Personal Protective Equipment Protocols Research Articles

Development of an Automated and Scalable Virtual Assistant to Aid in PPE Adherence: A Study with Implications for Applications within Anesthesiology.

Virtual assistants (VAs) are conversational agents that are able to provide cognitive aid. We developed a VA device for donning and doffing personal protective equipment (PPE) procedures and compared it to live human coaching to explore the feasibility of using VAs in the anesthesiology setting. An automated, scalable, voice-enabled VA was built using the Amazon Alexa device and Alexa Skills application. The device utilized voice-recognition technology to allow a touch-free interactive user experience. Audio and video step-by-step instructions for proper donning and doffing of PPE were programmed and displayed on an Echo Show device. The effectiveness of VA in aiding adherence to PPE protocols was compared to traditional human coaching in a randomized, controlled, single-blinded crossover design. 70 anesthesiologists, anesthesia assistants, respiratory therapists, and operating room nurses performed both donning and doffing procedures, once under step-by-step VA instructional guidance and once with human coaching. Performance was assessed using objective performance evaluation donning and doffing checklists. More participants in the VA group correctly performed the step of "Wash hands for 20 seconds" during both donning and doffing tests. Fewer participants in the VA group correctly performed the steps of "Put cap on and ensure covers hair and ears" and "Tie gown on back and around neck". The mean doffing total score was higher in the VA group; however, the donning score was similar in both groups. Our study demonstrates that it is feasible to use commercially available technology to create a voice-enabled VA that provides effective step-by-step instructions to healthcare professionals.

Personal Protective Equipment Protocols Lead to a Delayed Initiation of Patient Assessment in Mountain Rescue Operations.

van Veelen, Michiel J., Giulia Roveri, Ivo B. Regli, Tomas Dal Cappello, Anna Vögele, Michela Masè, Marika Falla, and Giacomo Strapazzon. Personal protective equipment protocols lead to a delayed initiation of patient assessment in mountain rescue operations. High Alt Med Biol. 24:127-131, 2023. Introduction: Mountain rescue operations can be challenging in austere environmental conditions and remote settings. Airborne infection prevention measures include donning of personal protective equipment (PPE), potentially delaying the approach to a patient. We aimed to investigate the time delay caused by these prevention measures. Methods: This randomized crossover trial consisted of 24 rescue simulation trials intended to be as realistic as possible, performed by mountain rescue teams in difficult terrain. We analyzed the time needed to perform an airborne infection prevention protocol during the approach to a patient. Time delays in scenarios involving patients already wearing versus not wearing face masks and gloves were compared using a linear mixed model Results: The airborne infection prevention measures (i.e., screening questionnaire, hand antisepsis, and donning of PPE) resulted in a time delay of 98 ± 48 (26-214) seconds on initiation of patient assessment. There was a trend to a shorter time to perform infection prevention measures if the simulated patient was already wearing PPE consisting of face mask and gloves (p = 0.052). Conclusion: Airborne infection prevention measures may delay initiation of patient assessment in mountain rescue operations and could impair clinical outcomes in time-sensitive conditions. Trial registration number 0105095-BZ Ethics Committee review board of Bolzano.

Chest Compressions and Defibrillation as Aerosolgenerating Procedures

SARS-CoV-2 is a highly contagious respiratory pathogen associated with significant mortality in certain patient populations. Patients may be asymptomatic, which causes problems regarding infection control and prevention. Health professionals are required to adhere to strict protocols regarding infection control and personal protective equipment (PPE), particularly when engaging in resuscitation activities thought to be aerosol-generating procedures (AGPs). While adherence to enhanced PPE protocols can delay life-saving interventions, non-adherence may put responders at risk. The aim of this scoping literature review was to establish if chest compressions and defibrillation should be classified as AGPs. Following application of systematic literature search criteria, a limited selection of studies was identified in relation to chest compressions and defibrillation as AGPs. An assumption that endotracheal intubation posed a high risk of nosocomial transmission was noted. Emerging evidence suggests that endotracheal intubation produces fewer aerosol particles than coughing so could be classed as a low-risk-procedure. Because of the lack of adequate prospective studies investigating chest compressions and defibrillation as AGPs, there is a clear need to perform further, well-controlled studies to better understand the aerosol-generating potential of chest compressions and defibrillation.

Assessment of knowledge, accessibility, and adherence to the use of personal protective equipment and standard preventive practices among healthcare workers during the COVID-19 pandemic.

Healthcare workers are at risk of acquiring infectious agents while providing services to patients. Thus, the need for evaluating and closely monitoring healthcare worker knowledge, perception, and adherence levels is critical. This study evaluates the knowledge, accessibility, and adherence regarding personal protective equipment (PPE) and preventive protocols among healthcare workers during the COVID-19 pandemic. A web-based cross-sectional survey was conducted from March to September 2021. The study participants were 187 healthcare workers who replied to a 31-item questionnaire using an online tool. A total of 187 participants responded to the questionnaire. Most of the participants 102 (54.5%) were in the age group of 25-34 years. Of the 187 participants, 98 (52.4%) were medical doctors, and 92 (49.2%) had correct knowledge regarding donning and doffing of PPE. The vast majority (93.7%) had access to essential PPE. The average adherence level was 82.1%. Accessibility (p = 0.003) and adherence (p < 0.01) were found to be significantly high in older age participants. The study showed most of the healthcare workers had appropriate knowledge and, they also adhered to the proper use of PPE and infection control protocols. However, few of them identified with poor knowledge about COVID-19, inappropriate doffing of PPE, non-adherence to the protocol, and unacceptable practices. We recommend the provision of adequate training that will lead to minimizing the risk of exposure to and transmission of COVID-19 among healthcare providers.

Transmission risk of COVID-19 infection with office-based flexible laryngoscopy

Since the beginning of the Coronavirus pandemic, recommendations to ensure safety in clinical practice have fluctuated. Within the Otolaryngology community, a variety of protocols have emerged to assure safety for both patients and healthcare workers while maintaining standard of care practices, especially surrounding aerosolizing in-office procedures. ObjectivesThis study aims to describe our Otolaryngology Department's Personal Protective Equipment protocol for both patients and providers during office laryngoscopy and to identify the risk of contracting COVID-19 after implementation of the protocol. Methods18,953 office visits divided between 2019 and 2020 where laryngoscopy was performed were examined and compared to the rate of COVID-19 contraction for both office staff and patients within a 14 day period after the encounter. Of these visits, two cases were examined and discussed; where a patient tested positive for COVID-19 ten days after office laryngoscopy, and one where a patient tested positive for COVID-19 ten days prior to office laryngoscopy. ResultsIn the year 2020, 8337 office laryngoscopies were performed, 100 patients tested positive within the year 2020, with only these 2 cases of COVID-19 infections occurring within 14 days prior to or after their office visit. ConclusionThese data suggest that using CDC-compliant protocol for aerosolizing procedures, such as office laryngoscopy, can provide a safe and effective method for mitigating infectious risk while providing timely quality care for the otolaryngology patient. Level of evidence3 Lay summaryDuring the COVID-19 Pandemic, ENTs have had to balance providing care while minimizing the risk of COVID-19 transmission with routine office procedures such as flexible laryngoscopy. In this large chart review, we show that the risk of transmission is low with CDC-compliant protective equipment and cleaning protocols.

Level of Compliance to Covid-19 Prevention Protocol in Primary Healthcare Centres in Obingwa Local Government Area

This study was carried out to assess the level of compliance to COVID-19 prevention protocol in in primary healthcare centres in Obingwa LGA. Eight research objectives and corresponding eight research questions were raised to guide the study along with three hypotheses. The Cross-sectional research design adopted and 250 primary healthcare workers were sampled using multi-stage sampling technique. Questionnaire and checklist were used for data collection while descriptive and inferential statistics contained in SPSS version were used for data analysis, the research question were answered using descriptive statistic while hypotheses were tested using independent sample t-test and ANOVA. The results revealed that; there is inadequate provision of facilities and material required for effective compliance to COVID-19 prevention protocols in the primary health caters within the studied area because only four (4) out of the eleven (11) identified essential facilities are fairly available in the sampled study area. the results revealed that the level of compliance to Coughing and Sneezing Protocols is high (2,79&gt; 2.50), compliance level for Personal Protective Equipment Protocols is low (2.07&lt;2.50), compliance level for Self-isolation Protocols is high (2.89&gt;2.50), the level of compliance for Mouth and Nose Covering (Masking) Protocols is low (2.21&lt;2.50), the compliance level for Social and Physical Distancing Procedure is high (2.53&gt;2.50( and compliance level for Hand-washing Procedure is low (2.08&lt;2.50). the results of the hypothesis testing revealed that the demographic characteristics (gender, type of work and years of experience) are significant predictor of compliance to the COVID-19 prevention protocols at 0.05 significance level. It was concluded, among others, that there is low level of compliance to COVID-19 prevention protocols by the health care workers in the study area. It was, therefore, recommended, among others, that government, and concerned non-governmental organizations should make provision for the facilities and material needed for effective compliance to COVID-19 protocols in primary healthcare Centre in the studied area.

Macroergonomics considerations on COVID-19 pandemic management in an alliance construction project, focusing on personal protective equipment protocols

Macroergonomics considerations on COVID-19 pandemic management in an alliance construction project, focusing on personal protective equipment protocols

Macroergonomics considerations on COVID-19 pandemic management in an alliance construction project, focusing on personal protective equipment protocols

Macroergonomics considerations on COVID-19 pandemic management in an alliance construction project, focusing on personal protective equipment protocols

A two-ward acute care hospital outbreak of SARS-CoV-2 delta variant including a point-source outbreak associated with the use of a mobile vital signs cart and sub-optimal doffing of personal protective equipment

BackgroundWe conducted a detailed epidemiological investigation of a linked 2-ward COVID-19 Delta variant outbreak to elucidate its source, risk factors, and control measures.MethodsInvestigations included epidemiologic analysis, detailed case review serial SARS-CoV-2 RT-PCR testing of patients and healthcare workers (HCWs), viral culture, environmental swabbing, HCW-unaware personal protective equipment (PPE) audits, ventilation assessments, and the use of whole genome sequencing (WGS).ResultsThis linked 2-ward outbreak resulted in 17 patient and 12 HCW cases, despite an 83% vaccination rate. In this setting suboptimal adherence and compliance to PPE protocols, suboptimal hand hygiene, multi-bedded rooms, and a contaminated vital signs cart (VSC) with potential fomite or spread via the hands of HCWs were identified as significant risk factors for nosocomial COVID-19 infection.Sudden onset of symptoms, within 72h, was observed in 79% of all Ward 2 patients and 93% of all cases (patients and HCWs) on Ward 2 occurred within one incubation period, consistent with a point source outbreak. RT-PCR assays showed low Cycle threshold (Ct) values, indicating high viral load from environmental swabs including the VSC. WGS results with ≤ 3 SNP differences between specimens were observed.ConclusionsOutbreaks on both wards settled rapidly, within 3 weeks, using a ‘back-to-basics’ approach without extraordinary measures or changes to standard PPE requirements. Strict adherence to recommended PPE, hand hygiene, education, assistance from infected cases (interviews and testing), and additional measures such as limiting movement of patients and staff temporarily were all deemed to have contributed to prompt resolution of the outbreak.

Using artificial intelligence for personal protective equipment guidance for healthcare workers in the COVID-19 pandemic and beyond

Background Current procedures for effective personal protective equipment (PPE) usage rely on the availability of trained observers or ‘buddies’ who, during the COVID-19 pandemic, are not always available. The application of artificial intelligence (AI) has the potential to overcome this limitation by assisting in complex task analysis. To date, AI use for PPE protocols has not been studied. In this paper we validate the performance of an AI PPE system in a hospital setting. Methods A clinical cohort study of 74 healthcare workers (HCW) at a 144-bed University teaching hospital. Participants were recruited to use the AI system for PPE donning and doffing. Performance was validated by the current gold standard double-buddy system across seven donning and ten doffing steps based on local infection control guidelines. Results The AI-PPE platform was 98.9% sensitive on doffing and 85.3% sensitive on donning, when compared to remediated double buddy. On average, buddy correction of PPE was required 3.8 ± 1.5% of the time. The average time taken to don was 240 ± 51.5 seconds and doff was 241 ± 35.3 seconds. Conclusion This study demonstrates the ability of an AI model to analyse PPE donning and doffing with real-time feedback for remediation. The AI platform can identify complex multi-task PPE donning and doffing in a single validated system. This AI system can be employed to train, audit, and thereby improve compliance whilst reducing reliance on limited HCW resources. Further studies may permit the development of this educational tool into a medical device with other industry uses for safety.

Awareness of personal protective equipment among frontline postgraduate medical residents who provide care to patients with coronavirus disease-2019

Background: To combat the coronavirus disease-2019 (COVID-19) pandemic, which affected the entire world, health-care workers (HCWs) were required to wear personal protective equipment (PPE). PPE offers protection by preventing microorganisms from contaminating hands, eyes, clothing, hair, and shoes. It is mandatory to know about the proper usage of PPE. Objective: The objective of this study was to evaluate the awareness of PPE and its effects on frontline health-care professionals who provide care to patients with COVID-19. Subjects and Methods: This noninterventional cross-sectional questionnaire-based study was conducted in 108 postgraduate (PG) medical residents who have been treated and provided care for COVID-19 in a tertiary care hospital. The Google questionnaire consisted of 25 questions prevalidated through the literature, senior faculty in the department, and ethics. Results: About 87.03% of the 108 PGs were trained in the donning and doffing protocols, whereas 92.59% were aware of the steps. About 62.96% did not follow the two-person protocol for doffing. About 83.33% were aware of the decontamination protocol of PPE. About 64.81% had difficulty intubating and 62.96% had headaches after using PPE. Conclusions: HCWs in a tertiary care center are aware of PPE use and protocols therein. Even though they were adequately trained about protocols, reluctance, and technical difficulties in following them still exist, which can be solved by adequate and repeated training. The problems faced with the use of PPE have appropriate solutions.

Coronavirus disease 2019 (COVID-19) personal protective equipment training: Using simulation-based training to prevent healthcare-associated infection.

In this pre- and postintervention study, we demonstrate the feasibility and effectiveness of comprehensive simulation-based personal protective equipment (PPE) training amid the COVID-19 pandemic. With rapid-cycle, deliberate practice feedback, simulation-based training can improve the learners' sense of confidence and security while standardizing PPE protocols.

Dermatoses due to Personal Protective Equipment and other protective/preventive measures in COVID-19 pandemic- A study on frontline Health care workers

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The use of personal protective equipment (PPE) around the world in view of COVID-19 pandemic has led to high incidence of occupational dermatoses amongst healthcare workers (HCWs). Amongst all staff members visiting dermatology services, irritant dermatitis (body, hand) and acne form eruption remained the most common concerns. Apart from improving staff morale and quality of life, prevention and management of these conditions will also minimize the risk of breaching stringent PPE protocol. Preventive strategies including frequent breaks from PPE and less than 6 hours of continuous PPE usage can make the working environment more conducive for HCWs.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A quantitative descriptive research-based study is utilized, in which participants who fulfilled the required criteria were selected and were asked to fill the questionnaire. Results were analysed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Redness and itching are the commonest complaints encountered followed by skin rash and acne. Facial occupational dermatoses due to PPE revealed that allergic and irritant contact dermatitis are most common, followed by acne form eruptions and contact urticaria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;With adequate hydration, workplace modifications, taking regular breaks from wearing PPE gear may help in alleviation of dermatoses and motivate HCWs in their fight against pandemic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;

SARS-CoV-2 exposures among healthcare workers in New York City.

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a significant impact on hospitals, including the occupational health departments in charge of handling healthcare worker (HCW) staffing during high rates of exposure and infection of HCWs. HCWs who were exposed to a patient or community member infected with SARS-CoV-2 were required to isolate from work for a minimum of 14 days from the date of exposure.AimsThis study was aimed to assess the relative risk of SARS-CoV-2 infection following different types of workplace and community exposures.MethodsWe analyzed the details of workplace and community exposures of HCWs to SARS-CoV-2 at Montefiore Medical Center in New York between 22 June 2020 and 22 November 2020.ResultsOf 562 HCW SARS-CoV-2 exposures analyzed, 218 were from the community and 345 were from the workplace. Twenty-nine per cent of community exposures resulted in infection, which was significantly greater than workplace exposure infection (2%). Household community exposures resulted in a larger frequency of infection than non-household community exposures. Of the seven infections after workplace exposures, five had qualifying exposures to a co-worker and two were exposed to an infected patient during a non-aerosolized procedure.ConclusionsHCW exposure to SARS-CoV-2 continues to present staffing challenges to healthcare systems. Even with deviations from standard personal protective equipment protocol, workplace exposures resulted in low frequencies of infection. In our study, the primary source of HCW infection was exposure in the community. Our findings support investing in efforts to educate around continued masking and social distancing in the community in addition to interventions targeted at addressing vaccine hesitancy.

Performance and impact of an airway management team launched during the COVID-19 pandemic.

PurposeTo determine the performance and impact of an airway management team (AMT) assembled during the COVID-19 pandemic.MethodsWe conducted a retrospective cohort review of all adult patients who had received airway management services from the AMT (n = 269) and administered a survey questionnaire targeting physicians who had the option to activate the AMT (n = 77). The retrospective review determined the performance of the AMT, and the physicians’ survey evaluated the impact of the AMT. The study was conducted at a large Canadian health centre (1,133 beds) from 28 March to 30 June 2020. We included patients in the cohort review who were ≥18 yr of age, whose chart showed that the AMT was activated, and whose airway was managed outside the operating room. We reviewed both electronic medical records and paper chart documentation. Outcomes included intubation success, number of intubation attempts, intubation time, team response time, patient contact time, intubation complications, and breaches of personal protective equipment (PPE) protocol. The physicians’ survey evaluated the relevance, performance, reasonableness, and clinical utility of the AMT.ResultsThe AMT intubated 231 patients. Charts showed that 91% of intubations were accomplished on first attempt. The mean (standard deviation) intubation time was 2.1 (0.2) min. The complication rate was minimal. The incidence of breaching PPE protocol items was less than 6%. No AMT members reported COVID-19 symptoms. The response rate for the physician’s survey was 36%. The consensus among the participants was that the AMT had considerable clinical utility during the COVID-19 pandemic.ConclusionAn AMT assembled during the COVID-19 pandemic showed high competency and effectiveness, and had favourable impact on the main responsible physicians who activated the team.

Perioperative Provider Safety in Low- and Middle-income Countries During the COVID-19 Pandemic: A Call for Renewed Investments in Resources and Training.

Perioperative Provider Safety in Low- and Middle-income Countries During the COVID-19 Pandemic: A Call for Renewed Investments in Resources and Training.

COVID-19 personal protective equipment protocol compliance audit

BackgroundPersonal protective equipment (PPE) compliance is important to reduce the rate of transmission of virulent pathogens to health care workers. Medical officer compliance with PPE protocol for COVID-19 was audited in a regional hospital in Australia early in the pandemic response.MethodsCompliance was assessed based on the order and technique of donning and doffing PPE, with medical officers from multiple departments and levels of seniority audited.ResultsAverage compliance from all participants was 58.61% with donning and 68.84% with doffing.ConclusionMedical Officer compliance with PPE donning and doffing was poor and additional training was required.

Management of endovascular therapy for acute ischemic stroke amid the COVID-2019 pandemic: a multicenter survey in China

ABSTRACT Objectives: The impact of COVID-19 pandemic on endovascular therapy (EVT) for acute ischemic stroke in China is unknown. This study was aimed to verify the volume change of EVT for acute ischemic stroke affected by COVID-19 and its potential factors. Methods: This cross-sectional study was conducted via an online questionnaire survey in China. The questionnaire was mainly composed of descriptive information, volume change of EVT for acute ischemic stroke, and the protection status of medical staff. Results: A total of 103 stroke physicians in 28 provinces across China completed the survey questionnaire. A volume decline in EVT for acute stroke occurred in 93 (90.3%) hospitals after lockdown (23 January 2020). Nearly half of the hospitals (51/103, 49.5%) experienced a volume decline of EVT case more than 50% and 14 (13.6%) hospitals completely ceased offering EVT. Hospitals with decline >50% of EVT case had higher proportion of hospitals with a designated area for COVID-19 screening in the emergency room (44/51, 86.3% vs 34/52, 65.4%, p= 0.01) and medical staff in quarantine (19/51, 37.3% vs 7/52, 13.5%, p< 0.01), with lower proportion of hospitals with personal protective equipment protocol (41/51, 80.4% vs 49/52, 94.2%, p= 0.03) than hospitals with decline ≤50%. Conclusions: The volume of EVT for acute ischemic stroke severely declined after lockdown in China. Designating a specific area for COVID-19 screening, insufficient personal protection and understaffing may exacerbate the volume decline of EVT.

Creating a Dedicated Pandemic Ambulatory Clinic: Lessons Learned From COVID-19.

Background and Objectives:COVID-19 is highly infectious and the pandemic requires many adaptations to how we deliver medical care. Early in the pandemic, much of this focus was on hospital and emergency department care delivery models to ensure the safety of non–COVID-19 patients and health care workers. However, providing much needed outpatient assessments for COVID-19 patients during a pandemic is also fraught with challenges. From our review of the literature, best practices for a dedicated pandemic ambulatory outpatient clinic have not previously been described. We present a model for creating a dedicated ambulatory pandemic clinic at our institution for the acute care needs of COVID-19 patients.Methods:To address the current pandemic, the Mayo Acute Symptoms of COVID-19 Clinic was implemented on April 13, 2020, with the aims of providing a stand-alone location for COVID-19 patients to have acute outpatient evaluations as well as diagnostics.Results:Recognized challenges addressed included consideration of airflow recirculation patterns in standard medical office buildings, optimization of protocols to conserve personal protective equipment (PPE), limiting total exposure time during patient flow, and reducing surfaces and spaces that patients would physically contact. To this end, unique methods of patient scheduling, patient flow process, staff training, and PPE protocols were developed and are explained in detail in this article.Conclusion:In the COVID-19 pandemic, as well as inevitably in future pandemics, outpatient medical facilities need to be prepared to care for nonhospitalized and nonemergent pandemic patients. We offer a practical approach that has been successful at our institution, with opportunity for local adaptation based on need and resources.

Personal Protective Equipment and Donning and Doffing Techniques in the Cardiac Catheterization Laboratory During the COVID-19 Pandemic: Insights From an Internet Search for Protocols.

Background: Due to the ongoing coronavirus disease 2019 (COVID-19) pandemic, a need for precise donning and doffing protocols for personal protective equipment (PPE) among healthcare infrastructures is paramount. Procedures involving the cardiac catheterization laboratory (CCL) are routinely non-aerosolizing but have the potential for rapid patient deterioration, creating the need for aerosolizing generating procedures. Multiple societal and governmental guidelines on the use of PPE during medical procedures are available on Internet websites; however, there is limited literature available in peer-reviewed formats in this context. This study aims to provide an overview of current PPE donning and doffing protocols specific to the catheterization laboratory.Methods: A series of internet searches regarding donning and doffing of PPE in the CCL including published articles and internet protocols were compiled and compared using Pubmed.gov, Google.com, www.twitter.com, and www.youtube.com.Results: Most institutions used N95 masks, shoe covers, at least one head covering, face shield or goggles, two pairs of gloves, and inner and outer gowns. Doffing variation was greater than donning. Doffing has the potential to contaminate the healthcare worker (HCW), and therefore, this step of PPE management requires further study. Common steps in temporal priority included cleaning of gloved hands, removal of outer (or only) gown, removal of outer gloves, repeat gloved hand cleaning, removal of facial PPE last, and a final non-gloved hand cleaning.Conclusions: This analysis provides a summary of commonly used practices that may be considered when designing CCL-specific PPE protocols. Analysis of consistent steps from the literature led the authors to formulate a suggested protocol for CCL HCWs when performing procedures on patients with confirmed or suspected/unknown COVID-19.