Design Of Personal Protective Equipment Research Articles

Self-contamination with use of personal protective equipment: Concept analysis using Rodgers’ evolutionary method

Background: Although self-contamination has been identified through relevant studies on the safe utilization of personal protective equipment (PPE) by healthcare personnel and the prevention of healthcare-associated infection transmission, there is a lack of in-depth understanding of self-contamination. This study aimed to review previous research on self-contamination and clarify the concept. By understanding this concept, healthcare personnel can improve their conscientiousness regarding self-contamination and gain a foundation for the requisite interventions to reduce self-contamination in healthcare settings. Method: MeSH terms such as “Health Personnel,” “Students, Health Occupations,” and keywords related to PPE combined with “contaminat*” and “self-contamination” to retrieve literature in OVID, EMBASE, Cochrane, CINAHL, and PsycINFO databases without time limits through December 2023 (Figure 1). The concept of self-contamination’s antecedents, attributes, and consequences were explained based on Rodgers’ evolutionary Results: After eliminating duplicates from the 2,195 studies that were initially searched, the authors reviewed the articles and determined eligibility independently. A total of 25 articles, published between 2006 and 2023, were included and analyzed. Antecedents to self-contamination were classified into three groups for each component (Figure 2). First, PPE factors included 1) types of PPE and/or ensemble choices, and 2) problems with PPE designs and/or their functions. Second, user factors involved 1) mistakes (errors of intent), 2) violations (deviations from recommendations), and 3) slips (natural flaws in humans). Third, organizational factors covered 1) unstandardized PPE protocol, 2) suboptimal and inconsistent PPE training, and 3) inadequate clinical environment. In total, five major concept attributes were the conveyance of organisms, unintentional behavior, preventable action, incidental contact, and difficulty discerning. Consequences were categorized into: 1) raising concerns about occupationally acquired infections, and 2) the potential transmission of the infection to the environment or other people (cross-contamination). Conclusion: While studies have raised questions about whether self-contamination causes infection, self-contamination was obvious among healthcare personnel when dealing with PPE. Considering the wide range of causes and potential results of self-contamination, multifaceted interventions, including improvement of the PPE design, tailoring protocols, and training for specific ensembles, should be implemented over an extended time period with suitable intervals to optimize interventions’ effectiveness.

New Design of Personal Protective Equipment for Handling Contagious Viruses: Evaluation of Comfort and Physiological Responses

New Design of Personal Protective Equipment for Handling Contagious Viruses: Evaluation of Comfort and Physiological Responses

Assessment of Design Values in Designing Product Standards: A Design Study on a Sport PPE

Participation in sports requires using Personal Protective Equipment (PPE) to preserve athletes’ well-being. Although equipment may negatively impact performance, governing bodies often impose standards on participants subject to their jurisdiction. Although the vast majority of new products are incremental innovations, radical innovation still attracts design researchers' and professionals' attention. The design of complex systems needs the expertise of various kinds: designers are fundamental in conceiving innovations in response to developing ways of product use and customer needs, despite they must face product standards, which often act against product innovation. Despite product innovations benefiting consumers in many markets, they do not necessarily benefit consumers in sports PPE markets. In this paper, the author reflects on an ethnographic case study and the importance of the involvement of end and co-dependent users in the design of sports PPE. For this study, the design of the Australian safety vests for jockeys, frequently overlooked, was examined for incremental innovation and its relationship with its standards. This was inspiring to consider an assessment of design values in designing product standards in the sports field. As co-design is increasingly applied across multiple sectors, there is a huge need for practical design guides to support product development and co-designing with users. Further research in this field is highly recommended.

Australian health care workers experience of PPE related side-effects. A cross-sectional survey.

Protection of health care workers (HCWs) is a fundamental aspect of an effective pandemic response. During the COVID-19 pandemic, frequency, and duration of Personal Protective Equipment (PPE) use increased. The experience of PPE-related side-effects has potential to contribute to decreased compliance resulting in breaches in infection prevention and increasing risk of HCW exposure. This study aims were to measure the frequency of PPE-related side-effects amongst HCW in Australia, and to establish if an increased frequency of adverse reactions was related to the significant increase in use and extended duration of time spent in PPE. A descriptive cross-sectional survey was used. Of the 559 respondents the majority were female (83.7%), aged 31-45 years old (33.6%). A pre-existing skin condition was reported by 266 (47.6%). Frequency of PPE related side-effects were: pressure-related 401 (71.7%), skin 321 (57.4%) and respiratory 20 (3.6%). Surgical mask use was significantly associated with pre-exiting skin conditions (β = 1.494 (SE 0.186), df (1), p < 0.001). Side effects to N95 respirator use was more commonly reported by staff working in COVID-19 high-risk areas (β = 0.572 (SE 0.211), df (1), p = 0.007) independent of work duration (β = -0.056 (SE 0.075), df (1), p = 0.456), and pre-existing skin conditions (β = 1.272, (SE.198), df (1), p < 0.001). The COVID-19 pandemic has seen a significant increase in the use of PPE. While the preventative benefits of PPE are significant, adverse events related to PPE use are frequently reported by HCW. Findings in this study highlight the need for innovation in PPE design to maximize protection while decreasing adverse effects and maintaining adhere to use.

Australian emergency nurses' experiences of working with personal protective equipment during the COVID-19 pandemic. A qualitative study

IntroductionThe COVID-19 pandemic has exposed a need to understand the challenges associated with wearing Personal protective Equipment (PPE). The aim in this study was to explore emergency nurses’ experiences early in the COVID-19 pandemic in Australia and the impact of PPE use on their practice. MethodsAn explorative descriptive qualitative study was conducted between January 2022 and April 2022. Eighteen emergency nurses and six leaders participated. Semi-structured interviews (n = 21) and one focus group were conducted. Interview transcripts were analysed using Braun and Clarke’s framework. ResultsTwo major themes were identified. The first theme was: (1) The shifting ground of the COVID-19 pandemic response. Associated sub-themes were: i) What’s the go with PPE today? ii) In the beginning we were scrambling for masks; iii) Emergency is the true frontline. The second theme was: (2) Physical and emotional impacts of emergency nursing work. Sub-themes were: (i) Facing the fear of exposure; (ii) By the end of the shift I am just absolutely spent; iii) Discomfort of wearing PPE impacts on compliance. ConclusionsHealthcare leaders need to secure PPE supply chains and evaluate the effectiveness and side-effects of different PPE designs to minimise occupational harms associated with prolonged PPE use.

The carbon footprint of Bubble-PAPR™: A novel item of personal protective equipment.

Personal protective equipment has important environmental impacts, assessing these impacts is therefore an important element of personal protective equipment design. We applied carbon footprinting methodology to Bubble-PAPR™, a novel, part-reusable and part-recyclable powered air-purifying respirator, designed at our institution. Current guidance states that disposable respirator masks can be worn for 1-h in the United Kingdom, whilst the Bubble-PAPR™ allows prolonged use. Following a detailed use-case analysis, the carbon footprint of each component was estimated using a bottom-up (attributional) cradle-to-grave process-based analysis. Modelling considered the use of virgin or closed loop recycled polyvinyl chloride for the disposable hood element, and disposal via infectious or recycling waste streams to estimate a per-use carbon footprint. The per-use carbon footprint with manufacture from virgin polyvinyl chloride and disposal via incineration is 0.805 kgCO2e. With nine cycles of closed loop recycling and manufacture of the polyvinyl chloride hood (10 uses), the carbon footprint falls to an average of 0.570 kgCO2e per use. Carbon footprinting may contribute to the value proposition of this novel technology. We estimate that a single Bubble-PAPR™ use has a higher carbon footprint than disposable respirator mask-based PPE. However, this is mitigated in circumstances when multiple disposable mask changes are required (e.g. prolonged use) and use may be justifiable when user comfort, visualisation and communication with patients and colleagues are essential.

Ballistic response of skin simulant against fragment simulating projectiles

The response of biological phantoms against high velocity impact is actively sought for applications in defense, space, soft robotics and sensing. Towards this end, we study the ballistic response of silicone based skin simulant against fragment impact. Using a pneumatic gas gun setup, six chisel-nosed and three regular shaped (sphere, cylinder, and cube) fragments were impacted on the skin simulant. The resulting skin simulant response was studied in terms of ballistic limit velocities, energy densities, failure pattern, and the mechanics of interaction. The results indicate that the shape of the fragment affects the ballistic limit velocities. The ballistic limit velocities, energy densities of the chisel-nosed fragment simulating projectiles were relatively insensitive to the size (mass), except for the smallest (0.16 g) and largest (2.79 g) chisel-nosed fragment. For the same size (1 g), ballistic limit velocities and failure are dependent on the shape of the fragment. The skin simulant failed by combined plugging and elastic hole enlargement. Failure in the spherical fragment was dominated by the elastic hole enlargement, whereas plugging failure was dominant in all other fragments. The spherical, cylindrical, and chisel-nosed fragments created circular cavities, and the cubical fragment created a square cavity. In the case of the spherical fragment, slipping of the fragment within the skin simulant was seen. Cubical fragments created lateral cracks emanating from the corners of the square cavity. Interestingly, for all the fragments, the maximum deformation corresponding to the perforation was lower than the non-perforation indicating rate dependent, stress driven failure. The maximum deformation was also dependent on the shape of the fragment. Overall, these results provide unique insights into the mechanical response of a soft simulant against ballistic impact. Results have utility in the calibration and validation of computational models, design of personal protective equipment, and antipersonnel systems.

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.

Efficacy of personal protective equipment to prevent environmental infection of COVID-19 among healthcare workers: a systematic review

Healthcare workers (HCWs) employed personal protective equipment (PPE) during the COVID-19 pandemic, crucial to protecting themselves from infection. To highlight the efficacy of PPE in preventing environmental infection among HCWs, a systematic review was conducted in line with PRISMA guidance. A search of the PubMed and Web of Science databases was conducted from January 2019 to April 2021 using pre-defined search terms. Articles were screened by three researchers. The approved papers were read in full and included in this review if relevance was mutually agreed upon. Data were extracted by study design and types of PPEs. 47 of 108 identified studies met the inclusion criteria, with seven reviews and meta-analyses, seven cohort, nine case-control, fifteen cross-sectional studies, four before and after, four case series, and one modeling studies. Wearing PPE offered COVID-19 protection in HCWs but required adequate training. Wearing surgical masks provided improved protection over cloth masks, while the benefit of powered air-purifying respirators is less clear, as are individual gowns, gloves, and/or face shields. Wearing PPE, especially facial masks, is necessary among HCWs, while training in proper use of PPE is also important to prevent COVID-19 infection.

Engineering a Holistic Response to the Global Crisis of Forced Displacement.

The global coronavirus pandemic has demonstrated the necessity of engineering approaches, from research and development to rapid prototyping and production, in saving lives all across the world [1]. From personal protective equipment design to vaccine production and distribution, engineering has been the bedrock of an effective global response. However, despite major gains made in the last several decades, there are still millions all across the world, including the vulnerable displaced, who rarely benefit from new developments at the interface of engineering, biology, and health.

Perceived Workload Using Separate (Filtering Facepiece Respirator and Face Shield) and Powered Air-Purifying Respirator and Integrated Lightweight Protective Air-Purifying Respirator: Protocol for an International Multisite Human Factors Randomized Crossover Feasibility Study.

The design of personal protective equipment (PPE) may affect well-being and clinical work. PPE as an integrated item may improve usability and increase adherence by healthcare professionals. Human factors design and safety may reduce occupational-acquired diseases. As an integrated PPE, a lightweight protective air-purifying respirator (L-PAPR) could be used during health procedures where healthcare professionals are exposed to airborne pathogens. The human factors affecting the implementation of alternative PPE such as L-PAPR have not been thoroughly studied. The population of interest is health care professionals, the intervention is the performance by PPE during tasks across the three PPE types 1.) N95 respirators and face shields, 2.)traditional powered air-purifying respirator(PAPR), and 3.) L-PAPR. The outcomes are user error, communications, safety, and end-user preferences. This study will assess whether the L-PAPR improves health care professionals' comfort in terms of perceived workload and physical and psychological burden during direct patient care when compared with the traditional PAPR or N95 and face shield. This study also aims to evaluate human factors during the comparison of the use of L-PAPR with a combination of N95 respirators plus face shields or the traditional PAPRs. This is an interventional randomized crossover quality improvement feasibility study consisting of a 3-site simulation phase with 10 participants per site and subsequent field testing in 2 sites with 30 participants at each site. The 3 types of respiratory PPE will be compared across medical tasks and while donning and doffing. We will evaluate the user's perceived workload, usability, usage errors, and heart rate. We will conduct semistructured interviews to identify barriers and enablers to implementation across each PPE type over a single continuous wear episode and observe interpersonal communications across conditions and PPE types. We expect the research may highlight communication challenges and differences in usability and convenience across PPE types along with error frequency during PPE use across PPE types, tasks, and time. The design of PPE may affect overall well-being and hinder or facilitate clinical work. Combining 2 pieces of PPE into a single integrated item may improve usability and reduce occupational-acquired diseases. The human factors affecting the implementation of an alternative PPE such as L-PAPR or PAPR have not been thoroughly studied. PRR1-10.2196/36549.

The thermal state of body when using personal protective equipment against biological factors

Introduction. The article presents the study results of the effect of personal protective equipment (PPE) from biological factors on the functional state of the medical workers’ body and thermoregulatory reactions when working in the “biohazard zone” of the infectious department. Materials and methods. The study involved twenty five volunteers (doctors and paramedical staff of the infectious diseases department) performing official duties for 5 hours in the “biohazard zone” with an air temperature of 23.9 ± 1.6 ○C and a relative humidity of 39.2 ± 11.8%. Measurements were carried out before the work shift start, during and within 30 minutes after leaving the “biohazard zone” in a room with a comfortable climatic conditions. Recorded indicators were skin temperature, heat, and moisture sensations on 11 areas of the body surface, body temperature (measured in the armpit), heart rate. Based on the obtained data, there were calculated the following parameters including body surface area, average skin, and body temperature, the change in the body’s heat content for each hour of work, moisture loss, and energy consumption. Results. The use of PPE from biological factors leads to a heat and moisture exchange disorder of the human body with the environment, which is expressed in an increase in “shell” and “core” temperature, moisture loss, energy consumption, and, consequently, overheating, the appearance of uncomfortable sensations, as well as working capacity decrease. Limitations. When studying the thermal state of the body of 25 medical workers, the tension of thermoregulatory mechanisms when using biological PPE was established, depending on the type of work performed, and the severity of the labour process, gender, age, and weight. Conclusion. The obtained results showed the greatest impact on the thermal state during work duties in a comfortable climatic conditions to be exerted by the design and thermophysical properties of PPE from biological factors made of vapour resistant and airtight fabrics, as well as a long stay in the “biohazard zone” along with a high degree of psychological stress of their occupational activities.

A Pilot Study of Healthcare Workers’ Experience With Personal Protective Equipment

Personal protective equipment (PPE) compliance in healthcare settings has continued to be an issue before and during the pandemic. The purpose of this study was to understand the overall experience of healthcare workers with PPE, including types and uses of PPE, their duties, satisfaction, and dissatisfaction with PPE. By examining the PPE design characteristics and requirements of healthcare workers, the ultimate goal is to redesign PPE to increase comfort and work efficiency. As a pilot study, one-to-one online interviews were conducted with three healthcare workers who had experience wearing PPE while working in a hospital. The transcripts were analyzed using NVivo software, and a total of 5 subgroups were created based on the 69 unique codes by grouping them into semantic units: environmental situation and characteristics, satisfaction, improvement and suggestion, issues and problems, and PPE wearing experience. Masks (N95 and surgical), eye protections (goggle and face shield), gowns, and gloves were investigated, and high risk of infection, discomfort and distrust about reusing PPE, low degree of protection, low usability, and low work efficiency were observed.

İş sağlığı ve güvenliği kapsamında 15-29 yaş aralığındaki genç kişilerin antropometrik verilerinin incelenmesi üzerine bir araştırma

In Turkey one-third of its employed population are composed of female and male young people aged 15-29 and according to the 2019 occupational accident data, 41% of the accidents occurred by young people aged 15-29. Therefore, an anthropometric data was wanted to be determined by making a study especially on the young population. In this study, a questionnaire including basic information was applied to the Turkish young population and their photographs were taken to determine their anthropometric data. A platform was created for photographing and on this platform, 394 randomly selected people were photographed standing up to reveal their postures. The obtained photos were transferred to a drawing software, individual measurements were made for each person, and an analysis showing some statistical parameters such as correlation and percentile were performed. The study shows that the change differs depending on age range of males and females. Healthy and safe working environments to be created with the anthropometric data obtained will reduce occupational accidents in the future. Furthermore, it will also contribute to the design of personal protective equipment in terms of occupational safety and design of office products as desk and chair to be used in the office conveniently for employees.

The dangers of reused personal protective equipment: healthcare workers and workstation contamination

BackgroundPersonal protective equipment (PPE) is essential to protect healthcare workers (HCWs). The practice of reusing PPE poses high levels of risk for accidental contamination by HCWs. Scarce medical literature compares practical means or methods for safe reuse of PPE while actively caring for patients.MethodsIn this study, observations were made of 28 experienced clinical participants performing five donning and doffing encounters while performing simulated full evaluations of patients with coronavirus disease 2019. Participants' N95 respirators were coated with a fluorescent dye to evaluate any accidental fomite transfer that occurred during PPE donning and doffing. Participants were evaluated using blacklight after each doffing encounter to evaluate new contamination sites, and were assessed for the cumulative surface area that occurred due to PPE doffing. Additionally, participants' workstations were evaluated for contamination.ResultsAll participants experienced some contamination on their upper extremities, neck and face. The highest cumulative area of fomite transfer risk was associated with the hook and paper bag storage methods, and the least contamination occurred with the tabletop storage method. Storing a reused N95 respirator on a tabletop was found to be a safer alternative than the current recommendation of the US Centers for Disease Control and Prevention to use a paper bag for storage. All participants donning and doffing PPE were contaminated.ConclusionPPE reusage practices pose an unacceptably high level of risk of accidental cross-infection contamination to healthcare workers. The current design of PPE requires complete redesign with improved engineering and usability to protect healthcare workers.

“Simulation of medical goggles to stop airborne transmission of viruses: computational fluid dynamics in ergonomics”

This paper presents a position statement on combining computational fluid dynamics (CFD) and ergonomics to guide the design of personal protective equipment (PPE). We used CFD to simulate 36 exposure scenarios of an infected patient sneezing at different distances and different angles while facing either the front or the side of a healthcare worker with or without goggles. The results show that medical goggles indeed block most droplets from the outer surface, but many droplets still deposit on the bottom edge (especially at the nose), inside the air holes and on the side edge. However, the edges of medical goggles have fitment problems with people in different regions, and the air holes do not function as filters and cannot prevent fine droplets from entering the interior and contacting the eyes. Our research demonstrates the feasibility of studying the design of PPE for airtightness and protection by means of CFD. Practitioner summary: Computational fluid dynamics can quickly and efficiently reflect the airtightness design problems of PPE. A model was developed using CFD to examine the protective effect of medical goggles in preventing the airborne transmission of viruses. The model demonstrates the feasibility of using CFD to solve ergonomic problems. Abbreviations: CFD: computational fluid dynamics; PPE: personal protective equipment; WHO: the World Health Organisation; COVID-19: coronavirus disease 2019; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; OSHA: the Occupational Safety and Health Administration; CDC: the Centres for Disease Control; FEM: finite element method; 3M: Minnesota Mining and Manufacturing Corporation; SPH: smoothed particle hydrodynamics; AROM: active range of motion; DPM: discrete phase model; PISO: pressure implicit with splitting of operators; VR: virtual reality; AR: augmented reality

Supporting Technologies for COVID-19 Prevention: Systemized Review.

BackgroundDuring COVID-19, clinical and health care demands have been on the rapid rise. Major challenges that have arisen during the pandemic have included a lack of testing kits, shortages of ventilators to treat severe cases of COVID-19, and insufficient accessibility to personal protective equipment for both hospitals and the public. New technologies have been developed by scientists, researchers, and companies in response to these demands.ObjectiveThe primary objective of this review is to compare different supporting technologies in the subjugation of the COVID-19 spread.MethodsIn this paper, 150 news articles and scientific reports on COVID-19–related innovations during 2020-2021 were checked, screened, and shortlisted to yield a total of 23 articles for review. The keywords “COVID-19 technology,” “COVID-19 invention,” and “COVID-19 equipment” were used in a Google search to generate related news articles and scientific reports. The search was performed on February 1, 2021. These were then categorized into three sections, which are personal protective equipment (PPE), testing methods, and medical treatments. Each study was analyzed for its engineering characteristics and potential social impact on the COVID-19 pandemic.ResultsA total of 9 articles were selected for review concerning PPE. In general, the design and fabrication of PPE were moving toward the direction of additive manufacturing and intelligent information feedback while being eco-friendly. Moreover, 8 articles were selected for reviewing testing methods within the two main categories of molecular and antigen tests. All the inventions endeavored to increase sensitivity while reducing the turnaround time. However, the inventions reported in this review paper were not sufficiently tested for their safety and efficiency. Most of the inventions are temporary solutions intended to be used only during shortages of medical resources. Finally, 6 articles were selected for the review of COVID-19 medical treatment. The major challenge identified was the uncertainty in applying novel ideas to speed up the production of ventilators.ConclusionsThe technologies developed during the COVID-19 pandemic were considered for review. In order to better respond to future pandemics, national reserves of critical medical supplies should be increased to improve preparation. This pandemic has also highlighted the need for the automation and optimization of medical manufacturing.

Characterizing exposure to benzene, toluene, and naphthalene in firefighters wearing different types of new or laundered PPE.

The fire service has become more aware of the potential for adverse health outcomes due to occupational exposure to hazardous combustion byproducts. Because of these concerns, personal protective equipment (PPE) manufacturers have developed new protection concepts like particulate-blocking hoods to reduce firefighters' exposures. Additionally, fire departments have implemented exposure reduction interventions like routine laundering of PPE after fire responses. This study utilized a fireground exposure simulator (FES) with 24 firefighters performing firefighting activities on three consecutive days wearing one of three PPE ensembles (stratified by hood design and treatment of PPE): 1) new knit hood, new turnout jacket and new turnout pants 2) new particulate-blocking hood, new turnout jacket and new turnout pants or 3) laundered particulate-blocking hood, laundered turnout jacket and laundered turnout pants. As firefighters performed the firefighting activities, personal air sampling on the outside and inside the turnout jacket was conducted to quantify exposures to volatile organic compounds (VOCs) and naphthalene. Pre- and immediately post-fire exhaled breath samples were collected to characterize the absorption of VOCs. Benzene, toluene, and naphthalene were found to diffuse through and/or around the turnout jacket, as inside jacket benzene concentrations were often near levels reported outside the turnout jacket (9.7-11.7% median benzene reduction from outside the jacket to inside the jacket). The PPE ensemble did not appear to affect the level of contamination found inside the jacket for the compounds evaluated here. Benzene concentrations in exhaled breath increased significantly from pre to post-fire for all three groups (p-values < 0.05). The difference of pre-to post-fire benzene exhaled breath concentrations were positively associated with inside jacket and outside jacket benzene concentrations, even though self-contained breathing apparatus (SCBA) were worn during each response. This suggests the firefighters can absorb these compounds via the dermal route.

PPE fit of healthcare workers during the COVID-19 pandemic

Historically, PPE (Personal Protective Equipment) has generally been designed around the size and shape of an average European or US white man's face and body. There is little academic evidence to support anecdotal reports that women are at a greater disadvantage than men from ill-fitting PPE. This is especially relevant in healthcare settings where women make up at least 75% of frontline workers. The COVID-19 pandemic has exacerbated problems associated with the fit of PPE that until now have been mainly anecdotal. This research presents results and analysis of a quantitative and qualitative survey concerning the fit of PPE worn by 248 healthcare workers, in a variety of healthcare roles and settings, during the COVID-19 pandemic. The analysis of the survey results showed that women were less likely than men to feel safe carrying out their roles, with only 30.5% of women and 53.3% of men stating that they felt safe all of the time. A statistically significant link is made between women suffering more with poor fit than men with certain categories of PPE (gowns, masks, visors, goggles). Over four times as many women (54.8%) as men (13.3%) reported their surgical gowns being large to some degree and women were nearly twice as likely (53.5%) to experience oversized surgical masks than men (28.6%). However, it was recognized that PPE fit problems are not exclusive to women as many men also do not conform to the underlying shape and size of PPE designs. Survey results indicated that both sexes felt equally hampered due to the fit of their PPE and around a third of both women and men had modified their PPE to address fit issues. Oversized and modified PPE presents its own set of unintended consequences. Following strict processes for doffing and removing PPE is key to virus control but doffing modified PPE can fall outside of these processes, risking cross infection. In addition, wearers of critical items of PPE (such as respirators) currently undergo a “fit test”; however, fit does not reconcile with comfort and over-tightened PPE can cause headaches, discomfort and distraction when worn for long periods. Requirements and fit tests are also not setting-specific; qualitative responses from the survey give an indication that this must be a future consideration.

Does wearing personal protective equipment affect the performance and decision of physicians? A cross-sectional study during the COVID-19 pandemic

BackgroundThe use of personal protective equipment (PPE) decreased the probability of viral transmission during the COVID-19 pandemic. However, some drawbacks have been observed with its extensive use, such as headaches, anxiety, and stress among physicians, which could affect decision-making processes, the performance of physicians, and consequently patients’ safety. Few articles have studied the impact of PPE on physicians from different specialties. This study assessed the effect of wearing PPE on the performance and decision-making of physicians during the COVID-19 pandemic and compared the effects of wearing PPE on physicians from different specialties. MethodsA descriptive cross-sectional study was carried out through an anonymous 39-item online questionnaire. The physicians were divided according to the probability and frequency of performing invasive procedures. Group 1 included emergency medicine and critical care physicians, intensivists, and anesthetists, group 2 included physicians from different surgical subspecialties, and group 3 included physicians from different medical fields. ResultsThis study included 272 physicians; group 1 included 54, group 2 included 120, and group 3 included 98 physicians. Approximately, 90.4% of the participants aged between 30 and -40 years, and 72.8% of the participants were specialists. Results indicated that the comfort, vision, and communication were significantly reduced in all groups (81.1%, 88.7%, and 75.5%, respectively). In contrast, the handling of instruments was not significantly affected in the second group only. In addition, the decision-making and the rate of complications were not significantly affected. ConclusionThere was a negative impact of wearing PPE on the non-technical skills (vision, communication and overall comfort), and the technical skills of the physicians. The decision-making and patients’ safety were not significantly affected. Recommendations include additional improvement of the PPE design due to its crucial effect on both non-technical and technical skills of physicians.