-b7vg439c.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1017/ice.2020.415
doi: 10.1017/ice.2020.415
summary:
  OBJECTIVE: In this study, we aimed to capture perspectives of healthcare workers (HCWs) on coronavirus disease 2019 (COVID-19) and infection prevention and control (IPAC) measures implemented during the early phase of the COVID-19 pandemic. INTERVENTION: A self-administered survey was distributed to HCWs. We analyzed factors influencing HCW knowledge and self-reported use of personal protective equipment (PPE), concerns about contracting COVID-19 and acceptance of the recommended IPAC precautions for COVID-19. 13, 14 During the 2003 SARS outbreak in Canada, inconsistent use of PPE and lack of adequate infection control training were among the factors contributing to the infection of HCWs. 15 In this study, we aimed to capture attitudes and knowledge of HCWs regarding COVID-19 and IPAC measures in the early phase of the COVID-19 pandemic, especially related to PPE. We also sought to identify factors influencing HCW knowledge and self-reported use of personal protective equipment (PPE), concerns about contracting COVID-19, and acceptance of the recommended IPAC precautions for COVID19 .

title:
  Healthcare worker perception of a global outbreak of novel coronavirus (COVID-19) and personal protective equipment: Survey of a pediatric tertiary-care hospital

abstract:
  OBJECTIVE: In this study, we aimed to capture perspectives of healthcare workers (HCWs) on coronavirus disease 2019 (COVID-19) and infection prevention and control (IPAC) measures implemented during the early phase of the COVID-19 pandemic. DESIGN: A cross-sectional survey of HCWs. PARTICIPANTS: HCWs from the Hospital for Sick Children, Toronto, Canada. INTERVENTION: A self-administered survey was distributed to HCWs. We analyzed factors influencing HCW knowledge and self-reported use of personal protective equipment (PPE), concerns about contracting COVID-19 and acceptance of the recommended IPAC precautions for COVID-19. RESULTS: In total, 175 HCWs completed the survey between March 6 and March 10: 35 staff physicians (20%), 24 residents or fellows (14%), 72 nurses (41%), 14 respiratory therapists (8%), 14 administration staff (8%), and 14 other employees (8%). Most of the respondents were from the emergency department (n = 58, 33%) and the intensive care unit (n = 58, 33%). Only 86 respondents (50%) identified the correct donning order; only 60 (35%) identified the correct doffing order; but the majority (n = 113, 70%) indicated the need to wash their hands immediately prior to removal of their mask and eye protection. Also, 91 (54%) respondents felt comfortable with recommendations for droplet and/or contact precautions for routine care of patients with COVID-19. HCW occupation and concerns about contracting COVID-19 outside work were associated with nonacceptance of the recommendations (P = .016 and P = .036 respectively). CONCLUSION: As part of their pandemic response plans, healthcare institutions should have ongoing training for HCWs that focus on appropriate PPE doffing and discussions around modes of transmission of COVID-19.


id: cord-287653-69nfi379
title: COVID-19: POSTMORTEM DIAGNOSTIC AND BIOSAFETY CONSIDERATIONS
author: Lacy, J. Matthew
date: 2020-04-24
txt: ./txt/cord-287653-69nfi379.txt
cache: ./cache/cord-287653-69nfi379.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32379077/
doi: 10.1097/paf.0000000000000567
summary:
   Prosect cases in negative pressure isolation suite with at least 6-12 air changes per hour  Doff contact and droplet precaution PPE, as well as N95 respirator or PAPR  Limit personnel in the isolation suite to the minimum necessary to perform the examination  Employ splash and aerosol reduction techniques during prosection; oscillating saws are discouraged but if used should have vacuum shroud attachment  Use caution when handling sharps; allow only one person to prosect at a given time  Ensure a technician is outside isolation room to monitor procedure and provide support as needed  Procure synthetic nasopharyngeal (+/-lung) respiratory swabs in sterile tubes of 2-3 ml of viral transport media for SARS-CoV-2 testing as needed  Carefully decontaminate morgue surfaces and outer body bag following autopsy  Ensure body is fully enclosed in a secure bag, tag as infectious and ensure funeral home is informed  Consider modifying release procedures to prevent bag being opened in morgue for identification  Perform hand hygiene after doffing PPE A C C E P T E D

abstract:
  As a result of the 2019 novel human coronavirus (COVID-19) global spread, medical examiner/coroner offices will inevitably encounter increased numbers of COVID-19-infected decedents at autopsy. While in some cases a history of fever and/or respiratory distress (e.g. cough or shortness of breath) may suggest the diagnosis, epidemiologic studies indicate that the majority of individuals infected with COVID-19 develop mild to no symptoms. Those dying with—but not of—COVID-19 may still be infectious, however. While multiple guidelines have been issued regarding autopsy protocol in cases of suspected COVID-19 deaths, there is some variability in the recommendations. Additionally, limited recommendations to date have been issued regarding scene investigative protocol, and there are a paucity of publications characterizing COVID-19 postmortem gross and histologic findings. A case of sudden unexpected death due to COVID-19 is presented as a means of illustrating common autopsy findings, as well as diagnostic and biosafety considerations. We also review and summarize the current COVID-19 literature in an effort to provide practical evidence-based biosafety guidance for ME/C offices encountering COVID-19 at autopsy.


id: cord-287707-ng0ha3vv
author: Pal, Arghya
date: 2020-06-04
txt: ./txt/cord-287707-ng0ha3vv.txt
cache: ./cache/cord-287707-ng0ha3vv.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0165178120317406
doi: 10.1016/j.psychres.2020.113178
abstract: nan
summary:
  title: ''Masking'' of the mental state: unintended consequences of personal protective equipment (PPE) on psychiatric clinical practice ''Masking'' of the mental state: unintended consequences of personal protective equipment (PPE) on psychiatric clinical practice "When your face says it all, your mouth waits its turn"this quotation by Anthony T. The mental state examination (MSE) derives significantly from simple observation of someone"s facial expressions and body language, in addition to clinical questions. The use of masks hampers the observation of facial expressions which is very important for any MSE. Apart from the difficulties in conducting MSE, PPE may also pose a barrier to observe some clinical signs which are as important to psychiatry as for other medical disciplines, e.g., injuries, pallor, icterus, cyanosis, etc. It would be highly beneficial for psychiatrists and patients alike if the national or international psychiatric bodies can prepare guidelines while weighing all the pros and cons, to conduct interviews and MSEs during the current pandemic.

title:
  ‘Masking’ of the mental state: unintended consequences of personal protective equipment (PPE) on psychiatric clinical practice


id: cord-290456-cgrn5c36
author: Soliman, Mohamed A. R.
date: 2020-09-25
txt: ./txt/cord-290456-cgrn5c36.txt
cache: ./cache/cord-290456-cgrn5c36.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33093987/
doi: 10.25259/sni_547_2020
summary:
  [16] e aim of this study is to present the current situation from a developing country perspective in dealing with emergency endoscopic endonasal skull base surgeries at the time of the COVID-19 pandemic in terms of preoperative patients'' screening, surgical techniques, and intraoperative PPE utilization. e survey consisted of 12 questions designed to explore three domains; patients'' information (age, clinical manifestations [neurological and COVID-19 related], diagnosis, preoperative COVID-19 screening, and COVID-19 symptoms during the first 3 weeks postsurgery), surgical team information (age, chronic medical conditions, and COVID-19 symptoms during the first 3 weeks postsurgery), and operative information (PPE utilization and basal craniectomy). ere was only one surgeon who developed a high-grade fever, malaise, and bony aches in the first 3 days after surgery who had undergone two nasopharyngeal swabs with RT-PCR testing 1 week apart and both came back negative representing 2.1% of the surgical team members [ Figure 2c ].

title:
  Endoscopic endonasal skull base surgery during the COVID-19 pandemic: A developing country perspective

abstract:
  BACKGROUND: Although primarily a respiratory disorder, the coronavirus pandemic has paralyzed almost all aspects of health-care delivery. Emergency procedures are likely continuing in most countries, however, some of them raises certain concerns to the surgeons such as the endoscopic endonasal skull base surgeries. The aim of this study is to present the current situation from a developing country perspective in dealing with such cases at the time of the COVID-19 pandemic. METHODS: A cross-sectional analytical survey was distributed among neurosurgeons who performed emergency surgeries during the COVID-19 pandemic in Cairo, Egypt, between May 8, 2020, and June 7, 2020. The survey entailed patients’ information (demographics, preoperative screening, and postoperative COVID-19 symptoms), surgical team information (demographics and postoperative COVID-19 symptoms), and operative information (personal protective equipment [PPE] utilization and basal craniectomy). RESULTS: Our survey was completed on June 7, 2020 (16 completed, 100% response rate). The patients were screened for COVID-19 preoperatively through complete blood cell (CBC) (100%), computed tomography (CT) chest (68.8%), chest examination (50%), C-reactive protein (CRP) (50%), and serological testing (6.3%). Only 18.8% of the surgical team utilized N95 mask and goggles, 12.5% utilized face shield, and none used PAPRs. Regarding the basal craniectomy, 81.3% used Kerrison Rongeur and chisel, 25% used a high-speed drill, and 6.3% used a mucosal shaver. None of the patients developed any COVID-19 symptoms during the first 3 weeks postsurgery and one of the surgeons developed high fever with negative nasopharyngeal swabs. CONCLUSION: In developing countries with limited resources, preoperative screening using chest examination, CBC, and CT chest might be sufficient to replace Reverse transcription polymerase chain reaction. Developing countries require adequate support with screening tests, PPE, and critical care equipment such as ventilators.


id: cord-290653-48swl1aq
author: Teng, Margaret
date: 2020-09-16
url: https://www.ncbi.nlm.nih.gov/pubmed/32994856/
doi: 10.4253/wjge.v12.i9.256
title:
  Endoscopy during COVID-19 pandemic: An overview of infection control measures and practical application

abstract:
  The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in coronavirus disease 2019 (COVID-19) which has affected more than 4.5 million people in 213 countries, and has been declared a pandemic by World Health Organization on March 11, 2020. The transmission of SARS-CoV-2 has been reported to occur primarily through direct contact or droplets. There have also been reports that SARS-CoV-2 can be detected in biopsy and stool specimens, and it has been postulated that there is potential for fecal–oral transmission as well. Gastrointestinal symptoms have been reported in 17.6% of COVID-19 patients and transmission can potentially occur through gastrointestinal secretions in this group of patients. Furthermore, transmission can also occur in asymptomatic carriers or patients with viral shedding during the incubation period. Endoscopic procedures hence may pose significant risks of transmission (even for those not directly involving confirmed COVID-19 cases) as endoscopists and endoscopy staff are in close contact with patients during these aerosol generating procedures. This could result in inadvertent transmission of infection at time of endoscopy.


id: cord-293055-8scoocvx
author: Deressa, W.
date: 2020-11-03
txt: ./txt/cord-293055-8scoocvx.txt
cache: ./cache/cord-293055-8scoocvx.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1101/2020.10.30.20223149
doi: 10.1101/2020.10.30.20223149
summary:
  Bivariate and multivariable logistic regression models were used to assess factors associated with the satisfaction level of healthcare workers with regard to the availability and use of proper PPE during the current COVID-19 pandemic. The independent predictors of the respondents satisfaction level about PPE were male gender (adjusted OR=1.39, 95% CI:1.05-1.85), healthcare workers who reported that PPE was adequately available in the hospital (adjusted OR=7.53, 95% CI:5.08-11.16), and preparedness to provide care to COVID-19 cases (adjusted OR=1.65, 95% CI:1.22-2.12). The purpose of this study was to assess the self-reported availability and use of PPE as well as satisfaction level of HCPs practicing in public hospitals in Addis Ababa during the current COVID-19 pandemic. ; https://doi.org/10.1101/2020.10.30.20223149 doi: medRxiv preprint Table 5 shows the satisfaction level of HCPs with regard to the current availability and use of PPE in the study hospitals, and 54.7% (n=584) and 17.5% (n=187) of the respondents reported that they were unsatisfied or somewhat unsatisfied with the availability of PPE, respectively.

title:
  Availability of personal protective equipment and satisfaction of healthcare professionals during COVID-19 pandemic in Ethiopia

abstract:
  Healthcare professionals (HCPs) are at the frontline in the fight against COVID-19 and are at an increased risk of becoming infected with coronavirus. Risk of infection can be minimized by use of proper personal protective equipment (PPE). This study assessed the availability of PPE and satisfaction of HCPs in six public hospitals in Addis Ababa, Ethiopia. A cross-sectional study was conducted from 9th to 26th June 2020. The study hospitals included: Tikur Anbessa Specialized Hospital, Zewditu Memorial Hospital, Ghandi Memorial Hospital, Menelik II Hospital, Yekatit 12 Hospital Medical College and St. Paul Hospital Millennium Medical College. Data were collected using a self-administered questionnaire. Descriptive statistics were used to describe the data and Chi-square test was used to assess the association between the groups. Bivariate and multivariable logistic regression models were used to assess factors associated with the satisfaction level of healthcare workers with regard to the availability and use of proper PPE during the current COVID-19 pandemic. A total of 1,134 (92.3%) valid questionnaires from a possible 1,228 were included in the analysis. The mean (SD) age of the participants was 30.26 (6.43) year and 52.6% were females. Nurses constituted about 40% of the overall sample, followed by physicians (22.2%), interns (10.8%), midwives (10.3%) and others (16.7%). An overall shortage of PPE was reported in all study hospitals. The majority (77%) of the healthcare professionals reported that their hospital did not have adequate PPE. A critical shortage of N95 respirator was particularly reported, the self-reported availability of N95 increased from 13% to 24% before and during COVID-19, respectively. The self-reported use of N95 increased from 9% to 21% before and during COVID-19, respectively. Almost 72% of the respondents were dissatisfied with the availability of PPE in their hospital. The independent predictors of the respondents satisfaction level about PPE were male gender (adjusted OR=1.39, 95% CI:1.05-1.85), healthcare workers who reported that PPE was adequately available in the hospital (adjusted OR=7.53, 95% CI:5.08-11.16), and preparedness to provide care to COVID-19 cases (adjusted OR=1.65, 95% CI:1.22-2.12). A critical shortage of appropriate PPE both before and during COVID-19 was identified. The high level of dissatisfaction with the availability of PPE might potentially lead to a lower level of preparedness and readiness to fight against COVID-19. Therefore, urgent efforts are needed to adequately supply the healthcare facilities with appropriate PPE to alleviate the challenges.


id: cord-294557-4h0sybiy
title: Coronavirus disease 2019 (COVID-19) in the radiology department: What radiographers need to know
author: Stogiannos, N.
date: 2020-06-04
txt: ./txt/cord-294557-4h0sybiy.txt
cache: ./cache/cord-294557-4h0sybiy.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1078817420300845
doi: 10.1016/j.radi.2020.05.012
summary:
  Objectives include to: i) outline pathophysiology and basic epidemiology useful for radiographers, ii) discuss the role of medical imaging in the diagnosis of Covid-19, iii) summarise national and international guidelines of imaging Covid-19, iv) present main clinical and imaging findings and v) summarise current safety recommendations for medical imaging practice. CXR imaging of suspected or confirmed Covid-19 cases should be performed with portable equipment within specifically designated isolated rooms for eliminating the risks of cross-infection within the Radiology department. After the outbreak of the Covid-19 pandemic, many professional bodies and learned societies have been quick to issue official guidelines on how medical imaging should optimally be performed for early diagnosis and related management of these patients, but also how staff should be protected from cross-infection. Chest radiographic and CT findings of the 2019 novel Coronavirus disease (COVID-19): analysis of nine patients treated in Korea Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2: a systematic review and meta-analysis

abstract:
  OBJECTIVES: The aim is to review current literature related to the diagnosis, management, and follow-up of suspected and confirmed Covid-19 cases. KEY FINDINGS: Medical Imaging plays an important auxiliary role in the diagnosis of Covid-19 patients, mainly those most seriously affected. Practice differs widely among different countries, mainly due to the variability of access to resources (viral testing and imaging equipment, specialised staff, protective equipment). It has been now well-documented that chest radiographs should be the first-line imaging tool and chest CT should only be reserved for critically ill patients, or when chest radiograph and clinical presentation may be inconclusive. CONCLUSION: As radiographers work on the frontline, they should be aware of the potential risks associated with Covid-19 and engage in optimal strategies to reduce these. Their role in vetting, conducting and often reporting the imaging examinations is vital as well as their contribution in patient safety and care. Medical Imaging should be limited to critically ill patients, and where it may have an impact on the patient management plan. IMPLICATIONS FOR PRACTICE: At the time of publication, this review offers the most up-to-date recommendations for clinical practitioners in radiology departments, including radiographers. Radiography practice has to significantly adjust to these new requirements to support optimal and safe imaging practices for the diagnosis of Covid-19. The adoption of low dose CT, rigorous infection control protocols and optimal use of personal protective equipment may reduce the potential risks of radiation exposure and infection, respectively, within Radiology departments.


id: cord-294591-793ywpcd
author: Hu, Xiaoyun
date: 2012-09-05
txt: ./txt/cord-294591-793ywpcd.txt
cache: ./cache/cord-294591-793ywpcd.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/22957101/
doi: 10.1371/journal.pone.0044723
summary:
  This study examined the knowledge, attitudes, and self-reported behaviors, and barriers to compliance with the use of PPE among ICU healthcare workers (HCWs) during the pandemic influenza. As the second part of the above survey, we wish to evaluate the self-reported compliance to the use of PPE during the current influenza pandemic among critical care clinicians in Chinese ICUs, as well as independent predictors of the compliance. In this survey of Chinese critical care clinicians, only 55% of respondents reported high compliance (.80%) to recommended PPE use, consistent with other relevant studies [16, 19] . Despite the lack of data validating such concept with regards to 2009 H1N1 influenza in ICU, studies did suggest that implementation of protocoled care and/or educational program, by addressing knowledge, attitude, and behavioral barriers, might significantly reduce catheter-related bloodstream infection [31] , and improve mortality in patients with severe sepsis [32] . Only 55% of Chinese critical care clinicians reported high compliance to PPE use during pandemic influenza, putting HCWs and their patients at risk.

title:
  Self-Reported Use of Personal Protective Equipment among Chinese Critical Care Clinicians during 2009 H1N1 Influenza Pandemic

abstract:
  BACKGROUND: Critically ill patients with 2009 H1N1 influenza are often treated in intensive care units (ICUs), representing significant risk of nosocomial transmission to critical care clinicians and other patients. Despite a large body of literature and guidelines recommending infection control practices, numerous barriers have been identified in ICUs, leading to poor compliance to the use of personal protective equipment (PPE). The use of PPE among critical care clinicians has not been extensively evaluated, especially during the pandemic influenza. This study examined the knowledge, attitudes, and self-reported behaviors, and barriers to compliance with the use of PPE among ICU healthcare workers (HCWs) during the pandemic influenza. METHODOLOGY/PRINCIPAL FINDINGS: A survey instrument consisting of 36 questions was developed and mailed to all HCWs in 21 ICUs in 17 provinces in China. A total of 733 physicians, nurses, and other professionals were surveyed, and 650 (88.7%) were included in the analysis. Fifty-six percent of respondents reported having received training program of pandemic influenza before they cared for H1N1 patients, while 77% reported to have adequate knowledge of self and patient protection. Only 18% of respondents were able to correctly identify all components of PPE, and 55% reported high compliance (>80%) with PPE use during patient care. In multivariate analysis, vaccination for 2009 H1N1 influenza, positive attitudes towards PPE use, organizational factors such as availability of PPE in ICU, and patient information of influenza precautions, as well as reprimand for noncompliance by the supervisors were associated with high compliance, whereas negative attitudes towards PPE use and violation of PPE use were independent predictors of low compliance. CONCLUSION/SIGNIFICANCE: Knowledge and self-reported compliance to recommended PPE use among Chinese critical care clinicians is suboptimal. The perceived barriers should be addressed in order to close the significant gap between perception and knowledge or behavior.


id: cord-294916-xc9ozxyn
title: Risk, uncertainty, ignorance and myopia: Their managerial implications for B2B firms
author: Oehmen, Josef
date: 2020-07-31
url: https://www.sciencedirect.com/science/article/pii/S0019850120304028
doi: 10.1016/j.indmarman.2020.05.018
abstract:
  Abstract Rare events are common: Even though any particular type of ‘rare event’ - a world war, global economic collapse, or pandemic for that matter - should only occur once every 100 years, there are enough of those types of ‘rare events’ that overall, they commonly occur about once every 10 years. As we are currently experiencing with the COVID-19 pandemic, we do not sufficiently leverage the rich toolset that risk management offers to prepare for and mitigate the resulting uncertainty. This article highlights four aspects of risk management, and their practical and theorical implications. They are: 1) Risk (in the narrower sense), where possible future outcomes can be captured through probability distributions. 2) A situation of uncertainty, where there is transparency regarding what is not known, but probability distributions are unknown, as well as causal relationships influencing the outcome in question. 3) A situation of ignorance, where there is no understanding that certain possible future developments are even relevant. And finally: 4) The emergence of organizational and inter-organizational myopia as an effect of risk, uncertainty and ignorance on collective human behaviour.


id: cord-295305-dfulr6nu
author: McIsaac, Sarah
date: 2020-04-24
txt: ./txt/cord-295305-dfulr6nu.txt
cache: ./cache/cord-295305-dfulr6nu.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32327003/
doi: 10.1017/cem.2020.379
summary:
  However, given the potential association of chest compressions with aerosolization, enhanced airborne precautions should be worn by all team members prior to commencing any other resuscitative efforts. 5 ED and EMS providers should have PPE, including airborne precautions (i.e., N95), readily available at all times given the risk of coronavirus disease 2019 (COVID-19) infection in the undifferentiated cardiac arrest. An additional member outside of the room in enhanced airborne precautions PPE may allow for a quick relief of chest compression duties. Outside of the room, the PCB team dons enhanced airborne PPE under supervision of a safety officer. • Early defibrillation can be provided by staff wearing only contact/droplet precautions prior to entry of the PCB team. • All PCB team members should be in appropriate enhanced airborne precautions before entering the room and commencing higher risk resuscitation interventions.

title:
  Just the Facts: Protected code blue – Cardiopulmonary resuscitation in the emergency department during the coronavirus disease 2019 pandemic

abstract:
  Emergency medical services (EMS) is called for a 65-year-old man with a 1-week history of cough, fever, and mild shortness of breath now reporting chest pain. Vitals on scene were HR 110, BP 135/90, SpO2 88% on room air. EMS arrives at the emergency department (ED). As the patient is moved to a negative pressure room, he becomes unresponsive with no palpable pulse. What next steps should be discussed in order to protect the team and achieve the best possible patient outcome?


id: cord-295322-9kye4w9g
author: Kumar, Parmeshwar
date: 2020-05-22
txt: ./txt/cord-295322-9kye4w9g.txt
cache: ./cache/cord-295322-9kye4w9g.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.jhin.2020.05.029
doi: 10.1016/j.jhin.2020.05.029
abstract: nan
summary:
  title: Adaptation of the ''Assembly Line'' and ''Brick System'' techniques for hospital resource management of personal protective equipment, as preparedness for mitigating the impact of the COVID-19 pandemic in a large public hospital in India An assembly line was put in place where components of the PPE kit were added in sequence until the final completed product was packed and ready for distribution. It is typically used inventory management of the personal kit issued to each fighting unit and also used by the United Nations Peace Keeping Forces (The UN Brick) [1] . The requisite number of in-house PPE kits for the various wards were then assembled into one brick(a carton) and supplied to that unit on a daily basis. Bricks of varying sizes and levels help in rationing of PPE between different wards based on differentiating essential and elective patients.

title:
  Adaptation of the ‘Assembly Line’ and ‘Brick System’ techniques for hospital resource management of personal protective equipment, as preparedness for mitigating the impact of the COVID-19 pandemic in a large public hospital in India


id: cord-295514-vhymj0rw
author: Lim, Peter A
date: 2004-08-01
txt: ./txt/cord-295514-vhymj0rw.txt
cache: ./cache/cord-295514-vhymj0rw.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/15295768/
doi: 10.1016/j.apmr.2004.01.022
summary:
  Severe acute respiratory syndrome (SARS) is a new respiratory viral epidemic that originated in China but has affected many parts of the world, with devastating impact on economies and the practice of medicine and rehabilitation. Rehabilitation was significantly affected by SARS, because strict infection control measures run counter to principles such as multidisciplinary interactions, patients encouraging and learning from each other, and close physical contact during therapy. Rehabilitation medicine was increasingly affected by everstricter infection control measures regarding close contacts and interactions between health care workers. Rehabilitation medicine was directly affected when the entire neurology ward, including patients and health care staff, were transferred out to TTSH for isolation and observation because of suspicious clusters of fevers that involved both patients and staff. Severe acute respiratory syndrome (SARS) in Singapore: clinical features of index patient and initial contacts

title:
  Impact of a viral respiratory epidemic on the practice of medicine and rehabilitation: Severe acute respiratory syndrome

abstract:
  Lim PA, Ng YS, Tay BK. Impact of a viral respiratory epidemic on the practice of medicine and rehabilitation: severe acute respiratory syndrome. Arch Phys Med Rehabil 2004;85:1365–70. Severe acute respiratory syndrome (SARS) is a new respiratory viral epidemic that originated in China but has affected many parts of the world, with devastating impact on economies and the practice of medicine and rehabilitation. A novel coronavirus has been implicated, with transmission through respiratory droplets. Rehabilitation was significantly affected by SARS, because strict infection control measures run counter to principles such as multidisciplinary interactions, patients encouraging and learning from each other, and close physical contact during therapy. Immunocompromised patients who may silently carry SARS are common in rehabilitation and include those with renal failure, diabetes, and cancer. Routine procedures such as management of feces and respiratory secretions (eg, airway suctioning, tracheotomy care) have been classified as high risk. Personal protection equipment presented not only a physical but also a psychologic barrier to therapeutic human contact. Visitor restriction to decrease chances of disease transmission are particularly difficult for long-staying rehabilitation patients. At the height of the epidemic, curtailment of patient movement stopped all transfers for rehabilitation, and physiatrists had to function as general internists. Our experiences strongly suggest that rehabilitation institutions should have emergency preparedness plans because such epidemics may recur, whether as a result of nature or of bioterrorism.


id: cord-296306-xcomjvaa
author: Rivett, Lucy
date: 2020-05-11
txt: ./txt/cord-296306-xcomjvaa.txt
cache: ./cache/cord-296306-xcomjvaa.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32392129/
doi: 10.7554/elife.58728
summary:
  Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Table 3 outlines the total number of SARS-CoV-2 tests performed in each screening group (HCW asymptomatic, HCW symptomatic, and HCW symptomatic household contact) categorised according to the ward with the highest anticipated risk of exposure to high; ''amber'', medium; ''green'', low; . Three subgroups of SARS-CoV-2 positive asymptomatic HCW Each individual in the HCW asymptomatic screening group was contacted by telephone to establish a clinical history, and COVID-19 probability criteria ( Table 1) were retrospectively applied to categorise any symptoms in the month prior to testing ( Figure 2 ). 12/30 (40%) individuals from the HCW asymptomatic screening group reported symptoms > 7 days prior to testing, and the majority experiencing symptoms consistent with a high probability of COVID-19 had appropriately self-isolated during that period.

title:
  Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission

abstract:
  Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Over a 3 week period (April 2020), 1032 asymptomatic HCWs were screened for SARS-CoV-2 in a large UK teaching hospital. Symptomatic staff and symptomatic household contacts were additionally tested. Real-time RT-PCR was used to detect viral RNA from a throat+nose self-swab. 3% of HCWs in the asymptomatic screening group tested positive for SARS-CoV-2. 17/30 (57%) were truly asymptomatic/pauci-symptomatic. 12/30 (40%) had experienced symptoms compatible with coronavirus disease 2019 (COVID-19)>7 days prior to testing, most self-isolating, returning well. Clusters of HCW infection were discovered on two independent wards. Viral genome sequencing showed that the majority of HCWs had the dominant lineage B∙1. Our data demonstrates the utility of comprehensive screening of HCWs with minimal or no symptoms. This approach will be critical for protecting patients and hospital staff.


id: cord-297704-70nbsrl4
title: Hearing the voices of Australian healthcare workers during the COVID-19 pandemic
author: Ananda-Rajah, M.
date: 2020-09-27
url: http://medrxiv.org/cgi/content/short/2020.09.25.20197061v1?rss=1
doi: 10.1101/2020.09.25.20197061
abstract:
  Background: The statistics of healthcare worker (HCW) COVID-19 infections do not convey the lived experience of HCWs during the pandemic. This study explores the working conditions and issues faced by Australian HCWs. Methods: Qualitative analysis of free-text responses from Australian HCWs from 3 August to 5 August 2020 from an open letter calling for better respiratory protection for HCWs, transparent reporting of HCW COVID-19 infections and diversity in national infection control policy development. The open letter was sent to an email list of 23,000 HCWs from a previous campaign and promoted on social media. Results: Among 2,733 HCWs who signed the open letter during the study period, 407 free-text responses were analysed. Doctors and nurses accounted for 58% and 35% of respondents, respectively. Most respondents came from Victoria (48%); New South Wales (18%); Queensland (12%) or Western Australia (12%). Dominant themes included concerns about: work health and safety standards; guidelines on respiratory protection including the omission of fit-testing of P2/N95 respirators; deficiencies in the availability, quality, appropriateness and training of personal protective equipment; a top-down workplace culture that enabled bullying in response to concerns about safety that culminated a loss of trust in leadership, self-reported COVID-19 infections in some respondents and moral injury. Conclusion: Occupational moral injury in HCWs is the consequence of lapses in leadership at policy-making and organisational levels that have violated the normative expectations of HCWs. The challenge for healthcare leaders is to address workplace culture, consultation and engagement with HCWs in order to prevent this hidden pandemic from spreading throughout the health system.


id: cord-297863-ou432md0
author: Ye, Lei
date: 2020-06-12
url: https://www.ncbi.nlm.nih.gov/pubmed/32532324/
doi: 10.1186/s13054-020-03076-1
abstract: nan
title:
  Infection prevention and control in nursing severe coronavirus disease (COVID-19) patients during the pandemic


id: cord-299346-f13xly6q
author: Awad, Mohamed E.
date: 2020-04-10
txt: ./txt/cord-299346-f13xly6q.txt
cache: ./cache/cord-299346-f13xly6q.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32282441/
doi: 10.5435/jaaos-d-20-00227
summary:
  title: Perioperative Considerations in Urgent Surgical Care of Suspected and Confirmed Coronavirus Disease 2019 Orthopaedic Patients: Operating Room Protocols and Recommendations in the Current Coronavirus Disease 2019 Pandemic To reduce the occupational risk in treating suspected or confirmed COVID-19 urgent orthopaedic patients, recommended precautions and preventive actions (triage area, ED consultation room, induction room, operating room, and recovery room) are reviewed. HCPs in high-risk areas should adhere to infection prevention and control practices, which includes the appropriate use of engineering controls (negative pressure rooms), administrative controls, and personal protective equipment (PPE) ( 6 Per CDC recommendations, a clinically suspected/ confirmed COVID-19 patient should wear a cloth face covering, over nose, and mouth and a surgical mask should be reserved for HCP and first responders. It is recommended for an environmental services worker to increase the Flowchart demonstrating the the recommended use of personal protective equipment for different activities at various settings managing suspected/clinically Coronavirus disease 2019 patients.

title:
  Perioperative Considerations in Urgent Surgical Care of Suspected and Confirmed Coronavirus Disease 2019 Orthopaedic Patients: Operating Room Protocols and Recommendations in the Current Coronavirus Disease 2019 Pandemic

abstract:
  By April 7, 2020, severe acute respiratory syndrome coronavirus 2 was responsible for 1,383,436 confirmed cases of Coronavirus disease 2019 (COVID-19), involving 209 countries around the world; 378,881 cases have been confirmed in the United States. During this pandemic, the urgent surgical requirements will not stop. As an example, the most recent Centers of Disease Control and Prevention reports estimate that there are 2.8 million trauma patients hospitalized in the United States. These data illustrate an increase in the likelihood of encountering urgent surgical patients with either clinically suspected or confirmed COVID-19 in the near future. Preparation for a pandemic involves considering the different levels in the hierarchy of controls and the different phases of the pandemic. Apart from the fact that this pandemic certainly involves many important health, economic, and community ramifications, it also requires several initiatives to mandate what measures are most appropriate to prepare for mitigating the occupational risks. This article provides evidence-based recommendations and measures for the appropriate personal protective equipment for different clinical and surgical activities in various settings. To reduce the occupational risk in treating suspected or confirmed COVID-19 urgent orthopaedic patients, recommended precautions and preventive actions (triage area, ED consultation room, induction room, operating room, and recovery room) are reviewed.


id: cord-299592-ymurfkbs
author: Bhattacharya, Sudip
date: 2020-04-15
txt: ./txt/cord-299592-ymurfkbs.txt
cache: ./cache/cord-299592-ymurfkbs.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3934/publichealth.2020019
doi: 10.3934/publichealth.2020019
abstract: nan
summary:
  title: Addressing the shortage of personal protective equipment during the COVID-19 pandemic in India-A public health perspective Nonetheless, it is only possible to address COVID-19 if we can flatten the epidemic curve by classical intervention measures like lockdown and social distancing processes, which may give lead time to many health care systems to arrange further management of the outbreak. When health care systems become stressed and enter the contingency mode, CDC recommends conserving resources by selectively cancelling nonemergency procedures, cancelling outpatient encounters which might require face masks/PPEs. When face masks are unavailable, the CDC recommends use of face shields without masks, taking clinicians at high risk for COVID-19 complications out of clinical service, staffing services with convalescent HCWs presumably immune to SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), and use of homemade/handmade masks, perhaps from bandanas or scarves if necessary [2] .

title:
  Addressing the shortage of personal protective equipment during the COVID-19 pandemic in India-A public health perspective


id: cord-301402-andxwyi3
author: Ding, Benjamin Tze Keong
date: 2020-05-06
url: https://www.ncbi.nlm.nih.gov/pubmed/32618915/
doi: 10.2106/jbjs.20.00568
title:
  Operating in a Pandemic: Lessons and Strategies from an Orthopaedic Unit at the Epicenter of COVID-19 in Singapore

abstract:
  ➤. With severe limitations in manpower, facilities, and equipment, and the concern for nosocomial transmission, operating in a pandemic is fraught with danger from multiple fronts. ➤. Strategies to mitigate nosocomial spread include prioritization of existing patients, triaging and treatment of new patient encounters, infection control protocols, perioperative considerations, manpower management, and novel strategies for interdisciplinary interaction and education. ➤. The decision to proceed with or postpone surgery should be based on the urgency of the surgical procedure and the physiological health of the patient. ➤. When performing an operation on a patient who has suspected or confirmed infection with novel coronavirus disease 2019 (COVID-19), personal protection equipment should include hair covers, face shields or goggles, N95 respirator masks, a blood-borne pathogen-resistant surgical gown, shoe covers, and double-gloving with single-use gloves. ➤. Loose-fitting, powered air-purifying respirators should be considered for prolonged surgeries. ➤. An astutely formulated and comprehensive business continuity plan is an orthopaedic unit’s best strategy for maintaining critical standards, discipline, and morale in severe and prolonged outbreaks.


id: cord-301582-922zyhti
title: COVID-19 community assessment hubs in Ireland—the experience of clinicians
author: Bury, Gerard
date: 2020-09-26
txt: ./txt/cord-301582-922zyhti.txt
cache: ./cache/cord-301582-922zyhti.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32980973/
doi: 10.1007/s11845-020-02381-6
summary:
  A half-day training course-''Clinical PPE training''-was developed by the departments, with significant input from the National Ambulance Service (NAS) staff with experience and expertise in the use of personal protective equipment (PPE) from the already established COVID-19 testing sites. The timing of hub availability-and therefore, potential exposure of clinicians to risk-is also considered by comparing Department of Health national data on daily case occurrence with ''real-time'' COVID-19-related emergency calls to Dublin Fire Brigade Ambulance Service. More than 500 GPs and GP registrars came forward to complete relevant clinical training in order to work in hubs, during April 2020-this represents around 15% of the general practice population. No data exists on the total number of clinicians who worked in hubs but the 170 GPs and GP registrars who responded to this study are likely to be a significant proportion of the doctors who carried out shifts and may therefore provide useful insights into this novel clinical setting.

abstract:
  BACKGROUND: COVID-19 required rapid innovation in health systems, in the context of an infection which placed healthcare professionals at high risk; general practice has been a key component of that innovative response. In Ireland, GPs were asked to work in a network of community assessment hubs. A focused training programme in infection control procedures/clinical use of personal protective equipment (PPE) was rapidly developed in advance. University departments of general practice were asked to develop and deliver that training. AIM: The aim of this article is to describe infection control procedure training in Ireland, the uptake by GPs and the initial experience of GPs working in this unusual environment. DESIGN AND SETTING: Two anonymous cross-sectional online surveys are sent to participants in training courses. METHOD: Survey 1 followed completion of training; survey 2 followed establishment of the hubs. RESULTS: Six hundred seventy-five participants (including 439 GPs, 156 GP registrars) took part in the training. Two hundred thirty-nine (50.3%) out of four hundred seventy-five responded to Survey 1—over 95% reported an increase in confidence in the use of PPE. Two hundred ten (44.2%) out of four hundred seventy-five participants responded to Survey 2; 195 had completed hub shifts. Younger, female GPs predominated. Very high levels of infection control procedures were reported. Participants commented positively on teamworking, environment and systems. However, ‘real-time’ ambulance service data suggest the peak of the surge may have passed by the time the hubs were established. CONCLUSION: Academic departments, GPs and the Irish health system collaborated effectively to respond to the need for community assessment of COVID-19 patients.


id: cord-302463-uw7xantz
title: Protective measures for COVID-19 for healthcare providers and laboratory personnel
author: AĞALAR, Canan
date: 2020-04-21
txt: ./txt/cord-302463-uw7xantz.txt
cache: ./cache/cord-302463-uw7xantz.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3906/sag-2004-132
doi: 10.3906/sag-2004-132
summary:
  During the care of these patients, HCP should wear their personal protective equipment (PPE) in accordance with the procedure and should not neglect hand hygiene. The novel coronavirus (COVID-19) carries a high risk for society and healthcare providers (HCP) because it can be transmitted even when the disease progresses asymptomatically in some patients [1] . European Centre of Diseases and Prevention Control (ECDC) states that if there is a shortage of FFP2/FFP3, if the HCP will be in contact with a diagnosed or suspected COVID-19 case, if there is no risk of aerosol transmission, surgical masks (alongside eye protection, gown, and gloves) can be used. However, ECDC states that if the HCP will be performing procedures like sample collecting that will generate aerosol, they should use FFP2/FFP3 masks that provide high-level protection [7] . Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings

abstract:
  In the COVID-19 pandemic, which affects the whole world, healthcare professionals (HCP) are at high risk of transmission due to their direct contact with patients with COVID-19. Therefore, how to ensure the triage of the patient with acute respiratory symptoms should be determined in advance, the contact distance should be arranged to be at least 2 m, COVID-19 suspect or diagnosed patient should be instructed to wear a surgical mask. During the care of these patients, HCP should wear their personal protective equipment (PPE) in accordance with the procedure and should not neglect hand hygiene. The samples of the patient with known or suspected COVID-19, patient should also be known to be risky in terms of contamination, and a risk assessment should be performed for the procedures to be performed in laboratories. The PPE should be used in accordance with the procedure to be performed. The protection of the HCP, who sacrifice at the risk of life, is possible only by complying with infection control and precautions.


id: cord-302902-34vftqt9
author: Law, Brenda Hiu Yan
date: 2020-08-18
txt: ./txt/cord-302902-34vftqt9.txt
cache: ./cache/cord-302902-34vftqt9.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33014919/
doi: 10.3389/fped.2020.00478
summary:
  Adaptations have been proposed for resuscitation of infants born to women with COVID-19, to protect health care providers, maintain infection control, and limit post-natal transmission. Changes especially impact respiratory procedures, personal protective equipment (PPE) use, resuscitation environments, teamwork, and family involvement. Adaptations have been proposed for resuscitation of infants born to women with suspected or confirmed COVID-19, to protect health care providers (HCPs), limit post-natal transmission, and maintain infection control (7) . Neonatal resuscitation may be especially impacted by changes in (i) respiratory support, (ii) personal protective equipment (PPE), (iii) resuscitation environment, (iv) team-based activities, and (v) family involvement ( Table 1) . Modifications to ventilation practices during neonatal resuscitation have been proposed to protect HCPs during AGPs, based on limited evidence on vertical transmission and aerosolization of SARS-CoV-2 (7, 9) . General COVID-19 resuscitation guidelines recommend the use of viral filters on mask ventilation devices to decrease risks to HCPs (9) .

title:
  Effect of COVID-19 Precautions on Neonatal Resuscitation Practice: A Balance Between Healthcare Provider Safety, Infection Control, and Effective Neonatal Care

abstract:
  Adaptations have been proposed for resuscitation of infants born to women with COVID-19, to protect health care providers, maintain infection control, and limit post-natal transmission. Changes especially impact respiratory procedures, personal protective equipment (PPE) use, resuscitation environments, teamwork, and family involvement. Adding viral filters to ventilation devices and modifications to intubation procedures might hinder effective ventilation. PPE could delay resuscitation, hinder task performance, and degrade communication. Changes to resuscitation locations and team composition alter workflow and teamwork. Physical distancing measures and PPE impede family-integrated care. These disruptions need to be considered given the uncertainty of vertical transmission of SARS-CoV-2.


id: cord-302987-znogutwp
title: Differences in SARS-CoV-2 recommendations from major ophthalmology societies worldwide
author: Nguyen, Anne X
date: 2020-07-07
url: https://doi.org/10.1136/bmjophth-2020-000525
doi: 10.1136/bmjophth-2020-000525
abstract:
  OBJECTIVE: Since the WHO declared the COVID-19 outbreak as a public health emergency, medical societies around the world published COVID-19 recommendations to physicians to ensure patient care and physician safety. During this pandemic, ophthalmologists around the world adapted their clinical and surgical practice following such guidelines. This original research examines all publicly available COVID-19 recommendations from twelve major ophthalmology societies around the world. METHODS AND ANALYSIS: Twelve ophthalmology societies recognised by the International Council of Ophthalmology were included in this study. One society per each WHO region was included: the society selected was the one who had the highest number of national COVID-19 confirmed cases on 11 May 2020. In addition to these countries, the major ophthalmology society in each G7 country was included. RESULTS: Ten out of 12 major international ophthalmology societies from countries covering all six WHO regions have given recommendations regarding urgent patient care, social distancing, telemedicine and personal protective equipment when caring for ophthalmic patients during the COVID-19 pandemic. While all guidelines emphasise the importance of postponing non-urgent care and taking necessary safety measures, specific recommendations differ between countries. CONCLUSIONS: As there is no clear consensus on ophthalmology guidelines across countries, this paper highlights the differences in international ophthalmic care recommendations during the COVID-19 pandemic. Knowledge of the differences in ophthalmic management plans will allow ophthalmologists and all eye care providers to consider the variety of international approaches and apply best practices following evidence-based recommendations during pandemics.


id: cord-305146-iprzeigk
author: Chughtai, Abrar Ahmad
date: 2020-03-04
txt: ./txt/cord-305146-iprzeigk.txt
cache: ./cache/cord-305146-iprzeigk.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.jiph.2020.02.032
doi: 10.1016/j.jiph.2020.02.032
summary:
  We conducted a systematic review of studies on PPE use for respiratory infections in healthcare settings in Pakistan. Face masks (or medical masks) and respirators are the most commonly used PPE to protect from influenza and other respiratory infection in healthcare settings. The aim of this study was to examine the use of PPE for respiratory infections in healthcare settings in Pakistan. Studies where PPE was examined for general infection control were also included, given respiratory protective equipment (face masks and/or respirators) was mentioned. Two studies examined the guidelines and current practices on the use of face masks/respirators for influenza, tuberculosis and SARS in Pakistan [21, 22] . Medical masks were generally used to protect from influenza, tuberculosis and other respiratory infections, while the use of respirators was limited to high-risk situations [21, 22] .

title:
  Use of personal protective equipment to protect against respiratory infections in Pakistan: A systematic review

abstract:
  Like other low-income countries, limited data are available on the use of personal protective equipment (PPE) in Pakistan. We conducted a systematic review of studies on PPE use for respiratory infections in healthcare settings in Pakistan. MEDLINE, Embase and Goggle Scholar were searched for clinical, epidemiological and laboratory-based studies in English, and 13 studies were included; all were observational/cross-sectional studies. The studies examined PPE use in hospital (n = 7), dental (n = 4) or laboratory (n = 2) settings. Policies and practices on PPE use were inconsistent. Face masks and gloves were the most commonly used PPE to protect from respiratory and other infections. PPE was not available in many facilities and its use was limited to high-risk situations. Compliance with PPE use was low among healthcare workers, and reuse of PPE was reported. Clear policies on the use of PPE and available PPE are needed to avoid inappropriate practices that could result in the spread of infection. Large, multimethod studies are recommended on PPE use to inform national infection-control guidelines.


id: cord-305262-23qylbmg
author: Rowan, Neil J.
date: 2020-09-10
url: https://api.elsevier.com/content/article/pii/S0048969720357880
doi: 10.1016/j.scitotenv.2020.142259
title:
  Unlocking the surge in demand for personal and protective equipment (PPE) and improvised face coverings arising from coronavirus disease (COVID-19) pandemic – Implications for efficacy, re-use and sustainable waste management

abstract:
  Currently, there is no effective vaccine for tackling the ongoing COVID-19 pandemic caused by SARS-CoV-2 with the occurrence of repeat waves of infection frequently stretching hospital resources beyond capacity. Disease countermeasures rely upon preventing person-to-person transmission of SARS-CoV2 so as to protect front-line healthcare workers (HCWs). COVID-19 brings enormous challenges in terms of sustaining the supply chain for single-use-plastic personal and protective equipment (PPE). Post-COVID-19, the changes in medical practice will drive high demand for PPE. Important countermeasures for preventing COVID-19 transmission include mitigating potential high risk aerosol transmission in healthcare setting using medical PPE (such as filtering facepiece respirators (FFRs)) and the appropriate use of face coverings by the general public that carries a lower transmission risk. PPE reuse is a potential short term solution during COVID-19 pandemic where there is increased evidence for effective deployment of reprocessing methods such as vaporized hydrogen peroxide (30 to 35% VH2OH) used alone or combined with ozone, ultraviolet light at 254 nm (2000 mJ/cm2) and moist heat (60 °C at high humidity for 60 min). Barriers to PPE reuse include potentially trust and acceptance by HCWs. Efficacy of face coverings are influenced by the appropriate wearing to cover the nose and mouth, type of material used, number of layers, duration of wearing, and potentially superior use of ties over ear loops. Insertion of a nose clip into cloth coverings may help with maintaining fit. Use of 60 °C for 60 min (such as, use of domestic washing machine and spin dryer) has been advocated for face covering decontamination. Risk of virus infiltration in improvised face coverings is potentially increased by duration of wearing due to humidity, liquid diffusion and virus retention. Future sustained use of PPE will be influenced by the availability of recyclable PPE and by innovative biomedical waste management.


id: cord-305419-l68ewxar
author: Smart, Hiske
date: 2020-06-11
txt: ./txt/cord-305419-l68ewxar.txt
cache: ./cache/cord-305419-l68ewxar.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32530822/
doi: 10.1097/01.asw.0000669920.94084.c1
summary:
  CONCLUSIONS: This creative and novel stepwise process of developing a safe skin protection method by which staff could apply a repurposed silicone border dressing beneath an N95 mask was largely effective and aided by the creation of the enabler. Accordingly, the Nursing Quality Committee advised the Pressure Injury Prevention Committee to follow this approach in developing and testing a skin care bundle specifically applicable to the work environment of KHUH for those HCPs providing acute COVID-19 care. One staff member with Fitzpatrick type 2 skin was willing to test the mask without facial protection for 2 hours on a different day, before the leak tests were conducted. This article describes a holistic approach to facial skin injury prevention for HCPs to "HELP" staff to embrace a Longer periods of PPE use (with each participant serving as their own control) produced a distinct difference between mask wear with and without protection, including improved facial condition and comfort without compromising mask seal.

title:
  Preventing Facial Pressure Injury for Health Care Providers Adhering to COVID-19 Personal Protective Equipment Requirements

abstract:
  OBJECTIVE: To determine if a repurposed silicone-based dressing used underneath a N95 mask is a safe and beneficial option for facial skin injury prevention without compromising the mask’s seal. METHODS: Since February 21, 2020, staff in high risk areas such as the ED and ICU of King Hamad University Hospital have worn N95 masks when doing aerosol-generating procedures to protect against the novel coronavirus 2019. At that time, without education enablers or resources that could be directly translated into practice, the hospital’s Pressure Injury Prevention Committee explored and created a stepwise process to protect the skin under these masks. This procedure was developed over time and tested to make sure that it did not interfere with the effectiveness of the N95 mask seal. RESULTS: Skin protection was achieved by repurposing a readily available silicone border dressing cut into strips. This was tested on 10 volunteer staff members of various skin types and both sexes who became part of this evidence generation project. Oxygen saturation values taken before and after the 4-hour wear test confirmed that well-fitted facial protection did not compromise the mask seal, but rather improved it. An added advantage was increased comfort with less friction as self-reported by the staff. An educational enabler to prevent MDRPI from N95 mask wear was an important additional resource for the staff. CONCLUSIONS: This creative and novel stepwise process of developing a safe skin protection method by which staff could apply a repurposed silicone border dressing beneath an N95 mask was largely effective and aided by the creation of the enabler.


id: cord-305503-j5e6fp61
author: Choi, Gordon Y.S.
date: 2020-04-10
txt: ./txt/cord-305503-j5e6fp61.txt
cache: ./cache/cord-305503-j5e6fp61.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0007091220302026
doi: 10.1016/j.bja.2020.04.001
abstract: nan
summary:
  5 Within the ICU, potentially aerosol generating procedures such as manual ventilation and tracheal intubation are known to enhance transmission of respiratory viral disease to HCWs, 6 and therefore introducing robust infection control processes as soon as possible is of paramount importance. To examine system and operational issues related to our infection control guidelines, we designed and implemented a high-fidelity in situ clinical simulation to replicate admission, including tracheal intubation, of a patient with suspected or known COVID-19 infection. The main objective of the simulation was to test the ability of the HCW team to effectively implement use of personal protective equipment (PPE), and the practicality of the intubation protocol and preliminary outbreak infection control guidelines.

title:
  Preparedness for COVID-19: in situ simulation to enhance infection control systems in the intensive care unit


id: cord-306770-hjzlj8k3
author: Mick, Paul
date: 2020-05-11
txt: ./txt/cord-306770-hjzlj8k3.txt
cache: ./cache/cord-306770-hjzlj8k3.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32393346/
doi: 10.1186/s40463-020-00424-7
summary:
  During the coronavirus disease 2019 (COVID-19) pandemic, personal protective equipment (PPE) worn by health care workers is critical for reducing transmission of the infection in health care settings, particularly when aerosol-generating medical procedures (AGMP) are being performed. For example, Givi et al and the Canadian Society of Otolaryngology-Head and Neck Surgery [2] call for airborne precautions when performing AGMP on patients for whom the index of suspicion for COVID-19 infection is not high, whereas the World Health Organization, the U.S. Centers for Disease Control, and the Public Health Agency of Canada do not [3, 14, 15] . Measuring the level of aerosolized viral particles in rooms where AGMPs are being performed on patients with COVID-19 would provide indirect evidence of the degree to which these procedures put health care workers at risk of aerosolized transmission, and whether exposure concentration affects risk of infection and/or severity of disease.

title:
  Aerosol-generating otolaryngology procedures and the need for enhanced PPE during the COVID-19 pandemic: a literature review

abstract:
  BACKGROUND: Adequate personal protective equipment is needed to reduce the rate of transmission of COVID-19 to health care workers. Otolaryngology groups are recommending a higher level of personal protective equipment for aerosol-generating procedures than public health agencies. The objective of the review was to provide evidence that a.) demonstrates which otolaryngology procedures are aerosol-generating, and that b.) clarifies whether the higher level of PPE advocated by otolaryngology groups is justified. MAIN BODY: Health care workers in China who performed tracheotomy during the SARS-CoV-1 epidemic had 4.15 times greater odds of contracting the virus than controls who did not perform tracheotomy (95% CI 2.75–7.54). No other studies provide direct epidemiological evidence of increased aerosolized transmission of viruses during otolaryngology procedures. Experimental evidence has shown that electrocautery, advanced energy devices, open suctioning, and drilling can create aerosolized biological particles. The viral load of COVID-19 is highest in the upper aerodigestive tract, increasing the likelihood that aerosols generated during procedures of the upper aerodigestive tract of infected patients would carry viral material. Cough and normal breathing create aerosols which may increase the risk of transmission during outpatient procedures. A significant proportion of individuals infected with COVID-19 may not have symptoms, raising the likelihood of transmission of the disease to inadequately protected health care workers from patients who do not have probable or confirmed infection. Powered air purifying respirators, if used properly, provide a greater level of filtration than N95 masks and thus may reduce the risk of transmission. CONCLUSION: Direct and indirect evidence suggests that a large number of otolaryngology-head and neck surgery procedures are aerosol generating. Otolaryngologists are likely at high risk of contracting COVID-19 during aerosol generating procedures because they are likely exposed to high viral loads in patients infected with the virus. Based on the precautionary principle, even though the evidence is not definitive, adopting enhanced personal protective equipment protocols is reasonable based on the evidence. Further research is needed to clarify the risk associated with performing various procedures during the COVID-19 pandemic, and the degree to which various personal protective equipment reduces the risk.


id: cord-307697-ds4uw7y1
author: Ahmed, Jawad
date: 2020-06-10
txt: ./txt/cord-307697-ds4uw7y1.txt
cache: ./cache/cord-307697-ds4uw7y1.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8550
doi: 10.7759/cureus.8550
summary:
  Whereas, doctors in Pakistan reported to have poor availability of PPE with only 37.4% having access to masks/N95 respirator, 34.5% to gloves, 13.8% to face-shields or goggles, and 12.9% to full-suit/gown. Whereas, doctors in Pakistan reported to have poor availability of PPE with only 37.4% having access to masks/N95 respirator, 34.5% to gloves, 13.8% to face-shields or goggles, and 12.9% to full-suit/gown. In contrast, doctors in Pakistan reported to have poor availability of PPE with only 37.4% (n = 130) having access to masks/N95 respirator, 34.5% (n = 120) to gloves, 13.8% (n = 48) to face-shields or goggles, and 12.9% (n = 44) to full-suit/gown. In our study, 73% of doctors from Pakistan and 58.4% from the US reported that HCWs in their hospitals had been infected with COVID-19. To conclude, there is a shortage of PPE in hospitals of the US and Pakistan due to COVID-19 and doctors are feeling scared working without adequate protection in the pandemic situation.

title:
  Availability of Personal Protective Equipment (PPE) Among US and Pakistani Doctors in COVID-19 Pandemic

abstract:
  Background The coronavirus disease (COVID-19) pandemic has put an excessive strain on healthcare systems across the globe, causing a shortage of personal protective equipment (PPE). PPE is a precious commodity for health personnel to protect them against infections. We investigated the availability of PPE among doctors in the United States (US) and Pakistan. Methods A cross-sectional study, including doctors from the US and Pakistan, was carried out from April 8 to May 5, 2020. An online self-administered questionnaire was distributed to doctors working in hospitals in the US and Pakistan after a small pilot study. All analysis was done using Statistical Package for Social Science (SPSS) version 23.0 (IBM Corp., Armonk, NY). Results After informed consent, 574 doctors (60.6% from Pakistan and 39.4% from the US) were included in the analysis. The majority of the participants were females (53.3%), and the mean age of the participants was 35.3 ± 10.3 years. Most doctors (47.7%) were from medicine and allied fields. Among the participants, 87.6% of doctors from the US reported having access to masks/N95 respirators, 79.6% to gloves, 77.9% to face-shields or goggles, and 50.4% to full-suit/gown. Whereas, doctors in Pakistan reported to have poor availability of PPE with only 37.4% having access to masks/N95 respirator, 34.5% to gloves, 13.8% to face-shields or goggles, and 12.9% to full-suit/gown. The reuse of PPE was reported by 80.5% and 60.3% physicians from the US and Pakistan, respectively. More doctors from Pakistan (50.6%) reported that they had been forced to work without PPE compared to doctors in the US (7.1%). Conclusion There is a lack of different forms of PPE in the US and Pakistan. Doctors from both countries reported that they had been forced to work without PPE. Compared to the US, more doctors from Pakistan reported having faced discrimination in receiving PPE.


id: cord-308100-tvk47fd7
title: Considerations in performing endoscopy during the COVID-19 pandemic
author: Soetikno, Roy
date: 2020-03-27
txt: ./txt/cord-308100-tvk47fd7.txt
cache: ./cache/cord-308100-tvk47fd7.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0016510720340335?v=s5
doi: 10.1016/j.gie.2020.03.3758
abstract: nan
summary:
  Based on experiences and the literature, our objective is to provide practical suggestions for performing endoscopy in the setting of COVID-19 pandemic. 6 It is unknown how much of the risk was related to the direct care of infected patients or to the inadequate use of personal protective equipment (PPE). 9 With numbers of COVID-19 cases continuing to rise in North America and Europe, we aim to provide practical suggestions to potentially avoid the transmissions of COVID-19 in the endoscopy unit. Possible routes of SARS-CoV-2 transmission include (1) person-to-person, (2) respiratory droplets, (3) aerosols generated during endoscopy, and (4) contact with contaminated surroundings and body fluids. 13 Recently, the World Health Organization (WHO) has published an extensive guideline on the rational use of personal protective equipment (PPE) for COVID-19 and provided specific instructions for healthcare workers performing AGP on patients with COVID-19. 17 Note that as an AGP, endoscopy of PUI/COVID patients requires the use of respiratory protection.


id: cord-308409-0n2ysgsa
title: Impact of COVID-19 on endoscopy trainees: an international survey
author: Pawlak, Katarzyna M.
date: 2020-06-11
txt: ./txt/cord-308409-0n2ysgsa.txt
cache: ./cache/cord-308409-0n2ysgsa.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S001651072034428X
doi: 10.1016/j.gie.2020.06.010
abstract: nan
summary:
  Therefore, in this international survey, we aimed to assess the impact of the COVID-19 pandemic on endoscopy trainees, including procedure numbers, barriers to training, and the physical and emotional well-being of trainees. 2) Changes to institutional case volume 3) Trainee concerns regarding competency development and prolongation of training; 4) Anxiety, assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale, 12 and rates of burnout, measured using the single item burnout scale. Of the 770 (93.8%) trainees who reported a reduction in endoscopy procedural volumes during the COVID-19 study period, the reasons cited included: changes to institutional policy to exclude trainees from procedures (79.9%); lack of cases (58.3%); shortage of available PPE (28.8%); redeployment to another clinical area (24.0%); and personal reasons (10.2%). Our study showed that the COVID-19 pandemic has led to drastic reductions in endoscopic volumes and restrictions on endoscopy training, with detrimental effects on trainee well-being, including high rates of anxiety and burnout among trainees worldwide.


id: cord-309324-vatugz84
author: Sorbello, Massimiliano
date: 2020-06-30
txt: ./txt/cord-309324-vatugz84.txt
cache: ./cache/cord-309324-vatugz84.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0007091220304980
doi: 10.1016/j.bja.2020.06.038
abstract: nan
summary:
  However significant limitations in their data hamper our ability to interpret the evidence base, but their data do highlight that the real concern is not measuring how limited airway management is by PPE, but rather the need for better understanding of PPE diversity, correct use of PPE and development and training in new techniques, protocols and devices to overcome such difficulties. Systematic review of simulated airway management whilst wearing personal protective equipment A randomised crossover simulation study comparing the impact of chemical, biological, radiological or nuclear substance personal protection equipment on the performance of advanced life support interventions The impact of respiratory protective equipment on difficult airway management: a randomised, crossover, simulation study The aerosol box for intubation in coronavirus disease 2019 patients: an in-situ simulation crossover study Utility of the Pentax-AWS in performing tracheal intubation while wearing chemical, biological, radiation and nuclear personal protective equipment: a randomised crossover trial using a manikin

title:
  Personal protective equipment, airway management and systematic reviews. Comment on Br J Anaesth 2020


id: cord-309521-2cb992u1
author: Iqbal, Muhammad Rafaih
date: 2020-05-21
txt: ./txt/cord-309521-2cb992u1.txt
cache: ./cache/cord-309521-2cb992u1.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1743919120304258?v=s5
doi: 10.1016/j.ijsu.2020.05.042
summary:
  title: "COVID-19: Results of a national survey of United Kingdom healthcare professionals'' perceptions of current management strategy – a cross-sectional questionnaire study" METHOD: A questionnaire survey, drafted using Google Forms, was distributed among Healthcare professionals working in the National Health Service (NHS) across the United Kingdom. Respondents were asked five questions regarding their trust preparation for the pandemic: whether they felt supported at their trust, availability of adequate facilities (specialist beds, specified isolated areas) to treat COVID-19 patients, availability of enough PPE, whether there was enough local guidance regarding the pandemic and if sufficient local training was provided. For "daily source of information regarding the COVID-19 pandemic", nearly half of the respondents (n=558, 55.41%) used multiple sources (daily hospital emails, news, social media, Gov.uk, friends and family and other health professionals) while a quarter (n=249, 24.73%) relied on daily hospital emails (Table 3) .

title:
  “COVID-19: Results of a national survey of United Kingdom healthcare professionals’ perceptions of current management strategy – a cross-sectional questionnaire study”

abstract:
  OBJECTIVE: COVID-19 has caused a global healthcare crisis with increasing number of people getting infected and dying each day. Different countries have tried to control its spread by applying the basic principles of social distancing and testing. Healthcare professionals have been the frontline workers globally with different opinions regarding the preparation and management of this pandemic. We aim to get the opinion of Healthcare professionals in United Kingdom regarding their perceptions of preparedness in their workplace and general views of current pandemic management strategy. METHOD: A questionnaire survey, drafted using Google Forms, was distributed among Healthcare professionals working in the National Health Service (NHS) across the United Kingdom. The study was kept open for the first 2 weeks of April 2020. RESULTS: A total of 1007 responses were obtained with majority of the responses from England (n=850, 84.40 %). There were 670 (66.53%) responses from doctors and 204 (20.26%) from nurses. Most of the respondents (95.23%) had direct patient contact in day to day activity. Only one third of the respondents agreed that they felt supported at their trust and half of the respondents reported that adequate training was provided to the frontline staff. Two-thirds of the respondents were of the view that there was not enough Personal Protective Equipment available while 80% thought that this pandemic has improved their hand washing practice. Most of the respondents were in the favour of an earlier lockdown (90%) and testing all the NHS frontline staff (94%). CONCLUSION: Despite current efforts, it would seem this is not translating to a sense of security amongst the UK NHS workforce in terms of how they feel trained and protected. It is vital that Healthcare professionals have adequate support and protection at their workplace and that these aspects be actively monitored.


id: cord-309751-7elnvjk3
title: COVID-19. An update for orthopedic surgeons
author: Abdelnasser, Mohammad Kamal
date: 2020-07-01
txt: ./txt/cord-309751-7elnvjk3.txt
cache: ./cache/cord-309751-7elnvjk3.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1051/sicotj/2020022
doi: 10.1051/sicotj/2020022
summary:
  The resultant information was organized under 5 main headings; the impact of pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries during the pandemic, peri-operative management of the patient with COVID-19, Miscellaneous effects of the pandemic such as those on training programs and the evolution of telemedicine. Relevant information was digested and organized under 5 main headings; the impact of COVID-19 pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries during the pandemic, perioperative management of the patient with COVID-19, Miscellaneous effects of the pandemic such as those on training programs and the evolution of telemedicine. Guidelines for ambulatory surgery centers for the care of surgically necessary/time-sensitive orthopaedic cases during the COVID-19 pandemic Perioperative considerations in urgent surgical care of suspected and confirmed COVID-19 orthopedic patients: Operating rooms protocols and recommendations in the current COVID-19 pandemic

abstract:
  The COVID-19 pandemic has affected our world in a short period of time, and the orthopedic surgery practice was not an exclusion. Elective care was deferred in most health care facilities and emergency care was continued with strict precautions. With rapid progression of the pandemic, the response of the medical community is also rapidly changing in all aspects of delivering care. This led to a large number of publications with reports, guidelines, measures, ways to react to the crisis, and post-pandemic predictions and speculations. In this review we aimed at summarizing all the relevant information to the orthopedic surgery community. To do this, a comprehensive search was performed with all related terms on two scientific search engines, PubMed and SCOPUS, and the results were filtered by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The result was 72 articles that were further reduced to 33 articles after full text reading. The resultant information was organized under 5 main headings; the impact of pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries during the pandemic, peri-operative management of the patient with COVID-19, Miscellaneous effects of the pandemic such as those on training programs and the evolution of telemedicine. This review represents the most up to date information published in the literature that is a must-know to every orthopedic surgeon.


id: cord-309956-topo2bc6
author: Zheng, Kenneth I.
date: 2020-09-10
txt: ./txt/cord-309956-topo2bc6.txt
cache: ./cache/cord-309956-topo2bc6.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3389/fmed.2020.571493
doi: 10.3389/fmed.2020.571493
abstract: nan
summary:
  The Occupational Safety and Health Administration respiratory protection regulations at 29 CFR 1910.134 mandated that HCWs be fit-tested and seal checked prior to the initial use of a respirator and whenever a different respirator face piece (size, style, model, or make) is used (4). While it is obvious that the use of respirators can cause discomfort and harm to HCWs, there is a need to evaluate adherence of protocol and to assess the risk of infection from skin lesions due to PPE. Nevertheless, it is recognized that HCWs in the current COVID-19 pandemic, through prolonged wearing of respirators, might be exposed to a higher risk of cross-infection and skin damage. It is necessary to improve the design of currently certified respirators in order to achieve better sealing capabilities and reduce pressure ulcerations.

title:
  COVID-19 Cross-Infection and Pressured Ulceration Among Healthcare Workers: Are We Really Protected by Respirators?


id: cord-310104-1c7q9m06
author: Sasangohar, Farzan
date: 2020-04-20
txt: ./txt/cord-310104-1c7q9m06.txt
cache: ./cache/cord-310104-1c7q9m06.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000004866
doi: 10.1213/ane.0000000000004866
abstract: nan
summary:
  T he novel Coronavirus Disease 2019 (COVID19) pandemic has resulted in an overall surge in new cases of depression and anxiety and an exacerbation of existing mental health issues, with a particular emotional and physical toll on health care workers. In this article, we share the lessons learned collectively by an interdisciplinary team of ICU leadership and collaborating scientists at the Center for Outcomes Research at HMH about the experience of occupational fatigue and burnout of intensive care personnel as a result of responding to the COVID-19 pandemic. Several factors may have exacerbated occupational fatigue and burnout in ICUs. Given our overarching roles across various facets of the health care system and our first-hand experiences with the response, the "lessons learned" documented here provide a holistic overview of major system-level problems exposed by the pandemic.

title:
  Provider Burnout and Fatigue During the COVID-19 Pandemic: Lessons Learned From a High-Volume Intensive Care Unit


id: cord-310285-ua894psi
title: COVID-19 and ophthalmology: An underappreciated occupational hazard
author: Khatri, Anadi
date: 2020-07-20
txt: ./txt/cord-310285-ua894psi.txt
cache: ./cache/cord-310285-ua894psi.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1017/ice.2020.344
doi: 10.1017/ice.2020.344
abstract: nan
summary:
  Letter to the Editor-We read the article "COVID-19 and ophthalmology: an underappreciated occupational hazard" by Kuo and O''Brien 1 with great interest. Personal protective equipment (PPE) has become the gold standard during the COVID-19 pandemic for prevention of infection. In the long term, these difficulties may hamper the performance of healthcare workers like ophthalmologists, whose work demands high precision. Although it has become a norm, the evidence is already clear that many ophthalmologists and eye care professionals are having difficulties related to PPE use. 6 Although this may be an advantage because much of the "design for the greatest ease of use" would have already been already improvised, many such DIY efforts remain unproven in terms of the actual protection they provide. COVID-19 and ophthalmology: an underappreciated occupational hazard Safety testing improvised COVID-19 personal protective equipment based on a modified full-face snorkel mask


id: cord-310944-tfn0ltrz
title: COVID 19: Impacts and Implications for Pediatric Practice
author: Peck, Jessica L.
date: 2020-07-09
txt: ./txt/cord-310944-tfn0ltrz.txt
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mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0891524520301772?v=s5
doi: 10.1016/j.pedhc.2020.07.004
summary:
  Other populations at significant risk include older adults (> 65 years of age), persons with underlying medical conditions (e.g., asthma, cardiovascular disease, kidney disease), persons with immunocompromise, persons with severe obesity (body mass index >40), persons with diabetes, persons undergoing dialysis, and persons residing in long-term care or nursing homes (CDC, 2020c) . Ideal PPE when caring for a patient with known or suspected COVID-19 infection includes: a new N-95 mask, gown, medical grade gloves, and eye covers and/or a face shield (CDC, 2020b). Recommendations for families include: 1) supporting children as they ask questions about the pandemic, 2) close monitoring of child health and well-being with prompt contact of primary healthcare providers if changes are noticed, and 3) continuing to seek care in-person or using telehealth to maintain well visits and immunization schedules while receiving anticipatory guidance and necessary screenings.

abstract:
  Since the rapid emergence of the novel coronavirus in December of 2019 and subsequent development of a global pandemic, clinicians around the world have struggled to understand and respond effectively and efficiently. With global response encompassing social, political, organizational, and economic realms, world leaders are struggling to keep pace with the rapid changes. Challenges within global healthcare system and the healthcare profession itself include rationing supplies and services within health care systems, many of which were stretched to the brink before this latest viral outbreak (American Hospital Association, 2020). Leaders are making policy decisions while balancing the slow and precise nature of science with the rapid and pressing need for life-saving information (Altmann, Douek, & Boyton, 2020). Shortcuts on research are occurring, including publishing papers with lack of peer review. Social media and lurid reporting bolster feelings of mistrust and panic-buying while burgeoning conspiracy theories commandeer national dialogue. This is a time in history to prioritize global health and thoughtful pandemic preparedness (Lancet, 2020). Pediatric Nurse Practitioners (PNPs) are ideally situated to be a trusted source of accurate health information for children. This continuing education article summarizes the latest evidence-based information on the rapidly developing coronavirus pandemic; equipping PNPs for clinical preparation and response. 1.. Distinguish risk factors for COVID-19-related morbidity and mortality and identify modes of transmission. 2.. Appraise appropriate COVID-19 testing parameters and procedures for children. 3.. Compare pediatric clinical presentation to adults with COVID-19 infection and recommend appropriate treatment measures. 4.. State appropriate infection-control measures to reduce transmission. 5.. Describe measures to reduce the risk of infection spread, mitigate adverse health effects in high-risk children, and to promote general health through preventive care.


id: cord-311401-7ugqjg5c
author: Alser, O.
date: 2020-05-13
txt: ./txt/cord-311401-7ugqjg5c.txt
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mime: text/plain
url: https://doi.org/10.1101/2020.05.09.20096099
doi: 10.1101/2020.05.09.20096099
summary:
  Sufficient training of healthcare workers (HCWs) in how to manage COVID-19 and the provision of personal protective equipment (PPE) to enable them to do so will be key tools in allowing oPt to mount a credible response to the crisis. (4) Other LMICs in the Middle East and Africa have also reported scarcity of personal protective equipment (PPE) for front line healthcare workers (HCWs).(5, 6) We hypothesize that (HCWs) in the oPt are largely underprepared to address COVID-19 related needs of the Palestinian population in both the West Bank and Gaza Strip. The secondary outcome was to assess the differences between Gaza Strip and West Bank, and between governmental and non-governmental in oPt in terms of availability of PPE and HCWs preparedness to face the COVID-19 pandemic.

title:
  Healthcare workers preparedness for COVID-19 pandemic in the occupied Palestinian territory: a cross-sectional survey

abstract:
  Background: The coronavirus disease 19 (COVID-19) pandemic threatens to overwhelm the capacity of the vulnerable healthcare system in the occupied Palestinian territory (oPt). Sufficient training of healthcare workers (HCWs) in how to manage COVID-19 and the provision of personal protective equipment (PPE) to enable them to do so will be key tools in allowing oPt to mount a credible response to the crisis. Methods: A cross-sectional study was conducted using a validated online questionnaire. Data collection occurred between March 30, 2020 and April 12, 2020. The primary outcomes was PPE provision and the secondary outcome was HCWs preparedness for the COVID-19 pandemic. Results: Of 138 respondents, only 38 HCWs (27.5%) always had access to facemasks when needed and 15 (10.9%) for isolation gowns. The vast majority of HCWs did not find eye protection (n=128, 92.8%), N95 respirators (n=132, 95.7%), and face shields (n=127, 92%) always available. Compared to HCWs in West Bank, those in the Gaza Strip were significantly less likely to have access to alcohol sanitizers (p=0.026) and gloves (p <0.001). On average, governmental hospitals were significantly less likely to have all appropriate PPE measures than non-governmental institutions (p = 0.001). As for preparedness, only 16 (11.6%) surveyed felt confident in dealing with a potential COVID-19 case. With 57 (41.3%) having received any COVID-19 related training and 57 (41.3%) not having a local hospital protocol. Conclusion: HCWs in oPt are underprepared and severely lacking adequate PPE provision. The lack of local protocols, and training has left HCWs confidence exceedingly low. The lack of PPE provision will exacerbate spread of COVID-19 and deepen the crisis, whilst putting HCWs at risk.


id: cord-311795-kvv3fx2n
author: Barratt, Ruth
date: 2019-08-31
txt: ./txt/cord-311795-kvv3fx2n.txt
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mime: text/plain
url: https://doi.org/10.1016/j.idh.2019.01.003
doi: 10.1016/j.idh.2019.01.003
summary:
  An important area of infection prevention and control (IPC) is the optimal use of personal protective equipment (PPE) by healthcare workers (HCWs), including masks for protection against respiratory pathogens. An important area of infection prevention and control (IPC) is the optimal use of personal protective equipment (PPE) by healthcare workers (HCWs), including masks for protection against respiratory pathogens. Respiratory infectious diseases are transmitted via contact, droplet and/or airborne modes, necessitating healthcare worker (HCW) use of surgical masks or respirators and other personal protective equipment (PPE) together with appropriate hand hygiene. During periods of high-risk for respiratory infectious disease, such as the annual influenza season or a novel influenza pandemic, health departments have, and may, encourage or mandate the use of a protective respiratory mask by the general public to minimise the transmission from symptomatic people to others [49] .

title:
  Clinician perceptions of respiratory infection risk; a rationale for research into mask use in routine practice

abstract:
  Abstract Outbreaks of emerging and re-emerging infectious diseases are global threats to society. Planning for, and responses to, such events must include healthcare and other measures based on current evidence. An important area of infection prevention and control (IPC) is the optimal use of personal protective equipment (PPE) by healthcare workers (HCWs), including masks for protection against respiratory pathogens. Appropriate mask use during routine care is a forerunner to best practice in the event of an outbreak. However, little is known about the influences on decisions and behaviours of HCWs with respect to protective mask use when providing routine care. In this paper we argue that there is a need for more research to provide a better understanding of the decision-making and risk-taking behaviours of HCWs in respect of their use of masks for infectious disease prevention. Our argument is based on the ongoing threat of emerging infectious diseases; a need to strengthen workforce capability, capacity and education; the financial costs of healthcare and outbreaks; and the importance of social responsibility and supportive legislation in planning for global security. Future research should examine HCWs' practices and constructs of risk to provide new information to inform policy and pandemic planning.


id: cord-313528-rp15vi1o
title: An adapted emergency department triage algorithm for the COVID‐19 pandemic
author: Wallace, Douglas W.
date: 2020-08-10
txt: ./txt/cord-313528-rp15vi1o.txt
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mime: text/plain
url: https://doi.org/10.1002/emp2.12210
doi: 10.1002/emp2.12210
summary:
  The novel coronavirus disease 2019 (COVID‐19) pandemic, with its public health implications, high case fatality rate, and strain on hospital resources, will continue to challenge clinicians and researchers alike for months to come. The authors describe an adapted COVID‐19 pandemic triage algorithm for emergency departments (EDs) guided by the best available evidence and responses to prior pandemics, with recommendations for clinician PPE use for each level of encounter in the setting of an ongoing PPE shortage. 3 Hospitals across the United States have adapted to the COVID-19 pandemic by limiting nonessential patient interaction and transforming their emergency departments (EDs) to treat patients who are both critically ill and highly contagious. It is the authors'' hope that use of this triage algorithm and PPE recommendations will aid frontline emergency clinicians in the ongoing response to COVID-19.

abstract:
  The novel coronavirus disease 2019 (COVID‐19) pandemic, with its public health implications, high case fatality rate, and strain on hospital resources, will continue to challenge clinicians and researchers alike for months to come. Accurate triage of patients during the pandemic will assign patients to the appropriate level of care, provide the best care for the maximum number of patients, rationally limit personal protective equipment (PPE) usage, and mitigate nosocomial exposures. The authors describe an adapted COVID‐19 pandemic triage algorithm for emergency departments (EDs) guided by the best available evidence and responses to prior pandemics, with recommendations for clinician PPE use for each level of encounter in the setting of an ongoing PPE shortage. Our algorithm adheres to Centers for Disease Control and Prevention guidelines and supports discharge of patients with mild symptoms coupled with explicit and strict return precautions and infection control education.


id: cord-314460-dbrp4vxc
title: Review of Literature for Air Medical Evacuation High-Level Containment Transport
author: Gibbs, Shawn G.
date: 2019-10-31
txt: ./txt/cord-314460-dbrp4vxc.txt
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mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/31578975/
doi: 10.1016/j.amj.2019.06.006
summary:
  We conducted a review of the literature to evaluate the processes and procedures utilized for safe AE high-level containment transport (AE-HLCT) of patients with HHCDs. Methods A literature search was performed in PubMed/MEDLINE (from 1966 through January 2019). A literature search was performed in PubMed/MEDLINE (from 1966 through January 2019) with the following terms: 1) "aeromedical isolation," 2) "aeromedical evacuation" OR "transportation of patients" OR "air ambulance" OR "HEMS" OR "Helicopter" AND "ebola" OR "lassa" OR "viral hemorrhagic" OR "highly infectious" OR "highly hazardous" OR "contagious" OR "communicable" OR "Middle East respiratory syndrome (MERS)" OR "SARS" OR "smallpox", and 3) "mobile" OR "transport" AND "high-level isolation" OR "high containment". Biselli et al 22 noted training includes personal protective equipment (PPE), patient management on ground and inflight, and equipment decontamination, whereas Christopher and Eitzen, 17 24 which detailed a 2006 Royal Air Force mission, remarked on the benefit of in-flight, just-in-time training that occurred on the flight to the patient, while also stating that the mission resulted in routine air transport isolator exercises.

abstract:
  Abstract Introduction Aeromedical evacuation (AE) is a challenging process, further complicated when a patient has a highly hazardous communicable disease (HHCD). We conducted a review of the literature to evaluate the processes and procedures utilized for safe AE high-level containment transport (AE-HLCT) of patients with HHCDs. Methods A literature search was performed in PubMed/MEDLINE (from 1966 through January 2019). Authors screened abstracts for inclusion criteria and full articles were reviewed if the abstract was deemed to contain information related to the aim. Results Our search criteria yielded 14 publications and were separated based upon publication dates, with the natural break point being the beginning of the 2013-2016 Ebola virus disease epidemic. Best practices and recommendations from identified articles are subdivided into pre-flight preparations, inflight operations, and post-flight procedures. Conclusions Limited peer-reviewed literature exists on AE-HLCT, including important aspects related to healthcare worker fatigue, alertness, shift scheduling, and clinical care performance. This hinders the sharing of best practices to inform evacuations and equip teams for future outbreaks. Despite the successful use of different aircraft and technologies, the unique nature of the mission opens the opportunity for greater coordination and development of consensus standards for AE-HLCT operations.


id: cord-314492-483rn3aw
author: Gallagher, Jennifer E.
date: 2020-07-24
txt: ./txt/cord-314492-483rn3aw.txt
cache: ./cache/cord-314492-483rn3aw.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32710059/
doi: 10.1038/s41415-020-1843-9
summary:
  It examined evidence on which type of full body PPE and which method of donning (putting on) or doffing (removing) are most effective, while having the least risk of contamination or infection for healthcare workers, as well as which training methods increase compliance with PPE protocols. The global COVID-19 pandemic, caused by the SARS-CoV-2 virus, 1 has highlighted the importance of personal protective equipment (PPE) for health and social care personnel. The global COVID-19 pandemic, caused by the SARS-CoV-2 virus, 1 has highlighted the importance of personal protective equipment (PPE) for health and social care personnel. 8 The evidence from this review is of great importance where there is a risk of highly infectious diseases, and even though COVID-19 is no longer considered to be a high consequence disease in the UK, 9 its findings remain relevant to the current pandemic 10 and continue to be updated.

title:
  Relevance and paucity of evidence: a dental perspective on personal protective equipment during the COVID-19 pandemic

abstract:
  The global COVID-19 pandemic, caused by the SARS-CoV-2 virus, has highlighted the importance of personal protective equipment (PPE) for health and social care personnel. This is a really important issue for dentistry, where we place great emphasis on infection control and universal precautions, given the nature of care provided. Cochrane have recently updated their review of PPE for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. It examined evidence on which type of full body PPE and which method of donning (putting on) or doffing (removing) are most effective, while having the least risk of contamination or infection for healthcare workers, as well as which training methods increase compliance with PPE protocols. The objective of this paper is to raise awareness of the above review of PPE, its findings and their relevance to dentistry as outlined in the Cochrane Oral Health website. The available evidence comes from healthcare generally, mostly involving simulation exercises, and is of low or very low certainty. None of the evidence specifically comes from dentistry. The findings in relation to the nature of PPE, methods of donning and doffing, and the importance of training are all of practical relevance to dentistry. Research is critically important to provide evidence for future decision making in support of patients and staff.


id: cord-314507-fgrvrlht
author: Sule, Harsh
date: 2020-03-27
txt: ./txt/cord-314507-fgrvrlht.txt
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url: https://www.ncbi.nlm.nih.gov/pubmed/32351813/
doi: 10.7759/cureus.7433
summary:
  Objective To determine the impact of Level C personal protective equipment (PPE) on the time to perform intravenous (IV) cannulation and endotracheal intubation, both with and without the use of adjuncts. Methods This prospective, case-control study of emergency medicine resident physicians was designed to assess the time taken by each subject to perform endotracheal intubation using both direct laryngoscopy (DL) and video laryngoscopy (VL), as well as peripheral IV cannulation both with and without ultrasound guidance and with and without PPE. Our primary objective was to determine the impact of Level C PPE on the time to perform intravenous cannulation and endotracheal intubation, both with and without the use of adjuncts. studied 40 emergency physicians (residents) with and without Level C PPE and found no difference in the mean time to successful endotracheal intubation (17.86 sec vs.

title:
  Maintenance of Skill Proficiency for Emergency Skills With and Without Adjuncts Despite the Use of Level C Personal Protective Equipment

abstract:
  Objective To determine the impact of Level C personal protective equipment (PPE) on the time to perform intravenous (IV) cannulation and endotracheal intubation, both with and without the use of adjuncts. Methods This prospective, case-control study of emergency medicine resident physicians was designed to assess the time taken by each subject to perform endotracheal intubation using both direct laryngoscopy (DL) and video laryngoscopy (VL), as well as peripheral IV cannulation both with and without ultrasound guidance and with and without PPE. Results While median times were higher using VL as compared to DL, there was no significant difference between intubation with either DL or VL in subjects with and without Level C PPE. Similarly, no significant difference in time was found for intravenous cannulation in the PPE and no-PPE groups, both with and without ultrasound guidance. Conclusions Existing skill proficiency was maintained despite wearing PPE and there was no advantage with the addition of adjuncts such as video-assisted laryngoscopy and ultrasound-guided intravenous cannulation. A safe and cost-effective strategy might be to conduct basic, just-in-time PPE training to enhance familiarity with donning, doffing, and mobility, and couple this with the use of personnel who have maximal proficiency in the relevant emergency skill, instead of more expensive, continuous, skills-focused PPE training.


id: cord-314517-n1yj2zdy
author: Huang, Dayong
date: 2020-08-31
txt: ./txt/cord-314517-n1yj2zdy.txt
cache: ./cache/cord-314517-n1yj2zdy.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1093/ofid/ofaa400
doi: 10.1093/ofid/ofaa400
summary:
  title: Social media survey and web posting assessment of the COVID-19 response in China: Health worker attitudes towards preparedness and personal protective equipment shortages BACKGROUND: Understanding health worker awareness, attitudes, and self-confidence in the workplace can inform local and global responses towards emerging infectious threats, like COVID-19 pandemic response. Health workers satisfied with current preparedness to address COVID-19 were more likely to be female, to obtain knowledge about the SARS-CoV-2 outbreak from government organizations, and to consider their hospital prepared for the outbreak management. They cannot function effectively if they lack personal protective equipment (PPE), essential to ensure continuity of healthcare services during a public health emergency and to avoiding nosocomial acquisitions 5 A c c e p t e d M a n u s c r i p t 6 As of April 4, 2020, 60 Chinese health workers have died, of whom 22 (36.7%) were confirmed dead of COVID-19, according to reports by China Central Television.

title:
  Social media survey and web posting assessment of the COVID-19 response in China: Health worker attitudes towards preparedness and personal protective equipment shortages

abstract:
  BACKGROUND: Understanding health worker awareness, attitudes, and self-confidence in the workplace can inform local and global responses towards emerging infectious threats, like COVID-19 pandemic response. Availability of accessible personal protective equipment (PPE) is vital to effective care and prevention. METHODS: We conducted a cross-sectional survey from February 24-28, 2020 to assess COVID-19 preparedness among health workers. In addition, we assessed trends from search engine web crawling and text-mining data trending over the Sina Weibo platform from January 1 to March 3, 2020. Data were abstracted on Chinese outbreak preparedness. RESULTS: In the survey, we engaged 6,350 persons, of whom 1,065 agreed to participate and after an eligibility logic check, 1,052 participated (16.6%). We accessed 412 internet posts as to PPE availability. Health workers satisfied with current preparedness to address COVID-19 were more likely to be female, to obtain knowledge about the SARS-CoV-2 outbreak from government organizations, and to consider their hospital prepared for the outbreak management. Health workers with more confidence in their abilities to respond were those with more faith in their institution’s response capacities. Elements of readiness included having airborne infection isolation room, visitor control procedures, training in precautions and PPE use. Both survey and web post assessments suggested that health workers in need were unable to reliably obtain PPE. CONCLUSION: Health workers’ self-confidence depends on perceived institutional readiness. Failure to maintain available PPE inventory for emerging infectious diseases preparedness suggests a failure to learn key lessons from the 2003-2004 SARS outbreak in China.


id: cord-315358-22srds0e
title: Just the Facts: Airway management during the coronavirus disease 2019 (COVID-19) pandemic
author: Kovacs, George
date: 2020-03-30
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mime: text/plain
url: https://doi.org/10.1017/cem.2020.353
doi: 10.1017/cem.2020.353
summary:
  3 COVID-19 pneumonia patients in respiratory distress with persistent hypoxemia and who are showing signs of fatigue (altered mental status) despite escalation of oxygen therapy (i.e., non-rebreather face mask at 15 L/min) are at significant risk for requiring urgent intubation. 5 Another major reason why airway management in COVID-19 patients is different relates to the details and sequencing related to provider safety. Answer: There is considerable discussion and concern amongst healthcare providers around the availability and access of appropriate personal protective equipment (PPE) for high-risk AGPs such as intubation. 6 While every institution should have access to PPE for providers performing an AGP, it is important to ask the question of whether these recommendations are what is best for a provider in a room (negative pressure or not) preparing to intubate the sickest of COVID-19 patients. • Airway management of COVID-19 patients requires a paradigm shift from a focus primarily on patientoriented outcomes to one that focuses on provider safety.

abstract:
  A previously healthy 42-year-old male developed a fever and cough shortly after returning to Canada from overseas. Initially, he had mild upper respiratory tract infection symptoms and a cough. He was aware of the coronavirus disease-2019 (COVID-19) and the advisory to self-isolate and did so; however, he developed increasing respiratory distress over several days and called 911. On arrival at the emergency department (ED), his heart rate was 130 beats/min, respiratory rate 32 per/min, and oxygenation saturation 82% on room air. As per emergency medical services (EMS) protocol, they placed him on nasal prongs under a surgical mask at 5 L/min and his oxygen saturation improved to 86%.


id: cord-316063-9bg2dm8e
title: Why meaning-making matters: the case of the UK Government’s COVID-19 response
author: Morgan, Marcus
date: 2020-10-15
txt: ./txt/cord-316063-9bg2dm8e.txt
cache: ./cache/cord-316063-9bg2dm8e.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33078075/
doi: 10.1057/s41290-020-00121-y
summary:
  The paper also offers more specific contributions to cultural sociology by showing why social performance theory needs to consider the effects of casting non-human actors in social dramas, how metaphor forms a powerful tool of political action through simplifying and shaping complex realities, and how casting can shift responsibility and redefine the meaning of emotionally charged events such as human death. On 28th February, the first death of a British national occurred on the quarantined Diamond Princess cruise ship, and the Sunday Times reported that around the same time Dominic Cummings (Johnson''s Chief Advisor, and former director of the successful Vote Leave campaign) had ''outlined the government''s strategy'' for the UK''s national response to the virus ''at a private engagement'', quoting those present as claiming that it was ''herd immunity, protect the economy, and if that means some pensioners die, too bad'' (Shipman and Wheeler 2020) .

abstract:
  Through analysis of the UK government’s management of the COVID-19 outbreak, this paper offers an empirical demonstration of the principle of culture’s relative autonomy. It does so by showing how the outcome of meaning-making struggles had impacts on political legitimacy, public behaviour, and control over the spread of the virus. Ultimately, these impacts contributed to the avoidable deaths of tens of thousands of UK citizens. Dividing the crisis into phases within a secular ritual passage or ‘social drama’, it shows how each phase was defined by struggles between the government and other actors to code the unfolding events in an appropriate moral way, to cast actors in their proper roles, and to plot them together in a storied fashion under a suitable narrative genre. Taken together, these processes constituted a conflictual effort to define the meaning of what was occurring. The paper also offers more specific contributions to cultural sociology by showing why social performance theory needs to consider the effects of casting non-human actors in social dramas, how metaphor forms a powerful tool of political action through simplifying and shaping complex realities, and how casting can shift responsibility and redefine the meaning of emotionally charged events such as human death.


id: cord-316126-j51dik7f
author: Zhang, X. Sophie
date: 2020-10-28
txt: ./txt/cord-316126-j51dik7f.txt
cache: ./cache/cord-316126-j51dik7f.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1128/cmr.00184-20
doi: 10.1128/cmr.00184-20
summary:
  title: SARS-CoV-2 and Health Care Worker Protection in Low-Risk Settings: a Review of Modes of Transmission and a Novel Airborne Model Involving Inhalable Particles Since the beginning of the COVID-19 pandemic, there has been intense debate over SARS-CoV-2''s mode of transmission and appropriate personal protective equipment for health care workers in low-risk settings. This review attempts to summarize current cumulative data on SARS-CoV-2''s modes of transmission and identify gaps in research while offering preliminary answers to the question on everyone''s mind: is the airborne route significant and should we modify our COVID-19 PPE recommendations for frontline workers in low-risk settings? Given that substantial disagreement persists on the importance of natural aerosol generation by COVID-19 patients, and consequently, the necessary level of respiratory protection in non-AGP contexts, our review will focus on transmission and PPE in low-risk health care settings.

title:
  SARS-CoV-2 and Health Care Worker Protection in Low-Risk Settings: a Review of Modes of Transmission and a Novel Airborne Model Involving Inhalable Particles

abstract:
  Since the beginning of the COVID-19 pandemic, there has been intense debate over SARS-CoV-2’s mode of transmission and appropriate personal protective equipment for health care workers in low-risk settings. The objective of this review is to identify and appraise the available evidence (clinical trials and laboratory studies on masks and respirators, epidemiological studies, and air sampling studies), clarify key concepts and necessary conditions for airborne transmission, and shed light on knowledge gaps in the field. We find that, except for aerosol-generating procedures, the overall data in support of airborne transmission—taken in its traditional definition (long-distance and respirable aerosols)—are weak, based predominantly on indirect and experimental rather than clinical or epidemiological evidence. Consequently, we propose a revised and broader definition of “airborne,” going beyond the current droplet and aerosol dichotomy and involving short-range inhalable particles, supported by data targeting the nose as the main viral receptor site. This new model better explains clinical observations, especially in the context of close and prolonged contacts between health care workers and patients, and reconciles seemingly contradictory data in the SARS-CoV-2 literature. The model also carries important implications for personal protective equipment and environmental controls, such as ventilation, in health care settings. However, further studies, especially clinical trials, are needed to complete the picture.


id: cord-316157-7nci4q1q
author: Iheduru‐Anderson, Kechi
date: 2020-10-03
txt: ./txt/cord-316157-7nci4q1q.txt
cache: ./cache/cord-316157-7nci4q1q.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33010197/
doi: 10.1111/nin.12382
summary:
  This study used a descriptive phenomenological design to describe the lived experience of acute care nurses working with limited access to PPE during the COVID‐19 pandemic. Existing studies have focused on hospital preparation, availability of resources, and the safety of patients (Barbisch & Koenig, 2006; Karabacak, Ozturk, & Bahcecik, 2011; Ruchlewska et al., 2014; Tzeng & Yin, 2008) , the education of hospital staff (Powers, 2007) , emergency room nurses'' description and management during a crisis (Vasli and Dehghan-Nayeri, 2016) , and the psychological impact of disease outbreaks on hospital workers (Sun et al., 2020; Wu et al., 2009; Yin & Zeng, 2020) . The purpose of this study was to describe the lived experience of acute care nurses working with limited access to PPE during the COVID-19 pandemic. This qualitative descriptive phenomenological study explored the lived experiences of acute care nurses working on the frontline during the COVID-19 disease outbreak. Descriptive phenomenology was chosen as the design for the current study because it explored and described the participants'' everyday experiences as they lived them while working with limited PPE on the frontline of the 2020 COVID-19 crisis.

title:
  Reflections on the lived experience of working with limited personal protective equipment during the COVID‐19 crisis

abstract:
  Coronavirus disease 2019 (COVID‐19) has placed significant strain on United States’ health care and health care providers. While most Americans were sheltering in place, nurses headed to work. Many lacked adequate personal protective equipment (PPE), increasing the risk of becoming infected or infecting others. Some health care organizations were not transparent with their nurses; many nurses were gagged from speaking up about the conditions in their workplaces. This study used a descriptive phenomenological design to describe the lived experience of acute care nurses working with limited access to PPE during the COVID‐19 pandemic. Unstructured interviews were conducted with 28 acute care nurses via telephone, WebEx, and Zoom. Data were analyzed using thematic analysis. The major theme, emotional roller coaster, describes the varied intense emotions the nurses experienced during the early weeks of the pandemic, encompassing eight subthemes: scared and afraid, sense of isolation, anger, betrayal, overwhelmed and exhausted, grief, helpless and at a loss, and denial. Other themes include: self‐care, ‘hoping for the best’, ‘nurses are not invincible’, and ‘I feel lucky’. The high levels of stress and mental assault resulting from the COVID‐19 crisis call for early stress assessment of nurses and provision of psychological intervention to mitigate lasting psychological trauma.


id: cord-316327-0hpthrjo
author: Brar, Branden
date: 2020-08-18
txt: ./txt/cord-316327-0hpthrjo.txt
cache: ./cache/cord-316327-0hpthrjo.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S2212440320311603
doi: 10.1016/j.oooo.2020.08.012
summary:
  The coronavirus disease 2019 (COVID-19) pandemic has specific implications for oral and maxillofacial surgeons due to an increased risk of exposure to the virus during surgical procedures of the aero-digestive tract. CMS also increased access to Medicare telehealth services for its beneficiaries under the Coronavirus Preparedness and Response Supplemental Appropriations Act. This rapid turn of events led to some urgent modifications to clinical care including surgery, by US health care providers in all specialties, to accommodate the critical shortages of hospital resources as the pandemic was evolving. This evoked the need to survey OMFS training programs and to start a discussion regarding some of the changes in emergency triage, urgent surgical procedures, and use of PPE to protect health care personnel. [16] The aim of this survey was to assess the impact of COVID -19 on Oral and Maxillofacial Surgery (OMFS) training programs in the different regions of USA during the early phase of this pandemic between March 6 th to May 6 th 2020.

title:
  A Survey Assessing the Early Effects of COVID-19 Pandemic on Oral & Maxillofacial Surgery Training Programs

abstract:
  The coronavirus disease 2019 (COVID-19) pandemic has specific implications for oral and maxillofacial surgeons due to an increased risk of exposure to the virus during surgical procedures of the aero-digestive tract. The objective of this survey was to evaluate how the COVID-19 pandemic affected oral and maxillofacial surgery (OMFS) training programs during the early phase of the pandemic. METHODS: A cross-sectional survey was sent to the program directors of 95 out of the 101 accredited OMFS training programs between April 3(rd) and May 6(th), 2020. The 35- question survey designed using Qualtrics software, to elicit information about the impact of COVID-19 on OMFS residency programs and the specific modifications made to clinical care, PPE and resident training/wellness to meet the response to the COVID-19 pandemic. RESULTS: The survey response rate from OMFS program directors was 35% (33/95) with most responses from states with high incidence of COVID19. All OMFS programs (100%) implemented guidelines to suspend elective and non-urgent surgical procedures and limited ambulatory clinic visits by third week of March, with an average date of March 16(th), 2020 (Date range March 8(th) -23(rd)). Programs used telemedicine (40%) and modified in-person visit (51%) protocols for dental and maxillofacial emergency triage to minimize exposure risk of HCP to SARS CoV2. PPE shortage was experienced by 51% of the programs. Almost two-thirds (63%) of the respondents recommended the use of a filtered respirator (i.e., N95 respirator) with full face shield as their preferred PPE, while 21% recommended Powered Air Purifying Respirators (PAPRs) during OMFS procedures. Only (73%) of the programs had resources for resident wellness and stress reduction. Virtual didactic training sessions conducted on digital platforms, most commonly “Zoom” formed a major part of education for all programs. CONCLUSION: All programs promptly responded to the pandemic by making appropriate changes to suspend elective surgery and, to limit patient care to emergent and urgent services. OMFS training programs should give more consideration to provide residents with adequate stress reduction resources to maintain their wellbeing and training to minimize exposure risk during an evolving global epidemic.


id: cord-316632-rr9f88oi
author: Kimura, Yurika
date: 2020-07-23
txt: ./txt/cord-316632-rr9f88oi.txt
cache: ./cache/cord-316632-rr9f88oi.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0385814620301656
doi: 10.1016/j.anl.2020.07.009
summary:
  On April 14, the Society of Swallowing and Dysphagia of Japan (SSDJ) proposed its position statement on dysphagia treatment considering the ongoing spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This statement is arranged into separate sections providing information and advice in consideration of the COVID-19 outbreak, including "terminology", "clinical swallowing assessment and examination", "swallowing therapy", "oral care", "surgical procedure for dysphagia", "tracheotomy care", and "nursing care". The current set of statements on dysphagia management in the COVID-19 outbreak is not an evidence-based clinical practice guideline, but a guide for all healthcare workers involved in the treatment of dysphagia during the COVID-19 epidemic to prevent SARS-CoV-2 infection. 48 This statement is arranged into separate sections provid-49 ing information and advice considering the COVID-19 out-50 break, including "clinical swallowing assessment and ex-51 amination", "dysphagia rehabilitation", "oral care", "nursing 52 care", "surgical procedure for dysphagia", and "tracheotomy 53 care".

title:
  Society of swallowing and dysphagia of Japan: Position statement on dysphagia management during the COVID-19 outbreak

abstract:
  On April 14, the Society of Swallowing and Dysphagia of Japan (SSDJ) proposed its position statement on dysphagia treatment considering the ongoing spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The main routes of transmission of SARS-CoV-2 are physical contact with infected persons and exposure to respiratory droplets. In cases of infection, the nasal cavity and nasopharynx have the highest viral load in the body. Swallowing occurs in the oral cavity and pharynx, which correspond to the sites of viral proliferation. In addition, the possibility of infection by aerosol transmission is also concerning. Dysphagia treatment includes a broad range of clinical assessments and examinations, dysphagia rehabilitation, oral care, nursing care, and surgical treatments. Any of these can lead to the production of droplets and aerosols, as well as contact with viral particles. In terms of proper infection control measures, all healthcare professionals involved in dysphagia treatment must be fully briefed and must appropriately implement all measures. In addition, most patients with dysphagia should be considered to be at a higher risk for severe illness from COVID-19 because they are elderly and have complications including heart diseases, diabetes, respiratory diseases, and cerebrovascular diseases. This statement establishes three regional categories according to the status of SARS-CoV-2 infection. Accordingly, the SSDJ proposes specific infection countermeasures that should be implemented considering 1) the current status of SARS-CoV-2 infection in the region, 2) the patient status of SARS-CoV-2 infection, and 3) whether the examinations or procedures conducted correspond to aerosol-generating procedures, depending on the status of dysphagia treatment. This statement is arranged into separate sections providing information and advice in consideration of the COVID-19 outbreak, including “terminology”, “clinical swallowing assessment and examination“, “swallowing therapy”, “oral care”, “surgical procedure for dysphagia”, “tracheotomy care”, and “nursing care”. In areas where SARS-CoV-2 infection is widespread, sufficient personal protective equipment should be used when performing aerosol generation procedures. The current set of statements on dysphagia management in the COVID-19 outbreak is not an evidence-based clinical practice guideline, but a guide for all healthcare workers involved in the treatment of dysphagia during the COVID-19 epidemic to prevent SARS-CoV-2 infection.


id: cord-316682-4360s2yu
title: Personal Protective Equipment: Protecting Health Care Providers in an Ebola Outbreak
author: Fischer, William A.
date: 2015-11-01
txt: ./txt/cord-316682-4360s2yu.txt
cache: ./cache/cord-316682-4360s2yu.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.clinthera.2015.07.007
doi: 10.1016/j.clinthera.2015.07.007
summary:
  Given that the Ebola virus is primarily transmitted through direct contact of mucous membranes and cuts in the skin with infected patients and/or their bodily fluids, it is necessary to cover these potential portals of infection with PPE as part of a structured and instructed donning and doffing procedure. Personal protective equipment (PPE) plays a critical role in mitigating the risk of health care personnel (HCP) exposure to contaminated body fluids in the care of patients with communicable infectious diseases, including EVD. 5 In the PAPR PPE set HCP wore a Tyvek (DuPont, Wilmington, Delaware) suit, shoe covers, a surgical gown, and a large hood, whereas the enhanced respiratory and contact precautions system included only a surgical gown, indicating that a second covering significantly reduced exposure to contaminated body fluids and provided evidence for the use of aprons on top of gowns or coveralls in the care of Ebola-infected patients.

abstract:
  Abstract Purpose The recent Ebola epidemic that devastated West Africa has infected and killed more health care providers than any other outbreak in the history of this virus. An improved understanding of pathogen transmission and the institution of strategies to protect health care providers against infection are needed in infectious disease outbreaks. This review connects what is known about Ebola virus transmission with personal protective equipment (PPE) designed to arrest nosocomial transmission. Methods Articles pertaining to filovirus transmission and PPE in filovirus outbreaks were reviewed and findings are presented. In addition, studies that evaluated PPE and donning and doffing strategies are presented. Findings PPE is one step in a comprehensive infection prevention and control strategy that is required to protect health care providers. Given that the Ebola virus is primarily transmitted through direct contact of mucous membranes and cuts in the skin with infected patients and/or their bodily fluids, it is necessary to cover these potential portals of infection with PPE as part of a structured and instructed donning and doffing procedure. Implications Current recommendations about PPE and the donning and doffing processes are based on anecdotal experience. However, the use of non-human viruses can help provide evidence-based guidelines on both PPE and donning and doffing processes.


id: cord-316718-7gtgqmcn
author: Murphy, D. L.
date: 2020-05-24
txt: ./txt/cord-316718-7gtgqmcn.txt
cache: ./cache/cord-316718-7gtgqmcn.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1101/2020.05.22.20110718
doi: 10.1101/2020.05.22.20110718
summary:
  We reviewed dispatch, EMS, and public health surveillance records to evaluate the temporal relationship between exposure and programmatic changes to EMS operations designed to identify high-risk patients, protect the workforce, and conserve PPE. Ideally, EMS strategies would incorporate COVID-19 risk assessment and target use of the limited PPE resource in order to achieve EMS provider safety, extend the supply of PPE, and support high-quality patient care. Of the 700 unique EMS providers caring for patients with confirmed COVID-19, 3 (0.4%) tested positive during the 14 days following an encounter (Table 3 ), yet none of these three had a documented occupational exposure. The series of practice changes involving dispatch advisement, patient COVID-19 risk criteria, and initial EMS scene deployment were associated with a temporal increase in adequate PPE use and conversely a decrease in EMS provider exposures (Figure 2, p<0.01) .

title:
  Occupational Exposures and Programmatic Response to COVID-19 Pandemic: An Emergency Medical Services Experience

abstract:
  Background Rigorous assessment of occupational COVID-19 risk and personal protective equipment (PPE) use are not well-described. We evaluated 9-1-1 emergency medical services (EMS) encounters for patients with COVID-19 to assess occupational exposure, programmatic strategies to reduce exposure, and PPE use. Methods We conducted a retrospective cohort investigation of lab-confirmed COVID-19 patients in King County, WA who received 9-1-1 EMS responses from February 14, 2020 to March 26, 2020. We reviewed dispatch, EMS, and public health surveillance records to evaluate the temporal relationship between exposure and programmatic changes to EMS operations designed to identify high-risk patients, protect the workforce, and conserve PPE. Results There were 274 EMS encounters for 220 unique COVID-19 patients involving 700 unique EMS providers with 988 EMS person-encounters. Use of full PPE including mask, eye protection, gown and gloves (MEGG) was 67%. There were 151 person-exposures among 129 individuals, who required 981 quarantine days. Of the 700 EMS providers, 3 (0.4%) tested positive within 14 days of encounter. Programmatic changes were associated with a temporal reduction in exposures. When stratified at the study encounters midpoint, 94% (142/151) of exposures occurred during the first 137 EMS encounters compared to 6% (9/151) during the second 137 EMS encounters (p<0.01). By the final week of the study period, EMS deployed MEGG PPE in 34% (3579/10,468) of all EMS person-encounters. Conclusion Less than 0.5% of EMS providers experienced COVID-19 illness within 14 days of occupational encounter. Programmatic strategies were associated with a reduction in exposures, while achieving a measured use of PPE.


id: cord-316918-mz5r7yiy
author: Rubin, Geoffrey A.
date: 2020-04-20
txt: ./txt/cord-316918-mz5r7yiy.txt
cache: ./cache/cord-316918-mz5r7yiy.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32281214/
doi: 10.1111/jce.14493
summary:
  In this proposal, we detail the specific protocol changes that our EP department has adopted during the COVID‐19 pandemic, including performance of only urgent/emergent procedures, after hours/7‐day per week laboratory operation, single attending‐only cases to preserve PPE, appropriate use of PPE, telemedicine and video chat follow‐up appointments, and daily conferences to collectively manage the clinical and ethical dilemmas to come. In this proposal, we detail the specific protocol changes that our EP department has adopted during the COVID-19 pandemic, including performance of only urgent/emergent procedures, after hours/7-day per week laboratory operation, single attending-only cases to preserve PPE, appropriate use of PPE, telemedicine and video chat follow-up appointments, and daily conferences to collectively manage the clinical and ethical dilemmas to come. Unless urgent/emergent, we have avoided performing procedures on COVID-19 infected patients in the EP laboratory to prevent transmission not only during transport to the laboratory, but also to prevent seeding the lab itself in the case of a prolonged operation.

title:
  Performance of electrophysiology procedures at an academic medical center amidst the 2020 coronavirus (COVID‐19) pandemic

abstract:
  A global coronavirus (COVID‐19) pandemic occurred at the start of 2020 and is already responsible for more than 74 000 deaths worldwide, just over 100 years after the influenza pandemic of 1918. At the center of the crisis is the highly infectious and deadly SARS‐CoV‐2, which has altered everything from individual daily lives to the global economy and our collective consciousness. Aside from the pulmonary manifestations of disease, there are likely to be several electrophysiologic (EP) sequelae of COVID‐19 infection and its treatment, due to consequences of myocarditis and the use of QT‐prolonging drugs. Most crucially, the surge in COVID‐19 positive patients that have already overwhelmed the New York City hospital system requires conservation of hospital resources including personal protective equipment (PPE), reassignment of personnel, and reorganization of institutions, including the EP laboratory. In this proposal, we detail the specific protocol changes that our EP department has adopted during the COVID‐19 pandemic, including performance of only urgent/emergent procedures, after hours/7‐day per week laboratory operation, single attending‐only cases to preserve PPE, appropriate use of PPE, telemedicine and video chat follow‐up appointments, and daily conferences to collectively manage the clinical and ethical dilemmas to come. We discuss also discuss how we perform EP procedures on presumed COVID positive and COVID tested positive patients to highlight issues that others in the EP community may soon face in their own institution as the virus continues to spread nationally and internationally.


id: cord-317323-wp3vh4c1
title: The changing paradigm of an aesthetic practice during the COVID‐19 pandemic: An expert consensus
author: Kandhari, Rajat
date: 2020-10-28
txt: ./txt/cord-317323-wp3vh4c1.txt
cache: ./cache/cord-317323-wp3vh4c1.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33090637/
doi: 10.1111/dth.14382
summary:
  It is pertinent that the physician today understands the infection, disinfection measures, and personal protective equipment to reduce chances of viral transmission and provide safe clinical settings for oneself, the staff and the patients. While certain guidelines and expert consensus have recently been published [2] [3] [4] providing an overview of "safe" working protocols, it appears that we are evolving every day in our practices with respect to "what works" and "what does not." Our article aims to bridge the gap between guidelines and in-clinic experiences to provide a set of best practices to follow for aesthetic procedures after reopening our practices. In contrast, the occurrence of airborne transmission is due to smaller particles, which maybe suspended in the air for long periods and can infect people distant from the source (eg, AGP''s)PPE consists of protective apparel and/or equipment designed for providing protection against infectious agents to HCW''s and their patients. Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings

abstract:
  Until vaccination for the SARS‐CoV‐2 becomes a reality, it appears that the infection is here to stay. With many countries lifting lockdown restrictions, aesthetic clinics have started reopening with strict standard operating procedures in place. It is pertinent that the physician today understands the infection, disinfection measures, and personal protective equipment to reduce chances of viral transmission and provide safe clinical settings for oneself, the staff and the patients. An online meeting of eight experts in the field of aesthetic dermatology was convened, which particularly focussed on PPE in detail, risk categorization of aesthetic procedures, preprocedure recommendations, and generalized and specialized SOP's for aesthetic procedures. These recommendations were aimed to bridge the gap between published guidelines and clinical practice and are by no means fully conclusive, but signify learnings over the past few months in an active clinical aesthetic practice.


id: cord-317574-wyzscmtr
title: Environmentally Sustainable Management of Used Personal Protective Equipment
author: Singh, Narendra
date: 2020-06-29
txt: ./txt/cord-317574-wyzscmtr.txt
cache: ./cache/cord-317574-wyzscmtr.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1021/acs.est.0c03022
doi: 10.1021/acs.est.0c03022
abstract: nan
summary:
  The lack of a coordinated international strategy to manage the PPE production and waste lifecycle threatens to impact progress toward achieving key components of the United Nation''s Sustainable Development Goals (SDGs), including SDG 3 good health and wellbeing, SDG 6 clean water and sanitation, SDG 8 decent work and economic growth, SDG 12 responsible consumption and production and SDG 13 climate action. Therefore, the local waste management agency deployed mobile incinerators in the city to dispose of the unprecedented quantities of discarded face masks, gloves, and other contaminated single-use protective gear. 7 The United Nation''s Basel Convention on the Transboundary Movement of Hazardous Wastes and their Disposal has recently urged member countries to treat waste management amid COVID-19 as an urgent and essential public service to minimize possible secondary impacts upon health and the environment. In summary, the COVID-19 pandemic has strained solid waste management globally, while also highlighting the bottleneck supply chain challenges regarding PPE manufacture, demand-supply, use, and disposal.


id: cord-317884-zni0aj1n
author: Shirodkar, Amy-lee
date: 2020-05-21
txt: ./txt/cord-317884-zni0aj1n.txt
cache: ./cache/cord-317884-zni0aj1n.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32439878/
doi: 10.1038/s41433-020-0970-5
summary:
  EEC staff were provided with rapidly changing personal PPE guidance by Public Health England (PHE) with specific subspecialty advice from the British Emergency Eye Care Society (BEECS) and the Royal College of Ophthalmologists (RCOphth) UK during the COVID19 pandemic. BEECS undertook a baseline survey of its members after the initial response from the RCOphth 16/3/20 mirroring Public Health England (PHE) advice and a followup survey after the guidance was updated on 9/4/20. EEC staff were provided with rapidly changing personal PPE guidance by Public Health England (PHE) with specific subspecialty advice from the British Emergency Eye Care Society (BEECS) and the Royal College of Ophthalmologists (RCOphth) UK. BEECS undertook a baseline survey of its members after the initial response from the RCOphth 16/3/20 mirroring Public Health England (PHE) advice and a follow-up survey after the guidance was updated on 9/4/20.

title:
  Personal Protective Equipment (PPE) use among emergency eye care professionals in the UK during the COVID19 pandemic

abstract:
  EEC staff were provided with rapidly changing personal PPE guidance by Public Health England (PHE) with specific subspecialty advice from the British Emergency Eye Care Society (BEECS) and the Royal College of Ophthalmologists (RCOphth) UK during the COVID19 pandemic. BEECS undertook a baseline survey of its members after the initial response from the RCOphth 16/3/20 mirroring Public Health England (PHE) advice and a follow- up survey after the guidance was updated on 9/4/20. A combined total of 84 responses were received. Improvements after RCOphth changes between the two surveys from hospital respondents showed increases in temperature screening (13%), scrub use (34%), use of aprons (31%), masks (4%), eye protection (35%), gloves (25%) and slit lamp guard (1%). Our findings demonstrate a positive and significant adaptation of PPE in response to change in guidance published by PHE, RCOphth and BEECS between 16/3/20 and 11/4/20. The COVID19 pandemic has rapidly taken over the normal activity of Ophthalmic departments creating unprecedented challenges. Following initial confusion and vulnerability expressed by EEC professionals to PPE guidance, most Trusts appear to have adapted and are doing similar things. The response has been swift and effective as a result of good team work and early advice from BEECS and the RCOphth. On the whole, management teams are listening.


id: cord-318348-7ns7r2g7
author: Bandaru, S V
date: 2020-09-28
txt: ./txt/cord-318348-7ns7r2g7.txt
cache: ./cache/cord-318348-7ns7r2g7.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1017/s0022215120002108
doi: 10.1017/s0022215120002108
summary:
  This study aimed to assess the effect of using an N95 mask and face shield on speech perception among healthcare workers with normal hearing. Speech reception threshold and speech discrimination score were obtained, first without using personal protective equipment and then repeated with the audiologist wearing an N95 mask and face shield. Our aim was to quantitatively assess the effect of using an N95 mask and face shield on speech understanding among healthcare workers with normal hearing by determining its effect on speech reception thresholds and speech discrimination scores. • N95 masks and face shields are being used to protect from aerosol-related spread of infection • However, this personal protective equipment (PPE) hampers communication • This study found a significant increase in speech reception threshold (mean of 12.4 dB) with PPE use • The speech discrimination score worsened by 7 per cent with PPE (vs without PPE) when stimuli were presented at the same level

title:
  The effects of N95 mask and face shield on speech perception among healthcare workers in the coronavirus disease 2019 pandemic scenario

abstract:
  OBJECTIVE: The current circumstances of the coronavirus disease 2019 pandemic necessitate the use of personal protective equipment in hospitals. N95 masks and face shields are being used as personal protective equipment to protect from aerosol-related spread of infection. Personal protective equipment, however, hampers communication. This study aimed to assess the effect of using an N95 mask and face shield on speech perception among healthcare workers with normal hearing. METHODS: Twenty healthcare workers were recruited for the study. Pure tone audiometry was conducted to ensure normal hearing. Speech reception threshold and speech discrimination score were obtained, first without using personal protective equipment and then repeated with the audiologist wearing an N95 mask and face shield. RESULTS: A statistically significant increase in speech reception threshold (mean of 12.4 dB) and decrease in speech discrimination score (mean of 7 per cent) was found while using the personal protective equipment. CONCLUSION: Use of personal protective equipment significantly impairs speech perception. Alternate communication strategies should be developed for effective communication.


id: cord-318660-47dqa1dd
title: Efficacy and Use of Cloth Masks: A Scoping Review
author: Jain, Mehr
date: 2020-09-13
txt: ./txt/cord-318660-47dqa1dd.txt
cache: ./cache/cord-318660-47dqa1dd.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10423
doi: 10.7759/cureus.10423
summary:
  Cloth masks have limited inward protection in healthcare settings where viral exposure is high but may be beneficial for outward protection in low-risk settings and use by the general public where no other alternatives to medical masks are available. Although guidelines from the World Health Organization (WHO) and Centre for Disease Control and Prevention (CDC) suggest various strategies to optimize the supply of PPE in healthcare settings [4, 7] , there are limited data on alternatives to surgical masks. In the current COVID-19 pandemic, Chinese recommendations on face mask use in community settings suggest that cloth masks could be used in a very low-risk population to prevent the spread of disease [13] . This review aims to integrate current studies and guidelines to determine the efficacy of cloth masks as both inward and outward protective equipment and whether they can be used in healthcare settings and/or the community in light of the PPE shortage.

abstract:
  During the coronavirus disease 2019 (COVID-19) pandemic, there has been a global shortage of personal protective equipment (PPE). In this setting, cloth masks may play an important role in limiting disease transmission; however, current literature on the use of cloth masks remains inconclusive. This review aims to integrate current studies and guidelines to determine the efficacy and use of cloth masks in healthcare settings and/or the community. Evidence-based suggestions on the most effective use of cloth masks during a pandemic are presented. Embase, MEDLINE, and Google Scholar were searched on March 31, 2020, and updated on April 6, 2020. Studies reporting on the efficacy, usability, and accessibility of cloth masks were included. Additionally, a search of guidelines and recommendations on cloth mask usage was conducted through published material by international and national public health agencies. Nine articles were included in this review after full-text screening. The clinical efficacy of a face mask is determined by the filtration efficacy of the material, fit of the mask, and compliance to wearing the mask. Household fabrics such as cotton T-shirts and towels have some filtration efficacy and therefore potential for droplet retention and protection against virus-containing particles. However, the percentage of penetration in cloth masks is higher than surgical masks or N95 respirators. Cloth masks have limited inward protection in healthcare settings where viral exposure is high but may be beneficial for outward protection in low-risk settings and use by the general public where no other alternatives to medical masks are available.


id: cord-318944-13zk6cco
author: Bizzoca, Maria Eleonora
date: 2020-05-27
txt: ./txt/cord-318944-13zk6cco.txt
cache: ./cache/cord-318944-13zk6cco.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32471083/
doi: 10.3390/ijerph17113793
summary:
  The authors performed a narrative review on Severe Acute Respiratory SyndromeCoronaVirus-2 ( SARS-CoV-2) and all infectious agents with the primary endpoints to illustrate the most accepted models of safety protocols in dentistry and oral medicine, and to propose an easy view of the problem and a comparison (prevs post-COVID19) for the most common dental procedures. After a brief excursus on all infectious agents transmittable at the dental chair, the authors described all the personal protective equipment (PPE) actually on the market and their indications, and on the basis of the literature, they compared (before and after COVID-19 onset) the correct safety procedures for each dental practice studied, underlining the danger of underestimating, in general, dental cross-infections. The precautions for infection control require wearing gloves, aprons, as well as eye and mouth protection (goggles and mask, such as medical masks and Filtering Face Piece or FPP) for each procedure involving direct contact with the patient body fluids.

title:
  Covid-19 Pandemic: What Changes for Dentists and Oral Medicine Experts? A Narrative Review and Novel Approaches to Infection Containment

abstract:
  The authors performed a narrative review on Severe Acute Respiratory Syndrome- CoronaVirus-2 ( SARS-CoV-2) and all infectious agents with the primary endpoints to illustrate the most accepted models of safety protocols in dentistry and oral medicine, and to propose an easy view of the problem and a comparison (pre- vs post-COVID19) for the most common dental procedures. The outcome is forecast to help dentists to individuate for a given procedure the differences in terms of safety protocols to avoid infectious contagion (by SARS-CoV-2 and others dangerous agents). An investigation was performed on the online databases Pubmed and Scopus using a combination of free words and Medical Subject Headings (MESH) terms: “dentist” OR “oral health” AND “COVID-19” OR “SARS-CoV-2” OR “coronavirus-19”. After a brief excursus on all infectious agents transmittable at the dental chair, the authors described all the personal protective equipment (PPE) actually on the market and their indications, and on the basis of the literature, they compared (before and after COVID-19 onset) the correct safety procedures for each dental practice studied, underlining the danger of underestimating, in general, dental cross-infections. The authors have highlighted the importance of knowing exactly the risk of infections in the dental practice, and to modulate correctly the use of PPE, in order to invest adequate financial resources and to avoid exposing both the dental team and patients to preventable risks.


id: cord-319232-qowtuhh6
author: Brazil, Victoria
date: 2020-06-03
txt: ./txt/cord-319232-qowtuhh6.txt
cache: ./cache/cord-319232-qowtuhh6.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32514386/
doi: 10.1186/s41077-020-00127-z
summary:
  We describe our strategy development and context, simulation delivery activities and outcomes and offer principles and practical suggestions for how simulation can directly and rapidly respond to urgent need for health service transformation. Turning the promise of simulation into reality for COVID-19 preparation requires a translational approacha simulation program that is attuned to emerging priorities, has strong relationships with clinicians and service leadership and with the skills and capacity to apply (or develop) simulation strategies to address those issues. The program includes educationally focused simulation but extends to ''in situ'' simulation in clinical areas designed for translational impact-diagnosing and addressing important process and teamwork issues in patient care. Our experience with using simulation for COVID-19 pandemic preparation has sharped reflection on the role of simulation in health service performance and change management, albeit in a unique and urgent context.

title:
  Translational simulation for rapid transformation of health services, using the example of the COVID-19 pandemic preparation

abstract:
  Healthcare simulation has significant potential for helping health services to deal with the COVID-19 pandemic. Rapid changes to care pathways and processes needed for protection of staff and patients may be facilitated by a translational simulation approach—diagnosing changes needed, developing and testing new processes and then embedding new systems and teamwork through training. However, there are also practical constraints on running in situ simulations during a pandemic—the need for physical distancing, rigorous infection control for manikins and training equipment and awareness of heightened anxiety among simulation participants. We describe our institution’s simulation strategy for COVID-19 preparation and reflect on the lessons learned—for simulation programs and for health services seeking to utilise translational simulation during and beyond the COVID-19 pandemic. We offer practical suggestions for a translational simulation strategy and simulation delivery within pandemic constraints. We also suggest simulation programs develop robust strategies, governance and relationships for managing change within institutions—balancing clinician engagement, systems engineering expertise and the power of translational simulation for diagnosing, testing and embedding changes.


id: cord-319567-4t5t8bcx
author: Şentürk, Mert
date: 2020-04-11
txt: ./txt/cord-319567-4t5t8bcx.txt
cache: ./cache/cord-319567-4t5t8bcx.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32414544/
doi: 10.1053/j.jvca.2020.03.059
summary:
  Recognizing the unique risks of intubation and mechanical ventilation in these high-risk groups and the high potential of infection risk to healthcare workers, several useful reports, algorithms and society endorsed recommendations have emerged in the recent literature regarding the general airway and anesthesia management of these patients. Anaesthesia Subspecialty group has considered these challenges and developed a preliminary set of expert recommendations regarding the airway management and ventilation of COVID-19 thoracic patients. The group has considered a broad spectrum of issues regarding thoracic anesthesia in COVID-19 patients and decided to focus on overall approaches to general and specific aspects of airway management, preparation for anaesthesia, lung isolation/separation and ventilation.  Tracheal intubation in COVID-19 patients for thoracic surgery is a high-risk procedure for the anesthesia team because of the risks of aerosol transmission of the infection during placement of the airway device and check bronchoscopy.

title:
  Thoracic Anesthesia of Patients with Suspected or Confirmed 2019 Novel Coronavirus Infection: Preliminary Recommendations for Airway Management by the EACTA Thoracic Subspecialty Committee

abstract:
  Abstract The novel coronavirus has caused a pandemic around the world. Management of patients with suspected or confirmed coronavirus infection who have to undergo thoracic surgery will be a challenge for the anesthesiologists. infection who have to undergo thoracic surgery will be a challenge for the anesthesiologists. The thoracic subspecialty committee of European Association of Cardiothoracic Anaesthesiology (EACTA) has conducted a survey of opinion in order to create recommendations for the anesthetic approach to these challenging patients. It should be emphasized that both the management of the infected patient with COVID-19 and the self-protection of the anesthesia team constitute a complicated challenge. The text focuses therefore on both important topics.


id: cord-319865-g3qxu6uv
title: Personal protective equipment against COVID-19: Vital for surgeons, harmful for patients?
author: Frountzas, Maximos
date: 2020-09-21
txt: ./txt/cord-319865-g3qxu6uv.txt
cache: ./cache/cord-319865-g3qxu6uv.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0002961020305833
doi: 10.1016/j.amjsurg.2020.09.014
abstract: nan
summary:
  All surgical societies published specific criteria about high-risk surgical procedures and management of oncologic patients with alternative treatment options, such as chemotherapy or radiotherapy, after discussion by virtual Tumor Boards, that included surgeons, medical oncologists and radiologists [3] . Therefore, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), followed by most GI surgical communities all over the world, suggested the following PPE during GI surgery of a confirmed or highly suspected COVID-19 patient [7] : Surgical gowns, caps and shoe covers for skin and clothing protection. In addition, 91.3% of the healthcare workers with a primary headache in the past, reported that the prolonged (over 4 hours) use of PPE during COVID-19 outburst worsened their headaches and affected their job performance [9] . The PPE-associated discomfort and side effects during surgery may increase surgeons'' anxiety and fatigue while performing difficult operations.


id: cord-320640-5m6sqwq8
title: COVID-19 Creating another problem? Sustainable solution for PPE disposal through LCA approach
author: Kumar, Harender
date: 2020-10-09
txt: ./txt/cord-320640-5m6sqwq8.txt
cache: ./cache/cord-320640-5m6sqwq8.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33071605/
doi: 10.1007/s10668-020-01033-0
summary:
  In the present work, Life Cycle Assessment of PPE kits has been performed using GaBi version 8.7 under two disposal scenarios, namely landfill and incineration (both centralized and decentralized) for six environmental impact categories covering overall impacts on both terrestrial and marine ecosystems, which includes Global Warming Potential (GWP), Human Toxicity Potential (HTP), Eutrophication Potential (EP), Acidification Potential (AP), Freshwater Aquatic Ecotoxicity Potential (FAETP) and Photochemical Ozone Depletion Potential (POCP). With reported cases of COVID-19 infected health and sanitation workers (Satheesh 2020 ; Hindustan times 2020; New India Express 2020), waste management of used infectious safety gears has become a critical component to restrict the spread of novel coronavirus (Bherwani et al. The effective management of coronavirus infectious waste, including PPEs, has been identified by as a key area of concern by regulatory agencies in India, with the release of waste handling-treatment-disposal guidelines generated during treatment-diagnosis-quarantine of COVID-19 patients (CPCB Revision 2020; Aggarwal 2020).

abstract:
  Amid COVID-19, there have been rampant increase in the use of Personal Protective Equipment (PPE) kits by frontline health and sanitation communities, to reduce the likelihoods of infections. The used PPE kits, potentially being infectious, pose a threat to human health, terrestrial, and marine ecosystems, if not scientifically handled and disposed. However, with stressed resources on treatment facilities and lack of training to the health and sanitation workers, it becomes vital to vet different options for PPE kits disposal, to promote environmentally sound management of waste. Given the various technology options available for treatment and disposal of COVID-19 patients waste, Life Cycle Assessment, i.e., cradle to grave analysis of PPE provides essential guidance in identifying the environmentally sound alternatives. In the present work, Life Cycle Assessment of PPE kits has been performed using GaBi version 8.7 under two disposal scenarios, namely landfill and incineration (both centralized and decentralized) for six environmental impact categories covering overall impacts on both terrestrial and marine ecosystems, which includes Global Warming Potential (GWP), Human Toxicity Potential (HTP), Eutrophication Potential (EP), Acidification Potential (AP), Freshwater Aquatic Ecotoxicity Potential (FAETP) and Photochemical Ozone Depletion Potential (POCP). Considering the inventories of PPE kits, disposal of PPE bodysuit has the maximum impact, followed by gloves and goggles, in terms of GWP. The use of metal strips in face-mask has shown the most significant HTP impact. The incineration process (centralized−3816 kg CO2 eq. and decentralized−3813 kg CO2 eq.) showed high GWP but significantly reduced impact w.r.t. AP, EP, FAETP, POCP and HTP, when compared to disposal in a landfill, resulting in the high overall impact of landfill disposal compared to incineration. The decentralized incineration has emerged as environmentally sound management option compared to centralized incinerator among all the impact categories, also the environmental impact by transportation is significant (2.76 kg CO2 eq.) and cannot be neglected for long-distance transportation. Present findings can help the regulatory authority to delineate action steps for safe disposal of PPE kits.


id: cord-321443-89o13sox
title: Survey on the use of personal protective equipment and COVID‐19 testing of pregnant women in Japan
author: Umazume, Takeshi
date: 2020-08-10
txt: ./txt/cord-321443-89o13sox.txt
cache: ./cache/cord-321443-89o13sox.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32779285/
doi: 10.1111/jog.14382
summary:
  AIM: To clarify the status of personal protective equipment (PPE) and coronavirus disease 2019 (COVID‐19) tests for pregnant women, we conducted an urgent survey. Our study also determined that around 65.0% of facilities for doctors and 73.5% of facilities for midwives used PPE beyond the "standard gown or apron, surgical mask, goggles or face shield" during labor of asymptomatic women. 3 In order to clarify the status of PPE usage during labor and delivery and COVID-19 tests for pregnant women, we conducted an urgent survey in Japan. Status of PPE use beyond "standard gown or apron, surgical mask, goggle or face shield" during labor of women without symptoms of COVID-19 Pregnant women were tested for COVID-19 not only in perinatal medical centers and university hospitals, but also other facilities, at a rate of 9-17% (Table S2) . Appropriate guidelines for PPE usage by medical providers and COVID-19 testing for pregnant women before delivery are necessary in Japan.

abstract:
  AIM: To clarify the status of personal protective equipment (PPE) and coronavirus disease 2019 (COVID‐19) tests for pregnant women, we conducted an urgent survey. METHODS: The survey was conducted online from April 27 to May 1, 2020. Questionnaires were sent to core facilities and affiliated hospitals of the obstetrics and gynecology training program and to hospitals of the national perinatal medical liaison council. RESULTS: A total of 296 institutions participated in our survey; however, 2 institutions were excluded. Full PPE was used by doctors in 7.1% of facilities and by midwives in 6.8%. Our study also determined that around 65.0% of facilities for doctors and 73.5% of facilities for midwives used PPE beyond the “standard gown or apron, surgical mask, goggles or face shield” during labor of asymptomatic women. N95 masks were running out of stock at 6.5% of the facilities and goggles and face shields at 2.7%. Disposable N95 masks and goggles or face shields were re‐used after re‐sterilization in 12% and 14% of facilities, respectively. Polymerase chain reaction (PCR) testing of asymptomatic patients was performed for 9% of vaginal deliveries, 14% of planned cesarean sections and 17% of emergency cesarean sections. The number of PCR tests for obstetrics and gynecology per a week ranged from zero to five in 92% of facilities. CONCLUSION: The shortage of PPE in Japan is alarming. Sufficient stockpiling of PPE is necessary to prevent unnecessary disruptions in medical care. Appropriate guidelines for PPE usage and COVID‐19 testing of pregnant women at delivery are needed in Japan.


id: cord-322382-p46slvka
title: 3-D Printed Protective Equipment during COVID-19 Pandemic
author: Wesemann, Christian
date: 2020-04-24
txt: ./txt/cord-322382-p46slvka.txt
cache: ./cache/cord-322382-p46slvka.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32344688/
doi: 10.3390/ma13081997
summary:
  Therefore, to provide HCWs with sufficient PPEs to increase facial protection, face shields could be 3-D printed. The increased space between the face and visor is sufficient for essential eye and mouth-nose protective equipment, but, at the same time, lateral protection against aerosols when using pre-fabricated DIN A4 foils is reduced. For effective and efficient manufacturing of the face shields presented in this study, fused deposition modeling (FDM) was preferred due to its increased printing capability and minimal post-processing requirements. Easy to use and self-sustaining face shield production using one''s own printing capabilities in combination with sufficiently available, commercial goods, such as the laser copy foils in the current study, can be considered to help protect HCWs from aerosol or accidental hand-to-face contamination during their daily clinical routines. 3-D printing of the frame of a face shield was possible using open-source data and biodegradable material.

abstract:
  While the number of coronavirus cases from 2019 continues to grow, hospitals are reporting shortages of personal protective equipment (PPE) for frontline healthcare workers. Furthermore, PPE for the eyes and mouth, such as face shields, allow for additional protection when working with aerosols. 3-D printing enables the easy and rapid production of lightweight plastic frameworks based on open-source data. The practicality and clinical suitability of four face shields printed using a fused deposition modeling printer were examined. The weight, printing time, and required tools for assembly were evaluated. To assess the clinical suitability, each face shield was worn for one hour by 10 clinicians and rated using a visual analogue scale. The filament weight (21–42 g) and printing time (1:40–3:17 h) differed significantly between the four frames. Likewise, the fit, wearing comfort, space for additional PPE, and protection varied between the designs. For clinical suitability, a chosen design should allow sufficient space for goggles and N95 respirators as well as maximum coverage of the facial area. Consequently, two datasets are recommended. For the final selection of the ideal dataset to be used for printing, scalability and economic efficiency need to be carefully balanced with an acceptable degree of protection.


id: cord-322871-cf4mn0pu
title: Ebola Emergency Preparedness: Simulation Training for Frontline Health Care Professionals
author: O''Keeffe, Dara Ann
date: 2016-08-08
txt: ./txt/cord-322871-cf4mn0pu.txt
cache: ./cache/cord-322871-cf4mn0pu.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/30800728/
doi: 10.15766/mep_2374-8265.10433
summary:
  The primary goal of this program was to ensure the safety of staff, patients, and the general public by training staff in the correct use of personal protective equipment (PPE) before, during, and after care of patients with EVD. RESULTS: This program was effectively deployed in the STRATUS Center for Medical Simulation over a 4-month period, with 220 health care professionals participating in the training and 195 participants completing the pre-/posttraining questionnaires. DISCUSSION: This interprofessional simulation-based program has been shown to be a well-received method of training clinicians to manage patients collaboratively during an EVD outbreak. Here, we describe a simulation laboratory-based program that was used as the foundation training for frontline staff in the correct use of PPE for clinical care activities. Our interprofessional simulation-based program has been shown to be a well-received method of training clinicians to manage patients collaboratively during an EVD outbreak.

abstract:
  INTRODUCTION: At Brigham and Women's Hospital, we identified the need for a comprehensive training program designed to prepare frontline staff to safely manage a patient with Ebola viral disease (EVD). The primary goal of this program was to ensure the safety of staff, patients, and the general public by training staff in the correct use of personal protective equipment (PPE) before, during, and after care of patients with EVD. METHODS: We delivered a 4-hour experiential training program to frontline health care professionals who would be expected to care for a patient with EVD. The program occurred in a simulation center with multiple flexible spaces and consisted of demonstration, multiple skills practice sessions, and a patient simulation case. We analyzed completed pre- and posttraining questionnaires. The questionnaire assessed their subjective level of confidence in three key areas: donning and doffing PPE, performing clinical skills while wearing PPE, and management of a contamination breach. RESULTS: This program was effectively deployed in the STRATUS Center for Medical Simulation over a 4-month period, with 220 health care professionals participating in the training and 195 participants completing the pre-/posttraining questionnaires. Our intervention significantly increased the confidence of participants on each primary objective (p = .001 for all three stations). DISCUSSION: This interprofessional simulation-based program has been shown to be a well-received method of training clinicians to manage patients collaboratively during an EVD outbreak. Our intent is that the skills taught in this training program would also be transferable to management of other infectious diseases in the clinical setting.


id: cord-323008-xk89ew1b
author: Rama, Asheen
date: 2020-08-30
txt: ./txt/cord-323008-xk89ew1b.txt
cache: ./cache/cord-323008-xk89ew1b.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0952818020315403
doi: 10.1016/j.jclinane.2020.110019
abstract: nan
summary:
  title: Individualized simulations in a time of social distancing: Learning on donning and doffing of an COVID-19 airway response team Recently, common biosafety breaches during donning and doffing of protective personal equipment (PPE) have been reported [2] . With the approval and wavier of institutional IRB, we report here our findings of examining our staff training regarding the common biosafety breaches in donning and doffing for aerosols generating medical procedures (AGMPs) based on key areas identified by Munoz-Leyva and Niazi [2] . Given the vast number of HCWs who are becoming infected with COVID-19 [6] , it is of vital importance that we not only distribute knowledge on PPE in the form of protocols, guidelines, demonstrations, and videos, but also provide simulations with personalized feedback which improves staff safety in anticipation of potential second wave infection as the world reopens [6] . Common breaches in biosafety during donning and doffing of protective personal equipment used in the care of COVID-19 patients

title:
  Individualized simulations in a time of social distancing: Learning on donning and doffing of an COVID-19 airway response team


id: cord-324654-nnojaupv
title: How 3D Printing and Social Media Tackles the PPE Shortage during Covid – 19 Pandemic
author: Vordos, Nick
date: 2020-06-07
txt: ./txt/cord-324654-nnojaupv.txt
cache: ./cache/cord-324654-nnojaupv.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32536750/
doi: 10.1016/j.ssci.2020.104870
summary:
  During the recent Covid-19 pandemic, additive Technology and Social Media were used to tackle the shortage of Personal Protective Equipment. They explore how 3D printed designs were utilized to address the Covid-19 pandemic, as well how the QALY model can be applied in this case to measure the effects of the use of PPE. The ultimate goal of the article is to highlight the use of Social Media and additive technology in general from common users, to address the lack of basic personal protective equipment or even parts of machinery used by health professionals. Patients using PPE gained quality of life compared to health worker professionals from Europe or US, without the usage of PPEs. This study examined the way individual social media users and 3D printer owners tackle the PPE shortage during a pandemic.

abstract:
  During the recent Covid-19 pandemic, additive Technology and Social Media were used to tackle the shortage of Personal Protective Equipment. A literature review and a social media listening software were employed to explore the number of the users referring to specific keywords related to 3D printing and PPE. Additionally, the QALY model was recruited to highlight the importance of the PPE usage. More than 7 billion users used the keyword covid or similar in the web while mainly Twitter and Facebook were used as a world platform for PPE designs distribution through individuals and more than 100 different 3D printable PPE designs were developed.


id: cord-327595-00fxzyhq
title: American Geriatrics Society (AGS) Policy Brief: COVID‐19 and Assisted Living Facilities
author: nan
date: 2020-05-14
txt: ./txt/cord-327595-00fxzyhq.txt
cache: ./cache/cord-327595-00fxzyhq.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1111/jgs.16510
doi: 10.1111/jgs.16510
summary:
  This policy brief sets forth the American Geriatrics Society''s (AGS''s) recommendations to guide federal, state, and local governments when making decisions about care for older adults in assisted living facilities (ALFs) during the coronavirus disease 2019 (COVID‐19) pandemic. ALFs, other congregate living settings (eg, NHs, residential care facilities for older adults, continuing care retirement communities), and home healthcare agencies (eg, Visiting Nurse Association) must be included as priorities when estimating what is needed for the US coordinated response to COVID-19. For older adults residing in ALFs and other congregate living settings, screening for COVID-19 will be particularly important for protecting the health and safety of their communities. This includes the ability to isolate or cohort the resident(s) separately from the rest of the community and provide dedicated staff to meet increased care needs for people with COVID-19.

abstract:
  This policy brief sets forth the American Geriatrics Societyʼs (AGSʼs) recommendations to guide federal, state, and local governments when making decisions about care for older adults in assisted living facilities (ALFs) during the coronavirus disease 2019 (COVID‐19) pandemic. It focuses on the need for personal protective equipment, access to testing, public health support for infection control, and workforce training. The AGS continues to review guidance set forth in peer‐reviewed articles, as well as ongoing and updated guidance from the US Department of Health and Human Services, the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and other key agencies. This brief is based on the situation and any federal guidance or actions as of April 15, 2020. Joining a separate AGS policy brief on COVID‐19 in nursing homes (DOI: https://doi.org/10.1111/jgs.16477), this brief is focused on ALFs, given that varied structure and staffing can impact their response to COVID‐19.


id: cord-329268-0zhabgkt
author: Savoia, E.
date: 2020-05-01
txt: ./txt/cord-329268-0zhabgkt.txt
cache: ./cache/cord-329268-0zhabgkt.txt
extension: .txt
mime: text/plain
url: http://medrxiv.org/cgi/content/short/2020.04.24.20073924v1?rss=1
doi: 10.1101/2020.04.24.20073924
summary:
  This study aimed to understand physicians access to personal protective equipment (PPE) and to information about their use, risk perception and strategies adopted to prevent contracting the infection. This study aimed to understand physicians'' access to PPE, reception of information about their use, ability to perform donning and doffing procedures, risk perception and strategies adopted to prevent contracting the infection. Questions were designed to inform the development of training and policies in response to the crisis and included questions about the physician''s work experience (years of experience, specialty, experience in COVID-19 units and geographic area of work), and questions related to the use of PPE divided in four parts: 1) Access to PPE and strategies to cope with shortage, 2) Information received on the use of PPE, 3) Self-reported ability to perform donning and doffing procedures, and 4) Risk perception of contracting the disease.

title:
  Factors Associated with Access and Use of PPE during COVID-19: A Cross-sectional Study of Italian Physicians

abstract:
  Objectives During the course of the Novel Coronavirus (SARS-CoV-2) pandemic, Italy has reported one of the highest number of infections. Nearly ten percent of reported coronavirus infections in Italy occurred in healthcare workers. This study aimed to understand physicians access to personal protective equipment (PPE) and to information about their use, risk perception and strategies adopted to prevent contracting the infection. Methods We undertook a cross-sectional, online self-reported survey implemented between March 31 and April 5 2020 of Italian physicians. Results Responses were received from 529 physicians, only 13% of which reported to have access to PPE every time they need them. Approximately half of the physicians reported that the information received about the use of PPE was either clear (47%) or complete (54%). Risk perception about contracting the infection was influenced by receiving adequate information on the use of PPE. Access to adequate information on the use of PPE was associated with better ability to perform donning and doffing procedures [OR=2.2 95% C.I. 1.7-2.8] and reduced perception of risk [OR=0.5, 95% C.I. 0.4-0.6]. Conclusions Results from this rapid survey indicate that while ramping up supplies on PPE for healthcare workers is certainly of mandatory importance, adequate training and clear instructions are just as important.


id: cord-329921-mi71bet3
author: Ogoina, Dimie
date: 2020-08-11
txt: ./txt/cord-329921-mi71bet3.txt
cache: ./cache/cord-329921-mi71bet3.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1093/trstmh/traa063
doi: 10.1093/trstmh/traa063
abstract: nan
summary:
  In light of the absence of alternative technologies, and the need to define the chest signs of severe COVID-19 cases upon admission to our isolation ward, we explored redesigning the head covering of some of our PPE to enable auscultation of the lungs and hearts of COVID-19 patients using manual stethoscopes. The redesigned head covering is worn by a clinician, who can easily place the earpiece of the manual stethoscope into both ears through the refashioned ear pouches of the hood (Figure 1 ). In resource-limited settings where alternative technologies may be lacking, clinicians managing COVID-19 patients should consider redesigning the head covering of PPE to make provisions for the use of manual stethoscopes. Manufacturers of PPE should also consider creating ear pouches as part of the product design of head coverings to allow for the routine use of manual stethoscopes during the care of contagious infectious diseases such as COVID-19.

title:
  COVID-19: the need to redesign head coverings of personal protective equipment for manual stethoscopes


id: cord-330333-un8lvw5o
author: Pieterse, Pieternella
date: 2020-09-30
txt: ./txt/cord-330333-un8lvw5o.txt
cache: ./cache/cord-330333-un8lvw5o.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1002/hpm.3080
doi: 10.1002/hpm.3080
summary:
  Locally made, washable and reusable personal protective equipment (PPE), used in combination with N95 masks that were reused safely, has proven to be a viable alternative to disposable gowns and caps for hospital staff in low‐ and middle‐income countries. Muhimbili University Hospital''s children''s cancer ward in Dar es Salaam, Tanzania, developed locally made PPE and created rigorous cleaning and disinfecting protocols, when the daily use of imported, disposable materials were not an option. In early March, when there were mere rumours of the virus across the continent, the children''s oncology ward management decided that everyone (including administrators, cleaners, patients and guardians, as well as nurses and doctors), would wear a mask at all times regardless of symptoms, and carry disinfectant gel to clean hands as frequently as possible. Locally produced personal protective equipment can offer hospital staff protection against Covid-19 if combined with surgical masks and rigorous personal protective equipment cleaning routine

title:
  Locally produced personal protective equipment can offer hospital staff protection against Covid‐19 if combined with surgical masks and rigorous personal protective equipment cleaning routine

abstract:
  Locally made, washable and reusable personal protective equipment (PPE), used in combination with N95 masks that were reused safely, has proven to be a viable alternative to disposable gowns and caps for hospital staff in low‐ and middle‐income countries. Muhimbili University Hospital's children's cancer ward in Dar es Salaam, Tanzania, developed locally made PPE and created rigorous cleaning and disinfecting protocols, when the daily use of imported, disposable materials were not an option. These items continue to protect staff, children and parents. The novel PPE approach was able to prevent staff from becoming infected during the pandemic despite the fact that several parents, and subsequently their children, became infected with Covid‐19 during cancer treatment at the facility.


id: cord-330666-puhijixa
author: Carrico, Ruth M.
date: 2007-02-02
txt: ./txt/cord-330666-puhijixa.txt
cache: ./cache/cord-330666-puhijixa.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/17276786/
doi: 10.1016/j.ajic.2005.12.013
summary:
  BACKGROUND: This pilot study was conducted to determine whether supplementing standard classroom training methods regarding respiratory disease transmission with a visual demonstration could improve the use of personal protective equipment among emergency department nurses. CONCLUSION: Supplementing the standard training methods with a visual demonstration can improve the use of personal protective equipment during care of patients exhibiting respiratory symptoms. We used pre-/posttest knowledge assessments and observations of HCW-patient interactions to evaluate the impact of the visual demonstration of respiratory disease transmission on PPE use by HCWs. The study was conducted during the peak of the 2005 influenza season (January to March) to ensure that the HCWs could be observed interacting with the greatest number of patients with respiratory symptoms. Observers with experience in the education and training of health care personnel were trained to recognize and evaluate the use of PPE by study participants during real patient interaction.

title:
  Changing health care worker behavior in relation to respiratory disease transmission with a novel training approach that uses biosimulation

abstract:
  BACKGROUND: This pilot study was conducted to determine whether supplementing standard classroom training methods regarding respiratory disease transmission with a visual demonstration could improve the use of personal protective equipment among emergency department nurses. METHODS: Participants included 20 emergency department registered nurses randomized into 2 groups: control and intervention. The intervention group received supplemental training using the visual demonstration of respiratory particle dispersion. Both groups were then observed throughout their work shifts as they provided care during January-March 2005. RESULTS: Participants who received supplemental visual training correctly utilized personal protective equipment statistically more often than did participants who received only the standard classroom training. CONCLUSION: Supplementing the standard training methods with a visual demonstration can improve the use of personal protective equipment during care of patients exhibiting respiratory symptoms.


id: cord-330737-6khv4kbj
title: Contributing factors to personal protective equipment shortages during the COVID-19 pandemic
author: Cohen, Jennifer
date: 2020-10-02
txt: ./txt/cord-330737-6khv4kbj.txt
cache: ./cache/cord-330737-6khv4kbj.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33017601/
doi: 10.1016/j.ypmed.2020.106263
summary:
  Problems from a dysfunctional costing model in hospital operating systems were magnified by a very large demand shock triggered by acute need in healthcare and panicked marketplace behavior that depleted domestic PPE inventories. Removing the profit motive for purchasing PPE in hospital costing models and pursuing strategic industrial policy to reduce the US dependence on imported PPE will both help to better protect healthcare workers with adequate supplies of PPE. Since early 2020 the US has experienced a severe shortage of personal protective equipment (PPE) needed by healthcare workers fighting the COVID-19 pandemic (Emanuel et al., 2020; Livingston, Desai, & Berkwits, 2020) . We now turn to our analysis of PPE shortages, which identifies on four contributing factors: the way that hospitals budget for PPE, domestic demand shocks, federal government failures, and disruptions to the global supply chain (Figure 2 ).

abstract:
  This study investigates the forces that contributed to severe shortages in personal protective equipment in the US during the COVID-19 crisis. Problems from a dysfunctional costing model in hospital operating systems were magnified by a very large demand shock triggered by acute need in healthcare and panicked marketplace behavior that depleted domestic PPE inventories. The lack of appropriate action on the part of the federal government to maintain and distribute domestic inventories, as well as severe disruptions to the PPE global supply chain, amplified the problem. Analysis of trade data shows that the US is the world's largest importer of face masks, eye protection, and medical gloves, making it highly vulnerable to disruptions in exports of medical supplies. We conclude that market prices are not appropriate mechanisms for rationing inputs to health because health is a public good. Removing the profit motive for purchasing PPE in hospital costing models and pursuing strategic industrial policy to reduce the US dependence on imported PPE will both help to better protect healthcare workers with adequate supplies of PPE.


id: cord-330870-l0ryikhv
title: Obstetric Simulation for a Pandemic
author: Eubanks, Allison
date: 2020-07-23
txt: ./txt/cord-330870-l0ryikhv.txt
cache: ./cache/cord-330870-l0ryikhv.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S014600052030077X
doi: 10.1016/j.semperi.2020.151294
summary:
  Conclusion: In the current COVID-19 pandemic, simulating obstetrical patient care from presentation to the hospital triage through postpartum care can prepare teams for even the most complicated patients while increasing their ability to protect themselves and their patients. Conclusion: In the current COVID-19 pandemic, simulating obstetrical patient care from presentation to the hospital triage through postpartum care can prepare teams for even the most complicated patients while increasing their ability to protect themselves and their patients. Communication, teamwork, and process efficiency are dramatically increased with simulations, which is why they are quickly being adapted as an essential part of medical training for small team events like codes and postpartum hemorrhages and large-scale, multi-hospital emergencies, disasters, and pandemics. The Ebola outbreak in 2014-2016 was the most recent event that demonstrated a need for pandemic and disaster preparedness throughout the country, as hospitals quickly realized they did not have plans for admitting, transporting, and caring for these highly contagious patients 6, 8, 15, 16 .

abstract:
  OBJECTIVE: In the middle of the COVID-19 pandemic, guidelines and recommendations are rapidly evolving. Providers strive to provide safe high-quality care for their patients in the already high-risk specialty of Obstetrics while also considering the risk that this virus adds to their patients and themselves. From other pandemics, evidence exists that simulation is the most effective way to prepare teams, build understanding and confidence, and increase patient and provider safety. FINDING: Practicing in-situ multidisciplinary simulations in the hospital setting has illustrated key opportunities for improvement that should be considered when caring for a patient with possible COVID-19. CONCLUSION: In the current COVID-19 pandemic, simulating obstetrical patient care from presentation to the hospital triage through postpartum care can prepare teams for even the most complicated patients while increasing their ability to protect themselves and their patients.


id: cord-331533-0toegbv8
author: Leiker, Brenna
date: 2020-07-27
txt: ./txt/cord-331533-0toegbv8.txt
cache: ./cache/cord-331533-0toegbv8.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32800348/
doi: 10.1016/j.disamonth.2020.101060
abstract: nan
summary:
  The approach to the coronavirus pandemic in the emergency department focused on identification and isolation of infected individuals, adequate protection of staff, reporting of positive cases to the health department, effective treatment, and education of patients and families. APP''s in the ICU have been critical in helping fill the gaps where additional staff where needed to care for COVID patients, make calls to update family members, and provide input for treatment protocols We, the authors of this article, work as APP''s within the NorthShore emergency department. 1,865 Illinois residents have tested positive for the virus, and 26 have died as of Thursday (03/26) at 2:30 p.m., according to the state''s Coronavirus (COVID-19) Response webpage." (Herscowitz, 2020) Despite the virus''s rapid spread, NorthShore and IDPH worked to match the testing protocol with the demand within the community.

title:
  COVID – 19 CASE STUDY IN EMERGENCY MEDICINE PREPAREDNESS AND RESPONSE; FROM PERSONAL PROTECTIVE EQUIPMENT TO DELIVERGY OF CARE


id: cord-331978-y4uo7o8g
title: “The Art of War” in the Era of Coronavirus Disease 2019 (COVID-19)
author: Maxwell, Daniel N
date: 2020-03-04
txt: ./txt/cord-331978-y4uo7o8g.txt
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mime: text/plain
url: https://doi.org/10.1093/cid/ciaa229
doi: 10.1093/cid/ciaa229
abstract: nan
summary:
  With rapidly increasing cases and local community transmission in multiple countries outside of China, including the United States, the outbreak has entered a new phase, which requires a shift in primary battle strategy from a focus on containment in China to international mitigation. As cases of COVID-19 explode internationally, a strategic shift is required away from primarily containment, keeping the virus "out there", to home-based mitigation and public health responses. Now, the task is bearing the burden of identifying, isolating, triaging and managing the rising number of cases, necessitating total engagement of the medical community, public health sector, governments and society as a whole. As Sun Tzu noted, "If in training soldiers'' commands are habitually enforced, the army will be well-disciplined." 1 The authors also highlight improvements in infection prevention and control (IPC) infrastructure, administrative controls, and public health coordination compared to their 2003 SARS experience.


id: cord-332083-135iic7m
author: Xia, Wei
date: 2020-09-29
txt: ./txt/cord-332083-135iic7m.txt
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mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32994038/
doi: 10.1016/j.jen.2020.08.004
summary:
  INTRODUCTION: The purpose of this study was to rapidly quantify the safety measures regarding donning and doffing personal protective equipment, complaints of discomfort caused by wearing personal protective equipment, and the psychological perceptions of health care workers in hospitals in Wuhan, China, responding to the outbreak. Detailed donning and doffing procedures are described in the Supplementary Figure The purpose of this study was to rapidly quantify the safety measures of donning and doffing PPE, complaints of discomfort caused by wearing PPE, and the psychological perceptions of HCWs in hospitals in Wuhan, China, responding to the COVID-19 outbreak. Because our participants were all HCWs in Wuhan hospitals, we divided their demographic information as follows: the demographic variables included sex (male or female); age (20-30 years, 30-40 years, 40-50 years, and >50 years); occupation (physician, nurse, pharmacist, medical technician, or other); workplace (a designated hospital for patients critically ill with severe COVID-19; an undesignated hospital for patients uninfected with COVID-19; and Fangcang Hospital for patients with mild symptoms of COVID-19); and department (general isolation ward, intensive care unit [ICU], emergency department for patients with fevers, and other).

title:
  The Physical and Psychological Effects of Personal Protective Equipment on Health Care Workers in Wuhan, China: A Cross-Sectional Survey Study

abstract:
  INTRODUCTION: The purpose of this study was to rapidly quantify the safety measures regarding donning and doffing personal protective equipment, complaints of discomfort caused by wearing personal protective equipment, and the psychological perceptions of health care workers in hospitals in Wuhan, China, responding to the outbreak. METHODS: A cross-sectional online questionnaire design was used Data were collected from March 14, 2020, to March 16, 2020, in Wuhan, China. Descriptive statistics and χ square analyses testing were used. RESULTS: Standard nosocomial infection training could significantly decrease the occurrence of infection (3.6% vs 13.0%, χ(2) = 4.47, P < 0.05). Discomfort can be classified into 7 categories. Female sex (66.0% vs 50.5%, χ(2) = 6.37), occupation (62.7% vs 30.8%, χ(2) = 5.33), working at designated hospitals (44.8% vs 26.7%, χ(2) = 5.17) or in intensive care units (70.4% vs 57.9%, χ(2) = 3.88), and working in personal protective equipment for > 4 hours (62.2% vs 39.2%, χ(2) = 9.17) led to more complaints about physical discomfort or increased occurrence of pressure sores (all P < 0.05). Psychologically, health care workers at designated hospitals (60.0% vs 42.1%, χ(2) = 4.97) or intensive care units (55.9% vs 41.5%, χ(2) = 4.40) (all P < 0.05) expressed more pride. DISCUSSION: Active training on infection and protective equipment could reduce the infection risk. Working for long hours increased the occurrence of discomfort and skin erosion. Reducing the working hours and having adequate protective products and proper psychological interventions may be beneficial to relieve discomfort.


id: cord-332815-1w1ikj7q
title: Lesson Learned from China Regarding Use of Personal Protective Equipment
author: Zhan, Mingkun
date: 2020-08-11
txt: ./txt/cord-332815-1w1ikj7q.txt
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mime: text/plain
url: https://doi.org/10.1016/j.ajic.2020.08.007
doi: 10.1016/j.ajic.2020.08.007
summary:
  METHODS: Based on their prior experience with the 2003 SARS epidemic, health authorities in China recognized the need for personal protective equipment (PPE). Existing PPE and protocols were limited and reflected early experience with SARS; however, as additional PPE supplies became available, designated COVID-19 hospitals in Hubei Province adopted the World Health Organization guidelines for Ebola to create a protocol specific for treating patients with COVID-19. The paper focuses primarily on the use of PPE to help prevent transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to HCWs. The aim is to provide more detail regarding level-3 protection protocols used at designated COVID-19 hospitals in Hubei Province to prevent the spread of the virus to HCWs. The methods to protect HCWs, designated as level-3 protection in China, included a personal protection protocol for proper use of PPE with coveralls and procedures for changes to the flow of patients and personnel through the designated COVID-19 hospitals.

abstract:
  BACKGROUND: In Wuhan, China, in December 2019, the novel coronavirus was detected. The virus causing COVID-19 was related to a coronavirus named severe acute respiratory syndrome coronavirus (SARS-CoV). The virus caused an epidemic in China and was quickly contained in 2003. Although coming from the same family of viruses and sharing certain transmissibility factors, the local health institutions in China had no experience with this new virus, subsequently named SARS-CoV-2. METHODS: Based on their prior experience with the 2003 SARS epidemic, health authorities in China recognized the need for personal protective equipment (PPE). Existing PPE and protocols were limited and reflected early experience with SARS; however, as additional PPE supplies became available, designated COVID-19 hospitals in Hubei Province adopted the World Health Organization guidelines for Ebola to create a protocol specific for treating patients with COVID-19. RESULTS: This article describes the PPE and protocol for its safe and effective deployment and the implementation of designated hospital units for COVID-19 patients. To date, only two nurses working in China who contracted SARS-CoV-2 have died from COVID-19 in the early period of the epidemic (February 11 and 14, 2020). CONCLUSION: The lessons learned by health care workers in China are shared in the hope of preventing future occupational exposure.


id: cord-332932-mq36xpai
author: Wood, David A.
date: 2020-05-04
txt: ./txt/cord-332932-mq36xpai.txt
cache: ./cache/cord-332932-mq36xpai.txt
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mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0735109720351652
doi: 10.1016/j.jacc.2020.04.063
abstract: nan
summary:
  In this consensus report, we harmonize recommendations from North American cardiovascular societies and provide guidance on the safe reintroduction of invasive cardiovascular procedures and diagnostic tests after the initial peak of the COVID-19 pandemic. As discussed below, COVID-19 testing of potential patients and health care workers (HCW), as well as personal protective equipment (PPE), must also be carefully monitored to minimize the risk of shortages as the pandemic escalates and abates. 2) COVID-19 Screening: Encourage routine screening of all patients prior to any cardiovascular procedure or test to ensure the safety of HCWs. This testing may include nasopharyngeal swabs and saliva or rapid antibody tests and should be guided by local institutional infectious disease experts and closely coordinated with regional public health officials. It provides an ethical framework with appropriate safeguards for the gradual reintroduction of invasive cardiovascular procedures and diagnostics tests after the initial peak of the COVID-19 pandemic.

title:
  Safe Reintroduction of Cardiovascular Services during the COVID-19 Pandemic: Guidance from North American Society Leadership


id: cord-333509-dnuakd6h
author: Chan, Hui Yun
date: 2020-10-17
txt: ./txt/cord-333509-dnuakd6h.txt
cache: ./cache/cord-333509-dnuakd6h.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s10991-020-09270-z
doi: 10.1007/s10991-020-09270-z
summary:
  Recent developments have witnessed strong responses from the public and healthcare workers, ranging from pursuing legal actions against the government or their employers (hospitals) for breaching their obligations of care towards employees to calling for a full public inquiry into pandemic management, including the status of the PPE stockpile. PPE under the Regulations means "all equip-ment…intended to be worn or held by a person at work and which protects the person against one or more risks to that person''s health or safety, and any addition or accessory designed to meet that objective." 29 Consequently, PPE in the hospital context is broad enough to include all equipment that protect healthcare workers from infectious particles arising from aerosol generating procedures, ventilators, respirators or testing facilities with high concentrations of droplets or airborne diseases. Imposing the duty to provide PPE is therefore central in ensuring healthcare workers are protected from the risks of infection and to realise the aim of delivering patient-centred care to the public.

title:
  Hospitals’ Liabilities in Times of Pandemic: Recalibrating the Legal Obligation to Provide Personal Protective Equipment to Healthcare Workers

abstract:
  The Covid-19 pandemic has precipitated the global race for essential personal protective equipment in delivering critical patient care. This has created a dearth of personal protective equipment availability in some countries, which posed particular harm to frontline healthcare workers’ health and safety, with undesirable consequences to public health. Substantial discussions have been devoted to the imperative of providing adequate personal protective equipment to frontline healthcare workers. The specific legal obligations of hospitals towards healthcare workers in the pandemic context have so far escaped important scrutiny. This paper endeavours to examine this overlooked aspect in the light of legal actions brought by frontline healthcare workers against their employers arising from a shortage of personal protective equipment. By analysing the potential legal liabilities of hospitals, the paper sheds light on the interlinked attributes and factors in understanding hospitals’ obligations towards healthcare workers and how such duty can be justifiably recalibrated in times of pandemic.


id: cord-333554-0wlgg450
author: Curzen, Nick
date: 2020-04-16
txt: ./txt/cord-333554-0wlgg450.txt
cache: ./cache/cord-333554-0wlgg450.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.15420/icr.2020.10
doi: 10.15420/icr.2020.10
abstract: nan
summary:
  The presidents of BCS and BCIS have released a joint statement of support and advice to our members, and have contributed to an NHS England statement about recommendations for ongoing cardiology activities. We suggest that clinical leads/senior cath lab staff have discussions across local networks regarding potential cross cover for emergency patients between local centres, in case this becomes necessary. To this end, the NHS England guidance continues to recommend primary PCI for STEMI and angiography with a view to revascularisation for all non-ST-elevation MI (NSTEMI) patients, except perhaps the lowest risk group. However, for BCIS members, it is the optimal PPE for cath lab procedures, especially primary PCI for STEMI, that has raised most anxiety and contention. For other situations the cath lab, when deemed low risk of AGP, can be regarded as an inpatient area or operating theatre with suspected or confirmed COVID-19 cases, and type 1 PPE is recommended for all those with direct patient contact.

title:
  An Extended Statement by the British Cardiovascular Intervention Society President Regarding the COVID-19 Pandemic


id: cord-334124-w9jww3hk
author: Murphy, David L
date: 2020-09-21
txt: ./txt/cord-334124-w9jww3hk.txt
cache: ./cache/cord-334124-w9jww3hk.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1136/emermed-2020-210095
doi: 10.1136/emermed-2020-210095
summary:
  We reviewed dispatch, EMS and public health surveillance records to evaluate the temporal relationship between exposure and programmatic changes to EMS operations designed to identify high-risk patients, protect the workforce and conserve PPE. We evaluated all 9-1-1 EMS responses to patients with COVID-19 to (1) determine occupational exposure, related workforce quarantine and potential transmission, and (2) understand how programmatic changes influenced occupational exposure, workforce quarantine and PPE use amidst the COVID-19 outbreak in Seattle and King County. The study is a retrospective cohort investigation of EMS providers responding to 9-1-1 calls for laboratory-confirmed COVID-19-positive patients in King County, Washington, USA between 14 February 2020 and 26 March 2020. The series of practice changes involving dispatch advisement, patient COVID-19 risk criteria and initial EMS scene deployment were associated with a temporal increase in adequate PPE use and conversely a decrease in EMS provider exposures (figure 2, p<0.01).

title:
  Occupational exposures and programmatic response to COVID-19 pandemic: an emergency medical services experience

abstract:
  Rigorous assessment of occupational COVID-19 risk and personal protective equipment (PPE) use is not well-described. We evaluated 9-1-1 emergency medical services (EMS) encounters for patients with COVID-19 to assess occupational exposure, programmatic strategies to reduce exposure and PPE use. We conducted a retrospective cohort investigation of laboratory-confirmed patients with COVID-19 in King County, Washington, USA, who received 9-1-1 EMS responses from 14 February 2020 to 26 March 2020. We reviewed dispatch, EMS and public health surveillance records to evaluate the temporal relationship between exposure and programmatic changes to EMS operations designed to identify high-risk patients, protect the workforce and conserve PPE. There were 274 EMS encounters for 220 unique COVID-19 patients involving 700 unique EMS providers with 988 EMS person-encounters. Use of ‘full’ PPE including mask (surgical or N95), eye protection, gown and gloves (MEGG) was 67%. There were 151 person-exposures among 129 individuals, who required 981 quarantine days. Of the 700 EMS providers, 3 (0.4%) tested positive within 14 days of encounter, though these positive tests were not attributed to occupational exposure from inadequate PPE. Programmatic changes were associated with a temporal reduction in exposures. When stratified at the study encounters midpoint, 94% (142/151) of exposures occurred during the first 137 EMS encounters compared with 6% (9/151) during the second 137 EMS encounters (p<0.01). By the investigation’s final week, EMS deployed MEGG PPE in 34% (3579/10 468) of all EMS person-encounters. Less than 0.5% of EMS providers experienced COVID-19 illness within 14 days of occupational encounter. Programmatic strategies were associated with a reduction in exposures, while achieving a measured use of PPE.


id: cord-334808-ds5yrr4w
title: Response to: Management of Traumatic Spinal Fracture in the Coronavirus Disease 2019 Situation
author: Liawrungrueang, Wongthawat
date: 2020-05-12
txt: ./txt/cord-334808-ds5yrr4w.txt
cache: ./cache/cord-334808-ds5yrr4w.txt
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mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32392647/
doi: 10.31616/asj.2020.0194.r1
abstract: nan
summary:
  I am wondering what your institute uses specifically for "full personal protective equipment (PPE)" for the high risk patients, i.e., National Institute for Occupational Safety and Health-approved (N95) respirator, face shield, etc. Our reply: In this review article, the authors concluded that an algorithm could help make decisions about surgical interventions for spine injuries in patients who are at risk for coronavirus disease 2019 (COVID-19) to prevent surgeons and nurses from contracting the virus. In this situation, where the health care professionals are in contact with a high-risk patient, the surgeons and nurses could use full PPE suits (Fig. 1A) . by anesthesiologists (B) , and intraoperative standard with full PPE according to Centers for Disease Control and Prevention guidelines (C). Management of traumatic spinal fracture in the coronavirus disease 2019 situation


id: cord-335477-po201szv
author: O''Leary, Fenton
date: 2020-09-21
txt: ./txt/cord-335477-po201szv.txt
cache: ./cache/cord-335477-po201szv.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32959477/
doi: 10.1111/1742-6723.13653
summary:
  OBJECTIVES: To estimate the Personal Protective Equipment (PPE) required in a Paediatric Emergency Department during the COVID‐19 pandemic comparing the use per patient to use per patient zone, based on the NSW Clinical Excellence Commission (CEC) guidelines in place at the time of the study. The aim of this study was to identify the number of staff contacts and AGPs with patients in the Paediatric ED over a 24 hour period and attribute PPE required according to the NSW CEC guideline and compare this to the PPE required based on staff zone allocations. Estimated PPE requirements for each of the three levels of risk of infection and transmission based on staff roles and zone allocations are described in Table 3 -supplementary file and based on patient contacts and procedures in Table 4 -supplementary file.

title:
  Personal Protective Equipment in the Paediatric Emergency Department during the COVID‐19 pandemic. Estimating requirements based on staff numbers and patient presentations.

abstract:
  OBJECTIVES: To estimate the Personal Protective Equipment (PPE) required in a Paediatric Emergency Department during the COVID‐19 pandemic comparing the use per patient to use per patient zone, based on the NSW Clinical Excellence Commission (CEC) guidelines in place at the time of the study. METHODS: A retrospective case note review of all patients and staff present in the emergency department of The Children's Hospital at Westmead, Sydney, Australia in the 24hour period of Sunday 5(th) April 2020. The primary outcome of PPE estimates was generated from identifying the number of patient contacts and aerosol generating procedures (AGPs) performed per patient as well as the number of staff on shift. RESULTS: One hundred patients attended the ED (50% of usual) and all were included in the study. For a low risk community environment allocating PPE per patient contact required 48 face shields, 382 surgical masks, 48 N95 masks and 430 gowns for the day, increasing to 430 face shields, 331 surgical masks, 430 N95 masks and 761 gowns in a high‐risk community environment. Allocating PPE using zoning reduces the requirement to 48 face shields, 192 surgical masks, 48 N95 masks and 204 gowns, increasing to 196 face shields, 96 surgical masks, 196 N95 masks and 292 gowns per day in a high‐risk community environment. CONCLUSION: This study has demonstrated the considerable requirement for PPE in a Paediatric ED, which varies according to presentation type and the background prevalence of COVID‐19 in the community. This article is protected by copyright. All rights reserved.


id: cord-335638-p84nmtfp
author: Swaminathan, Ashwin
date: 2007-10-17
txt: ./txt/cord-335638-p84nmtfp.txt
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extension: .txt
mime: text/plain
url: https://doi.org/10.3201/eid1310.070033
doi: 10.3201/eid1310.070033
summary:
  This study aimed to estimate the resource needs that a hospital might face in the fi rst few hours of management of a single patient who sought treatment with possible avian or pandemic infl uenza (API) or similar highly virulent respiratory infection. The study outcome measures were the following: 1) number of close contacts associated with the API patient during the initial 6 hours of patient management, including how many of these were HCW close contacts; 2) the total number of exposures experienced by close contacts; 3) overall quantity and type of PPE items (gowns, gloves, N95 masks, eyewear) actually used during the simulation by HCW close contacts and ancillary HCWs; 4) overall "opportunities for PPE item use" for HCW close contacts and ancillary HCWs (i.e., actual use plus missed opportunities for appropriate PPE use); and 5) stratifi cation of HCW close contacts into medium-or low-risk groups for the purpose of recommending antiviral postexposure prophylaxis.

title:
  Personal Protective Equipment and Antiviral Drug Use during Hospitalization for Suspected Avian or Pandemic Influenza(1)

abstract:
  For pandemic influenza planning, realistic estimates of personal protective equipment (PPE) and antiviral medication required for hospital healthcare workers (HCWs) are vital. In this simulation study, a patient with suspected avian or pandemic influenza (API) sought treatment at 9 Australian hospital emergency departments where patient–staff interactions during the first 6 hours of hospitalization were observed. Based on World Health Organization definitions and guidelines, the mean number of “close contacts” of the API patient was 12.3 (range 6–17; 85% HCWs); mean “exposures” were 19.3 (range 15–26). Overall, 20–25 PPE sets were required per patient, with variable HCW compliance for wearing these items (93% N95 masks, 77% gowns, 83% gloves, and 73% eye protection). Up to 41% of HCW close contacts would have qualified for postexposure antiviral prophylaxis. These data indicate that many current national stockpiles of PPE and antiviral medication are likely inadequate for a pandemic.


