Reuse Of Personal Protective Equipment Research Articles

Environmental Sustainability in Dermatological Surgery. Part 1: Reducing Carbon Intensity.

This two-part review addresses the pressing need for environmental sustainability in dermatological surgery, driven by the NHS's commitment to net-zero emissions. Part 1 focuses on strategies to reduce the carbon intensity of dermatological procedures by adopting low-carbon alternatives and optimising operational resource usage. Key strategies for a system-wide reduction in environmental impact include using leveraging local suppliers to reduce transport emissions, streamlining care models, promoting efficient waste management, and using mindful prescribing practices. Another aspect is integrating sustainability into dermatological education whilst minimising the carbon footprint of surgical education. Additionally, the review provides a comprehensive overview of optimising resource use in dermatological surgery, focusing on efficient management of consumables, equipment, and energy. This includes recycling, waste segregation, transitioning to reusable personal protective equipment and surgical instruments, and applying energy-saving and sustainable water use practices. By implementing these strategies, dermatological surgery can significantly reduce its environmental impact while upholding high standards of patient care.

Conditioning Factors for Biosafety Practice in Health Personnel: Integrative Review

In their attention to patients of different specialties, health personnel are the most vulnerable to contagion, which has been evidenced by the COVID-19 pandemic. The working conditions or factors for biosafety practices in health personnel worldwide will make it possible to detect the necessary and less treated lines of investigation, deficiencies and to draw up lines of work for their solution. It should be noted that it is estimated that 2.78 million workers die because of occupational accidents and 374 million injuries caused by work are reported, thus increasing absenteeism, the risk of contracting a disease in the workplace has become more latent and 4% of the world's GDP is occupied by diseases. The objective of this study was to analyze the evidence that exists regarding the conditioning factors for the practice of biosafety in health personnel. The methodology: where a descriptive systematic review was performed with the search of databases in Scopus selected articles from 2019 - 2023 in English and Spanish languages. The results indicate that with regard to the conditioning factors of Biosafety practice, it is evident that of the 400 articles 50 mention that it is important to know how to do, 45 mention that it is important not only the training but also the equipment for these practices to be favorable, also 31 of the articles refer to that in COVID-19 period the infections among health personnel were due to the reuse of personal protective equipment.

Perspectives and Awareness of Environmental Sustainability in the Infection Prevention and Control Community Nationally

Background: Healthcare contributes significantly to waste production and greenhouse gas emissions. This became especially apparent during the COVID-19 pandemic. Yet there is modest recognition of this issue, particularly within decision-making in Infection Prevention and Control (IPC). The aim of our study was to gauge general knowledge and attitudes of hospital epidemiologists (HEs) and infection preventionists (IPs) around the intersection of environmental sustainability and IPC, and to identify related institutional practices. Methods: An online survey, composed of ten questions related to environmental sustainability in IPC, was created and emailed to members of the SHEA Research Network (SRN), a national consortium of healthcare facilities collaborating on IPC research, from August - October 2023. Survey answers were collated via Redcap© and descriptive results were obtained. Results: Forty-two individuals (33 HEs, 7 directors of IPC, and 2 IPs) from unique institutions completed the survey. Thirty (71.4%) were from academic medical centers, 5 (11.9%) were from VA medical centers and 7 (16.7%) were from community hospitals. Over half of participants correctly estimated the amount of waste and carbon emissions produced annually by the US healthcare system (6 million tons and 8.5% of national emissions, respectively). However, only 42.9% considered environmental sustainability concerns important or very important when making IPC decisions. Fifteen (34.9%) had an environmental sustainability committee at their institution and of these, 8 had an established relationship with the IPC department. The most common techniques to promote sustainability amongst institutions were water/energy conservation (59.5%), reusable personal protective equipment (52.4%) and Leadership in Energy and Environmental Design (LEED) certification (47.6%). When asked which efforts they would support at their institution, 28.6% would eliminate the use of single-use endoscopes and one third would avoid use of ethylene oxide for sterilization. In deciding whether to support environmental sustainability measures, key considerations participants articulated were patient safety concerns, knowledge about effectiveness and costs, and administrative support. Conclusion: Although there is growing awareness around the contribution of the healthcare industry to carbon emissions and waste production, IPC professionals have not yet universally adopted measures to promote environmental sustainability. In our survey, many participants acknowledged the importance of balancing patient safety and sustainability concerns. Our study demonstrates the need for more research and education to inform decisions around environmentally sustainable efforts in IPC that also preserve patient safety. Additionally, professional and regulatory bodies must acknowledge and promote the importance of environmental sustainability in IPC decision-making.

Cross-sectional study of personal protective equipment use, training and biosafety preparedness among healthcare workers during the first months of the SARS-CoV-2 pandemic in Brazil

ObjectivesBrazil has high rates of COVID-19 and tuberculosis among healthcare workers (HCWs). Personal protective equipment (PPE) is essential for their protection. We aimed to evaluate PPE use, training, and preparedness...

An efficient UV-C device for photoinactivation of human Corona and Influenza virus: Solution for small-scale reuse of personal protective equipment (PPE)

The world has recently witnessed a significant surge in the use of non-recyclable items such as Personal Protective Equipment (PPE) due to the COVID-19 pandemic. This has increased environmental pollution and caused a massive burden on the global waste management system. Hence, an effective strategy to address the demand-supply disparity and provide road map for sustainable management of used PPE are the need of the hour. In the present work, we aimed to develop a cost-effective, convenient, and effective strategy to safely reuse PPE by engineering an in-house UV-C-based Sanitization Device (UVSD) and systematically evaluating its potential to disinfect virus-contaminated PPE. To this end, we tested the capacity of the UVSD to disinfect single-use PPE and N95 face masks, experimentally soiled with the human Influenza (A/PR/8/1934/H1N1) and human Coronavirus (HCoV-OC43). For this, the UV-C-based photoinactivation of both viruses was assessed by in vitro cell protection, quantification of viral gene transcript, and residual viral load by plaque-forming assay. Further, Indirect immunofluorescence and viral hemagglutination assays were also performed to visualize and quantify the viral titers at different post-exposure (UV-C) time points. Our results demonstrate that 15 min exposure to the virus-contaminated simple or complex PPE within the UVSD cabinet could effectively inactivate both the H1N1 and HCoV-OC43 viruses.

The assessment of personal protective equipment waste management in a developing neighbourhood: Examples of Tamale metropolis

This study assesses the management practices and factors influencing Personal Protective Equipment (PPE) waste disposal in the Tamale metropolis. A three-stage sampling approach was used to select 383 respondents to participate in this study. A social experiment was conducted for the first time to determine critical factors influencing waste bin use in the study area. 413.82 ± 2.16 kg PPE waste was generated from the six selected communities from October 2021 to January 2022. Single-use PPE comprised 58.72 %, and reusable PPE was 41.28 %. It was also found that the Tamale Central Hospital generated more (156.59 ± 0.41 kg) PPE waste than (137.63 ± 0.36 kg) the Tamale West Hospital. Waste materials were not segregated, and no standard treatment method was used to handle PPE waste. Waste bin height above 150 cm was the most preferred by males, while most female participants preferred a waste bin height of 125 cm. The participants chose yellow as the colour PPE waste bins should have. Interestingly the heart shape was the most (41 %) patronised waste bin shape by females, and the square shape was the most (38 %) preferred by males. The study concludes that inadequate provision of waste bins, lack of enforcement of assembly by-laws, and inadequate training of waste handlers retard the effective management of PPE waste in the Tamale metropolis.

The Impacts of Plastic Waste from Personal Protective Equipment Used during the COVID-19 Pandemic.

The period from 2019 to 2022 has been defined by the COVID-19 pandemic, resulting in an unprecedented demand for and use of Personal Protective Equipment (PPE). However, the disposal of PPE without considering its environmental impact and proper waste management practices has become a growing concern. The increased demand for PPE during the pandemic and associated waste management practices have been analyzed. Additionally, the discussion around treating these residues and exploring more environmentally friendly alternatives, such as biodegradable or reusable PPE, is crucial. The extensive use of predominantly non-degradable plastics in PPE has led to their accumulation in landfills, with potential consequences for marine environments through the formation of microplastics. Therefore, this article seeks to establish a connection between these issues and the Sustainable Development Goals, emphasizing the importance of efficient management aligned with sustainable development objectives to address these emerging challenges and ensure a more sustainable future.

Economic Considerations and Cost-Saving Strategies for Nonsterile Compounding Education

ObjectiveTo determine the economic considerations, including cost-saving strategies, associated with nonsterile compounding education for students in schools and colleges of pharmacy across the United States. MethodsAn electronic survey was sent to the American Association of Colleges of Pharmacy Pharmaceutics Section and Laboratory Instructor's Special Interest Group members. Quantitative and qualitative data were collected about the institution, student cohorts, compounding courses, equipment, budgets, personnel, and cost-saving measures. Descriptive statistics were calculated using SPSS. Open-ended responses were used by respondents if the primary question could not adequately capture their institution-specific information. These answers were added to the study findings. ResultsOf 555 surveys sent, 46 were completed. Reported annual compounding budgets ranged from $3000 to $96,000. Reported annual equipment maintenance costs ranged from $400 to $18,000. Fifty percent of respondents reported students shared equipment, and 29.6% collected a lab fee from students to offset costs. Approximately half of respondents reported the use of cost-saving measures, including contract pricing, purchasing supplies in bulk, price comparisons, use of simulated drugs, re-use of personal protective equipment, and procurement of donations. Fifty percent of respondents employed laboratory assistants to support nonsterile compounding sessions, with paid positions ranging from $200 to $1000 per semester. ConclusionFindings from this study may assist pharmacy administrators and course directors in evaluating the costs associated with nonsterile compounding education across the Academy and, more importantly, determining ways to reduce such costs while maintaining the intent and quality of these courses.

Role of Nanotechnology in Diagnosing, Safeguarding, and Treating COVID-19

Coronavirus disease (COVID-19) is arguably the worst health crisis the world has faced in the 21st century, and the World Health Organization declared this a “public health emergency of international concern” during the beginning of the pandemic and continued for a significant period of time. Considering the public health risk and the delay in introducing a suitable medical intervention to eradicate this virus, many reserachers embarked on different technologies to develop a cure. Nanotechnology has emerged as a promising weapon in the fight against COVID-19 and other similar viral diseases. The unique qualities of nanomaterials make them excellent for a variety of applications, including the development of low-cost, real-time diagnostic systems, reusable personal protective equipment, and innovative carriers for biological cargo such as mRNA in vaccines and CRISPR/Cas9 in gene editing. In this review the current available pharmacological and non-pharmacological options that are being used around the world against COVID-19 are compared with their nanotechnological counterparts. Here, we also elaborate the advantages of currently available nanotechnology-based diagnostics, protective equipment, vaccines and therapeutics and discuss future directions and steps that should be taken to translate these technologies into a clinical setting to combat the COVID-19 pandemic.

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

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

Environmental footprints of disposable and reusable personal protective equipment ‒ a product life cycle approach for body coveralls

Body coveralls, often made of single-use plastics, are essential Personal Protective Equipment (PPE) and, along with masks, are widely used in healthcare facilities and public spaces in the wake of the recent COVID-19 pandemic. The widespread use of these body coveralls poses a significant threat to terrestrial and aquatic ecosystems, given their polluting nature and disposal frequency. Therefore, it is necessary to promote the adoption of alternatives that increase the safe reusability of PPE clothing and reduce environmental and health hazards. This study presents a comparative Cradle-to-Grave Life Cycle Assessment (LCA) of disposable and reusable PPE body coveralls from a product life cycle perspective. A comprehensive life cycle inventory and LCA framework specific to Indian conditions have been developed through this study. The LCA is performed as per standard protocols using SimaPro software under recipe 2016 (H) impact assessment method. Six midpoint impact categories viz. Global Warming Potential, Terrestrial Acidification, Freshwater Eutrophication, Terrestrial Ecotoxicity, Human Carcinogenic Toxicity, and Water Consumption are assessed, along with Cumulative Energy Demand. Results suggest that reusable PPE improves environmental and human health performance in all the impact categories except water consumption. Sensitivity analysis reveals that replacing conventional electricity with solar energy for PPE manufacturing and disposal will provide additional environmental benefits. The findings can help the medical textile industries, healthcare workers, and policymakers to make environmentally informed choices.

Reusing personal protective equipment (PPE) did not increase surgical site infection in trauma surgical patients during the COVID-19 pandemic: A retrospective cohort study in Michigan Trauma Centers

BackgroundReuse of personal protective equipment (PPE), masks more specifically, during the COVID-19 pandemic was common. The primary objective of this study was to compare pre-pandemic surgical site infection (SSI) rates prior to reuse of PPE, to pandemic SSI rates after reuse of PPE in trauma surgical patients. MethodsA retrospective cohort analysis collected from the Michigan Trauma Quality Improvement Program database was performed. The pre-COVID cohort was from March 1, 2019 to December 31, 2019 and post-COVID cohort was March 1, 2020 to December 31,2020. Descriptive statistics were used to assess differences between variables in each cohort. ResultsNearly half (49.8%) of our cohort (n = 48,987) was in the post-COVID group. There was no significant difference in frequency of operative intervention between groups (p > .05). There was no significant increase (p > .05) between pre- and post-COVID cohorts for superficial, deep, or organ space SSI when reuse of masks was common. ConclusionReuse of PPE did not lead to an increase in SSI in surgical patients. These findings are consistent with previous studies, but the first to be described in the trauma surgical patient population. Studies such as this may help inform further discussion regarding PPE usage as we continue to emerge from the current pandemic with the continuous threat of future pandemics.

Surface Contamination of Reusable Respirators and Face Shields During Care of Critically Ill COVID-19 Patients.

With the emergence of SARS-CoV-2, healthcare workers (HCW) have relied on reusable personal protective equipment (PPE), including respirators and face shields (FSs). The effectiveness of decontamination procedures outside experimental settings is unclear. We examined the prevalence of surface contamination on reusable PPE used by HCWs at a hospital incorporating daily centralized decontamination and post-use wiping by sampling for common pathogens. Samples were collected from HCWs' CleanSpace Halo respirator face masks (FMs) and FSs at the start of shift, immediately after use, and after cleaning with disinfecting wipes. Samples were analyzed for pathogens using the Applied Biosystems™ TaqPath™ COVID-19 Combo Kit and ThermoFisher TaqMan Array Card. Patient charts were reviewed for clinical correlation. Of the 89 samples, 51 from FMs and 38 from FSs, none tested positive for SARS-CoV-2, despite 58 being obtained from PPE used in the care of patients with COVID-19, many with recent aerosol-generating procedures. Four samples tested positive (4.5%) for Staphylococcus aureus, two each from FMs and FSs. FMs that tested positive were not worn concurrently with FSs that tested positive. The FM and FS samples testing positive were worn in the care of patients without diagnosed S. aureus infection. No FMs tested positive following wipe-based disinfection, but both positive FS samples were found after disinfection wiping. Contamination of reusable PPE appears uncommon, especially with SARS-CoV-2, when regular decontamination programs are in place. The rare presence of S. aureus highlights the importance of doffing procedures and hand hygiene by HCW to prevent surface contamination.

Here Comes the Sun—Methylene Blue in Combination with Sunlight Sanitises Surgical Masks Contaminated with a Coronavirus and a Tenacious Small Non-Enveloped Virus

In the context of the SARS-CoV-2 pandemic, the reuse of personal protective equipment, specifically face coverings, has been recommended. Reuse of such items necessitates procedures to inactivate contaminating human respiratory and gastrointestinal pathogens. We previously demonstrated decontamination of face coverings contaminated with either infectious SARS-CoV-2 and animal coronaviruses or a highly resistant, non-enveloped norovirus via a novel photochemical treatment. Contaminated materials were coated with photosensitive methylene blue dye and were subsequently exposed to a visible bright light source (LED-equipped light boxes) to trigger the generation of virucidal singlet oxygen. A possible factor restricting the widespread use of such photochemical decontamination is its reliance on the availability of electricity to power light sources. Here, we show that natural sunlight can be used in lieu of artificial light. We demonstrate efficient inactivation of a SARS-CoV-2 surrogate, porcine respiratory coronavirus, via 10 µM dye coating in conjunction with short outdoor exposures of 5–30 min (blue sky to cloudy day; mean 46,578 lx). A tenacious human norovirus surrogate, murine norovirus, is inactivated via methylene blue solar decontamination involving 100 µM dye concentrations and 30 min of high-illuminance sunlight (blue sky; mean 93,445 lx) or 2 h of mid- to low-illuminance (cloudy day; mean 28,558 lx). The protocol developed here thus solidifies the position of methylene blue solar decontamination as an important equitable tool in the package of practical pandemic preparedness.

How Can Personal Protective Equipment Be Best Used and Reused: A Closer Look at Donning and Doffing Procedures.

The aim of this study was to examine safety-related contamination threats and risks to health-care workers (HCWs) due to the reuse of personal protective equipment (PPE) among emergency department (ED) personnel. We used a Participatory Design (PD) approach to conduct task analysis (TA) of PPE use and reuse. TA identified the steps, risks, and protective behaviors involved in PPE reuse. We used the Centers for Disease Control and Prevention (CDC) guidance for PPE donning and doffing specifying the recommended task order. Then, we convened subject matter experts (SMEs) with relevant backgrounds in Patient Safety, Human Factors and Emergency Medicine to iteratively identify and map the tasks, risks, and protective behaviors involved in the PPE use and reuse. Two emerging threats were associated with behaviors in donning, doffing, and re-using PPE: (i) direct exposure to contaminant, and (ii) transmission/spread of contaminant. Protective behaviors included: hand hygiene, not touching the patient-facing surface of PPE, and ensuring a proper fit and closure of all PPE ties and materials. TA was helpful revealed that the procedure for donning and doffing of re-used PPE does not protect ED personnel from contaminant spread and risk of exposure, even with protective behaviors present (e.g., hand hygiene, respirator use, etc.). Future work should make more apparent the underlying risks associated with PPE use and reuse.

Radio Frequency Heating of Washable Conductive Textiles for Bacteria and Virus Inactivation.

The ongoing COVID-19 pandemic has increased the use of single-use medical fabrics such as surgical masks, respirators, and other personal protective equipment (PPE), which have faced worldwide supply chain shortages. Reusable PPE is desirable in light of such shortages; however, the use of reusable PPE is largely restricted by the difficulty of rapid sterilization. In this work, we demonstrate successful bacterial and viral inactivation through remote and rapid radio frequency (RF) heating of conductive textiles. The RF heating behavior of conductive polymer-coated fabrics was measured for several different fabrics and coating compositions. Next, to determine the robustness and repeatability of this heating response, we investigated the textile's RF heating response after multiple detergent washes. Finally, we show a rapid reduction of bacteria and virus by RF heating our conductive fabric. 99.9% of methicillin-resistant Staphylococcus aureus (MRSA) was removed from our conductive fabrics after only 10 min of RF heating; human cytomegalovirus (HCMV) was completely sterilized after 5 min of RF heating. These results demonstrate that RF heating conductive polymer-coated fabrics offer new opportunities for applications of conductive textiles in the medical and/or electronic fields.

Of masks and methylene blue—The use of methylene blue photochemical treatment to decontaminate surgical masks contaminated with a tenacious small nonenveloped norovirus

BackgroundIn the context of the SARS-CoV-2 pandemic, reuse of personal protective equipment, specifically that of medical face coverings, has been recommended. The reuse of these typically single-use only items necessitates procedures to inactivate contaminating human respiratory and gastrointestinal pathogens. We previously demonstrated decontamination of surgical masks and respirators contaminated with infectious SARS-CoV-2 and various animal coronaviruses via low concentration- and short exposure methylene blue photochemical treatment (10 µM methylene blue, 30 minutes of 12,500-lux red light or 50,000 lux white light exposure).MethodsHere, we describe the adaptation of this protocol to the decontamination of a more resistant, non-enveloped gastrointestinal virus and demonstrate efficient photodynamic inactivation of murine norovirus, a human norovirus surrogate.ResultsMethylene blue photochemical treatment (100 µM methylene blue, 30 minutes of 12,500-lux red light exposure) of murine norovirus-contaminated masks reduced infectious viral titers by over four orders of magnitude on surgical mask surfaces.Discussion and ConclusionsInactivation of a norovirus, the most difficult to inactivate of the respiratory and gastrointestinal human viruses, can predict the inactivation of any less resistant viral mask contaminant. The protocol developed here thus solidifies the position of methylene blue photochemical decontamination as an important tool in the package of practical pandemic preparedness.

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.

Compatibility and efficacy of vaporised hydrogen peroxide technology to decontaminate reusable personal protective equipment

Compatibility and efficacy of vaporised hydrogen peroxide technology to decontaminate reusable personal protective equipment

Surveying Healthcare Workers to Improve the Design, Wearer Experience and Sustainability of PPE Isolation Gowns

This protective clothing design project responds to the urgent need for research into the redesign of personal protective equipment (PPE) isolation gowns, to be more fit for purpose and reusable to enhance the experiences of healthcare workers treating patients with COVID-19 and variants. Funded by the Arts and Humanities Research Council (AHRC) the research addresses the engineering question: “What new materials, design and manufacturing approaches should we start to consider in preparation for pandemics e.g. reusable PPE to replace single use?” The article focuses on the online questionnaire/ survey, its main findings and the ‘participatory clothing design’ methodology which prioritises the lived experiences and expressed needs of healthcare workers wearing disposable and reusable PPE in acute care scenarios. Research methods include literature and gown reviews, selected interviews and survey directed at nurses, to acquire first-hand qualitative data about the impact of current gown design and procurement policies on wearers. Selected results and commentary from the ongoing survey are presented and thematically analysed to inform the development of reusable gowns. Semi-structured interviews with clinical leads and caregivers, as well as responses from users, will be important to integrate expertise in fashion, textile and uniform design, clinical practice, and manufacturing. Further design will be based on a complex design brief that balances the needs of wearers and critical care providers while considering regulations, protection, comfort, sustainability, and cost. This research focuses on enhancing an overlooked area of critical care clothing and the people who wear it while reducing its detrimental impact on the planet.