Full Personal Protective Equipment Research Articles

Field evaluation of validity and feasibility of Pan-Lassa rapid diagnostic test for Lassa fever in Abakaliki, Nigeria: a prospective diagnostic accuracy study.

Lassa fever is a viral haemorrhagic fever with few options for diagnosis and treatment; it is also under-researched with knowledge gaps on its epidemiology. A point-of-care bedside test diagnosing Lassa fever, adhering to REASSURED criteria, is not currently available but is urgently needed in west African regions with high Lassa fever burden. We aimed to assess the validity and feasibility of a rapid diagnostic test (RDT) to confirm Lassa fever in people in Nigeria. We estimated the diagnostic performance of the ReLASV Pan-Lassa RDT (Zalgen Labs, Frederick, MD, USA) as a research-use-only test, compared to RT-PCR as a reference standard, in 217 participants at a federal tertiary hospital in Abakaliki, Nigeria. We recruited participants between Feb 17, 2022, and April 17, 2023. The RDT was performed using capillary blood at the patient bedside and using plasma at the laboratory. The performance of the test, based on REASSURED criteria, was assessed for user friendliness, rapidity and robustness, sensitivity, and specificity. Participants were aged between 0 and 85 years, with a median age of 33·0 years (IQR 22·0-44·3), and 24 participants were younger than 18 years. 107 (50%) participants were women and 109 (50%) were men; one participant had missing sex data. Although the specificity of the Pan-Lassa RDT was high (>90%), sensitivity at bedside using capillary blood was estimated as 4% (95% CI 1-14) at 15 min and 10% (3-22) at 25 min, far below the target of 90%. The laboratory-based RDT using plasma showed better sensitivity (46% [32-61] at 15 min and 50% [36-64] at 25 min) but did not reach the target sensitivity. Among the 52 PCR-positive participants with Lassa fever, positive RDT results were associated with lower cycle threshold values (glycoprotein precursor [GPC] gene mean 30·3 [SD 4·3], Large [L] gene mean 32·3 [3·7] vs GPC gene mean 24·5 [3·9], L gene mean 28·0 [3·6]). Personnel conducting the bedside test procedure reported being hindered by the inconvenient use of full personal protective equipment and long waiting procedures before a result could be read. The Pan-Lassa RDT is not currently recommended as a diagnostic or screening tool for suspected Lassa fever cases. Marked improvement in sensitivity and user friendliness is needed for the RDT to be adopted clinically. There remains an urgent need for better Lassa fever diagnostics to promote safety of in-hospital care and better disease outcomes in low-resource settings. Médecins Sans Frontières.

“If I blink twice everything is OK” – A qualitative study of Swedish midwives’ strategies for supporting birthing women while working in full personal protective equipment

ProblemMidwives all over the world have had to adapt to the use of personal protective equipment (PPE) during the COVID-19 pandemic. The issue of how they managed to support birthing women, despite the use of PPE, has been insufficiently studied. BackgroundMidwives support birthing women in one of their most life-changing situations. Having COVID-19 at the time of childbirth makes birthing women even more vulnerable. PPE has been shown to impact the ability of providing support to birthing women. AimTo describe midwives’ strategies for supporting birthing women while working in full PPE MethodsA qualitative study based on focus group discussons with Swedish midwives. Data were analysed by inductive content analysis. FindingsTo support birthing women while in full PPE, the midwives adapted existing working methods, increased collaboration with colleagues, unveiled, adapted to the requirements for contagion prevention, addressed women’s concern for the midwife and maintained focus on the birth while remaining mindful of the risk of contagion. DiscussionMidwives adopted strategies in order to uphold provision of support to the birthing women, as well as to address contextual factors related to PPE that hinder provision of support. ConclusionThe respective effects of different PPE types and models on the birth experience should be explored. Explicit strategies for supporting birthing women while working in full PPE must be created and discussed among midwives.

Preferences and Perceptions of Paediatric Dentists’ Attire among 4-12-year-old Children: A Cross-sectional Study

Introduction: Dentists’ attire includes their choice of clothes and Personal Protective Equipment (PPE) required to follow infection control measures. Investigating and understanding the paediatric patient’s preferences and perceptions towards the dentist’s attire can aid in establishing a more efficient and smoother relationship between them. Aim: To determine the children’s preferences and perceptions of their paediatric dentist’s attire and PPE among four to 12- year-old children. Materials and Methods: This cross-sectional study included four to 12-year-old Arabic-speaking children attending Department of Paediatric Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia for dental treatment with their parents/ guardians between February 2022 and April 2022. Data were collected from the participants using a validated Arabic electronic questionnaire to determine their preferences regarding different parts and types of the dentist’s attire and PPE, as well as their perceptions and feelings of comfort towards the dentist wearing the full standard PPE. Data were summarised as frequencies and percentages for categorical variables or means and standard deviations for continuous variables. The significance threshold was set at 0.05. Results: A total of 362 participants with a mean age of 8.4±2.3 years and their parents/guardians participated in the study. Female dentists were significantly more favoured by both male and female participants, with statistical significance among females (p<0.001) and younger participants (p<0.001). Both males and females (p=0.025) and older participants (p = 0.001) significantly favoured the traditional white coats over colourful paediatric coats. Furthermore, older participants significantly preferred surgical masks over paediatric masks (p<0.001), face shields as eye protection (p<0.001), and no head cover over colourful paediatric caps (p<0.001). Male participants showed significantly better acceptability towards the dentist wearing the full standard PPE. Conclusion: Both genders and younger children preferred female dentists. The traditional white coat is the most preferred attire by both genders and older children. Male and older children showed higher acceptability for the full standard PPE.

Assessment of health problem and associated factors among flower farm workers in Ejere Woreda, West Showa Zone Oromia Regional State, Ethiopia

Background: Floriculture is an agricultural sector that poses significant health risks, often due to unsafe work environments. Objectives: The study aimed to assess health problems and associated factors among flower farm workers in Ejere Woreda, West Showa, Oromia, Ethiopia, in 2018. Methods: A cross-sectional study incorporating quantitative and qualitative methods was conducted in Ejere Woreda from May 25 to June 30, 2018. A structured questionnaire was administered to 356 participants using simple and stratified random sampling, and qualitative data were gathered through in-depth interviews and observation checklists. Data were analyzed using EPI Info version 7 and SPSS 21. Descriptive statistics were computed, and the variables underwent binary logistic regression analysis, with a p-value < 0.3 for inclusion in multivariate logistic regression. Thematic analysis was applied to qualitative data. Results: A total of 356 workers participated, with 296 (83.3%) reporting at least one health problem in the last 12 months. Among the conditions observed, headaches were the most prevalent (226, 76.4%), followed by musculoskeletal injuries (220, 74.3%), fatigue (206, 69.3%), respiratory injuries (185, 62.5%), dizziness (180, 60.8%), and skin injuries (17, 58.8%). Factors such as sex, job satisfaction, availability of personal protective equipment, and safety training showed significant associations with health problems. Conclusion: The study revealed a high prevalence of health problems among flower farm workers, with job satisfaction, availability of safety training, and personal protective equipment shortages being significant factors. It is recommended that farm managements provide adequate safety training and full personal protective equipment to improve the health of workers.

1762. Clinical application of handheld ultrasound devices during the 2022 Sudan Virus disease Ebola outbreak in Uganda

Abstract Background The fluid status and causes of respiratory failure in patients with Ebola disease can be challenging to determine due to concomitant severe diarrhea, vascular leakage, and multiorgan failure. Point-of-care ultrasound (POCUS) could guide fluid resuscitation for patients in resource-limited settings. We present the clinical application of POCUS in the 2022 Sudan Virus disease Ebola outbreak in Uganda. Figure. Ultrasound findings from patient 2. 2A: Discrete B lines observed with an irregular pleural line; 2B: Inferior vena cava collapsibility <50% suggestive of adequate fluid resuscitation; 2C: parasternal short cardiac view with small pericardial effusion identified; 2D: apical cardiac view with small pericardial effusion redemonstrated. Methods A clinical research team in Fort Portal, Uganda was trained in advanced Infection Prevention and Control (IPC) to care for patients with Ebola disease and in POCUS for septic shock. The clinical team learned a standardized lung and cardiac critical care ultrasound approach to evaluate patients in septic shock. The scanning procedure was used during the care of 6 patients with confirmed Sudan virus disease within 2 weeks of outbreak declaration to make critical patient care decisions like fluid management. Chest X-ray services and mechanical ventilation were not accessible. A handheld Philips Lumify device was kept in the biocontainment area and was used in full personal protective equipment. Scanning procedures included 12-zone lung ultrasound and 4-view cardiac ultrasound scans to determine causes of respiratory disease and evaluate fluid status. Results Among 6 patients (age range 27 to 58 years; 1/6 female), 5/6 were in their third week of illness, and 1/6 was in his second week of illness. Lung ultrasound abnormalities included discrete B-lines (5/6 patients), confluent B-lines (1/6), irregular pleural lines (3/6 patients), and subpleural consolidations (1/6 patients). Two participants in respiratory distress had cardiac POCUS. Both had hyperdynamic left ventricular function and one had a small pericardial effusion (Figure). One patient had inferior vena cava (IVC) collapsibility < 50% (1.5 cm diameter), and another with a >50% IVC collapsibility (1.3 cm diameter). These findings contributed to a decision to continue fluid resuscitation. Conclusion Portable handheld ultrasound devices identified previously undescribed ultrasound features of Sudan virus disease. POCUS helped determine causes of respiratory failure and guided fluid resuscitation in a biocontainment ward without access to mechanical ventilation. Disclosures All Authors: No reported disclosures

SAT559 Challenges Involved in Managing a Paraplegic Patient with Metastatic Papillary Thyroid Cancer Requiring Radioactive Iodine Therapy

Abstract Disclosure: G. Al-Naqeeb: None. E. Munger: None. P. Veeraraghavan: None. C. Cochran: None. P. Bernaldez: None. P. Wong: None. N. Devaraj: None. T. Fisher: None. K. Lee: None. O. Owoade: None. I. Jones: None. S. Gubbi: None. J. Klubo-Gwiezdzinska: None. Background: High radioactive iodine (RAI) therapy doses utilized for treating thyroid cancer patients require a 24-48-hour radiation isolation period until the total effective dose equivalent exposure (TEDE) to the general population does not exceed 5mSv. We present a unique scenario of a paraplegic patient with metastatic papillary thyroid cancer (PTC) requiring RAI therapy and the radiation precaution strategies implemented by our team to reduce radiation exposure risk to the medical staff.A 69-year-old female with RAI-refractory tall cell-variant PTC (pT4aN1bM1; BRAF V600E pathogenic variant) with pulmonary metastases, paraplegia due to a motor vehicle accident with neurogenic bowel and bladder, was referred to our center for management of PTC. Laboratory data revealed a serum thyroglobulin of 2313 ng/mL (normal=1.6-59.9), and anatomical imaging showed numerous pulmonary nodules that had increased in size and number compared to prior imaging from 6 months ago. Due to disease progression, re-differentiation therapy with dabrafenib was initiated. After 3-months of dabrafenib therapy, a diagnostic thyroid hormone withdrawal-aided 131I scan with dosimetry revealed a significant re-induction of RAI uptake in pulmonary lesions and it was determined that therapy with an RAI dose of 200 mCi would not exceed a safe radiation exposure to the bone marrow of 200 rads. A multi-step mitigation strategy was developed based on a multidisciplinary team meeting and appropriate mock sessions. Stay times were estimated for individuals based on historical TEDE following the care of non-paralyzed patients receiving similarly prescribed activity. To minimize exposure to nursing staff, the patient’s Foley catheter was shielded with lead lining and bowels were emptied the night before RAI with a laxative. For each entry, posted safety sheets were updated with one-foot and one-meter isodose lines and on-contact exposure rates. Two nurses and one radiation safety staff member donned full personal protective equipment (PPE; full body suit, double gloves, booties, face covering) in the staging area and entered via lane one. While nursing provided direct care needs, radiation safety staff emptied the shielded catheter, organized clutter and packaged radioactive waste containers. Upon completion of duties, staff exited via lane two, removed PPE, and performed a full personnel contamination survey in the staging area. The patient successfully underwent RAI therapy with 200 mCi. Six months later the serum thyroglobulin had reduced to 48.4ng/ml with a substantial reduction in pulmonary metastatic tumor burden on imaging studies. Conclusion: Post-RAI therapy care of paralyzed patients during radiation isolation poses a unique challenge to medical staff warranting modifications in routine care practices, which can be achieved safely through optimal planning and enhanced training. Presentation Date: Saturday, June 17, 2023

Respiratory function of workers at some wood factories in Bac Tu Liem district, 2022

Objectives: This study aimed to assess the respiratory function status and associated factors among workers in wood factories in Bac Tu Liem district. Methods: A total of 80 workers from six woodworking establishments participated in this cross-sectional study. Respiratory symptom questionnaires based on ECCS-87 and ATS-DLD-78a were used to collect data on symptoms experienced within the past 12 months. Respiratory function measurements were also conducted during breaks and at the end of shifts. Results: Workers with 3-5 years of experience accounted for 63.8% of the total sample. The majority (92.5%) were exposed to harmful workplace factors for more than 8 hours per day. Only 13.8% reported using full personal protective equipment. Concentrations of respiratory particles and Total Suspended Particulate (TSP) in wood facilities exceeded allowable standards. Cough was the most commonly reported respiratory symptom, with a prevalence of 28.8%. Approximately 66.3% of subjects had normal respiratory function, while restrictive ventilation disorder accounted for the highest proportion of respiratory disorders at 21.3%. Statistical analysis revealed significant associations between respiratory dysfunction and work experience (OR=2.56, p<0.01), duration of exposure to hazardous factors (OR=1.8, p<0.05), use of personal protective equipment (OR=7.12, p<0.05), and the occurrence of respiratory symptoms (OR=1.73, p<0.01). Conclusions: workers in furniture manufacturing facilities in Bac Tu Liem district face exposure to high concentrations of total particles, respiratory particles, and toxic gases that surpass permissible standards. The study also found a significant relationship between respiratory dysfunction and employee characteristics. Keywords: Respiratory function, wood workers, wood factories.

The Correlation between Knowledge and Compliance with Personal Protective Equipment (PPE) Use in Construction Workers at EMC Alam Sutera Hospital, South Tangerang City

Construction work has a high-risk workplace. Construction workers are often faced with difficult and dangerous working situations. One of the efforts to protect workers in Occupational Safety and Health (OSH) is by supplying Personal Protective Equipment (PPE). This study analyzes the correlation between knowledge and compliance with personal protective equipment (PPE) used in construction workers. This paper correlated quantitative research with a cross-sectional approach. The study population was all construction workers at EMC Alam Sutera Hospital, South Tangerang, totaling 70 people. There were 70 respondents with a total sampling technique. The instruments were PPE compliance observation sheets and PPE knowledge questionnaires. Data analysis was univariate and bivariate analysis. Results showed that most respondents were 40 or older (60%). In addition, half of them had secondary and tertiary education (54.3%). Most also had good knowledge about PPE (65.7%). Of the 46 construction workers with good PPE knowledge, 42 complied with PPE use (91.3), and only four were not compliant (8.7%). Meanwhile, of the 24 construction workers with poor knowledge of PPE, 11 were not compliant with PPE use (45.8%), and 13 were compliant (54.3%). The statistical test results obtained were p=0.001. Thus, there was a significant correlation between knowledge and compliance with PPE use in respondents. In conclusion, knowledge correlates compliance with PPE uses among construction workers in EMC Alam Sutera Hospital, South Tangerang City. The hospital should provide recommendations to construction companies at EMC Alam Sutera Hospital, South Tangerang City, regarding using full PPE for construction workers.

Factors affecting the knowledge of vegetable farmers of Chitwan and Makwanpur district over pesticide use

A study was conducted in two districts of Nepal to determine the factors influencing the knowledge of vegetable farmers regarding pesticide use. The use of pesticides in agriculture is considered necessary but can pose significant risks if handled inadequately or impractically. The study collected data from 136 vegetable growers, with 68 farmers from each district, and also involved 5 agro vets from both districts using random sampling techniques. The findings indicated that only 13.23% of the farmers were found to wear full personal protective equipment (PPE), while 83.08% used partial PPE, and 3.67% applied pesticides without any protective gear. This finding was statistically significant at the 10% level. Among the different types of protective gear, masks were the most commonly used by the farmers. The majority of farmers (62.5%) reported being poisoned during pesticide mixing and spraying, with eye irritation being the most frequently reported symptom. Farm households that underwent training in pesticide usage and vegetable cultivation experienced a statistical enhancement of 20.6% in their knowledge. Moreover, farmers who were educated, had access to extension services, had long experience in pesticide usage, or had a history of poisoning in their farm household witnessed corresponding improvements of 9%, 18%, 2.1%, and 9.3% in their knowledge of pesticide use. The study urges agricultural organizations to implement training, promote literacy, offer extension services, and raise awareness to enhance farmers' knowledge and safety, contributing to sustainable agriculture and farmer well-being.

Pediatric COVID-19 extracorporeal membrane oxygenation transport during the pandemic.

ExtraCorporeal Membrane Oxygenation (ECMO) in pediatric patients with COVID-19 has a survival rate similar to adults. Occasionally, patients may need to be cannulated by an ECMO team in a referring hospital and transported to an ECMO center. The ECMO transport of a COVID-19 patient has additional risks than normal pediatric ECMO transport for the possible COVID-19 transmissibility to the ECMO team and the reduction of the ECMO team performance due to the need of wearing full personal protective equipment. Since pediatric data on ECMO transport of COVID-19 patients are lacking, we explored the outcomes of the pediatric COVID-19 ECMO transports collected in the EuroECMO COVID_Neo/Ped Survey. We reported five European consecutive ECMO transports of COVID-19 pediatric patients collected in the EuroECMO COVID_Neo/Ped Survey including 52 European neonatal and/or pediatric ECMO centers and endorsed by the EuroELSO from March 2020 till September 2021. The ECMO transports were performed for two indications, pediatric ARDS and myocarditis associated to the multisystem inflammatory syndrome related to COVID-19. Cannulation strategies differed among patients according to the age of the patients, transport distance varied between 8 and 390km with a total transport duration between 5 to 15h. In all five cases, the ECMO transports were successfully performed without major adverse events. One patient reported a harlequin syndrome and another patient a cannula displacement both without major clinical consequences. Hospital survival was 60% with one patient reporting neurological sequelae. No ECMO team member developed COVID-19 symptoms after the transport. Five transports of pediatric patients with COVID-19 supported with ECMO were reported in the EuroECMO COVID_Neo/Ped Survey. All transports were performed by an experienced multidisciplinary ECMO team and were feasible and safe for both the patient and the ECMO team. Further experiences are needed to better characterize these transports and draw insightful conclusions.

Intensive care nurses' experiences of caring for isolated COVID-positive patients during first wave of COVID-19.

COVID-19 has fundamentally changed all fields of health care. Intensive care nurses have been at the forefront of the pandemic facing the massive impact of the disease, both professionally and personally. This study investigated nurses' experiences of caring for isolated COVID-19 positive patients in the intensive care department during the first wave of the COVID-19 pandemic. The study investigated how isolation affected the nurses themselves, how they related with their patients, and how isolation affected patient care in general. The study was performed at a 20-bed university hospital intensive care department in Copenhagen, Denmark. COVID-19 positive patients were isolated or cohort isolated. A dedicated nurse cared for each isolated patient and wore full personal protective equipment. The study is based on in-depth phenomenological interviews with intensive care nurses conducted in summer 2020. The interviews were structured according to the principles of "Phenomenologically Grounded Qualitative Research." The data included observations from within the isolated patient rooms. Six intensive care nurses participated in the study. The analysis documented following themes consistently reported by all nurses: (1) a general sense of uncanniness, (2) intense feelings of confinement and co-isolation, and (3) heightened senses of bodily objectification, including how nurses' experienced their patients and also themselves. This is the first Scandinavian phenomenological study to focus on mapping the experiences of intensive care nurses during the extreme circumstances of the first wave of the COVID-19 pandemic. Further studies may explore long-term effects, such as psychiatric morbidity or psychological functioning in these individuals.

Unfamiliar personal protective equipment: The role of routine practice and other factors affecting healthcare personnel doffing strategies.

Healthcare personnel (HCP) may encounter unfamiliar personal protective equipment (PPE) during clinical duties, yet we know little about their doffing strategies in such situations. To better understand how HCP navigate encounters with unfamiliar PPE and the factors that influence their doffing strategies. The study was conducted at 2 Midwestern academic hospitals. The study included 70 HCP: 24 physicians and resident physicians, 31 nurses, 5 medical or nursing students, and 10 other staff. Among them, 20 had special isolation unit training. Participants completed 1 of 4 doffing simulation scenarios involving 3 mask designs, 2 gown designs, 2 glove designs, and a full PPE ensemble. Doffing simulations were video-recorded and reviewed with participants during think-aloud interviews. Interviews were audio-recorded and analyzed using thematic analysis. Participants identified familiarity with PPE items and designs as an important factor in doffing. When encountering unfamiliar PPE, participants cited aspects of their routine practices such as designs typically used, donning and doffing frequency, and design cues, and their training as impacting their doffing strategies. Furthermore, they identified nonintuitive design and lack of training as barriers to doffing unfamiliar PPE appropriately. PPE designs may not be interchangeable, and their use may not be intuitive. HCP drew on routine practices, experiences with familiar PPE, and training to adapt doffing strategies for unfamiliar PPE. In doing so, HCP sometimes deviated from best practices meant to prevent self-contamination. Hospital policies and procedures should include ongoing and/or just-in-time training to ensure HCP are equipped to doff different PPE designs encountered during clinical care.

MP15-01 THE NEW PANDEMIC: MONKEYPOX AND ITS UROLOGICAL PRESENTATIONS

You have accessJournal of UrologyCME1 Apr 2023MP15-01 THE NEW PANDEMIC: MONKEYPOX AND ITS UROLOGICAL PRESENTATIONS Alex Murray, Piotr Śluzar, Anna Daunt, Aatish Patel, Nori Achyuta, Geraldine O'Hara, and Tet Yap Alex MurrayAlex Murray More articles by this author , Piotr ŚluzarPiotr Śluzar More articles by this author , Anna DauntAnna Daunt More articles by this author , Aatish PatelAatish Patel More articles by this author , Nori AchyutaNori Achyuta More articles by this author , Geraldine O'HaraGeraldine O'Hara More articles by this author , and Tet YapTet Yap More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Monkeypox (MPX) is a zoonotic virus, endemic to Central and Western Africa. Since early May 2022, there has been an outbreak of the virus with 3,548 confirmed cases in the UK for 2022, predominantly affecting men who have sex with men (MSM). Due to the virus’ capacity to transmit via exchange of bodily fluids, colonisation of the genitalia is not uncommon. Despite this, there is a paucity of available literature concerning urological manifestations. This case series seeks to elucidate the natural history of MPX from a urological perspective. METHODS: We reviewed all MPX antigen-positive cases at Guy’s & St Thomas’ NHS Trust, and affiliated sexual health centres in south London, between May and October 2022. Patients that presented with penile lesions were identified — of those, cases that required specialist urological input were selected. RESULTS: 199 men with Monkeypox were identified. Of those, 10% (19/199) presented with penile lesions and required treatment in an isolation ward with full personal protection equipment; 4% (8/199) required input from the urology team. Their average age was 41.6 (±7.1) years. 62.5% (5/8) of these patients were HIV positive but only one was poorly controlled (>200 copies/mL). 75% (6/8) of patients experienced penile oedema and 50% (3/6) of these patients experienced paraphimosis. One patient experienced paraphimosis without oedema, another experienced penile cyanosis concomitant with severe distal oedema. Rarely, urinary insufficiency will develop. The average number of penile lesions was 6 (range: 1-14, s.d. ±5.4). Lesions demonstrated a range of presentations — some initially appeared as pustules and papules, while more severe cases developed extensive, wet ulcerations; in some cases secondary infections were superimposed on the lesions, leading to necrosis. All lesions, however, were painful and required analgesia. On average, patients would present to health services 5.4 (±1.6) days after onset of symptoms, and would take 21 (±7.9) days for all lesions to heal. CONCLUSIONS: MPX urological presentations seem to observe a continuum of severity. Currently, the long-term urological sequelae of MPX are unknown but small lesions seem to heal without issue. By assessing the number of penile lesions and the presence of/potential for superimposed infections, a clinical picture for the course of the infection can be constructed and be used to inform management. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e191 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Murray More articles by this author Piotr Śluzar More articles by this author Anna Daunt More articles by this author Aatish Patel More articles by this author Nori Achyuta More articles by this author Geraldine O'Hara More articles by this author Tet Yap More articles by this author Expand All Advertisement PDF downloadLoading ...

MP15-03 MONKEYPOX AND THE PENIS: AN EMPIRICAL CARE PATHWAY

You have accessJournal of UrologyCME1 Apr 2023MP15-03 MONKEYPOX AND THE PENIS: AN EMPIRICAL CARE PATHWAY Piotr Sluzar, Alex Murray, Anna Daunt, Aatish Patel, Achyuta Nori, Geraldine O'Hara, and Tet Yap Piotr SluzarPiotr Sluzar More articles by this author , Alex MurrayAlex Murray More articles by this author , Anna DauntAnna Daunt More articles by this author , Aatish PatelAatish Patel More articles by this author , Achyuta NoriAchyuta Nori More articles by this author , Geraldine O'HaraGeraldine O'Hara More articles by this author , and Tet YapTet Yap More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Monkeypox is a viral illness affecting predominantly gay, bisexual and other men having sex with men. The rapid progression of the recent outbreak meant genital manifestations preceded any guidelines for cases with urological symptoms. This study aims to develop an empirical care pathway for patients presenting with penile and scrotal symptoms secondary to monkeypox. METHODS: From May to September 2022, 198 patients with monkeypox who presented to a tertiary referral hospital were assessed for genital involvement by the infectious disease team, with the involvement of a urologist. Of these, 19 patients (10%) were admitted with genital lesions and were treated in an isolation ward with full personal protection equipment (PPE) in use. Symptoms requiring urological input were present in 8 individuals (4%). The mean time from the onset of symptoms to resolution was 25.3 (range 9-63) days. Based on the management of these patients, an empirical care pathway for genital monkeypox was developed. RESULTS: Four stages of genital monkeypox were observed (Figure 1). Limited penile oedema and discrete lesions should be managed conservatively with analgesia, cold compresses and elevation for swelling control. Patients with moderate oedema, paraphimosis and large coalescing ulcers should be considered for a topical 1% hydrocortisone cream to reduce the inflammation. In severe oedema with necrotic ulcers glyceryl trinitrate (GTN) patches are crucial to improve the vascularization of the necrotic ulcers on the penis. Cases of widespread necrosis and oedema may require imaging to assess the need for surgical debridement. GTN patches require daily changes for tissue salvage. Catheterization should be guided by the extent of oedema, the presence of paraphimosis and lesions close to the external urethral orifice. CONCLUSIONS: Monkeypox cases presenting through lesions on the penis and scrotum often require urological management to reduce penile oedema and prevent catheterisation. All admitted patients require isolation with full PPE. The initial stages of the infection should be managed conservatively with cold compresses, elevation and analgesia. Patients with advanced genital symptoms can benefit from the early use of topical steroid creams and GTN patches applied over the necrotic areas to reduce swelling and aid perfusion. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e192 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Piotr Sluzar More articles by this author Alex Murray More articles by this author Anna Daunt More articles by this author Aatish Patel More articles by this author Achyuta Nori More articles by this author Geraldine O'Hara More articles by this author Tet Yap More articles by this author Expand All Advertisement PDF downloadLoading ...

Attendance and Distribution Patterns of Patients in a Private Dental Clinic During the COVID-19 Pandemic

Background: To investigate the effects of the COVID-19 pandemic on the patients’ attendance/distribution patterns within different departments and the perception of the dental team providing dental services during the COVID-19 outbreak in a private dental clinic. Moreover, the impact of SARS-CoV-2 on dental professionals next to the role of personal protective equipment in the prevention of infection in the corresponding teams was simultaneously investigated.
 Methods: A clinic located in the northern part of Tehran was selected. Forty-four dentists with 48 staff members were involved in treatment teams. Preventive strategies, i.e., personnel/operator/patient management comprising full Personal Protective Equipment (PPE), high–volume evacuation suctions, primary screening questions, pulse oximetry, the patient’s body temperature measurement as well as administrative controls, e.g. disinfection of surfaces and using stairs instead of lifts, were implemented to manage the prevalence of disease and analyze the impact of COVID-19 on the distribution/attendance patterns of patients.
 Results: During 6 months, a 26% reduction in the number of patients was observed after the pandemic; however, men’s and women’s distributions were not affected. The department of orthodontics reported a 6% increase in new cases whereas the department of pediatric dentistry revealed the least changes in the number of patients. In the departments of operative dentistry, prosthodontics, oral/maxillofacial surgery, and periodontics, the number of patients was reduced by 10- 30%. In addition, three dentists and four staff members were affected by COVID-19 during the mentioned period.
 Conclusion: It seems that the potential for COVID-19 transmission in dental clinics is relatively low.

The effects of a ‘COVID Nurse Assistant’ application on patient satisfaction in COVID isolation rooms

Introduction: The COVID-19 pandemic has caused a major shift in the healthcare delivery system. With the limited personal protection equipment and a nursing service shortage caused ineffective nursing care delivered to COVID-19 patients. Wearing full personal protective equipment (PPE) hinders nurse-patients communication and inhibiting the achievement of treatment goals. This study aims to examine the effect of a ‘COVID Nurse Assistant’ (CNA) application on patient satisfaction in COVID-19 isolation rooms. Design and Methods: This was a comparative study with an experimental and control group design. The participants were patients confirmed positive with COVID-19 receiving care in an isolation room for at least three days and were fully conscious. The intervention used was accessing health information related to COVID-19 through a mobile-friendly application namely-‘COVID Nurse Assistant’. The instrument used was the Patient Satisfaction Questionnaire (PSQ-18) translated into Bahasa Indonesia. In addition, an independent t-Test was used to perform statistical analysis. Results and Discussions: A total 158 respondents completed the online survey among of 219 eligible patients (72% response rate). The score in the general and financial satisfaction sub-scales reported by patients in the experimental group were significantly different from the control with p-values of 0.032 and 0.018 respectively. However, other subscales were not significantly different between the two groups. Conclusions: The implementation of the CNA online application has noteworthy implications on patient satisfaction. However, further studies examining similar system in different clinical areas would provide better information for the optimal use of technology in patient education.

No: 4649 Video vs direct laryngoscopy for emergency endotracheal intubation in full personal protective equipment: a randomized, crossover, simulation trial

No: 4649 Video vs direct laryngoscopy for emergency endotracheal intubation in full personal protective equipment: a randomized, crossover, simulation trial

The Role of Interventional Radiology and Management of an Angiography Suite in the Treatment of COVID-19 Patients: Single-Center, 2-Year Experience.

Background and Objectives: Hospital angiography suites with negative-pressure ventilation facilities are challenging to equip. During the COVID-19 pandemic, we aimed to introduce interventional radiology procedures performed on COVID-19 patients and understand management of the angiography suite without a negative-pressure ventilation facility before and after the procedures to prevent the spread of infection. Materials and Methods: Between December 2020 and November 2022, 52 COVID-19 patients underwent interventional radiology procedures in an angiography suite, where no negative-pressure ventilation facility was installed. During the procedure, all staff members wore full personal protection equipment, and after the procedure for the COVID-19-positive patient was completed, the angiography suite was disinfected and entry to the angiography suite was prohibited for 1-3 h. In this angiography suite, procedures for COVID-19 patients and non-COVID-19 patients were performed. Results: A total of 61 interventional radiology procedures were performed in 52 patients with COVID-19. Of 52 patients, 21 underwent procedures under intubation and mechanical ventilation. All procedures were performed according to the guidelines set by the Infection Control Committee of our hospital. No major or minor complications were associated with the procedures. There were no cases of infection among staff members or other non-COVID-19 patients related to procedures on COVID-19 patients. Conclusions: Interventional radiology can play an important role in solving the complications of COVID-19 and the problems caused by patients' underlying diseases. In addition, if accurate guidelines are followed, both COVID-19 and non-COVID-19 patients can undergo procedures in an angiography room without negative-pressure ventilation while preventing infection.

Caution Regarding Enclosures for Airway Procedures

Article| January 2023 Caution Regarding Enclosures for Airway Procedures Uday Jain, BSEE, MD, PhD, FASA Uday Jain, BSEE, MD, PhD, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor January 2023, Vol. 87, 29. https://doi.org/10.1097/01.ASM.0000911788.66274.ff Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Uday Jain; Caution Regarding Enclosures for Airway Procedures. ASA Monitor 2023; 87:29 doi: https://doi.org/10.1097/01.ASM.0000911788.66274.ff Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: airway procedure, airway device Several enclosures for placement around the head and upper torso have been described during this pandemic (Anesth Analg 2020;131:e135-36; J Cardiothorac Vasc Anesth 2021;35:966-67). They are usually made of frames covered by transparent sheets. The enclosures have access ports for the operator's arms, supplemental oxygen, and airway equipment. The enclosures do not form an airtight seal around the patient's head and torso. They provide partial source control by suctioning aerosol and infectious droplets. If suction devices currently available in hospitals are utilized, the enclosure may only slightly reduce interior pressures relative to the ambient pressure. Hopefully most infectious material remains inside the enclosure, but during doffing and disposal contaminated material may escape. Although an enclosure may reduce health care personnel (HCP) exposure, full personal protective equipment (PPE) is still required. No studies demonstrate safety, efficacy, or usability. What is unambiguous is that airway enclosures adversely affect visibility... You do not currently have access to this content.

Self-reported adherence of healthcare workers to infection prevention and control practices during the early waves of the COVID-19 pandemic in Egypt

Introduction: Considering the absence of effective treatment, the World Health Organization had recommended stringent infection prevention and control (IPC) measures against coronavirus disease 2019 (COVID-19) to reduce its transmission. The non-adherence of healthcare workers (HCWs) to these measures had been reported as a major cause of infection. Aim: To assess the level of self-reported adherence of HCWs to IPC measures during their social life and work time. Methods: This cross-sectional study included 559 HCWs (411 females and 148 males) working at 39 hospitals across different Egyptian governorates. A predesigned structured questionnaire about COVID-19 IPC measures was completed by trained interviewers. Results: Washing hands before eating (98.2%), using soap for hand wash (97.9%), washing hands after returning home (96.6%), and wearing a face mask when going outside in public places (83.7%) were the commonest daily-life practices among the 559 studied HCWs, while the least common was social distancing (46.0%). Less than half of the studied HCWs were adherent to the proper duration of handwashing (P < 0.01). Only 5.9% of the studied HCWs usually wore full personal protective equipment (PPE) at work (P = 0.051). The highest percentages of HCWs working at outpatient clinics and laboratories (98.1% each) ‘sometimes’ used PPE (P = 0.017). There was a significant difference in self-reported adherence to wearing face masks at hospitals according to specialties (P < 0.01). HCWs working at intensive care units (ICUs) recorded the highest attendance rates at IPC training (53.8%, P = 0.012). A relatively higher percentage of HCWs at COVID-19 isolation hospitals wore PPE (15.7%) versus 2.2–4.7% in other hospitals (P = 0.015). Conclusion: The majority of HCWs sometimes complied with wearing PPE (93.6%). HCWs were more adherent to wearing masks at hospitals (94.6%) compared to community settings (42.9%). Older age and female gender were significantly associated with self-reported adherence to some IPC measures. Hand hygiene training session emphasizing the proper duration of hand wash is mandatory.