Resumption of dental practice after COVID-19 lockdown: perspectives of dental professionals in Karachi, Pakistan

BackgroundCorrect personal protective equipment (PPE) use is key to prevent infection. Observations on a single unit at the Veterans Affairs (VA) Tennessee Valley Healthcare System (TVHS) prior to COVID-19 (October 2019-February 2020) showed low rates of correct PPE use among healthcare workers (HCWs) (Figure 1). In response to the COVID-19 epidemic, the VA implemented new PPE protocols. Based on our initial observations, we were concerned that incorrect use of PPE may increase the risk of COVID-19 exposure among HCWs. Resident physicians, who work at many sites, may be at high-risk for incorrect PPE use due to rapid turnover and limited site-specific PPE training. We aimed to assess and improve COVID-19 PPE use among internal medicine residents rotating at the VA TVHS.Figure 1: Pre-COVID-19 Observations of Adherence to Contact Precaution Protocols at the Veterans Affairs Tennessee Valley Healthcare SystemMethodsWe used the plan, do, study, act (PDSA) model. Prior to starting VA rotations, residents were emailed PPE education to review. We implemented a 1-hour video conference PPE protocol review at rotation start followed by in-person PPE use evaluations for residents performed by infectious diseases fellows on day 2 and day 5-6 post-review to provide just-in-time educational intervention. Errors at each PPE don/doff step were tracked. Correct PPE use data from both observations were compared using McNemar’s test. Baseline and post-implementation resident surveys assessed PPE use knowledge and comfort.ResultsPre-implementation survey response rate was 72% (21/29); 19/21(91%) reported knowing which PPE to use and 16/21(76%) reported knowing how to safely don/doff PPE. Twenty of 29 (69%) residents completed both observations. Errors decreased by 55% (p=0.0045) from 17/20 (85%) to 6/20 (30%) between initial and follow up observations. Errors in hand hygiene, inclusion of all donning/doffing steps, and PPE reuse decreased, but PPE don/doff order errors increased (Figure 2). Post-project survey response rate was 16/29 (55%). All 16 reported knowing which PPE to use and how to safely don/doff PPE, and 11/16 (69%) residents felt both online and in-person interventions were helpful.Figure 2: COVID-19 PPE Errors and Correction Types by ObservationConclusionCorrect COVID-19 PPE use is essential to protect HCWs and patients. Just-in-time education intervention for PPE training may yield higher correct use compared to pre-recorded or online training.DisclosuresAll Authors: No reported disclosures

One form in avoiding the occurrence of occupational diseases and workplace accidents is to understand the use of PPE and wear personal protective equipment. Use of the intended personal protective equipment in which the scavenger conditions in the Tamangapa TPA while working with masks, boots, gloves and protective helmets. With the aim of preventing contamination of the disease and protecting the part or whole body there is a potential danger. This study aims to determine the relationship of knowledge and social economy to the use of personal protective equipment in garbage scavengers in TPA Tamangapa Makassar City. This research was conducted in TPA Tamangapa Kota Makassar. The research was conducted in January until February 2018. The research design used was analytic observational method is a research design that aims to see the relationship of two variables or without any treatment or intervention with cross sectional approach with the number of samples was 99 respondents according to the inclusion and exclusion criteria. Data collection using questionnaire and data analysis using statistic with chi square test. The result of bivariate analysis showed that there was a correlation of knowledge with the use of self-protective device p = 0.024, and there was an economic status relationship with the use of Personal Protective Equipment (p = 0,029). Conclusion there is a relationship between knowledge, and economic status of garbage scavengers in TPA Tamangapa Makassar City. It is advisable to garbage collectors to further improve their understanding and discipline of using Personal Protective Equipment when working.
 
 One form in avoiding the occurrence of occupational diseases and workplace accidents is to understand the use of PPE and wear personal protective equipment. Use of the intended personal protective equipment in which the scavenger conditions in the Tamangapa TPA while working with masks, boots, gloves and protective helmets. With the aim of preventing contamination of the disease and protecting the part or whole body there is a potential danger. This study aims to determine the relationship of knowledge and social economy to the use of personal protective equipment in garbage scavengers in TPA Tamangapa Makassar City. This research was conducted in TPA Tamangapa Kota Makassar. The research was conducted in January until February 2018. The research design used was analytic observational method is a research design that aims to see the relationship of two variables or without any treatment or intervention with cross sectional approach with the number of samples was 99 respondents according to the inclusion and exclusion criteria. Data collection using questionnaire and data analysis using statistic with chi square test. The result of bivariate analysis showed that there was a correlation of knowledge with the use of self-protective device p = 0.024, and there was an economic status relationship with the use of Personal Protective Equipment (p = 0,029). Conclusion there is a relationship between knowledge, and economic status of garbage scavengers in TPA Tamangapa Makassar City. It is advisable to garbage collectors to further improve their understanding and discipline of using Personal Protective Equipment when working.

The objective was to analyze the factors associated with use of Personal Protective Equipment (PPE) among Brazilian physicians during the COVID-19 pandemic. An analytical cross-sectional study was conducted from October to December 2020 with 1298 Brazilian physicians. The respondent driven sampling technique was used by sharing the survey through social media. Factors associated with the use of PPE while caring for COVID-19 patients were: being female (AOR = 1.57; 95% CI: 1.24-1.98; p ≤ 0.001); working in Intensive Care Unit (ICU) (AOR = 2.78; 95% CI: 2.06-3.75; p ≤ 0.001); training (AOR = 1.62; 95% CI: 1.25-2.09; p ≤ 0.001); access to sufficient PPE (AOR = 2.22; 95% CI: 1.27-3.90; p = 0.0050), and PPE of good quality (AOR = 1.84; 95% CI: 1.16-2.92; p = 0.009). The following factors were associated with the use of recommended PPE during procedures that generate aerosols in the context of COVID-19: working in the ICU (ORA=2.73; 95% CI: 2.06-3.62; p < 0.01); working in a field hospital (AOR = 1.37; 95% CI: 1.06-1.79; p = 0.018;) training (AOR = 1.72 95% CI: 1.32-2.24; p < 0.01); access to sufficient PPE (AOR = 1.63; 95% CI: 0.91-2.92; p < 0.01), PPE of good quality (AOR = 2.07; 95% CI: 1.28-3.35; p = 0.003). The factors associated with the use of necessary PPE with COVID-19 patients and for procedures that generate aerosols were identified. Educational interventions for professionals and managers must be implemented to direct them towards protecting themselves and others.

The COVID-19 pandemic created unprecedented challenges for nursing homes (NHs), particularly challenges related to personal protective equipment (PPE). This analysis explored PPE access and use by NH staff, residents, and visitors during the pandemic. As part of a larger study aimed at developing recommendations to improve NHs’ preparedness for infectious disease outbreaks, 116 interviews were conducted with leaders (n = 43), staff (n = 140), infection preventionists (n = 16) and residents/families (n = 63) from 24 Missouri NHs. Data were analyzed using directed content analysis to examine patterns of PPE access, usage, and challenges. To further verify challenges related to PPE access and use during the pandemic, a systematic review of 31 articles published between 2020 and 2023 was conducted. Interview findings revealed that all 24 NHs experienced PPE shortages due to supply chain disruptions and had to rely on corporate, state, and community support. Despite federal mandates, PPE use was inconsistent due to supply shortages, staff resistance, and communication difficulties with residents with dementia and hearing impairments. Training staff on PPE use and adapting care during shortages were key concerns. The systematic review findings echoed the interview findings, revealing a lack of streamlined PPE acquisition systems for NHs, significantly affecting supply and use. Few innovative solutions for maintaining resident care during PPE shortages were documented. Recommendations include ensuring NHs have reliable access to PPE, awareness of supply resources, and inclusive implementation processes. Special consideration for PPE use should be given to residents with memory and/or hearing impairment challenges.

Determine the frequency of personal protective equipment (PPE) use in adolescent inline skaters, skateboarders, and snowboarders; explore factors influencing PPE use; identify factors that would influence use; and examine the association of high-risk behaviors and PPE use. Cross-sectional survey. Central/southeast Wisconsin. Participants 13-18 years-old. None. Independent variables = age, gender, sport. None. Dependent variables = PPE use, factors influencing use, and frequency of other high-risk behaviors. The mean age of 333 participiants was 14.9 years. Adolescents wore considerably less PPE than recommended. Inline skaters wore the most; snowboarders the least. The most common reasons adolescents wore PPE were parents, peers, and rule/requirement. Younger adolescents cited parents more often than older adolescents as a factor for PPE use. Discomfort and lack of perceived need were the most common reasons for nonuse. Sustaining/witnessing an accident was the most common reason that would convince adolescents to wear PPE. Almost half of adolescents reported nothing would convince them to wear PPE. Younger adolescents wore more PPE than older adolescents. An association was seen between PPE use in all sports and bicycle helmets. An inverse relationship was found for tobacco and helmet use among skaters, as well as alcohol and helmet use in skateboarders. Adolescents underuse PPE. PPE reinforcement by parents/peers, encouraging bike helmets, manufacturing more comfortable gear, educating adolescents, and instituting PPE requirements in public areas may increase compliance. This could lead to decreased injuries. Physicians should discuss PPE with their patients/families. There may be an association between PPE use in extreme sports and decreased high-risk health behaviors.

Background: Hospital is one of the health services demanded according to standards by the community. But hospitals also have a high risk of infection, both due to treatment and medication. Of the many health workers, nurses are one who plays a role in the quality of service. In improving quality, nurses' behavior needs to be considered as a form of hospital prevention against infection. Measures that can prevent infection by washing hands and using PPE properly. Objective: Knowing the description of hand washing behavior and the use of nurses' personal protective equipment about the risk of spreading nasocomial infections. Method: Descriptive research using quantitative descriptive methods with total sampling techniques and using univariate test analysis. The subjects of this study were 67 respondents. Data collection was carried out by observation method regarding hand washing behavior and the use of nurses' personal protective equipment in hospitals.Results: The results of the study of 59 respondents studied found that 30 nurses behaved obediently (50.8%) while nurses who did not comply with the moment of hand washing amounted to 29 people (49.2%). With respondents who had a handwashing step behavior adhering to six steps amounted to 31 people (52.5%), while nurses who did not comply with six steps of hand washing amounted to 28 people (47.5%). While respondents who had compliant behavior in the use of PPE amounted to 34 people (57.6%), while nurses who did not comply in the use of PPE amounted to 25 people (42.4%). Conclusion: Inpatient nurses in hospitals have the majority of behaviors that comply with hand washing and the use of PPE (personal protective equipment) Keyword: Personal Protective Equipment; Hand Washing; Nasocomial Infection; Behavior Abstrak Latar Belakang : Pelayanan kesehatan yang diberikan oleh rumah sakit harus mematuhi standar yang diharapkan oleh Masyarakat.. Namun fasilitas kesehatan tersebut juga memiliki resiko tinggi terhadap infeksi, baik karena perawatan maupun pengobatan. Dari banyaknya petugas kesehatan, perawat ialah salah satu yang berperan dalam mutu pelayanan. Dalam meningkatkan mutu, perilaku perawat perlu diperhatikan sebagai bentuk dari pencegahan rumah sakit terhadap infeksi. Tindakan yang dapat mencegah terjadinya infeksi dengan cuci tangan serta penggunaan APD dengan benar. Tujuan : Mengetahui Gambaran Perilaku Cuci Tangan dan Penggunaan Alat pelindung diri Perawat Tentang Risiko Penyebaran Infeksi Nasokomial. Metode : Studi deskriptif dilakukan dengan metode deskriptif kuantitatif, teknik total sampling, serta analisis uji univariat pada 67 responden. Pengambilan data dilakukan dengan metode observasi mengenai perilaku cuci tangan dan penggunaan Alat pelindung diri perawat di Rumah sakit.Hasil : Hasil penelitian dari 59 responden yang diteliti didapatkan 30 orang perawat berperilaku patuh (50.8%) sedangkan perawat yang tidak patuh terhadap momen cuci tangan berjumlah 29 orang (49.2%). Dengan responden yang memiliki perilaku langkah cuci tangan patuh terhadap enam langkah berjumlah 31 orang (52.5%), sedangkan perawat yang tidak patuh terhadap enam langkah cuci tangan berjumlah 28 orang (47.5%). Sedangkan responden yang memiliki perilaku patuh dalam penggunaan APD berjumlah 34 orang (57.6%), sedangkan perawat yang tidak patuh dalam penggunaan APD berjumlah 25 orang (42.4%). Kesimpulan : Perawat rawat inap yang ada di Rumah Sakit memiliki perilaku mayoritas patuh terhadap cuci tangan maupun penggunaan APD (alat pelindung diri) Kata kunci: Alat Pelindung Diri; Cuci Tangan;Infeksi Nasokomial;Perilaku;

Trends in personal protective equipment use by clinicians performing airway procedures for patients with coronavirus disease 2019 in the USA from the intubateCOVID registry

BackgroundPPE (gowns, gloves and masks) is used in standard precautions (SP) as well as for contact, droplet or airborne isolation. Improper PPE use can lead to self-contamination and transmission of infectious agents, and at our institution the quality of PPE use has not been well assessed. For quality improvement purposes, we conducted an evaluation of healthcare worker (HCW) PPE use and knowledge of SP.MethodsTwo phases, direct observations and a survey, were completed between December 2018 and February 2019 in inpatient areas. Direct observations of PPE use were done by Infection Prevention nurses (IPs) in contact and droplet isolation rooms during daytime hours using an internally developed observation tool (Figure 1). Observations focused on 3 stages of PPE use: donning, in room clean/dirty activities and doffing. A survey consisting of 15 questions was developed to assess staff knowledge of SP in specific clinical scenarios, perceptions of current practices and barriers to use. The survey was distributed by IPs to HCWs during their regular rounds. Data were recorded and tabulated using RedCap electronic survey tool.Results106 observations and 107 surveys were completed. Observations showed appropriate PPE worn in 84% (n = 83) and hand hygiene (HH) post doffing in 95% (n = 79). Common gaps included no HH pre-donning [33% n = 43], PPE not changed between dirty and clean tasks (29% n = 2), incorrect mask removal (20% n = 16) and doffing gloves post-gowns [19% n = 69]. In the survey, answers to SP questions suggest PPE is overused in patients with diarrhea or respiratory illness but underused in draining wound management (Figure 2). HCW felt more compliant than their colleagues in both HH and PPE (Figure 3). The largest misperception was that gowns should be doffed pre-gloves (40% n = 40). Reasons for not using PPE included time (26%, n = 27), and perception that PPE is unnecessary (16%, n = 10). 75% (n = 80) of HCW felt adequately educated about PPE.ConclusionAt our institution, significant gaps still exist in HCW knowledge and use of PPE. Future QI work should focus on increasing HCW knowledge of standard precautions, HH pre-donning, changing PPE when appropriate in room as well as proper doffing order. The perception that HCW felt adequately educated despite significant gaps may be a barrier.DisclosuresAll authors: No reported disclosures.

Personal protective equipment (PPE) use is associated with reduced risk of SARS-CoV-2 infection among healthcare personnel (HCP). There are limited data on the impact of the novel coronavirus disease 2019 (COVID-19) pandemic on the PPE use of HCP. We describe the changes in PPE use from just before the widespread of community outbreaks ('pre-pandemic') to intra-pandemic time points, and examine factors associated with not changing in PPE use behavior among HCP in four Thai hospitals. We performed a retrospective cohort evaluation using two-time points: (i) February-March 2020 (pre-pandemic period); and (ii) January-March 2021 (intra-pandemic period). Self-reported frequency of appropriate PPE use was measured by a Likert scale. We used multivariable logistic regression to identify factors associated with no increase in self-reported PPE use. Of 343 HCP, the proportion of participants reporting 'always' using PPE rose from 66% during the pre-pandemic period to 80% during the pandemic. Factors associated with HCP who did not increase in PPE use included having high baseline reported PPE, being a non-registered HCP (e.g. nurse assistants, dental assistants, porters), being male, and having a low perceived risk of becoming infected with any respiratory virus while working in the hospital. PPE education, training, and risk communication content should target all cadres of HCP, regardless of registered/non-registered status, with a focus on behavior change for improved prevention and control of SARS-CoV-2 and other respiratory viruses in healthcare settings.

Background: Anesthesiologists, with their skills and expertise at performing various aerosol-generating procedures such as tracheal intubation and extubation, tracheostomies, and bronchoscopy-guided procedures, serve as frontline workers during the COVID-19 pandemic. They are exposed to the risk of infection as well as highly stressful environments in the operating theaters and intensive care units. Appropriate knowledge, attitudes, and practices (KAPs) with regard to the use of personal protective equipment (PPE) will help mitigate some of this stress. Materials and Methods: Owing to the nation's lockdown situation, an online questionnaire-based survey was conducted through WhatsApp, Facebook, and E-mail among anesthetists working at different health-care sectors in India. The KAP with regard to the use of PPE during the COVID-19 and its psychological impact were assessed by using a prevalidated questionnaire. All analyses were performed using SPSS version 25. Results: Among 301 study participants, 189 (62.8%) had good knowledge and 90% had favorable attitudes. Despite 66.4% of the study participants having received formal training regarding the use of PPE during the COVID-19 pandemic, good practices were seen only in 44.4%. Irrespective of the demographic variable assessed, 90% of the anesthesiologists felt that working was more stressful in the operating room during this pandemic, due to challenges with respect to effective communication, restrictions in movement and visibility attributed to PPE as well as an alteration in the usual routine. Conclusions: Despite adequate knowledge and attitudes regarding the use of appropriate PPE, the translation into practice was deficient. Emphasis on the checklist, protocol-based approaches, and regular updates on practice recommendations will help to improve adherence to quality practices. Donning of appropriate PPE contributes to significant physical and emotional stress among anesthesiologists during the COVID-19 pandemic. A platform to provide psychological support is the need of the hour.

EE386 Cost-of-Illness Analysis of Coronavirus Disease 2019 (COVID-19) Treatment in the Philippine General Hospital

Behavior change through educational interventions and text messaging to improve personal protective equipment use during pesticide handling among smallholder farmers in Uganda: A cluster randomized controlled trial.

Introduction:Coronavirus disease (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-COV2). COVID-19 is highly contagious, potentially fatal, and a global public health concern. Combining optimized personal protective equipment (PPE) use and hand hygiene is the best strategy for preventing COVID-19 in health care workers (HCWs).Methods:We conducted a national cross-sectional web-based survey of HCWs in the infection control program (IPC) in Thailand between May 5, 2020 and May 15, 2020. The primary objective was the prevalence of optimized PPE use amongst HCWs. The secondary objective was identification of the independent predictors of optimized PPE use.Results:We received a response from 46% of HCWs (756/1650), and all those who responded were nurse or HCWs who were registered in the IPC network. Five HCWs were excluded because of missing data, and 751 were included in the final analysis. The prevalences of PPE use were 22% (168/751) for optimized PPE use, 78% (583/751) for non-optimized PPE use, 35% (263/751) for PPE overuse, and 43% (320/751) for PPE underused. In univariate analysis, optimized PPE use was significantly associated with age, education level, knowledge of appropriate negative pressure room selection, and knowledge of apparently milder symptom severity in children than adults. In multivariate analysis, independent predictors of optimized PPE use were knowledge of appropriate negative pressure room selection (aOR = 1.95, 95% CI = 1.18-3.22), the difference in symptom severity between children and adults (aOR = 0.55, 95% CI = 0.37-0.81), and education level (aOR = 1.54, 95% CI = 1.04-2.27).Conclusion:The prevalence of optimized PPE use amongst HCWs was 22%. Independent predictors of optimized PPE use were COVID-19 knowledge-based factors and education level. Therefore, the continued education training program should be implemented to ensure maintenance of appropriate practices during the COVID-19 pandemic.

Controversies in airway management of COVID-19 patients: updated information and international expert consensus recommendations

IntroductionTo treat and properly care for COVID-19 patients it is vital to have healthy healthcare workers to ensure the continued function of the healthcare system and to prevent transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to patients, co-workers, and the community. Personal protective equipment (PPE) can prevent healthcare workers from being infected with and transmitting SARS-CoV-2. Experience and training are pivotal to ensure optimal protection. This study aims to examine the use and failure of PPE and compliance with PPE guidelines during the first and the second wave of the COVID-19 pandemic among Danish healthcare workers.MethodsHealthcare workers from the Central Denmark Region and the Capital Region of Denmark were invited to participate April–June 2020 during the first wave and November 2020–April 2021 during the second wave. Day-by-day, participants reported work procedures, use and failure of PPE, and compliance with PPE guidelines. Register-based information on sex, age, department, and profession was available for all participants.ResultsIn total, 21 684 and 10 097 healthcare workers participated during the first and the second wave, respectively. During the first wave, 1.7% used filtering face piece-2 or -3 (FFP2 or FFP3) respirators and 8.2% used face masks [fluid resistant (type IIR) masks, masks with visor (typically type IIR), and other unspecified face masks] during physical contact with patients. During the second wave, the corresponding figures increased to 17.8% and 80.7%. During respiratory procedures, the use of FFP2 or FFP3 respirators increased from 5.6 to 24.3%, and the use of face masks from 14.7 to 77.8%. The no PPE use decreased from 21.3% during the first wave to 0.4% in the second wave, during respiratory procedures. Total PPE failures decreased from 0.7 to 0.4% from the first to second wave. The proportion not complying with PPE guidelines declined from 3.6 to 2.2% during physical contact with patients and from 6.5 to 4.6% during respiratory procedures. PPE failure and non-compliance varied by age, sex and type of department. Frequent reasons for non-compliance were forgetfulness and lack of time, and during the first but not during the second wave, limited availability of PPE.ConclusionWe found a substantial increase in the use of PPE and a substantial decrease in PPE failures from the first to the second wave of COVID-19 in Denmark. However, there is still a need for continuous focus on compliance in use of PPE among healthcare workers.