Consumption Of Personal Protective Equipment Research Articles

Vascular Care Delivery during the COVID-19 Pandemic: Impact of Office-Based Laboratory and Ambulatory Surgery Center

Objective: To evaluate how access to an office-based laboratory (OBL) and ambulatory surgery center (ASC) impacted vascular care during the Coronavirus Disease 2019 (COVID-19) pandemic. Methods: Vascular procedures performed by our group during the 6-week period before COVID-19 restrictions (group 1) and in the first 6-week period during the COVID-19 restrictions (group 2) were reviewed. The number of procedures performed was categorized as hospital inpatient (HIP), hospital outpatient (HOP), OBL, ASC, and vein center (VC). The procedures were also grouped by type: aneurysm (AAA), carotid (CAR), peripheral arterial disease (PAD), amputation/wound care (AMP), vascular access (VA), deep vein thrombosis (DVT), and venous reflux (CVI). The number of healthcare provider contact points for each patient undergoing care at the HOP, OBL, and ASC were also collected and compared between groups 1 and 2. Differences between groups were determined using the two-way ANOVA. Results: There were no statistically significant differences between groups 1 and 2 for procedure location or type of procedure (p > 0.05). Patient contact with healthcare providers decreased between groups 1 and 2 for ambulatory care. However, projecting the number of contacts for patients in group 2 if they had to have ambulatory care in the HOP setting (913) compared to contacts in the OBL and ASC setting (588) was statistically significant (p < 0.05). No patient or staff member at the OBL or ASC developed COVID-19 infection because of the care received at these venues. Conclusions: The ability to provide essential care for patients in an ambulatory environment was enhanced using our OBL and ASC without compromising safety, efficacy, or transmission of the virus to patients or staff during the height of the COVID-19 pandemic and limited their contact with healthcare workers and therefore reduced the consumption of personal protective equipment by healthcare personnel.

Human resources and medical supplies consumption during the COVID-19 pandemic: a single-center study

Background: In the face of the unexpected coronavirus disease 2019 (COVID-19) pandemic, every country has struggled with insufficient human resources and medical supplies. This study aims to provide the statistical information necessary for discussing how to model stockpiles of medical resources.Methods: This study was conducted at the Hallym University Kangnam Sacred Heart Hospital, in South Korea. The study duration was 2 weeks, centered on March 16, 2022, when the number of daily confirmed patients with COVID-19 in Korea peaked. The number of human resources was obtained by counting the number of healthcare workers using CCTV. Drug prescriptions and medical device usage were obtained from electronic medical records.Results: In total, 117 inpatients and 26,485 outpatients were managed at this hospital during the 2-week study period. Daily visits were highest among nurses in all units, followed by doctors and radiology technicians. The mean daily consumption of personal protective equipment (PPE) per bed was 4.3 sets in the intensive care unit (ICU), 1.8 in the semi-ICU, and 1.4 in the ward. Despite the four-fold difference in the number of patients, there was no statistically significant difference between the two wards in the number of daily visits. Drug prescription rates were higher among inpatients than at-home patients.Conclusions: The higher the COVID-19 severity, the higher the consumption of PPE per patient. Among healthcare workers, nurses had the highest number of inpatient treatment visits for COVID-19. To efficiently utilize, PPE, structures containing more isolation beds in a single negative pressure isolation system would be preferred.

Production of singlet oxygen from photosensitizer erythrosine for facile inactivation of coronavirus on mask

The global health crisis caused by the COVID-19 pandemic has led to a surge in demand and use of personal protective equipment (PPE) such as masks, putting great pressure on social production and the environment.It is urgent to find an efficient and non-destructive disinfection method for the safe reuse of PPE. This study proposes a PPE disinfection method that uses erythrosine, a U.S. Food and Drug Administration-approved food dye, as photosensitizer to produce singlet oxygen for virus inactivation, and indicates the completion of disinfection by its photobleaching color change.After spraying 100 μL of 10 μM erythrosine on the surface of the mask for 3 times and light exposure for 25 min, the titer of coronavirus decreased by more than 99.999%, and the color of erythrosine on the mask surface disappeared. In addition, the structure of the mask was intact and the filtration efficiency was maintained at > 95% after 10 cycles of erythrosine treatment.Therefore, this disinfection method can provide at least 10 cycles of reuse with the advantages of high safety and convenient, and the completion of disinfection can be indicated by its photobleaching, which is suitable for hospitals and daily life to reduce the consumption of PPE.

Experimental Study on the Mechanical Behavior of Sandy Soil Reinforced by Disposable Face Mask Chips under Different Stress Paths

Since 2020, with the global spread of major respiratory infectious diseases, such as COVID–19, the demand and consumption of personal protective equipment, such as masks, have increased dramatically worldwide. The environmental pollution caused by numerous waste disposable face masks has gradually attracted people’s attention. In this study, the mechanical properties of mask–chip–reinforced soil are evaluated from a new perspective, through the uniaxial, biaxial, conventional triaxial, and true triaxial compression tests on reshaped sandy soil samples mixed with different contents of mask chips. The experimental results show that the mechanical properties of the sandy soil can be improved by the mask chips. With the proper content of mask chips, the failure strength is substantially improved, and the failure of soil is delayed. Meanwhile, the strength and stiffness are significantly affected by the stress path and the content of mask chips, even if the soil samples with the same mask–chip content can also show different mechanical properties under different stress paths. Additionally, the mechanical properties of soil are not necessarily improved constantly with the increasing content of mask chips. The failure strength of sandy soil samples under conventional and true triaxial stress paths decreases when the mass content of mask chips exceeds 0.3% and 0.5%, respectively. This study confirms the potential of mask chips applied to subgrade, slope, and other engineering construction fields in a sustainable way.

The use of Personal Protective Equipment (PPE) and associated environmental challenges: A study on Dhaka, Bangladesh

The Covid-19 pandemic has caused health crisis and concerns worldwide. The use of Personal Protective Equipment (PPE) has been the primary behavioral and policy response to avert the infection of coronavirus. The emergence of the situation resulted in increased production of PPE, creating a surge in plastic pollution and carbon footprint. The consumption of PPEs is unavoidable; however, proper PPE waste disposal plays a vital role in lessening the associated environmental impacts. This study aims to provide an overview of the environmental challenges associated with Covid-19 pandemic faced in the households located at the heart of Bangladesh, Dhaka City Corporation (DCC) area. The study determines carbon footprint in terms of carbon emission equivalent and plastic pollution potential associated with PPEs. The study further implies that there is a gap in the 3R Strategy implementation in Bangladesh hindering the nation in achieving UN's SDG-12. The findings depict that the proper implementation of the 3R strategy is fundamental for ensuring more a resilient, sustainable and livable environment in the in-pandemic and post-pandemic era and further emphasizes that a strengthened policy framework, operational environmental policy tools, environmental education, and the society and stakeholders' spontaneous response to the plastic pollution challenge are essentially required.

Validation of "Personal Protective Equipment Conservation Strategies Tool" to Predict Consumption of N95s, Facemasks, and Gowns During Pandemic-Related Shortages.

We sought to prospectively validate a model to predict the consumption of personal protective equipment in a pediatric emergency department during the COVID-19 pandemic. We developed the Personal Protective Equipment Conservation Strategies Tool, a Monte Carlo simulation model with input parameters defined by members of our emergency department personal protective equipment task force. Inputs include different conservation strategies that reflect dynamic reuse policies. Over the course of 4 consecutive weeks in April and May 2020, we used the model to predict the consumption of N95 respirators, facemasks, and gowns in our emergency department based on values for each input parameter. At the end of each week, we calculated the percent difference between actual consumption and predicted consumption based on model outputs. Actual consumption of personal protective equipment was within 20% of model predictions for each of the 4 consecutive weeks for N95s (range, -16.3% to 16.1%) and facemasks (range, -7.6% to 13.1%), using "maximum conservation" and "high conservation" strategies, respectively. Actual consumption of gowns was 11.8% less than predicted consumption for Week 1, gown resupply data were unavailable on Weeks 2-4. The Personal Protective Equipment Conservation Strategies Tool was prospectively validated for "maximum conservation" and "high conservation" models, with actual consumption within 20% of model predictions.

Using Container Houses to Reduce the Risks to Health-Care Workers While Performing the Throat Swab Test and Blood Sampling for SARS-CoV-2.

Coronavirus disease 2019 (COVID-19) is still pandemic all over the world. Patients requesting screening in emergency departments (ED) have continually increased. Establishing additional screening stations outside of the ED to increase the number of patients tested and protect the safety of health care workers poses an urgent challenge. We employed a container house near the entrance of an ED to create an outdoor screening station, which separates suspected patients of COVID-19 from regular emergency patients to prevent cross infections. In our experience, a container house station can not only provide additional screen area but also reduce the consumption of personal protective equipment. Container houses are sturdier than tents and can be fully assembled rapidly. Appropriate protective equipment can be installed with them to fulfi ll demands for COVID-19 screening.

Should Tenecteplase be Given in Clinical Practice for Acute Ischemic Stroke Thrombolysis?

Should Tenecteplase be Given in Clinical Practice for Acute Ischemic Stroke Thrombolysis?

Telerobotic Operation of Intensive Care Unit Ventilators.

Since the first reports of a novel coronavirus (SARS-CoV-2) in December 2019, over 33 million people have been infected worldwide and approximately 1 million people worldwide have died from the disease caused by this virus, COVID-19. In the United States alone, there have been approximately 7 million cases and over 200,000 deaths. This outbreak has placed an enormous strain on healthcare systems and workers. Severe cases require hospital care, and 8.5% of patients require mechanical ventilation in an intensive care unit (ICU). One major challenge is the necessity for clinical care personnel to don and doff cumbersome personal protective equipment (PPE) in order to enter an ICU unit to make simple adjustments to ventilator settings. Although future ventilators and other ICU equipment may be controllable remotely through computer networks, the enormous installed base of existing ventilators do not have this capability. This paper reports the development of a simple, low cost telerobotic system that permits adjustment of ventilator settings from outside the ICU. The system consists of a small Cartesian robot capable of operating a ventilator touch screen with camera vision control via a wirelessly connected tablet master device located outside the room. Engineering system tests demonstrated that the open-loop mechanical repeatability of the device was 7.5 mm, and that the average positioning error of the robotic finger under visual servoing control was 5.94 mm. Successful usability tests in a simulated ICU environment were carried out and are reported. In addition to enabling a significant reduction in PPE consumption, the prototype system has been shown in a preliminary evaluation to significantly reduce the total time required for a respiratory therapist to perform typical setting adjustments on a commercial ventilator, including donning and doffing PPE, from 271 to 109 s.

A New Challenge for the Management and Disposal of Personal Protective Equipment Waste during the COVID-19 Pandemic

To prevent the transmission of the Coronavirus (SARS-CoV-2) in the public, the demand and consumption of personal protective equipment (PPE) increased drastically. Such wide use of PPE has brough a new challenge to waste management and disposal. It is difficult to sort PPE waste before further treatment, and such waste will often end up being processed by some traditional disposal methods. During the pandemic, incineration and landfill facilities are currently under significant pressure. In addition, a certain amount of PPE waste is discarded into the environment rather than going to landfills and incinerators. It not only directly affects the ecosystem, but also indirectly threatens human health through various routes of exposure. PPE waste is also the source and carrier of pathogens and chemical contaminants, causing a secondary pollution. Therefore, it is necessary to establish appropriate strategies to deal with the PPE problems related to energy, environment and health, requiring the collaborative efforts of researchers, practitioners, policymakers, and governments.

Face mask waste generation and management during the COVID-19 pandemic: An overview and the Peruvian case

The ongoing COVID-19 pandemic has driven massive consumption of personal protective equipment (PPE) worldwide. Single-use face masks are one of the most used PPE to prevent the transmission of the virus. However, mismanagement of such materials threatens the environment with a new form of plastic pollution. Researchers argue that it is necessary to develop and implement innovative ways to manage and recycle PPE in order to reduce their impacts on the environment. In the present work, we have reviewed and discussed the recent development of sustainable face mask alternatives and recycling and repurposing routes under the COVID-19 pandemic context. Moreover, we have conducted estimations of the daily face mask waste generation in Peru, a developing country struggling with a poor solid waste management framework and infrastructure. Unlike previous studies, our equation incorporates the “economically active population” variable in order to provide more precise estimations, while evaluating single-use and reusable scenarios. The scenarios of incorporating reusable face masks significantly reduced the amount of solid waste generated in Peru. In situ evidence shows that face masks are polluting the streets and beaches of Peru, probably driven by mismanagement and poor environmental awareness.

Surgical Site Infection after Cesarean Delivery in Times of COVID-19.

To analyze effects of the COVID-19 pandemic on the consumption of personal protective equipment and products (PPEP), as well as the frequency of surgical site infection (SSI) among non-COVID-19 patients submitted to cesarean sections. A retrospective study was conducted in a maternity unity of a public teaching hospital which was not part of the reference service for COVID-19 treatment. It compared PPEP consumption and the occurrence of SSI after cesarean sections in monthly periods before and after the occurrence of the first case of COVID-19 in Porto Alegre, state of Rio Grande do Sul, Brazil. Personal protective equipment and products consumption was measured as units of masks, gloves, gowns, and caps, and use of alcohol-based products or soap for hand sanitation as ml/patient/day. The SSI index was calculated as the proportion of cases of SSI over the number of cesarean sections performed monthly during the study period. There was an increase in all measured items of PPEP, with consumption of disposable masks with a median of 1,450 units in the pre-COVID period, and of 2550 in the post-COVID period (a 75.9% increase). A decrease of 49% in SSI was detected, with a median of 1.74 in the pre-COVID period and of 0.89 in the post-COVID period. The increase in consumption of PPEP could be a result of safer practices adopted by healthcare workers with the advent of COVID-19, of which the following reduction in the occurrence of SSI could be a direct consequence. Despite the severity of the crisis, one could state that extreme situations can lead to valuable reflections and opportunities for improvement.

Short research paper: Personal protective equipment for the care of suspected and confirmed COVID-19 patients - Modelling requirements and burn rate.

BackgroundThe COVID-19 pandemic has caused unprecedented global demand for personal protective equipment (PPE). A paucity of data on PPE burn rate (PPE consumption over time) in pandemic situations exacerbated these issues as there was little historic research to indicate volumes of PPE required to care for surges in infective patients and thus plan procurement requirements.MethodsTo better understand PPE requirements for care of suspected or confirmed COVID-19 patients in our Australian quaternary referral hospital, the number of staff-to-patient interactions in a 24-h period for three patient groups (ward-based COVID suspect, ward-based COVID confirmed, intensive care COVID confirmed) was audited prospectively from 1st to 30th April 2020.ResultsThe average number of staff-to-patient interactions in a 24-h period was: 13.1 ± 5.0 (mean ± SD) for stable ward-managed COVID-19 suspect patients; 11.9 ± 3.8 for stable ward-managed confirmed COVID-19 patients; and 30.0 ± 5.3 for stable, mechanically ventilated, ICU-managed COVID-19 patients. This data can be used in PPE demand simulation modelling for COVID-19 and potentially other respiratory illnesses.ConclusionData on the average number of staff-to-patient interactions needed for the care of COVID-19 patients is presented. This data can be used for PPE demand simulation modelling.

Game theory to enhance stock management of Personal Protective Equipment (PPE) during the COVID-19 outbreak.

Since the outbreak of the COVID-19 pandemic, many healthcare facilities have suffered from shortages in medical resources, particularly in Personal Protective Equipment (PPE). In this paper, we propose a game-theoretic approach to schedule PPE orders among healthcare facilities. In this PPE game, each independent healthcare facility optimises its own storage utilisation in order to keep its PPE cost at a minimum. Such a model can reduce peak demand considerably when applied to a variable PPE consumption profile. Experiments conducted for NHS England regions using actual data confirm that the challenge of securing PPE supply during disasters such as COVID-19 can be eased if proper stock management procedures are adopted. These procedures can include early stockpiling, increasing storage capacities and implementing measures that can prolong the time period between successive infection waves, such as social distancing measures. Simulation results suggest that the provision of PPE dedicated storage space can be a viable solution to avoid straining PPE supply chains in case a second wave of COVID-19 infections occurs.

The daily direct costs of isolating patients identified with highly resistant micro-organisms in a non-outbreak setting

Isolation precautions are recommended when caring for patients identified with highly resistant micro-organisms (HRMOs). However, the direct costs of patients in isolation are largely unknown. To obtain detailed information on the daily direct costs associated with isolating patients identified with HRMOs. This study was performed from November until December 2017 on a 12-bed surgical ward. This ward contained solely isolation rooms with anterooms. The daily direct costs of isolation were based on three cost items: (1) additional personal protective equipment (PPE), measured by counting the consumption of empty packaging materials; (2) cleaning and disinfection of the isolation room, based on the costs of an outsourced cleaning company; and (3) additional workload for healthcare workers, based on literature and multiplied by the average gross hourly salary of nurses. A distinction was made between the costs for strict isolation, contact-plus isolation, and contact isolation. During the study period, 26 patients were nursed in isolation because of HRMO carriage. Time for donning and doffing of PPE was 31 min per day. The average daily direct costs of isolation were the least expensive for contact isolation (gown, gloves), €28/$31, and the most expensive for strict isolation (surgical mask, gloves, gown, cap), €41/$47. Using a novel, easy method to estimate consumption of PPE, we conclude that the daily direct costs of isolating a patient differ per type of isolation. Insight into the direct costs of isolation is of utmost importance when developing or updating infection prevention policies.

Can Medical-Grade Gloves Provide Protection after Repeated Disinfection?

The advent of the COVID-19 pandemic has generated an increased consumption of personal protective equipment (PPE), including gloves and masks, by healthcare workers and by the general public at a global scale. This has generated substantial shortage of these single-use and disposable PPEs that will end up as a landfill waste. Extending the life cycle of PPEs, such as gloves, by disinfecting treatments could help mitigate these concerns. However, the effect of various disinfection treatments on the functionality of gloves is unknown. In this study, six commonly used viral disinfection treatment methods (i.e., ultraviolet (UV) radiation, dry heat, steam, alcohol, chlorine compounds, and quaternary ammonium compounds) were evaluated for their effect on the performance attributes of two commonly used medical-grade gloves and nitrile and vinyl (latex) gloves. The barrier properties of both gloves against water and ethanol vapor flux were not affected up to 10 cycles of disinfection cycles. However, the increase in the disinfection cycle from 10 to 20 slightly reduced their barrier properties with minor variation in the type of disinfection and glove type. Infrared spectroscopy and microscopy investigations confirmed that both types of gloves could withstand up to 20 cycles of disinfection treatments with no observable change in the chemical structure and surface morphology of the disinfected surfaces, respectively. Lastly, tear property testing of the gloves indicated little to no change from the baseline after 20 cycles of treatment in both the nitrile and vinyl-based gloves. Overall, this study indicated that alcohol, UV, and heat treatment could be acceptable disinfection methods that allow the reuse of gloves up to 20 cycles. Such repeated disinfection of gloves not only reduces the strain on the supply of gloves but also decreases the postconsumer landfilled waste and environmental footprint of gloves.

Bundled interventions for consumption management and monitoring of personal protective equipment in COVID-19 pandemic in Hong Kong local hospitals.

Since the outbreak of COVID-19 in December 2019, there had been global shortage of personal protective equipment (PPE) supply due to the breakage of supply chain and also the forbidding of PPE exported by various countries. This situation had greatly affected the healthcare services in local hospitals of Hong Kong. To maintain the availability of PPE for healthcare workers in high-risk clinical settings, the cluster management of New Territories West Cluster, Hospital Authority, had implemented a bundle of interventions in controlling and managing the PPE consumption and ensuring its proper use. A Taskforce on Management of PPE was set up in February 2020 with the aim to monitor and manage the use of PPE in five local hospitals and eight general outpatient clinics of New Territories West Cluster, which were governed in a cluster basis, under the COVID-19 epidemic. Interventions including cutting down non-essential services, implementing telecare, monitoring PPE consumption at unit level and PPE stock at the Cluster Central Distribution Centre and forming mobile infection teams were implemented. The updated PPE standards and usage guidelines to clinical staff were promulgated through forums, newsletters and unit visits. The PPE consumption rates of individual unit were reviewed. Significant decrease in PPE consumption rates was noted when comparing with the baseline data. Comparing the data between 20 February and 1 June 2020, the overall PPE consumption rates were reduced by 64% (r=−0.841; p<0.001) while the PPE consumption rates in anaesthesia and operating theatres, and isolation and surveillance wards were reduced by 47% (r=−0.506; p=0.023) and 49% (r=−0.810; p<0.001), respectively. A bundled approach, including both administrative measures and staff education, is effective in managing PPE consumption during major infection outbreaks especially when PPE supply is at risk.

Synthea™ Novel coronavirus (COVID-19) model and synthetic data set

March through May 2020, a model of novel coronavirus (COVID-19) disease progression and treatment was constructed for the open-source Synthea patient simulation. The model was constructed using three peer-reviewed publications published in the early stages of the global pandemic, when less was known, along with emerging resources, data, publications, and clinical knowledge. The simulation outputs synthetic Electronic Health Records (EHR), including the daily consumption of Personal Protective Equipment (PPE) and other medical devices and supplies.For this simulation, we generated 124,150 synthetic patients, with 88,166 infections and 18,177 hospitalized patients. Patient symptoms, disease severity, and morbidity outcomes were calibrated using clinical data from the peer-reviewed publications. 4.1% of all simulated infected patients died and 20.6% were hospitalized. At peak observation, 548 dialysis machines and 209 mechanical ventilators were needed. This simulation and the resulting data have been used for the development of algorithms and prototypes designed to address the current or future pandemics, and the model can continue to be refined to incorporate emerging COVID-19 knowledge, variations in patterns of care, and improvement in clinical outcomes. The resulting model, data, and analysis are available as open-source code on GitHub and an open-access data set is available for download.

The Daily Direct Costs of Isolating Patients Identified With Highly Resistant Microorganisms

Background: Isolation precautions are recommended when caring for patients identified with highly resistant microorganisms (HRMOs). However, the direct costs of isolating patients are largely unknown. Therefore, we aimed to obtain detailed information on the daily direct costs associated with isolating patients identified with HRMO. Methods: This study was performed from November until December 2017 on a 12-bed surgical ward. This ward contained solely isolation rooms with an anteroom. The daily direct costs of isolation were based on three cost items: (1) additional personal protective equipment (PPE); measured by counting the consumption of empty packaging materials, (2) cleaning and disinfection of the isolation room; based on the costs of an outsourced cleaning company, and (3) additional workload for healthcare workers; based on literature and multiplied by the average gross hourly salary of nurses. A distinction was made between the costs for strict isolation, contact-plus isolation, and contact isolation. Results: During the study period, 26 patients were nursed in isolation because of HRMO carriage, resulting in a total of 304 isolation days (median 7 isolation days; range 1-44). Gloves were consumed the most and hair caps the least. The average daily direct costs of isolation were the least expensive for contact isolation, €28/$31, and the most expensive for strict isolation, €41/$47. Conclusions: By using a novel, easy method to estimate consumption of PPE, we conclude that the daily direct costs of isolating a patient, differs per type of isolation. Insight into the direct costs of isolation is of utmost importance when developing or revising policies.Funding: NoneDisclosures: None

Telemedicine in Times of the Pandemic Produced by COVID-19: Implementation of a Teleconsultation Protocol in a Hospital Emergency Department.

Since the first case of COVID-19 was reported in Spain, almost 22% of healthcare professionals have been infected. Among the main causes are exposure during the care of suspected patients and asymptomatic patients, which caused a greater lack of protection in some cases, and to the global shortage of personal protective equipment due to the strong demand for it. The main objective of this study was to evaluate the effectiveness of a teleconsultation protocol with patients who had respiratory symptoms in the reduction of the consumption of personal protective equipment (PPE) in a hospital emergency service (HES) during the COVID-19 pandemic. This is a descriptive and retrospective study that analyzes the implementation of a teleconsultation protocol with patients with respiratory problems treated in the HES at the Hospital de Poniente (Almeria), between 18 March and 30 April 2020. In the selected study period, 5353 patients were treated in the HES of the Hospital de Poniente; of these, 15.43% showed respiratory symptoms and were referred to the Respiratory Circuit, of which 42.2% did so via teleconsultation. Sixty-six cases of COVID-19 were diagnosed, 57.6% were male, and the median age was 71 years old. The main disease related was pneumonia (89.4%), symptoms more frequent were cough (77.3%), fever (77.3%), and dyspnea (60.6%). Lastly, 56.1% of the patients that attended had one or more comorbidities, high blood pressure (53%), and diabetes (36.4%), which became the main risk factors. The results showed that the implementation of teleconsultation in the HES reduced the possibility of infection and allowed for a more efficient consumption of personal protective equipment.