Level Of Personal Protective Equipment Research Articles

THE RELATIONSHIP BETWEEN DRY EYE SYNDROME AND THE USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE) IN HOSPITAL MEDICAL WORKERS)

Introduction & Objectives : Background: The need to wear personal protective equipment (PPE) during a pandemic can cause dry eye syndrome. It will increase sweating so reduce tear production and the use of masks increase air flow to the eye area so that tear evaporation increases. Objective: To determine the relationship between the incidence of dry eye syndrome and the use of PPE in hospital medical personnel.
 Methods : Methods: This was an analytic observational study with a cross-sectional design using the OSDI (Ocular Surface Disease Index) questionnaire. The research was carried out at the Cilacap Hospital in 2021. There were 49 samples (51% male and 49% female), with an age range of 20-50 years. The data was analyzed by using the Spearmans test.
 Results : Results: The incidence of dry eye syndrome was 69.5% (mild 18.4%, moderate 18.4%, severe 32.7%). As many as 53.1% of the incidence of dry eye syndrome occurred in wearing PPE for more than 4 hours and was more common in the use of PPE level 1 (40.8%), followed by level 3 (36.7%) and level 2 (22.5%). In the Spearman's test, it was found that there was a significant association between the incidence of dry eyes syndrome and the use of PPE (duration and level of PPE) (p<0.05) but had a weak relationship strength (r=0.3).
 Conclusion : Conclusion: There is a significant relationship between the incidence of dry eyes syndrome and the use of PPE (duration and level of PPE use) but has a weak relationship strength.

Making respiratory care safe for neonatal and paediatric intensive care unit staff: mitigation strategies and use of filters.

Many medical devices in pediatric and newborn intensive care units can potentially expose healthcare workers (HCWs) and others to transmission of respiratory and other viruses and bacteria. Such fomites include ventilators, nebulizers, and monitoring equipment. We report the general, novel approach we have taken to identify and mitigate these risks and to protect HCWs, visitors and patients from exposure while maintaining the optimal performance of such respiratory equipment. The approach combined a high level of personal protective equipment (PPE), strict hand hygiene, air filtration and air conditioning and other relevant viral risk mitigation guidelines. This report describes the experiences from the SARS-CoV-2 pandemic to provide a reference framework that can be applied generally. The steps we took consisted of auditing our equipment and processes to identify risk through sources of potentially contaminated gas that may contain aerosolized virus, seeking advice and liaising with suppliers/manufacturers, devising mitigation strategies using indirect and direct approaches (largely filtering), performing tests on equipment to verify proper function and the absence of negative impacts and the development and implementation of relevant procedures and practices. We had a multidisciplinary team to guide the process. We monitored daily for hospital-acquired infections among staff caring for SARS-CoV-2 patients. Our approach was successful as we have continued to offer optimal intensive care to our patients, and we did not find any healthcare worker who was infected through the course of caring for patients at the bedside. The lessons learnt will be of benefit to future local outbreaks or pandemics.

FROM CRISIS TO CONTROL THROUGH COVID-19: NURSING HOME LEADERSHIP PERSPECTIVES ON DELIVERING QUALITY CARE

Abstract A year after the US Government announced that the COVID-19 pandemic has transitioned to an endemic phase, nursing home (NH) leaders are still challenged to deliver quality care. This study aimed to describe NH leadership perspectives on preparing and maintaining quality care during times of diminishing resources as experienced through the COVID-19 pandemic to gain a perspective on how best to support NHs moving forward. We used convergent mixed methods to explore experiences of NH leaders (N=15) participating in the Project ECHO (Extension for Community Health Outcomes) study. Data were collected through publicly reported survey data and individual interviews conducted at 12-month follow-up. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using verbatim transcripts and inductive thematic coding subsequently organized by a guiding framework. Convergent analysis indicates that participating NHs (N=136) align with national trends in infection rates of residents, staff, access to resources such as personal protective equipment and testing supplies. Leadership from a sub-sample of these homes (N=14; 43% rural; 71% not-for-profit) perceived their NH to be in varied states of operations needed so support quality infection control at the transition to endemic COVID-19 phase. Leadership reported continued challenges in addressing resident & staff vaccinations, securing testing supplies, obtaining financial resources to maintain acceptable levels of personal protective equipment, and isolation practices. Leadership valued providing person-centered care even in times of crisis. These results indicate socio-cultural reasons behind why NHs continue to struggle delivering quality care post-pandemic and offers areas to focus support efforts.

Examination of urinary pesticide concentrations, protective behaviors, and risk perceptions among Latino and Latina farmworkers in Southwestern Idaho

IntroductionStudies have documented high levels of pesticide exposure among men farmworkers; however, few have examined exposures or the experiences of women farmworkers. Data gaps also exist regarding farmworkers’ perceived risk and control related to pesticides, information that is critical to develop protective interventions. ObjectiveWe aimed to compare urinary pesticide biomarker concentrations between Latino and Latina farmworkers and examine associations with occupational characteristics, risk perceptions, perceived control, and protective behaviors. MethodsWe enrolled a convenience sample of 62 farmworkers (30 men and 32 women) during the pesticide spray season from April–July 2022 in southwestern Idaho. Participants were asked to complete two visits within a seven-day period; at each visit, we collected a urine sample and administered a questionnaire assessing demographic and occupational information. Urine samples were composited and analyzed for 17 biomarkers of herbicides and of organophosphate (OP) and pyrethroid insecticides. ResultsTen pesticide biomarkers (TCPy, MDA, PNP, 3-PBA, 4-F-3-PBA, cis- and trans-DCCA, 2,4-D, Glyphosate, AMPA) were detected in >80% of samples. Men and women had similar urinary biomarker concentrations (p = 0.19–0.94); however, women worked significantly fewer hours than men (p = 0.01), wore similar or greater levels of Personal Protective Equipment (PPE), and were slightly more likely to report having experienced an Acute Pesticide Poisoning (26% of women vs. 14% of men; p = 0.25). We observed inconsistencies in risk perceptions, perceived control, and protective behaviors among men. DiscussionOur study is one the first to examine pesticide exposure and risk perceptions among a cohort of farmworkers balanced on gender. Taken with previous findings, our results suggest that factors such as job tasks, biological susceptibility, or access to trainings and protective equipment might uniquely impact women farmworkers’ exposure and/or vulnerability to pesticides. Women represent an increasing proportion of the agricultural workforce, and larger studies are needed to disentangle these findings.

BURNOUT AND RELATED FACTORS IN HOSPITAL HEALTH WORKERS AFTER ONE YEAR OF COVID-19 PANDEMIC

Workload, fear of contracting Covid-19 or the use of high levels of personal protective equipment which causes discomfort and exhaustion are some of the potential factors that can cause burnout in hospital health workers. The aims of this study were to determine the prevalence and factors related to burnout in hospital health workers after one year of the covid-19 pandemic. This study used a cross-sectional design and the Indonesian version of the Maslach Burnout Inventory (MBI) questionnaire to diagnose burnout. In the Masclach Burnout Inventory (MBI) questionnaire, burnout is grouped into the following three dimensions: a) emotional fatigue, b) loss of empathy, and c) self-esteem. The MBI questionnaire was distributed using a Google form (G-form). Data processing and analysing was conducted using SPSS version 20.0 program. A total of 135 health workers filled out the G-form questionnaire and it was found that 39.3% of them experienced burnout.  Factors significantly related (p<0,05) to burnout were higher education with ORa 4.10 (95% C.I.= 1.66 – 7.27) and shift work with ORa 2.44 (95% C.I.= 1.02 -5.86). The prevalence of burnout for health workers at the one of private Hospital in East Jakarta after more than 1 year of the Covid-19 pandemic was 39.3%. Factors that are significantly related to burnout are the level of education and shift work patterns.

3D printers in hospitals: Reducing bacterial contamination on 3D-printed material

Background: COVID-19 has presented hospitals with unique challenges. An SHEA Research Network survey showed that 40% reported “limited” or worse levels of personal protective equipment (PPE) and that 13% were self-producing PPE to address those deficits, including 3D-printed items. However, we do not know how efficiently, if at all, 3D-printed materials can be disinfected. Additionally, 2 filaments, PLACTIVE and PUREMENT, claim to be antimicrobial; they use copper nanocomposites and silver ions to reduce bacterial populations. We assessed how PLACTIVE and PUREMENT may be contaminated and how well they reduce contamination, and how readily polylactic acid (PLA), a standard 3D-printed material, may be disinfected. Methods: We grew methicillin-resistant and -susceptible Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae on 3D-printed disks and conducted bacterial survival assays to determine whether bacteria grow on PLA, PLACTIVE, and PUREMENT. We performed a time series (with 3- and 24-hour dry times) followed by serial dilutions to attain colony-forming unit (CFU) averages for each strain per disk. To determine whether 3D-printed material can be cleaned, we used 70% EtOH on PLA only. We conducted the same time series followed by a disinfectant time series (with dry times 30 seconds, 2.5, minutes, 5 minutes, and 10 minutes). Again, serial dilutions were performed to attain the PLA CFU averages with disinfectant. The CFU averages from the control group (PLA) and testing group (PLACTIVE and PUREMENT) were compared to see how well the antimicrobial material decreased bacterial load. We also compared the CFU averages of PLA with and without disinfectant to see how well 70% EtOH decreased bacterial load. Results: 3D-printed material is readily contaminated with bacteria common in hospitals and can sustain that contamination. Antimicrobial materials, PLACTIVE and PUREMENT, had lower levels of bacterial contamination when compared to PLA. However, disinfected disks had lower overall CFU averages than those that were not, but the level of disinfection was variable and bacterial populations recovered hours after disinfection application. Conclusions: Proper disinfection and using appropriate 3D-printed materials are essential to limiting bacterial contamination. 3D printers and their products can be invaluable for hospitals, especially when supplies are low and healthcare worker safety is paramount. Environmental services should be made aware of the presence of antimicrobial 3D-printed materials, and patients should be discouraged from printing their own items for use in hospital environments.Disclosures: None

Assessing the New Norm: A Simulation Study to Assess Pediatric Emergency Physician Success in Critical Procedures With an Air Purifying Respirator.

Physicians caring for patients with COVID-19 are at high risk for contracting the disease, thus, significant emphasis has been placed on personal protective equipment (PPE). The study aims to assess the impact of advanced PPE across 4 common procedures: endotracheal intubation, bag-valve mask ventilation, intraosseous (IO) insertion, and lumbar puncture (LP) performed by pediatric emergency physicians. Physicians performed the procedures in a simulated environment. Lumbar puncture and IO were performed with standard precautions versus an air purifying respirator (APR). A direct comparison was drawn for endotracheal intubation and bag-valve mask ventilation between 2 commonly used APRs. Success rate and number of attempts toward successful completion was recorded for all 4 procedures. Physicians filled out a postprocedure survey to assess their ease of use of the APR. Twenty participants performed IO and LP using an APR and standard precautions. There was no statistical difference in the success rate, number of attempts, average time, or maintenance of sterility (LP only) for both procedures. Twenty total participants divided across 2 types of APR groups performed intubation and BMV. Success rate and number of attempts had no statistical difference for both procedures. Physician feedback surveys to assess the ease of use of APR compared with standard precautions had no statistically significant difference for all 4 procedures. Wearing increased levels of PPE did not impact procedural success, length of time, sterility, number of attempts, or the physicians' ease in our study. Physicians should be encouraged to wear all appropriate PPE.

A Systematic Review of PPE Recommendations for First Responders, and Medical Professionals to Nuclear Radiological Events at Nuclear Power Plants

Introduction:Due to climate change, many countries are exploring nuclear power as a clean, sustainable, and alternative energy source. However, radiophobia stemming from a history of major accidents at nuclear power plants (most recently Fukushima Daiichi) inhibits the expansion of this industry. In an unlikely event of a large-scale accident, the risks posed to humans are minimal when mitigation measures are followed. This includes appropriate Personal Protective Equipment (PPE) for first responders, and medical professionals responding to these emergencies. An examination of the PPE recommendations for these scenarios will highlight best practices for minimizing exposures, and the effects of radiation.Method:A systematic literature review will provide a historical baseline of the PPE worn during previous nuclear power plant events. Additionally, current recommendations for PPE levels in response to these emergencies will be explored. Five databases will be utilized for this study, including PubMed, Web of Science, and SCOPUS.Results:Many studies examine different types of nuclear radiological exposures, but few focus on nuclear power plant scenarios. More than 5,000 articles emerged from a preliminary survey of the five databases. However, less than 1% of them satisfied the extraction criteria, and reviewed PPE for nuclear power plant accidents. Medical responders caring for “exposed” individuals who present at Emergency Departments have minimal exposure once they’re decontaminated, and everyday PPE is maintained. However, data on PPE recommendations for on-site response remains unexplored. Airtight suits and full-face respirators emerged as industry gold standard for protection, but a closer examination of these types of suits, and responders' self-efficacy utilizing the gear would clarify their actual protective qualities.Conclusion:While nuclear power plant accidents do not occur often, many remain fearful of their impact. Maintaining proper PPE (including respiratory habiliment) for event responders is one way to minimize the adverse health effects of these nuclear radiological exposures.

Headache in healthcare workers related to personal protective equipment use in COVID-19 referral hospital

BackgroundStudies show that wearing personal protective equipment (PPE) for long periods of time can lead to discomfort such as headaches, which could affect the performance of healthcare workers. The aim of this study was to determine the prevalence and risk factors of headaches related to PPE in healthcare workers at a COVID-19 referral hospital. MethodsA cross-sectional study was conducted involving 174 healthcare workers in a COVID-19 referral hospital in Bali. We conducted interviews using a questionnaire that consisted of three main parts: characteristics of the subjects, PPE usage, and PPE-associated headaches. A multiple logistic regression was used to analyze the data. ResultsThe analysis results showed that the PPE-associated headaches had a prevalence of 63.8% and were gradual in onset, pressure-like in quality (46%), and mild in intensity (80.1%). PPE level III-associated headache was the most common type. The majority of the participants had headaches up to 6 hours after using the protective gear, but improving within 15-30 minutes of removal and/or after pharmacotherapy. A Chi-squared analysis showed a statistically significant association between duration of PPE use, working units, and PPE levels (p<0.05). A logistic regression analysis found a significant relationship between PPE level and headache occurrence (OR=4.826;95%CI: 2.433-9.572; p<0.001). ConclusionThe frequency of PPE-associated headache was high and the PPE level was a risk factor of headache among healthcare workers. Better strategies are needed to reduce the duration of PPE exposure so that the work performance and quality of life of healthcare workers are not significantly affected.

SG-APSIC1201: Knowledge and awareness of healthcare workers in a residential care home regarding the use of personal protective equipment (PPE) during the COVID-19 pandemic: A pilot study

Background: According to the World Health Organization (WHO), as of April 9, 2022, there had been 494,587,638 confirmed COVID-19 cases and 6,170,283 deaths reported worldwide. In Hong Kong, in recent outbreak, ~55% of confirmed cases were residential care home (RCH) residents and >800 staff were infected. In 2016, ~15% of people aged ≥80 years were living in residential care homes. Objectives: To assess healthcare worker (HCW) knowledge level and attitudes about PPE use in residential care homes. Methods: This cross-sectional study, included participants who worked in the residential care homes, registered as healthcare workers (HCWs). HCWs who were part-time staff or worked <3 months in the residential care home were excluded. Ethical review approval from the faculty research committee of the university was obtained in January 2022. The Knowledge, Attitude, Practical (KAP) questionnaire was adapted. The questionnaire has 33 items pertaining to knowledge, attitude, and practice regarding PPE. Results: In total, 50 questionnaires were received; 32 respondents (64%) were female and 18 (36%) were male. Nearly half of the participants had completed a high diploma course, and 32% had graduated from secondary school. Using ANOVA, there were no significant differences of education level of participants or participant knowledge level of PPE [F(2,47) = .181; P = .835], attitudes [F(2,47) = 1.995; P = .147] and practice [F(2,47) = .459; P = .635]. The Pearson correlation was used to measure the relationship between knowledge level and PPE practices. Our results indicated a significant difference and moderate correlation between knowledge level and PPE practice among HCWs. Conclusions: Knowledge level does not directly affect HCW practice regarding PPE. PPE practice skills have been influenced by various factors during the pandemic situation, such as availability of PPE, manpower, workload, and communication.

Factors affecting providers’ comfort and fear during intubations of patients with COVID-19

BackgroundProviders performing endotracheal intubation are at high risk of contracting SARS-CoV-2. The objective was to assess various demographic, exposure and institutional preparedness factors affecting intubators’ comfort and fear level during...

The impact of COVID-19 on emergency medical service-led out-of-hospital cardiac arrest resuscitation: a qualitative study.

Following the emergence of COVID-19, there have been local and national changes in the way emergency medical service (EMS) staff respond to and treat patients in out-of-hospital cardiac arrest (OHCA). The views of EMS staff on the impact of COVID-19 and management of OHCA have not previously been explored. This study aimed to explore the views of staff, with a specific focus on communication during resuscitation, resuscitation procedures and the perception of risk. A qualitative phenomenological enquiry was conducted. A purposive sample of n = 20 participants of various clinical grades was selected from NHS EMS providers in the United Kingdom. Data were collected using semi-structured interviews, transcribed verbatim and inductive thematic analysis was applied. Three main themes emerged which varied according to clinical grade, location and guidelines.Decision making: Staff generally felt supported to make best-interest termination of resuscitation decisions. Staff made informed decisions to compromise on recommended levels of personal protective equipment (PPE), since it felt impractical in the pre-hospital context, to improve communication or to reduce delays to care.Service pressures: Availability of operational staff and in-hospital capacity were reduced. Staff felt pressure and disconnect from the continuous updates to clinical guidelines which resulted in organisational change fatigue.Moral injury: The emotional impacts of prolonged and frequent exposure to failed resuscitation attempts and patient death caused many staff to take time away from work to recover. This qualitative study is the first known to explore staff views on the impacts of COVID-19 on OHCA resuscitation, which found positive outcomes but also negative impacts important to inform EMS systems. Staff felt that COVID-19 created delays to the delivery of resuscitation, which were multi-faceted. Staff developed new ways of working to overcome the barriers of impractical PPE. There was little impact on resuscitation procedures. Moving forwards, EMS should consider how to limit organisational change and better support the ongoing emotional impacts on staff.

The correlation between knowledge and nurse compliance in the use of personal protective equipment level 2

Background: Personal Protective Equipment (PPE) is divided into 3 levels, the use of which is adjusted to the location of health services due to the COVID-19 pandemic. The second level of PPE is intended for health workers who work in patient care rooms. One of the causes of high cases of nurses contracting viral infections is the lack of knowledge and compliance in using PPE. 
 Purpose: The aim of this study was to find out the correlation between knowledge and nurse compliance in the use of PPE level 2.
 Methods: This study was a quantitative research with correlational analytic type. The number of respondents was 62 nurses. Collecting data using a knowledge  (8 qoestions) and compliance (10 questions) questionnaire of nurses in the use of PPE level 2. The analysis used was univariate and bivariate analysis with the Pearson Product Moment test with level of significance at the alpha = 0.05. 
 Results: The results of the univariate analysis of knowledge obtained a mean value of 6.16 with a standard deviation of 1.04 and nurses’ compliance obtained a mean value of 34.67 with a standard deviation of 3.56. The results of the study concluded that there was no significant correlation between knowledge and nurse compliance in the use of PPE level 2 in Petala Bumi Hospital, Riau Province with p = 0.513 and r = 0.085.
 Conclusions: This study suggests that nurses increase knowledge and compliance with the use of level 2 PPE in providing nursing services by attending training, seminars and workshops on preventing disease transmission, especially during the COVID-19 pandemic.

Saúde Ocupacional aplicada aos Pavimentadores de Estradas

Introduction/framework/objectives It is not uncommon for Occupational Health teams to have a client in the road paving sector; however, literature for this area is sparse. The aim of this article is to summarize the most pertinent and recent articles published on the subject. Methodology This is a Bibliographic Review, initiated through a search carried out in August 2021 in the databases “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina and RCAAP”. Contents The IARC (International Agency for Research on Cancer) classified the asphalt used for paving roads as possibly carcinogenic to humans (group 2b), due to polycyclic aromatic hydrocarbons. However, epidemiological studies do not show clear evidence of a higher incidence/prevalence of diseases of this type, although the risk may be different, depending on the route of entry (inhaled versus cutaneous) and the specific composition. There are also aliphatic hydrocarbons, cyclic alkanes and heterocyclic compounds. The association with different types of cancers is inconclusive but still stronger for lung versus skin. Some of these substances can cause chromosomal instability which, in turn, some argue that it can lead to cancer pathology. Discussion and Conclusions In the research carried out there was only data related to the chemical agents inserted in the asphalt; no references were found to other Occupational Risk/Risks Factors, such as other chemical agents, dust; noise, cut, vibrations associated with different machines; physical loads/efforts, forced/maintained postures, falling to the same level or at different levels, and eventual burial; ultraviolet radiation and thermal discomfort or trampling. As for the chemical risk, most authors consider that some substances included in the composition of the asphalt, especially under certain technical conditions (equipment, temperature, asphalt subtypes), may be carcinogenic to humans. However, even at this level, collective or individual protection measures are not mentioned, in order to provide concrete guidance for those who have clients in this sector. In the context of the former, it can be assumed that it would be pertinent to promote the rotation of tasks, to choose the types of asphalt considered less toxic (whenever possible) and the equipment that worked at lower temperatures, with less noise and vibrations; promote good maintenance of machines and purchase safer models; as well as organizing training and access to adequate Occupational Health services. In turn, at the level of Personal Protective Equipment, one could use mask/visor, hat/cap, uniform, glasses (for ultraviolet radiation and entry of foreign bodies), sun protection cream, ear protection, gloves (for cutting/abrasion and/or vibration), knee braces and/or abdominal restraint straps. It would be important for some Occupational Health teams working in the area to better study the sector and develop valid knowledge about the gaps mentioned, disseminated through publication in journals of the area. KEYWORDS: road paving, road pavers, occupational health, occupational medicine and occupational risks.

The Impact of Personal Protective Equipment on Speech Discrimination and Verbal Communication in the Operating Room and the Role of Audio Communication Devices.

Recent work has highlighted communication difficulties when wearing personal protective equipment (PPE) in the clinical setting, but currently, there are little objective data on its effects. We assessed the impact of PPE on verbal communication in a simulated operating room and evaluated use of an audio communication device. Frontline health professionals across specialties including surgery, anesthetics, and nursing undertook speech discrimination testing with and without standardized levels of PPE in a simulated operating room environment. Background noise (30- and 70-a-weighted decibel multitalker babble) at 2 distances (2 and 4 m) were selected representative of operating room environments. Bamford-Kowal-Bench (BKB) scoring (192 sentences per participant) was performed. A Digital Multichannel Transceiver System (DMTS) was evaluated. We assessed the effects of PPE use, distance, and use of the DMTS with pairwise comparisons, using a Bonferroni correction, and assessed participant experience via Likert scales. Thirty-one healthcare professionals were tested. Without PPE in 70-a-weighted decibel "babble," median BKB sentence scores were 90% and 76% at 2 and 4 m (adjusted P < 0.0005). The median BKB sentence scores dropped to 8% and 4% at 2 and 4 m in PPE (adjusted P < 0.0005). Improved speech discrimination was achieved with DMTS use to 70% and 76% at 2 and 4 m. Personal protective equipment led to a statistically significant reduction in BKB scores across all conditions compared with baseline. Overall participant confidence in PPE clinical communication was low. Addition of PPE dramatically impairs speech discrimination and communication in high levels of background noise characteristic of clinical environments, which can be significantly improved using DMTS. Measures should be taken by teams through both through reduction of background noise and consideration of assistive technologies maximizing patient safety. This may be further rehearsed in a simulation environment.

Pre- and post-COVID practice of interventional pulmonology in adults in Portugal

Introduction and objectivesThere is a lack of information regarding bronchoscopy practice in adults in Portugal. Our objective was to obtain an overview of the characteristics, resources, techniques and behaviors in national interventional pulmonology (IP) units, before and after SARS-CoV-2 outbreak. Materials and MethodsAn online survey was developed by an expert panel with a total of 46 questions comprising the specifications of each unit, namely physical space, equipment, staff, procedure planning, monitoring, technical differentiation, and numbers pre- and post-COVID-19. Forty-one interventional pulmonology centers were invited to participate between April and May 2021. Results37 units (90.2%) responded to the survey. The majority (64.9%) have a fully dedicated space with a weekly presence of ≥3 chest physicians (82.1%) and support of an anesthesiologist on specific days (48.6%). There is marked heterogeneity in the IP unit's equipment, and 56.8% acquired disposable bronchoscopes after COVID-19 pandemics. Pre-bronchoscopy hemogram, platelet count and coagulation tests are regularly asked by more than 90% of the units, even when deep sedation or biopsies are not planned. In 97.3% of cases, topical anesthesia and midazolam are utilized. Propofol (21.6%) and fentanyl (29.7%) are occasionally employed in some institutions. Most units use ancillary sampling techniques to diagnose central or peripheral lesions, with radial EBUS being used for guidance of distal procedures in 37.8% of centers, linear EBUS and EUS-B-FNA for mediastinal diagnosis and/or staging in 45.9% and 27.0% of units, respectively. Cryobiopsies are used by 21.6% of respondents to diagnose diffuse lung diseases. Rigid bronchoscopy is performed in 37.8% of centers. There was a decrease in the number of flexible (p < 0.001) and rigid (p = 0.005) bronchoscopies and an upscale of personal protective equipment (PPE) during the COVID-19 outbreak. ConclusionsIP units have variable bronchoscopic practices, but during the COVID-19 pandemic, they complied with most international recommendations, as elective procedures were postponed and PPE levels increased.

Variability in personal protective equipment in cross-sectional interventional abdominal radiology practices.

PurposeTo determine institutional practice requirements for personal protective equipment (PPE) in cross-sectional interventional radiology (CSIR) procedures among a variety of radiology practices in the USA and Canada.MethodsMembers of the Society of Abdominal Radiology (SAR) CSIR Emerging Technology Commission (ETC) were sent an eight-question survey about what PPE they were required to use during common CSIR procedures: paracentesis, thoracentesis, thyroid fine needle aspiration (FNA), superficial lymph node biopsy, deep lymph node biopsy, solid organ biopsy, and ablation. Types of PPE evaluated were sterile gloves, surgical masks, gowns, surgical hats, eye shields, foot covers, and scrubs.Results26/38 surveys were completed by respondents at 20/22 (91%) institutions. The most common PPE was sterile gloves, required by 20/20 (100%) institutions for every procedure. The second most common PPE was masks, required by 14/20 (70%) institutions for superficial and deep procedures and 12/12 (100%) institutions for ablation. Scrubs, sterile gowns, eye shields, and surgical hats were required at nearly all institutions for ablation, whereas approximately half of institutions required their use for deep lymph node and solid organ biopsy. Compared with other types of PPE, required mask and eye shield use showed the greatest increase during the SARS-CoV-2 pandemic.ConclusionPPE use during common cross-sectional procedures is widely variable. Given the environmental and financial impact and lack of consensus practice, further studies examining the appropriate level of PPE are needed.Graphical abstract

Skin Damage and Quality of Life among Healthcare Workers Providing Care during the COVID-19 Pandemic: A Multicenter Survey in Banten Province, Indonesia.

Since the occurrence of the coronavirus disease-2019 pandemic, healthcare workers (HCWs) have been strictly adhering to infection control practices within healthcare facilities. However, regular use of personal protective equipment (PPE) and hand hygiene have led to increased prevalence of skin damage, subsequently impacting the quality of life (QoL). To analyse the connection between skin damage and the QoL among HCWs in a multicenter setting in Indonesia. A cross-sectional survey was conducted among HCWs working in hospitals in Banten Province, Indonesia. The data was obtained using a reliable self-reported questionnaire (Cronbach α 0.765) and a validated Indonesian version of the Dermatology Life Quality Index. A total of 113 respondents (56.5%) who experienced at least one self-perceived PPE-related skin damage and had worn PPE of any level within the last 7 days were analysed. The mean age ± SD of respondents was 26.09 ± 6.22 years old, while the mean DLQI score ± SD was 5.46 ± 4.88, with a median of 4.0 (range, 0-24). The regression model showed that the level of PPE used (P < 0.05) to be a significant risk factor. Skin damage due to PPE affects HCWs physically and emotionally. It is crucial to recognise its impact on life and reinforce awareness, prevention, and treatment of skin damage. Dermatologist referral and intervention should be considered for optimum management.

Exploring the System Dynamics of COVID-19 and Reconfiguration of Emergency Medical Services

Emergency Medical Services (EMS) are essential to the medical healthcare landscape. EMS play a crucial role in maximizing the overall expected survival probability of patients with various health emergencies. During the COVID-19 pandemic, peoples’ lifestyle changed and their decisions to seek medical assistance were mixed with fear. This affected the type and number of missions that EMS responded to worldwide. Furthermore, COVID-19 affected EMS systems in terms of response protocols and personal protective equipment levels. These changes influenced the EMS’ provision of these essential services – fluctuations in demand impacted capacity decisions, the need for PPE altered response times, and lockdowns influenced roadway dynamics. This research focuses on describing and analyzing the performance of a major EMS provider in Lebanon in terms of response time to emergency missions during the COVID-19 pandemic compared to previous years and to the context of EMS in other countries. Results show that the number of calls and number of missions dropped yet, the emergency response time was found to be higher than previous years. The change in response time is most strongly tied to capacity allocation and PPE protocols. This study is an initial step toward exploring EMS system dynamics, with the goal of effectively allocating resources for improved EMS service during periods of heightened uncertainty and variability.

COVID-19 and gastrointestinal endoscopy in France: from the first to the second wave.

In March 2020, a week after the first lockdown in France, during the first wave of the SARS-CoV-2 pandemic, the French Society of Digestive Endoscopy (Société Française d’Endoscopie Digestive, SFED) sent gastroenterologists practicing endoscopy a web-based survey that included 35 questions about their endoscopic activity during 1 week [1]. The survey concluded that 91 % of the endoscopies were cancelled, and underscored the poor level of personal protective equipment (PPE) available, with difficulties obtaining masks reported by 14 % of respondents and 57 % of endoscopies eventually performed without a mask. In addition, 13 % of the respondents reported symptoms compatible with COVID-19 and 2 % had a positive polymerase chain reaction (PCR) test for it.